http://www.hindawi.comThe latest articles from Hindawi Publishing Corporation© 2012, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/journals/jeph/2012/810501/High molecular-weight phthalates, such as diisononyl phthalate (DINP), and diisodecyl phthalate (DIDP), are widely used as plasticizers in the manufacturing of polymers and consumer products. Human biological monitoring studies have employed the metabolites of DINP and DIDP as biomarkers to assess human exposure. In this review, we summarize and analyze publicly available scientific data on chemistry, metabolism, and excretion kinetics, of DINP and DIDP, to identify specific and sensitive metabolites. Human biological monitoring data on DINP and DIDP are scrutinised to assess the suitability of these metabolites as biomarkers of exposure. Results from studies carried out in animals and humans indicate that phthalates are metabolised rapidly and do not bioaccmulate. During Phase-I metabolism, ester hydrolysis of DINP and DIDP leads to the formation of hydrolytic monoesters. These primary metabolites undergo further oxidation reactions to produce secondary metabolites. Hence, the levels of secondary metabolites of DINP and DIDP in urine are found to be always higher than the primary metabolites. Results from human biological monitoring studies have shown that the secondary metabolites of DINP and DIDP in urine were detected in almost all tested samples, while the primary metabolites were detected in only about 10% of the samples. This indicates that the secondary metabolites are very sensitive biomarkers of DINP/DIDP exposure while primary metabolites are not. The NHANES data indicate that the median concentrations of MCIOP and MCINP (secondary metabolites of DINP and DIDP, resp.) at a population level are about 5.1 μg/L and 2.7 μg/L, respectively. Moreover, the available biological monitoring data suggest that infants/children are exposed to higher levels of phthalates than adults.Gurusankar Saravanabhavan and Janine MurrayCopyright © 2012 Gurusankar Saravanabhavan and Janine Murray. All rights reserved.http://www.hindawi.com/journals/jeph/2012/156435/Healthy People 2020 aims to achieve health equity, eliminate disparities, and improve the health of all groups. Regular physical activity (PA) improves overall health and fitness and has the capability to reduce risk for chronic diseases. Identifying barriers which relate to the Hispanic population is important when designing PA interventions. Therefore, the purpose was to review existing PA interventions targeting Hispanic adults published between 1988 and 2011. This paper was limited to interventions which included more than 35% Hispanic adults (n=20). Most of the interventions were community based (n=16), although clinical, family-based, and faith-based settings were also represented. Interventions incorporated theory (n=16), with social cognitive theory and transtheoretical model being used most frequently. Social support was integral, building on the assumption that it is a strong motivator of PA. Each of the interventions reported success related to PA, social support, and/or BMI. Lessons learned should be incorporated into future interventions.Melinda J. Ickes and Manoj SharmaCopyright © 2012 Melinda J. Ickes and Manoj Sharma. All rights reserved.http://www.hindawi.com/journals/jeph/2012/421989/Objective. Ensuring privacy of research subjects when epidemiologic data are shared with outside collaborators involves masking (modifying) the data, but overmasking can compromise utility (analysis potential). Methods of statistical disclosure control for protecting privacy may be impractical for individual researchers involved in small-scale collaborations. Methods. We investigated a simple approach based on measures of disclosure risk and analytical utility that are straightforward for epidemiologic researchers to derive. The method is illustrated using data from the Japanese Atomic-bomb Survivor population. Results. Masking by modest rounding did not adequately enhance security but rounding to remove several digits of relative accuracy effectively reduced the risk of identification without substantially reducing utility. Grouping or adding random noise led to noticeable bias. Conclusions. When sharing epidemiologic data, it is recommended that masking be performed using rounding. Specific treatment should be determined separately in individual situations after consideration of the disclosure risks and analysis needs.John Cologne, Eric J. Grant, Eiji Nakashima, Yun Chen, Sachiyo Funamoto, and Hiroaki KatayamaCopyright © 2012 John Cologne et al. All rights reserved.http://www.hindawi.com/journals/jeph/2012/959343/Objective. The objectives of the study were to detect high-risk areas and to examine how racial and ethnic status affect the geographic distribution of female breast cancer mortality in Texas. Analyses were based on county-level data for the years from 2000 to 2008. Materials and Methods. Breast cancer mortality data