Nalini Sathiakumar

Publications of Nalini Sathiakumar

• Indoor fine particle (PM(2.5) ) pollution exposure due to secondhand smoke in selected public places of Sri Lanka.

  Authors: Sumal Nandasena, Ananda R Wickremasinghe, Kiyoung Lee, Nalini Sathiakumar

  American journal of industrial medicine. 04/2012;

  BACKGROUND: Secondhand smoke accounts for a considerable proportion of deaths due to tobacco smoke. Although the existing laws ban indoor smoking in public places in Sri Lanka, the level ofBACKGROUND: Secondhand smoke accounts for a considerable proportion of deaths due to tobacco smoke. Although the existing laws ban indoor smoking in public places in Sri Lanka, the level of compliance is unknown. METHODS: Fine particulate matter (PM(2.5) ) levels in 20 public places in Colombo, Sri Lanka were measured by a PM monitor (Model AM510-SIDEPAK Personal Aerosol Monitor). Different types of businesses (restaurants, bars, cafés, and entertainment venues) were selected by purposive sampling. Only the places where smoking was permitted were considered. RESULTS: The average indoor PM(2.5) ranged from 33 to 299 µg/m(3) . The average outdoor PM(2.5) ranged from 18 to 83 µg/m(3) . The indoor to outdoor PM(2.5) ratio ranged from 1.05 to 14.93. In all venues, indoor PM(2.5) levels were higher than the Sri Lankan ambient PM(2.5) standard of 50 µg/m(3) . All indoor locations had higher PM(2.5) levels as compared to their immediate outdoor surroundings. CONCLUSION: The study highlights the importance of improving ventilation and enforcing laws to stop smoking in public places. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

• Tasman spirit oil spill in Pakistan: Research response and lessons learned.

  Authors: Naveed Z Janjua, Muhammad M Kadir, Shahid Lutfi, Meghan Tipre, Nalini Sathiakumar

  American journal of industrial medicine. 04/2012;

  BACKGROUND: This article presents lessons learned from an investigation of the acute human health effects of the "Tasman Spirit" oil spill from a perspective of conducting rapid responseBACKGROUND: This article presents lessons learned from an investigation of the acute human health effects of the "Tasman Spirit" oil spill from a perspective of conducting rapid response investigations in developing countries. METHODS: We reviewed various steps in our investigation, other studies on oil spills in Pakistan and around the world, and reflected upon our discussions and interactions with various stakeholders. RESULTS: The article highlights the importance of applying a public health, legal, and ethical framework for conducting rapid response investigations, developing a pre-established funding mechanism, and addressing study design issues, exposure and outcome measurements, political issues, community engagement, and communication of results. CONCLUSION: There is need to develop ethical and legal framework and funding mechanism for conducting rapid response research in developing countries. A repository of study protocols, validated tools, and laboratory methods for exposure and outcome assessment would be greatly beneficial. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

• MPH program at Manipal University, India-experiences, challenges, and lessons learned.

  Authors: Hattangadi Vinod Bhat, Ramachandra Kamath, Govindakarnavar Arunkumar, Elizabeth Delzell, Meghan Tipre, Divvy Kant Upadhyay, Nalini Sathiakumar

  American journal of industrial medicine. 03/2012;

  BACKGROUND: The UAB-ITREOH program has initiated a skill-based MPH program at Manipal University (MU), India, in 2009, to address the critical need for trained public health professionals and buildBACKGROUND: The UAB-ITREOH program has initiated a skill-based MPH program at Manipal University (MU), India, in 2009, to address the critical need for trained public health professionals and build institutional public health training capacity in the country. METHODS: Funds from Fogarty have supported the curriculum development and specialized training of MU faculty to teach in the MPH program. RESULTS: The program has been successfully launched and is gaining momentum. The lessons learned from our experiences as well as several challenges faced from the initialization to execution of the program are described in the article. CONCLUSIONS: Government support is crucial for raising the profile of this program by accreditation, creating job opportunities and by recognizing these professionals as leaders in the public health sector. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

• Prevalence of measles, mumps, rubella, and varicella susceptibility among health science students in a University in India.

