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BACKGROUND: Per and polyfluoroalkyl substances (PFAS), a class of environmentally and biologically persistent chemicals, have been used across many industries since the middle of the 20th century. Some PFAS have been linked to adverse health effects. OBJECTIVE: Our objective was to incorporate known and potential PFAS sources, physical characteristics of the environment, and existing PFAS water sampling results into a PFAS risk prediction map that may be used to develop a PFAS water sampling prioritization plan for the Colorado Department of Public Health and Environment (CDPHE). METHODS: We used random forest classification to develop a predictive surface of potential groundwater contamination from two PFAS, perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA). The model predicted PFAS risk at locations without sampling data into one of three risk categories after being "trained" with existing PFAS water sampling data. We used prediction results, variable importance ranking, and population characteristics to develop recommendations for sampling prioritization. RESULTS: Sensitivity and precision ranged from 58% to 90% in the final models, depending on the risk category. The model and prioritization approach identified private wells in specific census blocks, as well as schools, mobile home parks, and public water systems that rely on groundwater as priority sampling locations. We also identified data gaps including areas of the state with limited sampling and potential source types that need further investigation. IMPACT STATEMENT: This work uses random forest classification to predict the risk of groundwater contamination from two per- and polyfluoroalkyl substances (PFAS) across the state of Colorado, United States. We developed the prediction model using data on known and potential PFAS sources and physical characteristics of the environment, and "trained" the model using existing PFAS water sampling results. This data-driven approach identifies opportunities for PFAS water sampling prioritization as well as information gaps that, if filled, could improve model predictions. This work provides decision-makers information to effectively use limited resources towards protection of populations most susceptible to the impacts of PFAS exposure.
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The western United States is home to most of the nation's oil and gas production and, increasingly, wildfires. We examined historical threats of wildfires for oil and gas wells, the extent to which wildfires are projected to threaten wells as climate change progresses, and exposure of human populations to these wells. From 1984-2019, we found that cumulatively 102,882 wells were located in wildfire burn areas, and 348,853 people were exposed (resided ≤ 1 km). During this period, we observed a five-fold increase in the number of wells in wildfire burn areas and a doubling of the population within 1 km of these wells. These trends are projected to increase by late century, likely threatening human health. Approximately 2.9 million people reside within 1 km of wells in areas with high wildfire risk, and Asian, Black, Hispanic, and Native American people have disproportionately high exposure to wildfire-threatened wells.
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Introduction: Emerging risk factors for atrial fibrillation (AF) incidence and episodes (exacerbation), the most common and clinically significant cardiac arrhythmia, include air and noise pollution, both of which are emitted during oil and natural gas (O&G) well site development. Methods: We evaluated AF exacerbation risk and proximity to O&G well site development by employing a novel data source and interrupted time-series design. We retrospectively followed 1,197 AF patients living within 1-mile of an O&G well site (at-risk of exposure) and 9,764 patients living >2 miles from any O&G well site (unexposed) for AF claims in Colorado's All Payer Claims Dataset before, during, and after O&G well site development. We calculated AF exacerbation risk with multi-failure survival analysis. Results: The analysis of the total study population does not provide strong evidence of an association between AF exacerbation and proximity to O&G wells sites during (HR = 1.07, 95% CI: 0.94, 1.22) or after (HR = 1.01, 95% CI: 0.88, 1.16) development. However, AF exacerbation risk differed by patient age and sex. In patients >80 years living within 0.39 miles (2,059 feet) of O&G well site development, AF exacerbation risk increased by 83% (HR = 1.83, 95% CI: 1.25, 2.66) and emergency room visits for an AF event doubled (HR = 2.55, 95% CI: 1.50, 4.36) during development, with risk increasing with proximity. In female patients living within 0.39 miles of O&G well site development, AF exacerbation risk increased by 56% percent (95% CI: 1.13, 2.15) during development. AF exacerbation risk did not persist past the well development period. We did not observe increased AF exacerbation risk in younger or male patients. Discussion: The prospect that proximity to O&G well site development, a significant noise and air pollution source, may increase AF exacerbation risk in older and female AF patients requires attention. These findings support appropriate patient education to help mitigate risk and development of mitigation strategies and regulations to protect the health of populations in O&G development regions.
