Assessing the Psychometric Properties of the WHO-DAS 2.0 in an American Indian Community

American Indians and Alaska Natives report disability at rates higher than the general United States population. This disproportionate prevalence of disability warrants further investigation. We therefore administered the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to 119 Akwesasne Mohawk adults over 50 years of age residing along the St. Lawrence River in New York. We used exploratory factor analysis to summarize the 36-items comprising the WHODAS 2.0. The 7 factors retained by the analyses correspond to the 6 summary domains of disability, suggesting that the data are sound and measure the intended constructs. Our assessment concludes that WHODAS 2.0 is a valid tool for assessing disability within this American Indian population

Review of Environmental Contamination at Akwesasne and Associated Health Outcomes

The Akwesasne reservation along the St. Lawrence River has experienced significant exposure to several persistent organic pollutants due to rapid industrialization. The Aluminum Company of America, General Motors, and Reynolds Metals operated aluminum foundries that that used polychlorinated biphenyls (PCBs) as hydraulic fluids, which leaked and were washing down the drain into the rivers or disposed of on their property. This has resulted in the community, the soil, air and water, and their food sources being contaminated with PCBs, persistent organochlorine pesticides, and heavy metals. Epidemiological studies found that exposure to these environmental toxicants are negatively associated with growth and developmental, neurobehavioral health, reproductive health, thyroid function, and increased prevalence of chronic diseases. Fish advisories limited dietary exposure to PCBs, however, some of these investigations suggest that exposure to airborne, volatile, non-persistent PCBs, may adversely affect several health outcomes, requiring further investigation

A pilot investigation of couple-level phthalates exposure and in vitro fertilization (IVF) outcomes

Phthalates are reproductive toxicants in experimental animal studies and exposure has been associated with infertility in human populations, although the results have been inconsistent. To help to address the data gap, we conducted a hypothesis-generating investigation of associations between urinary phthalate metabolites and reproductive outcomes among women (n = 56) and their male partners (n = 43) undergoing in vitro fertilization (IVF). Urine was collected from participants on the day of oocyte retrieval. Samples were analyzed for a series of phthalates, MEP, MBP, MPP, MHxP, MEHP, MEHHP, MECPP, MiNP, MiDP, MCHP, and MBzP, using liquid chromatography-tandem mass spectrometry. We employed Poisson regression with robust variance estimation to estimate associations between urinary phthalate levels and biochemical pregnancy and live birth, adjusted for partner's concentration and confounding factors. Doublings in women's MBP (relative risk (RR) = 0.32, 95 % CI: 0.13, 0.78), and men's MEHP (RR = 0.28, 95 % CI: 0.09, 0.83), were associated with a lower likelihood for pregnancy. Doublings in women's (RR = 0.08, 95 % CI: 0.01, 0.67) and men's (RR = 0.13, 95 % CI: 0.02, 0.92) MHxP were associated with a lower likelihood of live birth. Our results suggest that phthalate exposure may impact IVF outcomes, and underscore the importance of including male partners when investigating the impact of phthalate exposure on IVF. These results also suggest that clinical recommendations should include male partners for limiting phthalate exposure. Still, a larger and more comprehensive investigation is necessary to more definitively assess the risks

Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry

Background and Aims: It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods: CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results: Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions: SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors