Health risk

HE WOMEN'S HEALTH INITIAtive (WHI) focuses on defining the risks and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colorectal cancer, and fractures in postmenopausal women. Between 1993 and 1998, the WHI enrolled 161809 postmenopausal women in the age range of 50 to 79 years into a set of clinical trials (trials of low-fat dietary pattern, calcium and vitamin D supplementation, and 2 trials of postmenopausal hormone use) and an observational study at 40 clinical centers in the United States. 1 This article reports principal results for the trial of combined estrogen and progestin in women with a uterus. The trial was stopped early based on health risks that exceeded health benefits over an average follow-up of 5.2 years. A parallel trial of estrogen alone in women who have had a hysterectomy is being continued, and the planned end of this trial is March 2005, by which time the average follow-up will be about 8.5 years. The WHI clinical trials were designed in 1991-1992 using the accumulated evidence at that time. The primary outcome for the trial of estrogen plus progestin was designated as coronary heart disease (CHD). Potential cardioprotection was based on generally Author Information and Financial Disclosures appear at the end of this article. Context Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain. Objective To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States. Design Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16 608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998. Interventions Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n=8506) or placebo (n=8102). Main Outcomes Measures The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes. Results On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10000 personyears attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10000 person-years. Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.

This paper contributes to the limited literature of monetary valuation of the effects of natural hazards. In particular, we focus on natural hazards caused by climate change and measure willingness to pay (WTP) to avoid relevant environmental and health risks in coastal environments. We also allow short, medium and long term for the effects of mitigation measures, in order to investigate differences and/or similarities in people's WTP for these different time horizons. A choice experiment is used and implemented in Stantander, Spain, a coastal region that faces a number of significant challenges due to climate change: (a) vulnerability to marine dynamics, with effects on its beaches (and their role as focal locations for social and touristic activities) as well as built environment and businesses, (b) loss of marine biodiversity and (c) increase in exposure to medusas and other dangerous and alien species present on the beaches, which result to restriction of bathing activities due to health risks. Finally, the empirical results from this paper provide useful insights with regards to the development of optimal (economically efficient, socially acceptable and environmentally sound) risk insurance schemes against extreme natural hazards.

The prevalence and characteristics of Escherichia coli and Salmonella spp. as well as counts of E. coli in raw oysters, condiments/spices, and raw oyster cocktails sampled from 72 vendors across Western Trinidad were determined. The microbial quality of the water used in the preparation of raw oysters was also investigated. Of 200 samples each of raw oysters, condiments/spices and oyster cocktails tested, 154 (77.0%), 89 (44.5%) and 154 (77.0%) respectively yielded E. coli. The differences were statistically significant (P = < 0.001; chi square = 62.91). The mean E. coli count per g in the ready-to-eat oyster cocktail ranged from 1.5 x 10(3) +/- 2.7 x 10(3) in Couva to 8.7x10(6) +/- 4.9x10(7) in San Fernando. One hundred and forty-six (73.0%) oyster cocktails contaminated with E. coli had counts that exceeded the recommended standard of 16 per g. Of a total of 590 E. coli isolates from various sources tested, 24 (4.1%), 20 (3.4%) and 69 (11.7%) were mucoid, haemolytic and non-sor...

Few comprehensive studies exist that evaluate the nutrient intake and health indicators of college-aged students. This article describes the University of New Hampshire's Young Adult Health Risk Screening Initiative and examines results from participants evaluated from September 2005 through July 2007. This cross-sectional study included 1,701 students who enrolled in an introductory nutrition course, met age requirements (18 to 24 years), agreed to participate, and completed related assessments. All evaluation components were built into the semester-long course design, thus minimizing participant burden. Anthropometric measurements, blood lipids, blood glucose, and blood pressure were measured directly by research staff. Online dietary intake was self-reported and evaluated using a software program. Health risk data indicate high rates of overweight (33%), elevated low-density lipoprotein cholesterol (53%), and elevated systolic (47%) and diastolic blood pressures (39%). Less than 30 minutes of physical activity per day was reported by 28% of respondents. The majority of males (94%) and females (73%) exceeded sodium guidelines. Although females were less likely to be overweight than males, few met recommended intakes for vitamin D (26%), calcium (25%), potassium (35%), iron (31%), and folate (32%). Undergraduate and graduate dietetics students assisted with biological assessments, data entry, and record maintenance. Data inclusion rates ranged between 84% and 94% for various measurements. The methods employed in this study could be modified by institutions interested in profiling the health status of students. Results have led to an enhanced understanding of the nutrition practices and health status of this population and will serve to inform university programs and policies.

