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This paper demonstrates the impact of an endemic fossorial animal, plateau pika (Ochotona curzoniae), on soil properties and N2O flux at the Zoige Wetland. Pika burrow and control sites without disturbance by pika were selected to measure the soil water content, bulk density, soil organic matter (SOM), NH4-N content and NO3-N content in August 2012. N2O fluxes were measured with static opaque chambers at these sites in June and August 2012. Pika burrowing altered soil aeration by transferring deeper soil to the surface and by constructing underground burrows, which significantly increased bulk density, and reduced soil water content, SOM and NH4-N content at 0–10 cm and 10–20 cm soil depth. N2O flux had a significant correlation with bulk density, SOM and NH4-N content. Pika burrowing significantly influenced N2O flux by increasing N2O flux at the control site from near zero to 0.063±0.011 mg m-2 h-1. Our findings described how pika burrowing influences the soil traits and significantly increases the principal greenhouse gas N2O emission. As plateau pika was commonly considered as a pest, our findings give a novel clue to effectively manage populations of plateau pika on the Qinghai-Tibet Plateau from the perspective of greenhouse gas emission. [ABSTRACT FROM AUTHOR]

Background: Oxytocin is the gold standard drug for the prevention of postpartum haemorrhage, but limitations in cold chain systems in resource-constrained settings can severely compromise the quality of oxytocin product available in these environments. This study investigated the perspectives and practices of stakeholders in low and lower-middle income countries towards oxytocin, its storage requirements and associated barriers, and the quality of product available. Methods: Qualitative inquiries were undertaken in Ethiopia, India and Myanmar, where data was collected through Focus Group Discussions (FGDs) and In-Depth Interviews (IDIs). A total of 12 FGDs and 106 IDIs were conducted with 158 healthcare providers (pharmacists, midwives, nurses, doctors and obstetricians) and 40 key informants (supply chain experts, program managers and policy-makers). Direct observations of oxytocin storage practices and cold chain resources were conducted at 51 healthcare facilities. Verbatim transcripts of FGDs and IDIs were translated to English and analysed according to a thematic content analysis framework. Findings: Stakeholder awareness of oxytocin heat sensitivity and the requirement for cold storage of the drug was widespread in Ethiopia but more limited in Myanmar and India. A consistent finding across all study regions was the significant barriers to maintaining a consistent cold chain, with the lack of refrigeration facilities and unreliability of electricity cited as major challenges. Perceptions of compromised oxytocin quality were expressed by some stakeholders in each country. Conclusion: Knowledge of the heat sensitivity of oxytocin and the potential impacts of inconsistent cold storage on product quality is not widespread amongst healthcare providers, policy makers and supply chain experts in Myanmar, Ethiopia and India. Targeted training and advocacy messages are warranted to emphasise the importance of cold storage to maintain oxytocin quality. [ABSTRACT FROM AUTHOR]

Background: So far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life(HRQOL) of the elderly. Objective: This study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China. Methods: The data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly. Results: The EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA,LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health. Conclusion: The findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children. [ABSTRACT FROM AUTHOR]

Background: It is a wide-spread assumption about footbinding that footbound girls and women were more of an economic burden on their families than those never bound. It is often presumed that government policies and missionary campaigns ended footbinding. Methods/ Objectives: We use regression and log-likelihood tests, with bootstrapping for confirmation, to analyze which of a series of ethnographically and historically hypothesized variables significantly correlate with footbinding. We also consider an indirect measure of government prohibitions. We analyze two large datasets based on oral surveys with elderly women of the last footbound generations from 12 inland Chinese provinces. Conclusions: Handicraft production, particularly commercial handicraft production, correlates with whether Chinese girls were subjected to footbinding before 1950. Girlhood knowledge of government prohibitions against footbinding, an indirect measure of awareness by the adults who decided whether to bind a girl’s feet, did not correlate with whether women were ever footbound. Spinning cotton thread for commercial purposes (sale, wage, direct exchange) correlated with greater daily production, with great county-level variation in quantity produced. Moreover, Chinese commercial spinners labored more years before marriage than domestic spinners. Implications: Chinese daughters—whether footbound or not—made important economic contributions to rural households, thus suggesting a need to revise our understanding of China’s gender and economic history. Further implications of our results are that research is warranted on the assumed efficacy of government prohibitions—in both rural and urban areas—and on the presumption that footbinding among elite Chinese women was unrelated to economic concerns, including handicraft production. The demonstrated economic correlates of footbinding in inland, rural China also suggest a need to reevaluate whether contemporary customs controlling and cloistering girls and women, such as female genital cutting in Africa and the threat of honor killings of girls and women in South Asia, might have economic correlates. [ABSTRACT FROM AUTHOR]

The present study aimed to assess socioeconomic inequalities in general and mental health, depression and substance use disorders (daily tobacco use, hazardous alcohol use). Data from the 2010 SIRS (French acronym for Health, Inequalities, and Social Ruptures) study, which is deemed to be representative of the French-speaking adult population living in the Paris Metropolitan Area, were analysed. Different socioeconomic position indicators were selected: education, income and perceived financial status. Absolute measures (the slope index of inequality (SII)) and relative measures (the odds ratio (OR) and relative index of inequality (RII)) of health inequalities were used. The OR, RII and SII were adjusted for age, household type and migration characteristics and all analyses were performed separately for men and women. The study included 3,006 adults. The results showed significant relative and absolute socioeconomic inequalities in general, mental health and depression for all socioeconomic position indicators considered (education, income, and perceived financial status). The absolute inequalities were greater for women than for men. Strongest inequalities were observed by perceived financial status for men and women. Education seemed to play a stronger role in inequalities for women, whereas, for men, income seemed to play a stronger role. Only few socioeconomic inequalities were found in daily tobacco use, while a reversed gradient was observed for hazardous alcohol use. We hope that these results will be regularly re-evaluated and compared across time in order to monitor socioeconomic inequalities in health. [ABSTRACT FROM AUTHOR]

Animal-vehicle collisions have become a serious traffic safety issue. Collisions have steadily increased over the last few decades, as have their associated socio-economic costs. Here, we explore the spatial and temporal patterns of animal-vehicle collisions reported to authorities in the province of Seville, southern Spain. Most animal-vehicle collisions involved domestic animals (>95%), particularly dogs (>80%), a pattern that sharply contrasts with that found in other Spanish and European regions, where collisions are mostly caused by game species. Dog-vehicle collisions were related to the traffic intensity of the roads and they were more frequent around dawn and dusk, coinciding with the peaks of activity of dogs. This pattern was consistent throughout the week, although on weekends there were fewer collisions due to lower traffic density at those times. These findings suggest that the aggregation of dog-vehicle collisions around twilight likely resulted from a combined effect of the activity peaks of dogs and traffic density. Seasonally, collisions increased in autumn and winter, coinciding with the period of intense hunting activity in the region. Further, during autumn and winter, rush hour partly overlaps with twilight due to longer nights in comparison with summer and spring, which may contribute to the increased rate of dog-vehicle collisions in these seasons. Spatially, satellite images of nighttime lights showed that dog-vehicle collisions were clustered near urban areas. Overall, the high incidence of stray dogs involved in animal-vehicle collisions highlights a road safety issue with this type of animals in the region. [ABSTRACT FROM AUTHOR]

