Preliminarno praćenje povezanosti stambenih zelenih i vodenih površina s boljim mentalnim zdravljem u sveučilišnih studenata

Previous research has suggested that natural urban environment (green space and blue space) benefit mental health, but only a few longitudinal studies have explored the underlying mechanisms. In this pilot study we aimed to examine mechanisms/variables mediating associations between residential green/blue space and symptoms of anxiety/depression in 109 Bulgarian students from Plovdiv university. The students were followed from the beginning to the end of the school year (October 2017 to May 2018). Residential green space was defined as the mean of the normalised difference vegetation index (NDVI) in circular buffers of 100, 300, and 500 m around their residences. Blue space was assessed based on its presence in the same buffers. Levels of anxiety/depression were assessed using the 12-item General Health Questionnaire. The investigated mediator variables included residential noise (LAeq) and air pollution (NO2), environmental annoyance, perceived restorative quality of the neighbourhood, neighbourhood social cohesion, physical activity, and sleep disturbance. Cross-sectional data (obtained at baseline) showed that higher NDVI correlated with better mental health only indirectly through higher physical activity and restorative quality. Longitudinal (follow-up) data showed improved mental health but no significant effect of mediator variables. Similarly, blue space correlated with better mental health in all models, but physical activity and restorative quality were significant mediator variables only in the cross-sectional analysis. Our findings support that green space and blue space are psychologically restorative features in urban environment. Future research should replicate these findings in the general population and employ longitudinal modelling tailored to the specific mechanisms under study.Rezultati presječnih istraživanja upućuju na to da prirodni okoliš u gradovima (zelene i vodene površine) povoljno utječe na mentalno zdravlje, ali tek je nekoliko dugoročnih istraživanja pokušalo utvrditi mehanizme u pozadini tog učinka. Cilj ovoga preliminarnog (pilot) istraživanja bio je ispitati mehanizme/varijable koji posreduju između zelenih/vodenih površina u mjestu stanovanja i tjeskobe/depresije u 109 bugarskih studenata sa Sveučilišta u Plovdivu. Studenti su praćeni od početka do kraja akademske godine (od listopada 2017. do svibnja 2018.). Stambeno se zelenilo odredilo pomoću normaliziranog indeksa razlike u vegetaciji (engl. normalised difference vegetation index, krat. NDVI) u radijusu od 100, 300 i 500 m oko adrese stanovanja. Udio vodenih površina također je procijenjen u tim radijusima. Razine tjeskobe/depresije ocijenjene su pomoću 12 stavki iz Upitnika o općem zdravstvenom stanju (General Health Questionnaire, krat. GHQ-12). Od posredničkih (engl. mediator) varijabli istražili smo buku, onečišćenje zraka (NO2), uzrujanost okolišem, percepciju utjecaja susjedstva na oporavak (engl. restorative quality), društvenu povezanost u susjedstvu (engl. social cohesion), tjelesnu aktivnost i poremećaj spavanja. Podaci iz presječnoga istraživanja (dobiveni za početnog mjerenja) pokazali su da viši NDVI korelira s boljim mentalnim zdravljem tek neizravno kroz izrazitiju tjelesnu aktivnost i snažniji utjecaj na oporavak u susjedstvu. Dugoročno je pak istraživanje (praćenje) pokazalo istu tu korelaciju, ali bez značajnog sudjelovanja posredničkih varijabli. Slično je i s vodenim površinama. Njihov veći udio korelirao je s boljim mentalnim zdravljem u svim modelima, ali su tjelesna aktivnost i oporavak značajno posredovali samo u presječnom istraživanju (početnom mjerenju). Naši rezultati potvrđuju povoljan psihološki utjecaj gradskih zelenih i vodenih površina na psihu i njezin oporavak, ali će tek buduća istraživanja trebati to potvrditi i u općoj populaciji. U dugoročnim bi istraživanjima svakako trebalo prilagoditi modeliranje konkretnim mehanizmima koji se ispituju

Profesionalna izloženost buci i razina testosterona u serumu u muškaraca obuhvaćenih ispitivanjem National Health and Nutrition Examination Survey od 1999. do 2004.

