Mitigating the health impacts of a natural disaster - the June 2007 long-weekend storm in the Hunter region of New South Wales.

Med J Aust. 2007 Dec 3;187(11-12):670-3

Authors: Cretikos MA, Merritt TD, Main K, Eastwood K, Winn L, Moran L, Durrheim DN

A severe storm that began on Thursday, 7 June 2007 brought heavy rains and gale-force winds to Newcastle, Gosford, Wyong, Sydney, and the Hunter Valley region of New South Wales. The storm caused widespread flooding and damage to houses, businesses, schools and health care facilities, and damaged critical infrastructure. Ten people died as a result of the storm, and approximately 6000 residents were evacuated. A natural disaster was declared in 19 local government areas, with damage expected to reach $1.5 billion. Additional demands were made on clinical health services, and interruption of the electricity supply to over 200 000 homes and businesses, interruption of water and gas supplies, and sewerage system pump failures presented substantial public health threats. A public health emergency operations centre was established by the Hunter New England Area Health Service to coordinate surveillance activities, respond to acute public health issues and prevent disease outbreaks. Public health activities focused on providing advice, cooperating with emergency service agencies, monitoring water quality and availability, preventing illness from sewage-contaminated flood water, assessing environmental health risks, coordinating the local government public health response, and surveillance for storm-related illness and disease outbreaks, including gastroenteritis. The local ABC (Australian Broadcasting Corporation) radio station played a key role in disseminating public health advice. A household survey conducted within a fortnight of the storm established that household preparedness and storm warning systems could be improved.

PMID: 18072915 [PubMed - in process]

[Integrated understanding for health surveillance in a forest environment: the case of the Araripe Plateau in Ceará State, Brazil]

Cad Saude Publica. 2007;23 Suppl 4:S549-58

Authors: Augusto LG, Góes L

Partial results from this study are presented with the objective of developing a health surveillance model for communities living on natural resources in the Araripe National Forest in Ceará State, Brazil. The research is justified primarily on the basis of this forest's importance for quality of life in Northeast Brazil and preservation of the country's forests in general. The study drew on a collective construction of integrated understanding on the subjectivity of social relations with the environment. Social and environmental health problems in the forest context have generally been overlooked by health policy.

PMID: 18038036 [PubMed - in process]

Participation in environmental health research by placenta donation - a perception study.

Environ Health. 2007 Nov 22;6(1):36

Authors: Lind U, Knudsen LE, Mose T

ABSTRACT: BACKGROUND: Much environmental health research depends on human volunteers participating with biological samples. The perception study explores why and how people participate in a placenta perfusion study in Copenhagen. The participation implies donation of the placenta after birth and some background information but no follow up. METHODS: Nineteen semi-structured qualitative interviews were conducted with participants in the placenta perfusion study after donation of placenta. Observation studies were made of recruitment sessions. RESULTS: The interviewed participants are generally in favour of medical research. They participated in the placenta perfusion study due to a belief that societal progress follows medical research. They also felt that participating was a way of giving something back to the Danish health care system. The participants have trust in medical science and scientists, but trust is something which needs to be created through "trust-work". Face-to-face interaction, written information material and informed consent forms play important parts in creating trusting relationships in medical research. Table 1 summarises the results of the study organised according to the themes in which they are presented CONCLUSION: Medical research ethics do not only amount to specific types of written information material but should also be seen as a number of trust making performances involving researchers as well as research participants.

PMID: 18034882 [PubMed - as supplied by publisher]

Evaluation and application of the RD50 for determining acceptable exposure levels of airborne sensory irritants for the general public.

Environ Health Perspect. 2007 Nov;115(11):1609-16

Authors: Kuwabara Y, Alexeeff GV, Broadwin R, Salmon AG

BACKGROUND: The RD(50) (exposure concentration producing a 50% respiratory rate decrease) test evaluates airborne chemicals for sensory irritation and has become an American Society for Testing and Materials (ASTM) standard method. Past studies reported good correlations (R(2)) between RD(50)s and the occupational exposure limits, particularly threshold limit values (TLVs). OBJECTIVE: The main purpose of this study was to examine the relationship between RD(50)s and human sensory irritation responses in a quantitative manner, particularly for chemicals that produce burning sensation of the eyes, nose, or throat, based on lowest observed adverse effect levels (LOAELs) reported for human subjects. METHODS: We compared RD(50)s with LOAELs and acute reference exposure levels (RELs). RELs, developed by the California Environmental Protection Agency's Office of Environmental Health Hazard Assessment, represent a level at which no adverse effects are anticipated after exposure. We collected RD(50)s from the published literature and evaluated them for consistency with ASTM procedures. We identified LOAELs for human irritation and found 25 chemicals with a corresponding RD(50) in mice. DISCUSSION: We found the relationship between RD(50)s and LOAELs as log RD(50) = 1.16 (log LOAEL) + 0.77 with an R(2) value of 0.80. This strong correlation supports the use of the RD(50) in establishing exposure limits for the public. We further identified 16 chemical irritants with both RD(50)s and corresponding acute RELs, and calculated the relationship as log RD(50) = 0.71 (log REL) + 2.55 with an R(2) value of 0.71. This relationship could be used to identify health protective values for the public to prevent respiratory or sensory irritation. CONCLUSION: Consequently, we believe that the RD(50) has benefits for use in setting protective levels for the health of both workers and the general population.

PMID: 18007993 [PubMed - in process]

Links between the built environment, climate and population health: interdisciplinary environmental change research in New York City.

Ann Acad Med Singapore. 2007 Oct;36(10):834-46

Authors: Rosenthal JK, Sclar ED, Kinney PL, Knowlton K, Crauderueff R, Brandt-Rauf PW

Global climate change is expected to pose increasing challenges for cities in the following decades, placing greater stress and impacts on multiple social and biophysical systems, including population health, coastal development, urban infrastructure, energy demand, and water supplies. Simultaneously, a strong global trend towards urbanisation of poverty exists, with increased challenges for urban populations and local governance to protect and sustain the wellbeing of growing cities. In the context of these 2 overarching trends, interdisciplinary research at the city scale is prioritised for understanding the social impacts of climate change and variability and for the evaluation of strategies in the built environment that might serve as adaptive responses to climate change. This article discusses 2 recent initiatives of The Earth Institute at Columbia University (EI) as examples of research that integrates the methods and objectives of several disciplines, including environmental health science and urban planning, to understand the potential public health impacts of global climate change and mitigative measures for the more localised effects of the urban heat island in the New York City metropolitan region. These efforts embody 2 distinct research approaches. The New York Climate & Health Project created a new integrated modeling system to assess the public health impacts of climate and land use change in the metropolitan region. The Cool City Project aims for more applied policy-oriented research that incorporates the local knowledge of community residents to understand the costs and benefits of interventions in the built environment that might serve to mitigate the harmful impacts of climate change and variability, and protect urban populations from health stressors associated with summertime heat. Both types of research are potentially useful for understanding the impacts of environmental change at the urban scale, the policies needed to address these challenges, and to train scholars capable of collaborative approaches across the social and biophysical sciences.

PMID: 17987235 [PubMed - in process]

Study of the cytogenetic effects of occupational exposure to pesticides on sanitation workers in Belo Horizonte, Brazil.

