Ticks - public health risks in urban green spaces.

BACKGROUND: Urban green spaces are important for human health, but they may expose visitors to tick-borne diseases. This not only presents a potential public health challenge but also undermines the expected public health gains from urban green spaces. The aim of this study is to assess the public health risk of tick-borne diseases in an urban green space used for recreation in Stockholm, Sweden. METHODS: We used a mixed method approach identifying both the magnitude of the tick hazard and the extent of the human exposure to tick-borne diseases. At six entry points to an urban green space, we sampled ticks and documented microhabitat conditions from five randomly assigned 2 m × 2 m plots. Surrounding habitat data was analyzed using geographical information system (GIS). Nymphs and adult ticks were tested for Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum using TaqMan qPCR. Positive B. burgdorferi (s.l.) ticks were further analyzed by nested PCR amplification and sequence analysis. Population census data and visitor count data were used to estimate the degree of human exposure to tick-borne diseases. To further understand the degree to which visitors get in contact with infected ticks we also conducted interviews with visitors to green spaces. RESULTS: High tick densities were commonly found in humid broadleaved forest with low field vegetation. High pathogen prevalence was significantly correlated with increasing proportions of artificial areas. Integrating the tick hazard with human exposure we found that the public health risk of tick-borne diseases was moderate to high at most of the studied entry points. Many of the visitors frequently used urban green spaces. Walking was the most common activity, but visitors also engaged in activities with higher risk for tick encounters. Individual protective measures were connected to specific recreational activities such as picking berries or mushrooms. CONCLUSIONS: The number of visitors can be combined with tick inventory data and molecular analyses of pathogen prevalence to make crude estimations of the public health risk of tick-borne diseases in urban green spaces. The risk of encountering infected ticks is omnipresent during recreational activities in urban green spaces, highlighting the need for public health campaigns to reduce the risk of tick-borne diseases.

Managing multi-functional peri-urban landscapes: Impacts of horse-keeping on water quality.

Eutrophication assessments in water management to quantify nutrient loads and identify mitigating measures seldom include the contribution from horse facilities. This may be due to lack of appropriate methods, limited resources, or the belief that the impact from horses is insignificant. However, the recreational horse sector is growing, predominantly in multi-functional peri-urban landscapes. We applied an ecosystem management approach to quantify nutrient loads from horse facilities in the Stockholm Region, Sweden. We found that horses increased the total loads with 30-40% P and 20-45% N, with average area-specific loads of 1.2 kg P and 7.6 kg N ha-1 year-1. Identified local risk factors included manure management practices, trampling severity, soil condition and closeness to water. Comparisons of assessment methods showed that literature standard values of area-specific loads and water runoff may be sufficient at the catchment level, but in small and more complex catchments, measurements and local knowledge are needed.

Factors responsible for Ixodes ricinus presence and abundance across a natural-urban gradient.

To better understand the spatial distribution of the common tick Ixodes ricinus, we investigated how local site factors and landscape characteristics influence tick presence and abundance in different greenspaces along the natural-urban gradient in Stockholm County, Sweden. Ticks and field data were collected in 2017 and 2019 and analyzed in relation to habitat type distributions estimated from land cover maps using geographical information system (GIS). A total of 1378 (992 larvae, 370 nymphs, 13 females, and 3 males) questing ticks were collected from 295 sampling plots in 47 different greenspaces. Ticks were present in 41 of the 47 greenspaces and our results show that both local site features such as vegetation height, and landscape characteristics like the amount of mixed coniferous forest, significantly affect tick abundance. Tick abundance was highest in rural areas with large natural and seminatural habitats, but ticks were also present in parks and gardens in highly urbanized areas. Greenspaces along the natural-urban gradient should be included in surveillance for ticks and tick-borne diseases, including highly urbanized sites that may be perceived by the public as areas with low risk for tick encounters.

Experiences of Mothers Participating in a Mother-Child Video Therapy Program.

