Arsenic, Cadmium, Lead, and Mercury in Sweat: A Systematic Review

Arsenic, cadmium, lead, and mercury exposures are ubiquitous. These toxic elements have no physiological benefits, engendering interest in minimizing body burden. The physiological process of sweating has long been regarded as “cleansing” and of low risk. Reports of toxicant levels in sweat were sought in Medline, Embase, Toxline, Biosis, and AMED as well as reference lists and grey literature, from inception to March 22, 2011. Of 122 records identified, 24 were included in evidence synthesis. Populations, and sweat collection methods and concentrations varied widely. In individuals with higher exposure or body burden, sweat generally exceeded plasma or urine concentrations, and dermal could match or surpass urinary daily excretion. Arsenic dermal excretion was severalfold higher in arsenic-exposed individuals than in unexposed controls. Cadmium was more concentrated in sweat than in blood plasma. Sweat lead was associated with high-molecular-weight molecules, and in an interventional study, levels were higher with endurance compared with intensive exercise. Mercury levels normalized with repeated saunas in a case report. Sweating deserves consideration for toxic element detoxification. Research including appropriately sized trials is needed to establish safe, effective therapeutic protocols

The Relationship Between Instruction Specificity and Resistiveness to Care During Activities of Daily Living in Persons with Dementia

It is common for persons with dementia to display resistant behaviors during activities of daily living (ADLs) and caregiver communication skills can influence the likelihood of these behaviors. Previous research suggests that the type of instructions issued by caregivers is related to rates of compliance during ADLs in persons with dementia. It is unclear, however, if these instruction types affect the likelihood resistiveness to care (RTC) during ADLs. The purpose of the current study was to examine how the use of different types of instructions relate to instances of RTC during ADLs. Results indicated that vague and ambiguous instructions (i.e., beta instructions) were more likely to precede and follow physical aggression compared to instructions that were more specific, clear and feasible (i.e., alpha instructions). Results also indicated that alpha instructions were more likely to precede verbal agitation. These findings have implications for communication training programs for caregivers working with persons with dementia

Assessing the feasibility of introducing health insurance in Afghanistan: a qualitative stakeholder analysis

Abstract Background In the last decade, the health status of Afghans has improved drastically. However, the health financing system in Afghanistan remains fragile due to high out-of-pocket spending and reliance on donor funding. To address the country’s health financing challenges, the Ministry of Public Health investigated health insurance as a mechanism to mobilize resources for health. This paper presents stakeholders’ opinions on seven preconditions of implementing this approach, as their understanding and buy-in to such an approach will determine its success. Methods Key informant interviews and focus group discussions were conducted with stakeholders. The interviews focused on perceptions of the seven preconditions of introducing health insurance, and adapting a framework developed by the International Labor Organization. Content analysis was conducted after interviews and discussions were transcribed and coded. Results Almost all of the stakeholders from government agencies, the private sector, and development partners are interested in introducing health insurance in Afghanistan, and they were aware of the challenges of the country’s health financing system. Stakeholders acknowledged that health insurance could be an instrument to address these challenges. However, stakeholders differed in their beliefs about how and when to initiate a health insurance scheme. In addition to increasing insecurity in the country, they saw a lack of clear legal guidance, low quality of healthcare services, poor awareness among the population, limited technical capacity, and challenges to willingness to pay as the major barriers to establishing a successful nationwide health insurance scheme. Conclusions The identified barriers prevent Afghanistan from establishing health insurance in the short term. Afghanistan must progressively address these major impediments in order to build a health insurance system

Comparison of Questionnaire Responses with Biomarkers of Tobacco Smoke Exposure in A Canadian Birth Cohort at Three Months of Age

