This week The Economist has an article about Asthmapolis in the science section.
According to the FCC, in the last ten years the number of payphones in the US has declined from more then 2 million to around 700,000. So far this disappearance has occurred almost without capturing any of my attention. Only recently, in traveling across the US, have I started to run across decommisioned pay phones where some or all of the payphone and its enclosure is left to degrade in place (as in this photo from the Midwest).
Rural asthma study launching in the Midwest
Novel technology automatically tracks where and when attacks occur
Beginning next week, Madison-based Reciprocal Sciences, with funding from the US Centers for Disease Control and Prevention, will launch a new study to learn more about the problem of rural asthma in the Midwest. The study follows a recent report by the CDC that rates of asthma in rural areas have been underestimated.
“Our analyses of national survey data suggest that asthma is as prevalent in rural areas as in urban areas,” says Teresa Morrison, medical epidemiologist in the Air Pollution and Respiratory Health Branch at CDC. “Our goal is to document patterns of asthma symptoms among rural residents in Midwestern states, and learn more about possible environmental exposures that potentially lead to asthma attacks.”
In the past, studies have relied on interviews and questionnaires to collect data on asthma. But now, volunteers who live in rural areas in the Midwest will be able to record their symptoms when and where they happen, using an innovative tool that Reciprocal Sciences unveiled last year. The device, called the Spiroscout, is a GPS-enabled inhaler that pinpoints the exact geographic location and time when the inhaler is used.
“For the first time, scientists will have definitive information about exactly where and when rural residents have symptoms,” says study director David Van Sickle, PhD, “and we can use that to identify important patterns in the disease.”
Participants in the six-month study will also be testing additional asthma management tools developed by Reciprocal Sciences, including a text messaging system designed to help people with asthma remember to take their daily medication.
Work-related respiratory diseases in the EU [Sigsgaard et al – ERJ]
New European Respiratory Society report surveys the epidemiology of the major occupational respiratory diseases in the EU, with a look at historic and contemporary risk factors, and an update on regulation. Highlights the emerging burden of occupational lung disease in “newer professions, such as public administration, education and occupational cleaning,” as well as the continued prevalence in traditional high-risk occupations, such as mining, farming, manufacturing and service work.
Social determinants of asthma [Cruz et al. – ERJ]
Editorial accompanying a report in ERJ by Sembajwe et al. on the relationship between gross national income, the prevalence of symptoms and doctor diagnosis of asthma. Cruz et al. review the interesting bimodal association between socioeconomic status and asthma and offer some thoughts on the puzzle, and the important distinction between risk of asthma ever and current symptoms: “Gross national product per capita is generally associated with both an increasing prevalence of wheezing ever and wheezing in the last 12 months. However, the prevalence of current symptoms is modifiable by current exposures (to allergens and environmental pollution,as well as other factors) and by effective treatment. Thus,even where prevalence is low, the burden of disease may be high, and poverty emerges as an important risk factor for current symptoms of asthma.”
What Genes Tell us about the Pathogenesis of Asthma and COPD [Weiss – AJRCCM]
“Recently a series of Genome Wide Association Study manuscripts (GWAS) in asthma and COPD have been published. These papers suggest that, in part, asthma and COPD have a common genetic origin, and that this common origin, is due to polymorphisms in genes that are involved with the development of the lung.”
Hygiene Hypothesis wanted: Dead or Alive [Linneberg letter and Douwes and Pearce reply – IJE]
This month IJE has published an interesting exchange between Allan Linneberg (http://bit.ly/9hunjr) and Douwes and Pearce (http://bit.ly/bd0Lz0), who suggest that “detailed exposure assessment strategies for both allergens and other potentially protective co-exposures are likely to shed new light on the roles of these exposures in the development of asthma and the validity of the hygiene and allergen tolerance hypotheses more generally.”
