How Physicians Should Respond to Climate Change

Urgent warnings about the existential threat of climate change are coming from leaders in nearly every sector of society, including virtually all climate scientists, notable heads of civil governments around the globe, the world's top religious leaders, prestigious medical journals, as well as principals of the largest financial firms. Surveys show that the majority of U.S. physicians in several specialties are caring for patients who are experiencing direct health harms due to climate change. In public platforms, physicians are expressing their awareness that this public health crisis places everyone at risk, but many people are at greater risk, including children, pregnant women, people with chronic health conditions, elders, and those who experience environmental injustice or live in harm's way. Physicians should respond to this crisis with meaningful activities performed within the context of their current roles. The role of medical care provider is the best known role. But, throughout their careers, physicians have ongoing responsibilities as educators of colleagues, trainees, and patients. They are influential employees of medical institutions, trusted experts who exercise civic responsibility, and sources of guidance for public policymakers. Physicians and other health professionals, individually and through their organizations, also work to influence our societal response to the challenge of climate change. The first annual Lancet Journal Countdown Report in 2016 tracking health indicators of climate change stated that climate change had the potential to wipe out all public health gains of the last half century, but it also presents a tremendous opportunity to save lives and improve health. All physicians should work toward the latter outcome.

Building towards an adolescent neural urbanome: Expanding environmental measures using linked external data (LED) in the ABCD study

Many recent studies have demonstrated that environmental contexts, both social and physical, have an important impact on child and adolescent neural and behavioral development. The adoption of geospatial methods, such as in the Adolescent Brain Cognitive Development (ABCD) Study, has facilitated the exploration of many environmental contexts surrounding participants' residential locations without creating additional burdens for research participants (i.e., youth and families) in neuroscience studies. However, as the number of linked databases increases, developing a framework that considers the various domains related to child and adolescent environments external to their home becomes crucial. Such a framework needs to identify structural contextual factors that may yield inequalities in children's built and natural environments; these differences may, in turn, result in downstream negative effects on children from historically minoritized groups. In this paper, we develop such a framework - which we describe as the "adolescent neural urbanome" - and use it to categorize newly geocoded information incorporated into the ABCD Study by the Linked External Data (LED) Environment & Policy Working Group. We also highlight important relationships between the linked measures and describe possible applications of the Adolescent Neural Urbanome. Finally, we provide a number of recommendations and considerations regarding the responsible use and communication of these data, highlighting the potential harm to historically minoritized groups through their misuse.

Residents' experiences during a hydrogen sulfide crisis in Carson, California

Background

In early October 2021, thousands of residents in Carson, California began complaining of malodors and headaches. The odor was identified as hydrogen sulfide (H2S), a noxious odorous gas. H2S was measured at concentrations up to 7000 parts per billion (ppb) and remained above California's acute air quality standard of 30 ppb for a month, with intermittent elevations continuing for 3 months. After 2 months of malodor in this environmental justice community, the H2S was attributed to a warehouse fire. Research has yielded conflicting results on the health effects of H2S exposure at levels that were experienced during this event. There remains a gap in understanding how people perceive and experience odor emergencies such as this H2S event.

Methods

Through a community-academic partnership, we conducted 6 focus groups in Carson with 33 participants who resided in the Carson area during the crisis. We sought to understand how this incident affected residents through facilitated discussion on topics including information acquisition, impressions of the emergency response, physical and mental health symptoms, and ongoing impacts.

Results

The majority of participants were women (n = 25), identified as Latina/o (n = 19), and rent their homes (n = 21). Participants described difficulty obtaining coherent information about the emergency, which resulted in feelings of abandonment. Most participants felt that local government and health care providers downplayed and/or disregarded their concerns despite ongoing odors and health symptoms. Participants described experiencing stress from the odors' unknown health effects and continued fear of future odor incidents. Residents sought to take control of the crisis through information sharing, community networking, and activism. Participants experienced longer term effects from this event, including increased awareness of pollution and reduced trust in local agencies.

Discussion

This study demonstrates the necessity of clear, comprehensive, and prompt responses by relevant decisionmakers to chemical emergencies to appropriately address residents' fears, curb the spread of misinformation, and minimize adverse health effects. Participant responses also point to the benefit of supporting horizontal community networks for improved information sharing. By engaging directly with community members, researchers and disaster responders can better understand the various and complex impacts of chemical disasters and can improve response.

Expanding the access of wearable silicone wristbands in community-engaged research through best practices in data analysis and integration

Wearable silicone wristbands are a rapidly growing exposure assessment technology that offer researchers the ability to study previously inaccessible cohorts and have the potential to provide a more comprehensive picture of chemical exposure within diverse communities. However, there are no established best practices for analyzing the data within a study or across multiple studies, thereby limiting impact and access of these data for larger meta-analyses. We utilize data from three studies, from over 600 wristbands worn by participants in New York City and Eugene, Oregon, to present a first-of-its-kind manuscript detailing wristband data properties. We further discuss and provide concrete examples of key areas and considerations in common statistical modeling methods where best practices must be established to enable meta-analyses and integration of data from multiple studies. Finally, we detail important and challenging aspects of machine learning, meta-analysis, and data integration that researchers will face in order to extend beyond the limited scope of individual studies focused on specific populations.

PM2.5 exposure, glycemic markers and incidence of type 2 diabetes in two large Indian cities

INTRODUCTION

Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high.

RESEARCH DESIGN AND METHODS

We studied the associations between ambient PM2.5 levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities.

RESULTS

We observed that 10 μg/m3 differences in monthly average exposure to PM2.5 was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m3 differences in annual average PM2.5 was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response.

CONCLUSIONS

We observed evidence of temporal association between PM2.5 exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.

A New Model of Learning: Environmental Health in a Global World

INTRODUCTION

Environmental Health in a Global World at New York University was re-designed as a class participatory effort, challenging undergraduate students to understand environmental hazards and the resultant adverse health outcomes by embracing the inherent complexity of environmental risks and proposing solutions.

METHODS

Following introductory lectures, students are placed into teams and assigned a specific perspective, or avatar, which includes learning to see the challenge from the perspective of a technical expert such as a biologist, an engineer, or an anthropologist. The teams then design specific systems maps to visualize the complex interactions that lead to adverse health outcomes after a given environmental exposure. The maps highlight potential leverage points where relatively minor interventions can provide a disproportionate benefit in health outcomes. The teams then explore potential interventions and identify the potential unintended consequences of those actions, develop and advocate for innovative new strategies to mitigate risk and improve outcomes.

