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PubMed2006

Helicobacter anseris sp. nov. and Helicobacter brantae sp. nov., isolated from feces of resident Canada geese in the greater Boston area.

Numbers of nonmigratory Canada geese have increased substantially in the past decade, and they have become a nuisance in some urban areas. Because of their close contact with humans in parks and areas adjacent to surface waterways, contact with their feces poses a zoonotic risk. A total of 97 geese from 10 separate geographic locales in the greater Boston area had their feces sampled for detection of Helicobacter spp. Identification of Helicobacter spp. based on 16S rRNA genus-specific helicobacter primers was noted in 39 of 97 (40.2%) DNA fecal extracts. Twenty-seven (27.8%) of these geese had helicobacters isolated from their feces. A urease-positive novel species, Helicobacter anseris, based on phenotypic, biochemical, and 16S rRNA analyses, was isolated from 20 geese from seven different flocks. A second, novel, urease-negative Helicobacter sp., H. brantae, was identified in seven geese. Four geese had both novel Helicobacter spp. cultured from their feces. Whether these two novel helicobacters pose a zoonotic risk, similar to other enteric helicobacters (e.g., H. canadensis, previously isolated from diarrheic and bacteremic humans and from geese in Europe), will require further studies.

Animals↗
PubMed1970

Serratia marcescens: biochemical, serological, and epidemiological characteristics and antibiotic susceptibility of strains isolated at Boston City Hospital.

The biochemical, serological, and epidemiological characteristics of 95 strains of Serratia marcescens isolated at the Boston City Hospital were examined. Several strains were shown to be endemic, and the majority of isolates were cultured from urine or respiratory secretions. Serratia species were highly resistant to polymyxin B and the cephalosporins, and various proportions were also resistant to other antibiotics including kanamycin, but all of the isolates were sensitive to gentamicin. The appearance of resistance to kanamycin and nalidixic acid among endemic strains was demonstrated. The nosocomial nature of Serratia infections, particularly those involving the urinary tract, was confirmed. Many clinical bacteriology laboratories currently fail to identify the nonpigmented strains.

Boston↗
PubMed1977

Changes in occurrence of capsular serotypes of Streptococcus pneumoniae at Boston City Hospital during selected years between 1935 and 1974.

The number of patients with pneumococcal bacteremia, empyema, and meningitis at Boston City Hospital during selected years between 1935 and 1974 is reported. The distribution of specific types in the bacteremic patients during each of the selected years and in the various focal infections in all the years is also detailed. The numbers and rates per 1,000 admissions of bacteremic pneumococcal infections and the numbers of cases of pneumococcal meningitis and empyema varied independently over these years and differed from those previously reported for 1929 to 1936. The types most frequent in pneumococcal bacteremias varied over the years, and the distribution of types among them differed markedly from that among the patients with focal infections. Variations in the distribution of pneumococcal types at different times in the same place, in different places, and in various sites of infection may be important in selecting types to include in pneumococcal vaccines for different populations.

Boston↗
PubMed2006

Air pollution and emergency admissions in Boston, MA.

STUDY OBJECTIVE: Many studies have shown that ambient particulate air pollution (PM) is associated with increased risk of hospital admissions and deaths for cardiovascular or respiratory causes around the world. In general these have been analysed in association with PM(10) and ozone, whereas PM(2.5) is now the particle measure of greatest health and regulatory concern. And little has been published on associations of hospital admissions and PM components. DESIGN: This study analysed hospital admissions for myocardial infarction (15 578 patients), and pneumonia (24 857 patients) in associations with fine particulate air pollution, black carbon (BC), ozone, nitrogen dioxide (NO(2)), PM not from traffic, and carbon monoxide (CO) in the greater Boston area for the years 1995-1999 using a case-crossover analysis, with control days matched on temperature. MAIN RESULTS: A significant association was found between NO(2) (12.7% change (95% CI: 5.8, 18)), PM(2.5) (8.6% increase (95% CI: 1.2, 15.4)), and BC (8.3% increase (95% CI: 0.2, 15.8)) and the risk of emergency myocardial infarction hospitalisation; and between BC (11.7% increase (95% CI: 4.8, 17.4)), PM(2.5) (6.5% increase (95% CI: 1.1, 11.4)), and CO (5.5% increase (95% CI: 1.1, 9.5)) and the risk of pneumonia hospitalisation. CONCLUSIONS: The pattern of associations seen for myocardial infarction and pneumonia (strongest associations with NO(2), CO, and BC) suggests that traffic exposure is primarily responsible for the association with heart attacks.

