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  • Association of PM2.5 concentration with health center outpatient visits for respiratory diseases of children under 5 years old in Lima, Peru
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-15
    Jennifer Estefanía Davila Cordova; Vilma Tapia Aguirre; Vanessa Vasquez Apestegui; Luis Ordoñez Ibarguen; Bryan N. Vu; Kyle Steenland; Gustavo F. Gonzales Rengifo

    Lima is one of the more polluted cities in Latin America. High levels of PM2.5 have been shown to increase health center outpatient visits of respiratory diseases. Health center outpatient visits for children < 5 years for childhood respiratory disease (acute lower respiratory infections (ALRI), pneumonia and acute bronchiolitis/asthma) from 498 public clinics in Lima were available on a weekly basis from 2011 to 2015 from Peru’s Ministry of Health (MINSA). The association between the average weekly concentrations of PM2.5 was evaluated in relation to the number of weekly health center outpatient visits for children. Weekly PM2.5 values were estimated using a recently developed model that combined data observed from ground monitors, with data from space satellite and meteorology. Ground monitoring data came from 10 fixed stations of the Peruvian National Service of Meteorology and Hydrology (SENAMHI) and from 6 mobile stations located in San Juan de Miraflores by Johns Hopkins University. We conducted a time-series analysis using a negative binomial model. We found a significant association between exposure to PM2.5 and all three types of respiratory diseases, across all age groups. For an interquartile increase in PM2.5, we found an increase of 6% for acute lower respiratory infections, an increase of 16–19% for pneumonia, and an increase of 10% for acute bronchiolitis / asthma. Higher emissions of environmental pollutants such as PM2,5 could be a trigger for the increase of health center outpatients visits for respiratory diseases (ALRI, pneumonia and asthma), which are themselves risk factors for mortality for children in Lima province, Peru.

    更新日期:2020-01-15
  • Association between exposure to traffic-related air pollution and pediatric allergic diseases based on modeled air pollution concentrations and traffic measures in Seoul, Korea: a comparative analysis
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-14
    Kyung-Duk Min; Seon-Ju Yi; Hwan-Cheol Kim; Jong-Han Leem; Ho-Jang Kwon; Soyoung Hong; Kyoo Sang Kim; Sun-Young Kim

    Pediatric allergic diseases are a major public health concern, and previous studies have suggested that exposure to traffic-related air pollution (TRAP) exposure is a risk factor. These studies have typically assessed TRAP exposure using traffic measures, such as distance to major roads, or by modeling air pollutant concentrations; however inconsistent associations with pediatric allergic diseases have often been found. Using road proximity and density, we previously found an association between TRAP and atopic eczema among approximately 15,000 children living in Seoul, Korea, heavily populated and highly polluted city in which traffic is a major emission source. We aimed to conduct a parallel analysis using modeled air pollution concentrations and thus examine the consistency of the association. Specifically, we examined the associations of individual-level annual-average concentrations of NO2, PM10, and PM2.5 with symptoms and diagnoses of three pediatric allergic diseases including asthma, allergic rhinitis, and atopic eczema. The study population included 14,614 children from the Seoul Atopy Friendly School Project Survey in Seoul, Korea, in 2010. To assess individual exposures to TRAP among these children, we predicted annual-average concentrations of NO2, PM10, and PM2.5 at the children’s home addresses in 2010 using universal kriging and land use regression models along with regulatory air quality monitoring data and geographic characteristics. Then, we estimated odds ratios (ORs) of the three allergic diseases for interquartile increases in air pollution concentrations after adjusting for individual risk factors in mixed effects logistic regression. Symptoms and diagnoses of atopic eczema symptoms showed an association with NO2 (OR = 1.07, 95% confidence interval = 1.02–1.13; 1.08, 1.03–1.14) and PM10 (1.06, 1.01–1.12; 1.07, 1.01–1.13). ORs of PM2.5 were positive but not statistically significant (1.01, 0.95–1.07; 1.04, 0.98–1.10). No association was found between asthma and allergic rhinitis, although PM2.5 showed a marginal association with allergic rhinitis. Our consistent findings regarding the association between TRAP and the prevalence of atopic eczema using traffic measures and surrogate air pollutants suggested the effect of TRAP on children’s health. Follow-up studies should elucidate the causal link, to support subsequent policy considerations and minimize adverse health effects in children.

    更新日期:2020-01-15
  • Associations of Perfluoroalkyl substances with blood lipids and Apolipoproteins in lipoprotein subspecies: the POUNDS-lost study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-13
    Gang Liu; Bo Zhang; Yang Hu; Jennifer Rood; Liming Liang; Lu Qi; George A. Bray; Lilian DeJonge; Brent Coull; Philippe Grandjean; Jeremy D. Furtado; Qi Sun

    The associations of perfluoroalkyl substance (PFAS) exposure with blood lipids and lipoproteins are inconsistent, and existing studies did not account for metabolic heterogeneity of lipoprotein subspecies. This study aimed to examine the associations between plasma PFAS concentrations and lipoprotein and apolipoprotein subspecies. The study included 326 men and women from the 2-year Prevention of Obesity Using Novel Dietary Strategies (POUNDS) Lost randomized trial. Five PFASs, including perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA), were measured in plasma at baseline. For lipoprotein and apolipoprotein subspecies, total plasma was fractionated first by apolipoprotein (apo) C-III content and then by density. Each subfraction was then measured for apoB, apoC-III, and apoE concentrations, as well as triglyceride and cholesterol contents, both at baseline and at 2 years. For lipids and apolipoproteins in total plasma at baseline, elevated plasma PFAS concentrations were significantly associated with higher apoB and apoC-III concentrations, but not with total cholesterol or triglycerides. After multivariate adjustment of lifestyle factors, lipid-lowering medication use, and dietary intervention groups, PFAS concentrations were primarily associated with lipids or apolipoprotein concentrations in intermediate-to-low density lipoprotein (IDL + LDL) and high-density lipoprotein (HDL) that contain apoC-III. Comparing the highest and lowest tertiles of PFOA, the least-square means (SE) (mg/dl) were 4.16 (0.4) vs 3.47 (0.4) for apoB (P trend = 0.04), 2.03 (0.2) vs 1.66 (0.2) for apoC-III (P trend = 0.04), and 8.4 (0.8) vs 6.8 (0.8) for triglycerides (P trend = 0.03) in IDL + LDL fraction that contains apoC-III. For HDL that contains apoC-III, comparing the highest and lowest tertiles of PFOA, the least-square means (SE) (mg/dl) of apoC-III were 11.9 (0.7) vs 10.4 (0.7) (P trend = 0.01). In addition, elevated PFNA and PFDA concentrations were also significantly associated with higher concentrations of apoE in HDL that contains apoC-III (P trend< 0.01). Similar patterns of associations were demonstrated between baseline PFAS concentrations and lipoprotein subspecies measured at 2 years. Baseline PFAS levels were not associated with changes in lipoprotein subspecies during the intervention. Our results suggest that plasma PFAS concentrations are primarily associated with blood lipids and apolipoproteins in subspecies of IDL, LDL, and HDL that contain apoC-III, which are associated with elevated cardiovascular risk in epidemiological studies. Future studies of PFAS-associated cardiovascular risk should focus on lipid subfractions.

