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PubMed1996

Climate change and malaria transmission.

There is a consensus among climatologists that our planet is experiencing a progressive rise in surface temperature due to the increased production of "greenhouse" gases. Some of the possible consequences of elevated temperature on malaria transmission are examined in the present review. A simple mathematical model is first used to examine the effect of temperature on the ability of Anopheles maculipennis to transmit vivax malaria. This indicates that small increases in temperature at low temperatures may increase the risk of transmission substantially. This is important, since vulnerable communities, poorly protected by health services, in areas of unstable or no malaria are likely to be at increased risk of future outbreaks. In contrast, areas of stable transmission may be little affected by rising temperature. It is thought that global warming will lead to coastal flooding, changes in precipitation and, indirectly, changes in land use. Just how these changes will effect transmission at a regional level requires an understanding of the ecology of local vectors, since environmental changes which favour malaria transmission in one vector species may reduce it in another. Methods for predicting future changes in malaria in different regions are discussed, highlighting the need for further research in this area. Most importantly, there is a need for researchers to validate the accuracy of the models used for predicting malaria and to confirm the assumptions on which the models are based.

Animals↗

PubMed2002

A comparison of stream biological responses to discharge from wastewater treatment plants in high and low population density areas.

The ultimate purpose of this study was to identify broad relationships that may have relevance for the risk assessment of chemicals and materials that are discharged to receiving streams via municipal wastewater treatment plant (WWTP) effluents (e.g., consumer product ingredients). The effects of municipal wastewaters occurring in high population density (>500 persons per square mile, urban) and low population density (<500 persons per square mile, rural) environments were determined via analysis of biological, habitat, and water chemistry data collected both immediately upstream and downstream of 221 WWTPs in Ohio, USA. Several biological and chemistry indicators demonstrated poorer water quality in urban areas compared to rural areas. After considering the effect of river size, adverse effects downstream of WWTPs for both fish and macroinvertebrate communities were clearly identified for only urban areas. These data indicate that WWTP potency may be greater in urban areas compared to rural areas.

Animals↗

PubMed2005

Future trends in dental benefits.

Dentistry and dental payment systems as we know them today will continue to evolve. Dentistry as practiced today and the prepayment systems of dentistry are substantially different than they were fifty years ago when dental insurance as we know it was first developed. Dentistry has always changed with the development of our science and the expression of dentistry's diseases in the populations we serve. The changes that are likely to occur in the future will be focused on improving health outcomes across risk-analyzed populations with the goals of providing optimal health outcomes at reasonable costs. Dentists will increasingly become engaged in the whole health of their patients. Where sufficient correlations can be leveraged between dentistry and overall health, medical plans will play an increasing role in dentistry's future for two reasons. Given favorably altered therapeutic outcomes for medical systems that preserve scarce resources, it will be an economic imperative to engage the dental system. It will also be the right thing to do from a total health perspective. In the final analysis, this elevates the role of dentistry and empowers the dentist to participate in the total health of their patients.

Delivery of Health Care, Integrated↗

PubMed1990

Estimation of exposure time distributions.

In many demographic analyses, such as the assessment of environmental cancer risks, one may be interested not only in the age-by-state distribution of the population but also in the distribution of the population by time spent in a given state. States can represent geographic areas, marital statuses, labor force participation, or states of epidemiologic exposure. Recursive formulas for the calculation of the distribution of the population according to exposure time are derived under time-invariant state transition rates. Although populations can have identical growth rates and identical age-by-state distributions, they can have very different distributions by exposure time. An application to the analysis of carcinogenic exposure states is given, using data from Finland. The effect of population heterogeneity on the estimated exposure time distributions is studied.

Adolescent↗

PubMedDate not supplied

Effects of consanguinity on pre-reproductive mortality: does demographic transition matter?

The aim of this study was to investigate whether there is an increase on premature deaths due to genetically determined factors at the beginning of a demographic transition. We also analyzed the effects of parental consanguinity on offspring mortality from an epidemiological viewpoint, using parish records for family reconstitution in a Basque population (1800-1990). Among the offspring of unrelated parents, 13.1% died before their first year of life (infant mortality), and 22.8% died before the age of 16 (pre-reproductive mortality). Significant increases in both infant (23.6%) and pre-reproductive (38.5%) deaths were found among the progeny of first cousins or closer relatives, 1C (F > or = 0.0625). The corresponding relative risks of mortality were 1.79 (95% confidence limits: 1.37-2.28) and 1.68 (1.38-2.01), respectively. Estimates of the population attributable risks indicate that 4% of pre-reproductive mortality is ascribable to consanguineous unions, although kinships other than 1C produced only slight increases in offspring mortality. Evidence on the relationship between the demographic transition and the increase in premature deaths due to genetic factors was obtained through a principal component analysis (95.1% of variance accounted for). During the initial stages of the demographic transition, the population experienced substantial elevations in mean family size, natural increase of the population, frequency of close consanguineous matings (1C), and death rate due to congenital anomalies and perinatal diseases. These findings are of interest for the health services of many developing societies in Asia, Africa, and Latin America, which are nowadays immersed in the demographic transition process.

