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Examines the beliefs and responses of parents about childhood ear infections in eastern North Carolina. Contribution of cultural factors to the problem of middle ear infection, also known as otitis media (OM); Discussion of biomedical perspectives of OM; Prognosis and treatment of OM.

Presents a survey conducted in an ambulatory pediatric clinic to learn about the socioeconomic and health problems resulting from flood disasters. Information on Hurricane Floyd that hit North Carolina in 1999; Proportion of families that experienced flood-related socioeconomic problems; Barriers to health care and health problems among families affected by the flood; Ways by which pediatricians can help mitigate the impact of disasters.

Otitis media (OM), a disease of the middle ear, is one of the most common diseases of childhood. Although the medical and surgical treatment of the disease by physicians is covered at length in the literature, information about the role of nurses in dealing with OM is scant. The purpose of this article is to propose a community-based nursing prevention plan for OM based on what is known about its prevalence and pathogenesis. [ABSTRACT FROM AUTHOR]

Background Studies of workers exposed to benzene at average air concentrations below one part per million suggest that benzene, a known hematotoxin, causes hematopoietic damage even at low exposure levels. However, evidence of such effects outside of occupational settings and for other volatile organic compounds (VOCs) is limited. Objective To investigate associations between ambient exposures to five VOCs, including benzene, and hematologic parameters among adult residents of the U.S. Gulf Coast. Materials and methods Blood concentrations of selected VOCs were measured in a sample of adult participants in the Gulf Long-term Follow-up Study (GuLF STUDY) during 2012 and 2013. Complete blood counts with differentials were also performed on a subset of participants (n=406). We used these data together with detailed questionnaire data to estimate adjusted associations between blood BTEXS (benzene, toluene, ethylbenzene, o-xylene, m/p-xylene, and styrene) concentrations and hematologic parameters using generalized linear models. Results We observed inverse associations between blood benzene concentrations and hemoglobin concentration and mean corpuscular hemoglobin concentration, and a positive association with red cell distribution width among tobacco smoke-unexposed participants (n=146). Among tobacco smoke-exposed participants (n=247), we observed positive associations between blood VOC concentrations and several hematologic parameters, including increased white blood cell and platelet counts, suggestive of hematopoietic stimulation typically associated with tobacco smoke exposure. Most associations were stronger for benzene than for the other VOCs. Conclusions Our results suggest that ambient exposure to BTEXS, particularly benzene, may be associated with hematologic effects, including decreased hemoglobin concentration, mean corpuscular hemoglobin concentration, and increased red cell distribution width. [ABSTRACT FROM AUTHOR]

BACKGROUND: During the 2010 Deepwater Horizon (DWH) disaster, controlled burning was conducted to remove oil from the water. Workers near combustion sites were potentially exposed to increased fine particulate matter [with aerodynamic diameter =2.5µm (PM[sub 2.5])] levels. Exposure to PM[sub 2.5] has been linked to decreased lung function, but to our knowledge, no study has examined exposure encountered in an oil spill cleanup. OBJECTIVE: We investigated the association between estimated PM[sub 2.5] only from burning/flaring of oil/gas and lung function measured 1–3 y after the DWH disaster. METHODS: We included workers who participated in response and cleanup activities on the water during the DWH disaster and had lung function measured at a subsequent home visit (푛=2,316). PM[sub 2.5] concentrations were estimated using a Gaussian plume dispersion model and linked to work histories via a job-exposure matrix. We evaluated forced expiratory volume in 1 s (FEV1; milliliters), forced vital capacity (FVC; milliliters), and their ratio (FEV1/FVC; %) in relation to average and cumulative daily maximum exposures using multivariable linear regressions. RESULTS: We observed significant exposure–response trends associating higher cumulative daily maximum PM[sub 2.5] exposure with lower FEV1 (푝-trend=0.04) and FEV1/FVC (푝-trend=0.01). In comparison with the referent group (workers not involved in or near the burning), those with higher cumulative exposures had lower FEV1 [-166.8mL, 95% confidence interval (CI): -337.3, 3.7] and FEV1/FVC (-1.7, 95% CI: -3.6, 0.2). We also saw nonsignificant reductions in FVC (high vs. referent: -120.9, 95% CI: -319.4, 77.6; 푝-trend=0.36). Similar associations were seen for average daily maximum PM[sub 2.5] exposure. Inverse associations were also observed in analyses stratified by smoking and time from exposure to spirometry and when we restricted to workers without prespill lung disease. CONCLUSIONS: Among oil spill workers, exposure to PM[sub 2.5] specifically from controlled burning of oil/gas was associated with significantly lower FEV1 and FEV1/FVC when compared with workers not involved in burning. [ABSTRACT FROM AUTHOR]