Genet Mol Res. 2007;6(3):581-93

Authors: Kehdy FS, Cerqueira EM, Bonjardim MB, Camelo RM, Castro MC

Sanitation workers handling pesticides in the control of disease vectors constitute an occupationally exposed population to genotoxic substances. The aim of the present study was to investigate the relation between the occupational exposure to various pesticides and the presence of cytogenetic damage. Fifty-nine men were selected (29 sanitation workers and 30 control individuals) with ages varying between 18-57 years who lived and worked in the same area in Belo Horizonte (Brazil). The following parameters were determined for all individuals using the cytokinesis-block micronucleus (MN) assay in peripheral blood lymphocytes: MN/1000 binucleated cells (BC), BC with MN (BCMN)/1000 BC, nucleoplasmic bridges (NB)/1000 BC, apoptotic and necrotic cells/500 cells and nuclear division index. The analysis of covariance showed significantly higher (p < 0.05) mean frequencies of MN (15.81 +/- 1.31 vs 4.71 +/- 0.42), BCMN (15.10 +/- 1.22 vs 4.62 +/- 0.44), NB (4.59 +/- 0.76 vs 1.00 +/- 0.34), and necrotic cells (12.07 +/- 1.45 vs 5.17 +/- 0.70) in the exposed group when compared to the control group. There was no significant difference in the apoptotic cell frequency between the two groups, while the nuclear division index was significantly lower (1.49 +/- 0.02 vs 1.61 +/- 0.02) in the control group. Neither the time of exposure nor the smoking or alcohol drinking habit influenced the cytogenetic parameters examined. According to these results, occupational exposure to pesticides induced genotoxic and cytotoxic effects in sanitation workers.

PMID: 17985311 [PubMed - indexed for MEDLINE]

Climate of change.

CMAJ. 2007 Nov 6;177(10):1320

Authors: Ramin B

PMID: 17984479 [PubMed - indexed for MEDLINE]

Estimating the burden of disease attributable to unsafe water and lack of sanitation and hygiene in South Africa in 2000.

S Afr Med J. 2007 Aug;97(8 Pt 2):755-62

Authors: Lewin S, Norman R, Nannan N, Thomas E, Bradshaw D,

OBJECTIVES: to estimate the burden of disease attributable to unsafe water, sanitation and hygiene (wsh) by age group for South Africa in 2000. DESIGN: World Health Organization comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. A scenario-based approach was applied for estimating diarrhoeal disease burden from unsafe WSH. Six exposure scenarios were defined based on the type of water and sanitation infrastructure and environmental faecal-oral pathogen load. For 'intestinal parasites' and schistosomiasis, the burden was assumed to be 100% attributable to exposure to unsafe WSH. SETTING: South Africa. OUTCOME MEASURES: Disease burden from diarrhoeal diseases, intestinal parasites and schistosomiasis, measured by deaths and disability-adjusted life years (DALYs). RESULTS: 13,434 deaths were attributable to unsafe WSH accounting for 2.6% (95% uncertainty interval 2.4 - 2.7%) of all deaths in South Africa in 2000. The burden was especially high in children under 5 years, accounting for 9.3% of total deaths in this age group and 7.4% of burden of disease. Overall, the burden due to unsafe WSH was equivalent to 2.6% (95% uncertainty interval 2.5 - 2.7%) of the total disease burden for South Africa, ranking this risk factor seventh for the country. CONCLUSIONS: Unsafe WSH remains an important risk factor for disease in South Africa, especially in children under 5. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and to promoting safe hygiene behaviours, particularly among children.

PMID: 17952234 [PubMed - indexed for MEDLINE]

The ambulatory pediatric association fellowship in pediatric environmental health: a 5-year assessment.

Environ Health Perspect. 2007 Oct;115(10):1383-7

Authors: Landrigan PJ, Woolf AD, Gitterman B, Lanphear B, Forman J, Karr C, Moshier EL, Godbold J, Crain E

BACKGROUND: Evidence is mounting that environmental exposures contribute to causation of disease in children. Yet few pediatricians are trained to diagnose, treat, or prevent disease of environmental origin. OBJECTIVES: To develop a cadre of future leaders in pediatric environmental health (PEH), the Ambulatory Pediatric Association (APA) launched a new 3-year fellowship in 2001-the world's first formal training program in PEH. Sites were established at Boston Children's Hospital, Mount Sinai School of Medicine, George Washington University, University of Cincinnati, and University of Washington. Fellows are trained in epidemiology, biostatistics, toxicology, risk assessment, and preventive medicine. They gain clinical experience in environmental pediatrics and mentored training in clinical research, policy development, and evidence-based advocacy. Thirteen fellows have graduated. Two sites have secured follow-on federal funding to enable them to continue PEH training. DISCUSSION: To assess objectively the program's success in preparing fellows for leadership careers in PEH, we conducted a mailed survey in 2006 with follow-up in 2007. CONCLUSIONS: Fifteen (88%) of 17 fellows and graduates participated; program directors provided information on the remaining two. Nine graduates are pursuing full-time academic careers, and two have leadership positions in governmental and environmental organizations. Ten have published one or more first-authored papers. Seven graduates are principal investigators on federal or foundation grants. The strongest predictors of academic success are remaining affiliated with the fellowship training site and devoting < 20% of fellowship time to clinical practice. CONCLUSION: The APA fellowship program is proving successful in preparing pediatricians for leadership careers in PEH.

PMID: 17938724 [PubMed - in process]

[Environmental health surveillance of low birth weight in Seoul using air monitoring and birth data]

J Prev Med Pub Health. 2007 Sep;40(5):363-70

Authors: Seo JH, Ha EH, Kim OJ, Kim BM, Park HS, Leem JH, Hong YC, Kim YJ

OBJECTIVES: The principal objective of this study was to determine the relationship between maternal exposure to air pollution and low birth weight and to propose a possible environmental health surveillance system for low birth weight. METHODS: We acquired air monitoring data for Seoul from the Ministry of Environment, the meteorological data from the Korean Meteorological Administration, the exposure assessments from the National Institute of Environmental Research, and the birth data from the Korean National Statistical Office between January 1, 2002 and December 31, 2003. The final birth data were limited to singletons within 37-44 weeks of gestational age. We defined the Low Birth Weight (LBW) group as infants with birth weights of less than 2500g and calculated the annual LBW rate by district. The air monitoring data were measured for CO, SO(2), NO(2), and PM(10) concentrations at 27 monitoring stations in Seoul. We utilized two models to evaluate the effects of air pollution on low birth weight: the first was the relationship between the annual concentration of air pollution and low birth weight (LBW) by individual and district, and the second involved a GIS exposure model constructed by Arc View 3.1. RESULTS: LBW risk (by Gu, or district) was significantly increased to 1.113(95% CI=1.111-1.116) for CO, 1.004 (95% CI=1.003-1.005) for NO(2), 1.202(95% CI=1.199-1.206) for SO(2), and 1.077(95% CI=1.075-1.078) for PM(10) with each interquartile range change. Personal LBW risk was significantly increased to 1.081(95% CI=1.002-1.166) for CO, 1.145(95% CI=1.036-1.267) for SO(2), and 1.053(95% CI=1.002-1.108) for PM(10) with each interquartile range change. Personal LBW risk was increased to 1.003(95% CI=0.954-1.055) for NO(2), but this was not statistically significant. The air pollution concentrations predicted by GIS positively correlated with the numbers of low birth weights, particularly in highly polluted regions. CONCLUSIONS: Environmental health surveillance is a systemic, ongoing collection effort including the analysis of data correlated with environmentally-associated diseases and exposures. In addition, environmental health surveillance allows for a timely dissemination of information to those who require that information in order to take effective action. GIS modeling is crucially important for this purpose, and thus we attempted to develop a GIS-based environmental surveillance system for low birth weight.

PMID: 17917484 [PubMed - indexed for MEDLINE]

Environmental Health: the first five years.

Environ Health. 2007;6:27

Authors: Grandjean P, Ozonoff D

PMID: 17848198 [PubMed - indexed for MEDLINE]

Workgroup report: developing environmental health indicators for European children: World Health Organization Working Group.

