This is the first study that uses a direct measure of skyglow, an important aspect of lightpollution, to examine its impact on infanthealthatbirth. We find evidence of reduced birth weight, shortened gestational length and even preterm births. Specifically, increased nighttime brightness, characterized by being able to see only one-third to one-fourth of the stars that are visible in the absence of artificial light, is associated with an increase in the likelihood of a preterm birth by as much as 12.8 percent, or an increase of approximately 45,000 preterm births nationwide annually. Our findings add to the literature on the impact of in utero and early-life exposure to pollution, which thus far has focused primarily on air pollution. The unique feature of our identification strategy to determine a causal effect is the application of Walker’s Law in physics, which provides a scientific basis to estimate skyglow. We use estimated skyglow as an instrumental variable to address the endogeneity problem associated with the skyglow variable. In addition, our study shows that increased skyglow is associated with less sleep, indicating a likely biological mechanism that links sleepdeprivation to light-pollution induced circadian disruption. This result, combined with the literature on the adverse effects of sleep disorders, completes the causal chain underlying our finding on the adverse health impact of skyglow. Our study has important policy implications for current installation of LED streetlights in many U.S. municipalities, highlighting the necessity of minimizing skyglow contributed by streetlights.
. Ideally a source of exogenous variation in infanthealth could be used to establish true causal effects. Finding a natural experiment which affects only early life conditions can be difficult, however one example of this is Almond (2006) which compares individuals exposed in utero to the 1918 flu pandemic with cohorts born just before and after. Affected cohorts are found to be worse off on a number of outcomes. Delaney et al. (2011) use a dramatic shift in public health which occurred in Ireland in the 1940s to show that those children who benefited from improvements in early life conditions went on to be healthier and stronger adults. Currie (2011) argues that differences that have previously seemed to be innate could in fact reflect external factors related to environment. Disadvantaged children are more likely to be exposed to pollution during pregnancy, therefore poor initial health may in part be due to the fact that their mothers are less able to provide a healthy environment in utero. Almond and Currie (2011) provide a recent summary.
birth, which have been demonstrated to be a good proxy for individual performance later in life ( Black et al. , 2007 ). Indeed, studying the impact of prenatal pollution exposure on fetal health is important because the intra-uterine environment is a crucial determinant of infant's survival andhealth for the years to come. Previous studies include pre-term birth (PTB) and low birth weight (LBW) among risk factors for delays in motor and social development throughout early childhood ( Hediger et al. , 2002 ). They also show that neonates with low birth weight who survive infancy are at increased risk for health problems, among which disability ( Elder et al. , 2019 ), and death from ischemic heart disease ( Barker et al. , 1989 ). Finally, birth weight (BW) strongly aects child cognitive development ( Figlio et al. , 2014 ), predicts important socio-economic outcomes later in life such as annual earnings ( Bharadwaj et al. , 2017 ) and is also subject to intergenerational transmission ( Currie and Moretti , 2007 ). Given that health shocks can impact human capital covering labor supply, productivity, and cognition, air pollution can be viewed as an important factor of production associated with economic growth. In this respect, the negative eects of poor healthatbirth on future child and adult outcomes stress the importance to identify the risk factors for fetal development ( Currie , 2009 ), among which exposure to PM is an important one. Nevertheless, the causal evidence on the impact of PM on health outcomes atbirth remains scant. 2
The Centinela Vigila Survey (CVS) is conducted by the Division of Public Environmental Health of the SDSB starting in 2007. From 2007 to 2009, the survey was only conducted in three out of the 19 localities in Bogot´ a (Fontib´ on, Kennedy, and Puente Aranda). 10 In 2010, two localities were added (Suba and Tunjuelito), in 2011 another 10, 11 and finally, in 2013, all localities were covered. 12 The aim of the survey is to gather information about the health status of children under the age of five who are attending public kindergartens. The survey is performed on children’s caregivers at their homes (although sometimes it is performed in the kindergarten). 13 Approximately 80% of the caretakers interviewed are the mothers, while the rest are either the father, an uncle or an aunt. We use the ample set of information provided by the questionnaire on characteristics of the child, the parents, and the surroundings, as well as specific questions regarding the childrens health to build outcomes (low birth weight and child suffering a lung-related disease), as well as a big set of co-variates accounting for child and parents characteristics and home-living conditions (see Appendix A.1). The survey is
The existing literature provides almost no evidence on birth order effects on parental health investment and childhood health. This paper aims to fill this gap; specifically, we offer two primary contributions: First, to the best of our knowledge, we provide the first estimates of birth order effects on parental health investment in childhood. Previous research has focused on parental health investment in the pre- and postnatal periods, such as prenatal care, breastfeeding, smoking, and alcohol use. Second, we analyze health status andhealth care utilization in childhood. Recent evidence on birth order effects on child- hood health is based on measures of health care utilization as a proxy for health status. Brenøe and Molitor (2018) use Danish registry data on inpatient and outpatient hospital admissions and emergency room contacts to demonstrate that the health disadvantage for first-borns decreases with age and becomes insignificant after age six. Bj¨ orkegren and Svaleryd (2017) study birth order effects in Sweden, and use hospital admissions registry and mortality data to show that first-born children exhibit poorer health until age six, a disadvantage that is later reversed. In later childhood and adolescence, children with a higher birth order are more likely to be hospitalized for injuries, avoidable conditions, alcohol-related problems, or mental health issues.
