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Karlsson H, Sjöqvist H, Brynge M, Gardner R, Dalman C. Childhood infections and autism spectrum disorders and/or intellectual disability: a register-based cohort study. J Neurodev Disord 2022; 14:12. [PMID: 35151261 PMCID: PMC8903600 DOI: 10.1186/s11689-022-09422-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
Objective To explore the associations between childhood infections and subsequent diagnoses of autism spectrum disorder (ASD), intellectual disability (ID), and their co-occurrence. Methods The association between specialized care for any infection, defined by ICD-codes, and later ASD or ID was investigated in a register-based cohort of 556,732 individuals born 1987–2010, resident in Stockholm County, followed from birth to their 18th birthday or December 31, 2016. We considered as potential confounders children’s characteristics, family socioeconomic factors, obstetric complications, and parental histories of treatment for infection and psychiatric disorders in survival analyses with extended Cox regression models. Residual confounding by shared familial factors was addressed in sibling analyses using within-strata estimation in Cox regression models. Sensitivity analyses with the exclusion of congenital causes of ASD/ID and documented risk for infections were also performed. Results Crude estimates indicated that infections during childhood were associated with later ASD and ID with the largest risks observed for diagnoses involving ID. Inclusion of covariates, exclusion of congenital causes of ASD/ID from the population, and sibling comparisons highlighted the potential for confounding by both heritable and non-heritable factors, though risks remained in all adjusted models. In adjusted sibling comparisons, excluding congenital causes, infections were associated with later “ASD without ID” (HR 1.24, 95%CI 1.15–1.33), “ASD with ID” (1.57, 1.35–1.82), and “ID without ASD” (2.01, 1.76–2.28). Risks associated with infections varied by age at exposure and by age at diagnosis of ASD/ID. Conclusions Infections during childhood may contribute to a later diagnosis of ID and ASD. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09422-4.
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Vanoli J, Coull BA, Ettinger de Cuba S, Fabian PM, Carnes F, Massaro MA, Poblacion A, Bellocco R, Kloog I, Schwartz J, Laden F, Zanobetti A. Postnatal exposure to PM 2.5 and weight trajectories in early childhood. Environ Epidemiol 2022; 6:e181. [PMID: 35169661 PMCID: PMC8835545 DOI: 10.1097/ee9.0000000000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inconsistent evidence has assessed the impact of air pollution exposure on children's growth trajectories. We investigated the role of 90-day average postnatal fine particulate matter (PM2.5) exposures by estimating the magnitude of effects at different ages, and the change in child weight trajectory by categories of exposure. METHODS We obtained weight values from electronic health records at each hospital visit (males = 1859, females = 1601) from birth to 6 years old children recruited into the Boston-based Children's HealthWatch cohort (2009-2014). We applied mixed models, adjusting for individual and maternal confounders using (1) varying-coefficient models allowing for smooth non-linear interaction between age and PM2.5, (2) factor-smooth interaction between age and PM2.5 quartiles. Additionally, we stratified by sex and low birthweight (LBW) status (≤2500 g). RESULTS Using varying-coefficient models, we found that PM2.5 significantly modified the association between age and weight in males, with a positive association in children younger than 3 years and a negative association afterwards. In boys, for each 10 µg/m3 increase in PM2.5 we found a 2.6% increase (95% confidence interval = 0.8, 4.6) in weight at 1 year of age and a -0.6% (95% confidence interval = -3.9, 2.9) at 5 years. We found similar but smaller changes in females, and no differences comparing growth trajectories across quartiles of PM2.5. Most of the effects were in LBW children and null for normal birthweight children. CONCLUSIONS This study suggests that medium-term postnatal PM2.5 may modify weight trajectories nonlinearly in young children, and that LBW babies are more susceptible than normal-weight infants.
