Proceedings of the 8th International Conference on Children's Health and the Environment

s Conference proceedings All sessions presented at the 8th International Conference on Children’s Health and Environment 14–16 September 2016 Parc de Recerca Biomèdica de Barcelona – PRBB Doctor Aiguader, 88 (at ISGlobal), Barcelona

The following is a list of abstracts presented at the 8th INCHES (International Network of Children's Health, Environment and Safety) Conference held on September 14-16, 2016 in Barcelona, Spain. Abstracts are presented in alphabetical order by corresponding author last name.
Neither the conference organizers or the Journal of Health and Pollution can be held responsible for inaccuracies or errors in any included abstracts.health, specifically in low-and middle-income countries. Further information Background Prenatal mercury exposure has been related to reductions in anthropometry at birth. Levels of mercury have been reported to be relatively high in the Spanish population, including vulnerable groups such as pregnant women and newborns. Our objective is to investigate the relationship between prenatal exposure to mercury, expressed as cord blood mercury levels, and fetal biometry in the Spanish Infancia y Medio Ambiente study.

Methods
The study subjects were 1867 pregnant women and their newborns participating in the Infancia y Medio Ambiente Spanish birth cohort study. Biparietal diamete, femur length, abdominal circumference and estimated fetal weight were measured by ultrasounds at 12, 20 and 34 weeks of gestation. Size and growth between these points were assessed by standard deviation scores adjusted for constitutional characteristics. Total mercury was determined in cord blood. Associations were investigated by linear regression models, adjusted by socio-demographic, nutritional -including four fish groups -and lifestyle-related variables in each area. Final estimates were obtained using meta-analysis. Ethical approval was granted by the ethical commitees of the participating health centers. S12 www.journalhealthpollution.org

Background
The indoor environment can expose us to a concentrated cocktail of chemicals. Indoor dust may be a source or sink for a range of contaminants. Most studies to date have focused on individual compounds or classes of contaminants. A review on dust indicated that a large number of different chemicals have been identified in recent years, e.g. polybrominated diphenyl ethers, pesticides, phthalates, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, and perfluorinated compounds. Polybrominated diphenyl ethers congener concentrations in serum and feces of toddlers were significantly correlated to those in house dust and suggest that dust exposure plays a larger role in the polybrominated diphenyl ethers body burden in toddlers than in their mothers, and this may be related to additional ingestion of dust as toddlers are apt to place toys and hands in the mouth, thus gaining additional exposure. An understanding of the hazards that contaminants in dust may pose to human health, a more comprehensive non-target approach using state of the art instruments will allow the identification of legacy compounds, but also identify potentially hazardous compounds not traditionally screened for.

Methods
We developed a targeted multi-residue screening method to analyse a diverse array of compounds such as may be found in indoor dust and human blood. In combination with non-target screening, previously unreported compounds in dust can be tentatively identified. Methods for screening blood and dust were tested using a mixture of >200 organic contaminants. By using different ionisation sources in positive and negative mode, identification of the introduced compounds was validated and different extraction procedures tested. The aim was primarily to understand the limitations of traditional extraction techniques and to see the differences that the extraction procedures has on the screening approach.

Results
Using the Norman recommended extraction technique for household dust and a trial of 5 typical blood extraction techniques we identified the recovery efficiency of a wide variety of organic contaminants in dust and blood. Using different ionisation sources, we further determined electrospray in positive, combined with negative mode, was able to detect around 80% of all compounds analyzed, however other ionisation sources identify unique features. Hydrophilic-lipophilic balance extraction cartridges, out of 5 extraction methods, extracted compounds with the highest recovery in blood, although other similar solid-phase extraction methods were also effective.

Conclusions
A single extraction technique for blood and the NORMAN non-target method for dust may be applicable for the determination of a wide range of compounds. For non-target analysis, electrospray ionization in positive and negative is necessary for the broadest range of most organic contaminants measured, however other ionization sources provide unique features that must be considered for a comprehensive approach. S15 www.journalhealthpollution.org

Background
Organohalogenated pollutants, namely organochlorine pesticides, polychlorobiphenyls (PCBs) and polybromodiphenyl ethers (PBDEs), may undergo long-range atmospheric transport because they are semi-volatile and chemically stable. They accumulate in organisms and humans as consequence of their lipophilic character. The toxic properties of most of them generate deleterious health effects in both humans and wild species. These compounds have been mostly synthesized and used in the northern hemisphere, but their strong capacity for long-range atmospheric transport has led to a global planetary distribution, including the southern hemisphere. While there is information on the occurrence of these compounds in the ecosystems of this hemisphere, the degree of information on the accumulation patterns of these compounds in southern hemisphere human populations is very limited.

Method
The present study was devoted to filling this gap by analysis of maternal serum from Argentina, representing postpartum mothers from the city of Salta (25ºS; n = 498) and Ushuaia (55ºS; n = 200). These samples were collected from April 2011 to March 2012 between the first and third days after delivery. Ethical approval was granted by the Ethics Committee at the Board of Medical School of Salta and conducted in accordance with the Helsinki declaration. The Northern Norway Regional Board of Research Ethics approved the study along with the Norwegian EMASAR biobank, containing the Argentinean blood samples.

Results
The median concentrations of the most abundant compounds were 0.33 and 0.51 ng/mL of total DDTs, 0.20 and 0.18 ng/mL of polychlorinated biphenyl, and 0.067 and 0.043 ng/mL of hexachlorobenzene in Ushuaia and Salta, respectively. These concentrations were generally low, but lower concentrations have been reported for various compounds in some northern hemisphere locations such as Norway. The influence of maternal age, parity, and body mass index on the concentrations of these pollutants has been investigated. S17 www.journalhealthpollution.org

Background
Cancer is generally associated with old age and the explanation most clinicians (and others) advance for its continuous increase, observed throughout the 20th century in all industrialized countries, is that it results from the progressive accumulation over the time of aging of genetic oxidative/stochastic damages with an additional role for the improvement of diagnostic capacities. It is too often forgotten that this increase concerns persons of all ages and, particularly in the last decades, the youth.

Methods
Through literature review, the aim of this study is to reconsider, in the light of new epigenetic models of environmental carcinogenesis and of transgenerational cancer transmission, the recent epidemiological data that confirm a substantial increase in childhood cancer throughout Europe, hardly explainable by the current stochastic mutational paradigm.

Results
Carcinogenesis is a long and complex process. As far as the increase in childhood cancer is concerned, the key factor for its occurrence should be looked for in parents (exposure of the reproductive cells) or the fetus (exposure in the very first stages of ontogenetic development).

Conclusions
The two main possibilities that have to be considered are: 1) direct exposure of the embryo/fetus to physical agents or, through transplacental transmission, to biological (viruses) or chemical agents, capable of directly damaging the fetal DNA or of inducing epigenetic changes in the fetal tissues (fetal programming); 2) transgenerational transmission of epigenetic "signatures" through the gametes. Admitting the importance of such mechanisms would have several implications. The first would be recognizing the highly underestimated role of environmental pollution in the genesis and the progressive increase of cancer. In particular, by hypothesizing that the "initiating" stage of cancer might take place much earlier, in the fetus or even in the parents' gametes, and that the increasing trends in cancer in the very early childhood should be seen as a sentinel sign of a possible transgenerational amplification of (epi)genetic/programmatic changes with their associated pathologies.

Background
Clinical evidence indicates that exposure to the antiepileptic agent valproic acid (VPA) during pregnancy increases the risk of congenital malformations and neurodevelopment delay in children. The mechanisms by which VPA causes neurotoxicity are still unknown, but epigenetic effects are likely implicated.

Methods
We used a rodent model to evaluate the transgenerational impact of fetal exposure to VPA on neurobehavioural development of laboratory mice, by studying F1 and F2 generations after a single injection of VPA during pregnancy.
On gestational day 10.5, the F0 pregnant mice were injected subcutaneously with VPA 500 mg/kg of body weight. Offspring of both sexes from the vehicle control and VPA-treated litters were assessed for motor and somatic growth, spontaneous locomotion, ultrasonic vocalization, and nest-odour recognition from postnatal day 4 to 12. Motor activity, social abilities and cognitive functions were also analyzed at the juvenile and adult stage. At adulthood male and female mice of the F1 generation were mated creating three experimental groups of F2 (maternal VPA/paternal vehicle, maternal vehicle/ paternal VPA, maternal vehicle/paternal vehicle) to evaluate the contribution of VPA parental exposure to multigenerational effects on the behavioural phenotype. In F2 offspring, the same F1 neurobehavioral assessment was performed. By PCR, we also analysed molecular markers of VPA effects on early brain development in both F1 and F2 generation.

Results
In F1, VPA offspring presented tail malformation ("kinky tail"), delay in somatic growth and motor development, hyperactivity and a reduced number of ultrasonic vocalizations. No prenatal treatmentinduced differences were evident in adult performance. Also in F2, alterations in early motor development were observed in VPA offspring.

Background
The Northern Adriatic Cohort II is a prospective mother-child cohort established in 2007 in coastal areas of Italy, Croatia and Slovenia to investigate the association between prenatal mercury exposure from maternal fish consumption and child neurodevelopment. The Italian Northern Adriatic Cohort II refers to the coastal area of the Friuli Venezia Giulia Region. At present, a biological bank collected during pregnancy and at birth from mother-child pairs is available. The data bank has collected neuropsychological outcomes measured at different developmental stages (18 months, 40 months), as well as a wide range of potential explanatory variables (socioeconomic indicators, diet habits, child postnatal exposures, maternal lifestyle). The Cross-Mediterranean Environment and Health Network Life (CROME LIFE+) project has followed 200 children born within The Northern Adriatic Cohort II for follow up at 7 years. S21 www.journalhealthpollution.org Background A decrease of the age of menarche and thelarche has been observed during the last decades. The cause of most cases of precocious puberty in girls remains unknown. Some environmental factors such as obesity and adoption have been related to early puberty. Our objective is to explore environmental factors within a sample of girls with early puberty disorders.

Methods
We performed a cross-sectional study with a sample of 30 randomly selected girls who consulted at a tertiary hospital in an agricultural area of southeastern Spain with a diagnosis of precocious puberty, isolated premature thelarche, early puberty, early menarche, early adrenarche or early pubarche. Environmental factors previously described in literature studies were explored through an interview performed by a single interviewer. Auxiological parameters were measured at the moment of the interview. The body mass index and z-scores for each parameter were calculated. Written informed consent was obtained from all participants. 6.9% of girls in the sample were adopted. The age of thelarche was positively and significantly correlated with family income (r 0.738, CI95% 0.342-1.345; p0.001), with the poorest girls being the ones that began puberty earlier. Of the total sample, 12% of the girls were overweight and 11.1% obese. Body mass index at the age of diagnosis was correlated, but not significantly, with the age of thelarche (r 0.702, CI95% -0.019 -1.423; p0.056). At least 80% of the girls were exposed to pesticides in different degrees. Another 80% of the sample was exposed to lice treatments, especially tea tree oil.

Conclusions
Adoption and obesity were present in the sample. The correlation between income status and menarche has been previously reported, but this is the first study to correlate poverty with earlier thelarche. Pesticide exposure is extremely common in our sample, probably due to the fact that agriculture is one of the most important activities in the area of study. Tea tree oil exposure has been related with gynecomastia in boys. The effect on puberty among girls remains unknown. An environmental approach of patients with early puberty disorders may help to create a hypothesis about the etiology and develop specific treatments. S22 www.journalhealthpollution.org

Background
Our aim is to assess the socio-demographic and environmental factors, morbidity, and health related quality of life (HRQL) of childhood brain tumor survivors.

Methods
Through this cross-sectional study we examined pediatric survivors (diagnosed 0-14 years of age) out of treatment and more than 2 years since the diagnosis in a specialized unit. Evaluations were administered though questionnaires regarding socio-demographics, environment, clinical history, scale of sequelae effects (LESS), and PedsQL™ 4.0 parents and patients generic scale (2-18 years and young adult).

Background
The National Cancer Institute considers that every child with cancer is a childhood cancer survivor (CCS) from the time of diagnosis, and will continue to be one for the rest of his or her life. In the last decades the pediatric cancer survival rate has increased progressively, reaching approximately 80%. The increase of survival has revealed the need for controlling late effects caused by treatments. International organizations recommend structured follow-up, and if possible, throughout their lifespan, for CCS. The objective of this work is to present the Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR).

Methods
In the Region of Murcia (Spain) with an implemented public primary care health system, we have developed PLASESCAP-MUR for the follow-up of CCS, which follows a shared-care model for the transition from hospital to primary care that is tailored to the specific needs of each CCS.

Results
The first objective of PLASESCAP is the education and promotion of healthier environments and lifestyles for the survivor, their family, and community, with the goal of improving their environmental standard and quality of life. The second objective is for early detection and screening for an appropriate management of the late effects arising from disease and treatments. S24 www.journalhealthpollution.org

Conclusions
Long-term follow-up programs for CCS based on creating healthier environments, reducing and eliminating exposure to environmental carcinogens and promoting healthy lifestyles in order to reduce the incidence of late effects and to help CCS to achieve the highest quality of life possible are necessary.

Background
In the last decades, the pediatric cancer survival rate has increased spectacularly, reaching approximately 80%. This increase has revealed the need to control late effects arising from treatments and disease that affect the quality of life of childhood cancer survivors (CCS). The Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR) offers an integrated follow-up for CCS and among its objectives is environmental education and awareness and healthier lifestyles to improve environmental and life quality of survivors and their environment.

Objectives
Assess the health related quality of life of a group of survivors of extracranial neoplasms and evaluate the associations of demographic, clinical, and environmental factors with the results.

Methods
Descriptive cross-sectional study. The PedsQL™ 4.0 self-administered generic version for 4 to >18 year old survivors was completed by 85 survivors.

Background
The prevention of late effects caused by treatments and the promotion of healthy environment and lifestyle are the two pillars of the Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (Spain) (PLASESCAP-MUR) to achieve the highest levels of environmental and quality of life in childhood cancer survivors. The objective of this project is to analyze the lifestyles of survivors of childhood hematologic neoplasms.

Methods
Descriptive cross-sectional study. A total of 55 survivors were analyzed within the PLASESCAP from August 2015 to May 2016. S26 www.journalhealthpollution.org

Results
There were 39 leukemias and 16 lymphomas. Mean age = 16.8 (15.6; 17.9). Of these, 9.4% are smokers and 50% occasionally consume alcohol. About 52% of the survivors engaged in physical activity less than three times a week. Almost 56% and 60% of the survivors eat less than one portion of fruit and vegetables per day, respectively. Finally, 53% use electronic devices more than 2 hours a day and 44% of them never engage in activities in contact with nature or do so only in summer.

Conclusions
More than half of the survivors do not meet the dietary and physical activity recommendations. Up to 50% of them consume alcohol with a mean age under 17. Programs that encourage the promotion of healthy lifestyles with a diet rich in fruits and vegetables, exercise, and regular contact with nature as well as avoidance of toxic habits and drugs such as alcohol or tobacco are necessary to obtain the best environmental standard and quality of life.

Background
The objective of this study is to test the causal hypothesis that exposure to carcinogens in utero leads to the onset of early childhood leukemia by exploring the presence of spatial and spatial-temporal clusters within administrative divisions in the region of Murcia, Spain, while considering the residential addresses of cases during pregnancy, early childhood and diagnosis.

Methods
The Pediatric Environmental Health Specialty Unit is carrying out an ongoing research project on the environment and pediatric cancer, collecting a pediatric environmental history (PEH) to create regional maps and analyze the geographical distribution of incident cancer cases in the region of Murcia. Between 1998 and 2010, 117 children were diagnosed with leukemia. Pregnancy, early childhood and diagnosis addresses were collected. Spatial and spatial-temporal clusters were then evaluated using the statistical software SatScan®. S27 www.journalhealthpollution.org

Results
Leukemia was most common in children under 5 years of age. The incidence rate was 40.1 per 1 million children during the study period. Among subtypes of leukemia, ALL (acute lymphoblastic leukemia) has a greater incidence in children, occurring in 31.5 per million children, in comparison to AML (acute myeloblastic leukemia), affecting 8.6 in every million children. The incidence rate of all leukemias and subtypes increased in the time frame between 1998-2004 and 2005-2010. Spatial clusters were observed for leukemia in general and ALL, considering the pregnancy addresses and census district; however, no clusters were identified for the residential addresses during diagnosis.

Conclusions
The detection of spatial clusters in a localized area when examining the distribution of pregnancy addresses and census district areas lends proof to the hypothesis that fetal environmental exposure is likely implicated in the etiology of childhood leukemia.

Background
Environmental tobacco smoke is associated with diseases and premature death in childhood. It has been associated with an increased risk of several pediatric tumors, including acute leukemias, with variable results. There are certain clinical and biological features that have prognostic influences in childhood acute lymphoblastic leukemia (ALL). However, the observed plateau in survival rates in recent years suggests that there must be other unknown factors affecting prognosis. In adults, there are some reports linking active smoking with decreased survival in patients with myeloblastic leukemia, but this relationship has not been studied in the pediatric population. Our objective is to study the relationship between environmental tobacco smoke and overall survival in children diagnosed with ALL. S28 www.journalhealthpollution.org

Methods
Survival analysis in the MACAPEMUR (Environment and Pediatric Cancer in the Region of Murcia) cohort of patients between 0 and 15 years with ALL diagnosed from January 1998 to December 2013 in the Region of Murcia (Spain).

Results
Sixty percent of children with ALL live with at least one parent smoking at diagnosis and in 26% of households both parents are smokers. Environmental tobacco smoke from maternal smokers after diagnosis was significantly associated with lower overall survival (HR = 9.92; 95% CI 1.89 -51.89).

Conclusions
Maternal smoking after diagnosis of ALL in children is an independent prognostic factor and easily adaptable in the overall survival of acute lymphoblastic leukemia. In order to increase survival and improve their environment and quality of life it is necessary to provide smoking cessation programs to parents of children with leukemia.

Background
In Norway, children in kindergarten spend a lot of time outdoors in all weather, and there is a natural concern about the quality of outdoor air. It is well known that air pollution is associated with a wide variety of adverse health impacts in children, with greater impact on children with asthma. Kindergartens in Oslo that are situated close to streets with busy traffic, or in areas where wood burning is used for house heating, can experience many days with bad air quality, particularly during winter and spring. During these periods, updated information on air quality levels can help to plan outdoor activities and thus protect children's health.

Methods
We tested new low-cost air quality monitoring platforms to provide air quality information to kindergartens. These platforms are smaller, cheaper and less complex to use than reference equipment. Performance evaluation shows that while they are less accurate and suffer from higher uncertainty than European Committee for Standardization reference equipment, they still can provide reliable coarse S29 www.journalhealthpollution.org information to the local pollution. We received approval from the Norwegian ethical committee.

Results
We installed the monitoring platforms in 17 kindergartens in Oslo to measure nitrogen dioxide, nitrogen dioxide, ozone, carbon monoxide and particulate matter. The data is displayed using the Air Pollution Indication in a 5-colour scale, indicating if the air pollution is very low, low, rather low, rather high and very high (http://oslo.citi-sense.eu).

Conclusions
We arranged a focus group with the participation of the local administration, kindergarten staff and parents to understand their opinion and needs related to the air quality information that was generated in Oslo kindergartens. They expressed concern about the data quality but agree that having updated information on the air quality in the surrounding kindergartens can help to reduce children's exposure to air pollution or to better plan medication to reduce asthma symptoms.

Background
Children spend a substantial part of their childhood in school buildings. The school staff might not have the time or knowledge to investigate the indoor environment, even though they acknowledge that it could be improved, nor do they have the capacity to have a dialogue with the students regarding a good S30 www.journalhealthpollution.org indoor environment.

Methods
As part of a CITI-SENSE project, we used citizen science approaches to investigate how the situation can be improved. We engaged schools to study the indoor environment with the help of sensor technology and support from scientists. Some schools took this as an opportunity to conduct individual student-led research as part of the school curriculum, while others wanted to confirm the indoor environmental issues the school was known to have.

Results
We provided 13 schools in Belgrade, Edinburgh, Ljubljana, Oslo and Haifa with low-cost sensor units, which collect indoor environmental data in near real time, and gave them the resulting data as graphs or data tables. The students defined and conducted related research, e.g., studied how the carbon dioxide concentration changes depending on the amount of students in the classroom, or investigated the variability of indoor parameters across classrooms and workshops in the schools. Others investigated why particulate matter is high when students are present in the classroom. A school with a known Radon issue was happy to investigate further which rooms were the most problematic. Questionnaires conducted by the scientists assessed learning outcomes related to general knowledge on the indoor environment or ability to think critically about the environment.

Conclusions
These activities created awareness in the schools, increased the individual students' and teachers' knowledge about indoor air, and sometimes led to mitigation measures at schools such as changing cleaning practices. in Europe project, (SINPHONIE), 2010-2014, which established a scientific/technical network to act at the EU level with the long-term perspective of improving air quality in schools and kindergartens and reducing the risk and burden of respiratory diseases among children and teachers due to outdoor and indoor air pollution. The project also supports future policy actions by formulating guidelines, recommendations and risk management options for better air quality and associated health effects in schools.

Indoor Air and Improving Children's Health, the School Indoor Pollution and Health-Observatory Network in Europe and the School Environment and Respiratory Health of Children Projects
The second is the pan-European School Environment and Respiratory Health of Children (SEARCH II) project (2010-2013). It is the second phase of the SEARCH initiative and was developed in order to expand monitoring of children's health and air quality, and to assess energy use in selected schools in 10 countries. Four new countries (Belarus, Kazakhstan, Tajikistan and Ukraine) joined the six countries that participated in The School Environment and Respiratory Health of Children I (Albania, Bosnia and Herzegovina, Hungary, Italy, Serbia and Slovakia).

Methods
The School Indoor Pollution and Health-Observatory Network in Europe has produced guidelines for healthy school environments (www.sinphonie.eu). The guidelines are intended to be generally applicable in most school environments in Europe. However, as each school environment is unique (in terms of design, climatic conditions, operational modes, etc.), the guidance needs to be adapted at the national or local level. This network was initiated and funded by the European Parliament. The project coordination committee includes Éva Csobod, REC, Eduardo de Oliveira Fernandes, IDMEC-FEUP, Peter Rudnai, NIEH and Stylianos Kephalopoulos, JRC.

Results
The final reports of the SINPHONIE project summarise the work performed by a consortium of 38 partners from 25 countries that involved around 300 people of specialised scientific and/or technical backgrounds (www.sinphonie.eu).
The extensive database of the SEARCH II project contains information on 7,860 children from 388 classrooms in 100 schools in 10 countries. It has created a unique opportunity to study a wide variety of school indoor and outdoor environments, to measure outdoor and indoor concentrations of several air pollutants, and to study the associations between the school environment and children's health (www. search.rec.org).

Conclusions
The implementation of both projects was coordinated by the Regional Environmental Center for Central and Eastern Europe (REC

Background
Natural environments including green spaces are thought to exert beneficial impacts on brain development; however, the available evidence on such impacts is still very scarce. The aim of this study was to evaluate the association between lifelong exposure to residential surrounding greenness and cognitive development during preschool and early primary school years.

Methods
A longitudinal study based on data from a well-established multi-centre population-based birth cohort in Sabadell and Valencia (Spain) followed participants from pregnancy (2003-2006) till 7 years of age (2012-2013). A satellite-derived normalized difference vegetation index was used to quantify surrounding greenness (100 m, 300 m, and 500 m buffers) of participants' residential addresses at birth and at 4 and 7 years of age. Attentional function was assessed using Kiddie-Continuous Performance Test at age 4 (N=888) and Attention Network Task at age 7 (N=978). Mixed effects linear and negative binomial models with cohort random effect were developed to quantify the association between greenness exposure and attention, adjusted for relevant covariates. Ethical approval was granted by the ethical committee of each cohort.

Results
Higher average residential surrounding greenness between birth and age 4 was associated with lower omission errors and lower hit reaction time standard error, both indicators of inattentiveness in the Kiddie-Continuous Performance Test. Similarly, higher average residential surrounding greenness S33 www.journalhealthpollution.org between birth and age 7 was associated with lower hit reaction time standard error in the Attention Network Task.

Conclusions
This is the first longitudinal study to report on the impact of lifelong green space exposure on cognitive development in general and attentional development in particular. It found this exposure was associated with enhanced attentiveness in preschool and primary school children. The associations for attentiveness were consistent using different tests (Kiddie-Continuous Performance Test and Attention Network Task) and different exposure windows (birth to 4 years and birth to 7 years).

Background
The influence of various exposures during the pre-and postnatal period is not limited to reproductive and childhood outcomes and can extend over a lifetime, a corpus of knowledge embodied by the Developmental Origins of Health and Diseases (DOHaD) concept. The overarching aim of this project is to study DOHaD in the Iranian population. Towards this aim, we will evaluate the impact of socioenvironmental, psychological and genetic factors on pregnancy outcomes, child mental and physical health, growth, and development, and early-and late-onset chronic non-communicable diseases.

Methods
The Prospective Epidemiological Research Studies of the Iranian Adults, Adolescents and Newborns S34 www.journalhealthpollution.org birth cohort is designed as a multi-centre network of population-based birth cohorts in areas representing cultural and contextual variations in Iran. Standardised protocols for data collection, maintenance, and analysis tailored for the Iranian population with the prospect of future international collaborations have been developed. The cohort will be conducted in 5 phases: periconception to birth, infancy, childhood, adolescence, and adulthood. Data collection will be based on computerized questionnaires, biological samples, physical examinations, clinical tests, hospital records, and surveys of living environment.

Results
The pilot phase will start in Shahreza (Isfahan) and Yazd in April 2016 and is expected to last 2 calendar years. In each study site, 2000 pregnant women will be recruited during their first pregnancy visit (at the end of the 1st trimester). We will utilize a combination of public and private healthcare providers in order to ensure that the participants represent the ethnic and socioeconomic distribution of the underlying population.

