Determinants of exposure to endocrine disruptors following hurricane Harvey.

Hurricane Harvey was a category four storm that induced catastrophic flooding in the Houston metropolitan area. Following the hurricane there was increased concern regarding chemical exposures due to damage caused by flood waters and emergency excess emissions from industrial facilities. This study utilized personal passive samplers in the form of silicone wristbands in Houston, TX to both assess chemical exposure to endocrine disrupting chemicals (EDCs) immediately after the hurricane and determine participant characteristics associated with higher concentrations of exposure. Participants from the Houston-3H cohort (n = 172) wore a wristband for seven days and completed a questionnaire to determine various flood-related and demographic variables. Bivariate and multivariate analysis indicated that living in an area with a high Area Deprivation Index (ADI) (indicative of low socioeconomic status), identifying as Black/African American or Latino, and living in the Houston neighborhoods of Baytown and East Houston were associated with increased exposure to EDCs. These results provide evidence of racial/ethnic and socioeconomic injustices in exposure to EDCs in the Houston Metropolitan Area. Since the multiple regression models conducted did not fully explain exposure (0.047 < R2 < 0.34), more research is needed on the direct sources of EDCs within this area to create effective exposure mitigation strategies.

Evaluation of Self-Reported Agricultural Tasks, Safety Concerns, and Health and Safety Behaviors of Young Adults in U.S. Collegiate Agricultural Programs.

Young adults enrolled in collegiate agricultural programs are a critical audience for agricultural health and safety training. Understanding the farm tasks that young adults engage in is necessary for tailoring health and safety education. The project analyzed evaluation survey responses from the Gear Up for Ag Health and Safety™ program, including reported agricultural tasks, safety concerns, frequency of discussing health and safety concerns with healthcare providers, safety behaviors, and future career plans. The most common tasks reported included operation of machinery and grain-handling. Most participants intended to work on a family-owned agricultural operation or for an agribusiness/cooperative following graduation. Reported safety behaviors (hearing protection, eye protection, and sunscreen use when performing outdoor tasks) differed by gender and education type. Male community college and university participants reported higher rates of "near-misses" and crashes when operating equipment on the roadway. One-third of participants reported discussing agricultural health and safety issues with their medical provider, while 72% were concerned about the health and safety of their family and co-workers in agriculture. These findings provide guidance for better development of agricultural health and safety programs addressing this population-future trainings should be uniquely tailored, accounting for gender and educational differences.

Influence of work organization and work environment on missed work, productivity, and use of pain medications among construction apprentices.

BACKGROUND: Construction is among the most dangerous industries. In addition to traditional hazards for workplace injury and illness, other threats to health and well-being may occur from work organization and work environment factors, including irregular employment, long commutes, long work hours, and employer policies regarding health and safety. These nontraditional hazards may affect work and health outcomes directly, or through effects on health behaviors. The cumulative impacts of both traditional and nontraditional hazards on health-related outcomes among construction workers are largely unknown. METHODS: We conducted a survey among apprentice construction workers to identify relationships between work organization and environmental factors with five outcomes of economic relevance to employers: missed work due to work-related injury, missed work due to any pain or injury, self-reported workability, health-related productivity, and use of prescription medications for pain. RESULTS: A total of 963 surveys were completed (response rate 90%) in this young (mean age 28) working cohort. Multivariate Poisson regression models found associations between the outcomes of interest and multiple work factors, including job strain, safety behaviors of coworkers, and mandatory overtime. Univariate analysis showed additional associations, including precarious work, and supervisor support for safety. CONCLUSIONS: Findings from this cross-sectional study suggest that work organization and environment factors influence health and work outcomes among young construction trade workers. Future work with longitudinal data will examine the hypothesized paths between work factors, health behaviors, health outcomes, and work outcomes.

Neurobehavioral and Menstrual Disorders among Adolescent Females Environmentally Exposed to Pesticides, Menoufia Governorate, Egypt.

