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.

PCB95 and PCB153 change dopamine levels and turn-over in PC12 cells.

Polychlorinated biphenyls (PCB) exposure at low chronic levels is a significant public health concern. Animal and epidemiological studies indicate that low PCB body burden may cause neurotoxicity and be a risk factor for neurodegenerative diseases. In the current study, we measured the ability of two non-dioxin like PCBs, 2,2',4,4',5,5'-hexachlorobiphenyl (PCB153) and 2,2'3,5',6-pentachlorobiphenyl (PCB95), to alter dopamine (DA) levels and metabolism using the dopaminergic PC12 cell line. Our hypothesis is that treatment of PC12 cells with non-toxic concentrations of PCB153 or PCB95 for 12 and 24 h will have different effects due to different congener structures. Levels of DA and of 3,4-dihydroxyphenylacetaldehyde (DOPAL), 3, 4-dihyroxylphenylethanol (DOPET), and 3,4-dihyroxylphenylacetic acid (DOPAC) metabolite, gene expression of the dopamine synthesis enzyme tyrosine hydroxylase (TH) and the vesicular monoamine transporter (VMAT2), and gene expression of the anti-oxidant enzymes Cu/Zn and Mn superoxide oxidase (Cu/ZnSOD, MnSOD), glutathione peroxidase (GPx) and catalase were determined. PCB153 decreased intracellular and extracellular levels of DA after 12 h exposure and this was consistent with an increase in DA metabolites. After 24 h, the level of DA in medium increased compared to the control. In contrast, PCB95 exposure increased the intracellular DA level and decreased DA in medium consistent with a down-regulation of VMAT2 expression at 12 h. After 24 h exposure, PCB95 increased DA levels in media. Expression of TH mRNA increased slightly following 12 h but not at 24 h exposure. MnSOD mRNA increased up to 6-7 fold and Cu/ZnSOD increased less than two-fold after treatment with both congeners. Catalase expression was up-regulated following 24 h exposure to PCB153 and PCB95, but GPx expression was down-regulated after 12 h exposure to PCB95 only. These results suggest that PCB153 and PCB95 are neurotoxic and affect DA turnover with structure-dependent differences between these two congeners.

Risk Factors for Road Traffic Injuries among Different Road Users in the Gambia.

We identified risk factors for road traffic injuries among road users who received treatment at two major trauma hospitals in urban Gambia. The study includes pedestrians, bicyclists, motorcyclists, and drivers/passengers of cars and trucks. We examined distributions of injury by age, gender, collision vehicle types and vehicle category, and driver and environment factors. Two hundred and fifty-four patients were included in the study. Two-thirds were male and one-third female. Two-thirds (67%) of road traffic injuries involved pedestrians, bicyclists, and motorcyclists; and these were more common during weekdays (74%) than weekends. Nearly half (47%) of road traffic injuries involved pedestrians. One-third (34%) of injured patients were students (mean age of students was less than 14 years), more than half (51%) of whom were injured on the roadway as pedestrians. Head/skull injuries were common. Concussion/brain injuries were 3.5 times higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Crashes involving pedestrians were more likely to involve young people (<25 years; aOR 6.36, 95% CI: 3.32-12.17) and involve being struck by a motor car (aOR 3.95, 95% CI: 2.09-7.47). Pedestrians contribute the largest proportion of hospitalizations in the Gambia. Young pedestrians are at particularly high risk. Prevention efforts should focus on not only vehicle and driver factors, but also protecting pedestrians, bicyclists, and motorcyclists.

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.

Psychological distress, job dissatisfaction, and somatic symptoms in office workers in 6 non-problem buildings in the Midwest.

BACKGROUND: Researchers examined office worker characteristics and reports of non-specific somatic symptoms in 6 non-problem buildings in the Midwestern United States. METHODS: We assessed office workers for demographic characteristics and somatic symptoms that occurred in the workplace. Sampling was conducted over a 1-week period in each building over 4 seasons. Our team administered the Medical Outcome Survey questionnaire, the Brief Symptom Inventory, and the Job Content Questionnaire to individuals at each site, comparing office workers reporting no symptoms to those reporting ≥4 symptoms. RESULTS: Self-reported nonspecific somatic symptoms were frequent in office workers in non-problem buildings. High symptom levels were associated with younger age, female sex, psychological distress, impaired quality of life, and poor job satisfaction. CONCLUSIONS: The findings suggest that office workers frequently report somatic symptoms they believe are related to the workplace even in buildings considered non-problematic. People with high symptom levels perceived as related to the workplace are psychologically distressed, have impaired quality of life, and feel dissatisfied and powerless in the workplace.

Unsuspected exposure to beryllium: potential implications for sarcoidosis diagnoses.

