Maternal residential greenness and congenital heart defects in infants: A large case-control study in Southern China.

BACKGROUND: Proximity to greenness has shown protective effects on coronary heart diseases by limiting exposure to environmental hazards, encouraging physical activity, and reducing mental stress. However, no studies have previously evaluated the impacts of greenness on congenital heart defects (CHDs). We examined the association between maternal residential greenness and the risks of CHDs. METHODS: We conducted a case-control study (8042 children with major CHDs and 6887 controls without malformations) in 21 cities in Southern China, 2004 - 2016. CHDs cases were diagnosed and verified by obstetrician, pediatrician, or pediatric cardiologists, within one year. We estimated maternal residential greenness using satellite-derived normalized difference vegetation index (NDVI) in zones of 500 meters (m) and 1000 m surrounding participants' residences. Logistic regression models were used to assess NDVI-CHD relationships adjusting for confounders. RESULTS: Interquartile range NDVI increases within 500 m or 1000 m were associated with odds ratios (OR) of 0.95 (95% confidence interval (CI): 0.92, 0.98) and 0.94 (95%CI: 0.91, 0.97) for total CHDs respectively. Air pollutants mediated 52.1% of the association. We also identified a protective threshold at 0.21 NDVI on CHD. Similar protective effects from greenness were found in most CHDs subtypes. The protective associations were stronger for fall, urban or permanent residents, higher household income maternal age ≤35 years of age, and high maternal education (ORs: ranged from 0.85 to 0.96). CONCLUSION: Our findings suggest a beneficial effect of maternal residential greenness on CHDs. Further studies are needed to confirm our findings, which will help to refine preventive health and urban design strategies.

Do multiple environmental factors impact four cancers in women in the contiguous United States?

BACKGROUND: Though there has been an increasing concern about the effects that environmental exposures have on cancer, limited knowledge exists regarding multiple environmental factors on cancers in women. METHODS: We performed a spatial autoregressive model to examine the association between the Environmental Quality Index (EQI) and mortalities of four cancers in women (breast, cervical, ovarian and uterine cancer) based on county-level data, and explored these associations by urbanicity. The EQI, which included five domains (air, water, land, built environment and sociodemographic domain) estimated from 2000 to 2005 data, was obtained from the United States Environmental Protection Agency. The mortality rates for 3107 counties in the US in 2014 were obtained from the Institute for Health Metrics and Evaluation. RESULTS: We found that each unit increase in the overall EQI was positively associated with the increased mortality of breast, ovarian and uterine cancer (2.5%, 3.6% and 3.1% respectively), but was negatively associated with cervical cancer mortality. Among the environmental domains, the air and sociodemographic EQIs were positively associated with increased risks of breast, ovarian and uterine cancers. Additionally, built environment EQI was associated with breast and ovarian cancers; land EQI was associated with uterine and ovarian cancers. The sociodemographic EQI was negatively associated with cervical cancer mortality. Furthermore, we have developed a novel Environmental Quality Health Index (EQHI) in identifying environment-health risk of cancers in women at county level. CONCLUSIONS: Our findings suggest that breast, ovarian, and uterine cancer mortalities are positively associated with multiple environmental factors, while cervical cancer mortality is mainly negatively associated with sociodemographic factors. The novel EQHI might help identify spatially-based environment-cancer risk.

Modification Effects of Population Expansion, Ageing, and Adaptation on Heat-Related Mortality Risks Under Different Climate Change Scenarios in Guangzhou, China.