There is compelling evidence from animal experiments that noise exposure suppresses testosterone in males by affecting the hypothalamic-pituitary-testicular axis. Virtually nothing is known about its effect in humans. Therefore, the aim of this study was to explore the association between occupational noise exposure and serum testosterone in a representative sample of the general population. The sample has been taken from the National Health and Nutrition Examination Survey (NHANES) data for the period between 1999 and 2004 and is limited to employed men aged 16-85+ years at the time. The associations between noise exposure (either established according to the Occupational Information Network - O*NET categories or self-reported) and total and free testosterone (TT and FT, respectively) were analysed using linear regression models with increasing adjustments. In the fully adjusted model (n=414), the third quartile of the O*NET noise exposure was associated with lower TT and FT, which reached statistically significant decrease of -58.32 ng dL-1 (95 % CI: -111.22, -5.42) and -1.58 ng dL-1 (95 % CI: -2.98, -0.18), respectively. In stratified analyses, younger, lower income, normal weight, better hearing, and workers not using hearing protection at work experienced significantly more severe adverse effects than the rest. The odds for hypogonadism (TT<300 ng dL-1) did not significantly rise with one interquartile range increment in O*NET noise exposure (OR=1.24, 95 % CI: 0.64, 2.39). Self-reported loud noise exposure did not significantly decrease TT when all men were considered (n=214) and only in the men ≥37 years did it decrease TT significantly by -87.55 ng dL-1 (95 % CI: -158.35, -16.74). In conclusion, noise exposure was associated with lower TT and FT only in some population subgroups and these associations were non-linearIstraživanja na životinjama uvjerljivo upozoravaju na to da izloženost buci potiskuje lučenje testosterona u mužjaka djelujući na osovinu hipotalamus-hipofiza-testisi. Međutim, gotovo se ništa ne zna o takvom djelovanju buke na ljude. Stoga je cilj ovog istraživanja bio utvrditi postoji li povezanost između profesionalne izloženosti buci i razina testosterona u serumu u reprezentativnom uzorku opće populacije. Uzorak je preuzet iz ispitivanja National Health and Nutrition Examination Survey (NHANES) koje se provodilo od 1999. do 2004. i bilo ograničeno na tada zaposlene muškarce u dobi od 16 do 85+ godina. Povezanost između izloženosti buci (koja je utvrđena bilo na temelju baze podataka i kategorizacije Occupational Information Networka - tzv. O*NET, ili na temelju izjava sudionika o izloženosti buci) i razina ukupnoga (UT) i slobodnoga testosterona (ST) analizirana je linearnim regresijskim modelima. U modelu sa svim varijablama (n=414) ispitanici u trećem kvartilu izloženosti buci prema O*NET-u imali su statistički značajno niže vrijednosti UT-a i ST-a u odnosu na neizložene radnike: vrijednosti njihova UT-a bile su niže za 58,32 ng dL-1 (95 % CI: -111,22; -5,42), a vrijednosti ST-a za 1,58 ng dL-1 (95 % CI: -2,98; -0,18) u odnosu na neizložene. Stratificirana je analiza pokazala da su mlađi radnici, radnici s manjim primanjima, radnici normalne tjelesne mase, oni koji bolje čuju te radnici koji ne nose zaštitu od buke na poslu imali značajno štetnije posljedice od izloženosti od ostalih radnika. Izgledi za hipogonadizam (UT<300 ng dL-1) nisu se značajno povećali s porastom izloženosti prema klasifikaciji O*NET-a u vrijednosti od jednoga interkvartilnog raspona (OR=1,24, 95 % CI: 0,64; 2,39). Izloženost buci nije značajno utjecala na pad UT-a kad su analizom bili obuhvaćeni svi radnici koji su sami prijavili izloženost (n=214) nego samo u radnika ≥37 godina, koji su imali za 87,55 ng dL-1 (95 % CI: -158,35; -16,74) niže vrijednosti u odnosu na neizložene radnike. Ovo je istraživanje pokazalo povezanost između izloženosti buci i sniženih razina UT-a i ST-a samo u pojedinim populacijskim podskupinama, a ta povezanost nije bila linearna

Odnos između izloženosti prometnoj buci i rizika od moždanog udara: sustavni pregled s metaanalizom

