A large proportion of breast cancer cases are thought related to environmental factors. Identification of specific geographical areas with high risk (clusters) may give clues to potential environmental risk factors. The aim of this study was to investigate whether clusters of breast cancer existed in space and time in Denmark, using 33 years of residential histories.
We conducted a population-based case-control study of 3138 female cases from the Danish Cancer Registry, diagnosed with breast cancer in 2003 and two independent control groups of 3138 women each, randomly selected from the Civil Registration System. Residential addresses of cases and controls from 1971 to 2003 were collected from the Civil Registration System and geo-coded. Q-statistics were used to identify space-time clusters of breast cancer. All analyses were carried out with both control groups, and for 66% of the study population we also conducted analyses adjusted for individual reproductive factors and area-level socioeconomic indicators.
In the crude analyses a cluster in the northern suburbs of Copenhagen was consistently found throughout the study period (1971-2003) with both control groups. When analyses were adjusted for individual reproductive factors and area-level socioeconomic indicators, the cluster area became smaller and less evident.
The breast cancer cluster area that persisted after adjustment might be explained by factors that were not accounted for such as alcohol consumption and use of hormone replacement therapy. However, we cannot exclude environmental pollutants as a contributing cause, but no pollutants specific to this area seem obvious.
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Abnormalities of the sex ratio of births may be linked with environmental factors, including diet and pollutants in the general or occupational environments, which in turn can cause ill-health. To examine this relationship in the Province of Newfoundland and Labrador, where a geographical imbalance of mortality has already been identified, we examined the geographical distribution of sex ratios (boys/girls x 100) of young children (0-4 years) in the communities of the Province during recent years. The individual communities of the 1976 and 1981 censuses were assigned to contiguous regions and their component districts. The numbers in the appropriate age-groups in the communities in these two census years were used to calculate a mean sex ratio for each community; each community was allocated, according to the value of its ratio, to one of four predefined categories of ratio. From the numbers of communities belonging to these various categories of sex ratio in the regions and districts, the community sex ratios of these areas (i.e. regions and districts) were derived. As a preliminary assessment of the relationship between sex ratios and mortality, a small group of communities with the highest sex ratios was selected, and the mean standardized mortality ratios (SMRs) for all deaths in those communities were calculated. The community sex ratios of regions and districts declined from east to west. The difference in the ratios between the Avalon region (in the most easterly part of the Province) and the southwest region was statistically significant. Districts with high ratios were frequent, particularly those on the Avalon peninsula in the south-east of the island, whereas low ratios were more frequent on the south-west coast of the island, and a low ratio was also found for the only inland district. Of the communities with statistically reliable numbers, the township of Makkovik in Labrador had the highest sex ratio (100 x 50/25 = 200). The SMR of that community during 1976-82 was statistically elevated at 218. In the small group of communities studied, however, high sex ratios from census data for individual communities were not reliable predictors of high SMRs. Further work is required to clarify the inter-relationships between the sex ratios of the census data, the sex ratios of births, the mortality rates and environmental factors.
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.
This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported >or= one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson's disease), age >or= 85 years, environmental hazards, previous slip or trip, and visual impairment.
The authors adduce the ecologo-hygienic characterization of the most significant dwelling environmental factors, such as chemical air pollution, microclimatic parameters, biological pollution, noise, electromagnetic fields, light, etc. They have developed a conception of providing ecologo-hygienic dwelling safety.
To assess factors influencing access to drug treatment among injecting drug users (IDUs) in two Russian cities.
Eighty-six qualitative interviews were conducted with IDUs in Volgograd and Barnaul in 2003. IDUs were recruited through local drug treatment services, needle exchanges, and drug user networks.
Three main barriers to treatment assess were identified: financial constraints, fear to registration as a drug user, and perceived low efficacy of available treatment services. Registration of drug users was associated with loss of employment, breaches in confidentiality. and stigma. Some participants did not think that drug treatment services could respond appropriately and effectively to their treatment needs.