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BACKGROUND: Researchers have used commercial databases containing residential addresses to reduce exposure misclassification in case-control studies. Our objective is to evaluate the potential systematic bias regarding case status when reconstructing residential locations from commercial databases. METHODS: Our study population of 3640 Colorado-born children includes 520 children diagnosed with acute lymphocytic leukemia between 2002 and 2019. We aligned addresses and date ranges obtained from LexisNexis with registry dates to determine three dichotomous outcomes: Found in LexisNexis, conception date found in LexisNexis, and reference date/diagnosis date found in LexisNexis. We applied logistic regression to determine whether outcomes differed by case status. RESULTS: Mothers of cases were 39% more likely to be found in LexisNexis than mothers of controls (OR = 1.39, 95% CI: 0.97, 2). Of the mothers found in LexisNexis, a conception address was 33% more likely (OR= 1.33, 95% CI: 1.06, 1.66) and a reference/diagnosis address was 60% more likely (OR= 1.60, 95% CI: 1.21, 2.12) to be found for mothers of cases than mothers of controls. CONCLUSION: This study indicates that use of commercial databases to reconstruct residential locations may systematically bias results in case-control studies of childhood cancers.
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Bases de Datos Factuales , Estudios de Factibilidad , Sistema de Registros , Humanos , Sistema de Registros/estadística & datos numéricos , Femenino , Niño , Estudios de Casos y Controles , Masculino , Preescolar , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Colorado/epidemiología , Lactante , Adolescente , Neoplasias/epidemiologíaRESUMEN
We evaluated the sensitivity of estimated PM2.5 and NO2 health impacts to varying key input parameters and assumptions including: 1) the spatial scale at which impacts are estimated, 2) using either a single concentration-response function (CRF) or using racial/ethnic group specific CRFs from the same epidemiologic study, 3) assigning exposure to residents based on home, instead of home and work locations for the state of Colorado. We found that the spatial scale of the analysis influences the magnitude of NO2, but not PM2.5, attributable deaths. Using county-level predictions instead of 1 km2 predictions of NO2 resulted in a lower estimate of mortality attributable to NO2 by â¼ 50 % for all of Colorado for each year between 2000 and 2020. Using an all-population CRF instead of racial/ethnic group specific CRFs results in a 130 % higher estimate of annual mortality attributable for the white population and a 40 % and 80 % lower estimate of mortality attributable to PM2.5 for Black and Hispanic residents, respectively. Using racial/ethnic group specific CRFs did not result in a different estimation of NO2 attributable mortality for white residents, but led to â¼ 50 % lower estimates of mortality for Black residents, and 290 % lower estimate for Hispanic residents. Using NO2 based on home instead of home and workplace locations results in a smaller estimate of annual mortality attributable to NO2 for all of Colorado by 2 % each year and 0.3 % for PM2.5. Our results should be interpreted as an exercise to make methodological recommendations for future health impact assessments of pollution.
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Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisis , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Material Particulado/efectos adversos , Material Particulado/análisis , Colorado/epidemiología , Dióxido de Nitrógeno/análisis , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisisRESUMEN
City and County of Broomfield (CCOB) residents reported over 500 health concerns between January 2020 and December 2021. Our objective was to determine if CCOB residents living within 1 mile of multi-well unconventional oil and gas development (UOGD) sites reported more frequent health symptoms than residents living > 2 miles away. We invited 3993 randomly selected households to participate in a health survey. We applied linear regression to test associations between distance to UOGD and summed Likert scores for health symptom categories. After covariate adjustment, respondents living within 1 mile of one of CCOB's UOGD sites tended to report higher frequencies of upper respiratory, lower respiratory, gastrointestinal and acute symptoms than respondents living more than 2 miles from the sites, with the largest differences for upper respiratory and acute symptoms. For upper respiratory and acute symptoms, scores differed by 0.81 (95% CI: 0.06, 2.58) and 0.75 (95% CI: 0.004, 1.99), respectively. Scores for adults most concerned about air pollution, noise and odors trended higher within 1 mile for all symptom categories, while scores among adults least concerned trended lower. Scores trended higher for lower respiratory, gastrointestinal and acute symptoms in children living within 2 miles of UOGD, after covariate adjustment. We did not observe any difference in the frequency of symptoms reported in unadjusted results. Additional study is necessary to understand relationships between proximity to UOGD and health symptoms.
