Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 50 Records) |
Query Trace: Yip F [original query] |
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Thrombocytopenia associated with elemental mercury poisoning in two siblings - Connecticut, July 2022
Hogeland EW , Somers TS , Yip L , Doyon S , Redlich CA , Orsey AD , Woda CB , Swan ST , Feder HM Jr . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1027-1031 Two siblings aged 5 and 15 years from Connecticut were hospitalized with petechial rash, oral mucositis, and severe thrombocytopenia approximately 10 days after they played with a jar of elemental mercury they found in their home. Before the mercury exposure was disclosed, the siblings were treated with platelet transfusions, intravenous immune globulin (IVIG) for possible immune thrombocytopenic purpura, and antibiotics for possible infectious causes. When their conditions did not improve after 6 days, poison control facilitated further questioning about toxic exposures including mercury, testing for mercury, and chelation with dimercaptosuccinic acid. The older sibling soon recovered, but the younger child required a prolonged hospitalization for severe thrombocytopenia, ultimately receiving repeated doses of IVIG, steroids, and romiplostim, a thrombopoietin receptor agonist. Close collaboration among multiple agencies was required to identify the extent of mercury contamination, evaluate and treat the other family members, and decontaminate the home. These cases demonstrate the importance of ongoing public health outreach to promote early detection of elemental mercury toxicity, and the need to evaluate for environmental exposures when multiple close contacts experience similar signs and symptoms. |
Large-scale agricultural burning and cardiorespiratory emergency department visits in the U.S. state of Kansas
Pennington AF , Vaidyanathan A , Ahmed FS , Manangan A , Mirabelli MC , Sircar KD , Yip F , Flanders WD . J Expo Sci Environ Epidemiol 2023 33 (4) 663-669 BACKGROUND: Prescribed agricultural burning is a common land management practice, but little is known about the health effects from the resulting smoke exposure. OBJECTIVE: To examine the association between smoke from prescribed burning and cardiorespiratory outcomes in the U.S. state of Kansas. METHODS: We analyzed a zip code-level, daily time series of primary cardiorespiratory emergency department (ED) visits for February-May (months when prescribed burning is common in Kansas) in the years 2009-2011 (n = 109,220). Given limited monitoring data, we formulated a measure of smoke exposure using non-traditional datasets, including fire radiative power and locational attributes from remote sensing data sources. We then assigned a population-weighted potential smoke impact factor (PSIF) to each zip code, based on fire intensity, smoke transport, and fire proximity. We used Poisson generalized linear models to estimate the association between PSIF on the same day and in the past 3 days and asthma, respiratory including asthma, and cardiovascular ED visits. RESULTS: During the study period, prescribed burning took place on approximately 8 million acres in Kansas. Same-day PSIF was associated with a 7% increase in the rate of asthma ED visits when adjusting for month, year, zip code, meteorology, day of week, holidays, and correlation within zip codes (rate ratio [RR]: 1.07; 95% confidence interval [CI]: 1.01, 1.13). Same-day PSIF was not associated with a combined outcome of respiratory ED visits (RR [95% CI]: 0.99 [0.97, 1.02]), or cardiovascular ED visits (RR [95% CI]: 1.01 [0.98, 1.04]). There was no consistent association between PSIF during the past 3 days and any of the outcomes. SIGNIFICANCE: These results suggest an association between smoke exposure and asthma ED visits on the same day. Elucidating these associations will help guide public health programs that address population-level exposure to smoke from prescribed burning. |
Morbidity and mortality of unintentional carbon monoxide poisoning: United States 2005 to 2018
Shin M , Bronstein AC , Glidden E , Malone M , Chang A , Law R , Boehmer TK , Strosnider H , Yip F . Ann Emerg Med 2022 81 (3) 309-317 STUDY OBJECTIVE: Centers for Disease Control and Prevention conducts case surveillance through the National Notifiable Diseases Surveillance System (NNDSS). This study aimed to provide surveillance report of unintentional carbon monoxide poisoning across multiple data sources to provide baseline data for the new NNDSS carbon monoxide poisoning surveillance. METHODS: For the period 2005 to 2018, we used 4 data sources to describe unintentional carbon monoxide poisoning: exposures reported by poison centers, emergency department (ED) visits, hospitalizations, and deaths. We conducted descriptive analyses by the cause of exposure (fire, nonfire, or unknown), age, sex, season, and US census region. Additional analyses were conducted using poison center exposure case data focusing on the reported signs and symptoms, management site, and medical outcome. RESULTS: Annually, we observed 39.5 poison center exposure calls (per 1 million, nationally), 56.5 ED visits (per 1 million, across 17 states), 7.3 hospitalizations (per 1 million, in 26 states), and 3.3 deaths (per 1 million, nationally) due to unintentional carbon monoxide poisoning. For 2005 to 2018, there was a decrease in the crude rate for non-fire-related carbon monoxide poisonings from hospital, and death data. Non-fire-related cases comprised 74.0% of ED visits data, 60.1% of hospitalizations, and 40.9% of deaths compared with other unintentional causes. Across all data sources, unintentional carbon monoxide poisonings were most often reported during the winter season, notably in January and December. Children aged 0 to 9 years had the highest reported rates in poison center exposure case data and ED visits (54.1 and 70.5 per 1 million, respectively); adults older than 80 years had the highest rates of hospitalization and deaths (20.2 and 9.9 per 1 million, respectively); and deaths occurred more often among men and in the Midwest region. Poison center exposure call data revealed that 45.9% of persons were treated at a health care facility. Headaches, nausea, and dizziness/vertigo were the most reported symptoms. CONCLUSION: The crude rates in non-fire-related carbon monoxide poisonings from hospitalizations, and mortality significantly decreased over the study period (ie, 2005 to 2018). This surveillance report provides trends and characteristics of unintentional carbon monoxide poisoning and the baseline morbidities and mortality data for the Centers for Disease Control and Prevention national surveillance system of carbon monoxide poisoning. |
Racial and Ethnic Disparities in Multisystem Inflammatory Syndrome in Children in the United States, March 2020 to February 2021.
