Imperial College London

Professor Mireille B Toledano

Faculty of MedicineSchool of Public Health

Mohn Chair; Population Child Health & Director-Mohn Centre
 
 
 
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Contact

 

m.toledano Website

 
 
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Location

 

525Medical SchoolSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

154 results found

Traini E, Smith RB, Vermeulen R, Kromhout H, Schüz J, Feychting M, Auvinen A, Poulsen AH, Deltour I, Muller DC, Heller J, Tettamanti G, Elliott P, Huss A, Toledano MBet al., 2024, Headache in the international cohort study of mobile phone use and health (COSMOS) in the Netherlands and the United Kingdom, Environmental Research, Vol: 248, ISSN: 0013-9351

Headache is a common condition with a substantial burden of disease worldwide. Concerns have been raised over the potential impact of long-term mobile phone use on headache due to radiofrequency electromagnetic fields (RF-EMFs). We explored prospectively the association between mobile phone use at baseline (2009-2012) and headache at follow-up (2015-2018) by analysing pooled data consisting of the Dutch and UK cohorts of the Cohort Study of Mobile Phone Use and Health (COSMOS) (N = 78,437). Frequency of headache, migraine, and information on mobile phone use, including use of hands-free devices and frequency of texting, were self-reported. We collected objective operator data to obtain regression calibrated estimates of voice call duration. In the model mutually adjusted for call-time and text messaging, participants in the high category of call-time showed an adjusted odds ratio (OR) of 1.04 (95 % CI: 0.94-1.15), with no clear trend of reporting headache with increasing call-time. However, we found an increased risk of weekly headache (OR = 1.40, 95 % CI: 1.25-1.56) in the high category of text messaging, with a clear increase in reporting headache with increasing texting. Due to the negligible exposure to RF-EMFs from texting, our results suggest that mechanisms other than RF-EMFs are responsible for the increased risk of headache that we found among mobile phone users.

Journal article

Shen C, Smith RB, Heller J, Spiers ADV, Thompson R, Ward H, Roiser JP, Nicholls D, Toledano MBet al., 2024, Depression and anxiety in adolescents during the COVID-19 pandemic in relation to the use of digital technologies: longitudinal cohort study, Journal of Medical Internet Research, Vol: 26, ISSN: 1438-8871

BACKGROUND: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. OBJECTIVE: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. METHODS: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. RESULTS: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3%; anxiety: 125/425, 29.4%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5%; anxiety: 58/425, 13.6%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95% CI 1.5-4.18) and anxiety (OR 2.11, 95% CI 1.23-3.61) at T2. A high level of total mobile

Journal article

Jose S, Zalin-Miller A, Knott C, Paley L, Tataru D, Morement H, Toledano MB, Khan SAet al., 2023, Cohort study to assess geographical variation in cholangiocarcinoma treatment in England., World J Gastrointest Oncol, Vol: 15, Pages: 2077-2092, ISSN: 1948-5204

BACKGROUND: Outcomes for cholangiocarcinoma (CCA) are extremely poor owing to the complexities in diagnosing and managing a rare disease with heterogenous sub-types. Beyond curative surgery, which is only an option for a minority of patients diagnosed at an early stage, few systemic therapy options are currently recommended to relieve symptoms and prolong life. Stent insertion to manage disease complications requires highly specialised expertise. Evidence is lacking as to how CCA patients are managed in a real-world setting and whether there is any variation in treatments received by CCA patients. AIM: To assess geographic variation in treatments received amongst CCA patients in England. METHODS: Data used in this cohort study were drawn from the National Cancer Registration Dataset (NCRD), Hospital Episode Statistics and the Systemic Anti-Cancer Therapy Dataset. A cohort of 8853 CCA patients diagnosed between 2014-2017 in the National Health Service in England was identified from the NCRD. Potentially curative surgery for all patients and systemic therapy and stent insertion for 7751 individuals who did not receive surgery were identified as three end-points of interest. Linear probability models assessed variation in each of the three treatment modalities according to Cancer Alliance of residence at diagnosis, and for socio-demographic and clinical characteristics at diagnosis. RESULTS: Of 8853 CCA patients, 1102 (12.4%) received potentially curative surgery. The mean [95% confidence interval (CI)] percentage-point difference from the population average ranged from -3.96 (-6.34 to -1.59)% to 3.77 (0.54 to 6.99)% across Cancer Alliances in England after adjustment for patient sociodemographic and clinical characteristics, showing statistically significant variation. Amongst 7751 who did not receive surgery, 1542 (19.9%) received systemic therapy, with mean [95%CI] percentage-point difference from the population average between -3.84 (-8.04 to 0.35)% to 9.28 (1.76 t

Journal article

Patjamontri S, Spiers A, Smith R, Shen C, Adaway J, Keevil BG, Toledano M, Ahmed SFet al., 2023, Salivary androgens in adolescence and their value as a marker of puberty: results from the SCAMP cohort, Endocrine Connections, Vol: 12, ISSN: 2049-3614

