Research and Faculty

Int Arch Occup Environ Health. 2023 Jun 1. doi: 10.1007/s00420-023-01980-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To elucidate whether occupational noise exposure increases the mortality from ischemic heart disease (IHD) and stroke, and if exposure to paper dust modified the risks.

METHODS: We studied 6686 workers from soft paper mills, with occupational noise exposure, < 85 dBA, 85-90 dBA and > 90 dBA, and high (> 5 mg/m³) exposure to paper dust. Person-years 1960-2019 were stratified according to gender, age, and calendar-year. Expected numbers of deaths were calculated using the Swedish population as the reference and standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were assessed.

RESULTS: SMR for IHD was 1.12 (95% CI 0.88-1.41) for noise < 85 dBA, 1.18 (95% CI 0.90-1.55) for 85-90 dBA, and 1.27 (95% CI 1.10-1.47) among workers exposed > 90 dBA. Joint exposure to high noise exposure and high exposure to paper dust resulted in slightly higher IHD mortality (SMR 1.39, 95% CI 1.15-1.67). SMR for ischemic stroke was 0.90 (95% CI 0.37-2.15) for noise < 85 dBA, 1.08 (95% CI 0.45-2.59) for 85-90 dBA, and 1.48 (95% CI 0.99-2.00) among workers exposed > 90 dBA. High noise exposure and high exposure to paper dust resulted in higher ischemic stroke mortality (SMR 1.83, 95% CI 1.12-2.98).

CONCLUSION: Noise levels > 90 dBA was associated with increased IHD mortality. Combined exposures of noise and paper dust may further increase the risks. Our results do not provide support for a causal relationship for ischemic stroke. Residual confounding from smoking has to be considered. Workers need to be protected from occupational noise levels exceeding 90 dBA.

PMID:37261594 | DOI:10.1007/s00420-023-01980-x

Toxics. 2023 May 3;11(5):424. doi: 10.3390/toxics11050424.

ABSTRACT

High blood pressure (BP) is a risk factor for hypertensive disease during pregnancy. Exposure to multiple toxic air pollutants can affect BP in pregnancy but has been rarely studied. We evaluated trimester-specific associations between air pollution exposure and systolic (SBP) and diastolic BP (DBP). Ozone (O₃), sulfur dioxide (SO₂), carbon monoxide (CO), nitrogen dioxide (NO₂), and particulate matter less than 10 and 2.5 μm in aerodynamic diameter (PM₁₀, PM_2.5) in the Pregnancy Research on Inflammation, Nutrition, & City Environment: Systematic Analyses (PRINCESA) study. Multipollutant generalized linear regression models with each pollutant and O₃ were fit. Due to nonlinear pollution/BP associations, results are presented for “below the median” or “above the median”, where the beta estimate is the change in BP at a pollutant’s median versus BP at the pollutant’s minimum or maximum, respectively. Associations varied across trimesters and pollutants, and deleterious associations (higher blood pressure with higher pollution) were found only at pollutant values below the median: for SBP with NO₂ in the second and third trimesters, and PM_2.5 during the third trimester, and for DBP, PM_2.5^, and NO₂ in the second and third trimesters. Findings suggest that minimizing prenatal exposure to air pollution may reduce the risks of changes in BP.

PMID:37235239 | PMC:PMC10222039 | DOI:10.3390/toxics11050424

Environ Sci Technol. 2023 Jun 6;57(22):8245-8255. doi: 10.1021/acs.est.2c09588. Epub 2023 May 23.

ABSTRACT

The recent concurrence of electrical grid failure events in time with extreme temperatures is compounding the population health risks of extreme weather episodes. Here, we combine simulated heat exposure data during historical heat wave events in three large U.S. cities to assess the degree to which heat-related mortality and morbidity change in response to a concurrent electrical grid failure event. We develop a novel approach to estimating individually experienced temperature to approximate how personal-level heat exposure changes on an hourly basis, accounting for both outdoor and building-interior exposures. We find the concurrence of a multiday blackout event with heat wave conditions to more than double the estimated rate of heat-related mortality across all three cities, and to require medical attention for between 3% (Atlanta) and more than 50% (Phoenix) of the total urban population in present and future time periods. Our results highlight the need for enhanced electrical grid resilience and support a more spatially expansive use of tree canopy and high albedo roofing materials to lessen heat exposures during compound climate and infrastructure failure events.

PMID:37219950 | DOI:10.1021/acs.est.2c09588

Am J Infect Control. 2023 May 12:S0196-6553(23)00363-2. doi: 10.1016/j.ajic.2023.05.005. Online ahead of print.

ABSTRACT

BACKGROUND: Heat strain and dehydration can affect an individual’s physical and mental performance. The purpose of this review was to examine the literature for the impact of heat strain on healthcare workers (HCWs) who care for patients with high-consequence infectious diseases (HCIDs) while wearing personal protective equipment (PPE), discuss risks of impaired safety caused by heat strain and dehydration in HCID environments, identify attempts to combat PPE-related heat strain, recognize limitations, and provide suggestions for further research.

