West Nile virus infection among the homeless, Houston, Texas

Among 397 homeless participants studied, the overall West Nile virus (WNV) seroprevalence was 6.8%. Risk factors for WNV infection included being homeless >1 year, spending >6 hours outside daily, regularly taking mosquito precautions, and current marijuana use. Public health interventions need to be directed toward this high-risk population.     

HIV seroprevalence among male IVDUs in Houston, Texas.

HIV seroprevalence was 8.4 percent in a sample of 921 heterosexual male intravenous drug users in Houston, Texas who were not in drug treatment at the time of the study. Males who were Black, injected drugs daily, or had a history of syphilis had greater odds of being HIV positive than participants without those characteristics.     

Long-Term Exposure to Low-Level [... formula ...] and Mortality among the Elderly Population in the Southeastern United States

Background: Mounting evidence has shown that long-term exposure to fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] and ozone (O3) can increase mortality. However, the health effects associated with long-term exposure to nitrogen dioxide (NO2) are less clear, in particular the evidence is scarce for NO2 at low levels that are below the current international guidelines.Methods: We constructed a population-based full cohort comprising all Medicare beneficiaries (aged ≥65, N=13,590,387) in the southeastern United States from 2000 to 2016, and we then further defined the below-guideline cohort that included only those who were always exposed to low-level NO2, that is, with annual means below the current World Health Organization guidelines (i.e., ≤21 ppb). We applied previously estimated spatially and temporally resolved NO2 concentrations and assigned annual means to study participants based on their ZIP code of residence. Cox proportional hazards models were used to examine the association between long-term exposure to low-level NO2 and all-cause mortality, adjusting for potential confounders.Results: About 71.1% of the Medicare beneficiaries in the southeastern United States were always exposed to low-level NO2 over the study period. We observed an association between long-term exposure to low-level NO2 and all-cause mortality, with a hazard ratio (HR)= 1.042 (95% CI: 1.040, 1.045) in single-pollutant models and a HR= 1.047 (95% CI: 1.045, 1.049) in multipollutant models (adjusting for PM2.5 and O3), per 10-ppb increase in annual NO2 concentrations. The penalized spline indicates a linear exposure–response relationship across the entire NO2 exposure range. Medicare enrollees who were White, female, and residing in urban areas were more vulnerable to long-term NO2 exposure.Conclusion: Using a large and representative cohort, we provide epidemiological evidence that long-term exposure to NO2, even below the national and global ambient air quality guidelines, was approximately linearly associated with a higher risk of mortality among older adults, independent of PM2.5 and O3 exposure. Improving air quality by reducing NO2 emissions, therefore, may yield significant health benefits. https://doi.org/10.1289/EHP9044     

Attitudes Toward Hepatitis B Virus among Vietnamese, Chinese and Korean Americans in the Houston Area, Texas

We explored attitudes about prevention, screening and treatment of hepatitis B virus (HBV) infection in Chinese, Korean and Vietnamese communities. We use qualitative methods in 12 focus groups (n = 113) of adults who self-reported their ethnicity to be Chinese, Korean, or Vietnamese. We use grounded theory (i.e., consensus-building between co-coders about recurring, emerging themes) for analysis. Diet, nutrition, fatigue and stress were misidentified as HBV causes. Improving hygiene, diet, exercise, and holistic methods were misidentified as viable HBV prevention methods. Common screening problems included not affording test and not understanding test results. Participants shared reasons for using complementary and alternative medicine—when Western medicine fails or becomes unaffordable. Participants sought information from medical providers and fellow community members, but also from the internet. Many of the attitudes and opinions that emerged may deter participation in HBV screening, prevention and treatment, insofar as community members may factor them into healthcare decision-making, choose alternative but ineffective methods of prevention and treatment, and undervalue the benefits of screening. More patient education in both traditional and new media is necessary for clarifying transmission, screening and treatment misunderstandings.     

