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Ornelas Van Horne Y, Johnston JE, Barahona DD, Razafy M, Kamai EM, Ruiz BC, Eckel SP, Bejarano E, Olmedo L, Farzan SF. Exposure to agricultural pesticides and wheezing among 5-12-year-old children in the Imperial Valley, CA, USA. Environ Epidemiol 2024; 8:e325. [PMID: 39165346 PMCID: PMC11335338 DOI: 10.1097/ee9.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/12/2024] [Indexed: 08/22/2024] Open
Abstract
Background Exposure to pesticides has been linked to adverse respiratory health outcomes in children. Methods We leveraged the Children's Assessing Imperial Valley Respiratory Health and the Environment cohort located in the rural community of Imperial Valley near the US-Mexico border. We calculated the kilograms of total pesticides applied within 400 m of children's residential addresses for the years 2016-2020. Estimated pesticide usage near homes was categorized into three groups (none vs. low vs. high [split at the median]). All health variables (i.e., asthma status and wheezing) were derived from a parent-reported questionnaire on respiratory health. We used generalized linear models, controlling for child sex, the language of survey, health insurance, respondents' highest education, and exposure to environmental secondhand smoking, to calculate prevalence differences between none versus low and high exposure to agricultural pesticides. Results Approximately 62% of the 708 children (aged 5-12 years) lived within 400 m of at least one pesticide application within 12 months prior to survey administration. Exposure to pesticides within 400 m of children's residences was associated with 12-month prior wheeze. Those in the "high" exposure group had a prevalence of wheezing that was 10 (95% confidence interval: 2%, 17%) percentage points higher than among children not exposed to pesticide applications. Associations for high exposure to specific categories of pesticide applications, sulfur only, all pesticides except sulfur, chlorpyrifos, and glyphosate, also were observed with a higher prevalence of wheezing than among children not exposed to pesticide applications. Conclusions We observed associations between living near pesticide applications and more wheeze symptoms among children.
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Affiliation(s)
- Yoshira Ornelas Van Horne
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, New York
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jill E. Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Dayane Duenas Barahona
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mitiasoa Razafy
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth M. Kamai
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brandyn C. Ruiz
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Luis Olmedo
- Comite Civico Del Valle, Brawley, California
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
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Keleb A, Daba C, Asmare L, Bayou FD, Arefaynie M, Mohammed A, Tareke AA, Kebede N, Tsega Y, Endawkie A, Kebede SD, Abera KM, Abeje ET, Enyew EB. The association between children's exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis. Front Public Health 2024; 12:1402908. [PMID: 38868160 PMCID: PMC11167956 DOI: 10.3389/fpubh.2024.1402908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
Background Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children. Methods A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique. Result A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14-1.35) with extreme heterogeneity (I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14-1.57), with high heterogeneity (I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45-2.21) with nonsignificant low heterogeneity (I 2 = 30%, p-value = 0.18). Conclusion This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.
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Affiliation(s)
- Awoke Keleb
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lakew Asmare
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Fekade Demeke Bayou
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anissa Mohammed
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health in Africa, COVID-19 Vaccine/EPI Technical Assistant at West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kaleab Mesfin Abera
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Eyob Tilahun Abeje
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Ermias Bekele Enyew
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Jestin-Guyon N, Raherison-Semjen C. [Pesticide exposure and chronic respiratory diseases]. Rev Mal Respir 2024; 41:343-371. [PMID: 38594123 DOI: 10.1016/j.rmr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Pesticides are used worldwide, mainly in agriculture as a means of controlling pests and protecting crops. That said, the entire world population is ultimately subject to pesticide exposure (consumption of fruits and vegetables, living near treated fields…), with varying degrees of toxicity involved. STATE OF THE ART In recent decades, epidemiological studies have contributed to the identification of chemical pesticide families with detrimental effects on human health: cognitive disorders, Parkinson's disease, prostate cancer… and impairment in respiratory functioning. Current scientific evidence points to the implication of the active substances in insecticides, herbicides and fungicides in chronic respiratory diseases, two examples being chronic obstructive pulmonary disease (COPD) in exposed workers, and asthmatic wheezing in children during prenatal or postnatal exposure. PERSPECTIVES The safety of individuals exposed to pesticides is of key importance in public health. Further epidemiological investigations are needed to identify the chemical families affecting certain populations. CONCLUSIONS The scientific literature suggests strong links between pesticide exposure and respiratory health. Whether it be environmental or occupational, pesticide exposure can lead to respiratory disorders and symptoms of varying severity.
