Determinants of Hair Manganese, Lead, Cadmium and Arsenic Levels in Environmentally Exposed Children.

Biomarkers of environmental metal exposure in children are important for elucidating exposure and health risk. While exposure biomarkers for As, Cd, and Pb are relatively well defined, there are not yet well-validated biomarkers of Mn exposure. Here, we measured hair Mn, Pb, Cd, and As levels in children from the Mid-Ohio Valley to determine within and between-subject predictors of hair metal levels. Occipital scalp hair was collected in 2009-2010 from 222 children aged 6-12 years (169 female, 53 male) participating in a study of chemical exposure and neurodevelopment in an industrial region of the Mid-Ohio Valley. Hair samples from females were divided into three two centimeter segments, while males provided a single segment. Hair was cleaned and processed in a trace metal clean laboratory, and analyzed for As, Cd, Mn, and Pb by magnetic sector inductively coupled plasma mass spectrometry. Hair Mn and Pb levels were comparable (median 0.11 and 0.15 µg/g, respectively) and were ~10-fold higher than hair Cd and As levels (0.007 and 0.018 µg/g, respectively). Hair metal levels were higher in males compared to females, and varied by ~100-1000-fold between all subjects, and substantially less (<40-70%) between segments within female subjects. Hair Mn, Pb, and Cd, but not As levels systematically increased by ~40-70% from the proximal to distal hair segments of females. There was a significant effect of season of hair sample collection on hair Mn, Pb, and Cd, but not As levels. Finally, hair metal levels reported here are ~2 to >10-fold lower than levels reported in other studies in children, most likely because of more rigorous hair cleaning methodology used in the present study, leading to lower levels of unresolved exogenous metal contamination of hair

Maternal ethnicity and pre-eclampsia in New York City, 1995-2003: Pre-eclampsia and maternal ethnicity

Studies on ethnic differences in risk of preeclampsia are limited. We linked birth records for 902,460 singleton births for the period 1995–2003 in New York City with hospital discharge data to evaluate the association between ethnicity and the risk of preeclampsia and compare risks between US-born and foreign-born women. Logistic regression models adjusted for maternal age, maternal education, parity, self-reported prepregnancy maternal weight, smoking during pregnancy, and year of delivery, were used to estimate the adjusted odds ratios of preeclampsia and 95% confidence intervals, comparing each ethnic group to non-Hispanic white women. The prevalence of preeclampsia in this study population was 3.2%. Among the major ethnic groups considered in our study, East Asian women had the lowest risk of preeclampsia (1.4%) and Mexican women had the highest risk (5.0%). Compared to non-Hispanic white women, there was a slightly decreased risk for East Asian women (adjusted OR=0.8, 95% CI [0.7, 0.8]), similar risk for North African women (adjusted OR=1.1, 95% CI [0.9, 1.3]), and increased risk for all other major ethnic groups (adjusted ORs: 1.3–2.9), with the highest risk for Mexican women (adjusted OR=2.9, 95% CI [2.7, 3.1]). No difference in risks was observed for US versus foreign born women with the exception that foreign-born South-East Asian and Pacific Islanders had increased risk of preeclampsia (adjusted OR=1.8, 95% CI [1.0, 3.1]) relative to those born in the US. We concluded that there was ethnic heterogeneity in the development of preeclampsia among women in New York City and Asian subgroups should be examined separately in future studies on ethnicity. Our results should contribute to screening for preeclampsia taking ethnic variation into account and may help to suggest leads for study of etiology

Gestational Weight Gain and Birth Outcome in Relation to Prepregnancy Body Mass Index and Ethnicity

The obesity epidemic raises concerns about the impact of excessive and insufficient weight gain during pregnancy

Mortality among World Trade Center rescue and recovery workers, 2002-2011

BACKGROUND: Rescue and recovery workers responding to the 2001 collapse of the World Trade Center (WTC) sustained exposures to toxic chemicals and have elevated rates of multiple morbidities. METHODS: Using data from the World Trade Center Health Program and the National Death Index for 2002-2011, we examined standardized mortality ratios (SMR) and proportional cancer mortality ratios (PCMR) with indirect standardization for age, sex, race, and calendar year to the U.S. general population, as well as associations between WTC-related environmental exposures and all-cause mortality. RESULTS: We identified 330 deaths among 28,918 responders (SMR 0.43, 95%CI 0.39-0.48). No cause-specific SMRs were meaningfully elevated. PCMRs were elevated for neoplasms of lymphatic and hematopoietic tissue (PCMR 1.76, 95%CI 1.06-2.75). Mortality hazard ratios showed no linear trend with exposure. CONCLUSIONS: Consistent with a healthy worker effect, all-cause mortality among responders was not elevated. There was no clear association between intensity and duration of exposure and mortality. Surveillance is needed to monitor the proportionally higher cancer mortality attributed to lymphatic/hematopoietic neoplasms