Environ Health Perspect. 2007 Sep;115(9):1376-82

Authors: Pond K, Kim R, Carroquino MJ, Pirard P, Gore F, Cucu A, Nemer L, MacKay M, Smedje G, Georgellis A, Dalbokova D, Krzyzanowski M

A working group coordinated by the World Health Organization developed a set of indicators to protect children's health from environmental risks and to support current and future European policy needs. On the basis of identified policy needs, the group developed a core set of 29 indicators for implementation plus an extended set of eight additional indicators for future development, focusing on exposure, health effects, and action. As far as possible, the indicators were designed to use existing information and are flexible enough to be developed further to meet the needs of policy makers and changing health priorities. These indicators cover most of the priority topic areas specified in the Children's Environment and Health Action Plan for Europe (CEHAPE) as adopted in the Fourth Ministerial Conference on Health and Environment in 2004, and will be used to monitor the implementation of CEHAPE. This effort can be viewed as an integral part of the Global Initiative on Children's Environmental Health Indicators, launched at the World Summit on Sustainable Development in 2002.

PMID: 17805431 [PubMed - in process]

Meeting report: the role of environmental lighting and circadian disruption in cancer and other diseases.

Environ Health Perspect. 2007 Sep;115(9):1357-62

Authors: Stevens RG, Blask DE, Brainard GC, Hansen J, Lockley SW, Provencio I, Rea MS, Reinlib L

Light, including artificial light, has a range of effects on human physiology and behavior and can therefore alter human physiology when inappropriately timed. One example of potential light-induced disruption is the effect of light on circadian organization, including the production of several hormone rhythms. Changes in light-dark exposure (e.g., by nonday occupation or transmeridian travel) shift the timing of the circadian system such that internal rhythms can become desynchronized from both the external environment and internally with each other, impairing our ability to sleep and wake at the appropriate times and compromising physiologic and metabolic processes. Light can also have direct acute effects on neuroendocrine systems, for example, in suppressing melatonin synthesis or elevating cortisol production that may have untoward long-term consequences. For these reasons, the National Institute of Environmental Health Sciences convened a workshop of a diverse group of scientists to consider how best to conduct research on possible connections between lighting and health. According to the participants in the workshop, there are three broad areas of research effort that need to be addressed. First are the basic biophysical and molecular genetic mechanisms for phototransduction for circadian, neuroendocrine, and neurobehavioral regulation. Second are the possible physiologic consequences of disrupting these circadian regulatory processes such as on hormone production, particularly melatonin, and normal and neoplastic tissue growth dynamics. Third are effects of light-induced physiologic disruption on disease occurrence and prognosis, and how prevention and treatment could be improved by application of this knowledge.

PMID: 17805428 [PubMed - in process]

Environmental exposures and gene regulation in disease etiology.

Environ Health Perspect. 2007 Sep;115(9):1264-70

Authors: Edwards TM, Myers JP

OBJECTIVE: Health or disease is shaped for all individuals by interactions between their genes and environment. Exactly how the environment changes gene expression and how this can lead to disease are being explored in a fruitful new approach to environmental health research, representative studies of which are reviewed here. DATA SOURCES: We searched Web of Science and references of relevant publications to understand the diversity of gene regulatory mechanisms affected by environmental exposures with disease implications. DATA SYNTHESIS: Pharmaceuticals, pesticides, air pollutants, industrial chemicals, heavy metals, hormones, nutrition, and behavior can change gene expression through a broad array of gene regulatory mechanisms. Mechanisms include regulation of gene translocation, histone modifications, DNA methylation, DNA repair, transcription, RNA stability, alternative RNA splicing, protein degradation, gene copy number, and transposon activation. Furthermore, chemically induced changes in gene regulation are associated with serious and complex human diseases, including cancer, diabetes and obesity, infertility, respiratory diseases, allergies, and neurodegenerative disorders such as Parkinson and Alzheimer diseases. One of the best-studied areas of gene regulation is epigenetics, especially DNA methylation. Our examples of environmentally induced changes in DNA methylation are presented in the context of early development, when methylation patterns are initially laid down. This approach highlights the potential role for altered DNA methylation in fetal origins of adult disease and inheritance of acquired genetic change. CONCLUSIONS: The reviewed studies indicate that genetic predisposition for disease is best predicted in the context of environmental exposures. Second, the genetic mechanisms investigated in these studies offer new avenues for risk assessment research. Finally, we are likely to witness dramatic improvements in human health, and reductions in medical costs, if environmental pollution is decreased.

PMID: 17805414 [PubMed - in process]

Reducing vector-borne disease by empowering farmers in integrated vector management.

Bull World Health Organ. 2007 Jul;85(7):561-6

Authors: van den Berg H, von Hildebrand A, Ragunathan V, Das PK

PROBLEM: Irrigated agriculture exposes rural people to health risks associated with vector-borne diseases and pesticides used in agriculture and for public health protection. Most developing countries lack collaboration between the agricultural and health sectors to jointly address these problems. APPROACH: We present an evaluation of a project that uses the "farmer field school" method to teach farmers how to manage vector-borne diseases and how to improve rice yields. Teaching farmers about these two concepts together is known as "integrated pest and vector management". LOCAL SETTING: An intersectoral project targeting rice irrigation systems in Sri Lanka. RELEVANT CHANGES: Project partners developed a new curriculum for the field school that included a component on vector-borne diseases. Rice farmers in intervention villages who graduated from the field school took vector-control actions as well as improving environmental sanitation and their personal protection measures against disease transmission. They also reduced their use of agricultural pesticides, especially insecticides. LESSONS LEARNED: The intervention motivated and enabled rural people to take part in vector-management activities and to reduce several environmental health risks. There is scope for expanding the curriculum to include information on the harmful effects of pesticides on human health and to address other public health concerns. Benefits of this approach for community-based health programmes have not yet been optimally assessed. Also, the institutional basis of the integrated management approach needs to be broadened so that people from a wider range of organizations take part. A monitoring and evaluation system needs to be established to measure the performance of integrated management initiatives.

PMID: 17768506 [PubMed - indexed for MEDLINE]

Childhood pneumonia--preventing the worlds biggest killer of children.

Bull World Health Organ. 2007 Jul;85(7):502-3

Authors: Greenwood BM, Weber MW, Mulholland K

PMID: 17768493 [PubMed - indexed for MEDLINE]

In silico analysis of p53 using the p53 knowledgebase: mutations, polymorphisms, microRNAs and pathways.

In Silico Biol. 2007;7(1):61-75

Authors: Yang Y, Tantoso E, Chua GH, Yeo ZX, Ng FS, Wong ST, Chung CW, Li KB

P53 is probably the most important tumor suppressor known. Over the years, information about this gene has increased dramatically. We have built a comprehensive knowledgebase of p53, which aims to facilitate wet-lab biologists to formulate their experiments and new-comers to learn whatever they need about the gene and bioinformaticians to make new discoveries through data analysis. Using the information curated, including mutation information, transcription factors, transcriptional targets, and single nucleotide polymorphisms, we have performed extensive bioinformatics analysis, and made several new discoveries about p53. We have identified point missense mutations that are over-represented in cancers, but lack of functional studies. By assessing the capability of six p53 transcriptional targets' tag SNPs selected from HapMap to capture SNPs obtained from National Institute of Environmental Health Sciences (NIEHS) Environmental Genome project and vice versa, we conclude that NIEHS data is a better source for tagSNP selections of these genes in future association studies. Analysis of microRNA regulation in the transcriptional network of the p53 gene reveals potentially important regulatory relationships between oncogenic microRNAs and transcription factors of p53. By mapping transcription factors of p53 to pathways involved in cell cycle and apoptosis, we have identified distinctive transcriptional controls of p53 in these two physiological states.

PMID: 17688428 [PubMed - indexed for MEDLINE]

The relationship between early childhood blood lead levels and performance on end-of-grade tests.

