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Abstract Background Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children’s health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer. Methods A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups. Results Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001). Conclusions In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment.

Background/Aim: Improper drug disposal methods are a threat to the nature and its ecosystem by accumulation of active compounds included in these pharmaceuticals. Aim of this study was to assess the knowledge, attitude and practice (KAP) on the rationale consumption and appropriate disposal methods of unused and expired medications among common public in Kanchipuram district, Tamilnadu, India. Method: KAP questionnaire was prepared to get responses from all participants who had volunteered for the study. Questionnaire had queries pertaining to the personal information about the respondent and respondent's knowledge, practice and attitude concerning drug usage, the disposal methods of unused and expired medicines and their awareness and knowledge towards drug take back programme. Results: In this study 37.91 % out of the 807 participants had excellent knowledge on the rationale consumption and appropriate disposal of unused/expired medications, 48.94 % had average knowledge, but only 6.56 % of the total participants had more positive attitude and 66.66 % had positive attitude. Only around 45.84 % of the participants were following the good practices. Conclusion: Guidelines, policies and strict vigilant actions need to be initiated by government of India for safe utilisation of pharmaceutical products and disposal of unused/expired medications to safeguard our ecosystem from some of the major treats like antimicrobial resistance.

From September 20 to 23, 2023, the 17th National Postgraduates Symposium on Environmental and Occupational Medicine was successfully held in Baotou, Inner Mongolia. This symposium was co-sponsored by the Editorial Board of Journal of Environmental and Occupational Medicine and School of Public Health, Baotou Medical College, Inner Mongolia University of Science and Technology. Themed "Research and practice: Healing the schism", the symposium aimed to activate academic thinking, expand research perspectives, encourage innovation awareness, enhance school-to-school exchanges, and cultivate young talents, especially to promote the close integration of academic research and public health practice. Participants from more than 30 universities and research institutions submitted a total of 82 articles. The symposium also gathered about 200 authors and postgraduates from all over the country to discuss the latest progress and future development in the field of environment and occupational medicine and strive to apply the research results to public health practice.

This scoping review aims to outline key discoveries, gaps in knowledge, and potential future directions in the field of forest therapy research in Europe. Clinical studies investigating the effects of forest therapy sessions in Europe were systematically screened through PubMed, Embase, Cochrane Library, the Directory of Open Access Journals (DOAJ), and Google Scholar (search date: January 2024). This review encompasses 26 selected studies, collectively engaging 2775 participants across various European countries, including Italy, Poland, Spain, Germany, Finland, Hungary, Sweden, Iceland, and Switzerland. These studies predominantly measured psychological outcomes such as mood states, affect, attention levels, subjective wellbeing, and quality of life. Additionally, physiological assessments were conducted, covering vital signs, salivary cortisol, body composition, and blood count. Notably, most of the investigation sites were covered by evergreen forests. Forest therapy practices in Europe demonstrated significant benefits in psychological aspects, including relaxation, mood enhancement, and improved wellbeing, accompanied by physiological improvements, particularly in asthma patients. While a fair-to-good methodological quality was identified in randomized controlled trials, the acknowledged weaknesses point towards a need for more rigorous and standardized research approaches. In conclusion, this comprehensive scoping review provides valuable insights into the current landscape of forest therapy research in Europe, highlighting its potential to positively impact both physical and mental wellbeing. The findings underscore the need for further research addressing methodological limitations and exploring gaps in understanding, thereby contributing to the continued advancement of forest therapy as a holistic wellbeing intervention within the European context.

