International expert workshop on the analysis of the economic and public health impacts of air pollution: workshop summary

Forty-nine experts from 18 industrial and developing countries met on 6 September 2001 in Garmisch-Partenkirchen, Germany, to discuss the economic and public health impacts of air pollution, particularly with respect to assessing the public health benefits from technologies and policies that reduce greenhouse gas (GHG) emissions. Such measures would provide immediate public health benefits, such as reduced premature mortality and chronic morbidity, through improved local air quality. These mitigation strategies also allow long-term goals--for example, reducing the buildup of GHG emissions--to be achieved alongside short-term aims, such as immediate improvements in air quality, and therefore benefits to public health. The workshop aimed to foster research partnerships by improving collaboration and communication among various agencies and researchers; providing a forum for presentations by sponsoring agencies and researchers regarding research efforts and agency activities; identifying key issues, knowledge gaps, methodological shortcomings, and research needs; and recommending activities and initiatives for research, collaboration, and communication. This workshop summary briefly describes presentations made by workshop participants and the conclusions of three separate working groups: economics, benefits transfer, and policy; indoor air quality issues and susceptible populations; and development and transfer of dose-response relationships and exposure models in developing countries. Several common themes emerged from the working group sessions and subsequent discussion. Key recommendations include the need for improved communication and extended collaboration, guidance and support for researchers, advances in methods, and resource support for data collection, assessment, and research.     

Soy-based formulae and infant growth and development: a review

Soy-based infant formulae, initially developed for infants who were lactose intolerant or allergic to cow's milk-based formulae, now account for >25% of the infant formulae sold in the United States. Formulations have changed over the years to improve digestibility, the stability and availability of minerals, and protein quality. Recent concerns have been raised regarding the phytoestrogenic isoflavone content of soy-based formulae. A systematic review of the literature was conducted to evaluate various measures of infant health and development in clinical studies comparing modern soy-based formulae with other diets and to document areas in which further research seems warranted. Results suggest that modern soy-based formulae support normal growth and nutritional status in healthy term infants in y 1 of life. However, there are very limited data on sexual and reproductive development or outcomes such as immune function, visual acuity/cognitive development and thyroid function. Available data do not provide evidence of meaningful differences in timing of maturation, sexual development or fertility in adolescents or adults. Nonetheless, given evidence suggesting that early exposure to soy and/or isoflavones might have long-term effects, further research following infants fed soy-based formulae into adulthood is warranted.     

Seasonal variations in injury rates during US Army Basic Combat Training

OBJECTIVES: Previous literature suggests that injury rates during physical activity may be higher in the summer than in the fall or winter, possibly due to the greater amount or intensity of physical activity in the summer. This study examined seasonal differences in injury incidence during US Army Basic Combat Training, where physical activity was similar at all times of the year. METHODS: Four independent groups of subjects (total n = 1543 men and 1025 women) were investigated, two training in the summer and two training in the fall. Injury data were obtained from a retrospective review of the subjects' medical records at the conclusion of the 8 week training program. RESULTS: For men, the corrected relative risk of suffering an injury or a time loss injury in the summer was, respectively, 2.0 [95% confidence interval (CI) = 1.7-2.4] and 2.5 (95% CI = 1.9-3.0) times higher than in the fall. For women, the corrected relative risk of suffering an injury or time-loss injury in the summer was, respectively, 1.4 (95% CI = 1.3-1.6) and 1.7 (95% CI = 1.5-2.0) times higher than in the fall. These risks were essentially unchanged after adjustment for subject physical characteristics (age, stature, body mass, body mass index) and physical fitness (push-ups, sit-ups and 2 mile run), indicating that the summer season was an injury risk factor independent of these variables. Linear correlations (r-values) between maximal daily temperature and injury incidence ranged from 0.92 to 0.97, indicating a strong relationship between these two variables. CONCLUSIONS: These data suggest that injury incidence among physically active individuals is higher in the summer than in the fall and that environmental temperature may provide a partial explanation for this finding.     