BACKGROUND: Adolescent females living in agricultural areas where crops are routinely sprayed by pesticides are expected to be environmentally exposed to pesticides' health hazards partially as those occupationally exposed. OBJECTIVE: to assess menstrual and neurobehavioral disorders among adolescent females environmentally exposed to pesticides. METHODS: This was a cross-sectional study conducted on 100 pesticide exposed adolescent females who had one or more of family members are pesticides' seasonal applicators and 50 non- exposed adolescent females matched for age and education, served as controls at Menoufia governorate, Egypt during the period of pesticide application season of cotton crop from the first days of May to the end of September 2017. A self-administered and a series of neurobehavioral tests were administered and serum Acetylcholinesterase (AChE) activity was assessed. RESULTS: A significant lower AChE activity levels were found in the exposed group than controls (Mean±SD=238.49± 23.83 vs 303.35±78.54 IU/L; respectively). There were significant higher mean scores of trail making test (parts 1 and 2) and significant lower mean scores of (similarities test, Benton visual retention test, block design test, Santa Ana dexterity test (dominant and non-dominant hands) and Beery visuo-motor imitation test in the exposed group than the controls (P<0.05). Also, the exposed group reported more prevalent irregular menstrual cycle (26.8%) and intermenstrual bleeding (28.2%) compared to the control participants (8.1% and 8.1%; respectively). CONCLUSION: Adolescent females living in agricultural areas and from families whose one or more members are pesticides' applicators have significantly lower neurobehavioral performance, report more prevalent menstrual irregularities and have lower levels of serum AChE compared to a control group. The neurobehavioral deficits demonstrated a dose-response relationship AChE levels in the exposed participants. This necessitates the need for implementation of health education programs to prevent or reduce health effects associated with pesticide exposure to adolescent females.

Indoor versus Outdoor Air Quality during Wildfires.

The human behavioral modification recommendations during wildfire events are based on particulate matter and may be confounded by the potential risks of gas-phase pollutants such as polycyclic aromatic hydrocarbons (PAHs). Moreover, the majority of adults spend over 90 percent of their time indoors where there is an increased concern of indoor air quality during wildfire events. We address these timely concerns by evaluating paired indoor and outdoor PAH concentrations in residential locations and their relationship with satellite model-based categorization of wildfire smoke intensity. Low-density polyethylene passive air samplers were deployed at six urban sites for 1 week in Eugene, Oregon with matched indoor and outdoor samples and 24 h time resolution. Samples were then quantitatively analyzed for 63 PAH concentrations using gas-chromatography-tandem mass spectrometry. A probabilistic principal components analysis was used to reduce all 63 PAHs into an aggregate measure. Linear regression of the first principal component against indoor versus outdoor shows that indoor gas-phase PAH concentrations are consistently equal to or greater than outdoor concentrations. Regression against a satellite-based model for wildfire smoke shows that outdoor, but not indoor gas-phase PAH concentrations are likely associated with wildfire events. These results point toward the need to include gas-phase pollutants such as PAHs in air pollution risk assessment.

Factors associated with occupational injuries in seasonal young workers.

BACKGROUND: Younger workers are more likely to be injured on the job than older workers. Investigation tends to focus on work-related explanatory factors but often neglects non-work-related causes. AIMS: To identify both work- and non-work-related factors that contribute to younger workers' injuries in seasonal work. METHODS: Two surveys of a set of seasonal parks and recreation workers were conducted measuring health and safety behaviours and self-reported injuries. RESULTS: Seventy per cent reported an injury at work over the summer. Among young workers, each additional year of age was associated with an almost 50% increase in injury rate (P < 0.05). Odds of injury in women were three times those for men (P < 0.05). We observed a linear relationship between average hours worked per week and injuries (P < 0.001). Alcohol abuse (P < 0.05) was also associated with injuries. CONCLUSIONS: Higher injury rates among younger workers in this sample is multifactorial and encompasses both work and non-work factors and suggest that more global approaches are required to address young worker safety.

Neurobehavioral performance among agricultural workers and pesticide applicators: a meta-analytic study.