Traffic noise is an established risk factor for some cardiovascular diseases such as hypertension and ischaemic heart disease, but the evidence regarding stroke is still limited. In this study we aimed to systematically review the related epidemiological data and make a meta-analysis of the risk of stroke morbidity associated with road and air traffic noise exposure. We searched articles in English, Spanish, and Russian indexed in MEDLINE, EMBASE, and Google Scholar on 24 November 2015. Qualitative synthesis was made for 13 studies, and 11 studies were included in quality effects meta-analyses. Overall, they were of high quality. Based on six studies (n≈8,790,671 participants) for road traffic noise, we found a pooled relative risk (RR) of stroke per 10 dB to be 1.03 (95 % CI: 0.87, 1.22). In the 70-75 dB noise range (versus <55 dB) RR increased to 1.29 (95 % CI: 0.74, 2.24). For air traffic noise we pooled five studies (n≈16,132,075 participants) and the RR per 10 dB was 1.05 (95 % CI: 1.00, 1.10). The air traffic group had low heterogeneity, whereas the road traffic group had high heterogeneity, but there was evidence of publication bias. In conclusion, we have established a small but elevated risk of stroke to be associated with both road and air traffic noise exposure, but the association was statistically significant only with the latter. The effect of road traffic noise followed a non-linear trend.Prometna je buka rizični čimbenik za nastanak bolesti krvožilja poput povišenoga krvnog tlaka i ishemijske bolesti srca, ali su saznanja vezana uz moždani udar još uvijek ograničena. Cilj je ovoga istraživanja bio napraviti sustavni pregled epidemioloških podataka i metaanalizu rizika od moždanog udara povezanoga s izloženošću buci cestovnog i zračnog prometa. Pretraživanje je provedeno 24. studenoga 2015., a obuhvatilo je članke na engleskom, španjolskom i ruskom jeziku koji su odgovarali kriterijima pretrage u bazama MEDLINE, EMBASE i Google Scholar. Kvalitativna sinteza obuhvatila je 13 istraživanja, od kojih je 11 obuhvaćeno metaanalizom kvalitativnih učinaka. U prosjeku su svi članci bili visokokvalitetni. Na temelju rezultata šest istraživanja (n≈8.790.671 sudionik) vezanih uz buku cestovnog prometa, utvrdili smo da ukupni relativni rizik (RR) od moždanog udara prilikom porasta buke od 10 dB iznosi 1,03 (95 % CI: 0,87, 1,22). U rasponu buke od 70 do 75 dB (prema <55 dB) RR se povećao na 1,29 (95 % CI: 0,74; 2,24). Prema objedinjenim podacima o buci zračnoga prometa iz pet istraživanja (n≈16.132.075 sudionika), RR za porast buke od 10 dB iznosio je 1,05 (95 % CI: 1,00; 1,10). Podaci iz istraživanja cestovne buke, za razliku od onih iz istraživanja zračne buke, bili su statistički izrazito heterogeni. Istraživanja cestovne buke iskazala su odstupanje podataka zbog pretežitog objavljivanja određenog tipa istraživanja (tzv. publication bias). Ovim smo istraživanjem utvrdili donekle povišeni rizik od moždanog udara zbog izloženosti buci cestovnog i zračnog prometa, ali je ta povezanost bila statistički značajna samo kod potonjega. Učinci cestovne buke slijedili su nelinearni trend

Attention deficit in children with attention deficit hyperactivity disorder at primary school age measured with the attention network test (ANT) : a protocol for a systematic review and meta-analysis