Aged↗
PubMed1978

Mortality among Boston firefighters, 1915--1975.

Although the nature of firefighting involves particular health hazards, previous mortality and morbidity studies of firemen have produced inconsistent evidence for an increased risk of mortality from cardiovascular disease, respiratory disease, cancer and accidents. Mortality experience since 1915 has been examined in 5655 Boston firefighters, comprising all male members of the city fire department with three or more years of service. The observed cause of death as stated on the death certificates of 2470 deceased firefighters has been compared with the numbers expected based on rates for the male population of Massachusetts and of the United States of America. Among all firefighters, deaths from all causes were 91% of expected. The standardised mortality ratio (SMR) was markedly reduced (less than 50) for infectious disease, diabetes, rheumatic heart disease, chronic nephritis, blood diseases and suicide. The SMR was 86 for cardiovascular deaths, 83 for neoplastic deaths, and 93 for respiratory deaths. The SMR for accidents was 135 for active firefighters. The results suggest that the survival experience of firefighters is strongly influenced by strict entry selection procedures, ethnic derivation, and sociocultural attributes of membership. While excessive morbidity has been demonstrated in firefighters, there does not appear to be a strong association between occupation and cause-specific mortality.

Accidents, Occupational↗
PubMed2006

Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon.

BACKGROUND: Multiple studies have individually documented cardiac dysfunction and biochemical evidence of cardiac injury after endurance sports; however, convincing associations between the two are lacking. We aimed to determine the associations between the observed transient cardiac dysfunction and biochemical evidence of cardiac injury in amateur participants in endurance sports and to elicit the risk factors for the observed injury and dysfunction. METHODS AND RESULTS: We screened 60 nonelite participants, before and after the 2004 and 2005 Boston Marathons, with echocardiography and serum biomarkers. Echocardiography included conventional measures as well as tissue Doppler-derived strain and strain rate imaging. Biomarkers included cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP). All subjects completed the race. Echocardiographic abnormalities after the race included altered diastolic filling, increased pulmonary pressures and right ventricular dimensions, and decreased right ventricular systolic function. At baseline, all had unmeasurable troponin. After the race, > 60% of participants had increased cTnT > 99th percentile of normal (> 0.01 ng/mL), whereas 40% had a cTnT level at or above the decision limit for acute myocardial necrosis (> or = 0.03 ng/mL). After the race, NT-proBNP concentrations increased from 63 (interquartile range [IQR] 21 to 81) pg/mL to 131 (IQR 82 to 193) pg/mL (P<0.001). The increase in biomarkers correlated with post-race diastolic dysfunction, increased pulmonary pressures, and right ventricular dysfunction (right ventricular mid strain, r=-0.70, P<0.001) and inversely with training mileage (r=-0.71, P<0.001). Compared with athletes training > 45 miles/wk, athletes who trained < or = 35 miles/wk demonstrated increased pulmonary pressures, right ventricular dysfunction (mid strain 16+/-5% versus 25+/-4%, P<0.001), myocyte injury (cTnT 0.09 versus < 0.01 ng/mL, P<0.001), and stress (NT-proBNP 182 versus 106 pg/mL, P<0.001). CONCLUSIONS: Completion of a marathon is associated with correlative biochemical and echocardiographic evidence of cardiac dysfunction and injury, and this risk is increased in those participants with less training.

Athletic Injuries↗
PubMed1996

Airways responsiveness, wheeze onset, and recurrent asthma episodes in young adolescents. The East Boston Childhood Respiratory Disease Cohort.