Conclusions
The Prospective Epidemiological Research Studies of the Iranian Adults, Adolescents and Newborns birth cohort will advance our knowledge of DOHaD in the Iranian population. Moreover, it will establish a platform in the Middle East for participating in international studies of DOHaD.

Background
Epidemiology is the scientific study of the spread and control of diseases as a function of time and location. Epidemiology follows the patterns of a disease on people in their healthy and unhealthy periods; and tracks their history of illness, especially to understand its nature and characteristics. In this context, spatial data is strongly required in order to understand the spatial pattern (distribution and expansion) of the illness. Epidemiologists have traditionally used maps to analyze the spatial characteristics of illnesses S35 www.journalhealthpollution.org in terms of relations between location, surrounding environment, and cases. Developing information technologies introduced geographical information systems (GIS) as a strong tool to be used in spatial decision making applications such as surveillance and monitoring of diseases. Geographical information systems and geostatistical techniques are used to account for spatially varying population sizes and spatial patterns in the surveillance and monitoring of diseases. In environmental and public health, identification and quantification of the disease patterns provide the first steps towards increased understanding and possibly, control of a particular disease. Spatial statistical methods, of which geostatistics is a subset, offer a means for us to use such location information to detect and quantify patterns in public health data and to investigate the degree of association between potential risk factors and disease.

Methods
This study presents a general overview of the geostatistical methods used in epidemiology, experimenting an innovative geographical information systems-based approach to the analysis of epidemiological data. The paper additionally aims to analyze the spatial pattern of Hepatitis A cases in children at ages under 15. In this context, province-based official data including the number of Hepatitis A cases and deaths by gender and age were provided monthly from 2001 to 2011. The data were classified by age considering 3 main groups: 0-4, 5-9, and 10-14 years of age. Incidence rates and morbidity of Hepatitis A cases were considered as the main parameters for primary analysis of the cases by province. Time series maps were prepared and Natural Neighbor analysis was also applied to introduce the spatial pattern of case distribution in time. Additionally, Moran's I and Local Indicators of Spatial Association analysis were respectively applied to introduce the characteristics of the global and local spatial pattern of cases in time. Ethical approval was granted by the Human Research Ethics Committee of the Istanbul Technical University.

Results
Time series maps of Hepatitis A cases in children concluded that incidence rates of the cases children under the age of 5 were significantly lower than the other age groups, while incidence rates the highest for children in the 5-9 age group during the study period. Although the results outlined a timely decrease in the incidences of Hepatitis A in Turkey, high incidence rates occurred in 2001, 2005 and 2007 and were significant for children, especially between the ages of 5-9. Spatial pattern analysis of the cases showed that incidence rates were relatively higher in the Eastern Mediterranean and South-eastern Anatolian Regions covering Ceyhan, Asi and Southeast part of the Fırat-Dicle river basins in Turkey. Gaziantep, Kilis and Hatay provinces were the hotspots of these regions. Incidence rates of cases in children aged 5-9 were also higher in the Aegean and Central Anatolia regions, especially in Gediz and Kızılırmak river basins.

Conclusions
At the conclusion of this study, the spatial distribution of Hepatitis A cases in children from 2001 to 2011 in Turkey were mapped and analyzed using GIS technology. Since Hepatitis A is a waterborne communicable disease, spatial distribution was also examined considering the coverages of the river basins in Turkey. The study outlined the regions and specific provinces where intensive water treatment facilities were needed in Turkey during the study period. S36 www.journalhealthpollution.org

Background
EU legislation restricting landfilled waste has led to an increase in Municipal Waste Incineration (MWI) within the UK. Persistent Organic Pollutants (POPs), including dioxins and heavy-metals, released from MWIs have been found in elevated levels in areas surrounding these sites. Due to public concern over health risks associated with MWIs, this project aims to quantify POPs in human breast-milk to examine relationships between individual level POP uptake in proximity to MWIs.

Methods
Recruitment was completed in three phases via postal invites. Primiparous women between 18-40 weeks gestation, aged >18 years and living within 20 km of three MWIs were invited. Women were asked to provide up to 120 ml of breast-milk and complete a questionnaire (including questions on lifestyle, diet, residential history). Selected breast-milk samples have been analyzed for selected POPs, depending on the amount of milk provided Results 587 women were recruited (14% recruitment rate), 329 provided milk (56% completion rate). Modelled PM 10 emissions from MWIs have been used as a proxy for incinerator exposure gradients for other pollutants, such as POPs, which cannot be directly modelled. Ground-level modelled estimations of PM 10 concentrations from incinerators is very low (yearly averages of incinerator postcode level concentrations varied from 1.00 10-8 to 5.53 10-5 mg m-3, 3-5 orders of magnitude lower than ambient background levels. 224 (38%) women live in areas in the top tertile of modelled incinerator PM 10 exposures and 203 (35%) women in the bottom tertile. Initial chemical analysis results will inform whether there are significant differences in POP or dioxin concentrations in women by MWI, proximity to MWI, and if any relationships are modified by lifestyle factors.

Conclusions
This study is the first and largest in the UK to provide individual level POP exposure estimates in S37 www.journalhealthpollution.org proximity to MWIs and improve understanding of the diverse routes of dioxin exposure. It will also aid the interpretation of findings from an ongoing national study of MWIs and risk of adverse birth outcomes.

Background
In young children, exposure to lead is associated with a reduced IQ (intelligence quotient) score even when exposure rates are low. On a population level, the loss of a few IQ points can have large consequences. For instance, the loss of one IQ point on a population level means an estimated 2% loss of productivity. It can also lead to an increase of people with (very) low IQ who need increased care and support. The European Food Safety Authority (EFSA) concluded that there is no evidence for a threshold for critical lead-induced effects. The main uptake pathways in young children are hand-mouth contact while playing in contaminated soil and the consumption of home-grown vegetables.

Methods
Using the integrated exposure uptake biokinetic (IEUBK) (a physiologically-based pharmacokinetic (PBPK)) model from the Environmental Protection Agency (EPA) and CSOIL from the National Institute for Public Health and Environment (RIVM), the maximum acceptable lead content in soil was calculated. For the calculations, the doses related to a loss of one and three IQ points were used. Calculations were made for different uses of the soil (i.e. vegetable garden, living with (vegetable) garden and places where children play).

Results
The calculated maximum lead content in soil for all soil uses was lower than the prevailing legislation. Recommendations are needed to lower the exposure of young children to a reasonably achievable level.

Conclusions
The Dutch public health services have set up recommendations for municipalities for managing health risks due to the exposure of soil lead. These recommendations include communication and education to residents about simple measures to reduce the exposure of soil lead and the removal of hot spots. Examples of recommendations to residents include having children play in specially prepared clean sand areas and growing vegetables in containers with clean soil separated from contaminated soil. In addition, it is advised to wash the hands of children frequently and to clean the in-home area by frequent vacuuming.

Background
Children are especially vulnerable to secondhand smoke (SHS) due to their reduced ability to metabolize and excrete toxic chemicals. Children exposed to SHS are at increased risk of developing asthma, sudden infant death syndrome, and ear and respiratory infections. In Spain, after 2011, a stricter antismoking legislation led to a reduction in the exposure in public places, however this reduction was not observed in private environments, and children are mostly exposed to SHS at home.

Methods
In the framework of the Demonstration of a Study to Coordinate and Perform Human Biomonitoring on a European Scale project (DEMOCOPHES), urinary levels of cotinine, cadmium and polycyclic aromatic hydrocarbon (PAH) metabolites (1-hydroxypyrene and hydroxyphenanthrene isomers) were studied in relation to SHS exposure. First morning urine samples corresponding to 120 children aged 6-11 years in urban (Madrid city) and rural (Añover de Tajo, Toledo) areas were collected from October 2011 to January 2012. Sociodemographic and environmental tobacco exposure data were collected by an epidemiological questionnaire. Cotinine levels were analyzed by high resolution liquid chromatography coupled to mass spectrometry in tandem mode and cadmium was determined by dynamic reaction cell inductively coupled plasma mass spectrometry. For PAH metabolites, high performance liquid chromatography-fluorimetric detection analyses were performed. Ethical approval was granted by the Ethical Committee of the Instituto de Salud Carlos III.

Conclusion
The home environment is a significant predictor of the cotinine levels in children and therefore efforts are required to protect children from SHS exposure in scenarios out of the scope of application of the current anti-smoking legislation.
Protecting children from environmental hazards requires individual clinicians to be alert to environmental causes of disease, but it also is important to adopt broad-based societal interventions; this is considered primordial prevention. Primordial prevention aspires to establish and maintain conditions to minimize hazards to health. It consists of actions and measures that inhibit the emergence and establishment of environmental, economic, social and behavioral conditions.
In the field of environmental health, population-level actions are needed to address, for example, the problem of global climate change. Clinicians can raise awareness and be effective advocates for action on the national and international level to promote energy efficiency and renewable energy production while decreasing incentives for continued production and consumption of carbon-intensive fuels. The American Academy of Pediatrics issued a policy statement and technical report on the health effects of climate change on children that encourage child health care professionals to engage in efforts to reduce national C0 2 emissions, and major medical journals and organizations have highlighted the importance of health professional involvement. In 2015, Pope Francis spoke out on the threats of global climate change to future generations in his encyclical Laudato Si, On the Urgent Need for Care of Our Common Home. When clinicians address these concerns and work to reduce the country's use of fossil fuels that result in C0 2 pollution, they are practicing primordial prevention.
The influential role child health professionals are playing in national and international efforts to reduce environmental threats to children is not new. In 1957, the American Academy of Pediatrics (AAP) launched this field when it formed a committee to educate providers about the importance of recognizing, treating and preventing exposure to radiation, the first environmental hazard to be noted by the AAP. In 1998, Pediatric Environmental Health Specialty Units were established by the Agency for Toxic Substances and Disease Registry and the US Environmental Protection Agency to provide resources about children's environmental health to clinicians and communities. In 1999, the American Academy of Pediatrics published the first Handbook of Pediatric Environmental Health; a 3rd edition was published in 2012. A Textbook of Children's Environmental Health was published in 2014. Many international bodies have endorsed the need for healthier environments for children and called for actions to reduce children's exposures to environmental hazards.
Primordial prevention is an integral part of the practice of pediatrics. It is foundational to addressing the major environmental health problems facing children today.

Background
Professional responsibilities for safe and effective diagnostic imaging consist of three A's: radiation awareness, collective accountability for protection of our patients (both adult and pediatric), and actions to achieve this end. These have been fundamental responsibilities in diagnostic imaging since the discovery of x-rays over 120 years ago. Concurrently, there have been remarkable advancements in imaging procedures that use ionizing radiation, including x-rays (radiography), fluoroscopy, and computed tomography (CT). This imaging portfolio clearly improves management and saves lives minute by minute, day by day across the world. Rapidly evolving technology affords both opportunities for improved service, but also challenges with the fundamental responsibilities for radiation safety. The principle components of radiation protection in medicine consist of justification (the imaging procedure is indicated) and optimization (the procedure is done in an appropriate fashion to balance diagnostic quality with risk considerations, including radiation exposure).

Methods/Results
Both justification and optimization are embodied in the action aspect of our professional responsibilities. Justification is really a shared duty between all stakeholders, including healthcare providers who request S41 www.journalhealthpollution.org imaging procedures and members of the imaging team. While the branding using "justification" seems relatively simple, it is actually quite complicated. There are a myriad of factors which come into play in determining which of any imaging modality is appropriate. Many of these are global, and some are regional, such as in the US with defensive medicine. The fundamental success for justification requires communication between healthcare providers (e.g. decision support) as well as the children we care for and their care providers.

Conclusions
Development on both fronts requires consensus efforts (cooperation); a partnership of shaking hands rather than pointing fingers and assigning blame. Success may be more effectively and efficiently realized through a fourth A: assurance. This is exemplified through the Image Gently Alliance and the Alliance's mission for radiation education awareness as an advocate in the care of children. Such efforts can serve as global models for improved imaging care of children.

Background
Diagnostic imaging is lauded as one of the most important advancements in medical care for both adults and children. The benefits are accompanied by risks, such as the potential cancer risk from the incumbent exposure to ionizing radiation. Radiation risk in diagnostic imaging can be approached through a review of patterns of use, radiation dose measurements and doses delivered, potential risk, and strategies to mitigate risk.

Methods/Results
The use of medical imaging, especially CT, has increased rapidly and globally over the past three decades for a variety of reasons. In the US, CT now accounts for 25% of the per capita exposure annually, included background (natural) sources. Exposures in medical imaging are considered low level radiation although CT is a relatively greater radiation exposure than x-rays, or fluoroscopy. Approximately 5-10% of CT examinations are performed in children. Based on data from several sources, especially atomic bomb survivors, a risk, at most small, has been attributed to medical exposures in the range of some of the higher dose procedures such as CT for children (in general a more vulnerable population). S42 www.journalhealthpollution.org The principle components of radiation protection in medicine consist of justification (the imaging procedure is indicated) and optimization. That is, the procedure is done in an appropriate fashion to balance diagnostic quality with risk considerations including radiation exposure.
General considerations for appropriate performance consist of minimizing the exposure time or views (e.g. fluoroscopy); examining only the necessary area; and adjusting the radiation exposure to the region scanned, clinical question(s), and the size of the child. Specific measures for CT include adjustment of scan settings, restricting multiple series taken of the same area, and avoiding overlapping of scan regions. There are special considerations for children in performing CT examinations such as the use of IV contrast media that must be not be neglected. There are also new technologies to help optimize the balance between dose and quality. Recently, dose monitoring programs for all patients have become a responsibility for the medical community. Finally, informed strategies supplementing requisite regulatory, guidance and accreditation components must include education.

Conclusions
Understanding and implementing appropriate strategies when imaging children will help in optimizing the value in medical care.

Background
The use of ionizing radiation diagnostic imaging procedures for children has rapidly increased globally during the past 20 years, including computed tomography as a valuable tool for assessing pediatric illness and injury, as well as pediatric image-guided procedures, which may replace more complex surgical options. While the clinical value of imaging involving the use of radiation for pediatric health-care is unquestionable, this is often juxtaposed with children's relative increased susceptibility to radiation, including the potential for cancer from low-level exposures. While individual radiation risks are at most quite small, radiation protection in pediatric imaging is a public health issue due to the large population exposed and public concern. This demands policies and actions that recognize, maximize, and promote the multiple health benefits that can be obtained, which at the same time minimize potential health risks S43 www.journalhealthpollution.org of the radiation exposure with the ultimate purpose of ensuring that the benefit outweighs potential harm. Radiation risk communication has a key role to inform the appropriate risk-benefit dialogue in healthcare settings. Healthcare providers requesting and/or performing radiological imaging procedures in children have a shared responsibility to communicate radiation risks to patients, parents and other caregivers.

Methods/Results
WHO organizes this seminar to present the new document "Communicating radiation risks in pediatric imaging: information to support health care discussions about benefit and risk" available at http://www. who.int/ionizing_radiation/pub_meet/radiation-risks-pediatric-imaging/en/ . This document is intended to serve as a tool for healthcare providers to communicate risks associated with pediatric imaging procedures. The session will discuss the effective and balanced benefit-risk dialogue in pediatric imaging and how this can be achieved to improve health service.

Conclusions
This WHO communication tool will serve as a basis to further develop training packages to improve communication skills of health care providers, as well as advocacy and information materials targeting patients, parents, other caregivers and the public.

Introduction
This integrated study examines the prevention and detection/follow-up of children at risk of S44 www.journalhealthpollution.org neurobehavioral disorders associated with prenatal and/or postnatal exposure to alcohol and illegal drugs. We utilized the Elijo Mas Sano (Choose Healthier) registry of children at environmental risk from drugs and alcohol.

Methods
For this descriptive study of environmental clinical history we observed the first 39 patients of Elijo Mas Sano. We included clinical, social and neurodevelopmental evaluations. The Elijo Mas Sano criteria of inclusion was a) >20 g/day of alcohol and/or 3 incidents of binge drinking of ≥40 g/day during periconceptional, gestational, or lactation stages and/or b) fetal exposure to any illegal drug at least once a week. Ethical approval was granted by the Clinical Research Ethics Committee of the University Hospital Virgen de la Arrixaca.
In the study group, 33% reported 3 or more incidents of binge drinking. Fetal exposure to illegal drugs occured in 18% of the study group. Four patients had neonatal anthropometry (≥36 gestation week) with an average head circumference of <p10, a birth weight of <p10: 9, and 3 patients had a height of <p10. There were 6 patients with major congenital malformations. Two patients had chromosomal comorbidities.
For some of the study group participants, growth curves and head circumference showed normalization by 2 years.

Conclusions
Half of the children from the Elijo Mas Sano registry had neurodevelopmental delays before the age of 2. The program of prevention and harm reduction of intrauterine exposure to alcohol and other drugs has been implemented with good preliminary results: decreased alcohol consumption during pregnancy and syndromes and alcohol-related birth defects. The next step is to follow-up to children who are at risk of fetal alcohol spectrum disorders through adolescence.

Background
Born without OH is a comprehensive program of prevention, reduction of harm and management of neurobehavioral disorders associated with prenatal exposure to alcohol and other drugs through the pediatric environmental health from the beginning of pregnancy until the end of adolescence. Our objective is to prevent and reduce damage from exposure to alcohol and other drugs during critical periods of development (periconceptional until the end of adolescence).

Methods
Beginning in 2009, at the University Clinical Hospital Virgen de la Arrixaca (Murcia, Spain), the GREEN SHEET was implemented in hospital and primary care. It is a set of basic and concise questions for women in the 1st trimester of pregnancy to detect the environmental risk factors related to alcohol and other drugs in early pregnancy. Those with high-risk criteria of prenatal exposure to alcohol and other drugs pass to a follow-up program called ELIJO MAS SANO (CHOOSE HEALTHIER): early and comprehensive intervention for the management and monitoring of pregnant women and / or children at risk of fetal alcohol spectrum disorders (FASD).

Results
In the follow-up of 200 children in the program ELIJO MÁS SANO, there was a significant decrease (p <0.05) in women who drank some alcohol in early pregnancy and the amount of alcohol drunk by the couple. There was a decrease in the number of newborns with congenital heart disease associated with intrauterine exposure to ethanol controlled by the number of births and abortions. There were 6 children diagnosed with fetal alcohol syndrome (FAS) (in 1500 pregnant couples), estimating a prevalence of 4 S46 www.journalhealthpollution.org cases of FAS per 1,000 newborns in the region of Murcia.

Conclusions
The Born without OH programme has been implemented with good preliminary results: reducing the consumption of alcohol during pregnancy, decreased congenital heart diseases related to intrauterine exposure to alcohol and registration of syndromes and alcohol-related birth defects.

Background
Persistent organic pollutants (POPs) have diverse deleterious health effects and are persistent in the environment. Moreover, due to their lipophilic nature, they bioaccumulate in humans in utero and in the breastfeeding period. Assessment of the significance of these early accumulation processes is important for understanding what are the main mechanisms leading to the human body burden of these pollutants and for identification of the toxic stresses in the early life period.

Methods
Organochlorine compounds (OCs) and polybromodiphenyl ethers (PBDEs) were measured in pregnant women (maternal serum, n=466), placental tissue (n=50), at birth (cord blood, n=323) and at 4 year-old children (serum, n=272) from a birth cohort in Asturias, Spain, sampled within the INMA (Childhood and Environment) Project. Ethical approval was granted by the Ethics Committee of San Agustin hospital, and each participant provided informed consent. To calculate the total serum burdens (in ng) for each compound and at each follow-up, total blood volumes were estimated using the body weight of each individual.

Results
Body burdens at childhood were 50% to 85% lower than in their mothers, while for PBDEs, children body burdens' reached similar levels or even higher than their mothers (median percentage of 107%). For all the compounds, the total serum burden increased from birth to 4 year-old children, although these increases were significantly higher for the PBDE compounds than for OCs. The influence of maternal breastfeeding in the accumulation of these compounds through time was also evaluated. At 4 years of age, formerly breast-fed children were found to have higher OC concentrations and total burdens than non-breastfed children. This tendency was not found for any of the PBDE compounds.

Conclusion
The significance of these general trends for each individual pollutant was identified. PBDEs were found to be much more accumulated in the first years of life than OC compounds. Maternal breastfeeding was the main factor in the OC body burden increases between newborns and 4 year old children. For PBDEs, other sources of exposure rather than maternal breastfeeding may be involved.

Background
In April 2008, a home visit activity was launched as part of the social area oriented work approach "TippTapp". This preventive program combines low-threshold health counselling for families with babies and screening on youth welfare topics.

Methods
The program is currently located in disadvantaged areas of Bremen, Germany. Pediatric nurses offer to visit families and their babies at the age of 6 weeks, 6 months and 12 months. Parents decide if they would like to take part. There is no obligation to take part in the program. Because of their regional work in outposts of the local health authority, our pediatric nurses provide specific knowledge about helpful offers in their particular region. During our visit in the families' homes, we get a chance to discover circumstances of different origins that might influence the health and development of children. A standardized documentation sheet is used. Important development and safety topics are discussed. A differentiation of subjects mentioned by parents is important to grasp the needs of the family and to initiate appropriate help.

Results
In 2014 there were visits in 46, 63% (n=2041) of 4345 invitations. Besides many helpful hints, 13 cases were reported to youth welfare. In 4 of them, help was given, although the parents did not agree. S48 www.journalhealthpollution.org

Conclusions
The content of our work is transferable. The gained knowledge may be helpful in questions of urban development. Individual and general support of families can be positively influenced. In an upcoming cohort study in Bremen, TiPP TAPP is part of the set of interventions.

Background
Breastfeeding is a unique and priority nutrition during the first year of life. However, its initiation and duration is determined by the interaction of multiple constitutional and environmental factors (physical, chemical, biological and psychosocial). Children are greatly vulnerable to environmental factors during the periods of pregnancy and lactation. Our aim is to study the protective and risk factors related to the initiation of breastfeeding in the Murcia Region.

Methods
A cross-sectional study of 99 women from the Region of Murcia, consisting of a personalized ¨face to face¨ interview with mothers at the time of hospital discharge, which were done by a nurse utilizing a carefully crafted questionnaire instrument called ¨the green page¨.

Results
About 90% of mothers had the intention of exclusively breastfeeding prior to giving birth, 5% partial breastfeeding, and 5% no breastfeeding. However, only 51% exclusively breastfed, 36% partially breastfed, 8% predominately breastfed, and 5% did not breastfeed. Especially during the immediate and early postpartum period, difficulties can arise such as the ones found during our study. About 27% of the mothers had problems breastfeeding, and of those mothers, 6% experienced pain in the nipple area, in 5% the newborn had issues latching on, 5% had cracks in the nipple, and 5% had irritated nipples.

Conclusions
Addressing multiple factors that affect breastfeeding can positively influence the initiation and duration S49 www.journalhealthpollution.org of breastfeeding. As health professionals, we are able to promote breastfeeding and thus improving the quality of life of our children.

Background
In the framework of the Cross-Mediterranean Environment and Health Network-Life (CROME-LIFE) project, a cohort of 453 adolescents aged 13-15 years living in urban (Rome) and rural (Viterbo) areas from the Italian Programme for Biomonitoring of Exposure (PROBE) was enrolled to examine metals exposure. Children are more vulnerable to environmental stressors than adults, and have less control over their environment. Although evidence indicating the impact on children's development is growing, there is still only a partial understanding of the environmental risks to children.

Methods
Non-fasting blood specimens obtained by the National Microcytemia Association during the annual screening for microcytemia in schools (2009-10) were analyzed for nineteen metals by sector field inductively coupled plasma mass spectrometry. Administered questionnaires included information such as sex, diet habits, lifestyle factors and parental occupational status. Socio economic status of the family was derived by merging the educational level and occupational status of the parents. The Ethics Committee of the National Public Health Institute of Italy (ISS) approved the project.
Metal concentrations in blood were statistically evaluated. Basic statistics were used to obtain reference values where the 95th percentile describes the upper value to be used in health care and environmental policy. Data on the study participants were geo-referenced on the basis of their residence address and the data were stored in a geo-database along with human biomonitoring data, dietary habits, environmental pollution and land cover data. In the frame of the Cross-Mediterranean Environment and Health Network LIFE+ project, an exposome-wide analysis was performed to identify the associations between metal concentration levels in blood and several exposure determinants including land cover, milk and fish consumption, both considering them individually and in combination to explore potential synergies between covariates. Ethical approval was granted by the Ethical Committee of Istituto Superiore di Sanità, Roma, Italy.

Results
Results show robust statistical associations of chromium with the dietary pathways analysed and land cover, showing that both out-of-region and local sources can be associated with the observed human biomonitoring levels of chromium in the population. Other robust associations were found between tungsten and co-exposure to contaminated milk and proximity to industrial activities and mercury, with a more complex interaction between co-exposure to different dietary pathways (milk and fish) coupled with proximity to industrial activities. No pathway alone was dominant, but the combined effect results in statistically significant associations with blood concentration levels of mercury. The associations of nickel with dietary pathways (co-exposure to milk and fish) and platinum with fish and industrial activities and enhanced traffic, even though statistically significant (p < 0.05), fail to meet the statistical robustness test. None of the other metals showed statistically significant associations with dietary patterns and/or land cover information.

