Seroprevalence and risk factors for Lassa virus infection in South-West and North-Central Nigeria: a community-based cross-sectional study.

BACKGROUND: Understanding the level of exposure to Lassa virus (LASV) in at-risk communities allows for the administration of effective preventive interventions to mitigate epidemics of Lassa fever. We assessed the seroprevalence of LASV antibodies in rural and semiurban communities of two cosmopolitan cities in Nigeria with poorly understood Lassa epidemiology. METHODS: A cross-sectional study was conducted in ten communities located in the Abuja Municipal Area Council (AMAC), Abuja, and Ikorodu Local Government Area (LGA), Lagos, from February 2nd to July 5th, 2022. Serum samples collected from participants were analyzed for IgG and IgM antibodies using a ReLASV® Pan-Lassa NP IgG/IgM enzyme-linked immunosorbent assay (ELISA) kit. A questionnaire administered to participants collected self-reported sociodemographic and LASV exposure information. Seroprevalence of LASV IgG/IgM was estimated overall, and by study site. Univariate and multivariate log-binomial models estimated unadjusted and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) for site-specific risk factors for LASV seropositivity. Grouped Least Absolute Shrinkage and Selection Operator (LASSO) was used for variable selection for multivariate analysis. RESULTS: A total of 628 participants with serum samples were included in the study. Most participants were female (434, 69%), married (459, 73%), and had a median age of 38 years (interquartile range 28-50). The overall seroprevalence was 27% (171/628), with a prevalence of 33% (126/376) in Abuja and 18% (45/252) in Lagos. Based on site-specific grouped LASSO selection, enrollment in the dry season (vs. wet; aPR, 95% CI: 1.73, 1.33-2.24), reported inconsistent washing of fruits and vegetables (aPR, 95% CI: 1.45, 1.10-1.92), and a positive malaria rapid test (aPR, 95% CI: 1.48, 1.09-2.00) were independently associated with LASV seropositivity in Abuja, whereas, only a self-reported history of rhinorrhea (PR, 95% CI: 2.21, 1.31-3.72) was independently associated with Lassa seropositivity in Lagos. CONCLUSIONS: The LASV seroprevalence was comparable to that in other areas in Nigeria. Our findings corroborate those from other studies on the importance of limiting human exposure to rodents and focusing on behavioral factors such as poor hygiene practices to reduce exposure to LASV.

Risk of dementia due to Co-exposure to air pollution and neighborhood disadvantage.

BACKGROUND: Co-exposure to air pollution and neighborhood disadvantage may influence cognition decline. We tested these associations in the context of dementia risk. METHODS: We leveraged a cohort of adults ≥65 years (n = 5397) enrolled from 2011 to 2018 in the National Health and Aging Trends Study (NHATS). Particulate matter (PM) ≤ 10 µm in diameter, PM ≤ 2.5 µm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide - and neighborhood disadvantage were tested for joint associations with dementia risk. Pollutant concentrations at the 2010 census tract level were assigned using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Neighborhood disadvantage was defined using the tract Social Deprivation Index (SDI). Dementia was determined through self- or proxy-report or scores indicative of "probable dementia" according to NHATS screening tools. Joint effects of air pollutants and SDI were tested using quantile g-computation Cox proportional hazards models. We also stratified joint air pollution effects across SDI tertiles. Analyses adjusted for age at enrollment, sex, education, partner status, urbanicity, income, race and ethnicity, years at residence, census segregation, and census region. RESULTS: SDI score (aHR = 1.08; 95% CI 0.96, 1.22), joint air pollution (aHR = 1.03, 95% CI 0.92, 1.16) and joint SDI with air pollution (aHR = 1.04, 95% CI 0.89, 1.22) were not associated with dementia risk. After accounting for competing risk of death, joint SDI with air pollution was not associated with dementia risk (aHR = 1.06; 95% CI 0.87, 1.29). In stratified models, joint air pollution was associated with greater risk of dementia at high (aHR = 1.19; 95% CI 0.87, 1.63), but not at medium or low SDI. CONCLUSION: Air pollution was associated with greater dementia risk in disadvantaged areas after accounting for competing risks. Air pollution associations with dementia incidence may be attenuated when other risk factors are more prominent in disadvantaged neighborhoods.

Dietary patterns and cognitive achievement among school children in socio-cultural context, a case of Montevideo, Uruguay.