Introduction: Maternal mortality is one of the significant health indicators of any country and it’s a frequent subject in many global heath discussions. Even though the global trends have shown a decrease on maternal mortality, many countries in sub-Saharan Africa failed to achieve the MDG 5 target in 2015.There is no specific single solution for reducing maternal mortality but there is unanimity that a reliable health system with skilled personal is vital for addressing maternal mortality. This study therefore seeks to identify the risk factors for maternal mortality in typical rural sub-Saharan African countries. Method: A longitudinal population based cohort study was conducted using data from 2000–2014 in Africa Health Research Institute (AHRI).The Cox regression method was used to assess the influence of selected risk factors using the Mosley-Chen model on maternal mortality. A total of 20701 women aged 15–49 years were included in the study. Results: The study found 212 maternal deaths from 32,620 live births with a maternal mortality ratio (MMR) of 650 per 100,000 live births. The main causes of death were Communicable diseases (38.2%), Aids and TB (31%) and Unknown causes (11.8%). An increased risk of death was identified on, poor wealth index (HR 3.92[1.01, 15.3]), period of death 2000–2006(HR32.1 [3.79, 71.5]) and number of deliveries (6.76[2.70, 16.9]) were associated with a high risk of maternal mortality after adjusting for other independent variables included in the study. Conclusion: Socio-economic status, number of deliveries and period of death were found to be associated with maternal death in rural South Africa. [ABSTRACT FROM AUTHOR]

Background: During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014–2015 EVD epidemic. Methodology/Principal findings: We performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014–July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as “potential cases”. Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases. We analyzed 25,830 contact tracing records for contacts who had monitoring initiated or were last exposed between June 4, 2014 and July 13, 2015. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during this period. Eighty-eight percent of contacts completed monitoring, and 334 contacts were identified as potential cases (PPV = 1.4%). Potential cases were more likely to be detected early in the outbreak; hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness compared to contacts who completed monitoring. Conclusions/Significance: Contact tracing was a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, these data suggest there were limitations to its performance—particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies. [ABSTRACT FROM AUTHOR]

The conservation of biodiverse areas around the world has contributed to the protection and recovery of endangered species. This has been the case for 11 species of Galapagos giant tortoises (Chelonoidis spp.) that today are successfully maintained over six islands: Española, Santiago, Pinzon, Isabela, San Cristobal and Santa Cruz. A favourable state of conservation will depend however on future development in the islands. In Santa Cruz Island the development of the agricultural areas has encroached on the migratory routes of the southwestern species C. porteri and may be an emergent conflict for tortoise conservation. We investigated the social and ecological inter-linkages using two methods framed under a participatory rural appraisal (PRA) approach: semi-structured interviews and questionnaires to study farmers’ perceptions and attitudinal factors regarding giant tortoises; as well as the associated socio-economic impacts of the conflict. Moreover, we coupled the PRA approach with an ecological assessment of giant tortoises’ population density by performing transect counts during the two yearly phases of giant tortoises’ migration to the lowlands (January to June) and back to the highlands (July to December). Our results indicate that farmers reporting damage and cultivating crops have higher odds of taking actions (fencing and physical actions) towards giant tortoises; regardless of having (or not) a negative perception towards the species. The economic losses for crops and fences averaged 2.8 USD/m2 and 13USD/m, respectively, and provide an initial step to further analyse and characterise the direct and indirect damage costs. Finally, we estimated a density of 76 and 185 individuals of giant tortoises per km2 in the rural area for the lowland and highland migratory phases, respectively. Our approach provides grounded scientific social and ecological information to effectively inform and aid managers, policy and decision makers in the selection of adequate social and ecological criteria to implement the best available options in the resolution of this emergent conservation conflict. [ABSTRACT FROM AUTHOR]

Urban agriculture has become a common form of urban land use in European cities linked to multiple environmental, social and economic benefits, as well as to diversified forms (from self-production allotments to high-tech companies). Social acceptance will determine the development of urban agriculture and specific knowledge on citizens’ perception is required in order to set the basis for policy-making and planning. The ecosystem services provided by urban agriculture can be determinant in this process. The goal of this paper is to evaluate the social acceptance and the perceived ecosystem services of urban agriculture in the city of Bologna (Italy), as an example of a Southern European city. In particular, we evaluated the preferences for urban land uses, for different typologies of urban agriculture and for the resulting products, the perceived provision of ecosystem services and the willingness to engage in new initiatives. A survey that investigated these topics (including open questions, closed questions and Likert-scale evaluation) was performed on the citizens of Bologna (n = 380) between October and November 2016. Results showed that urban agriculture is widely accepted by the inhabitants of Bologna, particularly regarding vegetable production. Although intensive farming systems were the least preferred forms to be implemented in Bologna, citizens highly accepted a large variety of urban agriculture goods, with preference for those obtained from plants as compared to animal products. The willingness-to-pay for urban food products was mostly the same as for conventional ones, although the participants recognised the social values, proximity and quality of the former. Socio-cultural ecosystem services were perceived as more valuable than environmental ones. Policy-making recommendations can be extracted from the results to facilitate the development of urban agriculture plans and policies. [ABSTRACT FROM AUTHOR]

Risk maps of dengue disease offer to the public health officers a tool to model disease risk in space and time. We analyzed the geographical distribution of relative incidence risk of dengue disease in a high incidence city from Colombia, and its evolution in time during the period January 2009—December 2015, identifying regional effects at different levels of spatial aggregations. Cases of dengue disease were geocoded and spatially allocated to census sectors, and temporally aggregated by epidemiological periods. The census sectors are nested in administrative divisions defined as communes, configuring two levels of spatial aggregation for the dengue cases. Spatio-temporal models including census sector and commune-level spatially structured random effects were fitted to estimate dengue incidence relative risks using the integrated nested Laplace approximation (INLA) technique. The final selected model included two-level spatial random effects, a global structured temporal random effect, and a census sector-level interaction term. Risk maps by epidemiological period and risk profiles by census sector were generated from the modeling process, showing the transmission dynamics of the disease. All the census sectors in the city displayed high risk at some epidemiological period in the outbreak periods. Relative risk estimation of dengue disease using INLA offered a quick and powerful method for parameter estimation and inference. [ABSTRACT FROM AUTHOR]

This study aims to analyse the relationship between intergenerational educational mobility and the overall health of the Indian women. It uses a nationally representative survey, India Human Development Survey (IHDS) 2011–12, and logistic regressions to study this relationship. The sample comprises of women aged 45 years and older. We find that the women experiencing upward intergenerational educational mobility (vis-a-vis their mothers) have significantly higher chances of experiencing good overall health compared to the women who are having same or lesser level of education as that of their mothers. Besides, women suffering from short term or major morbidity have remarkably lower chances of having overall good health. Also, women from rural India have significantly lesser chances of having overall good health as compared to that of urban areas. Further, Muslim women have lesser chances of having overall good health as that of women from other religious categories. Moreover, there is a significant variation in the overall health of women as we move from the eastern region to the western region of India. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess the regional deprivation and individual factors that influence how far a person will travel to access dental care. Using data from the Korea Health Panel (2008 to 2011), we selected a group of 4,256 subjects and geocoded their homes and dental hospitals/clinics. Using the road network analysis, we calculated the distance traveled by the subjects for dental care. We used the generalized estimating equation (GEE) for repeated data analysis and included an interaction term between regional deprivation and individual income to determine the effects of the two factors on the choice of a dental hospital/clinic. When the regional deprivation index was divided into three quarters (high, middle, and low), urban areas had higher”high” and “low" levels of deprivation, and rural areas had relatively higher middle level of deprivation. GEE regression showed that the level of education, regional deprivation level, and income all affected the distance traveled to dental clinics. The regional deprivation level had a higher association than income with the travel distance. At the same income level, subjects who lived in the least deprived areas were more likely to travel longer distances than subjects living in the most deprived areas. Regarding the distribution of dental hospitals/clinics, incentive based dental polices for either dental providers or patients are needed that will assure the delivery of dental care despite spatial inequality. [ABSTRACT FROM AUTHOR]

