Is intensive home-treatment a real alternative to classical hospitalization for managing acute psychiatric processes? Insights from clinical practice / ¿Es la hospitalización domiciliaria una alternativa real a la hospitalización clásica para el tratamiento de los procesos psiquiátricos agudos? Reflexiones desde la práctica clínica

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Prenatal Omega-6:Omega-3 Ratio and Attention Deficit and Hyperactivity Disorder Symptoms.

OBJECTIVE: To evaluate whether higher omega-6:omega-3 (n-6:n-3) long-chain polyunsaturated fatty acid ratio in cord plasma is associated with more symptoms of attention deficit and hyperactivity disorder (ADHD) at 4 and 7 years of age. STUDY DESIGN: This study was based on a population-based birth cohort in Spain. N-6 arachidonic acid and n-3 eicosapentaenoic and docosahexaenoic acid concentrations were measured in cord plasma. At 4 years old, ADHD symptoms were reported by teachers through the ADHD Diagnostic and Statistical Manual of Mental Disorders, 4th ed checklist (n = 580). At 7 years old, ADHD symptoms were reported by parents through the Conners' Rating Scale-Revised (short form; n = 642). The ADHD variable was treated as continuous (score) and as dichotomous (symptom diagnostic criteria). Child and family general characteristics were prospectively collected through questionnaires. We applied pooled zero-inflated negative binomial and logistic regressions adjusted for covariates. RESULTS: A higher omega-6:omega-3 long-chain polyunsaturated fatty acid ratio in cord plasma was associated with a higher ADHD index (incidence rate ratio, 1.13; 95% CI, 1.03, 1.23) at 7 years old. The association was not observed at 4 years old (incidence rate ratio, 1.04; 95% CI, 0.92-1.18). No associations were found using ADHD symptom diagnostic criteria. CONCLUSIONS: High prenatal omega-6:omega-3 long-chain polyunsaturated fatty acid ratio preceded the appearance of subclinical ADHD symptoms during mid-childhood. Our findings suggest that maternal diet during pregnancy may modulate the risk to develop long-term ADHD symptoms in the offspring.

Brain Structure and Function in School-Aged Children With Sluggish Cognitive Tempo Symptoms.

OBJECTIVE: Sluggish cognitive tempo (SCT) is a cluster of symptoms associated with poor function in various domains of major life activities that may comprise a novel attention disorder distinct from attention-deficit/hyperactivity disorder (ADHD). Nevertheless, very little is known about the neural substrate of SCT in children. The present study aimed to examine associations between SCT symptoms and brain structure and function in school-aged children. METHOD: We performed a cross-sectional MRI study in 178 children 8 to 12 years old from primary schools in Barcelona, Spain. Data were collected between January 2012 and March 2013. Parents completed the Sluggish Cognitive Tempo-Child Behavior Checklist (SCT-CBCL). Participants underwent magnetic resonance imaging to assess regional brain volume, white matter integrity using diffusion tensor imaging, and functional connectivity in major neural networks. RESULTS: SCT symptoms were associated with altered anatomy of the frontal lobe in the form of increased regional volume. The anomalously large cortical regions were less mature in terms of functional connectivity. Importantly, all the anatomical and functional anomalies identified remained significant after adjusting the analyses for ADHD symptom scores. CONCLUSION: Our results suggest that SCT symptoms are associated with distinct features of brain structure and function that differ from the classical neural substrates described in ADHD.

Autolesiones sin finalidad autolítica: una revisión sistemática en adolescentes de la comunidad / Non-suicidal self-injury: a systematic review

El objetivo de este artículo es presentar una revisión de la investigación existente sobre las autolesiones no suicidas (ANS) en población comunitaria adolescente. Las ANS son un fenómeno tan común entre los adolescentes que se han propuesto como potencial trastorno independiente. Los rangos prevalencia están entre el 4,8 y el 28 %, con una edad de inicio entre los 12 y los 15 años. Su presencia se acompaña de diversos trastornos además del Trastorno Límite de Personalidad (TLP). Las experiencias adversas en la infancia así como factores internos son potentes factores de riesgo

The aim of this article is to present a review of the existing research on Non-suicidal self-injury (NSSI) in adolescents. NSSI is such a common phenomenon among adolescents that it has been proposed to be treated as a potential independent disorder. The prevalence ranges are between 4.8 and 28%, with the age range between 12 and 15 years. It occurs together with Borderline Personality Disorder (BPD) and other types of disorders in addition to this. Both adverse experiences in childhood and internal factors are potent risk factors