    更新日期:2020-01-14
  • Mortality associated with wildfire smoke exposure in Washington state, 2006–2017: a case-crossover study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-13
    Annie Doubleday; Jill Schulte; Lianne Sheppard; Matt Kadlec; Ranil Dhammapala; Julie Fox; Tania Busch Isaksen

    Wildfire events are increasing in prevalence in the western United States. Research has found mixed results on the degree to which exposure to wildfire smoke is associated with an increased risk of mortality. We tested for an association between exposure to wildfire smoke and non-traumatic mortality in Washington State, USA. We characterized wildfire smoke days as binary for grid cells based on daily average PM2.5 concentrations, from June 1 through September 30, 2006–2017. Wildfire smoke days were defined as all days with assigned monitor concentration above a PM2.5 value of 20.4 μg/m3, with an additional set of criteria applied to days between 9 and 20.4 μg/m3. We employed a case-crossover study design using conditional logistic regression and time-stratified referent sampling, controlling for humidex. The odds of all-ages non-traumatic mortality with same-day exposure was 1.0% (95% CI: − 1.0 - 4.0%) greater on wildfire smoke days compared to non-wildfire smoke days, and the previous day’s exposure was associated with a 2.0% (95% CI: 0.0–5.0%) increase. When stratified by cause of mortality, odds of same-day respiratory mortality increased by 9.0% (95% CI: 0.0–18.0%), while the odds of same-day COPD mortality increased by 14.0% (95% CI: 2.0–26.0%). In subgroup analyses, we observed a 35.0% (95% CI: 9.0–67.0%) increase in the odds of same-day respiratory mortality for adults ages 45–64. This study suggests increased odds of mortality in the first few days following wildfire smoke exposure. It is the first to examine this relationship in Washington State and will help inform local and state risk communication efforts and decision-making during future wildfire smoke events.

    更新日期:2020-01-13
  • Climate factors driven typhus group rickettsiosis incidence dynamics in Xishuangbanna Dai autonomous prefecture of Yunnan province in China, 2005–2017
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-08
    Yuan Gao; Yanlin Niu; Wanwan Sun; Keke Liu; Xiaobo Liu; Ning Zhao; Yujuan Yue; Haixia Wu; Fengxia Meng; Jun Wang; Xueshuang Wang; Qiyong Liu

    Typhus group rickettsiosis (TGR), which is a neglected vector-borne infectious disease, including epidemic typhus and endemic typhus. We explored the lag effects and nonlinear association between meteorological factors and TGR incidence in Xishuangbanna Dai autonomous prefecture from 2005 to 2017, China. A Poisson regression with a distributed lag nonlinear model (DLNM) was utilized to analyze TGR cases data and the contemporaneous meteorological data. A J-shaped nonlinear association between weekly mean temperature and TGR incidence was found. The cumulative exposure to weekly mean temperature indicated that the RR increased with the increment of temperature. Taking the median value as the reference, lower temperatures could decrease the risk of TGR incidence, while higher temperatures could increase the risk of TGR incidence and last for 21 weeks. We also found a reversed U-shaped nonlinear association between weekly mean precipitation and TGR incidence. Precipitation between 5 mm and 13 mm could increase the risk of TGR incidence. Taking the median value as the reference, no precipitation and lower precipitation could decrease the risk of TGR incidence, while higher precipitation could increase the risk of TGR incidence and last for 18 weeks. The prevention and control measures of TGR should be implemented according to climatic conditions by the local government and health departments in order to improve the efficiency.

    更新日期:2020-01-08
  • What is useful research? The good, the bad, and the stable
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-07
    David M. Ozonoff; Philippe Grandjean

    A scientific journal like Environmental Health strives to publish research that is useful within the field covered by the journal’s scope, in this case, public health. Useful research is more likely to make a difference. However, in many, if not most cases, the usefulness of an article can be difficult to ascertain until after its publication. Although replication is often thought of as a requirement for research to be considered valid, this criterion is retrospective and has resulted in a tendency toward inertia in environmental health research. An alternative viewpoint is that useful work is “stable”, i.e., not likely to be soon contradicted. We present this alternative view, which still relies on science being consensual, although pointing out that it is not the same as replicability, while not in contradiction. We believe that viewing potential usefulness of research reports through the lens of stability is a valuable perspective.

    更新日期:2020-01-07
  • Association between short-term exposure to air pollution and ischemic stroke onset: a time-stratified case-crossover analysis using a distributed lag nonlinear model in Shenzhen, China
    Environ. Health-Glob. (IF 4.43) Pub Date : 2020-01-02
    Zhinghui Wang; Ji Peng; Peiyi Liu; Yanran Duan; Suli Huang; Ying Wen; Yi Liao; Hongyan Li; Siyu Yan; Jinquan Cheng; Ping Yin

    Stroke, especially ischemic stroke (IS), has been a severe public health problem around the world. However, the association between air pollution and ischemic stroke remains ambiguous. A total of 63, 997 IS cases aged 18 years or above in Shenzhen were collected from 2008 to 2014. We used the time-stratified case-crossover design combining with distributed lag nonlinear model (DLNM) to estimate the association between air pollution and IS onset. Furthermore, this study explored the variability across gender and age groups. The cumulative exposure-response curves were J-shaped for SO2, NO2 and PM10, and V-shaped for O3, and crossed over the relative risk (RR) of one. The 99th, 50th (median) and 1st percentiles of concentration (μg/m3) respectively were 37.86, 10.06, 3.71 for SO2, 116.26, 41.29, 18.51 for NO2, 145.94, 48.29, 16.14 for PM10, and 111.57, 49.82, 16.00 for O3. Extreme high-SO2, high-NO2, high-PM10, high-O3, and low-O3 concentration increased the risk of IS, with the maximum RR values and 95% CIs: 1.50(1.22, 1.84) (99th vs median) at 0–12 lag days, 1.37(1.13, 1.67) (99th vs median) at 0–10 lag days, 1.26(1.04, 1.53) (99th vs median) at 0–12 lag days, 1.25(1.04, 1.49) (99th vs median) at 0–14 lag days, and 1.29(1.03, 1.61) (1st vs median) at 0–14 lag days, respectively. The statistically significant minimal RR value and 95% CI was 0.79(0.66,0.94) at 0–10 lag days for extreme low-PM10. The elderly aged over 65 years were susceptible to extreme pollution conditions. Difference from the vulnerability of males to extreme high-SO2, high-NO2 and low-O3, females were vulnerable to extreme high-PM10 and high-O3. Comparing with the elderly, adults aged 18–64 year were immune to extreme low-NO2 and low-PM10. However, no association between CO and IS onset was found. SO2, NO2, PM10 and O3 exerted non-linear and delayed influence on IS, and such influence varied with gender and age. These findings may have significant public health implications for the prevention of IS.

