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New publication: Recurrent home flooding in Detroit, MI 2012-2020

Its always a thing to celebrate, getting these new papers out. This one covers a topic close to home. After years of doing global health work, I never thought I’d be doing domestic health and even less certain that I’d be covering topics just down the road from me.

Together with partners from Wayne State University (Health Urban Waters), UM-Dearborn and the University of Michigan Ann Arbor, we characterized the state of recurrent flooding in Detroit, MI and explore possible public health impacts. The article appears in the International Journal of Environmental Research in Public Health. This was extremely rewarding work.

Article is open access.

Abtract:

Household flooding has wide ranging social, economic and public health impacts particularly for people in resource poor communities. The determinants and public health outcomes of recurrent home flooding in urban contexts, however, are not well understood. A household survey was used to assess neighborhood and household level determinants of recurrent home flooding in Detroit, MI. Survey activities were conducted from 2012 to 2020. Researchers collected information on past flooding, housing conditions and public health outcomes. Using the locations of homes, a “hot spot” analysis of flooding was performed to find areas of high and low risk. Survey data were linked to environmental and neighborhood data and associations were tested using regression methods. 4803 households participated in the survey. Flooding information was available for 3842 homes. Among these, 2085 (54.26%) reported experiencing pluvial flooding. Rental occupied units were more likely to report flooding than owner occupied homes (Odd ratio (OR) 1.72 [95% Confidence interval (CI) 1.49, 1.98]). Housing conditions such as poor roof quality and cracks in basement walls influenced home flooding risk. Homes located in census tracts with increased percentages of owner occupied units (vs. rentals) had a lower odds of flooding (OR 0.92 [95% (CI) 0.86, 0.98]). Household factors were found the be more predictive of flooding than neighborhood factors in both univariate and multivariate analyses. Flooding and housing conditions associated with home flooding were associated with asthma cases. Recurrent home flooding is far more prevalent than previously thought. Programs that support recovery and which focus on home improvement to prevent flooding, particularly by landlords, might benefit the public health. These results draw awareness and urgency to problems of urban flooding and public health in other areas of the country confronting the compounding challenges of aging infrastructure, disinvestment and climate change.

Do stray dogs raise risk for human infections of a skin burrowing flea in Kenya?

Are dogs associated with infections by a skin burrowing flea in Kenya? Masanobu Ono and I with Kensuke Goto, Satoshi Kaneko, mwatasa Changoma just published a paper on #tungiasis in the journal Tropical Medicine and Health.

Most people haven’t heard of tungiasis, an ectopic skin disease caused by the skin burrowing parasite, T. pentrans. It causes itching, pain, is associated with serious secondary bacterial infections, gangrene, social exclusion and debilitation. It primarily afflicts the very young and very old and is found almost exclusively in the poorest parts of the poorest parts of the world. It fits the classic definition of a neglected tropical disease.

We explored associations of wildlife and domesticated animals with household level tungiasis in Kenya using a two stage complex sampling based survey in an area adjacent to a wildlife preserve.

Abstract:

Introduction
Tungiasis is a ectopic skin disease caused by some species of fleas in the Tunga genus, most notably T. penetrans. The disease afflicts poor and marginalized communities in developing countries. Transmission of tungiasis comprises a complex web of factors including domesticated animals and wildlife. This research explores animal and environmental risk factors for tungiasis in an area adjacent to a wildlife reserve in Kwale, Kenya.

Methods
A two-stage complex sampling strategy was used. Households were selected from three areas in and around Kwale Town, Kenya, an area close to the Kenyan Coast. Households were listed as positive if at least one member had tungiasis. Each household was administered a questionnaire regarding tungiasis behaviors, domesticated animal assets, and wild animal species that frequent the peridomiciliary area. Associations of household tungiasis were tests with household and environmental variables using regression methods.

Results
The study included 319 households. Of these, 41 (12.85%) were found to have at least one person who had signs of tungiasis. There were 295 (92.48%) households that possessed at least one species of domesticated animal. It was reported that wildlife regularly come into the vicinity of the home 90.59% of households. Presence of dogs around the home (OR 3.85; 95% CI 1.84; 8.11) and proximity to the park were associated with increased risk for tungiasis infestation in humans in a multivariate regression model.
Conclusions

Human tungiasis is a complex disease associated with domesticated and wild animals. Canines in particular appear to be important determinants of household level risk.