RESULTS AND DISCUSSION

Over the past 5 years, we have taught this methodology to over 680 students with strong, student-oriented results. The teams created and presented more than 100 strategies, addressing a diverse set of environmental challenges that include water contamination, gun violence, air pollution, environmental justice, health security, and climate change. Developing the strategies helped the students understand environmental threats in a more holistic way, provided them with some agency in finding solutions, and offered an opportunity for them to improve their presentation skills. The responses in course evaluations have been enthusiastic, with many students reporting a deep impact on their college experience.

Evaluation of the Effect of Educational Interventions on Knowledge, Attitude, and Practice Against COVID-19 in a Residential Complex in Tehran: A Prospective Cross-sectional Study

Background

The coronavirus disease 2019 (COVID-19) pandemic at the end of 2019 posed a global health concern. It has been found that health education is one of the best methods for health promotion, changing inappropriate personal behaviors, and increasing people's awareness and attitude through major health concerns, including the COVID-19 pandemic. This study aimed to investigate the effect of educational interventions with environmental health approach on the knowledge, attitude, and practice of people in the COVID-19 epidemic era in one residential complex in Tehran.

Methods

This cross-sectional study was conducted in Tehran in 2021. The study population was households of a residential complex in Tehran, which was selected by a random sampling method. A researcher-made checklist was used to gather data for this study, and its validity and reliability in the domains of environmental health and knowledge, attitude, and practice in the COVID-19 setting were evaluated before it was used. An intervention was made through social media and the checklist was reevaluated after the intervention.

Results

A total number of 306 participants were enrolled in this study. In the assessment of the knowledge, attitude, and practice after the intervention, the mean score of the mentioned values increased significantly (P < 0.001). However, the influence of intervention was more prominent in the improvement of knowledge and attitude than practice.

Conclusion

Public health intervention with an environmental health approach can increase people's knowledge, attitude, and practice against chronic diseases and epidemics such as COVID-19.

Evaluation of Model-Based PM2.5 Estimates for Exposure Assessment during Wildfire Smoke Episodes in the Western U.S

Investigating the health impacts of wildfire smoke requires data on people's exposure to fine particulate matter (PM2.5) across space and time. In recent years, it has become common to use machine learning models to fill gaps in monitoring data. However, it remains unclear how well these models are able to capture spikes in PM2.5 during and across wildfire events. Here, we evaluate the accuracy of two sets of high-coverage and high-resolution machine learning-derived PM2.5 data sets created by Di et al. and Reid et al. In general, the Reid estimates are more accurate than the Di estimates when compared to independent validation data from mobile smoke monitors deployed by the US Forest Service. However, both models tend to severely under-predict PM2.5 on high-pollution days. Our findings complement other recent studies calling for increased air pollution monitoring in the western US and support the inclusion of wildfire-specific monitoring observations and predictor variables in model-based estimates of PM2.5. Lastly, we call for more rigorous error quantification of machine-learning derived exposure data sets, with special attention to extreme events.

A science-based agenda for health-protective chemical assessments and decisions: overview and consensus statement

The manufacture and production of industrial chemicals continues to increase, with hundreds of thousands of chemicals and chemical mixtures used worldwide, leading to widespread population exposures and resultant health impacts. Low-wealth communities and communities of color often bear disproportionate burdens of exposure and impact; all compounded by regulatory delays to the detriment of public health. Multiple authoritative bodies and scientific consensus groups have called for actions to prevent harmful exposures via improved policy approaches. We worked across multiple disciplines to develop consensus recommendations for health-protective, scientific approaches to reduce harmful chemical exposures, which can be applied to current US policies governing industrial chemicals and environmental pollutants. This consensus identifies five principles and scientific recommendations for improving how agencies like the US Environmental Protection Agency (EPA) approach and conduct hazard and risk assessment and risk management analyses: (1) the financial burden of data generation for any given chemical on (or to be introduced to) the market should be on the chemical producers that benefit from their production and use; (2) lack of data does not equate to lack of hazard, exposure, or risk; (3) populations at greater risk, including those that are more susceptible or more highly exposed, must be better identified and protected to account for their real-world risks; (4) hazard and risk assessments should not assume existence of a "safe" or "no-risk" level of chemical exposure in the diverse general population; and (5) hazard and risk assessments must evaluate and account for financial conflicts of interest in the body of evidence. While many of these recommendations focus specifically on the EPA, they are general principles for environmental health that could be adopted by any agency or entity engaged in exposure, hazard, and risk assessment. We also detail recommendations for four priority areas in companion papers (exposure assessment methods, human variability assessment, methods for quantifying non-cancer health outcomes, and a framework for defining chemical classes). These recommendations constitute key steps for improved evidence-based environmental health decision-making and public health protection.

[Promoting Better Indoor Air Quality in Portugal for Disease Prevention and Control]

N/a.

Defining a new perspective in Environmental Health: the healing environment

With pollution-related health problems on the rise, the focus of modern Environmental Health (EH) has mostly been placed on toxicology and exposure science. Despite the importance of toxicological aspects, the environment should be studied not only to identify pollution-related hazards, but also to investigate potentially therapeutic and health-enhancing effects of its elements. Generally speaking, it is possible to benefit from a natural environment with a full-immersion experience or with a single-element interaction. Recently, scientific evidence is accumulating on the beneficial effects of natural settings for well-being promotion and psycho-physical health, especially for stress reduction and prevention of stress-related conditions. In light of these considerations, the paradigm of EH can change: the environment we live in should be considered not only as a precious resource to be protected against pollution (thus preventing the consequent health hazards), but, in a proactive vision, also as a potential source of elements capable of actively maintaining and promoting health and well-being.