    更新日期:2020-01-02
  • Associations between indoor environmental quality in schools and symptom reporting in pupil-administered questionnaires
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-27
    Kateryna Savelieva; Tero Marttila; Jussi Lampi; Sari Ung-Lanki; Marko Elovainio; Juha Pekkanen

    The associations between indoor environmental quality (IEQ) in homes and symptom reporting of children have been extensively studied, but only few large-scale studies have been done in schools. We examined associations between expert-assessed IEQ in schools and pupils’ reporting of different symptoms, and whether associations were stronger if participants relate symptoms to the school environment. The questionnaire survey was done in all primary and secondary schools in two areas of Helsinki, Finland. Primary school pupils (grade 3–6, n = 8775, 99 school-buildings) and secondary school pupils (grade 7–9, n = 3410, 30 school-buildings) reported their symptoms. Symptoms were combined into respiratory, lower respiratory, eye, skin, and general symptom groups. Surveys were also done among the parents of the primary school pupils (grade 1–6, n = 3540, 88 school buildings), but results are reported only in the supplement due to the low response rate (20% in 2017 and 13% in 2018). The associations between IEQ and symptoms were analyzed using multilevel logistic regression analysis. Several of the IEQ indicators were highly correlated and indicators were therefore mainly analyzed by combining them into a summary score and into latent classes. Dose-response associations were found between IEQ problems and higher reporting of respiratory and general symptoms among both primary and secondary school pupils. Some associations were also observed with lower respiratory and skin symptoms, but not with eye symptoms. The associations were somewhat stronger with symptoms related to the school environment compared to symptoms reported without such relation: for a unit change in IEQ summary score and respiratory symptoms in primary schools, odds ratios were 1.07 (95% CI 1.02–1.06) and 1.04 (95% CI 1.04–1.10), and in secondary schools 1.09 (95% CI 1.01–1.09) and 1.05 (95% CI 1.02–1.17), respectively. Expert-assessed IEQ problems in schools were associated with increased reporting of especially respiratory and general symptoms. The associations were only somewhat stronger in magnitude for symptoms reported in relation to the school environment compared to symptoms reported without such relation.

    更新日期:2019-12-30
  • Projected local rain events due to climate change and the impacts on waterborne diseases in Vancouver, British Columbia, Canada
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-30
    Bimal K. Chhetri; Eleni Galanis; Stephen Sobie; Jordan Brubacher; Robert Balshaw; Michael Otterstatter; Sunny Mak; Marcus Lem; Mark Lysyshyn; Trevor Murdock; Manon Fleury; Kirsten Zickfeld; Mark Zubel; Len Clarkson; Tim K. Takaro

    Climate change is increasing the number and intensity of extreme weather events in many parts of the world. Precipitation extremes have been linked to both outbreaks and sporadic cases of waterborne illness. We have previously shown a link between heavy rain and turbidity to population-level risk of sporadic cryptosporidiosis and giardiasis in a major Canadian urban population. The risk increased with 30 or more dry days in the 60 days preceding the week of extreme rain. The goal of this study was to investigate the change in cryptosporidiosis and giardiasis risk due to climate change, primarily change in extreme precipitation. Cases of cryptosporidiosis and giardiasis were extracted from a reportable disease system (1997–2009). We used distributed lag non-linear Poisson regression models and projections of the exposure-outcome relationship to estimate future illness (2020–2099). The climate projections are derived from twelve statistically downscaled regional climate models. Relative Concentration Pathway 8.5 was used to project precipitation derived from daily gridded weather observation data (~ 6 × 10 km resolution) covering the central of three adjacent watersheds serving metropolitan Vancouver for the 2020s, 2040s, 2060s and 2080s. Precipitation is predicted to steadily increase in these watersheds during the wet season (Oct. -Mar.) and decrease in other parts of the year up through the 2080s. More weeks with extreme rain (>90th percentile) are expected. These weeks are predicted to increase the annual rates of cryptosporidiosis and giardiasis by approximately 16% by the 2080s corresponding to an increase of 55–136 additional cases per year depending upon the climate model used. The predicted increase in the number of waterborne illness cases are during the wet months. The range in future projections compared to historical monthly case counts typically differed by 10–20% across climate models but the direction of change was consistent for all models. If new water filtration measures had not been implemented in our study area in 2010–2015, the risk of cryptosporidiosis and giardiasis would have been expected to increase with climate change, particularly precipitation changes. In addition to the predicted increase in the frequency and intensity of extreme precipitation events, the frequency and length of wet and dry spells could also affect the risk of waterborne diseases as we observed in the historical period. These findings add to the growing evidence regarding the need to prepare water systems to manage and become resilient to climate change-related health risks.

    更新日期:2019-12-30
  • Atrial fibrillation hospitalization is associated with exposure to fine particulate air pollutants
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-30
    Hsiu Hao Lee; Shih Chun Pan; Bing Yu Chen; Shih Hsiang Lo; Yue Leon Guo

    Although air pollutants have been associated with cardiopulmonary mortality, their effects on the occurrence of atrial fibrillation (Afib) remain unclear. This study examined the association between ambient air pollutants and Afib occurrence. Using a representative sample from the National Health Insurance Database of Taiwan, we applied a case–crossover study design to explore the associations between air pollutants and patients hospitalized with Afib from 2006 to 2011. The event day was when a patient was hospitalized with Afib, and the control days were the same days of the following weeks of the same month. The association between Afib occurrence and levels of ambient air pollutants (including particulate matter [PM] 2.5 PM10, NO2, SO2, and O3) was examined after adjusting for temperature and relative humidity. A two-pollutant model was used to examine the effect of the second pollutant when the first pollutant was determined to be significantly related to Afib. During 2006–2011, 670 patients hospitalized with the first onset of Afib were identified. The occurrence of Afib was associated with PM2.5, in which a 22% (95% confidence interval = 3–44%) increase was related to an interquartile range increase (26.2 μg/m3) on the same day and a 19% (95% confidence interval = 0–40%) increase on the second day. A two-pollutant model was applied, and the results indicated that the effect of PM2.5 was significantly associated with the occurrence of Afib. Patients aged over 65 years with DM and with hyperlipidemia were more susceptible to the effect of PM2.5. In conclusion, the occurrence of Afib was associated with short-term exposure to fine particulate air pollutants in the general population.

