<p> Long-term consequences of environmental lead exposure in Kosovo: Effects of pre and postnatal lead exposure in early adulthood Pashko R. Camaj Between May 1985 and December 1986, a cohort of 1,502 pregnant women was recruited at two government clinics in Kosovo (formerly a province of Yugoslavia) for a study of the relationship between environmental lead (Pb) exposure and birth outcomes. Subsequently, a representative group of 541 of their children were selected for long-term follow up. The children were followed longitudinally at six-month intervals for 12 years to examine the effects of environmental Pb exposure on a variety of health outcomes including cognitive and motor function, anemia, endocrine function and growth. This work produced numerous landmark publications (Popovac et al, 1982; Graziano et al., 1990, 1991, 2004; Murphy et al., 1990; Factor-Litvak et al, 1993, 1996, 1998, 1999; Wasserman et al,. 1992, 1994, 1997, 1998, 2000) that contributed to the modification of environmental policies to reduce Pb exposure worldwide. The long-term study ultimately linked environmental Pb exposure from the Trepca mining and smelting operations in Mitrovica to adverse effects on intelligence, motor function, blood pressure, renal, endocrine and hematological functioning. Follow up rates over time were excellent in that 70% of the total cohort was evaluated at 6 years of age, and 65% were evaluated at 12 years of age, at which point the study was - until now - concluded. For the present study, we located 101 members of the original study cohort and requested their participation in a follow-up study in which participants were evaluated to assess their current blood lead (BPb) levels and health outcomes as follows: a) blood pressure; b) biomarkers of endothelial cell function that are associated with cardiovascular disease; c) and measurements of erythropoietin, a glycoprotein hormone produced in the kidney that regulates the production of red blood cells in the bone marrow. The participants, whose environmental exposure history is very well documented from 12 weeks of gestation through 12 years of age, were between 25-26 years of age during the follow-up study. We found a statistically significant association between BPb and systolic blood pressure (sBP), and a marginally significant association between BPb and diastolic blood pressure (dBP), which is consistent with a multitude of studies and meta-analyses referenced in this dissertation. These results provide further evidence that recent circulating dose, as estimated by BPb, or as estimated by lifetime cumulative exposure, is associated with slight increase in sBP. Furthermore, we detected a suggestive relationship between BPb and levels of circulating serum intercellular adhesion molecules (sICAM-1) and serum intravascular adhesion molecules (sVCAM-1), possibly a mechanism by which Pb may lead to increased BP. These findings support the hypothesis that the exposure to Pb either prenatally or in early adulthood, may lead to increased BP and increased circulating levels of sICAM-1 and sVCAM-1 later in life. Lastly, the results regarding the serum erythropoietin (EPO) production presented here resemble the findings reported in this cohort at 4.5 and 6.5 years of age and in contrast with the findings in this cohort when the study participants were 9.5 and 12 years of age (Graziano et al., 2004). In addition, they also contrast the findings reported in the anemic mothers of this study cohort (Graziano et al., 1991) where serum-EPO levels were lower in those with higher BPb levels.</p>

<p> Since 1988 when the first HIV positive drug user was identified in Poland, for close to two decades, the predominant route of HIV transmission has been through injecting drug use. In mid 2000s, Polish officials reported that injecting drug use no longer contributed to incrasing HIV incidence. The consequences of such a statement are that many of the structural and personal risks associated with HIV infection go unaddressed, that drug users are neglected by HIV prevention efforts, that HIV treatment is not made available to drug users and that the policy environment does not adequately support effective public health initiatives. This case study is based on documentation, archival records, interviews, participant observation, and physical artifacts shows that these assertions were made, and continue to be repeated, in a highly political context. Poland is a post-socialist state with strong neoliberal leanings, and it is highly invested in successful integration with the European Union. Powerful Catholic Church serves as an important backdrop. While people considered "at risk" now have more freedom to conduct their lives, they also have a set of neoliberal expectations and religious pressures placed on them. Country's geographic location adds to this complexity - situated between "Old Europe" where HIV problem has been successfully contained and the former Soviet Union, where the HIV incidence among drug users is the highest in the world, Poland attempts to align itself with the success of the West. Furthermore, examination of the available data suggests that the assertions made by Polish officials omit numerous variables. My research shows that even though Polish leadership in the area of HIV and drug policy wishes to resemble Western Europe, Poland does not meet international standards for the prevention of HIV transmission. The interviews I conducted, as well as the review of the literature on drug and HIV policies and programs suggest that these services are scattered, often unavailable, and that their number is stagnating, at best, and in some cases, even decreasing. This maybe a direct result of lack of engagement of drug users in their design. Excluded from the discussion of risk, drug users are thus not the focus of prevention efforts. Based on gathered data, there are seven crucial issues that require immediate action if Poland is to manage HIV prevention and care for people who use drugs in a manner consistent with the international standards. The areas requiring action are: a change in the drug policy from the current very punitive approach, expansion of needle and syringe programs and other harm reduction services, improved data collection and an increase in the availability of HIV testing, scaled-up substitution treatment, improved quality of other forms of drug treatment, greater investment in civil society organizations, improved access to HIV treatment, and educational and training efforts that encourage greater attention to HIV related matters across disciplines.</p>

