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Newman NC, Knapke JM, Kiniyalocts R, Belt J, Haynes E. Evaluation of academic detailing to educate clinicians regarding childhood lead poisoning prevention: a pilot study. J Osteopath Med 2023; 123:159-165. [PMID: 36628491 DOI: 10.1515/jom-2022-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
CONTEXT Environmental exposures are associated with approximately 19% of disease globally, and exposure to neurotoxic chemicals is estimated to cost the United States $50 billion per year. Despite calls from the Institute of Medicine to increase training for clinicians regarding environmental health since the 1990s, there is still little instruction in environmental health for clinicians. This leaves gaps in knowledge that need to be bridged through outreach and education to practicing clinicians. Academic detailing (AD) is an educational intervention associated with improved prescribing practices in healthcare professionals but has not been applied to preventive or environmental health. Childhood lead exposure is a common condition associated with lifetime increased risk of cognitive and behavioral problems. Ohio has more than 2 million homes built before 1978, making exposure to lead-based paint a significant public health problem; however, only 50% of high-risk children are tested for lead. Few receive health promotion information regarding lead poisoning prevention, in part because this is not a part of training for healthcare providers (HCPs). OBJECTIVES The objectives of this study were twofold: (1) implement a pilot of AD sessions on the topic of childhood lead poisoning prevention with frontline HCPs and their staff in different practice settings; and (2) evaluate the acceptability of these training sessions utilizing quantitative and qualitative methods. METHODS Physicians, nurses, social workers, community health workers, and clinical office staff were recruited from clinics who care for children at high risk for lead exposure. Trainings consisting of small group AD style sessions were presented at these sites. Learning objectives included increasing knowledge regarding lead testing requirements, enabling identification of lead's impact on child development and equipping participants to provide anticipatory guidance for parents regarding lead poisoning prevention. Participants provided feedback through an anonymous questionnaire and qualitative feedback. RESULTS There were 46 participants (12 physicians in practice/in training, 21 nursing or office staff, and 13 community health or social workers); more than 90% of the participants reported that the training achieved its learning objectives. Small-group presentations were preferred (91%); approximately 39% of participants requested an online format. Participants preferred that the presenters be either a public health or lead clinical expert, and they suggested that future activities include clinical vignettes. CONCLUSIONS Academic-detailing style training shows promise in promoting childhood lead poisoning prevention for frontline HCPs.
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Affiliation(s)
- Nicholas C Newman
- Department of Pediatrics and Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Attending Physician, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jacqueline M Knapke
- Department of Family and Community Medicine at the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rachael Kiniyalocts
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John Belt
- Bureau of Environmental Health and Radiation Protection, Field Services Division, Ohio Department of Health, Columbus, OH, USA
| | - Erin Haynes
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
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Hartley K, MacDougall MC, Terrizzi B, Xu Y, Cecil KM, Chen A, Braun JM, Lanphear BP, Newman NC, Vuong AM, Sjödin A, Yolton K. Gestational exposure to polybrominated diphenyl ethers and social skills and problem behaviors in adolescents: The HOME study. Environ Int 2022; 159:107036. [PMID: 34896668 PMCID: PMC8748392 DOI: 10.1016/j.envint.2021.107036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Polybrominated diphenyl ethers (PBDEs) are persistent environmental pollutants used as flame retardants. Gestational PBDE exposure has been associated with a variety of behavior problems in children, but little is known about its impact into adolescence, particularly on social skills, which are important for achieving social competence, establishing identity, and forming lasting relationships. OBJECTIVE We investigated associations between gestational exposure to PBDEs and social skills and problem behaviors in early adolescence in a longitudinal pregnancy and birth cohort in Cincinnati, Ohio (recruited 2003-2006). METHODS We measured maternal serum concentrations of five PBDE congeners during gestation. At age 12, we measured social skills and problem behaviors scores for 243 adolescents using self- and caregiver-report on the Social Skills Improvement System (SSiS). We used multivariable linear regression models to estimate associations between maternal PBDE concentrations and SSiS scores, controlling for potential covariates. We report associations for the five congeners and a summary exposure variable (∑5BDE: the sum of BDE- 28, 47, 99, 100, and 153, n = 197). RESULTS We found sex-specific associations of ∑5BDE concentrations with adolescent-reported Problem Behaviors (∑5BDE × sex pint = 0.02) and caregiver-reported Social Skills (∑5BDE × sex pint = 0.02). In sex-stratified models, log10 transformed data revealed increased maternal ∑5BDE concentration among males was associated with decreased caregiver-reported Social Skills composite score (β = -10.2, 95% CI: -19.5, -1.0), increased adolescent-reported Problem Behaviors composite score (β = 12.1, 95% CI: 5.4, 18.8), and increased caregiver-reported Problem Behaviors composite score (β = 6.2, 95% CI: 0.7, 11.7). Further analysis on SSiS subscales revealed similar patterns in significant associations among males. There were no statistically significant associations in stratified models among females despite higher ∑5BDE exposure (Female GM=40.15 ng/g lipid, GSE=1.10; Male GM=35.30 ng/g lipid, GSE=1.09). DISCUSSION We found gestational PBDE exposure in males was associated with poorer behavioral outcomes, extending previous findings among this cohort into early adolescence.