    更新日期:2019-12-30
  • Intelligence gain and social cost savings attributable to environmental lead exposure reduction strategies since the year 2000 in Flanders, Belgium
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-27
    Sylvie Remy; Ramona Hambach; Marc Van Sprundel; Caroline Teughels; Tim S. Nawrot; Jurgen Buekers; Christa Cornelis; Liesbeth Bruckers; Greet Schoeters

    Recent lead (Pb) exposure reduction strategies enabled to lower children’s blood lead levels (B-Pb) worldwide. This study reports the estimated intelligence gain and social cost savings attributable to recent exposure reduction based on reported B-Pb levels observed in adolescents sampled within the framework of the Flemish Environment and Health Studies (FLEHS, Belgium), i.e. in 2003–2004 (FLEHSI), in 2008–2009 (FLEHSII), and in 2013–2014 (FLEHSIII). Intelligence Quotient (IQ) loss per 100,000 individuals - attributable to B-Pb above 20 μg/L - was estimated based on widely accepted dose response functions between children’s B-Pb and IQ (− 1.88 IQ points for a duplication in B-Pb from 20 μg/L onwards; 95% Confidence Interval (CI): − 1.16;-2.59) and B-Pb exposure distribution parameters of FLEHS studies. The results were translated to the Flemish population of 15-year-olds. Given a 3-year time gap between subsequent sampling periods, the exposure distribution of each study was assumed 3 years prior to the study as well. Economic impact was estimated based on expected decrease in lifetime earnings (€ 19,464 per decreasing IQ point in 2018). The percentage of the adolescent population exceeding a B-Pb of 20 μg/L decreased from 57% (FLEHSI) to 23% (FLEHSII), and even further to 2.5% (FLEHSIII). The estimated IQ loss per 100,000 individuals was 94,280 (95% CI: 58,427-130,138) in FLEHSI, 14,993 (95% CI: 9289-20,695) in FLEHSII, and 976 (95% CI: 604–1347) in FLEHSIII. This translates into a total loss of 378,962 (95%CI: 234,840-523,091) IQ points within the Flemish population of 15-year-olds between 2000 and 2014. Assuming that current exposure levels do not reincrease, the expected IQ loss during the subsequent period of 15 years is estimated to be maximally 10,275 (95%CI: 6363-14,182) points. 7176 (95%CI: 4447-9905) million € of social cost savings were achieved by Pb reduction strategies in Flanders over 15 years. If current exposure levels further reduce to B-Pb below 20 μg/L for the whole population, social cost savings may increase up to 7376 (95%CI: 4571-10,181) million €. Given the relatively low lead contamination in Flanders, the global impact of ongoing reduction strategies is expected to be tremendous.

    更新日期:2019-12-27
  • Cumulative solar ultraviolet radiation exposure and basal cell carcinoma of the skin in a nationwide US cohort using satellite and ground-based measures
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-27
    Mark P. Little; Martha S. Linet; Michael G. Kimlin; Terrence Lee; Zaria Tatalovich; Alice J. Sigurdson; Elizabeth K. Cahoon

    Basal cell carcinoma of the skin (BCC) is the most common cancer in populations of European ancestry. Although consistently linked with basal cell carcinoma of the skin in case-control studies, few prospective cohort studies have evaluated the shape of the exposure-response of basal cell carcinoma associated with cumulative radiant solar ultraviolet exposure (UVR). We followed 63,912 white cancer-free US radiologic technologists from entry (1983–1998) to exit (2003–2005) with known ultraviolet irradiance at up to 5 residential locations. Using generalized-additive and relative risk models we analyzed the exposure-response of basal cell carcinomas associated with ambient cumulative ultraviolet radiant exposure using ground-based National Solar Radiation database Average Daily Total Global data and satellite-based National Aeronautics and Space Administration Total Ozone Mapping Spectrometer data. There were 2151 technologists with an incident primary basal cell carcinoma. Risk of basal cell carcinoma rose with increasing cumulative ultraviolet radiation exposure using both measures, such that 1 MJ cm− 2 increased basal cell carcinoma risk by 8.48 (95% CI 5.22, 11.09, p < 0.001) and by 10.15 (95% CI 6.67, 13.10, p < 0.001) per 10,000 persons per year using the Average Daily Total Global and Total Ozone Mapping Spectrometer ultraviolet data, respectively; relative risk was likewise elevated. There was some evidence of upward curvature in the cumulative ultraviolet exposure response using both exposure measures with a greater increase in risk of basal cell carcinoma at higher levels of ultraviolet radiation exposure, but less evidence for curvature in relative risk. There are indications of substantial variation of relative risk with time after exposure and age at exposure, so that risk is highest for the period 10–14 years after ultraviolet radiation exposure and for those exposed under the age of 25. We observed increases in risk of basal cell carcinoma and a similar exposure-response for ground-based and satellite ultraviolet radiation measures. Our observations suggest that interventions should concentrate on persons with higher levels of ultraviolet radiation exposure.

    更新日期:2019-12-27
  • Comments on Vimercati et al., 2019, “Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register”
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-26
    Gabor Mezei; Ellen T. Chang; Fionna S. Mowat; Suresh H. Moolgavkar

