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Funding The project received a research grant from the Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain), awarded on the 2017 call under the Health Strategy Action 2013-2016 of the National Research Program oriented to Societal Challenges, within the Technical, Scientific and Innovation Research National Plan 2013-2016 (reference PI17/00914), cofunded with European Union ERDF funds (European Regional Development Fund). TD-S is funded by the Department of Health of the Generalitat de Catalunya, awarded on the 2016 call under the Strategic Plan for Research and Innovation in Health (PERIS) 2016-2020, modality incorporation of scientists and technologists, with reference SLT002/16/00308. ; Background Metabolic syndrome (MS) is defined by the clustering of specific metabolic disorders in one subject. MS is highly prevalent globally and currently considered a growing public health concern. MS comprises obesity, hypertension, dyslipidaemia and insulin resistance. Mechanisms linking MS with cancer are poorly understood, and it is as yet unknown if MS confers a greater risk than the risk entailed by each of its separate components. The main objective of this study is to compare the association between MS and 14 site-specific cancer against the association between one or two individual components of MS and cancer. The secondary objective is to evaluate the time elapsed since the diagnosis of MS and the subsequent onset of cancer within the 2006-2017 period by sex. Methods and analysis A case-control study will be conducted for the main objective and a cohort of patients with MS will be followed for the evaluation of the second objective. Incident cases of fourteen types of cancer in patients ≥40 years of age diagnosed prospectively will be selected from electronic primary care records in the Information System for Research in Primary Care (SIDIAP database; www.sidiap.org). The SIDIAP database includes anonymous data from 6 million people (80% of the Catalan population) registered in 286 ...

Urban outdoor play spaces are reported to improve children's health. However, there is little empirical evidence on the impact of outdoor play spaces on childhood mental and behavioral health. To fill this gap, we investigated the associations between residential proximity to outdoor play spaces and the prevalence of diagnosed mental and behavioral disorders. We explored whether these associations differ by individual and area-level socio-economic status (SES). This cross-sectional study included 151 110 children who were 0-12 years old in 2014 and were visited in public primary health care centers in Barcelona (Spain). Each child's demographic and mental and behavioral disorders information was extracted for 2005-2014, including diagnoses on disorders of psychological development together with other four types of mental and behavioral disorders. The pediatrician diagnosed mental and behavioral disorders we explored in this study were: mood/affective; neurotic, stress-related and somatoform; psychological development; behavioral and emotional; and overall mental and behavioral disorders. We assessed 300 m network buffer residential proximity to overall outdoor play spaces (i.e., the overall sum of play spaces of any type), outdoor green play spaces, and to a diversity of outdoor play spaces. We used robust Poisson regression models to investigate the association between proximity to outdoor play spaces indicators and each health outcome. We tested interaction terms for indicators of proximity to outdoor play spaces and individual and area SES. For measures with significant interaction terms, we conducted stratified models. We found residential proximity to outdoor play spaces to be protective of disorders of psychological development. Proximity to overall outdoor play spaces, proximity to outdoor green play spaces and proximity to a greater diversity of outdoor play spaces were associated with a 4% (95% CI: 1,7), 4% (95% CI: 1,7) and 5% (95% CI: 2,9) lower prevalence rates of disorders of psychological development respectively. Most of the associations were found to be in the same direction-although more pronounced-in low SES areas, but in the opposite direction for children living in high SES areas. No differences in these associations were found by individual SES. Residential proximity to outdoor play spaces is protective of children's mental and behavioral health living in low SES areas. ; This work was supported by the GREENLULU's Project under the European Union's Horizon 2020 research and innovation framework [grant number 678034]; the NATURVATION Project under the European Union's Horizon 2020 research and innovation framework [grant number 730243]; the ECHOCAT project of La Marató de TV3 Foundation [grant number 201621–30] and the the María de Maeztu Program for Units of Excellence of the Spanish Ministry of Science and Innovation [grant number CEX 2019-000940-M]. HC and MTM are funded by Juan de la Cierva fellowships awarded by the Spanish Ministry of Economy and Competitiveness [grant number FJCI-2018-035322 and FJCI-2017-33842]. The sponsors had no role in the design or analysis of this study.

