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The World Health Organization has concluded that the climatic changes that have occurred since the mid 1970s could already be causing annually over 150,000 deaths and five million disability-adjusted life-years (DALY), mainly in developing countries. The less developed countries are, ironically, those least responsible for causing global warming. Many health outcomes and diseases are sensitive to climate, including: heat-related mortality or morbidity; air pollution-related illnesses; infectious diseases, particularly those transmitted, indirectly, via water or by insect or rodent vectors; and refugee health issues linked to forced population migration. Yet, changing landscapes can significantly affect local weather more acutely than long-term climate change. Land-cover change can influence micro-climatic conditions, including temperature, evapo-transpiration and surface run-off, that are key determinants in the emergence of many infectious diseases. To improve risk assessment and risk management of these synergistic processes (climate and land-use change), more collaborative efforts in research, training and policy-decision support, across the fields of health, environment, sociology and economics, are required. [ABSTRACT FROM AUTHOR]

While malaria transmission varies seasonally, large inter-annual heterogeneity of malaria incidence occurs. Variability in entomological parameters, biting rates and entomological inoculation rates (EIR) have been strongly associated with attack rates in children. The goal of this study was to assess the weather's impact on weekly biting and EIR in the endemic area of Kisian, Kenya. Entomological data collected by the U.S. Army from March 1986 through June 1988 at Kisian, Kenya was analysed with concurrent weather data from nearby Kisumu airport. A soil moisture model of surface-water availability was used to combine multiple weather parameters with landcover and soil features to improve disease prediction. Modelling soil moisture substantially improved prediction of biting rates compared to rainfall; soil moisture lagged two weeks explained up to 45% of An. gambiae biting variability, compared to 8% for raw precipitation. For An. funestus, soil moisture explained 32% variability, peaking after a 4-week lag. The interspecies difference in response to soil moisture was significant (P < 0.00001). A satellite normalized differential vegetation index (NDVI) of the study site yielded a similar correlation (r = 0.42 An. gambiae). Modelled soil moisture accounted for up to 56% variability of An. gambiae EIR, peaking at a lag of six weeks. The relationship between temperature and An. gambiae biting rates was less robust; maximum temperature r2 = -0.20, and minimum temperature r2 = 0.12 after lagging one week. Benefits of hydrological modelling are compared to raw weather parameters and to satellite NDVI. These findings can improve both current malaria risk assessments and those based on El Niño forecasts or global climate change model projections. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy and safety of short chain fatty acids (SCFA) in the treatment of refractory distal ulcerative colitis (UC). Methods: Ten patients with distal UC who had failed to respond to rectal and oral therapy with 5-ASA and corticosteroids were treated with twice daily enemas containing sodium acetate 60 mM, sodium propionate 30 mM, and sodium butyrate 40 mM titrated to a pH of 7. Patients were assessed clinically (rectal bleeding, tenesmus, bowel motions), endoscopically, and histologically before and after 6 wk of therapy. In addition, patients gave a self-assessment of the efficacy of treatment. Results: Five of the 10 patients responded clinically, and four of these had a clinical remission as reflected by a decrease in degree of bleeding (2.2 vs. 1.2, p < 0.05) and tenesmus (1.6 vs. 0.3, p < 0.05) and by global self-assessment. Endoscopic improvement occurred in five (6.78 ± 0.83 vs. 4.44 ± 2.7, p < 0.05). Histologically, no improvement was noted. No side effects were noted, and no patient's condition deteriorated. Conclusions: in this open-labeled study in patients with highly refractory distal UC, 50% had an overall clinical and endoscopic response. Forty percent of the patients assessed the treatment to he superior to previous treatments and expressed a desire to continue. This trial confirms other studies as to the efficacy of this treatment and further confirms the need for controlled trials of this promising therapy. [ABSTRACT FROM AUTHOR]

A corrigendum to the article "Methotrexate in Chronic Active Crohn's Disease: A Double-Blind, Randomized, Israeli Multicenter Trial" published in a 1997 issue of the journal is presented.

Introduction: To investigate whether the El Niño phenomenon and ambient temperature had an effect on the epidemiology of childhood diarrhoea, we analysed data on daily number of admissions of children with diarrhoea to the Oral Rehydration Unit of the Instituto de Salud del Niño in Lima, Peru, between January, 1993, and November, 1998.Methods: We obtained daily data on hospital admissions from the Oral Rehydration Unit, and meteorological data from the Peruvian Weather Service, and used time-series linear regression models to assess the effects of the 1997-98 El Niño event on admissions for diarrhoea.Findings: 57,331 children under 10 years old were admitted to the unit during the study. During the 1997-98 El Niño episode, mean ambient temperature in Lima increased up to 5 degrees C above normal, and the number of daily admissions for diarrhoea increased to 200% of the previous rate. 6225 excess admissions were attributable to El Niño, and these cost US$277,000. During the period before the El Niño episode, admissions for diarrhoea increased by 8% per 1 degree C increase in mean ambient temperature. The effects of El Niño and ambient temperature on the number of admissions for diarrhoea were greatest during the winter months.Interpretation: El Niño had an effect on hospital admissions greater than that explained by the regular seasonal variability in ambient temperature. The excess increase in ambient temperature was the main environmental variable affecting admissions. If our findings are reproducible in other regions, diarrhoeal diseases may increase by millions of cases worldwide with each degree of increase in ambient temperature above normal. [ABSTRACT FROM AUTHOR]

