Seasonal Trends for Environmental Illness Incidence in the U.S. Army.

INTRODUCTION: The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the U.S. Army have been well documented. The "heat season", when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as May 1 through September 30, while the "cold season" is understood to occur from October 1 to April 30 each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. We also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations. METHODS: The U.S. Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defense Medical Surveillance System. Installation-specific denominator data were obtained from the Defense Manpower Data Center, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons. RESULTS: Our analysis indicates that the heat season starts around April 22 and ends around September 9. The cold season starts on October 3 and ends on March 24. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the "heat season" of May 1 to September 30, while 10.3% occurred before the heat season started (January1 to April 30) and 7.3% occurred after the heat season ended (October 1 to December 31). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons. CONCLUSIONS: The present study indicates that the traditional heat season definition should be revised to begin ∼3 weeks earlier than the current date of May 1; our data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations.

Duodenal Microbiota in Stunted Undernourished Children with Enteropathy.

BACKGROUND: Environmental enteric dysfunction (EED) is an enigmatic disorder of the small intestine that is postulated to play a role in childhood undernutrition, a pressing global health problem. Defining the incidence of this disorder, its pathophysiological features, and its contribution to impaired linear and ponderal growth has been hampered by the difficulty in directly sampling the small intestinal mucosa and microbial community (microbiota). METHODS: In this study, among 110 young children (mean age, 18 months) with linear growth stunting who were living in an urban slum in Dhaka, Bangladesh, and had not benefited from a nutritional intervention, we performed endoscopy in 80 children who had biopsy-confirmed EED and available plasma and duodenal samples. We quantified the levels of 4077 plasma proteins and 2619 proteins in duodenal biopsy samples obtained from these children. The levels of bacterial strains in microbiota recovered from duodenal aspirate from each child were determined with the use of culture-independent methods. In addition, we obtained 21 plasma samples and 27 fecal samples from age-matched healthy children living in the same area. Young germ-free mice that had been fed a Bangladeshi diet were colonized with bacterial strains cultured from the duodenal aspirates. RESULTS: Of the bacterial strains that were obtained from the children, the absolute levels of a shared group of 14 taxa (which are not typically classified as enteropathogens) were negatively correlated with linear growth (length-for-age z score, r = -0.49; P = 0.003) and positively correlated with duodenal proteins involved in immunoinflammatory responses. The representation of these 14 duodenal taxa in fecal microbiota was significantly different from that in samples obtained from healthy children (P<0.001 by permutational multivariate analysis of variance). Enteropathy of the small intestine developed in gnotobiotic mice that had been colonized with cultured duodenal strains obtained from children with EED. CONCLUSIONS: These results provide support for a causal relationship between growth stunting and components of the small intestinal microbiota and enteropathy and offer a rationale for developing therapies that target these microbial contributions to EED. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02812615.).

Manejo anestésico de histerectomía más doble anexectomía por tumor borderline de ovario izquierdo en paciente con síndrome de sensibilidad química múltiple / Anesthetic management of hysterectomy and double adnexectomy for borderline left ovarian tumor in a patient with multiple chemical sensitivity syndrome

El síndrome de sensibilidad química múltiple (SQM), también conocido como intolerancia ambiental idiopática (IAI), entre otros, es un desorden complejo y mal definido que produce diversos síntomas en respuesta a diferentes estímulos. No hay estudios válidos que establezcan la patogénesis de este síndrome. El manejo anestésico de estos pacientes es un reto para los anestesiólogos, dado que no hay unas pautas de actuación establecidas. Se presenta un caso de cirugía exitosa en una paciente afecta de SQM realizándose una anestesia total intravenosa (TIVA) convencional a la que se añadió una premedicación exhaustiva y la aplicación del protocolo de alergia al látex

The multiple chemical sensitivity syndrome (MCS), also known as idiopathic environmental intolerance (IAI), among others, is a complex and poorly defi ned disorder that produces various symptoms in response to various stimuli. There is a lack of valid studies that establish the pathogenesis of this syndrome. The anesthetic management of these patients is a challenge for anesthesiologists, due to the fact that there are no established guidelines. We present a case of successful surgery in a patient that suffers from MCS by performing a conventional TIVA enhanced with a thorough premedication and the latex allergy protocol

Neurologic complications of acute environmental injuries.

Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.

Environmental and infectious factors in eosinophilic esophagitis.

Identifying possible environmental or infectious etiologic factors for eosinophilic esophagitis (EoE) may offer insight into opportunities for disease prevention and treatment. We reviewed the current literature to assess environmental and infectious factors evaluated in EoE. Few studies have been conducted, however a consistent inverse association between EoE and H. pylori has been described. Several studies suggest a weak association between season and EoE diagnosis, but the evidence is inconclusive. EoE has also been associated with early life factors, including Cesarean delivery and antibiotic use. Larger studies are needed to evaluate these associations more thoroughly. Several papers have speculated the potential for anti-secretory agents to contribute to EoE. This has not been formerly evaluated. In summary, there is significant opportunity in the future to advance our understanding of possible environmental etiologic factors for EoE.

Urban–rural differences in asthma prevalence among young adolescents: The role of behavioural and environmental factors

BACKGROUND: Asthma prevalence has been reported to be lower in rural areas compared to urban areas, although this has been inconsistent. This study aims to identify the influence of urban-rural residence on asthma prevalence in adolescents in the Republic of Macedonia and to investigate characteristics that may explain observed associations. METHODS: Following International Study of Asthma and Allergies in Childhood protocol, a national sample of Macedonian urban and rural dwelling adolescents (12-16 years) was recruited in 2006. Self-completed questionnaires were used to collect data on wheeze and asthma as well as personal, environmental and dietary characteristics. Following descriptive and multiple logistic regression analyses, a mediation analysis approach was performed to help explain observed associations. RESULTS: A lower prevalence of current wheeze and ever-diagnosed asthma was observed in rural compared to urban dwelling adolescents (4.9% vs. 7.2% and 1.2% vs. 1.9%, respectively). After adjustment for potential confounders, the associations, although still protective, were not statistically significant (wheeze: OR = 0.74, 95%CI = 0.46-1.21; asthma: OR = 0.97, 95%CI = 0.38-2.46). The associations between urban-rural status with current wheeze and asthma were mediated by region of the country (wheeze 9%; asthma 19%) and by diet (>5% change for both wheeze and asthma). Having a dog resulted in a strengthening of the association between urban-rural status and current wheeze by 11.9%. CONCLUSIONS: The prevalence of asthma and wheeze was lower in rural dwelling Macedonian adolescents and the association was mediated by the region of the country with diet likely to be part of the reason for this mediating effect

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Relationship between daily exposure to biomass fuel smoke and blood pressure in high-altitude Peru.

Household air pollution from biomass fuel use affects 3 billion people worldwide; however, few studies have examined the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with elevated blood pressure in high altitude Peru and if this relationship was affected by lung function. We analyzed baseline information from a population-based cohort study of adults aged ≥ 35 years in Puno, Peru. Daily biomass fuel use was self-reported. We used multivariable regression models to examine the relationship between daily exposure to biomass fuel smoke and blood pressure outcomes. Interactions with sex and quartiles of forced vital capacity were conducted to evaluate for effect modification. Data from 1004 individuals (mean age, 55.3 years; 51.7% women) were included. We found an association between biomass fuel use with both prehypertension (adjusted relative risk ratio, 5.0; 95% confidence interval, 2.6-9.9) and hypertension (adjusted relative risk ratio, 3.5; 95% confidence interval, 1.7-7.0). Biomass fuel users had a higher systolic blood pressure (7.0 mm Hg; 95% confidence interval, 4.4-9.6) and a higher diastolic blood pressure (5.9 mm Hg; 95% confidence interval, 4.2-7.6) when compared with nonusers. We did not find interaction effects between daily biomass fuel use and sex or percent predicted forced vital capacity for either systolic blood pressure or diastolic blood pressure. Biomass fuel use was associated with a higher likelihood of having hypertension and higher blood pressure in Peru. Reducing exposure to household air pollution from biomass fuel use represents an opportunity for cardiovascular prevention.

