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Urinary tract infections (UTIs) make up a significant proportion of the global burden of disease in vulnerable groups and tend to substantially impair the quality of life of those affected, making timely detection of UTIs a priority for public health. However, economic and societal barriers drastically reduce accessibility of traditional lab-based testing methods for critical patient groups in low-resource areas, negatively affecting their overall healthcare outcomes. As a result, cellulose-based materials such as paper and thread have garnered significant interest among researchers as substrates for so-called frugal analytical devices which leverage the material’s portability and adaptability for facile and reproducible diagnoses of UTIs. Although the field may be only in its infancy, strategies aimed at commercial penetration can appreciably increase access to more healthcare options for at-risk people. In this review, we catalogue recent advances in devices that use cellulose-based materials as the primary housing or medium for UTI detection and chart out trends in the field. We also explore different modalities employed for detection, with particular emphasis on their ability to be ported onto discreet casings such as sanitary products. Graphical abstract

The entire world seems to have responded to COVID-19 pandemic in a knee-jerk manner with a short mindset without building on the existing strengths of public health infrastructure. National governments cannot be blamed for this as we are dealing with a crisis that comes once in a lifetime. Realising this, the Organized Medicine Academic Guild (OMAG) an association of major health associations in this country has suggested measures for long-term solutions to COVID-19-like pandemics in the form of a policy paper by OMAG.

There is widespread acknowledgement of the presence of vitamin D deficiency in the community and the pressing need to address this. From a public health perspective, emphasis has been placed on addressing vitamin D deficiency through dietary means. However, naturally rich food sources of vitamin D are few and infrequently consumed, and nutrition survey data from various countries have indicated that habitual vitamin D intakes in the community are much lower than the current vitamin D dietary guidelines. This review will briefly overview the extent of vitamin D deficiency within the community, its causes, and how our food chain, once its embraces the evidence-based practise of food fortification and potentially biofortification, can cater for meeting the dietary vitamin D needs of the community. Finally, international authorities, briefed with establishing vitamin D dietary guidelines over the past decade, have struggled with uncertainties and gaps in our understanding of the relative contribution of sunshine and diet to vitamin D status and vitamin D requirements for health maintenance. The review will also consider how emerging evidence of a possible minimal-risk UVB radiation exposure relative to skin cancer that also enables vitamin D production could greatly inform future vitamin D dietary guidelines.

Food-borne infections are major causes of public health concern in developing and developed countries. During the past decade, the Institut Hospitalo-Universitaire Méditerranée Infection has conducted or been involved in multiple investigations that aimed at identifying the sources and strains responsible for food-borne diseases and therefore at improving the understanding, diagnosis, prevention and control of these infections. Investigations were conducted in the Mediterranean area and in sub-Saharan Africa on more than 15 food-borne agents, 17 food products and 14 antibiotic resistance-associated genes. Multiple sources, including unexpected ones, and pathogens, including emerging ones, were involved. Travelling in developing countries and zoonoses are major contributors to food-borne infections, while food-borne transmission of resistance-associated genes is increasingly reported. However, risk factors and pathogens associated with food-borne infections likely remain untapped and must be more extensively investigated, monitored and regularly reassessed. Diagnostic tests based on new technologies and real-time surveillance tools based on microbiology laboratory data are promising approaches to detect known food-borne infections and decipher new ones. Studies of the microbiota and its relationships with dietary patterns are also worth being conducted. Keywords: Africa, bacteria, food, food-borne, fungus, IHU Mediterranée Infection, infections, Mediterranean Basin, virus, zoonosis

Automatic segmentation of bones in computed tomography (CT) images is used for instance in beam hardening correction algorithms where it improves the accuracy of resulting CT numbers. Of special interest are pelvic bones, which—because of their strong attenuation—affect the accuracy of brachytherapy in this region. This work evaluated the performance of the JJ2016 algorithm with the performance of MK2014v2 and JS2018 algorithms; all these algorithms were developed by authors. Visual comparison, and, in the latter case, also Dice similarity coefficients derived from the ground truth were used. It was found that the 3D-based JJ2016 performed better than the 2D-based MK2014v2, mainly because of the more accurate hole filling that benefitted from information in adjacent slices. The neural network-based JS2018 outperformed both traditional algorithms. It was, however, limited to the resolution of 1283 owing to the limited amount of memory in the graphical processing unit (GPU). Funding: VetenskapsradetSwedish Research Council [VR-NT 2016-05033]

Cerium oxide nanoparticles with integrated gadolinium have been proved to be useful as contrast agents in magnetic resonance imaging. Of question is their performance in dual-energy computed tomography. The aims of this work are to determine (1) the relation between the computed tomography number and the concentration of the I, Gd or Ce contrast agent and (2) under what conditions it is possible to resolve the type of contrast agent. Hounsfield values of iodoacetic acid, gadolinium acetate and cerium acetate dissolved in water at molar concentrations of 10, 50 and 100 mM were measured in a water phantom using the Siemens SOMATOM Definition Force scanner; gadolinium- and cerium acetate were used as substitutes for the gadolinium-integrated cerium oxide nanoparticles. The relation between the molar concentration of the I, Gd or Ce contrast agent and the Hounsfield value was linear. Concentrations had to be sufficiently high to resolve the contrast agents. Funding: VetenskapsradetSwedish Research Council [VR-NT 2016-05033]

This paper discusses the ways in which 2009 novel swine‐origin influenza A (H1N1) was announced and resonated with current pandemic anxieties. In particular, the US Centers for Disease Control and Prevention (CDC) are used as a lens through which recent pandemic anxieties can be analysed and understood. This entails a closer look at the securitisation of public health and the challenges and struggles this may have caused within public health agencies. In that light, CDC' formal entanglement with global health security and its announcement of the H1N1 pandemic are interpreted, followed by an ethnographically informed focus on various people who were engaged in the H1N1 emergency response and their practices and practical struggles in the face of pandemic anxiety.

BackgroundUnidentified depression in primary care is a public health concern, globally. There is a need for brief, valid and easily administered tools in primary care.AimsTo estimate reliability and validity of the newly developed Primary care Screening Questionnaire for Depression (PSQ4D), a four-item tool, with ‘yes’ or ‘no’ options.MethodPSQ4D was administered verbally (time required, n=827) in six primary care settings in Kerala, India. A psychiatrist evaluated each patient on the same day, using ICD-10 Diagnostic Criteria for Research, based on unstructured clinical interview.ResultsThe Cronbach's alpha for internal consistency reliability was 0.80; kappa coefficient for test-retest reliability was 0.9 and that for interrater reliability was 0.72. At a score ≥2, sensitivity was 0.96, specificity was 0.87, positive predictive value was 0.74, negative predictive value was 0.98, positive likelihood ratio was 7.4 and negative likelihood ratio was 0.05.ConclusionsWhen physician administered, PSQ4D has good reliability. At a cut-off score of ≥2, it has high sensitivity and specificity to identify depressive disorder in primary care.

