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Nyadanu SD, Tessema GA, Mullins B, Chai K, Yitshak-Sade M, Pereira G. Critical Windows of Maternal Exposure to Biothermal Stress and Birth Weight for Gestational Age in Western Australia. Environ Health Perspect 2023; 131:127017. [PMID: 38149876 PMCID: PMC10752220 DOI: 10.1289/ehp12660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND There is limited and inconsistent evidence on the risk of ambient temperature on small for gestational age (SGA) and there are no known related studies for large for gestational age (LGA). In addition, previous studies used temperature rather than a biothermal metric. OBJECTIVES Our aim was to examine the associations and critical susceptible windows of maternal exposure to a biothermal metric [Universal Thermal Climate Index (UTCI)] and the hazards of SGA and LGA. METHODS We linked 385,337 singleton term births between 1 January 2000 and 31 December 2015 in Western Australia to daily spatiotemporal UTCI. Distributed lag nonlinear models with Cox regression and multiple models were used to investigate maternal exposure to UTCI from 12 weeks preconception to birth and the adjusted hazard ratios (HRs) of SGA and LGA. RESULTS Relative to the median exposure, weekly and monthly specific exposures showed potential critical windows of susceptibility for SGA and LGA at extreme exposures, especially during late gestational periods. Monthly exposure showed strong positive associations from the 6th to the 10th gestational months with the highest hazard of 13% for SGA (HR = 1.13 ; 95% CI: 1.10, 1.14) and 7% for LGA (HR = 1.07 ; 95% CI: 1.03, 1.11) at the 10th month for the 1st UTCI centile. Entire pregnancy exposures showed the strongest hazards of 11% for SGA (HR = 1.11 ; 95% CI: 1.04, 1.18) and 3% for LGA (HR = 1.03 ; 95% CI: 0.95, 1.11) at the 99th UTCI centile. By trimesters, the highest hazards were found during the second and first trimesters for SGA and LGA, respectively, at the 99th UTCI centile. Based on estimated interaction effects, male births, mothers who were non-Caucasian, smokers, ≥ 35 years of age, and rural residents were most vulnerable. CONCLUSIONS Both weekly and monthly specific extreme biothermal stress exposures showed potential critical susceptible windows of SGA and LGA during late gestational periods with disproportionate sociodemographic vulnerabilities. https://doi.org/10.1289/EHP12660.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, Aflao, Ghana
| | - Gizachew A. Tessema
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- enAble Institute, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Kevin Chai
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Bentley, Western Australia, Australia
- World Health Organization Collaborating Centre for Environmental Health Impact Assessment, Faculty of Health Science, Curtin University, Bentley, Western Australia, Australia
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He MZ, Yitshak-Sade M, Just AC, Gutiérrez-Avila I, Dorman M, de Hoogh K, Mijling B, Wright RO, Kloog I. Predicting fine-scale daily NO 2 over Mexico City using an ensemble modeling approach. Atmos Pollut Res 2023; 14:101763. [PMID: 37193345 PMCID: PMC10168642 DOI: 10.1016/j.apr.2023.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In recent years, there has been growing interest in developing air pollution prediction models to reduce exposure measurement error in epidemiologic studies. However, efforts for localized, fine-scale prediction models have been predominantly focused in the United States and Europe. Furthermore, the availability of new satellite instruments such as the TROPOsopheric Monitoring Instrument (TROPOMI) provides novel opportunities for modeling efforts. We estimated daily ground-level nitrogen dioxide (NO2) concentrations in the Mexico City Metropolitan Area at 1-km2 grids from 2005 to 2019 using a four-stage approach. In stage 1 (imputation stage), we imputed missing satellite NO2 column measurements from the Ozone Monitoring Instrument (OMI) and TROPOMI using the random forest (RF) approach. In stage 2 (calibration stage), we calibrated the association of column NO2 to ground-level NO2 using ground monitors and meteorological features using RF and extreme gradient boosting (XGBoost) models. In stage 3 (prediction stage), we predicted the stage 2 model over each 1-km2 grid in our study area, then ensembled the results using a generalized additive model (GAM). In stage 4 (residual stage), we used XGBoost to model the local component at the 200-m2 scale. The cross-validated R2 of the RF and XGBoost models in stage 2 were 0.75 and 0.86 respectively, and 0.87 for the ensembled GAM. Cross-validated rootmean-squared error (RMSE) of the GAM was 3.95 μg/m3. Using novel approaches and newly available remote sensing data, our multi-stage model presented high cross-validated fits and reconstructs fine-scale NO2 estimates for further epidemiologic studies in Mexico City.
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Affiliation(s)
- Mike Z. He
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Allan C. Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Iván Gutiérrez-Avila
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Dorman
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bas Mijling
- Royal Netherlands Meteorological Institute, De Bilt, Netherlands
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Gaines B, Kloog I, Zucker I, Ifergane G, Novack V, Libruder C, Hershkovitz Y, Sheffield PE, Yitshak-Sade M. Particulate Air Pollution Exposure and Stroke among Adults in Israel. Int J Environ Res Public Health 2023; 20:1482. [PMID: 36674236 PMCID: PMC9860673 DOI: 10.3390/ijerph20021482] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 05/13/2023]
Abstract
Stroke is the second most common cause of death and disability in the world. Many studies have found fine particulate matter (PM2.5) exposure to be associated with an increased risk of atherosclerotic cardiovascular disease, mostly focusing on ischemic heart disease and acute myocardial infarction. In a national analysis conducted in Israel-an area with unique climate conditions and high air pollution levels, we estimated the association between short-term PM2.5 exposure and ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attacks (TIA). Using the Israeli National Stroke Registry, we obtained information on all stroke cases across Israel in 2014-2018. We obtained daily PM2.5 exposures from spatiotemporally resolved exposure models. We restricted the analytical data to days in which PM2.5 levels did not exceed the Israeli 24 h standard (37.5 µg/m3). We repeated the analysis with a stratification by sociodemographic characteristics and comorbidities. For all outcomes, the exposure-response curves were nonlinear. PM2.5 exposure was associated with a higher ischemic stroke risk, with larger effect estimates at higher exposure levels. Although nonsignificant, the exposure-response curve for TIA was similar. The associations with ICH were nonsignificant throughout the PM2.5 exposure distribution. The associations with ischemic stroke/TIA were larger among women, non-Jewish individuals, older adults, and individuals with diabetes, hypertension, and ischemic heart disease. In conclusion, short-term PM2.5 exposure is associated with a higher risk for ischemic stroke and possibly TIA, even when PM2.5 concentrations do not exceed the Israeli air quality guideline threshold. Vulnerability to the air pollution effects differed by age, sex, ethnicity, and comorbidities.
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Affiliation(s)
- Britney Gaines
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben Gurion University, Beer Sheva 8410501, Israel
| | | | - Gal Ifergane
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel
- Neurology Department, Soroka University Medical Center, Beer Sheva 8410101, Israel
| | - Victor Novack
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer Sheva 8410101, Israel
- Clinical Research Center, Soroka University Medical Center, Beer Sheva 8410101, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | | | | | - Perry E. Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Senay E, Levine R, Shepherd JM, Rizzo A, Yitshak-Sade M, Carrión D, Liu B, Lewis J, Wright R, Sorensen C, Wortzel J, Pinsky E, Hudson K, Katz C, Gore K, Basu G, Duritz N, Wright R, Sheffield P. Mental Health and Well-Being for Patients and Clinicians: Proceedings of the Fourth Annual Clinical Climate Change Meeting, January 7, 2022. J Occup Environ Med 2022; 64:e661-e666. [PMID: 36179344 DOI: 10.1097/jom.0000000000002655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Emily Senay
- From the Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Senay, Dr Yitshak-Sade, Dr Liu, Dr Rosalind Wright, Dr Robert Wright, Dr Sheffield); Assistant Secretary for Health, Department of Health and Human Services, Washington, District of Columbia (Dr Levine); Department of Geography and the College of Engineering, University of Georgia, Athens, Georgia (Dr Shepherd); American Lung Association, Chicago, Illinois (Dr Rizzo); Yale School of Public Health and Yale Center on Climate Change and Health, New Haven, Connecticut (Dr Carrión); University of Rochester, Rochester, New York (Dr Lewis, Dr Wortzel); Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Rosalind Wright); Mailman School of Public Health, Columbia University, New York, New York (Dr Sorensen); Massachusetts General Hospital, Boston, Massachusetts (Dr Pinsky); Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts (Dr Hudson); Departments of Psychiatry, Medical Education, and Health System Design & Global Health, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Katz); Union Theological Seminary, New York, New York (Dr Gore); Center for Climate Health and the Global Environment, Harvard TH Chan School of Public Health, Boston, Massachusetts (Dr Basu); The Medical Society Consortium on Climate & Health, Center for Climate Change Communication, George Mason University, Fairfax, Virginia (Dr Duritz, Dr Robert Wright)
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He MZ, Kloog I, Just AC, Gutiérrez-Avila I, Colicino E, Téllez-Rojo MM, Luisa Pizano-Zárate M, Tamayo-Ortiz M, Cantoral A, Soria-Contreras DC, Baccarelli AA, Wright RO, Yitshak-Sade M. Intermediate- and long-term associations between air pollution and ambient temperature and glycated hemoglobin levels in women of child bearing age. Environ Int 2022; 165:107298. [PMID: 35597113 PMCID: PMC9233109 DOI: 10.1016/j.envint.2022.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Air pollution has been linked to obesity while higher ambient temperatures typically reduce metabolic demand in a compensatory manner. Both relationships may impact glucose metabolism, thus we examined the association between intermediate- and long-term exposure to fine particulate matter (PM2.5) and ambient temperature and glycated hemoglobin(HbA1c), a longer-term marker of glucose control. METHODS We assessed 3-month, 6-month, and 12-month average air pollution and ambient temperature at 1-km2 spatial resolution via satellite remote sensing models (2013-2019), and assessed HbA1c at four, six, and eight years postpartum in women enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort based in Mexico City. PM2.5 and ambient temperature were matched to participants' addresses and confirmed by GPS tracker. Using linear mixed-effects models, we examined the association between 3-month, 6-month, and 12-month average PM2.5 and ambient temperature with repeated log-transformed HbA1c values. All models included a random intercept for each woman and were adjusted for calendar year, season, and individual-level confounders (age, marital status, smoking, alcohol consumption level, and education level). RESULTS We analyzed 1,265 HbA1c measurements of 484 women. Per 1 µg/m3 increase in 3-month and 6-month PM2.5, HbA1c levels increased by 0.28% (95% confidence interval (95 %CI): 0.14, 0.42%) and 0.28% (95 %CI: 0.04, 0.52%) respectively. No association was seen for 12-month average PM2.5. Per 1 °C increase in ambient temperature, HbA1c levels decreased by 0.63% (95 %CI: -1.06, -0.21%) and 0.61% (95 %CI: -1.08, -0.13%), while the 12-month average again is not associated with HbA1c. CONCLUSIONS Intermediate-term exposure to PM2.5 and ambient temperature are associated with opposing changes in HbA1c levels, in this region of high PM2.5 and moderate temperature fluctuation. These effects, measurable in mid-adult life, may portend future risk of type 2 diabetes and possible heart disease.
