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Mitani H, Suzuki K, Ako J, Iekushi K, Majewska R, Touzeni S, Yamashita S. Achievement Rates for Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Atherosclerotic Cardiovascular Disease in a Real-World Setting in Japan. J Atheroscler Thromb 2023; 30:1622-1634. [PMID: 36928267 PMCID: PMC10627744 DOI: 10.5551/jat.63940] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
AIMS The study aimed to investigate low-density lipoprotein cholesterol (LDL-C) goal achievement rates in patients receiving LDL-C-lowering therapy using recent real-world data, following the 2017 revision of the Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases (JAS GL2017). METHODS Patients with documented LDL-C test results were extracted from the Medical Data Vision claims database between July 2018 and June 2021 and divided into three groups according to JAS GL2017: primary prevention high risk (Group I, LDL-C goal <120 mg/dL), secondary prevention (Group II, LDL-C goal <100 mg/dL), and secondary prevention high risk (Group III, LDL-C goal <70 mg/dL). RESULTS The mean LDL-C value was 108.7 mg/dL (n=125,235), 94.4 mg/dL (n=57,910), and 90.6 mg/dL (n=33,850) in Groups I, II, and III, respectively. Intensive statin monotherapy (pitavastatin, rosuvastatin, or atorvastatin) was the most frequently prescribed lipid-lowering treatment (21.6%, 30.8%, and 42.7% in Groups I, II, and III, respectively), followed by ezetimibe (2.5%, 7.1%, and 8.5% in Groups I, II, and III, respectively). LDL-C goals were achieved by 65.5%, 60.6%, and 25.4% of patients overall in Groups I, II, and III, respectively. Achievement rates were 83.9%, 75.3%, and 29.5% in patients prescribed intensive statin monotherapy and 82.3%, 86.4%, and 46.4% in those prescribed statin and ezetimibe combinations in Groups I, II, and III, respectively. In Group III, the proportion of patients with familial hypercholesterolemia prescribed statin and ezetimibe combinations achieving LDL-C goals was low (32.5%). CONCLUSIONS The proportion of patients achieving LDL-C goals for secondary prevention in the high-risk group remains low even with statin and ezetimibe combination therapy.
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Affiliation(s)
- Hironobu Mitani
- Medical Affairs Division, Novartis Pharma K.K., Tokyo, Japan
| | - Kota Suzuki
- Medical Affairs Division, Novartis Pharma K.K., Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kazuma Iekushi
- Medical Affairs Division, Novartis Pharma K.K., Tokyo, Japan
| | - Renata Majewska
- Health Economics & Outcome Research, Creativ-Ceutical, Cracow, Poland
| | - Salsabil Touzeni
- Health Economics & Outcome Research, Creativ-Ceutical, Tunis, Tunisia
| | - Shizuya Yamashita
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
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Jaślan D, Rosiński J, Wałaszek M, Majewska R, Szczypta A, Wójkowska-Mach J, Różańska A. Polish infection control nurses' job satisfaction and cooperation with their colleagues reflect how the value of infection control is appreciated by other health care workers: findings from surveys conducted before and during the COVID-19 pandemic. Antimicrob Resist Infect Control 2023; 12:76. [PMID: 37559154 PMCID: PMC10413731 DOI: 10.1186/s13756-023-01284-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Infection prevention and control (IPC) is based on the activity of specialized, trained and highly qualified personnel, especially infection control nurses (ICNs). Effective implementation of IPC procedures demands close cooperation between IPC teams (IPCTs) and hospital personnel. Based on disturbing results on the epidemiology of health care-associated infections (HAIs) and compliance with preventive procedures, we suspect that cooperation between ICNs and different groups of hospital staff is poor. The aim of this study was to assess the perceptions of ICNs working in Polish hospitals with regard to difficulties in working with various professional groups in the hospital, their organizational conditions, and their job satisfaction before and after the COVID-19 pandemic. METHODS The study was conducted twice, in 2014 and 2021, among ICNs working in Polish hospitals. The survey used an anonymous questionnaire designed by the authors. RESULTS In 2014, 183 ICNs participated in the study, and 175 ICNs participated in 2021. The respondents' average age and seniority (duration of work as an ICN) were higher in 2021. Depending on the ward specialty, approximately 30-48.8% of the ICNs had difficulty cooperating with physicians. However, the ICNs declared better cooperation with nurses in various hospital wards and with other professionals. For some groups of hospital staff, there was a negative correlation between poor cooperation and ICNs' job satisfaction. The job satisfaction data were disturbing; for example, more than half of the respondents considered changing jobs, and the lack of a sense of purpose in their work was declared by 29.7% of ICNs in 2014 and by 54.3% of ICNs in 2021. CONCLUSIONS Our results suggest that infection prevention and control is not highly appreciated by health care workers and hospital management. Our study reveals difficulties in ICNs' cooperation with hospital staff and managers in both 2021 and 2014, moderate job satisfaction, a high level of willingness to change jobs, and insufficient training in interpersonal skills and the implementation of changes. These findings clearly indicate an urgent need to introduce modern competence development systems in infection control beyond the scope of traditional training.
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Affiliation(s)
- Dorota Jaślan
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, Kraków, 31-121, Poland
| | - Jerzy Rosiński
- Institute of Economics, Finance and Management, Faculty of Management and Social Communication, Jagiellonian University, ul. Łojasiewicza 4, Kraków, 30-348, Poland
| | - Marta Wałaszek
- Faculty of Health Science, University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Renata Majewska
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, ul. Kopernika 7, Kraków, 31-034, Poland
| | - Anna Szczypta
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, ul. Herlinga-Grudzińskiego 1, Kraków, 30-705, Poland
| | - Jadwiga Wójkowska-Mach
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, Kraków, 31-121, Poland
| | - Anna Różańska
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, Kraków, 31-121, Poland.
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François C, Germain N, Majewska R, Taieb V, Hewitt LA, Kymes S. Psychometric validation of a patient-reported single-item assessment of 'Good Day Bad Day' in a neurogenic orthostatic hypotension population treated with droxidopa. J Mark Access Health Policy 2022; 10:2010961. [PMID: 35035792 PMCID: PMC8757596 DOI: 10.1080/20016689.2021.2010961] [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] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Symptoms of neurogenic orthostatic hypotension (nOH), including lightheadedness/dizziness, presyncope, syncope, and falls, can lead to impaired functional ability and reduced quality of life. Because the severity and frequency of nOH symptoms fluctuate, it may be difficult for patients to accurately quantify the effect of symptoms on their daily lives using available outcome measures. A new single-item instrument, the 'Good Day Bad Day,' was developed, and its psychometric validity was assessed in patients with nOH. METHODS Data from a 6-month, prospective, observational cohort study of patients with nOH who were newly initiating droxidopa treatment were used. Patients were asked to quantify the number of good and bad days in the previous 7 days and responded to other validated patient-reported outcomes instruments. The concurrent and discriminant validities and the stability of the Good Day Bad Day instrument were assessed. RESULTS A total of 153 patients were included in the analysis (mean [SD] age, 62.3 [17] years). Change in the number of good days moderately correlated with improvements in other patient-reported outcomes (rho value range, -0.38 to -0.61). When data were examined categorically (low vs high symptom severity), the mean number of good days was higher in subgroups representing low symptom severity across measures at 1, 3, and 6 months (all P ≤ 0.01). CONCLUSIONS The Good Day Bad Day instrument provided good discrimination at baseline and over time and may aid in assessment of the effects of nOH symptoms on patients.
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Affiliation(s)
- Clément François
- Health Economics and Outcomes Research, Creativ-Ceutical, Paris, France
| | - Nicola Germain
- Health Economics and Outcomes Research, Creativ-Ceutical, Paris, France
| | - Renata Majewska
- Health Economics and Outcomes Research, Creativ-Ceutical S.A, Kraków, Poland
| | - Vanessa Taieb
- Health Economics and Outcomes Research, Creativ-Ceutical, London, UK
| | | | - Steven Kymes
- Health Economics and Outcomes Research, Lundbeck, Deerfield, Il, USA
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Vashi P, Batt K, Klamroth R, Mancuso ME, Majewska R, Tiede A, Mantovani LG. Indirect Treatment Comparison of Damoctocog Alfa Pegol versus Turoctocog Alfa Pegol as Prophylactic Treatment in Patients with Hemophilia A. J Blood Med 2021; 12:935-943. [PMID: 34754257 PMCID: PMC8570287 DOI: 10.2147/jbm.s321288] [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: 05/21/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the efficacy and FVIII consumption of BAY 94-9027 versus N8-GP in prophylaxis in adolescent and adult patients with severe hemophilia A (HA). Patients and Methods A systematic literature review was conducted to identify studies on the efficacy of BAY-94-9027 and N8-GP for prophylaxis in patients with HA aged ≥12 years without a history of inhibitors. Eight studies met systematic literature review inclusion criteria, but only data from PROTECT VIII on BAY 94-9027 and PATHFINDER 2 on N8-GP could be used for an indirect comparison. Matching-adjusted indirect comparison (MAIC) and simulated treatment comparison were performed. Results No significant differences (unadjusted and adjusted) were observed in the mean annualized bleeding rate (ABR) for any bleed and proportion of patients with zero bleeds when comparing BAY 94-9027 to N8-GP. The adjusted treatment difference [incidence rate ratio (IRR)] in terms of ABR was 1.11 (95% CI, 0.85–1.44). The odds ratio (OR) of any bleed, measuring the relative effect of BAY 94-9027 versus N8-GP on the proportion of patients with zero bleeds, was 1.03 (95% CI, 0.60–1.77). FVIII consumption was significantly lower in BAY 94-9027 [mean adjusted difference=−1292.57 IU/kg/year (95% CI, ‒2152.44 to ‒432.70)]; a 26.7% reduction in consumption of BAY-94-9027. The results of the sensitivity analyses were similar to the main analysis for mean ABRs, percentages of patients with zero bleeds, and significant reduction in rFVIII consumption. For patients on BAY 94-9027 every-5-days and every-7-days, no differences versus every-4-days N8-GP were observed for the mean ABR for any bleed [IRR=0.90 (95% CI, 0.68‒1.20)] and proportion of patients with zero bleeds [OR=1.06 (95% CI, 0.56‒2.02)]. Conclusion BAY 94-9027 prophylaxis demonstrated 26.7% lower annual consumption when compared to N8-GP with similar efficacy in terms of ABR and percentage of patients with zero bleeds.
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Affiliation(s)
- Parth Vashi
- US Data Generation and Observational Studies, Bayer Corporation, Whippany, NJ, USA
| | - Katharine Batt
- Department of Internal Medicine, Section on Hematology/Medical Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Robert Klamroth
- Department for Internal Medicine - Vascular Medicine and Coagulation Disorders, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Renata Majewska
- HEOR, Creativ-Ceutical, Krakow, Poland.,Department of Epidemiology, Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Andreas Tiede
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Lorenzo Giovanni Mantovani
- Center for Public Health Research, University of Milan - Bicocca, Monza, Italy.,Value-Based Healthcare Unit, IRCCS Multimedica, Sesto San Giovanni, Italy
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Wong TF, Majewska R, Tomiyama Y. Management of primary immune thrombocytopenia in a real-world setting in Japan: eltrombopag versus corticosteroids. Int J Hematol 2021; 114:152-163. [PMID: 33851348 DOI: 10.1007/s12185-021-03149-z] [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] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
This real-world study in Japan assessed the long-term safety of persistent use of eltrombopag compared to corticosteroids. Overall, 1887 patients with primary immune thrombocytopenia were included in the study cohort, based on hospital claims data. Eltrombopag was frequently used as a second- or third-line therapy (monotherapy: 13.1% and 25.7%; combination: 24.39% and 16.52%, respectively). The risk of bleeding was approximately 30% lower in the eltrombopag group (as monotherapy and in combination with other drugs including corticosteroids) than the corticosteroid group (hazard ratio, 0.66; 95% confidence interval, 0.45-0.96). Results from univariate and multivariate Cox models indicated that patients aged ≥ 60 years, male patients and patients who received the drugs for peptic ulcer or gastroesophageal reflux disease have a higher risk of cerebral haemorrhage or gastrointestinal bleeding. Surgeries were more common among patients on corticosteroids compared to patients on eltrombopag (39.1% vs 34.6%, P = 0.004), while splenectomies were very rare. There was no significant difference in the costs of scheduled, emergency, or any type of hospitalisations between the exposure groups. The risk of infections, cataracts, and thrombosis did not differ between the exposure groups.
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Affiliation(s)
| | | | - Yoshiaki Tomiyama
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, Japan.