Context: Salivary androgens represent non-invasive biomarkers of puberty that may have utility in clinical and population studies.Objective: To understand normal age-related variation in salivary sex steroids and demonstrate their correlation to pubertal development in young adolescents.Design, Setting, and participants: School-based cohort study of 1,495 adolescents at two time points for collecting saliva samples approximately two years apart.Outcome measures: The saliva samples were analyzed for five androgens (testosterone, androstenedione (A4), 17-hydroxyprogesterone (17-OHP), 11-ketotestosterone (11-KT) and 11β-hydroxyandrostenedione (11-OHA4)) using LC-MS/MS; in addition, salivary dehydroepiandrosterone (DHEA) and oestradiol (OE2) were analyzed by ELISA. Pubertal staging was self-reported using the pubertal development scale (PDS).Results: In 1,236 saliva samples from 903 boys aged between 11-16 years, salivary androgens except DHEA exhibited an increasing trend with an advancing age (ANOVA, p<0.001), with salivary testosterone and A4 concentration showing the strongest correlation (r=0.55, p<0.001 and r=0.48, p<0.001, respectively). In a subgroup analysis of 155 and 63 saliva samples in boys and girls, respectively morning salivary testosterone concentrations showed the highest correlation with composite PDS scores and voice-breaking category from PDS self-report in boys (r=0.75, r=0.67, respectively). In girls, salivary DHEA and OE2 had negligible correlations with age or composite PDS scores.Conclusion: In boys aged 11-16 years, increase in salivary testosterone and A4 is associated with self-reported pubertal progress and represent valid non-invasive biomarkers of puberty in boys.

Journal article

Reedijk M, Portengen L, Auvinen A, Kojo K, Heinävaara S, Feychting M, Tettamanti G, Hillert L, Elliott P, Toledano M, Smith R, Heller J, Schüz J, Deltour I, Harbo Poulsen A, Johansen C, Verheij R, Peeters P, Rookus M, Traini E, Huss A, Kromhout H, Vermeulen Ret al., 2023, Regression calibration of self-reported mobile phone use to optimize quantitative risk estimation in the COSMOS study, American Journal of Epidemiology, ISSN: 0002-9262

Journal article

Lawrance E, Thompson R, Roberts L, Grailey K, Ashrafian H, Maheswaran H, Toledano M, Darzi Aet al., 2023, Ambient temperature and mental health: a systematic review and meta analysis, The Lancet Planetary Health, Vol: 7, Pages: e580-e589, ISSN: 2542-5196

BackgroundIncreasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes.MethodsWe did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach.Findings114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8–2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3–3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associa

Journal article

Zalin-Miller A, Jose S, Knott C, Paley L, Tataru D, Morement H, Toledano MB, Khan SAet al., 2023, Regional variation in routes to diagnosis of cholangiocarcinoma in England from 2006 to 2017, WORLD JOURNAL OF GASTROENTEROLOGY, Vol: 29, Pages: 3825-3842, ISSN: 1007-9327

Journal article

Bennett J, Rashid T, Zolfaghari A, Doyle Y, Suel E, Pearson-Stuttard J, Davies B, Fecht D, Muller ES, Nathvani RS, Sportiche N, Daby H, Johnson E, Li G, Flaxman S, Toledano M, Asaria M, Ezzati Met al., 2023, Changes in life expectancy and house prices in London from 2002 to 2019: Hyper-resolution spatiotemporal analysis of death registration and real estate data, The Lancet Regional Health Europe, Vol: 27, Pages: 1-13, ISSN: 2666-7762

Background:London has outperformed smaller towns and rural areas in terms of life expectancy increase. Our aim was to investigate life expectancy change at very-small-area level, and its relationship with house prices and their change.Methods:We performed a hyper-resolution spatiotemporal analysis from 2002 to 2019 for 4835 London Lower-layer Super Output Areas (LSOAs). We used population and death counts in a Bayesian hierarchical model to estimate age- and sex-specific death rates for each LSOA, converted to life expectancy at birth using life table methods. We used data from the Land Registry via the real estate website Rightmove (www.rightmove.co.uk), with information on property size, type and land tenure in a hierarchical model to estimate house prices at LSOA level. We used linear regressions to summarise how much life expectancy changed in relation to the combination of house prices in 2002 and their change from 2002 to 2019. We calculated the correlation between change in price and change in sociodemographic characteristics of the resident population of LSOAs and population turnover.Findings:In 134 (2.8%) of London's LSOAs for women and 32 (0.7%) for men, life expectancy may have declined from 2002 to 2019, with a posterior probability of a decline >80% in 41 (0.8%, women) and 14 (0.3%, men) LSOAs. The life expectancy increase in other LSOAs ranged from <2 years in 537 (11.1%) LSOAs for women and 214 (4.4%) for men to >10 years in 220 (4.6%) for women and 211 (4.4%) for men. The 2.5th-97.5th-percentile life expectancy difference across LSOAs increased from 11.1 (10.7–11.5) years in 2002 to 19.1 (18.4–19.7) years for women in 2019, and from 11.6 (11.3–12.0) years to 17.2 (16.7–17.8) years for men. In the 20% (men) and 30% (women) of LSOAs where house prices had been lowest in 2002, mainly in east and outer west London, life expectancy increased only in proportion to the rise in house prices. In contrast, in the 30% (men) and

