Biofilm Formation by Hospital-Acquired Resistant Bacteria Isolated from Respiratory Samples.

BACKGROUND: Hospital-acquired resistant infections (HARI) are infections, which develop 48 h or more after admission to a healthcare facility. HARI pose a considerably acute challenge, due to limited treatment options. These infections are associated bacterial biofilms, which act as a physical barrier to diverse external stresses, such as desiccation, antimicrobials and biocides. We assessed the influence of multiple factors on biofilm production by HARI -associated bacteria. METHODS: Bacteria were isolated from samples of patients with respiratory HARI who were hospitalized during 2020-2022 in north Israel. Following antibiotic susceptibility testing by disc diffusion or broth microdilution, biofilm formation capacities of resistant bacteria (methicillin-resistant staphylococcus aureus, extended spectrum beta-lactamase-producing Escherichia coli and Klebsiela pneumonia, and multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii) was assessed using the crystalline violet staining method. Data regarding season, time to infection, bacterial species, patient age and gender, year, and medical department were collected from the patient medical records. RESULTS: Among the 226 study isolates, K. pneumonia was the most prevalent (35.4%) bacteria, followed by P. aeruginosa (23.5%), and methicillin-resistant staphylococcus aureus (MRSA) (21.7%). A significantly higher rate of HARI was documented in 2022 compared to 2020-2021. The majority of isolates (63.3%) were strong biofilm producers, with K. pneumonia (50.3%) being most dominant, followed by P. aeruginosa (29.4%). Biofilm production strength was significantly affected by seasonality and hospitalization length, with strong biofilm production in autumn and in cases where hospitalization length exceeded 30 days. CONCLUSION: Biofilm production by HARI bacteria is influenced by bacterial species, season and hospitalization length.

Residential greenness and lower breast and prostate cancer incidence: Evidence from a retrospective cohort study of 977,644 participants from Israel.

BACKGROUND: There is limited evidence on the associations between residential greenness and cancer incidence in longitudinal studies. OBJECTIVES: The aim of the study was to evaluate the associations between weighted mean residential greenness exposure and cancer incidence. METHODS: This is a registry based retrospective cohort study of 977,644 participants. The residential greenness exposure was estimated for every participant, as the weighted mean residential greenness exposure. This was based on the mean Normalized Difference Vegetation Index (NDVI) in the residential small geographic area and the duration of the residence in this area. Cancer incidence cases included consecutive newly diagnosed cases of primary cancer. Analyses were conducted for all cancer sites, lung cancer, bladder cancer, breast cancer, prostate cancer and melanoma-skin cancer. Cox regression models were used to evaluate the crude and adjusted associations (hazards ratios (HR) and its 95 % confidence intervals (CIs)) between tertiles of residential greenness and cancer incidence. Further adjusted models to nitrogen oxides (NOx) were estimated. RESULTS: After adjustment to covariates, exposure to the highest tertile of residential greenness, compared to the lowest, were associated with lower risk for all cancer sites (HR = 0.88, 95 % CI: 0.86-0.90), breast cancer (HR = 0.85, 95 % CI: 0.80-0.89) and prostate cancer (HR = 0.85, 95 % CI: 0.79-0.91). In addition, lower risk were observed for the middle tertile of exposure and all cancer sites (HR = 0.88, 95 % CI: 0.86-0.90), breast cancer (HR = 0.88, 95 % CI: 0.84-0.92) and prostate cancer (HR = 0.83, 95 % CI: 0.79-0.89). There was no evidence for mediation by air pollution (NOx). DISCUSSION: Residential greenness demonstrated beneficial associations with lower risk for all cancers, breast and prostate cancers. If our observations will be replicated, it may present a useful avenue for public-health intervention to reduce cancer burden through the provision of greenness exposure.

"Residential greenness, gestational diabetes mellitus (GDM) and microbiome diversity during pregnancy".

