Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial
To assess strategies for advice on analgesia and steam inhalation for respiratory tract infections.
Open pragmatic parallel group factorial randomised controlled trial.
Primary care in United Kingdom.
Patients aged ≥3 with acute respiratory tract infections.
889 patients were randomised with computer generated random numbers in pre-prepared sealed numbered envelopes to components of advice or comparator advice: advice on analgesia (take paracetamol, ibuprofen, or both), dosing of analgesia (take as required v regularly), and steam inhalation (no inhalation v steam inhalation).
Primary: mean symptom severity on days 2-4; symptoms rated 0 (no problem) to 7 (as bad as it can be). Secondary: temperature, antibiotic use, reconsultations.
Neither advice on dosing nor on steam inhalation was significantly associated with changes in outcomes. Compared with paracetamol, symptom severity was little different with ibuprofen (adjusted difference 0.04, 95% confidence interval −0.11 to 0.19) or the combination of ibuprofen and paracetamol (0.11, −0.04 to 0.26). There was no evidence for selective benefit with ibuprofen among most subgroups defined before analysis (presence of otalgia; previous duration of symptoms; temperature >37.5°C; severe symptoms), but there was evidence of reduced symptoms severity benefit in the subgroup with chest infections (ibuprofen −0.40, −0.78 to −0.01; combination −0.47; −0.84 to −0.10), equivalent to almost one in two symptoms rated as a slight rather than a moderately bad problem. Children might also benefit from treatment with ibuprofen (ibuprofen: −0.47, −0.76 to −0.18; combination: −0.04, −0.31 to 0.23). Reconsultations with new/unresolved symptoms or complications were documented in 12% of those advised to take paracetamol, 20% of those advised to take ibuprofen (adjusted risk ratio 1.67, 1.12 to 2.38), and 17% of those advised to take the combination (1.49, 0.98 to 2.18). Mild thermal injury with steam was documented for four patients (2%) who returned full diaries, but no reconsultations with scalding were documented.
Overall advice to use steam inhalation, or ibuprofen rather than paracetamol, does not help control symptoms in patients with acute respiratory tract infections and must be balanced against the possible progression of symptoms during the next month for a minority of patients. Advice to use ibuprofen might help short term control of symptoms in those with chest infections and in children.
Clean Air Issues in the 113th Congress: An Overview (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
As the 113th Congress continues consideration of air quality issues, oversight of Environmental Protection Agency (EPA) regulatory actions is expected to remain the main focus. Of particular interest are EPA’s Clean Air Act regulations on emissions of greenhouse gases and revision of the ambient air quality standards for ozone. President Obama’s June 25 announcement of initiatives to address climate change has sparked renewed interest in the former, and EPA’s expected proposal of new ozone standards by the end of the year is stimulating interest in the latter.
Air quality has improved substantially in the United States in the 40 years of EPA’s Clean Air Act (CAA) regulation. According to the agency’s science advisers and others, however, more needs to be done to protect public health and the environment from the effects of air pollution. Thus, the agency continues to promulgate regulations using authority given it by Congress in CAA amendments more than 20 years ago. Members of Congress from both parties have raised questions about the cost-effectiveness of some of these regulations and/or whether the agency has exceeded statutory authority in promulgating them. Others in Congress have supported EPA, noting that the Clean Air Act, often affirmed in court decisions, has authorized or required the agency’s actions. EPA’s regulatory actions on greenhouse gas (GHG) emissions have been one focus of congressional interest. Although the Obama Administration has consistently said that it would prefer that Congress pass new legislation to address climate change, such legislation now appears unlikely. Instead, over the last four years, EPA has developed GHG emission standards using its existing CAA authority. Relying on a finding that GHGs endanger public health and welfare, the agency promulgated GHG emission standards for cars and light trucks on May 7, 2010, and again on October 15, 2012, and for larger trucks on September 15, 2011. The implementation of these standards, in turn, triggered permitting and Best Available Control Technology requirements for new major stationary sources of GHGs (power plants, manufacturing facilities, etc.).
