To determine if age-related hearing loss may be related to bone health. Decreased vestibular func... more To determine if age-related hearing loss may be related to bone health. Decreased vestibular function has been associated with hearing loss, and osteoporosis may be a cause of such demineralization. We hypothesized that hearing loss would be related to an increased risk of falling and osteoporotic fracture in 6480 women aged 65 years or older enrolled in the Study of Osteoporotic Fractures. We further hypothesized that decreased bone mineral density would be associated with hearing loss. METHODS: Hearing sensitivity was ascertained via screening audiometry, and was classified as normal, mild loss, or significant loss. Incident non-spine fractures and falls were ascertained every 4 months for an average 6.7 years and 3 years, respectively. RESULTS: The age-adjusted annual fall rate did not differ significantly by hearing category, nor did the risk of incident fracture. Adjustment for confounding factors had no effect on our results. Ageand BMI-adjusted mean calcaneal bone mineral density (g/cm 2 ) was 0.380 in the normal hearing group, 0.375 in the mild loss group, and 0.371 in the significant loss group (p ϭ 0.02). There were no significant differences in total hip bone mineral density across hearing categories. CONCLUSIONS: Our results do not support the hypothesis that hearing loss is a risk factor for fracture or falls.
Background-Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is assoc... more Background-Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is associated with low survival. U.S. studies examining self-reported pesticide exposure in relation to HCC have demonstrated inconclusive results. We aimed to clarify the association between pesticide exposure and HCC by implementing a novel data linkage between Surveillance, Epidemiology, and End Results (SEER)-Medicare and California Pesticide Use Report (PUR) data using a geographic information system (GIS). Methods-Controls were frequency-matched to HCC cases diagnosed between 2000 and 2009 in California by year, age, race, sex, and duration of residence in California. Potential confounders were extracted from Medicare claims. From 1974 to 2008, pounds (1 pound represents 0.45 kg) of applied organophosphate, organochlorine, and carbamate pesticides provided in PURs were aggregated to the ZIP Code level using area weighting in a GIS. ZIP Code exposure estimates were linked to subjects using Medicare-provided ZIP Codes to calculate pesticide exposure. Agricultural residents were defined as living in ZIP Codes with a majority area intersecting agricultural land cover according to the 1992, 2001, and 2006 National Land Cover Database (NLCD) rasters. Multivariable conditional logistic regression was used to estimate the association between pesticide exposure and HCC. Results-Among California residents of agriculturally intensive areas, previous annual ZIP Code-level exposure to over 14.53 kg/km 2 of organochlorine pesticides (75 th percentile among controls) was associated with an increased risk of HCC after adjusting for liver disease and diabetes (adjusted odds ratio [OR] 1.87, 95% confidence interval [CI] 1.17, 2.99; p=0.0085). ZIP Code-level organochlorines were significantly associated with an increased risk of HCC among males (adjusted OR 2.76, 95% CI 1.58, 4.82; p=0.0004), but not associated with HCC among females (adjusted OR 0.83, 95% CI 0.35, 1.93; p=0.6600) (interaction p=0.0075). Conclusions-This is the first epidemiologic study to use GIS-based exposure estimates to study pesticide exposure and HCC. Our results suggest that organochlorine pesticides are associated with an increase in HCC risk among males but not females.
Efforts to communicate health risk information and to protect the health of groups exposed to tox... more Efforts to communicate health risk information and to protect the health of groups exposed to toxic substances are on the rise.1,2 However, such activities often take place in situations of intense commu- nityconflict.3 The basis ofthe conflict may be a longstanding debate in a community over the existence of toxic dumps or pol- luting factories. Or, after notification, law- suits and citizen action may create new tensions. Political, economic, or cultural tensions can affect both risk perceptions and participation in health protection ef- forts, yet they are seldom explicitly con- sidered in risk communication activities.4 These often focus on strictly technological or medical issues, and are insensitive to the history of the problems, the economic concerns of the community, or cultural issues. For public health professionals, the first challenge is to develop notification and health protection activities that are tailored to the community situation.5 The second challenge lies in professional con- duct when remediation may not be avail- able or where resources may not be adequate to the purpose.6 This article presents a case study that illustrates some general issues and strate- gies for public health professionals who must deal with community tensions. The Drake Chemical Workers' Health Regis- try overcame community conflicts over a toxic exposure problem, and facilitated participation through the resolution of these conflicts. The Registry, one of the first efforts funded through the Agency for Toxic Substances Disease Registry (ATSDR), was created to deal with a ma- jor health threat to former chemical workers.
This study compares mortality rates for selected causes of death in Kanawha County, West Virginia... more This study compares mortality rates for selected causes of death in Kanawha County, West Virginia, to rates reported in a number of geographically defined populations for 1950–1984. Specific conditions selected for study included cancers of the biliary passages and liver, the bladder and other urinary organs, and the central nervous system (CNS), as well as leukemia and aleukemia, lymphosarcoma and reticulosarcoma, Hodgkin's disease, and cancer of all other lymphopoietic tissue. The analysis made use of several techniques for the investigation of ecological data, including the modeling of rates using Poission regression. The primary findings of this study concern two subgroups of cancers of the lymphatic and hematopoietic tissue: (1) leukemia and aleukemia, and (2) lymphosarcoma and reticulosarcoma. For both subgroups of cancers, white male residents of Kanawha County show evidence of significantly elevated mortality rates over the 35‐year period of this study.
Journal of Public Health Management and Practice, Mar 1, 2015
Public Health Tracking Program spawned an invigorating and challenging approach toward implementi... more Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. Objective-To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. Design-A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. Main Outcomes-Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development.
