Neurodevelopmental Assessment in Kindergarten in Children Exposed to General Anesthesia before the Age of 4 Years

2016 ◽  
Vol 125 (4) ◽  
pp. 667-677 ◽  
Author(s):  
M. Ruth Graham ◽  
Marni Brownell ◽  
Daniel G. Chateau ◽  
Roxana D. Dragan ◽  
Charles Burchill ◽  
...  
Keyword(s):  
Animal Studies ◽  
General Anesthetic ◽  
Mixed Effect ◽  
Logistic Regression Models ◽  
Multiple Exposures ◽  
Increased Risk ◽  
Independent Association ◽  
Developmental Domains ◽  
Single Versus

Abstract Background Animal studies demonstrate general anesthetic (GA) toxicity in the developing brain. Clinical reports raise concern, but the risk of GA exposure to neurodevelopment in children remains uncertain. Methods The authors undertook a retrospective matched cohort study comparing children less than 4 yr of age exposed to GA to those with no GA exposure. The authors used the Early Development Instrument (EDI), a 104-component questionnaire, encompassing five developmental domains, completed in kindergarten as the outcome measure. Mixed-effect logistic regression models generated EDI estimates for single versus multiple GA exposure and compared both single and multiple exposures by the age of 0 to 2 or 2 to 4 yr. Known sociodemographic and physical confounders were incorporated as covariates in the models. Results A total of 18,056 children were studied: 3,850 exposed to a single GA and 620 exposed to two or more GA, who were matched to 13,586 nonexposed children. In children less than 2 yr of age, there was no independent association between single or multiple GA exposure and EDI results. Paradoxically, single exposure between 2 and 4 yr of age was associated with deficits, most significant for communication/general knowledge (estimate, −0.7; 95% CI, −0.93 to −0.47; P < 0.0001) and language/cognition (estimate, −0.34; 95% CI, −0.52 to −0.16; P < 0.0001) domains. Multiple GA exposure at the age of 2 to 4 yr did not confer greater risk than single GA exposure. Conclusions These findings refute the assumption that the earlier the GA exposure in children, the greater the likelihood of long-term neurocognitive risk. The authors cannot confirm an association between multiple GA exposure and increased risk of neurocognitive impairment, increasing the probability of confounding to explain the results.

scholarly journals Clinical Evidence for Any Effect of Anesthesia on the Developing Brain

2018 ◽  
Vol 128 (4) ◽  
pp. 840-853 ◽  
Author(s):  
Andrew J. Davidson ◽  
Lena S. Sun
Keyword(s):  
Animal Studies ◽  
Large Population ◽  
Population Based ◽  
Human Studies ◽  
General Anesthetics ◽  
Multiple Exposures ◽  
Weak Evidence ◽  
Increased Risk ◽  
Different Populations

Abstract A recent U.S. Food and Drug Administration warning advised that prolonged or repeated exposure to general anesthetics may affect neurodevelopment in children. This warning is based on a wealth of preclinical animal studies and relatively few human studies. The human studies include a variety of different populations with several different outcome measures. Interpreting the results requires consideration of the outcome used, the power of the study, the length of exposure and the efforts to reduce the confounding effects of comorbidity and surgery. Most, but not all, of the large population-based studies find evidence for associations between surgery in early childhood and slightly worse subsequent academic achievement or increased risk for later diagnosis of a behavioral disability. In several studies, the amount of added risk is very small; however, there is some evidence for a greater association with multiple exposures. These results may be consistent with the preclinical data, but the possibility of confounding means the positive associations can only be regarded as weak evidence for causation. Finally, there is strong evidence that brief exposure is not associated with any long term risk in humans.

