Prenatal Exposure to Airborne Polycyclic Aromatic Hydrocarbons and Children’s Intelligence at 5 Years of Age in a Prospective Cohort Study in Poland

Background

In this prospective cohort study of Caucasian mothers and children in Krakow, Poland, we evaluated the role of prenatal exposure to urban air pollutants in the pathogenesis of neurobehavioral disorders.

Objectives

The objective of this study was to investigate the relationship between prenatal polycyclic aromatic hydrocarbon (PAH) exposure and child intelligence at 5 years of age, controlling for potential confounders suspected to play a role in neurodevelopment.

Methods

A cohort of pregnant, healthy, nonsmoking women was enrolled in Krakow, Poland, between 2001 and 2006. During pregnancy, participants were invited to complete a questionnaire and undergo 48-hr personal air monitoring to estimate their babies’ exposure, and to provide a blood sample and/or a cord blood sample at the time of delivery. Two hundred fourteen children were followed through 5 years of age, when their nonverbal reasoning ability was assessed using the Raven Coloured Progressive Matrices (RCPM).

Results

We found that higher (above the median of 17.96 ng/m³) prenatal exposure to airborne PAHs (range, 1.8–272.2 ng/m³) was associated with decreased RCPM scores at 5 years of age, after adjusting for potential confounding variables (n = 214). Further adjusting for maternal intelligence, lead, or dietary PAHs did not alter this association. The reduction in RCPM score associated with high airborne PAH exposure corresponded to an estimated average decrease of 3.8 IQ points.

Conclusions

These results suggest that prenatal exposure to airborne PAHs adversely affects children’s cognitive development by 5 years of age, with potential implications for school performance. They are consistent with a recent finding in a parallel cohort in New York City.     

Paternalistic Leadership,Organizational Cynicism,and Intention to Quit One’s Job in Nursing

The aim of this study was to determine the relationship between paternalistic leadership, organizational cynicism, and the intention to quit one’s job among nurses. The implementation part of the study was carried out with nurses working in a public hospital in the city of Mersin, Turkey. Data were collected in January 2018 from 215 participants and then analyzed. The analyses indicate that the dimensions of organizational cynicism and paternalistic leadership explained 41.8% of the variance for the intention to quit. In addition, there were negative and significant relationships between paternalistic leadership and dimensions of organizational cynicism. As the participants’ perceptions of cognitive cynicism and behavioral cynicism increased, their intention to quit increased. In addition, as their perceptions of paternalistic leadership increased, their cognitive, affective, and behavioral cynicism decreased. This study will help managers of healthcare institutions better understand how paternalistic leadership is related to organizational cynicism and the intention to quit one’s job.     

Diabetes,Metabolic Syndrome,and Obesity in Relation to Serum Dioxin Concentrations: The Seveso Women’s Health Study

Background: In animal studies, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) alters glucose transport and increases serum lipid levels and blood pressure. Epidemiologic evidence suggests an association between TCDD and metabolic disease.Objectives: On 10 July 1976, a chemical explosion in Seveso, Italy, resulted in the highest known residential exposure to TCDD. Using data from the Seveso Women’s Health Study (SWHS), a cohort study of the health of the women, we examined the relation of serum TCDD to diabetes, metabolic syndrome, and obesity > 30 years later.Methods: In 1996, we enrolled 981 women who were newborn to 40 years of age in 1976 and resided in the most contaminated areas. Individual TCDD concentration was measured in archived serum that had been collected soon after the explosion. In 2008, 833 women participated in a follow-up study. Diabetes was classified based on self-report or fasting serum glucose and glycated hemoglobin levels. Metabolic syndrome was defined by International Diabetes Federation criteria. Obesity was defined as body mass index ≥ 30 kg/m².Results: A 10-fold increase in serum TCDD (log₁₀TCDD) was not associated with diabetes (adjusted hazard ratio = 0.76; 95% CI: 0.45, 1.28) or obesity [adjusted odds ratio (OR) = 0.80; 95% CI: 0.58, 1.10]. Log₁₀TCDD was associated with metabolic syndrome, but only among women who were ≤ 12 years of age at the time of the explosion (adjusted OR = 2.03; 95% CI: 1.25, 3.29; p_interaction = 0.01).Conclusions: We found an increased prevalence of metabolic syndrome associated with TCDD, but only among women who were the youngest at the time of the explosion. Continued follow-up of the SWHS cohort will be informative.     

