Cough Desensitization Treatment: Combination of Desensitization and Cough Suppression

Chronic cough (CC) is a cough that persists longer than 8 weeks. CC impacts 11% of Americans and 20% of those do not respond to standard medical treatment and are diagnosed with refractory chronic cough (RCC). Research shows that most of these patients suffer from RCC due to hypersensitivity of airway sensory nerves. The purpose of the current study is to gradually desensitize the nerves that regulate the cough reflex in patients with RCC through cough desensitization treatment (CDT). CDT combines repeated exposure to aerosolized capsaicin, a known cough stimulant found within chili peppers, in increasing doses while actively suppressing cough. This study is a randomized, placebo-controlled clinical trial. Participants attend up to 12 treatment sessions where they are exposed to the active treatment or placebo. The treatment group receives progressive doses of aerosolized capsaicin, while actively suppressing their cough. The placebo group receives aerosolized saline and isn’t coached to suppress their cough. Outcome measures include (1) Leicester Cough Questionnaire (a validated patient-report measure), (2) urge-to-cough (UTC) testing (cough frequency and perceived UTC following exposure to various cough stimulants), (3) a visual-analogue scale of overall cough severity from 0 (no cough) to 100 (maximum cough), and (4) cough-reflex sensory testing. Seventeen participants (eight placebo, nine treatment) have completed the study. We anticipate an additional 1-3 participants will complete the study by UMCUR. Our data thus far looks encouraging with the treatment group showing greater improvement than the placebo group on every measure. The 1-week posttest mean change in LCQ was 5.53 and 3.28 in the treatment and placebo groups, respectively. Mean reduction in VAS was 32.67 points and 8.75, respectively. Mean change in cough-reflex threshold was 1.12 and .12, respectively. Statistical analysis will be included in the final presentation

Retrospective Cohort Study of A Community Exposed To Herbicide: An Investigation of Perceived Acute Health Effects

Eighty-ͣfive subjects possibly exposed to herbicide following aerial spraying of Tordon 101 and Weedone 2,4-DP and 159 subjects from a referent, unexposed community were interviewed regarding exposure and health symptoms. The a priori hypotheses that exposure would be associated with reported worsening of respiratory symptoms and not with a dummy symptom were supported by the data. The relative risk for respiratory symptoms was thirteen. An exploratory analysis of responses regarding 32 symptoms indicated a significant association of exposure with eight symptoms: cough, difficulty breathing, sinus congestion, runny nose, swollen glands, wheezing, dizziness, and peeling skin. Adjustment for age, race, sex, smoking status, and educational attainment did not alter these findings. Those exposed subjects reporting a worsening, within a month, of any of the eight symptoms significantly associated with exposure, constituted the "reactor" group. Reactors so defined reported greater duration of exposure than the non—reacting exposed subjects. Reactors tended to be more educated and better acquainted with the identity of the sprayed material than the non-reactor's. The extent of over-reporting bias was assessed using dummy symptoms. This study constitutes the first epidemiological investigation of acute effects of community exposure to these herbicide formulations and demonstrates the importance of this type of community surveillance.Master of Science in Public Healt

Pediatric emergency department visits and ambient Air pollution in the

Estimating the health effects of ambient air pollutant mixtures is necessary to understand the risk of real-life air pollution exposures. Methods: Pediatric Emergency Department (ED) visit records for asthma or wheeze (n = 148,256), bronchitis (n = 84,597), pneumonia (n = 90,063), otitis media (n = 422,268) and upper respiratory tract infection (URI) (n = 744,942) were obtained from Georgia hospitals during 2002-2008. Spatially-contiguous daily concentrations of 11 ambient air pollutants were estimated from CMAQ model simulations that were fused with ground-based measurements. Using a case-crossover study design, odds ratios for 3-day moving average air pollutant concentrations were estimated using conditional logistic regression, matching on ZIP code, day-of-week, month, and year. Results: In multipollutant models, the association of highest magnitude observed for the asthma/wheeze outcome was with "oxidant gases" (O-3, NO2, and SO2)the joint effect estimate for an IQR increase of this mixture was OR: 1.068 (95% CI: 1.040, 1.097). The group of "secondary pollutants" (O-3 and the PM2.5 components SO42 -, NO3-, and NH4+) was strongly associated with bronchitis (OR: 1.090, 95% CI: 1.050, 1.132), pneumonia (OR: 1.085, 95% CI: 1.047, 1.125), and otitis media (OR: 1.059, 95% CI: 1.042, 1.077). ED visits for URI were strongly associated with "oxidant gases," "secondary pollutants," and the " criteria pollutants" (O-3, NO2, CO, SO2, and PM2.5). Conclusions: Short-term exposures to air pollution mixtures were associated with ED visits for several different pediatric respiratory diseases

Does Living Near a Superfund Site Contribute to Higher Polychlorinated Biphenyl (PCB) Exposure?

