Environmental, occupational, and medical exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to an eastern North Carolina hospital

Methicillin resistant Staphylococcus aureus (MRSA) is a versatile human pathogen. Originally acquired in medical settings, strains later emerged in the community and, most recently, within the context of industrial livestock production. Epidemiologic research on sources of MRSA acquisition and transmission is important for designing effective infection prevention measures. The objective of this work was to investigate medical, household, environmental, and occupational exposures associated with MRSA nasal carriage identified at admission among patients at a rural tertiary care hospital. I conducted a hospital based case control study at Vidant Medical Center (VMC), the largest hospital in eastern North Carolina, which is a region with intensive livestock production. VMC screens all admitted patients for MRSA using duplicate nasal swabs of the anterior nares. I interviewed 117 cases and 119 controls about occupational, household, and environmental exposures, abstracted information from medical charts, and used geographic mapping tools and publicly available data to estimate environmental exposures to livestock facilities. I used conditional logistic regression models to derive estimates of associations between MRSA carriage and medical, household, environmental, and occupational exposures. In this hospitalized population, community and household exposures were important predictors of MRSA carriage. Also, MRSA nasal carriage was associated with living near moderate densities of swine. This work represents an important baseline investigation and demonstrates the need for further research of environmental and occupational exposures that could be related to MRSA carriage with healthier populations.Doctor of Philosoph

Chronic Conditions and Pediatric Healthcare Utilization during Warm Weather Days in New York City

Background: While literature on the overall health burden of high temperature exposures on children continues to grow, little is known about whether children with chronic diseases are particularly vulnerable to the adverse health impacts of extreme heat. Methods: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to emergency department and hospitals during the warm months (May-September) from 2005 to 2011. We identified children with specific chronic diseases or conditions that plausibly enhance susceptibility to heat (i.e., asthma, obesity, cerebral palsy, cystic fibrosis, sickle cell disease, sickle cell trait, and mental health disorders). We also identified children with a complex chronic condition (CCC) defined using the Feudtner classification scheme. We used a time-stratified, case-crossover design and conditional logistic regression models, adjusted for mean daily relative humidity, to derive estimates of excess risk of pediatric admissions associated with daily maximum temperature (Tmax). Results: There were 2,480,556 pediatric cases in New York City during the study period; 90.8% (n = 2,252,550) occurred in emergency departments; chronic conditions appeared in 0.1% (sickle cell trait) up to 8.3% (asthma). The average Tmax was 80.3F (range 50F-104F). While we found an increase in overall pediatric admissions associated with Tmax, we found decreased risks among children with some specific categories of chronic conditions, including asthma, obesity, and mental health disorders. For children with CCC, temperature was associated with increased admissions when considering only the summer months. Conclusions: We found that children with chronic conditions show a complex pattern of risk of healthcare utilization. With further replication, our findings can help inform preparedness of the health system for prevention measures

Air Pollution and Odor in Communities Near Industrial Swine Operations

BackgroundOdors can affect health and quality of life. Industrialized animal agriculture creates odorant compounds that are components of a mixture of agents that could trigger symptoms reported by neighbors of livestock operations.ObjectiveWe quantified swine odor episodes reported by neighbors and the relationships of these episodes with environmental measurements.MethodsBetween September 2003 and September 2005, 101 nonsmoking volunteers living within 1.5 mi of industrial swine operations in 16 neighborhoods in eastern North Carolina completed twice-daily odor diaries for approximately 2 weeks. Meteorological conditions, hydrogen sulfide, and particulate matter ≤ 10 μm in aerodynamic diameter (PM10) were monitored in each neighborhood. We used mixed models to partition odor variance within and between people and between neighborhoods, and to quantify relationships between environmental factors and odor.ResultsParticipants reported 1,655 episodes of swine odor. In nine neighborhoods, odor was reported on more than half of study-days. Odor ratings were related to temperature, PM10, and semivolatile PM10 in standard but not mixed models. In mixed models, odor increased 0.15 ± 0.05 units (mean ± SE) for a 1-ppb increase in H2S, and 0.45 ± 0.14 units for a 10-μg/m3 increase in PM10 at wind speeds > 6.75 miles per hour. The odds of reporting a change in daily activities due to odor increased 62% for each unit increase in average odor during the prior 12 hr (t-value = 7.17).ConclusionsThis study indicates that malodor from swine operations is commonly present in these communities and that the odors reported by neighbors are related to objective environmental measurements and interruption of activities of daily life

Temperature and mental health–related emergency department and hospital encounters among children, adolescents and young adults

Abstract Aims We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults. Methods This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June–August) in New York City from 2005 to 2011 from patients of three age groups (6–11, 12–17 and 18–25 years). Using a distributed lag non-linear model over 0–5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations. Results In New York City, there were 82,982 mental health–related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health–related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13–1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09–1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04–1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature. Conclusions We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood

Air Pollution, Lung Function, and Physical Symptoms in Communities Near Concentrated Swine Feeding Operations

Concentrated animal feeding operations emit air pollutants that may affect health. We examined associations of reported hog odor and of monitored air pollutants with physical symptoms and lung function in people living within 1.5 miles of hog operations

A case control study of environmental and occupational exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region

