Essential and Toxic Elements in Infant Cereal in Brazil: Exposure Risk Assessment

Infant cereals, one of the first solid foods introduced to infants, have been reported to pose risks to human health because they contain toxic elements and an excess of essential elements. The objective of this study was to assess the cancer and non-cancer risk of exposure to essential and toxic elements in infant cereal in Brazil. In our analyses, we included data from 18 samples of infant cereals made from different raw materials and estimated the incremental lifetime cancer risks and non-cancer hazard quotients (HQs) for their consumption. Rice cereal is particularly concerning because it is immensely popular and usually contains high levels of inorganic arsenic. In addition to arsenic, we assessed aluminum, boron, barium, cadmium, chromium, copper, lead, manganese, nickel, selenium, silver, strontium, and zinc. The cancer risk was highest for rice cereal, which was also found to have an HQ > 1 for most of the tested elements. Inorganic As was the element associated with the highest cancer risk in infant cereal. All of the infant cereals included in this research contained at least one element with an HQ > 1. The essential and non-essential elements that presented HQ > 1 more frequently were zinc and cadmium, respectively. The cancer and non-cancer risks could potentially be decreased by reducing the amount of toxic and essential elements (when in excess), and public policies could have a positive influence on risk management in this complex scenario.

The Primary Prevention of Atopy: Does Early Exposure to Cats and Dogs Prevent the Development of Allergy and Asthma in Children? A Comprehensive Analysis of the Literature

The current literature shows mixed results relating to the significance of environmental exposure, such as owning a pet, and the development of atopy in children. Our review aimed to collect the most recent evidence on the association between early-life cat and dog ownership and the development of allergy and asthma. A comprehensive literature review was performed using PubMed and Scopus. The search included the main keywords of our PICO: (((early exposure) AND (children) AND (allergy)) OR (asthma)) AND (dog) OR (cat). Randomized controlled trials (RCTs), case-control studies, clinical trials, meta-analyses, and systematic reviews of children within the last five years (2018-2023) were searched and included. During the search process, 52 articles from PubMed and 43 from Scopus were found. A total of 17 articles were deemed to be suitable and included. Fairly consistent results regarding early exposure to pets, in particular dogs, and the prevention of food allergies have been described. Furthermore, there seems to be a protective effect against allergy and asthma in relation to the number of pets owned. The likelihood of a child developing allergy and asthma seems to be influenced by various factors, including the child's genetic background and early exposure to different environmental factors, including allergens that may interact with the gut microbiota and immune system.

The Transition to Ophthalmology Residency: A National Survey of the Combined Ophthalmology PGY-1 Program

Background  In 2017, the Accreditation Council for Graduate Medical Education announced all ophthalmology residency programs would provide a combined transitional or joint preliminary program for first postgraduate year (PGY-1) residents, with mandatory implementation by 2023. Purpose  This study aimed to survey ophthalmology residency program directors, postgraduate year 2 (PGY-2) ophthalmology residents who were a part of the first, official combined ophthalmology PGY-1 year, and postgraduate year 3 (PGY-3) residents who were a PGY-1 resident the year prior to integration to evaluate characteristics and perspectives on the combined ophthalmology PGY-1 year. Methods  A national, internet survey-based study approved by the Association of University Professors of Ophthalmology (AUPO) was disseminated to the AUPO listserv of program directors (PDs) and PGY-2 and PGY-3 ophthalmology residents from July to August 2022 and then again April to June 2023. Results  Twenty-six PDs completed the survey (response rate 20.3% out of 128 PDs). Forty-one PGY-2 ophthalmology residents who underwent the combined ophthalmology PGY-1 year and 33 PGY-3 ophthalmology residents also completed the survey. Most PGY-1 curricula focused on exposure to comprehensive ophthalmology and provided indirect ophthalmoscope, slit lamp, and refraction skills training to residents. Early exposure to fundamentals and clinical workflows were commonly cited benefits to the integration. When PDs were surveyed about how well-prepared PGY-1 residents who went through the combined year are for the PGY-2 relative to the prior year's class, 16 (61.5%) responded "better prepared." PGY-2 residents also reported a relatively higher level of clinical preparedness and familiarity with ophthalmology co-residents than PGY-3 residents. Several areas of improvement cited by both PDs and residents were identified including a dedicated didactic curriculum and more time in ophthalmology during the PGY-1 year. Conclusions  We found an overall net benefit from the integration of the combined ophthalmology PGY-1 year. Benefits include early exposure to clinical skills and knowledge specific to ophthalmology, leading to increased confidence and preparedness for the rigorous transition to ophthalmology residency. We also identified many areas for improvement to optimize the PGY-1 year including a formal curriculum and additional time in ophthalmology. Programs should work closely with their residents, faculty, and non-ophthalmology PDs to refine the PGY-1 for the benefit of future ophthalmologists.

