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Background: Renal denervation (RDN) can reduce cardiac sympathetic activity maintained by arterial hypertension (aHT). Its potential antiarrhythmic effect on rhythm outcome in patients with multi-drug resistant aHT undergoing catheter ablation for atrial fibrillation (AF) is unclear., Methods: The RDN+AF study was a prospective, randomized, two-center trial. Patients with paroxysmal or persistent AF and uncontrolled aHT (mean systolic 24-h ambulatory BP > 135 mmHg) despite taking at least three antihypertensive drugs were enrolled. Patients were 1:2 randomized to either RDN+AF ablation or AF-only ablation. Primary endpoint was freedom from any AF episode > 2 min at 12 months assessed by implantable loop recorder (ILR) or 7d-holter electrocardiogram. Secondary endpoints included rhythm outcome at 24 months, blood pressure control, periprocedural complications, and renovascular safety., Results: The study randomized 61 patients (mean age 65 ± 9 years, 53% men). At 12 months, RDN+AF patients tended to have a greater decrease in ambulatory BPs but did not reach statistical significance. No differences in rhythm outcome were observed. Freedom from AF recurrence in the RDN+AF and AF-only group measured 61% versus 53% p = .622 at 12 months and 39% versus 47% p = .927 at 24 months, respectively. Periprocedural complications occurred in 9/61 patients (15%). No patient died., Conclusion: Among patients with multidrug-resistant aHT and paroxysmal or persistent AF, concomitant RDN+AF ablation was not associated with better blood pressure control or rhythm outcome in comparison to AF-only ablation and medical therapy., (© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

BACKGROUND: Clinically effective ablation approaches for patients with persistent atrial fibrillation (AF) are still being debated. So far, ablation targets and strategies beyond pulmonary vein isolation (PVI) have failed to show systematic outcome improvement in randomized controlled clinical trials. METHODS: We conducted a multicenter, randomized trial to determine whether PVI plus individualized substrate ablation of atrial low-voltage myocardium improves outcome in patients with persistent AF. We randomly assigned 324 patients in a 1:1 ratio to receive PVI alone (163 patients; PVI only) or PVI plus substrate modification (161 patients; PVI+SM). The primary study end point was the first recurrence of an atrial arrhythmia longer than 30 seconds after single ablation, with 3 months blanking, using serial 7-day electrocardiogram recordings over 12 months of observation. Patients were also encouraged to receive implantable cardiac monitors. RESULTS: The primary study end point occurred in 75 PVI-only patients (50%) and in 54 PVI+SM patients (35%) (Kaplan–Meier event rate estimates: hazard ratio=0.62, 95% confidence interval [CI]=0.43 to 0.88, log rank P=0.006). Adverse events occurred in three PVI-only patients (1.8%) and in six PVI+SM patients (3.7%) (difference: −1.9 percentage points, 95% CI=−5.5 to 1.7 percentage points). Implant monitoring was used in 242 patients. Among them, 65 PVI-only patients (55%) versus 47 PVI+SM patients (39%) experienced recurrences (difference: 15 percentage points, 95% CI=3 to 28 percentage points). CONCLUSIONS: In this randomized trial, PVI plus individualized ablation of atrial low-voltage myocardium significantly improved outcomes in patients with persistent AF. (ClinicalTrials.gov number, NCT02732626.)

Aims: To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping., Methods and Results: Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80-0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97-0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF <40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71-0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02-1.10; P = 0.002) predicted presence of LVA., Conclusion: For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