Background: The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk monitoring of vaccines using existing healthcare databases in Europe. We estimated vaccine coverage from electronic healthcare databases as part of a fit-for-purpose assessment for vaccine benefit-risk studies. Methods: A retrospective dynamic cohort study was conducted through a distributed network approach. Coverage with measles-vaccine for birth year 2006, human papillomavirus (HPV)-vaccine for birth years 1990-2000 and influenza-vaccine for birth years 1920-1950 was estimated using period-prevalence and inverse probability weighting methods. Seven databases from four countries participated: Italy (Pedianet, Val Padana), Spain (BIFAP, SIDIAP), UK (RCGP-RSC, THIN), Denmark (SSI/AUH). Database access providers extracted the data, transformed it into a common structure and ran an R-script locally. The created output tables were shared and pooled at a central server. Results: The total study population comprised 274,616 persons for measles-vaccine, 2,011,666 persons for HPV-vaccine and 14,904,033 persons for influenza-vaccine. Measles-vaccine coverage varied from 84.3% (Denmark) to 96.5% (Italy, Val Padana) for the first dose and from 82.8% (Italy, Val Padana) to 90.9% (UK) for the second dose at the age of 7 years. The HPV-vaccine coverage, aggregated over birth years 1997-2000, ranged from 60% (UK) to 88.3% (Denmark) at the age of 15 years. The influenza-vaccine coverage for the influenza seasons from 2009 to 2015 for persons aged 65 years and more was roughly stable around 43% in Denmark and around 68% in the UK while a decrease from 58 to 50% was observed in Catalonia (Spain). Conclusions: We obtained detailed, age-specific coverage estimates though a common procedure. We discussed between database comparability and comparability to published national estimates. ; The Innovative Medicines Initiative Joint Undertaking funded this project under ADVANCE grant agreement no 115557, resources of which were composed of a financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and in kind contributions from EFPIA member companies. ; Braeye, T (reprint author), Sciensano, Rue Juliette Wytsman 14, B-1050 Brussels, Belgium. toon.braeye@sciensano.be

Objective: The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these associations. Design: Case-control study. Setting: Six European electronic health records databases. Participants: 291 780 cases at the date of first-recorded dementia diagnosis, compared with 29 170 549 controls randomly selected from the same databases, age matched and sex matched at this index date. Exposure: The following measures were extracted whenever recorded within each dataset: BMI (kg/m2), SBP and DBP (mm Hg) and serum total cholesterol (mmol/L). Levels for each of these variables were defined within six 2-year time intervals over the 12 years prior to the index date. Main outcomes: Case-control differences in exposures of interest were modelled for each time period and adjusted for demographic and clinical factors (ischaemic/unspecified stroke, type 2 diabetes mellitus, acute myocardial infarction, hypertension diagnosis, antihypertensive medication, cholesterol-lowering medication). Coefficients and interactions with time period were meta-analysed across the six databases. Results: Mean BMI (coefficient -1.16 kg/m2; 95% CI -1.38 to 0.93) and SBP (-2.83 mm Hg; 95% CI -4.49 to -1.16) were lower in cases at diagnosis, and case-control differences were greater in more recent time periods, as indicated by significant case-x-time interaction and case-x-time-squared interaction terms. Time variations in coefficients for cholesterol levels were less consistent between databases and those for DBP were largely not significant. Conclusion: Routine clinical data show emerging divergence in levels of BMI and SBP prior to the diagnosis of dementia but less evidence for DBP or total cholesterol levels. These divergences should receive at least some consideration in routine dementia risk screening, although underlying mechanisms still require further investigation. ; The research leading to these results has received support from the Innovative Medicines Initiative (IMI) Joint Undertaking under EMIF grant agreement n° 115372, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and EFPIA companies' in kind contribution. RS and GP are part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Biomedical Research Unit at South London and Maudsley NHS Foundation Trust and King's College London.

