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BackgroundOrganophosphorous (OP) pesticides are associated with reduced fetal growth in animals, but human studies are inconsistent.ObjectivesWe pooled data from four cohorts to examine associations of prenatal OP exposure with birth weight (n = 1,169), length (n = 1,152), and head circumference (n = 1,143).MethodsData were from the CHAMACOS, HOME, Columbia, and Mount Sinai birth cohorts. Concentrations of three diethyl phosphate (ΣDEP) and three dimethyl phosphate (ΣDMP) metabolites of OP pesticides [summed to six dialkyl phosphates (ΣDAPs)] were measured in maternal urine. Linear regression and mixed-effects models were used to examine associations with birth outcomes.ResultsWe found no significant associations of ΣDEP, ΣDMP, or ΣDAPs with birth weight, length, or head circumference overall. However, among non-Hispanic black women, increasing urinary ΣDAP and ΣDMP concentrations were associated with decreased birth length (β = -0.4 cm; 95% CI: -0.9, 0.0 and β = -0.4 cm; 95% CI: -0.8, 0.0, respectively, for each 10-fold increase in metabolite concentration). Among infants with the PON1192RR genotype, ΣDAP and ΣDMP were negatively associated with length (β = -0.4 cm; 95% CI: -0.9, 0.0 and β = -0.5 cm; 95% CI: -0.9, -0.1).ConclusionsThis study confirms previously reported associations of prenatal OP exposure among black women with decreased infant size at birth, but finds no evidence of smaller birth weight, length, or head circumference among whites or Hispanics. Contrary to our hypothesis, we found stronger inverse associations of DAPs and birth outcome in infants with the less susceptible PON1192RR genotype. The large pooled data set facilitated exploration of interactions by race/ethnicity and PON1 genotype, but was limited by differences in study populations.CitationHarley KG, Engel SM, Vedar MG, Eskenazi B, Whyatt RM, Lanphear BP, Bradman A, Rauh VA, Yolton K, Hornung RW, Wetmur JG, Chen J, Holland NT, Barr DB, Perera FP, Wolff MS. 2016. Prenatal exposure to organophosphorous pesticides and fetal growth: pooled results from four longitudinal birth cohort studies. Environ Health Perspect 124:1084-1092; http://dx.doi.org/10.1289/ehp.1409362.

BackgroundOrganophosphorus pesticides (OPs) are used in agriculture worldwide. Residential use was common in the United States before 2001.ObjectivesWe conducted a pooled analysis of four birth cohorts (children's centers; n = 936) to evaluate associations of prenatal exposure to OPs with child development at 24 months.MethodsUsing general linear models, we computed site-specific and pooled estimates of the association of total dialkyl (ΣDAP), diethyl (ΣDEP), and dimethylphosphate (ΣDMP) metabolite concentrations in maternal prenatal urine with mental and psychomotor development indices (MDI/PDI) and evaluated heterogeneity by children's center, race/ethnicity, and PON1 genotype.ResultsThere was significant heterogeneity in the center-specific estimates of association for ΣDAP and ΣDMP and the MDI (p = 0.09, and p = 0.05, respectively), as well as heterogeneity in the race/ethnicity-specific estimates for ΣDAP (p = 0.06) and ΣDMP (p = 0.02) and the MDI. Strong MDI associations in the CHAMACOS population per 10-fold increase in ΣDAP (β = -4.17; 95% CI: -7.00, -1.33) and ΣDMP (β = -3.64; 95% CI: -5.97, -1.32) were influential, as were associations among Hispanics (β per 10-fold increase in ΣDAP = -2.91; 95% CI: -4.71, -1.12). We generally found stronger negative associations of ΣDAP and ΣDEP with the 24-month MDI for carriers of the 192Q PON1 allele, particularly among blacks and Hispanics.ConclusionsData pooling was complicated by center-related differences in subject characteristics, eligibility, and changes in regulations governing residential use of OPs during the study periods. Pooled summary estimates of prenatal exposure to OPs and neurodevelopment should be interpreted with caution because of significant heterogeneity in associations by center, race/ethnicity, and PON1 genotype. Subgroups with unique exposure profiles or susceptibilities may be at higher risk for adverse neurodevelopment following prenatal exposure.CitationEngel SM, Bradman A, Wolff MS, Rauh VA, Harley KG, Yang JH, Hoepner LA, Barr DB, Yolton K, Vedar MG, Xu Y, Hornung RW, Wetmur JG, Chen J, Holland NT, Perera FP, Whyatt RM, Lanphear BP, Eskenazi B. 2016. Prenatal organophosphorus pesticide exposure and child neurodevelopment at 24 months: an analysis of four birth cohorts. Environ Health Perspect 124:822-830; http://dx.doi.org/10.1289/ehp.1409474.

