Home Interventions for Older Adults with Asthma

Older asthmatic adults are more likely to experience respiratory failure than younger adults and children with asthma. Older adults spend up to 90% of their time in the home where many allergens are found. While there is sufficient evidence that home interventions improve the health of asthmatic children, there is insufficient evidence for the effectiveness of home interventions with adults. Our research evaluates the hypothesis that multi-trigger, multifaceted home interventions improve respiratory health and reduce home asthma triggers for older adults. Methods: We evaluated the effectiveness of conducting interventions in the homes of 86 diverse, low-income older adults (age 62 or above) diagnosed with asthma, residing in public and private subsidized housing. The two largest populations include Hispanics (45%) and Asians (20%). Data was collected on respiratory health outcomes before and after the home intervention (questionnaires on symptoms, quality of life, medication use, doctor/ER/hospital visits, and exhaled nitric oxide (eNO) a measure of lung inflammation). Asthma trigger activities (ATAs) and exposures were also evaluated before and after the home intervention (questionnaire, home survey, measurement of nitrogen dioxide (NO2), dust samples for rodent and cockroach allergens, biomarker for cigarette smoke exposure (urinary cotinine). Interventions included education on asthma and environmental triggers; environmental remediation including mattress/pillow covers, provision of vacuum with HEPA filters, green cleaning supplies and changes in home as needed (commercial cleaning, integrated pest management, gas stove replacement, mold remediation). Results: Significant health improvements were found in the following areas: number of doctor visits due to asthma, quality of life indicators including symptom and activity levels, and asthma control test

Healthy Homes for Elders: Multi-trigger, Multi-component Environmental Interventions for Asthma

As part of the breakout session panel discussion entitled UMass Lowell Gerontology Community-Engaged Research Panel, Dr. Turcotte discusses his intervention study of environmental asthma triggers for asthmatic older adults in Lowell, Mass

Evaluation of cytotoxic, genotoxic and inflammatory responses of nanoparticles from photocopiers in three human cell lines

Background: Photocopiers emit nanoparticles with complex chemical composition. Short-term exposures to modest nanoparticle concentrations triggered upper airway inflammation and oxidative stress in healthy human volunteers in a recent study. To further understand the toxicological properties of copier-emitted nanoparticles, we studied in-vitro their ability to induce cytotoxicity, pro-inflammatory cytokine release, DNA damage, and apoptosis in relevant human cell lines. Methods: Three cell types were used: THP-1, primary human nasal- and small airway epithelial cells. Following collection in a large volume photocopy center, nanoparticles were extracted, dispersed and characterized in the cell culture medium. Cells were doped at 30, 100 and 300 μg/mL administered doses for up to 24 hrs. Estimated dose delivered to cells, was ~10% and 22% of the administered dose at 6 and 24 hrs, respectively. Gene expression analysis of key biomarkers was performed using real time quantitative PCR (RT-qPCR) in THP-1 cells at 5 μg nanoparticles/mL for 6-hr exposure for confirmation purposes. Results: Multiple cytokines, GM-CSF, IL-1β, IL-6, IL-8, IFNγ, MCP-1, TNF-α and VEGF, were significantly elevated in THP-1 cells in a dose-dependent manner. Gene expression analysis confirmed up-regulation of the TNF-α gene in THP-1 cells, consistent with cytokine findings. In both primary epithelial cells, cytokines IL-8, VEGF, EGF, IL-1α, TNF-α, IL-6 and GM-CSF were significantly elevated. Apoptosis was induced in all cell lines in a dose-dependent manner, consistent with the significant up-regulation of key apoptosis-regulating genes P53 and Casp8 in THP-1 cells. No significant DNA damage was found at any concentration with the comet assay. Up-regulation of key DNA damage and repair genes, Ku70 and Rad51, were also observed in THP-1 cells, albeit not statistically significant. Significant up-regulation of the key gene HO1 for oxidative stress, implicates oxidative stress induced by nanoparticles. Conclusions: Copier-emitted nanoparticles induced the release of pro-inflammatory cytokines, apoptosis and modest cytotoxicity but no DNA damage in all three-human cell lines. Taken together with gene expression data in THP-1 cells, we conclude that these nanoparticles are directly responsible for inflammation observed in human volunteers. Further toxicological evaluations of these nanoparticles, including across different toner formulations, are warranted

