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1. Injury incidence and characteristics in adolescent female football players: A systematic review with meta-analysis of prospective studies

Author: Marcos Quintana-Cepedal, Ismael López-Aguado, Ana Fernández-Somoano, Miguel Ángel Rodríguez, Miguel del Valle, and Hugo Olmedillas
Subjects: epidemiology, football, adolescent athlete, injuries, diagnosis, Sports medicine, RC1200-1245, Biology (General), QH301-705.5
Abstract: To observe overall, training, and match injury incidence in female youth football. We also aimed to quantify the incidence of injuries by affected tissue and body location. The following databases were examined: PubMed, Web of Science, Scopus, SPORTDiscus, Cochrane and PEDro. Papers that reported overall injury incidence, training or match injury incidence were included. Additionally, studies had to be performed in adolescent female football players (13 19 years of age). The Newcastle-Ottawa Scale and the checklist of items that must be included in epidemiological football reports were used to assess methodological quality of the included articles. For the meta-analyses, a random effect model was used. A total of 13 studies were included. There were 2,333 injuries; incidence was higher during games (12.7/1000 h) compared to training sessions (2.3/1000 h). The injury match-to-training ratio was 5.8. The lower limbs were the region in which the greatest number of injuries occurred, with the ankle (1.2/1000 h) and knee (0.8/1000 h) having the most injuries. In relation to injured tissue, ligament injuries represented an incidence of 1.3/1000 h, followed by muscle injuries (0.9/1000 h). This study represents the first step towards the creation and implementation of preventative measures in female youth football. The results suggest that attention should be focused on ankle and knee injuries, since they are the most frequent and can lead to sport retirement in some cases depending on the severity.
Published: 2024
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2. Ambient air temperature exposure and foetal size and growth in three European birth cohorts

Author: Esmée Essers, Laura Granés, Scott Delaney, Joan Ballester, Susana Santos, Sami Petricola, Tiffany C Yang, Ana Fernández-Somoano, Ainhoa Bereziartua, Ferran Ballester, Adonina Tardón, Martine Vrijheid, Aitana Lertxundi, Rosemary R.C. McEachan, Hanan El Marroun, Henning Tiemeier, Carmen Iñiguez, and Mònica Guxens
Subjects: Environmental health, Climate change, Foetal development, Pregnancy, Cohort study, Environmental sciences, GE1-350
Abstract: Introduction: Ambient air temperature may affect birth outcomes adversely, but little is known about their impact on foetal growth throughout pregnancy. We evaluated the association between temperature exposure during pregnancy and foetal size and growth in three European birth cohorts. Methods: We studied 23,408 pregnant women from the English Born in Bradford cohort, Dutch Generation R Study, and Spanish INMA Project. Using the UrbClimTM model, weekly ambient air temperature exposure at 100x100m resolution at the mothers’ residences during pregnancy was calculated. Estimated foetal weight, head circumference, and femur length at mid and late pregnancy and weight, head circumference, and length at birth were converted into standard deviation scores (SDS). Foetal growth from mid to late pregnancy was calculated (grams or centimetres/week). Cohort/region-specific distributed lag non-linear models were combined using a random-effects meta-analysis and results presented in reference to the median percentile of temperature (14 °C). Results: Weekly temperatures ranged from −5.6 (Bradford) to 30.3 °C (INMA-Sabadell). Cold and heat exposure during weeks 1–28 were associated with a smaller and larger head circumference in late pregnancy, respectively (e.g., for 9.5 °C: −1.6 SDS [95 %CI −2.0; −0.4] and for 20.0 °C: 1.8 SDS [0.7; 2.9]). A susceptibility period from weeks 1–7 was identified for cold exposure and a smaller head circumference at late pregnancy. Cold exposure was associated with a slower head circumference growth from mid to late pregnancy (for 5.5 °C: −0.1 cm/week [-0.2; −0.04]), with a susceptibility period from weeks 4–12. No associations that survived multiple testing correction were found for other foetal or any birth outcomes. Conclusions: Cumulative exposure to cold and heat during pregnancy was associated with changes in foetal head circumference throughout gestation, with susceptibility periods for cold during the first pregnancy trimester. No associations were found at birth, suggesting potential recovery. Future research should replicate this study across different climatic regions including varying temperature profiles.
Published: 2024
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3. Nitrogen dioxide exposure, attentional function, and working memory in children from 4 to 8 years: Periods of susceptibility from pregnancy to childhood

Author: Kellie L.H.A. Crooijmans, Carmen Iñiguez, Kristina W. Withworth, Marisa Estarlich, Aitana Lertxundi, Ana Fernández-Somoano, Adonina Tardón, Jesús Ibarluzea, Jordi Sunyer, Mònica Guxens, and Anne-Claire Binter
Subjects: Cohort studies, Air pollutants, Child development, Neuropsychological tests, Time factors, Environmental sciences, GE1-350
Abstract: Background: Air pollution exposure during pregnancy and childhood has been linked to executive function impairment in children, however, very few studies have assessed these two exposure periods jointly to identify susceptible periods of exposure. We sought to identify potential periods of susceptibility of nitrogen dioxide (NO2) exposure from conception to childhood on attentional function and working memory in school-aged children. Methods: Within the Spanish INMA Project, we estimated residential daily NO2 exposures during pregnancy and up to 6 years of childhood using land use regression models (n = 1,703). We assessed attentional function at 4–6 years and 6–8 years, using the Conners Kiddie Continuous Performance Test and the Attention Network Test, respectively, and working memory at 6–8 years, using the N-back task. We used distributed lag non-linear models to assess the periods of susceptibility of each outcome, adjusting for potential confounders and correcting for multiple testing. We also stratified all models by sex. Results: Higher exposure to NO2 between 1.3 and 1.6 years of age was associated with higher hit reaction time standard error (HRT-SE) (0.14 ms (95 % CI 0.05; 0.22) per 10 μg/m3 increase in NO2) and between 1.5 and 2.2 years of age with more omission errors (1.02 (95 % CI 1.01; 1.03) of the attentional function test at 4–6 years. Higher exposure to NO2 between 0.3 and 2.2 years was associated with higher HRT-SE (10.61 ms (95 % CI 3.46; 17.75) at 6–8 years only in boys. We found no associations between exposure to NO2 and working memory at 6–8 years. Conclusion: Our findings suggest that NO2 exposure during the first two years of life is associated with poorer attentional function in children from 4 to 8 years of age, especially in boys. These findings highlight the importance of exploring long-term effects of traffic-related air pollution exposure in older age groups.
Published: 2024
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4. Spatial distribution of hospital admissions for asthma in the central area of Asturias, Northern Spain

Author: Verónica González-Iglesias, Isabel Martínez-Pérez, Valentín Rodríguez Suárez, and Ana Fernández-Somoano
Subjects: Asthma, Spatial distribution, Geographic Information System, Disease mapping, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Asturias is one of the communities with the highest rates of hospital admission for asthma in Spain. The environmental pollution or people lifestyle are some of the factors that contribute to the appearance or aggravation of this illness. The aim of this study was to show the spatial distribution of asthma admissions risks in the central municipalities of Asturias and to analyze the observed spatial patterns. Methods Urgent hospital admissions for asthma and status asthmaticus occurred between 2016 to 2018 on the public hospitals of the central area of Asturias were used. Population data were assigned in 5 age groups. Standardised admission ratio (SAR), smoothed relative risk (SRR) and posterior risk probability (PP) were calculated for each census tract (CT). A spatial trend analysis was run, a spatial autocorrelation index (Morans I) was calculated and a cluster and outlier analysis (Anselin Local Morans I) was finally performed in order to analyze spatial clusters. Results The total number of hospital urgent asthma admissions during the study period was 2324, 1475 (63.46%) men and 849 (36.56%) women. The municipalities with the highest values of SRR and PP were located on the northwest area: Avilés, Gozón, Carreño, Corvera de Asturias, Castrillón and Illas. A high risk cluster was found for the municipalities of Avilés, Gozón y Corvera de Asturias. Conclusions The spatial analysis showed high risk of hospitalization for asthma on the municipalities of the northwest area of the study, which highlight the existence of spatial inequalities on the distribution of urgent hospital admissions.
Published: 2023
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5. Spatial distribution of unscheduled hospital admissions for chronic obstructive pulmonary disease in the central area of Asturias, Spain

Author: Isabel Martínez-Pérez, Verónica González-Iglesias, Valentín Rodríguez Suárez, and Ana Fernández-Somoano
Subjects: COPD, Chronic obstructive pulmonary disease, Spatial distribution, Disease mapping, Diseases of the respiratory system, RC705-779
Abstract: Abstract Background Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality worldwide and also reports high morbidity rates and the global burden COPD has continued to rise over the last several decades. The best-known COPD risk factors are tobacco smoke and air pollution, but genetics, age, sex, and socioeconomic status are additional factors. This study aimed to assess the spatial distribution of unscheduled COPD hospital admissions of men and women in the central area of Asturias during 2016–2018 and identify trends, spatial patterns, or clusters in the area. Methods Unscheduled COPD hospital admissions in the central area of Asturias were registered, geocoded, and grouped by census tracts (CTs), age, and sex. Standardized admission ratio, smoothed relative risk, posterior risk probability, and spatial clusters between relative risks throughout the study area were calculated and mapped. Results The spatial distribution of COPD hospital admissions differed between men and women. For men, high-risk values were located primarily in the northwestern area of the study, whereas for women the cluster pattern was not as clear and high-risk CTs also reached central and southern areas. In both men and women, the north-northwest area included the majority of CTs with high-risk values. Conclusions The present study showed the existence of a spatial distribution pattern of unscheduled COPD hospital admissions in the central area of Asturias that was more pronounced for men than for women. This study could provide a starting point for generating knowledge about COPD epidemiology in Asturias.
Published: 2023
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6. Cardiovascular risk factors and its patterns of change between 4 and 8 years of age in the INMA-Asturias cohort.

Author: Rocío Fernández-Iglesias, Ana Fernández-Somoano, Cristina Rodríguez-Dehli, Rafael Venta-Obaya, Isolina Riaño-Galán, and Adonina Tardón
Subjects: Medicine, Science
Abstract: AimThis study aimed to investigate whether there are subgroups of children with different clusters of cardiovascular disease (CVD) risk factors at 4 and 8 years of age, and their patterns of change between these two time points.MethodsThe analysis was conducted in 332 children who participated in the INMA-Asturias cohort (Spain) at 4 and at 8 years of age. The CVD risk factors were central obesity, dyslipidaemia, hyperglycaemia, and hypertension. Latent transition analysis was used to identify the different clusters and their probabilities of change.ResultsAt 4 years, three subgroups were identified: no disorders (prevalence of 55.9%); some disorders (21.2%), and central obesity (22.9%). Three distinct subgroups were identified at 8 years: no disorders (59.8%); hypertension (17.9%), and central obesity (22.3%). Central obesity at 4 years tends to appear simultaneously with dyslipidaemia, while at 8 years it tends to appear simultaneously with dyslipidaemia and/or hypertension. Children aged 4 years with no disorders had a 93.7% probability of remaining in the same status at 8 years of age. Children aged 4 who had some disorders had a 67.7% of probability of having only hypertension and a 32.3% of probability of having central obesity. Children aged 4 in the central obesity subgroup had a 32.4% of probability of having no disorders at 8 years of age, while 67.6% still had central obesity.ConclusionsThese exploratory findings suggest that children who do not present any disorder at 4 years of age tend to remain in that state at 8 years of age. And also that central obesity may play a major role in the development of other disorders, as the number of disorders with which it concomitantly occurs increases between the ages of 4 and 8 years.
Published: 2023
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7. Statistical Considerations for Analyzing Data Derived from Long Longitudinal Cohort Studies

Author: Rocío Fernández-Iglesias, Pablo Martínez-Camblor, Adonina Tardón, and Ana Fernández-Somoano
Subjects: missing data, quantile regression, tracking, cohort studies, children’s health, cardiovascular risk, Mathematics, QA1-939
Abstract: Modern science is frequently based on the exploitation of large volumes of information storage in datasets and involving complex computational architectures. The statistical analyses of these datasets have to cope with specific challenges and frequently involve making informed but arbitrary decisions. Epidemiological papers have to be concise and focused on the underlying clinical or epidemiological results, not reporting the details behind relevant methodological decisions. In this work, we used an analysis of the cardiovascular-related measures tracked in 4–8-year-old children, using data from the INMA-Asturias cohort for illustrating how the decision-making process was performed and its potential impact on the obtained results. We focused on two particular aspects of the problem: how to deal with missing data and which regression model to use to evaluate tracking when there are no defined thresholds to categorize variables into risk groups. As a spoiler, we analyzed the impact on our results of using multiple imputation and the advantage of using quantile regression models in this context.
Published: 2023
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8. Impact of a COVID-19 Outbreak in an Elderly Care Home after Primary Vaccination

Author: Elba Mauriz, José P. Fernández-Vázquez, Cristina Díez-Flecha, Sofía Reguero-Celada, Tania Fernández-Villa, Ana Fernández-Somoano, Joan A. Caylà, Jesús A. Lozano-García, Ana M. Vázquez-Casares, and Vicente Martín-Sánchez
Subjects: initial vaccination, elderly care home, pre-existing medical conditions, nursing home, vaccination coverage, Medicine
Abstract: Elderly care home residents are particularly vulnerable to COVID-19 due to immune-senescence, pre-existing medical conditions, and the risk of transmission from staff and visitors. This study aimed to describe the outcomes of a COVID-19 outbreak in a long-term care facility for elderly persons following the initial vaccination. A single-center, retrospective, observational design was used to analyze the variables associated with hospitalization and death rate by logistic regression. Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated. Sixty-eight residents received the first dose of the COVID-19 vaccine. Despite being negative six days after vaccination, the performance of a second test 4 days later revealed 51 positives (75.0%) among residents and 18 among workers (56.3%). A total of 65 of the 68 residents (95.58%) had positive results with symptoms, whereas 34.9% required hospitalization, and 25.8% died. The best-fitting model to explain the distribution of cases reflects three points at the time of infection.. The time from vaccination to symptom onset explains the hospitalization and mortality rates since a day elapsed halves the risk of hospitalization (aOR = 0.57; CI = 0.38−0.75) and the risk of death by a quarter (aOR = 0.74; CI = 0.63−0.88). Nursing homes present an elevated risk of transmission and severity of SARS-CoV-2 infection. Although vaccination reduces the risk of hospitalization and death, extreme prevention and control measures are essential in these institutions despite the high vaccination coverage.
Published: 2023
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9. Arsenic exposure and respiratory outcomes during childhood in the INMA study.

Author: Antonio J Signes-Pastor, Susana Díaz-Coto, Pablo Martinez-Camblor, Manus Carey, Raquel Soler-Blasco, Miguel García-Villarino, Ana Fernández-Somoano, Jordi Julvez, Paula Carrasco, Aitana Lertxundi, Loreto Santa Marina, Maribel Casas, Andrew A Meharg, Margaret R Karagas, and Jesús Vioque-Lopez
Subjects: Medicine, Science
Abstract: Ingested inorganic arsenic (iAs) is a human carcinogen that is also linked to other adverse health effects, such as respiratory outcomes. Yet, among populations consuming low-arsenic drinking water, the impact of iAs exposure on childhood respiratory health is still uncertain. For a Spanish child study cohort (INfancia y Medio Ambiente-INMA), low-arsenic drinking water is usually available and ingestion of iAs from food is considered the major source of exposure. Here, we explored the association between iAs exposure and children's respiratory outcomes assessed at 4 and 7 years of age (n = 400). The summation of 4-year-old children's urinary iAs, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) was used as a biomarker of iAs exposure (∑As) (median of 4.92 μg/L). Children's occurrence of asthma, eczema, sneeze, wheeze, and medication for asthma and wheeze at each assessment time point (i.e., 4- and 7-year) was assessed with maternal interviewer-led questionnaires. Crude and adjusted Poisson regression models using Generalized Estimating Equation (GEE) were performed to account for the association between natural logarithm transformed (ln) urinary ∑As in μg/L at 4 years and repeated assessments of respiratory symptoms at 4 and 7 years of age. The covariates included in the models were child sex, maternal smoking status, maternal level of education, sub-cohort, and children's consumption of vegetables, fruits, and fish/seafood. The GEE-splines function using Poisson regression showed an increased trend of the overall expected counts of respiratory symptoms with high urinary ∑As. The adjusted expected counts (95% confidence intervals) at ln-transformed urinary ∑As 1.57 (average concentration) and 4.00 (99th percentile concentration) were 0.63 (0.36, 1.10) and 1.33 (0.61, 2.89), respectively. These exploratory findings suggest that even relatively low-iAs exposure levels, relevant to the Spanish and other populations, may relate to an increased number of respiratory symptoms during childhood.
Published: 2022
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10. Prenatal air pollution exposure and growth and cardio-metabolic risk in preschoolers

Author: Serena Fossati, Damaskini Valvi, David Martinez, Marta Cirach, Marisa Estarlich, Ana Fernández-Somoano, Mònica Guxens, Carmen Iñiguez, Amaia Irizar, Aitana Lertxundi, Mark Nieuwenhuijsen, Ibon Tamayo, Jesus Vioque, Adonina Tardón, Jordi Sunyer, and Martine Vrijheid
Subjects: Environmental sciences, GE1-350
Abstract: Objectives: We investigated the association between outdoor air pollutants exposure in the first trimester of pregnancy, and growth and cardio-metabolic risk at four years of age, and evaluated the mediating role of birth weight. Methods: We included mother-child pairs (N = 1,724) from the Spanish INMA birth cohort established in 2003–2008. First trimester of pregnancy nitrogen dioxide (NO2) and fine particles (PM2.5) exposure levels were estimated. Height, weight, waist circumference, blood pressure, and lipids were measured at four years of age. Body mass index (BMI) trajectories from birth to four years were identified. Results: Increased PM2.5 exposure in the first trimester of pregnancy was associated with decreased z-scores of weight (zWeight) and BMI (zBMI) (zWeight change per interquartile range increase in PM2.5 exposure = −0.12; 95% CI: −0.23, −0.01; zBMI change = −0.12; 95% CI: −0.23, −0.01). Higher NO2 and PM2.5 exposure was associated to a reduced risk of being in a trajectory with accelerated BMI gain, compared to children with the average trajectory. Birth weight partially mediated the association between PM2.5 and zWeight and zBMI. PM2.5 and NO2 were not associated with the other cardio-metabolic risk factors. Conclusions: This comprehensive study of many growth and cardio-metabolic risk related outcomes suggests that air pollution exposure during pregnancy may be associated with delays in physical growth in the early years after birth. These findings imply that pregnancy exposure to air pollutants has a lasting effect on growth after birth and require follow-up at later child ages. Keywords: Air pollution, Prenatal exposure, Childhood growth, Childhood obesity, Particulate matter
Published: 2020
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11. Mother-child transfer rates of organohalogen compounds up to four years of age

Author: Mercè Garí, Joan O. Grimalt, Esther Vizcaino, Adonina Tardón, and Ana Fernández-Somoano
Subjects: Environmental sciences, GE1-350
Abstract: Background: Breastfed children absorb persistent and toxic chemicals such as organohalogen compounds (OHCs) during the entire lactation period. Nursing is a main contributor to the burden of these pollutants in the first years of life, hence further assessments on the OHC load processes are needed. Objectives: To identify the determinants of OHC increase in children at four years of age, considering concentration gains, maternal venous concentrations and breastfeeding time. Methods: Concentrations of 19 organochlorine compounds (OCs) and 14 polybrominated diphenyl ethers (PBDEs) were analyzed in maternal venous (n = 466), cord blood (n = 326) and children venous serum at four years of age (n = 272) in the Asturias INMA cohort representing the Spanish general population. Data were evaluated considering the socio-demographic and individual information collected at recruitment and follow up surveys, as well as the OHC physical-chemical constants. Results: The four years-old children concentration gains of the most abundant OHCs showed strong correlations (R2 = 0.65–0.93) with the maternal concentrations during pregnancy and lactation period. The child gain/maternal transfer rates of most correlated pollutants were similar. Discussion: Between 65 and 93% of the variance of OCs in four years-old children was explained by the maternal concentrations during pregnancy and the lactation period. The compounds with log(Kow) > 3.7 (hydrophobic) showed analogous child gain/maternal transfer rates indicating similar processes of membrane lipid dissolution and passive diffusion from the epithelial cells into the milk. Molecular weight of these pollutants did not influence on these rates. Compounds with low log(Koa) such as hexachlorobenzene are more volatile and less retained, involving lower child gain/maternal transfer rates. These results may be useful to anticipate the increase of the concentrations of OCs in children using the maternal concentration of these compounds during pregnancy and the planned lactation period and to implement prophylactic measures in mothers with high venous pollutant concentrations. Keywords: Organochlorine compounds, Polybrominated diphenyl ethers, Breastfeeding, Maternal and children body burdens, Concentration gains of organochlorine compounds at four years, Physical-chemical constants influencing in maternal-child transfer
Published: 2019
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12. Prenatal and postnatal exposure to air pollution and emotional and aggressive symptoms in children from 8 European birth cohorts

Author: Ainhoa Jorcano, Małgorzata J. Lubczyńska, Livia Pierotti, Hicran Altug, Ferran Ballester, Giulia Cesaroni, Hanan El Marroun, Ana Fernández-Somoano, Carmen Freire, Wojciech Hanke, Gerard Hoek, Jesús Ibarluzea, Carmen Iñiguez, Pauline W. Jansen, Johanna Lepeule, Iana Markevych, Kinga Polańska, Daniela Porta, Tamara Schikowski, Remy Slama, Marie Standl, Adonina Tardon, Tanja G.M. Vrijkotte, Andrea von Berg, Henning Tiemeier, Jordi Sunyer, and Mònica Guxens
Subjects: Environmental sciences, GE1-350
Abstract: Background: The association between air pollution exposure and emotional and behavioural problems in children is unclear. We aimed to assess prenatal and postnatal exposure to several air pollutants and child's depressive and anxiety symptoms, and aggressive symptoms in children of 7–11 years. Methods: We analysed data of 13182 children from 8 European population-based birth cohorts. Concentrations of nitrogen dioxide (NO2), nitrogen oxides (NOx), particulate matter (PM) with diameters of ≤10 μm (PM10), ≤ 2.5 μm (PM2.5), and between 10 and 2.5 μm (PMcoarse), the absorbance of PM2.5 filters (PM2.5abs), and polycyclic aromatic hydrocarbons (PAHs) were estimated at residential addresses of each participant. Depressive and anxiety symptoms and aggressive symptoms were assessed at 7–11 years of age using parent reported tests. Children were classified in borderline/clinical range or clinical range using validated cut offs. Region specific models were adjusted for various socio-economic and lifestyle characteristics and then combined using random effect meta-analysis. Multiple imputation and inverse probability weighting methods were applied to correct for potential attrition bias. Results: A total of 1896 (14.4%) children were classified as having depressive and anxiety symptoms in the borderline/clinical range, and 1778 (13.4%) as having aggressive symptoms in the borderline/clinical range. Overall, 1108 (8.4%) and 870 (6.6%) children were classified as having depressive and anxiety symptoms, and aggressive symptoms in the clinical range, respectively. Prenatal exposure to air pollution was not associated with depressive and anxiety symptoms in the borderline/clinical range (e.g. OR 1.02 [95%CI 0.95 to 1.10] per 10 μg/m3 higher NO2) nor with aggressive symptoms in the borderline/clinical range (e.g. OR 1.04 [95%CI 0.96 to 1.12] per 10 μg/m3 higher NO2). Similar results were observed for the symptoms in the clinical range, and for postnatal exposures to air pollution. Conclusions: Overall, our results suggest that prenatal and postnatal exposure to air pollution is not associated with depressive and anxiety symptoms or aggressive symptoms in children of 7 to 11 years old. Keywords: Air pollution, Depressive symptoms, Anxiety symptoms, Aggressive symptoms, children's mental health
Published: 2019
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13. Variaciones en el proceso de confirmación diagnóstica entre unidades de cribado poblacional de cáncer de mama

Author: Carmen Natal, Ana Fernández-Somoano, Isabel Torá-Rocamora, Adonina Tardón, and Xavier Castells
Subjects: Cáncer de mama, Detección precoz de cáncer, Técnicas y procedimientos diagnósticos, Variaciones en la práctica médica, Análisis de áreas pequeñas, Evaluación de servicios sanitarios, Public aspects of medicine, RA1-1270
Abstract: Objetivo: Analizar las variaciones en el proceso de confirmación diagnóstica entre unidades de cribado, las variaciones en los resultados de cada episodio y la relación entre las tasas de las diferentes pruebas de confirmación diagnóstica y las de detección de lesiones. Método: Estudio observacional de las variaciones de las tasas estandarizadas de pruebas diagnósticas y de detección de lesiones, en 34 unidades de cribado de los programas poblacionales de detección precoz de cáncer de mama, de tres comunidades autónomas, en el periodo de 2002 a 2011. Resultados: Las razones de variación entre los percentiles 25-75 en las tasas de realización de pruebas diagnósticas oscilaron entre 1,68 (recitaciones) y 3,39 (punción-aspiración con aguja fina). En las tasas de detección de lesiones benignas, carcinoma ductal in situ y cáncer invasivo fueron, respectivamente, 2,79, 1,99 y 1,36. Se encontró una relación positiva entre las tasas de realización de pruebas y las tasas de detección en punción-aspiración con aguja fina y lesiones benignas (R2: 0,53), punción-aspiración con aguja fina y carcinoma invasivo (R2: 0, 28), biopsias cerradas y lesiones benignas (R2: 0,64), biopsias cerradas y carcinoma ductal in situ (R2: 0,61), y biopsias cerradas y carcinoma invasivo (R2: 0,48). Conclusiones: Se observaron variaciones en la realización de pruebas invasivas entre las unidades de detección precoz de cáncer de mama de mayor magnitud que las de detección de lesiones. Las unidades con más pruebas de punción-aspiración con aguja fina tienen mayores tasas de detección de lesiones benignas, y las que realizan más biopsias cerradas detectan más lesiones benignas y cáncer.
Published: 2016
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14. Estudio de la evolución de la exposición a plomo en la población infantil española en los últimos 20 años: ¿Un ejemplo no reconocido de «salud en todas las políticas»? Trend in lead exposure in the Spanish child population in the last 20 years: An unrecognized example of health in all policies?

Author: Sabrina Llop, Miquel Porta, Maria Dolores Martinez, Xabier Aguinagalde, Mariana F. Fernández, Ana Fernández-Somoano, Maribel Casas, Martine Vrijheid, Mikel Ayerdi, Adonina Tardón, and Ferran Ballester
Subjects: Plomo, Exposición a riesgos ambientales, Salud del niño, Intoxicación del sistema nervioso por plomo en la infancia, Medio ambiente y salud pública, España, Lead, Environmental exposure, Child health, Lead poisoning, Nervous system, Childhood, Environment and public health, Spain, Public aspects of medicine, RA1-1270
Abstract: Objetivo: Describir la evolución temporal de las concentraciones de plomo en el aire en España, desde antes de su prohibición como aditivo de la gasolina hasta la actualidad, así como estudiar la evolución de la carga corporal de plomo en la población infantil española. Métodos: Se obtuvieron las concentraciones medias anuales de plomo en el aire en diversas ciudades españolas, desde la década de 1980 hasta la actualidad. Se realizó una búsqueda bibliográfica con el fin de identificar estudios publicados sobre concentraciones de plomo en la población infantil española. Resultados: En general se observó una disminución de las concentraciones de plomo, de mayor magnitud entre 1991 y 1999. Esta evolución decreciente se asocia con una disminución de las concentraciones de plomo en la población infantil española, desde 1989 (año en que se publica el primer estudio sobre exposición infantil al plomo) hasta hoy. La disminución, tanto en el aire como en la población infantil, es muy probable que sea consecuencia de las medidas legislativas que han regulado la cantidad máxima de plomo en la gasolina, desde 1987 hasta su prohibición total en agosto de 2001. Conclusiones: Desde el punto de vista de la salud pública, la prohibición del uso de gasolina con plomo fue una acción que aumentó la protección de la salud de la población española.Objective: To describe the time trend in atmospheric lead concentrations in Spain, from before lead was banned as a gasoline additive to the present, and to determine the trend in lead body burden in the Spanish child population. Methods: We obtained the annual average for atmospheric lead levels in several Spanish cities from the 1980s to the present. A literature search was conducted to identify published studies on lead concentrations in populations of Spanish children. Results: Overall, atmospheric lead levels decreased, particularly between 1991 and 1999. This downward trend was related to a decrease in lead concentrations in Spanish children from 1989, the year in which the first study of childhood lead exposure was published, until the present. The decreased concentrations in both air and in children was most probably a result of legislative measures regulating the maximum amount of lead in gasoline in 1987 until a complete ban in August 2001. Conclusions: From a public health point of view, the banning of leaded gasoline has significantly increased health protection in the Spanish population.
Published: 2013

15. Gastroenterology: evolution of specialty choice in recent years

Author: José Curbelo, José María Galván-Román, Fernando Sánchez-Lasheras, Jose María Romeo, Ana Fernández-Somoano, Tomás Villacampa, and Jaime Baladrón
Subjects: Gastroenterology, Specialization, Choice, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Introduction: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. Material and methods: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. Results: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. Conclusions: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity.
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16. Children who sleep more may have longer telomeres

