This study examines the factors that are likely to influence emergency managers’ willingness and ability to report to work after a catastrophic event using the Cascadia Subduction Zone earthquake threat as an example. The population approached for participation in this study was state-level emergency managers in Oregon and Washington, the areas anticipated to be the most impacted by the Cascadia Subduction Zone earthquake. Concept mapping was utilized to elucidate factors influencing emergency managers’ ability and willingness to report to work following a catastrophic earthquake, as well as to identify specific strategies for addressing these factors to facilitate reporting to work. The six-step concept mapping process (i.e., preparation, generation, structuring, representation, interpretation, and utilization) is a structured and integrated mixed-method process that employs both qualitative and quantitative components to gather ideas and concepts of participants, and subsequently produces visual representation of these ideas and concepts through multivariate statistical methods (Caracelli and Green in Eval Program Plan 12(1):45–52, 1993; Kane and Trochim in Concept mapping for planning and evaluation, Sage Publications, Thousand Oaks, 2007). Results influence across a wide range of the levels of the ecological framework for both ability (transit barriers and infrastructure impacts, family/pet health and safety, social support and preparedness, work-related influences, personal health and resources, professional obligations, and location) and willingness (family/community preparedness and safety, emergency management responsibility and professionalism, motivation to come to work, transit barriers and infrastructure impacts, professional contribution, physical and mental health, worksite operations: structure and process, family first, personal contribution and history).

In late 2010, a subsurface smoldering event was detected in the Bridgeton Sanitary Landfill in St. Louis County, Missouri. This was followed by complaints from nearby residents of foul odors emanating from the landfill. In 2016 a health survey was conducted of residents near the landfill and, as a comparison, other regions of St. Louis County. The survey was a two-stage cluster sample, where the first stage was census blocks, and the second stage was households within the census blocks. The health survey, which was conducted by face-to-face interviews of residents both near the landfill and away from the landfill, focused mainly on respiratory symptoms and diseases such as asthma and chronic obstructive pulmonary disease. The differences in the prevalence of asthma (26.7%, 95% CI 19.8-34.1 landfill vs 24.7%, 95% CI 15.7-33.6 comparison) and COPD (13.7%, 95% CI 7.2-20.3 landfill vs 12.5%, 95% CI 6.4-18.7 comparison) between the two groups were not statistically significant. Landfill households reported significantly more "other respiratory conditions," (17.6%, 95% CI 11.1-24.1 landfill vs 9.5%, 95% CI 4.8-14.3 comparison) and attacks of shortness of breath (33.9%, 95% CI 25.1-42.8 landfill vs 17.9%, 95% CI 12.3-23.5). Frequency of odor perceptions and level of worry about neighborhood environmental issues was higher among landfill households (p < 0.001). We conclude that the results do not support the hypothesis that people living near the Bridgeton Landfill have elevated respiratory or related illness compared to those people who live beyond the vicinity of the landfill.

ObjectiveA mixed methods study is being conducted on the statewide EarlyNotification of Community Based Epidemics (ESSENCE) systemin Missouri to identify factors that can improve the timeliness andidentification of outbreaks. This research will provide stakeholderswith guidance on how best to implement and improve ESSENCEusage statewide, and by sharing this research input can be solicitedon the utility of the applied framework as well as future implicationsfrom this body of work.IntroductionIn spite of the noted benefits of syndromic surveillance, andmore than a decade after it started gaining support, the primary usefor syndromic surveillance appears to be largely for seasonal andjurisdictional disease monitoring, event response and situationalawareness as opposed to its intended purpose of early event detection.(1-4) Research assessing the user characteristics and standards appliedat local public health agencies (LPHA’s) for syndromic surveillanceare scarce, and in national surveys epidemiologists frequently tendto utilize their own syndromic surveillance systems as opposed toa national system such as Biosense. While the National SyndromicSurveillance Program (NSSP) has addressed many operationalconcerns from stakeholders, and is in the process of providing accessto the cloud based Biosense platform-along with ESSENCE as a keytool, there is still a paucity of research that exists as to what can bedone to improve the utilization of syndromic surveillance systems forits primary purpose of early event detection.MethodsThis research proposes to evaluate the use of ESSENCE withinMissouri and the surrounding areas, to comprehensively identifyits strengths and limitations, through an assessment of the userexperience. This research will evaluate three key areas: 1) thequality of the data received by the syndromic surveillance system,2) the characteristics of the individuals and organizations utilizingthe system (end-users), 3) the influence and extent of syndromicsurveillance data on public health actions. ESSENCE data will beevaluated directly with special attention to the top three data qualityattributes across the literature, completeness, accuracy and timeliness.(5) A survey will also be administered to ESSENCE system users andpublic health leadership at LPHA’s, to gain insight into perspectives,perceptions and general practices, as well as how they interact withdata from ESSENCE.ResultsThe data for this research is primarily being collected throughoutthe fall of 2016, so the hope is to bring preliminary data to thisconference as a means to validate some of the findings, solicit inputon the proposed framework and share this research in a timely mannerfor the NSSP roll out of Biosense and ESSENCE.ConclusionsThrough a thorough evaluation, the application and utility ofESSENCE for early event detection will be better understood, alongwith the identification of factors that can be targeted in the future(and across syndromic surveillance platforms) for improvement in thetimely identification of outbreaks.