Distributive justice in environmental health hazards from industrial contamination: A systematic review of national and near-national assessments of social inequalities

Communities where polluting human activities are sited often show disadvantage in terms of social and economic variables. Environmental distributive justice studies seek to identify common characteristics in exposed populations and highlight the presence of environmental inequalities. We have conducted a review of the existing literature about justice in the distribution of health hazards from industrial pollution. We included papers investigating associations between social disadvantage and contamination through assessments at national or macro-area level. From each study we extracted: indicators for the social determinants of exposed communities (classified according to PROGRESS-plus categories); definition and measurement of environmental hazard (as either proximity to contamination sources, exposure to emissions or health impacts from pollutants); study design and methods; significant results. We retrieved 45 eligible articles. Most publications were from USA and had a nationwide scope with data at municipal/sub-municipal scale. Socioeconomic position and race/ethnicity were the social determinants most often explored, followed by occupation and education; air pollution was the commonest sort of contamination, while proximity prevailed as measurement of hazard. All papers found significant associations between social dimensions and health hazard from industrial contamination: the majority of associations supported an increased burden on vulnerable categories, especially ethnic minorities and unemployed - however, several relationships were found in the opposite direction or in both ways, particularly with wealth and education, reflecting a mixed reality where potential discrimination in siting decisions coexists with socioeconomic benefits for nearby communities due to industrial development. Assessments of environmental distributive justice are lacking in most countries and those that are conducted show vast methodological heterogeneity. We recommend consistency in models and indicators, the inclusion of female-led households among indicators of social disadvantage, and the adoption of a small scale to elicit significant findings and provide meaningful policy action.

The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.

[Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics]

PURPOSE

This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women.

METHODS

This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA.

RESULTS

Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007).

CONCLUSION

This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

Lead (Pb) concentrations and speciation in residential soils from an urban community impacted by multiple legacy sources

In many urban areas, elevated soil lead (Pb) concentrations are indicators of community-level Pb exposure. Here, we examine the spatial distribution and speciation of legacy soil Pb contamination in East Chicago, Ind., an industrial center with a wide range of Pb sources including a former lead smelter. In situ X-ray fluorescence spectroscopy (n = 358) revealed widespread soil Pb contamination above the Environmental Protection Agency regulatory limit for soils. This soil contamination was heterogenous across all neighborhoods, and mostly uncorrelated with distance from the former smelting site. Soil Pb levels increased with decreasing median household income in East Chicago's nine neighborhoods (r = -0.73, p = 0.03). Extended X-ray absorption fine structure spectroscopy (n = 44) indicated that the soil Pb was primarily adsorbed to iron and manganese oxides or humic acids, and as Pb hydroxycarbonate regardless of contamination levels. Crystalline insoluble forms of Pb, like pyromorphite, were not detected in significant concentrations. Thus, the unique chemical forms of potential Pb sources to soil, such as paint, ore and slag are not persistent and instead are extensively repartitioned into acid-soluble forms of Pb with greater bioavailability. These findings have implications for remediation efforts and human health as blood Pb levels in this community are significantly elevated.

Legacies of Environmental Injustice on Neighborhood Violence, Poverty and Active Living in an African American Community

Features of the built environment such as parks and open spaces contribute to increased physical activity in populations, while living in neighborhoods with high poverty, racial/ethnic segregation, presence of neighborhood problems, and violence has been associated with less active living. Our present study examined the factors that may facilitate or hinder the long-term success of built environment interventions aimed at promoting physical activity in communities with a legacy of environmental injustice. The data for this study came from a larger assessment of the impact of a new local park in Newark, NJ. Analysis included all adults from the original study population who self-identified as African American/Black (N=95). To provide an in-depth understanding of how neighborhood social and physical features influence physical activity among African Americans living in high poverty neighborhoods, we analyzed data from two focus groups with a total of 14 participants, and six in-depth interviews held in 2009-2010. Survey results indicated high exposure to violence, and associations between neighborhood features and walking. Self-reported neighborhood walkability was associated with increased walking (P=.01), while increased perception of neighborhood safety was associated with less walking (P=.01). Qualitative results indicated that residents perceived the new park as a positive change, but also expressed concern about the presence of violence and lack of social cohesion among neighbors, with younger generations expressing less optimism than the elderly. Positive changes associated with improvements to the built environment may be limited by social conditions such as neighborhood violence. These mixed findings suggest that policies and initiatives aimed at improving the built environment should address poverty, safety, and social cohesion to ensure more active living communities.

How can Environmental Health Practitioners contribute to ensure population safety and health during the COVID-19 pandemic?

The COVID-19 pandemic highlighted the relevance of public health professionals all over the world, in particular Environmental Health Practitioners (EHPs), who played a major role in the containment of the novel coronavirus, SARS-CoV-2. However, as in past disasters, their involvement was oriented towards urgent tasks, and did not fully utilize EHPs' competences and skills. Additionally, due to limited resources, during emergencies EHPs may temporarily transition away from their day-to-day role, potentially increasing other public health and safety risk factors without appropriate surveillance or intervention. To overcome this and prepare for possible future pandemics, it is important to identify and discuss the key roles of EHPs in different countries, providing a common framework for practices that can contribute to population safety and health. To this end, an international workgroup was established to discuss current environmental health practices and challenges across different countries during the pandemic. Findings from discussions concluded that, despite the observed differences across the countries, EHPs are one of the main public health emergency preparedness and response actors. However, since resources are still lagging significantly behind need, we argue that the role of these professionals during pandemics should be focused on practices that have higher impact to support population health and safety.

Sensitivity of the mangrove-estuarine microbial community to aquaculture effluent

Mangrove-dominated estuaries host a diverse microbial assemblage that facilitates nutrient and carbon conversions and could play a vital role in maintaining ecosystem health. In this study, we used 16S rRNA gene analysis, metabolic inference, nutrient concentrations, and δ¹³C and δ¹⁵N isotopes to evaluate the impact of land use change on near-shore biogeochemical cycles and microbial community structures within mangrove-dominated estuaries. Samples in close proximity to active shrimp aquaculture were high in NH₄⁺, NO₃⁻ NO₂⁻, and PO₄³⁻; lower in microbial community and metabolic diversity; and dominated by putative nitrifiers, denitrifies, and sulfur-oxidizing bacteria. Near intact mangrove forests we observed the presence of potential nitrogen fixers of the genus Calothrix and order Rhizobiales. We identified possible indicators of aquaculture effluents such as Pseudomonas balearica, Ponitmonas salivibrio, family Chromatiaceae, and genus Arcobacter. These results highlight the sensitivity of the estuarine-mangrove microbial community, and their ecosystem functions, to land use changes.