BackgroundThe psychiatric health burden of prisoners is substantial. However, there is a lack of high-quality studies of psychiatric disorders among young adults with a high risk of reoffending.AimsTo investigate the lifetime prevalence of psychiatric disorders and use of mental health services among young male violent offenders and the impact of childhood-onset conduct disorder (COCD).MethodA nationally representative cohort (n = 270, age 18–25) of male offenders was followed back in medical records and clinically assessed by gold standard methods. Lifetime prevalences are presented together with odds ratios (ORs) as risk estimates in relation to COCD.ResultsPrevious use of psychiatric services among the participants was high but their lifetime psychiatric morbidity was even higher, with 93% meeting criteria for at least one Axis I disorder. The COCD group was overrepresented in most clinical categories and carried five times higher odds (OR = 5.1, 95% CI 2.0–12.8) of a psychotic disorder, three times higher odds (OR = 3.2, 95% CI 1.2–8.5) of a substance use disorder and two times higher odds of a mood disorder (OR = 2.3, 95% CI 1.3–4.0) or anxiety disorder (OR = 2.0, 95% CI 1.1–3.5).ConclusionsThe mental health burden is substantial among young violent offenders, and COCD is an important indicator of future mental health problems which must be a priority for public health efforts.

Recognized for conducting cutting-edge science in the field of radiation health effects research, the Department of Energy's (DOE) Russian Health Studies Program has continued to generate excitement and enthusiasm throughout its 23-year mission to assess worker and public health risks from radiation exposure resulting from nuclear weapons production activities in the former Soviet Union. The three goals of the Program are to: (1) clarify the relationship between health effects and chronic, low-to-medium dose radiation exposure; (2) estimate the cancer risks from exposure to gamma, neutron, and alpha radiation; and (3) provide information to the national and international organizations that determine radiation protection standards and practices. Research sponsored by DOE's Russian Health Studies Program is conducted under the authority of the Joint Coordinating Committee for Radiation Effects Research (JCCRER), a bi-national committee representing Federal agencies in the United States and the Russian Federation. Signed in 1994, the JCCRER Agreement established the legal basis for the collaborative research between USA and Russian scientists to determine the risks associated with working at or living near Russian former nuclear weapons production sites. The products of the Program are peer-reviewed publications on cancer risk estimates from worker and community exposure to ionizing radiation following the production of nuclear weapons in Russia. The scientific return on investment has been substantial. Through 31 December 2015, JCCRER researchers have published 299 peer-reviewed publications. To date, the research has focused on the Mayak Production Association (Mayak) in Ozersk, Russia, which is the site of the first Soviet nuclear weapons production facility, and people in surrounding communities along the Techa River. There are five current projects in the Russian Health Studies Program: two radiation epidemiology studies; two historical dose reconstruction studies and a worker biorepository. National and international standard-setting organizations use cancer risk estimates computed from epidemiological and historical dose reconstruction studies to validate or revise radiation protection standards. An overview of the most important research results will be presented.

Health risks from air pollutants are evaluated by comparing chronic (i.e., an average over 1 yr or greater) or acute (typically 1-hr) exposure estimates with chemical- and duration-specific reference values or standards. When estimating long-term pollutant concentrations via exposure modeling, facility-level annual average emission rates are readily available as model inputs for most air pollutants. In contrast, there are far fewer facility-level hour-by-hour emission rates available for many of these same pollutants. In this report, we first analyze hour-by-hour emission rates for total reduced sulfur (TRS) compounds from eight kraft pulp mill operations. This data set is used to demonstrate discrepancies between estimating exposure based on a single TRS emission rate that has been calculated as the mean of all operating hours of the year, as opposed to reported hourly emission rates. A similar analysis is then performed using reported hourly emission rates for sulfur dioxide (SO2) and oxides of nitrogen (NOx) from three power generating units from a U.S. power plant. Results demonstrate greater variability at kraft pulp mill operations, with ratios of reported hourly to average hourly TRS emissions ranging from less than 1 to greater than 160 during routine facility operations. Thus, if fluctuations in hourly emission rates are not accounted for, over- or underestimates of hourly exposure, and thus acute health risk, may occur. In addition to this analysis, we also demonstrate an additional challenge when assessing health risk based on hourly exposures: the lack of human health reference values based on 1-hr exposures. Implications: Largely due to the lack of reported hourly emission rate data for many air pollutants, an hourly average emission rate (calculated from an annual emission rate) is often used when modeling the potential for acute health risk. We calculated ratios between reported hourly and hourly average emission rates from pulp and paper mills and a U.S. power plant to demonstrate that if not considered, hourly fluctuations in emissions could result in an over- or underestimation of exposure and risk. We also demonstrate the lack of 1-hr human health reference values meant to be protective of the general population, including children.

