Ambient particulate matter and surrounding greenness in relation to sleep quality among pregnant women: A nationwide cohort study.

Background: Particulate air pollution and residential greenness are associated with sleep quality in the general population; however, their influence on maternal sleep quality during pregnancy has not been assessed. Objective: This cross-sectional study investigated the individual and interactive effects of exposure to particulate matter (PM) air pollution and residential greenness on sleep quality in pregnant women. Methods: Pregnant women (n = 4933) enrolled in the Korean Children's Environmental Health Study with sleep quality information and residential address were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The average concentrations of PM (PM2.5 and PM10) during pregnancy were estimated through land use regression, and residential greenness in a 1000 m buffer area around participants' residences was estimated using the Normalized Difference Vegetation Index (NDVI1000-m). Modified Poisson regression models were used to estimate the associations between PM and NDVI and poor sleep quality (PSQI >5) after controlling for a range of covariates. A four-way mediation analysis was conducted to examine the mediating effects of PM. Results: After adjusting for confounders, each 10 µg/m3 increase in PM2.5 and PM10 exposure was associated with a higher risk of poor sleep quality (relative risk [RR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11; and RR: 1.09; 95% CI: 1.06, 1.13, respectively), and each 0.1-unit increase in NDVI1000-m was associated with a lower risk of poor sleep quality (RR: 0.97; 95% CI: 0.95, 0.99). Mediation analysis showed that PM mediated approximately 37%-56% of the association between residential greenness and poor sleep quality. Conclusions: This study identified a positive association between residential greenness and sleep quality. Furthermore, these associations are mediated by a reduction in exposure to particulate air pollution and highlight the link between green areas, air pollution control, and human health.

Exposure to Crude Oil-Related Volatile Organic Compounds Associated with Lung Function Decline in a Longitudinal Panel of Children.

BACKGROUND: Children in the affected area were exposed to large amounts of volatile organic compounds (VOCs) from the Hebei Spirit oil spill accident. OBJECTIVES: We investigated the lung function loss from the exposure to VOCs in a longitudinal panel of 224 children 1, 3, and 5 years after the VOC exposure event. METHODS: Atmospheric estimated concentration of total VOCs (TVOCs), benzene, toluene, ethylbenzene, and xylene for 4 days immediately after the accident were calculated for each village (n = 83) using a modeling technique. Forced expiratory volume in 1 s (FEV1) as an indicator of airway status was measured 1, 3, and 5 years after the exposure in 224 children 4~9 years of age at the exposure to the oil spill. Multiple linear regression and linear mixed models were used to evaluate the associations, with adjustment for smoking and second-hand smoke at home. RESULTS: Among the TVOCs (geometric mean: 1319.5 mg/m3·4 d), xylene (9.4), toluene (8.5), ethylbenzene (5.2), and benzene (2.0) were dominant in the order of air concentration level. In 224 children, percent predicted FEV1 (ppFEV1), adjusted for smoking and second-hand smoke at home, was 100.7% after 1 year, 96.2% after 3 years, and 94.6% after 5 years, and the loss over the period was significant (p < 0.0001). After 1 and 3 years, TVOCs, xylene, toluene, and ethylbenzene were significantly associated with ppFEV1. After 5 years, the associations were not significant. Throughout the 5 years' repeated measurements in the panel, TVOCs, xylene, toluene, and ethylbenzene were significantly associated with ppFEV1. CONCLUSIONS: Exposure to VOCs from the oil spill resulted in lung function loss among children, which remained significant up to 5 years after the exposure.

An Efficient Method for Selective Syntheses of Sodium Selenide and Dialkyl Selenides.

The studies on the selective synthesis of dialkyl selenide compounds 1 were presented. Overcoming the complexity and difficulty of selenides (R-Se-R) and/or multiselenides (R-Sen-R; n ≥ 2), we aimed to optimize the reaction condition for the tolerable preparation of sodium selenide (Na2Se) by reducing Se with NaBH4, and then to achieve selective syntheses of dialkyl selenides 1 by subsequently treating the obtained sodium selenide with alkyl halides (RX). Consequently, various dialkyl selenides 1 were efficiently synthesized in good-to-moderate yields. The investigations on reaction pathways and solvent studies were also described.

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures.

