Public Health Commons^™

Positive Correlation Of Employment And Psychological Well-Being For Veterans With Major Abdominal Surgery, David J. Horner, Christopher S. Wendel, Raymond Skeps, Susan M. Rawl, Marcia Grant, C. Max Schmidt, Clifford Y. Ko, Robert S. Krouse

United States Public Health Resources

BACKGROUND: Intestinal stomas (ostomies) have been associated negatively with multiple aspects of health-related quality of life. This article examines the relationship between employment status and psychological well-being (PWB) in veterans who underwent major bowel procedures with or without ostomy.

METHODS: Veterans from 3 Veterans Affairs (VA) medical centers were surveyed using the City of Hope ostomy-specific questionnaire and the Short Form 36 item Veteran’s version (SF-36V). Response rate was 48% (511 of 1,063). Employment and PWB relationship was assessed using multiple regression with age, income, SF-36V physical component summary (PCS), and employment status as independent variables.

RESULTS: Employed veterans reported …

The Past, Present, And Future Of Comparative Effectiveness Research In The Us Department Of Veterans Affairs, Joel Kupersmith, Alexander K. Ommaya

United States Public Health Resources

A particular challenge for the healthcare provider and the patient is to choose among competing therapeutic approaches for a particular condition. Often, the relative benefits and risks of potential therapies are not uniformly available from the existing scientific information. Many have pointed to the need for more comparative effectiveness research (CER) to aide in these decisions. The US Department of Veterans Affairs (VA) has a long history of conducting CER. The success of the VA CER program has been facilitated by several important aspects of scientific infrastructure related to (1) research question refinement, (2) study design, planning and coordination, (3) …

Comparisons Of Quality Of Surgical Care Between The Us Department Of Veterans Affairs And The Private Sector, Sierra R. Matula, Amal N. Trivedi, Isomi Miake-Lye, Peter A. Glassman, Paul Shekelle, Steven Asch

United States Public Health Resources

The Department of Veterans Affairs (VA) is the largest integrated health system in the United States. Since its establishment in 1930, the VA has provided medical and surgical care to veterans of US military service. VA services are provided primarily by salaried federal employees working in government-operated facilities.

By the 1990s, the VA had developed a negative reputation, with widespread concerns about poor quality of care and systematic inefficiencies.1-3 An overhaul of the organization took place in the mid-1990s to improve both clinical care and the greater VA health system.With regard to quality of surgical care in the VA, changes …

Demographic And Clinical Variation In Veterans Health Administration Provision Of Assistive Technology Devices To Veterans Poststroke, Sandra L. Hubbard Winkler, Diane C. Cowper Ripley, Samuel Wu, Dean M. Reker, Bruce Vogel, Shirley G. Fitzgerald, William C. Mann, Helen Hoenig

United States Public Health Resources

Objectives: To examine variation in provision of assistive technology (AT) devices and the extent to which such variation may be explained by patient characteristics or Veterans Health Administration (VHA) administrative region.

Design: Retrospective population-based study.

Setting: VHA.

Participants: Veterans poststroke in fiscal years 2001 and 2002 (N=12,046).

Interventions: Not applicable.

Main Outcome Measure: Provision of 8 categories of AT devices.

Results: There was considerable regional variation in provision of AT. For example, differences across administrative regions in the VHA ranged from 5.1 to 28.1 standard manual wheelchairs per 100 veterans poststroke. Using logistic …

Investigating The Risk Of Cancer In 1990–1991 Us Gulf War Veterans With The Use Of State Cancer Registry Data, Heather A. Young, Jessica D. Maillard, Paul H. Levine, Samuel J. Simmens, Clare M. Mahan, Han K. Kang

United States Public Health Resources

PURPOSE: The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans.

