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Epidemiological studies, which can have inherent methodological limitations, are used to study the relation between endocrine disrupting chemicals and autism spectrum disorder. The objective is to systematically review the treatment of methodological limitations and assess the quality and strength of the findings in the available literature. The quality and strength of the evidence were evaluated using the Navigation Guide Systematic Review Methodology. The overall quality and strength of the available studies were "moderate" and "limited," respectively. Risk of bias due to the methodological limitations regarding the exclusion of potential confounding factors and the lack of accuracy of exposure assessment methods were the most prevalent and were also considered to arrive at these results. The omnipresence of endocrine disrupting chemicals, their persistence and bioaccumulation, and the biological plausibility of the association between prenatal exposure to these and later development of autism spectrum disorder highlight the need to carry out well-designed epidemiological studies that overcome the methodological limitations observed in the currently available literature in order to be able to inform public policy to prevent exposure to these potentially harmful chemicals.

The objective is to identify obstetric and perinatal factors that could be significant predictors of ASD and may lead to early detection and intervention. A population-based case-control study including 128 children diagnosed with ASD and 311 controls was conducted. Information was collected through self-reported questionnaires. The factors retained as significant predictors for ASD in the final adjusted hierarchical logistic regression model were cesarean section and male gender. The study revealed a higher incidence of cesarean sections and male gender in children with ASD in comparison to unaffected children confirming the results of previous studies. Children born by cesarean section, especially males, should be more closely monitored for the presence of ASD traits for early diagnosis and intervention.

Children today are constantly exposed to several risk factors and high levels of stress that can impact their mental, emotional, and physical health, which can trigger burnout. The objective of this study was to determine the prevalence and frequency of burnout in young amateur athletes and to study the role of the Mediterranean diet on burnout risk. An observational, cross-sectional, and descriptive study of 183 basketball players between 8 and 15 years old was carried out. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire and the risk of burnout was assessed with the Athlete Burnout Questionnaire. Medians, minimums and maximum values for quantitative variables and absolute frequencies and percentages for qualitative variables were obtained. The results show a higher percentage of burnout among girls. The children who meet the established threshold for burnout spend more time watching television. Participants with better adherence to the Mediterranean diet have lower burnout values in both genders and those with a higher risk of burnout have a worse adherence to the Mediterranean diet. Therefore, it is important to implement a balanced diet appropriate to the individual needs of the athlete.

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6–9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status. [ABSTRACT FROM AUTHOR]

Air pollution significantly impacts cardiovascular health, yet pollution reduction strategies in cardiovascular disease prevention remain limited. Dietary flavonoids show promise in protecting cardiovascular health, but their potential to mitigate air-pollution-induced risks is unexplored. This study investigates this research gap. Following PRISMA-ScR guidelines, literature from 2014–2024 was searched across MedLine/PubMed, ScienceDirect, and MDPI databases. Of 463 identified studies, 53 were eligible for analysis based on PICO criteria. Findings revealed significant impacts of air pollution on cardiovascular health, including increased disease risks and mortality. Flavonoid intake demonstrated protective effects against these risks. Flavonoid mechanisms include improved endothelial function, antioxidant and anti-inflammatory effects, blood pressure regulation, antiplatelet effects, cardioprotection, and enhanced lipid and glucose metabolism. Higher flavonoid intake was consistently associated with reduced cardiovascular risks. While reducing pollution remains crucial, promoting flavonoid-rich diets is a promising complementary strategy. Public health initiatives should raise awareness about these benefits. Further research on direct interactions between flavonoid intake and air pollution exposure is needed. Current evidence supports integrating dietary interventions into broader strategies to reduce air pollution's cardiovascular impacts. [ABSTRACT FROM AUTHOR]

