Dilution effects on the quality of untreated wastewater used for irrigation along the USA-Mexico border

The Juarez Valley, located along the USA-Mexico border, currently relies on untreated municipal and industrial wastewater from nearby Ciudad Juarez (est. pop. 1.6 million) which has been diluted with water diverted from the Rio Bravo (Rio Grande), and groundwater from underlying aquifers, to irrigate 18000 hectares of crops. The results indicate that dilution does very little to reduce the risks associated with the use of untreated wastewater for irrigation as faecal coliforms levels remained high (> 10 7 cfu/100 ml). Concentrations of heavy metals were low in the raw wastewater and in the mixed waters. However, the practice of diluting raw wastewater seriously degrades significant volumes of high quality waters from the Rio Bravo and from the underlying aquifer, and thus is not an optimal use of the limited high-quality water available to this semi-arid region.     

The risk of enteric diseases in young children and environmental indicators in sentinel areas of Mexico City

The overall objective of this study is to promote the development of environmental health indicators in Mexico City. Specific examples focused on water quality, household characteristics e.g., sanitation and risk of enteric diseases. A geographic information system (GIS) was used in order to identify eligible wells and their surrounding homesteads (0.5 km around each well). A pilot study was conducted during the rainy season (1999), and a total of 1, 250 eligible households were visited on a random sample basis; only those having children under 5 years of age were interviewed. Data on diarrheal disease (i.e. occurrence in the previous two weeks) were obtained from 950 children, and their guardians provided information on their water supply, sanitation and socioeconomic variables. A total of 320 water samples were obtained from 40 wells, and tested for Total coliforms (TC/100 ml), Fecal coliforms (FC/100 ml). Escherichia coli (EC) and Fecal streptococci (FS). Bacterial indicators were detected in 40% of the wells in the western zone and in 32% of the southern zone (p = 0.01). The rate of diarrheal diseases was higher for children from the southern areas than in the west (OR = 1.7 and 95% CI: 0.99, 2.86). The final analysis showed a higher risk of diarrhea in children from rented homes than those living in owned dwellings (OR = 1.7 and 95% Cl: 1.04, 2.77): the risk was also highest for children living in houses with poor sanitation facilities (e.g., latrine) than those connected to a sewerage (OR = 1.7 and 95% Cl: 1.00, 2.93). Children from households perceiving unpleasant taste of water showed a higher risk than those without complaints (OR = 2.2 and 95% Cl: 1.28, 3.75). Linkages between environmental factors and health risk were created from spatially distributed information, and the proposed environmental health indicator (EHI) summarized the most significant predictors of diarrheal diseases. This baseline information may contribute to further environmental health investigation and policy making analysis.     

Making risk visible: The role of images in the assessment of (cancer) genetic risk

Whilst analysis of 'risk' (in its many conceptual shapes) has loomed large in both medicine and social sciences over the past 25 years, detailed investigations as to how risk assessments are actually put together (in either lay or professional contexts) are few in number. The studies that are available usually focus on the use of words or everyday conversation in assembling risk. Talking about risk is, of course, important, but what tends to be ignored is the fact that risk can be and is often made visible. For example, it can be made visible through the use of tables, charts, diagrams and various kinds of sophisticated laboratory images. This paper concentrates on the role of such images in the context of a cancer genetics clinic and its associated laboratory. Precisely how these images are tied into the production of risk estimates, how professionals discuss and use such images in clinical work, and how professionals reference them to display facts about risk is the focus of the paper. The paper concludes by highlighting the significance of different kinds of visibility for an understanding of genetic abnormalities and how such differences might impact on the attempts of lay people to get to grips with risk.     

Health risk aversion,health risk affinity,and socio-economic position in the USA: The demographics of multiple risk