To describe the role of airways responsiveness in predicting incidence of wheeze in early adolescence and to examine the association between airways responsiveness and active asthma symptoms, children who had been tested for airways hyperresponsiveness were assessed prospectively. Of 770 children in the East Boston Childhood Respiratory Disease Cohort who were between 5 and 9 yr of age at time of entry into the study, 281 children received airways challenges during voluntary follow-up conducted between 1980 and 1986. Each subject presented a sequence of wheeze or asthma diagnosis reports along with a sequence of time-varying covariates, including airways challenge results and symptom and exposure information. A robust "pooled repeated observations" analog of the proportional hazard regression model was used to assess associations among risk factors and the probability of incident wheeze or active asthma. In the analysis of wheeze incidence, airways responsiveness (elicited via eucapnic hyperventilation with cold air or methacholine challenge) among those free of a history of wheeze at a given visit was found to be associated with a greater tendency to develop wheezing in the next visit (odds ratio [OR] = 3.91, 95% confidence interval [CI] = 1.21, 12.66), after controlling for a constellation of known risk factors. In the analysis of recurrent asthma episodes, airways responsiveness at a given visit was associated with a greater tendency to have an asthma diagnosis reported at the subsequent visit (OR = 4.2, 95% CI = 1.92, 9.23). For subjects presenting multiple airways responsiveness challenge studies, two successive positive airways responsiveness results were independently associated with a higher likelihood of recurrent asthma episodes. These results confirm the predictive importance of airways responsiveness in the natural history of the development and persistence of asthmatic symptoms.

Adolescent↗
PubMed1980

Restraint versus treatment: seclusion as discussed in the Boston State Hospital case.

The recent Boston State Hospital case in Massachusetts produced, among other results, a decision that highlights areas of gross conceptual nonalignment between law and psychiatry on the subject of seclusion. The author presents a critique of aspects of the decision that have important implications for the psychiatric use of seclusion and explores related problem areas in the relationship between law and psychiatry.

Boston↗
PubMed1978

What makes adolescent girls flee from their homes? An analysis of 50 such girls studied at Boston Juvenile Court.

Fifty girls who were arrested in Boston on a charge of running away and their parents were studied via psychiatric interviews, rating schedules and psychotherapeutic data. There was an absence of psychosis and mental retardation in this group. A diversity of factors leading to running away episodes were elicited. Sexual factors were common. Family disturbances were usually found, reflecting in part the urban areas from which this group came. The girls showed a remarkable uniformity of behavior while on the run. Treatment of the whole family was often necessary for success in dealing with the runaway problem. The importance of intervention promptly is demonstrated by the associated self-destructive behavior of the girls, the frequency of severe family disturbances and the later histories of these youngsters.

Boston↗
PubMedDate not supplied

The stability of preferences for life-sustaining care among persons with AIDS in the Boston Health Study.

BACKGROUND: Clinicians recognize the importance of eliciting patient preferences for life-sustaining care, yet little is known about the stability of those preferences for patients with serious disease. OBJECTIVES: To examine the stability of preferences for life-sustaining care among persons with AIDS and to assess factors associated with changes in preferences. DESIGN: Two patient surveys and medical record reviews, administered four months apart in 1990-1991. SETTING: Three health care settings in Boston. PATIENTS: 252 of 505 eligible persons with AIDS who participated in both baseline and follow-up surveys. MAIN OUTCOME MEASURES: A single question assessing desire for cardiac resuscitation and a scale of preferences for life-extending treatment conditional on hypothetical health states. RESULTS: Approximately one-fourth of the respondents changed their minds about life-sustaining care during a four-month period. Of patients who initially desired cardiac resuscitation, 23% decided to forego it four months later, and of those who initially said they would decline care, 34% later said they would accept it. Of those who initially desired any of the life-extending treatments, 25% decided to forego them four months later, and of those who initially said they would decline life-extending care, 24% later said they would accept some treatment. Patients reporting changes in physical function, pain, or suicide ideation were more likely to modify their desires to be resuscitated (all p< or =0.05). Patients lacking an advance directive, not completing high school, or becoming more severely ill were more likely to change their preferences on the Life Extension scale (p< or =0.05). Patients who discussed their preferences with at least one physician were just as likely as others to change desires for cardiac resuscitation. Age, gender, race, emotional health, clinical severity, social support, and site of care were not significant correlates of change for either measure. CONCLUSIONS: Health care providers should periodically reassess preferences for life-sustaining care, particularly for patients with progressive disease, given the instability in patient preferences. However, predictors of instability may vary with how preferences are measured. In particular, changes in health status may be related to instability of preferences for certain types of treatments.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Lung function, asthma symptoms, and quality of life for children in public housing in Boston: a case-series analysis.