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with reduced gut microbiota richness that was also reported to differ significantly between those living in rural compared to urban environments. Therefore, our aim was to examine the associations between greenness and maternal blood glucose levels and GDM, with microbiome diversity as a possible mediator in these associations. METHODS: Pregnant women were recruited between January 2016 and October 2017. Residential greenness was evaluated as mean Normalized Difference Vegetation Index (NDVI) within 100, 300 and 500 m buffers surrounding each maternal residential address. Maternal glucose levels were measured at 24-28 weeks of gestation and GDM was diagnosed. We estimated the associations between greenness and glucose levels and GDM using generalized linear models, adjusting for socioeconomic status and season at last menstrual period. Using causal mediation analysis, the mediation effects of four different indices of microbiome alpha diversity in first trimester stool and saliva samples were assessed. RESULTS: Of 269 pregnant women, 27 participants (10.04%) were diagnosed with GDM. Although not statistically significant, adjusted exposure to medium tertile levels of mean NDVI at 300 m buffer had lower odds of GDM (OR = 0.45, 95% CI: 0.16, 1.26, p = 0.13) and decreased change in mean glucose levels (ß = -6.28, 95% CI: 14.91, 2.24, p = 0.15) compared to the lowest tertile levels of mean NDVI. Mixed results were observed at 100 and 500 m buffers, and when comparing highest tertile levels to lowest. No mediation effect of first trimester microbiome on the association between residential greenness and GDM was observed, and a small, possibly incidental, mediation effect on glucose levels was observed. CONCLUSION: Our study suggests possible associations between residential greenness and glucose intolerance and risk of GDM, though without sufficient evidence. Microbiome in the first trimester, while involved in GDM etiology, is not a mediator in these associations. Future studies in larger populations should further examine these associations.

Residence near industrial complex and cancer incidence: A registry-based cohort of 1,022,637 participants with a follow-up of 21 years, Israel.

BACKGROUND: Industrial complex (IC) residence is associated with higher cancer incidence in adults and children. However, the effect on young adults and the residence duration are not well described. Since the beginning of the 20th century, the Haifa bay area (HBA) has a major IC area with petrochemical industry complex and many other industries. The objectives of the current study were to estimate the association between IC residence and cancer incidence and to evaluate the effect of the residence duration. METHODS: This study is a registry-based cohort (N = 1,022,637) with a follow-up of 21 years. Cox regression models were used to evaluate the associations (hazards ratios (HR) and its 95% confidence intervals (CIs)) between HBA residence and incidence of all cancer sites (n = 62,049) and for site-specific cancer types including: lung cancer (n = 5398), bladder cancer (n = 3790), breast cancer (n = 11,310), prostate cancer (n = 6389) skin cancer (n = 4651), pancreatic cancer (n = 2144) and colorectal cancer (n = 8675). We evaluated the effect of the duration of exposure as categories of 7 years for those with 15 years of follow-up. RESULTS: IC residence was associated with higher risk for all cancer sites (HR:1.09, 95% CI: 1.06-1.12), for site-specific cancer incidence including: lung cancer (HR:1.14, 95% CI: 1.04-1.23), bladder cancer (HR:1.11, 95% CI: 1.01-1.23), breast cancer (HR:1.04, 95% CI: 0.98-1.10), prostate cancer (HR:1.07, 95% CI: 0.99-1.16), skin cancer (HR:1.22, 95% CI: 1.12-1.33) and colorectal cancer (HR:1.10, 95%CI: 1.03-1.17). Similar risk was also observed among young adults (HR: 1.10, 95% CI: 1.00-1.20). In the analyses for the duration of exposure, IC residence was associated with higher risk for all cancer site for the longest residence duration (15-21 years: HR: 1.08, 95% CI: 1.04-1.13). CONCLUSIONS: Harmful associations were found between IC residence and incidence of all cancer sites and site-specific cancers types. Our findings add to the limited evidence of associations between IC residence and cancer in young adults.

Antibiotic resistance patterns of Helicobacter pylori in North Israel - A six-year study.

