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Layton JB, Forns J, McQuay LJ, Danysh HE, Dempsey C, Anthony MS, Turner ME. Mortality in Patients with Parkinson's Disease-Related Psychosis Treated with Pimavanserin Compared with Other Atypical Antipsychotics: A Cohort Study. Drug Saf 2023; 46:195-208. [PMID: 36517664 PMCID: PMC9883317 DOI: 10.1007/s40264-022-01260-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pimavanserin is approved in the USA to treat hallucinations and delusions associated with Parkinson's disease psychosis (PDP). OBJECTIVES We evaluated mortality in patients with PDP after initiation of pimavanserin or comparator atypical antipsychotics, overall, over time, and across subgroups. METHODS A cohort of patients aged ≥65 years in the USA with PDP newly initiating pimavanserin or a comparator atypical antipsychotic (clozapine, quetiapine, risperidone, olanzapine, aripiprazole, brexpiprazole) was identified in 2016-2019 Medicare claims data. All-cause mortality in the propensity score-matched treatment groups was compared with hazard ratios (HRs) and 95% confidence intervals (CIs) estimated with Cox-proportional hazards models. Cumulative incidence curves and time period-specific models evaluated risk over time. Subgroup and sensitivity analyses were performed, including a sub-cohort of long-term care (LTC) or skilled nursing facility (SNF) residents. RESULTS We identified 2892 pimavanserin initiators and 19,083 comparator initiators (overall 47% female, mean age = 80.9 years, LTC/SNF residents = 30%). Before matching, pimavanserin users had fewer severe comorbidities and more anti-Parkinson medication use than comparators. Matching resulted in 2891 patients in both groups, and all covariates were well balanced. In the matched cohort, the HR for mortality for pimavanserin versus comparator was 0.78 (95% CI 0.67-0.91), with the lowest time period-specific HRs in the first 180 days. Hazard ratios were similar across sensitivity analyses and subgroups. In LTC/SNF residents, the HR was 0.78 (95% CI 0.60-1.01). CONCLUSION The observed mortality rates were lower among patients treated with pimavanserin compared with those treated with other atypical antipsychotics. STUDY REGISTRATION European Union Post-authorization Study (EU PAS) register number 46331.
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Affiliation(s)
- J. Bradley Layton
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Joan Forns
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Lisa J. McQuay
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Heather E. Danysh
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, MA USA
| | - Colleen Dempsey
- Drug Safety and Pharmacovigilance, Acadia Pharmaceuticals Inc, Princeton, NJ USA
| | - Mary S. Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Mary Ellen Turner
- Drug Safety and Pharmacovigilance, Acadia Pharmaceuticals Inc, Princeton, NJ USA
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Forns J, Danysh HE, McQuay LJ, Turner ME, Dempsey C, Anthony MS, Demos G, Layton JB. Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States. BMC Geriatr 2022; 22:784. [PMID: 36203129 PMCID: PMC9541053 DOI: 10.1186/s12877-022-03489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis. Given that dementia-related psychosis comprises various dementia types, this study describes the incidence of clinical events and treatment patterns by dementia type after patients with dementia are diagnosed with psychosis. Methods Adults aged ≥ 65 years with dementia and newly diagnosed with psychosis were identified in US Medicare claims during 2013–2018. Baseline characteristics were evaluated at the time of the psychosis diagnosis. After the initial psychosis diagnosis, incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described for each dementia type (Alzheimer’s disease [AD], Parkinson’s disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and unspecified dementia). Daily mean cumulative counts were estimated to describe the incidence of recurrent events over time. Mortality was described using Kaplan–Meier survival curves. Results We identified 484,520 patients with dementia-related psychosis: mean age, 84 years (standard deviation, 7.8); female, 66%. At the time of psychosis diagnosis, the most prevalent type of dementia was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%), and most patients had scores indicating severe illness on the Charlson Comorbidity Index (71%) and frailty index (62%). Across all dementia types, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections after the initial psychosis diagnosis. Patients with DLB had the highest incidence of most clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all dementia types, and after 5 years, was about 80% among patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia. Conclusions Patients with dementia-related psychosis had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03489-3.
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Affiliation(s)
- Joan Forns
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain.
| | - Heather E Danysh
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, MA, USA
| | - Lisa J McQuay
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Mary Ellen Turner
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA
| | - Colleen Dempsey
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA
| | - Mary S Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
| | - George Demos
- Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, San Diego, CA, USA
| | - J Bradley Layton
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA
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Forns J, Dudukina E, Hägg D, Szentkúti P, Gembert K, Plana E, Gilsenan A, Horváth-Puhó E, Ehrenstein V, Reutfors J, Rebordosa C. Risk of Major Cardiovascular and Cerebrovascular Events in Users of Lisdexamfetamine and Other Medications for Attention-Deficit/Hyperactivity Disorder in Denmark and Sweden: A Population-Based Cohort Study. Neurol Ther 2022; 11:1659-1676. [PMID: 36028603 DOI: 10.1007/s40120-022-00396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION This study aimed to estimate risks of cardiovascular and cerebrovascular events in patients treated with lisdexamfetamine dimesylate (LDX) compared with patients previously treated with other attention-deficit/hyperactivity disorder (ADHD) medications (amphetamine, dexamphetamine, methylphenidate or atomoxetine). METHODS This population-based cohort study used data from Danish and Swedish medical and administrative national registers. The LDX cohort included adult patients initiating LDX with at least 12 months' data preceding first LDX dispensing (index date). A random sample of patients treated with at least one non-LDX ADHD medication in the 6-24 months (but not less than 6 months) before index date (previous-users cohort) were matched to LDX users on age, sex, region and calendar year. The primary outcome, a composite of major adverse cardiovascular and cerebrovascular events (MACE), included first hospitalisation for acute myocardial infarction or stroke and out-of-hospital coronary heart disease or cerebrovascular disease death. Incidence rates (IRs) and IR ratios (IRRs) with 95% confidence intervals (CIs) of MACE were estimated using Poisson regression. RESULTS From Denmark/Sweden, 5516/40,163 LDX users and 27,494/200,389 previous users were included. In Denmark, IRs of MACE/1000 person-years (95% CI) were similar for LDX (1.63 [0.85-3.14]) and previous users (1.61 [1.28-2.01]). In Sweden, IRs (95% CI) were 1.40 (1.09-1.79) in LDX users and 1.17 (1.00-1.38) in previous users. Adjusted MACE IRRs (95% CI) for LDX versus previous use were 1.01 (0.48-2.13) in Denmark, 1.13 (0.75-1.71) in Sweden, and 1.10 (0.77-1.58) in the pooled analysis. CONCLUSION Our findings suggest little to no increased risk of cardiovascular and cerebrovascular events in patients treated with LDX compared with patients previously treated with other ADHD medications.
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Affiliation(s)
- Joan Forns
- Department of Epidemiology, RTI Health Solutions, RTI Health Solutions, Av. Diagonal, 605, 9-1, 08028, Barcelona, Spain.
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - David Hägg
- Department of Medicine, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Karin Gembert
- Department of Medicine, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Estel Plana
- Department of Epidemiology, RTI Health Solutions, RTI Health Solutions, Av. Diagonal, 605, 9-1, 08028, Barcelona, Spain
| | - Alicia Gilsenan
- Department of Epidemiology, RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Johan Reutfors
- Department of Medicine, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Cristina Rebordosa
- Department of Epidemiology, RTI Health Solutions, RTI Health Solutions, Av. Diagonal, 605, 9-1, 08028, Barcelona, Spain
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Forns J, Layton JB, Bartsch J, Turner ME, Dempsey C, Anthony M, Ritchey ME, Demos G. Increased risk of falls and fractures in patients with psychosis and Parkinson disease. PLoS One 2021; 16:e0246121. [PMID: 33503061 PMCID: PMC7840029 DOI: 10.1371/journal.pone.0246121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/10/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Evaluate whether the risk of falls and fractures differs between patients with Parkinson disease with psychosis (PDP) and patients with Parkinson disease (PD) without psychosis at similar disease stages. Methods Patients with PD without psychosis were identified in the Medicare claims databases (2008–2018) and followed from the first PD diagnosis date during the study period. Patients with a subsequent diagnosis of psychosis were included in the PDP group. Patients with PDP and PD without psychosis were propensity score-matched based on characteristics within blocks of time since cohort entry. The incidence rates (IRs), expressed per 100 person-years, and 95% confidence intervals (CIs) of falls and fractures were evaluated as composite and separate outcomes. Incidence rate ratios (IRRs) were used to compare patients with PDP and PD without psychosis in the matched cohort. Results 154,306 patients had PD without psychosis and no falls or fractures before cohort entry; the IR for falls and fractures was 11.41 events (95% CI, 11.29–11.53). 12,127 patients (7.8%) had a subsequent PDP diagnosis. PDP patients had a higher prevalence of most comorbidities and risk factors for falls and fractures than those without psychosis. The crude IR for falls and fractures among PDP patients was 29.03 events (95% CI, 28.27–29.81). PD without psychosis and PDP groups had more falls than fractures. After matching, 24,144 PD patients without psychosis (15.6%) and 12,077 PDP patients (99.6%) were retained. Matched PDP patients had a higher incidence of falls and fractures than PD patients without psychosis (IRR = 1.44; 95% CI, 1.39–1.49). The higher increased rate was noted separately for falls (IRR = 1.48; 95% CI, 1.43–1.54) and any fractures (IRR = 1.17; 95% CI, 1.08–1.27) as well as within specific types of fracture, including pelvis and hip fractures. Conclusions Our findings suggest a modest but consistently higher increased risk of falls and fractures in PDP patients compared with PD patients without psychosis.
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Affiliation(s)
- Joan Forns
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
- * E-mail:
| | - J. Bradley Layton
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Bartsch
- Biometrics, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - Mary Ellen Turner
- ACADIA Pharmaceuticals Inc., San Diego, California, United States of America
| | - Colleen Dempsey
- ACADIA Pharmaceuticals Inc., San Diego, California, United States of America
| | - Mary Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - Mary E. Ritchey
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, United States of America
| | - George Demos
- ACADIA Pharmaceuticals Inc., San Diego, California, United States of America
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Julvez J, Gignac F, Fernández-Barrés S, Romaguera D, Sala-Vila A, Ranzani OT, Persavento C, Delgado A, Carol A, Torrent J, Gonzalez J, Roso E, Barrera-Gómez J, López-Vicente M, Garcia-Esteban R, Boucher O, Forns J, Burgaleta M, Sebastián N, Canals J, Arija V, Basagaña X, Ros E, Vendrell J, Salas-Salvadó J, Sunyer J. Walnuts, Long-Chain Polyunsaturated Fatty Acids, and Adolescent Brain Development: Protocol for the Walnuts Smart Snack Dietary Intervention Trial. Front Pediatr 2021; 9:593847. [PMID: 34169045 PMCID: PMC8217431 DOI: 10.3389/fped.2021.593847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Adolescence, when the most complex behaviors are refined to adult sophistication, represents a major window of opportunity and vulnerability for neuropsychological development. To support and protect this complex and active brain growth, different nutritional components considered essential need to be acquired from the diet. For instance, omega-3 fatty acids are mainly obtained from seafood, seeds, and walnuts. Known for their rich lipid profile, walnuts contain sizable amounts of an essential fatty acid, alpha-linolenic acid (ALA), the vegetable omega-3 fatty acid that is the precursor of two longer-chain omega-3 polyunsaturated fatty acids (omega-3 PUFA): docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids. While there is growing evidence of neuropsychological improvements in the young developing brain associated with omega-3 PUFA intake, few studies have examined whether consuming walnuts during adolescence entails similar beneficial effects. There is a need to further explore the ways in which walnuts influence youthful brain function, particularly for the long-term. Thus, we designed the WALNUTs study (WSS), a population-based randomized controlled trial conducted in adolescents in Barcelona, Spain. We hypothesize that walnut intake will increase omega-3 PUFA tissue availability (particularly ALA) to a level that enhances the neuropsychological development during adolescence. Methodology/Design: We conducted a 6-month population-based randomized controlled trial in teenagers (n = 800) and we aimed to determine the effectiveness of the intervention (four walnuts per day, or 30 kernel g, ~1.5g of ALA) in enhancing brain neuropsychological and socio-emotional development compared to a control group with no walnut intervention. Before randomization, different neuropsychological tests were recorded for all participants, and blood samples (in a subsample of participants) were collected to measure omega-3 PUFA levels at baseline, and all again, after randomization and the intervention. The data is now collected and we will conduct linear regression models to assess the effect of the intervention. Discussion: The WALNUTs (WSS) study results will allow us to better understand the role of plant-based omega-3 PUFA intake from regular walnut consumption on neuropsychological development during adolescence. Results could be translated into nutritional public health recommendations targeting teenagers. Trial Registration: ClinicalTrials.gov, U.S. National Library of Medicine, National Institutes of Health # NCT02590848. Retrospectively registered 29/10/2015.
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Affiliation(s)
- Jordi Julvez
- Institut d'Investigació Sanitària Pere Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain.,ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Florence Gignac
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Silvia Fernández-Barrés
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Dora Romaguera
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Instituto de Investigación Sanitaria Illes Balears, Hospital Universitari Son Espases, Palma, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Aleix Sala-Vila
- Barcelonaßeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain.,IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Otavio T Ranzani
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Cecilia Persavento
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Anna Delgado
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Albert Carol
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Jaume Torrent
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Judith Gonzalez
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Eduard Roso
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Jose Barrera-Gómez
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Mónica López-Vicente
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Raquel Garcia-Esteban
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Olivier Boucher
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Joan Forns
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | | | | | - Josefina Canals
- Nutrition and Public Health Unit, Research Group on Nutrition and Mental Health, (NUTRISAM), Faculty of Medicine and Health Science, Universitat Rovira i Virgili, Reus, Spain
| | - Victoria Arija
- Nutrition and Public Health Unit, Research Group on Nutrition and Mental Health, (NUTRISAM), Faculty of Medicine and Health Science, Universitat Rovira i Virgili, Reus, Spain
| | - Xavier Basagaña
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Vendrell
- Institut d'Investigació Sanitària Pere Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Salas-Salvadó
- Institut d'Investigació Sanitària Pere Virgili, Hospital Universitari Sant Joan de Reus, Reus, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Human Nutrition Unit, Universitat Rovira i Virgili, Department of Biochemistry and Biotechnology, Reus, Spain
| | - Jordi Sunyer
- ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
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Camprodon-Rosanas E, Ribas-Fitó N, Batlle S, Persavento C, Alvarez-Pedrerol M, Sunyer J, Forns J. Association Between Sluggish Cognitive Tempo Symptoms and Attentional Network and Working Memory in Primary Schoolchildren. J Atten Disord 2020; 24:1787-1795. [PMID: 28397576 DOI: 10.1177/1087054717702245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Few consistent data are available in relation to the cognitive and neuropsychological processes involved in sluggish cognitive tempo (SCT) symptoms. The objective of this study was to determine the association of working memory and attentional networks with SCT symptoms in primary schoolchildren. Methods: The participants were schoolchildren aged 7 to 10 years (n = 183) from primary schools in Catalonia (Spain). All the participants completed a working memory task (n-back) and an attentional network task (ANT). Their parents completed an SCT-Child Behavior Checklist self-report and a questionnaire concerning sociodemographic variables. Teachers of the participants provided information on ADHD symptoms and learning determinants. Results: SCT symptoms were correlated with lower scores in both the n-back and ANT. In multivariate regression analysis, SCT symptoms were associated with slower hit reaction times from the ANT. Conclusions: Our results suggest that SCT symptoms are associated with a neuropsychological profile that is different from the classical ADHD profile and characterized by slower reaction times.