Exposure to Beryllium (Be) can cause sensitization (BeS) and chronic beryllium disease (CBD) in some individuals.  Even relatively low exposures may be sufficient to generate an asymptomatic, or in some cases a symptomatic, immune response. Since the clinical presentation of CBD is similar to that of sarcoidosis, it is helpful to have information on exposure to beryllium in order to reduce misdiagnosis. The purpose of this pilot study is to explore the occurrence of Be surface deposits at worksites with little or no previous reported use of commercially available Be products.  The workplaces chosen for this study represent a convenience sample of businesses in eastern Iowa. One hundred thirty-six surface dust samples were collected from 27 businesses for analysis of Be. The results were then divided into categories by the amount of detected Be according to U.S. Department of Energy guidelines as described in 10 CFR 850.30 and 10 CFR 850.31. Overall, at least one of the samples at 78% of the work sites tested contained deposited Be above the analytical limit of quantitation (0.035 µg beryllium per sample).  Beryllium was detected in 46% of the samples collected. Twelve percent of the samples exceeded 0.2 µg/100 cm² and 4% of the samples exceeded a Be concentration of 3 µg/100 cm². The findings from this study suggest that there may be a wider range and greater number of work environments that have the potential for Be exposure than has been documented previously.  These findings could have implications for the accurate diagnosis of sarcoidosis.

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.

Pesticide handling and exposures among cotton farmers in the gambia.

OBJECTIVES: There are substantial health hazards to farmers and the environment associated with pesticide use in developing countries. Based on observations by the authors and previous reports, most previous studies in Africa are descriptive in nature. The aim of this study was to investigate how cotton farmers are exposed to pesticides in The Gambia and quantify their pesticide exposures and provide information for the formulation of a policy on pesticide safety for the country. METHODS: A representative sample of 20 cotton farmers in the Central and Upper River Divisions (CRD and URD) of The Gambia were surveyed by questionnaires. Dermal pesticide exposures among a subset of 10 farmer/pesticide applicators were assessed by dermal patch samples, observation, and postapplication questionnaires. RESULTS: The study revealed that a toxic organochlorine insecticide, Callisulfan (endosulfan), is frequently sprayed on cotton plants by the farmers. The farmers wore no protective equipment and were inadequately dressed for work with this pesticide. Laboratory analysis of the mixed formulation showed a wide range in the concentration of the pesticide solution among the farmer/pesticide applicators and dermal patch samples showed very high residues of endosulfan analytes on their body surfaces. CONCLUSIONS: A low level of awareness of pesticide toxicity prevails amonsg cotton farmers in The Gambia. There is a less than adequate control of pesticides and other hazardous agrichemicals in the country.

Comparison of proposed frameworks for grouping polychlorinated biphenyl congener data applied to a case-control pilot study of prostate cancer.

Although the commercial synthesis of polychlorinated biphenyls (PCBs) has been banned in the United States for several decades, they are persistent in the environment with exposure mainly being through diet. The biologic and toxic effects of PCBs and their metabolites are due in part to their ability to interact with several cellular and nuclear receptors, thereby altering signaling pathways and gene transcription. These effects include endocrine modulation and disruption. Therefore, the natural history of cancer in tissues expressing these receptors may be modulated by PCB congeners, which are known to have estrogenic, antiestrogenic, and other hormonal effects. Several frameworks for grouping PCB congeners based on these interactions have been proposed. We conducted a hospital-based, case-control pilot study of 58 prostate cancer cases and 99 controls to evaluate the association between the proposed PCB groupings and the risk of prostate cancer. Serum samples were analyzed for a total of 30 PCBs. In multivariate analyses, the odds of prostate cancer among men with the highest concentrations of moderately chlorinated PCBs or PCBs with phenobarbital-like activities (constitutively active receptor (CAR) agonists) was over two times that among men with the lowest concentrations. Increasing trends in risk across the concentration levels were also observed. These results suggest that a higher burden of PCBs that are CAR agonists may be positively associated with an increased risk of prostate cancer and they encourage further research in this area.

Organochlorines and risk of prostate cancer.

This pilot study examined the relationships of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) with prostate cancer. Ninety-nine controls were frequency matched by age in 5-year increments to 58 prostate cancer patients. Thirty PCBs and 18 OCPs were measured in serum by gas chromatography. Multiple logistic regression was used to assess the magnitude of association. Seven organochlorines, dieldrin, p,p'-DDE, trans-nonachlor, oxychlordane, heptachlor epoxide, and PCBs 153 and 180 were detected in at least 20% of all study participants. Adjusting for age, body mass index, and a history of prostatitis, oxychlordane and PCB 180 were associated with an increased risk of prostate cancer. This study suggests that long-term, low-dose exposure to specific OCPs and PCBs in the general population may contribute to an increased risk of prostate cancer and supports further investigation in this area.