(1) Background: Although the health effects of future climate change have been examined in previous studies, few have considered additive impacts of population expansion, ageing, and adaptation. We aimed to quantify the future heat-related years of life lost (YLLs) under different Representative Concentration Pathways (RCP) scenarios and global-scale General Circulation Models (GCMs), and further to examine relative contributions of population expansion, ageing, and adaptation on these projections. (2) Methods: We used downscaled and bias-corrected projections of daily temperature from 27 GCMs under RCP2.6, 4.5, and 8.5 scenarios to quantify the potential annual heat-related YLLs in Guangzhou, China in the 2030s, 2060s, and 2090s, compared to those in the 1980s as a baseline. We also explored the modification effects of a range of population expansion, ageing, and adaptation scenarios on the heat-related YLLs. (3) Results: Global warming, particularly under the RCP8.5 scenario, would lead to a substantial increase in the heat-related YLLs in the 2030s, 2060s, and 2090s for the majority of the GCMs. For the total population, the annual heat-related YLLs under the RCP8.5 in the 2030s, 2060s, and 2090s were 2.2, 7.0, and 11.4 thousand, respectively. The heat effects would be significantly exacerbated by rapid population expansion and ageing. However, substantial heat-related YLLs could be counteracted by the increased adaptation (75% for the total population and 20% for the elderly). (4) Conclusions: The rapid population expansion and ageing coinciding with climate change may present an important health challenge in China, which, however, could be partially counteracted by the increased adaptation of individuals.

Are the current thresholds, indicators, and time window for cold warning effective enough to protect cardiovascular health?

More extreme cold weather and larger weather variations have raised concerns regarding their effects on public health. Although prior studies assessed the effects of cold air temperature on health, especially mortality, limited studies evaluated wind chill temperatures on morbidity, and health effects under the current cold warning threshold. This study identified the thresholds, lag periods, and best indicators of extreme cold on cardiovascular disease (CVD) by comparing effects of wind chill temperatures and cold air temperatures on CVD emergency department (ED) visits in winter and winter transition months. Information was collected on 662,625 CVD ED visits from statewide hospital discharge dataset in New York State. Meteorological factors, including air temperature, wind speed, and barometric pressure were collected from National Oceanic and Atmospheric Administration. A case-crossover approach was used to assess the extreme cold-CVD relationship in winter (December-February) and transition months (November and March) after controlling for PM2.5. Conditional logistic regression models were employed to analyze the association between cold weather factors and CVD ED visits. We observed CVD effects occurred when wind chill temperatures were as high as -3.8 °C (25 °F), warmer than current wind chill warning standard (≤-28.8 °C or ≤-20 °F). Wind chill temperature was a more sensitive indicator of CVD ED visits during winter with temperatures ≤ -3.8 °C (25 °F) with delay effect (lag 6); however, air temperature was better during transition months for temperatures ≤ 7.2 °C (45 °F) at earlier lag days (1-3). Among all CVD subtypes, hypertension ED visit had the strongest negative association with both wind chill temperature and air temperature. This study recommends modifying the current cold warning temperature threshold given larger proportions of CVD cases are occurring at considerably higher temperatures than the current criteria. We also recommend issuing cold warnings in winter transitional months.

Smoking and adult glioma: a population-based case-control study in China.

BACKGROUND: Smoking increases the risk of numerous cancers; however, an association of smoking with adult gliomas has not been found in a population. METHODS: This case-control study included 4556 glioma cases (ICD-9 code 191.0-191.9) aged ≥ 30 years and 9112 controls from a national survey of smoking and mortality in China in 1989-1991. Controls from 325 255 surviving spouses of all-cause deaths were randomly assigned to cases in each of 103 areas according to sex and age groups at a ratio of 2:1. Smoking information was ascertained retrospectively by interviewing surviving spouses. RESULTS: After adjustment for confounders, smoking increased the risk of glioma deaths by 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI]: 1.03-1.21). Compared with non-smokers; the increased risk was 9% (OR = 1.09; 95% CI: 0.99-1.20) in men and 16% (OR = 1.16; 95% CI: 1.00-1.36) in women. The risk increased with age and doses. For individuals aged ≥ 50 years, smoking was associated with higher risk of glioma death by 25% (OR = 1.25; 95% CI: 1.15-1.38); this increased risk for smokers who smoked ≥ 20 cigarettes daily for ≥ 30 years was 53% (OR = 1.53; 95% CI: 1.34-1.74). There were similar findings in both men and women and with either pathology-based or non-pathology-based comparisons. CONCLUSIONS: This study indicates that smoking is associated with glioma deaths in the Chinese population. Long-term heavy smoking could be a factor for risk stratification in individuals attending brain tumor clinics.