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Affiliation(s)
- Jacopo Vanoli
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Statistics and Quantitative Methods, Universita degli Studi di Milano-Bicocca, Milan, Italy
| | - Brent A. Coull
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Patricia M. Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Fei Carnes
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Marisa A. Massaro
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Ana Poblacion
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, Universita degli Studi di Milano-Bicocca, Milan, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Francine Laden
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Green MJ, Watkeys OJ, Whitten T, Thomas C, Kariuki M, Dean K, Laurens KR, Harris F, Carr VJ. Increased incidence of childhood mental disorders following exposure to early life infection. Brain Behav Immun 2021; 97:376-382. [PMID: 34390804 DOI: 10.1016/j.bbi.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
Early life exposure to infectious diseases confers risk for adult psychiatric disorders but relatively few human population studies have examined associations with childhood mental disorder. Here we examined the effects of exposure to maternal infection during pregnancy, and child infectious diseases in early childhood (birth to age 4 years), in relation to first mental disorder diagnosis (age 5-13 years). The study sample comprised 71,841 children represented in a population cohort of children in New South Wales, Australia, followed from birth to early adolescence via linkage of administrative registers. Childhood exposure to infectious disease was determined during the prenatal period (i.e., maternal infection during gestation), and in early childhood (between birth and age 4 years) using the NSW Ministry of Health Admitted Patients data collection. Days to first diagnosis with a mental disorder was determined from recorded diagnoses between age 5-13 years in the NSW Ministry of Health's Admitted Patients, Emergency Department and Mental Health Ambulatory data collections. While crude hazard ratios for both prenatal infection and childhood infection exposures indicated significantly earlier diagnosis with mental disorders associated with both of these risk factors, only childhood infection exposure was associated with higher adjusted hazard ratios (aHR) for any diagnoses (aHR = 1.21, 95% CI = 1.11-1.32), externalising disorders (aHR = 1.45, 95% CI 1.18-1.79) and developmental disorders (aHR = 1.82, 95% CI 1.49-2.22) when the effects of maternal and early childhood (age < 5 years) mental disorders were taken into account. Exposure to infectious diseases during early childhood, but not prenatal infection exposure, appears to be associated with earlier diagnosis of mental disorders in childhood.
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Affiliation(s)
- Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia.
| | - Oliver J Watkeys
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia
| | - Tyson Whitten
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; School of Social Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Thomas
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, QLD, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuroscience Research Australia, Sydney, NSW, Australia; Department of Psychiatry, Monash University, Melbourne, VIC, Australia
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Zubareva OE, Postnikova TY, Grifluk AV, Schwarz AP, Smolensky IV, Karepanov AA, Vasilev DS, Veniaminova EA, Rotov AY, Kalemenev SV, Zaitsev AV. Exposure to bacterial lipopolysaccharidein early life affects the expression of ionotropic glutamate receptor genes and is accompanied by disturbances in long-term potentiation and cognitive functions in young rats. Brain Behav Immun 2020; 90:3-15. [PMID: 32726683 DOI: 10.1016/j.bbi.2020.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/20/2023] Open
Abstract
Infections in childhood play an essential role in the pathogenesis of cognitive and psycho-emotional disorders. One of the possible mechanisms of these impairments is changes in the functional properties of NMDA and AMPA glutamate receptors in the brain. We suggest that bacterial infections during the early life period, which is critical for excitatory synapse maturation, can affect the subunit composition of NMDA and AMPA receptors. In the present study, we investigated the effect of repetitive lipopolysaccharide (LPS) intraperitoneal (i.p.) administration (25 μg/kg/day on P14, 16, and 18), mimicking an infectious disease, on the expression of subunits of NMDA and AMPA receptors in young rats. We revealed a substantial decrease of GluN2B subunit expression in the hippocampus at P23 using Western blot analysis and real-time polymerase chain reaction assay. Moderate changes were also found in GluN1, GluN2A, and GluA1 mRNA expression. The LPS-treated rats exhibited decreased exploratory and locomotor activity in the open field test and the impairment of spatial learning in the Morris water maze. Behavioral impairments were accompanied by a significant reduction in long-term hippocampal synaptic potentiation. Our data indicate that LPS-treatment in the critical period for excitatory synapse maturation alters ionotropic glutamate receptor gene expression, disturbs synaptic plasticity, and alters behavior.