It is the triggering of standards for stationary sources that has raised the most concern in Congress. A proposal to limit carbon dioxide emissions from new power plants is the focus of attention currently, but other sources (refineries, cement plants, etc.) could be subject to GHG emission controls under the same statutory authority. Also, on June 25, the President directed EPA to develop standards for existing power plants by June 2015. Legislation has been considered in both the House and Senate aimed at preventing EPA from implementing such requirements. The House passed several of these bills in the 112th Congress, but none of them passed the Senate.
Besides addressing climate change, EPA has taken action on a number of other air pollution regulations, generally in response to court actions remanding previous rules. Remanded rules included the Clean Air Interstate Rule (CAIR) and the Clean Air Mercury Rule—rules designed to control the long-range transport of sulfur dioxide, nitrogen oxides, and mercury from power plants through cap-and-trade programs. Other remanded rules included hazardous air pollutant standards for boilers and cement kilns. EPA also recently proposed a controversial rule to lower the sulfur content of gasoline, in conjunction with tighter (“Tier3”) standards for motor vehicle emissions.
In addition to these rules, EPA is reviewing ambient air quality standards (NAAQS) for ozone and other widespread air pollutants. An ozone NAAQS proposal is expected by the end of 2013. NAAQS serve as EPA’s definition of clean air, and drive a range of regulatory controls. EPA’s review process for the NAAQS, mandated at five-year intervals by the Clean Air Act, has also faced opposition in Congress. As passed by the House in the 112th Congress, H.R. 2401 and H.R. 3409 would have amended the act to require EPA to consider feasibility and cost in setting NAAQS, reversing a unanimous 2001 Supreme Court decision that the law requires standards based on health considerations alone.
Global premature mortality due to anthropogenic outdoor air pollution and the contribution of past climate change
Global premature mortality due to anthropogenic outdoor air pollution and the contribution of past climate change
Source: Environmental Research Letters
Increased concentrations of ozone and fine particulate matter (PM2.5) since preindustrial times reflect increased emissions, but also contributions of past climate change. Here we use modeled concentrations from an ensemble of chemistry–climate models to estimate the global burden of anthropogenic outdoor air pollution on present-day premature human mortality, and the component of that burden attributable to past climate change. Using simulated concentrations for 2000 and 1850 and concentration–response functions (CRFs), we estimate that, at present, 470 000 (95% confidence interval, 140 000 to 900 000) premature respiratory deaths are associated globally and annually with anthropogenic ozone, and 2.1 (1.3 to 3.0) million deaths with anthropogenic PM2.5-related cardiopulmonary diseases (93%) and lung cancer (7%). These estimates are smaller than ones from previous studies because we use modeled 1850 air pollution rather than a counterfactual low concentration, and because of different emissions. Uncertainty in CRFs contributes more to overall uncertainty than the spread of model results. Mortality attributed to the effects of past climate change on air quality is considerably smaller than the global burden: 1500 (−20 000 to 27 000) deaths yr−1 due to ozone and 2200 (−350 000 to 140 000) due to PM2.5. The small multi-model means are coincidental, as there are larger ranges of results for individual models, reflected in the large uncertainties, with some models suggesting that past climate change has reduced air pollution mortality.
Update: Recommendations for Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Source: Morbidity and Mortality Weekly Report (CDC)
On June 11, 2013, CDC issued interim infection prevention and control recommendations for hospitalized patients with known or suspected Middle East respiratory syndrome coronavirus (MERS-CoV) infection in U.S. hospitals (1). To date, no MERS-CoV cases have been reported in the United States; however, cases have been reported in eight other countries (2). Recent published reports (3,4) have described limited health-care transmission of MERS-CoV, including cases among health-care personnel in international settings. These published reports highlight the need for rapid detection of infectious patients and adherence to correct infection prevention measures to prevent transmission of the virus among patients, health-care personnel, and visitors.