Stierman B , Abrams JY , Godfred-Cato SE , Oster ME , Meng L , Yip L , Patel P , Balachandran N , Prezzato E , Pierce T , Hsu KK , Burns M , Peterson Pompa X , Lauro P , Hartley A , Jones C , Gretsch S , Reid H , Lim S , Campbell AP , Belay ED . Pediatr Infect Dis J 2021 40 (11) e400-e406 BACKGROUND: The incidence of multisystem inflammatory syndrome in children (MIS-C) varies by race and ethnicity. This study assessed whether disparities in MIS-C in the United States by race and ethnicity exceed known disparities in coronavirus disease 2019 (COVID-19) incidence. METHODS: We compared the distribution of race and ethnicity among patients with MIS-C (aged <21 years, termed children) with onset March 2020 to February 2021 to that of children with COVID-19 and in the general population. Analysis was restricted to 369 counties with high completeness of race and ethnicity reporting for MIS-C and COVID-19. For each racial and ethnic group, observed numbers of patients with MIS-C were compared with expected numbers (observed/expected ratio) in children with COVID-19 and in the general population within these counties. RESULTS: Compared with children in the general population, MIS-C was more frequent among Hispanic (139% of expected) and non-Hispanic Black children (183%) and less frequent among non-Hispanic White (64%) and non-Hispanic Asian children (48%). Compared with children with COVID-19, MIS-C was more frequent in non-Hispanic Black children (207% of expected) and less frequent in non-Hispanic White children (68%); however, frequency was not different among Hispanic (102%) and non-Hispanic Asian (74%) children. CONCLUSIONS: Disparities in MIS-C by race and ethnicity exist, even after controlling for COVID-19 disparities and geographic variations. The high proportion of MIS-C among Hispanic children and low proportion among non-Hispanic Asian children align with COVID-19 rates, while the high proportion among non-Hispanic Black children and low proportion among non-Hispanic White children are not explainable by COVID-19 rates. |
Framework for a Community Health Observing System for the Gulf of Mexico Region: Preparing for Future Disasters.
Sandifer P , Knapp L , Lichtveld M , Manley R , Abramson D , Caffey R , Cochran D , Collier T , Ebi K , Engel L , Farrington J , Finucane M , Hale C , Halpern D , Harville E , Hart L , Hswen Y , Kirkpatrick B , McEwen B , Morris G , Orbach R , Palinkas L , Partyka M , Porter D , Prather AA , Rowles T , Scott G , Seeman T , Solo-Gabriele H , Svendsen E , Tincher T , Trtanj J , Walker AH , Yehuda R , Yip F , Yoskowitz D , Singer B . Front Public Health 2020 8 578463 The Gulf of Mexico (GoM) region is prone to disasters, including recurrent oil spills, hurricanes, floods, industrial accidents, harmful algal blooms, and the current COVID-19 pandemic. The GoM and other regions of the U.S. lack sufficient baseline health information to identify, attribute, mitigate, and facilitate prevention of major health effects of disasters. Developing capacity to assess adverse human health consequences of future disasters requires establishment of a comprehensive, sustained community health observing system, similar to the extensive and well-established environmental observing systems. We propose a system that combines six levels of health data domains, beginning with three existing, national surveys and studies plus three new nested, longitudinal cohort studies. The latter are the unique and most important parts of the system and are focused on the coastal regions of the five GoM States. A statistically representative sample of participants is proposed for the new cohort studies, stratified to ensure proportional inclusion of urban and rural populations and with additional recruitment as necessary to enroll participants from particularly vulnerable or under-represented groups. Secondary data sources such as syndromic surveillance systems, electronic health records, national community surveys, environmental exposure databases, social media, and remote sensing will inform and augment the collection of primary data. Primary data sources will include participant-provided information via questionnaires, clinical measures of mental and physical health, acquisition of biological specimens, and wearable health monitoring devices. A suite of biomarkers may be derived from biological specimens for use in health assessments, including calculation of allostatic load, a measure of cumulative stress. The framework also addresses data management and sharing, participant retention, and system governance. The observing system is designed to continue indefinitely to ensure that essential pre-, during-, and post-disaster health data are collected and maintained. It could also provide a model/vehicle for effective health observation related to infectious disease pandemics such as COVID-19. To our knowledge, there is no comprehensive, disaster-focused health observing system such as the one proposed here currently in existence or planned elsewhere. Significant strengths of the GoM Community Health Observing System (CHOS) are its longitudinal cohorts and ability to adapt rapidly as needs arise and new technologies develop. |
Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol - Arizona and New Mexico, May-June 2020.
Yip L , Bixler D , Brooks DE , Clarke KR , Datta SD , Dudley S Jr , Komatsu KK , Lind JN , Mayette A , Melgar M , Pindyck T , Schmit KM , Seifert SA , Shirazi FM , Smolinske SC , Warrick BJ , Chang A . MMWR Morb Mortal Wkly Rep 2020 69 (32) 1070-1073 Alcohol-based hand sanitizer is a liquid, gel, or foam that contains ethanol or isopropanol used to disinfect hands. Hand hygiene is an important component of the U.S. response to the emergence of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). If soap and water are not readily available, CDC recommends the use of alcohol-based hand sanitizer products that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol) in community settings (1); in health care settings, CDC recommendations specify that alcohol-based hand sanitizer products should contain 60%-95% alcohol (≥60% ethanol or ≥70% isopropanol) (2). According to the Food and Drug Administration (FDA), which regulates alcohol-based hand sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an acceptable ingredient. Cases of ethanol toxicity following ingestion of alcohol-based hand sanitizer products have been reported in persons with alcohol use disorder (3,4). On June 30, 2020, CDC received notification from public health partners in Arizona and New Mexico of cases of methanol poisoning associated with ingestion of alcohol-based hand sanitizers. The case reports followed an FDA consumer alert issued on June 19, 2020, warning about specific hand sanitizers that contain methanol. Whereas early clinical effects of methanol and ethanol poisoning are similar (e.g., headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness. If left untreated methanol poisoning can be fatal (5). Survivors of methanol poisoning might have permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve (6). CDC and state partners established a case definition of alcohol-based hand sanitizer-associated methanol poisoning and reviewed 62 poison center call records from May 1 through June 30, 2020, to characterize reported cases. Medical records were reviewed to abstract details missing from poison center call records. During this period, 15 adult patients met the case definition, including persons who were American Indian/Alaska Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were subsequently admitted to a hospital. Four patients died and three were discharged with vision impairment. Persons should never ingest alcohol-based hand sanitizer, avoid use of specific imported products found to contain methanol, and continue to monitor FDA guidance (7). Clinicians should maintain a high index of suspicion for methanol poisoning when evaluating adult or pediatric patients with reported swallowing of an alcohol-based hand sanitizer product or with symptoms, signs, and laboratory findings (e.g., elevated anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of methanol poisoning includes supportive care, correction of acidosis, administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and frequently, hemodialysis. |
Fatal abrin poisoning by injection
Rinner GR , Watkins SA , Shirazi FM , Fernandez MC , Hess G , Mihalic J , Runcorn S , Waddell V , Ritter J , Reagan-Steiner S , Thomas J , Yip L , Walter FG . Clin Toxicol (Phila) 2020 59 (2) 1-3 Abrin is a toxin of public health concern due to its lethality, lack of antidote, and potential for use as a bioterrorism agent. Possible routes of exposure include ingestion, inhalation, and injection. Onset of symptoms is often delayed, even in severe cases. In fatal cases, death occurs from multi-organ failure. We describe the clinical course, laboratory, and pathologic findings in a case of fatal human poisoning associated with abrin injection. The Abrus precatorius seeds in this case were obtained via the internet. The Centers for Disease Control and Prevention's Laboratory Response Network detected abrine in the urine confirming abrin exposure in this fatal poisoning. |
