Among Inuit less than 30 years old the prevalence of myopia is far in excess of that of their elders. This is especially true for females. There seems to be little, if any, genetic contribution to this "epidemic" of myopia in the young. The age and sex distribution indicates the likelihood of an environmental factor, probably cultural, being responsible for the current pattern. Other data implicate school attendance as a possible etiologic factor.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2506.
To describe the experiences of people with systemic sclerosis (SSc) in different European countries of functioning and health and to link these experiences to the WHO International Classification of Functioning, Disability and Health (ICF) to develop a common understanding from a bio-psycho-social perspective.
A qualitative multicentre study with focus-group interviews was performed in four European countries: Austria, Romania, Sweden and Switzerland. The qualitative data analysis followed a modified form of 'meaning condensation' and the concepts that emerged in the analysis were linked to the ICF.
63 people with SSc participated in 13 focus groups. In total, 86 concepts were identified. 32 (37%) of these were linked to the ICF component body functions and structures, 21 (24%) to activities and participation, 26 (30%) to environmental factors, 6 (7%) to personal factors and 1 (1%) to the health condition itself. 19 concepts (22%) were identified in all four countries and included impaired hand function, household activities, paid work, drugs, climate and coldness, support from others and experiences with healthcare institutions, non-pharmacological treatment, social security and benefits.
Concepts identified in all four countries could be used for guiding clinical assessment, as well as interdisciplinary team care and rheumatological rehabilitation for patients with SSc. For a full understanding of the aspects of the disease that were most relevant to people with SSc, people with SSc from multiple countries needed to be involved.
In 1993 the Swedish parliament deregulated national forestry policy and established an environmental goal in parallel with the previous, long-standing goal of high wood production. This paper shows how the change occurred in the context of major changes in Swedish environmental policy during the late 1980s and early 1990s. Within a short time, new environmental legislation and the introduction of legal protection for small forest and agricultural habitats of high ecological value reoriented national forestry policy, away from an overriding focus on wood production to an increased awareness of nature conservation and biodiversity preservation. Reflecting a major compromise with the state, forest owners have gained greater freedom to manage their land, but must also improve environmental conditions while achieving high wood production, a policy known as 'freedom under responsibility'. The paper explains how both the parliament and industry supported increased nature conservation and biodiversity to maintain forest health and support the forestry industry, by favouring responsible resource use and not simply protection from human influence.
Faculté de Médecine, CRCHUM (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Department of Social & Preventive Medicine, Université de Montréal, Montréal, Québec, Canada. email@example.com
To examine the combined influence of poverty and dangerousness of the neighborhood on active transportation (AT) to school among a cohort of children followed throughout the early school years.
Growth curve modeling was used to identify determinants of AT to school among 710 children participating in the Quebec Longitudinal Study of Child Development from 2003 through 2006. Parent-reported dangerousness and pedestrian-vehicle collision data were merged with travel mode and health data.
At age 6 years, insufficient household income, having an older sibling, and living in a neighborhood that is not excellent for raising children, or characterized with high decay were predictive of greater likelihood of using AT and remained unchanged as children progressed from kindergarten through grade 2.
A public health concern is children experiencing environmental injustice. Since AT is most likely to be adopted by those living in poverty and because it is also associated with unsafe environments, some children are experiencing environmental injustice in relation to AT. Interventions may be implemented to reduce environmental injustice through improvements in road safety.