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Affiliation(s)
- Mike Z He
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States.
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Iván Gutiérrez-Avila
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - María Luisa Pizano-Zárate
- Nutrition and Bioprogramming Coordination, National Institute of Perinatology, Mexico City, Mexico; UMF 4, South Delegation of the Federal District, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | | | - Diana C Soria-Contreras
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, United States
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, United States
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Yitshak-Sade M, Kloog I, Schwartz JD, Novack V, Erez O, Just AC. The effect of prenatal temperature and PM 2.5 exposure on birthweight: Weekly windows of exposure throughout the pregnancy. Environ Int 2021; 155:106588. [PMID: 33940393 PMCID: PMC8292186 DOI: 10.1016/j.envint.2021.106588] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Birthweight is a strong predictor of normal growth, healthy development, and survival. Several studies have found associations between temperature, fine particulate matter (PM2.5), and birth weight. However, the relevant timing of exposures varies between studies and is yet unclear. Therefore, we assessed the difference in term birthweight (TBW) associated with weekly exposure to temperature and PM2.5 throughout 37 weeks of gestation. METHODS We included all singleton live term births in Massachusetts, U.S between 2004 and 2015 (n = 712,438). Weekly PM2.5 and temperature predictions were estimated on a 1 km grid from satellite-based models. We utilized a distributed lag nonlinear model (DLNM) to estimate the difference in TBW associated with weekly exposures from the last menstrual period to 37 weeks of gestation. RESULTS We found a nonlinear association with prenatal temperature exposure. Larger effects were observed in warmer temperatures, where higher temperatures were negatively associated with TBW. Temperature effects were larger in the first and final weeks of gestation. We observed a negative difference in TBW associated with PM2.5 exposure. Overall, a 1 µg/m3 increase in prenatal exposure was associated with 3.9 g lower TBW (95% CI -5.0 g; -2.9 g). PM2.5 effects were larger in the final weeks of gestation. CONCLUSION We found heat and PM2.5 exposure to be related to lower TBW. Our findings suggest that women are more susceptible to both exposures towards the end of pregnancy. Susceptibility to heat was higher in the initial weeks of pregnancy as well. These critical windows of susceptibility can be communicated to pregnant women during routine prenatal visits to increase awareness and target interventions to reduce exposures.
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Affiliation(s)
- Maayan Yitshak-Sade
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York, NY, USA.
| | - Itai Kloog
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York, NY, USA; Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Joel D Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victor Novack
- Negev Environmental Health Research Institute, Beer Sheva, Israel; Department of Medicine, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel; Soroka University Medical Center, Beer Sheva, Israel
| | - Offer Erez
- Soroka University Medical Center, Beer Sheva, Israel
| | - Allan C Just
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York, NY, USA
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Gat R, Kachko E, Kloog I, Erez O, Yitshak-Sade M, Novack V, Novack L. Differences in environmental factors contributing to preterm labor and PPROM - Population based study. Environ Res 2021; 196:110894. [PMID: 33609551 DOI: 10.1016/j.envres.2021.110894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Previous reports indicate an association between ambient temperature (Ta) and air pollution exposure during pregnancy and preterm birth (PTB). Nevertheless, information regarding the association between environmental factors and specific precursors of spontaneous preterm birth is lacking. We aimed to determine the association between Ta and air pollution during gestation and the precursors of spontaneous preterm parturition, i.e. preterm labor (PTL) and preterm prelabor rupture of membranes (PPROM). METHODS From 2003 to 2013 there were 84,476 deliveries of singleton gestation that comprised the study cohort. Exposure data during pregnancy included daily measurements of temperature and particulate matter <2.5 μm and <10 μm, PM2.5 and PM10, respectively. Deliveries were grouped into PPROM, PTL and non-spontaneous preterm and term deliveries. Exposure effect was tested in windows of a week and two days prior to admission for delivery and adjusted to gestational age and socio-economic status. Poisson regression models were used for analyses. RESULTS There is an association of environmental exposure with the precursors of spontaneous preterm parturition; PPROM was more sensitive to Ta fluctuations than PTL. This effect was modified by the ethnicity, Bedouin-Arabs were susceptible to elevated Ta, especially within the last day prior to admission with PPROM (Relative Risk (RR) =1.19 [95% CI, 1.03; 1.37]). Jews, on the other hand, were susceptible to ambient pollutants, two (RR=1.025 [1.010; 1.040]) and one (RR= 1.017 [1.002; 1.033]) days prior to spontaneous PTL with intact membranes resulting in preterm birth. CONCLUSION High temperature is an independent risk factor for PPROM among Bedouin-Arabs; ambient pollution is an independent risk factor for spontaneous PTL resulting in preterm birth. Thus, the precursors of spontaneous preterm parturition differ in their association with environmental factors.
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Affiliation(s)
- Roni Gat
- Negev Environmental Health Research Institute, Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Department of Geography and Environmental Development, Ben-Gurion University, Beer Sheva, Israel.
| | - Eric Kachko
- Negev Environmental Health Research Institute, Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University, Beer Sheva, Israel
| | - Offer Erez
- Maternity Department "D" Division of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Maayan Yitshak-Sade
- Negev Environmental Health Research Institute, Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Victor Novack
- Negev Environmental Health Research Institute, Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lena Novack
- Negev Environmental Health Research Institute, Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheva, Israel
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Milando CW, Yitshak-Sade M, Zanobetti A, Levy JI, Laden F, Fabian MP. Modeling the impact of exposure reductions using multi-stressor epidemiology, exposure models, and synthetic microdata: an application to birthweight in two environmental justice communities. J Expo Sci Environ Epidemiol 2021; 31:442-453. [PMID: 33824415 PMCID: PMC8141037 DOI: 10.1038/s41370-021-00318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/25/2021] [Accepted: 03/12/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Many vulnerable populations experience elevated exposures to environmental and social stressors, with deleterious effects on health. Multi-stressor epidemiological models can be used to assess benefits of exposure reductions. However, requisite individual-level risk factor data are often unavailable at adequate spatial resolution. OBJECTIVE To leverage public data and novel simulation methods to estimate birthweight changes following simulated environmental interventions in two environmental justice communities in Massachusetts, USA. METHODS We gathered risk factor data from public sources (US Census, Behavioral Risk Factor Surveillance System, and Massachusetts Department of Health). We then created synthetic individual-level data sets using combinatorial optimization, and probabilistic and logistic modeling. Finally, we used coefficients from a multi-stressor epidemiological model to estimate birthweight and birthweight improvement associated with simulated environmental interventions. RESULTS We created geographically resolved synthetic microdata. Mothers with the lowest predicted birthweight were those identifying as Black or Hispanic, with parity > 1, utilization of government prenatal support, and lower educational attainment. Birthweight improvements following greenness and temperature improvements were similar for all high-risk groups and were larger than benefits from smoking cessation. SIGNIFICANCE Absent private health data, this methodology allows for assessment of cumulative risk and health inequities, and comparison of individual-level impacts of localized health interventions.
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Affiliation(s)
- Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Francine Laden
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Karakis I, Landau D, Gat R, Shemesh N, Tirosh O, Yitshak-Sade M, Sarov B, Novack L. Maternal metal concentration during gestation and pediatric morbidity in children: an exploratory analysis. Environ Health Prev Med 2021; 26:40. [PMID: 33765932 PMCID: PMC7995788 DOI: 10.1186/s12199-021-00963-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/12/2021] [Indexed: 01/28/2023] Open
Abstract
Background The majority of studies linking exposure to metals with certain health outcomes focus on known toxic metals. Alternatively, this study assesses the extent to which exposure to a wider range of metals during gestation is associated with childhood morbidity. Methods We analyzed the concentrations of 25 metals found in urine samples of 111 pregnant women of Arab-Bedouin origin collected prior to birth. In addition, we collected medical records on their offspring for six years following birth, including every interaction with HMOs, local hospitals, and pharmacies. Results The main types of morbidities diagnosed and treated during this period were preterm births, malformations, asthma-like morbidity, cardiovascular and behavioral problems, and obesity. Multivariable analysis showed that offspring born before term were more likely to have been exposed to elevated maternal concentrations of zinc, thallium, aluminum, manganese, and uranium, all with adjusted relative risk above 1.40 for an increase by each quintile. Likewise, children with asthma had been exposed to higher levels of magnesium, strontium, and barium at gestation, while behavioral outcomes were associated with elevated biometals, i.e., sodium, magnesium, calcium, selenium, and zinc, as well as higher levels of lithium, cobalt, nickel, strontium, cadmium, vanadium, arsenic, and molybdenum. A heatmap of adjusted relative risk estimates indicates the considerable implications that exposure to metals may have for preterm birth and developmental outcomes. Conclusions The current study shows that perinatal exposure to metals is adversely associated with pediatric morbidity. Further such analyses on additional samples are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-021-00963-z.
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Affiliation(s)
- Isabella Karakis
- Environmental Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Daniella Landau
- Neonatology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Roni Gat
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nofar Shemesh
- Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ofir Tirosh
- The Fredy and Nadine Herrmann Institute of Earth Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maayan Yitshak-Sade
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Batia Sarov
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,Negev Environmental Health Research Institute, Soroka University Medical Center, Sderot Rager 151, 84101, Beer-Sheva, Israel.
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Yitshak-Sade M, Nethery R, Schwartz JD, Mealli F, Dominici F, Di Q, Abu Awad Y, Ifergane G, Zanobetti A. PM 2.5 and hospital admissions among Medicare enrollees with chronic debilitating brain disorders. Sci Total Environ 2021; 755:142524. [PMID: 33065503 PMCID: PMC7749824 DOI: 10.1016/j.scitotenv.2020.142524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although long-term exposure to particulate matter<2.5 μm (PM2.5) has been linked to chronic debilitating brain disorders (CDBD), the role of short-term exposure in health care demand, and increased susceptibility for PM2.5-related health conditions, among Medicare enrollees with CDBD has received little attention. We used a causal modeling approach to assess the effect of short-term high PM2.5 exposure on all-cause admissions, and prevalent cause-specific admissions among Medicare enrollees with CDBD (Parkinson's disease-PD, Alzheimer's disease-AD and other dementia). METHODS We constructed daily zipcode counts of hospital admissions of Medicare beneficiaries older than 65 across the United-States (2000-2014). We obtained daily PM2.5 estimates from a satellite-based model. A propensity score matching approach was applied to match high-pollution (PM2.5 > 17.4 μg/m3) to low-pollution zip code-days with similar background characteristics. Then, we estimated the percent change in admissions attributable to high pollution. We repeated the models restricting the analysis to zipcode-days with PM2.5 below of 35 μg/m3. RESULTS We observed significant increases in all-cause hospital admissions (2.53% in PD and 2.49% in AD/dementia) attributable to high PM2.5 exposure. The largest observed effect for common causes was for pneumonia and urinary tract infection. All the effects were larger in CDBD compared to the general Medicare population, and similarly strong at levels of exposure considered safe by the EPA. CONCLUSION We found Medicare beneficiaries with CDBD to be at higher risk of being admitted to the hospital following acute exposure to PM2.5 levels well below the National Ambient Air Quality Standard defined as safe by the EPA.