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Affiliation(s)
- E Camprodon-Rosanas
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | | | - S Batlle
- Institut de Neuropsiquiatria i Addiccions, CSMIJ, Parc de Salut Mar, Barcelona, Spain
| | - C Persavento
- Institut de Salut Global de Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health, Barcelona, Spain
| | - M Alvarez-Pedrerol
- Institut de Salut Global de Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health, Barcelona, Spain
| | - J Sunyer
- Institut de Salut Global de Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health, Barcelona, Spain
| | - J Forns
- Institut de Salut Global de Barcelona, Spain.,Hospital del Mar Research Institute, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health, Barcelona, Spain
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7
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Forns J, Verner MA, Iszatt N, Nowack N, Bach CC, Vrijheid M, Costa O, Andiarena A, Sovcikova E, Høyer BB, Wittsiepe J, Lopez-Espinosa MJ, Ibarluzea J, Hertz-Picciotto I, Toft G, Stigum H, Guxens M, Liew Z, Eggesbø M. Early Life Exposure to Perfluoroalkyl Substances (PFAS) and ADHD: A Meta-Analysis of Nine European Population-Based Studies. Environ Health Perspect 2020; 128:57002. [PMID: 32378965 PMCID: PMC7263458 DOI: 10.1289/ehp5444] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION To date, the evidence for an association between perfluoroalkyl substances (PFAS) exposure and attention deficit and hyperactivity disorder (ADHD) is inconclusive. OBJECTIVE We investigated the association between early life exposure to perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), and ADHD in a collaborative study including nine European population-based studies, encompassing 4,826 mother-child pairs. METHODS Concentrations of PFOS and PFOA were measured in maternal serum/plasma during pregnancy, or in breast milk, with different timing of sample collection in each cohort. We used a validated pharmacokinetic model of pregnancy and lactation to estimate concentrations of PFOS and PFOA in children at birth and at 3, 6, 12, and 24 months of age. We classified ADHD using recommended cutoff points for each instrument used to derive symptoms scores. We used multiple imputation for missing covariates, logistic regression to model the association between PFAS exposure and ADHD in each study, and combined all adjusted study-specific effect estimates using random-effects meta-analysis. RESULTS A total of 399 children were classified as having ADHD, with a prevalence ranging from 2.3% to 7.3% in the studies. Early life exposure to PFOS or PFOA was not associated with ADHD during childhood [odds ratios (ORs) ranging from 0.96 (95% CI: 0.87, 1.06) to 1.02 (95% CI: 0.93, 1.11)]. Results from stratified models suggest potential differential effects of PFAS related to child sex and maternal education. CONCLUSION We did not identify an increased prevalence of ADHD in association with early life exposure to PFOS and PFOA. However, stratified analyses suggest that there may be an increased prevalence of ADHD in association with PFAS exposure in girls, in children from nulliparous women, and in children from low-educated mothers, all of which warrant further exploration. https://doi.org/10.1289/EHP5444.
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Affiliation(s)
- Joan Forns
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Marc-Andre Verner
- Department of Occupational and Environmental Health, School of Public Health, Université de Montréal, Montreal, Canada
- Université de Montréal Public Health Research Institute (IRSPUM), Université de Montréal, Montreal, Canada
| | - Nina Iszatt
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Nikola Nowack
- Department of Developmental Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Cathrine Carlsen Bach
- Department of Pediatrics and Adolescent Medicine, Viborg Regional Hospital, Viborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Martine Vrijheid
- Global Health Institute Barcelona (ISGlobal), Institute for Global Health, Barcelona, Spain
- Univeristat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Olga Costa
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Ainara Andiarena
- Health Research Institute BIODONOSTIA, Donostia-San Sebastian, Basque Country, Spain
- Faculty of Psychology, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
| | - Eva Sovcikova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic
| | - Birgit Bjerre Høyer
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jürgen Wittsiepe
- Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Maria-Jose Lopez-Espinosa
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)-Universitat Jaume I-Universitat de València, Valencia, Spain
- Department of Nursing and Chiropody, Universitat de València, Valencia, Spain
| | - Jesus Ibarluzea
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Health Research Institute BIODONOSTIA, Donostia-San Sebastian, Basque Country, Spain
- Faculty of Psychology, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, School of Medicine, University of California, Davis (UC Davis), Davis, California, USA
- UC Davis Medical Investigations of Neurodevelopmental Disorders Institute, UC Davis, Davis, California, USA
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hein Stigum
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Mònica Guxens
- Global Health Institute Barcelona (ISGlobal), Institute for Global Health, Barcelona, Spain
- Univeristat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Merete Eggesbø
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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8
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Mortamais M, Pujol J, Martínez-Vilavella G, Fenoll R, Reynes C, Sabatier R, Rivas I, Forns J, Vilor-Tejedor N, Alemany S, Cirach M, Alvarez-Pedrerol M, Nieuwenhuijsen M, Sunyer J. Effects of prenatal exposure to particulate matter air pollution on corpus callosum and behavioral problems in children. Environ Res 2019; 178:108734. [PMID: 31539824 PMCID: PMC6892268 DOI: 10.1016/j.envres.2019.108734] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Air pollution (AP) may affect neurodevelopment, but studies about the effects of AP on the growing human brain are still scarce. We aimed to investigate the effects of prenatal exposure to AP on lateral ventricles (LV) and corpus callosum (CC) volumes in children and to determine whether the induced brain changes are associated with behavioral problems. METHODS Among the children recruited through a set of representative schools of the city of Barcelona, (Spain) in the Brain Development and Air Pollution Ultrafine Particles in School Children (BREATHE) study, 186 typically developing participants aged 8-12 years underwent brain MRI on the same 1.5 T MR unit over a 1.5-year period (October 2012-April 2014). Brain volumes were derived from structural MRI scans using automated tissue segmentation. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) and the criteria of the Attention Deficit Hyperactivity Disorder DSM-IV list. Prenatal fine particle (PM2.5) levels were retrospectively estimated at the mothers' residential addresses during pregnancy with land use regression (LUR) models. To determine whether brain structures might be affected by prenatal PM2.5 exposure, linear regression models were run and adjusted for age, sex, intracranial volume (ICV), maternal education, home socioeconomic vulnerability index, birthweight and mothers' smoking status during pregnancy. To test for associations between brain changes and behavioral outcomes, negative binomial regressions were performed and adjusted for age, sex, ICV. RESULTS Prenatal PM2.5 levels ranged from 11.8 to 39.5 μg/m3 during the third trimester of pregnancy. An interquartile range increase in PM2.5 level (7 μg/m3) was significantly linked to a decrease in the body CC volume (mm3) (β = -53.7, 95%CI [-92.0, -15.5] corresponding to a 5% decrease of the mean body CC volume) independently of ICV, age, sex, maternal education, socioeconomic vulnerability index at home, birthweight and mothers' smoking status during the third trimester of pregnancy. A 50 mm3 decrease in the body CC was associated with a significant higher hyperactivity subscore (Rate Ratio (RR) = 1.09, 95%CI [1.01, 1.17) independently of age, sex and ICV. The statistical significance of these results did not survive to False Discovery Rate correction for multiple comparisons. CONCLUSIONS Prenatal exposure to PM2.5 may be associated with CC volume decrease in children. The consequences might be an increase in behavioral problems.
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Affiliation(s)
- Marion Mortamais
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut National de la Santé et de la Recherche Médicale U1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France.
| | - Jesus Pujol
- MRI Research Unit, Hospital del Mar, Barcelona, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | | | - Raquel Fenoll
- MRI Research Unit, Hospital del Mar, Barcelona, Spain
| | - Christelle Reynes
- University of Montpellier, Montpellier, France; 3 EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Robert Sabatier
- University of Montpellier, Montpellier, France; 3 EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Ioar Rivas
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; MRC-PHE Centre for Environment & Health, Environmental Research Group, King's College London, SE1 9NH, London, UK
| | - Joan Forns
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Natàlia Vilor-Tejedor
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Silvia Alemany
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marta Cirach
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mar Alvarez-Pedrerol
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mark Nieuwenhuijsen
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jordi Sunyer
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut Hospital del Mar d'Investigacions Mèdiques-Parc de Salut Mar, Barcelona, Catalonia, Spain
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9
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Forns J, Cainzos‐Achirica M, Hellfritzsch M, Morros R, Poblador‐Plou B, Hallas J, Giner‐Soriano M, Prados‐Torres A, Pottegård A, Cortés J, Castellsagué J, Jacquot E, Deltour N, Perez‐Gutthann S, Pladevall M. Validity of ICD-9 and ICD-10 codes used to identify acute liver injury: A study in three European data sources. Pharmacoepidemiol Drug Saf 2019; 28:965-975. [PMID: 31172633 PMCID: PMC6618105 DOI: 10.1002/pds.4803] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
Abstract
Purpose Validating cases of acute liver injury (ALI) in health care data sources is challenging. Previous validation studies reported low positive predictive values (PPVs). Methods Case validation was undertaken in a study conducted from 2009 to 2014 assessing the risk of ALI in antidepressants users in databases in Spain (EpiChron and SIDIAP) and the Danish National Health Registers. Three ALI definitions were evaluated: primary (specific hospital discharge codes), secondary (specific and nonspecific hospital discharge codes), and tertiary (specific and nonspecific hospital and outpatient codes). The validation included review of patient profiles (EpiChron and SIDIAP) and of clinical data from medical records (EpiChron and Denmark). ALI cases were confirmed when liver enzyme values met a definition by an international working group. Results Overall PPVs (95% CIs) for the study ALI definitions were, for the primary ALI definition, 84% (60%‐97%) (EpiChron), 60% (26%‐88%) (SIDIAP), and 74% (60%‐85%) (Denmark); for the secondary ALI definition, 65% (45%‐81%) (EpiChron), 40% (19%‐64%) (SIDIAP), and 70% (64%‐77%) (Denmark); and for the tertiary ALI definition, 25% (18%‐34%) (EpiChron), 8% (7%‐9%) (SIDIAP), and 47% (42%‐52%) (Denmark). The overall PPVs were higher for specific than for nonspecific codes and for hospital discharge than for outpatient codes. The nonspecific code “unspecified jaundice” had high PPVs in Denmark. Conclusions PPVs obtained apply to patients using antidepressants without preexisting liver disease or ALI risk factors. To maximize validity, studies on ALI should prioritize hospital specific discharge codes and should include hospital codes for unspecified jaundice. Case validation is required when ALI outpatient cases are considered.
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Affiliation(s)
- Joan Forns
- EpidemiologyRTI Health SolutionsBarcelonaSpain
| | | | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
- Institut Català de la SalutBarcelonaSpain
| | - Beatriz Poblador‐Plou
- EpiChron Research Group. Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIIIZaragozaSpain
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Maria Giner‐Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)BarcelonaSpain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)BarcelonaSpain
- Institut Català de la SalutBarcelonaSpain
| | - Alexandra Prados‐Torres
- EpiChron Research Group. Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIIIZaragozaSpain
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jordi Cortés
- Departament d'Estadística i Investigació OperativaUniversitat Politècnica de CatalunyaBarcelonaSpain
| | | | | | - Nicolas Deltour
- Pharmacoepidemiology DepartmentLes Laboratoires ServierParisFrance
| | | | - Manel Pladevall
- EpidemiologyRTI Health SolutionsBarcelonaSpain
- The Center for Health Policy and Health Services Research, Henry Ford Health SystemDetroitMIUSA
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10
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Forns J, Stigum H, Høyer BB, Sioen I, Sovcikova E, Nowack N, Lopez-Espinosa MJ, Guxens M, Ibarluzea J, Torrent M, Wittsiepe J, Govarts E, Trnovec T, Chevrier C, Toft G, Vrijheid M, Iszatt N, Eggesbø M. Prenatal and postnatal exposure to persistent organic pollutants and attention-deficit and hyperactivity disorder: a pooled analysis of seven European birth cohort studies. Int J Epidemiol 2019; 47:1082-1097. [PMID: 29912347 DOI: 10.1093/ije/dyy052] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is increasing worldwide for reasons largely unknown and environmental chemicals with neurotoxic properties, such as persistent organic pollutants (POPs), have been proposed to play a role. We investigated the association between prenatal and postnatal exposure to polychlorinated biphenyl-153 (PCB-153), p-p´-dichlorodiphenyldichloroethylene (p-p'-DDE) and hexachlorobenzene (HCB) and ADHD in childhood. Methods We pooled seven European birth cohort studies encompassing 4437 mother-child pairs from the general population with concentrations of PCB-153, p-p´-DDE and HCB measured in cord blood, maternal blood or milk. We then calculated prenatal (birth) and postnatal (3, 6, 12 and 24 months) POP concentrations using a pharmacokinetic model. The operational definition of ADHD varied across cohorts and ranged from doctor diagnosis obtained from patient registries to maternal or teachers reports. We used multilevel (mixed) logistic regression models to estimate the associations between exposure to POPs at birth, 3, 6, 12 and 24 months and ADHD. Results The global prevalence of ADHD in our study was 6%. The mean age at assessment of ADHD was 5.8 years (range: 3.8-9.5 years). We found no association between exposure to PCB-153, p-p´-DDE and HCB at any age point between birth and 24 months and ADHD, in the pooled analyses (pooled odds ratios ranging from 1.00 to 1.01). A number of sensitivity analyses gave basically the same results. Conclusions In the largest study to date of 4437 children in seven European birth cohorts, we did not observe any association between either pre- or postnatal exposure (up to 24 months) to PCB-153, p-p´-DDE and HCB and the risk of ADHD before the age of 10 years.
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Affiliation(s)
- Joan Forns
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- Department of Non-Communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Birgit Bjerre Høyer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Isabelle Sioen
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Eva Sovcikova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic
| | - Nikola Nowack
- Department of Developmental Psychology, Ruhr University Bochum, Bochum, Germany
| | - Maria-Jose Lopez-Espinosa
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de Valencia, Valencia, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain
| | - Mònica Guxens
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.,ISGlobal, Center for Research in Environmental Epidemiology, Barcelona, Spain.,Pompeu Fabra University, Barcelona, Spain.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.,Sub-Directorate for Public Health of Gipuzkoa, Department of Health of the Basque Country, San Sebastián, Spain.,BIODONOSTIA Health Research Institute, Basque Country, Spain.,Faculty of Psychology, University of the Basque Country, San Sebastian, Spain
| | - Matias Torrent
- Pompeu Fabra University, Barcelona, Spain.,Menorca Health Area, Balearic Health Service (ib-salut), Menorca, Spain
| | - Jürgen Wittsiepe
- Department of Hygiene, Social and Environmental Medicine, Ruhr University Bochum, Bochum, Germany
| | - Eva Govarts
- Unit Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tomas Trnovec
- Faculty of Public Health, Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovakia
| | | | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Martine Vrijheid
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.,ISGlobal, Center for Research in Environmental Epidemiology, Barcelona, Spain.,Pompeu Fabra University, Barcelona, Spain
| | - Nina Iszatt
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Merete Eggesbø
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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11
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Vilor-Tejedor N, Alemany S, Forns J, Cáceres A, Murcia M, Macià D, Pujol J, Sunyer J, González JR. Assessment of Susceptibility Risk Factors for ADHD in Imaging Genetic Studies. J Atten Disord 2019; 23:671-681. [PMID: 27535943 DOI: 10.1177/1087054716664408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE ADHD consists of a count of symptoms that often presents heterogeneity due to overdispersion and excess of zeros. Statistical inference is usually based on a dichotomous outcome that is underpowered. The main goal of this study was to determine a suited probability distribution to analyze ADHD symptoms in Imaging Genetic studies. METHOD We used two independent population samples of children to evaluate the consistency of the standard probability distributions based on count data for describing ADHD symptoms. RESULTS We showed that the zero-inflated negative binomial (ZINB) distribution provided the best power for modeling ADHD symptoms. ZINB reveals a genetic variant, rs273342 (Microtubule-Associated Protein [MAPRE2]), associated with ADHD ( p value = 2.73E-05). This variant was also associated with perivascular volumes (Virchow-Robin spaces; p values < 1E-03). No associations were found when using dichotomous definition. CONCLUSION We suggest that an appropriate modeling of ADHD symptoms increases statistical power to establish significant risk factors.
