Archive
NRDC: It’s Not Just the Heat, It’s the Smog Pollution
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.
Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
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.
Zinc Lozenges May Shorten the Duration of Colds: A Systematic Review
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
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
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
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
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
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
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.