Purpose-To review the epidemiologic literature examining pesticide exposure and liver cancer inci... more Purpose-To review the epidemiologic literature examining pesticide exposure and liver cancer incidence. Methods-A search of the MEDLINE and Embase databases was conducted in October 2015. Eligibility criteria included examining hepatocellular carcinoma (HCC) or primary liver cancer, pesticides as an exposure of interest, and individual-level incidence. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results-Forty-eight papers were assessed for eligibility and 15 studies were included in the review. The majority of studies were conducted in China and Egypt (n=8), used a case-control design (n=14), and examined HCC (n=14). Most studies showed no association between selfreported and/or occupational exposure to pesticides and liver cancer risk. Six studies demonstrated
Journal of Exposure Science and Environmental Epidemiology, Jun 19, 2018
Although short-term exposure to ambient ozone (O 3 ) can cause poor respiratory health outcomes, ... more Although short-term exposure to ambient ozone (O 3 ) can cause poor respiratory health outcomes, the shape of the concentration-response (C-R) between O 3 and respiratory morbidity has not been widely investigated. We estimated the effect of daily O 3 on emergency department (ED) visits for selected respiratory outcomes in 5 U.S. cities under various model assumptions and assessed model fit. Population-weighted average 8-hr maximum O 3 concentrations were estimated in each city. Individual-level data on ED visits were obtained from hospitals or hospital associations. Poisson log-linear models were used to estimate city-specific associations between the daily number of respiratory ED visits and 3-day moving average O 3 levels controlling for long-term trends and meteorology. Linear, linear-threshold, quadratic, cubic, categorical, and cubic spline O 3 C-R models were considered. Using linear C-R models, O3 was significantly and positively associated with respiratory ED visits in each city with rate ratios of 1.02-1.07 per 25 ppb. Models suggested that O 3 -ED C-R shapes were linear until O 3 concentrations of roughly 60 ppb at which point risk continued to increase linearly in some cities for certain outcomes while risk flattened in others. Assessing C-R shape is necessary to identify the most appropriate form of the exposure for each given study setting. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:
International Journal of Environmental Research and Public Health, Nov 20, 2020
Asthma affects millions of people globally and is especially concerning in populations living wit... more Asthma affects millions of people globally and is especially concerning in populations living with poor air quality. This study examines the association of ambient outdoor air pollutants on asthma-related emergency department (ED) visits in children and adults throughout the Pittsburgh region. A time-stratified case-crossover design is used to analyze the lagged effects of fine particulate matter (PM 2.5 ) and gaseous pollutants, e.g., ozone (O 3 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and carbon monoxide (CO) on asthma-related ED visits (n = 6682). Single-, double-, and multi-pollutant models are adjusted for temperature and analyzed using conditional logistic regression. In children, all models show an association between O 3 and increased ED visits at lag day 1 (OR: 1.12, 95% CI, 1.03-1.22, p < 0.05) for the double-pollutant model (OR: 1.10, 95% CI: 1.01-1.20, p < 0.01). In adults, the single-pollutant model shows associations between CO and increased ED visits at lag day 5 (OR: 1.13, 95% CI, 1.00-1.28, p < 0.05) and average lag days 0-5 (OR: 1.22, 95% CI: 1.00-1.49, p < 0.05), and for NO 2 at lag day 5 (OR: 1.04, 95% CI: 1.00-1.07, p < 0.05). These results show an association between air pollution and asthma morbidity in the Pittsburgh region and underscore the need for mitigation efforts to improve public health outcomes.
IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known caus... more IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known cause. Case studies primarily of athletes and several case-control studies have suggested that high levels of strenuous physical activity (PA) may increase the risk for ALS. This relationship has yet to be evaluated among women in population-based cohort studies. OBJECTIVE To evaluate the relationship between PA and risk for ALS mortality in a large cohort of postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS The Women's Health Initiative (WHI) enrolled 161 809 postmenopausal women, aged 50 to 79 years (mean [SD] age, 63.6 [7.24] years), between 1993 and 1998 into either a clinical trial or an observational study at 40 clinical research centers across the United States. We conducted a cohort study from November 2014 to September 2015 using baseline and mortality data during an average of 9.6 years of follow-up from the entire WHI cohort, through September 1, 2013 (with 1.1% lost to follow-up), to address whether there is a relationship between PA and ALS mortality. EXPOSURES The WHI assessed frequency and duration of mild, moderate, and strenuous PA at baseline via self-administered questionnaire. Underlying cause of death from ALS collected from death certificates. The WHI enrolled 161 809 women, of whom 165 died of ALS; women who died of ALS were older (median age, 66 years; interquartile range, 61-69 years) compared with the total WHI study population (median age, 63 years; interquartile range, 57-69 years). Age-adjusted ALS mortality rates varied from 7.4 (95% CI, 5.5-9.9)/100 000 person-years for no strenuous PA to 10.6 (95% CI, 5.6-20.0)/100 000 person-years for strenuous PA 3 or more days per week (P = .07). Adjusted for age and body mass index (calculated as weight in kilograms divided by height in meters squared), the odds ratio for death from ALS for participants with strenuous PA 3 or more days per week compared with no reported strenuous PA was 1.56 (95% CI, 1.02-2.37; P = .04). To our knowledge, this is the first cohort study to report an increased risk for ALS mortality associated with strenuous PA in postmenopausal women. The association between strenuous PA and ALS risk observed does not compromise the overall benefit of strenuous PA for total mortality, coronary heart disease, and breast cancer reported in other WHI investigations, but it may provide an important clue to the etiology of ALS, if replicated by other studies.
