Melissa N. Poulsen

Early-life antibiotic use and subsequent diagnosis of food allergy and allergic diseases

Antibiotic use in early life has been linked to disruptions in the microbiome. Such changes can disturb immune system development. Differences have been observed in the microbiota of children with and without allergies, but there have been few studies on antibiotic use and allergic disease.

Associations of prenatal and childhood antibiotic use with child body mass index at age 3 years

Early‐life antibiotic exposure, whether through prenatal or childhood antibiotic use, may contribute to increased child body mass. Associations of prenatal and childhood antibiotic use with body mass index z‐score (BMIz) were evaluated at age 3 years.

Comparing objective measures of the built environment in their associations with youth physical activity and sedentary behavior across heterogeneous geographies

&NA; We compared two strategies for measuring built environment features in their associations with youth physical activity and sedentary behavior across heterogeneous geographies of Pennsylvania. Physical activity environments of communities representing a rural‐to‐urban gradient were characterized through direct observation and spatially referenced archival data subjected to confirmatory factor analysis. Stratified regression analyses assessed associations between environmental measures and behavioral outcomes by community type. Neither strategy was consistently associated with behavior across communities. Findings highlight the importance of differentiating community type in evaluating associations of the built environment, and the challenge of measuring meaningful differences that influence youth behavior across heterogeneous geographies. HighlightsCommunity features influence youth behavior, requiring evaluation of diverse places.We compared two strategies for measuring built environments across diverse places.Both measurement strategies captured differences in environmental features.Neither was consistently associated with physical activity or sedentary behavior.The study of diverse geographies poses methodological challenges.

The multifunctionality of urban farming: perceived benefits for neighbourhood improvement

ABSTRACT Urban farming – a type of urban agriculture focused on entrepreneurial food production – serves multiple functions in neighbourhoods; yet these are not well delineated. Expectations for urban farming often centre on traditional measures of economic development, potentially overlooking other benefits. Through a qualitative case study conducted in Baltimore, Maryland, we sought to understand community perceptions regarding the ways in which urban farms can benefit cities. Interviews with residents, neighbourhood leaders, and urban farmers in three residential neighbourhoods with urban farms revealed the pathways by which community members view farms as improving neighbourhoods. Benefits stemmed from four primary changes urban farms made to study neighbourhoods: creation of public projects welcoming involvement, physical improvement of degraded space, production of local food, and creation of new businesses. These changes led to multiple perceived benefits including increased social connectedness, a transformed physical landscape, improved neighbourhood reputation, increased access to fresh produce, and educational, youth development, and employment opportunities. Our findings demonstrate the importance of a multifunctional paradigm that accounts for social and educational functions in assessing the value of urban farming and bring empirical evidence to the concept of multifunctional agriculture. Urban farms with strong social aims may appear to contribute little to economic development if measured using traditional indicators of success such as job creation or fiscal impacts, but provide numerous other benefits for community development.

Residential proximity to high-density poultry operations associated with campylobacteriosis and infectious diarrhea

Poultry carry zoonotic bacteria that can cause gastroenteritis in humans. Environmental transmission of pathogens from poultry operations may increase gastrointestinal infection risk in surrounding communities. To evaluate associations between residential proximity to high-density poultry operations and individual-level diarrheal illnesses, we conducted a nested case-control study among 514,488 patients in Pennsylvania (2006-2015). Using electronic health records, we identified cases of five gastrointestinal outcomes: three pathogen-specific infections, including Escherichia coli (n = 1425), Campylobacter (n = 567), and Salmonella (n = 781); infectious diarrhea (n = 781); and non-specific diarrhea (2012-2015; n = 28,201). We estimated an inverse-distance squared activity metric for poultry operations based on farm and patient addresses. Patients in the second and fourth (versus first) quartiles of the poultry operation activity metric had increased odds of Campylobacter (AOR [CI], Q2: 1.36 [1.01, 1.82]; Q3: 1.38 [0.98, 1.96]; Q4: 1.75 [1.31, 2.33]). Patients in the second, third, and fourth quartiles had increased odds of infectious diarrhea (Q2: 1.76 [1.29, 2.39]; Q3: 1.76 [1.09, 2.85]; Q4: 1.60 [1.12, 2.30]). Stratification revealed stronger relations of fourth quartile and both Campylobacter and infectious diarrhea in townships, the most rural community type in the study geography. Increasing extreme rainfall in the week prior to diagnosis strengthened fourth quartile Campylobacter associations. The poultry operation activity metric was largely unassociated with E. coli, Salmonella, and non-specific diarrhea. Findings suggest high-density poultry operations may be associated with campylobacteriosis and infectious diarrhea in nearby communities, highlighting additional public health concerns of industrial agriculture.

Localization of health systems in low- and middle-income countries in response to long-term increases in energy prices

External challenges to health systems, such as those caused by global economic, social and environmental changes, have received little attention in recent debates on health systems’ performance in low-and middle-income countries (LMICs). One such challenge in coming years will be increasing prices for petroleum-based products as production from conventional petroleum reserves peaks and demand steadily increases in rapidly-growing LMICs. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors in LMICs who already struggle to deliver services to remote parts of their catchment areas. We propose the concept of “localization,” originating in the environmental sustainability literature, as one element of response to these challenges. Localization assigns people at the local level a greater role in the production of goods and services, thereby decreasing reliance on fossil fuels and other external inputs. Effective localization will require changes to governance structures within the health sector in LMICs, empowering local communities to participate in their own health in ways that have remained elusive since this goal was first put forth in the Alma-Ata Declaration on Primary Health Care in 1978. Experiences with decentralization policies in the decades following Alma-Ata offer lessons on defining roles and responsibilities, building capacity at the local level, and designing appropriate policies to target inequities, all of which can guide health systems to adapt to a changing environmental and energy landscape.