In coming months, the U.S. health-care system might be called upon to provide care to patients infected with MERS-CoV. Front-line providers and health-care organizations should be prepared to care for MERS-CoV patients as part of routine operations. To aid providers and facilities, CDC has developed checklists that identify key actions that can be taken now to enhance preparedness for treating persons with MERS-CoV infection and compiled a list of preparedness resources (available at http://www.cdc.gov/coronavirus/mers/preparedness).
Additional information, including guidance on case definitions, infection control, case investigation, and specimen collection and testing, is available at the CDC MERS website (2). The MERS website contains the most current information and guidance, which is subject to change. State and local health departments with questions should contact the CDC Emergency Operations Center at telephone, 770-488-7100.
Asthma and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine (NCCAM)
Asthma is a chronic lung disease that affects people of all ages. It causes episodes of wheezing, coughing, shortness of breath, and chest tightness. Although there is no cure, most people with asthma are able to manage the disease with medications and behavioral changes.
Researchers also are studying various complementary health approaches for asthma relief. This fact sheet provides basic information about asthma, summarizes scientific research on the effectiveness and safety of complementary health approaches for asthma, and suggests sources for additional information.
Potentially Improper Frequency of Pneumococcal Vaccinations for Medicare Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
Current vaccination recommendations state that individuals without immunocompromising medical conditions should receive a single pneumococcal vaccination at the age of 65 years or older and that individuals with immunocompromising conditions should receive a second vaccination 5 years after their first. Medicare instructs providers to administer a pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history in the past 5 years. Vaccination is intended to reduce the risk of contracting serious disease, but vaccination is not without risk. In 2012, the Vaccine Adverse Event Reporting System, a national vaccine surveillance program, reported more than 1,000 adverse events associated with the 4.6 million pneumococcal vaccinations for Medicare beneficiaries between 2007 and 2011.
HOW WE DID THIS STUDY
We obtained all Medicare Part B claims from the National Claims History File for the period 2007-2011 for the three different types of pneumococcal vaccine-PCV7, PCV13, and PPSV23-and the administration of the vaccine. Using this claims data, we reviewed the frequency of pneumococcal vaccinations for beneficiaries age 65 and older without immunocompromising medical conditions to detect beneficiaries receiving vaccinations more frequently than recommended. We then limited our review to claims for beneficiaries who were eligible for Medicare by age alone and whose diagnosis codes indicated vaccination against Streptococcus pneumoniae. We limited the period of review to 5 years and allowed for one vaccination of each type per beneficiary. Our calculations as to whether a given vaccination constituted a second (or greater) vaccination of the same type were based on the order of occurrence for each vaccination.
WHAT WE FOUND
Of the 4.6 million beneficiaries receiving a pneumococcal vaccination from 2007-2011, we identified 122,498 beneficiaries who received multiple pneumococcal vaccinations of the same type. Medicare allowed a total of $234 million for pneumococcal vaccinations in outpatient settings, of which nearly $7 million was for two or more pneumococcal vaccinations, and their administration, of the same type for the same beneficiary within the 5-year period. For beneficiaries who received repeat vaccinations of the same type, 43 percent received repeat vaccinations from their same providers.
WHAT WE CONCLUDE
We support CMS and CDC/ACIP in their vaccination goals and efforts, but the data suggest a need to educate certain providers about repeat vaccinations more often than recommended. The data also suggest that 43 percent of the unnecessary vaccination could be reduced through providers’ reviewing the medical history of established patients. Tools, such as electronic medical records, may assist in this effort.
CDC and NIH survey provides first report of state-level COPD prevalence
Source: Centers for Disease Control and Prevention
he age-adjusted prevalence of chronic obstructive pulmonary disease (COPD) varies considerably within the United States, from less than 4 percent of the population in Washington and Minnesota to more than 9 percent in Alabama and Kentucky. These state-level rates are among the COPD data available for the first time as part of the newly released 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey.
