Exposure to different residential indoor characteristics during childhood and asthma in adolescence: a latent class analysis of the Danish National Birth Cohort.

BACKGROUND: Many residential indoor environments may have an impact on children's respiratory health. OBJECTIVES: The aims of this study were to identify latent classes of children from the Danish National Birth Cohort (DNBC) who share similar patterns of exposure to indoor home characteristics, and to examine the association between membership in the latent classes and asthma in adolescence. METHODS: We included data on residential indoor characteristics of offspring from the DNBC whose mothers had responded to the child's 11-year follow-up and who had data on asthma from the 18-year follow-up. Number of classes and associations were estimated using latent class analysis. To account for sample selection, we applied inverse probability weighting. RESULTS: Our final model included five latent classes. The probability of current asthma at 18 years was highest among individuals in class one with higher clustering on household dampness (9, 95%CI 0.06-0.13). Individuals in class four (with higher clustering on pets ownership and living in a farm) had a lower risk of current asthma at age 18 compared to individuals in class one (with higher clustering on household dampness) (OR 0.53 (95%CI 0.32-0.88), p = .01). CONCLUSION: Our findings suggest that, in a high-income country such as Denmark, groups of adolescents growing up in homes with mold and moisture during mid-childhood might be at increased risk of current asthma at age 18. Adolescents who grew-up in a farmhouse and who were exposed to pets seem less likely to suffer from asthma by age 18.

Food allergens in mattress dust in Norwegian homes - a potentially important source of allergen exposure.

BACKGROUND: Sensitization to food allergens and food allergic reactions are mostly caused by ingesting the allergen, but can also occur from exposure via the respiratory tract or the skin. Little is known about exposure to food allergens in the home environment. OBJECTIVE: The objective of this study was firstly to describe the frequency of detection of allergens from fish, egg, milk, and peanut in mattress dust collected from homes of 13-year-old adolescents and secondly to identify home characteristics associated with the presence of food allergen contamination in dust. METHODS: Food allergens were measured by dot blot analysis in mattress dust from 143 homes in Oslo, Norway. We analysed associations between home characteristics (collected by parental questionnaires and study technicians) and food allergens by multivariate regression models. RESULTS: Fish allergen was detected in 46%, peanut in 41%, milk in 39%, and egg allergen in 22% of the mattress dust samples; only three samples contained none of these allergens. All four food allergens were more frequently detected in mattresses in small dwellings (< 100 m(2)) than larger dwellings (≥ 130 m(2)); 63-71% of the small dwellings (n = 24) had milk, peanut, and fish allergens in the samples compared with 33-44% of the larger dwellings (n = 95). Milk, peanut, and egg allergens were more frequently detected in homes with bedroom and kitchen on the same floor as compared with different floors, with odds ratios of 2.5 (95% confidence interval (CI): 1.1, 5.6) for milk, 2.4 (95% CI: 1.0, 6.1) for peanut, and 3.1 (95% CI: 1.3, 7.5) for egg allergens. CONCLUSIONS AND CLINICAL RELEVANCE: Food allergens occurred frequently in beds in Norwegian homes, with dwelling size and proximity of kitchen and bedroom as the most important determinants. Due to the amount of time children spent in the bedroom, mattress dust may be an important source of exposure to food allergens.

Sex-differences in the effects of indoor air pollutants and household environment on preschool child cognitive development.

Air pollution, outdoor residential environment, indoor household characteristics, and parental mental health are potential factors associated with child development. However, few studies have simultaneously analyzed the association between the aforementioned factors and preschool child (aged 2-5 years) development. This study investigated the effects of those factors on child development and their potential modifying effects. A total of 142 participants were recruited from a birth cohort study in the Greater Taipei Area, and the evaluation was conducted at each participant's home from 2017 to 2020. Child cognitive development was assessed by psychologists using the Bayley Scales of Infant and Toddler Development and the Wechsler Preschool & Primary Scale of Intelligence. Household air pollutants, outdoor residential environment, indoor household characteristics, parental mental health, and other covariates were evaluated. Multiple regressions were used to examine the relationships between child development and covariates. Stratified analysis by child sex and parental mental health was conducted. Average indoor air pollutant levels were below Taiwan's Indoor Air Quality Standards. After adjustment for covariates, the indoor total volatile organic compounds (TVOCs) level was significantly associated with poor child development (per interquartile range increase in the TVOC level was associated with a 5.1 percentile decrease in child cognitive development). Sex difference was observed for the association between TVOC exposure and child development. Living near schools, burning incense at home, purchasing new furniture, and parental anxiety were related to child development. Indoor TVOC level was associated with poor child cognitive development, specifically with the girls. Indoor and outdoor residential environment and parental anxiety interfered with child development. TVOCs should be used cautiously at home to minimize child exposure. A low-pollution living environment should be provided to ensure children's healthy development.

Associations between phthalic acid esters in house dust and home characteristics/living habits in a rural region of Taiwan.

Phthalic acid esters (PAEs) commonly used as plasticizers are distributed ubiquitously in the living environment. We conducted a field study to examine the associations between PAE residue in dust and home characteristics/living habits in 47 rural homes in Taiwan. A questionnaire regarding home characteristics/living habits and composite sampling of house dust were conducted in each participating home. Five PAEs were selected for analysis on gas chromatography-mass spectrometry with the limits of quantification being 0.5 ng/g or lower. Uni- and multivariate linear regression analyses were performed for examining the associations. The five PAEs were prevalently detected from the samples, and the concentrations were below 1000 ng/g; di(2-ethylhexyl) phthalate (DEHP) was the most frequently detected PAE (85%), whereas di-isobutyl phthalate (DiBP) appeared to the most abundant congener with the maximum concentration of 807.65 ng/g. Floor cleaning frequency and use of detergents for floor cleaning were significantly associated with DEHP in dust (P < 0.05), suggesting additives of plasticizers in detergent products. The factors of plastic wraps in storage and use of disposable cups were both significantly related to DiBP (P < 0.01), which could be extensively used in food packaging products. We confirmed that several home characteristics/living habits were related to certain PAE residue in dust.