Background: Autism spectrum disorders (ASD) constitute a major public health problem affecting on... more Background: Autism spectrum disorders (ASD) constitute a major public health problem affecting one in 68 children. There is little understanding of the causes of ASD despite its serious social impact. Air pollution contains many toxicants known to have adverse effects on the fetus. We conducted a population based case-control study in southwestern Pennsylvania to estimate the association between ASD and 2005 US EPA modeled NATA (National Air Toxics Assessment) levels for 30 neurotoxicants. Methods: A total of 217 ASD cases born between 2005 and 2009 were recruited from local ASD diagnostic and treatment centers. There were two different control groups: 1) interviewed controls (N = 224) frequency matched by child's year of birth, sex and race with complete residential histories from prior to pregnancy through the child's second birthday, and 2) 5,007 controls generated from a random sample of birth certificates (BC controls) using residence at birth. We used logistic regression analysis comparing higher to first quartile of exposure to estimate odds ratios (ORs) and 95 % confidence intervals (CI), adjusting for mother's age, education, race, smoking status, child's year of birth and sex. Results: Comparing fourth to first quartile exposures for all births, the adjusted OR for styrene was 2.04 (95 % CI = 1.17-3.58, p = 0.013) for the interviewed case-control analysis and 1.61 (95 % CI = 1.08-2.40, p = 0.018) for the BC analysis. In the BC comparison, chromium also exhibited an elevated OR of 1.60 (95 % CI = 1.08-2.38, p = 0.020), which was similarly elevated in the interviewed analysis (OR = 1.52, 95 % CI = 0.87-2.66). There were borderline significant ORs for the BC comparison for methylene chloride (OR = 1.41, 95 % CI = 0.96-2.07, p = 0.082) and PAHs (OR = 1.44, 95 % CI = 0.98-2.11, p = 0.064). Conclusions: Living in areas with higher levels of styrene and chromium during pregnancy was associated with increased risk of ASD, with borderline effects for PAHs and methylene chloride. These results are consistent with other studies. It is unclear, however, whether these chemicals are risk factors themselves or if they reflect the effect of a mixture of pollutants. Future work should include improved spatiotemporal estimates of exposure to air toxics, taking into account the dynamic movement of individuals during daily life.
The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very f... more The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very few studies have focused on spatiotemporally modeled exposure to air pollutants at the population level. This study aims to examine the short-term association of fine particulate matter (PM 2.5 ), Ozone (O 3 ), Nitrogen Dioxide (NO 2 ) and Sulfur Dioxide (SO 2 ) and CVD emergency room visits (ERV) in Allegheny County for a 13-year period using a case-crossover study design. We sought to estimate the effects of acute exposure to these four pollutants adjusting for temperature on CVD ERV and to compare outcomes in 1999-2005 compared to 2006-2011. Land-use regression was used to model the ground level exposures to PM 2.5 , O 3 , NO 2 and SO 2 . CVD ER visits were requested from the local hospitals of the two health networks in Allegheny County, which operate the majority of the ER services. The discharge International Classification of Diseases-9 (ICD-9) codes were used to identify the CVD cases and CVD subgroups. We linked the Zone Improvement Plan (ZIP) code level air pollution data with the patients' ZIP code (residence) to determine the individual level exposure estimation of both case days and control days. Conditional logistic regression with multi-pollutant and distributed lags of 0-3-days was applied to estimate the effect of acute exposure of these pollutants to CVD ER visits (ERV), adjusting for temperature. In the overall analyses, for every interquartile increase of O 3 exposure (25.52 ppb), there was a 6.6% (95% CI: 0.8%-12.7%) increase in the odds of an acute myocardial infarction ERV. This was consistent across both time periods. Among women and Black ERV, we observed an association of PM 2.5 with acute myocardial infarction, and with ischemic heart disease. Some of these associations persisted in the later years of the study period. The gaseous pollutants (NO 2 , SO 2 and O 3 ) were shown to increase risk of cardiovascular events in both time periods. We found an association of PM 2.5 and NO 2 with CVD ER visits, and this association persisted in the stratified analyses, as well as in the later years with lower exposure levels. The findings suggest that further actions to reduce the pollution level in this area should be taken. Ozone and NO 2 were related to increased risk for all CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) underscoring the importance of gaseous pollutants and their effect on coronary heart disease (CHD) risk.
Objective: To determine if polycystic-appearing ovaries (PAO) are associated with differences in ... more Objective: To determine if polycystic-appearing ovaries (PAO) are associated with differences in risk factors for cardiovascular disease among women with polycystic ovary syndrome (PCOS). Design: Case-control sub-study. Setting: Division of Reproductive Endocrinology, Magee-Womens Hospital. Patient(s): Women with PCOS (n ϭ 63) and non-PCOS controls (n ϭ 56). Intervention: Transvaginal ultrasonography and single sample venipuncture. Main Outcome Measure(s): Ultrasound ovarian appearance, fasting insulin, lipoproteins, androgens, LH/ FSH ratio, anthropomorphic measurements, and blood pressure. Result(s): Women with PCOS had higher androgen and fasting insulin levels, a more adverse lipid profile, greater waist-hip and LH/FSH ratios, and a larger ovarian volume than controls. Thirty-three percent of the cases with PCOS, but only 5% of controls, showed PAO on ultrasound study (PϽ.01). PCOS cases with and without PAO had comparable levels of fasting insulin, lipids, and blood pressures. PCOS cases with PAO had a higher LH/FSH ratio (Pϭ.028), increased levels of serum androstenedione (Pϭ.029) and testosterone (Pϭ.055), and greater ovarian volume (Pϭ.024) compared to non-PAO patients. Conclusion: Women with PCOS have greater cardiovascular risk than controls. Within PCOS cases, however, the ultrasound appearance of polycystic ovaries does not appear to further intensify the cardiovascular disease risk profile of these women.
Hypertensive disorders of pregnancy (HDP, including gestational hypertension, preeclampsia, and e... more Hypertensive disorders of pregnancy (HDP, including gestational hypertension, preeclampsia, and eclampsia) have a substantial public health impact. Maternal exposure to high levels of air pollution may trigger HDP, but this association remains unclear. The objective of our report is to assess and quantify the association between maternal exposures to criteria air pollutants (ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matter ≤ 10, 2.5 μm) on HDP risk. PubMed, EMBASE, MEDLINE, Current Contents, Global Health, and Cochrane were searched (last search: September, 2013). After a detailed screening of 270 studies, 10 studies were extracted. We conducted meta-analyses if a pollutant in a specific exposure window was reported by at least four studies. Using fixed-and random-effects models, odds ratios (ORs) and 95% CIs were calculated for each pollutant with specific increment of concentration. Increases in risks of HDP (OR per 10 ppb = 1.16; 95% CI, 1.03-1.30) and preeclampsia (OR per 10 ppb = 1.10; 95% CI, 1.03-1.17) were observed to be associated with exposure to NO 2 during the entire pregnancy, and significant associations between HDP and exposure to CO (OR per 1 ppm = 1.79; 95% CI, 1.31-2.45) and O 3 (OR per 10 ppb = 1.09; 95% CI, 1.05-1.13) during the first trimester were also observed. Our review suggests an association between ambient air pollution and HDP risk. Although the ORs were relatively low, the population-attributable fractions were not negligible given the ubiquitous nature of air pollution.