Author: Fanny Petermann-Rocha, Desirée Valera-Gran, Paula Fernández-Pires, Dries S. Martens, Jordi Júlvez, Cristina Rodríguez-Dehli, Ainara Andiarena, Manuel Lozano, Ana Fernández-Somoano, Aitana Lertxundi, Sabrina Llop, Mònica Guxens, Tim S. Nawrot, Eva-María Navarrete-Muñoz, and Child and Adolescent Psychiatry / Psychology
Subjects: Pediatrics, Perinatology and Child Health
Abstract: This study was funded by Instituto de Salud Carlos III/Agencia Estatal de Investigación, grant number PI18/00825 Project: ‘Dieta y actividad física en embarazo y tras el nacimiento y longitud del telómero en niños y adolescentes: Proyecto TeloDiPA’ and Unión Europea (FEDER) ‘Una manera de hacer Europa’; Generalitat Valenciana (GVA/2021/191); D.S.M. holds a postdoctoral grant by the Flemish Scientific Fund (FWO grant 12X9620N). In Sabadell, this study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; PI041436; PI081151 incl. FEDER funds; PI12/01890 incl. FEDER funds; CP13/00054 incl. FEDER funds, PI15/00118 incl. FEDER funds, CPII18/00018), CIBERESP, Generalitat de Catalunya-CIRIT 1999SGR 00241, Generalitat de Catalunya-AGAUR (2009 SGR 501, 2014 SGR 822), Fundació La marató de TV3 (090430), Spanish Ministry of Economy and Competitiveness (SAF2012-32991 incl. FEDER funds), Agence Nationale de Securite Sanitaire de l’Alimentation de l’Environnement et du Travail (1262C0010), EU Commission (261357, 308333, 603794 and 634453). We acknowledge support from the Spanish Ministry of Science and Innovation and the State Research Agency through the ‘Centro de Excelencia Severo Ochoa 2019–2023’ Program (CEX2018-000806-S) and support from the Generalitat de Catalunya through the CERCA Program. In Asturias, this study was funded by ISCIII: PI04/2018, PI09/02311, PI13/02429, PI18/00909 co-funded by FEDER, ‘A way to make Europe’/‘Investing in your future’, Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo. In Valencia, this study was supported by grants from Instituto de Salud Carlos III [FIS-FEDER: 13/1944, 16/1288, 19/1338; Miguel Servet-FSE: MS15/0025, MSII20/0006 incl. FEDER funds], Generalitat Valenciana [AICO/2020/285] and Gobierno de España through Ministerio de Universidades under the grant CAS21/00008., Petermann-Rocha F, Valera-Gran D, Fernández-Pires P, Martens DS, Júlvez J, Rodríguez-Dehli C, Andiarena A, Lozano M, Fernández-Somoano A, Lertxundi A, Llop S, Guxens M, Nawrot TS, Navarrete-Muñoz EM
Published: 2023

17. Sedentary Behaviour and Telomere Length Shortening during Early Childhood: Evidence from the Multicentre Prospective INMA Cohort Study

Author: Daniel Prieto-Botella, Dries S. Martens, Desiree Valera-Gran, Mikel Subiza-Pérez, Adonina Tardón, Manuel Lozano, Maribel Casas, Mariona Bustamante, Alba Jimeno-Romero, Ana Fernández-Somoano, Sabrina Llop, Martine Vrijheid, Tim S. Nawrot, Eva-María Navarrete-Muñoz, Prieto-Botella, Daniel, MARTENS, Dries, Valera-Gran, Desiree, Subiza-Pérez, Mikel, Tardón, Adonina, Lozano, Manuel, Casas, Maribel, Bustamante, Mariona, Jimeno-Romero, Alba, Fernández-Somoano, Ana, Llop, Sabrina, Vrijheid, Martine, NAWROT, Tim, and Navarrete-Muñoz, Eva-María
Subjects: lifestyle, cellular longevity, children, epigenetics, genetics, screen time, Health, Toxicology and Mutagenesis, Public Health, Environmental and Occupational Health
Abstract: Sedentary behaviour (SB) may be related to telomere length (TL) attrition due to a possible pro-inflammatory effect. This study examined the association between parent-reported sedentary behaviour (SB) and leukocyte TL at the age of 4 and telomere tracking from 4 to 8 years. In the Spanish birth cohort Infancia y Medio Ambiente (INMA) project, we analysed data from children who attended follow-up visits at age 4 (n = 669) and 8 (n = 530). Multiple robust regression models were used to explore the associations between mean daily hours of SB (screen time, other sedentary activities, and total SB) at 4 years categorised into tertiles and TL at 4 years and difference in TL rank between age 4 and 8, respectively. At the age of 4, the results showed that children with the highest screen time (1.6–5.0 h/day) had a shorter TL of −3.9% (95% CI: −7.4, −0.4; p = 0.03) compared with children in the lowest tertile (0.0–1.0 h/day). Between 4 and 8 years, a higher screen time (highest tertile group vs. lowest tertile) was associated with a decrease in the LTL rank of −1.9% (95% CI: −3.8, −0.1; p = 0.03) from 4 to 8 years. Children exposed to a higher screen time at 4 years were more prone to have shorter TL at 4 and between 4 and 8 years of age. This study supports the potential negative effect of SB during childhood on cellular longevity. This research was funded by the Instituto de Salud Carlos III/Agencia Estatal de Investigación (PI18/00825: “Dieta y actividad física en embarazo y tras el nacimiento y longitud del telómero en niños y adolescentes: Proyecto TeloDiPA” and European Regional Development Fund (ERDF): “Una manera de hacer Europa”); the Generalitat Valenciana (GVA/2021/191, CIAICO/2021/132); the Instituto de Salud Carlos III (FIS-PI09/00090, PI04/2018, PI09/02311, PI13/02429, PI16/1288, PI18/00909, PI19/1338 and FIS-PI18/01142 incl. ERFD funds, PS20/0006), the Department of Health of the Basque Government (2013111089); the Instituto de Salud Carlos III (FIS-PI13/02187 and FIS-PI18/01142 incl. ERFD funds), the Department of Health of the Basque Government (2015111065), and the Provincial Government of Gipuzkoa (DFG15/221) and annual agreements with the municipalities of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain); Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo; and Gobierno de España through Ministerio de Universidades under the grants CAS21/00008 and NextGenerationEU. DPB was supported by the Miguel Hernández University (Ayudas Movilidad Internacional 2021, Erasmus+ 2021) during the development of this study. In addition, DM holds a postdoctoral grant by the Flemish Scientific Fund (FWO grant 12X9620N). The funders had no role in the design of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval and submission of the manuscript. The APC was funded by PI18/00825.
Published: 2023

18. Associations between Gestational Exposure to Air Pollution and Maternal Vitamin D Levels

Author: Akhgar Ghassabian, Anne-Claire Binter, Hanan El Marroun, Kinga Polanska, Karen Switkowski, Tanja G. Vrijkotte, Rosie McEachan, Ana Fernández Somoano, Marisa Estarlich, Aitana Lertxundi, Jordi Sunyer, and Mònica Guxens
Subjects: General Earth and Planetary Sciences, General Environmental Science
Published: 2022
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19. Adherence to Mediterranean diet and metal exposure during childhood in the INMA study

Author: Leyre Notario, Raquel Soler, Gabriel Riutort, Jesús Ibarluzea, Loreto Santa-Marina, Martine Vrijheid, Jesús Vioque, Andrew Meharg, Manus Carey, Maribel Casas, Adonina Tardón, Ana Fernández Somoano, and Antonio J Signes Pastor
Subjects: General Earth and Planetary Sciences, General Environmental Science
Published: 2022
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20. Environmental and dietary determinants of metal exposure in four-year-old children from a cohort located in an industrial area (Asturias, Northern Spain)

Author: Ana Fernández Somoano, Eva Junqué, Adonina Tardon, Joan Grimalt, and European Commission
Subjects: Red meat consumption and urinary metals, Biochemistry, Arsenic, Zinc, Lead, Spain, Oil pollution metals, Children exposure, Traffic exposure and urinary metals, Animals, Humans, Metals and seafood, Metals in urine, Cadmium, General Environmental Science
Abstract: Urine samples from four-year-old children located in a heavily industrialized zone in Asturias (Spain) were collected between 2009 and 2012 (n = 334). Vanadium (V; median 54 μg/g creatinine), cobalt (Co; 1.0 μg/g c.), nickel (Ni; 3.8 μg/g c.), copper (Cu; 22 μg/g c.), zinc (Zn; 590 μg/g c.), arsenic (As; 64 μg/g c.), selenium (Se; 49 μg/g c.), molybdenum (Mo; 110 μg/g c.), cadmium (Cd; 0.27 μg/g c.), antimony (Sb; 1.0 μg/g c.), cesium (Cs; 14 μg/g c.), barium (Ba; 2.6 μg/g c.), thallium (Tl; 0.55 μg/g c.) and lead (Pb; 1.9 μg/g c.) were analysed. Comparison with children from other sites showed that this Asturias cohort was characterized by high levels of V, As, Sb, Cs and Tl. The concentrations of Co, Ni, Zn, Cu, Mo, Se, Cd, Ba and Pb were within the range of other cohorts. Terrestrial dietary items were most strongly related to increased urinary concentrations of metals in children, e.g., red meat with Ba and Ni, pasta/cereal with Ni and Zn, sweets with Zn, Co, and Cu, eggs with Mo, Cd, and Cs, and dairy products with Co and Sb. Seafood was the second group of dietary items significantly related to increased metals, e.g., shellfish with Ba, Cs, Pb, and V, fatty fish with As, and lean fish with As and Se. In contrast, higher fruit intake was significantly associated with decreased Cu and Sb, and higher legume intake with decreased Cu, Se and Cs. Higher intakes of other dietary items also led to significant decreases in some metals, such as vegetables and lower concentrations of Se and Mo, and dairy products with decreases in Cu and As. These negative correlations implied very low concentrations of the mentioned metals in these foods. Higher exposure to traffic was associated with higher concentrations of Ba, present in brake components. Children living outside urban areas had higher concentrations of Se. No association of metals with smoking in the family was found., The authors would particularly like to thank all the participants for their generous collaboration and the staff from Hospital San Agustin in Aviles for their effort. This study was funded by grants from CIBERESP, FIS-FEDER (PI04/2018, PI09/02311, PI13/02429, PI18/00909), Obra Social Cajastur/Fundación Liberbank and Oviedo University. This paper was also supported by funding from the European Union projects: EDCMET (H2020-HEALTH/0490–825762) and PARC (HLTH-2021-ENVHLTH-3:101057014).
Published: 2022

21. The popularity of neurology in Spain: an analysis of specialty selection

Author: José María Galván-Román, P. Jiménez-Fonseca, Ana Fernández-Somoano, Jose Curbelo, Jose María Romeo, Jaime Baladrón, Fernando Sánchez-Lasheras, Elena H. Martinez-Lapiscina, T. Villacampa, and J. Vega-Villar
Subjects: medicine.medical_specialty, Neurology, business.industry, Specialty, Social Welfare, University hospital, Popularity, Formación, lcsh:RC346-429, 03 medical and health sciences, Elección, 0302 clinical medicine, Intervention (counseling), Family medicine, Medicine, Christian ministry, business, Neurología, 030217 neurology & neurosurgery, Selection (genetic algorithm), lcsh:Neurology. Diseases of the nervous system
Abstract: Introduction: Neurology is one of the medical specialties offered each year to residency training candidates. This project analyses the data associated with candidates choosing neurology residency programmes in recent years. Methods: Data related to specialty selection were obtained from official reports by the Spanish Ministry of Health, Social Services, and Equality. Information was collected on several characteristics of teaching centres: availability of stroke units, endovascular intervention, national reference clinics for neurology, specific on-call shifts for neurology residents, and links with medical schools or national research networks. Results: The median selection list position of candidates selecting neurology training has been higher year on year; neurology was among the 4 most popular residency programmes in 2016. Potential residents were mainly female, Spanish, and had good academic results. The median number of hospitals with higher numbers of beds, endovascular intervention, stroke units, and national reference clinics for neurology is significantly lower. This is also true when centres are analysed by presence of specific on-call shifts for neurology residents and association with medical schools or national research networks. The centres selected by candidates with the highest median selection list position in 2012-2016 were the Clínico San Carlos, 12 de Octubre, and Vall d’Hebron university hospitals. Conclusions: Neurology has gradually improved in residency selection choices and is now one of the 4 most popular options. Potential residents prefer larger centres which are more demanding in terms of patient care and which perform more research activity. Resumen: Introducción: Neurología es una de las especialidades ofertadas a los opositores que acceden a la formación sanitaria especializada cada año. Este proyecto analiza los datos de elección de Neurología en los últimos años. Material y métodos: Los datos de la elección se han obtenido de la publicación oficial del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se ha recabado información de los distintos centros docentes con relación a la disponibilidad de unidad de ictus, intervencionismo endovascular, consultas de referencia nacional relacionadas con Neurología, guardias específicas para residentes y vinculación con facultades de medicina o redes de investigación nacional. Resultados: La mediana de elección de número de orden para Neurología ha descendido anualmente, situando la especialidad en la convocatoria 2016 entre las cuatro más populares. Los electores son mayoritariamente mujeres de nacionalidad española y baremo académico alto. La mediana de los hospitales con mayor número de camas, intervencionismo vascular, unidad de ictus o consultas de referencia nacional es significativamente menor. Lo mismo sucede al analizar los centros según guardias específicas de Neurología para residentes o vinculación con facultades de medicina o redes de investigación nacionales. Los centros con menor mediana de número de orden para el periodo 2012-2016 fueron los hospitales universitarios Clínico San Carlos, 12 de Octubre y Vall d’Hebron. Conclusiones: Neurología ha ido mejorando de manera progresiva en la elección de plazas de especialización, situándose entre las cuatro más populares. Los electores se decantan por centros grandes, de mayor complejidad asistencial y con intensa actividad investigadora.
Published: 2020