Environ Health Perspect. 2007 Aug;115(8):1242-7

Authors: Miranda ML, Kim D, Galeano MA, Paul CJ, Hull AP, Morgan SP

BACKGROUND: Childhood lead poisoning remains a critical environmental health concern. Low-level lead exposure has been linked to decreased performance on standardized IQ tests for school-aged children. OBJECTIVE: In this study we sought to determine whether blood lead levels in early childhood are related to educational achievement in early elementary school as measured by performance on end-of-grade (EOG) testing. METHODS: Educational testing data for 4th-grade students from the 2000-2004 North Carolina Education Research Data Center were linked to blood lead surveillance data for seven counties in North Carolina and then analyzed using exploratory and multivariate statistical methods. RESULTS: The discernible impact of blood lead levels on EOG testing is demonstrated for early childhood blood lead levels as low as 2 microg/dL. A blood lead level of 5 microg/dL is associated with a decline in EOG reading (and mathematics) scores that is roughly equal to 15% (14%) of the interquartile range, and this impact is very significant in comparison with the effects of covariates typically considered profoundly influential on educational outcomes. Early childhood lead exposures appear to have more impact on performance on the reading than on the mathematics portions of the tests. CONCLUSIONS: Our emphasis on population-level analyses of children who are roughly the same age linked to previous (rather than contemporaneous) blood lead levels using achievement (rather than aptitude) outcome complements the important work in this area by previous researchers. Our results suggest that the relationship between blood lead levels and cognitive outcomes are robust across outcome measures and at low levels of lead exposure.

PMID: 17687454 [PubMed - indexed for MEDLINE]

Ranking cancer risks of organic hazardous air pollutants in the United States.

Environ Health Perspect. 2007 Aug;115(8):1160-8

Authors: Loh MM, Levy JI, Spengler JD, Houseman EA, Bennett DH

BACKGROUND: In this study we compared cancer risks from organic hazardous air pollutants (HAPs) based on total personal exposure summed across different microenvironments and exposure pathways. METHODS: We developed distributions of personal exposure concentrations using field monitoring and modeling data for inhalation and, where relevant, ingestion pathways. We calculated risks for a nonoccupationally exposed and nonsmoking population using U.S. Environmental Protection Agency (EPA) and California Office of Environmental Health and Hazard Assessment (OEHHA) unit risks. We determined the contribution to risk from indoor versus outdoor sources using indoor/outdoor ratios for gaseous compounds and the infiltration factor for particle-bound compounds. RESULTS: With OEHHA's unit risks, the highest ranking compounds based on the population median are 1,3-butadiene, formaldehyde, benzene, and dioxin, with risks on the order of 10(-4)-10(-5). The highest risk compounds with the U.S. EPA unit risks were dioxin, benzene, formaldehyde, and chloroform, with risks on a similar order of magnitude. Although indoor exposures are responsible for nearly 70% of risk using OEHHA's unit risks, when infiltration is accounted for, inhalation of outdoor sources contributed 50% to total risk, on average. Additionally, 15% of risk resulted from exposures through food, mainly due to dioxin. CONCLUSIONS: Most of the polycyclic aromatic hydrocarbon, benzene, acetaldehyde, and 1,3-butadiene risk came from outdoor sources, whereas indoor sources were primarily responsible for chloroform, formaldehyde, and naphthalene risks. The infiltration of outdoor pollution into buildings, emissions from indoor sources, and uptake through food are all important to consider in reducing overall personal risk to HAPs.

PMID: 17687442 [PubMed - indexed for MEDLINE]

Reviewing the environmental and human health knowledge base of carbon nanotubes.

Environ Health Perspect. 2007 Aug;115(8):1125-31

Authors: Helland A, Wick P, Koehler A, Schmid K, Som C

Carbon nanotubes (CNTs) are considered one of the most promising materials in nanotechnology, with attractive properties for many technologic applications. The different synthesis, purification, and postprocessing methods produce CNTs with different physical characteristics, which can be applied in different fields ranging from composite materials, medical applications, and electronics to energy storage. The widespread projected use of CNTs makes it important to understand their potential harmful effects. In this environmental health review we observed a remarkable range of results of some of the toxicology studies. The comparability should be improved by further standardization and introduction of reference materials. However, at present the findings of this review suggest several key points: a) there are different types of CNTs, and therefore they cannot be considered a uniform group of substances; and b) in environmental compartments, CNTs can be bioavailable to organisms. The properties of CNTs suggest a possible accumulation along the food chain and high persistence. In organisms the absorption, distribution, metabolism, excretion, and toxicity of CNTs depend on the inherent physical and chemical characteristics such as CNT functionalization, coating, length, and agglomeration state that are influenced by the external environmental conditions during CNT production, use, and disposal stages. Characterized exposure scenarios could therefore be useful when conducting toxicologic studies. However, CNTs produce a toxic response upon reaching the lungs in sufficient quantity; this reaction is produced in a time-and dose-dependent manner. The identification of possible risks to human health and environment is a prerequisite for a successful introduction of CNTs in future applications.

PMID: 17687437 [PubMed - indexed for MEDLINE]

[Assessment of sanitation and housing conditions: the importance of home visits in the Family Health Program context]

Cien Saude Colet. 2007 May-Jun;12(3):743-53

Authors: Azeredo CM, Cotta RM, Schott M, Maia Tde M, Marques ES

Knowledge of health-related environmental conditions - such as basic sanitation and housing - are of singular importance for establishing measures designed to upgrade the quality of life at the individual, family and community levels. Through home visits, this paper evaluates families enrolled in the Family Health Program (FHP) in Teixeiras, Minas Gerais State, Brazil, including their housing and basic sanitation conditions. A transverse observational study, its semi-structured questionnaire was applied to 10% (n=364) of the families enrolled in this Program. The net water supply coverage reached 83% of homes in urban areas and 11.7% in rural areas. The public water supply was the final disposal point for the water used in 82.2% of urban dwellings and 10.9% of rural homes. Home visits offer inside glimpses into the lives of the beneficiaries of this Program, particularly in view of the unequal distribution of the sanitation infrastructure between urban and rural areas, constituting an important tool for the Family Health Strategy, by helping identify the key factors in the health x disease processes noted in the settings within which these families live, and paving the way to better health through Health Education.

PMID: 17680132 [PubMed - indexed for MEDLINE]

Current good manufacturing practice in manufacturing, packaging, labeling, or holding operations for dietary supplements. Final rule.

Fed Regist. 2007 Jun 25;72(121):34751-958

Authors:

The Food and Drug Administration (FDA) is issuing a final rule regarding current good manufacturing practice (CGMP) for dietary supplements. The final rule establishes the minimum CGMPs necessary for activities related to manufacturing, packaging, labeling, or holding dietary supplements to ensure the quality of the dietary supplement. The final rule is one of many actions related to dietary supplements that we are taking to promote and protect the public health.

PMID: 17674484 [PubMed - indexed for MEDLINE]

Prevention of allergic diseases.

Allergol Immunopathol (Madr). 2007 Jul-Aug;35(4):151-6

Authors: Lorente F, Isidoro M, D&#xE1;vila I, Laffond E, Moreno E

The prevalence of asthma and allergic diseases has increased in recent years, particularly in the industrialized world. Allergic disease begins to manifest in the first years of life. The disorder usually manifests initially in the form of food allergy and atopic dermatitis, followed in later stages by respiratory allergy with rhinitis and/or asthma. This has led to the adoption of preventive measures in those children with a high risk of atopy, based on the following considerations: 1) A family history of allergic diseases (asthma, eczema, and/or allergic rhinitis); 2) A personal history of atopy such as atopic dermatitis, particularly when associated to food allergy; and 3) The existence of allergic sensitization, particularly to pneumoallergens, of early or late onset, but persistent during childhood. Prevention is established at three different levels: primary prevention, avoiding sensitization; secondary prevention, avoiding appearance of the disease; and tertiary prevention, avoiding the symptoms. The present study discusses current knowledge of prevention and its efficacy, with mention of the importance of breastfeeding and the use of pre- and probiotics for securing adequate prevention.