Journal of Bone and Mineral Research, Apr 14, 2008
Lead is stored in the skeleton and can serve as an endogenous source for many years. Lead may inf... more Lead is stored in the skeleton and can serve as an endogenous source for many years. Lead may influence the risk of fracture, through direct effects on bone strength or indirectly by disturbing neuromuscular function and increasing the risk of falls. The objective of this analysis is to test the hypothesis that women with higher blood lead levels experience higher rates of falls and fracture. This was a prospective cohort study of 533 women 65-87 yr of age enrolled in the Study of Osteoporotic Fractures at two U.S. research centers (Baltimore, MD; Monongahela Valley, PA) from 1986 to 1988. Blood lead levels (in g/dl) were measured in 1990-1991 by atomic absorption spectrophotometry and classified as "low" (Յ3; lower 15th percentile, referent); "medium" (4-7); or "high" (Ն8; upper 15th percentile). Total hip BMD was measured by DXA twice, 3.55 yr apart. Information on falls was collected every 4 mo for 4 yr. Incident nonspine fractures were identified and confirmed over 10 yr. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% CI of fracture. Generalized estimating equations were used to calculate the incident rate ratio of falls (95% CI). The mean blood lead level was 5.3 ± 2.3 (SD) g/dl (range, 1-21 g/dl). Baseline BMD was 7% lower in total hip and 5% lower in femoral neck in the highest compared with lowest blood lead group (p < 0.02). Hip bone loss tended to be greater in the high lead group, but differences were not significant. In multivariable adjusted models, women with high blood lead levels had an increased risk of nonspine fracture (HR ס 2.50; 95% CI ס 1.25, 5.03; p trend ס 0.016) and higher risk of falls (incident rate ratio ס 1.62; 95% CI ס 1.07, 2.45; p trend ס 0.014) compared with women with lowest lead level. Blood lead levels are associated with an increased risk of falls and fractures, extending the negative health consequences of lead to include osteoporotic fractures.
Circulating complement protein C3 (C3) levels have been associated with coronary artery calcifica... more Circulating complement protein C3 (C3) levels have been associated with coronary artery calcification (CAC) in women with systemic lupus erythematosus, but have yet to be evaluated in women with polycystic ovary syndrome (PCOS). We aimed to determine whether C3 levels were elevated in women with PCOS compared to controls, and to quantify the association of C3 with cardiovascular disease (CVD) risk factors and CAC, and if PCOS modified this association. This cross-sectional analysis included 132 women with PCOS and 155 controls 35-62 years old from the third visit of a case-control study. CAC was measured during the study visit and circulating C3 was measured in stored sera. The presence of CAC and CAC categories (Agatston score 0, 1-9.9, and ≥10) were used for logistic and ordinal regression analysis, respectively. C3 levels were not significantly different between women with PCOS and controls. Among all women, C3 was associated with the presence of CAC and increasing CAC groups after adjusting for age, PCOS status, and insulin or BMI, all p<0.05. In addition, C3 was associated with the presence of CAC after adjusting for age, PCOS status, BMI, insulin and African American race, p=0.049. PCOS status did not modify these associations. In conclusion, circulating C3 levels may prove beneficial in identifying women at risk of CVD in women with PCOS and the general population.
An aquatic hazard assessment establishes a derived predicted no effect concentration (PNEC) below... more An aquatic hazard assessment establishes a derived predicted no effect concentration (PNEC) below which it is assumed that aquatic organisms will not suffer adverse effects from exposure to a chemical. An aquatic hazard assessment of the endocrine disruptor Bisphenol A [BPA; 2, 2-bis (4-hydroxyphenyl) propane] was conducted using a weight of evidence approach, using the ecotoxicological endpoints of survival, growth and development and reproduction. New evidence has emerged that suggests that the aquatic system may not be sufficiently protected from adverse effects of BPA exposure at the current PNEC value of 100 μg/L. It is with this background that; 1) An aquatic hazard assessment for BPA using a weight of evidence approach, was conducted, 2) A PNEC value was derived using a non parametric hazardous concentration for 5% of the specie (HC(5)) approach and, 3) The derived BPA hazard assessment values were compared to aquatic environmental concentrations for BPA to determine, sufficient protectiveness from BPA exposure for aquatic species. A total of 61 studies yielded 94 no observed effect concentration (NOEC) and a toxicity dataset, which suggests that the aquatic effects of mortality, growth and development and reproduction are most likely to occur between the concentrations of 0.0483 μg/L and 2280 μg/L. This finding is within the range for aquatic adverse estrogenic effects reported in the literature. A PNEC of 0.06 μg/L was calculated. The 95% confidence interval was found to be (0.02, 3.40) μg/L. Thus, using the weight of evidence approach based on repeated measurements of these endpoints, the results indicate that currently observed BPA concentrations in surface waters exceed this newly derived PNEC value of 0.06 μg/L. This indicates that some aquatic receptors may be at risk for adverse effects on survival, growth and development and reproduction from BPA exposure at environmentally relevant concentrations.
International Journal of Environmental Research and Public Health
Cognitive impairment in older adults is a major public concern for Kazakhstan’s aging population.... more Cognitive impairment in older adults is a major public concern for Kazakhstan’s aging population. We aimed to (1) administer a neuropsychological test battery (NTB) in domains relevant to aging-associated cognitive impairment in a sample of adults aged 60+ without dementia in Almaty, Kazakhstan; (2) investigate the associations between demographic factors and test performance; and (3) provide information on the distribution of NTB scores as preliminary local normative data relevant for this population. A cross-sectional evaluation of 276 participants aged 60+ in Almaty, Kazakhstan, was conducted using cognitive instruments including tests of memory, attention, language, executive functions, visuospatial abilities, and processing speed. Multiple linear regression analyses were used to examine the association of demographic factors with neuropsychological test performance. The results from the regression analysis showed that those who are younger, have more years of education, are wom...