Conclusions
All metals analyzed in this study are environmental pollutants posing high concerns with regard to their effects on human health. Their distribution in the environment is a result of natural processes and anthropogenic activities. However, in addition to environmental sources,other factors such as individual lifestyles, diet, and socio-economic factors need to be taken into account as they contribute to the levels of metals found in the human body.
The results obtained thus far support the utility of an exposome approach to get a more accurate and holistic perspective in order to determine the association between population exposure and its determinants using human biomonitoring studies S51 www.journalhealthpollution.org

Background
Prenatal chemical exposure has frequently been associated with reduced fetal growth, although results have been inconsistent. Most studies associate single pollutant exposure to these health outcomes, even though this does not reflect real life situations, as humans are exposed to thousands of pollutants during their life time. The objective of this study is to investigate the association between prenatal exposure to a mixture of environmental chemicals and birth weight.

Methods
We used exposure biomarker data obtained from cord blood samples of 2033 women from three Flemish birth cohorts (FLEHS I, II & III) and a regional birth cohort (3xG). The common set of exposure measures in these cohorts are the organochlorine compounds (three polychlorinated biphenyl (PCB) congeners (138, 153 and 180), hexachlorobenzene (HCB), p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE)) and the heavy metals cadmium and lead. Birth weight was assessed as a proxy for reduced fetal growth. Elastic net regression was used to assess the effect of multipollutant exposure on birth weight. Ethical approval was granted by the ethical committee of Antwerp University (Hospital) and of the local hospitals.

Results
In the pooled database, birth weight ranged from 1245 to 5575 g with a median of 3430 g. The median contaminant levels in cord blood were: 26 ng/g lipid for PCB 153, 15 ng/g lipid for PCB 138, 18 ng/g S52 www.journalhealthpollution.org lipid for PCB 180, 90 ng/g lipid for p,p'-DDE, 17 ng/g lipid for HCB, 0.045 µg/L for cadmium and 9 µg/L for lead. In single pollutant models, the three PCB congeners were significantly associated with reduced birth weight. The correlations between the different pollutants were low to moderate (r = 0.11 -0.59), except for the three PCB congeners which were highly correlated with Pearson correlation coefficients ranging from 0.74-0.84. From all exposure measures, the two PCB congeners PCB 153 and PCB 180 were most consistently associated with birth weight based on elastic net regression.

Conclusions
Assessing the health risk of combinations of exposure biomarkers better reflects real world situations. The findings allow for more effective risk assessment as addressing the critical chemicals in a mixture of pollutants is pivotal for risk assessment. The foetus and the child are particularly vulnerable to pollution. The foetus shares the mother's exposure and accumulated body burden of pollutants, and many chemicals are transferred to the infant via human milk. In relation to body weight, a newborn or small child needs more water, energy and oxygen than an adult, and contaminant exposures can therefore be comparatively larger. In addition, during early life, cell differentiation and organ development must occur in a particular sequence and at certain times to create optimal functions of the mature organism. This vulnerability is critical in regard to the nervous system. Because there is only one chance to develop a brain, even doses that are safe for adults may, if occurring during early development, cause permanent losses of IQ. More than 200 industrial chemicals are already known to cause brain toxicity in adults. About half of these substances are produced in high volumes. All of them must be suspected to be capable of harming the developing brain. However, only a dozen industrial chemicals are recognised causes of developmental brain dysfunction. Methylmercury may serve as a paradigm, where exposures previously thought to be safe are now linked to adverse Background Recent research has found that family socioeconomic status, parenting stress and other environmental factors can have impacts on child development. The aim of this study was to assess the association between psychosocial stress in the family and risk for obesity among 4−6 year old children.

Methods
This nested case-control study included 1,489 Kaunas Cohort Birth Study children followed-up for 4−6 years. We used the Parent-Child Dysfunctional Interaction subscale of the Parenting Stress Index (short form) and questionnaires on child development to assess risk factors for children obesity. The body mass index status for age was calculated and the risk factors for being overweight/obese were estimated. Logistic regression models were fitted to examine the associations as odds ratios (OR) between the parent-child relationship and the risk of overweight, adjusted for relevant covariates. The Kaunas Pregnant Women Birth Cohort had 3 ethical approvals conducted by the Lithuanian Bioethics Committee.

Results
A total of 6.8% of the children were overweight and 5.4% were obese. Children from smoking families with lower education faced almost double the risk of obesity. The stratified multivariate model showed that, with reference to the group of high educated and normal parent-child relations, low educated and pathological parent-child relationships were statistically significant risk factors for overweight children of 4-6 years old (OR 2.43; 95% confidence interval 1.31-4.51). S54 www.journalhealthpollution.org

Conclusions
Maternal tobacco smoking and pathological parent-child relations may be predictors of overweight and obesity throughout the developmental trajectory of childhood. Measures to quit smoking and psychosocial stress management should be encouraged among pregnant women to decrease their children's obesity risk.

Background
Transplacental transfer and breastfeeding are the main transport routes of organic pollutants to children at the beginning of life. These transmission mechanisms primarily depend on the maternal pollution burden, but its impact may be modulated by physiological effects. We found that gestational weight gain (GWG) exerts a considerable influence on the content of hydrophilic and low volatile pollutants in cord blood and breast milk.

Methods
We measured levels of 14 organochlorine pesticides, 7 polychlorobiphenyls and 14 polybromodiphenyl ethers (PBDEs). Persistent organic pollutant neonatal concentrations were inversely associated with GWG after adjustment for age, pre-pregnancy body mass index, educational level, and fish consumption. On average, neonates of women with high or recommended GWG as defined by the Institute of Medicine had lower persistent organic pollutant concentrations than neonates of mothers with low GWG. This study was approved by the ethics committees of the Clinical Research Ethical Committee of the Municipal Institute of Health Care, the Ethics Committee of the Donostia Hospital and San Agustin Hospital, and informed consent was provided by every participant.

Results
Colostrum from mothers with low GWG also had significantly higher concentrations of S55 www.journalhealthpollution.org polychlorobiphenyls and 4,4'-dichlorodiphenyldichloroethylene than colostrum from mothers who gained weight within Institute of Medicine recommendations or in those who exceeded this threshold. Statistically significant differences were also found in the colostrum: maternal serum ratios of these compounds. Women with low GWG retained higher pollutant amounts in colostrum.

Conclusions
The higher mobilization of stored organic pollutants observed in pregnant women with low GWG plays a role for in utero pollutant exposure and during breastfeeding. The present findings suggest an association between infant exposure to persistent organic pollutants and inadequate GWG, encouraging pregnant women to meet the recommended Institute of Medicine guidelines to reduce the accumulation of these pollutants in newborns and during breastfeeding.

Background
In general, children in Spain have the same environmental health conditions as other European children. However, they undergo some specific pollution stresses that must be considered for the implementation of adequate public health policies.

Methods
This presentation combines relevant information from the scientific literature and the results of the studies developed at the IDAEA.

Results
One of these stresses concerns mercury exposure. With the only exception of Portugal, the concentrations of this metal in hair from children living in Spain are considerably higher than in children from other European countries, and the differences are strong. In Spain, the high mercury content observed in children's hair, and also cord blood, is rather uniform independently of location. These high mercury concentrations are likely related with high fish and seafood consumption. Often, Mediterranean fish sold in Spanish market places, both oily and lean fish, contain mercury concentrations above the EU regulations for human consumption. Impaired intellectual development due to mercury exposure has been observed in children from Granada, but not in children from other Spanish cohorts. Another specific pollution stress of children living in Spain is exposure to hexachlorobenzene. Examination of S56 www.journalhealthpollution.org cord blood serum concentrations of this compound shows higher levels than in European children. In this case, the differences are significant when comparing newborns from different Spanish locations. In utero exposure to hexachlorobenzene has been observed to be related with lower birth size. It has also been associated with higher incidence of overweight, alteration of thyroid hormones, attention deficit hyperactive syndrome and poorer social behavior in four-year-old children from Spanish cohorts.
Cotinine content, and therefore exposure to tobacco smoking, is also high among Spanish newborns, although when compared with other European cohorts, the difference is not as strong as in the previously mentioned pollutants. Exposure to polychlorobiphenyls, hexachlorocyclohexanes, dichlorodiphenyltrichloroethane/dichlorodiphenyldichloroethylene, perfluorohexane sulfonate, perfluorooctane sulfonate, perfluorooctanoate, perfluorononanoate, bisphenol A, polybromodiphenyl ethers or cadmium in children from Spanish cohorts is similar to that observed in other European countries.
In recent studies, lower development of working memory and higher inattentiveness has been observed in children from Barcelona exposed to high levels of traffic pollutants, namely nitrogen dioxide, fine aerosol particles and polycyclic aromatic hydrocarbons. These effects are probably common in all children living in urban areas under strong traffic pollution.

Conclusions
In the context of health conditions that are comparable to those of other EU children, the specific pollution stresses described in this review deserve specific attention from the health authorities. S57 www.journalhealthpollution.org

Methods
During 2006 to 2010, 1,751 mother and child pairs were recruited. Various environmental factors including biomarkers in blood and urine and health outcomes including neurodevelopment and allergic diseases were checked throughout periods of childhood. The Korean Bayley Scale of Infant Development, 2nd edition was performed at 6, 12, 24, and 36 months of age, and intelligence quotient was measured using the Korean version of the Wechsler Preschool and Primary Scale of Intelligence, revised edition and Korean -Wechsler Intelligence Scale for Children IV at 62 months and after.

Results
We found significant effects on children's neurodevelopment in association with maternal exposure to lead, iron, manganese, cadmium, phthalates, secondhand smoke, air pollutants such as nitrogen dioxide and PM 10 , as well as maternal stress and depressive symptoms, job strain during pregnancy, and postnatal breastfeeding duration.
Two preliminary studies suggested an association with prenatal lead, cadmium, and iron exposure with children's cognitive development at 5 years of age. Currently, children in the Mothers and Children's Environment and Health study are between 7 to 10 years old, and are being measured on their social responsiveness and behavior using the Social Responsiveness Scale, Attention Deficit Hyperactivity Rating Scale and Child Behavior Checklist. Future analyses should consider multiple exposure factors, times of exposure, and various dimensions of neuro-behavioral-cognitive-development.

Conclusions
A new nationally representative birth cohort study, the Korean Children's Environmental Health Study, was initiated in 2015. Follow-up will be conducted at every growth stage for the following 17 years based on the experiences of the Mothers and Children's Environment and Health study, which is expected to provide statistically powerful and generalizable evidences in environmental and children's health.

Background
Studies show that Endocrine Disrupting Chemicals (EDCs) play a role in disrupting human brain development, deterioration of male and female reproductive health, increased incidence of male and S58 www.journalhealthpollution.org female hormone related cancers, and the increase in cardiovascular disease, obesity and diabetes. The most vulnerable groups are pregnant women, fetuses and children. Better regulation is urgently needed. The EDC criteria to classify EDCs for being banned/regulated under the EU pesticides and biocides regulations proposed by the European Commission in June this year are negligible, not protective and ignore precautionary principles. Since the EDC criteria should function as a blueprint for other EU regulations and probably even in countries outside the EU, pressure from all public interest groups is urgently needed. The WHO calls the ubiquitous presence of EDCs in daily products and food a "global threat". Scientists and scientific associations like FIGO and the Endocrine Society are calling for political action for better protection as well as on action from doctors on awareness raising. The voice of scientists and doctors is needed more urgently than ever.

Methods
Women in Europe for a Common Future is active on a national and European policy level around EDCs and on an international level within the framework of the United Nations Environment Programme chemical policy process Strategic Approach on International Chemicals Management (SAICM) to achieve better protection of children from EDC exposure. Within several projects, WECF works on different target groups to raise awareness, improve the legal situation and give concrete information to consumers. Together with other NGOs (www.edc-free-europe.org, www.ipen.org/search/node/EDCs ), WECF aims to increase the pressure for policy makers to take responsibility in protecting human health and the environment from EDCs.

Results
WECF informed thousands of people who work and live with children about hazardous chemicals in products and ways to reduce the exposure via its Nesting programme (www.projetnesting.fr ). It delivers websites in several languages, a mobile phone app, workshops for parents and health and educational experts and information materials. On a policy level, WECF advocates for better regulations and for their enforcement.

Conclusions
The presentation aims to give an overview of recent EDC policy developments, EDC awareness raising and media activities, and scientific advances around EDCs, as well as political action taken so far. We will also show how strengthened cooperation between NGOs, physicians, media and policy makers is possible.

Joachim Heinrich
Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany Corresponding author: Heinrich, Joachim Munich, Germany joachim.heinrich@med.uni-muenchen.de

Background
The causal role of ambient air pollution on the onset of asthma and allergic conditions continues to be debated. We provide a systematic review and meta-analysis of birth cohort studies with follow-ups from birth to adolescence.

Methods
In a previous systematic review by Bowatte et al. (2015), 19 birth cohort studies published from 1960 to March 2014 were identified. Using the same methodology, we extended this search up to January 2016, which allowed several key new studies to be considered. Random effects meta-analysis was used to obtain combined estimates.

Results
A total of 338 references published between April 2014 and January 2016 were identified. Of these, 88 were duplicates and 216 studies did not meet the inclusion criteria. Manual searches identified 4 additional papers. These new studies were added to those previously identified by Bowatte et al. (2015). Ultimately, 27 eligible papers were included in the systematic review, 15 of which could be used in metaanalyses.

Conclusions
Despite the existence of a wealth of high quality, large, longitudinal birth cohort studies, the epidemiological evidence supporting an association between traffic-related air pollution with asthma and other allergic health outcomes remains insufficient to confirm a causal association. S60 www.journalhealthpollution.org

Personal Exposure to PM 2.5 and Benzo[a]pyrene in Ostrava, Czech Republic
Vlasta Svecova (1), Ivo Solansky (1), Thomas Cole-Hunter (2), the CITI-SENSE Consortium (3) P) is a proven human carcinogen. In the air, it is associated with particulate matter ≤ 2.5 µm (PM 2.5 ). High concentrations of both compounds found in the Ostrava region, CZ, have led to concern in the local population. To support the local needs for a communication platform, we started a case study of the CITI-SENSE project "Citizen Observatories for Quality of Life", with a special study on personal exposure and monitoring in schools.

Methods
Twenty non-smoking adult volunteers were recruited in the most polluted part of Ostrava to participate in three biomonitoring campaigns. All participants completed a personal questionnaire and time-location-acitivity diary. High precision personal monitors for PM 2.5 were used next to the new sensor technology for NOx assessment. Outdoor concentrations of PM 2.5 and B[a]P were measured using a high volume air sampler.

Results
The

Conclusions
With use of low-cost sensors, we created a Citizens' Observatory to boost the cooperation between scientists, citizens and other stakeholders, to increase opportunities for environmental health governance. To improve relevance to the local population, we combined low-cost online measurements with high precision instumentation, and with measurements and information campaigns in schools, all in cooperation with city authorities. Such activities provide the context necessary for communicating the results of the biomonitoring study to citizens as well as authorities. S61 www.journalhealthpollution.org

Background
The United Nations Environment Programme's global mercury assessment in 2013 identified artisanal and small-scale gold mining (ASGM) as the largest single sector releasing mercury emissions from intentional use of mercury. The United Nations Industrial Development Organization identified artisanal and small-scale gold mining practices using mercury in more than 50 countries, many of them low-and middle-income countries. Very often, gold extraction processes using mercury occur within residential areas, polluting villages and exposing residents, including children, pregnant women and women of child bearing age. This mercury exposure leads to adverse health effects to the cognitive and neurological development of affected children. The long-term impact of mercury pollution could lead to high socioeconomic costs, fewer jobs and economic opportunities, and increased family burden and need for health care.

Methods
Observations conducted during the inter-governmental negotiation (INC) meetings to prepare a global legally binding instrument on mercury and literature review.

Results
The Minamata Convention on Mercury is a global environmental health agreement, signed by 128 countries in October 2013 and currently under ratification. The treaty's objective is to protect human health and the environment from anthropogenic releases of mercury and mercury compounds.
The mercury treaty specifically provides for and highlights the need to protect human health. Special attention to health aspects addressed in Article 16 aims to promote the development and implementation of strategies and programmes to protect populations at risk, particularly vulnerable populations. Among the most important requirements of the treaty is that information related to mercury and human health must not be kept confidential, thereby highlighting the public 'Right to Know' about S62 www.journalhealthpollution.org mercury impacts on their health.

Conclusions
Article 16 of the Minamata Convention on Mercury does not contain mandatory provisions, but it encourages parties to the treaty to promote a range of health related measures. In addition to the present study, health issues also addressed in other articles related to ASGM, mercury in products, emissions and releases, contaminated sites, awareness and education as well as information exchanges are discussed. Countries with ASGM activities are recommended to develop a public health strategy with regard to the exposure of artisanal and small-scale gold miners and their communities to mercury. Such strategies should be included in the national action plan after the respective country ratifies the treaty.

Background
The purpose of the present study was to evaluate the association between cord blood (CB) and CB serum levels of selected toxic and potentially toxic elements (manganese, copper, zinc, arsenic, selenium, cadmium, lead, mercury, magnesium, calcium and iron (III)) on birth weight in Slovenia, taking into account maternal socio-demographic characteristics and dietary habits due to various associations obtained in literature.

Methods
Delivering women (18-45 years) were recruited primarily from the central part of Slovenia as part of the Public Health Impact of Long-Term, Low-Level Mixed Element Exposure in Susceptible Population Strata study (PHIME) (2007-2011). CB samples were collected at delivery. Associations between birth weight and a) predictors obtained through the questionnaires and b) levels of the selected elements in CB samples were tested using univariate and multivariate analyses. S63 www.journalhealthpollution.org

Results
In general, babies had normal birth weight (GM=3400 g, 95% CI: 3348-3453 g) and levels of selected elements did not represent a health risk for the mother-child pairs. Linear regression analyses showed statistically significant positive correlations between birth weight and number of children in the family, maternal pregnancy problems, pregnancy body mass index of mothers, gestational age, level of maternal education; child's gender (boys were heavier) and negative correlations between birth weight and the number of bedrooms in the home. Among the elements tested, birth weight showed significant positive correlation with calcium in CB serum and negative association with iron (III) in CB serum.

Conclusions
The main predictors of the newborn's weight (length of baby, gender of the baby, gestational age, pregnancy and pre-pregnancy body mass, level of education) were expected, while the associations between birth weight and essential elements (calcium and iron (III)) in the Slovenian birth cohort should be evaluated to identify possible mechanisms/explanation for the observed associations.

Reality of Children's New Environment and Future Policy Needs
Marija Jevtic (1), Catherine Bouland (2) (1) University in Novi Sad, Faculty of Medicine, Institute of Public Health of Vojvodina Novi Sad, Serbia (2) Université libre de Bruxelles (ULB), School of Public Health, Research Center on Environmental Health and Occupational Health, Brussels, Belgium Corresponding author: Jevtic, Marija Novi Sad, Serbia marija.jevtic@uns.ac.rs

Background
As professionals, we are confronted with increasing challenges in the fields of environment and health. Attempting to find the best way to solve numerous problems, new disciplines have been established. How can we make efficient policy to reduce risks and prevent harmful scenarios in the future? Some of us will still be alive and children that are five years old today will have their own young children in 2050. Besides knowledge, do we have the courage and imagination for an effective holistic approach to produce successful policy to preserve the environment for our children?

Methods
Based on the premise that students are the decision makers of the future, this research examines and analyzes (using a questionnaire) students' opinions about public health priorities in the field of environment and health.

Results
The results present the initial phases of data collection and consider priorities in public health, S64 www.journalhealthpollution.org especially in connection to the environment. Preliminary results point to the necessity of giving priority to climate change, water safety, and other environmental challenges. The challenge of a fast changing environment due to climate changes is probably the most important. Children are growing up in different environments, full of risk as consequences of climate changes and different disasters, as well as human migration, homelessness, discontinuation of schooling, unsecure health protection, etc.

Conclusions
Future policy should be comprehensive, foster adaptation and mitigation activities and aim to include children all along their education. Policy should be established by multi-sector stakeholders, in collaboration between education and health, with the primary aim to decrease health consequences on children, protect children's health and the whole population, now and in the future. We need a new approach to prepare students, children, professors and families for climate changes, and provide them with knowledge to raise their awareness. We should increase capacity to overcome all these rapid changes in the environment now, and prepare children for the future.

Background
Several studies have related longer breastfeeding durations to better intellectual performance in children. However, whether this relationship is entirely attributable to socio-environmental factors remains under debate. Few studies have investigated the potential protecting effects of breastfeeding against behavioral problems such attention deficit hyperactivity disorder (ADHD) symptoms, and even fewer on autism spectrum disorders (ASD) traits, and the extent to which these effects are mediated by cognitive function has never been explored.

Methods
This study examines the association between breastfeeding duration and cognitive development, attention, ADHD symptoms, and autistic traits using data from the Infancia y Medio Ambiente -Environment and Childhood -Project, a Spanish multicenter birth-cohort study, taking into account the intensity of breastfeeding. Duration of overall, predominant, and exclusive breastfeeding was documented during infancy through maternal questionnaires. Children (N = 1,832; mean age = 4.8 years)

Results
Several potential confounding factors were documented through parental interviews. After adjustment for confounders, longer duration of breastfeeding was associated with better cognitive development, reduced ADHD symptoms, and lower autistic traits. The latter effects appeared independent from each other.

Conclusions
This study provides further confirmation of a positive association with cognitive function over socioenvironmental factors, and also suggests a protecting role against ADHD symptoms and autistic traits. Results are in agreement with recommendations of prolonged breastfeeding durations to promote child development.

Occupational Noise Exposure During Pregnancy -New Aspects in Children's Language Acquisition
Soile Jungewelter (1)

Background
Occupational noise in pregnancy may affect the child´s central auditory processing and language acquisition. There are no investigations on this topic. At present, work safety focuses on protecting maternal hearing.

Methods
We conducted a cohort study among women working in the food industry, and as kindergarten teachers, musicians, dental nurses or pharmacists. We contacted 855 women with new-born children, 578 (68%) of which responded to baseline and 423 (73%) when their children were 12 months old. The final analyses included 406 mother-child pairs. S66 www.journalhealthpollution.org The baseline questionnaires focused on maternal occupational exposure and family factors. Language acquisition was measured by a validated questionnaire, Esikko, evaluating social communication, speech production and language comprehension. The mother filled out the questionnaire when her child was 12 months old. An occupational hygienist assessed noise exposure on the basis of maternal profession, job tasks and noise measurements using the categories: no exposure (<70 dB, n=178), low exposure (>=70 dB<=80 dB, n=108), and moderate/high exposure (>80 dB, n=120). We used linear regression, adjusted for mother's age, employment, child's gender and father's education to evaluate the association between noise exposure and children's language acquisition. Ethical approval was granted by the Ethics Committee of The Hospital District of Helsinki and Uusimaa.

Results
The adjusted mean language acquisition scores (range 0-57) were 34.3 (95% confidence interval (CI) 32.5-36.0) for no exposure, 34.8 (32.6-36.9) for low noise exposure, and 34.9 (32.8-37.0) for moderate/ high exposure. There were no statistically significant differences among the exposure groups. This was also true in analyses of social communication, speech production and language comprehension among food industry workers' children. Noise exposure was suggestively associated with lower language acquisition scores among kindergarten teachers' children. Reading to the child was strongly associated with high language acquisition scores in the entire data.

Conclusions
We found no clear association between noise exposure during pregnancy and language acquisition among one-year-old children. The study provides further results concerning two-year old toddlers. Background health effects. Organochlorine compounds are synthetic products used in industrial and agricultural applications, whereas the environmental occurrence of mercury has been largely enhanced by human activities. Despite their different structure, these compounds share common properties such as high toxicity (several of them), persistence in the environment and are widely distributed on the planet. S67 www.journalhealthpollution.org Furthermore, they bioconcentrate and biomagnify along the food chain. Dietary intake is therefore a major route of incorporation of these compounds in most human populations. However, it is important to ascertain what specific food items are the most relevant. This is particularly important for children since their organs and metabolism are still developing.

Persistent Pollutants in Food Items from Menorca Island
Body burden of dichlorodiphenyltrichloroethane and mercury in children from Menorca Island (western Mediterranean Sea) were considerably high when compared with cohorts from continental Europe (INfancia y Medio Ambiente and Cross-Mediterranean Environment and Health Network).

Methods
The present study aimed to determine the content of organochlorine compounds and mercury in representative food items from Menorca Island. Foodstuffs including seafood, meat, vegetables, fruits, cheese and eggs were collected in 2014. Fish were captured by local fishermen and all other food stuffs were produced locally.
Organochlorine compounds analysis for the determination of pentachlorobenzene, hexachlorobenzene, hexachlorocyclohexanes, dichlorodiphenyltrichloroethaneand metabolites (dichlorodiphenyldichloroethane and dichlorodiphenyldichloroethylene) and polychlorobiphenyls were performed by gas chromatography-electron capture detector and gas chromatographymass spectrometry. Determination of mercury was performed by inductively coupled plasma mass spectrometry.
Organochlorine compounds analysis for the determination of pentachlorobenzene, hexachlorobenzene, hexachlorocyclohexanes, dichlorodiphenyltrichloroethaneand metabolites (dichlorodiphenyldichloroethane and dichlorodiphenyldichloroethylene) and polychlorobiphenyls were performed by gas chromatography-electron capture detector and gas chromatographymass spectrometry. Determination of mercury was performed by inductively coupled plasma mass spectrometry.

Results
Seafood was observed to be the foodstuff with highest organochlorine compounds and mercury levels. The highest organochlorine compound concentration in fish was found in european hake (6.14 ng/g fresh weight of 4,4'-dichlorodiphenyldichloroethylene) and in shellfish, the mussel specie (1.83 ng/g fresh weight of polychlorinated biphenyl 153). Fruits and vegetables presented the lower concentrations. Concerning mercury, most fish samples exceeded the maximum level fixed by the European Commission (0.5 and 1.0 mg/kg fresh weight). Small-spotted catshark presented the highest concentration with 3.77 mg/kg fresh weight.