PMID: 17663924 [PubMed - indexed for MEDLINE]

Addressing health disparities and environmental justice: the National Library of Medicine's Environmental Health Information Outreach Program.

J Med Libr Assoc. 2007 Jul;95(3):330-6

Authors: Dutcher GA, Spann M, Gaines C

PURPOSE: Disparities in health between minority and majority populations have become a topic of high interest in the health care and information communities. This paper describes the National Library of Medicine's (NLM's) oldest outreach program to a minority population, a project that has been going on for over fifteen years. SETTING/PARTICIPANTS/RESOURCES: The overview is based on internal documentation and reports, interviews, personal communications, and project reports. BRIEF DESCRIPTION: This is a historical overview of the Environmental Health Information Outreach Program, from its beginnings in 1991 as the Toxicology Information Outreach Project. The initial collaboration began with nine historically black colleges and universities (HBCUs) that had graduate programs in biomedicine. The current program includes representation from HBCUs, institutions serving Hispanic students, and tribal colleges. In addition to working with these institutions to promote the use of and access to electronic health information and related technology, this program brings attention to scientific research related to health issues that disproportionately affect minorities. RESULTS/OUTCOME: The program expanded due to its perceived success by the initial participants and NLM's management. Not only have faculty, staff, and students at the participating institutions received training in using NLM's toxicology, environmental health, and other electronic resources, but the participants ascribe other successes to their collaboration with NLM.

PMID: 17641769 [PubMed - indexed for MEDLINE]

An evaluation of infant immunization in Africa: is a transformation in progress?

Bull World Health Organ. 2007 Jun;85(6):449-57

Authors: Arevshatian L, Clements C, Lwanga S, Misore A, Ndumbe P, Seward J, Taylor P

OBJECTIVE: To assess the progress made towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunization between 2001 and 2005. METHODS: We reviewed data from national infant immunization programmes in the 46 countries of WHOs African Region, reviewed the literature and analysed existing data sources. We carried out face-to-face and telephone interviews with relevant staff members at regional and subregional levels. FINDINGS: The African Region fell short of the target for 80% of countries to achieve at least 80% immunization coverage by 2005. However, diphtheria-tetanus-pertussis-3 coverage increased by 15%, from 54% in 2000 to 69% in 2004. As a result, we estimate that the number of nonimmunized children declined from 1.4 million in 2002 to 900,000 in 2004. In 2004, four of seven countries with endemic or re-established wild polio virus had coverage of 50% or less, and some neighbouring countries at high risk of importation did not meet the 80% vaccination target. Reported measles cases dropped from 520,000 in 2000 to 316,000 in 2005, and mortality was reduced by approximately 60% when compared to 1999 baseline levels. A network of measles and yellow fever laboratories had been established in 29 countries by July 2005. CONCLUSION: Rates of immunization coverage are improving dramatically in the WHO African Region. The huge increases in spending on immunization and the related improvements in programme performance are linked predominantly to increases in donor funding.

PMID: 17639242 [PubMed - indexed for MEDLINE]

Environmental health impacts of CAFOs.

Environ Health Perspect. 2007 Jul;115(7):A342-3; author reply A343-4

Authors: Wagstrom L

PMID: 17637897 [PubMed - indexed for MEDLINE]

Problems with provision: barriers to drinking water quality and public health in rural Tasmania, Australia.

Rural Remote Health. 2007 Jul-Sep;7(3):627

Authors: Whelan JJ, Willis K

INTRODUCTION: Access to safe drinking water is essential to human life and wellbeing, and is a key public health issue. However, many communities in rural and regional parts of Australia are unable to access drinking water that meets national standards for protecting human health. The aim of this research was to identify the key issues in and barriers to the provision and management of safe drinking water in rural Tasmania, Australia. METHOD: Semi-structured interviews were conducted with key local government employees and public health officials responsible for management of drinking water in rural Tasmania. Participants were asked about their core public health duties, regulatory responsibilities, perceptions and management of risk, as well as the key barriers that may be affecting the provision of safe drinking water. RESULTS: This research highlights the effect of rural locality on management and safety of fresh water in protecting public health. The key issues contributing to problems with drinking water provision and quality identified by participants included: poor and inadequate water supply infrastructure; lack of resources and staffing; inadequate catchment monitoring; and the effect of competing land uses, such as forestry, on water supply quality. CONCLUSIONS AND IMPLICATIONS: This research raises issues of inequity in the provision of safe drinking water in rural communities. It highlights not only the increasing need for greater funding by state and commonwealth government for basic services such as drinking water, but also the importance of an holistic and integrated approach to managing drinking water resources in rural Tasmania.

PMID: 17625916 [PubMed - indexed for MEDLINE]

Linking public health, housing, and indoor environmental policy: successes and challenges at local and federal agencies in the United States.

Environ Health Perspect. 2007 Jun;115(6):976-82

Authors: Jacobs DE, Kelly T, Sobolewski J

We describe the successes and challenges faced by federal and local government agencies in the United States as they have attempted in recent years to connect public and environmental health, housing, community development, and building design with environmental, housing, and building laws, codes, and policies. These policies can either contribute to or adversely affect human physical and mental health, with important implications for economic viability, research, policy development, and overall social stability and progress. Policy impediments include tension between housing affordability and health investment that causes inefficient cost-shifting, privacy issues, unclear statutory authority, and resulting gaps in responsibility for housing, indoor air, and the built environment. We contrast this with other environmental frameworks such as ambient air and water quality statutes where the concept of "shared commons" and the "polluter pays" is more robust. The U.S. experiences in childhood lead poisoning prevention, indoor air, and mold provide useful policy insights. Local programs can effectively build healthy homes capacity through local laws and housing codes. The experience of coordinating remediation for mold, asthma triggers, weatherization, and other healthy housing improvements in Cuyahoga County, Ohio, is highlighted. The U.S. experience shows that policymakers should adopt a prevention-oriented, comprehensive multi-disciplinary approach at all levels of government to prevent unhealthy buildings, houses, and communities.

PMID: 17589610 [PubMed - in process]

[Occurrence of accidents caused by Lonomia obliqua Walker, in the State of Paraná between 1989 and 2001]

Rev Soc Bras Med Trop. 2007 Mar-Apr;40(2):242-6

Authors: Garcia CM, Danni-Oliveira IM

The present article aimed to show the distribution of accidents involving the caterpillar Lonomia obliqua, Walker, 1855, in the State of Paraná between 1989 and 2001. The data were obtained from the Environmental Health Department of Paraná. The information collected was mapped using the Arcview program, and maps of the seasonal occurrence of accidents were generated. This seasonality was correlated with the insects life cycle and summer was shown to be the period with greatest incidence of accidents. The greatest concentrations occurred in the central-southern, southeastern and southwestern regions of the State.

PMID: 17568899 [PubMed - indexed for MEDLINE]

Meeting report: alternatives for developmental neurotoxicity testing.