“COPD is a tremendous public health burden and a leading cause of death. It is a health condition that needs to be urgently addressed, particularly on a local level,” said Nicole Kosacz, M.P.H., an epidemiologist with the Centers for Disease Control and Prevention and one of the lead analysts of the data. “This first-ever state-level analysis and breakdown is a critical source of information that will allow states to focus their resources where they will have maximum impact.”
In addition to the nationwide prevalence data, surveys in 21 states as well as Washington, D.C., and Puerto Rico asked additional questions related to diagnosis and quality of life of those reporting COPD. Results from the more detailed surveys included:
- 71.4 percent of those reporting COPD were diagnosed via spirometry – a simple test to assess breathing
- 62.5 percent felt that symptoms adversely affected their quality of life
- 50.9 percent were taking at least one daily medication to manage their COPD, with rates of medication usage increasing with age
See: First Report of State-Level COPD Prevalence in U.S.(Science Daily)
Source: PLoS Medicine
More than half of the world’s population now live in cities , and while urbanization has the potential to allow greater access to health care for all, huge discrepancies in how resources are allocated within cities result in major inequities in health . Addressing these discrepancies and improving health require accurate assessment. To that point, earlier this month PLOS Medicine published a Policy Forum article by Jason Corburn and Alison Cohen that focused on the urbanizing planet and the need for health equity indicators to guide public health policy in cities and urban areas .
The major theme of Corburn and Cohen’s argument is that if societies are to ensure those living in the poorest urban slums have the same right to health as people living on the richest boulevards, health indicators must allow for the identification of where health inequities exist. For example, while indicators in Nairobi measure population access to communal toilet blocks, they give no information as to whether the toilet blocks are hygienic or safe to use and therefore mask inequity within the city. Such indicators, however, would have little value in cities like London or New York, which illustrates the need for context-specific measures.
Effect of Inhaled Glucocorticoids in Childhood on Adult Height
Source: New England Journal of Medicine
The initial decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted as a reduction in adult height, although the decrease was not progressive or cumulative.
See: Children Taking Steroids for Asthma Are Slightly Shorter Than Peers, Study Finds (Science Daily)
Health Benefits From Large Scale Ozone Reduction in the United States
Source: Environmental Health Perspectives
Exposure to ozone has been associated with adverse health effects, including premature mortality, cardiopulmonary and respiratory morbidity. In 2008, the U.S. Environmental Protection Agency (EPA) lowered the primary (health-based) National Ambient Air Quality Standard (NAAQS) for ozone to 75ppb, expressed as the fourth-highest daily maximum 8-hr average over a 24-hr period. Based on recent monitoring data, U.S. ozone levels still exceed this standard in numerous locations resulting in avoidable adverse health consequences.
To quantify the potential human health benefits from achieving the current primary NAAQS standard of 75ppb and two alternative standard levels, 70 and 60ppb, representing the range recommended by the EPA Clean Air Scientific Advisory Committee (CASAC).
We apply health impact assessment methodology to estimate numbers of deaths and other adverse health outcomes that would have been avoided during 2005, 2006 and 2007 if the current NAAQS ozone standards (or lower standards) had been met. Estimated reductions in ozone concentrations were interpolated according to geographic area and year, and concentration-response functions were obtained or derived from the epidemiological literature.
We estimated that annual numbers of avoided ozone-related premature deaths would have ranged from 1,410-2,480 at 75ppb to 2,450-4,130 at 70ppb and 5,210-7,990 at 60ppb. Acute respiratory symptoms would have been reduced by 3 million cases and school-loss days by one million cases annually if the current 75ppb standard had been attained. Substantially greater health benefits would have resulted if the CASAC recommended range of standards (70 to 60ppb) had been met.
Attaining a more stringent primary ozone standard would significantly reduce ozone-related premature mortality and morbidity.
Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.
Reporting Period Covered: September 2010–December 2011.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.
Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.
Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.
Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
Lung Cancer and Elemental Carbon Exposure in Trucking Industry Workers
Source: Environmental Health Perspectives
Background: Diesel exhaust has been considered to be a probable lung carcinogen based on studies of occupationally exposed workers. Efforts to define lung cancer risk in these studies have been limited in part by lack of quantitative exposure estimates.
Objectives: We conducted a retrospective cohort study to assess lung cancer mortality risk in US trucking industry workers. Elemental carbon (EC) was used as a surrogate of exposure to engine exhaust from diesel vehicles, traffic, and loading dock operations.
Methods: Work records were available for 31,135 male workers employed in the unionized US trucking industry in 1985. A statistical model based on a national exposure assessment was used to estimate historical work-related exposures to EC. Lung cancer mortality was ascertained through 2000 and associations with cumulative and average EC were estimated using proportional hazards models.
Results: Duration of employment was inversely associated with lung cancer risk consistent with a healthy worker survivor effect and a cohort comprised of prevalent hires. Adjusting for employment duration, there was suggestion of a linear exposure-response relationship. For each 1000 µg/m3-months of cumulative EC, based on a 5-year exposure lag, the Hazard Ratio (HR) = 1.07 (95%CI: 0.99, 1.15) with a similar association for a 10-year exposure lag, HR=1.09 (95%CI: 0.99, 1.20). Average exposure was not associated with relative risk.
Conclusions: Lung cancer mortality in trucking industry workers increased in association with cumulative exposure to EC after adjustment for negative confounding by employment duration.
A new report shows that adults (aged 18 and older) who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults aged 18 and older who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease, and stroke.For example, 21.9 percent of adults experiencing any mental illness (based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) in the past year had high blood pressure. In contrast, 18.3 percent of those not experiencing any mental illness had high blood pressure. Similarly, 15.7 percent of adults who had any mental illness in the past year also had asthma, while only 10.6 percent of those without mental illness had this condition.Adults who had a serious mental illness (i.e., a mental illness causing serious functional impairment substantially interfering with one or more major life activities) in the past year also evidenced higher rates of high blood pressure, asthma, diabetes, heart disease and stroke than people who did not experience serious mental illnesses.Adults experiencing major depressive episodes (periods of depression lasting two weeks or more in which there were significant problems with everyday aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher rates of the following physical illnesses than those without past-year major depressive episodes: high blood pressure (24.1 percent vs. 19.8 percent), asthma (17.0 percent vs. 11.4 percent), diabetes (8.9 percent vs. 7.1 percent), heart disease (6.5 percent vs. 4.6 percent), and stroke (2.5 percent vs. 1.1 percent).
+ Full Report (PDF)
More Than 70 Medicines in Development for Asthma
Source: Pharmaceutical Research and Manufacturers of America (PhRMA)
America’s biopharmaceutical research companies are developing 74 medicines to treat or prevent asthma, according to a report released today by the Pharmaceutical Research and Manufacturers of America (PhRMA). All of the medicines are either in clinical trials or awaiting review by the Food and Drug Administration.
Asthma is a narrowing of the airways to the lungs caused by inflammation in the air passages, resulting from both genetic and environmental influences. Today, more than 24 million American adults and children suffer from asthma, with the prevalence increasing 12 percent in the last decade, according to the Centers for Disease Control and Prevention. Each day, 40,000 Americans miss school or work due to asthma, costing the U.S. economy an estimated $56 billion each year in direct and indirect costs.
+ Full Document (PDF)
The Consumer Healthcare Products Association (CHPA) today released the following statement regarding a new survey from the Center for Medicine in the Public Interest (CMPI) finding that the majority of adult consumers and parents in the United States rely on accessible, affordable over-the-counter (OTC) cough medicines to treat themselves and their families’ cough symptoms. CMPI’s Cough Medicine Consumer Insights national survey found that 68 percent of adult consumers agreed that OTC cough medicines allow them to stay productive at work and school, and 60 percent of parents reported that these medicines allowed their children to stay productive at school.