METHODS: Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of …

Detection Of West Nile Virus In Stable Flies (Diptera: Muscidae) Parasitizing Juvenile American White Pelicans, Gregory Johnson, Nicholas Panella, Kristina Hale, Nicholas Komar

United States Public Health Resources

Stable flies, Stomoxys calcitrans (L.) (Diptera: Muscidae), an economically important pest of livestock and humans, were observed parasitizing prefledged American white pelicans, Pelecanus erythrorhynchos (Pelecaniformes: Pelecanidae), in a pelican breeding colony in northeastern Montana where die-offs attributed to West Nile virus (family Flaviviridae, genus Flavivirus, WNV) have occurred since 2002. Engorged and unengorged flies were collected off nine moribund chicks. Of 29 blood-engorged flies testing positive for vertebrate DNA, all 29 contained pelican DNA. Virus isolation was performed on 60 pools (1,176 flies) of unengorged flies using Vero cell plaque assay. Eighteen pools were positive for WNV …

Uses Of Youth Risk Behavior Survey And School Health Profiles Data: Applications For Improving Adolescent And School Health, Kathryn Foti, Alexandra Balaji, Shari Shanklin

United States Public Health Resources

BACKGROUND: To monitor priority health risk behaviors and school health policies and practices, respectively, the Centers for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) and the School Health Profiles (Profiles). CDC is often asked about the use and application of these survey data to improve adolescent and school health. The purpose of this article is to describe the importance and potential impact of Youth Risk Behavior Survey (YRBS) and Profiles data based on examples from participating sites.

METHODS: The authors spoke with representatives from 25 state and 8 local agencies funded by …

Family Level Phylogenies Reveal Modes Of Macroevolution In Rna Viruses, Andrew Kitchen, Laura Shackelton, Edward Holmes

United States Public Health Resources

Despite advances in understanding the patterns and processes of microevolution in RNA viruses, little is known about the determinants of viral diversification at the macroevolutionary scale. In particular, the processes by which viral lineages assigned as different “species” are generated remain largely uncharacterized. To address this issue, we use a robust phylogenetic approach to analyze patterns of lineage diversification in five representative families of RNA viruses. We ask whether the process of lineage diversification primarily occurs when viruses infect new host species, either through cross-species transmission or codivergence, and which are defined here as analogous to allopatric speciation in animals, …

Patterns Of Drug Use And Abuse Among Aging Adults With And Without Hiv: A Latent Class Analysis Of A Us Veteran Cohort, Traci C. Green, Trace Kershaw, Haiqun Lin, Robert Heimer, Joseph L. Goulet, Kevin L. Kraemer, Adam J. Gordon, Steve A. Maisto, Nancy L. Day, Kendall Bryant, David A. Fiellin, Amy C. Justice

United States Public Health Resources

This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and sociodemographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22–86), primarily male (95%) and African-American (64%). …

Female Veterans Of The Oef/Oif Conflict: Concordance Of Ptsd Symptoms And Substance Misuse, Sarah E. Nunnink, Gali Goldwaser, Pia S. Heppner, James O.E. Pittman, Caroline M. Nievergelt, Dewleen G. Baker

United States Public Health Resources

This study examined the post-deployment rates of comorbid PTSD and substance abuse in a cohort of female veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Female OEF/ OIF veterans and reservists (N=36) completed a battery of assessments as part of a larger study. Of the 36 participants, 11 (31%) screened positive for posttraumatic stress disorder (PTSD), 17 (47%) screened positive for high-risk drinking and 2 (6%) screened positive for drug abuse. Higher scores on measures of alcohol and drug use predicted positive PTSD status (p≤0.01) and alcohol misuse was significant in explaining …

Understanding Attitudes Toward People With Down Syndrome, Jill E. Pace, Mikyong Shin, Sonja A. Rasmussen

United States Public Health Resources

Understanding attitudes of the public toward people with Down syndrome is important because negative attitudes might create barriers to social integration, which can affect their success and quality of life. We used data from two 2008 U.S. surveys (HealthStyles© survey of adults 18 years or older and YouthStyles© survey of youth ages 9–18) that asked about attitudes toward people with Down syndrome, including attitudes toward educational and occupational inclusion and toward willingness to interact with people with Down syndrome. Results showed that many adults continue to hold negative attitudes toward people with Down syndrome: A quarter of respondents agreed that …

Prevalence Of Rural Intimate Partner Violence In 16 Us States, 2005, Matthew J. Breiding, Jessica S. Ziembroski, Michele C. Black

United States Public Health Resources

Context: Intimate partner violence (IPV) is a public health problem that affects people across the entire social spectrum. However, no previous population-based public health studies have examined the prevalence of IPV in rural areas of the United States. Research on IPV in rural areas is especially important given that there are relatively fewer resources available in rural areas for the prevention of IPV.

