Bedroom Floor Research Articles

Exposure to dust organophosphate and replacement brominated flame retardants during infancy and risk of subsequent adverse respiratory outcomes

BackgroundChildren are highly exposed to flame retardants in indoor environments, partly through inhalation. However, the associations of early life exposure to novel organophosphate (OPFRs) and replacement brominated flame retardants (RBFRs) with adverse respiratory outcomes during childhood are unclear. MethodsWe used a prospective birth cohort of 234 children recruited from the greater Cincinnati, Ohio metropolitan area between 2003 and 2006. OPFRs and RBFRs were analyzed in dust sampled from the homes' main activity room and the children's bedroom floor at child age 1 year. Caregivers reported subsequent respiratory symptoms every six months until child age 5 years and we measured forced expiratory volume in 1 s as well as peak expiratory flow (PEF) at child age 5 years. We performed generalized estimating equations and linear regression modeling adjusted for covariates to examine the exposure-outcome associations. ResultsGeometric means (GMs) (standard error [SE]) for dust concentrations were 10.27 (0.63) μg/g for total OPFRs (ΣOPFRs) and 0.48 (0.04) μg/g for total RBFRs (ΣRBFRs); GMs (SE) for dust loadings were 2.82 (0.26) μg/m2 for ΣOPFRs and 0.13 (0.01) μg/m2 for ΣRBFRs. Dust ∑OPFRs concentrations at age 1 year were associated with higher subsequent risks of wheezing (relative risk [RR]: 1.68, 95% confidence interval [CI]: 1.20–2.34), respiratory infections (RR: 4.01, 95% CI: 1.95–8.24), and hay fever/allergies (RR: 1.33, 95% CI: 1.10–1.60), whereas ∑OPFRs dust loadings at age 1 year were associated with higher risks of subsequent respiratory infections (RR: 1.87, 95% CI: 1.05–3.34) and hay fever/allergies (RR: 1.34, 95% CI: 1.19–1.51). PEF (mL/min) was lower with higher ∑OPFRs dust loadings (β: -12.10, 95% CI: -21.10, −3.10) and with the RBFR bis(2-ethylhexyl) tetrabromophthalate (β: -9.05, 95% CI: -17.67, −0.43). ConclusionsExposure to OPFRs and RBFRs during infancy may be a risk factor for adverse respiratory outcomes during childhood.

Residual Content of Synthetic Pyrethroid Transfluthrin on Bed Sheets, Pillowcases, Bedroom Floors, and Development of Analytical Methods Using GC-MS

Residual Content of Synthetic Pyrethroid Transfluthrin on Bed Sheets, Pillowcases, Bedroom Floors, and Development of Analytical Methods Using GC-MS

Indoor environmental exposures and obstructive lung disease phenotypes among children with asthma living in poor urban neighborhoods

Air trapping is an obstructive phenotype that has been associated with more severe and unstable asthma in children. Air trapping has been defined using pre- and postbronchodilator spirometry. The causes of air trapping are not completely understood. It is possible that environmental exposures could be implicated in air trapping in children with asthma. We investigated the association between indoor exposures and air trapping in urban children with asthma. Children with asthma aged 5 to 17 years living in Baltimore and enrolled onto the Environmental Control as Add-on Therapy for Childhood Asthma study were evaluated for air trapping using spirometry. Aeroallergen sensitization was assessed at baseline, and spirometry was performed at 0, 3, and6 months. Air trapping was defined as an FVC z score of lessthan -1.64 or a change in FVC with bronchodilation of ≥10% predicted. Logistic normal random effects models were used to evaluate associations of air trapping and indoor exposures. Airborne and bedroom floor mouse allergen concentrations were associated with air trapping but not airflow limitation (odds ratio 1.19, 95% confidence interval 1.02-1.37, P= .02 per 2-fold increase in airborne mouse allergen; odds ratio 1.23, 95% confidence interval 1.07-1.41, P= .003 per 2-fold increase in bedroom floor mouse allergen). Other indoor exposures (cockroach, cat, dog, dust mite, particulate matter, and nicotine) were not associated with air trapping or airflow limitation. Mouse allergen exposure, but not other indoor exposure, was associated with air trapping in urban children with asthma.