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6
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Voerman E, Santos S, Inskip H, Amiano P, Barros H, Charles MA, Chatzi L, Chrousos GP, Corpeleijn E, Crozier S, Doyon M, Eggesbø M, Fantini MP, Farchi S, Forastiere F, Georgiu V, Gori D, Hanke W, Hertz-Picciotto I, Heude B, Hivert MF, Hryhorczuk D, Iñiguez C, Karvonen AM, Küpers LK, Lagström H, Lawlor DA, Lehmann I, Magnus P, Majewska R, Mäkelä J, Manios Y, Mommers M, Morgen CS, Moschonis G, Nohr EA, Nybo Andersen AM, Oken E, Pac A, Papadopoulou E, Pekkanen J, Pizzi C, Polanska K, Porta D, Richiardi L, Rifas-Shiman SL, Roeleveld N, Ronfani L, Santos AC, Standl M, Stigum H, Stoltenberg C, Thiering E, Thijs C, Torrent M, Trnovec T, van Gelder MMHJ, van Rossem L, von Berg A, Vrijheid M, Wijga A, Zvinchuk O, Sørensen TIA, Godfrey K, Jaddoe VWV, Gaillard R. Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA 2019; 321:1702-1715. [PMID: 31063572 PMCID: PMC6506886 DOI: 10.1001/jama.2019.3820] [Citation(s) in RCA: 296] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
Importance Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. Objectives To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Design, Setting, and Participants Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. Exposures Gestational weight gain. Main Outcomes and Measures The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. Results Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). Conclusions and Relevance In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.
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Affiliation(s)
- Ellis Voerman
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Susana Santos
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Pilar Amiano
- Public Health Division of Gipuzkoa, San Sebastián, Spain
- BioDonostia Research Institute, San Sebastián, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Henrique Barros
- EPI Unit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Marie-Aline Charles
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center, ORCHAD Team, Villejuif, France
- Paris Descartes University, Villejuif, France
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands
| | - George P Chrousos
- First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - Eva Corpeleijn
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England
| | - Myriam Doyon
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Merete Eggesbø
- Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sara Farchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Vagelis Georgiu
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, School of Medicine, University of California, Davis
| | - Barbara Heude
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center, ORCHAD Team, Villejuif, France
- Paris Descartes University, Villejuif, France
| | - Marie-France Hivert
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston
| | - Daniel Hryhorczuk
- Center for Global Health, College of Medicine, University of Illinois, Chicago
| | - Carmen Iñiguez
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- Department of Statistics and Computational Research, Universitat de València, València, Spain
| | - Anne M Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Leanne K Küpers
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, England
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, England
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, England
| | - Irina Lehmann
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Per Magnus
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Renata Majewska
- Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Johanna Mäkelä
- Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Monique Mommers
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Camilla S Morgen
- National Institute of Public Health, University of Southern Denmark, Copenhagen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - George Moschonis
- Department of Dietetics, Nutrition, and Sport, La Trobe University, Melbourne, Australia
| | - Ellen A Nohr
- Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense
| | - Anne-Marie Nybo Andersen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Agnieszka Pac
- Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Eleni Papadopoulou
- Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Juha Pekkanen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Kinga Polanska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luca Ronfani
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Ana C Santos
- EPI Unit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Hein Stigum
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Carel Thijs
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Tomas Trnovec
- Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Reshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lenie van Rossem
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- ISGlobal, Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Alet Wijga
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Oleksandr Zvinchuk
- Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Thorkild I A Sørensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Keith Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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7
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Santos S, Voerman E, Amiano P, Barros H, Beilin LJ, Bergström A, Charles MA, Chatzi L, Chevrier C, Chrousos GP, Corpeleijn E, Costa O, Costet N, Crozier S, Devereux G, Doyon M, Eggesbø M, Fantini MP, Farchi S, Forastiere F, Georgiu V, Godfrey KM, Gori D, Grote V, Hanke W, Hertz-Picciotto I, Heude B, Hivert MF, Hryhorczuk D, Huang RC, Inskip H, Karvonen AM, Kenny LC, Koletzko B, Küpers LK, Lagström H, Lehmann I, Magnus P, Majewska R, Mäkelä J, Manios Y, McAuliffe FM, McDonald SW, Mehegan J, Melén E, Mommers M, Morgen CS, Moschonis G, Murray D, Ní Chaoimh C, Nohr EA, Nybo Andersen AM, Oken E, Oostvogels A, Pac A, Papadopoulou E, Pekkanen J, Pizzi C, Polanska K, Porta D, Richiardi L, Rifas-Shiman SL, Roeleveld N, Ronfani L, Santos AC, Standl M, Stigum H, Stoltenberg C, Thiering E, Thijs C, Torrent M, Tough SC, Trnovec T, Turner S, van Gelder M, van Rossem L, von Berg A, Vrijheid M, Vrijkotte T, West J, Wijga AH, Wright J, Zvinchuk O, Sørensen T, Lawlor DA, Gaillard R, Jaddoe V. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG 2019; 126:984-995. [PMID: 30786138 DOI: 10.1111/1471-0528.15661] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. DESIGN Individual participant data meta-analysis of 39 cohorts. SETTING Europe, North America, and Oceania. POPULATION 265 270 births. METHODS Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. MAIN OUTCOME MEASURES Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. RESULTS Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. CONCLUSIONS Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. TWEETABLE ABSTRACT Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.
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Affiliation(s)
- S Santos
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - E Voerman
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - P Amiano
- Public Health Division of Gipuzkoa, San Sebastián, Spain.,BioDonostia Research Institute, San Sebastián, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - H Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - L J Beilin
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - M-A Charles
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.,Paris Descartes University, Villejuif, France
| | - L Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Faculty of Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece.,Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands
| | - C Chevrier
- Inserm UMR 1085, Irset - Research Institute for Environmental and Occupational Health, Rennes, France
| | - G P Chrousos
- First Department of Pediatrics, Athens University Medical School, 'Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - O Costa
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - N Costet
- Inserm UMR 1085, Irset - Research Institute for Environmental and Occupational Health, Rennes, France
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - G Devereux
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Doyon
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada
| | - M Eggesbø
- Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - M P Fantini
- The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Farchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - F Forastiere
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - V Georgiu
- Faculty of Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Gori
- The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - V Grote
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany
| | - W Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - I Hertz-Picciotto
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA
| | - B Heude
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.,Paris Descartes University, Villejuif, France
| | - M-F Hivert
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada.,Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - D Hryhorczuk
- Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA
| | - R-C Huang
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A M Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - L C Kenny
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - B Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany
| | - L K Küpers
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - H Lagström
- Department of Public Health, University of Turku, Turku, Finland
| | - I Lehmann
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany
| | - P Magnus
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - R Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - J Mäkelä
- Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland
| | - Y Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - F M McAuliffe
- UCD Perinatal Research Centre, Obstetrics& Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - S W McDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - J Mehegan
- UCD Perinatal Research Centre, School of Public Health and Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - E Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sach's Children Hospital, Stockholm, Sweden
| | - M Mommers
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - C S Morgen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - G Moschonis
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Vic, Australia
| | - D Murray
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - C Ní Chaoimh
- Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.,Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - E A Nohr
- Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A-M Nybo Andersen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - E Oken
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Ajjm Oostvogels
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - A Pac
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - E Papadopoulou
- Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - J Pekkanen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - C Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - K Polanska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - D Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - L Richiardi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - N Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L Ronfani
- Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - A C Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - H Stigum
- Department of Non-communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - C Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - E Thiering
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C Thijs
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - M Torrent
- Ib-salut, Area de Salut de Menorca, Menorca, Spain
| | - S C Tough
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - T Trnovec
- Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic
| | - S Turner
- Child Health, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Mmhj van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L van Rossem
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany
| | - M Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal, Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Tgm Vrijkotte
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - J West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - A H Wijga
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - O Zvinchuk
- Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Tia Sørensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.,Section of Metabolic Genetics, Faculty of Health and Medical Sciences, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - D A Lawlor
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, University of Bristol, Bristol, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - R Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vwv Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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8
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Villani M, Onesto V, Coluccio M, Valpapuram I, Majewska R, Alabastri A, Battista E, Schirato A, Calestani D, Coppedé N, Zappettini A, Amato F, Di Fabrizio E, Gentile F. Transforming diatomaceous earth into sensing devices by surface modification with gold nanoparticles. Micro and Nano Engineering 2019. [DOI: 10.1016/j.mne.2018.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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9
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Santos S, Eekhout I, Voerman E, Gaillard R, Barros H, Charles MA, Chatzi L, Chevrier C, Chrousos GP, Corpeleijn E, Costet N, Crozier S, Doyon M, Eggesbø M, Fantini MP, Farchi S, Forastiere F, Gagliardi L, Georgiu V, Godfrey KM, Gori D, Grote V, Hanke W, Hertz-Picciotto I, Heude B, Hivert MF, Hryhorczuk D, Huang RC, Inskip H, Jusko TA, Karvonen AM, Koletzko B, Küpers LK, Lagström H, Lawlor DA, Lehmann I, Lopez-Espinosa MJ, Magnus P, Majewska R, Mäkelä J, Manios Y, McDonald SW, Mommers M, Morgen CS, Moschonis G, Murínová Ľ, Newnham J, Nohr EA, Andersen AMN, Oken E, Oostvogels AJJM, Pac A, Papadopoulou E, Pekkanen J, Pizzi C, Polanska K, Porta D, Richiardi L, Rifas-Shiman SL, Roeleveld N, Santa-Marina L, Santos AC, Smit HA, Sørensen TIA, Standl M, Stanislawski M, Stoltenberg C, Thiering E, Thijs C, Torrent M, Tough SC, Trnovec T, van Gelder MMHJ, van Rossem L, von Berg A, Vrijheid M, Vrijkotte TGM, Zvinchuk O, van Buuren S, Jaddoe VWV. Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania. BMC Med 2018; 16:201. [PMID: 30396358 PMCID: PMC6217770 DOI: 10.1186/s12916-018-1189-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 04/24/2018] [Accepted: 10/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies. METHODS We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape. RESULTS We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications. CONCLUSIONS Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.
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Affiliation(s)
- Susana Santos
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Iris Eekhout
- TNO Child Health, Leiden, the Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Ellis Voerman
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Marie-Aline Charles
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.,Paris Descartes University, Villejuif, France
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands
| | - Cécile Chevrier
- Inserm UMR 1085, Irset-Research Institute for Environmental and Occupational Health, F-35000, Rennes, France
| | - George P Chrousos
- First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RG, Groningen, the Netherlands
| | - Nathalie Costet
- Inserm UMR 1085, Irset-Research Institute for Environmental and Occupational Health, F-35000, Rennes, France
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Myriam Doyon
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada
| | - Merete Eggesbø
- Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Pia Fantini
- The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sara Farchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Luigi Gagliardi
- Department of Woman and Child Health, Ospedale Versilia, Local Health Authority Toscana Nord Ovest, Viareggio, Italy
| | - Vagelis Georgiu
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Davide Gori
- The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Veit Grote
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, 80337, Munich, Germany
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, 95616, USA
| | - Barbara Heude
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.,Paris Descartes University, Villejuif, France
| | - Marie-France Hivert
- Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada.,Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Hryhorczuk
- Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA
| | - Rae-Chi Huang
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Todd A Jusko
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Anne M Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, 80337, Munich, Germany
| | - Leanne K Küpers
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RG, Groningen, the Netherlands.,MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Irina Lehmann
- Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Maria-Jose Lopez-Espinosa
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Per Magnus
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Johanna Mäkelä
- Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Sheila W McDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Monique Mommers
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Camilla S Morgen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - George Moschonis
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Ľubica Murínová
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic
| | - John Newnham
- School of Women's and Infants' Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Ellen A Nohr
- Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne-Marie Nybo Andersen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Adriëtte J J M Oostvogels
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - Agnieszka Pac
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Eleni Papadopoulou
- Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Lovisenberggata 8, 0477, Oslo, Norway
| | - Juha Pekkanen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Kinga Polanska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Loreto Santa-Marina
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Subdirección de Salud Pública Gipuzkoa, San Sebastián, Spain.,Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain
| | - Ana C Santos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Thorkild I A Sørensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.,Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Carel Thijs
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Suzanne C Tough
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tomas Trnovec
- Department of Environmental Medicine, Slovak Medical University, Bratislava, 833 03, Slovak Republic
| | - Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lenie van Rossem
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Andrea von Berg
- Department of Pediatrics, Marien-Hospital Wesel, Research Institute, Wesel, Germany
| | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal, Institute for Global Health, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - Oleksandr Zvinchuk
- Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Stef van Buuren
- TNO Child Health, Leiden, the Netherlands.,Department of Methodology and Statistics, University of Utrecht, Utrecht, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. .,Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. .,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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10
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Majewska R, Pac A, Mróz E, Spengler J, Camann D, Mrozek-Budzyn D, Sowa A, Jacek R, Wheelock K, Perera FP. Lung function growth trajectories in non-asthmatic children aged 4-9 in relation to prenatal exposure to airborne particulate matter and polycyclic aromatic hydrocarbons - Krakow birth cohort study. Environ Res 2018; 166:150-157. [PMID: 29886391 DOI: 10.1016/j.envres.2018.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/09/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Patterns of lung function development during childhood can be helpful in understanding the pathogenesis of respiratory diseases. A variety of environmental and lifestyle factors, present from the prenatal period to adulthood, may affect or modulate lung function growth. The aim of this study was to investigate, the associations between individual growth trajectories of children's lung function during childhood and prenatal exposure to airborne fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAH), which were hypothesized to adversely affect spirometry parameters. MATERIAL AND METHODS The study group comprised 294 non-asthmatic, full term children from the Krakow birth cohort, who underwent annual spirometry testing at the ages of 4-9 years. Individual personal air monitoring of PM2.5 and PAH were performed over 48 h in the second trimester of pregnancy. Possible confounders or modifiers such as child's gender, height, atopic status and exposure to environmental tobacco smoke (ETS) were considered. Polynomial multilevel mixed models were used to assess the growth rates of children's lung functions. RESULTS Lung function trajectories differed significantly for boys and girls for FVC, FEV1 and FEF25-75. Girls had lower rates of increase than boys: - 20.5 (95%CI: - 32.4; - 8.6) ml/year (FVC); - 19.9 (95%CI: -30.7;-9.0) ml/year (FEV1); and - 32.5 (95%CI: - 56.9; - 8.2) ml/year (FEF25-75). Spirometry functions increased with age; however the growth rate decelerated over time. Significant lung function impairment (lower FVC and FEV1 levels) was observed from 4 to 9 years among subjects prenatally exposed to higher levels of PM2.5 as well as PAH, but not in the case of FEF25-75. No significant differences were observed in the rates of increase over time in relation to prenatal PM2.5 and PAH exposure. CONCLUSION Our results indicate that in non-asthmatic children high prenatal exposure to airborne PM2.5 and PAH is associated with lower trajectories of FVC and FEV1, but not the rate of increase over time, suggesting that the initial effect is not diminishing in time.