This case-control study investigated nutrient intake, healthy eating index with 10 items on foods and nutrients, on 3-day food diaries and anthropometric measurements in 105 children with autism spectrum disorder and 495 typically developing children (6-9 years) in Valencia (Spain). Children with autism spectrum disorder were at a higher risk for underweight, eating more legumes, vegetables, fiber, and some micronutrients (traditional Mediterranean diet) but fewer dairy and cereal products, and less iodine, sodium, and calcium than their typically developing peers. Differences existed in total energy intake but healthy eating index and food variety score differences were not significant. Autism spectrum disorder group failed to meet dietary recommendations for thiamin, riboflavin, vitamin C, or calcium. Risk of inadequate intake of fiber, vitamin E, and sodium was lower in children with autism spectrum disorder than typically developing children. Results suggest that (1) risk of inadequate intake of some micronutrients in children with autism spectrum disorder and (2) cultural patterns and environment may influence food intake and anthropometric characteristics in autism spectrum disorder. Primary care should include anthropometric and nutritional surveillance in this population to identify intervention on a case-by-case basis. Future research should explore dietary patterns and anthropometric characteristics in different autism spectrum disorder populations in other countries, enhancing our understanding of the disorder's impact.

Abstract Background Sex hormones closely regulate development of the male genital organs during fetal life. The hypothesis that xenobiotics may disrupt endogenous hormonal signalling has received considerable scientific attention, but human evidence is scarce. Objectives We analyse occurrence of hypospadias and cryptorchidism according to maternal and paternal occupational exposure to possible endocrine disrupting chemicals. Methods We conducted a follow-up study of 45,341 male singleton deliveries in the Danish National Birth Cohort during 1997-2009. Information on work during pregnancy was obtained by telephone interviews around gestational week 16. Parents' job titles were classified according to DISCO-88. A job exposure matrix for endocrine disrupting chemicals (EDCs) was implemented to assess occupational exposures. The Medical Birth and National Hospital Register provided data on congenital anomalies diagnosed at birth or during follow-up, which ended in 2009. Crude and adjusted hazard ratios (HR) were obtained from Cox regression models. Results Among all pregnancies, 6.3% were classified as possibly or probably exposed to EDCs. The most prevalent occupations conferring possible exposure were cleaners, laboratory technicians, hairdressers and agricultural workers (58% of all potentially exposed). The final cumulative incidence of cryptorchidism in boys was 2.2% (1002 cases), and of hypospadias 0.6% (262 cases). The occurrence of hypospadias increased when mothers were probably [HRa = 1.8 (95% CI 1.0-2.6)] or possibly exposed to one or more EDCs [HRa = 2.6 (95% CI 1.8-3.4). Possible paternal exposure to heavy metals increased the risk of hypospadias [HRa 2.2 (95% CI: 1.0-3.4)] and cryptorchidism [HRa 1.9 (95% CI: 1.1-2.7)]. None of the exposure groups reached statistical significance. Conclusion The study provides some but limited evidence that occupational exposure to possible endocrine disrupting chemicals during pregnancy increases the risk of hypospadias.

Abstract Background Exposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes. Methods We used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption. Results Pregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs) was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small. Conclusion Despite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.

We compared anthropometric values, nutrient intake, the Healthy Eating Index and food variety in children with autism spectrum disorder (ASD), 20 on a gluten-free casein-free (GFCF) diet and 85 on a regular diet in Valencia (Spain) using 3-days food diaries. Those on the GFCF diet had a lower weight, body mass index, and total energy, pantothenic acid, calcium, phosphorus and sodium intake, but a higher intake of fiber, legumes, and vegetables. Further, the GFCF diet group had a better quality of fat intake, but needed supplementation with vitamin D. Randomized controlled trials are required to explore long-term effects of this diet on anthropometric and nutritional status (the focus of our study), but also behavioral symptoms, in children with ASD.

Children with autism spectrum disorder (ASD) have problems of food selectivity, implying risks of nutritional deficiencies. The aim was to compare intakes of macro and micronutrients and body mass index in ASD and typically developing (TD) children. In a case--control study, 3-day food diaries and anthropometric measurements were completed for ASD (n = 40) and TD (n = 113) children (aged 6--10 years) living in the same area. Body mass indices were below the 5th percentile in 20 % of ASD versus 8.85 % of TD children. We found intakes were lower for fluoride (p = 0.017) and higher for vitamin E (p = 0.001). There was limited food variety and inadequacy of some intakes suggests that routine monitoring of ASD children should include assessment of their dietary habits, as well as anthropometric measurements.