L'objectiu d'aquest article és presentar una revisió de la investigació existent sobre les autolesions no suïcides (ANS) en població comunitària adolescent. Les ANS són un fenomen tan comú entre els adolescents que s'han proposat com a potencial trastorn independent. Els rangs de prevalença estan entre el 4,8 I el 28 %, amb una edat d'inici entre els 12 I els 15 anys. La seva preséncia s'acompanya de diversos trastorns, a banda del trastorn límit de la personalitat (TLP). Les experiències adverses en la infantesa, així com factors interns, són potents factors de risc

Sluggish Cognitive Tempo in a Child and Adolescent Clinical Outpatient Setting.

Sluggish cognitive tempo (SCT) symptoms have largely emerged from investigations of attention-deficit/hyperactivity disorder (ADHD). Recent research has demonstrated the relevance of SCT symptoms in the field of clinical child and adolescent psychiatry. The goal of this research was to study the symptoms of SCT in a clinical child and adolescent sample and to define its features and comorbid conditions. We reviewed 834 clinical records of patients referred to Child and Adolescent Mental Health Services and examined SCT symptoms and their relation with sociodemographic data, clinical diagnosis, comorbid conditions, Child Behavior Checklist dimensions, and intelligence quotient. Of the 515 patients (age range, 4 to 17 y, 62.5% male) for whom a fully completed Child Behavior Checklist for Children and Adolescents was available, 20.8% showed high levels of SCT symptoms. SCT symptoms were strongly associated with age, internalizing symptoms, learning disabilities, and ADHD inattentive subtype (ADHD-I). No significant correlations with intelligence quotient were found. We concluded that SCT symptoms are highly prevalent in a clinical sample, and that these symptoms might be related to the difficulties that some individuals have in responding to demands in their environments, such as academic or social demands, as they increase over time.

An evaluation of the sexual differences in the accumulation of organochlorine compounds in children at birth and at the age of 4 years.

This study of the body burden and serum concentrations of organochlorine compounds (OCs), represents a general population in a cohort from Menorca Island (birth 1997-1998) of children at birth and at 4 years of age; the study has shown that the concentrations of hexachlorobenzene (HCB), 4,4'-DDE, 4,4'-DDT, polychlorobiphenyl (PCB) congeners #153, #138 and #180 and total PCBs in sera collected at 4 years are much higher in breastfed children than in those fed with formula, e.g. HCB 0.48 vs 0.21 ng/ml, beta-HCH 0.32 vs 0.24 ng/ml, total DDTs 2.2 vs 0.57 ng/ml and total PCBs 1.4 vs 0.52 ng/ml. Comparison of gender differences in 4 years old children shows higher concentrations of all examined OCs in females than in males with the exception of HCB and PeCB in breastfed children, which are higher in males than in females, e.g. beta-HCH 0.34 vs 0.28 ng/ml, total DDTs 2.6 vs 1.7 ng/ml and total PCBs 1.6 vs 1.0 ng/ml for breastfed children and beta-HCH 0.23 vs 0.19 ng/ml, total DDTs 0.59 vs 0.48 ng/ml and total PCBs 0.58 vs 0.45 ng/ml for formula fed children. Gender comparison of the body burden between children fed with breastmilk or formula also shows higher concentrations in females than in males, e.g. beta-HCH 0.47 vs 0.35 microg, total DDTs 3.0 vs 1.8 microg and total PCBs 1.9 vs 1.2 microg for breastfed children, and beta-HCH 0.39 vs 0.17 microg, total DDTs 0.48 vs 0.27 microg and total PCBs 0.66 vs 0.55 microg for formula fed children. The results may suggest a higher capacity in female children for the retention of OCs incorporated through breastfeeding. However, these results should be taken with caution because the differences of the gender averages have low statistically significance when evaluated with the Student test.

Iodine sources and iodine levels in pregnant women from an area without known iodine deficiency.