Chronic low level exposure of agricultural workers and applicators to pesticides has been found to be associated with different degrees of decrement in cognitive and psychomotor functions. The goal of this study was to use meta-analysis to (1) identify and quantify neurobehavioral deficits among agricultural workers and pesticide applicators, and (2) analyse the potential confounders or moderators of these neurobehavioral deficits. Seventeen studies, reporting on 21 independent cohort groups, were included in the meta-analysis. These studies involved 16 neuropsychological tests providing 23 different performance measures that constitute the neurobehavioral constructs. All tests and measures of the neurobehavioral functions of attention, visuomotor integration, verbal abstraction and perception constructs showed significant decrements for exposed participants. One out of three tests of memory, two of five tests of sustained attention, and four of eight tests of motor speed constructs also showed significant decrements. Nine out of these 15 effect size distributions demonstrated significant heterogeneity across cohorts. A search for cohort-level variables (eg, agricultural workers vs applicators, duration of exposure, age and percentage of male participants) to explain this heterogeneity was largely unsuccessful. However, for one test, Block Design, the duration of exposure was positively associated with performance decrements. Furthermore, it was also found that performance decrements on this test were smaller for older participants. Increasing the number of studies and using more consistent methodologies in field studies are needed.

Clinical and biochemical parameters of children and adolescents applying pesticides.

BACKGROUND: The primary agricultural product in Egypt is the cotton crop. Children and adolescents work seasonally in the cotton fields applying pesticides. OBJECTIVE: To examine the effect of pesticide exposure on clinical and biochemical parameters in children and adolescents applying pesticides. METHODS: Male children currently applying pesticides and aged between 9 and 19 years (n = 50) were recruited for this study. They were asked to complete work, health, and exposure questionnaires; examined for any medical and neurological problems with particular attention to sensory and motor functions including cranial nerves, sensory and motor system, and reflexes. From each participant, a blood sample was taken to measure acetylcholinesterase activity, and liver and kidney functions. Children who have never worked in agriculture (n = 50), matched on age, education, and socioeconomic status were also studied and served as controls. RESULTS: More neuromuscular disorders were identified in pesticide applicators than controls. A significant lower level of acetylcholinesterase was found in the applicator group compared to the controls. There was also a significant difference in hematological, renal and hepatic indices in the exposed children compared to the control children. Working more days in the current season and also working more years as a pesticide applicator were both associated with an increase in the prevalence of neuromuscular abnormalities and significant changes in the laboratory tests. CONCLUSION: Children and adolescent pesticide applicators working in farms of Egypt are at risk of developing serious health problems similar to those of adults.

Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service.

OBJECTIVE: Controversy exists concerning unexplained illness in Persian Gulf War veterans, especially regarding the contribution of psychological trauma. We sought to determine if war zone trauma or posttraumatic stress symptomatology (PTSS) are associated with illnesses reported by Gulf War veterans that were documented by medical examination but not attributable to a medical diagnosis. METHODS: A total of 1119 (55% response rate) of 2022 randomly sampled veterans of the United States Persian Gulf War were screened and 237 cases and 113 controls were identified by medical examination for a case-control study comparing Persian Gulf War military veterans with or without medically documented, but unexplained, symptoms. Multivariate logistic regression and cross-validation analyses examined self-report measures of demographics, subjective physical symptoms and functioning, psychiatric symptoms, stressors, war zone trauma, and PTSS, to identify correlates of case-control status. RESULTS: Posttraumatic stress symptomatology and somatic complaints were independently associated with case status, as were (although less consistently) war zone trauma and depression. Age, education, and self-reported health, stress-related somatization, pain, energy/fatigue, illness-related functional impairment, recent stressors, and anxiety were univariate (but not multivariate) correlates of case status. CONCLUSIONS: PTSS related to war zone trauma warrants additional prospective research study and attention in clinical screening and assessment as a potential contributor to the often debilitating physical health problems experienced by Persian Gulf War veterans.

cTRAIN: a computer-aided training system developed in SuperCard for teaching skills using behavioral education principles.