Background Childhood lead exposure is a purported risk factor for antisocial behavior, but prior studies either relied on indirect measures of exposure or did not follow participants into adulthood to examine the relationship between lead exposure and criminal activity in young adults. The objective of this study was to determine if prenatal and childhood blood lead concentrations are associated with arrests for criminal offenses. Methods and Findings Pregnant women were recruited from four prenatal clinics in Cincinnati, Ohio if they resided in areas of the city with a high concentration of older, lead-contaminated housing. We studied 250 individuals, 19 to 24 y of age, out of 376 children who were recruited at birth between 1979 and 1984. Prenatal maternal blood lead concentrations were measured during the first or early second trimester of pregnancy. Childhood blood lead concentrations were measured on a quarterly and biannual basis through 6.5 y. Study participants were examined at an inner-city pediatric clinic and the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio. Total arrests and arrests for offenses involving violence were collected from official Hamilton County, Ohio criminal justice records. Main outcomes were the covariate-adjusted rate ratios (RR) for total arrests and arrests for violent crimes associated with each 5 µg/dl (0.24 µmol/l) increase in blood lead concentration. Adjusted total arrest rates were greater for each 5 µg/dl (0.24 µmol/l) increase in blood lead concentration: RR = 1.40 (95% confidence interval [CI] 1.07-1.85) for prenatal blood lead, 1.07 (95% CI 0.88-1.29) for average childhood blood lead, and 1.27 (95% CI 1.03-1.57) for 6-year blood lead. Adjusted arrest rates for violent crimes were also greater for each 5 µg/dl increase in blood lead: RR =1.34 (95% CI 0.88-2.03) for prenatal blood lead, 1.30 (95% CI 1.03-1.64) for average childhood blood lead, and 1.48 (95% CI 1.15-1.89) for 6-year blood lead. Conclusions Prenatal and postnatal blood lead concentrations are associated with higher rates of total arrests and/or arrests for offenses involving violence. This is the first prospective study to demonstrate an association between developmental exposure to lead and adult criminal behavior., Introduction Early onset of aggressive or violent behavior is a precursor to a life course marred by limited social and educational achievement, incarceration, underemployment, and premature mortality [1,2]. These maladaptive [...]

OBJECTIVES. The purpose of this work was to assess the long-term impact of childhood lead exposure on the neurosubstrate of language function and brain organization. METHODS. Young adults from the Cincinnati Lead Study were recruited to undergo functional magnetic resonance image scanning while performing a verb generation task. These subjects have been followed from birth through early childhood with extensive documentation of lead exposure, neuropsychology, and behavior. Forty-two subjects provided useful imaging data. The locale, strength, and the correlation between brain language activation and childhood blood lead concentration were studied. RESULTS. After adjusting for potential confounders, the activation in left frontal cortex, adjacent to Broca's area, and left middle temporal gyrus, including Wernicke's area, were found to be significantly associated with diminished activation in subjects with higher mean childhood blood lead levels, whereas the compensatory activation in the right hemisphere homolog of Wernicke's area was enhanced in subjects with higher blood lead levels. CONCLUSION. This study indicates that childhood lead exposure has a significant and persistent impact on brain reorganization associated with language function. www.pediatrics.org/cgi/doi/10.1542/ peds.2006-0467 doi:10.1542/peds.2006-0467 Key Words environmental pollutants, lead poisoning, neuroimaging, language development, pediatric research Abbreviations fMRI--functional magnetic resonance imaging CLS--Cincinnati Lead Study EPI--echo planar imaging BOLD--blood oxygen level dependant SES--socioeconomic status IQ--intelligence quotient ROI--region of interest, CHILDHOOD LEAD EXPOSURE is inversely associated with intellectual abilities, academic achievement, and psychomotor development. (1-4) Even low-level lead exposure can negatively impact a wide range of cognitive functions, such as [...]