BACKGROUND: One main challenge in Helicobacter pylori (H. pylori) eradication is its increasing antibiotic resistance. Additionally, resistance rates vary between geographic areas and periods. However, data are limited since susceptibility testing is not routinely performed. Thus, it is valuable to gather data regarding H. pylori's resistance rates in Israel that would aid in better adjustment of treatment. MATERIALS AND METHODS: The study included 540 H. pylori isolates, recovered from gastric biopsy samples of patients who had undergone endoscopy, during 2015-2020, at the Padeh Poriya Medical Center. Antibiotic susceptibility testing to amoxicillin, clarithromycin, metronidazole, levofloxacin, rifampicin, and tetracycline was performed using the Etest technique. Data regarding participants' sex, age, and ethnic group were collected. For every antibiotic and for multi-resistance, generalized linear models were used to estimate crude and adjusted estimated differences in mean MIC and odds ratios (ORs) for every year, compared with the reference year 2015. RESULTS: The highest resistance rates were for clarithromycin and metronidazole (46.3% and 16.3%, respectively). Patients above 18 had higher resistance rate to rifampicin and multi-resistance (3.3% and 14.8%), compared with patients under 18 (0.5% and 8.4%, respectively). Resistance rates for levofloxacin, rifampicin, and multi-resistance were significantly higher among Arab patients, compared with Jewish patients. During the 6-year surveillance, a significant annual trend in MIC for metronidazole and in ORs for metronidazole, levofloxacin, and multi-resistance were observed (after adjustment). During 2020 compared with 2015, significant increased ORs were observed for levofloxacin and metronidazole [5.72 (1.03-31.84); 4.28 (1.30-14.14), respectively]. CONCLUSIONS: In light of the remarkable changes in antibiotic resistance of H. pylori during the study's period and the increasing resistance rates to various antibiotics, it is very important to continuously monitor H. pylori antibiotic susceptibly. In order to increase eradication rates of this bacterium, therapy regimes must be based on an updated antibiotic resistance data.

"Residential greenness and site-specific cancer: A registry based cohort of 144,427 participants with a 21-years of follow-up, Tel-Aviv district, Israel".

BACKGROUND: Few longitudinal studies evaluated the beneficial associations between cumulative residential greenness and site-specific cancer. Our objective was to evaluate the associations between cumulative residential greenness exposure and site-specific cancer incidence (lung, bladder, breast, prostate, and skin cancer) within a registry-based cohort study. METHODS: This study was based on 144,427 participants who lived in the Tel Aviv district during 1995-2015. The residential greenness exposure was estimated for every participant, as the weighted mean residential greenness exposure, based on the mean Normalized Difference Vegetation Index (NDVI) in the residential area and the duration of the residence in this area. Cox regression models were used to evaluate the unadjusted and adjusted associations between exposure to greenness and cancer incidence during 1998-2015 (Hazard Ratios (HRs) and 95% Confidence Intervals (CIs)). Covariates included in adjusted models were selected based on prior knowledge and directed acyclic graphs. We imputed missing data and further sensitivity analyses were conducted. RESULTS: After adjustments, beneficial associations between exposure to greenness and cancer incidence were observed. An interquartile range (IQR) increase in NDVI was associated with a lower HRs for lung cancer (HRadj. = 0.75 95% CI: 0.66-0.85), bladder cancer (HRadj. = 0.71, 95% CI: 0.62-0.82), breast cancer (HRadj. = 0.81, 95% CI: 0.74-0.88), prostate cancer (HRadj. = 0.77, 95% CI: 0.70-0.86) and skin cancer (HRadj. = 0.78, 95% CI: 0.69-0.88). Generally, the patterns of associations were consistent between complete-case models and imputed models, when estimated for participants aged 16 years or 40 years and older at baseline, when stratified by area level socioeconomic status, when evaluated for non-movers participants and after further adjustment to social determinants of health. CONCLUSION: Residential greenness may reduce the risk for lung, bladder, breast, prostate, and skin cancers. If our observations will be replicated, it may present a useful avenue for public-health intervention to reduce cancer burden.

Obesity II: Establishing causal links between chemical exposures and obesity.

Obesity is a multifactorial disease with both genetic and environmental components. The prevailing view is that obesity results from an imbalance between energy intake and expenditure caused by overeating and insufficient exercise. We describe another environmental element that can alter the balance between energy intake and energy expenditure: obesogens. Obesogens are a subset of environmental chemicals that act as endocrine disruptors affecting metabolic endpoints. The obesogen hypothesis posits that exposure to endocrine disruptors and other chemicals can alter the development and function of the adipose tissue, liver, pancreas, gastrointestinal tract, and brain, thus changing the set point for control of metabolism. Obesogens can determine how much food is needed to maintain homeostasis and thereby increase the susceptibility to obesity. The most sensitive time for obesogen action is in utero and early childhood, in part via epigenetic programming that can be transmitted to future generations. This review explores the evidence supporting the obesogen hypothesis and highlights knowledge gaps that have prevented widespread acceptance as a contributor to the obesity pandemic. Critically, the obesogen hypothesis changes the narrative from curing obesity to preventing obesity.

Residential greenness and hair cortisol levels during the first trimester of pregnancy.