Women’s knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women’s Health in Midlife Study

Abstract

The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45–64 years were conducted during 2004–2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about “warning signs of a heart attack” and “family history.” Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients’ personal status by health providers.     

Prenatal exposure to bisphenol A and phthalates and behavioral problems in children at preschool age: the Hokkaido Study on Environment and Children’s Health

Background

Studies reported adverse behavioral development including internalizing and externalizing problems in association with prenatal exposure to bisphenol A (BPA) and phthalates; however, findings were not sufficient due to using different assessment tools and child ages among studies. This study aimed to examine associations between maternal serum levels of BPA and phthalate metabolites and behavioral problems at preschool age.

Methods

The Strengths and Difficulties Questionnaire (SDQ) was used to assess behavioral problems at 5 years of age. BPA and phthalate metabolite levels in the first trimester maternal serum was determined by LC-MS/MS for 458 children. Variables used for adjustment were parental ages, maternal cotinine levels, family income during pregnancy, child sex, birth order, and age at SDQ completed.

Results

The median concentrations of BPA, MnBP, MiBP, MEHP, and MECPP, primary and secondary metabolites of phthalates, were 0.062, 26.0, 7.0, 1.40, and 0.20 ng/ml, respectively. MECPP level was associated with increase conduct problem risk (OR?=?2.78, 95% CI 1.36–5.68) overall and the association remained after child sex stratification, and odds ratios were increased with wider confidence interval (OR?=?2.85, 95% CI 1.07–7.57 for boys, OR?=?4.04, 95% CI 1.31–12.5 for girls, respectively). BPA, ∑DBP_m (MnBP + MiBP), and ∑DEHP_m (MEHP+MECPP) levels were not associated with any of the child behavioral problems.

Conclusions

Our analyses found no significant association between BPA or summation of phthalate metabolite levels and any of the behavioral problems at 5 years of age but suggested possible association between MECPP levels and increased risk of conduct problems.

     

Chinese-Australian Women’s Knowledge,Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study

Understanding the different facilitators and barriers to screening within cultural and ethnic groups is important for developing appropriate education and outreach programs to underserved groups. Qualitative methods were employed to gain a rich understanding of participant views. In-depth interviews were conducted with 18 Chinese Australian women in their native languages and analysed using content analysis. Knowledge of cervical cancer was low, and few participants understood the benefits and purpose of screening. Having a doctor’s recommendation was a strong motivator, and returning for screening was encouraged by having a female Chinese doctor perform the exam, receiving a reminder letter and the absence of cost for screening participation. However, participation was inhibited by logistical barriers, cultural beliefs and previous painful screening experiences. A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.     

Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies.

Many believe that excessive intake of refined carbohydrates (CHO) plays a major role in the development of obesity/overweight, type 2 diabetes mellitus and insulin resistance, a collection of events commonly referred to as “diabesity,” and have sought natural means to overcome these linked perturbations. As a first approach, planned diets with low portions of refined CHO have become popular. However, these diets do not satisfy everyone; and many are concerned over replacing CHO with more fats. As a second option, addition of soluble fiber to the diet can slow absorption of refined CHO, i.e., lower the glycemic index of foods and overcome or at least ameliorate many of the adverse reactions resulting from increased refined CHO ingestion. Unfortunately, the general public does not favor diets high in fiber content, and various fibers can lead to gastrointestinal problems such as gas and diarrhea. A third choice to favorably influence CHO absorption is to use natural dietary supplements that block or slow CHO absorption in the gastrointestinal tract via inhibiting enzymes necessary for CHO absorption –amylase and alpha-glucosidases. Although a number of natural supplements with anti-amylase activity have been recognized, the most studied and favored one is white kidney bean extract. Animal and human studies clearly show that this agent works in vivo and has clinical utility. This paper reviews many aspects of diabesity and the use of “carb blockers” to prevent and ameliorate the situation. In many respects, carb blockers mimic the beneficial effects of fibers.     

