Naphthalene—an environmental and occupational toxicant

For many years naphthalene had been considered as a non-carcinogenic polycyclic aromatic hydrocarbon (PAH). Airborne naphthalene concentrations have always been observed to be below the limit values of various national committees, such as the threshold limit value (TLV) of the American Conference of Governmental Industrial Hygienists (ACGIH) and the MAK of the Deutsche Forschungsgemeinschaft (DFG) (10 ppm). Since 2000, when the US National Toxicology Program revealed clear evidence of the carcinogenic activity of naphthalene in rats, international agencies [the International Agency for Research on Cancer (IARC), the US Environmental Protection Agency (US EPA), DFG] have reclassified naphthalene as a potential human carcinogen, and the European Union (EU) is currently preparing a new risk assessment report. It is presently unknown how to protect humans from health risks resulting from occupational and environmental naphthalene exposure. Knowledge about the external and internal exposure of humans serves as the key determinant in a comprehensive risk assessment. We review here ambient monitoring studies concerning the external naphthalene exposure that results from ubiquitous environmental sources (indoor and outdoor air, water, soil, food) and from a variety of critical workplaces (coking plants, creosote impregnation, distillation of coal tar and naphthalene, manufacture of refractories, graphite electrodes, aluminium and mothballs). Based on results of ambient monitoring studies published so far, a new hygiene-based exposure limit of 1.5 mg naphthalene per cubic metre of air (0.3 ppm) is proposed. Furthermore, results from biological monitoring studies are summarised in this article. The internal burden was almost exclusively determined by means of the urinary metabolites 1-naphthol and 2-naphthol, but it is currently not possible for one to evaluate a biological tolerance level (BAT) or a biological exposure index (BEI). Based on the toxicokinetics and metabolism of naphthalene, the central question on its carcinogenicity is briefly sketched. Naphthoquinones play an important role in this context. Their adducts with macromolecules may be the parameters of choice for the estimation of effects to human health.     

EMMA — an eye movement measurement and analysis system

A system has been developed for stimulation, recording and analysis of a wide range of eye movements. Eye movements are stimulated with an LED bar or a video projector under the control of a PC. The eye movements are measured using a scleral reflection technique (IRIS instrument), and sampled and stored on a PC. A range of tests have been developed to measure saccadic and smooth pursuit eye movements. A variety of tools have been developed to assist in the analysis of the data. Several research studies have ably demonstrated the utility and versatility of the system.     

Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study

Background  

The aim of this study was to establish the prevalence of posttraumatic stress disorder (PTSD) and depression among Rwandese and Somali refugees resident in a Ugandan refugee settlement, as a measure of the mental health consequences of armed conflict, as well as to inform a subsequent mental health outreach program. The study population comprised a sample from 14400 (n = 519 Somali and n = 906 Rwandese) refugees resident in Nakivale refugee settlement in South Western Uganda during the year 2003.     

Folate intake and pancreatic cancer risk: an overall and dose–response meta-analysis

Objective

Inconsistent findings of association between supplemental folate consumption and pancreatic cancer risk have been observed in the literature. This study aims to summarize the relationship between folate intake and risk of pancreatic cancer.

Study design

Pertinent studies published before November 2011 were identified by searching PubMed and Embase and by reviewing the reference lists of retrieved articles. The summary relative risks were estimated by the random effects model. A linear regression analysis of the natural logarithm of the relative risk (RR) was carried out to assess a possible dose–response relationship between folate intake and pancreatic cancer risk.

Results

Ten studies on dietary and supplemental folate intake and pancreatic cancer (4 case–control and 6 cohort studies) were included in the meta-analysis. The pooled RRs of pancreatic cancer for the highest vs lowest categories of dietary folate intake and supplemental folate intake were 0.66 (95% CI: 0.49–0.88) and 1.08 (95% CI, 0.82–1.41), respectively. The dose–response meta-analysis indicated that a 100 μg/day increment in dietary folate intake conferred a RR of 0.93 (95% CI: 0.90–0.97). These findings support the hypothesis that dietary folate may play a protective role in carcinogenesis of pancreatic cancer.     

School health education and gender: an interactive effect?