BACKGROUND AND AIM: Studies have shown that increased maternal cortisol level is associated with child adverse health outcomes. Hair cortisol (HC) is suitable for assessing long-term circulating cortisol concentration. Only two previous studies reported beneficial associations between cortisol and residential greenness during pregnancy and no study focused on the first trimester. Our aim was to evaluate the association between residential greenness and first trimester HC levels among pregnant women in Israel. METHODS: Women were recruited during second and third trimesters. Hair samples were collected from the scalp and retrospective HC levels during the first trimester were quantified for 217 women. HC levels were natural log transformed and outliers were excluded. Based on geocoded birth address, small area sociodemographic status (SES) and mean residential surrounding greenness were calculated using high-resolution satellite-based Normalised Difference Vegetation Index (NDVI) data at 100, 300 and 500-m buffers in a cross-sectional approach. In addition, longitudinal exposure to mean greenness during a week preconception and during the first trimester were calculated. Missing covariates were imputed and linearity of the associations were evaluated. Generalized linear models were used to estimate the crude and adjusted associations controlled for the relevant covariates. RESULTS: After exclusion of outliers, for 211 women, crude and adjusted beneficial associations between exposure to higher mean NDVI and HC levels were observed for all the exposure measures. An increase in 1 interquartile range of greenness (100 m buffer) was associated with a statistically significant lower estimated natural log mean HC level (-0.27 95% CI: -0.44; -0.11). The associations were robust to adjustment for covariates. The findings were consistent for different buffers, for the longitudinal approach, when all observations were included in the analysis and slightly stronger associations were observed for women with addresses geocoded at the home or street level. For most of the exposure measures, stronger associations were observed among those of lower sociodemographic status. CONCLUSION: Our findings that more greenness associated with reduced maternal cortisol levels measured in the hair during the first trimester, could have substantial implications for urban planners and public health professional. If our observations will be replicated, it may present a useful avenue for public-health intervention to promote health through the provision of greenness exposure during early pregnancy, specifically to disadvantage populations.

Low and High Ambient Temperatures during Pregnancy and Birth Weight among 624,940 Singleton Term Births in Israel (2010-2014): An Investigation of Potential Windows of Susceptibility.

BACKGROUND: Exposure to heat during pregnancy has been associated with reduced fetal growth. Less is known about associations with cold and the potential for critical time windows of exposure. OBJECTIVES: We aimed to evaluate, in a national retrospective cohort, critical windows of susceptibility during pregnancy to extreme temperatures (low and high) and fetal growth, among 624,940 singleton term births in Israel during the period 2010-2014. METHODS: Temperature exposures were estimated using a spatially refined gridded climate data set with a 1-h and 1-km2 resolution. Percentiles of temperature were categorized by climatic zone for the entire pregnancy and by trimesters and weeks. Generalized additive models with the distributed lag nonlinear model framework were used to estimate unadjusted and adjusted associations between percentiles and categories of temperature and fetal growth markers: term [births after 36 weeks of gestational age (GA)] mean birth weight and term low birth weight (tLBW, term infants with birth weight below 2,500g). RESULTS: After adjustment, extreme temperatures (percentiles) during the entire pregnancy were associated with a lower mean birth weight {≤10th vs. 41st-50th percentile: -56g [95% confidence interval (CI): -63g, -50g)]; >90th vs. 41st-50th percentile: -65g; 95% CI: -72g, -58g}. Similar inverse U-shaped patterns were observed for all trimesters, with stronger associations for heat than for cold and for exposures during the third trimester. For heat, results suggest critical windows between 3-9 and 19-34 GA-weeks, with the strongest association estimated at 3 GA-weeks (temperature >90th vs. 41st-50th percentiles: -3.8g; 95% CI: -7.1g, -0.4g). For cold, there was a consistent trend of null associations early in pregnancy and stronger inverse associations over time, with the strongest association at 36 GA-week (≤10th vs. 41st-50th percentiles: -2.9g; 95% CI: -6.5g, 0.7g). For tLBW, U-shape patterns were estimated for the entire pregnancy and third trimester exposures, as well as nonsignificant associations with heat for 29-36 GA-weeks. Generally, the patterns of associations with temperatures during the entire pregnancy were consistent when stratified by urbanicity and geocoding hierarchy, when estimated for daily minimum and maximum temperatures, when exposures were classified based on temperature distributions in 49 natural regions, and when estimated for all live births. DISCUSSION: Findings from our study of term live births in Israel (2010-2014) suggest that exposure to extreme temperatures, especially heat, during specific time windows may result in reduced fetal growth. https://doi.org/10.1289/EHP8117.

