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1.
JAMA ; 321(17): 1702-1715, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063572

RESUMO

Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. Exposures: Gestational weight gain. Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação , Complicações na Gravidez , Resultado da Gravidez , Adulto , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional , Feminino , Humanos , Hipertensão Induzida pela Gravidez , Recém-Nascido , Obesidade , Gravidez , Nascimento Prematuro
2.
PLoS Med ; 16(2): e1002744, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30742624

RESUMO

BACKGROUND: Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact. METHODS AND FINDINGS: We conducted an individual participant data meta-analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia. We assessed the individual and combined associations of maternal pre-pregnancy BMI and gestational weight gain, both in clinical categories and across their full ranges, with the risks of overweight/obesity in early (2.0-5.0 years), mid (5.0-10.0 years) and late childhood (10.0-18.0 years), using multilevel binary logistic regression models with a random intercept at cohort level adjusted for maternal sociodemographic and lifestyle-related characteristics. We observed that higher maternal pre-pregnancy BMI and gestational weight gain both in clinical categories and across their full ranges were associated with higher risks of childhood overweight/obesity, with the strongest effects in late childhood (odds ratios [ORs] for overweight/obesity in early, mid, and late childhood, respectively: OR 1.66 [95% CI: 1.56, 1.78], OR 1.91 [95% CI: 1.85, 1.98], and OR 2.28 [95% CI: 2.08, 2.50] for maternal overweight; OR 2.43 [95% CI: 2.24, 2.64], OR 3.12 [95% CI: 2.98, 3.27], and OR 4.47 [95% CI: 3.99, 5.23] for maternal obesity; and OR 1.39 [95% CI: 1.30, 1.49], OR 1.55 [95% CI: 1.49, 1.60], and OR 1.72 [95% CI: 1.56, 1.91] for excessive gestational weight gain). The proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2% to 21.6%. Relative to the effect of maternal BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical BMI category (p-values for interactions of maternal BMI with gestational weight gain: p = 0.038, p < 0.001, and p = 0.637 in early, mid, and late childhood, respectively). Limitations of this study include the self-report of maternal BMI and gestational weight gain for some of the cohorts, and the potential of residual confounding. Also, as this study only included participants from Europe, North America, and Australia, results need to be interpreted with caution with respect to other populations. CONCLUSIONS: In this study, higher maternal pre-pregnancy BMI and gestational weight gain were associated with an increased risk of childhood overweight/obesity, with the strongest effects at later ages. The additional effect of gestational weight gain in women who are overweight or obese before pregnancy is small. Given the large population impact, future intervention trials aiming to reduce the prevalence of childhood overweight and obesity should focus on maternal weight status before pregnancy, in addition to weight gain during pregnancy.


Assuntos
Índice de Massa Corporal , Análise de Dados , Ganho de Peso na Gestação/fisiologia , Obesidade Pediátrica/epidemiologia , Austrália/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , América do Norte/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Obesidade Pediátrica/diagnóstico , Gravidez , Fatores de Risco
3.
BMC Med ; 16(1): 201, 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30396358

RESUMO

BACKGROUND: Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies. METHODS: We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape. RESULTS: We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications. CONCLUSIONS: Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.

4.
Eur J Epidemiol ; 32(9): 797-805, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28929268

RESUMO

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.


Assuntos
Asma/epidemiologia , Escolaridade , Mães , Asma/etiologia , Criança , Pré-Escolar , Comparação Transcultural , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Idade Materna , Mães/psicologia , Mães/estatística & dados numéricos , Prevalência , Fatores de Risco
5.
Artigo em Inglês | MEDLINE | ID: mdl-27490560