Understanding the distribution of behavioural risk factors in the population can improve health promotion. This article reports on a research project which analysed the distribution of numbers of behavioural risk factors among US adults, by race/Hispanic origin, sex, and age. Income, education, and region were examined as potential confounders in observed patterns. The B ehavioral Risk Factor Surveillance System (BRFSS) data for 1993 were used to assess the distribution of numbers of risk factors, i.e. smoking, heavy drinking, overweight, inadequate seatbelt use, Papanicolaou (pap) smear screening, mammography, colorectal screening, and influenza and pneumonia vaccination. Two hypotheses were examined: (1) given the distribution of each risk factor in the US population by age and sex, prevalences both of low and of high numbers of risk behaviours (but not of moderate numbers of risk behaviours) are greater than expected within each race/Hispanic origin-sex-age group; and (2) differences in socio-economic position among these groups account for the differences between observed and expected prevalences of numbers of risk factors. The second hypothesis was assessed both graphically by adjustment for income and education, and by multiple linear regression. The research found higher than expected prevalences of both low and high numbers of risk factors among whites and, possibly, among Hispanics. Among Asians prevalences were less than expected with greater numbers of risk factors. Among blacks and American Indians prevalences were lower than expected for low numbers of risk factors and were greater than expected with greater numbers of risk factors. Adjustment for income or education reduced differences between observed and expected prevalences. It appears that risk aversion and risk affinity vary substantially by race/Hispanic origin and are only partially explained by socio-economic position. Exploration of the causes of high and low risk behaviour may improve risk behaviour interventions.     

乙醇性肝硬化患者肺部感染的危险因素分析

目的探讨分析引发乙醇性肝硬化患者肺部感染的危险因素以及预防与控制感染措施,以降低肺部感染率。方法选取2009年1月-2012年12月收治的110例乙醇性肝硬化患者为研究对象,将其中发生肺部感染的35例患者为感染组,余75例为未感染组,采用logistic回归分析法对乙醇性肝硬化患者肺部感染的相关因素进行统计分析。结果 110例乙醇性肝硬化患者中发生肺部感染35例,感染率为31.8%;35例感染患者中发热、外周血白细胞计数>10×109/L、咳嗽、咳痰的阳性率分别为57.1%、51.4%、48.6%;共培养出病原菌19株,其中革兰阴性菌占68.4%,革兰阳性菌占21.1%,真菌占10.5%;肺部感染的发生与年龄、住院时间、肝衰竭、消化道出血、细菌性腹膜炎、肝性脑病及合并基础疾病有关(P<0.05),与性别无明显相关性;采用非条件logistic回归分析法结果发现,年龄(OR=5.791,95%CI=1.704¹9.681)、住院时间(OR=4.335,95%CI=1.34119.681)、住院时间(OR=4.335,95%CI=1.341¹4.017)、肝衰竭(OR=4.338,95%CI=1.01214.017)、肝衰竭(OR=4.338,95%CI=1.012¹9.198)、消化道出血(OR=6.909,95%CI=1.64319.198)、消化道出血(OR=6.909,95%CI=1.643²9.053)、细菌性腹膜炎(OR=5.593,95%CI=1.18929.053)、细菌性腹膜炎(OR=5.593,95%CI=1.189²6.311)、肝性脑病(OR=3.939,95%CI=1.16226.311)、肝性脑病(OR=3.939,95%CI=1.162¹3.424)、合并基础性疾病(OR=5.259,95%CI=1.60213.424)、合并基础性疾病(OR=5.259,95%CI=1.602¹7.072)是乙醇性肝硬化患者住院期间肺部感染的主要危险因素(P<0.05)。结论乙醇性肝硬化患者肺部感染率较高,医务人员要充分认识其危险因素,以预防和控制其发生。     

上海市青少年危险行为现状研究(二)--易导致意外伤害的危险行为

目的　了解上海市青少年与意外伤害相关的危险行为现状 ,为制定干预措施提供依据。　方法　于 2 0 0 2年 4～ 6月 ,在上海市 10 5所学校 (初中、高中和中等职业学校 )对 92 46名一年级学生 ,采用上海市青少年危险行为问卷进行调查。　结果　学生中步行乱穿马路、骑车违反交通规则、乘车不系安全带等危险行为发生率最高 ,分别为 40 .7%、48.4%、42 .0 % ,其次分别为打架行为 ( 2 7.3% )和到非泳区游泳 ( 9.8% ) ;学生中发生各种危险行为的比例有明显差异 ,男生显著高于女生 (P <0 .0 1) ;中等职业学校显著高于高中学生 (P <0 .0 1) ,骑车违反交通规则、打架等行为初中学生显著高于中等职业学校和高中学生 (P <0 .0 1) ;步行乱穿马路、乘车不系安全带等危险行为中心城区显著高于非中心城区 (P <0 .0 1) ,骑车违反交通规则、到非泳区游泳、受凶器威胁或伤害等危险行为非中心城区显著高于中心城区 (P <0 .0 1)。　结论　青少年中存在许多易导致意外伤害的危险行为 ,应针对青少年的性别、年龄特点和地区差异开展相关的健康教育 ,以提高其对意外伤害的预防和自我保健意识。     