OBJECTIVE: An adequate iodine intake during pregnancy is essential for normal development of the foetus. The World Health Organization (WHO) recommends that the median urinary iodine concentration (UIC) in a population of pregnant women should range between 150 and 249 microg/l. The aim of this study was to evaluate iodine status and to examine the main sources of iodine in pregnant women from an apparently iodine-sufficient area. METHODS: Six hundred pregnant women in the third trimester completed a food frequency questionnaire, and iodine was measured in urine samples. Urinary iodine concentrations were described in the whole population and in subgroups according to their frequency of intake of milk, fish, eggs, bread and iodized salt, as iodine supplements. RESULTS: The median UIC was 104 microg/l (n = 600), however, the median was higher among women who had a high milk intake (117 microg/l), used iodized salt (117 microg/l) or who were supplemented with iodine (141 microg/l). Women receiving iodine supplementation who also consumed more than one cup of milk per day had median UIC higher than 150 microg/l. In multivariate models, women with moderate and high milk intake had lower risk of having UIC below 150 microg/l [OR (95% CI): 0.42 (0.22-0.82) and 0.29 (0.15-0.55) respectively], after adjustment for potential confounders. CONCLUSIONS: On the basis of WHO criteria, the iodine status of pregnant women was inadequate in this area. Milk was the most important dietary source of iodine, and iodine supplementation was also an important source of iodine, although not enough to reach the current recommendations.

Maternal use of folic acid supplements during pregnancy and four-year-old neurodevelopment in a population-based birth cohort.

The use of folic acid supplements during very early pregnancy is recommended in order to reduce the incidence of neural tube defects. Little is known about the possible benefits of folic acid on child neurodevelopment. A total of 420 children (87% of those eligible) from a birth cohort had complete data for final analyses at age 4 years. Information about folic acid and other over-the-counter dietary supplements was obtained prospectively using interviewer-administered questionnaires at the end of the first trimester of pregnancy. Psychological outcomes were assessed by two psychologists and teachers 4 years later. Low maternal socio-economic status, smoking, high parity and short duration of breast feeding were associated with lower prevalence of folic acid supplement use. Verbal (b = 3.98, SE = 1.69), motor (b = 4.54, SE = 1.66) and verbal-executive function (b = 3.97, SE = 1.68) scores, social competence (b = 3.97, SE = 1.61) and inattention symptom [OR = 0.46; 95% CI 0.22, 0.95] scores were associated with reported folic acid use. Reported folic acid supplement use during pregnancy was associated with improved neurodevelopment in children after adjusting for a number of sociodemographic and behavioural factors.

Maternal fish and other seafood intakes during pregnancy and child neurodevelopment at age 4 years.

OBJECTIVE: To analyse the relationship between maternal intakes of fish and other seafood during pregnancy and child neurodevelopment at age 4 years. Although pregnant women are advised to limit seafood intakes because of possible neurotoxin contamination, several studies suggest that overall maternal seafood intakes are associated with improved child neurodevelopment, perhaps because of higher DHA intakes. DESIGN: The study uses data from a prospective birth cohort study. Maternal seafood intakes were assessed using a semi-quantitative FFQ administered shortly after delivery. Multivariate linear regression was used to estimate associations between seafood consumption and scores on the McCarthy Scales of Children's Abilities (MCSA). Analyses were stratified by breast-feeding duration as breast milk is a source of DHA during the postnatal phase of the brain growth spurt. SETTING: Menorca, Spain, 1997-2001. SUBJECTS: Full-term children (n 392) with data on maternal diet in pregnancy, breast-feeding duration and neurodevelopment at age 4 years. RESULTS: Among children breast-fed for <6 months, maternal fish intakes of >2-3 times/week were associated with significantly higher scores on several MCSA subscales compared with intakes < or =1 time/week. There was no association among children breast-fed for longer periods. Maternal intakes of other seafood (shellfish/squid) were, however, inversely associated with scores on several subscales, regardless of breast-feeding duration. CONCLUSIONS: The study suggests that moderately high intakes of fish, but not other seafood, during pregnancy may be beneficial for neurodevelopment among children breast-fed for <6 months. Further research in other populations with high seafood intakes and data on additional potential confounders are needed to confirm this finding.

Influence of glutathione S-transferase polymorphisms on cognitive functioning effects induced by p,p'-DDT among preschoolers.