Repurposing design in bedrooms to improve home accessibility: task and motion analysis using the virtual reality environment

Functional disabilities, which have an association with a higher risk of falling in households, are common in the U.S. Individuals with functional limitations may benefit from accessible homes since they improve safety and reduce the risk of falling. Repurposing design is one strategy to improve home accessibility, by adapting home spaces and fixtures to serve a new purpose. This study aimed to propose a repurposing design in the bedroom area. The idea for a new bedroom repurposing design was proposed after analyzing a standard bedroom floor plan. The original standard bedroom layout and the redesigned bedroom layout were simulated in a virtual reality environment. To evaluate the accessibility of the new bedroom repurposing design, six participants (four females, 56.3 ± 14.1 years old) were recruited to perform two daily activities (i.e., relocating the robe & going to the bathroom) in both the original and redesigned bedrooms. The comparison of participants' task performance and trunk motion in both bedroom layouts revealed: (1) the sequences of actions required for two daily activities were similar between both bedroom layouts, (2) participants spent less time and walked for a shorter distance in the redesigned bedroom layout than in the original layout, (3) the motion smoothness when walking to the closet improved, whereas the RMS of trunk acceleration when opening the bathroom door decreased in the redesigned bedroom layout compared to the original layout.

Lethal intoxications of medical staff with substances used in the profession – Presentation of a group of cases

The access medical staff has to special drugs through the nature of the job can lead to undesirable situations (illicit consumption, abuse and addiction, accidental overdoses, suicide, homicide). We focus on identifying situations of lethal intoxication of the medical staff with substances used within the profession and we propose a forensic approach to these types of cases. We made a review of the literature using MEDLINE, EMBASE, Scopus, Cochrane and internet search data of deaths among nurses and doctors due to intoxication with special regime drugs used in the profession. Five cases of autopsies performed at INML “Mina Minovici” Bucharest and Ilfov Medical-Legal Service, Romania, are presented (a veterinarian, a nurse and three anesthesiologist doctors). A 27-year-old female, a veterinarian, was found dead in bed, in her apartment, next to a 10-mL syringe with an attached branch, containing 4 ml of transparent liquid. It's a case of intravenous self-administration of T61, with a suicidal intention. T61 is a solution used for animal euthanasia, a mixture of 3 substances: embutramide (opioid analgesic), mebezonium iodide (curare-compound) and tetracaine hydrochloride (local anesthetic). A 38-year-old man, a male nurse, was found dead in his home, surrounded by several empty containers of Fentanyl and Mialgin. A bag with partially empty containers of medicines was found in his car: Enalapril, Telmisartan, Mialgin, Diazepam, Fentanyl, Acupan (nefopan chloridate), Dormicum (Midazolam), syringes and needles, used, but also sealed. The cause of death was an acute intoxication with a cocktail medication (opioid analgesics and benzodiazepines), stolen from the workplace. A 37-year-old man, an anesthesiologist doctor, was found by a colleague, at 7.00 a.m, in the on call room of the hospital, at the end of his shift. The cause of death was the acute intoxication with morphine (0.448 μg/mL). A 34-year-old woman, anesthesiologist doctor, was found dead by her father, on the bathroom floor of her apartment. Next to the body were found: a 5 mL syringe with 3 mL liquid content and 2 ampoules of tramadol hydrochloride (Mabron). In the trash, there was an empty bottle of ketamine hydrochloride (Ketamidor, for veterinary use) and fragments of ampoules of Midazolam and Calypsol. More than 150 ampoules labeled with various substances used in anesthesia were found in the house. In the last period, the woman doctor was exhausted as she had been working both in the public and private system. Female, 51 years old, anesthesiologist doctor, known as a consumer of analgesic substances for about 3 years, was found dead at home by her husband, on the bedroom floor. Cause of death was acute pulmonary edema, the consequence of an acute intoxication with drugs (pethidine > 2/mL μg/mL and nordazepam 0.03 μg/mL). The paper analyzes all the findings: the on-site investigations (extremely important to gather information), the necropsy data and the results of the histopathological, toxicological, tanatochemical and serological examinations. The analytical methods currently used for highlighting and dosing the identified substances are also presented. Autopsy findings were nonspecific, except for the stigma of chronic injectable drug use. That is why an algorithm for step by step approaching these types of cases could be very useful in order not to go beyond the possibility of an acute drug intoxication of medical staff. Nurses and doctors are vulnerable to chemical dependence due to the high work-related stress associated with easy access to medicines. This must always be suspected by the forensic doctors when they perform an autopsy of a medical staff person and they must follow a special algorithm in such cases.

