Neurobehavioral Development in Children With Potential Exposure to Pesticides

Children may be at higher risk than adults from pesticide exposure, due to their rapidly developing physiology, unique behavioral patterns, and interactions with the physical environment. This preliminary study conducted in Ecuador examines the association between household and environmental risk factors for pesticide exposure and neurobehavioral development. We collected data over 6 months in the rural highland region of Cayambe, Ecuador (2003–2004). Children age 24–61 months residing in 3 communities were assessed with the Ages and Stages Questionnaire and the Visual Motor Integration Test. We gathered information on maternal health and work characteristics, the home and community environment, and child characteristics. Growth measurements and a hemoglobin finger-prick blood test were obtained. Multiple linear regression analyses were conducted. Current maternal employment in the flower industry was associated with better developmental scores. Longer hours playing outdoors were associated with lower gross and fine motor and problem solving skills. Children who played with irrigation water scored lower on fine motor skills (8% decrease; 95% confidence interval 9.31 to 0.53), problem-solving skills (7% decrease; 8.40 to 0.39), and Visual Motor Integration test scores (3% decrease; 12.00 to 1.08). These results suggest that certain environmental risk factors for exposure to pesticides may affect child development, with contact with irrigation water of particular concern. However, the relationships between these risk factors and social characteristics are complex, as corporate agriculture may increase risk through pesticide exposure and environmental contamination, while indirectly promoting healthy development by providing health care, relatively higher salaries, and daycare options

Sociodemographic and nutritional correlates of neurobehavioral development: a study of young children in a rural region of Ecuador

To identify and describe the sociodemographic and nutritional characteristics associated with neurobehavioral development among young children living in three communities in the northeastern Andean region of Cayambe-Tabacundo, Ecuador. Women in the study communities who had a child 3 to 61 months of age completed a questionnaire about maternal and child health and sociodemographic characteristics. The Ages and Stages Questionnaire (ASQ) was directly administered to 283 children by two trained interviewers. Growth measurements and a hemoglobin finger-prick blood test were obtained in 2003–2004. Prevalence of developmental delay was calculated, and associations between child development and maternal, child, and household characteristics were explored. High frequencies of developmental delay were observed. Children 3 to 23 months old displayed delay in gross motor skills (30.1%), and children 48 to 61 months old displayed delay in problem-solving skills (73.4%) and fine motor skills (28.1%). A high frequency of both anemia (60.4%) and stunting (53.4%) was observed for all age groups. Maternal educational level was positively associated with communication and problem-solving skills, and monthly household income was positively associated with communication, gross motor, and problem-solving skills. The results suggest a high prevalence of developmental delay and poor child health in this population. Child health status and the child’s environment may contribute to developmental delay in this region of Ecuador, but sociodemographic factors affecting opportunities for stimulation may also play a role. Research is needed to identify what is causing high percentages of neurobehavioral developmental delay in this region of Ecuador.Identificar y describir las características sociodemográficas y nutricionales asociadas con el desarrollo neuroconductual en niños pequeños de tres comunidades de la región nororiental andina de Cayambe-Tabacundo, Ecuador. Mujeres de las comunidades estudiadas con algún hijo de 3 a 61 meses de edad llenaron un cuestionario sobre sus características, las características de salud de su hijo y las características sociodemográficas. Dos entrevistadores entrenados aplicaron el Cuestionario sobre Edades y Etapas (Ages and Stages Questionnaire, ASQ) directamente a 283 niños. Se midió el crecimiento y se realizó una prueba de hemoglobina mediante punción digital en el período 2003–2004. Se calculó la prevalencia del retraso en el desarrollo y se exploraron las asociaciones entre el desarrollo del niño y las características de la madre, del niño y del hogar. Se observaron elevadas frecuencias de retraso en el desarrollo. Los niños de 3 a 23 meses de edad presentaron retraso en las habilidades motrices básicas (30,1%) y los niños de 48 a 61 meses de edad presentaron retraso en las habilidades para solucionar problemas (73,4%) y en las habilidades motrices finas (28,1%). Se encontró una elevada frecuencia de anemia (60,4%) y de retraso en el crecimiento (53,4%) en todos los grupos de edad. Se observó una asociación directa entre el nivel educacional de la madre y las habilidades de comunicación y de solución de problemas de sus hijos, así como entre los ingresos mensuales del hogar y las habilidades de comunicación, las motrices básicas y de solución de problemas. Los resultados indican que hay una elevada prevalencia de retraso en el desarrollo y una deficiente salud infantil en la población estudiada. El estado de salud del niño y su entorno pueden contribuir al retraso en el desarrollo en esta región de Ecuador, sin embargo, los factores socioedemográficos que afectan negativamente a las oportunidades de estimulación pueden desempañar un papel importante en ello. Se requieren investigaciones que identifiquen las causas del elevado porcentaje de retraso en el desarrollo neuroconductual en esta región de Ecuador

Is there a rationale for the continuous infusion of cefepime? A multidisciplinary approach