PURPOSE: The benefits of a healthy diet on children´s cognition have been described in several studies. However, many previous studies have analyzed the effect on general cognitive domains (e.g. intelligence), used measures based almost exclusively on local examinations, and rarely consider social context. OBJECTIVE: The objective of the present study was to examine the relationship between two diet patterns and contextualized cognitive performance measures of children aged 6-8 years from low-average income neighborhoods in Montevideo, Uruguay. METHODS: 270 first-grade children with complete data participated in the study. Consumption of foods was determined via two averaged 24-h dietary recalls with the mother. Two dietary patterns were identified via principal component analysis: "processed (high calorie) foods" and "nutrient dense". Children´s cognitive performance, including general cognitive abilities, achievement in mathematics and reading, and discrepancy scores between predicted and actual achievement was assessed with the Woodcock-Muñoz Cognitive and Achievement scales. The association of dietary patterns and cognitive endpoints was analyzed in multilevel models, clustered by children´s school. Sociodemographic and biological variables were used as covariates. RESULTS: The nutrient dense foods pattern, characterized by higher consumption of dark leafy and red-orange vegetables, eggs, beans & peas, potatoes, was associated with better performance in reading, with beta coefficient 3.28 (95% CI 0.02, 6.54). There was also an association between the nutrient dense foods factor and the Discrepancy in reading, 2.52 (0.17, 4.87). Processed (high calorie) foods pattern, characterized by higher consumption of breads, processed meats, fats and oils, sweetened beverages, and sweetened yogurt/dairy products; reduced intake of milk, pastries and pizza dinners was not associated with cognitive performance. CONCLUSIONS: Nutrient dense food pattern was positively associated with children's reading achievement. A nutrient-rich diet may benefit written language acquisition at the beginning of schooling.

Neighborhood disadvantage and adolescent behavior problems: how do inferences differ across definitions of disadvantage?

BACKGROUND: Various definitions of neighborhood disadvantage (ND) exist, yet evidence is lacking on how ND operationalization may impact scientific inference. METHODS: We used data from wave 6 of the Fragile Families study, excluding those without census tract or behavior problem data (n = 2363). Outcomes included five scales from the caregiver-reported Child Behavior Checklist (CBCL) and a self-reported delinquency scale. ND was defined in four ways: (1) a modified Sampson definition which included four neighborhood poverty variables; (2) a poverty-only definition which only included percent households below poverty; (3) an overextended definition which added a mediator between the ND-behavior relationship, and (4) an expanded definition which added six additional ND variables to the modified Sampson definition. Using effect estimates from generalized linear models, differences were calculated using percent change-in-estimate, with the modified Sampson as the referent. RESULTS: Effect estimates were similar for the modified Sampson and expanded definitions (< 5% difference). The poverty-only definition differed from the modified Sampson unsystematically. Estimates for the overextended definition were consistently larger compared to modified Sampson (10-37% greater). The expanded and modified Sampson definitions produced similar results. CONCLUSION: Poverty-only and overextended ND definitions should be interpreted with caution.

Prenatal predictors of postpartum depression trajectories from birth to 24 months amongst smoking women.

AIMS AND OBJECTIVES: We aimed to identify postpartum depression (PPD) trajectories and examine relevant predictors amongst smoking women. BACKGROUND: PPD can adversely affect families. Predictors of PPD trajectories amongst smoking women are understudied. DESIGN: Longitudinal cohort study. METHODS: A cohort of 49 U.S. women (current or ex-smoking) completed the Edinburgh Postnatal Depression Scale from birth to 24 months postpartum. Latent class growth modelling was used to identify PPD trajectories. Predictors of PPD trajectories were identified, adjusting for confounders. Effect modification by prenatal Patient Health Questionnaire (PHQ) depression score was also assessed. STROBE guidelines were followed in reporting results. RESULTS: Three PPD trajectories were identified: non-PPD, transient PPD and chronic PPD. In multinomial logistic regression, social support was associated with lower odds of membership in the chronic PPD trajectory compared to non-PPD trajectory: being married or having a partner sharing resources (odds ratio OR = .14 [.02, .85], p-value = .03), greater partner support (OR = .87 [.77, .98], p-value = .02) and greater family/friends support (OR = .53 [.34, .82], p-value = .004). Transient PPD showed no differences with non-PPD on any predictors. In ordinal logistic regression models, social support was associated with lower odds of membership in a more severe PPD depression trajectory when prenatal PHQ depression score was in the low range (being married or having a partner sharing resources: p for effect modification = .06; partner support: p for effect modification = .05; and family/friends support: p for effect modification = .005). RELEVANCE TO CLINICAL PRACTICE: Compared to the general population, chronic PPD trajectories were more common amongst smoking women. Social support was an important predictor of more severe PPD trajectories, especially when prenatal depression is low. CONCLUSION: Our findings indicated that social support might decrease likelihood of severe PPD trajectories, especially when prenatal depression was low. Relevant predictors of transient PPD remained elusive.

