Recent studies have associated short-term exposure to respirable particulate matter (PM10) exposure with peak flow decrements, increased symptoms of respiratory irritation, increased use of asthma medications, and increased hospitalization for asthma. Increased mortality from chronic respiratory disease has also been reported. To help confirm whether PM10 exposure is a risk factor for the exacerbation of asthma, we compiled daily records of asthma emergency room visits from eight hospitals in the Seattle area. In Poisson regressions controlling for weather, season, time trends, age, hospital, and day of the week, the daily counts of emergency room visits for persons under age 65 were significantly associated with PM10 exposure on the previous day. The mean of the previous 4 days' PM10 was a better predictor (p < 0.005). The relative risk for a 30 micrograms/m3 increase in PM10 was 1.12 (95% confidence interval 1.20 to 1.04). Daily PM10 concentrations never exceeded 70% of the current ambient air quality standards during the period. The consistency of investigations of the health effects of PM10 suggest that increased attention should be given to the control of particulate matter air pollution.

Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes.OBJECTIVE To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. DESIGN, SETTING, AND PARTICIPANTSThis 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts.INTERVENTIONS Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI Ն 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. MAIN OUTCOMES AND MEASURESOne-year changes in age-and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. RESULTS At1year,weobtainedBMIzscoresfrom664children(92%)andfamily-centeredoutcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baselineand1.85(0.58)at1year,animprovementof−0.06BMIzscoreunits(95%CI,−0.10to−0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of −0.09 BMI z score units (95% CI, −0.13 to −0.05). However, there was no significant difference between the 2 intervention arms (difference, −0.02; 95% CI, −0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child's health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, −0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, −0.56 to 2.33). CONCLUSIONS AND RELEVANCETwo interventions that included a package of high-quality clinical care for obesity and linkages to communit...

Background The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from ‘positive outlier” families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. Design Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. Participants 2-12 year old children with overweight or obesity (BMI≥ 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. Intervention Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. Main Outcome Measures Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. Conclusions The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children.

No abstract

No abstract

No abstract

A facility has been assembled that provides a controlled inhalation exposure to freshly diluted and mixed diesel exhaust using a diesel engine under load and a two-stage exhaust dilution system with dynamic feedback control. The concentrations of particulate matter less than 2.5 µm in diameter (PM 2.5 ), particulate carbon, and gaseous pollutants including carbon monoxide and oxides of nitrogen (NO x ) have been characterized and the exposure conditions have been found to be both stable and reproducible. Control of the PM 2.5 concentration at intended levels relies on the relatively linear relationship between particle light scattering and exhaust particle mass concentration. While the exposure system does not entirely replicate diesel exhaust conditions in the atmosphere due to the relatively low ratio of nitrogen dioxide to total NO x , the fine particulate matter size distributions are quite similar to those of aged diesel exhaust. The facility enables study of the relationship between diesel exhaust and cardiovascular and respiratory health effects in human and animal models.We briefly describe a facility that provides a controlled inhalation exposure to freshly diluted and mixed diesel exhaust (DE) in order to study the relationship between DE and cardiovascular and respiratory health effects in human and animal models. Unique aspects of this facility, especially for human exposure, are engine operation under load and two-stage dilution system with dynamic control of the exposure concentration. In contrast, other research groups have produced controlled exposures for human inhalation studies using diesel exhaust from

This study suggests that CAM services may be a beneficial addition to hospitals, as demonstrated by inpatients' interest and stated willingness to pay for these services. These findings may help organizational leaders when making choices regarding the development of CAM services within hospitals, particularly since a significant percentage of inpatients reported that CAM services would increase their overall satisfaction with the hospitalization. These results merit further attention given the need to increase cost savings while enhancing the overall patient experience in today's medical marketplace.