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PubMed2006

Composition of bacillus species in aerosols from 11 U.S. cities.

A PCR-based heteroduplex assay was used to determine the presence and composition of Bacillus species in 11,059 Environmental Protection Agency PM2.5 aerosol samples from 11 U.S. cities. The assay differentiated three groups: Type A containing Bacillus anthracis and very closely related, often pathogenic, Bacillus cereus and Bacillus thuringiensis strains; Type B containing other B. cereus and B. thuringiensis strains; and a third group of more-distantly related Bacillus species. Eight of the 11 cities were positive for Bacillus species in 50% or more of the samples, and the percent of aerosol samples that contained the HD Type A group ranged from 3% to 32%. Cities from the eastern half of the United States generally contained a higher frequency and broader diversity of Bacillus species than the western half of the United States. Positive samples were detected throughout the year. These results have implications for pathogen detection in environmental samples, understanding the natural evolution of new pathogenic strains, and incidence of infection caused by strains of the B. cereus subgroup.

Aerosols↗
PubMed1987

Exposure of sheet-metal workers to asbestos during the construction and renovation of commercial buildings in New York City. A case study in social medicine.

New York City sheet-metal workers have a history of significant exposure to asbestos. Prior to 1972 when the use of sprayed asbestos insulation was banned in New York City, sheet-metal workers involved in building construction were exposed as they worked adjacent to spraying operations. Subsequent to that date, exposure continued as they renovated these same buildings. In 1982 the Occupational Health Program of Montefiore Medical Center and the Albert Einstein College of Medicine initiated a multidimensional asbestos evaluation and intervention program for the sheet-metal industry and union in New York. The long-term goal of the program was to eliminate asbestos exposure through the safe, systematic removal of asbestos in New York City buildings, most likely a legislated solution. In the short term, we attempted to assess and reduce asbestos exposure in the sheet-metal trade by a series of steps consisting of: mortality and morbidity studies; a medical audit of clinical screening services provided to sheet-metal workers; a comprehensive health education program; development of safe work practices; evaluation of personal protective equipment; and investigation into and support of legislative and regulatory solutions to the problem of asbestos contamination of commercial buildings. This intervention can be seen as a case study in the practice of social medicine.

Asbestos↗
PubMed1991

Radiological abnormalities and asbestos exposure among custodians of the New York City Board of Education.

Six hundred sixty custodians employed by the New York City Board of Education underwent examination from 1985 through 1987 for asbestos-related disease and other general medical conditions by the clinical staff of the Division of Environmental and Occupational Medicine of the Mount Sinai School of Medicine of the City University of New York. Two-thirds of the men (no women were examined) were 20 or more years from onset of any custodial work, with 44% having had at least 20 years of employment as custodial workers in New York City Board of Education schools. Twenty-four percent had begun custodial work in buildings 30 or more years earlier. Findings among them were of particular interest since asbestos-related disease might forecast what might be expected among school custodians with less seniority. Since the Board of Education, in selecting custodians for examination, had chosen only custodians currently employed, the study group comprised men still working in the school system. These, then, represented a "survivor population" (4% had retired between the time of enrollment in the study and the date of examination, and only one of the seventeen retirees had left work owing to disability). Although a considerable amount of clinical information was obtained, abnormalities on chest X-ray consistent with asbestos-induced scarring were used as the key index of disease resulting from exposure to asbestos. Since scarring of the lung tissue or lining of the lung or chest wall (pleura) may be present but undetectable on standard chest radiographs (a relatively insensitive diagnostic technique), the prevalence of abnormality on X-ray film represents a conservative estimate of the actual burden of scarring lung disease in the group. Such changes are indicative of previous asbestos exposure, however, and provide evidence of an increased risk of later asbestos-related malignancy. Overall, abnormalities on chest X-ray consistent with asbestos-related scarring were found in 28% of the men examined. The expected relationship of increasing prevalence of radiographic changes with increasing time since onset of exposure in buildings was demonstrated; among those with 35 or more years since beginning custodial work, 39% had abnormal films. This is evidence that custodial workers as a group have had asbestos exposure in the past, as reflected also in the work histories obtained at the time of examination. Eighty-four percent reported that they themselves removed asbestos-containing materials in the course of their work. Eighty-nine percent had been present in the work area during asbestos abatement projects in the schools in more recent years.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollution, Indoor↗
PubMed2006

Neighbourhood mortality inequalities in New York City, 1989-1991 and 1999-2001.

