"I Need my Own Place to get Better": Patient Perspectives on the Role of Housing in Potentially Preventable Hospitalizations

OBJECTIVE

To analyze patient perspectives on the role of housing in their potentially preventable hospitalization.

METHODS

Individuals admitted with cardiovascular-or diabetes-related diagnoses (n = 90) in a major medical center in Hawai'i completed an in-person interview eliciting patient perspectives on key factors leading to hospitalization. Using the framework approach, two independent coders identified themes. This study focused on housing-related findings.

RESULTS

Overall, 23% of participants reported housing as a precipitating factor to their hospitalization, including 12 with no regular place to stay. Four housing-related themes emerged: challenges meeting basic needs, complex chronic care management difficulties, stigma and relationship with provider, and stress and other mental health issues.

DISCUSSION

Almost 25% of patients identified housing as a key factor to their hospital stay. Patient-reported themes highlight specific mechanisms by which housing challenges may lead to hospitalization. Addressing housing issues could help reduce the number and associated cost burden of preventable hospitalizations.

"Aguantamos": Limits to Latino Migrant Farmworker Agency in North Carolina Labor Camps

Each year, tens of thousands of Latino migrant farmworkers return to the hills and fields of North Carolina to live in employer-provided labor camps that often fail to meet regulatory and ethical standards. Little attention has been paid to how these workers and their families perceive and respond to substandard housing conditions. This paper analyzes how far and in what ways Latino migrant farmworkers living in eastern North Carolina labor camps feel their agency extends in responding to substandard housing and work conditions, while also considering who among them has the power to exercise this agency. Based on qualitative analysis of interviews with twenty-three migrant farmworkers or partners of farmworkers, our findings indicate that the limits of migrant farmworker agency are strongly dictated by the close relationship between migrant farmworker employment and housing; by the importance of remittance wages for dependents; and by individual immigration, gender, and education characteristics. In the current context, the informal and reparative nature of agentive acts in substandard labor camps creates real but minor improvements while also co-constructing the very structural neglect to which it responds. We conclude that current housing and labor policy frameworks do little to amplify and support differentially distributed migrant farmworker agency and its individualized successes.

Social Risk Screening for Pediatric Inpatients

This systematic review aims to identify existing social risk screening instruments applicable to hospitalized children (primary) and evaluate their content validity and methodological quality (secondary). Individual questions were abstracted and sorted by social risk theme. Content validity was evaluated by 13 hospital-based social workers. Methodological quality was assessed using the 108-item Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. A total of 1070 citations were evaluated and 146 articles were reviewed, which identified 44 unique instruments. No instrument was applicable to social risk in hospitalized children. Sixty-one percent of instruments focused on a single social risk theme and only 18% of instruments covered more than 5 themes. The 2 instruments with the highest combination of social worker endorsement and COSMIN scores each addressed only 1 social risk theme relevant to hospitalized children. A broad, content valid and methodologically strong social risk screening instrument for hospitalized children was not identified.

Age-Friendly Communities Initiative: Public Health Approach to Promoting Successful Aging

Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place. Prominent among these are the World Health Organization's Global Age-Friendly Communities (AFC) Network, with 287 communities in 33 countries, and AARP's Network of AFCs with 77 communities in the United States. In an AFC, older adults are actively involved, valued, and supported with necessary infrastructure and services. Specific criteria include affordable housing, safe outdoor spaces and built environments conducive to active living, inexpensive and convenient transportation options, opportunities for social participation and community leadership, and accessible health and wellness services. Active, culture-based approaches, supported and developed by local communities, and including an intergenerational component are important. This article provides a brief historical background, discusses the conceptualization of the AFC, offers a list of criteria, narrates case studies of AFCs in various stages of development, and suggests solutions to common challenges to becoming age-friendly. Academic geriatric psychiatry needs to play a major role in the evolving AFC movement to ensure that mental healthcare is considered and delivered on par with physical care.

Health Complaints Associated with Poor Rental Housing Conditions in Arkansas: The Only State without a Landlord's Implied Warranty of Habitability

Arkansas is the only U.S. state that does not have a landlord’s implied warranty of habitability, meaning tenants have a requirement for maintaining their rental properties at certain habitability standards, but landlords are not legally required to contribute to those minimum health and safety standards. This project assessed the possibility that this lack of landlord responsibility affects tenants’ perceived health. Using surveys and interviews, we collected self-reported data on the prevalence and description of problems faced by renters who needed household repairs from their landlords. Of almost 1,000 renters, one-third of them had experienced a problem with their landlord making needed repairs; and one-quarter of those had a health issue they attributed to their housing conditions. Common issues included problems with plumbing, heating, or cooling systems, and pest or rodent control. Reported health problems included elevated stress levels, breathing problems, headaches, high blood pressure, and bites or infections. Hispanic respondents and those with less than a high school education were both significantly more likely to report problems with their landlords not making repairs as requested. These data suggest that the lack of landlord requirements may negatively impact the condition of rental properties and, therefore, may negatively impact the health of Arkansas renters.

Respiratory Diseases in University Students Associated with Exposure to Residential Dampness or Mold

University students are frequently exposed to residential dampness or mold (i.e., visible mold, mold odor, dampness, or water leaks), a well-known contributor to asthma, allergic rhinitis, and respiratory infections. This study aims to: (a) describe the prevalence of these respiratory diseases among university students; and (b) examine the independent contribution of residential dampness or mold to these diseases. An online survey was conducted in March 2014 among the 26,676 students registered at the Université de Sherbrooke (Quebec, Canada). Validated questions and scores were used to assess self-reported respiratory diseases (i.e., asthma-like symptoms, allergic rhinitis, and respiratory infections), residential dampness or mold, and covariates (e.g., student characteristics). Using logistic regressions, the crude and adjusted odd ratios between residential dampness or mold and self-reported respiratory diseases were examined. Results from the participating students (n = 2097; response rate: 8.1%) showed high prevalence of allergic rhinitis (32.6%; 95% CI: 30.6–34.7), asthma-like symptoms (24.0%; 95% CI: 22.1–25.8) and respiratory infections (19.4%; 95% CI: 17.7–21.2). After adjustment, exposure to residential dampness or mold was associated with allergic rhinitis (OR: 1.25; 95% CI: 1.01–1.55) and asthma-like symptoms (OR: 1.70; 95% CI: 1.37–2.11), but not with respiratory infections (OR: 1.07; 95% CI: 0.85–1.36). Among symptomatic students, this exposure was also associated with uncontrolled and burdensome respiratory symptoms (p < 0.01). University students report a high prevalence of allergic rhinitis, asthma-like symptoms and respiratory infections. A common indoor hazard, residential dampness or mold, may play a role in increasing atopic respiratory diseases and their suboptimal control in young adults. These results emphasize the importance for public health organizations to tackle poor housing conditions, especially amongst university students who should be considered “at-risk”.