Journal article

Gazula H, Rootes-Murdy K, Holla B, Basodi S, Zhang Z, Verner E, Kelly R, Murthy P, Chakrabarti A, Basu D, Nanjayya SB, Singh RL, Singh RL, Kalyanram K, Kartik K, Kalyanaraman K, Ghattu K, Kuriyan R, Kurpad SS, Barker GJ, Bharath RD, Desrivieres S, Purushottam M, Orfanos DP, Sharma E, Hickman M, Toledano M, Vaidya N, Banaschewski T, Bokde ALW, Flor H, Grigis A, Garavan H, Gowland P, Heinz A, Bruhl R, Martinot J-L, Martinot M-LP, Artiges E, Nees F, Paus T, Poustka L, Frohner JH, Robinson L, Smolka MN, Walter H, Winterer J, Whelan R, Turner JA, Sarwate AD, Plis SM, Benegal V, Schumann G, Calhoun VDet al., 2023, Federated Analysis in COINSTAC Reveals Functional Network Connectivity and Spectral Links to Smoking and Alcohol Consumption in Nearly 2,000 Adolescent Brains, NEUROINFORMATICS, Vol: 21, Pages: 287-301, ISSN: 1539-2791

Journal article

Sharma E, Ravi GS, Kumar K, Thennarasu K, Heron J, Hickman M, Vaidya N, Holla B, Rangaswamy M, Mehta UM, Krishna M, Chakrabarti A, Basu D, Nanjayya SB, Singh RL, Lourembam R, Kumaran K, Kuriyan R, Kurpad SS, Kartik K, Kalyanram K, Desrivieres S, Barker G, Orfanos DP, Toledano M, Purushottam M, Bharath RD, Murthy P, Jain S, Schumann G, Benegal Vet al., 2023, Growth trajectories for executive and social cognitive abilities in an Indian population sample: Impact of demographic and psychosocial determinants, ASIAN JOURNAL OF PSYCHIATRY, Vol: 82, ISSN: 1876-2018

Journal article

Thompson R, Smith RB, Bou Karim Y, Shen C, Drummond K, Teng C, Toledano MBet al., 2023, Air pollution and human cognition: a systematic review and meta-analysis, Science of the Total Environment, Vol: 859, ISSN: 0048-9697

Background:This systematic review summarises and evaluates the literature investigating associations between exposure to air pollution and general population cognition, which has important implications for health, social and economic inequalities, and human productivity.Methods:The engines MEDLINE, Embase Classic+Embase, APA PsycInfo, and SCOPUS were searched up to May 2022. Our inclusion criteria focus on the following pollutants: particulate matter, NOx, and ozone. The cognitive abilities of interest are: general/global cognition, executive function, attention, working memory, learning, memory, intelligence and IQ, reasoning, reaction times, and processing speed. The collective evidence was assessed using the NTP-OHAT framework and random-effects meta-analyses.Results:Eighty-six studies were identified, the results of which were generally supportive of associations between exposures and worsened cognition, but the literature was varied and sometimes contradictory. There was moderate certainty support for detrimental associations between PM2.5 and general cognition in adults 40+, and PM2.5, NOx, and PM10 and executive function (especially working memory) in children. There was moderate certainty evidence against associations between ozone and general cognition in adults age 40+, and NOx and reasoning/IQ in children. Some associations were also supported by meta-analysis (N = 14 studies, all in adults aged 40+). A 1 μg/m3 increase in NO2 was associated with reduced performance on general cognitive batteries (β = −0.02, p < 0.05) as was a 1 μg/m3 increase in PM2.5 exposure (β = −0.02, p < 0.05). A 1μgm3 increase in PM2.5 was significantly associated with lower verbal fluency by −0.05 words (p = 0.01) and a decrease in executive function task performance of −0.02 points (p < 0.001).Discussion:Evidence was found in support of some exposure-outcome associations, however more good quality research is required, particula

Journal article

Eeftens M, Shen C, Sonksen J, Schmutz C, van Wel L, Liorni I, Vermeulen R, Cardis E, Wiart J, Toledano M, Roosli Met al., 2023, Modelling of daily radiofrequency electromagnetic field dose for a prospective adolescent cohort, Environment International, Vol: 172, ISSN: 0160-4120

IntroductionRadiofrequency electromagnetic fields originate from a variety of wireless communication sources operating near and far from the body, making it challenging to quantify daily absorbed dose. In the framework of the prospective cohort SCAMP (Study of Cognition, Adolescents and Mobile Phones), we aimed to characterize RF-EMF dose over a 2-year period.MethodsThe SCAMP cohort included 6605 children from greater London, UK at baseline (age 12.1 years; 2014–2016) and 5194 at follow-up (age 14.2; 2016–2018). We estimated the daily dose of RF-EMF to eight tissues including the whole body and whole brain, using dosimetric algorithms for the specific absorption rate transfer into the body. We considered RF-EMF dose from 12 common usage scenarios such as mobile phone calls or data transmission. We evaluated the association between sociodemographic factors (gender, ethnicity, phone ownership and socio-economic status), and the dose change between baseline and follow-up.ResultsWhole body dose was estimated at an average of 170 mJ/kg/day at baseline and 178 mJ/kg/day at follow-up. Among the eight tissues considered, the right temporal lobe received the highest daily dose (baseline 1150 mJ/kg/day, follow-up 1520 mJ/kg/day). Estimated daily dose [mJ/kg/day] increased between baseline and follow-up for head and brain related tissues, but remained stable for the whole body and heart. Doses estimated at baseline and follow-up showed low correlation among the 3384 children who completed both assessments. Asian ethnicity (compared to white) and owning a bar phone or no phone (as opposed to a smartphone) were associated with lower estimated whole-body and whole-brain RF-EMF dose, while black ethnicity, a moderate/low socio-economic status (compared to high), and increasing age (at baseline) were associated with higher estimated RF-EMF dose.ConclusionThis study describes the first longitudinal exposure assessment for children in a critical period of development. Dos