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Affiliation(s)
- Olga E Zubareva
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia; Laboratory of Neurobiology of the Brain Integrative Functions, Pavlov Department of Physiology, Institute of Experimental Medicine, St. Petersburg, Russia
| | - Tatyana Y Postnikova
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexandra V Grifluk
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexander P Schwarz
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Ilya V Smolensky
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Anton A Karepanov
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Dmitry S Vasilev
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Ekaterina A Veniaminova
- Laboratory of Neurobiology of the Brain Integrative Functions, Pavlov Department of Physiology, Institute of Experimental Medicine, St. Petersburg, Russia
| | - Alexander Y Rotov
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Sergey V Kalemenev
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Aleksey V Zaitsev
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia.
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Karlsson H, Dalman C. Epidemiological Studies of Prenatal and Childhood Infection and Schizophrenia. Curr Top Behav Neurosci 2019; 44:35-47. [PMID: 30852763 DOI: 10.1007/7854_2018_87] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Certain infectious agents can target the brain and interfere with its growth, development, and/or function. A number of studies indicate that exposure to common infectious agents during fetal and postnatal life may also contribute to the later development of schizophrenia and other non-affective psychoses. Epidemiological studies of maternal infections during pregnancy have provided somewhat contradictory results with regard to infections in general but have reported surprisingly consistent associations with specific maternal exposures such as Toxoplasma gondii. Childhood is also beginning to emerge as a sensitive period for the influence of infections including infectious agents not known to target the brain. Recent studies have associated childhood infections not only with a later diagnosis of schizophrenia but also with impaired cognitive function. Importantly, independent studies indicate that the associations between early life infection and the later development of schizophrenia are not explained by factors shared between related individuals or by genetic liability for schizophrenia.
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Affiliation(s)
- Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Yanuck SF. Microglial Phagocytosis of Neurons: Diminishing Neuronal Loss in Traumatic, Infectious, Inflammatory, and Autoimmune CNS Disorders. Front Psychiatry 2019; 10:712. [PMID: 31632307 PMCID: PMC6786049 DOI: 10.3389/fpsyt.2019.00712] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/05/2019] [Indexed: 01/08/2023] Open
Abstract
Errors in neuron-microglial interaction are known to lead to microglial phagocytosis of live neurons and excessive neuronal loss, potentially yielding poorer clinical outcomes. Factors that affect neuron-microglial interaction have the potential to influence the error rate. Clinical comorbidities that unfavorably impact neuron-microglial interaction may promote a higher rate of neuronal loss, to the detriment of patient outcome. This paper proposes that many common, clinically modifiable comorbidities have a common thread, in that they all influence neuron-microglial interactions. Comorbidities like traumatic brain injury, infection, stress, neuroinflammation, loss of neuronal metabolic integrity, poor growth factor status, and other factors, all have the potential to alter communication between neurons and microglia. When this occurs, microglial phagocytosis of live neurons can increase. In addition, microglia can shift into a morphological form in which they express major histocompatibility complex II (MHC-II), allowing them to function as antigen presenting cells that present neuronal debris as antigen to invading T cells. This can increase risk for the development of CNS autoimmunity, or can exacerbate existing CNS autoimmunity. The detrimental influence of these comorbidities has the potential to contribute to the mosaic of factors that determine patient outcome in some CNS pathologies that have neuropsychiatric involvement, including TBI and CNS disorders with autoimmune components, where excessive neuronal loss can yield poorer clinical outcomes. Recognition of the impact of these comorbidities may contribute to an understanding of the common clinical observation that many seemingly disparate factors contribute to the overall picture of case management and clinical outcome in these complex disorders. In a clinical setting, knowing how these comorbidities can influence neuron-microglial interaction can help focus surveillance and care on a broader group of potential therapeutic targets. Accordingly, an interest in the mechanisms underlying the influence of these factors on neuron-microglial interactions is appropriate. Neuron-microglial interaction is reviewed, and the various mechanisms by which these potential comorbidities influence neuro-microglial interaction are described.
