Comparing impact of pesticide exposure on cognitive abilities of Latinx children from rural farmworker and urban non-farmworker families in North Carolina

Pesticide exposure remains a health hazard despite extensive study into adverse effects. Children in vulnerable populations, such as Latinx children in farmworker families, are particularly at risk for exposure. Several studies have demonstrated the detrimental cognitive effects of prenatal exposure to pesticides, particularly organophosphates (OPs) within this high-risk group. However, results from studies investigating the cognitive effects of early childhood pesticide exposure are equivocal. Most studies examining the effects of pesticide exposure have used correlative analyses rather than examining populations with expected high and low exposure. The current study compares 8-year-old children from rural families of farmworkers and urban, non-farmworker families. We used the Weschler Intelligence Scale for Children - Fifth Edition (WISC-V) to assess cognitive performance in these children. We designed this study with the expectation that children from farmworker families would have greater exposure to agricultural pesticides than urban, non-farmworker children. This assumption of exposure to agricultural pesticides was confirmed in a recent report that assessed exposure probabilities using life history calendars. However, data from passive wristband sampling of acute (1-week) pesticide exposure from these same children indicate that both study populations have considerable pesticide exposure but to different chemicals. As expected the children of farmworkers had greater OP exposure than non-farmworker children, but the non-farmworker children had greater exposure to two other classes of insecticides (organochlorines [OCs] and pyrethroids). Our analyses considered these findings. A comparison of the cognitive scores between groups revealed that children from farmworker families had slightly higher performance on the Visual-Spatial Index (VSI) and Verbal Comprehension Index (VCI) when compared to children from non-farmworker families. Regression analyses where pesticide exposure was included as covariates revealed that OC exposure accounted for the largest portion of the group differences for both VSI and VCI. However, a post-hoc moderation analysis did not find significant interactions. The main study outcome was that the non-farmworker children exhibited lower WISC-V scores than the children from farmworker families, and the analyses incorporating pesticide exposure measures raise the hypothesis the that pervasive and persistent nature of a variety of pesticides may have adverse effects on the neurodevelopment of young Latinx children whether living in rural or non-farmworker environments.

Declining HIV/AIDS mortality in New York City

BACKGROUND

New York City has only 3% of the U.S. population but has reported nearly 16% of all AIDS cases.

METHODS

This is an observational study using the New York City vital events and AIDS case surveillance registries to describe trends in HIV/AIDS mortality from 1983 through June 30, 1998.

RESULTS

Annual HIV/AIDS deaths increased steadily until stabilizing at 7046 in 1995, declined 29% to 4998 in 1996, and declined 47% to 2625 in 1997. Comparing data from 1997 with those from 1995, declines occurred in all demographic groups and in all major HIV transmission categories: 74% in men who have sex with men, 68% in injecting drug users, and 64% in heterosexuals. In the first 6 months of 1998, declines were smaller than they had been in previous 6-month intervals in all demographic groups except Hispanic males and those between 35 and 44 years of age. From 1995 to the first 6 months of 1998, the number of people living with AIDS in New York City increased 22% (from 32,692 to 39,976).

CONCLUSIONS

The precipitous 63% decline in HIV/AIDS deaths from 1995 to 1997 occurred at the same time that more effective antiretroviral therapies became widely available. The slowing in the mortality decline observed in 1998, however, suggests that although these new therapies may have a profound effect at the population level, deaths due to AIDS will continue.

An analysis of nonconfirmation rates. Experiences of a surgical second opinion program

A review was conducted of the first 12 months' experience with a voluntary second opinion surgery consultation program. The program covers approximately 950,000 persons: employees of the city of New York, retirees, and their dependents. On a simple yes or no basis, the program's surgical nonconfirmation rate was 25%. More detailed analysis of consultants' narrative suggestions for patient care showed that a firm rejection of surgical intervention occurred in only 8% of the cases reviewed. Nonconfirmation rates were found to be unsatisfactory measures of program success in preventing potentially unnecessary surgery. Data from second surgical opinion programs should not be used to estimate the prevalence of unnecessary surgery in a community. The key benefit of such programs may be to facilitate and to encourage patient-physician communication.

An eclectic approach to quality control in fee-for-service health care: The New York City Medicaid Experience

A computer-based system for evaluating the quality of fee-for-service health care in the New York City Medicaid Program is described. Specific information is sought for use in educational, enforcement and managerial activities to improve health care quality. The gathering of this information necessitates coordinated assessment of the structure, process and outcome of health care, through inspection of offices, computerized analysis of patterns of practice as revealed by billing forms, and reexamination of patients. The program's focus on patterns of practice, its use of multiple assessment techniques, and its concentration on unequivocally substandard care circumvent several limitations on current evaluation technology. Implications for Professional Standards Review Organizations and national health insurance are explored.