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Objective: We integratively assessed the effect of different indoor and outdoor environmental exposures early in life on respiratory and allergic health conditions among children from (sub-) urban areas. Methods: This study included children participating in four ongoing European birth cohorts located in three different geographical regions: INMA (Spain), LISAplus (Germany), GINIplus (Germany) and BAMSE (Sweden). Wheezing, bronchitis, asthma and allergic rhinitis throughout childhood were assessed using parental-completed questionnaires. We designed “environmental scores” corresponding to different indoor, green- and grey-related exposures (main analysis, a-priori-approach). Cohort-specific associations between these environmental scores and the respiratory health outcomes were assessed using random-effects meta-analyses. In addition, a factor analysis was performed based on the same exposure information used to develop the environmental scores (confirmatory analysis, data-driven-approach). Results: A higher early exposure to the indoor environmental score increased the risk for wheezing and bronchitis within the first year of life (combined adjusted odds ratio: 1.20 [95% confidence interval: 1.13–1.27] and 1.28 [1.18–1.39], respectively). In contrast, there was an inverse association with allergic rhinitis between 6 and 8 years (0.85 [0.79–0.92]). There were no statistically significant associations for the outdoor related environmental scores in relation to any of the health outcomes tested. The factor analysis conducted confirmed these trends. Conclusion: Although a higher exposure to indoor related exposure through occupants was associated with an increased risk for wheezing and bronchitis within the 1st year, it might serve as a preventive mechanism against later childhood allergic respiratory outcomes in urbanized environments through enhanced shared contact with microbial agents. This study was funded by Grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), and from Spain: Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/0178, 11/01007, 11/02591, 11/02038, 13/1944, 13/2032, 14/0891, and 14/1687) and the Conselleria de Sanitat, Generalitat Valenciana. The BAMSE study has been supported by the Swedish Research Council, the Swedish Heart-Lung Foundation, the Swedish Research Council Formas, the Swedish Environment Protection Agency, the European Community's Seventh Framework Program (FP7/2007–2011 under grant agreement no. 211250), the Swedish Asthma and Allergy Association Research Foundation, and the Stockholm County Council. Christina Tischer is a recipient of a European Respiratory Society Fellowship (RESPIRE2 – 2015– 7251). Payam Dadvand is funded by a Ramón y Cajal fellowship (RYC-2012-10995) awarded by the Spanish Ministry of Economy and Competitiveness. Elaine Fuertes is supported by a Marie Skłodowska-Curie Individual Fellowship (H2020-MSCA-IF-2015; proposal number 704268).

Background: Prenatal and postnatal exposure to air pollution has been linked to cognitive impairment in children, but very few studies have assessed its association with attentional function. Objectives: To evaluate the association between prenatal and postnatal exposure to nitrogen dioxide (NO2) and attentional function in children at 4–5 years of age. Methods: We used data from four regions of the Spanish INMA—Environment and Childhood—Project, a population-based birth cohort. Using land-use regression models (LUR), we estimated prenatal and postnatal NO2 levels in all of these regions at the participants' residential addresses. We assessed attentional function using the Kiddie-Conners Continuous Performance Test (K-CPT). We combined the region-specific adjusted effect estimates using random-effects meta-analysis. Results: We included 1298 children with complete data. Prenatal exposure to NO2 was associated with an impaired standard error of the hit reaction time (HRT(SE)) (increase of 1.12 ms [95% CI; 0.22 a 2.02] per 10 μg/m3 increase in prenatal NO2) and increased omission errors (6% [95% CI; 1.01 to 1.11] per 10 μg/m3 increase in prenatal NO2). Postnatal exposure to NO2 resulted in a similar but borderline significant increase of omission errors (5% [95% CI; =0.99 to 1.11] per 10 μg/m3 increase in postnatal NO2). These associations did not vary markedly between regions, and were mainly observed in girls. Commission errors and lower detectability were associated with prenatal and postnatal exposure to NO2 only in some regions. Conclusions: This study indicates that higher exposure to ambient NO2, mainly during pregnancy and to a lesser extent postnatally, is associated with impaired attentional function in children at 4–5 years of age., This study was funded by grants from the Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041 and PI031615; PI041931; PI041112; PI041436; PI041509; PI042018; PI051079; PI051052; PI060867; PI061213; PI070314; CP1100178; PI081151 incl. FEDER funds; PS0900090 incl. FEDER funds; PI0902311 incl. FEDER funds; PI0902647 incl. FEDER funds; PI1102591 incl. FEDER funds; PI1102038 incl. FEDER funds; PI131944 incl. FEDER funds; PI132032 incl. FEDER funds; PI1302429 incl. FEDER funds; PI1302187 incl. FEDER funds; PI140891 incl. FEDER funds; PI141687 incl. FEDER funds and MS13/00054), Generalitat de Catalunya-CIRIT 1999SGR 00241, Fundació La marató de TV3 (090430), Department of Health of the Basque Government (2005111093, 2009111069 and 2013111089), the Provincial Government of Gipuzkoa (DFG06/002 and DFG08/001), Convenios anuales con los ayuntamientos de la zona del estudio (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain), from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), from the European Research Council under the ERC Grant Agreement number ERC-AdG 2010 GA#268479 – the BREATHE project, from the Conselleria de Sanitat of Generalitat Valenciana (AP212/11, 002/008, 012/009, 013/2009, 014/009, 015/008, 016/009, 021/007, 021/008, 023/008 and 024/007) and from Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya.