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Aims: To study device performance, arrhythmia recurrence characteristics, and methods of outcome assessment using a novel implantable cardiac monitor (ICM) in patients undergoing ablation for atrial fibrillation (AF)., Methods and Results: In 419 consecutive patients undergoing first-time catheter ablation for symptomatic paroxysmal (n = 224) or persistent (n = 195) AF an ICM was injected at the end of the procedure. Telemedicine staff ensured full episode transmission coverage and manually evaluated all automatic arrhythmia episodes. Device detection metrics were calculated for ≥2, ≥6, and ≥10 min AF detection durations. Four methods of outcome assessment were studied: continuous recurrence analysis, discontinuous recurrence analysis, AF-burden analysis, and analysis of individual rhythm profiles. A total of 43 673 automatic AF episodes were transmitted over a follow-up of 15 ± 6 months. Episode-based positive predictive values changed significantly with longer AF detection durations (70.5% for ≥2 min, 81.8% for ≥6 min, and 85.9% for ≥10 min). Patients with exclusive short episode recurrences (≥2 to <6 min) were rare and their arrhythmia detection was clinically irrelevant. Different methods of outcome assessment showed a large variation (46-79%) in ablation success. Individual rhythm characteristics and subclinical AF added to this inconsistency. Analysis of AF-burden and individual rhythm profiles were least influenced and showed successful treatment in 60-70% of the patients., Conclusion: We suggest AF detection duration >6 min and AF burden >0.1% as a standardized outcome definition for AF studies to come in the future.

Objectives: The effects of prenatal exposure to Polychlorinated biphenyls (PCBs) on the development of asthma, frequent ear infections, and eczema/hay fever are not well understood. We aim to investigate associations between prenatal PCB exposure and these health outcomes in the offspring of women who worked at the LaSalle Electrical Utilities Company (EUC)., Methods: A retrospective cohort with at least one live birth and known employment time at EUC was eligible for this analysis. Exposure was defined and categorized by the number of fiscal quarters worked during the PCB era (1952-1981). A total of 288 women with 800 live births were included. A Chi-Square test was used to compare maternal and child characteristics across exposure groups and repeated measures logistic regression, controlling for clustering among siblings, was used to assess the associations between prenatal PCB exposure and these outcomes., Results: After adjustment for confounding and independent maternal predictors, 1-4 quarters of prenatal exposure to PCBs increased the odds for asthma (OR 3.24[1.30-8.09]), eczema/hay fever (OR 3.29[1.54-7.04]), and frequent ear infections (OR 2.24[1.19-4.22]) when compared with persons unexposed/exposed only to naphthalenes. The significance of the associations varied by exposure period and level of exposure, with the strongest associations in those employed exclusively after 1952 when PCBs were introduced., Conclusions: These results support previous findings of associations of prenatal exposure to PCBs with asthma, eczema/hay fever, and frequent ear infections. Additional prospective studies are needed to confirm these findings. Also required are more precise PCB exposures to separate them from other exposures in occupational settings.

Background: Until today, catheter interventional mapping and ablation of atrial fibrillation (AF) has been limited to the right and left atrial endocardium. We report feasibility, electrophysiological findings, and clinical outcome using a combined endo-/epicardial catheter approach for mapping and ablation of AF., Methods and Results: Fifty-nine patients with permanence of pulmonary vein isolation and further symptomatic recurrences of paroxysmal AF, persistent AF, or atrial tachycardia underwent reablation using biatrial endo-/epicardial mapping and ablation. Identification of arrhythmia substrates and selection of ablation strategy were based on sinus rhythm voltage mapping. Using continuous monitoring and a 3-month blanking period, freedom from AF/atrial tachycardia ≥2 minutes was defined as primary end point. In all patients, endo-/epicardial mapping and ablation was feasible using standard technologies of catheter access, 3-dimensional mapping, and radiofrequency ablation. Epicardial mapping and ablation did not add procedural risks. Exclusively epicardial low voltage substrates were found in 14% of the patients. For the first time, novel epicardial conduction abnormalities located in the epicardial fiber network were described in human AF patients (19% of the cohort). Epicardial ablation was needed in 80% of the patients. Over 23±10 months of follow-up freedom from arrhythmia recurrences measured 73%., Conclusions: Catheter-based endo-/epicardial mapping and ablation of AF was feasible and safe. Epicardial mapping provided new insights into AF mechanisms. Epicardial ablation increased transmurality of ablation lesions. Clinical outcome in this cohort of complex AF patients was favorable, indicating potential further development of current AF treatment., (© 2018 American Heart Association, Inc.)

