Neurotoxic exposures and effects: Gender and sex matter! Hänninen Lecture 2011

Sex-specific associations between co-exposure to multiple metals and externalizing symptoms in adolescence and young adulthood

Externalizing disorders, such as attention-deficit/hyperactivity disorder (ADHD), account for the majority of the child/adolescent referrals to mental health services and increase risk for later-life psychopathology. Although the expression of externalizing disorders is more common among males, few studies have addressed how sex modifies associations between metal exposure and adolescent externalizing symptoms. This study aimed to examine sex-specific associations between co-exposure to multiple metals and externalizing symptoms in adolescence and young adulthood. Among 150 adolescents and young adults (55% female, ages: 15-25 years) enrolled in the Public Health Impact of Metals Exposure (PHIME) study in Brescia, Italy, we measured five metals (manganese (Mn), lead (Pb), copper (Cu), chromium (Cr), nickel (Ni)) in four biological matrices (blood, urine, hair, and saliva). Externalizing symptoms were assessed using the Achenbach System of Empirically Based Assessment (ASEBA) Youth Self-Report (YSR) or Adult Self Report (ASR). Using generalized weighted quantile sum (WQS) regression, we investigated the moderating effect of sex (i.e., assigned at birth) on associations between the joint effect of exposure to the metal mixture and externalizing symptoms, adjusting for age and socioeconomic status. We observed that metal mixture exposure was differentially associated with aggressive behavior in males compared to females (β = -0.058, 95% CI [-0.126, -0.009]). In males, exposure was significantly associated with more externalizing problems, and aggressive and intrusive behaviors, driven by Pb, Cu and Cr. In females, exposure was not significantly associated with any externalizing symptoms. These findings suggest that the effect of metal exposure on externalizing symptoms differs in magnitude between the sexes, with males being more vulnerable to increased externalizing symptoms following metal exposure. Furthermore, our findings support the hypothesis that sex-specific vulnerabilities to mixed metal exposure during adolescence/young adulthood may play a role in sex disparities observed in mental health disorders, particularly those characterized by externalizing symptoms.

Associations of Urinary Nickel with NAFLD and Liver Fibrosis in the USA: A Nationwide Cross‑Sectional Study

Despite the robust correlation between metabolic disorders and heavy metals, there has been limited research on the associations between nickel levels and non-alcoholic fatty liver disease (NAFLD) as well as liver fibrosis. This study aimed to examine the associations among urinary nickel, NAFLD, and liver fibrosis. The data utilized in this study were obtained from the National Health and Nutrition Examination Survey 2017-2020. A comprehensive screening process was conducted, resulting in the inclusion of a total of 3169 American adults in the analysis. The measurement of urinary nickel was conducted through inductively coupled-plasma mass spectrometry. Vibration-controlled transient elastography was employed to assess the controlled attenuation parameter and liver stiffness measurement as indicators for NAFLD and liver fibrosis, respectively. Multivariable logistic regression models were employed to evaluate the associations among urinary nickel, NAFLD, and liver fibrosis. Restricted cubic splines were employed to explored the nonlinear associations. After adjusting for all covariates, the correlation between the highest quartile of urinary nickel and NAFLD was found to be significant (OR = 1.65; 95% CI, 1.19-2.27). Subgroup analysis revealed that the correlation was significant only in men. A significant association occurred between the second quartile of urinary nickel and liver fibrosis (OR 1.88; 95% CI, 1.22-2.90). Restricted cubic spline showed that the relationship was linear between urinary nickel and NAFLD and non-monotonic, inverse U-shaped between urinary nickel and liver fibrosis. This cross-sectional study indicated that the risk of NAFLD is associated with urinary nickel, and this correlation was only present among males.

Lead pollution-related health of children in China: Disparity, challenge, and policy

Lead (Pb) is a neurotoxic metal, and no level of lead exposure is safe for children. China has still experienced problems on child lead poisoning even though the Chinese government has phased out leaded gasoline since 2000. The underlying problem affecting the lead pollution-related health of children in China remains to be comprehensively investigated. It is found that although the significant decline of BLLs, as the Geometric Mean (GM), from 91.40 μg/L^GM in 2001 to 37.52 μg/L^GM in 2018 is observed, the average BLLs of children are still above 50 μg/L or more [average 59.70 (60.50-65.02, 95 % CI) μg/L^GM] after phasing out leaded gasoline since 2000 in China. Lead exposure causes 29.67 MID per 1000 children with a loss of 98.23 (59.40-146.21, 95 % CI) DALYs per 1000 in China, which is greater than the levels reported from the Western Pacific Region and other low- and middle-income countries. A significant correlation is observed between the number of child crimes (NoCCs) and the outcomes of long-term lead exposure for children in China. Although the disparities in BLLs in China are strongly influenced by unequal distributions of potential multi-lead related sources (soil lead, PM2.5 lead, dust lead), unbalance development of local industrialization and economies, as well as incorrect health care for younger children, the notable emissions from coal combustion (CC) and non-ferrous metals (NMS) exploitation dominate the crucial sources of low-level lead exposure to children after phasing out leaded gasoline in China currently. Faced with the unequal and disparate distribution of BLLs in China, the big bottleneck is to decrease the BLLs exertions of 36-45 μg/L in the next few decades. The Chinese government needs to make more efforts on developing more strict guidelines, implementing more policy strategies on prevention and management of blood Pb poisoning, and monitoring the nationwide changes in children's BLLs continuously.

How to carry out participatory research that takes account of sex and gender issues: a scoping review of guidelines targeting health inequities

OBJECTIVE

Conducting participatory research (PR) aimed at improving health implies considering inequitable power relations, including those related to sex/gender (S/G). This necessitates specific skills and methods and may be challenging especially since guidelines are scarce. Our objective was to perform a scoping review to provide a typology of existing guidelines for researchers on how to take account of S/G in the context of PR in public health, with a focus on occupational and environmental health.

METHODS

All steps of the research were conducted with the collaboration of an advisory committee, following PR principles. Nineteen documents were retained from 513 references identified in nine scientific databases and grey literature between 2000 and 2020. Data on recommendations were extracted and coded qualitatively. Cluster analysis based on similarities in recommendations proposed in the documents identified four types: (1) empowerment-centered; (2) concrete action-centered; (3) macrosystem-centered; and (4) stakeholder-centered.

SYNTHESIS

Many sources gave pointers on how to include S/G during data collection and analysis or during the dissemination of findings, but there was a dearth of suggestions for building partnerships with stakeholders and producing sustainable S/G sociopolitical transformations. Occupational health PR showed less similarities with other public health subfields including environmental health PR. Power relationships with workplace stakeholders generated specific obstacles related to S/G integration that require further attention. Intersectionality and reflexive practices emerged as overarching themes.

CONCLUSION

This review provides helpful guidelines to researchers at different stages of planning PR, ranging from familiarizing themselves with S/G approaches to anticipating difficulties in their ongoing S/G-transformative PR.

Determinants of Exposure to Potentially Toxic Metals in Pregnant Women of the DSAN-12M Cohort in the Recôncavo Baiano, Brazil

Exposure to potentially toxic metals (PTM) threatens maternal and child health. We investigated the determinants of exposure to lead (Pb), cadmium (Cd), arsenic (As), and manganese (Mn) in 163 pregnant women from the Recôncavo Baiano, Brazil, enrolled in the DSAN-12M cohort. We measured these metals in biological samples (blood, toenails, and hair) and the Pb dust loading rates (RtPb) at their homes by graphite furnace atomic absorption spectrophotometry (GFAAS). Questionnaires were applied to collect sociodemographic and general habits data. Only 2.91% (n = 4) of the pregnant women had As levels above the detection limit. Few participants had levels above the recommended reference values for blood Pb (5.1; 95% CI: 2.1-10.1%), and Mn in hair or toenails (4.3; 95% CI: 2.3-10.1%). On the other hand, 61.1 (95% CI: 52.4-69.3%) had elevated blood Cd levels. After binary logistic regression, low socioeconomic status, domestic waste burning, being a passive smoker, multiparity, and renovating the house significantly increased the chances of having high levels of Mn, Pb, and Cd. We detected a worrying situation related to exposure to Cd, showing the urgency of implementing human biomonitoring in the general population, especially in situations of social vulnerability.

