Climate change: the importance of place

Climate change-related risks are place-specific and path-dependent. Accordingly, location is an important determinant of hazardous exposure, and certain places will bear more risk than others. This article reviews the major environmental exposures associated with risky places in the U.S., including coastal regions, islands, the desert Southwest, vectorborne and zoonotic disease border regions, cities, and the U.S. Arctic (Alaska), with emphasis on exposures and vulnerable populations of concern. In addition to these hotspots, this study considers the ways in which the concept of place--the sense of human relationship with particular environments--will play a key role in motivating, developing, and deploying an effective public health response. In considering the importance of place, we highlight the concepts of community resilience and risk management, key aspects of a robust response to climate change in public health and other sectors.     

Risk factors for tick exposure and suboptimal adherence to preventive recommendations

BACKGROUND: Tickborne diseases are the most common vectorborne illnesses in the United States. Understanding risk factors for tick bites and adherence to preventive measures are important in preventing morbidity associated with tickborne disease. METHODS: A random-digit-dialing telephone survey was administered to 1820 residents of 11 counties in Tennessee. RESULTS: Of respondents, 16.4% reported a tick bite within the previous year. Only 29% consistently used insect repellant in high-risk situations, and only 54% always checked their bodies for ticks after leaving potentially infested areas. Nearly one fourth of dog owners removed ticks from their pets with bare hands. Dog ownership, rural residence, and exposure to a farm were associated with increased risk of tick bites. CONCLUSIONS: We identified several groups that were at increased risk of tick bites and might benefit from targeted prevention messages.     

Methodologic issues in exposure assessment for case-control studies of cancer and herbicides

Epidemiologic studies of cancer and exposure to herbicides have shown puzzling inconsistencies. Exposure-response gradients have been reported for non-Hodgkin's lymphoma in Sweden and Kansas, but no significant associations were seen in New Zealand or Washington State. Subjects in these studies were categorized by exposure using information obtained primarily by interview. A number of questions can be raised regarding the reliability and validity of such an exposure assessment. We examined procedures used to assess pesticide exposures in case-control studies of cancer to evaluate their limitations and their probable effects on risk estimates. Except for case recall bias, problems of misclassification in these studies would tend to bias risk estimates toward the null and dilute exposure-response gradients. These problems are, therefore, unlikely explanations for the positive associations between cancer and herbicide use noted in some investigations. A tendency for false-negative findings, however, is not reassuring, and improvements in exposure assessment are needed if epidemiologic investigations are to continue to provide reliable information on the relationships of cancer and pesticide exposure.     

Application of human biomonitoring (HBM) of chemical exposure in the characterisation of health risks under REACH

REACH requires health risk management for workers and the general population and introduced the concept of Derived No-Effect Level (DNEL). DNELs must be derived for all substances that are classified as hazardous. In analogy to other health-risk based guidance values, such as reference doses (RfDs) and tolerable daily intakes (TDIs), risk to health is considered negligible if the actual exposure is less than the DNEL. Exposure assessment is relatively simple for occupational situations but more complex for the general public, in which exposure may occur via multiple pathways, routes, and media. For such complex or partially defined exposure scenarios, human biomonitoring (HBM) gives a snapshot of the internal or absorbed dose of a chemical and is often the most reliable exposure assessment methodology. For human risk management, HBM data can be interpreted using the recently developed concept of Biomonitoring Equivalents (BEs). Basically, a BE translates an established reference value into a biomarker concentration using toxicokinetic data. If the results of an exposure assessment using HBM indicate that the levels measured are below the DNEL-based BE (BE(DNEL)), it would indicate that the combined exposure via all potential exposure routes is unlikely to pose a risk to human health and that health risk management measures might not be needed. Hence, BEs do not challenge existing risk assessments but rather build upon them to help risk management, the ultimate goal of any risk assessment. A challenge in implementing this approach forms the limited availability of toxicokinetic information for many substances. However, methodologies such as generic physiologically based toxicokinetic models, which allow estimation of biomarker concentrations based on physicochemical properties, are being developed for less data-rich chemicals. Acceptance of the use of BE by regulatory authorities will allow initial screening of population exposure to chemicals to identify those chemicals requiring more detailed risk and exposure assessment, assisting in priority setting and ultimately leading to improved product stewardship and risk management.     