Oil spill response and clean-up (OSRC) workers were exposed to hazardous airborne chemicals following the 2010 Deepwater Horizon disaster. The aim of this study was to evaluate lung function in workers 4–6 years following the disaster using a prospective cohort. Participants who completed two spirometry test sessions 1–3 years, and 4–6 years after the spill (N = 1,838) were included and forced expiratory volume in 1 s (FEV1; ml), forced vital capacity (FVC; ml), and ratio (FEV1/FVC; %) determined. Linear mixed models were utilized to estimate relationships between OSRC exposures and lung function 4–6 years after the spill and changes since the prior measurement. Despite suggestive reduced lung function at 1–3 years, at the 4–6-year exam workers with total hydrocarbon (THC) exposure 1–2.99 ppm and ≥3 ppm compared to those with ≤0.29 ppm exhibited higher FEV1 (β: 108 ml, 95% CI: 17, 198) and (β: 118 ml, 95% CI: 5, 232), respectively. Compared with support workers, those in higher exposed jobs displayed greater improvement in FEV1 between visits: cleanup on water (β: 143 ml, 95% CI: 35, 250), operations (β: 132 ml, 95% CI: 30, 234) and response (β: 149 ml, 95% CI: 43, 256). Greater FEV1 improvement was also associated with higher versus the lowest level THC exposure: 1–2.99 ppm (β: 134 ml, 95% CI: 57, 210) and ≥3 ppm (β: 205 ml, 95% CI: 109, 301). Lung function decrements seen shortly after the spill were no longer apparent 4–6 years later, with the greatest improvement among those with the highest exposures. [ABSTRACT FROM AUTHOR]

Abstract Introduction Oil spill response and cleanup (OSRC) workers had potentially stressful experiences during mitigation efforts following the 2010 Deepwater Horizon disaster. Smelling chemicals; skin or clothing contact with oil; heat stress; handling oily plants/wildlife or dead animal recovery; and/or being out of regular work may have posed a risk to worker respiratory health through psychological stress mechanisms. Objective To evaluate the association between six potentially stressful oil spill experiences and lung function among OSRC workers 1–3 years following the Deepwater Horizon disaster, while controlling for primary oil spill inhalation hazards and other potential confounders. Methods Of 6811 GuLF STUDY participants who performed OSRC work and completed a quality spirometry test, 4806 provided information on all exposures and confounders. We carried out complete case analysis and used multiple imputation to assess risk among the larger sample. Potentially stressful work experiences were identified from an earlier study of these workers. The lung function parameters of interest include the forced expiratory volume in 1 s (FEV 1 , mL), the forced vital capacity (FVC, mL) and the ratio (FEV 1 /FVC, %). Results On average, participants in the analytic sample completed spirometry tests 1.7 years after the spill. Among workers with at least 2 acceptable FEV 1 and FVC curves, workers with jobs that involved oily plants/wildlife or dead animal recovery had lower values for FEV 1 (Mean difference: −53 mL, 95% CI: −84, −22), FVC (Mean difference: −45 mL, 95% CI: −81, −9) and FEV 1 /FVC (Mean difference: −0.44%, 95% CI: −0.80, −0.07) compared to unexposed workers in analyses using multiple imputation. Conclusions Workers involved in handling oily plants/wildlife or dead animal recovery had lower lung function than unexposed workers after accounting for other OSRC inhalation hazards. Highlights • Oil spill response and cleanup workers had unique experiences that may have adversely affected their respiratory health. • We examined the impact of these experiences on measured lung function 1-3 years after the Deepwater Horizon disaster. • Jobs that involved handling oily plants/wildlife or dead animal recovery were associated with lower lung function. • This large study is the first to examine lung function in relation to potentially stressful work experiences during the DWH disaster response and clean-up effort. [ABSTRACT FROM AUTHOR]