Sex of First Child and Breast Cancer Survival in Young Women.

Two studies have reported that young women with breast cancer face increased risk of early mortality if their first child was male rather than female. An immunological mechanism has been suggested. We sought to confirm these results in a larger, historical cohort study of 223 parous women who were aged <45 years at breast cancer diagnosis during 1983-1987. Subjects were identified through the Maine Cancer Registry. Follow-up data were obtained from hospitals, physicians, and death certificates. Reproductive history data were obtained from the next of kin of the deceased women, birth certificates, physicians, hospitals, and lastly, subjects. With a 7-year follow-up, multivariate modeling found a lower mortality risk in women with a male first child (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32-0.81, log-rank comparison). The survival advantage remained for at least 13 years in women with a male firstborn. Thus, previous studies were not confirmed. Mortality risk in young women with breast cancer is not increased by having borne a male first child rather than a female first child.

Effects of active, passive, and combined smoking on cervical cancer mortality: a nationwide proportional mortality study in Chinese urban women.

PURPOSE: To determine whether smoking, in any form, is a risk factor in the development of cervical cancer (CC) among urban Chinese women. METHODS: We ascertained retrospectively the smoking habits of 1,865 women (aged 35+) who had died from CC (cases) and 48,781 who had died from causes unrelated to smoking (controls) in 24 cities using data from a large national survey of smoking and mortality in 1989-1991. We assessed the risk of smoking on CC mortality with and without considering passive smoke exposure from a spouse using a proportional mortality study design. RESULTS: Overall, there was a 51.0 % excess risk of death from CC among smokers. When the spouse's exposure was further considered, the RR (95 % CI) for exposed versus unexposed women was 1.28 (1.04-1.57) for passive smokers, 1.49 (1.02-2.20) for active smokers, and 1.69 (1.27-2.26) for women with both exposures (all p < 0.001). Significant dose-response associations were observed between smoking and CC for all categories of exposure. For example, individuals with both smoking exposure had the highest risk of CC mortality with moderate [RR = 1.67 (1.18-2.38)] and high [RR = 1.88 (1.04-3.41)] daily cigarette consumption, and they also had the highest risk with ≤15 years exposure [RR = 1.73 (1.19-2.52)] and >15 years exposure [RR = 1.95 (1.15-3.32)], compared with the active and passive groups (p for trend <0.001). CONCLUSIONS: Younger trend of CC death and the rapid increase in smoking among young women may have a profound impact on future incidence of CC. Our findings emphasize the need for preventive efforts among both women and men in China.

Integrating public health education in a public health practice setting: the experience of the School of Public Health, University at Albany and the New York State Department of Health.

The New York State Department of Health (DOH) has a long history of biomedical research, public health policy and program development, peer-reviewed scholarship, and teaching. Its evolution as an academic health department advanced significantly when the University at Albany and DOH formed the School of Public Health Sciences in 1985 to further develop these functions while formally training the next generation of public health workers. The School, renamed in 1990 as the School of Public Health (SPH), was initially located within the DOH with its staff as the founding faculty. The curriculum was heavily influenced by public health practice imperatives. The SPH has evolved to have an independent campus and full-time academic faculty, but the DOH remains closely linked. The relationship is governed by a memorandum of understanding that commits both partners to provide substantial and continuing resources to the SPH. The SPH brings value to the DOH's mission to improve the health of the state's citizens by providing an academic focus to problems faced in health department practice settings. The opportunity to teach and be involved in an academic environment increases the DOH's ability to recruit, retain, and improve the skill level of its professional and scientific staff and thereby improve its ability to assess health problems and to design and evaluate public health programs. The SPH also provides training and support to county health departments and nongovernment organizations, which further the DOH's mission, through continuing education programs and an online MPH degree program. International exchanges including those with China, Vietnam, and the Republic of Georgia have enriched the academic environment. Challenges include maintaining sufficient full-time faculty members, the need for the SPH to take on broader public health issues than those applicable to New York, and the shrinkage of the DOH's workforce and departure of many senior scientists who served as faculty.