Background: Asthma research has focused on postnatal exposures, but there is recent evidence to indicate atopic immune responses might be initiated in utero. Systemic inflammation during pregnancy might indicate an environment that could increase propensity in the child to develop allergic disease., Objective: To investigate the association of systemic inflammation, as measured by C-reactive protein (CRP) levels, with asthma and wheezing in offspring within an at-risk, mostly Mexican, cohort., Methods: Using data from a randomized education intervention of families at risk for asthma from 1998 followed through 2009 in urban Chicago, asthma was defined as ever having a physician diagnosis of asthma by 3 years of age and wheezing before the third year. Logistic regression models controlling for confounders investigated the effect of prenatal CRP levels on these outcomes., Results: There were 244 mother-child pairs included in the study analysis with median prenatal CRP levels of 4.9 mg/L (interquartile range 3.2-7.7). Continuous prenatal CRP levels were predictive of asthma by year 3 (relative risk 2.4, 95% confidence interval 1.3, 3.6) and wheezing in year 3 (relative risk 1.7, 95% confidence interval 1.1, 2.4) after adjustment. Associations remained significant in mothers who were of Mexican ethnicity and were nonsmokers, suggesting that effects might be stronger in children at lower risk of disease., Conclusion: Prenatal CRP levels are associated with asthma by year 3 and wheezing in year 3 within a high-risk, urban, mostly Mexican, cohort. Maternal systemic inflammation might reflect a prenatal environment that could increase offspring susceptibility to develop wheezing and asthma young in life., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Asthma prevalence has doubled in developed countries during the past 30 years. Pre- and perinatal events are essential in shaping the development of the immune system and systemic antibiotic use during this time could alter the maternal or placental microbiome, leading to an increase in the child's risk of developing asthma., Objective: To determine whether prenatal antibiotic use is associated with asthma and wheezing in children at risk for asthma., Methods: Using data from a randomized education intervention of families at risk for asthma from 1998 followed through 2009 in urban Chicago, asthma was defined as ever having a physician asthma diagnosis by year 3 and wheezing in the third year. Logistic regression models controlling for confounders investigated the effect of antibiotic use during pregnancy on these outcomes., Results: After adjustment, prenatal antibiotic use was a risk factor for asthma (odds ratio 3.1, 95% confidence interval 1.4-6.8) but was only weakly associated with wheezing (odds ratio 1.8, 95% confidence interval 0.9-3.3). Analyses of the effects of timing of prenatal antibiotic use on asthma and wheezing showed the relation remained consistent for antibiotic use later in pregnancy, but the outcomes were not associated with antibiotic use in the first trimester., Conclusion: This study suggests prenatal antibiotic use might be associated with the development of asthma in children at risk for asthma. Although the relation with prenatal antibiotics does not hold for wheezing in this study, there might be a trend that could be delineated further within a larger cohort study., (Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Plant induced defense against herbivory are generally associated with metabolic costs that result in the allocation of photosynthates from growth and reproduction to the synthesis of defense compounds. Therefore, it is essential that plants are capable of sensing and differentiating mechanical injury from herbivore injury. Studies have shown that oral secretions (OS) from caterpillars contain elicitors of induced plant responses. However, studies that shows whether these elicitors originated from salivary glands or from other organs associated with feeding, such as the ventral eversible gland (VEG) are limited. Here, we tested the hypothesis that the secretions from the VEG gland of Spodoptera exigua caterpillars contain elicitors that induce plant defenses by regulating the expression of genes involved in the biosynthesis of volatile organic compounds (VOCs) and other defense-related genes. To test this hypothesis, we quantified and compared the activity of defense-related enzymes, transcript levels of defense-related genes and VOC emission in tomato plants damaged by S. exigua caterpillars with the VEG intact (VEGI) versus plants damaged by caterpillars with the VEG ablated (VEGA)., Results: The quantified defense-related enzymes (i.e. peroxidase, polyphenol oxidase, and lipoxigenase) were expressed in significantly higher amounts in plants damaged by VEGI caterpillars than in plants damaged by VEGA caterpillars. Similarly, the genes that encode for the key enzymes involved in the biosynthesis of jasmonic acid and terpene synthase genes that regulate production of terpene VOCs, were up-regulated in plants damaged by VEGI caterpillars. Moreover, the OS of VEGA caterpillars were less active in inducing the expression of defense genes in tomato plants. Increased emissions of VOCs were detected in the headspace of plants damaged by VEGI caterpillars compared to plants damaged by VEGA caterpillars., Conclusion: These results suggest that the VEG of S. exigua caterpillars contains elicitors of late plant defense signaling in tomato which trigger defense-related enzymatic activity, regulate expression of defense-related genes, and induce emission of plant VOCs. These signaling cascades may have important ramifications for plant-insect and tritrophic interactions.