OBJECTIVES: To examine whether inequalities in mortality across socioeconomically diverse neighbourhoods changed alongside the decline in mortality observed in New York City between 1990 and 2000. DESIGN: Cross-sectional analysis of neighbourhood-level vital statistics. SETTING: New York City, 1989-1991 and 1999-2001. MAIN RESULTS: In both poor and wealthy neighbourhoods, age-adjusted mortality for most causes declined between the time periods, although mortality from diabetes increased. Relative inequalities decreased slightly-largely in the under 65 years population-although all-cause rates in 1999-2001 were still 50% higher, and rates of years of potential life lost before age 65 years were 150% higher, in the poorest communities than in the wealthiest ones (relative index of inequality 1.7 and 3.3, respectively). The relative index of inequality for mortality from AIDS increased from 4.7 to 13.9. Over 50% of the excess mortality in the poorest neighbourhoods in 1999-2001 was due to cardiovascular disease, AIDS and cancer. CONCLUSIONS: In New York City, despite substantial declines in absolute mortality and rate differences between poor and wealthy neighbourhoods, great relative socioeconomic inequalities in mortality persist.

Adolescent↗
PubMed2001

Trends in young adult mortality in three European cities: Barcelona, Bologna and Munich, 1986-1995.

OBJECTIVE: In recent decades, in most European countries young adult mortality has risen, or at best has remained stable. The aim of this study was to describe trends in mortality attributable to the principal causes of death: AIDS, drug overdose, suicide and motor vehicle traffic accidents, among adults aged between 15 and 34 years in three European cities (Barcelona, Bologna and Munich), over the period 1986 to 1995. METHODS: The population studied consisted of all deaths that occurred between 1986 and 1995 among residents of Barcelona, Bologna and Munich aged from 15 to 34 years. Information about deaths was obtained from mortality registers. The study variables were sex, age, the underlying cause of death and year of death. Causes of death studied were: drug overdose, AIDS, suicide and motor vehicle traffic accidents. Age standardised mortality rates (direct adjustment) were obtained in all three cities for the age range 15-34. To investigate trends in mortality over the study period Poisson regression models were fitted, obtaining the average relative risk (RR) associated with a one year increment. RESULTS: Young adult mortality increased among men in Barcelona and Bologna (RR per year: 1.04, 95% confidence intervals (95%CI): 1.03, 1.06 in Barcelona and RR:1.03, 95%CI:1.01, 1.06 in Bologna) and among women in Barcelona (RR:1.02, 95%CI: 1.01, 1.04), with a change in the pattern of the main causes of death attributable to the increase in AIDS and drug overdose mortality. In Munich, the pattern did not change as much, suicides being the main cause of death during the 10 years studied, although they have been decreasing since 1988 (RR:0.92, 95%CI:0.88, 0.96 for men and 0.81, 95%CI: 0.75-0.87 for women). CONCLUSION: The increase in AIDS mortality observed in the three European cities in the mid-80s and mid-90s has yielded substantial changes in the pattern of the main causes of death at young ages in Barcelona and Bologna. Munich presented a more stable pattern, with suicide as the main cause of death.

Accidents, Traffic↗
PubMed1997

Geographic diversity in tuberculosis trends and directly observed therapy, New York City, 1991 to 1994.