#research#science#publichealth#medicine#health#environmental#ntds#neglectedtropicaldiseases#poverty#parasitology#globalhealth#healthdisparities

Is pollen associated with suicide? New paper (from myself and colleagues) in Environmental Research

Is pollen associated with suicide? That’s the question we sought to answer. Pollen related allergic rhinitis is associated with depressive symptoms, discomfort, pain, sleep disruptions, isolation and reduced quality of life in people who have them. Our team, led by UM researcher Dr. Rachel Bergmans, set out to test associations of suicide mortality in Ohio with pollen exposures using data from Ohio’s vital records and a novel prognostic, model based raster of daily pollen counts from Dr. Allison Steiner’s team at UM’s College of Engineering.

We explored associations of suicide with exposure to four types of pollens and the paper can be found here (Open access for 50 days). Suicide is serious. Though the causes of suicide are complex, pollen allergies are associated with depressive symptoms, isolation, pain, discomfort and for some, complete debilitation. #suicide#pollen#epidemiology

Background Seasonal trends in suicide mortality are observed worldwide, potentially aligning with the seasonal release of aeroallergens. However, only a handful of studies have examined whether aeroallergens increase the risk of suicide, with inconclusive results thus far. The goal of this study was to use a time-stratified case-crossover design to test associations of speciated aeroallergens (evergreen, deciduous, grass, and ragweed) with suicide deaths in Ohio, USA (2007–2015).

Methods Residential addresses for 12,646 persons who died by suicide were linked with environmental data at the 4–25 km grid scale including atmospheric aeroallergen concentrations, maximum temperature, sunlight, particulate matter <2.5 μm, and ozone. A case-crossover design was used to examine same-day and 7-day cumulative lag effects on suicide. Analyses were stratified by age group, gender, and educational level.

Results In general, associations were null between aeroallergens and suicide. Stratified analyses revealed a relationship between grass pollen and same-day suicide for women (OR = 3.84; 95% CI = 1.44, 10.22) and those with a high school degree or less (OR = 2.03; 95% CI = 1.18, 3.49).

Conclusions While aeroallergens were generally not significantly related to suicide in this sample, these findings provide suggestive evidence for an acute relationship of grass pollen with suicide for women and those with lower education levels. Further research is warranted to determine whether susceptibility to speciated aeroallergens may be driven by underlying biological mechanisms or variation in exposure levels.

We published a new paper on Covid-19 and ER visits for suicide attempts/self harm incidents in Epidemiology and Community Health today

Rachel Bergmans, an epidemiologist from the University of Michigan Institute for Social Research (and soon the University of Michigan Medical School) and I recently wrote a paper on the impact of Covid-19 and Covid-19 policy in the state of Michigan on emergency room visits for suicide and self harm incidents.

I am happy to say that it appeared today in Epidemiology and Community Health and encourage everyone to read it here.

Many worried that Covid-19 and the resulting “lockdown” measures would result in rapid increases in suicide attempts due to increased unemployment and social isolation. We did not find an increase in ER visits for self harm and suicide attempts at the University of Michigan Hospital in Ann Arbor, MI. In fact, we found a decline in visits that continued into the winter.

Though it is impossible to know (from this data) what the actual reasons for this decline were, these results suggest that the Covid-19 crisis might not be comparable to previous economic downturns. It might suggest that efforts to financially support those left out of work by the shutdown might mitigate the worst effects of an rapid unemployment.

I am very proud of this work, here is the abstract:

Abstract

Objective Determine the early impact of the COVID-19 pandemic on emergency department (ED) encounters for suicide attempt and intentional self-harm at a regional tertiary academic medical centre in Washtenaw County, Michigan, which is one of the wealthier and more diverse counties in the state.

Methods Interrupted time series analysis of daily ED encounters from October 2015 through October 2020 for suicide attempt and intentional self-harm (subject n=3002; 62% female; 78% Caucasian) using an autoregressive integrated moving average modelling approach.

Results There were 39.9% (95% CI 22.9% to 53.1%) fewer ED encounters for suicide attempt and intentional self-harm during the first 12 weeks of the COVID-19 pandemic (ie, on or after 10 March 2020, when the first cases of COVID-19 were identified in Michigan).