Background Combustion, especially in diesel engines, emits a complex mixture of gases and particles that could be harmful for the respiratory and cardiovascular systems. Daily personal exposure to the smallest particulate matter (less than 0.1 µm and usually called nanoparticles or ultrafine particles – UFP) has been studied to a lesser extent compared to coarser particles. In this study we aim to assess personal exposure to UFP in different environments and transport modes among schoolchildren from a Spanish birth-cohort in the province of Valencia. Methods The study population consisted of 114 children aged 10-11 years. For each of them, personal exposure to UFP was measured continuously during two successive school days (24 hours) by means of a small backpack equipped with a UFP active sampler (DISCmini). The first day, a technician delivered the required material to the child’s home and instructed them on the monitoring period. The second day, families came to the health center where children underwent health examinations and parents answered questionnaires about time-activity patterns, sociodemographic factors, and other exposures. Median UFP exposure levels (numbers of particles per cm 3 – N/cm 3 – were obtained for the overall period, for different environments (at home and school) and during journeys by different modes of transport (active transport – walking or cycling – or passive transport – car, bus, metro or tram). Results Around 90% (N=101) of the schoolchildren had valid exposure data (at least at home and school). Mean monitoring time was 24 hours [range: 22-27 hours]. Participants spent 15 hours at home, 6 hours at school, 28 minutes in active transport, and 60 minutes in passive transport on average during the monitoring period. Passive transport in our study was over-represented since on the second day of the visit most families drove to the health center. Over this period, DISCmini obtained valid data for 98.5% of the time [interquartile range: 80.1%-100.0%]. Global personal exposure level was 9368 N/cm 3 [interquartile range: 5514-17607 N/cm 3 ], being higher during the cold season. Personal exposure levels were higher during journeys (especially in passive transport) than in other environments. Comparing exposure levels at home and school, UFP levels were higher at home, probably due to burning appliances (e.g., gas cooker). Conclusions Schoolchildren were exposed to a wide range of UFP levels. Personal exposure levels varied across the studied environments, being higher during journeys and especially in passive modes of transport.