OBJECTIVE: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. METHODS: Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. RESULTS: A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. CONCLUSION: This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Who has sustained psychological symptoms nine years after the Hebei Spirit oil spill?: The Health Effect Research on Hebei Spirit oil spill (HEROS) study.

This study evaluated risk factors for sustained psychological symptoms in affected residents, nine years after the Hebei Spirit oil spill in Korea in 2007. The participants included residents of high-exposure areas, living within 2 km from the contaminated coast (n = 2013), among the cohort of the Health Effect Research on Hebei Spirit oil spill study from 2009 to 2016. Symptoms for post-traumatic stress disorder (PTSD), depression, psychosocial distress, and anxiety, as well as sociodemographic information were assessed through questionnaire interviews. Trajectory analysis was conducted to identify the group with sustained symptoms over time and logistic regression analysis was performed to identify risk factors for sustained symptoms adjusted for covariates. A longer duration of clean-up work, lower household income, and presence of a chronic disease in all type of symptoms, and being female, younger age, and higher educational level in all symptoms but PTSD, showed a significant association with increased risk of sustained symptoms. The highest risk was found in the subgroup with a longer clean-up together with offshore and maritime occupations or lower income in PTSD, depression, and anxiety, compared with those with a shorter clean-up and other occupation or higher income. Increased risk of sustained PTSD in relation to a longer clean-up was limited to those with a lower educational level (p-interaction = 0.009). The results suggested that participating longer in clean-up work increased sustained psychological symptoms, synergistically with socioeconomic factors such as offshore and maritime occupations, lower household income, or economic losses related to educational level.

Trends in food and nutrient intake over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey.

OBJECTIVES: We aimed to examine the current status and trends of food and nutrient intake in the Korean population over the past 20 years using the data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: We conducted a survey of 116,284 subjects over the age of one year in Korea, who participated in the KNHANES between 1998 and 2018. We collected data on the subjects' intake for the day before using the 24-hour recall method. The annual percent change (APC) in the food groups and nutrient intake were calculated using SAS and Joinpoint software. RESULTS: The intake of grains (APC=-0.4, p<0.05) and vegetables (APC=-0.8, p<0.05) was observed to decrease. In contrast, the intake of beverages, meat, dairy, and eggs increased. In particular, beverage intake increased by more than four times (APC=9.2, p<0.05). There was no significant change in energy intake. However, the proportion of energy intake from carbohydrates decreased by approximately 5%p (APC=-0.3, p<0.05), whereas that from fat increased by approximately 5%p (APC= 1.1, p<0.05). Additionally, there were decreases in the proportion of energy intake from breakfast and homemade meals and increases in the energy intake from snacks, dining out, and convenience food. The intake of vitamin C (APC=-3.2, p<0.05) and sodium (APC=-2.3, p<0.05) significantly decreased. CONCLUSIONS: Over the past 20 years, there has been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat. Since nutritional status is an important factor in the prevention and management of chronic diseases, it should be continuously monitored.

Comparative parenting stress measures between segmental and community-based rehabilitation services in parents of children and adolescents with intellectual and developmental disabilities (IDD): A cross-sectional survey.

BACKGROUND: There is a dearth of information on the effects of different types (Segmental rehabilitation service (SRS) vs Community-based rehabilitation service (CRS)) on the parenting stress and family quality of life in parents of children who have individuals with intellectual and developmental disabilities (IDD). OBJECTIVE: This paper is to compare the effects of SRS and CRS on parenting stress and family quality of life in parents of individuals with IDD. METHODS: A cross-sectional design was used to examine parenting stress and family quality life in cohorts of 120 fathers and mothers of children with IDD who had received either SRS or CRS participated in the survey. The outcome measures included the modified Parenting Stress Index (PSI) and the modified Beach Center Family Quality of Life Scale (mBCFQLS). The Mann-Whitney U test was performed at P< 0.05. RESULTS: A significant difference was observed in social stress in PSI between the SRS and CRS groups (P= 0.03). The child rearing, emotional well-being, and physical and material well-being variables in mBCFQLS were different between the SRS and CRS groups (P< 0.05), indicating superior benefits from CRS than SRS. CONCLUSIONS: These findings provide important information and about parenting stress and family quality of life in children with IDD, for developing effective rehabilitation programs and services for these parents.