We assessed determinants of cord serum polychlorinated biphenyl (PCB) levels among 720 infants born between 1993 and 1998 to mothers living near a PCB-contaminated Superfund site in Massachusetts, measuring the sum of 51 PCB congeners (∑PCB) and ascertaining maternal address, diet, sociodemographics, and exposure risk factors. Addresses were geocoded to obtain distance to the Superfund site and neighborhood characteristics. We modeled log(10)(∑PCB) as a function of potential individual and neighborhood risk factors, mapping model residuals to assess spatial correlates of PCB exposure. Similar analyses were performed for light (mono–tetra) and heavy (penta–deca) PCBs to assess potential differences in exposure pathways as a function of relative volatility. PCB-118 (relatively prevalent in site sediments and cord serum) was assessed separately. The geometric mean of ∑PCB levels was 0.40 (range, 0.068–18.14) ng/g serum. Maternal age and birthplace were the strongest predictors of ∑PCB levels. Maternal consumption of organ meat and local dairy products was associated with higher and smoking and previous lactation with lower ∑PCB levels. Infants born later in the study had lower ∑PCB levels, likely due to temporal declines in exposure and site remediation in 1994–1995. No association was found between ∑PCB levels and residential distance from the Superfund site. Similar results were found with light and heavy PCBs and PCB-118. Previously reported demographic (age) and other (lactation, smoking, diet) correlates of PCB exposure, as well as local factors (consumption of local dairy products and Superfund site dredging) but not residential proximity to the site, were important determinants of cord serum PCB levels in the study community

Endometriosis Among Women Exposed to Polybrominated Biphenyls

We examined the association between endometriosis and exposure to polybrominated biphenyls (PBBs) and polychlorinated biphenyls (PCBs) among women inadvertently exposed to PBBs in 1973

Drinking water turbidity and emergency department visits for gastrointestinal illness in Atlanta, 1993–2004

The extent to which drinking water turbidity measurements indicate the risk of gastrointestinal illness is not well-understood. Despite major advances in drinking water treatment and delivery, infectious disease can still be transmitted through drinking water in the U.S., and it is important to have reliable indicators of microbial water quality to inform public health decisions. The objective of our study was to assess the relationship between gastrointestinal illness, quantified through emergency department visits, and drinking water quality, quantified as raw water and filtered water turbidity measured at the treatment plant

Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia

We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost three million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared to intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI) = 1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness

Prenatal Organochlorine Exposure and Measures of Behavior in Infancy Using the Neonatal Behavioral Assessment Scale (NBAS)

Background: Previous literature suggests an association between organochlorines and behavioral measures in childhood, including inattention. Objective: This study was designed to assess whether prenatal organochlorine exposure is associated with measures of attention in early infancy. Methods: We investigated an association between cord serum polychlorinated biphenyls (PCBs) and p,p′-dichlorodiphenyl dichloroethene (DDE) levels and measures of attention from the Neonatal Behavioral Assessment Scale (NBAS) in a cohort of 788 infants born 1993–1998 to mothers residing near a PCB-contaminated harbor and Superfund site in New Bedford, Massachusetts. Results: Medians (ranges) for the sum of four prevalent PCB congeners and DDE levels were 0.19 (0.01–4.41) and 0.30 (0–10.29) ng/g serum, respectively. For the 542 subjects with an NBAS exam at 2 weeks, we observed consistent inverse associations between cord serum PCB and DDE levels and NBAS measures of alertness, quality of alert responsiveness, cost of attention, and other potential attention-associated measures including self-quieting and motor maturity. For example, the decrement in quality of alert responsiveness score was −0.51 (95% confidence interval, −0.99 to −0.03) for the highest quartile of exposure to the sum of four prevalent PCB congeners compared with the lowest quartile. We found little evidence for an association with infant orientation, habituation, and regulation of state, assessed as summary cluster measures. Conclusions: Our findings provide evidence for an association between low-level prenatal PCB and DDE exposures and poor attention in early infancy. Further analyses will focus on whether organochlorine-associated decrements in attention and attention-related skills in infancy persist in later childhood