MATERIALS AND METHODS: A literature search was performed in PubMed/MEDLINE and Google Scholar. Authors screened abstracts for inclusion criteria and reviewed articles if abstracts were considered to include information relevant to the aim.

RESULTS: The search terms yielded 30 articles that were sorted based on environment setting, physiological impact, and interventions.

DISCUSSION: Safety of HCWs and patients can be enhanced through development and usage of cooler, more comfortable PPE and PPE ensembles to help slow the rate of dehydration and support regulation of core body temperature.

CONCLUSIONS: Heat strain caused by wearing PPE is an occupational health concern for HCWs in the high-risk environment that is HCID care. Future studies are needed to develop innovative PPE ensembles that can reduce heat strain and improve well-being.

PMID:37182761 | DOI:10.1016/j.ajic.2023.05.005

Air Med J. 2023 May-Jun;42(3):201-209. doi: 10.1016/j.amj.2022.12.007. Epub 2023 Jan 3.

ABSTRACT

OBJECTIVE: In 2019, our team conducted a literature review of air medical evacuation high-level containment transport (AE-HLCT) of patients infected with high-consequence pathogens. Since that publication, the coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous air medical evacuations. We re-examined the new literature associated with AE-HLCTs to determine new innovations developed as a result of the pandemic.

METHODS: A literature search was performed in PubMed/MEDLINE from February 2019 to October 2021. The authors screened abstracts for the inclusion criteria and reviewed full articles if the abstract was relevant to the aim.

RESULTS: Our search criteria yielded 19 publications. Many of the early transports of patients with COVID-19 used established protocols for AE-HLCT, which were built from the most recent transports of patients with Ebola virus disease. Innovations from the identified articles are subdivided into preflight considerations, in-flight operations, and postflight operations.

CONCLUSION: Lessons gleaned from AE-HLCTs of patients with COVID-19 in the early weeks of the pandemic, when little was known about transmission or the severity of the novel disease, have advanced the field of AE-HLCT. Teams that had never conducted such transports now have experience and processes. However, more research into AE-HLCT is needed, including research related to single-patient portable isolation units as well as containerized/multipatient transportation systems.

PMID:37150575 | PMC:PMC9808413 | DOI:10.1016/j.amj.2022.12.007

Environ Sci Pollut Res Int. 2023 May;30(24):65544-65557. doi: 10.1007/s11356-023-26833-5. Epub 2023 Apr 22.

ABSTRACT

Endocrine-disrupting chemicals (EDCs) may impact sleep during the menopausal transition by altering sex hormones. However, these studies are scarce among Latin American women. This investigation utilized cross-sectional and retrospective data from midlife women enrolled in the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) study to examine associations between exposure to EDCs (phthalates, phenols, and parabens) and sleep health measures. For cross-sectional analyses, single spot urine samples were collected between 2017-2019 from a pilot sample of women (N = 91) of midlife age to estimate the urinary concentration of individual phthalates, phenols, and parabens and to calculate the summary concentration of phthalate mixtures. Seven-day nightly sleep duration, midpoint, and fragmentation were obtained from wrist-actigraphy devices and estimated from the actigraphy data using a pruned dynamic programming algorithm. Self-reported poor sleep quality was assessed by one item from the Pittsburgh Sleep Quality Index (PSQI). We examined associations between urinary summary phthalate mixtures, phthalate metabolites, phenol, and paraben analytes with each sleep measure using linear or logistic (to compute odds of poor sleep quality only) regression models adjusted for specific gravity, age, and socioeconomic status. We ran similar regression models for retrospective analyses (N = 74), except that urine exposure biomarker data were collected in 2008 when women were 24-50 years old. At the 2017-2019 midlife visit, 38% reported poor sleep quality. Cross-sectionally, EDCs were associated with longer sleep duration, earlier sleep timing, and more fragmented sleep. For example, every 1-unit IQR increase in the phenol triclosan was associated with a 26.3 min per night (95% CI: 10.5, 42.2; P < 0.05) longer sleep duration and marginally associated with 0.2 decimal hours (95% CI: -0.4, 0.0; P < 0.10) earlier sleep midpoint; while every 1-unit IQR increase in the phthalate metabolite MEHP was associated with 1.1% higher sleep fragmentation (95% CI: 0.1, 2.1; P < 0.05). Retrospective study results generally mirrored cross-sectional results such that EDCs were linked to longer sleep duration, earlier sleep timing, and more fragmented sleep. EDCs were not significantly associated with odds of self-reported poor sleep quality. Results from cross-sectional and retrospective analyses revealed that higher exposure to EDCs was predictive of longer sleep duration, earlier sleep timing, and more fragmented sleep among midlife women.

PMID:37086320 | DOI:10.1007/s11356-023-26833-5

Environ Sci Technol. 2023 Apr 25;57(16):6435-6443. doi: 10.1021/acs.est.2c05911. Epub 2023 Apr 11.