Breathe Easy at Home: A Qualitative Evaluation of a Pediatric Asthma Intervention

The Breathe Easy at Home Program enables clinicians to refer asthmatic patients to Boston Inspectional Services Department (ISD) if they suspect housing conditions trigger symptoms. The authors conducted one-on-one interviews with clinicians (n = 10) who referred patients, and focus groups with inspectors from the ISD (n = 9) and a variety of stakeholders (n = 13), to gain insight into program function and implementation. Clinician interviews revealed inconsistencies in enrollment approaches, dissatisfaction with the web-based system, and patient follow-up difficulties. Inspectors identified barriers to working effectively with residents and landlords, and the stakeholder focus group highlighted successes of an unusual institutional collaboration. Interviews and focus groups identified strong and personal rapport between clinicians, inspectors, and patients as key to program retention, and that participating families required additional support throughout the process. Despite recommendations for improvement in program implementation, clinicians, inspectors, and stakeholders felt that the program overall improved both the home environment and asthma outcomes.

Housing type after the Great East Japan Earthquake and loss of motor function in elderly victims: a prospective observational study

OBJECTIVE

Previous studies have reported that elderly victims of natural disasters might be prone to a subsequent decline in motor function. Victims of the Great East Japan Earthquake (GEJE) relocated to a wide range of different types of housing. As the evacuee lifestyle varies according to the type of housing available to them, their degree of motor function loss might also vary accordingly. However, the association between postdisaster housing type and loss of motor function has never been investigated. The present study was conducted to investigate the association between housing type after the GEJE and loss of motor function in elderly victims.

METHODS

We conducted a prospective observational study of 478 Japanese individuals aged ≥65 years living in Miyagi Prefecture, one of the areas most significantly affected by the GEJE. Information on housing type after the GEJE, motor function as assessed by the Kihon checklist and other lifestyle factors was collected by interview and questionnaire in 2012. Information on motor function was then collected 1 year later. The multiple logistic regression model was used to estimate the multivariate adjusted ORs of motor function loss.

RESULTS

We classified 53 (11.1%) of the respondents as having loss of motor function. The multivariate adjusted OR (with 95% CI) for loss of motor function among participants who were living in privately rented temporary housing/rental housing was 2.62 (1.10 to 6.24) compared to those who had remained in the same housing as that before the GEJE, and this increase was statistically significant.

CONCLUSIONS

The proportion of individuals with loss of motor function was higher among persons who had relocated to privately rented temporary housing/rental housing after the GEJE. This result may reflect the influence of a move to a living environment where few acquaintances are located (lack of social capital).

Home visits are needed to address asthma health disparities in adults

Research on asthma frequently recruits patients from clinics because the ready pool of patients leads to easy access to patients in office waiting areas, emergency departments, or hospital wards. Patients with other chronic conditions, and with mobility problems, face exposures at home that are not easily identified at the clinic. In this article, we describe the perspective of the community health workers and the challenges they encountered when making home visits while implementing a research intervention in a cohort of low-income, minority patients. From their observations, poor housing, often the result of poverty and lack of social resources, is the real elephant in the chronic asthma room. To achieve a goal of reduced asthma morbidity and mortality will require a first-hand understanding of the real-world social and economic barriers to optimal asthma management and the solutions to those barriers.

Assessment of pets (cats and dogs) in homes using electrostatic dust collectors and QPCR: new tools to evaluate exposure and risk of allergies

Contradictory results are found in the literature concerning fungi, bacteria, and pet exposure and the risk of developing asthma. All these allergens have been thoroughly studied separately in cohort studies, and a variety of sampling and analytical methods are used. It is already possible to characterize fungi, mites, and bacteria by QPCR. The aim of our study is to evaluate QPCR systems to quantify the presence of cats and dogs in homes. Twenty-four houses were sampled with an Electrostatic Dust Collector which was analyzed by QPCR. Questionnaires on the presence of pets in homes were completed. The results from QPCR were correlated for real presence of cats and dogs, and highlighted indirect exposure. This study provides a useful screening tool that will be used in future large cohort studies, such as the ELFE cohort study.

Role of Landlords in Creating Healthy Homes: Section 8 Landlord Perspectives on Healthy Housing Practices

PURPOSE

This article presents qualitative research findings of Section 8 landlord perceptions regarding healthy housing practices to inform landlord-focused initiatives. Approach or Design: Five focus groups were conducted with landlords.

SETTING

Boston, Massachusetts.

PARTICIPANTS

Section 8 landlords participated in focus groups (n = 39).

METHOD

Focus group transcripts were coded for key themes using a grounded theory approach.

RESULTS

Landlords' primary challenges to creating a healthy housing environment included tenant behavior, financial burden, and policy enforcement; tenant safety and cost savings were seen as primary benefits.

CONCLUSION

Landlords play a critical role in implementing healthy housing practices. Several opportunities exist to reduce barriers and capitalize on perceived benefits of implementing these practices, including increasing access to educational and financial resources.

The Impact of Homelessness and Incarceration on Women's Health

Female inmates have multiple challenges during incarceration and as they transition into the community including: barriers to accessing health care within correctional facilities, poor transitional preparation preceding release, and inadequate continuity of health care after release. This qualitative study explored the health-seeking experiences and the health and housing needs of female inmates. Four focus groups were conducted in a remand facility in Canada. Women described poor health at entry to the correctional system and viewed incarceration as a means to access health care services. Transition back into the community represented a crossroad that was dependent on the stability of housing status. These findings support gender-sensitive health and housing programs to reduce addictions, recidivism, and poor health among this vulnerable population.

To stay or to go? Postretirement housing choices of single Baby Boomer women

Single women of the Baby Boomer generation are often financially disadvantaged in the retirement planning process due to their lower accumulated savings compared to male retirees. This disadvantage impacts significant consumption decisions such as postretirement housing choices. This study uses the theory of planned behavior to examine how certainty in intentions influences preparing and planning for postretirement housing. A typology of single Baby Boomer women is developed based on their financial, demographic, and psychological circumstances. Each segment likely requires different informational strategies and financial services to foster proactive planning for retirement. Significant implications exist for social policy and the financial services sector.