Follow up discussion to an editorial (PDF) published in 2008 by Jeroen Douwes and Neal Pearce, called, “The end of the hygiene hypothesis?” which concluded that “New aetiological theories of global asthma prevalence are, therefore, required that are more consistent with the epidemiological evidence and which take into account factors affecting the time trends for both allergic and non-allergic asthma.”
Last year (Nov 6, 2009), the House approved legislation to reduce the risks of terrorist attacks on chemical plants and water treatment facilities. The Chemical and Water Security Act of 2009, which passed without a single Republican vote, includes measures a NY Times editorial called “reasonable, vital and long overdue” that were long sought by environmental groups and organized labor. Public health, however, has been somewhat silent despite the fact that public health investigations and DHS reviews suggest that an accidental release or a deliberate attack on a chemical plant — or the rail lines used to transport the majority of these hazardous materials — near a population center would likely create a toxic cloud resulting in hundreds of thousands of casualties.
This bill – HR 2868 – is apparently a compromise that focused only on the plants posing the highest risk. According to the NY Times, it mandates that industry use safer chemicals or processes when DHS and the EPA determine that they are feaisble and cost effective. It does allow for states to pass stricter regulations.
While the House was considering the issue, the Clorox Company announced that it was choosing to convert all of its factories that use chlorine gas to safer chemical processes. The switch should reduce the threat to Americans who live near the rail lines used to transport the chlorine to plants — another point of high vulnerability to terrorist attack or accident.
OMB Watch posted a detailed review of the legislation.
Preparing for a Chlorine Gas Disaster
U.S. News & World Report, DC – Jan 8, 2009
Preparing for a Chlorine Gas Disaster
CBC.ca, Canada – Jan 8, 2009
Preparing for a Chlorine Gas Disaster
Washington Post, United States – Jan 7, 2009
Preparing for a Chlorine Gas Disaster
Forbes, NY – Jan 7, 2009
Study looks at major chlorine disaster
United Press International – Jan 6, 2009
Going Back to Graniteville: Studying the 2005 chlorine leak could help prepare the country for terrorism
Augusta Chronicle, GA – Jan 3, 2009
Study uses Graniteville accident as focal point
Aiken Standard (subscription), SC – Dec 31, 2008
Chlorine gas release data helps in planning
Augusta Chronicle, GA – Dec 29, 2008
Emergency Response: Chlorine Gas Mass-Exposure Study Recommends Hospitals Stockpile Ventilators.
BNA’s Occupational Safety & Health Reporter – Jan 1, 2009
Emergency Response: Chlorine Gas Mass-Exposure Study Recommends Hospitals Stockpile Ventilators
BNA’s Environmental Report – Jan 5, 2009
HULIQ NC – Dec 29, 2008
RedOrbit – Dec 29, 2008
PhysOrg.Com – Dec 29, 2008
Genetic Engineering News – Dec 29, 2008
Eureka! Science News, Canada – Dec 29, 2008
sciencecodex.com – Dec 29, 2008
Brightsurf.com – Dec 29, 2008
Project Disaster.Com – Dec 29, 2008
Emergency Medicine on the Web
News-Medical.net, Australia – Dec 30, 2008
Continuity Central (press release), UK – Jan 6, 2009
For Immediate Release
Wednesday, Dec. 24, 2008
New Study Examines Effects of Graniteville, S.C., Chlorine Gas Disaster:
Indicates How Chlorine Gas Release Could Affect Major Metropolitan Areas
Department of Homeland Security Identifies Chlorine Attack as Top-15 Scenario
A new study examining the aftereffects of a chlorine gas disaster in a South Carolina town gives larger metropolitan areas important insight into what to expect and how to prepare emergency response systems for an accidental or terrorist release of the potentially deadly gas. The study is now available in the January 2009 issue of the American Journal of Emergency Medicine.
“This is one of the largest community exposures to chlorine gas since World War I,” said David Van Sickle, Ph.D., a Robert Wood Johnson Foundation® (RWJF) Health & Society Scholar at the University of Wisconsin and lead author of the report. “It was a tragic disaster that shows us what a significant challenge a large-scale chlorine gas release poses to health care facilities.”