Vishniacozyma victoriae (syn. Cryptococcus victoriae) in the homes of asthmatic and non-asthmatic children in New York City.

Indoor environments contain a broad diversity of non-pathogenic Basidiomycota yeasts, but their role in exacerbating adverse health effects has remained unclear. To understand the role of Vishniacozyma victoriae exposure and its impact on human health. A qPCR assay was developed to detect and quantify an abundant indoor yeast species, Vishniacozyma victoriae (syn. Cryptococcus victoriae), from homes participating in the New York City Neighborhood Asthma and Allergy Study (NAAS). We evaluated the associations between V. victoriae, housing characteristics, and asthma relevant health endpoints. V. victoriae was quantified in 236 of the 256 bedroom floor dust samples ranging from less than 300-45,918 cell equivalents/mg of dust. Higher concentrations of V. victoriae were significantly associated with carpeted bedroom floors (P = 0.044), mean specific humidity (P = 0.004), winter (P < 0.0001) and spring (P = 0.001) seasons, and the presence of dog (P = 0.010) and dog allergen Can f 1 (P = 0.027). V. victoriae concentrations were lower in homes of children with asthma vs. without asthma (P = 0.027), an association observed only among the non-seroatopic children.

Outdoor air pollutants exposure associated with pulmonary function and EBC pH value in atopic asthmatic and non-asthmatic children

Objective Air pollution is associated with the prevalence of respiratory diseases. This study aimed to evaluate the impacts of outdoor air pollutants and indoor Dermatophagoides pteronyssinus 1 (Der p 1) exposure on levels of fractional exhaled nitric oxide (FeNO), exhaled breath condensate (EBC) pH, and pulmonary function in atopic children. Methods This study recruited 59 atopic mild-to-moderate asthmatic children and 23 atopic non-asthmatic children. Data on personal characteristics, FeNO, EBC pH, and pulmonary function were collected. Group 1 allergens of Der p 1 were measured on the tops of mattresses and on bedroom floors in the children’s homes, and outdoor air pollutant concentrations were estimated from air quality monitoring stations, using the ordinary kriging method. Results Exposure levels of outdoor air pollutants, except for particulate matter (PM)2.5, for the recruited children met outdoor air quality standards set by the Taiwan Environmental Protection Agency. The lag effect of outdoor PM10 exposure was negatively associated with the forced expiratory volume in one second (FEV1) [(Lag 1: β=–0.771, p = 0.028), and O3 (Lag 1–7: β=–2.02, p = 0.04, Lag 1–28: β=–3.213, p = 0.029)]. Median pulmonary function parameters differed significantly in forced vital capacity (FVC) (p = 0.004) and FEV1 (p = 0.024) values between atopic asthmatic and non-asthmatic children. No association was found between the FeNO/EBC pH level and exposure to Der p 1 allergen and air pollutants in the recruited children. Conclusions Outdoor PM10 and O3 exposure was associated with reduction in FEV1 in atopic asthmatic and non-asthmatic children.

House dust mites (Acari: Astigmata) from mattresses in Panama

The name “house dust mites” is commonly used to refer to species of mites belonging mainly to the Pyroglyphidae family (Astigmata) that are found in association with dust in the human dwellings. They represent the main source of allergens in the home and can cause allergic diseases. Mattresses often provide ideal conditions for mite colonization. In order to compare the diversity of house dust mites in the provinces of Panama and Panama Oeste in 2015, we collected dust from the surfaces of mattresses over an area of one square meter using the vacuum method. We obtained 50 samples using the vacuum method and recovered 10,225 mites. We found that the mites in our samples belonged to 15 families, 15 genera and 22 morphospecies. Relatively, high mean densities of mites per gram of dust on mattresses were obtained in the provinces of Panama (3,577 mites/g of dust) and Panama Oeste (6,273 mites/g of dust). The mite Blomia tropicalis was the most abundant species in mattresses in the Province of Panama and Dermatophagoides pteronyssinus was the most frequent one in Panama Oeste. Our results indicate that the mite community in mattresses is similar between PA and PO. However, our results differ significantly from those found in bedroom floors in a previous study. These differences correspond to a lower species richness, higher density and relative abundance of Astigmata mites in mattresses.