The New York City tuberculosis (TB) case rate declined from 1991 to 1994 following more than a decade of increases. The present study investigated TB trends in New York City neighborhoods and their association with neighborhood-specific rates of application of directly observed therapy (DOT). Using Poisson regression models, TB trends in each of New York City's 30 health districts were classified as increasing, decreasing, or stable, as indicated respectively by significant positive, negative, or nonsignificant regression coefficient. Case counts increased in four health districts, decreased in 10, and were stable in 16. Decreasing TB was associated with a higher rate of application of DOT. TB cases among foreign-born persons increased in 12 health districts and were stable in 18, whereas cases among persons born in the United States decreased in 19 and were stable in 11 districts. Among the foreign-born, increasing TB was not associated with a lesser rate of application of DOT. These data provide some support for the role of DOT in containing TB, but also suggest that the application of DOT among foreign-born residents is less effective than among United States-born residents. This may be due to a greater proportion of TB cases among the foreign-born being due to reactivation of TB rather than new infection.

Antitubercular Agents↗
PubMed2006

Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire Department.

RATIONALE: On September 11, 2001, the World Trade Center collapse created an enormous urban disaster site with high levels of airborne pollutants. First responders, rescue and recovery workers, and residents have since reported respiratory symptoms and developed pulmonary function abnormalities. OBJECTIVES: To quantify respiratory health effects of World Trade Center exposure in the New York City Fire Department. MEASUREMENTS: Longitudinal study of pulmonary function in 12,079 New York City Fire Department rescue workers employed on or before 09/11/2001. Between 01/01/1997 and 09/11/2002, 31,994 spirometries were obtained and the FEV(1) and FVC were analyzed for differences according to estimated World Trade Center exposure intensity. Adjusted average FEV(1) during the first year after 09/11/2001 was compared with the 5 yr before 09/11/2001. Median time between 09/11/2001 and a worker's first spirometry afterwards was 3 mo; 90% were assessed within 5 mo. MAIN RESULTS: World Trade Center-exposed workers experienced a substantial reduction in adjusted average FEV(1) during the year after 09/11/2001 (372 ml; 95% confidence interval, 364-381 ml; p < 0.001) This exposure-related FEV(1) decrement equaled 12 yr of aging-related FEV(1) decline. Moreover, exposure intensity assessed by initial arrival time at the World Trade Center site correlated linearly with FEV(1) reduction in an exposure intensity-response gradient (p = 0.048). Respiratory symptoms also predicted a further FEV(1) decrease (p < 0.001). Similar findings were observed for adjusted average FVC. CONCLUSIONS: World Trade Center exposure produced a substantial reduction in pulmonary function in New York City Fire Department rescue workers during the first year after 09/11/2001.

Adult↗
PubMed2000

Similarities and differences in homelessness in Amsterdam and New York City.

Differences and similarities in homelessness in Amsterdam and New York City were examined, particularly in regard to persons most at risk for homelessness--those with mental illness and with substance abuse problems. The Netherlands is a welfare state where rents are controlled by the national government and more than half of the housing is public housing. Virtually all homeless people in Amsterdam are unemployed and receive some sort of social security benefit. Direct comparisons of the results of American and Dutch studies on homelessness are impossible, mainly because the estimates are uncertain. Because of the Dutch welfare system, Amsterdam has a smaller proportion of homeless people than New York City, although more people are homeless in Amsterdam today than 15 years ago. Neither a lack of affordable housing or sufficient income nor unemployment has been a direct cause of the increase of homelessness. As in New York City, many of the homeless in Amsterdam are mentally ill or have substance use disorders. The increase in the number of homeless people in Amsterdam consists largely of mentally ill people who would have been admitted to a mental hospital 20 years ago and of older, long-term heroin abusers who can no longer live independently. Thus institutional factors such as fragmentation of services and lack of community programs for difficult-to-serve people are a likely explanation of the growing number of homeless people in Amsterdam.

Adult↗
PubMed1987

Health education, public policy and disease prevention: a case history of the New York City Coalition to End Lead Poisoning.