Smoke alarms and carbon monoxide alarms in households with children, Puerto Rico, 2010
Chen J , Dignam T , Yip F , Garcia BR , Blanton C , Brown MJ , Sircar K . J Prim Prev 2020 41 (3) 279-295 In 2017, Puerto Rico sustained extensive damage from Hurricane Maria, increasing the risk of fires and carbon monoxide (CO) poisonings. Using a population-based, in-person survey of households with children less than 6 years old in Puerto Rico, we collected data in 2010 concerning the presence of smoke alarms and CO alarms in these households. We generated national estimates by extrapolating the number of households in each stratum using data from the 2010 Census. We determined which household characteristics predicted the presence of these alarms. Of 355 households analyzed, 31% had functional smoke alarms, or an estimated 109,773 households territory wide. The presence of smoke alarms was associated with living in multifamily housing and no child in the household receiving government medical insurance. Public housing or publicly subsidized housing, as compared to owner-occupied housing and unsubsidized rental housing, was associated with having a functional smoke alarm in households with children aged less than 6 years. Based on only six houses having CO alarms, we estimated only 7685 (2%) households had CO alarms. The low prevalence of functional smoke or CO alarms 7 years before Hurricane Maria is unfortunate and should be remedied by ensuring that such alarms are widely installed in current rebuilding activities. |
Vitamin K1 treatment duration in patients with brodifacoum poisoning
Yip L , Stanton NV , Middleberg RA . N Engl J Med 2020 382 (18) 1764-1765 Brodifacoum, a long-acting vitamin K epoxide cycle antagonist, is a rodenticide encountered in intentional ingestions and as a contaminant of some synthetic cannabinoid products.1 Serious brodifacoum poisoning is characterized by life-threatening hemorrhage. | | Brodifacoum poisoning is treated with vitamin K1, but the treatment duration is variable, and thus management of the condition is challenging. Case reports indicate that the brodifacoum elimination half-life ranges from 16 to 62 days.2,3 On the basis of clinical experience, we propose discontinuing vitamin K1 treatment when a patient’s blood brodifacoum concentration is less than 10 ng per milliliter.3-5 In clinical practice, treatment has most often been discontinued at an arbitrary time, with the subsequent coagulation profile monitored. If the coagulation profile becomes abnormal, treatment is resumed. Another strategy is to discontinue treatment at an arbitrary time but monitor the activity of clotting factors; a decline in activity indicates the need to restart therapy. A third strategy is to exploit a consequence of vitamin K1 treatment — increased accumulation of vitamin K epoxide relative to vitamin K quinol, assessed by monitoring the ratio of vitamin K epoxide to vitamin K quinol. Vitamin K1 therapy then may be stopped when this ratio is less than 0.1.2 These strategies are all limited by the necessity of periodic blood-specimen collection, which puts the patient at risk for recurrent bleeding when treatment is withheld to assess periodic coagulation profiles, as well as by the requirement for specialized reference laboratory testing (e.g., measurement of active clotting-factor activity and vitamin K1 oxidation state) with a rapid turnaround time. |
Software application profile: the Rapid Inquiry Facility 4.0: an open access tool for environmental public health tracking
Piel FB , Parkes B , Hambly P , Roca-Barcelo A , McCallion M , Leonardi G , Strosnider H , Yip F , Elliott P , Hansell AL . Int J Epidemiol 2020 49 i38-i48 The Rapid Inquiry Facility 4.0 (RIF) is a new user-friendly and open-access tool, developed by the UK Small Area Health Statistics Unit (SAHSU), to facilitate environment public health tracking (EPHT) or surveillance (EPHS). The RIF is designed to help public health professionals and academics to rapidly perform exploratory investigations of health and environmental data at the small-area level (e.g. postcode or detailed census areas) in order to identify unusual signals, such as disease clusters and potential environmental hazards, whether localized (e.g. industrial site) or widespread (e.g. air and noise pollution). The RIF allows the use of advanced disease mapping methods, including Bayesian small-area smoothing and complex risk analysis functionalities, while accounting for confounders. The RIF could be particularly useful to monitor spatio-temporal trends in mortality and morbidity associated with cardiovascular diseases, cancers, diabetes and chronic lung diseases, or to conduct local or national studies on air pollution, flooding, low-magnetic fields or nuclear power plants. |
Availability, access, analysis and dissemination of small-area data.
Hodgson S , Fecht D , Gulliver J , Iyathooray Daby H , Piel FB , Yip F , Strosnider H , Hansell A , Elliott P . Int J Epidemiol 2020 49 i4-i14 In this era of 'big data', there is growing recognition of the value of environmental, health, social and demographic data for research. Open government data initiatives are growing in number and in terms of content. Remote sensing data are finding widespread use in environmental research, including in low- and middle-income settings. While our ability to study environment and health associations across countries and continents grows, data protection rules and greater patient control over the use of their data present new challenges to using health data in research. Innovative tools that circumvent the need for the physical sharing of data by supporting non-disclosive sharing of information, or that permit spatial analysis without researchers needing access to underlying patient data can be used to support analyses while protecting data confidentiality. User-friendly visualizations, allowing small-area data to be seen and understood by non-expert audiences, are revolutionizing public and researcher interactions with data. The UK Small Area Health Statistics Unit's Environment and Health Atlas for England and Wales, and the US National Environmental Public Health Tracking Network offer good examples. Open data facilitates user-generated outputs, and 'mash-ups', and user-generated inputs from social media, mobile devices and wearable tech are new data streams that will find utility in future studies, and bring novel dimensions with respect to ethical use of small-area data. |
Advancing global health through environmental and public health tracking
Lauriola P , Crabbe H , Behbod B , Yip F , Medina S , Semenza JC , Vardoulakis S , Kass D , Zeka A , Khonelidze I , Ashworth M , de Hoogh K , Shi X , Staatsen B , Knudsen LE , Fletcher T , Houthuijs D , Leonardi GS . Int J Environ Res Public Health 2020 17 (6) Global environmental change has degraded ecosystems. Challenges such as climate change, resource depletion (with its huge implications for human health and wellbeing), and persistent social inequalities in health have been identified as global public health issues with implications for both communicable and noncommunicable diseases. This contributes to pressure on healthcare systems, as well as societal systems that affect health. A novel strategy to tackle these multiple, interacting and interdependent drivers of change is required to protect the population's health. Public health professionals have found that building strong, enduring interdisciplinary partnerships across disciplines can address environment and health complexities, and that developing Environmental and Public Health Tracking (EPHT) systems has been an effective tool. EPHT aims to merge, integrate, analyse and interpret environmental hazards, exposure and health data. In this article, we explain that public health decision-makers can use EPHT insights to drive public health actions, reduce exposure and prevent the occurrence of disease more precisely in efficient and cost-effective ways. An international network exists for practitioners and researchers to monitor and use environmental health intelligence, and to support countries and local areas toward sustainable and healthy development. A global network of EPHT programs and professionals has the potential to advance global health by implementing and sharing experience, to magnify the impact of local efforts and to pursue data knowledge improvement strategies, aiming to recognise and support best practices. EPHT can help increase the understanding of environmental public health and global health, improve comparability of risks between different areas of the world including Low and Middle-Income Countries (LMICs), enable transparency and trust among citizens, institutions and the private sector, and inform preventive decision making consistent with sustainable and healthy development. This shows how EPHT advances global health efforts by sharing recent global EPHT activities and resources with those working in this field. Experiences from the US, Europe, Asia and Australasia are outlined for operating successful tracking systems to advance global health. |
Evaluation of Mannose Binding Lectin Gene Variants in Pediatric Influenza Virus-Related Critical Illness.
