Ambient Ammonia Exposures in an Agricultural Community and Pediatric Asthma Morbidity.

BACKGROUND: Large-scale animal feeding operations compromise regional air quality in the rural US through emission of pollutants, such as ammonia gas. Exposure to airborne pollution from animal feeding operations may cause pediatric asthma exacerbations in surrounding communities. OBJECTIVES: To describe spatial and temporal patterns in ambient ammonia concentrations in an agricultural region, and to investigate associations between short-term fluctuations in ammonia and subsequent changes in respiratory health in children with asthma. METHODS: For 13 months in the Yakima Valley of Washington State, 14 monitors sampled ammonia in outdoor air for 24-hour periods every 6 days. School-age children with asthma (n = 51) were followed for two health outcomes: biweekly reports of asthma symptoms and quick relief medication usage, and daily measurements of forced expiratory volume in 1 second. We assessed associations between each outcome and ammonia using generalized estimating equations. RESULTS: Twenty-four-hour ammonia concentrations varied from 0.2 to 238.1 µg/m during the study period and displayed a strong correlation with proximity to animal feeding operations. The percentage of forced expiratory volume in 1 second was 3.8% lower (95% confidence interval = 0.2, 7.3) per interquartile increase in 1-day lagged ammonia concentration and 3.0% lower (95% confidence interval = 0.5, 5.8) for 2-day lagged concentration. We observed no associations between self-reported asthma symptoms or medication usage and estimated ammonia exposure. CONCLUSIONS: Ammonia concentrations were elevated in this community and strongly predicted by proximity to animal feeding operations. Ammonia's association with acute lung function decrements in children with asthma in the surrounding community may be causal or, alternatively, ammonia may be a marker for other pollutants from animal feeding operations associated with respiratory effects.

Regional PM2.5 and asthma morbidity in an agricultural community: a panel study.

BACKGROUND: Elevated pediatric asthma morbidity has been observed in rural US communities, but the role of the ambient environment in exacerbating rural asthma is poorly understood. OBJECTIVES: To investigate associations between particulate matter less than 2.5 µm in diameter (PM2.5) and pediatric asthma exacerbations in an agricultural community of Washington State. METHODS: School-aged children with asthma (n=58) were followed for up to 25 months with repeated measures of respiratory health. Asthma symptoms and quick-relief medication use were assessed biweekly through phone administered surveys (n=2023 interviews). In addition, subjects used home peak flow meters on a daily basis to measure forced expiratory volume in one second (FEV1) (n=7830 measurements). Regional PM2.5 was measured at a single air monitor located centrally in the study region. To assess relationships between PM2.5 and these outcomes we used linear regression with generalized estimating equations, adjusting for meteorological and temporal confounders. Effect modification by atopy was explored as well. RESULTS: An interquartile increase (IQR) in weekly PM2.5 of 6.7 µg/m(3) was associated with an increase in reported asthma symptoms Specific symptoms including wheezing, limitation of activities, and nighttime waking displayed the strongest associations. FEV1 as a percent of predicted decreased by 0.9% (95%CI: -1.8, 0.0) for an IQR increase in PM2.5 one day prior, and by 1.4% (95%CI: -2.7, -0.2) when restricted to children with atopic asthma. CONCLUSIONS: This study provides evidence that PM2.5 in an agricultural setting contributes to elevated asthma morbidity. Further work on identifying and mitigating sources of PM2.5 in the area is warranted.

Empowering Agricultural Workers Through Community Health Worker-Led Pesticide Safety Workshops in Washington State.

