Effect of urban vs. rural residence on the association between atopy and wheeze in Latin America: findings from a case-control analysis.

BACKGROUND: The association between atopy and asthma is attenuated in non-affluent populations, an effect that may be explained by childhood infections such as geohelminths. OBJECTIVE: To investigate the association between atopy and wheeze in schoolchildren living in urban and rural areas of Ecuador and examine the effects of geohelminths on this association. METHODS: We performed nested case-control studies among comparable populations of schoolchildren living in rural communities and urban neighbourhoods in the Province of Esmeraldas, Ecuador. We detected geohelminths in stool samples, measured recent wheeze and environmental exposures by parental questionnaire, and atopy by specific IgE (sIgE) and skin prick test (SPT) reactivity to aeroallergens. RESULTS: Atopy, particularly sIgE to house dust mite (HDM), was more strongly associated with recent wheeze in urban than rural schoolchildren: (urban, adj. OR 5.19, 95% CI 3.37-8.00, P < 0.0001; rural, adj. OR 1.81, 95%CI 1.09-2.99, P = 0.02; interaction, P < 0.001). The population fractions of wheeze attributable to atopy were approximately two-fold greater in urban schoolchildren: SPT to any allergen (urban 23.5% vs. rural 10.1%), SPT to HDM (urban 18.5% vs. rural 9.6%), and anti-HDM IgE (urban 26.5% vs. rural 10.5%), while anti-Ascaris IgE was related to wheeze in a high proportion of rural (49.7%) and urban (35.4%) children. The association between atopy and recent wheeze was attenuated by markers of geohelminth infections. CONCLUSIONS: Our data suggest that urban residence modifies the association between HDM atopy and recent wheeze, and this effect is explained partly by geohelminth infections

Cohort Profile: The Ecuador Life (ECUAVIDA) study in Esmeraldas Province, Ecuador.

The ECUAVIDA birth cohort is studying the impact of exposures to soil-transmitted helminth (STH) parasites and early-life microbial exposures on the development of atopy, allergic diseases and immune responses in childhood. A total of 2404 newborns were recruited between 2006 and 2009 in a public hospital serving the rural district of Quininde, Esmeraldas Province, in a tropical region of coastal Ecuador. Detailed measurements were done around the time of the birth, at 7 and 13 months and at 2 and 3 years, and data collection is ongoing at 5 and 8 years. Data being collected include questionnaires for: sociodemographic, lifestyle, psychosocial (at 4-6 years only) and dietary (at 6-7 years only) factors; childhood morbidity and clinical outcomes; stool samples for parasites; blood samples for DNA, measurements of vaccine responses and other measures of immune function/inflammation; and anthropometrics. Allergen skin prick test reactivity is done from 2 years and measures of airway function and inflammation at 8 years

Risk factors for acute asthma in tropical America: a case-control study in the City of Esmeraldas, Ecuador.

BACKGROUND: Despite the high asthma rates described in Latin America, asthma risk factors in poor urban settings are not well established. We investigated risk factors for acute asthma among Ecuadorian children. METHODS: A matched case-control study was carried out in a public hospital serving a coastal city. Children with acute asthma were age- and sex-matched to non-asthmatics. A questionnaire was administered, and blood, as well as stool, and nasopharyngeal swabs were collected. RESULTS: Sixty cases and 119 controls aged 5-15 were evaluated. High proportions of cases were atopic with population-attributable fractions for atopy of 68.5% for sIgE and 57.2% for SPT. Acute asthma risk increased with greater titers of mite IgE (3.51-50 kU/l vs. 50kU/l vs. <0.70kU/l - OR 41.98, 95% CI: 8.97-196.39, p < 0.001). Asthma risk was significantly independently associated with bronchiolitis (adj. OR: 38.9, 95% CI 3.26-465), parental educational level (adj. OR 1.26, 95% CI: 1.08-1.46), and presence of sIgE (adj. OR: 36.7, 95% CI: 4.00-337), while a reduced risk was associated with current contact with pets (adj. OR: 0.07, 95% CI: 0.01-0.56). Rhinovirus infection was more frequent in cases (cases 35.6% vs. controls 7.8%, p = 0.002). None of the cases were on maintenance therapy with inhaled corticosteroids and most relied on emergency department for control. CONCLUSIONS: A high proportion of children presenting to a public hospital with acute asthma were allergic to mite, particularly at high IgE titer. Poor asthma control resulted in overuse of emergency care

Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study.

Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused

Conceptualising the Global Forest Response to Liana Proliferation

Lianas are woody vines, rooted in the soil, and supported physically by trees. Lianas contribute to forest ecosystem functioning globally, but especially in the tropics and subtropics. However, prolific liana growth following heavy disturbance frequently affects subsequent recovery of forest tree diversity, biomass, structure, and function. Understanding this forest liana dynamic, and its sensitivity to climate and anthropogenic forces, is essential for worldwide forest restoration and climate change mitigation. Here, we synthesise the evidence for both positive and negative effects of lianas on forests and propose a framework that outlines the expected global response of forests to disturbance-induced liana proliferation. Emerging evidence suggests that lianas play a major role in both facilitating and delaying forest recovery following disturbance. At low levels of disturbance and/or where environmental conditions favour tree growth, lianas can facilitate forest recovery by protecting trees from extreme weather, fire, weed invasion and herbivory. However, under conditions where lianas proliferate beyond critical thresholds, positive feedbacks are expected to induce and sustain liana-dominated forest states that can endure for decades or even longer. We conceptualise alternative classes of forest recovery response to disturbance and describe measurement and modelling of liana thresholds.We identify four essential challenges for global change science relating to lianas: (1) incorporation of lianas and sapling stems into forest monitoring and tree stand measurements worldwide; (2) long-term experiments to determine variation in liana-tree competition, and potential drivers across forest successional gradients; (3) identification and prediction of liana thresholds and other alternative forest recovery response classes; and (4) dynamicmechanisticmodelling of forest recovery to determine regional and global variation within and among different recovery response classes, in relation to variation in potential drivers, liana feedbacks and their interactions. Addressing these challenges will determine the importance of lianas in shaping regional and global forest composition, recovery and dynamics

Certified community forests positively impact human wellbeing and conservation effectiveness and improve the performance of nearby national protected areas

Community forests (CFs) aim to improve human wellbeing and conservation effectiveness, though their performance remains contested. A recent innovation in protected area (PA) governance is to combine CFs with forest certification. We assess (1) the impact of certified CFs on wellbeing and conservation effectiveness; (2) gender inequality and elite capture; (3) interaction effects with neighboring national PAs. We used a novel approach that integrates field data consisting of locally identified indicators representative of multidimensional wellbeing, with remotely sensed data on conservation effectiveness and statistical matching to improve causal inference. We found that CFs positively impacted wellbeing, conservation effectiveness, and reduced gender inequality, though they did not reduce elite capture. We also detected positive interaction effects between certified CFs and neighboring national PAs. Our findings suggest that locating contrasting local and national PA governance approaches next to each other may help to maximize wellbeing and conservation benefits within complex multiuse landscapes

Asthma in changing environments - chances and challenges of international research collaborations between South America and Europe - study protocol and description of the data acquisition of a case-control-study

