To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascu... more To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascularization in patients with proliferative diabetic retinopathy (PDR). Cross-sectional comparative case series. One hundred fifty-one consecutive patients with PDR who underwent surgery in our hospital were divided based on the presence of iris and/or angle neovascularization (NV group, 37 patients) or absence of NV (non-NV group, 114 patients). Pulse oximetry was conducted during the night and the mean SpO(2), 4% oxygen desaturation index (4% ODI times/hour), the lowest SpO(2)% during sleep (lowest SpO(2)), and the cumulative percentage of time at SpO(2) <90% in analysis times (CT90%) were calculated. When the 4% ODI exceeded 5 times/hour, sleep-disordered breathing was diagnosed. The results were compared between the 2 groups. Preoperative systemic parameters also were analyzed by logistic regression to clarify risk factors for the NV group. A mean total of 50% (62% of the NV group and 46% of the non-NV group) was diagnosed with sleep-disordered breathing. The mean SpO(2) and lowest SpO(2) did not differ significantly between the 2 groups; the 4% ODI (12.3 vs 6.6) and CT90% (3.8 vs 1.7) were significantly higher in the NV group (P=.02, for both comparisons). Logistic regression analysis identified insulin therapy (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.26∼7.20; P=.01); and 4% ODI (OR, 1.09; CI, 1.01∼1.16; P=.02) as risk factors for the NV group. In patients with PDR, nocturnal intermittent hypoxia/reoxygenation resulting from sleep-disordered breathing may be a risk factor for iris and/or angle neovascularization.
In order to determine the cause of the elevated blood lead levels in rural Illinois children, the... more In order to determine the cause of the elevated blood lead levels in rural Illinois children, the Illinois State Water survey has teamed up with the University of Illinois at Chicago and Northern Illinois University to do a pilot study in three rural Illinois counties. The team hypothesizes that the lead is coming from lead well packers in older wells and lead pipes in older homes. Their research goals include: 1. Characterize the distribution of lead concentrations and water corrosivity in homes using domestic well water in three counties in Illinois. 2. Develop and evaluate health department partnerships, participant recruitment approaches, and home sampling methods in order to inform the design of a scaledup study. 3. If water lead levels (WLLs) are found to be elevated, options for mitigating sources of lead and/or corrosivity will be explored with owners of impacted homes and with health departments. 4. Determine if a larger study and additional interventions are needed to redu...
(ISWS) assisted in kit preparation, data screening, and Phase II sampling. Sam Panno (Illinois St... more (ISWS) assisted in kit preparation, data screening, and Phase II sampling. Sam Panno (Illinois State Geological Survey) contributed to the study development and hydrogeological information. We are grateful to the homeowners who participated in the project, especially those who allowed us to sample their wells during Phase II.
To evaluate the interactions between polyfluoroalkyl substances (PFASs) and reproductive hormones... more To evaluate the interactions between polyfluoroalkyl substances (PFASs) and reproductive hormones and associated asthma, a total of 231 asthmatic and 225 non-asthmatic adolescents were selected from northern Taiwan in the Genetic and Biomarkers study for Childhood Asthma from 2009-2010. The interaction between PFASs and reproductive hormones on asthma was analyzed with a two-level binary logistic regression model. The results showed that, among asthmatics, PFASs were positively associated with estradiol levels and negatively associated with testosterone levels. However, only significant association was identified for PFNA and estradiol in control group. After controlling for hormone levels, associations between PFAS exposure and asthma were consistently stronger among children with higher than lower estradiol, with odds ratios (OR) for asthma ranging from 1.25 for PFOS (95% Confidence Interval [CI]: 0.90, 1.72) to 4.01 for PFDA (95% CI: 1.46, 11.06) among boys and 1.25 for PFOS (95% CI: 0.84, 1.86) to 4.16 for PFNA (95% CI: 1.36, 12.73) among girls. Notably, the interactions between estradiol and PFASs were significant for PFOS (p = 0.026) and PFNA (p = 0.043) among girls. However, testosterone significantly attenuated the association between PFOS and asthma across sex. In conclusions, our findings suggested that reproductive hormones amplify the association between PFASs and asthma among adolescents. Asthma is an increasing new onset inflammatory disease that involves both intrinsic and environmental factors. Research indicates that perfluoroalkyl and polyfluoroalkyl substances (PFASs), types of persistent organic pollutants, are associated with asthma and related outcomes, including airway hyperresponsiveness, increased serum levels of immunoglobulin E (IgE), and switched type 2 T helper cell (Th2) polarization 1-4. Anderson-Mahoney et al. first identified the positive association between PFOA exposure and asthma 4. US National Health and Examination Survey (NHANES) data showed that serum PFOA concentrations are positively associated with self-reported lifetime asthma prevalence 5 .
