Níveis de poluentes orgânicos persistentes e de metais pesados no sangue e os efeitos no desenvolvimento neuro-psicológico na primeira infância e em coortes mães-filhos INMA (INfância e Meio Ambiente)

Introduction: The INMA project is a multicenter study based on prospective monitoring of mother-child cohorts in different Spanish geographical areas. Objective: To study the relationship between major environmental pollutants and child development in the pre-and postnatal phases. Material and Methods: The cohort groups share data collection methodology and tools (environmental exposure, biological samples, physical and neuropsychological examinations, diet questionnaires etc.) during intrauterine growth and monitored childhood development. Results: The levels of Persistent Organic Pollutants (POPs) in serum during the first trimester of pregnancy are reported, together with those for lead (Pb) and total mercury (Hg-T) in the umbilical cord, which are associated with the neuropsychological development analyzed to date. The POPs most frequently found were p, p’-DDE (99%) and PCB 153 (95%) with geometric mean in serum (ng / g-lipid) of 110.0 (p, p’-DDE) and 38.9 (PCB 153). The geometric mean and the maximum Pb level were 1.06 mg/dL and 19 mg/dL, respectively. The geometric mean Hg-T was 8.2 mg/L, with fish consumption being the main predictor. The Hg-T reference levels set by USEPA (6.4 mg/L) were exceeded in 64% of the samples. Conclusion: T The levels of POPs and Pb observed in the study areas were within the range of values previously described in earlier studies. The Hg levels require more in-depth assessment, as well as study of the possible associations with neuropsychological development.Introducción: El proyecto INMA es un estudio multicéntrico basado en el seguimiento prospectivo de cohortes de madres-hijos en distintas áreas de la geografía española. Objetivo: Estudiar la relación entre los principales contaminantes ambientales y el desarrollo de los niños y niñas en las fases pre y postnatales. Material y Métodos: El conjunto de las cohortes comparten metodología e instrumentos de recogida de información (exposición ambiental, muestras biológicas, exámenes del desarrollo físico y neuropsicológico, cuestionarios de dieta etc.) durante el crecimiento intrauterino y en las fases de seguimiento en la infancia. Resultados: Se presentan los niveles de Compuestos Orgánicos Persistentes (COP) en suero del primer trimestre de embarazo y de plomo (Pb) y mercurio total (Hg-T) de cordón umbilical y las asociaciones con el desarrollo neuropsicológico analizadas hasta la fecha. Los COP más frecuentemente encontrados fueron el p,p ́-DDE (99%) y el PCB 153 (95%) con medias geométricas en suero (ng/g-lípido) de 110,0 (p,p ́-DDE) y 38,9 (PCB 153). La media geométrica y el nivel máximo de Pb fueron 1,06 μg/dL y 19 μg/dL, respectivamente. La media geométrica de Hg-T fue de 8,2 μg/L, siendo el consumo de pescado el principal predictor. Un 64% de las muestras superan los niveles de referencia de Hg-T establecidos por la USEPA (6,4 μg/L). Conclusión: Los niveles de COP y Pb observados en las áreas de estudio se encuentran en el rango de valores ya descritos en estudios anteriores. Los niveles de Hg requieren una valoración más profunda, así como el estudio de las posibles asociaciones con el desarrollo neuropsicológico. Introdução: O projeto INMA é um estudo multicêntrico, que consiste no acompanhamento prospetivo de coortes mães-filhos em diferentes regiões de Espanha. Objetivo: Estudar a relação entre os principais poluentes ambientais e desenvolvimento da criança nas fases pré e pós-natal. Material e Métodos: Em todas as coortes é utilizada a mesma metodologia e instrumentos de recolha de dados (exposição ambiental, amostras biológicas, exames de desenvolvimento físico e neuro-psicológico, questionários de dieta, etc.) durante o crescimento intrauterino e nas fases de seguimento da infância. Resultados: Apresentam-se os níveis de poluentes orgânicos persistentes (POP) no soro do primeiro trimestre de gravidez, os valores de chumbo (Pb) e de mercúrio total (Hg-T) no cordão umbilical, e as associações com o desenvolvimento neuro-psicológico analisadas até à data. Os POP encontrados com maior frequência foram p,p ́-DDE (99%) e PCB 153 (95%) com uma média no soro (ng/g-lípido) de 110,0 (p,p ́-DDE) e 38,9 (PCB 153). A média e o nível máximo de Pb foram 1,06 μg/dL e 19 μg/dL, respetivamente. A média de Hg-T foi de 8,2 μg/L, sendo o consumo de peixe o principal responsável. Os níveis de Hg-T de referência estabelecidos pela USEPA (6,4 μg/L) foram ultrapassados em 64% das amostras. Conclusão: Os níveis de POP e Pb observados nas áreas de estudo apresentaram-se dentro dos valores descritos em estudos anteriores. Os teores de Hg requerem uma avaliação mais aprofundada, assim como o estudo das possíveis associações com o desenvolvimento neuro-psicológico

