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Background: In California, climate change and competing water demands are intensifying the desiccation of the Salton Sea, a large land-locked "sea" situated near the southeastern rural US-Mexico border region known as the Imperial Valley., Methods: To examine the possible effects of living near a saline lake on children's respiratory health, we analyzed the relationship between respiratory health symptoms and ambient PM concentrations among a predominantly Latino/Hispanic cohort of 722 school age children. Guardians completed a survey of their child's wheeze and respiratory health symptoms over the past 12 months, adapted from the International Study of Asthma and Allergies in Childhood (ISAAC). Exposure to dust storm hours (hourly concentrations >150 μg/m 3 for PM 10 ) was estimated using a network of regulatory monitors., Results: Between 2017 and 2019, children were exposed to 98 to 395 dust event hours annually. We observed disparate effects for dust events and wheeze among children living near the Salton Sea. Every additional 100 dust storm hours per year among children living near the Sea (<11 km) was associated with a 9.5 percentage point increase in wheeze (95% CI: 3.5, 15.4), a 4.6 percentage point increase in bronchitic symptoms (95% CI: 0.18, 10.2) and a 6.7 percentage point increase in sleep disturbance due to wheeze (95% CI: 0.96, 12.4). Similarly, increases in PM 10 were also associated with greater reported wheeze and bronchitic symptoms among those living near the Sea, compared to children living ≥11 km from the Sea. There was no association of dust storms or PM 10 with wheeze or bronchitic symptoms among the children residing farther from the Sea., Conclusion: We observed stronger adverse impacts of PM 10 and dust events on respiratory health among those living closer to the drying Salton Sea, compared to children living farther away. In this community of predominantly low-income residents of color, these impacts raise environmental justice concerns about the effects of the drying Salton Sea on public health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance., Objective: To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg)., Design: Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success., Results: Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT-containing bismuth, metronidazole and tetracycline-plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness., Conclusion: The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness., Trial Registration Number: NCT02328131., Competing Interests: Competing interests: XC has received research grants and fees for lectures from Allergan. JPG has served as speaker, consultant and advisory member for or has received research funding from Mayoly Spindler, Allergan, Diasorin, Richen, Biocodex and Juvisé. OPN received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé. DSB served as a lecturer for Astellas, AstraZeneca, KRKA and Abbott. FM is a consultant for PHATHOM, DaVoltera and has received grants from Allergan, bioMerieux and Mobidiag. The remaining authors declare no conflict of interest., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Air quality management commonly aims to mitigate nitrogen oxide (NO x ) emissions from combustion, reducing ozone (O 3 ) and particulate matter (PM) pollution. Despite such ongoing efforts, regulations have recently proven ineffective in rural areas like the Salton Sea Air Basin of Southern California, which routinely violates O 3 and PM air quality standards. With over $2 billion in annual agricultural sales and low population density, air quality in the region is likely influenced by the year-round farming activity. We conducted a source apportionment of NO x (an important precursor to both O 3 and PM) using nitrogen stable isotopes of ambient NO 2 , which revealed a significant contribution from soil-emitted NO x to the regional budget. The soil source strength was estimated based on the mean δ 15 N-NO x from each emission category in the California Air Resources Board's NO x inventory. Our annual average soil emission estimate for the air basin was 11.4 ± 4 tons/d, representing ~ 30% of the extant NO x inventory, 10× larger than the state's inventory for soil emissions. Unconstrained environmental factors such as nutrient availability, soil moisture, and temperature have a first-order impact on soil NO x production in this agriculturally intensive region, with fertilization and irrigation practices likely driving most of the emissions variability. Without spatially and temporally accurate data on fertilizer application rates and irrigation schedules, it is difficult to determine the direct impacts that these variations have on our observations. Nevertheless, comparative analysis with previous studies indicates that soil NO x emissions in the Imperial Valley are likely underrepresented in current inventories, highlighting the need for more detailed and localized observational data to constrain the sizeable and variable emissions from these arid, agricultural soils., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

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., Competing Interests: The authors declare that they have no conflicts of interest with regard to the content of this report., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)

