Perfluoroalkyl Substances in the Blood of Wild Rats and Mice from 47 Prefectures in Japan: Use of Samples from Nationwide Specimen Bank

Numerous studies have reported on the global distribution, persistence, fate, and toxicity of perfluoroalkyl and polyfluoroalkyl substances (PFASs). However, studies on PFASs in terrestrial mammals are scarce. Rats can be good sentinels of human exposure to toxicants because of their habitat, which is in close proximity to humans. Furthermore, exposure data measured for rats can be directly applied for risk assessment because many toxicological studies use rodent models. In this study, a nationwide survey of PFASs in the blood of wild rats as well as surface water samples collected from rats’ habitats from 47 prefectures in Japan was conducted. In addition to known PFASs, combustion ion chromatography technique was used for analysis of total fluorine concentrations in the blood of rats. In total, 216 blood samples representing three species of wild rats (house rat, Norway rats, and field mice) were analyzed for 23 PFASs. Perfluorooctanesulfonate (PFOS; concentration range <0.05-148 ng/mL), perfluorooctane sulfonamide (PFOSA; <0.1–157), perfluorododecanoate (<0.05–5.8), perfluoroundecanoate (PFUnDA; <0.05–51), perfluorodecanoate (PFDA; <0.05–9.7), perfluorononanoate (PFNA; <0.05–249), and perfluorooctanoate (PFOA) (<0.05–60) were detected >80 % of the blood samples. Concentrations of several PFASs in rat blood were similar to those reported for humans. PFSAs (mainly PFOS) accounted for 45 % of total PFASs, whereas perfluoroalkyl carboxylates (PFCAs), especially PFUnDA and PFNA, accounted for 20 and 10 % of total PFASs, respectively. In water samples, PFCAs were the predominant compounds with PFOA and PFNA found in >90 % of the samples. There were strong correlations (p < 0.001 to p < 0.05) between human population density and levels of PFOS, PFNA, PFOA, and PFOSA in wild rat blood.     

ADONA and perfluoroalkylated substances in plasma samples of German blood donors living in South Germany

Perfluorinated compounds are fully fluorinated anthropogenic substances that have been used in various products, applications, and industrial processes. Due to their persistence and toxic effects, some of them are restricted, and therefore replacement products have been developed.The aim of the study was to quantify the body burden of different perfluorinated substances in two adult populations living close to or about 80 km apart from a former perfluorooctanoate (PFOA) production plant who are exposed via drinking water, and in a control population. In this plant, the replacement emulsifier 3H-perfluoro-3-[(3-methoxy-propoxy)propanoic acid] (ADONA) has been used in the production of fluoropolymers since 2008.We quantified 7 perfluorinated compounds and ADONA in a total of 396 plasma samples collected at different time points. With regard to samples collected in 2015 or 2016, the highest 95th percentile levels were 13.5 μg/l for perfluorooctane sulfonate (PFOS), 3.0 μg/l for perfluorononanoate (PFNA), and 1.5 μg/l for perfluorohexane sulfonate (PFHxS). For PFOA, the highest 95th percentile was found at the site close to the facility (85.5 μg/l), while in the control region the value was 2.4 μg/l. Overall, the concentration of PFOA and PFOS declined over time in all study regions. ADONA was detected only in few samples slightly above the limit of quantification (0.2 μg/l).While health risks related to ADONA are unlikely under the present exposure situation, the exposure to PFOA via tap water should be reduced markedly, especially for the population living close to the plant.     

Per- and polyfluoroalkyl substances in sera from children 3 to 11 years of age participating in the National Health and Nutrition Examination Survey 2013–2014

Several per- and polyfluoroalkyl substances (PFAS) have been measured in U.S. National Health and Nutrition Examination Survey (NHANES) participants 12 years of age and older since 1999–2000, but PFAS data using NHANES individual samples among children younger than 12 years do not exist. To obtain the first nationally representative PFAS exposure data in U.S. children, we quantified serum concentrations of 14 PFAS including perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), in a nationally representative subsample of 639 3–11 year old participants in NHANES 2013–2014. We used on-line solid-phase extraction coupled to isotope dilution-high performance liquid chromatography-tandem mass spectrometry; limits of detection were 0.1 ng/mL for all analytes. We calculated geometric mean concentrations, determined weighted Pearson correlations, and used linear regression to evaluate associations of sex, age (3–5 vs 6–11 years), race/ethnicity (Hispanic vs non-Hispanic), household income, and body mass index with concentrations of PFAS detected in more than 60% of participants. We detected PFOS, PFOA, PFHxS, and PFNA in all children at concentrations similar to those of NHANES 2013–2014 adolescents and adults, suggesting prevalent exposure to these PFAS or their precursors among U.S. 3–11 year old children, most of whom were born after the phase out of PFOS in the United States in 2002. PFAS concentration differences by sex, race/ethnicity, and age suggest lifestyle differences that may impact exposure, and highlight the importance of identifying exposure sources and of studying the environmental fate and transport of PFAS.     