Methods: In 2005, over 25,000 rural residents in 16 states completed the first-ever IPV module within the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a Centers for Disease Control and Prevention-sponsored annual random-digit-dialed …

Clostridium Difficile In Retail Meat Products, Usa, 2007, J. Glenn Songer, Hien T. Trinh, George E. Killgore, Angela D. Thompson, L. Clifford Mcdonald, Brandi M. Limbago

United States Public Health Resources

To determine the presence of Clostridium difficile, we sampled cooked and uncooked meat products sold in Tucson, Arizona. Forty-two percent contained toxigenic C. difficile strains (either ribotype 078/toxinotype V [73%] or 027/ toxinotype III [NAP1 or NAP1-related; 27%]). These findings indicate that food products may play a role in interspecies C. difficile transmission.

Modifying National Public Health Performance Standards For Local Public Health Department Accreditation, Jeffrey G. Kuhr

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Public health officials throughout the United States are currently preparing for a national accreditation initiative for local and state public health agencies. As a voluntary program, the accreditation process will measure the degree to which state, local, tribal, and territorial public health departments meet nationally recognized standards and measures. Proponents of the initiative feel that evaluating public health agencies on their capacities to achieve certain standards will lead to improved service quality, consistency of public health roles nationally, and a greater understanding of those roles among the general population. However, in planning for agency accreditation some potential barriers must be …

Bacillus Anthracis In China And Its Relationship To Worldwide Lineages, Tatum S. Simonson, Richard T. Okinaka, Bingxiang Wang, W. Ryan Easterday, Lynn Huynh, Jana M. U'Ren, Meghan Dukerich, Shaylan R. Zanecki, Leo J. Kenefic, Jodi Beaudry, James M. Schupp, Talima Pearson, David M. Wagner, Alex Hoffmaster, Jacques Ravel, Paul Keim

United States Public Health Resources

Background: The global pattern of distribution of 1033 B. anthracis isolates has previously been defined by a set of 12 conserved canonical single nucleotide polymorphisms (canSNP). These studies reinforced the presence of three major lineages and 12 sub-lineages and sub-groups of this anthrax-causing pathogen. Isolates that form the A lineage (unlike the B and C lineages) have become widely dispersed throughout the world and form the basis for the geographical disposition of "modern" anthrax. An archival collection of 191 different B. anthracis isolates from China provides a glimpse into the possible role of Chinese trade and commerce in the spread …

Births: Final Data For 2006, Joyce A. Martin, Brady E. Hamilton, Paul D. Sutton, Stephanie J. Ventura, Fay Menacker, Sharon Kirmeyer, T.J. Mathews

United States Public Health Resources

Objectives—This report presents 2006 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital …

Pharmacists’ And Pharmacy Students’ Ability To Identify Drug-Related Problems Using Timer (Tool To Improve Medications In The Elderly Via Review), Sarah Snyder Lee, Ann K. Schwemm, Jeffrey Reist, Matthew Cantrell, Michael Andreski, William R. Doucette, Elizabeth A. Chrischilles, Karen B. Farris

United States Public Health Resources

Objective. Determine the effectiveness of TIMER (Tool to Improve Medications in the Elderly via Review) in helping pharmacists and pharmacy students identify drug-related problems during patient medication reviews.
Methods. In a randomized, controlled study design, geriatric patient cases were sent to 136 pharmacists and 108 third-year pharmacy students who were asked to identify drug related-problems (DRPs) with and without using TIMER.
Results. Pharmacists identified more tool-related DRPs using TIMER (p 5 0.027). Pharmacy students identified more tool-related DRPs using TIMER in the first case (p 5 0.02), but not in the second.
Conclusion. TIMER increased the number of DRPs identified …