Air Pollution Exposure during Pregnancy and Childhood Autistic Traits in Four European Population-Based Cohort Studies: The ESCAPE Project

Background: Prenatal exposure to air pollutants has been suggested as a possible etiologic factor for the occurrence of autism spectrum disorder. Objectives: We aimed to assess whether prenatal air pollution exposure is associated with childhood autistic traits in the general population. Methods: Ours was a collaborative study of four European population-based birth/child cohorts—CATSS (Sweden), Generation R (the Netherlands), GASPII (Italy), and INMA (Spain). Nitrogen oxides (NO2, NOx) and particulate matter (PM) with diameters of ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and between 2.5 and 10 μm (PMcoarse), and PM2.5 absorbance were estimated for birth addresses by land-use regression models based on monitoring campaigns performed between 2008 and 2011. Levels were extrapolated back in time to exact pregnancy periods. We quantitatively assessed autistic traits when the child was between 4 and 10 years of age. Children were classified with autistic traits within the borderline/clinical range and within the clinical range using validated cut-offs. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. Results: A total of 8,079 children were included. Prenatal air pollution exposure was not associated with autistic traits within the borderline/clinical range (odds ratio = 0.94; 95% CI: 0.81, 1.10 per each 10-μg/m3 increase in NO2 pregnancy levels). Similar results were observed in the different cohorts, for the other pollutants, and in assessments of children with autistic traits within the clinical range or children with autistic traits as a quantitative score. Conclusions: Prenatal exposure to NO2 and PM was not associated with autistic traits in children from 4 to 10 years of age in four European population-based birth/child cohort studies.Funding was provided as follows: ESCAPE Project— European Community’s Seventh Framework Program (FP7/2007-2011-GA#211250). CATSS, Sweden— Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Research Council (VR) Formas, in partner hip with FORTE and VINNOVA (cross-disciplinary research program concerning children’s and young people’s mental health); VR through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework grant 340-2013-5867; HKH Kronprinsessan Lovisas förening för barnasjukvård; and the Strategic Research Program in Epidemiology at Karolinska Institutet. Generation R, the Netherlands—The Generation R Study is conducted by the Erasmus University Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam; the Municipal Health Service Rotterdam area, Rotterdam; the Rotterdam Homecare foundation, Rotterdam; and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. The general design of the Generation R Study is made possible by financial support from the Erasmus University Medical Center, Rotterdam; the Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); the Netherlands Organization for Scientific Research (NWO); and the Ministry of Health, Welfare and Sport. The Netherlands Organisation for Applied Scientific Research (TNO) received funding from the Netherlands Ministry of Infrastructure and the Environment to support exposure assessment. GASPII, Italy—grant from the Italian Ministry of Health (ex art.12, 2001). INMA, Spain— grants from Instituto de Salud Carlos III (Red INMA G03/176 and CB06/02/0041 FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, CP11/00178, FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090), PI13/1944, PI13_02032, PI14/0891, PI14/1687, MS13/00054, UE (FP7-ENV-2011 cod 282957, and HEALTH.2010.2.4.5-1); Generalitat de Catalunya-CIRIT 1999SGR 00241; La Fundació La Marató de TV3 (090430); Conselleria de Sanitat Generalitat Valenciana; Department of Health of the Basque Government (2005111093 and 2009111069); and Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001). V.W.V.J. received an additional grant from the Netherlands Organization for Health Research and Development (ZonMw 90700303, 916.10159). A.G.’s work was supported by a research grant from the European Community’s 7th Framework Programme (FP7/2008–2013-GA#212652). A full roster of the INMA project investigators can be found online (http://www. proyectoinma.org/presentacion-inma/listado-investigadores/ en_listado-investigadores.html)