How can health educators influence public policy so as to increase the resources for disease prevention? The following case history of the New York City Coalition to End Lead Poisoning (NYCCELP) describes how an advocacy group sought to educate parents, health workers and policy makers about a major urban health problem. Using health education techniques such as small group meetings, mass media coverage and community organizing, NYCCELP hoped to persuade city agencies to enforce more systematically existing laws for the prevention of lead poisoning and to allocate more resources for screening and education. By defining the problem of lead poisoning broadly, the Coalition was able to attract diverse constituencies including housing organizations, public health advocacy groups, public interest lawyers, elected officials and children's rights groups. In part as a result of NYCCELP's efforts, the city government has screened more children for lead poisoning, hired additional health educators, enforced relevant sections of the housing code more often, and allocated new resources for lead poisoning control.

Child↗
PubMed2004

Improving air quality in megacities: Mexico City case study.

The development and effective implementation of solutions to the air pollution problems in the Mexico City Metropolitan Area is essential to guarantee the health and welfare of its inhabitants. To achieve this, it is essential to have the active and informed participation of the civil society, the academic community, the private sector, and the government, because dealing with pollution requires the use of different strategies in multiple fields of action. The Mexico City case study brings together health, transportation, administration, and many other interdisciplinary approaches to understanding and defeating air pollution. Although focused on the Mexico City area, the work conducted under this case study has significance for developing nations generally. Although policies to reduce air pollution should be based on the best available scientific knowledge, political will and capacity must transform this knowledge into action. This case study has developed a series of recommendations emphasizing the interaction between different disciplines that have provided the foundation for the 10-year air quality management program prepared by the Mexican Metropolitan Environmental Commission.

Air Pollutants↗
PubMed2002

Biologic effects induced in vitro by PM10 from three different zones of Mexico City.

Exposure to urban airborne particles is associated with an increase in morbidity and mortality. There is little experimental evidence of the mechanisms involved and the role of particle composition. We assessed cytotoxicity (crystal violet assay), apoptosis [terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) or annexin V assay], DNA breakage (comet assay), and production of proinflammatory mediators [tumor necrosis factor Alpha (TNF-Alpha), interleukin 6 (IL-6), prostaglandin E2 (PGE2)] (enzyme-linked immunosorbent assay), and E-selectin (flow cytometry) in cell lines exposed to particulate matter < 10 microm in size (PM10) obtained from the northern, central, and southern zones of Mexico City. Particle concentrations ranged from 2.5 to 160 microg/cm(2). We used epithelial, endothelial, fibroblastic, and monocytic cells and assessed DNA damage in Balb-c cells, TNF-Alpha and IL-6 production in mouse monocytes, and PGE2 in rat lung fibroblasts. We determined the expression of E-selectin in human endothelial cells and evaluated the cytotoxic potential of the PM10 samples in all cell types. PM10 from all three zones of Mexico City caused cell death, DNA breakage, and apoptosis, with particles from the north and central zones being the most toxic. All of these PM10 samples induced secretion of proinflammatory molecules, and particles from the central zone were the most potent. Endothelial cells exposed to PM10 from the three zones expressed similar E-selectin levels. Mexico City PM10 induced biologic effects dependent on the zone of origin, which could be caused by differences in the mixture or size distribution within particle samples. Our data suggest that particle composition as well as particle size should be considered in assessing the adverse effects of airborne particulate pollution.

Air Pollutants↗
PubMed2003

Distribution and determinants of mouse allergen exposure in low-income New York City apartments.