These findings highlight the importance of environmental factors in mediating IDUs access to drug treatment, which might suggest the need for social and structural interventions. Access to drug treatment services should be enhanced by reducing the financial burdens of drug treatment and minimizing the stigma associated with drug user registration. Russia should shift from a highly medicalised model of treatment toward a more holistic approach that recognises the diversity of treatment needs among IDUs. These priorities are especially timely given the urgent need to integrate drug treatment as part of wider HIV prevention responses in Russia.
An analysis of a military database of about 36,000 tone audiograms from male Swedish conscripts aged 18 to 19 and recorded from 1969 to 1977 demonstrates a successively decreasing prevalence of hearing loss during this period. This might reflect improved therapy during the 1950s and 1960s of ear disorders causing hearing loss in small children. If observations in other studies on a reverse trend during the 1980s are confirmed, they indicate, together with the present study, that around 1980 young people began to be harmfully exposed to an environmental factor causing hearing loss. If this is the case, the causative factor would probably be non-occupational exposure to electronically amplified sounds from loudspeakers and headphones.
Environmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80- to 89-year-old single-living people.
This longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002-2003, and 393 were followed up for mortality until May 15, 2012.Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses.
A total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00).
Specific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals' health status which is difficult to fully control for. Further studies are called for.
Global environmental challenges require changes in both the production and the consumption of goods. In this paper we analyse how consumers perceive the high environmental burden of meat. We analysed consumer environmental consciousness, including problem awareness and a support to action dimensions, latter including perceived self-efficacy as well as solutions to problems. The solutions were positioned on a continuum from increasing the efficiency of production to discussing sufficiency levels in consumption practices (techno-optimism, local meat, organic meat and meat reduction, respectively). We used a statistically representative survey sample (n = 1890) from the population of Finland and cluster analysis to explore differences among consumers. The analysis revealed that most Finns seem to be rather unsure of the study topic. At the same time they tend to have a comparably high level of self-efficacy (55 per cent of respondents) and endorsement of particularly local meat solution type (55%), followed by organic meat (35%), meat reduction (25%) and techno-optimism (15%), though the neutral stand was the most common one across the data. We also identified six consumer groups that reveal not only a high number of Highly unsure consumers (40%), but also some Rather conscious (20%) and a relatively small number of Highly conscious (8%). In addition, there were also easily observable groups of Careless conscious (14%), Rather unsure (9%) and Resistant (8%). The results highlight the need for a multitude of political actions to guide meat consumption, as there are groups that may benefit from practical tools for making dietary changes as well as groups in need for more comprehensive selection of measures, including environmental information.
Accidental injury is the most important epidemic in the Western world today, and is especially important as a cause of death and disability in childhood. Many environmental factors are important causes of accidents, but there is no organisation within which doctors, official bodies, industry, and voluntary bodies can pool their experience and co-ordinate their efforts to reduce these environmental risks. A joint committee on childhood accident prevention should be formed in this country similar to that which exists in Sweden.
BACKGROUND: Clinical and epidemiological studies have shown an association between anxiety and depression and pain in the back and neck. The nature of this relationship is not clear. This study aimed to investigate the extent to which common genetic and environmental aetiological factors contribute to the covariance between symptoms of anxiety and depression and back-neck pain. METHODS: Measures of back-neck pain and symptoms of anxiety and depression were part of a self-report questionnaire sent in 1992 to twins born in Norway between 1967 and 1974 (3996 pairs). Structural equation modelling was applied to determine to what extent back-neck pain and symptoms of anxiety and depression share genetic and environmental liability factors. RESULTS: The phenotypic correlation between symptoms of anxiety and depression and back-neck pain was 0.31. Individual differences in both anxiety and depression and back-neck pain were best accounted for by additive genetic and individual environmental factors. Heritability estimates were 0.53 and 0.30 respectively. For back-neck pain, however, a model specifying only shared- and individual environmental effects could not be rejected. Bivariate analyses revealed that the correlation between back-neck pain and symptoms of anxiety and depression was best explained by additive genetic and individual environmental factors. Genetic factors affecting both phenotypes accounted for 60% of the covariation. There were no significant sex differences. CONCLUSION: The results support previous findings of a moderate association between back-neck pain and symptoms of anxiety and depression, and suggest that this association is primarily due to common genetic effects.
Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of problematic alcohol and other substance use in adolescence. This study used data from an ongoing, prospective, population-based twin study of Swedish children and adolescents to evaluate the extent to which the association between ADHD symptoms and alcohol problems reflects a unique source of genetic or environmental risk related to ADHD versus a broader predisposition to youth externalizing behavior. We used all available data from same-sex monozygotic (MZ) and dizygotic (DZ) twins on ADHD symptoms in childhood (age 9/12; N?=?15,549) and alcohol problems in late adolescence (age 18; N?=?2,564). Consistent with prior longitudinal studies, the phenotypic association between hyperactive/impulsive ADHD symptoms and alcohol problems was small in magnitude, whereas the association for inattentive symptoms was even weaker. Additive genetic influences explained 99.8% of the association between hyperactive/impulsive symptoms and alcohol problems. Furthermore, we found that the genetic risk specifically associated with hyperactive/impulsive symptoms was attenuated when estimated in the context of externalizing behavior liability during childhood, of which ADHD symptoms were specific expressions. In sensitivity analyses exploring hyperactivity in mid-adolescence, we found a similar pattern of genetic associations. These results are consistent with previous findings of genetically driven overlap in the etiology of ADHD and problematic alcohol use. At least some of this co-occurrence may result from a general predisposition to externalizing behaviors in youth. ? 2015 Wiley Periodicals, Inc.
The school food environment is important to target as less healthful food and beverages are widely available at schools. This study examined whether the availability of specific food/beverage items was associated with a number of school environmental factors.
Principals from elementary (n=369) and middle/high schools (n=118) in British Columbia (BC), Canada completed a survey measuring characteristics of the school environment. Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman's Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes.
In elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR=6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR=4.54 and OR=3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR=5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/beverage items available at school: chocolate candy (OR=?.80) and sugar-sweetened beverages (OR=?.76).
School nutritional capacity, resources, and practices were associated with the availability of specific food/beverage items in BC public schools. Policies targeting the school environment are increasingly being considered as one of the strategies used to address childhood obesity, as a result it is important to further understand the factors associated with the availability of specific food/beverage items at school.
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The development and testing of a measure evaluating the quality and variability in the home environment as it relates to the motor development of infants during the first year of life.
A sample of 112 boys and 95 girls with a mean age of 7.1 months (SD 1.8) and GA of 39.6 weeks (SD 1.5) participated in the study. The measurement development process was divided into three phases: measurement development (item generation or selection of items from existing measurement tools), pilot testing to determine acceptability and feasibility to parents, and exploratory factor analysis to organize items into meaningful concepts. Test-retest reliability and internal consistency were also determined.
The environmental opportunities questionnaire (EOQ) is a feasible 21-item measure comprised of three factors including opportunities in the play space, sensory variety and parental encouragement. Overall, test-retest reliability was 0.92 (CI 0.84-0.96) and the internal consistency is 0.79. The EOQ emphasizes quality of the environment and access to equipment and toys that have the potential to facilitate early motor development.
The preliminary analyses reported here suggest more work could be done on the EOQ to strengthen its use for research or clinical purposes; however, it is adequate for use in its current form. Implications for Rehabilitation New and feasible 21-item questionnaire that enables identification of malleable environmental factors that serve as potential points of intervention for children that are not developing typically. Therapeutic tool for use by therapists to inform and guide discussions with caregivers about potential influences of environmental, social and attitudinal factors in their child's early development.