The coastal environment and human health: microbial indicators,pathogens, sentinels and reservoirs

Innovative research relating oceans and human health is advancing our understanding of disease-causing organisms in coastal ecosystems. Novel techniques are elucidating the loading, transport and fate of pathogens in coastal ecosystems, and identifying sources of contamination. This research is facilitating improved risk assessments for seafood consumers and those who use the oceans for recreation. A number of challenges still remain and define future directions of research and public policy. Sample processing and molecular detection techniques need to be advanced to allow rapid and specific identification of microbes of public health concern from complex environmental samples. Water quality standards need to be updated to more accurately reflect health risks and to provide managers with improved tools for decision-making. Greater discrimination of virulent versus harmless microbes is needed to identify environmental reservoirs of pathogens and factors leading to human infections. Investigations must include examination of microbial community dynamics that may be important from a human health perspective. Further research is needed to evaluate the ecology of non-enteric water-transmitted diseases. Sentinels should also be established and monitored, providing early warning of dangers to ecosystem health. Taken together, this effort will provide more reliable information about public health risks associated with beaches and seafood consumption, and how human activities can affect their exposure to disease-causing organisms from the oceans.     

Climate and vectorborne diseases

Climate change could significantly affect vectorborne disease in humans. Temperature, precipitation, humidity, and other climatic factors are known to affect the reproduction, development, behavior, and population dynamics of the arthropod vectors of these diseases. Climate also can affect the development of pathogens in vectors, as well as the population dynamics and ranges of the nonhuman vertebrate reservoirs of many vectorborne diseases. Whether climate changes increase or decrease the incidence of vectorborne diseases in humans will depend not only on the actual climatic conditions but also on local nonclimatic epidemiologic and ecologic factors. Predicting the relative impact of sustained climate change on vectorborne diseases is difficult and will require long-term studies that look not only at the effects of climate change but also at the contributions of other agents of global change such as increased trade and travel, demographic shifts, civil unrest, changes in land use, water availability, and other issues. Adapting to the effects of climate change will require the development of adequate response plans, enhancement of surveillance systems, and development of effective and locally appropriate strategies to control and prevent vectorborne diseases.     

Methodologic issues and approaches to spatial epidemiology

Spatial epidemiology is increasingly being used to assess health risks associated with environmental hazards. Risk patterns tend to have both a temporal and a spatial component; thus, spatial epidemiology must combine methods from epidemiology, statistics, and geographic information science. Recent statistical advances in spatial epidemiology include the use of smoothing in risk maps to create an interpretable risk surface, the extension of spatial models to incorporate the time dimension, and the combination of individual- and area-level information. Advances in geographic information systems and the growing availability of modeling packages have led to an improvement in exposure assessment. Techniques drawn from geographic information science are being developed to enable the visualization of uncertainty and ensure more meaningful inferences are made from data. When public health concerns related to the environment arise, it is essential to address such anxieties appropriately and in a timely manner. Tools designed to facilitate the investigation process are being developed, although the availability of complete and clean health data, and appropriate exposure data often remain limiting factors.     

Vectorborne Transmission of Leishmania infantum from Hounds,United States

Leishmaniasis is a zoonotic disease caused by predominantly vectorborne Leishmania spp. In the United States, canine visceral leishmaniasis is common among hounds, and L. infantum vertical transmission among hounds has been confirmed. We found that L. infantum from hounds remains infective in sandflies, underscoring the risk for human exposure by vectorborne transmission.     

Sustainable Control of Water-Related Infectious Diseases: A Review and Proposal for Interdisciplinary Health-Based Systems Research

Objective

Even when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health oriented systems approach to research and intervention design.

Data sources

On the basis of the literature and the authors’ experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized.

Data extraction

We define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease.

Data synthesis

The limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains; incomplete data; a lack of relevant indicators; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances.

Conclusions

The proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.     

Mapping for prevention: GIS models for directing childhood lead poisoning prevention programs

Environmental threats to children's health--especially low-level lead exposure--are complex and multifaceted; consequently, mitigation of these threats has proven costly and insufficient and has produced economic and racial disparities in exposure among populations. Policy makers, public health officials, child advocates, and others currently lack the appropriate infrastructure to evaluate children's risk and exposure potential across a broad range of risks. Unable to identify where the highest risk of exposure occurs, children's environmental health programs remain mitigative instead of preventive. In this article we use geographic information system spatial analysis of data from blood lead screening, county tax assessors, and the U.S. Census to predict statistically based lead exposure risk levels mapped at the individual tax parcel unit in six counties in North Carolina. The resulting model uses weighted risk factors to spatially locate modeled exposure zones, thus highlighting critical areas for targeted intervention. The methods presented here hold promise for application and extension to the other 94 North Carolina counties and nationally, as well as to other environmental health risks.     

Using meta-quality to assess the utility of volunteered geographic information for science

Background

Volunteered geographic information (VGI) has strong potential to be increasingly valuable to scientists in collaboration with non-scientists. The abundance of mobile phones and other wireless forms of communication open up significant opportunities for the public to get involved in scientific research. As these devices and activities become more abundant, questions of uncertainty and error in volunteer data are emerging as critical components for using volunteer-sourced spatial data.

