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Overall diet quality during pregnancy has played an important role on maternal glucose metabolism. However, evidence based on the adherence to the dietary guideline is limited, especially for Asian populations. We aimed to examine the association between adherence to the Chinese dietary guideline measured by the Diet Balance Index for Pregnancy (DBI-P) and maternal glucose metabolism, including gestational diabetes mellitus (GDM) status, fasting and 2-h plasma glucose. Data were obtained from the baseline survey of the Yuexiu birth cohort. We recruited 942 pregnant women at 20–28 weeks of gestation in 2017–2018. Dietary intakes during the past month were collected using a validated semi-quantitative FFQ. The scores of DBI-P were calculated to assess dietary quality. Lower absolute values of the scores indicate higher adherence to the Chinese dietary guidelines. All participants underwent a 75 g of oral glucose tolerance test (OGTT). Multiple linear regression and logistic regression were conducted. The Benjamini–Hochberg method was used to adjust multiple comparisons across DBI-P food components. The value of high bound score indicator, reflecting excessive total food intake, was positively associated with OGTT-2h glucose levels (β = 0·037, P = 0·029). After adjustment for multiple comparisons, the score of animal food intake was positively associated with OGTT-2 h glucose levels (β = 0·045, P = 0·045) and risk of GDM (OR = 1·105, P = 0·030). In conclusion, excessive total food intake was associated with higher postprandial glucose in pregnant women. Lower compliance with the dietary guideline for animal food was associated with both higher postprandial glucose and increased risk of GDM during pregnancy.

Background: Intellectual developmental disorders are a serious source of health morbidity with negative consequences for adults as well as children. However, there is limited evidence on the environmental, trace element, behavioural, and emotional outcomes in children. Here, we investigated whether there is any association between child behaviour and emotional outcomes and micronutrients using network analysis. Methods: A cross-sectional study was conducted in 9-year-old children within a Pacific Island Families study birth cohort. Elemental concentration was determined in children’s toenails after acid digestion and analysed using inductively coupled plasma mass spectrometry. We used network analysis to identify closely associated trace elements and tested the directions and strength of these trace elements. MANCOVA were used to identify the significant associations between individual elements and the behavioural/emotional function of the children using the children behaviour checklist (CBCL). At the final step, quantile regression analysis was used to assess and quantify the identified associations between CBCL function scores and manganese, adjusted by sex, ethnicity, and standardized BMI. Results: Three major nutrient networks were identified. In the Mn network, Mn was strongly positively associated with Al (0.63) and Fe (r = 0.65) and moderately associated with Pb (r = 0.45) and Sb (r = 0.42). Al was also strongly associated with Fe (r = 0.9). Children in the second or third clinical group, with an elevated externalized CBCL score, had a much higher mean and median level of Mn as compared to the normal range group. The aggression score was significantly associated with Mn concentration and sex. Higher Mn concentrations were associated with a higher aggression score. A 1 ug/g unit increase in Mn was associated with a 2.44-fold increase (95% confidence interval: 1.55–4.21) in aggression score, and boys had higher median aggression score than girls (difference: 1.7, 95% CI: 0.9–2.8). Attention and rule breaking scores were both significantly associated with Mn concentration. Higher Mn concentrations were associated with higher attention behaviour problem and rule breaking scores. A 1 ug/g unit increase in Mn was found to be associated with a 1.80-fold increase (95% confidence interval: 1.37–2.82) in attention score, and a 1.46-fold increase (95% confidence interval: 1.01–1.74) in the rule breaking score. Thought score was not significantly associated with Mn concentration (p = 0.13) but was significantly lower in boys (p = 0.004). Conclusions: Exceeding Mn levels is potentially toxic and has been identified to be associated with worse externalized children’s behavioural health and emotional well-being. Future studies are necessary to find the exposure paths so that advice shall be provided to family and care providers in public health and environmental protection.

Chronic kidney disease of unknown cause is prevalent in a range of communities, however, its etiology remains unclear. We examined the association between pesticide exposures and the risk of kidney function loss using four waves of the National Health and Nutrition Examination Survey (NHANES) to identify a pathological pathway. We pooled data from four cross-sectional waves of NHANES, with 41,847 participants in total. Exposure to malathion increased the risk of low kidney function (aOR = 1.26, 95% CI = 1.01–1.56) in the adjusted model. Increased risk of low kidney function was not found among those exposed to 2,4-D (aOR = 0.88, 95% CI = 0.72–1.09), 3,5,6-trichloropyridinol (aOR = 0.96, 95% CI = 0.83–1.12), and 3-PBA (aOR = 1.03, 95% CI = 0.94–1.13). Our findings provide evidence of altered kidney function in people exposed to malathion, highlighting the potential of organophosphate pesticides’ role in renal injury.