Background: The A allele of rs9939609 polymorphism at the FTO gene has been consistently associated with higher body mass index in different populations, but conflicting results have been found regarding its contribution to food intake variability., Objective: This study aimed to investigate the association between this genetic variant and nutrient and food intake in an urban Argentinian population., Design: A cross-sectional, analytic investigation was performed between October 2018 and February 2020., Participants/settings: Adults of both sexes residing in La Plata, Argentina, were recruited through social networks (Instagram and Facebook). Of 179 eligible adults, a total of 173 adults were included in the final analyses., Outcome Measures: Nutrient and food group intake data were obtained by an interview-administered food frequency questionnaire. Height and weight were measured, and genotypes were obtained by real-time polymerase chain reaction., Statistical Analyses: The per-allele effect on nutrient and food group intake was assessed by general linear models, adjusting for age, sex, educational level, total energy intake, and body mass index. Dietary patterns were derived by principal component analysis. The association of the A allele with adherence to each dietary pattern was also evaluated by the general linear model., Results: The frequency of the risk allele was 27%. A-carriers showed a higher total fat (1.88 [0.55, 3.21] % of total energy intake), saturated fatty acids (0.82 [0.25-1.39] % of total energy intake), and monounsaturated fatty acids (0.66 [0.08, 1.24] % of total energy intake), and a lower carbohydrate (-1.99 [-3.48, -0.50] % of total energy intake) intake than TT homozygous. A-carriers also reported a higher "milk and yogurt" (1.08 [0.24, 1.91] % of total energy intake), "animal fats" (1.09 [0.14-2.03] % of total energy intake), and fat-rich ultraprocessed foods (2.10 [0.52, 3.67] % of total energy intake) intake in comparison with TT homozygous. Furthermore, A-carriers showed higher adherence to the Western dietary pattern., Conclusion: The A allele contributed to nutrient and food intake variability in the studied population and was associated with the consumption of saturated fatty acids-enriched foods., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: The Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study is a prospective cohort study of environmental influences on respiratory health in a rural, southeastern region of California (CA), which aims to longitudinally examine the contribution of a drying saline lake to adverse health impacts in children., Objectives: This cohort was established through a community-academic partnership with the goal of assessing the health effects of childhood exposures to wind-blown particulate matter (PM) and inform public health action. We hypothesize that local PM sources are related to poorer children's respiratory health., Population: Elementary school children in Imperial Valley, CA., Design: Prospective cohort study., Methods: Between 2017 and 2019, we collected baseline information on 731 children, then follow-up assessments yearly or twice-yearly since 2019. Data have been collected on children's respiratory health, demographics, household characteristics, physical activity and lifestyle, via questionnaires completed by parents or primary caregivers. In-person measurements, conducted since 2019, repeatedly assessed lung function, height, weight and blood pressure. Exposure to air pollutants has been assessed by multiple methods and individually assigned to participants using residential and school addresses. Health data will be linked to ambient and local sources of PM, during and preceding the study period to understand how spatiotemporal trends in these environmental exposures may relate to respiratory health., Preliminary Results: Analyses of respiratory symptoms indicate a high prevalence of allergies, bronchitic symptoms and wheezing. Asthma diagnosis was reported in 24% of children at enrolment, which exceeds both CA state and US national prevalence estimates for children., Conclusions: The Children's AIRE cohort, while focused on the health impacts of the drying Salton Sea and air quality in Imperial Valley, is poised to elucidate the growing threat of drying saline lakes and wind-blown dust sources to respiratory health worldwide, as sources of wind-blown dust emerge in our changing climate., (© 2024 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)

Objective: To examine the association between the level of marginalization and tooth loss in adults aged ≥50 years in Mexico., Methods: A retrospective cross‑sectional study was conducted on 2098 adults selected from communities presenting both high and medium levels of marginalization, with data obtained from the annual reports of the Epidemiological Surveillance System of Oral Pathologies 2019-2022. Analysis considered sociodemographic characteristics such as sex, age, and years of education. The prevalence of tooth loss was determined using the Decayed, Missing and Filled teeth (DMFT) index. Negative binomial regression was used to estimate rate ratio (RR) and 95% confidence intervals (CIs), using the presence of lost teeth as an outcome., Results: Most (62.4%) participants had lost at least one tooth, of whom 60.3% had a medium level of marginalization, 28.8% a high level, and 10.9% a very high level. More adults who lived in high or very high marginalization communities had lost teeth [RR=1.19 (95% CI 1.08 - 1.30)] than those living in communities with a medium level of marginalization. More males [RR=1.19 (95% CI 1.09 - 1.31)], adults ≥70 years [RR=1.77 (95% CI 1.57 - 1.99)], people who were illiterate [RR=1.60 (95% CI 1.35 - 1.88)] or who had poor oral hygiene [RR=1.26 (95% CI 1.15 - 1.38)] had also lost teeth., Conclusion: High and very high marginalization was associated with tooth loss in adults ≥50 years in Mexico. Effective oral health strategies are required to prevent tooth loss, as are interventions to improve access to and quality of dental services for marginalized communities., (Copyright© 2023 Dennis Barber Ltd.)

