Alan Zelicoff

Association between long-term air pollution and increased blood pressure and hypertension in China.

Several studies have investigated the short-term effects of ambient air pollutants in the development of high blood pressure and hypertension. However, little information exists regarding the health effects of long-term exposure. To investigate the association between residential long-term exposure to air pollution and blood pressure and hypertension, we studied 24 845 Chinese adults in 11 districts of 3 northeastern cities from 2009 to 2010. Three-year average concentration of particles with an aerodynamic diameter ⩽10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated from monitoring stations in the 11 districts. We used generalized additive models and 2-level logistic regressions models to examine the health effects. The results showed that the odds ratio for hypertension increased by 1.12 (95% confidence interval [CI], 1.08–1.16) per 19 &mgr;g/m3 increase in PM10, 1.11 (95% CI, 1.04–1.18) per 20 &mgr;g/m3 increase in SO2, and 1.13 (95% CI, 1.06–1.20) per 22 &mgr;g/m3 increase in O3. The estimated increases in mean systolic and diastolic blood pressure were 0.87 mm Hg (95% CI, 0.48–1.27) and 0.32 mm Hg (95% CI, 0.08–0.56) per 19 &mgr;g/m3 interquartile increase in PM10, 0.80 mm Hg (95% CI, 0.46–1.14) and 0.31 mm Hg (95% CI, 0.10–0.51) per 20 &mgr;g/m3 interquartile increase in SO2, and 0.73 mm Hg (95% CI, 0.35–1.11) and 0.37 mm Hg (95% CI, 0.14–0.61) per 22 &mgr;g/m3 interquartile increase in O3. These associations were only statistically significant in men. In conclusion, long-term exposure to PM10, SO2, and O3 was associated with increased arterial blood pressure and hypertension in the study population.

Breastfeeding as a modifier of the respiratory effects of air pollution in children.

Background: Breastfeeding and air pollution are both important factors for respiratory symptoms and asthma in children. Few studies have examined possible interaction between them on respiratory outcomes. Methods: We studied 31,049 Chinese children, ages 2–14 years old, from 25 elementary schools and 50 kindergartens in the Seven Northeastern Cities during 2008–2009. Parents or guardians completed questionnaires about the children’s histories of respiratory conditions, risk factors, and feeding methods. Three-year average concentrations of particles with an aerodynamic diameter ⩽10 µm, sulfur dioxide, nitrogen dioxides, and ozone were calculated from monitoring stations in 25 study districts. We used two-level logistic regressions to examine the effects of exposure, controlling for covariates. Results: Association of air pollution with childhood respiratory conditions was modified by breastfeeding. Compared with children who had been breastfed, those who were not exhibited consistently stronger effects of air pollution. Among non-breastfed children, odds ratios (ORs) per 10 µg/m3 increase in nitrogen dioxide were 1.40 (95% confidence interval = 1.19–1.64) for cough, 1.41 (1.16–1.71) for phlegm, 1.17 (1.00–1.36) for current wheeze, and 1.25 (1.07–1.46) for doctor-diagnosed asthma. For breastfed children, the ORs were 1.25 (1.09–1.43) for cough, 1.15 (0.99–1.34) for phlegm, 0.97 (0.87–1.08) for current wheeze, and 1.17 (1.05–1.32) for doctor-diagnosed asthma. Breastfeeding was more protective among younger children. Breastfeeding was also associated with reduced effects of passive smoke exposure in children. Conclusion: Breastfeeding is associated with smaller associations between air pollution and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of pollutants.

Vaccination against influenza: role and limitations in pandemic intervention plans

Influenza pandemics occur periodically and the subtype of the next pandemic strain cannot be predicted. Vaccination remains a critical intervention during pandemics, but current production technology requires several months to develop sufficient vaccine to meet anticipated worldwide need. Candidate prepandemic vaccines for use in population priming or rapid deployment during an epidemic are in development but are subtype specific and logistical obstacles to timely distribution exist. Intensive research is underway to identify a universal vaccine, providing protection against all known influenza strains based on shared epitopes. Vaccine access is expected to be limited during early response to a pandemic, necessitating ethical vaccine distribution plans for within-country and global allocation. Mass vaccination plans must be in place prior to an event to ensure appropriate infrastructures are in place. Carefully crafted education campaigns regarding pandemic vaccine safety and efficacy should aid in maximizing pandemic vaccine uptake during a future event.

Poor sleep quality associated with high risk of hypertension and elevated blood pressure in China: results from a large population-based study.

