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Circulating micronutrient levels of both serum copper and zinc have been studied to varying degrees in both the general public and patients having undergone bariatric surgery. According to the 2019 ASMBS clinical guidelines, copper supplementation is recommended for patients undergoing metabolic surgery, especially after Roux-en-Y gastric bypass and duodenal switch. Copper excess has not been previously reported to any significant degree in any population. In this study, we investigate an elevated serum copper level in the pre-surgical intervention population of the Bariatric Center of the University Medical Center–New Orleans, a primary safety net hospital for the state of Louisiana. Five hundred five consecutive patients from the bariatric surgery undergoing a workup for surgical intervention were assessed. Patients were included regardless of whether they proceeded to surgery. The study was conducted as a retrospective review of deidentified data that was collected as part of our routine workup for bariatric surgery. The study population of the clinic consisted of a mean BMI of approximately 50 kg/m2, with 91% of the population reporting female and 69% recording an African American race. It was discovered in this population that 26% of the patients had an elevated copper level of > 155 mcg/dl. Additional analysis was performed attempting to elucidate an environmental role in the elevation by qualitative analysis of patient’s location of residence using reported home address. Additional variables were studied as well including serum zinc concentration, age, BMI, and race to address any correlative variables with our findings. This study identifies an elevated serum copper concentration in a pre-intervention underserved bariatric center population positively associated with BMI, female gender, and African American race. Additional studies will be necessary to see if these trends are also apparent in normal weight controls, or if weight loss influences copper levels. Pre-existing serum copper deficiencies may be more prevalent in the bariatric populations than previously believed. Increased serum copper in this population was positively associated with increased BMI, age, and female gender compared to that of the male group. Increased serum copper was also associated more closely with African American ethnicity compared to Caucasian patients.

Background Cockroach allergen is one of the most important asthma triggers for children. There is an extensive body of research on interventions to reduce exposure. However, adherence to these interventions is low. Insight into the knowledge, attitudes, and practices (KAP) associated with cockroach remediation is needed. We assessed KAP using the Health Beliefs Model (HBM) as a framework for predicting behavior. This study aimed to assess the socio-demographic and psycho-social characteristics associated with cockroach KAP and to quantify the relationship between KAP and number of cockroaches in the home. Methods To identify factors associated with cockroach KAP a cross-sectional study was conducted using a structured questionnaire administered to caregivers of children with asthma in New Orleans, Louisiana. Positive scores in each metric of the KAP signified better cockroach knowledge, increased concern about cockroaches’ impact on health (attitudes), and participation in recommended cockroach remediation practices (practices). To evaluate cockroach KAP scores as a predictor of cockroach exposure in the home, a cohort study was conducted among a sub-sample of participants. Results Fifty-six caregivers participated in the study. Participants had positive scores on all subscales of KAP with knowledge having a lower score compared to attitudes and practices. Cockroach knowledge was inversely correlated with age at asthma diagnosis (ρ = − 0.36, p = 0.01). Caregivers identifying as black/African American had higher cockroach knowledge scores compared to other races (Median: 6.0 v 3.0; p = 0.05). Caregivers other than mothers had higher cockroach attitude scores (Median 6.5 v 4.0; p = 0.003) and total KAP scores (Median 18.0 v 14.0; p = 0.05). Twenty-six participants completed the cohort study. Cockroach exposure was not significantly associated with higher cockroach knowledge, cockroach practice, or total KAP score. For attitude scores, participants in the highest quartile had significantly lower exposure (β: -1.96, 95% CI: − 3.50 - 0.42) compared to those in the lowest quartile (p = 0.01). Conclusions Different socio-demographic and psycho-social factors were associated with the components of cockroach KAP. Greater concern about cockroaches (attitude) was significantly associated with reduced cockroach exposure. This highlights the importance of identifying the key elements of caregiver KAP to improve cockroach remediation among caregivers of children with asthma.

Background Exposure to black carbon indoors may be associated with blood pressure; however, evidence is limited to vulnerable subpopulations and highly exposed individuals. Our objective was to explore the relationship between indoor black carbon at various exposure windows on resting blood pressure in a general population sample. Methods Black carbon was measured in the home of 76 individuals aged 10-71 in New Orleans, Louisiana. Exposure was measured every 1 minute for up to 120 hours using an AE51 microaethalometer. Systolic blood pressure and diastolic blood pressure were measured at the conclusion of exposure monitoring. Results In adjusted models, at all exposure windows, increasing black carbon was associated with increased systolic blood pressure. The period 0-72 hours prior to blood pressure measurement showed the strongest effect; a 1 μg/m3 increase in black carbon was associated with a 7.55 mm Hg (P = .02) increase in systolic blood pressure. The relationship was stronger in participants reporting doctor-diagnosed hypertension (β = 6.47 vs β = 3.27). Black carbon was not associated with diastolic blood pressure. Conclusion Increasing black carbon concentration indoors is positively associated with increasing systolic blood pressure with the most relevant exposure window being 0-72 hours prior to blood pressure measurement. Individuals with hypertension may be a more susceptible population.

Background Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization. Methods A cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization. Results Overall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74–1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01–1.04 p Conclusions Provision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.

Circulating micronutrient levels of both serum copper and zinc have been studied to varying degrees in both the general public and patients having undergone bariatric surgery. According to the 2019 ASMBS clinical guidelines, copper supplementation is recommended for patients undergoing metabolic surgery, especially after Roux-en-Y gastric bypass and duodenal switch. Copper excess has not been previously reported to any significant degree in any population.In this study, we investigate an elevated serum copper level in the pre-surgical intervention population of the Bariatric Center of the University Medical Center-New Orleans, a primary safety net hospital for the state of Louisiana.Five hundred five consecutive patients from the bariatric surgery undergoing a workup for surgical intervention were assessed. Patients were included regardless of whether they proceeded to surgery. The study was conducted as a retrospective review of deidentified data that was collected as part of our routine workup for bariatric surgery.The study population of the clinic consisted of a mean BMI of approximately 50 kg/mThis study identifies an elevated serum copper concentration in a pre-intervention underserved bariatric center population positively associated with BMI, female gender, and African American race. Additional studies will be necessary to see if these trends are also apparent in normal weight controls, or if weight loss influences copper levels. Pre-existing serum copper deficiencies may be more prevalent in the bariatric populations than previously believed. Increased serum copper in this population was positively associated with increased BMI, age, and female gender compared to that of the male group. Increased serum copper was also associated more closely with African American ethnicity compared to Caucasian patients.