Burning of agricultural fields is an understudied source of air pollution in rural communities in the United States. Smoke from agricultural burning contains air toxics that adversely impact respiratory health. Imperial County in southeastern California is a highly productive agricultural valley that heavily employs agricultural burning to clear post-harvest crop remnants. We related individual-level exposure to agricultural burns to parent-reported respiratory symptoms in children. We leveraged the Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) cohort of 735 predominantly Hispanic low-income elementary school students in Imperial County. Parents reported children's respiratory health symptoms and family demographic characteristics in questionnaires collected at enrollment and in annual follow-up assessments from 2017 to 2019. Permitted agricultural burns in Imperial County from 2016 to 2019 were spatially linked to children's geocoded residential addresses. We used generalized estimating equations to evaluate prevalence differences (PDs) in respiratory symptoms with increasing exposure to agricultural burning within 3 km in the 12 months prior to each assessment. Nearly half of children (346, 49 %) lived within 3 km of at least one agricultural burn in the year prior to study enrollment. In adjusted models, each additional day of agricultural burning in the prior year was associated with a one percentage point higher prevalence of wheezing (PD 1.1 %; 95 % CI 0.2 %, 2.0 %) and higher bronchitic symptoms (PD 1.0 %; 95 % CI -0.2 %, 2.1 %). Children exposed to four or more days of burning had an absolute increased prevalence of wheezing and bronchitic symptoms of 5.9 % (95 % CI -0.3 %, 12 %) and 5.6 % (95 % CI -1.8 %, 13 %), respectively, compared to no burn exposure. Associations with wheezing were stronger among children with asthma (PD 14 %; 95 % CI -1.4 %, 29 %). To our knowledge, this is the first U.S. study of agricultural burning and children's respiratory health. This work suggests that reducing agricultural burning could improve children's respiratory health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Social enterprises are recognised as relevant rural development actors. The specific features of social enterprises operating within rural areas (i.e. their relational, socially innovative and multi-stakeholder character and their focus on integrated development) concur with the principles of the neo-endogenous approach to rural development, which stress the potential role of third sector organisations as development actors within governance frameworks. In order to study this phenomenon, that links social enterprises and rural development, we propose a conceptual and methodological framework drawing from Polanyi's socio-economic theory, complemented with the concepts of place, spatial scale and corporate agency. Through the proposed framework, we advocate for a plural vision of the economy, socio-spatial and geopolitical sensitive concepts and overcoming methodological individualism for the study of an increasingly relevant phenomenon such as the participation of third sector organisations like social enterprises in the (neo-endogenous) development of rural areas., Competing Interests: Conflict of interestThe authors have no relevant financial or non-financial interests to disclose., (© International Society for Third-Sector Research 2021.)

Pregnant women are included in the COVID-19 risk groups even if they do not have any pathology. This requires an analysis of research focused on pregnant women to understand the impact of SARS-CoV-2 on their condition. There is also a need to know whether there is vertical mother-to-child transmission, as well as other consequences in case the pregnant woman is infected and COVID-19 positive. A systematic review was carried out to analyze the existing information on the complications of a pregnant woman infected with the SARS-CoV-2 coronavirus and the possibility of vertical transmission from mother to child, registered in the PROSPERO website and searched in the PubMed, Scopus, CINAHL, and Cochrane Library databases. Finally, 22 articles were included in the review. The review suggests that vertical transmission from mother to child could be exceptionally possible at the time of delivery or breastfeeding, but not through the placenta. It is interesting to point out the good acceptance of vaccination by pregnant women, which may be the reason for the low infectivity. Further research on pregnant women should be carried out to provide evidence on vertical mother-to-child transmission and the role of breast milk in relation to SARS-CoV-2.

Objectives: To compare the prognostic value of 3 severity scales: the Pneumonia Severity Index (PSI), the CURB-65 pneumonia severity score, and the Severity Community-Acquired Pneumonia (SCAP) score. To build a new predictive model for in-hospital mortality in patients over the age of 75 years admitted with pneumonia due to the coronavirus disease 2019 (COVID-19)., Material and Methods: Retrospective study of patients older than 75 years admitted from the emergency department for COVID-19 pneumonia between March 12 and April 27, 2020. We recorded demographic (age, sex, living in a care facility or not), clinical (symptoms, comorbidities, Charlson Comorbidity Index [CCI]), and analytical (serum biochemistry, blood gases, blood count, and coagulation factors) variables. A risk model was constructed, and the ability of the 3 scales to predict all-cause in-hospital mortality was compared., Results: We included 186 patients with a median age of 85 years (interquartile range, 80-89 years); 44.1% were men. Mortality was 47.3%. The areas under the receiver operating characteristic curves (AUCs) were as follows for each tool: PSI, 0.74 (95% CI, 0.64-0.82); CURB-65 score, 0.71 (95% CI, 0.62-0.79); and SCAP score, 0.72 (95% CI, 0.63-0.81). Risk factors included in the model were the presence or absence of symptoms (cough, dyspnea), the CCI, and analytical findings (aspartate aminotransferase, potassium, urea, and lactate dehydrogenase. The AUC for the model was 0.81 (95% CI, 0.73-0.88)., Conclusion: This study shows that the predictive power of the PSI for mortality is moderate and perceptibly higher than the CURB-65 and SCAP scores. We propose a new predictive model for mortality that offers significantly better performance than any of the 3 scales compared. However, our model must undergo external validation.

Background: Since the first cases of COVID-19 were reported in Wuhan, the nutritional status of individuals infected with the virus has not been included in the risk profiles prepared. However, nutritional status, along with other factors, is decisive in the evolution of patients with other infectious diseases. The nutritional status of individuals is considered an indicator of health status. Furthermore, optimal nutritional status transcends the individual, and poor diet in a population can be considered a group risk factor. Evidence exists on the influence that diet has on the immune system and susceptibility to disease., Objective: To evaluate the nutritional status of patients older than 65 years who were admitted due to COVID-19 and how this has influenced the evolution of patients., Design: This prospective and observational study was performed in patients with COVID-19 infection confirmed by real-time polymerase chain reaction. Data were collected from the first 24 h of admission. All patients admitted during one month to the wards assigned to COVID-19 infection were included., Results: A total of 83 patients were studied. The statistical study of mortality showed associations with age ( p  = .005), living in a nursing home ( p  = .022), a high Charlson Comorbidity Index ( p  = .039), hypertension ( p  = .032), comorbidities of dementia ( p  = .019) and cerebral vascular disease ( p  = .041), and Barthel Index ( p  = .010). The analysis of the influence of the nutritional state on mortality revealed a statistical association between malnutrition and mortality in the pooled data analysis ( p  = .005) and analysis by degrees of malnutrition ( p  = .27)., Conclusions: Malnutrition was a risk factor as powerful as others such as hypertension, age, and different comorbidities. We must evaluate and treat the nutritional status of elderly patients with COVID-19 infection since it directly affects their evolution.