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Affiliation(s)
- N Vilor-Tejedor
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - S Alemany
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - J Forns
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain.,4 Norwegian Institute of Public Health, Oslo, Norway
| | - A Cáceres
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - M Murcia
- 3 CIBER Epidemiología y Salud Pública, Barcelona, Spain.,5 FISABIO-Universitat Jaume I-Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - D Macià
- 6 Hospital del Mar, Cibersam G21, Barcelona, Spain
| | - J Pujol
- 6 Hospital del Mar, Cibersam G21, Barcelona, Spain
| | - J Sunyer
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain.,7 Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - J R González
- 1 SGlobal - Centre for Research in Environmental Epidemiology, Barcelona, Spain.,2 Universitat Pompeu Fabra, Barcelona, Spain.,3 CIBER Epidemiología y Salud Pública, Barcelona, Spain
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12
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Forns J, Pottegård A, Reinders T, Poblador-Plou B, Morros R, Brandt L, Cainzos-Achirica M, Hellfritzsch M, Schink T, Prados-Torres A, Giner-Soriano M, Hägg D, Hallas J, Cortés J, Jacquot E, Deltour N, Perez-Gutthann S, Pladevall M, Reutfors J. Antidepressant use in Denmark, Germany, Spain, and Sweden between 2009 and 2014: Incidence and comorbidities of antidepressant initiators. J Affect Disord 2019; 249:242-252. [PMID: 30780117 DOI: 10.1016/j.jad.2019.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to describe patterns of use and characteristics of 10 commonly used antidepressants for the period 2009-2014 in Denmark, Germany, Spain, and Sweden. METHODS Adult initiators from 2009 to 2014 of each study antidepressant were identified in four countries using five data sources: the Danish National registers, GePaRD (Germany), EpiChron (Aragon, Spain), SIDIAP (Catalonia, Spain), and the Swedish National Registers. The study included 10 study antidepressants: citalopram, escitalopram, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine, amitriptyline, mirtazapine, and agomelatine. RESULTS Citalopram was the most prescribed study antidepressant, followed by mirtazapine. Paroxetine and agomelatine were the least prescribed antidepressants. Mirtazapine was widely used among older antidepressant initiators with higher percentages of comorbidities at baseline, and fluoxetine was used among young patients. Citalopram and amitriptyline had the lowest percentage of multiple antidepressant use in the 12 months prior to the current treatment episode, while agomelatine, duloxetine, and venlafaxine had the highest percentage of multiple antidepressant use in the year prior to the current treatment episode. LIMITATIONS The most important limitations are exposure information based on filled prescriptions, focus on antidepressant initiators only, lack of information on the indication, and heterogeneity of the type of data across data sources. CONCLUSIONS Results of this study including 4.8 million study antidepressant initiators of study antidepressants suggest that citalopram and mirtazapine are the most commonly prescribed antidepressants. Agomelatine and paroxetine were the least used antidepressants in the participating populations. Mirtazapine was the antidepressant most commonly prescribed among older antidepressant initiators with high percentage of comorbidities at baseline, whereas fluoxetine was commonly used among young patients.
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Affiliation(s)
- Joan Forns
- Epidemiology, RTI Health Solutions, Barcelona, Spain.
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tammo Reinders
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Institut Català de la Salut, Barcelona, Spain
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Institut Català de la Salut, Barcelona, Spain
| | - David Hägg
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jordi Cortés
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Institut Català de la Salut, Barcelona, Spain; Universitat Politècnica de Catalunya, Departament d'Estadística i Investigació Operativa, Barcelona, Spain
| | - Emmanuelle Jacquot
- Pharmacoepidemiology Department, Les Laboratoires Servier, Suresnes, France
| | - Nicolas Deltour
- Pharmacoepidemiology Department, Les Laboratoires Servier, Suresnes, France
| | | | | | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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13
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Pladevall-Vila M, Pottegård A, Schink T, Reutfors J, Morros R, Poblador-Plou B, Timmer A, Forns J, Hellfritzsch M, Reinders T, Hägg D, Giner-Soriano M, Prados-Torres A, Cainzos-Achirica M, Hallas J, Brandt L, Cortés J, Aguado J, Perlemuter G, Falissard B, Castellsagué J, Jacquot E, Deltour N, Perez-Gutthann S. Risk of Acute Liver Injury in Agomelatine and Other Antidepressant Users in Four European Countries: A Cohort and Nested Case-Control Study Using Automated Health Data Sources. CNS Drugs 2019; 33:383-395. [PMID: 30830574 PMCID: PMC6441103 DOI: 10.1007/s40263-019-00611-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Agomelatine is a melatonin receptor agonist and serotonin 5-HT2C receptor antagonist indicated for depression in adults. Hepatotoxic reactions like acute liver injury (ALI) are an identified risk in the European risk management plan for agomelatine. Hepatotoxic reactions have been reported for other antidepressants, but population studies quantifying these risks are scarce. Antidepressants are widely prescribed, and users often have risk factors for ALI (e.g. metabolic syndrome). OBJECTIVE The goal was to estimate the risk of ALI associated with agomelatine and other antidepressants (fluoxetine, paroxetine, sertraline, escitalopram, mirtazapine, venlafaxine, duloxetine, and amitriptyline) when compared with citalopram in routine clinical practice. METHOD A nested case-control study was conducted using data sources in Denmark, Germany, Spain, and Sweden (study period 2009-2014). Three ALI endpoints were defined using International Classification of Diseases (ICD) codes: primary (specific codes) and secondary (all codes) endpoints used only hospital discharge codes; the tertiary endpoint included both inpatient and outpatient settings (all codes). Validation of endpoints was implemented. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for current use were estimated for each data source and combined. RESULTS We evaluated 3,238,495 new antidepressant and 74,440 agomelatine users. For the primary endpoint, the OR for agomelatine versus citalopram was 0.48 (CI 0.13-1.71). Results were also < 1 when no exclusion criteria were applied (OR 0.37; CI 0.19-0.74), when all exclusion criteria except alcohol and drug abuse were applied (OR 0.47; CI 0.20-1.07), and for the secondary (OR 0.40; CI 0.05-3.11) and tertiary (OR 0.79; CI 0.50-1.25) endpoints. Regarding other antidepressants versus citalopram, most OR point estimates were also below one, although with varying widths of the 95% CIs. The result of the tertiary endpoint and the sensitivity analyses of the primary endpoint were the most precise. CONCLUSION In this study, using citalopram as a comparator, agomelatine was not associated with an increased risk of ALI hospitalisation. The results for agomelatine should be interpreted in the context of the European risk minimisation measures in place. Those measures may have induced selective prescribing and could explain the lower risk of ALI for agomelatine when compared with citalopram. Most other antidepressants evaluated had ORs suggesting a lower risk than citalopram, but additional studies are required to confirm or refute these results.
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Affiliation(s)
- Manel Pladevall-Vila
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain.
- The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Barcelona, Spain
- Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antje Timmer
- Division of Epidemiology and Biometry, Medical Faculty, Carl von Ossietzky University, Oldenburg, Germany
| | - Joan Forns
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tammo Reinders
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - David Hägg
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Barcelona, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jordi Cortés
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Barcelona, Spain
- Universitat Politècnica de Catalunya, Departament d'Estadística i Investigació Operativa, Barcelona, Spain
| | - Jaume Aguado
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
| | - Gabriel Perlemuter
- AP-HP, Hôpital Antoine Béclère, Service d'Hépato-gastroentérologie, 92140, Clamart, France
- Univ Paris-Sud/Paris-Saclay, Faculté de Médecine, Paris-Sud, 94270, Kremlin-Bicêtre, France
- INSERM U996, Clamart, 92140, France
| | - Bruno Falissard
- CESP INSERM U1018, Université Paris-Saclay, Université Paris-Sud, UVSQ, APHP, Paris, France
| | - Jordi Castellsagué
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
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Lenters V, Iszatt N, Forns J, Čechová E, Kočan A, Legler J, Leonards P, Stigum H, Eggesbø M. Early-life exposure to persistent organic pollutants (OCPs, PBDEs, PCBs, PFASs) and attention-deficit/hyperactivity disorder: A multi-pollutant analysis of a Norwegian birth cohort. Environ Int 2019; 125:33-42. [PMID: 30703609 DOI: 10.1016/j.envint.2019.01.020] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/20/2018] [Accepted: 01/07/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Numerous ubiquitous environmental chemicals are established or suspected neurotoxicants, and infants are exposed to a mixture of these during the critical period of brain maturation. However, evidence for associations with the risk of attention-deficit/hyperactivity disorder (ADHD) is sparse. We investigated early-life chemical exposures in relation to ADHD. METHODS We used a birth cohort of 2606 Norwegian mother-child pairs enrolled 2002-2009 (HUMIS), and studied a subset of 1199 pairs oversampled for child neurodevelopmental outcomes. Concentrations of 27 persistent organic pollutants (14 polychlorinated biphenyls, 5 organochlorine pesticides, 6 brominated flame retardants, and 2 perfluoroalkyl substances) were measured in breast milk, reflecting the child's early-life exposures. We estimated postnatal exposures in the first 2 years of life using a pharmacokinetic model. Fifty-five children had a clinical diagnosis of ADHD (hyperkinetic disorder) by 2016, at a median age of 13 years. We used elastic net penalized logistic regression models to identify associations while adjusting for co-exposure confounding, and subsequently used multivariable logistic regression models to obtain effect estimates for the selected exposures. RESULTS Breast milk concentrations of perfluorooctane sulfonate (PFOS) and β‑hexachlorocyclohexane (β-HCH) were associated with increased odds of ADHD: odds ratio (OR) = 1.77, 95% confidence interval (CI): 1.16, 2.72 and OR = 1.75, 95% CI: 1.22, 2.53, per interquartile range increase in ln-transformed concentrations, respectively. Stronger associations were observed among girls than boys for PFOS (pinteraction = 0.025). p,p'‑Dichlorodiphenyltrichloroethane (p,p'-DDT) levels were associated with lower odds of ADHD (OR = 0.64, 95% CI: 0.42, 0.97). Hexachlorobenzene (HCB) had a non-linear association with ADHD, with increasing risk in the low-level exposure range that switched to a decreasing risk at concentrations above 8 ng/g lipid. Postnatal exposures showed similar results, whereas effect estimates for other chemicals were weaker and imprecise. CONCLUSIONS In a multi-pollutant analysis of four classes of chemicals, early-life exposure to β-HCH and PFOS was associated with increased risk of ADHD, with suggestion of sex-specific effects for PFOS. The unexpected inverse associations between p,p'-DDT and higher HCB levels and ADHD could be due to live birth bias; alternatively, results may be due to chance findings.
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Affiliation(s)
- Virissa Lenters
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway.
| | - Nina Iszatt
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway.
| | - Joan Forns
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway.
| | - Eliška Čechová
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice; 753/5, 625 00 Brno, Czech Republic.
| | - Anton Kočan
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice; 753/5, 625 00 Brno, Czech Republic.
| | - Juliette Legler
- Institute for Environmental Studies, VU University Amsterdam, De Boelelaan 1087, 1081 HV Amsterdam, the Netherlands.
| | - Pim Leonards
- Institute for Environmental Studies, VU University Amsterdam, De Boelelaan 1087, 1081 HV Amsterdam, the Netherlands.
| | - Hein Stigum
- Department of Non-Communicable Diseases, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway.
| | - Merete Eggesbø
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway.
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15
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Camprodon-Rosanas E, Pujol J, Martínez-Vilavella G, Blanco-Hinojo L, Medrano-Martorell S, Batlle S, Forns J, Ribas-Fitó N, Dolz M, Sunyer J. Brain Structure and Function in School-Aged Children With Sluggish Cognitive Tempo Symptoms. J Am Acad Child Adolesc Psychiatry 2019; 58:256-266. [PMID: 30738552 DOI: 10.1016/j.jaac.2018.09.441] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 08/19/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Sluggish cognitive tempo (SCT) is a cluster of symptoms associated with poor function in various domains of major life activities that may comprise a novel attention disorder distinct from attention-deficit/hyperactivity disorder (ADHD). Nevertheless, very little is known about the neural substrate of SCT in children. The present study aimed to examine associations between SCT symptoms and brain structure and function in school-aged children. METHOD We performed a cross-sectional MRI study in 178 children 8 to 12 years old from primary schools in Barcelona, Spain. Data were collected between January 2012 and March 2013. Parents completed the Sluggish Cognitive Tempo-Child Behavior Checklist (SCT-CBCL). Participants underwent magnetic resonance imaging to assess regional brain volume, white matter integrity using diffusion tensor imaging, and functional connectivity in major neural networks. RESULTS SCT symptoms were associated with altered anatomy of the frontal lobe in the form of increased regional volume. The anomalously large cortical regions were less mature in terms of functional connectivity. Importantly, all the anatomical and functional anomalies identified remained significant after adjusting the analyses for ADHD symptom scores. CONCLUSION Our results suggest that SCT symptoms are associated with distinct features of brain structure and function that differ from the classical neural substrates described in ADHD.
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Affiliation(s)
- Ester Camprodon-Rosanas
- Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, and the Child and Adolescent Psychiatry Hospital Sant Joan de Déu of Barcelona, Spain
| | - Jesus Pujol
- MRI Research Unit, Hospital del Mar, Barcelona; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain.
| | | | - Laura Blanco-Hinojo
- MRI Research Unit, Hospital del Mar, Barcelona; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | | | - Santiago Batlle
- Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant, Martí i La Mina, Parc de Salut Mar, Barcelona, Catalonia, Spain
| | - Joan Forns
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Núria Ribas-Fitó
- Hospital de Dia Còrsega. CPB Serveis Salut Mental, Barcelona, Spain
| | - Montserrat Dolz
- Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, and the Child and Adolescent Psychiatry Hospital Sant Joan de Déu of Barcelona, Spain
| | - Jordi Sunyer
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, and the Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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16
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Panes J, Reinisch W, Rupniewska E, Khan S, Forns J, Khalid JM, Bojic D, Patel H. Burden and outcomes for complex perianal fistulas in Crohn's disease: Systematic review. World J Gastroenterol 2018; 24:4821-4834. [PMID: 30479468 PMCID: PMC6235801 DOI: 10.3748/wjg.v24.i42.4821] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review the literature on epidemiology, disease burden, and treatment outcomes for Crohn's disease (CD) patients with complex perianal fistulas. METHODS PubMed, Embase, and Cochrane were searched for relevant articles (published 2000-November 2016) and congress abstracts (published 2011-November 2016). RESULTS Of 535 records reviewed, 62 relevant sources were identified (mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14% (follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment (failure and relapse rates, respectively: medical, 12%-73% and 0%-41%; surgical: 0%-100% and 11%-20%; combined medical/surgical: 0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies (1 of infliximab; 3 of surgical interventions) have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD. CONCLUSION Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to anti-tumour necrosis factor-α agents, as evidenced by high failure and relapse rates.
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Affiliation(s)
- Julian Panes
- Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona 08036, Spain
| | | | - Ewa Rupniewska
- RTI Health Solutions, Manchester M20 2LS, United Kingdom
| | - Shahnaz Khan
- RTI Health Solutions, Research Triangle Park, NC 27709, United States
| | - Joan Forns
- RTI Health Solutions, Barcelona 08028, Spain
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17
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Alemany S, Vilor-Tejedor N, García-Esteban R, Bustamante M, Dadvand P, Esnaola M, Mortamais M, Forns J, van Drooge BL, Álvarez-Pedrerol M, Grimalt JO, Rivas I, Querol X, Pujol J, Sunyer J. Traffic-Related Air Pollution, APOEε4 Status, and Neurodevelopmental Outcomes among School Children Enrolled in the BREATHE Project (Catalonia, Spain). Environ Health Perspect 2018; 126:087001. [PMID: 30073950 PMCID: PMC6108838 DOI: 10.1289/ehp2246] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 05/18/2023]
Abstract
BACKGROUND Traffic-related air pollution is emerging as a risk factor for Alzheimer's disease (AD) and impaired brain development. Individual differences in vulnerability to air pollution may involve the ε4 allele of Apolipoprotein E (APOE) gene, the primary genetic risk factor for AD. OBJECTIVE We analyzed whether the association between traffic air pollution and neurodevelopmental outcomes is modified by APOEε4 status in children. METHODS Data on parent-reported behavior problems (total difficulties scores, Strengths and Difficulties Questionnaire), teacher-reported attention-deficit hyperactivity disorder (ADHD) symptom scores, cognitive performance trajectories (computerized tests of inattentiveness and working memory repeated 2-4 times during January 2012-March 2013), and APOE genotypes were obtained for 1,667 children age 7-11 y attending 39 schools in or near Barcelona. Basal ganglia volume (putamen, caudate, and globus pallidum) was measured in 163 of the children by MRI (October 2012-April 2014.) Average annual outdoor polycyclic aromatic hydrocarbons (PAHs), elemental carbon (EC), and nitrogen dioxide (NO2) concentrations were estimated based on measurements at each school (two 1-wk campaigns conducted 6 months apart in 2012). RESULTS APOEε4 allele carriers had significantly higher behavior problem scores than noncarriers, and adverse associations with PAHs and NO2 were stronger or limited to ε4 carriers for behavior problem scores (P-interaction 0.03 and 0.04), caudate volume (P-interaction 0.04 and 0.03), and inattentiveness trajectories (P-interaction 0.15 and 0.08, respectively). Patterns of associations with the same outcomes were similar for EC. CONCLUSION PAHs, EC, and NO2 were associated with higher behavior problem scores, smaller reductions in inattentiveness over time, and smaller caudate volume in APOEε4 allele carriers in our study population, and corresponding associations were weak or absent among ε4 noncarriers. These findings support a potential role of APOE in biological mechanisms that may contribute to associations between air pollution and neurobehavioral outcomes in children. https://doi.org/10.1289/EHP2246.