Material Hardship and Indoor Allergen Exposure among Low-Income, Urban, Minority Children with Persistent Asthma.

Traditional measures of socioeconomic status (SES) are associated with asthma morbidity, but their specific contributions are unclear. Increased exposure to indoor allergens among low SES children is an important consideration. Material hardship, a concept describing poor access to basic goods and services, may explain the relationship between low SES and indoor allergen exposure, and thereby, the increased risk of asthma morbidity. We sought to (i) describe the specific hardships experienced by low-Income, urban, minority children with asthma and indoor allergen sensitization and (ii) determine if material hardship is associated with indoor allergen exposure in this population. We conducted a cross-sectional analysis of children undergoing the baseline assessment for a clinical trial of home environmental modification. Participants were scored in five domains of material hardship. Domain scores were assigned based on caregiver responses to a questionnaire and were summed to generate a total material hardship score. Linear regression was used to examine the relationship between material hardship scores and bedroom floor concentrations of five common indoor allergens. Participants experienced high levels of material hardship in each of the five domains, with 33% not having access to a car, 35% not being able to pay utility bills, and 28% not being able to pay rent in the past year. Each one-point increase in material hardship was associated with an increase in cockroach allergen of 16.2% (95% CI 9.4%, 24.6%) and an increase in mouse allergen of 9.4% (95% CI 1.0%, 18.5%). After adjusting for traditional measures of SES, including household income, health insurance type, caregiver education, and caregiver employment status, the association between material hardship and cockroach allergen, but not mouse allergen, remained. These data suggest that a significant proportion of families of low-income, minority children with asthma may experience material hardship, and that they may be at greater risk of cockroach allergen exposure than their peers with similar income, but without material hardship.

Endotoxin clustering with allergens in house dust and asthma outcomes in a U.S. national study

BackgroundEndotoxin is ubiquitous in the environment, but its clustering with indoor allergens is not well characterized. This study examined the clustering patterns of endotoxin with allergens in house dust and their association with asthma outcomes.MethodsWe analyzed data from 6963 participants of the 2005–2006 National Health and Nutrition Examination Survey. House dust sampled from bedroom floor and bedding was evaluated for endotoxin and allergens from fungi, cockroach, dog, cat, mites, and rodents. Two-step cluster analysis and logistic regressions were performed to identify the clustering patterns and their associations with current asthma and wheeze in the past 12 months, adjusting for covariates.ResultsOf the homes, 17.8% had low endotoxin and allergen levels in house dust (Cluster 1). High endotoxin level clustered with Alternaria and pet allergens in the homes of participants with a high socioeconomic status who own pets (Cluster 2) (48.9%). High endotoxin clustered with Aspergillus, dust mites, cockroach, and rodent allergens in the homes of participants with low socioeconomic status (Cluster 3) (33.3%). Compared to Cluster 1, Cluster 2 was associated with higher asthma prevalence (OR 1.42, 95% CI: 1.06–1.91) and wheeze (OR 1.32, 95% CI: 1.07–1.63). Cluster 3 was positively associated with wheeze only in participants sensitized to inhalant allergens (OR 1.42, 95% CI: 1.06–1.91) or exposed to tobacco smoke (OR 1.72, 95% CI: 1.15–2.60).ConclusionsThe clustering of endotoxin with allergens in dust from homes with pets or of people with low socioeconomic status is associated with asthma and wheeze.