were obtained from the Texas Cancer Registry, and the Spatial Scan Statistics method was used to run Purely Spatial Analyses using the Discrete Poisson, Bernoulli, and Multinomial models. Results and Conclusions. Highest rates of female breast cancer mortality in Texas have shifted over time from southeastern areas towards northern and eastern areas, and breast cancer mortality at the county level is distributed heterogeneously based on racial/ethnic status. Non-Hispanic blacks were at highest risk in the northeastern region and lowest risk in the southern region, while Hispanics were at highest risk in the southern region along the border with Mexico and lowest risk in the northeastern region.Arvind B. Bambhroliya, Keith D. Burau, and Ken SextonCopyright © 2012 Arvind B. Bambhroliya et al. All rights reserved.http://www.hindawi.com/journals/jeph/2012/481641/Background. Bisphenol A (BPA) is a common chemical used in the manufacture of polycarbonate plastics and epoxy resins, with >93% of US adults having detectable BPA levels in urine. Recent animal studies have suggested that BPA exposure may have a role in several mechanisms involved in the development of hypertension, including weight gain, insulin resistance, thyroid dysfunction, endothelial dysfunction, and oxidative stress. However, no previous human study has examined the association between markers of BPA exposure and hypertension. Methods. We examined urinary BPA levels in 1380 subjects from the National Health and Nutritional Examination Survey 2003-2004. Main outcome-of-interest was hypertension, defined as blood pressure-reducing medication use and/or blood pressures >140/90 mm of Hg (n=580). Results. We observed a positive association between increasing levels of urinary BPA and hypertension independent of confounding factors such as age, gender, race/ethnicity, smoking, body mass index (BMI), diabetes mellitus and total serum cholesterol levels. Compared to tertile 1 (referent), the multivariate-adjusted odds ratio (95% confidence interval) of hypertension associated with tertile 3 was 1.50 (1.12−2.00); P-trend = 0.007. The association was consistently present in subgroup analyses by race/ethnicity, smoking status, BMI, and diabetes mellitus. Conclusions. Urinary BPA levels are associated with hypertension, independent of traditional risk factors.Anoop Shankar and Srinivas TeppalaCopyright © 2012 Anoop Shankar and Srinivas Teppala. All rights reserved.http://www.hindawi.com/journals/jeph/2012/861219/Policing is one of the most dangerous and stressful occupations and such stress can have deleterious effects on health. The purpose of this study was to examine the association between depressive symptoms and metabolic syndrome (MetSyn) in male and female police officers from two study populations, Buffalo, NY and Spokane, WA. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. MetSyn was defined using the 2005 AHA/NHBLI guidelines. Analysis of covariance was used to describe differences in number of MetSyn components across depressive symptom categories. The number of MetSyn components increased significantly across categories of CES-D for Spokane men only (p-trend = 0.003). For each 5-unit increase in CES-D score, odds increased by 47.6% for having hypertriglyceridemia, by 51.8% for having hypertension, and by 56.7% for having glucose intolerance. Exploring this association is important since both are predictors of future chronic health problems and the results could be helpful in developing future gender-specific prevention and intervention efforts among police officers.Tara A. Hartley, Sarah S. Knox, Desta Fekedulegn, Celestina Barbosa-Leiker, John M. Violanti, Michael E. Andrew, and Cecil M. BurchfielCopyright © 2012 Tara A. Hartley et al. All rights reserved.http://www.hindawi.com/journals/jeph/2012/641010/Objective. To evaluate the association between safety from crime and physical activity among older adults. Methods. A population-based survey including 1,656 older adults (60+ years) took place in Florianopolis, Brazil, in 2009-2010. Commuting and leisure time physical activity were assessed through the long version of the International Physical Activity Questionnaire. Perception of safety from crime was assessed using the Neighbourhood Environment Walkability Scale. Results. Perceiving the neighbourhood as safe during the day was related to a 25% increased likelihood of being active in leisure time (95% CI 1.02–1.53); general perception of safety was also associated with a 25% increase in the likelihood of being active in leisure time (95% CI 1.01–1.54). Street lighting was related to higher levels of commuting physical activity (prevalence ratio: 1.89; 95% CI 1.28–2.80). Conclusions. Safety investments are essential for promoting physical activity among older adults in Brazil.Maruí Weber Corseuil, Pedro Curi Hallal, Herton Xavier Corseuil, Ione Jayce Ceola Schneider, and Eleonora d'OrsiCopyright © 2012 Maruí Weber Corseuil et al. All rights