[The Reliability and Validity of Korean Version of Wong and Law Emotional Intelligence Scale (K-WLEIS)].

PURPOSE: The aim of this study was to evaluate the reliability and validity of the Korean version of the Wong and Law Emotional Intelligence Scale (K-WLEIS). METHODS: Data were collected from 360 nursing students using a self reported questionnaire. Exploratory and confirmatory factor analysis were used to test construct validity. Convergence validity was identified by correlation with communication competency. Item convergent and discriminant validity were also analyzed. Reliability was evaluated internal consistency and test-retest reliability. RESULTS: The results of exploratory factor analysis showed that the eigen values ranged from 1.34 to 5.86 and 73.2% of the total explained variance. Confirmatory factor analysis showed adequate model fit indices (χ²/df 1.89, RMSEA .07, GFI .89, CFI .95, and TLI .93) and standardized factor loadings (.48 to .87). The average extracted variances (.71 to .79) and composite reliability (.80 to .87) validated convergence and discriminant validity of the items. Test-retest reliability of intra-class correlation coefficient was .90 and the Cronbach's alpha coefficient was .88. CONCLUSION: The K-WLEIS is an appropriate scale for measuring the emotional intelligence of Korean nursing students. Therefore, it is expected that the K-WLEIS will be used for nursing education programs to improve nursing students' emotional intelligence.

An association between oil spill clean-up work and cardiovascular disease.

BACKGROUND: In December 2007, Taean, South Korea, experienced the largest oil spill in Korean history. After about 10 years of follow-up, we evaluated the long-term effect of the disaster on the cardiovascular health of residents and clean-up workers/volunteers. OBJECTIVE: We examined the relationship between the duration of oil clean-up work and the risk of incident angina and myocardial infarction (MI). METHODS: We used data from a prospective cohort study, the Health Effects Research of Oil Spill (HEROS); we included adult cohort members free from cardiovascular disease who completed at least the first two surveys (n = 1737). At baseline, members reported the number of days they participated in oil clean-up work; during the subsequent surveys, they reported newly diagnosed cases of angina or MI. We fitted a time-varying interval-censored proportional hazard model, controlling for age, sex, body mass index, smoking status, monthly household income, and distance from the affected seashore to residence. RESULTS: The risk of incident angina or MI was greater in those with more than 15 days' exposure; those with 15-59 days showed a hazard ratio (HR) of 1.34 (95% confidence interval [CI]: 0.87, 2.06) those with 60-179 days had an HR of 1.31 (0.95, 1.79), and those worked longest (180 or more days) showed the strongest association with a HR of 1.75 (95% CI: 1.17, 2.61). CONCLUSION: We found that a greater duration of clean-up work was associated with an increased risk of incident angina or MI.

Cross-sectional and longitudinal associations between global DNA (hydroxy) methylation and exposure biomarkers of the Hebei Spirit oil spill cohort in Taean, Korea.

The Hebei Spirit oil spill (HSOS) occurred on the west coast of South Korea (Taean county) on December 7, 2007, and studies revealed that exposure to the oil spill was associated with various adverse health issues in the inhabiting population. However, no studies evaluated the association between crude-oil exposure and epigenetic changes. This study aimed to investigate the HSOS exposure-associated longitudinal and cross-sectional variations in global DNA methylation (5-mc) and/or hydroxymethylation (5-hmc) and expression profiles of related genes in Taean cohort participants from 2009 (AH-baseline) and 2014 (AH-follow-up) relative to the reference group (AL). We measured global DNA 5-mc and 5-hmc levels and related gene expression levels in whole blood. We identified significant associations between HSOS exposure and AH-baseline-5-mc, AH-baseline-5-hmc, and AH-follow-up-5-hmc. HSOS exposure was associated with lower %5-mc content and higher %5-hmc content in the same individuals from both the cross-sectional and longitudinal studies. In addition, we found a strong correlation between 5-mc and DNMT3B expression, and between 5-hmc and TET1 expression. Our findings suggested that epigenetic changes are important biomarkers for HSOS exposure and that 5-hmc is likely to be more sensitive for environmental epidemiological studies.

The use of motivational interviewing during an interdisciplinary Service-Learning activity for older adults at risk for dementia.

