Our results provide little evidence that living in homes characterized by high measured time-weighted average magnetic-field levels or by the highest wire-code category increases the risk of ALL in children.

To assess epidemiologic risk factors for preterm birth subcategories in an urban population, we undertook a study of 31,107 singleton livebirths that took place at Mount Sinai Hospital in New York City between 1986 and 1994. We subdivided the preterm births into preterm premature rupture of the membranes, preterm labor, and medically induced births. We obtained information regarding the preterm subtypes and their epidemiologic risk factors from a computerized perinatal database. Adjusted odds ratios showed an increased risk for all three preterm birth subtypes in women who were black (1.9 for preterm premature rupture of membranes, 2.1 for preterm labor, and 1.7 for medically induced births) or Hispanic (1.7 for preterm premature rupture of membranes, 1.9 for preterm labor, and 1.6 for medically induced births), those who had had a previous preterm birth (3.2 for preterm premature rupture of membranes, 4.5 for preterm labor, and 3.3 for medically induced births), those who began prenatal care after the first trimester ( 1.4 for preterm premature rupture of membranes, 1.3 for preterm labor, and 1.3 for medically induced births), women who had been exposed to diethylstilbestrol in utero (3.1 for preterm premature rupture of membranes, 4.1 for preterm labor, and 3.7 for medically induced births), patients with preexisting diabetes mellitus (2.2 for preterm premature rupture of membranes, 2.4 for preterm labor, and 9.5 for medically induced births), and those with antepartum bleeding (2.8 for preterm premature rupture of membranes, 3.6 for preterm labor, and 3.7 for medically induced births). Other sociodemographic, constitutional, life-style, and obstetrical characteristics differed across the groups. Variation in some of the risk factors among the preterm subtypes implies that epidemiologic assessment of the more specific outcomes would be advisable.

Older adults with advanced chronic kidney disease (CKD) experience functional impairment that can complicate CKD management. Failure to recognize functional impairment may put these patients at risk of further functional decline, nursing home placement, and missed opportunities for timely goals of care conversations. Routine geriatric assessment could be a useful tool for identifying older CKD patients who are at increased risk of functional decline and provide contextual information to guide clinical decision-making. We implemented two innovative programs in the Veterans Health Administration that incorporate geriatric assessment performed concurrently with a nephrology visit. In one program, standardized geriatric assessment tools were performed on CKD patients ≥ 70 years by a geriatrician embedded in a nephrology clinic (Comprehensive Geriatric Assessment for CKD) (CGA-4-CKD). In the second program, a nephrology clinic employed comprehensive appointments for patients ≥ 75 years to conduct both geriatric assessments and CKD care (Renal Silver). We report data on 68 Veterans who had geriatric assessments through these programs between November 2013 and May 2015. In CGA-4-CKD, difficulty with one or more ADLs, history of falls, and cognitive impairment were each found in 27.3% of patients. ADL difficulty, falls and cognitive impairment were found in 65.7%, 28.6%, and 51.6% of patients in Renal Silver. Geriatric assessment guided care processes in 45.4% (n=15) and 37.1% (n=13) of Veterans in the CGA-4-CKD and Renal Silver programs, respectively. Findings suggest there is a significant burden of functional impairment in older adults with CKD. Knowledge of this impairment is applicable to CKD management.

Epidemiologic evaluation of the relation between magnetic field exposures and cancer depends critically on study design, particularly the methods used for exposure assessment. We incorporated a complex magnetic field exposure assessment protocol into a large incident case-control study of childhood leukemia. We measured residential magnetic fields using a standard protocol in current and former homes of 638 cases and 620 controls and determined wire codes for 414 case-control pairs. We chose a time-weighted average of magnetic field measurements in each eligible home, weighted by the time the subject lived in each home as the main exposure metric for each subject. We found that 24-hour bedroom magnetic field measurements adequately characterize children's residential exposure and that measuring other rooms contributes only slightly to the estimate of average residential exposure to magnetic fields. Front door measured fields provide useful exposure information when interior measurements are missing. If feasible, measuring multiple homes in which the subject has resided is preferable to measuring a single home. A similar distribution of wire codes for controls agreeing or refusing to participate in our study implies that risk estimates derived from wire code data will not be influenced by response bias.

A recent epidemiologic study reported associations between leukemia risk in children and their personal use of television (TV) sets, hair dryers, and stereo headsets, and the prenatal use by their mothers of sewing machines. To provide exposure data to aid in the interpretation of these findings, extremely and very low frequency (ELF and VLF) magnetic fields produced by a sample of each type of appliance were characterized in a field study of volunteers conducted in Washington DC and its Maryland suburbs. Questionnaire data regarding children's or mothers' patterns of usage of each type of appliance were also collected. ELF magnetic fields measured 10 cm from the nozzles of hair dryers were elevated over the ambient by a mean factor of 17 when these devices were in use. Fields near headsets being used to listen to music were not distinguishable from ambient levels except at frequencies below and well above 60 Hz and, even then, field levels were < 0.01 microT. Home sewing machines produced ELF magnetic fields that were elevated by a factor of 2.8 over ambient levels at the front surfaces of the lower abdomens of mothers. Estimated mean daily times of usage of hair dryers, stereo headsets, and sewing machines were 2.6, 19, and 17 minutes, respectively. These data and previously published data on TV sets, do not provide a consistent picture of increased (or decreased) leukemia risk in relation to increasing peak or time weighted average (TWA) ELF magnetic field exposure. The data could, however, conceivably be compatible with some more complex biophysical model with unknown properties. Overall, the results of this study provide little evidence supporting the hypothesis that peak or TWA ELF magnetic fields produced by appliances are causally related to the risk of childhood leukemia in children.