How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods

Taking account of sex and gender in occupational health studies poses statistical challenges. Other sociodemographic variables, such as racialization, class, and age, also affect the relations between workplace exposures and health and interact with sex and gender. Our objective was to perform a critical review of conventional and emerging statistical tools, examining whether each analysis takes account of sociodemographic variables (1) in a way that contributes to identification of critical occupational determinants of health (2) while taking account of relevant population characteristics to reflect intersectional approaches to health and (3) using sample sizes and population characteristics available to researchers. A two-step search was conducted: (1) a scientific watch concerning the statistical tools most commonly used in occupational health over the past 20 years; (2) a screening of the 1980-2022 literature with a focus on emerging tools. Our examination shows that regressions with adjustment for confounders and stratification fail to reveal the sociodemographic mechanisms that interact with occupational health problems, endangering the identification of occupational risks. Multilevel (notably MAIHDA) analyses, decision tree, cluster, and latent analyses are useful methods to consider when seeking to orientate prevention. Researchers should consider methods that adequately reveal the mechanisms connecting sociodemographic variables and occupational health outcomes.

Should data on gender and ethnicity inform ergonomics interventions? Lessons from four case studies

Ergonomists intervene to improve work for all workers and adapt jobs to a range of worker characteristics. But their mandate rarely includes explicit attention to the distribution of worker demographics, to divisions among workers, or to discrimination on the basis of sex/gender or racialisation. A decades-long collaboration between ergonomists and the women's committees of three union confederations in Québec, Canada led to several instances where ergonomists had to confront situations involving sexism or racism, not foreseen during their training. This article will explore four problematic situations and suggest solutions, including paying more attention to teamwork, considering gender during ergonomics training, and developing a code of practice for ergonomics interventions.Practitioner summary: Workplace inequities related to sex/gender, racialisation and other sources of social inequity can affect job performance and workers' health. As such, do ergonomists need to consider them during an intervention? How? We analyse four situations encountered during interventions and suggest more attention to understanding workplace dynamics and promoting team function.

Hair, serum and urine chromium levels in children with cognitive defects: A systematic review and meta-analysis of case control studies

Environmental chromium exposure may cause impaired development of children. We conducted a systematic review and meta-analysis. Electronic databases including PubMed, Embase, Web of Science and CINAHL were searched to identify case-control studies that reported childhood Cr exposure and cognitive development. The Newcastle-Ottawa Scale (NOS) was used to ensure the quality of the included studies. Cr levels were compared in cases and controls, and a random effect meta-analysis was performed using Stata version 16. Twelve of 61 studies identified in the literature search were eligible for this analysis. Hair, serum and urine Cr measurements were reported by seven, two and one studies, respectively. In addition, one study reported both serum and hair Cr exposure and another reported urine and hair Cr exposure. The pooled standard mean differences (SMD) showed that hair Cr levels were non-significantly lower among children with cognitive defects (-0.01 μg/g, 95% CI: -0.04, 00, p = 0.27). In serum and urine, the pooled SMD was higher in children with cognitive deficits compared with healthy control children (0.32 μg/g, 95% CI: -0.78, 1.42, p = 0.56 and 0.64 μg/g, CI: -0.07,1.36, p = 0.08; respectively). In summary, this systematic review found no significant differences in hair, serum and urine Cr levels between children with cognitive deficits and healthy control children when all study data were pooled in the meta-analysis. Larger studies using standardized criteria and longitudinal assessment of cognitive development are needed to determine whether there is a dose response effect of childhood Cr exposure on cognitive development of children.

Sex-specific neurotoxic effects of heavy metal pollutants: Epidemiological, experimental evidence and candidate mechanisms

The heavy metals lead (Pb), mercury (Hg), and cadmium (Cd) are ubiquitous environmental pollutants and are known to exert severe adverse impacts on the nervous system even at low concentrations. In contrast, the heavy metal manganese (Mn) is first and foremost an essential nutrient, but it becomes neurotoxic at high levels. Neurotoxic metals also include the less prevalent metalloid arsenic (As) which is found in excessive concentrations in drinking water and food sources in many regions of the world. Males and females often differ in how they respond to environmental exposures and adverse effects on their nervous systems are no exception. Here, we review the different types of sex-specific neurotoxic effects, such as cognitive and motor impairments, that have been attributed to Pb, Hg, Mn, Cd, and As exposure throughout the life course in epidemiological as well as in experimental toxicological studies. We also discuss differential vulnerability to these metals such as distinctions in behaviors and occupations across the sexes. Finally, we explore the different mechanisms hypothesized to account for sex-based differential susceptibility including hormonal, genetic, metabolic, anatomical, neurochemical, and epigenetic perturbations. An understanding of the sex-specific effects of environmental heavy metal neurotoxicity can aid in the development of more efficient systematic approaches in risk assessment and better exposure mitigation strategies with regard to sex-linked susceptibilities and vulnerabilities.

Sex-specific neurotoxic effects of early-life exposure to fluoride: A review of the epidemiologic and animal literature

PURPOSE OF REVIEW

A growing body of evidence suggests adverse neurodevelopmental effects of early-life exposure to fluoride that may differ depending on timing of exposure and sex of the exposed. We conducted a literature search to identify the animal and human epidemiologic studies that examined sex-specific neurodevelopmental differences in response to prenatal and postnatal exposure to fluoride.

RECENT FINDINGS

Six of 138 animal studies and 15 of 106 human epidemiologic studies tested for sex-specific effects. Prenatal exposure to fluoride was associated with a male susceptibility to adverse behavioural effects in four of six animal studies and lower IQ in one of three prospective cohort studies. The body of evidence examining sex-effects associated with postnatal fluoride exposure was scarce, and many animal and cross-sectional human studies were considered to have a high risk of bias.

SUMMARY

Compared to females, male offspring appear to be more sensitive to prenatal, but not postnatal, exposure to fluoride. We discuss several sex-specific mechanisms and emphasize the need for future research.

Blood lead levels among Chinese children: The shifting influence of industry, traffic, and e-waste over three decades

In China, data relating to the historic prevalence of childhood lead poisoning suggest its pervasiveness. This review analysed published epidemiological data on blood lead levels (BLLs) of 735,271 Chinese children aged 0-6 between 1987 and 2017. Among these children, the geometric mean (GM) BLL was 95.1 μg/L (geometric SD = 1.62), and 24.1% suffered lead poisoning (BLL ≥ 100 μg/L). Importantly, there was a temporal decrease in the GM BLL value, from 182.9 μg/L in 1987-1991 to 42.4 μg/L in 2012-2017. However, a rebound was seen in the most recent two years (2016 and 2017). Moreover, the GM BLL among Chinese children has not fallen as low as U.S. children. This indicates that either (1) leaded petrol or lead based-paint exposure sources have not been adequately controlled in China, or (2) other pollution sources, such as industry, traffic, and e-waste, are impacting Chinese children. Drivers behind spatio-temporal variations were explored to provide scientific evidence regarding the prevention of childhood lead poisoning. We found that BLLs among children in the central and eastern areas of China have dropped lower than those in the western area, and that the GM BLL of children living in rural areas now exceeds children in urban areas. These reversals may be associated with the industrial decentralization policy of the late 1980s, when many heavily polluting industries and manufacturers moved away from cities on the east coast. It was discovered that the BLLs of children living in areas associated with mining have remained high (GM BLL = 155.0 μg/L for 2007-2017), and that the lead poisoning rate (LPR) has become exceptionally high in areas associated with e-waste. Finally, the review offers a data comparison with other countries, an overview of potentially influencing factors and sources, as well as some suggested prevention strategies to reduce childhood lead exposure.

