Airborne particulate matter exposure and urinary albumin excretion: the Multi-Ethnic Study of Atherosclerosis.

OBJECTIVES: Understanding mechanistic pathways linking airborne particle exposure to cardiovascular health is important for causal inference and setting environmental standards. We evaluated whether urinary albumin excretion, a subclinical marker of microvascular function which predicts cardiovascular events, was associated with ambient particle exposure. METHODS: Urinary albumin and creatinine were measured among members of the Multi-Ethnic Study of Atherosclerosis at three visits during 2000-2004. Exposure to PM(2.5) and PM(10) (microg/m(3)) was estimated from ambient monitors for 1 month, 2 months and two decades before visit one. We regressed recent and chronic (20 year) particulate matter (PM) exposure on urinary albumin/creatinine ratio (UACR, mg/g) and microalbuminuria at first examination, controlling for age, race/ethnicity, sex, smoking, second-hand smoke exposure, body mass index and dietary protein (n = 3901). We also evaluated UACR changes and development of microalbuminuria between the first, and second and third visits which took place at 1.5- to 2-year intervals in relation to chronic PM exposure prior to baseline using mixed models. RESULTS: Chronic and recent particle exposures were not associated with current UACR or microalbuminuria (per 10 microg/m(3) increment of chronic PM(10) exposure, mean difference in log UACR = -0.02 (95% CI -0.07 to 0.03) and relative probability of having microalbuminuria = 0.92 (95% CI 0.77 to 1.08)) We found only weak evidence that albuminuria was accelerated among those chronically exposed to particles: each 10 microg/m(3) increment in chronic PM(10) exposure was associated with a 1.14 relative probability of developing microalbuminuria over 3-4 years, although 95% confidence intervals included the null (95% CI 0.96 to 1.36). CONCLUSIONS: UACR is not a strong mechanistic marker for the possible influence of air pollution on cardiovascular health in this sample.

Air pollution and inflammation in type 2 diabetes: a mechanism for susceptibility.

BACKGROUND: Particulate air pollution has been associated with several adverse cardiovascular health outcomes, and people with diabetes may be especially vulnerable. One potential pathway is inflammation and endothelial dysfunction-processes in which cell adhesion molecules and inflammatory markers play important roles. AIM: To examine whether plasma levels of soluble intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and von Willebrand factor (vWF) were associated with particle exposure in 92 Boston area residents with type 2 diabetes. METHODS: Daily average ambient levels of air pollution (fine particles (PM2.5), black carbon (BC) and sulphates) were measured approximately 500 m from the patient examination site and evaluated for associations with ICAM-1, VCAM-1 and vWF. Linear regressions were fit to plasma levels of ICAM-1, VCAM-1 and vWF, with the particulate pollutant index, apparent temperature, season, age, race, sex, glycosylated haemoglobin, cholesterol, smoking history and body mass index as predictors. RESULTS: Air pollutant exposure measures showed consistently positive point estimates of association with the inflammatory markers. Among participants not taking statins and those with a history of smoking, associations between PM(2.5), BC and VCAM-1 were particularly strong. CONCLUSIONS: These results corroborate evidence suggesting that inflammatory mechanisms may explain the increased risk of air pollution-associated cardiovascular events among those with diabetes.

Functional teams lead to Joint Commission success.

As the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) has shifted the focus of its survey process to the organization as a whole, new techniques are needed to prepare for surveys. Staten Island University Hospital used teams based on the eleven important functions to achieve a successful survey.

Helping schoolchildren with asthma breathe easier: partnerships in community-based environmental health education.

Hospitalizations and deaths attributed to asthma are increasing, and the disease has disproportionate impacts on children and minority populations, particularly African-Americans. Because asthma hospitalizations and deaths are viewed by many experts as preventable events, and because asthma's toll is so significant in economic terms, increased efforts to reverse these trends, particularly among the most affected groups, are warranted. Reducing exposures to airborne pollutants known to trigger asthma in both indoor and outdoor environments is one important preventive strategy. The public-private partnership effort to implement the Open Airways for Schools asthma management curriculum in urban elementary schools, with its emphasis on pollution prevention, is an example of a community-based effort that may help decrease the toll asthma takes on society.

Implementing clinical pharmacy services in an outpatient oncology clinic.

The implementation of clinical pharmacy services in an outpatient oncology clinic is described. An oncologist hired by the department of internal medicine and the director of the department of pharmacy designed the program. Both departments agreed that the pharmacists should have central responsibility for the antineoplastic agents. Pharmacists for the program were selected from the existing staff. They were trained in an established i.v. therapy certification course offered by the hospital. The biweekly clinics are staffed by a team consisting of two pharmacists, three nurses, two faculty physicians, and a rotating resident physician. The pharmacists provide clinical and distributive services including patient monitoring and medication storage, delivery, preparation, administration, and disposal. A survey showed that the pharmacists were well accepted by the other members of the team. After a trial period, principles of break-even analysis and differential accounting were used to justify the costs of the program. This program will remain an integral part of this hospital's pharmaceutical services.