Reduction in mouse allergen exposure is associated with greater lung function growth

Current childhood asthma therapies have little effect on lung function trajectory. We sought to determine whether mouse allergen exposure reduction is associated with lung function growth in mouse-sensitized/exposed asthmatic children. Three hundred fifty mouse-sensitized/exposed asthmatic children (5-17 years old) were enrolled in a 1-year randomized trial of integrated pest management plus education versus education alone. Prebronchodilator/postbronchodilator spirometry was performed at baseline and 6 and 12 months, and bedroom floor mouse allergen levels were measured every 3 months. Mouse allergen reduction was defined as a 75% or greater decrease in mouse allergen levels from baseline. Treatment groups were combined for analyses because there were no differences in outcomes between groups. Changes in lung function over time were modeled, adjusting for age, sex, race, atopy, group, and bronchodilator reversibility and including an interaction term (allergen reduction*time). The study population was predominantly black (79.4%) and low income (66.3% [<$30,000]). At baseline, the median mouse allergen level was 5.7 μg/g (interquartile range, 1.5-22.8 μg/g), and the mean (SD) prebronchodilator FEV1/forced vital capacity ratio was 80.2% (9.0%). Ninety-two (26.3%) participants had 75% or greater reduction in mouse allergen levels. For a 10-year-old black boy, 75% or greater allergen reduction was associated with an increase in prebronchodilator FEV1 of 238 mL/y (95% CI, 177-299 mL/y), whereas less than 75% allergen reduction was associated with an increase in prebronchodilator FEV1 of 131 mL/y (95% CI, 97-166 mL/y). Estimated differences in prebronchodilator and postbronchodilator FEV1 growth were as follows: 107 mL/y (95% CI, 37-177 mL/y; Pint= .003) and 48 mL/y (95% CI, -17 to 113 mL/y; Pint= .15), respectively. Estimated differences in prebronchodilator and postbronchodilator forced expiratory flow at 25% to 75% of vital capacity growth were as follows: 182 mL/y (95% CI, 61-304 mL/y; Pint= .003) and 181 mL/y (95% CI, 48-314 mL/y; Pint= .008), respectively. Mouse allergen reduction is associated with greater increases in prebronchodilator FEV1 and prebronchodilator/postbronchodilator forced expiratory flow at 25% to 75% of vital capacity over 1 year among sensitized/exposed asthmatic children.

Early life home microbiome and hyperactivity/inattention in school-age children

This study evaluates the association between indoor microbial diversity early in life and hyperactivity/inattention symptoms in children at ages 10 and 15 years.A random sample enriched with subjects with hyperactivity/inattention at age 15 years was selected from the German LISA birth cohort. Bedroom floor dust was collected at age 3 months and 4 bacterial and fungal diversity measures [number of observed operational taxonomic units (OTUs), Chao1, Shannon and Simpson indices] were calculated from Illumina MiSeq sequencing data. Hyperactivity/inattention was based on the Strengths and Difficulties Questionnaire at ages 10 and 15 (cut-off ≥7). Adjusted associations between 4 diversity measures in tertiles and hyperactivity/inattention were investigated with weighted and survey logistic regression models. We included 226 individuals with information on microbial diversity and hyperactivity/inattention. Early life bacterial diversity was inversely associated with hyperactivity/inattention at age 10 [bacterial OTUs (medium vs low: aOR = 0.4, 95%CI = (0.2–0.8)) and Chao1 (medium vs low: 0.3 (0.1–0.5); high vs low: 0.3 (0.2–0.6)], whereas fungal diversity was directly associated [Chao1 (high vs low: 2.1 (1.1–4.0)), Shannon (medium vs low: 2.8 (1.3–5.8)), and Simpson (medium vs low: 4.7 (2.4–9.3))]. At age 15, only Shannon index was significantly associated with hyperactivity/inattention [bacteria (medium vs low: 2.3 (1.2–4.2); fungi (high vs low: 0.5 (0.3–0.9))]. In conclusion, early life exposure to microbial diversity may play a role in the psychobehavioural development. We observe heterogeneity in the direction of the associations encouraging further longitudinal studies to deepen our understanding of the characteristics of the microbial community underlying the observed associations.

Changes in Indoor Insecticide Residue Levels after Adopting an Integrated Pest Management Program to Control German Cockroach Infestations in an Apartment Building.

