Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Ettinger AS[original query] |
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Assessment of neurodevelopment in infants with and without exposure to asymptomatic or mild maternal SARS-CoV-2 infection during pregnancy
Firestein MR , Shuffrey LC , Hu Y , Kyle M , Hussain M , Bianco C , Hott V , Hyman SP , Kyler M , Rodriguez C , Tejeda Romero M , Tzul Lopez H , Alcántara C , Amso D , Austin J , Bain JM , Barbosa J , Battarbee AN , Bruno A , Ettinger S , Factor-Litvak P , Gilboa S , Goldman S , Gyamfi-Bannerman C , Maniatis P , Marsh R , Morrill T , Mourad M , Muhle R , Newes-Adeyi G , Noble KG , O'Reilly KC , Penn AA , Reichle L , Sania A , Semenova V , Silver WG , Smotrich G , Tita AT , Tottenham N , Varner M , Welch MG , Zork N , Garey D , Fifer WP , Stockwell MS , Monk C , Dawood F , Dumitriu D . JAMA Netw Open 2023 6 (4) e237396 IMPORTANCE: Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding. OBJECTIVE: To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants. EXPOSURES: Maternal symptomatic or asymptomatic SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language. RESULTS: Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores. CONCLUSIONS AND RELEVANCE: In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections. |
Cake Decorating Luster Dust Associated with Toxic Metal Poisonings - Rhode Island and Missouri, 2018-2019
Viveiros B , Caron G , Barkley J , Philo E , Odom S , Wenzel J , Buxton M , Semkiw E , Schaffer A , Brown L , Ettinger AS . MMWR Morb Mortal Wkly Rep 2021 70 (43) 1501-1504 During 2018-2019, the Rhode Island Department of Health (RIDOH) and the Missouri Department of Health and Senior Services (DHSS) investigated cases of metal poisonings associated with commercially and home-prepared cakes decorated with products referred to as luster dust. Several types of glitters and dusts, broadly known as luster dust,* for use on prepared foods can be purchased online and in craft and bakery supply stores (1). Decorating foods with luster dust and similar products is a current trend, popularized on television programs, instructional videos, blogs, and in magazine articles.(†) Some luster dusts are specifically produced with edible ingredients that can be safely consumed. Companies that make edible luster dust are required by law to include a list of ingredients on the label (2). Luster dusts that are safe for consumption are typically marked "edible" on the label. Some luster dusts used as cake decorations are not edible or food grade; labeled as "nontoxic" or "for decorative purposes only," these luster dusts are intended to be removed before consumption (3). RIDOH (2018) and Missouri DHSS (2019), investigated heavy metal poisonings associated with commercially and home-prepared cakes decorated with luster dust after receiving reports of children (aged 1-11 years) who became ill after consuming birthday cake. Cases in Rhode Island were associated with copper ingestion, and the case in Missouri was associated with a child's elevated blood lead level. In Rhode Island, luster dust products that had been used in cake frosting were found to contain high levels of multiple metals.(§) These events indicate that increased vigilance by public health departments and further guidance to consumers and bakeries are needed to prevent unintentional poisonings. Labeling indicating that a product is nontoxic does not imply that the product is safe for consumption. Explicit labeling indicating that nonedible products are not safe for human consumption is needed to prevent illness from inappropriate use of inedible products on foods. Educating consumers, commercial bakers, and public health professionals about potential hazards of items used in food preparation is essential to preventing illness and unintentional poisoning from toxic metals and other nonedible ingredients. |
Blood Lead Levels in U.S. Children Ages 1-11 Years, 1976-2016
Egan KB , Cornwell CR , Courtney JG , Ettinger AS . Environ Health Perspect 2021 129 (3) 37003 BACKGROUND: Lead can adversely affect child health across a wide range of exposure levels. We describe the distribution of blood lead levels (BLLs) in U.S. children ages 1-11 y by selected sociodemographic and housing characteristics over a 40-y period. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) II (1976-1980), NHANES III (Phase 1: 1988-1991 and Phase II: 1991-1994), and Continuous NHANES (1999-2016) were used to describe the distribution of BLLs (in micrograms per deciliter; 1 μg/dL = 0.0483 μmol/L) in U.S. children ages 1-11 y from 1976 to 2016. For all children with valid BLLs (n = 27,122), geometric mean (GM) BLLs [95% confidence intervals (CI)] and estimated prevalence ≥ 5 μg/dL (95% CI) were calculated overall and by selected characteristics, stratified by age group (1-5 y and 6-11 y). RESULTS: The GM BLL in U.S. children ages 1-5 y declined from 15.2 μg/dL (95% CI: 14.3, 16.1) in 1976-1980 to 0.83 μg/dL (95% CI: 0.78, 0.88) in 2011-2016, representing a 94.5% decrease over time. For children ages 6-11 y, GM BLL declined from 12.7 μg/dL (95% CI: 11.9, 13.4) in 1976-1980 to 0.60 μg/dL (95% CI: 0.58, 0.63) in 2011-2016, representing a 95.3% decrease over time. Even so, for the most recent period (2011-2016), estimates indicate that approximately 385,775 children ages 1-11 y had BLLs greater than or equal to the CDC blood lead reference value of 5 μg/dL. Higher GM BLLs were associated with non-Hispanic Black race/ethnicity, lower family income-to-poverty-ratio, and older housing age. DISCUSSION: Overall, BLLs in U.S. children ages 1-11 y have decreased substantially over the past 40 y. Despite these notable declines in population exposures to lead over time, higher GM BLLs are consistently associated with risk factors such as race/ethnicity, poverty, and housing age that can be used to target blood lead screening efforts. https://doi.org/10.1289/EHP7932. |