Journal article

Nathvani R, Clark S, Muller E, Alli A, Bennett J, Nimo J, Moses J, Baah S, Metzler A, Brauer M, Suel E, Hughes A, Rashid T, Gemmel E, Moulds S, Baumgartner J, Toledano M, Agyemang E, Owusu G, Agyei-Mensah S, Arku R, Ezzati Met al., 2022, Characterisation of urban environment and activity across space and time using street images and deep learning in Accra, Scientific Reports, Vol: 12, ISSN: 2045-2322

The urban environment influences human health, safety and wellbeing. Cities in Africa are growing faster than other regions but have limited data to guide urban planning and policies. Our aim was to use smart sensing and analytics to characterise the spatial patterns and temporal dynamics of features of the urban environment relevant for health, liveability, safety and sustainability. We collected a novel dataset of 2.1 million time-lapsed day and night images at 145 representative locations throughout the Metropolis of Accra, Ghana. We manually labelled a subset of 1,250 images for 20 contextually relevant objects and used transfer learning with data augmentation to retrain a convolutional neural network to detect them in the remaining images. We identified 23.5 million instances of these objects including 9.66 million instances of persons (41% of all objects), followed by cars (4.19 million, 18%), umbrellas (3.00 million, 13%), and informally operated minibuses known as tro tros (2.94 million, 13%). People, large vehicles and market-related objects were most common in the commercial core and densely populated informal neighbourhoods, while refuse and animals were most observed in the peripheries. The daily variability of objects was smallest in densely populated settlements and largest in the commercial centre. Our novel data and methodology shows that smart sensing and analytics can inform planning and policy decisions for making cities more liveable, equitable, sustainable and healthy.

Journal article

Clark S, Alli AS, Ezzati M, Brauer M, Toledano M, Nimo J, Bedford Moses J, Baah S, Hughes A, Cavanaugh A, Agyei-Mensah S, Owusu G, Robinson B, Baumgartner J, Bennett J, Arku Ret al., 2022, Spatial modelling and inequalities of environmental noise in Accra, Ghana, Environmental Research, Vol: 214, ISSN: 0013-9351

Noise pollution is a growing environmental health concern in rapidly urbanizing sub-Saharan African (SSA) cities. However, limited city-wide data constitutes a major barrier to investigating health impacts as well as implementing environmental policy in this growing population. As such, in this first of its kind study in West Africa, we measured, modelled and predicted environmental noise across the Greater Accra Metropolitan Area (GAMA) in Ghana, and evaluated inequalities in exposures by socioeconomic factors. Specifically, we measured environmental noise at 146 locations with weekly (n = 136 locations) and yearlong monitoring (n = 10 locations). We combined these data with geospatial and meteorological predictor variables to develop high-resolution land use regression (LUR) models to predict annual average noise levels (LAeq24hr, Lden, Lday, Lnight). The final LUR models were selected with a forward stepwise procedure and performance was evaluated with cross-validation. We spatially joined model predictions with national census data to estimate population levels of, and potential socioeconomic inequalities in, noise levels at the census enumeration-area level. Variables representing road-traffic and vegetation explained the most variation in noise levels at each site. Predicted day-evening-night (Lden) noise levels were highest in the city-center (Accra Metropolis) (median: 64.0 dBA) and near major roads (median: 68.5 dBA). In the Accra Metropolis, almost the entire population lived in areas where predicted Lden and night-time noise (Lnight) surpassed World Health Organization guidelines for road-traffic noise (Lden <53; and Lnight <45). The poorest areas in Accra also had significantly higher median Lden and Lnight compared with the wealthiest ones, with a difference of ∼5 dBA. The models can support environmental epidemiological studies, burden of disease assessments, and policies and interventions that address underlying causes of noise exposure ineq

Journal article

Schmutz C, Burgler A, Ashta N, Soenksen J, Karim YB, Shen C, Smith RB, Jenkins RH, Mireku MO, Mutz J, Maes MJA, Hirst R, Chang I, Fleming C, Mussa A, Kesary D, Addison D, Maslanyj M, Toledano MB, Roosli M, Eeftens Met al., 2022, Personal radiofrequency electromagnetic field exposure of adolescents in the Greater London area in the SCAMP cohort and the association with restrictions on permitted use of mobile communication technologies at school and at home, Environmental Research, Vol: 212, ISSN: 0013-9351

Personal measurements of radiofrequency electromagnetic fields (RF-EMF) have been used in several studies to characterise personal exposure in daily life, but such data are limitedly available for adolescents, and not yet for the United Kingdom (UK). In this study, we aimed to characterise personal exposure to RF-EMF in adolescents and to study the association between exposure and rules applied at school and at home to restrict wireless communication use, likely implemented to reduce other effects of mobile technology (e.g. distraction).We measured exposure to RF-EMF for 16 common frequency bands (87.5 MHz–3.5 GHz), using portable measurement devices (ExpoM-RF), in a subsample of adolescents participating in the cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP) from Greater London (UK) (n = 188). School and home rules were assessed by questionnaire and concerned the school's availability of WiFi and mobile phone policy, and parental restrictions on permitted mobile phone use. Adolescents recorded their activities in real time using a diary app on a study smartphone, while characterizing their personal RF-EMF exposure in daily life, during different activities and times of the day.Data analysis was done for 148 adolescents from 29 schools who recorded RF-EMF data for a median duration of 47 h. The majority (74%) of adolescents spent part of their time at school during the measurement period. Median total RF-EMF exposure was 40 μW/m2 at home, 94 μW/m2 at school, and 100 μW/m2 overall. In general, restrictions at school or at home made little difference for adolescents’ measured exposure to RF-EMF, except for uplink exposure from mobile phones while at school, which was found to be significantly lower for adolescents attending schools not permitting phone use at all, compared to adolescents attending schools allowing mobile phone use during breaks. This difference was not statistically significant for total personal exposure.Total ex