INTRODUCTION: Responsive and sensitive parenting promotes the development of self-regulation and lowers stress in children, which in turn is associated with greater educational and economic achievement and better physical and emotional health later in life. Dyadic parent-child video-feedback programs can help parents learn effective parenting skills, yet these programs are estimated to retain only about half of eligible participants. Programs vary widely, and little is known about what is valued by parents who do complete these programs. The purpose of this qualitative study was to understand the goals, experiences, and outcomes important to mothers who completed a video-feedback program. METHODS: Transcripts of exit interviews of participants in a video-feedback program (N = 31) were analyzed using qualitative description methodology. Trustworthiness was achieved through deep engagement with the material, following an iterative process in analyzing transcripts, and member checks to confirm results. RESULTS: Mothers enrolled in the program to better understand their child, help their child learn, and to develop closer connections with their child. Elements of the program that helped mothers achieve these goals were (1) positive feedback and support by the therapist, (2) dedicated one-on-one time spent with their infant, (3) help with concrete needs, and (4) learning from watching videotaped play sessions. As a result, mothers reported greater confidence as caregivers, use of more responsive and sensitive parenting strategies, and improvements in their children's behaviors and their own mental health. DISCUSSION: Incorporating elements of the program found to be most useful in this study into video-feedback programs may make video-feedback programs more attractive to parents and increase retention. Midwives and women's health care providers may incorporate elements of the program into their clinical practice and advocacy, with special attention to elements most valued by parents themselves.

Economic Impact of Hearing Loss and Reduction of Noise-Induced Hearing Loss in the United States.

Purpose: Hearing loss (HL) is pervasive and debilitating, and noise-induced HL is preventable by reducing environmental noise. Lack of economic analyses of HL impacts means that prevention and treatment remain a low priority for public health and environmental investment. Method: This article estimates the costs of HL on productivity by building on established estimates for HL prevalence and wage and employment differentials between those with and without HL. Results: We estimate that HL affects more than 13% of the working population. Not all HL can be prevented or treated, but if the 20% of HL resulting from excessive noise exposure were prevented, the economic benefit would be substantial-we estimate a range of $58 billion to $152 billion annually, with a core estimate of $123 billion. We believe this is a conservative estimate, because consideration of additional costs of HL, including health care and special education, would likely further increase the benefits associated with HL prevention. Conclusion: HL is costly and warrants additional emphasis in public and environmental health programs. This study represents an important first step in valuing HL prevention-in particular, prevention of noise-induced HL-where new policies and technologies appear promising.

Valuing Quiet: An Economic Assessment of U.S. Environmental Noise as a Cardiovascular Health Hazard.

INTRODUCTION: Environmental noise pollution increases the risk for hearing loss, stress, sleep disruption, annoyance, and cardiovascular disease and has other adverse health impacts. Recent (2013) estimates suggest that more than 100 million Americans are exposed to unhealthy levels of noise. Given the pervasive nature and significant health effects of environmental noise pollution, the corresponding economic impacts may be substantial. METHODS: This 2014 economic assessment developed a new approach to estimate the impact of environmental noise on the prevalence and cost of key components of hypertension and cardiovascular disease in the U.S. By placing environmental noise in context with comparable environmental pollutants, this approach can inform public health law, planning, and policy. The effects of hypothetical national-scale changes in environmental noise levels on the prevalence and corresponding costs of hypertension and coronary heart disease were estimated, with the caveat that the national-level U.S. noise data our exposure estimates were derived from are >30 years old. RESULTS: The analyses suggested that a 5-dB noise reduction scenario would reduce the prevalence of hypertension by 1.4% and coronary heart disease by 1.8%. The annual economic benefit was estimated at $3.9 billion. CONCLUSIONS: These findings suggest significant economic impacts from environmental noise-related cardiovascular disease. Given these initial findings, noise may deserve increased priority and research as an environmental health hazard.