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 11, 2017
Existing studies on sleep quality and associated obesity are inconsistent, and few studies have p... more Existing studies on sleep quality and associated obesity are inconsistent, and few studies have prospectively evaluated the association between sleep quality and abdominal obesity among Chinese individuals. To fill this void, the current study aimed to assess the association between sleep quality and abdominal obesity in a rural Chinese population. A representative sample of 9,404 adults aged 20-93 y in northeastern China was selected between 2012 and 2013 by a multistage cluster and random sampling method. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), where a score of 6 or higher indicated sleep disorder. Abdominal obesity was measured by waist circumference (WC), with abdominal obesity defined as WC > 90 cm for men and WC > 80 cm for women. Male participants with abdominal obesity had higher global PSQI scores in addition to higher subscores in almost all of the elements compared to normal values. The odds ratios of abdominal obesity among partici...
Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertens... more Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertension, cardiovascular disease (CVD), and mortality. Self-rated health (SRH) has been shown to be a predictor of CVD and mortality. However, study of the association between insufficient sleep and SRH is limited. We examined participants >18 years of age (n=377, 160) from a representative, cross-sectional survey (2008 BRFSS). Self-reported insufficient sleep in the previous 30 days was categorized into six groups. The outcome was poor SRH. We calculated odds ratios ((OR) (95% confidence interval (CI)) of increasing categories of insufficient rest/sleep, taking zero days of insufficient sleep as the referent category. We found a positive association between increasing categories of insufficient sleep and poor SRH, independent of relevant covariates. In the multivariable-adjusted model, compared to 0 days insufficient sleep, the OR (95% CI) of poor SRH was 1.03 (0.97–1.10) for 1–6 days, 1....
Background: Hypertension is a leading cause of cardiovascular disease worldwide. Perfluorooctanoi... more Background: Hypertension is a leading cause of cardiovascular disease worldwide. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are perfluoroalkyl chemicals (PFCs) used in the manufacture of common consumer products and detected in the blood of the majority of Americans. Emerging biological data suggest that PFC exposure may have a role in the development of hypertension. However, the association between PFCs and hypertension has not yet been explored in humans. Therefore, we examined this association in a representative sample of US children. Methods: A cross-sectional study was performed on 1,655 children from the National Health and Nutrition Examination Survey, 1999-2000 and 2003-2008. The main outcome of interest was hypertension, defined as age, height, and sex specific systolic and/or diastolic blood pressure level at the 95th percentile. Results: We found no association between serum levels of PFOA and PFOS and hypertension in either unadjusted or multivariable-adjusted analyses controlling for age, sex, race-ethnicity, body mass index, annual household income, moderate activity, total serum cholesterol, and serum cotinine. Compared with the lowest quartile, the multivariable-adjusted odds ratio (95% confidence interval) of hypertension in the highest quartile of exposure was 0.69 (0.41-1.17) for PFOA and 0.77 (0.37-1.61) for PFOS (all P-trend values .0.30). Conclusion: Our findings indicate that exposure to PFOA or PFOS is not significantly associated with hypertension in children at the lower PFC exposure levels typical of the general population.
Hyperuricemia in children is associated with increased risk of high blood pressure, metabolic syn... more Hyperuricemia in children is associated with increased risk of high blood pressure, metabolic syndrome, and future cardiovascular disease. Serum perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) levels have been shown to be positively associated with hyperuricemia in adults, but the association in children remains unexplored. We therefore examined the association between serum PFOA and PFOS levels and hyperuricemia in a representative sample of US children. A cross-sectional study was performed on 1,772 participants ≤18 years of age from the National Health and Nutrition Examination Survey 1999-2000 and 2003-2008. The main outcome of interest was hyperuricemia, defined as serum uric acid levels ≥6 mg/dL. We found that serum levels of PFOA and PFOS were positively associated with hyperuricemia, independent of age, sex, race/ethnicity, body mass index, annual household income, physical activity, serum total cholesterol, and serum cotinine levels. Compared with subjects in quartile 1 (referent), subjects in quartile 4 had multivariable-adjusted odds ratios for hyperuricemia of 1.62 (95% confidence interval: 1.10, 2.37) for PFOA and 1.65 (95% confidence interval: 1.10, 2.49) for PFOS. Our findings indicate that serum perfluoroalkyl chemical levels are significantly associated with hyperuricemia in children even at the lower "background" exposure levels of the US general population.
