Teaching home environmental health to resident physicians.

Healthy Homes programs seek to integrate the evaluation and management of a multitude of health and safety risks in households. The education of physicians in the identification, evaluation, and management of these home health and safety issues continues to be deficient. Healthy Homes programs represent a unique opportunity to educate physicians in the home environment and stimulate ongoing, specific patient-physician discussions and more general learning about home environmental health. The Case Healthy Homes and Patients Program addresses these deficiencies in physician training while providing direct services to high-risk households. Pediatric and family practice resident physicians participate in healthy home inspections and interventions for their primary care patients and follow up on identified risks during health maintenance and acute illness visits.

Longevity of the effectiveness of interim soil lead hazard control measures and influencing factors.

A 7-year follow-up was conducted to determine factors associated with the longevity of interim soil lead hazard control measures that had been applied to housing in the Cleveland OH area. The approach involved (1) visual determination of the treatment integrity, (2) collection of information regarding 14 factors that may contribute to longevity of treatment integrity and (3) collection of one composite soil sample from treated areas with visual failure at each house and another composite sample from areas without visual failure. For the 200 houses studied, an average of 4 different soil areas were treated. For 96% of these areas, the treatments used were: (1) re-seeding, (2) mulch/wood chips and (3) gravel. Of a total of 191,034 ft(2) of treated soil areas observed, less than one-third, i.e. 59,900 ft(2) (31.3%) exhibited visual failure at the time of follow-up. Hazard control method and the presence/absence of shade were the only factors found to significantly affect visual failure rates. Of the three most commonly used control measures, the lowest visual failure rate was for re-seeding, 29.1% after a mean of 7.3 years; for non-shaded areas, which had been re-seeded, the failure rate was 22.2% compared to 35.7% for shaded areas. At 116 of the 193 houses (60%) that had both visually failed and visually non-failed treated soil areas, the geometric mean soil lead concentration was higher in the failed areas (p=0.003). The actual difference was only 13% with most levels equal to or exceeding 400 ppm. However, when compared to the US EPA limit for bare soil in other residential areas (1200 ppm) the percent equal to or exceeding the limit was much higher in the visually failed areas, 33.1%, than in areas where such failure was not observed, 22.0%.

Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources.

OBJECTIVE: Home dampness and the presence of mold and allergens have been associated with asthma morbidity. We examined changes in asthma morbidity in children as a result of home remediation aimed at moisture sources. DESIGN: In this prospective, randomized controlled trial, symptomatic, asthmatic children (n = 62), 2-17 years of age, living in a home with indoor mold, received an asthma intervention including an action plan, education, and individualized problem solving. The remediation group also received household repairs, including reduction of water infiltration, removal of water-damaged building materials, and heating/ventilation/air-conditioning alterations. The control group received only home cleaning information. We measured children's total and allergen-specific serum immuno-globulin E, peripheral blood eosinophil counts, and urinary cotinine. Environmental dust samples were analyzed for dust mite, cockroach, rodent urinary protein, endotoxin, and fungi. The follow-up period was 1 year. RESULTS: Children in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study. The remediation group had a significant decrease in symptom days (p = 0.003, as randomized; p = 0.004, intent to treat) after remodeling, whereas these parameters in the control group did not significantly change. In the postremediation period, the remediation group had a lower rate of exacerbations compared with control asthmatics (as treated: 1 of 29 vs. 11 of 33, respectively, p = 0. 003; intent to treat: 28.1% and 10.0%, respectively, p = 0.11). CONCLUSION: Construction remediation aimed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem.

The utility of psychological testing in assessing emotional damages in personal injury litigation.

Psychological testing and assessment instruments frequently play a small but important role when psychologists assist the courts as emotional damage experts in personal injury matters. However, examiners frequently, if sometimes inadvertently, mislead the court with test interpretations that are based on clinical rather than forensic populations and that fail to appreciate the lack of robustness of clinical measures in this forensic context. Whereas published computerized interpretations repeatedly remind experts that personality test results should only be used as a method to generate hypotheses about the examinee that are to be subjected to further investigation and consideration, experts all too often inform the courts of test interpretations as if the test results were measures of clinical constructs rather than plaintiffs' self-reports of symptoms.