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Affiliation(s)
- Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Rachel Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel D Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fabrizia Mealli
- Department of Statistics, Informatics and Applications, University of Florence, Florence, Italy
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qian Di
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Yara Abu Awad
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Gal Ifergane
- Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel
| | - Antonella Zanobetti
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Yitshak-Sade M, Fabian MP, Lane KJ, Hart JE, Schwartz JD, Laden F, James P, Fong KC, Kloog I, Zanobetti A. Estimating the Combined Effects of Natural and Built Environmental Exposures on Birthweight among Urban Residents in Massachusetts. Int J Environ Res Public Health 2020; 17:E8805. [PMID: 33260804 PMCID: PMC7731163 DOI: 10.3390/ijerph17238805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022]
Abstract
Intrauterine growth has health implications both in childhood and adulthood. Birthweight is partially determined by prenatal environmental exposures. We aim to identify important predictors of birthweight out of a set of environmental, built environment exposures, and socioeconomic environment variables during pregnancy (i.e., fine particulate matter (PM2.5), temperature, greenness, walkability, noise, and economic indices). We included all singleton live births of mothers who resided in urban census block-groups and delivered in Massachusetts between 2001 and 2011 (n = 640,659). We used an elastic-net model to select important predictors of birthweight and constructed a multivariate model including the selected predictors, with adjustment for confounders. We additionally used a weighted quantile sum regression to assess the contribution of each exposure to differences in birthweight. All exposures were selected as important predictors of birthweight. In the multivariate model, lower birthweight was significantly associated with lower greenness and with higher temperature, walkability, noise, and segregation of the "high income" group. Treating the exposures individually, nighttime noise had the highest weight in its contribution to lower birthweight. In conclusion, after accounting for individual confounders, maternal environmental exposures, built environment exposures, and socioeconomic environment during pregnancy were important predictors of birthweight, emphasizing the role of these exposures in fetal growth and development.
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Affiliation(s)
- Maayan Yitshak-Sade
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.P.F.); (K.J.L.)
| | - Kevin J. Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.P.F.); (K.J.L.)
| | - Jaime E. Hart
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.H.); (J.D.S.); (F.L.); (P.J.); (K.C.F.); (A.Z.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Joel D. Schwartz
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.H.); (J.D.S.); (F.L.); (P.J.); (K.C.F.); (A.Z.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Francine Laden
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.H.); (J.D.S.); (F.L.); (P.J.); (K.C.F.); (A.Z.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Peter James
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.H.); (J.D.S.); (F.L.); (P.J.); (K.C.F.); (A.Z.)
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Kelvin C. Fong
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.H.); (J.D.S.); (F.L.); (P.J.); (K.C.F.); (A.Z.)
- School of the Environment, Yale University, New Haven, MA 06511, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva 84105, Israel;
| | - Antonella Zanobetti
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.E.H.); (J.D.S.); (F.L.); (P.J.); (K.C.F.); (A.Z.)
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12
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Goshen S, Novack L, Erez O, Yitshak-Sade M, Kloog I, Shtein A, Shany E. The effect of exposure to particulate matter during pregnancy on lower respiratory tract infection hospitalizations during first year of life. Environ Health 2020; 19:90. [PMID: 32847589 PMCID: PMC7449075 DOI: 10.1186/s12940-020-00645-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 08/14/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND Lower respiratory tract infections (LRTI) in early life, including pneumonia, bronchitis and bronchiolitis, can lead to decreased lung function, persistent lung damage and increased susceptibility to various respiratory diseases such as asthma. In-utero exposure to particulate matter (PM) during pregnancy may disrupt biological mechanisms that regulate fetal growth, maturation and development. We aimed to estimate the association between intrauterine exposure to PM of size < 2.5 μm in diameter (PM2.5) and incidence of LRTIs during the first year of life. METHODS A retrospective population-based cohort study in a population of mothers and infants born in Soroka University Medical Center (SUMC) in the years 2004-2012. All infants < 1 year old that were hospitalized due to LRTIs were included. The main exposure assessment was based on a hybrid model incorporating daily satellite-based predictions at 1 km2 spatial resolution. Data from monitoring stations was used for imputation of main exposure and other pollutants. Levels of environmental exposures were assigned to subjects based on their residential addresses and averaged for each trimester. Analysis was conducted by a multivariable generalized estimating equation (GEE) Poisson regression. Data was analyzed separately for the two main ethnic groups in the region, Jewish and Arab-Bedouin. RESULTS The study cohort included 57,331 deliveries that met the inclusion criteria. Overall, 1871 hospitalizations of infants < 1 year old due to pneumonia or bronchiolitis were documented. In a multivariable analysis, intrauterine exposure to high levels of PM2.5 (> 24 μg/m3) in the first and second trimesters was found to be adversely associated with LRTIs in the Arab-Bedouin population (1st trimester, RR = 1.31, CI 95% 1.08-1.60; 2nd trimester: RR = 1.34, CI 95% 1.09-1.66). CONCLUSION Intrauterine exposure to high levels of PM2.5 is associated with a higher risk of hospitalizations due to lower respiratory tract infections in Arab-Bedouin infants.
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Affiliation(s)
- Sharon Goshen
- Department of Epidemiology, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lena Novack
- Department of Epidemiology, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexandra Shtein
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eilon Shany
- Department of Neonatology, Faculty of Health Sciences, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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13
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Yitshak-Sade M, Lane KJ, Fabian MP, Kloog I, Hart JE, Davis B, Fong KC, Schwartz JD, Laden F, Zanobetti A. Race or racial segregation? Modification of the PM2.5 and cardiovascular mortality association. PLoS One 2020; 15:e0236479. [PMID: 32716950 PMCID: PMC7384646 DOI: 10.1371/journal.pone.0236479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 07/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many studies have identified an inequitable distribution of exposure to PM2.5 (particulate matter less than 2.5 microns) by race. We investigated the association of PM2.5 and cardiovascular mortality considering both the decedents' race and neighborhood racial composition as potential modifiers. METHODS We obtained geocoded cardiovascular mortality records of all black and white decedents from urban block-groups in Massachusetts between 2001 and 2011 (n = 130,863). We examined the association between PM2.5 and cardiovascular mortality, and assessed effect modification by three types of racial modifiers: decedents' race, census block-group percent black and white, and two novel measures of racial segregation. The Racial Residential Segregation (RRS) quantifies the concentration of non-Hispanic blacks and whites in each block-group. The Index of Racial Dissimilarity measures dissimilarity in non-Hispanic black and white racial distribution between the smaller census block-group and larger tract. RESULTS We found a 2.35%(95%CI: 0.92%;3.79%) increase in mortality for each 10μg/m3 increase in two-day average exposure to PM2.5. The effect was modified by the block-group racial composition, with higher risks in block-groups with the highest percentage of black residents (interaction p-value = 0.04), and in block-groups with the lowest RRS (i.e. higher black to white resident ratio, interaction p-value = 0.072). Racial dissimilarity did not modify the associations. CONCLUSION Current levels of PM2.5 are associated with increased cardiovascular deaths in Massachusetts, with different risks between areas with different racial composition and segregation. This suggests that pollution reductions in neighborhoods with the highest percentage of non-Hispanic blacks would be most beneficial in reducing cardiovascular mortality and disparities.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Kevin J. Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Jaime E. Hart
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Brigette Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Kelvin C. Fong
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- School of Forestry & Environmental Sciences, Yale University, New Haven, CT, United States of America
| | - Joel D. Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Francine Laden
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Yitshak-Sade M, Nethery R, Abu Awad Y, Mealli F, Dominici F, Kloog I, Zanobetti A. Lowering Air Pollution Levels in Massachusetts May Prevent Cardiovascular Hospital Admissions. J Am Coll Cardiol 2020; 75:2642-2644. [PMID: 32439015 DOI: 10.1016/j.jacc.2020.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/18/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
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15
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Shashar S, Kloog I, Erez O, Shtein A, Yitshak-Sade M, Sarov B, Novack L. Temperature and preeclampsia: Epidemiological evidence that perturbation in maternal heat homeostasis affects pregnancy outcome. PLoS One 2020; 15:e0232877. [PMID: 32421729 PMCID: PMC7234374 DOI: 10.1371/journal.pone.0232877] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/22/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION This study aims to determine the association between temperature and preeclampsia and whether it is affected by seasonality and rural/urban lifestyle. METHODS This cohort study included women who delivered at our medical center from 2004 to 2013 (31,101 women, 64,566 deliveries). Temperature values were obtained from a spatiotemporally resolved estimation model performing predictions at a 1×1km spatial resolution. In "Warm" pregnancies >50% of gestation occurred during the spring-summer period. In cold pregnancies >50% of gestation occurred during the fall and winter. Generalized estimating equation multivariable models were used to estimate the association between temperature and incidence of preeclampsia. RESULTS 1) The incidence of preeclampsia in at least one pregnancy was 7% (2173/64,566); 2) during "warm" pregnancies, an elevation of one IQR of the average temperature in the 1st or the 3rd trimesters was associated with an increased risk to develop preeclampsia [patients with Jewish ethnicity: 1st trimester: relative risk (RR) of 2.38(95%CI 1.50; 3.80), 3rd trimester 1.94(95%CI 1.34;2.81); Bedouins: 1st trimester: RR = 2.91(95%CI 1.98;4.28), 3rd trimester: RR = 2.37(95%CI 1.75;3.20)]; 3) In "cold" pregnancies, an elevation of one IQR of average temperature was associated with a lower risk to develop preeclampsia among patients with Bedouin-Arab ethnicity RR = 0.68 (95% CI 0.49-0.94) for 1st trimester and RR = 0.62 (95% CI 0.44-0.87) for 3rd trimester. CONCLUSIONS 1) Elevated averaged temperature during the 1st or 3rd trimesters in "warm" pregnancies confer an increased risk for the development of preeclampsia, especially in nomadic patients; 2) Of interest, during cold pregnancies, elevated averaged temperature was associated with a lower risk to develop preeclampsia for nomadic patients. 3) These findings suggest temperature might be associated with perturbations in maternal heat homeostasis resulting in reallocation of energy resources and their availability to the fetus that may increase the risk for preeclampsia. This observation is especially relevant in the context of global warming and its effects on maternal/fetal reproductive health.