Low-level exposure to lead, mercury, arsenic, and cadmium, and blood pressure among 8-17-year-old participants of the 2009-2016 National Health and Nutrition Examination Survey.

BACKGROUND: Dysregulation of systolic, diastolic blood pressure (SBP, DBP), and pulse pressure (PP) in children may predict elevated blood pressure (BP) in adulthood. Toxicant exposure is widely studied as a risk factor for high BP in adults, but not in children. We assessed the joint associations between lead (Pb), mercury (Hg), arsenic (As), and cadmium (Cd) exposure and SBP, DBP, and PP among 8-17 year-old participants (n = 1642) of the 2009-2016 National Health and Nutrition Examination Survey (NHANES). METHODS: Participants with at least two BP measures were included. Urinary As and Cd were adjusted for urinary creatinine concentrations. Blood Pb, Hg, and urinary As, Cd were natural log-transformed. Bayesian Kernel Machine Regression (BKMR) analyses were conducted to assess the associations between the toxicant mixture and BP measures. Multivariable regression models assessed the associations between individual toxicants, and the four toxicants simultaneously with each of the outcomes. Interactions with sodium intake were tested. RESULTS: Exposure to all toxicants was low, with median (5%, 95%) level: Pb, 0.57 (0.26, 1.60) µg/dL; Hg, 0.37 (0.19, 2.12) µg/L; As, 5.61 (1.37, 33.2) µg/g creatinine, Cd, 0.06 (0.03, 0.23) µg/g creatinine. Toxicant mixture showed a statistically significant, inverse association with DBP, but not other BP measures. Linear regressions revealed no association between toxicants, individually or together, and BP measures. No evidence of interaction of sodium intake with any of the toxicants was observed. CONCLUSIONS: In a nationally representative sample of 8-17 year-olds, we found suggestive inverse association of the mixture of low-level Pb, Hg, As, and Cd, with DBP. Longitudinal studies with multiple toxicants are needed to understand the interactive effects of toxicants on children's BP.

Remote assessment of verbal memory in MS patients using the California Verbal Learning Test.

We used the California Verbal Learning Test, Second Edition (CVLT-II), one component of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), to determine feasibility of a remote assessment protocol. We compared telephone-administered CVLT-II data from MS patients to data acquired in person from an independent sample of patients and healthy controls. Mixed factor analyses of variance (ANOVAs) showed no significant differences between patient groups, but between-group effects comparing patients and healthy controls were significant. In this study, CVLT-II assessment by conventional in-person and remote telephone assessment yielded indistinguishable results. The findings indicate that telephone-administered CVLT-II is feasible. Further validation studies are underway.

Differential effects of aging on motor and cognitive functioning in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) patients are impaired in motor and cognitive performance, but the extent to which these deficits are magnified by aging is unknown. In one prior study, differences in cognitive processing speed between MS patients and healthy individuals were of similar magnitude across the lifespan. Here, we have improved on this work by expanding assessment to multiple cognitive domains and motor functioning. OBJECTIVE: To determine whether the degree of cognitive and motor dysfunction in MS is magnified with increasing age. METHODS: In all, 698 MS patients (aged 29-71 years) and 226 healthy controls (HCs; aged 18-72 years) completed neuroperformance tests covering ambulation, upper extremity function, information processing speed, and memory. RESULTS: Linear regression models predicting cognitive and motor function revealed main effects of MS/HC diagnosis, age, and education across all measures. There was also an interaction between age and diagnosis on measures of motor function, but not on cognitive outcomes. CONCLUSION: The progression of motor decline is amplified by aging in MS. However, the degree of cognitive impairment does not vary across the lifespan. Thus, evidence of accelerated cognitive impairment in older adults with MS may signal the presence of other age-related cognitive pathologies.

The Prospective Association Between Internalizing Symptoms and Adolescent Alcohol Involvement and the Moderating Role of Age and Externalizing Symptoms.

