Changes in depressive and anxiety symptoms during COVID-19 in children from the PROGRESS cohort.

BACKGROUND: We assessed associations between maternal stress, social support, and child resiliency during the COVID-19 pandemic in relation to changes in anxiety and depression symptoms in children in Mexico City. METHODS: Participants included 464 mother-child pairs from a longitudinal birth cohort in Mexico City. At ages 8-11 (pre-COVID, 2018-2019) and 9-12 (during COVID, May-Nov 2020) years, depressive symptoms were assessed using the child and parent-reported Children's Depressive Inventory. Anxiety symptoms were assessed using the child-reported Revised Manifest Anxiety Scale. Linear regression models were used to estimate associations between maternal stress, social support, and resiliency in relation to changes in depressive and anxiety symptoms. We additionally assessed outcomes using clinically relevant cut-points. Models were adjusted for child age and sex and maternal socioeconomic status and age. RESULTS: Higher continuous maternal stress levels during the COVID-19 pandemic were associated with increases in depressive symptoms (ß: 0.72; 95% CI: 0.12, 1.31), and higher odds of clinically relevant depressive and anxiety symptoms in the children. CONCLUSIONS: Maternal stress during the pandemic may increase mental health symptoms in pre-adolescent children. Additional studies are needed that examine the long-term pandemic-related impacts on mental health throughout the adolescent years. IMPACT: In this longitudinal cohort study of children in Mexico City, we observed that depressive symptoms were higher from before to during the pandemic. Maternal stress surrounding the pandemic may increase mental health symptoms in pre-adolescent children. Child resiliency may help to protect against pandemic-related stressors.

COVID-19 Infections, Pandemic-Related Social and Economic Impacts, and Changes to Mental and Self-Rated Health Among Latinx Immigrant Housecleaners in New York City: The Safe and Just Cleaners Study.

Objectives. To estimate impacts of COVID-19 infections and social and economic sequelae on mental and self-rated health among Latinx immigrant housecleaners in New York City. Methods. From March to June 2021, we conducted a follow-up study with 74% retention of 402 housecleaners initially surveyed before the pandemic between August 2019 and February 2020. We measured rates of self-reported COVID-19 infections, COVID-19 antibodies, and pandemic-related social and economic sequelae and examined predictors of mental and self-rated health changes using logistic regression models. Results. Fifty-three percent reported COVID-19 infections, consistent with the rate demonstrating COVID-19 antibodies. During shutdown of nonessential services, from March 22 to June 8, 2020, 29% worked as housecleaners, although this was not associated with higher COVID-19 infection rates. COVID-19-related stigma at work, lost earnings owing to COVID-19 infections, housing insecurity, food insecurity, and unsafe homes, including experiencing intimate partner verbal abuse, were statistically associated with changes in mental or self-rated health compared with prepandemic measures. Conclusions. The disproportionate impact and virtually nonexistent safety net housecleaners experienced during the first year of the pandemic highlight the importance of inclusive stopgap measures to mitigate economic insecurity and its sequelae. (Am J Public Health. 2023;113(8):893-903. https://doi.org/10.2105/AJPH.2023.307324).

Quaternary Ammonium Compounds: A Chemical Class of Emerging Concern.

Quaternary ammonium compounds (QACs), a large class of chemicals that includes high production volume substances, have been used for decades as antimicrobials, preservatives, and antistatic agents and for other functions in cleaning, disinfecting, personal care products, and durable consumer goods. QAC use has accelerated in response to the COVID-19 pandemic and the banning of 19 antimicrobials from several personal care products by the US Food and Drug Administration in 2016. Studies conducted before and after the onset of the pandemic indicate increased human exposure to QACs. Environmental releases of these chemicals have also increased. Emerging information on adverse environmental and human health impacts of QACs is motivating a reconsideration of the risks and benefits across the life cycle of their production, use, and disposal. This work presents a critical review of the literature and scientific perspective developed by a multidisciplinary, multi-institutional team of authors from academia, governmental, and nonprofit organizations. The review evaluates currently available information on the ecological and human health profile of QACs and identifies multiple areas of potential concern. Adverse ecological effects include acute and chronic toxicity to susceptible aquatic organisms, with concentrations of some QACs approaching levels of concern. Suspected or known adverse health outcomes include dermal and respiratory effects, developmental and reproductive toxicity, disruption of metabolic function such as lipid homeostasis, and impairment of mitochondrial function. QACs' role in antimicrobial resistance has also been demonstrated. In the US regulatory system, how a QAC is managed depends on how it is used, for example in pesticides or personal care products. This can result in the same QACs receiving different degrees of scrutiny depending on the use and the agency regulating it. Further, the US Environmental Protection Agency's current method of grouping QACs based on structure, first proposed in 1988, is insufficient to address the wide range of QAC chemistries, potential toxicities, and exposure scenarios. Consequently, exposures to common mixtures of QACs and from multiple sources remain largely unassessed. Some restrictions on the use of QACs have been implemented in the US and elsewhere, primarily focused on personal care products. Assessing the risks posed by QACs is hampered by their vast structural diversity and a lack of quantitative data on exposure and toxicity for the majority of these compounds. This review identifies important data gaps and provides research and policy recommendations for preserving the utility of QAC chemistries while also seeking to limit adverse environmental and human health effects.