Methods

Here we present a methodology for using VGI and assessing its sensitivity to three types of error. More specifically, this study evaluates the reliability of data from volunteers based on their historical patterns. The specific context is a case study in surveillance of tsetse flies, a health concern for being the primary vector of African Trypanosomiasis.

Results

Reliability, as measured by a reputation score, determines the threshold for accepting the volunteered data for inclusion in a tsetse presence/absence model. Higher reputation scores are successful in identifying areas of higher modeled tsetse prevalence. A dynamic threshold is needed but the quality of VGI will improve as more data are collected and the errors in identifying reliable participants will decrease.

Conclusions

This system allows for two-way communication between researchers and the public, and a way to evaluate the reliability of VGI. Boosting the public’s ability to participate in such work can improve disease surveillance and promote citizen science. In the absence of active surveillance, VGI can provide valuable spatial information given that the data are reliable.

     

Risk assessment and risk management of nanomaterials in the workplace: translating research to practice

In the last decade since the rise in occupational safety and health (OSH) research focusing on nanomaterials, some progress has been made in generating the health effects and exposure data needed to perform risk assessment and develop risk management guidance. Yet, substantial research gaps remain, as do challenges in the translation of these research findings to OSH guidance and workplace practice. Risk assessment is a process that integrates the hazard, exposure, and dose-response data to characterize risk in a population (e.g. workers), in order to provide health information needed for risk management decision-making. Thus, the research priorities for risk assessment are those studies that will reduce the uncertainty in the key factors that influence the estimates. Current knowledge of OSH in nanotechnology includes the following: (i) nanomaterials can be measured using standard measurement methods (respirable mass or number concentration), (ii) workplace exposures to nanomaterials can be reduced using engineering controls and personal protective equipment, and (iii) current toxicity testing and risk assessment methods are applicable to nanomaterials. Yet, to ensure protection of workers' health, research is still needed to develop (i) sensitive and quantitative measures of workers' exposure to nanomaterials, (ii) validation methods for exposure controls, and (iii) standardized criteria to categorize hazard data, including better prediction of chronic effects. This article provides a state-of-the-art overview on translating current hazard research data and risk assessment methods for nanomaterials to the development and implementation of effective risk management guidance.     

Vaccinomics,the new road to tick vaccines

Ticks are a threat to human and animal health worldwide. Ticks are considered to be second worldwide to mosquitoes as vectors of human diseases, the most important vectors of diseases that affect cattle industry worldwide and important vectors of diseases affecting pets. Tick vaccines are a cost-effective and environmentally friendly alternative to protect against tick-borne diseases through the control of vector infestations and reducing pathogen infection and transmission. These premises stress the need for developing improved tick vaccines in a more efficient way. In this context, development of improved vaccines for tick-borne diseases will be greatly enhanced by vaccinomics approaches starting from the study of tick–host–pathogen molecular interactions and ending in the characterization and validation of vaccine formulations. The discovery of new candidate vaccine antigens for the control of tick infestations and pathogen infection and transmission requires the development of effective screening platforms and algorithms that allow the analysis and validation of data produced by systems biology approaches to tick research. Tick vaccines that affect both tick infestations and pathogen transmission could be used to vaccinate human and animal populations at risk and reservoir species to reduce host exposure to ticks while reducing the number of infected ticks and their vectorial capacity for pathogens that affect human and animal health worldwide.     

Digital risk analysis of cardiovascular diseases: new opportunities for the patients. Cardiovascular prevention program in the praxis

Authors constructed a software helping the prevention programme of coronary and vascular diseases as the classical risk factors are used for graphic presentation of coronary risk as compared to "normal" risk. By repeated estimation alterations in coronary risk status can be compared to previous ones and thereby help evaluating the changes. This programme is highlighted by the presentation of changes in coronary risk of a patient during a 4-year-long period of her medical history. It is also shown how graphic presentation of risk can support the more effective treatment and patient care.     

应用Meta分析有效估计人群归因危险度百分比的探讨

人群归因危险度百分比 (populationattributableriskproportion ,PARP)是总体人群中某种疾病归因于某种因素的暴露所引起的发病 (死亡 )占全部发病 (死亡 )的百分比 ,反映该因素所引起的发病 (死亡 )占全部发病 (死亡 )的比重。通过PARP可了解各危险因素对人群中某疾病的发病所产生的影响 ,亦即消除某危险因素后 ,所产生的对预防该疾病的效果将占有多大比重。它能够为卫生政策的制订提供依据 ,有着重要的公共卫生的实际意义。目前常用的估计PARP的方法有两种 :一种是利用全国人群抽样调查获得的人群总暴露率来估计 ;另一种是利用某地区…     