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Affiliation(s)
- Samuel F Yanuck
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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Hendrickx D, Bowen AC, Marsh JA, Carapetis JR, Walker R. Ascertaining infectious disease burden through primary care clinic attendance among young Aboriginal children living in four remote communities in Western Australia. PLoS One 2018; 13:e0203684. [PMID: 30222765 PMCID: PMC6141079 DOI: 10.1371/journal.pone.0203684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 08/24/2018] [Indexed: 11/18/2022] Open
Abstract
Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia.
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Affiliation(s)
- David Hendrickx
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Asha C. Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie A. Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan R. Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Roz Walker
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Green MJ, Harris F, Laurens KR, Kariuki M, Tzoumakis S, Dean K, Islam F, Rossen L, Whitten T, Smith M, Holbrook A, Bore M, Brinkman S, Chilvers M, Sprague T, Stevens R, Carr VJ. Cohort Profile: The New South Wales Child Development Study (NSW-CDS)—Wave 2 (child age 13 years). Int J Epidemiol 2018; 47:1396-1397k. [DOI: 10.1093/ije/dyy115] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/28/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Stacy Tzoumakis
- School of Social Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Justice Health & Forensic Mental Health Network, Matraville, NSW, Australia
| | - Fakhrul Islam
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Larissa Rossen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Tyson Whitten
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Maxwell Smith
- School of Education, University of Newcastle, Newcastle, NSW, Australia
| | - Allyson Holbrook
- School of Education, University of Newcastle, Newcastle, NSW, Australia
| | - Miles Bore
- School of Psychology, University of Newcastle, Newcastle, NSW, Australia
| | - Sally Brinkman
- Telethon Kids Institute, Perth, WA, Australia
- Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Australia Institute for Social Research, University of Adelaide, Adelaide, SA, Australia
| | - Marilyn Chilvers
- NSW Department of Family and Community Services, New South Wales, Australia
| | | | | | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
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Green MJ, Kariuki M, Dean K, Laurens KR, Tzoumakis S, Harris F, Carr VJ. Childhood developmental vulnerabilities associated with early life exposure to infectious and noninfectious diseases and maternal mental illness. J Child Psychol Psychiatry 2018; 59:801-810. [PMID: 29278269 DOI: 10.1111/jcpp.12856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal exposure to infectious and noninfectious diseases may influence early childhood developmental functioning, on the path to later mental illness. Here, we investigated the effects of in utero exposure to maternal infection and noninfectious diseases during pregnancy on offspring developmental vulnerabilities at age 5 years, in the context of estimated effects for early childhood exposures to infectious and noninfectious diseases and maternal mental illness. METHODS We used population data for 66,045 children from an intergenerational record linkage study (the New South Wales Child Development Study), for whom a cross-sectional assessment of five developmental competencies (physical, social, emotional, cognitive, and communication) was obtained at school entry, using the Australian Early Development Census (AEDC). Child and maternal exposures to infectious or noninfectious diseases were determined from the NSW Ministry of Health Admitted Patients Data Collection (APDC) and maternal mental illness exposure was derived from both APDC and Mental Health Ambulatory Data collections. Multinomial logistic regression analyses were used to examine unadjusted and adjusted associations between these physical and mental health exposures and child developmental vulnerabilities at age 5 years. RESULTS Among the physical disease exposures, maternal infectious diseases during pregnancy and early childhood infection conferred the largest associations with developmental vulnerabilities at age 5 years; maternal noninfectious illness during pregnancy also retained small but significant associations with developmental vulnerabilities even when adjusted for other physical and mental illness exposures and covariates known to be associated with early childhood development (e.g., child's sex, socioeconomic disadvantage, young maternal age, prenatal smoking). Among all exposures examined, maternal mental illness first diagnosed prior to childbirth conferred the greatest odds of developmental vulnerability at age 5 years. CONCLUSIONS Prenatal exposure to infectious or noninfectious diseases appear to influence early childhood physical, social, emotional and cognitive developmental vulnerabilities that may represent intermediate phenotypes for subsequent mental disorders.
