Effects of blood lead on coronary artery disease and its risk factors: a Mendelian Randomization study.

Lead is pervasive, although lead exposure has fallen in response to public health efforts. Observationally, lead is positively associated with cardiovascular disease and hypertension. We used separate-sample instrumental variable analysis with genetic instruments (Mendelian randomization) based on 13 single nucleotide polymorphisms (SNP), from a genome wide association study, strongly (p-value < 5 × 10-6) and independently associated with blood lead. These SNPs were applied to a large extensively genotyped coronary artery disease (CAD) study (cases = <76014, controls = <264785) largely based on CARDIoGRAPMplusC4D 1000 Genomes and the UK Biobank SOFT CAD, to the UK Biobank (n = 361,194) for blood pressure and to the DIAGRAM 1000 genomes diabetes case (n = 26,676)-control (n = 132,532) study. SNP-specific Wald estimates were combined using inverse variance weighting, MR-Egger and MR-PRESSO. Genetically instrumented blood lead was not associated with CAD (odds ratio (OR) 1.01 per effect size of log transformed blood lead, 95% confidence interval (CI) 0.97, 1.05), blood pressure (systolic -0.18 mmHg, 95% CI -0.44 to 0.08 and diastolic -0.03 mmHg, 95% CI -0.09 to 0.15) or diabetes (OR 0.98, 95% CI 0.92 to 1.03) using MR-PRESSO estimates corrected for an outlier SNP (rs550057) from the highly pleiotropic gene ABO. Exogenous lead may have different effects from endogenous lead; nevertheless, this study raises questions about the role of blood lead in CAD.

The geo-spatial distribution of childhood diarrheal disease in West Africa, 2008-2013: A covariate-adjusted cluster analysis.

Diarrhea is a major cause of morbidity and mortality among children in West Africa. To determine whether there are areas of heightened risk and if so, how they may be influenced by household and climatic variables, we describe the geo-spatial distribution of childhood diarrhea in ten countries of West Africa for the period 2008-2013 using data from Demographic and Health Surveys. The purely spatial scan statistic was applied, where the observed diarrhea cases were modeled as a Poisson variable and were compared to expected cases predicted from non-spatial logistic regression. Covariate-adjusted cluster analysis detected statistically significant clusters (p < 0.05) in ten cities and thirteen largely rural areas. Areas with particularly high relative risk included Cotonou, Benin (7.16), and Kaduna, Nigeria (7.21). The study demonstrates the importance of development and adaptation measures to protect child health, and that these interventions should be tailored to meet the needs of specific populations.

Geo-Spatial Characterization of Soil Mercury and Arsenic at a High-Altitude Bolivian Gold Mine.

Soil mercury concentrations at a typical small-scale mine site in the Bolivian Andes were elevated (28-737 mg/kg or ppm) in localized areas where mercury amalgams were either formed or vaporized to release gold, but was not detectable beyond approximately 10 m from its sources. Arsenic was measurable, exceeding known background levels throughout the mine site (77-137,022 ppm), and was also measurable through the local village of Ingenio (36-1803 ppm). Although arsenic levels were high at all surveyed locations, its spatial pattern followed mercury, being highest where mercury was high.

A Community Needs Index for Adolescent Pregnancy Prevention Program Planning: Application of Spatial Generalized Linear Mixed Models.

Objective The objective is to estimate community needs with respect to risky adolescent sexual behavior in a way that is risk-adjusted for multiple community factors. Methods Generalized linear mixed modeling was applied for estimating teen pregnancy and sexually transmitted disease (STD) incidence by postal ZIP code in New York State, in a way that adjusts for other community covariables and residual spatial autocorrelation. A community needs index was then obtained by summing the risk-adjusted estimates of pregnancy and STD cases. Results Poisson regression with a spatial random effect was chosen among competing modeling approaches. Both the risk-adjusted caseloads and rates were computed for ZIP codes, which allowed risk-based prioritization to help guide funding decisions for a comprehensive adolescent pregnancy prevention program. Conclusions This approach provides quantitative evidence of community needs with respect to risky adolescent sexual behavior, while adjusting for other community-level variables and stabilizing estimates in areas with small populations. Therefore, it was well accepted by the affected groups and proved valuable for program planning. This methodology may also prove valuable for follow up program evaluation. Current research is directed towards further improving the statistical modeling approach and applying to different health and behavioral outcomes, along with different predictor variables.