Assessment of personal inhalation and skin exposures to polymeric methylene diphenyl diisocyanate during polyurethane fabric coating.

Methylene diphenyl diisocyanate (MDI) monomers and polymeric MDI (pMDI) are aromatic isocyanates widely used in the production of polyurethanes. These isocyanates can cause occupational asthma, hypersensitivity pneumonitis, as well as contact dermatitis. Skin exposure likely contributes toward initial sensitization but is challenging to monitor and quantitate. In this work, we characterized workers' personal inhalation and skin exposures to pMDI in a polyurethane fabric coating factory for subsequent health effect studies. Full-shift personal and area air samples were collected from eleven workers in representative job areas daily for 1-2 weeks. Skin exposure to hands was evaluated concomitantly with a newly developed reagent-impregnated cotton glove dosimeter. Samples were analyzed for pMDI by liquid chromatography-tandem mass spectrometry. In personal airborne samples, the concentration of 4,4'-MDI isomer, expressed as total NCO, had a geometric mean (GM) and geometric standard deviation (GSD) of 5.1 and 3.3 ng NCO/m3, respectively (range: 0.5-1862 ng NCO/m3). Other MDI isomers were found at much lower concentrations. Analysis of 4,4'-MDI in the glove dosimeters exhibited much greater exposures (GM: 10 ng/cm2) and substantial variability (GSD: 20 ng NCO/cm2; range: 0-295 ng NCO/cm2). MDI inhalation exposure was well below occupational limits for MDI for all the job areas. However, MDI skin exposure to hands was substantial. These findings demonstrated the potential for substantial isocyanate skin exposure in work settings with very low airborne levels. This exposure characterization should inform future studies that aim to assess the health effects of work exposures to MDI and the effectiveness of protective measures.

Exploring the Link Between the Hazards and Value of Work, and Overcoming Risk for Community-Based Health Interventions for Immigrant Latinx Low-Wage Workers.

Few studies integrate work and immigration as intersecting social determinants of health. We synthesize data from 12 focus groups (N = 97) originating from two separate community-engaged studies that originally centered on exploring barriers to health and hazards of work among immigrant Latinx women and men to explore the role of work in their overall health and well-being. The three major interrelated themes we drew from this research-hazards of work, value of work, and building agency to overcome risk-provide insights that can help to reframe and begin to operationalize how community-based health promotion practice might better incorporate workplace issues for Latinx low-wage workers. The value of work, and its subtheme, pride in performing well specifically, could be engaged by workers to actively change conditions for themselves and others. We discuss findings in light of previous occupational health research and implications for community-based intervention design and practice.

Validating and Comparing Highly Resolved Commercial "Off the Shelf" PM Monitoring Sensors with Satellite Based Hybrid Models, for Improved Environmental Exposure Assessment.

Particulate matter is a common health hazard, and under certain conditions, an ecological threat. While many studies were conducted in regard to air pollution and potential effects, this paper serves as a pilot scale investigation into the spatial and temporal variability of particulate matter (PM) pollution in arid urban environments in general, and Beer-Sheva, Israel as a case study. We explore the use of commercially off the shelf (COTS) sensors, which provide an economical solution for spatio-temporal measurements. We started with a comparison process against an A-grade meteorological station, where it was shown that under specific climatic conditions, a number of COTS sensors were able to produce robust agreement (mean R2=0.93, average SD=17.5). The second stage examined the COTS sensors that were proven accurate in a mobile measurement campaign. Finally, data collected was compared to a validated satellite prediction model. We present how these tests and COTS sensor-kits could then be used to further explain the continuity and dispersion of particulate matter in similar areas.