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Affiliation(s)
- Melissa J Green
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia.,Justice Health & Forensic Mental Health Network, Sydney, NSW, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,School of Psychology, Australian Catholic University, Brisbane, QLD, Australia
| | - Stacy Tzoumakis
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia.,School of Social Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, UNSW Sydney, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia.,Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Vic., Australia
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Bentley JP, Burgner DP, Shand AW, Bell JC, Miller JE, Nassar N. Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection. Acta Obstet Gynecol Scand 2018; 97:988-997. [PMID: 29768650 DOI: 10.1111/aogs.13371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/29/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Infections are a leading cause of mortality and morbidity in preschool children. We aimed to assess the impact of the co-occurrence of cesarean section, early birth and formula feeding on hospitalization with infection in early childhood. MATERIAL AND METHODS Population-based retrospective record-linkage cohort study of 488 603 singleton livebirths ≥32 weeks' gestational age in New South Wales, Australia, 2007-2012. Multivariable Cox-regression was used to estimate independent and combined adjusted associations of gestational age, mode of birth (vaginal or cesarean section by labor onset) and formula feeding with time to first and repeat hospitalization with infection for children less than five years of age. RESULTS In all, 95 346 (19.5%) children were hospitalized with infection, and of these 24.8% (23 615) more than once. Median age at first and repeat hospitalization was 1.1 and 1.7 years, respectively. Earlier gestation, modes of birth other than spontaneous vaginal, and formula feeding were independently associated with an increased risk of first and repeat hospitalization with infection. At 32-36 weeks' gestation, co-occurrence of perinatal factors (cf. spontaneous vaginal birth at 39+ weeks without formula feeding) was associated with a 2-fold and 1.5-fold increased risk of first and repeat hospitalization, respectively. For births at 37-38 weeks, the increased risk was 1.5-fold and 1.25-fold for first and repeat hospitalization, respectively. CONCLUSIONS Cesarean section, labor induction, birth at <39 weeks and formula feeding increase the risk of infection-related hospitalization in childhood, which increases further when these factors co-occur. Reducing early planned birth and supporting breastfeeding are potentially cost-effective approaches to reducing the risk of hospitalization.
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Affiliation(s)
- Jason P Bentley
- Menzies Center for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Pediatrics, Monash University, Clayton, Victoria, Australia
| | - Antonia W Shand
- Menzies Center for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Jane C Bell
- Menzies Center for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica E Miller
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Natasha Nassar
- Menzies Center for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012. PLoS One 2017; 12:e0188803. [PMID: 29190667 PMCID: PMC5708667 DOI: 10.1371/journal.pone.0188803] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to describe the occurrence of skin infection associated hospitalizations in children born in Western Australia (WA). We conducted a retrospective cohort study of all children born in WA between 1996 and 2012 (n = 469,589). Of these, 31,348 (6.7%) were Aboriginal and 240,237 (51.2%) were boys. We report the annual age-specific hospital admission rates by geographical location and diagnostic category. We applied log-linear regression modelling to analyse changes in temporal trends of hospitalizations. Hospitalization rates for skin infections in Aboriginal children (31.7/1000 child-years; 95% confidence interval [CI] 31.0–32.4) were 15.0 times higher (95% CI 14.5–15.5; P<0.001) than those of non-Aboriginal children (2.1/1000 child-years; 95% CI 2.0–2.1). Most admissions in Aboriginal children were due to abscess, cellulitis and scabies (84.3%), while impetigo and pyoderma were the predominant causes in non-Aboriginal children (97.7%). Admissions declined with age, with the highest rates for all skin infections observed in infants. Admissions increased with remoteness. Multiple admissions were more common in Aboriginal children. Excess admissions in Aboriginal children were observed during the wet season in the Kimberley and during summer in metropolitan areas. Our study findings show that skin infections are a significant cause of severe disease, requiring hospitalization in Western Australian children, with Aboriginal children at a particularly high risk. Improved community-level prevention of skin infections and the provision of effective primary care are crucial in reducing the burden of skin infection associated hospitalizations. The contribution of sociodemographic and environmental risk factors warrant further investigation.
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