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Affiliation(s)
- Kim Hartley
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA.
| | - Melinda C MacDougall
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA.
| | - Brandon Terrizzi
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA
| | - Yingying Xu
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA.
| | - Kim M Cecil
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
| | - Aimin Chen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Joseph M Braun
- Brown University, Department of Epidemiology, Providence, RI, USA.
| | - Bruce P Lanphear
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada.
| | - Nicholas C Newman
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA.
| | - Ann M Vuong
- University of Nevada, Las Vegas School of Public Health, Las Vegas, NV, USA.
| | - Andreas Sjödin
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Mail Stop F-20, 4770 Buford Highway NE, Atlanta, GA, USA.
| | - Kimberly Yolton
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
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Workman B, Beck AF, Newman NC, Nabors L. Evaluation of a Program to Reduce Home Environment Risks for Children with Asthma Residing in Urban Areas. Int J Environ Res Public Health 2021; 19:172. [PMID: 35010432 PMCID: PMC8750910 DOI: 10.3390/ijerph19010172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Pediatric asthma morbidity is often linked to challenges including poor housing quality, inability to access proper medical care, lack of medications, and poor adherence to medical regimens. Such factors also propagate known disparities, by race and income, in asthma-related outcomes. Multimodal home visits have an established evidence base in support of their use to improve such outcomes. The Collaboration to Lessen Environmental Asthma Risks (CLEAR) is a partnership between the Cincinnati Children's Hospital Medical Center and the local health department which carries out home visits to provide healthy homes education and write orders for remediation should code violations and environmental asthma triggers be identified. To assess the strengths and weaknesses of the program, we obtained qualitative feedback from health professionals and mothers of children recently hospitalized with asthma using key informant interviews. Health professionals viewed the program as a positive support system for families and highlighted the potential benefit of education on home asthma triggers and connecting families with services for home improvements. Mothers report working to correct asthma triggers in the home based on the education they received during the course of their child's recent illness. Some mothers indicated mistrust of the health department staff completing home visits, indicating a further need for research to identify the sources of this mistrust. Overall, the interviews provided insights into successful areas of the program and areas for program improvement.
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Affiliation(s)
- Brandon Workman
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH 45267-0056, USA;
| | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229-3026, USA;
| | - Nicholas C. Newman
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH 45267-0056, USA;
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229-3026, USA;
| | - Laura Nabors
- Department of Health Promotion and Education, University of Cincinnati, Cincinnati, OH 45221-0068, USA;
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Rasnick E, Ryan PH, Bailer AJ, Fisher T, Parsons PJ, Yolton K, Newman NC, Lanphear BP, Brokamp C. Identifying sensitive windows of airborne lead exposure associated with behavioral outcomes at age 12. Environ Epidemiol 2021; 5:e144. [PMID: 33870016 PMCID: PMC8043737 DOI: 10.1097/ee9.0000000000000144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022] Open
Abstract
Despite the precipitous decline of airborne lead concentrations following the removal of lead in gasoline, lead is still detectable in ambient air in most urban areas. Few studies, however, have examined the health effects of contemporary airborne lead concentrations in children. METHODS We estimated monthly air lead exposure among 263 children (Cincinnati Childhood Allergy and Air Pollution Study; Cincinnati, OH; 2001-2005) using temporally scaled predictions from a validated land use model and assessed neurobehavioral outcomes at age 12 years using the parent-completed Behavioral Assessment System for Children, 2nd edition. We used distributed lag models to estimate the effect of airborne lead exposure on behavioral outcomes while adjusting for potential confounding by maternal education, community-level deprivation, blood lead concentrations, greenspace, and traffic related air pollution. RESULTS We identified sensitive windows during mid- and late childhood for increased anxiety and atypicality scores, whereas sensitive windows for increased aggression and attention problems were identified immediately following birth. The strongest effect was at age 12, where a 1 ng/m3 increase in airborne lead exposure was associated with a 3.1-point (95% confidence interval: 0.4, 5.7) increase in anxiety scores. No sensitive windows were identified for depression, somatization, conduct problems, hyperactivity, or withdrawal behaviors. CONCLUSIONS We observed associations between exposure to airborne lead concentrations and poor behavioral outcomes at concentrations 10 times lower than the National Ambient Air Quality Standards set by the US Environmental Protection Agency.
