Saguaro National Park – New Years 2015

With all boys in tow, we hiked the Douglas Springs trail this morning to Bridal Wreath Falls, about 2.6 miles into the Rincon Mountains and Saguaro National Park. Inches of snow covered everything on the way out but was mostly gone on the return. Happy New Year from Tucson! 

Applied quantile regression in environmental health

This week, Sheryl Magzamen and colleagues published a report of early life lead exposure and educational outcomes (exam scores) in Wisconsin school children that illustrates how quantile regression can reveal relationships masked by conditional means approaches. The greater effect of lead exposure on children in the
lower tail of exam scores is an example of how “In many cases there may not be one, unique slope that effectively characterizes the changes across the probability distribution.”

Health 2.0 SXSW panel on sensors

Health 2.0 recently submitted a panel proposal for SXSW (South By Southwest) 2013 titled, “Sensor Technologies: The Future of Health?

The proposed panel includes me and an outstanding group of speakers including Indu Subaiya of Health 2.0, Eric Dishman of Intel, and DJ Patil of Greylock, promising a spirited discussion about how sensor technologies are transforming health as we know it (full description below).

You can help our proposal make it on to the agenda by voting for our proposal directly and by spreading the word. Please feel free to tweet/post via Twitter, Facebook, LinkedIn, your blog, or any other channel you think might be helpful. To vote yourself, please take the following brief steps, which together should take 30 seconds:

Register to vote at SXSW –
Click the “confirm” link in the email sent by the site
Visit and vote (click on the thumbs up) at:

Please note that voting closes next Friday, August 31st.

Thanks for your help and we hope to see you in Austin, TX in 2013.

“Sensor Technologies: The Future of Health?”

Can you imagine a world in which all your physiologic parameters were measured, monitored, and managed in such a way that that you always maintained perfect health? That world may be just around the corner.

Doctors and nurses have long used sensors (of one sort or another) to diagnose and manage illness. In a few short years, however, sensors have become increasingly important in health care as the devices have become more sophisticated and less costly. The advent of real-time data capture and analysis applications is making these new sensors increasingly useful in a range of diseases like diabetes, asthma, and heart failure.

This panel will explore the impact of sensors and the almost unlimited potential to apply these technologies to improve the health of all mankind. If you’re a technologist and you want to get into the health care field this is where you want to be.

The interactive event will feature a number of expert speakers, including:

Indu Subaiya, Health 2.0
Eric Dishman, Intel
David Van Sickle, Reciprocal Labs
DJ Patil, Greylock

New Public Health – Interview with Ted Smith

The New Public Health site of the Robert Wood Johnson Foundation features the Asthmapolis project in Louisville this month. The post, built on an interview with Ted Smith, Louisville’s Director of Innovation and Economic Development, makes a clear connection between health issues – in this case environmental exposures to poor air quality – and regional competitiveness.

When employers come into town, they want to know how healthy the workforce is. Most of them are self-insured. They don’t want to pick up a whole population of health hazards, and so this has become an economic competitiveness issue, and you’ll see over the next five or six years that the issue will become a selection criteria that businesses use as they move into communities.

Farm exposure and childhood atopy, wheeze, lung function, and exhaled nitric oxide

Some interesting new results from the GABRIEL study examining children living on farms and the development of wheeze and other objective markers of asthma and allergies today.

The project, which involved nearly 9,000 children, reported in the Journal of Allergy and Clinical Immunology that children living on farms are protected against wheeze independently of atopy.

Nor is the so-called farm effect attributable to improved airway size or lung mechanics; the team found no farm-related effect on lung function or exhaled nitric oxide.

I’ll admit that these kind of findings – which “imply as yet unknown protective mechanisms” – are exactly what makes asthma so continually intriguing to me. We’re gradually, unevenly, unravelling a very complicated relationship between patterns of squarely cultural human behavior and ecology, the human immune response over time, and the development of chronic respiratory disease. And maybe viruses are involved too. 

The article is here.


Asthma Prevalence, Health Care Use, and Mortality in the United States, 2001–2010

Two major asthma epidemiology reports today from CDC.

The National Center for Health Statistics released the latest data brief analyzing trends in asthma prevalence, health care utilization and mortality in the US from 2001-2010.

Most of the news is not good:

  • Prevalence rates of asthma have reached 8.4 percent, the highest ever recorded in the US.
  • Rates of emergency department visits and hospitalizations remained stable.

but mortality – which was highest among those 65 and older – did decline over the period.

The CDC’s Air Pollution and Respiratory Health Branch has also posted a new graphical overview of “Asthma’s Impact on the Nation”

“The information in this release is a stark reminder that asthma continues to be major public health concern with a large financial impact on families, the nation and our health care system,” Christopher Portier, director of CDC’s National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, said in an agency news release.

Portier also highlighted the lack of asthma action plans among the majority of children and adults with asthma, and encouraged those with asthma to work with their doctors to take control of this disease.

Questionnaire layout and wording influence prevalence and risk estimates of respiratory symptoms in a population cohort

One of the more interesting aspects of asthma epidemiology is the challenge of identifying who in a population has the disease. By and large, asthma remains a clinical diagnosis, made on the basis of a characteristic history of symptoms, occasionally supported by physiological measurement. Without a discrete clinical test, epidemiologists have to rely on proxy measures of asthma, such as self-reported history of symptoms or a physician-diagnosis, to determine the prevalence and risk of the disease. Which is where we run into problems.

A new article by Swedish researchers highlights the extent to which the results of epidemiological studies can be influenced by the choice of methodology. The researchers tested whether subtle differences – including questionnaire layout and wording – had a measurable impact on prevalence and risk estimates of asthma.

Their report, published in the Clinical Respiratory Journal, describes how questions with different set-up or differences in wording resulted in significantly different prevalence and risk estimates. In particular, the use of follow-up questions that excluded subjects answering no to the initial question, resulted in 2.9-6.7 percent-units lower prevalence.

These kinds of findings highlight some of the underestimated complexities of chronic disease epidemiology. But they also underscore how little attention developers of mobile and wireless health tools have put into understanding and incorporating previous research on the implications of different methodologies into their applications. Reports like these should motivate us to save ourselves a lot of unnecessary originality and admonish us to greater care and reflection in our work.