BACKGROUND: The 2010 Deepwater Horizon disaster led to the largest ever marine oil spill. Individuals who worked on the spill were exposed to toxicants and stressors that could lead to adverse effects. OBJECTIVES: The GuLF STUDY was designed to investigate relationships between oil spill exposures and multiple potential physical and mental health effects. METHODS: Participants were recruited by telephone from lists of individuals who worked on the oil spill response and clean-up or received safety training. Enrollment interviews between 2011 and 2013 collected information about spill-related activities, demographics, lifestyle, and health. Exposure measurements taken during the oil spill were used with questionnaire responses to characterize oil exposures of participants. Participants from Gulf states completed a home visit in which biological and environmental samples, anthropometric and clinical measurements, and additional health and lifestyle information were collected. Participants are being followed for changes in health status. RESULTS: Thirty-two thousand six hundred eight individuals enrolled in the cohort, and 11,193 completed a home visit. Most were young (56.2% ≤ 45 years of age), male (80.8%), lived in a Gulf state (82.3%), and worked at least 1 day on the oil spill (76.5%). Workers were involved in response (18.0%), support operations (17.5%), clean-up on water (17.4%) or land (14.6%), decontamination (14.3%), and administrative support (18.3%). Using an ordinal job exposure matrix, 45% had maximum daily total hydrocarbon exposure levels ≥ 1.0 ppm. CONCLUSIONS: The GuLF STUDY provides a unique opportunity to study potential adverse health effects from the Deepwater Horizon oil spill. CITATION: Kwok RK, Engel LS, Miller AK, Blair A, Curry MD, Jackson WB II, Stewart PA, Stenzel MR, Birnbaum LS, Sandler DP for the GuLF STUDY Research Team. 2017. The GuLF STUDY: a prospective study of persons involved in the Deepwater Horizon oil spill response and clean-up. Environ Health Perspect 125:570-578; http://dx.doi.org/10.1289/EHP715 [ABSTRACT FROM AUTHOR]

The 2010Deepwater Horizon(DWH) explosion in the Gulf of Mexico led to the largest ever marine oil spill by volume. The GuLF STUDY is investigating possible adverse human health effects associated with oil spill activities. One objective of the study was to utilize biological specimens from study participants to examine spill-related adverse health effects. This study describes the methods for collecting, processing, shipping, and storing specimens during the enrollment phase of the study. GuLF STUDY participants living in Gulf States (Alabama, Florida, Louisiana, Mississippi, and eastern Texas) were eligible to complete a home visit at enrollment, one to three years after theDWHexplosion. During this visit, blood, urine, toenail and hair clippings, and house dust samples were collected. Specimens were shipped overnight to a central processing laboratory in containers with cold and ambient temperature compartments. Most blood and urine specimens were then aliquoted and stored in liquid nitrogen vapor or at -80°C, with some samples stored at -20°C. A total of 11,193 participants completed a home visit, and over 99% provided at least one biospecimen. Most participants provided blood (93%), urine (99%), and toenail clippings (89%), and 40% provided hair. Nearly all participants (95%) provided house-dust samples. Most samples were received by the laboratory one (58%) or two (25%) days after collection. These biospecimens enable investigation of a range of biomarkers of spill-related adverse health effects, and possibly some biomarkers of spill-related exposures. The biospecimen collection, handling, and storage protocols were designed to maximize current and future scientific value within logistical and budgetary constraints and might serve as a template for future studies conducted in similar time-critical and geographically dispersed settings. [ABSTRACT FROM AUTHOR]

