Sustainability of residential environmental interventions and health outcomes in the elderly.

BACKGROUND: Research has documented that housing conditions can negatively impact the health of residents. Asthma has many known indoor environmental triggers including dust, pests, smoke and mold, as evidenced by the 25 million people in the U.S. population who have asthma. The paper describes a follow-up study involving elder adults with asthma who participated in a multifaceted home educational and environmental intervention shown to produce significant health benefits. On average the time between the end of the prior intervention study and the follow-up was 2.3 years. The objective of this study was to evaluate whether improvements in environmental conditions and health outcomes resulting from the original Older Adult Study (OAS, multifaceted educational and environmental interventions) would be maintained or decline over time for these low income seniors with asthma. METHODS: Health assessment included data on respiratory health outcomes included the Saint George's Respiratory Questionnaire (SGRQ) and Asthma Control Test from the original Older Adult Study (OAS) and this follow-up Older Adult Study (OAFS) along with health care utilization data. Environmental assessments included evaluation of asthma trigger activities (ATAs) and exposures before and after the original healthy homes intervention (questionnaire, home survey) and at this follow-up. Assessments were conducted in English, Khmer and Spanish. RESULTS: At assessment in the Older Adult Follow-up Study (OAFS), the older adults maintained some of the health improvements gained during the OAS when compared to the OAS pre-intervention baseline. However, health outcomes declined from the OAS final assessment to the OAFS (only the SGRQ Impact scores were significantly different). CONCLUSION: These findings suggest that further study with a larger population is needed to determine if the significant health outcome improvements from multifaceted home educational and environmental interventions (OAS) could be more strongly maintained by providing additional follow-up "booster" interventions to this older adult population with asthma.

Asthma, COPD, and home environments: Interventions with older adults.

BACKGROUND: We describe a multifaceted home environmental intervention project involving low-income older adults with asthma who have a greater risk of asthma-related respiratory impacts because they spend up to 90% of their time in the home where many allergens and respiratory irritants are found. Although sufficient evidence suggests that home interventions are effective in improving health of children with asthma, the Task Force on Community Preventive Services has stated that evidence is insufficient for the effectiveness of home interventions on adults with asthma. OBJECTIVE: To evaluate the hypothesis that multifaceted home environmental interventions improve the respiratory health and reduce asthma triggers for older adults with asthma. METHODS: We conducted community health worker-led interventions in the homes of 86 low-income older adults (age 62 or older) diagnosed with asthma, residing in public and private subsidized housing in Lowell, Massachusetts, from 2014 to 2017. Health and environmental assessment at baseline and follow-up 1 year later included collecting data on respiratory health, quality of life, medication use, doctor/emergency room/hospital visits, using the St. George Respiratory Questionnaire and Asthma Control Test and evaluation of asthma trigger activities and exposures through questionnaires and home surveys. Interventions included education on asthma and environmental triggers and environmental remediation. RESULTS: Statistically significant reductions in self-reported environmental asthma triggers and health improvements were found in the following areas: doctor visits, use of antibiotics for chest problems, respiratory symptoms and quality of life indicators, and asthma control (ACT score). CONCLUSION: Our results provide evidence that multifaceted home interventions are effective in improving the environmental quality and respiratory health of an older adult population with asthma.

Unsustainable Wind Turbine Blade Disposal Practices in the United States.

Finding ways to manage the waste from the expected high number of wind turbine blades in need of disposal is crucial to harvest wind energy in a truly sustainable manner. Landfilling is the most cost-effective disposal method in the United States, but it imposes significant environmental impacts. Thermal, mechanical, and chemical processes allow for some energy and/or material recovery, but they also carry potential negative externalities. This article explores the main economic and environmental issues with various wind turbine blade disposal methods. We argue for the necessity of policy intervention that encourages industry to develop better technologies to make wind turbine blade disposal sustainable, both environmentally and economically. We present some of the technological initiatives being researched, such as the use of bio-derived resins and thermoplastic composites in the manufacturing process of the blades.

Detection of allergen sources in the homes of sensitized children.