Inflammation and Autophagy: A Convergent Point between Autism Spectrum Disorder (ASD)-Related Genetic and Environmental Factors: Focus on Aluminum Adjuvants

Autism spectrum disorder (ASD), schizophrenia, and bipolar disorder are genetically complex and heterogeneous neurodevelopmental disorders (NDDs) resulting from genetic factors and gene-environment (GxE) interactions for which onset occurs in early brain development. Recent progress highlights the link between ASD and (i) immunogenetics, neurodevelopment, and inflammation, and (ii) impairments of autophagy, a crucial neurodevelopmental process involved in synaptic pruning. Among various environmental factors causing risk for ASD, aluminum (Al)-containing vaccines injected during critical periods have received special attention and triggered relevant scientific questions. The aim of this review is to discuss the current knowledge on the role of early inflammation, immune and autophagy dysfunction in ASD as well as preclinical studies which question Al adjuvant impacts on brain and immune maturation. We highlight the most recent breakthroughs and the lack of epidemiological, pharmacokinetic and pharmacodynamic data constituting a "scientific gap". We propose additional research, such as genetic studies that could contribute to identify populations at genetic risk, improving diagnosis, and potentially the development of new therapeutic tools.

Early-life exposure to antibiotics and subsequent development of atopic dermatitis

BACKGROUND

Antibiotic exposure may be associated with atopic dermatitis (AD). The objective of the study is to examine the risk of developing AD among children exposed early to antibiotics.

RESEARCH DESIGN AND METHODS

From the Italian Pedianet database, children aged 0-14 years between 2004-2017 were enrolled from birth up to at least one year. Cox proportional-hazards models were fitted to estimate Hazard Ratios (HR) and 95% Confidence Intervals (CI) for the association between antibiotic exposure during the first year of life with incident AD. Exposure was also considered as a time-varying variable.

RESULTS

73,816 children were included in the final cohort, of which 34,202 had at least one antibiotic prescription. Incident AD was present in 8% of unexposed and exposed children. Early antibiotic exposure was not associated with any excess risk of AD compared to unexposed children (HR: 1.02, 95% CI: 0.97-1.07), and no dose-response effect was observed. In the time-varying analysis, antibiotic exposure was significantly associated with AD onset (1.12, 1.07-1.17). However, when taking into account the time-lag between exposure and outcome, risks progressively decreased, suggesting possible protopathic bias.

CONCLUSION

These results are not suggestive of any significant association between exposure to antibiotics and subsequent AD onset and support the possible presence of protopathic bias.

Does Early Exposure to Chinese-English Biliteracy Enhance Cognitive Skills?

Clarifying the effects of biliteracy on cognitive development is important to understanding the role of cognitive development in L2 learning. A substantial body of research has shed light on the cognitive factors contributing to biliteracy development. Yet, not much is known about the effect of the degree of exposure to biliteracy on cognitive functions. To fill this research void, we measured three categories of biliteracy skills (language, reading, and cognitive-linguistic skills in both Chinese and English) jointly and investigated the effects of biliteracy skill performance in these three categories on cognitive skills (working memory and attentional control) in Chinese L1 children who were exposed to English as L2 beginning at age 3 ("early") or in grade 3 ("late"). In this cross-sectional study, 10 parallel Chinese and English language, reading, and cognitive-linguistic measures were administered to emerging Chinese-English bilingual children in grade 3 (n = 178) and grade 6 (n = 176). The results revealed that early exposure to Chinese-English biliteracy enhanced cognitive skills but with a cost of a slight delay in performance on Chinese L1 language skills in grade 3 (but not in grade 6). Importantly, the present findings suggest that, in addition to universal and developmental processes, the cumulative effect of early and sustained bi-scriptal exposure enhances working memory and attention in school children.