Children’S Exposure To Violence: A Comprehensive National Survey, David Finkelhor, Heather Turner, Richard Ormrod, Sherry Hamby, Kristen Kracke

United States Public Health Resources

This Bulletin discusses the National Survey of Children’s Exposure to Violence (NatSCEV), the most comprehensive nationwide survey of the incidence and prevalence of children’s exposure to violence to date, sponsored by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) and supported by the Centers for Disease Control and Prevention (CDC). Conducted between January and May 2008, it measured the past-year and lifetime exposure to violence for children age 17 and younger across several major categories: conventional crime, child maltreatment, victimization by peers and siblings, sexual victimization, witnessing and indirect victimization (including exposure to community violence and family violence), school …

Launching A Novel Preclinical Infrastructure: Comparative Oncology Trials Consortium Directed Therapeutic Targeting Of Tnfα To Cancer Vasculature, Melissa C. Paoloni, Anita Tandle, Christina Mazcko, Engy Hanna, Stefan Kachala, Amy Leblanc, Shelley Newman, David Vail, Carolyn Henry, Douglass Thamm, Karin Sorenmo, Amin Hajitou, Renata Pasqualini, Wadih Arap, Chand Khanna, Steven K. Libutti

United States Public Health Resources

Background: Under the direction and sponsorship of the National Cancer Institute, we report on the first pre-clinical trial of the Comparative Oncology Trials Consortium (COTC). The COTC is a novel infrastructure to integrate cancers that naturally develop in pet dogs into the development path of new human drugs. Trials are designed to address questions challenging in conventional preclinical models and early phase human trials. Large animal spontaneous cancer models can be a valuable addition to successful studies of cancer biology and novel therapeutic drug, imaging and device development.

Methodology/Principal Findings: Through this established infrastructure, the first trial of …

The Role Of Glutamate And Its Receptors In Mesocorticolimbic Dopaminergic Regions In Opioid Addiction, Yuan Guo, Hui-Ling Wang, Xiao-Hui Xiang, Yan Zhao

United States Public Health Resources

Accumulating evidence suggests that glutamate, as one of the most important excitatory neurotransmitters in the brain, plays a key role in drug addiction including opioid addiction. There is substantial evidence for glutamatergic projections into mesocorticolimbic dopaminergic neurons, which are associated with opioid psychological dependence and are also the key regions of enhancement effect. Glutamate may be involved in the process of opioid addiction not only by acting on its ionotropic and metabotropic glutamate receptors that activate several signal transduction pathways, but also by interacting with other neurotransmitters or neuropeptides such as opioids, dopamine, y-aminobutyric acid and substance P in the …

Comparison Of Video Laryngoscopy Technologies, C. Chiesa, N. Miljkovic, N. Schulte, J. B. Callahan, Jr., D. J. Miller, B. H. Boedeker

United States Public Health Resources

Indirect laryngoscopy allows practitioners to “see around the corner” of a patient’s airway during intubation. Inadequate airway management is a major contributor to patient injury, morbidity and mortality. The purpose of the present study was to evaluate the video quality of commercially available video laryngoscopy systems. A team of four investigators at the University of Nebraska at Omaha and the Peter Kiewit Institute performed intubation simulations using a number of video laryngoscopy systems. Testing was done with a Laerdal Difficult Airway Manikin (Laerdal Medical Corp., Wappingers Falls, NY) in a setting that simulated difficult airways, adverse lighting conditions and various …

Children's Behavioral Traits And Risk Of Injury: Analyses From A Case-Control Study Of Agricultural Households, Kathleen F. Carlson, Susan G. Gerberich, Bruce H. Alexander, Ann S. Masten, Timothy R. Church, John M. Shutske, Andrew D. Ryan, Colleen M. Renier