Insecticide use in homes leads to human exposure to insecticide residues that persist in the environment. Integrated pest management (IPM) programs have been known to be more environmentally friendly for managing German cockroach (Blattella germanica L.) infestations, but their effect on indoor insecticide residue levels are not well understood. An IPM program consisting of applying cockroach gel baits and placing insect sticky traps as the primary treatment methods were implemented. Floor wipe samples were collected from the bedroom and kitchen floors of 69 apartments with German cockroach infestations at 0 months and again at 12 months from 49 of the 69 apartments sampled at 0 months. Levels of 18 insecticide residues were measured. The mean insecticide residue concentration per apartment decreased by 74% after 12 months. The number of insecticides detected per apartment decreased from 2.5 ± 0.2 to 1.5 ± 0.2 (mean ± standard error). Indoxacarb residue was only detected in two apartments at 12 months despite the fact that an average of 32 ± 4 g 0.6% indoxacarb gel bait was applied per apartment. IPM implementation can result in significant reduction in the insecticide residue concentrations and number of detected insecticides in floor dust samples.

Synergistic Association of House Endotoxin Exposure and Ambient Air Pollution with Asthma Outcomes.

Rationale: House endotoxin and ambient air pollution are risk factors for asthma; however, the effects of their coexposure on asthma are not well characterized.Objectives: To examine potential synergistic associations of coexposure to house dust endotoxin and ambient air pollutants with asthma outcomes.Methods: We analyzed data of 6,488 participants in the National Health and Nutrition Examination Survey 2005-2006. Dust from bedding and bedroom floor was analyzed for endotoxin content. The Community Multiscale Air Quality Modeling System (CMAQ) and Downscaler Model data were used to determine annual average particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) exposures at participants' residential locations. The associations of the coexposures with asthma outcomes were assessed and tested for synergistic interaction.Measurements and Main Results: In adjusted analysis, PM2.5 (CMAQ) (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), O3 (Downscaler Model) (OR, 1.07; 95% CI, 1.02-1.13), and log10 NO2 (CMAQ) (OR, 3.15; 95% CI, 1.33-7.45) were positively associated with emergency room visits for asthma in the past 12 months. Coexposure to elevated concentrations of house dust endotoxin and PM2.5 (CMAQ) was synergistically associated with the outcome, increasing the odds by fivefold (OR, 5.01; 95% CI, 2.54-9.87). A synergistic association was also found for coexposure to higher concentrations of endotoxin and NO2 in children (OR, 3.45; 95% CI, 1.65-7.18).Conclusions: Coexposure to elevated concentrations of residential endotoxin and ambient PM2.5 in all participants and NO2 in children is synergistically associated with increased emergency room visits for asthma. Therefore, decreasing exposure to both endotoxin and air pollution may help reduce asthma morbidity.

Endotoxin, cat, and house dust mite allergens in electrostatic cloths and bedroom dust

Environmental exposure to endotoxin, Fel d I (cat) allergen and Der p I (house dust mite) allergen have been associated with asthma symptoms and have been measured in the environment using various sampling methods, including the electrostatic dust collector. The objectives of this study were to investigate whether levels of endotoxin and allergens were detectable in electrostatic dust collectors and to examine the correlation of allergen and endotoxin levels between electrostatic dust collectors and vacuum sampling methods (floor dust and mattress dust). Electrostatic cloths, bedroom floor dust and mattress dust samples from a subset of 60 homes were randomly selected from the Health of Occupants of Mouldy Homes study for allergen and endotoxin analysis. Fel d I and Der p I allergens were analyzed by double monoclonal antibody ELISA and endotoxin by the kinetic Limulus amoebocyte lysate assay. An enhanced ELISA method was used to analyze Der p I in the electrostatic cloths. Endotoxin was detected in all samples, however Fel d I and Der p I were not detected in all electrostatic dust collector samples (detection in 53% and 15% of cloths respectively). No correlations were found between cloth and dust samples for endotoxin or Der p I, but moderate-to-strong correlations were found between all three sampling methods for Fel d I (rs = 0.612–0.715, p < 0.001). Poor correlation was found between floor dust and mattress dust samples for Der p I (rs = 0.256, p = 0.048). Electrostatic dust collectors may provide a way to measure airborne dust and allergen. Given the moderate-to-low correlations with vacuum dust sampling, this may present a unique measurement system which, when collected alongside traditional vacuum dust sampling, could provide additional exposure measures. Further studies are required to correlate endotoxin and allergen levels measured by electrostatic dust collector with air sampling and to explore the relationships between these bioaerosols, environmental factors and asthma.