The relative roles of genetic and environmental factors in sciatica were studied in the nationwide Finnish twin panel consisting of 9365 adult pairs of the same gender. Morbidity was analysed from two sources of data: the life-long cumulative incidence was measured by a postal questionnaire, and the rate of hospital admission during a 14-year period was measured by record-linkage of the twin panel and the nationwide hospital registry. Altogether 2220 individuals reported sciatica diagnosed by a doctor and 304 were admitted to hospital with a diagnosis of sciatica. The proportion of concordant pairs (calculated from affected pairs) was 17.7% for monozygotic and 12.0% for dizygotic pairs in the life-long cumulative incidence of reported sciatica, and correspondingly 4.6% and 1.9% for those admitted to hospital (a 14-year period) because of sciatica. The estimated heritability was 20.8% for those with reported sciatica and 10.6% for those admitted to hospital. The results show that environmental factors account for more than 80% of the etiology of sciatica, and more than 90% in the case of patients admitted to the hospital. Genetic factors, however, were relatively more significant in individuals under 40.
There is a clear need for increased standardization of placement and therefore greater equity among long-term-care patients with similar clinical needs and environmental constraints. This article describes a multidimensional instrument that incorporates a decision rule for placement recommendations across 4 levels of care. Interrater reliability for the assessment items as well as the placement levels are reported.
Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries.
A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n?=?14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries.
Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI.
Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.
The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway).
Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child-parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children's sex and age.
In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children's computer time and more parental social environmental factors to children's television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children's television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children's television and computer time in Hungary. Having rules regarding children's television time was related to less television time in all countries, except for Belgium and Norway.
Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should focus on children's individual beliefs and habits as well parental social factors. As we identified some different correlates for television and computer time and across countries, cross-European interventions could make small adaptations per specific screen time activity and lay different emphases per country.
Cites: Int J Epidemiol. 2012 Oct;41(5):1460-7123045206
To test the hypothesis that environmental factors during early pregnancy may cause coarctation of the aorta (CoA), 50 cases of CoA and 756 controls were studied. The cases represented all verified CoAs in Finland during 1982-1983 and controls were randomly selected from all babies born during the same period. Both case and control mothers were interviewed by midwives approximately 3 months after delivery. In these data 18 patients had pure CoA only and the remaining 32 at least one other cardiac anomaly. Three CoA patients had a chromosomal anomaly. The relatives of CoA babies had more congenital anomalies than those of the control babies. Maternal overall exposure to chemicals at work was slightly more prevalent among the CoA group (32.0%) than the control group (26.2%). Maternal exposure to mineral oil products at work during early pregnancy was more common among CoA cases (8.0%) than controls (1.4%) [odds ratio (OR) = 5.9, 95% confidence interval (CI95) = 1.8-19.2]. The risk of CoA was also associated with previous miscarriages (OR = 2.3, CI95 = 1.2-4.4) and twin birth (OR = 16.3, CI95 = 4.0-67) of the child. The risk of CoA was not associated with seasonal variation, maternal smoking, alcohol consumption, or use of deodorants. It is concluded that genetic factors explain only a small fraction of the causes of CoA and that many common environmental exposures during early pregnancy are unlikely to be real risk factors for CoA. However, the power of this study was weak for testing the teratogenicity of specific chemicals.
Plasma adiponectin and high-density lipoprotein cholesterol (HDL-C) exhibit a well-known positive metabolic correlation. Neither heritability nor genome-wide linkage analysis for the high-molecular weight (HMW) adiponectin is available. This work estimates the genetic and environmental determinants and the heritabilities of the adiponectins and lipid traits in Finnish families with early onset coronary heart disease (CHD) and low HDL-C.
Heritability and genome-wide univariate linkage analysis was performed for total and HMW adiponectin in extended families from Northern Finland with early onset CHD and low HDL-C using a variance components approach. The genetic and environmental correlations between the plasma adiponectins and various lipid traits were also studied and a bivariate analysis for HDL-C and the adiponectins carried out.
In the partial correlation analysis (adjusted for sex, age, BMI and statin use) the adiponectins showed a stronger correlation with HDL-C (total 0.57, p=0.001, HMW 0.51, p