An Analysis of Technology-Related Distracted Biking Behaviors and Helmet Use Among Cyclists in New York City.

Bicycling is becoming an increasingly utilized mode of transportation in New York City. Technology-related distracted bicycling and helmet use are behaviors that can impact bike safety. The aims of this study were twofold: (1) to determine rates and types of technology-related distracted behaviors among bicyclists in the borough of Manhattan in New York City; and (2) to assess the rate of bicycle helmet use among these cyclists. Bicyclists in five popular riding areas in Manhattan were observed for a total of 50 h using a digital video camera during summer months in 2014. Videos were coded and enumerated for the total number and gender of cyclists, type of bicycle, number wearing headphones/earbuds and/or using a mobile phone, and whether the cyclist was wearing a helmet. Almost 25,000 cyclists were observed across the five selected locations (n = 24,861). Riders were almost four times more likely not to wear a helmet on rental bikes as compared with non-rentals (Citi Bike(®) OR 3.8; 95% CI 2.5, 5.9: other rental OR 3.8; 95% CI 3.0, 4.9). Significantly increased odds of not wearing a helmet were observed for females relative to males (OR 1.4; 95% CI 1.1, 1.8) across varied times and locations. Overall, rates of technology-related distraction were low, with headphone use being most prevalent. Males were more likely to wear headphones/earbuds (OR 2.0; 95% CI 1.4, 2.9), as were cyclists on Citi Bikes relative to other rental bikes (OR 2.2; 95% CI 1.3, 3.6). Findings from this study contribute to the growing literature on distracted biking and helmet use among bike share program riders and other cyclists and can inform policymakers and program planners aiming to improve bicycle safety in urban settings.

Maternal anemia associated with walkable distance to healthy food sources in Bronx, New York.

The relationship between walkable access to healthy food sources and risk of anemia in pregnancy was evaluated for a cohort of 4678 women who initiated prenatal care in the year 2010 at an academic medical center in Bronx, New York. After geocoding patient residences, street network distances were obtained for the closest healthy food sources, which were identified from multiple databases. For lower-income patients, as indicated by Medicaid or lack of health insurance, those who lived less than 0.25miles from a healthy food source were less likely to be anemic when compared to those who lived farther (adjusted OR=0.65, 95% CI 0.48, 0.88). Patients with commercial insurance showed no effect. These results help to understand how a nutritionally-mediated condition such as anemia during pregnancy can be affected by one's built environment, while also highlighting the importance of conditioning on socioeconomic status for these types of studies.

Breastfeeding practices in New York State maternity hospitals: results from a statewide survey.

OBJECTIVE: This study characterized maternity hospital breastfeeding practices in New York. METHODS: The New York State Department of Health Breastfeeding Survey was sent to 138 hospitals providing maternity services to assess breastfeeding and rooming-in policies, infant feeding practices, breastfeeding training, staff structure, and support mechanisms. Additionally, hospital-specific exclusive breastfeeding rates were obtained from Hospital Profile data. RESULTS: The response rate was 100%. Ninety-three percent of the hospitals allowed 24-hour rooming-in, in all postpartum rooms. Eighty-six percent of hospitals employed a designated lactation coordinator. Less than 1.5% of hospitals routinely gave formula, pacifiers, or glucose water to a breastfed infant. These supplements are most commonly provided because of the mother's request. The largest reported barrier to initiating breastfeeding in the hospital was presenting mothers with mixed messages, whereas the largest patient barrier was identified as the mother's culture. All hospitals provided obstetric nursing staff with lactation education, whereas 46.4% trained physicians. Among healthy births, exclusive breastfeeding was statistically more likely to occur in hospitals offering only basic care (Level I) or subspecialty care (Level III), relative to Regional Perinatal Centers delivering the highest level of care, and was more likely with hospitals outside of New York City, relative to those within the city. After controlling for hospital location and level of care, exclusive breastfeeding was statistically more likely in hospitals that initiate breastfeeding immediately following an uncomplicated vaginal or cesarean birth. CONCLUSIONS: Mothers should be encouraged to initiate breastfeeding immediately after birth. Practices of Level I hospitals that lead to increased breastfeeding should be identified.