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Contaminación del Aire , Adulto , Niño , Humanos , Colorado , Ruido , Encuestas EpidemiológicasRESUMEN
CONTEXT: Colorado is experiencing dramatic changes related to population growth, climate change, and expanded industrial activity. Local and state public health professionals are trying to address a growing array of unique public health issues with stagnant or limited resources. OBJECTIVES: To understand, through perspectives from local and state public health professionals, the alignment of contemporary environmental and community health issues with state and local capacity and state environmental public health-tracking priorities. DESIGN: During 2014-2015, we conducted semistructured interviews which informed the development of a statewide survey of Colorado's professionals from public health, emergency management, forestry, and transportation. SETTING: This work took place in Colorado. PARTICIPANTS: Fifteen professionals from public (n = 9), academic (n = 4), and private (n = 2) sectors were interviewed. Forty-seven professionals, representing 34 counties and 40 public agencies, completed the 25-minute online survey. MAIN OUTCOME MEASURES: Environmental and community health concerns; contributing factors to environmental concerns; strengths and limitations of capacity to respond to issues; and frequency of community engagement activities. RESULTS: Top environmental health concerns were indoor air pollution (eg, radon), outdoor air pollution, and waste management. Transportation, extreme weather (eg, wildfires), and oil and gas development were most frequently reported as major contributing factors to concerns. Obesity, physical inactivity, and mental illness were the top community health concerns. To remain prepared for emerging challenges, professionals cited a need for more spatiotemporal-refined data related to their top concerns in the environmental public health-tracking database, and support from local, state, and federal agencies, in addition to personnel and funding. To address concerns, participants reported frequently working with government officials, advisory committees, and media outlets. CONCLUSIONS: This project illuminates opportunities to strengthen connections between the state's environmental public health-tracking priorities and local-level capacity related to professionals' top concerns. It also suggests reinforcing and broadening partnerships to improve data infrastructure and inform environmental public health priorities.
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Salud Ambiental , Salud Pública , Colorado , Participación de la Comunidad , Agencias Gubernamentales , HumanosRESUMEN
BACKGROUND: Healthcare organisations require systems to consistently meet the needs of their patients while providing excellent quality of care. The value improvement (VI) approach was developed by the Institute for healthcare improvement and successfully piloted at Raigmore Hospital, Scotland. It showed positive results in improving outcomes and reducing costs. Our multidisciplinary team from a tertiary care cardiac hospital in Doha, Qatar wanted to see if we could improve value in a clinically and geographically distinct context. We sought to understand the effectiveness of this approach as an integrative management philosophy that aims for continuous improvement in the quality of services by increasing efficiency and reducing waste. METHODS: This study evaluates the outcomes achieved from applying the VI methodology. The method is rooted in a framework that emphasises standardisation, continuous process improvement and rightsizing capacity to demand. The main tools include a data box score, a visual management board and weekly communication huddles. RESULTS: As a result of the VI methodology, our team achieved improvements across performance, staff capacity and cost domains. Compared with the 4-8 weeks baseline data collection period, these improvements included an increase in discharges before 13:00 hour by 61%, a reduction in the number of blood samples per patient per day by 20%, an increase in nursing time spent in direct patient care by 18%, and an increase in staff satisfaction to 40%. CONCLUSIONS: We found that the VI approach offered a systematic method for continuously improving the quality of care by focusing attention each week on safety, efficiency and patient experience. The team improved numerous processes and outcomes resulting in a positive impact on patients and families and increased the engagement of staff in continuous improvement. In this way, we improved our capacity to undertake and complete quality projects.