BACKGROUND: Early-life exposure to p,p'-DDT [2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane] is associated with a decrease in cognitive skills among preschoolers at 4 years of age. We hypothesized that genetic variability in glutathione S-transferase (GST) genes (GSTP1, GSTM1, and GSTT1) could influence the effects of prenatal exposure to p,p'-DDT. METHODS: We used data from 326 children assessed in a prospective population-based birth cohort at the age of 4 years. In that study, the McCarthy Scales of Children's Abilities were administrated by psychologists, organochlorine compounds were measured in cord serum, and genotyping was conducted for the coding variant Ile105Val from GSTP1 and for null alleles from GSTM1 and GSTT1. We used linear regression models to measure the association between organochlorines and neurodevelopmental scores by GST polymorphisms. RESULTS: p,p'-DDT cord serum concentration was inversely associated with general cognitive, memory, quantitative, and verbal skills, as well as executive function and working memory, in children who had any GSTP1 Val-105 allele. GSTP1 polymorphisms and prenatal p,p'-DDT exposure showed a statistically significant interaction for general cognitive skills (p = 0.05), quantitative skills (p = 0.02), executive function (p = 0.01), and working memory (p = 0.02). There were no significant associations between p,p'-DDT and cognitive functioning at 4 years of age according to GSTM1 and GSTT1 polymorphisms. CONCLUSIONS: Results indicate that children with GSTP1 Val-105 allele were at higher risk of the adverse cognitive functioning effects of prenatal p,p'-DDT exposure.

Urinary porphyrin excretion in children is associated with exposure to organochlorine compounds.

BACKGROUND: Hexachlorobenzene (HCB) and other organochlorines induce porphyria cutanea tarda (PCT) in animal studies. Evidence in humans, however, is contradictory. In neonates and adults from a population historically highly exposed to HCB (Flix, Catalonia, Spain), no relation with PCT or with porphyrin excretion was found. OBJECTIVES: We aimed to analyze the association between urinary porphyrin excretion and exposure to HCB and other organochlorinated compounds in children 4 years of age. METHODS: Our birth cohort included all newborns from Flix and the five surrounding towns (where no airborne pollution occurred). Among the 68 children with porphyrins we measured in cord blood, 52 children 4 years of age provided blood to measure organochlorine compounds, hair for methylmercury, and urine for porphyrin excretion pattern. RESULTS: Quantitative porphyrin excretion was within the normal values. However, total porphyrins, coproporphyrin I (CPI), and coproporphyrin III (CPIII) adjusted to creatinine excretion increased with increasing levels of HCB, 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (p,p'-DDE), 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (p,p'-DDT), and polychlorinated biphenyl congener 153 (PCB-153). We found no association with methylmercury. When we fitted multiple pollutant models, p,p'-DDE had the strongest association. We found these associations in children from both Flix and other towns, and they were independent of breast-feeding and of organochlorine and porphyrin levels at birth. CONCLUSION: HCB at current levels did not induce porphyria or increase uroporphyrins. However, the increase of urinary coproporphyrins suggests an incipient toxic effect of the organochlorines, especially for p,p'-DDE, on the hepatic heme-synthesis pathway that differs from the major effects seen in PCT.

Exposure to hexachlorobenzene during pregnancy increases the risk of overweight in children aged 6 years.

AIM: To determine whether prenatal exposure to hexachlorobenzene (HCB) has potential adverse effects on child's weight and body mass index (BMI) in a general population with no local pollution sources. METHODS: Starting from mid 1997, all mothers presenting for antenatal exposure in Menorca were recruited. Subsequently, 482 children were enrolled. HCB was measured in cord blood. Weight and height were measured at birth and at age 6.5 years. RESULTS: Children with HCB levels higher than 1.03 ng/mL in cord blood were 1.14 kg (0.38) heavier and had a higher BMI (beta= 0.80 (0.34)) than children with HCB levels lower than 0.46 ng/mL. No statistically significant associations were found in height. Children in the higher exposure group of HCB had an increased risk of 2.5 and 3.0 of being overweight and obese. Children from normal weight mothers also presented an increased risk of having higher BMI with increasing concentrations of HCB in cord serum. CONCLUSION: Prenatal exposure to HCB is associated with an increase in BMI and weight at age 6.5 years. Further studies with larger samples and longer follow-up are needed to confirm these results.

Maternal smoking very early in pregnancy is related to child overweight at age 5-7 y.