Environ Health Perspect. 2007 May;115(5):764-8

Authors: Lein P, Locke P, Goldberg A

Developmental neurotoxicity testing (DNT) is perceived by many stakeholders to be an area in critical need of alternatives to current animal testing protocols and guidelines. To address this need, the Johns Hopkins Center for Alternatives to Animal Testing (CAAT), the U.S. Environmental Protection Agency, and the National Toxicology Program are collaborating in a program called TestSmart DNT, the goals of which are to: (a) develop alternative methodologies for identifying and prioritizing chemicals and exposures that may cause developmental neurotoxicity in humans; (b) develop the policies for incorporating DNT alternatives into regulatory decision making; and (c) identify opportunities for reducing, refining, or replacing the use of animals in DNT. The first TestSmart DNT workshop was an open registration meeting held 13-15 March 2006 in Reston, Virginia. The primary objective was to bring together stakeholders (test developers, test users, regulators, and advocates for children's health, animal welfare, and environmental health) and individuals representing diverse disciplines (developmental neurobiology, toxicology, policy, and regulatory science) from around the world to share information and concerns relating to the science and policy of DNT. Individual presentations are available at the CAAT TestSmart website. This report provides a synthesis of workgroup discussions and recommendations for future directions and priorities, which include initiating a systematic evaluation of alternative models and technologies, developing a framework for the creation of an open database to catalog DNT data, and devising a strategy for harmonizing the validation process across international jurisdictional borders.

PMID: 17520065 [PubMed - in process]

Global climate change: implications for international public health policy.

Bull World Health Organ. 2007 Mar;85(3):235-7

Authors: Campbell-Lendrum D, Corval&#xE1;n C, Neira M

PMID: 17486218 [PubMed - indexed for MEDLINE]

Children's health and the environment - building capacities of action.

Indian Pediatr. 2007 Apr;44(4):253-5

Authors: Pronczuk J, Bhave SY

PMID: 17468519 [PubMed - indexed for MEDLINE]

Assessment and prevention of acute health effects of weather conditions in Europe, the PHEWE project: background, objectives, design.

Environ Health. 2007;6:12

Authors: Michelozzi P, Kirchmayer U, Katsouyanni K, Biggeri A, McGregor G, Menne B, Kassomenos P, Anderson HR, Baccini M, Accetta G, Analytis A, Kosatsky T

BACKGROUND: The project "Assessment and prevention of acute health effects of weather conditions in Europe" (PHEWE) had the aim of assessing the association between weather conditions and acute health effects, during both warm and cold seasons in 16 European cities with widely differing climatic conditions and to provide information for public health policies. METHODS: The PHEWE project was a three-year pan-European collaboration between epidemiologists, meteorologists and experts in public health. Meteorological, air pollution and mortality data from 16 cities and hospital admission data from 12 cities were available from 1990 to 2000. The short-term effect on mortality/morbidity was evaluated through city-specific and pooled time series analysis. The interaction between weather and air pollutants was evaluated and health impact assessments were performed to quantify the effect on the different populations. A heat/health watch warning system to predict oppressive weather conditions and alert the population was developed in a subgroup of cities and information on existing prevention policies and of adaptive strategies was gathered. RESULTS: Main results were presented in a symposium at the conference of the International Society of Environmental Epidemiology in Paris on September 6th 2006 and will be published as scientific articles. The present article introduces the project and includes a description of the database and the framework of the applied methodology. CONCLUSION: The PHEWE project offers the opportunity to investigate the relationship between temperature and mortality in 16 European cities, representing a wide range of climatic, socio-demographic and cultural characteristics; the use of a standardized methodology allows for direct comparison between cities.

PMID: 17456236 [PubMed - indexed for MEDLINE]

Urban environmental health hazards and health equity.

J Urban Health. 2007 May;84(3 Suppl):i86-97

Authors: Kjellstrom T, Friel S, Dixon J, Corvalan C, Rehfuess E, Campbell-Lendrum D, Gore F, Bartram J

This paper outlines briefly how the living environment can affect health. It explains the links between social and environmental determinants of health in urban settings. Interventions to improve health equity through the environment include actions and policies that deal with proximal risk factors in deprived urban areas, such as safe drinking water supply, reduced air pollution from household cooking and heating as well as from vehicles and industry, reduced traffic injury hazards and noise, improved working environment, and reduced heat stress because of global climate change. The urban environment involves health hazards with an inequitable distribution of exposures and vulnerabilities, but it also involves opportunities for implementing interventions for health equity. The high population density in many poor urban areas means that interventions at a small scale level can assist many people, and existing infrastructure can sometimes be upgraded to meet health demands. Interventions at higher policy levels that will create more sustainable and equitable living conditions and environments include improved city planning and policies that take health aspects into account in every sector. Health equity also implies policies and actions that improve the global living environment, for instance, limiting greenhouse gas emissions. In a global equity perspective, improving the living environment and health of the poor in developing country cities requires actions to be taken in the most affluent urban areas of the world. This includes making financial and technical resources available from high-income countries to be applied in low-income countries for urgent interventions for health equity. This is an abbreviated version of a paper on "Improving the living environment" prepared for the World Health Organization Commission on Social Determinants of Health, Knowledge Network on Urban Settings.

PMID: 17450427 [PubMed - indexed for MEDLINE]

Identification of genes implicated in methapyrilene-induced hepatotoxicity by comparing differential gene expression in target and nontarget tissue.

Environ Health Perspect. 2007 Apr;115(4):572-8

Authors: Auman JT, Chou J, Gerrish K, Huang Q, Jayadev S, Blanchard K, Paules RS

BACKGROUND: Toxicogenomics experiments often reveal thousands of transcript alterations that are related to multiple processes, making it difficult to identify key gene changes that are related to the toxicity of interest. OBJECTIVES: The objective of this study was to compare gene expression changes in a nontarget tissue to the target tissue for toxicity to help identify toxicity-related genes. METHODS: Male rats were given the hepatotoxicant methapyrilene at two dose levels, with livers and kidneys removed 24 hr after one, three, and seven doses for gene expression analysis. To identify gene changes likely to be related to toxicity, we analyzed genes on the basis of their temporal pattern of change using a program developed at the National Institute of Environmental Health Sciences, termed "EPIG" (extracting gene expression patterns and identifying co-expressed genes). RESULTS: High-dose methapyrilene elicited hepatic damage that increased in severity with the number of doses, whereas no treatment-related lesions were observed in the kidney. High-dose methapyrilene elicited thousands of gene changes in the liver at each time point, whereas many fewer gene changes were observed in the kidney. EPIG analysis identified patterns of gene expression correlated to the observed toxicity, including genes associated with endoplasmic reticulum stress and the unfolded protein response. CONCLUSIONS: By factoring in dose level, number of doses, and tissue into the analysis of gene expression elicited by methapyrilene, we were able to identify genes likely to not be implicated in toxicity, thereby allowing us to focus on a subset of genes to identify toxicity-related processes.

PMID: 17450226 [PubMed - indexed for MEDLINE]

The NIEHS Environmental Health Sciences Data Resource Portal: placing advanced technologies in service to vulnerable communities.

Environ Health Perspect. 2007 Apr;115(4):564-71

Authors: Pezzoli K, Tukey R, Sarabia H, Zaslavsky I, Miranda ML, Suk WA, Lin A, Ellisman M

BACKGROUND: Two devastating hurricanes ripped across the Gulf Coast of the United States during 2005. The effects of Hurricane Katrina were especially severe: the human and environmental health impacts on New Orleans, Louisiana, and other Gulf Coast communities will be felt for decades to come. The Federal Emergency Management Agency (FEMA) estimates that Katrina's destruction disrupted the lives of roughly 650,000 Americans. Over 1,300 people died. The projected economic costs for recovery and reconstruction are likely to exceed $125 billion. OBJECTIVES: The NIEHS (National Institute of Environmental Health Sciences) Portal aims to provide decision makers with the data, information, and the tools they need to a) monitor human and environmental health impacts of disasters; b) assess and reduce human exposures to contaminants; and c) develop science-based remediation, rebuilding, and repopulation strategies. METHODS: The NIEHS Portal combines advances in geographic information systems (GIS), data mining/integration, and visualization technologies through new forms of grid-based (distributed, web-accessible) cyberinfrastructure. RESULTS: The scale and complexity of the problems presented by Hurricane Katrina made it evident that no stakeholder alone could tackle them and that there is a need for greater collaboration. The NIEHS Portal provides a collaboration-enabling, information-laden base necessary to respond to environmental health concerns in the Gulf Coast region while advancing integrative multidisciplinary research. CONCLUSIONS: The NIEHS Portal is poised to serve as a national resource to track environmental hazards following natural and man-made disasters, focus medical and environmental response and recovery resources in areas of greatest need, and function as a test bed for technologies that will help advance environmental health sciences research into the modern scientific and computing era.