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Affiliation(s)
- Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland.
| | - Agnieszka Pac
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland
| | - Elżbieta Mróz
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland
| | - John Spengler
- Department of Environmental Health, Harvard School of Public Health, P.O. Box 15677, Landmark 406 West, 401 Park Drive, Boston, MA 02215, USA
| | - David Camann
- Department of Analytical and Environmental Chemistry, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78228, USA
| | - Dorota Mrozek-Budzyn
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland
| | - Agata Sowa
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland
| | - Ryszard Jacek
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland
| | - Kylie Wheelock
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, 722 West 168 St., New York, NY 10032, USA
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, 722 West 168 St., New York, NY 10032, USA
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11
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Ostachowska-Gasior A, Kolarzyk E, Majewska R, Gasior A, Kwiatkowski J, Zaleska I. Diet and Physical Activity as Determinants of Lifestyle Chosen by Women from Southern Poland. Int J Environ Res Public Health 2018; 15:ijerph15102088. [PMID: 30249020 PMCID: PMC6211119 DOI: 10.3390/ijerph15102088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
Abstract
The aim of the study was to assess the relationship between the lifestyle of Polish women (characterized by the quality of diets and levels of reported physical activity) and their characteristics such as age, place of residence, physical activity at work or school, reported health status, and BMI. The sample consisted of 882 women from Southern Poland. Diet quality and the level of physical activity were evaluated by the Nutrition Beliefs Questionnaire established by the Polish Academy of Sciences. The lifestyle category (healthy, moderate, or unhealthy) was based on “Prohealthy Diet Index-10” and participant’s self-assessed physical activity during their leisure-time. The lifestyle category was significantly associated with age, BMI, physical activity at work/school, and health. Moderate lifestyle (high or moderate levels of physical activity combined with low prohealthy diet) was the most commonly found classification in examined women. Age (>35 years old) and overweight are the main factors determining unhealthy lifestyle behavior. Healthy lifestyle is more often chosen by the women from big cities. More intensive efforts should be undertaken to increase the knowledge and awareness of the health benefits of a healthy lifestyle. The main goal should be concentrated on increasing the level of physical activity, especially in leisure time, and promoting the tenets of a well-balanced diet.
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Affiliation(s)
- Agnieszka Ostachowska-Gasior
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, 7 Kopernika St., Krakow 31-034, Poland.
| | - Emilia Kolarzyk
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, 7 Kopernika St., Krakow 31-034, Poland.
- Cracow High School of Health Promotion, 73 Krowoderska St., Krakow 31-158, Poland.
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7A Kopernika St., Krakow 31-034, Poland.
| | - Anna Gasior
- Department of Molecular Biology and Biotechnology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
| | - Jacek Kwiatkowski
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, 7 Kopernika St., Krakow 31-034, Poland.
| | - Izabela Zaleska
- The Faculty of Motor Rehabilitation, University of Physical Education in Cracow, Jana Pawla II 78 Road, Krakow 31-571, Poland.
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12
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Sochacka-Tatara E, Majewska R, Perera FP, Camann D, Spengler J, Wheelock K, Sowa A, Jacek R, Mróz E, Pac A. Urinary polycyclic aromatic hydrocarbon metabolites among 3-year-old children from Krakow, Poland. Environ Res 2018; 164:212-220. [PMID: 29501831 DOI: 10.1016/j.envres.2018.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/10/2017] [Revised: 01/29/2018] [Accepted: 02/22/2018] [Indexed: 06/08/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are widespread in the environment and can adversely affect human health. The aim of the present study is to describe the level of PAHs exposure in children living in Kraków, one of the most polluted cities in Poland, and to determine the relationship of urinary biomarkers with environmental PAHsexposure. Urinary monohydroxy metabolites (OH-PAHs) of 20 PAHs were assessed in 218 three-year old children, of which only 10 were present in nearly all the samples: monohydroxy metabolites of naphthalene, fluorene, phenantrene and pyrene. Of the metabolites analyzed, hydroxynaphthalenes were predominant and constituted almost 73% of total excreted OH-PAHs, while 1-OH-PYRene was the least abundant (2.3% of total OH-PAHs). All measured urinary OH-PAHs were statistically significantly correlated with each other (R = 0.165-0.880) but the highest correlation coefficients with other individual OH-PAHs and with total OH-PAHs were observed for 2-OH-FLUOR. Children exposed at home to environmental tobacco smoke (ETS) had higher concentrations of fluorene and pyrene urinary metabolites compared to those without ETS exposure; and those exposed to gas-based appliances used for cooking or heating water had higher levels of fluorene and phenanthrene metabolites than children not exposed. The use of coal, wood or oil for heating was associated with elevated levels of 1-OH-PYRene. Urinary PAHs metabolites only modestly reflect high molecular weight carcinogenic PAHs exposures such as those monitored in air in the present study. None of the measured PAHs metabolites was correlated with airborne PM2.5 and only two were slightly correlated with measured higher molecular mass airborne PAHs. The average concentrations of these specific metabolites in Polish children were much higher than observed in other pediatric populations living in developed countries. Our findings suggest that to capture various sources of PAHs, in addition to 1-OH-PYRene, biomonitoring of PAHs exposure should include 2-OH-NAP and 2-OH-FLUOR.
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Affiliation(s)
- Elżbieta Sochacka-Tatara
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a Str., 31-034 Krakow, Poland.
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a Str., 31-034 Krakow, Poland
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, USA
| | - David Camann
- Chemistry and Chemical Engineering Division, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78228, USA
| | - John Spengler
- Department of Environmental Health, Harvard School of Public Health, P.O. Box 15677, Landmark 406 West, 401 Park Drive, Boston, MA 02215, USA
| | - Kylie Wheelock
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, USA
| | - Agata Sowa
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a Str., 31-034 Krakow, Poland
| | - Ryszard Jacek
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a Str., 31-034 Krakow, Poland
| | - Elżbieta Mróz
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a Str., 31-034 Krakow, Poland
| | - Agnieszka Pac
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a Str., 31-034 Krakow, Poland
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13
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Onesto V, Villani M, Coluccio ML, Majewska R, Alabastri A, Battista E, Schirato A, Calestani D, Coppedé N, Cesarelli M, Amato F, Di Fabrizio E, Gentile F. Silica diatom shells tailored with Au nanoparticles enable sensitive analysis of molecules for biological, safety and environment applications. Nanoscale Res Lett 2018; 13:94. [PMID: 29633086 PMCID: PMC5891442 DOI: 10.1186/s11671-018-2507-4] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/28/2018] [Indexed: 05/08/2023]
Abstract
Diatom shells are a natural, theoretically unlimited material composed of silicon dioxide, with regular patterns of pores penetrating through their surface. For their characteristics, diatom shells show promise to be used as low cost, highly efficient drug carriers, sensor devices or other micro-devices. Here, we demonstrate diatom shells functionalized with gold nanoparticles for the harvesting and detection of biological analytes (bovine serum albumin-BSA) and chemical pollutants (mineral oil) in low abundance ranges, for applications in bioengineering, medicine, safety, and pollution monitoring.
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Affiliation(s)
- V. Onesto
- Department of Experimental and Clinical Medicine, University of Magna Graecia, 88100 Catanzaro, Italy
| | - M. Villani
- IMEM-CNR, Parco Area delle Scienze 37/A, 43124 Parma, Italy
| | - M. L. Coluccio
- Department of Experimental and Clinical Medicine, University of Magna Graecia, 88100 Catanzaro, Italy
| | - R. Majewska
- Unit for Environmental Sciences and Management, School of Biological Sciences, North-West University, Potchefstroom, 2520 South Africa
- South African Institute for Aquatic Biodiversity, Grahamstown, 6140 South Africa
| | - A. Alabastri
- Department of Physics and Astronomy, Rice University, Houston, TX 77005 USA
| | - E. Battista
- Interdisciplinary Research Center on Biomaterials, University Federico II, 80125 Naples, Italy
| | - A. Schirato
- Department of Physics, Politecnico di Milano, 20133 Milan, Italy
| | - D. Calestani
- IMEM-CNR, Parco Area delle Scienze 37/A, 43124 Parma, Italy
| | - N. Coppedé
- IMEM-CNR, Parco Area delle Scienze 37/A, 43124 Parma, Italy
| | - M. Cesarelli
- Department of Electrical Engineering and Information Technology, University Federico II, 80125 Naples, Italy
| | - F. Amato
- Department of Experimental and Clinical Medicine, University of Magna Graecia, 88100 Catanzaro, Italy
| | - E. Di Fabrizio
- King Abdullah University of Science and Technology, Thuwal, 23955-6900 Saudi Arabia
| | - F. Gentile
- Department of Electrical Engineering and Information Technology, University Federico II, 80125 Naples, Italy
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14
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Majewska R, De Stefano M, Van de Vijver B. Labellicula lecohuiana, a new epizoic diatom species living on green turtles in Costa Rica. ACTA ACUST UNITED AC 2018. [DOI: 10.1127/1438-9134/2017/023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Jedrychowski WA, Majewska R, Spengler JD, Camann D, Roen EL, Perera FP. Prenatal exposure to fine particles and polycyclic aromatic hydrocarbons and birth outcomes: a two-pollutant approach. Int Arch Occup Environ Health 2017; 90:255-264. [PMID: 28168423 PMCID: PMC5360842 DOI: 10.1007/s00420-016-1192-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/23/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Previous epidemiologic studies have considered the effects of individual air pollutants on birth outcomes, whereas a multiple-pollutant approach is more relevant to public health policy. OBJECTIVES The present study compared the observed effect sizes of prenatal fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAH) (a component of PM2.5) exposures on birth outcome deficits, assessed by the single vs. two-pollutant approaches. METHODS The study sample included 455 term infants born in Krakow to non-smoking mothers, among whom personal exposures to PM2.5 and PAH were monitored in the second trimester of pregnancy. The exposure effect estimates (unstandardized and standardized regression coefficients) on birth outcomes were determined using multivariable linear regression models, accounting for relevant covariates. RESULTS In the single-pollutant approach, each pollutant was inversely associated with all birth outcomes. The effect size of prenatal PAH exposure on birth weight and length was twice that of PM2.5, in terms of standardized coefficients. In the two-pollutant approach, the negative effect of PM2.5 on birth weight and length, adjusted for PAH exposure, lost its significance. The standardized effect of PAH on birth weight was 10-fold stronger (β = -0.20, p = 0.004) than that estimated for PM2.5 (β = -0.02, p = 0.757). CONCLUSION The results provide evidence that PAH had a greater impact on several measures of fetal development, especially birth weight, than PM2.5. Though in the single-pollutant models PM2.5 had a significant impact on birth outcomes, this effect appears to be mediated by PAH.