A comparison of household lead exposure assessment methods in an old,urban community

The accurate assessment of lead hazards within the household is critical to the prevention of lead exposure to children living in urban communities. Although dust wipes are currently accepted as the best method of assessing lead hazards, questionnaires and visual inspections are also used. This study evaluates the level of agreement among these three methods of assessment using a sample of 126 women living in old, urban houses. The level of agreement was assessed using the kappa statistic, which adjusts for chance agreement. Overall, the kappa results for both the participant's assessment (questionnaire) and the visual inspector's assessment were low, indicating only slight to moderate agreement with the dust lead wipe levels. Kappas were higher and more consistent for the visual inspector's assessment than for the participant's assessment. These results indicate that visual inspections and participant questionnaires may provide less accurate information regarding lead hazards within the household than dust wipes. Because lead hazard recognition is important in the prevention of lead exposure in children, our data suggest that emphasis should be placed on the measurement of dust lead levels directly in assessing household lead hazards, possibly by teaching women in high-risk neighborhoods to take dust samples themselves.     

Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents

The purpose of this study was to discriminate subtypes of obsessive-compulsive disorder (OCD) in a clinical sample of children and adolescents. Sixty OCD patients were assessed in two outpatient psychiatric clinics; 15 patients had a lifetime history of tics and 45 patients had no tic history. Interviews were conducted with the patients and their parents by a child psychiatrist using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The symptom checklist of the CY-BOCS was used to categorize obsessions and compulsions. Discriminant function analysis was used to compare the two groups in their symptomatology. There was no difference between the two groups in seven obsession categories. However, there was a significant difference between the two groups in seven compulsion categories. Ordering, hoarding, and washing compulsions were more common in those with no tic history. The results indicate that tic-related OCD may be differentiated from non-tic-related OCD early in life by the presence or absence of certain compulsive symptoms.     

The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries

RESEARCH OBJECTIVE: Estimates of the prevalence of major depression vary widely. Current estimates range from 2 to 14 % depending upon the definition and procedure for diagnosis. Further, most estimates are for special populations, either living in selected geographic areas or receiving specific types of medical care. A national survey of Medicare Fee-for-Service (FFS) beneficiaries provides an opportunity to assess the current level of major depression or dysthymia among a diverse population of older Americans. STUDY DESIGN: The Health Outcomes Survey (HOS) was administered to a national random sample of 1,000 Medicare FFS beneficiaries. We used the Mental Component Summary (MCS) measure of the SF-36 to estimate the prevalence of major depression or dysthymia. Logistic regression was used to examine associated factors. RESULTS: The response rate was 61.7%. Using an MCS score of 42 or lower, prevalence of major depression or dysthymia was estimated to be 25% for respondents age 65 years and older. Logistic regression analysis revealed that the likelihood of major depression or dysthymia was associated with years of education (Odds Ratio (OR) = 0.87), difficulties performing activities of daily living (OR = 1.72), and Medicaid enrollment (OR = 2.67). CONCLUSIONS: The results revealed that one-quarter of the respondents reported mental health problems consistent with major depression or dysthymia. This is higher than previously reported. Like previous studies, years of education, physical impairment, and poverty are strong predictors of major depression or dysthymia. The high rate of major depression or dysthymia implies there may be considerable unmet need among elderly Medicare FFS beneficiaries for diagnosing and treating mental illness.     

Habituation of responding for food in humans

Habituation to repeated food stimuli has been demonstrated in various response systems across animals and humans. Patterns of responding to obtain food demonstrate many empirical characteristics of habituation, and the purpose of the present study was to determine whether motivated responding for food in humans follows an habituation pattern. Thirty-five nonobese men were randomized to groups in which they responded to gain access to repeated presentations of the same food or presentations of a variety of isocaloric food. Subjective ratings of food liking and hunger were assessed. Consistent with habituation theory, participants working for one type of food demonstrated a more rapid decrease in responding for food and in ratings of liking of the repeatedly presented food than participants working for varied foods. All participants showed similar reductions of hunger and resumed responding for a novel food stimulus. This study documents that motivated responding for food in human shares characteristics of an habituation process.