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Environmental pollutants are becoming increasingly conspicuous in modern society. Lung function testing is one of the ways of assessing their impact on the health of the public. However lung function tests present large between individual variation, some of the determinants of which are race, sex, age and morphometric characteristics. These are generally taken into account using prediction formulae derived from the best fit equation to a set of values observed in a particular survey. / In the present study new formulae were developed which used current physiological knowledge of the determinants of lung function. These formulae together with some of the models in current use were fitted to a single training data set and the homogeneity of the fit across all ages was then compared. The models so developed, together with some of the formulae proposed in the literature were then used to predict the values of certain lung function tests in two independent populations to assess the bias of the predictions. / In the working age range (25 to 65) in males all formulae yielded comparable predictions; however in females and teenagers of both sexes the proposed model or the model proposed by Schoenberg predicted the data better. / The model proposed included a smoking module. However in the population studied ex smokers were found to present better lung function than non smokers, so that the model proposed to evaluate the effect of smoking is only applicable for current smokers. The effect of smoking was acceptably predicted for the tests derived from the forced expiratory maneuver. / One of the possible reasons why the proposed model did not fit the training data better than the empirical models may lie in the incomplete knowledge of the determinants of lung function. Further research is needed to identify such determinants and to find an objective and simple methodology for their evaluation.

Seventy-five workers exposed to styrene in four reinforced plastics plants in the Montreal area have taken part in this study. All subjects were tested for peripheral nervous system functioning during a period of continuous exposure; 12 were re-evaluated after a lay-off period without exposure. During the period of continuous exposure, a dose-response relationship between the environmental exposure and the sensory nerve conduction velocity (NCV) was demonstrated. Almost all workers exposed for at least one month to levels of styrene above 100 ppm had a nerve conduction deficit. The effects observed were not related to cumulated exposure. After a period of lay-off, slight changes in NCV were observed in accordance with a functional improvement. No excess in symptoms reported in relation to a NCV deficit was demonstrated. Biological measures of styrene absorption and excretion were used; they appeared to be better predictors of neurotoxic effects than environmental measures of styrene exposure.

Asthma is a heterogeneous disorder, and the prevalence is increasing worldwide. The BCG vaccine is hypothesized to lower the risk of asthma by modulating specific aspects of T-cell mediated immunity (termed Th1 and Th2). We conducted a case-control study to determine the relationship between BCG vaccine given to children born and raised in Quebec and asthma in adult subjects. 93 case subjects with a clinical diagnosis of asthma and 118 control subjects without asthma answered a standardized questionnaire, and BCG vaccination status was verified in a central registry. After adjusting for potential confounders, vaccination with BCG after the age of one was associated with a reduced odds of adult-onset asthma (odds ratio: 0.3 (0.1-0.98)), and specifically of adult-onset atopic asthma (odds ratio: 0.2 (0.1-0.9)). These results suggest a critical time frame in immune system maturation during which administration of BCG vaccine may lower the risk of adult-onset asthma.

A leading hypothesis for the etiology of multiple sclerosis (MS) is that a delayed infection by Epstein-Barr Virus (EBV) generates an abnormal immune response, thereby inducing the disease. EBV is ubiquitous. While asymptomatic in children, the infection produces the clinical entity infectious mononucleosis (IM) when it is delayed until adolescence or young adulthood. Typically, case-control studies have measured exposure to EBV by serology assaying EBV antibodies or by IM self-report. The findings of these studies are not consistent. / Part of the problem in establishing a definite causal relationship between EBV and MS in case-control studies is related to exposure measurement and misclassification. Since neither EBV serology or IM self-report represent a 'gold standard' for exposure, particularly of delayed exposure, it is difficult to estimate the exposure misclassification that would occur in a case-control study, and the subsequent bias in the odds ratio (OR). / These results support that EBV serology is not a good measure of delayed EBV infection due to its lack specificity, and that estimates of association between MS and EBV serology may overestimate or underestimate the OR between MS and IM. EBV is extremely prevalent, and likely to be differentially misclassified by serology. We therefore recommend the use of IM self-report for future case-control studies of MS and EBV.

