Lights, Facts, and Goals: A Novel Framework to Enhance Community Health Messaging Campaign Design, Implementation, and Assessment

The spread of health misinformation has made the task of health communicators more difficult. However, the success of health messaging hinges not only on meaningful message content but also on the credibility of who is delivering the message. "Trusted messengers," like local leaders and community-based organizations, have a greater ability to influence improvements in community health, due to their shared cultural experience with their communities. Health communication agencies should empower trusted messengers with the tools they need to succeed in health communication. One tool critical for their success is a succinct health messaging framework to plan and implement health messaging. Marketing has "See, Think, Do"-a simple, practical framework used to influence consumer purchases. As a more trustworthy corollary, we propose the "Lights, Facts, and Goals" framework, a concise, authentic, and transparent method for planning, implementing, and assessing health messaging campaigns that influence health improvements. "Lights" refers to different methods of reaching communities like trusted messengers, advertisements, and text messages. "Facts" refers to key sourced scientific information relevant to a specific aspect of community health. "Goals" refers to actions community members can take to improve their health in connection with the communicated health facts. This article describes how the "Lights, Facts, and Goals" framework both simplifies the creation and communication of scientifically sound health messaging and strengthens the partnership between health agencies and trusted messengers in the community. Through "Lights, Facts, and Goals," community-based organizations, community leaders, and their partners will be more effective at improving community health through messaging.

Sociodemographic and health risk factors associated with health-related quality of life among adults living in Puerto Rico in 2019: a cross-sectional study

BACKGROUND

Puerto Rico, a US territory, faces numerous challenges adversely affecting public health, including poverty, a fragile healthcare system, inadequate infrastructure, a debt crisis, and vulnerability to climate change-related natural disasters. The impact of these factors on the Health-Related Quality of Life (HRQoL) measure has not been comprehensively evaluated. Only two studies have assessed HRQoL, with the latest conducted in 2011, prior to recent events that could affect public health. This study aimed to assess the HRQoL and associated sociodemographic and health risk factors among adults living in Puerto Rico in 2019.

METHODS

Prevalence and 95% confidence intervals were used to describe HRQoL and its associations with sociodemographic and health-related variables among adults living in Puerto Rico who answered the Behavioral Risk Factor Surveillance System (BRFSS) survey (n = 4,944) in 2019. Multivariable logistic regression models were developed to identify which of these variables were more likely to be associated with each of the four core HRQoL questions (HRQoL-4), expressed as prevalence odds ratios with 95% confidence intervals adjusted for potential confounders.

RESULTS

Through a comprehensive multivariable analysis, we uncovered significant risk factors - increasing number of chronic conditions, advanced age, and low income - associated with poor HRQoL among adults living in Puerto Rico. Specifically, our findings suggest that individuals with an increasing number of chronic conditions were more likely to report poor HRQoL across all 4 domains. As the number of reported chronic conditions increases by one, the odds of reporting having: fair/poor general health increased by a factor of 2.24 (POR: 2.24, 95% CI: 2.08-2.41), physical health impairment increased by a factor of 1.93 (POR: 1.93, 95% CI: 1.78-2.08), mental health impairment increased by a factor of 1.90 (POR: 1.90, 95% CI: 1.78-2.02) and activity limitation increased by a factor of 1.27 ( POR: 1.27, 95% CI: 1.13-1.42). Advancing age was associated with all domains of poor HRQoL, except for the mental health domain for which we observed higher rates of poor HRQoL among the younger population (POR: 4.76, 95% CI: 2.4-9.1).

CONCLUSION

This paper shows that the prevalence of poor HRQoL has not improved compared to the only previous study of HRQoL of Puerto Rico in the last decade. We also found that poor HRQoL is associated with having multiple chronic conditions in adults living in Puerto Rico. This may be a consequence of a decline in health services after natural disasters and socioeconomic downturns on the island. The study emphasizes the need for targeted interventions and ongoing monitoring of the population's HRQoL over time to reach vulnerable subgroups, especially those with chronic conditions, advanced age, and low income, in order to reduce health disparities in Puerto Rico.

Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents

Today more than half of the world's population lives in urban areas. Children spend about 40 h a week in the school environment. Knowing the influence of school exposure to green/blue spaces could improve the children's health, creating healthier environments and preventing exposure to legal/illegal drugs. This systematic review summarized the main results of published studies on active or passive exposure to green or blue spaces in different domains of child neurodevelopment. In August 2022, five databases were searched and twenty-eight eligible studies were included in the analysis. Cognitive and/or academic performance was the most frequently studied (15/28). Most studies evaluate passive exposure to green/blue spaces (19/28) versus active exposure (9/28). Only three studies addressed the relationship between blue space and neurodevelopment. The main results point toward mixed evidence of a protective relationship between green/blue space exposure and neurodevelopment, especially in improving cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting "greener" capacities for school environmental health could improve children's neurodevelopment. There was great heterogeneity in methodologies and adjustment for confounding factors across studies. Future research should seek a standardized approach to delivering school environmental health interventions beneficial to children's development.

Including the Public in Public eHealth: The Need for Community Participation in the Development of State-Sponsored COVID-19-Related Mobile Apps

The COVID-19 pandemic has overwhelmed health care systems worldwide, particularly in underresourced communities of color with a high prevalence of pre-existing health conditions. Many state governments and health care entities responded by increasing their capacity for telemedicine and disease tracking and creating mobile apps for dissemination of medical information. Our experiences with state-sponsored apps suggest that because many of these eHealth tools did not include community participation, they inadvertently contributed to widening digital health disparities. We propose that, as eHealth tools continue to expand as a form of health care, more attention needs to be given to their equitable distribution, accessibility, and usage. In this viewpoint collaboratively written by a minority-serving community-based organization and an eHealth academic research team, we present our experience participating in a community advisory board working on the dissemination of the COVID Alert NY mobile app to illustrate the importance of public participation in app development. We also provide practical recommendations on how to involve community representatives in the app development process. We propose that transparency and community involvement in the process of app development ultimately increases buy-in, trust, and usage of digital technology in communities where they are needed most.

Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes

Air pollution is a well-known contributor to asthma. Air toxics are hazardous air pollutants that cause or may cause serious health effects. Although individual air toxics have been associated with asthma, only a limited number of studies have specifically examined combinations of air toxics associated with the disease. We geocoded air toxic levels from the US National Air Toxics Assessment (NATA) to residential locations for participants of our AiRway in Asthma (ARIA) study. We then applied Data-driven ExposurE Profile extraction (DEEP), a machine learning-based method, to discover combinations of early-life air toxics associated with current use of daily asthma controller medication, lifetime emergency department visit for asthma, and lifetime overnight hospitalization for asthma. We discovered 20 multi-air toxic combinations and 18 single air toxics associated with at least 1 outcome. The multi-air toxic combinations included those containing acrylic acid, ethylidene dichloride, and hydroquinone, and they were significantly associated with asthma outcomes. Several air toxic members of the combinations would not have been identified by single air toxic analyses, supporting the use of machine learning-based methods designed to detect combinatorial effects. Our findings provide knowledge about air toxic combinations associated with childhood asthma.

