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Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan

November 1, 2011 Comments off

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.

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Associations between pre-pregnancy obesity and asthma symptoms in adolescents

September 30, 2011 Comments off

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)

FDA: Over-the-counter asthma inhalers containing chloroflouorocarbons (CFCs) will no longer be made or sold after Dec. 31, 2011

September 27, 2011 Comments off

FDA: Over-the-counter asthma inhalers containing chloroflouorocarbons (CFCs) will no longer be made or sold after Dec. 31, 2011
Source: U.S. Food and Drug Administration

The U.S. Food and Drug Administration says users of epinephrine inhalers containing chlorofluorocarbons (CFCs) should plan now to get a prescription for a replacement product because these inhalers will not be made or sold after Dec. 31, 2011.

Epinephrine inhalers, marketed by Armstrong Pharmaceutical Inc. as Primatene Mist, are the only FDA-approved inhalers for the temporary relief of occasional symptoms of mild asthma that are sold over-the-counter in retail stores without a prescription. The product uses CFCs to propel the medicine out of the inhaler so that consumers can breathe it into their lungs.

However, Primatene Mist will no longer be available by year’s end because no CFC-containing epinephrine inhalers can be made or sold after Dec. 31, 2011, to comply with obligations made under the Montreal Protocol on Substances that Deplete the Ozone Layer. This is an international agreement signed by the United States, in which countries agreed to phase-out substances that deplete the ozone layer, including CFCs, after certain dates.

“If you rely on an over-the-counter inhaler to relieve your asthma symptoms, it is important that you contact a health care professional to talk about switching to a different medicine to treat your asthma,” said Badrul Chowdhury, M.D., director of the Division of Pulmonary, Allergy and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research.

+ Phase-Out of Epinephrine CFC Metered-Dose Inhalers
+ Epinephrine CFC Metered-dose Inhalers – Questions and Answers
+ Consumer Update: Primatene Mist With Chlorofluorocarbons No Longer Available After Dec. 31, 2011

Early Releases of Selected Estimates From the National Health Interview Survey

September 22, 2011 Comments off

Early Releases of Selected Estimates From the National Health Interview Survey
Source: National Center for Health Statistics
From press release (PDF):

In this release, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) updates estimates for 15 selected health measures based on data from the January–March 2011 National Health Interview Survey (NHIS) and presents estimates from 1997 through 2010 for comparison. The 15 Early Release measures are being published prior to final data editing and final weighting, to provide access to the most recent information from NHIS. The estimates will be updated as each new quarter of NHIS data becomes available.

The 15 measures included in the present report are lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure-time physical activity, current smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma.

+ Full Release (PDF)

Hospital Readmissions for COPD Highest Among Black Patients

September 21, 2011 Comments off

Hospital Readmissions for COPD Highest Among Black Patients
Source: Agency for Healthcare Research and Quality

For patients age 40 and over with chronic obstructive pulmonary disease (COPD), hospital readmissions within 30 days of initial treatment were 30 percent higher among Blacks than Hispanics or Asians and Pacific Islanders and about 9 percent higher than Whites in 2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ).

Based on data for patients who were hospitalized with COPD in 15 States during 2008:

  • About 7 percent of patients were readmitted within 30 days principally for COPD, but 21 percent were readmitted for any health condition (all-cause readmission). There were 190,700 initial hospital admissions specifically to treat COPD at an average cost of $7,100. The average readmission cost principally for COPD was 18 percent higher—$8,400 per stay—but all-cause readmissions were 50 percent more expensive than the initial stay—$11,100.
  • Readmissions were 22 percent higher among patients from the poorest communities than among those from the highest income areas.
  • Readmissions were about 13 percent higher among male patients compared to females.

+ Statistical Brief #121: Readmissions for Chronic Obstructive Pulmonary Disease, 2008 (PDF)

Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial

September 8, 2011 Comments off

Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial
Source: British Medical Journal

In children selected for adenoidectomy for recurrent upper respiratory tract infections, a strategy of immediate surgery confers no clinical benefits over a strategy of initial watchful waiting.

Global status report on noncommunicable diseases 2010

August 29, 2011 Comments off

Global status report on noncommunicable diseases 2010
Source: World Health Organization

Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide, and the greatest increase is expected to be seen in low- and middle-income regions.

While popular belief presumes that NCDs afflict mostly high-income populations, the evidence tells a very different story. Nearly 80% of NCD deaths occur in low-and middle-income countries and NCDs are the most frequent causes of death in most countries, except in Africa. Even in African nations, NCDs are rising rapidly and are projected to exceed communicable, maternal, perinatal, and nutritional diseases as the most common causes of death by 2030.