Levy ER , Yip WK , Super M , Ferdinands JM , Mistry AJ , Newhams MM , Zhang Y , Su HC , McLaughlin GE , Sapru A , Loftis LL , Weiss SL , Hall MW , Cvijanovich N , Schwarz A , Tarquinio KM , Mourani PM , Randolph AG . Front Immunol 2019 10 1005 Background: Mannose-binding lectin (MBL) is an innate immune protein with strong biologic plausibility for protecting against influenza virus-related sepsis and bacterial co-infection. In an autopsy cohort of 105 influenza-infected young people, carriage of the deleterious MBL gene MBL2_Gly54Asp("B") mutation was identified in 5 of 8 individuals that died from influenza-methicillin-resistant Staphylococcus aureus (MRSA) co-infection. We evaluated MBL2 variants known to influence MBL levels with pediatric influenza-related critical illness susceptibility and/or severity including with bacterial co-infections. Methods: We enrolled children and adolescents with laboratory-confirmed influenza infection across 38 pediatric intensive care units from November 2008 to June 2016. We sequenced MBL2 "low-producer" variants rs11003125("H/L"), rs7096206("Y/X"), rs1800450Gly54Asp("B"), rs1800451Gly57Glu("C"), rs5030737Arg52Cys("D") in patients and biologic parents. We measured serum levels and compared complement activity in low-producing homozygotes ("B/B," "C/C") to HYA/HYA controls. We used a population control of 1,142 healthy children and also analyzed family trios (PBAT/HBAT) to evaluate disease susceptibility, and nested case-control analyses to evaluate severity. Results: We genotyped 420 patients with confirmed influenza-related sepsis: 159 (38%) had acute lung injury (ALI), 165 (39%) septic shock, and 30 (7%) died. Although bacterial co-infection was diagnosed in 133 patients (32%), only MRSA co-infection (n = 33, 8% overall) was associated with death (p < 0.0001), present in 11 of 30 children that died (37%). MBL2 variants predicted serum levels and complement activation as expected. We found no association between influenza-related critical illness susceptibility and MBL2 variants using family trios (633 biologic parents) or compared to population controls. MBL2 variants were not associated with admission illness severity, septic shock, ALI, or bacterial co-infection diagnosis. Carriage of low-MBL producing MBL2 variants was not a risk factor for mortality, but children that died did have higher carriage of one or more B alleles (OR 2.3; p = 0.007), including 7 of 11 with influenza MRSA-related death (vs. 2 of 22 survivors: OR 14.5, p = 0.0002). Conclusions: MBL2 variants that decrease MBL levels were not associated with susceptibility to pediatric influenza-related critical illness or with multiple measures of critical illness severity. We confirmed a prior report of higher B allele carriage in a relatively small number of young individuals with influenza-MRSA associated death. |
Public perceptions of environmental public health risks in the United States
Shin M , Werner AK , Strosnider H , Hines LB , Balluz L , Yip FY . Int J Environ Res Public Health 2019 16 (6) Understanding public perceptions about environmental health hazards, exposures, and health impacts can help environmental public health practitioners to target and prioritize community activities, policy needs, and communication strategies. The online cross-sectional 2013 summer wave of the ConsumerStyles survey sampled U.S. adults and used questions from the Centers for Disease Control's Environmental Public Health Tracking Program to measure public awareness of governmental efforts to track environmental exposures and links to health impacts, as well as perceptions of environmental health issues. Unadjusted and adjusted logistic regressions examined the associations between demographic characteristics and level of awareness of government environmental public health efforts or level of concern about health risks associated with environmental pollutants. Responses were received from 4033 participants, yielding a response rate of 66.0%. More than half of respondents (57.8%) noted concerns about health risks from environmental pollutants. More than one-third (40.0%) of respondents reported awareness of government efforts. Nearly 40% of respondents felt that none of the health impacts listed in the survey were related to environmental issues. Multiple logistic regression models showed that non-Hispanic blacks, other races, females, people with a college or higher education, and people living in the Midwest or South regions were more likely than their counterparts to be concerned about how the environment affects their health. Future work should focus on improving risk communication, filling the information gap on environmental health issues, and understanding how perceptions change over time. |
Nerve agent incidents and public health preparedness
Chang A , Thomas J , Johnson R , Gorman SE , Schier J , Yip L . Ann Intern Med 2018 170 (1) 59-61 Recent use of nerve agents (NAs) by terrorists and assassins exposes the need for public health responders and medical preparedness personnel to work together (1). Health care providers might find themselves at the scene of such an attack. Would the involvement of an NA be recognized? What should be done immediately to assess the situation, treat the victims, protect others and oneself, and alert appropriate health officials? These are essential questions a health care provider in the vicinity of an attack might face. We provide an overview of key clinical and public health concerns related to this topic for health care practitioners and public health officials. |
Notes from the Field: Outbreak of severe illness linked to the vitamin K antagonist brodifacoum and use of synthetic cannabinoids - Illinois, March-April 2018
Moritz E , Austin C , Wahl M , DesLauriers C , Navon L , Walblay K , Hendrickson M , Phillips A , Kerins J , Pennington AF , Lavery AM , El Zahran T , Kauerauf J , Yip L , Thomas J , Layden J . MMWR Morb Mortal Wkly Rep 2018 67 (21) 607-608 Synthetic cannabinoids, also known as K2 and spice, are heterogeneous psychoactive compounds identified as substances of abuse (1,2). On March 22, 2018, the Illinois Department of Public Health was notified by the Illinois Poison Center of four patients seen in emergency departments (EDs) during the preceding 2 weeks with unexplained bleeding and high international normalized ratios (INRs; range from 5 to >20 [normal <1.1]), indicating a clotting disorder, and reported synthetic cannabinoid use during the previous 3 days. None reported taking prescription anticoagulants or exposure to anticoagulant rodenticides. An investigation by the Illinois Department of Public Health, the Illinois Poison Center, CDC, local health departments, and law enforcement agencies was initiated to identify additional cases, ascertain epidemiologic links among patients, and implement control measures. |
Air quality awareness among U.S. adults with respiratory and heart disease
