Asbestos-containing materials in abandoned residential dwellings in Detroit.

OBJECTIVE: The efforts of many municipalities to demolish abandoned residential dwellings (ARDs) are hampered by the presence of asbestos-containing materials (ACMs) in these structures. However, the extent of such materials is unknown. Our study sought to characterize ACMs present in ARDs demolished in Detroit. METHODS: Working with the City of Detroit, we obtained information on all ARDs demolished from 2014 to 2017. We randomly sampled 605 ARDs and analyzed the presence, type, and amount of ACM present, and the associated abatement and demolition costs. RESULTS: Asbestos was present in about 95% of the sampled ARDs. The most common types of ACMs were flooring, roofing, siding, and duct insulation. The material containing the greatest fraction of asbestos was duct insulation. The type of asbestos generally present was chrysotile. Only eight (1%) ARDs contained commercial amphibole asbestos; another 36 contained vermiculite. The total cost of demolition averaged $13,645 per home, of which 20.1% was asbestos abatement. CONCLUSIONS: The majority of the ACM in the ARDs was nonfriable and consisted of chrysotile. This study contributes information about the nature and extent of ACM in ARDs, which can provide part of the foundation for making an assessment of possible asbestos-containing air emissions during the demolitions of ARDs, and the nature or extent of pre-demolition abatement that may be needed (if any) to protect the public's health.

Urinary tract infection: self-reported incidence and associated costs.

PURPOSE: To estimate the annual incidence, cumulative probability of presumed urinary tract infection (UTI) by age, and the social costs. METHODS: Analysis of a random digit dialing survey of 2000 women in the United States. RESULTS: 10.8 percent (95% CI: 9.4, 12.1%) of women aged 18 and older reported at least one presumed UTI during the past 12 months, with the majority of the cases occurring among women with a history of two or more UTI episodes in their life. We estimate that by age 24, one-third of women will have at least one physician-diagnosed UTI that was treated with prescription medication. Overall, an estimated 11.3 million women in the United States had at least one presumed UTI treated with antibiotics in 1995. We estimate the annual cost of UTI cases with prescriptions to be $1.6 billion in 1995. If the costs occurring after 1995 are discounted at 5% annually, the total cost over 20 years has a present value of $25.5 billion. CONCLUSION: If a vaccine were developed that would prevent either initial or recurrent UTI the net benefits to society would be substantial, even at a developmental cost of one billion dollars.

Respiratory symptoms in mothers of young children.

OBJECTIVES: Children receiving child care outside the home are at greater risk of upper respiratory infection, but whether parents of those children are also at increased risk is undocumented. We describe the incidence of 2 or more respiratory symptoms in the previous 2 weeks among 185 mothers of children 3 years of age or younger by child care use. METHODS: Mothers in Michigan and Nebraska were interviewed by phone regarding respiratory symptoms, use of outside child care (for an index child), sleeping habits, and demographic information. RESULTS: Nearly one half (46.5%) reported 2 or more symptoms during the past 2 weeks; 15.1% had contacted a health care provider and 13.0% spent 1 or more days in bed because of their symptoms, which lasted an average of 5.5 days. Prevalence of symptoms was invariant to sociodemographic characteristics. Mothers using outside child care (74.6%) were twice as likely as those without outside care to have been ill in the past 2 weeks (odds ratio: 2.26; 95% confidence interval [CI]: 1.12,4.54). Most mothers (69.2%) reported having their sleep interrupted by their children at least once in the last 2 weeks or sharing a bed with a child part or all of the night (61.1%); 25.4% slept 6 hours or less nightly. Women reporting that they rarely or never felt rested (26. 5%) were 2.65 times more likely to be ill (95% CI: 1.26,5.55), compared with those reporting that they frequently or always felt rested (46.5%), after adjusting for any outside child care. CONCLUSIONS: Future studies should focus on risk factors that can be modified to reduce illness among both children and their parents.

Candida vaginitis: self-reported incidence and associated costs.

BACKGROUND AND OBJECTIVES: Incidence of Candida vaginitis by age and racial or ethnic group is poorly described. GOAL: Estimate incidence, cumulative probability of presumed C vaginitis by age, racial or ethnic group, and associated costs. STUDY DESIGN: Random digit-dialing survey of 2000 US women. RESULTS: A total of 6.5 percent (95% CI, 5.4-7.5%) of women older than 18 years reported a least one episode of presumed C vaginitis during the previous 2 months. Women reporting a 1-year period with four or more episodes comprised 8.0% of the sample but accounted for 37.2% of women reporting episodes. Black women reported approximately three times more yeast infections in the previous 2 months (17.4%; 95% CI, 11.2-23.5%) than white women (5.8%; 95% CI, 4.7-6.9%). CONCLUSION: The high incidence and the propensity for recurrence underscore the need for a better understanding of the epidemiology and pathogenesis, and stress the need for the development of more accurate, rapid diagnostics and effective treatments.

Emergency magnetic resonance imaging of cervical spinal cord injuries: clinical correlation and prognosis.

OBJECTIVE: The goal of this study was to determine the prognostic and clinical value of magnetic resonance imaging (MRI) performed within hours after cervical spinal cord injuries in human patients. METHODS: Fifty-five patients with acute cervical vertebral column and spinal cord injuries underwent MRI as part of their initial treatment at the University of Michigan Medical Center. All images were obtained within 21 hours after injury (mean, 7.8 h) and were interpreted by an attending neuroradiologist who was blinded to the clinical status of the patients. Neurological function at presentation and in long-term follow-up examinations was compared with MRI characteristics assessed immediately after the injury. RESULTS: The presence and rostrocaudal length of intra-axial hematoma, the rostrocaudal length of spinal cord edema, the presence of spinal cord compression, and spinal cord compression by extra-axial hematoma were each significantly associated with poor neurological function at presentation and in long-term follow-up examinations. Although the best single predictor of long-term improvement in neurological function was the neurological function at presentation, four MRI characteristics, i.e., the presence of intra-axial hematoma, the extent of spinal cord hematoma, the extent of spinal cord edema, and spinal cord compression by extra-axial hematoma, provided significant additional prognostic information. MRI data demonstrated spinal cord compression for 27 of 55 patients (49%), leading to emergency surgery. Among patients who underwent imaging after restoration of normal vertebral alignment using closed cervical traction, 13 of 26 (50%) underwent emergency surgery for treatment of persistent, MRI-demonstrated, spinal cord compression. CONCLUSION: Emergency MRI after spinal cord injury provides accurate prognostic information regarding neurological function and aids in the diagnosis and treatment of persistent spinal cord compression after vertebral realignment.