Conclusions Fewer individuals sought emergency care for suicide-related behaviour during the earlier phase of the COVID-19 pandemic than expected when compared to prior years. This suggests initial outbreaks of COVID-19 and state of emergency executive orders did not increase suicide-related behaviour in the short term. More work is needed to determine long-term impacts of the COVID-19 pandemic on suicide-related behaviour and whether there are high-risk groups.


I was interviewed by WCBN on Covid-19

Among other things. Check out the full interview here:

How many workers are testing positive for Covid 19?

To date, there has been no data on incidence of Covid 19 cases in the workplace in Michigan.

The State of Michigan, as part of Executive Order 2020-114 requires that businesses immediately notify the local public health department and any co-workers, contractors, or suppliers who may have come into contact with the person with a confirmed case of COVID-19 within 24 hours. Businesses must also shut down operations when any person is found to show symptoms of Covid 19 in the establishment and has a positive test.

But anecdotal reports are suggesting that compliance with the directive is spotty. No doubt, businesses will be hesitant to shut down operations with little notice or to draw undue attention to themselves. However, after one local business (so far the only one to do so) issued a public statement that one of their employees tested positive for the disease, the public is becoming skeptical of the private sector’s commitment to responding to potential exposures.

Rumors are flying through service workers that businesses are slow to respond or are actively covering up information on cases that have appeared in their workplaces. Of course, these are rumors and anecdotes, but even if the incidents are wholly unsubstantiated, public skepticism on social media is not. The public does not trust businesses, and particularly service businesses to adhere to the guidelines spelled out in the executive order.

Clearly, we are in real trouble. Cases have spiked in the past week, hospitalizations are up, and many states have lost or are about to lose the gains they have made. Hospitals in Texas are overflowing. Even the US military has extended bans on movement or personnel into specific states, most notably, my own while lifting them for other states.

We need businesses to adhere to the guidelines for reporting in the executive order, but we also need to use that data to inform the public on risks for infection when visiting businesses. While businesses are required to report to local health authorities, there is no indication that the data will be made public and very little indication that the data will be disseminated in a manner that will facilitate research on specific risks in different types of businesses.

Supposedly, you can call your local health department and they will tell you if you if you might have been exposed when you went to Place X. That requires a lot of work on the part of the consumer, and how are they going to know to ask about a specific business without having an alarm raised anyway? I can’t see how that can work.

Public health authorities and the private sector MUST work together to implement systems and information sharing that protects the public health. While businesses are right to be concerned about their survival, becoming the center of a superspreader event will be a public relations disaster as we saw in Lansing, MI over the weekend.

The public has a right to know when service employees test positive for Covid 19

But so far, that’s not happening.

In the past week employees at a handful of business in the tiny college town of Ann Arbor have tested positive for Covid 19. I won’t name names because I think that each businesses needs to be afforded an opportunity to make create a response and write a formal announcement.

Responses, however, should be immediate. Any delay in messaging puts the public at unnecessary risk. Businesses should be required by law to immediately make it public when an employee has tested positive.

When an employee tests positive for Covid 19, operations should be shut down, and every employee of that business should be tested without fail. Once everyone has been cleared, people can return to work and operations might commence.

Every single person who entered those businesses or had contact with employees needs to be immediately informed that they might have been exposed to Covid 19. Businesses must do this so that patrons can be tested if possible and isolate themselves if necessary.

Businesses who fail to do these things should be shut down.

One business is currently still open. I have it on good knowledge that an employee tested positive for Covid 19 there, yet there has been no announcement and business moved forward as usual (at the time of my walking past it yesterday.)

Covid 19 is no joke. People should be staying at home. They should not be eating out. Restaurants, bars and entertainment venues should not be open, but they are. If we are going to reopen these places, we need to do so under strict regulation that keeps the public informed and protected.

Michigan, you are in trouble.

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We went from 74 new cases of Covid 19 on June 15 to 389 cases on June 26, a five fold increase after several weeks of people partying like it is 2019.

Assuming that nothing changes between now and then, we will exceed the peak of new cases found (1,953) in Michigan back on April 3rd…. by the middle of July.

Certainly, case fatality rates are down, but if disease is not, this leaves us with even larger numbers of people suffering debilitating disease. Some will suffer for years and some of them might die earlier than they would otherwise.