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Affiliation(s)
- Silvia Alemany
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Natàlia Vilor-Tejedor
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Raquel García-Esteban
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mariona Bustamante
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Payam Dadvand
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mikel Esnaola
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Marion Mortamais
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joan Forns
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Barend L van Drooge
- Institute for Environmental Assessment and Water Research (IDÆA-CSIC), Barcelona, Spain
| | - Mar Álvarez-Pedrerol
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joan O Grimalt
- Institute for Environmental Assessment and Water Research (IDÆA-CSIC), Barcelona, Spain
| | - Ioar Rivas
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Institute for Environmental Assessment and Water Research (IDÆA-CSIC), Barcelona, Spain
| | - Xavier Querol
- Institute for Environmental Assessment and Water Research (IDÆA-CSIC), Barcelona, Spain
| | - Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar and Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM G21), Barcelona, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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18
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Cainzos-Achirica M, Varas-Lorenzo C, Pottegård A, Asmar J, Plana E, Rasmussen L, Bizouard G, Forns J, Hellfritzsch M, Zint K, Perez-Gutthann S, Pladevall-Vila M. Methodological challenges when evaluating potential off-label prescribing of drugs using electronic health care databases: A case study of dabigatran etexilate in Europe. Pharmacoepidemiol Drug Saf 2018; 27:713-723. [DOI: 10.1002/pds.4416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Anton Pottegård
- Department of Public Health; University of Southern Denmark; Odense Denmark
| | | | - Estel Plana
- Epidemiology; RTI Health Solutions; Barcelona Spain
| | - Lotte Rasmussen
- Department of Public Health; University of Southern Denmark; Odense Denmark
| | | | - Joan Forns
- Epidemiology; RTI Health Solutions; Barcelona Spain
| | - Maja Hellfritzsch
- Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Kristina Zint
- Global Epidemiology; Boehringer Ingelheim GmbH; Ingelheim Germany
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Forns J, Dadvand P, Esnaola M, Alvarez-Pedrerol M, López-Vicente M, Garcia-Esteban R, Cirach M, Basagaña X, Guxens M, Sunyer J. Longitudinal association between air pollution exposure at school and cognitive development in school children over a period of 3.5 years. Environ Res 2017; 159:416-421. [PMID: 28858754 DOI: 10.1016/j.envres.2017.08.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/02/2017] [Accepted: 08/15/2017] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Recently, we showed that exposure to traffic-related air pollutants (TRAPs) at school was negatively associated with cognitive development, specifically working memory and inattentiveness, in primary schoolchildren during a course of 12 months. The persistence of such associations over longer periods remains as an open question. OBJECTIVE To study the longitudinal association between TRAPs at school and cognitive development over a period of 3.5 years. METHODS Indoor and outdoor levels of TRAPs (elemental carbon (EC), dioxide nitrogen (NO2), particulate matter (PM2.5) from traffic sources and ultrafine particles (UFP)) were measured at 39 schools across Barcelona during 2012/2013. Working memory, as a measure of cognitive development, was evaluated 4 times in 2012/2013 assessment and was re-evaluated one more time in 2015 using computerized n-back test (3-back d' as main outcome). Linear mixed effects models were used to test the association between TRAPs and 3-back d', adding child and school as random effects to account for the multilevel nature of the data, and school air pollutants levels (one at a time) as predictor. RESULTS We found detrimental associations between all TRAPs and annual change in 3-back d' (working memory) (i.e. slower development of working memory in children attending schools with higher levels of air pollution). The associations (per one interquartile range increase in exposure) were strongest for outdoor NO2 (Coefficient (Coef) = - 4.22, 95% confidence interval (CI), - 6.22, - 2.22) and indoor UFP (Coef = - 4.12, 95%CI, - 5.68, - 1.83). These reductions were equivalent to - 20% (95%CI, - 30.1, - 10.7) and - 19.9% (95%CI, - 31.5, - 8.4) change in annual working memory development associated with one interquartile range increase in outdoor NO2 and indoor UFP, respectively. CONCLUSION Our findings suggest the persistence of the negative association between TRAPs exposure at school and cognitive trajectory measured by n-back test over a period of 3.5 years.
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Affiliation(s)
- Joan Forns
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain.
| | - Payam Dadvand
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Mikel Esnaola
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Mar Alvarez-Pedrerol
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Mònica López-Vicente
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Pompeu Fabra University, Barcelona, Spain
| | - Raquel Garcia-Esteban
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Marta Cirach
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Xavier Basagaña
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Mònica Guxens
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Pompeu Fabra University, Barcelona, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jordi Sunyer
- ISGlobal-Center for Research in Environmental Epidemiology, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain; Pompeu Fabra University, Barcelona, Spain
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20
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Casas M, Forns J, Martínez D, Guxens M, Fernandez-Somoano A, Ibarluzea J, Lertxundi N, Murcia M, Rebagliato M, Tardon A, Sunyer J, Vrijheid M, Vrijheid M. Maternal pre-pregnancy obesity and neuropsychological development in pre-school children: a prospective cohort study. Pediatr Res 2017; 82:596-606. [PMID: 28493861 DOI: 10.1038/pr.2017.118] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/09/2017] [Indexed: 11/09/2022]
Abstract
BackgroundMaternal pre-pregnancy obesity may impair infant neuropsychological development, but it is unclear whether intrauterine or confounding factors drive this association.MethodsWe assessed whether maternal pre-pregnancy obesity was associated with neuropsychological development in 1,827 Spanish children. At 5 years, cognitive and psychomotor development was assessed using McCarthy Scales of Children's Abilities, attention deficit hyperactivity disorder (ADHD) symptoms using the Criteria of Diagnostic and Statistical Manual of Mental Disorders, and autism spectrum disorder symptoms using the Childhood Asperger Syndrome Test. Models were adjusted for sociodemographic factors and maternal intelligence quotient. We used paternal obesity as negative control exposure as it involves the same source of confounding than maternal obesity.ResultsThe percentage of obese mothers and fathers was 8% and 12%, respectively. In unadjusted models, children of obese mothers had lower scores than children of normal weight mothers in all McCarthy subscales. After adjustment, only the verbal subscale remained statistically significantly reduced (β: -2.8; 95% confidence interval: -5.3, -0.2). No associations were observed among obese fathers. Maternal and paternal obesity were associated with an increase in ADHD-related symptoms. Parental obesity was not associated with autism symptoms.ConclusionMaternal pre-pregnancy obesity was associated with a reduction in offspring verbal scores at pre-school age.
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Affiliation(s)
- Maribel Casas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Joan Forns
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - David Martínez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Mònica Guxens
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Ana Fernandez-Somoano
- Instituto Universitario de Oncología del Principado de Asturias (IUOPA); Departamento de Medicina, Universidad de Oviedo, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jesus Ibarluzea
- Instituto de Investigación Sanitaria (BioDonostia), Donostia-San Sebastian, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Nerea Lertxundi
- Instituto de Investigación Sanitaria (BioDonostia), Donostia-San Sebastian, Spain; University of the Basque Country (EHU/UPV), Donostia-San Sebastian, Spain
| | - Mario Murcia
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Adonina Tardon
- Instituto Universitario de Oncología del Principado de Asturias (IUOPA); Departamento de Medicina, Universidad de Oviedo, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Sunyer
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Martine Vrijheid
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
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21
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López-Vicente M, Garcia-Aymerich J, Torrent-Pallicer J, Forns J, Ibarluzea J, Lertxundi N, González L, Valera-Gran D, Torrent M, Dadvand P, Vrijheid M, Sunyer J. Are Early Physical Activity and Sedentary Behaviors Related to Working Memory at 7 and 14 Years of Age? J Pediatr 2017; 188:35-41.e1. [PMID: 28688631 DOI: 10.1016/j.jpeds.2017.05.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/17/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the role of extracurricular physical activity and sedentary behavior at preschool and primary school age on working memory at primary school age and adolescence, respectively. STUDY DESIGN This prospective study was based on a birth cohort across 4 Spanish regions. In the 3 younger subcohorts (n = 1093), parents reported lifestyle habits of child at age 4 years of age on a questionnaire, and children performed a computerized working memory task at 7 years of age. In the older subcohort (n = 307), the questionnaire was completed at 6 years of age and working memory was tested at 14 years of age. Adjusted regression models were developed to investigate the associations between lifestyle habits and working memory. RESULTS Low extracurricular physical activity levels at 4 years of age were associated with a nonsignificant 0.95% (95% CI -2.81 to 0.92) reduction of correct responses in the working memory task at age 7 years of age. Low extracurricular physical activity levels at 6 years of age were associated with a 4.22% (95% CI -8.05 to -0.39) reduction of correct responses at age 14 years. Television watching was not associated with working memory. Other sedentary behaviors at 6 year of age were associated with a 5.07% (95% CI -9.68 to -0.46) reduction of correct responses in boys at 14 years of age. CONCLUSION Low extracurricular physical activity levels at preschool and primary school ages were associated with poorer working memory performance at primary school age and adolescence, respectively. High sedentary behavior levels at primary school age were related negatively to working memory in adolescent boys.
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Affiliation(s)
- Mónica López-Vicente
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain.
| | - Judith Garcia-Aymerich
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain
| | - Jaume Torrent-Pallicer
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain
| | - Joan Forns
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain
| | - Jesús Ibarluzea
- Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain; Health Research Institute BIODONOSTIA, Donostia-San Sebastian, Spain; Sub-Directorate of Public Health of Gipuzkoa, Department of Health, Government of Basque Country, San Sebastian, Spain
| | - Nerea Lertxundi
- Health Research Institute BIODONOSTIA, Donostia-San Sebastian, Spain; Department of Social Psychology and Methodology of Behavioral Sciences, Basque Country University (EHU/UPV), Spain
| | - Llúcia González
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO/CSISP), Public Health, Valencia, Spain
| | - Desirée Valera-Gran
- Department of Public Health, Miguel Hernández University, San Juan de Alicante, Spain
| | | | - Payam Dadvand
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain
| | - Martine Vrijheid
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain
| | - Jordi Sunyer
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Biomedical Research Networking Centres Epidemiology and Public Health (CIBERESP), Spain
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22
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Mortamais M, Pujol J, van Drooge BL, Macià D, Martínez-Vilavella G, Reynes C, Sabatier R, Rivas I, Grimalt J, Forns J, Alvarez-Pedrerol M, Querol X, Sunyer J. Effect of exposure to polycyclic aromatic hydrocarbons on basal ganglia and attention-deficit hyperactivity disorder symptoms in primary school children. Environ Int 2017; 105:12-19. [PMID: 28482185 DOI: 10.1016/j.envint.2017.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/12/2017] [Accepted: 04/25/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND Polycyclic aromatic hydrocarbons (PAHs) have been proposed as environmental risk factors for attention deficit hyperactivity disorder (ADHD). The effects of these pollutants on brain structures potentially involved in the pathophysiology of ADHD are unknown. OBJECTIVE The aim of this study was to investigate the effects of PAHs on basal ganglia volumes and ADHD symptoms in school children. METHODS We conducted an imaging study in 242 children aged 8-12years, recruited through a set of representative schools of the city of Barcelona, Spain. Indoor and outdoor PAHs and benzo[a]pyrene (BPA) levels were assessed in the school environment, one year before the MRI assessment. Whole-brain volumes and basal ganglia volumes (caudate nucleus, globus pallidus, putamen) were derived from structural MRI scans using automated tissue segmentation. ADHD symptoms (ADHD/DSM-IV Scales, American Psychiatric Association 2002) were reported by teachers, and inattentiveness was evaluated with standard error of hit reaction time in the attention network computer-based test. RESULTS Total PAHs and BPA were associated with caudate nucleus volume (CNV) (i.e., an interquartile range increase in BPA outdoor level (67pg/m3) and indoor level (76pg/m3) was significantly linked to a decrease in CNV (mm3) (β=-150.6, 95% CI [-259.1, -42.1], p=0.007, and β=-122.4, 95% CI [-232.9, -11.8], p=0.030 respectively) independently of intracranial volume, age, sex, maternal education and socioeconomic vulnerability index at home). ADHD symptoms and inattentiveness increased in children with higher exposure to BPA, but these associations were not statistically significant. CONCLUSIONS Exposure to PAHs, and in particular to BPA, is associated with subclinical changes on the caudate nucleus, even below the legislated annual target levels established in the European Union. The behavioral consequences of this induced brain change were not identified in this study, but given the caudate nucleus involvement in many crucial cognitive and behavior processes, this volume reduction is concerning for the children's neurodevelopment.
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Affiliation(s)
- Marion Mortamais
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Jesus Pujol
- MRI Research Unit, Hospital del Mar, Barcelona, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | | | - Didac Macià
- MRI Research Unit, Hospital del Mar, Barcelona, Spain
| | | | - Christelle Reynes
- University of Montpellier, , Montpellier, France; 3 EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Robert Sabatier
- University of Montpellier, , Montpellier, France; 3 EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Ioar Rivas
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institute of Environmental Assessment and Water Research, Barcelona, Spain
| | - Joan Grimalt
- Institute of Environmental Assessment and Water Research, Barcelona, Spain
| | - Joan Forns
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mar Alvarez-Pedrerol
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Querol
- Institute of Environmental Assessment and Water Research, Barcelona, Spain
| | - Jordi Sunyer
- ISGLOBAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Pompeu Fabra University, Barcelona, Catalonia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut Hospital del Mar d'Investigacions Mèdiques-Parc de Salut Mar, Barcelona, Catalonia, Spain
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23
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Camprodon-Rosanas E, Ribas-Fitó N, Batlle-Vila S, Persavento C, Alvarez-Pedrerol M, Sunyer J, Forns J. Sluggish Cognitive Tempo: Sociodemographic, Behavioral, and Clinical Characteristics in a Population of Catalan School Children. J Atten Disord 2017; 21:632-641. [PMID: 27269005 DOI: 10.1177/1087054716652477] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of the present study were to examine the presence of sluggish cognitive tempo (SCT) symptoms in children; associations of the symptoms with sociodemographic characteristics of the children; and relationships between SCT symptoms and symptoms of ADHD, dyslexia, academic performance, and behavioral problems. METHOD We evaluated Catalan schoolchildren aged 7 to 10 years in Barcelona, 2012-2013. Parents filled out the SCT-Child Behavior Checklist (SCT-CBCL), the Strengths and Difficulties Questionnaire (SDQ), and a questionnaire concerning sociodemographic characteristics. Teachers completed the ADHD criteria of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) (ADHD- DSM-IV), a list of dyslexia symptoms, and evaluated the children's academic performance. SCT symptoms were studied as a continuous and dichotomous variable. RESULTS In all, 11% of the children in our sample scored above the clinical cut-off on the SCT-CBCL scale. We observed a higher rate of SCT symptoms in boys, children whose father was unemployed, those whose maternal educational level was lower, children with a high socioeconomic vulnerability index at home, those who reported maternal smoking during pregnancy and current second-hand smoke exposure at home, and children with an ADHD diagnosis. More SCT symptoms were associated with inattention symptoms, symptoms of dyslexia, academic problems, and emotional and peer relationship problems. CONCLUSION We observed a higher prevalence of SCT symptoms in our sample than expected in the general population. While girls are less prone to SCT symptoms, some socioeconomic indicators, dyslexia, and inattention symptoms as well as exposure to smoking at home increase the risk of SCT and must be taken into account during assessments.