Background and aims: Because their lungs and immune system are not completely developed, children are more susceptible to respiratory disease and more vulnerable to ambient pollution. We assessed the relation between prenatal and postnatal nitrogen dioxide (NO2) levels and the development of lower respiratory tract infections (LRTI), wheezing and persistent cough during the first year of life. Methods: The study population consisted of 352 children from a birth cohort in Valencia, Spain. Prenatal exposure to NO2, a marker of traffic related air pollution was measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. It was modeled for each residential address through land use regression using the empirical measurements and data from geographic information systems. Postnatal exposure was measured once inside and outside each home using passive samplers for a period of 14 days. Outcomes studied were any episode of LRTI during the child's first year of life diagnosed by a doctor (bronchitis, bronchiolitis or pneumonia), wheezing (defined as whistling sounds coming from the chest), and persistent cough (more than three consecutive weeks). Outcomes and potential confounders were obtained from structured questionnaires. Multiple logistic regression was used to identify associations. Results: The cumulative incidence (CI) at first year of life was 30.4% for LRTI (23.0% bronchiolitis, 11.9% bronchitis and 1.4% pneumonia), 26.1% for wheezing and 6.3% for persistent cough. The adjusted odds ratio (95% confidence interval) per 10 mu g/m(3) increment in postnatal outdoor NO2 concentration was 1.40 (1.02-1.92) for persistent cough. We also found some pattern of association with LRTI, bronchiolitis, bronchitis, wheezing and persistent cough in different prenatal periods, although it was not statistically significant. Conclusions: Our results indicate that exposure to outdoor, but not indoor, NO2 during the first year of life increases the risk of persistent cough. (C) 2011 Elsevier B.V.. All rights reserved.

ResumenObjetivoDescribir las prevalencias de exposición declarada a riesgos laborales en mujeres embarazas y analizar su relación con características sociodemográficas y laborales a partir de la información recogida en la cohorte INMA-Valencia.MétodosLa cohorte INMA-Valencia se inicia en 2004 con 855 mujeres embarazadas residentes en la provincia de Valencia. En la semana 32 de gestación se recogió información, mediante entrevista personal con cuestionario estructurado, sobre características sociodemográficas (edad, nivel de estudios, país de nacimiento), condiciones de empleo (actividad, ocupación, tipo de contrato, tipo de jornada) y exposición laboral autorreferida a carga física y riesgos psicosociales, físicos, químicos y biológicos, en las mujeres con un trabajo remunerado durante el embarazo (n=649).ResultadosLas prevalencias de exposición laboral declarada a carga física, riesgos psicosociales y riesgos físicos (incluyendo radiaciones no ionizantes) fueron, respectivamente, del 56%, 63% y 62%. La prevalencia de exposición declarada a riesgos químicos (incluyendo productos de limpieza) fue del 22%, y del 6% a los riesgos biológicos. En general, la exposición referida a riesgos laborales fue más frecuente en las mujeres más jóvenes, con nivel educativo bajo, no españolas y trabajadoras temporales y autónomas.ConclusionesEn este estudio se cuantifica por primera vez en España la prevalencia de exposición declarada a riesgos laborales en una muestra de base poblacional de mujeres embarazadas. Según los datos obtenidos parece necesario reforzar las medidas de vigilancia y control de estas exposiciones, algunas de ellas asociadas consistentemente con efectos negativos sobre la reproducción y el desarrollo.AbstractObjectiveTo describe the prevalence of exposure to occupational risks among pregnant women and analyze its relationship with personal and occupational characteristics using information collected in the Childhood and Environment (Infancia y Medio Ambiente [INMA])-Valencia cohort study.MethodsThe INMA-Valencia cohort study started in 2004 with 855 pregnant women living in Valencia, Spain. Data on sociodemographic variables (age, education and country of birth) and occupational conditions (activity, occupation, type of contract, working hours and self-reported occupational exposure to physical load and psychosocial, physical, chemical and biological risks) in women with paid employment during pregnancy (n=649) were collected through face-to-face interviews with a structured questionnaire in week 32 of pregnancy.ResultsThe prevalences of reported exposure to physical and psychosocial load and to physical pollutants (including non-ionizing radiations) were 56%, 63% and 62%, respectively. The prevalence of reported exposure to chemicals (including cleaning products) and biological pollutants was 22% and 6%, respectively. In general, the characteristics most closely associated with exposure to occupational risks were younger age, non-Spanish nationality, lower education, having a temporary contract or being self-employed.ConclusionsThis study is the first to quantify the prevalence of exposure to occupational risks during pregnancy in a Spanish population-based sample. According to the data observed, surveillance and control actions should be intensified in pregnant workers, as some of the observed occupational exposures have been consistently associated with detrimental reproductive and developmental effects.