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In near-intact mangrove forests, we observed the presence of nitrogen fixers

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Calothrix could play a role in increasing nitrogen inventories via nitrogen fixation

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Disturbed sites were correlated with increased nitrogen and reduction in diversity

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Disturbed sites were dominated by nitrifiers, denitrifies, and sulfur-oxidizing bacteria

COVID-19 Pandemic and Environmental Health: Effects and the Immediate Need for a Concise Risk Analysis

COVID-19 pandemic, as another disease emerging in the interface between animals and humans, has revealed the importance of interdisciplinary collaborations such as the One Health initiative. Environmental Health, whose role in the One Health concept is well established, has been associated with COVID-19 pandemic via various direct and indirect pathways. Modern lifestyle, climate change, environmental degradation, exposure to chemicals such as endocrine disruptors, and exposure to psychological stress factors impact human health negatively. As a result, many people are in the disadvantageous position to face the pandemic with an already impaired immune system due to their exposure to environmental health hazards. Moreover, the ongoing pandemic has been associated with outdoor and indoor air pollution, water and noise pollution, food security, and plastic pollution issues. Also, the inadequate infrastructure, the lack of proper waste and wastewater management, and the unequal social vulnerability reveal more linkages between Environmental Health and COVID-19 pandemic. The significant emerging ecological risk and its subsequent health implications require immediate risk analysis and risk communication strategies.

Transforming cities for sustainability: A health perspective

Transformational change is urgently needed to address planetary health challenges in cities. Through an interdisciplinary overview of the literature, we consider how to frame and unpack city-level transformation towards synergistic benefits for urban health and environmental sustainability. By describing the characteristics of a 'healthy sustainable city' and by bringing together the ideas underlying frameworks for health and sustainability, we develop a conceptual understanding of how cities may progress towards achieving significant improvements in health and the environment. We investigate how urban change works, and build a theoretical understanding of how urban change may be directed to integrate health and sustainability. We conclude that urban transformation needs to be a multi-scalar process across city sectors to meet the scale, speed and form of change required. We propose that this can best be achieved in practice through a composition of mechanisms, including strengthening city governance, enabling technological and social innovations, applying sustainable urban planning and infrastructure development, and impelling social behaviour change; supported by systems-driven policy and practice-focused scientific evidence.

Arsenic Concentrations in Household Drinking Water: A Cross-Sectional Survey of Pregnant Women in Tacna, Peru, 2019

The World Health Organization (WHO) estimates that around ~150 million people in 70 different countries have been consuming water with arsenic levels higher than the recommended limit of 10 μg/L. Here we describe the concentrations of inorganic arsenic in drinking water in homes of pregnant women living in the province of Tacna, near the southern border of Peru. 161 pregnant women were enrolled in their second trimester of pregnancy. A total of 100mL drinking water was collected in each household from the source of most common use. Inorganic arsenic was categorized into 3 levels with a commercial kit. Thirty percent of women had drinking water ≤10 μg/L (the WHO recommended level), 35% had 25 μg/L, and 35% had greater than 50 μg/L. Low arsenic levels were found in the southernmost homes, supplied by groundwater, while high levels were found in the northern and metropolitan homes supplied by river water.

Exposure to Air Pollution Disrupts Circadian Rhythm through Alterations in Chromatin Dynamics

Particulate matter ≤2.5μm (PM_2.5) air pollution is a leading environmental risk factor contributing disproportionately to the global burden of non-communicable disease. We compared impact of chronic exposure to PM_2.5 alone, or with light at night exposure (LL) on metabolism. PM_2.5 induced peripheral insulin resistance, circadian rhythm (CR) dysfunction, and metabolic and brown adipose tissue (BAT) dysfunction, akin to LL (with no additive interaction between PM_2.5 and LL). Transcriptomic analysis of liver and BAT revealed widespread but unique alterations in CR genes, with evidence for differentially accessible promoters and enhancers of CR genes in response to PM_2.5 by ATAC-seq. The histone deacetylases 2, 3, and 4 were downregulated with PM_2.5 exposure, with increased promoter occupancy by the histone acetyltransferase p300 as evidenced by ChIP-seq. These findings suggest a previously unrecognized role of PM_2.5 in promoting CR disruption and metabolic dysfunction through epigenetic regulation of circadian targets.

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Air pollution disrupts the circadian rhythm (CR) similar to light at night

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Dysregulated circadian genes result in insulin resistance and metabolic diseases

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PM_2.5 alters chromatin structure of circadian genes at regulatory regions

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PM_2.5 alters chromatin structure by recruiting histone acetyl transferase (HAT), p300

[Mental health and environmental health. A prospective view. SESPAS Report 2020]

Since the dawn of psychiatry, the environment has been an essential factor in the study and understanding of mental illness. Traditionally, the interrelationship between genome and environment has been a central theme in research on the etiopathogenesis of mental health problems and in the very conception of mental health. In its application to psychopathology and mental health, psychiatric enviromics was defined as «the study of environmental conditions and processes that promote mental health or increase the risk of developing mental disorders». However, environmental health -at least in Spain and in connection with its powers within the Spanish General Health System- has paid attention to aspects pertaining to risks associated with the physical, chemical and biological pollution of the air, the water and the ground, as well as to its correlation with food pollution. Although environmental risks such as air quality, extreme temperatures, noise, climate change and various environmental toxicants can play a particularly important role, they can hardly be identified as single etiopathogenic elements. This work reviews the recent literature on environmental research and problems of psychiatric morbidity and mortality. Although the results are inconclusive, future lines of research should consider a more agile interdisciplinary collaboration, allowing, on the one hand, a better understanding of mental illness and, on the other hand, to be able to shift from "traditional" environmental health to an environmental health that takes social environmental factors into account and seriously addresses the still little studied concept of "social pollution".

Cutaneous leishmaniasis: Spatial distribution and environmental risk factors in the state of Pará, Brazilian Eastern Amazon

INTRODUCTION

Cutaneous leishmaniasis is an infectious disease transmitted by phlebotomine sandflies and is considered a great environmental and public health problem. Thus, this work presents initial results of the analyses about the relationship between the spatial distribution of this disease and its environmental risk factors in three municipalities, in the state of Pará, Brazil, from 2012 to 2016.