Understanding how hostility may affect health risk is predicated on articulating its core physiological, psychological and social features. . Developments in the measurement of hostility. In: Friedman, H.S. (Ed.), Hostility, Coping and Health, pp. 13-31. American Psychological Association, Washington, D.C] emphasized the importance of cognitive, affective and behavioural components. The present study examined whether hostile people differ from non-hostile people on measures of emotional verbal behaviour. Forty participants were interviewed about an anger-eliciting experience. Interviews were transcribed and evaluated for the use of emotional language using the Dictionary of Affect in Language . The dictionary of affect in language. In: Plutchik, R. and Kellerman, H. (Eds.), The Measurement of Emotions. Emotion: Theory, Research and Experience. Vol. 4. Academic, San Diego]. Independent judges read the transcripts and rated the amount of anger experienced by the participants. Participants' use of activation and evaluation words, subjective reports of anger and judges' ratings of their anger were examined as a function of gender, social desirability and hostility subcomponents: cynicism, hostile attributions, aggressive responding and hostile affect. Cognitive/attitudinal components were related to the use of more positive language in the anger interview, while behavioural and affective components were related to judged anger. The findings suggest that there are complex differences in emotional communication associated with hostility components. While supporting transactional models, they underscore the multidimensional nature of the affective repertoires associated with hostility. The findings suggest that further study of emotional behaviour associated with hostility components would be fruitful.

Abstract Recent theoretical and empirical research has highlighted the importance of understanding the relationship between social structure and health beliefs. The empirical study described here explores the relationships between occupational social class and two dimensions of health beliefs which were concepts of health and perception of vulnerability to disease. Both the dimensions are claimed to be associated with decisions to carry out health behaviour and thus one of the aims was to shed some light on the social class gradient in patterns of preventive health behaviour and risk-taking behaviour. The findings showed a more marked social class differentiation in concepts of health when they were defined in the abstract compared with when they were defined in relation to personal health. The concept of personal vulnerability itself was shown to be problematic and theories about vulnerability were similar for both classes. Explanations for the findings are discussed.

High-altitude populations using biofuels for household energy may be at health risk due to a combination of altitudinal stress and indoor exposures to biomass smoke. In this article, the authors measure indoor and outdoor breathing level concentrations of PM 2.5 and CO during periods of meal preparation in a convenience sample of homes above 3000 m in Cusco, Peru. From July 10 to 21, 2005, 237 measurements were taken during a pilot study at 41 residences. Results show the highest levels of PM 2.5 and CO occurred during the early morning in the kitchen when dung and wood were used. Additionally, findings suggest that residential biomass fuel combustion in Cusco results in elevated indoor PM 2.5 and CO exposure levels that are of potential human health concern, an issue that may be exacerbated by the physiological impact of living in a high-altitude environment.

Although socioeconomic status is a major contributing factor to health disparities, the mechanisms through which socioeconomic status influences health remain unclear. The purpose of the present study was to evaluate an a priori conceptual model of the pathways between socioeconomic status and modifiable health risk factors in a sample of 399 African Americans seeking smoking cessation treatment. A latent variable modeling approach was utilized to characterize the interrelationships among socioeconomic status, neighborhood disadvantage, social support, negative affect/perceived stress, and three specific modifiable risk factors (i.e., overweight/obesity, insufficient physical activity, at-risk drinking). Findings indicated that neighborhood disadvantage, social support, and negative affect/perceived stress function as pathways linking socioeconomic status and modifiable risk factors among African American smokers, and negative affect/perceived stress appears to play a key mediating role. Policy, community, and individual-level interventions may attenuate the impact of socioeconomic status on health by targeting intermediate psychosocial, environmental, and behavioral pathways.

Paediatricians are in an excellent position to identify children with environmental risk, to advise their parents about the best way of reducing or preventing such risks, and to recommend actions to the responsible politicians involved. Paediatric environmental health speciality units (PEHSU) can help to qualify and support paediatricians in this task. PEHSU is defined as a unit within a paediatric hospital or clinic that is able to recognize, assess, and prevent environment-related health risks, to help other paediatric specialists in the management of such diseases in children, as well as to provide education, training, and research, putting emphasis on thorough and adequate establishment of paediatric environmental histories (PEHis) and to the application of the precautionary principle. Although activities and services provided by each PEHSU would differ depending on the centre or community where it is located, all should include training, research, medical care and community and school health.

The removal of heavy metals has been investigated widely in recent years due to their potential health risk to human beings. In this study, the removals of copper from aqueous phase by alginate and SDBS entrapped alginate was investigated. First, a series of equilibrium sorption experiments were conducted at different initial pH values. Both equilibrium copper concentration and final pH values were observed. Then, a series of kinetic experiments were conducted and a second order rate relationship was fit to the experimental data. Equilibrium sorption experiments showed that the sorption of Cu +2 ions by 2% of SDBS entrapped alginate beads were greater than the plain and 0.5% of SDBS entrapped alginate beads. More H + ion exchange occurred with the 2% of SDBS entrapped alginate beads, which was attributed to the increased number of the exchange sites on the alginate due to the sorption of surfactant to the beads. Kinetic sorption experiments showed that the equilibrium was reached faster for 2% of SDBS entrapped alginate beads. Results were successfully represented using second order kinetic model. Both equilibrium and kinetic experiments showed that the sorption of Cu +2 ions increased as the pH of the aqueous solution increased.