reserved.http://www.hindawi.com/journals/jeph/2012/849305/Aims. To evaluate potential health risk and benefits of fish consumption, the association of fish consumption with total mercury levels in red blood cells (RBCs) and serum eicosapentaenoic acid (EPA) concentrations was examined. Subjects and Methods. Study subjects were 269 Japanese (98 men and 171 women) living in a remote island of Kagoshima, and their blood was drawn in 1994. Results. Total mercury levels were related to weekly fish consumption among women (P=0.035) but not among men (P=0.643). However, serum EPA levels were not related to fish consumption in both women and men. In contrast, EPA levels in the high-density ipoprotein (HDL) fraction of the sera were significantly related to fish consumption (P values for men and women were 0.014 and 0.073, resp.). Interestingly, mercury levels were related to serum EPA levels and EPA in the HDL fraction of the sera (P=0.001) among women (P=0.005) but not among men. Sex differences in fish species consumed may be an explanation for the observed sex difference. Conclusion. Those findings suggest that the health benefit of fish consumption can be maximized by the careful selection of fish species consumed.Mayumi Tsuji, Tetsuo Ando, Takao Kitano, Junji Wakamiya, Chihaya Koriyama, and Suminori AkibaCopyright © 2012 Mayumi Tsuji et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/964617/Background. Cardiovascular disease (CVD) is the leading cause of death among American Indians. It is not known if symptoms of insomnia are associated with CVD in this population. Methods. We examined 449 American Indians aged ≥55 years from the Native Elder Care Study. The main outcome-of-interest was self-reported CVD. Results. Short sleep duration, daytime sleepiness, and difficulty falling asleep were positively associated with CVD after adjusting for demographic, lifestyle, and clinical risk factors. Compared with a sleep duration of 7 h, the multivariable odds ratio (OR) (95% confidence interval [CI]) of CVD among those with sleep duration ≤5 h was 2.89 (1.17–7.16). Similarly, the multivariable OR (95% CI) of CVD was 4.45 (1.85–10.72) and 2.60 (1.25–5.42) for daytime sleepiness >2 h and difficulty falling asleep often/always. Conclusion. Symptoms of insomnia including short sleep duration, daytime sleepiness, and difficulty falling asleep are independently associated with CVD in American Indians aged ≥55 years.Charumathi Sabanayagam, Anoop Shankar, Dedra Buchwald, and R. Turner GoinsCopyright © 2011 Charumathi Sabanayagam et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/850105/The study's purpose was to investigate thyroid cancer incidence time trends, birth cohort effects, and association with socioeconomic status (SES) in New Jersey (NJ), a high incidence state, using NJ State Cancer Registry data. Thyroid cancer incidence rates in each sex, nearly all age groups, two major histologies and all stages significantly increased between 1979 and 2006. For each sex, age-specific incidence rates began greatly increasing in the 1924 birth cohort and, generally, the highest thyroid cancer incidence rate for each five-year age group occurred in the latest birth cohort and diagnosis period. Thyroid cancer incidence rates were significantly higher in NJ Census tracts with higher SES and in counties with a higher percentage of insured residents. These results support further investigation into the relationship between rising thyroid cancer incidence and increasing population exposure to medical (including diagnostic) radiation, as well as widespread use of more sensitive diagnostic techniques.Lisa M. Roche, Xiaoling Niu, Karen S. Pawlish, and Kevin A. HenryCopyright © 2011 Lisa M. Roche et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/161574/This paper outlines the challenges faced during direct built environment (BE) assessments of 42 Canadian communities of various income and urbanization levels. In addition, we recommend options for overcoming such challenges during BE community assessments. Direct BE assessments were performed utilizing two distinct audit methods: (1) modified version of Irvine-Minnesota Inventory in which a paper version of an audit tool was used to assess BE features and (2) a Physical Activity and Nutrition Features audit tool, where the presence and positions of all environmental features of interest were recorded using a Global-Positioning-System (GPS) unit. This paper responds to the call for the need of creators and users of environmental audit tools to share experiences regarding the usability of tools for BE assessments. The outlined BE assessment challenges plus recommendations for overcoming them can help improve and refine the existing audit tools and aid researchers in future assessments of the BE.Danijela Gasevic, Ina Vukmirovich, Salim Yusuf, Koon Teo, Clara Chow, Gilles Dagenais, and Scott A. LearCopyright © 2011 Danijela Gasevic et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/789514/Libby, Montana is a Superfund