Background: Our study sought to evaluate gender representation and the impact of gender on the large volume of research presented at The American Society of Breast Surgeons (ASBrS) Annual Meeting, the largest breast surgery meeting in the United States., Methods: Publicly available ASBrS meeting programs and proceedings from 2009 to 2019 were reviewed to ascertain proportions of female engagement in society positions, contributions to scientific sessions, and subsequent manuscript publications. Trend analyses for temporal changes in gender representation and univariate tests of associations between authorship gender and publication success were performed., Results: Women comprised 44.8% of members of the board of directors, 41.7% of committee chairs, and 54.8% of committee members. There were significant annual increased proportions of female committee members (3.2% per year, p = 0.01) and chairs (6.0% per year, p = 0.03). Women represented > 50% of all speakership positions, except keynote (42.2%). For oral, quickshot, and poster scientific presentations, > 70% of first authors and > 60% of senior authors were women. The meeting-related publication rate with female senior authorship was higher than that with male senior authorship (41.0% vs. 36.3%, p = 0.04)., Conclusions: Although female surgeons remain a minority at most conferences, women have represented the majority of participants in committees, speakership, and scientific presentations at the ASBrS Annual Meeting over the past 10 years. The glass ceiling in breast surgery has been shattered, but efforts to improve gender equity must continue, not only in breast surgery, but all surgical specialties.

Background: The current cure rates with triple therapy combining a proton-pump inhibitor, amoxicillin and clarithromycin are unacceptably low., Aims: To evaluate the efficacy of a 14-day concomitant therapy as an empirical first-line treatment for curing Helicobacter pylori ( Hp ) infection in primary care., Methods: Patients from six primary care centers in Catalonia -Spain- were included consecutively. Hp status pre and post treatment was assessed according to local clinical practice protocol. A 14-day concomitant therapy (amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg plus omeprazole 20 mg, all drugs administered twice daily) was prescribed. Adherence to therapy and adverse events were assessed by personal interview., Results: 112 patients were enrolled. Mean age was 46.7 ± 16.1 years. Main indication for treatment was non-investigated dyspepsia (83%). Hp eradication was achieved in 100 of the 112 patients. Eradication rates were 89.3% (95% CI: 81.7-94.1) by intention-to-treat (ITT) analysis and 91.7% (95% CI; 84.6-95.9) per protocol (PP). No major side effects were reported; 104 (92.8%) patients complete the treatment. Forty-seven patients (42%) complained of mild side effects (metallic taste, nausea). Low adherence to treatment ( p = 0.004) and significant adverse events ( p = 0.004) were the variables associated with treatment failure., Conclusions: In primary care, a 14-day concomitant therapy is highly effective and well tolerated.

Air monitoring networks developed by communities have potential to reduce exposures and affect environmental health policy, yet there have been few performance evaluations of networks of these sensors in the field. We developed a network of over 40 air sensors in Imperial County, CA, which is delivering real-time data to local communities on levels of particulate matter. We report here on the performance of the Network to date by comparing the low-cost sensor readings to regulatory monitors for 4 years of operation (2015-2018) on a network-wide basis. Annual mean levels of PM 10 did not differ statistically from regulatory annual means, but did for PM 2.5 for two out of the 4 years. R 2 s from ordinary least square regression results ranged from 0.16 to 0.67 for PM 10 , and increased each year of operation. Sensor variability was higher among the Network monitors than the regulatory monitors. The Network identified a larger number of pollution episodes and identified under-reporting by the regulatory monitors. The participatory approach of the project resulted in increased engagement from local and state agencies and increased local knowledge about air quality, data interpretation, and health impacts. Community air monitoring networks have the potential to provide real-time reliable data to local populations., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

With a rapidly changing climate, new leaders must be trained to understand and act on emerging environmental threats. In California's Imperial Valley, a collaborative of community members, researchers, and scientists developed a community air monitoring network to provide local residents with better air quality information. To expand the reach of the project and to prepare the next generation of youth leaders we developed an internship program to increase environmental health literacy and civic leadership. In the 10-week program, high school students learned about air quality science, respiratory health, community air monitoring, and policies intended to improve air quality. The students learned to present this information to their peers, neighbors, family, and community leaders. The program used participatory approaches familiar to community-engaged research to center the students' experience. Surveys and interviews with the students were used to assess the program and found that the students became more familiar with air quality policies, increased their ability to use air monitoring resources, and increased their own confidence in their ability to effect change. With the growing threats related to environmental hazards, it is vital to prepare youth leaders to understand, communicate, and act., Competing Interests: Authors declare no conflict of interest.