Improving global health education: development of a Global Health Competency Model.

Although global health is a recommended content area for the future of education in public health, no standardized global health competency model existed for master-level public health students. Without such a competency model, academic institutions are challenged to ensure that students are able to demonstrate the knowledge, skills, and attitudes (KSAs) needed for successful performance in today's global health workforce. The Association of Schools of Public Health (ASPH) sought to address this need by facilitating the development of a global health competency model through a multistage modified-Delphi process. Practitioners and academic global health experts provided leadership and guidance throughout the competency development process. The resulting product, the Global Health Competency Model 1.1, includes seven domains and 36 competencies. The Global Health Competency Model 1.1 provides a platform for engaging educators, students, and global health employers in discussion of the KSAs needed to improve human health on a global scale.

The birth certificate as an efficient means of identifying children conceived with the help of infertility treatment.

Recent work suggests that infertility treatment is associated with adverse child health outcomes. In exploring various methods of assembling a cohort of children conceived by infertility treatment, the authors conducted a validation study of the assisted reproductive technology and infertility drug use check boxes on the Massachusetts birth certificate. Using 2001 and 2002 data, the authors conducted telephone interviews with 399 women whose child's birth certificate had at least one of the boxes checked along with 185 women who were over age 42 years or who delivered twins or higher order multiples to compare the check box information with maternal report. Among the 579 women with available information, the birth certificate was fully concordant with respect to infertility treatment status for 271 (47%) women, partially concordant for 248 (43%) women, and discordant for 60 (10%) women. Agreement between the birth certificate and maternal report was good for singletons (weighted kappa = 0.66) but was found to be very poor among twins and higher order multiples (weighted kappa = 0.05). The authors concluded that birth certificates are an efficient means of locating children conceived with the help of infertility treatment but that they are not appropriate for identifying type of treatment.

Community knowledge, attitudes, and practices toward rabies prevention in North Vietnam.

In recent years, despite the accessibility to vaccines (both for humans and animals), rabies remains a problem in many areas of Vietnam. While the number of rabies deaths decreased by 90% from 1994 to 2003, the number of rabies deaths increased from 2004 to 2007. In 2007, the number of rabies victims was 2-3 times higher than in 2003 and 131 people died as a result of rabies. In order to better understand Knowledge, Attitudes, and Practices (KAP) toward rabies in areas of both high and low incidence of rabies mortality in Vietnam, and KAP between pet and non-pet owners, a cross-sectional study was carried out by administering a structured questionnaire to 585 respondents from selected households in Thanh Son District-Phu Tho Province and Viet Yen District-Bac Giang Province, Vietnam. KAP in both high and low incidence areas, especially in groups with pets, need to be improved, particularly regarding treatment practices after a dog-bite and recommended pet care. We recommend not only enhanced IEC activities, but also the development of a Behavior Change Communication Strategy (BCC).

Comparative study of control selection in a national population-based case-control study: Estimating risk of smoking on cancer deaths in Chinese men.

PURPOSE: To assess the validation of a novel control selection design by comparing the consistency between the new design and a routine design in a large case-control study that was incorporated into a nationwide mortality survey in China. METHODS: A nationwide mortality study was conducted during 1989-1991. Surviving spouses or other relatives of all adults who died during 1986-1988 provided detailed information about their own as well as the deceased person's smoking history. In this study, 130,079 males who died of various smoking-related cancers at age 35 or over were taken as cases, while 103,248 male surviving spouses (same age range with cases) of women who died during the same period and 49,331 males who died from causes other than those related to smoking were used as control group 1 and control group 2, respectively. Consistency in the results when comparing cases with each of the control groups was assessed. RESULTS: Consistency in the results was observed in the analyses using different control groups although cancer deaths varied with region and age. Equivalence could be ascertained using a 15% criterion in most cancer deaths which had high death rates in urban areas, but they were uncertain for most cancers in rural areas irrespective of whether the hypothesis testing showed significant differences or not. CONCLUSIONS: Sex-matched living spouse control design as an alternative control selection for a case-control study is valid and feasible, and the basic principles of the equivalence study are also supported by epidemiological survey data.

