Diesel exhaust exposure, its multi-system effects, and the effect of new technology diesel exhaust.

Exposure to diesel exhaust (DE) from vehicles and industry is hazardous and affects proper function of organ systems. DE can interfere with normal physiology after acute and chronic exposure to particulate matter (PM). Exposure leads to potential systemic disease processes in the central nervous, visual, hematopoietic, respiratory, cardiovascular, and renal systems. In this review, we give an overview of the epidemiological evidence supporting the harmful effects of diesel exhaust, and the numerous animal studies conducted to investigate the specific pathophysiological mechanisms behind DE exposure. Additionally, this review includes a summary of studies that used biomarkers as an indication of biological plausibility, and also studies evaluating new technology diesel exhaust (NTDE) and its systemic effects. Lastly, this review includes new approaches to improving DE emissions, and emphasizes the importance of ongoing study in this field of environmental health.

Effects of glycosylated hemoglobin levels on neutrophilic phagocytic functions.

It is well established that diabetic patients with poor glycemic control have increased susceptibility to infections, but glucose levels have not been directly associated with this increase. The assessment of the effects of glycosylated hemoglobin (A1 c) on the body's ability to fight infections may be useful directly in establishing a link between elevated blood sugar and the risk of infections. A total of 127 subjects in Heart Pilot Study (HPS), sub-study of the Adventist Health Study 2 (AHS-2) completed a lifestyle, medical and food frequency questionnaire (FFQ) at baseline between 2013 and 2014. The A1 c and phagocytic index (PI) were measured in the same blood sample and their associations were assessed using linear regression. Mean blood glucose (MBG) was estimated based on A1 c levels using a standard formula. Three levels of MBG were used to compare prediabetic and diabetic ranges to the normal range. The PI is the average number of bacteria in the cytoplasm of 50 neutrophils, manually counted under a light microscope after the whole blood was briefly exposed to a standard dose of bacteria and stained. In multivariable analysis, we found that MBG in the prediabetic (117 to137 mg/dL) and diabetic (>137 mg/dL) ranges were associated with 12.9% (ß= -0.129, 95% Cl: -0.30, 0.05) and 20.4% decrease in PI (ß= -0.204, 95% Cl: -0.592, 0.184) compared to that, observed among those with normal MBG (p for trend=0.119). Elevated MBG levels contribute a decrease in the PI among those in the prediabetic and diabetic range compared to the normal range. Although our findings were not quite statistically significant due to low power which are clinically relevant in line with observations of an increased infections among diabetics. Further research on larger populations is needed.

Nutritional status of highland and lowland children in Ecuador.

UNLABELLED: We assessed the nutritional status of children in Ecuador using anthropometric measurements and body composition. OBJECTIVES: To determine whether living in the highlands in Quito was a predisposing factor to poor nutrition in children. METHOD: We compared the children in highlands at 2772 m above sea level with their costal (605 m above sea level) counterparts at Santo Domingo de Los Colorados. By using the WHO standard reference 2007, we distinguished malnourished children from healthy children using Z-score of -2 as a cut-off point. RESULTS: Mean Z-score indices for both height-for-age (HFA) and weight-for-age (WFA) were found to be significantly lower among urban children than for rural children (p < 0.001). Urban children were also four times more likely of becoming mildly stunted (OR = 3.95%, 95% confidence interval (CI): 1.818-8.448) and three times more likely of being mildly underweight (OR = 3.95%, 95% CI: 1.241-7.551). CONCLUSION: Living in highland urban areas of Ecuador is a predisposing factor for poor nutrition among children.

Patient and hospital characteristics associated with inpatient severe sepsis mortality in California, 2005-2010.