Kağıt endüstrisi; ülkemizde ve dünyada kişi başına kağıt tüketiminin artmasıyla birlikte büyüyen ve ürün çeşitliliği olan potansiyel bir sektördür. Yapılan bu araştırma ile iş sağlığı ve güvenliği kavramı irdelenerek, son dönemde kağıt sektöründe meydana gelen iş kazaları ve meslek hastalıklarının nedenleri araştırılarak çözüm önerileri geliştirilmiştir.6331 sayılı İş Sağlığı ve Güvenliği Kanununun yürürlüğe girmesi ile birlikte, iş sağlığı ve güvenliği alanında iş kazası ve meslek hastalıklarının gerçekleşmesini önlemeye yönelik bir yaklaşım yasal olarak benimsenmiştir. Aile, Çalışma ve Sosyal Hizmetler Bakanlığı Rehberlik ve Teftiş Başkanlığınca, iş yerlerindeki çalışma ortamının sağlıklı ve güvenli olup olmadığının, iş kazalarını önlemeye yardımcı olan önlemlerin alınıp alınmadığının tespit edilmesi ve varsa uygunsuzlukların giderilmesi amacıyla denetimler yapılmaktadır.Yapılan bu çalışmada, 7 ilde yer alan kağıt ve kağıt ürünleri imalatı yapan 106 iş yerinde, 2014 yılında yapılan denetim verileri derlenerek ve tespit edilen temel riskler sınıflandırılarak denetimlerin iş yeri üzerindeki olumlu etkileri araştırılmıştır. Sektördeki işletmeler için tehlikelerin belirlenerek alınabilecek önlemlerin değerlendirilmesi, pratik ve yol gösterici çözümlerin oluşturulması hedeflenmiştir. Çalışma sonucunda, yapılan proaktif denetimlerin kağıt ürünü imal eden iş yerlerinde yüksek oranda iyileşme sağladığı görülmüştür. Considering modern-day demands with the regard of the varieties and in vast amount of manufacturing, paper industry is a potential sector that grows with the increasing consumption of paper per person. With this thesis, the concept of occupational health and safety has been studied and the solutions of occupational accidents and diseases have been investigated and solution proposals have been developed in the paper industry. With come out of the Occupational Health and Safety Law (6331), an approach to prevent the occurrence of occupational accidents and diseases in the field of occupational health and safety has been legally adopted. By the Head of Guidance and Inspection within the Ministry of Family, Labour and Social Services, inspections are carried out that whether or not exist of health and safety in workplaces, precautions to prevent occupational accidents and eliminated non-conformities. In this study, the positive effects of the inspections on the workplace were investigated by compiling the inspection data in 2014 and the main risks classificated in 106 workplaces manufacturing paper and paper products in 7 provinces. It is aimed to determine the hazards for the workplaces in the sector and to evaluate the precautions that can be taken and to create practical and guiding solutions. Conclusion of the study, it has been observed that proactive inspections have improved greatly in the paper industry workplaces. 88

Epidemics such as viral haemorrhagic fevers, severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus or yet unknown ones have few chances of disappearing. Globalization, worldwide travel, climate change, social conflicts and wars, among others, are likely to favor the emergence of epidemics. Preparedness of hospitals to prevent the spread of these outbreaks is among the prioritized political programmes of many countries. The EuroNHID network has in the past drawn a map of features and equipment of hospitals across Europe to take care of highly contagious patients. We update the data regarding isolation capabilities and recommendations, with an emphasis on Mediterranean countries., peer-reviewed

The United States Department of Health and Human Services (HHS) is fully committed to the development of medical countermeasures to address national security threats from chemical, biological, radiological, and nuclear agents. Through the Public Health Emergency Medical Countermeasures Enterprise, HHS has launched and managed a multi-agency, comprehensive effort to develop and operationalize medical countermeasures. Within HHS, development of medical countermeasures includes the National Institutes of Health (NIH), (led by the National Institute of Allergy and Infectious Diseases), the Office of the Assistant Secretary of Preparedness and Response/Biomedical Advanced Research and Development Authority (BARDA); with the Division of Medical Countermeasure Strategy and Requirements, the Centers for Disease Control and Prevention, and the Food and Drug Administration as primary partners in this endeavor. This paper describes various programs and coordinating efforts of BARDA and NIH for the development of medical countermeasures for radiological and nuclear threats.

The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by healthcare professionals with biodosimetry assays providing critical supporting data.

Introduction Hantaviruses are maintained by mammalian hosts, such as rodents, and are shed in their excretions. Clinical disease can occur in humans from spillover infection. Brown rats (Rattus norvegicus) are the globally distributed reservoir host of Seoul virus (SEOV). Human cases of SEOV-associated haemorrhagic fever with renal syndrome (SEOV-HFRS)have been reported in Great Britain (GB) since 1977. Methods Brown rats (n=68) were trapped from a variety of peridomestic locations, with a focus on pig farms. Kidney and lung tissues were tested for viral RNA using a pan-hantavirus RT-PCR assay followed by Sanger sequencing and analysis. Results SEOV RNA was detected in 19 per cent (13/68, 95% CI 11 to 30) of rats and all sequences fell within SEOV lineage 9. Twelve sequences were highly similar to each other and to the previously reported GB Humber strain of SEOV (98 per cent). One rat SEOV sequence was more distant. The SEOV prevalence in rats from pig farms was significantly greater (p=0.047) than other sites sampled. No significant sex or age differences were observed among positive and negative rats. Discussion The results from this study suggest that SEOV could be widespread in wild rats in GB and therefore pose a potential risk to public health.

Background A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. Methods The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews. Results The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p

Background: Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. Objective: To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. Methods: Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called ‘enumerators’, and households’ members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed. Results: Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p

BackgroundMental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated.AimsTo describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period.MethodThis is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents (n=196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009.ResultsThe hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, andvice versa.ConclusionsMothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.

Tensions in the field have emerged over how best to communicate to the public about genomic discoveries in an era of direct-to-consumer (DTC) DNA testing services available through the Internet. Concerns over what the psychological and behavioral response might be to a nuanced, multiplex risk message have spurred some to offer caution in communicating to the public about personalized risk until the necessary research has been completed on how to communicate effectively. The popularization of DTC testing services, along with a spreading Internet culture on transparency for personal data, may make ‘waiting to communicate’ a moot point. To steer communication efforts in the midst of increasing access to personal genomic information, a self-regulation framework is presented. The framework emphasizes the importance of presenting a coherent message in all communiqués about public health genomics. Coherence should be based on an evidence-based model of how the public processes information about health conditions and an emphasis on risk-to-action links. Recommendations from the President’s Council of Advisors for Science and Technology are reviewed as a way of identifying targets of opportunity for structured communications both within the healthcare system and in the broader external ecosystem of publicly available health information technologies.

The existence of pronounced differences in health outcomes between US populations is a problem of moral significance and public health urgency. Pursuing research on genetic contributors to such disparities, despite striking data on the fundamental role of social factors, has been controversial. Still, advances in genomic science are providing an understanding of disease biology at a level of precision not previously possible. The potential for genomic strategies to help in addressing population-level disparities therefore needs to be carefully evaluated. Using 3 examples from current research, we argue that the best way to maximize the benefits of population-based genomic investigations, and mitigate potential harms, is to direct research away from the identification of genetic causes of disparities and instead focus on applying genomic methodologies to the development of clinical and public health tools with the potential to ameliorate healthcare inequities, direct population-level health interventions or inform public policy. Such a transformation will require close collaboration between transdisciplinary teams and community members as well as a reorientation of current research objectives to better align genomic discovery efforts with public health priorities and well-recognized barriers to fair health care delivery.