Prenatal health care interventions are effective ways to improve maternal and neonatal health. There have been few large investigations conducted on the inequalities in maternal health services utilization in Shaanxi Province of west China since the health care reform in 2009. This study examined the inequalities and determinants of maternal health services utilization in Shaanxi Province. A household survey was conducted from August to November in 2013. By using a multistage sampling method, local women aged 15–49 who had given birth in the preceding three years were recruited. Information including social-demographic characteristics and maternal health services utilization was collected through a face-to-face interview. A concentration index approach was used to measure inequalities in maternal health services utilization. A logistic regression model was employed to investigate the determinants of maternal health services utilization. There were 8,488 women from urban areas and 18,724 women from rural areas enrolled in this study. The concentration index for all the indicators of maternal health services utilization showed significance in these two areas. In urban areas, the concentration index of having 5 or more prenatal visits, receiving the first prenatal visit within 12 weeks, delivering at secondary- or higher-level health facilities and delivering by C-section were 0.0356, 0.0166, 0.0177 and 0.0591, respectively, while in rural areas, the corresponding figures were 0.0385, 0.0183, 0.0334 and 0.0566, respectively. The determinants related to maternal health services utilization were women’s age at delivery, educational level, employment status, parity, health problems during pregnancy and household income. Inequalities in maternal health services utilization still exist in Shaanxi Province. Providing maternal health services for younger, less educated, unemployed, high parity and poorer women, especially in rural areas, is expected to reduce the inequalities in maternal health services utilization. [ABSTRACT FROM AUTHOR]

On the Qinghai-Tibetan Plateau, the high-altitudinal gradients can negatively affect plant distribution and limit plant growth and reproduction. Leymus secalinus (Georgi) Tzvel. is an important forage crop on the Qinghai-Tibetan Plateau and has an excellent ability to fix sand and improve soil. To evaluate the effect of altitude on the physiological characteristics of L. secalinus on the Qinghai-Tibetan Plateau, we measured the lipid peroxidation; chlorophyll a (Chl a), chlorophyll b (Chl b), total carotenoid (Car), soluble protein, proline and soluble sugar contents; and the activities of superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) in leaves from eight different altitudes in Minhe County and Huangzhong County. The leaves were collected at the initial bloom stage, and the average vertical distance between two adjacent collection sites was approximately 100 meters. The reduction in Chl a and Chl b contents and the increase in Car contents can allow plants to weaken their light absorption and avoid photodamage to the chloroplast. The decrease in malondialdehyde (MDA) content associated with lower lipid peroxidation, and the changes of CAT, SOD and POD activities reflect a higher reactive oxygen species (ROS) scavenging capacity in high-altitude plants. The increase in proline and soluble sugar contents with elevation suggests that proline and soluble sugar may play a key role in the osmotic adjustment of plants in alpine regions. The results suggested that altitudinal gradients negatively affect L. secalinus on the Qinghai-Tibetan Plateau and that the adaptation mechanism and survival strategies of L. secalinus were attributed to the combined effects of multiple protective strategies. [ABSTRACT FROM AUTHOR]

The central part of Jalisco, Mexico, has experienced low-magnitude earthquake sequences and swarms. Although the effects of these earthquakes have been limited to relatively small areas, the earthquakes have caused general alarm among the population and, in some cases, have been catastrophic. These earthquake swarms are significant because they affect the most populous area of the state, including the capital city of Guadalajara. An extraordinary example is an earthquake swarm that started on 8 May 1912 and lasted until September of that year. The region remained seismically quiescent until May 2012, when seismic activity resumed, lasting to the present. We analyze the recent seismic activity, starting with the earthquake of 18 May 2012 (03:07 UT) at the western edge of Lake Chapala and ending with the magnitude 4.2 earthquake on 3 November 2016. Our analysis includes eight earthquakes with magnitudes between 3.5 and 4.8, the revision of hypocenter locations, and the determination of focal mechanism solutions using the inversion of the moment tensor method. When possible, inversion solutions are compared with solutions obtained with the first arrival polarity method. We compare our results for the recent seismicity with the distribution of reported damage associated with historical earthquakes. Our work indicates a N-S trending seismic source zone and an orientation of nodal planes that suggests reactivation of preexisting local faults induced by the interaction of the western border of the Trans-Mexican Volcanic Belt with the eastern border of the Jalisco Block. [ABSTRACT FROM AUTHOR]

Wild boar (Sus scrofa) population spread into urban and periurban areas has exacerbated conflicts with humans. There is a need for planned wild boar management strategies, and Population viability analysis (PVA) combined with perturbation analyses allow the assessment of the management effort of control methods. Our study aims to develop stochastic predictive models of the increasing wild boar population of the 80 km2 peri-urban Mediterranean area of Collserola Natural Park (CNP), located near Barcelona, Spain, as well as assessing specific management measures (including reduced food availability, selective harvest, and reduction in fertility). Population parameters were estimated from previously published census and hunting data provided by the CNP and the local hunting administration. The results revealed that under the current conditions the CNP wild boar population will continue to increase. The most efficient strategy to reduce wild boar abundance was a combination of reducing supplementary anthropogenic food resources and selective removal of juvenile (<1 year) and yearling (1–2 years) wild boar. These strategies will probably be also the most efficient ones in other oversupplemented increasing wild boar populations in similar situations, although specific studies will be needed to fine-tune the best management option for each context. PVA allows the prediction of future population trends and the assessment of the efficacy and efficiency of potential management strategies before implementing management measures. [ABSTRACT FROM AUTHOR]

Dengue is a prevalent disease in Colombia and all dengue virus serotypes (DENV-1 to -4) co-circulate in the country since 2001. However, the relative impact of gene flow and local diversification on epidemic dynamics is unknown due to heterogeneous sampling and lack of sufficient genetic data. The region of Santander is one of the areas with the highest incidence of dengue in Colombia. To provide a better understanding of the epidemiology of dengue, we inferred DENV population dynamics using samples collected between 1998 and 2015. We used Bayesian phylogenetic analysis and included 143 new envelope gene sequences from Colombia, mainly from the region of Santander, and 235 published sequences from representative countries in the Americas. We documented one single genotype for each serotype but multiple introductions. Whereas the majority of DENV-1, DENV-2, and DENV-4 strains fell into one single lineage, DENV-3 strains fell into two distinct lineages that co-circulated. The inferred times to the most recent common ancestors for the most recent clades of DENV-1, DENV-2, and DENV-4 fell between 1977 and 1987, and for DENV-3 was around 1995. Demographic reconstructions suggested a gradual increase in viral diversity over time. A phylogeographical analysis underscored that Colombia mainly receives viral lineages and a significant diffusion route between Colombia and Venezuela. Our findings contribute to a better understanding of the viral diversity and dengue epidemiology in Colombia. [ABSTRACT FROM AUTHOR]

Achieving access to safe water and sanitation still pose major challenges in urban areas of sub-Saharan Africa countries, despite all the progress achieved in the last decade. This study assessed the ability of populations living in poor peri-urban settlements to access improved water and sanitation and identified factors influencing this access, in order to guide sustainable mitigating solutions to address associated health and environmental risks. We conducted a cross-sectional study in six poor peri-urban settlements of Yopougon, the largest municipality of Abidjan. A total of 556 randomly selected households were included. The factors associated with access to improved water and sanitation were identified through explanatory models using multivariate logistic regression. A proportion of 25% of all households assessed did not have access to clean water and 57% lacked improved sanitation. Socioeconomic status and settlement characteristics appear as the main indicators of poor access to reliable water and sanitation in peri-urban settlements. The presence of the household head’s wife at home was associated with greater access to clean water (OR = 3.57; 95% CI: 1.74, 7.31), thus highlighting the important role of women in ensuring access to clean water in these specific environments. Household size, education and religion were not significantly associated with the two considered outcomes. Women therefore should be involved at all levels of programming in water promotion in these settlements to improve the population’s well-being. While religion does not appear to play an important role in access to water and sanitation, successful interventions should involve religious communities because of their large representation. [ABSTRACT FROM AUTHOR]