The Prevalence of Live Birth Down Syndrome in the Region of Primorsko-goranska County in Croatia, 1996–2005: The Impact of Screening and Amniocentesis

Objectives To investigate the prevalence of live birth Down syndrome (DS) in the region of Primorsko-goranska County (PGC) in Croatia from 1996 to 2005 and to evaluate the impact of second-trimester maternal serum screening (MSS) and amniocentesis on live birth DS prevalence. Methods Study was based on databases from the Department of Gynecology and Obstetrics, University Hospital Centre Rijeka, the Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, and the Croatian National Institute of Public Health. The regional policy of prenatal diagnosis for DS includes amniocentesis for pregnant women aged 35 or over and MSS for younger women. We estimated live birth and total prevalence of DS and measured the proportion of pregnant women using MSS and amniocentesis. Trends of live birth and total prevalence of DS were tested by linear regression analysis. Results The live birth prevalence of DS was 1.4/1000 in the period 1996–2005. A decreasing, but nonsignificant, trend of prevalence was observed over time (P = 0.577). Women aged 35 or over represented 11.6% of all pregnant women included in the study. The proportion of women who had MSS was 33.9%. The proportion who underwent amniocentesis was 6.1%. Conclusions No marked decrease in prevalence of live birth DS was observed in the region of PGC during the last 10 years. The usage of MSS and amniocentesis was too low to have any significant impact on live birth DS prevalence. Women’s, as well as physician’s, knowledge and attitudes towards prenatal diagnosis of DS should be evaluated.     

Resource Use and Cost of Alzheimer’s Disease in France: 18-Month Results from the GERAS Observational Study

Background

There is little longitudinal data on resource use and costs associated with Alzheimer’s disease (AD) in France.

Screening for cognitive impairment,Alzheimer’s disease and other dementias: Opinions of European caregivers,payors, physicians and the general public

The IMPACT survey queried physicians, caregivers, payors and members of the general public from 5 European countries (France, Germany, Italy, Spain and the United Kingdom) regarding their opinions towards screening for Alzheimer’s disease (AD) as part of a 30-minute Web-based questionnaire conducted between April and May 2009. A larger proportion of caregivers (84%) and members of the general public (80%) than of physicians (56%) or payors (40%) viewed routine screening for AD as extremely or very important (P<0.001 for caregivers or general public vs physicians or payors). When asked if everyone should be routinely screened for AD at age 65, a smaller proportion of physicians (42%) and payors (44%) than members of the general public (81%) or caregivers (80%) agreed (P<0.001 for caregivers or general public vs physicians or payors). These opinions were generally consistent across the 5 countries for each respondent group. A notable exception was physician respondents from Italy, where most generalists and specialists actually favoured screening. Overall, generalists had a more positive attitude towards screening than specialists. The most frequently cited reason given by those who did not favour routine screening at age 65 was screening inaccuracy. This article discusses these results in relation to what screening is, when to screen and the barriers to screening. Despite the majority of IMPACT respondents being in favour of screening for AD, the evidence to support the introduction of population screening for cognitive impairment is not available; however, the importance of optimal identification of AD and other dementias in primary care should be a priority for community health professionals and payors. In order to do this effectively, further work is required to identify good assessment guidelines for use during opportunistic screening for cognitive impairment in primary care.     

‘A preferred consultant and partner to the Royal Government,NGOs, and the community’: British American Tobacco’s access to policy-makers in Cambodia

British American Tobacco Cambodia (BATC) has dominated the country’s tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC’s in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia’s increasingly controversial political and business leadership that is centred around the Cambodian People’s Party with the aim of gaining access to policy-makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company’s ostensible contribution to Cambodia’s economic and social development and, more significantly, provided BATC with opportunities to petition policy-makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia’s economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia’s compliance with the Framework Convention on Tobacco Control.     

Changes in Young Adults’ Alcohol and Marijuana Use,Norms, and Motives From Before to During the COVID-19 Pandemic