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Affiliation(s)
- Sagi Shashar
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben Gurion University, Beersheba, Israel
| | - Offer Erez
- Division of Obstetrics and Gynecology, Maternity Department "D", Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Alexandra Shtein
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben Gurion University, Beersheba, Israel
| | - Maayan Yitshak-Sade
- Department of Environmental Health Exposure, Epidemiology, and Risk Program Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Batia Sarov
- Department of Public Health, Faculty of Heath Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
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16
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Fong KC, Yitshak-Sade M, Lane KJ, Fabian MP, Kloog I, Schwartz JD, Coull BA, Koutrakis P, Hart JE, Laden F, Zanobetti A. Racial Disparities in Associations between Neighborhood Demographic Polarization and Birth Weight. Int J Environ Res Public Health 2020; 17:E3076. [PMID: 32354151 PMCID: PMC7246784 DOI: 10.3390/ijerph17093076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/13/2020] [Accepted: 04/25/2020] [Indexed: 12/02/2022]
Abstract
Neighborhood demographic polarization, or the extent to which a privileged population group outnumbers a deprived group, can affect health by influencing social dynamics. While using birth records from 2001 to 2013 in Massachusetts (n = 629,675), we estimated the effect of two demographic indices, racial residential polarization (RRP) and economic residential polarization (ERP), on birth weight outcomes, which are established predictors of the newborn's future morbidity and mortality risk. Higher RRP and ERP was each associated with higher continuous birth weight and lower odds for low birth weight and small for gestational age, with evidence for effect modification by maternal race. On average, per interquartile range increase in RRP, the birth weight was 10.0 g (95% confidence interval: 8.0, 12.0) higher among babies born to white mothers versus 6.9 g (95% CI: 4.8, 9.0) higher among those born to black mothers. For ERP, it was 18.6 g (95% CI: 15.7, 21.5) higher among those that were born to white mothers versus 1.8 g (95% CI: -4.2, 7.8) higher among those born to black mothers. Racial and economic polarization towards more privileged groups was associated with healthier birth weight outcomes, with greater estimated effects in babies that were born to white mothers than those born to black mothers.
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Affiliation(s)
- Kelvin C. Fong
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- School of Forestry and Environmental Studies, Yale University, New Haven, CT 06511, USA
| | - Maayan Yitshak-Sade
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
| | - Kevin J. Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02218, USA; (K.J.L.); (M.P.F.)
| | - M. Patricia Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02218, USA; (K.J.L.); (M.P.F.)
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, 8410501 Beer Sheva, Israel;
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
| | - Brent A. Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
| | - Jaime E. Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Francine Laden
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
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Codish S, Amichay D, Yitshak-Sade M, Gat R, Liberty IF, Novack L. Improvement of Blood Samples Preanalytic Management Alters the Clinical Results of Glucose Values: Population Study. J Diabetes Sci Technol 2020; 14:284-289. [PMID: 30646746 PMCID: PMC7196853 DOI: 10.1177/1932296818823780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prolonged time elapsing between the blood drawing and separation of the cell mass may result in decreased sample glucose levels due to continuous glycolysis. This can lead to underdiagnoses of hyperglycemic states and overdiagnosis of hypoglycemia. We aimed to evaluate the clinical impact of shortened transit time and earlier centrifugation of laboratory specimens on reported glucose results and diagnosis of clinically significant hypoglycemia (<50 mg/dL) or elevated glucose levels (>100 mg/dL). METHODS We assessed all fasting-serum glucose tests from the adult population (190 767 subjects) without known diabetes residing in Southern Israel. Before and after intervention periods were compared: 268 359 blood tests were performed during 2009-2010, and 317 336 during 2012-2013. RESULTS While glucose levels were 94.17 mg/dL ± 14.12 in 2012-2013 versus 83.53 mg/dL ± 14.50 in 2009-2010 (12.75% ± 0.88 increase, P < .001), the difference in glycated hemoglobin levels was statistically significant but clinically negligible: 5.84% ± 0.56 in 2012-2013 versus 5.88% ± 0.56 in 2009-2010 (0.53% ± 0.78 decrease, P < .01). There was an increased likelihood of a glucose result to be above 100 mg/dL following intervention: 9.80% versus 25.90%, P < .001. For clinics distanced over 40 km from the laboratory, age-adjusted odds ratio value was 1.26 (95% CI 1.13, 1.41). The proportion of samples with hypoglycemia values decreased from 0.33% to 0.03% (P < .001). CONCLUSIONS We demonstrated an important change in glucose values over a two-year period following an improvement of the preanalytic processes. The intervention was related to an increase in the frequency of hyperglycemia results and a decrease in the number of hypoglycemia results. Future administrative projects should consider clinical consequences with involvement of all relevant stakeholders.
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Affiliation(s)
- Shlomi Codish
- Medical Management Unit, Soroka
University Medical Center, Be’er Sheva, Israel
- Department of Public Health, Faculty of
Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Doron Amichay
- Central Laboratory, Clalit Health
Services & Departments of Clinical Biochemistry and Pharmacology, Ben-Gurion
University, Be’er Sheva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka
University Medical Center, Be’er Sheva, Israel
| | - Roni Gat
- Clinical Research Center, Soroka
University Medical Center, Be’er Sheva, Israel
| | - Idit F. Liberty
- Department of Internal Medicine, Soroka
University Medical Center, Be’er Sheva, Israel
| | - Lena Novack
- Department of Public Health, Faculty of
Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
- Lena Novack, PhD, Department of Public
Health, Faculty of Health Sciences, Ben Gurion University of the Negev, POB 653,
Be’er Sheva 84105, Israel.
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18
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Novack V, Beitler JR, Yitshak-Sade M, Thompson BT, Schoenfeld DA, Rubenfeld G, Talmor D, Brown SM. Alive and Ventilator Free: A Hierarchical, Composite Outcome for Clinical Trials in the Acute Respiratory Distress Syndrome. Crit Care Med 2020; 48:158-166. [PMID: 31939783 PMCID: PMC6986198 DOI: 10.1097/ccm.0000000000004104] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Survival from acute respiratory distress syndrome is improving, and outcomes beyond mortality may be important for testing new treatments. The "ventilator-free days" score, is an established composite that equates ventilation on day 28 to death. A hierarchical outcome treating death as a worse than prolonged ventilation would enhance face validity, but performance characteristics and reporting of such an outcome are unknown. We therefore evaluated the performance of a novel hierarchical composite endpoint, the Alive and Ventilator Free score. DESIGN Using data from four Acute Respiratory Distress Syndrome Network clinical trials, we compared Alive and Ventilator Free to the ventilator-free days score. Alive and Ventilator Free compares each patient with every other patient in a win-lose-tie for each comparison. Duration of mechanical ventilation is only compared if both patients survived. We evaluated power of Alive and Ventilator Free versus ventilator-free days score under various circumstances. SETTING ICUs within the Acute Respiratory Distress Syndrome Network. PATIENTS Individuals enrolled in four Acute Respiratory Distress Syndrome Network trials. INTERVENTIONS None for this analysis. MEASUREMENTS AND MAIN RESULTS Within the four trials (n = 2,410 patients), Alive and Ventilator Free and ventilator-free days score had similar power, with Alive and Ventilator Free slightly more powerful when a mortality difference was present, and ventilator-free days score slightly more powerful with a difference in duration of mechanical ventilation. Alive and Ventilator Free less often found in favor of treatments that increased mortality and increased days free of ventilation among survivors. CONCLUSIONS A hierarchical composite endpoint, Alive and Ventilator Free, preserves statistical power while improving face validity. Alive and Ventilator Free is less prone to favor a treatment with discordant effects on survival and days free of ventilation. This general approach can support complex outcome hierarchies with multiple constituent outcomes. Approaches to interpretation of differences in Alive and Ventilator Free are also presented.
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Affiliation(s)
- Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David A Schoenfeld
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center and University of Utah School of Medicine, Salt Lake City, UT
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19
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Yitshak-Sade M, Blomberg AJ, Zanobetti A, Schwartz JD, Coull BA, Kloog I, Dominici F, Koutrakis P. County-level radon exposure and all-cause mortality risk among Medicare beneficiaries. Environ Int 2019; 130:104865. [PMID: 31200153 PMCID: PMC6679989 DOI: 10.1016/j.envint.2019.05.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/29/2019] [Accepted: 05/23/2019] [Indexed: 05/12/2023]
Abstract
BACKGROUND Radon is an inert gas formed from the decay of naturally-occurring materials in the earth's crust. It infiltrates into homes from soil, water, and construction materials. Its decay products are radionuclides, which attach to ambient particles. Residential radon is one of the leading risk factors for lung cancer. The scarce evidence for associations with other mortality causes originates mostly from occupational studies. METHODS In a cohort study with 14 years of follow-up (2000-2013), we evaluated the association between chronic radon exposure and all-cause mortality, and explored whether there are subpopulations who are more vulnerable to radon effects. We included 87,296,195 person-years of follow-up from all Medicare beneficiaries in the Mid-Atlantic and Northeastern U.S. states. We examined the association between the logarithm of county-averaged radon (ln(Rn)) and mortality and assessed effect modification by chronic conditions. RESULTS An interquartile range increase in the ln(Rn) was associated with a 2·62% increase (95% CI 2·52%; 2·73%) in mortality, independent of PM2.5 exposure. Larger mortality risks were observed among individuals with respiratory, cardiovascular and metabolic diseases, with the highest associations observed among those with diabetes (4·98% increase), heart failure (4·58% increase), and chronic obstructive pulmonary disease (4·49% increase). CONCLUSION We found an increased risk for all-cause mortality associated with increased radon exposure. The risk was enhanced among susceptible individuals with chronic conditions. We believe this is the first cohort study to identify populations at higher risk for non-malignant health consequences of radon exposure. Due to the limitations in exposure assessment and availability of individual confounders, these findings should be interpreted with caution.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Annelise J Blomberg
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel D Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Brent A Coull
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Francesca Dominici
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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20
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Yitshak-Sade M, James P, Kloog I, Hart JE, Schwartz JD, Laden F, Lane KJ, Fabian MP, Fong KC, Zanobetti A. Neighborhood Greenness Attenuates the Adverse Effect of PM 2.5 on Cardiovascular Mortality in Neighborhoods of Lower Socioeconomic Status. Int J Environ Res Public Health 2019; 16:E814. [PMID: 30845676 PMCID: PMC6427452 DOI: 10.3390/ijerph16050814] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
Features of the environment may modify the effect of particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5) on health. Therefore, we investigated how neighborhood sociodemographic and land-use characteristics may modify the association between PM2.5 and cardiovascular mortality. We obtained residence-level geocoded cardiovascular mortality cases from the Massachusetts Department of Public Health (n = 179,986), and PM2.5 predictions from a satellite-based model (2001⁻2011). We appended census block group-level information on sociodemographic factors and walkability, and calculated neighborhood greenness within a 250 m buffer surrounding each residence. We found a 2.54% (1.34%; 3.74%) increase in cardiovascular mortality associated with a 10 µg/m³ increase in two-day average PM2.5. Walkability or greenness did not modify the association. However, when stratifying by neighborhood sociodemographic characteristics, smaller PM2.5 effects were observed in greener areas only among cases who resided in neighborhoods with a higher population density and lower percentages of white residents or residents with a high school diploma. In conclusion, the PM2.5 effects on cardiovascular mortality were attenuated by higher greenness only in areas with sociodemographic features that are highly correlated with lower socioeconomic status. Previous evidence suggests health benefits linked to neighborhood greenness may be stronger among lower socioeconomic groups. Attenuation of the PM2.5⁻mortality relationship due to greenness may explain some of this evidence.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva 8410501, Israel.
| | - Jaime E Hart
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.
| | - Joel D Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.
| | - Francine Laden
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, USA.