Objective: Our objective was to examine racial/ethnic disparities in injury-related risk behavior... more Objective: Our objective was to examine racial/ethnic disparities in injury-related risk behaviors and deaths among teens in Missouri, with a focus on Hispanic people—the fastest-growing racial/ethnic group in the state. Methods: We used data from the 2013 Missouri Youth Risk Behavior Survey, which included 1616 students in grades 9 through 12 from 32 public and charter high schools. The overall response rate was 69%. We compared the prevalence of 10 injury-related risk behaviors among racial/ethnic groups and used multivariate logistic regression models to control for respondent age and sex. Using data from the 2000-2014 Missouri death records, we also compared injury-related death rates among racial/ethnic groups of teens aged 15 to 19 years. Results: Hispanic students had a significantly higher prevalence than non-Hispanic white students for 9 of 10 risk behaviors and a significantly higher prevalence than non-Hispanic black students for 6 of the 10 risk behaviors included in the...
Journal of Public Health Management and Practice, 2017
Extreme heat waves elevate the population&amp... more Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. Visualization of vulnerability could help local public health agencies prepare for future extreme heat events.
WMJ : official publication of the State Medical Society of Wisconsin, 2013
The hottest year on record for the contiguous United States was 2012. July 2012 ranked as Wiscons... more The hottest year on record for the contiguous United States was 2012. July 2012 ranked as Wisconsin's fourth warmest July, which has profound implications for heat-related mortality. We conducted a case series of 27 heat-related fatalities in Wisconsin during summer 2012. Data from death certificates supplemented by coroner reports were analyzed to characterize factors that increase vulnerability to heat-related fatality. The 2012 heat-related fatalities occurred in both urban and rural counties. All cases had 1 or more known risk factors: 100% lacked functioning residential air conditioning; 70% were over age 65; 75% had a cardiovascular disease; and 52% had a mental health condition. Of the 14 cases with a mental health condition, half were known to be taking psychotropic medication. None of the decedents had been in air conditioning immediately prior to death, and 8 (36%) had been using fans. Air conditioning is known to be a strong protective factor in preventing heat-relate...
To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascu... more To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascularization in patients with proliferative diabetic retinopathy (PDR). Cross-sectional comparative case series. One hundred fifty-one consecutive patients with PDR who underwent surgery in our hospital were divided based on the presence of iris and/or angle neovascularization (NV group, 37 patients) or absence of NV (non-NV group, 114 patients). Pulse oximetry was conducted during the night and the mean SpO(2), 4% oxygen desaturation index (4% ODI times/hour), the lowest SpO(2)% during sleep (lowest SpO(2)), and the cumulative percentage of time at SpO(2) <90% in analysis times (CT90%) were calculated. When the 4% ODI exceeded 5 times/hour, sleep-disordered breathing was diagnosed. The results were compared between the 2 groups. Preoperative systemic parameters also were analyzed by logistic regression to clarify risk factors for the NV group. A mean total of 50% (62% of the NV group and 46% of the non-NV group) was diagnosed with sleep-disordered breathing. The mean SpO(2) and lowest SpO(2) did not differ significantly between the 2 groups; the 4% ODI (12.3 vs 6.6) and CT90% (3.8 vs 1.7) were significantly higher in the NV group (P=.02, for both comparisons). Logistic regression analysis identified insulin therapy (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.26∼7.20; P=.01); and 4% ODI (OR, 1.09; CI, 1.01∼1.16; P=.02) as risk factors for the NV group. In patients with PDR, nocturnal intermittent hypoxia/reoxygenation resulting from sleep-disordered breathing may be a risk factor for iris and/or angle neovascularization.
In order to determine the cause of the elevated blood lead levels in rural Illinois children, the... more In order to determine the cause of the elevated blood lead levels in rural Illinois children, the Illinois State Water survey has teamed up with the University of Illinois at Chicago and Northern Illinois University to do a pilot study in three rural Illinois counties. The team hypothesizes that the lead is coming from lead well packers in older wells and lead pipes in older homes. Their research goals include: 1. Characterize the distribution of lead concentrations and water corrosivity in homes using domestic well water in three counties in Illinois. 2. Develop and evaluate health department partnerships, participant recruitment approaches, and home sampling methods in order to inform the design of a scaledup study. 3. If water lead levels (WLLs) are found to be elevated, options for mitigating sources of lead and/or corrosivity will be explored with owners of impacted homes and with health departments. 4. Determine if a larger study and additional interventions are needed to redu...
