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The social factors that moderate stroke caregiver burden have been found to be culture- and gender-specific. We examined the factors that influence the social support and self-efficacy of caregivers of stroke survivors and the burden of caregiving in China. To determine the caregiver burden of stroke survivors, their social support, and their self-efficacy. A total of 328 stroke survivors and their caregivers were recruited from 4 tertiary medical centers to participate in this cross-sectional study. The sociodemographic and stroke-related characteristics of the participants were obtained. Perceived social support and self-efficacy were assessed using the Social Support Rating Scale and General Self-efficacy Scale, respectively. Caregiver burden was assessed using the Zarit Burden Interview Scale. Relationships between the variables were assessed using Pearson's correlation, the chi-square test, and a paired t test. A total of 27.4% of the caregivers reported receiving adequate social support, while 20.7% reported high levels of self-efficacy. A total of 67.1% of the caregivers experienced varying degrees of care burden, while the remaining 32.9% felt no burden. Participants' sociodemographic characteristics (age, daily care time, self-rated health, and financial situation) were significantly related to caregiver burden, social support, and self-efficacy (P .001). The findings indicate an inverse relationship between caregiver burden, social support and self-efficacy. Adequate social support and self-efficacy can reduce stroke caregivers' burden. Hospital departments should provide assistance to stroke caregivers through educational programs and group training to increase their social support and self-efficacy, thereby alleviating their burden.

The fetus is prenatally exposed to a mixture of organochlorine pesticides (OCPs), mercury (Hg), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and selenium (Se) through maternal seafood consumption in real-life scenario. Prenatal exposure to these contaminants and nutrients has been suggested to affect thyroid hormone (TH) status in newborns, but the potential relationships between them are unclear and the joint effects of the mixture are seldom analyzed. The aim of the study is to investigate the associations of prenatal exposure to a mixture of OCPs, Hg, DHA, EPA and Se with TH parameters in newborns. 228 mother-infant pairs in Shanghai, China were included. We measured 20 OCPs, total Hg, DHA, EPA and Se in cord blood samples as exposure variables. The total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels and the FT3/FT4 ratio in cord serum were determined as outcomes. Using linear regression models, generalized additive models and Bayesian kernel machine regression, we found dose-response relationships of the mixture component with outcomes: among the contaminants, p,p'-DDE was the most important positive predictor of TT3, while HCB was predominantly positively associated with FT3 and the FT3/FT4 ratio, indicating different mechanisms underlying these relationships; among the nutrients, EPA was first found to be positively related to the FT3/FT4 ratio. Additionally, we found suggestive evidence of interactions between p,p'-DDE and HCB on both TT3 and FT3, and EPA by HCB interactions for TT3, FT3 and FT3/FT4 ratio. However, the overall effects of the mixture on thyroid hormone parameters were not significant. Our result suggests that prenatal exposure to p,p’-DDE, HCB and EPA as part of a mixture might affect thyroid function of newborns in independent and interactive ways. The potential biological mechanisms merit further investigation.

Background: The extent to which low-level, in utero mercury exposure affects child neurobehavioral development during early childhood has been inconclusive. In addition, the effects of sex and docosahexaenoic acid (DHA) on these relationships remain unclear and controversial. Objectives: This study aimed to explore the associations between prenatal low-level mercury exposure and child neurobehavioral development during the neonatal and toddler periods and to examine the potential confounding or interactive effects of sex and DHA status on these relationships. Methods: This longitudinal study included 286 mother-child pairs in Shanghai, China, whose cord blood samples were analyzed for total mercury, DHA, other nutrients and coexposure contaminants possibly due to maternal consumption of seafood. Children's neurobehavioral development was assessed with the Neonatal Behavioral Neurological Assessment (NBNA) three days after birth and the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at 18 months of age. Results: Cord blood mercury concentration, with geometric mean of 2.00 μg/l, was related to poorer NBNA performance but unrelated to BSID-III scores with adjustment for DHA and other covariates. Cord serum DHA was positively associated with motor development assessed by the BSID-III. The interaction was found between mercury and DHA on the NBNA score, and the inverse relation of cord blood mercury with NBNA was significant only among the children with lower DHA levels (

Persistent organic pollutants (POPs), known as common environmental pollutants, which have adverse effects on neurobehavioral development, are widely applied in industry and agriculture. However, evidence about neurodevelopmental toxicity of POPs in humans is limited. This study aimed to explore the relationship between prenatal exposure to POPs and birth outcome of the newborn including birth length, weight, and head circumference. In this study, 1522 mother-child pairs were included in this study and cord blood samples were collected, which were detected to determine exposure level of 37 POPs in total. After delivery, the neonatal anthropometric indices detection (birth length, weight, and head circumference) was performed. According to the multivariate linear regression, the newborn with high detection rates (≥75 percentile) of hexachlorobenzene (HCB), beta-hexachlorocyclohexane (β-HCH), p,p’-dichlorodiphenyl dichloroethylene (p,p’-DDE) in the umbilical cord blood were demonstrated negative relationship with birth head circumference after adjusting for confounding factors, but not related with birth length and weight. After confirming that there was a nonlinear relationship between HCB and birth head circumference based on sex stratification through the generalized additive model (GAM), further two-piecewise linear regression model was conducted to explore the saturation threshold effect between HCB and birth head circumference, which showed cord serum HCB concentration greater than 0.5 μg/L was negatively associated with birth head circumference in girls. Our study provided evidence for the adverse influence of HCB, β-HCH and p,p'-DDE exposure during pregnancy on the birth head circumference of offspring. Although HCB induced reduction of birth head circumference was found in girls, the mechanism of gender difference remained unclear. Further studies are needed to explore the effect of POPs on the growth and development of offspring based on in vivo or in vitro experimental models.

