M Vrijheid

Publications of M Vrijheid

• Ambient Air Pollution and Risk of Congenital Anomalies in England, 1991-99.

  Authors: Helen Dolk, Ben Armstrong, Kate Lachowycz, M Vrijheid, Judith Rankin, L Abramsky, Patricia Boyd, Diana Wellesley

  Occupational and environmental medicine. 10/2009;

  OBJECTIVES: To investigate whether there is an association between risk of congenital anomaly and annual ward level exposure to air pollution in England during the 1990s. METHODS: A geographicalOBJECTIVES: To investigate whether there is an association between risk of congenital anomaly and annual ward level exposure to air pollution in England during the 1990s. METHODS: A geographical study was conducted across four regions of England with population-based congenital anomaly registers, 1991-99. Exposure was measured as 1996 annual mean background SO2, PM10 and NO2 concentrations at census ward level (n=1474). Poisson regression, controlling for maternal age, area socioeconomic deprivation, and hospital catchment area was used to estimate relative risk for an increase in pollution from the 10th to the 90th centile. RESULTS: For non-chromosomal anomalies combined, relative risks were 0.99 (95%CI 0.93-1.05) for SO2, 0.97 (95%CI 0.84-1.11) for NO2, 0.89(95%CI 0.75-1.07) for PM10. For chromosomal anomalies, relative risks were 1.06 (95%CI 0.98-1.15) for SO2, 1.11 (95%CI 0.95-1.30) for NO2, 1.18 (0.97-1.42) for PM10. Raised risks were found for Tetralogy of Fallot and SO2 (RR=1.38, 95%CI 1.07-1.79), NO2 (RR=1.44, 95%CI 0.71-2.93) and PM10 (RR=1.48, 95%CI 0.57-3.84), of interest in the light of previously reported associations between this cardiac anomaly and other air pollutants. CONCLUSIONS: While air pollution in the 1990s did not lead to sustained geographical differences in overall congenital anomaly rate in England, further research regarding specific anomalies is indicated.

• Prevalence of congenital anomalies in five British regions, 1991-99.

  Authors: J Rankin, S Pattenden, L Abramsky, P Boyd, H Jordan, D Stone, M Vrijheid, D Wellesley, H Dolk

  Archives of disease in childhood. Fetal and neonatal edition. 10/2005; 90(5):F374-9.

  AIMS: To describe trends in total and live birth prevalence, regional differences in prevalence, and outcome of pregnancy of selected congenital anomalies. METHODS: Population based registry study ofAIMS: To describe trends in total and live birth prevalence, regional differences in prevalence, and outcome of pregnancy of selected congenital anomalies. METHODS: Population based registry study of 839,521 births to mothers resident in five geographical areas of Britain during 1991-99. Main outcome measures were: total and live birth prevalence; pregnancy outcome; proportion of stillbirths due to congenital anomalies; and secular trends. RESULTS: The sample consisted of 10,844 congenital anomalies, giving a total prevalence of 129 per 10,000 registered births (95% CI 127 to 132). Live birth prevalence was 82.2 per 10,000 births (95% CI 80.3 to 84.2) and declined significantly with time. The proportion of all stillbirths with a congenital anomaly was 10.5% (453 stillbirths). The proportion of pregnancies resulting in a termination increased from 27% (289 cases) in 1991 to 34.7% (384 cases) in 1999, whereas the proportion of live births declined from 68.2% (730 cases) to 58.5% (648 cases). Although similar rates of congenital anomaly groups were notified to the registers, variation in rates by register was present. There was a secular decline in the total prevalence of non-chromosomal and an increase in chromosomal anomalies. CONCLUSIONS: Regional variation exists in the prevalence of specific congenital anomalies. For some anomalies this can be partially explained by ascertainment variation. For others (neural tube defects, diaphragmatic hernia, gastroschisis), higher prevalence rates in the northern regions (Glasgow and Northern) were true differences. Live birth prevalence declined over the study due to an increase in terminations of pregnancy.

• Congenital anomaly surveillance in England--ascertainment deficiencies in the national system.

  Authors: P A Boyd, B Armstrong, H Dolk, B Botting, S Pattenden, L Abramsky, J Rankin, M Vrijheid, D Wellesley

  BMJ (Clinical research ed.). 02/2005; 330(7481):27.

  OBJECTIVE: Firstly, to assess the completeness of ascertainment in the National Congenital Anomaly System (NCAS), the basis for congenital anomaly surveillance in England and Wales, and its variationOBJECTIVE: Firstly, to assess the completeness of ascertainment in the National Congenital Anomaly System (NCAS), the basis for congenital anomaly surveillance in England and Wales, and its variation by defect, geographical area, and socioeconomic deprivation. Secondly, to assess the impact of the lack of data on pregnancies terminated because of fetal anomaly. DESIGN: Comparison of the NCAS with four local congenital anomaly registers in England. SETTING: Four regions in England covering some 109,000 annual births. PARTICIPANTS: Cases of congenital anomalies registered in the NCAS (live births and stillbirths) and independently registered in the four local registers (live births, stillbirths, fetal losses from 20 weeks' gestation, and pregnancies terminated after prenatal diagnosis of fetal anomaly). MAIN OUTCOME MEASURE: The ratio of cases identified by the national register to those in local registry files, calculated for different specified anomalies, for whole registry areas, and for hospital catchment areas within registry boundaries. RESULTS: Ascertainment by the NCAS (compared with data from local registers, from which terminations of pregnancy were removed) was 40% (34% for chromosomal anomalies and 42% for non-chromosomal anomalies) and varied markedly by defect, by local register, and by hospital catchment area, but not by area deprivation. When terminations of pregnancy were included in the register data, ascertainment by NCAS was 27% (19% for chromosomal anomalies and 31% for non-chromosomal anomalies), and the geographical variation was of a similar magnitude. CONCLUSION: The surveillance of congenital anomalies in England is currently inadequate because ascertainment to the national register is low and non-uniform and because no data exist on termination of pregnancy resulting from prenatal diagnosis of fetal anomaly.

• Risk of congenital anomalies near the Byker waste combustion plant.

  Authors: P A Cresswell, J E S Scott, S Pattenden, M Vrijheid

  Journal of public health medicine. 10/2003; 25(3):237-42.

  BACKGROUND: The aim of this study was to determine whether the risk of congenital anomalies in a population resident close to a waste combustion plant located at Byker in the city of Newcastle uponBACKGROUND: The aim of this study was to determine whether the risk of congenital anomalies in a population resident close to a waste combustion plant located at Byker in the city of Newcastle upon Tyne, United Kingdom, was higher than in a population resident further away. METHODS: A geographical study was carried out on the prevalence of congenital anomalies in residents living within 3 km (inner zone) of the Byker combustion plant compared with those living 3-7 km (outer zone) from the plant. There were 81255 live births (1985-1999) and 1508 cases with chromosomal and non-chromosomal congenital anomalies. The cases were identified from the Northern Region Congenital Abnormality Survey. RESULTS: After the site commenced operation the estimated rate ratio (inner versus outer zone) was 1.11 (95 per cent confidence interval (CI) 0.96-1.28) adjusted for socio-economic deprivation. There was significant heterogeneity across years and an increasing trend, of marginal significance (p = 0.07), in the rate ratio. The inner zone rate approached or became significantly higher than that in the outer zone in some of the later years. CONCLUSIONS: No significant overall association between the number of congenital anomalies and proximity of residence to the Byker waste combustion plant has been found in this study. Significantly increased rates near the site during the later years may suggest a possible risk but are difficult to interpret. More comprehensive, multi-site investigations around other waste combustion plants are indicated.

• Risk of hypospadias in relation to maternal occupational exposure to potential endocrine disrupting chemicals.

  Authors: M Vrijheid, B Armstrong, H Dolk, M van Tongeren, B Botting

  Occupational and environmental medicine. 09/2003; 60(8):543-50.

  BACKGROUND: Reported rises in the prevalence of hypospadias and other abnormalities of the male reproductive system may be a result of exposure to endocrine disrupting chemicals. AIMS: To analyse theBACKGROUND: Reported rises in the prevalence of hypospadias and other abnormalities of the male reproductive system may be a result of exposure to endocrine disrupting chemicals. AIMS: To analyse the relation between risk of hypospadias and maternal occupation, particularly with regard to exposure to potential endocrine disrupting chemicals (EDCs). METHODS: Data (1980-96) from the National Congenital Anomaly System (NCAS) were used to analyse the proportion of all congenital anomaly cases (n = 35 962) which were notified with hypospadias (n = 3471) by occupational codes (348 individual job titles) and by categories of exposure to potential EDCs from a job exposure matrix. RESULTS: Five individual occupations (of 348) showed nominally statistically significant excesses, none of which had possible or probable exposure to potential EDCs. Odds ratios for "possible" or "probable" compared to "unlikely" exposure to potential EDCs did not show statistically significant increases in any of the EDC categories after adjustment for social class of the mother and father, nor was there evidence of an upward trend in risk with likelihood of exposure. In the 1992-96 time period odds ratios were increased for hairdressers (the largest group exposed to potential EDCs) and for probable exposure to phthalates (of which hairdressers form the largest group) before social class adjustment. CONCLUSIONS: There was little evidence for a relation between risk of hypospadias and maternal occupation or occupational exposure to potential EDCs, but as the exposure classification was necessarily crude, these findings should be interpreted with caution.