Use of the CUSUM and Shewhart control chart methods to identify changes of public health significance using childhood blood lead surveillance data
Dignam T , Hodge J , Chuke S , Mercado C , Ettinger AS , Flanders WD . Environ Epidemiol 2020 4 (2) Background: Local, state, and national childhood blood lead surveillance is based on healthcare providers and clinical laboratories reporting test results to public health departments. Increased interest in detecting blood lead level (BLL) patterns and changes of potential public health significance in a timely manner has highlighted the need for surveillance systems to rapidly detect and investigate these events. Objective(s): Decrease the time to detect changes in surveillance patterns by using an alerting algorithm developed and assessed through historical child blood lead surveillance data analysis. Method(s): We applied geographic and temporal data-aggregation strategies on childhood blood lead surveillance data and developed a novel alerting algorithm. The alerting algorithm employed a modified cumulative summary/Shewhart algorithm, initially applied on 113 months of data from two jurisdictions with a known increase in the proportion of children <6 years of age with BLLs >=5 micro g/dl. Result(s): Alert signals retrospectively identified time periods in two jurisdictions where a known change in the proportion of children <6 years of age with BLLs >=5 micro g/dl occurred. Additionally, we identified alert signals among six of the 18 (33%) randomly selected counties assessed where no previously known or suspected pattern changes existed. Conclusion(s): The modified cumulative summary/Shewhart algorithm provides a framework for enhanced blood lead surveillance by identifying changes in the proportion of children with BLLs >=5 micro g/dl. The algorithm has the potential to alert public health officials to changes requiring further important public health investigation. |
Blood lead levels in U.S. women of childbearing age, 1976-2016
Ettinger AS , Egan KB , Homa DM , Brown MJ . Environ Health Perspect 2020 128 (1) 17012 BACKGROUND: Lead can adversely affect maternal and child health across a wide range of exposures; developing fetuses and breastfeeding infants may be particularly vulnerable. We describe the distribution of blood lead levels (BLLs) in U.S. women of childbearing age and associations with sociodemographic, reproductive, smoking, and housing characteristics over a 40-y period. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) II, NHANES III Phase I and Phase II, and 1999-2016 continuous NHANES were used to describe the distribution of BLLs (given in micrograms per deciliter; 1mug/dL=0.0483mumol/L) in U.S. women 15-49 years of age between 1976 and 2016. For all women with valid BLLs (n=22,408), geometric mean (GM) BLLs and estimated prevalence of BLLs >/=5mug/dL were calculated overall and by selected demographic characteristics. For NHANES II, estimated prevalence of BLLs >/=10 and >/=20mug/dL were also calculated. RESULTS: The most recent GM BLLs (2007-2010 and 2011-2016, respectively) were 0.81mug/dL [95% confidence interval (CI): 0.79, 0.84] and 0.61mug/dL (95% CI: 0.59, 0.64). In comparison, GM BLLs in earlier periods (1976-1980, 1988-1991, and 1991-1994) were 10.37mug/dL (95% CI: 9.95, 10.79), 1.85mug/dL (95% CI: 1.75, 1.94), and 1.53mug/dL (95% CI: 1.45, 1.60), respectively. In 2011-2016, 0.7% of women of childbearing age had BLLs >/=5mug/dL, and higher BLLs were associated with older age, other race/ethnicity, birthplace outside the United States, four or more live births, exposure to secondhand tobacco smoke, and ever pregnant or not currently pregnant. DISCUSSION: Lead exposure in U.S. women of childbearing age is generally low and has substantially decreased over this 40-y period. However, based on these estimates, there are still at least 500,000 U.S. women being exposed to lead at levels that may harm developing fetuses or breastfeeding infants. Identifying high-risk women who are or intend to become pregnant remains an important public health issue. https://doi.org/10.1289/EHP5925. |
Lead poisoning prevention: The unfinished agenda
