W. Randolph Daley

dyspnea, respiratory rate >30 breaths per minute, hypoxemia, or chest x-ray with multilobar infiltrates or >50% progression of pulmonary infiltration within 24-48 hours per WHO. https://www.who.

OBJECTIVES: We sought to reexamine the effects of the 1995 Chicago heat wave on all-cause and cause-specific mortality, including mortality displacement, using advanced time-series analysis methods. METHODS: We used Poisson regression with penalized regression splines to model excess mortality and mortality displacement over a 50-day period centered on the day in which the heat wave temperature peaked, adjusting for meteorological and other variables. We controlled for temporal trends by using daily mortality data during 1993-1997. We estimated relative risks (RRs) with reference to the first day of the 50-day period. RESULTS: We estimated that there were 692 excess deaths from June 21, 1995, to August 10, 1995; 26% of these deaths were owing to mortality displacement. RR for all-cause mortality on the day with peak mortality was 1.74 (95% confidence interval=1.67, 1.81). Risk of heat-related death was significantly higher among Blacks, and mortality displacement was substantially lower. CONCLUSIONS: The 1995 Chicago heat wave substantially effected all-cause and cause-specific mortality, but mortality displacement was limited. Mortality risks and displacement affected Blacks disproportionally. Appropriately targeted interventions may have a tangible effect on life expectancy.

Dhaka, Bangladesh, has one of the highest air lead levels in the world. In February 2000, we evaluated children at five primary schools in Dhaka to determine blood lead (BPb) levels, sources of environmental exposure, and potential risk factors for lead poisoning. Selected schools represented a range of geographic and socioeconomic strata. A total of 779 students 4-12 years of age participated. The mean BPb level was 15.0 microg/dL (range 4.2-63.1 microg/dL). Most students (87.4%) had BPb levels above the Centers for Disease Control and Prevention's level of concern (10 microg/dL). Elevated BPb levels correlated with soil eating [odds ratio (OR) = 3.31; 95% confidence interval (CI), 1.30-8.39], low parental education (OR = 2.72; 95% CI, 1.97-3.75), living close to major roads (OR = 2.30; 95% CI, 1.23-4.29), and increasing age (OR = 1.11; 95% CI, 1.06-1.16). BPb levels measured were similar to those in other countries that use leaded gasoline. No other potential sources of lead exposure were consistently identified. Combustion of leaded gasoline is the main source of lead exposure in Dhaka, resulting in ubiquitous contamination of the environment. The increase in BPb levels with age, a finding contrary to observations in the United States and Australia, may be related to increased outdoor activities. The Bangladeshi government recently announced a plan to eliminate leaded gasoline. Baseline BPb surveys are critical to develop and evaluate intervention policies. Strategies to reduce BPb levels need to address variations in socioeconomic status, construction type and location of housing, and levels of hygiene.