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Affiliation(s)
- Erika Rasnick
- Department of Statistics, Miami University, Oxford
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
| | - Patrick H. Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Patrick J. Parsons
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany
- Department of Environmental Health Sciences, School of Public Health, University at Albany, Rensselaer, New York
| | - Kimberly Yolton
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Nicholas C. Newman
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health, Albany
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Newman NC, Elam S, Igoe C, Jones C, Menrath W, Porter D, Haynes EN. A Community-Academic Partnership to Reduce Lead Exposure From an Elevated Roadway Demolition, Cincinnati, Ohio, 2012. Public Health Rep 2017; 132:622-626. [PMID: 28977765 DOI: 10.1177/0033354917732756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Disseminating public health recommendations to community members is an important step in protecting the public's health. We describe a community-academic partnership comprising health-based organizations, community groups, academia, and government organizations. This partnership undertook an iterative process to develop an outreach plan, educational materials, and activities to bring lead-poisoning prevention recommendations from a health impact assessment of a roadway demolition/construction project to the residents of an affected neighborhood in Cincinnati, Ohio, in 2012. Community partners played a key role in developing outreach and prevention activities. As a result of this project, activities among members of the partnership continue.
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Affiliation(s)
- Nicholas C Newman
- 1 Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah Elam
- 3 Center for Clinical and Translational Science and Training, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - William Menrath
- 2 Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | | | - Erin N Haynes
- 2 Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
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Haynes EN, Sucharew H, Hilbert TJ, Kuhnell P, Spencer A, Newman NC, Burns R, Wright R, Parsons PJ, Dietrich KN. Impact of air manganese on child neurodevelopment in East Liverpool, Ohio. Neurotoxicology 2017; 64:94-102. [PMID: 28888663 DOI: 10.1016/j.neuro.2017.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/01/2017] [Accepted: 09/01/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND East Liverpool, Ohio, the site of a hazardous waste incinerator and a manganese (Mn) processor, has had air Mn concentrations exceeding United States Environmental Protection Agency reference levels for over a decade. Save Our County, Inc., a community organization, was formed to address community environmental health concerns related to local industry. Researchers from the University of Cincinnati partnered with Save Our County to determine if air Mn had an impact on the neurocognitive function of children in the community. METHODS Children 7-9 years of age from East Liverpool and its surrounding communities, were enrolled (N=106) in the Communities Actively Researching Exposure Study from between March 2013-June 2014. Blood and hair were analyzed for Mn and lead, and serum was analyzed for cotinine. We used linear regression to assess associations between biological measures and IQ subscale scores. RESULTS Geometric mean blood lead (n=67), blood Mn (n=66), hair Mn (n=98), and serum cotinine (n=69) concentrations were 1.13±1.96μg/dL, 10.06±1.30μg/L, and 360.22±2.17ng/g, 0.76±6.12μg/L respectively. After adjusting for potential confounders, hair Mn was negatively associated with Full Scale IQ. CONCLUSIONS Hair Mn was negatively associated with child IQ scores. Community partners were instrumental in the conception and implementation of this study.
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Affiliation(s)
- Erin N Haynes
- University of Cincinnati, College of Medicine, Department of Environmental Health, 160 Panzeca Way, Cincinnati, OH, 45267, USA.
| | - Heidi Sucharew
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Timothy J Hilbert
- University of Cincinnati, College of Medicine, Department of Environmental Health, 160 Panzeca Way, Cincinnati, OH, 45267, USA.
| | - Pierce Kuhnell
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | | | - Nicholas C Newman
- University of Cincinnati, College of Medicine, Department of Environmental Health, 160 Panzeca Way, Cincinnati, OH, 45267, USA; Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Roxanne Burns
- Kent State University East Liverpool Campus, 400 E 4th St, East Liverpool, OH, 43920, USA
| | - Robert Wright
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
| | - Patrick J Parsons
- Wadsworth Center, New York State Department of Health, Albany, NY, 12201-0509, USA; University of Albany, School of Public Health, Department of Environmental Health Sciences, 1400 Washington Ave, Albany, NY, 12222, USA.
| | - Kim N Dietrich
- University of Cincinnati, College of Medicine, Department of Environmental Health, 160 Panzeca Way, Cincinnati, OH, 45267, USA.