Childhood chromium exposure and neuropsychological development in children living in two polluted areas in southern Spain

This study aimed to assess the association between exposure to chromium and neuropsychological development among children. A cross-sectional study was conducted with 393 children aged 6-11 years old randomly selected from State-funded schools in two provinces in Southern Spain (Almeria and Huelva), in 2010 and 2012. Chromium levels in urine and hair samples were analyzed by inductively coupled plasma mass spectrometry with an octopole reaction system. Neuropsychological development was evaluated using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and three computerized tests from the Behavioural Assessment and Research System (BARS): Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT). Multivariable linear regression models adjusted for potential confounders, including heavy metals, were applied to examine the association between chromium levels and neuropsychological outcomes. A 10-fold increase in urine chromium levels was associated with a decrease of 5.99 points on the WISC-IV Full-Scale IQ (95% CI: 11.98 to -0.02). Likewise, a 10-fold increase in urine chromium levels in boys was associated with a decrease of 0.03 points in the percentage of omissions (95% CI: 0.0 to 0.05) in the SAT, with an increase of 68.35 points in latency (95% CI: 6.60 to 130.12) in the RTT, and with an increase in the number of trials with latencies > 1000 ms (β = 37.92; 95% CI: 2.73 to 73.12) in the RTT. An inverse significant association was detected between chromium levels in hair and latency in the SAT in boys (β = -50.53; 95% CI: 86.86 to -14.22) and girls (β = -55.95; 95% CI: 78.93 to -32.97). Excluding trials with latencies >1000 ms in the RTT increased latency scores by 29.36 points in boys (95% CI: 0.17 to 58.57), and 39.91 points in girls (95% CI: 21.25 to 58.59). This study is the first to show the detrimental effects of postnatal chromium exposure on neuropsychological development in school-aged children.

Sex still matters: has the prevalence of male-only studies of drug effects on rodent behaviour changed during the past decade?

During the past 10 years, for a number of biomedical disciplines, including behavioural pharmacology, there have been appeals to include both sexes in animal studies of processes that are not sex specific. In 2007, a survey of experimental studies of drug or other chemical effects on rodent behaviour, published in five prominent journals over 20 months (February 2005 to September 2006, inclusive), revealed that 85% of these conducted with rats and 78% of these conducted with mice involved males only. This was in spite of the evidence of sex differences in responsiveness to an increasing number of compounds. To see if the situation has improved, the survey was repeated with the same journals for a comparable period namely, February 2016 to September 2017 (inclusive). Even though there have been repeated appeals for biomedical research that is not sex specific to involve both sexes, it was apparent that little has changed since 2005-2006, as 82% of rat and 75% of mouse studies were again conducted with males only. However, there was an increase in studies with mice, which may be owing to a greater interest in genetic factors. The male-only situation could be rectified by appropriate funding agencies and journals that publish behavioural pharmacological research insisting that both sexes must be included in research that is not sex specific along with valid scientific justification for single-sex studies, as now typifies some other disciplines.

Residential exposure to urban traffic is associated with the poorer neurobehavioral health of Ecuadorian schoolchildren

PURPOSE

We investigated whether chronic traffic-generated air pollution containing fine and ultrafine particulate matter is associated with reduced neurobehavioral performance and behavioral dysfunction in urban Ecuadorian schoolchildren. Also, we examined the effect of child hemoglobin and sociodemographic risk factors on these neurocognitive outcomes.

METHODS

A convenience sample of healthy children aged 8-14 years attending public schools were recruited in Quito, Ecuador. Child residential proximity to the nearest heavily trafficked road was used as a proxy for traffic-related pollutant exposure. These included high exposure (<100 m), medium exposure (100-199 m) and low exposure (≥ 200 m) from the nearest heavily trafficked road. The Behavioral Assessment and Research System (BARS), a computerized test battery assessing attention, memory, learning and motor function was used to evaluate child neurobehavioral performance. The Child Behavior Checklist (CBCL/6-18) was used to assess child behavioral dysfunction as reported by mothers. The data were analyzed using multiple linear regression.

RESULTS

Children with the highest residential exposure to traffic pollutants (< 100 m) had significantly longer latencies as measured by match to sample (b = 410.27; p = 0.01) and continuous performance (b = 37.90; p = 0.02) compared to those living ≥ 200 m away. A similar but non-significant association was observed for reaction time latency. Children living within 100 m of heavy traffic also demonstrated higher scores across all CBCL subscales although only the relationship with thought problems (p = 0.05) was statistically significant in the adjusted model.

CONCLUSION

The study findings suggest that children living within 100 m of heavy traffic appear to experience subtle neurobehavioral deficits that may result from fine and ultrafine particulate matter exposure.

Association of Low Lead Levels with Behavioral Problems and Executive Function Deficits in Schoolers from Montevideo, Uruguay

The negative effect of lead exposure on children's intelligence is well-documented. Less is known about the impact of lead on the use of executive functions to self-regulate behavior. We measured blood lead level (BLL) in a sample of first grade children from Montevideo, Uruguay (n = 206, age 6.7 ± 0.5 years, 59.7% boys). Behavior was assessed with teacher versions of the Conners Rating Scale (CRS) and the Behavior Rating Inventory of Executive Functions (BRIEF). Mean BLL was 4.2 ± 2.1 μg/dL; 10% had mild-to-severe ratings of Attentional Deficit with Hyperactivity Disorder (ADHD) (T score > 65). In negative binomial regression, BLL was not associated with CRS sub-scales, but was associated with a poorer ability to inhibit inappropriate behaviors, prevalence ratio (PR) [95% CI]: 1.01 [1.00, 1.03] as measured by the BRIEF. In covariate-adjusted models, the association with BLL was attenuated. When stratified by sex, the covariate-adjusted association between BLL, hyperactivity, poorer inhitibion, emotional control, and behavioral regulation was marginally significant for girls but not boys. In summary, among children with low lead-exposure, we found some, but nonetheless modest, evidence of a relationship between higher BLL and child behavior. If confirmed by larger studies and other objective measures of behavior, such links could have implications for learning and social interaction, particularly among girls.

Organic solvent exposure and contrast sensitivity: comparing men and women

The goal of this study was to compare the visual contrast sensitivity (CS) of men and women exposed and not exposed to organic solvents. Forty-six volunteers of both genders aged between 18 and 41 years (mean±SD=27.72±6.28) participated. Gas station attendants were exposed to gas containing 46.30 ppm of solvents at a temperature of 304±274.39 K, humidity of 62.25±7.59% and ventilation of 0.69±0.46 m/s (a passive gas chromatography-based sampling method was used considering the microclimate variables). Visual CS was measured via the psychophysical method of two-alternative forced choice using vertical sinusoidal gratings with spatial frequencies of 0.2, 0.5, 1.0, 2.0, 5.0, 10.0, and 16.0 cpd (cycles per degree) and an average luminance of 34.4 cd/m2. The results showed that visual CS was significantly lower (P<0.05) in the following groups: i) exposed men compared to unexposed men at frequencies of 0.2, 0.5, 1.0, and 2.0 cpd; ii) exposed women compared to unexposed women at a frequency of 5.0 cpd; and iii) exposed women compared to exposed men at a frequency of 0.5 cpd, even at exposures below the tolerance limit (300 ppm). These results suggest that the visual CS of exposed men was impaired over a wider range of spatial frequencies than that of exposed women. This difference may have been due to the higher body fat content of women compared to that of men, suggesting that body fat in women can serve as a protective factor against neurotoxic effects.