Heat Stress, Physiological Response, and Heat-Related Symptoms among Thai Sugarcane Workers

Prolonged or intense exposure to heat can lead to a range of health effects. This study investigated heat exposure and heat-related symptoms which sugarcane workers (90 sugarcane cutters and 93 factory workers) experienced during a harvesting season in Thailand. During the hottest month of harvesting season, wet bulb globe temperature was collected in the work environment, and workloads observed, to assess heat stress. Urine samples for dehydration test, blood pressure, heart rate, and body temperature were measured pre- and post-shift to measure heat strain. Fluid intake and heat-related symptoms which subjects had experienced during the harvesting season were gathered via interviews at the end of the season. From the results, sugarcane cutters showed high risk for heat stress and strain, unlike factory workers who had low risk based on the American Conference of Governmental Industrial Hygiene (ACGIH) threshold limit values (TLVs) for heat stress. Dehydration was observed among sugarcane cutters and significant physiological changes including heart rate, body temperature, and systolic blood pressure occurred across the work shift. Significantly more sugarcane cutters reported experiencing heat-related symptoms including weakness/fatigue, heavy sweating, headache, rash, muscle cramp, dry mouth, dizziness, fever, dry/cracking skin, and swelling, compared to sugarcane factory workers. We conclude that the heat stress experienced by sugarcane cutters working in extremely hot environments, with high workloads, is associated with acute health effects. Preventive and control measures for heat stress are needed to reduce the risk of heat strain

Prevalence and Factors Associated with Musculoskeletal Disorders among Thai Burley Tobacco Farmers

This cross-sectional analysis study aimed to identify the prevalence and factors associated with musculoskeletal disorders (MSDs) among Thai Burley tobacco farmers. Subjects included 603 burley tobacco farmers from Sukhothai province. Farmers were interviewed twice, (during planting and harvesting seasons), with a questionnaire consisting of demographic and health characteristics, musculoskeletal symptoms, and ergonomic exposure questions. The subjects average age was 49.5 years, more were female (58.5%), most had only a primary education (74.3%), 38% were overweight or obese. Farmers had a significantly higher prevalence of MSDs in the lower back (37.1%), knee (28.7%), shoulder (22.9%), wrist (19.9%), and hip (8.3%) during the harvesting season than in the planting season (p < 0.05). Models found that factors influencing MSDs prevalence during planting included long work hours in seedling, tasks such as topping tobacco plants, and using machine tools, after controlling for age, gender, and body mass index (BMI). While in the harvesting season, models found tasks conducted as a group had lower MSDs prevalence than individual work when carrying fresh tobacco to the barn, piercing/threading and curing the leaves, baling the bundles, and transporting the finished goods. We recommended working in groups to reduce workload and MSDs, especially during harvesting, in burley tobacco farming

Urinary Cypermethrin Metabolites among Conventional and Organic Farmers in Thailand

Cypermethrin, a pyrethroid insecticide, is frequently spread on agricultural farmlands and is also used in households in Thailand. Conventional pesticide-using farmers (n = 209) were recruited from the Phitsanulok and Nakornsawan provinces. Certified organic farmers (n = 224) were also recruited in the Yasothorn province. The farmers were interviewed via a questionnaire and the urine from their first morning void was collected. The urine samples were analyzed for 3-phenoxybenzoic acid (3-PBA), cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA), and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (trans-DCCA). The results showed no significant difference in the urinary cypermethrin metabolites between the conventional farmers and the organic farmers, for whom the usage of cypermethrin was not accounted for. However, when conventional farmers who used cypermethrin on the farm and in the home were compared with conventional farmers who did not use any cypermethrin or with organic farmers, a significant difference was noted for all metabolites except for trans-DCCA. These findings show that the most significant exposures to cypermethrin are among conventional farmers who use the insecticide on their farms or in their homes. However, measurable levels of all metabolites were found among both conventional and organic farmers who only used cypermethrin in the home or not at all, suggesting that the at-home use of pyrethroids and other possible exposures from pyrethroid residues on market-bought food may contribute to urinary levels of pyrethroids that exceed those of the general population in the US and Canada