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Kelvin C Fong
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
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21
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Kachalia A, Sands K, Niel MV, Dodson S, Roche S, Novack V, Yitshak-Sade M, Folcarelli P, Benjamin EM, Woodward AC, Mello MM. Effects Of A Communication-And-Resolution Program On Hospitals’ Malpractice Claims And Costs. Health Aff (Millwood) 2018; 37:1836-1844. [DOI: 10.1377/hlthaff.2018.0720] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Allen Kachalia
- Allen Kachalia is chief quality officer at Brigham Health, in Boston, Massachusetts
| | - Kenneth Sands
- Kenneth Sands is chief epidemiologist and chief patient safety officer at HCA Healthcare, in Nashville, Tennessee
| | - Melinda Van Niel
- Melinda Van Niel is a project manager at Beth Israel Deaconess Medical Center for the Massachusetts Alliance for Communication and Resolution following Medical Injury, in Boston
| | - Suzanne Dodson
- Suzanne Dodson, now retired, was project manager at Baystate Health, in Springfield, Massachusetts
| | - Stephanie Roche
- Stephanie Roche is a health care quality research analyst at Beth Israel Deaconess Medical Center
| | - Victor Novack
- Victor Novack is head of the Clinical Research Center at Soroka University Medical Center and a professor of medicine at the Faculty of Health Sciences, Ben-Gurion University of the Negev, in Beer Sheva, Israel
| | - Maayan Yitshak-Sade
- Maayan Yitshak-Sade is a postdoctoral research fellow at the Harvard T. H. Chan School of Public Health, in Boston
| | - Patricia Folcarelli
- Patricia Folcarelli is vice president of health care quality at Beth Israel Deaconess Medical Center
| | - Evan M. Benjamin
- Evan M. Benjamin is chief medical officer of Ariadne Labs, Harvard T. H. Chan School of Public Health and Brigham and Women’s Hospital
| | - Alan C. Woodward
- Alan C. Woodward, an emergency medicine physician in Concord, Massachusetts, is past president and former chair of the Committee on Professional Liability of the Massachusetts Medical Society
| | - Michelle M. Mello
- Michelle M. Mello is a professor of law at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine, in California
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22
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Yitshak-Sade M, Bobb JF, Schwartz JD, Kloog I, Zanobetti A. The association between short and long-term exposure to PM 2.5 and temperature and hospital admissions in New England and the synergistic effect of the short-term exposures. Sci Total Environ 2018; 639:868-875. [PMID: 29929325 PMCID: PMC6051434 DOI: 10.1016/j.scitotenv.2018.05.181] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Particulate matter < 2.5 μm in diameter (PM2.5) and heat are strong predictors of morbidity, yet few studies have examined the effects of long-term exposures on non-fatal events, or assessed the short and long-term effect on health simultaneously. OBJECTIVE We jointly investigated the association of short and long-term exposures to PM2.5 and temperature with hospital admissions, and explored the modification of the associations with the short-term exposures by one another and by temperature variability. METHODS Daily ZIP code counts of respiratory, cardiac and stroke admissions of adults ≥65 (N = 2,015,660) were constructed across New-England (2001-2011). Daily PM2.5 and temperature exposure estimates were obtained from satellite-based spatio-temporally resolved models. For each admission cause, a Poisson regression was fit on short and long-term exposures, with a random intercept for ZIP code. Modifications of the short-term effects were tested by adding interaction terms with temperature, PM2.5 and temperature variability. RESULTS Associations between short and long-term exposures were observed for all of the outcomes, with stronger effects of long-term exposures to PM2.5. For respiratory admissions, the short-term PM2.5 effect (percent increase per IQR) was larger on warmer days (1.12% versus -0.53%) and in months of higher temperature variability (1.63% versus -0.45%). The short-term temperature effect was higher in months of higher temperature variability as well. For cardiac admissions, the PM2.5 effect was larger on colder days (0.56% versus -0.30%) and in months of higher temperature variability (0.99% versus -0.56%). CONCLUSIONS We observed synergistic effects of short-term exposures to PM2.5, temperature and temperature variability. Long-term exposures to PM2.5 were associated with larger effects compared to short-term exposures.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer F Bobb
- Biostatistics Unit, Kaiser Permanent Washington Health Research Institute, Seattle, WA, USA
| | - Joel D Schwartz
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Antonella Zanobetti
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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23
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Mendel R, Yitshak-Sade M, Nash M, Joshua BZ. Assessment of the Association Between Post-tonsillectomy Hemorrhage and Weather Conditions. Isr Med Assoc J 2018; 20:349-353. [PMID: 29911754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The most common complication after tonsillectomy is bleeding. We investigated whether performing the procedure during the summer or the winter affects the bleeding rate. OBJECTIVES To investigate whether there is an association between meteorological conditions and the occurrence of post-tonsillectomy hemorrhage (PTH) in the southern Israel Negev region. METHODS All patients who underwent tonsillectomy from 2001-2013 at the Soroka Medical Center were included. We collected patient demographic data and indications for surgery. Meteorological data were obtained from a weather station operated by the Israel Ministry of Environmental Protection. RESULTS Of 4438 patients who underwent tonsillectomy, with or without adenoidectomy, 432 (9.73%) experienced hemorrhage. Patients who suffered from PTH were significantly older: median age 9.61 years vs.4.7 years, P < 0.0001. When comparing patients without PTH to those who bled within 0-3 days after surgery, there was a higher risk for bleeding during the warmer seasons: relative risk (RR) 1.38, 95% confidence interval ([95%CI] 1.07-1.77), RR 1.45 (95%CI 1.17-1.80), and 1.62 (95%CI 1.27-2.06) comparing the winter to spring, summer, and fall, respectively. A statistically significant positive association was also found with the average temperature on the day of surgery. Bleeding more than 3 days after surgery was less likely in summer: RR 0.82, 95%CI 0.69-0.97. We found no association with temperature on the day of surgery and PTH after postoperative day 3. CONCLUSIONS Seasonality, and to an extent temperature, seem to play only a minor role in PTH.
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Affiliation(s)
- Rom Mendel
- Department of Neurology, Rabin Medical center, Petah Tikva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Ben-Zion Joshua
- Department of Otolaryngology-Head and Neck Surgery, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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24
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Zimhony N, Abu-Salameh I, Sagy I, Dizitzer Y, Oxman L, Yitshak-Sade M, Novack V, Horev A, Ifergane G. Increase in Ischemic Stroke Incident Hospitalizations Among Bedouin Arabs During Ramadan Month. J Am Heart Assoc 2018; 7:JAHA.117.008018. [PMID: 29728012 PMCID: PMC6015316 DOI: 10.1161/jaha.117.008018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Previous studies have not shown any significant effect on stroke incidence during Ramadan. We aimed to investigate the association between ischemic stroke incident hospitalizations and Ramadan, accounting for seasonality and temperature. Methods and Results This retrospective cohort study included all patients admitted with acute ischemic stroke to Soroka University Medical Center from June 2012 to June 2016. We obtained daily mean temperatures and relative humidity rates from 2 monitoring stations in South Israel. We analyzed the association between stroke incidence and Ramadan month, adjusting for weekly temperature and seasonality using Poisson regression models. We compared the first versus the last Ramadan fortnight. We performed an effect specificity analysis by assessing stroke incidence in the non‐Bedouin population. We identified 4727 cases of ischemic stroke, 564 cases of which were Bedouin Arabs. Fifty‐one cases occurred during Ramadan. Ramadan was significantly associated with an increased risk for ischemic stroke (RR 1.48; 95% confidence interval, 1.04–2.09), mainly during the first fortnight (RR 1.73, 95% confidence interval, 1.13–2.66) when compared with non‐Ramadan periods. Mean weekly temperatures and the summer season were not associated with stroke incidence among Bedouin Arabs (RR 0.98; 95% confidence interval, 0.82–1.18 and RR 0.77; confidence interval 0.56–1.06 accordingly). Such association was not observed in the non‐Bedouin population. Conclusion The Ramadan month, particularly in its first 2 weeks, is an independent and ethnicity specific risk factor for ischemic stroke hospitalizations among the Bedouin Arab fasting population.
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Affiliation(s)
- Noa Zimhony
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ibrahim Abu-Salameh
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Oxman
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Department of Environmental Health, Exposure, Epidemiology, and Risk Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Horev
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Ifergane
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel .,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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25
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Leikin-Zach V, Shany E, Yitshak-Sade M, Eshel R, Shafat T, Borer A, Melamed R. Neonatal Risk Factors for Colonization with Extended-Spectrum Beta-Lactamase-Producing Bacteria in the Neonatal Intensive Care Unit. Isr Med Assoc J 2018; 20:286-290. [PMID: 29761673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Extended-spectrum beta-lactamase (ESBL) production is the most common antimicrobial resistance mechanism in the neonatal intensive care unit (NICU), with colonization and blood stream infections being a major threat to this population. Since 2013, all NICU admissions at our facility were screened twice weekly for ESBL colonization. OBJECTIVES To determine independent risk factors for colonization of infants with ESBL-producing bacteria in the NICU. METHODS A retrospective case study of ESBL-colonized infants vs. controls (matched by date of birth and gestational age) was conducted in the NICU of Soroka University Medical Center, Israel, between 2013 and 2014. Epidemiological, laboratory, and clinical data were extracted from medical files. Univariable and multivariable analyses were used to assess associations between ESBL colonization and possible clinical risk factors. RESULTS Of 639 admissions during the study period, 87 were found to be ESBL-colonized (case infants) and were matched to 87 controls. Five case infants became infected (5.7%) with ESBL strains. Klebsiella pneumoniae was the most common isolated bacteria. The mean time from admission to colonization was 15 days. Univariable analysis showed an association of male gender and highest Apgar score at 1 and 5 minutes with ESBL colonization (P < 0.05). Multivariable analysis yielded only a possible association of higher Apgar score at 1 and 5 minutes (hazard ratio [HR] 1.515, 95% confidence interval [95%CI] 0.993-2.314; HR 1.603, 95%CI 0.958-2.682, respectively) with ESBL colonization. CONCLUSIONS Future studies should focus on maternal colonization and possible strategies for preventing vertical transmission of ESBL strains to high-risk neonates.
