Polychlorinated biphenyl exposure and neuropsychological status among older residents of upper Hudson River communities.

BACKGROUND: Polychlorinated biphenyls (PCBs) may accelerate the cognitive and motor dysfunction found in normal aging, but few studies have examined these outcomes and PCB exposure among older adults. OBJECTIVE: We evaluated neuropsychological status and low-level PCB exposure among older adults living along contaminated portions of the upper Hudson River in New York. METHODS: A total of 253 persons between 55 and 74 years of age were recruited and interviewed, and provided blood samples for congener-specific PCB analysis. Participants also underwent a neuropsychological battery consisting of 34 tests capable of detecting subtle deficits in cognition, motor function, affective state, and olfactory function. RESULTS: After adjustment for potential confounders, the results indicated that an increase in serum total PCB concentration from 250 to 500 ppb (lipid basis) was associated with a 6.2% decrease in verbal learning, as measured by California Verbal Learning Test trial 1 score (p = 0.035), and with a 19.2% increase in depressive symptoms, as measured by the Beck Depression Inventory (p = 0.007). CONCLUSIONS: The results suggest that exposure to PCBs may be associated with some measures of memory and learning and depression among adults 55-74 years of age whose current body burdens are similar to those of the general population. Although the results are useful in delineating the neuropsychological effects of low-level exposure to PCBs, further studies of whether older men and women are a sensitive subpopulation are needed.

Self-reported home environmental risk factors for childhood asthma: a cross-sectional study of children in Buffalo, New York.

We present prevalence estimates of indoor and outdoor environmental risk factors for asthma from a cross-sectional study of children 1 to 17 years of age living in Buffalo, New York. A child's primary caretaker completed a questionnaire about the household's demographics, lifestyle habits, housing, indoor and outdoor environment, and the child's activity patterns, family history of asthma, asthma symptoms and treatment, and medical care access. Significant environmental risk factors were presence of smokers in the household, humidifier or vaporizer use, chemical odors indoors, frequent truck traffic, and chemical odors outdoors. Most of these risk factors can be mitigated or controlled.

Outdoor air PCB concentrations in three communities along the Upper Hudson River, New York.

Outdoor air polychlorinated biphenyl (PCB) concentrations were measured in upstate New York as part of a nonoccupational exposure investigation. The adjacent study communities of Hudson Falls and Fort Edward contain numerous sites of current and former PCB contamination, including two capacitor-manufacturing facilities. Outdoor air PCB concentrations in the study municipalities were significantly higher than in the comparison municipality of Glens Falls. Total PCB concentrations in the study area ranged from 0.102 to 4.011 ng/m(3) (median: 0.711 ng/m(3)). For the comparison area, concentrations ranged from 0.080 to 2.366 ng/m(3) (median: 0.431 ng/m(3)). Although our sampling was not designed to identify point sources, the presence of PCB-contaminated sites in the study area likely contributed to this observed difference in concentration. While elevated relative to the comparison area, total PCB concentrations in the study area are lower than those in other communities with known PCB-contaminated sites, and similar to levels reported in other locations from the northeastern United States.

Adverse birth outcomes and maternal exposure to trichloroethylene and tetrachloroethylene through soil vapor intrusion in New York State.

BACKGROUND: Industrial spills of volatile organic compounds (VOCs) in Endicott, New York (USA), have led to contamination of groundwater, soil, and soil gas. Previous studies have reported an increase in adverse birth outcomes among women exposed to VOCs in drinking water. OBJECTIVE: We investigated the prevalence of adverse birth outcomes among mothers exposed to trichloroethylene (TCE) and tetrachloroethylene [or perchloroethylene (PCE)] in indoor air contaminated through soil vapor intrusion. METHODS: We examined low birth weight (LBW), preterm birth, fetal growth restriction, and birth defects among births to women in Endicott who were exposed to VOCs, compared with births statewide. We used Poisson regression to analyze births and malformations to estimate the association between maternal exposure to VOCs adjusting for sex, mother's age, race, education, parity, and prenatal care. Two exposure areas were identified based on environmental sampling data: one area was primarily contaminated with TCE, and the other with PCE. RESULTS: In the TCE-contaminated area, adjusted rate ratios (RRs) were significantly elevated for LBW [RR = 1.36; 95% confidence interval (CI): 1.07, 1.73; n = 76], small for gestational age (RR = 1.23; 95% CI: 1.03, 1.48; n = 117), term LBW (RR = 1.68; 95% CI: 1.20, 2.34; n = 37), cardiac defects (RR = 2.15; 95% CI: 1.27, 3.62; n = 15), and conotruncal defects (RR = 4.91; 95% CI: 1.58, 15.24; n = 3). In the PCE-contaminated area, RRs for cardiac defects (five births) were elevated but not significantly. Residual socioeconomic confounding may have contributed to elevations of LBW outcomes. CONCLUSIONS: Maternal residence in both areas was associated with cardiac defects. Residence in the TCE area, but not the PCE area, was associated with LBW and fetal growth restriction.

Polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs) and neuropsychological status among older adults in New York.

Polybrominated diphenyl ethers (PBDEs) are emerging environmental contaminants, but little is known about their possible human health effects. The objective of this study is to evaluate the association between exposure to PBDEs and neuropsychological function among older adults and the possibility of effect modification with polychlorinated biphenyls (PCBs). Serum samples were analyzed for concentrations of 9 PBDE and 30 PCB congeners and 34 tests of cognitive and motor function, affective state, and olfactory function were assessed among 144 men and women of 55-74 years of age. After adjustment for relevant confounders, no overall associations were observed between the sum of the PBDE congener concentrations in serum (∑ PBDE) and scores on the neuropsychological tests. However, statistically significant interactions were found between PBDEs and PCBs for some measures of verbal learning and memory. Among persons with ∑ PCB concentrations at or above the median of 467ppb (lipid basis), an increase in ∑ PBDE concentrations from the 25th to 75th percentile was associated with decreases between 7% and 12% on scores for certain subscales of the California Verbal Learning Test. In contrast, no statistically significant associations were observed for PBDEs among persons with ∑ PCB levels below the median. The results suggest that PBDEs and PCBs may interact to affect verbal memory and learning among persons 55-74 years old. This is the first study to evaluate the neuropsychological effects of PBDEs in adults and the possibility of synergy with PCBs in humans.

Polychlorinated biphenyls (PCBs) in indoor air and in serum among older residents of upper Hudson River communities.

A study was conducted to evaluate the association between PCBs in residential indoor air and in the serum of older, long time residents of three upper Hudson River communities. Samples of indoor air and of serum were collected from 170 persons 55 to 74 years of age, and analyzed for PCBs using glass capillary gas chromatography. After adjusting for age, BMI, cigarette smoking, and Hudson River fish consumption with multiple linear regression analysis, the results indicated statistically significant associations between concentrations in indoor air and serum for PCB-28, a lightly chlorinated congener common in air that accumulates in serum, and PCB-105. Duration of exposure was an important factor, since among persons who had lived in their home for 39 years or more, 11 of the 12 most commonly detected congeners were significantly correlated, as was their sum (∑ PCB). Significant associations between indoor air and serum PCB concentrations also were more likely when collected in cooler months and if the two samples were collected within 20 d of each other. The study is among the first to indicate that PCB concentrations characteristic of residential indoor air are associated with a detectable increase in body burden.

Respiratory and cardiovascular hospitalizations after the World Trade Center disaster.

The objective of this study was to determine whether there were increases in respiratory and cardiovascular hospital admissions among residents of lower Manhattan after the destruction of the World Trade Center. The authors used hospital admission records from 1991 to 2001 with a diagnosis of respiratory, cardiovascular, or cerebrovascular illness and a residential address in lower Manhattan or Queens. The authors assessed the change in admissions by comparing lower Manhattan to Queens (the control area) and before and after 9/11 admissions in lower Manhattan. They found the following significant increases in hospital admissions: for respiratory illnesses during the weeks of 9/11/01 and 10/16/01; asthma during the week of 9/11/01; cardiovascular during the weeks of 9/18/01 and 10/9/01; cerebrovascular during the weeks of 9/11/01, 9/18/01, 10/2/01, and 10/9/01. There was an immediate increase in respiratory admissions after the disaster and a delayed increase in cardiovascular and cerebrovascular admissions.