site and epicenter of one of the worst environmental disasters in the USA history in terms of asbestos-related mortality and morbidity. Perceptions of access and financial aspects of care were explored among a national cohort of persons postasbestos exposure and prior to a 2009 Public Health Emergency Declaration. Our findings indicated the Libby cohort was significantly less satisfied with access and financial aspects of care as measured by two PSQ-III scales when compared to an adult, chronically ill patient sample. Participants with higher levels of respiratory morbidity and depression had significantly lower satisfaction scores.Charlene A. Winters, Wade Hill, Sandra W. Kuntz, Clarann Weinert, Kimberly Rowse, Tanis Hernandez, and Brad BlackCopyright © 2011 Charlene A. Winters et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/407505/Background. We set out to identify the level of previous exposure to influenza A (H1N1) in unvaccinated healthcare workers (HCWs) at the peak of the pandemic outbreak in the UK, with control samples collected prior to the outbreak. Methods. Cross-sectional study (seroprevalence assessed before and at pandemic peak, with questionnaire data collected at peak of outbreak) in HCWs in Scotland. Results. The prevalence of seropositivity in 493 HCWs at pandemic peak was 10.3%, which was higher than the prepandemic level by 3.7 percentage points (95% CI 0.3% to 7.3%, P=0.048). Seropositivity rates for frontline and nonfrontline HCWs were similar. Conclusion. At pandemic peak, only 10.3% of HCWs were seropositive for influenza A (H1N1), so the great majority were still susceptible to infection at the introduction of the vaccination programme. Few studies have reported on seroprevalence in unvaccinated and asymptomatic participants, so our findings may have relevance to the wider population.Kate Smith, Pamela Warner, Linda J. Williams, Walt E. Adamson, S. Vittal Katikireddi, Paul Dewart, William F. Carman, Kate Templeton, Fiona C. Denison, and D. Graham MackenzieCopyright © 2011 Kate Smith et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/597073/Opportunistic pathogens related to degradation in water quality are of concern to both wildlife and public health. The objective of this study was to identify spatial, temporal, and environmental risk factors for E. coli colonization among Atlantic bottlenose dolphins (Tursiops truncatus) inhabiting the Indian River Lagoon (IRL), FL between 2003 and 2007. Age, gender, capture location, coastal human population density, proximity of sewage treatment plants, number of septic tanks, cumulative precipitation 48 hrs and 30 days prior to capture, salinity, and water temperature were analyzed as potential risk factors. Highest E. coli colonization rates occurred in the northern segments of the IRL. The risk of E. coli colonization was the highest among the youngest individuals, in counties with the highest cumulative rainfall 48 hrs and in counties with the highest number of septic systems during the year of capture. The prevalence of colonization was the highest during 2004, a year during which multiple hurricanes hit the coast of Florida. Septic tanks, in combination with weather-related events suggest a possible pathway for introduction of fecal coliforms into estuarine ecosystems. The ability of E. coli and related bacteria to act as primary pathogens or cause opportunistic infections adds importance of these findings.Adam M. Schaefer, Gregory D. Bossart, Marilyn Mazzoil, Patricia A. Fair, and John S. ReifCopyright © 2011 Adam M. Schaefer et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/130467/Whereas Tanzania has seen considerable improvements in water and sanitation infrastructure over the past 20 years, the country still faces high rates of childhood morbidity from diarrheal diseases. This study utilized a qualitative, cross-sectional, modified Photovoice method to capture daily activities of Dar es Salaam mothers. A total of 127 photographs from 13 households were examined, and 13 interviews were conducted with household mothers. The photographs and interviews revealed insufficient hand washing procedures, unsafe disposal of wastewater, uncovered household drinking water containers, a lack of water treatment prior to consumption, and inappropriate toilets for use by small children. The interviews revealed that mothers were aware and knowledgeable of the risks of certain household practices and understood safer alternatives, yet were restricted by the perceived impracticality and financial constraints to make changes. The results draw attention to the real economic and behavioral challenges faced in reducing the spread of disease.Natalie Badowski, Cynthia M. Castro, Maggie Montgomery, Amy J. Pickering, Simon Mamuya, and Jennifer DavisCopyright © 2011 Natalie Badowski et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/232168/Miners fitness test was assessed in terms of determination of maximum aerobic capacity by an indirect method following a standard