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RESEARCH BRIEFSPublic Housing Gets Asthma TreatmentThe Boston Housing Authority is spring-cleaning. In an effort to contain household environmental hazards, including those that provoke asthma attacks and other respiratory illnesses, the city's largest landlord has entered into a partnership with resident groups to enact a five-year Healthy Public Housing initiative, also aimed at energy-saving renovations. Government organizations and private institutions, including HSPH, will participate. Together they aim to modernize buildings in the West Broadway and Franklin Hill developments, located in Boston's asthma hub (see map). "Housing has a lot to do with increasing asthma rates because this is where you find many of the triggers and the sensitizers to the condition," said Jack Spengler, co-coordinator of the effort and the Akira Yamaguchi professor of environmental health and human habitation at HSPH. Children in low-income settings are especially at risk for the disease that afflicts an estimated 15 million Americans.
High asthma hospitalization rates in Boston's poorer communities have spurred an initiative to improve living conditions in two of the city's housing projects (black circles). The map, originally from the Boston Health Commission, Office of Research, Health Assessment and Data Systems, shows data collected from 1994 to 1997. "Not only will the project improve the well-being of residents," said Kimberley Vermeer of Urban Habitat Initiatives, "it will give them the power to advocate for themselves for safe and decent housing." To identify triggering agents, tenants surveyed fellow community members in a pilot study. The residents reported that dust mites in worn-out mattresses, cigarette smoke, cockroach and rodent infestations, and mold made their homes unsafe and at times uninhabitable. Other problems included standing water from leaky pipes and outdated heating systems that run so hot tenants sometimes turn on their air conditioners in the winter. With this data in hand, the partnership will now work to improve overall air quality in the buildings through, among other things, mattress exchanges, pest management programs, cleaning, and upgrades in air filtration systems. Essential to the effort is a paid resident workforce that will educate others, help follow up with asthma patients, and evaluate the effectiveness of the interventions. Eventually the collaborators hope that the program will serve as a model for more widespread initiatives. "I see this project as being a catalyst for the future of healthier public housing," said the executive director of the West Broadway Tenant Task Force, Deidre Butler Henderson. Participating organizations also include the Committee for Boston Public Housing, the Franklin Hill Tenant Task Force, Boston Public Health Commission, South Boston Community Health Center, and the Tufts and Boston University schools of public health. --Anne Mahon
Racial, Other Gaps Found in Asthma CareEven when Medicaid will pay the cost, many black and Latino children with asthma are not receiving appropriate preventive medications for their condition--and white children covered by Medicaid are doing only slightly better.A new study by HMS researchers is the first to gather information directly from parents to evaluate racial and ethnic differences in children's asthma status and management. Led by Tracy Lieu, HMS associate professor of ambulatory care and prevention at Harvard Pilgrim Health Care, the researchers interviewed parents of children age 2 to 16 with asthma who were insured by Medicaid programs. Co-authors of the study, published in the May Pediatrics, are at Kaiser Permanente in California and the Group Health Cooperative in Seattle. Of the 1,658 children studied, 38 percent were black, 19 percent Latino, and 31 percent white. The results show that black children had worse asthma on average than white or Latino children. On an asthma scale of 0 to 100 for physical health, black children scored six points lower than white or Latino children. "What's unique about our study is that all the children had Medicaid, and all were in similar systems of care," Lieu said. "That means the disparities cannot be explained by differences in financial access to health care systems." Instead, she said, emerging ideas about these disparities focus on communication and on understanding cultural beliefs about health and illness. Both black and Latino children were less likely than white children to use daily inhaled anti-inflammatory medications. However, among children with persistent asthma--about two thirds of the total group--only 33 percent of whites were using the drugs, compared with 28 percent of blacks and 22 percent of Latinos. These findings reveal that suboptimal use of drugs that can help prevent asthma flare-ups is a problem for children across races and ethnicities, Lieu said. The findings may have wider implications because asthma is a "sentinel condition" for monitoring quality of health care delivery. --Tom Reynolds
Eye's Imperfect Optics May Enable More Perfect VisionLight rays are bent as they travel through a lens, and this poses a problem for human vision. Short wavelengths are refracted more strongly than long, making it impossible to focus all colors in one point. This leads to chromatic aberration--the "color fringing" sometimes seen in photos. To minimize the effect, optical instruments are made from compound lenses with different dispersion characteristics. Despite the simple structure of the eye, we see little chromatic blurring, and for a long time researchers have wondered why.According to a report in the May 9 Nature, the answer is found in the eye's imperfect optics, a result that may guide future refractive surgery research. Stephen Burns, HMS associate professor of ophthalmology at Schepens Eye Research Institute, and Spanish collaborators from Murcia and Madrid evaluated the often overlooked contribution of all types of optical aberrations across the entire visual spectrum. Lead author and Schepens researcher James McLellan determined image quality when light entered the pupil at different points and compared these results with predictions based on mathematical modeling. Though spatial vision was sharp at discrete wavelengths for the theoretical eye, it was poor across the rest of the spectrum. Yet for human test subjects, image quality at all wavelengths was nearly constant. The difference between the model and the human eye was attributed to wave aberrations, local deviations in the light path caused by irregularities in the cornea and lens. Apparently, the flawed optics of the eye works to our advantage by compensating for the variable refractive angles of polychromatic light. Theoretically, humans are "nearsighted" for the violet end of the spectrum: when a distant red object is seen clearly, the blue one next to it should be fuzzy. But our blue vision is sharper than expected. To explain this, it has been proposed that near-violet light is selectively absorbed by macular pigment. But after wave aberrations were taken into account, McLellan, Burns, and colleagues found the pigment had negligible effect. Approximately one million patients undergo refractive eye surgery each year, and some researchers dream of ridding the eye of all aberrations to create super-vision. "Our results suggest this might be unwise," Burns said. --Anne Mahon |