Correlates of Bacterial Pneumonia Hospitalizations in Elders,Texas Border

Background Immunization preventable bacterial pneumonia is an Agency for Healthcare Research and Quality (AHRQ) prevention quality indicator of health care. This study explored associations of individual and county correlates with bacterial pneumonia hospitalization rates for elders residing in 32 Texas counties bordering Mexico. Methods We estimated baseline rates from Texas Health Care Information Collection’s hospital discharge data for 1999–2001, and population counts from the 2000 U.S. Census. Results The rate among the total Texas border population was 500/10,000, three times the national rate. Elders 75+, males, and Latinos had the highest rates. An increase of 1 primary care physician per 1000 population is associated with a decrease in pneumonia-related hospitalization rates by 33%, while each 10% increase in Latinos is associated with a 0.1% rate increase. Discussion This baseline bacterial pneumonia hospitalization study demonstrates a systematic approach to estimate county rates, a process that could lead to improved outcomes through effective community interventions. Methodology demonstrates how publicly available hospital discharge data can be used by communities to better measure and improve quality of health care.     

The epidemiology of HIV and AIDS among Central American, South American, and Caribbean immigrants to Houston, Texas

A retrospective study with respect to demographics and clinical parameters was conducted of all HIV/AIDS patients born in Central America, South America, and the Caribbean region, presenting to the Harris County Hospital District (public facilities) between 1994 and 1998. The original case definition criteria were fulfilled by 240 patients, 168 (70.0%) of whom were from Central America (including Panama), 42 (17.5%) of whom were from the Caribbean, and 30 (12.5%) of whom were from South America. The Central America group contained the highest proportion of women (37.5% compared with 20.8% among the group from the Caribbean and South America, P = 0.01, chi-square). The mean age was significantly lower among those born in Central America (32.4 vs. 38.8 for those born in the other two areas). The most commonly observed opportunistic infections were toxoplasmosis (14.8%), pneumocystosis (19.9%), and tuberculosis (12.1%). These data confirm the distinct epidemiologic parameters among Central American residents compared to the non-Central American populations as the Central American patients present with HIV infection to our health care system at a younger age and are more often women. The high rate of toxoplasmosis, pneumocystosis, and tuberculosis among those immigrants from the areas assessed in this study are a reminder of the need for intensified prophylaxis against these infections when working with patients from these populations.     

Asbestos Exposure and Cancer Mortality among Petroleum Refinery Workers: A Poisson Regression Analysis of Updated Data

The authors investigated the relationship between asbestos exposure and respiratory cancer mortality among maintenance workers and other blue-collar workers at an Italian oil refinery. The cohort contained 931 men, 29,511 person-years, and 489 deaths. Poisson regression analysis using white-collar workers as an internal referent group provided relative risk estimates (RRs) for main causes of death, adjusted for age, age at hiring, calendar period, length of exposure, and latency. Among maintenance workers, RRs for all tumors (RR = 1.50), digestive system cancers (RR = 1.41), lung cancers (RR = 1.53), and nonmalignant respiratory diseases (RR = 1.71) were significantly increased (p 0.05); no significant excess was found for all causes and among maintenance (RR = 1.12) and other blue-collar workers (RR - 1.01). Results confirm the increased risk of death from respiratory diseases and cancer among maintenance workers exposed to asbestos, whereas other smoking-related diseases (circulatory system) were not statistically different among groups.     

Folk Constructions of Syphilis in an African-American Community in Houston,Texas

This paper analyses folk constructions of syphilis in a predominately African-American community in Houston, Texas. In-depth interviews with 17 African-Americans were conducted to describe the folk models of syphilis present. Interviews centred on prevalence transmission, risk, personal protection and detection, relationships and expectations for the future. Physical appearance, the earwax test, the match test and the smell test were used to 'detect' syphilis infection. Respondents conflated the symptoms of several STDs including syphilis, gonorrhoea, herpes and chlamydia into a single class. The study findings indicate miscommunication regarding STD information and use of different models (folk vs. medical) to explain risk of infection and prevention. The use of folk constructions in syphilis interventions would provide a better understanding of the community's knowledge and perceptions of STDs and a better focus for future education and prevention programmes.     

Ambient Heat and Sudden Infant Death: A Case-Crossover Study Spanning 30 Years in Montreal,Canada

Background

Climate change may lead to more severe and extreme heat waves in the future, but its potential impact on sudden infant death—a leading cause of infant mortality—is unclear.