The Effect of Early Life Exposure to Triclosan on Thyroid Follicles and Hormone Levels in Zebrafish

Triclosan (TCS) is an antimicrobial chemical widely used in personal care products. Most of the TCS component is discharged and enters the aquatic ecosystem after usage. TCS has a similar structure as thyroid hormones that are synthesized by thyroid follicular epithelial cells, thus TCS has a potential endocrine disrupting effect. It is still not clear how the different levels of the environmental TCS would affect early development in vivo. This study examines the effects of TCS on thyroid hormone secretion and the early development of zebrafish. The fertilized zebrafish eggs were exposed to TCS at 0 (control), 3, 30, 100, 300, and 900 ng/mL, and the hatching rate and the larvae mortality were inspected within the first 14 days. The total triiodothyronine (TT₃), total thyroxine (TT₄), free triiodothyronine (FT₃), and free thyroxine (FT₄) were measured at 7, 14, and 120 days post-fertilization (dpf). The histopathological examinations of thyroid follicles were conducted at 120 dpf. TCS exposure at 30-300 ng/mL reduced the hatching rate of larvae to 34.5% to 28.2 % in the first 48 hours and 93.8 .7 % to 86.8 % at 72 h. Extremely high TCS exposure (900 ng/mL) strongly inhibited the hatching rate, and all the larvae died within 1 day. Exposure to TCS from 3 to 300 ng/mL reduced the thyroid hormones production. The mean TT₃ and FT₃ levels of zebrafish decreased in 300 ng/mL TCS at 14 dpf (300 ng/mL TCS vs. control : TT₃ , 0.19 ± 0.08 vs. 0.39 ± 0.06; FT₃, 19.21 ± 3.13 vs. 28.53 ± 1.98 pg/mg), and the FT₄ decreased at 120 dpf ( 0.09 ± 0.04 vs. 0.20 ± 0.14 pg/mg). At 120 dpf , in the 300 ng/mL TCS exposure group, the nuclear area and the height of thyroid follicular epithelial cells became greater, and the follicle cell layer got thicker. This happened along with follicle hyperplasia, nuclear hypertrophy, and angiogenesis in the thyroid. Our study demonstrated that early life exposure to high TCS levels reduces the rate and speed of embryos hatching, and induces the histopathological change of thyroid follicle, and decreases the TT₃, FT₃, and FT₄ production in zebrafish.

Ciprofloxacin exposure and adverse pregnancy outcomes: a Danish nationwide cohort study

Objective

To examine the association between maternal exposure to ciprofloxacin and the risk of miscarriage and major malformations.

Design

A nationwide register‐based cohort study.

Setting

Data were obtained from the Medical Birth Registry, the National Hospital Registry, the Danish National Prescription Registry and Statistics Denmark.

Population

Data were collected in the period between 1997 and 2016 and included all registered pregnancies that ended in an elective termination, miscarriage, stillbirth or a live birth. Exposure was defined as redeeming one or more prescriptions of ciprofloxacin.

Methods

Miscarriage was defined as a diagnosis given before 22 weeks without any medical intervention. Major malformations were classified according to EUROCAT 1.4. We matched ciprofloxacin‐exposed pregnancies to unexposed pregnancies on the propensity score in a ratio 1:4. To estimate the hazard ratio (HR) of miscarriage a Cox proportional hazard regression model was used. A log binomial model was used to estimate the relative risk ratio (RR) of major malformations.

Main outcome measures

HR of miscarriage and the RR of major malformations.

Results

A total of 1 650 649 pregnancies were identified. Of these, 10 250 (2050 ciprofloxacin‐exposed) and 6100 (1220 ciprofloxacin‐exposed) were included in the miscarriage and major malformation analysis, respectively. The HR of miscarriage was 0.99 (95% confidence interval [CI] 0.84–1.17). For major malformation, the RR was 1.01 (95% CI 0.72–1.40). For the organ‐specific major malformations and the sensitivity analyses, no significant increased risks were identified.

Conclusion

We demonstrated no association between miscarriage and maternal ciprofloxacin exposure within the first 22 weeks of pregnancy, or between major malformations and maternal exposure during the first trimester.

Tweetable abstract

No association between maternal ciprofloxacin exposure and adverse pregnancy outcomes.

No association between maternal ciprofloxacin exposure and adverse pregnancy outcomes.