Intraoperative Awareness

2018 ◽  
pp. 443-446
Author(s):  
Jennifer Knuth ◽  
Lindsay Gennari ◽  
John Cagino
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Trauma Surgery ◽  
Rare Event ◽  
General Anesthetic ◽  
Intraoperative Awareness ◽  
Patient Reports ◽  
Increased Risk ◽  
Patient’S Outcome

Awareness following general anesthesia is a rare event; however, it may have significant impact on patient satisfaction and long-term morbidity. Detecting intraoperative awareness during a general anesthetic is difficult due to the fact that the signs and symptoms are often absent in documented cases of awareness. Often, intraoperative awareness goes unnoticed until a patient reports the experience. Anesthesiologists should be cognizant of the risk factors associated with an increased risk of intraoperative awareness. Cesarean section performed under general anesthesia, cardiac surgery, and trauma surgery all carry an increased risk. Anesthesiologists should consider patient specific risk factors involving a higher than expected anesthetic requirement in developing their anesthetic plan. In the event of intraoperative awareness, the anesthesiologist’s actions and interactions with the patient are critical in improving the patient’s’ outcome and minimizing long-term psychological stress. Anesthesiologists should acknowledge the event and create a supportive relationship with the patient.

scholarly journals Long‐Term Particulate Matter Exposure and Incidence of Arrhythmias: A Cohort Study

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Zhenyu Zhang ◽  
Jeonggyu Kang ◽  
Yun Soo Hong ◽  
Yoosoo Chang ◽  
Seungho Ryu ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cohort Study ◽  
Particulate Matter ◽  
Cardiac Arrhythmia ◽  
Logistic Regression Models ◽  
Atrial Contraction ◽  
Short Term Exposure ◽  
Increased Risk ◽  
Prospective Association

Background Studies have shown that short‐term exposure to air pollution is associated with cardiac arrhythmia hospitalization and mortality. However, the relationship between long‐term particulate matter air pollution and arrhythmias is still unclear. We evaluate the prospective association between particulate matter (PM) air pollution and the risk of incident arrhythmia and its subtypes. Methods and Results Participants were drawn from a prospective cohort study of 178 780 men and women who attended regular health screening exams in Seoul and Suwon, South Korea, from 2002 to 2016. Exposure to PM with an aerodynamic diameter of ≤10 and ≤2.5 μm (PM 10 and PM 2.5 , respectively) was estimated using a land‐use regression model. The associations between long‐term PM air pollution and arrhythmia were examined using pooled logistic regression models with time‐varying exposure and covariables. In the fully adjusted model, the odds ratios (ORs) for any arrhythmia associated with a 10 μg/m 3 increase in 12‐, 36‐, and 60‐month PM 10 exposure were 1.15 (1.09, 1.21), 1.12 (1.06, 1.18), and 1.14 (1.08, 1.20), respectively. The ORs with a 10 μg/m 3 increase in 12‐ and 36‐month PM 2.5 exposure were 1.27 (1.15, 1.40) and 1.10 (0.99, 1.23). PM 10 was associated with increased risk of incident bradycardia and premature atrial contraction. PM 2.5 was associated with increased risk of incident bradycardia and right bundle‐branch block. Conclusions In this large cohort study, long‐term exposure to outdoor PM air pollution was associated with increased risk of arrhythmia. Our findings indicate that PM air pollution may be a contributor to cardiac arrhythmia in the general population.

Dental health of long-term survivors of childhood cancer: The childhood cancer survivor study (CCSS)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9017-9017
Author(s):  
S. C. Kaste ◽  
S. Baker ◽  
P. Goodman ◽  
W. Leisenring ◽  
M. Stovall ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Childhood Cancer ◽  
Dental Health ◽  
Alkylating Agents ◽  
Specific Treatment ◽  
Logistic Regression Models ◽  
Dental Abnormalities ◽  
Increased Risk ◽  
Dental Abnormality