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Affiliation(s)
- E Camprodon-Rosanas
- 1 CSMIJ Sant Martí i La Mina, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain.,2 Departament de Psiquiatria i Medicina Legal, Facultat de Medicina, Universitat Autònoma de Barcelona, Spain
| | - N Ribas-Fitó
- 3 CSMIJ Gavà, Fundació Orienta, Barcelona, Spain
| | - S Batlle-Vila
- 1 CSMIJ Sant Martí i La Mina, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - C Persavento
- 4 Center for Research in Environmental Epidemiology, Barcelona, Spain.,5 Hospital del Mar Research Institute, Barcelona; Spain.,6 Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP)
| | - M Alvarez-Pedrerol
- 4 Center for Research in Environmental Epidemiology, Barcelona, Spain.,5 Hospital del Mar Research Institute, Barcelona; Spain.,6 Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP)
| | - J Sunyer
- 4 Center for Research in Environmental Epidemiology, Barcelona, Spain.,5 Hospital del Mar Research Institute, Barcelona; Spain.,6 Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP)
| | - J Forns
- 4 Center for Research in Environmental Epidemiology, Barcelona, Spain.,5 Hospital del Mar Research Institute, Barcelona; Spain.,6 Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP)
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24
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Suades-González E, Forns J, García-Esteban R, López-Vicente M, Esnaola M, Álvarez-Pedrerol M, Julvez J, Cáceres A, Basagaña X, López-Sala A, Sunyer J. A Longitudinal Study on Attention Development in Primary School Children with and without Teacher-Reported Symptoms of ADHD. Front Psychol 2017; 8:655. [PMID: 28559855 PMCID: PMC5432613 DOI: 10.3389/fpsyg.2017.00655] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Prospective longitudinal studies are essential in characterizing cognitive trajectories, yet few of them have been reported on the development of attention processes in children. We aimed to explore attention development in normal children and children with attention deficit and hyperactivity disorder (ADHD) symptoms in a repeated measures design using the attention network test (ANT). Methods: The population sample included 2,835 children (49.6% girls) aged 7-11 years from 39 schools in Barcelona (Catalonia, Spain) who performed the ANT four times from January 2012 to March 2013. According to teacher ratings, 10.5% of the children presented ADHD symptoms. We performed multilevel mixed-effects linear regression models, adjusting for school and individual, to test the effects of age-related growth on the ANT networks: alerting, orienting and executive attention, and three measurements related to attentiveness: median of hit reaction time (HRT), hit reaction time standard error (HRT-SE) and variability. Results: We observed age-related growth in all the outcomes, except orienting. The curves were steeper at the younger groups, although for alertness the improvement was further at the oldest ages. Gender and ADHD symptoms interacted with age in executive attention, HRT and variability. Girls performed better in executive attention at young ages although boys reached females at around 10 years of age. For HRT, males showed faster HRT. However, girls had a more pronounced improvement and reached the levels of boys at age 11. Children with ADHD symptoms had significant differences in executive attention, HRT and variability compared to children without ADHD symptoms. Conclusions: We detected an ongoing development of some aspects of attention in primary school children, differentiating patterns by gender and ADHD symptoms. Our findings support the ANT for assessing attention processes in children in large epidemiological studies.
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Affiliation(s)
- Elisabet Suades-González
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,Learning Disabilities Unit (UTAE), Neuropediatrics Department, Hospital Sant Joan de Déu, University of BarcelonaBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Joan Forns
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Raquel García-Esteban
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Mónica López-Vicente
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain.,Hospital del Mar Medical Research InstituteBarcelona, Spain
| | - Mikel Esnaola
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Mar Álvarez-Pedrerol
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Jordi Julvez
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain.,Hospital del Mar Medical Research InstituteBarcelona, Spain.,Environmental Health Department, Harvard T.H. Chan School of Public HealthBoston, MA, USA
| | - Alejandro Cáceres
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Xavier Basagaña
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Anna López-Sala
- Learning Disabilities Unit (UTAE), Neuropediatrics Department, Hospital Sant Joan de Déu, University of BarcelonaBarcelona, Spain
| | - Jordi Sunyer
- Center for Research in Environmental Epidemiology, Barcelona Institute for Global HealthBarcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra UniversityBarcelona, Spain.,CIBER Epidemiología y Salud PúblicaBarcelona, Spain.,Hospital del Mar Medical Research InstituteBarcelona, Spain
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25
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Čechová E, Scheringer M, Seifertová M, Mikeš O, Kroupová K, Kuta J, Forns J, Eggesbø M, Quaak I, de Cock M, van de Bor M, Patayová H, Palkovičová Murínová Ľ, Kočan A. Developmental neurotoxicants in human milk: Comparison of levels and intakes in three European countries. Sci Total Environ 2017; 579:637-645. [PMID: 27890414 DOI: 10.1016/j.scitotenv.2016.11.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
Developmental neurotoxicants (DNTs), such as methylmercury (MeHg), polychlorinated biphenyls (PCBs) and selected organochlorine pesticides (OCPs), have gained increasing interest recently due to their possible relation to developmental disorders in children, which are increasing worldwide. We analyzed levels of 14 developmental neurotoxicants in human milk samples from Slovakia (n=37), the Netherlands (n=120) and Norway (n=388). Positive identification for most target analytes was >95% in all samples. In all three countries MeHg was measured for the first time in mother milk. The highest MeHg levels were observed in Norway (39pgg-1 ww) with the highest fish consumption. Levels of indicator PCBs (iPCBs, sum of PCB 28, 52, 101, 138, 153 and 180), HCB and DDE+DDT were 2-4 times higher in Slovakia compared to the Netherlands or Norway. The levels of MeHg and organochlorine compounds were used for calculations of weekly or daily intakes (top-down approach) by means of pharmacokinetic modeling. The intakes ranged from 0.014 to 0.142μgkgbw-1week-1 for MeHg and from 0.043 to 17.4ngkgbw-1day-1 for organochlorine compounds in all three countries. Intakes of iPCBs exceeded a tolerable daily intake of 10ngkgbw-1day-1 in 16% of the Slovak participants. The top-down estimates were compared with bottom-up intakes based on national dietary estimates and the results showed good consistency between both approaches, with the bottom-up intakes exceeding the top-down by a factor of maximum 3.8 for iPCBs in the Netherlands and 3.9 for HCB in Slovakia. This confirms that food consumption in all three countries represents the dominant pathway of exposure to these developmental neurotoxicants.
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Affiliation(s)
- Eliška Čechová
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Martin Scheringer
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic; Institute for Chemical and Bioengineering, ETH Zürich, Vladimir-Prelog-Weg 1, CH-8093 Zürich, Switzerland.
| | - Marta Seifertová
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Ondřej Mikeš
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Kristýna Kroupová
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Jan Kuta
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Joan Forns
- Norwegian Institute of Public Health, Lovisenberggata 8, 0403 Oslo, Norway
| | - Merete Eggesbø
- Norwegian Institute of Public Health, Lovisenberggata 8, 0403 Oslo, Norway
| | - Ilona Quaak
- Department of Earth and Life Sciences, Vrije University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Marijke de Cock
- Department of Earth and Life Sciences, Vrije University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Margot van de Bor
- Department of Earth and Life Sciences, Vrije University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Henrieta Patayová
- Faculty of Public Health, Slovak Medical University, Limbová 12, 83303 Bratislava, Slovakia
| | | | - Anton Kočan
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
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26
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Fuertes E, Standl M, Forns J, Berdel D, Garcia-Aymerich J, Markevych I, Schulte-Koerne G, Sugiri D, Schikowski T, Tiesler CMT, Heinrich J. Traffic-related air pollution and hyperactivity/inattention, dyslexia and dyscalculia in adolescents of the German GINIplus and LISAplus birth cohorts. Environ Int 2016; 97:85-92. [PMID: 27835751 DOI: 10.1016/j.envint.2016.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Few studies have examined the link between air pollution exposure and behavioural problems and learning disorders during late childhood and adolescence. OBJECTIVES To determine whether traffic-related air pollution exposure is associated with hyperactivity/inattention, dyslexia and dyscalculia up to age 15years using the German GINIplus and LISAplus birth cohorts (recruitment 1995-1999). METHODS Hyperactivity/inattention was assessed using the German parent-completed (10years) and self-completed (15years) Strengths and Difficulties Questionnaire. Responses were categorized into normal versus borderline/abnormal. Parent-reported dyslexia and dyscalculia (yes/no) at age 10 and 15years were defined using parent-completed questionnaires. Individual-level annual average estimates of nitrogen dioxide (NO2), particulate matter (PM)10 mass, PM2.5 mass and PM2.5 absorbance concentrations were assigned to each participant's birth, 10year and 15year home address. Longitudinal associations between the air pollutants and the neurodevelopmental outcomes were assessed using generalized estimation equations, separately for both study areas, and combined in a random-effects meta-analysis. Odds ratios and 95% confidence intervals are given per interquartile range increase in pollutant concentration. RESULTS The prevalence of abnormal/borderline hyperactivity/inattention scores and parental-reported dyslexia and dyscalculia at 15years of age was 12.9%, 10.5% and 3.4%, respectively, in the combined population (N=4745). In the meta- analysis, hyperactivity/inattention was associated with PM2.5 mass estimated to the 10 and 15year addresses (1.12 [1.01, 1.23] and 1.11 [1.01, 1.22]) and PM2.5 absorbance estimated to the 10 and 15year addresses (1.14 [1.05, 1.25] and 1.13 [1.04, 1.23], respectively). CONCLUSIONS We report associations suggesting a potential link between air pollution exposure and hyperactivity/inattention scores, although these findings require replication.
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Affiliation(s)
- Elaine Fuertes
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Marie Standl
- Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
| | - Joan Forns
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
| | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Iana Markevych
- Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany; Division of Metabolic and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Gerd Schulte-Koerne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilian University of Munich, Munich, Germany.
| | - Dorothea Sugiri
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
| | - Carla M T Tiesler
- Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany; Division of Metabolic and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany; Ludwig-Maximilians-University, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research, Munich, Germany.
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Llop S, Ballester F, Murcia M, Forns J, Tardon A, Andiarena A, Vioque J, Ibarluzea J, Fernández-Somoano A, Sunyer J, Julvez J, Rebagliato M, Lopez-Espinosa MJ. Prenatal exposure to mercury and neuropsychological development in young children: the role of fish consumption. Int J Epidemiol 2016; 46:827-838. [DOI: 10.1093/ije/dyw259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/10/2023] Open
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Forns J, Mandal S, Iszatt N, Polder A, Thomsen C, Lyche JL, Stigum H, Vermeulen R, Eggesbø M. Novel application of statistical methods for analysis of multiple toxicants identifies DDT as a risk factor for early child behavioral problems. Environ Res 2016; 151:91-100. [PMID: 27466755 DOI: 10.1016/j.envres.2016.07.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The aim of this study was to assess the association between postnatal exposure to multiple persistent organic pollutants (POPs) measured in breast milk samples and early behavioral problems using statistical methods to deal with correlated exposure data. METHODS We used data from the Norwegian HUMIS study. We measured concentrations of 24 different POPs in human milk from 612 mothers (median collection time: 32 days after delivery), including 13 polychlorinated biphenyls (PCB) congeners, 6 polybrominated diphenyl ethers (PBDE) congeners and five organochlorine compounds. We assessed child behavioral problems at 12 and 24 months using the infant toddler symptom checklist (ITSC). Higher score in ITSC corresponds to more behavioral problems. First we performed principal component analysis (PCA). Then two variable selection methods, elastic net (ENET) and Bayesian model averaging (BMA), were applied to select any toxicants associated with behavioral problems. Finally, the effect size of the selected toxicants was estimated using multivariate linear regression analyses. RESULTS p,p'-DDT was associated with behavioral problems at 12 months in all the applied models. Specifically, the principal component composed of organochlorine pesticides was significantly associated with behavioral problems and both ENET and BMA identified p,p'-DDT as associated with behavioral problems. Using a multiple linear regression model an interquartile increase in p,p'-DDT was associated with a 0.62 unit increase in ITSC score (95% CI 0.45, 0.79) at 12 months, corresponding to more behavioral problems. The association was modified by maternal education: the effect of p,p'-DDT was strongest in women with lower education (β=0.59; 95%CI: 0.38, 0.81) compared to the mother with higher education (β=0.14; 95%CI: -0.05, 0.34) (p-value for interaction=0.089). At 24 months, neither selection method consistently identified any toxicant associated with behavioral problems. CONCLUSION Within a mixture of 24 toxicants measured in breast milk, p,p'-DDT was the single toxicant associated with behavioral problems at 12 months using different methods for handling numerous correlated exposures.
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Affiliation(s)
- Joan Forns
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Siddhartha Mandal
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Nina Iszatt
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anuschka Polder
- Department of Food Safety and Infection Biology, Norwegian University of Life Sciences, Ås, Norway
| | - Cathrine Thomsen
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Ludvig Lyche
- Department of Food Safety and Infection Biology, Norwegian University of Life Science, Oslo, Norway
| | - Hein Stigum
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht, The Netherlands
| | - Merete Eggesbø
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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Marinelli M, Pappa I, Bustamante M, Bonilla C, Suarez A, Tiesler CM, Vilor-Tejedor N, Zafarmand MH, Alvarez-Pedrerol M, Andersson S, Bakermans-Kranenburg MJ, Estivill X, Evans DM, Flexeder C, Forns J, Gonzalez JR, Guxens M, Huss A, van IJzendoorn MH, Jaddoe VW, Julvez J, Lahti J, López-Vicente M, Lopez-Espinosa MJ, Manz J, Mileva-Seitz VR, Perola M, Pesonen AK, Rivadeneira F, Salo PP, Shahand S, Schulz H, Standl M, Thiering E, Timpson NJ, Torrent M, Uitterlinden AG, Smith GD, Estarlich M, Heinrich J, Räikkönen K, Vrijkotte TG, Tiemeier H, Sunyer J. Heritability and Genome-Wide Association Analyses of Sleep Duration in Children: The EAGLE Consortium. Sleep 2016; 39:1859-1869. [PMID: 27568811 PMCID: PMC5020368 DOI: 10.5665/sleep.6170] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/09/2016] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES Low or excessive sleep duration has been associated with multiple outcomes, but the biology behind these associations remains elusive. Specifically, genetic studies in children are scarce. In this study, we aimed to: (1) estimate the proportion of genetic variance of sleep duration in children attributed to common single nucleotide polymorphisms (SNPs), (2) identify novel SNPs associated with sleep duration in children, and (3) investigate the genetic overlap of sleep duration in children and related metabolic and psychiatric traits. METHODS We performed a population-based molecular genetic study, using data form the EArly Genetics and Life course Epidemiology (EAGLE) Consortium. 10,554 children of European ancestry were included in the discovery, and 1,250 children in the replication phase. RESULTS We found evidence of significant but modest SNP heritability of sleep duration in children (SNP h2 0.14, 95% CI [0.05, 0.23]) using the LD score regression method. A novel region at chromosome 11q13.4 (top SNP: rs74506765, P = 2.27e-08) was associated with sleep duration in children, but this was not replicated in independent studies. Nominally significant genetic overlap was only found (rG = 0.23, P = 0.05) between sleep duration in children and type 2 diabetes in adults, supporting the hypothesis of a common pathogenic mechanism. CONCLUSIONS The significant SNP heritability of sleep duration in children and the suggestive genetic overlap with type 2 diabetes support the search for genetic mechanisms linking sleep duration in children to multiple outcomes in health and disease.