• Hazard potential ranking of hazardous waste landfill sites and risk of congenital anomalies.

  Authors: M Vrijheid, H Dolk, B Armstrong, G Boschi, A Busby, T Jorgensen, P Pointer

  Occupational and environmental medicine. 12/2002; 59(11):768-76.

  BACKGROUND: A 33% increase in the risk of congenital anomalies has been found among residents near hazardous waste landfill sites in a European collaborative study (EUROHAZCON). AIMS: To develop andBACKGROUND: A 33% increase in the risk of congenital anomalies has been found among residents near hazardous waste landfill sites in a European collaborative study (EUROHAZCON). AIMS: To develop and evaluate an expert panel scoring method of the hazard potential of EUROHAZCON landfill sites, and to investigate whether sites classified as posing a greater potential hazard are those with a greater risk of congenital anomaly among nearby residents relative to more distant residents. METHODS: A total of 1270 cases of congenital anomaly and 2308 non-malformed control births were selected in 14 study areas around 20 landfill sites. An expert panel of four landfill specialists scored each site in three categories-overall, water, and air hazard-based on readily available, documented data on site characteristics. Tertiles of the average ranking scores defined low, medium, and high hazard sites. Calculation of odds ratios was based on distance of residence from the sites, comparing a 0-3 km "proximate" with a 3-7 km "distant" zone. RESULTS: Agreement between experts measured by intraclass correlation coefficients was 0.50, 0.44, and 0.20 for overall, water, and air hazard before a consensus meeting and 0.60, 0.56, and 0.53 respectively after this meeting. There was no evidence for a trend of increasing odds ratios with increasing overall hazard or air hazard. For non-chromosomal anomalies, odds ratios by water hazard category showed an increasing trend of borderline statistical significance (p = 0.06) from 0.79 in the low hazard category, 1.43 in the medium, to 1.60 in the high water hazard category. CONCLUSIONS: There is little evidence for a relation between risk of congenital anomaly in proximate relative to distant zones and hazard potential of landfill sites as classified by the expert panel, but without external validation of the hazard potential scoring method interpretation is difficult. Potential misclassification of sites may have reduced our ability to detect any true dose-response effect.

• Chromosomal congenital anomalies and residence near hazardous waste landfill sites.

  Authors: M Vrijheid, H Dolk, B Armstrong, L Abramsky, F Bianchi, I Fazarinc, E Garne, R Ide, V Nelen, E Robert, J E S Scott, D Stone, R Tenconi

  Lancet. 02/2002; 359(9303):320-2.

  Previous findings of the EUROHAZCON study showed a 33% increase in risk of non-chromosomal anomalies near hazardous waste landfill sites. Here, we studied 245 cases of chromosomal anomalies and 2412Previous findings of the EUROHAZCON study showed a 33% increase in risk of non-chromosomal anomalies near hazardous waste landfill sites. Here, we studied 245 cases of chromosomal anomalies and 2412 controls who lived near 23 such sites in Europe. After adjustment for confounding by maternal age and socioeconomic status, we noted a higher risk of chromosomal anomalies in people who lived close to sites (0-3 km) than in those who lived further away (3-7 km; odds ratio 1.41, 95% CI 1.00-1.99). Our results suggest an increase in risk of chromosomal anomalies similar to that found for non-chromosomal anomalies.

• Stillbirth and neonatal mortality due to congenital anomalies: temporal trends and variation by small area deprivation scores in England and Wales, 1986-96.

  Authors: D Neasham, H Dolk, M Vrijheid, T Jensen, N Best

  Paediatric and perinatal epidemiology. 11/2001; 15(4):364-73.