Background: The practice of physical exercise during pregnancy has benefits for both the mother and baby. Currently, there is scientific evidence that supports the inclusion of a monitored physical activity program in the daily activities of pregnant women. The objective of this study is to provide an overview of the current status of the association between physical activity during pregnancy and the effects on the mother and the newborn. Methods: A systematic review of the literature, assessing each study using the Scottish Intercollegiate Guidelines Network, from different databases PubMed, Embase, or ScienceDirect, on the association between maternal physical activity and its effects on the mother and the newborn published from 2010 until 2018 was conducted. Results: About 25 studies were identified and divided into categories according to the health problems affecting the mother or newborn. It was found that 8% of all the studies received a grade B, 68% obtained a grade C, and the remaining 24% obtained less than a grade C. Improved cardiovascular function, decreased risk of gestational diabetes mellitus, hypertension, and the limitation of weight gain are among the benefits to the mother with lower percentage of body fat, increased gestational age, and potentially improved neurodevelopment as benefits for the child. Conclusions: The realization of physical activity during pregnancy is supported by most of the studies reviewed. However, given the vulnerability of the studied populations, more studies on the association between physical activity and pregnancy are necessary. [ABSTRACT FROM AUTHOR]

Los hospitales son grandes productores de residuos y consumidores de recursos energéticos y naturales, pero ¿se preocupan por la salud ambiental? Partiendo de esta cuestión con el objetivo de poder aproximarnos a las prácticas ambientales hospitalarias, se evalúa la implantación en la red hospitalaria española de los sistemas de gestión medioambiental certi cados (SGMA) más reconocidos, ISO 14001 y EMAS, para disponer de un referente de experiencias ambientales en nuestro sistema nacional de salud y dado que no existe un registro oficial específico y actualizado. Para ello se ha elaborado un listado de hospitales por comunidad autónoma con SGMA certificado en vigor en 2015, partiendo de bases de datos oficiales, evaluación de información y trabajo de campo. Nos encontramos con un 18,9 % de los hospitales que cuenta con un SGMA (ISO 14001 en todos los casos): 149 de 787, en el Catálogo Nacional de Hospitales, especialmente en Madrid (40) y Andalucía (37). 81 de los centros certificados son de ámbito privado. Solo 23 tienen EMAS: 12 son hospitales públicos y 11, privados. El “mapa” resultante muestra las principales referencias para compararse y plantearse desde la actividad hospitalaria la necesidad de ofrecer a la ciudadanía el equilibrio entre la atención sanitaria y el respeto al medio ambiente, situando a los hospitales como organizaciones socialmente responsables y respetuosas con el medio ambiente, buscando el liderazgo en el campo de la sostenibilidad ambiental compartido con otros sectores (medio ambiental, ingeniería, industrial).

Background: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old). Methods: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the requirements in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utilisation. The mean cost per patient was calculated in this group of women. Results: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher (€4,689.4/non-pregnant and €2,945.07/pregnant). Conclusions: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning.

OBJECTIVES: We investigated the association between occupational exposure to endocrine-disrupting chemicals (EDC) and the risk of uveal melanoma using international data of a case–control study from nine European countries. METHODS: After exclusion of proxy interviews, 280 cases and 3084 control subjects were included in the final analysis. Information on possible exposure to EDC was derived from 27 job-specific questionnaires (JSQ), which solicited detailed questions on occupational tasks. Relative risk estimates were based on the JSQ and potential exposure to a group of endocrine-disrupting agents. We constructed several exposure scores, taking into account intensity of exposure, use of personal protective equipment, and exposure duration. We calculated unconditional logistic regression analyses, adjusting for country, age, sex, eye color and a history of ocular damage due to intense ultraviolet (UV) exposure. RESULTS: The overall exposure prevalence to EDC was low reaching a maximum of 11% for heavy metals with endocrine-disrupting properties. Although working in some industries was associated with increased melanoma risk [such as dry cleaning: odds ratio (OR) 6.15, 95% confidence interval (95% CI) 2.0–18.96 and working in the glass manufacturing industry: OR 3.49, 95% CI 1.10–11.10], agent-specific risks were not elevated. The strongest possible risk increase was observed for organic solvents with endocrine-disrupting properties (OR 1.31, 95% CI 0.78–2.21). Calculation of exposure scores did not indicate consistently elevated results with higher score values. Sensitivity analyses did not alter these results. CONCLUSION: Occupational exposure to EDC was not associated with an increased risk for uveal melanoma.