(ISWS) assisted in kit preparation, data screening, and Phase II sampling. Sam Panno (Illinois St... more (ISWS) assisted in kit preparation, data screening, and Phase II sampling. Sam Panno (Illinois State Geological Survey) contributed to the study development and hydrogeological information. We are grateful to the homeowners who participated in the project, especially those who allowed us to sample their wells during Phase II.
To evaluate the interactions between polyfluoroalkyl substances (PFASs) and reproductive hormones... more To evaluate the interactions between polyfluoroalkyl substances (PFASs) and reproductive hormones and associated asthma, a total of 231 asthmatic and 225 non-asthmatic adolescents were selected from northern Taiwan in the Genetic and Biomarkers study for Childhood Asthma from 2009-2010. The interaction between PFASs and reproductive hormones on asthma was analyzed with a two-level binary logistic regression model. The results showed that, among asthmatics, PFASs were positively associated with estradiol levels and negatively associated with testosterone levels. However, only significant association was identified for PFNA and estradiol in control group. After controlling for hormone levels, associations between PFAS exposure and asthma were consistently stronger among children with higher than lower estradiol, with odds ratios (OR) for asthma ranging from 1.25 for PFOS (95% Confidence Interval [CI]: 0.90, 1.72) to 4.01 for PFDA (95% CI: 1.46, 11.06) among boys and 1.25 for PFOS (95% CI: 0.84, 1.86) to 4.16 for PFNA (95% CI: 1.36, 12.73) among girls. Notably, the interactions between estradiol and PFASs were significant for PFOS (p = 0.026) and PFNA (p = 0.043) among girls. However, testosterone significantly attenuated the association between PFOS and asthma across sex. In conclusions, our findings suggested that reproductive hormones amplify the association between PFASs and asthma among adolescents. Asthma is an increasing new onset inflammatory disease that involves both intrinsic and environmental factors. Research indicates that perfluoroalkyl and polyfluoroalkyl substances (PFASs), types of persistent organic pollutants, are associated with asthma and related outcomes, including airway hyperresponsiveness, increased serum levels of immunoglobulin E (IgE), and switched type 2 T helper cell (Th2) polarization 1-4. Anderson-Mahoney et al. first identified the positive association between PFOA exposure and asthma 4. US National Health and Examination Survey (NHANES) data showed that serum PFOA concentrations are positively associated with self-reported lifetime asthma prevalence 5 .
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 11, 2017
Existing studies on sleep quality and associated obesity are inconsistent, and few studies have p... more Existing studies on sleep quality and associated obesity are inconsistent, and few studies have prospectively evaluated the association between sleep quality and abdominal obesity among Chinese individuals. To fill this void, the current study aimed to assess the association between sleep quality and abdominal obesity in a rural Chinese population. A representative sample of 9,404 adults aged 20-93 y in northeastern China was selected between 2012 and 2013 by a multistage cluster and random sampling method. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), where a score of 6 or higher indicated sleep disorder. Abdominal obesity was measured by waist circumference (WC), with abdominal obesity defined as WC > 90 cm for men and WC > 80 cm for women. Male participants with abdominal obesity had higher global PSQI scores in addition to higher subscores in almost all of the elements compared to normal values. The odds ratios of abdominal obesity among partici...
Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertens... more Reduced sleep has been found to be associated with increased risk of diabetes mellitus, hypertension, cardiovascular disease (CVD), and mortality. Self-rated health (SRH) has been shown to be a predictor of CVD and mortality. However, study of the association between insufficient sleep and SRH is limited. We examined participants >18 years of age (n=377, 160) from a representative, cross-sectional survey (2008 BRFSS). Self-reported insufficient sleep in the previous 30 days was categorized into six groups. The outcome was poor SRH. We calculated odds ratios ((OR) (95% confidence interval (CI)) of increasing categories of insufficient rest/sleep, taking zero days of insufficient sleep as the referent category. We found a positive association between increasing categories of insufficient sleep and poor SRH, independent of relevant covariates. In the multivariable-adjusted model, compared to 0 days insufficient sleep, the OR (95% CI) of poor SRH was 1.03 (0.97–1.10) for 1–6 days, 1....