Ettinger AS , Ruckart PZ , Dignam T . J Public Health Manag Pract 2019 25 S1-s2 Overall, US population blood lead levels (BLLs)—as evidenced by NHANES (National Health and Nutrition Examination Survey) data—continue to fall.1 This special issue of the Journal of Public Health Management & Practice on Lead Poisoning Prevention marks a turning point in the nation’s “war on lead” that has spanned over a century and highlights the accomplishments of the Centers for Disease Control and Prevention (CDC) and its state and local partners in preventing and controlling lead poisoning. Ettinger et al in this issue outline CDC’s long-standing role in protecting children from lead exposure. |
Response to the US FDA LeadCare Testing Systems Recall and CDC Health Alert
Mason J , Ortiz D , Pappas S , Quigley S , Yendell S , Ettinger AS . J Public Health Manag Pract 2019 25 S91-s97 On May 17, 2017, the Food and Drug Administration issued a safety recall for the Magellan Diagnostics' LeadCare Testing Systems due to the potential for inaccurately low blood lead test results when used with venous blood samples. Concurrently, the Centers for Disease Control and Prevention (CDC) issued a health alert with retesting recommendations for specific high-risk populations. The purpose of the CDC retesting recommendations was to help identify high-risk individuals so that those potentially impacted by falsely low test results could be retested and receive appropriate follow-up care. The CDC's Lead Poisoning Prevention Program sought to understand how the recall and recommendations impacted state and local public health agencies. Childhood lead poisoning prevention programs (CLPPPs) in state and local public health agencies collect blood lead test results for children and had a lead role in identifying children for retesting. Case studies are presented that highlight the experiences of 4 state CLPPPs in responding to the recall and recommendations. Collectively, the case studies point to several lessons learned, including the importance of (1) having a well-functioning surveillance system in place prior to a serious incident; (2) having a clear understanding of the roles partners play in the continuum of care for children potentially exposed to lead; and (3) ensuring effective communications with all staff, both internal and external, to public health agencies that have a role in responding to a serious incident. The ability to respond to public health emergencies or other serious incidents takes the combined effort of federal, state, and local public health agencies as well as others in the health care delivery system. The CDC will continue to support state and local lead poisoning prevention programs so that they have the information and tools they need to address and prevent the health effects of lead exposures in communities. |
CDC's Lead Poisoning Prevention Program: A long-standing responsibility and commitment to protect children from lead exposure
Ettinger AS , Leonard ML , Mason J . J Public Health Manag Pract 2019 25 Suppl 1 S5-s12 The Centers for Disease Control and Prevention's (CDC's) Childhood Lead Poisoning Prevention Program (CLPPP) serves as the nation's public health leader and resource on strategies, policies, and practices aimed at preventing lead exposure in young children. CDC supports and advises state and local public health agencies and works with other federal agencies and partners to achieve the Healthy People 2020 objective of eliminating childhood lead exposure as a public health concern. Primary prevention-the removal of lead hazards from the environment before a child is exposed-is the most effective way to ensure that children do not experience the harmful effects of lead exposure. Blood lead screening tests and secondary prevention remain an essential safety net for children who may be exposed to lead. CDC's key programmatic strategy is to strengthen blood lead surveillance by supporting state and local programs to improve blood lead screening test rates, identify high-risk populations, and ensure effective follow-up for children with elevated blood lead levels. Surveillance plays a central role in helping measure the collective progress of federal, state, and local public health agencies in protecting children from lead, as well as enhancing our ability to target population-based interventions for primary prevention to those areas at highest risk. The CDC CLPPP has been at the front line of efforts to protect children from lead exposure and the resulting adverse health effects over the last 3 decades. As we chart our path for the future, we will continue to learn from past successes and challenges, incorporate new evidence and lessons learned, and work closely with federal, state, local, and nonprofit partners, experts in academia, and the community to advance the overarching goal of eliminating lead exposure in children. |
The Flint Water Crisis: A coordinated public health emergency response and recovery initiative