Background: It is difficult to reach migrant or refugee agricultural workers about pesticide exposure prevention. Here, we describe a community health worker (CHW)-led pesticide exposure prevention workshop and the impact of this program among migrant and refugee workers in Washington state. Methods: A focus group of migrants and refugees participated in the development of a CHW-led Spanish language pesticide exposure prevention mobile phone app and workshop. Pre- and post-workshop surveys assessed pesticide training, knowledge, and characteristics. Results: Community health workers facilitated 28 workshops attended by 263 participants from 49 agricultural communities. Approximately 79% of participants reported no prior pesticide training. Significant improvements were observed in the proportion familiar with illnesses associated with pesticides, knowledge about pesticide definition, ability to correctly identify the content of pesticide labels, and the correct method to wash fruits and vegetables. Conclusions: Community health workers are effective in addressing the gaps in pesticide safety education and awareness among migrant and refugee communities. Further work is needed to assess how to better integrate a mobile phone app into this training and subsequent use of the knowledge.

Estimated time-varying exposures to air emissions from animal feeding operations and childhood asthma.

BACKGROUND/AIM: Industrial-scale animal feeding operations (AFOs) have adverse impacts on regional air quality. Air emissions include endotoxins and other pro-inflammatory components, and exposure may cause airway inflammation and respiratory effects in susceptible individuals residing nearby. We aimed to develop and validate metrics for estimating time-varying exposure to AFO air pollution in surrounding communities and, secondly, to determine whether exposure is associated with health effects in children with asthma. METHODS: We conducted a longitudinal panel study of N = 58 children with asthma in an agricultural region of Washington State with a high density of dairy AFOs. Children were followed for up to 26 months with repeated measures of respiratory health (N = 2023 interviews; N = 3853 lung function measurements); urine was collected in a subcohort (N = 16) at six-day intervals over three months and analyzed for leukotriene E4 (LTE4), a biomarker of systemic inflammation (N = 138 measurements). We developed an approach to estimate daily exposure to AFO airborne emissions based on distance to AFOs, AFO size, and daily wind speed and direction, and validated the estimates against direct measurements of ammonia, a chemical marker of AFO emissions, measured biweekly at 18 sites across the region for 14 months. Short-term relationships between AFO pollutant exposure and outcomes were assessed using regression models accounting for within-participant correlation and several potential confounders. RESULTS: Estimates of daily AFO air pollution correlated moderately well with outdoor ammonia measurements (N = 842; r = 0.62). Forced expiratory volume in 1 s (FEV1) as percent of predicted was 2.0% (95% CI: 0.5, 3.5) lower with each interquartile increase in previous day exposure, but no associations with asthma symptoms were observed. There was suggestive evidence that LTE4 concentrations were higher following days of elevated exposure to AFO emissions (p = 0.06). CONCLUSIONS: A simple metric of time-varying exposure to AFO emissions was correlated with daily outdoor ammonia levels. Children with asthma may be adversely affected by exposure to AFO emissions.

Boston Naming Test: problems with administration and scoring.

The poorly written administration and scoring instructions for the Boston Naming Test allow too wide a range of interpretations. Three different, seemingly correct interpretations of the scoring methods were compared. The results show that these methods can produce large differences in the total score.

Antropometría en la evaluación nutricional de adolescentes del sexo femenino / Anthropometry in the nutritional evaluation of female adolescents

Se realizó un estudio antropométrico en 197 niñas de Ciudad de La Habana, según las normas del Programa Biológico Internacional. Se tomó peso, talla, pliegues cutáneos tricipital y subescapular, y dimensiones corporales. Los índices antropométricos fueron área grasa del brazo (AGB), índice energía/proteína (I E/P), el índice de masa corporal (IMC) y área muscular del brazo (AMB). Se clasificaron en canales percentilares según las Normas de Cuba para individuos hasta los 19 años. Se buscó el valor promedio, la desviación estándar y la mediana por edad, e indicadores para evaluar el estado nutricional de la muestra. Los datos se procesaron de forma automatizada y se aplicó la prueba de significación estadística. Se halló que la muestra en su mayoría se situó a la derecha de los percentiles 4 y 5 para todas las determinaciones y que el mayor tanto por ciento de obesidad fue el punto de corte de Amador(AU)