Letter to the Editor

The environmental impact on health is an inevitable by-product of human activity. Environmental health sciences is a multidisciplinary field addressing complex issues on how people are exposed to hazardous chemicals that can potentially affect adversely the health of present and future generations. Exposure sciences and environmental epidemiology are becoming increasingly data-driven and their efficiency and effectiveness can significantly improve by implementing the FAIR (findable, accessible, interoperable, reusable) principles for scientific data management and stewardship. This will enable data integration, interoperability and (re)use while also facilitating the use of new and powerful analytical tools such as artificial intelligence and machine learning in the benefit of public health policy, and research, development and innovation (RDI). Early research planning is critical to ensuring data is FAIR at the outset. This entails a well-informed and planned strategy concerning the identification of appropriate data and metadata to be gathered, along with established procedures for their collection, documentation, and management. Furthermore, suitable approaches must be implemented to evaluate and ensure the quality of the data. Therefore, the ‘Europe Regional Chapter of the International Society of Exposure Science’ (ISES Europe) human biomonitoring working group (ISES Europe HBM WG) proposes the development of a FAIR Environment and health registry (FAIREHR) (hereafter FAIREHR). FAIR Environment and health registry offers preregistration of studies on exposure sciences and environmental epidemiology using HBM (as a starting point) across all areas of environmental and occupational health globally. The registry is proposed to receive a dedicated web-based interface, to be electronically searchable and to be available to all relevant data providers, users and stakeholders. Planned Human biomonitoring studies would ideally be registered before formal recruitment of study participants. The resulting FAIREHR would contain public records of metadata such as study design, data management, an audit trail of major changes to planned methods, details of when the study will be completed, and links to resulting publications and data repositories when provided by the authors. The FAIREHR would function as an integrated platform designed to cater to the needs of scientists, companies, publishers, and policymakers by providing user-friendly features. The implementation of FAIREHR is expected to yield significant benefits in terms of enabling more effective utilization of human biomonitoring (HBM) data.

Summary: Evidence concerning PM1 exposure, maternal blood pressure (BP), and hypertensive disorders of pregnancy (HDP) is sparse. We evaluated the associations using 105,063 participants from a nationwide cohort. PM1 concentrations were evaluated using generalized additive model. BP was measured according to the American Heart Association recommendations. Generalized linear mixed models were used to assess the PM1-BP/HDP associations. Each 10 μg/m3 higher first-trimester PM1 was significantly associated with 1.696 mmHg and 1.056 mmHg higher first-trimester SBP and DBP, and with 11.4% higher odds for HDP, respectively. The above associations were stronger among older participants (> 35 years) or those educated longer than 17 years or those with higher household annual income (> 400,000 CNY). To conclude, first-trimester PM1 were positively associated with BP/HDP, which may be modified by maternal age, education level, and household annual income. Further research is warranted to provide more information for both health management of HDP and environmental policies enactment.

The space environment is a harsh space for humans who have evolved for a long time by adapting to the earth environment. The cosmic conditions that humans experience in outer space including the moon and Mars, such as altered gravity, exposure to cosmic radiation, changes in atmospheric pressure, and lunar dust, not only make the human body uncomfortable but also threaten survival. Space medicine is one of a field of environmental medicine that aims to clarify the physiology and response of body to these harmful space conditions. The primary purpose of space medicine is to protect the health and life of astronauts, and to support mission performance to succeed in space exploration. In addition, it contributes to mankind by utilizing and industrializing the knowledge and technology acquired in the process of developing knowledge about medical countermeasures, basic life support in the space.

Summary: Virus surveillance in wastewater can be a useful indicator of the development of the COVID-19 pandemic in communities. However, knowledge about how the amount of SARS-CoV-2 RNA in wastewater relates to different data on the burden on the health system is still limited. Herein, we monitored the amount of SARS-CoV-2 RNA and the spectrum of virus variants in weekly pooled wastewater samples for two years from mid-February 2020 and compared them with several clinical data. The two-year monitoring showed the weekly changes in the amount of viral RNA in wastewater preceded the hospital care needs for COVID-19 and the number of acute calls on adult acute respiratory distress by 1-2 weeks during the first three waves of COVID-19. Our study demonstrates that virus surveillance in wastewater can predict the development of a pandemic and its burden on the health system, regardless of society’s test capacity and possibility of tracking infected cases.