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Sistemas de Atención de Punto , Mejoramiento de la Calidad , Atención a la Salud , Hospitales , Humanos , Poder PsicológicoRESUMEN
Little is known about the relation between socioeconomic factors and health outcomes in adults and adolescents with congenital heart defects (CHD). Population-level data from the Colorado CHD surveillance system from 2011 to 2013 was used to examine the association between area deprivation and outcomes including hospitalizations, emergency department visits, cardiac procedures, all-cause and cardiac-related mortality, and major adverse cardiac events. Socioeconomic context was measured by the Area Deprivation Index at census tract level. Missing race/ethnicity was imputed using the Bayesian Improved Surname Geocoding algorithm. Generalized linear models were utilized to examine health disparities across deprivation quintiles after adjusting for insurance type, race/ethnicity, age, gender, urbanicity, and CHD severity in 5,748 patients. Cases residing in the most deprived quintile had 51% higher odds of inpatient admission, 74% higher odds of emergency department visit, 41% higher odds of cardiac surgeries, and 45% higher odds of major adverse cardiac events compared with cases in the least deprived quintile. Further, rates of hospitalizations, emergency department admissions, and cardiac surgeries were elevated in the most deprived compared with the least deprived quintile. Mortality was not significantly different across quintiles. In conclusion, findings suggest significant health equity issues for adolescent and adults with CHD based on area-based deprivation.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Cardiopatías Congénitas/epidemiología , Hospitalización/tendencias , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/economía , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Pronóstico , Estudios Retrospectivos , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The objective was to describe the design of a population-level electronic health record (EHR) and insurance claims-based surveillance system of adolescents and adults with congenital heart defects (CHDs) in Colorado and to evaluate the bias introduced by duplicate cases across data sources. METHODS: The Colorado CHD Surveillance System ascertained individuals aged 11-64â¯years with a CHD based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic coding between 2011 and 2013 from a diverse network of health care systems and an All Payer Claims Database (APCD). A probability-based identity reconciliation algorithm identified duplicate cases. Logistic regression was conducted to investigate bias introduced by duplicate cases on the relationship between CHD severity (severe compared to moderate/mild) and adverse outcomes including all-cause mortality, inpatient hospitalization, and major adverse cardiac events (myocardial infarction, congestive heart failure, or cerebrovascular event). Sensitivity analyses were conducted to investigate bias introduced by the sole use or exclusion of APCD data. RESULTS: A total of 12,293 unique cases were identified, of which 3,476 had a within or between data source duplicate. Duplicate cases were more likely to be in the youngest age group and have private health insurance, a severe heart defect, a CHD comorbidity, and higher health care utilization. We found that failure to resolve duplicate cases between data sources would inflate the relationship between CHD severity and both morbidity and mortality outcomes by ~15%. Sensitivity analyses indicate that scenarios in which APCD was excluded from case finding or relied upon as the sole source of case finding would also result in an overestimation of the relationship between a CHD severity and major adverse outcomes. DISCUSSION: Aggregated EHR- and claims-based surveillance systems of adolescents and adults with CHD that fail to account for duplicate records will introduce considerable bias into research findings. CONCLUSION: Population-level surveillance systems for rare chronic conditions, such as congenital heart disease, based on aggregation of EHR and claims data require sophisticated identity reconciliation methods to prevent bias introduced by duplicate cases.