Background: Attentional deficits are among the most bothersome symptoms of attention deficit hyperactivity disorder (ADHD). To date, the neurological basis of attentional deficits has not been fully described according to the diagnostic criteria. ADHD may result from deficits in various attributes of attention. There is no specialist neuropsychological diagnostic method that allows reliable distinction between primary attention disorders in the etiology of ADHD and secondary problems that may arise due to co-morbidities. This protocol aims to systematically review the literature to evaluate patterns of attention common to school-age children either diagnosed with ADHD or at high risk of ADHD, as measured by the neuropsychological attention network test (ANT). Methods: Our search strategy will consist of electronic databases (PubMed, PsychInfo, Web of Science, EMBASE, and Cochrane Library) and hand searching. Both prospective cohort studies and prospective studies of intervention effects will be included, provided they used the ANT. The primary output variable will be attention deficits. Screening and eligibility will be done independently by two reviewers based on pre-specified eligibility criteria. Data extraction will be based on a pre-pilot data extraction form and conducted by two authors independently. The risk of bias will be assessed by two authors independently. The rating of the certainty of the entire body of evidence will be evaluated using the GRADE approach. Any discrepancies identified at any stage of the review will be resolved by discussion or/and consultation with another reviewer. We plan a narrative synthesis of findings and a quantitative meta-analysis if the data allow. Discussion: The research will identify patterns of neuropsychological ANT results characteristic of both school-age children diagnosed with ADHD and those at high risk of having ADHD. Our results could be used to check whether the pattern of a child’s performance in the ANT corresponds to the characteristic pattern of the results of children with ADHD. At present, the ANT is used only in research; the results of this review will serve as a useful benchmark. Hopefully, in the future, it will be possible to use the ANT in the wider diagnosis of ADHD

Sociodemographic inequalities in residential nighttime light pollution in urban Bulgaria : an environmental justice analysis

Introduction: Outdoor nighttime light (NTL) is a potential anthropogenic stressor in urban settings. While ecological studies have identified outdoor NTL exposure disparities, uncertainties remain about disparities in individual exposure levels, particularly in Europe. Aim: To assess whether some populations are disproportionately affected by outdoor NTL at their residences in urban Bulgaria. Methods: We analyzed 2023 data from a representative cross-sectional survey of 4,270 adults from the five largest Bulgarian cities. Respondents' annual exposures to outdoor artificial nighttime luminance were measured using satellite imagery and assigned at their places of residence. We calculated the Gini coefficient as a descriptive NTL inequality measure. Associations between respondents’ NTL exposure levels and sociodemographic characteristics were assessed by estimating quantile mixed regression models. Stratified regressions were fitted by gender and for each city. Results: We found moderate distributive NTL inequalities, as indicated by a Gini coefficient of 0.214. Regression analyses showed associations between greater NTL exposure and higher educational attainment. Respondents with incomes perceived as moderate experienced less NTL exposure at the 0.5 and 0.8 quantiles, while unemployed respondents experienced lower exposure at the 0.2 and 0.5 quantiles. We observed null associations for the elderly and non-Bulgarian ethnicities. Regardless of the quantile, greater population density was associated with higher NTL levels. Stratification by sex did not yield substantial differences in the associations. We observed notable city-specific heterogeneities in the associations, with differences in the magnitudes and directions of the associations and the NTL quantiles. Conclusions: NTL exposures appeared to embody an environmental injustice dimension in Bulgaria. Our findings suggest that some sociodemographic populations experience higher exposure levels to NTL; however, those are not necessarily the underprivileged or marginalized. Identifying populations with high exposure levels is critical to influencing lighting policies to ease related health implications

Procjena socijalnog i ekonomskog tereta infarkta miokarda povezanog s cestovnom bukom u bugarskog urbanog stanovništva