Hydrogeogenic fluoride in groundwater and dental fluorosis in Thai agrarian communities: a prevalence survey and case-control study

Background

Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand.

Methods

A cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as ‘cases’ while their counterparts were ‘controls’ for a subsequent case–control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008–2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error.

Result

There were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7–1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PR_crude–PR_adjusted)/PR_adjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates.

Conclusions

In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01902-8.

Inequalities in Exposure to Ambient Air Neurotoxicants and Disparities in Markers of Neurodevelopment in Children by Maternal Nativity Status

Exposure levels to environmental pollutants vary significantly among different populations. These inequities in exposure to hazardous air pollutants (HAP) among different populations can contribute to disparities in neurodevelopmental outcomes. The aim of this study was to determine if exposure to HAP varies by maternal nativity status, a demographic marker often overlooked in the study of health disparities. We also assessed if those inequalities in exposure levels are associated with neurodevelopmental measures in young children. To do this, we obtained data from the Early Childhood Longitudinal Study-Birth cohort (ECLS-B), a nationally representative sample of children born in the U.S. in the year 2001 (n = 4750). Bayley’s Short Form-Research Edition (BSF-R) was used to measure cognitive development at 2 years of age. Using residential location at nine months of age, participants were assigned exposures to ten HAPs identified as potentially neurotoxic. Linear regression models were used to assess the joint effect of maternal nativity status and HAP exposure on neurodevelopment. Results showed inequities in exposure levels to ten different HAPs among the populations, as approximately 32% of children of foreign-born mothers were exposed to high levels of HAPs, compared to 21% of children born to U.S.-born mothers. Adjusting for socioeconomic factors, both isophorone exposure (a marker of industrial pollution) (−0.04, 95% CI, −0.12, 0.04) and maternal nativity status (−0.17, 95% CI, −0.27, −0.06) were independently associated with lower standardized BSF-R mental scores in children. Interaction between nativity status and isophorone was not statistically significant, but the change in mental scores associated with isophorone exposure was greater in children of foreign-born mothers compared to children of U.S.-born mothers (−0.12, vs. −0.03, p = 0.2). In conclusion, exposure to HAPs within the highest quartile was more commonly found among children of foreign-born mothers as compared to children of US-born mothers, indicating inequities in pollutant exposure by nativity status within urban populations. Exposures associated with nativity status may negatively contribute to children’s neurodevelopment.

Environment, lifestyle behavior and health-related quality of life in childhood and adolescent cancer survivors of extracranial malignancies

BACKGROUND

Childhood cancer is a chronic disease with high survival rates. Childhood cancer survivors (CCS) can still face health effects later in their lives. Health-related quality of life (HRQoL) and the factors that modify it allow CCS and their families to improve care in the long-term follow-up. This study aims to: (1) examine the differences in HRQoL between CCS of extracranial malignancies and a comparison group, and (2) explore the clinical, environmental and lifestyles factors implicated in the HRQoL of CCS.

METHODS

In this cross-sectional study with a case vs. non-case comparison, the HRQoL of 117 CCS between 8 and 18 years old was compared with healthy non-cases paired by sex and age. The Pediatric Environmental History (PEHis) was applied to obtain information on sociodemographic, clinical, environmental and lifestyle factors. The PedsQL™ Generic Core Scales questionnaire was used to evaluate HRQoL.

RESULTS

In the multivariate analysis among the CCS, the following variables were significantly associated with HRQoL: Poor outdoor air quality (Total, Psychosocial, Emotional, Social and School domains); household income (Total, Psychosocial and School domains); and the presence of late effects (Total, Physical, Psychosocial, and Social domains); regular contact with nature (Physical domain); and the daily hours of screen-time (Emotional domain). CCS present HRQoL results superior to the non-cases group in the physical domain (86.10 vs. 80.34; p=0.001), finding no differences in the other domains evaluated.

CONCLUSIONS

An environmental and community health approach, such as PEHis, in CCS long-term programs promoting the creation of healthier environments and lifestyles contributes to improving their HRQoL and secondarily other chronic diseases.

Social distancing at health care centers early in the pandemic helps to protect population from COVID-19

The impact of COVID-19 outbreak has been unequal across Spanish regions. The epidemic wave has been smoother in the Region of Murcia (RM) (6 deaths/100,000 residents). Physical distance from health centers from day 0 is an additional social distancing measure that confers an advantageous starting position in the fight against COVID-19. Late healthcare distancing measures are not as powerful as the early ones.

Family life stress, maternal depression and child behavioral health in industrialized Italian cities

Although family life stress adversely impacts child health, few tools measure its relationship to child outcomes in the setting of maternal variables. This study validates the Italian version of Crisis in Family Systems-Revised (CRISYS-R) and characterizes relationships between family life stress, maternal depression and child behavior in two Italian cities.

This cross-sectional study was nested in current research on health impacts of neurotoxic environmental exposures in children. 101 mother-child pairs (child age=9.91±2.17yrs; 53% female) and children's teachers were enrolled in Taranto (south Italy) and Brescia (north Italy). Mothers performed the Italian CRISYS-R and PHQ9; teachers completed Child Behavior Checklist (CBCL/6-18). Spearman's rank correlation coefficients showed associations of family CRISYS-R, maternal PHQ9 and child CBCL/6-18. Wilcoxon Rank-Sum test compared groups of continuous variables.

Mothers with depressive symptoms (PHQ9≥5) reported higher ongoing stress and proportion of negative stressors on CRISYS-R than non-depressed mothers (p &lt; 0.05). Children of depressed mothers performed worse in all CBCL/6-18 domains: Internalizing Problems, Externalizing Problems and Total Problems (p &lt; 0.01). Specifically, children of depressed mothers scored higher on subscales of Anxious-Depressed (p &lt; 0.05), Withdrawn-Depressed (p &lt; 0.01), Rule-Breaking (p &lt; 0.01) and Aggressive Behavior (p &lt; 0.05). Maternal depressive symptoms correlated with ongoing stress (rs = 0.27; p &lt; 0.01), child Internalizing Problems (rs = 0.34; p &lt; 0.001), Externalizing Problems (rs = 0.28; p &lt; 0.01) and Total Problems (rs = 0.35; p &lt; 0.001).

This study describes links among maternal depression, family life stress, and child behavioral health. It is first to validate Italian CRISYS-R and to explore these factors conjointly in Italian contexts with known neurotoxic exposures. Findings support considering maternal depression and family life stress in child behavioral and environmental health research and policy.

Key messages

Family life stress, maternal depressive symptoms, and preadolescent behavioral health were highly interrelated in two industrialized Italian cities. The Italian version of CRISYS-R is a useful instrument for assessing and understanding family life stress, a crucial yet under-explored contributor to child behavioral health outcomes.

