Impact of Cognitive Intervention on Neurocognitive Development of Schoolchildren Exposed to Lead in a Semi-Urban Community in Mexico.

Lead exposure is a severe public health issue that can adversely affect children's neurocognitive development. A semi-urban community in Mexico has been exposed to lead from food cooked in glazed clay pots. A cognitive intervention was conducted from 2015 to 2016 to minimize this negative impact. This intervention aimed to improve the neurocognitive development of the affected children. METHODS: A quasi-experimental study with a control group was conducted in children aged 7 to 12 years from 2 communities in Morelos, Mexico. Blood lead levels were determined, and the neurocognitive function was assessed pre- and postintervention with the Wechsler Intelligence Scale for Children and Children's Auditory Verbal Learning Test-2. A cognitive intervention was conducted at the school. The difference-in-differences method adjusted for variables known as priori and evaluated the impact of cognitive intervention. RESULTS: The differences-in-differences models indicated a significant average increase in scores on the Verbal Comprehension Index (9.58 points), Processing Speed Index (5.33 points), intelligence quotient (5.63 points) level of learning (7.66 points), interference trial (10.12 points), immediate memory span (7.98 points), and recognition accuracy (1.18 points) subtests after the cognitive intervention. CONCLUSION: The results suggest that cognitive intervention improves neurocognitive development in schoolchildren exposed to Pb.

Prenatal current-use pesticide exposure and children's neurodevelopment at one year of age in the Infants' Environmental Health (ISA) birth cohort, Costa Rica.

BACKGROUND: Pesticide exposure may affect young children's neurodevelopment, but only few cohort studies have addressed possible effects of non-organophosphate pesticides. OBJECTIVE: We evaluated associations between prenatal current-use pesticide exposure and neurodevelopmental outcomes among 1-year-old children from the Infants' Environmental Health (ISA) birth cohort. METHODS: To determine prenatal pesticide exposure, we measured biomarkers of pyrimethanil, chlorpyrifos, synthetic pyrethroids, and 2,4-D in urine samples among 355 women, 1-3 times during pregnancy. One-year post-partum, we evaluated children's neurodevelopment with the Bayley Scales of Infant and Toddler Development 3rd edition (BSID-III). We assessed associations between exposures and neurodevelopmental outcomes (composite and z-scores) using single-chemical linear regression models adjusted for possible confounders (maternal education, parity, sex, gestational age at birth, child age, HOME-score, location of assessment, biomarkers of mancozeb), and studied effect-modification by sex. We evaluated non-linear associations of multiple pesticide exposures with Bayesian kernel machine regression (BKMR). RESULTS: We found higher prenatal urinary 2,4-D concentrations were associated with lower language (ßper ten-fold increase = -2.0, 95 % confidence interval (CI) = -3.5, -0.5) and motor (ßper ten-fold increase = -2.2, 95 %CI = -4.2, -0.1) composite scores among all children. Also, higher chlorpyrifos exposure [measured as urinary 3,5,6-trichloro-2-pyridinol (TCPy)] was associated with lower cognitive composite scores (ßper ten-fold increase = -1.9, 95 %CI = -4.7, 0.8), and lower motor composite scores among boys (ßper ten-fold increase = -3.8, 95 % CI = -7.7, 0.1) but not girls (ßper ten-fold increase = 2.3, 95 %CI = -1.6, 6.3, pINT = 0.11). Finally, higher pyrimethanil was associated with lower language abilities among girls, but not boys. Pyrethroid metabolite concentrations did not explain variability in BSID-III composite scores. Associations were similar for BSID-III z-scores, and we found no evidence for non-linear associations or mixture effects. DISCUSSION: Prenatal exposure to common-use pesticides may affect children's neurodevelopment at 1-year of age, some effects may be sex-specific.

Prenatal Co-Exposure to Manganese, Mercury, and Lead, and Neurodevelopment in Children during the First Year of Life.