United States Public Health Resources

Problem: Children on family agricultural operations have high risk of injury. The association between children's behavioral traits and their risk of injury is not well understood. Method: Data from the Regional Rural Injury Study-II were used to assess behavioral risk factors for injury to children ages six to <20 years. A total of 379 injury events (cases) and 1,562 randomly selected controls were identified. Adjusted odds ratios (OR) and 95% confidence intervals (CI), calculated using logistic regression, were used to estimate injury risk in reference to behavioral traits. Results: Injury risks were greater for children with high levels of depressive symptoms (OR=1.9, CI=1.0-3.7) and aggression (OR=1.6, CI=0.9-2.7), and low levels of careful/cautious behavior (OR=1.8, CI=1.1-2.9). Children with low levels of self-regulation had reduced risks (OR=0.4, CI=0.2-0.8). Discussion: Results suggest that children's behaviors affect their risk of agricultural injury. Additional research …

Carbon Tetrachloride-Induced Liver Damage In Asialoglycoprotein Receptor-Deficient Mice, Shana R. Dalton, Serene M.L. Lee, Rachel N. King, Amin A. Nanji, Kusum K. Kharbanda, Carol A. Casey, Benita L. Mcvicker

United States Public Health Resources

The asialoglycoprotein (ASGP) receptor is an abundant hepatocyte-specific receptor involved in receptor-mediated endocytosis. This receptor’s abundance and function is decreased by chronic ethanol administration prior to the appearance of pathology such as necrosis or inflammation. Hence, this study aimed to determine if ASGP receptor function is required to protect against liver injury by utilizing a knockout mouse model lacking functional ASGP receptor in the setting of carbon tetrachloride (CCl₄) hepatotoxicity. Briefly, ASGP receptor-deficient (RD) mice and wild-type (WT) mice were injected with 1 ml/kg body weight of CCl₄. In the subsequent week, mice were monitored for …

Nitric Oxide Inhibits Insulin-Degrading Enzyme Activity And Function Through S-Nitrosylation, Crystal M. Cordes, Robert G. Bennett, Gerri L. Siford, Frederick G. Hamel

United States Public Health Resources

Insulin-degrading enzyme (IDE) is responsible for the degradation of a number of hormones and peptides, including insulin and amyloid β (Aβ). Genetic studies have linked IDE to both type 2 diabetes and Alzheimer’s disease. Despite its potential importance in these diseases, relatively little is known about the factors that regulate the activity and function of IDE. Protein S-nitrosylation is now recognized as a redox-dependent, cGMP-independent signaling component that mediates a variety of actions of nitric oxide (NO). Here we describe a mechanism of inactivation of IDE by NO. NO donors decreased both insulin and Aβ degrading activities of IDE. Insulin-degrading …

Proteomics Reveal A Concerted Upregulation Of Methionine Metabolic Pathway Enzymes, And Downregulation Of Carbonic Anhydrase-Iii, In Betaine Supplemented Ethanol-Fed Rats, Kusum K. Kharbanda, Vasanthy Vigneswara, Benita L. Mcvicker, Anna U. Newlaczyl, Kevin Bailey, Dean Tuma, David E. Ray, Wayne G. Carter

United States Public Health Resources

We employed a proteomic profiling strategy to examine the effects of ethanol and betaine diet supplementation on major liver protein level changes. Male Wistar rats were fed control, ethanol or betaine supplemented diets for 4 weeks. Livers were removed and liver cytosolic proteins resolved by onedimensional and two-dimensional separation techniques. Significant upregulation of betaine homocysteine methyltransferase-1, methionine adenosyl transferase-1, and glycine N-methyltransferase were the most visually prominent protein changes observed in livers of rats fed the betaine supplemented ethanol diet. We hypothesise that this concerted upregulation of these methionine metabolic pathway enzymes is the protective mechanism by which betaine restores …

Identification Of Francisella Tularensis Subsp. Tularensis A1 And A2 Infections By Real-Time Polymerase Chain Reaction, Claudia R. Molins, Jennifer K. Carlson, Jana Coombs, Jeannine M. Petersen