A computer-aided training program was developed in SuperCard and piloted with professional painters. Taking a modern programmed-instruction/behavioral-education approach, cTRAIN is structured as a series of information sets. Each information set consists of a series of information screens (three to five recommended) followed by quiz screens (one to three recommended) structured as four-response multiple choice questions. Correct quiz responses produce positive feedback and continuation in the series, whereas incorrect responses result in "error" feedback and return the student to the beginning of the information set to repeat the same information screens and the same quiz question. This report demonstrates a specific implementation, respiratory protection requirements, using the flexible cTRAIN system for developing training modules. Fifteen adults completed the respiratory protection program, demonstrating substantial and significant (p < .0001 by paired t test) gains from baseline pretest (19.4 out of 30 questions) to the immediate posttest (28.1). Performance remained elevated (26.4) on a retest taken 1 week later.

Assessment of neurobehavioral function with computerized tests in a population of hispanic adolescents working in agriculture.

In recent years there has been heightened concern over the potential of occupational or environmental exposures to affect neurological function in children and adolescents. The current study was designed to develop computerized tests to effectively assess neurobehavioral function in Hispanic adolescents working in agriculture and to evaluate those tests in Hispanic youths working in agriculture and in a non-agricultural group. After exclusions, 96 adolescents currently working in agriculture (AG) and 51 adolescents currently non-migratory and not working in agriculture (Non-AG) were tested. Neurobehavioral tests were selected from the computerized Behavioral Assessment and Research System. AG test performance was significantly below Non-AG performance on the cognitive tests. However, educational and cultural differences between the AG and Non-AG groups may explain this difference. Repeat testing of the AG group revealed substantially improved performance, further supporting educational or cultural differences as an explanation for the group differences. Together, these results expose the limitations in case-control or cross-sectional designs for testing migrant worker populations in the United States. Longitudinal or cross-sectional designs with repeat testing offer more promise and may be essential for drawing accurate conclusions in migrant worker groups where there are no truly equivalent comparison or control groups.

Neurobehavioral deficits in Persian Gulf veterans: additional evidence from a population-based study.

Reports of low-concentration nerve gas exposures during the Gulf War (GW) have spurred concern about possible health consequences and symptoms reported by many returning veterans. The Portland Environmental Hazards Research Center is studying veterans from the northwest United States who report persistent, unexplained "Gulf War" symptoms (cases) and those who do not report those symptoms (controls). An epidemiological survey focused on exposures and symptoms was mailed to a random sample of GW veterans from Oregon and southwestern Washington. Volunteers recruited from survey respondents agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with Persian Gulf service (e.g., fatigue, muscle pain, memory deficits) beginning during or after the war qualified respondents as cases. The 239 cases with unexplained symptoms and the 112 controls without symptoms were administered a computerized assessment battery of 12 psychosocial and 6 neurobehavioral tests. Replicating and extending previous interim findings, a subgroup of veterans emerged from the initial analysis in the form of extreme outliers which produced a visually and quantitatively obvious bimodal distribution. This led, as it had previously, to analyses of the outliers as a separate group (labeled "slow ODTP"), which confirmed the initial findings of neurobehavioral differences between the outliers and the other cases and controls and provided more convincing evidence that the majority of cases who report neurobehavioral symptoms have no objective evidence of neurobehavioral deficits. However, the larger group of symptomatic veterans do have highly significant and compelling evidence of psychological distress based on scores from 11 separate psychological tests. Whereas the cases differed from the controls by poorer neurobehavioral test performance, extraction of the slow ODTP participants (almost all cases) eliminated neurobehavioral performance differences between the remaining cases and the controls and provided support for the hypothesis that the slow ODTP cases might have been from the unhealthy end of the GW population prior to the war. However, there was no evidence of poor motivation, pre-GW educational differences, or greater association with abnormal psychological function in this group than in other cases or controls.

Development of a neurobehavioral battery for children exposed to neurotoxic chemicals.