  Authors: G Arunkumar, K E Vandana, Nalini Sathiakumar

  American journal of industrial medicine. 03/2012;

  BACKGROUND: Health science students (HSS) are at increased risk of contracting and transmitting viral diseases such as measles, mumps, rubella, and varicella (chickenpox). This study was undertakenBACKGROUND: Health science students (HSS) are at increased risk of contracting and transmitting viral diseases such as measles, mumps, rubella, and varicella (chickenpox). This study was undertaken to determine the prevalence of susceptibility of HSS to these infections. METHODS: Using a cross-sectional design, 790 HSS of Manipal University, Manipal, India, answered a questionnaire and provided a blood sample which was tested for specific IgG antibodies to measles, mumps, rubella and varicella by ELISA (Enzygnost®). RESULTS: The study group was comprised of medical (53.9%), nursing (16.6%), and allied health (29.5%) students. Among the overall group (n = 790), the prevalence of serological susceptibility to measles, mumps, rubella, and varicella were 9.5%, 32.0%, 16.6%, and 25.8%, respectively. Among the subgroup of vaccinated subjects, susceptibility to measles, mumps, rubella, and varicella were 7.9%, 34.7%, 10.7%, and 35.2%, respectively. CONCLUSION: HSS susceptible to measles, mumps, rubella, and/or varicella are at risk of acquiring these diseases during their training period. In addition, they may be a potential source for nosocomial transmission posing a risk to immunocompromised patients. Hence, in the Indian setting, HSS should be immunized against measles, mumps, rubella, and varicella at the time of joining the medical school. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

• Respiratory health status of children from two different air pollution exposure settings of Sri Lanka: A cross-sectional study.

  Authors: Sumal Nandasena, Ananda R Wickremasinghe, Nalini Sathiakumar

  American journal of industrial medicine. 02/2012;

  BACKGROUND: Health effects due to air pollution is becoming a major public health problem with growing traffic congestion and establishment of small- to medium-scale industries with poor emissionBACKGROUND: Health effects due to air pollution is becoming a major public health problem with growing traffic congestion and establishment of small- to medium-scale industries with poor emission controls in urban cities of Sri Lanka. METHODS: Respiratory health status of 7- to 10-year-old children in two settings (urban and semi-urban) was assessed using standard questionnaires. Information on socio-demographic characteristics and potential determinants of both outdoor and indoor air pollutants exposure levels were also obtained. The respiratory health status of children in the two settings was compared. RESULTS: We found that children from the urban setting had a significantly higher prevalence of wheezing within the last 12 months as compared to children from the semi-urban setting (adjusted OR = 2.02; 95% CI = 1.13-3.59). Indoor cooking with unclean fuels was a risk factor for wheezing independent of the area of residence (adjusted OR = 1.57; 95% CI = 1.01-2.46). CONCLUSIONS: Poor indoor air quality was a major determinant of wheezing for the overall study group. Children from urban areas of Sri Lanka have poorer respiratory health status as compared to children from semi-urban areas. Besides poor outdoor air quality, this difference may also be due to other unexplored factors which may differ between urban and semi-urban areas in Sri Lanka. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

• Capacity building in environmental and occupational health in Sri Lanka.

  Authors: Ananda R Wickremasinghe, Roshini Peiris-John, Sumal Nandasena, Elizabeth Delzell, Meghan Tipre, Nalini Sathiakumar

  American journal of industrial medicine. 12/2011;

  BACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the InternationalBACKGROUND: Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated. METHODS: We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka. RESULTS: The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country. CONCLUSIONS: The program has established North-South, South-South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

• Cadmium a metalloestrogen: are we convinced?