Introduction: Environmental health is deteriorating worldwide. Evidence shows that exposure to air, water and soil pollution has caused many deaths worldwide, a trend that is increasing day by day. Health consequences from exposure to environmental pollutants range from cancer, lung disease, heart disease and a series health problems which often lead to death. The majority of pollution related deaths happens mostly in low and middle-income countries. Environmental and pollution health related issues are not getting the attention they deserve in Albania. The main purpose of this article is to identify the relationship between environmental problems and public health consequences, by analysing public policies, case studies and instruments for measuring environmental health indicators. The article also presents suggestions regarding development of Environmental Medicine in Albania, and Public Health Tracking methods. Methods: Qualitative method is thoughtfully used in this article. Specifically, literature review methodology is used to identify environmental indicators that directly affect public health, adequate policies and instruments for the protection of public health, as well as environmental health at the international and national level. Qualitative method is used to reveal and evaluate the topic through multiple facets covering relevant contextual conditions. This method helps identifying the link between public and environment health indicators in a real-life situation, and to understand the relationship between these indicators in the Albanian context. Results and Discussion: Albania lacks a specific measurement system of Environmental Public Health Tracking, as well an established methodology for linking environmental and public health. Potential capacities for measuring environmental and health indicators are limited at the national level, thus, the public health policies do not clearly and fully integrate environmental health indicators for the protection of public health. Vocational training in health and environment is being practiced through various disciplines, but there is a need for specialized environmental medicine health professionals, with adequate competences in the field. Conclusions: The correlation between environment and public health is gaining attention nationally and globally. As in other countries, the need for Environmental Medicine professionals is growing also in Albania. Strong correlations between of environmental pollution indicators (air, water, land pollution) and public health indicators (such as infant and general mortality, morbidity rates, respiratory diseases, etc.) have increased in the last years. Use of instruments (such as EPHT), a fully integrated university curricula and a specific discipline of Environmental Medicine should be made a priority not only nationally, but also globally as environmental problems such as climate change do not recognize national borders. In order to manage the rising cases, states need to be resilient, and build appropriate research based policies and action plans to prevent the occurrence of environmental related public health consequences. Doi: 10.28991/SciMedJ-2021-0302-3 Full Text: PDF

Bisphenol A (BPA) is an endocrine-disruptor compound that exhibits estrogenic activity. BPA is used in the production of materials such as polycarbonate plastics, epoxy resins and dental sealants. Whereas, the endocrine modulating activity of BPA and its effects on reproductive health have been widely studied, its effects on the function of the immune system are poorly characterized. This might be attributable to the different BPA doses used in a diversity of animal models. Moreover, most studies of the effect of BPA on the immune response are limited to in vitro and in vivo studies that have focused primarily on the impact of BPA on the number and proportion of immune cell populations, without evaluating its effects on immune function in response to an antigenic challenge or infectious pathogens. In this review, we discuss the current literature on the effects of BPA on the function of immune system that potentially increases the susceptibility to infections by the virtue of acting as a pro-inflammatory molecule. Thus, it appears that BPA, while by such an impact might be useful in the control of certain disease states that are helped by an inflmmatory response, it can worsen the prognosis of diseases that are adversely affected by inflammation.

Purpose: Arterial stiffness predicts cardiovascular complications. The association between arterial stiffness and blood lead (BL) remains poorly documented. We aimed to assess the association of central hemodynamic measurements, including pulse wave velocity (aPWV), with blood lead in a Flemish population. Materials and Methods: In this Flemish population study (mean age, 37.0 years; 48.3% women), 267 participants had their whole BL and 24-h urinary cadmium (UCd) measured by electrothermal atomic absorption spectrometry in 1985–2005. After 9.4 years (median), they underwent applanation tonometry to estimate central pulse pressure (cPP), the augmentation index (AI), pressure amplification (PA), and aPWV. The amplitudes of the forward (Pf) and backward (Pb) pulse waves and reflection index (RI) were derived by a pressure-based wave separation algorithm. Results: BL averaged 2.93 μg/dL (interquartile range, 1.80–4.70) and UCd 4.79 µg (2.91–7.85). Mean values were 45.0 ± 15.2 mm Hg for cPP, 24.4 ± 12.4% for AI, 1.34 ± 0.21 for PA, 7.65 ± 1.74 m/s for aPWV, 32.7 ± 9.9 mm Hg for Pf, 21.8 ± 8.4 mm Hg for Pb, and 66.9 ± 18.4% for RI. The multivariable-adjusted association sizes for a 2-fold higher BL were: +3.03% (95% confidence interval, 1.56, 4.50) for AI; −0.06 (−0.08, −0.04) for PA; 1.02 mm Hg (0.02, 2.02) for Pb; and 3.98% (1.71, 6.24) for RI (p ≤ .045). In 206 participants never on antihypertensive drug treatment, association sizes were +2.59 mm Hg (0.39, 4.79) for cPP and +0.26 m/s (0.03, 0.50) for aPWV. Analyses adjusted for co-exposure to cadmium were consistent. Conclusion: In conclusion, low-level environmental lead exposure possibly contributes to arterial stiffening and wave reflection from peripheral sites.