The use of moulds as a seasoning for sausage can have both desirable and undesirable consequences. The desirable consequences are the creation of a successful product that appeals to consumers. The undesirable consequences are due to the growth of undesirable moulds that produce highly toxic secondary metabolites referred to as mycotoxins. The aim of the paper was to investigate the presence of moulds producing ochratoxin A (OTA) on the surface of sausages from northern Italy. A total of 757 mould strains were isolated from sausage casings. The most frequently identified species were Penicillium nalgiovense, Penicillium oxalicum, Eurotium amstelodami, Penicillium olsonii, Penicillium chrysogenum, Penicillium verrucosum, Penicillium viridicatum, and Eupenicillium crustaceum. Aspergillus ochraceus was detected in only one production lot. Approximately 45% of these samples were positive for the presence of OTA. On the casings of the investigated sausages, the lowest and highest OTA values were 3 and 18 mg/kg, respectively.

Eight-hundred seventy-three Indiana high school football players were surveyed to investigate the use of anabolic-androgenic steroids (AAS). Subjects were varsity football players that were randomly selected from 27 high schools throughout Indiana. Out of a possible 1,325 subjects, 873 or 66% participated in the study. Subjects completed a 50 item questionnaire that measured demographic information, perceived use of AAS, reasons for use, and how AAS are taken. The results indicate that 6.3% of Indiana high school football players were current or former AAS users. The average age at time of first use of AAS was 14 years and 15% began taking before the age of ten. Almost half of respondents indicated they could obtain AAS if they so desired, and that other athletes, physicians, and coaches were listed as sources for AAS. Athletic trainers can play a vital role in disseminating accurate information about AAS abuse, including the long-term adverse health risks. These messages should beg...

Diarrhea and respiratory infections account for more than two-fifths of all deaths among children under five. Parental education and economic status are well-known risk factors for child morbidity, but little is known about whether education and economic status operate synergistically or independently to influence children's health. Confirming the presence and direction of such interactions is important to better target education and development policies. Our objective is to test for interactions between parental education and economic status in predicting the risk of diarrhea and respiratory illness among children under five, before and after adjusting for key proximate risk factors.

The occurrence of microbial colonisation on artificial surfaces in urban areas (building facades, roof tiles) and interiors (damp rooms: silicone sealings, wallpaper) causes not only an aesthetically unacceptable discolouration of the surface, it also represents a conspicuous problem in terms of biodeterioration, accelerated weathering and a potential health risk for humans by fungal mycotoxines. The most conspicuous organisms responsible for biofouling terrestrial surfaces are fungi and green microalgae as well as cyanobacteria. Microorganisms are often estimated by cultivating, but the biomass can be misjudged because of contaminations or the existence of nonculturable cells and spores. By using ergosterol as a specific biomarker for living fungi and yeasts in combination with chlorophyll a for aeroterrestrial microalgae it is possible to quantify fungal and algal infection independent from cultivation and undisturbed by surface (dis)colouration. Using HPLC and photometric methods, conversion factors for microbial biomass were determined in representative fungal and algal species: 5 mg ergosterol g À1 fungal dry biomass and 23 mg chlorophyll a g À1 algal dry biomass. The applied wipe technique allowed a non-invasive sampling and evaluating of infections per square meter. Very low detection limits for ergosterol and chlorophyll a permitted determining fungi and algae before they become macroscopically visible. Up to 36 mg ergosterol m À2 and 180 mg chlorophyll a m À2 were detected on outdoor artificial surfaces, equivalent to approximately 7 g m À2 fungal dry biomass and 8 g m À2 algal dry biomass. The distribution and the composition of the microbial communities varied strongly between the sampling locations. Fungi were observed above windows of damp rooms or at more sun-exposed locations, whereas algae covered more wet and shadowed surfaces. The established methods are well suited for the precise joint determination of fungal and algal biomass in microbial communities of natural biofilms on artificial surfaces as a pre-condition for the development of prevention strategies against microbial colonisation. r

Despite the growing number of homeless women of reproductive age, little is known about their reproductive health and contraceptive use. METHODS: A representative sample of 974 currently homeless women surveyed in Los Angeles County in 1997 included 229 who were chronically homeless and at risk for unintended pregnancy. The relationships between perceived deterrents among these women and their frequency of contraceptive use were evaluated using chi-square tests. Logistic regression analyses were performed to identify independent predictors of contraceptive deterrents. RESULTS: The most commonly cited deterrents to contraceptive use were side effects, fear of potential health risks, partner's dislike of contraception and cost (20-27%). Women who reported substantial deterrents were significantly less likely than others to use contraceptives consistently. Perceived deterrents differed by women's characteristics: Hispanic women were more likely than whites to view not knowing how to use contraceptives or which method to use as a deterrent (odds ratios, 9.6-9.8); black women were more likely than whites to cite not knowing which method to use (4.0), lack of storage (5.5), health risks (6.0) and discomfort (3.3). Women with a history of drug abuse had elevated odds of citing not knowing how to use contraceptives, uncertainty about which method to use and cost as deterrents (5.2-7.7). CONCLUSION: Homeless women report substantial deterrents that reduce their contraceptive use. The multiplicity and heterogeneity of their perceived deterrents suggest a need for reproductive health services that are more integrated and culturally competent than those currently offered.