Development of an Interception Glove Sampler for Skin Exposures to Aromatic Isocyanates.

OBJECTIVES: Skin is an important exposure route for isocyanate chemicals and contributes to systemic sensitization. Methods for assessing skin exposure are currently limited and generally rely upon removal (e.g. tape-strip) techniques prone to underestimation. The aim of this study is to (i) develop and field test an interception-based hand exposure sampler to monitor potential skin exposure to isocyanates in the workplace, (ii) to develop an analytical method based on ultra-high-performance liquid chromatography-UV absorbance-tandem mass spectrometry (UHPLC-UV-MS/MS) for analyzing glove samples; and (iii) compare it with tape-stripping skin sampling method. METHODS: Laboratory investigations assessed different glove materials/fabrics, methods for impregnating with 1-(9-anthracenylmethyl)piperazine (MAP) derivatizing agent, methylene diphenyl diisocyanate (MDI) uptake and recovery, and durability. Following use, gloves were dissected into sections corresponding to different spatial regions (finger, palm) and analyzed using a newly developed UHPLC-UV-MS/MS method capable of differentiating and quantitating different MDI isomers with high sensitivity. Performance of the glove sampler was further assessed in a pilot field study using six workers. RESULTS: A MAP-impregnated thin cotton glove sampler and UHPLC-UV-MS/MS analytical method for detecting MDI were successfully developed in laboratory studies. In subsequent field studies, a total of 384 samples from 14 glove pairs identified full-shift exposures ranged from 0.01 to 306 µg of 4,4'-MDI/worker for each hand. Surface area adjusted MDI values measured with the glove sampler (0.13-572ng MDI cm-2) were considerably higher (~400-fold) than values obtained with tape stripping. CONCLUSION: A glove sampler and a novel UHPLC-UV-MS/MS analytical method were developed to quantitatively measure MDI skin exposure. The novel interception technique overcomes inherent limitations of removal techniques for measuring isocyanate skin exposure and may be useful in exposure surveillance and future research on isocyanate's health risks.

Association between prenatal and childhood PM2.5 exposure and preadolescent anxiety and depressive symptoms.

Background: Fine particulate matter (PM2.5) exposure has been linked to anxiety and depression in adults; however, there is limited research in the younger populations, in which symptoms often first arise. Methods: We examined the association between early-life PM2.5 exposure and symptoms of anxiety and depression in a cohort of 8-11-year-olds in Mexico City. Anxiety and depressive symptoms were assessed using the Spanish versions of the Revised Children's Manifest Anxiety Scale and Children's Depression Inventory. Daily PM2.5 was estimated using a satellite-based exposure model and averaged over several early and recent exposure windows. Linear and logistic regression models were used to estimate the change in symptoms with each 5-µg/m3 increase in PM2.5. Models were adjusted for child's age, child's sex, maternal age, maternal socioeconomic status, season of conception, and temperature. Results: Average anxiety and depressive symptom T-scores were 51.0 (range 33-73) and 53.4 (range 44-90), respectively. We observed consistent findings for exposures around the fourth year of life, as this was present for both continuous and dichotomized anxiety symptoms, in both independent exposure models and distributed lag modeling approaches. This window was also observed for elevated depressive symptoms. An additional consistent finding was for PM2.5 exposure during early pregnancy in relation to both clinically elevated anxiety and depressive symptoms, this was seen in both traditional and distributed lag modeling approaches. Conclusion: Both early life and recent PM2.5 exposure were associated with higher mental health symptoms in the child highlighting the role of PM2.5 in the etiology of these conditions.

Urban Stress and its Association with Symptoms of Depression, Fatigue, and Sleep Disruption in Women in Mexico City.