Neighborhood-level built environment and social characteristics associated with serious childhood motor vehicle occupant injuries.

The effect of residential neighborhood characteristics on a child's risk of serious motor vehicle traffic occupant injuries was evaluated in New York State, USA, for the years 1993-2003, with particular focus on the effect of neighborhood walkability. Risk increased significantly (p < 0.0001) with decreasing street connectivity and as more workers commuted more than 30 min using means other than public transportation, along with more single-parent households and less college attainment in the neighborhood, regardless of whether New York City was in the study. After adjusting for age, gender and socio-economic community factors, the apparent loss of walkability in a child's neighborhood increases their risk of serious injury as an occupant of a motor vehicle.

Geographic prediction of human onset of West Nile virus using dead crow clusters: an evaluation of year 2002 data in New York State.

The risk of becoming a West Nile virus case in New York State, excluding New York City, was evaluated for persons whose town of residence was proximal to spatial clusters of dead American crows (Corvus brachyrhynchos). Weekly clusters were delineated for June-October 2002 by using both the binomial spatial scan statistic and kernel density smoothing. The relative risk of a human case was estimated for different spatial-temporal exposure definitions after adjusting for population density and age distribution using Poisson regression, adjusting for week and geographic region, and conducting Cox proportional hazards modeling, where the week that a human case was identified was treated as the failure time and baseline hazard was stratified by region. The risk of becoming a West Nile virus case was positively associated with living in towns proximal to dead crow clusters. The highest risk was consistently for towns associated with a cluster in the current or prior 1-2 weeks. Weaker, but positive associations were found for towns associated with a cluster in just the 1-2 prior weeks, indicating an ability to predict onset in a timely fashion.

Small area mapping of prostate cancer incidence in New York State (USA) using fully Bayesian hierarchical modelling.

BACKGROUND: As part of a long-term initiative to improve cancer surveillance in New York State, small area maps of relative risk, expressed as standardized incidence ratios (SIRs), were produced for the most common cancers. This includes prostate cancer, the focus of this paper, since it is the most common non-dermatologic malignancy diagnosed among men and the second leading cause of cancer deaths for men in the United States.ZIP codes were chosen as mapping units for several reasons, including the need to balance between protecting personal privacy and public demand for fine geographic resolution. Since the population size varies greatly among such small mapping units, hierarchical Bayes spatial modelling was applied in this paper to produce a map of smoothed SIRs. It is further demonstrated how other characteristics of the large sample from the stationary posterior distribution of SIRs can be mapped to investigate various aspects of the statewide spatial pattern of prostate cancer incidence. RESULTS: Thematic mapping of the median and 95 percentile range of SIRs provided, respectively, a map of spatially smoothed values and the uncertainty associated with these smoothed values. Maps were also produced to identify ZIP codes expressing a 95% probability, in the Bayesian paradigm, of being less than or greater than the null value of 1. CONCLUSION: The model behaved as expected since areas that were statistically elevated coincided with areas identified by the spatial scan statistic, plus the relative uncertainty increased as a ZIP code's population decreased, with an exaggerated effect for low population ZIP codes on the edge of the state border.The overall smoothed pattern, along with identified high and low areas, may reflect difference across the state with respect to socio-demographics and risk factors; however, this is confounded by potential differences in screening and diagnostic follow-up. Nevertheless, the Bayes modelling approach is shown to provide not only smoothed results, but also considerable other information from a large empirical distribution of outcomes associated with each mapping unit.