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Cardiopatías Congénitas/epidemiología , Almacenamiento y Recuperación de la Información/estadística & datos numéricos , Registro Médico Coordinado , Vigilancia de la Población/métodos , Adolescente , Adulto , Sesgo , Niño , Colorado/epidemiología , Registros Electrónicos de Salud , Femenino , Humanos , Formulario de Reclamación de Seguro , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
In their study "Assessing Agreement in Exposure Classification between Proximity-Based Metrics and Air Monitoring Data in Epidemiology Studies of Unconventional Resource Development" [...].
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Contaminantes Atmosféricos/análisis , Gas Natural , Benchmarking , Monitoreo del Ambiente , Estudios EpidemiológicosRESUMEN
BACKGROUND: There is widespread recognition that creating a safety culture supports high-quality health care. However, the complex factors affecting cultural change interventions are not well understood. This study examines factors influencing the implementation of an intervention to promote professionalism and build a safety culture at an Australian hospital. METHODS: The study was completed midway into the three-year intervention and involved collecting qualitative data from two sources. First, face-to-face interviews were conducted pre- and mid-intervention with a purposely selected sample. Second, a survey with three open-ended questions was completed one year into the intervention by clinical and patient support staff. Data from interviews and survey questions were analyzed using a combination of inductive and deductive approaches. RESULTS: A total of 25 participants completed preintervention interviews, and 24 took part mid-intervention. Of the 2,047 staff who completed the survey (61% response rate), 59.1% of respondents answered at least one open-ended question. Multiple interrelated factors were identified as enhancing intervention implementation. These include sustaining a favorable implementation climate, leaders consistently demonstrating behaviors that support a safety culture, increasing compatibility of working conditions with intervention aims, building confidence in systems to address unprofessional behaviors, and responding to evolving needs. CONCLUSION: Strengthening safety culture remains an enduring challenge, but this study yields valuable insights into factors influencing implementation of a multifaceted behavior change intervention. The findings provide a basis for practical strategies that health care leaders seeking cultural improvements can employ to enhance the delivery of similar interventions and address potential impediments to success.
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Cultura Organizacional , Profesionalismo/normas , Administración de la Seguridad/organización & administración , Adulto , Australia , Comunicación , Femenino , Administración Hospitalaria , Humanos , Capacitación en Servicio , Entrevistas como Asunto , Liderazgo , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Calidad de la Atención de Salud , Administración de la Seguridad/normas , Medio SocialRESUMEN
BACKGROUND: Preliminary studies suggest that offspring to mothers living near oil and natural gas (O&G) well sites are at higher risk of congenital heart defects (CHDs). OBJECTIVES: Our objective was to address the limitations of previous studies in a new and more robust evaluation of the relationship between maternal proximity to O&G well site activities and births with CHDs. METHODS: We employed a nested case-control study of 3324 infants born in Colorado between 2005 and 2011. 187, 179, 132, and 38 singleton births with an aortic artery and valve (AAVD), pulmonary artery and valve (PAVD), conotruncal (CTD), or tricuspid valve (TVD) defect, respectively, were frequency matched 1:5 to controls on sex, maternal smoking, and race and ethnicity yielding 2860 controls. We estimated monthly intensities of O&G activity at maternal residences from three months prior to conception through the second gestational month with our intensity adjusted inverse distance weighted model. We used logistic regression models adjusted for O&G facilities other than wells, intensity of air pollution sources not associated with O&G activities, maternal age and socioeconomic status index, and infant sex and parity, to evaluate associations between CHDs and O&G activity intensity groups (low, medium, and high). RESULTS: Overall, CHDs were 1.4 (1.0, 2.0) and 1.7 (1.1, 2.6) times more likely than controls in the medium and high intensity groups, respectively, compared to the low intensity group. PAVDs were 1.7 (0.93, 3.0) and 2.5 (1.1, 5.3) times more likely in the medium and high intensity groups for mothers with an address found in the second gestational month. In rural areas, AAVDs, CTDs, and TVDs were 1.8 (0.97, 3.3) and 2.6 (1.1, 6.1); 2.1 (0.96, 4.5) and 4.0 (1.4, 12); and 3.4 (0.95, 12) and 4.6 (0.81, 26) times more likely than controls in the medium and high intensity groups. CONCLUSIONS: This study provides further evidence of a positive association between maternal proximity to O&G well site activities and several types of CHDs, particularly in rural areas.