Introduction: Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socio-economic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship. Methods: The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM2.5), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables. Results: An increased risk for developing childhood asthma was observed in association with exposure to PM2.5, pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01–1.10), 1.05 (95% CI: 1.02–1.09) and 1.02 (95% CI: 1.00–1.04), for PM2.5, pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM2.5 and the components BC, pOC and SOA were stronger in areas with lower SES. Conclusion: Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollution-attributed asthma among low SES children.

Background Our objective was to determine associations of occupational exposures with cardiac structure and function in Hispanic/Latino adults. Methods and Results Employed participants were included (n=782; 52% women, mean age 52.9 years). Occupational exposures to burning wood, vehicle exhaust, solvents, pesticides, and metals at the current and longest‐held job were assessed by questionnaire. Survey multivariable linear regression analyses were used to model the relationship of each self‐reported exposure with echocardiographic measures of cardiac structure and function. Exposure to burning wood at the current job was associated with decreased left ventricular (LV) ejection fraction (−3.1%; standard error [SE], 1.0 [P=0.002]). When the analysis was restricted to exposure at the longest‐held job, occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL; SE, 1.6 [P

Background This study aims to explore whether higher blood lead levels (BLL) may be associated with failure to control blood pressure and subsequent uncontrolled hypertension. Methods and Results We used serial cross‐sectional waves of the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. 30 762 subjects aged 20 years and above were included. Uncontrolled hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. We estimated odds ratios (ORs) of quartiles of BLL for any hypertension and uncontrolled hypertension by sex using logistic regression, adjusted for demographics, smoking status, serum cotinine, alcohol intake, body mass index, and menopause status in women. The weighted prevalence of hypertension was 46.7%, of which 80.1% were uncontrolled. Men, younger ages, ethnic minorities, people with lower income, never and current smokers, and people with higher BLL were less likely to have their hypertension controlled. In men, compared with the lowest quartile of BLL (

Anthropogenic ultrafine particulate matter (UFPM) and industrial and natural nanoparticles (NPs) are ubiquitous. Normal term, preeclamptic, and postconceptional weeks(PCW) 8–15 human placentas and brains from polluted Mexican cities were analyzed by TEM and energy-dispersive X-ray spectroscopy. We documented NPs in maternal erythrocytes, early syncytiotrophoblast, Hofbauer cells, and fetal endothelium (ECs). Fetal ECs exhibited caveolar NP activity and widespread erythroblast contact. Brain ECs displayed micropodial extensions reaching luminal NP-loaded erythroblasts. Neurons and primitive glia displayed nuclear, organelle, and cytoplasmic NPs in both singles and conglomerates. Nanoscale Fe, Ti, and Al alloys, Hg, Cu, Ca, Sn, and Si were detected in placentas and fetal brains. Preeclamptic fetal blood NP vesicles are prospective neonate UFPM exposure biomarkers. NPs are reaching brain tissues at the early developmental PCW 8–15 stage, and NPs in maternal and fetal placental tissue compartments strongly suggests the placental barrier is not limiting the access of environmental NPs. Erythroblasts are the main early NP carriers to fetal tissues. The passage of UFPM/NPs from mothers to fetuses is documented and fingerprinting placental single particle composition could be useful for postnatal risk assessments. Fetal brain combustion and industrial NPs raise medical concerns about prenatal and postnatal health, including neurological and neurodegenerative lifelong consequences.