PMID: 17450225 [PubMed - indexed for MEDLINE]

Biodiesel exhaust: the need for health effects research.

Environ Health Perspect. 2007 Apr;115(4):496-9

Authors: Swanson KJ, Madden MC, Ghio AJ

BACKGROUND: Biodiesel is a diesel fuel alternative that has shown potential of becoming a commercially accepted part of the United States' energy infrastructure. In November 2004, the signing of the Jobs Creation Bill HR 4520 marked an important turning point for the future production of biodiesel in the United States because it offers a federal excise tax credit. By the end of 2005, industry production was 75 million gallons, a 300% increase in 1 year. Current industry capacity, however, stands at just over 300 million gallons/year, and current expansion and new plant construction could double the industry's capacity within a few years. Biodiesel exhaust emission has been extensively characterized under field and laboratory conditions, but there have been limited cytotoxicity and mutagenicity studies on the effects of biodiesel exhaust in biologic systems. OBJECTIVES: We reviewed pertinent medical literature and addressed recommendations on testing specific research needs in the field of biodiesel toxicity. DISCUSSION: Employment of biodiesel fuel is favorably viewed, and there are suggestions that its exhaust emissions are less likely to present any risk to human health relative to petroleum diesel emissions. CONCLUSION: The speculative nature of a reduction in health effects based on chemical composition of biodiesel exhaust needs to be followed up with investigations in biologic systems.

PMID: 17450214 [PubMed - indexed for MEDLINE]

Using nutrition for intervention and prevention against environmental chemical toxicity and associated diseases.

Environ Health Perspect. 2007 Apr;115(4):493-5

Authors: Hennig B, Ettinger AS, Jandacek RJ, Koo S, McClain C, Seifried H, Silverstone A, Watkins B, Suk WA

BACKGROUND: Nutrition and lifestyle are well-defined modulators of chronic diseases. Poor dietary habits (such as high intake of processed foods rich in fat and low intake of fruits and vegetables), as well as a sedentary lifestyle clearly contribute to today's compromised quality of life in the United States. It is becoming increasingly clear that nutrition can modulate the toxicity of environmental pollutants. OBJECTIVES: Our goal in this commentary is to discuss the recommendation that nutrition should be considered a necessary variable in the study of human disease associated with exposure to environmental pollutants. DISCUSSION: Certain diets can contribute to compromised health by being a source of exposure to environmental toxic pollutants. Many of these pollutants are fat soluble, and thus fatty foods often contain higher levels of persistent organics than does vegetable matter. Nutrition can dictate the lipid milieu, oxidative stress, and antioxidant status within cells. The modulation of these parameters by an individual's nutritional status may have profound affects on biological processes, and in turn influence the effects of environmental pollutants to cause disease or dysfunction. For example, potential adverse health effects associated with exposure to polychlorinated biphenyls may increase as a result of ingestion of certain dietary fats, whereas ingestion of fruits and vegetables, rich in antioxidant and anti-inflammatory nutrients or bioactive compounds, may provide protection. CONCLUSIONS: We recommend that future directions in environmental health research explore this nutritional paradigm that incorporates a consideration of the relationships between nutrition and lifestyle, exposure to environmental toxicants, and disease. Nutritional interventions may provide the most sensible means to develop primary prevention strategies of diseases associated with many environmental toxic insults.

PMID: 17450213 [PubMed - indexed for MEDLINE]

Beyond the bench: healthy home, healthy community.

Environ Health Perspect. 2007 Apr;115(4):A194-5

Authors: Tillett T

PMID: 17450205 [PubMed - indexed for MEDLINE]

Children's health centers: past, present, and future.

Environ Health Perspect. 2007 Apr;115(4):A192-4

Authors: Spivey A

PMID: 17450203 [PubMed - indexed for MEDLINE]

A new venue for the Director's Perspective.

Environ Health Perspect. 2007 Apr;115(4):A182

Authors: Schwartz DA

PMID: 17450190 [PubMed - indexed for MEDLINE]

Climate change: healthy solutions.

Environ Health Perspect. 2007 Apr;115(4):A180-1

Authors: Epstein PR

PMID: 17450189 [PubMed - indexed for MEDLINE]

Clinical, classroom, or personal education: attitudes about health literacy.

J Med Libr Assoc. 2007 Apr;95(2):127-37, e48

Authors: Logan RA

PURPOSE: This study explores how diverse attitudes about health literacy are assessed by medical librarians and other health care professionals. PROCEDURES: An online survey of thirty-six items was conducted using Q methodology in two phases in spring 2005 and winter 2006. Respondents (n = 51) were nonrandomly self-selected from a convenience sample of members of the Medical Library Association and a group of environmental health consultants to the National Library of Medicine. FINDINGS: Three factors were identified. Factor 1 is optimistic and supportive of health literacy's transformative sociocultural and professional potential, if clinical settings become a launching point for health literacy activities. Factor 2 is less optimistic about health literacy's potential to improve clinical or patient outcomes and prefers to focus health literacy initiatives on classroom education settings. Factor 3 supports improving the nation's health literacy but tends to support health literacy initiatives when people privately interact with health information materials. CONCLUSIONS: Each factor's attitudes about the appropriate educational venue to initiate health literacy activities are different and somewhat mutually exclusive. This suggests that health literacy is seen through different perceptual frameworks that represent a possible source of professional disagreement.

PMID: 17443245 [PubMed - indexed for MEDLINE]

Climate change and developing-country cities: implications for environmental health and equity.

J Urban Health. 2007 May;84(3 Suppl):i109-17

Authors: Campbell-Lendrum D, Corval&#xE1;n C

Climate change is an emerging threat to global public health. It is also highly inequitable, as the greatest risks are to the poorest populations, who have contributed least to greenhouse gas (GHG) emissions. The rapid economic development and the concurrent urbanization of poorer countries mean that developing-country cities will be both vulnerable to health hazards from climate change and, simultaneously, an increasing contributor to the problem. We review the specific health vulnerabilities of urban populations in developing countries and highlight the range of large direct health effects of energy policies that are concentrated in urban areas. Common vulnerability factors include coastal location, exposure to the urban heat-island effect, high levels of outdoor and indoor air pollution, high population density, and poor sanitation. There are clear opportunities for simultaneously improving health and cutting GHG emissions most obviously through policies related to transport systems, urban planning, building regulations and household energy supply. These influence some of the largest current global health burdens, including approximately 800,000 annual deaths from ambient urban air pollution, 1.2 million from road-traffic accidents, 1.9 million from physical inactivity, and 1.5 million per year from indoor air pollution. GHG emissions and health protection in developing-country cities are likely to become increasingly prominent in policy development. There is a need for a more active input from the health sector to ensure that development and health policies contribute to a preventive approach to local and global environmental sustainability, urban population health, and health equity.

PMID: 17393341 [PubMed - indexed for MEDLINE]

The design of housing and shelter programs: the social and environmental determinants of inequalities.