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Affiliation(s)
- Marcella Marinelli
- Agency for Healthcare Quality and Evaluation of Catalonia (AQuAS), Roc Boronat, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Irene Pappa
- School of Pedagogical and Educational Sciences, Erasmus University Rotterdam, The Netherlands
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mariona Bustamante
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Centre for Genomic Regulation (CRG), the Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carolina Bonilla
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anna Suarez
- Institute of behavioural sciences, University of Helsinki, Helsinki, Finland
| | - Carla M. Tiesler
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Division of Metabolic Diseases and Nutritional Medicine, Munich, Germany
| | - Natalia Vilor-Tejedor
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Mohammad Hadi Zafarmand
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Mar Alvarez-Pedrerol
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Sture Andersson
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | | | - Xavier Estivill
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centre for Genomic Regulation (CRG), the Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mediques (IMIM), 08003 Barcelona, Spain
| | - David M. Evans
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Claudia Flexeder
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Joan Forns
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Juan R. Gonzalez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Monica Guxens
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Marinus H. van IJzendoorn
- School of Pedagogical and Educational Sciences, Erasmus University Rotterdam, The Netherlands
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Centre for Child and Family Studies, Leiden University, Leiden, The Netherlands
| | - Vincent W.V. Jaddoe
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jordi Julvez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Jari Lahti
- Institute of behavioural sciences, University of Helsinki, Helsinki, Finland
- Helsinki Collegium for Advanced Studies, Helsinki, Finland
- Folkhälsan Research Centre, Finland
| | - Mónica López-Vicente
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Maria-Jose Lopez-Espinosa
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO, Universitat Jaume I, Universitat de València, Spain
| | - Judith Manz
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Markus Perola
- Public Health Genomics Unit and Institute for Molecular Medicine FIMM, University of Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Fernando Rivadeneira
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Perttu P. Salo
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Shayan Shahand
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center (AMC), University of Amsterdam, The Netherlands
| | - Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Marie Standl
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Elisabeth Thiering
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Division of Metabolic Diseases and Nutritional Medicine, Munich, Germany
| | - Nicholas J. Timpson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - André G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, The Netherlands
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC/University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Marisa Estarlich
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO, Universitat Jaume I, Universitat de València, Spain
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Katri Räikkönen
- Institute of behavioural sciences, University of Helsinki, Helsinki, Finland
| | - Tanja G.M. Vrijkotte
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jordi Sunyer
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mediques (IMIM), 08003 Barcelona, Spain
- Address correspondence to: Jordi Sunyer, PhD,
ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader, 88, E-08003 Barcelona, Spain+34 93 214 73 00+ 34 93 214 73 02
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Basagaña X, Esnaola M, Rivas I, Amato F, Alvarez-Pedrerol M, Forns J, López-Vicente M, Pujol J, Nieuwenhuijsen M, Querol X, Sunyer J. Neurodevelopmental Deceleration by Urban Fine Particles from Different Emission Sources: A Longitudinal Observational Study. Environ Health Perspect 2016; 124:1630-1636. [PMID: 27128166 PMCID: PMC5047777 DOI: 10.1289/ehp209] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 09/30/2015] [Accepted: 04/12/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND A few studies have reported associations between traffic-related air pollution exposure at schools and cognitive development. The role of PM components or sources other than traffic on cognitive development has been little explored. OBJECTIVES We aimed to explore the role of PM sources in school air on cognitive development. METHODS A cohort of 2,618 schoolchildren (average age, 8.5 years) belonging to 39 schools in Barcelona (Spain) was followed up for a year. Children completed computerized tests assessing working memory, superior working memory, and inattentiveness during four visits. Particulate matter ≤ 2.5 μm (PM2.5) was measured during two 1-week campaigns in each school, both outdoors and in the classroom. Source apportionment resulted in nine sources: mineral, organic/textile/chalk, traffic, secondary sulfate and organics, secondary nitrate, road dust, metallurgy, sea spray, and heavy oil combustion. Differences in cognitive growth trajectories were assessed with mixed models with age-by-source interaction terms. RESULTS An interquartile range increase in indoor traffic-related PM2.5 was associated with reductions in cognitive growth equivalent to 22% (95% CI: 2%, 42%) of the annual change in working memory, 30% (95% CI: 6%, 54%) of the annual change in superior working memory, and 11% (95% CI: 0%, 22%) of the annual change in the inattentiveness scale. None of the other PM2.5 sources was associated with adverse effects on cognitive development. CONCLUSIONS Traffic was the only source of fine particles associated with a reduction in cognitive development. Reducing air pollution from traffic at primary schools may result in beneficial effects on cognition. CITATION Basagaña X, Esnaola M, Rivas I, Amato F, Alvarez-Pedrerol M, Forns J, López-Vicente M, Pujol J, Nieuwenhuijsen M, Querol X, Sunyer J. 2016. Neurodevelopmental deceleration by urban fine particles from different emission sources: a longitudinal observational study. Environ Health Perspect 124:1630-1636; http://dx.doi.org/10.1289/EHP209.
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Affiliation(s)
- Xavier Basagaña
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Address correspondence to X. Basagaña, Centre for Research in Environmental Epidemiology (CREAL), c/ Doctor Aiguader 88, 08003 Barcelona, Spain. Telephone: (34) 932147306. E-mail:
| | - Mikel Esnaola
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ioar Rivas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Fulvio Amato
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Mar Alvarez-Pedrerol
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Mònica López-Vicente
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jesús Pujol
- MRI Research Unit, CRC Mar, Hospital del Mar, Barcelona, Spain
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM G21), Barcelona, Spain
| | - Mark Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Xavier Querol
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Catalonia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Catalonia, Spain
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Alemany S, Vilor-Tejedor N, Bustamante M, Pujol J, Macià D, Martínez-Vilavella G, Fenoll R, Alvárez-Pedrerol M, Forns J, Júlvez J, Suades-González E, Llop S, Rebagliato M, Sunyer J. A Genome-Wide Association Study of Attention Function in a Population-Based Sample of Children. PLoS One 2016; 11:e0163048. [PMID: 27656889 PMCID: PMC5033492 DOI: 10.1371/journal.pone.0163048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/01/2016] [Indexed: 01/19/2023] Open
Abstract
Background Attention function filters and selects behaviorally relevant information. This capacity is impaired in some psychiatric disorders and has been proposed as an endophenotype for Attention-Deficit/Hyperactivity Disorder; however, its genetic basis remains largely unknown. This study aimed to identify single nucleotide polymorphism (SNPs) associated with attention function. Materials and Methods The discovery sample included 1655 children (7–12 years) and the replication sample included 546 children (5–8 years). Five attention outcomes were assessed using the computerized Attentional Network Test (ANT): alerting, orienting, executive attention, Hit Reaction time (HRT) and the standard error of HRT (HRTSE). A Genome-wide Association Study was conducted for each outcome. Gene set enrichment analyses were performed to detect biological pathways associated with attention outcomes. Additional neuroimaging analyses were conducted to test neural effects of detected SNPs of interest. Results Thirteen loci showed suggestive evidence of association with attention function (P<10−5) in the discovery sample. One of them, the rs4321351 located in the PID1 gene, was nominally significant in the replication sample although it did not survive multiple testing correction. Neuroimaging analysis revealed a significant association between this SNP and brain structure and function involving the frontal-basal ganglia circuits. The mTOR signaling and Alzheimer disease-amyloid secretase pathways were significantly enriched for alerting, orienting and HRT respectively (FDR<5%). Conclusion These results suggest for the first time the involvement of the PID1 gene, mTOR signaling and Alzheimer disease-amyloid secretase pathways, in attention function during childhood. These genes and pathways have been proposed to play a role in neuronal plasticity, memory and neurodegenerative disease.
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Affiliation(s)
- Silvia Alemany
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- * E-mail:
| | - Natàlia Vilor-Tejedor
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Mariona Bustamante
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Jesús Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | - Dídac Macià
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | | | - Raquel Fenoll
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Mar Alvárez-Pedrerol
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Joan Forns
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jordi Júlvez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Elisabet Suades-González
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Learning Disabilities Unit (UTAE); Neuropediatrics Department, Hospital de Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Sabrina Llop
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO−Universitat Jaume I−Universitat de València, Valencia, Spain
| | - Marisa Rebagliato
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO−Universitat Jaume I−Universitat de València, Valencia, Spain
- University Jaime I (UJI), Castellón, Spain
| | - Jordi Sunyer
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Pujol J, Fenoll R, Forns J, Harrison BJ, Martínez-Vilavella G, Macià D, Alvarez-Pedrerol M, Blanco-Hinojo L, González-Ortiz S, Deus J, Sunyer J. Video gaming in school children: How much is enough? Ann Neurol 2016; 80:424-33. [PMID: 27463843 DOI: 10.1002/ana.24745] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/12/2016] [Accepted: 07/24/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Despite extensive debate, the proposed benefits and risks of video gaming in young people remain to be empirically clarified, particularly as regards an optimal level of use. METHODS In 2,442 children aged 7 to 11 years, we investigated relationships between weekly video game use, selected cognitive abilities, and conduct-related problems. A large subgroup of these children (n = 260) was further examined with magnetic resonance imaging approximately 1 year later to assess the impact of video gaming on brain structure and function. RESULTS Playing video games for 1 hour per week was associated with faster and more consistent psychomotor responses to visual stimulation. Remarkably, no further change in motor speed was identified in children playing >2 hours per week. By comparison, the weekly time spent gaming was steadily associated with conduct problems, peer conflicts, and reduced prosocial abilities. These negative implications were clearly visible only in children at the extreme of our game-playing distribution, with 9 hours or more of video gaming per week. At a neural level, changes associated with gaming were most evident in basal ganglia white matter and functional connectivity. INTERPRETATION Significantly better visuomotor skills can be seen in school children playing video games, even with relatively small amounts of use. Frequent weekly use, by contrast, was associated with conduct problems. Further studies are needed to determine whether moderate video gaming causes improved visuomotor skills and whether excessive video gaming causes conduct problems, or whether children who already have these characteristics simply play more video games. Ann Neurol 2016;80:424-433.
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Affiliation(s)
- Jesus Pujol
- Magnetic Resonance Imaging Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain. .,Biomedical Research Center Network for Mental Health (CibersamG21), Barcelona, Spain.
| | - Raquel Fenoll
- Magnetic Resonance Imaging Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Joan Forns
- Center for Research in Environmental Epidemiology, Barcelona, Spain.,Pompeu Fabra University, Barcelona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (Ciberesp), Madrid, Spain
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Gerard Martínez-Vilavella
- Magnetic Resonance Imaging Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Dídac Macià
- Magnetic Resonance Imaging Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Mar Alvarez-Pedrerol
- Center for Research in Environmental Epidemiology, Barcelona, Spain.,Pompeu Fabra University, Barcelona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (Ciberesp), Madrid, Spain
| | - Laura Blanco-Hinojo
- Magnetic Resonance Imaging Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | | | - Joan Deus
- Magnetic Resonance Imaging Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Guttmann Neurorehabilitation Institute, Autonomous University of Barcelona, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Sunyer
- Center for Research in Environmental Epidemiology, Barcelona, Spain.,Pompeu Fabra University, Barcelona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (Ciberesp), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
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Pujol J, Fenoll R, Macià D, Martínez-Vilavella G, Alvarez-Pedrerol M, Rivas I, Forns J, Deus J, Blanco-Hinojo L, Querol X, Sunyer J. Airborne copper exposure in school environments associated with poorer motor performance and altered basal ganglia. Brain Behav 2016; 6:e00467. [PMID: 27134768 PMCID: PMC4842931 DOI: 10.1002/brb3.467] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Children are more vulnerable to the effects of environmental elements. A variety of air pollutants are among the identified factors causing neural damage at toxic concentrations. It is not obvious, however, to what extent the tolerated high levels of air pollutants are able to alter brain development. We have specifically investigated the neurotoxic effects of airborne copper exposure in school environments. METHODS Speed and consistency of motor response were assessed in 2836 children aged from 8 to 12 years. Anatomical MRI, diffusion tensor imaging, and functional MRI were used to directly test the brain repercussions in a subgroup of 263 children. RESULTS Higher copper exposure was associated with poorer motor performance and altered structure of the basal ganglia. Specifically, the architecture of the caudate nucleus region was less complete in terms of both tissue composition and neural track water diffusion. Functional MRI consistently showed a reciprocal connectivity reduction between the caudate nucleus and the frontal cortex. CONCLUSIONS The results establish an association between environmental copper exposure in children and alterations of basal ganglia structure and function.
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit Hospital del Mar Barcelona Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21 Barcelona Spain
| | | | - Dídac Macià
- MRI Research Unit Hospital del Mar Barcelona Spain
| | | | - Mar Alvarez-Pedrerol
- Centre for Research in Environmental Epidemiology (CREAL) Barcelona Catalonia Spain; Pompeu Fabra University Barcelona Catalonia Spain; Ciber on Epidemiology and Public Health (CIBERESP) Barcelona Spain
| | - Ioar Rivas
- Centre for Research in Environmental Epidemiology (CREAL) Barcelona Catalonia Spain; Pompeu Fabra University Barcelona Catalonia Spain; Ciber on Epidemiology and Public Health (CIBERESP) Barcelona Spain; Institute of Environmental Assessment and Water Research (IDAEA-CSIC) Barcelona Catalonia Spain
| | - Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL) Barcelona Catalonia Spain; Pompeu Fabra University Barcelona Catalonia Spain; Ciber on Epidemiology and Public Health (CIBERESP) Barcelona Spain
| | - Joan Deus
- MRI Research Unit Hospital del Mar Barcelona Spain; Department of Clinical and Health Psychology Autonomous University of Barcelona Barcelona Spain
| | | | - Xavier Querol
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC) Barcelona Catalonia Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL) Barcelona Catalonia Spain; Pompeu Fabra University Barcelona Catalonia Spain; Ciber on Epidemiology and Public Health (CIBERESP) Barcelona Spain; IMIM (Hospital del Mar Medical Research Institute) Barcelona Catalonia Spain
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López-Vicente M, Forns J, Suades-González E, Esnaola M, García-Esteban R, Álvarez-Pedrerol M, Júlvez J, Burgaleta M, Sebastián-Gallés N, Sunyer J. Developmental Trajectories in Primary Schoolchildren Using n-Back Task. Front Psychol 2016; 7:716. [PMID: 27242625 PMCID: PMC4866535 DOI: 10.3389/fpsyg.2016.00716] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background: Neuropsychological instruments to assess cognitive trajectories during childhood in epidemiological studies are needed. This would improve neurodevelopment characterization in order to identify its potential determinants. We aimed to study whether repeated measures of n-back, a working memory task, detect developmental trajectories in schoolchildren during a 1-year follow-up. Methods: We administered the n-back task to 2897 healthy children aged 7–11 years old from 39 schools in Barcelona (Spain). The task consisted of 2 levels of complexity or loads (2- and 3-back) and 2 different stimuli (numbers and words). Participants performed the task four times from January 2012 to March 2013. To study the trajectories during the follow-up, we performed linear mixed-effects models including school, individual and age as random effects. Results: We observed improvements related to age in n-back outcomes d′, HRT and accuracy, as well as reduced cognitive growth at older ages in d′ and HRT. Greater improvements in performance were observed at younger ages, in 2-back, in verbal rather than numerical stimuli and in girls compared to boys. Boys responded faster at baseline, while girls showed increased growth in 2-back numbers. Children with ADHD (Attention Deficit and Hyperactivity Disorder) symptoms (15% of boys and 6% of girls) had a lower working memory at baseline, but they showed similar cognitive growth trajectories in numbers variants of the task, as compared to children without ADHD symptoms. However, the age-related improvement in response speed was not observed in children with ADHD symptoms. Conclusions: Changes in n-back outcomes reflected developmental trajectories in 1-year follow-up. The present results suggest that the repeated administration of this task can be used to study the factors that may alter the cognitive development during childhood.
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Affiliation(s)
- Mónica López-Vicente
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain; Hospital del Mar Medical Research InstituteBarcelona, Spain
| | - Joan Forns
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain; Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public HealthOslo, Norway
| | - Elisabet Suades-González
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; Learning Disabilities Unit (UTAE), Neuropediatrics Department, Hospital Sant Joan de Déu, Universitat de BarcelonaBarcelona, Spain
| | - Mikel Esnaola
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Raquel García-Esteban
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Mar Álvarez-Pedrerol
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain
| | - Jordi Júlvez
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain; Hospital del Mar Medical Research InstituteBarcelona, Spain; Environmental Health Department, Harvard T.H. Chan School of Public HealthBoston, MA, USA
| | - Miguel Burgaleta
- Center for Brain and Cognition, Department of Technology, Universitat Pompeu Fabra Barcelona, Spain
| | - Núria Sebastián-Gallés
- Center for Brain and Cognition, Department of Technology, Universitat Pompeu Fabra Barcelona, Spain
| | - Jordi Sunyer
- ISGlobal, Centre for Research in Environmental EpidemiologyBarcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu FabraBarcelona, Spain; CIBER Epidemiología y Salud PúblicaBarcelona, Spain; Hospital del Mar Medical Research InstituteBarcelona, Spain
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Pujol J, Martínez-Vilavella G, Macià D, Fenoll R, Alvarez-Pedrerol M, Rivas I, Forns J, Blanco-Hinojo L, Capellades J, Querol X, Deus J, Sunyer J. Traffic pollution exposure is associated with altered brain connectivity in school children. Neuroimage 2016; 129:175-184. [DOI: 10.1016/j.neuroimage.2016.01.036] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022] Open
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Forns J, Dadvand P, Foraster M, Alvarez-Pedrerol M, Rivas I, López-Vicente M, Suades-Gonzalez E, Garcia-Esteban R, Esnaola M, Cirach M, Grellier J, Basagaña X, Querol X, Guxens M, Nieuwenhuijsen MJ, Sunyer J. Traffic-Related Air Pollution, Noise at School, and Behavioral Problems in Barcelona Schoolchildren: A Cross-Sectional Study. Environ Health Perspect 2016; 124:529-35. [PMID: 26241036 PMCID: PMC4829987 DOI: 10.1289/ehp.1409449] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 07/30/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND The available evidence of the effects of air pollution and noise on behavioral development is limited, and it overlooks exposure at schools, where children spend a considerable amount of time. OBJECTIVE We aimed to investigate the associations of exposure to traffic-related air pollutants (TRAPs) and noise at school on behavioral development of schoolchildren. METHODS We evaluated children 7-11 years of age in Barcelona (Catalonia, Spain) during 2012-2013 within the BREATHE project. Indoor and outdoor concentrations of elemental carbon (EC), black carbon (BC), and nitrogen dioxide (NO2) were measured at schools in two separate 1-week campaigns. In one campaign we also measured noise levels inside classrooms. Parents filled out the strengths and difficulties questionnaire (SDQ) to assess child behavioral development, while teachers completed the attention deficit/hyperactivity disorder criteria of the DSM-IV (ADHD-DSM-IV) list to assess specific ADHD symptomatology. Negative binomial mixed-effects models were used to estimate associations between the exposures and behavioral development scores. RESULTS Interquartile range (IQR) increases in indoor and outdoor EC, BC, and NO2 concentrations were positively associated with SDQ total difficulties scores (suggesting more frequent behavioral problems) in adjusted multivariate models, whereas noise was significantly associated with ADHD-DSM-IV scores. CONCLUSION In our study population of 7- to 11-year-old children residing in Barcelona, exposure to TRAPs at school was associated with increased behavioral problems in schoolchildren. Noise exposure at school was associated with more ADHD symptoms. CITATION Forns J, Dadvand P, Foraster M, Alvarez-Pedrerol M, Rivas I, López-Vicente M, Suades-Gonzalez E, Garcia-Esteban R, Esnaola M, Cirach M, Grellier J, Basagaña X, Querol X, Guxens M, Nieuwenhuijsen MJ, Sunyer J. 2016. Traffic-related air pollution, noise at school, and behavioral problems in Barcelona schoolchildren: a cross-sectional study. Environ Health Perspect 124:529-535; http://dx.doi.org/10.1289/ehp.1409449.