  Authors: Nalinda Silva, Roshini Peiris-John, Rajitha Wickremasinghe, Hemantha Senanayake, Nalini Sathiakumar

  Journal of applied toxicology : JAT. 12/2011;

  Metalloestrogens are inorganic metal ions that bind to and activate oestrogen receptors. They are implicated in the aetiology of oestrogen-dependent diseases such as cancers of the breast andMetalloestrogens are inorganic metal ions that bind to and activate oestrogen receptors. They are implicated in the aetiology of oestrogen-dependent diseases such as cancers of the breast and endometrium as well as endometriosis. Cadmium is one of the most studied metalloestrogens. In this review, scientific evidence for the oestrogenic effects of cadmium is critically evaluated to determine if there is sufficient evidence to support cadmium as an aetiological factor of oestrogen-dependent disease in humans. Results of the review indicated that, although the in vitro and in vivo evidence of the oestrogenic properties of cadmium was persuasive, evidence from population-based human studies remains conflicting. Considerable knowledge gaps exist on the potential oestrogenic effect of cadmium in humans. Research that focuses on bridging these knowledge gaps would be useful in preventing and managing oestrogen-dependent disease in humans. Copyright © 2011 John Wiley & Sons, Ltd.

• Biomass fuel use for cooking in Sri Lanka: Analysis of data from national demographic health surveys.

  Authors: Sumal Nandasena, Ananda R Wickremasinghe, Nalini Sathiakumar

  American journal of industrial medicine. 11/2011;

  BACKGROUND: Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. Sri Lanka is an island of about 20 million population with urban,BACKGROUND: Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. Sri Lanka is an island of about 20 million population with urban, rural, and estate population of 14.6%, 80.0%, and 5.4%, respectively. This study describes biomass fuel use for cooking in Sri Lanka. METHODS: We analyzed data from two national Demographic Health Surveys (2000 and 2007) to identify the use and determinants of cooking fuels in Sri Lankan households. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007. RESULTS: Wood was the principal cooking fuel used in 78.3% and 78.5% of households in 2000 and 2007, respectively. In 2007, 96.3% of estate sector households used firewood as compared to 84.2% in the rural and 34.6% in the urban sectors. Similar trends were noted in 2000 as well. CONCLUSIONS: The shift from firewood to cleaner fuels in Sri Lanka is negligible from 2000 to 2007. Improving the quality of life of the population does not necessarily predict a shift towards the use of cleaner cooking fuels in Sri Lanka. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

• Mortality following bone metastasis and skeletal-related events among women with breast cancer: a population-based analysis of U.S. Medicare beneficiaries, 1999-2006.

  Authors: Nalini Sathiakumar, Elizabeth Delzell, Michael A Morrisey, Carla Falkson, Mellissa Yong, Victoria Chia, Justin Blackburn, Tarun Arora, Ilene Brill, Meredith L Kilgore

  Breast cancer research and treatment. 08/2011; 131(1):231-8.

  The aim of the study is to quantify the impact of bone metastasis and skeletal-related events (SREs) on mortality in older breast cancer patients. Using the linked Surveillance, Epidemiology and EndThe aim of the study is to quantify the impact of bone metastasis and skeletal-related events (SREs) on mortality in older breast cancer patients. Using the linked Surveillance, Epidemiology and End Results-Medicare database, we identified women aged 65 years or older diagnosed with breast cancer between July 1, 1999 and December 31, 2005 and followed them to determine deaths occurring through December 31, 2006. We classified patients as having possible bone metastasis and SREs using discharge diagnoses from inpatient claims and diagnoses paired with procedure codes from outpatient claims. We used Cox regression to estimate mortality hazards ratios (HR) among women with bone metastasis with or without SRE, compared with women without bone metastasis. Among 98,260 women with breast cancer (median follow-up, 3.3 years), 7,189 (7.3%) had bone metastasis either at breast cancer diagnosis (1.5%) or during follow-up (5.8%). SREs occurred in 3,319 (46%) of women with bone metastasis. HRs for risk of death were 4.9 (95% CI 4.7-5.1) and 6.2 (95% CI 5.9-6.5), respectively, for women with bone metastasis but no SRE and for women with bone metastasis plus SRE, compared with women without bone metastasis. In analyses restricted to women with bone metastasis, the adjusted HR was 1.5 (95% CI 1.4-1.6) for women with bone metastasis plus SRE, compared with women with bone metastasis but without SRE. Having a bone metastasis, as indicated by Medicare claims, was associated strongly with mortality among women with breast cancer. This association was stronger for bone metastasis complicated by SRE than for bone metastasis without SRE.