Profile and determinants of unsuccessful tuberculosis outcome in rural Nigeria: Implications for tuberculosis control

AIM: To determine the treatment outcomes and predictors for unsuccessful tuberculosis (TB) outcomes in rural Nigeria. METHODS: Adult rural TB patients treated during 2011 and 2012 in two healthcare facilities (one urban public and one rural private) were identified from the TB treatment registers and retrospectively reviewed. Tuberculosis treatment outcomes were assessed according to World Health Organisation guidelines. Determinants of unsuccessful treatment outcomes were identified using a multivariable logistic regression analysis. RESULTS: Between January 2011 to December 2012, 1180 rural TB patients started treatment, of whom 494 (41.9%) were female. The treatment success rate was 893 (75.7%), while the rates of death, loss-to-follow-up, and treatment failure were 129 (10.9%), 100 (8.5%), and 18 (1.5%) respectively. In the final multivariable logistic regression model, the odds of unsuccessful treatment outcome were higher among patients who received care at the urban public facility (aOR = 2.9, 95%CI: 1.9-4.4), smear-negative (1.3, 1.0-1.8) and extrapulmonary (2.7, 1.3-5.6) TB patients, human immunodeficiency virus (HIV) co-infected (2.1, 1.5-3.0), and patient who received the longer (8-mo) anti-TB regimen (1.3, 1.1-1.8). CONCLUSION: Treatment success among rural TB patient in Nigeria is low. High risk groups should be targeted for closer monitoring, socio-economic support, and expansion of TB/HIV activities.     

'HIV is HIV to me': The meanings of treatment,viral load and reinfection for gay men living with HIV

This paper identifies some aspects of the risk management practices of HIV positive gay men in relation to HIV treatments and sexual practice. The paper uses qualitative methods to examine sexual practice and HIV transmission in relation to HIV blood test viral load information. Questions of reinfection with HIV are also examined. Open-ended interviews were conducted with 25 gay and other homosexually active men and analysed for relevant themes. Interviewees spoke of different approaches to risk assessment in relation to viral load and reinfection, drawing on their experiences and advice. This diversity is connected with various risk management 'styles' that reflected positions about HIV transmission risk, the characteristics of the partner and the sexual situation. Some implications for HIV prevention are identified, including the need to address the links between prevention and treatment. HIV prevention strategies will need to address development of education in relation to evolving knowledge about treatment technologies and connections with HIV transmission.     

The risk of cancer among patients with sleep disturbance: a nationwide retrospective study in Taiwan

PurposeTo investigate the risk of cancer among patients with nonapnea sleep disorders (SDs).MethodsWe included newly diagnosed SD patients aged 20 years and older without antecedent cancer between 2000 and 2010 from the National Health Insurance Research Database. Standardized incidence ratios (SIRs) of cancers were calculated to compare the cancer incidence of patients with SD with that of the general population.ResultsDuring the 10-year study period, 2062 cancers developed among 63,381 SD patients, who were observed for 382,826 person-years (median follow-up of 6.23 years). The SIR for all cancers was 1.19 (95% confidence interval [CI], 1.14–1.24). For specific cancer types, SD patients exhibited an increased SIR for liver and lung cancers (1.44; 95% CI, 1.28–1.61 and 1.34; 95% CI, 1.18–1.51, respectively).ConclusionsWe observed that overall cancer risk is increased among Asian SD patients. In terms of individual cancers, the risks of liver and lung cancers were elevated. Clinicians should be aware of the possibility of increased liver and lung cancers among SD patients in Taiwan. A prospective study is necessary to confirm these findings.     