Background: There is growing concern about children’s chronic low-level pesticide exposure and its impact on health. Green building practices (e.g. reducing leakage of the thermal and pressure barrier that surrounds the structure, integrated pest management, improved ventilation) have the potential to reduce pesticide exposure. However, the potential impact of living in green housing on children’s pesticide exposure is unknown. Objective: To address this question, a longitudinal study of pyrethroid metabolites (3-phenoxybenzoic acid [3-PBA], 4-fluoro-3-phenoxybenzoic acid [4-F-3-PBA], trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid [trans-DCCA]) in first morning void urine, collected from 68 children from New Orleans, Louisiana residing in green and non-green housing was conducted. Methods: Children were followed for one year with three repeated measures of pesticide exposure. Generalized Estimating Equations examined associations between housing type (green v non-green) and urinary pyrethroid metabolite concentrations adjusting for demographic and household factors over the year. Results: Ninety-five percent of samples had detectable concentrations of 3-PBA (limit of detection [LOD]: 0.1 μg/L); 8% of 4-F-3-PBA (LOD: 0.1 μg/L), and 12% of trans-DCCA (LOD: 0.6 μg/L). In adjusted models, green housing was not associated with statistically significant differences in children’s 3-PBA urinary concentrations compared to non-green housing. Significance: In this study, green building practices had no impact on children’s pyrethroid urinary concentrations. Further studies with larger sample sizes are needed to confirm these findings.

Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1

Asthma is related to various cardiovascular risk. Whether a history of asthma from childhood contributes to arterial stiffness in adulthood, a noninvasive surrogate for cardiovascular events, is unknown. Prospective analyses were performed among 1746 Bogalusa Heart Study participants aged 20 to 51 years with data on self-report asthma collected since childhood. Aorta–femoral pulse wave velocity (af-PWV, m/s) was repeatedly assessed among adults ≥aged 18 years. Generalized linear mixed models and generalized linear models were fitted for the repeated measurements of af-PWV and its changes between the last and the first measurements, respectively. After a median follow-up of 11.1 years, participants with a history of asthma from childhood had a higher af-PWV (6.78 versus 6.13; P =0.048) and a greater increase in af-PWV (8.99 versus 2.95; P =0.043) than those without asthma, adjusted for age, sex, race, smoking status, heart rate, body mass index, systolic blood pressure, lipids, and glycemia. In addition, we found significant interactions of asthma with body mass index and systolic blood pressure on af-PWV and its changes ( P for interaction 2 ) or with prehypertension and hypertension (systolic blood pressure ≥120 mm Hg) compared with those with a normal body mass index or systolic blood pressure. Our findings indicate that a history of asthma from childhood is associated with higher af-PWV and greater increases in af-PWV, and such associations are stronger among young adults who are overweight or with elevated blood pressure.

Background Exposure to cockroaches is an important asthma trigger, particularly for children with asthma living in inner cities. Integrated pest management is the recommended approach to cockroach abatement; however, it is costly and difficult to implement. The impact of reducing cockroach exposure on asthma outcomes is not known. Objective We sought to test the use of a single intervention, insecticidal bait, to reduce cockroach exposure in the home of children with asthma in New Orleans and to examine the impact of cockroach reduction on asthma outcomes. Methods One hundred two children aged 5 to 17 years with moderate to severe asthma were enrolled in a 12-month randomized controlled trial testing the use of insecticidal bait on cockroach counts and asthma morbidity. Homes were visited 6 times and asthma symptoms were assessed every 2 months. Results After adjustment, intervention homes had significantly fewer cockroaches than did control homes (mean change in cockroaches trapped, 13.14; 95% CI, 6.88-19.39; P P = .03; 1.17, 95% CI, 0.11-2.24, P = .03, respectively) and a higher proportion of children with FEV 1 of less than 80% predicted (odds ratio, 5.74; 95% CI, 1.60-20.57; P = .01) compared with children living in intervention homes. Conclusions Previous research has demonstrated improvement in asthma health outcomes using multifaceted interventions. The strategic placement of insecticidal bait, which is inexpensive, has low toxicity, and is widely available, resulted in sustained cockroach elimination over 12 months and was associated with improved asthma outcomes. This single intervention may be an alternative to multifaceted interventions currently recommended to improve asthma morbidity.

Objectives This study aimed to examine whether a history of asthma from childhood is associated with left ventricular (LV) mass in adulthood. Background Asthma has been related to various cardiovascular risk factors affecting LV hypertrophy. The authors saw a need for a prospective study to analyze the relationship between a history of asthma from childhood and markers of LV mass among asymptomatic young adults. Methods Prospective analyses were performed among 1,118 Bogalusa Heart Study participants (average age at follow-up 36.7 ± 5.1 years), with a baseline history of self-reported asthma collected since childhood (average age at baseline 26.8 ± 10.1 years). LV mass (g) was assessed using 2-dimensional guided M-mode echocardiography and was indexed for body height (m2.7) as LV mass index (LVMI; g/m2.7). A multivariate linear mixed model was fitted for the repeated measures. Results After an average of 10.4 ± 7.5 years of follow-up, participants with a history of asthma from childhood had a greater LV mass (167.6 vs. 156.9; p = 0.01) and LVMI (40.7 vs. 37.7; p Conclusions The findings of this study indicate that a history of asthma is associated with higher LVMI, and this association is stronger among participants with pre-hypertension and hypertension.