Prenatal exposure to perfluoroalkyl substances,immune-related outcomes,and lung function in children from a Spanish birth cohort study

BackgroundPrenatal exposure to perfluoroalkyl substances (PFASs) has been associated with impaired immune and respiratory health during childhood but the evidence is inconsistent and limited for lung function. We studied the association between prenatal PFASs exposure and immune and respiratory health, including lung function, up to age 7 years in the Spanish INMA birth cohort study.MethodsWe assessed four PFASs in maternal plasma samples collected during the 1st trimester of pregnancy (years: 2003–2008): perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA). Mothers reported the occurrence (yes/no) of lower respiratory tract infections, wheezing, asthma, and eczema in the previous 12 months at 1.5 and 4 years of the child (n = 1188) and at 7 years (n = 1071). At ages 4 (n = 503) and 7 (n = 992) years lung function was assessed using spirometry tests.ResultsThe most abundant PFASs were PFOS and PFOA (geometric means: 5.80 and 2.31 ng/mL, respectively). The relative risk of asthma during childhood per each doubling in PFNA concentration was 0.74 (95 CI%: 0.57, 0.96). The relative risk of eczema during childhood per every doubling in PFOS concentration was 0.86 (95 CI%: 0.75, 0.98). Higher PFOA concentrations were associated with lower forced vital capacity and lower forced expiratory volume in 1 s z-scores at 4 years [β (95 CI %): −0.17 (−0.34, −0.01) and −0.13 (−0.29, 0.03), respectively], but not at 7 years.ConclusionThis longitudinal study suggests that different PFASs may affect the developing immune and respiratory systems differently. Prenatal exposure to PFNA and PFOS may be associated with reduced risk of respiratory and immune outcomes, particularly asthma and eczema whereas exposure to PFOA may be associated with reduced lung function in young children. These mixed results need to be replicated in follow-up studies at later ages.     

Perfluoroalkyl acids in children and their mothers: Association with drinking water and time trends of inner exposures—Results of the Duisburg birth cohort and Bochum cohort studies

BackgroundPerfluoroalkyl acids (PFAAs) are widely distributed in the environment and humans are globally exposed with them. Contaminated drinking water can considerably contribute to the inner exposure levels.ObjectivesWe report the results of a human biomonitoring study with mother–child pairs living in two German cities, one city with PFAA contaminated drinking water in the sub μg/l-range (Bochum) and the other one without contamination (Duisburg). Furthermore, we studied time trends of exposure levels within the Duisburg cohort study.MethodsWe measured seven PFAAs (PFOS, PFOA, PFHxS, PFNA, PFBS, PFDeA, PFDoA) in blood samples by high performance liquid chromatography and tandem mass spectrometry. Samples were taken during pregnancy, from umbilical cord blood (2000–2002), 6–7 years (5th follow-up) and 8–10 years after birth (7th follow-up). The consumption of drinking water was recorded by a standardized questionnaire. Statistical analyses were calculated with multiple linear regression models.ResultsChildren and mothers from Bochum showed higher PFOS and PFOA plasma concentrations than from Duisburg. The median concentrations (μg/l) for children were: PFOS 4.7 vs. 3.3; PFOA 6.0 vs. 3.6 μg/l (p ≤ 0.05). Consumption of >0.7 l (children) and >0.9 l (mothers) drinking water/day was associated with 13–18% higher PFOS, PFOA and PFHxS concentrations in children (p ≤ 0.01), and 22% higher PFOA in mothers (p ≤ 0.05). Within the Duisburg cohort, PFAA levels in children peaked in the 5th follow-up study (medians (μg/l): cord plasma: 2.7 (PFOS); 1.9 (PFOA); 5th follow-up: 3.6 (PFOS); 4.6 (PFOA); 7th follow-up: 3.3 (PFOS); 3.6 (PFOA)). PFOS concentrations in mothers declined from pregnancy to the 5th follow-up (medians: 8.7 vs. 4.0 μg/l).ConclusionResidents exposed to PFOS and PFOA through drinking water showed significantly higher PFOS and PFOA concentrations in blood plasma. Although PFAA concentrations in the children slightly decreased from the 5th to the 7th follow-up, we detected increasing exposure trends with increasing age in the 7th follow-up.     