Influencia de las condiciones climáticas en el empeoramiento de los síntomas de artritis reumatoide: el posible efecto de la temperatura / Weather conditions may worsen symptoms in rheumatoid arthritis patients: the possible effect of temperature

Objetivo. Los pacientes con artritis reumatoide (AR) se quejan de que las condiciones meteorológicas empeoran sus síntomas. Este estudio trata de ver los efectos a corto plazo de las condiciones climáticas en empeoramiento sintomático en pacientes con AR y determinar posibles fluctuaciones estacionales. Métodos. Se realizó un estudio de casos cruzados en Madrid, España. Los casos diarios de empeoramiento de la AR se obtuvieron de la sala de urgencias de un hospital terciario entre 2004 y 2007. Resultados. 245 pacientes con AR con 306 visitas a urgencias con AR como diagnostico principal se incluyeron en el estudio. Los pacientes de 50 a 65 años tuvieron un 16% más de probabilidades de presentar empeoramiento sintomático de la AR con una menor temperatura media. Conclusiones. Nuestros resultados apoyan la creencia de que el clima influye en el dolor reumático de los pacientes con mediana edad (AU)

Objective: Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and determined possible seasonal fluctuations. Methods: We conducted a case-crossover study in Madrid, Spain. Daily cases of RA flares were collected from the emergency room of a tertiary level hospital between 2004 and 2007. Results: 245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures. Conclusions: Our results support the belief that weather influences rheumatic pain in middle aged patients (AU)

Stress and odor sensitivity in persons with noise sensitivity.

Previous research has indicated that sensory sensitivity/intolerance to a specific modality may be part of a more general environmental hypersensitivity, and possibly mediated by stress. This study investigated the relationship between noise sensitivity, perceived stress, and odor sensitivity in a group of men. A quasi-experimental design was used. One-hundred and thirty-four male undergraduate students completed Weinstein's noise sensitivity scale from which a low-sensitivity group (n = 16) and a high-sensitivity (n = 16) group were formed. These two groups were screened for loss in auditory and olfactory detection sensitivity, and completed the perceived stress questionnaire (PSQ) and the chemical sensitivity scale (CSS). One-way analysis of variance and Spearman correlational analyses were performed. Significantly higher scores on the PSQ (P < 0.05) and the CSS (P < 0.05) were found in the high noise-sensitivity group compared to the low noise-sensitivity group. These findings raise the question of whether the relation between noise and odor sensitivity reflects a general environmental sensitivity.

Environmental risk factor assessment: a multilevel analysis of childhood asthma in China.

BACKGROUND: Rapid changes in socioeconomic environment and their diverse patterns in China raise a question: how socio-environmental factors affect childhood asthma in China. We performed a multilevel analysis based on a 2005 national survey to understand the association between environmental factors and asthma, and to provide insights on developing prevention strategies. METHODS: A multi-center, cross-sectional survey was conducted in 2018 school-aged children chosen from eight Chinese cities. Children of 6-13 years old were chosen randomly from schools of 39 centers in 8 cities. The multilevel analysis was made to assess both individual-level and city-level risk factors. The effect of gross domestic product (GDP) was further investigated by analysis of the factors. RESULTS: Analysis of city-level environmental factors showed that GDP [adjusted odds ratio (OR)=1.88], particulate matter with aerodynamic diameter ≤10 µm (PM10) (adjusted OR=1.37), and average humidity (adjusted OR=1.33) were strong risk factors. Further analysis of the factors decomposed GDP into two major factors, the first represented by urban construction, energy consumption, nitrogen dioxide concentration, and the second represented by health-system coverage. This suggested that the negative effects of GDP outweighed its positive effects on asthma. CONCLUSIONS: The prevalence of childhood asthma varies significantly in the eight Chinese cities. Socioenvironmental factors such as GDP, PM10 and average humidity are strong risk factors controlling individual attributes, suggesting that balance is needed between public health and economic development in China.

[The inflammatory response as a manifestation of the influence of environmental chemical factors].

The paper shows that a chronic slowly developing inflammation manifesting itself as adipokine imbalance and lipid metabolism abnormalities in the body under the influence of unfavorable environmental factors.