RESUMO

BACKGROUND: Environmental lead exposure detrimentally affects children's educational performance, even at very low blood lead levels (BLLs). Among children in Chicago Public Schools (CPS), the severity of the effects of BLL on reading and math vary by racial subgroup (White vs. Hispanic vs. non-Hispanic Black). We investigated the impact of BLL on standardized test performance by Hispanic subgroup (Mexican, Puerto Rican, and Other Hispanic). METHODS: We examined 12,319 Hispanic children born in Chicago between 1994 and 1998 who were tested for BLL between birth and 2006 and enrolled in the 3rd grade at a CPS school between 2003 and 2006. We linked the Chicago birth registry, the Chicago Blood Lead Registry, and 3rd grade Illinois Standard Achievement Test (ISAT) scores to examine associations between BLL and school performance. Primary analyses were restricted to children with BLL below 10 µg/dL (0.483 µmol/L). RESULTS: BLLs below 10 µg/dL (0.483 µmol/L) were inversely associated with reading and math scores in all Hispanic subgroups. Adjusted Relative Risks (RRadj) and 95% confidence intervals (CI) for reading and math failure were 1.34 (95% CI = 1.25, 1.63) and 1.53 (95% CI = 1.32, 1.78), respectively, per each additional 5 µg/dL of lead exposure for Hispanic children; RRadj did not differ across subgroups. We estimate that 7.0% (95% CI = 1.8, 11.9) of reading and 13.6% (95% CI = 7.7, 19.2) of math failure among Hispanic children can be attributed to exposure to BLLs of 5-9 µg/dL (0.242 to 0.435 µmol/L) vs. 0-4 µg/dL (0-0.193 µmol/L). The RRadj of math failure for each 5 µg/dL (0.242 µmol/L) increase in BLL was notably (p = 0.074) stronger among black Puerto Rican children (RRadj = 5.14; 95% CI = 1.65-15.94) compared to white Puerto Rican children (RRadj = 1.50; 95% CI = 1.12-2.02). CONCLUSIONS: Early childhood lead exposure is associated with poorer achievement on standardized reading and math tests in the 3rd grade for Mexican, Puerto Rican, and Other Hispanic children enrolled in Chicago Public Schools. While we did not see interactions between BLL and ISAT performance by Hispanic subgroup, the stronger association between BLL and math failure for Black Puerto Rican children is intriguing and warrants further study.


Assuntos
Avaliação Educacional , Hispano-Americanos/estatística & dados numéricos , Chumbo/toxicidade , Processos Mentais/efeitos dos fármacos , Afro-Americanos , Grupo com Ancestrais do Continente Africano , Chicago , Criança , Pré-Escolar , Estudos de Coortes , Grupos de Populações Continentais , Exposição Ambiental , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Illinois , Chumbo/sangue , Masculino , Americanos Mexicanos , Porto Rico/etnologia , Leitura , Sistema de Registros , Fatores de Risco , Instituições Acadêmicas
6.
Paediatr Perinat Epidemiol ; 30(3): 274-84, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26945670

RESUMO

BACKGROUND: Comparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood. METHODS: Prospective data of 45 413 children from 11 European cohorts were used. Children's height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts. RESULTS: Low maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts. CONCLUSIONS: Considerable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote children's immediate health and well-being and throughout the life course.


Assuntos
Escolaridade , Comportamento Materno , Mães , Obesidade Pediátrica/etiologia , Adulto , Pré-Escolar , Comparação Transcultural , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Comportamento Materno/psicologia , Mães/psicologia , Mães/estatística & dados numéricos , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Gravidez , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos
7.
Addict Behav ; 50: 222-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26164763

RESUMO

AIMS: Our study aimed to examine the association between early life stress and early initiation of alcohol and tobacco use. DESIGN: This prospective cohort study of women and children belongs to the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood. SETTING: Dniprodzerzhynsk, a city of some 250,000 inhabitants in south central Ukraine. PARTICIPANTS: All 4398 women who visited antenatal clinics between December 25, 1992 and July 23, 1994, planned to continue their pregnancy, and were permanent residents of the city were invited to participate. Of the 4398 invitees, 2148 agreed and 1020 of the mother-child pairs were available for complete follow-up until the children were 16 years old. MEASUREMENTS: When study children reached ages 3 and 7, their mothers completed questionnaires about their children's exposure to and impact from a standard list of recent stressful life events. From the data on event prevalence and severity, we assigned each child to low, medium, or high early life stress. When the children became age 16, they completed questionnaires about their history of smoking and drinking. FINDINGS: In multivariate analysis that controlled for current level of family income, current family type, current school type, year of child's birth, lifetime smoking and current drinking by mother, and education of mother and father, girls with high stress at age 3 had 2.2 times (95% confidence interval: 1.23-4.08) higher odds than girls with low stress to start smoking early. CONCLUSIONS: Our study may be the first to use a longitudinal study design to examine early life stress as a risk factor for early smoking initiation in adolescence.