The Internet is becoming an important source of information about genetics and holds promise for public health applications. However, the public has concerns about the credibility of online genetics information. We conducted a content analysis of genetics blogs (n = 94). Specifically, we assessed the prevalence of various genetics-related topics and perceived credibility indicators. The relationship between content indicators, credibility indicators, and blog influence, measured as links between blogs, was evaluated. Coverage of issues related to health or self-knowledge (31%) and life science (26%) was most common among genetics blogs. In terms of credibility indicators, most blogs disclosed authors’ full names (81%) and biographical information (67%). Many blog authors reported having genetics (67%) or life science expertise (59%). However, only 7% of blogs were affiliated with educational or medical institutions. Overall, blogs that focused on ancestry, that had authors with life science expertise, and that posted more frequently tended to be more influential. Findings suggest that life scientists and those who blog frequently may figure more centrally in shaping the genetics information available to the public via blogs. There is room for institutions that are likely to be perceived as credible sources of genetics information to assume a greater presence through blogs.

The objective of this World Bank technical assistance has been to support the Government of Bangladesh’s (GoB) national capacity development framework for improving water and sanitation services (WSS) in Bangladesh, focusing on demand-responsive peer-to-peer or horizontal learning processes and improve horizontal accountability communication and monitoring systems to track progress in the sector. This technical assistance is in line with the World Bank country assistance strategy (CAS) which seeks to support the GoB target of ensuring safe drinking water and sanitation for all. It has contributed to strengthening the long-term capacity of the government, in particular the union Parishad (UP) which is responsible for ensuring water and sanitation services for all in Bangladesh.

Background In the Western world, a significant portion of college students have gambled. College gamblers have one of the highest rates of problem gambling. To date, there have been no studies on gambling participation or the rates of problem gambling in India. Aims This study evaluated the prevalence of gambling participation and problem gambling in college students in India. It also evaluated demographic and psychosocial correlates of gambling in that population. Method We surveyed 5784 college students from 58 colleges in the district of Ernakulam, Kerala, India, using cluster random sampling. Students completed questionnaires that addressed gambling, substance use, psychological distress, suicidality and attention-deficit hyperactivity disorder (ADHD). Results A total of 5580 completed questionnaires were returned, and while only 1090 (19.5%) college students reported having ever gambled, 415 (7.4%) reported problem gambling. Lotteries were the most popular form of gambling. Problem gamblers in comparison with non-gamblers were significantly more likely to be male, have a part-time job, greater academic failures, higher substance use, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. In comparison with non-problem gamblers, problem gamblers were significantly more likely to have greater academic failures, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. Conclusions This study, the first to look at the prevalence of gambling in India, found relatively low rates of gambling participation in college students but high rates of problem gambling among those who did gamble. Correlates of gambling were generally similar to those noted in other countries. Since 38% of college students who had gambled had a gambling problem, there is a need for immediate public health measures to raise awareness about gambling, and to prevent and treat problem gambling in this population. Declaration of interest S.G. was (until October 2014) a member of the UK Responsible Gambling Strategy Board, and authored the Royal College of Psychiatrists’ Faculty report FR/AP/01 Gambling: The Hidden Addiction – Future Trends in Addictions (2014). Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Objectives: This study aimed to systematically identify and evaluate the readability and document complexity of currently available family history tools for the general public. Methods: Three steps were undertaken to identify family history tools for evaluation: (a) Internet searches, (b) expert consultation, and (c) literature searches. Tools identified were assessed for readability using the Simple Measure of Gobbledygook (SMOG) readability formula. The complexity of documents (i.e., forms collecting family history information) was assessed using the PMOSE/IKIRSCH document readability formula. Results: A total of 78 tools were identified, 47 of which met the criteria for inclusion. SMOG reading grade levels for multimedia-based tools ranged from 10.1 to 18.3, with an average score of 13.6. For print-based tools, SMOG ranged from 8.7 to 14.1, with an average score of 12.0. Document complexity ranged from very low complexity (level 1 proficiency) to high complexity (level 4 proficiency). Conclusion: The majority of tools are written at a reading grade level that is beyond the 8th grade average reading level in the United States. The lack of family history tools that are easy to read or use may compromise their potential effectiveness in identifying individuals at increased risk for chronic diseases in the general population.

OBJECTIVES: Cigarette price increases reduce smoking prevalence but as a tobacco control policy are undermined by the availability of lower cost alternatives such as hand-rolling tobacco. The aim of this descriptive study is to explore time trends in the price of manufactured cigarettes and hand-rolling tobacco, and in the numbers of people who smoke these products, over recent years in the UK. SETTINGS AND PARTICIPANTS: UK. OUTCOME MEASURES: Trends in the most popular price category (MPPC) data for cigarettes and hand-rolling tobacco from 1983 to 2012 adjusted for inflation using the Retail Price Index, and trends in smoking prevalence and the proportion of smokers using hand-rolling tobacco from 1974 to 2010. RESULTS: After adjustment for inflation, there was an increase in prices of manufactured cigarettes and hand-rolling tobacco between 1983 and 2012. Between 1974 and 2010, the prevalence of smoking fell from 45% to 20%, and the estimated total number of smokers from 25.3 to 12.4 million. However the number of people smoking hand-rolling tobacco increased from 1.4 to 3.2 million, and MPPC cigarette price was strongly correlated with number of people smoking hand-rolling tobacco. CONCLUSIONS: Although the ecological study design precludes conclusions on causality, the association between increases in manufactured cigarette price and the number of people smoking hand-rolling tobacco suggests that the lower cost of smoking hand-rolling tobacco encourages downtrading when cigarette prices rise. The magnitude of this association indicates that the lower cost of hand-rolling tobacco seriously undermines the use of price as a tobacco control measure.

This synthesis report details the process, outputs and intermediate outcomes of the World Bank’s Water and Sanitation Program (WSP) Technical Assistance (TA) to Support Government of India for implementation of the National Urban Sanitation Policy (P131963). The objective of this TA was to (i) strengthen urban sanitation services and target the urban poor by development of strategies for regulation, funds allocation, improved accountability mechanisms and implementation of inclusive sanitation policies at national level and in at least five states, with two of these low-income states (LIS). This was to be supplemented with (ii) enabling design and use of improved performance monitoring systems by Government of India, 3 states and 300 urban local bodies by 2015, and (iii) strengthen capacity of local urban government institutions to provide improved – inclusive and sustainable – sanitation services for all. This TA provides the building blocks for sustainable sanitation improvements which are being adopted and implemented as part of another TA (P131967) in Madhya Pradesh and Tripura to pilot and operationalize City Sanitation Plans (CSPs) towards outcome oriented sector improvements. The areas addressed in this TA include the following specific goals of the NUSP: open defecation free cities, and integrated city-wide sanitation. The TA provided assistance to central government and the states in putting in place various elements identified as necessary for sector improvement, including planning, provisioning and monitoring processes. The TA also identified the need for the cities to see opportunities for financial recovery of investments through reuse and recycle strategies, to strengthen the incentive for investment in sanitation improvements.