J Urban Health. 2007 May;84(3 Suppl):i98-108

Authors: Sheuya S, Howden-Chapman P, Patel S

Both developed and less developed countries are becoming increasingly urbanized. The earlier industrialized countries have developed more infrastructure to support the building of healthy housing, in neighborhoods that are strongly linked to municipal and global health initiatives, but to some degree housing and neighborhood issues vary only in degree between the developing and developed worlds. Overall, a billion people, a third of people living in urban areas, live in slums, where environmental determinants lead to disease. Although communicable diseases predominate in the developing world and have reemerged in the developed world, noncommunicable diseases are also growing disproportionately in the developing world. At a global level, the Millennium Development Goals explicitly focus on an integrated approach to slum upgrading. The per capita cost of slum upgrading is almost twice the cost of providing new affordable housing at the outset. It is argued that to improve health and well-being in the slums we need to have interventions that reduce urban poverty in the broadest sense and improve the deficiencies associated with slums. There is an urgent need to scale up the best-practice interventions. Examples are given of successful local community initiatives that have been set up under national strategies in Tanzania and by Indian women's collectives that are globally linked and have helped develop housing and sanitation improvements. The unit costs for such interventions are within the reach of all the key stakeholders. Global commitment is the only missing link.

PMID: 17387617 [PubMed - indexed for MEDLINE]

The potential role of concentrated animal feeding operations in infectious disease epidemics and antibiotic resistance.

Environ Health Perspect. 2007 Feb;115(2):313-6

Authors: Gilchrist MJ, Greko C, Wallinga DB, Beran GW, Riley DG, Thorne PS

The industrialization of livestock production and the widespread use of nontherapeutic antimicrobial growth promotants has intensified the risk for the emergence of new, more virulent, or more resistant microorganisms. These have reduced the effectiveness of several classes of antibiotics for treating infections in humans and livestock. Recent outbreaks of virulent strains of influenza have arisen from swine and poultry raised in close proximity. This working group, which was part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards--Searching for Solutions, considered the state of the science around these issues and concurred with the World Health Organization call for a phasing-out of the use of antimicrobial growth promotants for livestock and fish production. We also agree that all therapeutic antimicrobial agents should be available only by prescription for human and veterinary use. Concern about the risk of an influenza pandemic leads us to recommend that regulations be promulgated to restrict the co-location of swine and poultry concentrated animal feeding operations (CAFOs) on the same site and to set appropriate separation distances.

PMID: 17384785 [PubMed - indexed for MEDLINE]

Impacts of waste from concentrated animal feeding operations on water quality.

Environ Health Perspect. 2007 Feb;115(2):308-12

Authors: Burkholder J, Libra B, Weyer P, Heathcote S, Kolpin D, Thorne PS, Wichman M

Waste from agricultural livestock operations has been a long-standing concern with respect to contamination of water resources, particularly in terms of nutrient pollution. However, the recent growth of concentrated animal feeding operations (CAFOs) presents a greater risk to water quality because of both the increased volume of waste and to contaminants that may be present (e.g., antibiotics and other veterinary drugs) that may have both environmental and public health importance. Based on available data, generally accepted livestock waste management practices do not adequately or effectively protect water resources from contamination with excessive nutrients, microbial pathogens, and pharmaceuticals present in the waste. Impacts on surface water sources and wildlife have been documented in many agricultural areas in the United States. Potential impacts on human and environmental health from long-term inadvertent exposure to water contaminated with pharmaceuticals and other compounds are a growing public concern. This work-group, which is part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards--Searching for Solutions, identified needs for rigorous ecosystem monitoring in the vicinity of CAFOs and for improved characterization of major toxicants affecting the environment and human health. Last, there is a need to promote and enforce best practices to minimize inputs of nutrients and toxicants from CAFOs into freshwater and marine ecosystems.

PMID: 17384784 [PubMed - indexed for MEDLINE]

Monitoring and modeling of emissions from concentrated animal feeding operations: overview of methods.

Environ Health Perspect. 2007 Feb;115(2):303-7

Authors: Bunton B, O'shaughnessy P, Fitzsimmons S, Gering J, Hoff S, Lyngbye M, Thorne PS, Wasson J, Werner M

Accurate monitors are required to determine ambient concentration levels of contaminants emanating from concentrated animal feeding operations (CAFOs), and accurate models are required to indicate the spatial variability of concentrations over regions affected by CAFOs. A thorough understanding of the spatial and temporal variability of concentration levels could then be associated with locations of healthy individuals or subjects with respiratory ailments to statistically link the presence of CAFOs to the prevalence of ill health effects in local populations. This workgroup report, which was part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards-Searching for Solutions, describes instrumentation currently available for assessing contaminant concentration levels in the vicinity of CAFOs and reviews plume dispersion models that may be used to estimate concentration levels spatially. Recommendations for further research with respect to ambient air monitoring include accurately determining long-term average concentrations for a region under the influence of CAFO emissions using a combination of instruments based on accuracy, cost, and sampling duration. In addition, development of instruments capable of accurately quantifying adsorbed gases and volatile organic compounds is needed. Further research with respect to plume dispersion models includes identifying and validating the most applicable model for use in predicting downwind concentrations from CAFOs. Additional data are needed to obtain reliable emission rates from CAFOs.

PMID: 17384783 [PubMed - indexed for MEDLINE]

Health effects of airborne exposures from concentrated animal feeding operations.

Environ Health Perspect. 2007 Feb;115(2):298-302

Authors: Heederik D, Sigsgaard T, Thorne PS, Kline JN, Avery R, B&#xF8;nløkke JH, Chrischilles EA, Dosman JA, Duchaine C, Kirkhorn SR, Kulhankova K, Merchant JA

Toxic gases, vapors, and particles are emitted from concentrated animal feeding operations (CAFOs) into the general environment. These include ammonia, hydrogen sulfide, carbon dioxide, malodorous vapors, and particles contaminated with a wide range of microorganisms. Little is known about the health risks of exposure to these agents for people living in the surrounding areas. Malodor is one of the predominant concerns, and there is evidence that psychophysiologic changes may occur as a result of exposure to malodorous compounds. There is a paucity of data regarding community adverse health effects related to low-level gas and particulate emissions. Most information comes from studies among workers in CAFO installations. Research over the last decades has shown that microbial exposures, especially endotoxin exposure, are related to deleterious respiratory health effects, of which cross-shift lung function decline and accelerated decline over time are the most pronounced effects. Studies in naïve subjects and workers have shown respiratory inflammatory responses related to the microbial load. This working group, which was part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards-Searching for Solutions, concluded that there is a great need to evaluate health effects from exposures to the toxic gases, vapors, and particles emitted into the general environment by CAFOs. Research should focus not only on nuisance and odors but also on potential health effects from microbial exposures, concentrating on susceptible subgroups, especially asthmatic children and the elderly, since these exposures have been shown to be related to respiratory health effects among workers in CAFOs.

PMID: 17384782 [PubMed - indexed for MEDLINE]

Environmental health impacts of concentrated animal feeding operations: anticipating hazards--searching for solutions.

Environ Health Perspect. 2007 Feb;115(2):296-7

Authors: Thorne PS

A scientific conference and workshop was held March 2004 in Iowa City, Iowa, that brought together environmental scientists from North America and Europe to address major environmental health issues associated with concentrated animal feeding operations (CAFOs) in large, industrialized livestock production facilities. After one and a half days of plenary sessions, five expert workgroups convened to consider the most relevant research areas, including respiratory health effects, modeling and monitoring of air toxics, water quality issues, influenza pandemics and antibiotic resistance, and community health and socioeconomic issues. The workgroup reports that follow outline the state of the science and public health concerns relating to livestock production as they apply to each workgroup topic. The reports also identify areas in which further research is needed and suggest opportunities to translate science to policy initiatives that would effect improvements in public and environmental health. Viable solutions to some of the current environmental health problems associated with CAFOs are outlined. In addition, these reports bring to light several major concerns, including air and water contamination, the rise of antibiotic-resistant bacteria in livestock, and the specter of influenza outbreaks arising from siting industrialized poultry and swine production in proximity to each other and to humans.

PMID: 17384781 [PubMed - indexed for MEDLINE]