[Display omitted] • Proximity to concentrated animal feeding operation is associated with autoimmunity. • Proximity to CAFO is associated with rheumatoid arthritis. • Xenobiotic response gene ARNT SNPs are associated with rheumatoid arthritis. • AHR-ARNT pathway, vicinity to CAFO confer risk of some immune-mediated diseases. • ARNT SNPs, CAFO vicinity are associated with autoimmune disease, rheumatoid arthritis. Concentrated animal feeding operations (CAFOs) are a source of environmental pollution and have been associated with a variety of health outcomes. Immune-mediated diseases (IMD) are characterized by dysregulation of the normal immune response and, while they may be affected by gene and environmental factors, their association with living in proximity to a CAFO is unknown. We explored gene, environment, and gene-environment (GxE) relationships between IMD, CAFOs, and single nucleotide polymorphisms (SNPs) of prototypical xenobiotic response genes AHR , ARNT , and AHRR and prototypical immune response gene PTPN22. The exposure analysis cohort consisted of 6,464 participants who completed the Personalized Environment and Genes Study Health and Exposure Survey and a subset of 1,541 participants who were genotyped. We assessed the association between participants' residential proximity to a CAFO in gene, environment, and GxE models. We recombined individual associations in a transethnic model using METAL meta-analysis. In White participants, ARNT SNP rs11204735 was associated with autoimmune diseases and rheumatoid arthritis (RA), and ARNT SNP rs1889740 was associated with RA. In a transethnic genetic analysis, ARNT SNPs rs11204735 and rs1889740 and PTPN22 SNP rs2476601 were associated with autoimmune diseases and RA. In participants living closer than one mile to a CAFO, the log-distance to a CAFO was associated with autoimmune diseases and RA. In a GxE interaction model, White participants with ARNT SNPs rs11204735 and rs1889740 living closer than eight miles to a CAFO had increased odds of RA and autoimmune diseases, respectively. The transethnic model revealed similar GxE interactions. Our results suggest increased risk of autoimmune diseases and RA in those living in proximity to a CAFO and a potential role of the AHR-ARNT pathway in conferring risk. We also report the first association of ARNT SNPs rs11204735 and rs1889740 with RA. Our findings, if confirmed, could allow for novel genetically-targeted or other preventive approaches for certain IMD. [ABSTRACT FROM AUTHOR]

The 2010 Deepwater Horizon (DWH) oil spill response and cleanup (OSRC) workers were exposed to airborne total hydrocarbons (THC), benzene, toluene, ethylbenzene, o-, m-, and p-xylenes and n-hexane (BTEX-H) from crude oil and PM 2.5 from burning/flaring oil and natural gas. Little is known about asthma risk among oil spill cleanup workers. Objectives: We assessed the relationship between asthma and several oil spill-related exposures including job classes, THC, individual BTEX-H chemicals, the BTEX-H mixture, and PM 2.5 using data from the Gulf Long-Term Follow-up (GuLF) Study, a prospective cohort of 24,937 cleanup workers and 7,671 nonworkers following the DWH disaster. Our analysis largely focused on the 19,018 workers without asthma before the spill who had complete exposure, outcome, and covariate information. We defined incident asthma 1–3 years following exposure using both self-reported wheeze and self-reported physician diagnosis of asthma. THC and BTEX-H were assigned to participants based on measurement data and work histories, while PM 2.5 used modeled estimates. We used modified Poisson regression to estimate risk ratios (RR) and 95% confidence intervals (CIs) for associations between spill-related exposures and asthma and a quantile-based g-computation approach to explore the joint effect of the BTEX-H mixture on asthma risk. OSRC workers had greater asthma risk than nonworkers (RR: 1.60, 95% CI: 1.38, 1.85). Higher estimated THC exposure levels were associated with increased risk in an exposure-dependent manner (linear trend test p < 0.0001). Asthma risk also increased with increasing exposure to individual BTEX-H chemicals and the chemical mixture: A simultaneous quartile increase in the BTEX-H mixture was associated with an increased asthma risk of 1.45 (95% CI: 1.35,1.55). With fewer cases, associations were less apparent for physician-diagnosed asthma alone. THC and BTEX-H were associated with increased asthma risk defined using wheeze symptoms as well as a physician diagnosis. [ABSTRACT FROM AUTHOR]