Background. Efforts to make health care for adolescents with chronic illnesses more patient-centered must be grounded in an understanding and clear measures of adolescents' preferences and priorities. Objective. To develop a measure of health care preferences of adolescents with chronic illnesses and to determine demographic, developmental, and health factors associated with adolescents' preferences. Design. Mixed-method questionnaire development and survey. Setting. Subspecialty clinics of a tertiary care children's hospital. Participants. All adolescents (age: 11-19 years) with juvenile rheumatoid arthritis, sickle cell disease, inflammatory bowel disease, or cystic fibrosis of at least 2-year duration who were being treated at the participating center were eligible to participate, and 155 of 251 did so (62%). The participants had a mean age of 15.5 [+ or -] 2.4 years, 45% were male, and 75% were white. Intervention. None. Main Outcome Measures. Ratings of 65 items related to quality of care and 17 items related to physician-patient communication styles. Results. An 82-item questionnaire, devised from qualitative analysis of focus group results, contained 65 Likert scale items that adolescents considered important for health care quality and 17 forced-choice items related to adolescents' preferences for communication. Among the first 65 items, the group of questions related to physician trust and respect had the highest rating of 5.24 [+ or -] 0.62 of 6, followed by patient power and control (mean rating: 4.72 [+ or -] 0.77) and then caring and closeness in the patient-doctor relationship (mean rating: 4.19 [+ or -] 0.91). For the communication items, the adolescents, on average, preferred communication directly to them rather than to their parents and were nearly neutral regarding physicians' inquiries about personal issues. Conclusions. Participants rated aspects of interpersonal care (especially honesty, attention to pain, and items related to respect) as most important in their judgments of quality. As in most previous studies of adults, technical aspects of care were also rated highly, suggesting that adolescents understand and value both scientific and interpersonal aspects of care. Pediatrics 2004;114: 1272-1280; patient-centered care, health care priorities, doctor-patient communication, chronic illness, adolescent., In 2001, the Institute of Medicine published a blueprint for improving the quality of health care in the United States. The report, titled Crossing tilt Quality Chasm, (1) identified patient-centeredness [...]

Background. Health disparities between children from urban minority backgrounds and children from more affluent backgrounds are well-recognized. Few studies specifically address urban children's perceptions of their health-related quality of life (HRQOL) or the factors that contribute to these perceptions. Since schools are pivotal to children's intellectual, social, and emotional development, school connectedness may be a factor that contributes to their perception of HRQOL. Objective. To examine children's perceptions of HRQOL in an elementary school-based population of urban children. Methods. The study population consisted of 2nd, 3rd, and 5th graders from 6 urban kindergarten to 8th grade schools and their parents. Children completed a survey that included questions on HRQOL and school connectedness. Parents completed a telephone survey that assessed demographics, the child's health, health care usage, and parental health status. Data on school absences and mobility from the computerized school database were linked to survey data. Bivariate analyses were used to evaluate the association between child report of HRQOL and collected variables, including school connectedness. Multivariable linear regression was conducted to identify the factors best predicting HRQOL in these urban children. Results. Of the 1150 eligible students, parent and child survey data were available for 525 (45.6%). Fifty-one percent of students were male and 89% were black. Ninety-four percent of parents were female, 29% were married, and 62% had family incomes below $20 000 per year. The mean total score for HRQOL was 67.2, with a possible range of 0 to 100 (higher scores reflecting better HRQOL). In the multivariable analysis, child grade, the relationship of the "parent" to the child, employment, family income, type/presence of insurance, and school connectedness were significantly associated with the HRQOL total score. Conclusions. Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children. Pediatrics 2003;111: 1372-1381; school health, underserved populations, health status., ABBREVIATIONS. HRQOL, health-related quality of life; CSDHP, Cincinnati School Health Demonstration Project; SF, short form. Health disparities between children from urban minority backgrounds and those from more affluent backgrounds are [...]

