For the past six years, the Asthma and Allergy Foundation of America (AAFA) has evaluated conditions in the 100 largest cities in America and ranked them based on the quality of life each affords for people with asthma. Researchers at AAFA review 12 factors that impact the quality of life for people with asthma, including: the crude death rate for asthma; the estimated prevalence of adult and pediatric asthma; risk factors, such as air pollution, pollen counts and public smoking; and medical factors, such as the number of asthma medications used per patient and the number of asthma specialists in the area. Below is a list of the cities that rank worst in quality of life for people with asthma in 2009.

This year’s top 10 worst cities in the U.S. to live in if you have asthma are:

1. St. Louis, MO. This Midwest city tops the list this year after coming in ninth last year, due to a variety of factors, including poor air quality and a rise in the percentage of uninsured residents.
   
   
2. Milwaukee, WI. Climbing up one spot from last year, Milwaukee has rates of self-reported asthma and estimated asthma prevalence that are higher than average, poor air quality, and only below average use of asthma control medications.
   
   
3. Birmingham, AL. Jumping all the way up from number 13 on the list last year, Birmingham saw an increase in estimated asthma prevalence and ranks poorly in air quality and public smoke free laws. In fact, all of the cities that make the top 10 lack public smoking bans.
   
   
4. Chattanooga, TN. Rising twelve spots from last year, this Appalachian city saw an increase in the crude asthma death rate and a decline in the use of rescue medications from last year. Chattanooga also ranks below average in air quality.
   
   
5. Charlotte, NC. While this Southern city has an above average rate of estimated asthma prevalence, Charlotte saw a jump in its annual pollen score, which accounts for its rise from last years position in the number seven spot.
   
   
6. Memphis, TN. A small bright spot on the list, Memphis improved in self-reported asthma incidence, annual pollen score, and uninsured rate from last year, causing it to drop one spot from last year’s list. High crude death rates from asthma and poor air quality still negatively impact people living with asthma in Memphis.
   
   
7. Knoxville, TN. Home to the University of Tennessee, Knoxville improved its ranking considerably over last year when it held the top spot. Knoxville improved because both the estimated and self-reported prevalence of asthma decreased, and reported pollen levels were lower than the national average. However, poor air quality and low adherence to asthma medications keep Knoxville in the top 10.
   
   
8. McAllen, TX. Perhaps not a household name, this border town near Brownsville jumps all the way up from number 26 last year. While the air quality ranking actually improved from last year, increases in the estimated and self-reported asthma prevalence and the annual pollen score are responsible for the precipitous rise.
   
   
9. Atlanta, GA. The "Jewel of the South" improved its ranking from last year, moving down from the number four spot thanks to improvements in crude asthma death rate, poverty rate, rate of uninsured people, and use of quick-relief asthma medications. Below average air quality and low numbers of asthma specialists are still a problem in Atlanta.
   
   
10. Little Rock, AK. Rounding out the top 10, Little Rock rose 12 spots from last year to just make the list. Increases in the annual pollen score, air pollution levels, and self-reported asthma rates offset a nice improvement in crude asthma death rate.

No matter where you live, having asthma that is uncontrolled can significantly impact your life and lead to missed school or work, emergency room visits, hospitalization, and even death. If your asthma is poorly controlled, talk to your doctor about making changes to your asthma action plan include adjustments in your current asthma prevention medications. Not sure if your asthma is well controlled? Take the Asthma Quiz Challenge and find out how much you know about uncontrolled asthma symptoms. Learn more by reading the Healia Health Guide to Uncontrolled Asthma.

_{Source: Allergy and Asthma Foundation of America, Asthma Capitals 2009, Jan 2009. http://www.aafa.org/pdfs/2009ACPublicList.PDF}

A large study of the long-term effects of kidney donation finds that kidney donors can expect to live full, healthy lives in most cases. The retrospective analysis reported in today’s New England Journal of Medicine concludes that people who donate one of their two kidneys have a long term survival rate similar to non-donors and do not face increased risk of kidney failure.

Researchers at the University of Minnesota examined data from nearly 3,700 people who had donated a kidney at the university since 1963. They tracked down as many surviving donors as they could and used government records in an attempt to determine who had died. They randomly selected 255 donors to undergo tests of kidney function.

The results showed that the survival of kidney donors was similar to that of the general population when matched for age, sex, and race or ethnic group. Kidney failure requiring dialysis or transplant developed in 11 donors, which translates to a rate of 180 cases per million people per year. This is actually lower than the rate in the general population of 268 per million per year. The researchers noted that most donors who were studied enjoyed an excellent quality of life.

One of the main reasons for the good outcome for donors may have been the strict criteria in place for kidney donation. Donors had to be in good health and free of high blood pressure and diabetes, two of the main contributing factors for kidney disease. There are no official regulations regarding living kidney donation but most transplant centers adhere to similar criteria.