step test protocol before going down to mine by taking into consideration of heart rates (Telemetric recording) and oxygen consumption of the subjects (Oxylog-II) during exercise at different working rates. Maximal heart rate was derived as 220−age. Coal miners reported a maximum aerobic capacity within a range of 35–38.3 mL/kg/min. It also revealed that oldest miners (50–59 yrs) had a lowest maximal oxygen uptake (34.2±3.38 mL/kg/min) compared to (42.4±2.03 mL/kg/min) compared to (42.4±2.03 mL/kg/min) the youngest group (20–29 yrs). It was found to be negatively correlated with age (r=−0.55 and −0.33 for younger and older groups respectively) and directly associated with the body weight of the subjects (r=0.57 – 0.68, P≤0.001). Carriers showed maximum cardio respiratory capacity compared to other miners. Indian miners VO2max was found to be lower both compared to their abroad mining counterparts and various other non-mining occupational working groups in India.Ratnadeep Saha, Netai Chandra Dey, Amalendu Samanta, and Rajib BiswasCopyright © 2011 Ratnadeep Saha et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/709549/The population growth, changing consumption patterns, and rapid urbanization contribute significantly to the growing volumes of solid waste that are generated in urban settings. As the rate of urbanization increases, demand on the services of solid waste management increases. The rapid urban growth in Langkawi Island, Malaysia, combined with the increasing rates of solid waste production has provided evidence that the traditional solid waste management practices, particularly the methods of waste collection and disposal, are inefficient and quite nonsustainable. Accordingly, municipal managers and planners in Langkawi need to look for and adopt a model for solid waste management that emphasizes an efficient and sustainable management of solid wastes in Langkawi Island. This study presents the current practices of solid waste management in Langkawi Island, describes the composition of the solid waste generated in that area, and presents views of local residents and tourist on issues related to solid waste management like the aesthetic value of the island environment. The most important issue of this paper is that it is the first time that integrated solid waste management is investigated in the Langkawi Island.Elmira Shamshiry, Behzad Nadi, Mazlin Bin Mokhtar, Ibrahim Komoo, Halimaton Saadiah Hashim, and Nadzri YahayaCopyright © 2011 Elmira Shamshiry et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/402148/This experiment was conducted to determine how much contaminant could be expected to be inhaled when overbreathing several different types of respirators. These included several tight-fitting and loose-fitting powered air-purifying respirators (PAPRs) and one air-purifying respirator (APR). CO2 was used as a tracer gas in the ambient air, and several loose-and tight-fitting respirators were tested on the head form of a breathing machine. CO2 concentration in the exhaled breath was monitored as well as CO2 concentration in the ambient air. This concentration ratio was able to give a measurement of protection factor, not for the respirator necessarily, but for the wearer. Flow rates in the filter/blower inlet and breathing machine outlet were also monitored, so blower effectiveness (defined as the blower contribution to inhaled air) could also be determined. Wearer protection factors were found to range from 1.1 for the Racal AirMate loose-fitting PAPR to infinity for the 3M Hood, 3M Breath-Easy PAPR, and SE 400 breath-responsive PAPR. Inhaled contaminant volumes depended on tidal volume but ranged from 2.02 L to 0 L for the same respirators, respectively. Blower effectiveness was about 1.0 for tight-fitting APRs, 0.18 for the Racal, and greater than 1.0 for two of the loose-fitting PAPRs. With blower effectiveness greater than 1.0, some blower flow during the exhalation phase contributes to the subsequent inhalation. Results from this experiment point to different ways to measure respirator efficacy.Arthur T. Johnson, Frank C. Koh, William H. Scott Jr., and Timothy E. RehakCopyright © 2011 Arthur T. Johnson et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/463701/Background. An increased risk of lung cancer has been observed at exposure to certain industrial chemicals in occupational settings; however, less is known about their carcinogenic potential to the general population when those agents are released into the environment. Methods. We used the Toxics Release Inventory (TRI) database and Surveillance, Epidemiology, and End Results (SEER) data to conduct an ecological study at the county level. We used multiple linear regression to assess the association of age-adjusted lung cancer incidence with the quantities of on-site air and water releases of six selected industrial chemicals including arsenic, 1,3 butadiene, cadmium, chromium, formaldehyde, and nickel after controlling for other risk