Chronic Organic Solvent Exposure Changes Visual Tracking in Men and Women

Organic solvents can change CNS sensory and motor function. Eye-movement analyses can be important tools when investigating the neurotoxic changes that result from chronic organic solvent exposure. The current research measured the eye-movement patterns of men and women with and without histories of chronic organic solvent exposure. A total of 44 volunteers between 18 and 41 years old participated in this study; 22 were men (11 exposed and 11 controls), and 22 were women (11 exposed and 11 controls). Eye movement was evaluated using a 250-Hz High-Speed Video Eye Tracker Toolbox (Cambridge Research Systems) via an image of a maze. Specific body indices of exposed and non-exposed men and women were measured with an Inbody 720 to determine whether the differences in eye-movement patterns were associated with body composition. The data were analyzed using IBM SPSS Statistics version 20.0.0. The results indicated that exposed adults showed significantly more fixations (t = 3.82; p = 0.001; r = 0.51) and longer fixations (t = 4.27; p = 0.001, r = 0.54) than their non-exposed counterparts. Comparisons within men (e.g., exposed and non-exposed) showed significant differences in the number of fixations (t = 2.21; p = 0.04; r = 0.20) and duration of fixations (t = 3.29; p = 0.001; r = 0.35). The same was true for exposed vs. non-exposed women, who showed significant differences in the number of fixations (t = 3.10; p = 0.001; r = 0.32) and fixation durations (t = 2.76; p = 0.01; r = 0.28). However, the results did not show significant differences between exposed women and men in the number and duration of fixations. No correlations were found between eye-movement pattern and body composition measures (p > 0.05). These results suggest that chronic organic solvent exposure affects eye movements, regardless of sex and body composition, and that eye tracking contributes to the investigation of the visual information processing disorders acquired by workers exposed to organic solvents.

Multiple exposures of sevoflurane during pregnancy induces memory impairment in young female offspring mice

Background

Earlier studies have reported conflicting results regarding long-term behavioral consequences after anesthesia during the fetal period. Previous studies also suggest several factors that may explain such conflicting data. Thus, we examined the influence of age and sex on long-term behavioral consequences after multiple sevoflurane exposures during the fetal period.

Methods

C57BL/6J pregnant mice received oxygen with or without sevoflurane for 2 hours at gestational day (GD) 14-16. Offspring mice were subjected to behavioral assays for general activity (open field test), learning, and memory (fear chamber test) at postnatal day 30–35.

Results

Multiple sevoflurane exposures at GD 14–16 caused significant changes during the fear chamber test in young female offspring mice. Such changes did not occur in young male offspring mice. However, general activity was not affected in both male and female mice.

Conclusions

Multiple sevoflurane exposures in the second trimester of pregnancy affects learning and memory only in young female mice. Further studies focusing on diverse cognitive functions in an age-, sex-dependent manner may provide valuable insights regarding anesthesia-induced neurotoxicity.

PCBs and measures of attention and impulsivity on a continuous performance task of young adults

The present study examines the relationship between current body burden of persistent PCBs and attention and impulsivity in 140 Akwesasne Mohawk young adults aged 17 to 21 whose environment has been contaminated by industrial effluent. Attention and impulsivity were measured by errors of omission, errors of commission, and patterns of reaction time responses on the Conners Continuous Performance Test. The PCB measure was the sum of those persistent PCB congeners detected in 50% of the participants. After adjusting for multiple covariates, regression analyses showed a significant positive relationship between PCB levels and omission scores, but only for males.

Information sources, awareness and preventive health behaviors in a population at risk of Arsenic exposure: The role of gender and social networks

The population of Paracatu is at risk of Arsenic (As) exposure associated with long-term exploration of the largest open pit gold mine in Brazil. As part of the interdisciplinary research "The Paracatu project: Arsenic environmental contamination and human health risks assessment in Paracatu-MG", carried out between 2011 and 2013, we used data disaggregated by gender to identify the sources of As-related information being accessed by inhabitants of Paracatu and to examine if access to these sources was correlated to awareness of As health effects and adoption of behaviors to reduce risk of As exposure. Semi-structured, face-to-face interviews were carried out with 460 participants (294 women and 166 men) to collect data on respondent's socio-demographic characteristics, use of mass media and social communication networks as sources of information on As issues, the trustworthiness of these information sources, awareness of As health effects, and adoption of behaviors to reduce As exposure. For both men and women, interpersonal communication was used and trusted more frequently than mass media to obtain information on As. Discussion of As issues occurred preferentially among individuals of the same gender and was associated with awareness of As health risks. There are marked differences in variables correlated with the adoption of behaviors to reduce the risk of As exposure between men and women. Discussing As issues with women was associated with adoption of risk-reduction practices for both genders. In contrast, men who discuss As issues with other men were less likely to adopt As exposure prevention behaviors. Finally, adoption was associated with awareness of As health effects for women, but this was not the case for men. Policy implications for decision makers, practitioners and researchers are discussed, based on concrete examples of how gender-specific approaches can effectively guide the formulation and implementation of health promotion campaigns and programs.

Changes in water manganese levels and longitudinal assessment of intellectual function in children exposed through drinking water

BACKGROUND

Manganese is commonly found in water but potential neurotoxic effects from exposure through drinking water are poorly understood. We previously reported a cross-sectional study showing that drinking water Mn concentration was associated with lower IQ in children aged 6 to 13 years.

OBJECTIVE

For this follow-up study, we aimed to re-assess the relation between exposure to Mn from drinking water and IQ at adolescence. In addition, we aimed to examine whether changes in drinking water Mn concentration was associated with changes in IQ scores.

METHODS

From the 380 children enrolled in the baseline study, 287 participated to this follow-up study conducted in average 4.4 years after. Mn concentration was measured in home tap water and children's hair. The relationships between these Mn exposure indicators and IQ scores (Weschsler Abbreviated Scale of Intelligence) at follow-up were assessed with linear regression analysis, adjusting for potential confounders. Intra-individual differences in IQ scores between the two examinations were compared for children whose Mn concentration in water remained stable between examinations, increased or decreased.

RESULTS

The mean age at follow-up was 13.7 years (range, 10.5 to 18.0 years). Geometric mean of Mn concentration in water at follow-up was 14.5μg/L. Higher Mn concentration in water measured at follow-up was associated with lower Performance IQ in girls (β for a 10-fold increase=-2.8, 95% confidence intervals [CI] -4.8 to -0.8) and higher Performance IQ in boys (β=3.9, 95% CI 1.4 to 6.4). IQ scores were not significantly associated with Mn concentration in hair, although similar trends as for concentration in water were observed. For children whose Mn concentration in water increased between baseline and follow-up, Performance IQ scores decreased significantly (intra-individual difference, -2.4 points).

CONCLUSION

Higher levels of Mn in drinking water were associated with lower Performance IQ in girls, whereas the opposite was observed in boys. These findings suggest long-term exposure to Mn through drinking water is associated differently with cognition in boys and girls.