Inspiring Women in Engineering and Medicine: The Impact of a One-Day STEM Experience on High School Females' Attitude Toward Male-Dominant Professions

OBJECTIVE

Inspiring Women in Orthopedics and Engineering (IWEM) is a program founded by UConn Health orthopedic surgeon Dr. Katherine Coyner (KC) focused on boosting diversity and introducing young women to the traditionally male-dominant fields of orthopedics and engineering. Over the course of one day, we assessed change in interest in (1) STEM, (2) medical school, (3) orthopedic surgery, and (4) confidence in performing basic surgical skills.

DESIGN

Pre- and postevent matched surveys.

SETTING

UConn Health, Department of Orthopedic Surgery.

PARTICIPANTS

Ten IWEM events were held from 2018 to 2020. Data was collected on a total of 475 female high school student applicants from across Connecticut were accepted into one of the IWEM workshops based on their responses to short answer questions.

RESULTS

In response to the statement "I am interested in orthopedics" 127 students (27%, p < 0.01) changed their answer after participating in the IWEM workshop and a significant number of participants reported feeling more confident and competent in the use of power tools as well as a self-reported increased understanding of basic orthopedic surgery knowledge. Additionally, participants scored significantly higher on a 6-question quiz evaluating orthopedic knowledge after attending the workshop.

CONCLUSIONS

An immersive 1-day program that provides exposure to orthopedic surgery and STEM careers creates increased interest in these fields and may combat the large gender disparity that persists in these fields today.

Preventing Atopic Diseases During Childhood - Early Exposure Matters

Atopic diseases in childhood are a major burden worldwide and there is still a lack of knowledge about treatable causes. In industrialized countries such as Germany, almost every second child is sensitized to at least one common allergen. Recent studies show that although the predisposition to allergies is inherited, the adaptive immune system of neonates and infants follows a developmental trajectory and whether an allergy actually occurs depends also on timing of allergen exposure including diet as well as environmental factors. New recommendations are far from being rigid of allergen avoidance; it is rather moving toward conditions that stand for more biodiversity. The observation that introduction of peanuts or eggs early in life significantly reduced the development of a later allergy will change our recommendations for the introduction of complementary foods. This is consistent with the hygiene hypothesis that early provocation shapes the developing immune system so that it reacts appropriately. Therefore, promoting the development of tolerance is at the heart of sensible allergy prevention - and this begins with the last trimester of pregnancy. In light of this concept, actual recommendations are discussed.

Detection of Phytoestrogen Metabolites in Breastfed Infants' Urine and the Corresponding Breast Milk by Liquid Chromatography-Tandem Mass Spectrometry

To date, there has been limited information on phytoestrogen (PE) exposure and metabolism in breastfed infants. In the present work, 50 sample pairs of Chinese breastfed infants' urine and the corresponding breast milk were collected. The contents of the relevant PE metabolites in the biosamples were detected via liquid chromatography-tandem mass spectrometry. The correlations between the PE metabolite contents in breastfed infants' urine and those in the corresponding breast milk were analyzed. The average concentrations of total PE metabolites in breast milk and urine were 0.27 and 0.23 nmol/mL, respectively. Genistein and enterolactone levels in the infant urine were positively correlated with their concentrations in the corresponding breast milk samples, which implies that urine excretion can be utilized as a noninvasive parameter for precise genistein and enterolactone intake assessment. Additionally, the efficiency of PE urine excretion showed significant differences across infants with different ages, genders, and durations of pregnancy.

Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection

Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical students and decrease the frequency with which they perform these procedures in the future. The authors sought to change this paradigm by: (1) introducing a suturing module to first-year medical students in the context of the anatomy dissection laboratory and (2) measuring its effects on student attitudes and behavior over the course of their third-year clerkships when they encounter patients. The authors found that early and prolonged introduction to suturing was associated with increased student confidence relative to suturing a patient. Participation in the suturing module was associated with increased student confidence in identifying suturing instruments (P < 0.001) and suturing patients (P = 0.013). Further it positively affected their behavior as demonstrated by increased performance of suturing events from students exposed to the suturing module. (P < 0.001) This study demonstrates that early and prolonged opportunities to practice a procedural skill in a low-stress environment increases student confidence during patient interactions and alters student behavior.