9017 Background: This study describes the frequencies of and risk factors for altered oral health and dental development in pediatric patients who have survived childhood cancer. Methods: We identified 8,522 participants and 2,831 siblings in the CCSS with information on dental health. Dental outcomes of treatment and socioeconomic-demographic (SED) data, were analyzed using univariate and multivariate logistic regression models to estimate odds ratios (OR). Results: Survivors included 4,249 females (49.9%), 7,367 white non-Hispanic (86.5%). Median age at cancer diagnosis, 6.8y (range, 0–20 y); time from diagnosis to interview, 31.4 y (range, 17–54 y). Overall, 30% of survivors self-reported ≥ 1 oral-dental abnormality: microdontia (10%), hypodontia (8%), > 5 caries (55%), root stunting (6%), enamel hypoplasia (13%), gingivitis (7%). Compared to siblings, survivors were at increased risk of ≥ 1 oral-dental abnormalities when adjusted for SED (OR = 2.0, p<0.001). Increased risk of abnormalities was associated with being female (p<0.001) or white non-Hispanic (p=0.001), having an income < $20K (p=0.001) or lower education (p=0.004), and lack of health insurance (p=0.02). Patients with central nervous system tumors, neuroblastoma and soft tissue sarcoma had highest risk of abnormality (all P-values < 0.001). In multivariate models adjusted for SED, radiation dose to jaw, and exposure to increasing doses of alkylating agents increased risk of oral-dental abnormalities (radiation dose = 20 Gy OR = 5.6, p < 0.001; alkylating agent score OR=1.6, p<0.0001). Conclusions: Childhood cancer therapy results in adverse long- term oral-dental sequelae and is associated with specific treatment factors. No significant financial relationships to disclose.

scholarly journals Exposure to airborne cadmium and breast cancer stage, grade and histology at diagnosis: findings from the E3N cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amina Amadou ◽  
Delphine Praud ◽  
Thomas Coudon ◽  
Aurélie M. N. Danjou ◽  
Elodie Faure ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Conditional Logistic Regression ◽  
Positive Association ◽  
Cadmium Exposure ◽  
Tubular Carcinoma ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Estrogenic Properties ◽  
Nested Case Control

AbstractMolecular studies suggest that cadmium due to its estrogenic properties, might play a role in breast cancer (BC) progression. However epidemiological evidence is limited. This study explored the association between long-term exposure to airborne cadmium and risk of BC by stage, grade of differentiation, and histological types at diagnosis. A nested case–control study of 4401 cases and 4401 matched controls was conducted within the French E3N cohort. A Geographic Information System (GIS)-based metric demonstrated to reliably characterize long-term environmental exposures was employed to evaluate airborne exposure to cadmium. Multivariable adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. There was no relationship between cadmium exposure and stage of BC. Also, no association between cadmium exposure and grade of differentiation of BC was observed. However, further analyses by histological type suggested a positive association between cadmium and risk of invasive tubular carcinoma (ITC) BC [ORQ5 vs Q1 = 3.4 (95% CI 1.1–10.7)]. The restricted cubic spline assessment suggested a dose–response relationship between cadmium and ITC BC subtype. Our results do not support the hypothesis that airborne cadmium exposure may play a role in advanced BC risk, but suggest that cadmium may be associated with an increased risk of ITC.

scholarly journals LONG-TERM EXPOSURE TO AIR POLLUTION AND THE RISK OF DEMENTIA: THE ROLE OF CARDIOVASCULAR DISEASES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S119-S119 ◽  
Author(s):  
Debora Rizzuto ◽  
Giulia Grande ◽  
Petter Ljungman ◽  
Tom Bellander
Keyword(s):  
Air Pollution ◽  
Cognitive Decline ◽  
Road Traffic ◽  
Dispersion Model ◽  
National Study ◽  
Linear Regression Models ◽  
Mixed Effect ◽  
Increased Risk

