Use of race and ethnicity in public health surveillance: summary of the CDC/ATSDR Workshop

"Improvement of the health of racial and ethnic minority populations is a priority for CDC and the Agency for Toxic Substances and Disease Registry (ATSDR). Information on race and ethnicity is a critical element in public health surveillance efforts. To address this issue, CDC and the ATSDR conducted a 2-day workshop, "The Use of Race and Ethnicity in Public Health Surveillance," held in Atlanta on March 1-2, 1993. Workshop participants included CDC and ATSDR professional staff and invited experts from academia and the private sector. Objectives of the workshop were to: Describe the current measures of race and ethnicity and their use in public health surveillance at CDC/ATSDR. Assess the epidemiologic basis of the use of race and ethnicity in surveillance for planning, operation, and evaluation of public health programs at CDC/ATSDR. Propose better use of existing measures for race and ethnicity or to identify alternative measures." - p. 1"The recommendations generated from the workshop were developed for CDC/ATSDR and some of them may be used to improve surveillance systems at CDC/ATSDR and in other parts of the Public Health Service. In addition, some of these recommendations may be used to update the 1985 Report of the Secretary's Task Force on Black and Minority Health, as well as in measuring progress in reaching the Year 2000 Health Objectives. These recommendations have been submitted to the Director of CDC for consideration. They are being published in this format to stimulate further discussion. Some of these recommendations may exceed the missions of CDC and ATSDR, may be in conflict with other recommendations, or may be in various stages of implementation." - p. viiiPreface -- Introduction -- Background -- Workshop Objectives and Agenda -- -- Summary of Plenary Presentations -- Issues in the use of race and ethnicity in the United States -- Current use of race and ethnicity in public health surveillance -- Measurement and use of race in public health surveillance -- Measurement and use of ethnicity in public health surveillance -- Race in the health of America: problems, issues, and directions -- A Private sector view of health, surveillance, and communities of color -- Perspective of a health scientist: use of race in public health surveillance -- -- Work Group Summaries -- Limitations of Concepts, Measures, and Uses -- Recommendations for Concepts, Measures, and Uses"Held in Atlanta on March 1-2, 1993"--P. 1.Cover title."June 25, 1993."Papers from the workshop published in Public health reports ; v. 109, no. 1, p. 4-52."CDC/ATSDR PLANNING COMMITEE: Agency for Toxic Substances and Disease Registry Linda Carnes, D.P.A. Epidemiology Program Office Richard A. Goodman, M.D., M.P.H. Robert A. Hahn, Ph.D., M.P.H. Donna F. Stroup, Ph.D., M.Sc. Scott F. Wetterhall, M.D., M.P.H. International Health Program Office Ruth Wilson, Ph. D. National Center for Chronic Disease Prevention and Health Promotion Richard B. Rothenberg, M.D., M.P.H. Diane Rowley, M.D., M.P.H. National Center for Environmental Health Jose F. Cordero, M.D., M.P.H. Marshalyn Yeargin-Allsopp, M.D. National Center for Health Statistics Diane M. Makuc, Ph.D. National Center for Infectious Diseases Ralph L. Cordell, Ph.D. National Center for Injury Prevention and Control Christine M. Branche-Dorsey, Ph.D., M.S.P.H. National Center for Prevention Services Henry J. Montes National Institute of Occupational Safety and Health Richard L. Ehrenberg, M.D. Office of the Associate Director for Minority Health Rueben C. Warren, D.D.S., M.P.H., Dr.P.H. Public Health Practice Program Office Mark W. Oberle, M.D., M.P.H. " - p. iiiAlso available via the World Wide Web.Includes bibliographical references (p. 17).Centers for Disease Control and Prevention. Use of race and ethnicity in public health surveillance. Summary of the CDC/ATSDR Workshop. MMWR 1993;42(No.RR-10): {1-17)

Di(2-ethylhexyl) Phthalate Metabolites May Alter Thyroid Hormone Levels in Men

Background: Phthalates are used extensively in many personal-care and consumer products, resulting in widespread nonoccupational human exposure through multiple routes and media. A limited number of animal studies suggest that exposure to phthalates may be associated with altered thyroid function, but human data are lacking. Methods: Concurrent samples of urine and blood were collected from 408 men. We measured urinary concentrations of mono(2-ethylhexyl) phthalate (MEHP), the hydrolytic metabolite of di(2-ethylhexyl) phthalate (DEHP), and other phthalate monoester metabolites, along with serum levels of free thyroxine (T$_4$), total triiodothyronine (T$_3$), and thyroid-stimulating hormone (TSH). Oxidative metabolites of DEHP were measured in urine from only 208 of the men. Results: We found an inverse association between MEHP urinary concentrations and free T$_4$ and T$_3$ serum levels, although the relationships did not appear to be linear when MEHP concentrations were categorized by quintiles. There was evidence of a plateau at the fourth quintile, which was associated with a 0.11 ng/dL decrease in free T$_4$ [95% confidence interval (CI), –0.18 to –0.03] and a 0.05 ng/mL decrease in T$_3$ (95% CI, –0.10 to 0.01) compared with the first (lowest) MEHP quintile. The inverse relationship between MEHP and free T$_4$ remained when we adjusted for oxidative metabolite concentrations; this simultaneously demonstrated a suggestive positive association with free T$_4$. Conclusions: Urinary MEHP concentrations may be associated with altered free T$_4$ and/or total T$_3$ levels in adult men, but additional study is needed to confirm the observed findings. Future studies must also consider oxidative DEHP metabolites relative to MEHP as a potential marker of metabolic susceptibility to DEHP exposure

Geophagy Practices and the Content of Chemical Elements in the Soil Eaten by Pregnant Women in Artisanal and Small Scale Gold Mining Communities in Tanzania.