Adolescent↗

PubMed2003

The LNT model is the best we can do--today.

The form of the dose-response curve for radiation-induced cancers, particularly at low doses, is the subject of an ongoing and spirited debate. The present review describes the current database and basis for establishing a low dose, linear no threshold (LNT) model. The requirement for a dose-response model to be used for risk assessment purposes is that it fits the great majority of data derived from epidemiological and experimental tumour studies. Such is the case for the LNT model as opposed to other nonlinear models. This view is supported by data developed for radiation-induced mutations and chromosome aberrations. Potential modifiers of low dose cellular responses to radiation (such as adaptive response, bystander effects and genomic instability) have not been shown to be associated with tumour development. Such modifiers tend to influence the slope of the dose-response curve for cellular responses at low doses and not the shape--thereby resulting in a quantitative modification rather than a qualitative one. Additional data pertinent to addressing the shape of the tumour dose-response relationship at low doses are needed.

Chromosome Aberrations↗

PubMed2006

The future of epidemiology: methodological challenges and multilevel inference.

A decade ago there was considerable debate about the appropriate objectives and paradigms of modern epidemiologic research. One concern put forth in these debates was that "risk factor epidemiology" might be forcing our field to focus more on individuals and less on populations and public health. Today, most epidemiologists acknowledge that public health is influenced by both population-level and individual-level determinants. Ecologic studies are valuable tools for generating hypotheses and addressing group-level determinants of disease risk. Traditional risk factor studies and genomic studies have helped establish the multifactorial concept of disease causation. Individual-level studies also have provided the biomedical community with hypotheses that have stimulated research into disease mechanisms that have led to reductions in morbidity and mortality for diseases such as HIV/AIDS, cardiovascular disease, and cancer. Current debates about the role of genomic data in epidemiology and public health mirror the debates about risk factor epidemiology one decade ago. Genomic variation is measured at the individual level, but how this variation is maintained in human populations is a group-level (population) phenomenon that is worthy of epidemiologic investigation in its own right. Multilevel epidemiology seeks to understand multiple levels of inference, from genes to individuals to populations and could combine hypothesis-driven research with aspects of data mining. Multilevel epidemiology calls for the study of health and disease determinants defined at the population level and individual level for a more comprehensive strategy to understanding human disease etiology. With the continued development of multilevel statistical methods and the advent of data mining, the technical constraints of the past will become less relevant to the next generation of epidemiologists who wish to embrace a more multilevel epidemiology.

Data Interpretation, Statistical↗

PubMedDate not supplied

Why dose-response relationships are often non-linear and some consequences.

Given the dependence of many risk assessments on the assumption of linearity of dose-response relationships in human populations, we analyze the circumstances likely to lead to non-linearity and test our hypothesis of the high prevalence of non-linearity by examination of recent literature. METHODS. The analysis of Bross, based on whether irradiated cells die or can manifest malignancy, leads him to generalize that if a single exposure can have one of two (or more) countervailing outcomes, non-linearity of dose-response will result. We list four other common mechanisms which would have similar effects: symptom-stimulated withdrawal from exposures to respiratory irritants; certain aspects of the "healthy worker effect" (especially its obverse-withdrawal from the work force due to illness); selected consequences of the competing risks of long-term disease; and shift in relative strength among multiple independent variables. We then examine recent literature to see how often reports of linear, monotonic, and non-monotonic dose-response relationships occur and discuss the likelihood of countervailing alternate outcomes in selected examples. RESULTS. Non-linear and linear relationships are about equally frequent. Under circumstances where countervailing outcomes are probable, dose-response relationships should be non-linear and often are. These conditions may also lead to non-linear difference equations, which may manifest "chaotic" attributes. CONCLUSIONS. Regulations and policies cannot be routinely derived on the basis of extrapolating linear dose-response relationships for human populations. Although our analysis is oriented principally to epidemiology, similar considerations apply to toxicological studies as well.