Air quality related to respiratory illness is examined in many settings, including populations that work or reside close to sources of pollution. Industry produced pollution from mining and metal manufacturing, natural environmental pollution as in the case of bushfires and large-scale dust storms are examples. We reviewed any available literature and data concerning the Queensland coal industry and its effect on respiratory health of miners, mining related workers and communities in proximity to coal mines. We searched various databases using keywords related to coal and respiratory diseases, using the five step criteria defined by Denyer and Tranfield. In the Queensland coal mining industry, the negative effect of mining on workers’ respiratory health has been known for many years and has received increased attention in the last five years both nationally and internationally due to the resurgence in Coal Mine Dust Lung Diseases and specifically Coal Worker’s Pneumoconiosis (CWP). A Queensland parliamentary review has prompted regulatory amendments for the permitted (occupational) exposure level (PEL; OEL) to coal dust and silica; amendments have also been enacted for better occupational respiratory health surveillance of Queensland coal miners, both surface and underground. Considering Queensland has a high proportion of Australian coal mines, the literature available on respiratory health in Queensland coal mines and surrounding communities is minimal. There is very limited research into, and possible underreporting of CMDLD amongst the coal mining workers in Queensland. Further studies are required to better understand air pollution and health effects in coal miners in Queensland.

Electronic waste management is a global rising concern that is primarily being handled by informal recycling practices. These release a mix of potentially hazardous chemicals, which is an important public health concern. These chemicals include polybrominated diphenyl ethers (PBDEs), used as flame retardants in electronic parts, which are persistent in nature and show bioaccumulative characteristics. Although PBDEs are suspected endocrine disruptors, particularly targeting thyroid and reproductive hormone functions, the relationship of PBDEs with these health effects are not well established. We used the Navigation Guide methodology to conduct a systematic review of studies in populations exposed to e-waste to better understand the relationships of these persistent flame retardants with hormonal and reproductive health. We assessed nineteen studies that fit our pre-determined inclusion criteria for risk of bias, indirectness, inconsistency, imprecision, and other criteria that helped rate the overall evidence for its quality and strength of evidence. The studies suggest PBDEs may have an adverse effect on thyroid hormones, reproductive hormones, semen quality, and neonatal health. However, more research is required to establish a relationship of these effects in the e-waste-exposed population. We identified the limitations of the data available and made recommendations for future scientific work.

This study examined the psychosocial burden of inflammatory bowel disease (IBD) in young people aged 15-25 years attending a tertiary specialist health centre for adolescents and young adults in Brisbane.To describe the impact of IBD on psychosocial well-being in young people and to compare well-being in the IBD cohort to well-being among young people with other chronic conditions, with a view to identifying characteristics and challenges unique to those with IBD.Young people with IBD provided demographic information and psychosocial data through a cross-sectional self-report survey. Psychosocial data included the Kessler Psychological Distress Scale, Perceived Stress Scale, Brief Illness Perception Questionnaire, World Health Organisation Well-being Index, Paediatric Quality of Life Inventory, Short Quality of Life Questionnaire for IBD, Multidimensional Scale of Perceived Social Support, Connor Davidson Resilience Scale 2 and the Multidimensional Health Locus of Control Scale.Surveys were collected from 51 young people with IBD and compared with surveys from 210 young people with juvenile rheumatic disease (n = 31), phenylketonuria (n = 21), cystic fibrosis (n = 33), renal transplants (n = 14) and craniomaxillofacial conditions (n = 111). On the psychosocial domains, 41% of young people with IBD had poor well-being and 37% were at risk of depression. When assessed against the comparison group, young people with IBD reported higher depressive symptoms (P = 0.04), worse illness perceptions (P 0.01) and lower internal locus of control (P 0.01).Early recognition and treatment of depression and other psychosocial comorbidities within integrated pathways of care is crucial in adolescents and young adults with IBD and likely to improve the course of IBD and their overall health and well-being. Interventions aimed at enhancing self-efficacy and increasing public awareness are also likely to be helpful.