The present study aims to determine the levels of trihalomethanes (THMs) in drinking water from different Spanish cities, and assess whether the temperature and rainfall influence them. Also assess the possible association of THM to mortality from stomach cancer and bladder. For this we took water samples from 49 cities in 2002, 2005 and 2006, which were analyzed by gas chromatography coupled with mass spectrometry obtaining THM levels. Climatic classifications were made according Koppën Lang and index the data of temperature and precipitation, and finally death rates from cancer of the stomach and bladder were standardized by sex and age. We found a decrease in the levels of THMs in Spain over time, managing to be below the limits established by Royal Decree 140/2003, but three cities studied. The results indicate that climatic classifications most of the Spanish territory has a temperate climate type - Wet. However it was found that different climatic zones exhibit an influence on the levels of THMs. Nor was significant correlation of the levels of THM with cancer of stomach and bladder, but is significant between stomach cancer and Köppen climate classification. It should continue with studies that include other variables allow clarifying and / or strengthening these results.El presente trabajo tiene como objetivo conocer los niveles de trihalometanos (THM) en el agua potable de diferentes ciudades españolas y evaluar si la temperatura y las precipitaciones influyen sobre ellos. También, valorar la posible asociación de los THM con la mortalidad por cáncer de estómago y vejiga. Para esto, se tomaron muestras de agua de 49 ciudades en el 2002, 2005 y 2006, las cuales se analizaron por cromatografía de gases acoplada a espectrometría de masas, obteniendo los niveles de THM. Se realizaron las clasificaciones climáticas según Koppën y el índice de Lang con los datos de temperatura y precipitación y, por último, las tasas de mortalidad por cáncer de estómago y vejiga fueron estandarizadas por sexo y edad. Se evidencia un descenso de los niveles de THM en España con el paso del tiempo, logrando estar por debajo de los límites establecidos por el R. D. 140/2003, excepto en tres ciudades estudiadas. Los resultados de las clasificaciones climáticas nos indican que la mayor parte del territorio español presenta un tipo de clima templado-húmedo. Sin embargo, no se encontró que las diferentes zonas climáticas presenten alguna influencia sobre los niveles de THM. Tampoco se encontró relación significativa de los niveles de THM con el cáncer de estomago y de vejiga, pero sí es significativa entre el cáncer de estómago y clasificación climática de Koppën. Es preciso continuar con estudios que incluyan otras variables permitirán esclarecer y/o reforzar estos resultados.

Background: The infant-juvenile period is one of high vulnerability during the lifestyles chosen become determining factors for future health status. This study aimed to evaluate lifestyle, specifically eating habits and physical activity, in 5-15-year-olds in Spain and their health status (anthropometry). Methods: This cross-sectional population study with two time points (2006 and 2013) was conducted by compiling data from the Spanish National Health Survey. We used the minor survey, specifically the data from the Health Determinants module, which included 5-15-year-olds. Compiled information was obtained from parents or guardians. Results: The overall overweight and obesity prevalence in Spain (2013) in 5- to 15-year-olds is 24.3%. A drop of 8.2% in meat consumption was found, while overall intake was high. Daily intake of plant-based food (fruit, vegetables, pulses) was low, especially vegetables (32.9%). Increased sedentary lifestyle was observed, probably because the use of communication technologies has increased in recent years (P