As common environmental pollutants, persistent organic pollutants (POPs) that are widely applied in industry and agriculture have adverse effects on neurodevelopment. However, evidence on the neurotoxicity of POPs in neural development of offspring is limited. This study explored the relationship between prenatal exposure to POPs and neurodevelopment of 18-month-old toddlers in a mother-child cohort in Shanghai, China. In this study, we determined exposure levels of 37 POPs in cord blood serum collected at the time of delivery. The detection rate of pollutants HCB, β-HCH, and p,p′-DDE was higher than 60%, so these will be discussed in the following analysis. From birth to approximately 18 months, we followed up infants to longitudinally explore whether POPs influenced their language, motor, and cognitive development according to a Bayley-Ⅲ assessment . Based on multivariable regression analyses, the β-HCH concentration in cord serum was negatively related to motor development scores in children at 18 months by adjusting for the covariates, but there was no change in language and cognition. Further piecewise linear regression analysis showed that a cord serum β-HCH concentration greater than 0.2 μg/L had a significantly negative correlation with the motor development scores. p,p′-DDE was positively associated with language development at 18 months before and after adjusting for covariates. But prenatal HCB levels were not associated with any of the Bayley-Ⅲ subscales at 18 months. We concluded that prenatal exposure to β-HCH might have adverse effects on infants’ motor development. The minimum harmful concentration of β-HCH was estimated at 0.2 μg/L in cord serum. The unexpected positive association between p,p′-DDT and language development could be due to live birth bias.

It is well known that iodine plays an important role in the process of early growth and development of most organs, especially the brain. However, iodine concentration in the colostrum and its association with the neurobehavioral development of infants remains unclear. Colostrums from 150 women were collected, and their iodine concentrations were measured. The median colostrum iodine level was 187.8 μg/L. The Bayley Scales of Infant and Toddler Development–III test was performed when the infants were about 18 months. The mean cognitive, language, and motor composite scores were 105.3 ± 9.8, 105.2 ± 11.1, and 104.6 ± 6.7, respectively. And the mean scores of the 5 subtests were 11.1 ± 2.0, 9.3 ± 2.0, 12.4 ± 2.3, 11.1 ± 1.2, and 10.4 ± 1.2, respectively. No statistically significant difference was observed in the cognition, language, or motor development of infants across different levels of colostrum iodine. After adjusting for a range of confounding factors, colostrum iodine concentration was a predictor of motor development, specifically gross motor development.

The effects of low-level prenatal manganese (Mn) exposure on neonatal growth remain unclear. The level of fetal Mn that may be considered "safe" has never been examined.A multicenter study including 1377 mother-infant pairs was conducted from 2008 through 2009 in Shanghai. Mn concentrations were determined for both the cord and maternal serum, as well as neonatal birth weight and birth length. The ponderal index (PI) was calculated as (birth weight g/birth length cm(3))×100, and a ponderal index ≥3.17 was defined as a high ponderal index (HPI).The median serum Mn concentration was 4.0μg/L in the cord blood, and was 2.8μg/L in maternal blood. Of 1377 infants, 135 (9.8%) had a HPI. After adjusting for potential confounders, cord serum Mn was not associated with birth weight. However, there was a linear relationship between the cord serum Mn and the birth length (adjusted ß=-0.5, 95% CI=-0.7 to -0.2, p0.0001). Additionally, a nonlinear relationship was observed between the cord serum Mn and the ponderal index, and between the cord serum Mn and HPI. The ponderal index and the prevalence of HPI increased with Mn levels above 5.0μg/L (Log Mn ≥0.7). A high level of Mn in the cord (≥5.0μg/L) was associated with a higher ponderal index (adjusted ß=0.2, 95% CI=0.1 to 0.2, p0.001) and a high risk of HPI (adjusted OR=3.3, 95% CI=1.8-6.0, p0.001).Higher prenatal Mn exposure, even at a low level, is associated with a higher prevalence of HPI in a nonlinear pattern. Cord serum Mn levels less than 5.0μg/L may be considered safe with respect to neonatal ponderal index assessment.

