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The Gulf of Mexico (GoM) region is prone to disasters, including recurrent oil spills, hurricanes, floods, industrial accidents, harmful algal blooms, and the current COVID-19 pandemic. The GoM and other regions of the U.S. lack sufficient baseline health information to identify, attribute, mitigate, and facilitate prevention of major health effects of disasters. Developing capacity to assess adverse human health consequences of future disasters requires establishment of a comprehensive, sustained community health observing system, similar to the extensive and well-established environmental observing systems. We propose a system that combines six levels of health data domains, beginning with three existing, national surveys and studies plus three new nested, longitudinal cohort studies. The latter are the unique and most important parts of the system and are focused on the coastal regions of the five GoM States. A statistically representative sample of participants is proposed for the new cohort studies, stratified to ensure proportional inclusion of urban and rural populations and with additional recruitment as necessary to enroll participants from particularly vulnerable or under-represented groups. Secondary data sources such as syndromic surveillance systems, electronic health records, national community surveys, environmental exposure databases, social media, and remote sensing will inform and augment the collection of primary data. Primary data sources will include participant-provided information via questionnaires, clinical measures of mental and physical health, acquisition of biological specimens, and wearable health monitoring devices. A suite of biomarkers may be derived from biological specimens for use in health assessments, including calculation of allostatic load, a measure of cumulative stress. The framework also addresses data management and sharing, participant retention, and system governance. The observing system is designed to continue indefinitely to ensure that essential pre-, during-, and post-disaster health data are collected and maintained. It could also provide a model/vehicle for effective health observation related to infectious disease pandemics such as COVID-19. To our knowledge, there is no comprehensive, disaster-focused health observing system such as the one proposed here currently in existence or planned elsewhere. Significant strengths of the GoM Community Health Observing System (CHOS) are its longitudinal cohorts and ability to adapt rapidly as needs arise and new technologies develop.

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OBJECTIVES: To examine elevated neonatal inflammatory and neurotrophic proteins from children born extremely preterm in relation to later childhood brain Magnetic Resonance Imaging volumes and cognition. STUDY DESIGN: We measured circulating inflammation-related proteins and neurotrophic proteins on postnatal days 1, 7, and 14 in 166 children at 10 years of age (73 males; 93 females). Top quartile levels on ≥2 days for ≥3 inflammation-related proteins and for ≥4 neurotrophic proteins defined exposure. We examined associations among protein levels, brain Magnetic Resonance Imaging volumes, and cognition with multiple linear and logistic regressions. RESULTS: Analyses were adjusted for gestational age at birth and sex. Children with ≥3 elevated inflammation-related proteins had smaller grey matter, brain stem/cerebellar, and total brain volumes than those without elevated inflammation-related proteins, adjusted for neurotrophic proteins. When adjusted for inflammation-related proteins, children with ≥4 neurotrophic proteins, compared with children with no neurotrophic proteins, had larger grey matter and total brain volumes. Higher grey matter, white matter, and cerebellum and brainstem volumes were significantly correlated with higher IQ. Grey and white matter volumes were correlated with each other (r = -0.18; P = .021), and cerebellum and brainstem was highly correlated with grey matter (r = 0.55; P < .001) and white matter (r = 0.29; P < .001). Adjusting for other brain compartments, cerebellum and brainstem was associated with IQ (P = .016), but the association with white matter was marginally significant (P = .051). Grey matter was not associated with IQ. After adjusting for brain volumes, elevated inflammation-related proteins remained significantly associated with a lower IQ, and elevated neurotrophic proteins remained associated with a higher IQ. CONCLUSIONS: Newborn inflammatory and neurotrophin protein levels are associated with later brain volumes and cognition, but their effects on cognition are not entirely explained by altered brain volumes.

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Dr. David L. Cochran é graduado pela University of Virginia e recebeu os títulos de DDS, MS e PhD em Bioquímica pela Medical College of Virginia. Especializou-se em Periodontia pela Harvard School of Dental Medicine, onde também recebeu um segundo título de mestre. Recentemente, o Dr. Cochran recebeu o título de Doctor HonorisCausa pela University of Bern, na Suíça. Atualmente, é professor e chefe do Departamento de Periodontia na Faculdade de Odontologia da University of Texas Health Science Center, na cidade de San Antonio, nos Estados Unidos. Antes de assumir o cargo em San Antonio, era diretor do programa de pós-graduação em Periodontia naMedical College of Virginia. Dr. Cochran é membro de muitas organizações profissionais de Odontologia e diplomado pelo American Board of Periodontology. Além disso, é membro do American College of Dentistry e do International College of Dentistry.Dr. Cochran publicou inúmeros artigos científicos e resumos sobre vários tópicos relacionados à Periodontia, Bioquímica e Implantodontia. Recebeu prêmios nacionais e internacionais por suas pesquisas, e é um pesquisador clínico e científico ativo financiado tanto pela NIH-NIDCR (National Institutes of Health / National Institute of Dental and Craniofacial Research) quanto pela indústria privada...

Dr. David L. Cochran is a graduate of the University of Virginia and received hisDDS., MS. and PhD degrees in Biochemistry from the Medical College of Virginia (MCV). He was trained in Periodontology at the Harvard School of Dental Medicine where he also obtained a second Masters degree. He recently received an Honorary Doctorate from the University of Bern in Switzerland. Dr. Cochran is currently Professor and Chairman of the Department of Periodontics at The University of Texas Health Science Center at San Antonio, Dental School. Prior to his appointmentat San Antonio, Dr. Cochran was Director of Postgraduate Periodontics atMCV. Dr. Cochran is a member of many professional dental organizations and isa Diplomate of the American Board of Periodontology. He is a fellow of the American College of Dentistry and the International College of Dentistry. Dr. Cochran has published numerous scientific articles and abstracts on various periodontal, biochemistry, and implant topics. He has received awards for his research work at both the national and international levels. Dr. Cochran is an active basic science and clinical researcher who has received funding from both the NIH-NIDCR andprivate industry...

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