    We read with interest the review by Vimercati et al. [1] of the scientific literature on malignant mesothelioma of the tunica vaginalis testis (MMTVT). The authors reviewed case series and case reports, and primarily focused their discussion on diagnostic and prognostic characteristics of MMTVT and options for MMTVT treatment. The authors also briefly discussed the potential etiologic role of asbestos exposure in MMTVT development, and declared, “[T]he only causal factor so far ascertained is asbestos exposure, and exposure to different asbestos-containing materials is the only well-documented risk factor, as stated by IARC [International Agency for Research on Cancer].” In this context, the authors referenced our recent review of the epidemiologic literature on mesothelioma of the pericardium and MMTVT [2], stating, “Nevertheless, there are authors [2] who do not agree with the absence, until today, of analytical case-control epidemiologic studies to test this relationship.” In response to this statement, we note several points. In our systematic literature review and complementary analysis of U.S. registry-based incidence rates of MMTVT [2], we assessed relevant epidemiologic findings regarding the potential etiologic role of asbestos exposure in MMTVT development. We acknowledged the lack of analytical epidemiologic studies, including case-control studies, to test this hypothesis but pointed to several lines of scientific evidence that support our conclusion that the available epidemiologic literature does not support an association, let alone a causal association, between inhaled asbestos exposure and the risk of developing MMTVT. First, in large occupational cohorts with heavy workplace exposures to asbestos, no cases of MMTVT have been reported (e.g., [3]). Second, registry-based incidence rates of MMTVT in the U.S. do not show temporal or geographical trends that would correspond with trends in commercial asbestos use, with due consideration of latency, nor do they reflect incidence rates of pleural malignant mesothelioma, for which asbestos historically played an etiologic role in a substantial fraction of male cases [2, 4]. Third, the incidence of extra-pleural mesothelioma, including MMTVT, in a recent study using the National Mesothelioma Register in Italy does not demonstrate an exposure-response relationship, as MMTVT cases were not reported in some of the highest-risk industries (e.g., asbestos cement, national defense, shipbuilding, and railway industries) [5]. If inhaled asbestos caused MMTVT, the highest risk of MMTVT would be expected in industries with the highest exposure; no such exposure-response relationship is reported (see Mezei et al. [2] for the details of this argument). Interestingly, Vimercati et al. [1] did not reference their Italian colleagues in their article. We also note that case reports and case series are not epidemiologic studies; they cannot establish associations, let alone causal relationships, between exposure and disease. Nevertheless, we found that a substantial proportion of MMTVT cases reported in the published literature did not have documented asbestos exposure [2]. Vimercati et al. [1] also referenced the most recent IARC monograph (2012) on the carcinogenic risks of asbestos [6] in support of their view that asbestos is an established cause of MMTVT. The IARC monograph (2012) does not contain a single mention of MMTVT (or of mesothelioma of the pericardium) either in the main text or in the reference list. Thus, the IARC monograph (2012) does not and cannot conclude that asbestos causes these rare extra-pleural forms of malignant mesothelioma. While an earlier version of the IARC monograph (1987) concerning asbestos mentions MMTVT and pericardial mesothelioma [7], the three references cited in a single sentence are case reports. In addition, contrary to the opinion expressed by Vimercati et al. [1], there is considerable evidence that in addition to asbestos and some other fibers such as erionite, ionizing radiation increases the risk of malignant mesothelioma (e.g., [8]). Finally, the current paradigm of carcinogenesis as a process of mutation accumulation implies that all cancers, including malignant mesothelioma can and do occur spontaneously without exposure to any external agents (e.g., [9, 10]). In summary, we conclude that the available epidemiology provides no evidence that inhaled asbestos exposure is a risk factor for the development of MMTVT. Vimercati et al. [1] provide no evidence to the contrary. We look forward to the results of the forthcoming Italian case-control study mentioned by the authors. All references are publicly available. IARC: International Agency for Research on Cancer MMTVT: Malignant mesothelioma of the tunica vaginalis testis 1. Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health. 2019;18(1):78. Article Google Scholar 2. Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol. 2017;27:348–59. Article Google Scholar 3. Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Ann Occup Hyg. 2000;44(8):565–601. CAS Article Google Scholar 4. Lowry SJ, Weiss NS. Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA. Cancer Causes Control. 2016;27(12):1487–9. Article Google Scholar 5. Marinaccio A, Binazzi A, Di Marzio D, Scarselli A, Verardo M, Mirabelli D, Gennaro V, Mensi C, Merler E, De Zotti R, Mangone L, Chellini E, Pascucci C, Ascoli V, Menegozzo S, Cavone D, Cauzillo G, Nicita C, Melis M, Iavicoli S. Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register. Occup Environ Med. 2010;67:760–5. CAS Article Google Scholar 6. International Agency for Research on Cancer (IARC). IARC monographs on the evaluation of carcinogenic risks to humans. Volume 100C: Arsenic, metals, fibres and dusts. IARC, World Health Organization (WHO). Lyon: IARC; 2012. Google Scholar 7. International Agency for Research on Cancer (IARC). Overall evaluations of carcinogenicity: an updating of IARC monographs volumes 1–42. IARC monographs supplement 7. IARC, World Health Organization (WHO). Lyon: IARC; 1987. Google Scholar 8. Chang ET, Lau EC, Mowat FS, Teta MJ. Therapeutic radiation for lymphoma and risk of second primary malignant mesothelioma. Cancer Causes Control. 2017;28:971–9. Article Google Scholar 9. Tomasetti C, Li L, Vogelstein B. Stem cell divisions, somatic mutations, cancer etiology, and cancer prevention. Science. 2017;355:1330–4. CAS Article Google Scholar 10. Carbone M, Adusumilli PS, Alexander HR Jr, Baas P, Bardelli F, Bononi A, Bueno R, Felley-Bosco E, Galateau-Salle F, Jablons D, Mansfield AS, Minaai M, de Perrot M, Pesavento P, Rusch V, Severson DT, Taioli E, Tsao A, Woodard G, Yang H, Zauderer MG, Pass HI. Mesothelioma: scientific clues for prevention, diagnosis, and therapy. CA Cancer J Clin. 2019;69(5):402–29. Article Google Scholar Download references Not applicable. Funding No outside funding was received for this work. Affiliations Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA, 94025, USA Gabor Mezei , Ellen T. Chang  & Fionna S. Mowat Exponent, Inc., 15735 SE 30th Place, Suite 250, Bellevue, WA, USA Suresh H. MoolgavkarAuthors Search for Gabor Mezei in: PubMed • Google Scholar Search for Ellen T. Chang in: PubMed • Google Scholar Search for Fionna S. Mowat in: PubMed • Google Scholar Search for Suresh H. Moolgavkar in: PubMed • Google Scholar Contributions All authors equally contributed to this work. All authors read and approved the final manuscript. Corresponding author Correspondence to Gabor Mezei. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors have been involved in asbestos litigation as both testifying and consulting experts (GM, ETC, FSM, SHM). Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. An author's reply to this comment is available online at https://doi.org/10.1186/s12940-019-0553-8. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Mezei, G., Chang, E.T., Mowat, F.S. et al. Comments on Vimercati et al., 2019, “Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register”. Environ Health 18, 111 (2019) doi:10.1186/s12940-019-0552-9 Download citation Received 18 October 2019 Accepted 06 December 2019 Published 26 December 2019 DOI https://doi.org/10.1186/s12940-019-0552-9 Keywords Malignant mesothelioma Tunica vaginalis testis Epidemiology Etiology

    更新日期:2019-12-27
  • Response to the “Letter to the Editor” by Gabor Mezei et al., Comments on Vimercati et al., 2019, “Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register”
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-26
    Luigi Vimercati; Domenica Cavone; Maria Celeste Delfino; Luigi De Maria; Antonio Caputi; Giovanni Maria Ferri; Gabriella Serio