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Affiliation(s)
- N Jestin-Guyon
- UMR1219 Bordeaux Population Health Centre de Recherche, ISPED, université de Bordeaux, 146, rue Léo-Saignat, 33000 Bordeaux, France.
| | - C Raherison-Semjen
- UMR1219 Bordeaux Population Health Centre de Recherche, ISPED, université de Bordeaux, 146, rue Léo-Saignat, 33000 Bordeaux, France; Centre hospitalier universitaire de la Guadeloupe, 97159 Pointe-à-Pitre, Guadeloupe
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Li Y, Lu D, Xia Y, Xu X, Huang H, Mei X, Yang M, Li J, Zhu S, Liu Y, Zhang Z. Effects of allyl isothiocyanate fumigation on medicinal plant root knot disease control, plant survival, and the soil bacterial community. BMC Microbiol 2023; 23:278. [PMID: 37775764 PMCID: PMC10542678 DOI: 10.1186/s12866-023-02992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/22/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Allyl isothiocyanate (AITC) is a natural product with high volatility that is used as a biofumigant to alleviate soil-borne plant diseases, and problems such as root knot nematodes (RKNs) that necessitate continuous cropping. However, little research has assessed the effects of AITC fumigation on medicinal plants. RESULTS AITC significantly reduced the population of RKNs in soil (p < 0.0001) and showed an excellent RKN disease control effect within 6 months after sowing Panax notoginseng (p < 0.0001). The seedling survival rate of 2-year-old P. notoginseng was approximately 1.7-fold higher after soil treatment with AITC (p = 0.1008). 16S rRNA sequencing indicated that the AITC treatment affected bacterial richness rather than diversity in consecutively cultivated (CC) soil. Furthermore, biomarkers with statistical differences between AITC-treated and untreated CC soil showed that Pirellulales (order), Pirellulaceae (family), Pseudomonadaceae (family), and Pseudomonas (genus) played important roles in the AITC-treated group. In addition, the microbiome functional phenotypes predicted using the BugBase tool suggested that AITC treatment is more conducive to improving CC soil through changes in the bacterial community structure. Crucially, our research also suggested that AITC soil treatment significantly increases soil organic matter (p = 0.0055), total nitrogen (p = 0.0054), and available potassium (p = 0.0373), which promotes the survival of a succeeding medicinal plant (Polygonatum kingianum). CONCLUSION AITC is an ecologically friendly soil treatment that affects the top 10 bacterial richness but not diversity. It could also provide a basis for a useful agricultural soil management measure to alleviate soil sickness.
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Affiliation(s)
- Yingbin Li
- Department of Pesticide Science, College of Plant Protection, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Daqing Lu
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Yan Xia
- Department of Pesticide Science, College of Plant Protection, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Xinjing Xu
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Huichuan Huang
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Xinyue Mei
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Min Yang
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Jianqiang Li
- Department of Plant Pathology, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University, Beijing, 100193, China
| | - Shusheng Zhu
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China
| | - Yixiang Liu
- Key Laboratory for Agro-biodiversity and Pest Control of Ministry of Education, Yunnan Agricultural University, Kunming, Yunnan, 650201, China.
| | - Zhiping Zhang
- Department of Horticulture, College of Landscape and Horticulture, Yunnan Agricultural University, Kunming, Yunnan, 650201, China.
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Rodrigues MDB, Carvalho DSD, Chong-Silva DC, Urrutia-Pereira M, Albuquerque GSCD, Cieslak F, Chong-Neto HJ. Association between exposure to pesticides and allergic diseases in children and adolescents: a systematic review with meta-analysis. J Pediatr (Rio J) 2022; 98:551-564. [PMID: 34982974 PMCID: PMC9617275 DOI: 10.1016/j.jped.2021.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents. METHOD A systematic review and meta-analysis were performed using the PRISMA method with the question "What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?" MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected. RESULTS Exposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29). CONCLUSIONS Exposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review.
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Affiliation(s)
| | - Denise Siqueira de Carvalho
- Universidade Federal do Paraná, Programa de Pós-Graduação em Saúde Coletiva, Curitiba, PR, Brazil; Universidade Federal do Paraná, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| | | | - Marilyn Urrutia-Pereira
- Universidade Federal dos Pampas, Centro de Pesquisa em Educação em Saúde e Meio Ambiente, Uruguaiana, RS, Brazil
| | - Guilherme Souza Cavalcanti de Albuquerque
- Universidade Federal do Paraná, Programa de Pós-Graduação em Saúde Coletiva, Curitiba, PR, Brazil; Universidade Federal do Paraná, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| | - Fabrício Cieslak
- Universidade Federal do Paraná, Departamento de Educação Física, Curitiba, PR, Brazil
| | - Herberto José Chong-Neto
- Universidade Federal do Paraná, Programa de Pós-Graduação em Saúde Coletiva, Curitiba, PR, Brazil
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Van Horne YO, Farzan SF, Razafy M, Johnston JE. Respiratory and allergic health effects in children living near agriculture: A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 832:155009. [PMID: 35381238 PMCID: PMC9167771 DOI: 10.1016/j.scitotenv.2022.155009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/08/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exposure to pesticides and agricultural burning are likely to co-occur in agricultural communities, but these exposures have remained distinct bodies of research. We reviewed epidemiological studies to identify the respiratory health effects of children exposed to pesticides and agricultural burning through a systematic evaluation of peer-reviewed publications of children living in industrial agricultural areas. METHODS Two academic search databases (PubMed and Scopus) were queried for all available studies published in English before May 31st, 2021. The initial search combining both exposure metrics (pesticides and agricultural burning) yielded zero publications and thus the queries were performed and presented separately. RESULTS Studies were categorized based on main exposure of interest (i.e., pesticides or agricultural burning) and by respiratory health outcome assessment (i.e., self-reported asthma, acute respiratory symptoms, and lung function measurements). In total we identified 25 studies that focused on pesticide exposures and children's respiratory health, and 12 studies that focused on exposure to agricultural burning and children's respiratory health. A majority of the pesticide studies (18/25) reported a positive association between exposure to pesticides and adverse childhood respiratory health effects. Similarly, most (11/12) of the agricultural burning studies also reported a positive association between exposure to agricultural burning and adverse respiratory health effects. CONCLUSION The most frequently studied health outcomes in these publications were acute respiratory symptoms (n = 11 pesticides, n = 3 agricultural burning), followed by asthma (n = 9 pesticides, n = 3 agricultural burning), and lung function measurements (n = 5 pesticides, n = 6 agricultural burning). Although health outcome assessment differed between pesticide studies and agricultural burning studies, similar adverse respiratory health effects were observed across the majority of studies.