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Affiliation(s)
- W A Jedrychowski
- Former Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7, Kopernika Street, Krakow, Poland.
| | - J D Spengler
- Department of Environmental Health, School of Public Health, Harvard University, Boston, MA, USA
| | - David Camann
- Department of Analytical and Environmental Chemistry, Southwest Research Institute, San Antonio, TX, USA
| | - E L Roen
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - F P Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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16
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Mrożek-Budzyn D, Kiełtyka A, Majewska R, Mróz E. What mother know about vaccine preventable diseases? Przegl Epidemiol 2017; 71:595-602. [PMID: 29417786] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVE The improving epidemiological situation of the most of communicable diseases causes, that the real and potential risks attributable to them have been forgotten. The aim of study was to determine the mothers knowledge about vaccine preventable diseases MATERIALS AND METHODS A survey was conducted among 177 randomly selected mothers. The interviews with mothers hospitalized after childbearing in two hospitals in Krakow and Myslenice were conducted at the end of 2014 and in 2015 RESULTS The assessment of risk to develop an infectious diseases in unvaccinated children significantly varied among mothers. Individual respondents claimed that the risk does not exist regarding each of considered disease. The highest percentage of that kind of answers was related to poliomyelitis – 3.9% of mothers assessed that unvaccinated children have no risk to become ill. The similar percentage of respondents assessed a risk as remote probable regarding poliomyelitis, pertussis and hepatitis A - 16.8%, 15.2% and 16.3%, respectively. The highest risk was attributed to varicella – 50.6% mothers gave that answers. Mothers could not state a risk of disease developing mostly with regard to poliomyelitis, diphtheria, hepatitis A and pertussis – 42.7%, 38.2%, 33.7% and 33.2%, respectively. Relatively high percentage of respondents stated a mild course of that kind of diseases like varicella, mumps, rubella, infectious diarrhea and measles - from 17.4% with respect to measles to 34.3% regarding varicella. To life-threating category mothers primarily included sepsis (74.2%), meningitis and tick-borne encephalitis (each obtained 68.5% answers) CONCLUSIONS Mothers knowledge about vaccine preventable diseases varied depending on the type of disease. The lack of awareness of the risk related to communicable diseases regarded not only those diseases which have not been occurred in Poland for many years but also those ones that still represent significant epidemiological problem. The society too often has an opinion that some diseases like varicella, mumps or rubella are the mild diseases what can conduce to easy withdrawal from those vaccinations
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Affiliation(s)
- Dorota Mrożek-Budzyn
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow
- Sanitary Inspection in Myslenice
| | - Agnieszka Kiełtyka
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow
| | - Renata Majewska
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow
| | - Elżbieta Mróz
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow
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17
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Kiałka M, Milewicz T, Mrozińska S, Rogatko I, Sztefko K, Majewska R. Pressure pain threshold and β-endorphins plasma level are higher in lean polycystic ovary syndrome women. MINERVA ENDOCRINOL 2016; 42:297-305. [PMID: 27603705 DOI: 10.23736/s0391-1977.16.02494-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite some evidence that indicates that the evolution of polycystic ovary syndrome (PCOS) is related to the activity of the endogenous opioid system, and that concentration of plasma β-endorphin levels can increase pain threshold, there are no studies which evaluate pressure pain threshold in the PCOS women population. METHODS In 48 lean women with PCOS and 38 lean women without this disorder plasma β-endorphins and PPT were measured. RESULTS The β-endorphins level was higher in the PCOS group compared to the controls (15.28±2.49 pg/mL vs. 6.33±1.71 pg/mL, P<0.001). In PCOS group PPTs measured on deltoid and trapezius muscles were higher compared to the controls (9.33±1.3 kg/cm² vs. 5.19±0.57 kg/cm², P<0.001; 8.23±1.04 kg/cm² vs. 4.79±0.55 kg/cm², P<0.001). The β-endorphin levels positively correlated with PPTs in PCOS group. Increase in β-endorphin level of 1 pg/mL was associated with increase of PPT value on deltoid muscle of 0.23 kg/cm² (R=0.632, P=0.011) and of 0.18 kg/cm² on trapezius muscle (R=0.588, P=0.037). There were no correlations between testosterone level and PPT in PCOS group. CONCLUSIONS β-endorphin serum level as well as PPT are higher in lean PCOS group than in controls. We found correlations between β-endorphin levels and PPT in the PCOS group. It may suggest the role of endogenous opioids in the pathogenesis of PCOS and also that the increases in circulating plasma β-endorphins concentration can increases PPT in this group.
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Affiliation(s)
- Marta Kiałka
- Department of Gynecological Endocrinology, Medical College, Jagiellonian University, Cracow, Poland -
| | - Tomasz Milewicz
- Department of Gynecological Endocrinology, Medical College, Jagiellonian University, Cracow, Poland
| | - Sandra Mrozińska
- Department of Metabolic Diseases, Medical College, Jagiellonian University, Cracow, Poland
| | - Iwona Rogatko
- Department of Clinical Biochemistry, Medical College, Jagiellonian University, Cracow, Poland
| | - Krystyna Sztefko
- Department of Clinical Biochemistry, Medical College, Jagiellonian University, Cracow, Poland
| | - Renata Majewska
- Unit of Epidemiology and Preventive Medicine, Department of Epidemiology, Medical College, Jagiellonian University, Cracow, Poland
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Kiałka M, Milewicz T, Sztefko K, Rogatko I, Majewska R. Metformin increases pressure pain threshold in lean women with polycystic ovary syndrome. Drug Des Devel Ther 2016; 10:2483-90. [PMID: 27536069 PMCID: PMC4977100 DOI: 10.2147/dddt.s109086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Despite the strong preclinical rationale, there are only very few data considering the utility of metformin as a potential pain therapeutic in humans. The aim of this study was to determine the association between metformin therapy and pressure pain threshold (PPT) in lean women with polycystic ovary syndrome (PCOS). We hypothesized that metformin therapy in lean PCOS women increases PPT. Materials and methods Twenty-seven lean PCOS women with free androgen index phenotype >5 and 18 lean healthy controls were enrolled in the study. Fifteen of the PCOS women were randomly assigned to be treated with metformin 1,500 mg daily for 6 months. PPT and plasma β-endorphin levels were measured in all women at the beginning of the study and after 6 months of observation. Results We observed an increase in PPT values measured on deltoid and trapezius muscle in the PCOS with metformin group after 6 months of metformin administration (4.81±0.88 kg/cm2, P<0.001 on deltoid muscle, and 5.71±1.16 kg/cm2 on trapezius muscle). We did not observe any significant changes in PPT values in the PCOS without treatment group and in controls. We did not observe any significant changes in serum β-endorphin levels in any studied groups during the 6-month observation. Conclusion We conclude that metformin therapy increases PPT in lean PCOS women, without affecting plasma β-endorphin concentration. Our results may suggest the potential role of metformin in pain therapy. We propose that larger, randomized studies on metformin impact on pain perception should be performed.
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Affiliation(s)
- Marta Kiałka
- Department of Gynecological Endocrinology, Jagiellonian University, Medical College, Kraków, Poland
| | - Tomasz Milewicz
- Department of Gynecological Endocrinology, Jagiellonian University, Medical College, Kraków, Poland
| | - Krystyna Sztefko
- Department of Clinical Biochemistry, Jagiellonian University, Medical College, Kraków, Poland
| | - Iwona Rogatko
- Department of Clinical Biochemistry, Jagiellonian University, Medical College, Kraków, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
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Mrozek-Budzyn D, Kieltyka A, Majewska R, Augustyniak M. The effectiveness of rotavirus vaccine in preventing acute gastroenteritis during rotavirus seasons among Polish children. Arch Med Sci 2016; 12:614-20. [PMID: 27279856 PMCID: PMC4889696 DOI: 10.5114/aoms.2016.59935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rotavirus is the main etiological cause of intestinal infections in children. Voluntary rotavirus vaccines were included in the Polish vaccination schedule in 2007. The aim of this study was to assess the effectiveness of a completed rotavirus vaccination course in preventing acute gastroenteritis in Polish infants during their first five years of life. MATERIAL AND METHODS This was a retrospective cohort study conducted in Lesser Poland (Malopolska Province). The sample population included a group of 303 children who received the completed rotavirus vaccination course and 303 children not vaccinated against rotavirus. The date of the child's acute gastroenteritis diagnosis and his or her vaccination history were extracted from the physicians' records. Each kind of diagnosed acute gastroenteritis during winter-spring rotavirus seasons was treated as the endpoint. The relative risk of having gastrointestinal infection was assessed using the hazard ratio from the Cox proportional hazards regression model. RESULTS In the examined group, 96 (15.8%) children had winter-spring gastrointestinal infections. In the non-vaccinated children, the cumulative incidence of these infections in the first 5 years of life was 20.8%, whereas in the children vaccinated with Rotarix it was only 10.9%. Those who were vaccinated with Rotarix had a 44% reduction in the risk of a winter-spring acute gastroenteritis infection compared to those not vaccinated with Rotarix (p = 0.005). Birth weight less than 2500 g increased the risk of the infection twofold and also reached statistical significance (p = 0.044). CONCLUSIONS The results showed that Rotarix is effective in preventing acute gastroenteritis in Polish children during rotavirus seasons.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Kieltyka
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata Augustyniak
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
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Mrozek-Budzyn D, Majewska R, Kiełtyka A. Reply to correspondence letter "Krakow's children cohort and long term follow-up of thimerosal exposure--design and statistics". Eur J Pediatr 2015; 174:1557-8. [PMID: 26003660 DOI: 10.1007/s00431-015-2569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Dorota Mrozek-Budzyn
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034, Krakow, Poland.
| | - Renata Majewska
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034, Krakow, Poland.
| | - Agnieszka Kiełtyka
- Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034, Krakow, Poland.
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Genkinger JM, Stigter L, Jedrychowski W, Huang TJ, Wang S, Roen EL, Majewska R, Kieltyka A, Mroz E, Perera FP. Prenatal polycyclic aromatic hydrocarbon (PAH) exposure, antioxidant levels and behavioral development of children ages 6-9. Environ Res 2015; 140:136-44. [PMID: 25863187 PMCID: PMC4492867 DOI: 10.1016/j.envres.2015.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 09/09/2014] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 05/15/2023]
Abstract
PURPOSE Prenatal polycyclic aromatic hydrocarbon (PAH) exposure has been shown to increase DNA adduct levels and to affect neurodevelopment. Micronutrients may modify the adverse effect of PAH on neurodevelopment. Thus, we examined if micronutrient concentrations modified the association between PAH exposure and neurodevelopmental outcomes. METHODS 151 children from a birth cohort who had micronutrient concentrations measured in cord blood and completed the Child Behavioral Checklist (CBCL), between the ages of 6 and 9 years, were evaluated. Prenatal airborne PAH exposure was measured by personal air monitoring. The betas and 95% CI for the associations of antioxidant concentrations and PAH exposure with each of the outcomes of CBCL raw score and dichotomized standardized T-score (based on clinical cutpoints) were estimated, respectively, by multivariable poisson and logistic models. RESULTS Children below the median for alpha-tocopherol and gamma-tocopherol concentrations, compared to those above, were more likely to have thought problems, aggressive behavior and externalizing problems (p<0.05). Lower carotenoid concentration was associated with more thought problems (MVβ=0.60, p<0.001) and externalizing problems (MVβ=0.13, p<0.05) for the same contrast. No statistically significant associations were observed between retinol concentrations and neurodevelopmental symptoms. Overall, no consistent patterns were observed when we examined the interaction between antioxidants (e.g., alpha-tocopherol) and PAH in relation to CBCL symptoms (e.g., internalizing and externalizing problems, p<0.05). CONCLUSIONS Lower alpha-tocopherol, gamma-tocopherol and carotenoid levels may adversely affect healthy neurodevelopment, even after accounting for PAH exposure. Future research to confirm these findings are warranted given the importance of identifying modifiable factors for reducing harmful PAH effects.