Assuntos
Comportamento do Adolescente/psicologia , Fumar/epidemiologia , Fumar/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Ucrânia/epidemiologia
8.
Environ Health ; 14: 21, 2015 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-25889033

RESUMO

BACKGROUND: Environmental lead exposure poses a risk to educational performance, especially among poor, urban children. Previous studies found low-level lead exposure was a risk factor for diminished academic abilities, however, this study is distinct because of the very large sample size and because it controlled for very low birth weight and early preterm birth-two factors closely associated with lower academic performance. In this study we examined the association between lead concentration in whole blood (B-Pb) of Chicago Public School (CPS) children and their performance on the 3(rd) grade Illinois Standard Achievement Tests (ISAT) reading and math scores. METHODS: We examined 58,650 children born in Chicago between 1994 and 1998 who were tested for blood lead concentration between birth and 2006 and enrolled in the 3(rd) grade at a CPS school between 2003 and 2006. We linked the Chicago birth registry, the Chicago Blood Lead Registry, and 3(rd) grade ISAT scores to examine associations between B-Pb and school performance. RESULTS: After adjusting for other predictors of school performance including poverty, race/ethnicity, gender, maternal education and very low birth weight or preterm-birth, we found that B-Pbs below 10 µg/dL were inversely associated with reading and math scores in 3(rd) grade children. For a 5 µg/dL increase in B-Pb, the risk of failing increased by 32% for reading (RR = 1.32, 95%CI = 1.26, 1.39) and math (RR = 1.32, 95%CI = 1.26, 1.39). The effect of lead on reading was non-linear with steeper failure rates at lower B-Pbs. We estimated that 13% of reading failure and 14.8% of math failure can be attributed to exposure to blood lead concentrations of 5 to 9 vs. 0 to 4 µg/dL in Chicago school children. CONCLUSIONS: Early childhood lead exposure is associated with poorer achievement on standardized reading and math tests in the third grade, even at very low B-Pbs. Preventing lead exposure in early childhood is critical to improving school performance.


Assuntos
Logro , Exposição Ambiental , Chumbo/sangue , Chicago , Criança , Pré-Escolar , Estudos de Coortes , Monitoramento Ambiental , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Instituições Acadêmicas
9.
J Epidemiol Community Health ; 69(9): 826-33, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25911693

RESUMO

BACKGROUND: A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries. METHODS: Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts. RESULTS: Mother's education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied. CONCLUSIONS: This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe.


Assuntos
Recém-Nascido Pequeno para a Idade Gestacional , Mães/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Comparação Transcultural , Escolaridade , Europa (Continente)/epidemiologia , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Gravidez , Estudos Prospectivos , Análise de Regressão , Fatores de Risco
10.
Paediatr Perinat Epidemiol ; 27(4): 393-414, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23772942

RESUMO

BACKGROUND: During the past 25 years, many pregnancy and birth cohorts have been established. Each cohort provides unique opportunities for examining associations of early-life exposures with child development and health. However, to fully exploit the large amount of available resources and to facilitate cross-cohort collaboration, it is necessary to have accessible information on each cohort and its individual characteristics. The aim of this work was to provide an overview of European pregnancy and birth cohorts registered in a freely accessible database located at http://www.birthcohorts.net. METHODS: European pregnancy and birth cohorts initiated in 1980 or later with at least 300 mother-child pairs enrolled during pregnancy or at birth, and with postnatal data, were eligible for inclusion. Eligible cohorts were invited to provide information on the data and biological samples collected, as well as the timing of data collection. RESULTS: In total, 70 cohorts were identified. Of these, 56 fulfilled the inclusion criteria encompassing a total of more than 500,000 live-born European children. The cohorts represented 19 countries with the majority of cohorts located in Northern and Western Europe. Some cohorts were general with multiple aims, whilst others focused on specific health or exposure-related research questions. CONCLUSION: This work demonstrates a great potential for cross-cohort collaboration addressing important aspects of child health. The web site, http://www.birthcohorts.net, proved to be a useful tool for accessing information on European pregnancy and birth cohorts and their characteristics.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Bem-Estar do Lactente/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Europa (Continente) , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez
11.
Environ Health Perspect ; 120(2): 192-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22030231