BACKGROUND: Despite being associated with lower birth weight, maternal smoking in the last 2 trimesters of pregnancy has been associated with increased risk of offspring overweight in several studies. To date, only one study has examined whether smoking in the first trimester only, which is not associated with birth weight, is also associated with childhood overweight. OBJECTIVE: This study uses prospective data to examine associations between maternal smoking in the first compared with later trimesters of pregnancy and child overweight at age 5-7 y. DESIGN: Data from a prospective cohort of 369 Spanish children born in 1997-1998 were used. Logistic regression was used to estimate associations between maternal smoking during different time periods and odds of child overweight later in life. RESULTS: Maternal smoking during the first trimester was more strongly associated with overweight (adjusted odds ratio: 2.65; 95% CI: 1.26, 5.54) than smoking later in pregnancy (1.88, 0.85, 4.15). Smoking limited to the first month of pregnancy was also associated with child overweight. Neither paternal smoking nor maternal smoking before or after pregnancy was associated with child overweight. Significant interactions with breastfeeding duration indicated that first-trimester smoking was associated with overweight only among children breastfed for <6 mo, suggesting prolonged breastfeeding may help to counter adverse effects of smoking in early pregnancy. CONCLUSIONS: These data suggest maternal smoking very early in pregnancy may increase risk of later overweight in children and provide further support for promoting smoking cessation before rather than during early pregnancy. Further studies are needed to confirm these results.

[Studies conducted in Spain on concentrations in humans of persistent toxic compounds]. / Estudios realizados en España sobre concentraciones en humanos de compuestos tóxicos persistentes.

No systematic review is available on studies conducted in Spain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene (HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrations of DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individuals may be over 200-fold higher than those of others. The actual magnitude of human contamination by PTS and their trends across Spain -as well as the geographic and social heterogeneity- remain largely unknown.

Estudios realizados en España sobre concentraciones en humanos de compuestos tóxicos persistentes / Studies conducted in Spain on concentrations in humans of persistent toxic compounds

Aunque en España se han realizado estudios sobre concentraciones en medios biológicos humanos de compuestos tóxicos persistentes (CTP) desde hace varias décadas, no se ha llevado a cabo una revisión sistemática. Los objetivos fueron: a) identificar los estudios realizados en España en los últimos30 años que hubiesen determinado concentraciones en humanos de diclorodifeniltricloroetano (DDT), diclorodifenildicloroeteno (DDE), hexaclorobenceno (HCB), hexaclorociclohexanos (HCH) y policlorobifenilos (PCB), y b) sintetizar las principales característicasy resultados de cada estudio. Los estudios son sumamenteheterogéneos y la mayoría carece de representatividad poblacional. Las concentraciones de DDT y DDE parecenhaber decrecido moderadamente en los últimos 20 años. Haynumerosas fluctuaciones en los valores de HCB, HCH y PCB,en algún caso compatibles con un estancamiento. Se observan grandes diferencias en los valores detectados en los distintos estudios y dentro de un mismo grupo: las concentraciones de CTP de algunos individuos pueden llegar a ser más de 200 veces superiores a los de otros. La magnitud real de la contaminación humana por CTP y sus tendencias a lo largo del territorio español, así como su diversidad geográfica y social, siguen siendo ampliamente desconocidas

No systematic review is available on studies conducted inSpain on human concentrations of persistent toxic substances (PTS). The objectives were: to identify studies conducted in Spain in the past 30 years that determined concentrations in humans of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethane (DDE), hexachlorobenzene(HCB), hexachlorocyclohexane (HCH) and polychlorinated biphenyls (PCBs); and to summarize the main characteristics and results of each study. Studies are highly heterogeneous and most lack population representativeness. Concentrationsof DDT and DDE might have decreased moderately in the last 20 years. Numerous fluctuations are apparent in levels of HCB, HCHs and PCBs, in some instances compatible with some stagnation. There are enormous differences in levels detected across and within studies: PTS concentrations of some individualsmay be over 200-fold higher than those of others. Theactual magnitude of human contamination by PTS and theirtrends across Spain –as well as the geographic and social heterogeneity– remain largely unknown

Thyroid disruption at birth due to prenatal exposure to beta-hexachlorocyclohexane.

OBJECTIVE: Thyroid hormones play an important role in human brain development, and some organochlorine compounds (OCs) act as thyroid disruptors. The objective of the present study was to evaluate the association between prenatal exposure to organochlorine compounds and thyroid function in newborns from a general population birth cohort in Menorca, with an a-priori specific focus on beta-HCH. METHODS: Levels of polychlorinated biphenyls (PCB congeners 28, 52, 101, 118, 138, 153 and 180), hexachlorobenzene (HCB), beta-hexachlorocyclohexane (beta-HCH), dichlorodiphenyl dichloroethylene (p'p'-DDE) and dichlorodiphenyl trichloroethane (p'p-DDT) in cord serum, and thyrotropin (TSH) concentration in plasma three days after birth were measured in 387 newborns from Menorca. The TSH concentration was categorized (high or low), except for 27 children whose TSH levels were quantified. RESULTS: Levels of beta-HCH and PCB-153 were positively related to TSH concentrations (gestational age-adjusted coefficient (p-value): 0.26 (p = 0.006) and 0.31 (p = 0.050), respectively). CONCLUSIONS: beta-HCH is potentially a new thyroid disrupting compound, deserving special interest in future studies given its high body burden in humans.