Dose-Response Relationship, Drug↗

PubMed2004

Bayesian Monte Carlo uncertainty analysis of human health risks from animal antimicrobial use in a dynamic model of emerging resistance.

Recent qualitative analyses warn of potential future human health risks from emergence of antibiotic resistance in food-borne pathogens due to the use of similar antimicrobial drugs in both food animals and human medicine. While historical data suggest that human health risks from some animal antimicrobials, such as virginiamycin (VM), have remained low (McDonald et al., 2001), there is a widespread concern that "resistance epidemics" or endemics could arise in the future. How reassuring is the past about the future? This article applies quantitative risk assessment methods to help find out, using human health risks from VM and the nearly identical human antimicrobial quinupristin-dalfopristin (QD) as a case study. A dynamic simulation model is used to predict the risks of emerging resistance to human antimicrobials in human populations from given input assumptions. Bayesian Monte Carlo uncertainty analysis allows past data to constrain and inform selection of input parameter values, and thus to predict the possible future resistance patterns that are consistent with historical data. The results show that health risks from VM use in food animals are highly sensitive to the human prescription rate of QD. For realistic prescription rates, quantitative risks are less than 1 x 10(-6) even for members of the most-threatened (ICU patient) population, while societal risks are <1 excess statistical death per year for the whole U.S. population. Such quantitative estimates complement more qualitative assessments that discuss the possibility of future "resistance epidemics" (or endemics) without quantifying their probabilities.

Animals↗

PubMed2002

[Injury prevention in the elderly population].

Injuries in the elderly population have more considerable consequences (more difficult treatment, higher costs,worse outcome) than in the younger population. Therefore, the prevention is especially important. The majority of the injuries are caused by traffic accidents and falls. TRAFFIC ACCIDENTS: An analysis of the current injury situation in elderly road users (65 years and older) involved in road traffic accidents was intended to allow conclusions regarding future prophylaxis. FALLS: Falls are mostly caused by numerous factors. The most important predictors for falls are dementia,Parkinson-Syndrome and neurologic deficits after cerebrovascular insults. The most important symptoms, that indicate an increased risk for fall are gait abnormalities, balance lack and underweight. The most important anamnestic indications are more than one falls in the recent 90 days, need for assistance in daily living and prevailing medication. Another important factor is the residential setting (lighting, stairs, floor conditions,bath installations). The most affective protective interventions involve multiple factors. The incidence of falls could be reduced by 30%. The hip protector is an effective protection against proximal femur fractures. which is the most frequent fracture in the elderly population that requires treatment as an inpatient. Injury prevention in the elderly population is an interdisciplinary task as for example shown by the successful fall clinics in the anglo-american area.

Accident Prevention↗

PubMed2002

Review of the potential use of brown algal ecotoxicological assays in monitoring effluent discharge and pollution in southern Australia.

The temperate near-shore reefs of southern Australasia possess diverse assemblages of brown algal macrophytes which underpin major grazing and detrital food chains in medium to high energy coastal habitats. These 'kelp' communities are at risk from effluent discharge with documented decline of macrophyte stands in areas subject to outfall. Recent studies utilising reproductive endpoints of several Australian species in ecotoxicological assays have highlighted their sensitivity to pollution. Results indicate an acceptable degree of reproducibility for assays with variation in response between taxa presumably related to differing habitat requirements and potential for stress resulting from toxicant/pollution exposure. Species studied are drawn from the orders Laminariales and Fucales, with the latter in particular offering substantial scope for further investigation. The greatest diversity of fucoid algae is found in south-eastern Australia and closely related taxa occur in similar latitudes in both the southern and northern hemispheres. The broad distribution of taxa from both taxonomic groups enables ready comparison of assays from disparate locations and offers the potential for simple, routine toxicological testing and habitat monitoring across broad geographic ranges.

Australia↗

PubMed2001

Experimental investigations and numerical modelling of Cryptosporidium parvum transport behaviour in aquifers.

The purpose of this study was to improve understanding of the potential for transfer of the protozoan pathogen Cryptosporidium parvum through aquifers to drinking water wells. Therefore, the factors characterising this transport were experimentally determined. We have developed a continuously recirculating column assay. The latter allows small amounts of C. parvum oocysts to be manipulated providing as much protection as possible from the risks of contamination. As the analysis of oocyst samples is time consuming, a numerical model, simulating the transport phenomena of oocysts under the experimental conditions of assays, was developed to establish the whole experimental curve of results using a small number of experimental points. The comparisons drawn between analytic solutions, experimental results with tracer (NaCl solution) and numerical simulation were in good agreement. A continuously recirculating column assay was performed using oocysts in suspension (flow rate = 1.43 mL/min). Treated sand was used as previous experiments had shown that no adsorption occurs. We observed almost total filtration (99.85%). To check this result, an assay with an open column was carried out under the same conditions. We observed a filtration value of 97%. Consequently, we may say that the continuously recirculating column assay provides satisfactory results.