Journal article

Spiers A, Patjamontri S, Smith RB, Shen C, Toledano MB, Ahmed SFet al., 2022, Urinary gonadotrophins as markers of puberty in girls and boys during late childhood and adolescence: Evidence from the SCAMP Cohort, Publisher: KARGER, Pages: 342-342, ISSN: 1663-2818

Conference paper

Shen C, Mireku MO, Di Simplicio M, Dumontheil I, Thomas MSC, Röösli M, Elliott P, Toledano MBet al., 2022, Bidirectional associations between sleep problems and behavioural difficulties and health‐related quality of life in adolescents: Evidence from the SCAMP longitudinal cohort study, JCPP Advances, Vol: 2, Pages: 1-11, ISSN: 2692-9384

BackgroundSleep problems show associations with negative outcomes in both physical and mental health in adolescents, but the associations may be reciprocal. We aimed to assess bidirectional associations between sleep problems and mental health symptoms including behavioural difficulties (internalising and externalising difficulties) and low health-related quality of life (HRQoL).MethodsA total of 6616 adolescents (52.4% females) across Greater London completed baseline assessments when they were aged 11–12 years, and 3803 of them (57.2% females) completed follow-up assessments at aged 13–15 years. Weekday and weekend sleep duration were derived from self-reported bedtime, sleep onset latency and wake time. Sleep disturbance was assessed using a standardized sleep disturbance scale. Internalising and externalising difficulties were assessed using subscales of the Strength and Difficulties Questionnaire. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Cross-lagged structural equation modelling was used with multiple imputation to examine bidirectional associations between sleep problems and mental health symptoms.ResultsFemales had greater internalising difficulties, worse HRQoL and more sleep disturbance than males. Persistent insufficient weekday and weekend sleep, and sleep disturbance (i.e., at both baseline and follow-up) were associated with internalising and externalising difficulties and low HRQoL at follow-up (ORs ranged from 1.53 to 3.63). Persistent externalising difficulties and low HRQoL were also associated with insufficient weekend sleep and sleep disturbance at follow-up (ORs ranged from 1.68 to 4.25). Using continuous variables, we found bidirectional associations between weekday sleep duration and HRQoL, weekend sleep duration and externalising score, sleep quality and internalising score, and sleep quality and HRQoL. The association magnitudes were mostly similar in the two directions.ConclusionsOur study showed bidirectional as

Journal article

Vu TV, Stewart GB, Kitwiroon N, Lim S, Barratt B, Kelly FJ, Thompson R, Smith RB, Toledano MB, Beevers SDet al., 2022, Assessing the contributions of outdoor and indoor sources to air quality in London homes of the SCAMP cohort, Building and Environment, Vol: 222, Pages: 1-8, ISSN: 0360-1323

Given that many people typically spend the majority of their time at home, accurate measurement and modelling of the home environment is critical in estimating their exposure to air pollution. This study investigates the fate and impact on human exposure of outdoor and indoor pollutants in London homes, using a combination of sensor measurements, outdoor air pollution estimated from the CMAQ-urban model and indoor mass balance models. Averaged indoor concentrations of PM2.5, PM10 and NO2 were 14.6, 24.7 and 14.2 μg m−3 while the outdoor concentrations were 14.4, 22.6 and 21.4 μg m−3, respectively. Mean infiltration factors of particles (0.6–0.7) were higher than those of NO2 (0.4). In contrast, higher loss rates were found for NO2 (0.5–0.8 h−1) compared to those for particles (0.1–0.3 h−1). The average concentrations of PM2.5, PM10 and NO2 in kitchen environments were 22.0, 33.7 and 20.8 μg m−3, with highest hourly concentrations (437, 644 and 136 μg m−3, respectively) during cooking times (6–7 pm). Indoor sources increased the indoor concentrations of particles and NO2 by an average of 26–37% in comparison to the indoor background level without indoor sources. Outdoor and indoor air exchange plays an important role in reducing air pollution indoors by 65–86% for particles and 42–65% for NO2.