The physical and social characteristics of internal and external environments of the YTU Library Building were examined and the results were compared with the required levels and standards. Negative characteristics which may cause health problems on temporary and permanent users were determined, and potential health risks due to those characteristics were identified. r

Harry T. Whelan, MD1a,2,3, John M Houle, BS1a, Noel T. Whelan1a,3, Deborah L. Donohoe, AS, LATG1a, Joan Cwiklinski, MSN, CPNP1a, Meic H. Schmidt, MD1c, Lisa Gould, MD, PhD.1b, David Larson, MD1b, Glenn A. Meyer, MD1a, Vita Cevenini3, Helen ...

Since 1990s, a systematic program to measure air toxics has been active in New York State with monitors located both in urban and rural areas. In this study we examined the spatial and temporal characteristics of benzene, a known human carcinogen that is emitted by many source categories. The analysis indicates that ambient concentration levels of benzene have decreased by as much as 60% over this period not only in the ozone non-attainment area of New York City that had the reformulated gas (RFG) requirements, but also over the rest of the state as well. Although the rate of decrease appears to have flattened out in recent years, the annual average concentration levels are found to be above the health risk threshold even at the remote location, Whiteface Mountain, suggesting the need for further reductions in benzene emissions. r

In recent decades, public health policy and practice have been increasingly challenged by globalization, even as global financing for health has increased dramatically. This article discusses globalization and its health challenges from a vantage of political science, emphasizing increased global flows (of pathogens, information, trade, finance, and people) as driving, and driven by, global market integration. This integration requires a shift in public health thinking from a singular focus on international health (the higher disease burden in poor countries) to a more nuanced analysis of global health (in which health risks in both poor and rich countries are seen as having inherently global causes and consequences). Several globalization-related pathways to health exist, two key ones of which are described: globalized diseases and economic vulnerabilities. The article concludes with a call for national governments, especially those of wealthier nations, to take greater account of ...

Particle concentrations and size distributions have been measured from different heights inside and above a boreal forest during three BIOFOR campaigns (14 April–22 May 1998, 27 July–21 August 1998 and 20 March–24 April 1999) in Hyytiälä, Finland. Typically, the shape of the background distribution inside the forest exhibited 2 dominant modes: a fine or Aitken mode with a geometric number mean diameter of 44 nm and a mean concentration of 1160 cm−3 and an accumulation mode with mean diameter of 154 nm and a mean concentration of 830 cm−3. A coarse mode was also present, extending up to sizes of 20 μm having a number concentration of 1.2 cm−3, volume mean diameter of 2.0 μm and a geometric standard deviation of 1.9. Aerosol humidity was lower than 50% during the measurements. Particle production was observed on many days, typically occurring in the late morning. Under these periods of new particle production, a nucleation mode was observed to form at diameter of the order of 3 nm and, on most occasions, this mode was observed to grow into Aitken mode sizes over the course of a day. Total concentrations ranged from 410–45 000 cm−3, the highest concentrations occurring on particle production days. A clear gradient was observed between particle concentrations encountered below the forest canopy and those above, with significantly lower concentrations occurring within the canopy. Above the canopy, a slight gradient was observed between 18 m and 67 m, with at maximum 5% higher concentration observed at 67 m during the strongest concentration increases.

This study explores the utility of a self-completion survey method to quickly and cheaply generate information on patterns and trends among regular 'recreational' drug consumers. Data is reported here from 1151 subjects accessed through a dance music publication. In keeping with previous studies of drug use within the dance scene polysubstance use was the norm. Many of those reporting use of 'ecstasy' were regularly using multiple tablets often consumed in combination with other substances thus exposing themselves to serious health risks, in particular the risk of dose related neurotoxic effects. Seventy percent were drinking alcohol at hazardous levels. Subjects' patterns of drug purchasing also put them at risk of severe criminal sanction. Data supported evidence that cocaine use had become increasing popular in the UK, but contrasted with some commentators' views that ecstasy use was in decline. The utility of this method and how the results should be interpreted is discussed, as are the data's implications for harm and risk reduction activities.

An high level of ROS (Reactive Oxygen Species), due to an increased production of oxidant species and/or a decreased efficacy of antioxidant system, can lead to oxidative stress, an emerging health risk factor involved in the aging and in many diseases, including inflammatory, infectious and degenerative disorders, either in humans or in animals. In the last years some assays panels have been developed to globally evaluate the oxidative balance by means of the concomitant assessment of ROS production and antioxidant system capability. In this report, the validation trials of d-ROMs (Reactive Oxygen Metabolites-derived compounds) and BAP (Biological Antioxidant Potential) tests in canine specie are described and also the specific referral ranges are calculated in a Labrador population. The results of linearity, precision and accuracy trials show that both tests exhibit good to excellent analytical performances. The possibility of measuring oxidative stress in vivo with simple, cheap and accurate tests, d-ROMs test and BAP test, provides for the veterinarians a very suitable tool to monitor oxidative stress and to correctly choice of eventual antioxidant supplementations in diseases proven related to oxidative stress in animals and particularly in dogs. Further studies will be useful to confirm this possibility.