ID: 2017-197In response to the Deepwater Horizon disaster and resulting Gulf of Mexico oil spill (GOS), the National Institute of Environmental Health Sciences (NIEHS) facilitated the conduct of health and safety training and development of training materials for over 147,000 cleanup workers (e.g., on-shore and off-shore volunteers, technical specialists) across four Gulf States. Of the approximately 47,000 trained workers who engaged in cleanup activities, 507 workers participated in a training evaluation effort (facilitated by community-based organizations) by completing the GOS Training Evaluation Survey. Survey respondents were primarily male from six racial/ethnic groups: Black, White, Asian (Vietnamese), Isleno, Hispanic, and Native American.The evaluation results demonstrate that, overall, the GOS training was very effective in enhancing trainee knowledge and environmental cleanup behaviors, and it had a meaningful impact on responder safety. Notably, when considering results stratified by workers' ethnicity/race, responders from sub-populations most vulnerable to the effects of the oil spill were not as positively affected by the training. Related, the results also indicated that the social and organizational aspects of the worksite, such as safety climate/culture, supported or inhibited the exhibition of safety behaviors learned during training. Results will be discussed with respect to making quality improvements to responder safety training, identifying best practices, and making better use of available resources and strategies.

Worldwide, floods are the most common natural disaster and produce a broad array of health impacts. In Canada, it is difficult to quantify all of the health impacts associated with flooding. This data gap is salient because of the increasing risks floods are posing to society as a result of climate change. This paper reviews the epidemiological evidence of flood-related health effects, and the Canadian susceptibility to these effects. The health impacts from flooding range from mortality, drowning and other injuries to hypothermia, mental health impacts, deterioration of elderly/patients who required emergency transportation, homelessness and transmission of contagious diseases and others. The Canadian population includes a range of socio-economic levels, demographics and pre-existing illness. Additionally, many Canadians live and work in flood plains or on shorelines where floods are a hazard. There is, therefore, variable susceptibility to flood events in the population. Susceptibility to these health i...

We examined urinary pesticide (UP) metabolite levels in asthmatic children residing in subsidized housing in New Orleans, Louisiana and compared these levels between children residing in green and ...

Despite their importance to respiratory and other health outcomes, housing conditions have been little-studied with respect to perinatal outcomes.1927 participants in the British National Child Development Study reported on housing conditions and pregnancy outcomes, including presence/severity of mold/dampness; type of heating; and whether remodeling of various sorts had been conducted. Crowding, based on the number of people in the residence and the number of rooms, was also considered. Outcomes assessed were low birthweight (2500g), preterm birth (37 weeks), and small-for-gestational-age (10th percentile for gestational age). Multiple logistic regression with adjustment for maternal, sociodemographic, and housing factors was conducted.Women who reported serious problems with mold were more likely to give birth to a low birthweight (adjusted OR 1.98, 95% CI 1.13-3.47) or small-for-gestational-age (2.06, 1.25-3.38) baby; no consistent associations were seen with preterm birth. Crowding was associated only with small-for-gestational-age (1.73, 1.11-2.76).Exposure to mold or dampness, and housing conditions generally, is a potentially important but under-investigated aspect of women's lives during pregnancy. Future studies should more thoroughly investigate housing characteristics and their relationship with birth outcomes.

American cockroaches are an important source of household allergens in tropical and semitropical climates. To determine which outdoor niches produce American cockroaches, traps were placed at 40 homes in New Orleans to collect nymphs. Nymphs were collected from the sewers, yards, and within the homes themselves. To compare sewers and yards as sources of cockroaches entering homes, adult cockroaches were collected, marked, and released into yards and sewers. No sewer-released cockroaches were collected in homes. Cockroaches released into yards were collected in the homes, suggesting that yards, rather than sewers, are a more important source niche. A field trial applying boric acid granules to the yard was performed in an effort to reduce entry of cockroaches. There was a significant reduction in the cockroach antigen collected in intervention homes compared with controls.

Purpose: To determine the incidence of retinoblastoma in the United States from 1973 to 2012 (40 years) and characterize the 5-year overall survival rate of the included patients. Methods: Cases of retinoblastoma were derived from the Surveillance, Epidemiology, and End Results (SEER) Program (National Cancer Institute, Rockville, MD). Incidence rates were calculated using U.S. Census Bureau data as the standard population, and trends over time were determined using the chi-square test. Hazard ratios with a 95% confidence interval (CI) were estimated for variables associated with mortality using Cox regression models. Survival rates were calculated using the Kaplan–Meier method and compared among different clinical and demographic categories. Results: A total of 879 cases of retinoblastoma were derived from the SEER databases. The annual incidence rates of retinoblastoma for a period of 40 years were 12.14 (95% CI: 11.32 to 12.96) cases per 1 million children 4 years or younger and 0.49 (95% CI: 0.36 to 0.65) cases per 1 million children between the ages of 5 and 9 years. There was no significant trend for children 4 years or younger ( P = .6324) or between the ages of 5 and 9 years ( P = .7695). The 5-year overall survival rates were 97.6%, 92.7%, 91.1%, and 96.4% for children diagnosed at the first, second, third, and after the third year of life, respectively ( P = .0136). The 5-year overall survival rates were 92.5% for bilateral and 96.3% for unilateral cases ( P = .0116). The 5-year overall survival rates were 90.8%, 92.5%, 97.6%, 97.3% for increasing time intervals (1973 to 1979, 1980 to 1989, 1990 to 1999, and 2000 to 2012, respectively; P = .0017). Conclusions: The incidence rate of retinoblastoma in the United States has remained stable for the past 40 years. Survival rate analysis indicates a significant effect of laterality of tumor, age at diagnosis, and decade of diagnosis. [ J Pediatr Ophthalmol Strabismus . 2018;55(3):182–188.]