Associations between pre-pregnancy obesity and asthma symptoms in adolescents

August 18, 2011 Comments off

Associations between pre-pregnancy obesity and asthma symptoms in adolescents
Source: Journal of Epidemiology and Community Health

Background The high prevalence of children’s asthma symptoms, worldwide, is unexplained. We examined the relation between maternal pre-pregnancy weight and body mass index (BMI), and asthma symptoms in adolescents.

Methods Data from 6945 adolescents born within the Northern Finland Birth Cohort 1986 were used. Prospective antenatal and birth outcome data, including maternal pre-pregnancy weight and BMI, and asthma symptoms in adolescent offspring at age 15–16 years, were employed. Logistic regression analyses were performed to examine the associations between relevant prenatal factors and asthma symptoms during adolescence.

Results Current wheeze (within the past year) was reported by 10.6% of adolescents, and physician-diagnosed asthma by 6.0%. High maternal pre-pregnancy BMI was a significant predictor of wheeze in the adolescents (increase per kilogram per square metre unit; 2.7%, 95% CI 0.9 to 4.4 for ever wheeze; 3.5%, 95% CI 1.3 to 5.8 for current wheeze), and adjusting for potential confounders further increased the risk (2.8%, 95% CI 0.5 to 5.1; 4.7%, 95% CI 1.9 to 7.7, respectively). High maternal pre-pregnancy weight, in the top tertile, also significantly increased the odds of current wheeze in the adolescent by 20% (95% CI 4 to 39), and adjusting for potential confounders further increased the risk (OR=1.52, 95% CI 1.19 to 1.95). Results were similar for current asthma. Furthermore, these significant associations were observed only among adolescents without parental history of atopy but not among those with parental history of atopy.

Conclusions The association demonstrated here between maternal pre-pregnancy overweight and obesity, and asthma symptoms in adolescents suggests that increase in asthma may be partly related to the rapid rise in obesity in recent years.

NRDC: It’s Not Just the Heat, It’s the Smog Pollution

August 17, 2011 Comments off

NRDC: It’s Not Just the Heat, It’s the Smog Pollution
Source: Natural Resources Defense Council

Most of the nation – from seaside suburbs to our national parks – has experienced health-threatening “bad air” days this year due to smog pollution, according to a new analysis of government air pollution data by the Natural Resources Defense Council.

Led by California, about 250 communities and parks in nearly 40 states have experienced one or more “code orange” dangerous air days this year, making it unsafe for children, older adults and people with breathing problems to go outside.

In all, more than 2,000 “code orange” air quality alerts occurred nationwide in just the first seven months of this year, with many areas having long stretches of days with bad air due to elevated smog levels.

NRDC’s analysis comes amid ongoing EPA delays for approving updated air pollution standards that could save thousands of American lives and stop tens of thousands of asthma attacks each year.

+ Locations and number of days on which smog levels reached “Code Orange” levels – dangerous to children and other sensitive groups (under existing standards.) (PDF)

Diagnosis and Treatment of Obstructive Sleep Apnea in Adults

August 8, 2011 Comments off

Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Source: Agency for Healthcare Research and Quantity

The strength of evidence is moderate that fixed CPAP is an effective treatment to minimize AHI and improve sleepiness symptoms, as supported by more than 40 trials of patients treated with CPAP or no treatment. However, no trial reported long-term clinical outcomes, and compliance with CPAP treatment is poor. Because patients frequently do not tolerate CPAP, many alternative treatments have been proposed. First, several alternative CPAP machines have been designed to vary the pressure during the patient’s inspiratory cycle or to titrate the pressure to a minimum necessary level. Other modifications include different masks, nasal pads, and added humidification. The large majority of relevant trials have compared autotitrating CPAP (autoCPAP) with fixed CPAP and the strength of evidence of no clinical differences between them is moderate. The strength of evidence is insufficient for other device comparisons and, overall, the evidence does not support the use of one device for all patients, since such decisions should be individualized.

The second alternative to CPAP therapeutic option is the use of oral devices, which have been designed with the goal of splinting open the oropharynx to prevent obstruction. The most commonly tested are the mandibular advancement devices (MAD), for which the strength of evidence for their efficacy in sleep outcomes is moderate. Based on direct and indirect comparisons, CPAP appeared to be more effective than MAD. However, given the issues with noncompliance with CPAP, the decision as to whether to use CPAP or MAD will likely depend on patient preference.