Sudden death associated with melanoma brain metastases

A 48-year-old male Caucasian, with no relevant medical history except for a mild depression, was found by the partner, passed out on the bedroom floor. Since he was found in cardiac arrest, cardiopulmonary resuscitation was attempted, without success. Initially, it was suspected to be a suicide attempt and autopsy findings revealed coronary atherosclerosis of about 40%, with no other recoverable cardiac findings.The brain showed multiple probable neoplastic lesions, associated with cerebral and cerebellar hemorrhage. The primary tumor was not identified, but the victim had multiple cutaneous nevi. Histological examination revealed melanoma metastases, confirmed by immunohistochemistry.In this case, the forensic autopsy allowed an accurate determination of the cause of death. Besides having fulfilled its role to the judiciary system, the autopsy also had relevance from an epidemiological point of view, which is essential for Public Health prevention programs.

Residential Ambient Traffic in Relation to Childhood Pneumonia among Urban Children in Shandong, China: A Cross-Sectional Study.

Pneumonia is a leading cause of childhood death. Few studies have investigated associations between residential ambient environmental exposures and pneumonia. In January–April 2015, we conducted a cross-sectional study in Shandong Province (China) and collected 9597 (response rate: 78.7%) parent-reported questionnaires for 3–6-year-old children from 69 urban kindergartens. We then selected 5640 children who had never changed residence since birth and examined associations between residential ambient traffic-related facilities and childhood pneumonia considering residential characteristics. Prevalence of doctor-diagnosed pneumonia during lifetime-ever was 25.9%. In the multivariate logistic regression analyses, residence close to a main traffic road (adjusted odds ratio, 95% confidence interval: 1.23, 1.08–1.40) and automobile 4S shop (1.76, 1.16–2.67) within 200 m, residence close to a filling station within 100 m (1.71, 1.10–2.65; reference: >200 m), as well as having a ground car park in the residential community (1.24, 1.08–1.42) were significantly associated with childhood pneumonia. The cumulative numbers of these traffic-related facilities had a positive dose-response relationship with the increased odds of childhood pneumonia. These associations and dose-response relationships were stronger among boys and among children with worse bedroom ventilation status during the night. Associations of residence close to the main traffic road and ground car parks in the residential community with childhood pneumonia were stronger among children living in the 1st–3rd floors than those living on higher floors. Similar results were found in the two-level (kindergarten-child) logistic regression analyses. Our findings indicate that living near traffic-related facilities is likely a risk factor for childhood pneumonia among urban children. The child’s sex, bedroom floor level, and bedroom ventilation could modify associations of ambient traffic-related facilities with childhood pneumonia.

Exposure and Sensitization to Pets Modify Endotoxin Association with Asthma and Wheeze

Pets are major contributors of endotoxin in homes, but whether they influence endotoxin association with respiratory outcomes is unclear. To examine whether exposure and sensitization to dog and cat modify the relationship between endotoxin exposure and asthma and wheeze. We analyzed data from 6051 participants in the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES). House dust from bedroom floor and bedding was evaluated for endotoxin and for dog (Canis familiaris 1) and cat (Feline domesticus 1) allergens. The NHANES also collected data on respiratory outcomes and measured IgE specific to allergens. Associations of log-endotoxin and pet exposure with respiratory outcomes were examined, adjusting for covariates including pet avoidance. Dog and cat ownership among participants was 48.3% and 37.5%, respectively. Endotoxin geometric mean (SE) was 15.49 (0.50) EU/mg. Endotoxin and petallergen levels were significantly higher in households with a dog or cat. Overall, endotoxin was positively associated with wheeze (odds ratio [OR], 1.30; 95% CI, 1.04-1.62), but not with asthma. However, in participants nonsensitized to dog, the odds of endotoxin association with wheeze were higher with exposure to dog allergen (OR, 1.80; 95% CI, 1.27-2.53; Pinteraction= .048). In participants sensitized to cat and exposed to cat allergen, endotoxin became positively associated with asthma (OR, 1.92; 95% CI, 1.21-3.0; Pinteraction= .040). With coexposure to dog and cat allergens, endotoxin association with asthma and wheeze was exacerbated (OR, 2.00; 95% CI, 1.04-3.83; Pinteraction= .012 and OR, 1.88; 95% CI, 1.32-2.66; Pinteraction= .016, respectively). Exposure to dog and cat allergens enhances the association of endotoxin with asthma and wheeze.