Per- and polyfluoroalkyl substances impact human spermatogenesis in a stem-cell-derived model

Per- and polyfluoroalkyl substances (PFASs) represent a highly ubiquitous group of synthetic chemicals used in products ranging from water and oil repellents and lubricants to firefighting foam. These substances can enter and accumulate in multiple tissue matrices in up to 100% of people assessed. Though animal models strongly identify these compounds as male reproductive toxicants, with exposed rodents experiencing declines in sperm count, alterations in hormones, and DNA damage in spermatids, among other adverse outcomes, human studies report conflicting conclusions as to the reproductive toxicity of these chemicals. Using an innovative, human stem-cell-based model of spermatogenesis, we assessed the effects of the PFASs perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and a mixture of PFOS, PFOA, and PFNA for their impacts on human spermatogenesis in vitro under conditions relevant to the general and occupationally exposed populations. Here, we show that PFOS, PFOA, PFNA, and a mixture of PFOS, PFOA, and PFNA do not decrease in vitro germ cell viability, consistent with reports from human studies. These compounds do not affect mitochondrial membrane potential or increase reactive oxygen species generation, and they do not decrease cell viability of spermatogonia, primary spermatocytes, secondary spermatocytes, or spermatids in vitro under the conditions examined. However, exposure to PFOS, PFOA, and PFNA reduces expression of markers for spermatogonia and primary spermatocytes. While not having direct effects on germ cell viability, these effects suggest the potential for long-term impacts on male fertility through the exhaustion of the spermatogonial stem cell pool and abnormalities in primary spermatocytes.

Abbreviations: CDC: Centers for Disease Control; DMSO: dimethyl sulfoxide; GHR: growth hormone receptor; hESCs: human embryonic stem cells; PFASs: per- and polyfluoroalkyl substances; PFCs: perfluorinated compounds; PFNA: perfluorononanoic acid; PFOS: perfluorooctanesulfonic acid; PFOA: perfluorooctanoic acid; PLZF: promyelocytic leukemia zinc finger; ROS: reactive oxygen species; HILI: RNA-mediated gene silencing 2; SSC: spermatogonial stem cell     

Prenatal exposure to perfluroalkyl substances and children's IQ: The Taiwan maternal and infant cohort study

BackgroundPerfluoroalkyl substances (PFASs) are a group of fluorinated organic substances that are widely used in consumer products and are often detectable in human tissues. Human studies on prenatal exposure to PFASs and neurodevelopment in children are few and inconsistent.MethodsIn the Taiwan Maternal and Infant Cohort Study, we collected serum samples from pregnant women during the third trimester and measured concentrations of 9 PFASs using a high performance liquid chromatography system. A subsample of their children was assessed with full scale intelligence quotient (FSIQ), verbal IQ (VIQ) and performance IQ (PIQ) at both age 5 (n = 120) and 8 years (n = 120). We used multivariate linear regression models to examine prenatal PFAS exposure in relation to IQ scores at each age period.ResultsPrenatal perfluoroundecanoic acid (PFUnDA) concentrations were inversely associated with children's PIQ scores at age 5 years, with an adjusted coefficient (β) of −1.6 (95% confidence interval [CI]: (−3.0, −0.2). When children reached 8 years, most of the prenatal PFASs showed inverse association with children's FSIQ, VIQ and PIQ scores. Among them, prenatal perfluorononanoic acid (PFNA) reached significance. Children with higher prenatal PFNA levels had lower VIQ with an adjusted β of −2.1 (95% CI: −3.9, −0.2).ConclusionsWe found two prenatal PFAS exposure, both long-chain PFASs, in association with decreased IQ test scores in children. Our findings suggest more studies on long-chain PFASs and children's neurodevelopment.     

