Methods for characterizing fine particulate matter using ground observations and remotely sensed data: potential use for environmental public health surveillance.

This study describes and demonstrates different techniques for surface fitting daily environmental hazards data of particulate matter with aerodynamic diameter less than or equal to 2.5 microm (PM2.5) for the purpose of integrating respiratory health and environmental data for the Centers for Disease Control and Prevention (CDC) pilot study of Health and Environment Linked for Information Exchange (HELIX)-Atlanta. It presents a methodology for estimating daily spatial surfaces of ground-level PM2.5 concentrations using the B-Spline and inverse distance weighting (IDW) surface-fitting techniques, leveraging National Aeronautics and Space Administration (NASA) Moderate Resolution Imaging Spectrometer (MODIS) data to complement U.S. Environmental Protection Agency (EPA) ground observation data. The study used measurements of ambient PM2.5 from the EPA database for the year 2003 as well as PM2.5 estimates derived from NASA's satellite data. Hazard data have been processed to derive the surrogate PM2.5 exposure estimates. This paper shows that merging MODIS remote sensing data with surface observations of PM,2. not only provides a more complete daily representation of PM,2. than either dataset alone would allow, but it also reduces the errors in the PM2.5-estimated surfaces. The results of this study also show that although the IDW technique can introduce some numerical artifacts that could be due to its interpolating nature, which assumes that the maxima and minima can occur only at the observation points, the daily IDW PM2.5 surfaces had smaller errors in general, with respect to observations, than those of the B-Spline surfaces. Finally, the methods discussed in this paper establish a foundation for environmental public health linkage and association studies for which determining the concentrations of an environmental hazard such as PM2.5 with high accuracy is critical.

Prevalence of self-reported diabetes and exposure to organochlorine pesticides among Mexican Americans: Hispanic health and nutrition examination survey, 1982-1984.

BACKGROUND: The prevalence of diabetes is higher among Mexican Americans than among non-Hispanic whites. Higher serum levels of organochlorine pesticides in Mexican Americans have been reported. Few studies have explored the association between pesticide exposure and diabetes. OBJECTIVES: We set out to examine the association between self-reported diabetes and serum concentrations of organochlorine pesticides among Mexican Americans residing in the southwestern United States from 1982 to 1984. METHODS: This study was conducted among a sample of 1,303 Mexican Americans 20-74 years of age from the Hispanic Health and Nutrition Examination Survey. Serum concentrations were available for seven pesticides or pesticide metabolites at quantifiable levels in at least 1% of the study population: p,p'-DDT (dichlorodiphenyltrichloroethane), p,p'-DDE (dichlorodiphenyldichloro-ethylene), dieldrin, oxychlordane, beta-hexachlorocyclohexane, hexachlorobenzene, and trans-nonachlor. We used logistic regression to evaluate the association of self-reported diabetes with exposure to organochlorine pesticides, with and without adjustment for total serum lipids. Nonfasting serum glucose values were compared among exposure groups. RESULTS: Self-reported diabetes was significantly associated with serum levels above the detectable limit for trans-nonachlor, oxychlordane, and beta-hexachlorocyclohexane and among those with the highest level of exposure to p,p'-DDT and p,p'-DDE. On adjustment for total serum lipids, the association with p,p'-DDT remained significant. Serum glucose levels were elevated among those exposed to trans-nonachlor and beta-hexachlorocyclohexane. CONCLUSION: This study suggests that higher serum levels of certain organochlorine pesticides may be associated with increased prevalence of diabetes. Additional studies with more extensive clinical assessment are needed to confirm this association.

Who uses complementary and alternative medicine in Israel?

OBJECTIVE: To describe the Israeli complementary and alternative medicine users and examine whether they are the same or different from non-users. DESIGN: This analysis was conducted on data collected from the use of health services module (n=2,365) of the Israeli National Health Interview Survey conducted 2003-2004. The questionnaire was based on the European Health Interview Survey and was administered over the telephone by trained interviewers. SUBJECTS: This survey was conducted on a random sample of the Israel general population age 21 years or more. OUTCOME MEASURES: Chi-square tests and logistic regression analyses were conducted. Complementary and alternative medicine was defined as self-reported use of homeopath, acupuncturist, chiropractor/osteopath, naturopath, or other complementary and alternative provider services for the subjects' own health needs in the last 12 months. RESULTS: Almost 6 percent of Israelis reported using complementary and alternative medicine. Use increased with income. Users were more likely to visit any doctor or a specialist in the prior 4 weeks to the survey compared to nonusers. Users self-reported similar use of pain medications compared to nonusers. CONCLUSIONS: These findings inform the international debate regarding if and how complementary and alternative medicine services should be covered by national health insurance.