<p>Abstract</p> <p>Background</p> <p>Asthma in children is an emerging public health problem in South America. So far, research in this part of the world is limited. This paper presents the methodology and description of the data acquisition of an asthma case-control study conducted in the Central South of Chile.</p> <p>Methods/Design</p> <p>A hospital-based case-control study about asthma (188 cases, 294 controls) in children (6-15 years) was carried out in Valdivia, Chile between November 2008 and December 2009. Data on asthma risk factors were collected by computer-assisted personal interview using validated questions from e.g. ISAAC phase II. Data on household dust exposure (endotoxin, allergen analyses), skin prick tests to most common allergens, stool examinations for parasitic infection, and blood samples (total IgE, genetics) were collected. Additionally, 492 randomly chosen blood donors were recruited in order to assess allele frequencies in the population of Valdivia.</p> <p>Discussion</p> <p>Overall 1,173 participants were contacted. Response was 82% among cases and 65% among controls. Atopic sensitization was high (78% among cases, 47% among controls). Cases had a statistically significantly (p < .0001) increased self-reported 12-month prevalence of symptoms of rhinitis (82% vs. 51%) and wheeze (68% vs. 16%). The study is well placed to address current hypotheses about asthma and its correlates in the South American context. Results of this study might help develop novel, innovative and individualized prevention strategies in countries in transition with respect to the South American context.</p

Impact of early life geohelminths on wheeze, asthma, and atopy in Ecuadorian children at 8 years.

BACKGROUND: Early-lifeexposures to geohelminths may protect against development of wheeze/asthma and atopy. OBJECTIVE: Study effect of maternal geohelminths and infections in children during the first 5 years on atopy, wheeze/asthma, and airways reactivity/inflammation at 8 years. METHODS: Birth cohort of 2,404 neonates followed to 8 years in rural Ecuador. Data on wheeze/asthma were collected by questionnaire and atopy by skin prick test (SPT) reactivity to 9 allergens. We measured airways reactivity to bronchodilator, fractional exhaled nitric oxide (FeNO), and nasal eosinophilia. Stool samples were examined for geohelminths by microscopy. RESULTS: 1,933 (80.4%) children were evaluated at 8 years. Geohelminths were detected in 45.8% of mothers and 45.5% of children to 5 years. Frequencies of outcomes at 8 years were: wheeze (6.6%), asthma between 5 and 8 years (7.9%), SPT (14.7%), airways reactivity (10%), and elevated FeNO (10.3%) and nasal eosinophilia (9.2%). Any maternal geohelminth was associated with reduced SPT prevalence (OR 0.72).Childhood Trichuris trichiura infectionsduring the first 5 years were associated with reduced wheeze (OR 0.57) but greater parasite burdens with Ascaris lumbricoidesat 5 years were associated with increased wheeze (OR 2.83) and asthma (OR 2.60). Associations between maternal geohelminths and wheeze/asthma were modified by atopy. Parasite-specificeffects on wheeze/asthma and airways reactivity and inflammation were observed in non-atopic children. CONCLUSIONS: Our data provide novel evidence for persistent effects of in utero geohelminth exposures on childhood atopy but highlight the complex nature of the relationship between geohelminths and the airways. Registered as an observational study (ISRCTN41239086)

Community-Based Climate Change Adaptation Action Plans to Support Climate-Resilient Development in the Eastern African Highlands

Smallholder farmers in the Eastern African Highlands depend on rain-fed agriculture for their livelihoods. Climate adaptation and sustainable development goals must be targeted in an integrated way to better match farmers’ realities and address local priorities and vulnerabilities in these areas. To support climate-resilient development in the Eastern African Highlands, 224 local stakeholders were engaged in the development of community-based climate change adaptation action plans for the Jimma Highlands in Ethiopia, Taita Hills in Kenya and Mount Kilimanjaro in Tanzania. Participatory methods, high-resolution climate projections and the United Nations Development Programme’s (UNDP’s) guidelines were used in the design of these climate action plans with specific objectives to: 1) engage stakeholders to increase understanding of climate change impacts, adaptation options and their potential trade-offs, 2) build their capacities to design climate change adaptation projects, 3) empower stakeholders to identify existing vulnerabilities and enhance climate resilience and 4) strengthen networks to facilitate information access and sharing. Increased risk of water stress and reduction of agricultural productivity were the most frequently identified climate-change-induced problems in the three areas. The developed action plans target the underlying causes of these problems and describe sector-specific responses, activities, critical barriers and opportunities and support the National Adaptation Programmes of Action.Peer reviewe