Lead (Pb), mercury (Hg), and manganese (Mn) are neurotoxic, but little is known about the neurodevelopmental effects associated with simultaneous prenatal exposure to these metals. We aimed to study the associations of Pb, Hg, and Mn prenatal levels (jointly and separately) with neurodevelopment in the first year of life. Methods: Pb, Hg, and Mn blood lead levels were measured in 253 pregnant women. Their offspring's neurodevelopment was assessed through the Bayley Scale of Infant Development III® at one, three, six, and twelve months. The metals' mean blood levels (µg/L) were Pb = 11.2, Hg = 2.1, and Mn = 10.2. Mean language, cognitive, and motor development scores of the infants at each age were between low-average and average. Multilevel models' results showed that language development coefficients of the offspring decreased by 1.5 points per 1 µg/dL increase in maternal blood lead levels (p = 0.002); the magnitude of the aforementioned association increased in children with maternal blood Mn < 9.6 µg/L (ß = -1.9, p = 0.003) or Hg > 1.9 µg/L (ß = -1.6, p = 0.013). Cognitive and motor development had negative associations with maternal blood Pb levels; the latter was statistically significant when the interaction term between Pb, Mn, and Hg was included (ß = -0.037, p = 0.03). Prenatal exposure to low Pb levels may impair infants' neurodevelopment in the first year of life, even more so if they are exposed to Hg or deficient in Mn.

Diseño de una intervención conductual para el control de peso en mujeres en edad fértil, con sobrepeso u obesidad, residentes de la Ciudad de México / Design of a behavioral intervention for weight control in women of childbearing age, with overweight or obesity, residents of Mexico City

Resumen Entender cómo las personas construyen y modifican sus decisiones y acciones en materia de salud, es indispensable para el abordaje del sobrepeso y la obesidad. El objetivo fue diseñar una intervención en salud que fomente el cambio de comportamientos que favorezcan la adherencia a un plan de alimentación y actividad física en mujeres en edad fértil. Se realizó un análisis mixto que incluyó la revisión de 193 expedientes clínicos en un consultorio privado de nutrición y la aplicación de 16 entrevistas semiestructuradas a mujeres con sobrepeso y obesidad, entre 20 y 49 años, con intención y sin intención de perder peso, para identificar factores relacionados con el aumento de peso. A partir de esto se diseñó una intervención en salud que busca fomentar el cambio de comportamientos para la pérdida de peso, a partir de modelos de cambio de comportamiento. Se encontró que factores relacionados con actitudes, normas percibidas y agencia personal estructuran el cambio de comportamiento y estos fueron distintos cuando sí hay intención de perder peso. Las intervenciones para control de peso deberían buscar la adherencia terapéutica; fomentar el fortalecimiento y creación de redes de apoyo; identificar y abordar las barreras de adherencia y adaptarse a las necesidades individuales.

Abstract To understand how people construct and modify their decisions and actions in health matters, is an essential requirement for the treatment of overweight and obesity. The objective was designing a health intervention that encourages behavior change that favors adherence to a diet and a physical activity plan in women of childbearing age. A mixed analysis was carried out that included the review of 193 clinical records in a private nutrition practice and the application of 16 semi-structured interviews to women with overweight, between 20 and 49 years old, with and without intention of losing weight, to identify factors related to the development of overweight. Based on this, a health intervention was designed to promote behavior change for weight loss, from de thranstheoretical model of change and integrated behavior. Factors related to attitudes, perceived norms, and personal agency were found to structure behavior change, and these were different when there is an intention to lose weight. Weight control interventions should seek adherence; promote the strengthening and creation of support social networks; identify and address barriers to adherence; adapt to the needs of the individual.

Prenatal and postnatal exposure to pesticides and school-age children's cognitive ability in rural Bogotá, Colombia.

Colombia is one of the largest pesticide consumers in South America. These products have a variety of negative consequences on the health of rural populations, especially neurocognitive disorders in children. In this work, the prenatal and postnatal exposure to pesticides was evaluated and the association between the cognitive capacity of school-age children in rural areas of the city of Bogotá, Colombia, investigated. Separate multiple linear regression models were used to evaluate associations of pesticide exposure measures and WISC-IV scales, adjusted for child sex, maternal educational attainment, growth retardation, and effect modification explored by sex, using a cross products term of 232 children between the ages of 7 and 10. It was found that among all children, pesticide exposure at school was associated with a worse working memory index (ß = -3.40; 95%CI; -6.6; -0.2) and a worst verbal comprehension index (ß = -3.2; 95%CI; -6.5; -0.2). Among girls, pesticide use at home was associated with a worse processing speed index (ß = -5.1; 95% CI; -10.1; -0.20) but not among boys (ß = 1.73; 95% CI; -2.6; 6.9). This revealed an association between the prenatal and postnatal exposure reported and some IQ sub-indices of children aged between 7 and 10 years residing in the rural areas of Usme and Sumapaz in the city of Bogotá, Colombia.

Environmental and occupational exposure to metals (manganese, mercury, iron) and Parkinson's disease in low and middle-income countries: a narrative review.

