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Traditional cooking with solid fuels (biomass, animal dung, charcoals, coal) creates household air pollution that leads to millions of premature deaths and disability worldwide each year. Exposure to household air pollution is highest in low- and middle-income countries. Using data from a stepped-wedge randomized controlled trial of a cookstove intervention among 230 households in Honduras, we analyzed the impact of household and personal variables on repeated 24-h measurements of fine particulate matter (PM2.5) and black carbon (BC) exposure. Six measurements were collected approximately six-months apart over the course of the three-year study. Multivariable mixed models explained 37% of variation in personal PM2.5 exposure and 49% of variation in kitchen PM2.5 concentrations. Additionally, multivariable models explained 37% and 47% of variation in personal and kitchen BC concentrations, respectively. Stove type, season, presence of electricity, primary stove location, kitchen enclosure type, stove use time, and presence of kerosene for lighting were all associated with differences in geometric mean exposures. Stove type explained the most variability of the included variables. In future studies of household air pollution, tracking the cooking behaviors and daily activities of participants, including outdoor exposures, may explain exposure variation beyond the household and personal variables considered here.
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Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Animais , Carbono , Culinária , Monitoramento Ambiental , Honduras , Humanos , Material Particulado/análise , População Rural , FuligemRESUMO
Household air pollution from solid fuel combustion was estimated to cause 2.31 million deaths worldwide in 2019; cardiovascular disease is a substantial contributor to the global burden. We evaluated the cross-sectional association between household air pollution (24-h gravimetric kitchen and personal particulate matter (PM2.5) and black carbon (BC)) and C-reactive protein (CRP) measured in dried blood spots among 107 women in rural Honduras using wood-burning traditional or Justa (an engineered combustion chamber) stoves. A suite of 6 additional markers of systemic injury and inflammation were considered in secondary analyses. We adjusted for potential confounders and assessed effect modification of several cardiovascular-disease risk factors. The median (25th, 75th percentiles) 24-h-average personal PM2.5 concentration was 115 µg/m3 (65,154 µg/m3) for traditional stove users and 52 µg/m3 (39, 81 µg/m3) for Justa stove users; kitchen PM2.5 and BC had similar patterns. Higher concentrations of PM2.5 and BC were associated with higher levels of CRP (e.g., a 25% increase in personal PM2.5 was associated with a 10.5% increase in CRP [95% CI: 1.2-20.6]). In secondary analyses, results were generally consistent with a null association. Evidence for effect modification between pollutant measures and four different cardiovascular risk factors (e.g., high blood pressure) was inconsistent. These results support the growing evidence linking household air pollution and cardiovascular disease.
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Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Proteína C-Reativa , Culinária/métodos , Estudos Transversais , Feminino , Honduras/epidemiologia , Humanos , Material Particulado/análise , Madeira/análise , Madeira/químicaRESUMO
Introduction: Household air pollution from cooking-related biomass combustion remains a leading risk factor for global health. Black carbon (BC) is an important component of particulate matter (PM) in household air pollution. We evaluated the impact of the engineered, wood-burning Justa stove intervention on BC concentrations. Methods: We conducted a 3-year stepped-wedge randomized controlled trial with 6 repeated visits among 230 female primary cooks in rural Honduras. Participants used traditional stoves at baseline and were randomized to receive the Justa after visit 2 or after visit 4. At each visit, we measured 24-hour gravimetric personal and kitchen fine PM (PM2.5) concentrations and estimated BC mass concentrations (Sootscan Transmissometer). We conducted intent-to-treat analyses using linear mixed models with natural log-transformed 24-hour personal and kitchen BC. Results: BC concentrations were reduced for households assigned to the Justa vs. traditional stoves: e.g., personal BC geometric mean (GSD), 3.6 µg/m3 (6.4) vs. 11.5 µg/m3 (4.6), respectively. Following the intervention, we observed 53% (95% CI: 35-65%) lower geometric mean personal BC concentrations and 76% (95% CI: 66-83%) lower geometric mean kitchen BC concentrations. Conclusions: The Justa stove intervention substantially reduced BC concentrations, mitigating household air pollution and potentially benefitting human and climate health.