Reductions in the United Kingdom's Government Housing Benefit and Symptoms of Depression in Low-Income Households

Housing security is an important determinant of mental ill health. We used a quasinatural experiment to evaluate this association, comparing the prevalence of mental ill health in the United Kingdom before and after the government's April 2011 reduction in financial support for low-income persons who rent private-sector housing (mean reduction of approximately £1,220 ($2,315) per year). Data came from the United Kingdom's Annual Population Survey, a repeated quarterly cross-sectional survey. We focused our analysis on renters in the private sector, disaggregating data between an intervention group receiving the government's Housing Benefit (n = 36,859) and a control group not receiving the Housing Benefit (n = 142,205). The main outcome was a binary measure of self-reported mental health problems. After controlling for preexisting time trends, we observed that between April 2011 and March 2013, the prevalence of depressive symptoms among private renters receiving the Housing Benefit increased by 1.8 percentage points (95% confidence interval: 1.0, 2.7) compared with those not receiving the Housing Benefit. Our models estimated that approximately 26,000 (95% confidence interval: 14,000, 38,000) people newly experienced depressive symptoms in association with the cuts to the Housing Benefit. We conclude that reducing housing support to low-income persons in the private rental sector increased the prevalence of depressive symptoms in the United Kingdom.

Evaluation of a Home-Based Environmental and Educational Intervention to Improve Health in Vulnerable Households: Southeastern Pennsylvania Lead and Healthy Homes Program

This evaluation examined whether participation in a home-based environmental educational intervention would reduce exposure to health and safety hazards and asthma-related medical visits. The home intervention program focused on vulnerable, low-income households, where children had asthma, were at risk for lead poisoning, or faced multiple unsafe housing conditions. Home visitors conducted two home visits, two months apart, consisting of an environmental home assessment, Healthy Homes education, and distribution of Healthy Homes supplies. Measured outcomes included changes in participant knowledge and awareness of environmental home-based hazards, rate of children’s asthma-related medical use, and the presence of asthma triggers and safety hazards. Analysis of 2013–2014 baseline and post-intervention program data for a cohort of 150 families revealed a significantly lower three-month rate (p < 0.05) of children’s asthma-related doctor visits and hospital admissions at program completion. In addition, there were significantly reduced reports of the presence of home-based hazards, including basement or roof leaks (p = 0.011), plumbing leaks (p = 0.019), and use of an oven to heat the home (p < 0.001). Participants’ pre- and post- test scores showed significant improvement (p < 0.05) in knowledge and awareness of home hazards. Comprehensive home interventions may effectively reduce environmental home hazards and improve the health of asthmatic children in the short term.

Delivering alcohol Identification and Brief Advice (IBA) in housing settings: A step too far or opening doors?

Within the UK, there is a drive to encourage the delivery of alcohol screening (or identification) and brief advice (IBA) in a range of contexts beyond primary care and hospitals where the evidence is strongest. However, the evidence base for effectiveness in non-health contexts is not currently established. This paper considers the case of housing provided by social landlords, drawing on two research studies which were conducted concurrently. One study examined the feasibility of delivering alcohol IBA in housing settings and the other the role of training in delivering IBA in non-health contexts including housing. This paper draws mainly on the qualitative data collected for both studies to examine the appropriateness and feasibility of delivering IBA in a range of social housing settings by the housing workforce. Findings suggest that while it is feasible to deliver IBA in housing settings, there are similar challenges and barriers to those already identified in relation to primary care. These include issues around role inadequacy, role legitimacy and the lack of support to work with people with alcohol problems. Results indicate that the potential may lie in focusing training efforts on specific roles to deliver IBA rather than it being expected of all staff.

Prevalence of housing needs among inpatients: a 1 year audit of housing needs in the acute mental health unit in Tallaght Hospital

OBJECTIVE

There is a dearth of information relating to the prevalence of housing needs among psychiatric in-patients in Ireland. Most of the information we have to date emerged as a result of attempts to plan for the closure of old psychiatric hospitals and inappropriate community residences. This study sought to identify the prevalence of housing needs among in-patients in the acute psychiatric unit in Tallaght Hospital.

METHODS

Each week, over a 12-month period, nursing managers and/or key nurses who knew the patients well were asked for numerical data. Information was collected on the numbers of in-patients with accommodation needs, number of delayed discharges due to accommodation needs and number of discharges to homeless accommodation in the previous week.

RESULTS

On average, 38% of in-patients had accommodation related needs at any one time. Most (98%) of delayed discharges had accommodation related needs. Delayed discharge in-patients with accommodation needs accounted for 28% of all inpatients and for 72% of all inpatients with accommodation related needs.

CONCLUSIONS

Accommodation need among psychiatric in-patients is underreported. Housing need data should be routinely collected and effective interagency strategies developed to address housing needs.

Household Disorder, Network Ties, and Social Support in Later Life

Family relationships, social interactions, and exchanges of support often revolve around the household context, but scholars rarely consider the social relevance of this physical space. In this article the author considers social causes and consequences of household disorder in the dwellings of older adults. Drawing from research on neighborhood disorder and social connectedness in later life, she describes how network characteristics may contribute to household disorder and how household disorder may weaken relationships and reduce access to support. This is explored empirically by estimating cross-lagged panel models with data from 2 waves of the National Social Life, Health, and Aging Project. The results reveal that household disorder reflects a lack of social support, and it leads to more kin-centered networks and more strain within family relationships. The author concludes by urging greater attention to how the household context shapes-and is shaped by-the social interactions and processes that occur within it.

'Growing Old' in Shelters and 'On the Street': Experiences of Older Homeless People

Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

Case Manager Perspectives on the Role of Treatment in Supportive Housing for People with Severe Mental Illness

OBJECTIVE

Growing recognition exists of housing as a social determinant of health, and thus, health care reform initiatives are expanding the reach of health care beyond traditional settings. One result of this expansion is increased Medicaid funds for supportive-housing programs for people with severe mental illnesses. This qualitative study explores the ways in which case managers working in a supportive housing program approach treatment and how their approach is influenced by both program requirements and their beliefs about mental illness.

METHOD

The study is part of a longitudinal qualitative study on recovery for people with severe mental illnesses living in supportive housing. Multiple interviews (n = 55) with 24 case managers from a residential-continuum supportive-housing program were conducted over 18 months. To provide an in-depth view of case manager perspectives, the study uses thematic analysis with multiple coders.

RESULTS

Overall, case managers understand supportive housing as being a treatment program but predominantly characterize treatment as medication management. The following themes emerged: believing medication to be the key to success in the program, persuading residents to take medication, and questioning the utility of the program for residents who were not medication adherent.

CONCLUSIONS

Case managers understand supportive housing to be a treatment program; however, given the external constraints and their own beliefs about mental illness, case managers often equate treatment with taking medication. Study findings demonstrate the need to train case managers about mental health recovery and integrated health care. The findings also have implications for policies that tie housing to services.