Journal article

Girela Serrano BM, Spiers A, Ruotong L, Gangadia S, Toledano MB, Di Simplicio Met al., 2022, Impact of mobile phones and wireless devices use on children and adolescents´ mental health: a systematic review, European Child and Adolescent Psychiatry: official journal of the European Society for Child and Adolescent Psychiatry, ISSN: 1018-8827

Growing use of mobiles phones (MP) and other wireless devices (WD) has raised concerns about their possible effects on children and adolescents’ wellbeing. Understanding whether these technologies affect children and adolescents’ mental health in positive or detrimental ways has become more urgent following further increase in use since the COVID-19 outbreak. To review the empirical evidence on associations between use of MP/WD and mental health in children and adolescents. A systematic review of literature was carried out on Medline, Embase and PsycINFO for studies published prior to July 15th 2019, PROSPERO ID: CRD42019146750. 25 observational studies published between January 1st 2011 and 2019 were reviewed (ten were cohort studies, 15 were cross-sectional). Overall estimated participant mean age and proportion female were 14.6 years and 47%, respectively. Substantial between-study heterogeneity in design and measurement of MP/WD usage and mental health outcomes limited our ability to infer general conclusions. Observed effects differed depending on time and type of MP/WD usage. We found suggestive but limited evidence that greater use of MP/WD may be associated with poorer mental health in children and adolescents. Risk of bias was rated as ‘high’ for 16 studies, ‘moderate’ for five studies and ‘low’ for four studies. More high-quality longitudinal studies and mechanistic research are needed to clarify the role of sleep and of type of MP/WD use (e.g. social media) on mental health trajectories in children and adolescents.

Journal article

Filippi R, Ceccolini A, Booth E, Shen C, Thomas MSC, Toledano MB, Dumontheil Iet al., 2022, Modulatory effects of SES and multilinguistic experience on cognitive development: a longitudinal data analysis of multilingual and monolingual adolescents from the SCAMP cohort, International Journal of Bilingual Education and Bilingualism, Pages: 1-18, ISSN: 1367-0050

Previous research has shown that cognitive development is sensitive to socio-economic status (SES) and multilinguistic experiences. However, these effects are difficult to disentangle and SES may modulate the effects of multilingualism. The present study used data from a large cohort of pupils who took part in the Study of Cognition, Adolescents and Mobile Phones (SCAMP) at ages 11–12 (T1) and 13–15 years old (T2). Cognitive measures were derived from tasks of cognitive flexibility, verbal, spatial and visuo-spatial working memory, speech processing and non-verbal reasoning. Using SES information collected through questionnaires (school type, level of deprivation, parental education and occupation), the sample was clustered into high/medium/low SES groups. Comparisons focused on 517 monolingual and 329 multilingual pupils in the high/low SES groups. Having controlled for multiple comparisons, the results indicated a significant beneficial effect of bilingualism in measures of working memory, visuo-spatial processing and non-verbal reasoning. These effects were present in both high and low SES individuals and sustained at both times of development, with a particularly significant improvement of working memory abilities in low SES bilinguals at T2 as compared to monolingual peers. Theoretical and practical implications of these findings are considered and guidance for educators is discussed.

Journal article

Basu D, Ghosh A, Naskar C, Balachander S, Fernandes G, Vaidya N, Kumaran K, Krishna M, Barker GJ, Sharma E, Murthy P, Holla B, Jain S, Orfanos DP, Kalyanram K, Purushottam M, Bharath RD, Varghese M, Thennarasu K, Chakrabarti A, Singh RL, Singh RL, Nanjayya SB, Ahuja CK, Kartik K, Krishnaveni G, Kuriyan R, Kurpad SS, Desrivieres S, Iyengar U, Zhang Y, Hickman M, Spiers A, Toledano M, Schumann G, Benegal Vet al., 2022, Risk clustering and psychopathology from a multi-center cohort of Indian children, adolescents, and young adults, DEVELOPMENT AND PSYCHOPATHOLOGY, ISSN: 0954-5794

Journal article

Thompson R, Toledano M, Dewa L, Fisher HL, Kabba Z, Hussain Tet al., 2022, Adolescents’ thoughts and feelings about the local and global environment: a qualitative interview study, Child and Adolescent Mental Health, Vol: 27, Pages: 4-13, ISSN: 1475-357X

BackgroundDespite a recent increase in engagement with environmental issues among young people, their impact upon adolescent mental health and wellbeing is not yet fully understood. Therefore, this study aimed to explore adolescents' thoughts and feelings about current environmental issues.MethodsSemi-structured interviews were conducted with a convenience sample of 15 UK-based adolescents aged 14–18 years (66.7% female). Transcripts were inductively thematically analysed by the interviewing researcher and two adolescent co-researchers, with priority given to the co-researchers' impressions to strengthen interpretations of the personal experiences of the interviewees.ResultsSix themes were identified: the local environment, efficacy, challenging emotions, information, hindrances and perceptions of the future. The local environment was found to affect adolescents positively and negatively. Factors including greenspace and fresh air had a positive impact, and factors including noise and litter had a negative impact. Most participants reported feeling disempowered to personally influence environmental problems but were engaged with them and felt that trying to make a difference was beneficial for their wellbeing. Adolescents largely reported negative expectations about the environment’s future.ConclusionThe UK adolescents interviewed appeared to be very engaged and emotionally affected by a perceived lack of care towards the environment, locally and globally. It is therefore imperative to amplify young people’s voices and involve them in influencing environmental policy, for the benefit of young people and the planet. Further research should quantify the extent to which environmental issues affect young people's mental health and identify factors that could prevent or alleviate distress.