OBJECTIVES: We designed and conducted a narrative review consistent with the PRISMA guidelines (PROSPERO registration number: CRD42018099498) to evaluate the association between environmental metals (manganese, mercury, iron) and Parkinson's Disease (PD) in low and middle-income countries (LMIC). METHODS: Data sources: A total of 19 databases were screened, and 2,048 references were gathered. Study selection: Randomized controlled trials, cluster trials, cohort studies, case-control studies, nested case-control studies, ecological studies, cross-sectional studies, case series, and case reports carried out in human adults of LMIC, in which the association between at least one of these three metals and the primary outcome were reported. Data extraction: We extracted qualitative and quantitative data. The primary outcome was PD cases, defined by clinical criteria. A qualitative analysis was conducted. RESULTS: Fourteen observational studies fulfilled the selection criteria. Considerable variation was observed between these studies' methodologies for the measurement of metal exposure and outcome assessment. A fraction of studies suggested an association between the exposure and primary outcome; nevertheless, these findings should be weighted and appraised on the studies' design and its implementation limitations, flaws, and implications. CONCLUSIONS: Further research is required to confirm a potential risk of metal exposure and its relationship to PD. To our awareness, this is the first attempt to evaluate the association between environmental and occupational exposure to metals and PD in LMIC settings using the social determinants of health as a framework.

Prenatal PM2.5 exposure and neurodevelopment at 2 years of age in a birth cohort from Mexico city.

BACKGROUND: Recent studies have reported that air pollution exposure may have neurotoxic properties. OBJECTIVE: To examine longitudinal associations between prenatal particles less than 2.5 µm in diameter (PM2.5) exposure and neurodevelopment during the first two years of children's life. METHODS: Analysis was conducted in PROGRESS, a longitudinal birth cohort between 2007 and 2013 in Mexico City. We used satellite data to predict daily PM2.5 concentrations at high spatial resolution. Multivariate mixed-effect regression models were adjusted to examine cognitive, language and motor scores in children up to 24 months of age (n = 740) and each trimester-specific and whole pregnancy exposure to PM2.5. RESULTS: Models adjusted by child sex, gestational age, birth weight, smoking and mother's IQ, showed that each increase of 1 µg/m3 of PM2.5 was associated with a decreased language function of -0.38 points (95% CI: -0.77, -0.01). PM2.5 exposure at third trimester of pregnancy contributed most to the observed association. CONCLUSION: Our findings suggest that language development up to 24 months of age may be particularly sensitive to PM2.5 exposure during pregnancy.

Environmental Health Promotion of a Contaminated Site in Mexico.

Entangled in complex ecological, sociocultural, and economic systems, current environmental health problems require integrated participatory approaches. Alpuyeca, a semi-urban, highly marginalized community in South-Central Mexico burdened by lead and polychlorinated biphenyl (PCB) contamination, dengue fever, and intestinal diseases, illustrates this. Its residents are distinctive, however, for their concerted actions in the face of environmental problems and the presence of defenders of a prehispanic worldview based on the protection of nature. This article addresses the health impacts of an integrated environmental health promotion strategy implemented through a participatory action research intervention based on qualitative and quantitative methods. Different actors, sectors, dimensions, and knowledge types were harmonized in a collaborative space created specifically for our interdisciplinary research team, community residents and local authorities. Reflections, plans and actions were developed collectively in this space with the view of finding solutions anchored in the local culture. Results included sharp reductions in blood-lead concentrations among children, in entomological indices, and in PCB contamination, as well as capacity strengthening. Medium-level community participation was achieved. This work contributes evidence that participatory environmental health research can be effective in analyzing and reducing problems in communities with multiple environmental health concerns. It complements ecohealth and environmental health literacy approaches.

Prenatal Mancozeb Exposure, Excess Manganese, and Neurodevelopment at 1 Year of Age in the Infants' Environmental Health (ISA) Study.