This study aimed to develop a service-learning program based on motivational interviewing for older adults living alone and at risk for dementia. This paper focused on description and implementation of the developed program and students' preliminary outcomes as a mixed-methods pilot study. Participants were nine students in occupational therapy, physical therapy, and social work and three older adults matched to each of the three interdisciplinary student groups. Students' attitudes about community service improved. Also, participation in the program was regarded as a new useful experience that helped in realizing the importance of interprofessional collaboration, expanding knowledge about other disciplines, contributing to the community and professional development, and understanding older adults living alone. Future study should include a larger sample size and measure the program's effectiveness for both the students and older adults.

Activation of the nucleotide excision repair pathway by crude oil exposure: A translational study from model organisms to the Hebei Spirit Oil Spill Cohort.

In order to gain insight into the human health implications of the Hebei Spirit Oil Spill (HSOS), the mechanism of toxicity of the Iranian heavy crude (IHC), the main oil component in the HSOS was investigated in Caenorhabditis elegans and zebrafish. The identified mechanism was translated to humans using blood samples from Taean residents, who experienced HSOS with different levels of exposure to the spill. C. elegans TF RNAi screening with IHC oil revealed the nucleotide excision repair (NER) pathway as being significantly involved by oil exposure. To identify the main toxicity contributors within the chemical mixture of the crude oil, further studies were conducted on C. elegans by exposure to C3-naphthalene, an alkylated polycyclic aromatic hydrocarbon (PAH), which constitutes one of the major components of IHC oil. Increased expression of NER pathway genes was observed following exposure to the IHC oil, C3-naphthalene enriched fraction and C3-naphthalene. As the NER pathway is conserved in fish and humans, the same experiment was conducted in zebrafish, and the data were similar to what was seen in C. elegans. Increased expression of NER pathway genes was observed in human samples from the high exposure group, which suggests the involvement of the NER pathway in IHC oil exposure. Overall, the study suggests that IHC oil may cause bulk damage to DNA and activation of the NER system and Alkylated PAHs are the major contributor to DNA damage. Our study provides an innovative approach for studying translational toxicity testing from model organisms to human health.

Hebei Spirit oil spill and its long-term effect on children's asthma symptoms.

On December 7th, 2007, an estimated 12,547 kL of crude oil was spilled from the collision of Hebei Spirit near residential area. Our previous study demonstrated worsening of children's asthma symptoms one year after the accident. This study investigated long-term effect of the oil spill on children's asthma symptoms up to five years after the accident. All elementary and middle school students in the exposure area were surveyed on one year (n = 655), three years (664), and five years (611) after the accident. Oil spill exposure was estimated using two estimates including distance from the oil spill (A) and modeled estimates of benzene, toluene, ethylbenzene, and xylene (BTEX) compounds (B), and each was dichotomously categorized (A: high-exposure vs low-exposure; B: ≥20 mg/m3 vs < 20 mg/m3). Asthma symptoms were evaluated using a standard questionnaire. Oil spill exposure estimates were associated with asthma symptoms on one year (odds ratio (95% confidence interval) A: 1.9 (1.1-3.1); B: 1.6 (0.9-2.7)), three years (A: 1.9 (1.1-3.2); B: 1.3 (0.8-2.2)), and five years (A: 1.2 (0.7-1.9); B: 1.8 (1.1-2.8)) after the oil spill. Significant longitudinal relationship between oil spill exposure estimates and asthma symptoms was also observed (A: 1.6 (1.2-2.2); B: 1.6 (1.1-2.1)). Overall, the effect of oil spill exposure estimates was more severe on younger children. Oil spill exposure estimates were associated with asthma symptoms in children up to five years after the oil spill.

Erratum: Choi, K.-H., et al. Cancer Incidence Trend in the Hebei Spirit Oil Spill Area, from 1999 to 2014: An Ecological Study. Int. J. Environ. Res. Public Health 2018, 15, 1006.

Due to an error during production, the legend presented in Figure 2 in the Results section of the published paper [1] were incorrect.[...].

Cancer Incidence Trend in the Hebei Spirit Oil Spill Area, from 1999 to 2014: An Ecological Study.