Background: The control of Triatoma dimidiata, a major vector of Chagas disease, was believed to eliminate Trypanosoma cruzi transmission in Central America. This vector was known for its ability to repeatedly reinfest human dwellings even after initial insecticide spraying. Current vector control programs assume that community-based surveillance can maintain low levels of infestation over many years, despite a lack of evidence in the literature to corroborate this assumption. This study aims to evaluate long-term reinfestation risk in the Nicaraguan vector control program from 2010 to 2016. Methods: We collected data from a cohort of 395 houses in Pueblo Nuevo, Nicaragua. Primary data were collected through a field survey to assess post-intervention levels of T. dimidiata house infestation in 2016, two years after the large-scale insecticide spraying. We obtained secondary data from the records about past infestation levels and control activities between 2010 and 2015. Multilevel mixed-effects logistic regression analyses were used to identify factors associated with post-intervention house infestation. Results: The control program effectively reduced the infestation level from 2010 to 2014. Community-based surveillance was introduced in 2013; however, post-intervention infestation in 2016 had nearly reached pre-intervention levels in rural villages. Post-intervention house infestation was positively associated with poor wall construction, roofing tiles piled in the peri-domestic areas or the presence of dogs. Interestingly, the odds of post-intervention house infestation were one-fifth less when villagers sprayed their own houses regularly. Past infestation levels and the intensity of government-led insecticide spraying did not explain post-intervention house infestation. Conclusions: The vector control program failed to offer sustained reductions in T. dimidiata house infestation. This experience would suggest that community-based surveillance is an insufficient approach to suppressing T. dimidiata house infestation over many years. This study provides evidence to suggest that control policies for T. dimidiata should be reconsidered throughout Central America. [ABSTRACT FROM AUTHOR]

Objectives: Non-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003−2013 and explore how these changes differ by subpopulation. Methods: Three independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003. Results: In 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly. Conclusions: Chronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases. [ABSTRACT FROM AUTHOR]

In the past four decades, there has been an increase in the occurrence of zoonotic diseases. Some outbreaks have been devastating because of the inability of individuals and health workers to identify the diseases early. Generally, most zoonotic diseases are heralded by a fever. While fevers are common, they are often the symptoms of different diseases. This paper explores how a population at potential risk of zoonotic diseases identify fevers, and what treatments they seek when they develop fevers. The data are from focus group discussions and a survey of three communities in the Brong Ahafo, Volta and Greater Accra regions in Ghana. The quantitative data were analysed using descriptive statistics while the qualitative data were analysed using thematic analysis. The findings indicate that the perceived causes of fever differ from the traditional biomedical view. While orthodox treatment was the preferred choice for most participants, rural dwellers utilised traditional medicine more than their urban counterparts. Though there is no record of bat-borne zoonotic disease in Ghana, our findings could be used as a proxy to indicate how populations at risk of exposure might respond in the event of a spillover event from a zoonosis. We recommend that educational campaigns on zoonotic diseases should target rural dwellers, especially farmers, who may be most at risk of zoonoses. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs. Methods: Cross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20–59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs. Results: Compared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs. Conclusions: Implementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills. [ABSTRACT FROM AUTHOR]

Salmonella enterica serovar Napoli (serovar Napoli) is an emerging cause of human salmonellosis in Northern Italy. No specific reservoirs of serovar Napoli have been identified in Italy, so far. However, the environment, especially surface waters, has been hypothesized as an important source of infection based on the observation that genotypically different clusters of serovar Napoli are detected in different geographical macro-areas. To further support the hypothesis of a spatially-restricted pattern of serovar Napoli diffusion, a spatial segregation of serovar Napoli lineages should be observed also at smaller geographical scale. However, classical genotyping techniques used for Salmonella, such as pulsed-field gel electrophoresis (PFGE), did not possess enough discriminatory power to highlight spatial clustering of serovar Napoli within the macro-areas. To this purpose, we performed phylogeographical analyses based on genome-wide single nucleotide polymorphisms to test whether spatio-temporal evolution patterns of serovar Napoli in Northern Italy could be recognized with high geographical resolution, i.e. at local level. Specifically, we analyzed the local spread of the main PFGE clonal group, responsible for more than 60% of human infections in the study area, that did not show any geographical differentiation by PFGE within Northern Italy, i.e. the macro-area considered in the study. Both discrete and continuous phylogeography highlighted the existence of two main geographically-restricted clades: a Southern clade corresponding to the Po Valley and a Northern clade corresponding to the Pre-Alps area. Furthermore, the phylogeographical analyses suggested that the most probable site of origin of the clone was in an area of the Po Valley at the confluence of the Po and Ticino rivers, one of the most important Italian wetlands. These findings provide further support to the hypothesis that environmental transmission may play an important role in the ecology of serovar Napoli. [ABSTRACT FROM AUTHOR]

With rapid economic growth since the 21st century, cities in China have experienced considerable economic and social reconstruction. Driven by rapid industrialization, urban spatial structures are undergoing evolution and change. Therefore, this paper analyzes the processes and mechanisms associated with the evolution of the commercial spatial structure in Guangzhou after the financial crisis in 2008 based on both theoretical and empirical analyses. We use a Dirichlet multinomial regression (DMR) model to extract latent semantic information and determine urban functional areas from global positioning system (GPS) and point-of-interest (POI) data collected in Guangzhou in 2009 and 2013. In addition, we use movement patterns and POI data to identify the evolution of Guangzhou's commercial zones from 2009 to 2013. The results show that the urban commercial structure in Guangzhou gradually changed from a single-center model to a multi-center model with dispersed clusters and that the distribution of the entire spatial structure changed. Meanwhile, Guangzhou’s commercial structure not only varied over time but also exhibited specific geographical features. This paper demonstrates that the proposed method can clearly identify the boundary of the commercial area in Guangzhou and provides a valid spatial-temporal model of change in the city. Moreover, this study not only expounds the future development trends of the urban spatial structure in Guangzhou from a microcosmic perspective but also provides a scientific basis for clarifying the spatial locations and development advantages of urban functions within the city. [ABSTRACT FROM AUTHOR]

Many urban indicators and functional citywide properties have been shown to scale with population due to agglomeration effects. We hypothesize that scaling relations may also exist for water-related urban indicators such as the water footprint. The water footprint is an indicator of water use that measures humans’ appropriation of freshwater resources. We analyze the scaling of the water footprint for 65 mid- to large-sized US cities using both empirical estimates and a social interaction network model of city functioning. The network model is used to explain the presence of any scaling exponent in the empirical estimates of the urban water footprint by linking to previous theories of urban scaling. We find that the urban water footprint tends to approximately show sublinear scaling behavior with both population and gross domestic product. Thus, large cities tend to be more water footprint efficient and productive than mid-sized cities, where efficiency and productivity are quantified, in a broad sense, as deviations from a linear scaling exponent. We find the sublinear scaling may be linked to changes in urban economic structure with city size, which lead to large cities shifting water intensive economic activities to less populated regions. In addition, we find that green water contributes to the scaling both positively by transferring the dependence of food consumption on population into the water footprint and negatively by increasing heterogeneity. Overall, the proposed scaling relations allow for the comparison of water footprint efficiency and productivity of cities. Comparing these properties and identifying deviations from the expected behavior has implications for water resources and urban sustainability. [ABSTRACT FROM AUTHOR]