Geophagy, a form of pica, is the deliberate consumption of soil and is relatively common across Sub-Saharan Africa. In Tanzania, pregnant women commonly eat soil sticks sold in the market (pemba), soil from walls of houses, termite mounds, and ground soil (kichuguu). The present study examined geophagy practices of pregnant women in a gold mining area of Geita District in northwestern Tanzania, and also examined the potential for exposure to chemical elements by testing soil samples. We conducted a cross sectional study using a convenience sample of 340 pregnant women, ranging in age from 15-49 years, who attended six government antenatal clinics in the Geita District, Tanzania. Structured interviews were conducted in June-August, 2012, to understand geophagy practices. In addition, soil samples taken from sources identified by pregnant women practicing geophagy were analysed for mineral element content. Geophagy was reported by 155 (45.6%) pregnant women with 85 (54.8%) initiating the practice in the first trimester. A total of 101 (65%) pregnant women reported eating soil 2 to 3 times per day while 20 (13%) ate soil more than 3 times per day. Of 155 pregnant women 107 (69%) bought pemba from local shops, while 48 (31%) consumed ground soil kichuguu. The estimated mean quantity of soil consumed from pemba was 62.5 grams/day. Arsenic, chromium, copper, iron, manganese, nickel and zinc levels were found in both pemba and kichuguu samples. Cadmium and mercury were found only in the kichuguu samples. Based on daily intake estimates, arsenic, copper and manganese for kichuguu and copper and manganese for pemba samples exceed the oral Minimum Risk Levels designated by the U.S. Agency for Toxic Substance and Disease Registry. Almost 50% of participants practiced geophagy in Geita District consistent with other reports from Africa. Both pemba and kichuguu contained chemical elements at varying concentration, mostly above MRLs. As such, pregnant women who eat soil in Geita District are exposed to potentially high levels of chemical elements, depending upon frequency of consumption, daily amount consumed and the source location of soil eaten

Recommendations to improve preconception health and health care -- United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care

"This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives" - p. 1Introduction -- -- Preconception Health and Care -- Healthy People 2000/2010 Objectives for Improving Preconception Health and Guidelines for Preconception Care -- Preconception Risks Associated with Adverse Pregnancy Outcomes -- Preconception Prevention and Intervention -- -- Context and Frame Work for Recommendations -- How the Recommendations were Developed -- Recommendations to Improve Preconception Health -- Recommendations -- Conclusion References -- Appendix: External Partner Organizationsprepared by Kay Johnson, Samuel F. Posner, Janis Biermann , Jose\ucc? F. Cordero, Hani K. Atrash, Christopher S. Parker, Sheree Boulet, Michele G. Curtis."April 21, 2006."Cover title."The material in this report originated in the National Center on Birth Defects and Developmental Disabilities, Jose\ucc? F. Cordero, MD, Director; and the Office of Program Development, Hani K. Atrash, MD, Associate Director; and the National Center for Chronic Disease Prevention and Health Promotion, Janet Collins, PhD, Director, and the Division of Reproductive Health, John Lehnherr, Director. " - p. 1Also available via the World Wide Web.Includes bibliographical references (p. 16-21)

Lactational Exposure to Polychlorinated Biphenyls, Dichlorodiphenyltrichloroethane, and Dichlorodiphenyldichloroethylene and Infant Neurodevelopment: An Analysis of the Pregnancy, Infection, and Nutrition Babies Study

BackgroundPolychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDT) are persistent, bioaccumulative, and toxic pollutants that were broadly used in the United States until the 1970s. Common exposure to PCBs, DDT, and dichlorodiphenyldichloroethylene (DDE), the most stable metabolite of DDT, may influence children’s neurodevelopment, but study results are not consistent.ObjectivesWe examined the associations between lactational exposure to PCBs, DDT, and DDE and infant development at 12 months, using data from the Pregnancy, Infection, and Nutrition Babies Study, 2004–2006.MethodsWe measured PCBs, DDT, and DDE in breast milk at the third month postpartum. Lactational exposure of these chemicals was estimated by the product of chemical concentrations and the duration of breast-feeding. Infant development at 12 months of age was measured by the Mullen Scales of Early Learning (n = 231) and the Short Form: Level I (infant) of the MacArthur–Bates Communicative Development Indices (n = 218).ResultsNo consistent associations were observed between lactational exposure to PCBs, DDT, and DDE through the first 12 months and the measures of infant development. However, DDE was associated with scoring below average on the gross motor scale of the Mullen among males only (adjusted odds ratio = 1.9; 95% confidence interval, 1.1–3.3).ConclusionInfant neurodevelopment at 12 months of age was not impaired by PCBs, DDT, and DDE at the concentrations measured here, in combination with benefits from long duration of breast-feeding in this population

Size fractionation of trace elements in the surface water and groundwater of the Ganjiang River and Xiushui River basins, China

The research of trace element behaviour and size fractionation is significant to understand the processes in the water-rock system. Moreover, the aqueous speciation of trace elements is strongly related to their distribution and toxicity. In this research, trace elements behaviour and their size fractionation are investigated in the natural water (the surface water and shallow groundwater) of the Ganjiang River and Xiushui River basins. Trace element concentrations were measured by ICP-MS. The authors estimated the size fractionation of the trace elements between suspended forms (>0.45 [mu]m) and dissolved fractions, which included truly dissolved (1 kDa) and colloidal particles (0.45 [mu]m-1 kDa)), after filtration through a 0.45 [mu]m acetate cellulose membrane filter. The distinct features of the trace element size fractionation were identified. The size fractionation of the trace elements under different conditions (in the surface water and shallow groundwater) was studied