Ranking the contributions of commercial fish and shellfish varieties to mercury exposure in the United States: Implications for risk communication

Fish and shellfish have important nutritional benefits, and US per capita seafood consumption has increased substantially since 2002. Recent research has reinforced concerns about adverse effects of methylmercury exposure, suggesting that methylmercury doses associated with typical US rates of fish consumption may pose measurable risks, with no threshold. These converging trends create a need to improve risk communication about fish consumption and mercury. The analysis performed here identifies the relative importance of different fish and shellfish as sources of mercury in the US seafood supply and proposes improved consumer advice, so that the public can benefit from fish consumption while minimizing mercury exposure. I have quantified contributions to total mercury in the US seafood supply by 51 different varieties of fish and shellfish, then ranked and sorted the 51 varieties in terms of relative impact. Except for swordfish, most fish with the highest mercury levels are relatively minor contributors to total inputs. Tuna (canned light, canned albacore and fresh/frozen varieties) accounts for 37.4 percent of total mercury inputs, while two-thirds of the seafood supply and nine of the 11 most heavily consumed fish and shellfish are low or very low in mercury. Substantial improvement in risk communication about mercury in fish and seafood is needed; in particular, several population subsets need better guidance to base their seafood choices more explicitly on mercury content. I have sorted the 51 seafood varieties into six categories based on mercury levels, as a framework for improving risk communication in this regard.     

Critical incidents and the perception of health risks: The experiences of young people in relation to their use of alcohol and tobacco

Personal experience of an accident or ill-health might be expected to challenge a young person's sense of invulnerability when it comes to health risks. Such experiences might act as 'critical incidents' that drive home the message that 'it could indeed happen to me' and make the young person more concerned to avoid unnecessary health risks. But, is this 'rational' expectation borne out in practice? The research reported here investigates the extent to which such experiences constitute critical incidentsflashpoints in the lives of young people influencing their perceptions of health risks. In particular, it investigates how young people, aged 1516 years, reflect on their personal experiences and the degree to which they believe the experiences have affected them. Based on survey research, focus groups and interviews conducted in the East Midlands of England, a diversity of responses is reported and discussed. The findings indicate that the objective features of critical incidents in themselves are not the crucial factor influencing changes in attitudes and behaviour. More importantly, it is the meaning that young people give to those incidents that is significant.     

Impact and attribute of each obesity-related cardiovascular risk factor in combination with abdominal obesity on total health expenditures in adult Japanese National Health insurance beneficiaries: The Ibaraki Prefectural health study

Background

The aim of this study was to examine the attribution of each cardiovascular risk factor in combination with abdominal obesity (AO) on Japanese health expenditures.

Behavioral adjustment to avian flu in Europe during spring 2006: The roles of knowledge and proximity to risk

The threat of a widespread avian flu influenza outbreak represented a significant public health challenge for the European region during late 2005 and early 2006. Little is known, however, about how individuals learn about new global-level health risks, especially influenza outbreaks. We empirically test the hypothesis that knowledge about and geographic proximity to avian flu play a role in individuals' consumption behavior regarding this health risk. This article employs Eurobarometer survey data collected in spring 2006 to examine how Europeans (from 27 European Union countries plus Croatia and Turkey) altered their consumption of poultry, eggs and egg-based products during the virus' emergence in Europe. Our findings are consistent with the hypothesis that behavioral change indeed depends on proximity to those risks. Significant differences emerged between individuals' likelihood of behavioral change in countries where avian flu had been found in humans either in individuals' countries of residence or in bordering countries. Furthermore, we find that those who were more knowledgeable about avian flu risks were less likely to have reduced their consumption of poultry, eggs or egg-related products in the spring of 2006 compared to six months prior. Yet, the influence knowledge has on consumption behavior is found to change depending on proximity to avian flu risks. These findings have implications for our larger understanding of how individuals alter their behavior in the face of new health risks.     

Exposure to indoor air pollution from household energy use in rural China: the interactions of technology, behavior, and knowledge in health risk management

Indoor air pollution (IAP) from household use of biomass and coal is a leading environmental health risk in many developing nations. Much of the initial research on household energy technology overlooked the complex interactions of technological, behavioral, economic, and infrastructural factors that determine the success of environmental health interventions. Consequently, despite enormous interest in reducing the large and inequitable risks associated with household energy use in international development and global health, there is limited empirical research to form the basis for design and delivery of effective interventions. We used data from four poor provinces in China (Gansu, Guizhou, Inner Mongolia, and Shaanxi) to examine the linkages among technology, user knowledge and behavior, and access and infrastructure in exposure to IAP from household energy use. We conclude that broad health risk education is insufficient for successful risk mitigation when exposure behaviors are closely linked to day-to-day activities of households such as cooking and heating, or have other welfare implications, and hence cannot be simply stopped. Rather, there should be emphasis on the economic and infrastructure determinants of access to technology, as well as the details of behaviors that affect exposure. Better understanding of technology-behavior interface would also allow designing technological interventions that account for, and are robust to, behavioral factors or to provide individuals and households with alternative behaviors. Based on the analysis, we present technological and behavioral interventions for these four Chinese provinces.     