PhenoWorld: addressing animal welfare in a new paradigm to house and assess rat behaviour

The use of animals is essential in biomedical research. The laboratory environment where the animals are housed has a major impact on them throughout their lives and influences the outcome of animal experiments. Therefore, there has been an increased effort in the refinement of laboratory housing conditions which is explicitly reflected in international regulations and recommendations. Since housing conditions affect behaviour and brain function as well as well-being, the validation of an animal model or paradigm to study the brain and central nervous system disorders is not complete without an evaluation of its implication on animal welfare. Here we discuss several aspects of animal welfare, comparing groups of six rats living in the PhenoWorld (PhW), a recently developed and validated paradigm for studying rodent behaviour, with standard-housed animals (in cages of six rats or pair-housed). In this study we present new data on home-cage behaviour showing that PhW animals have a clearer circadian pattern of sleep and social interaction. We conclude that, by promoting good basic health and functioning, together with the performance of natural behaviours, and maintaining animals' control over some of their environment but still keeping some physical and social challenges, the PhW stimulates positive affective states and higher motivation in rats, which might contribute to an increased welfare for animals living in the PhW.

'Mortgaged lives': the biopolitics of debt and housing financialisation

The paper expands the conceptual framework within which we examine mortgage debt by reconceptualising mortgages as a biotechnology: a technology of power over life that forges an intimate relationship between global financial markets, everyday life and human labour. Taking seriously the materiality of mortgage contracts as a means of forging new embodied practices of financialisation, we urge for the need to move beyond a policy- and macroeconomics-based analysis of housing financialisation. We argue that more attention needs to be paid to how funnelling land-related capital flows goes hand in hand with signing off significant parts of future labour, decisionmaking capacity and well-being to mortgage debt repayments. The paper offers two key insights. First, it exemplifies how macroeconomic and policy changes could not have led to the financialisation of housing markets without a parallel biopolitical process that mobilised mortgage contracts to integrate the social reproduction of the workforce into speculative global real-estate practices. Second, it expands the framework of analysis of emerging literature on financialisation and subjectification. Focusing on the mortgage defaults and evictions crisis in Spain, we document how during Spain's 1997-2007 real-estate boom the promise of mortgages as a means to optimise income and wealth enrolled livelihoods into cycles of global financial and real-estate speculation, as home security and future wealth became directly dependent on the fluctuations of financial products, interest rates and capital accumulation strategies rooted in the built environment. When, after 2008 unemployment escalated and housing prices collapsed, mortgages became a punitive technology that led to at least 500 000 foreclosures and over 250 000 evictions in Spain.

The Socioeconomic, Demographic, and Political Effects of Housing in Comparative Perspective

Few sociologists treat housing as a key independent variable, despite the emergence of disparate bodies of research analyzing how housing affects outcomes that traditionally interest sociologists. Scholars across the social sciences have proposed and tested mechanisms whereby housing could shape subjective wellbeing, socioeconomic status, demography, and politics. We review the evidence for causal effects across these domains. Next, we make recommendations for research designs to advance this literature. Most studies only test effects of homeownership, and most are focused on the United States and Western Europe. The evidence for causation is often weak, although studies increasingly employ complex techniques for identifying effects. Throughout, we emphasize studies beyond the United States, and we conclude by discussing distinctive insights yielded by comparative research. We advocate for a comparative perspective and more expansive conceptualization of housing status as a means to build theory and evidence regarding the conditions under which housing exerts effects.

Variations Among Medicare Beneficiaries Living in Different Settings: Demographics, Health Status, and Service Use

Older people with complex health issues and needs for functional support are increasingly living in different types of residential care environments as alternatives to nursing homes. This study aims to compare the demographics and health-care expenditures of Medicare beneficiaries by the setting in which they live: nursing homes, residential care settings, and at home using data from the 2002 to 2010 Medicare Current Beneficiary Study (MCBS), a nationally representative survey of the Medicare population. All Medicare beneficiaries aged 65 years or older who participated in the fall MCBS interview (years 2002-2010) and were alive for the full year (N = 83,507) were included in the sample. We found that there is a gradient in health status, physical and cognitive functioning, and health-care use and spending across settings. Minority elderly are overrepresented in facilities and underrepresented in alternative living settings.

The importance of burrowing, climbing and standing upright for laboratory rats

Standard laboratory cages prevent rats (Rattus norvegicus) from performing many behaviours that they perform in the wild, but little is known about how this may affect their welfare. The aims of this study were (i) to record the propensity to burrow, climb and stand upright in 3-, 8- and 13-month old laboratory rats housed in semi-naturalistic environments and (ii) to compare the frequency of lateral stretching in semi-naturalistic versus standard-housed rats; we predicted standard-housed rats would perform more lateral stretches to compensate for the inability to stretch upright. Rats' propensity to burrow remained constant as they aged (approx. 30 bouts per day totalling 20-30 min), suggesting burrowing is important to rats. Climbing decreased from 76 to 7 bouts per day at 3 versus 13 months, probably because of declining physical ability. Upright standing decreased from 178 to 73 bouts per day, but continued to be frequently expressed even in older rats. Standard-housed rats stretched much more frequently than semi-naturalistic-housed rats (53 versus 6 bouts per day at 13 months), perhaps in compensation for inability to stretch upright and to relieve stiffness caused by low mobility associated with standard housing. These findings suggest that standard laboratory cages interfere with important natural behaviours, which is likely to compromise rat welfare.

Housing as a Social Determinant of Health in Singapore and Its Association with Readmission Risk and Increased Utilization of Hospital Services

BACKGROUND

Residence in public rental housing is an area-level measure of socioeconomic status, but its impact as a social determinant of health in Singapore has not been studied. We therefore aimed to examine the association of public rental housing with readmission risk and increased utilization of hospital services in Singapore.

METHODS

We conducted a retrospective cohort study using retrospective 2014 data from Singapore General Hospital's electronic health records. Variables known to affect readmission risk and health-care utilization were identified a priori and include patient demographics, comorbidities, health-care utilization in the preceding 1 year and clinical variables from the index admission in 2014. Multivariate logistic regression was used to evaluate public rental housing as an independent risk factor for admission risk, emergency department (ED), and specialist outpatient clinic attendances.

RESULTS

A total of 14,457 unique patients were analyzed, and 2,163 patients (15.0%) were rental housing residents. Rental housing patients were significantly more likely to be male; required financial assistance; have chronic obstructive pulmonary disease; usage of anti-depressant and anti-psychotic medications; longer length of hospital stay during the index admission; and higher Charlson Comorbidity Index scores. After adjusting for demographics and clinical variables, staying in public rental housing remained an independent risk factor for readmission within 15 and 30 days, frequent hospital admissions and ED attendances in Singapore.

CONCLUSION

Our study showed an association between public rental housing with readmission risk and increased utilization of hospital services in Singapore. A deeper understanding of the residents' social circumstances and health seeking behavior would be insightful.

A joined-up approach to improving older people's health and wellbeing

This article describes how a joined-up approach to housing, health and wellbeing is making a difference to the lives of older people and particularly the lives of frail individuals. It looks at the services available at ExtraCare Charitable Trust's retirement villages and discusses how investing in the right staff and tools produces the best results and helps to keep people out of hospital.