Background: Rennes, a midsize city in France, features many opportunities for active travel. City officials seek to increase walking and cycling by 2030 to improve public health. Physical inactivity, a leading risk factor for premature mortality around the globe, has been shown to be associated with many chronic diseases including heart disease, type 2 diabetes, and cancer., Methods: Using the 2018 household travel survey of Rennes residents, we apply the Health-Oriented Transportation statistical model to assess health impacts associated with population-level rates of walking and cycling. We consider two proposed mobility and climate objectives which outline sustainable transportation goals by 2030. These include a shift in transportation mode share to increase walking and cycling trips, as well as a broad reduction in vehicle miles traveled (VMT) across the metropolitan area., Results: Our regression analysis demonstrated that factors of household car access and inner-city residency were predictors of prevalence (observed one-day proportion engaging in walking or cycling), participation (weekly proportion), and intensity (mean individual physical activity achieved through walking/cycling) of active travel. Age and education were additionally associated with prevalence. The 2030 mobility objective (mode share: 9% cycle, 35% walk) was associated with a reduction of 1,051 DALYs (disability-adjusted life-years), translating to $73 million USD ($23-$177) in averted costs. The climate objective (10% reduction in VMT) was associated with a reduction of 369 DALYs when replaced entirely by walking and 714 DALYs with cycling, translating to $26 million ($8-$62) and $50 million ($15-$121) saved, respectively., Conclusions: Rennes residents experience high participation in active travel, particularly those in the inner city. If residents achieve the city's active travel goals for 2030, there is potential for a large reduction in health burden and subsequent costs. Reaching these goals may require significant investment in transportation programming and infrastructure to improve active travel opportunities., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Fremont H et al.)

Background: The prevalence of chronic disease in the US adult population varies across socioeconomic groups in the USA where approximately six in 10 adults have a chronic condition. Walking or cycling reduces the risk to many of these diseases and is influenced by the built environment, accessibility, and safety., Methods: We performed multivariate logistic and linear regression on the Health-Oriented Transportation model parameters using the 2009 and 2017 US National Household Transportation surveys, restricted to adults in major metropolitan areas. Model covariates included socioeconomic and environmental characteristics., Results: Using odds ratios (OR) adjusted for model covariates, we observe several significant variables in 2009 and 2017. Residents of households with no cars were more likely to walk or cycle than those with two cars; OR=5.4 (4.8, 6.0). Residents of households in a census block with population density greater than 2,5000 persons/square mile were more likely to walk or cycle than those with a population density of 2000-3999; OR=2.6 (2.3, 2.8). Individuals with a graduate or professional degree were more likely to walk or cycle than those with a high school degree; OR=2.1 (1.9, 2.2). Individuals that self-report as Black or African American, or Asian are less likely to walk or cycle than White; OR=0.60 (0.56, 0.66), OR=0.70 (0.65, 0.75). The proportional increase in all-cause mortality from estimated reductions in physical activity for African American, Asian, and Hispanic populations were 1.0%, 0.7%, 0.8%, respectively., Conclusions: Access to automobiles and the surrounding population density are primary factors in the decision to walk or cycle. After adjusting for these and other factors, members of low-income, low-education, Black or African American, and Asian populations in US metropolitan areas are less likely to walk or cycle than high-income, high-education, or White populations and the discrepancy in physical activity is likely to contribute to health inequity., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Younkin S et al.)

The infertility of many couples rests on an enigmatic dysfunction of the man's sperm. To gain insight into the underlying pathomechanisms, we assessed the function of the sperm-specific multisubunit CatSper-channel complex in the sperm of almost 2,300 men undergoing a fertility workup, using a simple motility-based test. We identified a group of men with normal semen parameters but defective CatSper function. These men or couples failed to conceive naturally and upon medically assisted reproduction via intrauterine insemination and in vitro fertilization. Intracytoplasmic sperm injection (ICSI) was, ultimately, required to conceive a child. We revealed that the defective CatSper function was caused by variations in CATSPER genes. Moreover, we unveiled that CatSper-deficient human sperm were unable to undergo hyperactive motility and, therefore, failed to penetrate the egg coat. Thus, our study provides the experimental evidence that sperm hyperactivation is required for human fertilization, explaining the infertility of CatSper-deficient men and the need of ICSI for medically assisted reproduction. Finally, our study also revealed that defective CatSper function and ensuing failure to hyperactivate represents the most common cause of unexplained male infertility known thus far and that this sperm channelopathy can readily be diagnosed, enabling future evidence-based treatment of affected couples.

The development of infrastructure, a rapidly increasing population, and urbanization has resulted in increasing air pollution levels in the African city of Addis Ababa. Prior investigations into air pollution have not yet sufficiently addressed the sources of atmospheric particulate matter. This study aims to identify the major sources of fine particulate matter (PM 2.5 ) and its seasonal contribution in Addis Ababa, Ethiopia. Twenty-four-hour average PM 2.5 mass samples were collected every 6th day, from November 2015 through November 2016. Chemical species were measured in samples and source apportionment was conducted using a chemical mass balance (CMB) receptor model that uses particle-phase organic tracer concentrations to estimate source contributions to PM 2.5 organic carbon (OC) and the overall PM 2.5 mass. Vehicular sources (28%), biomass burning (18.3%), plus soil dust (17.4%) comprise about two-thirds of the PM 2.5 mass, followed by sulfate (6.5%). The sources of air pollution vary seasonally, particularly during the main wet season (June-September) and short rain season (February-April): From motor vehicles, (31.0 ± 2.6%) vs. (24.7 ± 1.2%); biomass burning, (21.5 ± 5%) vs. (14 ± 2%); and soil dust, (11 ± 6.4%) vs. (22.7 ± 8.4%), respectively, are amongst the three principal sources of ambient PM 2.5 mass in the city. We suggest policy measures focusing on transportation, cleaner fuel or energy, waste management, and increasing awareness on the impact of air pollution on the public's health.