Background: The incidence of canine rabies cases in El Salvador has decreased in the last decade since the establishment of intense control programs, such as massive vaccination campaigns implemented by the Ministry of Health. Socioeconomic crises in recent years have limited the access to certain areas across the country and have impacted surveillance and prevention campaigns, which places the country at risk for a resurgence of canine rabies.We aimedto describe the spatiotemporal patterns of canine rabies and its association with critical social factors in El Salvador from 2005 to 2014. Method: We included 459 cases of canine rabies. Several socioeconomic, demographic, and surveillance variables were modeled using a Poisson regression to evaluate their associations with the incidence of canine rabies. Spatial scan statistics were adjusted or unadjusted with covariates and applied to identify statistically significant clusters of canine rabies. Finally, a canine rabies risk map was created. Results: A positive association and higher risk of canine rabies were found for low poverty zones, where it is suspected that urban slums contribute to ongoing rabies transmission (RR = 7.74). Violence had a negative association with rabies (RR = 0.663), which is likely due to reporting bias. Significant clusters were identified in all five epidemiological regions, and the Eastern region had the highest risk (RR = 50.62). The influences of the selected variables in cluster detection were confirmed by the adjusted analysis. Higher-risk townships were distributed from the Western to the Eastern regions of the country. Conclusion: Social factors are determinants of rabies in El Salvador and play a major role in national spatial patterns of the disease. There are high-risk areas for canine rabies across the country, and there were two persistent rabies foci during the study period. Examining the role of social factors can provide better insight into rabies in vulnerable countries, and socioeconomic factors can be key elements in developing better policies and interventions for rabies control. [ABSTRACT FROM AUTHOR]

It is unknown whether urban versus rural residency affects pancreatic cancer survival in a universal tax-financed healthcare system. We conducted a nationwide, population-based cohort study of all patients diagnosed with pancreatic cancer in Denmark from 2004–2015. We used nationwide registries to collect information on characteristics, comorbidity, cancer-directed treatment, and vital status. We followed the patients from pancreatic cancer diagnosis until death, emigration, or 1 October 2017, whichever occurred first. We truncated at five years of follow up. We stratified patients into calendar periods according to year of diagnosis (2004–2007, 2008–2011, and 2012–2015). We used Cox proportional hazards model to compute hazard ratios (HRs) with associated 95% confidence intervals (CIs) of death, comparing patients in urban and rural areas. HRs were adjusted for age, sex, comorbidity, tumor stage, and localization. In a sub-analysis, we also adjusted for cancer-directed treatment. We included 10,594 patients diagnosed with pancreatic cancer. Median age was 71 years (inter-quartile range: 63–78 years), and half were men. The majority (61.7%) lived in an urban area at the time of diagnosis. When adjusting for potential confounders, we observed a better survival rate among pancreatic cancer patients residing in urban areas compared with rural areas (adjusted HR: 0.92; 95% CI: 0.87–0.98). When taking treatment into account, the association was unclear (adjusted HR: 0.96; 95% CI: 0.88–1.04). Pancreatic cancer patients residing in urban areas had a slightly better survival rate compared with patients in rural areas. [ABSTRACT FROM AUTHOR]

Objective: To investigate medicine accessibility and antibiotic use in households in western China using World Health Organization (WHO) methodology as well as to identify the influencing factor of care-seeking outside the home and primary determinant factors that influence the use of antibiotics in Chinese residents. Methods: A cross-sectional household survey was conducted from March to July 2015, and 1200 households from six cities in Sichuan China were selected for a questionnaire survey using stratified multistage random cluster sampling. We used logistic regression models to identify the determinants of care-seeking outside the home and subsequent antibiotic use among the surveyed residents. Results: Overall, 1103 valid questionnaires were collected, and 458 households reported that they had had experienced at least one acute illness in the previous 2 weeks. Of these households, 97.2% of individuals with acute conditions sought care outside their homes and 40.1% of individuals who took medicine received antibiotics. Only 15.9% of the individuals with acute conditions reported that the medical insurance reimbursement covered at least one medicine. According to the multivariate analyses, women were less likely to seek care outside the home compared to men. Among those who sought outside care, fever and upper respiratory symptoms increased the odds of taking antibiotics, and visiting a private hospital also increased antibiotic use. Low-income households were less likely to receive antibiotics. Symptoms were strong determinants of antibiotic use when patients sought outside care. Conclusion: The accessibility of medicine for acute illness among households in western China was favorable; however, medical insurance reimbursement must be improved. The nature of the symptoms and patterns of care-seeking had the greatest influence on the decision to take antibiotics among residents with acute conditions. The percentage of antibiotic use in patients with acute illness has declined, but the indications for using antibiotics must be standardized. [ABSTRACT FROM AUTHOR]

Background: The near-surface urban drainage system in Shanghai is highly complex, with hundreds of thousands of catch basins (CBs) and manhole chambers (MCs). Comparatively little is known about the breeding of mosquitoes in this vast system, especially for the locally predominant species Aedes albopictus. A cross-sectional mosquito sampling study was conducted from late July to early August of 2017 using 539 CBs and 309 MCs located in 10 communities of downtown Shanghai. We measured the water-holding status of the drainage systems and density of mosquito larvae. Mosquito species were examined on site and in the laboratory later. Results: The CBs were characterized by a lower percentage of standing water compared to MCs (47.0% vs. 79.9%, respectively; X2 = 76.407, P<0.001), but CBs contained a higher percentage of stagnant water percent than MCs (45.2% vs. 35.3%, respectively; X2 = 11.465, P = 0.001). There were exclusively two species of mosquito larvae found in the drainage systems, Ae. albopictus and Culex pipiens complex. Compared with MCs, the structures of CBs were more conducive to larval production and yielded more larvae-positive samples (43.4% vs 14.2%, X2 = 53.136, P<0.001) and higher larval density (8.23 vs. 4.09 per dipper, t = 3.287, P = 0.001). Aedes albopictus was the predominant species in CBs, with a constituent ratio of 71.7%. Regarding structures with different features in different locations, CBs that had a vertical grate with an unsealed lid and MCs with plastic composite covers were the most favorable types for mosquito breeding, and residential neighborhoods yielded the highest number of Ae. albopictus. Conclusion: Aedes albopictus was the predominant species in both CBs and stormwater MCs, especially in residential neighborhoods. CBs, particularly those with vertical grates, were a major source of mosquito production in downtown Shanghai. MCs featured more running water and fewer larvae by percentage, and few larvae were found in Sewage MCs. However, due to the tremendous baseline amount, MCs were still an important breeding source of mosquitoes. We suggest that Aedes control in Shanghai should focus on CBs or other potential larvae habitats in and around residential neighborhoods. The use of permeable materials and completely sealed covers should be adopted in the construction of CBs and MCs henceforth. [ABSTRACT FROM AUTHOR]