Objective: To describe the occurrence of myasthenia gravis in the Baltic area. Methods: Data were obtained from hospital files recorded during the period 1942 to 1996 from neurologists and the patient organisation. Survival data were checked with the Estonian Citizenship and Migration Board. Prevalence was determined on 1 January 1997. A questionnaire on the course of myasthenia gravis was sent to all the prevalent patients. Results: The size of the population surveyed was 1 462 130. The average annual incidence from 1970 to 1996 was 4.0 per million (women, 5.2; men, 2.6). The point prevalence was 99 per million (women, 133; men 59). The incidence in the younger age group (

Objective: To identify the clinical, demographic, and socioeconomic factors that are associated with a poor quality of life in patients with epilepsy in Georgia. Methods: Clinical, demographic, and socioeconomic status data were collected from 115 adult epileptic outpatients being treated in the epilepsy programme at the Sarajishvili Institute of Neurology and Neurosurgery (SINN) in Tbilisi, Georgia. Health Related Quality of Life (HRQL) was measured by the Quality of Life in Epilepsy Inventory (QOLIE-31). Multiple regression analysis was used to determine which variables were associated with QOLIE-31 total and subcomponent scores. Results: Mean age of the patient population was 37.9 (SD 15.8) years; 43.5% were females; 51.8% did not have a partner; 39.1% had some university education; 82.6% were unemployed. Of 115 epileptic patients 83.3% had partial, and 16.7% had generalised seizures. Overall, 32.2% of patients were seizure free, and 28.7% experienced more than 10 seizures over the past year. The variables that most strongly predicted a lower QOLIE-31 total score were a low education level, high seizure frequency, and long duration of epilepsy. The QOLIE-31 all subcomponent scores correlated strongly with seizure frequency. Advanced age was a significant predictor for a low overall quality of life, energy/fatigue, and cognitive scores. Female sex was the factor that significantly predicted a low seizure worry score. Education level strongly correlated with overall quality of life, and cognitive and social functioning scores. Conclusions: Clinical factors such as high seizure frequency and long duration of epilepsy had a significant influence on HRQL. Advanced age, female sex, and a low education level were the demographic factors that correlated strongly with low quality of life scores.

Objectives: To ascertain the prevalence of multiple sclerosis (MS) in the islands of Malta and compare it with a previous study undertaken 21 years earlier, when a remarkably low prevalence was found. Method: Deaths with MS on the death certificate since the last study were reviewed. Sources of information about new patients were the Hospital Activity Analysis scheme, the MS Society of Malta, the records of the state hospitals, long stay private hospitals and nursing homes, lists provided by the state pharmacies, and magnetic resonance imaging, cerebrospinal fluid, and evoked response studies. Prevalence day was 1 January 1999. The Poser classification was used. Results: Since 1978, 17 patients had died with a verified diagnosis of MS on the death certificate. They included all 10 deaths with MS from the original study and two immigrants. Fifty patients had clinically definite MS (CDMS) and 13 clinically probable MS (CPMS). The prevalence of CDMS was 13.2/100 000 (male 11.2, female 15.2). The prevalence of CDMS and CPMS combined was 16.7/100 000 (male 13.3, female 19.9). The annual incidence was 0.7/100 000. Twelve patients were found with CDMS among the 7213 immigrants resident in Malta (166/100 000). The expected rate was 1/100 000, determined at Maltese born rates. There were major changes in the population distribution during the 21 years between the two studies, with a big increase in the age groups with a high risk of MS. There is a longer expectation of life and the diagnosis in now made earlier. Conclusion: Malta still has a low MS prevalence. In comparison with Sicily and other Mediterranean countries of Europe it offers an opportunity to ascertain the genetic and environmental factors responsible for the disease.

BackgroundThe psychometric properties of an online test are not necessarily identical to its paper and pencil original. The aim of this study is to test whether the factor structure of the Community Assessment of Psychic Experiences (CAPE) is measurement invariant with respect to online vs. paper and pencil assessment.MethodThe factor structure of CAPE items assessed by paper and pencil (N = 796) was compared with the factor structure of CAPE items assessed by the Internet (N = 21,590) using formal tests for Measurement Invariance (MI). The effect size was calculated by estimating the Signed Item Difference in the Sample (SIDS) index and the Signed Test Difference in the Sample (STDS) for a hypothetical subject who scores 2 standard deviations above average on the latent dimensions.ResultsThe more restricted Metric Invariance model showed a significantly worse fit compared to the less restricted Configural Invariance model (χ(2)(23) = 152.75, pConclusionsOur findings did not support measurement invariance with respect to assessment method. Because of the small effect sizes, the measurement differences between the online assessed CAPE and its paper and pencil original can be neglected without major consequences for research purposes. However, a person with a high vulnerability for psychotic symptoms would score 4.80 points lower on the total scale if the CAPE is assessed online compared to paper and pencil assessment. Therefore, for clinical purposes, one should be cautious with online assessment of the CAPE.

This qualitative study explored characteristics of a record-keeping log that students would find appealing and be receptive to using. A heterogeneous sample of undergraduate university students aged 18 to 25 years participated. An experienced moderator, using a semistructured interview guide, conducted 13 focus groups (N = 65). All focus groups were audio-recorded and transcribed verbatim. Inductive content analysis was conducted independently by two qualitative researchers. Measures were incorporated throughout the study to ensure data trustworthiness. Four themes illustrated students' suggestions for the log: layout, convenience, maximum distribution, and concerns. In particular, students discussed the use of a computer-based versus a paper-based log, hesitancies in using a log, and the need for: additional health information, multivenue distribution, and low to no cost. Students confirmed that a record-keeping log tailored to their needs and preferences would be attractive and appealing to students.

