Industrial air pollution in rural Kenya: community awareness, risk perception and associations between risk variables.

BACKGROUND: Developing countries have limited air quality management systems due to inadequate legislation and lack of political will, among other challenges. Maintaining a balance between economic development and sustainable environment is a challenge, hence investments in pollution prevention technologies get sidelined in favor of short-term benefits from increased production and job creation. This lack of air quality management capability translates into lack of air pollution data, hence the false belief that there is no problem. The objectives of the study were to: assess the population's environmental awareness, explore their perception of pollution threat to their health; examine the association between specific health hazards. METHODS: A cross-sectional study was implemented by gathering quantitative information on demographic, health status, environmental perception and environmental knowledge of residents to understand their view of pollution in their neighborhood. Focus group discussions (FGDs) allowed for corroboration of the quantitative data. RESULTS: Over 80% of respondents perceived industrial pollution as posing a considerable risk to them despite the fact that the economy of the area largely depended on the factory. Respondents also argued that they had not been actively involved in identifying solutions to the environmental challenges. The study revealed a significant association between industrial pollution as a risk and, perception of risk from other familiar health hazards. The most important factors influencing the respondents' pollution risk perception were environmental awareness and family health status. CONCLUSION: This study avails information to policy makers and researchers concerning public awareness and attitudes towards environmental pollution pertinent to development and implementation of environmental policies for public health.

Why is disulfiram superior to acamprosate in the routine clinical setting? A retrospective long-term study in 353 alcohol-dependent patients.

AIMS: To compare the long-term effectiveness of acamprosate (ACP) and disulfiram (DSF) in the treatment of alcohol dependence and their effectiveness in regard to patient characteristics, within a naturalistic outpatient treatment setting. METHOD: Retrospective data from 2002 to 2007 were analysed on 353 alcohol-dependent subjects in outpatient treatment, who, according to the patient's and the clinician's mutual decision, received either supervised DSF (with thrice-weekly appointments) or ACP (once-weekly appointments) following an inpatient alcohol detoxification treatment. Abstinence was assessed by alcohol breathalyzer, patients' self-report, urine and serum analyses, and overall physicians' rating. RESULTS: Baseline data in terms of current addictive behaviour and course of disease differed between groups to the disadvantage of the DSF group; compared to the ACP group, subjects treated with DSF showed a longer duration of alcohol dependence, higher amounts of daily alcohol consumption and more alcohol detoxification treatments in their history. In follow-up, Kaplan-Meier survival analysis revealed significant differences between groups in the primary and secondary measures of outcome (P always <0.01). Time elapsed before the first alcohol relapse as well as attendance to outpatient treatment and cumulative alcohol abstinence achieved within outpatient treatment was explicitly longer in the DSF group. A longer duration of alcohol dependence predicted a favourable treatment outcome in the DSF group, while for the ACP group the chances for a successful treatment increased with shorter duration of alcohol dependence. CONCLUSIONS: This study supports the thesis that supervised DSF is an important component of alcoholism treatment, and it appears to be more effective than the treatment with ACP particularly in patients with a long duration of alcohol dependence.