Background Allergen exposure is associated with increased specific IgE (sIgE), and allergen exposure plus sensitization is predictive of asthma outcomes. However, it is not known if sIgE is predictive of asthma outcomes in the absence of exposure data. Objective To investigate whether IgE to indoor allergens is predictive of and has a dose-response relationship with asthma emergency department (ED) visits and wheeze. Methods In the 2005-2006 National Health and Nutrition Examination Survey, 351 children and 390 adults reported current asthma. Continuous sIgE to 9 indoor allergens were considered. Asthma morbidity in the past year was measured by wheezing. Health care utilization was defined as any asthma ED visits in the past year. Results Analyses were adjusted for race, age, education, poverty index ratio and (in adults) tobacco use. In children, ED visits were associated with cockroach (odds ratio [OR] 1.5 [95% CI, 1.1-2 .1), rat (OR 1.9 [95% CI, 1.2-2.8]), and Aspergillus (OR 1.6 [95% CI, 1.001-2.60]). Continuous Aspergillus (OR 1.5 [95% CI, 1.04-2.1), Alternaria (OR 1.4 [95% CI, 1.1-1.6]), and total IgE (OR 1.2 [95% CI, 1.1-1.4]) were associated with wheeze in children. Adult ED visits were associated with sIgE for dust mites (Dermatophagoides pteronyssinus OR 1.6 [95% CI, 1.3-2.1]; Dermatophagoides farinae OR 1.6 [95% CI, 1.3-1.9]), total IgE (OR 1.4 [95% CI, 1.04- 1.9]), and the sum of sIgEs (OR 1.6 [95% CI, 1.2-2.2]). Conclusions Sensitization to particular indoor environmental allergens was found to be a risk factor for wheeze and asthma ED visits. These outcomes increased as the concentration of sIgE to these allergens increased.

Using data from a large cohort of urban children, this study identified multilevel correlates of asthma to determine whether neighborhood attributes remain associated with asthma after adjustment for individual level and immediate housing characteristics. A cross-sectional analysis was conducted using data from the Fragile Families and Child Well-being Study and its substudy, the In-Home Longitudinal Study of Pre-Schooled Age Children (n = 1,784). The primary outcome was asthma diagnosis by age 5. Sociodemographic measures were assessed via telephone survey, housing and block conditions recorded via direct observation, and neighborhood characteristics came from geocoded census tract data. After multivariable adjustment, non-Hispanic Black, Puerto Rican, or other Hispanic race, child's lack of insurance coverage, male gender, presence of allergies, the exterior condition of a child's home, mother's educational attainment, and the percent of the neighborhood population with a bachelor's degree remained significantly associated with having received an asthma diagnosis by age 5. The authors identified sociodemographic and economic factors at the individual, household, and neighborhood level which are correlates of childhood asthma in urban areas. After adjustment for more proximal characteristics, the effects of all neighborhood markers were minimal, with the exception of neighborhood education.

Background: As a result of Hurricane Katrina, > 100,000 homes were destroyed or damaged and a significant amount of sediment was deposited throughout the city of New Orleans, Louisiana. Researchers have identified the potential for increased lead hazards from environmental lead contamination of soils. Objectives: We assessed the distribution of residential soil and dust lead 2 years poststorm and compared soil lead before and after the storm. Methods: We conducted a cross-sectional study in New Orleans in which households were selected by stratified random sampling. A standard residential questionnaire was administered, and lead testing was performed for both the interior and exterior of homes. Logistic regression was used to identify significant predictors of interior and exterior lead levels in excess of allowable levels. Results: One hundred nine households were enrolled; 61% had at least one lead measurement above federal standards. Of homes with bare soil, 47% had elevated lead and 27% had levels exceeding 1,200 ppm. Housing age was associated with soil lead, and housing age and soil lead were associated with interior lead. Race, income, and ownership status were not significantly associated with either interior or exterior lead levels. The median soil lead level of 560 ppm was significantly higher than the median level of samples collected before Hurricane Katrina. Conclusions: The high prevalence (61%) of lead above recommended levels in soil and dust samples in and around residences raises concern about potential health risks to the New Orleans population, most notably children. Steps should be taken to mitigate the risk of exposure to lead-contaminated soil and dust. Further research is needed to quantify the possible contribution of reconstruction activities to environmental lead levels.

Background The reliance on Latino migrant day labor in the U.S. is increasing. Prospective data on day laborers' work and health experience in non-agriculture settings are lacking and outcomes are generally restricted to injury rates. Methods An ambidirectional study was conducted to quantify the number of job and job task changes held over 12 months in a cohort of 73 migrant day laborers and assessed the relation between work type, health symptoms, and blood lead level. Results On average, participants worked 2.4 different jobs over the past year averaging 41.5 hr per week. Construction work was associated with a twofold increase in sino-nasal and respiratory symptoms in both adjusted and unadjusted models and was associated with increased blood lead levels. Conclusions Despite day labor status, workers had relatively stable employment. Respiratory symptoms were common and often improved when away from work suggesting that workplace irritant exposure is likely. Migrant day laborers working construction are vulnerable to adverse health effects associated with irritant and lead exposure. Am. J. Ind. Med. 54:366–374, 2011. © 2010 Wiley-Liss, Inc.

Objectives. The study's objective was to examine the relation between mold/dampness exposure and mold sensitization among residents of Greater New Orleans following Hurricane Katrina. Methods. Patients were recruited from the Allergy Clinic of a major medical facility. Any patient receiving a skin prick test for one of 24 molds between December 1, 2005 and December 31, 2008 was eligible for the study. Exposure was assessed using standardized questionnaires. Positive mold reactivity was defined as a wheal diameter >3 mm to any mold genera. Results. Approximately 57% of participants tested positive to any indoor allergen, 10% to any mold. Over half of respondents had significant home damage, 34% reported dampness/mold in their home, half engaged in renovation, and one-third lived in a home undergoing renovation. Despite extensive exposure, and multiple measures of exposure, we found no relationship between mold/dampness exposure and sensitivity to mold allergens. Conclusions. These results along with results of earlier research indicate no excess risk of adverse respiratory effects for residents living in New Orleans after the devastation of Hurricane Katrina.

