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Numerous studies have reported associations between fine particulate and sulfur oxide air pollution and human mortality. Yet there continues to be concern that public policy efforts to improve air quality may not produce actual improvement in human health. This study retrospectively explored a natural experiment associated with a copper smelter strike from 15 July 1967 through the beginning of April 1968. In the 1960s, copper smelters accounted for approximately 90% of all sulfate emissions in the four Southwest states of New Mexico, Arizona, Utah, and Nevada. Over the 8.5-month strike period, a regional improvement in visibility accompanied an approximately 60% decrease in concentrations of suspended sulfate particles. We collected monthly mortality counts for 1960-1975 and analyzed them using Poisson regression models. The strike-related estimated percent decrease in mortality was 2.5% (95% confidence interval, 1.1-4.0%), based on a Poisson regression model that controlled for time trends, mortality counts in bordering states, and nationwide mortality counts for influenza/pneumonia, cardiovascular, and other respiratory deaths. These results contribute to the growing body of evidence that ambient sulfate particulate matter and related air pollutants are adversely associated with human health and that the reduction in this pollution can result in reduced mortality.

Weather variability is associated with enteric infections in people through a complex interaction of human, animal, and environmental factors. Although infections have been previously associated with precipitation and temperature, the association between precipitation and drought on campylobacteriosis has not been studied. Using data from Arizona, Colorado, New Mexico, and counties in Utah, this ecological study aimed to assess the association between precipitation and the incidence of campylobacteriosis by county from 2009 to 2021 and to determine how this association is modified by prior drought level and animal operations. We merged 38,782 cases of campylobacteriosis reported in 127 counties with total precipitation (in inches), temperature (in average degrees Fahrenheit), Palmer Drought Severity Index (PDSI, category), and animal census data (presence, density per square mile) by week from 2009 to 2021. Negative binomial generalized estimating equations adjusted for temperature with a 3-wk lag were used to explore the association between precipitation on campylobacteriosis with resulting incidence rate ratios (IRRs). Stratified analyses explored the association with precipitation following antecedent drought, presence of farm operations, and animal density. A 1-in ( ) increase in precipitation was associated with a 3% increase in campylobacteriosis reported 3 wks later ( 1.03; 95% CI: 1.02, 1.04) after adjusting for average temperature and PDSI. Compared with normal conditions, there were significantly more cases when precipitation followed antecedent extremely wet ( 1.15; 95% CI: 1.04, 1.26), very wet ( 1.09; 95% CI: 1.01, 1.18), moderately wet ( 1.06; 95% CI: 1.01, 1.12), moderate drought ( 1.11; 95% CI: 1.07, 1.16), and severe drought ( 1.06; 95% CI: 1.02, 1.11) conditions, whereas there were significantly fewer cases ( 0.89; 95% CI: 0.85, 0.94) for antecedent extreme drought. Compared to counties with no animal operations, counties with animal operations had significantly more cases following precipitation for every PDSI category except extreme drought. Counties with a higher density of beef cattle, goats for meat, chicken broilers, and chicken layers had significantly higher rates of campylobacteriosis following precipitation than those with no such operations, whereas those with dairy cattle and goats for milk, did not. In this majority arid and semiarid environment, precipitation following prior wet conditions and moderate and severe drought were significantly associated with increased rates of campylobacteriosis, and only in prior extreme drought did rates decrease. Where the precipitation fell made a difference; after precipitation, counties with farm operations had significantly more cases compared to counties without farm operations. Further work should assess individual-level risk factors within environmental exposure pathways for . https://doi.org/10.1289/EHP14693.

Coccidioidomycosis (or valley fever) is a fungal disease with high morbidity and mortality that affects tens of thousands of people each year. This infection is caused by two sibling species, Coccidioides immitis and C. posadasii , which are endemic to specific arid locales throughout the Western Hemisphere, particularly the desert southwest of the United States. Recent epidemiological and population genetic data suggest that the geographic range of coccidioidomycosis is expanding, as new endemic clusters have been identified in the state of Washington, well outside the established endemic range. The genetic mechanisms and epidemiological consequences of this expansion are unknown and require better understanding of the population structure and evolutionary history of these pathogens. Here we performed multiple phylogenetic inference and population genomics analyses of 68 new and 18 previously published genomes. The results provide evidence of substantial population structure in C. posadasii and demonstrate the presence of distinct geographic clades in central and southern Arizona as well as dispersed populations in Texas, Mexico, South America, and Central America. Although a smaller number of C. immitis strains were included in the analyses, some evidence of phylogeographic structure was also detected in this species, which has been historically limited to California and Baja, Mexico. Bayesian analyses indicated that C. posadasii is the more ancient of the two species and that Arizona contains the most diverse subpopulations. We propose a southern Arizona-northern Mexico origin for C. posadasii and describe a pathway for dispersal and distribution out of this region. IMPORTANCE Coccidioidomycosis, or valley fever, is caused by the pathogenic fungi Coccidioides posadasii and C. immitis . The fungal species and disease are primarily found in the American desert southwest, with spotted distribution throughout the Western Hemisphere. Initial molecular studies suggested a likely anthropogenic movement of C. posadasii from North America to South America. Here we comparatively analyze eighty-six genomes of the two Coccidioides species and establish local and species-wide population structures to not only clarify the earlier dispersal hypothesis but also provide evidence of likely ancestral populations and patterns of dispersal for the known subpopulations of C. posadasii . Coccidioidomycosis, or valley fever, is caused by the pathogenic fungi Coccidioides posadasii and C. immitis . The fungal species and disease are primarily found in the American desert southwest, with spotted distribution throughout the Western Hemisphere. Initial molecular studies suggested a likely anthropogenic movement of C. posadasii from North America to South America. Here we comparatively analyze eighty-six genomes of the two Coccidioides species and establish local and species-wide population structures to not only clarify the earlier dispersal hypothesis but also provide evidence of likely ancestral populations and patterns of dispersal for the known subpopulations of C. posadasii .