Manganese-induced sex-specific gut microbiome perturbations in C57BL/6 mice

Overexposure to manganese (Mn) leads to toxic effects, such as promoting the development of Parkinson's-like neurological disorders. The gut microbiome is deeply involved in immune development, host metabolism, and xenobiotics biotransformation, and significantly influences central nervous system (CNS) via the gut-brain axis, i.e. the biochemical signaling between the gastrointestinal tract and the CNS. However, it remains unclear whether Mn can affect the gut microbiome and its metabolic functions, particularly those linked to neurotoxicity. In addition, sex-specific effects of Mn have been reported, with no mechanism being identified yet. Recently, we have shown that the gut microbiome is largely different between males and females, raising the possibility that differential gut microbiome responses may contribute to sex-selective toxicity of Mn. Here, we applied high-throughput sequencing and gas chromatography-mass spectrometry (GC-MS) metabolomics to explore how Mn2+ exposure affects the gut microbiome and its metabolism in C57BL/6 mice. Mn2+ exposure perturbed the gut bacterial compositions, functional genes and fecal metabolomes in a highly sex-specific manner. In particular, bacterial genes and/or key metabolites of neurotransmitter synthesis and pro-inflammatory mediators are significantly altered by Mn2+ exposure, which can potentially affect chemical signaling of gut-brain interactions. Likewise, functional genes involved in iron homeostasis, flagellar motility, quorum sensing, and Mn transportation/oxidation are also widely changed by Mn2+ exposure. Taken together, this study has demonstrated that Mn2+ exposure perturbs the gut microbiome and its metabolic functions, which highlights the potential role of the gut microbiome in Mn2+ toxicity, particularly its sex-specific toxic effects.

A Feminist Intervention That Hurt Women: Biological Differences, Ergonomics, and Occupational Health: Une intervention féministe qui a nui aux femmes: différences biologiques, égalité, ergonomie et santé au travail

The University of Québec in Montréal has agreements with trade unions providing access to university resources. Researchers involved in this program worked in partnership with union women's and health and safety committees for more than twenty years. Not all studies succeeded in improving women's working conditions. One joint project involved observational studies of tasks done by health-care workers, complemented by interviews and questionnaires. We found that task assignments, movements, postures, and work-related musculoskeletal disorders varied by gender/sex and made recommendations for change. However, issues of pay equity, spending on health care, and contracting-out of "ancillary work" were salient. Researchers learned that in the absence of changes in power relationships in the workplace, women may be disadvantaged by denial as well as by exaggeration of female-male differences. Men may also be at risk when their gender is invisible. We suggest some feminist approaches to workplace solutions and some pathways for research. Résumé L'Université du Québec à Montréal a signé avec des centrales syndicales des ententes leur donnant un accès à des ressources universitaires. Des chercheures ont travaillé en partenariat avec des comités syndicaux de condition des femmes et de santé-sécurité au travail pendant plus de 25 ans, mais ce ne sont pas toutes les études qui ont abouti à des améliorations. Un projet concernait des observations du travail d'employé.e.s du secteur de la santé, dont les tâches, mouvements, et postures variaient selon le genre/sexe. Nous avons recommandé des transformations, mais des enjeux d'équité salariale, de coûts et de sous-traitance y ont fait obstacle. Les chercheures ont appris qu'en l'absence de transformation des rapports de pouvoir au travail, le déni des différences hommes-femmes, autant que leur exagération, peut désavantager les travailleuses (et les travailleurs). Nous suggérons des approches féministes aux solutions pour le milieu de travail, ainsi que des pistes de recherche.

How to study the impact of sex and gender in medical research: a review of resources

There is a growing appreciation by the biomedical community that studying the impact of sex and gender on health, aging, and disease will lead to improvements in human health. Sex- and gender-based comparisons can inform research on disease mechanisms and the development of new therapeutics as well as enhance scientific rigor and reproducibility. This review will assist basic researchers, clinical investigators, as well as epidemiologists, population, and social scientists by providing an annotated bibliography of currently available resource tools on how to consider sex and gender as independent variables in research design and methodology. These resources will assist investigators applying for funding from the National Institutes of Health since all grant applicants will be required (as of January 25, 2016) to address the role of sex as a biological variable in vertebrate animal and human studies.

Effects of manganese exposure on visuoperception and visual memory in schoolchildren

BACKGROUND

Manganese (Mn) is an essential metal involved in multiple physiological functions. Environmental exposure to airborne Mn is associated with neurocognitive deficits in humans. Children, whose nervous system is in development, are particularly susceptible to Mn neurotoxicity.

OBJECTIVE

The objective of this study was to assess the association between Mn environmental exposure, and effects on visuoperception and visual memory in schoolchildren.

METHODS

We assessed schoolchildren between 7 and 11 years old, with similar socioeconomic status, from the mining district of Molango (n=148) and Agua Blanca (n=119, non-mining area) in Hidalgo state, Mexico. The Rey-Osterrieth Complex Figure (ROCF) test was used to assess visuoperception and short-term visual memory. Hair manganese (MnH) concentrations were determined. Linear regression models were constructed to estimate the associations between MnH and ROCF scores, adjusted for potential confounders.

RESULTS

The geometric mean MnH was nine times higher in schoolchildren from the Mn mining area (5.25μg/g) than in schoolchildren from the non-mining area (0.55μg/g). For the ROCF Copy trial, MnH was significantly associated with an increase in distortion errors (tangency, closure), angle errors, overtracing (partial overtracing). In the Immediate Recall trial, MnH was significantly associated with increased overtracing (partial overtracing) and omissions, and negatively associated with the number of perceptual drawn units, total score and percentage immediate recall.

CONCLUSIONS

MnH is associated with alterations in visuoperception and short-term visual memory in schoolchildren exposed to airborne Mn.

Pesticide exposure and neurodevelopment in children aged 6-9 years from Talamanca, Costa Rica

Certain pesticides may affect children's neurodevelopment. We assessed whether pesticide exposure was associated with impaired neurobehavioral outcomes in children aged 6-9 years. We conducted a cross-sectional study in 140 children living near banana plantations and plantain farms in the Talamanca County, Costa Rica and assessed their neurobehavioral performance. Exposure was determined by analyzing urinary metabolites of chlorpyrifos (3,5,6-trichloro-2-pyridinol, TCPy), mancozeb (ethylenethiourea, ETU), and pyrethroids (3-phenoxybenzoic acid, 3-PBA). Repeated urine samples were obtained for 36 children. We estimated associations of pesticide concentrations with neurobehavioral outcomes using multivariable linear and logistic regression models. Median (25th-75th percentiles) TCPy, ETU, and 3-PBA concentrations were 1.4 (.7-3.1), 1.2 (.7-3.0), and .8 (.5-1.5) μg/L, respectively. Intraclass correlation coefficients (ICC) ranged between .32 and .67. After adjustment for potential confounders, higher urinary TCPy concentrations were associated with poorer working memory in boys (n = 59) (β per 10-fold increase in TCPy concentrations = -7.5, 95% CI: -14.4, -.7); poorer visual motor coordination (β = -1.4, 95% CI: -2.7, -.1); increased prevalence of parent-reported cognitive problems/inattention (adjusted OR per 10-fold increase in urinary concentrations = 5.8, 95% CI: 1.6, 22.9), oppositional disorders (aOR = 3.9, 95% CI: 1.0, 16.0), and ADHD (aOR = 6.8, 95% CI: 1.8, 28.6), and; decreased ability to discriminate colors (aOR = 6.6, 95% CI: 1.6, 30.3; the higher the score the worse). Higher ETU concentrations were associated with poorer verbal learning outcomes (β = -7.0, 95% CI: -12.7, -1.3). Higher 3-PBA concentrations were associated with poorer processing speed scores, particularly in girls (β = -8.8, 95% CI: -16.1, -1.4). Our findings indicate that children living near banana and plantain plantations are exposed to pesticides that may affect their neurodevelopment, which for certain domains may differ between boys and girls. We recommend the implementation of measures to reduce pesticide exposure in children living nearby banana plantations.

Sex determination in blue mussels: Which method to choose?