Post-primary school students (n = 2407) and young adults (n = 477) participated in a cross-sectional evaluation of a health education programme for schools. The Lifeskills programme is based on a philosophy of student empowerment, and aims to teach knowledge and skills relevant to health promoting behaviour. School students were recruited in schools, while young adults were opportunistically recruited in workplaces, training centres and on public transport. Those who attended schools where Lifeskills had been taught and who remembered such lessons were conservatively classified as the intervention group, while those who attended other schools and did not remember such lessons were classified as the comparison group. Participants completed questionnaires designed to collect data on health-related behaviours, indicators, knowledge and psychological health. School-level factors were employed as covariates in subsequent analyses of covariance. Amongst younger pupils, females reported more positive health behaviours but lower levels of psychological well-being and more symptoms. The impact of the programme became evident at ages 13-15. Those involved drank less and reported more positive adjustment to school. However, sex differences remained, with females reporting more health-promoting behaviour and more symptoms, and lagging behind males in self-esteem and general well-being. An interaction between gender and the intervention was identified among senior pupils. Exposure was especially beneficial for females. However, as young adults, the two main effects of gender and programme participation re-emerged as the most important independent variables, and the interaction between them was not significant. This pattern has implications for the interpretation of evaluations conducted on short-term interventions as well as for short-term impact evaluations.     

Obesity and eating disorder prevention: an integrated approach?

This article provides a rationale for interventions aimed at the prevention of eating disorders and obesity, an overview of some of the questions and controversies currently facing the fields of eating disorder and obesity prevention, and a discussion of the potential for integrated prevention approaches that address the broad spectrum of weight-related disorders. A rationale for utilizing an integrated approach, the challenges inherent to developing such an approach, and suggestions for working toward integrated approaches aimed at preventing the broad spectrum of weight-related disorders are discussed.     

Physician-leaders and hospital performance: Is there an association?

Although it has long been conjectured that having physicians in leadership positions is valuable for hospital performance, there is no published empirical work on the hypothesis. This cross-sectional study reports the first evidence. Data were collected on the top-100 U.S. hospitals in 2009, as identified by a widely-used media-generated ranking of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery. The personal histories of the 300 chief executive officers of these hospitals were then traced by hand. The CEOs are classified into physicians and non-physician managers. The paper finds a strong positive association between the ranked quality of a hospital and whether the CEO is a physician or not (p < 0.001). This kind of cross-sectional evidence does not establish that physician-leaders outperform professional managers, but it is consistent with such claims and suggests that this area is now an important one for systematic future research.     

A comparison of subjective and physiological measures of mechanically produced and erotically produced erections (or, is an erection an erection?)

The current investigation explores possible reasons for the poor overall success rates of medical techniques used in the treatment of erectile dysfunction. This is the first study to compare directly the psychological impact of a mechanically produced versus an erotically produced erection. Subjective and objective parameters of sexual arousal were used to compare the experience of a mechanically attained erection versus an erotically stimulated erection. Twenty-eight (28) men without sexual dysfunction were asked to reach a full erection during each of the following two conditions: (a) by using an ErecAid System and (b) by self-stimulating while watching an erotic video. The results of this study suggest that the penile vacuum device was a successful method for attaining penile tumescence; however, the presence of penile tumescence was not accompanied by a subjective state of physical or mental sexual arousal. Thus, the mere physical presence of an erection does not seem to evoke bodily or mental feelings of sexual arousal. It is important to note that these findings suggest that attention to the psychosexual components of the individual's sexual experience are critical to the subjective experience of sexual arousal and reflect once again the multimodal response systems involved in sexual arousal. These results suggest that more effective treatment approaches would be based on a clinical strategy that provides instruction both on the technical use of a mechanical device as well as on the importance of creating an appropriate psychosexual environment.     

Is there an association between sweetened beverages and adiposity?

Four mechanisms were reviewed to explain the possible association between sweetened beverages and increased overweight or obesity: excess caloric intake, glycemic index and glycemic load, lack of effect of liquid calories on satiety, and displacement of milk. The findings were inconsistent across studies. The strongest support was for the excess caloric intake hypothesis, but the findings were not conclusive. Assigning possible links between sweetened beverage consumption and adiposity requires research that compares and contrasts specific mechanisms, especially in populations at risk for obesity, while controlling for likely confounding variables.     