Environmental exposures to polychlorinated biphenyls (PCBs) among older residents of upper Hudson River communities.

The upper Hudson River has been heavily contaminated with polychlorinated biphenyls (PCBs) due to discharges from former electrical capacitor plants in Hudson Falls and Fort Edward, NY. An epidemiologic study was conducted to assess the impact of dietary and residential exposure on PCB body burden among older, long-term, non-occupationally exposed adults living in the vicinity of these former capacitor plants. The study population consisted of 133 persons 55-74 years of age who had lived in Hudson Falls or Fort Edward for 25 years or more. The comparison group consisted of 120 persons from Glens Falls, which is upriver. Both groups were interviewed, and blood samples were obtained for congener-specific PCB analysis. Persons from the study area reported greater past consumption of Hudson River fish than did the comparison area, but current rates were very low in both areas. The geometric mean serum PCB concentrations for the study and comparison populations did not differ significantly (3.07 ppb wet weight and 3.23 ppb, respectively, for total PCB). Serum PCB concentrations increased with cumulative lifetime exposure to PCBs from Hudson River fish consumption (p<0.10). Persons who lived within 800 m of the river did not have significantly greater serum PCB concentrations than the control population, nor did persons who lived downwind and within 800 m of a PCB-contaminated site. The results indicate no detectable differences in serum PCB levels according to proximity or wind direction relative to local point sources, but lifetime consumption of Hudson River fish was positively associated with serum PCB concentrations.

Upper respiratory symptoms and other health effects among residents living near the World Trade Center site after September 11, 2001.

The authors investigated changes in respiratory health after September 11, 2001 ("9/11") among residents of the area near the World Trade Center (WTC) site in New York City as compared with residents of a control area. In 2002, self-administered questionnaires requesting information on the presence and persistence of respiratory symptoms, unplanned medical visits, and medication use were sent to 9,200 households (22.3% responded) within 1.5 km of the WTC site (affected area) and approximately 1,000 residences (23.3% responded) in Upper Manhattan, more than 9 km from the site (control area). Residents of the affected area reported higher rates of new-onset upper respiratory symptoms after 9/11 (cumulative incidence ratio = 2.22, 95% confidence interval (CI): 1.88, 2.63). Most of these symptoms persisted 1 year after 9/11 in the affected area. Previously healthy residents of the affected area had more respiratory-related unplanned medical visits (prevalence ratio = 1.73, 95% CI: 1.13, 2.64) and more new medication use (prevalence ratio = 2.89, 95% CI: 1.75, 4.76) after 9/11. Greater impacts on respiratory functional limitations were also found in the affected area. Although bias may have contributed to these increases, other analyses of WTC-related pollutants support their biologic plausibility. Further analyses are needed to examine whether these increases were related to environmental exposures and to monitor long-term health effects.

An evaluation of the asthma intervention of the New York State Healthy Neighborhoods Program.

BACKGROUND: The Healthy Neighborhoods Programs (HNP) are funded by the Federal Preventive Health and Health Services block grants and administered by the New State Department of Health (NYSDOH). Eight county and local health departments are funded for 3 years for a total of $1.25 million per year to target households at risk for environmental health and safety hazards. The HNP asthma intervention uses home visits to identify asthmatics, assess asthma morbidity and management, and identify environmental asthma triggers. Outreach workers provide education about asthma, referrals, and controls for asthma triggers. The purpose of this evaluation was to assess the impact of the HNP asthma intervention for the 1997-1999 funding cycle and for the first year of the 2000-2002 funding cycle. Because of changes in reporting requirements across the funding cycles, the findings for 1997-1999 and 2000 were analyzed separately. METHODS: We analyzed one final outcome measure, the rate of self-reported hospitalizations (admissions and emergency room visits), and three intermediate outcome measures (the percent of homes with cockroaches, the percent of asthmatics with a written management plan, and the percent of asthmatics using a peak flow meter). We also estimated the net savings resulting from a reduction in hospital admissions due to asthma. RESULTS: For the 1997-1999 funding cycle, the average hospitalization rate was 86 hospitalizations per 100 asthmatics per year at the intervention visit (i.e., the baseline rate) and 44.5 at the 1-year follow-up, a decrease of 48%. This was a larger decrease than the 24% average annual decrease in the baseline rates during the 3 years. In 2000, there were 96 hospitalizations per 100 asthmatics per year at the intervention visit and 25 at the one-year follow-up, a decrease of 74%. In 2000 there were about 110 fewer hospital admissions thought to be due to the net effects of the HNP intervention, resulting in an estimated gross savings of $905,300 (110 x $8,230). After subtracting the estimated cost of the asthma intervention ($624,683), the net savings were $280,617. CONCLUSION: New York's HNP seems to be succeeding in reducing asthma morbidity as measured by the hospitalization rates among asthmatics who have received the intervention. The HNP was successful in decreasing cockroach infestation in HNP homes. A standardized evaluation methodology and instrument are necessary to conduct a more rigorous evaluation of the HNP.