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Affiliation(s)
- Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Address correspondence to J. Forns, Centre for Research in Environmental Epidemiology (CREAL), C. Doctor Aiguader 88, 08003 Barcelona, Spain. Telephone: 34 93 214 73 11. E-mail:
| | - Payam Dadvand
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Maria Foraster
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mar Alvarez-Pedrerol
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Ioar Rivas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Mònica López-Vicente
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Catalonia, Spain
| | - Elisabet Suades-Gonzalez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Raquel Garcia-Esteban
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Mikel Esnaola
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Marta Cirach
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - James Grellier
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom
| | - Xavier Basagaña
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Xavier Querol
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Mònica Guxens
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Mark J. Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Catalonia, Spain
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Hjortebjerg D, Andersen AMN, Christensen JS, Ketzel M, Raaschou-Nielsen O, Sunyer J, Julvez J, Forns J, Sørensen M. Exposure to Road Traffic Noise and Behavioral Problems in 7-Year-Old Children: A Cohort Study. Environ Health Perspect 2016; 124:228-34. [PMID: 26126294 PMCID: PMC4749080 DOI: 10.1289/ehp.1409430] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 06/25/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Exposure to traffic noise has been associated with adverse effects on neuropsychological outcomes in children, but findings with regard to behavioral problems are inconsistent. OBJECTIVE We investigated whether residential road traffic noise exposure is associated with behavioral problems in 7-year-old children. METHODS We identified 46,940 children from the Danish National Birth Cohort with complete information on behavioral problems at 7 years of age and complete address history from conception to 7 years of age. Road traffic noise (Lden) was modeled at all present and historical addresses. Behavioral problems were assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). Associations between pregnancy and childhood exposure to noise and behavioral problems were analyzed by multinomial or logistic regression and adjusted for potential confounders. RESULTS A 10-dB increase in average time-weighted road traffic noise exposure from birth to 7 years of age was associated with a 7% increase (95% CI: 1.00, 1.14) in abnormal versus normal total difficulties scores; 5% (95% CI: 1.00, 1.10) and 9% (95% CI: 1.03, 1.18) increases in borderline and abnormal hyperactivity/inattention subscale scores, respectively; and 5% (95% CI: 0.98, 1.14) and 6% (95% CI: 0.99, 1.12) increases in abnormal conduct problem and peer relationship problem subscale scores, respectively. Exposure to road traffic noise during pregnancy was not associated with child behavioral problems at 7 years of age. CONCLUSIONS Residential road traffic noise in early childhood may be associated with behavioral problems, particularly hyperactivity/inattention symptoms.
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Affiliation(s)
- Dorrit Hjortebjerg
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark
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Hjortebjerg D, Andersen AMN, Christensen JS, Ketzel M, Raaschou-Nielsen O, Sunyer J, Julvez J, Forns J, Sørensen M. Response to "Comment on 'Exposure to Road Traffic Noise and Behavioral Problems in 7-Year-Old Children: A Cohort Study'". Environ Health Perspect 2016; 124:A28. [PMID: 26829329 PMCID: PMC4749087 DOI: 10.1289/ehp.1510851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Jordi Sunyer
- Center for Research in Environmental Epidemiology, Barcelona, Spain
| | - Jordi Julvez
- Center for Research in Environmental Epidemiology, Barcelona, Spain
| | - Joan Forns
- Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
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Guxens M, Ghassabian A, Gong T, Garcia-Esteban R, Porta D, Giorgis-Allemand L, Almqvist C, Aranbarri A, Beelen R, Badaloni C, Cesaroni G, de Nazelle A, Estarlich M, Forastiere F, Forns J, Gehring U, Ibarluzea J, Jaddoe VW, Korek M, Lichtenstein P, Nieuwenhuijsen MJ, Rebagliato M, Slama R, Tiemeier H, Verhulst FC, Volk HE, Pershagen G, Brunekreef B, Sunyer J. Air Pollution Exposure during Pregnancy and Childhood Autistic Traits in Four European Population-Based Cohort Studies: The ESCAPE Project. Environ Health Perspect 2016; 124:133-40. [PMID: 26068947 PMCID: PMC4710593 DOI: 10.1289/ehp.1408483] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/08/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Prenatal exposure to air pollutants has been suggested as a possible etiologic factor for the occurrence of autism spectrum disorder. OBJECTIVES We aimed to assess whether prenatal air pollution exposure is associated with childhood autistic traits in the general population. METHODS Ours was a collaborative study of four European population-based birth/child cohorts-CATSS (Sweden), Generation R (the Netherlands), GASPII (Italy), and INMA (Spain). Nitrogen oxides (NO2, NOx) and particulate matter (PM) with diameters of ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and between 2.5 and 10 μm (PM(coarse)), and PM2.5 absorbance were estimated for birth addresses by land-use regression models based on monitoring campaigns performed between 2008 and 2011. Levels were extrapolated back in time to exact pregnancy periods. We quantitatively assessed autistic traits when the child was between 4 and 10 years of age. Children were classified with autistic traits within the borderline/clinical range and within the clinical range using validated cut-offs. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. RESULTS A total of 8,079 children were included. Prenatal air pollution exposure was not associated with autistic traits within the borderline/clinical range (odds ratio = 0.94; 95% CI: 0.81, 1.10 per each 10-μg/m3 increase in NO2 pregnancy levels). Similar results were observed in the different cohorts, for the other pollutants, and in assessments of children with autistic traits within the clinical range or children with autistic traits as a quantitative score. CONCLUSIONS Prenatal exposure to NO2 and PM was not associated with autistic traits in children from 4 to 10 years of age in four European population-based birth/child cohort studies. CITATION Guxens M, Ghassabian A, Gong T, Garcia-Esteban R, Porta D, Giorgis-Allemand L, Almqvist C, Aranbarri A, Beelen R, Badaloni C, Cesaroni G, de Nazelle A, Estarlich M, Forastiere F, Forns J, Gehring U, Ibarluzea J, Jaddoe VW, Korek M, Lichtenstein P, Nieuwenhuijsen MJ, Rebagliato M, Slama R, Tiemeier H, Verhulst FC, Volk HE, Pershagen G, Brunekreef B, Sunyer J. 2016. Air pollution exposure during pregnancy and childhood autistic traits in four European population-based cohort studies: the ESCAPE Project. Environ Health Perspect 124:133-140; http://dx.doi.org/10.1289/ehp.1408483.
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Affiliation(s)
- Mònica Guxens
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, the Netherlands
- Address correspondence to M. Guxens, Centre for Research in Environmental Epidemiology, Carrer Doctor Aiguader 88, 08003-Barcelona, Spain. Telephone: 34 932147394. E-mail:
| | - Akhgar Ghassabian
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, the Netherlands
- The Generation R Study, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Raquel Garcia-Esteban
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Daniela Porta
- Department of Epidemiology Lazio Regional Health Service, Rome Italy
| | - Lise Giorgis-Allemand
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Inserm (National Institute of Health and Medical Research) (U823), Grenoble, France
- University Grenoble-Alpes, Institut Albert Bonniot, Grenoble, France
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aritz Aranbarri
- Psychobiology area, Department of Basic Psychological Processes and Their Development, Faculty of Psychology, University of The Basque Country (UPV/EHU), Donostia-San Sebastian, Spain
- Health Research Institute BIODONOSTIA, Donostia-San Sebastian, Spain
| | - Rob Beelen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Chiara Badaloni
- Department of Epidemiology Lazio Regional Health Service, Rome Italy
| | - Giulia Cesaroni
- Department of Epidemiology Lazio Regional Health Service, Rome Italy
| | - Audrey de Nazelle
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Centre for Environmental Policy, Imperial College London, London, UK
| | - Marisa Estarlich
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, University of Valencia–University Jaume I Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | | | - Joan Forns
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute BIODONOSTIA, Donostia-San Sebastian, Spain
- Sub-Directorate of Public Health of Gipukzoa, Department of Health, Government of Basque Country, San Sebastian, Spain
| | - Vincent W.V. Jaddoe
- The Generation R Study, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Michal Korek
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark J. Nieuwenhuijsen
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marisa Rebagliato
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, University of Valencia–University Jaume I Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
- Department of Medicine, University Jaume I, Castelló de la Plana, Spain
| | - Rémy Slama
- Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Inserm (National Institute of Health and Medical Research) (U823), Grenoble, France
- University Grenoble-Alpes, Institut Albert Bonniot, Grenoble, France
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Heather E. Volk
- Department of Preventive Medicine, and
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, California, USA
- Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Jordi Sunyer
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
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Júlvez J, Paus T, Bellinger D, Eskenazi B, Tiemeier H, Pearce N, Ritz B, White T, Ramchandani P, Gispert JD, Desrivières S, Brouwer R, Boucher O, Alemany S, López-Vicente M, Suades-González E, Forns J, Grandjean P, Sunyer J. Environment and Brain Development: Challenges in the Global Context. Neuroepidemiology 2015; 46:79-82. [PMID: 26684467 DOI: 10.1159/000442256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jordi Júlvez
- Centre for Research in Environmental Epidemiology, Barcelona, Catalonia, Spain
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Casas M, Forns J, Martínez D, Avella-García C, Valvi D, Ballesteros-Gómez A, Luque N, Rubio S, Julvez J, Sunyer J, Vrijheid M. Exposure to bisphenol A during pregnancy and child neuropsychological development in the INMA-Sabadell cohort. Environ Res 2015; 142:671-9. [PMID: 26343751 DOI: 10.1016/j.envres.2015.07.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/16/2015] [Accepted: 07/31/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND Bisphenol A (BPA) may be a neurodevelopmental toxicant, but evidence is not consistent in terms of the sex-specific patterns of the associations and the specific behavioral or cognitive domains most affected. OBJECTIVE To examine the effects of prenatal BPA exposure on cognitive, psychomotor, and behavioral development in 438 children at 1, 4 and 7 years of age. METHODS BPA was measured in spot urine samples collected in trimester 1 and 3 of pregnancy from women participating in the INMA-Sabadell birth cohort study. Cognitive and psychomotor development was assessed at 1 and 4 years using psychologist-based scales. Attention deficit hyperactivity disorder (ADHD) symptoms and other behavioral problems were assessed at 4 years by teachers and at 7 years by parents using questionnaire-based rating scales. RESULTS Geometric mean creatinine-adjusted BPA concentration of the averaged samples was 2.6 μg/g creatinine. BPA exposure was not associated with the cognitive scores or their subscales at 1 and 4 years of age. At 1 year of age, exposure in the highest tertile of BPA concentrations was associated with a reduction of psychomotor scores (T3 vs T1 β=-4.28 points, 95% CI: -8.15, -0.41), but there was no association with psychomotor outcomes at 4 years. At 4 years, BPA exposure was associated with an increased risk of ADHD-hyperactivity symptoms (Incidence Rate Ratio (IRR) per log10 μg BPA/g creatinine increase=1.72; 1.08, 2.73) and this association was stronger in boys than in girls. Further, boys had an increased risk of ADHD-inattention symptoms whereas girls showed a reduced risk (p for interaction <0.1). At 7 years, these associations were not statistically significant nor were any other behavioral problems. CONCLUSIONS These results suggest that prenatal BPA exposure does not affect cognitive development up to age 4 years. Associations are observed with psychomotor development and ADHD-related symptoms at early ages, but these do not appear to persist until later ages.
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Affiliation(s)
- Maribel Casas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - David Martínez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Claudia Avella-García
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Unitat Docent de Medicina Preventiva i Salut Publica H. Mar-UPF-ASPB, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Damaskini Valvi
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | | | - Noelia Luque
- Department of Analytical Chemistry, University of Cordoba, Cordoba, Spain
| | - Soledad Rubio
- Department of Analytical Chemistry, University of Cordoba, Cordoba, Spain
| | - Jordi Julvez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Martine Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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42
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Forns J, Iszatt N, White RA, Mandal S, Sabaredzovic A, Lamoree M, Thomsen C, Haug LS, Stigum H, Eggesbø M. Perfluoroalkyl substances measured in breast milk and child neuropsychological development in a Norwegian birth cohort study. Environ Int 2015; 83:176-82. [PMID: 26159671 DOI: 10.1016/j.envint.2015.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 05/04/2023]
Abstract
Perfluoroalkyl substances (PFASs) are chemicals with potential neurotoxic effects although the current evidence is still limited. This study investigated the association between perinatal exposure to perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) and neuropsychological development assessed at 6, 12 and 24 months. We measured PFOS and PFOA in breast milk samples collected one month after delivery by mothers of children participating in the HUMIS study (Norway). Cognitive and psychomotor development was measured at 6 and at 24 months using the Ages and Stages Questionnaire (ASQ-II). Behavioral development was assessed using the infant-toddler symptom checklist (ITSC) at 12 and at 24 months. Weighted logistic regression and weighted negative binomial regression models were applied to analyze the associations between PFASs and ASQ-II and ITSC, respectively. The median concentration of PFOS was 110 ng/L, while the median for PFOA was 40 ng/L. We did not detect an increased risk of having an abnormal score in ASQ-II at 6 months or 24 months. Moreover, no consistent increase in behavioral problems assessed at 12 and 24 months by ITSC questionnaire was detected. We observed no association between perinatal PFOS and PFOA exposure and early neuropsychological development. Further longitudinal studies are needed to confirm the effects of these compounds on neuropsychological development in older children.
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Affiliation(s)
- J Forns
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - N Iszatt
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - R A White
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - S Mandal
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - A Sabaredzovic
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - M Lamoree
- Institute for Environmental Studies, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - C Thomsen
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - L S Haug
- Department of Exposure and Risk Assessment, Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - H Stigum
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - M Eggesbø
- Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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43
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Gascon M, Valvi D, Forns J, Casas M, Martínez D, Júlvez J, Monfort N, Ventura R, Sunyer J, Vrijheid M. Prenatal exposure to phthalates and neuropsychological development during childhood. Int J Hyg Environ Health 2015; 218:550-8. [DOI: 10.1016/j.ijheh.2015.05.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 01/03/2023]
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Álamo-Junquera D, Sunyer J, Iñiguez C, Ballester F, Garcia-Esteban R, Forns J, Turner MC, Lertxundi A, Lertxundi N, Fernandez-Somoano A, Rodriguez-Dehli C, Julvez J. Prenatal head growth and child neuropsychological development at age 14 months. Am J Obstet Gynecol 2015; 212:661.e1-11. [PMID: 25499263 DOI: 10.1016/j.ajog.2014.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/30/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to assess the association between prenatal head growth and child neuropsychological development in the general population. STUDY DESIGN We evaluated 2104 children at the age of 14 months from a population-based birth cohort in Spain. Head circumference (HC) was measured by ultrasound examinations at weeks 12, 20, and 34 of gestation and by a nurse at birth. Head growth was assessed using conditional SD scores between weeks 12-20 and 20-34. Trained psychologists assessed neuropsychological functioning using the Bayley Scales of Infant Development. Head size measurements at birth were transformed into a 3-category variable: microcephalic (<10th percentile), normocephalic (≥10th and <90th percentile), and macrocephalic (≥90th percentile) based on the cohort distribution. P values<.05 were considered statistically significant. RESULTS No overall associations were observed between HC or head growth and mental and psychomotor scores. In particular, no associations were found between HC at birth and mental scores (coefficient, 0.04; 95% confidence interval, -0.02 to 0.09) and between interval head growth (20-34 weeks) and mental scores (0.31; 95% confidence interval, -0.36 to 0.99). Upon stratification by microcephalic, normocephalic, or macrocephalic head size, results were imprecise, although there were some significant associations in the microcephalic and macrocephalic groups. Adjustment by various child and maternal cofactors did not affect results. The minimum sample size required for present study was 883 patients (β=2, α=0.05, power=0.80). CONCLUSION Overall prenatal and perinatal HC was not associated with 14-month-old neuropsychological development. Findings suggest HC growth during uterine life among healthy infants may not be an important marker of early-life neurodevelopment but may be marginally useful with specific populations.