The oleoresin of the copaiba tree (Copaifera sp., Fabaceae) is traditionally used in Brazilian herbal medicine to treat a variety of illnesses and symptoms. This study, conducted according to the OECD Guideline 414, provides data on the developmental toxicity of oleoresin from C. reticulata (COPA-R) in rats. Pregnant Wistar rats (25 per dose group) were treated by gavage with COPA-R (0, 500, 1000 and 1250 mg/kg bw/day) on gestation days (GD) 6-19 and Caesarean sections performed on GD20. Implantations, living and dead fetuses and resorptions were recorded. Half of the fetuses from each litter were examined for visceral abnormalities and the remaining were cleared and stained for skeleton evaluation. COPA-R was maternally toxic (reduced food intake and weight gain) and embryotoxic (lower fetal body weight and increased occurrence of fetal skeleton variations) at the two highest doses, but did not cause embryo deaths or fetal malformations at any dose level. The study derived an oral no-observed-adverse-effectlevel (NOAEL) for maternal and developmental toxicity induced by COPA-R of 500 mg/kg bw/day. The results suggest that copaiba oleoresin does not pose a health risk to pregnant women when used according to the recommended doses (up to five drops, three times a day).

PWN's water treatment plant Andijk was commissioned almost 40 years ago. It services water from the IJssel Lake by conventional surface water treatment. In view of taste and odor problems the plant was retrofitted with GAC filtration 25 years ago. The finished water quality still complies with all E.C. and Dutch drinking water standards. Nevertheless an upgrade is desired to avoid the use of chlorine and to extend the barriers against pathogenic microorganisms and a broad range of organic micropollutants such as pesticides, rocket fuel by-products (NDMA), fuel oxygenates (MTBE), solvents (dioxane), endocrine disruptors, algae toxins, pharmaceuticals, etc. UV/H 2 O 2 treatment was selected for both primary disinfection and organic contaminant control. The disinfection requirements were based on a 10 À4 health risk. The required 3 log inactivation for Giardia and Cryptosporidium was achieved by an UV dose lower than 20 mJ/cm 2. The highest UV dose, 105 mJ/cm 2 , was needed for the inactivation of spores of Sulphite Reducing Clostridia. Reactivation of protozoa was established for UV doses up to 25 mJ/cm 2 , for doses higher than 45 mJ/cm 2 no reactivation was observed. In view of the raw water concentrations the required organic contaminant degradation was set at 80%. Collimated beam and pilotplant work showed that the required degradation can be achieved by the proper combination of electric energy and H 2 O 2. In a UV reactor optimized for organic contaminant control, UV dose of 540 mJ/cm 2 (about 0.5 kWh/m 3) and 6 mg/L H 2 O 2 were needed. Under those conditions pesticides (atrazine), NDMA, MTBE, dioxane, endocrine disruptors (bisphenol A), microcystine and pharmaceuticals (diclofenac, ibuprofen) could be removed up to the required 80%. Bromate formation was absent while formation of primary metabolites was insignificant. The UV dose for organic contaminant control is about five times higher than the dose needed for disinfection. The UV/H 2 O 2 process was implemented into the existing treatment train between the sand and GAC filters. In the GAC filters excess H 2 O 2 is degraded, nitrite is converted into nitrate and biodegradable reaction products are consumed by bacteria. The full-scale installation with 3 streets of 4 Trojan Swift 16L30 reactors has been in operation since October 2004. Disinfection and organic contaminant control are as expected.

Groundwater long-term monitoring (LTM) is required to assess the performance of groundwater remediation and human being health risk at post-closure sites where groundwater contaminants are still present. The large number of sampling locations, number of constituents to be monitored, and the frequency of the sampling make the LTM costly, especially since LTM may be required over several decades. An optimization

Over the past years, one of the most discussed topics in policy debates on genetics has been the use of genetic testing in insurance. Many of these debates have been rather speculative and abstract. In a recent contribution to this journal, Kaufert therefore urged for "a proper research agenda" to study the issue, arguing for the need of anthropological and sociological research of the insurance world. This article will make a start with this. Based on ethnographic fieldwork in two Belgium insurance companies, this study analyses the ways insurers account for predictive medicine (lifestyle, genetics) during underwriting. We demonstrate how insurers highlight predictive lifestyle health information and how this articulates with a fault based approach in underwriting. Individual responsibility for health risks becomes the golden standard for assessing one's fitness for membership of the insurance pool. Moreover, these developments imply a changed concept of "normal standard" in insurance, increasing the conditions to fulfil to be part of the insurance group. Predictive medicine constitutes new ground in the old debates about individual control, responsibility and blame for health. This goes to the heart of the basis for citizenship and how this articulates with membership--or, if you want, exclusion--of the insurance pool.