ABSTRACT

Organophosphate esters (OPEs) are an emerging class of chemicals used in a variety of consumer products as flame retardants, plasticizers, and additives. While prior epidemiologic studies suggest that OPEs may impact respiratory health, results remain inconclusive. We examined associations between urinary biomarkers of OPEs and symptoms of respiratory morbidity in a panel study of 147 predominantly Black school-aged children with asthma living in Baltimore City, Maryland. The study consisted of up to four seasonal, week-long, in-home visits where urine samples and self-reported asthma symptoms were collected on days 4 and 7 (n_samples = 438). We quantified concentrations of nine urinary OPE biomarkers: bis(2-chloroethyl) phosphate (BCEtp), bis(1-chloro-2-propyl) phosphate (BCPP), bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), di-n-butyl phosphate (DBuP), di-benzyl phosphate (DBzP), di-o-cresylphosphate (DOCP), di-p-cresylphosphate (DPCP), di-(2-propylheptyl) phthalate (DPHP), and 2,3,4,5-tetrabromo benzoic acid (TBBA). We estimated prevalence odds ratios (POR) of respiratory morbidity symptoms using logistic regression with generalized estimating equations to account for our repeated measure design. We assessed BDCIPP and DPHP as continuous (log₂) concentrations and dichotomized exposure of BCEtP, DBuP, and DPCP (detect vs non-detect) based on their lower detection frequencies. We adjusted models for season, visit day, age, gender, caregiver education, health insurance type, exposure to household smoking, atopy, and PM_2.5. Higher DPHP concentrations were significantly associated with odds of daytime symptoms (POR: 1.26; 95% CI: 1.04-1.53; p = 0.02) where daytime symptoms consisted of trouble breathing due to asthma, reporting bother caused by asthma, and/or limitation in activities due to asthma. DBuP detection was associated with use of rescue medication on the day of sample collection (POR: 2.36; 95% CI: 1.05-5.29; p = 0.04). We also observed several consistent, albeit non-significant (p > 0.05), positive associations for BCEtP and DPCP and respiratory morbidity measures. This is the first study to evaluate the relationship between OPE biomarkers and respiratory morbidity symptoms in children with asthma, and findings suggest that further studies are warranted to confirm whether these associations are causal.

PMID:37040548 | DOI:10.1021/acs.est.2c05911

Am J Epidemiol. 2023 Mar 24:kwad071. doi: 10.1093/aje/kwad071. Online ahead of print.

ABSTRACT

The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children’s health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-wide Cohort data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in five main outcome areas: pre-, peri-, and post-natal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include place- (e.g., air pollution, neighborhood socioeconomic status), family- (e.g., parental mental health), and individual-level (e.g., diet, genomics) factors.

PMID:36963379 | DOI:10.1093/aje/kwad071

Environ Health Perspect. 2023 Mar;131(3):37006. doi: 10.1289/EHP10723. Epub 2023 Mar 15.

ABSTRACT

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress.

OBJECTIVES: We estimated risk of adverse birth outcomes in relation to prenatal PFAS concentrations and evaluate whether maternal stress modifies those relationships.

METHODS: We included 3,339 participants from 11 prospective prenatal cohorts in the Environmental influences on the Child Health Outcomes (ECHO) program to estimate the associations of five PFAS and birth outcomes. We stratified by perceived stress scale scores to examine effect modification and used Bayesian Weighted Sums to estimate mixtures of PFAS.

RESULTS: We observed reduced birth size with increased concentrations of all PFAS. For a 1-unit higher log-normalized exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS), we observed lower birthweight-for-gestational-age z-scores of β=–0.15 [95% confidence interval (CI): –0.27, –0.03], β=–0.14 (95% CI: –0.28, –0.002), β=–0.22 (95% CI: –0.23, –0.10), β=–0.06 (95% CI: –0.18, 0.06), and β=–0.25 (95% CI: –0.37, –0.14), respectively. We observed a lower odds ratio (OR) for large-for-gestational-age: ORPFNA=0.56 (95% CI: 0.38, 0.83), ORPFDA=0.52 (95% CI: 0.35, 0.77). For a 1-unit increase in log-normalized concentration of summed PFAS, we observed a lower birthweight-for-gestational-age z-score [–0.28; 95% highest posterior density (HPD): –0.44, –0.14] and decreased odds of large-for-gestational-age (OR=0.49; 95% HPD: 0.29, 0.82). Perfluorodecanoic acid (PFDA) explained the highest percentage (40%) of the summed effect in both models. Associations were not modified by maternal perceived stress.

DISCUSSION: Our large, multi-cohort study of PFAS and adverse birth outcomes found a negative association between prenatal PFAS and birthweight-for-gestational-age, and the associations were not different in groups with high vs. low perceived stress. This study can help inform policy to reduce exposures in the environment and humans. https://doi.org/10.1289/EHP10723.

PMID:36920051 | PMC:PMC10015888 | DOI:10.1289/EHP10723

Workplace Health Saf. 2023 Mar;71(3):152. doi: 10.1177/21650799221147169.

NO ABSTRACT

PMID:36869719 | PMC:PMC10153065 | DOI:10.1177/21650799221147169