Prenatal and early postnatal exposure to perfluoroalkyl substances and bone mineral content and density in the Odense child cohort

INTRODUCTION

Exposure to perfluoroalkyl substances (PFAS) has been associated with lower bone mineral density (BMD) in animal and human studies, but prospective data from children are limited.

OBJECTIVES

To determine associations between prenatal and early postnatal PFAS exposure and BMD at age 7 years.

METHODS

In the Odense Child Cohort, Denmark, pregnant women were recruited in 2010-2012, and their children were invited for subsequent health examinations. At 12 weeks of gestation the pregnant women delivered a serum sample, and at age 18 months serum was obtained from the child to measure perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) by LC-MS/MS. At age 7 years DXA scans were performed to measure bone mineral content (BMC) and BMD Z-score. PFAS in pregnancy (n = 924) and/or at age 18 months (n = 511) were regressed against DXA measurements, adjusted for maternal education, child height Z-score, sex (for BMC) and for postnatal exposure, additionally duration of total breastfeeding. We additionally performed structural equation models determining combined effects of pre-and postnatal PFAS exposures.

RESULTS

Higher prenatal and early postnatal serum concentrations of all measured PFAS were associated with lower BMC and BMD Z-scores at age 7 years, all estimates were negative although not all significant. For each doubling of prenatal or 18-month exposure to PFDA, BMD Z-scores were lowered by -0.07 (95 % CI -0.10; -0.03) and -0.14 (-0.25; -0.03), respectively after adjustment. Pre- and postnatal PFAS were correlated, but structural equation models suggested that associations with BMD were stronger for 18-month than prenatal PFAS exposure.

DISCUSSION

Bone density is established in childhood, and a reduction in BMD during early childhood may have long-term implication for peak bone mass and lifelong bone health. Future studies of the impact of PFAS exposure on fracture incidence will help elucidate the clinical relevance.

Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children

This study aims to evaluate the effectiveness of two school-based physical education (PE) programmes (exercise-based and games-based) compared with traditional PE, on health- and skill-related physical fitness components in children in Tirana, Albania. Participants were 378 first-grade (6.8 years) and 389 fourth-grade (9.8 years) children attending four randomly selected schools in Tirana. Twenty-four school classes within these schools were randomly selected (stratified by school and school grade) to participate as exercise group (EG), games group (GG) and control group (CG). Both EG and GG intervention programmes were taught by professional PE teachers using station/circuit teaching framework while CG referred to traditional PE school lessons by a general teacher. All programmes ran in parallel and lasted 5 months, having the same frequency (twice weekly) and duration (45 min). Heart rate (HR) monitoring showed that intensity during PE lessons was significantly higher in the intervention groups compared with control (P < 0.001). Both PE exercise- and games programmes significantly improved several health- and skill-related fitness indicators compared with traditional PE lessons (e.g. gross motor skill summary score: 9.4 (95% CI 7.9; 10.9) for exercise vs. control and 6.5 (95% CI 5.1; 8.1) for games vs. control, cardiorespiratory fitness: 2.0 ml O2 · min(-1) · kg(-1) (95% CI 1.5; 2.4) for exercise vs. control and 1.4 ml O2 · min(-1) · kg(-1) (95% CI 1.0; 1.8) for games vs. control). Furthermore, compared to games-based PE, exercise-based PE showed more positive changes in some gross motor coordination skills outcomes, coordination skills outcomes and cardiorespiratory fitness. The results from this study show that exercise- and games-based PE represents a useful strategy for improving health- and skill-related physical fitness in Albanian elementary school children. In addition, the study shows that exercise-based PE was more effective than games-based PE in improving gross motor function and cardiorespiratory fitness.