In Brazil, in the last 20 years, dietary risk assessments have been conducted on pesticides, mycotoxins, food additives, heavy metals (mainly mercury), environmental contaminants (mainly DDT) and acrylamide, a compound formed during food processing. The objectives of this paper were to review these studies, discuss their limitations and uncertainties and identify the most critical chemicals that may pose a health risk to Brazilian consumers. The studies have shown that the cumulative intake of organophosphorus and carbamate pesticides by high consumers of fruits and vegetables may represent a health concern (up to 169% of the ARfD), although the benefits of consuming large portions of those foods most probably overcome the risks. High consumers of maize products may also be at risk due to the presence of fumonisin (355% of the PMTDI), a mycotoxin present at high levels in Brazilian maize. The studies conducted in the Brazilian Amazon have shown that riparian fish consumers are exposed to unsafe levels of mercury. However, this is a more complex issue, as mercury levels in the region are naturally high and the health benefits of a fish-based diet are well known. Studies conducted both in Brazil and internationally on acrylamide have shown that the exposure to this genotoxic compound, mainly from the consumption of French fries and potato chips, is of health concern. Reducing the population dietary exposure to toxic chemicals is a challenge for government authorities and food producers in all countries. Management strategies aimed at decreasing exposure to the critical chemicals identified in this review involve limiting the use or eliminating highly toxic pesticides, implementing good agricultural practices to decrease maize contamination by fumonisins, educating local fish-eating communities toward a fish diet less contaminated by mercury, and changing dietary habits concerning the consumption of fried potatoes, the main processed food containing acrylamide.

An attempt has been made to apply air dispersion modeling for exposure assessment of particulate matter in terms of mortality change. Ambient particulate matter concentrations have been estimated by AERMOD (07026) for the year 2004 in Delhi, India. Concentration output has been obtained for all sources as well as individual source category. It has been found that though the model has a tendency towards under-prediction, estimated concentration values agree with the observed concentrations within factor of two. The transport sector shows highest contribution towards particulate matter pollution. Model results have been used to analyse mortality change associated with two hypothetical emission reduction scenarios in vehicular traffic emissions and thermal power plants. The results from the exposure assessment study highlighted the significance of reduction in vehicular emissions in controlling particulate matter pollution in Delhi.

Objectives: Understanding the potential for volatile chemicals to elicit chemosensory irritation in the upper respiratory tract is critical to setting occupational exposure limits that are protective of comfort and wellbeing for the majority of workers. However, the determination of irritant potency for any volatile chemical has been limited by the lack of reliable and non-invasive assays for studying sensory irritation in humans and a failure to appreciate the many non-sensory factors that can influence the reactions to an odor or an irritant in the workplace. Methods: This paper reviews the issues involved in distinguishing and measuring sensations of odor and irritation from volatile chemicals, and describes recent developments in psychophysical methods for evaluating chemical irritancy in humans, and discusses some of the many non-sensory factors such as exposure history, attitudes and expectations and personality variables that can significantly alter the perception of odor, irritation and health risk following exposure to a volatile chemical. Results: The availability of safe, non-invasive assays to measure directly odor and irritant responses in the species of interest, humans, can both simplify and improve accuracy in the process of developing appropriate occupational exposure guidelines. Conclusions: Objective measures of irritation onset obtained in conjunction with subjective responses can lend valuable input to the decision process for determining occupational exposure limits but should always account for other factors (e.g., cognitive or emotional) that may be modulating the subjective response.

AbstractÐDetailed epidemiological studies in the UK have shown a dose±response relationship between water quality and gastroenteritis experienced by bathers. Other predictors of gastroenteritis found in the studies provide comparative levels of risk attributable to, for example, certain types of food. The statistical distribution of faecal streptococci, based on log 10 mean and log 10 SD, is used to describe the exposure of the bathing population. The exposure distribution is used in combination with the dose±response relationship and other independent risk factors as a framework for a health-related``standards'' system. The standard system de®nes a series of water quality thresholds which take into account variation in water quality. These categories could provide a basis for both``health-related'' water quality objectives and advice to the public on potential health risks from bathing. #