Sexing methods of blue mussels are mostly based on the presence or absence of gametes, and do not take into account reproductive cycle stages. Exposure effects can be affected by the sex of mussels, thus the aim of this study is to determine an efficient sex determination protocol taking into account the reproductive cycle stage. Eight mussel sexing methods were compared. This study demonstrates that the first step in discerning sex in blue mussels should be assessing the reproductive stage, which can be done by mantle histology. During gametogenesis, histology allows the differentiation of males from females by the observation of gametes. However, when mussels are in sexual rest, the only method that should be used is the sex-specific gene method.

The Role of Gender in Chagas Disease Prevention and Control in Honduras: An Analysis of Communication and Collaboration Networks

In Honduras, where Chagas disease is a serious health and environmental concern, prevention measures face the challenge of achieving widespread and long-term sustainable adoption by communities. The article integrates social network analysis and a gender-sensitive approach to understand the role of men and women in the implementation of a community-level intervention, based on the adoption of housing improvements to reduce the presence of the insect vector. A total of 108 people in the community of El Salitre were interviewed. Data were collected on socio-demographic characteristics, participation in project activities, communication and collaboration networks related to Chagas disease prevention, knowledge of Chagas disease, and adoption of housing improvements techniques. Communication mostly occurred between the same gender individuals and was associated with knowledge of Chagas disease. Socioeconomic status, Chagas disease knowledge, and collaboration with men were associated with women adopting housing improvements. For men, however, participation in project activities, formal education, and collaboration with women were associated with adoption. These findings suggest that men and women were driven by distinct concerns, interests, and motivations when adopting new Chagas disease prevention strategies. Participatory community interventions that seek to generate health knowledge and foster collaborations to reduce health risk should address gender differences.

Prenatal low-level mercury exposure and infant neurodevelopment at 12 months in rural northern China

Although MeHg is a confirmed neurotoxin at sufficiently high dosages, the effect of prenatal low-level Hg exposure on infant neurodevelopment is still unknown. Four hundred ten mother-infant pairs were recruited in rural northern China from September 2010 to September 2012. We investigated maternal diet during pregnancy, collected maternal and umbilical blood samples, and tested infant neurodevelopment using Gesell developmental schedules (GDS) at the age of 1 year old. The geometric means (GM) of Hg exposure in maternal and umbilical blood were 0.72 and 1.2 μg/L, respectively. Positive associations between Hg levels and the frequency of total fish consumption were found (Spearman's correlation, r = 0.09 for maternal Hg, r = 0.14 for umbilical Hg, p < 0.01). After adjusting for confounding factors, we found a log-unit increase in umbilical blood Hg levels was associated with a 4.22-point (95 % confidence interval (95 %CI) 0.77 to 7.67) increase in the adaptive domain and a 4.06-point (95 %CI 0.51 to 7.62) increase in the social domain. No significant association has been found between other domains and Hg levels in our study. In further analysis, we noticed the positive correlation between the developmental quotient (DQ) scores of the adaptive domain and frequencies of total fish consumption (p = 0.04). Our results failed to indicate the adverse effects between prenatal Hg exposure and infant neurodevelopment. However, given the low-level Hg exposure and its predominant source, the potential positive associations in our study may be attributed to the beneficial nutrients of fish consumption.

Representative levels of blood lead, mercury, and urinary cadmium in youth: Korean Environmental Health Survey in Children and Adolescents (KorEHS-C), 2012-2014

BACKGROUND

This study examined levels of blood lead and mercury, and urinary cadmium, and associated sociodemographic factors in 3-18 year-old Korean children and adolescents.

MATERIALS AND METHODS

We used the nationally representative Korean Environmental Health Survey in Children and Adolescents data for 2012-2014 and identified 2388 children and adolescents aged 3-18 years. The median and 95th percentile exposure biomarker levels with 95% confidence intervals (CIs) were calculated. Multivariate regression analyses were performed on log transformed exposure biomarker levels adjusted for age, sex, area, household income, and father's education level. The median exposure biomarker levels were compared with data from Germany, the US, and Canada, as well as the levels of Korean children measured at different times.

RESULTS

The median levels of blood lead and mercury, as well as urinary cadmium were 1.23μg/dL, 1.80μg/L, and 0.40μg/L (95% CIs, 1.21-1.25, 1.77-1.83, and 0.39-0.41, respectively). The blood lead levels were significantly higher in boys and younger children (p<0.0001) and children with less educated fathers (p=0.004) after adjusting for covariates. Urinary cadmium level increased with age (p<0.0001). The median levels of blood mercury and urinary cadmium were much higher in Korean children and adolescents than those in their peers in Germany, the US, and Canada. Blood lead levels tended to decrease with increasing age and divergence between the sexes, particularly in the early teen years. Median levels of blood lead and urinary cadmium decreased since 2010.

CONCLUSION

Sociodemographic factors, including age, sex, and father's education level were associated with environmental exposure to heavy metals in Korean children and adolescents. These biomonitoring data are valuable for ongoing surveillance of environmental exposure in this vulnerable population.

Lead exposure induces changes in 5-hydroxymethylcytosine clusters in CpG islands in human embryonic stem cells and umbilical cord blood

Prenatal exposure to neurotoxicants such as lead (Pb) may cause stable changes in the DNA methylation (5mC) profile of the fetal genome. However, few studies have examined its effect on the DNA de-methylation pathway, specifically the dynamic changes of the 5-hydroxymethylcytosine (5hmC) profile. Therefore, in this study, we investigate the relationship between Pb exposure and 5mC and 5hmC modifications during early development. To study the changes in the 5hmC profile, we use a novel modification of the Infinium™ HumanMethylation450 assay (Illumina, Inc.), which we named HMeDIP-450K assay, in an in vitro human embryonic stem cell model of Pb exposure. We model Pb exposure-associated 5hmC changes as clusters of correlated, adjacent CpG sites, which are co-responding to Pb. We further extend our study to look at Pb-dependent changes in high density 5hmC regions in umbilical cord blood DNA from 48 mother-infant pairs from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohort. For our study, we randomly selected umbilical cord blood from 24 male and 24 female children from the 1st and 4th quartiles of Pb levels. Our data show that Pb-associated changes in the 5hmC and 5mC profiles can be divided into sex-dependent and sex-independent categories. Interestingly, differential 5mC sites are better markers of Pb-associated sex-dependent changes compared to differential 5hmC sites. In this study we identified several 5hmC and 5mC genomic loci, which we believe might have some potential as early biomarkers of prenatal Pb exposure.

Neurodevelopment outcomes in children exposed to organic mercury from multiple sources in a tin-ore mine environment in Brazil

Methylmercury (from fresh-water fish) and ethylmercury [from thimerosal-containing vaccines (TCVs)] are the most prevalent source of neurotoxic exposure during early life in families consuming fish and using these vaccines. But children living in Amazonian mining environments are exposed to additional toxic metals in waste materials. We studied mercury (Hg) exposure and neurodevelopment in 294 children (105 boys and 189 girls) from Bom Futuro (Rondonia, Brazil), the epicenter of a tin-ore open-pit mine. Hair-Hg (HHg) concentrations and total ethylmercury (from TCVs) were taken from infants and respective mothers during pregnancy. We used bivariate analysis to determine the effect of sex and linear mixed models to assess the association of prenatal and postnatal organic Hg exposures with children's Bayley Scales of Infant Development (BSID) as psychomotor developmental index and mental developmental index (MDI) at 6 and 24 months of age as well as milestones achievements (age of walking and age of talking). Significant differences between boys and girls were observed for both MDI score (p = 0.0073) and MDI score (p = 0.0288) at 6 months but not at 24 months. Regression analysis showed that only in boys was there a significant interaction between MDI score with family income (β = 0.288, p = 0.018) and with birth weight (β = -0.216, p = 0.036) at 6 months; at 24 months, however, only boys showed a significant association of both MDI score (β = -0.222, p = 0.045) and MDI score (β = -0.222, p = 0.045) with neonatal HHg. In boys, age of walking was associated with HHg (β = 0.188, p = 0.019) and breastfeeding (β = -0.282, p = 0.000), whereas for girls, age of walking was only associated with breastfeeding (β = -0.275, p = 0.001). In this mining environment, with only a weak association for prenatal Hg exposure, there was a significant sex difference in neurodevelopment, with boys showing more sensitivity related to BSID delays.