Objectives

We sought to determine whether risk of sudden infant death syndrome (SIDS) is elevated during hot weather.

Methods

We undertook a case-crossover analysis of all sudden infant deaths during warm periods in metropolitan Montreal, Quebec, Canada, from 1981 through 2010. Our analysis included a total of 196 certified cases of SIDS, including 89 deaths at 1–2 months of age, and 94 at 3–12 months. We estimated associations between maximum outdoor temperatures and SIDS by comparing outdoor temperatures on the day of or day before a SIDS event with temperatures on control days during the same month, using cubic splines to model temperature and adjusting for relative humidity.

Results

Maximum daily temperatures of ≥ 29°C on the same day were associated with 2.78 times greater odds of sudden infant death relative to 20°C (95% CI: 1.64, 4.70). The likelihood of sudden death increased steadily with higher temperature. Associations were stronger for infants 3–12 months of age than for infants 1–2 months of age, with odds ratios of 3.90 (95% CI: 1.87, 8.13) and 1.73 (95% CI: 0.80, 3.73), respectively, for 29°C compared with 20°C on the day of the event.

Conclusions

High ambient temperature may be a novel risk factor for SIDS, especially at ≥ 3 months of age. Climate change and the higher temperatures that result may account for a potentially greater proportion of sudden infant deaths in the future.

Citation

Auger N, Fraser WD, Smargiassi A, Kosatsky T. 2015. Ambient heat and sudden infant death: a case-crossover study spanning 30 years in Montreal, Canada. Environ Health Perspect 123:712–716; http://dx.doi.org/10.1289/ehp.1307960     

上海市闸北区大气污染与死亡率的病例交叉研究

目的 探索上海市闸北区大气污染与居民死亡率之间的联系。方法 应用病例交叉设计case-crossover)和STATA 6．0中的条件Logistic回归模型对2000年6月1日-2002年12月31日期间上海市闸北区大气污染与居民死亡率之间的联系进行分析。结果 在调整气象因素并采用1：4双向对称性对照模型中,PM10、SO2及NO2 48h平均浓度每增加10μg／m^3与总死亡率(损伤中毒除外)的OR分别为1．007(95％可信区间1．003-1．011),1．011(95％可信区间1．001-1．021),1．010(95％可信区间1．000-1．020),其中PM10与死亡率的联系在敏感度分析中不随模型参数的改变而不同。PM10与循环系统疾病死亡率有关,NO2与呼吸系统疾病死亡率有关。结论 上海市闸北区大气污染物暴露对居民死亡率有急性效应。     

发达国家与中国老年人口主要死因别死亡率的水平及趋势分析

本文以65～74岁年龄组死因结构代表老年人口的死亡模式,对9个发达国家的重要死因别死亡率(1969～1985年)进行了时间序列的自相关分析,并将中国城市、农村地区的相应死因资料(1973～1975年和1987年)与之对比。主要死因别死亡率的时间序列特征归纳为3种:随机性、稳态性和非稳态性(非稳态性又可根据其决定系数分为线性和非线性变化)。     

大型综合医院住院患者调查分析

本文对本院住院患者进行研究,分析了年龄、性别、科室、区域公布等特点,提出床位安排应注意性别差异,在完善军队伤病员住院管理基础上,关注外地患者和优势科室患者的需求。     

Role of a modified ovitrap in the control of Aedes aegypti in Houston, Texas, USA

A modified ovitrap from which larvae could not escape was employed for one year for the control of Aedes aegypti at Blossom Heights, Houston, Texas. At the end of this period, the Breteau index in the ovitrap area had declined by 36%, in contrast to a sharp increase of nearly 500% in the non-ovitrap area. The premises index in the ovitrap area remained unchanged, while the index in the non-ovitrap area increased by 440%. The problems associated with this control campaign and the use of these “autocidal” ovitraps are discussed.     