Real-time monitoring of fine particulate matter (PM 2.5 ) concentrations and assessing the health impact are limited in Ethiopia. The objective of this study is to describe current levels of PM 2.5 air pollution in Addis Ababa and examine temporal patterns and to consider the health impact of current PM 2.5 exposure levels., Methods: PM 2.5 concentrations were measured using a centrally-located Beta Attenuator Monitor (BAM-1022) for 3 years (1 April 2017 to 31 March 2020), with data downloaded biweekly. Deaths attributable to current PM 2.5 concentration levels were estimated using the AirQ+ tool. The daily average was estimated using hourly data., Results: The daily mean (SD) PM 2.5 concentration was 42.4 µg/m 3 (15.98). Two daily extremes were observed: morning (high) and afternoon (low). Sundays had the lowest PM 2.5 concentration, while Mondays to Thursdays saw a continuous increase; Fridays showed the highest concentration. Seasons showed marked variation, with the highest values during the wet season. Concentration spikes reflected periods of intensive fuel combustion. A total of 502 deaths (4.44%) were attributable to current air pollution levels referenced to the 35 µg/m 3 WHO interim target annual level and 2,043 (17.7%) at the WHO 10 µg/m 3 annual guideline., Conclusion: PM 2.5 daily levels were 1.7 times higher than the WHO-recommended 24-hour guideline. The current annual mean PM 2.5 concentration results in a substantial burden of attributable deaths compared to an annual mean of 10 µg/m 3 . The high PM 2.5 level and its variability across days and seasons calls for citywide interventions to promote clean air., Competing Interests: The authors declare that they have no conflicts of interest with regard to the content of this report.Sponsorships or competing interests that may be relevant to content are disclosed at the end of the article., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)

Competing Interests: CAFG declares consulting fees from the Planetary Health Alliance. CH declares consulting fees from the Lancet Countdown on Health and Climate Change and from CODA Change and board positions or steering committee for Global Climate and Health Alliance, the WHO-Civil Society Working Group on Climate Change and Health, the Planetary Health Alliance, the Canadian Association of Physicians for the Environment, and the Canadian Medical Association. EB declares being the chair of the WONCA Working Party on the Environment and was a grant recipient from WONCA Air Health Train-the-Trainer. JP declares being recipient of the Chanchlani Award for Global Health Research. MZ declares consulting work with the Organization for Noetic Ecology NPO and Wildlands Studies; and pro-bono advisor or associate to Sea Change Trust (South Africa), Masiyembo Association (South Africa), The Connective (Australia), and Earthfire Institute (USA). NE declares a previous role as a data analysis consultant at HowGood starting March 17, 2021. Brunel University London has supported provision on OM's time in-kind for this project and preparation of this manuscript. TP declares budget for travel to Planetary Health events, but funds were not used during the writing of this paper. All other authors declare no competing interests.

In this study, we estimate the health benefits of more stringent alternative energy goals and the costs of reducing coal-fired power plant pollution in China projected in 2030. One of our two overarching alternative energy goals was to estimate the health benefits of complete elimination of coal energy, supplemented by natural gas and renewables. The second was a policy scenario similar to the U.S. 2013 Climate Action Plan (CAP), which played a pivotal role leading up to the 2015 Paris Climate Agreement. We used the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model created by the International Institute for Applied Systems Analysis for our model simulations. We found that 17,137-24,220 premature deaths can be avoided if coal energy is completely replaced by alternative energy, and 8,693-9,281 premature deaths can be avoided if coal energy is replaced by alternatives in a CAP-like scenario. A CAP-like scenario using emission-controls in coal plants costs $11-18 per person. Reducing coal energy in China under a CAP-like scenario would free up $9.4 billion in the annual energy budget to spend on alternatives, whereas eliminating the cost of coal energy frees up $32 billion. This study's estimates show that more stringent alternative energy targets in China are worth the investment in terms of health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Scott, Sander, Nemet and Patz.)

Ambient air pollution is a growing public health concern in major African cities, including Addis Ababa (Ethiopia), where little information is available on fine particulate matter (PM 2.5 , with aerodynamic diameter <2.5 µm) pollution. This paper aims to characterize annual PM 2.5 , including bulk composition and seasonal patterns, in Addis Ababa. We collected 24-h PM 2.5 samples in the central city every 6 days from November 2015 to November 2016. The mean (±SD) daily PM 2.5 concentration was 53.8 (±25.0) µg/m 3 , with 90% of sampled days exceeding the World Health Organization's guidelines. Principal components were organic matter (OM, 44.5%), elemental carbon (EC, 25.4%), soil dust (13.5%), and SNA (sulfate, nitrate, and ammonium ions, 8.2%). Higher PM 2.5 concentrations were observed during the heavy rain season, while crustal dust concentrations ranged from 2.9 to 37.6%, with higher levels during dry months. Meteorological variables, vehicle emissions, biomass fuels, unpaved roads, and construction activity contribute to poor air quality. Compared to the Air Quality Index (AQI), 31% and 36% of observed days were unhealthy for everyone and unhealthy for sensitive groups, respectively. We recommend adopting effective prevention strategies and pursuing research on vehicle emissions, biomass burning, and dust control to curb air pollution in the city.