BACKGROUND: Children in urban public housing are at high risk for asthma, given elevated environmental and social exposures and suboptimal medical care. For a multifactorial disease like asthma, design of intervention studies can be influenced by the relative prevalence of key risk factors. To better understand risk factors for asthma morbidity in the context of an environmental intervention study, we conducted a detailed baseline evaluation of 78 children (aged 4-17 years) from three public housing developments in Boston. METHODS: Asthmatic children and their caregivers were recruited between April 2002 and January 2003. We conducted intake interviews that captured a detailed family and medical history, including questions regarding asthma symptom severity, access to health care, medication usage, and psychological stress. Quality of life was evaluated for both the child and caregiver with an asthma-specific scale. Pulmonary function was measured with a portable spirometer, and allergy testing for common indoor and outdoor allergens was conducted with skin testing using the prick puncture method. Exploratory linear and logistic regression models evaluating predictors of respiratory symptoms, quality of life, and pulmonary function were conducted using SAS. RESULTS: We found high rates of obesity (56%) and allergies to indoor contaminants such as cockroaches (59%) and dust mites (59%). Only 36% of children with persistent asthma reported being prescribed any daily controller medication, and most did not have an asthma action plan or a peak flow meter. One-time lung function measures were poorly correlated with respiratory symptoms or quality of life, which were significantly correlated with each other. In multivariate regression models, household size, body mass index, and environmental tobacco smoke exposure were positively associated with respiratory symptom severity (p < 0.10). Symptom severity was negatively associated with asthma-related quality of life for the child and the caregiver, with caregiver (but not child) quality of life significantly influenced by caregiver stress and whether the child was in the intensive care unit at birth. CONCLUSION: Given the elevated prevalence of multiple risk factors, coordinated improvements in the social environment, the built environment, and in medical management would likely yield the greatest health benefits in this high-risk population.

Adolescent↗
PubMed1988

Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin.

Sunlight has long been recognized as a major provider of vitamin D for humans; radiation in the UVB (290-315 nm) portion of the solar spectrum photolyzes 7-dehydrocholesterol in the skin to previtamin D3, which, in turn, is converted by a thermal process to vitamin D3. Latitude and season affect both the quantity and quality of solar radiation reaching the earth's surface, especially in the UVB region of the spectrum, but little is known about how these influence the ability of sunlight to synthesize vitamin D3 in skin. A model has been developed to evaluate the effect of seasonal and latitudinal changes on the potential of sunlight to initiate cutaneous production of vitamin D3. Human skin or [3 alpha-3H]7-dehydrocholesterol exposed to sunlight on cloudless days in Boston (42.2 degrees N) from November through February produced no previtamin D3. In Edmonton (52 degrees N) this ineffective winter period extended from October through March. Further south (34 degrees N and 18 degrees N), sunlight effectively photoconverted 7-dehydrocholesterol to previtamin D3 in the middle of winter. These results quantify the dramatic influence of changes in solar UVB radiation on cutaneous vitamin D3 synthesis and indicate the latitudinal increase in the length of the "vitamin D winter" during which dietary supplementation of the vitamin may be advisable.

Alberta↗
PubMed2000

Socioeconomic predictors of high allergen levels in homes in the greater Boston area.

In the United States, childhood asthma morbidity and prevalence rates are the highest in less affluent urban minority communities. More than 80% of childhood asthmatics are allergic to one or more inhalant allergens. We evaluated whether socioeconomic status was associated with a differential in the levels and types of indoor home allergens. Dust samples for an ELISA allergen assay were collected from the homes of 499 families as part of a metropolitan Boston, Massachusetts, longitudinal birth cohort study of home allergens and asthma in children with a parental history of asthma or allergy. The proportion of homes with maximum home allergen levels in the highest category was 42% for dust mite allergen (> or = 10 microg/g Der p 1 or Der f 1), 13% for cockroach allergen (> or = 2 U/g Bla g 1 or Bla g 2), 26% for cat allergen (> or = 8 microg/g Fel d 1), and 20% for dog allergen (> or = 10 microg/g Can f 1). Homes in the high-poverty area (> 20% of the population below the poverty level) were more likely to have high cockroach allergen levels than homes in the low-poverty area [51 vs. 3%; OR, 33; 95% confidence interval (CI), 12-90], but less likely to have high levels of dust mite allergen (16 vs. 53%; OR, 0.2; CI, 0.1-0.4). Lower family income, less maternal education, and race/ethnicity (black or Hispanic vs. white) were also associated with a lower risk of high dust mite levels and a greater risk of high cockroach allergen levels. Within a single U.S. metropolitan area we found marked between-community differences in the types of allergens present in the home, but not necessarily in the overall burden of allergen exposure.