BACKGROUND: Although growing evidence suggests that early-life excess manganese (Mn) impairs neurodevelopment, data on the neurodevelopmental effects of mancozeb, a fungicide containing Mn, and its main metabolite ethylenethiourea (ETU) are limited. OBJECTIVE: We examined whether prenatal mancozeb exposure and excess Mn were associated with neurodevelopment in 355 1-y-old infants living near banana plantations with frequent aerial mancozeb spraying in Costa Rica. METHODS: We measured urinary ETU, hair Mn, and blood Mn concentrations in samples collected 1-3 times during pregnancy from mothers enrolled in the Infants' Environmental Health (ISA) study. We then assessed neurodevelopment in their 1-y-old infants using the Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III). We estimated exposure-outcome associations using linear regression models adjusted for maternal education, parity, gestational age at birth, child age, Home Observation for Measurement of the Environment score, and location of neurodevelopmental assessment. RESULTS: Median (P25-P75) urinary ETU, hair Mn, and blood Mn measured during pregnancy were 3.3 µg/L (2.4-4.9; specific gravity-corrected), 1.7 µg/g (0.9-4.1), and 24.0 µg/L (20.3-28.0), respectively. Among girls, higher ETU was associated with lower social-emotional scores [ß per 10-fold increase=-7.4 points (95% CI: -15.2, 0.4)], whereas higher hair Mn was associated with lower cognitive scores [-3.0 (-6.1, 0.1)]. Among boys, higher hair Mn was associated with lower social-emotional scores [-4.6 (-8.5, -0.8)]. We observed null associations for blood Mn, language, and motor outcomes. CONCLUSIONS: Our findings indicate that maternal exposure to mancozeb and excess Mn during pregnancy may have adverse and sex-specific effects on infant neurodevelopment. https://doi.org/10.1289/EHP1955.

Evaluation of the effect of an environmental management program on exposure to manganese in a mining zone in Mexico.

BACKGROUND: In the state of Hidalgo, Mexico, is found the largest second deposit of Manganese (Mn) in Latin America. Various studies on the sources of emission, exposure, and the effects on the health of children and adults have been conducted utilizing an ecosystem approach. Given the findings of Mn levels in air and the neurocognitive effects, an Environmental Management Program (EMP) was designed and implemented with the purpose of reducing exposure to Mn of the population, including various actions for reducing Mn emissions into the atmosphere. OBJECTIVE: To evaluate the impact of the EMP on the concentrations of Mn in air, as well as the modification of exposure to Mn in the blood and hair of adult residents of the communities intervened. METHODS: A quasi-experimental study was conducted in five rural communities, in which Mn concentrations were evaluated in air and in blood in the years 2002 and 2007, pre-intervention, and in 2013, postintervention. In 2003, the concentration of hair Mn among the communities was evaluated. Measurements were carried out of Particulate Matter (PM) of >10 and 2.5µm (PM10 and PM2.5), and Mn in PM10 and PM2.5 were measured using proton-induced X-ray emissions (PIXE). The method of Difference in Differences (DID) was applied to estimate the impact of EMP on Mn concentrations in particulate matter via linear regression through multilevel models. To evaluate the effect of Mn concentrations in air over Mn concentrations in blood in both study periods in the mining communities per year (2002 and 2013), a linear regression model for each year was employed. RESULTS: We estimated that the EMP contributed to reducing the average daily concentrations of Mn in PM10 and PM2.5 by 92 and 85%, respectively. The adjusted model did not show an effect of Mn concentrations in air over Mn concentrations in blood in both study periods. CONCLUSIONS: The results suggest that the measures implemented to reduce Mn emissions in air exerted a significant impact on the reduction of inhaled exposure in adult population.

Pesticide exposure and neurodevelopment in children aged 6-9 years from Talamanca, Costa Rica.

Certain pesticides may affect children's neurodevelopment. We assessed whether pesticide exposure was associated with impaired neurobehavioral outcomes in children aged 6-9 years. We conducted a cross-sectional study in 140 children living near banana plantations and plantain farms in the Talamanca County, Costa Rica and assessed their neurobehavioral performance. Exposure was determined by analyzing urinary metabolites of chlorpyrifos (3,5,6-trichloro-2-pyridinol, TCPy), mancozeb (ethylenethiourea, ETU), and pyrethroids (3-phenoxybenzoic acid, 3-PBA). Repeated urine samples were obtained for 36 children. We estimated associations of pesticide concentrations with neurobehavioral outcomes using multivariable linear and logistic regression models. Median (25th-75th percentiles) TCPy, ETU, and 3-PBA concentrations were 1.4 (.7-3.1), 1.2 (.7-3.0), and .8 (.5-1.5) µg/L, respectively. Intraclass correlation coefficients (ICC) ranged between .32 and .67. After adjustment for potential confounders, higher urinary TCPy concentrations were associated with poorer working memory in boys (n = 59) (ß per 10-fold increase in TCPy concentrations = -7.5, 95% CI: -14.4, -.7); poorer visual motor coordination (ß = -1.4, 95% CI: -2.7, -.1); increased prevalence of parent-reported cognitive problems/inattention (adjusted OR per 10-fold increase in urinary concentrations = 5.8, 95% CI: 1.6, 22.9), oppositional disorders (aOR = 3.9, 95% CI: 1.0, 16.0), and ADHD (aOR = 6.8, 95% CI: 1.8, 28.6), and; decreased ability to discriminate colors (aOR = 6.6, 95% CI: 1.6, 30.3; the higher the score the worse). Higher ETU concentrations were associated with poorer verbal learning outcomes (ß = -7.0, 95% CI: -12.7, -1.3). Higher 3-PBA concentrations were associated with poorer processing speed scores, particularly in girls (ß = -8.8, 95% CI: -16.1, -1.4). Our findings indicate that children living near banana and plantain plantations are exposed to pesticides that may affect their neurodevelopment, which for certain domains may differ between boys and girls. We recommend the implementation of measures to reduce pesticide exposure in children living nearby banana plantations.