A method for determination of concentrations of polychlorinated biphenyl congeners (PCB-28, 52, 101, 118, 138, 153, 156, and 187) and organochlorine pesticides (hexachlorobenzene, alpha-hexachlorocyclohexane, beta-hexachlorocyclohexane, gamma-hexachlorocyclohexane, delta-hexachlorocyclohexane, p,p'-dichlorodiphenyl dichloroethylene, o,p'-dichlorodiphenyl trichloroethane, p,p'-dichlorodiphenyl dichloroethane, p,p'-dichlorodiphenyl trichloroethane, alpha-chlordane, gamma-chlordane, heptachlor, heptachlor epoxide, and aldrin) in human serum is developed. Recovery is assessed with artificial serum, in which PCBs and OCPs could not be detected. The method is then confirmed with pooled human serum. Experiments are performed by adding two concentrations of analytes (0.5 µg/L and 1.0 µg/L) to both matrices. The sample pretreatment process involves denaturing with a mixture of water-1-propanol (v:v, 85:15), extraction with a C-18 cartridge, and cleanup with an Alumina B cartridge. This process required about 2 mL of serum. The limit of detection ranged from 0.05-0.35 µg/L for all the analytes. Recovery of analytes at low and high spiking concentrations varied from 63-122% and 61-124% for artificial serum and pooled human serum, respectively. Relative standard deviation was lower than 16% and 18% for artificial serum and pooled human serum, respectively. Stability of the method, expressed as relative standard deviation, was lower than 14%. The method has been applied in epidemiological research.

To explore the exposure level and risk factors of heavy metal among Shanghai infants in their prenatal period.A total of 1652 pregnant or puerperal women were recruited from 10 midwifery-qualified hospitals in Shanghai since October 2008 to October 2009, by the stratified cluster sampling method. They answered the questionnaire and their umbilical cord blood and serum were collected to detect the content of Pb, Hg, Mn, Cd, As and Tl. The risk factors were analyzed by single and multiple regression methods respectively.The median value of the content of Pb, Hg, Mn, Cd, As and Tl were 41.00, 1.88, 4.10, 0.03, 0.86 and 0.02 µg/L respectively. The Hg concentration of pregnant women who ate fish for 4 - 7 times per week (9.7% (160/1652)) was 2.76 µg/L, which was higher than that of pregnant women who only ate fish for 1-3 times per week (49.3% (814/1652)) and those who seldom ate fish (40.0% (661/1652)); the Hg concentration in the two groups above were 2.41 and 2.03 µg/L separately. The difference had statistical significance (χ(2) = 36.40, P0.001). Meanwhile, the concentrations of Pb and Tl in the group of pregnant women whose houses were remodeled by PVC pipe (85.0% (1404/1652)) was higher than the concentrations in group of pregnant women whose houses were remodeled by galvanized pipe (15.0% (248/1652)); the Pb concentration in the two groups above were 45.54 and 40.00 µg/L (Z = 2.54, P0.05) and the Tl concentration in the two groups above were 0.021 and 0.018 µg/L (Z = 2.97, P0.05). However, the As concentration in the group of PVC pipe remodeled was 4.33 µg/L, which was lower than that in the group of galvanized pipe (9.37 µg/L). The difference had statistical significance (Z = 3.99, P0.01). The concentrations of Mn, Cd and Tl in the groups of pregnant women whose house had been remodeled in the last 3 years (38.0% (628/1652)) were 14.78, 0.51 and 0.022 µg/L separately, which were all significantly higher than those in the groups of women whose houses' were not remodeled (62.0% (1024/1652)), whose concentrations were 11.01, 0.29 and 0.02 µg/L respectively. The differences had statistical significance (Mn: Z = 2.46, P0.05; Cd: Z = 2.38, P0.05; Tl: Z = 2.81, P0.01).The infants in Shanghai were exposed to heavy metals in their prenatal period. The main sources of the exposure were daily diet and remodeled pollution.

The use of most polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) has been restricted in China; however, their use remains a concern because of their adverse effects on human health, especially on fetuses and infants. To date, there is no data regarding the exposure levels of pregnant women to PCBs and OCPs in Shanghai. In order to evaluate PCB and OCP exposure levels and the contribution of dietary habits to these levels, we determined the concentrations of 8 PCBs and 14 OCPs in the umbilical cord blood serum of healthy pregnant women in Shanghai. Dietary habits of the pregnant women were obtained from a self-administered questionnaire. Results showed that p, p′-DDE, HCB and β-HCH were the major pollutants present in the serum samples; PCBs were detected in a few samples at low concentrations. Age, weight and body mass index before delivery were positively associated with serum levels of p, p′-DDE and β-HCH. Women and their husbands who had higher education levels, higher income levels, tended to have higher levels of p, p′-DDE and β-HCH. Spearman correlation analysis results suggested that consumption of foods such as milk, eggs, meat, fish, and shrimp may contribute to higher serum levels of p, p′-DDE and β-HCH. Furthermore, multiple linear regression analyses indicated that the age and educational levels of the pregnant women and their intake of fried/flamed food and shellfish were positively associated with β-HCH levels, and that the age and educational levels of the pregnant women and their intake of parity, beef, pork, mutton, and shrimp were positively associated with p, p′-DDE levels. This is the first study to investigate the exposure levels of pregnant women to PCBs and OCPs in Shanghai, and it should provide useful information for future related research.