Journal article

Thompson R, Smith RB, Bou Karim Y, Shen C, Drummond K, Teng C, Toledano MBet al., 2022, Noise pollution and human cognition: An updated systematic review and meta-analysis of recent evidence, Environment International, Vol: 158, Pages: 1-27, ISSN: 0160-4120

BackgroundThis systematic review provides a comprehensive synthesis of recent epidemiological evidence that environmental noise negatively impacts human cognition.MethodsWe update a prior review with recent publications (PROSPERO CRD42019151923). The strength of evidence for associations was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. We also conducted random-effects meta-analyses where suitable.Results16 studies were identified and reviewed in tandem with 32 studies previously reviewed by Clark & Paunovic (2018). A meta-analysis from 3 studies found that reading comprehension scores in quiet classrooms were 0.80 (95% confidence interval: 0.40; 1.20) points higher than children in noisier classrooms. Meta-analysis of the impact of 1 dB (dB) increase in environmental noise on reading and language abilities gave a pooled beta coefficient of −0.11(95% confidence interval: −0.32; 0.10). A meta-analysis of Odds Ratios (OR) from 3 studies found higher odds of cognitive impairment in people aged 45 + with higher residential noise exposure (OR 1.40, 95% CI: 1.18;1.61). After qualitative synthesis of remaining studies, there was high quality evidence for an association between environmental noise and cognitive impairment in middle-to-older adults, moderate quality evidence for an association between aircraft noise and reading and language in children, and moderate quality evidence against an association between aircraft noise and executive functioning in children. Generally the literature was supportive for other cognitive outcomes, but with low or very low-quality evidence.DiscussionThe evidence so far suggests that noise exposure is associated with cognition, but more good quality research using standardised methodology is required to corroborate these results and to allow for precise risk estimation by larger meta-analyses. There is also a need for more research with older teenagers and young-to

Journal article

Kenny RPW, Millar EB, Adesanya A, Richmond C, Beyer F, Calderon C, Rankin J, Toledano M, Feychting M, Pearce MS, Craig D, Pearson Fet al., 2021, The effects of radiofrequency exposure on male fertility and adverse reproductive outcomes: A protocol for two systematic reviews of human observational studies with meta-analysis, Environment International, Vol: 158, ISSN: 0160-4120

BackgroundThe World Health Organization (WHO) is bringing together evidence on radiofrequency electromagnetic field (RF-EMF) exposure in relation to health outcomes, previously identified as priorities for evaluation by experts in the field, to inform exposure guidelines. A suite of systematic reviews are being undertaken by a network of topic experts and methodologists in order to collect, assess and synthesise data relevant to these guidelines. Here, we present the protocol for the systematic review on the effect of exposure to RF on adverse reproductive outcomes (human observational studies), also referred to as Systematic Review (SR) 3 within the series of systematic reviews currently being commissioned.ObjectivesFollowing the WHO handbook for guideline development and the COSTER conduct guidelines, we will systematically review the effect of RF-EMF exposure on both male fertility (SR3A) and adverse pregnancy outcomes (SR3B) in human observational studies. Herein we adhere to the PRISMA-P reporting guidelines.Data sourcesWe will conduct a broad search for potentially relevant records relevant for both reviews within the following bibliographic databases: MEDLINE; Embase; and EMF Portal. We will also conduct searches of grey literature through relevant databases and organisational websites. RF-EMF experts will also be consulted. We will hand search citation and reference lists of included study records.Study eligibility criteriaWe will include quantitative human observational studies on the effect of RF-EMF exposure: (in SR3A) in adult male participants on infertility, sperm morphology, concentration or total sperm count or motility; and (in SR3B) in preconception adults or pregnant women on preterm birth, small for gestational age (associated with intrauterine growth restriction), miscarriage, stillbirth and congenital anomalies.Study appraisal and synthesis methodsTitles, abstracts and then full texts will be screened in blinded duplicate against eligibility cr

Journal article

Rashid T, Bennett J, Paciorek C, Doyle Y, Pearson-Stuttard J, Flaxman S, Fecht D, Toledano M, Li G, Daby H, Johnson E, Davies B, Ezzati Met al., 2021, Life expectancy and risk of death in 6,791 English communities from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data, The Lancet Public Health, Vol: 6, Pages: e805-e816, ISSN: 2468-2667

Background: There is limited data with high spatial granularity on how mortality and longevity have changed in English communities. We estimated trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6,791 English middle-layer super output areas (MSOAs).Methods: We used de-identified data for all deaths in England from 2002 to 2019 with information on age, sex and MSOA of residence, and population counts by age, sex and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA.Results: In 2002-2006 and 2006-2010, the vast majority of MSOAs experienced a life expectancy increase for both sexes. In 2010-2014, female life expectancy decreased in 351 (5%) of MSOAs. By 2014-2019, the number of MSOAs with declining life expectancy was 1,270 (19%) for women and 784 (12%) for men. The life expectancy increase from 2002 to 2019 was smaller where life expectancy had been lower in 2002, mostly northern urban MSOAs, and larger where life expectancy had been higher in 2002, mostly MSOAs in and around London. As a result of these trends, the gap between the 1st and 99th percentiles of MSOA life expectancy for women increased from 10.7 (95% credible interval 10.4-10.9) in 2002 to reach 14.2 (13.9-14.5) years in 2019, and from 11.5 (11.3-11.7) years to 13.6 (13.4-13.9) years for men. Interpretation: In many English communities, life expectancy declined in the years prior to the Covid-19 pandemic. To ensure that this trend does not continue there is a need for pro-equity economic and social policies, and greater investment on public health and healthcare.