The Psychophysiological Detection of Deception, or 'polygraph' test as it is commonly known, is often used in screening of applicants for employment in security or information-sensitive positions, in law enforcement, and in the courtroom. In the courtroom, the primary use of the polygraph is by the criminal defence team to bolster belief in the innocence of the defendant. In publications and in testimony, professional polygraphers present polygraph 'accuracy' as some combination of sensitivity and specificity. They rarely describe the positive and negative predictive value of the test (PPV and NPV, respectively) or place confidence limits on estimates for these measures. Thus, courts and juries are confronted with the difficult problem of assessing the evidentiary value of the polygraph as compared to other evidence. Despite more than 80 years of field use, there is very limited data that may be applied to assess the diagnostic utility of the polygraph for purposes of establishing the innocence of a defendant. In this article, we present a fully Bayesian analysis of what is probably the largest and most realistic existing data set and we obtain the posterior distribution for the PPV(the probability of guilt conditioned on 'failing' the polygraph) and the NPV (the probability of innocence conditioned on 'passing' the polygraph). We show that these quantities have a high degree of uncertainty that is often unexpressed when just point estimates are given. This information may be of value to courts and juries weighing the contribution of polygraph evidence.

The authors regret the misspelling of co-author ‘Kahee A. Mohammed’. The authors would like to apologise for any inconvenience caused.

Objective: To examine the racial disparity in the association between obesity and asthma in US children and adolescents. Methods: This study was based on a nationally representative, random-digit-dial sample of US households with children less than 18 years of age from the National Survey of Children's Health in 2011/2012 and 2007. The study sample included 88,668 children ages 10-17 with data on body mass index (BMI), parental reporting of asthma diagnosis, and potential confounders. Multiple logistic regression analysis was performed to estimate the crude and adjusted odds ratios stratified by child race/ethnicity. Results: The prevalence of overweight was 15.2% and obesity was 14.1%. Self-reported asthma diagnosis was 16.7% in our study sample. Obese children were 51% more likely to have asthma compared to normal weight children after controlling for child's sex, child age, socioeconomic status, environmental tobacco smoke (ETS), and neighborhood conditions. Our study also shows that the strength of this association varied by race/ethnicity after stratification. Being male, being non-Hispanic Black or Multi-racial, below the Federal Poverty Level, ETS and having detracting neighborhood elements were also significantly associated with higher odds of having a self-reported asthma diagnosis. Conclusion: We observed a racial difference in the association between BMI and asthma in US children. Our findings have significant public health implications and may help public health practitioners to target children and adolescents at higher risk of prevention and intervention efforts.

School participation in collecting and reporting syndromic surveillance (SS) data to public health officials and school nurses’ attitudes regarding SS have not been assessed.