Effects of Metabolic Cage Housing on Rat Behavior and Performance in the Social Interaction Test

Although the metabolic cage is commonly used for housing nonhuman animals in the laboratory, it has been recognized as constituting a unique stressor. Such an environment would be expected to affect behavioral change in animals housed therein. However, few studies have specifically addressed the nature or magnitude of this change. The current study sought to characterize the behavioral time budget of rats in metabolic cage housing in comparison to that of individually housed animals in standard open-top cages. Rats in metabolic cages spent less time moving, manipulating enrichment, and carrying out rearing behaviors, and there was a corresponding shift toward inactivity. In an applied Social Interaction Test, behavioral scoring implied that metabolic cage housing had an anxiogenic effect. In conclusion, metabolic cage housing produces measurable effects on spontaneous and evoked behavior in rats in the laboratory. These behavioral changes may lead to a negative emotional state in these animals, which could have negative welfare consequences. Further research is needed to quantify the existence and magnitude of such an effect on rat well being.

Healthy Aging in Community for Older Lesbians

PURPOSE

In Boston and Outer Cape, Massachusetts, we explored the expectations of lesbians 60 years and older regarding healthy aging and community importance.

METHODS

Focus groups were conducted with participants after completing an anonymous demographic questionnaire. Thematic analysis was used to generate themes and identify how they varied by urban versus rural settings.

RESULTS

Group discussions focused on community, finances, housing, and healthcare. Primary concerns included continued access to supportive and lesbian communities as a source of resilience during aging.

CONCLUSION

Concerns about discrimination and isolation mirror themes found in national research. The study findings suggest a need for more research into the housing and transportation needs of lesbians approaching later life, with a focus on how those needs relate to affordability, accessibility, and proximity to social support and healthcare. These findings also suggest the need for substantial investments in strengthening the LGBT-related cultural competence of providers of services for the elderly.

Associations of selected bedding types with incidence rates of subclinical and clinical mastitis in primiparous Holstein dairy cows

The objective of this observational study was to determine the association of exposure to selected bedding types with incidence of subclinical (SM) and clinical mastitis (CM) in primiparous Holstein dairy cows housed in identical pens at a single facility. At parturition, primiparous cows were randomly assigned to pens containing freestalls with 1 of 4 bedding materials: (1) deep-bedded new sand (NES, n=27 cows), (2) deep-bedded recycled sand (RS, n=25 cows), (3) deep-bedded manure solids (DBMS, n=31 cows), and (4) shallow-bedded manure solids over foam-core mattresses (SBMS, n=26 cows). For 12mo, somatic cell counts of quarter milk samples were determined every 28d and duplicate quarter milk samples were collected for microbiological analysis from all quarters with SM (defined as somatic cell count >200,000 cells/mL). During this period, duplicate quarter milk samples were also collected for microbial analysis from all cases of CM. For an additional 16mo, cases of CM were recorded; however, no samples were collected. Quarter days at risk (62,980) were distributed among bedding types and most quarters were enrolled for >150d. Of 135 cases of SM, 63% resulted in nonsignificant growth and 87% of recovered pathogens (n=33) were identified as coagulase-negative staphylococci. The distribution of etiologies of pathogens recovered from cases of SM was associated with bedding type. Coagulase-negative staphylococci were recovered from 12, 38, 11, and 46% of quarters with SM from cows in pens containing NES, RS, DBMS, and SBMS, respectively. A result of nonsignificant growth was obtained for 81, 59, 89, and 46% of quarters with SM from cows in pens containing NES, RS, DBMS, and SBMS, respectively. Quarters of primiparous cows bedded with NES tended to have greater survival time to incidence of CM than quarters of primiparous cows bedded with RS or DBMS.

Relationship between Housing Status and Retention Rates among HIV-Positive African Americans Enrolled in a Comprehensive Care Program

Service provision using "one-stop shopping" of medical, psychiatric, and case management services at the same location has been associated with superior client retention. The Yadumu project tested this premise, with attention to HIV-infected African Americans. Each client was assigned a case manager, who arranged meetings with mental health, substance abuse, and medical care professionals. The Center for Mental Health Services, National Outcome Measures (CMHS NOMs) questionnaire was used to evaluate client progress. Data were collected longitudinally and the program evaluation was performed by an outside center. Among 129 clients, 47% were male, 30% were female, and 22% were transgender. The majority (72%) were African American. Clients who lived in detox/drug treatment programs had higher completion rates (48%) than those who were homeless or otherwise housed (28%) (p = 0.04). Logistic regression was used to assess associations between independent factors and retention. Clients satisfied with their housing situation were less likely to retain in the program than those who were not satisfied with their housing situation (OR = 0.15, 95% CI: 0.03-0.78). High discharge rates among HIV-infected people were observed and may reflect the unstable circumstances of the population studied, but structured residential programs could be advantageous for improving retention.

Challenges and Opportunities for Urban Environmental Health and Sustainability: the HEALTHY-POLIS initiative

Cities around the world face many environmental health challenges including contamination of air, water and soil, traffic congestion and noise, and poor housing conditions exacerbated by unsustainable urban development and climate change. Integrated assessment of these risks offers opportunities for holistic, low carbon solutions in the urban environment that can bring multiple benefits for public health. The Healthy-Polis consortium aims to protect and promote urban health through multi-disciplinary, policy-relevant research on urban environmental health and sustainability. We are doing this by promoting improved methods of health risk assessment, facilitating international collaboration, contributing to the training of research scientists and students, and engaging with key stakeholders in government, local authorities, international organisations, industry and academia. A major focus of the consortium is to promote and support international research projects coordinated between two or more countries. The disciplinary areas represented in the consortium are many and varied, including environmental epidemiology, modelling and exposure assessment, system dynamics, health impact assessment, multi-criteria decision analysis, and other quantitative and qualitative approaches. This Healthy-Polis special issue presents a range of case studies and reviews that illustrate the need for a systems-based understanding of the urban environment.

Collaboration and involvement of persons with lived experience in planning Canada's At Home/Chez Soi project

Planning the implementation of evidence-based mental health services entails commitment to both rigour and community relevance, which entails navigating the challenges of collaboration between professionals and community members in a planning environment which is neither 'top-down' nor 'bottom-up'. This research focused on collaboration among different stakeholders (e.g. researchers, service-providers, persons with lived experience [PWLE]) at five project sites across Canada in the planning of At Home/Chez Soi, a Housing First initiative for homeless people with mental health problems. The research addressed the question of what strategies worked well or less well in achieving successful collaboration, given the opportunities and challenges within this complex 'hybrid' planning environment. Using qualitative methods, 131 local stakeholders participated in key informant or focus group interviews between October 2009 and February 2010. Site researchers identified themes in the data, using the constant comparative method. Strategies that enhanced collaboration included the development of a common vision, values and purpose around the Housing First approach, developing a sense of belonging and commitment among stakeholders, bridging strategies employed by Site Co-ordinators and multiple strategies to engage PWLE. At the same time, a tight timeline, initial tensions, questions and resistance regarding project and research parameters, and lack of experience in engaging PWLE challenged collaboration. In a hybrid planning environment, clear communication and specific strategies are required that flow from an understanding that the process is neither fully participatory nor expert-driven, but rather a hybrid of both.