Background When the federal levee system broke after Hurricane Katrina, 80 percent of New Orleans, approximately 134,000 homes, flooded. As repopulation and revitalization activities continue, exposure to mold and other respiratory irritants has emerged as a major health concern; however, there has been no study examining children's respiratory health and indoor mold levels in the post-Katrina environment. Objective The Children's Respiratory Health Study was designed as a preliminary examination of indoor air levels of mold, children's lung function, and common indices of respiratory health in a select sample of children returning to live in New Orleans immediately after Hurricane Katrina. Methods Children were recruited from a private primary school in the Garden District of New Orleans. Respiratory health questionnaire and spirometric data were collected on children 7 to 14 years of age, and mold air sampling was conducted at baseline and again after 2 months. Conclusions There was an overall decrease in mold levels and respiratory symptoms over the study period, and indoor mold levels were low despite reported hurricane damage.

The effects of atopic and nonatopic asthma phenotypes on asthma morbidity are unclear. Moreover, asthma morbidity in patients without atopy might be mediated by immunoglobulin E (IgE).To determine differences in morbidity in patients with asthma with and without atopy in a population of inner-city adolescents with asthma and to assess the impact of total IgE (tIgE) in this population.Data were obtained from 546 inner-city adolescents in the Asthma Control Evaluation study. A positive skin prick test reaction to 14 aeroallergens and specific IgE to 5 aeroallergens determined atopic status. High (≥75th percentile) and low (≤25th percentile) tIgE levels were categorized. Asthma control (Asthma Control Test) and asthma severity (Composite Asthma Severity Index [CASI]) were measured at multiple time points over 1 year. Fractional exhaled nitric oxide (FeNO) and measurements of morbidity also were collected. Multivariable and repeated measures analyses modeled the relation between atopic status and morbidity.Baseline CASI scores increased 0.90 point (P.05) and FeNO increased 0.85 natural logarithmic unit (P.001) in participants with vs without atopy. Repeated measures analyses showed consistent results. Participants without atopy and increased tIgE had FeNO 0.73 natural log unit higher (P.01) than low tIgE and a nonsignificant increase in CASI. The CASI score and FeNO levels were higher for high than for low tIgE in participants with atopy.In this population, participants with atopic asthma had worse asthma severity and higher FeNO compared with those with nonatopic asthma, but no difference in control. In all participants, higher tIgE indicated worse severity and higher FeNO. In this population, asthma severity and FeNO might be mediated by IgE in the 2 asthma phenotypes.

Background Ethiopia has been providing free Antiretroviral Treatment (ART) since 2005 for HIV/AIDS patients. ART improves survival time and quality of life of HIV patients but ART treatment outcomes might be affected by several factors. However, factors affecting treatment outcomes are poorly understood in Ethiopia. Hence, this study assesses treatment outcomes and its determinants for HIV patients on ART in selected health facilities of Kembata and Hadiya zones. Methods A retrospective cohort study was conducted on 730 adult HIV/AIDS patients who enrolled antiretroviral therapy from 2007 to 2011 in four selected health facilities of Kembata and Hadiya zones of Southern Ethiopia. Study subjects were sampled from the health facilities based on population proportion to size. Data was abstracted using data extraction format from medical records. Kaplan-Meier survival function was used to estimate survival probability. Cox proportional hazards regression model was used to identify factors associated with time to death. Result Median age of patients was 32.4 years with Inter Quartile Range (IQR) [15, 65]. The female to male ratio of the study participants’ was 1.4:1. Median CD4 count significantly increased during the last four consecutive years of follow up. A total of 92 (12.6 %) patients died, 106(14.5 %) were lost to follow-up, and 109(15 %) were transferred out. Sixty three (68 %) deaths occurred in the first 6 months of treatment. The median survival time was 25 months with IQR [9, 43]. After adjustment for confounders, WHO clinical stage IV [HR 2.42; 95 % CI, 1.19, 5.86], baseline CD4 lymphocyte counts of 201 cell/mm3 and 350 cell/mm3 [HR 0.20; 95 % CI; 0.09−0.43], poor regimen adherence [HR 2.70 95 % CI: 1.4096, 5.20], baseline hemoglobin level of 10gm/dl and above [HR 0.23; 95 % CI: 0.14, 0.37] and baseline functional status of bedridden [HR 3.40; 95 % CI: 1.61, 7.21] were associated with five year survival of HIV patients on ART. Conclusion All people living with HIV/AIDS should initiate ART as early as possible. Initiation of ART at the early stages of the disease, before deterioration of the functional status of the patients and before the reduction of CD4 counts and hemoglobin levels with an intensified health education on adherence to ART regimen is recommended.

Background Humans are extensively exposed to triclosan, an antibacterial and antifungal agent. Triclosan's effects on human health, however, have not been carefully investigated. Objective To examine whether triclosan exposure is associated with obesity traits. Methods This study included 2898 children (6–19 years old) and 5066 adults (20 years or older) who participated in the National Health and Nutrition Examination Surveys (NHANES) 2003–2010 and had a detectable level of urinary triclosan. Multiple linear regression models were used to examine the association between urinary triclosan and both body mass index (BMI) and waist circumference. Results Each standard deviation increase in urinary triclosan was associated with a 0.34 (95% confidence interval, CI: 0.05, 0.64) kg/m 2 lower level of BMI ( P = 0.02) and 0.92 (95% CI: 0.09, 1.74) cm smaller waist circumference ( P = 0.03) in boys, and a 0.62 (95% CI: 0.31, 0.94) kg/m 2 lower level of BMI ( P = 0.0002) and 1.32 (95% CI: 0.54, 2.09) cm smaller waist circumference in girls ( P = 0.001); a 0.42 (95% CI: 0.06, 0.77) kg/m 2 lower level of BMI ( P = 0.02) and 1.35 (95% CI: 0.48, 2.22) cm smaller waist circumference ( P = 0.003) in men, and a 0.71 (95% CI: 0.34, 1.07) kg/m 2 lower level of BMI ( P = 0.0002) and 1.68 (95% CI: 0.86, 2.50) cm smaller waist circumference ( P = 0.0001) in women. In both children and adults, there was a consistent trend for lower levels of BMI and smaller waist circumference with increasing levels of urinary triclosan, from the lowest to the highest quartile of urinary triclosan ( P ≤ 0.001 in all cases). Conclusion Triclosan exposure is inversely associated with BMI and waist circumference. The biological mechanisms linking triclosan exposure to obesity await further investigation.