La genética de la depresión: ¿qué información aportan las nuevas aproximaciones metodológicas? / The genetics of depression: What information can new methodologic approaches provide?

El trastorno depresivo mayor forma parte del grupo de enfermedades denominadas genéticamente complejas en cuya base se encuentran involucrados una serie de genes de efecto menor o susceptibilidad cuya expresión podría estar modulada por un gran número de factores ambientales. Desde los primeros estudios clásicos de ligamiento hasta las nuevas metodologías de estudio de genoma completo se ha puesto de manifiesto la dificultad para comprender las bases genéticas de la depresión mayor. En muchos estudios se han identificado una o varias regiones génicas cuya variabilidad confiere un riesgo pequeño para desarrollar un trastorno depresivo; es decir, dichas variantes explicarían un porcentaje muy pequeño del componente genético total de la enfermedad en la población y, por tanto, poseerían un valor predictivo bajo. Aunque los resultados obtenidos hasta el momento no son concluyentes, las nuevas aproximaciones basadas en estudios de interacción gen-ambiente así como los análisis de vías biológicas (basados en los estudios GWAS) abren nuevas y prometedoras perspectivas en la investigación de las bases genéticas y biológicas de la depresión mayor (AU)

Major depressive disorder is a genetically complex disease involving several minor, or susceptibility, genes whose expression may be modulated by many environmental factors. From the classical early linkage studies to the complete genome-wide association (GWA) study methodologies, it is evident that it is difficult to understand the genetic bases of this mental disorder. Many studies have identified one or more gene regions whose variability confers a small risk for developing depressive disorder, explaining a small percentage of the total genetic component of disease with low predictive value. Although the results to date are inconclusive, new approaches based on gene-environment interactions and biological pathway analysis (based on GWA studies) open new and promising perspectives in the investigation of the genetic and biological basis of major depression (AU)

Prevalence and psychiatric comorbidity of self-reported electromagnetic field sensitivity in Taiwan: a population-based study.

BACKGROUND/PURPOSE: Psychological factors have been implicated in the etiology of idiopathic environmental illness in many studies. Few studies have ever reported psychiatric morbidity among individuals with electromagnetic hypersensitivity. We aimed to estimate the prevalence and identify the associated factors of self-reported electromagnetic field sensitivity (SREMFS) in adults of Taiwan. METHODS: A total of 1251 adults selected from a nationwide Computer-Assisted Telephone Interviewing system received a telephone survey about the perception of risk from various environmental agents and their effects on health and well-being. RESULTS: The estimated prevalence of people with SREMFS was 13.3 % (95% confidence interval: 11.2-15.3). People aged >65 years were associated with a lower risk of reporting sensitivity to electromagnetic fields, whereas people with a very poor self-reported health status, those who were unable to work, and those who had psychiatric morbidity were associated with a higher risk of having SREMFS. CONCLUSION: The prevalence of SREMFS in the general population of Taiwan is higher than that reported in western countries. People with psychiatric morbidity are more likely to report sensitivity to electromagnetic fields. The cross-sectional design precludes the causal inference of all identified correlates and electromagnetic field sensitivity.

[Scientific and methodological rationale for the pathomorphism of Lamblia infection in children during chemical contamination of the biosphere].

The paper analyzes the clinical and laboratory features of Lamblia infection in children living under long-term low-dose chemical load. The scientific search methodology comprised the meticulous examination of the patients randomized by the presence or absence of protozoonosis and the statistical processing and expert analysis of the results. The comprehensive approach could define the main signs of the pathomorphism of lambliosis in the areas with high anthropogenic loads and identify immunological disorders, intoxication, and hepatobiliary dysfunctions. The impact of environmentally induced chemical contamination of the biosphere on the natural history of protozoonosis should be borne in mind when evaluating the biological hazard and risk of environmental biological factors on the population health and when scheduling and implementing hygienic and sanitary-and-epidemiological measures to prevent lambliosis in the high anthropogenic load areas.

[Efficiency of ACE inhibitors, beta adrenoblocker and antihypoxant in the phase of stationary rehabilitation of patients with myocardial infarction working in environmentally unfriendly conditions].

