Importance Atopic dermatitis is a common inflammatory skin condition that is heavily influenced by environmental factors, and while ambient air pollution has been linked to atopic dermatitis outcomes in adults, its effects in children remain more uncertain. Objective To synthesize the evidence examining the associations between ambient air pollutants and atopic dermatitis prevalence in children. Data Sources MEDLINE, Embase, and Cochrane databases were searched from inception to February 10, 2026. Study Selection Observational studies of children under 18 years of age that examined the association between at least 1 atopic dermatitis outcome of interest and a pollutant exposure were included. Data Extraction and Synthesis The PRISMA 2020 reporting guidelines were used; methodological quality was assessed using the Joanna Briggs Institute checklist, and risk of bias was evaluated using the risk of bias in nonrandomized studies of exposure effects (ROBINS-E) tool. Data were synthesized using random-effects models, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Main Outcomes and Measures The primary outcomes were health care utilization and prevalence, incidence, or severity of atopic dermatitis in relation to predefined ambient air pollutant exposures, including nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter with a diameter of 10 µm or less (PM10), particulate matter with a diameter of 2.5 µm or less (PM2.5), ozone (O3), carbon monoxide (CO), and traffic-related pollution. Results Of 2528 citations, 52 observational studies met the inclusion criteria and were included. It was found that every 10-µg/m3 increase in NO2 (odds ratio [OR], 3.46; 95% CI, 1.06-11.31; moderate certainty) and SO2 (OR, 3.96; 95% CI, 1.00-15.65; moderate certainty) was probably associated with increased atopic dermatitis outpatient visits. It was also found that every 10-µg/m3 increase in PM2.5 (OR, 1.04; 95% CI, 1.00-1.08; moderate certainty) and PM10 (OR, 1.19; 95% CI, 1.06-1.35; moderate certainty) was probably associated with higher atopic dermatitis prevalence. Findings were mixed or did not support associations between air pollutions exposure and incidence or severity of atopic dermatitis. Conclusions and Relevance This systematic review and meta-analysis found that increased levels of certain ambient air pollutants were probably associated with some increased population burden of atopic dermatitis in children.
This systematic review and meta-analysis investigates the association between later cardiometabolic risk markers in youth and physical activity and sedentary time. QuestionAre physical activity and sedentary time associated with later cardiometabolic risk markers in youth?FindingsIn this harmonized individual participant data meta-analysis including 12 874 youth, device-measured physical activity was associated with lower insulin, low-density lipoprotein cholesterol, and triglyceride levels but not with body mass index (BMI); systolic blood pressure associations differed by physical activity intensity. Effect sizes were small and varied by modeling approach, sex, BMI, age, and follow-up time; sedentary time was not associated with cardiometabolic risk markers.MeaningResults suggest that physical activity showed weak but beneficial prospective associations with some cardiometabolic risk markers, whereas sedentary time did not appear to be an important determinant of cardiometabolic risk in youth. ImportanceThe evidence for benefits of higher physical activity and lower sedentary time on the cardiometabolic risk profile in youth is based on cross-sectional and small prospective studies.ObjectiveTo determine the prospective associations between device-measured physical activity and sedentary time with later cardiometabolic risk profiles in youth.Data SourcesThe International Children's Accelerometry Database and cohorts identified from a systematic literature search (final search performed December 2024).Study SelectionStudies measured physical activity and sedentary time with an accelerometer at baseline and had prospective data on at least 1 cardiometabolic risk marker.Data Extraction and SynthesisIndividual participant data were transferred to a secure network, harmonized, and analyzed as a single dataset using mixed linear regression models with different statistical adjustment based on directed acyclic graphs. Effect sizes are beta coefficients per SD exposure increment.Main Outcomes and MeasuresBody mass index (BMI); insulin, glucose, low-density lipoprotein (LDL) cholesterol, and triglyceride levels; and systolic blood pressure, analyzed individually and as composite scores.ResultsOf 5432 records screened, 12 relevant studies were identified, of which 8 provided individual participant data. Fourteen cohorts (12 874 participants; mean [range] age, 10.4 [5.0-17.9] years; 6577 female [52%]) with a mean (SD) follow-up of 3.1 (2.0) years were included. Moderate to vigorous physical activity (per SD, 26 minutes/day) was inversely associated with insulin (-0.24 & micro;IU/mL; 95% CI, -0.38 to -0.10 & micro;IU/mL), LDL cholesterol level (-1.54 mg/dL; 95% CI, -1.93 to -0.77 mg/dL), triglyceride level (-1.77 mg/dL, 95% CI, -2.65 to -0.88 mg/dL), and the composite risk scores (-0.04; 95% CI, -0.06 to -0.02). However, moderate to vigorous physical activity was not associated with BMI (0.00; 95% CI, -0.005 to 0.005) and associated with a higher systolic blood pressure (0.25 mm Hg; 95% CI, 0.04-0.46 mm Hg). Associations for vigorous intensity activity were similar, except that there was no association with systolic blood pressure. Higher sedentary time was not associated with a worse cardiometabolic profile but was associated with lower blood glucose concentration (-0.36 mg/dL; 95% CI, -0.72 to 0 mg/dL) and lower systolic blood pressure (-0.90 mm Hg; 95% CI, -1.22 to -0.58 mm Hg). The magnitude and direction of associations were modified by modeling approach, sex, BMI, age, and follow-up time.Conclusions and RelevanceResults of this harmonized individual participant data meta-analysis suggest that physical activity of moderate and vigorous intensity was beneficially associated with some cardiometabolic risk markers during childhood and adolescence. However, associations were weak, sensitive to the modeling approach, and heterogeneous across subgroups. Sedentary time is unlikely an important determinant of cardiometabolic risk in youth.