To determine if age-related hearing loss may be related to bone health. Decreased vestibular func... more To determine if age-related hearing loss may be related to bone health. Decreased vestibular function has been associated with hearing loss, and osteoporosis may be a cause of such demineralization. We hypothesized that hearing loss would be related to an increased risk of falling and osteoporotic fracture in 6480 women aged 65 years or older enrolled in the Study of Osteoporotic Fractures. We further hypothesized that decreased bone mineral density would be associated with hearing loss. METHODS: Hearing sensitivity was ascertained via screening audiometry, and was classified as normal, mild loss, or significant loss. Incident non-spine fractures and falls were ascertained every 4 months for an average 6.7 years and 3 years, respectively. RESULTS: The age-adjusted annual fall rate did not differ significantly by hearing category, nor did the risk of incident fracture. Adjustment for confounding factors had no effect on our results. Ageand BMI-adjusted mean calcaneal bone mineral density (g/cm 2 ) was 0.380 in the normal hearing group, 0.375 in the mild loss group, and 0.371 in the significant loss group (p ϭ 0.02). There were no significant differences in total hip bone mineral density across hearing categories. CONCLUSIONS: Our results do not support the hypothesis that hearing loss is a risk factor for fracture or falls.
Background-Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is assoc... more Background-Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is associated with low survival. U.S. studies examining self-reported pesticide exposure in relation to HCC have demonstrated inconclusive results. We aimed to clarify the association between pesticide exposure and HCC by implementing a novel data linkage between Surveillance, Epidemiology, and End Results (SEER)-Medicare and California Pesticide Use Report (PUR) data using a geographic information system (GIS). Methods-Controls were frequency-matched to HCC cases diagnosed between 2000 and 2009 in California by year, age, race, sex, and duration of residence in California. Potential confounders were extracted from Medicare claims. From 1974 to 2008, pounds (1 pound represents 0.45 kg) of applied organophosphate, organochlorine, and carbamate pesticides provided in PURs were aggregated to the ZIP Code level using area weighting in a GIS. ZIP Code exposure estimates were linked to subjects using Medicare-provided ZIP Codes to calculate pesticide exposure. Agricultural residents were defined as living in ZIP Codes with a majority area intersecting agricultural land cover according to the 1992, 2001, and 2006 National Land Cover Database (NLCD) rasters. Multivariable conditional logistic regression was used to estimate the association between pesticide exposure and HCC. Results-Among California residents of agriculturally intensive areas, previous annual ZIP Code-level exposure to over 14.53 kg/km 2 of organochlorine pesticides (75 th percentile among controls) was associated with an increased risk of HCC after adjusting for liver disease and diabetes (adjusted odds ratio [OR] 1.87, 95% confidence interval [CI] 1.17, 2.99; p=0.0085). ZIP Code-level organochlorines were significantly associated with an increased risk of HCC among males (adjusted OR 2.76, 95% CI 1.58, 4.82; p=0.0004), but not associated with HCC among females (adjusted OR 0.83, 95% CI 0.35, 1.93; p=0.6600) (interaction p=0.0075). Conclusions-This is the first epidemiologic study to use GIS-based exposure estimates to study pesticide exposure and HCC. Our results suggest that organochlorine pesticides are associated with an increase in HCC risk among males but not females.
Efforts to communicate health risk information and to protect the health of groups exposed to tox... more Efforts to communicate health risk information and to protect the health of groups exposed to toxic substances are on the rise.1,2 However, such activities often take place in situations of intense commu- nityconflict.3 The basis ofthe conflict may be a longstanding debate in a community over the existence of toxic dumps or pol- luting factories. Or, after notification, law- suits and citizen action may create new tensions. Political, economic, or cultural tensions can affect both risk perceptions and participation in health protection ef- forts, yet they are seldom explicitly con- sidered in risk communication activities.4 These often focus on strictly technological or medical issues, and are insensitive to the history of the problems, the economic concerns of the community, or cultural issues. For public health professionals, the first challenge is to develop notification and health protection activities that are tailored to the community situation.5 The second challenge lies in professional con- duct when remediation may not be avail- able or where resources may not be adequate to the purpose.6 This article presents a case study that illustrates some general issues and strate- gies for public health professionals who must deal with community tensions. The Drake Chemical Workers' Health Regis- try overcame community conflicts over a toxic exposure problem, and facilitated participation through the resolution of these conflicts. The Registry, one of the first efforts funded through the Agency for Toxic Substances Disease Registry (ATSDR), was created to deal with a ma- jor health threat to former chemical workers.
This study compares mortality rates for selected causes of death in Kanawha County, West Virginia... more This study compares mortality rates for selected causes of death in Kanawha County, West Virginia, to rates reported in a number of geographically defined populations for 1950–1984. Specific conditions selected for study included cancers of the biliary passages and liver, the bladder and other urinary organs, and the central nervous system (CNS), as well as leukemia and aleukemia, lymphosarcoma and reticulosarcoma, Hodgkin's disease, and cancer of all other lymphopoietic tissue. The analysis made use of several techniques for the investigation of ecological data, including the modeling of rates using Poission regression. The primary findings of this study concern two subgroups of cancers of the lymphatic and hematopoietic tissue: (1) leukemia and aleukemia, and (2) lymphosarcoma and reticulosarcoma. For both subgroups of cancers, white male residents of Kanawha County show evidence of significantly elevated mortality rates over the 35‐year period of this study.
Journal of Public Health Management and Practice, Mar 1, 2015
Public Health Tracking Program spawned an invigorating and challenging approach toward implementi... more Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. Objective-To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. Design-A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. Main Outcomes-Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development.