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Affiliation(s)
- Viktoria Leikin-Zach
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eilon Shany
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Neonatology, Soroka Medical Center, Beer Sheva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka Medical Center, Beer Sheva, Israel
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Ron Eshel
- Clinical Research Center, Soroka Medical Center, Beer Sheva, Israel
| | - Tali Shafat
- Clinical Research Center, Soroka Medical Center, Beer Sheva, Israel
| | - Avraham Borer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Infection Control and Hospital Epidemiology Unit, Soroka Medical Center, Beer Sheva, Israel
| | - Rimma Melamed
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatric Infectious Diseases Unit, Soroka Medical Center, Beer Sheva, Israel
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26
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Besser L, Sabag-Shaviv L, Yitshak-Sade M, Mastrolia SA, Landau D, Beer-Weisel R, Klaitman V, Benshalom-Tirosh N, Mazor M, Erez O. Medically indicated late preterm delivery and its impact on perinatal morbidity and mortality: a retrospective population-based cohort study. J Matern Fetal Neonatal Med 2018; 32:3278-3287. [PMID: 29621920 DOI: 10.1080/14767058.2018.1462325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34-36 + 6/7 weeks), accounting for 60-70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries. Study design: This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term (n = 242,286), spontaneous (n = 10,063), and medically indicated (n = 4833) late preterm deliveries. Results: (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups (p < .01 for all comparisons); (2) medically indicated late preterm delivery was an independent risk factor for composite neonatal morbidity (low Apgar score at 5', seizures, asphyxia, acidosis) after adjustment for confounding factors (maternal age and ethnicity and neonatal gender) and stratification according to gestational age at delivery; and (3) the proportion of medically indicated late preterm deliveries affected the neonatal mortality rate. Below 35% of all late preterm deliveries, indicated late preterm birth were associated with a reduction in neonatal mortality; however, above this threshold medically indicated late preterm deliveries were associated with an increased risk for neonatal death. Conclusions: (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.
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Affiliation(s)
- Limor Besser
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Liat Sabag-Shaviv
- b School of Medicine, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Maayan Yitshak-Sade
- c Clinical Research Center , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Salvatore Andrea Mastrolia
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel.,d Department of Maternal Fetal Medicine , Fondazione MBBM, San Gerardo Hospital, Università degli Studi di Milano-Bicocca , Monza , Italy
| | - Danielle Landau
- e Department of Neonatology, Faculty of Health Sciences , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Ruthy Beer-Weisel
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Vered Klaitman
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Neta Benshalom-Tirosh
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Moshe Mazor
- a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel
| | - Offer Erez
- f Maternity Department D and Obstetrical Day care Unit , Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel
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Shashar S, Yitshak-Sade M, Sonkin R, Novack V, Jaffe E. The Association Between Heat Waves and Other Meteorological Parameters and Snakebites: Israel National Study. J Emerg Med 2018; 54:819-826. [PMID: 29661659 DOI: 10.1016/j.jemermed.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Published annual estimates report a global burden of 2.5 million snakebite cases and >100,000 deaths. In Israel, envenomations are the third most frequent cause of poisonings that are of moderate to major clinical severity. Most studies focus on the clinical descriptions of snakebites in tropical climates, and we sought to investigate the association between snakebite frequency and meteorological parameters. OBJECTIVE We sought to investigate the seasonality of snakebites and evaluate the association between increasingly common heat waves and other meteorological parameters and snakebite frequency in a semiarid nontropical climate. METHODS We obtained data for all medical evacuations (2008-2015) because of snakebites in Israel. Climate data included daily 24-hour average temperature (°C) and relative humidity (%). We used a time-stratified case crossover method, in which a conditional logistic regression was applied to estimate the association, and we also stratified our analysis by season and by region. RESULTS We identified 1234 snakebite cases over 8 years, of which most (74.2%) occurred in hot seasons and between 6 pm and 9 pm. The risk of snakebite was positively associated with temperature >23°C (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.01-1.53) and inversely with humidity >40% (OR 0.74, 95% CI 0.57-0.97). We also found an association with heat waves both in cold (OR 1.62, 95% CI 1.01-2.60) and hot seasons (OR 1.50, 95% CI 1.18-1.92). CONCLUSIONS In a semiarid nontropical climate, we observed an association between an increase in the number of snakebite cases and higher temperatures and lower humidity. Moreover, heat waves increased the frequency of snakebites in both cold and hot seasons.
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Affiliation(s)
- Sagi Shashar
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maayan Yitshak-Sade
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Victor Novack
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Brzezinski-Sinai NA, Stavsky M, Rafaeli-Yehudai T, Yitshak-Sade M, Brzezinski-Sinai I, Imterat M, Andrea Mastrolia S, Erez O. Induction of labor in cases of late preterm isolated oligohydramnios: is it justified? J Matern Fetal Neonatal Med 2018; 32:2271-2279. [DOI: 10.1080/14767058.2018.1430134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Moshe Stavsky
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Tal Rafaeli-Yehudai
- Department of Obstetrics and Gynecology “B”, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Majdi Imterat
- Department of Obstetrics and Gynecology “B”, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, School of Medicine, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Offer Erez
- Maternity Department “D”, Division of Obstetrics and Gynaecology Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Yitshak-Sade M, Kloog I, Novack V. Do air pollution and neighborhood greenness exposures improve the predicted cardiovascular risk? Environ Int 2017; 107:147-153. [PMID: 28735151 DOI: 10.1016/j.envint.2017.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Numerous studies show associations between exposure to Particulate Matter and Cardiovascular disease (CVD). Current cardiovascular equations incorporate the major risk factors for CVD. The patients' environment, however, is not incorporated in these equations. METHODS In a retrospective analysis, we assessed the contribution of neighborhood greenness and particulate matter (coarse-PM and PM<2.5μm-PM2.5) to the development of CVD by analyzing the change in prediction abilities. We included members of the largest health-care provider in Southern-Israel, who had at least one cardiovascular risk factor (dyslipidemia, diabetes, hypertension or smokers). PM exposure and neighborhood greenness (Normalized Difference Vegetation Index-NDVI) were assessed by satellite-based models. We used pooled logistic mixed regressions to obtain the CVD risks including conventional risk factors (i.e. age, gender, blood-pressure, etc.) and measured the model performance with and without PM and NDVI. RESULTS We included 23,110 subjects, of whom 12% had CVD. Coarse-PM exposure was associated with stroke and Myocardial-Infarction (MI) (OR 1.02,p<0.01 for both). NDVI was associated with MI: OR 0.72(p<0.01) for NDVI 0.1-0.2; and OR 0.52(p=0.270) for NDVI >0.2. The c-statistics slightly improved from 77.30%-77.40% for the prediction of MI (p=0.004) and from 75.60%-75.76% for the prediction of stroke (p=0.027). Calibration was fair in all models. The associations were partially mediated through the patients' comorbidities. CONCLUSION The negligible improvement in the prediction performance, despite significant associations with PM and NDVI, may be due to partial mediation of these associations through the conventional cardiovascular risk factors, suggesting the importance in assessing the environmental effects on more basic physiological pathways when addressing the contribution to the cardiovascular risk.
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Affiliation(s)
- Maayan Yitshak-Sade
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Itai Kloog
- Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel.
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Fraenkel M, Yitshak-Sade M, Beacher L, Carmeli M, Mandelboim M, Siris E, Novack V. Is the association between hip fractures and seasonality modified by influenza vaccination? An ecological study. Osteoporos Int 2017; 28:2611-2617. [PMID: 28536736 DOI: 10.1007/s00198-017-4077-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED Osteoporotic hip fractures in 4344 patients were more common during winter. Lower temperatures were associated with higher rates of fracture only in those not vaccinated for influenza. Influenza outbreaks increased the risk of hip fractures. Further studies are needed to assess whether influenza vaccination can prevent hip fractures. INTRODUCTION Winter seasonality of osteoporotic hip fracture incidence has been demonstrated, yet the explanation for the association is lacking. We hypothesize that the seasonality of osteoporotic hip fracture can be explained by an association between hip fractures and seasonal influenza outbreaks. METHODS This retrospective cohort study included all patients admitted to Soroka University Medical Center with a diagnosis of osteoporotic hip fracture (ICD-9 code 820) between the years 2001 and 2013. Patients with malignancies, trauma, and age under 50 were excluded. In a time series analysis, we examined the association between hip fracture incidence and seasonality adjusted for meteorological factors, and population rates of influenza infection and vaccination using Poisson models. RESULTS Four thousand three hundred forty-four patients with a hip fracture were included (69% females, mean age 78). Daily fracture rates were significantly higher in winter (1.1 fractures/day) compared to summer, fall, and spring (0.79, 0.90, and 0.91; p < 0.001). In analysis adjusted for seasons and spline function of time, temperatures were associated with hip fractures risk only in those not vaccinated for influenza (n = 2939, for every decrease of 5 °C, RR 1.08, CI 1.02-1.16; p < 0.05). In subgroup analysis during the years with weekly data on national influenza rates (2010-2013), the risk for hip fracture, adjusted for seasons and temperature, was 1.26 2 weeks following a week with high infection burden (CI 1.05;1.51 p = 0.01), while the temperature was not significantly associated with the fracture risk. CONCLUSIONS Under dry and warm desert climate, winter hip fracture incidence increase might be associated with influenza infection, and this effect can be negated by influenza vaccination.
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Affiliation(s)
- M Fraenkel
- Endocrine Unit, Soroka University Medical Center, Beersheba, Israel.
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - M Yitshak-Sade
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - L Beacher
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - M Carmeli
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Ben-Gurion University Medical School, Beersheba, Israel
| | - M Mandelboim
- Central Virology Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Siris
- Division of Endocrinology, Columbia University Medical Center, New York, USA
| | - V Novack
- Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
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Novack L, Yitshak-Sade M, Landau D, Kloog I, Sarov B, Karakis I. Association between ambient air pollution and proliferation of umbilical cord blood cells. Environ Res 2016; 151:783-788. [PMID: 27665250 DOI: 10.1016/j.envres.2016.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
It has been established as a common knowledge that ambient air pollution (AAP) has an adverse effect on human health. The pathophysiological mechanism of this impact is likely to be related to the oxidative stress. In the current study we estimate the association between AAP and cell proliferation (CP) of umbilical cord blood cells, representing maternal organism most proximal to the fetal body. Blood samples were tested for proliferation in 292 enrolled Arab-Bedouin women at delivery (July 2012-March 2013). The estimates of AAP were defined by a hybrid satellite based model predicting both PM2.5 (particles<2.5µm in diameter) and PM10 (particles<10µm in diameter) as well as monitoring stations for gaseous air pollutants. Risk estimates of pollution exposure were adjusted to medical history, household risk factors and meteorological factors on the day of delivery or one week prior. Ambient ozone (O3) levels on 1, 2, 3and 4 days prior to delivery were associated with lower CP (Prevalence ratio (PR)=0.92, 0.92, 0.93, 0.93, respectively). Increase in inter-quartile range (IOR) of PM2.5 one day before delivery was associated with 9% increase in CP levels (PR=1.09). The positive direction in association was changed to negative association with CP for PM2.5 levels measured at more distant time periods (PR=0.90 and 0.93 for lags 5 and 6 days, respectively). Investigation of PM10 levels indicated a similar pattern (PR=1.05 for pollution values recorded one day before delivery and 0.93 and 0.95 for lags of 5 and 6 days, respectively). Carbon monoxide (CO) levels were associated with lower CP on the day of delivery and 1day prior (PR=0.92 and PR=0.94). To conclude, the levels of cell proliferation of umbilical cord blood cells appear to be associated with the AAP. More studies are needed to support our findings.