Little information is available concerning the association between sleep quality and blood pressure (BP) in Chinese individuals. This study evaluated the association between sleep quality, as determined by the Pittsburgh sleep quality index (PSQI), and hypertension in a rural Chinese population. Using a multistage cluster and random sampling method, a representative sample of 9404 adults aged 20–93 years in northeastern China was selected from 2012 to 2013. Sleep quality was assessed by PSQI, and trained observers measured BP. A sleep disorder (SD) was diagnosed for any participant with a score of 6 or greater. Overall, 1218 male participants (25.53%) and 1261 female participants (27.22%) were defined as having SDs. Compared with the normal subjects, participants with hypertension had higher global PSQI scores and subscores in all elements. The odds ratios (ORs) of hypertension, systolic hypertension and diastolic hypertension among participants with SDs were 2.38 (95% confidence interval (CI): 2.13–2.65), 2.52 (95% CI: 2.26–2.80) and 1.93 (95% CI: 1.74–2.14) in contrast to the reference group, respectively. The risk for hypertension in poor sleepers with subscores over 0 in all of the elements was significantly increased, with ORs ranging from 1.16 (95% CI: 1.04–2.30) to 3.88 (95% CI: 1.24–12.16). The global PSQI score and its components were associated with hypertension and high BP.

Home Renovation, Family History of Atopy, and Respiratory Symptoms and Asthma Among Children Living in China

OBJECTIVES To investigate the association of indoor air pollution with the respiratory health of children, we evaluated the associations of childrens respiratory symptoms with asthma and recent home renovation. METHODS We conducted a cross-sectional survey in a school recruitment sample of 31,049 children aged 2 to 14 years in 25 districts of 7 cities of northeast China in 2008-2009. The childrens parents completed standardized questionnaires characterizing the childrens histories of respiratory symptoms and illness, recent home renovation information, and other associated risk factors. RESULTS The effects of home renovation in the past 2 years were significantly associated with cough, phlegm, current wheeze, doctor-diagnosed asthma, and current asthma. The associations we computed when combining the status of home renovation and family history of atopy were higher than were those predicted from the combination of the separate effects. However, the interactions between home renovation and family history of atopy on a multiplicative scale were not statistically significant (P>.05). CONCLUSIONS Home renovation is associated with increases in the prevalence of respiratory symptoms and asthma in children. The effects of different renovation materials on child respiratory health should be studied further.

Racial disparity in the association between body mass index and self-reported asthma in children: a population-based study.

Abstract Objective: To examine the racial disparity in the association between obesity and asthma in US children and adolescents. Methods: This study was based on a nationally representative, random-digit-dial sample of US households with children less than 18 years of age from the National Survey of Children’s Health in 2011/2012 and 2007. The study sample included 88,668 children ages 10–17 with data on body mass index (BMI), parental reporting of asthma diagnosis, and potential confounders. Multiple logistic regression analysis was performed to estimate the crude and adjusted odds ratios stratified by child race/ethnicity. Results: The prevalence of overweight was 15.2% and obesity was 14.1%. Self-reported asthma diagnosis was 16.7% in our study sample. Obese children were 51% more likely to have asthma compared to normal weight children after controlling for child’s sex, child age, socioeconomic status, environmental tobacco smoke (ETS), and neighborhood conditions. Our study also shows that the strength of this association varied by race/ethnicity after stratification. Being male, being non-Hispanic Black or Multi-racial, below the Federal Poverty Level, ETS and having detracting neighborhood elements were also significantly associated with higher odds of having a self-reported asthma diagnosis. Conclusion: We observed a racial difference in the association between BMI and asthma in US children. Our findings have significant public health implications and may help public health practitioners to target children and adolescents at higher risk of prevention and intervention efforts.

Pineal Gland Calcification in Kurdistan: A Cross-Sectional Study of 480 Roentgenograms.

Objective The goal of this study was to compare the incidence of Pineal Gland Calcification (PGC) by age group and gender among the populations living in the Kurdistan Region-Iraq. Methods This prospective study examined skull X-rays of 480 patients between the ages of 3 and 89 years who sought care at a large teaching public hospital in Duhok, Iraq from June 2014 to November 2014. Descriptive statistics and a binary logistic regression were used for analysis. Results The overall incidence rate of PGC among the study population was 26.9% with the 51–60 age group and males having the highest incidence. PGC incidence increased after the first decade and remained steady until the age of 60. Thereafter the incidence began to decrease. Logistic regression analysis revealed that both age and gender significantly affected the risk of PGC. After adjusting for age, males were 1.94 (95% CI, 1.26–2.99) times more likely to have PGC compared to females. In addition, a one year increase in age increases the odds of developing PGC by 1.02 (95% CI, 1.01–1.03) units after controlling for the effects of gender. Conclusion Our analysis demonstrated a close relationship between PGC and age and gender, supporting a link between the development of PGC and these factors. This study provides a basis for future researchers to further investigate the nature and mechanisms underlying pineal gland calcification.