An Integrative Screening Tool of Alcohol Exposure During Early Pregnancy: Combining of the CDT Biomarker with Green Page Questionnaire

AIMS

In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman by applying questionnaires. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy.

METHODS

A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data.

RESULTS

About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women's body mass index and European white race.

CONCLUSION

Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Combined association of BTEX and material hardship on ADHD-suggestive behaviours among a nationally representative sample of US children

BACKGROUND

Previous research shows that environmental and social factors contribute to the development of attention-deficit/hyperactivity disorder (ADHD).

OBJECTIVE

To determine the relationship between early-life exposure to common ambient air pollutants (benzene, toluene, ethylbenzene, and xylene, also known as BTEX), household material hardship (a measure of socio-economic status), and ADHD-suggestive behaviours in kindergarten-age children.

METHODS

Pollutant exposure estimated from the 2002 National Air Toxics Assessment at each child's residential ZIP code at enrolment was linked to the Early Childhood Longitudinal Study Birth Cohort (n = 4650). Material hardship was assigned as a composite score of access to food, health care, and housing. Kindergarten teachers rated children's behaviours and activity in the classroom using a five-point Likert scale. Children with summary scores in the bottom decile were classified as displaying ADHD-suggestive behaviours. Logistic regression models were constructed to estimate the association between both BTEX exposure and material hardship on ADHD-suggestive behaviours.

RESULTS

The odds of displaying ADHD-suggestive behaviours were greater in children with combined high-level exposure to BTEX and in those experiencing material hardship (odds ratio 1.54, 95% confidence interval [CI] 1.12, 2.11, and OR 2.12, 95% CI 1.25, 3.59, respectively), adjusting for covariates. These associations were stronger when restricting the study population to urban areas. There was no evidence of interaction between early life BTEX exposure and material hardship, although the effects of BTEX exposure were slightly greater in magnitude among those with higher material hardship scores.

CONCLUSIONS

Children exposed to air toxics, material hardship, or both early in life are more likely to display signs of ADHD-suggestive behaviours as assessed by their kindergarten teachers. The associations between exposures to air pollution and to socio-economic hardship were observed in all children but were particularly strong in those living in urban areas.

Secondhand smoke: A new and modifiable prognostic factor in childhood acute lymphoblastic leukemias

BACKGROUND

The 5-year overall survival (OS) in childhood acute lymphoblastic leukemia (ALL) has reached 90% in high-income countries, levels that can no be longer overcome with strategies based on intensification of treatment. Other approaches in the search for new and modifiable prognostic factors are necessary to continue to improve these rates. The importance of environmental factors in the etiopathogenesis of childhood ALL has been regaining interest but its role in the prognosis and survival of this disease is not well explored. We aim to investigate the association between secondhand smoke (SHS) and survival in children diagnosed with ALL.

METHODS

We analyzed survival rates in 146 patients under the age of 15 years diagnosed with ALL between January 1998 and May 2016 in the Region of Murcia, Spain. Evaluation of parental SHS and other known prognostic factors (sex, age, white blood cell count at diagnosis, cytogenetics, NCI/Rome Criteria, early response to therapy, and relapse) were assessed for impact on OS, event-free survival (EFS), cumulative incidence of relapse (CIR), and treatment-related mortality (CITRM) using Kaplan-Meier analysis, Cox regression, and Fine-Gray model.

RESULTS

The mean follow-up time was 105.3 months (±66.5). Prenatal exposure to SHS due to parental smoking was highly prevalent. Of the mothers, 44.4% and 55.5% of the fathers smoked at some point during pregnancy. After the child's diagnosis of ALL 39.7% of mothers and 45.9% of fathers reported smoking. The Cox proportional hazards model showed that maternal smoking during pregnancy and after diagnosis (HR = 4.396, 95% CI: 1.173-16.474, p = 0.028); and relapse (HR = 7.919; 95% CI: 2.683-21.868; p < 0.001) are independent prognostic factors in determining survival. The Fine-Gray model showed that maternal smoking during pregnancy and after diagnosis (HR = 14.525, 95% CI: 4.228-49.90, p < 0.001) is an independent prognostic factor in CITRM.

CONCLUSIONS

Persistent SHS worsens OS and TRM in children with ALL. This negative impact contributes to a different prognosis and may possibly provide an exceptional insight into new therapeutic approaches, including environmental aspects such as prevention and smoking cessation to improve survival outcomes.

Metabolic Outcomes in Southern Italian Preadolescents Residing Near an Industrial Complex: The Role of Residential Location and Socioeconomic Status

Evidence suggests that environmental exposures and socioeconomic factors may interact to produce metabolic changes in children. We assessed the influence of residential location and socioeconomic status (SES) on pediatric body mass index (BMI) Z-score and fasting blood glucose (FBG) concentration. Participants included 214 children aged 6-11 years who live near a large industrial complex in Taranto, Italy. Participants were grouped into residential zones based on the distance between their home address and the complex periphery (Zone 1: 0.000-4.999 km, Zone 2: 5.000-9.999 km, Zone 3: 10.000-15.000 km). BMI Z-scores were calculated via World Health Organization (WHO) pediatric reference curves. FBG was obtained via venous blood sampling. Closer residential location to the industrial complex on the order of 5.000 km was significantly associated with worsened metabolic outcomes, particularly in female children. Zone 1 participants had higher BMI-adjusted FBG than Zone 2 and 3 participants (p < 0.05 versus Zone 2; p < 0.01 versus Zone 3). SES did not significantly influence BMI-adjusted FBG. Moreover, BMI Z-scores indicated high rates of overweight (22.0%) and obesity (22.9%) in the cohort. BMI Z-score was not significantly associated with SES or residential zone but was negatively associated with maternal education level (p < 0.05). These results offer new evidence that residing near industrial activity may predict adverse effects on child metabolic health.

Full Breastfeeding and Obesity in Children: A Prospective Study from Birth to 6 Years

BACKGROUND

Obesity is a major public health crisis among both children and adults and contributes to significant physical, psychological, and economic burden. We aim to investigate the effect of duration of breastfeeding on excessive weight and obesity at 6 years of age.

SUBJECTS/METHODS

Data on breastfeeding and child anthropometric measurements were collected in a birth-cohort study in Murcia, Spain (n = 350). Breastfeeding status and body mass index (BMI) were established according to WHO definitions. Other factors potentially related to children's weight were considered. Multiple log-linear and ordinal regressions were used to analyze the effects of breastfeeding on overweight and obesity when considering potential confounders.

RESULTS

33% and 17.3% of children in the study were of excess weight and obesity, respectively. Univariate predictors of BMI in children aged 6 were as follows: pregestational maternal BMI (kg/m2) (R2 = 0.127, p < 0.01); full breastfeeding (weeks) R2 = -0.035, p < 0.01); infant weight gain (kg) (R2 = 0.348, p < 0.01); and maternal alcohol consumption during pregnancy (g/day) (R2 = 0.266, p < 0.01) at age 6. In the ordinal logistic regression, full breastfeeding was associated with a significant decrease in obesity -0.052 (95% CI, -0.10 to -0.003).