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Affiliation(s)
- L Novack
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - M Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - D Landau
- Division of Neonatology, University Medical Center, Beer-Sheva, Israel
| | - I Kloog
- Department of Geography, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - B Sarov
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - I Karakis
- Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel; Ashkelon Academic College, Ashkelon, Israel
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Yitshak-Sade M, Novack L, Landau D, Kloog I, Sarov B, Hershkovitz R, Karakis I. Relationship of ambient air pollutants and hazardous household factors with birth weight among Bedouin-Arabs. Chemosphere 2016; 160:314-322. [PMID: 27391054 DOI: 10.1016/j.chemosphere.2016.06.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Air pollution and meteorology exposures during pregnancy have been suggested to be associated with Birth Weight (BW). Yet, the individual medical background and close household environment is rarely addressed. We aimed to evaluate the independent association of BW with meteorological and air pollution exposures during pregnancy, in addition to individual, parental and household risk factors, among the Bedouin-Arab population in Southern Israel; a semi nomadic population, featured by low socio-economic levels and poor housing and household environment. METHODS In a retrospective cohort study we enrolled pregnant women upon their arrival in the local hospital for delivery during December 2011-April 2013. We interviewed the women and collected data on socio-demographic characteristics, medical history and household environmental hazards. Air pollution (NO2, SO2, CO, Ozone and Particulate Matter <2.5 μ and 10 μ in diameter) and meteorological data (temperature, relative humidity), retrieved from 13 monitoring sites, were linked to each woman based on the proximity of her residential address. RESULTS A total of 959 women were eligible for the study, half of them resided in temporary tribal localities. Ozone IQR elevation in the 3rd trimester was associated with 0.119 gr decrease in BW (95%CI -0.127 gr; -0.112 gr); temperature IQR elevation in the 3rd trimester was associated with 0.002 gr (95%CI -0.004 gr; -0.001 gr) decrease in BW. Waste in the house surroundings was associated with a decrease of 117.27 gr in BW (95%CI -209.19 gr; -25.34 gr). CONCLUSION Although exposure to high levels of temperature and O3 were associated with lower BW, the contribution of poor household environment indicators to BW reduction was substantially higher.
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Affiliation(s)
- Maayan Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel; Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel
| | - Lena Novack
- Department of Public Health, Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel.
| | - Daniella Landau
- Department of Public Health, Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel; Department of Neonatology Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Itai Kloog
- Department of Geography, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Batia Sarov
- Department of Public Health, Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel
| | - Reli Hershkovitz
- Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel; Ultrasound Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Isabella Karakis
- Department of Public Health, Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel; Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel; Ashkelon Academic College, Ashkelon, Israel
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Abstract
OBJECTIVE Recent years have seen a global trend of declining immunization rates of recommended vaccines that is more pronounced among school-age children. Ethnic disparities in child immunization rates have been reported in several countries. We investigated an effect of ethnicity on the vaccination rates of immunizations routinely administered within schools in Israel. DESIGN Data were collected from the Ministry of Health database regarding immunization coverage for all registered Israeli schools (3736) in the years 2009-2011. Negative binomial regression was used to assess the association between school ethnicity and immunization coverage while controlling for school characteristics. RESULTS The lowest immunization coverage was found in Bedouin schools (median values of 75.1%, 81.5% and 0% for the first, second and eighth grades, respectively) in 2011. During this year, vaccination coverage in the first and second grades in Jewish schools was 1.51 and 1.35 times higher, respectively, compared to Bedouin schools. In the years 2009 and 2010, no significant increase in risk for lower vaccination rate was observed in Bedouin schools, and children in Arab and Druze schools were more likely to have been vaccinated. CONCLUSION The lower vaccination refusal rate found in Bedouin schools supports the hypothesis that difficulties related to accessibility constitute the main problem rather than noncompliance with the recommended vaccination protocol for school-age children, featuring higher socio-economic status groups. Our study emphasizes the importance of identifying, beyond the national-level data, subpopulation groups at risk for non-vaccination. This knowledge is essential to administrative-level policy-makers for the allocation of resources and the planning of intervention programs.
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Affiliation(s)
- Maayan Yitshak-Sade
- a Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel
- b Clinical Research Center , Soroka University Medical Center , Beer-Sheva , Israel
| | - Nadav Davidovitch
- c Department of Health Systems Management , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Lena Novack
- d Department of Public Health , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Itamar Grotto
- d Department of Public Health , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
- e Ministry of Health , Jerusalem , Israel
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Erez O, Sinai NB, Rafaeli-Yehudai T, Imterat M, Mastrolia SA, Yitshak-Sade M, Stavsky M. 749: How to manage isolated oligohydramnios at late preterm? Lessons from a population based study. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mor O, Stavsky M, Yitshak-Sade M, Mastrolia SA, Beer-Weisel R, Rafaeli-Yehudai T, Besser L, Hamou B, Mazor M, Erez O. Early onset preeclampsia and cerebral palsy: a double hit model? Am J Obstet Gynecol 2016; 214:105.e1-9. [PMID: 26283455 DOI: 10.1016/j.ajog.2015.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/01/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a late sequel of pregnancy, and the role of preeclampsia is debatable. OBJECTIVE The aims of this study were to determine the association between preeclampsia and cerebral palsy and to determine the risk factors for the development of cerebral palsy in these patients. STUDY DESIGN A retrospective population-based cohort study was designed that included 229,192 singleton pregnancies. The study population was divided into 2 groups: (1) patients with preeclampsia (n = 9749) and (2) normotensive gestations (n = 219,443). Generalized Estimating Equation multiple logistic regression models were performed to study the associations among preeclampsia, small for gestational age, gestational age at delivery, and the risk factors for the development of cerebral palsy in neonates of women with preeclampsia. RESULTS The rate of cerebral palsy was double in patients with preeclampsia than in the normotensive group (0.2% vs 0.1%; P = .015); early onset preeclampsia and small for gestational age were independent risk factors for the subsequent development of cerebral palsy (odds ratio, 8.639 [95% confidence interval, 4.269-17.480]; odds ratio, 2.737 [95% confidence interval, 1.937-3.868], respectively). A second model was conducted to determine the risk factors for the development of cerebral palsy in women with preeclampsia. Birth asphyxia, complications of prematurity, and neonatal infectious morbidity, but not small for gestational age or gestational age at delivery, were independent risk factors for the development of cerebral palsy. CONCLUSION In a comparison with normal pregnant women, the rate of cerebral palsy is double among patients with preeclampsia, especially those with early-onset disease. Early-onset preeclampsia is an independent risk factor for cerebral palsy. Among women with preeclampsia, the presence of neonatal infectious morbidity, birth asphyxia, and complications of prematurity are independent risk factors for the development of cerebral palsy, which further supports the role of a multi-hit model in the pathogenesis of this syndrome.
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Affiliation(s)
- Omer Mor
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Moshe Stavsky
- Center of Clinical Research, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
| | - Maayan Yitshak-Sade
- Center of Clinical Research, Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, Universita' degli Studi di Bari "Aldo Moro", School of Medicine, Bari, Italy
| | - Ruthy Beer-Weisel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Tal Rafaeli-Yehudai
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Limor Besser
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Batel Hamou
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Moshe Mazor
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel.
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Landau D, Novack L, Yitshak-Sade M, Sarov B, Kloog I, Hershkovitz R, Grotto I, Karakis I. Nitrogen Dioxide pollution and hazardous household environment: what impacts more congenital malformations. Chemosphere 2015; 139:340-348. [PMID: 26171819 DOI: 10.1016/j.chemosphere.2015.06.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/11/2015] [Accepted: 06/26/2015] [Indexed: 06/04/2023]
Abstract
Nitrogen Dioxide (NO2) is a product of fuel combustion originating mainly from industry and transportation. Studies suggest an association between NO2 and congenital malformations (CM). We investigated an independent effect of NO2 on CM by adjusting to individual factors and household environment in 1024 Bedouin-Arab pregnant women in southern Israel. This population is characterised by high rates of CMs, frequent consanguineous marriages, paternal smoking, temporary housing and usage of open fire for heat cooking. Information on household risk factors was collected during an interview. Ambient measurements of 24-h average NO2 and meteorological conditions were obtained from 13 local monitors. Median value of daily NO2 measured in the area was 6.78ppb. CM was diagnosed in 8.0% (82) of offspring. Maternal NO2 exposure during the 1st trimester >8.6ppb was significantly associated with minor CM (RR=2.68, p=0.029). Major CM were independently associated with maternal juvenile diabetes (RR=9.97, p-value=0.002) and heating by open fire (RR=2.00, p-value=0.049), but not NO2 exposure. We found that NO2 emissions had an independent impact only on minor malformations, whereas major malformations depended mostly on the household environment. Antepartum deaths were associated by maternal morbidity.
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Affiliation(s)
- D Landau
- Department of Neonatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - L Novack
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - M Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - B Sarov
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - I Kloog
- Department of Geography, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - R Hershkovitz
- Department of Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - I Grotto
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - I Karakis
- Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel; Ashkelon Academic College, Ashkelon, Israel
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Karakis I, Landau D, Yitshak-Sade M, Dukler D, Hershkovitz R, Rotenberg M, Sarov B, Grotto I, Novack L. Exposure to Metals and Congenital Anomalies: A Biomonitoring Pilot Study in Bedouin Women in Southern Israel. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Raz I, Novack L, Yitshak-Sade M, Shahar Y, Wiznitzer A, Sergienko R, Warshawsky-Livne L. Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms. Health Policy 2015; 119:1358-65. [PMID: 26341842 DOI: 10.1016/j.healthpol.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/03/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022]
Abstract
In view of the growing proportion of "non-urgent" admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours. We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of "non-urgent" visits. The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR=1.22) and in non-urgent OER visits (IRR=1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home. We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications.