Factors associated with not receiving homecare,end-of-life homecare,or early homecare referral among cancer decedents: A population-based cohort study

Publicly funded homecare has been shown to reduce acute care use and improve quality of life for those nearing end-of-life (EOL). Yet despite the known benefits of homecare, many EOL cancer patients never receive these services. We used administrative data on all cancer decedents in Ontario, Canada in 2006 to determine predictive factors of not receiving homecare, not receiving EOL homecare, and late initiation of EOL homecare. 22,262 decedents met the eligibly criteria, 25% of whom never received homecare in the last six months of life. A logistic regression found that cancer disease site, having a comorbidity (OR: 1.15, 95% CI: 1.1–1.2), region of residence, shorter cancer survival (OR: 2.09, 95% CI: 1.8–2.4), being male (OR: 1.25, 95% CI: 1.2–1.3), lower income (OR: 1.06, 95% CI: 1.03–1.08), older age (OR: 1.03, 95% CI: 1.02–1.05), and less prior emergency department use were significant factors associated with not receiving homecare (p < 0.001). Individuals with hematological cancer (OR: 1.57, 95% CI: 1.3–1.8) were less likely to receive homecare in their final months. Some of these covariates also predicted not receiving EOL homecare and late referral to these services (p < 0.05). The systematic differences in homecare use that we identified can help to guide strategies for improving access to these important services.     

Facteurs associés aux perdus de vue des patients sous traitement antirétroviral dans un centre de traitement ambulatoire du VIH à Conakry,Guinée

Background

Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry.

Inequalities in cervical cancer screening utilisation and results: A comparison between Italian natives and immigrants from disadvantaged countries

Cervical cancer screening underutilisation is documented among immigrants from poor countries and it is associated to an augmented risk for severe lesions. In a cohort of 1,410,364 Italian women and 200,491 immigrants from poor countries differences in screening participation and results were investigated. Participation rate was lower for immigrants than for Italians: 43.98% versus 48.59% (chi(1): p < 0.001). This gap increased with age (ptrend < 0.0001). Some socio-demographic factors negatively influenced immigrants' participation. Illiteracy (OR = 0.75) versus secondary school, being single (OR = 0.71) versus attached, first screens (OR = 0.67) versus subsequent ones. Although the interaction between educational and professional levels showed that graduated immigrant women conducting an intellectual job have a higher inclination towards screening than their Italian peers (OR = 1.43 vs OR = 1.04). The Standardised Detection Ratio (SDR) suggested a frequency of severe lesions nearly double among immigrants in first screens (SDR = 1.94; 95% CI: 1.82–2.08) and even higher (SDR = 2.53; 95% CI: 2.35–2.73) for Central/Eastern Europeans. Multi-component interventions involving both patients and providers offer the greatest potential to increase cervical cancer screening uptake within foreign-born populations. So immigrant-specific interventions are needed for some immigrant groups, like Central/Eastern Europeans who are at higher risk of cervical lesions and, together with Asians and Africans, showed a poor attitude towards cancer prevention.     

Perfluorooctanoic acid and low birth weight: Estimates of US attributable burden and economic costs from 2003 through 2014

Background and objective

In utero exposure to perfluorooctanoic acid (PFOA) has been associated with decreases in birth weight. We aimed to estimate the proportion of PFOA-attributable low birth weight (LBW) births and associated costs in the US from 2003 to 2014, a period during which there were industry-initiated and regulatory activities aimed at reducing exposure.

Association of Perfluoroalkyl Substances,Bone Mineral Density,and Osteoporosis in the U.S. Population in NHANES 2009–2010

Background

Perfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), are detectable in the serum of 95% of the U.S. population.

Objective

Considering the role of PFASs as endocrine disruptors, we examined their relationships with bone health.

Methods

The association between serum PFAS concentration and bone mineral density at total femur (TFBMD), femoral neck (FNBMD), lumbar spine (LSBMD), and physician-diagnosed osteoporosis was assessed in 1,914 participants using data from the National Health and Nutritional Examination Survey 2009–2010.