• Indoor air pollution (PM2.5) due to secondhand smoke in selected hospitality and entertainment venues of Karachi, Pakistan.

  Authors: Asaad Ahmed Nafees, Tahir Taj, Muhammad Masood Kadir, Zafar Fatmi, Kiyoung Lee, Nalini Sathiakumar

  Tobacco control. 06/2011;

  Objective To determine particulate matter smaller than 2.5 μm (PM(2.5)) levels at various hospitality and entertainment venues of Karachi, Pakistan. Methods This was a descriptive cross-sectionalObjective To determine particulate matter smaller than 2.5 μm (PM(2.5)) levels at various hospitality and entertainment venues of Karachi, Pakistan. Methods This was a descriptive cross-sectional study conducted at various locations in Karachi, during July 2009. Sampling was performed at 20 enclosed public places, including hospitality (restaurants and cafés) and entertainment (snooker/billiard clubs and gaming zones) venues. PM(2.5) levels were measured using an aerosol monitor. Results All entertainment venues had higher indoor PM(2.5) levels as compared to the immediate outdoors. The indoor PM(2.5) levels ranged from 25 to 390 μg/m(3) and the outdoor PM(2.5) levels ranged from 18 to 96 μg/m(3). The overall mean indoor PM(2.5) level was 138.8 μg/m(3) (±112.8). Among the four types of venues, the highest mean indoor PM(2.5) level was reported from snooker/billiard clubs: 264.7 μg/m(3) (±85.4) and the lowest from restaurants: 66.4 μg/m(3) (±57.6) while the indoor/outdoor ratio ranged from 0.97 to 10.2, highest being at the snooker/billiard clubs. The smoking density ranged from 0.21 to 0.57, highest being at gaming zones. The indoor PM(2.5) concentration and smoking density were not significantly correlated (Spearman's correlation coefficient=0.113; p=0.636). Conclusions This study demonstrates unacceptably high levels of PM(2.5) exposure associated with secondhand smoke (SHS) at various entertainment venues of Karachi even after 8 years since the promulgation of smoke-free ordinance (2002) in Pakistan; however, better compliance may be evident at hospitality venues. The results of this study call for effective implementation and enforcement of smoke-free environment at public places in the country.

• A review of epidemiologic studies of triazine herbicides and cancer.

  Authors: Nalini Sathiakumar, Paul A MacLennan, Jack Mandel, Elizabeth Delzell

  Critical reviews in toxicology. 04/2011; 41 Suppl 1:1-34.

  This is an update of a previous review of epidemiological evidence pertaining to the human carcinogenic potential of triazine herbicides. In 36 studies evaluated, atrazine was the most commonThis is an update of a previous review of epidemiological evidence pertaining to the human carcinogenic potential of triazine herbicides. In 36 studies evaluated, atrazine was the most common triazine investigated. In general the studies were limited by lack of in-depth exposure measurements and by small numbers of subjects with potential high exposure and/or with many years of follow-up since first exposure. Non-Hodgkin lymphoma, prostate cancer, and breast cancer were most frequently investigated. Only one to three analytical or ecological studies investigated Hodgkin lymphoma, leukemia, multiple myeloma, soft tissue sarcoma, hairy-cell leukemia, melanoma, and cancers of the ovary, testes, colon, stomach, lung, brain, bladder, buccal cavity, and pharynx. Results of these studies were typically imprecise and did not form an adequate basis for determining if triazine exposure causes any form of cancer. Collectively, the available epidemiology studies do not provide consistent, scientifically convincing evidence of a causal relationship between exposure to atrazine or triazine herbicides and cancer in humans. Based upon the assessment studies, there is no scientific basis for inferring the existence of a causal relationship between triazine exposure and the occurrence of cancer in humans.