22. Popularidad de Neurología en España: análisis de la elección de la especialidad

Author: José María Galván-Román, Jose Curbelo, Jaime Baladrón, P. Jiménez-Fonseca, T. Villacampa, J. Vega-Villar, Elena H. Martinez-Lapiscina, Fernando Sánchez-Lasheras, Jose María Romeo, and Ana Fernández-Somoano
Subjects: 03 medical and health sciences, 0302 clinical medicine, Neurology, Training, 030212 general & internal medicine, Neurology (clinical), Selection, lcsh:Neurology. Diseases of the nervous system, lcsh:RC346-429, 030218 nuclear medicine & medical imaging
Abstract: Resumen: Introducción: Neurología es una de las especialidades ofertadas a los opositores que acceden a la formación sanitaria especializada cada año. Este proyecto analiza los datos de elección de Neurología en los últimos años. Material y métodos: Los datos de la elección se han obtenido de la publicación oficial del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se ha recabado información de los distintos centros docentes con relación a la disponibilidad de unidad de ictus, intervencionismo endovascular, consultas de referencia nacional relacionadas con Neurología, guardias específicas para residentes y vinculación con facultades de medicina o redes de investigación nacional. Resultados: La mediana de elección de número de orden para Neurología ha descendido anualmente, situando la especialidad en la convocatoria 2016 entre las cuatro más populares. Los electores son mayoritariamente mujeres de nacionalidad española y baremo académico alto. La mediana de los hospitales con mayor número de camas, intervencionismo vascular, unidad de ictus o consultas de referencia nacional es significativamente menor. Lo mismo sucede al analizar los centros según guardias específicas de Neurología para residentes o vinculación con facultades de medicina o redes de investigación nacionales. Los centros con menor mediana de número de orden para el periodo 2012-2016 fueron los hospitales universitarios Clínico San Carlos, 12 de Octubre y Vall d’Hebron. Conclusiones: Neurología ha ido mejorando de manera progresiva en la elección de plazas de especialización, situándose entre las cuatro más populares. Los electores se decantan por centros grandes, de mayor complejidad asistencial y con intensa actividad investigadora. Abstract: Introduction: Neurology is one of the medical specialties offered each year to residency training candidates. This project analyses the data associated with candidates choosing neurology residency programmes in recent years. Methods: Data related to specialty selection were obtained from official reports by the Spanish Ministry of Health, Social Services, and Equality. Information was collected on several characteristics of teaching centres: availability of stroke units, endovascular intervention, national reference clinics for neurology, specific on-call shifts for neurology residents, and links with medical schools or national research networks. Results: The median selection list position of candidates selecting neurology training has been higher year on year; neurology was among the 4 most popular residency programmes in 2016. Potential residents were mainly female, Spanish, and had good academic results. The median number of hospitals with higher numbers of beds, endovascular intervention, stroke units, and national reference clinics for neurology is significantly lower. This is also true when centers are analysed by presence of specific on-call shifts for neurology residents and association with medical schools or national research networks. The centres selected by candidates with the highest median selection list position in 2012-2016 were the Clínico San Carlos, 12 de Octubre, and Vall d’Hebron university hospitals. Conclusions: Neurology has gradually improved in residency selection choices and is now one of the 4 most popular options. Potential residents prefer larger centres which are more demanding in terms of patient care and which perform more research activity.
Published: 2020
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23. Associations of residential greenspace exposure and fetal growth across four areas in Spain

Author: Maria Torres Toda, Marisa Estarlich, Ferran Ballester, Montserrat De Castro, Ana Fernández-Somoano, Jesús Ibarluzea, Carmen Iñiguez, Aitana Lertxundi, Mikel Subiza-Perez, Jordi Sunyer, Adonina Tardón, Maria Foraster, and Payam Dadvand
Subjects: Health (social science), Parks, Recreational, Geography, Planning and Development, Natural environments, Public Health, Environmental and Occupational Health, Greenness exposure, Fetal development, utrasound measurements, Ultrasound measurements, Spain, Maternal Exposure, Pregnancy, Air Pollution, Humans, Female
Abstract: An accumulating body of evidence has associated exposure to greenspace with improved birth outcomes, including higher birth weight and lower risk of low birth weight; however, evidence on such association with in-utero fetal growth is scarce. We explored the influence of maternal exposure to residential greenspace and fetal growth in four INMA (Infancia y Medio Ambiente) Spanish birth cohorts (2003-2008), with 2,465 participants. Residential greenspace was characterised by the Normalised Difference Vegetation Index (NDVI) average across 100 m, 300 m, and 500 m buffers around the residence. Repeated ultrasound measurements of the abdominal circumference (AC), biparietal diameter (BPD), femur length (FL), and estimated fetal weight (EFW) were used. We created customised-generalised least squares models to evaluate associations of residential greenspace exposure on each fetal growth parameter, controlled for the relevant confounders. There were associations be-tween the 500 m buffer and BPD, FL, and AC. We also found associations in the 300 m buffer and FL and AC. The associations in the 100 m buffer were null. Estimates were higher among participants with lower socioeconomic status. Mediation analyses found that air pollution might explain 15-37% of our associations. Mediation by physical activity was not observed. Greenspace exposure may be beneficial for fetal growth. We are grateful to all the participants for their generous collaboration. A full roster of the INMA Project founders can be found at: https://www.proyectoinma.org/proyecto-inma/financiadores/. Maria Torres Toda is funded by a PFIS (Contrato Predoctoral de Formación en Investigación en Salud) fellowship (FI17/00128) awarded by Instituto de Salud Carlos III. Maria Foraster is beneficiary of an AXA Research Fund grant. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.
Published: 2022

24. Association between the use of folic acid supplements during pregnancy and children's cognitive function at 7-9 years of age in the INMA cohort study

Author: Laura María Compañ-Gabucio, Laura Torres-Collado, Manuela Garcia-de la Hera, Ana Fernández-Somoano, Adonina Tardón, Jordi Julvez, Jordi Sunyer, Marisa Rebagliato, Mario Murcia, Jesús Ibarluzea, Loreto Santa-Marina, and Jesús Vioque
Subjects: Male, Folic acid, Health, Toxicology and Mutagenesis, Attentional function, Public Health, Environmental and Occupational Health, Working memory, Sex specific, Cohort Studies, Cognition, Memory, Short-Term, Pregnancy, Birth cohort study, Dietary Supplements, folic acid, deficiency, high, birth cohort study, working memory, attentional function, sex specific, Humans, Deficiency, Female, Child, High
Abstract: This study investigated the association between maternal low (
Published: 2022

25. Exposure to metal mixture and growth indicators at 4–5 years. A study in the INMA-Asturias cohort

Author: Margaret R. Karagas, Adonina Tardón, Isolina Riaño-Galán, Miguel García-Villarino, Eva Junqué, Antonio J. Signes-Pastor, Ana Fernández-Somoano, Joan O. Grimalt, and Cristina Rodriguez-Dehli
Subjects: inorganic chemicals, Waist, chemistry.chemical_element, Growth, Urine, Biochemistry, Article, Arsenic, Cohort Studies, Metal mixture, Animal science, Linear regression, Birth Weight, Humans, Medicine, Child, Children, General Environmental Science, Cadmium, business.industry, Bayes Theorem, Anthropometry, Circumference, Confidence interval, Bayesian kernel machine regression, chemistry, Metals, Cohort, business, Body mass index
Abstract: Exposure to toxic and non-toxic metals impacts childhood growth and development, but limited data exists on exposure to metal mixtures. Here, we investigated the effects of exposure to individual metals and a mixture of barium, cadmium, cobalt, lead, molybdenum, zinc, and arsenic on growth indicators in children 4-5 years of age., The authors would particularly like to thank the staff from Hospital San Agustin in Aviles for their valuable support and all the participants enrolled in the INMA-Asturias cohort for their generous collaboration. This research was funded by grants from, CIBERESP (PhD-employment-contract and fellowship for short stays abroad-2019), ISCIII: PI04/2018, PI09/02311, PI13/02429, PI18/00909 co-funded by the European Regional Development Fund (FEDER), “A way to make Europe"/"Investing in your future”; Obra Social Cajastur/Fundación Liberbank, and Universidad de Oviedo. A.J.S.P. and M.R.K. are funded by the following projects P01ES022832, RD83544201, R25CA134286, and P42ES007373. A.J.S.P. is also funded by CIDEGENT /2020/050. We thank Katherine Thieltges from Edanz (https://www.edanz.com/ac) for editing a draft of this manuscript.
Published: 2022

26. Serum concentrations of persistent organic pollutants mixture during pregnancy and anogenital distance in 8-year-old children from the INMA-Asturias cohort

Author: Miguel García-Villarino, Antonio J. Signes-Pastor, Isolina Riaño-Galán, Ana Cristina Rodríguez-Dehli, Esther Vizcaíno, Joan O. Grimalt, Ana Fernández-Somoano, and Adonina Tardón
Subjects: Male, BKMR, WQSR models, Anal Canal, Bayes Theorem, Biochemistry, Anogenital distance, Cohort Studies, Persistent Organic Pollutants, Genital development, Maternal Exposure, Pregnancy, Mixtures, Humans, Environmental Pollutants, Female, Child, General Environmental Science
Abstract: During pregnancy, women are commonly exposed to several endocrine-disrupting chemicals, including persistent organic pollutants (POPs). These compounds can transfer to the fetus through the placenta. Prenatal POP exposure is related to altered fetal genital and reproductive tract development. However, the relationship between exposure to POP mixtures and anogenital distance (AGD) is poorly investigated. This study investigated the association between prenatal exposure to POP mixtures and AGD in 8-year-old children., The authors would particularly like to thank all the participants for their generous collaboration and the staff from Hospital San Agustin in Aviles for their effort. This study was funded by grants from, CIBERESP (PhD-employment-contract and fellowship for short stays abroad-2019), ISCIII: PI04/2018, PI09/02311, PI13/02429, PI18/00909 co-funded by FEDER, “A way to make Europe”/“Investing in your future”, Obra Social Cajastur/Fundación Liberbank, and Universidad de Oviedo. Antonio J. Signes-Pastor is currently funded by CIDEGENT/2020/050. We thank Katherine Thieltges from Edanz (https://www.edanz.com/ac) for editing a draft of this manuscript.
Published: 2022
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27. Spatial Distribution of Hospitalizations for Ischemic Heart Diseases in the Central Region of Asturias, Spain

Author: Valentín Rodríguez Suárez, Verónica González-Iglesias, Ana Fernández-Somoano, and Isabel Martínez-Pérez
Subjects: Male, Health, Toxicology and Mutagenesis, Myocardial Infarction, disease mapping, acute myocardial infarction, Disease, Spatial distribution, Article, Angina, angina pectoris, medicine, Humans, Myocardial infarction, Census Tract, Socioeconomic status, spatial distribution, business.industry, Incidence (epidemiology), Incidence, Public Health, Environmental and Occupational Health, Census, medicine.disease, Hospitalization, hospital admission, Spain, Relative risk, Medicine, Female, business, Demography
Abstract: Hospitalizations for ischemic heart disease have an uneven distribution throughout Spain, in which Asturias is the community with the highest rates of acute myocardial infarction (AMI) and angina pectoris (AP). Cardiovascular diseases are related to environmental, socioeconomic and previous medical conditions, which result in geographical differences in the incidence of hospital admissions and mortality. The goal of this study was to describe the spatial distribution of hospital admissions in the central area of Asturias and explore the existence of spatial patterns or clusters. Urgent hospital admissions for AMI and angina AP in the hospitals of the central area of Asturias were registered, geocoded and grouped by census tracts. Standardized admission ratio, smoothed relative risk, posterior risk probability and analysis of spatial clusters between relative risks throughout the study area were calculated and mapped. Geographical differences were found in the distribution of hospital admissions for AMI and AP across the area and between men and women. The cluster analysis indicated contiguous census tracts with high relative risk values in the northwest region of the study area and low relative risk in the east, particularly for men. The geographical analysis shows the existence of patterns and spatial clusters in the incidence of AMI and AP, for both men and women, in the central area of Asturias.
Published: 2021

28. Maternal seafood consumption during pregnancy and child attention outcomes: a cohort study with gene effect modification by PUFA-related genes

Author: Martine Vrijheid, Jordi Julvez, Sílvia Fernández-Barrés, Miguel Burgaleta, Ana Fernández-Somoano, Jesús Ibarluzea, Jordi Sunyer, Raquel Garcia-Esteban, Sabrina Llop, Mónica López-Vicente, Ferran Ballester, Cathryn Tonne, Adonina Tardón, Núria Sebastián-Gallés, Jesús Vioque, Florence Gignac, Mariona Bustamante, Amaia Irazabal, and Dora Romaguera
Subjects: Epidemiology, Single-nucleotide polymorphism, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Environmental health, medicine, Humans, Attention deficit hyperactivity disorder, Prospective Studies, 030212 general & internal medicine, Child, chemistry.chemical_classification, Nutritional epidemiology, business.industry, Incidence (epidemiology), food and beverages, General Medicine, medicine.disease, Diet, Seafood, chemistry, Attention Deficit Disorder with Hyperactivity, Spain, Prenatal Exposure Delayed Effects, Relative risk, Fatty Acids, Unsaturated, Female, business, 030217 neurology & neurosurgery, Cohort study, Polyunsaturated fatty acid
Abstract: Background There is a need to test the fetal programming theoretical framework in nutritional epidemiology. We evaluated whether maternal seafood intake during pregnancy was associated with 8-year-old attention outcomes after adjusting for previous child seafood intake and cognitive function. We also explored effect modification by several single nucleotide polymorphisms (SNPs) related with polyunsaturated fatty acid (PUFA) metabolism. Methods Our final analyses included 1644 mother-child pairs from the prospective INMA (INfancia y Medio Ambiente) cohort study (Spain, recruitment between 2003 and 2008). We used food frequency questionnaires to assess prenatal and postnatal seafood consumption of the mother-child pairs. We evaluated attention function of the children through the computer-based Attention Network Test (ANT) and we used the number of omission errors and the hit reaction time standard error (HRT-SE). Parents reported child attention deficit hyperactivity disorder (ADHD) symptoms using the Revised Conners’ Parent Rating Scale Short Form (CPRS-R: S). We measured seven candidate SNPs in a subsample of 845 children. We estimated associations using regression models, adjusting for family characteristics, child seafood intake and cognitive functions at early ages, and to explore SNP effect modifications. Results Higher total seafood intake during early pregnancy was associated with a reduction of child ANT omission errors, 5th quintile (median = 854 g/week) vs 1st quintile (median = 195 g/week), incidence risk ratio (IRR) 0.76; 95% CI = 0.61, 0.94. Similar results were observed after adjusting the models for child seafood intake and previous cognitive status. Lean, large and small fatty fish showed similar results, and generally similar but less robust associations were observed with the other attention outcomes. Shellfish and canned tuna showed weaker associations. The association patterns were weaker in late pregnancy and null in child seafood consumption. Child rs1260326 (glucokinase regulator, GCKR) and child/maternal rs2281591 (fatty acid elongase 2, ELOVL2) polymorphisms showed nominal P-value for interactions Conclusions After adjusting for previous child cognitive functions and child seafood intake, high pregnancy consumption (total, lean, small and large fatty fish) was independently associated with improvements of some 8-year-old attention outcomes. Genetic effect modification analyses suggest PUFA intake from seafood as a potential biological mechanism of such association.
Published: 2019
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29. Inorganic arsenic exposure and neuropsychological development of children of 4-5 years of age living in Spain