BACKGROUND: As predicted by self-medication theories that drinking is motivated by a desire to ameliorate emotional distress, some studies find internalizing symptoms (e.g., anxiety, depression) increase risk of adolescent drinking; however, such a risk effect has not been supported consistently. Our prior work examined externalizing symptoms as a potential moderator of the association between internalizing symptoms and adolescent alcohol use to explain some of the inconsistencies in the literature. We found that internalizing symptoms were protective against early adolescent alcohol use particularly for youth elevated on externalizing symptoms (a 2-way interaction). Our sample has now been followed for several additional assessments that extend into young adulthood, and the current study tests whether the protective effect of internalizing symptoms may change as youth age into young adulthood, and whether this age-moderating effect varied across different clusters of internalizing symptoms (social anxiety, generalized anxiety, and depression). Internalizing symptoms were hypothesized to shift from a protective factor to a risk factor with age, particularly for youth elevated on externalizing symptoms. METHODS: A community sample of 387 adolescents was followed for 9 annual assessments (mean age = 12.1 years at the first assessment and 55% female). Multilevel cross-lagged 2-part zero-inflated Poisson models were used to test hypotheses. RESULTS: The most robust moderating effects were for levels of alcohol use, such that the protective effect of all internalizing symptom clusters was most evident in the context of moderate to high levels of externalizing problems. A risk effect of internalizing symptoms was evident at low levels of externalizing symptoms. With age, the risk and protective effects of internalizing symptoms were evident at less extreme levels of externalizing behavior. With respect to alcohol-related problems, findings did not support age moderation for generalized anxiety or depression, but it was supported for social anxiety. CONCLUSIONS: Findings highlight the importance of considering the role of emotional distress from a developmental perspective and in the context of externalizing behavior problems.

Benchmarks of meaningful impairment on the MSFC and BICAMS.

BACKGROUND: Cognitive and motor abilities in multiple sclerosis (MS) are typically quantified using reliable, consensus standard tests validated in the MS population. While these performance measures are associated with vocational disability in parametric analyses, translation of raw scores into anchors reflecting clinically relevant, functional impairment requires further research. OBJECTIVE: To examine performance-based motor and cognitive outcomes among definitive anchors that designate varying degrees of functional impairment, thereby establishing benchmarks for score interpretation. METHODS: We evaluated MS patients and healthy controls, all undergoing a brief test battery. Outcomes were derived from the MS Functional Composite (MSFC) and the Brief International Cognitive Assessment for MS (BICAMS). Functional impairment anchors were (1) disability benefits, (2) employed with negative work events, and (3) employed without problems. RESULTS: All measures yielded statistically significant differences across all levels of work status, after accounting for the effects of age and education. Benchmark values distinguished the functional impairment groups. When evaluated in combination, the Timed 25-Foot Walk and the Symbol Digit Modalities Test were the most robust predictors of functional decline. CONCLUSION: We have established benchmark scores for popular motor and cognitive tests that are associated with specific degrees of impairment in work status.

Disclosure of disease status among employed multiple sclerosis patients: association with negative work events and accommodations.

BACKGROUND: Unemployment is common in multiple sclerosis (MS) and detrimental to quality of life. Studies suggest disclosure of diagnosis is an adaptive strategy for patients. However, the role of cognitive deficits and psychiatric symptoms in disclosure are not well studied. OBJECTIVE: The goals of this paper were to (a) determine clinical factors most predictive of disclosure, and (b) measure the effects of disclosure on workplace problems and accommodations in employed patients. METHODS: We studied two overlapping cohorts: a cross-sectional sample (n = 143) to determine outcomes associated with disclosure, and a longitudinal sample (n = 103) compared at four time points over one year on reported problems and accommodations. A case study of six patients, disclosing during monitoring, was also included. RESULTS: Disclosure was associated with greater physical disability but not cognitive impairment. Logistic regression predicting disclosure status retained physical disability, accommodations and years of employment (p < 0.0001). Disclosed patients reported more work problems and accommodations over time. The case study revealed that reasons for disclosing are multifaceted, including connection to employer, decreased mobility and problems at work. CONCLUSION: Although cognitive impairment is linked to unemployment, it does not appear to inform disclosure decisions. Early disclosure may help maintain employment if followed by appropriate accommodations.

Predicting blood lead in uruguayan children: Individual- vs neighborhood-level ensemble learners.