Manganese and Mercury Levels in Water, Sediments, and Children Living Near Gold-Mining Areas of the Nangaritza River Basin, Ecuadorian Amazon.

Artisanal and small-scale gold-mining activities performed in mountain areas of the Southern Ecuadorian Amazon have incorporated several heavy metals into the aquatic systems, thus increasing the risk of exposure in populations living in adjacent zones. Therefore, the objective of this study was to evaluate the contamination levels of mercury (Hg) and manganese (Mn) in several rivers of the Nangaritza River basin and assess the exposure in school-aged children residing near the gold-mining zones. River water and sediment samples were collected from a highly contaminated (HEx) and a moderately contaminated (MEx) zones. Hair Mn (MnH) and urinary Hg (HgU) levels were determined in school-aged children living in both zones. High concentrations of dissolved Mn were found in river waters of the HEx zone (between 2660 and 3990 µg l(-1)); however, Hg levels, in general, were lower than the detection limit (DL; <1.0 µg l(-1)). Similarly, Mn levels in sediments were also increased (3090 to 4086 µg g(-1)). Median values of MnH in children of the HEx and MEx zones were 5.5 and 3.4 µg g(-1), respectively, whereas the median values of HgU concentrations in children living in the HEx and MEx zones were 4.4 and 0.62 µg g-creat(-1), respectively. Statistically significant differences were observed between both biomarkers in children from the HEx and MEx zones. In addition, boys presented significantly greater MnH levels in both zones. The greater MnH values were found in children living in alluvial areas, whereas children living in the high mountain areas, where some ore-processing plants are located close to or inside houses and schools, had the greater HgU concentrations. In summary, the data reported in this paper highlights that artisanal and small-scale gold-mining activities can not only produce mercurial contamination, that can also release other heavy metals (such as Mn) that may pose a risk to human health.

Prenatal and postnatal manganese teeth levels and neurodevelopment at 7, 9, and 10.5 years in the CHAMACOS cohort.

BACKGROUND: Numerous cross-sectional studies of school-age children have observed that exposure to manganese (Mn) adversely affects neurodevelopment. However, few prospective studies have looked at the effects of both prenatal and postnatal Mn exposure on child neurodevelopment. METHODS: We measured Mn levels in prenatal and early postnatal dentine of shed teeth and examined their association with behavior, cognition, memory, and motor functioning in 248 children aged 7, 9, and/or 10.5 years living near agricultural fields treated with Mn-containing fungicides in California. We used generalized linear models and generalized additive models to test for linear and nonlinear associations, and generalized estimating equation models to assess longitudinal effects. RESULTS: We observed that higher prenatal and early postnatal Mn levels in dentine of deciduous teeth were adversely associated with behavioral outcomes, namely internalizing, externalizing, and hyperactivity problems, in boys and girls at 7 and 10.5 years. In contrast, higher Mn levels in prenatal and postnatal dentine were associated with better memory abilities at ages 9 and 10.5, and better cognitive and motor outcomes at ages 7 and 10.5 years, among boys only. Higher prenatal dentine Mn levels were also associated with poorer visuospatial memory outcomes at 9 years and worse cognitive scores at 7 and 10.5 years in children with higher prenatal lead levels (≥0.8 µg/dL). All these associations were linear and were consistent with findings from longitudinal analyses. CONCLUSIONS: We observed that higher prenatal and early postnatal Mn levels measured in dentine of deciduous teeth, a novel biomarker that provides reliable information on the developmental timing of exposures to Mn, were associated with poorer behavioral outcomes in school-age boys and girls and better motor function, memory, and/or cognitive abilities in school-age boys. Additional research is needed to understand the inconsistencies in the neurodevelopmental findings across studies and the degree to which differences may be associated with different Mn exposure pathways and biomarkers.