PurposeAlongside the SARS-CoV-2 virus, the COVID-19 pandemic is associated with several secondary health effects. There is concern for increased substance use motivated by coping with stress, anxiety, depression, and boredom–all of which may be elevated during the pandemic. The current study examined intraindividual changes (from pre-COVID to during COVID) in young adults’ alcohol and marijuana use, perceptions of peers’ use (i.e., norms), and motives for use.MethodsA community sample of young adults (N = 572; M_age = 25.14; 60.8% women) was recruited in Washington State. By using a repeated-measures design, data were collected prior to the COVID-19 pandemic (January 2020) and again during the initial acute phase of the pandemic (April/May of 2020).ResultsYoung adults, on average, increased alcohol use frequency but decreased the amount consumed per drinking occasion. No changes in marijuana use were identified. Young adults (on average) perceived that peers had increased the frequency and total amount of alcohol use and perceived that peers were engaging in heavier marijuana use than prior to COVID-19. For alcohol use motives, there was a significant increase in depression coping motives and significant decreases in social, enhancement, and conformity motives. Boredom motives for marijuana use significantly increased, while celebration motives decreased.ConclusionsUsing a prospective design with a sample initially recruited in Washington State, these data indicate that (a) young adults’ patterns of alcohol use may have changed, (b) young adults tend to think that peers are engaging in heavier alcohol/marijuana use than before the pandemic, and (c) motives for using alcohol/marijuana may have changed during the pandemic.     

Changes in Dietary Intake in Pregnant Women from Periconception to Pregnancy in the Japan Environment and Children’s Study: A Nationwide Japanese Birth Cohort Study

Maternal and Child Health Journal - Nutritional requirements increase during pregnancy. However, relatively few studies have examined longitudinal changes in dietary intake from periconception to...     

Using National and Local Extant Data to Characterize Environmental Exposures in the National Children’s Study: Queens County,New York

Objective

The National Children’s Study is a long-term epidemiologic study of 100,000 children from 105 locations across the United States. It will require information on a large number of environmental variables to address its core hypotheses. The resources available to collect actual home and personal exposure samples are limited, with most of the home sampling completed on periodic visits and the personal sampling generally limited to biomonitoring. To fill major data gaps, extant data will be required for each study location. The Queens Vanguard Center has examined the extent of those needs and the types of data that are generally and possibly locally available.

Data

In this review we identify three levels of data—national, state and county—and local data and information sets (levels 1–3, respectively), each with different degrees of availability and completeness, that can be used as a starting point for the extant data collection in each study location over time. We present an example on the use of this tiered approach, to tailor the data needs for Queens County and to provide general guidance for application to other NCS locations.

Conclusions

Preexisting and continually evolving databases are available for use in the NCS to characterize exposure. The three levels of data we identified will be used to test a method for developing exposure indices for segments and homes during the pilot phase of NCS, as outlined in this article.     

Dietary Carbohydrate and Nocturnal Sleep Duration in Relation to Children’s BMI: Findings from the IDEFICS Study in Eight European Countries

Previous research has found an association between being overweight and short sleep duration. We hypothesized that this association could be modified by a high carbohydrate (HC) diet and that the timing and type (starch or sugar) of intake may be an important factor in this context. Participants in the prospective, eight-country European study IDEFICS were recruited from September 2007 to June 2008, when they were aged two to nine years. Data on lifestyle, dietary intake and anthropometry were collected on two occasions. This study included 5944 children at baseline and 4301 at two-year follow-up. For each meal occasion (morning, midday, and evening), starch in grams and sugar in grams were divided by total energy intake (EI), and quartiles calculated. HC-starch and HC-sugar intake categories were defined as the highest quartile for each meal occasion. In a mutually adjusted linear regression model, short sleep duration as well as HC-starch in the morning were positively associated with body mass index (BMI) z-scores at baseline. HC-starch at midday was positively associated with body mass index (BMI) z-scores in children with short sleep duration, and negatively associated with BMI z-scores in those with normal sleep. After adjustment for baseline BMI z-scores, associations between total HC from starch or sugar and high BMI z-scores at two-year follow-up did not persist. Our observations offer a perspective on optimal timing for macronutrient consumption, which is known to be influenced by circadian rhythms. Reduced carbohydrate intake, especially during morning and midday meals, and following nocturnal sleep duration recommendations are two modifiable factors that may protect children from being overweight in the future.     