Conclusions
Low concentrations of many organochlorine compounds found in the present study suggest that the population has not been exposed to these compounds. However, high mercury levels evidence that there is a risk for children living in the Mediterranean Basin if they are consumers of large amounts of local seafood.

Methods
We collected official data from the Capital District Health Inspection, SRZI, and regional health inspection in the city of Pelven over a two-year period from 2009-2011. S69 www.journalhealthpollution.org Background Globally, Indonesia is well known for its natural environment and rich resources of potential mining areas. However, a number of environmental health issues have arisen due to mining activities. Human exposure could lead to various health impacts, such as kidney damage, cancer, child development, and other toxic effects. Children are most vulnerable to various heavy metal intoxications, especially in the first five years of life, since this is the critical period for brain and physical development. This study aimed to understand the potential environmental hazards in a prospective mining area in North Sumatra and to assess the heavy metals concentration on children's blood.

Methods
This is a cross-sectional study conducted in areas which may potentially be affected by future mining activities. The survey covered ten villages living in the 30 kilometer radius of the mining areas. Fatherchild pairs were recruited, with male adults aged 19-55 years and a young child 24-59 months old. Surveys were conducted to gather data on environment, food market, and diet patterns. Assessment of heavy metals concentration in blood was performed. Ethical approval was granted by the Committee of the Medical Research Ethics, Faculty of Medicine, University of Indonesia.

Results
The environmental survey showed the heavy metals concentration were within allowable range as sources for drinking water, while mercury and zinc level in soils were high. The mean capillary blood lead levels in children were 7.17 ± 0.23 µg/dL, whereas those of fathers were 6.01± 2.89 µg/dL. The blood concentrations of arsenic, copper, zinc, cadmium, and mercury were in the acceptable range for both children and fathers. The mean hemoglobin level of children and fathers were 11.72 ± 1.19 g/dL and 15.08 ± 1.50 g/dL, respectively. No correlation was found between lead and hemoglobin level.

Conclusions
This study showed that the heavy metals concentration in the environment and human body were within tolerable limits. However, further research should be done when mining activities take place in the area.

Background
Children are at high risk of developing neurodevelopmental disorders that affect the brain and nervous S70 www.journalhealthpollution.org system, including autism, attention deficit hyperactivity disorder, intellectual disabilities, and other learning and behavioral disabilities. Thousands of chemicals are used in material production processes (nearly 100,000 in the EU) that have not been adequately assessed for human and environmental impacts, and yet are used daily in consumer products. There is ample scientific evidence to support a link between children's risks for neurodevelopmental disorders and toxic chemicals, such as mercury, in consumer products, food, air and water.
Mercury ranked 3rd in the hazardous list of toxic substances, and it is a pollutant of increasing concern, as it is not only toxic to humans, but also to wildlife and the environment. In view of mercury and mercury-added products' toxicity and hazardousness, in 2013, under the United Nations Environment program, the Minamata Convention on Mercury was enacted by over 140 countries, already signed by 128 countries (including Spain & Pakistan) and ratified by 28 countries (including USA). The main objective of this convention is to protect human health and the environment from emissions and releases of mercury and mercury compounds. Articles 4 & 16 of the convention deal, respectively, with mercury added products (including dental amalgam & skin lightening/tanning creams) and health aspects (to protect population at risk, particularly vulnerable populations -children, pregnant women & others).

Methods
Over the past few years, the Sustainable Development Policy Institute has been actively involved in the negotiations process leading to the Minamata Convention on Mercury, as well as research on the health and environmental effects of the use of mercury-added products, such as mercury dental amalgam and skin lightening/tanning creams in Pakistan. Standard analytical methods were used for the measurement of mercury in air and semisolid skin lightening creams. For opinion sharing, interviews based on developed questionnaires were held with dental professionals and dermatologists/skin specialists.

Results
Measurements at 34 dental sites indicated mercury vapors levels in outdoor/indoor air in the range 109 -26,000 ng/m 3 for air (against reference standard = 300 ng/m 3 ). Survey work/interviews at 38 dentistry teaching institutions in the country and over 90 private dental clinics in 3 main cities showed 90% of the respondents supported review and revision of the current curriculum and inclusion of additional contents on dental mercury amalgam related to health, waste issues and mercury free dentistry, using mercury free material for dental restoration. Of the interviewed dental professionals, 70% supported mercury free material use for dental restoration as the first choice for pregnant women and children (under 12 years age) and 67% supported a ban on mercury dental amalgam use. Chemical analyses of 20 samples (others in progress) of different skin lightening creams brands revealed alarmingly high total mercury content in some of the analyzed samples. On the basis of total mercury contents, the studied skin whitening creams have been categorized into 4 groups: most, (mercury > 10,000 ppm), highly (mercury > 5000), moderately (mercury < 5000) and least (mercury < 1 ppm) hazardous skin lightening creams.

Conclusions
Our research findings provide ample evidence of most likely mercury exposure to personnel (especially children) at dental sites and due to the use of skin lightening creams containing high levels of mercury content. We strongly recommend (i) mercury specific legislation for public/consumers daily use products, (ii) review and revision of dentistry & dermatology curriculum at medical institutions and (iii) ban on the S71 www.journalhealthpollution.org production/use of skin lightening creams with total mercury content above one ppm (as per Minamata convention on mercury requirement) and in the first phase, use of mercury amalgam for dental health restoration of pregnant women and children below the age of 12 years. In this regard, our awareness & advocacy activities and discussion with the stakeholders (including government) are in progress.

Background
The high value of gold reserves in West Sumbawa Regency and West Nusa Tenggara Province, Indonesia has resulted in an increase in small-scale gold mining activity in this area. Artisanal and smallscale gold mining is an attractive alternative livelihood for rural workers because it has good potential to improve the wealth of a community. Women and children are often involved in mining activities as miners usually bring their family to live close to their place of employment, thus women and children (<13 years old) are potentially highly exposed to mercury. The current study was conducted to better understand the life style, extent of mercury exposure, and the health of people living in the Taliwang artisanal and small-scale gold mining area, West Sumbawa Regency, West Nusa Tenggara Province, Indonesia. The present study was designed as a purposive field sampling study conducted in the Taliwang artisanal and small-scale gold mining area, West Sumbawa Regency, West Nusa Tenggara Province, Indonesia.

Methods
The subjects were miners and families including their children from three different areas within the West Sumbawa Regency: individuals directly exposed to mercury, indirectly exposed individuals and non-exposed individuals. Hair samples and medical examination were obtained from the subjects and subjects were questioned about their mercury exposure over time. Hair samples were collected at the time of the study. Ethical approval was granted by the Ethical Committee from Medical Faculty of University of Mataram, Indonesia. S72 www.journalhealthpollution.org

Results
A sub-analysis of data showed that children in individuals directly exposed subgroups had highest mercury in their hair (mean 4.7 mg/kg) than indirectly exposed individuals subgroups (mean 1.5 mg/kg) and non-exposed individuals subgroups (mean 0.4 mg/kg). Medical examination on children showed no symptom of mercury intoxication yet. The results indicated that artisanal and small-scale gold mining activities were shown to affect the health of miners and their family in a very short time, as evidenced from the high mercury residue in their bodies above the normal level permitted by World Health Organization.

Conclusions
The current scale of artisanal and small-scale gold mining activity in the West Sumbawa Regency is predicted to rise, raising the possibility of environmental and health disasters.

Background
Pollution-related disease (PRD) is a massive and growing global problem. Diseases caused by pollution are responsible for nearly 9 million premature deaths each year, almost three times as many deaths as result from AIDS, tuberculosis and malaria combined. PRD, poverty and inequity are intertwined, and PRD falls most heavily upon children, women, and the poor. More than 90% of deaths due to PRD occur in low-and middle-income countries (LMICs).
The nature of pollution is changing. In rapidly developing countries, levels of ambient air pollution, toxic chemical pollution and soil pollution are increasing sharply as a consequence of urbanization, increasing motor vehicle use and the proliferation of toxic chemicals, pesticides and polluting industries. Asthma, neurodevelopmental disorders and sudden infant death syndrome are the main health consequences for children. In adults, health effects include chronic obstructive pulmonary disease, atherosclerosis, ischemic heart disease, stroke, renal disease, lung cancer and accelerated neurological degeneration. PRD is responsible for staggering economic costs. These costs include direct medical expenses as well as the diminished productivity of people who die prematurely or are disabled by PRD. These costs are largely invisible, but they are so great that they can distort health system spending and undermine the growth of entire societies. S73 www.journalhealthpollution.org Pollution can be prevented. Pollution and PRD are not the unavoidable consequences of development. Cost-effective pollution control strategies have been developed and successfully deployed in countries at all levels of income. These strategies are data-driven and are based on combinations of law, policy, civil engagement, governmental institutions and technology. They provide practical tools of proven efficacy that are available today to governments and people around the world. Interventions against PRD can win economic benefits as great as those associated with other highly effective public health programs such as childhood immunization.
PRD and pollution have been neglected in the global health and international development agendas. The resources allocated to pollution control and PRD prevention have, apart from water pollution and sanitation, been meager. Pollution has continued to worsen, and PRD has quietly become the world's largest cause of avoidable premature death.

Methods
To address this great and growing global problem, we have launched the Global Commission on Pollution & Health (the Commission). The Commission is an initiative of The Lancet, the Global Alliance on Health and Pollution, and the Icahn School of Medicine at Mount Sinai. The Commission will present the first-ever analysis of the global burden of disease attributable to all types of pollution combined and the first analysis of PRD's global economic costs. It will present case studies of successful interventions against pollution.

Results
The goal is to provide world leaders and global policy-makers the data and the strategic blueprint that they need to justify decisive action against pollution. The Commission's report will be published in early 2017.

Conclusions
PRD is at a tipping point. While the problem is massive, it is now well mapped, and the tools for its control have been developed, tested and proven effective. With leadership and resources, pollution and PRD are problems than can be largely resolved within a generation.

Methods
This project has been approved by the Ethics Committees of Istituto Superiore di Sanità and Bambino Gesù Children's Hospital.
In HBM, 2160 mother-child pairs from urban and rural areas of the Italian geographical macro-areas (North, Centre, South) are recruited by trained family pediatricians. Data on lifestyles, food storage and consumption are collected through a structured questionnaire and a food diary. BPA and DEHP metabolites (mono-(2-ethylhexyl) phthalate (MEHP), 5OH-MEHP and 5oxo-MEHP) levels are determined in urine samples by electrospray ionization, liquid chromatography-mass spectrometry. S75 www.journalhealthpollution.org boys and 30 girls, aged 6-10 years (idiopathic obesity) are recruited. BPA and DEHP metabolite levels are assessed in urine samples, and clinical and toxicological biomarkers related to puberty onset and obesity in serum samples.

Results
The project approach and descriptive preliminary results on DEHP metabolites and BPA internal levels will be presented at the meeting.

Conclusions
LIFE PERSUADED fills the data gap on DEHP and BPA exposure in Italian children by setting background levels for susceptible groups of population and implementing the EU database. Data integration for endocrine disruptors risk assessment, the evaluation of determinants of exposure as well as the creation of a biobank for urine samples will represent relevant output of the project.

Low Level Arsenic Exposure During Pregnancy in the 3xG Cohort In Flanders: Less Efficient Detoxification is Associated with Higher Oxidative Stress
Nathalie Lambrechts (1), Eva Govarts (1)

Background
Increasing epidemiologic evidence indicates that even low level arsenic exposure affects adverse pregnancy outcomes. On the other hand, it is known that arsenic metabolism changes during pregnancy by means of detoxification. The adverse outcome pathways from arsenic exposure during pregnancy need further clarification.

Methods
This study investigates whether urinary arsenic species and arsenic methylation efficiency are associated with oxidative stress in 151 pregnant women of the 3xG cohort in Flanders, Belgium (2012-2015). Urine samples were collected between 25 and 35 weeks of gestation and different arsenic species (inorganic arsenic (inorganic arsenic; arsenic (III), arsenic (V)), monomethyl arsenic acid (MMA) and dimethyl arsenic acid) were measured using liquid chromatography-mass spectrometry. Multiple linear regression analyses were performed to evaluate the associations between arsenic exposure and oxidative stress, measured by the amount of 8-hydroxy-2′-deoxyguanosine (8-OHdG, ln-transformed) in the same urine samples (enzyme-linked immunosorbent assay). The associations were adjusted for age and smoking before sample collection. Ethical approval was granted by the Ethical Committee of Antwerp University (Hospital) and of the local hospitals.

Conclusions
The information in this study indicates that in a region with a relatively low environmental arsenic burden, the toxic metabolite MMA is associated with increased oxidative stress in pregnant women. Furthermore, mothers with less efficient detoxification of arsenic had higher levels of 8-OHdG.
The 3xG study is part of the cAT project, funded by NIRAS and the local partnerships MONA and STORA.

Lead and Mercury Exposure Associated with Low Resting Heart Rate in Community Children
Jianghong Liu, Naixue Cui School of Nursing, University of Pennsylvania, Pennsylvania, USA Corresponding author: Liu, Jianghong Philadelphia, Pennsylvania, USA jhliu@nursing.upenn.edu

Background
Few studies have examined the neurotoxic influence of heavy metals on the autonomic nervous system. Previously, one study showed that occupational chronic lead exposure decreased resting heart rate (RHR). The purpose of our study is to test whether environmental lead and mercury exposure is associated with decreased RHR in community children. S77 www.journalhealthpollution.org

Methods
As part of the China Jintan Cohort Study, 564 children aged 12 years (standard deviation=0.6) were tested for blood levels of lead (BLL) and mercury (BML) and RHR. RHR was recorded using electrocardiography placed axially on the left and right ribs. Generalized linear models (GLMs) were conducted to test the relationship between BLL and BML and the RHR controlling for children's sex, age, and socioeconomic status. Analysis was clustered at the preschool level when the children were recruited to adjust for standard error. Ethical approval was granted by the University of Pennsylvania Institutional Review Board.

Results
The mean (standard deviation) BLL and BML was 3.1 (1.2) μg/dL, with a median value of 2.9 μg/dL and 0.1 (0.07) μg/dL and a median value of 0.1, respectively. GLMs results showed that after adjusting confounders, children with BLL (B=-1.23, p=0.010) or BML (B=-1.86, p=0.013) higher than the median level showed decreased RHR. Particularly, compared with girls, boys were more likely to have decreased RHR when their BML exceeded the median level (i.e. 0.1 ug/dL) (B=-3.33, p<0.001). No gender differences were observed for BLL and RHR. A further analysis showed that RHR was the lowest among children with both high BLL and BML (B= -3.30, p<0.001), and this combined effect was greater among boys (B=-4.09, p<0.001) than among girls (b=-2.64, p=0.147).

Conclusions
Low RHR is an indication of chronic under-arousal and has been implicated to psychopathology, particularly for externalizing behavior. We previously reported that lead exposure was associated with increased behavioral problems in community children. Our finding of the relationship between heavy metal exposure and low RHR provides the direction for our future study testing the possible mediating role of low RHR on the relationship between heavy metals and behavioral problems in children. S78 www.journalhealthpollution.org

Background
Essential fatty acids play a key role in brain development. The balance between omega-6 and omega-3 is important for an optimal nutrition pattern. We aim to assess the role of omega-6/omega-3 ratio on child attention deficit and hyperactivity disorder (ADHD) symptoms and cognitive functions.

Methods
This study was based on the population-based birth cohort INMA, including 4 different Spanish regions (Asturias, Gipuzkoa, Sabadell and Valencia). Fatty acids were collected from whole cord blood samples by using venipuncture of cord vessels before the placenta was delivered. The omega-6/omega-3 ratio was calculated by dividing arachidonic acid (AA) with the sum of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The ADHD symptoms were reported by each child's teacher using the Diagnostic Manual of Mental Disorders, 4th ed. (ADHD DSM-IV) at age 4. The child cognitive functions of the children were assessed by a psychologist using McCarthy Scales of Children's Abilities (MSCA) at age 4. Pooled negative binomial regression models were used for ADHD symptoms (n=571). Pooled linear regression models were used for MSCA (mean=100, SD=15) (n=670). All models were adjusted for child gestational age, birth weight, gender, age during testing, maternal social class, smoking during pregnancy and cohort location. The study was approved by the ethics committees of participating hospitals in Valencia and Sabadell (Spain).

Conclusions
Higher omega-6/omega-3 ratio on cord blood was related to more ADHD symptoms and worse cognitive functioning at 4 years of age. The identification of nutritional biomarkers that explain its effects on child cognitive development will enable the implementation of appropriate and effective nutritional recommendations as well as interventions during pregnancy.

Background
Studies on the association between exposure to elemental composition of particulate matter in outdoor air and neuropsychological development are sparse. We aimed to investigate the association of prenatal exposure to trace elements of outdoor particulate matter with diameter of <2.5 µm (PM 2.5 ) with cognitive and psychomotor development during childhood.

Methods
We analyzed data from 4 European population-based birth cohorts -Generation R (The Netherlands), Duisburg (Germany), GASPII (Italy) and INMA-Sabadell (Spain) -with mother-infant pairs recruited between 2000 and 2006. Monitoring campaigns measuring PM 2.5 levels were performed between 2008 and 2011 in all corresponding regions and the elemental composition of the particles was determined. Individual exposures to 8 elements (copper, iron, potassium, nickel, sulfur, silicon, vanadium and zinc) that represent major anthropogenic sources of air pollution were estimated at birth addresses using land use regression models. Cognitive (general, verbal, and non-verbal) and psychomotor (global, fine, and gross) development was assessed between ages 1 and 9. Adjusted region-specific effect estimates were combined using random-effects meta-analysis. Ethical approval was granted by local authorized institutional review boards. S80 www.journalhealthpollution.org

Results
There were 2904 children included in this complete case analysis. That is, children that had information on exposure, at least one of the outcomes and all the selected potential confounding variables. Prenatal exposure to vanadium and nickel was associated with a reduced verbal development (-1.71 points [95% CI = -3.06 to -0.37] per increase of 2 μg/m 3 of vanadium and -1.96 points [95% CI = -3.46 to -0.46 per increase of 1 μg/m 3 of nickel]). A similar tendency, although statistically not significant, was found for exposures to sulfur and silicon with verbal development; for exposure to nickel, sulfur, and silicon with general cognitive development; and for exposure to all elements with fine psychomotor development. In a few cases, exposure to some elements showed a tendency towards improved non-verbal and gross psychomotor development, although these results were statistically non-significant as well.

Conclusions
Prenatal exposure to airborne trace elements vanadium and nickel of outdoor PM 2.5 was associated with an impaired verbal development during childhood.

Background
Health care workers (HCW) are opinion leaders in the field of food safety and their promotion in the population is very effective in public health. Food is an important exposure source for many environmental contaminants and children are the most vulnerable age group for most of them.

Methods
With the aim to improve the knowledge about food contaminants for HCW, 275 HCW in 16 of the main hospitals from the Balearic Islands attended 2 hours of lessons in 2015. A test before and after the lesson was given to assess the knowledge of HCW about how to prevent the exposure of children and pregnant women to food contaminants and to determine their opinion about the course. In addition, teaching materials for families was provided to the HCW.

Results
Of those workers, 60% answered the test correctly. The average percentage of correct responses prior the training was 10%. The most valued aspects were the high profit and the opportunity to share S81 www.journalhealthpollution.org scientific knowledge about risks in food between HCW and public health workers. Their demands have been to extend the course contents and its duration.

Conclusions
The low percentage of tests performed was due to the difficulty of workers leaving their tasks to arrive on time at the sessions. This fact, added to their wish to receive more extended content and longer courses, requires another course format. Also, the low score of correct answers shows the necessity to provide more courses to HCW.
In 2016, a new online food safety course for HCW will be available in the Balearic Islands. The attendees will connect when they can and will have access to more extended content. To access the content they will have to take the introductory tests, and to obtain the certificate they will have to do the post test, and thus the entirety of the data will be collected. We will dtermine if better knowledge is achieved with online lessons in order to better prevent exposure of children to contaminants.

Background
Mercury is a strong neurotoxic agent that can cause severe neurological damage to children because of their immature metabolism and organs. Mercury (Hg) emissions in the atmosphere due to mining and fossil fuel burning (Hg 0 ) are deposited into seawaters after oxidation to Hg 2+ . There, Hg may undergo bioaccumulation and scavenging by organic-rich particles, be eventually transported from surface to deep waters and reduced back to Hg 0 and to CH 3 Hg.
Fish and shellfish consumption is the known predominant input of this metal into human populations of Mediterranean regions. Attention has been focussed on oily fish as the main group of species responsible for the incorporation of Hg into the human diet. Conversely, few studies on the potential role of lean fish regularly consumed by humans have been reported so far in the scientific literature. The present study is therefore aimed to determine the Hg levels in commercial seafood from the Mediterranean Sea. S82 www.journalhealthpollution.org

Methods
Samples were caught between February 2014 and December 2015 in the Balearic Islands. The sampling plan included the most consumed and fished species in the Balearic Islands, grouping them for their study in three trophic levels with the aim to identify the species which carry the most Hg. Samples were collected in local fish markets and auction halls with validated sampling and analysis methods. Information gathering included data for each specimen of variables related with the amount of mercury in fish, as size, weight and catch location.

Results
Eighty-two percent of the samples showed detectable Hg levels. The levels were generally higher than those reported in seafood from the Atlantic Ocean. A substantial number of samples exceeded the maximum level set forth by the European Union Maximum Limits of 0.5 and 1.0 mg/kg wet weight. Twenty-nine percent of the thirty-nine fish and shellfish species studied had average concentrations above these limits.

Conclusions
The present study shows that not only oily fish, but also lean and shellfish species from the Mediterranean Sea have mercury concentrations above the recommended European Union Maximum limits. A reassessment of the impact of fish consumption from this region on children and the general population is needed. This assessment should estimate how much mercury intake can be attributed to this source and along with its health effects.

Background
Patterns of early life function development during childhood may be helpful in understanding the pathogenesis of respiratory diseases throughout life. The aim was to investigate the individual growth trajectories of children's lung functions as they get older by gender and prenatal personal level of exposure to airborne particulate matter 2.5 (PM 2.5 ), which was hypnotized to decline studied parameters. Both the shape of trajectories and the degree of variability in growth among children were of interest. S83 www.journalhealthpollution.org

Methods
The study sample was comprised of 322 children from a Cracow birth cohort who annually underwent standard lung function testing (forced volume capacity, forced expiratory volume in 1 s and forced expiratory flow 25-75%) between 4 and 9 years of age. Personal measurements of PM 2.5 were performed over 48 hours in the second trimester of pregnancy among pregnant women recruited prenatally to the study. Data on child development and health status as well as exposure assessment were collected regularly based on standardized questionnaire. Growth trajectories of children's lung functions were adjusted by polynomial multilevel linear mixed models. The parents of all children involved in the study gave their informed consent and the Ethical Committee of the Jagiellonian University in Krakow and Columbia Presbyterian Medical Center approved the research.

Results
Lung function trajectories differed significantly for boys and girls for FVC and FEV1. Boys had a higher increase than girls (mean annual difference: 23.1ml (95% confidence interval: 8.8;37.1), p=0.002 and 22.6 ml (95% confidence interval: 10.0;35.2), p<0.001 ), respectively). In cases of FEF25-75%, trajectories had similar shape for boys and girls. Significant lung function impairment (decrease in FVC and FEV1) was observed from 4 through 9 years among subjects prenatally exposed to higher levels of PM 2.5 , but not in the case of FEF25-75%.

Conclusions
High levels of prenatal exposure to PM 2.5 might be related to diminishing lung function growth in children.

Background
Prenatal exposure to perfluoralkyl substances (PFAS) might increase obesity and cardio-metabolic (CM) risk during childhood, but results are inconclusive. We evaluated the effect of PFAS on individual and combined CM risk components during childhood in a Spanish birth cohort.

Methods
We measured perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) in maternal plasma. We assessed S84 www.journalhealthpollution.org rapid growth at 6 months of life (n=1109) and age-and sex-specific z-scores for body mass index, waist circumference and mean arterial pressure at 4 (n=1,230) and 7 (n=1094) years. Using non-fasting blood samples at 4 years we measured lipid concentrations (n=629): total cholesterol, triglycerides and, highdensity and low-density lipoprotein cholesterol. We calculated a continuous CM risk score at 4 years; a higher score indicated a higher CM risk. All participating women signed written informed consent before beginning the study. The study was approved by the regional ethical committees of each cohort.

Results
Twenty-four percent of children were rapid growers at 6 months and 30% and 35% were overweight at ages 4 and 7, respectively. At 6 months, PFOA was associated with increased weight gain in boys [β=0.22 (95% confidence interval: 0.04, 0.40)] but not in girls [β=-0.06 (-0.21, 0.10)] (p-value for sex-interaction=0.08). We found no association between PFAS and body mass index z-scores, overweight or waist circumference at 4 and 7 years. PFAS tended to decrease mean arterial pressure z-scores at 4 years of age, but was not statistically significant.

Conclusions
This is one of the largest studies to comprehensively assess the effect of PFAS on individual and combined CM risk components during early childhood. Our results suggest that PFAS can affect some CM risk components during childhood, especially in boys. Further replication of our results is needed.

Methods
Data on cognitive function, wireless device use and lifestyle are collected at baseline and follow-up via school-based computerised assessments and optional parent/pupil home-based questionnaires. Parents are invited to consent to linkage of their child's assessment data with routine records (e.g. health and educational records, mobile traffic data), thus allowing for comparisons between self-reported and objective mobile phone use. Biological samples (e.g. urine, saliva) are collected to provide additional information about potential confounders, such as pubertal status. A RF personal monitoring study is also being conducted in a subset of the cohort to gain an in-depth understanding of children's personal RF exposure and the relative contribution of each RF source. Ethical approval was granted by the North West Haydock Research Ethics Committee.