Background: Distinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina. Methods: MRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). Participants were interviewed about recent environmental and occupational exposures. Home addresses were geocoded and publicly available data were used to estimate the density of swine in residential census block groups of residence. Conditional logistic regression models were used to derive odds ratio (OR) estimates and 95% confidence intervals (CI). Presence of the scn gene in MRSA isolates was assessed. In addition, multi locus sequence typing (MLST) of the MRSA isolates was performed, and the Diversilab® system was used to match the isolates to USA pulsed field gel electrophoresis types. Results: From July - December 2011, 117 cases and 119 controls were enrolled. A higher proportion of controls than cases were current workforce members (41.2% vs. 31.6%) Cases had a higher odds of living in census block groups with medium densities of swine (OR: 4.76, 95% CI: 1.36-16.69) and of reporting the ability to smell odor from a farm with animals when they were home (OR: 1.51, 95% CI: 0.80-2.86). Of 49 culture positive MRSA isolates, all were scn positive. Twenty-two isolates belonged to clonal complex 5. Conclusions: Absence of livestock workers in this study precluded evaluation of occupational exposures. Higher odds of MRSA in medium swine density areas could reflect environmental exposure to swine or poultry

Medical and Household Characteristics Associated with Methicillin Resistant Staphylococcus aureus Nasal Carriage among Patients Admitted to a Rural Tertiary Care Hospital

BackgroundMethicillin resistant Staphylococcus aureus (MRSA) poses a threat to patient safety and public health. Understanding how MRSA is acquired is important for prevention efforts. This study investigates risk factors for MRSA nasal carriage among patients at an eastern North Carolina hospital in 2011.MethodsUsing a case-control design, hospitalized patients ages 18 – 65 years were enrolled between July 25, 2011 and December 15, 2011 at Vidant Medical Center, a tertiary care hospital that screens all admitted patients for nasal MRSA carriage. Cases, defined as MRSA nasal carriers, were age and gender matched to controls, non-MRSA carriers. In-hospital interviews were conducted, and medical records were reviewed to obtain information on medical and household exposures. Multivariable conditional logistic regression was used to derive odds ratio (OR) estimates of association between MRSA carriage and medical and household exposures.ResultsIn total, 117 cases and 119 controls were recruited to participate. Risk factors for MRSA carriage included having household members who took antibiotics or were hospitalized (OR: 3.27; 95% Confidence Interval (CI): 1.24–8.57) and prior hospitalization with a positive MRSA screen (OR: 3.21; 95% CI: 1.12–9.23). A lower proportion of cases than controls were previously hospitalized without a past positive MRSA screen (OR: 0.40; 95% CI: 0.19–0.87).ConclusionThese findings suggest that household exposures are important determinants of MRSA nasal carriage in hospitalized patients screened at admission

Exposure to pesticides and risk of Hodgkin lymphoma in an international consortium of agricultural cohorts (AGRICOH)

Purpose: Some pesticides may increase the risk of certain lymphoid malignancies, but few studies have examined Hodgkin lymphoma (HL). In this exploratory study, we examined associations between agricultural use of 22 individual active ingredients and 13 chemical groups and HL incidence. Methods: We used data from three agricultural cohorts participating in the AGRICOH consortium: the French Agriculture and Cancer Cohort (2005–2009), Cancer in the Norwegian Agricultural Population (1993–2011), and the US Agricultural Health Study (1993–2011). Lifetime pesticide use was estimated from crop-exposure matrices or self-report. Cohort-specific covariate-adjusted overall and age-specific (< 40 or ≥ 40 years) hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression and combined using random effects meta-analysis. Results: Among 316 270 farmers (75% male) accumulating 3 574 815 person-years at risk, 91 incident cases of HL occurred. We did not observe statistically significant associations for any of the active ingredients or chemical groups studied. The highest risks of HL overall were observed for the pyrethroids deltamethrin (meta-HR = 1.86, 95% CI 0.76–4.52) and esfenvalerate (1.86, 0.78–4.43), and inverse associations of similar magnitude were observed for parathion and glyphosate. Risk of HL at ≥ 40 years of age was highest for ever-use of dicamba (2.04, 0.93–4.50) and lowest for glyphosate (0.46, 0.20–1.07). Conclusion: We report the largest prospective investigation of these associations. Nonetheless, low statistical power, a mixture of histological subtypes and a lack of information on tumour EBV status complicate the interpretability of the results. Most HL cases occurred at older ages, thus we could not explore associations with adolescent or young adult HL. Furthermore, estimates may be attenuated due to non-differential exposure misclassification. Future work should aim to extend follow-up and refine both exposure and outcome classification

Non-Hodgkin Lymphoma and Occupational Exposure to Agricultural Pesticide Chemical Groups and Active Ingredients: A Systematic Review and Meta-Analysis

This paper describes results from a systematic review and a series of meta-analyses of nearly three decades worth of epidemiologic research on the relationship between non-Hodgkin lymphoma (NHL) and occupational exposure to agricultural pesticide active ingredients and chemical groups. Estimates of associations of NHL with 21 pesticide chemical groups and 80 active ingredients were extracted from 44 papers, all of which reported results from analyses of studies conducted in high-income countries. Random effects meta-analyses showed that phenoxy herbicides, carbamate insecticides, organophosphorus insecticides and the active ingredient lindane, an organochlorine insecticide, were positively associated with NHL. In a handful of papers, associations between pesticides and NHL subtypes were reported; B cell lymphoma was positively associated with phenoxy herbicides and the organophosphorus herbicide glyphosate. Diffuse large B-cell lymphoma was positively associated with phenoxy herbicide exposure. Despite compelling evidence that NHL is associated with certain chemicals, this review indicates the need for investigations of a larger variety of pesticides in more geographic areas, especially in low- and middle-income countries, which, despite producing a large portion of the world’s agriculture, were missing in the literature that were reviewed