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TRIAL DESIGN: We evaluated the impact of a biomass stove intervention on fine particulate matter (PM2.5) concentrations using an individual-level, stepped-wedge randomized trial. METHODS: We enrolled 230 women in rural Honduran households using traditional biomass stoves and randomly allocated them to one of two study arms. The Justa stove, the study intervention, was locally-sourced, wood-burning, and included an engineered combustion chamber and chimney. At each of 6 visits over 3 years, we measured 24-hour gravimetric personal and kitchen PM2.5 concentrations. Half of the households received the intervention after Visit 2 and half after Visit 4. We conducted intent-to-treat analyses to evaluate the intervention effect using linear mixed models with log-transformed kitchen or personal PM2.5 (separately) as the dependent variable, adjusting for time. We also compared PM2.5 concentrations to World Health Organization (WHO) guidelines. RESULTS: Arms 1 and 2 each had 115 participants with 664 and 632 completed visits, respectively. Median 24-hour average personal PM2.5 exposures were 81 µg/m3 (25th-75th percentile: 50-141 µg/m3) for the traditional stove condition (n=622) and 43 µg/m3 (25th-75th percentile: 27-73 µg/m3) for the Justa stove condition (n=585). Median 24-hour average kitchen concentrations were 178 µg/m3 (25th-75th percentile: 69-440 µg/m3; n=629) and 53 µg/m3 (25th-75th percentile: 29-103 µg/m3; n=578) for the traditional and Justa stove conditions, respectively. The Justa intervention resulted in a 32% reduction in geometric mean personal PM2.5 (95% confidence interval [CI]: 20-43%) and a 56% reduction (95% CI: 46-65%) in geometric mean kitchen PM2.5. During rainy and dry seasons, 53% and 41% of participants with the Justa intervention had 24-hour average personal PM2.5 exposures below the WHO interim target-3 guideline (37.5 µg/m3), respectively. CONCLUSION: The Justa stove intervention substantially lowered personal and kitchen PM2.5 and may be a provisional solution that is feasible for Latin American communities where cleaner fuels may not be available, affordable, or acceptable for some time. Clinicaltrials.gov: NCT02658383.
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Poluição do Ar em Ambientes Fechados , Material Particulado , Poluição do Ar em Ambientes Fechados/análise , Culinária , Feminino , Honduras , Humanos , Material Particulado/análise , População Rural , Madeira/químicaRESUMO
Household air pollution (HAP) is estimated to be an important risk factor for cardiovascular disease, but little clinical evidence exists and collecting biomarkers of disease risk is difficult in low-resource settings. Among 54 Nicaraguan women with woodburning cookstoves, we evaluated cross-sectional associations between 48-hour measures of HAP (eg, fine particulate matter, PM2.5 ) and C-reactive protein (CRP) via dried blood spots; secondary analyses included seven additional biomarkers of systemic injury and inflammation. We conducted sub-studies to calculate the intraclass correlation coefficient (ICC) in biomarkers collected over four consecutive days in Nicaragua and to assess the validity of measuring biomarkers in dried blood by calculating the correlation with paired venous-drawn samples in Colorado. Measures of HAP were associated with CRP (eg, a 25% increase in indoor PM2.5 was associated with a 7.4% increase in CRP [95% confidence interval: 0.7, 14.5]). Most of the variability in CRP concentrations over the 4-day period was between-person (ICC: 0.88), and CRP concentrations were highly correlated between paired dried blood and venous-drawn serum (Spearman ρ = .96). Results for secondary biomarkers were primarily consistent with null associations, and the sub-study ICCs and correlations were lower. Assessing CRP via dried blood spots provides a feasible approach to elucidate the association between HAP and cardiovascular disease risk.
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Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Proteína C-Reativa/metabolismo , Exposição por Inalação/estatística & dados numéricos , Adulto , Poluição do Ar , Biomarcadores/sangue , Colorado , Culinária/métodos , Culinária/estatística & dados numéricos , Feminino , Humanos , Exposição por Inalação/análise , Pessoa de Meia-Idade , NicaráguaRESUMO
Household air pollution from combustion of solid fuels is an important risk factor for morbidity and mortality, causing an estimated 2.6 million premature deaths globally in 2016. Self-reported health symptoms are a meaningful measure of quality of life, however, few studies have evaluated symptoms and quantitative measures of exposure to household air pollution. We assessed the cross-sectional association of self-reported symptoms and exposures to household air pollution among women in rural Honduras using stove type (traditional [n = 76]; cleaner-burning Justa [n = 74]) and 24-hour average personal and kitchen fine particulate matter (PM2.5) concentrations. The odds of prevalent symptoms were higher among women using traditional stoves vs Justa stoves (e.g. headache: odds ratio = 2.23; 95% confidence interval = 1.13-4.39). Associations between symptoms and measured PM2.5 were generally consistent with the null. These results add to the evidence suggesting reduced exposures and better health-related quality of life among women using cleaner-burning biomass stoves.