Abstract Aim: We aimed to investigate the association between long-term air pollution and cognitive decline and dementia, and to clarify the role of CVD on the studied association. Methods: We examined 3150 dementia-free 60+ year-olds in the Swedish National study on Aging and Care in Kungsholmen, Stockholm for up to 13 years, during which 363 persons developed dementia. Outdoor air pollution levels at the home address were assessed yearly for all participants, using a dispersion model for nitrogen oxides (NOX), mainly emitted from road traffic. Mixed-effect linear regression models were used to quantify the association between air pollution and cognitive decline (with the Mini Mental State Examination). The risk of dementia, in keeping with the Diagnostic and Statistical Manual of Mental Disorders IV edition, was estimated using competing-risks models, considering death as competing event, and considering an exposure window 0-5 years before a year at risk. Stratified analyses by CVD were also performed. Results: Higher levels of traffic-related residential air pollution were associated with steeper cognitive decline over the follow-up period. After controlling for potential confounders, higher levels of air pollution were associated with increased risk of dementia (HR: 1.13, 95%CI: 1.05-1.22, for an µg/m3 unit increase NOX). The stratified analyses showed that the presence of CVD enhanced the effect of air pollution on dementia risk. Conclusion: Long-term exposure to traffic-related air pollution was associated with a higher risk of dementia. Cardiovascular disease might have played a role in this association.

Influence of Long-term Non-Aspirin NSAID use on Risk of Frailty in Men ≥60 years: The Physicians’ Health Study

2022 ◽  
Author(s):  
Ariela R Orkaby ◽  
Rachel Ward ◽  
Jiaying Chen ◽  
Akshay Shanbhag ◽  
Howard D Sesso ◽  
...  
Keyword(s):  
Propensity Score ◽  
Frailty Index ◽  
Health Study ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Propensity Score Adjustment

Abstract Background Inflammation is a central pathway leading to frailty but whether commonly used non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) can prevent frailty is unknown. Methods Prospective cohort study of male physicians ≥60 who participated in the Physicians’ Health Study. Annual questionnaires collected data on NSAID use, lifestyle and morbidity. Average annual NSAID use was categorized as 0 days/year, 1-12 days/year, 13-60 days/year, and &gt;60 days/year. Frailty was assessed using a validated 33-item frailty index. Propensity score inverse probability of treatment weighting was used to address confounding by indication and logistic regression models estimated odds ratios (ORs) of prevalent frailty according to non-aspirin NSAID use. Results 12,101 male physicians were included (mean age 70±7 years, mean follow-up 11 years). Reported NSAID use was 0 days/year for 2,234, 1-12 days/year for 5,812, 13-60 days/year for 2,833, and &gt;60 days/year for 1,222 participants. 2,413 participants (20%) were frail. Higher self-reported NSAID use was associated with greater alcohol use, smoking, arthritis, hypertension, and heart disease, while less NSAID use was associated with coumadin use and prior bleeding. After propensity score adjustment, all characteristics were balanced. ORs (95% CIs) of prevalent frailty were 0.90 (0.80-1.02), 1.02 (0.89-1.17), and 1.26 (1.07-1.49) for average NSAID use of 1-12 days/year, 13-60 days/year, and &gt;60 days/year, compared to 0 days/year (p-trend&lt;0.001). Conclusions Long term use of NSAIDs at high frequency is associated with increased risk of frailty among older men. Additional study is needed to understand the role of anti-inflammatory medication in older adults and its implication for overall health.

Maternal Hypothyroidism during Pregnancy and the Risk for Infectious Morbidity of the Offspring

2019 ◽  
Vol 37 (03) ◽  
pp. 291-295 ◽  
Author(s):  
Ofer Beharier ◽  
Asnat Walfisch ◽  
Tamar Wainstock ◽  
Irit Szaingurten-Solodkin ◽  
Daniela Landau ◽  
...  
Keyword(s):  
Animal Studies ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Infectious Morbidity ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Objective Animal studies indicate a possible intrauterine immunological imprinting in pregnancies complicated by hypothyroidism. We aimed to evaluate whether exposure to maternal hypothyroidism during pregnancy increases the risk of long-term infectious morbidity of the offspring. Study Design A retrospective cohort study compared the long-term risk of hospitalization associated with infectious morbidity in children exposed and unexposed in utero to maternal hypothyroidism. Outcome measures included infectious diagnoses obtained during any hospitalization of the offspring (up to the age of 18 years). Results The study included 224,950 deliveries. Of them, 1.1% (n = 2,481) were diagnosed with maternal hypothyroidism. Children exposed to maternal hypothyroidism had a significantly higher rate of hospitalizations related to infectious morbidity (13.2 vs. 11.2% for control; odds ratio: 1.2; 95% confidence interval: 1.08–1.36; p = 0.002). Specifically, incidences of ear, nose, and throat; respiratory; and ophthalmic infections were significantly higher among the exposed group. The Kaplan–Meier curve indicated that children exposed to maternal hypothyroidism had higher cumulative rates of long-term infectious morbidity. In the Cox proportional hazards model, maternal hypothyroidism remained independently associated with an increased risk of infectious morbidity in the offspring while adjusting for confounders. Conclusion Maternal hypothyroidism during pregnancy is associated with significant pediatric infectious morbidity of the offspring.