Background: Being aware of consumption patterns of antimicrobials is the first step in designing and implementing strategies to change behaviors and, thus, to reduce the occurrence of antimicrobial resistance. The present survey was carried out to identify and describe the use of antimicrobials without prescription in riverside dwellers of the Brazilian Amazon Basin. Methods: A cross-sectional study was carried out from a conglomerate stratified sample in the rural municipality of Coari, Amazonas State, Brazil, between April and July 2016. The survey was conducted in the riverside dwellers’ homes, and information was collected on all antimicrobials taken with and without medical or dental prescription for a 30-day period, together with indications of their use before the interview. Results: A total of 492 riverside dwellers were included in the present survey; 346 (70.3%) had taken at least one medication during the previous month, and 74 (21.3% of those taking a medicine) used an antimicrobial. Two-thirds of the patients treated with an antimicrobial (49; 66.2%) obtained it without a prescription. Additionally, one-third of the antimicrobials consumed by the study sample (25) were used for non-infectious or non-bacterial conditions. Discussion: The present survey showed not only that inappropriate use of antimicrobials is present in remote places such as the Amazon Basin, but also that one-third of those antimicrobials were taken to treat non-infectious or non-bacterial conditions. In addition to an unnecessary risk of adverse effects to the exposed populations, the inappropriate use of antibiotics without prescription helps to increase antibiotic-resistant strains. In the present case, this was happening near one of Latin America’s most important water supplies, which could contribute to the global impact of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Urbanization is associated with higher prevalence of cardiovascular disease worldwide. Aortic stiffness, as measured by carotid-femoral pulse wave velocity is a validated predictor of cardiovascular disease. Our objective was to determine the association between urbanization and carotid-femoral pulse wave velocity. The analysis included 6166 participants enrolled in an ongoing population-based study (mean age 42 years; 58% female) who live in an 80 × 80 km region of southern India. Multiple measures of urbanization were used and compared: 1) census designations, 2) satellite derived land cover (crops, grass, shrubs or trees as rural; built-up areas as urban), and 3) distance categories based on proximity to an urban center. The association between urbanization and carotid-femoral pulse wave velocity was tested in sex-stratified linear regression models. People residing in urban areas had significantly (p < 0.05) elevated mean carotid-femoral pulse wave velocity compared to non-urban populations after adjustment for other risk factors. There was also an inverse association between distance from the urban center and mean carotid-femoral pulse wave velocity: each 10 km increase in distance was associated with a decrease in mean carotid-femoral pulse wave velocity of 0.07 m/s (95% CI: -0.09, -0.06 m/s). The association was stronger among older participants, among smokers, and among those with other cardiovascular risk factors. Further research is needed to determine which components in the urban environment are associated with higher carotid-femoral pulse wave velocity. [ABSTRACT FROM AUTHOR]

The World Intellectual Property Organization's Intergovernmental Committee on Intellectual Property and Genetic Resources, Traditional Knowledge and Folklore (IGC) is negotiating a text in anticipation of a Diplomatic Conference to agree on binding obligations for traditional knowledge (TK). The holders of this TK are Indigenous Peoples and "local communities This article addresses the identity of local communities in the context of TK. The analysis shows that "local communities" are likely to be very broadly conceived as groupings of people linked by social ties and shared common perspectives across generations in some form o f geographical location or setting. If this is intended, then TK as a new form of intellectual property will have a very broad application and a very exciting future for practitioners that extends TK well into the economies of developed countries. [ABSTRACT FROM AUTHOR]

The rapidly developing economy and growing urbanization in China have created the largest rural-to-urban migration in human history. Thus, a comprehensive understanding of the pattern of rural flight and its prevalence and magnitude over the country is increasingly important for sociological and political concerns. Because of the limited availability of internal migration data, which was derived previously from the decennial population census and small-scale household survey, we could not obtain timely and consistent observations for rural depopulation dynamics across the whole country. In this study, we use aggregate location-aware data collected from mobile location requests in the largest Chinese social media platform during the period of the 2016 Chinese New Year to conduct a nationwide estimate of rural depopulation in China (in terms of the grid cell-level prevalence and the magnitude) based on the world’s largest travel period. Our results suggest a widespread rural flight likely occurring in 60.2% (36.5%-81.0%, lower-upper estimate) of rural lands at the grid cell-level and covering ~1.55 (1.48–1.94) million villages and hamlets, most of China’s rural settlement sites. Moreover, we find clear regional variations in the magnitude and spatial extent of the estimated rural depopulation. These variations are likely connected to regional differences in the size of the source population, largely because of the nationwide prevalence of rural flight in today’s China. Our estimate can provide insights into related investigations of China’s rural depopulation and the potential of increasingly available crowd-sourced data for demographic studies. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab. Methods: A cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence. Results: 5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%–4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%–3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08–2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62–3.95) and was most strongly associated with those aged 40–49 (adjusted odds ratio 40–49 vs. 19–29-year-olds 3.41; 95% CI: 1.90–6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10–1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16–0.82). Genotype 3 (58%) was most common among infected individuals. Discussion: The study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals. [ABSTRACT FROM AUTHOR]

Jerald Fagliano and Ana Diez Roux discuss the challenges of climate change in an urban environment, but also opportunities for healthier lifestyles and green spaces. [ABSTRACT FROM AUTHOR]

Background: Past studies have demonstrated an association between waterborne disease and heavy precipitation, and climate change is predicted to increase the frequency of these types of intense storm events in some parts of the United States. In this study, we examined the linkage between rainfall and sewage contamination of urban waterways and quantified the amount of sewage released from a major urban area under different hydrologic conditions to identify conditions that increase human risk of exposure to sewage.Methods and Findings: Rain events and low-flow periods were intensively sampled to quantify loads of sewage based on two genetic markers for human-associated indicator bacteria (human Bacteroides and Lachnospiraceae). Samples were collected at a Lake Michigan estuary and at three river locations immediately upstream. Concentrations of indicators were analyzed using quantitative polymerase chain reaction (qPCR), and loads were calculated from streamflow data collected at each location. Human-associated indicators were found during periods of low flow, and loads increased one to two orders of magnitude during rain events from stormwater discharges contaminated with sewage. Combined sewer overflow (CSO) events increased concentrations and loads of human-associated indicators an order of magnitude greater than heavy rainfall events without CSO influence. Human-associated indicator yields (load per km2 of land per day) were related to the degree of urbanization in each watershed. Contamination in surface waters were at levels above the acceptable risk for recreational use. Further, evidence of sewage exfiltration from pipes threatens drinking water distribution systems and source water. While this study clearly demonstrates widespread sewage contamination released from urban areas, a limitation of this study is understanding human exposure and illness rates, which are dependent on multiple factors, and gaps in our knowledge of the ultimate health outcomes.Conclusions: With the prediction of more intense rain events in certain regions due to climate change, sewer overflows and contamination from failing sewer infrastructure may increase, resulting in increases in waterborne pathogen burdens in waterways. These findings quantify hazards in exposure pathways from rain events and illustrate the additional stress that climate change may have on urban water systems. This information could be used to prioritize efforts to invest in failing sewer infrastructure and create appropriate goals to address the health concerns posed by sewage contamination from urban areas. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to describe current practices of medical waste management, including its generation, investments, collection, storage, segregation, and disposal, and to explore the level of support from upper tiers of the government and health care system for medical waste management in rural China. Methods: The authors draw on a dataset comprised of 209 randomly selected rural township health centers (THCs) in 21 counties in three provinces of China: Anhui, Shaanxi and Sichuan. Surveys were administered to health center administrators in sample THCs in June 2015. Results: The results show that the generation rate of medical waste was about 0.18 kg/bed, 0.15 kg/patient, or 0.13 kg/person per day on average. Such per capita levels are significant given China’s large rural population. Although investments of medical waste facilities and personnel in THCs have improved, results show that compliance with national regulations is low. For example, less than half of hazardous medical waste was packed in sealed containers or containers labeled with bio-hazard markings. None of the THCs segregated correctly according to the categories required by formal Chinese regulations. Many THCs reported improper disposal methods of medical waste. Our results also indicate low levels of staff training and low rates of centralized disposal in rural THCs. Conclusions: Medical waste is a serious environmental issue that is rising on the agenda of policymakers. While a large share of THCs has invested in medical waste facilities and personnel, it appears that actual compliance remains low. Using evidence of low rates of training and centralized disposal, we surmise that a lack of support from upper tiers of management is one contributing factor. Given these findings, we recommend that China’s policymakers should enhance support from upper tiers and improve monitoring as well as incentives in order to improve medical waste management. [ABSTRACT FROM AUTHOR]