Increased morbidity is associated with increasing severity of obesity. However, among morbidly obese patients, comorbid prevalence has been reported primarily in the bariatric surgical literature. This study compares demographic characteristics and selected comorbid conditions of morbidly obese patients discharged after surgical obesity procedures and morbidly obese patients discharged after all other hospital procedures.The 2002 National Hospital Discharge Survey (a nationally representative sample of hospital discharge records) and the International Classification of Diseases, 9th Revision, Clinical Modification were used to identify and describe all morbidly obese patient discharges (n = 3,473) and to quantify the prevalence of selected obesity-related comorbid conditions.Compared with all other morbidly obese patients, the obesity surgery patients (n = 833) were younger (median, 42 vs 48 years; range, 17 to 67) and more female (82.3% vs. 63.7%), with higher rates of sleep apnea (24.0% vs. 11.8%), osteoarthritis (22.9% vs. 11.8%), and gastroesophageal reflux disease (27.7% vs. 11.7%) (all P.001). The prevalence of type 2 diabetes mellitus was lower in the obesity surgery patients (16.1% vs. 24.3%; P = .003), whereas the rates of hypertension (45.9% vs. 41.0%; P = .13) and asthma (9.6% vs. 12.0%; P = .26) were similar in the two groups.Demographic characteristics and comorbid prevalence of morbidly obese patients discharged after obesity surgery are consistent with reports in the bariatric surgical literature. Obesity surgery patients had a higher prevalence of some comorbid conditions. Possible explanations for this include preferential diagnosis, differential diagnostic coding, or increased severity of morbid obesity. Advancing surgical and insurance guidelines for bariatric surgery will require clinical data that accurately describe and quantify the demographic distribution of obesity and the associated burden of disease.

Efforts aimed at enhancing the knowledge of target populations constitute a widely used public health intervention strategy with the ultimate goal of improving health. However, integral to planning, implementing, and evaluating educational programs is identifying the knowledge base of the intended recipient. Improving health through educational interventions is a strategy commonly utilized in efforts to prevent childhood lead poisoning. However, few instruments have been validated for measuring lead knowledge, particularly among high-risk populations. We used factor analysis to evaluate the applicability of a previously developed lead knowledge assessment tool, the Chicago Lead Knowledge Test (CLKT), to a high-risk minority population in New Orleans and found that the structure of the CLKT did not accurately measure the knowledge of this population.

Background Exposure to lead hazards is a serious health concern for inner-city children. In the United States, the greatest contributor to an elevated lead level is lead exposure in the home. There are federal regulations to protect children in public housing developments from exposure to lead paint. The efficacy of these regulations has not been examined. Methods We assessed the association between residence in a public housing development and the risk of an elevated blood lead level among high-risk children in New Orleans. We did so by conducting a case-control study among 7121 children age 6 to 71 months who received a screening blood lead test from New Orleans public health clinics in 1998. Results We found elevated blood lead levels for 29% of children who were screened. Children residing in New Orleans housing developments had lead levels no different from those residing in nondevelopment housing when controlling for housing age, and child's sex and age (odds ratio = 0.93; 95% confidence interval = 0.77-1.1). Conclusions Despite legislative efforts, public housing does not appear to protect children from elevated lead levels, calling into question the efficacy of existing regulations.

Background Asthma mortality rates have been increasing despite our improved understanding of the pathophysiology of asthma and advanced methods of treatment. Although there are many national studies of asthma mortality rates, few studies have concentrated on subnational regions such as individual states. Objectives We sought to determine the trends in asthma mortality in children and young adults during the last 15 years in Louisiana. Methods Asthma mortality data were acquired from the Louisiana State Center for Health Statistics for the years 1983 through 1997. All asthma deaths coded International Classification of Disease, Ninth Revision 493 were included in the data set along with year, sex, and rate characteristics. State population estimates obtained from the United States Bureau of Census for three 5-year periods (1983 to 1987, 1988 to 1992, and 1993 to 1997) were used to calculate crude and adjusted mortality rates. These time periods were compared with one another and with the period 1983 to 1987, which was used as a baseline. Results For all residents, the mortality rate increased from 0.41 deaths per 100,000 persons during the 1983 to 1987 time period to 0.49 and 0.63 deaths per 100,000 persons during 1988 to 1992 and 1993 to 1997 time periods, respectively. Mortality rates have increased in both the white and non-white populations over the 15-year study period, with the most pronounced increases among the non-white population. Conclusion Asthma mortality rates in Louisiana have increased, particularly among the non-white population, over the last 15 years, although the results are not statistically significant. When compared with other states, asthma mortality in Louisiana is lower than in the northeast and central north states.

Background Up to 40% of the world's population has been diagnosed with an allergic disease. The most prevalent allergy is to house dust mites. Impermeable mattress covers are often the first treatment in the prevention and decrease of symptoms of allergic disease. Objective To perform a meta-analysis evaluating the effectiveness of impermeable mattress covers in the primary prevention of allergic disease and as a single intervention in the tertiary prevention of allergic disease symptoms. Methods MEDLINE, Embase, Web of Science, and CINAHL were systematically searched for relevant publications. Seven primary prevention trials (n = 3,461) and 17 tertiary prevention trials (n = 1,671) met the inclusion criteria and were included in the review. All article reviews and abstractions were performed in duplicate. Results No significant pooled relative risks were found for the prevention of allergic disease. The pooled relative risks were 0.97 (95% confidence interval [CI] 0.62–1.51) for house dust mite sensitization, 0.92 (95% CI 0.81–1.05) for wheeze, 0.85 (95% CI 0.70–1.02) for asthma, 1.03 (95% CI 0.90–1.19) for allergic rhinitis, and 1.05 (95% CI 0.84–1.32) for allergic dermatitis. Likewise, no significant pooled standardized mean differences were found in the tertiary prevention of symptoms. The pooled standardized mean differences were −0.03 (95% CI −0.15 to 0.09) for peak flow, −0.06 (95% CI –0.32 to 0.20) for asthma symptom score, and −0.39 (95% CI −0.88 to 0.11) for nasal symptom score. A significant effect was seen in the decrease of house mite dust level in the mattress (−0.79, 95% CI −0.98 to −0.60). Conclusion No evidence was found to support the use of impermeable mattress covers in the primary prevention of allergic disease or in the tertiary prevention of allergic disease symptoms.