Under extended wakefulness, light exposure has been shown to influence the EEG either following short exposures of lightat high intensities or longer exposures at low intensities. Badia et al. [ 12 ] showed that alternating 90-min episodes of bright polychromatic white light with 90-min of darkness increased EEG beta power (15–30 Hz) with each additional light episode. On the other hand, Phipps-Nelson et al. [ 56 ] showed that a 6-h exposure to very low intensity monochromatic short-wavelength light prevented the increase of EEG delta (1–4.5 Hz) power. This was observed despite extended wakefulness, which generally results in increased EEG delta power. This same study showed a similar result with EEG theta (4.5–8 Hz) levels, but did not observe enhancement of EEG alpha (8–12.5 Hz) activity, contrary to Lockley and colleagues [ 55 ]. Another study reported that a 1-h low-intensity (10–40 lux) monochromatic short-wavelength light exposure after midnight increased EEG beta activity (12–30 Hz) and decreased EEG alpha activity (8–12 Hz) [ 57 ]. Similar effects were obtained with 10 lux, but not 40 lux, of monochromatic long-wavelength light in that study. In chronically sleep-deprived subjects, light exposure may not have any impact on the EEG [ 80 ]. This study allowed subjects only 8 h of sleep over 48 h, prior to a 3-h light exposure during daytime (either with monochromatic blue or green light) and they found no significant differences between the light conditions on the waking EEG nor on measures of subjective sleepiness, cognitive throughput, or attention-related task.
Eltern-Baby-Therapie: eine neue Option
Eltern-Baby-Therapien sind die wichtigste Option und die erste Wahl unter den Behandlungsmöglichkeiten für die frühe Kindheit. Die Grundlagen für diese Intervention sind gleichzeitig in verschiedenen Disziplinen herangereift, insbeson- dere in der objekttheoretisch orientierten Psychoanalyse und in der akademischen Interaktionsforschung. Eine wichtige frühe Referenz auf psychoanalytischer Seite ist das Buch «Clinical studies in infant mental health» von Selma Fraiberg (1980). Darin hat diese Autorin – unter vielen anderen wegweisenden Aussagen – die Figur der (unbewussten) Projektion rigider, aus früheren Beziehungserfahrungen stam- menden Vorstellungen der Eltern auf das Kind und ihren Einfluss auf die Bildung der kindlichen Symptomatik so überzeugend dargestellt, dass auch Fachpersonen im Frühbereich, die dem psychoanalytischen Denken abgeneigt sind, die Tatsache der transgenerationalen Weitergabe von Konflikten anerkennen. «Ghosts in the nursery» (Gespenster in der Kinderstube) ist die populär gewordene Bezeichnung für diese ungebetenen Gäste aus der Vergangenheit, die sich in der Eltern-Kind- Beziehung in Szene setzen.
levels as low as 0.08 particles per million (ppm), there are negative impacts of exposure to ozone on the respiratory system. Koken et al. (2003) find that increases in ozone correlate with hospitalizations of elderly adults due to cardiovascular ailments. Gryparis et al. (2004) use data from 24 different European urban agglomerations and conclude that an increase by 10 miligrams per cubic meter (mg/m 3 ) in the levels of 1-hour maximum daily ozone raise total mortality rates by 0.31%. Using time-series methods Holgate et al. (2003) finds that an increase of 10 mg/m 3 in daily average-ozone raises mortality by 0.25%. Bell et al. (2005) compares the study in Holgate et al. (2003) to a meta-analysis of 39 different time-series studies on the effects of ozone exposure on mortality. Their results point towards an even higher coefficient (0.83%) than the one found by Holgate et al. (2003). Graff Zivin and Neidell (2012) analyze the consequences of ozone exposure on the productivity of Californian farm workers. They find significant decreases in farm output due to increases in ozone concentrations.