Women in urban neighborhoods often face disproportionately higher levels of environmental and social stressors; however, the health effects from urban stressors remains poorly understood. We aimed to evaluate the association between urban stress and symptoms of depression, fatigue, and sleep disruption in a cohort of 460 women in Mexico City. To assess urban stress, women were administered the Urban Annoyances (Nuisances Environnementales) scale. Six constructs were summarized to create an overall index. Depressive symptoms were assessed using the Edinburgh Depression Scale; the Patient-Reported Outcomes Information System scales were used to assess sleep disruption and fatigue. Linear regression models were used to estimate the association with continuous symptoms comparing women with high urban stress to those with lower levels. Models were adjusted for socioeconomic status, education, age, social support, and previous depressive symptoms. High urban stress was associated with greater depressive symptoms (ß: 1.77; 95%CI: 0.83, 2.71), fatigue (ß: 2.47; 95%CI: 0.87, 4.07), and sleep disruption (ß: 2.14; 95%CI: 0.54, 3.73). Urban stress plays an important role in women's psychological and physical health, highlighting the importance of including these measures in environmental health studies. Urban interventions, such as promoting alternative transport options, should additionally be addressed to improve health of urban populations.

Transferability of aliphatic isocyanates from recently applied paints to the skin of auto body shop workers.

Isocyanates, the essential cross-linking chemicals used to make polyurethane, are potent sensitizers and a common cause of occupational asthma. In addition, isocyanate (NCO) skin contact may contribute to the development of isocyanate asthma. Prior work has shown that unbound NCO can persist on recently spray coated auto body parts after appearing dry. The purpose of this study was to assess whether isocyanate skin exposure can result from handling such surfaces. Quantitative surface and skin wipe sampling for total NCO was performed on test panels sprayed with aliphatic isocyanate coatings, and on paired skin samples obtained from participants who had rubbed the recently dried surfaces. Surface and skin samples, obtained from 18 workers in five auto body shops, were prepared following NIOSH method 5525 (modified for skin samples), and isocyanate species derived from hexamethylene diisocyanate and isophorone diisocyanate were analyzed using high-performance liquid chromatography with ultraviolet and fluorescence detectors. Quantifiable unbound NCO species were detected on 84.2% of all sprayed surfaces sampled after initially considered dry. Only 7 out of a total of 104 (6.7%) non-compounded skin samples obtained after contact with the recently dried coatings had detectable quantities of free NCO. The 7 positive samples, all obtained at the initial sampling time (t(0)), had a geometric mean of 0.016 µg NCO cm(-2) (range: 0.002-0.88 µg NCO cm(-2)). Only 1 of 12 (8.3%) of skin samples obtained after compounding contained detectable free NCO. The risk of substantial human isocyanate skin exposure from contact with the dry appearing (yet not fully cured) isocyanate coatings evaluated in this study appears to be low, although other isocyanate coatings and tasks may pose a greater risk of NCO skin exposure.

Employment Quality and Mental and Self-Reported Health Inequities among Latinx Housecleaners: The Safe and Just Cleaners Study.

Precarious employment, such as housecleaning, is one important structural contributor to health inequities. We used an employment quality (EQ) framework to characterize the impact of employment conditions on mental and self-reported ill-health among Latinx housecleaners in the New York City metropolitan area. Using a community-based participatory research approach, we collected cross-sectional survey data from 402 housecleaners between August 2019 and February 2020 to characterize housecleaners' EQ and its association with depression, perceived stress, and self-reported health. We also measured work-related irritant eye, skin, and respiratory symptoms, which have been shown in previous research to be associated with housecleaners' exposure to chemical components of cleaning products. Our housecleaner cohort was largely female and immigrant and most had worked at least five years. Survey items capturing the EQ dimensions of unbalanced interpersonal relations, low material resources, and violations of workers' rights were associated with increased odds of depression, perceived stress, and self-reported ill-health. Work-related irritant eye, skin, and respiratory symptoms were also independently associated with mental and self-reported ill-health and some of the effects of EQ on health were potentially partially mediated through their association with work-related irritant symptoms. Findings can inform directions for community-based educational and policy initiatives to improve housecleaners' employment quality.

The influence of maternal anxiety and cortisol during pregnancy on childhood anxiety symptoms.