Environmental noise pollution in the United States: developing an effective public health response.

BACKGROUND: Tens of millions of Americans suffer from a range of adverse health outcomes due to noise exposure, including heart disease and hearing loss. Reducing environmental noise pollution is achievable and consistent with national prevention goals, yet there is no national plan to reduce environmental noise pollution. OBJECTIVES: We aimed to describe some of the most serious health effects associated with noise, summarize exposures from several highly prevalent noise sources based on published estimates as well as extrapolations made using these estimates, and lay out proven mechanisms and strategies to reduce noise by incorporating scientific insight and technological innovations into existing public health infrastructure. DISCUSSION: We estimated that 104 million individuals had annual LEQ(24) levels > 70 dBA (equivalent to a continuous average exposure level of >70 dBA over 24 hr) in 2013 and were at risk of noise-induced hearing loss. Tens of millions more may be at risk of heart disease, and other noise-related health effects. Direct regulation, altering the informational environment, and altering the built environment are the least costly, most logistically feasible, and most effective noise reduction interventions. CONCLUSION: Significant public health benefit can be achieved by integrating interventions that reduce environmental noise levels and exposures into the federal public health agenda.

Major trends in public health law and practice: a network national report.

Since its inception in September 2010, the Network for Public Health Law has responded to hundreds of public health legal technical assistance claims from around the country. Based on a review of these data, a series of major trends in public health practice and the law are analyzed, including issues concerning: the Affordable Care Act, tobacco control, emergency legal preparedness, health information privacy, food policy, vaccination, drug overdose prevention, sports injury law, public health accreditation, and maternal breastfeeding. These and other emerging themes in public health law demonstrate the essential role of law and practice in advancing the public's health.

Governance of water resources in the phase of change: a case study of the implementation of the EU Water Framework Directive in Sweden.

In this article, focusing on the ongoing implementation of the EU Water Framework Directive, we analyze some of the opportunities and challenges for a sustainable governance of water resources from an ecosystem management perspective. In the face of uncertainty and change, the ecosystem approach as a holistic and integrated management framework is increasingly recognized. The ongoing implementation of the Water Framework Directive (WFD) could be viewed as a reorganization phase in the process of change in institutional arrangements and ecosystems. In this case study from the Northern Baltic Sea River Basin District, Sweden, we focus in particular on data and information management from a multi-level governance perspective from the local stakeholder to the River Basin level. We apply a document analysis, hydrological mapping, and GIS models to analyze some of the institutional framework created for the implementation of the WFD. The study underlines the importance of institutional arrangements that can handle variability of local situations and trade-offs between solutions and priorities on different hierarchical levels.

Effects of fish stocking on ecosystem services: an overview and case study using the Stockholm Archipelago.

In this article, we focus on documented and possible effects of fish stocking in terms of ecosystem services. The increasing use of fish stocking between 1970 and 2000 in the semiurban setting of Stockholm archipelago, Sweden, is used as case study. The objective is to analyze this management practice from an ecosystem perspective, accounting for both the ecological and social context of releasing fish. The results show that enhancements of four native species (Salmo S. trutta, Salmo salar, Stizostedion lucioperca, and Anguilla anguilla) have dominated over new introductions of one nonnative species. (Oncorhynchus mykiss). The major objective has been to increase fish catches for local resource users. Involved stakeholders include three management agencies, one hydropower company, and several local sport fishing associations. Documented effects focus on recapture and production rates. However, our analysis suggests that additional positive or negative effects on biodiversity, food web dynamics, mobile links, or ecological information may also result, with possible consequences for the long-term provision of food, game, and aesthetic values. We conclude that a more adaptive and cooperative management approach could benefit from a deeper analysis of where, when, and what species is released, by whom, which stakeholders that use the fish and those ecosystem services the fish generate, and of the role of formal and informal institutions for monitoring and evaluating the success of releasing fish.