Comparison of polyfluoroalkyl compound concentrations in maternal serum and amniotic fluid: A pilot study

The extent to which polyfluoroalkyl compounds (PFCs) are detectable in amniotic fluid is unknown. Using paired samples from 28 women, we compared the concentration of 8 PFCs measured in serum, the standard matrix for assessing human exposure, amniotic fluid from routine amniocentesis, and urine. Perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorooctane sulfonate (PFOS), and perfluorohexane sulfonate (PFHxS) were detected in all maternal serum samples. The number of amniotic fluid samples with detectable concentrations differed by PFC (PFOA n=24; PFNA n=10; PFOS n=9; PFHxS n=4). The correlation coefficient between maternal serum and amniotic PFC levels varied considerably by PFC (PFOA ρ=0.64, p<0.001; PFNA ρ=0.05, p=0.9; PFOS ρ=0.76, p=0.01; PFHxS ρ=0.80, p=0.2). Using linear regression, PFOA appeared to be commonly detected in amniotic fluid if the serum concentration exceeded approximately 1.5 ng/mL whereas PFOS was rarely detected in amniotic fluid until the serum concentration was about 5.5 ng/mL. No PFCs were detected in urine

Forced Smoking Abstinence: Not Enough for Smoking Cessation

Importance: Millions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration. Objective: To evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison. Design: Participants were recruited approximately 8 weeks prior to their release from a smoke-free prison and randomized to 6 weekly sessions of either education videos (control) or the WISE intervention. Setting: A tobacco-free prison in the United States. Participants: A total of 262 inmates (35% female). Main Outcome Measure: Continued smoking abstinence was defined as 7-days point-prevelance abstinence validated by urine cotinine measurement. Results: At the 3-week follow-up, 25% of the participants in the WISE intervention (31 of 122) and 7% of the control participants (9 of 125) continued to be tobacco-abstinent (odds ration [OR], 4.4; 95% CI, 2.0-9.7). In addition to the intervention, Hispanic ethnicity, a plan to remain abstinent, and being incarcerated for more than 6 months were all associated with increased likelihood of remaining abstinent. In the logistical regression analysis, participants randomized to the WISE intervention were 6.6 times more likely to remain tobacco abstinent at the 3-week follow up than those randomized to the control condition (95% CI, 2.5-17.0). Nonsmokers at the 3-week follow-up had an additional follow-up 3 months after release, and overall 12% of the participants in the WISER intervention (14 of 122) and 2% of the control participants (3 of 125) were tobacco free at 3 months, as confirmed by urine cotinine measurement (OR, 5.3; 95% CI, 1.4-23.8). Conclusions and Relevance: Forced tobacco abstinence alone during incarceration has little impact on postrelease smoking status. A behavioral intervention provided prior to release greatly improves cotinine-confirmed smoking cessation in the community. Trial Registration: clinicaltrials.gov Identifier: NCT0112258

Sulfa Use, Dihydropteroate Synthase Mutations, and Pneumocystis jirovecii Pneumonia

Meta-analysis shows increased risk for DHPS mutations in patients exposed to sulfa prophylaxis for PCP, but clinical relevance of mutations is not known

Using Hospital Antibiogram Data To Assess Regional Pneumococcal Resistance to Antibiotics

Antimicrobial resistance to penicillin and macrolides in Streptococcus pneumoniae has increased in the United States over the past decade. Considerable geographic variation in susceptibility necessitates regional resistance tracking. Traditional active surveillance is labor intensive and costly. We collected antibiogram reports from North Carolina hospitals and assessed pneumococcal susceptibility to multiple agents from 1996 through 2000. Susceptibility in North Carolina was consistently lower than the national average. Aggregating antibiogram data is a feasible and timely method of monitoring regional susceptibility patterns and may also prove beneficial in measuring the effects of interventions to decrease antimicrobial resistance