    Dear Sir, Thank you for the opportunity to respond to the Letter to the Editor you have received from Gabor Mezei et al., on our study titled “Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register” [1]. We thank the Authors for their comments, which open the debate that we aimed at by submitting our paper. Here, we provide our specific comments regarding their concerns. They highlight that our review incorrectly states that “the most recent IARC Monograph on the carcinogenic risks of asbestos (IARC, 2012) in support of their view that asbestos is an established cause of MMTVT.” The criticism is correct, and we thank them for pointing out that our suggestion in reference [1] is not correct. However, it is important to note that confounding due to exposure to asbestos is always a concern when studying mesothelioma. Regarding the rare or non-existing cases of MMTVT reported in occupational cohorts and the absence of temporal or geographical trends corresponding with commercial asbestos use, we consider it necessary to keep in mind the rarity of this disease and at the same time the relatively recent agreement on the definition of the clinicopathological entity [1], which may have involved difficulty in diagnosis, miss-classification and miss-coding. Moreover, registry-based studies on cancer might be affected by detection bias (also called surveillance bias) [2]. Lowry and Weiss, cited in the letter, mention that “this study was limited by small numbers and was unable to directly ascertain asbestos exposure” [3]. We disagree with the statement that only heavy workplace exposures to asbestos may induce MMTVT; proof of this is, for example, the occurrence of peritoneal mesothelioma in subjects with only established environmental exposure [4]. Unfortunately, earlier studies on 289 MMTVT cases reported that 47.6% of the cases with asbestos exposure investigated are positive, whereas for 42% of cases, these data are not available, i.e., have not been investigated (see table 2 in Vimercati et al. 2019 [1]). Regarding the cited study of Marinaccio et al. 2010 [5], of which some of us are co-authors, we would like to note that in table 3 of the work, 50% of MMTVT cases are reported in economic sectors such as in the construction, steel, and transport construction and maintenance industries wherein the use of asbestos is well known in the technological cycles as well as (especially in past years, and this agrees with the latency time) the failure to comply with safety requirements to protect the health of workers [6]. More recently, as we reported in our review, in the sixth report of the Italian National Mesothelioma Register (Renam) on 68 cases of MMTVT recorded in 1993–2015, 78% of cases were ascertained as exposure to asbestos [7]. We also agree with the Authors that case reports and case series are not epidemiological studies, but, as mentioned above, we do not agree with the Authors statement “cases reported in the published literature did not have documented asbestos exposure”, as exposure to asbestos is not “undocumented” but is not investigated at all, as we have seen in our review paper [1]. We disagree with the statement that “there is a considerable evidence that in addition to asbestos…. ionizing radiation increase the risk of malignant mesothelioma”, which in our opinion cannot be applied to MMTVT despite the biological plausibility in the current state of knowledge. To the best of our knowledge, only more cases of pericardial mesothelioma after therapeutic radiation have been reported [8,9,10,11], but not MMTVT. Of note, the same Authors, Mezei et al. (2017), reported that “for mTVT , prior history of radiation therapy was nonexistent” [12]. Finally, in regards to “the current paradigm of carcinogenesis”, we agree with Authors and with the current knowledge on a background incidence of non-asbestos-related mesothelioma or idiopathic cases, as well as with the possible role of talc, environmental exposures, genetic predisposition and gene-environment interactions in the development of this disease [13,14,15,16,17,18]. Similarly, we agree with the Authors that little is known about the epidemiology, the amount of information on potential confounders is limited, and the aetiology of MMTVT is inadequately researched and poorly understood. However, there is growing evidence on the potential aetiologic role of asbestos exposure in MMTVT development, although the underlying mechanisms remain to be elucidated. While not definitive evidence of causality, considering both case reports and mode of action, it is certainly suggestive. It should be emphasized that our cases, as mentioned in the paper, have established an ascertained exposure to asbestos, an average latency period of 47 years, have no other cancers and have ever been subjected to radiation therapy or exposed to ionizing radiation. As stated in our discussion, the preliminary results of the case control study from the Italian mesothelioma registry, by Marinaccio et al. personal communication, show that occupational exposure to asbestos was significantly associated with the risk of the disease (OR = 7.940; 95% CI 3.01–18.2 in MMTVT). In summary, the weight of evidence from currently available data strongly suggests that asbestos exposure increases mesothelioma TVT risk. Further contributions from a more in-depth assessment are needed to promote a substantial improvement in the knowledge of the epidemiology of MMTVT. All references are publicly available. IARC: International agency research on cancer MMTV: Malignant mesothelioma tunica vaginalis testis OR: Odds ratio TVT: Tunica vaginalis testis 1. Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health. 2019;18(1):78. https://doi.org/10.1186/s12940-019-0512-4. Article Google Scholar 2. Farioli A, Violante FS, Mattioli S, Curti S, Kriebel D. Risk of mesothelioma following external beam radiotherapy for prostate cancer: a cohort analysis of SEER database. Cancer Causes Control. 2013;24(8):1535–45. https://doi.org/10.1007/s10552-013-0230-0. Article Google Scholar 3. Lowry SJ, Weiss NS. Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA. Cancer Causes Control. 2016;27(12):1487–9. Article Google Scholar 4. Serio G, Pezzuto F, Marzullo A, Scattone A, Cavone D, Punzi A, Fortarezza F, Gentile M, Buonadonna AL, Barbareschi M, Vimercati L. Peritoneal mesothelioma with residential asbestos exposure. Report of a case with long survival (seventeen years) analyzed by Cgh-array. Int J Mol Sci. 2017;18(8):E1818. https://doi.org/10.3390/ijms18081818. CAS Article Google Scholar 5. Marinaccio A, Binazzi A, Di Marzio D, Scarselli A, Verardo M, Mirabelli D, Gennaro V, Mensi C, Merler E, De Zotti R, Mangone L, Chellini E, Pascucci C, Ascoli V, Menegozzo S, Cavone D, Cauzillo G, Nicita C, Melis M, Iavicoli S. Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register. Occup Environ Med. 2010;67(11):760–5. https://doi.org/10.1136/oem.2009.051466. CAS Article Google Scholar 6. Vimercati L, Cavone D, Caputi A, Delfino MC, De Maria L, Ferri GM, Serio G. Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy. BMC Res Notes. 2019;12(1):636. https://doi.org/10.1186/s13104-019-4675-4. CAS Article Google Scholar 7. RENAM Registro Nazionale Mesotelomi Sesto rapporto. Il registro nazionale dei mesoteliomi: Inail; 2018. https://www.inail.it/cs/internet/docs/alg-pubblregistro-nazionale-mesoteliomi-6-rapporto.pdf Google Scholar 8. Velissaris TJ, Tang AT, Millward-Sadler GH, Morgan JM, Tsang GM. Pericardial mesothelioma following mantle field radiotherapy. J Cardiovasc Surg (Torino). 2001;42(3):425–7. CAS Google Scholar 9. Small GR, Nicolson M, Buchan K, Broadhurst P. Pericardial malignant mesothelioma: a latent complication of radiotherapy? Eur J Cardiothorac Surg. 2008;33(4):745–7. https://doi.org/10.1016/j.ejcts.2007.12.024. Article Google Scholar 10. Bendek M, Ferenc M, Freudenberg N. Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature. Cardiovasc Pathol. 2010;19(6):377–9. https://doi.org/10.1016/j.carpath.2009.08.003. Article Google Scholar 11. Yıldırım H, Metintaş M, Ak G. Malignant pericardial mesothelioma following thoracal radiotherapy; dissemination from pericardium to pleura. Tuberk Toraks. 2010;58(3):301–5. Google Scholar 12. Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol. 2017;27(5):348–359.e11. https://doi.org/10.1016/j.annepidem.2017.04.001. Article Google Scholar 13. Huncharek M. Non-asbestos related diffuse malignant mesothelioma. Tumori. 2002;88(1):1–9 Review. Google Scholar 14. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Carbon black, titanium dioxide, and talc. IARC Monogr Eval Carcinog Risks Hum. 2010;93:1–413. Google Scholar 15. Serio G, Pagliarulo V, Marzullo A, et al. Molecular changes of malignant mesothelioma in the testis and their impact on prognosis: analyses of two cases. Int J Clin Exp Pathol. 2016;9(7):7658–67. Google Scholar 16. Serio G, Vimercati L, Pennella A, Gentile M, Cavone D, Buonadonna AL, Scattone A, Fortarezza F, De Palma A, Marzullo A. Genomic changes of chromosomes 8p23.1 and 1q21: novel mutations in malignant mesothelioma. Lung Cancer. 2018;126:106–11. https://doi.org/10.1016/j.lungcan.2018.10.012. Article Google Scholar 17. Attanoos RL, Churg A, Galateau-Salle F, Gibbs AR, Roggli VL. Malignant mesothelioma and its non-Asbestos causes. Arch Pathol Lab Med. 2018;142(6):753–60. https://doi.org/10.5858/arpa.2017-0365-RA. CAS Article Google Scholar 18. Carbone M, Adusumilli PS, Alexander HR Jr, Baas P, Bardelli F, Bononi A, Bueno R, Felley-Bosco E, Galateau-Salle F, Jablons D, Mansfield AS, Minaai M, de Perrot M, Pesavento P, Rusch V, Severson DT, Taioli E, Tsao A, Woodard G, Yang H, Zauderer MG, Pass HI. Mesothelioma: scientific clues for prevention, diagnosis and therapy. CA Cancer J Clin. 2019;69(5):402–29. https://doi.org/10.3322/caac.21572. Article Google Scholar Download references Affiliations Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy Luigi Vimercati , Domenica Cavone , Maria Celeste Delfino , Luigi De Maria , Antonio Caputi  & Giovanni Maria Ferri Department of Emergency and Organ Transplantation (DETO), Pathology Division, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124, Bari, Italy Gabriella SerioAuthors Search for Luigi Vimercati in: PubMed • Google Scholar Search for Domenica Cavone in: PubMed • Google Scholar Search for Maria Celeste Delfino in: PubMed • Google Scholar Search for Luigi De Maria in: PubMed • Google Scholar Search for Antonio Caputi in: PubMed • Google Scholar Search for Giovanni Maria Ferri in: PubMed • Google Scholar Search for Gabriella Serio in: PubMed • Google Scholar Contributions All authors equally contributed to this work. All authors read and approved the final manuscript. Corresponding author Correspondence to Luigi Vimercati. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Vimercati, L., Cavone, D., Delfino, M.C. et al. Response to the “Letter to the Editor” by Gabor Mezei et al., Comments on Vimercati et al., 2019, “Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register”. Environ Health 18, 112 (2019) doi:10.1186/s12940-019-0553-8 Download citation Received 22 November 2019 Accepted 06 December 2019 Published 26 December 2019 DOI https://doi.org/10.1186/s12940-019-0553-8 Keywords Malignant mesothelioma Tunica vaginalis testis Epidemiology Etiology