Using the internet to administer questionnaires for data collection has triggered interest in the past decade of survey research (Israel 2009). In Canada, the general population with access to the internet has grown from 60 % in 2005 to 80 % (Statistics Canada 2011), with young adults following the same trend (Lenhart et al. 2010). However, this trend is not evident across population subgroups as only 54 % of households in the lowest income quartile have access to the internet (Statistics Canada 2011). It is thought that web questionnaire administration can help in countering low response rates and growing research costs, but we were concerned that it should not create socio-economic selection bias problems. Researchers have questioned the influence of invitations that promote access to web versions of questionnaires only, hereby defined as ‘‘Web-only’’ invitations (Kwak and Radler 2002). Indeed, ‘‘Mixed-mode’’ invitations, hereby defined as invitations promoting additional modes of response (paper copy, phone or face-to-face interviews, etc.), have had relative success in increasing response rates (Shih and Fan 2007; Zuidgeest et al. 2011; Van den Berg et al. 2011). With the internet use trends changing rapidly, few recent studies have examined whether response rate and socio-economic status are associated with invitation methods in a population of young adults. In this paper, we report results from a study in which we tested whether adding a paper version of a questionnaire to a mailed invitation (a Mixed-mode invitation) will leads to a sample with different modes of response (i.e. telephone, mail or web), rates of response and socio-demographic characteristics when compared with a Web-only mailed invitation. This study was undertaken within the purview of a larger study entitled the Interdisciplinary Study of Inequalities in Smoking (ISIS), whose goal is to better understand the effects of neighbourhood and individual characteristics in the inequitable socio-economic distribution of smoking across Montreal neighbourhoods.

There have been considerable advances in the past few years in our understanding of how chronic kidney disease (CKD) predisposes to acute kidney injury (AKI) and vice versa. This review shows, however, that few studies have focused on the elderly or conducted stratified analysis by age. It does appear that elderly patients with estimated glomerular filtration rate (eGFR) 45–59 ml/min/1.73 m2 are at higher risk for AKI compared with their counterparts with eGFR >60 ml/min/1.73 m2. This is a similar relationship to that seen in younger patients, although effect size appears smaller. As the incidence of AKI has been increasing over the past several years, the proportion of elderly patients surviving after AKI has also been increasing. Since AKI heightens the risk for the development and acceleration of CKD, this implies significant public health concerns with regard to the absolute number of elderly persons developing incident CKD.

Traumatic brain injury (TBI) in infants and children remains a public health problem of enormous magnitude. It is a complex and heterogeneous condition that presents many diagnostic, therapeutic and prognostic challenges. A number of investigative teams are studying pediatric TBI both in experimental models and in clinical studies at the bedside. This review builds on work presented in a prior supplement to Developmental Neuroscience that was published in 2006, and addresses several active areas of research on this topic, including (1) the application of novel imaging methods, (2) the use of serum and/or CSF biomarkers of injury, (3) advances in neuromonitoring, (4) the development and testing of novel therapies, (5) developments in modeling pediatric TBI, (6) the consideration of a new approach to classification of pediatric TBI, and (7) assessing the potential impact of the development of pediatric and neonatal neurocritical care services on the management and outcome of pediatric TBI.

Objectives: This study examined the levels of genetic knowledge, health literacy and beliefs about causation of health conditions among individuals in different age groups. Methods: Individuals (n = 971) recruited through 8 community health centers in Suffolk County, New York, completed a one-time survey. Results: Levels of genetic knowledge were lower among individuals in older age groups (26–35, p = 0.011; 36–49, p = 0.002; 50 years and older, pConclusions: Providing additional information that compensates for their lower genetic knowledge may help individuals in older age groups benefit from rapidly emerging genetic health information more fully. Increasing the levels of genetic knowledge about common complex diseases may help motivate individuals to engage in health promoting behaviors to maintain healthy weight through increases in behavioral causal attributions.

Aims: This study assessed parent knowledge of newborn screening (NBS) and parent attitudes toward NBS for untreatable conditions, NBS for late-onset disorders and informed consent in NBS. Methods: Seventeen qualitative focus groups were held in Alaska, California, Hawaii, and Washington with mothers of children 10 years old or younger. Results: Most participants did not recall receiving information about NBS, and all wanted this information prenatally. In addition, most felt that the current system of ‘informed dissent’ was adequate, provided they were told about NBS prior to delivery. All women supported NBS for conditions that occur in infancy without a proven treatment. However, they disagreed about NBS for disorders that manifest in late childhood or adulthood. Conclusions: The results show a general consensus among the focus group participants about issues that cause dissent among public health and health care professionals. Parent attitudes differ from those of many professional communities with regard to timing of NBS education, informed consent, NBS for disorders that lack an effective treatment, and predictive testing of children for late-onset disorders. The results highlight the need to further research parent opinions about expanded NBS using new technologies and to include parents in the development of NBS policies.

Genomic research is transforming our understanding of the role of genes in health and disease. These advances, and their application to common diseases that affect large segments of the general population, suggest that researchers and practitioners in public health genomics will increasingly be called upon to translate genomic information to individuals with varying levels of health literacy and numeracy. This paper discusses the current state of research regarding public understanding of genetics and genomics, the influence of health literacy and numeracy on genetic communication, and behavioral responses to genetic and genomic information. The existing research suggests that members of the general public have some familiarity with genetic and genomic terms but have gaps in understanding of underlying concepts. Findings from the limited research base to date indicate that health literacy affects understanding of print and oral communications about genetic and genomic information. Numeracy is also likely to be an important predictor of being able to understand and apply this information, although little research has been conducted in this area to date. In addition, although some research has examined behavior change in response to the receipt of information about genetic risk for familial disorders and genomic susceptibility to common, complex diseases, the effects of health literacy and numeracy on these responses have not been examined. Potential areas in which additional research is needed are identified and practical suggestions for presenting numeric risk information are outlined. Public health genomics researchers and practitioners are uniquely positioned to engage in research that explores how different audiences react to and use genomic risk information.

With the domestic and international proliferation of biobanks and their associated connections to health information databases, scholarly attention has been turning from the ethical issues arising from the construction of biobanks to the ethical issues that emerge in their operation and management. Calls for greater transparency in governance structures, coupled with stern reminders of the value of maintaining public trust, are seen as critical components in the success of these resources. Two different approaches have been adopted for addressing these types of ethical issues: the first is a ‘top-down’ approach which focuses on developing policy, procedures, regulations and guidelines to aid decision-makers. The second is a ‘bottom-up’ approach, which begins with those who are most affected by the issues and attempts to inductively develop consensus recommendations and policy. While both approaches have merit, I argue that more work needs to be done on ‘bottom-up’ strategies if trust and transparency are to be more than mere slogans. Using 2 case examples from Indiana, the paper summarizes data from a set of surveys we recently conducted that address issues arising from biobanks that provide some insight into issues associated with trust and transparency.