Background: Hypertension is a leading cause of cardiovascular disease worldwide. Perfluorooctanoi... more Background: Hypertension is a leading cause of cardiovascular disease worldwide. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are perfluoroalkyl chemicals (PFCs) used in the manufacture of common consumer products and detected in the blood of the majority of Americans. Emerging biological data suggest that PFC exposure may have a role in the development of hypertension. However, the association between PFCs and hypertension has not yet been explored in humans. Therefore, we examined this association in a representative sample of US children. Methods: A cross-sectional study was performed on 1,655 children from the National Health and Nutrition Examination Survey, 1999-2000 and 2003-2008. The main outcome of interest was hypertension, defined as age, height, and sex specific systolic and/or diastolic blood pressure level at the 95th percentile. Results: We found no association between serum levels of PFOA and PFOS and hypertension in either unadjusted or multivariable-adjusted analyses controlling for age, sex, race-ethnicity, body mass index, annual household income, moderate activity, total serum cholesterol, and serum cotinine. Compared with the lowest quartile, the multivariable-adjusted odds ratio (95% confidence interval) of hypertension in the highest quartile of exposure was 0.69 (0.41-1.17) for PFOA and 0.77 (0.37-1.61) for PFOS (all P-trend values .0.30). Conclusion: Our findings indicate that exposure to PFOA or PFOS is not significantly associated with hypertension in children at the lower PFC exposure levels typical of the general population.
Hyperuricemia in children is associated with increased risk of high blood pressure, metabolic syn... more Hyperuricemia in children is associated with increased risk of high blood pressure, metabolic syndrome, and future cardiovascular disease. Serum perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) levels have been shown to be positively associated with hyperuricemia in adults, but the association in children remains unexplored. We therefore examined the association between serum PFOA and PFOS levels and hyperuricemia in a representative sample of US children. A cross-sectional study was performed on 1,772 participants ≤18 years of age from the National Health and Nutrition Examination Survey 1999-2000 and 2003-2008. The main outcome of interest was hyperuricemia, defined as serum uric acid levels ≥6 mg/dL. We found that serum levels of PFOA and PFOS were positively associated with hyperuricemia, independent of age, sex, race/ethnicity, body mass index, annual household income, physical activity, serum total cholesterol, and serum cotinine levels. Compared with subjects in quartile 1 (referent), subjects in quartile 4 had multivariable-adjusted odds ratios for hyperuricemia of 1.62 (95% confidence interval: 1.10, 2.37) for PFOA and 1.65 (95% confidence interval: 1.10, 2.49) for PFOS. Our findings indicate that serum perfluoroalkyl chemical levels are significantly associated with hyperuricemia in children even at the lower "background" exposure levels of the US general population.
Objective: Our objective was to examine racial/ethnic disparities in injury-related risk behavior... more Objective: Our objective was to examine racial/ethnic disparities in injury-related risk behaviors and deaths among teens in Missouri, with a focus on Hispanic people—the fastest-growing racial/ethnic group in the state. Methods: We used data from the 2013 Missouri Youth Risk Behavior Survey, which included 1616 students in grades 9 through 12 from 32 public and charter high schools. The overall response rate was 69%. We compared the prevalence of 10 injury-related risk behaviors among racial/ethnic groups and used multivariate logistic regression models to control for respondent age and sex. Using data from the 2000-2014 Missouri death records, we also compared injury-related death rates among racial/ethnic groups of teens aged 15 to 19 years. Results: Hispanic students had a significantly higher prevalence than non-Hispanic white students for 9 of 10 risk behaviors and a significantly higher prevalence than non-Hispanic black students for 6 of the 10 risk behaviors included in the...
Journal of Public Health Management and Practice, 2017
Extreme heat waves elevate the population&amp... more Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. Visualization of vulnerability could help local public health agencies prepare for future extreme heat events.
WMJ : official publication of the State Medical Society of Wisconsin, 2013
The hottest year on record for the contiguous United States was 2012. July 2012 ranked as Wiscons... more The hottest year on record for the contiguous United States was 2012. July 2012 ranked as Wisconsin's fourth warmest July, which has profound implications for heat-related mortality. We conducted a case series of 27 heat-related fatalities in Wisconsin during summer 2012. Data from death certificates supplemented by coroner reports were analyzed to characterize factors that increase vulnerability to heat-related fatality. The 2012 heat-related fatalities occurred in both urban and rural counties. All cases had 1 or more known risk factors: 100% lacked functioning residential air conditioning; 70% were over age 65; 75% had a cardiovascular disease; and 52% had a mental health condition. Of the 14 cases with a mental health condition, half were known to be taking psychotropic medication. None of the decedents had been in air conditioning immediately prior to death, and 8 (36%) had been using fans. Air conditioning is known to be a strong protective factor in preventing heat-relate...
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