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Affiliation(s)
- Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Laura Stigter
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wieslaw Jedrychowski
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Tzu-Jung Huang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shuang Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emily L Roen
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renata Majewska
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Agnieszka Kieltyka
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Elzbieta Mroz
- Department of Epidemiology and Preventive Medicine, Jagiellonian University College of Medicine, Krakow, Poland
| | - Frederica P Perera
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Jedrychowski WA, Perera FP, Maugeri U, Majewska R, Spengler J, Mroz E, Flak E, Klimaszewska-Rembiasz M, Camman D. Antihistamine medication may alleviate negative effects of prenatal exposure to polycyclic aromatic hydrocarbons (PAH) on lung function in children. Birth cohort prospective study. Pediatr Pulmonol 2015; 50:469-78. [PMID: 25154482 PMCID: PMC4336849 DOI: 10.1002/ppul.23104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 03/18/2014] [Revised: 06/30/2014] [Accepted: 07/25/2014] [Indexed: 11/09/2022]
Abstract
The main purpose of the present study was to test the hypothesis that the depressed lung growth attributable to prenatal exposure to polycyclic aromatic hydrocarbons (PAH) may be modified by the intake of antihistamine medications. Individual prenatal PAH exposure was assessed by personal air monitoring in 176 children who were followed over nine years, in the course of which outdoor residential air monitoring, allergic skin tests for indoor allergens, lung function tests (FVC, FEV(1), FEV(05), and FEF(25-75)) were performed. The analysis with the General Estimated Equation (GEE) showed no association between prenatal PAH exposure and lung function in the group of children who were reported to be antihistamine users. However, in the group of antihistamine non-users all lung function tests except for FEF(25-75) were significantly and inversely associated with prenatal airborne PAH exposure. The results of the study suggest that the intake of antihistamine medications in early childhood may inhibit the negative effect of fetal PAH exposure on lung growth and provides additional indirect evidence for the hypothesis that lung alterations in young children resulting from PAH exposure may be caused by the allergic inflammation within lung.
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Affiliation(s)
- Wieslaw A Jedrychowski
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
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Jedrychowski WA, Perera FP, Camann D, Spengler J, Butscher M, Mroz E, Majewska R, Flak E, Jacek R, Sowa A. Prenatal exposure to polycyclic aromatic hydrocarbons and cognitive dysfunction in children. Environ Sci Pollut Res Int 2015; 22:3631-9. [PMID: 25253062 PMCID: PMC4334078 DOI: 10.1007/s11356-014-3627-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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: 08/12/2014] [Accepted: 09/16/2014] [Indexed: 04/15/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental pollutants produced by combustion of fossil fuel and other organic materials. Both experimental animal and human studies have reported the harmful impacts of PAH compounds on fetal growth and neurodevelopment, including verbal IQ of children. Here, we have assessed the association between cognitive function of children and prenatal PAH exposures. The study is part of an ongoing, longitudinal investigation of the health effects of prenatal exposure to air pollution on infants and children in Krakow, Poland. The subjects in this report included 170 children whose mothers were enrolled to the study in the first or second trimester of pregnancy whose cord blood were tested for PAH-DNA adducts and who were assessed at age 7 using the Wechsler Intelligence Scale for Children-Revised (WISC-R). The outcome of a priori interest was depressed verbal IQ index (DepVIQ), which is the difference between WISC-R performance and verbal IQ scores. Prenatal PAH exposure was measured by cord blood PAH-DNA adducts, an individual dosimeter, integrating exposure from various sources of exposure over the gestational period. The estimated effect of prenatal PAH exposure on cognitive function was adjusted in multivariable regression for a set of potential confounders (child's gender, parity, maternal education, breastfeeding practice, environmental tobacco smoke (ETS), and postnatal PAH exposure). The prevalence of DepVIQ was significantly higher in children with detectable PAH-DNA adducts compared to those with undetectable adducts (13.7 vs. 4.4 %,). Binary multivariable regression documented that the relative risk of DepVIQ increased threefold with a ln-unit increase in cord blood adducts (relative risk (RR) = 3.0, 95 % confidence interval (CI) 1.3-6.8). Postnatal PAH exposure also increased the risk of DepVIQ (RR = 1.6, 95 % CI 1.1-2.5). Long-term exclusive breastfeeding (at least 6 months) showed a protective effect (RR = 0.3, 95 % CI 0.1-0.9). In conclusion, these results provide further evidence that PAHs are harmful to the developing fetal brain with effects extending through childhood, with implications for the academic success of the children.
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Affiliation(s)
- Wiesław A Jedrychowski
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7, Kopernika Street, Krakow, Poland,
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Ochrem D, Kaim I, Majewska R, Jaworowski A, Sowa A, Jędrychowski W. [The influence of tocolytic drugs usage in the third trimester of pregnancy on obstetric and neonatal outcomes]. Przegl Lek 2015; 72:343-348. [PMID: 26817346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The occurrence of preterm labor is the cause of 75% of preterm births. Prematurity is the leading cause of mortality of children under four weeks of age. Tocolytic drugs are used widely in the treatment of preterm labor. The aim of this study was to assess the impact of the tocolytic therapy on obstetric and neonatal outcomes. MATERIAL AND METHODS The prospective, cohort study included 499 pregnant women The study enrolled women who met certain criteria of age, with singleton pregnancy, having no chronic diseases. After delivery the following data were obtained: sociodemographic profile (including data on occupational activity), body height and weight before pregnancy, weight gain, duration of pregnancy, mode of delivery, obstetric complications, medications, anthropometric parameters and state of health of newborns. A group of patients treated with tocolytic drugs and a control group were identified. Then obstetric and neonatal outcomes in both groups were subjected to statistical analysis. RESULTS There was no statistically significant difference between the two groups in terms of the following variables: mother's age, her education, professional activity of mothers in the first and second trimester of pregnancy, weight gain during pregnancy, parity, exposure to passive smoking during pregnancy, method of pregnancy termination. We found a statistically significant difference between the groups with respect to maternal weight before pregnancy (lower in the group using tocolytics), the average duration of pregnancy (lower in the group using tocolytics), the frequency of preterm birth (higher in the group using tocolytics) and neonatal anthropometric parameters and the number of points in the Apgar score at 5 minutes of age (lower in the group using tocolytics). CONCLUSIONS Low pregestational weight is a risk factor for preterm labor. Term birth rate in pregnant women treated for preterm labor is significantly smaller compared to the general population, which may indicate low efficacy of tocolytic drugs. There was no positive correlation found between the professional activity of pregnant women and the risk of threatening preterm labor.
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Jedrychowski WA, Perera FP, Maugeri U, Majewska R, Mroz E, Flak E, Camann D, Sowa A, Jacek R. Long term effects of prenatal and postnatal airborne PAH exposures on ventilatory lung function of non-asthmatic preadolescent children. Prospective birth cohort study in Krakow. Sci Total Environ 2015; 502:502-9. [PMID: 25300014 PMCID: PMC4254060 DOI: 10.1016/j.scitotenv.2014.09.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/20/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 05/20/2023]
Abstract
The main goal of the study was to test the hypothesis that prenatal and postnatal exposures to polycyclic aromatic hydrocarbons (PAH) are associated with depressed lung function in non-asthmatic children. The study sample comprises 195 non-asthmatic children of non-smoking mothers, among whom the prenatal PAH exposure was assessed by personal air monitoring in pregnancy. At the age of 3, residential air monitoring was carried out to evaluate the residential PAH exposure indoors and outdoors. At the age of 5 to 8, children were given allergic skin tests for indoor allergens; and between 5 and 9 years lung function testing (FVC, FEV05, FEV1 and FEF25-75) was performed. The effects of prenatal PAH exposure on lung function tests repeated over the follow-up were adjusted in the General Estimated Equation (GEE) model for the relevant covariates. No association between FVC with prenatal PAH exposure was found; however for the FEV1 deficit associated with higher prenatal PAH exposure (above 37 ng/m(3)) amounted to 53 mL (p=0.050) and the deficit of FEF25-75 reached 164 mL (p=0.013). The corresponding deficits related to postnatal residential indoor PAH level (above 42 ng/m(3)) were 59 mL of FEV1 (p=0.028) and 140 mL of FEF25-75 (p=0.031). At the higher residential outdoor PAH level (above 90 ng/m(3)) slightly greater deficit of FEV1 (71 mL, p=0.009) was observed. The results of the study suggest that transplacental exposure to PAH compromises the normal developmental process of respiratory airways and that this effect is compounded by postnatal PAH exposure.
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Affiliation(s)
- Wieslaw A Jedrychowski
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, New York, NY, USA
| | - Umberto Maugeri
- Institute for Studies in Clinical Medicine and Rehabilitation, Pavia, Italy
| | - Renata Majewska
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Elzbieta Mroz
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Elzbieta Flak
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - David Camann
- Department of Analytical and Environmental Chemistry, Southwest Research Institute, San Antonio, TX, USA
| | - Agata Sowa
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Ryszard Jacek
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
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Jedrychowski WA, Perera FP, Majewska R, Mrozek-Budzyn D, Mroz E, Roen EL, Sowa A, Jacek R. Depressed height gain of children associated with intrauterine exposure to polycyclic aromatic hydrocarbons (PAH) and heavy metals: the cohort prospective study. Environ Res 2015; 136:141-7. [PMID: 25460630 PMCID: PMC4262637 DOI: 10.1016/j.envres.2014.08.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 05/26/2014] [Revised: 08/12/2014] [Accepted: 08/15/2014] [Indexed: 05/20/2023]
Abstract
Fetal exposure to environmental toxicants may program the development of children and have long-lasting health impacts. The study tested the hypothesis that depressed height gain in childhood is associated with prenatal exposure to airborne polycyclic aromatic hydrocarbons (PAH) and heavy metals (lead and mercury). The study sample comprised 379 children born to non-smoking mothers among whom a total of 2011 height measurements were carried out over the 9-year follow-up period. Prenatal airborne PAH exposure was assessed by personal air monitoring of the mother in the second trimester of pregnancy and heavy metals were measured in cord blood. At the age of 3 residential air monitoring was done to evaluate the level of airborne PAH, and at the age 5 the levels of heavy metals were measured in capillary blood. The effect estimates of prenatal PAH exposure on height growth over the follow-up were adjusted in the General Estimated Equation (GEE) models for a wide set of relevant covariates. Prenatal exposure to airborne PAH showed a significant negative association with height growth, which was significantly decreased by 1.1cm at PAH level above 34.7 ng/m(3) (coeff.=-1.07, p=0.040). While prenatal lead exposure was not significantly associated with height restriction, the effect of mercury was inversely related to cord blood mercury concentration above 1.2 μg/L (coeff.=-1.21, p=0.020), The observed negative impact of prenatal PAH exposure on height gain in childhood was mainly mediated by shorter birth length related to maternal PAH exposure during pregnancy. The height gain deficit associated with prenatal mercury exposure was not seen at birth, but the height growth was significantly slower at later age.
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Affiliation(s)
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, NY, USA
| | | | | | - Elżbieta Mroz
- Jagiellonian University Medical College, Krakow, Poland
| | - Emily L Roen
- Columbia Center for Children's Environmental Health, Mailman School Public Health, Columbia University, NY, USA
| | - Agata Sowa
- Jagiellonian University Medical College, Krakow, Poland
| | - Ryszard Jacek
- Jagiellonian University Medical College, Krakow, Poland
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Jedrychowski WA, Perera FP, Majewska R, Camman D, Spengler JD, Mroz E, Stigter L, Flak E, Jacek R. Separate and joint effects of tranplacental and postnatal inhalatory exposure to polycyclic aromatic hydrocarbons: prospective birth cohort study on wheezing events. Pediatr Pulmonol 2014; 49:162-72. [PMID: 24155203 PMCID: PMC4021044 DOI: 10.1002/ppul.22923] [Citation(s) in RCA: 23] [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] [Received: 04/24/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 01/22/2023]
Abstract
The goal of this epidemiologic investigation was to analyze the associations between prenatal and postnatal exposure to airborne polycyclic aromatic hydrocarbons (PAH) and severity of wheeze and recurrent wheeze. The 257 children included in this analysis had a complete set of prenatal and postnatal PAH measurements and attended regular health checkups over a 4-year follow-up period since birth. Transplacental PAH exposure was measured by personal air monitoring of the mothers during the second trimester of pregnancy; postnatal exposure was estimated using the same instruments indoors at the children's residences at age 3. Chemical analysis tests were performed to determine airborne concentrations of nine PAH compounds. The results show that both prenatal and postnatal exposure were associated positively with the severity of wheezing days and recurrent wheezing reported in the follow-up. While the incidence rate ratio (IRR) for severity of wheeze and prenatal PAH exposure was 1.53 (95%CI: 1.43-1.64) that for postnatal PAH exposure was 1.13 (95%CI: 1.08-1.19). However, recurrent wheezing was more strongly associated with airborne PAH levels measured at age 3 (OR = 2.31, 95%CI: 1.26-4.22) than transplacental PAH exposure (OR = 1.40, 95% CI: 0.85-2.09), but the difference was statistically insignificant. In conclusion, it appears that prenatal PAH exposure may precipitate and intensify early onset of wheezing symptoms in childhood, resulting from the postnatal exposure and suggest that success in reducing the incidence of respiratory diseases in children would depend on reducing both fetal and childhood exposure to air pollution.