Schoolteachers’ Nutrition Knowledge,Beliefs, and Attitudes Before and After an E-Learning Program

ObjectiveΤο explore teachers’ nutrition knowledge, beliefs, and attitudes and to examine the effectiveness of an electronic learning (e-learning) program in teachers’ nutrition knowledge.DesignCross-sectional and experimental design.SettingThe study took place in Greece, while schoolteachers were invited by e-mail.ParticipantsTeachers of primary and secondary education, with no exclusion criteria, were enrolled in the study between March, 2015 and 2016.Main Outcome MeasuresSchoolteachers' nutrition knowledge, beliefs, and attitudes.InterventionTeachers completed a 36-item nutrition questionnaire and then a subgroup participated in an e-learning program. After the intervention, teachers completed the same questionnaire.AnalysisPrincipal component analysis and multivariate logistic regression were used for data analysis.ResultsA total of 1,094 teachers completed the questionnaire; 619 participated in the e-learning program. Teachers showed moderate nutrition knowledge scores (ie, 65% correct answers) before the intervention, whereas their attitudes regarding acting as role models and their belief in the importance of the role of nutrition were associated with 74% (odds ratio, 1.28; 95% confidence interval, 1.13–1.45) and 79% (odds ratio, 1.21; 95% confidence interval, 1.07–1.37) increased possibility of having good nutrition knowledge, respectively. The e-learning program was effective in strengthening teachers’ nutrition knowledge (P < .001) and improving their beliefs and attitudes (P < .05).Conclusions and ImplicationsFuture research is needed to validate the current results, which can be used to design and implement similar educational programs to teachers as a means of creating health-promoting schools.     

Women and heart transplantation: an issue of gender equity?

Heart transplantation (HT) is increasingly commonplace in countries with advanced health care systems. A review of the family and HT literature points to a gender inequity in the field: Men are more likely to be heart transplant recipients; women are more likely to contribute as their caregivers. In this critique, we argue that there are not only physiological but also social and economic issues that contribute to inequitable access to HT for women. Further, we point out that another invisible inequity in the heart transplant field is the lack of acknowledgment of, and support for, women whose contributions as family caregivers to the heart transplant process often ensure the success of heart transplant procedures. The authors call for recognition of these inequities and the development of policies that have the potential to ensure that women have equitable access to cardiovascular care in general and HT in particular, and that woman are recognized for, and supported in, their role as caregivers.     

Does an employee assistance programme benefit employers and employees alike?

EAPs are not a psychological sticking plaster. They are a clinically and corporately balanced service which benefits the employee, via the direct services and the employer, via the feedback in the form of usage statistics derived from the continuous tracking of the account through which organizational and employment issues are identified. Well positioned EAPs offer employees confidential counselling, and information services including legal, financial and child-based issues and are able to offer employers tailored training and consultancy.     

Single employed mothers and preschool child nutrition —an ecological analysis

Maternal employment has become a major factor in the workplace. This study examined the impact of such employment on a particularly vulnerable group: preschool children with single mothers. An ecological model was developed to examine the interrelated influence of the job, child care and family settings on child nutrition. The model was tested in a cross-sectional survey of 160, two- to four-year-old children with single, employed mothers in Winnipeg, Canada. Diet diversity emerged as a key variable, mediating the influence that child feeding practices and certain job, child care and home variables had on diet quality. The most important predictors of diet diversity were relative income and type of child care (i.e., licensed vs unlicensed). These results suggest that an ecological perspective be adopted for interventions as it would force the consideration of a multiple and interacting set of influences on child nutrition.     

Shrinking areas and mortality: an artefact of deprivation effects?

There is evidence that mortality rates are highest in areas that are experiencing population decline, and researchers have recommended that this should be accounted for in health resource allocation. This research finds a significant negative association between population change and mortality for small areas in Scotland, which remains when low social class is accounted for. However, this relation disappears when the area deprivation is accounted for. It is suggested that it is more important to account for deprivation than population change in health resource allocation.