Occupational, Environmental, and Climate Medicine Program

Biomass Smoke Exposure and Atopy among Young Children in the Western Highlands of Guatemala: A Prospective Cohort Study

Wenxin Lu
Laura Ann Wang
Jennifer Mann
Alisa Jenny
Carolina Romero
Andrea Kuster
Eduardo Canuz
Ajay Pillarisetti
Kirk R Smith
John Balmes, MD
Lisa Thompson
2022

Women and children in rural regions of low-income countries are exposed to high levels of household air pollution (HAP) as they traditionally tend to household chores such as cooking with biomass fuels. Early life exposure to air pollution is associated with aeroallergen sensitization and developing allergic diseases at older ages. This prospective cohort study assigned HAP-reducing chimney stoves to 557 households in rural Guatemala at different ages of the study children. The children's air pollution exposure was measured using personal CO diffusion tubes. Allergic outcomes at 4-5...

The Association between Ambient PM2.5 and Low Birth Weight in California

Jasmine Lee
Sadie Costello
John R Balmes
Stephanie M Holm
2022

Previous studies have shown associations between air pollutants and low birth weight. However, few studies assess whether poverty and race/ethnicity are effect modifiers for this relationship. We used publicly available data on 7785 California census tracts from the California Communities Environmental Health Screening Tool (CalEnviroScreen). Multivariable linear regression was used to examine the association between outdoor PM2.5 and low birth weight (LBW), including stratification by poverty and race/ethnicity (as a proxy for experienced racism). A 1 µg m...

Depressive symptoms in lung transplant recipients: trajectory and association with mortality and allograft dysfunction

Nicholas A Kolaitis
Ying Gao
Allison Soong
John R Greenland
Steven R Hays
Jeffrey A Golden
Aida Venado
Lorriana E Leard
Rupal J Shah
Mary Ellen Kleinhenz
Patricia P Katz
Jasleen Kukreja
Paul D Blanc
Patrick J Smith
Jonathan Paul Singer
2022

Objective: Most studies observing an association between depressive symptoms following lung transplantation and mortality are limited to depressive symptom measurement at a single time point, unrelated to allograft function. We aimed to test the association of depressive symptoms over multiple assessments with allograft dysfunction and with mortality.

Methods: We assessed depressive symptoms before and serially up to 3 years after lung transplantation in lung transplant recipients. We quantified depressive symptoms with the Geriatric Depression...

Increased Bloodborne Pathogen Exposure Hotline Utilization During the COVID-19 Pandemic: An Unexpected Phenomenon

Matthew Kiok
Sandeep Guntur, MD, MPH
Paul Blanc, MD, MSPH
Olga Lozato
Grace Domingo
Robert Kosnik
Chika E Ugbaja
Noreen Chan
Alan Ramos
Sandra Domeracki, RN, MSN, FNP-BC, COHN-S, FAAOHN
2022

Background: Mitigating bloodborne pathogen exposure (BBPE) risk among healthcare workers is a major focus of hospital-based occupational health programs. The COVID-19 pandemic has placed added demands on occupational health services for healthcare workers. Its impact on BBPE incidence is unreported. Methods: As part of quality improvement efforts, we examined BBPE case incidence at two affiliated health centers during a 24-month period, 12 months preceding and following the COVID-19 pandemic onset. We used Year 1 to Year 2 change in incidence at the larger health center...

Agent Orange Exposure and Risk of Idiopathic Pulmonary Fibrosis among U.S. Veterans

Bhavika Kaul
Joyce S Lee
David V Glidden
Paul D Blanc
Ning Zhang
Harold R Collard
Mary A Whooley
2022
Rationale

There is limited literature exploring the relationship between military exposures and idiopathic pulmonary fibrosis (IPF).

Objectives

To evaluate whether exposure to Agent Orange is associated with an increased risk of IPF among veterans.

Methods

We used Veterans Health Administration data to identify patients diagnosed with IPF between 2010 and 2019. We restricted the cohort to male Vietnam veterans and performed multivariate logistic regression to examine the association between presumptive Agent Orange exposure and IPF. We conducted sensitivity...

A Rapid Nucleic Acid Amplification Test-Based, Conditional Release-to-Work Policy for Health Care Personnel With Symptoms Consistent With COVID-19

Mark A Jacobson
Colin Hart
Will Huen
Griselda Suarez Guardado
Allyson Villanueva
Jeffrey Whitman
Paul D Blanc
2022

Objective: Most health care personnel (HCP) reporting symptoms consistent with COVID-19 illness are assessed by high-accuracy SARS-CoV-2 assays performed in clinical laboratories, but the results of such assays typically are not available until the following day.

Methods: This is an observational study over 16 weeks of a rapid nucleic acid amplification test (NAAT) performed at point of contact. The benchmark for comparison was a simultaneously obtained specimen assayed by a routine NAAT assay performed in a clinical laboratory.

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Tracking Environmental and Health Disparities to Strengthen Resilience Before the Next Crisis

Catalina Garzón-Galvis
Maxwell J Richardson
Gina M Solomon
2022

The COVID-19 pandemic has underscored how underlying disparities in environmental and health conditions exacerbate vulnerability during public health emergencies in low-income and communities of color. Neglected epidemics-high rates of pollution, chronic disease, and racial and socioeconomic health disparities-have continued amid persistent systemic racism and declining investment in public health. Recognized too late due to shortcomings in public health data tracking, COVID-19 has surged through vulnerable communities. Improved public health tracking is critical for informing the...

Military deployment-related respiratory problems: an update

Eric Garshick
Paul D Blanc
2023

Purpose of review: Military personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation.

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Rare case of occupational pulmonary hemorrhage in a firefighter

Sheiphali A Gandhi
TJ Welch
Kirk D Jones
Kristin J Cummings
Laura Styles
Paul D Blanc
Robert J Harrison
2022

Alveolar hemorrhage associated with physical exertion, known as exercise-induced pulmonary hemorrhage (EIPH), is a rare condition linked to strenuous exertion. This can be an unusual form of respiratory and occupational illness. We present the case of a healthy firefighter who developed fatal pulmonary hemorrhage after participating in a strenuous physical training exercise regimen. This case represents a severe presentation of EIPH, which results from the disruption of the pulmonary blood-gas barrier as a result of strenuous exertion. Clinicians caring for those in vocations and...

Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis

Michael J Falvo
Anays M Sotolongo
John J Osterholzer
Michelle W Robertson
Ella A Kazerooni
Judith K Amorosa
Eric Garshick
Kirk D Jones
Jeffrey R Galvin
Kathleen Kreiss
Stella E Hines
Teri J Franks
Robert F Miller
Cecile S Rose
Mehrdad Arjomandi
Silpa D Krefft
Michael J Morris
Vasiliy V Polosukhin
Paul D Blanc
Jeanine M D’Armiento
2022

BACKGROUND: The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments.

RESEARCH QUESTION: What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals? STUDYDESIGNANDMETHODS: Nineteen experts participated in a three-round modified Delphi study, ranking their level of agreement for each statement with an a priori definition of...