ObjectiveThe goal of this study was to compare the incidence of Pineal Gland Calcification (PGC) by age group and gender among the populations living in the Kurdistan Region-Iraq.MethodsThis prospective study examined skull X-rays of 480 patients between the ages of 3 and 89 years who sought care at a large teaching public hospital in Duhok, Iraq from June 2014 to November 2014. Descriptive statistics and a binary logistic regression were used for analysis.ResultsThe overall incidence rate of PGC among the study population was 26.9% with the 51-60 age group and males having the highest incidence. PGC incidence increased after the first decade and remained steady until the age of 60. Thereafter the incidence began to decrease. Logistic regression analysis revealed that both age and gender significantly affected the risk of PGC. After adjusting for age, males were 1.94 (95% CI, 1.26-2.99) times more likely to have PGC compared to females. In addition, a one year increase in age increases the odds of developing PGC by 1.02 (95% CI, 1.01-1.03) units after controlling for the effects of gender.ConclusionOur analysis demonstrated a close relationship between PGC and age and gender, supporting a link between the development of PGC and these factors. This study provides a basis for future researchers to further investigate the nature and mechanisms underlying pineal gland calcification.

Epidemiological studies have reported inconsistent and inconclusive associations between long-term exposure to ambient air pollution and lung function in children from Europe and America, where air pollution levels were typically low. The aim of the present study is to examine the relationship between air pollutants and lung function in children selected from heavily industrialized and polluted cities in northeastern China. During 2012, 6740 boys and girls aged 7-14 years were recruited in 24 districts of seven northeastern cities. Portable electronic spirometers were used to measure lung function. Four-year average concentrations of particulate matter with an aerodynamic diameter <= 10 mu m (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O-3) were measured at monitoring stations in the 24 districts. Two-staged regression models were used in the data analysis, controlling for covariates. Overall, for all subjects, the increased odds of lung function impairment associated with exposure to air pollutants, ranged from 5% (adjusted odds ratio [aOR] = 1.05; 95% confidence interval [CI] = 1.01, 1.10) for FVC < 85% predicted per 46.3 mu g/m(3) for O-3 to 81% (aOR = 1.81; 95%0 = 1.44, 2.28) for FEV1 < 85% predicted per 30.6 mu g/m(3) for PM10. The linear regression models consistently showed a negative relationship between all air pollutants and lung function measures across subjects. There were significant interaction terms indicating gender differences for lung function impairment and pulmonary function from exposure to some pollutants (P < 0.10). In conclusion, long term exposure to high concentrations of ambient air pollution is associated with decreased pulmonary function and lung function impairment, and females appear to be more susceptible than males. (C) 2016 Elsevier Ltd. All rights reserved.

Seasonal influenza has serious impacts on morbidity and mortality and has a significant economic toll through lost workforce time and strains on the health system. Health workers, particularly emergency medical services (EMS) workers have the potential to transmit influenza to those in their care, yet little is known of the factors that influence EMS workers’ decisions regarding seasonal influenza vaccination (SIV) uptake, a key factor in reducing potential for transmitting disease. This study utilizes a modified Theory of Planned Behavior (TPB) model as a guiding framework to explore the factors that influence SIV uptake in EMS workers. Concept mapping, which consists of six-stages (preparation, generation, structuring, representation, interpretation, and utilization) that use quantitative and qualitative approaches, was used to identify participants’ perspectives towards SIV. This study identified nine EMS-conceptualized factors that influence EMS workers’ vaccination intent and behavior. The EMS-conceptualized factors align with the modified TPB model and suggest the need to consider community-wide approaches that were not initially conceptualized in the model. Additionally, the expansion of non-pharmaceutical measures went above and beyond original conceptualization. Overall, this study demonstrates the need to develop customized interventions such as messages highlighting the importance of EMS workers receiving SIV as the optimum solution. EMS workers who do not intend to receive the SIV should be provided with accurate information on the SIV to dispel misconceptions. Finally, EMS workers should also receive interventions which promote voluntary vaccination, encouraging them to be proactive in the health decisions they make for themselves.