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Poluentes Atmosféricos/efeitos adversos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Culinária , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Doenças Respiratórias/epidemiologia , População Rural/estatística & dados numéricos , Transtornos da Visão/epidemiologia , Adulto , Estudos Transversais , Feminino , Honduras/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência , Doenças Respiratórias/induzido quimicamente , Autorrelato , Transtornos da Visão/induzido quimicamenteRESUMO
Cooking and heating with solid fuels results in high levels of household air pollutants, including particulate matter (PM); however, limited data exist for size fractions smaller than PM2.5 (diameter less than 2.5 µm). We collected 24-h time-resolved measurements of PM2.5 (n = 27) and particle number concentrations (PNC, average diameter 10-700 nm) (n = 44; 24 with paired PM2.5 and PNC) in homes with wood-burning traditional and Justa (i.e., with an engineered combustion chamber and chimney) cookstoves in rural Honduras. The median 24-h PM2.5 concentration (n = 27) was 79 µg/m3 (interquartile range [IQR]: 44-174 µg/m3); traditional (n = 15): 130 µg/m3 (IQR: 48-250 µg/m3); Justa (n = 12): 66 µg/m3 (IQR: 44-97 µg/m3). The median 24-h PNC (n = 44) was 8.5 × 104 particles (pt)/cm3 (IQR: 3.8 × 104-1.8 × 105 pt/cm3); traditional (n = 27): 1.3 × 105 pt/cm3 (IQR: 3.3 × 104-2.0 × 105 pt/cm3); Justa (n = 17): 6.3 × 104 pt/cm3 (IQR: 4.0 × 104-1.2 × 105 pt/cm3). The 24-h average PM2.5 and particle number concentrations were correlated for the full sample of cookstoves (n = 24, Spearman ρ: 0.83); correlations between PM2.5 and PNC were higher in traditional stove kitchens (n = 12, ρ: 0.93) than in Justa stove kitchens (n = 12, ρ: 0.67). The 24-h average concentrations of PM2.5 and PNC were also correlated with the maximum average concentrations during shorter-term averaging windows of one-, five-, 15-, and 60-min, respectively (Spearman ρ: PM2.5 [0.65, 0.85, 0.82, 0.71], PNC [0.74, 0.86, 0.88, 0.86]). Given the moderate correlations observed between 24-h PM2.5 and PNC and between 24-h and the shorter-term averaging windows within size fractions, investigators may need to consider cost-effectiveness and information gained by measuring both size fractions for the study objective. Further evaluations of other stove and fuel combinations are needed.
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Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Culinária/instrumentação , Material Particulado/análise , Biomassa , Monitoramento Ambiental , Honduras , HumanosRESUMO
BACKGROUND: Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN: We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24-59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM2.5) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM2.5 and indicators of cardiometabolic health. DISCUSSION: This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02658383 , posted January 18, 2016, field work completed May 2018. Official title, "Community-Based Participatory Research: A Tool to Advance Cookstove Interventions." Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018.
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Poluição do Ar em Ambientes Fechados/prevenção & controle , Doenças Cardiovasculares/prevenção & controle , Culinária/métodos , Exposição Ambiental/prevenção & controle , Utensílios Domésticos , Adulto , Poluição do Ar em Ambientes Fechados/efeitos adversos , Biomassa , Doenças Cardiovasculares/etiologia , Exposição Ambiental/efeitos adversos , Características da Família , Feminino , Honduras , Humanos , Pessoa de Meia-Idade , Material Particulado/análise , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , População Rural , Adulto JovemRESUMO
Growing evidence links household air pollution exposure from biomass cookstoves with elevated blood pressure. We assessed cross-sectional associations of 24-hour mean concentrations of personal and kitchen fine particulate matter (PM2.5 ), black carbon (BC), and stove type with blood pressure, adjusting for confounders, among 147 women using traditional or cleaner-burning Justa stoves in Honduras. We investigated effect modification by age and body mass index. Traditional stove users had mean (standard deviation) personal and kitchen 24-hour PM2.5 concentrations of 126 µg/m3 (77) and 360 µg/m3 (374), while Justa stove users' exposures were 66 µg/m3 (38) and 137 µg/m3 (194), respectively. BC concentrations were similarly lower among Justa stove users. Adjusted mean systolic blood pressure was 2.5 mm Hg higher (95% CI, 0.7-4.3) per unit increase in natural log-transformed kitchen PM2.5 concentration; results were stronger among women of 40 years or older (5.2 mm Hg increase, 95% CI, 2.3-8.1). Adjusted odds of borderline high and high blood pressure (categorized) were also elevated (odds ratio = 1.5, 95% CI, 1.0-2.3). Some results included null values and are suggestive. Results suggest that reduced household air pollution, even when concentrations exceed air quality guidelines, may help lower cardiovascular disease risk, particularly among older subgroups.
