The important health impact of where a child lives: neighborhood characteristics and the burden of lead poisoning

Toxins and other health threats can cause health problems, whether they are present in the child's own home, other neighborhood homes where the child spends time, or common areas such as playgrounds. We assess the impact of where a child lives on the burden of lead poisoning. Statewide lead screening data was obtained from the Rhode Island Department of Health. Block group level indicators of old housing and poverty were obtained from the US Census. Of the 204,746 study children, 35,416 (17.3%) had a blood lead level≥10 μg/dL. The proportion of study children who were lead poisoned in each block group ranged from 0.0 to 48.6%. The proportion of study children with an elevated blood lead level increased from 8% among children living in block groups in the lowest quintile of poverty to 31% for those in the highest quintile for poverty. Old housing also had an important impact on the risk of lead poisoning. The proportion of children with an elevated blood lead level increased from 7% among children living in block groups in the lowest quintile for pre-1950 housing to 27% for those in the highest quintile for pre-1950 housing. The adjusted odds ratio was 1.64 for the highest quintile of poverty and 1.77 for the highest quintile of pre-1950 housing. The findings of this large, statewide study demonstrate the powerful impact of where children live on the risk of lead poisoning. The findings have important implications for understanding the problem of lead poisoning and for planning primary prevention programs.

Reversals of association for Pap, colorectal, and prostate cancer testing among Hispanic and non-Hispanic black women and men

BACKGROUND

Several studies have found that Hispanics and non-Hispanic blacks have statistically significantly higher adjusted OR for cancer screening tests compared to non-Hispanic whites, even though their crude percentages were lower than, or about equal to, those for the non-Hispanic whites. Most documentation is for mammography. This article investigates the prevalence of such unadjusted-to-adjusted "reversed associations" (RA) for Pap, colorectal, and prostate testing. We also investigate large percent changes (LPC) to the unadjusted ORs.

METHODS

Data were from the 2004/2006/2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000/2003/2005/2008 National Health Interview Survey (NHIS). Analyses used a consistent set of covariates.

RESULTS

RAs were more common for non-Hispanic blacks than Hispanics, but Hispanics had a greater number of LPCs. RAs and LPCs occurred more often for Pap testing than colorectal and prostate testing. However, results from the BRFSS and NHIS were often not consistent.

CONCLUSIONS

Attention should be given to the National Breast and Cervical Cancer Early Detection Program, as well as public programs addressing other cancers, as possible contributors to RAs and LPCs. Hispanics may show more RAs in analyses of future data. Discrepancies between the BRFSS and the NHIS also must be recognized and explained.

IMPACT

This research highlights the need for vigilance regarding the results of analyses to identify race/ethnicity as a correlate of cancer screening. Results also direct attention to aspects of the results of multivariable analysis other than ORs and confidence intervals.

The asthma/mental health nexus in a population-based sample of the United States

BACKGROUND

Asthma is one of the most prevalent chronic medical conditions in the United States. The relationship of asthma with psychological factors has been known for centuries, and recently there has been a resurgence of interest in this topic. This study investigates the relationship between current asthma and poor mental health in a nationally representative sample of the US population.

METHODS

This study utilizes data from the 2006 Behavioral Risk Factor Surveillance System survey (n = 355,710). A multinomial logistic regression model was constructed to assess the relationship between current asthma and poor mental health. The relationship between formerly having asthma and poor mental health was also investigated.

RESULTS

Persons reporting poor mental health have increased risk of currently having asthma compared to persons reporting good mental health. Additionally, this asthma/mental health relationship has a "dose-response" relationship. For every incremental increase in days of poor mental health, there is a corresponding increase in risk of currently having asthma. Previously reported risk factors for asthma (ie, age, gender, race, marital, smoking, overall health, exercise, obesity, and socioeconomic status) were all found to be important covariates of asthma. The relationship between former asthma and poor mental health is less clear.

CONCLUSIONS

This large, nationally representative sample confirms the relationship between asthma and mental health symptoms. Any degree of poor mental health appears to increase one's risk for asthma. Future research is needed to determine the causal and/or physiologic relationship between asthma and mental health symptoms.

Total Laparoscopic Hysterectomy in Obese Versus Nonobese Patients

OBJECTIVE

To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients.

METHODS

A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m(2) or greater with those whose BMI was less than 30 kg/m(2).

RESULTS

Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m(2) or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups.

CONCLUSION

Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients.

LEVEL OF EVIDENCE

II-2