The 2018 NASA Health and Air Quality Applied Science Team (HAQAST) "Indicators" Tiger Team collaboration between NASA-supported scientists and civil society stakeholders aimed to develop satellite-derived global air pollution and climate indicators. This Commentary shares our experience and lessons learned. Together, the team developed methods to track wildfires, dust storms, pollen counts, urban green space, nitrogen dioxide concentrations and asthma burdens, tropospheric ozone concentrations, and urban particulate matter mortality. Participatory knowledge production can lead to more actionable information but requires time, flexibility, and continuous engagement. Ground measurements are still needed for ground truthing, and sustained collaboration over time remains a challenge., Competing Interests: The authors declare that they have no conflicts of interest relevant to this study., (©2020. The Authors.)

West Nile virus (WNV) is the most important and widespread mosquito-borne virus in the United States (U.S.). WNV has the ability to spread rapidly and effectively, infecting more than 320 bird and mammalian species. An examination of environmental conditions and the health of keystone species may help predict the susceptibility of various habitats to WNV and reveal key risk factors, annual trends, and vulnerable regions. Since 2002, WNV outbreaks in Wisconsin varied by species, place, and time, significantly affected by unique climatic, environmental, and geographical factors. During a 15 year period, WNV was detected in 71 of 72 counties, resulting in 239 human and 1397 wildlife cases. Controlling for population and sampling efforts in Wisconsin, rates of WNV are highest in the western and northwestern rural regions of the state. WNV incidence rates were highest in counties with low human population densities, predominantly wetland, and at elevations greater than 1000 feet. Resources for surveillance, prevention, and detection of WNV were lowest in rural counties, likely resulting in underestimation of cases. Overall, increasing mean temperature and decreasing precipitation showed positive influence on WNV transmission in Wisconsin. This study incorporates the first statewide assessment of WNV in Wisconsin.

Background: Heart failure with preserved ejection fraction is the most common cause of heart failure and is characterized by impaired diastolic relaxation. Bariatric surgery significantly improves diastolic relaxation, but a mechanism beyond weight loss remains unknown., Objectives: We tested the hypothesis that a sleeve gastrectomy (SG) will improve diastolic dysfunction independent of weight loss due to postoperative alterations in the enterocardiac axis., Setting: University research laboratory., Methods: Male Wistar rats were fed a high-fat diet (HFD) or low-fat diet (LFD) for 10 weeks and then divided into SG-HFD, pair-fed sham HFD, ad-lib sham HFD, or ad-lib sham LFD groups (n = 9-14 per group). At least 2 months postoperatively, cardiac function, meal tolerance, glucose tolerance, and cardiac gene expression were compared between groups., Results: Only the SG cohort showed significant improvements in postoperative diastolic relaxation (isovolumetric relaxation time pre-SG: 14.7 ± 2.3 msec, post-SG: 11.2 ± 1.8 msec, P < .001). SG significantly increased active glucagon-like peptide-1 (P = .03). Compared to pair-fed sham HFD rats, SG-HFD rats had significantly altered mRNA cardiac gene expression, including sarco/endoplasmic reticulum Ca2+-ATPase 2 a (SERCA2 a) (P < .001)., Conclusions: SG improves diastolic function independent of weight loss in a rat model of obesity with beneficial alterations in cardiac gene expression of multiple known targets related to cardiac failure, including SERCA2 a. These data support that a greater curve gastrectomy induces beneficial intracellular cardiac signaling for diastolic function mediated by the enterocardiac axis that is independent of weight loss. These findings could translate to offering metabolic surgery to patients with heart failure with preserved ejection fraction., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Past studies have established strong connections between meteorology and air quality, via chemistry, transport, and natural emissions. A less understood linkage between weather and air quality is the temperature-dependence of emissions from electricity generating units (EGUs), associated with high electricity demand to support building cooling on hot days. This study quantifies the relationship between ambient surface temperatures and EGU air emissions (CO 2 , SO 2 , and NO X ) using historical data. We find that EGUs in the Eastern U.S. region from 2007 to 2012 exhibited a 3.87% ± 0.41% increase in electricity generation per °C increase during summer months. This is associated with a 3.35%/°C ± 0.50%/°C increase in SO 2 emissions, a 3.60%/°C ± 0.49%/°C increase in NO X emissions, and a 3.32%/°C ± 0.36%/°C increase in CO 2 emissions. Sensitivities vary by year and by pollutant, with SO 2 both the highest sensitivity (5.04% in 2012) and lowest sensitivity (2.19% in 2007) in terms of a regional average. Texas displays 2007-2012 sensitivities of 2.34%/°C ± 0.28%/°C for generation, 0.91%/°C ± 0.25%/°C for SO 2 emissions, 2.15%/°C ± 0.29%/°C for NO X emissions, and 1.78%/°C ± 0.22%/°C for CO 2 emissions. These results suggest demand-side and supply side technological improvements and fuel choice could play an important role in cost-effective reduction of carbon emissions and air pollution.