CONCLUSIONS

The delay of bottle feeding introduction may have a protective effect against obesity at 6 years of age. Our findings reinforce the need for greater support of breastfeeding and to promote a healthy environment and antipoverty interventions during pregnancy and infancy, alongside other strategies for obesity prevention.

Communicating environmental exposure results and health information in a community-based participatory research study

Background

Communicating results to participants is a fundamental component of community-based participatory research (CBPR). However, in environmental exposure studies this is not always practiced, partly due to ethical concerns of communicating results that have unknown clinical significance.

Methods

Growing Up Healthy was a community-based participatory research study that sought to understand the relationship between environmental exposures to phthalates and early puberty in young girls. After in-depth consultation with a Community Advisory Board, study investigators provided group summary results of phthalate exposures and related health information to the parents of study participants. Parents’ comprehension and knowledge of the health information provided was then assessed through questionnaires.

Results

After receiving the information from the research team, responders were able to correctly answer comprehension questions about phthalate exposures in their community, were able to identify ways to reduce exposure to phthalates, and indicated plans to do so. Questionnaires revealed that parents wanted more information on phthalates, and that children’s environmental health was an important concern.

Conclusions

We conclude that effective communication of exposure results of unknown clinical significance to participants in environmental health studies can be achieved by providing group summary results and actionable health information. Results suggest that there was an improvement in knowledge of environmental health and in risk reduction behaviors in our study population.

Nativity as a Determinant of Health Disparities Among Children

Nativity is not often considered in the study of health disparities. We conducted a cross-sectional, parent-reported survey of demographics, socioeconomic characteristics, healthcare access, and health conditions in New York City schoolchildren (n = 9029). US-born children with US-born parents (US/US) had higher socioeconomic status, better access to healthcare, and reported higher rates of disease diagnoses compared to US-born children with immigrant parents and to immigrant children. Dental cavities were the only condition in which US/US children reported lower prevalence. US/US children had the best healthcare access, most favorable parent-reported health status and highest rate of satisfaction with healthcare. The magnitude of racial/ethnic disparities varied based on nativity of the children being compared. Factors such as the healthy immigrant effect and differential diagnosis rates may explain the results. In conclusion, nativity influences disease burdens and should be considered in health disparities studies.

A Systematic Review of Children's Environmental Health in Brazil

In the region of the Americas, approximately 100,000 children under the age of 5 years die each year due to environmental hazards. Brazil, due to its large size and wide range of environmental challenges, presents numerous hazards to children's health. The aim of this study was to systematically review the scientific literature that describes children's exposures to environmental pollutants in Brazil and their effects on Brazilian children's health. A systematic review of the scientific literature was performed without language restrictions and time of publication (years). The literature search was conducted in the following key resources: PubMed (MEDLINE), Scopus and Web of Science with the MeSH Terms: Environmental exposure AND Brazil (filters: Human, Child [birth to 18 years] and Affiliation Author). The Virtual Health Library was also employed to access the databases Scielo and Lilacs. The search strategy was [DeCS Terms]: Child OR adolescent AND Environmental exposure AND Brazil. Health effects in children associated with exposure to environmental pollutants in Brazil were reported in 74 studies, during the period between 1995 and 2015. The most frequently cited effect was hospital admission for respiratory causes including wheezing, asthma, and pneumonia among children living in areas with high concentrations of air pollutants. A broad spectrum of other health effects possibly linked to pollutants also was found such as prematurity, low birth weight, congenital abnormality (cryptorchidism, hypospadia, micropenis), poor performance in tests of psychomotor and mental development, and behavioral problems. Exposure to pesticides in utero and postnatally was associated with a high risk for leukemia in children <2 years old. These results show that there is a need in Brazil for stricter monitoring of pollutant emissions and for health surveillance programs especially among vulnerable populations such as pregnant women and young children.

Outcomes of Global Public Health Training Program for US Minority Students: A Case Report

The numbers and success of minority students in science and the health fields remain relatively low. This study presents the outcomes of a research training program as an illustrative case study. The Short-Term Training Program for Minority Students (STPMS) recruits underrepresented minority undergraduate and graduate students for immersion in research training. A total of 69 students participated in the STPMS between 1995 and 2012, and 59 of these completed our survey to determine the perceived impact of the program on the students' motivations and professional development. Results indicated that motivations to participate in the STPMS were commonly related to long-term professional development, such as obtaining mentoring and guidance in career decision making, rather than gaining specific research skills or for economic reasons. Students reported that participation in short-term research training had the most significant effect on improving their attitudes toward biomedical research and promoted positive attitudes toward future careers in health research. A total of 85% of the program's alumni have since completed or are currently working toward a degree in higher education, and 79% are currently working in science research and health care fields. Overall, the short-term training program improved students' attitudes toward research and health science careers. Mentoring and career guidance were important in promoting academic development in students.

Using machine learning to identify air pollution exposure profiles associated with early cognitive skills among U.S. children

Data-driven machine learning methods present an opportunity to simultaneously assess the impact of multiple air pollutants on health outcomes. The goal of this study was to apply a two-stage, data-driven approach to identify associations between air pollutant exposure profiles and children's cognitive skills. Data from 6900 children enrolled in the Early Childhood Longitudinal Study, Birth Cohort, a national study of children born in 2001 and followed through kindergarten, were linked to estimated concentrations of 104 ambient air toxics in the 2002 National Air Toxics Assessment using ZIP code of residence at age 9 months. In the first-stage, 100 regression trees were learned to identify ambient air pollutant exposure profiles most closely associated with scores on a standardized mathematics test administered to children in kindergarten. In the second-stage, the exposure profiles frequently predicting lower math scores were included within linear regression models and adjusted for confounders in order to estimate the magnitude of their effect on math scores. This approach was applied to the full population, and then to the populations living in urban and highly-populated urban areas. Our first-stage results in the full population suggested children with low trichloroethylene exposure had significantly lower math scores. This association was not observed for children living in urban communities, suggesting that confounding related to urbanicity needs to be considered within the first-stage. When restricting our analysis to populations living in urban and highly-populated urban areas, high isophorone levels were found to predict lower math scores. Within adjusted regression models of children in highly-populated urban areas, the estimated effect of higher isophorone exposure on math scores was -1.19 points (95% CI -1.94, -0.44). Similar results were observed for the overall population of urban children. This data-driven, two-stage approach can be applied to other populations, exposures and outcomes to generate hypotheses within high-dimensional exposure data.