scholarly journals Physiology-based toxicokinetic modelling of aluminium in rat and man

2021 ◽  
Author(s):  
Christoph Hethey ◽  
Niklas Hartung ◽  
Gaby Wangorsch ◽  
Karin Weisser ◽  
Wilhelm Huisinga
Keyword(s):  
Risk Assessment ◽  
Animal Studies ◽  
Quantitative Risk Assessment ◽  
Mixed Effect ◽  
Naturally Occurring ◽  
Substance Dependent ◽  
Quantitative Understanding ◽  
Intravenous And Oral Administration ◽  
Chloride Salts

AbstractA sufficient quantitative understanding of aluminium (Al) toxicokinetics (TK) in man is still lacking, although highly desirable for risk assessment of Al exposure. Baseline exposure and the risk of contamination severely limit the feasibility of TK studies administering the naturally occurring isotope 27Al, both in animals and man. These limitations are absent in studies with 26Al as a tracer, but tissue data are limited to animal studies. A TK model capable of inter-species translation to make valid predictions of Al levels in humans—especially in toxicological relevant tissues like bone and brain—is urgently needed. Here, we present: (i) a curated dataset which comprises all eligible studies with single doses of 26Al tracer administered as citrate or chloride salts orally and/or intravenously to rats and humans, including ultra-long-term kinetic profiles for plasma, blood, liver, spleen, muscle, bone, brain, kidney, and urine up to 150 weeks; and (ii) the development of a physiology-based (PB) model for Al TK after intravenous and oral administration of aqueous Al citrate and Al chloride solutions in rats and humans. Based on the comprehensive curated 26Al dataset, we estimated substance-dependent parameters within a non-linear mixed-effect modelling context. The model fitted the heterogeneous 26Al data very well and was successfully validated against datasets in rats and humans. The presented PBTK model for Al, based on the most extensive and diverse dataset of Al exposure to date, constitutes a major advancement in the field, thereby paving the way towards a more quantitative risk assessment in humans.

scholarly journals Febrile Seizures: Current Views and Investigations

2009 ◽  
Vol 36 (6) ◽  
pp. 679-686 ◽  
Author(s):  
Aylin Y. Reid ◽  
Michael A. Galic ◽  
G. Campbell Teskey ◽  
Quentin J. Pittman
Keyword(s):  
Animal Models ◽  
Current Literature ◽  
Growth And Development ◽  
Animal Studies ◽  
Pediatric Population ◽  
Febrile Seizures ◽  
Long Term Effects ◽  
Common Cause ◽  
Increased Risk

Febrile seizures (FSs) are seizures that occur during fever, usually at the time of a cold or flu, and represent the most common cause of seizures in the pediatric population. Up to 5% of children between the ages of six months and five years-of-age will experience a FS. Clinically these seizures are categorized as benign events with little impact on the growth and development of the child. However, studies have linked the occurrence of FSs to an increased risk of developing adult epileptic disorders. There are many unanswered questions about FSs, such as the mechanism of their generation, the long-term effects of these seizures, and their role in epileptogenesis. Answers are beginning to emerge based on results from animal studies. This review summarizes the current literature on animal models of FSs, mechanisms underlying the seizures, and functional, structural, and molecular changes that may result from them.

Sign in / Sign up

Export Citation Format

Share Document