Housing outcomes and predictors of success: the role of hospitalization in street outreach

ACCESSIBLE SUMMARY

What is known on the subject? Outreach services are often successful in engaging and housing street homeless individuals. People experiencing homelessness have greatly increased rates of mental illness and substance abuse. What this paper adds to existing knowledge? Given the relative lack of research involving street homeless individuals, this retrospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework. The majority of clients were successfully housed by the end of outreach team involvement. An admission to hospital was strongly associated with successful housing for those with a psychotic disorder. What are the implications for practice? Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homelessness and psychosis. Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals. Introduction Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness.

METHOD

A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement.

RESULTS

Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization (OR = 9.04, 95% CI [2.43, 33.59]). It was significantly diminished by psychosis (OR = 0.22, 95% CI [0.05, 0.95]) and prior homelessness >36 months (OR = 0.10, 95% CI [0.02, 0.50]). Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized (Fisher's exact, P < .001).

DISCUSSION

Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage.

Prevalence of Residential Dampness and Mold Exposure in a University Student Population

The impact of residential dampness or mold on respiratory health is well established but few studies have focused on university students. This study aims to: (a) describe the prevalence of exposure to residential dampness or mold in university students according to socio-geographic factors and (b) identify associated housing characteristics. A web survey was conducted in 2014 among the 26,676 students registered at the Université de Sherbrooke (QC, Canada). Residential dampness and mold being closely intertwined, they were considered as a single exposure and assessed using a validated questionnaire. Exposure was compared according to socio-geographic and housing characteristics using chi-square tests and logistic regressions. Among the 2097 participants included in the study (response rate: 8.1%), over 80% were tenants. Residential exposure to dampness or mold was frequent (36.0%, 95% CI: 33.9-38.1). Marked differences for this exposure were noted according to home ownership (39.7% vs. 25.5% among tenants and owners respectively; OR = 1.92%, 95% CI: 1.54-2.38). Campus affiliation, household composition and the number of residents per building were associated with exposure to dampness or mold (p < 0.01), while sex and age were not. Exposure was also associated with older buildings, and buildings in need of renovations and lacking proper ventilation (p < 0.001). This study highlights the potential risk of university students suffering from mold-related health effects given their frequent exposure to this agent. Further research is needed to fully evaluate the mold-related health impact in this at risk group.

Recent social conditions affect boldness repeatability in individual sticklebacks

Animal personalities are ubiquitous across the animal kingdom and have been shown both to influence individual behaviour in the social context and to be affected by it. However, little attention has been paid to possible carryover effects of social conditions on personality expression, especially when individuals are alone. Here we investigated how the recent social context affected the boldness and repeatability of three-spined sticklebacks, Gasterosteus aculeatus, during individual assays. We housed fish either solitarily, solitarily part of the time or socially in groups of four, and subjected them twice to a risk-taking task. The social conditions had a large effect on boldness repeatability, with fish housed solitarily before the trials showing much higher behavioural repeatability than fish housed socially, for which repeatability was not significant. Social conditions also had a temporal effect on the boldness of the fish, with only fish housed solitarily taking more risks during the first than the second trial. These results show that recent social conditions can thus affect the short-term repeatability of behaviour and obfuscate the expression of personality even in later contexts when individuals are alone. This finding highlights the need to consider social housing conditions when designing personality studies and emphasizes the important link between animal personality and the social context by showing the potential role of social carryover effects.

HPA Axis Gene Expression and DNA Methylation Profiles in Rats Exposed to Early Life Stress, Adult Voluntary Ethanol Drinking and Single Housing

The neurobiological basis of early life stress (ELS) impact on vulnerability to alcohol use disorder is not fully understood. The effect of ELS, adult ethanol consumption and single housing, on expression of stress and DNA methylation regulatory genes as well as blood corticosterone levels was investigated in the hypothalamus and pituitary of adult out-bred Wistar rats subjected to different rearing conditions. A prolonged maternal separation (MS) of 360 min (MS360) was used to study the effect of ELS, and a short MS of 15 min (MS15) was used as a control. Voluntary ethanol drinking was assessed using a two-bottle free choice paradigm to simulate human episodic drinking. The effects of single housing and ethanol were assessed in conventional animal facility rearing (AFR) conditions. Single housing in adulthood was associated with lower Crhr1 and higher Pomc expression in the pituitary, whereas ethanol drinking was associated with higher expression of Crh in the hypothalamus and Crhr1 in the pituitary, accompanied by lower corticosterone levels. As compared to controls with similar early life handling, rats exposed to ELS displayed lower expression of Pomc in the hypothalamus, and higher Dnmt1 expression in the pituitary. Voluntary ethanol drinking resulted in lower Fkbp5 expression in the pituitary and higher Crh expression in the hypothalamus, independently of rearing conditions. In rats exposed to ELS, water and ethanol drinking was associated with higher and lower corticosterone levels, respectively. The use of conventionally reared rats as control group yielded more significant results than the use of rats exposed to short MS. Positive correlations, restricted to the hypothalamus and ELS group, were observed between the expression of the hypothalamus-pituitary-adrenal receptor and the methylation-related genes. Promoter DNA methylation and expression of respective genes did not correlate suggesting that other loci are involved in transcriptional regulation. Concluding, single housing is a confounding factor to be considered in voluntary ethanol drinking paradigms. ELS and ethanol drinking in adulthood exert independent effects on hypothalamic and pituitary related genes, however, in a manner dependent on the control group used.

Nurses in Supportive Housing are Associated With Decreased Health Care Utilization and Improved HIV Biomarkers in Formerly Homeless Adults

A San Francisco study conducted in 2008 showed that the permanent supportive housing program, Direct Access to Housing, dramatically decreased the risk of death in people living with HIV. In our study, we compared the health care utilization patterns and HIV-related biological markers of formerly homeless adults with HIV before and during two types of permanent supportive housing: (a) housing with on-site nursing care for residents, and (b) housing without on-site nursing care. Using nearest-neighbor matching with propensity scoring, the difference in outcomes was calculated. In the matched analysis, adjusted for adherence to combination antiretroviral therapy, people housed at sites with nurses had 4.8 fewer emergency department visits per person (SE: 1.53, p < .01), and they had an increased mean CD4+ T cell count (101.14 cells per person [SE: 55.10, p < .05]) compared to those who lived at sites without nurses.