Objectives To describe the degree of annoyance caused by air pollution and noise in pregnant women in a birth cohort; to determine the modifying factors and their relation with exposure to ambient nitrogen dioxide (NO2). Methods The study population was 855 pregnant women in Valencia, Spain. Annoyance caused by air pollution and noise, and explanatory factors were obtained from 786 pregnant women through a questionnaire. NO2 levels were determined combining measurements at 93 points within the area of study and using geostatistical techniques (kriging). Results In all 7.9% of the women reported high annoyance caused by air pollution and 13.1% high annoyance caused by noise. There was a significant difference in the degree of annoyance due to both air pollution and noise depending on the area where the women lived and their working status. The degree of annoyance correlated better with measured NO2 at the municipality level (air pollution: r=0.53; noise: r=0.44) than at the individual level (air pollution and noise: r=0.21). On multivariate analysis, being a housewife, higher NO2 levels and high traffic density were associated with higher degrees of annoyance. Conclusions There was a high percentage of women who perceived medium–high annoyance due to noise and air pollution. Annoyance caused by environmental pollutants could lead to some psychological effects, which impair the quality of life, or even physiological ones, which affect prenatal development.

Air pollution exposure during pregnancy has been linked to a wide range of negative health effects. NO2, a traffic pollution marker, and benzene, an industrial pollution indicator, stand out among the types of air pollution linked to these effects. The aim of this work is to show the methodology used to assign exposure levels for both pollutants and preliminary reports in the INMA (Environment and Childhood) Asturias cohort in Spain. This cohort consists of 494 pregnant women and their children, who have been recruited and followed since 2004. Air pollution levels were measured at 67 points by means of passive samplers. The mean NO2 measured value was 21.2 mu g m(-3) (range 3.5 mu g m(-3) to 44.5 mu g m(-3)), and the mean benzene value was 2.72 mu g m(-3) (range 0.18 mu g m(-3) to 9.17 mu g m(-3)) at urban sampling points and 0.64 mu g m(-3) (range 0.04 mu g m(-3) to 2.62 mu g m(-3)) in rural locations. The Pearson correlation coefficient among pollutants was 0.42. Land Use Regression models were built to predict exposure at the homes of pregnant women. Altitude, road distances and land use were part of the models. The percent of explained variance was 52% for NO2 and 73% for benzene in the urban zones. No residual autocorrelation was found. Predictions were corrected based on the Air Quality Network of the Principality of Asturias taking into account pregnancy seasonality. Exposure indicators were determined for each term and for the entire pregnancy for each woman. Values for urban locations were higher than those for rural and benzene estimations for 5% of the cohort women were above the European Union annual limit value. Air pollution exposure for the INMA-Asturias cohort clearly depends on the place of residence. In particular, benzene concentrations are remarkably high if an individual lives in an urban and industrial area, which is an issue of management intervention and regulatory concern. Exposure assessment for different pollutants will allow us to evaluate potential adverse effects in foetal and infant health caused by air pollution. (C) 2011 Elsevier Ltd. All rights reserved.

Volatile organic compounds (VOCs), which are habitually found in both outdoor and indoor environments, may represent a significant health risk. In this context, pregnancy is a critical period since foetuses are more vulnerable than adults to exposure to toxic compounds. The objective of this study is to present the preliminary results of a series of measurements of outdoor (O), indoor (I) and personal exposure (P) to benzene, toluene, ethylbenzene, o-xylene and m,p-xylene (BTEX) in 107 pregnant women from two areas in Spain, namely Valencia and Sabadell. BTEX samplers were installed for 48 hours both inside and outside of the women’s homes, along with personal samplers. In addition, the test subjects filled out a questionnaire about the activities they carried out during the sampling period. BTEX levels were higher in Valencia than in Sabadell (median O, I and P benzene levels in Valencia were 1.40, 2.40 and 3.05 μg/m3, respectively, while in Sabadell they were 0.01, 0.32 and 1.02 μg/m3). In both locations, an O