RESUMO

BACKGROUND: Wastewater-impacted waters that do not support swimming are often used for boating, canoeing, fishing, kayaking, and rowing. Little is known about the health risks of these limited-contact water recreation activities. OBJECTIVES: We evaluated the incidence of illness, severity of illness, associations between water exposure and illness, and risk of illness attributable to limited-contact water recreation on waters dominated by wastewater effluent and on waters approved for general use recreation (such as swimming). METHODS: The Chicago Health, Environmental Exposure, and Recreation Study was a prospective cohort study that evaluated five health outcomes among three groups of people: those who engaged in limited-contact water recreation on effluent-dominated waters, those who engaged in limited-contact recreation on general-use waters, and those who engaged in non-water recreation. Data analysis included survival analysis, logistic regression, and estimates of risk for counterfactual exposure scenarios using G-computation. RESULTS: Telephone follow-up data were available for 11,297 participants. With non-water recreation as the reference group, we found that limited-contact water recreation was associated with the development of acute gastrointestinal illness in the first 3 days after water recreation at both effluent-dominated waters [adjusted odds ratio (AOR) 1.46; 95% confidence interval (CI): 1.08, 1.96] and general-use waters (1.50; 95% CI: 1.09, 2.07). For every 1,000 recreators, 13.7 (95% CI: 3.1, 24.9) and 15.1 (95% CI: 2.6, 25.7) cases of gastrointestinal illness were attributable to limited-contact recreation at effluent-dominated waters and general-use waters, respectively. Eye symptoms were associated with use of effluent-dominated waters only (AOR 1.50; 95% CI: 1.10, 2.06). Among water recreators, our results indicate that illness was associated with the amount of water exposure. CONCLUSIONS: Limited-contact recreation, both on effluent-dominated waters and on waters designated for general use, was associated with an elevated risk of gastrointestinal illness.


Assuntos
Gastroenteropatias/epidemiologia , Recreação , Microbiologia da Água , Qualidade da Água , Adolescente , Adulto , Algoritmos , Chicago/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Estudos de Coortes , Infecções Oculares/epidemiologia , Infecções Oculares/microbiologia , Feminino , Seguimentos , Gastroenteropatias/microbiologia , Humanos , Incidência , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Natação , Adulto Jovem
12.
J Med Entomol ; 47(5): 907-12, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20939389

RESUMO

Although there is some detailed research on anaphylactic reactions to Hymenoptera venom, there continues to be little epidemiological data about the distribution, trend, and factors associated with the occurrence of Hymenoptera envenomations in humans. We describe characteristics of persons suffering Hymenoptera stings from bees, wasps, and hornets as reported to the Illinois Poison Center, and assess seasonal, climatologic, and time trends of calls for envenomations between 2002 and 2007. Mean daily temperature and mean daily atmospheric pressure were positively associated with envenomations, whereas wind speed was negatively associated with envenomations. We also observed a significant increase in calls for envenomations on summer holidays (P < 0.001). In addition, our findings showed that the number of calls for envenomations declined by nearly half after 2005 (P < 0.001) compared with previous years. Our findings indicate that the decline in bees, wasps, and hornets may be widespread, affecting both wild and commercial populations, and that the decline appears to have been rapid and sustained in recent years. Poison center data are a valuable resource for the surveillance of poisoning in humans, but our findings show that the data can be used to monitor changes in nonhuman species.