Purpose-To review the epidemiologic literature examining pesticide exposure and liver cancer inci... more Purpose-To review the epidemiologic literature examining pesticide exposure and liver cancer incidence. Methods-A search of the MEDLINE and Embase databases was conducted in October 2015. Eligibility criteria included examining hepatocellular carcinoma (HCC) or primary liver cancer, pesticides as an exposure of interest, and individual-level incidence. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results-Forty-eight papers were assessed for eligibility and 15 studies were included in the review. The majority of studies were conducted in China and Egypt (n=8), used a case-control design (n=14), and examined HCC (n=14). Most studies showed no association between selfreported and/or occupational exposure to pesticides and liver cancer risk. Six studies demonstrated
Journal of Exposure Science and Environmental Epidemiology, Jun 19, 2018
Although short-term exposure to ambient ozone (O 3 ) can cause poor respiratory health outcomes, ... more Although short-term exposure to ambient ozone (O 3 ) can cause poor respiratory health outcomes, the shape of the concentration-response (C-R) between O 3 and respiratory morbidity has not been widely investigated. We estimated the effect of daily O 3 on emergency department (ED) visits for selected respiratory outcomes in 5 U.S. cities under various model assumptions and assessed model fit. Population-weighted average 8-hr maximum O 3 concentrations were estimated in each city. Individual-level data on ED visits were obtained from hospitals or hospital associations. Poisson log-linear models were used to estimate city-specific associations between the daily number of respiratory ED visits and 3-day moving average O 3 levels controlling for long-term trends and meteorology. Linear, linear-threshold, quadratic, cubic, categorical, and cubic spline O 3 C-R models were considered. Using linear C-R models, O3 was significantly and positively associated with respiratory ED visits in each city with rate ratios of 1.02-1.07 per 25 ppb. Models suggested that O 3 -ED C-R shapes were linear until O 3 concentrations of roughly 60 ppb at which point risk continued to increase linearly in some cities for certain outcomes while risk flattened in others. Assessing C-R shape is necessary to identify the most appropriate form of the exposure for each given study setting. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:
International Journal of Environmental Research and Public Health, Nov 20, 2020
Asthma affects millions of people globally and is especially concerning in populations living wit... more Asthma affects millions of people globally and is especially concerning in populations living with poor air quality. This study examines the association of ambient outdoor air pollutants on asthma-related emergency department (ED) visits in children and adults throughout the Pittsburgh region. A time-stratified case-crossover design is used to analyze the lagged effects of fine particulate matter (PM 2.5 ) and gaseous pollutants, e.g., ozone (O 3 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and carbon monoxide (CO) on asthma-related ED visits (n = 6682). Single-, double-, and multi-pollutant models are adjusted for temperature and analyzed using conditional logistic regression. In children, all models show an association between O 3 and increased ED visits at lag day 1 (OR: 1.12, 95% CI, 1.03-1.22, p < 0.05) for the double-pollutant model (OR: 1.10, 95% CI: 1.01-1.20, p < 0.01). In adults, the single-pollutant model shows associations between CO and increased ED visits at lag day 5 (OR: 1.13, 95% CI, 1.00-1.28, p < 0.05) and average lag days 0-5 (OR: 1.22, 95% CI: 1.00-1.49, p < 0.05), and for NO 2 at lag day 5 (OR: 1.04, 95% CI: 1.00-1.07, p < 0.05). These results show an association between air pollution and asthma morbidity in the Pittsburgh region and underscore the need for mitigation efforts to improve public health outcomes.
IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known caus... more IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known cause. Case studies primarily of athletes and several case-control studies have suggested that high levels of strenuous physical activity (PA) may increase the risk for ALS. This relationship has yet to be evaluated among women in population-based cohort studies. OBJECTIVE To evaluate the relationship between PA and risk for ALS mortality in a large cohort of postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS The Women's Health Initiative (WHI) enrolled 161 809 postmenopausal women, aged 50 to 79 years (mean [SD] age, 63.6 [7.24] years), between 1993 and 1998 into either a clinical trial or an observational study at 40 clinical research centers across the United States. We conducted a cohort study from November 2014 to September 2015 using baseline and mortality data during an average of 9.6 years of follow-up from the entire WHI cohort, through September 1, 2013 (with 1.1% lost to follow-up), to address whether there is a relationship between PA and ALS mortality. EXPOSURES The WHI assessed frequency and duration of mild, moderate, and strenuous PA at baseline via self-administered questionnaire. Underlying cause of death from ALS collected from death certificates. The WHI enrolled 161 809 women, of whom 165 died of ALS; women who died of ALS were older (median age, 66 years; interquartile range, 61-69 years) compared with the total WHI study population (median age, 63 years; interquartile range, 57-69 years). Age-adjusted ALS mortality rates varied from 7.4 (95% CI, 5.5-9.9)/100 000 person-years for no strenuous PA to 10.6 (95% CI, 5.6-20.0)/100 000 person-years for strenuous PA 3 or more days per week (P = .07). Adjusted for age and body mass index (calculated as weight in kilograms divided by height in meters squared), the odds ratio for death from ALS for participants with strenuous PA 3 or more days per week compared with no reported strenuous PA was 1.56 (95% CI, 1.02-2.37; P = .04). To our knowledge, this is the first cohort study to report an increased risk for ALS mortality associated with strenuous PA in postmenopausal women. The association between strenuous PA and ALS risk observed does not compromise the overall benefit of strenuous PA for total mortality, coronary heart disease, and breast cancer reported in other WHI investigations, but it may provide an important clue to the etiology of ALS, if replicated by other studies.