Little information is available concerning the association between sleep quality and blood pressure (BP) in Chinese individuals. This study evaluated the association between sleep quality, as determined by the Pittsburgh sleep quality index (PSQI), and hypertension in a rural Chinese population. Using a multistage cluster and random sampling method, a representative sample of 9404 adults aged 20–93 years in northeastern China was selected from 2012 to 2013. Sleep quality was assessed by PSQI, and trained observers measured BP. A sleep disorder (SD) was diagnosed for any participant with a score of 6 or greater. Overall, 1218 male participants (25.53%) and 1261 female participants (27.22%) were defined as having SDs. Compared with the normal subjects, participants with hypertension had higher global PSQI scores and subscores in all elements. The odds ratios (ORs) of hypertension, systolic hypertension and diastolic hypertension among participants with SDs were 2.38 (95% confidence interval (CI): 2.13–2.65), 2.52 (95% CI: 2.26–2.80) and 1.93 (95% CI: 1.74–2.14) in contrast to the reference group, respectively. The risk for hypertension in poor sleepers with subscores over 0 in all of the elements was significantly increased, with ORs ranging from 1.16 (95% CI: 1.04–2.30) to 3.88 (95% CI: 1.24–12.16). The global PSQI score and its components were associated with hypertension and high BP.

To the Editor: Tsuruta et al. [1] have called attention to the potential value of febuxostat in the management of hyperuricemia in patients with chronic kidney disease (CKD). Their important contribution augments existing literature regarding the safety and efficacy of febuxostat in this population [2] as we await results from prospective studies on the utility of the drug in slowing the progression of CKD in hyperuricemic individuals without gout [3]. In their retrospective study, Tsuruta et al. conclude that uric acid levels are lower and glomerular filtration rate are better preserved among patients taking febuxostat as compared to allopurinol (Tables 3 and 4 of [1]). However, their statistical analysis is based on a repeated Student’s t test but without adjustment for associated multiple comparisons via Bonferroni, Sidak-Holm, or related corrections [4]. Might the authors apprise interested readers of the relevant corrected statistical values? More compelling still would be an analysis with a randomeffects model or perhaps a survival analysis (perhaps utilizing percent of patients maintaining some level of glomerular filtration rate (GFR)), as these approaches would fully take into the time-series nature of their data.

Objectives. To investigate the association of indoor air pollution with the respiratory health of children, we evaluated the associations of children’s respiratory symptoms with asthma and recent home renovation. Methods. We conducted a cross-sectional survey in a school recruitment sample of 31 049 children aged 2 to 14 years in 25 districts of 7 cities of northeast China in 2008–2009. The children’s parents completed standardized questionnaires characterizing the children’s histories of respiratory symptoms and illness, recent home renovation information, and other associated risk factors. Results. The effects of home renovation in the past 2 years were significantly associated with cough, phlegm, current wheeze, doctor-diagnosed asthma, and current asthma. The associations we computed when combining the status of home renovation and family history of atopy were higher than were those predicted from the combination of the separate effects. However, the interactions between home renovation and family history of atopy on a multiplicative scale were not statistically significant (P> .05). Conclusions. Home renovation is associated with increases in the prevalence of respiratory symptoms and asthma in children. The effects of different renovation materials on child respiratory health should be studied further. (Am J Public Health. 2014;104:1920–1927. doi:10.2105/AJPH.2013.301438)

Previous studies examining pet ownership as a risk factor for respiratory conditions have yielded inconsistent results. Little is known about whether or not pet ownership modifies the relationship between air pollutants and respiratory symptoms and asthma in children. In order to evaluate the interaction between pet and air pollution on respiratory health in children, we recruited 30,149 children, aged 2-12 years, from 25 districts of seven cities in northeast China. Parents of the children completed questionnaires that characterized the children's histories of respiratory symptoms and illnesses and associated risk factors. Average ambient annual exposures to particulate matter with an aerodynamic diameter <= 10 mu m (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2). and ozone (O-3) were estimated from monitoring stations in each of the 25 study districts. The results showed that among children without pets at home, there were statistically significant associations between both recent exacerbations of asthma among physician-diagnosed asthmatics and respiratory symptoms and all pollutants examined. Odds ratios (ORs) ranged from 1.12 [95% confidence interval (Cl), 1.00-1.26] to 1.41 (95% Cl, 1.24-1.61) per 31 mu g m(-3) for PM10, whereas, among children with pets at home, there were no effects or small effects for either asthma or the symptoms. The interactions between dog ownership and PM10, SO2, NO2, and O-3 were statistically significant, such that children with a dog at home had lower reporting of both current asthma and current wheeze. In conclusion, this study suggests that pet ownership decreased the effects of air pollution on respiratory symptoms and asthma among Chinese children. (C) 2014 Published by Elsevier Ltd.