This case-series describes the 6 human infections with Onchocerca lupi, a parasite known to infect cats and dogs, that have been identified in the United States since 2013. Unlike cases reported outside the country, the American patients have not had subconjunctival nodules but have manifested more invasive disease (eg, spinal, orbital, and subdermal nodules). Diagnosis remains challenging in the absence of a serologic test. Treatment should be guided by what is done for Onchocerca volvulus as there are no data for O. lupi. Available evidence suggests that there may be transmission in southwestern United States, but the risk of transmission to humans is not known. Research is needed to better define the burden of disease in the United States and develop appropriately-targeted prevention strategies.

BACKGROUNDHomelessness affects an estimated 1.6 million US youth annually. Compared with housed youth, homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk. However, there is no national estimate of STD prevalence among this population. METHODSWe identified 10 peer-reviewed articles (9 unique studies) reporting STD prevalence among homeless US youth (2000–2015). Descriptive and qualitative analyses identified STD prevalence ranges and risk factors among youth. RESULTSEight studies reported specific STD prevalence estimates, mainly chlamydia, gonorrhea, and syphilis. Overall STD prevalence among homeless youth ranged from 6% to 32%. STD rates for girls varied from 16.7% to 46%, and from 9% to 13.1% in boys. Most studies were conducted in the Western United States, with no studies from the Southeast or Northeast. Youths who experienced longer periods of homelessness were more likely to engage in high-risk sexual behaviors. Girls had lower rates of condom use and higher rates of STDs; boys were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to protective effects on individual sexual risk behavior. CONCLUSIONSSexually transmitted disease prevalence estimates among homeless youth fluctuated greatly by study. Sexually transmitted disease risk behaviors are associated with unmet survival needs, length of homelessness, and influence of social networks. To promote sexual health and reduce STD rates, we need better estimates of STD prevalence, more geographic diversity of studies, and interventions addressing the behavioral associations identified in our review.

OBJECTIVE:The aim of this study was to investigate the prevalence and severity of firefighter sleep quality across department shift schedules. METHODS:Sleep quality was assessed using a Pittsburgh Sleep Quality Index in a sample of 109 male career firefighters from six fire departments in three Southwestern US states. The three shift schedules studied were 24on/48off, 48on/96off, and Kelly. RESULTS:Seventy-three percent of firefighters report poor sleep quality. The 24on/48off shift schedule is associated with the best sleep quality and Kelly is associated with the worst sleep quality. Firefighters working second jobs report significantly poorer sleep quality than those who do not. CONCLUSIONS:Shift schedules that disrupt normal circadian rhythms more result in poorer sleep quality, which can lead to less effective emergency response and increased risk to firefighter health and safety.

Background Onchocerca lupi is a zoonotic, vector-borne filarioid nematode that mainly infects wild and domestic canids in the Southwestern USA, Europe, Asia, and Africa. Clinical canine infections are associated with ocular disease, characterized by the presence of nodules and conjunctivitis. Subclinical cases can be challenging to diagnose, even with evaluation of cutaneous tissues for microfilariae. Current diagnostic tests include conventional polymerase chain reaction (cPCR) to detect O. lupi DNA, and, alternatively, real-time PCR (qPCR), which provides more rapid results and higher throughput. The objectives of this study were to: I) optimize a novel qPCR assay that detects O. lupi and II) to assess the prevalence of O. lupi in shelter dogs from Albuquerque, NM, USA. Methods This probe-based qPCR was optimized with a detection threshold of 0.33 pg for DNA of an adult female O. lupi . We further optimized the assay by performing a dynamic range test to determine the ideal dilution factor and inclusion of an internal positive control. We collected skin snips from the interscapular region of 404 dogs between January and September 2023. Demographics were recorded, including age, sex, American Kennel Club breed groups, and coat color. Dogs were separated into age groups, including juveniles ≤ 1 year old ( n =  120; 29.7%), adults > 1–7 years old ( n =  260; 64.3%), and seniors > 7 years old ( n =  24; 5.9%). Of those, 194 were female, and 210 were male. We also had nine different American Kennel Club breed groups represented, as well as two coat colors: single (33.0%) and mixed (67.0%). Genomic DNA was subjected to cPCR followed by Sanger sequencing and our probe-based qPCR. Both PCRs targeted a fragment of the cytochrome oxidase c subunit 1 ( cox1 ) of the mitochondrial DNA. We performed statistical analysis to assess any association between exposure factors, such as age, sex, breed, and coat color and the outcome, whether O. lupi was present. Results Overall, eight (1.9%; 95% confidence interval (CI) 0.8–3.8%) dogs tested O. lupi -positive via qPCR and five (1.2%; 95% CI 0.4–2.8%) via cPCR. Of the qPCR-positive dogs, six were adults and two were juveniles. Age ( P  = 0.704), sex ( P  = 0.910), breed groups ( P  = 0.217), and coat color ( P  = 0.781) were not statistically associated with a qPCR-positive result with a cutoff of P  < 0.2. In addition, 20 dogs tested positive for Cercopithifilaria bainae via cPCR and sequencing, but these did not cross-react with our qPCR. Conclusions This is the first epidemiological study on O. lupi in a canine population from an urban center within an endemic area in North America. Active surveillance using reliable diagnostic tools can better elucidate the epidemiology of this zoonotic parasite and enable the implementation of strategies for control and prevention. Graphical Abstract