Behavioral problems are multifactorial and includes perinatal, maternal, family, parenting, socio-economic and personal risk factors, but less is known about the association of postnatal heavy metals on children&rsquo, s behavioral problems in Pacific Island children. Methods: A cohort of eligible nine-year-old children within a Pacific Island Families longitudinal study were recruited for a cross-sectional study. Child behavior problems were assessed using the child behavior checklist. Heavy metals (including Ni, Cu, Pb, Al, Cr and Cd) were determined in toenails, after acid digestion and analyzed using inductively coupled plasma mass spectrometry. Other factors such as lifestyle (smoking in pregnancy), health outcomes (obesity, health status), demographics (gender, ethnicity, parents&rsquo, marital status) and socioeconomic status (household income levels) were also collected. The statistical analysis included t-tests for independent sample and Mann&ndash, Whitney U-test, and chi-square or Fisher&rsquo, s exact tests of independence for comparisons of the proportions. Regression models tested the hypothesized risk factors for behavior outcomes. Results: This observational study enrolled 278 eligible Pacific Island children living in Auckland, New Zealand. The prevalence of behavioral problems in the clinical range was high (22%) but there was no significant association between heavy metals in toenails and adverse behavioral outcomes. Conclusion: Regular monitoring and assessments of children for environmental risk factors, as well as social and lifestyle factors for behavior problems, continues. Alternative indicators of exposure to heavy metal should be evaluated.

Objective Elemental deficiencies or in excess effects growth and development. Pacific population are at a disadvantage due to food insecurity as compared to New Zealand European households. This study aims to evaluate the status and interrelationship of elements (essential, non-essential and toxic) in nine-year-old Pacific children who were part of the Pacific Island Families Study living in New Zealand. Materials and Methods This observational study included 278 eligible nine-year-old children. Essential elements (including calcium, chromium, cobalt, copper, iodine, iron, magnesium, manganese, selenium, zinc, molybdenum), non-essential and toxic elements (arsenic, aluminum, antimony, boron, cadmium, lead, mercury, nickel,) were determined in toenails and after acid digestion, analysed using inductively coupled plasma mass spectrometry. Principal component analysis and multivariate analysis of covariance was used to identify differences in the groups of elements and the inter-correlations between elements. Results The mean calcium (868 μg/g Ca), selenium (0.35 μg/g Se) and zinc (129 μg/g Zn) concentrations were lower while the mean cadmium (0.21 μg/g Cd) lead (0.86 μg/g Pb) and mercury (0.72 μg/g Hg) concentrations were higher than the optimal health requirements. Ethnic differences in relation to toenail elemental concentrations were observed for aluminium and iron. Gender differences were observed for aluminium, antimony, arsenic and lead. Selenium and molybdenum were inversely associated with mercury. Manganese, zinc and calcium were positively associated. Conclusions This research contributes to the understanding of the elemental concentrations for Pacific children by using tissue samples from toenails, which improves the completeness of sampling than other tissues and provides a longer exposure time frame. The study also reports several inter-correlations between essential, non-essential and toxic elements in Pacific Island population.

There is limited evidence on the distribution of heavy metals and its association with secondhand smoking (SHS) within Pacific Island children living in New Zealand. Certain heavy metals such as cadmium (Cd), lead (Pb), and aluminum (Al) bioaccumulates in the body and can deteriorate health in both children and adults. Others, such as chromium (Cr) and nickel (Ni) in trace amounts are necessary but become toxic at high levels. Exposure routes of these elements include food, water, and air. The purpose of this study was to identify the distribution of toxic metal concentrations and its possible correlation with SHS within the Pacific Island children. A sub-sample of children within Pacific Island families longitudinal study, at the nine-year phase, who were living in the New Zealand city of Auckland were invited to participate, (n = 278). Toenails were used as a biomarker to determine Cr, Pb, Cd, Cu, Ni, and Al concentration using inductively coupled plasma mass spectrometry. Reliable and validated questionnaires were used for demographics, lifestyle, and health outcome variables. Significant differences between household smoking status and ethnicity, as well as parents&rsquo, marital status, were observed (p &lt, 0.05). There was no statistical difference in heavy metal concentrations in smoking versus non-smoking households. However, Cr, Pb, Cd, Cu, and Ni concentrations were all higher than the required optimal health value in both groups. A high concentration of heavy metals was observed in these children that exceeded the value required for optimal health, although no significant difference in heavy metals with regards to secondhand smoking was observed. SHS was associated with children&rsquo, s ethnicity and parental marital status, but not with household income levels or maternal education.

Background: Mercury is a neurotoxin that affects neurodevelopment in children, however, its association at the lowest concentration is not clear. The main objective of this study is to measure and evaluate mercury concentrations in mother&ndash, child pairs and its association demographics, lifestyle, and dietary factors within the Pacific Island Families living in Auckland, New Zealand. Methods: Mercury exposure was assessed in a sub-sample of mother&ndash, child pairs who were a part of the Pacific Island Families birth cohort, in Auckland, New Zealand at the 6-year phase. Hair samples were collected from both mothers and their children to determine mercury concentrations. Total mercury was measured using inductively coupled plasma mass spectrometry for hair samples. An interviewer-based reliable food frequency questionnaire (FFQ) examined the frequency of seafood by all the participants. Other variables such as sociodemographic (ethnicity and gender), lifestyle factors (income, education, and smoking status) and health outcomes (child behaviour and obesity) were also collected. Results: In this study, 41% of both mothers and their children had mercury concentrations above the US Environmental Protection Agency (EPA) recommended value of 1 &micro, g/g. Most of the participants ate fish 3 or more times a week. A significant correlation was observed between mother and child hair mercury concentrations (Spearman Rho 0.79 (95% confidence interval (CI): 0.65, 0.88)). Conclusions: Mercury levels in children can be affected by their mothers&rsquo, levels due to similar eating patterns.