Reduced Susceptibility to Chlorhexidine among Staphylococcus aureus Isolates in Israel: Phenotypic and Genotypic Tolerance.

Antiseptic use for body decolonization is the main activity applied to prevent healthcare-associated infections, including those caused by S. aureus. Consequentially, tolerance to several antiseptics such as chlorhexidine gluconate (CHG) has developed. This study aimed to estimate the prevalence of CHG tolerance among S. aureus strains in Israel and to evaluate factors that may affect this tolerance. Furthermore, it tested the associations between phenotypic and genotypic CHG tolerance. S. aureus strains (n = 190) were isolated from clinical samples of patients admitted to various medical institutions in Israel. Phenotypic susceptibility to CHG was assessed by determining minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Genotypic tolerance was detected using real-time PCR for detection of qac A/B genes. MIC for the antibiotic mupirocin was determined using the Etest method. Presence of the Panton-Valentine Leucocidin (pvl) toxin, mecA and mecC genes was detected using an eazyplex® MRSAplus kit (AmplexDiagnostics GmbH, Gars, Germany). CHG tolerance was observed in 13.15% of the isolates. An association between phenotypic and genotypic tolerance to CHG was observed. Phenotypic tolerance to CHG was associated with methicillin resistance but not with mupirocin resistance. Additionally, most of the CHG-tolerant strains were isolated from blood cultures. In conclusion, this work shed light on the prevalence of reduced susceptibility to CHG among S. aureus strains in Israel and on the characteristics of tolerant strains. CHG-tolerant strains were more common than methicillin-resistant ones in samples from invasive infections. Further research should be performed to evaluate risk factors for the development of CHG tolerance.

There's no place like home? The psychological, physiological, and cognitive effects of short visits to outdoor urban environments compared to staying in the indoor home environment, a field experiment on women from two ethnic groups.

BACKGROUND: The home environment is regarded as a safe, comfortable environment, however, home can also be a stressful place. Compared to staying in the indoor home environment, the effects of short visits to outdoor urban environments on short-term psychological, physiological and cognitive responses were not studied previously. AIM: To evaluate whether visits to different urban and ethnic environments, in comparison to staying in the home indoor environment, leads to short-term changes in psychological, physiological and cognitive responses and whether these responses are independent of ethnicity. METHODS: The participants, 20-35 year-old healthy women (N = 72, 48 Arab and 24 Jewish), started the experiment at their home and visited six different outdoor urban environments in predominantly ethnic Arab or Jewish cities, in Israel. First they visited intra-ethnic city and afterward inter-ethnic city environments. In each city they first visited an urban park and afterward, in a random order, a residential neighborhood and the city center. In each environment (including home) the following measures were used to evaluate psychological, physiological and cognitive effects: mood (measured as positive and negative emotions, cheerfulness, relaxed, natural and discomfort feelings), autonomic nervous system balance (assessed using heart rate variability (HRV)) and working memory (measured by a backwards digit-span task). Several potential mediators were measured: carbon monoxide (CO), heat, noise, social aspects, and the self-perceived restoration scale. RESULTS: Compared to staying in the indoor home environment, short visits to outdoor urban environments, specifically intra and inter-ethnic parks, were associated with beneficial psychological, physiological, and cognitive responses, and the strongest effects were found for the intra-ethnic park. The results for the other urban environments were different between Jewish and Arab women. The self-perceived restoration, social aspects and reduced CO, heat and noise exposures during the visits did not explain the observed changes between the outdoor environments and home. CONCLUSIONS: Visits to urban parks compared to staying in the home environment had beneficial short-term changes in psychological, physiological, and cognitive responses, regardless of ethnicity. The changes could not be attributed to the investigated mediators. Women should be encouraged to go outdoors and specifically visit parks to improve their psychological and physiological health.

Unconventional oil and gas development and health outcomes: A scoping review of the epidemiological research.