Animals↗

PubMed2001

Toxicity of atrazine to the estuarine phytoplankter Pavlova sp. (Prymnesiophyceae): increased sensitivity after long-term, low-level population exposure.

Phytoplankton are potentially more at risk to the adverse effects of herbicides than many other organisms in estuarine ecosystems. The focus of this study was to characterize the toxicity of a widely used herbicide, atrazine, to a single species of phytoplankton. The nanoplankter Pavlova sp. was grown under controlled laboratory conditions and was used to elucidate short-term, high-level population effects of atrazine. Secondly, a long-term, multigenerational population exposure was performed with a low level of atrazine followed by an additional short-term, high-level exposure on the same population with no recovery period. The 96-h growth rate of 50% effective concentration (EC50) for Pavlova sp. was 147 [microg/L (95% CI = 116.4-178.7 microg/L). Long-term exposure at 20 [microg/L for four (batch culture) growth cycles (approximately 20 generations) had no significant effect on the growth rate of Pavlova sp. except during the fourth growth cycle. However, a subsequent short-term, high-level 96-h exposure inoculated from the long-term, low-level exposed population showed increased sensitivity to atrazine (96-h growth rate EC50 = 96.0 microg/L, 95% CI = 90.2-103.7 microg/L). Multigenerational exposure to atrazine appeared to render phytoplankton significantly more sensitive (35%) to atrazine effects. Given the documented persistence of atrazine in surface waters, long-term exposure to low levels of atrazine without recovery may lead to shifts in species sensitivity and potential alterations in phytoplankton population dynamics.

Atrazine↗

PubMed2004

Effects of heavy metals on earthworms along contamination gradients in organic rich soils.

Earthworm communities and metal (bio)availability to earthworms along contamination gradients was studied in order to support chemical analyses in risk assessment of metal contaminated soils. Earthworms were sampled in three metal contaminated areas with different habitat and soil properties in Finland. Earthworm and soil samples were collected at three distances (1, 2, and 4 km) from the emission sources. Earthworms were identified as to species and analyzed for heavy metals. Total soil metal concentrations were analyzed using an ultrasound-assisted extraction method and bioavailable metal fraction was estimated by acetic acid extraction. In two of the three areas studied, heavy metal concentrations close to the emission sources were high enough to have harmful effects on earthworms and their environments. In general, diversity, total numbers, and biomass of earthworms increased with increasing distance from the emission sources. When individuals were available for analyses close to the emission source, positive correlations between metal concentrations in the earthworms and those in the soils were observed.

Animals↗

PubMed2006

Quantifying uncertainty in the potential distribution of an invasive species: climate and the Argentine ant.

Maps of a species' potential range make an important contribution to conservation and invasive species risk analysis. Spatial predictions, however, should be accompanied by an assessment of their uncertainty. Here, we use multimodel inference to generate confidence intervals that incorporate both the uncertainty involved in model selection as well as the error associated with model fitting. In the case of the invasive Argentine ant, we found that it was most likely to occur where the mean daily temperature in mid-winter was 7-14 degrees C and maximum daily temperatures during the hottest month averaged 19-30 degrees C. Uninvaded regions vulnerable to future establishment include: southern China, Taiwan, Zimbabwe, central Madagascar, Morocco, high-elevation Ethiopia, Yemen and a number of oceanic islands. Greatest uncertainty exists over predictions for China, north-east India, Angola, Bolivia, Lord Howe Island and New Caledonia. Quantifying the costs of different errors (false negatives vs. false positives) was considered central for connecting modelling to decision-making and management processes.

Animals↗

PubMed1977

Lung cancer among black migrants. Interaction of host and occupational environment factors.

A study of Ohio residents by place of birth identified an increased cancer risk (100% excess) among black migrants born in the South compared with blacks born in Ohio. The migration of blacks from South to North for the purpose of industrial employment was extensive between the years 1940-1970. The hypothesis is that biological and social imprints (poverty, malnutrition, genetics), endemic of the early years of life, provide a physiological imbalance which provides the basis for increased susceptibility to adverse environmental stresses subsequent to migration. Findings consistent with this hypothesis were obtained in a prospective study of steel workers in which 2,543 men in coke plant operations were included, in which a prior high rate for lung cancer had already been established. A strong association was found between place of birth and place of death from lung cancer in the nonwhite coke plant workers. Examination of these death certiricates revealed that 33 of 35 deaths of lung cancer occurred among men born in the South.