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Poluição do Ar em Ambientes Fechados/efeitos adversos , Pressão Sanguínea/fisiologia , Hipertensão/induzido quimicamente , Adulto , Biomassa , Índice de Massa Corporal , Culinária , Estudos Transversais , Fontes Geradoras de Energia , Monitoramento Ambiental , Feminino , Honduras/epidemiologia , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Material Particulado/análise , População RuralRESUMO
BACKGROUND: Household air pollution from cooking with solid fuels affects nearly 3 billion people worldwide and is responsible for an estimated 2.5 million premature deaths and 77 million disability-adjusted life years annually. Investigating the effect of household air pollution on indicators of cardiometabolic disease, such as metabolic syndrome, can help clarify the pathways between this widespread exposure and cardiovascular diseases, which are increasing in low- and middle-income countries. METHODS: Our cross-sectional study of 150 women in rural Honduras (76 with traditional stoves and 74 with cleaner-burning Justa stoves) explored the effect of household air pollution exposure on cardiovascular disease risk factors. Household air pollution was measured by stove type and 24-h average kitchen and personal fine particulate matter [PM2.5] mass and black carbon concentrations. Health endpoints included non-fasting total cholesterol, high-density lipoprotein, calculated low-density lipoprotein, triglycerides, waist circumference to indicate abdominal obesity, and presence of metabolic syndrome (defined by current modified international guidelines: waist circumferenceâ¯≥â¯80â¯cm plus any two of the following: triglyceridesâ¯>â¯200â¯mg/dL, HDLâ¯<â¯50â¯mg/dL, systolic blood pressureâ¯≥â¯130â¯mmHg, diastolic blood pressureâ¯≥â¯85â¯mmHg, or glycated hemoglobinâ¯>â¯5.6%). RESULTS: Forty percent of women met the criteria for metabolic syndrome. The prevalence ratio [PR] for metabolic syndrome (versus normal) per interquartile range increase in kitchen PM2.5 and kitchen black carbon was 1.16 (95% confidence interval [CI]: 1.01-1.34) per 312⯵g/m3 increase in PM2.5, and 1.07 (95% CI: 1.03-1.12) per 73⯵g/m3 increase in black carbon. There is suggestive evidence of a stronger effect in women ≥â¯40 years of age compared to women <â¯40 (p-value for interactionâ¯=â¯0.12 for personal PM2.5). There was no evidence of associations between all other exposure metrics and health endpoints. CONCLUSIONS: The prevalence of metabolic syndrome among our study population was high compared to global estimates. We observed a suggestive effect between metabolic syndrome and exposure to household air pollution. These results for metabolic syndrome may be driven by specific syndrome components, such as blood pressure. Longitudinal research with repeated health and exposure measures is needed to better understand the link between household air pollution and indicators of cardiometabolic disease risk.
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Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Culinária , Lipídeos/sangue , Síndrome Metabólica/epidemiologia , Circunferência da Cintura , Adulto , Poluição do Ar , Animais , Biomassa , Bovinos , Estudos Transversais , Características da Família , Feminino , Honduras/epidemiologia , Humanos , Material Particulado , MulheresRESUMO
Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justa stoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO).