Road traffic noise is a widely studied environmental risk factor for ischaemic heart disease and myocardial infarction in particular. Given that myocardial infarction is a leading disability and mortality cause in Bulgaria and that a significant proportion of the urban population is exposed to high noise levels, quantification of the burden of disease attributable to traffic noise is essential for environmental health policy making and noise control engineering. This study aimed at estimating the burden of the myocardial infarction cases attributable to road traffic noise in the Bulgarian urban population. We used the methodology for estimating the burden of disease attributable to environmental noise outlined by the World Health Organization. Risk data were extracted from a recently published meta-analysis providing updated exposure-response relationship between traffic noise and the risk for myocardial infarction. Based on these data we calculated the fraction of myocardial infarction cases attributable to traffic noise, loss of quality-adjusted life-years (QALYs), and the economic burden, assuming € 12,000 per QALY. About 2.9 % or 101 of all myocardial infarction cases could be attributed to road traffic noise. Fifty-five of these were fatal. Nine hundred and sixty-eight QALYs were lost to these cases. The monetary value of these QALYs was about € 11.6 million. Although the measures used in this study are crude and give only an approximation of the real burden of disease from road traffic noise, they are indicative of the important social and economic aspect of noise pollution in Bulgaria. Hopefully, these results will direct the attention of epidemiologists, environmental hygienists, and health economists to this pivotal environmental issue.Prometna je buka pomno istražen rizični čimbenik za nastanak ishemijske bolesti srca, napose infarkta miokarda. Budući da je infarkt miokarda vodeći uzrok invalidnosti i smrtnosti u Bugarskoj te da je veliki udio urbanoga stanovništva izložen visokim razinama buke, za donošenje odluka iz područja zdravstvene ekologije i kontrole buke bitno je utvrditi koliki je taj teret bolesti povezane s prometnom bukom. Cilj našeg istraživanja bio je procijeniti teret infarkta miokarda povezanog s cestovnom bukom u bugarskom urbanom stanovništvu oslanjajući se na metodologiju Svjetske zdravstvene organizacije za procjenu tereta bolesti povezanih s okolišnom bukom. Podaci o riziku preuzeti su iz nedavno objavljene meta-analize koja daje pregled odnosa izloženosti i odgovora između cestovne buke i rizika od infarkta miokarda. Na temelju tih podataka izračunali smo udio slučajeva infarkta miokarda koji se mogu povezati s cestovnom bukom, a na temelju njih gubitak u godinama kvalitetnog života (engl. quality-adjusted life-years, krat. QALY) te ekonomski teret bolesti, uz pretpostavku da gubitak svake godine kvalitetnog života košta 12.000 eura. Rezultati su pokazali da se oko 3 % odnosno 101 slučaj infarkta miokarda može pripisati cestovnoj buci, od kojeg je njih 55 bilo kobno. Izgubljenih godina kvalitetnog života bilo je 968, a njihova ekonomska cijena iznosila je oko 11,6 milijuna eura. Premda su te procjene grube i daju tek približan uvid u stvarni teret bolesti povezane s cestovnom bukom, one ipak jasno pokazuju koliko je važan socijalni i ekonomski aspekt zagađenja okoliša bukom u Bugarskoj. Nadamo se stoga da će rezultati našeg istraživanja privući pažnju ne samo epidemiologa nego i zdravstvenih ekologa i ekonomista, s obzirom na to da se radi o iznimno važnom ekološkom problemu

Kratkoročni učinci onečišćenja zraka na broj bolničkih prijama zbog bolesti srca i krvožilja i šećerne bolesti u Sofiji u Bugarskoj (2009. – 2018.)

Bulgaria has a very high incidence of cardiometabolic diseases and air pollution-related mortality rate. This study investigated the relationship between daily air pollution levels and hospital admissions for ischaemic heart diseases (IHD), cerebral infarction (CI), and type 2 diabetes mellitus (T2DM) in Sofia, Bulgaria. We obtained daily data on hospitals admissions and daily average air pollution levels from 2009 to 2018. Pollutants of interest were particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3), and carbon monoxide (CO). Negative binomial regressions were fitted to study the effects of air pollution on hospital admission over the course of seven days prior to that event, accounting for autocorrelations and time trend in the data, day of the week, temperature, and relative humidity. Our findings confirm that higher air pollution levels generally increase the risk of hospital admissions for IHD and CI. For T2DM the association is less clear. Admissions often lagged several days behind and were more common in specific demographic subgroups or when pollution crossed a particular threshold. However, we did not expect to find the risk of hospital admissions increased in warmer rather than colder months of the year. Our findings are to be taken with reservation but do provide an idea about how air pollution could trigger acute episodes of related cardiovascular diseases, and our model may serve to investigate similar associations across the country.Bugarska ima izrazito visoku incidenciju kardiometaboličkih bolesti i mortaliteta koja je povezana s onečišćenjem zraka. Ovdje smo ispitivali povezanost dnevnih razina onečišćenja zraka s brojem bolničkih prijama zbog ishemijskih bolesti srca (I20 – I25), cerebralnog infarkta (I63) i šećerne bolesti neovisne o inzulinu (E11) u Sofiji u Bugarskoj. Na raspolaganju smo imali dnevne podatke o broju bolničkih prijama te o prosječnim razinama onečišćenja zraka za desetogodišnje razdoblje, tj. od početka 2009. do kraja 2018. Onečišćivala koja smo promatrali obuhvatila su lebdeće čestice (PM2.5 i PM10), dušikov dioksid (NO2), sumporov dioksid (SO2), ozon (O3) i ugljikov monoksid (CO). Kako bismo utvrdili učinke onečišćenja zraka na broj bolničkih prijama, oslonili smo se na modele binomijalne regresije, prilagođene za razdoblje do sedam dana uoči bolničkoga prijama, uzimajući pritom u obzir autokorelacije i vremenske trendove podataka, dan u tjednu te temperature i vlažnost zraka. Naši rezultati potvrđuju da veće onečišćenje načelno povećava rizik od bolničkoga prijama zbog ishemijskih bolesti srca i cerebralnog infarkta, a ta je povezanost sa šećernom bolesti nejasnija. Prijam u bolnicu obično je kasnio nekoliko dana za porastom onečišćenja te je bio učestaliji u pojedinim demografskim podskupinama odnosno nakon što bi onečišćenje prešlo određeni prag. Ono što, međutim, nismo očekivali jest da se broj bolničkih prijama (i povezani rizik) povećao za topla vremena, a ne za hladnih mjeseci. Dakako, naše rezultate treba uzeti s određenim oprezom, no i takvi daju dobru ideju kako onečišćenje zraka može potaknuti akutne epizode s njim povezanih bolesti srca i krvožilja, a naš model može poslužiti za istraživanje sličnih veza diljem Bugarske

