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Persistent pollutants, such as polychlorinated biphenyls (PCBs), affect endocrine function. Human exposure to polybrominated diphenyl ethers (PBDEs), which are similar in structure to PCBs, has increased recently, but health effects have not been well studied. Our goal in this study was to determine whether PBDE body burdens are related to thyroid and steroid hormone levels, thyroid antibodies, and thyroid disease in a cohort of frequent and infrequent adult male sport fish consumers. We tested serum from 405 adult males for PBDE congeners, PCB congeners, testosterone, sex-hormone-binding globulin (SHBG), SHBG-bound testosterone, thyroglobulin antibodies, and the thyroid hormones thyroxine (T(4)), triiodothyronine (T(3)), thyroid-stimulating hormone (TSH), and T(4)-binding globulin (TBG). We collected data on demographics, fish consumption, medical diseases, and medication use. The median sum of PBDEs was 38 ng/g lipid. In 308 men without thyroid disease or diabetes, PBDEs were positively related to measures of T(4) and reverse T(3) and inversely related to total T(3) and TSH. PBDEs were positively related to the percentage of T(4) bound to albumin, and inversely related to the percentage of T(4) bound to TBG. Associations of BDE congeners with hormones varied. BDE-47 was positively associated with testosterone levels. Participants with PBDEs over the 95th percentile were more likely to have thyroglobulin antibodies, although high PBDE exposure was not associated with thyroid disease. PBDE effects were independent of PCB exposure and sport fish consumption. PBDE exposure, at levels comparable with those of the general U.S. population, was associated with increased thyroglobulin antibodies and increased T(4) in adult males.

Background: Thyroid hormone homeostasis can be disrupted by exposure to ubiquitous and bioaccumulative organochlorines such as polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins (PCDDs). Whereas investigations of health effects have generally focused on human populations with relatively high exposures through occupation, accident, or high fish consumption, general population exposures may also carry risk. Methods: We studied associations of total thyroxine (T4) and thyroid-stimulating hormone (TSH) with PCBs, dioxin-like toxic equivalents (TEQs), and p,p'-diphenyldichloroethene (DDE) in adult participants without thyroid disease who participated in the 1999-2002 National Health and Nutrition Examination Survey, a cross-sectional survey examining a random sample representative of the U.S. population. Results: We found inverse associations of total T4with exposure to TEQs in both sexes, with stronger associations in females. In women, mean T4was$8.2 \\mu g/dL$, and levels were on average$0.75 \\mu g/dL$lower (95% confidence interval, 0.04-1.46) in women in the highest quintile of TEQ exposure compared with the lowest two quintiles. Effects were stronger in people > 60 years of age, with negative associations of T4with PCBs and TEQs, and positive associations of TSH with PCBs and TEQs in older women, and a negative association of TSH with PCBs in older men. Conclusions: The data show a dose-dependent decrease in total T4with exposure to TEQs at levels similar to those found in the general U.S. population. The effects were stronger in women. The results suggest that older adults, who have a high risk of thyroid disease, may be more at risk for disruption of thyroid hormone homeostasis by dioxin-like organochlorines than younger adults.

ObjectiveCardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers.MethodsCross-sectional data from 7404 employed individuals, aged 18–74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models.ResultsHispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures.ConclusionsOur results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively.

Exposures to environmental pollutants are often composed of mixtures of chemicals that can be highly correlated because of similar sources and/or chemical structures. The effect of an individual chemical on a health outcome can be weak and difficult to detect because of the relatively low level of exposures to many environmental pollutants. To tackle the challenging problem of assessing the health risk of exposure to a mixture of environmental pollutants, we propose a statistical approach to assessing the proportion of the variation of an outcome explained by a mixture of pollutants. The proposed approach avoids the difficult task of identifying specific pollutants that are responsible for the effects and may also be used to assess interactions among exposures. Extensive simulation results demonstrate that the proposed approach has very good performance. Application of the proposed approach is illustrated by investigating the main and interaction effects of the chemical pollutants on systolic and diastolic blood pressure in participants from the National Health and Nutrition Examination Survey.