Mirabelli MC , Boehmer TK , Damon SA , Sircar KD , Wall HK , Yip FY , Zahran HS , Garbe PL . Am J Prev Med 2018 54 (5) 679-687 INTRODUCTION: Poor air quality affects respiratory and cardiovascular health. Information about health risks associated with outdoor air quality is communicated to the public using air quality alerts. This study was conducted to assess associations of existing respiratory and heart disease with three aspects of air quality awareness: awareness of air quality alerts, discussing with a health professional strategies to reduce air pollution exposure, and avoiding busy roads to reduce air pollution exposure when walking, biking, or exercising outdoors. METHODS: During 2014-2016, a total of 12,599 U.S. adults participated in summer waves of the ConsumerStyles surveys and self-reported asthma, emphysema/chronic obstructive pulmonary disease, heart disease, and each aspect of air quality awareness. In 2017, associations between each health condition and air quality awareness were estimated using log binomial and multinomial regression. RESULTS: Overall, 49% of respondents were aware of air quality alerts, 3% discussed with a health professional strategies to reduce air pollution exposure, and 27% always/usually avoided busy roads to reduce air pollution exposure. Asthma was associated with increased prevalence of awareness of air quality alerts (prevalence ratio=1.11, 95% CI=1.04, 1.20), discussing with a health professional (prevalence ratio=4.88, 95% CI=3.74, 6.37), and always/usually avoiding busy roads to reduce air pollution exposure (prevalence ratio=1.13, 95% CI=1.01, 1.27). Heart disease was not associated with air quality awareness. CONCLUSIONS: Existing respiratory disease, but not heart disease, was associated with increased air quality awareness. These findings reveal important opportunities to raise awareness of air quality alerts and behavior changes aimed at reducing air pollution exposure among adults at risk of exacerbating respiratory and heart diseases. |
Developing an online tool for identifying at-risk populations to wildfire smoke hazards
Vaidyanathan A , Yip F , Garbe P . Sci Total Environ 2017 619-620 376-383 Wildfire episodes pose a significant public health threat in the United States. Adverse health impacts associated with wildfires occur near the burn area as well as in places far downwind due to wildfire smoke exposures. Health effects associated with exposure to particulate matter arising from wildfires can range from mild eye and respiratory tract irritation to more serious outcomes such as asthma exacerbation, bronchitis, and decreased lung function. Real-time operational forecasts of wildfire smoke concentrations are available but they are not readily integrated with information on vulnerable populations necessary to identify at-risk communities during wildfire smoke episodes. Efforts are currently underway at the Centers for Disease Control and Prevention (CDC) to develop an online tool that utilizes short-term predictions and forecasts of smoke concentrations and integrates them with measures of population-level vulnerability for identifying at-risk populations to wildfire smoke hazards. The tool will be operationalized on a national scale, seeking input and assistance from several academic, federal, state, local, Tribal, and Territorial partners. The final product will then be incorporated into CDC's National Environmental Public Health Tracking Network (http://ephtracking.cdc.gov), providing users with access to a suite of mapping and display functionalities. A real-time vulnerability assessment tool incorporating standardized health and exposure datasets, and prevention guidelines related to wildfire smoke hazards is currently unavailable for public health practitioners and emergency responders. This tool could strengthen existing situational awareness competencies, and expedite future response and recovery efforts during wildfire episodes. |
Environmental public health tracking: From data to action
Yip FY . J Public Health Manag Pract 2017 23 Suppl 5 Supplement, Environmental Public Health Tracking S1-s3 Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data for the planning, implementation, and evaluation of public health practice and is an important component in assessing the function of public health.1 In 2000, a Pew Environmental Health Commission's report highlighted the lack of surveillance data and information to monitor the burden of environmentally related disease and the need to improve our understanding of the links between environmental hazards and chronic diseases.2 In response, the National Environmental Public Health Tracking Program (Tracking Program) at the Centers for Disease Control and Prevention (CDC) was developed in 2002. Since its inception, the Tracking Program has worked closely with a community of funded state and local health departments to build capacity and infrastructure to develop the National Environmental Public Health Tracking Network (Tracking Network), an integrated network of environmental health surveillance data at the local, state, and national levels. Application of these data is key to support evidence-based decision making and public health actions within state and local programs to help promote healthy and informed communities. Now in its 15th year, the Tracking Program continues to enhance the infrastructure of the Tracking Network to support more consistent use of its data and program resources to help inform public health actions, with the ultimate goal of reducing the burden of environmentally related health conditions. | This special issue of the Journal of Public Health Management & Practice offers a unique examination of the breadth of work by CDC and its partners in the Tracking Program, with a focus on how the Tracking Network and program resources have been utilized to support environmental public health practice and inform specific public health actions. Wilson and Charleston3 first provide an overview of the Tracking Program's history and development and how support from the Tracking Program can improve environmental public health practice at the state and local levels. Eatman and Strosnider4 then discuss the process that is taken to monitor public health actions, which serves as a performance measurement for the Tracking Program. They provide 3 case studies to highlight the diversity of actions taken by tracking partners. More than 400 public health actions have been finalized by the Tracking Program since 2005, thereby illustrating the opportunities for our partners to use the data and resources to help address the environmental public health needs at the state and local levels. Zhou et al5 then provide an initial examination of standardized approaches for estimating the monetary value of different health outcomes, for both generating additional information to support environmental health decision making and evaluating the costs and benefits of public health actions informed by the Tracking Program and its partners. Lucas-Pipkorn and Tuomi6 provide the last article at the national level and describe efforts by the Tracking Program to address gaps in the Tracking Network by developing new partnerships between the Tracking Program, state health departments, and tribal communities. |
Cancer-attributable mortality among people with treated human immunodeficiency virus infection in North America