Predicting childhood blood lead levels (BLLs) has had mixed success, and it is unclear if individual- or neighborhood-level variables are most predictive. An ensemble machine learning (ML) approach to identify the most relevant predictors of BLL ≥2µg/dL in urban children was implemented. A cross-sectional sample of 603 children (~7 years of age) recruited between 2009-2019 from Montevideo, Uruguay participated in the study. 77 individual- and 32 neighborhood-level variables were used to predict BLLs ≥2µg/dL. Three ensemble learners were created: one with individual-level predictors (Ensemble-I), one with neighborhood-level predictors (Ensemble-N), and one with both (Ensemble-All). Each ensemble learner comprised four base classifiers with 50% training, 25% validation, and 25% test datasets. Predictive performance of the three ensemble models was compared using area under the curve (AUC) for the receiver operating characteristic (ROC), precision, sensitivity, and specificity on the test dataset. Ensemble-I (AUC: 0.75, precision: 0.56, sensitivity: 0.79, specificity: 0.65) performed similarly to Ensemble-All (AUC: 0.75, precision: 0.63, sensitivity: 0.79, specificity: 0.69). Ensemble-N (AUC: 0.51, precision: 0.0, sensitivity: 0.0, specificity: 0.50) severely underperformed. Year of enrollment was most important in Ensemble-I and Ensemble-All, followed by household water Pb. Three neighborhood-level variables were among the top 10 important predictors in Ensemble-All (density of bus routes, dwellings with stream/other water source and distance to nearest river). The individual-level only model performed best, although precision was improved when both neighborhood and individual-level variables were included. Future predictive models of lead exposure should consider proximal predictors (i.e., household characteristics).

Social cohesion as a modifier of joint air pollution exposure and incident dementia.

Social cohesion can reduce stress, increase social interaction, and improve cognitive reserve. These social mechanisms may modify the effects of air pollution on dementia risk. This cohort study examines the potential moderating effect of social cohesion on associations between joint air pollution exposure and incident dementia leveraging data from 5112 community-dwelling adults ≥65 years of age enrolled in the National Health and Aging Trends Study (NHATS). Study participants were enrolled in 2011 and followed through 2018. We assigned 2010 residential census tract-level exposures to five air pollutants, particulate matter (PM) ≤ 10 µm in diameter, PM ≤ 2.5 µm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide, using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Dementia status was determined based on self- or proxy-reported dementia diagnosis or "probable dementia" according to NHATS cognitive screening tools. Participants' self-rated neighborhood social cohesion was evaluated based on three questions: neighbors knowing each other, being helpful, and being trustworthy. Social cohesion was dichotomized at the median into high vs low social cohesion. Associations between air pollutants and incident dementia were assessed using quantile g-computation Cox proportional hazard models and stratified by high vs low social cohesion, adjusting for age, sex, education, partner status, urbanicity, annual income, race and ethnicity, years lived at current residence, neighborhood disadvantage index, and tract segregation. High social cohesion (HR = 1.20, 95 % CI = 0.98, 1.47) and air pollution (HR = 1.08, 95 % CI = 0.92, 1.28) were not associated with incident dementia alone. However, when stratified, greater joint air pollution exposure increased dementia risk among participants at low (HR = 1.34, 95 % CI = 1.04, 1.72), but not high (HR = 1.00, 95 % CI = 0.93, 1.06) social cohesion. Air pollution was a risk factor for dementia only when reported social cohesion was low, suggesting that social interaction may play a protective role, mitigating dementia risk via air pollution exposure.

Environmental Exposure Disparities and Neurodevelopmental Risk: a Review.

PURPOSE OF REVIEW: Neurotoxicant exposures are of particular concern in historically marginalized communities. Often a consequence of structural racism, low-income minoritized populations experience a disproportionate burden of hazardous exposures through proximity to industrial facilities, high traffic roads, and suboptimal housing. Here, we summarize reports on exposures and neurodevelopment focused on differences by education, income, race/ethnicity, or immigration status from 2015 to 2022, discuss the importance of such investigations in overburdened communities, and recommend areas for future research. RECENT FINDINGS: We found 20 studies that investigated exposure disparities and neurodevelopment in children. Most were conducted in the USA, and many focused on air pollution, followed by metal exposures and water contamination. Although several studies showed differences in exposure-outcome associations by income and education, many examining differences by race/ethnicity did not report notable disparities between groups. However, measures of individual race and ethnicity are not reliable measures of discrimination experienced as a consequence of structural racism. Our review supports scientific evidence that the reduction of individual and widespread municipal exposures will improve child development and overall public health. Identified research gaps include the use of better indicators of economic status and structural racism, evaluations of effect modification and attributable fraction of outcomes by these factors, and considerations of multidimensional neighborhood factors that could be protective against environmental insults. Considering that vulnerable populations have disparities in access to and quality of care, greater burden of exposure, and fewer resources to incur associated expenses, such populations should be prioritized.