Assuntos
Himenópteros/fisiologia , Mordeduras e Picadas de Insetos/epidemiologia , Adolescente , Adulto , Idoso , Animais , Criança , Pré-Escolar , Feminino , Humanos , Illinois/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações , Fatores de Tempo , Adulto Jovem
13.
Paediatr Perinat Epidemiol ; 23(4): 346-51, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19523081

RESUMO

The prevalence of wheezing in children varies widely around the world. The reasons for this geographic variability remain unclear but may be related in part to exposures in the home environment during pregnancy and early childhood. We investigated the prenatal and early childhood risk factors for wheezing symptoms among 2127 children aged 6-8 years who were participants in the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). Cases included the 169 children whose parents answered yes to the International Study of Asthma and Allergy in Children (ISAAC) question: 'Has your child had wheezing or whistling in the chest in the past 12 months' during the ELSPAC assessment of the children at age 7. These were compared with the 1861 children in the cohort whose parents answered 'no' to this question. Factors significantly associated with increased risk of wheezing illness at age 7 in adjusted analyses included mother's asthma [adjusted odds ratio (OR) 3.46, 95% confidence interval (CI) 1.22, 9.85]; mother's allergy problems (OR 1.43, [1.00, 2.05]); rarely playing with other children at age 3 (OR 1.84, [1.09, 3.11]); water intrusion (OR 1.62, [1.09, 2.39]) and inadequate heating of the home (OR 1.52, [1.06, 2.16]) during pregnancy. Factors protective of wheezing at age 7 included being first-born (adjusted OR 0.70, 95% CI 0.50, 0.98); living in the city of Dniprodzerzynsk as compared with Kyiv (OR 0.36, [0.24, 0.54]) and weekly contact with furry animals (OR 0.44, [0.20, 0.97]) before age 3. The constellation of risk factors for wheezing in Ukrainian children is similar to that of children in other parts of the world. Known risk factors do not account for the significant between-city variability of wheezing in Ukrainian children.


Assuntos
Asma/etiologia , Sons Respiratórios/etiologia , Asma/epidemiologia , Criança , Exposição Ambiental , Métodos Epidemiológicos , Feminino , Humanos , Indústrias , Masculino , Prevalência , Fatores de Risco , Meio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Ucrânia/epidemiologia
14.
Int J Pediatr Obes ; 4(2): 81-90, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18972243

RESUMO

BACKGROUND: While obesity is a growing epidemic in most developed countries, we still lack information on countries in economic transition. In this study, we evaluate the built environment, activity levels, economic status and dietary patterns associated with body mass index (BMI) greater than or equal to the 85th percentile among 3-year-old Ukrainian children living through the downturn in the economy during the mid-1990s. METHODS: We evaluated 883 3-year-old children from the Ukraine ELSPAC cohort. Principal components analysis was used as a data reduction tool for dietary, built environment and activity variables. We evaluated predictors of elevated BMI (> or = 85th percentile) using a multivariable logistic regression model. RESULTS: The final multivariable model showed that for every kilogram increase in the mother's weight, there was a corresponding 2% increase in risk of a child having a BMI> or = 85th percentile (OR=1.02; 95% CI: 1.00-1.04). A higher social class and a friendly neighborhood were associated with higher BMI, whereas infrequent outings to places that require spending money was associated with lower BMI. Except for meat consumption, none of the dietary variables were associated with elevated BMI. DISCUSSION: The picture in the Ukraine during the 1990s, a period of economic hardship, revealed that variables associated with higher standards of living were predictive of elevated BMI: higher social class, meat consumption and friendly neighborhoods. Variables associated with economic isolation were predictive of a lower risk of elevated BMI.


Assuntos
Índice de Massa Corporal , Dieta , Meio Ambiente , Sobrepeso/epidemiologia , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Carne , Análise Multivariada , Análise de Componente Principal , Características de Residência , Fatores de Risco , Classe Social , Fatores Socioeconômicos , Ucrânia/epidemiologia
15.
J Air Waste Manag Assoc ; 58(8): 1022-32, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18720652