The Hebei Spirit oil spill (HSOS) occurred in the Republic of Korea on 7 December 2007. We aimed to describe the cancer incidence trend in Taean County before and after the oil spill. Five major cancers and leukemia were analyzed. Cancer incidence data were obtained from the Korean National Cancer Center. We compared the standardized incidence rates in Taean with those observed nationwide and selected three coastal areas. Joinpoint regression analysis was used to examine the trends in the average annual percent change and perform comparisons. The incidence rate of prostate cancer increased from 2007 to 2009 at an annual average of 39.3% (95% confidence interval (CI): -25.9, 161.8), 13.5% (95% CI: 11.7, 15.4), and 15.6% (95% CI: 11.9, 19.5), respectively, in Taean, nationwide, and in the coastal areas. The incidence of leukemia among women increased at an annual average of 9.5% (95% CI: -26.6, 63.4) in Taean and 0.6% (95% CI: 0.2, 0.9) nationwide; the rate decreased by 1.9% (95% CI: -12.8, 10.4) in the coastal areas. The trends between Taean County and the coastal areas differed only for prostate cancer (p = 0.0004). The incidence of prostate cancer among Taean County residents has increased since the HSOS.

Histone methylation-associated transgenerational inheritance of reproductive defects in Caenorhabditis elegans exposed to crude oil under various exposure scenarios.

As part of a study to explore the long-term effects of the Hebei Spirit oil spill accident, transgenerational toxicity and associated epigenetic changes were investigated in the nematode Caenorhabditis elegans. Under experimental conditions, worms were exposed to Iranian heavy crude oil (IHC) under three different scenarios: partial early-life exposure (PE), partial late-life exposure (PL), and whole-life exposure (WE). Growth, reproduction, and histone methylation were monitored in the exposed parental worms (P0) and in three consecutive unexposed offspring generations (F1-3). Reproductive potential in the exposed P0 generation in the WE treatment group was reduced; additionally, it was inhibited in the unexposed offspring generations of the P0 worms. This suggests that there was transgenerational inheritance of defective reproduction. Comparison of developmental periods of exposure showed that IHC-treated worms in the PL group had a greater reduction in reproductive capacity than those in the PE group. Decreased methylation of histone H3 (H3K9) was found in the IHC-exposed parental generation. A heritable reduction in reproductive capacity occurred in wildtype N2 but was not found in a H3K9 histone methyltransferase (HMT) mutant, met-2(n4256), suggesting a potential role for HMT in transgenerational toxicity. Our results suggest that the reproductive toxicity after IHC exposure could be heritable and that histone methylation is associated with the transmission of the inherited phenotype.

Preventive Effect of Residential Green Space on Infantile Atopic Dermatitis Associated with Prenatal Air Pollution Exposure.

Few birth cohort studies have examined the role of traffic-related air pollution (TRAP) in the development of infantile atopic dermatitis (AD), but none have investigated the role of preventive factors such as green spaces. The aim of this study was to investigate whether exposure to nitrogen dioxide (NO2) and particulate matter with an aerodynamic diameter of <10 µm (PM10) during pregnancy is associated with increased risk of development of AD in 6-month-old children and also to examine how this association changes with residential green space. This study used prospective data from 659 participants of the Mothers and Children's Environmental Health study. Subjects were geocoded to their residential addresses and matched with air pollution data modeled using land-use regression. Information on infantile AD was obtained by using a questionnaire administered to the parents or guardians of the children. The association between infantile AD and exposure to NO2 and PM10 was determined using logistic regression models. We assessed the effects of residential green spaces using stratified analyses and by entering product terms into the logistic regression models. The risk of infantile AD significantly increased with an increase in air pollution exposure during the first trimester of pregnancy. The adjusted odds ratio (OR) and 95% confidence interval (CI) were 1.219 (1.023-1.452) per 10 µg/m³ increase in PM10 and 1.353 (1.027-1.782) per 10 ppb increase in NO2. An increase in the green space within 200 m of residence was associated with a decreased risk of AD (OR = 0.996, 95% CI: 0.993-0.999). The stratified analysis of residential green space revealed stronger associations between infantile AD and PM10 and NO2 exposure during the first trimester in the areas in the lower tertiles of green space. This study indicated that exposure to TRAP during the first trimester of pregnancy is associated with infantile AD. Less residential green space may intensify the association between TRAP exposure and infantile AD.