• Secondhand smoke exposures in indoor public places in seven Asian countries.

  Authors: Jiyeon Lee, Soogil Lim, Kiyoung Lee, Xinbiao Guo, Ramachandra Kamath, Hiroshi Yamato, Adinegara L Abas, Sumal Nandasena, Asaad A Nafees, Nalini Sathiakumar

  International journal of hygiene and environmental health. 09/2010; 213(5):348-51.

  Exposure to secondhand smoke (SHS) is a major threat to public health. Asian countries having the highest smoking prevalence are seriously affected by SHS. The objective of the study was to measureExposure to secondhand smoke (SHS) is a major threat to public health. Asian countries having the highest smoking prevalence are seriously affected by SHS. The objective of the study was to measure SHS levels in hospitality venues in seven Asian countries and to compare the SHS exposure to the levels in Western countries. The study was carried out in four types of related hospitality venues (restaurant, café, bar/club and entertainment) in China, India, Japan, Korea, Malaysia, Pakistan and Sri Lanka. Real-time measurement of particulate matter of <2.5microm aerodynamic diameter (PM(2.5)) was made during business hour using a handheld laser operated monitor. A total of 168 venues were measured in seven countries. The average indoor PM(2.5) level was 137microg/m(3), ranging from 46microg/m(3) in Malaysia to 207microg/m(3) in India. Bar/club had the highest PM(2.5) level of 191microg/m(3) and restaurants had the lowest PM(2.5) level of 92microg/m(3). The average indoor PM(2.5) level in smoking venues was 156micro/m(3), which was 3.6 times higher than non-smoking venues (43microg/m(3)). Indoor PM(2.5) levels were significantly associated with country, type of venue, smoking density and air exchange rate (p<0.05). In the seven Asian countries, PM(2.5) levels were high due to SHS in public places. The current levels are comparable to the levels in Western countries before the adoption of smoke-free policy. Since Asian country has high prevalence of SHS in public places, there is an urgent need for comprehensive smoke-free regulation in Asian countries.

• Situational analysis of household energy and biomass use and associated health burden of indoor air pollution and mitigation efforts in Pakistan.

  Authors: Zafar Fatmi, Asma Rahman, Ambreen Kazi, M Masood Kadir, Nalini Sathiakumar

  International journal of environmental research and public health. 07/2010; 7(7):2940-52.

  Biomass fuel burning leads to high levels of suspended particulate matter and hazardous chemicals in the indoor environment in countries where it is in common use, contributing significantly toBiomass fuel burning leads to high levels of suspended particulate matter and hazardous chemicals in the indoor environment in countries where it is in common use, contributing significantly to indoor air pollution (IAP). A situational analysis of household energy and biomass use and associated health effects of IAP was conducted by reviewing published and un-published literature about the situation in Pakistan. In addition to attempt to quantify the burden of ill health due to IAP, this paper also appraises the mitigation measures undertaken to avert the problem in Pakistan. Unfortunately, IAP is still not a recognized environmental hazard in Pakistan and there are no policies and standards to control it at the household level. Only a few original studies related to health effects of IAP have been conducted, mainly on women's health and birth outcome, and only a few governmental, non-governmental and academic institutions are working to improve the IAP situation by introducing improved stoves and renewable energy technology at a small scale. Control of IAP health hazards in Pakistan requires an initial meeting of the stakeholders to define a policy and an action agenda. Simultaneously, studies gathering evidence of impact of intervention through available technologies such as improved stoves would have favorable impact on the health, especially of women and children in Pakistan.