  We investigated the variation of stillbirth and neonatal mortality due to congenital anomalies in relation to small-area measures of deprivation in a population-based study in England and Wales,We investigated the variation of stillbirth and neonatal mortality due to congenital anomalies in relation to small-area measures of deprivation in a population-based study in England and Wales, 1986-96. We found 10 954 stillbirths and neonatal deaths from all non-chromosomal and chromosomal anomalies during the study period out of a total of 7 487 007 live and stillbirths. The extended perinatal mortality rate (EPM rate) (defined as babies who were stillborn or died within 28 completed days after birth per 10 000 total live and stillbirths) for all chromosomal and all non-chromosomal anomalies was 1.5/10 000 and 13.2/10 000, respectively, over the whole period. The rate for non-chromosomal anomalies halved over the decade while the rate for chromosomal anomalies remained unchanged. The relative risks of EPM for chromosomal and non-chromosomal anomalies were 0.71 [0.80, 0.95] and 1.17 [95%CI 1.06, 1.30], respectively, in the group of wards with highest deprivation compared with the least deprived group. Increasing gradients of EPM with increasing deprivation were observed for (1) grouped non-chromosomal anomalies including neural tube defects, all renal and urinary anomalies, all musculoskeletal anomalies, and multiple anomalies, and (2) several specific non-chromosomal anomalies including anencephaly, limb reduction defects, diaphragm and abdominal wall defects. This study provides strong evidence that increased deprivation is associated with increased EPM due to most non-chromosomal anomalies; the finding of decreased relative risk for chromosomal anomalies is probably related to differences in maternal age distribution between deprivation groups.

• Socioeconomic inequalities in risk of congenital anomaly.

  Authors: M Vrijheid, H Dolk, D Stone, L Abramsky, E Alberman, J E Scott

  Archives of disease in childhood. 06/2000; 82(5):349-52.

  AIMS: To investigate socioeconomic inequalities in the risk of congenital anomalies, focusing on risk of specific anomaly subgroups. METHODS: A total of 858 cases of congenital anomaly and 1764AIMS: To investigate socioeconomic inequalities in the risk of congenital anomalies, focusing on risk of specific anomaly subgroups. METHODS: A total of 858 cases of congenital anomaly and 1764 non-malformed control births were collected between 1986 and 1993 from four UK congenital malformation registers, for the purposes of a European multicentre case control study on congenital anomaly risk near hazardous waste landfill sites. As a measure of socioeconomic status, cases and controls were given a value for the area level Carstairs deprivation index, by linking the postcode of residence at birth to census enumeration districts (areas of approximately 150 households). RESULTS: Risk of non-chromosomal anomalies increased with increasing socioeconomic deprivation. The risk in the most deprived quintile of the deprivation index was 40% higher than in the most affluent quintile. Some malformation subgroups also showed increasing risk with increasing deprivation: all cardiac defects, malformations of the cardiac septa, malformations of the digestive system, and multiple malformations. No evidence for socioeconomic variation was found for other non-chromosomal malformation groups, including neural tube defects and oral clefts. A decreasing risk with increasing deprivation found for all chromosomal malformations and Down's syndrome in unadjusted analyses, occurred mainly as a result of differences in the maternal age distribution between social classes. CONCLUSION: Our data, although based on limited numbers of cases and geographical coverage, suggest that more deprived populations have a higher risk of congenital anomalies of non-chromosomal origin and some specific anomalies. Larger studies are needed to confirm these findings and to explore their aetiological implications.

• Health effects of residence near hazardous waste landfill sites: a review of epidemiologic literature.

  Authors: M Vrijheid

  Environmental health perspectives. 04/2000; 108 Suppl 1:101-12.

  This review evaluates current epidemiologic literature on health effects in relation to residence near landfill sites. Increases in risk of adverse health effects (low birth weight, birth defects,This review evaluates current epidemiologic literature on health effects in relation to residence near landfill sites. Increases in risk of adverse health effects (low birth weight, birth defects, certain types of cancers) have been reported near individual landfill sites and in some multisite studies, and although biases and confounding factors cannot be excluded as explanations for these findings, they may indicate real risks associated with residence near certain landfill sites. A general weakness in the reviewed studies is the lack of direct exposure measurement. An increased prevalence of self-reported health symptoms such as fatigue, sleepiness, and headaches among residents near waste sites has consistently been reported in more than 10 of the reviewed papers. It is difficult to conclude whether these symptoms are an effect of direct toxicologic action of chemicals present in waste sites, an effect of stress and fears related to the waste site, or an effect of reporting bias. Although a substantial number of studies have been conducted, risks to health from landfill sites are hard to quantify. There is insufficient exposure information and effects of low-level environmental exposure in the general population are by their nature difficult to establish. More interdisciplinary research can improve levels of knowledge on risks to human health of waste disposal in landfill sites. Research needs include epidemiologic and toxicologic studies on individual chemicals and chemical mixtures, well-designed single- and multisite landfill studies, development of biomarkers, and research on risk perception and sociologic determinants of ill health.