Background: Autism spectrum disorders (ASD) constitute a major public health problem affecting on... more Background: Autism spectrum disorders (ASD) constitute a major public health problem affecting one in 68 children. There is little understanding of the causes of ASD despite its serious social impact. Air pollution contains many toxicants known to have adverse effects on the fetus. We conducted a population based case-control study in southwestern Pennsylvania to estimate the association between ASD and 2005 US EPA modeled NATA (National Air Toxics Assessment) levels for 30 neurotoxicants. Methods: A total of 217 ASD cases born between 2005 and 2009 were recruited from local ASD diagnostic and treatment centers. There were two different control groups: 1) interviewed controls (N = 224) frequency matched by child's year of birth, sex and race with complete residential histories from prior to pregnancy through the child's second birthday, and 2) 5,007 controls generated from a random sample of birth certificates (BC controls) using residence at birth. We used logistic regression analysis comparing higher to first quartile of exposure to estimate odds ratios (ORs) and 95 % confidence intervals (CI), adjusting for mother's age, education, race, smoking status, child's year of birth and sex. Results: Comparing fourth to first quartile exposures for all births, the adjusted OR for styrene was 2.04 (95 % CI = 1.17-3.58, p = 0.013) for the interviewed case-control analysis and 1.61 (95 % CI = 1.08-2.40, p = 0.018) for the BC analysis. In the BC comparison, chromium also exhibited an elevated OR of 1.60 (95 % CI = 1.08-2.38, p = 0.020), which was similarly elevated in the interviewed analysis (OR = 1.52, 95 % CI = 0.87-2.66). There were borderline significant ORs for the BC comparison for methylene chloride (OR = 1.41, 95 % CI = 0.96-2.07, p = 0.082) and PAHs (OR = 1.44, 95 % CI = 0.98-2.11, p = 0.064). Conclusions: Living in areas with higher levels of styrene and chromium during pregnancy was associated with increased risk of ASD, with borderline effects for PAHs and methylene chloride. These results are consistent with other studies. It is unclear, however, whether these chemicals are risk factors themselves or if they reflect the effect of a mixture of pollutants. Future work should include improved spatiotemporal estimates of exposure to air toxics, taking into account the dynamic movement of individuals during daily life.
The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very f... more The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very few studies have focused on spatiotemporally modeled exposure to air pollutants at the population level. This study aims to examine the short-term association of fine particulate matter (PM 2.5 ), Ozone (O 3 ), Nitrogen Dioxide (NO 2 ) and Sulfur Dioxide (SO 2 ) and CVD emergency room visits (ERV) in Allegheny County for a 13-year period using a case-crossover study design. We sought to estimate the effects of acute exposure to these four pollutants adjusting for temperature on CVD ERV and to compare outcomes in 1999-2005 compared to 2006-2011. Land-use regression was used to model the ground level exposures to PM 2.5 , O 3 , NO 2 and SO 2 . CVD ER visits were requested from the local hospitals of the two health networks in Allegheny County, which operate the majority of the ER services. The discharge International Classification of Diseases-9 (ICD-9) codes were used to identify the CVD cases and CVD subgroups. We linked the Zone Improvement Plan (ZIP) code level air pollution data with the patients' ZIP code (residence) to determine the individual level exposure estimation of both case days and control days. Conditional logistic regression with multi-pollutant and distributed lags of 0-3-days was applied to estimate the effect of acute exposure of these pollutants to CVD ER visits (ERV), adjusting for temperature. In the overall analyses, for every interquartile increase of O 3 exposure (25.52 ppb), there was a 6.6% (95% CI: 0.8%-12.7%) increase in the odds of an acute myocardial infarction ERV. This was consistent across both time periods. Among women and Black ERV, we observed an association of PM 2.5 with acute myocardial infarction, and with ischemic heart disease. Some of these associations persisted in the later years of the study period. The gaseous pollutants (NO 2 , SO 2 and O 3 ) were shown to increase risk of cardiovascular events in both time periods. We found an association of PM 2.5 and NO 2 with CVD ER visits, and this association persisted in the stratified analyses, as well as in the later years with lower exposure levels. The findings suggest that further actions to reduce the pollution level in this area should be taken. Ozone and NO 2 were related to increased risk for all CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) underscoring the importance of gaseous pollutants and their effect on coronary heart disease (CHD) risk.
Objective: To determine if polycystic-appearing ovaries (PAO) are associated with differences in ... more Objective: To determine if polycystic-appearing ovaries (PAO) are associated with differences in risk factors for cardiovascular disease among women with polycystic ovary syndrome (PCOS). Design: Case-control sub-study. Setting: Division of Reproductive Endocrinology, Magee-Womens Hospital. Patient(s): Women with PCOS (n ϭ 63) and non-PCOS controls (n ϭ 56). Intervention: Transvaginal ultrasonography and single sample venipuncture. Main Outcome Measure(s): Ultrasound ovarian appearance, fasting insulin, lipoproteins, androgens, LH/ FSH ratio, anthropomorphic measurements, and blood pressure. Result(s): Women with PCOS had higher androgen and fasting insulin levels, a more adverse lipid profile, greater waist-hip and LH/FSH ratios, and a larger ovarian volume than controls. Thirty-three percent of the cases with PCOS, but only 5% of controls, showed PAO on ultrasound study (PϽ.01). PCOS cases with and without PAO had comparable levels of fasting insulin, lipids, and blood pressures. PCOS cases with PAO had a higher LH/FSH ratio (Pϭ.028), increased levels of serum androstenedione (Pϭ.029) and testosterone (Pϭ.055), and greater ovarian volume (Pϭ.024) compared to non-PAO patients. Conclusion: Women with PCOS have greater cardiovascular risk than controls. Within PCOS cases, however, the ultrasound appearance of polycystic ovaries does not appear to further intensify the cardiovascular disease risk profile of these women.
Hypertensive disorders of pregnancy (HDP, including gestational hypertension, preeclampsia, and e... more Hypertensive disorders of pregnancy (HDP, including gestational hypertension, preeclampsia, and eclampsia) have a substantial public health impact. Maternal exposure to high levels of air pollution may trigger HDP, but this association remains unclear. The objective of our report is to assess and quantify the association between maternal exposures to criteria air pollutants (ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matter ≤ 10, 2.5 μm) on HDP risk. PubMed, EMBASE, MEDLINE, Current Contents, Global Health, and Cochrane were searched (last search: September, 2013). After a detailed screening of 270 studies, 10 studies were extracted. We conducted meta-analyses if a pollutant in a specific exposure window was reported by at least four studies. Using fixed-and random-effects models, odds ratios (ORs) and 95% CIs were calculated for each pollutant with specific increment of concentration. Increases in risks of HDP (OR per 10 ppb = 1.16; 95% CI, 1.03-1.30) and preeclampsia (OR per 10 ppb = 1.10; 95% CI, 1.03-1.17) were observed to be associated with exposure to NO 2 during the entire pregnancy, and significant associations between HDP and exposure to CO (OR per 1 ppm = 1.79; 95% CI, 1.31-2.45) and O 3 (OR per 10 ppb = 1.09; 95% CI, 1.05-1.13) during the first trimester were also observed. Our review suggests an association between ambient air pollution and HDP risk. Although the ORs were relatively low, the population-attributable fractions were not negligible given the ubiquitous nature of air pollution.