Using zebrafish in systems toxicology for developmental toxicity testing

With the high cost and the long-term assessment of developmental toxicity testing in mammals, the vertebrate zebrafish has become a useful alternative model organism for high-throughput developmental toxicity testing. Zebrafish is also very favorable for the 3R perspective in toxicology; however, the methodologies used by research groups vary greatly, posing considerable challenges to integrative analysis. In this review, we discuss zebrafish developmental toxicity testing, focusing on the methods of chemical exposure, the assessment of morphological abnormalities, housing conditions and their effects on the production of healthy embryos, and future directions. Zebrafish as a systems toxicology model has the potential to elucidate developmental toxicity pathways, and to provide a sound basis for human health risk assessments.

Opinion of Belgian Egg Farmers on Hen Welfare and Its Relationship with Housing Type

Simple Summary

Until 2012, laying hens in the EU were often housed in conventional cages that offered limited space and few opportunities to perform highly motivated behaviors. Conventional cages are now banned in the EU in order to improve animal welfare. In this study, egg farmers were surveyed (winter 2013–2014) to assess whether they perceived any changes in animal welfare since changing housing systems, what role hen welfare played in choosing a new housing system, and which aspects of hen welfare they find most important. The data show that the answers differ depending on which housing system the farmers currently use and whether they had used conventional cages in the past.

Abstract

As of 2012, the EU has banned the use of conventional cages (CC) for laying hens, causing a shift in housing systems. This study’s aim was to gain insight into farmers’ opinions on hen health and welfare in their current housing systems. A survey was sent to 218 Belgian egg farmers, of which 127 (58.3%) responded, with 84 still active as egg farmer. Hen welfare tended to be less important in choosing the housing system for farmers with cage than with non-cage systems. Respondents currently using cage systems were more satisfied with hen health than respondents with non-cage systems. Reported mortality increased with farm size and was higher in furnished cages than in floor housing. Feather pecking, cannibalism, smothering and mortality were perceived to be higher in current housing systems than in CC, but only by respondents who shifted to non-cage systems from previously having had CC. Health- and production-related parameters were scored to be more important for hen welfare as compared to behavior-related parameters. Those without CC in the past rated factors relating to natural behavior to be more important for welfare than those with CC. This difference in opinion based on farmer backgrounds should be taken into account in future research.

Effect of housing type on health and performance of preweaned dairy calves during summer in Florida

The objective was to evaluate the effect of housing type on health and performance of preweaned dairy calves. One hundred calves, Holsteins (HO) or Holstein-Jersey crosses (HJ), were randomly assigned to a Calf-Tel (L. T. Hampel Corp., Germantown, WI) polyethylene hutch exposed to direct sun light (n=25 for both HO and HJ) or a wire hutch with a plywood shade located under trees (n=24 and 26 for HO and HJ, respectively). Calf rectal temperature, respiratory rate, health scores, and weaning weight were compared by housing type. Rectal temperatures were higher in calves in Calf-Tel hutches compared with calves in wire hutches at 1500 h, at 40.1±0.28 and 39.1±0.22°C, respectively. Similarly, respiratory rates were higher in calves in Calf-Tel hutches compared with calves in wire hutches at 1500 h, at 90±15 and 65±10 breaths per minute, respectively. Frequencies of calves presenting abnormal ear scores did not differ between calves in Calf-Tel or wire hutches. Abnormal eye scores were less likely to occur for calves in the wire hutches. Frequencies of calves with signs of respiratory disease, such as nasal discharge and coughing, were higher in the wire hutches compared with the Calf-Tel hutches. No differences were noted in the incidence and time of first diarrhea event in calves between hutch types. Calves in wire hutches had 5.47 greater odds of receiving veterinary treatment compared with calves in the Calf-Tel hutches. Weaning weights were not different for calves in Calf-Tel or in wire hutches. The lower frequency of calves with abnormal health scores and receiving veterinary treatment in Calf-Tel hutches and the lack of difference in weight gain suggests that this housing system adapted well to the specific environmental conditions of this study.

Collecting Comparative Data on Farmworker Housing and Health: Recommendations for Collecting Housing and Health Data Across Places and Time

The substandard nature of the housing in which most farmworkers live has detrimental effects on their health, as well as on their children's health and development. However, little research has directly documented associations between farmworker housing and health; existing research is not always comparable due to differences in design and measurement. Comparative data can help determine actual causal links between housing characteristics and farmworker health and help to evaluate the efficacy of current housing policy. The goal of this paper is to provide guidelines promoting comparable research on farmworker housing and the association of this housing with health. This paper reviews general concepts relevant to measuring farmworker housing and health, issues that should be considered in designing farmworker housing and health research, data collection methods, and measures. It concludes with recommendations for a research agenda on farmworker housing and health.

The decision, implementation and assessment of a credit-bearing activity class by faculty in residence: A case study

This case study reports on a programmatic decision to require a credit-bearing course that was made by Faculty in Residence (FIR), including its implementation and results over a two-year period from 2010-2012. The focus is on FIR and on the impact of their decision upon the students enrolled in their Living Learning Communities (LLCs). The credit-bearing course was a Kinesiology Activities class taken by all seven LLCs at Boise State University. Anonymous feedback from students was obtained via end of semester surveys; results were used to improve the course. Survey feedback was analyzed to assess the value students perceived to have gained from the course. The majority of students reported gaining value from the class. Students noted that it positively affected their time management/personal accountability, that it decreased their stress level and that it increased their awareness of the Recreational Center offerings. Some students were critical of the course, reporting little to no value or even resentment about the course requirement. The decision, implementation and improvements of the course required faculty leadership and full participation of all LLCs; perceptions of the FIR in terms of the effects of adding the required course on their LLC are reported.

Housing First for People With Severe Mental Illness Who Are Homeless: A Review of the Research and Findings From the At Home-Chez soi Demonstration Project

OBJECTIVE

To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)-Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing.

METHOD

The AH-CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care.

RESULTS

Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH-CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual.

CONCLUSIONS

Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH-CS project and to scale up the HF approach across Canada.

Effect of floor type on the performance, physiological and behavioural responses of finishing beef steers

BACKGROUND

The study objective was to investigate the effect of bare concrete slats (Control), two types of mats [(Easyfix mats (mat 1) and Irish Custom Extruder mats (mat 2)] fitted on top of concrete slats, and wood-chip to simulate deep bedding (wood-chip placed on top of a plastic membrane overlying the concrete slats) on performance, physiological and behavioral responses of finishing beef steers. One-hundred and forty-four finishing steers (503 kg; standard deviation 51.8 kg) were randomly assigned according to their breed (124 Continental cross and 20 Holstein-Friesian) and body weight to one of four treatments for 148 days. All steers were subjected to the same weighing, blood sampling (jugular venipuncture), dirt and hoof scoring pre study (day 0) and on days 23, 45, 65, 86, 107, 128 and 148 of the study. Cameras were fitted over each pen for 72 h recording over five periods and subsequent 10 min sampling scans were analysed.