Perinatal risk factors for neuroblastoma.

Neuroblastoma is the most common cancer among infants, suggesting an etiologic role for prenatal factors. In this case-cohort study, neuroblastoma cases (n = 529) diagnosed between 1985 and 2001 were identified from the New York State Cancer Registry and were matched to the electronic birth records for 1983-2001 from New York State and New York City. Controls (n = 12,010) were selected from the same birth cohorts. Analysis was stratified by age at diagnosis, with one to six months (younger infants), seven to 18 months (older infants), and older than 18 months (older children) analyzed separately. Perinatal exposure data was obtained from the birth certificates. No risk factors were identified to be consistently associated with risk across all three age groups. Generally, more risk factors were identified as associated with neuroblastoma among younger infants relative to older ages, including high birth weight, heavier maternal gestational weight gain, maternal hypertension, older maternal age, ultrasound, and respiratory distress. Among older infants, low birth weight was associated with increased risk while heavier maternal gestational weight gain was protective. In the oldest age group, first born status, primary cesarean delivery, prolonged labor and premature rupture of the membranes were associated with increased risk.

Age-related effects of smoking on lung cancer mortality: a nationwide case-control comparison in 103 population centers in China.

PURPOSE: To examine age-related effects of smoking on lung cancer mortality in a large population-based case-control study that was incorporated into a nationwide retrospective survey of mortality in China. METHODS: Two data sets were pooled for this analysis: national mortality survey data and data from a nationwide case-control comparison. These pooled data were used to calculate age-specific lung cancer death rates by smoking status and expected years of lost life expectancy for each smoking-associated death. RESULTS: There was a significant excess of deaths (54% of urban deaths, 51% of rural deaths) at 35 to 69 years of age among male smokers and the average loss of life expectancy per smoking-associated death at these ages was 18.3 years. For women ages 35 to 69 years of age, 29% and 11% excess lung cancer mortality was observed in urban and rural smokers, respectively, with an average loss of life expectancy per smoking-associated death of 21.3 years. CONCLUSIONS: Tobacco smoking was associated with a large number of deaths from lung cancer. Utilizing information from a population-based retrospective mortality survey for conducting an analytic epidemiological study of main determinants of disease is feasible and can generate important results.

The association between body mass index and osteoporosis in patients referred for a bone mineral density examination.

PURPOSE: Osteoporosis affects 4-6 million (13%-18%) postmenopausal white women in the United States. Most studies to date on risk factors for osteoporosis have considered body mass index (BMI) only as a possible confounder. In this study, we assess the direct relationship between BMI and osteoporosis. METHODS: We conducted a cross-sectional study among women aged 50-84 years referred by their physicians for a bone mineral density (BMD) examination at Baystate Medical Center between October 1998 and September 2000. BMI was determined prior to the BMD examination in the clinic. Information on other risk factors was obtained through a mailed questionnaire. Ordinal logistic regression was used to model the association between BMI and osteoporosis, controlling for confounding factors. RESULTS: BMI was inversely associated with BMD status. After adjustment for age, prior hormone replacement therapy (HRT) use, and other factors, odds ratios (OR) for low, high, and obese compared with moderate BMI women were 1.8 (95% CI 1.2-2.7), 0.46 (95% CI 0.29- 0.71), and 0.22 (95% CI 0.14-0.36), respectively, with a significant linear trend (p < 0.0001) across BMI categories. Evaluating BMI as a continuous variable, the odds of bone loss decreased 12% for each unit increase in BMI (OR = 0.88, 95% CI 0.85-0.91). CONCLUSIONS: Women with low BMI are at increased risk of osteoporosis. The change in risk associated with a 1 unit change in BMI ( approximately 5-8 lb) is of greater magnitude than most other modifiable risk factors. To help reduce the risk of osteoporosis, patients should be advised to maintain a normal weight.