The objective of the program is to assess the feasibility of combining a dust transport model with MODIS derived phenology to study pollen transport for integration with a public health decision support system. The use of pollen information has specifically be identified as a critical need by the New Mexico State Health department for inclusion in the Environmental Public Health Tracking (EPHT) program. Material and methods: Pollen can be transported great distances. Local observations of plan phenology may be consistent with the timing and source of pollen collected by pollen sampling instruments. The Dust REgional Atmospheric Model (DREAM) is an integrated modeling system designed to accurately describe the dust cycle in the atmosphere. The dust modules of the entire system incorporate the state of the art parameterization of all the major phases of the atmospheric dust life such as production, diffusion, advection, and removal. These modules also include effects of the particles size distribution on aerosol dispersion. The model was modified to use pollen sources instead of dust. Pollen release was estimated based on satellite-derived phenology of key plan species and vegetation communities. The MODIS surface reflectance product (MOD09) provided information on the start of the plant growing season, growth stage, and pollen release. The resulting deterministic model is useful for predicting and simulating pollen emission and downwind concentration to study details of phenology and meteorology and their dependencies. The proposed linkage in this project provided critical information on the location timing and modeled transport of pollen directly to the EPHT> This information is useful to support the centers for disease control and prevention (CDC)'s National EPHT and the state of New Mexico environmental public health decision support for asthma and allergies alerts.

Background: Breastfeeding and air pollution are both important factors for respiratory symptoms and asthma in children. Few studies have examined possible interaction between them on respiratory outcomes. Methods: We studied 31,049 Chinese children, ages 2–14 years old, from 25 elementary schools and 50 kindergartens in the Seven Northeastern Cities during 2008–2009. Parents or guardians completed questionnaires about the children’s histories of respiratory conditions, risk factors, and feeding methods. Three-year average concentrations of particles with an aerodynamic diameter ⩽10 µm, sulfur dioxide, nitrogen dioxides, and ozone were calculated from monitoring stations in 25 study districts. We used two-level logistic regressions to examine the effects of exposure, controlling for covariates. Results: Association of air pollution with childhood respiratory conditions was modified by breastfeeding. Compared with children who had been breastfed, those who were not exhibited consistently stronger effects of air pollution. Among non-breastfed children, odds ratios (ORs) per 10 µg/m3 increase in nitrogen dioxide were 1.40 (95% confidence interval = 1.19–1.64) for cough, 1.41 (1.16–1.71) for phlegm, 1.17 (1.00–1.36) for current wheeze, and 1.25 (1.07–1.46) for doctor-diagnosed asthma. For breastfed children, the ORs were 1.25 (1.09–1.43) for cough, 1.15 (0.99–1.34) for phlegm, 0.97 (0.87–1.08) for current wheeze, and 1.17 (1.05–1.32) for doctor-diagnosed asthma. Breastfeeding was more protective among younger children. Breastfeeding was also associated with reduced effects of passive smoke exposure in children. Conclusion: Breastfeeding is associated with smaller associations between air pollution and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of pollutants.

OBJECTIVES To investigate the association of indoor air pollution with the respiratory health of children, we evaluated the associations of children's respiratory symptoms with asthma and recent home renovation. METHODS We conducted a cross-sectional survey in a school recruitment sample of 31,049 children aged 2 to 14 years in 25 districts of 7 cities of northeast China in 2008-2009. The children's parents completed standardized questionnaires characterizing the children's histories of respiratory symptoms and illness, recent home renovation information, and other associated risk factors. RESULTS The effects of home renovation in the past 2 years were significantly associated with cough, phlegm, current wheeze, doctor-diagnosed asthma, and current asthma. The associations we computed when combining the status of home renovation and family history of atopy were higher than were those predicted from the combination of the separate effects. However, the interactions between home renovation and family history of atopy on a multiplicative scale were not statistically significant (P>.05). CONCLUSIONS Home renovation is associated with increases in the prevalence of respiratory symptoms and asthma in children. The effects of different renovation materials on child respiratory health should be studied further.