Introduction: Environmental factors contribute with 16% of the burden of disease in Colombia. A main obstacle in implementing national and regional environmental and occupational health policies is the limited knowledge on the local ability to study and control the impact of harmful exposures on health., Objective: To identify needs for research and training in environmental and occupational health in Colombia., Materials and Methods: We conducted a three-round hybrid Delphi study. A group of environmental and occupational health Colombian experts (n=16) from government agencies, universities, and research centers was recruited to participate in the study. Expert´s opinions on research and training needs were gathered through online questionnaires, followed by an in-person meeting. The percentage of agreement and the coefficient of variation were used to measure consensus., Results: Air pollution and chemical products were considered the most important environmental and occupational exposures, due to their significant impact on chronic non-communicable diseases, such as respiratory diseases, cardiovascular diseases, and cancer. Research on the effects of outdoor air pollution on cardiovascular and respiratory diseases was considered of the greatest importance. Priority training areas included environmental and occupational health risk assessment, exposure modeling, advanced statistical methods, urban planning, occupational safety and hygiene, and epidemiology and toxicology., Conclusions: These findings provide a valuable input for the definition and implementation of national environmental and occupational health policies and for the development of a regional hub aimed at strengthening the capacity for research and training in Colombia.

Objectives: To improve our understanding of climate variability and diarrheal disease at the community level and inform predictions for future climate change scenarios, we examined whether the El Niño climate pattern is associated with increased rates of diarrhea among Peruvian children., Methods: We analyzed daily surveillance data for 367 children aged 0 to 12 years from 2 cohorts in a peri-urban shantytown in Lima, Peru, 1995 through 1998. We stratified diarrheal incidence by 6-month age categories, season, and El Niño, and modeled between-subject heterogeneity with random effects Poisson models., Results: Spring diarrheal incidence increased by 55% during El Niño compared with before El Niño. This increase was most acute among children older than 60 months, for whom the risk of a diarrheal episode during the El Niño spring was nearly 100% greater (relative risk=1.96; 95% confidence interval=1.24, 3.09)., Conclusions: El Niño-associated climate variability affects community rates of diarrhea, particularly during the cooler seasons and among older children. Public health officials should develop preventive strategies for future El Niño episodes to mitigate the increased risk of diarrheal disease in vulnerable communities.

For conditions with wide-ranging consequences, such as cerebral palsy (CP), population-based surveillance provides an estimate of the prevalence of case status but only the broadest understanding of the impact of the condition on children, families or society. Beyond case status, information regarding health, functional skills and participation is necessary to fully appreciate the consequences of the condition. The purpose of this study was to assess the feasibility and reliability of enhancing population-based surveillance by classifying gross motor function (GMF) from information available in medical records of children with CP. We assessed inter-rater reliability of two GMF classification methods, one the Gross Motor Function Classification System (GMFCS) and the other a 3-category classification of walking ability: (1) independently, (2) with handheld mobility device, or (3) limited or none. Two qualified clinicians independently reviewed abstracted evaluations from medical records of 8-year-old children residing in southeast Wisconsin, USA who were identified as having CP (n = 154) through the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. Ninety per cent (n = 138) of the children with CP had information in the record after age 4 years and 108 (70%) had adequate descriptions of gross motor skills to classify using the GMFCS. Agreement was achieved on 75.0% of the GMFCS ratings (simple kappa = 0.67, 95% confidence interval [95% CI 0.57, 0.78], weighted kappa = 0.83, [95% CI 0.77, 0.89]). Among case children for whom walking ability could be classified (n = 117), approximately half walked independently without devices and one-third had limited or no walking ability. Across walking ability categories, agreement was reached for 94% (simple kappa = 0.90, [95% CI 0.82, 0.96], weighted kappa = 0.94, [95% CI 0.89, 0.98]). Classifying GMF in the context of active records-based surveillance is feasible and reliable. Future surveillance efforts that include functional level among children with cerebral palsy may provide important information for monitoring the impact of the condition for programmatic and policy purposes., (© 2010 Blackwell Publishing Ltd.)

Background: : Kawasaki disease exhibits a distinct seasonality, and short-term changes in weather may affect its occurrence., Methods: : To investigate the effects of weather variability on the occurrence of this syndrome, we conducted a time-between-events analysis of consecutive admissions for Kawasaki disease to a large pediatric hospital in Chicago. We used gamma regression to model the times between admissions. This is a novel application of gamma regression to model the time between admissions as a function of subject-specific covariates., Results: : We recorded 723 admissions in the 18-year (1986-2003) study period, of which 700 had complete data for analysis. Admissions for Kawasaki disease in Chicago were seasonal: The mean time between admissions was 34% shorter (relative time = 0.66, 95% confidence interval 0.54-0.81) from January-March than from July-September. In 1998, we recorded a larger number of admissions for Kawasaki disease (n = 65) than in other years (mean n = 37). January-March months of 1998 were warmer by a mean of 3 degrees C (1.5 degrees C-4.4 degrees C) and the mean time between admissions was 48% shorter (relative time = 0.52, 0.36-0.75) than in equivalent periods of other study years., Conclusions: : Our findings show that atypical changes in weather affect the occurrence of Kawasaki disease and are compatible with a link to an infectious trigger. The analysis of interevent times using gamma regression is an alternative to Poisson regression in modeling a time series of sparse daily counts.