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Affiliation(s)
- Wiesław A Jedrychowski
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
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Mrożek-Budzyn D, Majewska R, Kiełtyka A, Augustyniak M. Sensitivity of passive diarrhea surveillance in infants up to the second year of life in Małopolskie voivodeship. Przegl Epidemiol 2014; 68:451-558. [PMID: 25391009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In EU countries and also in Poland, the surveillance of infectious acute gastro-enteritis is a mandatory system based on cases notification (suspected and confirm) conducted by physicians in hospitals and ambulatory care. STUDY OBJECTIVE The assessment of surveillance sensitivity on acute diarrhea in children up to 2nd year of life in Małopolskie voivodeship from 2009 to 2012. MATERIAL AND METHODS The data about 720 infants surveyed respectively from birth up to 2nd year of life were used in this study. The information on acute diarrhea cases (outpatient and hospitalized) occurred in infants during follow-up was included in analysis. The data derived from medical records. Each case of acute diarrhea in infants detected by medical records was surveyed in local surveillance system on infectious diseases whether it was notified by physician. RESULTS The surveillance sensitivity on acute diarrhea in infants up to 2nd year of life increased in Małopolskie voivodeship from 14.3% in 2009 to 24.3% in 2012. The sensitivity of surveillance on hospitalized cases was twofold higher compared to all kind of cases assessed inclusively. CONCLUSION The surveillance sensitivity on acute diarrhea in infants up to 2nd year of life improved significantly in recent years but is still too low, especially with respect to outpatient cases.
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Myszkowska D, Majewska R. Pollen grains as allergenic environmental factors--new approach to the forecasting of the pollen concentration during the season. Ann Agric Environ Med 2014; 21:681-688. [PMID: 25528901 DOI: 10.5604/12321966.1129914] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES It is important to monitor the threat of allergenic pollen during the whole season, because of practical application in allergic rhinitis treatment, especially in the specific allergen immunotherapy. The aim of the study was to propose the forecast models predicting the pollen occurrence in the defined pollen concentration categories related to the patient exposure and symptom intensity. MATERIAL AND METHODS The study was performed in Cracow (southern Poland), pollen data were collected using the volumetric method in 1991-2012. For all independent variables (meteorological elements) and the daily pollen concentrations the running mean for periods: 2-, 3-, 4-, 5-, 6- and 7 days before the predicted day were calculated. The multinomial logistic regression was used to find the relation between the probability of the pollen concentration occurrence in the selected categories and meteorological elements and pollen concentration in days preceding the predicted daily concentration. The models were constructed for each taxon using data in 1991-2011 (without 1992 and 1996 due to missing data in these years) and 1998-2011 pollen seasons. RESULTS The days classified among the lowest category (0-10 PG/m3) (pollen grains/m 3 of air) dominated for all the studied taxa. The percentage of the obtained predictions of the pollen occurrence fluctuated between 35-78% which is a sufficient value of model predictions. Considering the studied taxon, the best model accuracy was obtained for models forecasting Betula pollen concentration (both data series), and Poaceae (both data series). CONCLUSIONS The application of the recommended threshold values during the predictive models construction seems to be really useful to estimate the real threat of allergen exposure. It was indicated that the polynomial logistic regression models could be a practical tool for effective forecasting in biological monitoring of pollen exposure.
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Affiliation(s)
- Dorota Myszkowska
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Cracow, Poland
| | - Renata Majewska
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Cracow, Poland
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Mrozek-Budzyn D, Kiełtyka MAA, Majewska R. Validity and clinical utility of children development assessement using milestones reported by mothers. Przegl Epidemiol 2014; 68:71-155. [PMID: 25004635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The monitoring of infants development during preventive care visits to identify children whose development is concerning for delay is an essential part of pediatric practice. STUDY OBJECTIVE The aim of the study was to examine the validity and clinical utility of developmental milestones reported by mothers in assessment of children development compared with the outcomes of BSID-II (Bayley Scales of Infant Development--second edition). MATERIAL AND METHODS The cohort recruited prenatally, included 384 children. The Mental and Motor Scales of BSID-II were administered to each child at the end of the 12th, 24th and 36th month of life. When children were 3 years old, mothers were questioned about their child's age at attainment of 8 significant developmental milestones. RESULTS Sensitivity for the developmental milestones compared with score on the motor and mental scales of the BSID-II varied from 25.0% to 75.0%, specificity from 54.1% to 80.2%. The all of analysed milestones were characterized by low positive predictive value and rather high the negative one. CONCLUSION Parent report developmental milestones are a better tool for excluding those children who attain milestones rapidly, as a group with low risk of developmental delays, than in identifying children whose development is suspected of being delayed.
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Perera FP, Wang S, Rauh V, Zhou H, Stigter L, Camann D, Jedrychowski W, Mroz E, Majewska R. Prenatal exposure to air pollution, maternal psychological distress, and child behavior. Pediatrics 2013; 132:e1284-94. [PMID: 24101766 PMCID: PMC3813389 DOI: 10.1542/peds.2012-3844] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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: 12/22/2022] Open
Abstract
BACKGROUND Airborne polycyclic aromatic hydrocarbons (PAHs) are pollutants generated by combustion of fossil fuel and other organic material. Both prenatal PAH exposure and maternal psychological distress during pregnancy have each been associated with neurodevelopmental problems in children. The goal was to evaluate potential interactions between prenatal exposure to airborne PAHs and maternal psychological distress during pregnancy on subsequent behavioral problems in children. METHODS In a longitudinal birth cohort study, 248 children of nonsmoking white women in the coal-burning region of Krakow, Poland, were followed from in utero until age 9. Prenatal PAH exposure was measured by personal air monitoring during pregnancy, maternal demoralization during pregnancy by the Psychiatric Epidemiology Research Instrument-Demoralization, and child behavior by the Child Behavior Checklist. RESULTS Significant interactions between maternal demoralization and PAH exposure (high versus low) were identified for symptoms of anxious/depressed, withdrawn/depressed, social problems, aggressive behavior, internalizing problems, and externalizing problems. The effects of demoralization on syndromes of anxious/depressed, withdrawn/depressed, rule-breaking, aggressive behavior, and the composite internalizing and externalizing scores were seen only in conjunction with high PAH exposure. Fewer significant effects with weaker effect sizes were observed in the low-PAH-exposure group. CONCLUSIONS Maternal demoralization during pregnancy appears to have a greater effect on child neurobehavioral development among children who experienced high prenatal PAH exposure. The results provide the first evidence of an interaction between prenatal exposure to maternal demoralization and air pollution on child neurobehavioral development, indicating the need for a multifaceted approach to the prevention of developmental problems in children.
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Affiliation(s)
- Frederica P. Perera
- Department of Environmental Health Sciences, Mailman School of Public Health,,Columbia Center for Children’s Environmental Health, and
| | - Shuang Wang
- Columbia Center for Children’s Environmental Health, and,Department of Biostatistics and
| | - Virginia Rauh
- Columbia Center for Children’s Environmental Health, and,Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Laura Stigter
- Columbia Center for Children’s Environmental Health, and
| | - David Camann
- Southwest Research Institute, San Antonio, Texas; and
| | - Wieslaw Jedrychowski
- Department of Epidemiology and Preventive Medicine, Jagiellonian University, Krakow, Poland
| | - Elzbieta Mroz
- Department of Epidemiology and Preventive Medicine, Jagiellonian University, Krakow, Poland
| | - Renata Majewska
- Department of Epidemiology and Preventive Medicine, Jagiellonian University, Krakow, Poland
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Myszkowska D, Stobiecki M, Dyga W, Majewska R, Czarnobilska E. A two year survey of the practical application of pollen monitoring in immunotherapy with grass allergens. Allergo J 2013. [DOI: 10.1007/s15007-013-0401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jedrychowski WA, Perera FP, Tang D, Rauh V, Majewska R, Mroz E, Flak E, Stigter L, Spengler J, Camann D, Jacek R. The relationship between prenatal exposure to airborne polycyclic aromatic hydrocarbons (PAHs) and PAH-DNA adducts in cord blood. J Expo Sci Environ Epidemiol 2013; 23:371-7. [PMID: 23299301 PMCID: PMC3733112 DOI: 10.1038/jes.2012.117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 08/14/2012] [Accepted: 11/27/2012] [Indexed: 05/23/2023]
Abstract
In a birth cohort study, we have assessed the dose-response relationship between individual measurements of prenatal airborne polycyclic aromatic hydrocarbon (PAH) exposure and specific PAH-DNA adducts in cord blood adjusted for maternal blood adducts and season of birth. The study uses data from an earlier established birth cohort of children in Krakow. The final analysis included 362 pregnant women who gave birth to term babies and had complete data on personal exposure in the second trimester of pregnancy to eight airborne PAHs including benzo[a]pyrene (B[a]P), as well as DNA adducts, both in maternal and cord blood. The relation between cord blood PAH-DNA adducts and airborne prenatal PAH exposure was non-linear. Although cord blood PAH-DNA adducts were significantly associated with the B[a]P exposure categorized by tertiles (non-parametric trend z=3.50, P<0.001), the relationship between B[a]P and maternal blood adducts was insignificant (z=1.63, P=0.103). Based on the multivariable linear regression model, we estimated the effect of the prenatal airborne B[a]P on the level of cord blood adducts. In total, 14.8% of cord blood adducts variance was attributed to the level of maternal adducts and 3% to a higher prenatal B[a] exposure above 5.70 ng/m(3). The calculated fetal/maternal blood adduct ratio (FMR) linearly increased with B[a]P exposure (z=1.99, P=0.047) and was highest at B[a]P concentrations exceeding 5.70 ng/m(3). In conclusion, the results support other findings that transplacental exposure to B[a]P from maternal inhalation produces DNA damage in the developing fetus. It also confirms the heightened fetal susceptibility to prenatal PAH exposure that should be a matter of public health concern, particularly in the highly polluted areas, because DNA adducts represent a pro-carcinogenic alteration in DNA. The continuation of this birth cohort study will assess the possible health effects of fetal DNA damage on the health of children and help in establishing new protective guidelines for newborns.
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Affiliation(s)
- Wieslaw A Jedrychowski
- Department of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland.
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Mrozek-Budzyn D, Kiełtyka A, Majewska R, Augustyniak M. Measles, mumps and rubella (MMR) vaccination has no effect on cognitive development in children - the results of the Polish prospective cohort study. Vaccine 2013; 31:2551-7. [PMID: 23588083 DOI: 10.1016/j.vaccine.2013.03.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/15/2013] [Accepted: 03/28/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of the study was to examine the hypothesis that MMR exposure has a negative influence on cognitive development in children. Furthermore, MMR was compared to single measles vaccine to determine the potential difference of these vaccines safety regarding children's cognitive development. METHODS The prospective birth cohort study with sample consisted of 369 infants born in Krakow. Vaccination history against measles (date and the type of the vaccine) was extracted from physicians' records. Child development was assessed using the Bayley Scales of Infant Development (BSID-II) up to 3rd year of life, Raven test in 5th and 8th year and Wechsler (WISC-R) in 6th and 7th year. Data on possible confounders came from mothers' interview, medical records and analyses of lead and mercury level at birth and at the end of 5th year of life. Linear and logistic regression models adjusted for potential confounders were used to assess the association. RESULTS No significant differences in cognitive and intelligence tests results were observed between children vaccinated with MMR and those not vaccinated up to the end of the 2nd year of life. Children vaccinated with MMR had significantly higher Mental BSID-II Index (MDI) in the 36th month than those vaccinated with single measles vaccine (103.8±10.3 vs. 97.2±11.2, p=0.004). Neither results of Raven test nor WISC-R were significantly different between groups of children vaccinated with MMR and with single measles vaccine. After standardization to child's gender, maternal education, family economical status, maternal IQ, birth order and passive smoking all developmental tests were statistically insignificant. CONCLUSION The results suggest that there is no relationship between MMR exposure and children's cognitive development. Furthermore, the safety of triple MMR is the same as the single measles vaccine with respect to cognitive development.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034 Krakow, Poland.