• Inequalities in low birth weight: parental social class, area deprivation, and "lone mother" status.

  Authors: S Pattenden, H Dolk, M Vrijheid

  Journal of epidemiology and community health. 07/1999; 53(6):355-8.

  OBJECTIVE: To describe the extent of socioeconomic inequalities in low birth weight. To assess the relative benefits of measuring socioeconomic status by individual occupation, socioeconomicOBJECTIVE: To describe the extent of socioeconomic inequalities in low birth weight. To assess the relative benefits of measuring socioeconomic status by individual occupation, socioeconomic deprivation status of area of residence, or both, for describing inequalities and targeting resources. DESIGN: Analysis of birth registrations by registration status: joint compared with sole registrants ("lone mothers"), routinely recorded parental occupation (father's for joint registrants), and census derived enumeration district (ED) deprivation. SETTING: England and Wales, 1986-92. SUBJECTS: 471,411 births with coded parental occupation (random 10% sample) and birth weight. MAIN OUTCOME MEASURES: Proportion of low birth weight (< 2500 g) RESULTS: 34% of births to joint registrants in social classes IV and V, and 45% of births to sole registrants, were in the quintile of most deprived EDs. It was found that 6.8% of births were of low birth weight. Sole registrants were at higher risk (9.3% overall) than joint registrants, across all deprivation quintiles. For joint registrants, the socioeconomic risk gradient was similar by social class or area deprivation, but a greater gradient from 4.7% to 8.7% was found with combined classification. CONCLUSIONS: Up to 30% of low birth weight can be seen as being associated with levels of socioeconomic deprivation below that of the most affluent group, as measured in this study. Caution is needed when targeting interventions to high risk groups when using single indicators. For example, the majority of births to lone mothers and to joint registrants in social classes IV and V would be missed by targeting the most deprived quintile. There is a high degree of inequality in low birth weight according to social class, area deprivation and lone mother status. When using routinely recorded birth and census data, all three factors are important to show the true extent of inequalities.

• Immaturity related lung hypoplasia: comment on current classification in neonatal death statistics.

  Authors: M Vrijheid, H Dolk

  Archives of disease in childhood. Fetal and neonatal edition. 10/1998; 79(2):F159.

• Risk of congenital anomalies near hazardous-waste landfill sites in Europe: the EUROHAZCON study.

  Authors: H Dolk, M Vrijheid, B Armstrong, L Abramsky, F Bianchi, E Garne, V Nelen, E Robert, J E Scott, D Stone, R Tenconi

  Lancet. 09/1998; 352(9126):423-7.

  BACKGROUND: Waste-disposal sites are a potential hazard to health. This study is a multicentre case-control study of the risk of congenital anomalies associated with residence near hazardous-wasteBACKGROUND: Waste-disposal sites are a potential hazard to health. This study is a multicentre case-control study of the risk of congenital anomalies associated with residence near hazardous-waste landfill sites in Europe. METHODS: We used data from seven regional registers of congenital anomalies in five countries. We studied 1089 livebirths, stillbirths, and terminations of pregnancy with non-chromosomal congenital anomalies and 2366 control births without malformation, whose mothers resided within 7 km of a landfill site; 21 sites were included. A zone within 3 km radius of each site was defined as the "proximate zone" of most likely exposure to teratogens. FINDINGS: Residence within 3 km of a landfill site was associated with a significantly raised risk of congenital anomaly (295 cases/511 controls living 0-3 km from sites, 794/1855 living 3-7 km from sites; combined odds ratio 1.33 [95% CI 1.11-1.59], adjusted for maternal age and socioeconomic status). There was a fairly consistent decrease in risk with distance away from the sites. A significantly raised odds ratio for residence within 3 km of a landfill site was found for neural-tube defects (odds ratio 1.86 [1.24-2.79]), malformations of the cardiac septa (1.49 [1.09-2.04]), and anomalies of great arteries and veins (1.81 [1.02-3.20]). Odds ratios of borderline significance were found for tracheo-oesophageal anomalies (2.25 [0.96-5.26]), hypospadias (1.96 [0.98-3.92]), and gastroschisis (3.19 [0.95-10.77]). There was little evidence of differences in risk between landfill sites but power to detect such differences was low. INTERPRETATION: This study shows a raised risk of congenital anomaly in babies whose mothers live close to landfill sites that handle hazardous chemical wastes, although there is a need for further investigation of whether the association of raised risk of congenital anomaly and residence near landfill sites is a causal one. Apparent differences between malformation subgroups should be interpreted cautiously.