The Combined Influence of Air Pollution and Home Learning Environment on Early Cognitive Skills in Children

Cognitive skills are one component of school readiness that reflect a child’s neurodevelopment and are influenced by environmental and social factors. Most studies assess the impact of these factors individually, without taking into consideration the complex interactions of multiple factors. The objective of this study was to examine the joint association of markers of environmental pollution and of social factors on early cognitive skills in an urban cohort of children. For this, we chose isophorone in ambient air as a marker of industrial air pollution. Low quality home learning environments was chosen as a marker of the social factors contributing to cognitive development. Using a subpopulation from the Early Childhood Longitudinal Study, Birth Cohort (N = 4050), isophorone exposure was assigned using the 2002 National Air Toxics Assessment. Home learning environment was assessed with a modified version of the Home Observation for Measurement of the Environment (HOME) Inventory, and standardized math assessment scores were used as a measure of early cognitive skills. Multiple linear regression was used to estimate the effect of both exposures on math scores. After adjustment for confounders, children living in areas with ambient isophorone in the upper quintile of exposure (>0.49 ng/m³) had math scores that were 1.63 points lower than their less exposed peers [95% CI: −2.91, −0.34], and children with lower HOME scores (at or below 9 out of 12) had math scores that were 1.20 points lower than children with better HOME scores [95% CI: −2.30, −0.10]. In adjusted models accounting for identified confounders and both exposures of interest, both high isophorone exposure and low HOME score remained independently associated with math scores [−1.48, 95% CI: −2.79, −0.18; −1.05, 95% CI: −2.15, 0.05, respectively]. There was no statistical evidence of interaction between the two exposures, although children with both higher isophorone exposure and a low HOME score had a decrement in math scale score beyond the additive effect of each exposure. This was primarily observed among male children. These findings suggest that aspects of both the physical and social environments are independently associated with children’s early cognitive skills. Future research aiming to improve children’s early cognitive skills and subsequent school readiness should address both domains.

Positive correlation between pesticide sales and central nervous system and cardiovascular congenital abnormalities in Brazil

BACKGROUND

This study investigated the association between pesticide exposure in Brazil (2005-2013) with rates of central nervous system (CNS) and cardiovascular system (CVS) congenital abnormalities in 2014.

METHOD

An exposure variable was established from data on production and sales of pesticides (kg) per crop area (ha) for 2012 and 2013 years. The Brazilian states were divided into three categories: high, medium, and low pesticide use and rate ratios were estimated for each group of states (CI: 95 %).

RESULTS

In 2013 and 2014, the high use group presented a 100 and a 75 % increase, and the medium group a 65 and 23 % increase, respectively, in the risk of CNS and CVS congenital abnormalities at birth, compared to the low use group.

CONCLUSION

These findings suggest that pesticide exposure could be associated with increased risk of congenital malformations at birth in Brazil.

Cognitive performance among cohorts of children exposed to a waste disposal site containing heavy metals in Chile

Between 1984 and 1998, people living in Arica were involuntarily exposed to metal-containing waste stored in the urban area. The study aims to determine whether children who lived near the waste disposal site during early childhood experienced negative effects on their cognitive development. The cognitive performance was assessed using the Wechsler Intelligence Scale for Children. The exposure variable was defined by the year of birth in three categories: (1) Pre-remediation (born before 1999); (2) During-remediation (born between 1999 and 2003); and (3) Post-remediation (born after 2003). In the crude analysis, a difference of 10 points in the IQ average was observed between the group born in the pre- (81.9 points) and post-remediation period (91.1 points). The difference between both groups was five times higher as compared to children of similar age and socioeconomic status in other cities of Chile. This result could be related with a period of high potential for exposure to this contaminated site.

Early-life exposure to air pollution and greater use of academic support services in childhood: a population-based cohort study of urban children

BACKGROUND

There is a growing literature showing associations between prenatal and early-life exposure to air pollution and children's neurodevelopment. However, it is unclear if decrements in neurodevelopment observed in epidemiologic research translate into observable functional outcomes in the broader pediatric population. The objective of this study was to examine the association between early-life exposures to common urban air toxics and the use of academic support services, such as early intervention and special education within a population-based cohort of urban children.

METHODS

Data for 201,559 children born between 1994 and 1998 in New York City were obtained through administrative data linkages between birth, early intervention and educational records. Use of academic support services was ascertained from birth through attendance in 3rd grade. Census tract at birth was used to assign estimates of annual average ambient concentrations of benzene, toluene, ethylbenzene and xylenes (BTEX) using the 1996 National Air Toxics Assessment. Discrete-time hazard models were fit to the data and adjusted for confounders including maternal, childhood and neighborhood factors.

RESULTS

Children with higher exposures to BTEX compounds were more likely to receive academic support services later in childhood. For example, the adjusted hazard ratio comparing children exposed to the highest decile of benzene to those with lower exposure was 1.09 (95% confidence interval 1.05, 1.13). Results were consistent across individual BTEX compounds, for exposure metrics which summarized exposure to all four BTEX pollutants and for multiple sensitivity analyses.

CONCLUSIONS

These findings suggest urban air pollution may affect children's neurodevelopment and educational trajectories. They also demonstrate the use of public health data systems to advance children's environmental health research.

Association between prenatal exposure to ambient diesel particulate matter and perchloroethylene with children's 3rd grade standardized test scores

The objective of this research was to determine if prenatal exposure to two common urban air pollutants, diesel and perchloroethylene, affects children's 3rd grade standardized test scores in mathematics and English language arts (ELA). Exposure estimates consisted of annual average ambient concentrations of diesel particulate matter and perchloroethylene obtained from the Environmental Protection Agency's 1996 National Air Toxics Assessment for the residential census tract at birth. Outcome data consisted of linked birth and educational records for 201,559 singleton, non-anomalous children born between 1994 and 1998 who attended New York City public schools. Quantile regression models were used to estimate the effects of these exposures on multiple points within the continuous distribution of standardized test scores. Modified Poisson regression models were used to calculate risk ratios (RR) and 95% confidence intervals (CI) of failing to meet curricula standards, an indicator derived from test scores. Models were adjusted for a number of maternal, neighborhood and childhood factors. Results showed that math scores were approximately 6% of a standard deviation lower for children exposed to the highest levels of both pollutants as compared to children with low levels of both pollutants. Children exposed to high levels of both pollutants also had the largest risk of failing to meet math test standards when compared to children with low levels of exposure to the pollutants (RR 1.10 95%CI 1.07,1.12 RR high perchloroethylene only 1.03 95%CI 1.00,1.06; RR high diesel PM only 1.02 95%CI 0.99,1.06). There was no association observed between exposure to the pollutants and failing to meet ELA standards. This study provides preliminary evidence of associations between prenatal exposure to urban air pollutants and lower academic outcomes. Additionally, these findings suggest that individual pollutants may additively impact health and point to the need to study the collective effects of air pollutant mixtures.

KEY WORDS

air toxics, academic outcomes, urban health, tetrachloroethylene, air pollutant mixtures.

Association Between Markers of Classroom Environmental Conditions and Teachers' Respiratory Health

BACKGROUND

Studies have assessed health in schoolchildren. Less is known about the environmental and occupational health of teachers.

METHODS

A cross-sectional survey of teachers was conducted in 24 randomly selected public elementary schools. Questionnaire included sociodemographic information, healthcare, school conditions, and health outcomes. Chi-square and logistic regression were used to analyze bivariate relationships. Multivariable logistic regression model was created for each health outcome, adjusted for sex and smoking to calculate estimates of association (OR) for variables that were significant in bivariate analysis.