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Affiliation(s)
- Yoshira Ornelas Van Horne
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA.
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA
| | - Mitiasoa Razafy
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA
| | - Jill E Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA 90032, USA
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Diyapoglu A, Oner M, Meng M. Application Potential of Bacterial Volatile Organic Compounds in the Control of Root-Knot Nematodes. Molecules 2022; 27:molecules27144355. [PMID: 35889228 PMCID: PMC9318376 DOI: 10.3390/molecules27144355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Plant-parasitic nematodes (PPNs) constitute the most damaging group of plant pathogens. Plant infections by root-knot nematodes (RKNs) alone could cause approximately 5% of global crop loss. Conventionally, chemical-based methods are used to control PPNs at the expense of the environment and human health. Accordingly, the development of eco-friendly and safer methods has been urged to supplement or replace chemical-based methods for the control of RKNs. Using microorganisms or their metabolites as biological control agents (BCAs) is a promising approach to controlling RKNs. Among the metabolites, volatile organic compounds (VOCs) have gained increasing attention because of their potential in the control of not only RKNs but also other plant pathogens, such as insects, fungi, and bacteria. This review discusses the biology of RKNs as well as the status of various control strategies. The discovery of VOCs emitted by bacteria from various environmental sources and their application potential as BCAs in controlling RKNs are specifically addressed.
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Affiliation(s)
- Ali Diyapoglu
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan
| | - Muhammet Oner
- Department of Life Science, National Chung Hsing University, Taichung 402, Taiwan
| | - Menghsiao Meng
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung 402, Taiwan
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Yu HR, Lin CHR, Tsai JH, Hsieh YT, Tsai TA, Tsai CK, Lee YC, Liu TY, Tsai CM, Chen CC, Chang CH, Hsu TY, Niu CK. A Multifactorial Evaluation of the Effects of Air Pollution and Meteorological Factors on Asthma Exacerbation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114010. [PMID: 32512940 PMCID: PMC7313451 DOI: 10.3390/ijerph17114010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 01/05/2023]
Abstract
In the real world, dynamic changes in air pollutants and meteorological factors coexist simultaneously. Studies identifying the effects of individual pollutants on acute exacerbation (AE) of asthma may overlook the health effects of the overall combination. A comprehensive study examining the influence of air pollution and meteorological factors is required. Asthma AE data from emergency room visits were collected from the Taiwan National Health Insurance Research Database. Complete monitoring data for air pollutants (SO2; NO2; O3; CO; PM2.5; PM10) and meteorological factors were collected from the Environmental Protection Agency monitoring stations. A bi-directional case-crossover analysis was used to investigate the effects of air pollution and meteorological factors on asthma AE. Among age group divisions, a 1 °C temperature increase was a protective factor for asthma ER visits with OR = 0.981 (95% CI, 0.971–0.991) and 0.985 (95% CI, 0.975–0.994) for pediatric and adult patients, respectively. Children, especially younger females, are more susceptible to asthma AE due to the effects of outdoor air pollution than adults. Meteorological factors are important modulators for asthma AE in both asthmatic children and adults. When studying the effects of air pollution on asthma AE, meteorological factors should be considered.
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Affiliation(s)
- Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
- Correspondence: ; Tel.: +886-7-5252000 (ext. 4339); Fax: +886-7-5254-301
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan;
- PhD Program in Environmental and Occupation Medicine, (Taiwan) National Health Research Institutes and Kaohsiung Medical University, Kaohsiung 80737, Taiwan
| | - Yun-Ting Hsieh
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
| | - Ti-An Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chang-Ku Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Yi-Chen Lee
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Ta-Yu Liu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chih-Min Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chih-Cheng Chen
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chih-Hao Chang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung 83301, Taiwan;
| | - Te-Yao Hsu
- Department of Obstetrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan;
| | - Chen-Kuang Niu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
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