• Air pollution and health in Sri Lanka: a review of epidemiologic studies

  Authors: Yatagama Nandasena, Ananda Wickremasinghe, Nalini Sathiakumar

  BMC Public Health. 01/2010;

  Abstract Background Air pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientificAbstract Background Air pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientific literature on outdoor and indoor air pollution, and health effects are important to identify the burden, develop and implement interventions and to fill knowledge gaps in Sri Lanka. Methods PUBMED and Medline databases, local journals and conference proceedings were searched for epidemiologic studies pertaining to air pollution and health effects in Sri Lanka. All the studies pertaining to air pollution and health effects were considered. Results Sixteen studies investigated the association between exposure to ambient or indoor air pollution (IAP) and various health outcomes ranging from respiratory symptoms, low birth weight and lung cancers. Of the sixteen, three used a case control design. Half of the studies collected exposure data only through questionnaires. There were positive associations between air pollution and adverse health effects in all studies. Methodological limitations in most of the studies resulted in poor quantification of risk estimates. Conclusion A limited number of epidemiological studies in Sri Lanka have investigated the health effects of air pollution. Based on findings of studies and reported air quality levels, air pollution may be considered a neglected public health problem in Sri Lanka.

• Air pollution and health in Sri Lanka: a review of epidemiologic studies.

  Authors: Yatagama Lokuge S Nandasena, Ananda R Wickremasinghe, Nalini Sathiakumar

  BMC public health. 01/2010; 10:300.

  Air pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientific literature on outdoorAir pollution is increasingly documented as a threat to public health in most developing countries. Evaluation of current air quality levels, regulatory standards and scientific literature on outdoor and indoor air pollution, and health effects are important to identify the burden, develop and implement interventions and to fill knowledge gaps in Sri Lanka. PUBMED and Medline databases, local journals and conference proceedings were searched for epidemiologic studies pertaining to air pollution and health effects in Sri Lanka. All the studies pertaining to air pollution and health effects were considered. Sixteen studies investigated the association between exposure to ambient or indoor air pollution (IAP) and various health outcomes ranging from respiratory symptoms, low birth weight and lung cancers. Of the sixteen, three used a case control design. Half of the studies collected exposure data only through questionnaires. There were positive associations between air pollution and adverse health effects in all studies. Methodological limitations in most of the studies resulted in poor quantification of risk estimates. A limited number of epidemiological studies in Sri Lanka have investigated the health effects of air pollution. Based on findings of studies and reported air quality levels, air pollution may be considered a neglected public health problem in Sri Lanka.

• 1,3-butadiene, styrene and lung cancer among synthetic rubber industry workers.

  Authors: Nalini Sathiakumar, Ilene Brill, Elizabeth Delzell

  Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 11/2009; 51(11):1326-32.

  OBJECTIVE: To evaluate the association between cumulative exposure to 1,3-butadiene (BD) or styrene (STY) and lung cancer among synthetic rubber industry workers. METHODS: Internal Cox regressionOBJECTIVE: To evaluate the association between cumulative exposure to 1,3-butadiene (BD) or styrene (STY) and lung cancer among synthetic rubber industry workers. METHODS: Internal Cox regression analyses were performed both with and without natural logarithm transformation of exposure variables and both with and without the inclusion of those unexposed to monomers. RESULTS: Among women, analyses using untransformed BD exposure showed no trend. Analyses using natural logarithm-transformed BD exposure indicated a positive trend when the unexposed were included (P < 0.05) and an inverse trend when the unexposed were excluded (P < 0.05). No exposure-response trends were seen for BD among men or for STY among women or men. CONCLUSIONS: These results suggest that the association between BD and lung cancer, seen in some analyses of female employees, is not causal. STY did not appear to be associated with lung cancer.