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Affiliation(s)
- Dolores Álamo-Junquera
- Teaching Unit, Parc de Salut Mar-Universitat Pompeu Fabra & Agéncia de Salut Pública de Barcelona, Barcelona, Spain
| | - Jordi Sunyer
- Center for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain; Institut Municipal d'Investigació Mèdica-Hospital del Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | | | - Ferran Ballester
- Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain; Department of Nursing, University of Valencia, Valencia, Spain
| | - Raquel Garcia-Esteban
- Center for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain; Institut Municipal d'Investigació Mèdica-Hospital del Mar, Barcelona, Spain
| | - Joan Forns
- Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain; Institut Municipal d'Investigació Mèdica-Hospital del Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Michelle C Turner
- Center for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain
| | - Aitana Lertxundi
- Departamento Medicina Preventiva y Salud Pública, Facultad de Medicina y Odontología, Universidad del País Vasco, Leioa, Spain
| | - Nerea Lertxundi
- Department of Social Psychology and Behavioral Sciences Methodology, Faculty of Psychology, University of the Basque Country, Leioa, Spain; BioDonostia Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
| | | | | | - Jordi Julvez
- Center for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain; Institut Municipal d'Investigació Mèdica-Hospital del Mar, Barcelona, Spain.
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Sunyer J, Esnaola M, Alvarez-Pedrerol M, Forns J, Rivas I, López-Vicente M, Suades-González E, Foraster M, Garcia-Esteban R, Basagaña X, Viana M, Cirach M, Moreno T, Alastuey A, Sebastian-Galles N, Nieuwenhuijsen M, Querol X. Association between traffic-related air pollution in schools and cognitive development in primary school children: a prospective cohort study. PLoS Med 2015; 12:e1001792. [PMID: 25734425 PMCID: PMC4348510 DOI: 10.1371/journal.pmed.1001792] [Citation(s) in RCA: 284] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/09/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Air pollution is a suspected developmental neurotoxicant. Many schools are located in close proximity to busy roads, and traffic air pollution peaks when children are at school. We aimed to assess whether exposure of children in primary school to traffic-related air pollutants is associated with impaired cognitive development. METHODS AND FINDINGS We conducted a prospective study of children (n = 2,715, aged 7 to 10 y) from 39 schools in Barcelona (Catalonia, Spain) exposed to high and low traffic-related air pollution, paired by school socioeconomic index; children were tested four times (i.e., to assess the 12-mo developmental trajectories) via computerized tests (n = 10,112). Chronic traffic air pollution (elemental carbon [EC], nitrogen dioxide [NO2], and ultrafine particle number [UFP; 10-700 nm]) was measured twice during 1-wk campaigns both in the courtyard (outdoor) and inside the classroom (indoor) simultaneously in each school pair. Cognitive development was assessed with the n-back and the attentional network tests, in particular, working memory (two-back detectability), superior working memory (three-back detectability), and inattentiveness (hit reaction time standard error). Linear mixed effects models were adjusted for age, sex, maternal education, socioeconomic status, and air pollution exposure at home. Children from highly polluted schools had a smaller growth in cognitive development than children from the paired lowly polluted schools, both in crude and adjusted models (e.g., 7.4% [95% CI 5.6%-8.8%] versus 11.5% [95% CI 8.9%-12.5%] improvement in working memory, p = 0.0024). Cogently, children attending schools with higher levels of EC, NO2, and UFP both indoors and outdoors experienced substantially smaller growth in all the cognitive measurements; for example, a change from the first to the fourth quartile in indoor EC reduced the gain in working memory by 13.0% (95% CI 4.2%-23.1%). Residual confounding for social class could not be discarded completely; however, the associations remained in stratified analyses (e.g., for type of school or high-/low-polluted area) and after additional adjustments (e.g., for commuting, educational quality, or smoking at home), contradicting a potential residual confounding explanation. CONCLUSIONS Children attending schools with higher traffic-related air pollution had a smaller improvement in cognitive development.
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Affiliation(s)
- Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques–Parc de Salut Mar, Barcelona, Catalonia, Spain
- * E-mail:
| | - Mikel Esnaola
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mar Alvarez-Pedrerol
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ioar Rivas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Mònica López-Vicente
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elisabet Suades-González
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Learning Disabilities Unit (UTAE), Neuropediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Maria Foraster
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Raquel Garcia-Esteban
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Basagaña
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mar Viana
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Marta Cirach
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Teresa Moreno
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | - Andrés Alastuey
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
| | | | - Mark Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- Pompeu Fabra University, Barcelona, Catalonia, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Querol
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona, Catalonia, Spain
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Amoly E, Dadvand P, Forns J, López-Vicente M, Basagaña X, Julvez J, Alvarez-Pedrerol M, Nieuwenhuijsen MJ, Sunyer J. Green and blue spaces and behavioral development in Barcelona schoolchildren: the BREATHE project. Environ Health Perspect 2014; 122:1351-8. [PMID: 25204008 PMCID: PMC4256702 DOI: 10.1289/ehp.1408215] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/08/2014] [Indexed: 05/19/2023]
Abstract
BACKGROUND Green spaces have been associated with improved mental health in children; however, available epidemiological evidence on their impact on child behavioral development is scarce. OBJECTIVES We investigated the impact of contact with green spaces and blue spaces (beaches) on indicators of behavioral development and symptoms of attention deficit/hyperactivity disorder (ADHD) in schoolchildren. METHODS This study was based on a sample of 2,111 schoolchildren (7-10 years of age) from 36 schools in Barcelona in 2012. We obtained data on time spent in green spaces and beaches and Strengths and Difficulties Questionnaires (SDQ) from parents, and ADHD/DSM-IV questionnaires from teachers. Surrounding greenness was abstracted as the average Normalized Difference Vegetation Index (NDVI) in buffers of 100 m, 250 m, and 500 m around each home address. Proximity to green spaces was defined as living within 300 m of a major green space (≥ 0.05 km2). We applied quasi-Poisson mixed-effects models (with school random effect) to separately estimate associations between indicators of contact with green spaces and SDQ and ADHD total and subscale scores. RESULTS We generally estimated beneficial associations between behavioral indicators and longer time spent in green spaces and beaches, and with residential surrounding greenness. Specifically, we found statistically significant inverse associations between green space playing time and SDQ total difficulties, emotional symptoms, and peer relationship problems; between residential surrounding greenness and SDQ total difficulties and hyperactivity/inattention and ADHD/DSM-IV total and inattention scores; and between annual beach attendance and SDQ total difficulties, peer relationship problems, and prosocial behavior. For proximity to major green spaces, the results were not conclusive. CONCLUSION Our findings support beneficial impacts of contact with green and blue spaces on behavioral development in schoolchildren.
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Affiliation(s)
- Elmira Amoly
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
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Valera-Gran D, García de la Hera M, Navarrete-Muñoz EM, Fernandez-Somoano A, Tardón A, Julvez J, Forns J, Lertxundi N, Ibarluzea JM, Murcia M, Rebagliato M, Vioque J. Folic acid supplements during pregnancy and child psychomotor development after the first year of life. JAMA Pediatr 2014; 168:e142611. [PMID: 25365251 DOI: 10.1001/jamapediatrics.2014.2611] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Folate intake during pregnancy has been associated with improved neuropsychological development in children, although the effects of high dosages of folic acid (FA) supplements are unclear. OBJECTIVE To examine the association between the use of high dosages of FA supplements during pregnancy and child neuropsychological development after the first year of life. DESIGN, SETTING, AND PATIENTS The multicenter prospective mother-child cohort Infancia y Medio Ambiente (INMA) Project recruited pregnant women from 4 areas of Spain (Asturias, Sabadell, Gipuzkoa, and Valencia) between November 2003 and January 2008. Pregnant women completed an interviewer-administered questionnaire on the usual dietary folate intake and FA supplements at 10 to 13 weeks and 28 to 32 weeks of gestation. The main analyses were based on a sample of 2213 children with complete information on neuropsychological development and FA supplement intake during pregnancy. Multiple linear and logistic regression analyses were used to explore the effects of FA supplements on child neuropsychological development. MAIN OUTCOMES AND MEASURES Neuropsychological development was assessed using the Bayley Scales of Infant Development. We calculated mental scale and psychomotor scale scores. One SD below the mean established a delay in neurodevelopment (score <85). RESULTS A high proportion of women (57.3%) did not reach the recommended dosages of FA supplements (400 μg/d), but 25.2% women took more than 1000 μg/d of FA supplements (3.5% consuming >5000 μg/d). In multivariate analysis, we observed that children whose mothers used FA supplement dosages higher than 5000 μg/d during pregnancy had a statistically significantly lower mean psychomotor scale score (difference, -4.35 points; 95% CI, -8.34 to -0.36) than children whose mothers used a recommended dosage of FA supplements (400-1000 μg/d). An increased risk of delayed psychomotor development (psychomotor scale score <85) was also evident among children whose mothers took FA supplement dosages higher than 5000 μg/d, although the association was not statistically significant (odds ratio = 1.59; 95% CI, 0.82-3.08). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first time a detrimental effect of high dosages of FA supplements during pregnancy on psychomotor development after the first year of life has been shown. Further research from longitudinal studies is warranted to confirm these results.
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Affiliation(s)
- Desirée Valera-Gran
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain2Department of Public Health, History of Science, and Gynecology, Miguel Hernández University, Sant Joan d'Alacant Campus, Sant Joan d'Alacant, Spain
| | - Manuela García de la Hera
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain2Department of Public Health, History of Science, and Gynecology, Miguel Hernández University, Sant Joan d'Alacant Campus, Sant Joan d'Alacant, Spain
| | - Eva María Navarrete-Muñoz
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain2Department of Public Health, History of Science, and Gynecology, Miguel Hernández University, Sant Joan d'Alacant Campus, Sant Joan d'Alacant, Spain
| | - Ana Fernandez-Somoano
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain3University of Oviedo, Asturias, Spain
| | - Adonina Tardón
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain3University of Oviedo, Asturias, Spain
| | - Jordi Julvez
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain4Centre for Research in Environmental Epidemiology, Barcelona, Spain
| | - Joan Forns
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain4Centre for Research in Environmental Epidemiology, Barcelona, Spain5Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, O
| | - Nerea Lertxundi
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain6Subdirección de Salud Pública de Gipuzkoa, San Sebastian, Spain
| | - Jesús María Ibarluzea
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain6Subdirección de Salud Pública de Gipuzkoa, San Sebastian, Spain
| | - Mario Murcia
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain7Centre of Public Health Research, Valencia, Spain
| | - Marisa Rebagliato
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain7Centre of Public Health Research, Valencia, Spain8James I University, Castelló de la Plana, Spain
| | - Jesús Vioque
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública, Madrid, Spain2Department of Public Health, History of Science, and Gynecology, Miguel Hernández University, Sant Joan d'Alacant Campus, Sant Joan d'Alacant, Spain
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48
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Vilahur N, Fernández MF, Bustamante M, Ramos R, Forns J, Ballester F, Murcia M, Riaño I, Ibarluzea J, Olea N, Sunyer J. In utero exposure to mixtures of xenoestrogens and child neuropsychological development. Environ Res 2014; 134:98-104. [PMID: 25086706 DOI: 10.1016/j.envres.2014.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND To date, no epidemiological studies have explored the impact and persistence of in utero exposure to mixtures of xenoestrogens on the developing brain. We aimed to assess whether the cumulative effect of xenoestrogens in the placenta is associated with altered infant neuropsychological functioning at two and at four years of age, and if associations differ among boys and girls. METHODS Cumulative prenatal exposure to xenoestrogens was quantified in the placenta using the biomarker Total Effective Xenoestrogen Burden (TEXB-alpha) in 489 participants from the INMA (Childhood and the Environment) Project. TEXB-alpha was split in tertiles to test its association with the mental and psychomotor scores of the Bayley Scales of Infant Development (BSID) at 1-2 years of age, and with the McCarthy Scales of Children׳s Abilities (MSCA) general cognitive index and motor scale assessed at 4-5 years of age. Interactions with sex were investigated. RESULTS After adjustment for potential confounders, no association was observed between TEXB-alpha and mental scores at 1-2 years of age. We found a significant interactions with sex for the association between TEXB-alpha and infant psychomotor development (interaction p-value=0.029). Boys in the third tertile of exposure scored on average 5.2 points less than those in the first tertile on tests of motor development at 1-2 years of age (p-value=0.052), while no associations were observed in girls. However, this association disappeared in children at 4-5 years of age and no association between TEXB-alpha and children׳s cognition was found. CONCLUSIONS Our results suggest that boys' early motor development might be more vulnerable to prenatal exposure to mixtures of xenoestrogens, but associations do not persist in preschool children.
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Affiliation(s)
- Nadia Vilahur
- Center for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader, 83. 08003 Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Genomics and Disease Group, Bioinformatics and Genomics Program, Centre for Genomic Regulation (CRG), Barcelona, Spain.
| | - Mariana F Fernández
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Radiology, Centro de Investigación Biomédica, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Hospital Universitario San Cecilio, Granada, Spain
| | - Mariona Bustamante
- Center for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader, 83. 08003 Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Genomics and Disease Group, Bioinformatics and Genomics Program, Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Rosa Ramos
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Radiology, Centro de Investigación Biomédica, University of Granada, Granada, Spain
| | - Joan Forns
- Center for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader, 83. 08003 Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Ferran Ballester
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centre for Public Health Research (CSISP-FISABIO), Valencia, Spain; University of Valencia, Valencia, Spain
| | - Mario Murcia
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Centre for Public Health Research (CSISP-FISABIO), Valencia, Spain
| | - Isolina Riaño
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; University of Oviedo, Asturias, Oviedo, Spain
| | - Jesús Ibarluzea
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Biodonostia, Health Research Institute, San Sebastián, Spain; Sub-Directorate for Public Health of Gipuzkoa, Department of Health, Government of the Basque Country, San Sebastian, Spain
| | - Nicolás Olea
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Radiology, Centro de Investigación Biomédica, University of Granada, Granada, Spain
| | - Jordi Sunyer
- Center for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader, 83. 08003 Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health and Life Sciences, University Pompeu Fabra (UPF), Barcelona, Spain
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Forns J, Esnaola M, López-Vicente M, Suades-González E, Alvarez-Pedrerol M, Julvez J, Grellier J, Sebastián-Gallés N, Sunyer J. The n-back Test and the Attentional Network Task as measures of child neuropsychological development in epidemiological studies. Neuropsychology 2014; 28:519-29. [DOI: 10.1037/neu0000085] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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50
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Forns J, Vegas O, Julvez J, Garcia-Esteban R, Rivera M, Lertxundi N, Guxens M, Fano E, Ferrer M, Grellier J, Ibarluzea J, Sunyer J. Association between child cortisol levels in saliva and neuropsychological development during the second year of life. Stress Health 2014; 30:142-8. [PMID: 23818417 DOI: 10.1002/smi.2504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 11/12/2022]
Abstract
Exposure to highly elevated levels of cortisol has been linked with impairments in cognitive capacities in both children and adults. By contrast, moderate levels of cortisol may engender beneficial effects. The main aim of this study was to assess the association between child cortisol levels and neuropsychological development during the second year of life. A population-based birth cohort was established in the city of Sabadell (Catalonia, Spain) as part of the INMA (Environment and Childhood) Project. We assessed the cognitive and psychomotor development at the age of 14 months using the Bayley Scales of Infant Development (BSID). We included 302 children assessed during their second year of life for whom we had information on neuropsychological assessment and measurements of cortisol in saliva. Higher levels of cortisol were associated with better scores in BSID's mental scale. There was no association between cortisol levels and psychomotor test scores. We found a small positive association between duration of breastfeeding and child cortisol levels. This association was only found in boys. The results of this study suggest that moderate levels of cortisol in children could have small beneficial effects on their early neuropsychological development.
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Affiliation(s)
- Joan Forns
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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