This cohort study investigates the association of congenital TORCH (toxoplasmosis, syphilis, rubella, cytomegalovirus, or herpes simplex) infections with neurodevelopmental and psychiatric outcomes. QuestionAre congenital TORCH (toxoplasmosis, syphilis, rubella, cytomegalovirus, or herpes simplex) infections associated with neurodevelopmental and psychiatric outcomes?FindingsIn this cohort study of 3 666 002 individuals born in Sweden, including 975 who were exposed, TORCH infections were associated with intellectual disability and autism in population analyses and sibling comparisons, with markedly higher risks for severe intellectual disability and autism with co-occurring intellectual disability.MeaningThis study found that congenital TORCH infections had associations with intellectual disability and autism, underscoring the importance of strengthening global vaccination programs and other preventive strategies. ImportanceCongenital TORCH (toxoplasmosis, syphilis, rubella, cytomegalovirus, or herpes simplex) infections are established causes of severe fetal injury, yet their population-level contribution to neurodevelopmental and psychiatric outcomes, independent of familial confounding, remains yet to be quantified.ObjectiveTo investigate whether congenital TORCH infections are associated with neurodevelopmental and psychiatric outcomes, including autism and intellectual disability, as well as academic performance, using population-based and sibling-controlled analyses.Design, Setting, and ParticipantsThis nationwide, population-based cohort study with sibling comparisons was conducted using linked data from Swedish national health, birth, insurance, education, and death registers. Individuals born in Sweden between 1987 and 2021, including individuals diagnosed with a congenital TORCH infection, were included. Full siblings were identified for within-family comparisons. Individuals were followed up from birth until death, emigration, or December 31, 2023. Data were analyzed from November 2025 to July 2026.ExposureClinically diagnosed congenital TORCH infections, identified from national registers, including cytomegalovirus, Toxoplasma gondii, rubella, and herpes simplex viruses.Main Outcomes and MeasuresAutism (with and without co-occurring intellectual disability), intellectual disability (by severity), attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, Tourette and chronic tic disorders, nonaffective psychosis, and standardized school grades at age 16 years were assessed. Associations were estimated with hazard ratios (HRs) using Cox regression and sibling-comparison models.ResultsAmong 3 666 002 individuals born in Sweden, including 3 665 027 individuals without TORCH infections (1 883 911 male [51.4%]; mean [SD] follow-up, 20.50 [11.15] years) and 975 individuals with TORCH infections (532 male [54.6%]; mean [SD] follow-up, 18.70 [10.39] years), congenital TORCH infections were associated with increased risks of intellectual disability (HR, 7.22; 95% CI, 6.14-8.49) and autism (HR, 3.10; 95% CI, 2.55-3.76), with similar or greater HRs in sibling comparisons (intellectual disability: HR, 11.28; 95% CI, 5.97-21.33; autism: HR, 3.19; 95% CI, 1.97-5.15). Risks increased with greater severity of intellectual disability, with HRs ranging from 3.01; 95% CI, 2.21-4.11 for mild to 23.51; 95% CI, 18.06-30.60 for severe to profound intellectual disability) and were greater for autism with (HR, 6.23; 95% CI, 4.69-8.28) vs without (HR, 1.97; 95% CI, 1.51-2.57) co-occurring intellectual disability. No consistent associations were observed for obsessive-compulsive disorder, and associations with attention-deficit/hyperactivity disorder attenuated in sibling analyses. Individuals who were exposed had lower school grades in adolescence (TORCH-associated decrease = -1.50 points; 95% CI, -2.60 to -0.40 points).Conclusions and RelevanceIn this study, congenital TORCH infections were rare but associated with intellectual disability and autism, with evidence of broader associated cognitive outcomes extending beyond diagnosed conditions, underscoring the importance of preventing specific vertically transmitted infections.
This cross-sectional study examines errors in patient and guardian contact information in the electronic health record (EHR) to measure the scope of inaccurate documentation and to substantiate the need for improved EHR standards and workflows.