OBJECTIVES: The primary objective of this study was to identify which patient demographic, patient health, and hospital characteristics were associated with in-hospital mortality. A secondary objective was to determine the relative influence of these characteristics on mortality. DESIGN AND SETTING: Public-use data for 2005-2010 were used in this retrospective, cross-sectional analysis of discharges from nonfederal, general acute hospitals in California. A staged logistic regression approach was used to examine the relative influence of variables associated with in-hospital mortality. PATIENTS: A total of 1,213,219 patient discharges for adults (aged ≥18 yrs) having International Classification of Diseases-9 diagnosis and procedure codes indicating severe sepsis. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patient demographics (age, gender, race, ethnicity, and payer category), patient health status (acute transfer, Charlson-Deyo comorbidity index, and organ failures), and hospital characteristics (ownership type, teaching status, bed size, annual patient days, acute discharges, emergency department visits, inpatient surgeries, severe sepsis as a percentage of all discharges, and year) were obtained from the California Office of Statewide Health Planning and Development. Overall, in-hospital mortality was 17.8%. There was a steady annual increase in the number of sepsis discharges, but a decrease in mortality throughout the study period. Mortality increased with age and was associated with white race, and Medicaid (Medi-Cal) and private insurance. Patient health status additionally explained inpatient mortality. Hospital volume measures were statistically significant in regression analysis, whereas static structural measures were not. There were modest associations between measures of annual treatment volume and likelihood of inpatient mortality, notably decreasing likelihood with more acute discharges and with greater severe sepsis volume. CONCLUSIONS: Although patient demographics and health status are the most important predictors of in-hospital mortality of patients with severe sepsis, hospital characteristics do play a substantial role. Findings regarding hospital volume can be used to improve processes and improve patient outcomes.

En Balance participants decrease dietary fat and cholesterol intake as part of a culturally sensitive Hispanic diabetes education program.

PURPOSE: The purpose of this study was to assess dietary intake habits of Mexican American Hispanic adults participating in the En Balance diabetes education program. METHODS: En Balance is a 3-month culturally sensitive diabetes education intervention for Spanish-speaking Hispanics. Of the 46 participants enrolled, 39 mainly Mexican American Hispanic adults with type 2 diabetes completed the En Balance program. Participants lived in the Riverside and San Bernardino counties of California, and all participants completed the program by June 2008. Dietary intake was assessed at baseline and at 3 months using the validated Southwest Food Frequency Questionnaire. RESULTS: Clinically important decreases in glycemic control and serum lipid levels were observed at the end of the 3-month program. The baseline diet was characterized by a high intake of energy (2478 ± 1140 kcal), total fat (87 ± 44 g/day), saturated fat (28 ± 15 g/day), dietary cholesterol (338 ± 217 mg/day), and sodium (4236 ± 2055 mg/day). At 3 months, the En Balance group mean intake of dietary fat (P = .045) and dietary cholesterol (P = .033) decreased significantly. Low dietary intakes of docosahexaenoic acid, eicosapentaenoic acid, and vitamin E were also observed in these adults with type 2 diabetes. CONCLUSIONS: The En Balance program improved glycemic control and lipid profiles in a group of Hispanic diabetic participants. En Balance also promoted decreases in dietary fat and dietary cholesterol intake.

Comparison of body composition by bioelectrical impedance and dual-energy x-ray absorptiometry in overweight/obese postmenopausal women.

The purpose of this study was to compare the Rudolph J. Liedtke (RJL) Sciences Quantum II system bioelectrical impedance analyzer (BIA) with the fan beam Hologic dual-energy X-ray absorptiometry (DXA, software V8.26a) for assessing body composition in postmenopausal obese women. Thirty-three postmenopausal overweight/obese females (mean age: 53.9+/-6.0 yr; mean weight: 91.3+/-17.5 kg; and mean body mass index [BMI]: 33.1+/-5.7 kg/m2) were evaluated for comparison of body weight (BW), fat mass (FM), percent FM (%FM), and fat free mass (FFM). The comparison was assessed by RJL Quantum 2 Cyprus 2.6 (Clinton Township, MI) BIA vs fan beam DXA Hologic QDR-4500A software V8.26a (ODR 4500 Hologic, Inc., Waltham, Mass). RJL-BIA and DXA measurements were performed at the same time. BW was measured using a balance scale (Detecto; Web City, MO) and these results were used for the RJL-BIA analysis. Balance weight was compared with DXA BW. Correlations between DXA and RJL-BIA for BW, FM, %FM, and FFM were 0.998, 0.980, 0.782, and 0.926 (p<0.01), respectively. Bland-Altman plots demonstrated general agreement between methods for BW, FM, %FM, and FFM. However, for the latter 3 metrics of body composition, one unit change using BIA does not correspond to one unit change using DXA, as there were systematic disagreements at either end of the range of values. But RJL-BIA could be a valid method for assessing body composition of overweight/obese postmenopausal women once appropriate validated regression equations have been developed.