METHODOLOGY

It was used data from the Ministry of Health, the National Institute for Space Research and the Brazilian Institute of Geography and Statistics. The statistical and spacial analysis of the variables were done using G-test goodness-of-fit, kernel interpolation technique and the Bivariate Global Moran Index (I).

RESULTS

The analyses showed that the most affected individuals were males, adults, low schooling, residents in rural areas and small farmers. The disease spatial distribution was not homogeneous in the municipalities and it was associated to different relationships between the land use and occupation and the notificated cases density, with direct spatial autocorrelation.

CONCLUSIONS

The deforestation was the most significant risk factor linked to the cases occurrence in all the studied area. We emphasize the need of intensification of epidemiological and environmental surveillance actions in the studied areas.

The Ancestral Environment Shapes Antiviral CD8+ T cell Responses across Generations

Recent studies have linked health fates of children to environmental exposures of their great grandparents. However, few studies have considered whether ancestral exposures influence immune function across generations. Here, we report transgenerational inheritance of altered T cell responses resulting from maternal (F0) exposure to the aryl hydrocarbon receptor ligand 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Since F0 exposure to TCDD has been linked to transgenerational transmission of reproductive problems, we asked whether maternal TCDD exposure also caused transgenerational changes in immune function. F0 exposure caused transgenerational effects on the CD8+ T cell response to influenza virus infection in females but not in males. Outcrosses showed changes were passed through both parental lineages. These data demonstrate that F0 exposure to an aryl hydrocarbon receptor (AHR) agonist causes durable changes to immune responses that can affect subsequent generations. This has broad implications for understanding how the environment of prior generations shapes susceptibility to pathogens and antiviral immunity in later generations.

Metabolism of 3-[5'-deoxy-5'-(dimethylarsinoyl)-β-ribofuranosyloxy]-2-hydroxypropylene glycol in an artificial digestive system

Seaweeds contain large amounts of organoarsenic compounds, mostly arsenosugars (AsSug) and arsenolipids (AsLipid). AsSug is mainly metabolized into dimethylarsinic acid (DMA^V) in humans. However, this metabolic process is not well understood. We investigated the metabolism of an AsSug, 3-[5'-deoxy-5'-(dimethylarsinoyl)-β-ribofuranosyloxy]-2-hydroxypropylene glycol (AsSug328), in the gastrointestinal tract using an in vitro artificial gastrointestinal digestion system. AsSug328 was incubated with gastric juice for 4 h, with bile-pancreatic juice for 0.5 h, and finally with enteric bacteria solution for 24 h. The conversion of arsenic compounds after artificial digestion was analyzed by HPLC-ICP-MS and HPLC-ESI-Q-TOF-MS. Our results show that artificial gastrointestinal digestion converted AsSug328 into thio-AsSug328. However, no formation of DMA^V was detected. Under the artificial digestion system, the 5-deoxyribofuranose structure of AsSug was maintained. Therefore, AsSug should be absorbed in the intestinal tract after its sugar moiety is partially decomposed. They are then possibly metabolized to DMA^V in the liver and subsequently excreted through urine.

Reuse of materials from a Sustainable Drainage System device: Health, Safety and Environment assessment for an end-of-life Pervious Pavement Structure

Pervious pavement systems can have a life span of about 20years but, at end-of-life, it becomes necessary to evaluate the state of the infrastructure to determine whether they pose a health and safety risk to workers during dismantling, and also determine potential reuse of the waste material generated. In this paper, we report of an investigation conducted to evaluate whether Pervious pavement systems are hazardous to human health at end-of-life and also to assess the mobility of the stormwater pollutants trapped in the system as a measure of their potential release to receiving systems such as water-bodies and groundwater systems. After decommissioning, the pervious pavement structure was sampled for analysis including Gas Chromatography, inductively coupled plasma spectroscopy and, leachate analysis. Results show that carcinogenic risks were significantly below the regulatory limit of 1×10^-6 while, the hazard quotients and cumulative hazard indices were also below regulatory value of 1, based on United States Environmental Protection Agency standards. Furthermore, mean concentrations of benzene, toluene, ethylbenzene and xylene were significantly less than the UK soil guideline values. The results of the leachate analysis show that the metals of concern, Pb, Zn, Cr, Ni, Cd and Cu were all below the threshold for reuse applications such as irrigation purposes as they were all below the regulatory limits such as Food and Agriculture Organization and, United States Environmental Protection Agency standards. Finally, the evaluation of potential reuse and recycling purposes indicate that wastes generated from the dismantling of the PPS are within limits for recycling as aggregates for other civil engineering projects as per European Union standards. This has potential to enhance UK's drive to achieve the target of 70% level of construction & demolition waste recovery for reuse and recycling by the year 2020 as per European Union Water Framework Directive.

AIR Louisville: Addressing Asthma With Technology, Crowdsourcing, Cross-Sector Collaboration, And Policy

Cross-sector partnerships benefit public health by leveraging ideas, resources, and expertise from a wide range of partners. In this study we documented the process and impact of AIR Louisville (a collaboration forged among the Louisville Metro Government, a nonprofit institute, and a technology company) in successfully tackling a complex public health challenge: asthma. We enrolled residents of Louisville, Kentucky, with asthma and used electronic inhaler sensors to monitor where and when they used medication. We found that the use of the digital health platform achieved positive clinical outcomes, including a 78 percent reduction in rescue inhaler use and a 48 percent improvement in symptom-free days. Moreover, the crowdsourced real-world data on inhaler use, combined with environmental data, led to policy recommendations including enhancing tree canopy, tree removal mitigation, zoning for air pollution emission buffers, recommended truck routes, and developing a community asthma notification system. AIR Louisville represents a model that can be replicated to address many public health challenges by simultaneously guiding individual, clinical, and policy decisions.

What 'Merle' Taught Me About Energy Insecurity And Health

Being unable to meet basic household energy needs can have dire health consequences and merits more attention and resources.