Multifactorial risk assessment for atherosclerotic cardiovascular disease.

In Reply We agree with Dr Legrand and colleagues that our study providesfurtherindirectevidencethatnonhemodynamicfactors maybeimportanttothepathogenesisofAKIaftercardiacsurgery. We also agree that increases in serum creatinine level represent an already advanced level of decreased GFR, at which time interventions may be less likely to succeed in preserving GFR. However, in a previous randomized double-blind clinical trial of fenoldopam in which the drug was given at anesthesia induction, we also failed to see a beneficial effect.1 Moreover, although we have conducted several studies of renal biomarkers in the setting of cardiac surgery and the development of AKI,2-4 we are not aware of any studies conducted among cardiac surgery patients in which interventions triggered by novel biomarkers instead of creatinine level delivered better functional outcomes. Thus, the putative advantage of biomarkertriggered interventions, although interesting and perhaps logical, remains theoretical at this stage.

A respiratory health survey of a subsurface smoldering landfill

ABSTRACT In late 2010, a subsurface smoldering event was detected in the Bridgeton Sanitary Landfill in St. Louis County, Missouri. This was followed by complaints from nearby residents of foul odors emanating from the landfill. In 2016 a health survey was conducted of residents near the landfill and, as a comparison, other regions of St. Louis County. The survey was a two‐stage cluster sample, where the first stage was census blocks, and the second stage was households within the census blocks. The health survey, which was conducted by face‐to‐face interviews of residents both near the landfill and away from the landfill, focused mainly on respiratory symptoms and diseases such as asthma and chronic obstructive pulmonary disease. The differences in the prevalence of asthma (26.7%, 95% CI 19.8–34.1 landfill vs 24.7%, 95% CI 15.7–33.6 comparison) and COPD (13.7%, 95% CI 7.2–20.3 landfill vs 12.5%, 95% CI 6.4–18.7 comparison) between the two groups were not statistically significant. Landfill households reported significantly more “other respiratory conditions,” (17.6%, 95% CI 11.1–24.1 landfill vs 9.5%, 95% CI 4.8–14.3 comparison) and attacks of shortness of breath (33.9%, 95% CI 25.1–42.8 landfill vs 17.9%, 95% CI 12.3–23.5). Frequency of odor perceptions and level of worry about neighborhood environmental issues was higher among landfill households (p < 0.001). We conclude that the results do not support the hypothesis that people living near the Bridgeton Landfill have elevated respiratory or related illness compared to those people who live beyond the vicinity of the landfill. HighlightsA landfill subsurface smoldering event was not related to higher asthma prevalence.Chronic obstructive pulmonary disease similar in exposed and comparison households.Attacks of shortness of breath were strongly related to living near landfill event.Pneumonia, sleep apnea, and bronchitis were reported more by landfill households.Households near landfill perceive odors more often; very worried about environment.

Factors Influencing Seasonal Influenza Vaccination Uptake in Emergency Medical Services Workers: A Concept Mapping Approach

Seasonal influenza has serious impacts on morbidity and mortality and has a significant economic toll through lost workforce time and strains on the health system. Health workers, particularly emergency medical services (EMS) workers have the potential to transmit influenza to those in their care, yet little is known of the factors that influence EMS workers’ decisions regarding seasonal influenza vaccination (SIV) uptake, a key factor in reducing potential for transmitting disease. This study utilizes a modified Theory of Planned Behavior (TPB) model as a guiding framework to explore the factors that influence SIV uptake in EMS workers. Concept mapping, which consists of six-stages (preparation, generation, structuring, representation, interpretation, and utilization) that use quantitative and qualitative approaches, was used to identify participants’ perspectives towards SIV. This study identified nine EMS-conceptualized factors that influence EMS workers’ vaccination intent and behavior. The EMS-conceptualized factors align with the modified TPB model and suggest the need to consider community-wide approaches that were not initially conceptualized in the model. Additionally, the expansion of non-pharmaceutical measures went above and beyond original conceptualization. Overall, this study demonstrates the need to develop customized interventions such as messages highlighting the importance of EMS workers receiving SIV as the optimum solution. EMS workers who do not intend to receive the SIV should be provided with accurate information on the SIV to dispel misconceptions. Finally, EMS workers should also receive interventions which promote voluntary vaccination, encouraging them to be proactive in the health decisions they make for themselves.