Effects of traffic-related air pollution on susceptibility to infantile bronchiolitis and childhood asthma: A cohort study in Korea.

OBJECTIVE: This study examined the role of exposure to traffic-related air pollution (TRAP) on susceptibility to asthma in children with past episodes of bronchiolitis. METHODS: The baseline data included 2,627 school children aged 6-14 years who had participated in the longitudinal follow-up survey of the Children's Health and Environmental Research of Korea. Lifetime wheezing, past episodes of bronchiolitis, and doctor-diagnosed asthma were evaluated using an International Study of Asthma and Allergies in Childhood questionnaire. We used generalized linear regression with binomial distribution to calculate the relative risk (RR) between TRAP, assessed by proximity to a main road and the total length of roads, and asthma. RESULTS: Compared with the subjects who had less than 100 m of road length within 200-m radius from their home, those with more than 500 m of road length had significantly increased odds for infantile bronchiolitis (adjusted OR [aOR]: 1.57, 95% confidence interval [CI]: 1.01-2.42). Positive exposure-response relationships were found between residential proximity to the main road and asthma (aOR: 1.79, 95% CI: 1.05-3.06; <75 m vs. >700 m from a main road, P for the trend = 0.02). Closer residential proximity to the main road (<75 m) and bronchiolitis combined increased the risks of newly diagnosed asthma (adjusted RR: 3.62, 95% CI: 1.07-12.26) compared with those without bronchiolitis and living ≥ 75 m away from the main road. CONCLUSIONS: TRAP appeared to be associated with an increased asthma among children with bronchiolitis, indicating the importance of modifying effects of bronchiolitis in asthma pathogenesis.

Human health and ecological assessment programs for Hebei Spirit oil spill accident of 2007: Status, lessons, and future challenges.

Hebei Spirit oil spill (HSOS) of December 2007 is one of the worst oil spill accidents that occurred in Yellow Sea. The affected coastline along the west coast of Korean Peninsula hosts one of the largest tidal flats worldwide, and is home to tens of thousands of human residents. Based on nation-wide concerns on ecosystem damages and adverse human health effects, two separate surveillance programs on ecosystem and human health were initiated: a 10-year follow-up program by Ministry of Oceans and Fisheries to assess ecological impacts of the oil spill, and an exposure and health effect assessment program by Ministry of Environment for the residents of Taean and its vicinity. For the past eight years, extensive monitoring and surveillance data on ecosystem and humans have been accumulated through these programs. But these studies have been conducted mostly independently, and collaborations were seldom made between two programs. The lack of communication resulted in gaps and overlaps between the programs which led to loss of critical information and efficiency. As oil spill can affect both humans and ecosystem through various pathways, collaboration and communication between human and ecosystem health surveillance programs are necessary, and will synergize the success of both programs. Such concerted efforts will provide better platform for understanding the status of impact, and for developing approaches to address human and ecosystem health challenges that may be faced following environmental disasters like HSOS.

Instruments and Taxonomy of Workplace Bullying in Health Care Organizations.

PURPOSE: This study was aimed to evaluate the methodological issues and comprehensiveness of workplace bullying instruments and to suggest a taxonomy of psychological abuse. METHODS: Nineteen instruments applied in health care organizations and 469 questionnaire items mainly regarding psychological abuse were collected through a literature review. Three researchers classified the questionnaire items according to a "taxonomy of psychological abuse in the workplace." RESULTS: Many instruments of workplace bullying were developed in the 2000s using a reflective measurement model, but their psychometric property was not sufficient and the measurement model is questioned. Based on the questionnaire items, the "taxonomy of psychological abuse in the workplace" was modified by adding two new subcategories (unachievable work and unfair treatment) and clarifying some operational definitions. According to the modified taxonomy of 11 (sub)categories, the reviewed instruments assessed 6.5 (sub)categories on average. No instrument measured all (sub)categories. Category 4.2 (disrespect, humiliation, and rejection of the person) was measured in all instruments, followed by Categories 5 (professional discredit and denigration) and 1.2 (social isolation) behaviors. CONCLUSION: The current instruments are not comprehensive enough. It is suggested that the modified taxonomy is verified and guide more reliable and inclusive instruments in the future. Furthermore, a formative measurement model, which defines a bullying as an inventory of different types of behaviors, should be used.