BACKGROUND: The etiology of child and adolescent anxiety remains poorly understood. Although several previous studies have examined associations between prenatal maternal psychological functioning and infant and child health outcomes, less is known about the impact of maternal anxiety specific to pregnancy and cortisol during pregnancy on childhood anxiety outcomes. METHODS: Participants included 496 mother-child pairs from the PROGRESS longitudinal birth cohort in Mexico City. Anxiety symptoms were assessed at age 8-11 years during 2018-2019 using the Revised Children's Manifest Anxiety Scale. Pregnancy-specific anxiety was assessed using an expanded version of the Pregnancy Anxiety Scale. Maternal biological stress response during pregnancy was assessed using salivary cortisol measures (area under the curve, cortisol awakening response, and diurnal slope). Linear regression models were used to estimate associations between maternal anxiety and cortisol in relation to continuous child anxiety symptom T-scores. Models were adjusted for maternal age, socioeconomic status, child sex and age, and gestational age at saliva collection. RESULTS: We found that higher levels of pregnancy-specific anxiety in the mother were associated with higher anxiety symptoms in the child (ß: 1.30, 95% CI: 0.19, 2.41). We additionally observed an association between higher maternal total cortisol output during pregnancy and higher anxiety symptoms in the child (ß: 1.13, 95% CI: 0.25, 2.01). DISCUSSION: These findings highlight the importance of screening for maternal pregnancy-specific anxiety and the need to identify interventions and support for mothers during pregnancy in order to promote healthy outcomes for mothers and their children.

Children's environment and health in Latin America: the Ecuadorian case.

Environmental health problems of children in Latin America and Ecuador are complex due to the close relationship that exists between social and environmental factors. Extended poverty and basic problems, such as the lack of drinking water and sanitation, are common. Infectious diseases are the greatest cause of morbidity and mortality among children. Development in industry and the introduction of chemical substances in agriculture add new risks including pesticide use, heavy metal exposure, and air pollution. Major problems can be divided into (a) lack of basic infrastructure, (b) poor living conditions, (c) specific environmental problems, and (d) child labor. Reproductive health disorders are frequent in developing countries like Ecuador. Issues related to children's health should consider new approaches, creative methodologies, and the search for independent predictors to separate environmental from social problems. Only with knowledge of the specific contribution of each factor, can it be possible to develop a strategy for prevention.

Residual Isocyanates in Medical Devices and Products: A Qualitative and Quantitative Assessment.

We conducted a pilot qualitative and quantitative assessment of residual isocyanates and their potential initial exposures in neonates, as little is known about their contact effect. After a neonatal intensive care unit (NICU) stockroom inventory, polyurethane (PU) and PU foam (PUF) devices and products were qualitatively evaluated for residual isocyanates using Surface SWYPE™. Those containing isocyanates were quantitatively tested for methylene diphenyl diisocyanate (MDI) species, using UPLC-UV-MS/MS method. Ten of 37 products and devices tested, indicated both free and bound residual surface isocyanates; PU/PUF pieces contained aromatic isocyanates; one product contained aliphatic isocyanates. Overall, quantified mean MDI concentrations were low (4,4'-MDI = 0.52 to 140.1 pg/mg) and (2,4'-MDI = 0.01 to 4.48 pg/mg). The 4,4'-MDI species had the highest measured concentration (280 pg/mg). Commonly used medical devices/products contain low, but measurable concentrations of residual isocyanates. Quantifying other isocyanate species and neonatal skin exposure to isocyanates from these devices and products requires further investigation.

Major concerns in developing countries: applications of the Precautionary Principle in Ecuador.

Ecuador is a Latin American country with one of the biggest biodiversities. At the same time, social and environmental problems are also big. Poverty, political and social problems as well as questions like old transport systems, imported hazards from industrialized countries and lack of information and weak health care systems are the framework of this situation. The most common problems are the use of heavy metals in many activities without safety and health protection, a low technological oil production during two decades, intensive use of pesticides in agriculture, and some other chemical risks. A limited capacity to develop prevention strategies, reduced technical and scientific skills, and the absence of a reliable information and control system, lead to a weak response mechanism. The Precautionary Principle could help to stimulate prevention, protection and to have a new tool to improve the interest in environment and health problems. Reinforcing the presence of international organizations like the World Health Organization or the International Labour Organization, establishing bridges among scientific organizations from developed and developing countries and introducing the Precautionary Principle in the legislation and daily practices of industry and agriculture could lead to an improvement in our environment and health.