Climate change is projected to have adverse impacts on public health. Cobenefits may be possible from more upstream mitigation of greenhouse gases causing climate change. To help measure such cobenefits alongside averted disease-specific risks, a health impact assessment (HIA) framework can more comprehensively serve as a decision support tool. HIA also considers health equity, clearly part of the climate change problem. New choices for energy must be made carefully considering such effects as additional pressure on the world's forests through large-scale expansion of soybean and oil palm plantations, leading to forest clearing, biodiversity loss and disease emergence, expulsion of subsistence farmers, and potential increases in food prices and emissions of carbon dioxide to the atmosphere. Investigators must consider the full range of policy options, supported by more comprehensive, flexible, and transparent assessment methods.

Autoimmune atrophic gastritis is encountered in 20-27% of patients with obscure, or refractory iron deficiency anemia and is 4 to 6 times more common than celiac disease causing unexplained iron deficiency. The unique clinical features of iron deficiency anemia associated with achlorhydria and mucosal atrophy sparing the gastric antrum have all been accurately described by Faber and others over 100 years ago, including its refractoriness to oral iron treatment, female predominance, relatively young age, increased prevalence of thyroid disease and tendency to progress to pernicious anemia. A significant new development is the relation between autoimmune gastritis and Helicobacter pylori infection. H. pylori per se impairs gastric acid secretion and it is quite likely that a proportion of patients described originally as achylia gastrica represented H. pylori and not autoimmune gastritis. The demonstration of H. pylori antibodies in atrophic gastritis directed against epitopes on gastric mucosal cells implies an autoimmune mechanism triggered by H. pylori and directed against gastric parietal cells by antigenic mimicry of H+K+-ATPase, the most common autoantigen in pernicious anemia. These findings introduce a new element into the 100-year-old saga of achylia gastrica and open new options for its prevention and management.

Iron deficiency is a known complication of achlorhydria and may precede the development of pernicious anemia. Among 160 patients with autoimmune gastritis identified by hypergastrinemia and strongly positive antiparietal antibodies, we explored the overlap between 83 subjects presenting with iron deficiency anemia (IDA), 48 with normocytic indices, and 29 with macrocytic anemia. Compared with macrocytic patients, patients with IDA were 21 years younger (41 +/- 15 years versus 62 +/- 15 years) and mostly women. All groups had a high prevalence of thyroid disease (20%) and diabetes (8%) suggestive of the autoimmune polyendocrine syndrome. Stratification by age cohorts from younger than 20 years to older than 60 years showed a regular and progressive increase in mean corpuscular volume (MCV) from 68 +/- 9 to 95 +/- 16 fl, serum ferritin levels from 4 +/- 2 to 37 +/- 41 microg/L, gastrin level from 166 +/- 118 to 382 +/- 299 pM/L (349 +/- 247 to 800 +/- 627 pg/mL), and a decrease in cobalamin level from 392 +/- 179 to 108 +/- 65 pg/mL. The prevalence of Helicobacter pylori infection was 87.5% at age younger than 20 years, 47% at age 20 to 40 years, 37.5% at 41 to 60 years, and 12.5% at age older than 60 years. These findings challenge the common notion that pernicious anemia is a disease of the elderly and imply a disease starting many years before the establishment of clinical cobalamin deficiency, by an autoimmune process likely triggered by H pylori.

This paper reviews the background that has led to the now almost-universally held opinion in the scientific community that global climate change is occurring and is inescapably linked with anthropogenic activity. The potential implications to human health are considerable and very diverse. These include, for example, the increased direct impacts of heat and of rises in sea level, exacerbated air and water-borne harmful agents, and--associated with all the preceding--the emergence of environmental refugees. Vector-borne diseases, in particular those associated with blood-sucking arthropods such as mosquitoes, may be significantly impacted, including redistribution of some of those diseases to areas not previously affected. Responses to possible impending environmental and public health crises must involve political and socio-economic considerations, adding even greater complexity to what is already a difficult challenge. In some areas, adjustments to national and international public health practices and policies may be effective, at least in the short and medium terms. But in others, more drastic measures will be required. Environmental monitoring, in its widest sense, will play a significant role in the future management of the problem.

