Associations between residential proximity to agricultural land use as pesticides exposure and birth outcomes.

Pesticides are widely used globally. Due to their widespread use, exposure to pesticides is of concern. In addition to occupational exposure, residential exposure during pesticide application is a concern for those living in or near agricultural areas. The objective of this study was to analyze the association between residential proximity to agricultural pesticide use and birth outcomes. The association between residential proximity to agricultural land use as pesticide exposure and birth outcomes was explored in a birth cohort including 283 pregnant women from a medical center in Hualien during 2013-2016. In the third trimester, we collected demographic information and the residential addresses of pregnant women via structured questionnaires. After delivery, newborn birth weight, gestational age, and head circumference were collected from medical records. Maternal residential address during pregnancy was collected for geospatial mapping. The percentages of farmland area within circular buffers of different sizes were applied to estimate pesticide exposure. Associations between residential proximity to agricultural land use as pesticide exposure and birth outcomes were analyzed by multiple linear regression analyses. A significantly smaller head circumference was associated with agricultural farmland located within 400 m (ß = - 0.51 [95% CI, - 0.99, - 0.03], P = 0.037) and 500 m (ß = - 0.67 [95% CI, - 1.14, - 0.19], P = 0.006) radii of residences in the tertile 2 group. A significantly smaller head circumference was also associated with dry farming area within 400 m (ß = - 0.70 [95% CI, - 1.17, - 0.24], P = 0.003) and 500 m (ß = - 0.81 [95% CI, - 1.27, - 0.34], P = 0.001) radii of residences in the tertile 2 group. The multivariate linear regression analyses did not show any significant association between residential farmland area and birth weight or gestational age. In conclusion, residential proximity to agricultural land use as pesticide exposure was associated with negative infant birth outcomes, especially a small head circumference. In the future, agricultural land use information could be combined with biological samples to more accurately assess exposure in pregnant women.

The Relationship of Urbanization and Performance of Activity and Participation Functioning among Adults with Developmental Disabilities in Taiwan.

Developmental disability is likely to be lifelong in nature and to result in substantial activity and societal participation limitations. The performance of individuals is related to the environment, supports, and urbanization of living cities. Most of the surveys for people with disabilities have not discussed the relationship between the cognitive impairment properties and performance of participation and activities functioning, and most cognitive impairments are regarded as having similar performance. The location of residence in childhood is mainly influenced by parents and main caregivers, but the factors related to the preferences of adults with cognitive impairment in the location of residence are more complicated. OBJECTIVE(S): The aim was to explore and compare the relationships of the urbanization degree of their living cities and the functioning performance of daily living in various domains among adults with intellectual disability (ID), autism, and concomitant communicative impairment (CCI). METHOD: The cross-sectional study was applied, and the data was collected face-to-face by professionals in all authorized hospitals in Taiwan. The participants were 5374 adults with ID (n = 4455), autism (n = 670), CCI (n = 110) and combination disabilities (n = 139) which were according to the International Statistical Classification of Diseases 9th Revision (ICD-9) from a total of 167,069 adults with disabilities from the Disability Eligibility System (DES) in Taiwan between July 2012 and October 2013. The authors used the World Health Organization Disability Assessment Schedule 2.0-36 item version of WHO (WHODAS 2.0-36 items) to measure performance and capability of daily living. RESULTS AND CONCLUSIONS: There were significant differences in age, gender, disabled severity, and the urbanization between all subgroups (p < 0.05). After adjusting the age of all participators, the degree of urbanization just significantly affected the functioning score distribution in domain 1: cognition for an adult with ID, autism, and CCI; in domain 2, mobility for an adult with CCI and combination disability; in domain 3, self-care; domain 4, independent domains for ID (p < 0.05). There were no significant differences between urbanization degree and functioning scores in all domains for adults with autism. All in all, only in groups with combination disability did we find that the worse the degree of impairment was, the lower the degree of urbanization of their place of residence was, and there was no such phenomenon in adults with autism and ID in our study.

Association between the First Occurrence of Asthma and Residential Greenness in Children and Teenagers in Taiwan.