variables. Results. Overall, we observed a significantly increased risk of lung cancer incidence associated with releases of chromium, formaldehyde, and nickel. The links were present for both males and females. Significant effects were present in nonmetropolitan but not metropolitan counties. Releases of arsenic, 1,3 butadiene, and cadmium were reported by small numbers of facilities, and no relationships to lung cancer incidence were detected. Conclusions. Our results suggest that environmental exposure to chromium, formaldehyde, and nickel from TRI sites may increase population risk of lung cancer. These findings need to be confirmed in individual-level studies, but in congruence with the precautionary principle in environmental science, support prudent efforts to limit release of these agents into the environment.Juhua Luo, Michael Hendryx, and Alan DucatmanCopyright © 2011 Juhua Luo et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/948789/This study examined commuting patterns among 23,141 methadone patients enrolling in 84 opioid treatment programs (OTPs) in the United States. Patients completed an anonymous one-page survey. A linear mixed model analysis was used to predict distance traveled to the OTP. More than half (60%) the patients traveled <10 miles and 6% travelled between 50 and 200 miles to attend an OTP; 8% travelled across a state border to attend an OTP. In the multivariate model (n=17,792), factors significantly (P<.05) associated with distance were, residing in the Southeast or Midwest, low urbanicity, area of the patient's ZIP code, younger age, non-Hispanic white race/ethnicity, prescription opioid abuse, and no heroin use. A significant number of OTP patients travel considerable distances to access treatment. To reduce obstacles to OTP access, policy makers and treatment providers should be alert to patients' commuting patterns and to factors associated with them.Andrew Rosenblum, Charles M. Cleland, Chunki Fong, Deborah J. Kayman, Barbara Tempalski, and Mark ParrinoCopyright © 2011 Andrew Rosenblum et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/484010/Background. Urbanization is a process which alters the structure and function of urban environments. The alteration in the quality of urban environmental conditions has significant implications for health. This applies both to the ecology of insect vectors that may transmit diseases and the burden of disease. Study Objectives. To investigate the relationship between malaria and infectious diarrhea mortality and spatially varied neighborhood environmental quality conditions in a low-income economy. Design. A one time point spatial analysis of cluster-level environmental conditions and mortality data using principal component analysis (PCA), one-way analysis of variance (ANOVA) and generalized linear models (GLMs). Methods. Environmental variables were extracted from the Ghana Census 2000 database while mortality data were obtained from the Ghana Births and Deaths Registry in Accra over the period 1998–2002. Results. Whereas there was a strong evidence of a difference in relative mortality of malaria across urban environmental zones of differing neighborhood environmental conditions, no such evidence of mortality differentials was observed for diarrhea. In addition, whereas bivariate analyses showed a weak to strong evidence of association between the environmental variables and malaria mortality, no evidence of association was found between diarrhea mortality and environmental variables. Conclusion. We conclude that environmental management initiatives intended for infectious disease control might substantially reduce the risk of urban malaria mortality and to a less extent that for urban diarrhea mortality in rapidly urbanizing areas in a low-income setting.Julius N. Fobil, Alexander Kraemer, Christian G. Meyer, and Juergen MayCopyright © 2011 Julius N. Fobil et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/242457/Objective. The objective of this study was to quantify and describe the distribution of the 36 molds that make up the Environmental Relative Moldiness Index (ERMI). Materials and Methods. As part of the 2006 American Healthy Homes Survey, settled dust samples were analyzed by mold-specific quantitative PCR (MSQPCR) for the 36 ERMI molds. Each species' geographical distribution pattern was examined individually, followed by partitioning analysis in order to identify spatially meaningful patterns. For mapping, the 36 mold populations were divided into disjoint clusters on the basis of their standardized concentrations, and First Principal Component (FPC) scores were computed. Results and Conclusions. The partitioning analyses failed to uncover a valid partitioning that yielded compact, well-separated partitions with systematic spatial distributions, either on global or local criteria. Disjoint variable clustering resulted in seven mold clusters. The 36 molds and ERMI values themselves were found to be heterogeneously distributed across the