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Tamm L, Denton CA, Epstein JN, Schatschneider C, Taylor H, Arnold LE, Bukstein O, Anixt J, Koshy A, Newman NC, Maltinsky J, Brinson P, Loren REA, Prasad MR, Ewing-Cobbs L, Vaughn A. Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial. J Consult Clin Psychol 2017; 85:434-446. [PMID: 28333510 DOI: 10.1037/ccp0000170] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This trial compared attention-deficit/hyperactivity disorder (ADHD) treatment alone, intensive reading intervention alone, and their combination for children with ADHD and word reading difficulties and disabilities (RD). METHOD Children (n = 216; predominantly African American males) in Grades 2-5 with ADHD and word reading/decoding deficits were randomized to ADHD treatment (medication + parent training), reading treatment (reading instruction), or combined ADHD + reading treatment. Outcomes were parent and teacher ADHD ratings and measures of word reading/decoding. Analyses utilized a mixed models covariate-adjusted gain score approach with posttest regressed onto pretest. RESULTS Inattention and hyperactivity/impulsivity outcomes were significantly better in the ADHD (parent Hedges's g = .87/.75; teacher g = .67/.50) and combined (parent g = 1.06/.95; teacher g = .36/41) treatment groups than reading treatment alone; the ADHD and Combined groups did not differ significantly (parent g = .19/.20; teacher g = .31/.09). Word reading and decoding outcomes were significantly better in the reading (word reading g = .23; decoding g = .39) and combined (word reading g = .32; decoding g = .39) treatment groups than ADHD treatment alone; reading and combined groups did not differ (word reading g = .09; decoding g = .00). Significant group differences were maintained at the 3- to 5-month follow-up on all outcomes except word reading. CONCLUSIONS Children with ADHD and RD benefit from specific treatment of each disorder. ADHD treatment is associated with more improvement in ADHD symptoms than RD treatment, and reading instruction is associated with better word reading and decoding outcomes than ADHD treatment. The additive value of combining treatments was not significant within disorder, but the combination allows treating both disorders simultaneously. (PsycINFO Database Record
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Carolyn A Denton
- Department of Pediatrics, University of Texas Health Science Center at Houston
| | - Jeffery N Epstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | | | - Heather Taylor
- Department of Pediatrics, University of Texas Health Science Center at Houston
| | | | | | - Julia Anixt
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Anson Koshy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Nicholas C Newman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Jan Maltinsky
- Department of Education, Mount St. Joseph University
| | - Patricia Brinson
- Department of Pediatrics, University of Texas Health Science Center at Houston
| | - Richard E A Loren
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Mary R Prasad
- Department of Pediatrics, University of Texas Health Science Center at Houston
| | - Linda Ewing-Cobbs
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Aaron Vaughn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Vander Schaaf E, Potisek NM, Puri K, Schlaudecker EP, Newman NC, Notario PM, Nagpal R. Index of suspicion. Pediatr Rev 2014; 35:487-92. [PMID: 25361908 PMCID: PMC5830884 DOI: 10.1542/pir.35-11-487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Kriti Puri
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Newman NC, Ryan PH, Huang B, Beck AF, Sauers HS, Kahn RS. Traffic-related air pollution and asthma hospital readmission in children: a longitudinal cohort study. J Pediatr 2014; 164:1396-1402.e1. [PMID: 24680015 PMCID: PMC4097891 DOI: 10.1016/j.jpeds.2014.02.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the association between exposure to traffic-related air pollution (TRAP) and hospital readmission for asthma or bronchodilator-responsive wheezing. STUDY DESIGN A population-based cohort of 758 children aged 1-16 years admitted for asthma or bronchodilator-responsive wheezing was assessed for asthma readmission within 12 months. TRAP exposure was estimated with a land use regression model using the home address at index admission, with TRAP dichotomized at the sample median (0.37 μg/m3). Covariates included allergen-specific IgE, tobacco smoke exposure, and social factors obtained at enrollment. Associations between TRAP exposure and readmission were assessed using logistic regression and Cox proportional hazards models. RESULTS The study cohort was 58% African American and 32% white; 19% of the patients were readmitted within 12 months of the original admission. Higher TRAP exposure was associated with a higher readmission rate (21% vs. 16%; P = .05); this association was not significant after adjusting for covariates (aOR, 1.4; 95% CI, 0.9-2.2). Race modified the observed association; white children with high TRAP exposure had 3-fold higher odds of asthma readmission (OR, 3.0; 95% CI, 1.1-8.1), compared with white children with low TRAP exposure. In African American children, TRAP exposure was not associated with increased readmission (OR, 1.1; 95% CI, 0.6-1.8). In children with high TRAP exposure, TRAP exposure was associated with decreased time to readmission in white children (hazard ratio, 3.2; 95% CI, 1.5-6.7) compared with African American children (hazard ratio, 1.0; 95% CI, 0.7-1.4). African American children had a higher readmission rate overall. CONCLUSION TRAP exposure is associated with increased odds of hospital readmission in white children, but not in African American children.