Associations between bicycling and carotid arterial stiffness in adolescents: The European Youth Hearts Study

The aim of the study was to investigate the associations between bicycling and carotid arterial stiffness, independent of objectively measured moderate-and-vigorous physical activity. This cross-sectional study included 375 adolescents (age 15.7 ± 0.4 years) from the Danish site of the European Youth Heart Study. Total frequency of bicycle usage was assessed by self-report, and carotid arterial stiffness was assessed using B-mode ultrasound. After adjusting for pubertal status, body height, and objectively measured physical activity and other personal lifestyle and demographic factors, boys using their bicycle every day of the week displayed a higher carotid arterial compliance {standard beta 0.47 [95% confidence interval (CI) 0.07-0.87]} and distension [standard beta 0.38 (95% CI -0.04 to 0.81)]. Boys using their bicycle every day of the week furthermore displayed a lower Young's elastic modulus [standard beta -0.48 (95% CI -0.91 to -0.06)]. Similar trends were observed when investigating the association between commuter bicycling and carotid arterial stiffness. These associations were not observed in girls. Our observations suggest that increasing bicycling in adolescence may be beneficial to carotid arterial health among boys.

[Foreign body in the esophagus]

A ten year retrospective survey of 346 cases of oesophageal foreign bodies is reported. Although coins were the most frequent foreign bodies in the pediatry group, meat was the most common offender in the material taken as a whole. Rigid oesophagoscopy in general anaesthesia was performed on 312 patients. A foreign body was removed in 281 cases (90%). Only one case of oesophageal cancer was discovered. The risk of iatrogenic perforation of the oesophagus was greatest in old patients who had a lump of meat stuck in the distal third of the oesophagus.

[Surgical treatment of snoring and sleep apnea]

Twenty-one patients (four females and 17 males) greatly inconvenienced by snoring were subjected to UPP with CO2-laser technique. All patients were overweight (body-mass index average 30 kg/m2). Narrowing was found at the naso/oropharyngeal border in 71%. All had either abnormal uvula or soft palate. Snoring was reduced to a degree no longer socially troublesome in 17 patients. Three patients were still inconvenienced to some extent. Snoring was completely unchanged in only one patient. UPPP is not very difficult to perform, and we did not notice any sequelae of importance. We think that UPPP is an effective operation for severe snoring, although it does not eliminate the symptom.

Results of uvulopalatopharyngoplasty in snoring

Twenty-one patients (4 females and 17 males) with very annoying snoring were subjected to UPPP with CO2-laser technique. All patients were overweight (bodymass index average 30.3 kg/m2). In 71%, narrowing were found at the naso/oropharyngeal border. All had either abnormal uvula or soft palate. In 17 patients, snoring was reduced to a degree no longer socially annoying. Three were annoying to some extent. In only one patient, snoring was completely unchanged. UPPP is not very difficult to perform and we did not notice any troublesome sequelae. We think that UPPP is an effective operation for severe snoring, although it does not eliminate the symptom.

Tuberculous otomastoiditis

A review of the 20th century English-language literature has produced a total of 320 cases of tuberculous otitis media or otomastoiditis, of which a surprising 93 cases have been reported in the 5-year period 1986-1990. Eighty-three percent of these have come from indigenous African populations. The international health and sociological implications of this development are disturbing. three personal cases seen during the past 8 years are presented, all of whom came from the indigenous Norwegian population. The epidemiology of these cases is therefore different, which can result in a diagnostic delay due to a low index of suspicion. The historically classical signs of this disease are frequently absent.

Inverted papilloma of the nose and paranasal sinuses: a study of 67 patients

Retrospectively, 67 patients with inverted nasal papillomas were studied. In 12, the lesions were localized exclusively on the nasal septum. In 55, the lesion involved the lateral wall and/or the paranasal sinuses. There was a male predominance of 3:1. After histological revision the most dominating epithelial type was found to be transitional. Inverted papilloma was in one patient associated with squamous cell carcinoma. Ten per cent suffered recurrences from 6 to 37 months after the primary surgical procedure. We found that limited septal lesions could be managed by an intranasal procedure but lateral rhinotomy is recommended as the procedure of choice in the treatment of inverted papilloma of the lateral wall.

Gas chromatographic analysis and storage of gas samples from the middle ear

Methods for storage and analysis of gas samples were studied prior to measuring the composition of gas in the human middle ear cavity. Storage and analysis of gas samples are beset with several pitfalls. The dead space of the sampling syringe must be considered and the gas sample can equilibrate with the surrounding atmosphere, especially if the analysis cannot be done immediately. In this study the equilibration rate was found to fit an exponential function with a time constant of 0.004 min-1. The time constant was reduced by more than a factor of ten when butyl rubber stoppers were used to seal the syringes. Silicone rubber stoppers were less efficient. Disposable plastic syringes were found just as efficient as 'gas-tight' syringes.