Previous studies of mouse allergens and laboratory-animal-worker-related allergy and asthma suggest that quantifying mouse allergen levels in homes could augment our understanding of inner-city asthma. We hypothesized that levels of mouse allergen in inner-city homes would be related to certain household characteristics. Dust samples were collected from the kitchens and beds of 221 mothers enrolled in a prospective birth cohort study, 92 of African American and 129 of Dominican ethnicity. Samples were analyzed for mouse urinary protein. The geometric mean for kitchen samples was 4.6 micro g/g [95% confidence interval (95% CI), 3.2-6.5] and for bed samples was 0.9 micro g/g (95% CI, 0.8-1.1). The variables associated with mouse allergen levels in the home were frequency of mouse sightings, use of traps or pesticides for mice, presence of holes in ceilings or walls, absence of a cat, and living in a building with fewer than eight floors. Statistically significant neighborhood differences in levels of mouse allergen and report of rodents in the home were also observed. In conclusion, mouse allergen was prevalent among inner-city apartments, and the positive predictive value of self-reported frequent mouse sightings was high (90% for kitchens). However, high levels of mouse allergen were also found in many homes where mothers reported never seeing mice.

Black or African American↗
PubMed2004

Pesticide spraying for West Nile virus control and emergency department asthma visits in New York City, 2000.

Pyrethroid pesticides were applied via ground spraying to residential neighborhoods in New York City during July-September 2000 to control mosquito vectors of West Nile virus (WNV). Case reports link pyrethroid exposure to asthma exacerbations, but population-level effects on asthma from large-scale mosquito control programs have not been assessed. We conducted this analysis to determine whether widespread urban pyrethroid pesticide use was associated with increased rates of emergency department (ED) visits for asthma. We recorded the dates and locations of pyrethroid spraying during the 2000 WNV season in New York City and tabulated all ED visits for asthma to public hospitals from October 1999 through November 2000 by date and ZIP code of patients' residences. The association between pesticide application and asthma-related emergency visits was evaluated across date and ZIP code, adjusting for season, day of week, and daily temperature, precipitation, particulate, and ozone levels. There were 62,827 ED visits for asthma during the 14-month study period, across 162 ZIP codes. The number of asthma visits was similar in the 3-day periods before and after spraying (510 vs. 501, p = 0.78). In multivariate analyses, daily rates of asthma visits were not associated with pesticide spraying (rate ratio = 0.92; 95% confidence interval, 0.80-1.07). Secondary analyses among children and for chronic obstructive pulmonary disease yielded similar null results. This analysis shows that spraying pyrethroids for WNV control in New York City was not followed by population-level increases in public hospital ED visit rates for asthma.

Adolescent↗
PubMed2006

Extreme temperatures and mortality: assessing effect modification by personal characteristics and specific cause of death in a multi-city case-only analysis.

BACKGROUND: Extremes of temperature are associated with short-term increases in daily mortality. OBJECTIVES: We set out to identify subpopulations and mortality causes with increased susceptibility to temperature extremes. METHODS: We conducted a case-only analysis using daily mortality and hourly weather data from 50 U.S. cities for the period 1989-2000, covering a total of 7,789,655 deaths. We used distributions of daily minimum and maximum temperature in each city to define extremely hot days (>/= 99 th percentile) and extremely cold days (</= 1st percentile) , respectively. For each (hypothesized) effect modifier, a city-specific logistic regression model was fitted and an overall estimate calculated in a subsequent meta-analysis. RESULTS: Older subjects [odds ratio (OR) = 1.020 ; 95% confidence interval (CI) , 1.005-1.034], diabetics (OR = 1.035 ; 95% CI, 1.010-1.062) , blacks (OR = 1.037 ; 95% CI, 1.016-1.059) , and those dying outside a hospital (OR = 1.066 ; 95% CI, 1.036-1.098) were more susceptible to extreme heat, with some differences observed between those dying from a cardiovascular disease and other decedents. Cardiovascular deaths (OR = 1.053 ; 95% CI, 1.036-1.070) , and especially cardiac arrest deaths (OR = 1.137 ; 95% CI, 1.051-1.230) , showed a greater relative increase on extremely cold days, whereas the increase in heat-related mortality was marginally higher for those with coexisting atrial fibrillation (OR = 1.059 ; 95% CI, 0.996-1.125) . CONCLUSIONS: In this study we identified several subpopulations and mortality causes particularly susceptible to temperature extremes. This knowledge may contribute to establishing health programs that would better protect the vulnerable.