Antropometría en la evaluación nutricional de adolescentes del sexo femenino / Anthropometry in the nutritional evaluation of female adolescents

Se realizó un estudio antropométrico en 197 niñas de Ciudad de La Habana, según las normas del Programa Biológico Internacional. Se tomó peso, talla, pliegues cutáneos tricipital y subescapular, y dimensiones corporales. Los índices antropométricos fueron área grasa del brazo (AGB), índice energía/proteína (I E/P), el índice de masa corporal (IMC) y área muscular del brazo (AMB). Se clasificaron en canales percentilares según las Normas de Cuba para individuos hasta los 19 años. Se buscó el valor promedio, la desviación estándar y la mediana por edad, e indicadores para evaluar el estado nutricional de la muestra. Los datos se procesaron de forma automatizada y se aplicó la prueba de significación estadística. Se halló que la muestra en su mayoría se situó a la derecha de los percentiles 4 y 5 para todas las determinaciones y que el mayor tanto por ciento de obesidad fue el punto de corte de Amador

Indicadores antropométricos en la evaluación nutricional en adolescentes del sexo masculino / Anthropometric indicators in the nutritional evaluation of male adolescents

Se realizó un estudio antropométrico transversal descriptivo en 179 adolescentes del sexo masculino, en edades comprendidas entre 11,0 y 14,9 años de edad, procedentes de Ciudad de La Habana, según las normas del Programa Biológico Internacional. Se tomó peso, talla, pliegue cutáneo tricipital y subescapular y se determinaron las dimensiones corporales siguientes: peso y talla para la edad, peso para la talla, índice de masa corporal, área grasa del brazo e índice energía/proteína. Se clasificaron por canales percentilares según las Normas Nacionales para individuos de 0 a 19 años del sexo masculino. Se determinó el valor promedio, la desviación estándar, la mediana y el porcentaje de individuos por canal percentilar para cada indicador y se compararon además con los valores del National Center Health Statistics (NCHS) y con los valores del Estudio Nacional de Crecimiento y Desarrollo para la Población Cubana, 1982. Los datos se procesaron de forma automatizada y se aplicó la prueba de significación estadística, donde se encontró que la muestra fue típica según las normas de referencias y con los valores del NCHS, y en su mayoría los valores porcentuales se ubicaron entre el 4 y 7 canal percentilar. El mayor tanto por ciento de obesidad correspondió al punto de corte de Amador para el índice energía/proteína ( ³ 1500)(AU)

Indicadores antropométricos en la evaluación nutricional en adolescentes del sexo masculino / Anthropometric indicators in the nutritional evaluation of male adolescents

Se realizó un estudio antropométrico transversal descriptivo en 179 adolescentes del sexo masculino, en edades comprendidas entre 11,0 y 14,9 años de edad, procedentes de Ciudad de La Habana, según las normas del Programa Biológico Internacional. Se tomó peso, talla, pliegue cutáneo tricipital y subescapular y se determinaron las dimensiones corporales siguientes: peso y talla para la edad, peso para la talla, índice de masa corporal, área grasa del brazo e índice energía/proteína. Se clasificaron por canales percentilares según las Normas Nacionales para individuos de 0 a 19 años del sexo masculino. Se determinó el valor promedio, la desviación estándar, la mediana y el porcentaje de individuos por canal percentilar para cada indicador y se compararon además con los valores del National Center Health Statistics (NCHS) y con los valores del Estudio Nacional de Crecimiento y Desarrollo para la Población Cubana, 1982. Los datos se procesaron de forma automatizada y se aplicó la prueba de significación estadística, donde se encontró que la muestra fue típica según las normas de referencias y con los valores del NCHS, y en su mayoría los valores porcentuales se ubicaron entre el 4 y 7 canal percentilar. El mayor tanto por ciento de obesidad correspondió al punto de corte de Amador para el índice energía/proteína.