Longitudinal study of energy and nutrient intakes for infants from low-income, urban families.

OBJECTIVE: To assess the energy and nutrient intakes of healthy infants from low-income families and to compare intakes with current recommendations. DESIGN: We interviewed mother-infant pairs longitudinally when the infants were 3, 6, 9, 12, 18 and 24 months old. Food intake data were obtained by 24-hour dietary recalls. Selected nutrient intakes were calculated and compared with the Recommended Dietary Allowances (RDAs). SUBJECTS/SETTING: Infants were the offspring of low-income, pregnant women recruited at the Albany County Department of Health, New York for the Albany Pregnancy and Infancy Lead Study, a prospective investigation of factors related to blood lead levels, including nutrition. Interviews were conducted during paediatric clinic visits. STATISTICAL ANALYSES PERFORMED: Means and standard deviations were used to describe energy and micronutrient intakes for age groups. The probability approach was utilised to examine the prevalence of inadequate intakes. RESULTS: Mean energy and nutrient intakes generally met or exceeded the RDA. The exceptions were vitamin D and zinc for which observed means were below the RDA at several data points. Protein consumption was exceptionally high in this sample. The highest estimated prevalences of inadequate intakes were observed for iron, zinc and vitamin D at the older ages. CONCLUSIONS: This study identified several potential concerns about the diets of infants during the transition from infant food and formula to table foods. Low intakes of vitamin D, zinc and iron, especially at 12 and 18 months, were observed. High protein intakes were noted at all ages.

Prevalence and predictors of respiratory symptoms among New York farmers and farm residents.

BACKGROUND: Data from telephone interviews with New York farmers and farm residents were used to study the prevalence and risk factors of symptoms that could be related to asthma and allergies. METHODS: Participants were asked if they had wheezing or whistling in the chest in the past year and about the occurrence of stuffy, itchy, runny nose or watery, itchy eyes in the past year. RESULTS: The prevalence of wheeze was 18.2% and of stuffy nose/watery eyes was 57.4% (N = 1,620). Significant risk factors for wheeze were cigarette smoking, a systemic reaction to allergy skin testing, immunotherapy, or insect sting, reactivity to a pet, having goats, and more acreage in corn for silage. Significant risk factors of stuffy nose/watery eyes were younger age, having more than a high school education, being a worker on the farm, and having done spraying. CONCLUSIONS: Wheeze may be indicative of existing or latent asthma, a potentially limiting respiratory illness. Stuffy, itchy, runny nose or watery, itchy eyes, which may cause irritation and discomfort, may also indicate an increased sensitivity to respirable dusts and chemicals. This cohort of New York farmers had significant farm-related risk factors for wheeze and stuffy nose/watery eyes.

Índices prognósticos em Medicina Intensiva / Prognostic index in intensive medicine

Os objetivos propostos para o emprego dos índices prognósticos em pacientes graves podem ser resumidos em quatro grandes áreas de interesse para o intensivista: 1. Permitem aos médicos focalizarem sua atenção àqueles pacientes que podem mais podem mais se beneficiar do tratamento intensivo. 2. Permitem complementar o juízo clínico na limitação ou suspensão do suporte avançado de vida. 3. Permitem a comparação de desempenho entre diferentes unidades. 4. Permitem estratificar grupos de pacientes para a avaliação de novas tecnologias e procedimentos terapêuticos