Non-communicable Diseases will Cost Global Economy $47 Trillion by 2030
Source: Chatham House
Non-communicable diseases (NCDs) are the greatest cause of deaths and disability for humans and have a serious economic impact, says a new Chatham House paper, Silent Killer, Economic Opportunity: Rethinking Non-Communicable Disease. The cumulative losses in global economic output due to NCDs will total $47 trillion, or 5% of GDP, by 2030. The author, Sudeep Chand, says modest investments to prevent and treat NCDs could bring major economic returns and save tens of millions of lives.
NCDs, such as heart disease, cancer, asthma and depression, have their place alongside economic risks such as infectious diseases, illicit trade, migration, terrorism and food security. They have global scope, cross-industry relevance and a high economic and social impact. Economic policy-makers and businesses concerned with capital and labour costs have good reasons to consider the burdens from NCDs. Sustainable, balanced economic policy can consider low rates of NCDs as a measure of success. Where the economic benefits outweigh the costs, civil society has a major role to play in harnessing an effective response to NCDs.
Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan
Source: Institute of Medicine
From press release:
Insufficient data on service members’ exposures to emissions from open-air burn pits for trash on military bases in Iraq and Afghanistan is one of the reasons why it is not possible to say whether these emissions could cause long-term health effects, says a new report from the Institute of Medicine. High background levels of ambient pollution from other sources and lack of information on the quantities and composition of wastes burned in the pits also complicate interpretation of the data.
During deployment to a war zone, military personnel can be exposed to a variety of environmental hazards, many of which have been associated with long-term adverse health outcomes such as cancer and respiratory disease. Many veterans returning from Iraq and Afghanistan have health problems that they worry are related to their exposure to burn pits on military bases. Special attention has been focused on the burn pit at Joint Base Balad (JBB), one of the largest U.S. military bases in Iraq and a central logistics hub.
Based on its analysis of raw data from air monitoring efforts at JBB conducted by the U.S. Department of Defense, the committee that wrote the report concluded that levels of most pollutants of concern at the base were not higher than levels measured at other polluted sites worldwide. Moreover, research on other populations exposed to complex mixtures of pollutants, primarily firefighters and workers at municipal waste incineration plants, has not indicated increased risk for long-term health consequences such as cancer, heart disease, and most respiratory illnesses among these groups.
Even so, the committee pointed out shortcomings in research and gaps in evidence that prevented them from drawing firm conclusions, and it recommended a path to overcome some of these limitations. Lack of information on the specific quantities and types of wastes burned and on other sources of background pollution when air samples were being collected meant it was difficult to correlate pit emissions, including smoke events, with potential health outcomes. Different types of wastes produce different combinations of chemical emissions with the possibility of different health outcomes in those exposed. Moreover, it is hard to determine whether surrogate populations such as firefighters experience exposures to pollutants and durations of exposures similar to those of service members stationed at JBB.
Associations between pre-pregnancy obesity and asthma symptoms in adolescents
Source: Journal of Epidemiology & Community Health
What is already known on this subject
- The increased and high prevalence of children’s asthma symptoms, worldwide, is unexplained.
- Rapidly changing environmental factors that go beyond genetic predisposition are likely to explain the increase in asthma prevalence.
What this study adds
- Prenatal exposure to maternal overweight and obesity is an important risk of asthma symptoms later in life through to adolescence, after controlling for numerous relevant confounders.
- Our results suggest that maternal overweight and obesity prior to pregnancy may programme the risk of asthma symptoms in their adolescent offspring and be a new target for prevention of adolescents’ asthma and wheeze if the associations are causal.
See: Overweight Mothers Increase Asthma Risk for Their Children (Science Daily)