RESUMO

Polychlorinated biphenyls (PCBs) were banned in the United States in 1979, and since then a significant decline in their release to the environment has been observed. This decline has now reached a plateau. Several new regulatory programs have been put in place to further reduce PCB emissions/releases. However, our ability to measure the effectiveness of these regulatory/voluntary programs and to support regional fate/transport and source/receptor modeling efforts depend on reliable emission information. In this study, we attempt to improve the emission inventory for PCBs by compiling and analyzing the multimedia total PCB emission/release data reported for the U.S Great Lakes states for each year from 1990 to 2000. Although Toxic Release Inventory (TRI), National Emissions Inventory (NEI), Great Lakes Regional Air Toxic Emissions Inventory (GLRATEI), and Integrated Atmospheric Deposition Network (IADN) data formed the basis of estimating air emissions, we used the TRI, National Response Center (NRC), and PCB transformer inventory data to estimate PCB releases to land. We used the Permit Compliance System and NRC data to obtain estimates of PCB discharges to water systems in the Great Lakes states. The Remedial Action Plans for each area of concern were the primary source for estimating PCB loads of dredged sediments. On the basis of the NEI, IADN, and GLRATEI data, the total air emissions within the decade were approximately 126 t. The regionwide discharges to water systems and releases to land in the form of landfills and accidental spills in 1990-2000 were estimated as approximately 170 and 3225 t, respectively. We estimated that approximately 1.3 million t of PCB-contaminated sediment were removed or targeted for removal in five lakes of the U.S. portion of the Great Lakes basin. We stress that these estimates were based on reported amounts and the unreported PCB releases/emissions could result in significantly higher estimates.


Assuntos
Poluentes Ambientais/análise , Bifenilos Policlorados/análise , Poluentes Ocupacionais do Ar/análise , Poluição do Ar/análise , Monitoramento Ambiental , Recuperação e Remediação Ambiental , Sedimentos Geológicos/análise , Great Lakes Region , Poluentes do Solo/análise , Poluentes da Água/análise
16.
J Environ Health ; 70(1): 42-6, 63, 2007 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17802816

RESUMO

The Great Lakes Center of Excellence in Environmental Health (GLCEEH), an innovative capacity-building component of the University of Illinois, performs health hazard evaluations in collaboration with the Illinois Department of Public Health and local health departments. GLCEEH has provided state and local health departments with faculty, industrial-hygiene expertise, and research expertise to help them investigate a variety of environmental health issues. This article describes health hazard evaluations performed with support from the National Center for Environmental Health, lessons learned, and recommendations for successful collaboration between academic and public health departments. From the academic perspective, health hazard evaluations are beneficial because they provide faculty and students with the opportunity to engage in public health practice and encounter new issues that advance the science of environmental health through research. From the perspective of a public health department, health hazard evaluations are beneficial because they address priority environmental health concerns and build the capacity of department personnel to conduct health hazard evaluations with internal resources. A collaborative health hazard evaluation program increases public health capacity by developing new approaches to environmental health problems and by sharing limited resources.


Assuntos
Relações Comunidade-Instituição , Comportamento Cooperativo , Saúde Ambiental/métodos , Prática de Saúde Pública , Gestão de Riscos/métodos , Saúde Ambiental/organização & administração , Substâncias Perigosas , Humanos , Illinois , Relações Interdepartamentais , Administração em Saúde Pública , Gestão de Riscos/organização & administração , Universidades
17.
Lik Sprava ; (3): 13-8, 2007 Apr-May.
Artigo em Ucraniano | MEDLINE | ID: mdl-18271175

RESUMO

In 2002 authors initiated a US-Ukraine collaborative study on bronchial asthma among 2177 6-8 year old children who resided in Kyiv, Dniprodzerzhinsk and Mariupol, Ukraine in 2002 and who were participants in the Family and Children of Ukraine Longitudinal Cohort Study. The overall goal of the study is to investigate the epidemiology and risk factors for asthma and asthma--related symptoms among these children. The study design comprises of three phases. During the first phase Questionnaires including the International Study of Asthma and Allergies in Childhood (ISAAC) core module on wheeze, as well as questions about other respiratory symptoms (including night cough and phlegm) were given to parents of 2177 children aged 6-8 years. The authors examined the prevalence of wheezing and dry cough at night not associated with colds during the past year among the surveyed children. The parent-reported prevalence of wheezing was significantly different among these three Ukrainian cities: 14.4% in Kyiv, 19% in Mariupol and 5.7% in Dniprodzerzhinsk. The prevalence of dry cough at night not associated with colds was also different in Kyiv, Mariupol and Dniprodzerzhinsk and was 11.4%, 6.9% and 6.9% respectively). The authors conclude that the prevalence of wheezing illness and dry cough at night not associated with colds during the past year varies among Ukrainian cities with the highest prevalence in kyiv, the most "westernized" of these cities.