    更新日期:2019-12-27
  • Developmental fluoride neurotoxicity: an updated review
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-19
    Philippe Grandjean

    After the discovery of fluoride as a caries-preventing agent in the mid-twentieth century, fluoridation of community water has become a widespread intervention, sometimes hailed as a mainstay of modern public health. However, this practice results in elevated fluoride intake and has become controversial for two reasons. First, topical fluoride application in the oral cavity appears to be a more direct and appropriate means of preventing caries. Second, systemic fluoride uptake is suspected of causing adverse effects, in particular neurotoxicity during early development. The latter is supported by experimental neurotoxicity findings and toxicokinetic evidence of fluoride passing into the brain. An integrated literature review was conducted on fluoride exposure and intellectual disability, with a main focus on studies on children published subsequent to a meta-analysis from 2012. Fourteen recent cross-sectional studies from endemic areas with naturally high fluoride concentrations in groundwater supported the previous findings of cognitive deficits in children with elevated fluoride exposures. Three recent prospective studies from Mexico and Canada with individual exposure data showed that early-life exposures were negatively associated with children’s performance on cognitive tests. Neurotoxicity appeared to be dose-dependent, and tentative benchmark dose calculations suggest that safe exposures are likely to be below currently accepted or recommended fluoride concentrations in drinking water. The recent epidemiological results support the notion that elevated fluoride intake during early development can result in IQ deficits that may be considerable. Recognition of neurotoxic risks is necessary when determining the safety of fluoride-contaminated drinking water and fluoride uses for preventive dentistry purposes.

    更新日期:2019-12-20
  • Short-term association between ambient temperature and homicide in South Africa: a case-crossover study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-16
    Abigail Gates; Mitchel Klein; Fiorella Acquaotta; Rebecca M. Garland; Noah Scovronick

    Criminology research has traditionally investigated sociodemographic predictors of crime, such as sex, race, age, and socioeconomic status. However, evidence suggests that short-term fluctuations in crime often vary more than long-term trends, which sociodemographic factors cannot explain. This has redirected researchers to explore how environmental factors, such as meteorological variables, influence criminal behavior. In this study we investigate the association between daily ambient temperature and homicide incidence in South Africa, a country with one of the highest homicide rates in the world. Mortality data was from South Africa’s civil registration system and includes all recorded deaths in the country from 1997 to 2013 (17 years). Daily temperature was from the National Oceanographic and Atmospheric Association of the United States and South Africa’s Agricultural Research Council. Data were analyzed using a time-stratified case-crossover design with conditional logistic regression. We delineated cases as either “definite” (ICD-10 codes X85-Y09, n = 68,356) or “probable” homicides (ICD-10 codes W25-W26, W32-W34, W50, Y22-Y24, Y28-Y29, n = 177,873). Case periods were defined as the day on which a death occurred. Control periods were selected using a day-of-week match within the same month and district. Analyses investigated same-day and lagged effects of maximum, mean and minimum temperature. A one-degree Celsius increase in same-day maximum temperature – our a priori metric of choice – was associated with a 1.5% (1.3–1.8%) increase in definite homicides and a 1.2% (1.1–1.3%) increase in total (definite + probable) homicides. Significant (p < 0.05) positive associations were also observed when applying other temperature metrics (mean, minimum) and lags (1, 0–1). The shape of the association did not display any clear non-linearities. There was no evidence of confounding by public holidays or air pollution. This study suggests a positive association between daily ambient temperature and homicide in South Africa. This temperature-health relationship may be of particular concern in the context of climate change. The ability to include meteorological variables as a predictor of criminal activity and violent behavior could prove valuable in resource allocation for crime prevention efforts.

    更新日期:2019-12-17
  • Correction to: Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-12
    Niels Nijsingh; Christian Munthe; D. G. Joakim Larsson

    Following publication of the original article [1], the author explained that there are multiple errors in the original article

    更新日期:2019-12-13
  • Fluoride exposure and sleep patterns among older adolescents in the United States: a cross-sectional study of NHANES 2015–2016
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-09
    Ashley J. Malin; Sonali Bose; Stefanie A. Busgang; Chris Gennings; Michael Thorpy; Robert O. Wright; Rosalind J. Wright; Manish Arora

    Fluoride from environmental sources accumulates preferentially in the pineal gland which produces melatonin, the hormone that regulates the sleep-wake cycle. However, the effects of fluoride on sleep regulation remain unknown. This population-based study examined whether chronic low-level fluoride exposure is associated with sleep patterns and daytime sleepiness among older adolescents in the United States (US). This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2015–2016). We analyzed data from adolescents who had plasma fluoride (n = 473) and water fluoride (n = 419) measures and were not prescribed medication for sleep disorders. Relationships between fluoride exposure and self-reported sleep patterns or daytime sleepiness were examined using survey-weighted linear, binomial logistic or multinomial logistic regression after covariate adjustment. A Holm-Bonferroni correction accounted for multiple comparisons. The average age of adolescents was 17 years (range = 16–19). Median (IQR) water and plasma fluoride concentrations were 0.27 (0.52) mg/L and 0.29 (0.19) μmol/L respectively. An IQR increase in water fluoride was associated with 1.97 times higher odds of reporting symptoms suggestive of sleep apnea (95% CI: 1.27, 3.05; p = 0.02), a 24 min later bedtime (B = 0.40, 95% CI: 0.10, 0.70; p = 0.05), a 26 min later morning wake time (B = 0.43, 95% CI: 0.13, 0.73; p = 0.04), and among males, a 38% reduction in the odds of reporting snoring (95% CI: 0.45, 0.87, p = 0.03). Fluoride exposure may contribute to changes in sleep cycle regulation and sleep behaviors among older adolescents in the US. Additional prospective studies are warranted to examine the effects of fluoride on sleep patterns and determine critical windows of vulnerability for potential effects.