Reducing the complexity of high-dimensional environmental data: An analytical framework using LASSO with considerations of confounding for statistical inference.

PURPOSE: Frameworks for selecting exposures in high-dimensional environmental datasets, while considering confounding, are lacking. We present a two-step approach for exposure selection with subsequent confounder adjustment for statistical inference. METHODS: We measured cognitive ability in 338 children using the Woodcock-Muñoz General Intellectual Ability (GIA) score, and potential associated features across several environmental domains. Initially, 111 variables theoretically associated with GIA score were introduced into a Least Absolute Shrinkage and Selection Operator (LASSO) in a 50% feature selection subsample. Effect estimates for selected features were subsequently modeled in linear regressions in a 50% inference (hold out) subsample, first adjusting for sex and age and later for covariates selected via directed acyclic graphs (DAGs). All models were adjusted for clustering by school. RESULTS: Of the 15 LASSO selected variables, eleven were not associated with GIA score following our inference modeling approach. Four variables were associated with GIA scores, including: serum ferritin adjusted for inflammation (inversely), mother's IQ (positively), father's education (positively), and hours per day the child works on homework (positively). Serum ferritin was not in the expected direction. CONCLUSIONS: Our two-step approach moves high-dimensional feature selection a step further by incorporating DAG-based confounder adjustment for statistical inference.

Predicting Low-Level Childhood Lead Exposure in Metro Atlanta Using Ensemble Machine Learning of High-Resolution Raster Cells.

Low-level lead exposure in children is a major public health issue. Higher-resolution spatial targeting would significantly improve county and state-wide policies and programs for lead exposure prevention that generally intervene across large geographic areas. We use stack-ensemble machine learning, including an elastic net generalized linear model, gradient-boosted machine, and deep neural network, to predict the number of children with venous blood lead levels (BLLs) ≥2 to <5 µg/dL and ≥5 µg/dL in ~1 km2 raster cells in the metro Atlanta region using a sample of 92,792 children ≤5 years old screened between 2010 and 2018. Permutation-based predictor importance and partial dependence plots were used for interpretation. Maps of predicted vs. observed values were generated to compare model performance. According to the EPA Toxic Release Inventory for air-based toxic release facility density, the percentage of the population below the poverty threshold, crime, and road network density was positively associated with the number of children with low-level lead exposure, whereas the percentage of the white population was inversely associated. While predictions generally matched observed values, cells with high counts of lead exposure were underestimated. High-resolution geographic prediction of lead-exposed children using ensemble machine learning is a promising approach to enhance lead prevention efforts.

Do Neighborhood Factors Modify the Effects of Lead Exposure on Child Behavior?

Lead exposure and neighborhoods can affect children's behavior, but it is unclear if neighborhood characteristics modify the effects of lead on behavior. Understanding these modifications has important intervention implications. Blood lead levels (BLLs) in children (~7 years) from Montevideo, Uruguay, were categorized at 2 µg/dL. Teachers completed two behavior rating scales (n = 455). At one-year follow-up (n = 380), caregivers reported child tantrums and parenting conflicts. Multilevel generalized linear models tested associations between BLLs and behavior, with neighborhood disadvantage, normalized difference vegetation index (NDVI), and distance to nearest greenspace as effect modifiers. No effect modification was noted for neighborhood disadvantage or NDVI. Children living nearest to greenspace with BLLs < 2 µg/dL were lower on behavior problem scales compared to children with BLLs ≥ 2 µg/dL. When furthest from greenspace, children were similar on behavior problems regardless of BLL. The probability of daily tantrums and conflicts was ~20% among children with BLLs < 2 µg/dL compared to ~45% among children with BLLs ≥ 2 µg/dL when closest to greenspace. Furthest from greenspace, BLLs were not associated with tantrums and conflicts. Effect modification of BLL on child behavior by distance to greenspace suggests that interventions should consider both greenspace access and lead exposure prevention.

Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): discrete and regression-based norms for the Brazilian context.

BACKGROUND: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been recently developed as a brief, practical, and feasible tool for cognitive impairment in multiple sclerosis (MS). OBJECTIVE: This study aimed to provide continuous and discrete normative values for the BICAMS in the Brazilian context. METHODS: Normatization was achieved using six hundred and one healthy controls from the community assessed at five Brazilian geopolitical regions. RESULTS: Mean raw scores, T scores, percentiles, and Z scores for each BICAMS measure are provided, stratified by age and educational level. Regression-based norms were provided by converting raw scores to scaled scores, which were regressed on age, gender, and education, yielding equations that can be used to calculate the predicted scores. Regression analyses revealed that age, gender, and education significantly influenced test results, as in previous studies. CONCLUSIONS: The normative data of the BICAMS to the Brazilian context presented good representativeness, improving its use in daily clinical practice.

A mixed methods study examining neighborhood disadvantage and childhood behavior problems in Montevideo, Uruguay.

BACKGROUND: Neighborhood disadvantage (ND) is a risk factor for child behavior problems (CBPs), but is understudied outside the United States and Europe. Our mixed methods study aims to (1) create a culturally meaningful measure of ND, (2) test cross-sectional associations between ND and CBPs and (3) qualitatively explore life in the neighborhoods of families participating in the Salud Ambiental Montevideo (SAM) study. METHODS: The quantitative study (Study 1) comprised 272, ~7-year-old children with geolocation and complete data on twelve behavioral outcomes (Conner's Teachers Rating Scale - Revised Short Form: CTRS-R:S and Behavioral Rating Inventory of Executive Functioning: BRIEF). A ND factor was created at the census segment level (1,055 segments) with 19 potential indicators of ND downloaded from the Municipality of Montevideo Geographic Services. Children were assigned ND scores based on the location of their household within a census segment. Multilevel models tested associations between ND and all CBP scales, controlling for confounders at the individual level. The qualitative study (Study 2) comprised 10 SAM caregivers. Photovoice alongside semi-structured interviews in Spanish were used to foster conversations about neighborhood quality, activities, and raising children. Thematic analysis with inductive coding was used to summarize qualitative study findings. RESULTS: The ND factor consisted of 12 census-based indicators related to education, employment, ethnicity, housing quality, and age characteristics, but unrelated to home ownership and some ethnicity variables. In multivariable models, ND was associated with greater conduct problems (ß = 1.37, p < .05), poor shifting (ß = 1.56, p < .01) and emotional control problems (ß = 2.36, p < .001). Photovoice and semi-structured interviews yielded four themes: physical disorder, recreation, safety and crime, and community resources. Residents discussed improving waste management and transportation, updating playgrounds, and ensuring neighborhood safety. CONCLUSIONS: ND in Montevideo comprised a unique set of census indicators. ND was primarily related to behavioral regulation problems. Hypothesized pathways whereby ND affects CBPs are discussed.

Internalizing symptoms and cannabis and alcohol use: Between- and within-person risk pathways with coping motives.

OBJECTIVE: To test reciprocal associations among internalizing symptoms (depression and social anxiety), using alcohol and cannabis to cope, and use-related problems. METHOD: The study utilized a community sample (N = 387, 55% female; majority non-Hispanic Caucasian (83.1%) or African American (9.1%) and a longitudinal design that spanned 17 to 20 years of age, and distinguished within- and between-person associations using latent curve models with structured residuals. RESULTS: Reciprocal prospective within-person associations were supported for alcohol, such that elevated depression symptoms were associated with increased alcohol coping motivates 1 year later, which, in turn, was associated with subsequent increased depression symptoms. Bidirectional associations were not supported for social anxiety, although high levels of social anxiety were associated with elevated levels of coping drinking 1 year later. Cannabis coping motives were associated with exacerbation of depression, but not social anxiety symptoms, 1 year later. Between- and within-person contemporaneous associations suggested that depression and social anxiety were more strongly associated with coping than social/enhancement motives, and that coping motives were associated with use-related problems. CONCLUSION: Findings suggest that alcohol coping motivates exacerbate rather than ameliorate depression symptoms, which, in turn, leads to greater reliance on alcohol to cope. There was more consistent support for associations with substance use-related problems for depression than for social anxiety. Both between- and within-person associations may be useful for identifying targets and timing of coping-oriented interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).