Black or African American↗

PubMed1998

An overview of remote sensing and GIS for surveillance of mosquito vector habitats and risk assessment.

This paper provides a brief nontechnical overview of the use of remote sensing to achieve multiple objectives, focusing on mosquito management. It also shows how Geographic Information Systems, combined with remote sensing analysis, have the potential to assist in minimizing disease risk. Examples are used from subtropical Queensland, Australia, where the salt marsh mosquito, Aedes vigilax, and the freshwater species, Culex annulirostris, are vectors of human arbovirus diseases such as Ross River and Barmah Forest virus disease. Culex annulirostris is also implicated in the transmission of Japanese Encephalitis. Mapping the breeding habitats of the species facilitates assessment of the risk of contracting the diseases and also assists in control of the vectors. First, it considers a simple risk model that is applied to data for the city of Brisbane in southeast Queensland. This is then linked to computer-aided analysis of remotely sensed data to map potential ephemeral freshwater breeding sites of Cx. annulirostris. This has the potential to guide control at critical times, for example after heavy summer rainfall or when there is an outbreak of Ross River virus disease. Second, the use of color infrared aerial photography is used to identify the specific parts of the salt marsh in which larvae and eggs of Ae. vigilax are found. Finally, we explore novel ways to map the detailed pattern of water under mangrove forest canopy to identify where mosquitoes are breeding and as an aid to planning modification. For each we discuss the limitations and advantages and the possibilities for combining methods and/or using a single method for multiple objectives.

Animals↗

PubMed2002

Malaria transmission risk variations derived from different agricultural practices in an irrigated area of northern Tanzania.

Malaria vector Anopheles and other mosquitoes (Diptera: Culicidae) were monitored for 12 months during 1994-95 in villages of Lower Moshi irrigation area (37 degrees 20' E, 3 degrees 21' S; approximately 700 m a.s.l.) south of Mount Kilimanjaro in northern Tanzania. Adult mosquito populations were sampled fortnightly by five methods: human bait collection indoors (18.00-06.00 hours) and outdoors (18.00-24.00 hours); from daytime resting-sites indoors and outdoors; by CDC light-traps over sleepers. Anopheles densities and rates of survival, anthropophily and malaria infection were compared between three villages representing different agro-ecosystems: irrigated sugarcane plantation; smallholder rice irrigation scheme, and savannah with subsistence crops. Respective study villages were Mvuleni (population 2200), Chekereni (population 3200) and Kisangasangeni (population approximately/= 1000), at least 7 km apart. Anopheles arabiensis Patton was found to be the principal malaria vector throughout the study area, with An. funestus Giles sensu lato of secondary importance in the sugarcane and savannah villages. Irrigated sugarcane cultivation resulted in water pooling, but this did not produce more vectors. Anopheles arabiensis densities averaged four-fold higher in the ricefield village, although their human blood-index was significantly less (48%) than in the sugarcane (68%) or savannah (66%) villages, despite similar proportions of humans and cows (ratio 1:1.1-1.4) as the main hosts at all sites. Parous rates, duration of the gonotrophic cycle and survival rates of An. arabiensis were similar in villages of all three agro-ecosystems. The potential risk of malaria, based on measurements of vectorial capacity of An. arabiensis and An.funestus combined, was four-fold higher in the ricefield village than in the sugarcane or savannah villages nearby. However, the more realistic estimate of malaria risk, based on entomological inoculation rates, indicated that exposure to infective vectors was 61-68% less for people in the ricefield village, due to the much lower sporozoite rate in An. arabiensis (ricefield 0.01%, sugarcane 0.1%, savannah 0.12%). This contrast was attributed to better socio-economic conditions of rice farmers, facilitating relatively more use of antimalarials and bednets for their families. Our findings show that, for a combination of reasons, the malaria challenge is lower for villagers associated with an irrigated rice-growing scheme (despite greater malaria vector potential), than for adjacent communities with other agro-ecosystems bringing less socio-economic benefits to health. This encourages the development of agro-irrigation schemes in African savannahs, provided that residents have ready access to antimalaria materials (i.e. effective antimalaria drugs and insecticidal bednets) that they may better afford for protection against the greater vectorial capacity of An. arabiensis from the ricefield agro-ecosystem.

Agriculture↗