House Dust Endotoxin Association with Chronic Bronchitis and Emphysema.

Background:Endotoxin has been reported to be associated with chronic bronchitis or emphysema (CBE) at high occupational exposures. However, whether levels found in domestic environments have similar effects is unknown.Objectives:We aimed to study the association between house dust endotoxin and CBE in a sample representative of the U.S. population.Methods:We analyzed data from 3,393 participants from the National Health and Nutrition Examination Survey (NHANES) 2005–2006. House dust from bedding and from bedroom floors was analyzed for endotoxin content. NHANES participants received questionnaires and underwent examination as well as extensive laboratory testing. Logistic regression was used to examine the association of endotoxin levels with CBE diagnosis and symptoms, adjusting for covariates. The survey design and weights were applied so that estimates were nationally representative and so that statistical inferences were made appropriately.Results:The median endotoxin concentration in house dust was , and CBE was reported by 8.2% of participants. In the adjusted analysis, one unit (EU/mg) increase in -transformed endotoxin concentrations was associated with a 27% increase in the odds of CBE diagnosis [ (95% CI: 1.00, 1.61)] and a 78% increase in the odds of chronic bronchitis symptoms (defined as cough and phlegm for in a year for ) [ (95% CI: 1.01, 3.12)]. Sensitization to inhalant allergens () modified the relationship between endotoxin and CBE diagnosis, with stronger associations observed in sensitized participants [ (95% CI: 1.72, 3.50) for a unit increase in -endotoxin].Conclusions:In a population-based sample of U.S. adults, endotoxin levels in homes were associated with a self-reported history of CBE diagnosis and chronic bronchitis symptoms, with stronger associations among people sensitized to inhalant allergens. https://doi.org/10.1289/EHP2452

Endotoxin predictors and associated respiratory outcomes differ with climate regions in the U.S.

RationaleAlthough endotoxin is a recognized cause of environmental lung disease, how its relationship with respiratory outcomes varies with climate is unknown. ObjectiveTo examine the endotoxin predictors as well as endotoxin association with asthma, wheeze, and sensitization to inhalant allergens in various US climate regions. MethodsWe analyzed data on 6963 participants in the National Health and Nutrition Examination Survey. Endotoxin measurements of house dust from bedroom floor and bedding were performed at the University of Iowa. Linear and logistic regression analyses were used to identify endotoxin predictors and assess endotoxin association with health outcomes. ResultsThe overall median house dust endotoxin was 16.2 EU/mg; it was higher in mixed-dry/hot-dry regions (19.7 EU/mg) and lower in mixed-humid/marine areas (14.8 EU/mg). Endotoxin predictors and endotoxin association with health outcomes significantly differed across climate regions. In subarctic/very cold/cold regions, log10-endotoxin was significantly associated with higher prevalence of wheeze outcomes (OR:1.48, 95% CI:1.19–1.85 for any wheeze, OR:1.48, 95% CI:1.22–1.80 for exercise-induced wheeze, OR:1.50, 95% CI:1.13–1.98 for prescription medication for wheeze, and OR:1.95, 95% CI:1.50–2.54 for doctor/ER visit for wheeze). In hot-humid regions, log10-endotoxin was positively associated with any wheeze (OR:1.66, 95% CI:1.04–2.65) and current asthma (OR:1.56, 95% CI:1.11–2.18), but negatively with sensitization to any inhalant allergens (OR:0.83, 95% CI:0.74–0.92). ConclusionEndotoxin predictors and endotoxin association with asthma and wheeze differ across U.S. climate regions. Endotoxin is associated positively with wheeze or asthma in cold and hot-humid regions, but negatively with sensitization to inhalant allergens in hot-humid climates.