Primjena prostorne sintakse radi poboljšanja simulacija buke: preliminarni rezultati iz dvaju cestovnih sustava

Noise pollution is one of the four major pollutions in the world. In order to implement adequate strategies for noise control, assessment of traffic-generated noise is essential in city planning and management. The aim of this study was to determine whether space syntax could improve the predictive power of noise simulation. This paper reports a record linkage study which combined a documentary method with space syntax analysis. It analyses data about traffic flow as well as field-measured and computer-simulated traffic noise in two Bulgarian agglomerations. Our findings suggest that space syntax might have a potential in predicting traffic noise exposure by improving models for noise simulations using specialised software or actual traffic counts. The scientific attention might need to be directed towards space syntax in order to study its further application in current models and algorithms for noise prediction.Buka je jedan od četiriju glavnih oblika onečišćenja u svijetu. Da bi se urbanim planiranjem i upravljanjem gradovima mogle osmisliti i primijeniti odgovarajuće strategije ograničavanja buke, ključni je korak procijeniti razinu prometne buke u nekom gradu. Cilj je ovog istraživanja bio utvrditi može li prostorna sintaksa, koja se od 70-ih godina prošlog stoljeća rabi za predviđanje kretanja ljudi u gradskom okolišu, pridonijeti većoj prediktivnoj snazi simulacija buke. Analizirani su podaci o prometnim tokovima i o prometnoj buci dobiveni mjerenjima na terenu i računalnim simulacijama u dvama bugarskim gradovima: Sofiji i Plovdivu. Rezultati upućuju na to da prostorna sintaksa može poslužiti u predviđanju izloženosti prometnoj buci s obzirom na to da je u ovom istraživanju poboljšala postojeće modele simulacije buke koji se temelje na računalnim izračunima odnosno stvarnim mjerenjima. Nadamo se da ćemo ovim privući pozornost znanstvene zajednice na prostornu sintaksu kako bi se nastavila istraživati njena primjena u postojećim modelima i algoritmima predviđanja buke

Attention deficit in primary-school-age children with attention deficit hyperactivity disorder measured with the attention network test: a systematic review and meta-analysis