The third major alternative to OSA treatment includes surgical interventions to alleviate airway obstruction. Given the very few randomized trials and the differences in the populations that choose to undergo surgery versus conservative treatment, the strength of evidence is insufficient to determine the relative value of surgery to no treatment, to CPAP, to MAD, or to alternative types of surgery. Additional interventions were also evaluated in randomized trials, (including weight loss programs, atrial overdrive pacing, eight different drugs, and other interventions) but in general the strength of evidence is insufficient to determine the effects of these potential treatments.

+ Full Report
+ Clinician Guide
+ Consumer Guide

Zinc Lozenges May Shorten the Duration of Colds: A Systematic Review

July 28, 2011 Comments off

Zinc Lozenges May Shorten the Duration of Colds: A Systematic Review
Source: The Open Respiratory Medical Journal

Background: A number of controlled trials have examined the effect of zinc lozenges on the common cold but the findings have diverged. The purpose of this study was to examine whether the total daily dose of zinc might explain part of the variation in the results.

Methods: The Medline, Scopus and Cochrane Central Register of Controlled Trials data bases were searched for placebocontrolled trials examining the effect of zinc lozenges on common cold duration. Two methods were used for analysis: the P-values of the trials were combined by using the Fisher method and the results of the trials were pooled by using the inverse-variance method. Both approaches were used for all the identified trials and separately for the low zinc dose and the high zinc dose trials.

Results: Thirteen placebo-controlled comparisons have examined the therapeutic effect of zinc lozenges on common cold episodes of natural origin. Five of the trials used a total daily zinc dose of less than 75 mg and uniformly found no effect. Three trials used zinc acetate in daily doses of over 75 mg, the pooled result indicating a 42% reduction in the duration of colds (95% CI: 35% to 48%). Five trials used zinc salts other than acetate in daily doses of over 75 mg, the pooled result indicating a 20% reduction in the duration of colds (95% CI: 12% to 28%).

Conclusions: This study shows strong evidence that the zinc lozenge effect on common cold duration is heterogeneous so that benefit is observed with high doses of zinc but not with low doses. The effects of zinc lozenges should be further studied to determine the optimal lozenge compositions and treatment strategies.

+ Full Paper (PDF)

Constrictive Bronchiolitis in Soldiers Returning from Iraq and Afghanistan

July 25, 2011 Comments off

Constrictive Bronchiolitis in Soldiers Returning from Iraq and Afghanistan
Source: New England Journal of Medicine

Among the soldiers who were referred for evaluation, a history of inhalational exposure to a 2003 sulfur-mine fire in Iraq was common but not universal. Of the 49 soldiers who underwent lung biopsy, all biopsy samples were abnormal, with 38 soldiers having changes that were diagnostic of constrictive bronchiolitis. In the remaining 11 soldiers, diagnoses other than constrictive bronchiolitis that could explain the presenting dyspnea were established. All soldiers with constrictive bronchiolitis had normal results on chest radiography, but about one quarter were found to have mosaic air trapping or centrilobular nodules on chest CT. The results of pulmonary-function and cardiopulmonary-exercise testing were generally within normal population limits but were inferior to those of the military control subjects.

The Clean Air Act and Health — A Clearer View from 2011

July 23, 2011 Comments off

The Clean Air Act and Health — A Clearer View from 2011
Source: New England Journal of Medicine

From my office, I have views of downtown Los Angeles and the San Gabriel Mountains. Air pollution infrequently obscures these views, and only rarely are my eyes and throat irritated by smog when I’m outdoors. The Los Angeles air of today is far better than that of the mid-20th century, when severe oxidant pollution, initially of unknown origins, threatened the health and welfare of the city’s residents. Severe smog was a common occurrence. Today, throughout the United States, air quality has improved greatly, and the last century’s severe, life-threatening episodes of air pollution, such as one that caused about 20 deaths in Donora, Pennsylvania, over a 3-day period in 1948, have largely been forgotten. The Clean Air Act of 1970 (CAA) has driven this progress, but we now face new challenges in air-quality management.

Ohio, Pennsylvania and Florida Lead List of “Toxic 20″ States with Most Toxic Air Pollution from Power Plants

July 20, 2011 Comments off

Ohio, Pennsylvania and Florida Lead List of “Toxic 20″ States with Most Toxic Air Pollution from Power Plants
Source: National Resources Defense Council

Residents of Ohio, Pennsylvania and Florida live in states with the most toxic air pollution from coal- and oil-fired power plants, according to an analysis by the Natural Resources Defense Council.