Engels EA , Yanik EL , Wheeler W , Gill MJ , Shiels MS , Dubrow R , Althoff KN , Silverberg MJ , Brooks JT , Kitahata MM , Goedert JJ , Grover S , Mayor AM , Moore RD , Park LS , Rachlis A , Sigel K , Sterling TR , Thorne JE , Pfeiffer RM , Benson CA , Bosch RJ , Kirk GD , Boswell S , Mayer KH , Grasso C , Hogg RS , Harrigan PR , Montaner JSG , Yip B , Zhu J , Salters K , Gabler K , Buchacz K , Gebo KA , Carey JT , Rodriguez B , Horberg MA , Rabkin C , Jacobson LP , D'Souza G , Klein MB , Rourke SB , Rachlis AR , Globerman J , Kopansky-Giles M , Hunter-Mellado RF , Deeks SG , Martin JN , Patel P , Saag MS , Mugavero MJ , Willig J , Eron JJ , Napravnik S , Crane HM , Drozd DR , Haas D , Rebeiro P , Turner M , Bebawy S , Rogers B , Justice AC , Fiellin D , Gange SJ , Anastos K , McKaig RG , Freeman AM , Lent C , Van Rompaey SE , Morton L , McReynolds J , Lober WB , Abraham AG , Lau B , Zhang J , Jing J , Modur S , Wong C , Hogan B , Desir F , Liu B , You B . Clin Infect Dis 2017 65 (4) 636-643 Background Cancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts. Methods We evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load. Results There were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts <100 cells/mm 3. PAFs for NADCs increased during 1995-2009, reaching 10.1% in 2006-2009. Conclusions Approximately 10% of deaths in PWHIV prescribed ART during 1995-2009 were attributable to cancer, but this fraction increased over time. A large proportion of cancer-attributable deaths were associated with non-Hodgkin lymphoma, lung cancer, and liver cancer. Deaths due to NADCs will likely grow in importance as AIDS mortality declines and PWHIV age. |
Rural and urban differences in air quality, 2008-2012, and community drinking water quality, 2010-2015 - United States
Strosnider H , Kennedy C , Monti M , Yip F . MMWR Surveill Summ 2017 66 (13) 1-10 PROBLEM/CONDITION: The places in which persons live, work, and play can contribute to the development of adverse health outcomes. Understanding the differences in risk factors in various environments can help to explain differences in the occurrence of these outcomes and can be used to develop public health programs, interventions, and policies. Efforts to characterize urban and rural differences have largely focused on social and demographic characteristics. A paucity of national standardized environmental data has hindered efforts to characterize differences in the physical aspects of urban and rural areas, such as air and water quality. REPORTING PERIOD: 2008-2012 for air quality and 2010-2015 for water quality. DESCRIPTION OF SYSTEM: Since 2002, CDC's National Environmental Public Health Tracking Program has collaborated with federal, state, and local partners to gather standardized environmental data by creating national data standards, collecting available data, and disseminating data to be used in developing public health actions. The National Environmental Public Health Tracking Network (i.e., the tracking network) collects data provided by national, state, and local partners and includes 21 health outcomes, exposures, and environmental hazards. To assess environmental factors that affect health, CDC analyzed three air-quality measures from the tracking network for all counties in the contiguous United States during 2008-2012 and one water-quality measure for 26 states during 2010-2015. The three air-quality measures include 1) total number of days with fine particulate matter (PM2.5) levels greater than the U.S. Environmental Protection Agency's (EPA's) National Ambient Air Quality Standards (NAAQS) for 24-hour average PM2.5 (PM2.5 days); 2) mean annual average ambient concentrations of PM2.5 in micrograms per cubic meter (mean PM2.5); and 3) total number of days with maximum 8-hour average ozone concentrations greater than the NAAQS (ozone days). The water-quality measure compared the annual mean concentration for a community water system (CWS) to the maximum contaminant level (MCL) defined by EPA for 10 contaminants: arsenic, atrazine, di(2-ethylhexyl) phthalate (DEHP), haloacetic acids (HAA5), nitrate, perchloroethene (PCE), radium, trichloroethene (TCE), total trihalomethanes (TTHM), and uranium. Findings are presented by urban-rural classification scheme: four metropolitan (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) and two nonmetropolitan (micropolitan and noncore) categories. Regression modeling was used to determine whether differences in the measures by urban-rural categories were statistically significant. RESULTS: Patterns for all three air-quality measures suggest that air quality improves as areas become more rural (or less urban). The mean total number of ozone days decreased from 47.54 days in large central metropolitan counties to 3.81 days in noncore counties, whereas the mean total number of PM2.5 days decreased from 11.21 in large central metropolitan counties to 0.95 in noncore counties. The mean average annual PM2.5 concentration decreased from 11.15 mug/m3 in large central metropolitan counties to 8.87 mug/m3 in noncore counties. Patterns for the water-quality measure suggest that water quality improves as areas become more urban (or less rural). Overall, 7% of CWSs reported at least one annual mean concentration greater than the MCL for all 10 contaminants combined. The percentage increased from 5.4% in large central metropolitan counties to 10% in noncore counties, a difference that was significant, adjusting for U.S. region, CWS size, water source, and potential spatial correlation. Similar results were found for two disinfection by-products, HAA5 and TTHM. Arsenic was the only other contaminant with a significant result. Medium metropolitan counties had 3.1% of CWSs reporting at least one annual mean greater than the MCL, compared with 2.4% in large central counties. INTERPRETATION: Noncore (rural) counties experienced fewer unhealthy air-quality days than large central metropolitan counties, likely because of fewer air pollution sources in the noncore counties. All categories of counties had a mean annual average PM2.5 concentration lower than the EPA standard. Among all CWSs analyzed, the number reporting one or more annual mean contaminant concentrations greater the MCL was small. The water-quality measure suggests that water quality worsens as counties become more rural, in regards to all contaminants combined and for the two disinfection by-products individually. Although significant differences were found for the water-quality measure, the odds ratios were very small, making it difficult to determine whether these differences have a meaningful effect on public health. These differences might be a result of variations in water treatment practices in rural versus urban counties. PUBLIC HEALTH ACTION: Understanding the differences between rural and urban areas in air and water quality can help public health departments to identify, monitor, and prioritize potential environmental public health concerns and opportunities for action. These findings suggest a continued need to develop more geographically targeted, evidence-based interventions to prevent morbidity and mortality associated with poor air and water quality. |
Characterization of carbon monoxide exposure during Hurricane Sandy and subsequent Nor'easter