In recent years there has been heightened concern over the potential impact of environmental exposures on neurological function in children. Children are thought to be especially vulnerable to neurotoxic effects due to a number offactors including play behavior, differences in metabolism, and the development state of the brain. Performance tests from the computerized Behavioral Assessment and Research System (BARS) and other non-computerized tests have been combined to develop a brief battery that assesses multiple neurobehavioral functions in preschool children aged 4-6. Tests were selected to assess a variety of cognitive functions including attention, memory, motor speed and coordination and other executive functions. The battery has also been translated into Spanish and developed for use with Latino populations. Four to six-year-old children are particularly challenging because of the shorter attention span and lower motivation to complete an extended test session. When testing this group it is important to maintain the motivation of the child throughout the entire session in order to obtain accurate performance measures. A series of sequential pilot studies were used to select and develop appropriate methods and parameters for the tests in the battery. Although English-speaking children were able to complete the initial battery with minimal difficulties, several difficulties were encountered when the tests were administered to a Latino population. Cultural differences made some material inappropriate for testing due to unfamiliarity with the material, and in some cases items in a test had more than one correct translation which made administration difficult.

Neurobehavioral deficits associated with chronic fatigue syndrome in veterans with Gulf War unexplained illnesses.

Gulf War unexplained illnesses (GWUI) are a heterogeneous collection of symptoms of unknown origin known to be more common among veterans of the Gulf War than among nonveterans. In the present study we focused on one of these unexplained illnesses. We tested the hypothesis that in a sample of Persian Gulf War veterans chronic fatigue syndrome (CFS) was associated with cognitive deficits on computerized cognitive testing after controlling for the effects of premorbid cognitive differences. We obtained Armed Forces Qualification Test (AFQT) data acquired around the date of induction into the military on 94 veterans of the Gulf War, 32 with CFS and 62 healthy controls. Controls performed better than participants diagnosed with CFS on the AFQT. Cognitive deficits were associated with CFS on 3 of 8 variables after the effect of premorbid AFQT scores was removed with ANCOVA.

Neurobehavioral testing in humans.

The evaluation of the effects of chemical exposures on humans is a worldwide concern, and most chemicals have not been evaluated for neurotoxic effect. Human neurobehavioral research or clinical evaluations of populations exposed to chemicals must be carefully planned and structured. This unit describes the steps required to create such a study, select the appropriate measures, and evaluate the results.

Establishing stable test performance in tests from the Behavioral Assessment and Research System (BARS).

Research to identify adverse effects in humans chronically exposed to neurotoxic substances in the workplace or environment typically assesses people at one point in time in a cross-sectional study. The most widely used strategy employs performance measures taken from a single point in time and compares these with either performance of a control group or established normative data. However, multiple comparison points of the same people on the same test allow the dissection of acute--from chronic--exposure effects, among other important questions. When performance measures are used from multiple points in time, within-subject deviations are examined. For either research design, the goal is to minimize the effects of practice and to obtain stable performance on a test. Demographic variables such as age, education, and cultural background or ethnicity influence performance on neurobehavioral tests. These variables may also influence the development of stable performance. Different populations may have different learning curves so that stable performance on a test is achieved with different amounts of practice. This is especially important when making comparisons across groups that may not have equivalent backgrounds. The performance of three groups, English-speaking adults, Spanish-speaking adolescents, and Spanish-speaking migrant adolescents, was examined. Each group completed a battery of neurobehavioral tests from the Behavioral Assessment and Research System (BARS) during four sessions. Repeated measures ANOVAs were used to investigate performance across time. Tests measuring motor performance produced stable performance from the first session. More complex tasks that involved attention and memory showed a practice effect across sessions.

Lessons learned--15 years of the WHO-NCTB: a review.

