Health-related quality of life in rural children living in four European countries: the GABRIEL study

Objective: Measuring children's health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS). Methods: The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL. Results: Austrian children reported highest KINDL-R scores (mean: 80.9; 95% CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p=0.002). Significantly lower scores were observed in children with allergic diseases (p<0.001), with sleeping difficulties (p<0.001) and in overweight children (p=0.04). The German GABRIEL sample reported higher mean scores (age 7-10years: 80.1, [79.9, 80.4]; age 11-13years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7-10years: 79.0, [78.7-79.3]; age 11-13years: 75.1 [74.6-75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries. Conclusions: Future increases in chronic diseases may negatively impact children's HRQO

An Updated Algorithm for Estimation of Pesticide Exposure Intensity in the Agricultural Health Study

An algorithm developed to estimate pesticide exposure intensity for use in epidemiologic analyses was revised based on data from two exposure monitoring studies. In the first study, we estimated relative exposure intensity based on the results of measurements taken during the application of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) (n = 88) and the insecticide chlorpyrifos (n = 17). Modifications to the algorithm weighting factors were based on geometric means (GM) of post-application urine concentrations for applicators grouped by application method and use of chemically-resistant (CR) gloves. Measurement data from a second study were also used to evaluate relative exposure levels associated with airblast as compared to hand spray application methods. Algorithm modifications included an increase in the exposure reduction factor for use of CR gloves from 40% to 60%, an increase in the application method weight for boom spray relative to in-furrow and for air blast relative to hand spray, and a decrease in the weight for mixing relative to the new weights assigned for application methods. The weighting factors for the revised algorithm now incorporate exposure measurements taken on Agricultural Health Study (AHS) participants for the application methods and personal protective equipment (PPE) commonly reported by study participants

SESSION 6B EPIDEMIOLOGY: C40 EXOGENOUS RISK FACTORS IN ALS: A POPULATION-BASED CASE-CONTROL STUDY

Background: Sporadic amyotrophic lateral sclerosis (ALS) is probably caused by multiple genetic and environmental factors causing motor neuron degeneration.Although environmental risk factors have been extensively studied in ALS, most environmental risk factors are still unknown.Systematic reviews of the literature suggest this may be due to limitations in study design: most risk factor studies had a hospital-based study design, which introduces the risk of referral bias. This source of bias can be eliminated in a population-based casecontrol study, which enables the provision of class I evidence according to the Armon criteria (1) for exogenous risk factor studies in ALS. Objectives: To determine the association between ALS and multiple exogenous factors: smoking; alcohol; education; medical history; medication use; nutrition; family history; hormonal factors; occupational history; occupational exposures (pesticides, metals, electrical accidents, etc.); physical activity. Methods: A population based study has been performed in the Netherlands between January 2006 and June 2011 (mean population 16,426,273; area 41,528 km2 ).Patients were ascertained from five sources.Diagnosis was made according to the El Escorial criteria.700 incident sporadic ALS patients and 2100 controls filled in questionnaires to obtain data about exogenous factors. Results: Multivariate analyses showed an increased risk of ALS in current smokers (OR 1.38; p = 0.04).Current smoking was also associated with shorter survival (hazard ratio of 1.51 (p = 0.02) adjusted for vital capacity, gender, age and site of onset).Current alcohol consumption was found to be an independent protective factor for ALS (OR = 0.52; p = 6.6x10-5 ), but did not have an effect on survival.Relatives of sporadic ALS patients had a mildly elevated risk of dementia (recurrence risk lambda 1.16; 95% CI: 1.01-1.33).The risk of Parkinson Disease (PD) was not elevated ( lambda 1.14; 95% CI: 0.83-1.55).A reduced risk of vascular diseases was found in relatives of sporadic ALS patients (stroke: lambda 0.94; 95% CI: 0.82-1.07 and myocardial infarction: lambda 0.87; 95% CI: 0.76-0.98).Longest job held in the agricultural sector is associated with an increased risk of developing ALS (OR 1.7; 95% CI: 1.01- 3.00, p = 0.045) (adjusted for smoking, use of alcohol, and age).Last job held in the agricultural sector is associated with ALS as well (OR 1.8; 95%CI: 1.1-3.1, p = 0.03).Subsequently a Job Exposure Matrix (JEM) was used, which enables the linking of occupations to profiles of environmental exposures by providing semi-quantitative assessments of exogenous exposures for each occupation.Mean lifetime occupational exposures to chromium, nickel, diesel motor exhaust, and mine dust were significantly higher in patients compared with controls.Exposure to pesticides was not significantly increased in patients. Results on the other exogenous factors will be presented, as well as the result of a multivariate analysis including all exogenous risk factors.Discussion and conclusions: Cigarette smoking, occupation in the agricultural sector, and a low level of education are risk factors for ALS.Current smoking is associated with a worse prognosis, alcohol consumption reduces the risk of ALS.Familial aggregation of ALS, dementia and PD is substantially lower than previously thought.The lowered risk of vascular diseases in relatives of ALS patients supports the view that a beneficial vascular risk profile increases ALS susceptibility.More risk factors will be analyzed and presented at the symposium.The multivariate analysis, including all exogenous risk factors, will determine which risk factors are independently associated with ALS