Background Exposure to tobacco smoke increases the risk for several adverse health effects in children including wheeze, asthma, and asthma exacerbation. Accurately assessing tobacco smoke exposure is important for understanding and preventing these health effects. Questionnaires are a flexible and relatively inexpensive method of assessing exposure, but biomarkers of tobacco smoke exposure are considered more accurate. We developed questionnaire-based exposure models predicting urinary levels of biomarkers cotinine and trans-3’-hydroxycotinine (3HC) (metabolites of nicotine) in 3-month old infants using parent-reported questionnaire responses about tobacco smoke exposure from the Canadian Healthy Infant Longitudinal Development (CHILD) Study. Methods We used a manual model building process to build multiple linear regression models predicting urinary concentrations of cotinine, 3HC, and the sum of cotinine and 3HC on a molar basis (Cot+3HC) for 987, 1003, and 983 infants, respectively. Questions were included on the infant’s exposure assessed at 3 months of age and tobacco smoke odour in the home. We also included questions on maternal smoking status and history, passive exposure, and family socio-economic status assessed during pregnancy, as potential indirect measures of the infant’s exposure at 3 months. Adjusted R2 values were maximized in the final models. Results During pregnancy, the prevalence of maternal smoking was 2.4 %, and 115 (11.4 %) mothers reported smoking by at least 1 person at home. Of the 144 (14.3 %) infants whose mothers reported that smoking occurred at home when their child was 3 months, 129 (89.6%) and 136 (94.4%) had cotinine and 3HC levels above the detection limit (0.03 ng/mL), respectively. Of the 811 infants who had no parent-reported exposure at 3 months, 538 (66.3%) and 715 (88.2%) had detectable cotinine and 3HC levels, respectively. After correcting for urine dilution, the geometric mean levels were 0.085 ng/mL for cotinine, 0.20 ng/mL for 3HC, and 1.62 picomole/mL for Cot+3HC. The final questionnaire models explained 43.4%, 41.0%, and 42.9% of the variance in cotinine, 3HC, and Cot+3HC levels, respectively. Conclusions Our results indicate that exposure of these infants to tobacco smoke is not completely captured by questionnaires, suggesting that exposure assessment could be improved by using a combination of biomarker and questionnaire methods. Though more detectable, the inclusion of 3HC did not increase the ability of the questionnaires to explain variance in metabolite levels, but 3HC may be important since the ratio of 3HC to cotinine can be used to quantify the rate of nicotine metabolism and variation within population

The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: Assessment of environmental exposures

The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3–4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set

The British Lexicon Project: Lexical decision data for 28,730 monosyllabic and disyllabic English words

We present a new database of lexical decision times for English words and nonwords, for which two groups of British participants each responded to 14,365 monosyllabic and disyllabic words and the same number of nonwords for a total duration of 16 h (divided over multiple sessions). This database, called the British Lexicon Project (BLP), fills an important gap between the Dutch Lexicon Project (DLP; Keuleers, Diependaele, & Brysbaert, Frontiers in Language Sciences. Psychology, 1, 174, 2010) and the English Lexicon Project (ELP; Balota et al., 2007), because it applies the repeated measures design of the DLP to the English language. The high correlation between the BLP and ELP data indicates that a high percentage of variance in lexical decision data sets is systematic variance, rather than noise, and that the results of megastudies are rather robust with respect to the selection and presentation of the stimuli. Because of its design, the BLP makes the same analyses possible as the DLP, offering researchers with a new interesting data set of word-processing times for mixed effects analyses and mathematical modeling. The BLP data are available at http://crr.ugent.be/blp and as Electronic Supplementary Materials

Efficacy of Fidaxomicin Versus Vancomycin as Therapy for Clostridium difficile Infection in Individuals Taking Concomitant Antibiotics for Other Concurrent Infections

Concomitant antibiotic (CA) use compromised initial response to Clostridium difficile infection therapy and durability of that response. Fidaxomicin was significantly more effective than vancomycin in achieving clinical cure in the presence of CAs and preventing recurrence regardless of CA use

The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: Assessment of environmental exposures

The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3–4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set

Birth cohorts in asthma and allergic diseases: Report of a NIAID/NHLBI/MeDALL joint workshop

Population-based birth cohorts on asthma and allergies increasingly provide new insights into the development and natural history of the diseases. Over 130 birth cohorts focusing on asthma and allergy have been initiated in the last 30 years. A NIAID (National Institute of Allergy and Infectious Diseases), NHLBI (National Heart Lung and Blood Institute), MeDALL (Mechanisms of the Development of Allergy, Framework Programme 7 of the European Commission) joint workshop was held in Bethesda, MD, USA September 11–12, 2012 with 3 objectives (1) documenting the knowledge that asthma/allergy birth cohorts have provided, (2) identifying the knowledge gaps and inconsistencies and (3) developing strategies for moving forward, including potential new study designs and the harmonization of existing asthma birth cohort data. The meeting was organized around the presentations of 5 distinct workgroups: (1) clinical phenotypes, (2) risk factors, (3) immune development of asthma and allergy, (4) pulmonary development and (5) harmonization of existing birth cohorts. This manuscript presents the workgroup reports and provides web links (AsthmaBirthCohorts.niaid.nih.gov or www.medall-fp7.eu) where the reader will find tables describing the characteristics of the birth cohorts included in this report, type of data collected at differing ages, and a selected bibliography provided by the participating birth cohorts