Objective: Very little is known about the relationship between postnatal methylmercury concentrations (via toenails as bioindicator) and behavioural characteristics of Pacific Island children living in New Zealand. The aim of this study was to explore the association between total mercury exposure and different domains of behavioural problems in Pacific children. Materials and Methods: A sample of nine-year-old Pacific Island children resident in Auckland, New Zealand participated in this study. Total mercury was determined in biological samples (toenail clippings) on behavioural problems as identified by mothers (using the child behaviour checklist). Specific behavioural domains, particularly aggression, rule breaking, attention and social problems were studied in relation to mercury exposure using toenails. The determination of mercury concentration in toenail clippings, after acid digestion was carried out using inductively coupled plasma mass spectrometry. Results: The observational study was conducted between July 2010 and July 2011 in which 278 eligible nine-year-old Pacific Island children were enrolled (Girls n= 58%; boys n=42%). Findings showed that 21% of the children had total toenail mercury concentrations (1.5 µg/g to 6 µg/g) higher than the United State Environmental Protection Agency recommended levels (RfD; 1 µg/g Hg) for optimal health in children. Aggressive behaviour was associated with total toenail mercury exposure after adjusting for gender, ethnicity and income levels (OR: 2.15 95% CI 1.45, 3.18 p-value< 0.05; OR 1.38 95% CI 0.83, 1.2 p value

Background Aggressive challenging behaviour in people with intellectual disability (ID) is frequently treated with antipsychotic drugs, despite a limited evidence base. Method A multi-centre randomised controlled trial was undertaken to investigate the efficacy, adverse effects and costs of two commonly prescribed antipsychotic drugs (risperidone and haloperidol) and placebo. Results The trial faced significant problems in recruitment. The intent was to recruit 120 patients over 2 years in three centres and to use a validated aggression scale (Modified Overt Aggression Scale) score as the primary outcome. Despite doubling the period of recruitment, only 86 patients were ultimately recruited. Conclusions Variation in beliefs over the efficacy of drug treatment, difficulties within multidisciplinary teams and perceived ethical concerns over medication trials in this population all contributed to poor recruitment. Where appropriate to the research question cluster randomised trials represent an ethically and logistically feasible alternative to individually randomised trials.

Summary Background Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour. Methods 86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks' treatment, which was recorded with the modified overt aggression scale (MOAS). Analysis was by intention to treat. This study is registered as ISRCTN 11736448. Findings 80 patients had adherence of 80% or more to prescribed drug. Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change (median decrease in MOAS score after 4 weeks=9 [95% CI 5–14] for placebo, 79% from baseline; 7 [4–14] for risperidone, 58% from baseline; 6·5 [5–14] for haloperidol, 65% from baseline; p=0·06). Furthermore, although no important differences between the treatments were recorded, including adverse effects, patients given placebo showed no evidence at any time points of worse response than did patients assigned to either of the antipsychotic drugs. Interpretation Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability.

To measure the repeatability of a cancer risk factor questionnaire in a population-based case-control study.Questionnaires were completed on two occasions by patients with cancer of the ovary (n=25) or esophagus (n=23) and by 37 controls without cancer. We assessed general cancer risk factors including height and weight (for calculating body mass index (BMI)), smoking and anti-inflammatory (NSAID) use. Risk factors specific for ovarian and esophageal cancers were also assessed. Agreement was measured by the correlation coefficient and weighted kappa statistic (kw) for continuous and categorical variables respectively.We observed very high levels of agreement for BMI (kw=0.84) and smoking history, including ages at initiation and quitting (Pearson correlation = 0.87 and 0.86 respectively). There was moderate to substantial agreement for use of anti-inflammatory drugs (aspirin kw =0.52, other NSAIDS kw =0.72). Agreement for lifetime prevalence of medical conditions varied from almost perfect (e.g. history of benign breast disease (k =0.86)) to moderate (e.g. heartburn (k =0.57)). Item repeatability was not materially altered by case-control status, age or sex of respondents or interval between completions.Self-reported cancer risk factor information demonstrates moderate to almost perfect levels of agreement, suggesting these items are suitable for risk estimation and epidemiologic inference.