RESULTS

Response rate was 71.2 % (N = 797). Classroom conditions significantly associated with respiratory symptoms included having no windows or windows that do not open were associated with asthma or colds (OR 2.0); carpeting was associated with having asthma, itchy eyes, and eye irritation (OR 1.9); mold or water damage was associated with respiratory infections, eye irritation (OR 2.1), nasal congestion (OR 2.4), and sore throat (OR 2.7); visible dust was associated with frequent colds (OR 2.2), nasal congestion (OR 1.7), and sore throat (1.9).

CONCLUSIONS

Asthma, respiratory infections, colds, eye irritation, nasal congestion, and sore throat were associated with the classroom environment. Results indicate that the school environment could affect teachers' respiratory health. Further assessments are necessary to establish causation.

Comparison of the nutrient content of children's menu items at US restaurant chains, 2010-2014

Objective

To determine changes in the nutritional content of children’s menu items at U.S. restaurant chains between 2010 and 2014.

Methods

The sample consisted of 13 sit down and 16 fast-food restaurant chains ranked within the top 50 US chains in 2009. Nutritional information was accessed in June-July 2010 and 2014. Descriptive statistics were calculated for nutrient content of main dishes and side dishes, as well as for those items that were added, removed, or unchanged during the study period.

Results

Nutrient content of main dishes did not change significantly between 2010 and 2014. Approximately one-third of main dishes at fast-food restaurant chains and half of main dishes at sit down restaurant chains exceeded the 2010 Dietary Guidelines for Americans recommended levels for sodium, fat, and saturated fat in 2014. Improvements in nutrient content were observed for side dishes. At sit down restaurant chains, added side dishes contained over 50 % less calories, fat, saturated fat, and sodium, and were more likely to contain fruits/vegetables compared to removed sides (p < 0.05 for all comparisons). Added side dishes at fast-food restaurant chains contained less saturated fat (p < 0.05).

Conclusions

The majority of menu items, especially main dishes, available to children still contain high amounts of calories, fat, saturated fat, and sodium. Efforts must be made by the restaurant industry and policy makers to improve the nutritional content of children’s menu items at restaurant chains to align with the Dietary Guidelines for Americans. Additional efforts are necessary to help parents and children make informed choices when ordering at restaurant chains.

Intravesical chemo-immunotherapy in non muscle invasive bladder cancer

Non-Muscle-Invasive-Bladder-Cancer represents 75-85% of the new bladder cancer cases per year. Trans-uretral vesical resection is the milestone for diagnosis and therapy. After primary treatment, recurrence is frequent depending on the presence of several established risk factors: multiplicity, T dimension, prior recurrence. In some patients disease progress to an advanced stage. Adjuvant chemo-immunotherapy has been widely used depending on the risk category assigned on the basis of the risk factors for recurrence. In low risk categories a one shot treatment with chemotherapy is considered the standard treatment without any maintenance therapy. In intermediate risk patients, adjuvant induction therapy and maintenance chemotherapy or immunotherapy for at least one year is recommended. In high risk patients adjuvant induction and maintenance immunotherapy until 3 years is considered the best strategy. In this review data on the different drugs used in this setting will be discussed.

Risk Perception and Communication Regarding Pesticide Use in Rural Work: A Case Study in Rio de Janeiro State, Brazil

In an agricultural region of Rio de Janeiro State, Brazil, rapid assessment procedures were used for risk-perception studies based on methodologic triangulation that included semi-structured interviews, participatory observations, and focus groups. Data were qualitatively categorized. Women's risk perception was prioritized, as they did not recognize some risks they were exposed to during work activities. To reach women likely to be exposed to pesticides, a photographic soap opera (fotonovela) was constructed in collaboration with rural workers, using community-based participatory research methods. Contents of the risk-communication strategies included the harmful effects of pesticides. Results showed that the inclusion of risk-perception studies in the development of educative and risk-communication campaigns is very important, bridging research to action.

Fifteen years of occupational and environmental health projects support in Brazil, Chile, and Mexico: a report from Mount Sinai School of Medicine ITREOH program, 1995-2010

BACKGROUND

The Fogarty International Center of the National Institutes of Health created the International Training and Research Program in Occupational and Environmental Health (ITREOH program) in 1995 with the aim to train environmental and occupational health scientists in developing countries. Mount Sinai School of Medicine was a grantee of this program since its inception, partnering with research institutions in Brazil, Chile, and Mexico. This article evaluates Mount Sinai's program in order to determine whether it has contributed to the specific research capacity needs of the international partners.

METHODS

Information was obtained from: (a) international and regional scientific literature databases; (b) databases from the three participating countries; and (c) MSSM ITREOH Program Database.

RESULTS

Most of the research projects supported by the program were consistent with the themes found to be top priorities for the partner countries based on mortality/morbidity and research themes in the literature. Indirect effects of the training and the subsequent research projects completed by the trained fellows in the program included health policy changes and development of collaborative international projects.

CONCLUSION

International research training programs, such as the MSSM ITREOH, that strengthen scientific research capacity in occupational and environmental health in Latin America can make a significant impact on the most pressing health issues in the partner countries.

Design of risk communication strategies based on risk perception among farmers exposed to pesticides in Rio de Janeiro State, Brazil

BACKGROUND

This study aims to assess pesticide exposure risk perception among farmers from three rural areas of Nova Friburgo, Rio de Janeiro State, Brazil.

METHODS

Data were collected through semi-structured interviews with 66 adults and participatory workshops with 27 teenagers and analyzed through content analysis techniques. Systematized results were discussed at local meetings, and two risk communication initiatives were devised.

RESULTS

Study results demonstrated the use of defensive strategies by men and a diminished risk perception among women. Teenagers relied on parents to develop their own work practices. These findings supported the importance of cultural and social determinants of farmers' understandings of risk and of the relevance of different pesticide exposure pathways.

CONCLUSIONS

Risk perceptions and work practices are strongly influenced by local cultural patterns and, therefore, must be taken into account when developing effective intervention strategies, including risk communication initiatives.

Variations in peak expiratory flow measurements associated to air pollution and allergic sensitization in children in Sao Paulo, Brazil

BACKGROUND

In the last 20 years, there has been an increase in the incidence of allergic respiratory diseases worldwide and exposure to air pollution has been discussed as one of the factors associated with this increase. The objective of this study was to investigate the effects of air pollution on peak expiratory flow (PEF) and FEV1 in children with and without allergic sensitization.

METHODS

Ninety-six children were followed from April to July, 2004 with spirometry measurements. They were tested for allergic sensitization (IgE, skin prick test, eosinophilia) and asked about allergic symptoms. Air pollution, temperature, and relative humidity data were available.