A scientist not involved in the study notes the donors were mostly young and mainly white. It remains to be seen whether the safety of living kidney donation holds for older, non-white donors. The University of Minnesota is part of an ongoing study that will examine a larger and more diverse donor group.

Most people are born with two kidneys, which function to eliminate waste from the body in form of urine. If someone’s kidneys fail the only options for survival are dialysis or a transplant. More than 78,000 people are currently on the national waiting list to receive a kidney from a deceased donor. Due in part to new surgical techniques that have shortened recovery times, living kidney donation has become more common in recent years. Lving donors must be tissue matched to recipients in order to be able to donate a kidney.

To find out more about living kidney donation, visit the Organ Procurement and Transplantation Network Web site or the National Kidney Foundation Web site.

If you want to learn more about kidney failure, join the Healia Health Community and Support Group for Kidney Failure. For information about type 2 diabetes, see the Healia Health Community for Diabetes Type 2 or read the Healia Health Guide on Diabetes Type 2.

_{Photo: shanelkalicharan, Flickr, Creative Commons}

Canadian researchers report today that athletes who suffer a concussion while playing sports continue to show negative effects of their injury 30 years later. The results are alarming because until recently, most research into the aftereffects of concussions has focused on the period immediately following the injury or at most a few years after.

Researchers at the Université de Montréal gave a questionnaire to former university-level athletes (mainly hockey players) who are now in their 50s and asked them if they had ever suffered a concussion during their playing days. The researchers identified a group of 19 healthy former athletes who had sustained concussion more than 30 years ago and another group of 21 healthy former athletes with no history of concussion. When compared, the results showed that former athletes who had suffered only one or two concussions showed declines in their attention and memory, as well as a slowing of movements compared to athletes who had not suffered a concussion.

Specifically, former athletes who had suffered a concussion more than 30 years ago (and not since) showed signs of mild cognitive impairment on the Mini-Mental Status Examination (MMSE), which tests orientation, attention, immediate and short-term recall, language, and the ability to follow simple verbal and written commands. They also showed deficits on tests of episodic memory and executive function. Electroencephalogram (EEG) tests showed impairments in brain activity as well: concussed participants showed aberrant responses to unpredictable stimuli. Even their overall movements were slower than their non-concussed counterparts.

The results of the study are alarming on several levels. For one, they call into question the current thinking about sports concussions, which is often focused on ensuring safety by determining how much time should pass after a concussion before an athlete returns to competition. The results also indicate that sports concussions may actually accelerate the aging process in the brain, perhaps making these athletes more vulnerable to developing severe neurological disorders including dementia, Alzheimer’s disease, and Parkinson’s disease.

However, it is important to note that all the study participants were all still fit and healthy and continued to engage in some form of regular physical activity at least three times a week. They lived relatively normal lives despite their mild impairments. The researchers intend to follow the participants in the coming years to determine if they experience more severe deteriorations in their mental functioning and quality of life.

The researchers suggest that athletes should be better informed about the long-term effects of sports concussion on mental and physical functioning so that they can weigh the potential risks of returning to competition after a concussion.

Do you have child who plays contact sports? If he or she experiences an on-field concussion, you may want to consider talking to the doctor about the risks of a return to competition. For more information about concussions, join the Healia Health Community for Head and Brain Injuries.

_{Photo: JamieL.WilliamsPhotograph y, Flickr, Creative Commons} 

The State of the Air report is an annual publication of the American Lung Association (ALA) that ranks cities and counties based on their levels of air pollution. The following is a list of the cleanest cities for air pollution from that report, based on the annual PM2.5 concentration, a measure of the yearly concentration of particles in the air that are less than 2.5 micrometers in size (PM2.5), which are thought to be the most harmful to human health. The ALA used the Environmental Protection Agency’s database to obtain the data, calculated the concentration of a pollutant, and ranked cities based on the EPA’s determination of the number of days that violated the national ambient air quality standard for annual PM2.5 of 15 µg/m³. The list below represents the cities with the best annual PM2.5 measures over the years 2004-2006 followed in parentheses by the total population that inhabits each area. Note that mostly small and medium-sized cities make the list.

The top 10 cities with the cleanest air in the U.S. are:

1. Cheyenne, WY (85,384)
2. Santa Fe-Espanola, NM (183,356)
3. Honolulu, HI (909,863)
4. Great Falls, MT (79,385)
5. Farmington, NM 126,473
6. Tucson, AZ (946,362)
7. Bismarck, ND (101,138)
8. Flagstaff, AZ 124,953
9. Anchorage, AK (359,180)
10. Salinas, CA (410,206)

To find out more about diseases caused by air pollution, join the Healia Health Community for Lung Diseases or the Healia Health Community for Heart Diseases.

Related blog posts: Study Finds Cleaner Air Lengthens American Lives by Nearly Five Months

        The Top 10 Most Polluted Cities in America

_{Source: American Lung Association, State of the Air 2008, Table 2. http://www.stateoftheair.org/2008/key-findings/SOTA08_Table2.pdf}