This study was an investigation of prevalence and associations between self-rated health and working conditions for small-scale enterprisers in a county in Sweden. A postal questionnaire was answered by 340 male and 153 female small-scale enterprisers in different sectors, with a response rate of 66%. For comparative purposes, data from a population study of 1,699 employees in private companies was included in the analyses. Differences were tested by Chi(2)-test and associations were presented as odds ratios (OR) with a 95% confidence interval (95% CI). The frequency of health problems in male enterprisers was higher than in employees in the private sector, while the frequency of health problems in female enterprisers was equal to that of the control employees. The main findings highlighted that male enterprisers reported higher rate of health problems and female enterprisers equal rate compared with employees in the private sector. Enterprisers stated musculoskeletal pain (women 59%, men 56%) and mental health problems (women 47%, men 45%) as the most frequent health problems. Poor job satisfaction, reported by 17% of the females and 20% of the male enterprisers, revealed an OR of 10.42 (95% CI 5.78-18.77) for poor general health. For the enterprisers, the most frequent complaints, musculoskeletal pain and mental health problems, were associated with poor job satisfaction and poor physical work environment. An association between poor general health and working as an enterpriser remained after adjusting for working conditions, sex and age.
Global climate change is inevitable--the combustion of fossil fuels has resulted in a buildup of greenhouse gases within the atmosphere, causing unprecedented changes to the earth's climate. The Fourth Assessment Report of the Intergovernmental Panel on Climate Change suggests that North America will experience marked changes in weather patterns in coming decades, including warmer temperatures and increased rainfall, summertime droughts and extreme weather events (e.g., tornadoes and hurricanes). Although these events may have direct consequences for health (e.g., injuries and displacement of populations due to thermal stress), they are also likely to cause important changes in the incidence and distribution of infectious diseases, including vector-borne and zoonotic diseases, water-and food-borne diseases and diseases with environmental reservoirs (e.g., endemic fungal diseases). Changes in weather patterns and ecosystems, and health consequences of climate change will probably be most severe in far northern regions (e.g., the Arctic). We provide an overview of the expected nature and direction of such changes, which pose current and future challenges to health care providers and public health agencies.
BACKGROUND: There is a familial influence on risk of many diseases and on mortality in general, which, according to studies of twins, is due to a combination of genetic and environmental effects. Adoption studies, which rest on different assumptions, may also be used to estimate separately the genetic and environmental effects on rate of dying. METHODS: The genetic influence on the rate of dying before age 70 years was investigated by estimation of the associations in total and cause-specific mortality of Danish adoptees and their biologic full and half siblings. Familial environmental influences shared at the same time in life were investigated in adoptees and their adoptive siblings. The study basis is the 14,425 nonfamilial adoptions formally granted in Denmark during the period 1924 through 1947, recorded in the Danish Adoption Register. From this register we selected the 1552 "case" adoptees (who died before 01 April 1993) and 1710 "noncase" adoptees alive at that date. The siblings of the case and noncase adoptees were traced in the archives and followed forward, and the rates of dying before age 70 years were compared. RESULTS: Compared with mortality of the biologic siblings of noncase adoptees, the mortality of biologic siblings of dead adoptees was approximately 2-fold higher for death with infections and vascular causes, and around 45% increased for natural causes and for all causes. CONCLUSION: The results suggest that there is a genetic effect on the rate of death with infections, vascular causes, natural causes and all causes, whereas there is no indication of an influence of shared sibling environment.
Strategic environmental assessment (SEA) of sewage sludge management in a Danish municipality (Aalborg), with 160,000 inhabitants using alternative methods for aggregation of environmental impacts was performed. The purpose is to demonstrate the use of SEA in relation to sludge management and to improve SEA methodology. Six different scenarios for management of sewage sludge within the Aalborg municipality involving thermal treatment, composting and landfilling of sludge were evaluated. Environmental impact categories considered were global warming, non-renewable resources (nutrients and fossil fuels) and land use. Impact categories human health, ecotoxicity and soil quality were excluded as methodology for their assessment is not yet fully developed. Thermal sludge treatment with energy utilisation was shown to be a promising option for sewage sludge management in Aalborg. Sensitivity of the relative environmental impacts with respect to calculation methodology and input parameter values were evaluated to identify important parameters and calculation methods. The analysis showed that aggregation procedures, sludge biogas potential and sludge production were very important whereas sludge transport was not.