Background. Little attention has been given to the assessment of quality of life (QOL) in injection drug users (IDUs). Some studies have suggested that existing measures are inadequate for use in IDUs. / Objectives. The objectives were: (1) to develop and evaluate a QOL measure for IDUs, the Injection Drug User Quality of Life Scale (IDUQOL), (2) to describe the QOL of cocaine and heroin IDUs and identify its constituents and correlates, and (3) to describe the relation between the QOL of cocaine and heroin IDUs and the use of public health programs. / Methods. The psychometric properties of the IDUQOL were assessed in 61 IDUs, 85% of whom were re-interviewed within 4-weeks. The Flanagan Quality of Life Scale was used to assess the criterion validity of the IDUQOL. The IDUQOL was subsequently applied in a study of 260 Montreal IDUs to identify their most important life areas. Associations between QOL and the use of public health programs and other correlates were assessed using multiple linear regression. / Results. The IDUQOL had good psychometric properties: the test-retest reliability was within accepted standards (intraclass correlation coefficient = 0.71) and the concurrent criterion validity between the IDUQOL and the Flanagan was moderate (Pearson coefficient = 0.57). In the study of 260 Montreal IDUs, housing was the most frequently selected life area of cocaine IDUs. Heroin IDUs most frequently selected money and feeling good about yourself. Both cocaine and heroin IDUs were generally dissatisfied with how these life areas fared. QOL was significantly better for HIV positive IDUs and IDUs who used meal programs, and was worse for IDUs who attended shelters and emergency departments. No strong relations were found with needle exchange program use, methadone or other drug treatment. / Conclusion. The IDUQOL appeared to be a conceptually clear and culturally relevant QOL instrument with good psychometric properties. Programs that address the life conditions of IDUs might be needed foremost to other initiatives. Understanding the constituents and correlates of the QOL of IDUs is important to the development of more effective programs to curb disease transmission, and improve the well-being of IDUs.

Research has found that 90% of those who complete suicide have a history of one or more psychiatric disorders. Mood disorders and substance use disorders (SUDs) are the key disorders related to suicide. This study not only replicates other data from previous research studies but examines other variables such as comorbid mood and SUDs associated with suicide, while also comparing different age ranges. We investigated three main domains. The first parallels work done by numerous groups comparing suicide completers to controls. The second, more novel approach, examined factors that differentiated those with MD/SUDs and those without it. The last approach, also unique to our study, focused on identifying factors associated with the two main age ranges (12-18 years old and 19-25 years old). Becoming aware of the increased risk of suicide completion within these domains can better prepare professionals when addressing treatment options. / Des recherches antérieures ont trouvé que 90% des individus décédés par suicide portent un historique d'un ou plusieurs antécédents psychiatriques. Les troubles de l'humeur ainsi que des troubles de consommation sont ceux qui sont principalement associés au suicide. La présente étude confirme les résultats mentionnés ci-haut et examine de nouvelles variables telles que la comorbidité entre les deux troubles et son association au suicide à travers divers groupes d'âge. Nous avons investigués trois domaines. Le premier présente le travail de plusieurs groupes de recherche ayant comparé le profil d'individus décédés par suicide à un groupe contrôle. Le second, abordé de façon plus novatrice, examine les facteurs qui permettent de différencier les individus souffrant d'un trouble de l'humeur ou d'un trouble de consommation à ceux qui n'en souffrent pas. Le troisième domaine exploré est aussi un qui est unique à notre étude. Par ce dernier, nous visons l'identification de facteurs associés à deux groupes d'âge spécifique, soit les 12 à 18 ans et les 19 à 25 ans. La connaissance de ces facteurs de risque permettrait aux professionnels d'être mieux équipés lorsque vient le temps d'offrir des traitements.

Objective. The aim of the study was to assess the effectiveness of antenatal mebendazole plus iron supplementation versus placebo plus iron supplementation on birthweight in a highly hookworm-endemic area. / Methods. This study was a double-blind randomized controlled trial set in rural and peri-urban communities in the Peruvian Amazon region. A total of 1042 second trimester pregnant women between the ages of 18 and 44 years were recruited from April to November 2003, and followed to July 2004. Women were randomly assigned to receive either mebendazole (500 mg single dose) plus iron supplements (60 mg elemental iron daily) or placebo plus iron supplements. The primary outcome was mean infant birthweight and secondary measures included proportion of low birthweight (&lt;2500g) and maternal anemia. Adverse birth outcomes were also recorded. / Results. The prevalence of hookworm infection was 47.5%. There were no differences between intervention groups in mean birthweight (3104 g vs 3090 g, p=0.629), proportion of low birthweight (8.1% vs 8.7%, p=0.755) or maternal anemia in the 3rd trimester (33.0% (158/479) vs 32.3% (152/471), p=0.815). However, the proportion of very low birthweight (&lt;1500g) was significantly lower in the mebendazole group (0% (0/479) vs 1.5% (7/471), p=0.007). No statistically significant difference (p=0.664) in adverse birth outcomes (miscarriages, malformations, stillbirths, early neonatal deaths and premature babies) was found between the mebendazole group and the placebo group (28 versus 31, respectively). / Conclusion. This trial provides additional evidence for the use of anthelminthics, over and above iron supplementation, within antenatal care programs in hookworm-endemic areas.