Workers exposed to 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) may not have a higher risk of developing liver disease or gastrointestinal disease than individuals who are not exposed to TCDD. A study compared 281 workers who were exposed to TCDD at two chemical plants 15 years earlier to 260 individuals who had not been exposed to TCDD, but who matched individuals in the first group on other characteristics. Those exposed to TCDD did not report higher occurrences of liver disease or gastrointestinal disease compared to the individuals who were not exposed to TCDD. Exposed workers did have significantly higher levels of the enzyme gamma-glutamyltransferase (GGT) than unexposed individuals, but this occurred mainly in those workers who habitually drank alcohol. Among workers who drank, the risk of high blood levels of GGT increased as blood levels of TCDD increased. Elevated blood levels of GGT is often an indication of liver disease.

The relationship between the electromagnetic fields emitted by video display terminals (VDTs) and spontaneous abortion (miscarriage) has been a public health concern for over a decade. Extremely-low-frequency fields have been implicated in seasonal spontaneous abortions among those who used electric blankets or ceiling-cable electric heat. Studies of very-low-frequency electromagnetic fields and spontaneous abortion have concentrated on the effects of VDTs. Full-time female telephone operators, half of whom were directory-assistance operators who used VDTs, and half who were general operators who did not use them were surveyed to determine the effects of working at VDTs. Eight hundred eighty-two pregnancies (in 730 women) met the criteria of the study. There was no increase in the risk of spontaneous abortion among those women who used VDTs. Although statistically a moderate increase could not be ruled out, various other measures of risk make an association unlikely. Spontaneous abortion was more frequent among those who drank alcohol heavily, smoked cigarettes, or had a thyroid disorder. There were no differences in VDT use outside the workplace that could have influenced the results. There was no way to measure very early (subclinical) fetal loss in this study, nor was the effect of VDT use on older women (over 33 years of age) or unmarried women measured, and these women are in the majority in the population. The study found that abdominal exposure to extremely-low-frequency fields was similar to exposure found in the home, and there was no evidence of an increased risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

The effect of diesel fuel exhaust on truck drivers has not been well studied. Rodents exposed to diesel fuel exhaust have an increased chance of developing lung cancer. To see if there is an increased risk for lung cancer among diesel truck drivers, the records of 996 Teamster Union truck drivers who had applied for pension benefits and had died in 1982 or 1983 were studied. Results were adjusted to remove other confounding factors known to cause lung cancer, such as smoking, diet and asbestos. Work history, smoking history and truck type information were obtained by interviewing the next of kin and from Teamster Union records. The results were compared with those from 1,085 similar workers with no known exposure to diesel fumes. There was no increased risk found between the different truck driver job categories. However, certain increases were seen among subgroups of workers. Long-haul truckers employed after the introduction of diesel engines (1959) were 1.55 times more likely get lung cancer. Long-term drivers who drove primarily diesel trucks were 1.89 times more likely to get lung cancer. On the basis of these results it is concluded that there is an increased risk of lung cancer among Teamsters who drive diesel trucks compared with workers not exposed to diesel exhaust. The risk from diesel exposure for diesel mechanics, who are exposed to high levels of diesel exhaust, especially in the winter months, was marginally higher. Since the actual levels of diesel exhaust fumes were not known, there is no information linking the effect of diesel fumes to lung cancer directly. Although there were many limitations in this study, the conclusions are supported by other studies. (Consumer Summary produced by Reliance Medical Information, Inc.)