Author: Sabrina Llop, Eva María Navarrete-Muñoz, Loreto Santa-Marina, Manoli Garcia-de-la-Hera, Miguel García-Villarino, Maribel Casas, Adonina Tardón, Andrew A. Meharg, Manus Carey, Jesús Vioque, Raquel Soler-Blasco, Margaret R. Karagas, Mònica Guxens, Ana Fernández-Somoano, Antonio J. Signes-Pastor, Amaia Irizar, Erasmus MC other, and Child and Adolescent Psychiatry / Psychology
Subjects: Male, Neurodevelopment, McCarthy scales of Children's abilities, Developmental toxicology, Urine, 010501 environmental sciences, Neuropsychological development, Environment, 01 natural sciences, Biochemistry, Arsenicals, Article, Arsenic, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Child Development, Interquartile range, Cacodylic acid, Medicine, Cacodylic Acid, Humans, 030212 general & internal medicine, Children, Developmental toxicology, Dietary arsenic, Environment, Inorganic arsenic, McCarthy scales of Children's abilities, Neurodevelopment, Neuropsychological development, Urinary arsenic species, Adverse effect, Child, Children, 0105 earth and related environmental sciences, General Environmental Science, Urinary arsenic species, business.industry, Dietary Arsenic, Confounding, Inorganic arsenic, Environmental Exposure, McCarthy Scales of Children's Abilities, Confidence interval, Diet, Cross-Sectional Studies, chemistry, Dietary arsenic, Spain, Child, Preschool, Female, business, Demography
Abstract: This study was funded by grants from Spanish Institute of Health Carlos III-Ministry of Economy and Competitiveness (INMA Network G03/176, CB06/02/0041, and FIS-FEDER: PI03/1615, PI04/1436, PI08/1151, PI04/2018, PI04/1509, PI04/1112, PI04/1931, PI05/1079, PI05/1052, PI06/1213, PI06/0867, PI07/0314, PI09/02647, PS09/00090, PI09/02311, MS11/0178, PI13/1944, PI13/2032, PI14/00891, PI16/1288, and PI17/00663). Miguel Servet-FEDER: MSII16/ 00051, CP14/00108 & PI16/00261 (Co-funded by European Regional Development Fund “A way to make Europe”), FEDER funds, MS13/00054. Generalitat de Catalunya-CIRIT 1999SGR 00241, JCI2011–09771–MICINN, Generalitat Valenciana (Conselleria de Sanitat048/2010 and 060/2010 and FISABIO-UGP 15-230, 15-244, and 15-249). Generalitat de Catalunya-CIRIT 1999SGR 00241, and Fundació La Marató de TV3 (090430). Alicia Koplowitz Foundation (2017). Universidad de Oviedo. FISS-PI13/2429. Fundación CajasturLiberbank. Department of Health of the Basque Government (2005111093 and 2009111069). The Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001). The Fundación Roger Torné. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. Mònica Guxens is funded by a Miguel Servet fellowship (MS13/00054) awarded by the Spanish Institute of Health Carlos III (Ministry of Economy and Competitiveness). Antonio J. Signes-Pastor and Margaret R. Karagas are funded by the following projects P01ES022832, RD 83544201, R25CA134286 and P42ES007373., Signes-Pastor, A.J., Vioque, J., Navarrete-Muñoz, E.M., Carey, M., García-Villarino, M., Fernández-Somoano, A., Tardón, A., Santa-Marina, L., Irizar, A., Casas, M., Guxens, M., Llop, S., Soler-Blasco, R., García-de-la-Hera, M., Karagas, M.R., Meharg, A.A.
Published: 2019
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30. Spatial Distribution of Hospitalisations for Cardiovascular Diseases in the Central Region of Asturias, Spain

Author: Ana Fernández-Somoano, Isabel Martínez-Pérez, Valentín Rodríguez Suárez, and Verónica González-Iglesias
Subjects: Geography, Spatial distribution, Central region, Cartography
Abstract: BackgroundCardiovascular diseases are the leading cause of death worldwide; it is estimated that they cause 17 million deaths annually. In 2019, there were more than 29,000 deaths, and in 2018, ischemic heart diseases cause more than 118,000 hospitalisations in Spain. There is an unevenly distribution throughout the different autonomous communities, being Asturias the community with the highest rate for acute myocardial infarction (AMI) and angina pectoris (AP) of the country. Cardiovascular diseases are related to environmental, socioeconomic and previous medical conditions which result in geographical differences in the incidence of hospital admissions and mortality. To know the distribution of hospital admissions in the central area of Asturias and the existence of spatial patterns or clusters is the goal of this study.MethodsUrgent hospital admissions for AMI and angina AP in the hospitals of the central area of Asturias were registered, geocoded and grouped by census tracts. Standardised admission ratio, smoothed relative risk and posterior risk probability, together with analysis of spatial clusters between relative risks throughout the study area were calculated and mapped.ResultsGeographical differences were found in the distribution of hospital admissions for AMI and AP in the study area. The cluster analysis indicated aggregates of census tracts with high relative risk values in the northwest region of the study area.ConclusionThe geographical analysis shows the existence of patterns and spatial aggregations in the incidence of AMI and AP, for men and women, in the central area of Asturias.
Published: 2021
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31. Geographical Variability in Mortality in Urban Areas: A Joint Analysis of 16 Causes of Death

Author: Josu Delfrade Osinaga, Marc Marí-Dell’Olmo, Francisca Corpas-Burgos, Elena Aldasoro, Carlos Vergara-Hernández, Lluís Cirera, Elena Cabeza, Pedro L Lorenzo Ruano, Ana Fernández-Somoano, Paloma Botella-Rocamora, Oscar Zurriaga, Ana Gandarillas, Maica Rodríguez-Sanz, Andreu Nolasco, Miguel A. Martinez-Beneito, Rebeca Ramis, Carme Borrell, M Dolores Prieto-Salceda, Pablo Sánchez-Villegas, Jordi Pérez-Panadés, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Salud Comunitaria (SALUD), and Instituto de Salud Carlos III
Subjects: Male, Risk, Health, Toxicology and Mutagenesis, urban areas, Joint analysis, 01 natural sciences, Article, 010104 statistics & probability, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, geographical inequalities, Humans, 030212 general & internal medicine, 0101 mathematics, Cities, Mortality, Socioeconomics, multivariate disease mapping, Geography, Public Health, Environmental and Occupational Health, mortality, Socioeconomic Factors, Medicine, Enfermería, Female, Geographical inequalities
Abstract: The authors acknowledge the support of the research grants PI16/00670, PI16/00755, PI16/01004, PI16/01187, PI16/01273, PI16/01281, and PI18/01313 of Instituto de Salud Carlos III, co-funded with FEDER grants., Martinez-Beneito, M.A., Vergara-Hernández, C., Botella-Rocamora, P., Corpas-Burgos, F., Pérez-Panadés, J., Zurriaga, Ó., Aldasoro, E., Borrell, C., Cabeza, E., Cirera, L., Osinaga, J.D., Fernández-Somoano, A., Gandarillas, A., Lorenzo Ruano, P.L., Marí-Dell’olmo, M., Nolasco, A., Prieto-Salceda, M.D., Ramis, R., Rodríguez-Sanz, M., Sánchez-Villegas, P.
Published: 2021

32. Maternal sleep duration and neonate birth weight: A population-based cohort study

Author: Jordi Julvez, Marcella Marinelli, Michelle C. Turner, Mikel Basterrechea, Jordi Sunyer, Ana Fernández-Somoano, Maria-Jose Lopez-Espinosa, Loreto Santa-Marina, Ana Cristina Rodríguez-Dehli, Carmen Iñiguez, and Anne-Elie Carsin
Subjects: medicine.medical_specialty, Birth weight, Mothers, Affect (psychology), Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, medicine, Birth Weight, Humans, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Confounding, Excessive sleep, Infant, Newborn, Obstetrics and Gynecology, General Medicine, medicine.disease, Sleep in non-human animals, Duration (music), Pregnancy Trimester, Second, Gestation, Female, business, Sleep
Abstract: Objective Sleep duration is an important health indicator. Our aim was to investigate the association between maternal sleep duration and infant birthweight. Methods The study included 2,536 mother-infant pairs of a Spanish birth cohort (2004-2006, INMA project). The exposures were questionnaire-based measures of sleep duration before and during pregnancy. The primary outcome was infant birthweight score (g) standardized to 40 weeks of gestation. Results In women sleeping less than 7 hours per day before pregnancy, each additional hour of sleep increased birthweight score by 44.7 g (p = 0.049) in the minimally-adjusted model, although findings were not statistically significant after considering other potential confounders (p > 0.05). However, increasing sleep duration for the group of mothers who slept more than 9 hours per day decreased birthweight score by 39.2 g per additional hour (p = 0.001). Findings were similar after adjusting for several socio-demographic confounders and maternal depression-anxiety clinical history as an intermediate factor. Similar but attenuated associations were observed with sleep duration in the second pregnancy trimester. Conclusion The relationship between maternal sleep duration before and during pregnancy and infant birthweight is an inverse U-shaped curve. Excessive sleep duration may adversely affect infant health through its impact on birthweight.
Published: 2021

33. The Use of Lower or Higher Than Recommended Doses of Folic Acid Supplements during Pregnancy Is Associated with Child Attentional Dysfunction at 4–5 Years of Age in the INMA Project

Author: Ana Fernández-Somoano, Martine Vrijheid, Mario Murcia, Manuela García de la Hera, Laura Torres Collado, Marisa Rebagliato, Jesús Ibarluzea, Mònica Guxens, Laura María Compañ Gabucio, Adonina Tardón, Jesús Vioque, Itxaso Martí, Child and Adolescent Psychiatry / Psychology, and Erasmus MC other
Subjects: Adult, Male, medicine.medical_specialty, lcsh:TX341-641, 030209 endocrinology & metabolism, Neuropsychological Tests, Article, 03 medical and health sciences, folic acid, Child Development, 0302 clinical medicine, children, Supplement use, Humans, Medicine, Attention, Prospective Studies, supplement use, attentional function, Pregnancy, Nutrition and Dietetics, neurodevelopment, business.industry, Obstetrics, medicine.disease, Confidence interval, 3. Good health, Standard error, Folic acid, Spain, Child, Preschool, Prenatal Exposure Delayed Effects, Dietary Supplements, Cohort, Linear Models, Female, pregnancy, business, lcsh:Nutrition. Foods and food supply, 030217 neurology & neurosurgery, Food Science
Abstract: We assessed the association between the use of lower- and higher-than-recommended doses of folic acid supplements (FAs) during pregnancy and attentional function in boys and girls at age of 4–5. We analyzed data from 1329 mother-child pairs from the mother-child cohort INfancia y Medio Ambiente Project (INMA) study. Information on FAs use during pregnancy was collected in personal interviews at weeks 12 and 30, and categorized in &lt, 400, 400–999 (recommended dose), and ≥1000 μg/day. Child attentional function was assessed by Conners’ Kiddie Continuous Performance Test. Multivariable regression analyses were used to estimate incidence rate ratios (IRR) and beta coefficients with 95% confidence intervals (CI). Compared to recommended FAs doses, the periconceptional use of &lt, 400 and ≥1000 μg/day was associated with higher risk of omission errors—IRR = 1.14 (95% CI: 1.01, 1.29) and IRR = 1.16 (95% CI: 1.02, 1.33), respectively. The use of FAs &lt, 400 μg/day and ≥1000 μg/day was significantly associated with deficits of attentional function only in boys. FAs use &lt, 400 μg/day was associated with higher omission errors with IRR = 1.22 and increased hit reaction time (HRT) β = 34.36, and FAs use ≥ 1000 μg/day was associated with increased HRT β = 33.18 and HRT standard error β = 3.31. The periconceptional use of FAs below or above the recommended doses is associated with deficits of attentional function in children at age of 4–5, particularly in boys.
Published: 2021
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34. Prenatal exposure to cigarette smoke and anogenital distance at 4 years in the INMA‐Asturias cohort

Author: Rocío Fernández-Iglesias, Adonina Tardón, Isolina Riaño-Galán, Ana Fernández-Somoano, Izaro Babarro, Miguel García-Villarino, and Cristina Rodriguez-Dehli
Subjects: Male, medicine.medical_specialty, Offspring, Health, Toxicology and Mutagenesis, Anal Canal, Article, maternal cigarette smoking, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Pregnancy, Smoke, Medicine, Humans, 030212 general & internal medicine, anogenital distance, tobacco smoking, Child, endocrine-disrupting chemicals, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Anogenital distance, Smoking, Public Health, Environmental and Occupational Health, Infant, Newborn, medicine.disease, Confidence interval, Passive Smoke Exposure, Low birth weight, chemistry, Maternal Exposure, Spain, Prenatal Exposure Delayed Effects, Cohort, Female, medicine.symptom, business, Cotinine
Abstract: Smoking by women is associated with adverse pregnancy outcomes such as spontaneous abortion, preterm delivery, low birth weight, infertility, and prolonged time to pregnancy. Anogenital distance (AGD) is a sensitive biomarker of prenatal androgen and antiandrogen exposure. We investigated the effect of smoking and passive smoke exposure during pregnancy on anogenital distance in offspring at 4 years in the INMA-Asturias cohort (Spain). Women were interviewed during pregnancy to collect information on tobacco consumption, and anogenital distance was measured in 381 children: Anoscrotal distance in boys and anofourchetal distance in girls. We also measured maternal urinary cotinine levels at 32 weeks of pregnancy. We constructed linear regression models to analyze the association between prenatal smoke exposure and anogenital distance and adjusted the models by relevant covariates. Reported prenatal smoke exposure was associated with statistically significant increased anogenital index (AGI), both at week 12 of pregnancy (β = 0.31, 95% confidence interval: 0.00, 0.63) and at week 32 of pregnancy (β = 0.31, 95% confidence interval: 0.00, 0.63) in male children, suggesting altered androgenic signaling. Funding was provided by CIBERESP (PhD employment contract and fellowship for short stays abroad—2019), FIS-FEDER (grants PI04/2018, PI09/02311, PI13/02429, and PI18/00909), Obra Social Cajastur/Fundación Liberbank, and Universidad de Oviedo.
Published: 2021

35. Pre and postnatal exposure to mercury and respiratory health in preschool children from the Spanish INMA Birth Cohort Study