One of the world’s most important crops, barley, was domesticated in the Near East around 11,000 years ago. Barley is a highly resilient crop, able to grown in varied and marginal environments, such as in regions of high altitude and latitude. Archaeobotanical evidence shows that barley had spread throughout Eurasia by 2,000 BC. To further elucidate the routes by which barley cultivation was spread through Eurasia, simple sequence repeat (SSR) analysis was used to determine genetic diversity and population structure in three extant barley taxa: domesticated barley (Hordeum vulgare L. subsp. vulgare), wild barley (H. vulgare subsp. spontaneum) and a six-rowed brittle rachis form (H. vulgare subsp. vulgare f. agriocrithon (Åberg) Bowd.). Analysis of data using the Bayesian clustering algorithm InStruct suggests a model with three ancestral genepools, which captures a major split in the data, with substantial additional resolution provided under a model with eight genepools. Our results indicate that H. vulgare subsp. vulgare f. agriocrithon accessions and Tibetan Plateau H. vulgare subsp. spontaneum are closely related to the H. vulgare subsp. vulgare in their vicinity, and are therefore likely to be feral derivatives of H. vulgare subsp. vulgare. Under the eight genepool model, cultivated barley is split into six ancestral genepools, each of which has a distinct distribution through Eurasia, along with distinct morphological features and flowering time phenotypes. The distribution of these genepools and their phenotypic characteristics is discussed together with archaeological evidence for the spread of barley eastwards across Eurasia. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to explore the misconceptions, knowledge gaps and constructs of leptospirosis among 72 respondents from rural and urban districts in two states of Malaysia. We conducted focus group discussions and data were examined using thematic analyses. The layman term of ‘rat urine disease’ contributed the most to the misconceptions regarding leptospirosis. There were gaps in the knowledge among urban and rural respondents in the two states, with the majority of subjects demonstrating a poor understanding of the disease. Construction of knowledge about leptospirosis relied mostly on the information provided by mass and social media; reading materials; word-of-mouth publicity; observations; experiences; and knowledge sharing among families, friends, and communities. The study findings may provide the foundation for the development of educational materials that may reduce the gaps in knowledge, and thereby improve health literacy and enhance preventive health behaviours for avoiding leptospirosis. [ABSTRACT FROM AUTHOR]

The human genetic diversity around the world was studied through several high variable genetic markers. In South America the demic consequences of admixture events between Native people, European colonists and African slaves have been displayed by uniparental markers variability. The mitochondrial DNA (mtDNA) has been the most widely used genetic marker for studying American mixed populations, although nuclear markers, such as microsatellite loci (STRs) commonly used in forensic science, showed to be genetically and geographically structured. In this work, we analyzed DNA from buccal swab samples of 296 individuals across Peru: 156 Native Amazons (Ashaninka, Cashibo and Shipibo from Ucayali, Huambiza from Loreto and Moche from Lambayeque) and 140 urban Peruvians from Lima and other 33 urban areas. The aim was to evaluate, through STRs and mtDNA variability, recent migrations in urban Peruvian populations and to gain more information about their continental ancestry. STR data highlighted that most individuals (67%) of the urban Peruvian sample have a strong similarity to the Amazon Native population, whereas 22% have similarity to African populations and only ~1% to European populations. Also the maternally-transmitted mtDNA confirmed the strong Native contribution (~90% of Native American haplogroups) and the lower frequencies of African (~6%) and European (~3%) haplogroups. This study provides a detailed description of the urban Peruvian genetic structure and proposes forensic STRs as a useful tool for studying recent migrations, especially when coupled with mtDNA. [ABSTRACT FROM AUTHOR]

In this study we apply two methods for data collection that are relatively new in the field of atmospheric science. The two developed methods are designed to collect essential geo-localized information to be used as input data for a high resolution emission inventory for residential wood combustion (RWC). The first method is a webcrawler that extracts openly online available real estate data in a systematic way, and thereafter structures them for analysis. The webcrawler reads online Norwegian real estate advertisements and it collects the geo-position of the dwellings. Dwellings are classified according to the type (e.g., apartment, detached house) they belong to and the heating systems they are equipped with. The second method is a model trained for image recognition and classification based on machine learning techniques. The images from the real estate advertisements are collected and processed to identify wood burning installations, which are automatically classified according to the three classes used in official statistics, i.e., open fireplaces, stoves produced before 1998 and stoves produced after 1998. The model recognizes and classifies the wood appliances with a precision of 81%, 85% and 91% for open fireplaces, old stoves and new stoves, respectively. Emission factors are heavily dependent on technology and this information is therefore essential for determining accurate emissions. The collected data are compared with existing information from the statistical register at county and national level in Norway. The comparison shows good agreement for the proportion of residential heating systems between the webcrawled data and the official statistics. The high resolution and level of detail of the extracted data show the value of open data to improve emission inventories. With the increased amount and availability of data, the techniques presented here add significant value to emission accuracy and potential applications should also be considered across all emission sectors. [ABSTRACT FROM AUTHOR]

Introduction: The global incidence of snakebite is estimated at more than 2.5 million cases annually, with greater than 100,000 deaths. Historically, Myanmar has one of the highest incidences of venomous snakebites. In order to improve the health outcomes of snakebite patients in Myanmar, access to accurate snakebite incidence data is crucial. The last population-based study in Myanmar was conducted more than a decade ago. In 2014, the Ministry of Health and Sports data from health facilities indicated an incidence of about 29.5 bites/ 100,000 population/year (a total of 15,079 bites). Since data from health facilities lack information about those who do not seek health care from government health services, a new population-based survey was conducted in 2 rural areas of Mandalay region. The survey data were compared to those obtained from healthcare services. Method: 4,276 rural respondents in Kyaukse and Madaya townships in Mandalay Division were recruited using cluster sampling that involved random selection of 150 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire. Results: One respondent from each of 4,276 households represented 19,877 residents from 144 villages. 24 people in these households had suffered snakebite during the last one year giving an annual incidence of 116/100,000. During the last ten years, 252 people suffered snakebites. 44.1% of the victims were women. 14% of the villages reported 4 or more bites during the last ten years, whereas 27% villages reported no snakebites. 92.4% of the victims recovered fully, 5.4% died, and 2% suffered long term health issues. One victim was reported to have died from causes unrelated to the snakebite. While there was no statistically significant difference between outcomes for children and adults, 4 of 38 of those under 18 years of age died compared to 7 of 133 adults between 19 to 40 years of age. Conclusion: This incidence reported by the community members points to substantially more snakebites than the number of snakebite patients attending health facilities. This higher incidence points to the need for a nation-wide population-based survey, community education about gaining access to care where antivenom is available, and to the potential need for a larger supply of antivenom and expansion of medical care in rural areas. [ABSTRACT FROM AUTHOR]

Cities are arguably both the cause, and answer, to societies’ current sustainability issues. Urbanization is the interplay between a city’s physical growth and its socio-economic development, both of which consume a substantial amount of energy and resources. Knowledge of the underlying driver(s) of urban expansion facilitates not only academic research but, more importantly, bridges the gap between science, policy drafting, and practical urban management. An increasing number of researchers are recognizing the benefits of innovative remotely sensed datasets, such as nighttime lights data (NTL), as a proxy to map urbanization and subsequently examine the driving socio-economic variables in cities. We further these approaches, by taking a trans-pacific view, and examine how an array of socio-economic ind0icators of 25 culturally and economically important urban hubs relate to long term patterns in NTL for the past 21 years. We undertake a classic econometric approach—panel causality tests which allow analysis of the causal relationships between NTL and socio-economic development across the region. The panel causality test results show a contrasting effect of population and gross domestic product (GDP) on NTL in fast, and slowly, changing cities. Information derived from this study quantitatively chronicles urban activities in the pan-Pacific region and potentially offers data for studies that spatially track local progress of sustainable urban development goals. [ABSTRACT FROM AUTHOR]