The study used publicly-available data in the Environmental Protection Agency’s Toxics Release Inventory (TRI). The analysis, entitled “Toxic Power: How Power Plants Contaminate Our Air and States” was jointly released today by NRDC and Physicians for Social Responsibility (PSR).

Among the key findings:

  • Nearly half of all the toxic air pollution reported from industrial sources in the United States comes from coal- and oil-fired power plants.
  • Power plants are the single largest industrial source of toxic air pollution in 28 states and the District of Columbia.

+ Full report and map (PDFs)

Fact Sheet — The U.S. Commitment to Cookstoves in Africa

June 20, 2011 Comments off

Fact Sheet — The U.S. Commitment to Cookstoves in Africa
Source: U.S. Department of State

In September 2010, U.S. Secretary of State Clinton announced the Global Alliance for Clean Cookstoves, a public-private partnership led by the United Nations Foundation to save lives, improve livelihoods, empower women, and combat climate change by creating a thriving global market for clean and efficient household cooking solutions. The Alliance’s 100 by 20 goal calls for 100 million homes to adopt clean and efficient stoves and fuels by 2020.

On the heels of Secretary Clinton’s visit to Africa this week, seven African nations have joined the Alliance, including Burkina Faso, Ethiopia, Kenya, Lesotho, Rwanda, and Tanzania as well as the Nigerian Alliance for Clean Cookstoves, which includes four Nigerian federal ministries.

The Problem: Nearly half of the world’s population – about 3 billion people – cooks their food each day on polluting, inefficient stoves. Exposure to smoke from traditional cookstoves and open fires is the fifth worst health risk factor in poor countries and leads to nearly 2 million premature deaths of mostly women and young children each year (more than twice the mortality from malaria).

More than 70% of Africans burn solid fuels such as wood, charcoal or crop residues for their home cooking needs. The World Health Organization (WHO) estimates that each year more than one quarter of the worldwide deaths associated with exposure to cookstove smoke occur in Africa – that equates to more than 550,000 deaths in Africa attributable to cookstoves. Also according to WHO, out of the 23 countries in the world where cookstoves represent more than 4 percent of the national burden of disease*, 21 are in Africa.

Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008

May 9, 2011 Comments off

Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008
Source: Health Affairs

A 2002 analysis documented $54.9 billion in annual costs of environmentally mediated diseases in US children. However, few important changes in federal policy have been implemented to prevent exposures to toxic chemicals. We therefore updated and expanded the previous analysis and found that the costs of lead poisoning, prenatal methylmercury exposure, childhood cancer, asthma, intellectual disability, autism, and attention deficit hyperactivity disorder were $76.6 billion in 2008. To prevent further increases in these costs, efforts are needed to institute premarket testing of new chemicals; conduct toxicity testing on chemicals already in use; reduce lead-based paint hazards; and curb mercury emissions from coal-fired power plants.

Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education — United States, 2001–2009

May 5, 2011 Comments off

Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education — United States, 2001–2009
Source: Morbidity and Mortality Weekly Report (CDC)

Background: Most persons with asthma can be symptom-free if they receive appropriate medical care, use inhaled corticosteroids when prescribed, and modify their environment to reduce or eliminate exposure to allergens and irritants. This report reviews recent progress in managing asthma and reducing its prevalence in the United States.

Methods: CDC analyzed asthma data from the 2001–2009 National Health Interview Survey concerning children and adults, and from the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System concerning adults.

Results: Among persons of all ages, the prevalence of asthma increased from 7.3% (20.3 million persons) in 2001 to 8.2% (24.6 million persons) in 2009, a 12.3% increase. Prevalence among children (persons aged <18 years) was 9.6%, and was highest among poor children (13.5%) and among non-Hispanic black children (17.0%). Prevalence among adults was 7.7%, and was greatest in women (9.7%) and in adults who were poor (10.6%). More uninsured persons with asthma than insured could not afford to buy prescription medications (40.3% versus 11.5%), and fewer uninsured persons reported seeing or talking with a primary-care physician (58.8% versus 85.6%) or specialist (19.5% versus 36.9%). Among persons with asthma, 34.2% reported being given a written asthma action plan, and 68.1% had been taught the appropriate response to symptoms of an asthma attack. Only about one third of children or adults were using long-term control medicine such as inhaled corticosteroids at the time of the survey.

Conclusions and Comment: Persons with asthma need to have access to health care and appropriate medications and use them. They also need to learn self-management skills and practice evidence-based interventions that reduce environmental risk factors.

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