United States of America (USA).Stephen Vesper, Jennie Wakefield, Peter Ashley, David Cox, Gary Dewalt, and Warren FriedmanCopyright © 2011 Stephen Vesper et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/382510/Objectives. To determine the prevalence of musculoskeletal disorders in hospital cleaners. Methods. Injury data on all hospital employees were extracted from occupational health records and compared. Additionally an interview-based modified Nordic Questionnaire (response rate 98.14%) was conducted. Results. The mean total injury rate for cleaners was 35.9 per 100 full-time equivalent (FTE), while that for other employees was 13.64 per 100 FTE. Slips/trips/falls and MMH contributed 4.39 and 2.37 per 100 FTE among cleaners and rest of the hospital employees, respectively. The most common type of injury was strain while the most common cause of injury was a striking object. Conclusion. The cleaners have higher injury rates and morbidity as compared to other employees of the hospital. The lower back was most commonly affected.Kirtigandha Salwe, Shrawan Kumar, and Joyce HoodCopyright © 2011 Kirtigandha Salwe et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/230894/Many communities in low-income countries use in-home pesticides for the control of pests. Such use is often inadequately controlled. In this study, 100 households in Kireka ward, Wakiso district in Uganda were involved in a cross-sectional survey to assess pests, knowledge, and use patterns of pesticides. A structured pretested questionnaire was administered via personal interviews, and observational checklists were used. Mosquitoes were the most prevalent pests (83%), followed by cockroaches (69%) and rats (52%). Pesticides were the most preferred method for pest control (98%), with insecticide spray being the most common form of application (71.4%). Pesticide application was inappropriately done in many households mainly due to inadequate knowledge on use. Only 48% of the respondents read manufacturer's instructions for use. Information on what pesticide to use was obtained from friends (53.1%), points of sales (48%). Educational interventions particularly at points of sale would be a critical avenue for promoting safe use of pesticides in households.Eva Nalwanga and John C. SsempebwaCopyright © 2011 Eva Nalwanga and John C. Ssempebwa. All rights reserved.http://www.hindawi.com/journals/jeph/2011/435078/Linear mixed models (LMMs) are frequently used to analyze longitudinal data. Although these models can be used to evaluate mediation, they do not directly model causal pathways. Structural equation models (SEMs) are an alternative technique that allows explicit modeling of mediation. The goal of this paper is to evaluate the performance of LMMs relative to SEMs in the analysis of mediated longitudinal data with time-dependent predictors and mediators. We simulated mediated longitudinal data from an SEM and specified delayed effects of the predictor. A variety of model specifications were assessed, and the LMMs and SEMs were evaluated with respect to bias, coverage probability, power, and Type I error. Models evaluated in the simulation were also applied to data from an observational cohort of HIV-infected individuals. We found that when carefully constructed, the LMM adequately models mediated exposure effects that change over time in the presence of mediation, even when the data arise from an SEM.Emily A. Blood and Debbie M. ChengCopyright © 2011 Emily A. Blood and Debbie M. Cheng. All rights reserved.http://www.hindawi.com/journals/jeph/2011/473143/A combination of local flow measurement techniques and fog flow visualization was used to determine the inward leakage for two tight-fitting powered air-purifying respirators (PAPRs), the 3M Breathe-Easy PAPR and the SE 400 breathing demand PAPR. The PAPRs were mounted on a breathing machine head form, and flows were measured from the blower and into the breathing machine. Both respirators leaked a little at the beginning of inhalation, probably through their exhalation valves. In both cases, the leakage was not enough for fog to appear at the mouth of the head form.Frank C. Koh, Arthur T. Johnson, and Timothy E. RehakCopyright © 2011 Frank C. Koh et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/202783/Widely cited ecological analyses of autism have reported associations with mercury emissions, with precipitation, and race at the level of counties or school districts. However, state educational agencies often suppress any low numerical autism counts before releasing data—a phenomenon known as “administrative censoring.” Previous analyses did not describe appropriate methods for censored data analysis; common substitution or exclusion methods are known to introduce bias and produce artificially narrow confidence intervals. We apply a Bayesian censored random effects Poisson model to reanalyze associations between 2001 Toxic Release Inventory reported mercury emissions and 2000-2001 autism counts in Texas. Relative