Learning to like vegetables during breastfeeding: a randomized clinical trial of lactating mothers and infants

Background: What lactating mothers eat flavors breast milk and, in turn, modifies their infants' acceptance of similarly flavored foods.Objective: We sought to determine the effects of the timing and duration of eating a variety of vegetables during breastfeeding on the liking of vegetables in both members of the dyad.Design: We conducted a randomized controlled study of 97 mother-infant dyads. Lactating mothers drank vegetable, beet, celery, and carrot juices for 1 mo beginning at 0.5, 1.5, or 2.5 mo postpartum or for 3 mo beginning at 0.5 mo postpartum. The control group drank equal volumes of water and avoided drinking the juices. Mothers rated the tastes of the juices and self-reported dietary intakes at each monthly visit (0.5-4.5 mo). After weaning, when 7.9 mo of age, infants' acceptance of plain, carrot-flavor (exposed flavor), and broccoli-flavor (nonexposed flavor) cereals was assessed on separate days.Results: The timing of exposure affected the acceptance of the carrot flavor that did not generalize to the novel broccoli flavor. A relatively brief experience (1 mo) with vegetable flavors in mothers' milk, starting at 0.5 mo postpartum, was sufficient to shift the hedonic tone, which resulted in a faster rate of eating carrot-flavored cereal than that in infants who were exposed during subsequent months or not at all. One month of exposure had a greater effect than 3 mo of exposure or no exposure. Regardless of when exposure occurred, infants were less likely to display facial expressions of distaste initially when eating the carrot cereal. Over time, mothers liked the tastes of carrot, beet, and celery juices more, but no changes in dietary intake of vegetables were observed.Conclusions: Early life may be an optimum time for both infants and their mothers to learn to like the taste of healthy foods. More research is needed to facilitate the liking and eating of these foods by mothers, which will, in turn, increase the likelihood of their feeding these foods to their children. This trial was registered at clinicaltrials.gov as NCT01667549.

Adverse Health Effects of Thirdhand Smoke: From Cell to Animal Models

The newly identified smoke hazard, thirdhand smoke (THS), has gained public attention in recent years but its health impact and biological effects are largely unknown. THS may be defined by “the four Rs”: tobacco chemicals that remain, react, re-emit, and/or are resuspended long after active smoking has ceased. This review summarizes recent research progress in the effects of THS on genotoxicity, metabolism and early life development using cellular and animal models. We first reported that THS generated in laboratory systems caused significant DNA damage in human cell lines. Our finding that THS significantly induces oxidative base lesions has been confirmed in skin wounds of mice models exposed to THS. THS also induced metabolomic changes in human reproductive cell lines. Furthermore, we demonstrated that early exposure to THS not only negatively impacts body weight in both male and female mice, but also induces persistent changes to immunological parameters in peripheral blood in these mice. These results indicate that THS is genotoxic at realistic experimental doses and that there may be a window of susceptibility for some forms of cellular damage induced by THS.

Benefits of off-campus education for students in the health sciences: a text-mining analysis

BACKGROUND

In Japan, few community-based approaches have been adopted in health-care professional education, and the appropriate content for such approaches has not been clarified. In establishing community-based education for health-care professionals, clarification of its learning effects is required. A community-based educational program was started in 2009 in the health sciences course at Gunma University, and one of the main elements in this program is conducting classes outside school. The purpose of this study was to investigate using text-analysis methods how the off-campus program affects students.

METHODS

In all, 116 self-assessment worksheets submitted by students after participating in the off-campus classes were decomposed into words. The extracted words were carefully selected from the perspective of contained meaning or content. With the selected terms, the relations to each word were analyzed by means of cluster analysis.

RESULTS

Cluster analysis was used to select and divide 32 extracted words into four clusters: cluster 1-"actually/direct," "learn/watch/hear," "how," "experience/participation," "local residents," "atmosphere in community-based clinical care settings," "favorable," "communication/conversation," and "study"; cluster 2-"work of staff member" and "role"; cluster 3-"interaction/communication," "understanding," "feel," "significant/important/necessity," and "think"; and cluster 4-"community," "confusing," "enjoyable," "proactive," "knowledge," "academic knowledge," and "class."

CONCLUSIONS

The students who participated in the program achieved different types of learning through the off-campus classes. They also had a positive impression of the community-based experience and interaction with the local residents, which is considered a favorable outcome. Off-campus programs could be a useful educational approach for students in health sciences.