Assuntos
Asma/etiologia , Poluição Ambiental/efeitos adversos , Sons Respiratórios , Saúde da População Urbana , Asma/diagnóstico , Asma/epidemiologia , Criança , Cidades , Estudos de Coortes , Feminino , Humanos , Masculino , Prevalência , Inquéritos e Questionários , Ucrânia/epidemiologia
19.
Int J Occup Environ Health ; 12(4): 415-22, 2006 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17168231

RESUMO

The 1986 Chernobyl accident contaminated 23% of Belarus with radioactive iodine and long half-life radionuclides. Radiation causes breast cancer. Population-based breast cancer incidence data from the Belarus National Cancer Registry were used to study secular trends and urban-rural differences, and determine whether an effect of Chernobyl radiation exposure was discernable. Trends in age-standardized incidences in Gomel and Vitebsk oblasts maximally and minimally exposed to Chernobyl radiation, respectively, were compared for 1978-2003 among all women, and women aged 30-49, separately for urban and rural areas. Incidences were higher and increasing more rapidly in urban than rural areas of both oblasts, annually increasing 0.150 +/- 0.008 vs. 0.098 +/- 0.007 new cases per 10,000 persons, p < 0.00005. Levels were similar in urban Gomel and Vitebsk, and slightly higher in rural Vitebsk than rural Gomel. For ages 30-49 trends in urban and rural Gomel and rural Vitebsk were similar to the all-ages rural trend: common urban/rural Gomel slope 0.098 +/- 0.015, rural Vitebsk slope 0.091 +/- 0.022. In urban Vitebsk, significant but erratic nonlinearity suggested stabilizing incidence since the mid-nineties after a sharp rise. However, recent declines in slopes, greater in Vitebsk, are nonsignificant. Secular breast cancer increases in Gomel have been generally consistent for 26 years. Secular increases in Vitebsk have been similar, but could be slowing. However, these data provide no convincing evidence for Chernobyl-induced breast cancer in Belarus.


Assuntos
Neoplasias da Mama/epidemiologia , Centrais Elétricas , Liberação Nociva de Radioativos , Adulto , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , República de Belarus/epidemiologia , Ucrânia
20.
Environ Health Perspect ; 114(6): 848-52, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16759983

RESUMO

Many older homes are equipped with mercury-containing gas regulators that reduce the pressure of natural gas in the mains to the low pressure used in home gas piping. Removal of these regulators can result in elemental mercury spills inside the home. In the summer of 2000, mercury spills were discovered in the basements of several Chicago-area homes after removal of gas regulators by gas company contractors. Subsequent inspections of approximately 361,000 homes by two northern Illinois gas companies showed that 1,363 homes had residential mercury contamination. Urine mercury screening was offered to concerned residents, and results of urine bioassays and indoor mercury air measurements were available for 171 homes. Six of these 171 homes (3.5%) had a cumulative total of nine residents with a urine mercury > or = 10 microg/L. The highest urine mercury concentration observed in a resident was 26 microg/L. Positive bioassays were most strongly associated with mercury air concentrations > 10 microg/m3 on the first floor [odds ratio (OR) = 21.4 ; 95% confidence interval (CI) , 3.6-125.9] rather than in the basement (OR = 3.0 ; 95% CI, 0.3-26) , and first-floor air samples were more predictive of positive bioassays than were basement samples. Overall, the risk of residential mercury contamination after gas regulator removal ranged from 0.9/1,000 to 4.3/1,000 homes, depending on the gas company, although the risk was considerably higher (20 of 120 homes, 16.7%) for one of the contractors performing removal work for one of the gas companies. Gas companies, their contractors, and residents should be aware of these risks and should take appropriate actions to prevent these spills from occurring and remediate them if they occur.


Assuntos
Mercúrio/toxicidade , Adulto , Bioensaio , Chicago , Criança , Feminino , Humanos , Masculino , Mercúrio/urina , Saúde Pública
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