Data are lacking on the effect of low level prenatal lead exposure. We examined the change in blood lead from the second trimester until delivery and the association between maternal and cord blood lead and birth outcomes in 98 participants of the CANDLE birth cohort study. Mixed effects models were constructed to assess blood lead change over pregnancy and regression models were used to explore the relationship with cord blood lead, characteristics effecting maternal lead, birth weight and gestational age. Overall, the geometric mean maternal blood level was 0.43 μg/dL. Maternal blood lead at each time point was predictive of cord blood lead level. A 0.1 μg/dL increase in second trimester lead was associated with lower birth weight and pre-term birth. Maternal blood lead below 1 μg/dL behaves in a manner similar to lead at higher levels and is associated with a small decrease in birth weight and gestational age.

Although weather changes are known to cause asthma symptoms, their impact on asthma-related health-care utilization is poorly understood. The objective of the present study was to determine the association between short-term outdoor temperature change and asthma-related emergency department (ED) visits among children 3-18 years of age in Detroit, Michigan, in 2000-2001. Descriptive analyses of patient and ED visit characteristics were performed. A case-crossover study utilizing time-stratified controls was conducted to determine the impact of maximum temperature change and change rate measured during 4-, 8-, 12-, and 24-hour periods. Multivariable conditional logistic regression demonstrated the relation between ED visits and temperature change after controlling for other weather and pollutant measures. There were 4,804 asthma-related ED visits during the study period, and they occurred most frequently in the fall and during morning hours. The case-crossover study showed a statistically significant inverse relation between ED visits and maximum 24-hour temperature change after adjustment for climatic factors (for temperature change, odds ratio = 0.992, P = 0.04; for temperature change rate, odds ratio 0.972, P = 0.01). The association persisted after air pollutant measures were added to the model, although the association was not significant. Despite the finding that a greater 24-hour temperature change decreased the risk of asthma-related ED visits, the overall results suggested a negligible association with short-term temperature change.

We thank Mielke for his interest in our study of residential lead hazards in New Orleans (Rabito et al. 2012). In our study we found that most homes had either dust or soil lead above federal standards and concluded that children are at risk for lead exposure. Regarding the specific issue of whether soil lead has increased or decreased, we agree that a direct comparison between census-level soil lead survey data and direct measure-ments of residential samples has limitations. To reiterate the limitations outlined in our article (Rabito et al. 2012), differences in the number of soil samples, the sampling methodology, and the sample location limited our ability to directly measure any change in soil lead levels. Although it is of interest to know whether soil lead has increased or decreased as a result of Hurricane Katrina, our focus was to measure current residential lead hazards, because lead contamination in and around homes is the primary pathway of exposure for children (Lanphear and Roghmann 1997). Our finding that 61% of homes had lead levels above federal standards provides evidence that New Orleans children are at high risk of exposure. That the samples were collected from homes typically considered to be low risk (given the socio-demographic characteristics of the sample) is cause for added concern. In his letter, Mielke refers to trends in blood lead levels. The issue of whether blood lead levels are increasing or decreasing in New Orleans children—which was not within the scope of our study (Rabito et al. 2012)—is not easily addressed using surveillance data. Screening practices and rates drive the reported prevalence in any given year. Zahran et al. (2010) compared aggregate blood lead levels derived from the Louisiana Childhood Blood Lead Surveillance System (CBLSS) pre-Hurricane Katrina to levels post-Hurricane Katrina and found that median blood lead had decreased. However, profound changes in the socio-demographic makeup of the New Orleans population make the comparison vulnerable to significant bias (Bloomberg 2011). The surveillance data provided by Mielke supports our notion that the post-Hurricane Katrina population screened under the CBLSS is not stable from year to year. As stated by Mielke, 6.4% of children had elevated blood lead levels in 2008, but the estimate decreased to 3.3% in 2010. This decrease might not be valid because the majority of children in the 2008 cohort were from the inner city (with the highest prevalence of old housing) whereas the 2010 cohort included a higher proportion from outer areas of the city (considered low risk based on housing age). The assumption by Zahran et al. (2010) that soil lead serves as a proxy for length of lead exposure is likely not valid given the amount of housing destabilization and subsequent mobility of the population in the years following the storm. Finally, low screening rates, coupled with a reporting level of > 10 µg/dL (widely accepted as above the level of concern) does not allow for the valid estimation of the preva-lence of elevated blood lead levels in New Orleans children. Regardless of the inconclusive nature of blood lead data, given that 61% of sampled homes have significant lead hazards, we maintain that New Orleans children who live in old housing are at risk for lead exposure independent of race or income. We support the recent statement by the Centers for Disease Control and Prevention Advisory Committee on Childhood Lead Poisoning Prevention that “the goal of primary prevention is to ensure that all homes become lead-safe and do not contribute to childhood lead exposure” (Centers for Disease Control and Prevention 2012). The City of New Orleans has made strides in its fight to reduce lead hazards in public places; however, they should not relax in their efforts to protect the environ-ment from further contamination.

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes, primarily asthma, associated with exposure to moisture, mold, and allergens. Three of the 11 interventions reviewed had sufficient evidence for implementation: multifaceted, in-home, tailored interventions for reducing asthma morbidity; integrated pest management to reduce cockroach allergen; and combined elimination of moisture intrusion and leaks and removal of moldy items to reduce mold and respiratory symptoms. Four interventions needed more field evaluation, one needed formative research, and three either had no evidence of effectiveness or were ineffective. The three interventions with sufficient evidence all applied multiple, integrated strategies. This evidence review shows that selected interventions that improve housing conditions will reduce morbidity from asthma and respiratory allergies.