Acute ecotoxicity bioassay using Dendrocephalus brasiliensis: alternative test species for monitoring of contaminants in tropical and subtropical freshwaters

In International guidelines for standard ecotoxicological bioassays, Daphnia magna is the most applied microcrustacea for assessing toxicity of different pollutants. However, in research realized in tropical and subtropical areas, autochthonous species must be prioritized because they are adapted to the specificities of ecosystems. In this sense, the present study aimed to assess and compare (with D. magna) the sensitivity of the tropical species Dendrocephalus brasiliensis as alternative test species for monitoring of contaminants in tropical and subtropical freshwaters, by carrying out acute toxicity tests with different pollutants. According results, D. brasiliensis presented EC50-48 h values lower than D. magna for all substances tested, indicating higher sensitivity of the tropical organism in relation to the temperate organism. Furthermore, comparing the results obtained with data from other studies, D. brasiliensis is more sensitive to the chemicals tested than D. magna and has similar sensitivity to Pseudosida ramosa and Ceriodaphnia dubia, common species in tropical areas. In view of this, we suggest that D. brasiliensis can be used as alternative test species for monitoring of contaminants in tropical and subtropical freshwaters.

Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009-14

In recent years, various levels of government in the United States have adopted or discussed subsidies, tax breaks, zoning laws, and other public policies that promote geographic access to healthy food. However, there is little evidence from large-scale longitudinal or quasi-experimental research to suggest that the local mix of food outlets actually affects body mass index (BMI). We used a longitudinal design to examine whether the proximity of food outlets, by type, was associated with BMI changes between 2009 and 2014 among 1.7 million veterans in 382 metropolitan areas. We found no evidence that either absolute or relative geographic accessibility of supermarkets, fast-food restaurants, or mass merchandisers was associated with changes in an individual's BMI over time. While policies that alter only geographic access to food outlets may promote equitable access to healthy food and improve nutrition, our findings suggest they will do little to combat obesity in adults.

In Puerto Rico, Counting Deaths And Making Deaths Count

Island officials have struggled to capture Hurricane Maria's full impact in mortality statistics.

Asthma And Injustice On Chicago's Southeast Side

A physician discovers a potential environmental link to asthma attacks in a poor Chicago community.

Using Green Building As A Model For Making Health Promotion Standard In The Built Environment

The built environment-the constructed physical parts of the places where people live and work-is a powerful determinant of both individual and population health. Awareness of the link between place and health is growing within the public health sector and among built environment decision makers working in design, construction, policy, and both public and private finance. However, these decision makers lack the knowledge, tools, and capacity to ensure that health and well-being are routinely considered across all sectors of the built environment. The green building industry has successfully established environmental sustainability as a normative part of built environment practice, policy making, and investment. We explore the value of this industry's experience as a template for promoting health and well-being in the built environment.

Predictors of Saudi nursing students' attitudes towards environment and sustainability in health care

AIM

This study aimed to investigate the predictors of Saudi nursing students' attitudes towards the environment and sustainability in health care.

BACKGROUND

With rising temperature and decreasing annual rainfall, Saudi Arabia is threatened by the harmful effects of climate change on its population. In response to these threats, the Ministry of Health adapted sustainable development and environmental preservation in their National E-Health strategy.

INTRODUCTION

To implement these policies successfully, healthcare practitioners should be educated on how climate change could impact human health negatively.

METHODS

A secondary analysis of 280 questionnaires from baccalaureate nursing students of a university in Hail City, Saudi Arabia, was completed. The New Ecological Paradigm (NEP) Scale and Sustainability Attitudes in Nursing Survey 2 (SANS-2) were used to investigate the predictors of student attitudes towards the environment and sustainable development in health care.

RESULTS

The NEP score indicated moderate pro-environment attitudes, whereas the SANS-2 mean score showed very positive attitudes towards sustainability in health care. Learning about the environment and related issues in the nursing programme, raising climate change awareness and attending environment-related seminars and training positively influenced the environmental and sustainability attitudes of nursing students.

DISCUSSION

Saudi nursing students moderately manifested pro-environment attitudes but exhibited extremely positive attitudes towards sustainability in health care. The results support the need to strengthen the education of nursing students about environmental and sustainability concepts and the inclusion of these topics in the nursing curricula.

CONCLUSION

The study underscores the critical role of enriching the awareness of nursing students on environmental issues and concerns and sustainability in health care.

IMPLICATIONS FOR NURSING AND NURSING POLICY

The findings of this study can support the inclusion of course contents, which deal specifically with environmental health and sustainability practices, in the creation of new policies directed towards curricular revision.

The effectiveness of an intervention to reduce alcohol-related violence in premises licensed for the sale and on-site consumption of alcohol: a randomized controlled trial

BACKGROUND AND AIMS

Premises licensed for the sale and consumption of alcohol can contribute to levels of assault-related injury through poor operational practices that, if addressed, could reduce violence. We tested the real-world effectiveness of an intervention designed to change premises operation, whether any intervention effect changed over time, and the effect of intervention dose.

DESIGN

A parallel randomized controlled trial with the unit of allocation and outcomes measured at the level of individual premises.

SETTING

All premises (public houses, nightclubs or hotels with a public bar) in Wales, UK.

PARTICIPANTS

A randomly selected subsample (n = 600) of eligible premises (that had one or more violent incidents recorded in police-recorded crime data; n = 837) were randomized into control and intervention groups.

INTERVENTION AND COMPARATOR

Intervention premises were audited by Environmental Health Practitioners who identified risks for violence and provided feedback by varying dose (informal, through written advice, follow-up visits) on how risks could be addressed. Control premises received usual practice.

MEASUREMENTS

Police data were used to derive a binary variable describing whether, on each day premises were open, one or more violent incidents were evident over a 455-day period following randomization.

FINDINGS

Due to premises being unavailable at the time of intervention delivery 208 received the intervention and 245 were subject to usual practice in an intention-to-treat analysis. The intervention was associated with an increase in police recorded violence compared to normal practice (hazard ratio = 1.34, 95% confidence interval = 1.20-1.51). Exploratory analyses suggested that reduced violence was associated with greater intervention dose (follow-up visits).

CONCLUSION

An Environmental Health Practitioner-led intervention in premises licensed for the sale and on-site consumption of alcohol resulted in an increase in police recorded violence.

Noise level in a neonatal intensive care unit in Santa Marta - Colombia

Introduction:

The environment of neonatal intensive care units is influenced by numerous sources of noise emission, which contribute to raise the noise levels, and may cause hearing impairment and other physiological and psychological changes on the newborn, as well as problems with care staff.