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Poluição do Ar em Ambientes Fechados/efeitos adversos , Inflamação/etiologia , Exposição por Inalação/efeitos adversos , Óxido Nítrico/análise , Fumaça/efeitos adversos , Adulto , Poluição do Ar , Poluição do Ar em Ambientes Fechados/análise , Biomassa , Testes Respiratórios , Culinária , Estudos Transversais , Expiração , Características da Família , Feminino , Honduras , Utensílios Domésticos , Humanos , Exposição por Inalação/análise , Pessoa de Meia-Idade , Material Particulado/análise , População Rural , Fumaça/análiseRESUMO
STUDY DESIGN: Comparing thoracic pedicle screw trajectories, screw lengths, and starting points by examining osteologic specimens. OBJECTIVE: Describe a medial screw trajectory (MST) compared to a screw trajectory along the anatomic pedicle angle (APA) in terms of trajectory, screw length, and starting point. SUMMARY OF BACKGROUND DATA: Although thoracic pedicle screw insertion is commonly used for posterior fusion and instrumentation, there is little data to quantify an MST that avoids the great vessels and allows for greater screw purchase. METHODS: Thirty adult female skeleton thoracic vertebral columns from the University of New Mexico Maxwell Museum of Anthropology Osteology Collection were photographed from axial and right and left lateral views from T1 to T12. Axial plane measurements included APA and MST (both measured from the midline), screw lengths, and APA/MST intersection on the superior articular facet (SAF). The MST was defined as an insertion angle through the midpoint of the pedicle isthmus intersecting the anterior midpoint of the vertebral body. The intersection of each trajectory with the SAF was measured in relation to the lateral base of the SAF, reported as a percentage of the SAF base width from the lateral SAF border. RESULTS: At every vertebral level, the APA was different from the MST for angle, screw length, and SAF intersection (p < .0001), with the largest difference at T12. The T12 differences were APA versus MST angles (-25.5°, 95% CI -22.7° to -28.4°), screw lengths (11.0 mm, 95% CI 9.2 mm to 12.9 mm), and percentage of SAF width from the lateral border of the SAF base (38.6%, 95% CI 29.1% to 48.1%). CONCLUSIONS: The MST was approximately 8° to 10° greater at T1-T10 (19° at T11 and 25° at T12) than the traditional APA insertion angle. This resulted in a much more lateral starting point on the SAF and longer screw length, greatest at T12.
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Parafusos Pediculares , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adulto , Feminino , Humanos , México , Esqueleto , Parede TorácicaRESUMO
PURPOSE: Drug-resistant tuberculosis (DRTB) is steadily increasing in Mexico, but little is known of patient risk factors in the Mexico-United States border region. This preliminary case-control study included 95 patients with active pulmonary TB with drug susceptibility results attending the José E. González University Hospital in the urban hub of Nuevo León-the Monterrey Metropolitan Area. We report potential social and clinical risk factors of DRTB among this hospital-based sample. METHODS: We collected data through face-to-face interviews and medical record reviews from 25 cases with DRTB and 70 drug-sensitive controls. DNA was collected to assess an effect of genetic ancestry on DRTB by using a panel of 291,917 genomic markers. We calculated crude and multivariate logistic regression. RESULTS: After adjusting for potential confounding factors, we found that prior TB treatment (odds ratio, 4.5; 95% confidence interval, 0.9-21.1) and use of crack cocaine (odds ratio, 4.6; 95% confidence interval, 1.1-18.7) were associated with DRTB. No other variables, including genetic ancestry and comorbidities, were predictive. CONCLUSIONS: Health care providers may benefit from recognizing predictors of DRTB in regions where routine drug susceptibility testing is limited. Prior TB treatment and illicit drug use, specifically crack cocaine, may be important risk factors for DRTB in this region.
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Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack/efeitos adversos , Marcadores Genéticos , Mycobacterium/genética , Tuberculose Resistente a Múltiplos Medicamentos/genética , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Comorbidade , DNA/análise , DNA/genética , Feminino , Hospitais Urbanos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Prontuários Médicos/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/genéticaRESUMO
Diverse socioeconomic and clinical factors influence susceptibility to tuberculosis (TB) disease in Mexico. The role of genetic factors, particularly those that differ between the parental groups that admixed in Mexico, is unclear. The objectives of this study are to identify the socioeconomic and clinical predictors of the transition from latent TB infection (LTBI) to pulmonary TB disease in an urban population in northeastern Mexico, and to examine whether genetic ancestry plays an independent role in this transition. We recruited 97 pulmonary TB disease patients and 97 LTBI individuals from a public hospital in Monterrey, Nuevo León. Socioeconomic and clinical variables were collected from interviews and medical records, and genetic ancestry was estimated for a subset of 142 study participants from 291,917 single nucleotide polymorphisms (SNPs). We examined crude associations between the variables and TB disease status. Significant predictors from crude association tests were analyzed using multivariable logistic regression. We also compared genetic ancestry between LTBI individuals and TB disease patients at 1,314 SNPs in 273 genes from the TB biosystem in the NCBI BioSystems database. In crude association tests, 12 socioeconomic and clinical variables were associated with TB disease. Multivariable logistic regression analyses indicated that marital status, diabetes, and smoking were independently associated with TB status. Genetic ancestry was not associated with TB disease in either crude or multivariable analyses. Separate analyses showed that LTBI individuals recruited from hospital staff had significantly higher European genetic ancestry than LTBI individuals recruited from the clinics and waiting rooms. Genetic ancestry differed between individuals with LTBI and TB disease at SNPs located in two genes in the TB biosystem. These results indicate that Monterrey may be structured with respect to genetic ancestry, and that genetic differences in TB susceptibility in parental populations may contribute to variation in disease susceptibility in the region.
