Assessing exposure of young children to common endocrine-disrupting chemicals in the home environment: A review and commentary of the questionnaire-based approach

Background: Although infants and young children are particularly vulnerable to endocrine disrupting chemical (EDC) exposure, there is an absence of comprehensive exposure data for this age group. As young children spend the majority of their time indoors, improved methods of exposure assessment are needed to characterise the health risks from exposures in the home environment. Biologic assessment, which has been considered the gold standard for exposure assessment in recent years, is difficult to conduct in young children. Questionnaires are an alternative and indirect method of predicting exposure, which may overcome some of the limitations of direct exposure assessment. Research problem: The feasibility of using a questionnaire-based approach to predict exposure of young children to EDCs in the home has yet to be comprehensively reviewed. Moreover, there is no one questionnaire that has been validated for predicting the exposure of infants to common EDCs in the home. Aims and objectives: The aim of this review is to discuss the use and validation of the questionnaire-based approach to predict exposure of children to chemicals from three common classes of EDCs in the home, namely, plasticisers, flame retardants, and insecticides. We discuss the strengths and weaknesses of the questionnaire-based approach as well as the important pathways of exposure in the home environment, by which to guide the design and validation of future exposure questionnaires. Results: The findings from our review indicate that the questionnaire-based approach is a valuable tool in the prediction of exposure to persistent organic pollutants, as well as to toxicants that have consistent patterns of exposure. With improvements to the design and validation process, the questionnaire-based approach may also prove to be a reliable instrument in predicting exposure to EDCs with short-half lives, including bisphenol A, phthalates, and pyrethroid and organophosphate insecticides

BDE-209 in the Australian environment: desktop review

The commercial polybrominated diphenyl ether (PBDE) flame retardant mixture c-decaBDE is now being considered for listing on the Stockholm Convention on Persistent Organic Pollutants. The aim of our study was to review the literature regarding the use and detection of BDE-209, a major component of c-decaBDE, in consumer products and provide a best estimate of goods that are likely to contain BDE-209 in Australia. This review is part of a larger study, which will include quantitative testing of items to assess for BDE-209. The findings of this desktop review will be used to determine which items should be prioritized for quantitative testing. We identified that electronics, particularly televisions, computers, small household appliances and power boards, were the items that were most likely to contain BDE-209 in Australia. Further testing of these items should include items of various ages. Several other items were identified as high priority for future testing, including transport vehicles, building materials and textiles in non-domestic settings. The findings from this study will aid in the development of appropriate policies, should listing of c-decaBDE on the Stockholm Convention and Australia's ratification of that listing proceed

Consumption of foods by young children with diagnosed campylobacter infection - a pilot case-control study

Objective: To determine whether parentally reported habitual intake of specific foods differed between children with diagnosed Campylobacter jejuni infection and children of a comparison group without diagnosed infection. Design, setting and subjects: Information was collected from the parents or primary caregivers of South Australian children aged 1–5 years with diagnosed C. jejuni (cases, n = 172) and an age- and gender-matched group of uninfected children (controls, n = 173). Frequency of consumption of 106 food and drink items was determined for the preceding two months by food-frequency questionnaire. Four children in the control group had recorded diarrhoeal episodes during the assessment period and were excluded, so 169 responses were evaluated for this group. Information was gathered on possible confounders including socio-economic status. Response frequencies were classified into three levels of consumption (rarely, weekly or daily) and statistical comparison was made by frequency of consumption of foods versus the ‘rarely’ classification for cases and controls, respectively. Results: Frequency of consumption of most foods, including starchy foods and fruits and vegetables, did not differ between cases and controls. However, reported consumption of eight food items (block and processed cheese (slices and spread), salami/fritz (a form of processed sausage), chicken nuggets, pasteurised milk, fish (canned or fresh) and hot French fries) was significantly higher by controls. Conclusions: The hypothesis that reported consumption of starchy foods was lower by cases than by controls was not supported by the data. However, consumption of some processed and unprocessed foods was higher by controls. Some of these foods have established bactericidal actions in vitro that may indicate a possible mechanism for this apparent protection