Ruckart PZ , Ettinger AS , Hanna-Attisha M , Jones N , Davis SI , Breysse PN . J Public Health Manag Pract 2019 25 S84-s90 CONTEXT: The City of Flint was already distressed because of decades of financial decline when an estimated 140 000 individuals were exposed to lead and other contaminants in drinking water. In April 2014, Flint's drinking water source was changed from Great Lakes' Lake Huron (which was provided by the Detroit Water and Sewerage Department) to the Flint River without necessary corrosion control treatment to prevent lead release from pipes and plumbing. Lead exposure can damage children's brains and nervous systems, lead to slow growth and development, and result in learning, behavior, hearing, and speech problems. After the involvement of concerned residents and independent researchers, Flint was reconnected to the Detroit water system on October 16, 2015. A federal emergency was declared in January 2016. PROGRAM: The Centers for Disease Control and Prevention provided assistance and support for response and recovery efforts including coordinating effective health messaging; assessing lead exposure; providing guidance on blood lead screening protocols; and identifying and linking community members to appropriate follow-up services.In response to the crisis in Flint, Congress funded the Centers for Disease Control and Prevention to establish a federal advisory committee; enhance Childhood Lead Poisoning Prevention Program activities; and support a voluntary Flint lead exposure registry. The registry, funded through a grant to Michigan State University, is designed to identify eligible participants and ensure robust registry data; monitor health, child development, service utilization, and ongoing lead exposure; improve service delivery to lead-exposed individuals; and coordinate with other community and federally funded programs in Flint. The registry is also collaborating to make Flint "lead-free" and to share best practices with other communities. DISCUSSION: The Flint water crisis highlights the need for improved risk communication strategies, and environmental health infrastructure, enhanced surveillance, and primary prevention to identify and respond to environmental threats to the public's health. Collecting data is important to facilitate action and decision making to prevent lead poisoning. Partnerships can help guide innovative strategies for primary lead prevention, raise awareness, extend outreach and communication efforts, and promote a shared sense of ownership. |
Re: Errata for Prevention of Childhood Lead Toxicity
Ettinger AS , Brown MJ . Pediatrics 2018 141 (4) In 2017, the American Academy of Pediatrics Council on Environmental Health clarified the use of terminology related to testing children’s blood lead levels in an erratum to its June 2016 Policy Statement, “Prevention of Childhood Lead Toxicity.”1 Although we applaud this effort to develop consistent terminology, we offer the following cautions for consideration. | | First, all but 5 states have regulatory language that defines health care providers’ obligations in terms of blood lead testing or screening in children <6 years old. The language in these regulations is not necessarily consistent with that proposed by the American Academy of Pediatrics. It is incumbent on providers to follow the requirements in the state where the child lives. State lead poisoning prevention programs provide this information on their Web sites. | | Second, the sensitivity and specificity of the Centers for Disease Control and Prevention (CDC) lead screening questionnaire has been tested in a wide variety of practice settings and subpopulations.2 It has never been demonstrated to reasonably predict risk of high blood lead levels, and in a systematic review, it performed little better than chance at predicting lead poisoning risk among children.3 This is not surprising given that the questionnaire was originally developed to ensure that reimbursement was available for testing at shorter intervals, if necessary, in a state with universal annual testing of children <6 years old. | | Finally, the 1997 CDC guidance in Screening Young Children for Lead Poisoning4 is not mentioned in the erratum.1 In this document, later adopted by the Centers for Medicare and Medicaid Services, the CDC recommended that public and clinical health professionals collaborate to develop screening plans that are responsive to local conditions by using local data. In the absence of such plans, universal blood lead testing remains the default, as does the Centers for Medicare and Medicaid Services requirement that all Medicaid-enrolled children be tested at 1 and 2 years of age. | | In the recent high-profile reports on the continued threat of lead exposure for US children, the authors underscore the need to ensure that all children living in high-risk areas have blood lead tests periodically, at least until 2 years of age. This testing is key to state and local lead programs’ abilities to respond to the children most at risk for continued exposure. Unfortunately, blood lead testing rates are extremely variable, even in areas where testing is legally required.5 | | The CDC remains committed to supporting state and local efforts to engage pediatric health care providers in identifying and evaluating children who are exposed to lead and ensuring that these children receive the necessary follow-up services. We believe that blood lead testing remains the best method to screen children for lead exposure and to enforce local efforts to prevent childhood lead poisoning. |
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