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Filogenia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/genética , Genoma Humano/genética , Genótipo , Humanos , Tuberculose Latente , Modelos Logísticos , México/epidemiologia , Análise Multivariada , Polimorfismo de Nucleotídeo Único/genética , Tamanho da Amostra , Fatores SocioeconômicosRESUMO
The objectives of this study were to ascertain the prevalence and potential sources of lead exposure among pregnant women residing in a socially-disadvantaged immigrant community in Albuquerque, New Mexico. Pregnant women (n = 140) receiving prenatal care through a community clinic participated in a structured interview and screening to measure their blood lead levels (BLLs). Potential sources of lead exposure were ascertained by the CDC and New Mexico Department of Health questionnaires. Self-reported risk factors were examined as predictors of BLLs using multiple linear regression and partial least squares discriminant analysis. Most patients were Spanish-speaking (88.6%), Latina (95%), foreign-born (87.1%), lacked health insurance (86.4%), and had a high school education or lower (84.3%). While risk factors were prevalent in this population, only three women (2.1%) had BLLs ≥3 µg/dL. Results of multivariate analyses demonstrated that pica symptoms in pregnancy, history of elevated BLLs before pregnancy, use of non-commercial pottery, and living in older houses were important predictors of elevated BLLs. Although the prevalence of other risk factors relevant to immigrant communities (i.e., use of traditional/folk remedies and cosmetics, seasonings and food products from Mexico) was high, they were not predictive of elevated BLLs. Clinics providing prenatal care to immigrant Hispanic communities should carefully assess patients' pica symptoms, use of non-commercial pottery, and a history of elevated BLLs. Moreover, additional efforts need to focus on the development of screening questionnaires which better reflect exposures of concern in this population.
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Hispânico ou Latino/estatística & dados numéricos , Intoxicação por Chumbo/etiologia , Comportamento Materno/etnologia , Exposição Materna/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Emigrantes e Imigrantes , Feminino , Humanos , Entrevistas como Assunto , Intoxicação por Chumbo/epidemiologia , Intoxicação por Chumbo/prevenção & controle , Programas de Rastreamento , Análise Multivariada , New Mexico/epidemiologia , Pica , Gravidez , Gestantes , Prevalência , Análise de Regressão , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
Binge drinking during pregnancy might lead to the development of Fetal Alcohol Spectrum Disorders in the offspring. Latinas are often considered a low-risk group for alcohol abuse, although recent reports indicate that the prevalence of alcohol consumption in this group is increasing due to changing cultural norms. The predictors of alcohol consumption during pregnancy among Latinas are largely unknown. We explored predictors of periconceptional drinking among Latinas (n=155) recruited into an ongoing cohort study at the University of New Mexico. Women were interviewed by a bilingual trained interviewer about any episodes of binge drinking (>or=4 drinks/occasion) a month around their last menstrual period (LMP) and were administered a TWEAK questionnaire. Sociodemographic, lifestyle, and reproductive health characteristics were also ascertained. Predictors of binge drinking were identified by Chi-square test and logistic regression in univariate and multivariable analyses, respectively. Backward selection procedure was used to identify covariates that were independently associated with binge drinking in the final model. The mean age of participants was 27.0+/-5.8 years and 69% were foreign born. In the entire sample, 17.4% of pregnant Latinas admitted at least one binge-drinking episode in the month around their LMP. Results of multivariate analysis indicate that Latinas born in the United States have a much greater risk of binge drinking in the periconceptional period (odds ratio [OR]=3.2; 95% confidence interval [CI]: 1.2, 8.9) compared with foreign-born Latinas. Similarly, Latinas who primarily speak English at home were at much greater risk (OR=3.6; 95% CI: 1.3, 10.5) compared with primarily Spanish-speaking women. No other variables were identified as significant predictors in multivariable models. Our results indicate that more acculturated Latinas are at much greater risk of binge drinking before conception and in early pregnancy compared with less acculturated Latinas. Culturally sensitive interventions should be developed to address risky alcohol consumption among Latinas of reproductive age.