Author: Ana Esplugues, Carlos Zabaleta, Jordi Sunyer, Sabrina Llop, Mario Murcia, Amparo Ferrero, Martine Vrijheid, Paula Carrasco, Carmen Iñiguez, Marisa Estarlich, Adonina Tardón, Jesús Vioque, Ferran Ballester, Gorka Iriarte, Ana Fernández-Somoano, and Loreto Santa Marina
Subjects: Pediatrics, medicine.medical_specialty, Allergy, Environmental Engineering, 010504 meteorology & atmospheric sciences, Eczema, chemistry.chemical_element, 010501 environmental sciences, Logistic regression, 01 natural sciences, Cohort Studies, Pregnancy, Environmental Chemistry, Medicine, Humans, Prenatal, Respiratory system, Child, Waste Management and Disposal, Children, Respiratory health, 0105 earth and related environmental sciences, 2. Zero hunger, business.industry, Mercury, medicine.disease, Pollution, 3. Good health, Mercury (element), Otitis, chemistry, Maternal Exposure, Cord blood, Child, Preschool, Prenatal Exposure Delayed Effects, Cohort, Respiratory, Environmental Pollutants, Female, medicine.symptom, business, Hair
Abstract: Effects of mercury on maturing immune system have been reported, however the association with respiratory and allergy problems during infancy remains unclear. The aim of this study is to evaluate the association between pre and postnatal mercury exposure and respiratory and allergy problems among preschool children and to examine the role of potential modifying factors. Study subjects were children participant in Spanish Childhood and Environment Project (INMA, 2003-2008). We measured total mercury levels in cord blood (n = 1868) and hair at 4 years of age (n = 1347). Respiratory outcomes (wheezing, severe wheezing, chestiness, persistent cough, eczema and otitis) were obtained by questionnaires administered to parents. Associations were investigated by logistic regression adjusted for socio-demographic and lifestyle-related variables in each cohort and subsequent meta-analysis. We tested effect modification by factors related to individual susceptibility, diet and co-exposure with other pollutants. The geometric mean of cord blood and hair total mercury was 8.20 μg/L and 0.97 μg/g, respectively. No statistically significant association between pre or postnatal mercury exposure and respiratory and allergy outcomes was found. Notwithstanding, lower maternal intake of fruits and vegetables increased the risk of some respiratory outcomes due to the prenatal exposure to mercury (pint < 0.05). Moreover, an inverse association between prenatal mercury exposure and some respiratory outcomes was observed among children with higher maternal exposure to organocholorine compounds or smoking (pint < 0.05). Also, sex and postnatal smoking exposure modulated mercury postnatal effects on persistent cough (pint < 0.05). In conclusion, no association between pre and postnatal mercury exposure and respiratory and allergy problems among the whole population at study was found. However, diet and other toxicants could modulate this relation, especially during prenatal period. More research on this topic is warranted due to the limited evidence. This study was funded by Grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), Spain: ISCIII (Red INMA G03/176, CB06/02/0041; FIS-FEDER: PI03/1615, PI04/1509, PI04/1112, PI04/1931, PI04/2018, PI04/1436, PI05/1079, PI05/1052, PI06/1213, PI06/0867, PI07/0314, PI08/1151, PI09/00090, PI09/02647, PI09/2311, PI11/01007, PI11/02591, PI11/02038, PI13/2429, PI13/02187, PI13/1944, PI13/2032, PI14/00891, PI14/01687, PI16/1288, PI17/00663, PI18/01142, PI18/0909, PI19/1338; Miguel Servet-FEDER: CP15/0025; Miguel Servet-FSE: MS15/0025, MS20/0006), Generalitat Valenciana: FISABIO (UGP 15-230, UGP-15-244, and UGP-15-249), BEST/2020/059, AICO/2020/285 and GV/2020/058, Alicia Koplowitz Foundation 2017, Generalitat de Catalunya-CIRIT 1999SGR 00241, Fundació la Marató de TV3 (090430), CIBERESP, Obra Social Cajastur/Fundación Liberbank, Universidad de Oviedo, Department of Health of the Basque Government (2005111093, 2009111069, 2013111089 and 2015111065), and the Provincial Government of Gipuzkoa (DFG06/002, DFG08/001 and DFG15/221) and annual agreements with the municipalities of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain).
Published: 2021

36. Urinary cobalt and ferritin in four-years-old children

Author: Eva Junqué, Joan O. Grimalt, Ana Fernández-Somoano, Adonina Tardón, European Commission, Grimalt, Joan O., and Grimalt, Joan O. [0000-0002-7391-5768]
Subjects: Anemia, Iron, Physiology, Four-years-old children, Urine, 010501 environmental sciences, 01 natural sciences, Biochemistry, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Child, 0105 earth and related environmental sciences, General Environmental Science, Creatinine, Ferritin, biology, business.industry, Iron deficiency, DMT1, Environmental exposure, Cobalt, medicine.disease, 3. Good health, chemistry, 13. Climate action, Metals, Spain, Child, Preschool, Cohort, Ferritins, biology.protein, business
Abstract: Cobalt (Co) is an essential trace element but may cause toxic effects upon occupational or environmental exposure. The present study is aimed to determine the urine concentrations of Co in four years-old children in the INMA-Asturias cohort (Spain) and to assess the factors determining the observed levels. This cohort is located in a heavily industrialized zone with strong potential for metal exposure. Some diet components such as consumption of sweets were meaningfully associated with higher urine Co concentrations. Traffic pollution also showed a noteworthy positive association with Co levels. Family tobacco consumption did not show substantial association with the urine concentrations of this metal in the INMA-Asturias children. A significant inverse association between urine Co and venous blood ferritin was found. Iron deficiency anemic children had significantly higher concentrations of Co than those with normal levels, e.g. median values 1.9 μg/g creatinine and 1.0 μg/g creatinine, respectively. This association could be explained by an increased expression of DMT1, a divalent metal transporter that captures higher levels of iron in deficiency states of this metal. This transporter is non-specific and not only captures iron but also other divalent metals such as Co. The presence of this metal in iron deficiency anemic children may represent an additional disturbing health factor that must be considered during treatment., The authors would particularly like to thank all the participants for their generous collaboration and the staff from Hospital San Agustin in Aviles for their effort. This study was funded by grants from CIBERESP, FIS-FEDER (PI04/2018, PI09/02311, PI13/02429, PI18/00909), Obra Social Cajastur/Fundación Liberbank and Oviedo University. This paper was also supported by funding from the European Union project: EDC-MET (H2020-HEALTH/0490–825762).
Published: 2020

37. Protein-altering germline mutations implicate novel genes related to lung cancer development

Author: Ma'en Obeidat, Richard S. Houlston, Pier Alberto Bertazzi, David C. Nickle, Angela Cecilia Pesatori, Penella J. Woll, Semanti Mukherjee, María Soler Artigas, Rosario Tumino, David C. Christiani, Ivan P. Gorlov, Chu Chen, Sanjay Shete, Anush Mukeria, Yohan Bossé, Lynne R. Wilkens, Hermann Brenner, Yonathan Brhane, Victoria L. Stevens, Matthew B. Schabath, Angeline S. Andrew, Dakai Zhu, Natasha B. Leighl, Nancy Diao, Thomas Muley, Christopher A. Haiman, Shan Zienolddiny, Xuemei Ji, Michael F. Berger, Loic Le Marchand, Adonina Tardón, Mikael Johansson, Frances A. Shepherd, Ghislaine Scelo, Angela Cox, Xiangjun Xiao, Olga Y. Gorlova, Michael W. Marcus, Susanne M. Arnold, Rayjean J. Hung, Stig E. Bojesen, Gad Rennert, Mark E. Robson, William S. Bush, Christopher I. Amos, Neil E. Caporaso, Mattias Johansson, David B. Solit, Simona Ognjanovic, Lesley M. Butler, Hans Brunnström, Jonas Manjer, Stephen J. Chanock, Gary E. Goodman, Jin Hee Kim, Erik H.F.M. van der Heijden, Tadeusz M Orlowski, Ana Fernández-Somoano, Albert Rosenberger, Kjell Grankvist, Kim Overvad, Fiona Taylor, Paul Brennan, Zsofia K. Stadler, Stephen Lam, Lei Song, James McKay, Charles M. Rudin, Anders Mellemgaard, Preethi Srinivasan, Guillermo Fernández-Tardón, Antonia Trichopoulou, Milica Kontic, Philip Lazarus, Younghun Han, Jolanta Lissowska, Wim Timens, Ruyang Zhang, Geoffrey Liu, Ming-Sound Tsao, Ivana Holcatova, John K. Field, John R. McLaughlin, Eric B. Haura, Erich Wichmann, Demetrios Albanes, Ciprian Bolca, Vidar Skaug, Angela Risch, Heike Bickeböller, Robert Carreras-Torres, Konstantin H. Dragnev, Kenneth Offit, Melinda C. Aldrich, Olle Melander, Jakob S Johansen, Li Su, Chaitanya Bandlamudi, David C. Muller, Beata Swiatkowska, David Zaridze, Vladimir Janout, Walid Saliba, Matthew D. Hellmann, Maria Teresa Landi, Philippe Joubert, Jinyoung Byun, Michael P.A. Davies, Lambertus Fa Kiemeney, Per Bakke, Barry S. Taylor, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Groningen Research Institute for Asthma and COPD (GRIAC), Cancer Research UK, and National Institutes of Health
Subjects: 0301 basic medicine, Male, Candidate gene, Lung Neoplasms, Genotyping Techniques, General Physics and Astronomy, Ataxia Telangiectasia Mutated Proteins, Germline, Loss of heterozygosity, 0302 clinical medicine, Risk Factors, Databases, Genetic, Odds Ratio, RNA-Seq, lcsh:Science, Oligonucleotide Array Sequence Analysis, Cancer, Genetics, Multidisciplinary, respiratory system, Middle Aged, Pedigree, Urological cancers Radboud Institute for Health Sciences [Radboudumc 15], 030220 oncology & carcinogenesis, Female, Medical Genetics, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9], Heterozygote, Science, Mutation, Missense, Biology, Adenocarcinoma, General Biochemistry, Genetics and Molecular Biology, White People, Article, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Germline mutation, medicine, Humans, Genetic Predisposition to Disease, Allele, Lung cancer, Alleles, Germ-Line Mutation, Aged, Medicinsk genetik, General Chemistry, medicine.disease, Lung cancer susceptibility, Computational biology and bioinformatics, 030104 developmental biology, Jews, lcsh:Q
Abstract: The CAPUA study was supported by FIS-FEDER/Spain grant numbers FIS-01/310, FIS-PI03-0365, and FIS-07-BI060604, FICYT/Asturias grant numbers FICYT PB02-67 and FICYT IB09-133, and the University Institute of Oncology (IUOPA), of the University of Oviedo and the Ciber de Epidemiologia y Salud Pública. CIBERESP, SPAIN (...), Ji, X., Mukherjee, S., Landi, M.T., Bosse, Y., Joubert, P., Zhu, D., Gorlov, I., Xiao, X., Han, Y., Gorlova, O., Hung, R.J., Brhane, Y., Carreras-Torres, R., Christiani, D.C., Caporaso, N., Johansson, M., Liu, G., Bojesen, S.E., Le Marchand, L., Albanes, D., Bickeböller, H., Aldrich, M.C., Bush, W.S., Tardon, A., Rennert, G., Chen, C., Byun, J., Dragnev, K.H., Field, J.K., Kiemeney, L.F., Lazarus, P., Zienolddiny, S., Lam, S., Schabath, M.B., Andrew, A.S., Bertazzi, P.A., Pesatori, A.C., Diao, N., Su, L., Song, L., Zhang, R., Leighl, N., Johansen, J.S., Mellemgaard, A., Saliba, W., Haiman, C., Wilkens, L., Fernandez-Somoano, A., Fernandez-Tardon, G., Heijden, E.H.F.M., Kim, J.H., Davies, M.P.A., Marcus, M.W., Brunnström, H., Manjer, J., Melander, O., Muller, D.C., Overvad, K., Trichopoulou, A., Tumino, R., Goodman, G.E., Cox, A., Taylor, F., Woll, P., Wichmann, E., Muley, T., Risch, A., Rosenberger, A., Grankvist, K., Johansson, M., Shepherd, F., Tsao, M.-S., Arnold, S.M., Haura, E.B., Bolca, C., Holcatova, I., Janout, V., Kontic, M., Lissowska, J., Mukeria, A., Ognjanovic, S., Orlowski, T.M., Scelo, G., Swiatkowska, B., Zaridze, D., Bakke, P., Skaug, V., Butler, L.M., Offit, K., Srinivasan, P., Bandlamudi, C., Hellmann, M.D., Solit, D.B., Robson, M.E., Rudin, C.M., Stadler, Z.K., Taylor, B.S., Berger, M.F., Houlston, R., McLaughlin, J., Stevens, V., Nickle, D.C., Obeidat, M., Timens, W., Artigas, M.S., Shete, S., Brenner, H., Chanock, S., Brennan, P., McKay, J.D., Amos, C.I.
Published: 2020
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38. Prenatal air pollution exposure and growth and cardio-metabolic risk in preschoolers

