Open fire ovens and effects of in-home lavash bread baking on carbon monoxide exposure and carboxyhemoglobin levels among women in rural Armenia.

Lavash is a traditional flatbread commonly baked at home by women in Armenia and other Middle Eastern and Caucasus countries. The baking process follows centuries' old recipes and is done primarily in open fire ovens. Data are limited regarding the impact of baking on indoor air quality and health outcomes. This study aimed at assessing the effects of lavash baking on household air pollution and cardiovascular outcomes among women who bake lavash in rural Armenia. A convenience sample of 98 bakers, all women, never-smokers, representing 36 households were enrolled. Carbon monoxide (CO) concentrations and carboxyhemoglobin (COHb) levels were monitored before, during, and/or after baking. As expected, exposure to concentrations of CO peaking at/or above 35-ppm during baking was more likely to occur in homes with fully enclosed and poorly ventilated baking rooms, compared to those with three or fewer walls and/or one or more windows. Bakers in homes where CO concentrations peaked at/or above 35-ppm were more likely to have an increase in post-baking COHb levels compared to those in homes with lower CO concentrations.

Toxic metals in ayurvedic preparations from a public health lead poisoning cluster investigation.

Background Herbal formulations, traditional medicine, and complementary and alternative medicine are used by the majority of the world's population. Toxicity associated with use of Ayurvedic products due to metal content is an increasingly recognized potential public health problem. Objectives Report on toxic metals content of Ayurvedic products obtained during an investigation of lead poisoning among users of Ayurvedic medicine. Methods Samples of Ayurvedic formulations were analyzed for metals and metalloids following established US. Environmental Protection Agency methods. Results Lead was found in 65% of 252 Ayurvedic medicine samples with mercury and arsenic found in 38 and 32% of samples, respectively. Almost half of samples containing mercury, 36% of samples containing lead and 39% of samples containing arsenic had concentrations of those metals per pill that exceeded, up to several thousand times, the recommended daily intake values for pharmaceutical impurities. Conclusions Lack of regulations regarding manufacturing and content or purity of Ayurvedic and other herbal formulations poses a significant global public health problem.

Environmental and occupational health needs assessment in West Africa: opportunities for research and training.

OBJECTIVES: Data are lacking on environmental and occupational health risks and resources available for the prevention of related diseases in the West African subregion. METHODS: A needs assessment survey was conducted to identify environmental and occupational health concerns, and needs and strategies for skills training in the region. The survey was followed by a consensus-building workshop to discuss research and training priorities with representatives from countries participating in the study. RESULTS: Two hundred and two respondents from 12 countries participated in the survey. Vector-borne diseases, solid waste, deforestation, surface and ground water contamination together with work-related stress, occupational injury and pesticide toxicity were ranked as top environmental and occupational health priorities, respectively, in the region. Top training priorities included occupational health, environmental toxicology and analytic laboratory techniques with semester-long Africa-based courses as the preferred type of training for the majority of the courses. Major differences were found between the subregion's three official language groups, both in perceived health risks and training courses needed. CONCLUSIONS: The study results have implications for regional policies and practice in the area of environmental and occupational health research and training.

Lower limit of normal based spirometric abnormalities associated with radiographic abnormality in an elderly cohort at low risk for exposure.

BACKGROUND: Although the relation between radiographic abnormalities and spirometric impairment in people with asbestosis has been studied extensively, the extent of spirometric impairment associated with milder radiographic abnormalities is not established. OBJECTIVE: To test associations between mild radiographic abnormalities and Lower Limit of Normal (LLN)-based spirometry interpretation. METHODS: Spirometry and CXRs were collected for 1,026 at low risk of exposure to pneumoconiotic agents participants in a medical screening program. RESULTS: Individuals with each type of isolated or combined International Labour Organization (ILO) abnormalities had up to over sixfold statistically significant increase in odds of LLN-based restrictive pattern physiology (OR = 1.96, 95%CI 1.03-3.73 for parenchymal to OR = 6.09, 95%CI 1.94-19.10 for parenchymal and pleural) compared to those with normal films. CONCLUSIONS: The findings from this study confirm the association of mild profusion abnormalities with clinically relevant, LLN-based lung function abnormalities.

Novel Logistic Regression Model of Chest CT Attenuation Coefficient Distributions for the Automated Detection of Abnormal (Emphysema or ILD) Versus Normal Lung.

RATIONALE AND OBJECTIVES: We evaluated the role of automated quantitative computed tomography (CT) scan interpretation algorithm in detecting interstitial lung disease (ILD) and/or emphysema in a sample of elderly subjects with mild lung disease. We hypothesized that the quantification and distributions of CT attenuation values on lung CT, over a subset of Hounsfield units (HUs) range (-1000 HU, 0 HU), can differentiate early or mild disease from normal lung. MATERIALS AND METHODS: We compared the results of quantitative spiral rapid end-exhalation (functional residual capacity, FRC) and end-inhalation (total lung capacity, TLC) CT scan analyses of 52 subjects with radiographic evidence of mild fibrotic lung disease to the results of 17 normal subjects. Several CT value distributions were explored, including (1) that from the peripheral lung taken at TLC (with peels at 15 or 65 mm), (2) the ratio of (1) to that from the core of lung, and (3) the ratio of (2) to its FRC counterpart. We developed a fused-lasso logistic regression model that can automatically identify sub-intervals of -1000 HU and 0 HU over which a CT value distribution provides optimal discrimination between abnormal and normal scans. RESULTS: The fused-lasso logistic regression model based on (2) with 15-mm peel identified the relative frequency of CT values of over -1000 HU and -900 and those over -450 HU and -200 HU as a means of discriminating abnormal versus normal lung, resulting in a zero out-sample false-positive rate, and 15% false-negative rate of that was lowered to 12% by pooling information. CONCLUSIONS: We demonstrated the potential usefulness of this novel quantitative imaging analysis method in discriminating ILD and/or emphysema from normal lungs.