• Who are the 'low energy reporters' in the dietary and nutritional survey of British adults?

  Authors: J A Pryer, M Vrijheid, R Nichols, M Kiggins, P Elliott

  International journal of epidemiology. 03/1997; 26(1):146-54.

  BACKGROUND: Underreportin in dietary surveys is a potential source of bias in studies of diet and disease. The aim of this study was to identify characteristics of men and women participants in theBACKGROUND: Underreportin in dietary surveys is a potential source of bias in studies of diet and disease. The aim of this study was to identify characteristics of men and women participants in the Dietary and Nutritional Survey of British Adults (DNSBA) who stated that they were neither slimming nor ill, and who reported an average energy intake over a 7-day period below 1.2 times estimated basal metabolic rate (BMR), termed here 'low energy reporters' (LER). METHODS: In all, 2197 men and women aged 16-64 years participated in the DNSBA. Dietary intake was assessed using the 7-day weighed intake method. Their BMR was estimated using predictive equations based upon age, sex and body weight. RESULTS: Compared with non-LER, LER had higher mean ratios of urinary urea nitrogen to dietary nitrogen and urinary potassium to dietary potassium, indicating that, as a group, LER were underreporting at least for protein and potassium intakes. Overall LER were overrepresented among the manual social classes, smokers, and self-reported non-alcohol drinkers, and were on average heavier than non-LER. There was indication of differential reporting of foods and differences in macronutrient and micronutrient densities between LER and non-LER. CONCLUSION: These results suggest that LER may be overrepresented within specific population subgroups and that underreporting bias may not be food and nutrient neutral. This has implications for the design and interpretation of studies of diet and disease.

• Perinatal and infant mortality and low birth weight among residents near cokeworks in Great Britain.

  Authors: H Dolk, S Pattenden, M Vrijheid, B Thakrar, B Armstrong

  Archives of environmental health. 55(1):26-30.

  With growing evidence of the adverse health effects of air pollution--especially fine particulates--investigators must concentrate on the fetus, neonate, and infant as potentially vulnerable groups.With growing evidence of the adverse health effects of air pollution--especially fine particulates--investigators must concentrate on the fetus, neonate, and infant as potentially vulnerable groups. Cokeworks are a major source of smoke and sulfur dioxide. In the current study, the authors investigated whether populations residing near cokeworks had a higher risk of adverse perinatal and infant outcomes. Zones of 7.5-km radius around 22 cokeworks in Great Britain were studied, within which the authors assumed that exposure declined from highest levels within 2 km to background levels. Routinely recorded birth and death data for Great Britain during the period 1981-1992 were analyzed. Each individual record had a postcode that referred to a small geographical area of typically 15-17 addresses. The authors calculated expected numbers on the basis of regional rates, stratified by year, sex, and a small-area socioeconomic deprivation score. For all cokeworks combined, the observed/expected ratio (95% confidence intervals within parentheses) within 2 km of cokeworks was 1.00 (0.95, 1.06) for low-birth-weight (i.e., < 2,500 g) infants; 0.94 (0.78, 1.12) for still births; 0.95 (0.83, 1.09) for infant mortality; 0.86 (0.72, 1.03) for neonatal mortality; 1.10 (0.90, 1.33) for postneonatal mortality; 0.79 (0.30, 1.46) for respiratory postneonatal mortality; and 1.07 (0.77, 1.43) for postneonatal Sudden Infant Death Syndrome. Respiratory postneonatal mortality was low throughout the entire 0-7.5-km study area (observed/expected = 0.74 [0.61, 0.88]). There was no statistically significant decline in risk with distance from cokeworks for any of the outcomes studied. The authors concluded that there was no evidence of an increased risk of low birth weight, stillbirths, and/or neonatal mortality near cokeworks, and there was no strong evidence for any association between residence near cokeworks and postneonatal mortality. One must remember, however, the limited statistical power of the study to detect small risks.

• Toward the effective surveillance of hypospadias

  Authors: MC Addor, B Botting, E Calzolari, VC de, WH De, H Dolk, S Garcia-Minaur, E Garne, M Loane, N Physick, A Pierini, JES Scott, D Stone, R Tenconi, M Vrijheid, A Wiesel