Schnall A , Law R , Heinzerling A , Sircar K , Damon S , Yip F , Schier J , Bayleyegn T , Wolkin A . Disaster Med Public Health Prep 2017 11 (5) 1-6 OBJECTIVE: Carbon monoxide (CO) is an odorless, colorless gas produced by fossil fuel combustion. On October 29, 2012, Hurricane Sandy moved ashore near Atlantic City, New Jersey, causing widespread morbidity and mortality, $30 to $50 billion in economic damage, and 8.5 million households to be without power. The combination of power outages and unusually low temperatures led people to use alternate power sources, placing many at risk for CO exposure. METHODS: We examined Hurricane Sandy-related CO exposures from multiple perspectives to help identify risk factors and develop strategies to prevent future exposures. This report combined data from 3 separate sources (health departments, poison centers via the National Poison Data System, and state and local public information officers). RESULTS: Results indicated that the number of CO exposures in the wake of Hurricane Sandy was significantly greater than in previous years. The persons affected were mostly females and those in younger age categories and, despite messaging, most CO exposures occurred from improper generator use. CONCLUSIONS: Our findings emphasize the continued importance of CO-related communication and ongoing surveillance of CO exposures to support public health response and prevention during and after disasters. Additionally, regional poison centers can be a critical resource for potential on-site management, public health promotion, and disaster-related CO exposure surveillance. (Disaster Med Public Health Preparedness. 2017;page 1 of 6). |
Cross-disciplinary consultancy to enhance predictions of asthma exacerbation risk in Boston
Reid M , Gunn J , Shah S , Donovan M , Eggo R , Babin S , Stajner I , Rogers E , Ensor KB , Raun L , Levy JI , Painter I , Phipatanakul W , Yip F , Nath A , Streichert LC , Tong C , Burkom H . Online J Public Health Inform 2016 8 (3) e199 This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission. Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement. |
Assessment of traditional and improved stove use on household air pollution and personal exposures in rural western Kenya
Yip F , Christensen B , Sircar K , Naeher L , Bruce N , Pennise D , Lozier M , Pilishvili T , Loo Farrar J , Stanistreet D , Nyagol R , Muoki J , de Beer L , Sage M , Kapil V . Environ Int 2016 99 185-191 BACKGROUND: Over 40% of the world's population relies on solid fuels for heating and cooking. Use of improved biomass cookstoves (ICS) has the potential to reduce household air pollution (HAP). OBJECTIVES: As part of an evaluation to identify ICS for use in Kenya, we collected indoor air and personal air samples to assess differences between traditional cookstoves (TCS) and ICS. METHODS: We conducted a cross-over study in 2012 in two Kenyan villages; up to six different ICS were installed in 45 households during six two-week periods. Forty-eight hour kitchen measurements of fine particulate matter (PM2.5) and carbon monoxide (CO) were collected for the TCS and ICS. Concurrent personal CO measurements were conducted on the mother and one child in each household. We performed descriptive analysis and compared paired measurements between baseline (TCS only) and each ICS. RESULTS: The geometric mean of 48-hour baseline PM2.5 and CO concentrations in the kitchen was 586mug/m3 (95% CI: 460, 747) and 4.9ppm (95% CI: 4.3, 5.5), respectively. For each ICS, the geometric mean kitchen air pollutant concentration was lower than the TCS: median reductions were 38.8% (95% CI: 29.5, 45.2) for PM2.5 and 27.1% (95% CI: 17.4, 40.3) for CO, with statistically significant relationships for four ICS. We also observed a reduction in personal exposures to CO with ICS use. CONCLUSIONS: We observed a reduction in mean 48-hour PM2.5 and CO concentrations compared to the TCS; however, concentrations for both pollutants were still consistently higher than WHO air quality guidelines. Our findings illustrate that ICS tested in real-world settings can reduce exposures to HAP, but implementation of cleaner fuels and related stove technologies may also be necessary to optimize public health benefits. |
Effectiveness of six improved cookstoves in reducing household air pollution and their acceptability in rural western Kenya
Pilishvili T , Loo JD , Schrag S , Stanistreet D , Christensen B , Yip F , Nyagol R , Quick R , Sage M , Bruce N . PLoS One 2016 11 (11) e0165529 BACKGROUND: Household air pollution (HAP) from biomass fuel burning is linked to poor health outcomes. Improved biomass cookstoves (ICS) have the potential to improve HAP. OBJECTIVES: A pre-/post- intervention study assessed the impact of six ICS on indoor air quality and acceptability of ICS to local users in rural Western Kenya. METHODS: We measured mean personal and kitchen level concentrations of particulate matter <2.5mum in diameter (PM2.5, mug/m3) and carbon monoxide (CO, ppm) during the 48-hour period of each ICS use in 45 households. We compared these levels to those observed with traditional 3-stone fire (TSF) use. We assessed ICS acceptability through interviews and focus groups. We evaluated association of stove type, fuel use, and factors related to cooking practices with mean kitchen PM2.5 and CO using multivariable regression. RESULTS: Stove type, exclusive ICS use (vs. concurrent TSF use), and the amount of fuel used were independently associated with kitchen PM2.5 and CO levels. Reductions (95%CI) in mean PM2.5 compared to TSF, ranged by ICS from 11.9% (-2.8-24.5) to 42.3% (32.3-50.8). Reductions in kitchen CO compared to TSF, ranged by ICS from -5.8% (-21.9-8.2) to 34.5% (23.2-44.1). Mean kitchen PM2.5 ranged from 319mug/m3 to 518mug/m3 by ICS. Women thought ICS were easy to use, more efficient, produced less smoke, and cooked faster, compared to TSF. Women also reported limitations for each ICS. CONCLUSIONS: We documented reductions in HAP from ICS compared to TSF. The PM2.5 levels with ICS use were still considerably higher than WHO indoor air quality guidelines. Achieving maximal potential of ICS requires adherence to more exclusive use and addressing user reported ICS limitations. |
The relationship of high PM2.5 days and subsequent asthma-related hospital encounters during the fireplace season in Phoenix, AZ, 2008–2012
Pope R , Stanley KM , Domsky I , Yip F , Nohre L , Mirabelli MC . Air Qual Atmos Health 2016 10 (2) 161–169 Exposure to particulate matter less than 2.5 μm in diameter (PM2.5) exacerbates asthma and increases mortality. In Phoenix, AZ, the highest PM2.5 values frequently occur during the winter fireplace season and air quality health standards are often exceeded during the Christmas and New Year’s holidays. It was clear that enhanced messaging was needed by air quality and public health authorities to discourage biomass fires (BMF) on days when unhealthful levels of pollution were likely to be caused by that activity. Demonstrating adverse health outcomes would bolster this effort. We conducted this study to evaluate associations between elevated PM2.5 exposures during the fireplace season and asthma-related hospital admissions in Phoenix; days with average PM2.5 > 35 μg/m3 were categorized as elevated PM2.5 exposure. We used hospital discharge data to identify patients with an asthma-related hospital encounter and who lived within an 8-km radius of a PM2.5 monitor. To estimate the risk of a hospital encounter following an elevated PM2.5 event, we used generalized estimating equations, specified with a Poisson distribution, and exposure lags of 0–3 days. Controlling for influenza, temperature, humidity, rain, and year, these analyses generated elevated estimates of emergency department visit risk among adults on lag days 2 (relative risk [RR] 1.19; 95 % CI 1.06, 1.34) and 3 (RR 1.20, 95 % CI 1.05, 1.37). Elevated PM2.5 was not associated with hospital encounters among children. Our findings suggest that adults may be at elevated risk of asthma-related hospital encounters during the fireplace season. © 2016 Springer Science+Business Media Dordrecht |