Author: Adonina Tardón, Amaia Irizar, Jordi Sunyer, Aitana Lertxundi, Jesús Vioque, Serena Fossati, David Martinez, Damaskini Valvi, Martine Vrijheid, Marisa Estarlich, Ana Fernández-Somoano, Marta Cirach, Ibon Tamayo, Mònica Guxens, Carmen Iñiguez, Mark J. Nieuwenhuijsen, European Commission, and Child and Adolescent Psychiatry / Psychology
Subjects: obesity, 010504 meteorology & atmospheric sciences, air pollution, prenatal exposure, use regression-models, 010501 environmental sciences, Malalties neonatals, 01 natural sciences, Pregnancy, Interquartile range, Prenatal exposure, Childhood obesity, Child, lcsh:Environmental sciences, General Environmental Science, lcsh:GE1-350, 2. Zero hunger, Air Pollutants, Obstetrics, Childhood growth, health, traffic pollution, fetal, Pollution, Maternal Exposure, Child, Preschool, Contaminació, maternal smoking, Female, Neonatal diseases, childhood obesity, pregnant-women, medicine.medical_specialty, Waist, Birth weight, Nitrogen Dioxide, Air pollution, complex mixtures, childhood growth, early-childhood, medicine, Humans, mediation analysis, 0105 earth and related environmental sciences, particulate matter, Fetus, business.industry, medicine.disease, Particulate matter, Obesity, business, Body mass index
Abstract: Objectives: We investigated the association between outdoor air pollutants exposure in the first trimester of pregnancy, and growth and cardio-metabolic risk at four years of age, and evaluated the mediating role of birth weight. Methods: We included mother-child pairs (N = 1,724) from the Spanish INMA birth cohort established in 2003-2008. First trimester of pregnancy nitrogen dioxide (NO2) and fine particles (PM2.5) exposure levels were estimated. Height, weight, waist circumference, blood pressure, and lipids were measured at four years of age. Body mass index (BMI) trajectories from birth to four years were identified. Results: Increased PM2.5 exposure in the first trimester of pregnancy was associated with decreased z-scores of weight (zWeight) and BMI (zBMI) (zWeight change per interquartile range increase in PM2.5 exposure = -0.12; 95% CI: -0.23, -0.01; zBMI change = -0.12; 95% CI: -0.23, -0.01). Higher NO2 and PM2.5 exposure was associated to a reduced risk of being in a trajectory with accelerated BMI gain, compared to children with the average trajectory. Birth weight partially mediated the association between PM2.5 and zWeight and zBMI. PM2.5 and NO2 were not associated with the other cardio-metabolic risk factors. Conclusions: This comprehensive study of many growth and cardio-metabolic risk related outcomes suggests that air pollution exposure during pregnancy may be associated with delays in physical growth in the early years after birth. These findings imply that pregnancy exposure to air pollutants has a lasting effect on growth after birth and require follow-up at later child ages. This study was funded by grants from the Eulji University (grant numbers ESCAPE project FP7-ENV-2007-1-211250, DENAMIC project FP7-ENV-2011-282957, HELIX project FP7-ENV-2012-308333, and MEDALL project HEALTH.2010.2.4.5-1), from the Spanish Instituto de Salud Carlos III (grant numbers Red INMA G03/176; CB06/02/0041; PI03/1615 incl. FEDER funds, PI04/1112 incl. FEDER funds, PI041436, PI04/1509 incl. FEDER funds, PI04/1931 incl. FEDER funds, PI042018 incl. FEDER funds, PI05/1079 incl. FEDER funds, PI05/1052 incl. FEDER funds, FIS-PI06/0867, PI06/1213 incl. FEDER funds, PI07/0314 incl. FEDER funds, PI081151 incl. FEDER funds, FIS-PI09/00090, PI09/02311 incl. FEDER funds, PI09/02647 incl. FEDER funds, PI11/01007 incl. FEDER funds, PI11/02591 incl. FEDER funds, PI11/02038 incl. FEDER funds, PI13/1944 incl. FEDER funds, PI13/2032 incl. FEDER funds, PI13/02429 incl. FEDER funds, PI14/00891 incl. FEDER funds, PI14/01687 incl. FEDER funds, PI15/00118 incl. FEDER funds, PI16/1288 incl. FEDER funds, and PI17/00663 incl. FEDER funds, PI18/00547 incl. FEDER funds, PI18/00909 incl. FEDER funds; CP11/00178, CP15/00025, and CPII16/00051; MS13/00054 incl. FEDER funds), CIBERESP, Department of Health of the Basque Government (grant numbers 2005111093, 2013111089), Generalitat de Catalunya-CIRIT (grant numbers 1999SGR 00241), Generalitat Valenciana: FISABIO (grant numbers UGP 15-230, UGP-15-244, and UGP-15-249), Provincial Government of Gipuzkoa (grant number DFG06/002), Alicia Koplowitz Foundation 2017, Fundacio La marato de TV3 (grant number 090430), Obra Social Cajastur/Fundacion Liberbank, Universidad de Oviedo, and annual agreements with the municipalities of the study area of the Gipuzkoa sub-cohort (Zumarraga, Urretxu, Legazpi, Azkoitia, Azpeitia and Beasain). ISGlobal is a member of the Agency for the Research Centres of Catalonia (CERCA) Programme, Generalitat de Catalunya.
Published: 2020

39. Residential Surrounding Greenspace and Mental Health in Three Spanish Areas

Author: Jordi Julvez, Ana Fernández-Somoano, Marisa Estarlich, Isolina Riaño-Galán, Jordi Sunyer, Marta Cirach, Asier Anabitarte Riol, Mònica Guxens, Llúcia González-Safont, Payam Dadvand, Maria Torres Toda, and Child and Adolescent Psychiatry / Psychology
Subjects: Adult, Parks, Health, Toxicology and Mutagenesis, Population, lcsh:Medicine, Symptom Checklist 90, Anxiety, Environment, 010501 environmental sciences, 01 natural sciences, Article, psychiatric disorder, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Environmental health, medicine, Humans, 030212 general & internal medicine, education, 0105 earth and related environmental sciences, education.field_of_study, lcsh:R, parks, Public Health, Environmental and Occupational Health, nature, Mental illness, medicine.disease, Mental Illness, Mental health, mental illness, Nature, Mental Health, Cohort, Female, medicine.symptom, Psychology, Somatization, psychosomatic symptoms, Psychopathology
Abstract: Exposure to greenspace has been related to improved mental health, but the available evidence is limited and findings are heterogeneous across different areas. We aimed to evaluate the associations between residential exposure to greenspace and specific psychopathological and psychosomatic symptoms related to mental health among mothers from a Spanish birth cohort. Our study was based on data from 1171 women participating in two follow-ups of a population-based cohort in Valencia, Sabadell, and Gipuzkoa (2004&ndash, 2012). For each participant, residential surrounding greenspace was estimated as the average of the satellite-based Normalized Difference Vegetation Index (NDVI) across different buffers around the residential address at the time of delivery and at the 4-year follow-up. The Symptom Checklist 90 Revised (SCL-90-R) was applied to characterize mental health at the 4-year follow-up. We developed mixed-effects logistic regression models controlled for relevant covariates to evaluate the associations. Higher residential surrounding greenspace was associated with a lower risk of somatization and anxiety symptoms. For General Severity Index (GSI), obsessive&ndash, compulsive, interpersonal sensitivity, depression, hostility, phobic anxiety, paranoid ideation, and psychoticism symptoms, we generally observed protective associations, but none attained statistical significance. Findings from this study suggested a potential positive impactof greenspace on mental health.
Published: 2020

40. Association between pre/perinatal exposure to POPs and children's anogenital distance at age 4 years: A study from the INMA-Asturias cohort

Author: Carmen Freire, Joan O. Grimalt, Adonina Tardón, Ana Cristina Rodríguez-Dehli, Ana Fernández-Somoano, Esther Vizcaino, Miguel García-Villarino, Isolina Riaño-Galán, Grimalt, Joan O., and Grimalt, Joan O. [0000-0002-7391-5768]
Subjects: Male, Anal Canal, Endocrine Disruptors, 010501 environmental sciences, 01 natural sciences, Cohort Studies, Anogenital index, chemistry.chemical_compound, 0302 clinical medicine, Pregnancy, Halogenated Diphenyl Ethers, Hydrocarbons, Chlorinated, Medicine, 030212 general & internal medicine, Maternal-Fetal Exchange, Anthropometry, Perinatal Exposure, Obstetrics, Persistent organic pollutants, Anogenital distance, Fetal Blood, Endocrine disruptor, Maternal Exposure, Child, Preschool, Prenatal Exposure Delayed Effects, Cohort, Environmental Pollutants, Female, Biological Monitoring, Adult, medicine.medical_specialty, 03 medical and health sciences, Humans, Sex organ, Genitalia, Persistent organic pollutant, 0105 earth and related environmental sciences, business.industry, Infant, Newborn, Public Health, Environmental and Occupational Health, Hexachlorobenzene, Confidence interval, Genital development, chemistry, Spain, business
Abstract: Background Prenatal exposure to endocrine-disrupting chemicals may impair genital development and alter reproductive tract anatomy. Anogenital distance (AGD) is a useful biomarker of exposure to chemicals that act as endocrine disruptors. We evaluated associations between prenatal and perinatal exposure to several persistent organic pollutants (POPs) and AGD in 4-year-old children. Methods Data were drawn from the INMA-Asturias cohort. Pediatricians measured the anofourchetal distance in female children and anoscrotal distance in male children. The anogenital index (AGI) was defined as the AGD divided by the child's weight at age of examination. We measured the levels of two hexachlorocyclohexane isomers, hexachlorobenzene, dichlorodiphenyltrichloroethane (DDT) and its metabolites, six polychlorinated biphenyl (PCB) congeners, and six polybrominated diphenyl ether (PBDE) congeners in maternal serum at 12 gestational weeks (n = 155) and in cord blood serum (n = 229). Anthropometric and parental sociodemographic variables were collected via face-to-face interviews. Linear regression models were used to evaluate the relationship between exposure to POPs and AGI, adjusted for confounders and stratified by sex. Results In male children, we found inverse associations between AGI and maternal concentrations of PCB-138 (ß = −0.041, 95% confidence interval [CI]: −0.074, −0.008, second tertile), PCB-153 (ß = −0.052, 95% CI: −0.085, −0.020, second tertile), PCB-180 ß = −0.065, 95% CI: −0.096, −0.035, second tertile; ß = −0.042, 95% CI: −0.073, −0.011, third tertile), PBDE-209 (ß = −0.031, 95% CI: −0.058, −0.006), cord serum concentrations of PCB-153 (ß = −0.029, 95% CI: −0.059, −0.000, second tertile; ß = −0.047, 95% CI: −0.085, −0.008, third tertile), and PCB-180 (ß = −0.041, 95% CI: −0.078, −0.005, third tertile). In female children, AGI was positively associated with maternal serum concentrations of PCB-101 (ß = 0.039, 95% CI: 0.002, 0.076, second tertile), and higher cord serum levels of 4,4′-DDT (ß = 0.032, 95% CI: 0.003, 0.061, third tertile) and 4,4′-DDE (ß = 0.040, 95% CI: 0.011, 0.069, third tertile). Conclusions Our findings provide evidence of associations between specific POPs and AGI in boys and girls aged 4 years, and suggest that pre/perinatal exposure to POPs has a feminizing effect in males and a masculinizing effect in females., The authors would particularly like to thank all the participants for their generous collaboration and the staff from Hospital San Agustin in Aviles for their effort. This study was funded by grants from, CIBERESP (PhD-employment-contract and fellowship for short stays abroad-2019), FIS-FEDER: PI04/2018, PI09/02311, PI13/02429, PI18/00909; Obra Social Cajastur/Fundación Liberbank, and Universidad de Oviedo. We thank Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript, and Fundación NOE Alimerka.
Published: 2020

41. High adherence to a mediterranean diet at age 4 reduces overweight, obesity and abdominal obesity incidence in children at the age of 8

Author: Leyre Notario-Barandiaran, Martine Vrijheid, Manuela García-de-la-Hera, Inma, Desirée Valera-Gran, Eva Mª Navarrete-Muñoz, Ana Fernández-Somoano, Loreto Santa-Marina, Carmen Iñiguez, Sílvia Fernández-Barrés, Eva Pereda-Pereda, Sandra Gonzalez-Palacios, Mònica Guxens, Adonina Tardón, Jesús Vioque, Dora Romaguera, and Child and Adolescent Psychiatry / Psychology
Subjects: medicine.medical_specialty, Nutrition and Dietetics, Waist, Mediterranean diet, business.industry, Endocrinology, Diabetes and Metabolism, Incidence (epidemiology), Hazard ratio, Medicine (miscellaneous), 030209 endocrinology & metabolism, Overweight, medicine.disease, Obesity, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Internal medicine, Medicine, 030212 general & internal medicine, medicine.symptom, business, Abdominal obesity, Cohort study
Abstract: Background/objectives A higher adherence to a Mediterranean diet has been shown to be protective against obesity in adults, but the evidence is still inconclusive in children at early ages. Our objective was to explore the association between adherence to Mediterranean Diet at the age of 4 and the prevalence of overweight, obesity, and abdominal obesity at 4 years of age, and incidence at the age of 8. Subjects/methods We analyzed data from children of the INMA cohort study who attended follow-up visits at age 4 and 8 years (n = 1801 and n = 1527, respectively). Diet was assessed at the age of 4 using a validated food frequency questionnaire. The adherence to MD was evaluated by the relative Mediterranean diet (rMED) score, and categorized as low (0-6), medium (7-10), and high (11-16). Overweight and obesity were defined according to the age-sex specific BMI cutoffs proposed by the International Obesity Task Force, and abdominal obesity as waist circumference >90th percentile. We used Poisson regression models to estimate prevalence ratios at 4 years of age, and Cox regression analysis to estimate hazard ratios (HR) from 4-8 years of age. Results In cross-sectional analyses at the age of 4 no association was observed between adherence to MD and overweight, obesity, or abdominal obesity. In longitudinal analyses, a high adherence to MD at age 4 was associated with lower incidence of overweight (HR = 0.38; 95% CI: 0.21-0.67; p = 0.001), obesity (HR = 0.16; 95% CI: 0.05-0.53; p = 0.002), and abdominal obesity (HR = 0.30; 95% CI: 0.12-0.73; p = 0.008) at the age of 8. Conclusion This study shows that a high adherence to MD at the age of 4 is associated with a lower risk of developing overweight, obesity, and abdominal obesity at age 8. If these results are confirmed by other studies, MD may be recommended to reduce the incidence of obesity at early ages.
Published: 2020

42. Poor mothers, unhealthy children: the transmission of health inequalities in the INMA study, Spain

Author: Marisa Rebagliato, Adonina Tardón, Clara L. Rodríguez-Bernal, Ana Jiménez-Zabala, Ana Fernández-Somoano, Loreto Santa-Marina, Jesús Ibarluzea, Mar Alvarez-Pedrerol, Amaia Molinuevo, Martine Vrijheid, and Isabel Larrañaga
Subjects: Adult, Male, Gerontology, Inequality, Body mass index procedure, media_common.quotation_subject, Mothers, Socioeconomic factors, Weight Gain, 03 medical and health sciences, Fetus, 0302 clinical medicine, Pregnancy, Risk Factors, Political science, Humans, Underweight, 030212 general & internal medicine, Occupations, Child, media_common, Health disparity, Educational status, 030503 health policy & services, Smoking, Infant, Newborn, Pregnancy Outcome, Public Health, Environmental and Occupational Health, Infant, Birth outcome, Small for gestational age, Health Status Disparities, Pregnancy Complications, Social Class, Spain, Educational Status, Premature Birth, Female, Christian ministry, Pregnant Women, 0305 other medical science, Humanities, Maternal Age
Abstract: Background The health of pregnant women and their fetuses are especially sensitive to socioeconomic conditions. This study analyzes the impact of maternal socioeconomic status (SES), evaluated by occupation and maternal education level, in preterm births (PTBs) and in small for gestational age (SGA) fetuses, considering the effect of the potential mediating factors on the SES and birth outcomes. Methods A total of 2497 mother/newborn dyads from the INMA-Spain project were studied. We examined maternal occupation and education in relation to PTB and SGA along with covariate data, using logistic regression analysis. Adjusted models for each of the outcome variables in relation to SES indicators were estimated, considering potential mediating factors. Results About 4.7% of babies were PTB and 9.7% SGA. Full adjusted logistic regression models showed similar odds ratio (OR) for SGA in both SES indicators. Manual working women or without university studies had higher risk of SGA than their counterpart groups (OR = 1.39% CI = 1.03–1.88 and OR = 1.39% CI = 1.00–2.00, respectively). Likewise, mothers with a manual occupation were at more risk of PTB than those with a non-manual occupation (OR = 1.74 95% CI = 1.13–2.74), but there was no association between education and PTB. Smoking, pre-pregnancy BMI and underweight gain during pregnancy were significantly associated to SGA births. The mother’s age, presence of complications and overweight gain during pregnancy were related to PTB. Conclusion The mother’s socioeconomic disadvantage was consistently associated with birth outcomes giving rise to intergenerational transmission of health inequalities. Reducing inequalities requires eliminating the upstream causes of poverty itself.
Published: 2018
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43. Maternal Metabolic Health Parameters During Pregnancy in Relation to Early Childhood BMI Trajectories