• A follow-up study of mortality among women in the North American synthetic rubber industry.

  Authors: Nalini Sathiakumar, Elizabeth Delzell

  Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine. 11/2009; 51(11):1314-25.

  OBJECTIVE: To evaluate mortality from cancer and other diseases among 4863 women employed at eight North American styrene-butadiene rubber plants. Cancers of the lymphohematopoietic tissues, breast,OBJECTIVE: To evaluate mortality from cancer and other diseases among 4863 women employed at eight North American styrene-butadiene rubber plants. Cancers of the lymphohematopoietic tissues, breast, and ovary were of strongest a priori interest. METHODS: Cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were estimated. RESULTS: The observed number of deaths was approximately equal to that expected for leukemia (10 observed/13 expected), Hodgkin lymphoma (1/1.6), multiple myeloma (7/7.9), non-Hodgkin lymphoma (15/14), and cancers of the breast (72/74) and ovary (21/22). Ever-hourly women had more than expected deaths from lung (47/30, SMR = 159, CI = 117 to 211) and bladder (6/1.8, SMR = 332, CI = 122 to 723) cancers. Exposure-response analysis, done only for lung cancer, indicated no trend for butadiene or styrene. CONCLUSIONS: The observed excesses of lung and bladder cancers may be attributable to nonoccupational factors rather than to workplace exposures.

• Epidemiology of stroke in chronic heart failure patients with normal sinus rhythm: Findings from the DIG stroke sub-study.

  Authors: Marjan Mujib, Grigorios Giamouzis, Syed Abbas Agha, Inmaculada Aban, Nalini Sathiakumar, O James Ekundayo, Edward Zamrini, Richard M Allman, Javed Butler, Ali Ahmed

  International journal of cardiology. 05/2009;

  BACKGROUND: Little is known about the epidemiology of stroke in chronic systolic and diastolic heart failure (HF) patients in normal sinus rhythm (NSR) receiving angiotensin-converting enzyme (ACE)BACKGROUND: Little is known about the epidemiology of stroke in chronic systolic and diastolic heart failure (HF) patients in normal sinus rhythm (NSR) receiving angiotensin-converting enzyme (ACE) inhibitors. Because all HF patients in the Digitalis Investigation Group (DIG) trial (N=7788) were in NSR and nearly all were receiving ACE inhibitors, a survey-based stroke-sub-study was conducted but its findings have never been published. METHODS: DIG investigators confirmed a total 222 cases of stroke of which 144 had neurological deficit >/=24 h. We used logistic regression models to determine predictors of incident stroke among all 7788 patients and predictors of neurological deficit >/=24 h and all-cause mortality among 222 stroke patients. RESULTS: Age >/=65 years (adjusted odds ratio {AOR}, 1.36; 95% confidence interval {CI}, 1.02-1.80; P=0.035), nonwhite race (AOR, 0.65; 95% CI, 0.42-0.99; P=0.047), hypertension (AOR, 1.46; 95% CI, 1.11-1.94; P=0.008), diabetes mellitus (AOR, 1.37; 95% CI, 1.03-1.82; P=0.030), and cardiomegaly (AOR, 1.39; 95% CI, 1.03-1.86; P=0.030) were independent predictors of stroke. However, among those with stroke, nonwhites had higher odds of neurological deficits >/=24 h (AOR, 2.86; 95% CI, 1.01-8.07; P=0.047) and death (AOR, 3.28; 95% CI, 1.30-8.30; P=0.012). CONCLUSION: Older age, hypertension, diabetes and cardiomegaly were associated with increased incidence of stroke among HF patients with NSR receiving ACE inhibitors. The association of race and stroke, however, was complex. While nonwhite race was associated with decreased risk of stroke, among those with stroke, nonwhite race was associated with increased stroke severity and mortality.

• Maternal nutritional status during pregnancy and surma use determine cord lead levels in Karachi, Pakistan.