4. Interpretation of results and concluding remarks
As expected, our analysis reveals that the largest effects of LBW and VLBW on health care utilization occur in the first year of life, with particularly pronounced impacts on the number of days spent hospitalized and the consumption of medical drugs. The increased intake of medical drugs is predominantly driven by anti-infectives, an effect explained by the fact that the immune systems of these newborns are not yet fully developed (Saari, 2003). Consequently, the administration of these drugs prevents those infants from contracting infectious diseases. Although the effects of birth weight on aggregate outcomes decline with age, suggesting that children of lower birth weights catch up to others over time, some differences persist. The disaggregated analyses suggest that LBW mainly affects physical health in infancy and early childhood. During compulsory schooling, we find the first evidence that the cognitive development of those children may be retarded. This conclusion is supported by four facts: (i) LBW children are more likely to be hospitalized for mental and behavioral disorders, (ii) their intake of drugs affecting the nervous system is substantially elevated, (iii) these children have a higher rate of treatment by speech therapists, and (iv) VLBW children receive more ergo- and hippotherapy. Drugs affecting the nervous system include preparations including the active ingredient methylphenidate (e.g., Ritalin). This suggests that children who consume this medication are more likely to suffer from mental disorders such as attention deficit hyperactivity syndrome (ADHS) that become noticeable when they enroll in school. This result is in line with the findings of Currie et al. (2010) and Linnet et al. (2006), who show that premature or LBW babies are at much higher risk of contracting ADHS. Nevertheless, we do not find significant effects regarding utilization of psychiatric services during compulsory schooling. This indicates that the majority of this category of drugs may be consumed without adequate
observed negative relationship between birth order and human capital outcomes seems to be driven by differences in parental behavior and not by biological differences (Kristensen and Bjerkedal, 2007; Barclay, 2015b; Black et al., 2018; Lehmann et al., 2018).
This paper contributes to the literature on birth order andhealth, which to date pro- vides mixed evidence. While this research documents that first-borns as adults are taller (Myrskyl¨ a et al., 2013), have superior cardio-respiratory fitness (Barclay and Myrskyl¨ a, 2014), a lower mortality risk (Barclay and Kolk, 2015), and better self-reported physical and mental health (Black et al., 2016), it also indicates that first-borns have a higher body mass index and are more likely to be overweight or obese and to have high blood pressure (Jelenkovic et al., 2013; Black et al., 2016). Atbirth, first-born children are less healthy than their later-born siblings. They are more likely to be born pre-term and with low birth weights, and their mothers are more likely to suffer from pregnancy complica- tions (Brenøe and Molitor, 2018; Lehmann et al., 2018; Breining et al., forthcoming). In summary, the existing literature demonstrates that despite their disadvantages in terms of healthatbirth, first-borns as adults have better health in some dimensions. Initially, this result is not as anticipated; however, pre- and post-natal maternal behavior seems to favor first-born children. Mothers are more likely to attend prenatal care in their first pregnancy and are more likely to breastfeed the first-born child (Buckles and Kolka, 2014; Black et al., 2016; Brenøe and Molitor, 2018; Lehmann et al., 2018). 3 This differ-
are net food buyers. Their consideration is also worthy given that food purchases was identified as the most important household source of food, even among the subsistence agricultural households in the country (Mmopelwa and Seleka, 2012; Seleka and Lekobane, 2017). We used the average prices for cereals (the most consumed in Botswana). Statistics Botswana also produced data on primary health care accessibility for the period 2006/2007. This shows the proportions of population who are within three categories of distance to the nearest health care facilities; 0-5, 5-8 and 8-15 kilometres in health districts (Statistics Botswana, 2012; 2017). The data reveals that at national level, 84 per cent of population were within the 5km radius, 11 per cent within 5 and 8km while the rest were within 8 and 15 kilometre radius. Moreover, the proportion at urban areas stood at 96 and 4 per cent for 0-5 km and 5-8 kilometres respectively, whereas 72, 17 and 11 per cent were in the 0-5, 5-8 and 8-15 kilometres range respectively in rural areas. We used this information to create dummy variable for the probability of care facility being sufficiently close, also factoring in rural-urban differences. For instance, we have a dummy of 1 if mothers resided in a district whose proportion of those in 0-8km is higher than 95% (observed at national level), otherwise 0. However, since it has been observed that in urban districts the proportion within 8km is 100, we consider 0-5km for the urban subsample. Thus, an urban district was assigned a value of 1 if proportion of those residing within 5 km radius is higher than that of all urban districts combined. Table 2 presents variable definitions.
