How to ensure that national radon survey results are useful for public health practice

Exposure to radon gas increases the risk of lung cancer. Preliminary national survey data collected by Health Canada indicate that approximately 10% of households exceed the recommended federal long-term guideline of 200 Bq/m3. However, results to date have been reported for large geographic areas in broad measurement categories. Given that Health Canada recommends the most rapid remediation for buildings with the highest concentrations, such reporting makes it challenging for public health authorities to target interventions to communities at the highest risk. Here we use data from a survey in British Columbia to illustrate how improved spatial resolution and more refined concentration categories would be valuable for prioritizing the use of limited public health resources. We encourage Health Canada in future to provide more specific, community-level information that can be used to inform local policy and to engage building owners in radon testing and remediation.     

Complications of ectopic ureterocele in adult female

Three examples of ectopic ureterocele in adult female were presented. Of these three patients, two had unusual complications: one with a ureterovaginal fistula and the other with neoplastic transformation. Pathologic changes varied from squamous and glandular metaplasia to adenocarcinoma.     

Lead in school drinking water: Canada can and should address this important ongoing exposure source

Reducing all preventable lead exposures in children should be a public health priority given that blood lead levels in children that were once considered "safe" have since been associated with important neuro-developmental deficits. Limited Canadian data indicate that school drinking water can be an important component of children's overall exposure to lead. Outside of Ontario, however, Canadian schools are not required to test for lead in water; in most of Canada, school testing is case by case, typically initiated by parental concerns. Provinces and territories are encouraged to follow Ontario's example by instituting a routine school water lead testing program in order to identify facilities where action can result in a decrease in students' exposure to lead. Testing and remediation frameworks developed by the US Environmental Protection Agency, Health Canada, and the province of Ontario provide direction to school boards and local and provincial/territorial health authorities.     

From Good Intentions to Proven Interventions: Effectiveness of Actions to Reduce the Health Impacts of Air Pollution

Background

Associations between air pollution and a multitude of health effects are now well established. Given ubiquitous exposure to some level of air pollution, the attributable health burden can be high, particularly for susceptible populations.

Objectives

An international multidisciplinary workshop was convened to discuss evidence of the effectiveness of actions to reduce health impacts of air pollution at both the community and individual level. The overall aim was to summarize current knowledge regarding air pollution exposure and health impacts leading to public health recommendations.

Discussion

During the workshop, experts reviewed the biological mechanisms of action of air pollution in the initiation and progression of disease, as well as the state of the science regarding community and individual-level interventions. The workshop highlighted strategies to reduce individual baseline risk of conditions associated with increased susceptibility to the effects of air pollution and the need to better understand the role of exposure duration in disease progression, reversal, and adaptation.

Conclusion

We have identified two promising and largely unexplored strategies to address and mitigate air pollution–related health impacts: reducing individual baseline risk of cardiovascular disease and incorporating air pollution–related health impacts into land-use decisions.     

Effect of TNF‐inhibitor therapy on spinal structural progression in ankylosing spondylitis patients: A systematic review and meta‐analysis