SESSION 6B EPIDEMIOLOGY: C40 EXOGENOUS RISK FACTORS IN ALS: A POPULATION-BASED CASE-CONTROL STUDY

Background: Sporadic amyotrophic lateral sclerosis (ALS) is probably caused by multiple genetic and environmental factors causing motor neuron degeneration.Although environmental risk factors have been extensively studied in ALS, most environmental risk factors are still unknown.Systematic reviews of the literature suggest this may be due to limitations in study design: most risk factor studies had a hospital-based study design, which introduces the risk of referral bias. This source of bias can be eliminated in a population-based casecontrol study, which enables the provision of class I evidence according to the Armon criteria (1) for exogenous risk factor studies in ALS. Objectives: To determine the association between ALS and multiple exogenous factors: smoking; alcohol; education; medical history; medication use; nutrition; family history; hormonal factors; occupational history; occupational exposures (pesticides, metals, electrical accidents, etc.); physical activity. Methods: A population based study has been performed in the Netherlands between January 2006 and June 2011 (mean population 16,426,273; area 41,528 km2 ).Patients were ascertained from five sources.Diagnosis was made according to the El Escorial criteria.700 incident sporadic ALS patients and 2100 controls filled in questionnaires to obtain data about exogenous factors. Results: Multivariate analyses showed an increased risk of ALS in current smokers (OR 1.38; p = 0.04).Current smoking was also associated with shorter survival (hazard ratio of 1.51 (p = 0.02) adjusted for vital capacity, gender, age and site of onset).Current alcohol consumption was found to be an independent protective factor for ALS (OR = 0.52; p = 6.6x10-5 ), but did not have an effect on survival.Relatives of sporadic ALS patients had a mildly elevated risk of dementia (recurrence risk lambda 1.16; 95% CI: 1.01-1.33).The risk of Parkinson Disease (PD) was not elevated ( lambda 1.14; 95% CI: 0.83-1.55).A reduced risk of vascular diseases was found in relatives of sporadic ALS patients (stroke: lambda 0.94; 95% CI: 0.82-1.07 and myocardial infarction: lambda 0.87; 95% CI: 0.76-0.98).Longest job held in the agricultural sector is associated with an increased risk of developing ALS (OR 1.7; 95% CI: 1.01- 3.00, p = 0.045) (adjusted for smoking, use of alcohol, and age).Last job held in the agricultural sector is associated with ALS as well (OR 1.8; 95%CI: 1.1-3.1, p = 0.03).Subsequently a Job Exposure Matrix (JEM) was used, which enables the linking of occupations to profiles of environmental exposures by providing semi-quantitative assessments of exogenous exposures for each occupation.Mean lifetime occupational exposures to chromium, nickel, diesel motor exhaust, and mine dust were significantly higher in patients compared with controls.Exposure to pesticides was not significantly increased in patients. Results on the other exogenous factors will be presented, as well as the result of a multivariate analysis including all exogenous risk factors.Discussion and conclusions: Cigarette smoking, occupation in the agricultural sector, and a low level of education are risk factors for ALS.Current smoking is associated with a worse prognosis, alcohol consumption reduces the risk of ALS.Familial aggregation of ALS, dementia and PD is substantially lower than previously thought.The lowered risk of vascular diseases in relatives of ALS patients supports the view that a beneficial vascular risk profile increases ALS susceptibility.More risk factors will be analyzed and presented at the symposium.The multivariate analysis, including all exogenous risk factors, will determine which risk factors are independently associated with ALS

Health-related quality of life in rural children living in four European countries : the GABRIEL study

Measuring children's health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).; The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.; Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p > 0.001), with sleeping difficulties (p > 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7-10 years: 80.1, [79.9, 80.4]; age 11-13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7-10 years: 79.0, [78.7-79.3]; age 11-13 years: 75.1 [74.6-75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.; Future increases in chronic diseases may negatively impact children's HRQOL