Green spaces have benefits but may also increase the risk of allergic disease. This study examined the association between the first occurrence of asthma and greenness exposure in children and teenagers. We conducted a 1:1 matched case-control study matched by sex, age, and the first diagnosis year with 7040 eligible subjects from a systematic sampling cohort database in Taiwan from 2001 to 2013. A normalized difference vegetation index (NDVI) value ≥0.4 was used as the criterion to determine the green space. The green cover images were then transformed to the green coverage rate in the township surrounding the residential areas of the asthma and control subjects. Conditional logistic regression analyses demonstrated that a significantly increased risk of asthma in preschool children was associated with the surrounding greenness after adjusting for urbanization level, frequency of healthcare provider visits, mean township family income, CO, NOx, and PM2.5. The risk of asthma occurrence increased significantly with increasing greenness exposure (p-trend < 0.05). Nevertheless, exposure to the highest greenness levels (81-100%) was not associated with a significantly higher risk of asthma occurrence than was exposure to the lowest values (0-20%) of greenness. This study suggests that green space design should consider more effective methods of reducing the allergy impact.

Justice in Dementia Care Resource Allocation: How Should We Plan for Dementia Services?

Dementia care resources in Taiwan have not been allocated taking into account patients' needs and the distance between service users and providers. The objective of this study was to use two newly developed indicators; profit willing distance (PWD) and tolerance limited distance (TLD), to profile the service availability and accessibility of the 22 administrative areas in Taiwan and facilitate justice-based resource allocation by the central government. The study employed secondary data analysis by using a geographic information system (GIS) and geocoding to identify distances between service users and providers. The study samples were drawn from the databank of the National Disability Eligibility Determination System and grouped by the acuteness of registrants' needs. Both the PWD and TLD were found in 15 of the administrative areas, and neither was found in three areas (Penghu, Kinmen, and Lienchiang County). Either the PWD or TLD (but not both) were found in four areas (only have PWD: Hsinchu and Chiayi City; only have TLD: Yunlin and Taitung County). How the priorities should be set for dementia service allocation based on these findings was also addressed. We conclude that the indicators of PWD and TLD can add value to the policy decision-making process, help set priorities, and facilitate efficient and fair resource allocation by defining specifics of the resources needed.

New indices for home nursing care resource disparities in rural and urban areas, based on geocoding and geographic distance barriers: a cross-sectional study.

BACKGROUND: Aging in place is the crucial object of long-term care policy worldwide. Approximately 15.6-19.4% of people aged 15 or above live with a disability, and 15.3% of them have moderate or severe disabilities. The allocation of home nursing care services is therefore an important issue. Service providers in Taiwan vary substantially across regions, and between rural and urban areas. There are no appropriate indices for describing the capacity of providers that it is due to the distances from care recipients. This study therefore aimed to describe and compare distance barriers for home nursing care providers using indices of the "profit willing distance" and the "tolerance limited distance". METHODS: This cross-sectional study was conducted during 2012 and 2013 using geocoding and a geographic information system to identify the distance from the providers' locations to participants' homes in urban (Taipei City) and rural (Hualien County) areas in Taiwan. Data were collected in-person by professionals in Taiwanese hospitals using the World Health Organization Disability Assessment Schedule 2.0. The indices were calculated using regression curves, and the first inflection points were determined as the points on the curves where the first and second derivatives equaled 0. RESULTS: There were 5627 participants from urban areas and 956 from rural areas. In urban areas, the profit willing distance was 550-600 m, and we were unable to identify them in rural areas. This demonstrates that providers may need to supply services even when there is little profit. The tolerance limited distance were 1600-1650 m in urban areas and 1950-2000 m in rural areas. In rural areas, 33.3% of those living inside the tolerance limited distance and there was no provider within this distance, but this figure fell to just 13.9% in urban areas. There were strong disparities between urban and rural areas in home nursing care resource allocation. CONCLUSIONS: Our new "profit willing distance" and the "tolerance limited distance" are considered to be clearer and more equitable than other evaluation indices. They have practical application in considering resource distribution issues around the world, and in particular the rural-urban disparities for public resource.