risk estimates for autism decreased from 4.44 (95% CI: 4.16, 4.74) per thousand lbs. of air mercury emissions using a naive zero-substitution approach to 1.42 (95% CI: 1.09, 1.78) using the Bayesian approach. Inadequate attention to censoring poses a serious threat to the validity of ecological analyses of autism and other health outcomes.Scott M. Bartell and Thomas A. LewandowskiCopyright © 2011 Scott M. Bartell and Thomas A. Lewandowski. All rights reserved.http://www.hindawi.com/journals/jeph/2011/750236/This paper compares syndromic surveillance and predictive weather-based models for estimating emergency department (ED) visits for Heat-Related Illness (HRI). A retrospective time-series analysis of weather station observations and ICD-coded HRI ED visits to ten hospitals in south eastern Ontario, Canada, was performed from April 2003 to December 2008 using hospital data from the National Ambulatory Care Reporting System (NACRS) database, ED patient chief complaint data collected by a syndromic surveillance system, and weather data from Environment Canada. Poisson regression and Fast Orthogonal Search (FOS), a nonlinear time series modeling technique, were used to construct models for the expected number of HRI ED visits using weather predictor variables (temperature, humidity, and wind speed). Estimates of HRI visits from regression models using both weather variables and visit counts captured by syndromic surveillance as predictors were slightly more highly correlated with NACRS HRI ED visits than either regression models using only weather predictors or syndromic surveillance counts.Alexander G. Perry, Michael J. Korenberg, Geoffrey G. Hall, and Kieran M. MooreCopyright © 2011 Alexander G. Perry et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/417980/Background. Chemicals that store in lipid-rich compartments have the potential for long-term disruption of metabolic and endocrine processes. Given the evidence that persistent organic pollutants (POPs) also alter systemic metabolic, endocrine, and immune system functions, it follows that elevated chemical concentrations in intra-abdominal fat may alter function, through local chemical signaling, of visceral organs. Despite this potential, there has been little study defining POP concentrations in live human intra-abdominal fat. It is at present uncertain whether POPs distribute equally to all fat compartments, including fat in serum. Methods. Seven human subjects scheduled for elective surgery for benign lesions or cancer provided consent for removal of samples of subcutaneous and intra-abdominal fat and/or cancerous tissue. These samples were analyzed for 22 chlorinated pesticides and 10 polychlorinated biphenyl (PCB) congeners by GC/ECD plus GC/MS. Results. In only two subjects were the patterns and relative concentrations of PCBs and pesticides about the same in all fat compartments. In the other subjects, there were major differences in levels in subcutaneous as compared to other compartments, but with some higher and some lower. While the pattern of PCBs in the various compartments matched that of the pesticides in some, it was opposite in others. Interpretation. These results demonstrate a complicated distribution of PCB congeners and pesticides in various lipid compartments. The difference may reflect various Kows, different rates of metabolism, and/or different lengths of exposure. But the results suggest that contaminant levels in serum or even subcutaneous fat do not necessarily indicate concentrations and patterns in other kinds of adipose tissue.George W. Yu, John Laseter, and Charles MylanderCopyright © 2011 George W. Yu et al. All rights reserved.http://www.hindawi.com/journals/jeph/2011/797646/Background. Dissemination of health promotion interventions generally has followed an efficacy, effectiveness to full scale paradigm, and most programs have failed to traverse that sequence. Objective. Report national dissemination of a health promotion program and juxtapose sequential case study observations with the current technology transfer literature. Design. Multiple department-level case studies using contact logs, transcribed interactions, augmented with field notes and validated by respondent review; at least two investigators independently generated site summaries, which were compared to formulate a final report. Results. Adoption was facilitated with national partners and designing branded materials. Critical site influences included departmental features, local champions, and liaison relationships. Achieving distal reach and fidelity required sequential process and program revisions based on new findings at each site. Conclusions. Beta testing to redesign program elements and modify process steps appears to be a needed and often ignored translational step between efficacy and more widespread dissemination.Diane L. Elliot, Kerry S. Kuehl, Linn Goldberg, Carol A. DeFrancesco, and Esther L. MoeCopyright © 2011 Diane L. Elliot et al. All rights reserved.