Family context assessment in a public health study

Objetivo: analizar la estructura factorial de un nuevo instrumento para evaluar la calidad del contexto familiar (Escala Etxadi-Gangoiti) en la cohorte de Gipuzkoa del proyecto INMA (Infancia y Medio Ambiente) Métodos: se evaluaron las familias de 433 niños/as de 2 años. Se analizaron la estructura factorial y las propiedades psicométricas de los datos. Resultados: Se realizaron un análisis factorial exploratorio (factorización de ejes principales y rotación varimax) y un análisis factorial confirmatorio que confirmó parcialmente la estructura original del instrumento revelando la existencia de los siguientes factores: sub-escala 1 (promoción del desarrollo cognitivo y lingüístico; promoción de habilidades sociales; promoción de habilidades psicomotoras; promoción del juego simbólico y de la imitación) sub-escala 2 (promoción de la autonomía y autoestima; práctica de la frustración óptima; calidad socio-emocional de la relación; ausencia castigo físico) sub-escala 3 (implicación del padre, baja exposición al conflicto; baja frecuencia de conflicto; relaciones con la familia extensa; apoyo social; diversidad de experiencias; baja frecuencia de acontecimientos estresantes y baja percepción parental de estrés). Discusión: se obtiene confirmación parcial de la estructura original del instrumento, lo cual se atribuye a las características de la muestra. Se constata la relevancia de la variabilidad en la evaluación familiar y de sus indicadores adecuados de fiabilidad. Se señala la potencialidad para la salud pública de los hallazgos para la identificación de contextos familiares de calidad deficiente y para la elaboración de criterios preventivos, centrados en el desarrollo de competencias parentales

What influences early cognitive development? Family context as a key mediator.

Early cognitive development is sensitive to multiple biological, social, familial, and psychological factors. However, discerning the underlying mechanistic pathways has proved to be challenging. Using data from 506 mother-child dyads from the prospective longitudinal birth-cohort of the INMA—INfancia y Medio Ambiente—(Environment and Childhood) Project, this study aimed to test how maternal SES influences early cognitive development, examining potential mediating factors, including maternal mental health, family context, and first nursery school attendance. Results indicate that the association of maternal mental health and SES on early cognitive development is fully mediated by the quality of the family context. Nursery attendance early in life also had a full mediation effect on maternal SES. These findings suggest that epidemiological studies should consider more than SES variables when studying environmental influences on early cognitive development. Policy implications are discussed in the current context of a global likelihood of economic crises and mental health challenges

Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation.

As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed

Iodine Supplementation During Pregnancy and Infant Neuropsychological: INMA Mother and Child Cohort Study

Iodine supplementation during pregnancy is a common practice in developed countries. However, scant evidence is available regarding the safety and effectiveness of maternal iodine supplementation with regard to child neuropsychological development. We previously reported an inverse association between iodine supplementation and the psychomotor development of infants in a birth cohort from Valencia, Spain. In the present study, we assessed this association in a wider sample of mother and child pairs from 3 other regions in Spain. Neuropsychological development was assessed using the Bayley Scales of Infant Development in 1,519 infants (median age, 16 months) between 2006 and 2009. In multivariate analyses, maternal consumption of 150 μg/day or more of iodine from supplements was related to a 1.5-fold increase in the odds of a psychomotor score less than 85 (95% confidence interval: 0.8, 2.9) and to a 1.7-fold increase in the odds of a mental score less than 85 (95% confidence interval: 0.9, 3.0). Findings previously reported in the Valencia cohort were only partially verified. The results of the present study suggest that, at least in these regions, iodine supplementation does not improve infant neuropsychological development at 1 year of age. Further research is needed on the risks and benefits of supplementary iodine for both maternal thyroid function and child neurodevelopment

Caregiver Voices: Cross-Cultural Input on Improving Access to Autism Services.

Decades of research have established that racial ethnic minority, low-income, and/or non-English speaking children with autism spectrum disorder (ASD) are diagnosed later than white children, and their families experience greater difficulty accessing services in the USA. Delayed access to timely diagnosis and early intervention may impact child outcomes and family quality of life. Despite their cognition of these disparities and their significant impact on the lives of those affected, explanations for the barriers experienced by underserved families are elusive, likely due to the complex interaction between structural and family factors. This study used qualitative methods to gather family and provider perspectives of perceived barriers and facilitators to obtaining an ASD diagnosis and accessing ASD-related services for underserved families. Themes from focus groups and interviews with families from three cultural groups (black, Hispanic/Latino, and Korean) and three primary languages (English, Korean, and Spanish) highlight specific barriers related to family, community, and systemic challenges as well as facilitators to accessing care for these populations. Family experiences are expanded upon with viewpoints from the providers who work with them. Recommendations are made for reducing disparities in the existing ASD service system including increasing professional, family, and community education; increasing culturally responsive care; improving provider-family partnerships; and addressing practical challenges to service access