“健康扶贫”——西藏食品放射性污染风险监测及个人剂量监测调查与分析

为精准实施“健康扶贫”“脱贫攻坚”工作任务、完善对口扶贫工作机制、提高贫困地区疾控工作能力、使个人剂量监测与食品放射性污染风险监测工作达到全国覆盖,依据党中央、国务院脱贫攻坚决策部署,落实精准扶贫精准脱贫基本方略,中国疾病预防控制中心辐射防护与核安全医学所从2012年对西藏开展“健康扶贫”工作,针对西藏地区职业人员的个人剂量监测及食品放射性污染风险监测工作进行了重点指导和帮扶。截至2021年4月,共援助西藏自治区开展了13个季度的免费个人剂量监测、2次培训指导和1次现场教学等工作。在食品放射性污染风险监测方面连续5年为西藏自治区进行了3次现场培训指导、60份食品样品的放射性核素检测与分析等工作。此项工作弥补了西藏在全区放射卫生监测领域的空白,显著提高了西藏自治区疾控工作能力,对西藏放射卫生事业发展和保障放射工作人员健康具有重要意义。     

Change in income and change in self-rated health: Systematic review of studies using repeated measures to control for confounding bias

It is generally assumed that income is strongly and positively associated with health. However, much of the evidence supporting this assumption comes from cross-sectional data or analyses that have not fully accounted for biases from confounding and health selection (the reverse pathway from health to income). This paper reports results of a systematic review of panel and longitudinal studies investigating whether changes in income led to changes in self-rated health (SRH) in adults. A variety of electronic databases were searched, up until January 2010, and thirteen studies were included, using data from five different panel or longitudinal studies. The majority of studies found a small, positive and statistically significant association of income with SRH, which was much reduced after controlling for unmeasured confounders and/or health selection. Residual bias, particularly from measurement error, probably reduced this association to the null. Most studies investigated short-term associations between income and SRH or the effect of temporary (usually one year) income changes or shocks, so did not rule out possibly stronger associations between health and longer-term average income or income lagged over longer time periods. Nevertheless, the true causal short-term relationship between income and health, estimated by longitudinal studies of income change and SRH that control for confounding, may be much smaller than that suggested by previous, mostly cross-sectional, research.     

慢性阻塞性肺疾病患者死亡危险因素队列研究的系统综述和荟萃分析

目的  系统评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者死亡危险因素。方法  检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普网、万方数据知识服务平台和中国生物医学文献数据库有关COPD患者死亡危险因素的研究,再筛选文献、提取数据和质量评价,并进行荟萃分析。结果  纳入15篇队列研究,纽卡斯尔-渥太华(Newcastle-Ottawa Scale, NOS)量表评分7~9分。荟萃分析结果显示：高龄(HR=1.074, 95% CI: 1.048~1.101, P＜0.001)、吸烟(HR=1.390, 95% CI: 1.298~1.490, P＜0.001)、低BMI(HR=1.434, 95% CI: 1.190~1.727, P＜0.001)、高改良英国医学研究学会呼吸困难指数(modified British medical research council, mMRC)(HR=1.597, 95% CI: 1.550~1.646, P＜0.001)、高Charlson共病指数(Charlson comorbidity index, CCI)(HR=1.191, 95% CI: 1.096~1.294, P＜0.001)、Ⅳ级COPD(HR=2.114, 95% CI: 1.681~2.658, P＜0.001)与COPD患者死亡关联有统计学意义。女性(HR=1.091, 95% CI: 0.781~1.522, P=0.610)、低去脂体重指数(fat free mass index, FFMI)(HR=3.025, 95% CI: 0.268~34.203, P=0.371)与COPD患者死亡关联无统计学意义。描述性分析结果显示高N端脑钠肽前体(N-terminal pro-brain nitric peptide, NT-proBNP)、铜绿假单孢菌(pseudomonas aeruginosa, PA)阳性可能是COPD患者死亡的危险因素。结论  高龄、吸烟、低BMI、高mMRC、高CCI、Ⅳ级COPD是COPD患者死亡的独立危险因素,女性和低FFMI不是COPD患者死亡的危险因素,高NT-proBNP、PA感染与COPD患者的死亡关系还需进一步研究证明。