A cluster of lead poisoning among consumers of Ayurvedic medicine.

BACKGROUND: Use of alternative medications and herbal remedies is widespread in the United States and across the globe. These traditional medications can be contaminated with toxic metals. Despite several case reports of poisoning from such contamination, the epidemiological data are still limited. OBJECTIVES: To report on a cluster of lead and mercury toxicity cases in 2011 among a community of adherents of traditional medical practice of Ayurveda. METHODS: Adherents of Ayurveda were offered heavy metals screening following the identification of the index case. RESULTS: Forty-six of 115 participants (40%) had elevated blood lead levels (BLLs) of 10 µg/dl or above, with 9.6% of BLLs at or above 50 µg/dl. CONCLUSIONS: This is the largest cluster of lead and mercury toxicity following use of Ayurvedic supplements described in the literature in the US. Contamination of herbal products is a public health issue of global significance. There are few regulations addressing contamination of "natural" products or supplements.

Agreement between fixed-ratio and lower limit of normal spirometry interpretation protocols decreases with age: is there a need for a new GOLD standard?

OBJECTIVES: To assess concordance between the fixed 70% ratio cutoff point with the fixed percent predicted values (Fixed-ratio) and the lower limit of normal (LLN) algorithms in interpreting spirometry results in an older population. METHODS: Spirometries were interpreted using Third National Health and Nutrition Examination Survey reference equations for 2319 workers. RESULTS: The Fixed-ratio algorithm characterized 34.5% (n = 801) results as abnormal, compared with 29.7% (n = 689) by the LLN. There were almost twice as many obstructive and mixed airways spirometries identified under the Fixed-ratio compared to LLN. Rates of restrictive pattern physiology were virtually the same under each algorithm. Overall agreement between the algorithms decreased with age from "almost perfect" for those younger than 60 years to "substantial" for those older than 80 years. CONCLUSIONS: This study found age-related discordance between two algorithms possibly related to the lack of reference equations and standards for individuals older than 80 years.

Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers.

OBJECTIVE: To estimate prevalence and risk factors for International Labour Organization radiographic abnormalities, and assess relationship of these abnormalities with spirometry results in former Department of Energy nuclear weapons workers. METHODS: Participants were offered chest x-ray (CXR) and lung function testing. Three occupational medicine physicians read CXRs. RESULTS: Forty-five (5.9%) of 757 screened workers were found to have isolated parenchymal abnormalities on CXR and this rate is higher than that in many Department of Energy studies. Parenchymal and pleural and isolated pleural abnormalities were found in 19 (2.5%) and 37 (4.9%) workers, respectively, and these rates are lower than those in other Department of Energy studies to date. Lung function impairment was associated with radiographic abnormalities. CONCLUSIONS: This study found an elevated rate of parenchymal abnormalities compared to other DoE populations but the effect of age or other causes could not be ruled out.

Risk of beryllium sensitization in a low-exposed former nuclear weapons cohort from the Cold War era.

BACKGROUND: The nuclear weapons industry has long been known as a source of beryllium exposure. METHODS: A total of 1,004 former workers from a nuclear weapons assembly site in the Midwest were screened for sensitization to beryllium (BeS). The screenings were part of the Department of Energy (DOE) Former Worker Program established in 1996. RESULTS: Twenty-three (2.3%) workers were found sensitized to beryllium and this prevalence was comparable to other DOE sites. Occasional, direct exposure to beryllium through machining and grinding of copper-beryllium (Cu-Be) 2% alloy tools was found to increase the risk of sensitization compared to background exposure (OR = 3.83; 95% CI: 1.04-14.03) with a statistically significant trend (P = 0.03) revealing that particular jobs are associated with sensitization. Exposure potential in this study was estimated based on job titles and not personal exposure information. CONCLUSIONS: These results confirm the need to screen workers using beryllium alloy tools in other industries and for consideration of altering work practices.

Prevalence of beryllium sensitization among Department of Defense conventional munitions workers at low risk for exposure.

OBJECTIVE: To estimate the prevalence of beryllium sensitization among former and current Department of Defense workers from a conventional munitions facility. METHODS: Participants were screened by using Beryllium Lymphocyte Proliferation Test. Those sensitized were offered clinical evaluation for chronic beryllium disease. RESULTS: Eight (1.5%) of 524 screened workers were found sensitized to beryllium. Although the confidence interval was wide, the results suggested a possibly higher risk of sensitization among workers exposed to beryllium by occasional resurfacing of copper-2% beryllium alloy tools compared with workers with the lowest potential exposure (odds ratio = 2.6; 95% confidence interval, 0.23-29.9). CONCLUSIONS: The findings from this study suggest that Department of Defense workers with low overall exposure to beryllium had a low prevalence of beryllium sensitization. Sensitization rates might be higher where higher beryllium exposures presumably occurred, although this study lacked sufficient power to confirm this.