Particulate Matter Air Pollution Exposure,Distance to Road,and Incident Lung Cancer in the Nurses’ Health Study Cohort

Background: A body of literature has suggested an elevated risk of lung cancer associated with particulate matter and traffic-related pollutants.Objective: We examined the relation of lung cancer incidence with long-term residential exposures to ambient particulate matter and residential distance to roadway, as a proxy for traffic-related exposures.Methods: For participants in the Nurses’ Health Study, a nationwide prospective cohort of women, we estimated 72-month average exposures to PM_2.5, PM_2.5–10, and PM₁₀ and residential distance to road. Follow-up for incident cases of lung cancer occurred from 1994 through 2010. Cox proportional hazards models were adjusted for potential confounders. Effect modification by smoking status was examined.Results: During 1,510,027 person-years, 2,155 incident cases of lung cancer were observed among 103,650 participants. In fully adjusted models, a 10-μg/m³ increase in 72-month average PM₁₀ [hazard ratio (HR) = 1.04; 95% CI: 0.95, 1.14], PM_2.5 (HR = 1.06; 95% CI: 0.91, 1.25), or PM_2.5–10 (HR = 1.05; 95% CI: 0.92, 1.20) was positively associated with lung cancer. When the cohort was restricted to never-smokers and to former smokers who had quit at least 10 years before, the associations appeared to increase and were strongest for PM_2.5 (PM₁₀: HR = 1.15; 95% CI: 1.00, 1.32; PM_2.5: HR = 1.37; 95% CI: 1.06, 1.77; PM_2.5–10: HR = 1.11; 95% CI: 0.90, 1.37). Results were most elevated when restricted to the most prevalent subtype, adenocarcinomas. Risks with roadway proximity were less consistent.Conclusions: Our findings support those from other studies indicating increased risk of incident lung cancer associated with ambient PM exposures, especially among never- and long-term former smokers.Citation: Puett RC, Hart JE, Yanosky JD, Spiegelman D, Wang M, Fisher JA, Hong B, Laden F. 2014. Particulate matter air pollution exposure, distance to road, and incident lung cancer in the Nurses’ Health Study Cohort. Environ Health Perspect 122:926–932; http://dx.doi.org/10.1289/ehp.1307490     

Peer Reviewed: Prenatal HIV Testing in the US-Mexico Border Region, 2005: The Brownsville-Matamoros Sister City Project for Women’s Health

Introduction

Routine prenatal human immunodeficiency virus (HIV) screening provides a critical opportunity to diagnose HIV infection, begin chronic care, and prevent mother-to-child transmission. However, little is known about the prevalence of prenatal HIV testing in the US-Mexico border region. We explored the correlation between prenatal HIV testing and sociodemographic, health behavior, and health exposure characteristics.

Methods

The study sample consisted of women who delivered live infants in 2005 in hospitals with more than 100 deliveries per year and resided in Matamoros, Tamaulipas, Mexico (n = 489), or Cameron County, Texas (n = 458). We examined univariate and bivariate distributions of HIV testing in Matamoros and Cameron County and quantified the difference in odds of HIV testing by using logistic regression.

Results

The prevalence of prenatal HIV testing varied by place of residence — 57.6% in Matamoros and 94.8% in Cameron County. Women in Cameron County were significantly more likely than those in Matamoros to be tested. Marital status, education, knowledge of methods to prevent HIV transmission (adult-to-adult), discussion of HIV screening with a health care professional during prenatal care, and previous HIV testing were significantly associated with prenatal HIV testing in Matamoros, although only the latter 2 variables were significant in Cameron County.

Conclusion

Although national policies in both the United States and Mexico recommend prenatal testing for HIV, a greater proportion of women in Cameron County were tested, compared with women in Matamoros. Efforts between Matamoros and Cameron County to improve HIV testing during pregnancy in the border region should consider correlates for testing in each community.     

Exploring the Roles of Family Members in Women’s Decision to Use Postpartum Healthcare Services from the Perspectives of Women and Health Care Providers

Although the postpartum period is a significant time in a family’s life, few studies have addressed the lack of continuity of care and service use during the postpartum period. The aim of this study was to explore the roles of family members in Jordanian women’s decision to use postpartum health care services. An exploratory qualitative design was employed to elicit the perspectives of 24 women and 30 health care providers through six focus groups discussions conducted in April 2006. Interviews were transcribed verbatim, translated to English, and analyzed using an inductive content analysis approach. In our study, three roles of family members influencing Jordanian women’s decision to use postpartum health care services emerged: supporter role, opponent role, and active participant in care role. Findings supported the need for a family-centered approach when providing postpartum care to enhance positive family roles and limit negative ones to promote continuity of healthcare services use during the postpartum period.