It is generally accepted that cancer is caused by environmental and inherited factors but these are only partially identified. Family studies can be informative but they do not separate shared lifestyles and genes. We estimate familial risks for concordant cancers between spouses in common cancers of both sexes in order to quantify cancer risks from the shared environment. The risks are compared to those seen between parents and offspring in order to estimate the inherited component. The nation-wide Family-Cancer Database was used as the source of family and cancer data. Standardized incidence ratios (SIRs) were calculated for concordant cancer in offspring by parental cancer and in spouses. Among the 23 cancer sites considered, all but two showed an increased SIR for offspring by father or mother. Only two sites, stomach and lung, showed an increase in SIR of concordant cancer among spouses. Additionally, pancreatic cancer and melanoma were increased in couples where at least one spouse was diagnosed before age 50. If both spouses presented melanoma before age 40, SIR was 3.82 for husbands. SIRs of colon, renal, and skin (squamous cell) cancers were unchanged by spouses' concordant cancer. Shared lifestyle among spouses seems to explain only a small proportion of cancer susceptibility. Because lifestyles are likely to differ more between parents and offspring than between spouses, familial cancer risks between parents and offspring are likely to be more due to heritable rather than environmental effects.
Cancer has predominant environmental and somatic causes but the assessment of hereditary (genetic) causes is difficult, except for highly penetrant single-gene causes. Family studies are only partially informative in this regard because family members share diet and life-styles. Twin studies have been classically used to disentangle the effects of heredity and environment on disease etiology. We estimate the genetic and environmental components in colorectal and lung cancer and melanoma by comparing cancer risks in family members. The Swedish Family-Cancer Database, comprising more than 6 million individuals, was used as the source of family and cancer data. Tetrachoric correlations were used to describe similarity in cancer liability among family members. Structural equation modelling was used to derive estimates of the importance of genetic and environmental effects. The estimated genetic component ranged from 10% in colon and colorectal cancer to 18% in melanoma. For lung cancer, the share was 14%. If assortative mating were important for liability to cancer, these heritability estimates may be an underestimation of the true genetic effects. Non-shared environmental effect was 67-68% in colorectal cancer and melanoma, and 71% in lung cancer. Shared and childhood environments were equally important in colorectal cancer and melanoma, whereas no childhood effect was observed for lung cancer.
To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features.
The study is based on data collected in the "Home and Health in the Third Age Project". In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data.
The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people.
These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly. Implications for Rehabilitation In order to support the ageing process, the need for assistive technology has to be monitored in the third age. Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home. Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter - older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.
Patients who fall present a diagnostic challenge to family physicians. The diagnostic workup of these patients must be thorough enough to detect and treat important causes of the fall yet not subject patients to unnecessary tests. Previous studies have provided only limited guidance for primary care physicians because in general they occurred in settings other than primary care and focused on a single age group.
The Ambulatory Sentinel Practice Network (ASPN) conducted a 6-month study of primary care patients of all ages presenting after a fall, or with medical problems resulting from a fall. ASPN clinicians collected information about the history, physical examination findings, and follow-up of these patients. Causes of falls were grouped into three categories: external reasons for falling, internal reasons related to gait, and internal reasons unrelated to gait.
Participating clinicians identified 431 patients who had falls out of the 256,680 seen for any reason during the study period. The patients ranged in age from 1 to 94 years. The rate of falls for patients increased rapidly after age 65 years. Most falls occurred for reasons external to the patient, but internal reasons, both nonlocomotor and locomotor, increased after age 65 years. No nonlocomotor causes for a fall were found in patients younger than 65 years of age. Also, the rate of hospitalization of patients seen for falls was greater in the geriatric age group.
The results highlight the need for further research about falls, particularly those occurring in pediatric and young adult patients. Furthermore, correcting environmental hazards and modifying gait problems in the elderly by increasing lower extremity and truncal strength could decrease the risk of falling.