To review the effect of tumor necrosis factor‐alpha inhibitor (TNFi) therapies on radiographic progression in ankylosing spondylitis (AS) patients as evaluated by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases were searched from inception to August 2019. All comparative and non‐comparative studies that evaluated the clinical effectiveness of TNFi on radiographic progression as assessed by mSASSS change at a minimum follow‐up of 1 year were included. The Newcastle–Ottawa Scale and Cochrane Collaboration Risk of Bias Tool were utilized to assess the methodological quality. Pooled analysis was performed for continuous and binomial variables where appropriate. Inter‐rater reliability of mSASSS status and change scores were assessed with intra‐class coefficients (ICC). Twenty‐one studies were identified with a total of 4460 patients (mean age: 40.4 years [range 25.3‐50 years]; 76% male; mean baseline mSASSS: 12.7 units [range 5.5‐19.8 units]). All studies (3 randomized and 18 observational studies) were considered to have moderate‐to‐high methodological quality. The inter‐rater reliability of mSASSS status and change scores from 14 of the 21 studies were excellent (ICC ranges, 0.91‐0.99) and moderate‐to‐excellent (ICC ranges, 0.58‐0.90), respectively. From the 21 studies, 11/21 (50%) demonstrated a delayed effect in mSASSS in AS patient administered TNFi. When stratifying these studies into those with ≤4 years of follow‐up and >4 years follow‐up, 3/11 (27%) and 8/10 (80%) studies respectively indicated a delayed effect of mSASSS with TNFi in AS patients. Pooling for meta‐analysis from 3 studies (1159 patients) with study durations ranging 4‐8 years, indicated that TNFi‐treated patients had reduced odds of structural progression (odds ratio 0.81; 95% CI 0.68‐0.96; P = .01; I² = 0%). Mean rate of mSASSS change from 16 studies ranged from ?0.15 to 7.3 mSASSS units for all AS patients. Meta‐analysis indicated a numerical, but statistically non‐significant, reduction in the rate of mSASSS change with TNFi treatment (7 studies [1438 patients]; mean difference, ?0.24; 95% CI, ?0.49‐0.01; P = .06; I² = 0%). This systematic review and meta‐analysis indicated that >4 years of TNFi usage was associated with delayed structural progression by mSASSS. The narrative analysis of the data from 21 studies further confirmed that studies with >4 years of follow‐up had delayed structural progression with TNFi use in AS patients. The systematic review also confirmed that mSASSS has good‐to‐excellent inter‐rater reliability in AS.     

Increases in Serum Autoantibodies After Left Ventricular Assist Device Implantation

Background

Left ventricular assist devices (LVADs) can serve as a bridge to transplant or destination therapy for patients with advanced heart failure. Implantation of LVADs is known to be associated with increases in anti-HLA antibodies, but less is known about how autoantibody levels change with the use of these devices.

Infiltration of forest fire and residential wood smoke: an evaluation of air cleaner effectiveness

Communities impacted by fine-particle air pollution (particles with an aerodynamic diameter less than 2.5 microm; PM(2.5)) from forest fires and residential wood burning require effective, evidence-based exposure-reduction strategies. Public health recommendations during smoke episodes typically include advising community members to remain indoors and the use of air cleaners, yet little information is available on the effectiveness of these measures. Our study attempted to address the following objectives: to measure indoor infiltration factor (F(inf)) of PM(2.5) from forest fires/wood smoke, to determine the effectiveness of high-efficiency particulate air (HEPA) filter air cleaners in reducing indoor PM(2.5), and to analyze the home determinants of F(inf) and air cleaner effectiveness (ACE). We collected indoor/outdoor 1-min PM(2.5) averages and 48-h outdoor PM(2.5) filter samples for 21 winter and 17 summer homes impacted by wood burning and forest fire smoke, respectively, during 2004-2005. A portable HEPA filter air cleaner was operated indoors with the filter removed for one of two sampling days. Particle F(inf) and ACE were calculated for each home using a recursive model. We found mean F(inf)+/-SD was 0.27+/-0.18 and 0.61+/-0.27 in winter (n=19) and summer (n=13), respectively, for days when HEPA filters were not used. Lower F(inf)+/-SD values of 0.10+/-0.08 and 0.19+/-0.20 were found on corresponding days when HEPA filters were in place. Mean+/-SD ACE ([F(inf) without filter-F(inf) with filter]/F(inf) without filter) in winter and summer were 55+/-38% and 65+/-35%, respectively. Number of windows and season predicted F(inf) (P<0.001). No significant predictors of ACE were identified. Our findings show that remaining indoors combined with use of air cleaner can effectively reduce PM(2.5) exposure during forest fires and residential wood burning.     

Endometrial carcinoma of prostate

Endometrial carcinoma of the prostate is a unique lesion which contrasts markedly to the more ubiquitous prostatic acinar carcinoma with regard to morphology, clinical manifestations, localization stage at diagnosis, and possibly prognosis. Although endometrial carcinoma of the prostate may occur more commonly than previously recognized, wider recognition and study are essential for further delineation of this lesion. Finally, the inherent limits of endoscopic or of enucleative surgery and the propensity of endometrial carcinoma to present at a low stage suggest in appropriately selected cases that radical prostatectomy or possible external radiotherapy may offer the best opportunity for cure.