Background: Studies have shown associations of diabetes and endogenous hormones with exposure to a wide variety of organochlorines. We have previously reported positive associations of polychlorinated biphenyls (PCBs) and inverse associations of selected steroid hormones with diabetes in postmenopausal women previously employed in a capacitor manufacturing plant., Methods: This paper examines associations of PCBs with diabetes and endogenous hormones in 63 men previously employed at the same plant who in 1996 underwent surveys of their exposure and medical history and collection of bloods and urine for measurements of PCBs, lipids, liver function, hematologic markers and endogenous hormones., Results: PCB exposure was positively associated with diabetes and age and inversely associated with thyroid stimulating hormone and triiodothyronine-uptake. History of diabetes was significantly related to total PCBs and all PCB functional groupings, but not to quarters worked and job score, after control for potential confounders. None of the exposures were related to insulin resistance (HOMA-IR) in non-diabetic men., Conclusions: Associations of PCBs with specific endogenous hormones differ in some respects from previous findings in postmenopausal women employed at the capacitor plant. Results from this study, however, do confirm previous reports relating PCB exposure to diabetes and suggest that these associations are not mediated by measured endogenous hormones.

There is an increasing body of literature showing associations of organochlorine exposure with risk of diabetes and insulin resistance. Some studies suggest that associations differ by gender and that diabetes risk, in turn, may be affected by endogenous steroid hormones. This report examines the relationships of serum PCBs and endogenous hormones with history of diabetes in a cohort of persons previously employed at a capacitor manufacturing plant. A total of 118 women were post-menopausal with complete data, of whom 93 were not using steroid hormones in 1996, at the time of examination, which included a survey of exposure and medical history, height, weight and collection of blood and urine for measurements of lipids, liver function, hematologic markers and endogenous hormones. This analysis examines relationships of serum polychlorinated biphenyls (PCBs), work exposure and endogenous hormones with self-reported history of diabetes after control for potential confounders. All PCB exposure groups were significantly related to history of diabetes, but not to insulin resistance as measured by the homeostatic model assessment of insulin resistance (HOMA-IR) in non-diabetics. Diabetes was also independently and inversely associated with follicle stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEAS) and triiodothyronine (T3) uptake. HOMA-IR was positively associated with body mass index (BMI) and C-reactive protein (CRP) and inversely associated with sex hormone binding globulin (SHBG) and T3 uptake after control for PCB exposure. Possible biologic mechanisms are discussed. This study confirms previous reports relating PCB exposure to diabetes and suggests possible hormonal pathways deserving further exploration., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Previous studies have suggested that environmental exposures may be related to the development of respiratory symptoms in early life. Intervention studies, however, have not produced consistent findings., Objective: The Peer Education in Pregnancy Study examined the effect of home environment intervention with pregnant women at risk for having children with asthma on the development of respiratory symptoms in their infants., Methods: A total of 383 pregnant women whose unborn child had a first-degree relative with an allergic history were randomized to 1 of 2 intervention groups, both of whom received general health education, smoking cessation advice, and encouragement to breastfeed. In addition, the intensive education group received 3 home visits focused on home environment modification. Home assessment was performed at baseline and after 1 year of follow-up. Respiratory symptoms were identified during the first year of life., Results: Families in both intervention groups showed significant changes in several environmental factors, with significant differences between the 2 groups in insects other than cockroaches, use of mattress covers, and washing in hot water. Children in the intensive education group had slightly lower incidence rates of respiratory symptoms, but few differences were statistically significant., Conclusions: The results of this study do not provide strong support for a primary intervention focused on general modification of the home environment during pregnancy for high-risk children. It does not address the effects of more aggressive approaches or of interventions targeting individual environmental factors.