Studies on gas tension in the normal middle ear. Gas chromatographic analysis and a new sampling technique

In studying mechanisms regulating the middle ear pressure it is essential to know the gas compositions of the middle ear. We have constructed a device which made it possible to sample middle ear gas without creating a negative pressure, thus eliminating the risk of admixture of atmospheric air. The samples were analysed by gas chromatography. In 26 normal subjects we found relatively stable values of carbon dioxide (median 52 mmHg, range 31-69 mmHg) and nitrogen (median 605 mmHg, range 563-627 mmHg). The values of oxygen were more fluctuating (median 54 mmHg, range 23-111 mmHg). In 10 of the subjects, arterial gases were determined simultaneously. No correlation could be shown between middle ear and arterial oxygen and carbon dioxide tensions. This investigation provides evidence contradicting the classical theory of a high negative middle ear pressure in Eustachian tube closure. We found strong indications that the Eustachian tube plays an active role in regulating the pressure in the normal middle ear, but variations in blood flow through the middle ear capillaries may also be an important regulating factor.

Topical anaesthesia of the normal tympanic membrane: a controlled clinical trial of different suspensions of lidocaine

The purpose of this investigation was to find an effective method for topical lidocaine anaesthesia of the tympanic membrane for minor therapeutical procedures. Twelve subjects with healthy ears were tested in a randomized double-blind crossover trial. Xylocaine (lidocaine) aerosol 10%, lidocaine 4%, and lidocaine hydrochloride 5% were tested against placebo. Xylocaine aerosol was sprayed into a small container, shaken, and tempered. This made the application painless. The eardrum was stimulated by a point of a needle effective 25 min after application (p = 0.008 and p less than 0.05, respectively). Lidocaine hydrochloride showed no effect. No side effects were observed. The effectiveness seems to be dependent on the ionization of the drug, since the two effective drugs lidocaine and Xylocaine are un-ionized, whereas the ineffective lidocaine hydrochloride is ionized.

Peak flow nasal patency indices in patients operated for nasal obstruction

In 26 patients undergoing operation for nasal obstruction, nasal and oral peak expiratory and inspiratory flow rates were measured preoperatively and 1 month postoperatively. Peak expiratory and inspiratory flow nasal patency indices were calculated from the ratio between the nasal and oral peak flow rates. Postoperatively, these indices were significantly increased for the total nose and for the preoperatively worse nasal cavity. No significant change was observed for the oral peak flow rates. A significant preoperative difference in nasal patency between the two nasal cavities was eliminated by surgery, as the postoperative peak flow of each nasal cavity reached 80% of the peak flow of the total nose on expiration and close to 50% on inspiration. A good correspondence between the subjective improvement of nasal patency and the increase in peak expiratory and inspiratory flow nasal patency indices was observed for the total nose. These findings show that peak flow nasal patency indices give valuable information pre- and post-operatively in patients undergoing nasal surgery and that the method is simple and easy to perform.

Monitoring middle ear pressure by tympanometry. A study of middle ear pressure variation through seven hours

The aim of this investigation was to monitor fluctuations in middle ear pressure, to study tympanometric signs of Eustachian tube functioning and to assess the validity of the tympanometric readings. In 20 patients with a low initial middle ear pressure (-150 daPa or lower) and 5 normals, impedance tympanometry was performed every 3 min through 7 h. Median pressure for the patients was -150 daPa (range 100 to -400 daPa) and for the normals 0 daPa (range 50 to -50 daPa). A remarkable pressure increase was seen after changing the body position to the supine. The patients were arranged into three groups according to the lowest middle ear pressure registered. Median pressures for the groups were running at a rather constant level. However, the individual pressure fluctuations in many patients were so great that a single tympanometric reading has to be considered unreliable when selecting patients for insertion of ventilation tubes. Thirteen patients never equalized their negative middle ear pressure, indicating that their Eustachian tube did not open during the test period. In spite of this the pressure did not decrease to lower values, indicating that maintaining a relative constant middle ear pressure is independent of opening of the Eustachian tube.