BACKGROUND: Hydraulic fracturing together with directional and horizontal well drilling (unconventional oil and gas (UOG) development) has increased substantially over the last decade. UOG development is a complex process presenting many potential environmental health hazards, raising serious public concern. AIM: To conduct a scoping review to assess what is known about the human health outcomes associated with exposure to UOG development. METHODS: We performed a literature search in MEDLINE and SCOPUS for epidemiological studies of exposure to UOG development and verified human health outcomes published through August 15, 2019. For each eligible study we extracted data on the study design, study population, health outcomes, exposure assessment approach, statistical methodology, and potential confounders. We reviewed the articles based on categories of health outcomes. RESULTS: We identified 806 published articles, most of which were published during the last three years. After screening, 40 peer-reviewed articles were selected for full text evaluation and of these, 29 articles met our inclusion criteria. Studies evaluated pregnancy outcomes, cancer incidence, hospitalizations, asthma exacerbations, sexually transmitted diseases, and injuries or mortality from traffic accidents. Our review found that 25 of the 29 studies reported at least one statistically significant association between the UOG exposure metric and an adverse health outcome. The most commonly studied endpoint was adverse birth outcomes, particularly preterm deliveries and low birth weight. Few studies evaluated the mediating pathways that may underpin these associations, highlighting a clear need for research on the potential exposure pathways and mechanisms underlying observed relationships. CONCLUSIONS: This review highlights the heterogeneity among studies with respect to study design, outcome of interest, and exposure assessment methodology. Though replication in other populations is important, current research points to a growing body of evidence of health problems in communities living near UOG sites.

The effects of crossing ethnic boundaries on the autonomic nervous system in Muslim and Jewish young women in Israel.

Exposure to alien inter-group environments can differently effect ethnic groups' autonomous nervous system, measured by heart rate variability (HRV). Our aim was to evaluate the effect of crossing alien ethnic boundaries on heart rate variability in three selected types of environments. In a field experiment study, we test responses of 72 Muslim and Jewish women to exposure to alien ethnic environments. We measured their HRV in intra and inter-ethnic parks, town centers and residential neighborhoods in Arab and Jewish adjacent towns. The subjects stayed half an hour in each environment. Mixed models were used to evaluate the effects. The results show that for both groups more favorable HRV measurements were demonstrated in intra-ethnic environments as compared to their HRV once crossing ethnic boundaries. The strongest effect in frequency domain (LF/HF) in response to ethnic boundary crossing was observed in the park for Muslims (ß:0.65, 95%CI: 0.60-0.70) and for Jews (ß: 0.60, 95%CI: 0.57-0.63). Following the eruption of the uprising, the most significant increase in LF/HF in response to ethnic boundary crossing was demonstrated in parks (ß: 0.66, 95%CI: 0.60-0.71). In conclusion, both groups are effected by boundary crossing but there are ethnic differences in the autonomic nervous system balance and in response to crossing alien ethnic boundaries. A further study is needed to understand the causes of these differences.

Mean and variance of greenness and pregnancy outcomes in Tel Aviv during 2000-14: longitudinal and cross-sectional approaches.

BACKGROUND: Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel. METHODS: Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to 'outdoor gyms' located in parks. RESULTS: Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to 'outdoor gyms' and variance of greenness had the largest estimates of mediation. CONCLUSION: This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations.

A comparison of the effects of selected mono-ethnic urban environments on the autonomic functions of Muslim and Jewish women in Israel.

Few previous studies evaluated ethnic differences in the effects of urban environments on the autonomic balance in intra-ethnic environments and the mediation effects of environmental exposures (air pollution, noise, and thermal load). In a field experimental study, we exposed 48 Muslim and 24 Jewish women to park, town center, and residential street in Israeli mono-ethnic small towns. Heart rate variability (HRV), noise, thermal load, and carbon monoxide (CO) were measured by portable devices while visiting the environments and were analyzed using mixed models. The results highlight the restorative effect of parks on both ethnic groups with stronger effect for Jewish women compared to Muslim women (ß coefficient (95% confidence interval (CI)): - 6.45(- 6.70, - 6.20); - 4.99 (- 5.15, - 4.83), respectively). However, significant differences were recorded in Muslim and Jewish coping with the environments and the environmental exposures as measured by HRV.

Trends in Fetal Growth Between 2000 to 2014 in Singleton Live Births from Israel.