Testing for genetic variation in drug response, in order to improve the safety and efficacy of drug therapy, is both intuitively appealing and scientifically grounded. The impact on health care could be significant, given the potentially disruptive effect of pharmacogenomic testing on clinical practice, reimbursement policies, research and development, and perhaps most significantly, on the approach of patients to their own health care, as argued by Carlson in this issue [1]. But as with many scientific innovations, transformation into medical applications has proven complicated. Though many gene variants are known to play a role, drug response is a complex phenomenon, influenced by factors such as diet, co-morbidities, and even other drugs. Thus, the predictive value of many potential pharmacogenomic tests remains small, and their clinical utility is generally not yet established. These considerations lead Garrison to argue that the impact of pharmacogenomics is likely to be moderate – an evolution or refinement rather than a revolution – and as with most new healthcare technologies, change will take decades to fully work through the healthcare system [2]. Given these uncertainties, it is not yet possible to forecast the public health impact of pharmacogenomics. It is clear, however, that important scientific, social, and policy issues need to be addressed to optimize the potential benefits to patients and the public's health. These include careful consideration of incentives – such as research funding, partnership development, and reimbursement mechanisms – and oversight. The needs and expectations of both clinicians and patients must be considered, and unanticipated consequences, such as the potential ‘nocebo’ effect described by Haga and colleagues [3], must be considered. And as with other genomic research, limitations in study design or analysis may lead to overly simplistic interpretations of population differences in drug response, with potential adverse consequences for how tests and drugs are used [4]. The papers in this special issue illustrate the broad range of scientific, ethical, and social issues to be considered as the field develops. Pharmacogenomics has different potential applications and the settings that offer the greatest opportunities are difficult to predict. To some extent, opportunities will be influenced by the nature of the scientific and clinical challenge. Given the adverse effects and variable responses associated with cancer chemotherapy and the somatic genetic variation inherent in the biology of cancer, it is not surprising that some of the most promising applications of pharmacogenomics are found in oncology [5, 6]. In general, though, the benefits of pharmacogenomics may relate most to issues of service delivery. Patients receiving ‘state of the art’ care from clinicians, involving close follow-up, monitoring for adverse effects, and appropriate dose adjustments and drug changes, may be least likely to benefit from pharmacogenomic guidance. But if patients receiving less than ideal care stand to receive the greatest benefit, we are faced with the conundrum that these patients are typically the least likely to have access to ‘fancy’ new technologies. The good news is that testing costs for many well-known pharmacogenomic variants as well as genome-wide scanning are dropping dramatically. And logistical aspects of actual testing have evolved to the point of direct patient access and ‘mail-in’ testing. These observations underscore the importance of rigorous health services research to explore the potential for pharmacogenomics to be truly cost-saving, or at a minimum, cost-effective. In this context, how might pharmacogenomics improve public health specifically? Two examples, one involving drug safety and the other drug effectiveness, provide useful examples. Warfarin is a widely used drug with a narrow therapeutic index: approximately 3–10% of warfarin users experience a serious bleeding event each year, and some of these events are fatal. Testing for variants in the CYP2C9 and VKORC1 genes identifies individuals with lower warfarin dosing requirements and could provide a means to prescribe the drug more safely [7]. Even a small reduction in bleeding episodes could have a positive effect on public health. However, the ability of testing to improve outcomes beyond those achieved in a ‘state of the art’ anticoagulation clinic has not been shown to date, and indeed may prove to be challenging. Therefore, evaluation of pharmacogenomic applications in diverse patient populations and settings will be important to determine where they provide most value. The populations likely to benefit the most may also be the most challenging to collaborate with because of logistical issues, cultural barriers, and difficulties conducting research studies in real-world settings. Research partnerships that promote community participation and shared governance may be an important component of successful pharmacogenomic research. In addition to reducing adverse events, pharmacogenomics might also improve the efficacy of drug treatment. Tamoxifen is a widely used adjuvant treatment to prevent the recurrence of early stage breast cancer. Tamoxifen is actually a ‘pro-drug’ – that is, it needs to be activated via the body's metabolic enzymes. Studies have indicated that variants of CYP2D6 may be associated with the risk of breast cancer recurrence: women with a low-activity variant of CYP2D6 have less active metabolites of tamoxifen and thus may have lower effectiveness [8]. There is no effective approach to monitoring women for their response to tamoxifen over time. Fortunately, there is a good drug alternative, aromatase inhibitors, which have been shown to be at least equally efficacious, but these are significantly more expensive than tamoxifen. The clinical and patient impact of breast cancer recurrence is obviously significant, and CYP2D6 testing with tamoxifen therapy would appear to be an ideal application of pharmacogenomics, especially in resourcelimited situations. Several questions must be resolved: Is the genetic association with disease recurrence (and/or survival) valid? And what level of evidence would be required to recommend testing? Does genetic testing provide a means to optimize the use of a less expensive drug in a cost-effective manner, and if so, will clinicians and patients find this an acceptable approach? As with drug safety, effective strategies for community-based research are needed. The promise of pharmacogenomics will not be realized without effective leadership. Despite rapid growth of the pharmacogenomic literature, research addressing clinical outcomes is still very limited [9]. And with costs dropping, collaborative effort is needed to minimize the dangers of premature translation. For example, analysis of a test marketed as a means to reduce the risk of hearing loss from aminoglycosides indicated little scientific evidence of benefit, lack of cost effectiveness, and a potential for net harm [10]. Leadership is needed to assure oversight mechanisms that either prevent such tests from reaching the marketplace or assure that clinicians and consumers are well informed of their limitations when they do. At the same time, reimbursement policies that provide appropriate incentives for development are needed, with reasonable standards for clinical utility [11]. Perhaps most important, infrastructures will be required to assure adequate evaluation of pharmacogenomic testing in a range of routine clinical settings so that meaningful evaluation of the risks and benefits (both clinical and social) can occur. Robust partnerships between industry and academia [12], careful attention to research ethics [13], and methods to incorporate patient perspectives [14] will all be important in this effort. If researchers, health care leaders, policy makers, and test developers can work cooperatively and in concert with patients to achieve these goals, benefits to public health are likely.