Adherence to travel health guidelines: the experience of Nigerian immigrants in Houston, Texas

The objective of this study was to learn about the travel health practices of Nigerians in Houston, Texas, and to describe factors affecting adherence to recommendations for the prevention of malaria, typhoid, and hepatitis A set forth by the Centers for Disease Control and Prevention (CDC). Data were collected through focus group discussions and one-on-one interviews with travelers and health care providers. Data collection and analysis relied on a process-based framework that included questions about health and health-maintenance strategies before, during, and after travel. The cost of travel health services and the availability of vaccines and medications were important structural barriers to adherence. Perceptions of individual susceptibility and disease severity varied across the infections of interest. Travelers perceive themselves to be at risk for malaria, but are generally not concerned about its consequences. A notable exception is the fear of becoming symptomatic post-travel in the United States. Typhoid was less salient than malaria, and few had heard of or worried about acquiring hepatitis A. Stigma associated with the acquisition of travel-related conditions and the perceived incompetence of physicians to treat illnesses related to overseas travel, and malaria in particular, also affect preventive decisions and strategies. The results of the study have broad relevance for the traveling public and for programs and services that seek to improve travel health and travel health care.     

Spatial and Temporal Distribution of Current-Use Pesticides in Atmospheric Particulate Matter in Houston,Texas

The atmospheric concentrations of seven current-use pesticides in particulate matter were determined at four locations throughout the Houston metropolitan area in TSP and PM_2.5 samples from September 2013. Atmospheric concentrations in both TSP and PM_2.5 ranged from below method detection limits (MDLs) to nearly 1100 pg m^?3. The three compounds most frequently detected above MDLs were chlorothalonil, bifenthrin, and λ-cyhalothrin. Atmospheric chlorothalonil concentrations were above 800 pg m^?3 in several TSP samples, but <MDL in PM_2.5 samples. Bifenthrin atmospheric concentrations, which were detected above MDLs in all samples, differed between urban and suburban sites, while also being more associated with fine particulate matter. λ-cyhalothrin had high atmospheric concentrations at one of the suburban sites and the industrial site, but was <MDL in the urban site samples. Diurnal trends in atmospheric concentration, as related to wind direction, showed that daytime peaks came from east while nighttime peaks came from northeast directions.     

Healthcare Coverage and Use Among Undocumented Central American Immigrant Women in Houston,Texas

We investigated the prevalence and correlates of having current healthcare coverage and of having a usual formal source of care among undocumented Central American immigrant women. Participants were recruited using respondent driven sampling. Thirty-five percent of participants had healthcare coverage and 43 % had a usual formal source of care. Healthcare coverage was primarily through the local indigent healthcare program and most of those with a usual formal source of care received care at a public healthcare clinic. Having healthcare coverage and having a usual formal source of care were both associated with older age; having a usual formal source of care was also marginally associated with increased time of residence in the US and increased income security. The primary barriers to healthcare use were not having money or insurance, not knowing where to go, and not having transportation. Healthcare interventions may benefit from targeting young and newly arrived immigrants and addressing the structural and belief barriers that impede undocumented immigrant women’s use of healthcare services.     

A Cohort Study on Mortality and Exposure to Polychlorinated Biphenyls

In 1979, an outbreak of food poisoning (“Yu-Cheng”) occurred in Central Taiwan, ROC, involving more than 2 000 people. The event was caused by ingestion of rice oil contaminated with polychlorinated derivatives of biphenyls, dibenzofurans, and quaterphenyls. A retrospective cohort study on mortality was undertaken, and possible long-term health effects in the affected individuals were studied. The mortality experience of 1 940 victims (929 males, 1 011 females) between 1980 and 1991 was compared with the expected numbers, which were calculated from national and local mortality rates. By the end of 1991, 102 deaths were identified, thus producing a standardized mortality ratio (SMR) of overall mortality of 0.99 for males and 1.34 for females. Total cancer mortality was lower than in each comparison group. Mortality from liver diseases was elevated significantly (SMR = 3.22), especially during the first 3 y after the food-poisoning event (SMR = 10.76). Increased clinical severity of polychlorinated biphenyl intoxication was associated with increased mortality from all causes and from liver diseases. In summary, there was a positive association between mortality and intoxication dose, and severe polychlorinated biphenyl poisoning acutely affected mainly the liver. A continued follow-up of this cohort would be valuable in the study of long-term health effects of polychlorinated biphenyl poisoning.