The Canadian Environmental Protection Act (CEPA) came into force in June 1988. This legislation provides the federal government with broad powers to deal with health and environmental problems posed by chemicals and the products of biotechnology throughout their life cycle. Responsibility for administering CEPA is shared between the Department of the Environment and the Department of National Health and Welfare. Part II of the Act, the "toxic substances" provisions, enables the federal government to impose controls on substances new to Canadian commerce and to address the health and environmental risks posed by existing substances. Part II of CEPA also delineates the manner in which existing substances are to be selected for assessment (priority substances) and controlled. The first Priority Substances List was published in February 1989. The 44 entries on this list include discrete chemicals, classes of chemicals, and complex mixtures of chemicals; the Department of the Environment and the Department of National Health and Welfare must ascertain whether these substances pose a risk (are "toxic" as defined in CEPA) to the environment or to human health by February 1994. This paper outlines the administrative arrangements for conducting risk assessments and the requirements for ascertaining whether a substance is "toxic" with respect to human health under CEPA. The rationale for deeming dioxins and furans, the first two priority substances to be assessed, as "toxic" with respect to human health is also described.
Effective management of contaminated sediments is important for long-term human and environmental health, but site-management decisions are often made under high uncertainty and without the help of structured decision support tools. Potential trade-offs between remedial costs, environmental effects, human health risks, and societal benefits, as well as fundamental differences in stakeholder priorities, complicate decision making. Formal decision-analytic tools such as multicriteria decision analysis (MCDA) move beyond ad hoc decision support to quantitatively and holistically rank management alternatives and add transparency and replicability to the evaluation process. However, even the best decisions made under uncertainty may be found suboptimal in hindsight, once additional scientific, social, economic, or other details become known. Value of information (VoI) analysis extends MCDA by systematically evaluating the impact of uncertainty on a decision. VoI prioritizes future research in terms of expected decision relevance by helping decision makers estimate the likelihood that additional information will improve decision confidence or change their selection of a management plan. In this study, VoI analysis evaluates uncertainty, estimates decision confidence, and prioritizes research to inform selection of a sediment capping strategy for the dibenzo-p-dioxin and -furan contaminated Grenland fjord system in southern Norway. The VoI model extends stochastic MCDA to model decisions with and without simulated new information and compares decision confidence across scenarios with different degrees of remaining uncertainty. Results highlight opportunities for decision makers to benefit from additional information by anticipating the improved decision confidence (or lack thereof) expected from reducing uncertainties for each criterion or combination of criteria. This case study demonstrates the usefulness of VoI analysis for environmental decisions by predicting when decisions can be made confidently, for prioritizing areas of research to pursue to improve decision confidence, and for differentiating between decision-relevant and decision-irrelevant differences in evaluation perspectives, all of which help guide meaningful deliberation toward effective consensus solutions.
Schools are supposed to be places where children learn and thrive; not where they, teachers, and other staff get sick. The hazards are many but recognition of those hazards is hard to come by in schools in Canada and the United States. The result can be an uphill fight for school-based organizations and unions. Representatives of four such groups, two each from Canada and the United States, discuss the hazards and their effects. They also have many-often unrecognized-successes and related lessons to share. These include taking comprehensive approaches, looking for broad sweeps and entrees, using building sciences and strategies of solid information, acting with respect and with persistence, including students and parents, going for green cleaners, and using participatory methods. The representatives build on these to discuss what else needs to be done. The ideas are underpinned by the creativity, dedication, and persistence evident in their work to date.