Individual change was measured with RCIs according to Jacobson & Truax (1991). RCIs after 26 hours and 32 hours time awake appeared rather stable and therefore confirm the trait-like character of the sleep restriction effects. With mixed model MANOVAs we examined whether the extent of performance change was significantly related to group membership based on the Introversion-Extraversion scale of the FPI. The multivariate effects were significant for both points of time with medium effect sizes. Participants who scored low in this scale (i.e. introverts) appeared more resilient against effects of sleep restriction when compared to the extraverts. This finding is in line with other studies (e.g. Taylor & McFatter, 2003; Killgore et al. 2011; Rupp et al. 2012) and confirms the assumption of Eysenck’s theory of personality that extraverts have a lower cortical arousal level, which leads to performance deficits in monotonous tasks with little outside stimulation. In our study the relationship of Extraversion to the vulnerability of sleepdeprivation effects was largest for the Psychomotor Vigilance Task, a simple reaction time task with only on/off visual signals to be monitored during the test period.
B in Table 5 demonstrates that the magnitude of the negative birth order effect actually increases when we control for healthatbirth, suggesting a positive correlation between healthatbirthand vaccine uptake. 22
Our findings indicate a negative relationship between birth order and parental health investment, which cannot be simply explained by differences in healthatbirth or delayed vaccinations among later-born children. Thus, we will discuss the potential reasons why parental health investments and vaccines’ uptake in particular—may differ across siblings, and why birth order effects may differ across the types of vaccines. First, vaccination uptake may relate to participation in the MCP program, as the physician checks the child’s immunization status at the MCP visit and typically recommends immunizations according to the national immunization plan. We observe that both participation in the MCP program in the first year of life and uptake of the 6-in-1 vaccine, which is recommended in the first year, do not relate to birth order. In contrast, participation in the MCP program in the second year of life and uptake of the MMR vaccine as recommended in the second year negatively relate to birth order. This finding suggests that children who do not participate in the MCP program are less likely to receive immunizations against childhood diseases. Further, this implies that if non-participation occurs because parents do not consider health screenings as a health investment, they are more likely to miss out on another health investment (vaccination). Second, vaccination carries some risk of adverse reaction, and parents may decide not to vaccinate later-born children because the first-born sibling had experienced adverse effects. However, common side effects are mild (e.g., redness and swelling at the injection site, or fever), and severe reactions are exceptionally rare; thus, we do not believe that this can explain the estimated birth order effect or the difference in this effect across types of vaccines. 23 Third, the MMR vaccine
We link individual health service data with the Austrian birth register to obtain information on newborns birth weights. 20 The birth register includes information on all births
from 1984 to 2007. Given the structure of our data, we cannot observe health-service utilization over a child s complete life cycle. For each individual, utilization data is available for a maximum of five consecutive years. Since births to the same mother can be linked, we include sibling fixed- effects in our analysis to account for time-invariant unobserved heterogeneity. Consequently, we restrict our data set to siblings. On average, we observe 2.39 siblings per mother and year, and the average age difference between the children is 3.6 years. The resulting unbalanced panel data include information on the yearly outcomes of 113,064 siblings between birthand 21 years old. Infants enter the sample either in the year of birth or when they join the sickness fund afterwards. Children and young adults drop out of the sample if they change their sickness fund within the province of Upper Austria (because of a new employer), they move to another province, or they die. We consider it highly unlikely for parents to change their sickness fund because their infants health conditions require expensive medical treatments, as all sickness funds cover almost an identical spectrum of services with only minor differences in deductibles and copayments. 21 The majority of children in our sample (72.65 percent) can be observed in
and the medical institution hospital beds master file (BED), we can link the above to hospital ownership, classification level, and the number of hospital beds.