Objectives: To determine whether the microemulsified formulation of cyclosporine (MCsA; Neoral; Novartis A.G.), combined with azathioprine (Imuran; Glaxo Wellcome), and prednisolone (Delta-Cortef; Upjohn), would be effective in preventing acute renal allograft rejection in unrelated mongrel dogs. To document any toxic effects associated with this drug combination., Study Design: rospective, pilot study., Animals: Four healthy, adult, mongrel, canine renal allograft recipients., Methods: Heterotopic renal transplantation, with bilateral nephrectomy, was performed in 4 dogs. Allografts were harvested from 2 unrelated dogs that were to be euthanatized for reasons unrelated to this study. The dogs were treated for 100 days or until signs of illness or allograft rejection required euthanasia. Microemulsified cyclosporine (20 mg/kg/day), azathioprine (5 mg/kg every other day), and prednisolone (1 mg/kg/day) were administered for the prevention of acute rejection. Body weight, serum biochemistry profiles, complete blood counts, and trough whole-blood cyclosporine concentrations were measured throughout the study. Cyclosporine dose was adjusted to maintain a trough concentration of 400-500 ng/mL. Azathioprine dose was decreased if evidence of hepatotoxicity developed or if the total blood white cell count was <4,000 cells/micro L. The prednisolone was tapered by 0.25 mg/kg increments every 3 weeks and discontinued 14 days before the end of the study in the surviving dogs. Complications were recorded. A complete necropsy and histopathologic examination were performed in each recipient., Results: Two of the 4 dogs survived the 100-day period. One dog was euthanatized at 8 days because of an intestinal intussusception. One dog was euthanatized at 64 days because of a severe upper respiratory infection. At the time of death, these 2 dogs had plasma creatinine concentrations of 1.5 and 2.6 mg/dL, respectively, with no histopathologic evidence of allograft rejection. All dogs had transient weight loss (range, 4.6%-17.7% of preoperative body weight) between days 7 and 14. Two dogs had evidence of hepatotoxicity. The 2 dogs surviving to 100 days had normal serum creatinine concentrations and no clinical signs of rejection. One of these dogs had evidence of a grade IIa acute/active rejection based on the modified BANFF 97 histopathologic classification. The second dog had no evidence of rejection or inflammation within the allograft., Conclusions: This preliminary experimental study shows that immunosuppression using MCsA, combined with azathioprine and prednisolone, may be effective in preventing acute renal allograft rejection in unrelated mongrel dogs for 100 days. Complications included ileocolic intussusception, upper respiratory infection, weight loss, and transient hepatotoxicity., Clinical Relevance: Immunosuppression using MCsA, azathioprine, and prednisolone may be effective in preventing acute renal allograft rejection in unrelated, mongrel dogs. This triple drug protocol is cost-effective and was easy to administer. Further investigation is warranted to minimize toxic effects and to determine the efficacy of prophylactic renal biopsies to detect and treat subclinical acute/active rejection., (Copyright 2003 by The American College of Veterinary Surgeons)

Objectives: Rainfall and runoff have been implicated in site-specific waterborne disease outbreaks. Because upward trends in heavy precipitation in the United States are projected to increase with climate change, this study sought to quantify the relationship between precipitation and disease outbreaks., Methods: The US Environmental Protection Agency waterborne disease database, totaling 548 reported outbreaks from 1948 through 1994, and precipitation data of the National Climatic Data Center were used to analyze the relationship between precipitation and waterborne diseases. Analyses were at the watershed level, stratified by groundwater and surface water contamination and controlled for effects due to season and hydrologic region. A Monte Carlo version of the Fisher exact test was used to test for statistical significance., Results: Fifty-one percent of waterborne disease outbreaks were preceded by precipitation events above the 90th percentile (P = .002), and 68% by events above the 80th percentile (P = .001). Outbreaks due to surface water contamination showed the strongest association with extreme precipitation during the month of the outbreak; a 2-month lag applied to groundwater contamination events., Conclusions: The statistically significant association found between rainfall and disease in the United States is important for water managers, public health officials, and risk assessors of future climate change.

Diseases such as plague, typhus, malaria, yellow fever, and dengue fever, transmitted between humans by blood-feeding arthropods, were once common in the United States. Many of these diseases are no longer present, mainly because of changes in land use, agricultural methods, residential patterns, human behavior, and vector control. However, diseases that may be transmitted to humans from wild birds or mammals (zoonoses) continue to circulate in nature in many parts of the country. Most vector-borne diseases exhibit a distinct seasonal pattern, which clearly suggests that they are weather sensitive. Rainfall, temperature, and other weather variables affect in many ways both the vectors and the pathogens they transmit. For example, high temperatures can increase or reduce survival rate, depending on the vector, its behavior, ecology, and many other factors. Thus, the probability of transmission may or may not be increased by higher temperatures. The tremendous growth in international travel increases the risk of importation of vector-borne diseases, some of which can be transmitted locally under suitable circumstances at the right time of the year. But demographic and sociologic factors also play a critical role in determining disease incidence, and it is unlikely that these diseases will cause major epidemics in the United States if the public health infrastructure is maintained and improved.

Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.

Global climate change might expand the distribution of vector-borne pathogens in both time and space, thereby exposing host populations to longer transmission seasons, and immunologically naive populations to newly introduced pathogens. In the African highlands, where cool temperatures limit malaria parasite development, increases in temperature might enhance malaria transmission. St Louis encephalitis viral replication and the length of the transmission season depend upon ambient temperature. Warming temperatures in the American southwest might place at risk migratory, non-immune elderly persons that arrive in early fall to spend the winter. Warm temperatures might intensify or extend the transmission season for dengue fever. Immunologists should examine this interplay between human immunocompetence and vector-borne disease risks in a warmer world.