Maternal and infant birth characteristics and hepatoblastoma.

Hepatoblastoma is a rare embryonal tumor with unknown etiology. The authors conducted a case-cohort study using public health surveillance data sets to examine perinatal risk factors for hepatoblastoma. Hepatoblastoma cases (n = 58) diagnosed between 1985 and 2001 were identified from the New York State Cancer Registry and were matched to electronic birth records for 1985-2001 from New York State, excluding New York City. Controls (n = 6,056) were selected from the birth cohorts for the same years. Having a birth weight less than 1,000 g was associated with a strongly increased risk of hepatoblastoma (relative risk (RR) = 56.9, 95% confidence interval (CI): 24.0, 130.7). After adjustment for birth weight, a moderately increased risk of hepatoblastoma was found for younger maternal age (<20 years vs. 20-29 years: RR = 2.5, 95% CI: 1.0, 5.5), presumptive use of infertility treatment (RR = 9.2, 95% CI: 2.1, 31.5), maternal smoking (RR = 2.1, 95% CI: 1.0, 4.2), and higher maternal prepregnancy body mass index (body mass index of 25-29 vs. 20-24: RR = 2.9, 95% CI: 1.2, 7.6).

Physical exposures during pregnancy and congenital cardiovascular malformations.

Congenital cardiovascular malformations (CCM) cause substantial neonatal morbidity and mortality. Known risk factors for CCM explain only 10-20% of all cases. Few studies have examined mothers' physical exposures during pregnancy and the risk of CCM in their offspring. This study examined the association between exposures to extreme temperatures, prolonged standing, and heavy lifting during early pregnancy and risk of CCM in offspring. Using a case-control study design, 502 cases and 1066 controls were drawn from the population of all liveborn infants born between January 1988 and June 1991 to mothers living in 14 counties in New York State. Cases were identified from a population-based registry of congenital malformations. Controls were randomly selected from birth certificate records. Interviews were conducted by telephone, using a structured questionnaire. Exposure estimates were based on women's self-reports of conditions in the residence and workplace. Eighty-three per cent of the mothers were white, and 66% were between 25 and 34 years old. After adjusting all results for known risk factors and confounding variables, we found no significant increased risk of CCM in subjects whose mothers reported being exposed during early pregnancy to extreme heat (OR = 1.13, 95% CI 0.59, 2.19), nor to extreme cold (OR = 1.19, 95% CI 0.66, 2.15). Mothers who reported ever using a hot tub, hot bath, or sauna during early pregnancy had no increased risk of CCM in their offspring (OR = 0.88, 95% CI 0.65, 1.18). Performing heavy lifting during early pregnancy did not increase the risk of CCM in offspring (OR = 0.80, 95% CI 0.57, 1.11). Prolonged standing during early pregnancy was not associated with an increased risk of CCM in children (OR = 1.03, 95% CI 0.82, 1.28). Thus if these maternal exposures have an adverse effect, it is unlikely to involve CCMs.

Temporal factors and the prevalence of transient exposures at the time of an occupational traumatic hand injury.

Temporal factors and the prevalence of exposure to transient risk factors for occupational traumatic hand injury were analyzed among 1166 subjects participating in a case-crossover study. Temporal factors included time of injury and elapsed time to injury since the start of the work shift. Transient exposures included work equipment, work practice, and worker-related factors. The highest frequency of injury was observed from 08:00 am to 12:00 pm (54.6%), with a peak from 10:00 to 11:00 am (14.9%). The median time into the work shift for injury was 3.5 hours. Subjects injured 2 to 3 hours into their work shift most often reported using a machine, tool, or work material that performed differently than usual (23.9%). These results suggest that acute hand injuries occur earlier in the workday and safety programs should place increased vigilance on these times.