The aim of this work was to study effect of fosinopril combined with propranolol or cytomack on ecoendotoxicosis, size of myocardial infarction (MI), left ventricular (LV) systolic function, and clinical picture of stationary phase MI in patients working in environmentally unfriendly conditions. 42 patients aged 30-70 yr presenting with MI and initial Q-wave were randomized into 2 groups of 21 subjects each. In group 1, they were given fosinopril with propranolol, in group 2 fosinopril with cytomack. Mean age of group 1 and 2 patients was 57.8 +/- 2.1 and 56.9 +/- 23 yr respectively. All the patients were hospitalized within 6 hr after onset of the disease and received heparin. They underwent PETG and echoCG, also studied were endotoxicosis (PSD), central hemodynamics, left ventricular systolic functions (ESV, EDV, EF), size of MI (total ST, AST, total Rh), and clynical symptoms. It was shown that patients working in environmentally unfriendly conditions were characterized by high degree of PSD. In group 1 they exhibited reduction of PSD, total ST, AST, ESV, EDV and increase of total Rh and EF. Decreased systolic and diastolic AP did not lead to clinically significant hypotension. Patients of group 2 showed stabilization of AP, decrease of PSD, total ST, AST, ESV, EDV and increase of total Rh and EF that prevented the development of cardiac insufficiency in the phase of stationary rehabilitation of MI. Characteristics of groups 1 and 2 were not significantly different. The clinical course of IM in patients given fosinopril with cytomack was more favourable than in those treated with fosinopril and propranolol. Two patients of group 1 suffered cardiac insufficiency.

Dermatitis atópica infantil: revisión y actualización / review and update of current understanding of childhood atopic dermatitis

La dermatitis atópica infantil es una enfermedad de distribución mundial, con una elevada prevalencia en los países desarrollados, lo que la ha convertido en una prioridad de salud. A pesar de que es una entidad que ha sido estudiada durante años todavía existen numerosas controversias en distintas áreas. En esta revisión se comentan los principales trabajos publicados sobre el tema, actualizando diversos conceptos: terminología aplicada (diferencia entre atópica y atopiforme), epidemiología, etiopatogenia (estudios moleculares, genes implicados y factores ambientales), medida de la gravedad, influencia en la calidad de vida del paciente y la familia, impacto económico y tratamientos (AU)

Although childhood atopic dermatitis is reported throughout the world, it has become a health priority in developed countries, where its prevalence is particularly high. Despite extensive study for many years, various aspects of the disease are still subject to debate. This review will discuss the main studies published on the topic and update certain concepts such as the terminology used (the difference between atopic and atopiform), epidemiology, etiopathogenesis (molecular mechanisms, implicated genes, and environmental factors), assessment of severity, influence on the quality of life of the patients and their families, economic impact, and treatment (AU)

Environmental factors as disease accelerators during chronic hepatitis C.

Progression of chronic hepatitis is highly variable among individuals, as the result of several host, viral and environmental factors. The latter have been extensively investigated in order to ameliorate hepatitis C outcome, particularly in difficult-to-treat patients. Over the last decade, several studies have shown that a combination of HCV infection and high levels of alcohol abuse results in synergistic acceleration of liver fibrogenesis. In addition, recent data indicate that light alcohol intake may also exacerbate fibrosis progression. It has also been suggested that cigarette smoking may enhance activity grade in patients with chronic hepatitis C, thereby increasing progression of fibrosis. This assumption mostly relies on epidemiological evidences in the absence of pathogenic studies. Finally, cannabis use is increasingly emerging as a novel co-morbidity in patients with chronic hepatitis C. Indeed, regular cannabis smoking is an independent predictor of both fibrosis and steatosis severity in infected patients. In addition, experimental studies have shown that cannabinoid CB1 receptors enhance liver fibrogenesis and steatogenesis by distinct mechanisms, therefore strongly supporting epidemiological findings. Altogether, patients should be informed of the deleterious impact of alcohol, tobacco and cannabis use and should be offered appropriate support to achieve abstinence.