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Jedrychowski WA, Perera FP, Spengler JD, Mroz E, Stigter L, Flak E, Majewska R, Klimaszewska-Rembiasz M, Jacek R. Intrauterine exposure to fine particulate matter as a risk factor for increased susceptibility to acute broncho-pulmonary infections in early childhood. Int J Hyg Environ Health 2013; 216:395-401. [PMID: 23333083 DOI: 10.1016/j.ijheh.2012.12.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 11/06/2012] [Accepted: 12/20/2012] [Indexed: 11/24/2022]
Abstract
Over the last decades many epidemiologic studies considered the morbidity patterns for respiratory diseases and lung function of children in the context of ambient air pollution usually measured in the postnatal period. The main purpose of this study is to assess the impact of prenatal exposure to fine particulate matter (PM2.5) on the recurrent broncho-pulmonary infections in early childhood. The study included 214 children who had measurements of personal prenatal PM2.5 exposure and regularly collected data on the occurrence of acute bronchitis and pneumonia diagnosed by a physician from birth over the seven-year follow-up. The effect of prenatal exposure to PM2.5 was adjusted in the multivariable logistic models for potential confounders, such as prenatal and postnatal ETS (environmental tobacco smoke), city residence area as a proxy of postnatal urban exposure, children's sensitization to domestic aeroallergens, and asthma. In the subgroup of children with available PM2.5 indoor levels, the effect of prenatal exposure was additionally adjusted for indoor exposure as well. The adjusted odds ratio (OR) for incidence of recurrent broncho-pulmonary infections (five or more spells of bronchitis and/or pneumonia) recorded in the follow-up significantly correlated in a dose-response manner with the prenatal PM2.5 level (OR=2.44, 95%CI: 1.12-5.36). In conclusion, the study suggests that prenatal exposure to PM2.5 increases susceptibility to respiratory infections and may program respiratory morbidity in early childhood. The study also provides evidence that the target value of 20μg/m(3) for the 24-h mean level of PM2.5 protects unborn babies better than earlier established EPA guidelines.
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Affiliation(s)
- Wiesław A Jedrychowski
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College in Krakow, Poland.
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Majewska R, Mrozek-Budzyn D, Kieltyka A, Augustyniak M. Usefulness of maternal assessment of children development based on reported age of achieved milestones. Przegl Epidemiol 2013; 67:487-587. [PMID: 24340566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
STUDY OBJECTIVE The aim of the study was to examine the usefulness of maternal recall of selected developmental milestones by testing their correlations with the Bayley Scales of Infant Development (BSID-II). MATERIAL AND METHODS Prospective cohort study. The cohort recruited prenatally, included 387 children. The BSID-II tests were carried out in each child at the end of the 12th, 24th and 36th month of life. When children were 3 years old, mothers were questioned about their child's age at attainment of 8 significant developmental milestones. RESULTS The infants who attained developmental milestones earlier in their first years of life were more likely to achieved a better scores on the motor scale of the BSID-II. Correlation coefficients ranged from -0.117 for bladder control to -0.424 for standing without assistance and -0.586 for walking unassisted. Correlation arose when the difference between the time of achieving a particular milestone and time of managing the BSID-II was smaller. CONCLUSION Our study demonstrated that maternal reports of developmental milestones of children under 3 years old are sufficiently reliable to be used in clinical judgment.
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Myszkowska D, Stobiecki M, Dyga W, Majewska R, Czarnobilska E. [A three year survey of the practical application of pollen monitoring in specific allergen immunotherapy]. Przegl Lek 2013; 70:1027-1032. [PMID: 24720121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Specific allergen immunotherapy should be modified according to sensitivity of the patient and the time interval between injections and seasonal allergen exposition. The aim of the study was to check the effectiveness of the multinomial logistic regression models predicting the pollen concentration during the pollen season in the immunotherapy trial in patients treated with grass and birch allergens. The study was performed in Krakow in 2011-2013. Models were validated for 2012 and 2013. The effectiveness of the total correct predictions slightly differed depending on the time series, in case of birch pollen the similar percentage of correct predictions was found in both study year, while in case of grass pollen, the predictions were more correct in 2012. A group of patients treated with grass and birch allergens filled in the diary cards during the pollen season. After the 2011 season 14 diary cards were analysed, while 18 and 19, in 2012 and 2013, respectively. Because of manifested symptoms, the injection dose was reduced during the season in 12 patients in 2011, in 9 patients in 2012 and in 6 patients in 2013. No visits were delayed because of medical indications. In some cases patients got the injection in time of the high pollen occurrence (2 cases, in 2011 and 2012). In 2013 in 10/17 patients the high pollen exposure was avoided thanks the information from pollen monitoring, in opposite to 1 and 8 patients in 2011 and 2012, respectively. Patients used antihistaminic drugs on request. The regional pollen monitoring data and satisfied co-operation with patients makes the possibility of closer control of the injection doses administration during immunotherapy in the pollen season.
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Mrozek-Budzyn D, Majewska R, Kiełyka A, Augustyniak M. The frequency and risk factors of allergy and asthma in children with autism--case-control study. Przegl Epidemiol 2013; 67:675-764. [PMID: 24741916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The evolution of autistic disorders in children depends on many factors, like concomitance of the other diseases, which can escalate the autistic symptoms. One of those groups are allergic diseases, which have one of the highest prevalence rates in children. OBJECTIVES The aim of this analysis was to determine the frequency of asthma and allergy in children with autism in comparison to controls and the risk factors of allergic diseases and asthma in both groups. MATERIAL AND METHODS Study population included 96 cases diagnosed with childhood or atypical autism and 192 controls matched individually by year of birth, gender and physician's practice. The analysis was performed in each group separately giving possibility to compare the results between study groups. RESULTS The frequency of asthma and allergic diseases in both groups has not revealed any statistically significant differences. Children with autism have been affected by asthma in 5,2% and by allergy in 25,0%, controls in 4,7% and 21,9% respectively. All cases of asthma was diagnosed in boys, commonly allergy was also more frequent in boys than girls in both studied groups. However those differences was statistically insignificant. The father's allergy and asthma was revealed as a risk factor of allergy in children with autism. In controls additionally allergy or asthma diagnosed in mother or grandparent increased risk of allergy in children. CONCLUSIONS Children with autism were affected by asthma and allergy with similar frequency like children without autistic disorders. Allergy in father was the risk factor of allergic diseases in children with autism.
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Augustyniak M, Mrozek-Budzyn D, Kieltyka A, Majewska R. Stability of the mental and motor Bayley Scales of Infant Development (2nd ed.) in infants over first three years of life. Przegl Epidemiol 2013; 67:483-584. [PMID: 24340565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Despite the Bayley Scales of Infant Development second edition (BSID-II) are wide used both clinically and in research settings, only a few published studies have been examined their stability over time. AIM OF STUDY The aim of this study was to examine the stability of mental and motor BSID-II scores over the first three years of life. MATERIAL AND METHODS All children included in this study were a sample followed up in a study on the susceptibility of the fetus and child to environmental factors. The cohort recruited prenatally in Krakow Poland, included 408 children. The mental and motor scales of BSID-II were administered to infants at the end of 12th, 24th and 36th month of life. Stability of the test scores from first to second and third assessment was evaluated using the Pearson's correlation coefficient calculated for the entire group of infants, and for the each gender separately. RESULTS The older infants obtained the better outcomes in BSID-II. The correlation between the first and second assessments for the Psychomotor Developmental Index (PDI) was r = 0.30, for the Mental Developmental Index (MDI) was r = 0.33, and between the second and third assessments the correlation for the PDI was r = 0.40, for the MDI was r = 0.59. That results suggest a low or moderate degree of relationship between the tests outcomes. Only 8,8% to 34,8% of variance in the infants later BSID-II scores could be explained by their earlier scores. The correlation between the tests scores was higher between outcomes obtained by girls than boys. CONCLUSION The BSID-II should not be treated as a useful measure for predictive purposes of infants development.
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Mrozek-Budzyn D, Majewska R, Kieltyka A, Augustyniak M. Neonatal exposure to Thimerosal from vaccines and child development in the first 3years of life. Neurotoxicol Teratol 2012; 34:592-7. [DOI: 10.1016/j.ntt.2012.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
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Vrijheid M, Casas M, Bergström A, Carmichael A, Cordier S, Eggesbø M, Eller E, Fantini MP, Fernández MF, Fernández-Somoano A, Gehring U, Grazuleviciene R, Hohmann C, Karvonen AM, Keil T, Kogevinas M, Koppen G, Krämer U, Kuehni CE, Magnus P, Majewska R, Andersen AMN, Patelarou E, Petersen MS, Pierik FH, Polanska K, Porta D, Richiardi L, Santos AC, Slama R, Sram RJ, Thijs C, Tischer C, Toft G, Trnovec T, Vandentorren S, Vrijkotte TGM, Wilhelm M, Wright J, Nieuwenhuijsen M. European birth cohorts for environmental health research. Environ Health Perspect 2012; 120:29-37. [PMID: 21878421 PMCID: PMC3261945 DOI: 10.1289/ehp.1103823] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [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: 04/14/2011] [Accepted: 08/29/2011] [Indexed: 05/03/2023]
Abstract
BACKGROUND Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning. OBJECTIVES Our goal was to create a comprehensive overview of European birth cohorts with environmental exposure data. METHODS Birth cohort studies were included if they a) collected data on at least one environmental exposure, b) started enrollment during pregnancy or at birth, c) included at least one follow-up point after birth, d) included at least 200 mother-child pairs, and e) were based in a European country. A questionnaire collected information on basic protocol details and exposure and health outcome assessments, including specific contaminants, methods and samples, timing, and number of subjects. A full inventory can be searched on www.birthcohortsenrieco.net. RESULTS Questionnaires were completed by 37 cohort studies of > 350,000 mother-child pairs in 19 European countries. Only three cohorts did not participate. All cohorts collected biological specimens of children or parents. Many cohorts collected information on passive smoking (n = 36), maternal occupation (n = 33), outdoor air pollution (n = 27), and allergens/biological organisms (n = 27). Fewer cohorts (n = 12-19) collected information on water contamination, ionizing or nonionizing radiation exposures, noise, metals, persistent organic pollutants, or other pollutants. All cohorts have information on birth outcomes; nearly all on asthma, allergies, childhood growth and obesity; and 26 collected information on child neurodevelopment. CONCLUSION Combining forces in this field will yield more efficient and conclusive studies and ultimately improve causal inference. This impressive resource of existing birth cohort data could form the basis for longer-term and worldwide coordination of research on environment and child health.
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Affiliation(s)
- Martine Vrijheid
- Centre for Research in Environmental Epidemiology, Doctor Aiguader 88, Barcelona, Spain.
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Mrozek-Budzyn D, Agnieszka K, Majewska R, Augustyniak M. [The influence of rotavirus vaccinations on the risk of gastrointestinal infections in children. Methods and preliminary results]. Przegl Epidemiol 2012; 66:459-464. [PMID: 23230717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED The gastrointestinal infection in infants are the significant health and epidemiological issue. The voluntary rotavirus vaccines was included to Polish vaccination schedule in 2007. AIM OF THE STUDY Aim of the study was the assessment of rotaviruses vaccines effectiveness in prevention of rotavirus gastrointestinal infections requiring hospitalization and the influence or these vaccinations on the risk of gastrointestinal outpatient infections. The additional aim of the study was determine the incidence of adverse events following immunization caused by rotavirus vaccinations and comparison of both vaccines--Rotarix and RotaTeq with respect to the mentioned objectives. MATERIALS AND METHODS The retrospective cohort study was designed to achieve the aims of study. The study cohort included infants from Malopolska Voivodeship vaccinated with rotavirus vaccine in 2007-2008 and eligible matched unvaccinated children. The preliminary study was conducted in 2011. RESULTS The cohort study included 74 vaccinated and 74 unvaccinated infants. The preliminary analysis revealed that infants vaccinated against rotavirus had 40% lower risk to be affected by gastrointestinal infections in comparison to unvaccinated children. Nevertheless the results were not statistically significant owing to the scarce number of infants in pilot study group (95% CI: 0,27-1,30). CONCLUSION The preliminary results indicates, that the rotavirus vaccines have the positive influence on the decrease risk of gastrointestinal infections in children up to 2 years of years but the evidence is not sufficient yet, to be conclusive. The ongoing survey is given the possibility to gain the bigger cohort under study and to attain the presumed objectives.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Katedra Epidemiologii i Medycyny Zapobiegawczej, Uniwersytet Jagiellotiski, Collegium Medicum.