We assessed the cross-sectional relationships of self-reported current occupational exposures to solvents, metals, and pesticides with metabolic syndrome and its components among 7127 participants in the Hispanic Community Health Study/Study of Latinos. Metabolic syndrome was defined as a clustering of abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and/or high fasting glucose. Regression models that incorporated inverse probability of exposure weighting were used to estimate prevalence ratios. Solvent exposure was associated with a 32% higher prevalence of high blood pressure (95% confidence interval: 1.09 to 1.60) than participants not reporting exposure. No associations were observed for occupational exposures with abdominal obesity, high triglycerides, low high-density lipoprotein, or metabolic syndrome. Our findings suggest that solvent exposure may be an important occupational risk factor for high blood pressure among Hispanics/Latinos in the United States.

[...]it is important to continue research in the area with animal models and more precise measures of the amount and timing of exposure, possible confounding associated symptoms, and benefit versus risk assessments of alternative approaches.

Background Studies have shown associations of diabetes and endogenous hormones with exposure to a wide variety of organochlorines. We have previously reported positive associations of polychlorinated biphenyls (PCBs) and inverse associations of selected steroid hormones with diabetes in postmenopausal women previously employed in a capacitor manufacturing plant. Methods This paper examines associations of PCBs with diabetes and endogenous hormones in 63 men previously employed at the same plant who in 1996 underwent surveys of their exposure and medical history and collection of bloods and urine for measurements of PCBs, lipids, liver function, hematologic markers and endogenous hormones. Results PCB exposure was positively associated with diabetes and age and inversely associated with thyroid stimulating hormone and triiodothyronine-uptake. History of diabetes was significantly related to total PCBs and all PCB functional groupings, but not to quarters worked and job score, after control for potential confounders. None of the exposures were related to insulin resistance (HOMA-IR) in non-diabetic men. Conclusions Associations of PCBs with specific endogenous hormones differ in some respects from previous findings in postmenopausal women employed at the capacitor plant. Results from this study, however, do confirm previous reports relating PCB exposure to diabetes and suggest that these associations are not mediated by measured endogenous hormones.

Background: Studies have demonstrated ubiquitous human exposure to persistent organic pollutants (POPs) such as p,p'-diphenyldichloroethene (DDE) and polychlorinated biphenyls (PCBs). Although there is considerable evidence that POP exposures are associated with prevalent diabetes, these studies do not establish causality because the cross-sectional study design does not allow for assessment of temporality of the exposure-disease association. Prospective studies, however, have been lacking. Objectives: This study was designed to determine whether POP body burdens are related to incidence of diabetes in a cohort of Great Lakes sport fish consumers. Methods: The cohort was established in the early 1990s and followed through 2005. We tested serum for DDE and PCB congeners and assessed diabetes diagnosis, demographics, and fish consumption. Associations of diabetes with exposures were examined prospectively in participants without diabetes in 1994-1995, followed through 2005. Annual percent changes in DDE and PCB-132/153 from 1994 to 2005 were examined by diabetes status. Results: DDE exposure was associated with incident diabetes. Incident diabetes was not associated with mono-ortho PCB-118, total PCBs, or years of sport fish consumption. Annual percent change in DDE and PCB-132/153 did not differ significantly by diabetes status. Conclusions: This study demonstrates an association between DDE exposure and incident diabetes. The findings of an association of DDE with incident diabetes and the lack of effect of diabetes on annual percent change in POPs do not support the hypothesis that associations of POPs with diabetes are attributable to reverse causality. Additional studies should address the biological pathways by which DDE could affect glucose homeostasis.

Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre-post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child's asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites.

Objectives. We analyzed the response of the Chicago Department of Public Health with respect to its effectiveness in providing health care to Hurricane Katrina evacuees arriving in the city. Methods. Between September 12 and October 21, 2005, we conducted a real-time qualitative assessment of a medical unit in Chicago's Hurricane Victim Welcome and Relief Center. A semistructured guide was used to interview 33 emergency responders in an effort to identify key operational successes and failures. Results. The medical unit functioned at a relatively high level, primarily as a result of the flexibility, creativity, and dedication of its staff and the presence of strong leadership. Chronic health care services and prescription refills were the most commonly mentioned services provided, and collaboration with a national pharmacy proved instrumental in reconstructing medication histories. The lack of a comprehensive and well-communicated emergency response plan resulted in several preventable inefficiencies. Conclusions. Our findings highlight the need for improved planning for care of evacuee populations after a major emergency event and the importance of ensuring continuity of care for the most vulnerable. We provide an emergency response preparedness checklist for local public health departments.