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Contaminación del Aire/efectos adversos , Cardiopatías Congénitas/etiología , Exposición Materna , Yacimiento de Petróleo y Gas , Adulto , Estudios de Casos y Controles , Colorado , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Embarazo , Factores de RiesgoRESUMEN
The drilling phase of oil and natural gas development is a growing area of environmental justice (EJ) research, particularly in the United States. Its emergence complements the longstanding EJ scholarship on later phases of the oil and gas commodity chain, such as pipeline transport, refining, and consumption. The growing scholarly attention to the EJ implications of drilling has been prompted by the surge in development of unconventional oil and gas resources in recent decades. More specifically, the oil and gas industry's adoption of horizontal drilling and hydraulic fracturing (a.k.a., "fracking" or "fracing") as methods for extracting oil and gas from a wider range of geologic formations has simultaneously heightened oil and gas production, brought extractive activities closer to more people, intensified them, and made well pad siting more flexible. Here, we provide a critical review of the novel EJ research questions that are being prompted by these on-the-ground changes in extractive techniques and patterns, propose an interdisciplinary conceptual framework for guiding EJ inquiry in this context, discuss key methodological considerations, and propose a research agenda to motivate future inquiry.
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Fracking Hidráulico , Gas Natural , Monitoreo del Ambiente , Yacimiento de Petróleo y Gas , Estados UnidosRESUMEN
Unconventional oil and gas development (UOGD) in the United States is increasingly being conducted on multiwell pads (MWPs) and in residential areas. We measured air pollution, noise, and truck traffic during four distinct phases of UOGD: drilling, hydraulic fracturing, flowback, and production. We monitored particulate matter (PM2.5), black carbon (BC), A-weighted (dBA), and C-weighted (dBC) noise using real-time instruments on 1 and 5 min time scales, and truck traffic for 4-7 days per phase at a large 22-well pad sited in a residential area of Weld County, Colorado. Hydraulic fracturing, which requires frequent truck trips to move supplies and diesel engines to power the process, had the highest median air pollution levels of PM2.5 and BC and experienced the greatest number of heavy trucks per hour compared to other phases. Median air pollution was lowest during drilling at this MWP, possibly because an electric drill rig was used. The equivalent continuous noise level ( Leq) exceeded guidelines of 50 dBA and 65 dBC for A-weighted and C-weighted noise, respectively, during all development phases. Our data show that these multiple stressors are present around the clock at these sites, and this work provides baseline measurements on likely human exposure levels near similarly sized MWPs.
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Contaminantes Atmosféricos , Contaminación del Aire , Colorado , Exposición a Riesgos Ambientales , Monitoreo del Ambiente , Humanos , Ruido , Material Particulado , Estados UnidosRESUMEN
Glioblastoma (GBM) is a lethal brain tumour. Despite therapy with surgery, radiation, and alkylating chemotherapy, most people have recurrence within 6 months and die within 2 years. A major reason for recurrence is resistance to DNA damage. Here, we demonstrate that CHD4, an ATPase and member of the nucleosome remodelling and deactetylase (NuRD) complex, drives a component of this resistance. CHD4 is overexpressed in GBM specimens and cell lines. Based on The Cancer Genome Atlas and Rembrandt datasets, CHD4 expression is associated with poor prognosis in patients. While it has been known in other cancers that CHD4 goes to sites of DNA damage, we found CHD4 also regulates expression of RAD51, an essential component of the homologous recombination machinery, which repairs DNA damage. Correspondingly, CHD4 suppression results in defective DNA damage response in GBM cells. These findings demonstrate a mechanism by which CHD4 promotes GBM cell survival after DNA damaging treatments. Additionally, we found that CHD4 suppression, even in the absence of extrinsic treatment, cumulatively increases DNA damage. Lastly, we found that CHD4 is dispensable for normal human astrocyte survival. Since standard GBM treatments like radiation and temozolomide chemotherapy create DNA damage, these findings suggest an important resistance mechanism that has therapeutic implications.