Snowblowers injure approximately 5000 people a year and can cause devastating hand injuries. Even with added safety measures and warnings on modern snowblowers, hand injuries are still occurring at an alarming rate. We have reviewed our series of snowblower-related hand injuries to elucidate the epidemiology, patterns of injury, and strategies for prevention.Questionnaires and treatment records of 22 individuals with snowblower injuries to the hand between 2002 and 2005 were reviewed. All patients were treated by a single hand surgeon at Hartford Hospital in Hartford, CT.Eleven of the 22 held upper level educational degrees. Averaged results include operator experience of 15.17 years, machine age of 21.38 years, temperature of 29.05 degrees F (-1.51 degrees C), precipitation of 8.60 cm (3.38 in), and duration of use of 20.59 minutes excluding 3 outliers. Three patients consumed 1 alcoholic drink and 1 consumed 2 alcoholic drinks before injury. The majority of patients were aware of safety warnings (77.20%) and injured themselves with the machine running (82.35%) resulting in multiple digit injury (2.0 on average) on the dominant hand (68.18%).Operator inexperience, low operator intelligence, and excessive alcohol consumption do not seem to contribute to injury. Instead, significant experience, older machines, short durations of use before injury, characteristic weather patterns, and underlying misperceptions about snowblower design and function typically set the stage for injury. Injuries may be prevented in the future by improving snowblower design and/or by making brief public service announcements.

Background: Prevalence of asthma in developed countries increased between the 1970s and the 1990s. One factor that might contribute to the trends in asthma is the increased use of acetaminophen vs aspirin in children and pregnant women., Objective: To examine relationships between in utero exposure to acetaminophen and incidence of respiratory symptoms in the first year of life., Methods: A total of 345 women were recruited in the first trimester of pregnancy and followed up with their children through the first year of life. Use of acetaminophen in pregnancy was determined by questionnaire and related to incidence of respiratory symptoms., Results: Use of acetaminophen in middle to late but not early pregnancy was significantly related to wheezing (odd ratio, 1.8; 95% confidence interval, 1.1-3.0) and to wheezing that disturbed sleep (odds ratio, 2.1; 95% confidence interval, 1.1-3.8) in the first year of life after control for potential confounders., Conclusion: This study suggests that use of acetaminophen in middle to late but not early pregnancy may be related to respiratory symptoms in the first year of life. Additional follow-up will examine relationships of maternal and early childhood use of acetaminophen with incidence of asthma at ages 3 to 5 years, when asthma diagnosis is more firmly established.

Recent studies suggest that psychosocial factors may contribute to asthma. We examined associations of stressful life events with asthma prevalence and morbidity among Chicago adolescents. Self-reported asthma, measures of asthma morbidity, and 15 life events were collected from 2026 seventh to ninth grade students from 34 Chicago Catholic schools as part of the International Study of Allergies and Asthma in Childhood in 1994-95. Life events were reported by 77% of adolescents and overall asthma prevalence was 15.5%. Stressful life events in adolescents were significantly related to both asthma and asthma morbidity. Odds of asthma was 1.44 (95% confidence interval [CI] = 1.07, 1.95) for those reporting two to three stressful events and 1.92 (95% CI = 1.41, 2.62) for subjects endorsing more than three stressful events. In adolescents with asthma, number of asthma symptoms (odds ratio [OR] for increase in one event = 1.16, 95% CI = 1.07, 1.27), asthma-related school absenteeism (OR = 1.17, 95% CI = 1.04, 1.32), physician visits for asthma (OR = 1.16, 95% CI = 1.04, 1.29), and hospitalization for asthma (OR = 1.20, 95% CI = 1.001, 1.44) were significantly associated with the number of stressful events, independent of home exposure to cigarette smoke and dampness, use of inhaled substances, and sociodemographic factors. While these results are not sufficient to assign causality in the relationship between stress and asthma, they are supported by a number of other studies and by plausible biologic mechanisms. Assessing and addressing the effects of stressful life events may be helpful in managing asthma in inner city adolescents.

Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor of the skin and mucous membranes. Whereas the literature describes pyogenic granulomas of pregnancy as occurring mainly within the gingival or oral mucosa, we present 5 cases of a histologically confirmed pyogenic granuloma on the hands of gravid women, each with no history of antecedent trauma. These tumors failed to resolve spontaneously postpartum necessitating surgical removal. We propose the term epulis gravidarum manum to describe this skin lesion.

Asthma morbidity and mortality are disproportionately high in low-income minority populations. Variations in environmental exposures, stress, and access to appropriate health care all contribute to these disparities. The complex nature of asthma with strong contributions from environmental, psychosocial, and biological factors suggest that community-based approaches focused on the unique needs of high-risk populations may be effective. The few previous randomized trials suggest that case management with professionals and/or community health educators may reduce asthma morbidity. Health-educator programs should be lodged in stable infrastructures with training and funding for community health workers to obtain long-term sustainability. Factors not amenable to individual intervention, however, such as poor condition of homes, outdoor pollution, and lack of access to appropriate care, will require collaborative efforts of community groups, academic professionals, public agencies, and health-care providers.

The composition of polychlorinated biphenyl (PCB) congeners in serum samples is compared between a cohort previously exposed to PCBs from working at a capacitor plant (n=180) and a cohort of Great Lakes sport-caught fish eaters (n=217). Fourteen congeners were measured in both samples. A multiple logistic regression model differentiating the two groups as a function of relative proportions amongst congeners 74, 138, 153, 180, and 201 correctly classifies more than 99% of the people (395/397); higher proportions of congeners 74, 153, and 201 characterize capacitor plant workers, while higher proportions of congeners 138 and 180 characterize fish eaters. The pattern is driven by the relative amounts of 74+153+201 compared to 138+180; all of the fish eaters, but only 5% of the capacitor plant workers, have a greater percent of 138+180 than 74+153+201. Consideration of combinations of congener levels and their relative proportions is relevant to tracking route of exposure and may also be relevant to modeling effects on health outcomes.

Many older homes are equipped with mercury-containing gas regulators that reduce the pressure of natural gas in the mains to the low pressure used in home gas piping. Removal of these regulators can result in elemental mercury spills inside the home. In the summer of 2000, mercury spills were discovered in the basements of several Chicago-area homes after removal of gas regulators by gas company contractors. Subsequent inspections of approximately 361,000 homes by two northern Illinois gas companies showed that 1,363 homes had residential mercury contamination. Urine mercury screening was offered to concerned residents, and results of urine bioassays and indoor mercury air measurements were available for 171 homes. Six of these 171 homes (3.5%) had a cumulative total of nine residents with a urine mercury > or = 10 microg/L. The highest urine mercury concentration observed in a resident was 26 microg/L. Positive bioassays were most strongly associated with mercury air concentrations > 10 microg/m3 on the first floor [odds ratio (OR) = 21.4 ; 95% confidence interval (CI) , 3.6-125.9] rather than in the basement (OR = 3.0 ; 95% CI, 0.3-26) , and first-floor air samples were more predictive of positive bioassays than were basement samples. Overall, the risk of residential mercury contamination after gas regulator removal ranged from 0.9/1,000 to 4.3/1,000 homes, depending on the gas company, although the risk was considerably higher (20 of 120 homes, 16.7%) for one of the contractors performing removal work for one of the gas companies. Gas companies, their contractors, and residents should be aware of these risks and should take appropriate actions to prevent these spills from occurring and remediate them if they occur.