Postnatal arsenic exposure and attention impairment in school children

Over the last few decades there has been an increased concern about the health risks from exposure to metallic trace elements, including arsenic, because of their potential neurotoxic effects on the developing brain. This study assessed whether urinary arsenic (UA) levels are associated with attention performance and Attention-Deficit/Hyperactivity Disorder (ADHD) in children living in an area with high industrial and mining activities in Southwestern Spain. A cross-sectional study was conducted on 261 children aged 6-9 years. Arsenic levels were determined in urine samples. Attention was measured by using 4 independent tools: a) tests from the Behavioral Assessment and Research System (BARS) designed to measure attention function: Simple Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT); b) AULA Test, a virtual reality (VR)-based test that evaluates children's response to several stimuli in an environment simulating a classroom; c) Child Behavior Checklist (CBCL), administered to parents; and d) Teacher's Report Form (TRF), administered to teachers. Multivariate linear and logistic regression models, adjusted for potential confounders, were used to estimate the magnitude of the association between UA levels and attention performance scores. Higher UA levels were associated with an increased latency of response in RTT (β = 12.3; 95% confidence interval (CI): 3.5-21.1) and SAT (β = 3.6; 95% CI: .4-6.8) as well as with worse performance on selective and focalized attention in the AULA test (β for impulsivity = .6; 95% CI: .1-1.1; β for inattention = .5; 95% CI: .03-1.0). A dose-response relationship was observed between UA levels and inattention and impulsivity scores. In contrast, results from the CBCL and TRF tests failed to show a significant association with UA levels. In conclusion, UA levels were associated with impaired attention/cognitive function, even at levels considered safe. These results provide additional evidence that postnatal arsenic exposure impairs neurological function in children.

Meta-analysis on occupational exposure to pesticides--neurobehavioral impact and dose-response relationships

While the health impact of high exposures to pesticides is acknowledged, the impact of chronic exposures in the absence of acute poisonings is controversial. A systematic analysis of dose-response relationships is still missing. Its absence may provoke alternative explanations for altered performances. Consequently, opportunities for health prevention in the occupational and environmental field may be missed. Objectives were (1) quantification of the neurotoxic impact of pesticides by an analysis of functional alterations in workers measured by neuropsychological performance tests, (2) estimates of dose-response relationships on the basis of exposure duration, and (3) exploration of susceptible subgroups. The meta-analysis employed a random effects model to obtain overall effects for individual performance tests. Twenty-two studies with a total of 1758 exposed and 1260 reference individuals met the inclusion criteria. At least three independent outcomes were available for twenty-six performance variables. Significant performance effects were shown in adults and referred to both cognitive and motor performances. Effect sizes ranging from dRE=-0.14 to dRE=-0.67 showed consistent outcomes for memory and attention. Relationships between effect sizes and exposure duration were indicated for individual performance variables and the total of measured performances. Studies on adolescents had to be analyzed separately due to numerous outliers. The large variation among outcomes hampered the analysis of the susceptibility in this group, while data on female workers was too scant for the analysis. Relationships exist between the impact of pesticides on performances and exposure duration. A change in test paradigms would help to decipher the impact more specifically. The use of biomarkers appropriate for lower exposures would allow a better prevention of neurotoxic effects due to occupational and environmental exposure. Intervention studies in adolescents seem warranted to specify their risk.

Gender in occupational health research of farmworkers: a systematic review

Background

Farmwork is one of the most hazardous occupations for men and women. Research suggests sex/gender shapes hazardous workplace exposures and outcomes for farmworkers. This paper reviews the occupational health literature on farmworkers, assessing how gender is treated and interpreted in exposure-outcome studies.

Methods

The paper evaluates peer-reviewed articles on men and women farmworkers' health published between 2000 and 2012 in PubMed or SCOPUS. Articles were identified and analyzed for approaches toward sampling, data analysis, and use of exposure indicators in relation to sex/gender.

Results

18% of articles reported on and interpreted sex/gender differences in health outcomes and exposures. Sex/gender dynamics often shaped health outcomes, yet adequate data was not collected on established sex/gender risk factors relating to study outcomes.

Conclusion

Research can better incorporate sex/gender analysis into design, analytical and interpretive approaches to better explore its mediation of health outcomes in light of emerging calls to mainstream gender research. Am. J. Ind. Med. 57:1344–1367, 2014. © 2014 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cadmium exposure and neuropsychological development in school children in southwestern Spain

This study assessed the association between cadmium exposure and neuropsychological development in children from a region with high industrial and mining activities in southwestern Spain. We conducted a cross-sectional study with 261 children aged 6-9 years between January and March 2012. Cadmium exposure was measured in urine and hair of children, and neuropsychological development was assessed with the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and with three computerized tests from the Behavioral Assessment and Research System (BARS): Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT). Multivariate linear regression models, adjusted for potential confounders, were used to estimate the association between neuropsychological development and cadmium exposure measured in urine and hair samples. Geometric means of urine and hair cadmium levels were 0.75 μg/g creatinine and 0.01 μg/g, respectively. We observed that doubling of levels of cadmium in urine was associated with a reduction of two points (95% CI: -3.8 to -0.4) in the Full-Scale intelligence quotient (IQ) in boys. By domains, association was statistically significant for Verbal Comprehension (β=-2.0; p=0.04) and close to the significance level for Perceptual Reasoning (β=-1.8; p=0.06). Among girls, only Verbal Comprehension showed suggestive associations with cadmium exposure (β=-1.7; p=0.06). Cadmium exposure is associated with cognitive delays in boys in our region. Our results provide additional evidence of the neurotoxic effect of low-level postnatal cadmium exposure among children, and support the hypothesis of differences between sexes in the neurotoxic effect of metals on children.

Blood lead concentrations and children's behavioral and emotional problems: a cohort study

IMPORTANCE

The association between lead exposure and children's IQ has been well studied, but few studies have examined the effects of blood lead concentrations on children's behavior.

OBJECTIVE

To evaluate the association between blood lead concentrations and behavioral problems in a community sample of Chinese preschool children with a mean blood lead concentration of less than 10 µg/dL.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study was conducted at 4 preschools in Jintan, Jiangsu province of China. Participants included 1341 children aged 3 to 5 years.

EXPOSURES

Lead.

MAIN OUTCOMES AND MEASURES

Blood lead concentrations were measured in children aged 3 to 5 years. Behavioral problems were assessed using Chinese versions of the Child Behavior Checklist and Caregiver-Teacher Report Form when children were aged 6 years.

RESULTS

The mean (SD) blood lead concentration was 6.4 (2.6) µg/dL, with the 75th and 90th percentiles being 7.5 and 9.4 µg/dL, respectively. General linear modeling showed significant associations between blood lead concentrations and increased scores for teacher-reported behavioral problems. A 1-µg/dL increase in the blood lead concentration resulted in a 0.322 (95% CI, 0.058 to 0.587), 0.253 (95% CI, 0.016 to 0.500), and 0.303 (95% CI, 0.046 to 0.560) increase of teacher-reported behavior scores on emotional reactivity, anxiety problems, and pervasive developmental problems, respectively (P < .05), with adjustment for parental and child variables. Spline modeling showed that mean teacher-reported behavior scores increased with blood lead concentrations, particularly for older girls.