RESULTS

Live weight gain and carcass characteristics were similar among treatments. The number of lesions on the hooves of the animals was greater (P < 0.05) on mats 1 and 2 and wood-chip treatments compared with the animals on the slats. Dirt scores were similar for the mat and slat treatments while the wood-chip treatment had greater dirt scores. Animals housed on either slats or wood-chip had similar lying times. The percent of animals lying was greater for animals housed on mat 1 and mat 2 compared with those housed on concrete slats and wood chips. Physiological variables showed no significant difference among treatments.

CONCLUSIONS

In this exploratory study, the performance or welfare of steers was not adversely affected by slats, differing mat types or wood-chip as underfoot material.

The association of respiratory symptoms and indoor housing conditions among migrant farmworkers in eastern North Carolina

Farm labor housing has been described as among the worst in the nation, oftentimes with poor and unsanitary indoor living conditions. The objective of this study was to evaluate the association between indoor environmental risk factors and respiratory health among migrant farmworker occupants (N = 352) living in employer-provided housing. A cross-sectional sample of adult Latino male farm laborers were administered a questionnaire to identify the prevalence of major respiratory symptoms. Self-reported and independent observations were made to evaluate environmental respiratory risk factors and indoor housing conditions, including but not limited to, the presence of cockroaches, rodents, pesticides, and visible signs of mold. Spirometry was performed to evaluate lung function using FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and FEV1 /FVC ratio. Bivariate analysis was applied to evaluate associations between respiratory symptoms and selected indoor environmental risk factors. Findings for respiratory health included prevalence of wheeze (11.4%), coughing up phlegm (17.3%), tightness of chest (16.8%), and runny or stuffy nose (34.4%). Respiratory risks identified inside the dwellings included the use of pesticides or bug sprays for cockroaches (31.5%), rat or mouse poison (19.5%), visible signs of water damage in the bathroom (22.5%), and mold in the sleeping room (11.1%). Spirometry values were normal for most occupants, although statistically significant associations were found between mold and coughing up phlegm when not having a cold (P = .0262); presence of mold and asthma (P = .0084); pesticides used in the home and tightness of chest (P = .0001); and use of tobacco and coughing up phlegm (P = .0131). Although causal inference can be difficult to establish from a cross-sectional study, findings from this study represents suggestive evidence that indoor environmental risk factors may be contributory factors for respiratory health problems among this vulnerable workgroup population.

The effects of building design on hazard of first service in Norwegian dairy cows

Reproductive inefficiency is one of the major production and economic constraints on modern dairy farms. The environment affects onset of ovarian activity in a cow postcalving and influences estrus behavior, which in turn affects a stockperson's ability to inseminate her at the correct time. This study used survival analysis to investigate effects of building design and animal factors on the postpartum hazard of first service (HFS) in freestall-housed Norwegian Red cows. The study was performed on 232 Norwegian dairy farms between 2004 and 2007. Data were obtained through on farm measurements and by accessing the Norwegian Dairy Herd Recording System. The final data set contained data on 38,436 calvings and 27,127 services. Univariate Cox proportional hazard analyses showed that herd size and milk yield were positively associated with HFS. Total free accessible area and free accessible area available per cow year were positively associated with the HFS, as was the number of freestalls available per cow. Cows housed on slatted floors had a lower HFS than those housed on solid floors. Conversely, cows housed on rubber floors had a higher HFS than cows on concrete floors. Dead-ending alleyways reduced the hazard of AI after calving. A multivariable Cox proportional hazards model, accounting for herd management by including a frailty term for herd, showed relationships between hazard of postpartum service and explanatory variables. Animals in herds with more than 50 cows had a higher HFS [hazard ratio (HR)=3.0] compared with those in smaller herds. The HFS was also higher (HR=4.3) if more than 8.8 m(2) of space was available per cow year compared with herds in which animals had less space. The HFS after calving increased with parity (parity 2 HR=0.5, parity ≥3 HR=1.7), and was reduced if a lactation began with dystocia (HR=0.82) or was a breed other than Norwegian Red (HR=0.2). The frailty term, herd, was large and highly significant indicating a significant proportion of the variation resides at herd level. The hazard of first insemination decreased with time for all predictive variables, except dystocia. This study shows that providing adequate environmental conditions for estrus behavior is imperative for reproductive efficiency and after herd management factors and time from calving have been accounted for. Thus, optimizing building design for reproductive efficiency is of significant importance when constructing new cattle housing.

Asthma and allergy development: contrasting influences of yeasts and other fungal exposures

BACKGROUND

Infancy is a developmental stage with heightened susceptibility to environmental influences on the risk of chronic childhood disease. Few birth cohort studies have detailed measures of fungal diversity data in infants' bedrooms, limiting the potential to measure long-term associations of these complex exposures with development of asthma or allergy.

OBJECTIVE

We evaluated the relation of home fungal levels in infancy to repeated measures of wheeze and development of asthma and rhinitis by age 13, and sensitization by age 12 years.

METHODS

In the Epidemiology of Home Allergens and Asthma prospective birth cohort study, we recruited 408 children with family history of allergic disease or asthma. When children were aged 2-3 months, we measured culturable fungi in bedroom air and dust, and in outdoor air. Main outcomes included ascertainment of symptoms/disease onset by questionnaire from birth through age 13. We estimated hazard ratios and, for wheeze and sensitization, odds ratios for an interquartile increase in log-transformed fungal concentrations, adjusting for other outcome predictors and potential confounders.

RESULTS

Elevated levels of yeasts in bedroom floor dust were associated with reduced: i) wheeze at any age; ii) fungal sensitization; and iii) asthma development by age 13 (hazard ratio (HR) = 0.86; 95% confidence interval (CI), [0.75 to 0.98]). Outdoor airborne Cladosporium and dustborne Aspergillus predicted increased rhinitis. Risk of fungal sensitization by age 12, in response to environmental Alternaria and Aspergillus, was elevated in children with a maternal history of fungal sensitization.

CONCLUSIONS AND CLINICAL RELEVANCE

Despite the irritant and allergenic properties of fungi, early-life elevated dust yeast exposures or their components may be protective against allergy and asthma in children at risk for these outcomes. Ascertainment of fungal components associated with immunoprotective effects may have therapeutic relevance for asthma.

Farmworker Housing: A Photo Essay

Migrant and seasonal farmworkers often reside in poor housing conditions which expose them to numerous hazards. These housing conditions are an issue of environmental health and justice. The photographs in this essay illustrate the living conditions confronted by farmworkers, offering a visual context for the reviews published in this issue of New Solutions. Farmworker housing conditions are often shocking to those who have not visited farmworker communities. Continued research is needed to document these conditions, how they affect the health of farmworkers, and provide leverage in the struggle to improve farmworker housing conditions.