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Affiliation(s)
- Nicholas C Newman
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew F Beck
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Hadley S Sauers
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Robert S Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Abstract
BACKGROUND AND OBJECTIVES Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. RESULTS The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
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Affiliation(s)
- Andrew F. Beck
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Hadley S. Sauers
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Chen Chen
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick H. Ryan
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Newman NC, Ryan P, Lemasters G, Levin L, Bernstein D, Hershey GKK, Lockey JE, Villareal M, Reponen T, Grinshpun S, Sucharew H, Dietrich KN. Traffic-related air pollution exposure in the first year of life and behavioral scores at 7 years of age. Environ Health Perspect 2013; 121:731-6. [PMID: 23694812 PMCID: PMC3672910 DOI: 10.1289/ehp.1205555] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 04/05/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is increasing concern about the potential effects of traffic-related air pollution (TRAP) on the developing brain. The impact of TRAP exposure on childhood behavior is not fully understood because of limited epidemiologic studies. OBJECTIVE We explored the association between early-life exposure to TRAP using a surrogate, elemental carbon attributed to traffic (ECAT), and attention deficit/hyperactivity disorder (ADHD) symptoms at 7 years of age. METHODS From the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort we collected data on exposure to ECAT during infancy and behavioral scores at 7 years of age. Children enrolled in CCAAPS had at least one atopic parent and a birth residence either < 400 m or > 1,500 m from a major highway. Children were followed from infancy through 7 years of age. ECAT exposure during the first year of life was estimated based on measurements from 27 air sampling sites and land use regression modeling. Parents completed the Behavioral Assessment System for Children, 2nd Edition, when the child was 7 years of age. ADHD-related symptoms were assessed using the Hyperactivity, Attention Problems, Aggression, Conduct Problems, and Atypicality subscales. RESULTS Exposure to the highest tertile of ECAT during the child's first year of life was significantly associated with Hyperactivity T-scores in the "at risk" range at 7 years of age, after adjustment [adjusted odds ratio (aOR) = 1.7; 95% CI: 1.0, 2.7]. Stratification by maternal education revealed a stronger association in children whose mothers had higher education (aOR = 2.3; 95% CI: 1.3, 4.1). CONCLUSIONS ECAT exposure during infancy was associated with higher Hyperactivity scores in children; this association was limited to children whose mothers had more than a high school education.
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Affiliation(s)
- Nicholas C Newman
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Genter MB, Newman NC, Shertzer HG, Ali SF, Bolon B. Distribution and systemic effects of intranasally administered 25 nm silver nanoparticles in adult mice. Toxicol Pathol 2012; 40:1004-13. [PMID: 22549977 DOI: 10.1177/0192623312444470] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous work indicates that silver nanoparticles (AgNPs) given IP to mice alter the regulation of inflammation- and oxidative stress-related genes in brain. Here we assessed the distribution and toxic potential of AgNP following intranasal (IN) exposure. Adult male C57BL/6J mice received 25-nm AgNP (100 or 500 mg/kg) once IN. After 1 or 7 days, histopathology of selected organs was performed, and tissue reduced glutathione (GSH) levels were measured as an indicator of oxidative stress. Aggregated AgNP were found in spleen, lung, kidney, and nasal airway by routine light microscopy. Splenic AgNP accumulation was greatest in red pulp and occurred with modestly reduced cellularity and elevated hemosiderin deposition. Aggregated AgNP were not associated with microscopic changes in other tissues except for nasal mucosal erosions. Autometallography revealed AgNP in olfactory bulb and the lateral brain ventricles. Neither inflammatory cell infiltrates nor activated microglia were detected in brains of AgNP-treated mice. Elevated tissue GSH levels was observed in nasal epithelia (both doses at 1 day, 500 mg/kg at 7 days) and blood (500 mg/kg at 7 days). Therefore, IN administration of AgNP permits systemic distribution, produces reversible oxidative stress in the nose and in blood, and mildly enhances macrophage-mediated erythrocyte destruction in the spleen.
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Affiliation(s)
- Mary Beth Genter
- Department of Environmental Health and Center for Environmental Genetics, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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