Van Sickle added that hospitals need to be able to quickly recognize the signs of chlorine exposure, and have a plan to provide a sufficient number of mechanical ventilators in the event of another massive chlorine disaster.
Van Sickle was part of a team from the Centers for Disease Control and Prevention (CDC) and the South Carolina Department of Health and Environmental Control (DHEC) that investigated the resulting health effects.
In January 2005, a freight train carrying three tanker cars—each loaded with 90 tons of chlorine—collided with a parked locomotive in the center of Graniteville, S.C., a 7,000-person town located 15 miles from Augusta, Ga. The 2 a.m. train collision ruptured one tank, releasing between 42 and 60 tons of chlorine gas that infiltrated a large textile mill, where 180 people were working the overnight shift.
On the night of the South Carolina disaster, eight people died at the scene. At least 525 people were treated in emergency rooms and 71 were hospitalized, at nine hospitals in South Carolina and Georgia.
Chlorine gas is an irritating, fast-acting and potentially deadly inhalant. It is also one of the most universal toxic chemicals, widely used in water treatment and industrial manufacturing. Much of the 13 million to 14 million tons produced in the United States each year is transported by rail, often through densely populated areas.
New federal regulations on the transport of rail cargo seek to prevent a similar disaster in a major metropolitan area. In addition, the U.S. Department of Homeland Security has identified a deliberate attack on a chlorine storage tank as a top concern. According to agency estimates, as many as 100,000 people would be hospitalized and 10,000 would die if a chlorine storage tank was attacked in an urban area. In 2007, terrorists used chlorine gas in at least seven attacks on U.S. troops.
While small accidental and occupational exposures to chlorine gas occur regularly, the South Carolina disaster was one of the largest community exposures in modern history. As a result, CDC and South Carolina DHEC scientists sought to learn as much as possible about the health effects from this widespread chlorine gas exposure.
“We also wanted to understand how physicians treated the patients, how quickly they recovered, and what resources hospitals would need to respond effectively in the future,” Van Sickle said.
According to the report, many hospitalized patients showed evidence of severe lung damage. More than a third were admitted to intensive care, and 10 percent required mechanical ventilation. But despite the severity of their injuries, the majority recovered quickly and was discharged within a week.
“Public health agencies and hospitals across the country can learn a lot from this disaster and be better prepared to help in the next emergency” said James J. Gibson, M.D., M.P.H., state epidemiologist and director of the Bureau of Disease Control at the South Carolina DHEC and a co-author of the report. “We continue to monitor area residents for any possible long-term health effects.”
The DHEC has established a registry of persons potentially exposed to chlorine gas and/or traumatic stress during the chlorine gas release and has offered free standardized medical screenings with referral for follow-up evaluation when necessary.
For this report, the investigators reviewed medical records of all individuals who were hospitalized or who died as a result of the chlorine gas release, analyzing information about the victims’ demographic characteristics, laboratory, pulmonary and radiographic studies, as well as medical treatment and diagnoses.
Supported in part by the RWJF Health & Society Scholars Program, the Centers for Disease Control and Prevention (CDC) and the South Carolina Department of Health and Environmental Control, the study, Acute Health Effects After Exposure to Chlorine Gas Released After a Train Derailment, is available at www.sciencedirect.com/science/journal/07356757.
The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership, and policy change to address the broad range of factors that affect health. Additional information about the RWJF Health & Society Scholars Program, including application information, can be found at .
In January 2005, a train derailment in South Carolina released 42-60 tons of chlorine gas in the middle of a small town. I was part of the CDC team that went to South Carolina to help the Dept of Health and Environmental Control respond to the disaster and investigate the health effects.
One of our papers, which looks in detail at the clinical presentation, hospital course, and pathology among those individuals who died or were hospitalized as a result of their exposure, was just published in the January 2009 issue of the American Journal of Emergency Medicine [abstract] (free download at their site).
I’ve written more about the derailment and our investigation here.