In 2003, there was a recall of three processed (chicken franks, spice ham and turkey ham ready-to-eat (RTE) meat products by a large processing plant in Trinidad as a result of contamination by Listeria monocytogenes. The study was conducted to investigate the possible source(s) of Listeria contamination of recalled RTE meat products and to determine the prevalence of Listeria spp., Salmonella spp., Escherichia coli and Campylobacter spp. in the products and air within the plant. Raw and processed meat products, as well as food contact surfaces were also tested for Salmonella spp., Listeria spp. and Campylobacter spp. initially after thorough clean-up and close-down of the plant. Faecal and effluent samples from the piggery, in close proximity to the plant, were tested for the presence of Salmonella spp., Listeria spp. and Campylobacter spp. Air samples and food contact surfaces were negative for the tested organisms. Ten (58.8%) of the 17 effluent samples and 4 (11.8%) of the 34 faecal samples were positive for Campylobacter coli. Of the 11 raw meat products tested, 10 (90.9%) were positive for E. coli and Listeria spp. either singly or in combination. Of the 32 processed RTE products tested, 11 (34.4%) were positive for E. coli, Salmonella spp., Listeria spp. and Campylobacter spp. in combination or singly. Eleven (61.1%) of 18 processed products contained unacceptable levels of aerobic bacteria using international standards. Four months later, following the implementation of recommended cleaning, sanitizing and hygienic practices at the plant, pre-and post-processed products were sampled and Listeria spp. were identified in 4 (80.0%) of the 5 raw products and in 1 of the 5 (20.0%) finished products. Two (40.0%) of the finished products contained unacceptable microbial levels. It was concluded that the close proximity of the piggery to the processing plant was not the probable source of Listeria contamination of the recalled meat products. The data suggested that improved sanitary practices on food contact surfaces and during handling of products, reduced the risk of Listeria spp. and other pathogens studied. The problem at the plant can therefore, be inferred to be due to lapses in good sanitary practices, inadequate heat treatments or the presence of pathogens particularly Listeria in biofilms on different surfaces continuously or occasionally contaminating finished products. r

Background: Adolescent health risk behaviors often occur together, suggesting that youth involvement with one risk behavior may inform understanding of other risk behaviors. We examined the association between involvement in nonsexual risk behaviors and trends among sexual behaviors. Methods: We analyzed 1991-2007 data (n ¼~125,000) from the Youth Risk Behavior Survey, a nationally representative survey of high school students in the United States. We categorized students into groups based on lifetime (Lifetime Risk Scale) and recent involvement (Recent Risk Scale) in nonsexual risk behaviors, such as smoking and drug use. We examined each group's prevalence of and trends for four sexual behaviors: ever having had sexual intercourse, having four or more lifetime partners, current sexual activity, and use of contraception at last sex. Data were examined for linear and quadratic (U-shaped) change using logistic regression. Results: Sexual behaviors varied considerably between youth engaged in no risk behaviors and those in the highest risk behavior groups: sevenfold for ever having had intercourse (13% vs. 87% in 2007) and threefold for four or more lifetime sexual partners (19% vs. 57%). Despite these differences, trends in sexual risk behaviors among youth engaged in multiple nonsexual risk behaviors and those engaged in few or no risk behaviors were remarkably similar. In contrast, sexual behaviors demonstrated a very different pattern of change from that found or nonsexual behaviors: sexual experience and having multiple sexual partners declined into the early 2000s and then increased, whereas nonsexual behaviors increased over time, peaked in the late 1990s, and then declined. Conclusions: Youth who engaged in little risk taking and those who engaged in considerable risk taking showed similar trends over time. However, the pattern of changes in sexual and nonsexual risk behaviors were remarkably different, raising questions about the potential impact of interventions that would reduce sexual risk taking by reducing nonsexual risk behaviors. Recent increases in sexual risk behaviors may have ominous implications for prevention of unplanned pregnancy and sexually transmitted infections among youth. Ó

■ BACKGROUND This study assessed which demographic groups were most likely to consume alcohol excessively, and which groups had received inquiries and discussion about alcohol use from their physicians compared with discus- sions about other health risks. ■ STUDY DESIGN This was a cross-sectional study using data from the Centers for Disease Control Behavioral Risk Factors Surveillance System 1997 data

Water-related diseases continue to pose major threats to children's survival and well-being in many places in the developing world. This article develops a theoretical perspective on the ways in which children's vulnerability to water-related disease hazard is produced within the everyday circumstances of livelihood and child care. Central to this analysis is the role that household resources play in mediating or shaping particular microenvironments of health risk. Further, the effects of local geographies of gender on how household resources are accessed and on how child care is structured are examined. Children's vulnerability is evaluated in a community in the District of Gilgit in northern Pakistan, a region presently undergoing tremendous social and economic transformation. The case study highlights household-level response and adaptation to child health risks associated with diarrheal disease transmission and infection in this mountain environment. The case study draws from ethnographic fieldwork involving qualitative household microstudies and interviewing to elicit mothers' resource and risk-response strategies in the context of changes in livelihood systems and household dynamics. Key Words: gender, household resources, northern Pakistan, vulnerability, waterrelated diseases.