Genetic variation is the basis upon which natural selection acts to yield evolutionary change. In a rapidly changing environment, increasing genetic variation should increase evolutionary potential, particularly for small, isolated populations. However, the introduction of new alleles, either through natural or human-mediated processes, may have unpredictable consequences such as outbreeding depression. In this study, we identified a contact zone and limited gene flow between historically separated genetic lineages of American pikas (Ochotona princeps), representing the northern and southern Rocky Mountain subspecies, within Rocky Mountain National Park. The limited spatial extent of gene flow observed may be the result of geographic barriers to dispersal, selection against hybrid individuals, or both. Our fine-scale population genetic analysis suggests gene flow is limited but not completely obstructed by extreme topography such as glacial valleys, as well as streams including the Colorado River. The discovery of two subspecies within this single protected area has implications for monitoring and management, particularly in the light of recent analyses suggesting that the pikas in this park are vulnerable to fragmentation and local extinction under future projected climates. Future research should focus on the fitness consequences of introgression among distinct genetic lineages in this location and elsewhere, as well as within the context of genetic rescue as a conservation and management strategy for a climate sensitive species. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is a potentially life-threatening vector-borne infection caused by Orientia species. It occurs mainly in the Asian-Pacific region, where it causes significant morbidity and mortality. Recently, an endemic focus of scrub typhus has been described in South America, on Chiloé Island in southern Chile. Dogs have been used as sentinel hosts to determine the presence and spatial distribution of various vector-borne infections. Their suitability to gain insight into human exposure to Orientia tsutsugamushi has been suggested in studies from Asia. Methodology: In January 2016, we conducted a cross-sectional study, which included the two main cities on Chiloé Island. Canine blood samples were obtained in households, chosen by double stratified random sampling in urban and by convenience in rural locations. Specimens were tested by ELISA for IgG antibodies against whole-cell antigen preparations from three strains of O. tsutsugamushi. Data were further analyzed for factors associated with seropositivity including spatial clustering. Results: Serum samples from 202 dogs (104 urban, 98 rural) were tested for IgG against O. tsutsugamushi, of which 43 (21.3%) were positive. Seroprevalence rates were higher in rural than in urban settings (p<0.01) and in older compared to younger dogs (p<0.01). Spatial analysis by LISA indicated the presence of four localities of highly grouped cases. Conclusions: The detected seroprevalence supports the endemicity of scrub typhus in southern Chile and suggests a wide exposure of household dogs to the infected, yet unknown vector(s). The spatial data will be used for future research identifying further human cases as well as the local vector(s)/reservoirs for scrub typhus in southern Chile. The study reinforces that dogs are useful sentinels for Orientia spp. in regions of uncertain endemicity and distribution. [ABSTRACT FROM AUTHOR]

Models of human migration provide powerful tools to forecast the flow of migrants, measure the impact of a policy, determine the cost of physical and political frictions and more. Here, we analyse the migration of individuals from and to cities in the US, finding that city to city migration follows scaling laws, so that the city size is a significant factor in determining whether, or not, an individual decides to migrate and the city size of both the origin and destination play key roles in the selection of the destination. We observe that individuals from small cities tend to migrate more frequently, tending to move to similar-sized cities, whereas individuals from large cities do not migrate so often, but when they do, they tend to move to other large cities. Building upon these findings we develop a scaling model which describes internal migration as a two-step decision process, demonstrating that it can partially explain migration fluxes based solely on city size. We then consider the impact of distance and construct a gravity-scaling model by combining the observed scaling patterns with the gravity law of migration. Results show that the scaling laws are a significant feature of human migration and that the inclusion of scaling can overcome the limits of the gravity and the radiation models of human migration. [ABSTRACT FROM AUTHOR]

Exposure to fecal contamination in public areas, especially in dense, urban environments, may significantly contribute to enteric infection risk. This study examined associations between sanitation and fecal contamination in public environments in four low-income neighborhoods in Accra, Ghana. Soil (n = 72) and open drain (n = 90) samples were tested for E. coli, adenovirus, and norovirus. Sanitation facilities in surveyed households (n = 793) were categorized by onsite fecal sludge containment (“contained” vs. “uncontained”) using previous Joint Monitoring Program infrastructure guidelines. Most sanitation facilities were shared by multiple households. Associations between spatial clustering of household sanitation coverage and fecal contamination were examined, controlling for neighborhood and population density (measured as enumeration areas in the 2010 census and spatially matched to sample locations). E. coli concentrations in drains within 50m of clusters of contained household sanitation were more than 3 log-units lower than those outside of clusters. Further, although results were not always statistically significant, E. coli concentrations in drains showed consistent trends with household sanitation coverage clusters: concentrations were lower in or near clusters of high coverage of household sanitation facilities—especially contained facilities—and vice versa. Virus detection in drains and E. coli concentrations in soil were not significantly associated with clustering of any type of household sanitation and did not exhibit consistent trends. Population density alone was not significantly associated with any of the fecal contamination outcomes by itself and was a significant, yet inconsistent, effect modifier of the association between sanitation clusters and E. coli concentrations. These findings suggest clustering of contained household sanitation, even when shared, may be associated with lower levels of fecal contamination within drains in the immediate public domain. Further research is needed to better quantify these relationships and examine impacts on health. [ABSTRACT FROM AUTHOR]

Abstract: This study contributes with original empirical evidence on the distributional and welfare effects of one of the most important health policies implemented by the Mexican government in the last decade, the Seguro Popular de Salud (SPS). We analyze the effect of SPS on households’ welfare using a decomposable index that considers insured and uninsured households’ response to out-of-pocket (OOP) payments using both social welfare weights and inequality aversion. The disaggregation of the welfare index allows us to explore the heterogeneity of the SPS impact on households’ welfare. We applied propensity score matching to reduce the self-selection bias of being SPS insured. Overall results suggest non-conclusive results of the impact of SPS on households’ welfare. When we disaggregated the welfare index by different sub-population groups, our results suggest that households’ beneficiaries of SPS with older adults or living in larger cities are better protected against OOP health care payments than their uninsured counterparts. However, no effect was found among SPS-insured households living in rural and smaller cities, which is a result that could be attributed to limited access to health resources in these regions. Scaling up health insurance coverage is a necessary but not sufficient condition to ensure the protection of SPS coverage against financial risks among the poor. [ABSTRACT FROM AUTHOR]

The vast majority of rabies deaths occur in developing countries and rural areas. Due to the absence of surveillance and the lack of reliable information, many endemic countries are not able to assess their rabies burden and implement appropriate solutions. This study reports the incidence of animal bites considered at risk of rabies transmission, along with rates and determinants of the adherence to post-exposure prophylaxis (PEP) between 2008 and 2014 in Dodoma Region, Tanzania. A retrospective analysis of rabid animal bites considered at risk of rabies transmission at Dodoma Regional Referral Hospital (DRRH) during 2008–2014 was conducted. Data were collected from the registers of patients presenting to the hospital because of a potential rabies exposure. The patients were assessed by a trained health worker and each bite was considered as “at risk of rabies” based on the victim’s description of the event. Overall, 10,771 patients coming from Dodoma Region attended DRRH because of a bite from a suspected rabid animal, giving a mean incidence of 74 bites at risk of rabies transmission per 100,000 persons per year. Overall, only 46.0% of people exposed received a complete course of PEP and 61.6% attended the clinic within 48 hours after the bite. Multivariate analysis shows that people age >15 years, residence in rural areas and occurrence during the rainy season were independently associated to delayed access to care. Male gender, age below 15 years. and bites occurring during the dry season were associated with completion of PEP. In this area with a high rate of at-risk bites, several factors—mainly related to health care access and to the affordability and delivery of rabies vaccines—still need to be addressed in order to reduce gender and social inequalities in rabies prevention and control. Further efforts are required to establish an efficient rabies surveillance system in Dodoma Region. [ABSTRACT FROM AUTHOR]