RESULTS

Decrements in PEF were observed with previous 24-hr average exposure to air pollution, as well as with 3-10-day average exposure and were associated mainly with PM(10), NO(2), and O(3) in all three categories of allergic sensitization. Even though allergic sensitized children tended to present larger decrements in the PEF measurements they were not statistically different from the non-allergic sensitized. Decrements in FEV1 were observed mainly with previous 24-hr average exposure and 3-day moving average.

CONCLUSIONS

Decrements in PEF associated with air pollution were observed in children independent from their allergic sensitization status. Their daily exposure to air pollution can be responsible for a chronic inflammatory process that might impair their lung growth and later their lung function in adulthood.

Computer-assisted school-based asthma management: a pilot study

Background

The high prevalence of asthma among children continues to be a major public health issue. In particular, low-income African-American and Hispanic children often receive asthma care in the emergency department and lack access to continuity of care.

Objective

The aim of the current study was to test the feasibility of implementing a computerized program for empowering low-income children with asthma to manage their own disease. This pilot program consisted of a guided, personalized, Web-based computer program as the main component of a school-based asthma intervention.

Methods

The Automated Live E-Health Response Tracking System (ALERTS), a computer-assisted, Web-based tracking program, was tested for implementation in a school in East Harlem, New York. The program required children with asthma, assisted by trained researchers, to routinely measure their peak flow meter readings and answer a symptom questionnaire. The program provided individualized feedback on their disease status based on peak flow meter input. The computer program sent reports to the child’s physician and the nurse practitioner at the on-site school health center. The children were also encouraged to bring the reports home to their parents. A pre/post study design was employed such that each participant acted as his/her own control. Comparisons of preintervention and postintervention outcomes were calculated using the paired t-test and the McNemar test for dichotomous data.

Results

Twenty-four children (6 to 12 years) participated in the program over 2 to 15 months. Improvements in health outcomes showed the greatest significance among the group of participants who were enrolled for 8 months or longer. Statistically significant improvements were seen in the average physical health score of the children (from 65.64 preintervention to 76.28 postintervention, P = .045). There was a significant decrease in the number of participants experiencing wheezing episodes (n = 9 to n = 2, P = .03), and in the average number of wheezing episodes per child (1.86 to 0.43, P = .02). Although not statistically significant, decreases were also seen in the number of children experiencing an asthma attack and in the average number of asthma attacks among participants. There was also a significant decrease in the average number of visits to doctors’ offices or clinics (1.23 to 0.38, P = .04). There were no overnight hospitalizations in the two-week period following the end of the pilot program, a nonsignificant reduction from an average of 0.21 per child.

Conclusion

This individualized, computer-assisted intervention resulted in improvements in some health outcomes among low-income children in an urban, public school-based setting. Consistent peak flow meter self-measurements, management of medication usage, and a computerized approach to symptom tracking resulted in fewer asthma exacerbations and improved overall physical health among this pediatric population with asthma.

Head circumference at birth and exposure to tobacco, alcohol and illegal drugs during early pregnancy

AIMS

We aimed to assess the effects of exposure to tobacco smoke, alcohol and illegal drugs during early pregnancy on the head circumference (HC) at birth of otherwise healthy neonates.

METHODS

A follow-up study from the first trimester of pregnancy to birth was carried out in 419 neonates. An environmental reproductive health form was used to record data of substance exposure obtained during the first obstetric visit at the end of the first trimester. A multiple linear regression model was created for this purpose.

RESULTS

Alcohol intake during pregnancy and medical ionizing radiation exposure were the most significant predictors of HC. The mothers' alcohol consumption increased with the mothers' and fathers' education level, net family income and fathers' alcohol consumption. In contrast, maternal smoking decreased with increasing mothers' and fathers' education level and net family income. About 13% of the surveyed embryos were exposed to illegal drugs.

CONCLUSIONS

Mild to moderate alcohol consumption diminishes the at-birth HC of theoretically healthy newborns in a linear form. There was no threshold dose. We perceived a need for increasing the awareness, and for training, of health care professionals and parents, in regard to risks of alcohol consumption and for recommending abstinence of these substances in both parents during pregnancy. It should also be remembered that medical ionizing radiation should be performed only during the first half of the cycle in fertile women. We think that our study has an important social impact as it affords data for implementing policies for promoting "healthy pregnancies".

Prenatal dichlorodiphenyldichloroethylene (DDE) exposure and child growth during the first year of life

BACKGROUND

Due to its long-term persistence in the environment and its ability to cross the placental barrier, prenatal p,p'-dichlorodiphenyldichloroethene (DDE) exposure continues to be a public health concern. This study aimed to evaluate the association between prenatal DDE exposure and child growth, at birth and during the first year of life.

METHODS

253 pregnant women were recruited between January 2001 and June 2005 in a prospective cohort in Morelos, Mexico. Serum levels of DDE were measured during each trimester of pregnancy by gas chromatography with an electron capture detector. Using the generalized mixed-effects models, the association between DDE and child growth parameters (weight-for-age, length-for-age, weight-for-length, BMI-for-age and head circumference-for-age Z-scores) from birth to 1 year of age was assessed. Maternal dietary intake was considered as covariable among others.

RESULTS

DDE levels were 6.3±2.8 ng/mL (first trimester), 6.6±2.9 ng/mL (second trimester), and 7.6±2.9 ng/mL (third trimester). After adjusting for potential confounder variables, no significant associations were observed with prenatal DDE exposure and each of the selected parameters.

CONCLUSIONS

Our results show no evidence of an association between prenatal DDE exposure and child growth during the first year of life.

Prevalence, demographics, and health outcomes of comorbid asthma and overweight in urban children

BACKGROUND

Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity.

OBJECTIVE

To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence.

METHOD

Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes.

RESULTS

Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%).

CONCLUSIONS

The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma-obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.

Phthalate exposure associated with self-reported diabetes among Mexican women

BACKGROUND

Phthalates are ubiquitous industrial chemicals used as plasticizers in plastics made of polyvinyl chloride (PVC) to confer flexibility and durability. They are also present in products used for personal-care, industry and in medical devices. Phthalates have been associated with several adverse health effects, and recently it has been proposed that exposure to phthalates, could have an effect on metabolic homeostasis. This exploratory cross-sectional study evaluated the possible association between phthalate exposure and self-reported diabetes among adult Mexican women.

METHODS

As part of an on-going case-control study for breast cancer, only controls were selected, which constituted 221 healthy women matched by age (±5 years) and place of residence with the cases. Women with diabetes were identified by self-report. Urinary concentrations of nine phthalate metabolites were measured by online solid phase extraction coupled to high performance liquid chromatography-isotope-dilution tandem mass spectrometry.

RESULTS

Participants with diabetes had significantly higher concentrations of di(2-ethylhexyl) pththalate (DEHP) metabolites: mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) but lower levels of monobenzyl phthalate (MBzP) a metabolite of benzylbutyl phthalate, compared to participants without diabetes. A marginally significant positive associations with diabetes status were observed over tertiles with MEHHP (OR(T3 vs. T1)=2.66; 95% CI: 0.97-7.33; p for trend=0.063) and MEOHP (OR(T3 vs. T1)=2.27; 95% CI; 0.90-5.75; P for trend=0.079) even after adjusting for important confounders.