Environmental data assessment for use in public health surveillance.

Public health surveillance is the ongoing systematic collection, analysis, interpretation, and dissemination of data on health-related events for use in public health action to reduce morbidity and mortality and to improve health. Total trihalomethanes are an example of a chemical in drinking water that is regulated by the U.S. Environmental Protection Agency (U.S. EPA) but is not under public health surveillance. The U.S. EPA database that stores this environmental information is called the Safe Drinking Water Information System (SDWIS). Its purpose is to collect data on noncompliance events in drinking-water utilities in each state. For this discussion, the SDWIS data on TTHMs, which are an example of environmental data, were assessed for public health surveillance system attributes as defined by the Centers for Disease Control and Prevention: simplicity, flexibility, data quality, acceptability, sensitivity, predictive value positive, representativeness, timeliness, and stability.

National environmental public health tracking program: bridging the information gap.

In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program's academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.

A federal agency's role in fulfilling the public health core functions: the childhood lead poisoning prevention program model.

The Institute of Medicine identified 3 core functions of public health: assessment, policy development, and assurance. Federal, state, and local public health agencies all have an obligation to provide these vital functions to ensure conditions in which people can be healthy. However, the few publications that provide core function applications only focus on applications at the local or state levels. The Centers for Disease Control and Prevention's Childhood Lead Poisoning Prevention Program uses a comprehensive public health approach. This article describes the Centers for Disease Control and Prevention's leading role in applying the core public health functions to prevent childhood lead poisoning.

Associations between serum levels of selected organochlorine compounds and endometriosis in infertile Japanese women.

Endocrine-disrupting chemicals (EDCs) have been proposed as risk factors for endometriosis. Persistent organochlorine compounds, a group of suspected EDCs, are present to some extent in almost all human adipose tissue and blood via the food chain. A few animal studies have confirmed that exposure to these compounds can increase the incidence of endometriosis. In this study, we examined the associations between endometriosis and exposure to selected organochlorine compounds, including 8 polychlorinated dibenzo-p-dioxins (PCDDs), 10 polychlorinated dibenzofurans (PCDFs), 4 coplanar polychlorinated biphenyls (cPCBs), 36 ortho-substituted polychlorinated biphenyls (PCBs), and 13 chlorinated pesticides or their metabolites. The participants were 139 infertile Japanese women who were examined by laparoscopy and diagnosed as either endometriosis cases (Stages II-IV) or controls (Stages 0-I). The serum levels (lipid adjusted) of the targeted organochlorine compounds were in both 58 cases and 81 controls. There were very few differences in the various levels between endometriosis cases and controls. The total serum toxic equivalency (TEQ) value of PCDDs was significantly higher in the controls than in the cases (P=0.02). No other total TEQ values differed between cases and controls. For PCDDs, PCDFs, cPCBs, and PCBs, the multivariate odds ratio was 0.38 [95% confidence interval (CI), 0.12-1.17] and 0.41 (95% CI, 0.14-1.27) for the third and highest quartiles, respectively, compared to the lowest quartile of total TEQ values. A weak, negative dose-response relationship was evident for total TEQs (P for trend of 0.06). The results of this study provide some evidence that serum levels of these organochlorine compounds are not associated with an increased risk of endometriosis in infertile Japanese women.

Mean and median hearing thresholds among children 6 to 19 years of age: the Third National Health And Nutrition Examination Survey, 1988 to 1994, United States.

OBJECTIVE: The objective of this study was to provide the first national representative values for mean and median hearing thresholds among US children 6 to 19 yrs of age. METHODS: Hearing thresholds were obtained from 6166 children in the Third National Health and Nutrition Examination Survey (1988 to 1994), a national, population-based cross-sectional survey with household interview and audiometric testing at 0.5 to 8 kHz. Means, medians, and standard errors of the mean were obtained and reported by ear, frequency, sex, and age. RESULTS: The mean and median thresholds ranged from 3.0 to 11.8 dB HL and -1.0 to 10.8 dB HL, respectively. The highest (poorest) thresholds were obtained at test frequencies above 4000 Hz. Similar mean and median thresholds were found between boys and girls at all frequencies. CONCLUSIONS: These data indicate that the mean thresholds fall below the standard screening guidelines recommended by the American Speech-Language-Hearing Association (< or =20 dB HL for the frequencies from 1000< or =20 dB HL for the frequencies from 2000, and 4000 Hz). The results of this study suggest the need to include the test frequency of 6000 Hz in screening protocols for children.