Studies of inner-city asthmatic children have shown significant regional variation in dust allergen exposures. The home environment of asthmatic children in the Gulf South region of the USA has not been characterized. This study describes indoor dust allergen levels in the homes of 86 asthmatic children in New Orleans and explores regional variability in dust allergen exposure. Data were used from baseline home visits of children in the New Orleans Healthy Homes Initiative. Interview, visual observation, and environmental dust sampling data of 86 children between 4 and 17 years of age were analyzed. Seventy-seven percent of households had moderate (2.0-9.9 microg/g) or high (or =10.0 microg/g) levels of either Der p 1 or Der f 1 dust mite allergen and 56.6% had moderate (2.0-8.0 U/g) or high (8.0 U/g) levels of cockroach allergen (Bla g 1). The prevalence of high (10 microg/g) levels of dog (Can f 1) allergen was 26.5%, and few households (6.0%) had high cat allergen (Fel d 1) levels (8.0 microg/g). Households with average humidity levels50% were three times more likely to have elevated dust mite levels (odds ratio = 3.2; 95% confidence interval = 1.1, 9.3; p = 0.03). Home ownership and education level were inversely associated with cockroach and dust mite allergen levels, respectively. Our findings reinforce the evidence of regional variability in dust allergen exposure levels. Asthmatic children living in the Gulf South are exposed to multiple indoor allergen exposures and live in a highly allergenic environment.

In light of recent data suggesting adverse health effects at blood lead levels (PbB)10 microg/dl, lowering the current definition of elevated blood lead (or=10 microg/dl) has been recommended. To ascertain the population level impact of such a change, we calculated the prevalence of PbBor=5 microg/dl in 1-21-year-old population in the United States. Furthermore, we characterized changes in PbB between 1988-1994 and 1999-2002. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) III (n=10,755) and NHANES 1999-2002 (n=8013). In 1999-2002, about 91.7% of study children had detectable levels of lead in the blood. Among them, 7.3%, 2.8%, and 1.0% children and adolescents aged 1-5, 6-11, and 12-21 years, respectively, had PbB between 5 and 9.9 microg/dl. This number translates to approximately 2.4 million individuals. Between 1988-1994 and 1999-2002, the geometric mean PbB declined from 2.88 to 1.94 microg/dl in children 1-5 years, 1.80 to 1.36 microg/dl in children 6-11 years, and 1.24-1.02 microg/dl in children and adolescents 12-21 years of age. Also, the prevalence of PbBor=5 microg/dl declined from 25.7% to 8.8%, 12.8% to 3.0%, and 7.5% to 1.2% in these age groups, respectively.A substantial proportion of children may be at risk for adverse health effects from lead exposure below 10 microg/dl and a large number of children will be classified as having elevated PbB if 5 microg/dl is considered the threshold. Significant public health resources will have to be mobilized for intervention, screening, and case management of these children.

Background After Hurricane Katrina, many New Orleans homes remained flooded for weeks, promoting heavy microbial growth. Objectives A small demonstration project was conducted November 2005–January 2006 aiming to recommend safe remediation techniques and safe levels of worker protection, and to characterize airborne mold and endotoxin throughout cleanup. Methods Three houses with floodwater lines between 0.3 and 2 m underwent intervention, including disposal of damaged furnishings and drywall, cleaning surfaces, drying remaining structure, and treatment with a biostatic agent. We measured indoor and outdoor bioaerosols before, during, and after intervention. Samples were analyzed for fungi [culture, spore analysis, polymerase chain reaction (PCR)] and endotoxin. In one house, real-time particle counts were also assessed, and respirator-efficiency testing was performed to establish workplace protection factors (WPF). Results At baseline, culturable mold ranged from 22,000 to 515,000 colony-forming units/m3, spore counts ranged from 82,000 to 630,000 spores/m3, and endotoxin ranged from 17 to 139 endotoxin units/m3. Culture, spore analysis, and PCR indicated that Penicillium, Aspergillus, and Paecilomyces predominated. After intervention, levels of mold and endotoxin were generally lower (sometimes, orders of magnitude). The average WPF against fungal spores for elastomeric respirators was higher than for the N-95 respirators. Conclusions During baseline and intervention, mold and endotoxin levels were similar to those found in agricultural environments. We strongly recommend that those entering, cleaning, and repairing flood-damaged homes wear respirators at least as protective as elastomeric respirators. Recommendations based on this demonstration will benefit those involved in the current cleanup activities and will inform efforts to respond to future disasters.

The association between body lead burden and kidney disease remains controversial. Fifty-five African-American end-stage renal disease (ESRD) cases and 53 age- and sex-matched African-American controls without known renal disease were recruited from Tulane University-affiliated dialysis clinics and out-patient clinics, respectively. Blood lead was measured via atomic absorption spectrophotometry and tibia lead (a measure of body lead) was measured via (109)Cd-based K shell X-ray fluorescence. Median blood lead levels were significantly higher among ESRD cases (6 microg/dL) compared to their control counterparts (3 microg/dL; P0.001). Although no participants had overt lead poisoning (blood leador = 25 microg/dL), seven cases but no controls had blood lead levels above 10 microg/dL (P=0.006). The median tibia lead level was 17 micrograms of lead per gram of bone mineral (microg/g) and 13 microg/g among ESRD cases and their control counterparts, respectively (P=0.134). Four ESRD cases (7%), but no controls, had a tibia lead level above 40 microg/g (P=0.115) while a similar proportion of cases and controls had tibia lead between 20 and 39 microg/g (33% and 32%, respectively; P=0.726). After adjustment for potential confounders, the odds ratios of ESRD associated with a tibia leador = 20 microg/g and each four-fold higher tibia lead (e.g., 5-20 microg/g) were 1.55 (95% CI: 0.55, 4.41) and 1.88 (95% CI: 0.53, 6.68), respectively. These findings support the need for prospective cohort studies of body lead burden and renal disease progression.