Objective: Appendectomy was shown to be protective in patients with ulcerative colitis (UC). There are fewer data in Crohn's disease (CD). Other operations were less studied. The aim of this study was to investigate the prevalence of appendectomy, cholecystectomy, and tonsillectomy, including their timing, in patients with inflammatory bowel disease in comparison to controls., Methods: Two hundred seventy-one patients with UC and 260 with CD, 475 clinic controls, and 428 community controls were interviewed., Results: Appendectomy was found in 5.5% patients with UC, in 11% of clinic controls (p < 0.05), and 7.7% of community controls (p = not significant). The differences were more significant for appendectomy before onset of disease. Appendectomy was performed in 19.2% of patients with CD, in 10.9% of clinic controls, and in 10.1% of community controls (p < 0.01). However, there were no significant differences when only appendectomy before onset of disease was considered. Cholecystectomy was found in 1.5% of patients with UC, in 6.1% of clinic controls (p < 0.01), and in 4.5% of community controls (p = not significant). The difference remained significant when confined to operations performed before disease onset. No such difference was found in patients with CD. No significant difference was found in the prevalence of tonsillectomy between patients and controls., Conclusions: Appendectomy is protective in UC; it is more frequent, but not a risk factor in CD. The role of cholecystectomy should be investigated further.

Ecological disturbances exert an influence on the emergence and proliferation of malaria and zoonotic parasitic diseases, including, Leishmaniasis, cryptosporidiosis, giardiasis, trypanosomiasis, schistosomiasis, filariasis, onchocerciasis, and loiasis. Each environmental change, whether occurring as a natural phenomenon or through human intervention, changes the ecological balance and context within which disease hosts or vectors and parasites breed, develop, and transmit disease. Each species occupies a particular ecological niche and vector species sub-populations are distinct behaviourally and genetically as they adapt to man-made environments. Most zoonotic parasites display three distinct life cycles: sylvatic, zoonotic, and anthroponotic. In adapting to changed environmental conditions, including reduced non-human population and increased human population, some vectors display conversion from a primarily zoophyllic to primarily anthrophyllic orientation. Deforestation and ensuing changes in landuse, human settlement, commercial development, road construction, water control systems (dams, canals, irrigation systems, reservoirs), and climate, singly, and in combination have been accompanied by global increases in morbidity and mortality from emergent parasitic disease. The replacement of forests with crop farming, ranching, and raising small animals can create supportive habitats for parasites and their host vectors. When the land use of deforested areas changes, the pattern of human settlement is altered and habitat fragmentation may provide opportunities for exchange and transmission of parasites to the heretofore uninfected humans. Construction of water control projects can lead to shifts in such vector populations as snails and mosquitoes and their parasites. Construction of roads in previously inaccessible forested areas can lead to erosion, and stagnant ponds by blocking the flow of streams when the water rises during the rainy season. The combined effects of environmentally detrimental changes in local land use and alterations in global climate disrupt the natural ecosystem and can increase the risk of transmission of parasitic diseases to the human population.

The 1993 U.S. hantavirus pulmonary syndrome (HPS) outbreak was attributed to environmental conditions and increased rodent populations caused by unusual weather in 1991- 92. In a case-control study to test this hypothesis, we estimated precipitation at 28 HPS and 170 control sites during the springs of 1992 and 1993 and compared it with precipitation during the previous 6 years by using rainfall patterns at 196 weather stations. We also used elevation data and Landsat Thematic Mapper satellite imagery collected the year before the outbreak to estimate HPS risk by logistic regression analysis. Rainfall at case sites was not higher during 1992-93 than in previous years. However, elevation, as well as satellite data, showed association between environmental conditions and HPS risk the following year. Repeated analysis using satellite imagery from 1995 showed substantial decrease in medium- to high-risk areas. Only one case of HPS was identified in 1996.

After a century of absence, in late January 1991, Vibrio cholerae invaded the Western Hemisphere by way of Peru. Although a number of theories have been proposed, it is still not understood how that invasion took place. We reviewed the clinical records of persons attending hospital emergency departments in the major coastal cities of Peru from September through January of 1989/1990 and 1990/1991. We identified seven adults suffering from severe, watery diarrhea compatible with a clinical diagnosis of cholera during the four months preceding the cholera outbreak, but none during the previous year. The patients were scattered among five coastal cities along a 1,000 km coastline. We postulate that cholera vibrios, autochthonous to the aquatic environment, were present in multiple coastal locations, and resulted from environmental conditions that existed during an El Nino phenomenon. Once introduced into the coastal communities in concentrations large enough for human infection to occur, cholera spread by the well-known means of contaminated water and food.

We examined the potential impacts of climate variability and change on human health as part of a congressionally mandated study of climate change in the United States. Our author team, comprising experts from academia, government, and the private sector, was selected by the federal interagency U.S. Global Change Research Program, and this report stems from our first 18 months of work. For this assessment we used a set of assumptions and/or projections of future climates developed for all participants in the National Assessment of the Potential Consequences of Climate Variability and Change. We identified five categories of health outcomes that are most likely to be affected by climate change because they are associated with weather and/or climate variables: temperature-related morbidity and mortality; health effects of extreme weather events (storms, tornadoes, hurricanes, and precipitation extremes); air-pollution-related health effects; water- and foodborne diseases; and vector- and rodent-borne diseases. We concluded that the levels of uncertainty preclude any definitive statement on the direction of potential future change for each of these health outcomes, although we developed some hypotheses. Although we mainly addressed adverse health outcomes, we identified some positive health outcomes, notably reduced cold-weather mortality, which has not been extensively examined. We found that at present most of the U.S. population is protected against adverse health outcomes associated with weather and/or climate, although certain demographic and geographic populations are at increased risk. We concluded that vigilance in the maintenance and improvement of public health systems and their responsiveness to changing climate conditions and to identified vulnerable subpopulations should help to protect the U.S. population from any adverse health outcomes of projected climate change.