Trends in birthweight and abnormal fetal growth, namely term low birthweight (LBW), macrosomia, small-for-gestational age (SGA) and large-for-gestational age (LGA), are important indicators of changes in the health of populations. We performed this epidemiological study to evaluate these trends among 2,039,415 singleton live births from Israel over a period of 15 years. Birth certificate data was obtained from the Ministry of Health. Multivariable linear and logistic regression models were used to evaluate crude and adjusted estimates compared to the baseline of 2000 and polynomial trends. During the study period we observed a significant decrease in the rates of infants born SGA and LGA (10.7% to 9.2%, 10.2% to 9.6% respectively). After adjustment, based on the imputed data set, term mean birthweight increased by 6.0 grams (95% CI: 2.9, 9.1), and term LBW odds decreased by 19% in 2014 compared to 2000 (adj ORs: 0.81; 95% CI: 0.77, 0.85). Significant decreases were also observed for adjusted SGA, LGA and macrosomia rates. The decrease in abnormal fetal growth rates were not entirely explained by changes in sociodemographic characteristics or gestational age and may imply real improvement in child intrauterine growth in Israel during the last 15 years, especially in the Jewish population.

Exposure to Endocrine-Disrupting Chemicals during Pregnancy and Weight at 7 Years of Age: A Multi-pollutant Approach.

BACKGROUND: Prenatal exposure to endocrine-disrupting chemicals (EDCs) may induce weight gain and obesity in children, but the obesogenic effects of mixtures have not been studied. OBJECTIVE: We evaluated the associations between pre- and perinatal biomarker concentrations of 27 EDCs and child weight status at 7 years of age. METHODS: In pregnant women enrolled in a Spanish birth cohort study between 2004 and 2006, we measured the concentrations of 10 phthalate metabolites, bisphenol A, cadmium, arsenic, and lead in two maternal pregnancy urine samples; 6 organochlorine compounds in maternal pregnancy serum; mercury in cord blood; and 6 polybrominated diphenyl ether congeners in colostrum. Among 470 children at 7 years, body mass index (BMI) z-scores were calculated, and overweight was defined as BMI > 85th percentile. We estimated associations with EDCs in single-pollutant models and applied principal-component analysis (PCA) on the 27 pollutant concentrations. RESULTS: In single-pollutant models, HCB (hexachlorobenzene), ßHCH (ß-hexachlorocyclohexane), and polychlorinated biphenyl (PCB) congeners 138 and 180 were associated with increased child BMI z-scores; and HCB, ßHCH, PCB-138, and DDE (dichlorodiphenyldichloroethylene) with overweight risk. PCA generated four factors that accounted for 43.4% of the total variance. The organochlorine factor was positively associated with BMI z-scores and with overweight (adjusted RR, tertile 3 vs. 1: 2.59; 95% CI: 1.19, 5.63), and these associations were robust to adjustment for other EDCs. Exposure in the second tertile of the phthalate factor was inversely associated with overweight. CONCLUSIONS: Prenatal exposure to organochlorines was positively associated with overweight at age 7 years in our study population. Other EDCs exposures did not confound this association.

Green spaces and adverse pregnancy outcomes.

OBJECTIVE: The objective of this study was to evaluate the associations between proximity to green spaces and surrounding greenness and pregnancy outcomes, such as birth weight, low birth weight (LBW), very LBW (VLBW), gestational age, preterm deliveries (PTD) and very PTD (VPTD). METHODS: This study was based on 39,132 singleton live births from a registry birth cohort in Tel Aviv, Israel, during 2000-2006. Surrounding greenness was defined as the average of satellite-based Normalised Difference Vegetation Index (NDVI) in 250 m buffers and proximity to major green spaces was defined as residence within a buffer of 300 m from boundaries of a major green space (5000 m(2)), based on data constructed from OpenStreetMap. Linear regression (for birth weight and gestational age) and logistic regressions models (for LBW, VLBW, PTD and VPTD) were used with adjustment for relevant covariates. RESULTS: An increase in 1 interquartile range greenness was associated with a statistically significant increase in birth weight (19.2 g 95% CI 13.3 to 25.1) and decreased risk of LBW (OR 0.84, 95% CI 0.78 to 0.90). Results for VLBW were in the same direction but were not statistically significant. In general, no associations were found for gestational age, PTD and VPTD. The findings were consistent with different buffer and green space sizes and stronger associations were observed among those of lower socioeconomic status. CONCLUSIONS: This study confirms the results of a few previous studies demonstrating an association between maternal proximity to green spaces and birth weight. Further investigation is needed into the associations with VLBW and VPTD, which has never been studied before.