Many organizations interested in renewable, domestic energy have switched from petroleum diesel to biodiesel blends for use in transportation and heavy-duty equipment. Although considerable evidence exists on the negative health effects of petroleum diesel exhaust exposures in occupational settings, there has been little research examining biodiesel exposures. Working collaboratively with a local municipality, concentrations of particulate matter (PM) and other air toxics were measured at a recycling facility in southwestern New Hampshire while heavy equipment operated first on petroleum diesel and then on a B20 blend (20% soy-based biodiesel/80% petroleum diesel). This pilot study used a combination of established industrial hygiene and environmental air monitoring methods to estimate occupational exposure profiles to PM and air toxics from combustion of petroleum diesel and biodiesel. Results indicate that B20 use dramatically reduces work area respirable particle, PM 2.5 (PM Յ2.5 m in aerodynamic diameter), and formaldehyde levels compared with petroleum diesel. Some volatile organic compound concentrations were higher for petroleum diesel and others were higher for the B20 blend. Overall, this study suggests that biodiesel blends reduce worker exposure to and health risk from petroleum diesel exhaust, but additional exposure research is recommended.

PWN's water treatment plant Andijk was commissioned almost 40 years ago. It services water from the IJssel Lake by conventional surface water treatment. In view of taste and odor problems the plant was retrofitted with GAC filtration 25 years ago. The finished water quality still complies with all E.C. and Dutch drinking water standards. Nevertheless an upgrade is desired to avoid the use of chlorine and to extend the barriers against pathogenic microorganisms and a broad range of organic micropollutants such as pesticides, rocket fuel by-products (NDMA), fuel oxygenates (MTBE), solvents (dioxane), endocrine disruptors, algae toxins, pharmaceuticals, etc. UV/H 2 O 2 treatment was selected for both primary disinfection and organic contaminant control. The disinfection requirements were based on a 10 À4 health risk. The required 3 log inactivation for Giardia and Cryptosporidium was achieved by an UV dose lower than 20 mJ/cm 2. The highest UV dose, 105 mJ/cm 2 , was needed for the inactivation of spores of Sulphite Reducing Clostridia. Reactivation of protozoa was established for UV doses up to 25 mJ/cm 2 , for doses higher than 45 mJ/cm 2 no reactivation was observed. In view of the raw water concentrations the required organic contaminant degradation was set at 80%. Collimated beam and pilotplant work showed that the required degradation can be achieved by the proper combination of electric energy and H 2 O 2. In a UV reactor optimized for organic contaminant control, UV dose of 540 mJ/cm 2 (about 0.5 kWh/m 3) and 6 mg/L H 2 O 2 were needed. Under those conditions pesticides (atrazine), NDMA, MTBE, dioxane, endocrine disruptors (bisphenol A), microcystine and pharmaceuticals (diclofenac, ibuprofen) could be removed up to the required 80%. Bromate formation was absent while formation of primary metabolites was insignificant. The UV dose for organic contaminant control is about five times higher than the dose needed for disinfection. The UV/H 2 O 2 process was implemented into the existing treatment train between the sand and GAC filters. In the GAC filters excess H 2 O 2 is degraded, nitrite is converted into nitrate and biodegradable reaction products are consumed by bacteria. The full-scale installation with 3 streets of 4 Trojan Swift 16L30 reactors has been in operation since October 2004. Disinfection and organic contaminant control are as expected.

Five (5) essential macro, three (3) micro and two (2) trace mineral elements were determined in fresh fruits of twenty-two (22) accessions of okra using Instrumental Neutron Activation Analysis (INAA). These were correlated to assess the level of associations existing between these elements. Concentrations of these elements were juxtaposed with their recommended daily dietary intake (RDI) in the individual accessions of okra and their variability with other traits examined for future improvement works towards breeding for high or low micro nutrient containing variety (ies).

Biofilms are considered a significant health risk in the food and dairy industries because they can harbor pathogens, and direct contact with them can lead to food contamination. Biofilm control is often performed using strong oxidizing agents like chlorine and peracetic acid.

Fish processing, especially squid, creates high strength biochemical oxygen demand (BOD) wastewater that must be pretreated prior to sewer discharge. This study evaluated (1) new squid processing techniques, (2) advanced biological/chemical treatment technologies to meet local wastewater discharge regulations, and (3) recycling opportunities for materials formerly discarded as waste. Low technology modifications such as improved housekeeping/management systems were implemented in order to obtain initial reductions in BOD loadings. Various high technology separation processes, aimed at removing soluble BOD from the process effluent, were evaluated. A first order cost-benefit analysis based on capital and operating costs, BOD reduction efficiencies, and worker health risk factors indicated that a modified biological trickling filter was the best available pretreatment technology for squid processing wastewater.

Prediction of cancer risk is a minor component of current health risk appraisals. Perception of individual cancer risk is poor. A Cancer Risk Index was developed to predict individual cancer risk for cancers accounting for 80% of the cancer burden in the United States. We used group consensus among researchers at the Harvard Medical School and Harvard School of Public Health to identify risk factors as definite, probable and possible causes of cancer. Risk points were allocated according to the strength of the causal association and summed. Population average risk of cancer and cumulative 10-year risk was obtained from SEER data. Individual ranking relative to the population average was determined. The risk index was evaluated for validity using colon cancer incidence in prospective cohort data. The Harvard Cancer Risk Index provides a broad classification of cancer risk. Validation against cohort data shows good agreement for colon cancer. The Harvard Cancer Risk Index offers a sim...