CONCLUSIONS

The results suggest that levels of some phthalates may play a role in the genesis of diabetes.

New academic partnerships in global health: innovations at Mount Sinai School of Medicine

Global health has become an increasingly important focus of education, research, and clinical service in North American universities and academic health centers. Today there are at least 49 academically based global health programs in the United States and Canada, as compared with only one in 1999. A new academic society, the Consortium of Universities for Global Health, was established in 2008 and has grown significantly. This sharp expansion reflects convergence of 3 factors: (1) rapidly growing student and faculty interest in global health; (2) growing realization-powerfully catalyzed by the acquired immune deficiency syndrome epidemic, the emergence of other new infections, climate change, and globalization-that health problems are interconnected, cross national borders, and are global in nature; and (3) rapid expansion in resources for global health. This article examines the evolution of the concept of global health and describes the driving forces that have accelerated interest in the field. It traces the development of global health programs in academic health centers in the United States. It presents a blueprint for a new school-wide global health program at Mount Sinai School of Medicine. The mission of that program, Mount Sinai Global Health, is to enhance global health as an academic field of study within the Mount Sinai community and to improve the health of people around the world. Mount Sinai Global Health is uniting and building synergies among strong, existing global health programs within Mount Sinai; it is training the next generation of physicians and health scientists to be leaders in global health; it is making novel discoveries that translate into blueprints for improving health worldwide; and it builds on Mount Sinai's long and proud tradition of providing medical and surgical care in places where need is great and resources few.

Concomitant CXCR4 and CXCR7 expression predicts poor prognosis in renal cancer

CXCR4 is a chemokine receptor implicated in the metastatic process. The CXCR4 ligand, CXCL12, was shown to bind also the CXCR7 receptor, a recently deorphanized chemokine receptor whose signalling pathway and function are still controversial. This study was conducted to determine patients clinic-pathological factors and outcome according to the expressions of CXCR4 and CXCR7 in renal cell carcinoma (RCC). CXCR4 and CXCR7 expression was evaluated in 223 RCC patients through immunohistochemistry; moreover CXCR4 and CXCR7 was detected in 49 others consecutive RCC patients trough RT- PCR. CXCR4 expression was low in 42/223 RCC (18.8%), intermediate in 71/223 (31.9%) and high in 110/223 (49.3%). CXCR7 expression was low in 44/223 RCC patients (19.8%), intermediate in 65/223 (29.1%) and high in 114/223 (51.1%). High CXCR4 and high CXCR7 expression predicted shorter disease free survival. In multivariate analysis, high CXCR4 expression (p= 0.0061), high CXCR7 (p= 0.0194) expression and the concomitant high expression of CXCR4 and CXCR7 (p= 0.0235) are independent prognosis factors. Through RT-PCR, CXCR4 was overexpressed in 36/49 and CXCR7 in 33/49 samples correlating with symptoms at diagnosis and lymph nodes status. So we can hypothesize that CXCR4 and CXCR7, singularly evaluated and in combination, are valuable prognostic factors in RCC patients.

Prenatal exposure of a girl with autism spectrum disorder to 'horsetail' (Equisetum arvense) herbal remedy and alcohol: a case report

INTRODUCTION

Autism is a complex neurodevelopmental disorder in which the interactions of genetic, epigenetic and environmental influences are thought to play a causal role. In humans, throughout embryonic and fetal life, brain development is exquisitely susceptible to injury caused by exposure to toxic chemicals present in the environment. Although the use of herbal supplements during pregnancy is relatively common, little information is available on their association with fetal neurodevelopment. This is, to the best of our knowledge, the first report in the literature to associate a new plausible mechanism of neurodevelopmental toxicity with a case of autism spectrum disorder through a vitamin deficiency potentiated by concomitant use of herbal supplements and ethanol exposure.

CASE PRESENTATION

We describe the pediatric environmental history of a three-year-old Caucasian girl with an autism spectrum disorder. We utilized her pediatric environmental history to evaluate constitutional, genetic, and environmental factors pertinent to manifestation of neurodevelopment disorders. Both parents reported prenatal exposure to several risk factors of interest. A year prior to conception the mother began a weight loss diet and ingested 1200 mg/day of 'horsetail' (Equisetum arvense) herbal remedies containing thiaminase, an enzyme that with long-term use can lead to vitamin deficiency. The mother reported a significant weight loss during the pregnancy and a deficiency of B-complex vitamins. Thiamine (vitamin B1) deficiency could have been potentiated by the horsetail's thiaminase activity and ethanol exposure during pregnancy. No other risk factors were identified.

CONCLUSIONS

A detailed and careful pediatric environmental history, which includes daily intake, herbal remedies and ethanol exposure, should be obtained from all patients with autism spectrum disorder. Maternal consumption of ethanol and of herbal supplements with suspected or potential toxicity should be avoided during pregnancy. The prospective parents should perform preconception planning before pregnancy.

Asthma mortality in Puerto Rico: 1980-2007

BACKGROUND

Asthma is a highly prevalent chronic disease. Prevalence and mortality are particularly high in Puerto Ricans living in the United States as compared with other populations.

OBJECTIVE

To determine asthma mortality rates in Puerto Rico (1980-2007) and to assess the sociodemographic variables that may be associated with these rates.

METHODS

Data were obtained from the Vital Statistics Office at the Puerto Rico Department of Health. Crude mortality rates (CMRs) and their 95% confidence intervals (95% CIs) were used to evaluate differences between age groups and across years. Mortality risk ratios (RRs) by sociodemographic variables were estimated using generalized lineal models with a Poisson link function to identify at-risk groups.

RESULTS

During the study period, there were 4232 deaths recorded with asthma as the cause of death. From 1980 to 1998, annual asthma mortality rates fluctuated between 3.32 and 6.56 deaths per 100,000 (mean 4.77), followed by a decline after implementation of the ICD-10 for reporting cause of death in 1999. Between 1999 and 2007, the mean asthma death rate declined to 3.01 (4.89 in 1999 to 2.02 in 2007). Overall, asthma mortality rates were between 1.77 and 4.0 times higher in Puerto Rico than in the United States. Throughout the whole study period, mortality rates were higher in older age groups. In addition, the adjusted regression model for asthma deaths showed that persons divorced or widowed, and persons with only elementary education had significantly higher risk of asthma mortality than their counterparts.

CONCLUSION

Asthma death rates were higher in Puerto Rico than in the United States general population. Although asthma mortality in Puerto Rico declined, rates continued to be significantly higher than those recorded in the United States. There was a progressive decline in asthma mortality rates after 1999 that may be explained by changes in reporting classification, increased use of corticosteroids, and improved asthma awareness. After controlling for possible confounding variables, age and elementary education were found to increase the risk of mortality due to asthma among Puerto Ricans.