Results

The mean age of the participants was 43 years. Men had higher serum PFAS concentrations than women (p < 0.001) except for PFNA. In both sexes, serum PFOS concentrations were inversely associated with FNBMD (p < 0.05). In women, significant negative associations were observed for natural log (ln)–transformed PFOS exposure with TFBMD and FNBMD, and for ln-transformed PFOA exposure with TFBMD (p < 0.05). In postmenopausal women, serum PFOS was negatively associated with TFBMD and FNBMD, and PFNA was negatively associated with TFBMD, FNBMD, and LSBMD (all p < 0.05). With one log unit increase in serum PFOA, PFHxS, and PFNA, osteoporosis prevalence in women increased as follows: [adjusted odds ratios (aORs)] 1.84 (95% CI: 1.17, 2.905), 1.64 (95% CI: 1.14, 2.38), and 1.45 (95% CI: 1.02, 2.05), respectively. In women, the prevalence of osteoporosis was significantly higher in the highest versus the lowest quartiles of PFOA, PFHxS, and PFNA, with aORs of 2.59 (95% CI: 1.01, 6.67), 13.20 (95% CI: 2.72, 64.15), and 3.23 (95% CI: 1.44, 7.21), respectively, based on 77 cases in the study sample.

Conclusion

In a representative sample of the U.S. adult population, serum PFAS concentrations were associated with lower bone mineral density, which varied according to the specific PFAS and bone site assessed. Most associations were limited to women. Osteoporosis in women was also associated with PFAS exposure, based on a small number of cases.

Citation

Khalil N, Chen A, Lee M, Czerwinski SA, Ebert JR, DeWitt JC, Kannan K. 2016. Association of perfluoroalkyl substances, bone mineral density, and osteoporosis in the U.S. population in NHANES 2009–2010. Environ Health Perspect 124:81–87; http://dx.doi.org/10.1289/ehp.1307909     

Exposure to fine particulate matter during pregnancy and risk of term low birth weight in Jinan,China, 2014–2016

Background

Existing studies exploring the association between low birth weight (LBW) and maternal fine particulate matter (aerodynamic diameter < 2.5 μm, PM_2.5) exposure have presented equivocal results, and one of the possible reasons for this finding might be due to relatively low maternal exposures. In addition, relatively narrow maternal exposure windows to PM_2.5 have not been well established for LBW.

Exposure to Polyfluoroalkyl Chemicals and Cholesterol,Body Weight,and Insulin Resistance in the General U.S. Population

Background

Polyfluoroalkyl chemicals (PFCs) are used commonly in commercial applications and are detected in humans and the environment worldwide. Concern has been raised that they may disrupt lipid and weight regulation.

Objectives

We investigated the relationship between PFC serum concentrations and lipid and weight outcomes in a large publicly available data set.

Methods

We analyzed data from the 2003–2004 National Health and Nutrition Examination Survey (NHANES) for participants 12–80 years of age. Using linear regression to control for covariates, we studied the association between serum concentrations of perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS) and measures of cholesterol, body size, and insulin resistance.

Results

We observed a positive association between concentrations of PFOS, PFOA, and PFNA and total and non-high-density cholesterol. We found the opposite for PFHxS. Those in the highest quartile of PFOS exposure had total cholesterol levels 13.4 mg/dL [95% confidence interval (CI), 3.8–23.0] higher than those in the lowest quartile. For PFOA, PFNA, and PFHxS, effect estimates were 9.8 (95% CI, −0.2 to 19.7), 13.9 (95% CI, 1.9–25.9), and −7.0 (95% CI, −13.2 to −0.8), respectively. A similar pattern emerged when exposures were modeled continuously. We saw little evidence of a consistent association with body size or insulin resistance.

Conclusions

This exploratory cross-sectional study is consistent with other epidemiologic studies in finding a positive association between PFOS and PFOA and cholesterol, despite much lower exposures in NHANES. Results for PFNA and PFHxS are novel, emphasizing the need to study PFCs other than PFOS and PFOA.     