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Affiliation(s)
- Iris Raz
- Obstetrics and Gynecology Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lena Novack
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Maayan Yitshak-Sade
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yemima Shahar
- Obstetrics and Gynecology Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Arnon Wiznitzer
- Obstetrics and Gynecology Division, The Rabin Medical Center, Petach-Tikva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Yitshak-Sade M, Gorodischer R, Aviram M, Novack L. Prenatal exposure to H2 blockers and to proton pump inhibitors and asthma development in offspring. J Clin Pharmacol 2015; 56:116-23. [PMID: 26096778 DOI: 10.1002/jcph.574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/12/2015] [Indexed: 01/08/2023]
Abstract
Fetal exposure to H2 blockers (H2 Bs) or proton pump inhibitors (PPIs) has been reported to be associated with asthma in children. We evaluated the risk of asthma in offspring following prenatal H2 Bs. We enrolled 91 428 children and their mothers who resided in southern Israel during 1998-2011. The computerized medications database was linked with records from the district hospital. Of the eligible children, 11 227 developed asthma, and overall 5.5% had been exposed to H2 Bs or PPIs prenatally. The risk of developing asthma was slightly higher in the group exposed to H2 Bs or PPIs (RR, 1.09; P = .023). At greater risk were children whose mothers purchased these medications more than 3 times (RR, 1.22; P = .038) or exposed to >20 defined daily doses or prenatally exposed to lansoprazole. The statistical association was significant and depended on magnitude of exposure and specific medication, but the absolute risk was low. The association between maternal consumption of H2 Bs or PPIs and asthma and childhood remained statistically significant 2 years after delivery, raising the possibility of confounding by the indication phenomenon. In view of the findings, a causal relationship could not be ascertained, and an unidentified etiological factor could be operative.
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Affiliation(s)
- Maayan Yitshak-Sade
- Clinical Research Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel
| | - Rafael Gorodischer
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel.,Department of Pediatrics, Ben Gurion University of the Negev, Beer-Sheva, Israel.,"Clalit" Health Services (Southern District), Beer-Sheva, Israel
| | - Micha Aviram
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel.,Department of Pediatrics, Ben Gurion University of the Negev, Beer-Sheva, Israel.,"Clalit" Health Services (Southern District), Beer-Sheva, Israel
| | - Lena Novack
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Department of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Novack L, Manor E, Gurevich E, Yitshak-Sade M, Landau D, Sarov B, Hershkovitz R, Dukler D, Vodonos T, Karakis I. Can cell proliferation of umbilical cord blood cells reflect environmental exposures? Springerplus 2015. [PMID: 26217549 PMCID: PMC4512979 DOI: 10.1186/s40064-015-1134-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Environmental hazards were shown to have an impact on cell proliferation (CP). We investigated CP of lymphocytes in umbilical cord blood in relation to prenatal environmental exposures in a sample of 346 Arab-Bedouin women giving birth in a local hospital. Information on subjects' addresses at pregnancy, potential household exposures and demographical status was collected in an interview during hospitalization. This population is usually featured by high rates of neonatal morbidity and multiple environmental exposures, originating from the local industrial park (IP), household hazards and frequent male smoking. A geometric mean CP ratio 2.17 (2.06; 2.29), and was high in women residing in a direction of prevailing winds from the local IP (p value = 0.094) and who gave birth during fall-winter season (p value = 0.024). Women complaining on disturbing exposure to noise had lower CP (p value = 0.015), compared to other women. CP was not indicative of neonatal morbidity. However, our findings suggest that CP of umbilical cord might be modified by environmental exposures. A long-term follow-up of the children is required to assess their developmental outcomes.
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Affiliation(s)
- Lena Novack
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Department of Public Health, Ben-Gurion University of the Negev, P.O.B. 653, Beersheba, Israel
| | - Esther Manor
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Genetic Institute, Soroka University Medical Center, Beersheba, Israel
| | - Elena Gurevich
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Genetic Institute, Soroka University Medical Center, Beersheba, Israel
| | - Maayan Yitshak-Sade
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - Daniella Landau
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Department of Neonatology, Soroka University Medical Center, Beersheba, Israel
| | - Batia Sarov
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Reli Hershkovitz
- Ultrasound Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beersheba, Israel
| | - Doron Dukler
- Obstetric Emergency Room and Delivery Wards, Soroka University Medical Center, Beersheba, Israel
| | - Tali Vodonos
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Genetic Institute, Soroka University Medical Center, Beersheba, Israel
| | - Isabella Karakis
- Faculty of Health Science, Ben-Gurion University of the Negev, Beersheba, Israel ; Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel
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Abstract
Recent studies demonstrated an adverse effect of chronic exposure to air pollution (AP) on metabolic syndrome and its components. In a population-based study, we investigated the association between exposure to ambient AP and serum glucose (SG), among subjects with normal glucose, impaired fasting glucose (IFG), and diabetes mellitus (DM).We included 1,063,887 SG tests performed in 131,882 subjects (years 2001-2012). Exposure data included daily levels of SO2, NO2 and other pollutants of industrial, traffic, and nonanthropogenic sources. Demographical, clinical, and medications purchase data were assessed. Log-transformed SG levels were analyzed by linear mixed models adjusted for seasonal variables and personal characteristics.SG increases (%increase [95% CI]), among subjects with normal glucose, IFG, and DM, respectively, were associated with 6.36 ppb increase of NO2 measured 24 to 72 hours before the test (0.40% [0.31%; 0.50%], 0.56% [0.40%; 0.71%], and 1.08% [0.86%; 1.29%]); and with 1.17 ppb increase of SO2 measured 24 hours before the test (0.29% [0.22%; 0.36%], 0.20% [0.10%; 0.31%], and 0.33% [0.14%; 0.52%]). Among DM population, weakest association was observed among patients treated with Metformin (0.56% increase in SG [0.18%; 0.95%]).In conclusion, NO2 and SO2 exposure is associated with small but significantly increased levels of SG. Although DM patients were found to be more susceptible to the AP induced SG variations, Metformin treatment seem to have a protective effect. Given the chronic lifetime exposure to AP and the broad coverage of the population, even small associations such as those found in our study can be associated with detrimental health effects and may have profound public health implications.
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Affiliation(s)
- Maayan Yitshak-Sade
- From the Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel (MYS, VN); Department of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel (IK, IK); Department of Internal Medicine, Soroka University Medical Center, Be'er-Sheva, Israel (IFL); and Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel (LN)
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Karakis I, Landau D, Yitshak-Sade M, Hershkovitz R, Rotenberg M, Sarov B, Grotto I, Novack L. Exposure to metals and congenital anomalies: a biomonitoring study of pregnant Bedouin-Arab women. Sci Total Environ 2015; 517:106-112. [PMID: 25725195 DOI: 10.1016/j.scitotenv.2015.02.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/13/2015] [Accepted: 02/16/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The Bedouin-Arab population in Israel comprises a low socio-economic society in transition. Smoking among males and consanguineous marriages are frequent. A previous study showed elevated rates of major malformations within groups from this population residing near an industrial park, where high ambient values of arsenic (As) and nickel (Ni) were detected, compared to groups living in remote localities. OBJECTIVES We estimated the extent of exposure to metals in pregnant Bedouin-Arab women in relation to congenital malformations. METHODS We collected maternal urine samples from 140 Bedouin women who gave birth in a local hospital. Patient medical history, type of marriage (consanguineous or non-consanguineous), and parental exposure history were collected by interview and medical records. RESULTS Aluminum (Al) was detected in 37 women (26.4%), cadmium (Cd) in 2 (1.4%), As in 10 (7.1%), and Ni in 1 woman (0.7%). The detected rate of Cd exposure was low, though more than 92% of the fathers reported smoking. Concentrations of Al were higher for women residing within 10 km of the local industrial park (Prevalence Ratio (PR)=1.12, p-value=0.012) or who reported using a wood burning stove (PR=1.37, p-value=0.011) and cooking over an open fire (PR=1.16, p-value=0.076). Exposure to Al was adversely associated with minor anomalies (OR=3.8, p-value=0.046) after adjusting for history of abortions (OR=6.1, p-value=0.007). Fetuses prenatally exposed to As were born prematurely (p-value=0.001) and at lower weights (pv=0.023). CONCLUSIONS The study population of pregnant women is exposed to high levels of metals mainly of household origin. Our findings may be generalized to similar populations in developing countries.
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Affiliation(s)
- Isabella Karakis
- Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel; Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Public Health, The Ashkelon Academic College, Ashkelon, Israel
| | - Daniella Landau
- Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Neonatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Maayan Yitshak-Sade
- Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Reli Hershkovitz
- Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Ultrasound Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Rotenberg
- Laboratory of Clinical Toxicology and Pharmacology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Batia Sarov
- Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itamar Grotto
- Environmental Epidemiology Department, Ministry of Health, Jerusalem, Israel; Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Lena Novack
- Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Yitshak-Sade M, Novack V, Katra I, Gorodischer R, Tal A, Novack L. Non-anthropogenic dust exposure and asthma medication purchase in children. Eur Respir J 2014; 45:652-60. [PMID: 25323244 DOI: 10.1183/09031936.00078614] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Air pollution has been shown to increase frequency of asthma attacks, as usually measured by hospitalisation rates. We hypothesise that purchase of asthma reliever medications will reflect a broader association between the environmental exposure and asthma exacerbations. In a time series analysis, we estimated the association of dust storms with mild asthma manifestations, as indicated by medication purchases, during 2005-2011. We compared our results with the estimation of the association of dust storms with hospitalisations due to asthma and asthma-like symptoms. We detected 289 dust storms characterised by high levels of particulate matter <10 μm in diameter. We identified 42,920 children with asthma, wheezing or asthma-like symptoms, of whom 2418 were hospitalised. We observed a higher risk of asthma medication purchase on the day of a mild dust storm (relative risk 1.05, 95% CI 1.00-1.10). The next peak in drug purchases was 3 days later and was more pronounced among Bedouin-Arab children. Stratified analyses showed higher risks for hospitalisation among Bedouin-Arab children; especially among children living in temporary houses (relative risk 1.33, 95% CI 1.04-1.71). We observed an increased risk of asthma medication purchase associated with mild dust storms. The risk observed for hospitalisation was more pronounced among the rural Bedouin-Arab population.
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Affiliation(s)
- Maayan Yitshak-Sade
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Itzhak Katra
- Dept of Geography and Environmental Development, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rafael Gorodischer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dept of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Asher Tal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dept of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lena Novack
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Karakis I, Sarov B, Landau D, Manor E, Yitshak-Sade M, Rotenberg M, Hershkovitz R, Grotto I, Gurevich E, Novack L. Association between prenatal exposure to metals and neonatal morbidity. J Toxicol Environ Health A 2014; 77:1281-1284. [PMID: 25268554 DOI: 10.1080/15287394.2014.932313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An association between prenatal exposure to (semi-)metals and of neonatal morbidity was assessed by introducing an oxidative stress as a possible intermediate step. An oxidative stress was measured by cell proliferation (CP) ratio in umbilical cord blood cells. Urine samples of 18 out of 58 enrolled women (31%) were positive for (semi-)metals; 25.9% of women were positive for aluminum (Al). The CP ratio was higher (1) in subjects with Al, (2) in mothers to newborns diagnosed as small-for-gestational age (p value = .052), (3) neonates that weighed less (p value = .079), and (4) in women who experienced repeated abortions (p value = .049). Our findings suggest the possibility of metal-induced oxidative stress.
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Affiliation(s)
- Isabella Karakis
- a Department of Environmental Epidemiology , Public Health Services, Ministry of Health , Jerusalem , Israel
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