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Neoplasias Encefálicas/genética , Glioblastoma/genética , Complejo Desacetilasa y Remodelación del Nucleosoma Mi-2/genética , Recombinasa Rad51/genética , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/radioterapia , Estudios de Casos y Controles , Línea Celular Tumoral , Supervivencia Celular , Cromatina/genética , Cromatina/metabolismo , Daño del ADN , Regulación Neoplásica de la Expresión Génica , Glioblastoma/mortalidad , Glioblastoma/patología , Glioblastoma/radioterapia , Recombinación Homóloga , Humanos , Complejo Desacetilasa y Remodelación del Nucleosoma Mi-2/metabolismo , Regiones Promotoras Genéticas , Recombinasa Rad51/metabolismoRESUMEN
BACKGROUND: Oil and natural gas (O&G) extraction emits pollutants that are associated with cardiovascular disease, the leading cause of mortality in the United States. OBJECTIVE: We evaluated associations between intensity of O&G activity and cardiovascular disease indicators. METHODS: Between October 2015 and May 2016, we conducted a cross-sectional study of 97 adults living in Northeastern Colorado. For each participant, we collected 1-3 measurements of augmentation index, systolic and diastolic blood pressure (SBP and DBP), and plasma concentrations of interleukin (IL)-â¯1ß, IL-6, IL-8 and tumor necrosis factor alpha (TNF-α). We modelled the intensity of O&G activity by weighting O&G well counts within 16â¯km of a participant's home by intensity and distance. We used linear models accounting for repeated measures within person to evaluate associations. RESULTS: Adjusted mean augmentation index differed by 6.0% (95% CI: 0.6, 11.4%) and 5.1% (95%CI: -0.1, 10.4%) between high and medium, respectively, and low exposure tertiles. The greatest mean IL-1ß, and α-TNF plasma concentrations were observed for participants in the highest exposure tertile. IL-6 and IL-8 results were consistent with a null result. For participants not taking prescription medications, the adjusted mean SBP differed by 6 and 1â¯mm Hg (95% CIs: 0.1, 13â¯mm Hg and -6, 8â¯mm Hg) between the high and medium, respectively, and low exposure tertiles. DBP results were similar. For participants taking prescription medications, SBP and DBP results were consistent with a null result. CONCLUSIONS: Despite limitations, our results support associations between O&G activity and augmentation index, SBP, DBP, IL-1ß, and TNF-α. Our study was not able to elucidate possible mechanisms or environmental stressors, such as air pollution and noise.
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Enfermedades Cardiovasculares/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Hipertensión , Yacimiento de Petróleo y Gas , Adulto , Presión Sanguínea , Colorado/epidemiología , Estudios Transversales , Femenino , Humanos , Indicadores y Reactivos , Gas Natural , Estados UnidosRESUMEN
OBJECTIVE: The aim of this study was to examine adherence of state guidelines for Colorado workers' compensation physicians/providers treating individuals as injured workers with chronic pain after initiation of an opioid management program and provider incentives. METHODS: A retrospective cohort of chronic, non-cancer pain claims was constructed from the Colorado's workers' compensation database. Adherence to treatment guidelines and opioid prescribing practices were evaluated during implementation of a new billing code to incentivize adherence. RESULTS: Overall, less than 33% of claims showed evidence of opioid management. Comprehensive opioid management was observed in only 4.4% of claims. In 2010, after implementing the new billing code, the ratio of long acting opioids to short acting opioids decreased from 0.2 to 0.13; returning to 0.2 in one year. Similarly, morphine equivalent doses declined for a short period. CONCLUSIONS: Incentivizing physicians to adhere to chronic pain management guidelines only temporarily improves prescribing practices.