In utero and childhood DDT,DDE, PBDE and PCBs exposure and sex hormones in adolescent boys: The CHAMACOS study

Dichlorodiphenyltrichloroethane (DDT), polybrominated diphenyl ether (PBDE) flame retardants, and polychlorinated biphenyls (PCBs) are believed to be endocrine-disrupting chemicals (EDCs) in humans and animals. The purpose of this study is to examine the relationship of in utero and childhood exposure to these purported EDCs and reproductive hormones in adolescent boys who participated in CHAMACOS, an ongoing birth cohort in California's Salinas Valley. We measured o,p′- and p,p′-DDT, p,p′-DDE, PBDEs and PCBs in serum collected from mothers during pregnancy or at delivery and from their sons at 9 years. We measured concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone (T) from 234 of their sons at 12 years. In adjusted models, we found that a 10-fold increase in maternal prenatal serum concentrations of BDE-153 was associated with a 22.2% increase (95% CI: 1.0, 47.9) in FSH, a 96.6% increase (95% CI: 35.7, 184.7) in LH, and a 92.4% increase (95% CI: 20.9, 206.2) increase in T. Similarly, BDE-100 concentrations were associated with increases in boys’ LH levels. A 10-fold increase in total prenatal ΣPCBs was associated with a 64.5% increase (95% CI: 8.6, 149.0) in FSH, primarily driven by non- dioxin-like congeners. Boys' hormone levels were only marginally associated with prenatal DDT or DDE in primary models, but when boys' Tanner stage at age 12 was added to models, prenatal maternal DDT levels were associated with decreases in LH (adjusted percent change per 10-fold increase = ?18.5%, 95% CI: ?29.8, ?5.4) and T (percent change = ?18.2%, 95% CI: ?30.2, ?4.2) and DDE with LH (percent change = ?18.3%, 95% CI: ?32.9, ?0.6). Exposures measured in the children's serum at 9 years also showed associations between BDE-153 and ΣPCBs. However, there is evidence that these associations appear to be mediated by child BMI. This study suggests associations on male hormones of 12 year old boys related to exposure to certain EDC exposure prenatally. The implications on future reproductive function in puberty and adulthood should be determined.     

Thyroid function and perfluoroalkyl acids in children living near a chemical plant

Background: Animal studies suggest that some perfluoroalkyl acids (PFAAs), including perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), and perfluorononanoic acid (PFNA) may impair thyroid function. Epidemiological findings, mostly related to adults, are inconsistent.Objectives: We investigated whether concentrations of PFAAs were associated with thyroid function among 10,725 children (1–17 years of age) living near a Teflon manufacturing facility in the Mid-Ohio Valley (USA).Methods: Serum levels of thyroid-stimulating hormone (TSH), total thyroxine (TT₄), and PFAAs were measured during 2005–2006, and information on diagnosed thyroid disease was collected by questionnaire. Modeled in utero PFOA concentrations were based on historical information on PFOA releases, environmental distribution, pharmacokinetic modeling, and residential histories. We performed multivariate regression analyses.Results: Median concentrations of modeled in utero PFOA and measured serum PFOA, PFOS, and PFNA were 12, 29, 20, and 1.5 ng/mL, respectively. The odds ratio for hypothyroidism (n = 39) was 1.54 [95% confidence interval (CI): 1.00, 2.37] for an interquartile range (IQR) contrast of 13 to 68 ng/mL in serum PFOA measured in 2005–2006. However, an IQR shift in serum PFOA was not associated with TSH or TT₄ levels in all children combined. IQR shifts in serum PFOS (15 to 28 ng/mL) and serum PFNA (1.2 to 2.0 ng/mL) were both associated with a 1.1% increase in TT₄ in children 1–17 years old (95% CIs: 0.6, 1.5 and 0.7, 1.5 respectively).Conclusions: This is the first large-scale report in children suggesting associations of serum PFOS and PFNA with thyroid hormone levels and of serum PFOA and hypothyroidism.     