Adult↗
PubMed2004

Determinants of bone and blood lead levels among minorities living in the Boston area.

We measured blood and bone lead levels among minority individuals who live in some of Boston's neighborhoods with high minority representation. Compared with samples of predominantly white subjects we had studied before, the 84 volunteers in this study (33:67 male:female ratio; 31-72 years of age) had similar educational, occupational, and smoking profiles and mean blood, tibia, and patella lead levels (3 microg/dL, 11.9 microg/g, and 14.2 microg/g, respectively) that were also similar. The slopes of the univariate regressions of blood, tibia, and patella lead versus age were 0.10 microg/dL/year (p < 0.001), 0.45 microg/g/year (p < 0.001), and 0.73 microg/g/year (p < 0.001), respectively. Analyses of smoothing curves and regression lines for tibia and patella lead suggested an inflection point at 55 years of age, with slopes for subjects greater than or equal to 55 years of age that were not only steeper than those of younger subjects but also substantially steeper than those observed for individuals > 55 years of age in studies of predominantly white participants. This apparent racial disparity at older ages may be related to differences in historic occupational and/or environmental exposures, or possibly the lower rates of bone turnover that are known to occur in postmenopausal black women. The higher levels of lead accumulation seen in this age group are of concern because such levels have been shown in other studies to predict elevated risks of chronic disease such as hypertension and cognitive dysfunction. Additional research on bone lead levels in minorities and their socioeconomic and racial determinants is needed.

Adult↗
PubMed1991

Neoplasms and nonneoplastic liver lesions in winter flounder, Pseudopleuronectes americanus, from Boston Harbor, Massachusetts.

A variety of neoplasms and nonneoplastic hepatic lesions have been noted in winter flounder, Pseudopleuronectes americanus, from Boston Harbor, Massachusetts. Inflammatory lesions include cholangiitis, pericholangiitis, pericholangial fibrosis, hepatitis, and pancreatitis. Necrotic lesions consist essentially of focal coagulative necrosis and a distinctive vacuolated cell lesion of the hepatic parenchyma. The most conspicuous and numerous proliferative lesion is macrophage aggregate hyperplasia and hypertrophy. Preneoplastic lesions include principally basophilic foci of cellular alteration and hepatocellular adenoma. Carcinomas consist of several morphologic varieties: hepatocarcinoma, cholangiocarcinoma, and anaplastic adenocarcinoma. The pathogenesis of the lesions observed is discussed with respect to anthropogenically introduced chemical contaminants and the resistant hepatocyte model of hepatocarcinogenesis. This study, and others of bottom-living food fish with enzootic neoplastic disease, warrants further evaluation, particularly with respect to possible bioaccumulation of chemical contaminants in edible tissues.

Animals↗
PubMed2004

Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II.

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.

Adolescent↗
PubMed1997

Lesbian uses of and satisfaction with mental health services: results from Boston Lesbian Health Project.

In response to the dearth of specific information about lesbians' health status and practices in the health literature, a national study utilizing a self-administered questionnaire was conducted in 1987 by four associates of the Fenway Community Health Center in Boston to access data in these areas. The questionnaire solicited information about demographics, health practices, stress in personal and work lives, mental and physical health problems, sexual practices, family history of health related problems, and genetic attributes hypothesized to be related to "gayness." Questionnaires from 1,633 lesbian women provided the database for the study. This paper discusses the portion of the survey that dealt with mental health services and life experiences. Past studies that investigated mental health needs of lesbians focused on the quality of treatment by mental health providers, rates of suicide attempts, and alcoholism. This paper compares these past findings with the responses of the lesbians in this national, community-based study. Findings indicate that although a significant number of the lesbian women in this sample had been in therapy, they sought out therapy as a coping strategy to deal with similar issues as other women, i.e., depression and relationships. Suicide attempts decreased considerably after adolescence and "coming out." Rates of alcohol use and abuse, although difficult to compare with other studies, were higher than other women but similar to other studies investigating a community sample of lesbians. Even with a high family history of alcoholism, less than 5 percent reported having sought out therapy to deal with any issues of alcohol or drug use.

Adolescent↗