Background Non-Hodgkin's lymphomas (NHLs) have been linked to proximity to industrial areas, but evidence regarding the health risk posed by residence near pollutant industries is very limited. The European Pollutant Emission Register (EPER) is a public register that furnishes valuable information on industries that release pollutants to air and water, along with their geographical location. This study sought to explore the relationship between NHL mortality in small areas in Spain and environmental exposure to pollutant emissions from EPER-registered industries, using three Poisson-regression-based mathematical models. Methods Observed cases were drawn from mortality registries in Spain for the period 1994–2003. Industries were grouped into the following sectors: energy; metal; mineral; organic chemicals; waste; paper; food; and use of solvents. Populations having an industry within a radius of 1, 1.5, or 2 kilometres from the municipal centroid were deemed to be exposed. Municipalities outside those radii were considered as reference populations. The relative risks (RRs) associated with proximity to pollutant industries were estimated using the following methods: Poisson Regression; mixed Poisson model with random provincial effect; and spatial autoregressive modelling (BYM model). Results Only proximity of paper industries to population centres (>2 km) could be associated with a greater risk of NHL mortality (mixed model: RR:1.24, 95% CI:1.09–1.42; BYM model: RR:1.21, 95% CI:1.01–1.45; Poisson model: RR:1.16, 95% CI:1.06–1.27). Spatial models yielded higher estimates. Conclusion The reported association between exposure to air pollution from the paper, pulp and board industry and NHL mortality is independent of the model used. Inclusion of spatial random effects terms in the risk estimate improves the study of associations between environmental exposures and mortality. The EPER could be of great utility when studying the effects of industrial pollution on the health of the population.

Using data from the North Carolina School Asthma Survey about the respiratory health of 64,432 adolescents attending public schools in North Carolina and data provided by school employees about the environmental health conditions of the school buildings, we assessed the prevalence of daytime wheezing during the past year among students estimated to be exposed to air pollutants arising from pulp and paper mills located near the schools. Of the schools the students attended, 14% (37/266) were located within 30 miles of one or more pulp and paper mills and odor from the mills was identified by survey respondents for 9 of the 266 schools. The prevalences of daytime wheezing in smokers and nonsmokers with household cigarette smoke exposure were elevated among students attending schools located within 30 miles of a pulp and paper mill, compared to the prevalence among students attending schools located beyond 30 miles (⩽10 miles, prevalence ratio (PR): 1.21, 95% confidence interval (95% CI): 0.99, 1.43; 10–⩽30 miles, PR: 1.06, 95% CI: 0.96, 1.16) and among students attending schools with noticeable odor from a pulp and paper mill (PR: 1.12, 95% CI: 0.93, 1.31). These results indicate a possible association between paper mill location and wheezing symptoms among adolescents and suggest that community-based exposure to pulp and paper mill emissions may have a greater impact on smokers and individuals exposed to cigarette smoke in the home than on nonsmokers without such household exposure.

Liquid packaging board (LPB) collected in Germany is processed in Finland as recycled fibre and as plastic reject for incineration. The chemical, biological and physical changes occurring in recycled LPB bales were monitored during storage of six and 18 months. The moisture content in the core of the bales ranged from 7% to 53%, and pH values varied from 6.0 to 8.5. The average amount of mesophilic bacteria per container was 1.5 x 10(7) - 5 x 10(8), which means that recycled LPB pulp cannot be recommended for sanitary use. The concentration of CO2 inside the bale is an indicator of the activity of aerobic microorganisms and might be suitable for identifying deteriorated bales and removing them from the production line. Insects were found in some bales and the more deteriorated the bale was the more species of insects were found. The results showed the conversion of cellulose into humic acids to be clearly underway in some recycled LPB bales. The bale samples were extracted into hot water and into fulvic acids and humic acid (HA) fractions. The concentration of the humic acid fraction varied in the range 0.3-0.6% of the organic matter in fresh bales and 2.2% in one old bale. During aging nitrogen was enriched in all fractions.

Background Adiponectin is an adipocyte-derived hormone that acts as a marker of insulin sensitivity. Bloodspot sampling by fingerstick onto filter paper may increase the feasibility of large-scale studies of the determinants of insulin sensitivity. We first describe the validation of an enzyme-linked immunoassay (ELISA) for quantifying adiponectin from dried blood spots and then demonstrate its application in a large trial (PROBIT). Methods We quantified adiponectin from 3-mm diameter discs (≈3 µL of blood) punched from dried blood spots obtained from: i) whole blood standards (validation); and ii) PROBIT trial samples (application) in which paediatricians collected blood spots from 13,879 children aged 11.5 years from 31 sites across Belarus. We examined the distribution of bloodspot adiponectin by demographic and anthropometric factors, fasting insulin and glucose. Results In the validation study, mean intra-assay coefficients of variation (n = 162) were 15%, 13% and 10% for ‘low’ (6.78 µg/ml), ‘medium’ (18.18 µg/ml) and 'high’ (33.13 µg/ml) internal quality control (IQC) samples, respectively; the respective inter-assay values (n = 40) were 23%, 21% and 14%. The correlation coefficient between 50 paired whole bloodspot versus plasma samples, collected simultaneously, was 0.87 (95% CI: 0.78 to 0.93). Recovery of known quantities of adiponectin (between 4.5 to 36 µg/ml) was 100.3–133%. Bloodspot adiponectin was stable for at least 30 months at −80°C. In PROBIT, we successfully quantified fasting adiponectin from dried blood spots in 13,329 of 13,879 (96%) children. Mean adiponectin (standard deviation) concentrations were 17.34 µg/ml (7.54) in boys and 18.41 µg/ml (7.92) in girls and were inversely associated with body mass index, fat mass, triceps and subscapular skin-fold thickness, waist circumference, height and fasting glucose. Conclusions Bloodspot ELISA is suitable for measuring adiponectin in very small volumes of blood collected on filter paper and can be applied to large-scale studies.

The possible risks of infection associated with the practice of licking envelopes, stamps and labels were investigated. Although pathogenic bacteria and viruses were not isolated from sample envelopes obtained from various sources, the gums used in manufacture were found to exert a protective effect against death from desiccation on the bacteria and viruses which had been introduced into them.Staph. aureus and Salm. paratyphi Bremained viable for several months in dried films of two out of four gums tested. An echovirus could be recovered from similar films for up to 30 days, and an adenovirus for up to 10 days.Bacterial multiplication occurred in the gum used for the manufacture of postage stamps. The comparison is drawn between the possible consequences of minimal contamination of this gum and of cans of corned beef in the light of recent studies.

Received for publication July 17, 1957. Paper NS 235 from the Department of Veterinary Science, University of Wisconsin, Madison, published with the approval of the director of the Wisconsin Agricultural Experiment Station. * On leave from the Central Institute of Hygiene, Zagreb, Yugoslavia. Many of the blood samples from wild birds were collected by Drs. L. E. Starr and R. L. Watson, Georgia Department of Public Health. Dr. Watson is now Public Health Veterinarian, U. S. Public Health Service, Baltimore, Maryland.