  Authors: Naveed Zafar Janjua, Elizabeth Delzell, Rodney R Larson, Sreelatha Meleth, Edmond K Kabagambe, Sibylle Kristensen, Nalini Sathiakumar

  Environmental research. 09/2008; 108(1):69-79.

  To estimate the umbilical cord blood lead levels (BLLs) of Pakistani neonates and to identify determinants for umbilical BLLs. We conducted a cross-sectional study of mothers and infants at one ofTo estimate the umbilical cord blood lead levels (BLLs) of Pakistani neonates and to identify determinants for umbilical BLLs. We conducted a cross-sectional study of mothers and infants at one of the two obstetric units of two tertiary care hospitals in Karachi during January-August 2005. Information from 540 mothers selected randomly from those registered for delivery was obtained about their pregnancy, diet, and current and past lead exposures. We collected umbilical cord blood for lead levels analyzed using graphite furnace atomic absorption spectrophotometry. We computed geometric and arithmetic means. We performed multiple linear regression analysis to identify factors associated with log-transformed umbilical cord BLLs. We also performed logistic regression analysis to identify determinants of high lead cord BLLs (10 microg/dl). The geometric mean cord BLL of the neonates was 9.6 microg/dl; arithmetic mean (S.D.) was 10.8 microg/dl (5.7) with a median of 9.7 microg/dl and a range of 1.8-48.9 microg/dl. Women who reported intake of less than 58.5mg of elemental iron supplement per day during pregnancy had cord BLL of 10.0 microg/dl; in comparison those women who had higher iron intake had lower cord BLL (8.4 microg/dl). Those who used surma (an eye cosmetic) daily had higher cord BLL (11.5 microg/dl) as compared to those who used it less frequently (9.4 microg/dl). In multivariable linear regression model, higher iron intake, owning a car, and being in 2nd quartile of mid-arm circumference were associated with low lead levels while father's occupation in lead-based industry was associated with significantly higher umbilical cord BLLs. There was interaction of daily surma use and ethnicity. Geometric mean BLLs were varied among surma users by ethnicity. Umbilical cord BLLs are high in Karachi, Pakistan, in comparison to those in developed countries such as United States. Measures are needed to reduce fetal lead exposure to prevent adverse affect on neurocognitive development. Association of low iron (below RDA of 60 mg per day) with high umbilical cord has implications for strengthening iron supplement intake during pregnancy. Umbilical cord BLLs differed among surma users by ethnicity.

• Status of children's blood lead levels in Pakistan: Implications for research and policy.

  Authors: Muhammad Masood Kadir, Naveed Zafar Janjua, Sibylle Kristensen, Zafar Fatmi, Nalini Sathiakumar

  Public health. 08/2008; 122(7):708-15.

  OBJECTIVES: Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. METHODS: A systematic review was conducted of published studies found throughOBJECTIVES: Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. METHODS: A systematic review was conducted of published studies found through PubMed, an index of Pakistani medical journals PakMediNet and unpublished reports from governmental and non-governmental agencies in Pakistan. RESULTS: With the exception of a few studies that had adequate sample sizes and population-based samples, most studies were small and used convenience sampling methods to select study subjects. Overall, blood lead levels declined from 38mug/dl in 1989 to 15mug/dl in 2002. The major sources of lead that directly or indirectly resulted in lead exposure of children included: leaded petrol; father's occupation in lead-based industry; leaded paint; traditional cosmetics; and remedies. Apart from leaded petrol, there was no information regarding the level of lead in other sources such as paints and the household environment. Very little information was available regarding the adverse health effects of lead among children. CONCLUSION: The phasing out of leaded petrol was a commendable mitigation measure undertaken in July 2001 in Pakistan. A comprehensive assessment is now needed urgently to explore other sources of lead contributing to adverse health effects, and to plan intervention options with the ultimate goal of reducing the burden of disease due to lead exposure.