Local bars, restaurants and music venues are opening up and trying to get people to come out like they did before, albeit under new rules. Some places are making a greater effort to protect workers and customers than others.

A local bar discovered that one of their staff tested positive for Covid 19 and, to their credit, shut down operations and tested the entire staff. But the infected staff member could have been infected up to two weeks ago and could have infected other staff, who could have infected customers. Every single person who stepped into that building needs to be informed. Is there a mechanism to do this? Obviously not, but there should be.

Moreover, the public needs to know which establishments have positive cases and when so that people can judge the relative safety of businesses and can act accordingly when they believe that they might have been at risk. This is also not happening but it should be.

People will inevitably say “it is worse everywhere else.” That doesn’t do anything to help a person on a vent. We are in real trouble, we need to act like it.

What will the State of Michigan do about this? Will we have another shut down? What does this bode for the future? Whatever it is, it isn’t good.

So… wear your damn mask. Stay the fuck home. Get carry out. Ignore all these people trying to get you to go out and act like life is the same as before, because it just isn’t.

Leeches for sale: The economy of bloodletting in France, 1827-1836

N8000057-Leech_use,_historical_artwork-SPLI found this great post on drug shortages that appeared in BMJ today.  Among all of the other great gems in it, was this incredibly interesting article on the creation of a mechanical bloodletting device. Jean-Baptiste Sarlandière, a French anatomist and inventor, created the “mechanical leech”, a device intended to extract a controlled amount of blood from the body. Sarlandiere intended the device to replace leeches, which were subject to increasing demand, were becoming expensive, were difficult to cultivate, and were subject to shortages in the Netherlands, who was a large producer of leeches at the time.

A paper was written on the device back in 2009, and within there is a dataset of leech imports and exports to France, which includes data on the monetary value of leeches and public consumption. Of course, I couldn’t resist pulling this data out and doing something with it (despite having better things to do.)

Here is the data, pulled from yet another paper (Alexandre E Baudrimont, Adolphe J Blanqui, et al.Dictionnaire de l’industrie manufacturie`re, commerciale et agricole, Paris, J-B Baillière, 1833–1841, pp. 25–30.):

Year Number of leeches imported Value in Francs National consumption Exports Import export ratio Value per leech
1827 33653694 1009611 33456744 196950 170.87 0.03
1828 26981900 809457 26689100 292800 92.15 0.03
1829 44573754 1337212 44069848 503906 88.46 0.03
1830 35485000 1064550 34745848 739250 48 0.03
1831 36487975 1094639 35245875 1242100 29.38 0.03
1832 57487000 1724610 55591700 1895300 30.33 0.03
1833 41654300 1249629 40785650 868650 47.95 0.03
1834 21885965 656579 21006865 879100 24.90 0.03
1835 22560440 676813 21323910 1236530 18.24 0.03
1836 19736800 592104 18721555 1015245 19.44 0.03

Leeches

Of course, I am fascinated with this. The number of leeches exported from France rose during this period as did the market price of each leech. Though the entire industry would eventually collapse because other medical advances of the nineteenth century would supercede it, it is clear that increased demand and expense led to innovation to create devices to replace it. I don’t know whether the “mechanical leech” led to the development of other medical devices, but would like to think that even batshit ideas like how swamp worms draw out blood to cure any and all medical conditions would lead to the creation of methods which do improve health.

Detroit Communities Reducing Energy and Water (use): Jefferson-Chalmers edition

test (9 of 11)Once again, I tagged along on a trip to Detroit with the D-CREW, a community based participatory research project aimed at developing strategies to improve housing and thereby reduce wasteful water and energy use in Detroit communities.

This weeks data collection efforts focused on the Jefferson-Chalmers area of Detroit, just adjacent to Gross Pointe.

Data collection went as smoothly as before, but with a more affluent and sophisticated group of people the vast majority of whom own their own homes.

The informational session became quickly energized, with participants asking pointed questions like “how is this research going to benefit us?” “are you going to sell our data?” “is my cousin going to be able to see my data?”

Doing research in the communities of Detroit is every bit as exciting and engaging as doing work in Kenya, where researchers are rightly met with skepticism, the goals of the research are obscure, and the direct benefits likely non-existent.

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