Objective:

To evaluate the level and sources of noise in the neonatal intensive care unit.

Methods:

Sampled for 20 consecutive days every 60 seconds in A-weighting curves and fast mode with a Type I sound level meter. Recorded the average, maximum and minimum, and the 10th, 50th and 90th percentiles. The values are integrated into hours and work shift, and studied by analysis of variance. The sources were characterized in thirds of octaves.

Results:

The average level was 64.00 ±3.62 dB(A), with maximum of 76.04 ±5.73 dB(A), minimum of 54.84 ±2.61dB(A), and background noise of 57.95 ±2.83 dB(A). We found four sources with levels between 16.8-63.3 dB(A). Statistical analysis showed significant differences between the hours and work shift, with higher values in the early hours of the day.

Conclusion:

The values presented exceed the standards suggested by several organizations. The sources identified and measured recorded high values in low frequencies.

A Food Systems Approach To Healthy Food And Agriculture Policy

Food has become a prominent focus of US public health policy. The emphasis has been almost exclusively on what Americans eat, not what is grown or how it is grown. A field of research, policy, and practice activities addresses the food-health-agriculture nexus, yet the work is still often considered "alternative" to the mainstream. This article outlines the diverse ways in which agriculture affects public health. It then describes three policy issues: farm-to-school programming, sustainability recommendations in the Dietary Guidelines for Americans, and antibiotic use in animal agriculture. These issues illustrate the progress, challenges, and public health benefits of taking a food systems approach that brings together the food, agriculture, and public health fields.

Access to human, animal, and environmental journals is still limited for the One Health community

OBJECTIVE

"One Health" is an interdisciplinary approach to evaluating and managing the health and well-being of humans, animals, and the environments they share that relies on knowledge from the domains of human health, animal health, and the environmental sciences. The authors' objective was to evaluate the extent of open access (OA) to journal articles in a sample of literature from these domains. We hypothesized that OA to articles in human health or environmental journals was greater than access to animal health literature.

METHODS

A One Health seminar series provided fifteen topics. One librarian translated each topic into a search strategy and searched four databases for articles from 2011 to 2012. Two independent investigators assigned each article to human health, the environment, animal health, all, other, or combined categories. Article and journal-level OA were determined. Each journal was also assigned a subject category and its indexing evaluated.

RESULTS

Searches retrieved 2,651 unique articles from 1,138 journals; 1,919 (72%) articles came from 406 journals that contributed more than 1 article. Seventy-seven (7%) journals dealt with all 3 One Health domains; the remaining journals represented human health 487 (43%), environment 172 (15%), animal health 141 (12%), and other/combined categories 261 (23%). The proportion of OA journals in animal health (40%) differed significantly from journals categorized as human (28%), environment (28%), and more than 1 category (29%). The proportion of OA for articles by subject categories ranged from 25%-34%; only the difference between human (34%) and environment (25%) was significant.

CONCLUSIONS

OA to human health literature is more comparable to animal health than hypothesized. Environmental journals had less OA than anticipated.

Foundations Invest In Environmental Health

Nearly one in four deaths globally are due to environmental hazards such as air and water pollution, according to the World Health Organization. However, knowledge about how the environment affects health and health equity outcomes has not been well integrated into decisions that shape the conditions in which people live, work, and play. To address this challenge, US foundations have invested millions of dollars to make it easier to incorporate environmental health information into decisions ranging from family purchases and governmental policy making to business, medical, and other professional practices. This article summarizes grant making aimed at improving environmental conditions to improve health and health equity outcomes. We provide examples of environmental health grants that focus on tools that the public, policy makers, and professionals can use in making decisions. We found that the investment in and attention to environmental factors, including in work addressing social determinants of health, have been insufficient to realize the potential for reducing negative environmental impacts on health and health disparities. We argue that the grant making highlighted here has increased knowledge that could enable more widespread consideration of environmental health in many decisions, with positive effects on health and health equity.

Health promotion and empowerment in Henganofi District, Papua New Guinea

Evidence shows that the government of Papua New Guinea is failing to provide basic services in health to the majority of its people. Local non-government organisations (NGOs), partnered with international NGOs, are attempting to fill this gap. With limited resources, these small Indigenous organisations must focus much of their effort on training that supports self-reliance as the main strategy for communities to improve their quality of life. This project explored the training content and methodology of Touching The Untouchables (TTU), a small Indigenous NGO based in Goroka, Eastern Highlands Province, that has trained a network of village volunteers in health promotion and safe motherhood.<br />Village life imposes multiple demands, from self-sufficiency in food to maintaining law and order. There are established attitudes about power and dependence, referred to as 'cargo thinking'. Cargo thinking stands as a barrier to the necessity of self-reliance, and requires training strategies that seek to empower participants to create change from their own initiative. Empowerment is understood as oriented towards individual people taking collective action to improve their circumstances by rectifying disparities in social power and control. To achieve self-reliance, empowerment is necessarily operational on the levels of person, community and society.<br />In addition to being operational on all three levels of empowerment, the training content and methodology adopted and developed by TTU demonstrate that empowering practice in training employs approaches to knowledge that are evidence-based, reflexive, contextual and skill-based. Creating knowledge that is reflexive and exploring knowledge about the broader context uses special kinds of communicative tools that facilitate discussion on history, society and political economy. Furthermore, training methodologies that are oriented to empowerment create settings that require the use of all three types of communication required for cooperative action: dramaturgical, normative and teleological communication.<br />The success of TTU's training content and methodology demonstrates that creating the conditions for achieving collective self-reliance through empowerment is a necessary part of primary health promotion in Papua New Guinea, and that underlying the success of empowerment oriented training are definable types of knowledge and communication.

Health concerns associated with unconventional gas mining in rural Australia

CONTEXT

Many governments globally are investigating the benefits and risks associated with unconventional gas mining for shale, tight and coal seam gas (coalbed methane) to determine whether the industry should proceed in their jurisdiction. Most locations likely to be developed are in rural areas, with potential impact on farmers and small communities. Despite significant health concerns, public health knowledge and growing evidence are often overlooked in decision-making. It is difficult to gain a broad but accurate understanding of the health concerns for rural communities because the evidence has grown very recently and rapidly, is complex and largely based in the USA, where the industry is advanced. In 2016, a concerned South Australian beef and lamb farmer in an area targeted for potential unconventional gas development organised visits to homes in developed unconventional gas areas of Pennsylvania and forums with leading researchers and lawyers in Pennsylvania and New York. Guided by priorities identified during this trip, this communication concisely distils the research evidence on these key concerns, highlighting the Australian situation where evidence exists. It summarises key information of particular concern to rural regions, using Australia as an example, to assist rural health professionals to be better prepared to engage in decision-making and address the challenges associated with this new industry.