志贺菌检验技术的研究进展

志贺菌（Shigella spp）是引起人类肠道传染病最常见的病原菌,近年来稳居我国感染性腹泻病原菌的首位。为了能够有效防控和治疗水或食源性疾病,快速检验患者、水、食品中的志贺菌,作者就志贺菌的各种检验技术进展进行系统的综述,侧重说明其原理、敏感性、特异性及实用性。当前志贺菌检验技术的开发向着简易、快速、可靠的方向发展,以适用突发公共卫生事件的应急处理和临床诊断治疗的需要。     

Three times the injuries among occasional wood cutters compared to professional loggers: sample of emergency rooms in central and northern Wisconsin

BACKGROUND: No reliable statistics exist for injury rates among occasional woodcutters as opposed to professional loggers. Study objectives were to assess woodcutting injuries seen in emergency rooms and identify risk factors. METHODS: Individuals with woodcutting related injuries were identified in 14 emergency and urgent care departments in central and northern Wisconsin. A telephone survey was conducted within 3 weeks of presentation to determine number and types of injuries, causes, and characteristics of the injured. RESULTS: Three times as many woodcutting-related injuries occurred in non-logger survey participants (54 vs. 17). There was no significant difference in age or type of injury. Loggers were more likely to wear personal protective equipment. Younger individuals attributed their accidents to human errors, whereas older individuals felt their injuries were unavoidable. CONCLUSIONS: Occasional woodcutting activities result in comparable, but more frequent injuries than professional logging activities. Further data are needed to assess impact on public safety.     

Public health surveillance and assessment of emerging infectious threats: method and criteria for risk analysis

One of the objectives of the surveillance systems implemented by the French National Institute for Public Health Surveillance is to detect communicable diseases and to reduce their impact. For emerging infections, the detection and risk analysis pose specific challenges due to lack of documented criteria for the event. The surveillance systems detect a variety of events, or “signals” which represent a potential risk, such as a novel germ, a pathogen which may disseminate in a non-endemic area, or an abnormal number of cases for a well-known disease. These signals are first verified and analyzed, then classified as: potential public health threat, event to follow-up, or absence of threat. Through various examples, we illustrate the method and criteria which are used to analyze and classify these events considered to be emerging. The examples highlight the importance of host characteristics and exposure in groups at particular risk, such as professionals in veterinarian services, health care workers, travelers, immunodepressed patients, etc. The described method should allow us to identify future needs in terms of surveillance and to improve timeliness, quality of expertise, and feedback information regarding the public health risk posed by events which are insufficiently documented.     

第26届世界大学生夏季运动会病媒生物防制策略的探讨

目的 分析2011年深圳市第26届大学生运动会（大运会）病媒生物控制所面临的风险与挑战,及时制定行之有效的控制措施和保障策略。方法 对深圳市病媒生物种群、密度消长情况以及危害程度进行分析研究;同时,依据2009-2011年大运会场馆及周边环境病媒生物密度消长情况、病原与抗药性监测结果,提出大运会召开期间虫媒传染病发生的危害性以及病媒生物可能造成的骚扰影响,制定大运会病媒生物控制保障策略。结果 大运会在深圳市召开期间存在病媒生物性传染病发生和病媒生物造成骚扰的危险;健全的管理体制与完善的突发病媒生物性传染病事件应急预案和技术实施方案、科学的密度监测与风险评估、合理用药、应急演练、全员培训、专家咨询委员会的组建等措施成为大运会病媒生物控制的主要策略;通过这些策略的实施,保障大运会举办期间不发生病媒生物危害的影响。结论 第26届大运会举办期间未发生病媒生物危害及骚扰的控制目标,为今后大型活动的公共卫生保障尤其是病媒生物控制打下了坚实基础。     

Estimating the spatial distribution of acute undifferentiated fever (AUF) and associated risk factors using emergency call data in India. A symptom-based approach for public health surveillance

The System for Early-warning based on Emergency Data (SEED) is a pilot project to evaluate the use of emergency call data with the main complaint acute undifferentiated fever (AUF) for syndromic surveillance in India. While spatio-temporal methods provide signals to detect potential disease outbreaks, additional information about socio-ecological exposure factors and the main population at risk is necessary for evidence-based public health interventions and future preparedness strategies. The goal of this study is to investigate whether a spatial epidemiological analysis at the ecological level provides information on urban–rural inequalities, socio-ecological exposure factors and the main population at risk for AUF. Our results displayed higher risks in rural areas with strong local variation. Household industries and proximity to forests were the main socio-ecological exposure factors and scheduled tribes were the main population at risk for AUF. These results provide additional information for syndromic surveillance and could be used for evidence-based public health interventions and future preparedness strategies.