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children

PurposeWe tested the hypotheses that consistency and strength of clinician recommendation of the human papillomavirus (HPV) vaccination would be associated with vaccine delivery rates.MethodsFrom October 2015 through January 2016, we conducted a survey of primary care clinicians (n = 227) in Southeastern Minnesota to evaluate clinician behaviors regarding HPV vaccination. The survey response rate was 41.0% (51 clinical sites). We used the Rochester Epidemiology Project, a clinical data linkage infrastructure, to ascertain clinical site-level HPV vaccination rates. We examined associations of clinician self-reports of both the consistency and strength of their recommendations for HPV vaccination for patients aged 11–12 years (n = 14,406) with site-level vaccination rates.ResultsThe majority of clinicians reported consistently (always or usually) recommending the HPV vaccine to females (79.0%) and to males (62.2%); 71.9% of clinicians reported strongly recommending the vaccine to females while 58.6% reported strongly recommending to males. Consistency and strength of recommending the HPV vaccine was significantly higher among those practicing in pediatrics and board certified in pediatrics compared to family medicine. Higher rates of initiation (1 dose) [Incidence Rate Ratio (IRR) = 1.05; 95% CI (1.01–1.09)] and completion (3 doses) [IRR = 1.08; 95% CI (1.02–1.13)] were observed among clinical sites where, on average, clinicians more frequently reported always or usually recommending the vaccine for females compared to sites where, on average, clinicians reported recommending the vaccine less frequently. Similarly, higher rates of initiation [IRR = 1.03; 95% CI (1.00–1.06)] and completion [IRR = 1.04; CI (1.00, 1.08)] were observed among sites where clinicians reported strongly recommending the vaccine to females more frequently compared to sites where, on average, clinicians reported strongly recommending the HPV vaccine less frequently; similar associations were observed for male initiation [IRR = 1.05; CI (1.02,1.08)] and completion [IRR = 1.05; 95% CI (1.01, 1.09)].ConclusionsConsistency and strength of HPV vaccination recommendation was associated with higher vaccination rates.     

Relationships between hours of sleep and health-risk behaviors in US adolescent students

ObjectiveTo examine associations between insufficient sleep (< 8 h on average school nights) and health-risk behaviors.Methods2007 national Youth Risk Behavior Survey data of U.S. high school students (n = 12,154) were analyzed. Associations were examined on weighted data using multivariate logistic regression.ResultsInsufficient sleep on an average school night was reported by 68.9% of students. Insufficient sleep was associated with higher odds of current use of cigarettes (age-adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.45–1.93), marijuana (AOR, 1.52; 95% CI, 1.31–1.76), and alcohol (AOR, 1.64; 95% CI, 1.46–1.84); current sexual activity (AOR, 1.41; 95% CI, 1.25–1.59); seriously considered attempting suicide (AOR, 1.86; 95% CI, 1.60–2.16); feeling sad or hopeless (AOR, 1.62; 95% CI, 1.43–1.84); physical fighting (AOR, 1.40; 95% CI, 1.24–1.60), not being physically active at least 60 min ≥ 5 days in the past 7 days (AOR, 1.16; 95% CI, 1.04–1.29), using the computer ≥ 3 h/day (AOR, 1.58; 95% CI, 1.38–1.80), and drinking soda/pop > 1 time/day (AOR, 1.14; 95% CI, 1.03–1.28).ConclusionTwo-thirds of adolescent students reported insufficient sleep, which was associated with many health-risk behaviors. Greater awareness of the impact of sleep insufficiency is vital.     

Prevalencia de hipovitaminosis D y factores asociados en la edad infantojuvenil

Objective

To analyse the prevalence of hypovitaminosis D and associated factors in school children and adolescents living in a region of northern Spain.

Satisfacción del paciente con la relación con su médico de familia: un estudio con el Patient-Doctor Relationship Questionnaire

ObjectiveTo describe patient satisfaction of their relationship with the family physician, using the PDRQ-9 questionnaire and assess its psychometric properties.DesignCross-sectional study.SettingSix Primary Care Health centres in the Community of Madrid, Spain.ParticipantsFour hundred and fifty one patients randomly selected from those who had just visited their family physician.InterventionsInterviews were carried out to collect demographic characteristics, health needs, the accessibility to the service, and the socioeconomic situation of the subjects.MeasurementsThe PDRQ-9 responses were collected and a synthetic satisfaction index was constructed. A multivariable model was designed to explain differences in satisfaction.ResultsThe mean satisfaction index was 4.41 (95% CI: 4.33 – 4.48) on a scale of 1 (the worst) to 5 (the best satisfaction possible), with a median of 4.78 (interquartile range 4.00 – 5.00). Four of every 10 subjects expressed the maximum possible satisfaction (“ceiling effect”). A single factor explained 75.3% of the variance, with a Cronbach α value of 0.952. Age (OR 1.03, 95% CI: 1.02 – 1.05) and living in rural areas (OR 1.44, 95% CI: 0.94 – 2.20) were associated with above average satisfaction.ConclusionsPrimary care users feel their relationship with their family physicians are very satisfactory, particularly in those who are older and who live in rural areas. The PDRQ-9 questionnaire shows a high internal consistency, but it is not good enough to discriminate in the upper part of the scale.