Journal article

Fernandes GS, Spiers A, Vaidya N, Zhang Y, Sharma E, Holla B, Heron J, Hickman M, Murthy P, Chakrabarti A, Basu D, Subodh BN, Singh L, Singh R, Kalyanram K, Kartik K, Kumaran K, Krishnaveni G, Kuriyan R, Kurpad S, Barker GJ, Bharath RD, Desrivieres S, Purushottam M, Orfanos DP, Toledano MB, Schumann G, Benegal Vet al., 2021, Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort, BMC Public Health, Vol: 21, ISSN: 1471-2458

Background: Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such assubstance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.Methods: Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in Indiawas used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse ChildhoodExperiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smokingand Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysisexplained the associations between ACEs and substance misuse with adjustments for confounders such as sex andfamily structure.Results: 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, malesreport more of every individual childhood adversity and are more likely to report misusing substances comparedwith females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5–11.7) and collective levelACEs (adj OR 6.6, 95% CI 1.4–31.1) show associations with substance misuse whilst in young adults, child level ACEssuch as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1–3.5).Conclusion: ACEs such as abuse and domestic violence are strongly associated with substance misuse, mostcommonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACEresilience programmes and ‘trauma-informed’ approaches to tackling longer-term impact of ACEs in India.Funding: Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and theIndian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

Journal article

Patjamontri S, Spiers ADV, Smith RB, Shen C, Adaway J, Keevil BG, Toledano MB, Ahmed Fet al., 2021, Salivary sex steroids as markers of puberty in boys during late childhood and adolescence, European Society for Paediatric Endocrinology

Introduction: Salivary androgens represent a non-invasive marker of puberty that may have utility in population studies as well as in the clinical arena.Objectives: To establish normal reference values of salivary androgens using LC-MS/MS and demonstrate the correlations between salivary androgens and pubertal development in boys.Methods: School-based adolescent cohort study with two time points for collecting saliva samples two years apart. Five androgens (Testosterone;T, androstenedione; A4, 17-hydroxyprogesterone; 17-OHP, 11-ketotestosterone; 11-KT and 11β-hydroxyandrostenedione; 11OHA4 were analyzed in saliva samples using LC-MS/MS. In addition, self-reported assessment of puberty through the Pubertal Development Scale (PDS) was also collected at both time points. Receiver-operating characteristic (ROC) curves were used to determine the areas under the curves (AUCs), of each androgen as a predictor of self-reported voice maturation.Results: A total of 1,166 saliva samples were available from 929 boys aged between 11-16 years at either baseline or follow up or both time points with the median age of 12.3 yrs (range 11.3-13.2) and 14.3 yrs (range 13.4-15.8) at baseline and follow up time point, respectively. Median salivary T increased from 7 pmol/l (10th,90th centile, 5, 41) in participants aged 11-12 yrs to 122 pmol/l (21.6, 267.4) in participants aged 15-16 yrs and median salivary A4 increased from 53 pmol/l (26.2, 92.0) in participants aged 11-12 yrs to 144 pmol/l (50.7, 241.2) in participants aged 15-16 yrs. In a subgroup analysis of 147 saliva samples that were collected within 90 days before or after PDS, salivary T and A4 concentrations showed the highest correspondence with self-reported voice-breaking (One-way ANOVA P < 0.005). ROC curve analysis showed that a salivary testosterone of 82.7 pmol/l and a salivary A4 of 113.4 pmol/l provided a sensitivity of 77% and 74%, respectively and a specificity of 76% and 74%, respectively. Salivary T concent

Poster

Patjamontri S, Spiers A, Smith RB, Shen C, Adaway J, Keevil BG, Toledano MB, Ahmed SFet al., 2021, Salivary sex steroids as markers of puberty in boys during late childhood and adolescence, 59th Annual Meeting of the European Society for Paediatric Endocrinology - 2021, Publisher: KARGER, Pages: 366-366, ISSN: 1663-2818

Conference paper

Maes MJA, Pirani M, Booth ER, Shen C, Milligan B, Jones KE, Toledano MBet al., 2021, Benefit of woodland and other natural environments for adolescents' cognition and mental health, Nature Sustainability, Vol: 4, Pages: 851-858, ISSN: 2398-9629

Epidemiological studies have established positive associations of urban nature with cognitive development and mental health. However, why specifically these health benefits are received remains unclear, especially in adolescents. We used longitudinal data in a cohort of 3,568 adolescents aged 9 to 15 years at 31 schools across London, UK, to examine the associations between natural-environment types and adolescents’ cognitive development, mental health and overall well-being. We characterized natural-environment types in three tiers, where natural space was distinguished into green and blue space, and green space was further distinguished into woodland and grassland. We showed that, after adjusting for other confounding variables, higher daily exposure to woodland, but not grassland, was associated with higher scores for cognitive development and a lower risk of emotional and behavioural problems for adolescents. A similar but smaller effect was seen for green space, but not blue space, with higher scores for cognitive development. Our results suggest that urban planning decisions to optimize ecosystem benefits linked to cognitive development and mental health should carefully consider the type of natural environment included.

Journal article

Shen C, Dumontheil I, Thomas M, Röösli M, Elliott P, Toledano Met al., 2021, Digital technology use and BMI: evidence from a cross-sectional analysis of an adolescent cohort study, Journal of Medical Internet Research, Vol: 23, Pages: 1-16, ISSN: 1438-8871

Background:The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep.Objective:This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents.Methods:We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep.Results:Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted β=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (≤30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect.Conclusions:We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, sugg

Journal article

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