During compilation of the above sub-databases, phenomena such as unknown infant gender, infants treated by more than one physician, death on the day of birth (treated as stillbirth), referral on the first day of admission, unknown discharge status, seeking medical treatment from non-pediatricians, pediatric surgery, neonatology, physician’s unknown gender, a non-pediatric certified exclusive physician, and an inability to link a medical institution’s hospital beds to infants, all affect the number observations (refer to Diagram 1 for the sample screening process). In summary, if the file of hospital beds is not linked, there are 15,223 infants, 663 physicians, and 140 hospitals entering the final analysis whereas, if the file of hospital beds is linked, there are 9,593 infants, 455 physicians and 98 hospitals.
largely on adult mortality. This is all the more surprising because studies on adult mortality suffer from conceptual and methodological problems that studies on infant mortality obviate (Chay and Greenstone 2003b). First, the excess deaths attributable to air pollution may occur primarily among the old and infirm, who may not have lived long anyway. Of course, this “harvesting” is also important for studies on infant mortality that identify effects on the basis of short term variation in mortality andpollution. But if decreases in air pollution are found to reduce infant mortality rates overall, the number of life-years gained is large. Second, there is considerable uncertainty regarding the life-time exposure of adults. As Chay and Greenstone (2003b) argue, this uncertainty is greatly reduced by the low migration rates of pregnant women and infants. These advantages sparked a recent interest in the effects of air pollution, not only among epidemiologists but also among economists (see references below).
Moderate alcohol consumption has been associated with a lower risk of CHD in healthy people, partly explained by its beneficial effects of raising high-density lipoprotein (HDL) and anti-clotting  . Although any type of alcoholic beverage appears beneficial, red wine seems to confer additional health benefits because of the presence of red wine polyphenolic compounds (RWPC)  . RWPC are antioxidants which could lower free radical properties, the aggregation of platelet and the thrombotic activities; they are also powerful vasodilators, contribute to the preservation of the integrity of the endothelium and the inhibition of smooth muscle cell proliferation and migration  . However, the American Heart Association  recommends people who do not drink never to start, as many other ways such as controlling body weight, regular physical activities, and a healthy diet could decrease the risk of CVD, and bring no potential risk of drinking too much or even alcoholism. Too much alcohol intake will increase blood pressure and triglycerides, and elevate the risk for obesity because of the extra calorie intake.
conceived between January 1980 and February 2003 and find that in utero exposure to
terrorism early in pregnancy, as measured by the number of bomb casualties in the mother’s province of residence in the first trimester of pregnancy, has detrimental effects on birth outcomes: in terms of average birth weight (lower), prevalence of low birth weight (higher) and fraction of “normal” babies (lower). Our results are robust to a battery of checks, such as controlling for “economic” factors and accounting for spatial “spillover” effects. In addition, we investigate potential non-linear effects and explore heterogeneous effects across groups of regions, different time periods and family characteristics. In support of our identification strategy, the number of bomb casualties after birth does not predict birth outcomes. We do not find evidence of migration effects (in terms of population size responses to last year terrorist activity), but the number of still births increases with bomb casualties in the first and third trimesters of pregnancy. The estimated effect of 1 bomb casualty in the first trimester of pregnancy on average birth weight (around half a gram) is likely to be downward biased due to selective mortality. Finally, we provide a conceptual framework to understand what can be identified about the production of child health by exploiting shocks that affect (unobserved) maternal inputs.
Most light therapy devices on the market are suitable for clinical use. They reach a corneal illuminance of 7000–10,000 lx at a viewing distance of 20–35 cm and are equipped with a protective screen with almost complete UV ﬁltering. Ideally designed devices illuminate the patient diagonally from above with an irradi- ation angle of ~ 15°. A bevelled light surface prevents annoying glare and al- lows simultaneous reading, thus being better tolerated. To obtain a therapeu- tic eﬀect, it is not necessary to look di- rectly into the light source, but the eyes must be open. Available light therapy glasses, which even allow mobility dur- ing the sessions, also partially meet the required criteria of suﬃcient light illumi- nance. However, most of them have not yet been evaluated in large, randomised clinical trials. Another alternative to re- ceive light in the early morning hours is through dawn simulators. These devices start providing a relatively weak light sig- nal about 90 min before wake-up time, which, covering the patients’ ﬁnal sleep cycle, then gradually increases in inten- sity from about 0.001 lx to about 300 lx. However, also for these devices, the de- sign plays an important role, as a diﬀuse, wide lighting area is necessary to reach the sleeper in the diﬀerent lying posi- tions. For the same reason, other types of available miniature lighting devices are not recommended because of their small luminous ﬁeld [ 98 ].