Initiated in response to community concerns about high levels of air pollution and asthma, the Imperial County Community Air Monitoring Project was conducted as a collaboration between a community-based organization, a non-governmental environmental health program, and academic researchers. This community-engaged research project aimed to produce real-time, community-level air quality information through the establishment of a community air monitoring network (CAMN) of 40 low-cost particulate matter (PM) monitors in Imperial County, California. Methods used to involve the community partner organization and residents in the development, operation, and use of the CAMN included the following: (1) establishing equitable partnerships among the project collaborators; (2) forming a community steering committee to guide project activities; (3) engaging residents in data collection to determine monitor sites; (4) providing hands-on training to assemble and operate the air monitors; (5) conducting focus groups to guide display and dissemination of monitoring data; and (6) conducting trainings on community action planning. This robust community engagement in the project resulted in increased awareness, knowledge, capacity, infrastructure, and influence for the community partner organization and among community participants. Even after the conclusion of the original research grant funding for this project, the CAMN continues to be operated and sustained by the community partner, serving as a community resource used by residents, schools, researchers, and others to better understand and address air pollution and its impacts on community health, while strengthening the ability of the community to prepare for, respond to, and recover from harmful air pollution.

Residents of the Imperial Valley, a rural, agricultural border region in California, have raised concerns over high rates of pediatric asthma symptoms. There is an urgent need to understand the influences and predictors of children's respiratory health in Imperial Valley. We assessed the impacts of sociodemographic, lifestyle, and household factors on children's respiratory health and asthma prevalence by administering a survey to parents of elementary school children ( n = 357) in northern Imperial Valley. We observed an overall asthma prevalence of 22.4% and respiratory symptoms and allergies were widely reported, including wheezing (35.3%), allergies (36.1%), bronchitic symptoms (28.6%), and dry cough (33.3%). Asthmatics were significantly more likely to report respiratory symptoms, but high rates of wheezing, allergies, and dry cough were observed among nonasthmatics, suggesting the possibility for underdiagnosis of respiratory impairment in our school-age population. Having an asthmatic mother and exposure to environmental tobacco smoke were also associated with greater odds of asthma. Our findings provide evidence to support community concerns about children's respiratory health, while also suggesting that household and demographic characteristics have limited explanatory power for assessing asthma in this population. This work provides critical baseline data with which to evaluate local environmental factors and their influence on asthma and respiratory symptoms.

Conventional regulatory air quality monitoring sites tend to be sparsely located. The availability of lower-cost air pollution sensors, however, allows for their use in spatially dense community monitoring networks, which can be operated by various stakeholders, including concerned residents, organizations, academics, or government agencies. Networks of many community monitors have the potential to fill the spatial gaps between existing government-operated monitoring sites. One potential benefit of finer scale monitoring might be the ability to discern elevated air pollution episodes in locations that have not been identified by government-operated monitoring sites, which might improve public health warnings for populations sensitive to high levels of air pollution. In the Imperial Air study, a large network of low-cost particle monitors was deployed in the Imperial Valley in Southeastern California. Data from the new monitors is validated against regulatory air monitoring. Neighborhood-level air pollution episodes, which are defined as periods in which the PM 2.5 (airborne particles with sizes less than 2.5 μm in diameter) hourly average concentration is equal to or greater than 35 μg m -3 , are identified and corroborate with other sites in the network and against the small number of government monitors in the region. During the period from October 2016 to February 2017, a total of 116 episodes were identified among six government monitors in the study region; however, more than 10 times as many episodes are identified among the 38 community air monitors. Of the 1426 episodes identified by the community sensors, 723 (51%) were not observed by the government monitors. These findings suggest that the dense network of community air monitors could be useful for addressing current limitations in the spatial coverage of government air monitoring to provide real-time warnings of high pollution episodes to vulnerable populations., Competing Interests: The authors declare no conflict of interest.

Changing weather patterns, droughts and competing water demands are dramatically altering the landscape and creating conditions conducive to the production of wind-blown dust and dust storms. In California, such factors are leading to the rapid shrinking of the Salton Sea, a 345 mile 2 land-locked "sea" situated near the southeastern rural border region known as the Imperial Valley. The region is anticipated to experience a dramatic increase in wind-blown dust and existing studies suggest a significant impact on the health and quality of life for nearby residents of this predominantly low-income, Mexican-American community. The discussion calls attention to the public health dimensions of the Salton Sea crisis. We know little about the possible long-term health effects of exposure to mobilized lakebed sediments or the numerous toxic contaminants that may become respirable on entrained particles. We draw on existing epidemiological literature of other known sources of wind-blown dust, such as desert dust storms, and related health effects to begin to understand the potential public health impact of wind-blown dust exposure. The increased production of wind-blown dust and environmental exposures to such non-combustion related sources of particulate matter are a growing health threat, due in part to drought coupled with increasing pressures on limited water resources. Recent population-based studies have linked dust storms with cardiovascular mortality, asthma hospitalization and decrease in pulmonary function in both adults and children. A growing number of studies provide evidence of the acute health effects of wind-blown dust exposures among children, which with repeated insults have the potential to influence respiratory health over time. The shrinking of the Salton Sea illustrates a public health and environmental justice crisis that requires action and attention to protect the health and well-being of local communities., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Air pollution continues to be a global public health threat, and the expanding availability of small, low-cost air sensors has led to increased interest in both personal and crowd-sourced air monitoring. However, to date, few low-cost air monitoring networks have been developed with the scientific rigor or continuity needed to conduct public health surveillance and inform policy. In Imperial County, California, near the U.S./Mexico border, we used a collaborative, community-engaged process to develop a community air monitoring network that attains the scientific rigor required for research, while also achieving community priorities. By engaging community residents in the project design, monitor siting processes, data dissemination, and other key activities, the resulting air monitoring network data are relevant, trusted, understandable, and used by community residents. Integration of spatial analysis and air monitoring best practices into the network development process ensures that the data are reliable and appropriate for use in research activities. This combined approach results in a community air monitoring network that is better able to inform community residents, support research activities, guide public policy, and improve public health. Here we detail the monitor siting process and outline the advantages and challenges of this approach., Competing Interests: The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