Use of temperature sensors to determine exclusivity of improved stove use and associated household air pollution reductions in Kenya
Lozier MJ , Sircar K , Christensen B , Pillarisetti A , Pennise D , Bruce N , Stanistreet D , Naeher L , Pilishvili T , Farrar JL , Sage M , Nyagol R , Muoki J , Wofchuck T , Yip F . Environ Sci Technol 2016 50 (8) 4564-71 Household air pollution (HAP) contributes to 3.5-4 million annual deaths globally. Recent interventions using improved cookstoves (ICS) to reduce HAP have incorporated temperature sensors as stove use monitors (SUMs) to assess stove use. We deployed SUMs in an effectiveness study of 6 ICSs in 45 Kenyan rural homes. Stove were installed sequentially for 2 weeks and kitchen air monitoring was conducted for 48 h during each 2-week period. We placed SUMs on the ICSs and traditional cookstoves (TCS), and the continuous temperature data were analyzed using an algorithm to examine the number of cooking events, days of exclusive use of ICS, and how stove use patterns affect HAP. Stacking, defined as using both a TCS and an ICS in the same day, occurred on 40% of the study days, and exclusive use of the ICS occurred on 25% of study days. When researchers were not present, ICS use declined, which can have implications for long-term stove adoption in these communities. Continued use of TCSs was also associated with higher HAP levels. SUMs are a valuable tool for characterizing stove use and provide additional information to interpret HAP levels measured during ICS intervention studies. |
Respiratory health effects of ultrafine particles in children: A literature review
Heinzerling A , Hsu J , Yip F . Water Air Soil Pollut 2016 227 32 By convention, airborne particles ≤0.1 μm (100 nm) are defined as ultrafine particles (UFPs). UFPs can comprise a large number of particles in particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5). Despite the documented respiratory health effects of PM2.5 and concerns that UFPs might be more toxic than larger particular matter, the effects of UFPs on the respiratory system are not well-described. Even less is known about the respiratory health effects of UFPs among particularly vulnerable populations including children. We reviewed studies examining respiratory health effects of UFPs in children and identified 12 relevant articles. Most (8/12) studies measured UFP exposure using central ambient monitors, and we found substantial heterogeneity in UFP definitions and study designs. No long-term studies were identified. In single pollutant models, UFPs were associated with incident wheezing, current asthma, lower spirometric values, and asthma-related emergency department visits among children. Also, higher exhaled nitric oxide levels were positively correlated with UFP dose among children with asthma or allergy to house dust mites in one study. Multivariate models accounting for potential copollutant confounding yielded no statistically significant results. Although evidence for a relationship between UFPs and children's respiratory is accumulating, the literature remains inconclusive. Interpretation of existing data is constrained by study heterogeneity, limited accounting for UFP spatial variation, and lack of significant findings from multipollutant models. |
The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013
Haagsma JA , Graetz N , Bolliger I , Naghavi M , Higashi H , Mullany EC , Abera SF , Abraham JP , Adofo K , Alsharif U , Ameh EA , Ammar W , Antonio CA , Barrero LH , Bekele T , Bose D , Brazinova A , Catala-Lopez F , Dandona L , Dandona R , Dargan PI , De Leo D , Degenhardt L , Derrett S , Dharmaratne SD , Driscoll TR , Duan L , Petrovich Ermakov S , Farzadfar F , Feigin VL , Franklin RC , Gabbe B , Gosselin RA , Hafezi-Nejad N , Hamadeh RR , Hijar M , Hu G , Jayaraman SP , Jiang G , Khader YS , Khan EA , Krishnaswami S , Kulkarni C , Lecky FE , Leung R , Lunevicius R , Lyons RA , Majdan M , Mason-Jones AJ , Matzopoulos R , Meaney PA , Mekonnen W , Miller TR , Mock CN , Norman RE , Orozco R , Polinder S , Pourmalek F , Rahimi-Movaghar V , Refaat A , Rojas-Rueda D , Roy N , Schwebel DC , Shaheen A , Shahraz S , Skirbekk V , Soreide K , Soshnikov S , Stein DJ , Sykes BL , Tabb KM , Temesgen AM , Tenkorang EY , Theadom AM , Tran BX , Vasankari TJ , Vavilala MS , Vlassov VV , Woldeyohannes SM , Yip P , Yonemoto N , Younis MZ , Yu C , Murray CJ , Vos T . Inj Prev 2015 22 (1) 3-18 BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made. |
Short-term effects of ambient air pollutants on asthma-related emergency department visits in Indianapolis, Indiana, 2007-2011
Byers N , Ritchey M , Vaidyanathan A , Brandt AJ , Yip F . J Asthma 2015 53 (3) 1-8 OBJECTIVE: We estimate the short-term associations between daily changes in ambient air pollutants and daily asthma-related emergency department (ED) visits in Indianapolis, IN. METHODS: We identified asthma-related ED visits among Indianapolis residents aged ≥5 years. We used Poisson regression in a time-series framework to estimate the increased risk for asthma-related ED visits from exposure to ambient SO2, PM2.5 and ozone during the warm season (April-September) and SO2 and PM2.5 during the cold (October-March) season, from 2007 to 2011. Our models controlled for measured confounders, including weather and respiratory infections, as well as unmeasured confounders using a natural cubic spline to account for long-term seasonal trends. RESULTS: During 2007-2011 in Indianapolis, 165 056 asthma-related ED visits occurred. We found statistically significant positive associations (p < 0.05) between ambient air pollutants and ED visits during the warm season for persons aged 5-44 years. Interquartile range increases in daily ozone concentrations with same day, 2-day lagged, and 3-day moving average were associated with increased risks for ED visits of 3.2% (95% CI: 0.2%, 6.3%), 4.4% (0.1%, 8.9%) and 4.8% (0.2%, 9.6%), respectively. Interquartile range increases in 3-day moving averages for SO2 were associated with an increased risk of 3.3% (95% CI: 0.2%, 6.5%). We identified statistically significant associations (p < 0.05) between increased SO2 and PM2.5 levels and decreased ED visits among some age groups, primarily during the cold season, and no significant positive associations between changes in PM2.5 concentration and asthma-related ED visits. CONCLUSIONS: During the warm season, increases in ozone and SO2 concentrations were associated with increased asthma morbidity in children and young adults in Indianapolis. These results will enable reliable estimation of the health impacts of increases in these pollutants on asthma-related ED visits in Indianapolis and similar communities. |
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