United States Public Health Resources

Francisella tularensis subsp. tularensis (type A) is subdivided into clades A1 and A2. Human tularemia infections caused by A1 and A2 differ with respect to clinical outcome; A1 infections are associated with a higher case fatality rate. In this study, we develop and evaluate TaqMan polymerase chain reaction (PCR) assays for identification of A1 and A2. Both assays were shown to be specific to either A1 or A2, with sensitivities of 10 genomic equivalents. Real-time PCR results for identification of A1 and A2 were in complete agreement with results obtained by pulsed field gel electrophoresis analysis or conventional PCR when …

Attenuation Of Doxorubicin-Induced Cardiac Injury By Mitochondrial Glutaredoxin 2, Nicole M. Diotte, Ye Xiong, Jinping Gao, Balvin H.L. Chua, Ye-Shih Ho

United States Public Health Resources

While the cardiotoxicity of doxorubicin (DOX) is known to be partly mediated through the generation of reactive oxygen species (ROS), the biochemical mechanisms by which ROS damage cardiomyocytes remain to be determined. This study investigates whether S-glutathionylation of mitochondrial proteins plays a role in DOX-induced myocardial injury using a line of transgenic mice expressing the human mitochondrial glutaredoxin 2 (Glrx2), a thiotransferase catalyzing the reduction as well as formation of protein–glutathione mixed disulfides, in cardiomyocytes. The total glutaredoxin (Glrx) activity was increased by 76% and 53 fold in homogenates of whole heart and isolated heart mitochondria of Glrx2 transgenic mice, …

Animal Helminths In Human Archaeological Remains: A Review Of Zoonoses In The Past, Luciana Sianto, Marcia Chame, Cassius S. P. Silva, Marcelo L. C. Gonçalves, Karl Reinhard, Martín Horacio Fugassa, Adauto Araújo

Karl Reinhard Publications

The authors present a review of records of intestinal parasitic helminths from animals in human archaeological remains, reported since the emergence of paleopathological studies. The objective was to relate paleoparasitological findings to geographic, biotic, and abiotic factors from the environment in which the prehistoric populations lived, and understand some aspects related to the process of human dispersion and biological and cultural evolution. Modification of eating habits and the incorporation of new cultural practices are analyzed from the perspective of zoonoses from prehistory to the present day, especially in Brazilian indigenous populations. Three tables identifying the helminths, their natural hosts, dates, …

Ecological Niche Of The 2003 West Nile Virus Epidemic In The Northern Great Plains Of The United States, Michael Wimberly, Michael B. Hildreth, Stephen P. Boyte, Erik Lindquist, Lon Kightlinger

United States Public Health Resources

Background: The incidence of West Nile virus (WNv) has remained high in the northern Great Plains compared to the rest of the United States. However, the reasons for the sustained high risk of WNv transmission in this region have not been determined. To assess the environmental drivers of WNv in the northern Great Plains, we analyzed the county-level spatial pattern of human cases during the 2003 epidemic across a seven-state region.
Methodology/Principal Findings: County-level data on WNv cases were examined using spatial cluster analysis, and were used to fit statistical models with weather, climate, and land use variables as predictors. …

How Does A Riverine Setting Affect The Lifestyle Of Shellmound Builders In Brazil?, Sabine Eggers, C. C. Petronilho, K. Brandt, C. Jericó-Daminello, J. Filippini, Karl Reinhard

Karl Reinhard Publications

The contact of inland and coastal prehistoric groups in Brazil is believed to have been restricted to regions with no geographical barrier, as is the case in the Ribeira de Iguape valley. The inland osteological collection from the riverine shellmound Moraes (5800–4500 BP) represents a unique opportunity to test this assumption for this region. Despite cultural similarities between riverine and coastal shellmounds, important ecological and site distribution differences are expected to impact on lifestyle. The purpose of this study is thus to document and interpret health and lifestyle indicators in Moraes in comparison to coastal shellmound groups. Specifically we test …