The Imperial County Community Air Monitoring Network was developed as part of a community-engaged research study to provide real-time particulate matter (PM) air quality information at a high spatial resolution in Imperial County, California. The network augmented the few existing regulatory monitors and increased monitoring near susceptible populations. Monitors were both calibrated and field validated, a key component of evaluating the quality of the data produced by the community monitoring network. This paper examines the performance of a customized version of the low-cost Dylos optical particle counter used in the community air monitors compared with both PM 2.5 and PM 10 (particulate matter with aerodynamic diameters <2.5 and <10 μm, respectively) federal equivalent method (FEM) beta-attenuation monitors (BAMs) and federal reference method (FRM) gravimetric filters at a collocation site in the study area. A conversion equation was developed that estimates particle mass concentrations from the native Dylos particle counts, taking into account relative humidity. The R 2 for converted hourly averaged Dylos mass measurements versus a PM 2.5 BAM was 0.79 and that versus a PM 10 BAM was 0.78. The performance of the conversion equation was evaluated at six other sites with collocated PM 2.5 environmental beta-attenuation monitors (EBAMs) located throughout Imperial County. The agreement of the Dylos with the EBAMs was moderate to high (R 2 = 0.35-0.81)., Implications: The performance of low-cost air quality sensors in community networks is currently not well documented. This paper provides a methodology for quantifying the performance of a next-generation Dylos PM sensor used in the Imperial County Community Air Monitoring Network. This air quality network provides data at a much finer spatial and temporal resolution than has previously been possible with government monitoring efforts. Once calibrated and validated, these high-resolution data may provide more information on susceptible populations, assist in the identification of air pollution hotspots, and increase community awareness of air pollution.

Background: Laser therapy influences oxidative stress parameters such as the activity of antioxidant enzymes and the production of reactive oxygen species., Objective: To analyze the effects of low-level laser therapy on oxidative stress in diabetics rats with skin wounds., Methods: Thirty-six animals were divided into 4 groups: NDNI: non-diabetic rats with cutaneous wounds that not received laser therapy; NDI: non-diabetic rats with cutaneous wounds that received laser therapy; DNI: diabetic rats with skin wounds who did not undergo laser therapy; DI: rats with diabetes insipidus and cutaneous wounds and received laser therapy. The animals were treated with LLLT (660 nm, 100 mW, 6 J/cm, spot size 0.028 cm). On the day of killing the animals, tissue-wrapped cutaneous wounds were collected and immediately frozen, centrifuged, and stored to analyze malondialdehyde (MDA) levels., Results: Significant difference was observed within the groups of MDA levels (ANOVA, p = 0.0001). Tukey's post-hoc test showed significantly lower values of MDA in irradiated tissues, both in diabetic and non-diabetic rats. ANOVA of the diabetic group revealed a significant difference (p &#60; 0.01) when all groups, except NDI and DI, were compared., Conclusions: LLLT was effective in decreasing MDA levels in acute surgical wounds in diabetic rats.

Summary: The Imperial County Community Air Monitoring Network (the Network) is a collaborative group of community, academic, nongovernmental, and government partners designed to fill the need for more detailed data on particulate matter in an area that often exceeds air quality standards. The Network employs a community-based environmental monitoring process in which the community and researchers have specific, well-defined roles as part of an equitable partnership that also includes shared decision-making to determine study direction, plan research protocols, and conduct project activities. The Network is currently producing real-time particulate matter data from 40 low-cost sensors throughout Imperial County, one of the largest community-based air networks in the United States. Establishment of a community-led air network involves engaging community members to be citizen-scientists in the monitoring, siting, and data collection process. Attention to technical issues regarding instrument calibration and validation and electronic transfer and storage of data is also essential. Finally, continued community health improvements will be predicated on facilitating community ownership and sustainability of the network after research funds have been expended. https://doi.org/10.1289/EHP1772