Results
To date, 5,504 predominantly 11 to12-year-olds participate in SCAMP (53.2% female, mean age 12.0 (SD 0.4); 42.3% White, 20.3% South Asian, 15.9% Black, 11.5% Mixed, 9.9% Other). Preliminary analysis shows that over 80% of participants own a mobile phone. Device usage is comparable among boys and girls, apart from gaming. Black adolescents consistently report highest use across all devices. Validating self-reported information against traffic data in a subset revealed children had underestimated call frequency, but overestimated call duration and text messages.

Conclusions
SCAMP will improve our understanding of children's RF exposures, device use, and cognitive function and will provide an evidence base to inform public health policy in this area.

Background
In previous studies, we have reported that environmental contaminants such as polychlorinated biphenyls (PCBs) were detected in maternal blood, umbilical cord and cord blood. On the other hand, in animal studies, it has been reported that intake of PCBs induced the alteration of the microbiome. Moreover, several studies have reported that the gut microbiome influences the balance between S86 www.journalhealthpollution.org health and disease. A birth cohort study, the Chiba Study of Mother and Children's Health focuses on environmental health effects on foetuses, and involves multiomics analysis and has been conducted since 2014. Currently, the correlation between maternal blood PCB levels and microbiome status is being investigated. The associations between changes in the maternal gut microbiome and alteration of differentially methylated regions of diabetes-associated genes in umbilical cord samples are also examined.

Methods
The Chiba Study of Mother and Children's Health consists of three hospital-based cohorts. Ethical approval was given by the Biomedical Research Ethics Committee of the Graduate School of Medicine, Chiba University. Consent to participate was obtained from 433 pregnant women. Among those, 376 women answered the questionnaires regarding their characteristics and life style during the early gestational period. The mean age was 32.5 (± 4.4) years old. Blood PCBs concentration level in 93 women was measured by gas chromatography-mass spectrometry. The microbiome of 10 participants was studied. The 16S rRNA metagenome analysis of maternal stool samples and deoxyribonucleic acid methylation assays of umbilical cord samples were performed.

Results
The mean concentration of blood total PCBs was 420 pg g−1 wet wt, in which chlorinated biphenyl (CB)153 (mean: 100 pg g−1 wet wt), CB138 (mean: 70 pg g−1 wet wt), and CB180 (mean: 58 pg g−1 wet wt), contributing the most of the total PCB. In our preliminary analysis, total PCB level and one genus of gut microbiome showed positive correlation. Additionally, the proportion of Firmicutes in the maternal gut were associated with deoxyribonucleic acid methylation levels of some diabetes-associated genes in umbilical cord samples.

Conclusions
These findings suggest that PCB exposure of mothers might affect the microbiota components of mothers and epigenetic change in fetuses. Further detailed studies are needed to reveal whether maternal exposure will affect maternal microbiota components or epigenetic statues in fetuses. and poorly paid jobs, with higher health risks and poorer access to health care, successively with more disease and injuries, again less income and consecutively poorer housing and even more risks. Not only does this lead to individual misfortune, but also affects the fate of offspring. The mechanisms are even more visible in developing countries without a well-established welfare-system with social securities and free access to public education.

Methods
We investigated health in relation to occupational exposures in the cotton industry of Pakistan. A random sample of plants in the area of Faisalabad was selected, stratified by plant size. Most workers present at the plant at the day of visit received and answered a questionnaire about job history and health complaints. A random sample of workers in each plant was further examined by spirometry and buccal cell test. Dust measures were performed during each visit. Ethical approval was granted by the Ethical Review Committee of the Health Services Academy, Ministry of National Health Services, Regulation and Coordination in Islamabad, Pakistan.

Results
We found that small enterprises producing for the local market generally, but also on demand for big companies with long-standing contracts with European and American traders, not only displayed the highest dust exposures, poorest occupational safety measures and hygiene, but also had the longest shifts (typically 2 shifts of 12 hours each), and the least educated work-force, typically with a working history from the age of 15. These workers also fared poorest on several health parameters, from poorer lung function to a long list of reported symptoms not exclusively but also including respiratory symptoms, along with signs of cytotoxicity and genetic damage.

Conclusions
In this observational study it was not possible to disentangle the effects of longer years of exposure because of early initiation of work, longer occupational exposure per day, and higher exposures due to poorer occupational hygiene. Nevertheless we want to point out that all these factors were primarily caused by poor education and early termination or even lack of proper schooling. index case was a young female who developed deadly bronchiolitis obliterans a few weeks after an uncomplicated pregnancy. Consecutive examinations revealed that dozens of similar cases had appeared throughout the country, mostly in children and in females, the latter often either pregnant or shortly after pregnancy. The mortality rate was exceptionally high among cases and many more cases only survived after lung transplantation. We will summarize the findings of other authors reported in the literature. The aim is to draw attention to a highly instructive episode.

Methods
As infectious causes could not be established, further studies focused on toxic exposures. Because of the characteristics of the affected persons (no common occupational exposure), indoor pollutants were suspected.

Results
It turned out that cases had used humidifiers at home and had treated these with disinfectants as advertised by industry. Several case-control studies clearly indicated the causal role of these disinfectants. Animal studies demonstrated the same severe damage of lung tissue after inhalative exposure towards a disinfectant previously deemed "safe" and "not toxic". Further studies also revealed that similar epidemics had happened for the last couple of years, usually in the cold season, without anyone taking notice.

Conclusions
General implications for toxicity testing and for the application of the precautionary principle will be discussed.

Background
The question of whether licensing of glyphosate, a widely used herbicide, should be continued or phased out has been subject to intense and sometimes very emotional controversy during the last two years. The media, non-governmental organizations (NGOs), farmers, scientists, and official and government agencies, e.g. the International Agency on Research of Cancer (IARC), the Joint Meeting of the FAO/WHO on Pesticide Residues (JMPR), the German Federal Institute for Risk Assessment (Bundesinstitut für Risikobewertung (BfR)), and the European Food Safety Agency (EFSA) have differed in their opinions, namely on the carcinogenicity of glyphosate. Despite its low acute toxicity and the fact that glyphosate is not persistent, the worldwide distribution of some 700,000 tons per year, resulting in S89 www.journalhealthpollution.org the practically ubiquitous presence of this substance, doubtlessly warrant thorough evaluation.

Methods
The publications and arguments of different agencies and NGOs have been reviewed and evaluated, including, in some cases, the underlying primary studies and publications. Since the carcinogenicity of glyphosate has been the aspect most widely and intensely discussed, our analysis centered on this question, but we are aware that endocrine disruption and mutagenicity are further aspects of interest.

Results
Both BfR and EFSA see no risk for human health under the present conditions of application. However, during their deliberations, the IARC classified glyphosate as probably carcinogenic to humans (Group 2A), arguing that, although "there is limited evidence in humans for the carcinogenicity of glyphosate", there is an "observed positive association for non-Hodgkin lymphoma. There is sufficient evidence in experimental animals for carcinogenicity". The animal experiments cited by the IARC report marginal effects with borderline significances in some groups under chronic and very high glyphosate dosage. The JMPR declared that there was no risk for humans, considering real exposure rates.

Conclusions
The unresolved conflicts within these official agencies and with NGOs are caused by insufficient wording and lack of public awareness of the fact that hazard and risk denote different categories. Several years ago, the IARC defined these concepts: "A cancer 'hazard' is an agent that is capable of causing cancer under some circumstances, while a cancer 'risk' is an estimate of the carcinogenic effects expected from exposure to a cancer hazard", being "one part of the body of information on which public health decisions may be based". The European Commission prolonged the license for another 18 months on June 30, 2016, thus giving time for more deliberation and discussion.

Background
During the last two or three decades, awareness of the existence of autism and, more generally, autism spectrum disorders (ASD), also classified as pervasive developmental disorders (PDD), has increased. This has led to a wider recognition and more frequent diagnosis of ASD. It has been debated, but S90 www.journalhealthpollution.org remains questionable, whether the incidence really has increased. Both genetic and environmental factors are important for the phenotypic manifestation of ASD.

Methods
The more recent literature on the genetics of ASD and on precipitating environmental factors have been evaluated and reviewed.

Results
The prevalence of ASD is generally reported as 5 to 6 per thousand population, and in some studies and populations even more than 10 per thousand population. The male to female ratio is about 3:1. Homozygotic twins very frequently both manifest the ASD phenotype, more than 95% in boys, and around 80% in girls. The recurrence rate in families with more than one affected member is about 50% for boys and 20% for girls. Thus heritability apparently is one cause, and is probably necessary to make individuals susceptible to environmental factors. The extensive literature on environmental conditions is partly highly speculative, in other publications, however, more solidly founded. For instance, five epidemiologic studies in the United States show statistically significant associations between air pollution or residence close to highways and ASD incidence.

Conclusions
As the genesis of ASD is multifactorial, there remains much to be elucidated as to the causes and mechanisms which can lead to its phenotypic manifestation. However, there exist already sufficient data showing that adequate nutrition during pregnancy is important, and, if necessary, adequate supplementation of vitamins, folate and micronutrients can decrease the risk of ASD in offspring. Avoidance of other environmental conditions, as heavy traffic and pesticide exposure, or fever during pregnancy, is difficult for most families.

Background
Autism is known as a complex developmental disability. Experts believe that autism presents itself during the first three years of a person's life. The condition is the result of a neurological disorder that has an effect on normal brain function, affecting development of the person's communication and S91 www.journalhealthpollution.org social interaction skills. Lead is a neurotoxin to which the developing brain is particularly vulnerable. Moreover, lead poisoning in children is known to negatively affect brain systems implicated in cognitive, communication, and social functioning. One potential weakness of autistic children is that they are less able to remove heavy metals from the body so that the metal accumulates in the body and brain.

Methods
This observational study with a cross-sectional approach, examined 44 children diagnosed with autism n Grogol Jakarta and the Islamic Hospital Mental Klender Jakarta. Data were collected through interviews, and blood lead levels were checked by flame atomic emission absorption spectrophotometer. Ethical approval was granted by YARSI University.

Results
Hair examination of children with autism showed elevated levels of heavy metals. Examination of the 44 children with autism, ages 1-10 years old, 97% boys and 23% girls, showed that 16.7% had high levels of heavy metals. Patients were diagnosed since one-month-old.

Conclusions
If a child is showing symptoms of autism, then detoxification and other types of therapies, such as speech therapy, behavioral, occupational must be done. If there has been damage to the brain, detoxification cannot directly fix the symptoms. Detoxification is just to prevent further damage. Toxic metals are not the cause of autism, but can be a trigger, or aggravate the symptoms of autism.

Background
Exposure to hazardous environments can cause damage to the respiratory tract, particularly in individuals who have atopy who may suffer from continuous inflammation and can also cause asthma in children. A recent study describes the correlation between exposures to traffic air pollution with the S92 www.journalhealthpollution.org respiratory tract exchanges. One evidence of this correlation is the increasing concentration of nitric oxide (eNO) expiration as a sign of inflammation of the respiratory tract in children. The analysis showed a strong correlation between asthma with the exposure to nitric oxide (NO) and other toxic air. Our objective is to verify the hypothesis which stated that children who live in shelters around industrial areas and are exposed to air pollution will experience more respiratory tract irritation than children who do not live in the surrounding district of the industrial area, confirmed by increased concentrations of eNO.

Methods
Case controls and data collection were held in Jakarta to investigate the effects of the environment around the plant with increased exposure of FeNO, and data from the area of East Nusa Tenggara, Lombok, Indonesia were used as a control.

Results
Children whom are often exposed to toxic air pollutants can undergo an inflammatory process and this may cause a decrease in vital lung function. This was supported by evidence found from the increasing eNO concentrations and derivation of expiratory peak flow rate (PEFR) in children who live around industrial areas under study.

Conclusions
There are strong correlations between asthma in children with the exposure of toxic factory air pollution. Others factors that may increase asthma include (1) the size and width of the house, (2) the humidity of the house, (3) the lighting of the house, (4) the ventilation of the house, and (5) mother's education and knowledge.

Children's Environmental Health and Opportunities for Action in the Sustainable Development Goals Era
Maria Neira

Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland
Corresponding author: Neira, Maria Geneva, Switzerland brunedrissem@who.int The Sustainable Development Goals (SDG) present an opportunity for the health sector to work with other fields in reducing environmental hazards to children. What children experience in the first five years of life is the foundation for their future health; SDG 3, which emphasizes the importance of wellbeing at all ages, depends on this critical period. Healthy lives must be nurtured in healthy environments, S93 www.journalhealthpollution.org but environmental influences to children's health extend far beyond SDG 3. Of the 5.9 million deaths of children under five each year, 26% are attributable to the environment, deaths which can only be prevented with multilateral action.
Children need access to clean water and sanitation to be healthy; action to address water, sanitation and hygiene issues will not only work towards the goals of SDG 6, but also prevent child deaths from diarrhoea, malnutrition and vector borne disease. Children should breathe fresh air and live pneumoniafree with clean energy for home and industrial use, the focus of SDG 7. They must be at the center of urban planning, addressed in SDG 11, as safe roads, buildings and public spaces can prevent injury and encourage healthy activity among the young. It is crucial for children's development and well-being that early toxic exposures are prevented and that SDG12 on sustainable production and consumption is achieved. Children's special vulnerability is also a great motivator for SDG 13: take urgent action to combat climate change and its impacts, as these impacts, including extreme weather and increased levels of asthma-inducing pollen and mould, are most harmful to children.
Improving children's health and reducing environmental risks are at the heart of sustainable development. Every SDG relates to an element of children's environmental health, and multisectoral collaboration has the potential to improve the lives of so many. Children's futures are the strongest motivation for all SDGs, and should inspire the multisectoral efforts that will bring about a healthier world, free of environmental hazards.

Prenatal Exposure to Particulate Matter and the Occurrence of Wheezing in the Chest in Children
Agnieszka Pac (1), Renata Majewska (1), Frederica P. Perera (2) (1) Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland (2) Columbia Center for Children's Environmental Health, Columbia University, New York, USA Corresponding author: Pac, Agnieszka Krakow, Poland agnieszka.pac@uj.edu.pl

Background
Several studies have found associations between air pollution levels and respiratory symptoms occurrence. We hypothesized that prenatal exposure to particulate matter (PM 2.5 ) may be associated with respiratory symptom (especially wheezing) occurrence in children.

Material and methods
The subjects come from the birth cohort study from Krakow, Poland. Air pollution was measured with personal samplers for PM 2.5 over a 48 hour period in the end of second trimester of pregnancy. The newborns S94 www.journalhealthpollution.org and later children were examined regularly up to 9 years of age. Parents were concerned about their child's heath, especially about symptoms related to the respiratory tract. Overall, the data for full 9 years of follow-up were available for 272 children (135 boys). The impact of PM 2.5 on the number of days of wheezing symptoms was adjusted for other known factors of respiratory diseases, using a zero-inflated Poisson regression model. Ethical approval was granted by the Bioethical Committee of the Jagiellonian University.

Results
Wheezing symptoms were present for 18.8% of children during the first year of their life, and was decreased for the next years to 4.8% for nine year olds. The risk of wheezing episodes was significantly related to PM 2.5 level during the first four years of life: during the first year incidence rate ratio =1.010; 95% confidence interval: 1.007-1.013 for 1 ug/m 3 of PM 2.5 ; and this impact was decreased to an incidence rate ratio =1.0006 (95% confidence interval: 1.0003-1.0009). Later, this impact was no longer significant.

Conclusions
Prenatal exposure to PM 2.5 pollution can lead to higher occurrence of wheezing symptoms among children. However, this association was weaker with time.

Background
In the quest to promote health and protect the environment it has been our experience that the power of youth can impact communities and the results are far reaching and sustained. In the process of working with youth from underprivileged communities we are creating future generations who can ensure a responsible society who will protect the planet and leave behind a legacy for the children of tomorrow to inherit.

Methods
The primary objective of our efforts was to promote community responsibility and action for health S95 www.journalhealthpollution.org promotion. The secondary objectives were to create self responsibility for health, focus on issues of livelihood, health and safety concerns, to promote need based social and health intervention and research, protect the environment, promote health and also to establish a network of health professionals, policy makers and the public. For the past few years we have constantly strived in this direction and have had several experiments that have yielded very positive results encouraging us to make our services widespread, accessible and affordable. The media has supported the propagation of health practices relevant for the time and needs of the specific population. All of our initiatives in communities have been followed up with impact studies and the results have been highly encouraging.

Results
Some of our activities included the setting up of twenty-one schools in three years in villages in and around Bangalore in communities where children did not have an option but to continue in the traditional sculpting profession of the elders as there were no schools in the nearby vicinity. Today an impact study reveals that 65% of the children of this village are being educated in the schools that we have built for them. We also had the local policy makers involved and today there is community responsibility for the cause of education.
The solar lighting project of the Menda Foundation has been another significant step in lighting the dark homes of underprivileged sections of society. We have installed solar panels in schools, hostels and homes of agricultural workers to ensure the safety and security of the people along with additional subsidies for parents of girls to promote the education of girls in particular. An impact study revealed a 24% increase in the admission of girls to schools. In the State of Karnataka, 800 student hostels have been lit up and 15,000 students have benefited. Girls are now spared hard work in the fields and are getting educated. Low cost toilet blocks have been put up in schools with no proper toilet facilities and girls are again back to school. A low cost sanitary napkin making machine has been set up in the Bangalore Central Prisons for the benefit of women inmates and girls and follow-up studies have shown a reduction in genitourinary tract infections by 33% in less than one year. Another project, called Asha Kiran, is about getting one child back to school at a cost borne by a donor. These are children who are in bonded labor and destitute who now have their right to education and a happy childhood restored. Youth have been motivated to conduct blood donation camps and a record 3000 units of blood are regularly collected monthly from voluntary donors -college students and youth in particular to be given free for those who cannot afford the cost. We conduct these camps in association with the blood banks who provide the logistics free of cost. We have started a program called WASH in SCHOOLS which has reduced infections significantly in children going to school where they previously never had a hand washing facility. We have raised funds for supporting dialysis costs of poor renal failure patients. We also conduct free health camps for children in schools and ensure their timely immunisation. Free midday meals are provided to children in all our schools thereby catering to their nutritional needs. We also identify exceptional talent in children and youth and promote their training in areas of their interest.
There are several other initiatives that we have undertaken and these efforts are directed to the promotion of education and literacy, provision of a clean environment, health care, nutritional support of children and the welfare of underprivileged children in particular. S96 www.journalhealthpollution.org

Conclusions
Interventions for promoting health and protecting the environment need to be issue and need based and tailored to suit particular communities. Involvement of communities in addressing the issue of health promotion and protection of environment is imperative and the results are far reaching and sustainable. The interplay of stake holders has also ensured effective services and promoted community responsibility. Involvement of youth in our community welfare programs have enabled the creation of responsible future citizens and leaders. The involvement of corporate sectors has been an added incentive for the funding of these projects. Positive significant changes in lifestyle and health practices can develop a nation of healthy and productive individuals. Accessibility to health, good nutrition, safe environment and education is everyone's right. Igniting the passion among youth to serve the underprivileged in society ensures continuity and responsibility. We intend to widen our network to involve more stake holders, NGOs and governmental agencies and reach out to the remotest areas in communities.

Background
Allergic airway disease is increasing in prevalence globally. Asthma is a global health epidemic and over 1 billion people currently suffer and this is anticipated to increase to about 4 billion in 2050. Air pollution causes 8 million deaths globally.

Methods
Over the years our objectives have been to control the symptoms of allergic disease and improve quality of life focusing on bronchoconstriction, airway hyper-responsiveness, inflammation and remodelling, the united airway concept, phenotypes and genetics. The current focus is on dietary habits to prevent airway allergies and reduce the morbidity, mortality and socioeconomic burden of these diseases.

Results
Diet plays a multifaceted role in shaping the observed world-wide trends of childhood allergies and in particular airway diseases. Sensitivity can occur by ingestion or inhalation of allergens. Both IgE and non IgE mediated immune responses and both early and late phase reactions are observed. S97 www.journalhealthpollution.org Dietary measures to prevent airway allergies are reviewed with regard to diet in pregnant mothers, breastfeeding of infants and diet. Diet in children with airway disease, dietary restrictions, and links between obesity and asthma are also addressed.
Maternal Dietary Intention: Maternal diet rich in antioxidants during pregnancy has the potential to influence postnatal susceptibility to allergic diseases by modulatory T cell response. However, strict elimination of essential foods like milk, egg etc. may have an adverse effect on maternal and fetal nutrition. Meta-analysis is not recommended at this stage. Diet of infants and Breast feeding: It is recommended to continue breast feeds for 6 months and add solids after 6 months. Emerging data suggest that early introduction of allergic foods may reduce the risk of food allergy.
Diet for Allergic Children: Diet rich in antioxidants like fruits, vegetables, vitamins, curds, butter, fish and Omega 3 fatty acids and home-made food is recommended Diet to be avoided in allergic children: Salty food snacks, take away food consumption, and soft drinks containing preservatives or colorants.
Obesity and Asthma: Obesity is increasing in India. Between, 2002-2011 it increased from 15-20% in boys and 13.7-18.1% in girls. Decreased lung function is proportionately related to obesity. Asthmatic children should reduce the intake of gas producing food items like asparagus, broccoli, cabbage, garlic, melons, peppers, radish, cauliflower, cucumbers, raw onions, beans etc.

Conclusions
Epidemiology and tradition strongly suggest the association of nutrition and airway allergy, but we lack robust scientific data to make national policy. Traditional local food habits should be encouraged along with disease guidelines to be followed to manage disease and costs can be cut by two thirds. For better compliance, links between patients, parents and other health providers is essential as well as science to progress the link between practitioners, academicians, researches and pharmaceutical companies. S98 www.journalhealthpollution.org

Background
Cough is a reflex response to mechanical, inflammatory or chemical irritation of the respiratory tract predominantly and also a social signal as well. Depending on duration, cough may be considered to be chronic if it lasts at least 2 to 8 weeks. The present study considered cough to be chronic if it lasted more than two weeks.
Chronic cough has a tremendous socio-economic impact on children. It produces sleep disturbance, exhaustion, nausea, vomiting, urinary incontinence, rectal prolapse, fecal soiling, subconjunctival hemorrhage, hernia, cerebral hypoxic encephalopathy, and cough syncope. Parents often feel frustrated, upset, helpless and may experience sleepless nights and financial burden. In the present study, 80% of children had five consultations for cough.

Methods
The aim of our study is to determine the prevalence and spectrum of chronic cough and to correlate our findings with earlier data and city demographic changes.
We analysed 510 patients referred for pulmonary problems between Jan 2015 to March 2016. Among these patients, 106 patients came just for cough over 2 weeks duration. A detailed history including environmental history, clinical examination and laboratory testings, imaging, pulmonary function were performed as needed according to clinical judgement and patient capacity to perform pulmonary function testing.

Results
The prevalence of chronic cough was 105 out of 510 cases (20.78%). Wet cough and night/early morning cough were present in 80% and 84% of cases, respectively. The majority were due to allergic rhinosinusitis and asthma, and 3 cases each of bronchiectasis, pertussis, and psychogenic origin.
In 1999, the prevalence of chronic cough was 8%, and this has risen to 20.78%. In 2010, the prevalence of chronic cough was reported to be 10.5%. The population in Bangalore was 2.92 million in 1981, and had risen to 8.5 million in 2011. Traffic congestion has also increased. A total of 1,600 vehicles are added every day. A road length of 13,000 km would be needed to park all vehicles bumper to bumper. Vehicle now average 9.6 km per hour. Slow vehicles emit 5.5 times more emissions than vehicles moving at 70 km/hr. In summer there is greater production of ozone, slow wind velocity, and higher automobile emissions. Air pollution produces oxidative stress on airways, causing smooth muscle contraction, S99 www.journalhealthpollution.org epithelial damage, altered release of inflammatory mediators and produces hyper-reactive airways and chronic cough.

Discussion
The prevalence of chronic cough in children was 8% in 1999 and has increased to 20.78%. A community survey by same group in the year 2010 on point prevalence of chronic cough was 10.5%. The Bangalore city population was 2.92 million in the year 1981 it was increased to 8.5 million in the year 2011.
Traffic congestion is increased. There were 5,875,237 vehicles in Oct 2015. Of these, 406,456 are two wheelers, 11,44,196 are cars, and 569,579 are buses. Now we add 1,600 new vehicles every single day. Previously, from 2009-2010, there were 600 vehicles per day. We would need 13,000 km length of roads to park our vehicles bumper to bumper. The speed of vehicles now is 9.6 km per hour.
Slow vehicles emit 5½ times more emissions to the atmosphere than vehicles at 70 Km/hr speed. In summer time there is greater production of ozone in bright sun, slow wind velocity and higher automobile emission. Air pollution produces oxidative stress on airways causing airway smooth muscle contraction, epithelial damage, excess mucus production, decreased ciliary movement, increased permeability of vessels, altered release of inflammatory mediators and airway hyper-reactivity and chronic cough.

Conclusions
Rapid urbanization and demographic changes have increased the number of slow moving vehicles, with greater emissions producing oxidative stress and airway hyper-reactivity, leading to chronic cough. Chronic cough has increased from 8% to 20.78% over a period of 17 years. Along with proper medications, measures to mitigate air pollution should be taken with all stakeholders.

Background
Therapeutic advances in pediatric oncology have led to an increase the number of childhood cancers survivors (CCSs). Emerging evidence shows that CCSs experience long-term morbidity due to their cancer therapy (and the cancer itself). The Spain-CCSS (Spanish Childhood Cancer Survivors Study) aims to set up a childhood cancer survivor's cohort in Spain in order to join international efforts for studying long term health effects among this population and optimise treatment and follow-up.