ISSUES

Discussions with communities and experts, supported by the expanding research from the USA and Australia, revealed increasing health concerns in six key areas. These are absence of a safe solution to the toxic wastewater management problems, air pollution, land and water competition, mental health and psychosocial wellbeing risks, fugitive methane emissions and lack of proven regulatory regimes. Emerging epidemiological studies suggesting interference with foetal development and birth outcomes, and exacerbation of asthma conditions, are particularly concerning to rural families and livestock.

LESSONS LEARNED

Rural residents in potentially affected areas should be supported to access and interpret the best current evidence regarding the multiple health concerns associated with unconventional gas mining. This knowledge should be part of wider discourse and decision-making processes driving local economic development and national and global energy choices.

Integrating public health and community development to tackle neighborhood distress and promote well-being

Recently there have been calls for public health to reconnect to urban planning in ways that emphasize the impact of place on health and that address fundamental causes of poor health, such as poverty, social inequality, and discrimination. Community developers have realized that poor health limits individuals' and communities' economic potential and have begun to integrate into their work such neighborhood health issues as access to fresh food and open space. In this article we review recent shifts in the community development field and give examples of programs that operate at the intersection of community development, public health, and civic engagement. For example, in Sacramento, California, the Building Healthy Communities program successfully promoted the creation of community gardens and bike paths and the redevelopment of brownfields. A major housing revitalization initiative in San Francisco, California, known as Sunnydale-Velasco, is transforming the city's largest public housing site into a mixed-income community that provides existing residents with new housing, infrastructure, services, and amenities. These examples and others illustrate the need to identify and make use of interdisciplinary approaches to ensure that all places are strong platforms for economic mobility, full democratic participation, and community health.

Principal components analysis to identify influences on research communication and engagement during an environmental disaster

OBJECTIVES

To discern community attitudes towards research engagement in Libby, Montana, the only Superfund site for which a public health emergency has been declared.

STUDY DESIGN

Survey study of convenience samples of residents near the Libby, Montana Superfund site.

PARTICIPANTS

Residents of the Libby, Montana area were recruited from a local retail establishment (N=120, survey 1) or a community event (N=127, survey 2).

MEASURES

Two surveys were developed in consultation with a Community Advisory Panel.

RESULTS

Principal components of survey 1 showed four dimensions of community members' attitudes towards research engagement: (1) researcher communication and contributions to the community, (2) identity and affiliation of the researchers requesting participation, (3) potential personal barriers, including data confidentiality, painful or invasive procedures and effects on health insurance and (4) research benefits for the community, oneself or family. The score on the first factor was positively related to desire to participate in research (r=0.31, p=0.01). Scores on factors 2 and 3 were higher for those with diagnosis of asbestos-related disease (ARD) in the family (Cohen's d=0.41, 0.57). Survey 2 also found more positive attitudes towards research when a family member had ARD (Cohen's d=0.48).

CONCLUSIONS

Principal components analysis shows different dimensions of attitudes towards research engagement. The different dimensions are related to community members' desire to be invited to participate in research, awareness of past research in the community and having been screened or diagnosed with a health condition related to the Superfund contaminant.

Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster

INTRODUCTION

In 2005, a train derailment and subsequent chlorine spill ravaged the rural town of Graniteville in South Carolina, resulting in one of the worst chlorine gas exposures in US.

HISTORY

Significant health and economic challenges persist in the community more than a decade later. Healthcare providers offered healthcare services to community members in the immediate aftermath of the disaster, and many still live in the community and continue to provide healthcare services. As such, healthcare professionals provide a unique and important perspective to help understand the impact of the disaster on the community's health. The purpose of this study was to explore healthcare providers' perspectives about the long-term effects of the disaster on community health, healthcare access, and wellbeing.

METHODS

Semi-structured interviews were conducted with 30 healthcare providers who treated survivors of the Graniteville train disaster. A qualitative, essentialist, inductive thematic analytic approach was used to analyze study data.

RESULTS

Four themes emerged regarding the disaster's long-term impact: effects of chlorine exposure on physical health, issues with healthcare access, residual effects of the disaster on personal and community wellbeing, and improving health and community wellbeing.

CONCLUSIONS

Disaster recovery should not be considered solely an acute event; agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities. Efforts to address the long-term health needs of communities post-disaster should consider the perspectives of healthcare providers to offer a well-rounded assessment of community needs. Study findings can help inform future disaster response strategies in communities locally and globally.

Community emergency department utilization following a natural disaster (the Goderich Tornado)

INTRODUCTION

On 21 August 2011 an F3 tornado hit the Canadian town of Goderich, Ontario, leaving 40 people injured and one dead. Specific medium-term changes in utilization of health care following a disaster have not been analyzed in medical literature. Documenting the emergency department utilization through this subacute period would be helpful to enable institutions and healthcare practitioners to be better prepared for future events.

METHODS

A medical chart review was conducted at the Alexandra Marine and General Hospital in Goderich. All emergency department visits made during the 30 days after the Tornado in 2011 (intervention group), 30 days prior to the tornado in 2011 (primary control group), and during the similar calendar period of 30 days after the tornado in 2010 (seasonal control group) were reviewed. Medical diagnoses of all patients who presented at the emergency department were collected and compared.

RESULTS

Fewer people presented to the emergency department following the tornado than during the control periods, and those who did were significantly older than those who presented in the control periods (p<0.001). A significantly greater number of patients presented with undiagnosed medical problems, many came to refill their medications, and significantly fewer people left the emergency department without being seen (p<0.001).

CONCLUSIONS

This study identifies the medical conditions that are most likely to be seen in an emergency department following a tornado in a rural Ontario community. This information serves to inform the medical community and other hospitals how to increase their level of preparedness should a comparable disaster occur again in the future.