Based on expert recommendations, the World Health Organization (WHO) recommended the Neurobehavioral Core Test Battery (NCTB) in 1983 to detect neurotoxicity in world-wide populations. The NCTB consists of 7 neurobehavioral tests (Digit Symbol, Digit Span, Benton visual memory test/recognition form, Santa Ana dexterity test, Simple Reaction Time, Pursuit Aiming II, and Profile of Mood States). Research with the NCTB provides the context for the results of a mini-symposium held in 1999 to discuss the lessons learned about using the NCTB in working populations. Speakers from Africa, Asia, Europe, and North America reviewed data from 94 studies using the NCTB, including 63 from China, 13 from Korea, 11 from Poland, three from South Africa, three from the USA, and one from Ecuador. Although a consensus was not sought in the symposium, the key lessons learned that emerged from the various presentations, were: * The NCTB is effective in testing adults with 12 or more years of formal education, but can not reliably test persons with less than 9 years of education. * People from cultures very different from those in Europe and North America (eg, aboriginal and African cultures) may not be tested effectively by the NCTB, although others such as at least some Asian populations, can be. To address this problem, the construct validity of the NCTB should be established in a wide range of countries. * The POMS measures of emotion proved to be very sensitive to neurotoxic exposures in several countries, but the POMS was the NCTB test most affected by cultural differences. The Digit Symbol or the Milan modification of that test was also highly sensitive to neurotoxic exposures. * Examiner drift following training to administer the NCTB is a significant problem in technically trained Examiners. Pursuit Aiming II is very difficult to score reliably.

Psychological differences between veterans with and without Gulf War unexplained symptoms. Portland Environmental Hazards Research Center.

OBJECTIVE: The objective of this study was to assess measures of psychological and neurobehavioral functioning to determine their association with unexplained symptoms in Gulf War veterans. METHODS: An epidemiological survey focusing on exposures and symptoms was mailed to a random sample of Gulf War veterans from Oregon and southwestern Washington. Volunteers were recruited from survey respondents who agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with service in the Persian Gulf (eg, fatigue, muscle pain, and memory deficits) that began during or after the war qualified respondents as cases. The 241 veterans with unexplained symptoms were classified as case subjects, and the 113 veterans without symptoms were classified as control subjects. All veterans completed a battery of computerized assessment tests consisting of 12 psychosocial and 6 neurobehavioral tests. Differences between case and control subjects on neurobehavioral and psychological variables were assessed with univariate and multivariate statistical comparisons. RESULTS: Case subjects differed substantially and consistently from control subjects on diverse psychological tests in the direction of increased distress and psychiatric symptoms. Case subjects had small but statistically significant deficits relative to control subjects on some neurobehavioral tests of memory, attention, and response speed. A logistic regression model consisting of four psychological variables but no neurobehavioral variables classified case and control subjects with 86% accuracy. CONCLUSIONS: Our results revealed that Gulf War veterans who report symptoms associated with that conflict differed on multiple psychological measures in the direction of increased distress and performed more poorly on neurobehavioral measures when compared with control subjects who did not report symptoms. This suggests that psychological differences have a prominent role in investigation of possible explanations of Gulf War symptoms.

Comparison of MMPI-2 profiles of Gulf War veterans with epileptic and nonepileptic seizure patients.

As part of a larger study of illnesses related to service in the Gulf War, MMPI-2 profiles of epileptic seizure (ES) patients; nonepileptic seizure (NES) patients; Gulf War veterans with unexplained cognitive, psychological, musculoskeletal, fatigue, or dermatologic symptoms; and asymptomatic Gulf War veterans (Controls) were analyzed. There were 70 people in each group. Seizure diagnosis was based upon intensive EEG monitoring. Gulf War cases were mildly abnormal on MMPI-2 Scales Hs and D and significantly higher than controls on 8 of 10 MMPI-2 clinical scales, but they were significantly lower than NES patients on several scales including Hs and Hy.

Smiling faces and other rewards: using the Behavioral Assessment and Research System (BARS) with unique populations.

Concern about the exposure of children and adolescents to occupational and environmental hazards has increased, and so has the need to develop testing methods that can adequately assess the effects of exposure in children. A computerized testing system, the Behavioral Assessment and Research System (BARS), was successfully modified to test both younger populations and populations which do not speak English, the original language of the battery. These adaptations were modifications of the existing features of the BARS system which was designed to assess the broadest possible audience: simple language instructions broken down into basic concepts (step-by-step training with competency testing at each instruction step); a token dispenser along with a "smiling face" stimulus that reinforced appropriate performance; and adjustable parameter settings (e.g., number of trials, difficulty). Data from four groups demonstrate the feasibility of using BARS with children as young as preschool age and for non-English speaking children.