Author: Parisa Montazeri, Mario Murcia, Aitana Lertxundi, Carmen Iñiguez, Martine Vrijheid, David Martinez, Jordi Sunyer, Mònica Guxens, Ana Fernández-Somoano, Damaskini Valvi, Mikel Basterrechea, and Adonina Tardón
Subjects: Pregnancy, Nutrition and Dietetics, business.industry, Offspring, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), 030209 endocrinology & metabolism, medicine.disease, Gestational diabetes, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Relative risk, medicine, Gestation, 030212 general & internal medicine, Early childhood, medicine.symptom, business, Weight gain, Body mass index, Demography
Abstract: Objective The objective of this study was to evaluate the associations between maternal metabolic parameters and early childhood BMI trajectories. Methods Two thousand two hundred fifty-one children born in Spain between 2004 and 2008 were analyzed. Five BMI z score trajectories from birth to age 4 years were identified by using latent class growth analysis. Multinomial regression assessed the associations between maternal metabolic parameters and offspring's BMI trajectories. Results Children in the reference BMI trajectory had average size at birth followed by a slower BMI gain. Maternal prepregnancy obesity was associated with trajectories of accelerated BMI gain departing from either higher (relative risk ratio [RRR] = 1.77; 95% CI: 1.07-2.91) or lower size at birth (RRR = 1.91; 95% CI: 1.17-3.12). Gestational weight gain (GWG) above clinical guidelines was associated with a trajectory of higher birth size followed by accelerated BMI gain (RRR = 2.14; 95% CI: 1.53-2.97). Maternal serum triglycerides were negatively associated with BMI trajectories departing from lower birth sizes. Gestational diabetes, maternal serum cholesterol, and C-reactive protein were unrelated to children's BMI trajectories. Conclusions Maternal prepregnancy obesity, GWG, and serum triglycerides are associated with longitudinal BMI trajectories in early childhood that may increase disease risk in later life. Health initiatives should promote healthy weight status before and during pregnancy to improve maternal and child health.
Published: 2018
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44. Urban upbringing and childhood respiratory and allergic conditions: A multi-country holistic study

Author: Elaine Fuertes, Christina Tischer, Jesus Ibarlueza, Olena Gruzieva, Marie Standl, Lourdes Cirugeda, Dietrich Berdel, Erik Melén, Iana Markevych, Xavier Basagaña, Aitana Lertxundi, Payam Dadvand, Josep M. Antó, Marisa Estarlich, Joachim Heinrich, Jordi Sunyer, Ana Fernández-Somoano, Dorothea Sugiri, Sibylle Koletzko, Anna Bergström, Adonina Tardón, and Amparo Ferrero
Subjects: 0301 basic medicine, 05 Environmental Sciences, Indoor exposure, First year of life, Microbial load, Toxicology, Biochemistry, Grey space, Allergic rhinitis, 03 medical and health sciences, 0302 clinical medicine, Germany, Environmental health, medicine, Humans, Respiratory system, Child, Respiratory Sounds, General Environmental Science, Asthma, Sweden, Green space, 2. Zero hunger, business.industry, Environmental Exposure, Odds ratio, 06 Biological Sciences, medicine.disease, Rhinitis, Allergic, Confidence interval, Confirmatory factor analysis, 3. Good health, 030104 developmental biology, 030228 respiratory system, Spain, Bronchitis, Environmental Pollutants, 03 Chemical Sciences, business, Allergic Rhinitis, Green Space, Grey Space, Indoor Exposure, Microbial Load, Multi country
Abstract: 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).
Published: 2018
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45. La elección de la especialidad medicina intensiva: análisis de los últimos 10 años

Author: Jose Curbelo, T. Villacampa, Jaime Baladrón, Ana Fernández-Somoano, J.M. Romero, and Fernando Sánchez-Lasheras
Subjects: 03 medical and health sciences, 0302 clinical medicine, business.industry, MEDLINE, Medicine, Critical Care and Intensive Care Medicine, business, Humanities, 030217 neurology & neurosurgery, Career choice, 030218 nuclear medicine & medical imaging
Published: 2018
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46. Prenatal and postnatal exposure to NO2 and child attentional function at 4–5 years of age

Author: Albert Dalmau-Bueno, Ainara Andiarena, Martine Vrijheid, F Ballester, Mònica Guxens, Marta Cirach, Adonina Tardón, Ana Fernández-Somoano, Jordi Sunyer, Marisa Estarlich, Aitana Lertxundi, Mark J. Nieuwenhuijsen, Jesús Ibarluzea, Carmen Iñiguez, Alexis Sentís, and Child and Adolescent Psychiatry / Psychology
Subjects: medicine.medical_specialty, Complete data, Embaràs, Population, Environmental pollution, Diòxids de nitrogen, 010501 environmental sciences, 01 natural sciences, 03 medical and health sciences, Cognition, 0302 clinical medicine, Medicine, 030212 general & internal medicine, Psychiatry, Cognitive impairment, education, Child development, lcsh:Environmental sciences, 0105 earth and related environmental sciences, General Environmental Science, lcsh:GE1-350, Pregnancy, education.field_of_study, medicine.diagnostic_test, business.industry, Obstetrics, Aire -- Contaminació, 1. No poverty, Neuropsychological test, medicine.disease, Attention deficit disorder with hyperactivity, 3. Good health, Trastorn per dèficit d'atenció amb hiperactivitat, Standard error, business
Abstract: 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.
Published: 2017
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47. Maternal pre-pregnancy obesity and neuropsychological development in pre-school children: a prospective cohort study

Author: David Martinez, Marisa Rebagliato, Martine Vrijheid, Maribel Casas, Adonina Tardón, Mònica Guxens, Joan Forns, Jordi Sunyer, Mario Murcia, Ana Fernández-Somoano, Nerea Lertxundi, and Jesús Ibarluzea
Subjects: Adult, Male, Autism Spectrum Disorder, Maternal Health, Embaràs, Child Behavior, Neuropsicologia pediàtrica, Body Mass Index, Ensenyament preescolar, Fathers, Young Adult, 03 medical and health sciences, Child Development, Cognition, 0302 clinical medicine, Memory, Risk Factors, 030225 pediatrics, medicine, Humans, Attention deficit hyperactivity disorder, Obesity, Prospective Studies, 030212 general & internal medicine, Psychomotor learning, Parental obesity, Intelligence quotient, Verbal Behavior, business.industry, Body Weight, Age Factors, Maternal Nutritional Physiological Phenomena, medicine.disease, Child development, 3. Good health, Socioeconomic Factors, Attention Deficit and Disruptive Behavior Disorders, Spain, Asperger syndrome, Autism spectrum disorder, Child, Preschool, Pediatrics, Perinatology and Child Health, Autism, Female, business, Psychomotor Performance, Clinical psychology
Abstract: BackgroundMaternal pre-pregnancy obesity may impair infant neuropsychological development, but it is unclear whether intrauterine or confounding factors drive this association.MethodsWe assessed whether maternal pre-pregnancy obesity was associated with neuropsychological development in 1,827 Spanish children. At 5 years, cognitive and psychomotor development was assessed using McCarthy Scales of Children's Abilities, attention deficit hyperactivity disorder (ADHD) symptoms using the Criteria of Diagnostic and Statistical Manual of Mental Disorders, and autism spectrum disorder symptoms using the Childhood Asperger Syndrome Test. Models were adjusted for sociodemographic factors and maternal intelligence quotient. We used paternal obesity as negative control exposure as it involves the same source of confounding than maternal obesity.ResultsThe percentage of obese mothers and fathers was 8% and 12%, respectively. In unadjusted models, children of obese mothers had lower scores than children of normal weight mothers in all McCarthy subscales. After adjustment, only the verbal subscale remained statistically significantly reduced (β: -2.8; 95% confidence interval: -5.3, -0.2). No associations were observed among obese fathers. Maternal and paternal obesity were associated with an increase in ADHD-related symptoms. Parental obesity was not associated with autism symptoms.ConclusionMaternal pre-pregnancy obesity was associated with a reduction in offspring verbal scores at pre-school age. This study was funded by grants from European Union (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1)
Published: 2017
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48. Effect of alcohol and its metabolites in lung cancer: CAPUA study

Author: Adonina Tardón, Sara M Álvarez-Avellón, Jesús Vioque, Eva María Navarrete-Muñoz, and Ana Fernández-Somoano
Subjects: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, 030220 oncology & carcinogenesis, medicine, 030212 general & internal medicine, General Medicine, business
Abstract: Resumen Antecedentes y objetivo El alcohol y sus metabolitos tienen un papel importante en la carcinogenesis, pudiendo estar este efecto modulado por polimorfismos en genes que codifican enzimas participantes en el metabolismo de alcohol y folato. Por ello, analizamos el efecto que podria tener el consumo de alcohol y los polimorfismos ADH1B Arg48His, ADH1B Arg370Cys, ADH1C Ile349Val, ALDH2 Glu540Lys, CYP2E1 RsaI, CYP2E1 DraI, CYP2E1 TaqI y MTHFR C677T en el riesgo de cancer de pulmon. Pacientes y metodo Se incluyeron 876 casos de cancer de pulmon y 840 controles del estudio caso-control de base hospitalaria CAPUA. El genotipado de los SNP se realizo mediante la tecnologia Sequenom MassArray (iPLEX GOLD). Resultados Un consumo de alcohol de 0,1-9,9 g/dia disminuye el riesgo de cancer de pulmon (ORajustada = 0,71; IC 95% 0,48-1,05), aunque no se alcanza la significacion estadistica. Un consumo de alcohol ≥ 30 g/dia y de tabaco ≥ 36 paquetes/ano aumenta el riesgo de cancer de pulmon (ORajustada = 26,68; IC 95% 12,69-56,10). Por otro lado, un consumo elevado de verduras (≥ 116,65 g/dia) o de frutas (≥ 233,13 g/dia) disminuye el riesgo de cancer de pulmon con un consumo de alcohol de 0,1-9,9 g/dia (ORajustada = 0,52; IC 95% 0,30-0,89; ORajustada = 0,58; IC 95% 0,33-1,03, respectivamente). Un consumo de alcohol de 10-29,9 g/dia en individuos portadores del alelo ADH1B 48His aumenta el riesgo de cancer de pulmon (ORajustada = 3,32; IC 95% 1,03-10,70). Conclusiones El alcohol y polimorfismos en genes que participan en el metabolismo del alcohol y del folato estan relacionados con el cancer de pulmon.
Published: 2017
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49. Effect of alcohol and its metabolites in lung cancer: CAPUA study

Author: Eva María Navarrete-Muñoz, Sara M Álvarez-Avellón, Ana Fernández-Somoano, Adonina Tardón, and Jesús Vioque
Subjects: medicine.medical_specialty, TaqI, business.industry, Acetaldehyde, ADH1B, Alcohol, CYP2E1, medicine.disease_cause, medicine.disease, Gastroenterology, Surgery, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, 030220 oncology & carcinogenesis, Internal medicine, medicine, 030212 general & internal medicine, Carcinogenesis, Lung cancer, business, ALDH2
Abstract: Background and objective Alcohol and its metabolites play an important role in carcinogenesis. This effect could be modulated by polymorphisms in genes encoding enzymes involved in the metabolism of alcohol and folate. Therefore, we analyzed the effect of alcohol consumption and ADH1B Arg48His, ADH1B Arg370Cys, ADH1C Ile349Val, ALDH2 Glu540Lys, CYP2E1 RsaI, CYP2E1 DraI, CYP2E1 TaqI and MTHFR C677T polymorphisms on the risk of developing lung cancer. Patients and methods We included 876 lung cancer cases and 840 controls of the CAPUA hospital-based case–control study. Genotyping was performed using the Sequenom MassArray (iPLEX GOLD) technology. Results An alcohol consumption of 0.1–9.9 g/day decreased lung cancer risk (ORadjusted = 0.71; 95% CI 0.48–1.05), although statistical significance was not achieved. A consumption ≥30 g/day of alcohol and ≥36 PY of tobacco increases lung cancer risk (ORadjusted = 26.68; 95% CI 12.69–56.10). On the other hand, a high consumption of vegetables (≥116.65 g/day) and fruits (≥233.13 g/day) decreases lung cancer risk with an alcohol consumption of 0.1–9.9 g/day (ORadjusted = 0.52; 95% CI 0.30–0.89; ORadjusted = 0.58; 95% CI 0.33–1.03, respectively). An alcohol consumption of 10–29.9 g/day in ADH1B 48His allele-carriers increases lung cancer risk (ORadjusted = 3.32; 95% CI 1.03–10.70). Conclusions Alcohol and polymorphisms in genes involved in the metabolism of alcohol and folate are related to the onset of lung cancer.
Published: 2017
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50. Análisis de la elección de la especialidad de radiodiagnóstico en el examen MIR desde el año 2006 hasta 2015

Author: F. Sánchez Lasheras, Ana Fernández-Somoano, E. Murias Quintana, S.M. Costilla García, J.M. Romeo Ladrero, J.B. Baladrón Romero, and M. Cadenas Rodríguez
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Radiology, Nuclear Medicine and imaging, 030218 nuclear medicine & medical imaging
Abstract: Resumen Objetivo Analizar el perfil del opositor que ha escogido la especialidad de radiodiagnostico, analizando variables relacionadas con las plazas convocadas a lo largo de la historia. Material y metodos Se recogen los datos publicados por el Ministerio de Sanidad espanol en su pagina web durante los actos de eleccion de plaza en el examen MIR desde el ano 2006 hasta 2015, comparando la especialidad de radiodiagnostico con el resto de las ofertadas en terminos de plaza, preguntas netas, sexo, nacionalidad y lugar de eleccion de la plaza. Resultados La especialidad de radiodiagnostico ocupa la posicion numero 16 en el ranking de especialidades ordenadas segun la mediana de numero de orden con la que se escogio cada una de sus plazas desde el ano 2006 hasta 2015. La primera plaza se suele escoger por debajo del numero de orden 75 y la eleccion de la especialidad se suele terminar entre los numeros de orden 3.700 y 4.100. Durante el periodo estudiado, un 58% de los electores de radiodiagnostico fueron mujeres y un 76%, espanoles. Los opositores prefieren los hospitales de la comunidad de Madrid, y el hospital elegido con la mediana mas baja (mejor numero de orden) es el Hospital Clinic de Barcelona. Conclusiones Radiodiagnostico se escoge en el MIR con buenos numeros de orden, con menor tendencia a ser elegida por mujeres que otras especialidades y escogida en su mayoria por medicos espanoles. Se prefieren hospitales grandes en capitales de provincia.
Published: 2017
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