Perfil lipídico de cortes comerciales de terneros lactantes en pastoreo

The objective of the present research was to determine the contents of fat, cholesterol and fatty acids of eight beef cuts from unsupplemented, suckling, 7-8 month old male and female calves reared on permanent pastures in the VIIth Region of Chile by small cattle producers. A total of 54 animals with a mean carcass weight of 150 ± 22 kg were slaughtered in a commercial abattoir on three different dates during the month of March, 2008. Five samples of each of eight cuts were collected at random as they exited the abattoir, cooled and packed following industry practices. Beef cuts were selected based on an earlier, unreplicated analysis of 21 common cuts, to represent a wide range of cuts currently available to consumers. Large and significant differences were observed in fat content with a mean of 2.12%, ranging between 4.23% for sirloin strip and 0.68% for butcher’s roast. The cholesterol content did not differ between cuts (mean 44.7 mg/100 mg meat) and was unrelated to fat percentage. A stringent discriminant analysis of the fatty acid profiles detected highly significant differences between cuts and correctly classified 37 of the 40 samples. The n6:n3 ratio did not differ between cuts and ranged between 1.9 for sirloin strip and 2.6 for rib roast and silverside’s end. Significant differences between cuts were detected for most fatty acids, and for the atherogenicity index. Nevertheless, the latter only varied between 0.60 and 1.07 for topside and sirloin strip respectively. The results are compared with literature values. Notwithstanding differences between cuts, all beef samples were lean and had lipid profiles compatible with human health as part of a balanced diet.El objetivo del trabajo fue determinar el contenido de grasa, colesterol y perfil de ácidos grasos de ocho cortes provenientes de terneros lactantes, de 7-8 meses de edad y engordados en prados permanentes de la VII Region de Chile, por productores pequeños. Se sacrificaron 54 animales en tres fechas diferentes de Marzo de 2008, con un peso medio de canal de 150±22 kg. Se obtuvieron cinco muestras al azar de cada corte a medida que salían de la planta procesadora, las que fueron enfriadas y empaquetadas siguiendo el protocolo industrial. Los cortes fueron seleccionados en base a un análisis no replicado anterior de 21 cortes comúnmente disponibles en el mercado. Se encontraron diferencias significativas y considerables en el contenido de grasa, con una media de 2,12% y rango de 4,23 para lomo liso y 0,68% para asado abastero. El contenido medio de colesterol fue de 44,7 mg/100 g de carne, sin diferencias significativas entre cortes. Un análisis discriminante exigente detectó diferencias altamente significativas en el perfil de ácidos grasos, y clasificó correctamente a 37 de las 40 muestras analizadas. La relación n6:n3 no difirió entre cortes y osciló entre 1,9 para lomo liso y 2,6 para sobrecostilla y punta de ganso respectivamente. Se encontraron diferencias significativas para la mayoría de los ácidos grasos y para el índice de aterogenicidad. Sin embargo este último osciló sólo entre 0,60 y 1,07 para posta negra y lomo liso respectivamente. Los resultados son comparados con valores informados en la literatura. A pesar de las diferencias halladas entre cortes, todos fueron magros y tuvieron perfiles lipídicos compatibles con la salud humana, en dietas balanceadas

Development of a questionnaire-based insecticide exposure assessment method and comparison with urinary insecticide biomarkers in young Australian children

Environmental and behavioural factors assessed via an online questionnaire were compared to insecticide metabolite concentrations in urine collected from 61 children from South East Queensland, Australia. Metabolite concentrations (μg/L urine) were transformed using the natural logarithm prior to regression analysis and adjusted for age and creatinine. A significant dietary association was reported for vegetable intake and 3-phenoxybenzoic acid (3-PBA) (β: 1.47 for top quartile of intake versus bottom quartile of intake 95% CI: 0.36, 2.57). Intake of vegetables and fruit were also positively associated with sum non-specific organophosphate metabolites (ƩnsOP). ƩnsOP concentrations were lower when fruits and vegetables were always or almost always washed prior to cooking or eating (β: -0.69 95% CI: -1.25, -0.12). In multivariable modelling 3-PBA concentrations were also associated with hand-washing frequency (β: 1.69 95% CI: 0.76, 2.61 for  3 day), presence of a dog in the home (β: 0.73 95% CI: 0.07, 1.38), frequency of pest-spray use in the summer months (β: 0.88 95% CI: 0.22, 1.54 weekly versus less than weekly) and season (β: 0.88 95% CI: 0.32, 1.44 for spring/summer versus winter/autumn). This is the first study in Australia to report dietary, behavioural and environmental factors associated with biomarkers of insecticide exposure in young children

Malaria Rapid Testing by Community Health Workers Is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania

Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients. Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. Primary outcome was provision of ACT and main secondary outcomes were referral rates and health status by days 3 and 7. The CHWs enrolled 2930 fever patients during five months of whom 1988 (67.8%) presented within 24 hours of fever onset. ACT was provided to 775 of 1457 (53.2%) patients during RDT weeks and to 1422 of 1473 (96.5%) patients during CD weeks (Odds Ratio (OR) 0.039, 95% CI 0.029-0.053). The CHWs adhered to the RDT results in 1411 of 1457 (96.8%, 95% CI 95.8-97.6) patients. More patients were referred on inclusion day during RDT weeks (10.0%) compared to CD weeks (1.6%). Referral during days 1-7 and perceived non-recovery on days 3 and 7 were also more common after RDT aided diagnosis. However, no fatal or severe malaria occurred among 682 patients in the RDT group who were not treated with ACT, supporting the safety of withholding ACT to RDT negative patients. RDTs in the hands of CHWs may safely improve early and well-targeted ACT treatment in malaria patients at community level in Africa.\ud \ud \ud \u

Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda

<p>Abstract</p> <p>Background</p> <p>Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid diagnostic tests (RDTs) could address these challenges but only if the communities will accept their use by CHWs. This study assessed community acceptability of the use of RDTs by Ugandan CHWs, locally referred to as community medicine distributors (CMDs).</p> <p>Methods</p> <p>The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. Pre-designed FGD and KII guides were used to collect data. Manifest content analysis was used to explore issues of trust and confidence in CMDs, stigma associated with drawing blood from children, community willingness for CMDs to use RDTs, and challenges anticipated to be faced by the CMDs.</p> <p>Results</p> <p>CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred.</p> <p>Conclusion</p> <p>Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support. A well-designed behaviour change communication strategy is needed to address the anticipated programmatic challenges as well as community fears and stigma about drawing blood. Level of formal education may have to be a criterion for CMD selection into programmes deploying RDTs.</p