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Jedrychowski W, Spengler JD, Maugeri U, Miller RL, Budzyn-Mrozek D, Perzanowski M, Flak E, Mroz E, Majewska R, Kaim I, Perera F. Effect of prenatal exposure to fine particulate matter and intake of Paracetamol (Acetaminophen) in pregnancy on eczema occurrence in early childhood. Sci Total Environ 2011; 409:5205-5209. [PMID: 21962593 PMCID: PMC3428593 DOI: 10.1016/j.scitotenv.2011.08.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/05/2010] [Revised: 08/22/2011] [Accepted: 08/29/2011] [Indexed: 05/31/2023]
Abstract
The goal of the study was to test the hypothesis that prenatal Paracetamol exposure increases the risk of developing eczema in early childhood and that this association may be stronger in children who are exposed in fetal period to higher concentrations of fine particulate matter (PM2.5). The study sample consisted of 322 women recruited from January 2001 to February 2004 in the Krakow inner city area who gave birth to term babies and completed 5-year follow-up. Paracetamol use in pregnancy was collected by interviews and prenatal personal exposure to PM2.5 over 48 h was measured in recruited women in the second trimester of pregnancy. After delivery, every three months in the first 24 months of the newborn's life and every 6 months later, a detailed standardized face-to-face interview on the infant's health was administered to each mother by trained interviewers. During the interviews at each of the study periods after birth, a history of eczema was recorded. The incident rate ratio (IRR) for frequency of eczema events over the follow-up was estimated from the Poisson regression model and the overall effect of main exposure variables on eczema was assessed by odds ratios (ORs) by the logistic model. The estimated relative risk of eczema occurring whenever in the follow-up was related significantly neither with prenatal Paracetamol nor higher PM2.5 exposure, however, their joint effect was significant (OR interaction term=6.04; 95%CI: 1.04-35.16). Of potential confounders considered in the analysis only damp/moldy home significantly increased the risk of eczema (OR=1.53; 95%CI: 1.14-2.05). In contrast, there was an inverse significant association between the presence of older siblings and eczema (OR=0.55; 95%CI: 0.35-0.84). The joint effect of the main exposure variables significantly increased frequency of eczema events (IRR=1.78, 95%CI: 1.22-2.61). In conclusion, the findings of the study suggest that Paracetamol use by mothers in pregnancy is not an independent risk factor for eczema in children, however, even very small doses of Paracetamol taken in pregnancy may contribute to the occurrence of allergic symptoms in early childhood if there is prenatal co-exposure to higher airborne fine particulate matter.
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Affiliation(s)
- Wieslaw Jedrychowski
- Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland.
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Jedrychowski W, Perera F, Maugeri U, Mroz E, Flak E, Perzanowski M, Majewska R. Wheezing and asthma may be enhanced by broad spectrum antibiotics used in early childhood. Concept and results of a pharmacoepidemiology study. J Physiol Pharmacol 2011; 62:189-95. [PMID: 21673367 PMCID: PMC3684948] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 04/28/2011] [Indexed: 05/30/2023]
Abstract
UNLABELLED One of the mechanisms supposed to explain the increasing prevalence of asthma, among children in particular, is the use of antibiotics because they may modify natural microbial exposure and development of the immune system in early childhood. The aim of this study is to investigate the association between the use of various classes of antibiotics (penicillin, cephalosporin and macrolide derivatives) in early childhood and the medical diagnosis of asthma or wheezing reported by mothers over the follow-up after adjustment for potential confounders and respiratory infections. In a population-based sample of 5-year-olds, a part of the ongoing birth cohort study, the standardized interviews on health outcomes, potential confounders (child's gender, maternal atopy, parity, prenatal and postnatal environmental tobacco smoke) and the use of antibiotics were gathered from mothers of 310 children. While the overall use of antibiotics during the early childhood was insignificantly associated with asthma (adjusted OR = 1.65, 95%CI: 0.93 - 2.93), the risk estimates were significant both for macrolide antibiotics (adjusted OR=2.14, 95%CI: 1.16-3.95) and cephalosporins (OR=1.98, 95%CI: 1.14-3.37). The significant excess in IRR (incident risk ratio) of wheezing episodes was related only to the use of macrolide antibiotics (adjusted IRR=1.91, 95%CI: 1.12-3.27). The use of other classes of antibiotics was found not to be associated with the medical diagnosis of asthma or wheezing episodes recorded in the study period. CONCLUSION as early childhood use of broad spectrum antibiotics is associated with an increased risk of developing asthma in 5-year-olds, it may be hypothesized that the antibiotic- related suppression of allergic inflammatory responses in the course of treatment may later lead to greater than before atopic immune response in Th2 children or an impairment of Th1 immune responses in early childhood.
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Affiliation(s)
- W Jedrychowski
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Cracow, Poland.
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Jedrychowski W, Perera F, Maugeri U, Miller RL, Rembiasz M, Flak E, Mroz E, Majewska R, Zembala M. Intrauterine exposure to lead may enhance sensitization to common inhalant allergens in early childhood: a prospective prebirth cohort study. Environ Res 2011; 111:119-24. [PMID: 21094490 PMCID: PMC3026073 DOI: 10.1016/j.envres.2010.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [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: 03/30/2010] [Revised: 11/03/2010] [Accepted: 11/05/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Several in vivo and in vitro studies have shown that metal-rich particles may enhance allergic responses to house dust mites and induce an increased release of allergy-related cytokines. OBJECTIVES The main goal of this analysis is to define the possible association of intrauterine exposure to lead and mercury with the occurrence of skin sensitization to common aeroallergens in early childhood. MATERIAL AND METHODS The present study refers to a sample of 224 women in the second trimester of pregnancy recruited from Krakow inner city area who had full term pregnancies and whose children underwent skin prick testing (SPT) at the age of 5. Lead and mercury levels were assessed in cord blood and retested in children at age of 5 years. Aeroallergen concentrations in house dust were measured at the age of 3 years. The main health outcome (atopic status) was defined as the positive SPT to at least one common aeroallergen (Der f1, Der p1, Can f1 and Fel d1) at the age of 5 years. In the statistical analysis of the association between atopic status of children and exposure to metals, the study considered a set of covariates such as maternal characteristics (age, education, atopy), child's gender, number of older siblings, prenatal (measured via cord blood cotinine) and postnatal environmental tobacco smoke together with exposure to polycyclic aromatic hydrocarbons (PAH) as measured by PAH-DNA adducts. RESULTS AND CONCLUSION In the binary regression analysis, which controlled for the confounders, the risk ratio (RR) estimate for atopic sensitization was significantly associated with the lead exposure (RR=2.25, 95%CI: 1.21-4.19). In conclusion, the data suggest that even very low-level of prenatal lead exposure may be implicated in enhancing sensitization to common aeroallergens in early childhood.
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Affiliation(s)
- Wieslaw Jedrychowski
- Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7 Kopernika Str., Krakow, Poland.
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Mrozek-Budzyn D, Majewska R, Kiełtyka A, Augustyniak M. [Lack of association between thimerosal-containing vaccines and autism]. Przegl Epidemiol 2011; 65:491-495. [PMID: 22184954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In Poland, administered childhood vaccines still contain thimerosal as a preservative. Despite the access to mercury free formulas, the most of children are still vaccinated by thimerosal-containing vaccines (TCV) owing to economical reasons. That circumstances caused the rising discussion on potential harmful influence of TCVs on children health. The objective of this analysis was to determine an association of TCVs exposure with the risk of autism. Study population included 96 cases diagnosed with childhood or atypical autism and 192 controls matched individually by year of birth, gender, and physician's practice. Data on autism diagnose and vaccination history were from GPs. Data on the other possible autism risk factors were collected from mothers. Conditional logistic regression was used to assess the risk of autism due to TCVs exposure. No significant association was found between TCVs exposure and autism. After adjusting to potential confounders, odds ratios of the risk of autism developing for infants vaccinated with TCVs were 1.52 (95% CI: 0.29-11.11) for doses 12.5-87.5 microg, 2.78 (95% CI: 0.29-11.11) for 100-137.5 microg and 1.97 (95% CI: 0.37-18.95) for these exposed > or = 150 microg. Our study revealed no evidence of an association between TCVs and autism.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Katedra Epidemiologii i Medycyny Zapobiegawczej, Uniwersytet Jagielloński - Collegium Medicum, Kraków.
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Mrozek-Budzyn D, Kiełtyka A, Majewska R, Augustyniak M. [The parents opinion on the risk factors of autism in their children]. Przegl Epidemiol 2011; 65:101-105. [PMID: 21735845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The mothers' opinions about the reasons of their children autism have been collected during case-control study on risk factors of that disease. The relationship between different opinions and mothers' characteristics have been analyzed. The categories of autism reasons mentioned by mothers have been related to the current knowledge about the risk factors of disease.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Katedra Epidemiologii i Medycyny Zapobiegawczej, Uniwersytet Jagielloński-Collegium Medicum.
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Jedrychowski W, Maugeri U, Perera FP, Mroz E, Klimaszewska-Rembiasz M, Flak E, Edwards S, Majewska R, Sowa A. Early wheeze as reported by mothers and lung function in 4-year-olds. Prospective cohort study in Krakow. Pediatr Pulmonol 2010; 45:919-26. [PMID: 20672363 PMCID: PMC3691468 DOI: 10.1002/ppul.21273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
SUMMARY The purpose of the study was to check the hypothesis that early wheezing as reported by mothers would be associated with reduced lung function in 4-year olds. Study participants were recruited prenatally, as part of a prospective cohort study on the respiratory health of young children exposed to various ambient air pollutants. After delivery, infants were followed over 4 years and the interviewers visited participants at their home to record respiratory symptoms every 3 months in the child's first 2 years of life and every 6 months in the 3rd and 4th years. In the 4th year of follow-up, children were invited for standard lung function testing by spirometry quantified by forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV(1)), and forced expiratory volume in 0.5 sec (FEV(0.5)) levels. Out of 258 children attending spirometry testing 139 performed at least two acceptable exhalation efforts. Cohort children with acceptable spirometric measurements did not differ with respect to wheezing experience and exposure characteristics from those without. The study shows that episodic wheeze was reported in 28.1% of 4-year olds, 6.5% had transient wheeze, and 4.3% had recurrent wheeze. There was an increased frequency of wheezing symptoms and their duration in transient and recurrent wheezers. Adjusted multivariable regression models for gender and height showed that children who reported more than two episodes of wheezing at any point over the follow-up had FVC values lower by 120.5 ml (P = 0.016) and FEV(1) values lower by 98.3 ml (P = 0.034) compared to those who did not report any wheezing; children experiencing more than 10 wheezing days by age 4 showed FVC deficit of 87.4 ml (P = 0.034) and FEV(1) values of 65.7 ml (P = 0.066). The ratios of FEV(1)/FVC%, and FEV(0.5)/FVC% were neither associated with wheezing episodes nor wheezing days. In recurrent wheezers, lung function decrement amounted to 207 ml of FVC, 175 ml of FEV(1), and 104 ml of FEV(0.5). In conclusion, our findings show that wheezing experience during early postnatal life may be associated with lung function deficit of restrictive character in preschool children and detailed history of wheeze in early postnatal life, even though not physician-confirmed, may help define the high risk group of children for poor lung function testing.
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Affiliation(s)
- Wieslaw Jedrychowski
- Epidemiology and Preventive Medicine, Medical College, Jagiellonian University, Krakow, Poland.
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Mrozek-Budzyn D, Kiełtyka A, Majewska R. [Lack of association between MMR vaccination and the incidence of autism in children: a case-control study]. Przegl Epidemiol 2009; 63:107-112. [PMID: 19522237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The matched case-control study has been undertook to investigate whether measles, mumps, and rubella (MMR) vaccine may be casually associated with autism in children. Cases were children to 14-year old with diagnosis of core autism or atypical autism. Controls were matched on age, sex and general practice. The 96 cases and 192 controls were included. The study provides strong evidence against association of autism with both MMR and a single measles individual vaccine. Additionally children vaccinated with MMR, regardless of age of vaccination (to 18th, 24th and 36th month of life), had risk equal half of that of single measles vaccinated (for vaccinated to 18th month OR=0.41 95%PU: 0.20-0.85). Our findings confirm that MMR vaccination is not associated with an increased risk of autism in children.
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Affiliation(s)
- Dorota Mrozek-Budzyn
- Zakład Epidemiologii Katedra Epidemiologii i Medycyny Zapobiegawczej Uniwersytet Jagielloński Collegium Medicum
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