Methods
CCSs treated between 1980 and 2009 in the pediatric hemato-oncology department of Hospital Sant Joan de Deu in Barcelona (one of the largest in Spain) were invited, via mail services and by phone call, to participate in the study and to complete a health status questionnaire (HSQ). Recruitment, disease validation and retrospective record collection (treatment) are still ongoing. Ethical approval was granted by the ethical committees of Hospital Sant Joan de Dèu and Parc de Salut Mar.

Results
Of over 1568 individuals who survived more than 5 years, 536 (34%) consented to participate (509 returned a complete HSQ), 83 (5%) were not alive at the time of the questionnaire, 480 (30%) could not be traced, and 140 (6%) refused to participate. We are still waiting for a response from 340 (30%) participants.

Conclusions
Though more effort is needed to increase the participation rate, this cohort is an important source of information on different health outcomes among CCSs. S101 www.journalhealthpollution.org

Cognitive Effects After Low-to Moderate Dose Exposure: Study Plan in a Cohort of Childhood Cancer Survivors
Elisa Pasqual (1,2,3 However, the effect of low dose radiotherapy (such as the scatter radiation that is absorbed by the brain when radiotherapy is delivered in another anatomical region) still needs to be clarified and more research is warranted in this area.

Methods
We are planning to evaluate the neuro cognitive profile in a cohort of childhood cancer survivors who received a dose below 5 mGy to the brain. Brain tumor survivors will be excluded in order to avoid confounding due to the cancer itself. Function will be assessed in different cognitive domains (intelligence, executive function, processing speed, memory, attention and executive function among others) and the score of each test will be correlated with the dose absorbed in different anatomical brain structures (with matter, hippocampus, temporal lobe, frontal lobe and posterior fossa) as estimated from medical records. We haven't yet submitted the protocol to an ethics committee, as we are still designing the study.

Results
Assuming that around 40% of survivors did not received radiotherapy, 35% received a dose below 1 Gy and 5% between 1 and 5 Gy (de Valthaire personal communication) and assuming a 4 point difference in the test score (average 100, standard deviation 15) between dose groups, we expect to have 80% power to find a trend among those three groups with around 100 participants. To reach 80% power to find a 4 point difference between the group who did not receive RT and the ones who received a dose below 1 Gy, we would need around 500 patients.

Conclusions
It appears to be feasible -and informative for radiation protection -to study cognitive effects due to low-to moderate doses of radiation in a cohort of childhood cancer survivors. S102 www.journalhealthpollution.org

Jamie Pearce
Centre for Research on Environment, Society and Health, University of Edinburgh, Edinburgh, United Kingdom Corresponding author: Pearce, Jamie Edinburgh, UK Jamie.Pearce@ed.ac.uk

Background
Point of sale displays are one of the most important forms of tobacco marketing still permitted in many countries. Point of sale displays have been shown to increase susceptibility to smoking, experimentation and initiation into smoking, particularly amongst adolescents. These displays may also influence perceived prevalence of smoking and the perception that tobacco products are easily obtained and are a 'normal' product.

Methods
This study examines the impact of the implementation of both a partial and comprehensive ban on point of sale tobacco advertising on attitudes to smoking, brand awareness, perceived ease of access to tobacco products and youth smoking prevalence. The study has a multi-modal before and after design and uses mixed methods to collect data, at baseline and then with longitudinal follow-up for 4 years, in four purposively selected communities. In each of the four communities (school catchment areas), at baseline and in follow-up years, data collection includes: mapping and spatial analyses of tobacco retail outlets; tobacco advertising and marketing audits of tobacco retail outlets most used by young people; cross-sectional school surveys of secondary school pupils; and focus group interviews with purposive samples of secondary school pupils. The tobacco audit is supplemented by interviews and observations conducted with a panel of tobacco retailers recruited from four matched communities.

Results
The results to be presented from the initial phases of data collection consider: the changing levels of point of sale exposure over the study period; the degree of compliance with the new legislation post implementation; connections between point of sale displays and young people's brand awareness; the emergence of e-cigarette marketing; and the connections between e-cigarette/cigarette marketing and e-cigarette use amongst young people.

Conclusions
The results will be of considerable interest to policy makers both from the UK and other jurisdictions where they are considering the development and implementation of similar legislation.

Background
Poor mental health in childhood has implications for health, wellbeing, and productivity in later life, as well as presenting a considerable burden for families and wider society. Independent play is a crucial part of 4-6 year olds' social, emotional and behavioural development. We investigate whether total natural space, public parks and access to a private gardens enhance children's social, emotional and behavioural development.

Methods
We analysed longitudinal data for 2,909 urban-dwelling children (aged 4 at 2008/9 baseline) from the Growing Up in Scotland survey. Social, emotional and behavioural difficulties were scored using the Strengths and Difficulties Questionnaire (divided into four domains), and area (%) of total natural space and parks within 500 m of the child's home was quantified using Scotland's Greenspace Map. Access to a private garden was captured at the household level. We ran repeated-measures multilevel models, then stratified by sex or household educational attainment.

Results
Prosocial behaviour scores were higher (i.e., better) throughout for children with more total natural space, but neighbourhood natural space was unrelated to change over time of any Strengths and Difficulties Questionnaire domain. Boys and girls in neighbourhoods with more total and park space, respectively, had fewer problems. Better social outcomes were found for all groups with more neighbourhood natural space. Having access to a garden was related to the largest benefits for all except those from high education households. Having access to a garden was related to mental health benefits on a par with the advantage apparent for girls over boys, children from degree-educated households over those from households without educational qualifications, or a £20,000 to £50,000 increase in equivalised household income.

Conclusions
Neighbourhood natural space may reduce social, emotional and behavioural difficulties for 4 to 6 year olds, but private garden access may be most beneficial. S104 www.journalhealthpollution.org

Background
Proper hydration is important for maintaining homeostasis in all physiological processes and to avoid some diseases. Some reports have suggested that 87.5% of males and 65.4% of females have water intake below the recommendations. In children, there is a lack of information about hydration habits. This study was aimed to assess modifiable factors related to low water intake in a Mexican sample of adolescents and children.

Methods
A cross sectional study was performed. Cardiovascular risk factors were determined (overweight, obesity, abdominal obesity). Physical activity (frequency and type) and dietetic habits such times of eating per day were assessed. Statistics were performed using SPSS Version 22.0. Ethical approval was granted by Ethics Committee and Research from Mexican School of Medicine, Univesity La Salle.

Results
247 children and adolescents were included; the average age was 12.5±1.9 years old and boys made up 54.91% of the sample.. The global prevalence of overweight and obesity was 49.2%. The daily intake of water, including foods, was 1317.5 ± 648.8 ml, with no differences between boys and girls or according to the presence of cardiovascular risk factors. Only 12.1% reach the recommendations of water intake according to Mexican recommendations. Also, water intake was not different between those who practice any physical activity more than 3 days per week compared with those physically actives (1163.3±571.3 vs 1339.6±697.9, respectively; p=0.181) and considering the type of activity (aerobic or anaerobic; p>0.05). According to times of eating, those who eat less than 3 times per day reported lower water intake (778.6±477.2 vs 1342.0±688.0; p=0.033) lunch and the afternoon snack being most important, and seem to risk of not accomplishing the recommendations (odds ratio=1.148 (1.093-1.206).

Conclusions
There is a high prevalence of cardiovascular risk factors among Mexican adolescents. Low water consumption was reported in this population and it seemed not to be related to anthropometric indicators, suggesting that environmental factors such number of meals could be more important than nutritional status or the practice of physical activity.

Background
The Next Generation Study is a new prospective birth cohort initiated as a collaborative project of Masaryk University and the University Hospital in Brno, Czech Republic. The study is designed to follow up 7000 children from their prenatal period to adolescence with the aim of assessing multiple factors potentially affecting children's health (exposome factors).

Methods
Special attention is being paid to prenatal and early postnatal developmental abnormities, postnatal psychomotor development, neurobehavioral disorders and immune system disorders. Information on complex exposures will be based on on-line versions of a combination of validated on-line questionnaires and biological tissue analyses will be used to estimate complex exposures. Information on health outcomes will be taken from the psychomotor developmental screening questionnaires, medical records, and health registers. Ethical approval was granted by The University Hospital Brno.

Results
The Next Generation Study was initiated in April 2015 with a three-stage pilot. Feasibility of the cord blood sample collection and processing protocol was assessed at the first stage on 100 mother-child pairs. The aim of the second stage was to evaluate feasibility of the protocol for recruitment of women in the 38th week of pregnancy. That allowed for estimation of future study response rates. Samples of venous blood, urine, and saliva were collected from 150 participating mothers, and stool and saliva were taken from newborns in addition to cord blood samples. On-line versions of the self-reported questionnaires will be tested at the third stage (scheduled to start in August 2016) together with robustness of the IT systems.
A majority of the approached mothers was willing to participate in the Next Generation pilot study (90% of mothers were willing to donate venous blood in 38th week of pregnancy, 70% agreed to donate cord blood, to fill the questionnaire and provide health data). The sample collection and processing Background Substantial attention has been paid in recent years to the impact of environmental factors on child development. The objective of this study was to evaluate the association between maternal lifestyle factors and child neurodevelopment.

Methods
The current analysis included mother-child pairs from the Polish Mother and Child Cohort study (REPRO_PL). The following factors related to maternal lifestyle were considered: smoking (based on cotinine level), phthalate exposure based on their metabolite levels in urine, microelements levels in maternal and cord blood, alcohol consumption, leisure-time physical activity and stress in pregnancy, pre-pregnancy body mass index and folic acid supplementation based on questionnaire data. Psychomotor development was assessed in children at the ages of one and two by the Bayley Scales of Infant and Toddler Development. Ethical approval was granted by the Ethical Committee of the Nofer Institute of Occupational Medicine, Łódź, Poland and written consent was obtained from all subjects. S107 www.journalhealthpollution.org

Results
A significant association was observed between prenatal exposure to tobacco constituents and decreased child motor development in assessments performed at both ages (β=−0.8, p=0.01; β=−1.4, p=0.001). Child motor development was also inversely associated with natural log concentrations of most of the phthalate metabolites (p<0.05). Maternal pre-pregnancy underweight was associated with decreased child language abilities (β=−5.2, p=0.01). Negative impact on child cognitive development at the age of two was observed for the Perceived Stress Scale (β=-0.8, p=0.01) and the Social Readjustment Rating Scale (β=-0.4, p=0.03). The recommended level of leisure-time physical activity during pregnancy was beneficial for child language development (β=4.8, p=0.02). Finally, a positive association between selenium levels in pregnancy and motor development (β=0.2, p=0.002) at one year of age and language development (β=0.2, p=0.03) at two years of age was observed. For alcohol and folic acid there were no significant associations with any of the analyzed domains of child neurodevelopment.

Conclusions
These results underscore the importance of policies and public health interventions promoting healthy lifestyle among women in reproductive age and during pregnancy. The objective of the present study was to evaluate the effect of different prenatal exposure assessment approaches on reproductive outcomes.

Methods
In the Emilia-Romagna region (Northern Italy) two independent studies (Moniter and Sinatra projects) were conducted on air pollution and several reproductive outcomes. The first assessed the residential exposure to incinerator pollution of mothers living in areas next to plants; the latter considered different factors of environmental pressure in an urban-industrial city (Ravenna). Each newborn was georeferenced and characterized by a specific level of exposure emissions, and categorized in quartiles of PM 10 . Modeling approaches were adopted for exposure assessment, namely an ADMS-Urban dispersion model for each type of environmental determinant, to account for both spatial (residential street number) and temporal (monthly simulations) variability of exposure. Both studies showed statistical associations only with preterm births. Analyses were repeated considering poorest indicators of exposure, to verify the influence of exposure assessment approach on final results.

Results
Considering the best method of exposure (spatio-temporal variability of air-pollution), both studies showed a significant association between preterm births (PTB) and exposure to incinerators and port activities. The exclusion or an inadequate assessment of the temporal variability of the exposure led to a reduction of the associations and loss of statistical significance in RRs (from 1.30: CI95% 1.08-1.57 to 1.02: CI95% 0.88; 1.25 and from 1.52: CI95% 1.01-2.29 to 1.01: CI95% 0.66-1.55) respectively, considering the highest versus the lowest level of exposure.

Conclusions
Air pollution from industrial sources is associated with PTB. Our experience confirms the need of exposure models capable of capturing both the spatial and temporal variability of air pollution exposures, in order to be able to detect associations with birth outcomes.

Background
Air pollution is estimated to cause around 800 deaths in children under 5 years of age in low-and middle-income countries of the Americas. Although it is not the worst scenario compared to regions like S109 www.journalhealthpollution.org Africa or the Eastern Mediterranean region, this rate may be underestimated because environmental awareness and air pollution monitoring are extremely scarce, even in middle-income countries like Brazil.

Methods
A quick review of children's environmental health in Brazil is presented, highlighting some issues regarding risk awareness and current environmental threats.

Results
Around 19 million people use biomass for cooking or heating purposes in Brazil, and the country has one of the highest rates of pediatric asthma as evidenced in worldwide epidemiologic studies. The lack of awareness about children's environmental health in low-and middle-income countries is not exclusive to air pollution: children's access to unsafe water, the emergence of vector-borne diseases (like the triad Zika / Dengue / Chikungunya viruses), manmade disasters, and unsafe buildings in landslide areas are problems that occur frequently, mostly due to the lack of proper risk perception. Another example is the fact that Brazil has led the use of pesticides in the world since 2008 and yet concerns about children's ingestion of pesticides are rare. Efforts to increase awareness (not only about air pollution) are urgently needed, not only in Brazil, but probably in most low-and middle-income countries. On the other hand, children's exposure to indoor pollution due to second-hand tobacco smoke has been reduced consistently in Brazil over the last 2 decades, after a strong action of all stakeholders and a long-lasting governmental campaign. This successful case shows that it is indeed possible to increase awareness about other children's environmental health issues as long as all players work together.

Conclusions
In an effort to collect data, help policy makers, increase research possibilities, and create training programs for health workers, the WHO has recently created a Collaborating Center for Children's Environmental Health in the South of Brazil with the goal of helping improve this scenario.

Background
Due to their unique characteristics, children are more vulnerable to environmental hazards than adults. The environment is responsible for one third of the global burden of disease in children, but there is a lack of proper awareness of such risks in many countries. S110 www.journalhealthpollution.org

Methods
To highlight the current state of environmental pediatric training in Brazil, and describe ongoing strategies to address problems.

Results
The environmental burden of disease in children is not equally distributed throughout the world: the heaviest burden lies in low-and middle-income countries. To prevent, assess and treat environmental problems, it is essential to understand the hazards and physiologic characteristics particular to children. Unfortunately, many pediatricians still lack knowledge and awareness regarding environmental health issues in low-and middle-income countries. In Brazil, for example, 79% of pediatricians have never received any kind of training regarding children's environmental health. Only 17% declared they knew about the risks of lead intoxication in children, a concern included long ago in the routine pediatric care in developed countries.
In Brazil, the inclusion of children's environmental health in the pediatric curricula during residency is rare. Pediatric departments of universities lack specific divisions or even pediatricians able to share information and promote environmental health. The Brazilian Society of Pediatrics is the third largest in the world, with 22.000 affiliates. It has 33 different departments, but no one dedicated to children's environmental health (although some of them are in related areas, like toxicology).

Conclusions
The pediatric curricula in residency programs in Brazil have a giant gap that urgently needs to be fixed. To help with this, the WHO and the Collaborating Center for children's environmental health in the south of Brazil are working to disseminate training programs in the country, based on 29 training modules developed by the WHO and translated into Portuguese by the Collaborating Center. In addition, partnerships with governmental administrators and pediatrics societies are being established. The subject was formally introduced in some post-graduate and residency programs in the south of Brazil.

Background
It has long been known that a number of infective agents have the capacity to induce severe cerebral S111 www.journalhealthpollution.org lesions in fetuses of women infected during the first months of pregnancy, but this was considered to be a rather rare event, under the influence of several environmental conditions. During the last few years, the Zika virus, known for decades as an agent of a very mild disease, has for the first time rapidly spread across Central and South America. Some months ago an international alarm ("Public Health Emergency of International Concern") was created under the hypothesis that this virus could be the cause of a large epidemic (thousands of cases) of cerebral malformations and microcephalia in Brazil. This WHO declaration has had enormous environmental and economic consequences worldwide.

Methods
We summarize the scientific literature (and the daily contributions of health authorities and of "experts" in the media reports) available on the issue of the Brazilian "epidemic" of microcephaly which could be caused by the Zika virus.

Results
According to available data, after one year from the beginning of the "epidemic", three things can be said: 1) in Brazil the number of cases of craniostenosis confirmed from September 2015 up to the present is not higher than the incidence expected on the basis of international global epidemiology. 2) in Brazil more than 80% of these cases of microcephalia were registered in a few states in the northeast of the country, where peaks of this malformation were also registered several years before the appearance of the Zika virus. At the same time, no cases were reported in the western or southern states of the country where Zika virus infection has the highest incidence.
3) in none of the more than 60 other countries around the world in which the Zika virus is epidemiologically active has there been a reported increase in the incidence of microcephalia.

Conclusions
These data suggest that in Brazil there is no link between the Zika virus and an "epidemic" of microcephalia. If this is the case, then the "scientific medical community" should discuss why, at least sometimes, an unjustified "burden" can arise from causes outside of a scientific rationale.

Background
Endocrine disruptors (EDs) are chemicals compounds that send confusing messages causing various dysfunctions by mimicking or altering the effect of hormones in the human body. Several EDs such as bisphenol A, phthalates, organotins, among others are involved in obesity and diabetes diseases in children. Recent studies have shown evidences that these chemicals can cross the placental barrier making fetal exposure closely related to maternal exposure. The aim of this research is to establish and detect early fetal exposure to different EDs.

Methods
To address this issue, recently, a human biomonitoring campaign in a cohort of pregnant women has begun, in order to predict the ED mothers' intake and also the dose of ED at which the child has been exposed in the early stage of the development. The data obtained from this cohort (biological levels of EDs and results from questionnaires regarding food frequency intake, habits, and lifestyles) will be implemented into the physiological based pharmacokinetic model. For the physiological based pharmacokinetic model development and parameterization, data from literature were used. Approval of the hospital ethical committee was received.

Results
Regarding the human biomonitoring campaign, complete data are expected to be analyzed by April 2018. Development of PBPK models and parameterisation for selected EDs are in progress. Initial validation of these models is performed using literature data. Biomonitoring data obtained during this study will be cross validated and further analysed to understand early fetal exposure of selected EDs.

Conclusions
The integration of the data obtained from current on-going human biomonitoring campaign and the physiological based pharmacokinetic model, here developed, will predict the prenatal early exposure of the child/foetus to EDs. This work is included in the frame of HEALS project (FP7-603946). S113 www.journalhealthpollution.org

Background
Evidence of associations between exposure to ambient particulate matter (PM) and cardiovascular and respiratory diseases has being widely reported. In recent years, in addition to PM 10 and PM 2.5 (particle having a diameter of less than 10 and 2.5 μm, respectively), other smaller fractions such as PM 1 and "ultrafine" particles (PM 0.1 ) become more relevant in the literature due to their capacity to deposit deeper in the respiratory tract. With a changing lifestyle, children, same as adults, spend most of their time in indoors (mainly in school and homes). However compared to adults, children are more susceptible to air pollutants. The aim of this study is to characterize the composition of indoor PM fractions at schools and validate with an indoor air quality model.

Methods
Indoor and outdoor samples of PM 10 , PM 2.5 , PM 1 and PM 0.25 were collected in different schools close to one of the largest industrial complexes of southern Europe located in Tarragona (Northeast Spain). Using AERMOD, an air dispersion model, schools were selected from the most impacted by industrial (chemical and petrochemical) and harbor emissions. PM fraction levels were measured in both the indoor and outdoor environment of schools using two different samplers, high volume samplers and cascade impactors for outdoor and indoor air, respectively. Chemical characterization was carried out by analyzing elements and ions content. In addition, electron microscope analyses were done in order to assess the morphology of different particles fractions. In order to establish the amount of particles coming from ambient air to inside the schools, an indoor air quality simulation model (IAQX 1.1) was applied. This model takes into account building parameters such as ventilation rates and room volumes in order to calculate the infiltration of outdoor particles to indoor compartments. Sensitivity analysis and calibration with real data were applied. S114 www.journalhealthpollution.org

Results
Despite the absence of indoor PM sources, indoor PM levels were higher than outdoor. The gym was the environment where highest levels of PM were reached. These results are related with the phenomena of resuspension. For that reason, the lack of a module to introduce resuspension is the main limitation of indoor air quality simulation. As a result, modelled indoor PM levels were about 10% of actual levels. To correct this, resuspension was introduced into the model as an indoor source, having thus a higher similitude between modelled and measured PM levels. Chemical characterization of outdoor PM show a higher contribution from every component in PM 2.5 fraction, except for Secondary inorganic aerosols Regarding morphology, four main types of particles were found in our samples: fly ash, mineral, soot and undetermined.

Conclusions
Higher levels of PM were experienced in indoor environments, mainly by the effect of resuspension. IAQX model results are improved by taking into account the phenomena of resuspension as an indoor particle source. Characterization of outdoor PM shows that playgrounds could act as a source of fine mineral matter. Future research with more samples is needed to improve the present results. This work is in the framework of the Ultrapar project (Spanish Ministry) and HEALS project (7FP European Union).

Background
With the changing lifestyle in developed countries, children are spending more than 80% of their time indoors. Pollutants levels, as well as emission sources, could be different between inside and outside buildings and change across heterogeneous indoor environments. Children are one of the most vulnerable population groups to environmental pollutants, including particulate matter (PM). In a previous study we measured several fractions of indoor PM ("coarse" (PM 10 -PM 2.5 ), "fine" (PM 2.5 -PM 0.25 ) and "quasi-ultrafine" (PM 0.25 )) in several schools. These schools are in a highly impacted area of the largest petrochemical industrial complex in southern Europe, located in Tarragona (Northeast Spain). The S115 www.journalhealthpollution.org aim of the present study is to provide an advanced risk assessment of PMs in a vulnerable population cohort by: 1) characterizing the PM exposure of children in schools impacted by industrial emission in Tarragona; and 2) assessing of primary toxicity of these particle fractions through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium Bromide assay with epithelial alveolar cell. Mechanistic exposure models can provide a valuable insight that considers human variability for risk assessment.

Methods
The exposure model applied was a respiratory tract dosimetry model that evaluates the dose retained in the different parts of the human respiratory tract (Multiple-Path Particle Dosimetry Model). This exposure model takes into account the parameters affecting human exposure to particles such as PM concentration and size, and activity patterns of children in different environments (indoors and outdoors). The activity patterns of children were assessed using time use surveys and physical activity questionnaires. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays with human pulmonary alveolar cells were conducted to evaluate the viability of exposed cells to PM collected in the schools.

Results
A total mass of 198 µg was retained daily by children in the respiratory tract as a whole. More than half of this mass was retained in the head region. Maximum deposition fractions for every PM fraction were reached in this region. Similar mass of PM was contained in tracheobronchial (41.1 µg) and pulmonary (37.5 µg) regions. However, most of the mass found in the tracheobronchial region is composed of PM 10-2.5 , while deposition in lungs consists almost exclusively of PM 2.5-0.25 and PM 0.25 . Since most of the particles reaching the alveolar region were the fractions PM 0.25 and PM 2.5-0.25 , we performed the cytotoxicity assay for these two fractions. At low doses, PM 0.25 show greater toxicity, while doses equal or higher than 50 µg/mL exhibit similar damage for both fractions.

Conclusions
The approach here described provides a framework for evaluating of PM exposure and toxicology. Principal advantages of this methodology are the ability of working with different microenvironments, activities, and population collectives, instead of using only PM levels in one environment (usually outdoor) and physiological parameters of one population group (usually adult males). This methodology also provides a powerful tool to join toxicological assays with real PM exposures. This work is in the framework of the Ultrapar project (Spanish Ministry) and HEALS project (7FP European Union). S116 www.journalhealthpollution.org

Methods
The study incorporated ambient air particulate matter (PM) sampling in several sites, as well as chemical analysis of PAHs and levoglucosan, as the most specific tracer of biomass combustion. External exposure was estimated accounting for PAHs concentration variability among the various locations and the use of personal sensors providing information on location, temperature and intensity of activity. Internal exposure to PAHs was estimated taking into account the deposition of the respective PM fractions across the human respiratory tract and the respective PAHs concentration of the respective PM fractions. Deposition at different regions of the human respiratory tract was estimated using the Multiple-Path Particle Dosimetry model. Potential cancer risk due to exposure to the mixture of urban ambient air PAHs was calculated using the toxicity equivalence factor approach using as basis the benzo(a)pyrene cancer potency. Cancer risk was estimated from the integral of the toxic equivalent quotient of the different size of PM deposited daily across different human respiratory tract regions, by a slope-factor equal to 0.25·10 -6 ng/kg body weight/day) function, initially derived by the benzo(a)pyrene Inhalation Unit Risk (equal to 0.88·10 -6 (ng/m 3 ) -1 ).
This refined exposure and risk characterization methodology allowed us to identify significant differences experienced by the different age group, as well as people living in different areas within an urban agglomeration.

Results
The human respiratory tract deposition results indicated that the lower respiratory tract of infants and S117 www.journalhealthpollution.org children (up to 14 years old) can retain up to 74% higher mass fraction of PM 1 particles than that of adults. The maximum difference in the thoracic deposition between adults and children (referring to children between 3 and 8 years old) is that of 68% and 230% for the PM 2.5-1 and PM 10-2.5 fractions respectively. Thus, the PM 2.5 and PM 1 fractions rather than PM 10 contribute to a greater extent to the absorption of PAHs by the respiratory tract in younger individuals compared to adults. The estimated lung cancer risk was above 10-6 for the areas affected by biomass combustion. Age dependent differences in the estimated risk were mainly attributed to the respiratory physiology differences and the increased intensity of activity characterizing children, favoring the deposition of smaller (and more toxic particles) in children. In addition, biomass emitted particles were found to be more toxic (in terms of PAHs content) than the ones emitted from traffic sources.