Cardiomyopathy in children is a serious disorder that often results in cardiac transplantation or death. This study was based on a 1996–1999 registry of cases in New England and in Texas, Oklahoma, and Arkansas. The overall annual incidence was 1.13 cases per 100,000 children, but the incidence was much higher among infants than in other age groups. Dilated and hypertrophic cardiomyopathies predominated. The incidence was higher in boys than in girls and in blacks than in whites. Cardiomyopathy is a very serious disorder in children, and nearly 40 percent of children who present with symptomatic cardiomyopathy receive a heart transplant or die within the first two years. 1 The time to transplantation or death for children with cardiomyopathy has not improved during the past 35 years, and the outcomes in the most economically advanced nations are no better than those in developing nations. 2 – 4 The cardiomyopathies have an associated cost of nearly $200 million per year in adults and children in the United States alone. 5 , 6 The percentage of children with cardiomyopathy who receive a heart transplant has . . .

The burden of Alzheimer’s disease and related dementias (ADRD) has increased substantially in the United States, particularly in health disparity populations. Little is known about the epidemiology of ADRD in American Indian (AI) adults, although they have a high prevalence of ADRD risk factors including hypertension, diabetes, obesity, and smoking. Using electronic health records from a large health care organization during 2016-18, we describe characteristics of AI patients aged ≥55 years with and without an ADRD diagnosis, assess ADRD risk factors and contrast findings with results from age- and sex-matched non-Hispanic White (NHW) patients. To identify factors associated with ADRD diagnoses, we estimated population-averaged prevalence rate ratios to approximate relative risk (RR) using generalized estimating equations models adjusted for age, sex, and marital and rural residency status. The age-adjusted prevalence of ADRD diagnosis was 6.6% of AI patients, compared with 4.4% in NHW patients. Patient age and diagnosis of hypertension, depression, hyperlipidemia, or diabetes were significantly associated with higher risk of ADRD diagnosis in AIs (RR range: 1.1-2.8) whereas female sex or being married/having a partner were associated with lower risk of ADRD diagnosis (each RR=.7). ADRD risk factors were generally similar between AI and NHW patients, except for sex and marital status. However, the adjusted risk of ADRD was approximately 49% higher in AI patients. To our knowledge, our study is the first to examine ADRD diagnoses and comorbidities in AIs across a large geographical region in southwest United States. Future efforts to confirm our findings in diverse AI communities are warranted.

Purpose This study sought to develop a comprehensive measure of fitness that is predictive of injury risk and can be used in the fire service to assess individual-level health and fit-for-duty status. Methods A retrospective occupational cohort of 799 career fire service employees was observed over the years 2005–2009. An equally weighted score for comprehensive fitness was calculated based on cardiovascular fitness, muscular strength, endurance, flexibility, and body composition. Repeated measures survival analyses were used to estimate the risk of any injury, sprain or strain, and exercise-related injuries in relation to comprehensive fitness. Results A well-distributed comprehensive fitness score was developed to distinguish three tiers of overall fitness status. Intraclass correlations identified flexibility, total grip strength, percent body fat, and resting heart rate as the most reliable fitness metrics, while push-ups, sit-ups, and aerobic capacity demonstrated poor reliability. In general, individuals with a lower comprehensive fitness status had an increased injury risk of injury as compared to the most fit individuals. The risk of any injury was 1.82 (95 % CI 1.06–3.11) times as likely for the least fit individuals, as compared to individuals in the top fire fitness category, increasing to 2.90 (95 % CI 1.48–5.66) when restricted to sprains and strains. Conclusions This 5-year analysis of clinical occupational health assessments enabled the development of a relevant metric for relating comprehensive fitness with the risk of injury. Results were consistent with previous studies focused on cardiorespiratory fitness, but also less susceptible to inter-individual variability of discrete measurements.