Adolescent↗
PubMed2006

An intervention to reduce residential insecticide exposure during pregnancy among an inner-city cohort.

BACKGROUND: We previously reported widespread insecticide exposure during pregnancy among inner-city women from New York City. Here we report on a pilot intervention using integrated pest management (IPM) to reduce pest infestations and residential insecticide exposures among pregnant New York City African-American and Latina women (25 intervention and 27 control homes). METHODS: The IPM consisted of professional cleaning, sealing of pest entry points, application of low-toxicity pesticides, and education. Cockroach infestation levels and 2-week integrated indoor air samples were collected at baseline and one month postintervention. The insecticides detected in the indoor air samples were also measured in maternal and umbilical cord blood collected at delivery. RESULTS: Cockroach infestations decreased significantly (p = 0.016) after the intervention among intervention cases but not control households. Among the intervention group, levels of piperonyl butoxide (a pyrethroid synergist) were significantly lower in indoor air samples after the intervention (p = 0.016). Insecticides were detected in maternal blood samples collected at delivery from controls but not from the intervention group. The difference was significant for trans-permethrin (p = 0.008) and of borderline significance (p = 0.1) for cis-permethrin and 2-isopropoxyphenol (a propoxur metabolite). CONCLUSION: To our knowledge, this is the first study to use biologic dosimeters of prenatal pesticide exposure for assessing effectiveness of IPM. These pilot data suggest that IPM is an effective strategy for reducing pest infestation levels and the internal dose of insecticides during pregnancy.

Adolescent↗
PubMed1990

Trends in reporting of maternal drug abuse and infant mortality among drug-exposed infants in New York City.

New York City trends in maternal drug abuse during pregnancy and in mortality rates for infants with in utero drug exposure are reported; causes of death among drug-exposed infants are studied, as is the association between maternal drug abuse and other factors that contribute to infant mortality (e.g., low birthweight, lack of prenatal care). Data for this study are derived from the linked files of New York City birth and infant death certificates. Reports of infants born to drug abusing mothers increased from 6.7 per 1000 live births in 1981 to 20.3 per 1000 live births in 1987, with abuse of cocaine accounting for most of the rise. When standardized for race and ethnicity, the mortality rate for drug-exposed infants born from 1978 through 1986 was 35.9, or 2.4 times that for infants in New York City in general. Drug-exposed infants were over three times as likely as infants in the general population to be of low birthweight. The association of both opiates and cocaine with increased mortality and low birthweight was similar. Death rates from SIDS and AIDS were especially higher for drug-exposed infants than for those in the general population, and were similar for opiate- and cocaine-exposed infants. The impact of drug abuse on infant mortality rates in selected low socioeconomic health districts is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Current and future trends in AIDS in New York City.

Over the past five years, the proportion of AIDS cases among gay and bisexual men in New York City has fallen as the proportion of AIDS cases has risen among IV drug abusers, the major channel of HIV infection to children and heterosexuals in New York City. By 1991, there will be over 40,000 cumulative AIDS cases in New York City, with close to 30,000 deaths. Controlling the spread of HIV infection among drug addicts, children, and heterosexuals requires education, outreach, and exploration of strategies such as increasing the legal availability of sterile needles and syringes. For at least the next several years, massive programs of public health education and voluntary, confidential risk-reduction counseling and HIV antibody testing will remain our critical weapons for reducing the spread of HIV infection among people engaged in high-risk behavior as well as among the general public.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Legal syringe purchases by injection drug users, Brooklyn and Queens, New York City, 2000-2001.

OBJECTIVE: To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City. DESIGN: Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001. SETTING: Brooklyn and Queens, New York City. PARTIPANTS: IDUs. MAIN OUTCOME MEASURES: Attempts to purchase syringes from pharmacies and success in doing so. RESULTS: Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%. CONCLUSIONS: The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.

Data Collection↗