Conclusions
Age dependent differences in human physiology, combined with the increased intensity of activity characterizing children, resulted in 2-3 times higher risk estimates from exposure to PAHs compared to adults.

Methods
The current study aims at a comprehensive exposure analysis of BPA, using an integrated exposure modelling framework that comprises far field and near field exposure modelling coupled to a dynamic S118 www.journalhealthpollution.org lifetime physiologically based pharmacokinetic model. Exposure analysis was applied in European data, largely based on literature review of BPA food residues, as well as exposure reconstruction of human biomonitoring data. The latter were further assimilated through an advanced exposure reconstruction modelling framework. Special attention was paid to the assessment of BPA internal exposure through critical developmental stages such as gestation, by modelling the mother-fetus toxicokinetic interaction.

Results
The analysis indicated that current exposure levels in Europe are below the temporary tolerable daily intake of 4 μg/kg body weight/day proposed by the European Food Safety Authority. For chemicals with widespread consumer applications such as BPA, environmental pathways contribute insignificantly to BPA intake, while overall exposure is dominated by specific consumer behaviors. For BPA these pertain to consumption of canned food and beverages and the use of medical products found in neonatal intensive care units, such as bags containing intravenous fluids and total parenteral nutrition and tubing associated with their administration. Premature neonates hosted in intensive care units have also been also identified as the only population group that potentially faces some risk related to BPA exposure, especially when accounting for the immaturity of the detoxification pathway. In principle, health risks might be underestimated for specific population groups (e.g. neonates and infants) if the assessment does not take into account the variability in internal exposure due to genetic, physiological and developmental factors. In utero exposure was found to be highly associated to maternal exposure; actual fetal exposure was higher than maternal exposure by almost 20% due to the presence of βglucuronidase in the placenta. Nevertheless, at the current levels of maternal exposure to BPA, in utero exposure is also very low, and significantly below the respective biologically effective dose derived from the European Food Safety Authority temporary tolerable daily intake.
Exposure reconstruction of literature available on human biomonitoring data resulted in very low intake estimates, similar to the ones estimated from the exposure models. Using biological pathway altering dose derived from in vitro BPA toxicity assessment as the internal exposure reference value, the maximum derived internal exposure values of the worst-case exposure scenarios (premature neonates) are 10 times lower to the lower 99th percentile of the Biological Pathway Activating dose, indicating that there is no reason for concern for individual or aggregate scenarios of BPA exposure.

Conclusions
In addition, the use of the internal dosimetry module allowed the translation of the European Food Safety Authority temporary tolerable daily intake into a biomonitoring equivalent urinary BPA-Glu concentration of320 μg/L. Comparison of this value to the collected biomonitoring data shows that the current existing levels of BPA in EU are 2 orders of magnitude below the European Food Safety Authority temporary tolerable daily intake; this margin of safety is in the same magnitude of order to the one estimated when daily intake is estimated from human biomonitoring data. S119 www.journalhealthpollution.org

Background
Assessment of the health impacts (e.g. cancer, neurodevelopmental disorders and congenital anomalies) related to hazardous waste is an emerging scientific challenge with multiple societal implications. Most studies on the links between hazardous waste and health are based on proxies of exposure to wasterelated toxicants. They do not provide established mechanistic links between environmental exposure and disease burden prohibiting the exploration of cost-effective waste management options.

Methods
The exposome paradigm embraces dynamic interactions between environmental and endogenous exposures and genetic expression in humans, with a special focus on early developmental stages that have been proven determining for later life health status. Thus, it provides a novel tool for holistic hazardous waste management taking into account their adverse effects on children's health. Waste streams are associated with a broad range of contaminants, such as PCDDs and PCDFs, toxic metals (Cd, As, Cr(VI), Hg), VOCs, PAHs, H 2 S, particulate matter, CH4, pesticides, phthalates, and PCBs. All of these compounds form a complex mixture of highly variable composition in space and time-accounting for differences in multimedia environmental transfer, persistence and bioaccumulation among the mixture components-to which children are exposed through multiple pathways and routes. Waste streams and the related contamination of environmental media are not viewed in isolation, but rather as components of the expotype, the vector of exposures an individual is exposed to over time.
An array of sensors including in situ systems for regulatory monitoring of environmental media, remote and personal sensors and human biomonitoring were used to provide the data necessary for determining the external exposome associated with hazardous waste contamination. Advanced data and model fusion algorithms were designed to integrate functionally integrate these different environmental datasets taking into account and adequately filling data gaps in space and time. External exposures were translated into internal dose through the use of physiology-based biokinetic models and they were assimilated with the biomonitoring data. Biological perturbations were identified through the use of multi-omics technologies. According to our paradigm, starting from untargeted transcriptomics and metabolomics we proceed with joint analysis of biological processes induced by exposure to wasterelated xenobiotics at the molecular level and of metabolic processes induced in parallel. Dynamic flux balance analysis is used to jointly interpret gene expression data and metabolite profiles. Thus putative pathways of toxicity are identified; they need to be verified by targeted multi-omics and functional assays to confirm the causal association of waste components with adverse health outcomes. Advanced bioinformatics deep learning algorithms allow us to identify the functional links among the data derived from high throughput testing platforms and disease phenotypes providing phenotypic anchoring of the mechanistic hypotheses made earlier. Waste management practices are thus assessed with regard to their effects on children's health at the individual and community level, taking into account intra-subject variability.

Results
The health risk associated with exposure to potential contaminants from recycling waste streams and recycled waste processing under normal and accidental conditions was assessed. Experimental data were obtained for the case of a disastrous fire at the waste recycling facility in Aspropyrgos, Greece. Based on agnostic metabolome analysis, inhibition of de novo fatty acid biosynthesis was manifested by down-regulation of acetyl-CoA, malonyl-CoA, palmitoyl-CoA metabolites and related mRNA levels. Results strongly support the important role of the AhR in mediating the metabolic effects seen following PCDDs/PCDFs exposure. This additional evidence on the AhR perturbation, allowed the use of the wellestablished slope factor for TCDDs and to translate this into an internal exposure slope factor. The latter was used to estimate risk for the exposed and the non-exposed population. The risk of chronic exposure was estimated (mean value) equal to 2.57·10 -7 , while the exposed population risk (mean value) was up to 2.91·10 -7 . The respective risk is expected to be higher for neonates (almost 20%) and even higher for neonates that are also breast fed (up to 32%).

Conclusions
There is sufficient evidence that the various waste management options contribute to potential health effects; yet it is obvious that a more systematic approach is required. Exposome research proposes a paradigm shift that goes far beyond the proxy of exposure and macroscopic health effects association, enhancing our understanding of (a) the type of compounds released from the waste management sites, (b) the environmental fate of these compounds, (c) how population space-time lines cross with the space-time lines of these compounds and (d) the effects at the multiple biological organization levels as a result of this cross.

Methods
Since 2006, the Pediatric Environmental Health Specialty Unit of the Hospital Clínico Universitario Virgen de la Arrixaca has worked along with Colegio San Jorge (Murcia) to promote school environmental health by developing knowledge and maintained goals/concerns that allow us to carry out and implement concrete activities in schools.
The first step was to have the approval and commitment of the school administration to free a professor for a couple hours a month to carry out these tasks. Subsequently, a complete environmental diagnosis of the school was completed in order to understand the strengths and weaknesses of the environment of the school. Once completed, the goals were developed, two of which were implemented and one which will be implemented next year.

Results
1st Goal -Tobacco: Identification of the prevalence of smoking at school, awareness activities, ephemeris celebrations (global day without tobacco), and group therapies of tobacco dishabituation for professors and parents of students.
2nd Goal -Ultraviolet Radiation: Including a hat for the school uniform, choosing a time during the year least hot for the most exhaustive physical activity, as well as organizing schedules so that the younger children have exposure to the sun earlier in the day. S122 www.journalhealthpollution.org 3rd Goal -Pesticides: Inform parents at school of fumigation days and the products that are used, production and use of organic pesticides, awareness activities.

Conclusions
These goals are integrated into the day-to-day activities of the school, which affects future habits and strengths of both students and the school community.

Smoking Cessation Consultation In Pediatrics
Miguel

Background
Exposure to tobacco smoke (active or passive) is one of the leading causes of pregnancy complications and a risk factor for developing multiple pediatric diseases. Smoking cessation consultation in pediatrics is aimed at pregnant couples. The consult has a group structure (although in exceptional cases is done individually) and is divided into 5 in-person and 5 telephone sessions. The main action developed in the consult is the control of nicotine dependence, and above all, behavioral and emotional dependence to tobacco.

Methods
During 2016, we developed 3 therapy groups with a mean of 5 patients per group. Individuals who did not attend all sessions and also did not respond to the telephone calls were excluded from the results. There were a total of 16 patients, 12 women and 4 men. The average consumption of cigarettes/day average was 9.78.

Results
For the Fagerström test there was an average of 4.4 (little dependence) and for the Richmond test there was an average of 7.5 (moderate motivation). The current cessation rate is 75%. Emotional and behavioral control is very important during pregnancy. The inclusion of the partner in the process S123 www.journalhealthpollution.org ensures that the cessation is long-lasting, while also promoting a smoke free childhood environment.

Conclusions
The strengths of group therapy are that individuals with the same characteristics (feelings, fears, motivations, etc.), avoid feeling lonely during the process. The group can solve doubts and questions (fears, shyness, etc.) that otherwise would not be resolved. It helps us to establish pertinent emotional linkages among patients within the group. The results indicate a strong adherence to treatment.

Background
The Environmental Reproductive Nursing consultation involves a clinical consultation focused on detection, intervention and prevention of exposures to environmental hazards during the critical periods of fetus development (spermatogenesis and pregnancy) that pays special attention to legal and illegal drugs.

Methods
The consultation is supplemented with an ultrasound at 12 weeks of gestation. The goals of the consultation are to detect and reduce environmental exposures that can negatively affect the health of the fetus (or embryo) and to prevent recurrent diseases. In addition, to establish "environmental risk labels " in those pregnancies where the exposures have been severe enough to trigger diseases related to those exposures and allow us to make diagnoses prenatally or in the first months of life. The working tool is called the "hoja verde" and consists of a set of basic and concise questions that allow us to identify and manage/reduce environmental risk factors at critical periods of pregnancy (including spermatogenesis) and breastfeeding. We examine socioeconomic factors, reproductive history, ionizing radiation, drugs/herbalism/homeopathy, occupational exposures, smoking, illegal drugs, alcohol, pesticides and environmental perception of their community. Ethical approval was granted by La Hoja Verde's ethics committee. S124 www.journalhealthpollution.org

Results
Of the first 1,500 couples with risk during early pregnancy (2009/2012), we found a rate of 34.9% of maternal smoking, 45.4% of paternal smoking, 59.4% of maternal alcohol consumption during early pregnancy, 85% of paternal alcohol consumption during spermatogenesis, and 10.1% of fetuses exposed to illegal drugs during early pregnancy. In the successive years, the data presented showed a significant decrease in women who drink some alcohol in early pregnancy, a significant decrease in the amount of alcohol that the couples consume and a decrease in the number of newborns with congenital heart disease associated with intrauterine exposure to ethanol.

Conclusions
The Environmental Reproductive Nursing consultation is a clinical consultation/practice that allows us to identify, address and prevent environmental risk factors that would be otherwise go unnoticed. The training in this type of discipline/consultation is critical in order to increase the quality of pregnancy, health of the pregnant couple, as well as the health of the upcoming newborn.

Methods
For this investigation, children between the ages of 12 and 16 years were recruited after agreement of the local ethical committee. Blood samples (1.2 ml ethylenediaminetetraacetic acid) were drawn from 54 shooters (67% boys) and 48 controls (79% boys) after written consent from children and parents. Lead was analyzed by graphite furnace atomic absorption spectroscopy (GF-AAS) under strict internal and external quality control. All 102 samples were above the detection limit of 5.0 µg/l. Ethical approval was S125 www.journalhealthpollution.org granted by the Hospital of University Munich, Munich, Germany.

Results
The shooters reported a mean training time of 4.8 (SD 2.7) hours per month with 215 shots (SD 115). The mean lead concentration of shooters was 32.4 µg/l (SD 15.1) and somewhat higher compared to controls (mean 25.4 µg/l, SD 13.2). The difference was borderline significant (p = 0.048). There was no difference between results from boys and girls and there was no correlation between shooting hours and blood lead levels.

Conclusions
The results underline that shooting with airguns maybe an additional source of lead in children. Due to the known health effects of lead for children, all sources of lead uptake need to be reduced. Further research is necessary to obtain more recent data of the body burden of children in Germany and to look to previously unknown sources.

Training Modules for Pediatricians: Health Effects of Climate Change
Julia Schoierer (1)

Background
Health care systems will be increasingly faced with new challenges due to climate change-related health risks. There are several risks to be mentioned: heat-related health problems, allergies and respiratory diseases as well as a new onset of infectious diseases, increased risk of skin cancer due to strong ultraviolet radiation and accidents due to extreme weather events and as a result -mental stress. Children, due to their vulnerability, are seen as a special risk group for numerous pollution and exposure to climate change related factors. It is therefore important for the health sector to improve knowledge about the health effects of climate change.

Methods
As part of the German Strategy for Adaptation to Climate Change (DAS), the Institute of Occupational, Social and Environmental Medicine at the Ludwig Maximilian University of Munich receives funding for S126 www.journalhealthpollution.org a project from the Federal Ministry for Environment, Nature Conservation, Building and Nuclear Safety (grant number 03DAS073) to develop training modules for pediatricians.

Results
The project funding was launched in April 2016 and will continue until March of 2019. With the support of a cooperation network of professional associations and stakeholders of the target group, a blended learning module is currently being developed for pediatricians. The e-learning phase will begin in spring 2017. The phase to phase teaching will take place during three pediatric annual meetings from summer to autumn 2017.

Conclusions
The project aims to provide scientific knowledge on climate change-related health risks for children and adolescents. Pediatricians will develop necessary skills for the new challenges in diagnosis, therapy and prevention. It is hoped that the project will enable adequate preventive and curative action for children.

Background
In recent years, it has become increasingly clear that environmental harm is one of the most pressing human rights challenges facing humanity in the twenty-first century. A vast range of human rights, including the rights to life, health, food, water, and housing, depend on a healthy environment. Children are particularly vulnerable to environmental harm. Nevertheless, the effect of environmental degradation on their lives is rarely addressed as a rights issue. The UN Convention on the Rights of the Child (CRC) is often overlooked in setting and implementing environmental policies and standards even though the convention specifically identifies "the dangers and risks of environmental pollution" as a threat to the right to health. States rarely address environmental issues in their periodic reports to the Committee on the Rights of the Child, which monitors the implementation of the CRC, and while many NGOs (and academics) have started working on human rights and the environment, only a few of them cover issues related to children in particular. S127 www.journalhealthpollution.org

Methods
The Committee on the Rights of the Child (CRC) periodically devotes one day of general discussion (DGD) to a specific article of the UN Convention on the Rights of the Child (CRC) or to a child rights issue. The purpose of the DGD is to foster a deeper understanding of the contents and implications of the UN Convention. The 2016 Day of General Discussion (DGD) on 23 September will be on the topic of children's rights and the environment. Local and global experts from different fields will participate.

Results
The presentation will provide an overview of the main objectives and scope of the UN conference and highlight key aspects of the current debate, including the potential added value of a rights-based approach to children's environmental health.

Conclusions
To strengthen the link between the protection of children's environmental health and rights, the child rights community should aim to clarify how relevant provisions of the UN Convention on the Rights of the Child relate to environmental issues. Environmental decision-makers, on the other hand, should explicitly recognize that children's rights apply to environmental (health) matters. Furthermore, environmental health policy-makers and experts should become more familiar with the specifics of the UN Convention on the Rights of the Child and learn how to apply it to their field. Human rights experts would hugely benefit from tailor-made data and arguments to frame environmental health issues in human rights terms.   in India represent about 20% adolescents as proportion of total population. The classroom is a formal environment for learning. A conducive and comfortable classroom environment motivates students to perform better and encourages the learning process. Furniture plays an important role in the maintenance of good sitting posture. Using furniture that promotes proper posture is more important as sitting habits acquired in childhood are very difficult to change later in adolescence or adulthood. Anthropometric measurements are an important factor that should be taken into account in classroom furniture design. The function of the furniture should be to facilitate learning through providing a comfortable and stress free workstation. Hence, the classroom furniture needs to be designed to allow children to move about in their seats, as it is unnatural to keep still for long periods. S128 www.journalhealthpollution.org

Methods
To fulfill this objective, an observation based study was undertaken in public schools of New Delhi for devising suitable furniture measurements for a sample size of 450 school children in relation to their anthropometric measurements. In the study, the school furniture measurements were compared with the Bureau of Indian Standards given for children of 10-13 years and > 13 yrs age group, but no comparison was made for the anthropometric measurements for children. However, a correlation between the anthropometric measurements with age was found, along with comparing the findings between the boys and girls.

Results
The results showed that none of the schools conformed to the standards given by the Bureau of Indian Standards for school furniture. Also, the majority of the students were getting injured because of certain defects in the classroom furniture. It was reported by 49.5% of school children that the classroom seat on which they were sitting for continuous durations was not comfortable to them. Also, 34.5% of school children from 10-11 years found the classroom seat to be uncomfortable to them, whereas 31.4% children from 12-13 years and 34.1% from the >13 years age group reported the same. Furthermore, the furniture dimensions are one of the main aspects and, amongst these, the seat height is typically the starting point for the design of this type of furniture. The study also indicated the potential relationship between anthropometric data of children and the furniture dimensions. Furthermore, we reported, based on the rules adopted from Parcells et al. (1999), the children's anthropometric measurements and furniture dimensions were mismatched.

Conclusions
This highlights the fact that students in the sample schools did not find the existing seats and desks to adequately fit their body dimensions, which indicates an urgent problem for school children in Delhi.

Assessment of Indoor Air Quality in Air -Conditioned and Naturally Ventilated Schools in Delhi, India
Pratima Singh (1), Renu Arora (2) (1) Department of Resource Management, University of Delhi, New Delhi, India (2) Institute of Home Economics, New Delhi, India Corresponding author: Singh, Pratima Delhi, India pratima_lic@hotmail.com

Background
Understanding the impact of the indoor environment on children is important as they spend most of their time indoors (approximately 80-90%), either at school or the home. Within a school, students spend most of their time inside classrooms, engaging in various activities which require considerable S129 www.journalhealthpollution.org amount of concentration and attention. Several research studies have indicated that the air quality inside classrooms is often poor and carbon dioxide (CO 2 ) concentration exceeds recommended levels prescribed by the American Society of Heating, Refrigerating and Air-Conditioning Engineers for indoor environments in majority of schools; which might be due to high student density or poor facilities at schools. If the air inside classrooms is deteriorated, it may cause several health effects that may directly impair concentration or memory of students -e.g., neurological effects -or cause other health effects that indirectly affect learning of children -e.g., absenteeism, poor concentration, restlessness or dizziness. Hence the present research was designed to assess the quality of air inside air-conditioned (AC) and naturally ventilated (NV) schools in Delhi, India.

Methods
The present research was exploratory in nature. The research was conducted in four private schools (two AC and two NV) located in Delhi, India. The design features of the selected classrooms were studied using a checklist and observation tool. The indoor-air quality parameters namely CO 2 , temperature and relative humidity (rH) were monitored at continuous 5 minutes interval from 7:30 am to 2:00 pm for three working days and 8:00 am to 2:00 pm for one non-working day in each school using air quality monitor Testo 435-2.

Results
The results of the research study indicated that the measured CO 2 concentrations varied among school classrooms based on type of ventilation, windows, room occupancy and student movement. The average CO 2 concentration in naturally ventilated classrooms were within recommended limits (472.97 ppm to 718.02 ppm) on all the working day,s i.e less than 1000-ppm CO 2 limit prescribed by the American Society of Heating, Refrigerating and Air-Conditioning Engineers 62-2001 standards. However, the average CO 2 concentrations frequently exceeded the limits in the AC classrooms on all working days (1674.51 ppm to 3298.12 ppm). The CO 2 concentrations were within limits in all classrooms irrespective of ventilation type on all non-working days (minimum 386.08 ppm and maximum 478.37 ppm). The average temperature and rH ranged between 24.22 C to 26.29 C and 53.68% to 63.72%, respectively, in AC classrooms on working days providing adequate thermal comfort to occupants. The same was found to be ranging from 30.6 C to 33.01 C and 66.5% and 82.92% respectively in NV schools; exceeding the limits of comfortable temperature (approx. 20 C to 28 C) and rH ( less than 65%) suggested by the American Society of Heating, Refrigerating and Air-Conditioning Engineers. The analysis of the data highlighted the degraded indoor air quality in the air-conditioned school on all the working days.

Conclusions
The elevated indoor carbon dioxide concentrations in AC schools may indicate inadequate ventilation per occupant, which may lead to sick building syndrome symptoms in students affecting their health and performance in schools. On the contrary, students in NV schools often experienced thermal discomfort due to higher temperature and relative humidity in class. S130 www.journalhealthpollution.org

Background
Dietary and intestinal microbiota related exposure factors directly influence human metabolism, thus affecting health states. Quantitative metabolic profiling by mass spectrometry and specifically selected reaction monitoring (SRM) assays may be used to capture an individual's metabolic phenotype, revealing potential perturbations. Biomarker levels correspond to a specific exposure factor and perhaps are consistent with early indications of disease. This study focuses on biochemical intermediates of tryptophan metabolism to explore the influence of dietary and microbial exposure factors on this essential biochemical pathway.

Methods
A chemical library containing 234 standards of diverse biochemical intermediates was analyzed using ultra-high pressure liquid chromatography-mass spectrometry system (1290 Infinity II and 6495 QqQ, both from Agilent, CA, USA) to develop SRM assays for all detectable metabolites. Urine samples (n=51) from pregnant women collected in the 38th week of gestation were lyophilized, extracted with methanol, internally standardized and assayed for a panel of metabolites relevant to tryptophan metabolism by SRM technology. Ethical approval was granted by the Ethics Committee of Central European Longitudinal Study of Pregnancy and Childhood.

Results
The dietary intake of tryptophan is essential in humans to maintain protein biosynthesis and synthesis of neurotransmitters (serotonin and melatonin). At the same time, tryptophan is metabolized by microbiota residing in the human intestine. The collective dietary and microbiota exposure was explored using highly selective, sensitive and reproducible SRM assays for 20 key intermediates of tryptophan metabolism. The levels of these intermediates were determined in urine samples from pregnant women collected in the frames of Central European Longitudinal Study for Pregnancy and Childhood in the region of South Moravia, Czech Republic. Quantitative metabotypes were compared in urine samples based on abundance levels and mutual ratios between metabolic markers. This study contributes novel data in the area of health related dietary and microbial exposure factors, particularly to the emerging field of the exposome (i.e. non genetic factors affecting human health).

Background
Children are vulnerable to environmental exposures resulting in disease burden. This can be quantified using the environmental burden of disease (EBD) method. EBD method and key findings of children's EBD are presented.

Methods
Quantifying the EBD in terms of disability-adjusted life years (DALYs) is explained. Recent global studies estimating DALYs caused by environmental risk factors (ERF) for children are summarized and discussed to understand DALYs. A focus is given to global estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME).

Results
EBD is a method to quantify how many DALYs in a population are lost due to health restricted life time and premature death attributable to ERF. The WHO estimated that 25% of global DALYs for children (<5 years) are caused by modifiable ERF (e.g., air pollution, noise, unsafe water). In children, ERF contributes the most to the burden of infectious diseases, neonatal conditions, nutritional diseases, and injuries. E.g., 11% of 25 Mio DALYs due to neonatal conditions in children (<5 years) worldwide are assumed to be caused by ERF as in indoor/outdoor air pollution, tobacco smoke during pregnancy, unsafe water/ S133 www.journalhealthpollution.org sanitation. In comparison, the environmental contribution to lower respiratory infections is with 60% of 52 Mio DALYs much higher. IHME quantified DALYs for a selection of ERF, including unsafe water/ sanitation/handwashing, air pollution, radon, and lead. These ERF explain less than 5% of the total DALYs for children <5 years but more than 10% for children aged 5-9 years.

Conclusions
The EBD studies differ regarding the definition of "environment" and inclusion of ERF. Moreover, data restrictions avoid the inclusion of all ERF of relevance. However, obvious is a high impact of the environment for children's health. This contains a high chance for prevention of the burden by reducing the exposure.

Methods
The Scientific Review Board of the Public Health Institute has reviewed the methodology of this study and the Ethical Review Board of Ministry of Health gave permission to conduct the study. In order to find a connection with the causes of these defects and the parents' work environments, we implemented a human bio monitoring survey of mercury exposures among children 0-5 years of age who were living in a mining area. A total of 56 children participated in this study, 22 boys and 34 girls. We performed pediatric clinical examinations for the all of the participants. S134 www.journalhealthpollution.org

Conclusions
The results of mercury analysis were compared to the threshold of the Human Bio monitoring I limit. It concluded that no statistically significant differences were observed between mercury levels in biological samples of children and their parents' work related to gold mining with mercury. Parents working condition of the children involved in the study was not found to have an influence on children's health status (p=0.130, p=0.619).