This review is the fruit of multidisciplinary discussions concerning the continuous administration of β-lactams, with a special focus on cefepime. Pooling of the analyses and viewpoints of all members of the group, based on a review of the literature on this subject, has made it possible to test the hypothesis concerning the applicability of this method of administering cefepime. Cefepime is a cephalosporin for injection which exhibits a broader spectrum of activity than that of older, third-generation cephalosporins for injection (cefotaxime, ceftriaxone, ceftazidime). The specific activity of cefepime is based on its more rapid penetration (probably due to its zwitterionic structure, this molecule being both positively and negatively charged) through the outer membrane of Gram-negative bacteria, its greater affinity for penicillin-binding proteins, its weak affinity for β-lactamases, and its stability versus certain β-lactamases, particularly derepressed cephalosporinases. The stability of cefepime in various solutions intended for parenteral administration has been studied, and the results obtained demonstrated the good compatibility of cefepime with these different solutions. These results thus permit the administration of cefepime in a continuous infusion over a 24-h period, using two consecutive syringes

Effect of Community of Residence on Neurobehavioral Development in Infants and Young Children in a Flower-Growing Region of Ecuador

OBJECTIVE: In this study we compared neurobehavioral development in Ecuadoran children living in two communities with high potential for exposure to organophosphate (OP) and carbamate pesticides to that of children living in a community with low potential for exposure. METHODS: Women residing in the study communities who had a child 3–61 months of age completed a questionnaire about maternal and child health and sociodemographic characteristics. The Ages and Stages Questionnaire (ASQ) was administered to each child (n = 283). Growth measurements and a hemoglobin finger-prick blood test were obtained. We used multiple linear regressions to evaluate associations between community of residence and delayed development, adjusting for child health status and other characteristics of the home environment. RESULTS: Children 3–23 months of age who resided in high-exposure communities scored lower on gross motor (p = 0.002), fine motor (p = 0.06), and socioindividual (p-value = 0.02) skills, compared with children in the low-exposure community. The effect of residence in a high-exposure community on gross motor skill development was greater for stunted children compared with non-stunted children (p = < 0.001) in the same age group of 3–23 months. Children 24–61 months of age residing in the high-exposure communities scored significantly lower on gross motor skills compared with children of similar ages residing in the low-exposure community (p = 0.06). CONCLUSIONS: Residence in communities with high potential for exposure to OP and carbamate pesticides was associated with poorer neurobehavioral development of the child even after controlling for major determinants of delayed development. Malnourished populations may be particularly vulnerable to neurobehavioral effects of pesticide exposure

Mapping socio-environmental vulnerability and environmental health promotion in a rural community of Lamarão, Federal District, Brazil, 2011

Objetivo: realizar atividade de ensino e extensão com alunos de graduação para construção de diagnóstico participativo sobre as condições de vida, ambiente e trabalho em núcleo populacional rural, visando subsidiar ações de promoção da saúde pela equipe de agentes comunitários da Estratégia Saúde da Família. Métodos: trabalho realizado no Núcleo Rural do Lamarão, no Distrito Federal, de outubro/2010 a janeiro/2011. Alunos, conjuntamente com agentes comunitários de saúde, por meio de entrevistas, visitas e oficinas, aplicaram instrumentos de Estimativa Participativa Rápida e de construção de mapa de vulnerabilidade socioambiental e de contextos de promoção da saúde ambiental. Resultados: identificaram-se como promotores da vida na comunidade: diversidade de produção de alimentos, liberdade e segurança, união e organização da comunidade, geração de empregos e natureza. Foram considerados ameaçadores à vida: cultura alimentar, uso inadequado de agrotóxicos, uso incorreto de equipamentos de proteção individual, pulverização aérea, falta de lazer, falta de transporte, uso de drogas lícitas e ilícitas. Conclusão: a partir do diagnóstico, será construído um projeto de intervenção participativo que incorporará características de ensino, pesquisa e extensão na relação Saúde, Trabalho, Ambiente e Nutrição.Objective: To involve undergraduate students in an extension activity aimed at conducting a participatory diagnosis on life, environment, and work conditions in a rural settlement, with the purpose of raising goals for future health promotion actions performed by community health agents of the Family Health Strategy. Methods: The study was held between October 2010 and January 2011 in the rural community of Lamarão, located in the Federal District in Brazil. By means of interviews, visits, and workshops, students and community health agentes used Participatory Rapid Appraisal instruments as well as tools for mapping socio-environmental vulnerability and health promotion related issues. Results: The following were identified as life promotion factors in the community: food production diversity, freedom and safety, unity and community organization, job generation, and nature. Considered as threatening to life were: food culture, improper use of pesticides, inadequate use of personal protective equipment, aerial spraying, lack of leisure, lack of transportation, use of licit and illicit drugs. Conclusion: A participatory intervention project will be developed, which will incorporate teaching, research and extension activities regarding Health, Work, Environment, and Nutrition