Journal of Bone and Mineral Research, Apr 14, 2008
Lead is stored in the skeleton and can serve as an endogenous source for many years. Lead may inf... more Lead is stored in the skeleton and can serve as an endogenous source for many years. Lead may influence the risk of fracture, through direct effects on bone strength or indirectly by disturbing neuromuscular function and increasing the risk of falls. The objective of this analysis is to test the hypothesis that women with higher blood lead levels experience higher rates of falls and fracture. This was a prospective cohort study of 533 women 65-87 yr of age enrolled in the Study of Osteoporotic Fractures at two U.S. research centers (Baltimore, MD; Monongahela Valley, PA) from 1986 to 1988. Blood lead levels (in g/dl) were measured in 1990-1991 by atomic absorption spectrophotometry and classified as "low" (Յ3; lower 15th percentile, referent); "medium" (4-7); or "high" (Ն8; upper 15th percentile). Total hip BMD was measured by DXA twice, 3.55 yr apart. Information on falls was collected every 4 mo for 4 yr. Incident nonspine fractures were identified and confirmed over 10 yr. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% CI of fracture. Generalized estimating equations were used to calculate the incident rate ratio of falls (95% CI). The mean blood lead level was 5.3 ± 2.3 (SD) g/dl (range, 1-21 g/dl). Baseline BMD was 7% lower in total hip and 5% lower in femoral neck in the highest compared with lowest blood lead group (p < 0.02). Hip bone loss tended to be greater in the high lead group, but differences were not significant. In multivariable adjusted models, women with high blood lead levels had an increased risk of nonspine fracture (HR ס 2.50; 95% CI ס 1.25, 5.03; p trend ס 0.016) and higher risk of falls (incident rate ratio ס 1.62; 95% CI ס 1.07, 2.45; p trend ס 0.014) compared with women with lowest lead level. Blood lead levels are associated with an increased risk of falls and fractures, extending the negative health consequences of lead to include osteoporotic fractures.
Circulating complement protein C3 (C3) levels have been associated with coronary artery calcifica... more Circulating complement protein C3 (C3) levels have been associated with coronary artery calcification (CAC) in women with systemic lupus erythematosus, but have yet to be evaluated in women with polycystic ovary syndrome (PCOS). We aimed to determine whether C3 levels were elevated in women with PCOS compared to controls, and to quantify the association of C3 with cardiovascular disease (CVD) risk factors and CAC, and if PCOS modified this association. This cross-sectional analysis included 132 women with PCOS and 155 controls 35-62 years old from the third visit of a case-control study. CAC was measured during the study visit and circulating C3 was measured in stored sera. The presence of CAC and CAC categories (Agatston score 0, 1-9.9, and ≥10) were used for logistic and ordinal regression analysis, respectively. C3 levels were not significantly different between women with PCOS and controls. Among all women, C3 was associated with the presence of CAC and increasing CAC groups after adjusting for age, PCOS status, and insulin or BMI, all p<0.05. In addition, C3 was associated with the presence of CAC after adjusting for age, PCOS status, BMI, insulin and African American race, p=0.049. PCOS status did not modify these associations. In conclusion, circulating C3 levels may prove beneficial in identifying women at risk of CVD in women with PCOS and the general population.
An aquatic hazard assessment establishes a derived predicted no effect concentration (PNEC) below... more An aquatic hazard assessment establishes a derived predicted no effect concentration (PNEC) below which it is assumed that aquatic organisms will not suffer adverse effects from exposure to a chemical. An aquatic hazard assessment of the endocrine disruptor Bisphenol A [BPA; 2, 2-bis (4-hydroxyphenyl) propane] was conducted using a weight of evidence approach, using the ecotoxicological endpoints of survival, growth and development and reproduction. New evidence has emerged that suggests that the aquatic system may not be sufficiently protected from adverse effects of BPA exposure at the current PNEC value of 100 μg/L. It is with this background that; 1) An aquatic hazard assessment for BPA using a weight of evidence approach, was conducted, 2) A PNEC value was derived using a non parametric hazardous concentration for 5% of the specie (HC(5)) approach and, 3) The derived BPA hazard assessment values were compared to aquatic environmental concentrations for BPA to determine, sufficient protectiveness from BPA exposure for aquatic species. A total of 61 studies yielded 94 no observed effect concentration (NOEC) and a toxicity dataset, which suggests that the aquatic effects of mortality, growth and development and reproduction are most likely to occur between the concentrations of 0.0483 μg/L and 2280 μg/L. This finding is within the range for aquatic adverse estrogenic effects reported in the literature. A PNEC of 0.06 μg/L was calculated. The 95% confidence interval was found to be (0.02, 3.40) μg/L. Thus, using the weight of evidence approach based on repeated measurements of these endpoints, the results indicate that currently observed BPA concentrations in surface waters exceed this newly derived PNEC value of 0.06 μg/L. This indicates that some aquatic receptors may be at risk for adverse effects on survival, growth and development and reproduction from BPA exposure at environmentally relevant concentrations.
International Journal of Environmental Research and Public Health
Cognitive impairment in older adults is a major public concern for Kazakhstan’s aging population.... more Cognitive impairment in older adults is a major public concern for Kazakhstan’s aging population. We aimed to (1) administer a neuropsychological test battery (NTB) in domains relevant to aging-associated cognitive impairment in a sample of adults aged 60+ without dementia in Almaty, Kazakhstan; (2) investigate the associations between demographic factors and test performance; and (3) provide information on the distribution of NTB scores as preliminary local normative data relevant for this population. A cross-sectional evaluation of 276 participants aged 60+ in Almaty, Kazakhstan, was conducted using cognitive instruments including tests of memory, attention, language, executive functions, visuospatial abilities, and processing speed. Multiple linear regression analyses were used to examine the association of demographic factors with neuropsychological test performance. The results from the regression analysis showed that those who are younger, have more years of education, are wom...
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