Autosomal dominant osteopetrosis: an otoneurological investigation of the two radiological types

Otoneurological examination was performed on 14 patients with autosomal dominant osteopetrosis. Eight patients had radiological type I osteopetrosis, characterized by a pronounced osteosclerosis of the skull and an enlarged thickness of the cranial vault. Six patients had type II, in which osteosclerosis is most pronounced at the base of the skull. All investigated patients except one had otoneurological manifestations, but only two of of the 14 had otoneurological complaints. Symptoms were related to radiological types. Involvement of the trigeminal nerve was seen only in type I, whereas involvement of the facial nerve was found primarily in type II. Conductive hearing loss was particularly common in type I, and may reflect a high frequency of otosclerosis. Tomography of the petrous bones showed a significant narrowing of the internal acoustic meatus in type I (p less than 0.01) when compared to normal controls, but no significant narrowing in type II.

Auditory brain stem responses in dyslexic and normal children. A prospective clinical investigation

Auditory Brain stem Responses (ABR) were performed prospectively in 24 severely constitutionally dyslexic children. None of the subjects showed any signs of organic or psychologic abnormality. The results were matched with a corresponding group of normal children. The response latencies of the two groups were almost identical (no statistically significant difference). We conclude that dysfunction of the brain stem auditory pathways should not be expected in constitutionally dyslexic children.

Normal ABR's in dyslexic children

Auditory Brain stem Responses (ABR) were recorded in 24 severely constitutional dyslexic--and 21 normal children. The response latencies of the two groups were almost identical. We conclude that dysfunction of the brain stem auditory pathways should not be expected in dyslexic children.

Ginger root against seasickness. A controlled trial on the open sea

In a double-blind randomized placebo trial, the effect of the powdered rhizome of ginger (Zingiber officinale) was tested on seasickness. Eighty naval cadets, unaccustomed to sailing in heavy seas reported during voyages on the high seas, symptoms of seasickness every hour for 4 consecutive hours after ingestion of 1 g of the drug or placebo. Ginger root reduced the tendency to vomiting and cold sweating significantly better than placebo did (p less than 0.05). With regard to vomiting, a modified Protection Index (PI) = 72% was calculated. Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant. For all symptom categories, PI = 38% was calculated.

Autosomal dominant osteopetrosis (a family study)

Osteopetrosis is a rare metabolic disorder, characterized by an abnormal accumulation of bone mass probably caused by diminished bone resorption. Symptoms are directly and indirectly derived from the increased amount of bone. A family study was made, starting with a proband presenting with symptoms of trigeminal neuralgia. The pedigree indicated an autosomal dominant inheritance through three generations, comprising four affected subjects, of whom two were free of symptoms.

Benign and malignant neoplasms of the parotid gland: incidence and histology in the Danish County of Funen

The present series is comprised of 155 patients from the county of Funen who were operated on for tumors of the parotid gland during the 5-year period, 1978 to 1982. Fifteen cases were malignant, 116 were benign, while no neoplasms were found in 24 cases. The incidence was calculated as 5.8 parotid neoplasms per year per 100,000 inhabitants. Computation of age standardized incidence rates adjusted to European and World Standard populations has been performed. It is stated that the county of Funen is a well-defined area and the series can be regarded to be representative of a certain geographical area. The histological classification was carried out according to the rules of the World Health Organization (WHO) and revealed a remarkably high occurrence of Warthin's tumors, i.e., 27.5%.

Vertigo-reducing effect of ginger root. A controlled clinical study

The effect of powdered ginger root (Zingiber officinale) upon vertigo and nystagmus following caloric stimulation of the vestibular system was studied in 8 healthy volunteers in a double-blind crossover placebo trial. The results reported are based upon 48 vertigo scores and 48 electronystagmograms. Ginger root reduced the induced vertigo significantly better than did placebo. There was no statistically significant action upon the duration or the maximum slow phase velocity of nystagmus.