Nursing Home and Market Factors and Risk-Adjusted Hospitalization Rates Among Urban, Micropolitan, and Rural Nursing Homes.

OBJECTIVES: Hospitalizations are common among long-stay nursing home (NH) residents, but the role of rurality in hospitalization is understudied. This study examines the relationships between rurality, NH, and market characteristics and NH quarterly risk-adjusted hospitalization rates of long-stay residents over 10 quarters (2011 Q2-2013 Q3). DESIGN: The longitudinal associations of NH and market factors and hospitalization rates were modeled separately on urban, micropolitan, and rural NHs using generalized estimating equation models and a fully interacted model of all NH and market characteristics with micropolitan and rural indicators to test significance of differences compared with urban NHs. SETTING AND PARTICIPANTS: In total, 14,600 unique NHs. MEASURES: Risk-adjusted hospitalization rates were calculated from 2011 to 2013 national Medicare claims and NH Minimum Data Set 3.0. Rurality was defined based on the 2010 Rural Urban Commuting Area codes. NH and market characteristics were extracted from Certification and Survey Provider Enhanced Reporting and Area Health Resources File. RESULTS: Over the study period, risk-adjusted hospitalization rates averaged 9.8% (standard deviation = 8.2%). No difference was found in the overall hospitalization rates of long-stay NH residents among urban, micropolitan, and rural NHs. Generalized estimating equation models show that urban NHs with higher percentages of Medicare and Medicaid residents and any nurse practitioner/physician assistant were associated with lower rates, but these associations were insignificant in rural settings. Higher registered nurse to total nurses ratio was only associated with lower hospitalization rates in urban settings. Higher median household income was associated with lower hospitalization rates in micropolitan and rural NHs. CONCLUSIONS/IMPLICATIONS: Rurality is not associated with hospitalization rates of long-stay residents, but NH and market factors (eg, payer distribution, staffing, and population income) may affect hospitalization differently in micropolitan/rural NHs than urban NHs. Future intervention on hospitalization should target factors unique to micropolitan/rural NHs which adopt strategies appropriate to their setting.

Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act.

OBJECTIVE: In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examines trends in facility, resident, and quality characteristics since passage of that legislation. METHODS: We conducted univariate analyses of national data on US NHs from 3 sources: (1) the 1985 National Nursing Home Survey (NNHS), (2) the 1992-2015 Online Survey Certification and Reporting (OSCAR) Data, and (3) LTCfocUS data for 2000-2015. We examined changes in NH characteristics, resident composition, and quality. SETTING AND PARTICIPANTS: US NH facilities and residents between 1985 and 2015. RESULTS: The proportion of NHs that are Medicare and Medicaid certified, members of chains, and operating not-for-profit has increased over the past 30 years. There have also been reductions in occupancy and increases in the share of residents who are racial or ethnic minorities, admitted for post-acute care, in need of physical assistance with daily activities, primarily supported by Medicare, and diagnosed with a psychiatric condition such as schizophrenia. With regard to NH quality, direct care staffing levels have increased. The proportion of residents physically restrained has decreased dramatically, coupled with changes in inappropriate antipsychotic (chemical restraint) use. CONCLUSIONS AND IMPLICATIONS: Together with changes in the long-term care market, the NHs of today look very different from NHs 30 years ago. The 30th anniversary of OBRA provides a unique opportunity to reflect, consider what we have learned, and think about the future of this and other sectors of long-term care.

Indicators of airborne fungal concentrations in urban homes: understanding the conditions that affect indoor fungal exposures.

Indoor fungal exposure can compromise respiratory health. Low-income urban areas are of concern because of high asthma and allergy rates and housing disrepair. Understanding the conditions that affect indoor fungal exposures is important for assessing health risks and for developing mitigation strategies. We examined the types and concentrations of airborne fungi inside and outside of homes in low-income areas of Syracuse, NY as well as the effect of snow cover on fungal levels. At 103 homes, air samples for viable fungi were collected, occupants were interviewed and homes were inspected for visible mold, musty odors, water problems and other factors. Multivariable logistic regression was used to relate high fungal levels to home conditions. Predominant indoor fungi included Cladosporium, Penicillium, Aspergillus, Alternaria and hyaline unknowns. Basidiomycetes and an uncommon genus Acrodontium were also found frequently due to analysis methods developed for this project. With snow cover, outdoor total fungal levels were depressed and indoor concentrations were three times higher than outdoor on average with a maximum of 29 times higher. Visible mold was related to elevated levels of Penicillium (OR 4.11 95% CI 1.37-14.0) and bacteria (OR 3.79 95% CI 1.41-11.2). Musty, moldy odors were associated with elevated concentrations of total fungi (OR 3.48 95% CI 1.13-11.6) and basidiomycetes. Cockroaches, an indicator of moisture, were associated with elevated levels of Penicillium (OR 3.66 95% CI 1.16-13.1) and Aspergillus (OR 4.36 95% CI 1.60-13.4). Increasing relative humidity was associated with higher concentrations of Penicillium, yeasts and basidiomycetes. Visible mold, musty odors, indoor humidity and cockroaches are modifiable factors that were important determinants of indoor fungal exposures. Indoor air investigators should interpret indoor:outdoor fungal ratios cautiously when snow cover is present.