Paraquat Exposure of Pregnant Women and Neonates in Agricultural Areas in Thailand

This study aimed to assess paraquat concentrations in the urine of women at 28 weeks of pregnancy, delivery and 2 months postpartum and in the meconium of neonates. In all, 79 pregnant women were recruited from three hospitals located in agricultural areas in Thailand. The subjects were interviewed about personal characteristics, agricultural activities and pesticide use patterns. Paraquat was analyzed in urine and meconium using high performance liquid chromatography equipped with a fluorescence detector. The geometric mean (GSD) of urinary paraquat concentrations at 28 weeks of pregnancy, delivery and 2 months postpartum were 2.04 (4.22), 2.06 (5.04) and 2.42 (5.33) ng/mL, respectively. The urinary paraquat concentrations at 28 weeks of pregnancy, delivery and 2 months postpartum between agriculturist and non-agriculturist were not significantly different (p = 0.632, p = 0.915, p = 0.57 respectively). The geometric mean (GSD) of paraquat concentration in the meconium was 33.31 (4.59) ng/g. The factors predicting paraquat exposures among pregnant women and neonates included working outside, living near farmland, having family members who work on a farm, drinking well water and using herbicides or paraquat

Urinary Organophosphate Metabolites and Metabolic Biomarkers of Conventional and Organic Farmers in Thailand

Organophosphate (OP) pesticides are used by most farmers to remove insects and to increase productivity; however, questions remain on the long-term health impacts of their use. This study assessed the relationship between OP biomarker levels and metabolic biomarker parameters. Conventional farmers (n = 213) and organic farmers (n = 225) were recruited, interviewed, and had physical health examinations. Serum glucose and lipid profiles, triglycerides, total cholesterol, high-density lipoproteins (HDL), and low-density lipoproteins (LDL) were measured. The average age, gender, education, and self-reported agricultural work time, work in second jobs, smoking status, alcohol consumption, insecticide use at home, home location near farmlands and years of pesticide use were significantly different between the conventional and organic farmers. The urinary OP metabolite levels were also significantly different between the two groups. With an increase in urinary diethyl phosphate, dimethyl phosphate and dialkyl phosphate metabolites, the total cholesterol, LDL and HDL, were significantly increased for all farmers after controlling for age, gender, alcohol consumption, years of pesticide use, and home location near farmlands. The results are consistent with our previous studies which suggests that pesticide usage, especially organophosphates, may increase the risk of cardiovascular disease and stroke among Thai farmers

Thyroid Hormones in Conventional and Organic Farmers in Thailand

Pesticides can act as endocrine disruptors by different mechanisms including inhibition of iodine absorption, increases in thyroid hormone clearance, decreased cellular uptake of thyroid hormones, or changes in expression of thyroid hormone regulated genes. This study examined how exposure to pesticides impacts thyroid hormone levels, thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free T3 (FT3), and free T4 (FT4) by comparing conventional (n = 195) and organic farmers (n = 222), and by evaluating which types of pesticides might be associated with changes in thyroid hormone levels. Questionnaires were used to collect information about farmer characteristics, self-reported stress, agricultural activities, and history of pesticide use. Conventional farmers were asked to report the type and quantity of pesticides used each day. The TSH, FT3, T3, and T4 levels of conventional farmers were 1.6, 1.2, 1.3, and 1.1 times higher than those of organic farmers, respectively, after adjusting for covariates. Several specific herbicides had a significant relationship between the amount applied and an increase in thyroid hormone levels, after covariate adjustment. They included: paraquat (TSH, FT3 and T3); acetochlor (FT4); atrazine (TSH, FT3 and T3); glyphosate (T4); diuron (TSH) and the “other” herbicides including alachlor, propanil, and butachlor (FT4 and T3). The most commonly used herbicide among conventional farmers was glyphosate, followed by paraquat, 2,4-dichlorophenoxyacetic acid (2,4-D). These findings suggest that exposure to pesticides could impact the development of metabolic diseases and other health outcomes by altering the endocrine system (the thyroid hormone levels) through the hypothalamic–pituitary–thyroid (HPT) axis. This work is a part of a longitudinal study which will evaluate the sub-chronic effects of repeated exposure to different types of pesticides on thyroid hormone levels