Exposure to perchlorate is ubiquitous in the United States and has been found to be widespread in food and drinking water. People living in the lower Colorado River region may have perchlorate exposure because of perchlorate in ground water and locally-grown produce. Relatively high doses of perchlorate can inhibit iodine uptake and impair thyroid function, and thus could impair neurological development in utero. We examined human exposures to perchlorate in the Imperial Valley among individuals consuming locally grown produce and compared perchlorate exposure doses to state and federal reference doses. We collected 24-hour urine specimen from a convenience sample of 31 individuals and measured urinary excretion rates of perchlorate, thiocyanate, nitrate, and iodide. In addition, drinking water and local produce were also sampled for perchlorate. All but two of the water samples tested negative for perchlorate. Perchlorate levels in 79 produce samples ranged from non-detect to 1816 ppb. Estimated perchlorate doses ranged from 0.02 to 0.51 µg/kg of body weight/day. Perchlorate dose increased with the number of servings of dairy products consumed and with estimated perchlorate levels in produce consumed. The geometric mean perchlorate dose was 70% higher than for the NHANES reference population. Our sample of 31 Imperial Valley residents had higher perchlorate dose levels compared with national reference ranges. Although none of our exposure estimates exceeded the U. S. EPA reference dose, three participants exceeded the acceptable daily dose as defined by bench mark dose methods used by the California Office of Environmental Health Hazard Assessment.

Antecedents: Most of the literature has focused on the morphological and histochemical characteristics of palatine glands during the development histogenesis and maturation process. However, there are no publications regarding protein glycosylation and the distribution of glycoproteins with N and O-glycoside bonds, and their possible functional role., Objective: Based on this background we committed ourselves to studying the human palatine glands in different age groups in order to determine the beginning of mucine secretion and the presence of glycoproteins with N and O-glycoside bonds during the processes of differentiation and maturation., Materials and Method: Human palatine glands were obtained from embryos, fetuses, newborn infants, youngsters and adults. They were studied using histochemical methods (PAS, Dane, Alcian blue, Toluidine blue), and lectin histochemistry., Results: The variations observed in glycoconjugates during the development and maturation of human palatine glands show that secretion starts at early stages of prenatal development; it is made up of various sugars that might play an important role in the pre-natal and postnatal periods., Conclusions: The study of modifications in sugar residues in the human palatine glands during embryogenesis, differentiation and maturation processes allows us to have further knowledge of their histophysiology and possible changes taking place during aging. This study may also help to understand pathological processes in mature salivary glands.

Introduction: The studies in which the direct costs generated by enteral nutrition have been analyzed in hospitals of our country are limited. The objective of our study has been the analysis of costs incurred by this treatment in our center., Material and Methods: A total of 449 consecutive patients who received nutritional support and that were hospitalized in the Hospital Río Ortega (Valladolid) since January 1999 to June 2001 has been studied. In this study only the direct costs were analyzed., Results: The nutritional support was effective in the complete group with an improvement in the serum levels of albumin, prealbumin, and transferrin. In the analysis of direct costs generated by enteral nutrition the total median cost was of 598.4 +/- 761 euros/total treatment/patient, which represents a daily median cost of 36.3 +/- 8.8 euros/day/patient. In the analysis of costs by paragraphs, the expendable equipment constituted 36% of the total, representing the tubes 3%, the lines of nutrition 12%, the containers 21% and the nutritional preparations 64%. A cost analysis was also carried out in relation to the different groups of pathologies, and in this way the patients with hematological tumors and the patients with higher aereodigestive tract tumors showed some greater costs, due to their higher median hospital stay. The patients who received nutrition through a gastrostomy probe showed also higher costs, in addition due to a greater hospital stay., Conclusions: The costs of the nutritional support were superior in the group of patients with hematological tumors and with higher aereodigestive tract, due to their greatest hospital stay. A greater cost in the patients whose access route was the gastrostomy was also observed.

Introduction: Studies on the analysis of direct costs generated by household enteral nutrition (HEN) have been scant. The objective of our study was to carry out a direct costs analysis of household enteral nutrition using both the biochemical and nutritional monitoring values of the nutritional state as a point of reference., Material and Methods: Since January 1999 until December 2001, we studied a total sample of 102 consecutive patients with indication of household nutritional support. The following epidemiological data were obtained in all patients: age, sex, and primary condition for which enteral nutrition was prescribed; we carried out an anthropometric assessment and a biochemical nutritional assessment quarterly. We recorded also the number of episodes of diarrhea, vomiting, aspiration pneumonia, and death during the treatment., Results: Average age of the patients was 58.7 13.3 years. The number and proportion of patients according to primary conditions were the following: 71 (69.3%) with head and neck cancer, 14 (13.9%) with a neurological condition with swallowing disturbance (stroke and/or dementia), 6 (5.9%) with tumors in other locations, and 11 (10.9%) with a group of diseases associated with dysphagia or anorexia. HEN was administered by oral route in 81 patients (79.4%), by nasogastric tube (NGT) in 15 patients (14.7%), by PEG in 5 patients (4.9%) and by yeyunostomy in 1 patient (1%). Average duration of HEN was 101 46.9 days. We showed a significant improvement of biochemical and anthropometric parameters in patients with HEN. The economic analysis of direct costs generated by enteral nutrition showed that the total average cost of nutritional formulas and expendable equipment utilized (holders, probes and nutritional tubes) was 300,033 599,203 pesetas/full treatment/patient (1,803 3,601 euros), or a daily average cost of 2,970 5,932 pesetas/day/patient (17.8 35.6 euros). In the analysis of costs acording to different items, the expendable equipment (nutritional tubes, nasogastric tubes and nutritional formula holders) were an average of 1,284 4,571 pesetas/full treatment/patient (7.7 27.4 euros) (5% in total), and the nutritional preparations were an average of 231,313 399,756 pesetas/full treatment/patient (1,390.2 2,402 euros) (95%). The patients with greater resources expenditure were those with tumors of head and neck. In order to analyze the efficiency of this treatment an analysis of costs was carried out for each objective parameter indicating nutritional status improvement; that way, the increase of 1 g/dl of albumin was an average cost of 103,817 2,897 pesetas (623.9 17.4 euros), while the increase of 1 kg of weight was an average cost of 857,237 25,097 pesetas (5,152.1 150.8 euros). CONCLUSIONS. In summary, nutrition enteral household was an effective therapy for nutritional status improvement in different groups of ambulatory patients. The cost of the nutritional support was superior in the group of patients with tumors of the upper aereodigestive system because of the greater duration of the treatment and the complex access route.