Prenatal exposure to mercury in a prospective mother-infant cohort study in a Mediterranean area, Valencia, Spain.

BACKGROUND: Mercury (Hg) is a ubiquitous pollutant that negatively affects fetal and child neurodevelopment at accidental high-dose exposure. Some studies indicate that Mediterranean populations could be at risk of prenatal exposure to mercury through fish consumption. OBJECTIVES: To assess the prenatal exposure to total mercury (T-Hg), both inorganic and organic, in newborns by analyzing the T-Hg concentration in cord blood, and to evaluate the role of maternal fish consumption in this exposure. METHODS: In the context of a multi-center project (INMA project), a prospective birth cohort was set up in Valencia, Spain, from 2005 to 2006. A total of 253 newborns were included in this study. We compared cord blood T-Hg concentration by levels of fish intake assessed by a food frequency questionnaire completed at 28-32 weeks of gestation. Maternal covariates were obtained through a questionnaire. RESULTS: The geometric mean of T-Hg at birth was 9.9 microg/L (95% CI: 9.0, 10.8). Seventy five percent of cord blood samples were above the estimated level assumed to be without appreciable harm (5.8 microg/L). Women who consumed a portion of large oily fish, lean fish, or mixed fried fish two or more times per week had mean cord blood levels 1.6, 1.4 and 1.3 times higher, respectively, than those who rarely or never consumed fish. Other factors such as the mother's age, country of origin, smoking and season of delivery were also significantly and independently associated with cord blood T-Hg concentrations. CONCLUSIONS: Newborns from a Mediterranean area presented elevated levels of T-Hg in cord blood. Higher concentrations of T-Hg were related to maternal fish intake, particularly in the case of large oily fish species.

Monitoring concentrations of persistent organic pollutants in the general population: the international experience.

Assessing the adverse effects on human health of persistent organic pollutants (POPs) and the impact of policies aiming to reduce human exposure to POPs warrants monitoring body concentrations of POPs in representative samples of subjects. While numerous ad hoc studies are being conducted to understand POPs effects, only a few countries are conducting nationwide surveillance programs of human concentrations of POPs, and even less countries do so in representative samples of the general population. We tried to identify all studies worldwide that analyzed the distribution of concentrations of POPs in a representative sample of the general population, and we synthesized the studies' main characteristics, as design, population, and chemicals analyzed. The most comprehensive studies are the National Reports on Human Exposure to Environmental Chemicals (USA), the German Environmental Survey, and the Arctic Monitoring and Assessment Programme. Population-wide studies exist as well in New Zealand, Australia, Japan, Flanders (Belgium) and the Canary Islands (Spain). Most such studies are linked with health surveys, which is a highly-relevant additional strength. Only the German and Flemish studies analyzed POPs by educational level, while studies in the USA offer results by ethnic group. The full distribution of POPs concentrations is unknown in many countries. Knowledge gaps include also the interplay of age, gender, period and cohort effects on the prevalence of exposures observed by cross-sectional surveys. Local and global efforts to minimize POPs contamination, like the Stockholm convention, warrant nationwide monitoring of concentrations of POPs in representative samples of the general population. Results of this review show how such studies may be developed and used.

Pentachlorobenzene, hexachlorobenzene, and pentachlorophenol in children's serum from industrial and rural populations after restricted use.

The study of a population of 4-year-old children born between 1997 and 1999 in an urban area under strong inputs of pentachlorobenzene (PeCB) and hexachlorobenzene (HCB) suggested that the measured concentrations of pentachlorophenol (PCP) in serum may essentially result from metabolism of these chlorinated hydrocarbons. In contrast, examination of a rural population of children where the same compounds were present at relatively low levels points to other inputs besides transformation of PeCB and HCB being responsible for the measured PCP concentrations. In both populations, the results showed that a major proportion of the organochlorine compounds present in these children's serum at 4 years of age was incorporated during the lactation period.