CONCLUSIONS AND RELEVANCE

Blood lead concentrations, even at a mean concentration of 6.4 µg/dL, were associated with increased risk of behavioral problems in Chinese preschool children, including internalizing and pervasive developmental problems. This association showed different patterns depending on age and sex. As such, continued monitoring of blood lead concentrations, as well as clinical assessments of mental behavior during regular pediatric visits, may be warranted.

Resolving the enigma of the mesoamerican nephropathy: a research workshop summary

The First International Research Workshop on Mesoamerican Nephropathy (MeN) met in Costa Rica in November 2012 to discuss how to establish the extent and degree of MeN, examine relevant causal hypotheses, and focus efforts to control or eliminate the disease burden. MeN describes a devastating epidemic of chronic kidney disease of unknown origin predominantly observed among young male sugarcane cutters. The cause of MeN remains uncertain; however, the strongest hypothesis pursued to date is repeated episodes of occupational heat stress and water and solute loss, probably in combination with other potential risk factor(s), such as nonsteroidal anti-inflammatory drug and other nephrotoxic medication use, inorganic arsenic, leptospirosis, or pesticides. At the research workshop, clinical and epidemiologic case definitions were proposed in order to facilitate both public health and research efforts. Recommendations emanating from the workshop included measuring workload, heat, and water and solute loss among workers; quantifying nephrotoxic agents in drinking water and food; using biomarkers of early kidney injury to explore potential causes of MeN; and characterizing social and working conditions together with methods for valid data collection of exposures and personal risk factors. Advantages and disadvantages of different population study designs were detailed. To elucidate the etiology of MeN, multicountry studies with prospective cohort design, preferably integrating an ecosystem health approach, were considered the most promising. In addition, genetic, experimental, and mechanistic methods and designs were addressed, specifically the need for kidney biopsy analysis, studies in animal models, advances in biomarkers, genetic and epigenetic studies, a common registry and repository of biological and demographic data and/or specimens, and other areas of potential chronic kidney disease experimental research. Finally, in order to improve international collaboration on MeN, workshop participants agreed to establish a research consortium to link these Mesoamerican efforts to other efforts worldwide.

Mercury transfer during pregnancy and breastfeeding: hair mercury concentrations as biomarker

Hair mercury (HHg) concentration is a biomarker of exposure that is widely used to assess environmental contamination by fish methylmercury and neurodevelopment in children. In the Rio Madeira basin (Brazilian Amazon), total HHg concentrations in 649 mother-infant pairs were measured at birth (prenatal exposure) and after 6 months of exclusive breastfeeding; these mother-infant pairs were from high fish-eating communities (urban, n = 232; rural, n = 35; and Riverine, n = 262) and low fish-eating tin-miner settlers (n = 120). Differences in kinetics were seen between Hg exposure from fish consumption and environmental exposure to a tin-ore mining environment. Overall maternal HHg concentrations (at childbirth and after 6 months of lactation) were higher than those of infant HHg. However, the relative change in HHg after 6 months of lactation showed that mothers decreased HHg while infants increased HHg. The relative change showed a consistently higher increase for girls than boys with a statistical significance only in high fish-eating mothers. The correlation coefficients between maternal and newborn hair were high and statistically significant for mothers living in urban (r = 0.66, p < 0.001), rural (r = 0.89, p < 0.001), and Riverine (r = 0.89, p < 0.001) communities not for tin miner settlers (r = 0.07, p = 0.427). After 6 months of exclusive breastfeeding, correlation coefficients showed high correlation coefficients and statistical significance for all groups (urban, r = 0.73, p < 0.001; rural, r = 0.88, p < 0.001; Riverine, r = 0.91, p < 0.001) except for Tin miners (r = -0.07, p = 0.428). A linear model analysis was used to assess the longitudinal associations of maternal total HHg and total HHg at birth (0 days) and 6 months of age in exclusively breastfed infants. Regression analysis significantly predicted HHg in newborn from maternal HHg for high fish-eating maternal-infant pairs.

CONCLUSION

The concentration of mercury accumulated in newborn tissues (in utero and during breastfeeding) relevant to both, maternal sources and infant exposure, can be reliably assessed from maternal hair.

Association of arsenic, cadmium and manganese exposure with neurodevelopment and behavioural disorders in children: a systematic review and meta-analysis

The aim of this study was to analyse the scientific evidence published to date on the potential effects on neurodevelopment and behavioural disorders in children exposed to arsenic, cadmium and manganese and to quantify the magnitude of the effect on neurodevelopment by pooling the results of the different studies. We conducted a systematic review of original articles from January 2000 until March 2012, that evaluate the effects on neurodevelopment and behavioural disorders due to pre or post natal exposure to arsenic, cadmium and manganese in children up to 16 years of age. We also conducted a meta-analysis assessing the effects of exposure to arsenic and manganese on neurodevelopment. Forty-one articles that evaluated the effects of metallic elements on neurodevelopment and behavioural disorders met the inclusion criteria: 18 examined arsenic, 6 cadmium and 17 manganese. Most studies evaluating exposure to arsenic (13 of 18) and manganese (14 of 17) reported a significant negative effect on neurodevelopment and behavioural disorders. Only two studies that evaluated exposure to cadmium found an association with neurodevelopmental or behavioural disorders. The results of our meta-analysis suggest that a 50% increase of arsenic levels in urine would be associated with a 0.4 decrease in the intelligence quotient (IQ) of children aged 5-15 years. Moreover a 50% increase of manganese levels in hair would be associated with a decrease of 0.7 points in the IQ of children aged 6-13 years. There is evidence that relates arsenic and manganese exposure with neurodevelopmental problems in children, but there is little information on cadmium exposure. Few studies have evaluated behavioural disorders due to exposure to these compounds, and manganese is the only one for which there is more evidence of the existence of association with attention deficit disorder with hyperactivity.

Gender differences in brain susceptibility to oxidative stress are mediated by levels of paraoxonase-2 expression

Paraoxonase 2 (PON2), a member of a gene family that also includes PON1 and PON3, is expressed in most tissues, including the brain. In mouse brain, PON2 levels are highest in dopaminergic areas (e.g., striatum) and are higher in astrocytes than in neurons. PON2 is primarily located in mitochondria and exerts a potent antioxidant effect, protecting mouse CNS cells against oxidative stress. The aim of this study was to characterize PON2 expression and functions in the brains of male and female mice. Levels of PON2 (protein, mRNA, and lactonase activity) were higher in brain regions and cells of female mice. Astrocytes and neurons from male mice were significantly more sensitive (by 3- to 4-fold) to oxidative stress-induced toxicity than the same cells from female mice. Glutathione levels did not differ between genders. Importantly, no significant gender differences in susceptibility to the same oxidants were seen in cells from PON2(-/-) mice. Treatment with estradiol induced a time- and concentration-dependent increase in the levels of PON2 protein and mRNA in male (4.5-fold) and female (1.8-fold) astrocytes, which was dependent on activation of estrogen receptor-α. In ovariectomized mice, PON2 protein and mRNA were decreased to male levels in brain regions and in liver. Estradiol protected astrocytes from wild-type mice against oxidative stress-induced neurotoxicity, but did not protect cells from PON2(-/-) mice. These results suggest that PON2 is a novel major intracellular factor that protects CNS cells against oxidative stress and confers gender-dependent susceptibility to such stress. The lower expression of PON2 in males may have broad ramifications for susceptibility to diseases involving oxidative stress, including neurodegenerative diseases.