Objective: To review and meta-analyze patterns of attention deficit in primary-school-age children with ADHD measured with the neuropsychological attention network test (ANT). Methods: Six electronic databases were searched to 5.05.2022. Selection criteria included prospective cohort and intervention studies; ANT used; primary-school-age; diagnosis of ADHD/at high risk. Results: Seven studies met inclusion criteria (N = 3,826). Compared with controls, children with ADHD had higher scores for Reaction Time (Hedges’ g = 0.433; 95% CI: 0.135–0.731), Reaction Time Variability (Hedges’ g = 0.334; 95% CI: 0.012–0.657), and Alerting Network (Hedges’ g = 0.235; 95% CI: 0.021–0.449) while children at high risk had higher Alerting Network scores (Hedges’ g = 0.176; 95% CI: 0.003–0.349) and Correctness scores (Hedges’ g = 1.956; 95% CI: 0.020–3.892). Conclusions: Children with ADHD and at risk of ADHD had different ANT results from children without ADHD only for the alerting network. There were no significant differences for executive and orienting outcomes. Children at risk of ADHD also made more errors (commission and omission) measured with the ANT compared with children without ADHD. Reaction time was longer and reaction time variability higher in children with ADHD than in children without ADHD, and in children at risk of ADHD compared with children without ADHD.publishedVersio

The effect of occupational exposure to welding fumes on trachea, bronchus and lung cancer: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are the producers of the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). Welding fumes have been classified as carcinogenic to humans (Group 1) by the WHO International Agency for Research on Cancer (IARC) in IARC Monograph 118; this assessment found sufficient evidence from studies in humans that welding fumes are a cause of lung cancer. In this article, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from trachea, bronchus, and lung cancer attributable to occupational exposure to welding fumes, to inform the development of WHO/ILO Joint Estimates on this burden of disease (if considered feasible). Objectives: We aimed to systematically review and meta-analyse estimates of the effect of any (or high) occupational exposure to welding fumes, compared with no (or low) occupational exposure to welding fumes, on trachea, bronchus, and lung cancer (three outcomes: prevalence, incidence, and mortality). Data sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CENTRAL and CISDOC. We also searched grey literature databases, Internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. Study eligibility and criteria: We included working-age (≥15 years) workers in the formal and informal economy in any Member State of WHO and/or ILO but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies, and other non-randomized intervention studies with an estimate of the effect of any (or high) occupational exposure to welding fumes, compared with occupational exposure to no (or low) welding fumes, on trachea, bronchus, and lung cancer (prevalence, incidence, and mortality). Study appraisal and synthesis methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first review stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. If studies reported odds ratios, these were converted to risk ratios (RRs). We combined all RRs using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence, and strength of evidence, using the Navigation Guide tools and approaches adapted to this project. Subgroup (e.g., by WHO region and sex) and sensitivity analyses (e.g., studies judged to be of “high”/“probably high” risk of bias compared with “low”/“probably low” risk of bias) were conducted. Results: Forty-one records from 40 studies (29 case control studies and 11 cohort studies) met the inclusion criteria, comprising over 1,265,512 participants (≥22,761 females) in 21 countries in three WHO regions (Region of the Americas, European Region, and Western Pacific Region). The exposure and outcome were generally assessed by job title or self-report, and medical or administrative records, respectively. Across included studies, risk of bias was overall generally probably low/low, with risk judged high or probably high for several studies in the domains for misclassification bias and confounding.Our search identified no evidence on the outcome of having trachea, bronchus, and lung cancer (prevalence). Compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk of acquiring trachea, bronchus, and lung cancer (incidence) by an estimated 48 % (RR 1.48, 95 % confidence interval [CI] 1.29–1.70, 23 studies, 57,931 participants, I2 24 %; moderate quality of evidence). Compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk dying from trachea, bronchus, and lung cancer (mortality) by an estimated 27 % (RR 1.27, 95 % CI 1.04–1.56, 3 studies, 8,686 participants, I2 0 %; low quality of evidence). Our subgroup analyses found no evidence for difference by WHO region and sex. Sensitivity analyses supported the main analyses. Conclusions: Overall, for incidence and mortality of trachea, bronchus, and lung cancer, we judged the existing body of evidence for human data as “sufficient evidence of harmfulness” and “limited evidence of harmfulness”, respectively. Occupational exposure to welding fumes increased the risk of acquiring and dying from trachea, bronchus, and lung cancer. Producing estimates for the burden of trachea, bronchus, and lung cancer attributable to any (or high) occupational exposure to welding fumes appears evidence-based, and the pooled effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates. Protocol identifier: https://doi.org/10.1016/j.envint.2020.106089