OBJECTIVE: To identify the presence of environmental factors linked to the onset of allergies and asthma in the homes of children participating in an early detection program that were identified with sensitivity to common allergens in the region of Sonora, Mexico. METHODS: A walkthrough assessment was carried out in the homes of sensitized children; the research tools were the questionnaire and environmental checklist proposed by the Lowell Healthy Homes Program of the University of Massachusetts-Lowell. RESULTS: The results showed the presence of environmental allergen sources, to which most of the children in the study are sensitized, as well as the environmental conditions and habits that determine the quality of the indoor air of the households, were both related to triggering allergies and asthma in this population. A statistically significant association was found between the visual observation of dust inside homes and the sensitivity of children to dust mites. CONCLUSIONS: Dust found inside the home was the most relevant environmental factor related to positive cases of IgE in children. Early detection of allergies in children in the study and the methodology used in this investigation provided a useful framework for the design of plans and intervention alternatives in these homes to prevent the development of allergies and asthma panorama. These plans should be designed with a multidisciplinary approach to impact social, environmental and economic benefits in the family, improving the living conditions of the study population and contributing to the sustainable development goals of the United Nations for 2030.

Healthy homes: in-home environmental asthma intervention in a diverse urban community.

OBJECTIVES: We evaluated health outcomes associated with in-home interventions in low-income urban households with children with asthma. METHODS: A comprehensive health and environmental assessment and subsequent intervention were completed in 116 households with 170 enrolled children with asthma. Home health workers provided household safety, asthma prevention education, and targeted environmental intervention to decrease asthma triggers and improve household safety. We collected environmental data with questionnaire and dust samples and health information with a questionnaire incorporating the American Academy of Pediatrics Children's Health Survey for Asthma and other instruments at baseline and at follow-up 11 to 12 months later to evaluate the impact of the intervention on the health of the child and family in Lowell, Massachusetts, from September 2009 to January 2012. RESULTS: The diverse study population of low-income children showed a statistically significant health improvement from baseline to follow-up. The cost of the interventions (not including personnel) was $36 240, whereas the estimated medical savings over a 4-week assessment period was $71 162, resulting in an estimated annual savings of about $821 304. CONCLUSIONS: Low-cost, multicomponent interventions decrease all measures of asthma severity and health care utilization in a diverse population of urban children.

Community-university partnerships: achieving the promise in the face of changing goals, changing funding patterns, and competing priorities.

An important challenge that community-university partnerships face is how to maintain themselves in the face of changing goals, priorities, and funding. Partnerships often form as a result of some sort of "spark:" an incident, perhaps, or the identification of a shared need or common concern. Often, external funding is sought to provide the majority of resources for the establishment of a partnership and for the implementation of the partnership's action plan. Whatever external funding is obtained is typically of short duration. The funding will not continue over time. And usually the funding comes with stipulations about allowable partnership approaches; inevitably the priorities of one funder will differ from those of another. These issues of the maintenance of partnership in the face of shifting funding and priorities are ones that confront most community-university partnerships. This article examines these issues through the lens of an environmental justice partnership that has existed for nearly a decade, has undergone many changes in who is involved, and has operated with funding from many different sources, including the National Institute of Environmental Health Sciences, Housing and Urban Development, and the Environmental Protection Agency. In addition, the entities in the partnerships, while they share certain environmental objectives, are sometimes at odds on particular goals when the needs of the agencies differ. Further complicating this issue of continuity is the reality that partners, on occasion, must shift priorities after partnership goals are established. The experiences of this environmental justice partnership shed light on the kinds of struggles community-university partnerships face when they hope to avoid being undermined by the larger concerns of the funders or by the power brokers in their individual organizations. This article examines approaches that community-university partnerships might take to remain resilient in the face of changing goals, priorities and funding.

Sustainable development: a better holistic view.

This article offers a critique of an article by Margrit Hugentobler that proposes a multi-systems level framework to guide sustainable development initiatives and evaluate completed projects. While praising Hugentobler's analysis of inadequacies with the United Nations' concept of sustainable development and her proposal for an integrative approach, this article raises concerns about the proposed framework's ability to equally achieve economic, environmental, and social objectives. As a better alternative, the author suggests a non-hierarchal, holistic framework. Moreover, this article contends that a sustainable development framework must include a focus on fair compensation and health and safety of workers.