The article reports on the results of research which was conducted in an effort to assess whether the measurement of exhaled nitric oxide (NO), as a biomarker of airway inflammation, could increase the effectiveness of asthma treatment, when used as an adjunct to clinical care based on asthma guidelines. Researchers used a randomized, double blind parallel group trial and examined 780 patients between the ages of twelve and twenty. They found that conventional asthma management resulted in good symptom control and that the addition of a fraction of exhaled NO as an indicator of asthma control did not lead to clinically important improvements in symptom control.

The 2010 Deepwater Horizon (DWH) disaster exposed tens of thousands of oil spill response and cleanup (OSRC) workers to hydrocarbons and other hazardous chemicals. Some hydrocarbons, such as toluene and hexane, have been found to have acute adverse effects on the central nervous system in occupational settings. However, no studies have examined the association between oil spill exposures and neurobehavioral function. We used data from the Gulf Long-term Follow-up Study, a cohort of adults who worked on the DWH response and cleanup. Total hydrocarbon (THC) exposure attributed to oil spill cleanup work was estimated from a job-exposure matrix linking air measurement data to detailed cleanup work histories. Participants were also categorized into 6 job categories, or OSRC classes, based on their activity with the highest exposure. Neurobehavioral performance was assessed at a clinical exam 4–6 years after the spill. We used multivariable linear regression to evaluate relationships of ordinal THC levels and OSRC classes with 16 neurobehavioral outcomes. We found limited evidence of associations between THC levels or OSRC classes and decreased neurobehavioral function, including attention, memory, and executive function. Workers exposed to ≥3 ppm THC scored significantly worse (difference 1.0–2.9ppm = -0.39, 95% confidence interval (CI) = -0.74, −0.04) than workers exposed to <0.30 ppm THC for the digit span forward count test. There was also a possible threshold effect above 1 ppm THC for symbol digit test total errors (difference 1.0–2.9ppm = −0.56 (95% CI = −1.13, −0.003), difference ≥3.0ppm = −0.55 (95% CI = −1.20, 0.10)). Associations appeared to be stronger in men than in women. A summary latency measure suggested an association between more highly exposed jobs (especially support of operations workers) and decreased neurobehavioral function. OSRC-related exposures were associated with modest decreases in neurobehavioral function, especially attention, memory, and executive function. • Attention, memory, and executive function may be impaired by oil spill cleanup exposures. • Adverse association between job and executive function was strongest in operations workers. • Adverse associations tended to be slightly stronger in men than in women. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: The aim of this study was to assess the relationship between total hydrocarbon (THC) exposures attributed to oil spill clean-up work and lung function 1 to 3 years after the Deepwater Horizon (DWH) disaster. Methods: We used data from the GuLF STUDY, a large cohort of adults who worked on response to the DWH disaster and others who were safety trained but did not work. We analyzed data from 6288 workers with two acceptable spirometry tests. We estimated THC exposure levels with a job exposure matrix. We evaluated lung function using the forced expiratory volume in 1 second (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Results: Lung function measures did not differ by THC exposure levels among clean-up workers. Conclusion: We did not observe an association between THC exposure and lung function among clean-up workers 1 to 3 years following the DWH disaster. [ABSTRACT FROM AUTHOR]