Introduction: Prenatal exposure to organochlorine compounds (OCs) can increase the risk of reported respiratory symptoms in children. It remains unclear whether these compounds can also impact on lung function. We assessed the association between prenatal exposure to OCs and lung function during childhood. Methods: We included 1308 mother-child pairs enrolled in a prospective cohort study. Prenatal concentrations of p,p′-dichlorodiphenyltrichloroethane [p,p′-DDT], p,p′-dichlorodiphenyldichloroethylene [p,p′-DDE], hexachlorobenzene [HCB], and seven polychlorinated biphenyls [PCBs] were measured in cord blood. Spirometry was performed in the offspring at ages 4 (n = 636) and 7 years (n = 1192). Results: More than 80% of samples presented quantifiable levels of p,p′-DDE, HCB, PCB-138, PCB-153, and PCB-180; p,p′-DDE was the compound with the highest median concentrations. At 4 years, prenatal p,p′-DDE exposure was associated with a decrease in forced expiratory volume in 1 s (FEV1) in all quartiles of exposure (e.g., third quartile [0.23–0.34 ng/mL]: β for FEV1 −53.61 mL, 95% CI −89.87, −17.35, vs. the lowest). Prenatal p,p′-DDE levels also decreased forced vital capacity (FVC) and FEV1/FVC, but associations did not reach statistical significance in most exposure quartiles. At 7 years, p,p′-DDE was associated with a decrease in FVC and FEV1 in only the second quartile of exposure (e.g. β for FEV1 −36.96 mL, 95% CI −66.22, −7.70, vs. the lowest). Prenatal exposure to HCB was associated with decreased FVC and FEV1, but in only the second quartile and at 7 years (e.g. [0.07–0.14 ng/mL]: β for FEV1 −25.79 mL, 95% CI −55.98, 4.39, vs. the lowest). PCBs were not consistently associated with lung function. Conclusion: Prenatal exposure to p,p′-DDE may decrease lung function during childhood, especially FEV1 and at medium levels of exposure. Further and deeper knowledge on the impact of environmental chemicals during pregnancy on lung development is needed. ; Gipuzkoa: This study was funded by grants from Instituto de Salud Carlos III (FIS-PI06/0867 and FIS-PI09/00090), CIBERESP, Department of Health of the Basque Government (2005111093, 2009111069, 2013111089 and 2015111065), and the Provincial Government of Gipuzkoa (DFG06/002, DFG08/001 and DFG15/221) and annual agreements with the municipalities of the study area (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain). Sabadell: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; PI041436; PI081151 incl. FEDER funds; CP16/00128), CIBERESP, Generalitat de Catalunya-CIRIT 1999SGR 00241, Generalitat de Catalunya-AGAUR 2009 SGR 501, Fundació La marató de TV3 (090430), EU Commission (261357). ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. Valencia: This study was funded by Grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), Instituto de Salud Carlos III (G03/176; FIS-FEDER: PI11/01007, PI11/02591, PI11/02038, PI12/00610, PI13/1944, PI13/2032, PI14/00891, PI14/01687, PI16/1288, and PI17/0663; Miguel Servet-FEDER CP11/00178, CP15/00025, and MSII16/00051), Alicia Koplowitz Foundation 2017, and Generalitat Valenciana: FISABIO (UGP 15-230, UGP-15-244, and UGP-15-249).

BackgroundIt is known that the COVID-19 pandemic and social isolation has increased anxiety, depression, and gender-based violence. However, to the best of our knowledge no studies have evaluated differences in the association between anxiety and depression symptomatology with concern about becoming infected with COVID-19, and the differential risk of suffering from gender-based violence among women with a previous mental disorder, and black women.
MethodsWe conducted a cross-sectional study among adults living in Brazil during the COVID-19 lockdown (20th June-30th August 2020). We administered an online questionnaire containing questions on socioeconomic characteristics, risk perception, confinement, health conditions, and gender-based violence. We ran two ordinal logistic regression models. In the first, we considered having a previous mental disorder and sex as the predictors, and concern about becoming infected with COVID-19 as the outcome. In the second model, we considered previous mental disorders and race as the predictors, and gender-based violence as the outcome. Depressive symptomatology and anxiety symptomatology was assessed through PHQ-9 and GAD-7, respectively.
FindingsPeople who declared that they suffered from depression had a 2% less chance of concern about becoming infected with COVID-19, while those with anxiety had an 11% higher chance. Women had 19% more chance of being very concerned about becoming infected with COVID-19, compared to men. Women with previous mental health disorders had a 34% higher chance of suffering from gender-based violence, compared to women who did not declare having a previous mental health disorder. Black women had a 54% higher chance of suffering from gender-based violence during the COVID-19 pandemic, compared to white women.
ConclusionsThis is the first study to demonstrate that black women and those with mental health problems are more likely to suffer from gender- based violence during the pandemic. These findings could be used in the preparation of protection policies focused on women in situations of major vulnerabilities, optimising interventions and enhancing resource allocation for those most in need, especially during pandemics.