A mortality study of workers employed between 1944 and 1977 at an electrical capacitor manufacturing plant where polychlorinated biphenyls (PCBs), chlorinated naphthalenes, and other chemicals were used was undertaken. Age, gender, and calendar year-adjusted standardized mortality ratios (SMRs) were calculated for 2885 white workers. Total mortality and all-cancer mortality were similar to expected in both males and females. Females employed 10 or more years had a significantly elevated SMR of 6.2 for liver/biliary cancer. Intestinal cancer was significantly elevated in females employed 5 or more years after PCBs were introduced (SMR = 2.2). In males, stomach cancer (SMR = 2.2) and thyroid cancer (SMR = 15.2) were significantly elevated. Although individual exposure assessment was limited, PCBs alone or in combination with other chemicals could be associated with increased risks for liver/biliary, stomach, intestinal, and thyroid cancer.

Objectives: Changes in breast and gastric cancers and coronary artery disease among people of Polish descent after migration to the United States suggest there may be potentially modifiable factors affecting incidence of these diseases. We examined relationships of dietary factors associated with these diseases with stage of migration among Polish women in Chicago., Design: Women of Polish descent (N = 396) were selected from Polish women's social organizations. Women completed a modified Health Habits and History Questionnaire., Setting: The questionnaire was completed either at the participant's home or at a Polish social organization., Participants: Participants ranged in age from 17-81 years, and included women born in Poland or the United States, who had at least one parent of Polish., Interventions: Participants were stratified by country of birth and migration period (1935-1979, 1980-1989, 1990-1997)., Main Outcome Measures: The average daily intake of food groups and nutrients was assessed using multiple linear regression., Results: We found statistically significant differences by birth country for 19 of 34 nutrients, 4 of 7 food groups, and for 21 nutrients, and 5 food groups among the different migration tertiles., Conclusions: Women from Poland and more recent migrants had generally more nutritious intakes, compared to US-born women, or earlier migrants., Applications/conclusions: There are significant dietary differences among women of Polish descent that vary by duration of US residency and birth country. Women with dietary intakes which place them at higher risk for cancers and cardiovascular disease could be targeted for interventions to lower their disease risk.

The most effective means of educating children with asthma and their families has not been clearly demonstrated in previous studies. Peer education is uniquely suited to the complex problems encountered in underserved populations. The purpose of this study was to show the feasibility of delivering a peer education program for children with asthma and the effect of the program on indoor allergen levels in an inner-city population in Chicago. Overall, the program was well received. Baseline allergen levels were consistent with some previous studies in showing low levels of mite allergens and high levels of cockroach allergens, with 79.6% of samples having levels > 8 U/g. A total of 28.2% of samples had cat allergen levels > 2 microg/g, although only 9.7% of homes had cats, confirming previous reports that cat allergen is ubiquitous. Mold levels were seasonal, with the highest levels in the summer. Results from this study suggest that intervention programs should focus more on elimination of cockroaches than was previously appreciated, while minimizing the use of pesticides, and on identification of the sources of cat allergen. Structural and psychosocial issues in homes need to be addressed in future studies. This study has demonstrated the feasibility of delivering peer education in a inner-city population and highlighted the need for comprehensive intervention strategies addressing complex issues facing underserved neighborhoods.

Background: Asthma mortality rates in Chicago are among the highest in the United States, with substantially greater rates in poor and minority populations. How much of the differential can be attributed to differences in prevalence versus severity or access to care has not been determined., Objective: To examine rates of asthma prevalence, severity, and symptoms and to explore the relationships of these rates to race and socioeconomic status in a random sample of Chicago school children., Methods: Self-administered survey., Results: Overall, rates of asthma were higher than previously reported, with 16% of students in the stratified cluster random sample of 3,670 children in the 7th and 8th grades having had asthma. Prevalence rates were significantly higher in schools with >98% African Americans than in other schools, with the highest prevalence rates seen in African American schools in low income neighborhoods. Rates were associated with the percent of African American children in the school and with median income of the school's census tract. Relationships were most consistent with indices of more severe disease., Conclusions: Asthma prevalence is higher than previously noted, with rates greatest in minority and low income populations. Differences are more striking for measures of severity than for symptoms of wheezing, but are far less than previously reported differences in mortality, suggesting that additional factors, such as differential access to continuous health care, may be affecting high death rates from asthma in Chicago.