Finland has the world's highest incidence of type 1 diabetes, and it is steadily increasing. We determined concordance rates and estimated heritability for type 1 diabetes in the Finnish Twin Cohort, a population-based twin cohort of 22,650 twin pairs. In addition, we studied age of onset in the first affected twin and discordance time between concordant twin pairs. Finnish twins born between 1958 and 1986 were followed for type 1 diabetes until 1998. We identified 228 twin pairs with type 1 diabetes: 44 monozygotic (MZ), 183 dizygotic (DZ), and 1 pair with unknown zygosity. The pairwise concordance for type 1 diabetes was 27.3% (95% CI 22.8-31.8) in MZ and 3.8% (2.7-4.9) in DZ twins. The probandwise concordance was 42.9% (26.7-59.2) and 7.4% (2.2-12.6), respectively. The longest discordance times were 6.9 years among concordant MZ twins and 23.6 years among DZ twins. The risk for type 1 diabetes was highest in cotwins of the index twins diagnosed at a very young age. The model with additive genetic and individual environmental effects was the best-fitting liability model, with 88% of phenotypic variance due to genetic factors and the remaining variance due to unshared environmental factors. In conclusion, these nationwide twin data demonstrated high genetic liability for type 1 diabetes. Early-onset diabetes increases the risk in cotwins. However, the majority of affected MZ twin pairs remain discordant for type 1 diabetes.
Biometric studies have shown that happiness is strongly affected by genes. The findings are mainly based on twin data, however, and the full validity of the results has been debated. To overcome some limitations in classical twin research, we examined aetiological sources of subjective well-being (SWB), using two independent population-based samples, one including nuclear families (N = 54,540) and one including twins (N = 6,620). Biometric modelling using R was conducted to test for a data structure implying either non-additive genetic effects or higher environmental co-twin correlation in MZ than DZ pairs (violation of the EEA). We also estimated non-random mating, cultural transmission and shared environments specific for regular siblings and twins. Two sets of nested models were fitted and compared. The best explanatory model shows that family matters for happiness predominantly due to quantitative sex-specific genetic effects, a moderate spousal correlation and a shared twin environment. Upper limits for broad-sense heritability were estimated to be 0.33 (females) and 0.36 (males). Our study constitutes the most elaborate biometric study of SWB to date and illustrates the utility of including responses from multiple types of relatives in quantitative genetic analyses.
We tested the association between alcohol use disorder (AUD) and divorce; estimated the genetic and environmental influences on divorce; estimated how much genetic and environmental influences accounted for covariance between AUD and divorce; and estimated latent genetic and environmental correlations between AUD and divorce. We tested sex differences in these effects.
We identified twin and sibling pairs with AUD and divorce information in Swedish national registers. We described the association between AUD and divorce using tetrachorics and used twin and sibling models to estimate genetic and environmental influences on divorce, on the covariance between AUD and divorce and the latent genetic and environmental correlations between AUD and divorce.
A total of 670?836 individuals (53% male) born 1940-1965.
Life-time measures of AUD and divorce.
AUD and divorce were related strongly (males: rtet = +0.44, 95% CI = 0.43, 0.45; females rtet = +0.37, 95% CI = 0.36, 0.38). Genetic factors accounted for a modest proportion of the variance in divorce (males: 21.3%, 95% CI = 7.6, 28.5; females: 31.0%, 95% CI = 18.8, 37.1). Genetic factors accounted for most of the covariance between AUD and divorce (males: 52.0%, 95% CI = 48.8, 67.9; females: 53.74%, 95% CI = 17.6, 54.5), followed by non-shared environmental factors (males: 45.0%, 95% CI = 37.5, 54.9; females: 41.6%, 95% CI = 40.3, 60.2). Shared environmental factors accounted for a negligible proportion of the covariance (males: 3.0%, 95% CI = -3.0, 13.5; females: 4.75%, 95% CI = 0.0, 6.6). The AUD-divorce genetic correlations were high (males: rA = +0.76, 95% CI = 0.53, 0.90; females +0.52, 95% CI = 0.24, 0.67). The non-shared environmental correlations were modest (males: rE = +0.32, 95% CI = 0.31, 0.40; females: +0.27, 95% CI = 0.27, 0.36).
Divorce and alcohol use disorder are correlated strongly in the Swedish population, and the heritability of divorce is consistent with previous studies. Covariation between AUD and divorce results from overlapping genetic and non-shared environmental factors. Latent genetic and non-shared environmental correlations for alcohol use disorder and divorce are high and moderate.