Abstract Background Most clinicians feel ill-equipped to assess or educate patients about toxicant exposures, and it is unclear how expert environmental medicine clinicians assess these exposures or treat exposure-related conditions. We aimed to explore expert clinicians’ perspectives on their practice of environmental medicine to determine the populations and toxicants that receive the most attention, identify how they deal with toxicant exposures and identify the challenges they face and where they obtain their knowledge. Methods A qualitative study involving semi-structured interviews with expert environmental clinicians in Australia and New Zealand was conducted. Interviews were recorded and transcribed, and themes were identified and collated until no new themes emerged. Results Five dominant themes emerged from 16 interviews: (1) environmental medicine is a divided profession based on type of practice, patient cohort seen and attitudes towards nutrition and exposure sources; (2) clinical assessment of toxicant exposures is challenging; (3) the environmental exposure history is the most important clinical tool; (4) patients with environmental sensitivities are increasing, have unique phenotypes, are complex to treat and rarely regain full health; and (5) educational and clinical resources on environmental medicine are lacking. Conclusions Environmental medicine is divided between integrative clinicians and occupational and environmental physicians based on their practice dynamics. All clinicians face challenges in assessing toxicant loads, and an exposure history is seen as the most useful tool. Standardised exposure assessment tools have the potential to significantly advance the clinical practice of environmental medicine and expand its reach across other clinical disciplines.

Abstract A significant association of office diastolic blood pressure with low-level blood lead exposure was reported in a Brazilian adult population. However, caution should be taken to interpret these results. The multivariable-adjusted association with blood pressure was positive for diastolic blood pressure, but inverse for systolic blood pressure. The association sizes were infinitesimal without clinical relevance. The outcome measures, i.e. blood pressure and the prevalence of hypertension were analysed across categories of the blood lead distribution – not in relation to blood lead as continuous variable. Blood pressure was the average of two oscillometric office readings, whereas ambulatory monitoring is the state-of-the-art.

December 2014 marked the 30th year anniversary of Bhopal gas tragedy. This sudden and accidental leakage of deadly poisonous methyl isocyanate (MIC) gas instigated research efforts to understand the nature, severity of health damage and sufferings of 570 000 ailing survivors of this tragedy. In a decade-long period, our systematic laboratory investigations coupled with long-term molecular surveillance studies have comprehensively demonstrated that the risk of developing an environmental associated aberrant disease phenotype, including cancer, involves complex interplay of genomic and epigenetic reprogramming. These findings poised us to translate this knowledge into an investigative framework of “molecular biodosimetry” in a strictly selected cohort of MIC exposed individuals. A pragmatic cancer risk-assessment strategy pursued in concert with a large-scale epidemiological study might unfold molecular underpinnings of host-susceptibility and exposureresponse relationship. The challenges are enormous, but we postulate that the study will be necessary to establish a direct initiation-promotion paradigm of environmental carcinogenesis. Given that mitochondrial retrograde signaling-induced epigenetic reprogramming is apparently linked to neoplasticity, a cutting-edge tailored approach by an expert pool of biomedical researchers will be fundamental to drive these strategies from planning to execution. Validating the epigenomic signatures will hopefully result in the development of biomarkers to better protect human lives in an overburdened ecosystem, such as India, which is continuously challenged to meet population demands. Besides, delineating the mechanistic links between MIC exposure and cancer morbidity, our investigative strategy might help to formulate suitable regulatory policies and measures to reduce the overall burden of occupational and environmental carcinogenesis.

Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach.