Background: Nutritional education is an essential issue for the proper approach to patients. One of the first issues to have in mind is the appropriate nutritional guidelines in theses professionals in their routine life. The aim of out work was to determine the oral intake pattern in a group of health professionals., Materials and Methods: A 24-hours nutritional survey (encuesta) was performed in a group of 51 health professionals (including both medical and nurse personnel) who attended a course in specialized training in nutrition at Hospital Universitario Río Hortega. All participants had their weight, length, age, and profession recorded. Before complying with diet they received an identification session of alimentary rations., Results: The mean age of participants was 25.9 (5.4) years and they were all women (52.9% nurses and 47.1% physicians). Body mass index (BMI) was 21.9 (2.6). The intake of vitamin D was lower than international recommendations (RDA): 2.25 (3.27) g/day. However, the intake of vitamin C, 183.8 (118) mg/day; vitamin B12, 4.73 (3.18) mg/day; folic acid, 262.4 (126) g/day, and iodine, 310.3 (185) g/day were higher than international recommendations. The caloric intake was appropriate for the age of participants and protein intake was 2-fold above normality 1.66 (0.9) g/ kg/day. Differences were observed only between the group of nurses and physicians regarding iodine intake, slightly higher in the former individuals., Conclusion: In summary, the caloric intake in these health professionals is appropriate, and there is an excess in the intake of proteins, vitamin C, vitamin B12, folic acid and iodine, with a low intake of vitamin D.

Salivary glands are a good model to investigate the relationship between cell secretion and glandular structure. Most studies of this organ deal with mammals, but we are interested in a morphofunctional characterization of these glands in poultry in relation with particular feeding habits. For this purpose, conventional and lectin histochemical methods as well as ultrastructural methods have been applied to the chicken lateral and medial palatine salivary glands. It was found that periodic acid-Schiff (PAS)-positive, alcianophilic, and metachromatic or orthochromatic cells were present with a more homogeneous distribution pattern in lateral glands than in medial palatine glands. Lectin staining depended on the lectin type that was applied, but also on the glandular part both in lateral and medial glands. Ultrastructural studies showed cytoplasmic membranous structures with a scattered granular or filamentous content depending on the secretory cell. In conclusion, morphofunctional characteristics of salivary glands of chicken suggest that their products are involved in lubrication and humidification of food ingested, and probably in protection of the oral surface, as has been previously described for other animals showing similar histochemical staining patterns.

The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.

Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.

Ultrastructural descriptions in birds are scarce thus, in this study we have characterized the secretory granules of mucous and seromucous cells from the palatine and lingual salivary glands of birds with different diets. The samples were taken from the tongue and palatine mucosa of chicken (Gallus gallus), quail (Coturnix coturnix), chimango (Milvago chimango) and white heron (Egretta thula). The samples were processed for observation by transmission electron microscopy (TEM) employing 4% Karnovsky solution for fixation. The most noteworthy finding was the heterogeneous ultrastructural appearance of the secretory granules. Differences in substructure were found between the four species, between the palatine and lingual glands in the same species and even within the same acinus and the same cell. At variance with other authors, these differences cannot be attributed to the type of fixative solution used taking into account that all the samples were processed in the same way. Previous histochemical studies have shown the presence of sulfated and non sulfated glycoconjugates in these glands which can be associated to the maturation of the granules. These granules are probably representative of peculiar storage of the secretory products that would give rise to a heterogeneous and complex ultrastructural pattern of granules in the mucosa and seromucosa cells of these avian species.

The risks and negative consequences of adolescent sexual intercourse are of national concern, and promoting sexual abstinence is an important goal of the American Academy of Pediatrics. In previous publications, the American Academy of Pediatrics has addressed important issues of adolescent sexuality, pregnancy, sexually transmitted diseases, and contraception. The development of new contraceptive technologies mandates a revision of this policy statement, which provides the pediatrician with an updated review of adolescent sexuality and use of contraception by adolescents and presents current guidelines for counseling adolescents on sexual activity and contraceptive methods.