Background
One of the most important and underestimated challenges is high noise exposure in kindergarten. More than 50 percent of teachers complain about unfavourable noise conditions in child development facilities. Constant noise exposure affects not only attention performance and the development of language; it may also cause psychosomatic complaints or higher stress perception. Furthermore, legislative authorities, architects and teachers see noise pollution as an inevitable fact and do not consider noise protection or current needs, like children's exercise, when building or renovating premises, for example. Our priority intention is to introduce, develop and evaluate noise reducing interventions, which are easily to apply and have immediate effects. levels (n=12) and also reverberation time of the rooms), because an authentic and natural setting was of great interest. In addition there were two observers in each group, observing and documenting near misses, conflict rate and also the daily routine respective of confounding variables, for example children shouting into their dosimeters. After the first measurement, all involved people developed a specific action plan for noise prevention. After the intervention implementation, a second measurement was taken.

Results
The evaluation was carried out by comparing inter-and intra-individual differences between noise exposure levels in both groups (IG and CG) before and after implementation of measures. At the first survey IG showed an average sound level of 76,3 dB, and after the implementation the sound level reduced to 70.9 dB (compared to CG: 71.5-72.7). Hence, it can be concluded that the noise prevention measures were successful. If the analysis of the observed conflicts and near misses rate in both groups beyond the two times of measurements is considered, a reduction was also achieved. The difference between CG and IG suggests a correlation between conflicts (IG: 23-9/CG: 18-16) or near misses (IG: 14-0) and high noise exposure. As the baselines of both groups differed, we do not want to interpret without further research. Looking at the individual sound exposure levels of adults and children, it appears that children are more affected than teachers, which matches our observations.

Conclusions
On basis of these results it can be assumed that high noise exposure seems to have a negative impact on kindergartens. Construction, organisational or educational measures are able to reduce stressful sound volume and as a consequence the conflict and near misses rate as well. Noise measurements and consulting interventions in kindergartens should be put into practice. A Noise Prevention Checklist ("Which interventions are the most useful at a specific kindergarten?") and guidance about noise preventions for kindergarten management and policy makers is needed. Further research and evaluation of technical, organisational and pedagogical interventions should be developed in order to make policy makers and other stakeholders, like architects, aware of noise problems and its negative impacts.

Background
Forests for Health (FFH) is a project within the program "Nacer sin OH" (Births without OH), promoted by the Pediatric Environmental Health Speciality Unit of the Clinical University Hospital Virgen of Arrixaca (Murcia, Spain). This project intends that each child born and raised will be linked with a tree: incorporating a forest within each of the maternity hospitals of the Region of Murcia (Spain), creating healthy environments as protective factors during infancy, thus building health equity and promoting the enjoyment of natural heritage and regional biodiversity.

Objective
To foster the linkage of pregnant partners with nature and their future children from birth through adolescence, stimulating contact with nature as a preventive and therapeutic tool to achieve health, wellness and quality of life.

Methods
The environmental health midwife and various maternity healthcare professionals collaborate, giving the family a pine seedling, linked with the birth of a child, and an information package containing educational and prevention materials in line with the goals of the program. Subsequently they contact and invite parents to the replanting day, with the aim of creating forests for health.

Results
From 2015 to 2016, approximately 2000 pine seedlings were given to families. There have been 3,637 S137 www.journalhealthpollution.org newborns. Approximately 450 trees have been planted in the FFH, with 4,694 tons CO 2 /year absorbed.

Conclusions
As health professionals, midwives are vital in accompanying pregnant couples and influencing the stages of preconception, pregnancy, childbirth, postpartum, throughout the cycle of sexual and reproductive health. The simplicity of the project allows it to be feasible and transferable for families, especially during such a receptive period.

Background
Autism spectrum disorder has a high prevalence. This disease remains a complex issue and each patient is an etiological challenge. Hundreds of mutations in all chromosomes have been identified related to autism. In fetal life, brain development is exquisitely susceptible to exposure to toxic chemicals present in the environment. This report presents a case of a patient with a somatic mosaicism related to parental exposure to chemicals during early pregnancy.

Methods
We examined the case of an 8-year-old boy diagnosed with pervasive developmental and attention deficit and hyperactivity disorder. Microarray hybridization identified a duplication of a segment of chromosome 19 from band p12 to q13.12. He was the first child of healthy non consanguineous parents. The pregnancy was achieved naturally and there was no medication or drug intake. Both parents work as operators in a chemical plant. The mother stopped working at 4 weeks gestation. She had episodes of nausea and dizziness when purging fuel vapors.

Results
The affected segment includes over 160 genes that have possible associations with autism. Using the National Center for Biotechnology Information and Medical Data Institute database, we identified the chemicals associated with these genes, and volatile organic compounds, and volatile organic compounds and metals were some of the most common mutagenic chemicals identified.
A careful environmental history is needed to understand the etiology of Autism spectrum disorder. In this case we describe acute symptoms of intoxication with gases derived from fossil fuels around the time of gastrulation. These gases contain volatile organic compounds and metals that are classified as mutagenic and could be associated with the chromosomal duplication and the clinical picture present in the patient. Despite the limitations, there is evidence to support that environmental and genetic factors could converge in neurotoxicity.

Neuropsychological Profile of an Adopted Patient with Fetal Alcohol Spectrum Disorder.
Esther Tobarra Sánchez (1)

Background
Prenatal exposure to alcohol causes a variety of clinical manifestations known as fetal alcohol spectrum disorder (FASD), with neurodevelopmental effects, among others. Alcoholism is common among mothers of children adopted from Spanish institutions, especially from Eastern Europe.

Methods
A 17-year old boy, born in Ukraine and adopted by a Spanish family at the age of two was referred to the Genetics Unit because of psychomotor delay and facial dysmorphia. He is the product of an unknown controlled pregnancy, and had a sister with psychomotor retardation. The presence of dysmorphic features was detected in infancy by the Medical Genetics Unit, as well as psychomotor and pondostatural growth retardation. At the age of 7 he developed inattention and hyperactivity, as well as anxiety and depressive symptoms. The child was evaluated by the Neuropediatrics and Psychiatry Unit. Subsequently, the child was evaluated at school and by the Environmental Pediatric Service.

Results
He presented with behavioral problems and poor school performance, limited IQ and verbal reasoning capacity below average, as well as significant curricular gaps in grammatics, mathematics and languages and difficulties in social relationships. He did not show an adequate level of autonomy, all in S139 www.journalhealthpollution.org the context of FASD. The child was diagnosed with FASD.

Conclusions
Patients with FASD may have a normal or decreased IQ, from minimum to profound mental retardation. Executive functions are the most frequently affected. In addition, they usually have poor performance in behavioral inhibition and self-control, verbal and nonverbal fluency, organization and planning. Other manifestations include difficulties in the area of mathematics and social communication because of language disorders. Problems in socialization are influenced by understimulation, common in adopted children. Behavioral problems, substance use, sexual behavior and psychotic disorders are also common. Early diagnosis and intervention and psychopedagogical treatment seem to achieve an improvement in the neurodevelopment of these patients.

Background
Environmental Burden of Disease (EBD) estimates are increasingly used by scientists to inform decisionmakers about environmental risk factors causing ill-health. Currently, no up-to-date national estimates of the EBD are available for Germany. Children and adolescents represent a group vulnerable to the effects of environmental risk factors. Therefore, the research project UKAGEP aims to estimate the EBD of 16 risk factors for children aged between 3 and 17 years of age in Germany.

Methods
The UKAGEP project uses the EBD methodology and its core measure, the disability-adjusted life year (DALY). Current exposure and human-biomonitoring data derived in the currently ongoing populationrepresentative German Environmental Survey (GerES 2014-2017) are used to estimate the exposure of children in Germany. Combined with exposure-response functions (ERF) and data on the related health effects, DALYs will be estimated. The ERF will be derived from or updated by systematic literature reviews and meta-analyses. To take into account cumulative chronic effects, probabilistic modeling will be performed. Furthermore, it is also necessary to estimate the potential future burden, because many current exposures might affect health after a long lag-period. S140 www.journalhealthpollution.org

Results
The concentration of most environmental hazards is expected to be rather low. However, some of the risk factors might still pose a considerable threat at population level, especially if both effects of mortality and morbidity are considered. Furthermore, the estimated future burden will show how current exposures will impact the health of children living with today's exposures in the upcoming years.

Conclusions
The UKAGEP study will present the EBD of a set of known hazards, but will also provide insights on newly emerging risk factors. It is also envisaged to strengthen the use of human-biomonitoring data and methods of probabilistic modelling in EBD assessments.
Financial support of the GerES by the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety and the German Federal Ministry of Education and Research, and financial support of the KiGGS study by the German Federal Ministry of Health is gratefully acknowledged. We also thank the Robert Koch Institute for its support in this collaborative study.

What is the Environmental Burden of Disease? An Animated Video Gives an Answer
Myriam Tobollik (1), Theresa Tobollik (2)

Background
The Environmental Burden of Disease (EBD) method is used to quantify disability-adjusted life years (DALYs) which can be attributed to environmental risk factors. Thereby, risk factors of major concern for population health can be identified. DALYs are not easily understandable, which might prevent their use in risk communication to the general public as well as in political decision-making. S141 www.journalhealthpollution.org

Methods
An animated video was produced to explain the EBD method and its possible application fields to the interested general population, scientists from other research fields and policy makers. A vivid example, outdoor air pollution, which affects everyone's health, was chosen to illustrate the quantification steps. Technical terms are used and explained in common language.

Results
The 8-minute video describes the DALY as a summary measure of population health which consists of years of life lost due to premature mortality and years lived with disability. Likewise, the attribution of DALYs to the risk factor outdoor air pollution is illustrated. The video is freely available on YouTube in German and English (https://www.youtube.com/watch?v=Inentz31Kqk).

Conclusions
The video is designed to be understandable to a broad audience by using a balance between simplification and scientific correctness. It gives a short but comprehensive explanation of the complex EBD method and is therefore an attempt to break out of the scientific ivory tower.

Emiko Todaka
World Health Organization, Geneva, Switzerland Corresponding author: Todaka, Emiko Geneva, Switzerland todakae@who.int In 2012, 38 million people lost their lives due to non-communicable diseases (NCDs), and threequarters of these deaths occurred in low and middle income countries. NCDs include obesity/diabetes, cardiovascular diseases, respiratory diseases, cancers, allergies and mental illnesses. Recently, the number of children with NCDs has increased, and this is cause for serious concern.
In the United Nation's (UN) Sustainable Development Goals (SDGs), target 3.4 aims to reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being by 2030; target 3.9 aims to reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. Although according to the Organisation for Economic Co-operation and Development (OECD), chemical production is increasing rapidly in the world, many chemical exposures could potentially be reduced or removed through environmental management. These chemicals include pesticides, asbestos, various other household and occupational chemicals, ambient and household air pollution, second-hand tobacco smoke, lead and arsenic. S142 www.journalhealthpollution.org In June 2016, an international expert meeting on "Avoidable Early Environmental Exposure" was convened by the World Health Organization (WHO) in Geneva. Experts from various fields such as maternal/children's health, developmental origin of health and disease, epigenetic effects, cohort study, and communication participated. The meeting discussed the current situation of early life exposure to chemicals, possible interventions to reduce the risks to children, and effective advocacy among health care professionals, policy makers, and civil society. A roadmap of action for implementing interventions is now being developed. The outcomes of the meeting results will be submitted for publication in a scientific journal.

Background
The aim of the present study was to evaluate association between prenatal exposure to mercury and the neurodevelopment of children, taking into account relevant confounders and some relevant genetic polymorphisms. We examined apolipoprotein E (Apoe) and glutathione transferase (GSTM1 and GSTT1), the genes that are hypothetically involved in elimination of mercury from the body, and Apoe in neurodevelopment.

Methods
The study population was comprised of 601 mother-child pairs recruited from the central Slovenia region and 243 from Rijeka, on the Croatian coast of the northern Adriatic. Determination of total mercury in cord blood, neurodevelopment assessment using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III) at 18 months of age and genotyping was done in 361 children; 237 of them were from Slovenia and 124 from Croatia. The National Ethics Committees of Slovenia and Croatia approved this study. S143 www.journalhealthpollution.org

Results
The results showed a negative association between low-to-moderate mercury exposure levels and cognitive outcomes and with fine motor scores at 18 months of age. The observed decrease in cognitive function was significant only in children carrying at least one Apoe ε4, while the decrease in fine motor score was independent of the Apoe genotype. Adjusting for selenium and lead revealed positive association between selenium and language and negative between lead and motor function, but only in the subgroup of children not carrying the ε4 allele. The GSTT1 genotype revealed positive association between cord blood selenium and cognition in children without gene deletion (β=11.8, p=0.008), but not in children with GSTT1 deletion (β=-15.1, p=0.128).

Conclusions
The present study indicates that even low-to-moderate mercury exposure in children with normal neurodevelopmental outcome can be associated with lower cognitive and fine motor Bayley III scores and that stratifying for specific genotypes and accounting for beneficial and other potentially neurotoxic substances is crucial in assessing such associations.

Background
Although organochlorine pesticides were banned in the West decades ago, bioaccumulation in younger generations still occurs. Exposure to organochlorine pesticides may be related to adverse effects on behavioral development. Exposure during early life may be particularly harmful, as rapid structural and functional changes take place. The aim of this study is to explore the association between early life exposure to organochlorine pesticides and behavioral development at 18 months. S144 www.journalhealthpollution.org

Methods
Data from 59 mother-child pairs from LINC, a prospective birth cohort in the Netherlands, were used. The targeted compounds were the sum of polychlorinated biphenyls (ΣPCBs), hexachlorobenzene (HCB), the sum of hexachlorocyclohexane isomers (ΣHCH), heptachlor epoxide, and dieldrin; all determined in breast milk. The scales 'Attention Deficit Hyperactivity Disorder' (ADHD) and 'Externalizing Behavior' of the Child Behavior Checklist 1.5-5 were used for the behavioral assessment. Whole population and sex-stratified regression analyses were performed, in which exposure levels were classified in tertiles (T1, T2 and T3). A family history of ADHD, educational level, smoking, and alcohol or illicit drug use during pregnancy were included as confounders. Ethical approval was granted by the Vrije University Medical Center.

Results
Children exposed to the highest levels of ΣHCH presented higher scores on the ADHD-scale of the CBCL. After stratification for sex, significant associations were only found for girls. Positive associations were found between early life exposure to the highest levels of ΣPCBs, ΣHCH, dieldrin, and T2 levels of HCB; and ADHD symptoms. Higher scores were found on the Externalizing Behavior scale of the CBCL after exposure to dieldrin (T3) and ΣPCBs (T2 en T3).

Conclusions
Significant associations were found between early life exposure to organochlorine compounds and behavioral development at the age of 18 months. Associations were sex-specific (in girls only). Results should be seen as exploratory, as the sample size was small.

Background
Neurodevelopmental disorders such as attention deficit hyperactivity disorder and autism have been associated with exposure to environmental chemicals, including dioxins and organochlorine pesticides. Effects have been observed, particularly in relation to exposure in early life. Mechanistic pathways, such as relations between chemical exposure and neurotransmitter levels, have, however, been studied less frequently. Our objective was to study the effect of early life exposure to environmental chemicals on neurotransmitter levels in cord blood.

Methods
Data were used from 63 mother-child pairs from the LINC study, a prospective birth cohort in the Netherlands. Cord plasma was collected at birth and was used to determine both levels of environmental chemicals and neurotransmitters. Exposure to various compounds was determined, including phthalates (metabolites of di-2-ethylhexyl phthalate [DEHP]), perfluorinated alkyl acids (perfluorooctanesulfonic acid [PFOS], and perfluorooctanoic acid [PFOA]), and brominated flame retardants. The neurotransmitters included dopamine, epinephrine, norepinephrine, acetylcholine, serotonin, gamma-amino butyric acid (GABA), and glutamate. Univariate regression models were composed for each compound in tertiles, and each neurotransmitter. Ethical approval was granted by the Vrije University Medical Center.

Results
An overall significant effect of PFOA exposure on GABA was observed (p = 0.049). It appeared to be that higher levels were observed in the second tertile compared to the first, and lower levels in the third tertile compared to the first. Furthermore significant overall effects were observed for MEHHP (acetylcholine, p = 0.039), and MEOHP (epinephrine, p = 0.048). For mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), lower levels of acetylcholine were observed in the highest exposure tertile, whereas for mono(2-ethyl-5carboxypentyl) phthalate (MEOHP) higher levels of epinephrine were observed in the second exposure tertile.

Conclusions
Prenatal exposure to PFOA and DEHP was associated with levels of GABA, acetylcholine, and epinephrine. Dose-response effects were non-linear. Whether these changes in neurotransmitter levels in cord blood are related to abnormal behavioral development needs to be further explored. S146 www.journalhealthpollution.org

Background
Maternal exposure to particulate matter (PM) may cause decreased transplacental oxygen and nutrient transport to the fetus, potentially resulting in a lower birth weight (BW). Results of observational studies have, however, been inconsistent and because of the potential health implications, further research is needed to confirm the relation between maternal exposure to PM and BW.

Objective
To investigate the association between maternal residential exposure to fine and coarse particulate matter (PM 2.5 and PM 10 ) and BW.

Background
Water is the major constituent of the human body and drinking water is the most important source to fulfil its needs. There are several choices in water provision (e.g., bottled water consumption, homebased water treatment or installation of water storage facilities) which can be adapted to the existing S149 www.journalhealthpollution.org water supply system in urban communities where we cannot ensure access to potable water. According to the World Health Organization, not only physical environmental, biological or chemical factors affect human health, but also environmental and psychosocial factors. In this sense, factors such as little or no availability of drinking water can contribute to low water consumption. The aim of this analysis is to emphasize the need for multicomponent strategies (access, social campaigns, social empowerment and psychosocial factors) to attain the recommended levels of water consumption in Mexican children and adolescents living in Santa Fe, CDMX.

Methods
This study examines the feasibility of implementing strategies aimed at increasing water consumption in children and adolescents as stated in the National Food Health Agreement (Acuerdo Nacional de Salud Alimentaria) in 2010 according to the socio-demographic conditions reported for a marginalized urban area in CDMX, Mexico. We also describe various other factors that could play a decisive role in the trend of tap water consumption in this specific population, putting them at risk for not accomplishing the recommendations and discuss a direction for developing specific child welfare policy for vulnerable groups.

Results
In Mexico, one sixth of the population has no access to drinking water (1100 million) and almost 40% lack basic sanitation. These figures are worse in marginalized vulnerable urban communities as Santa Fe in CDMX where only 18% of children and adolescents reach water consumption recommendations. As this population spends most of their time in schools and at home, these places should been considered key places to promote and ensure water consumption. Current polices to promote drinking water are focused only on the installation of water fountains in schools (some reports estimated that 55% of public elementary schools have this service) without considering availability at home and it has been recognized that confidence about the quality of water filters affects water consumption. Psychosocial factors such as intent, knowledge, beliefs, attitudes, subjective norms and self-efficacy, which are associated factors with low water consumption, have not been considered as part of environmental modifications.

Conclusions
Policies aimed to increase water consumption in children and adolescents should involve not only multicomponent environmental modifications aimed to ensure access to drinking water not only in schools, but also consider broader psychosocial factors. S150 www.journalhealthpollution.org

Background
Although there is a considerable number of children involved in child labour worldwide, data on occupational hazards and injuries is limited. Thus, the objective of this study was to investigate the lifetime prevalence of and risk factors for occupational injuries in child labourers in Peru.

Methods
Between August and December 2010, a cross-sectional study was conducted at five public night schools in Cusco Province. 375 students (response 91.5%) aged 10 to 17 years completed an interviewbased questionnaire on socio-demographic factors (age, sex, place of birth, education, residential status, minority status, health care coverage), work-related factors (income, working days per week, occupational sector) as well as lifetime prevalence of occupational injuries. Multiple logistic regression analyses were performed to estimate risk factors for different types of occupational injuries. Ethical approval was granted by the Medical Faculty of the University of Munich and the Ministerio de la Mujer y Desarrollo Social (Ministry of Women und Social Development) in Peru.

Results
We found falls (11%), car accidents (9%) and physical violence (3%) were common causes of injuries in this population. Severe injuries (fractures, luxation or amputations) were reported by three percent of the study sample. Participants with high daily income (≥20 PEN, ~15 USD) showed increased odds for falls (odds ratio 2.8; 95% confidence interval 1.2-6.5) and physical violence at work (odds ratio 12.1; 95% confidence interval 1.3-116.0). Children working in the service sector were at higher risk of injuries caused by car accidents (odds ratio 4.2; 95% confidence interval 1.2-15.3). S151 www.journalhealthpollution.org

Conclusions
Occupational accidents among child workers attending public night schools are common in Cusco with a lifetime prevalence of three percent for severe injuries. High income seems to convince child labourers to accept poor working conditions.

Background
Maternal exposure to air pollutants can affect fetal development and cause adverse birth outcomes. Nitrogen oxides (NOx) can react with amines to generate toxic alkylating agents (AAs), and their biological effects are mediated, in part, by the formation of DNA damage including the promutagenic and toxic, O6-methylguanine. O6-methylguanine methyl transferase (MGMT) removes O6-alkylguanine adducts by transferring the alkyl group from the O6 position to the cysteine residue within its active site. The aim of this study is to quantify MGMT functional repair activity in placentas and to determine its association with air pollutant exposure over various time windows during pregnancy.

Methods
Tissue samples from the middle, cord and peripheral areas of the normal placentas were collected from 10 mothers, who lived in Greater Manchester, and stored at -80˚C until processed. MGMT repair activity was quantified in cell-free sonicates of 100-120 mg tissue using a standard radioistotopic methyl transfer assay and protein levels were quantified by a Bradford assay. Postcodes of the mothers were geocoded by ArcGIS and air pollutant data obtained from the Department for Environment, Food and Rural Affairs. Ethical approval was granted by the Central Manchester University Hospitals NHS Foundation Trust.

Conclusions
This initial study indicates that the placenta contains functional MGMT activity that may affect susceptibility to alkylating agent exposure. The biological significance of variable placental MGMT activity remains to be characterized. An association between placental MGMT activity with pregnancy outcomes need to be further studied.

Background
Currently, there are more than 11 million acquired immune deficiency syndrome (AIDS)-affected orphans that suffer from various adverse effects, most of whom reside in sub-Saharan Africa. The difference between whether a child resides in a rural or urban environment can have a significant role in a child's education, health status and access to healthcare, and social or family relationships.

Methods
A systematic review was conducted in order to understand these environment-based differences on orphans directly affected by human immunodeficiency virus infection (HIV)/AIDS in sub-Saharan Africa. There were 233 sources used for this review; however, 164 manuscripts focused more on a general review of orphans within a rural or urban environment. Thus, after eliminating for various factors, 69 manuscripts were used, which focused primarily on the social aspect of orphans due to HIV/AIDS.

Results
Rural environments provided more family support, while urban environments generally had more resources available to orphans (e.g. school fees). Unfortunately, both rural and urban environments were found to be fairly non-supportive of orphans and their development. This systematic review found, in general, that orphans in both urban and rural environments continue to suffer from the iatrogenic effects of low parental support due to AIDS mortality.

Conclusions
These conclusions continue to support an increase in developmental support through school and social relationships specific to orphans throughout sub-Saharan Africa. S153 www.journalhealthpollution.org

Background
Global health interventions focus on providing solutions to unaddressed public health issues in lowand middle-income countries. Providing nearby access to safe drinking water is a primary public health concern and a frequent public health intervention throughout sub-Saharan Africa; access to water eliminates long gathering and transport time and provides an individual with more personal time. Previous research has not reviewed the aspect of time and relationship changes after implemented water interventions.

Method
A qualitative phenomenological approach used 52 semistructured interviews to examine relationship experiences among primary water gatherers and their families after receiving nearby access to water. The study group consisted of men and women from approximately 7 years old to 75 years old. This study took place throughout the historically semiarid eastern region in Kitui, Kenya, where community members have been beneficiaries of various water interventions. Ethical approval was granted by both North Dakota State University and Moi University.

Results
Before the water intervention, family members experienced difficulties with irregular meal times and food availability, infrequent family conversations, irritation with lack of bathing and cleanliness, and general discontent without the availability of 1 able-bodied family member. Participants' experiences after implemented water interventions revealed enhanced relationships within household family units; additional personal time was gained and used to rebuild relationships. The newly established relationships included constructive discussions and conversations built around understanding and developing solutions to address economic or individual challenges encountered by the family.

Conclusions
This study's findings suggest that relationships significantly improved after households receive access to nearby water. Furthermore, this research provides evidence of an increased need for access to quality water for communities throughout the world to positively contribute to constructive family relationships. S154 www.journalhealthpollution.org

Background
Small artisanal gold mining (SAGM) continues to be a pervasive public health issue worldwide, affecting miners as well as both children and women. While there are various problems associated with SAGM, mercury exposure is the primary hazard contributing to adverse health effects in exposed human populations.

Methods
A literature review was conducted in order to specifically assess the impact of current mercury interventions within the entire SAGM industry. To aid in this review, a resource pool of information on SAGM and mercury emissions, treatment and management of emissions, and interventions was assembled through a search conducted via multiple search engines.

Results
Mercury usage continues to be largely embedded in the handling, processing, and extraction techniques of SAGM; however, current interventions have been implemented worldwide to focus specifically on reducing or eliminating mercury emissions through education, processing centers, or mercury alternative techniques. Education focused on environment or health awareness or more specifically on alternative techniques. Processing centers offered areas of large-scale technology centers for smallscale miners. Alternative techniques included retorts, vat-leaching, magnets, direct smelting of gold, and borax. Results determined positive and negative outcomes associated with every intervention, thereby confirming the fact that a single solution managing and treating mercury currently does not exist.

Conclusions
Ultimately, the need for novel techniques addressing mercury emissions in SAGM needs to be pushed to the forefront of critical issues in public health in order to aid in developing positive change in the industry.