Mechanistic investigations coupled with epidemiology, case-control, cohort and observational studies have increasingly linked isocyanate exposure (both chronic and acute) with pulmonary morbidity and mortality. Though ascribed for impairment in endothelial cell function, molecular mechanisms of these significant adverse pulmonary outcomes remains poorly understood. As preliminary studies conducted in past have failed to demonstrate a cause-effect relationship between isocyanate toxicity and compromised pulmonary endothelial cell function, we hypothesized that direct exposure to isocyanate may disrupt endothelial structural lining, resulting in cellular damage. Based on this premise, we comprehensively evaluated the molecular repercussions of methyl isocyanate (MIC) exposure on human pulmonary arterial endothelial cells (HPAE-26). We examined MIC-induced mitochondrial oxidative stress, pro-inflammatory cytokine response, oxidative DNA damage response and apoptotic index. Our results demonstrate that exposure to MIC, augment mitochondrial reactive oxygen species production, depletion in antioxidant defense enzymes, elevated pro-inflammatory cytokine response and induced endothelial cell apoptosis via affecting the balance of mitochondrial-nuclear cross talk. We herein delineate the first and direct molecular cascade of isocyanate-induced pulmonary endothelial cell dysfunction. The results of our study might portray a connective link between associated respiratory morbidities with isocyanate exposure, and indeed facilitate to discern the exposure-phenotype relationship in observed deficits of pulmonary endothelial cell function. Further, understanding of inter- and intra-cellular signaling pathways involved in isocyanate-induced endothelial damage would not only aid in biomarker identification but also provide potential new avenues to target specific therapeutic interventions.

In public places many countries banned smoking as the most important indoor source of fine airborne particulate matter. In Austria partial bans have been in force since 2009, with exemptions for the hospitality industry. From February to October 2010 we investigated PM2.5 concentrations in the breathing area of guests in well frequented Viennese establishments of all sizes, and compared these chance indoor samples with PM2.5 concentrations measured during the same half hour at the next outdoor monitoring station. The laser particle counter (OPC1.108, Grimm®) used for indoor measurements had been calibrated by ß-attenuation (FH 62 I-R, Eberline®), which was used outdoors. 48% of 112 venues visited did not fully comply with the law, notwithstanding its weakness. Highest median concentrations (in µg/m3) were found in bars (443.7), followed by nightclubs/discotheques (421.1), pubs (147.7), cafes (106.1) and restaurants (23.4). Concentrations increased with number of smokers present (p < 0.01), with medians of 282.4/241,3/67.6/6.9 µg/m³ in smoking venues/smoking rooms/adjacent non-smoking rooms/exclusive non-smoking venues. Only for the latter, a significant correlation was found with outdoor concentrations (r = 0.48, p < 0.01), while concentrations in non-smoking rooms were higher (p < 0.01) and unrelated to outdoor concentrations, but significantly dependent on concentrations in the adjacent smoking room (r = 0.64, p < 0.01). In conclusion, the partial smoking ban failed and guests of Viennese hospitality venues continue to risk disease from passive smoking, even in so-called “non-smoking rooms”, which are second-hand smoke rooms.

Abstract Background Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression. This study aimed to explore GPs views of sickness certification in relation to depression. Methods A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009. Results A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work. Conclusions GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry.

A queda em idosos é resultado de uma interação complexa entre fatores intrínsecos e extrínsecos. Embora seja difícil separar esses fatores, estudos apontam que fatores de risco ambientais estão presentes em aproximadamente 40% das quedas. O objetivo deste estudo foi realizar uma revisão sistemática da literatura sobre o envolvimento de fatores ambientais nas quedas em idosos vivendo na comunidade. Para tanto, foram selecionados estudos publicados no período de janeiro de 2000 a maio de 2014 nas bases de dados eletrônicas MEDLINE, LILACS e SciELO. Apenas artigos disponíveis na íntegra e em inglês, português e espanhol foram considerados para esta revisão. Após a análise do título, do resumo e do texto na íntegra, dez artigos foram incluídos na revisão. Nos estudos analisados, aproximadamente metade das quedas ocorreu durante a locomoção e envolveu tropeços e escorregões. Os fatores de risco ambientais estão muito presentes nas quedas (20-58%), sendo que superfícies irregulares, superfícies molhadas/escorregadias, objetos/tapetes soltos e desníveis no chão/problemas com degraus foram os mais prevalentes. Observou-se tendência de aumento na ocorrência de quedas em ambientes externos, as quais são frequentemente precipitadas por fatores extrínsecos. Mais estudos são necessários na caracterização e no desenvolvimento de estratégias de prevenção de quedas em ambientes externos.