    更新日期:2019-12-11
  • Longitudinal follow-up of health effects among workers handling engineered nanomaterials: a panel study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-12-09
    Wei-Te Wu; Lih-Ann Li; Tsui-Chun Tsou; Shu-Li Wang; Hui-Ling Lee; Tung-Sheng Shih; Saou-Hsing Liou

    Although no human illness to date is confirmed to be attributed to engineered nanoparticles, occupational epidemiological studies are needed to verify the health effects of nanoparticles. This study used a repeated measures design to explore the potential adverse health effects of workers handling nanomaterials. Study population was 206 nanomaterial-handling workers and 108 unexposed controls, who were recruited from 14 nanotechnology plants. They were followed up no less than two times in four years. A questionnaire was used to collect potential confounders and detailed work conditions. Control banding was adopted to categorize risk level for each participant as a surrogate marker of exposure. Health hazard markers include cardiopulmonary dysfunction markers, inflammation and oxidative damage markers, antioxidant enzymes activity, and genotoxicity markers. The Generalized Estimating Equation model was applied to analyze repeated measurements. In comparison to the controls, a significant dose-dependent increase on risk levels for the change of superoxide dismutase (p<0.01) and a significant increase of glutathione peroxidase change in risk level 1 was found for nanomaterial-handling workers. However, the change of cardiovascular dysfunction, lung damages, inflammation, oxidative damages, neurobehavioral and genotoxic markers were not found to be significantly associated with nanomaterials handling in this panel study. This repeated measurement study suggests that there was no evidence of potential adverse health effects under the existing workplace exposure levels among nanomaterials handling workers, except for the increase of antioxidant enzymes.

    更新日期:2019-12-11
  • The effects of daily meteorological perturbation on pregnancy outcome: follow-up of a cohort of young women undergoing IVF treatment
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-11-28
    Mingpeng Zhao; Haoyang Zhang; Tarah H. B. Waters; Jacqueline Pui Wah Chung; Tin Chiu Li; David Yiu Leung Chan

    Human reproduction follows a seasonal pattern with respect to spontaneous conception, a phenomenon wherein the effect of meteorological fluctuations might not be unique. However, the effect of seasonal variations on patients who underwent in vitro fertilization (IVF) treatment is unclear. We aimed to evaluate the effects of meteorological variation on the pregnancy rate in a cohort undergoing IVF treatment by performing multivariable analyses. We conducted a cohort study in a sub-tropical region with prominent seasonal variations (2005–2016). Women aged < 35 years who were treated with a long ovarian stimulation protocol and underwent fresh embryo transfer (ER) were included. Data on gonadotropin administration (CYCL), oocyte retrieval (OR), ER, and pregnancy outcomes were prospectively recorded. For each patient, the daily average of meteorological data (temperature, humidity, sunlight duration, solar radiation) was recorded from the date of CYCL to ER. Multiple logistic regression analysis adjusted for age, fertilization method, year of the cycle, gonadotropin dose, and transferred embryo grade was performed to determine the relationship between the meteorological parameters and clinical pregnancy. Patients with one successful cycle and one failed cycle were subtracted for a case-control subgroup analysis through mixed effect logistics regressions. Time-series analysis of data in the epidemic level was conducted using the distributed lag linear and non-linear models (DLNMs). There were 1029 fresh cycles in 860 women (mean age 31.9 ± 2.0 years). Higher mean temperature from CYCL to OR (adjusted odds ratio [aOR] 1.04; 95% confidence interval [CI] 1.01–1.07, P = 0.01) increased the odds of pregnancy, while OR to ER did not show any statistical significance. Compared to that in winter, the odds of becoming pregnant were higher during higher temperature seasons, summer and autumn (aOR 1.47, 95%CI 0.97–2.23, P = 0.07 (marginally significant) and aOR 1.73, 95%CI 1.12–2.68, P = 0.02, respectively). Humidity, sunlight duration, and solar radiation had no effect on the outcome. The subgroup analysis confirmed this finding. The time-series analysis revealed a positive association between temperature and relative risk for pregnancy. In IVF treatment, the ambient temperature variation alters the pregnancy rates; this aspect must be considered when obtaining patient consent for assisted conception.

    更新日期:2019-11-29
  • Low-moderate arsenic exposure and respiratory in American Indian communities in the Strong Heart Study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-11-28
    Martha Powers; Tiffany R. Sanchez; Maria Grau-Perez; Fawn Yeh; Kevin A. Francesconi; Walter Goessler; Christine M. George; Christopher Heaney; Lyle G. Best; Jason G. Umans; Robert H. Brown; Ana Navas-Acien

    Arsenic exposure through drinking water is an established lung carcinogen. Evidence on non-malignant lung outcomes is less conclusive and suggests arsenic is associated with lower lung function. Studies examining low-moderate arsenic (< 50 μg/L), the level relevant for most populations, are limited. We evaluated the association of arsenic exposure with respiratory health in American Indians from the Northern Plains, the Southern Plains and the Southwest United States, communities with environmental exposure to inorganic arsenic through drinking water. The Strong Heart Study is a prospective study of American Indian adults. This analysis used urinary arsenic measurements at baseline (1989–1991) and spirometry at Visit 2 (1993–1995) from 2132 participants to evaluate associations of arsenic exposure with airflow obstruction, restrictive pattern, self-reported respiratory disease, and symptoms. Airflow obstruction was present in 21.5% and restrictive pattern was present in 14.4%. The odds ratio (95% confidence interval) for obstruction and restrictive patterns, based on the fixed ratio definition, comparing the 75th to 25th percentile of arsenic, was 1.17 (0.99, 1.38) and 1.27 (1.01, 1.60), respectively, after adjustments, and 1.28 (1.02, 1.60) and 1.33 (0.90, 1.50), respectively, based on the lower limit of normal definition. Arsenic was associated with lower percent predicted FEV1 and FVC, self-reported emphysema and stopping for breath. Low-moderate arsenic exposure was positively associated with restrictive pattern, airflow obstruction, lower lung function, self-reported emphysema and stopping for breath, independent of smoking and other lung disease risk factors. Findings suggest that low-moderate arsenic exposure may contribute to restrictive lung disease.

    更新日期:2019-11-29
  • Estimation and application of population attributable fraction in ecological studies
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-06-13
    Cheng-Kuan Lin; Szu-Ta Chen

    Estimation of population attributable fraction (PAF) requires unbiased relative risk (RR) by using either Levin’s or Miettinen’s formula, on which decision depends on the available exposure information in reference group, not the types of studies. For ecological studies and studies with aggregated outcomes, once having unbiased RRs, Levin’s and Miettinen’s formulae would provide identical PAF estimates. PAF could also be applied to compare relative burdens of disease between countries across time, which is an additional information in consideration of country-level policies.

    更新日期:2019-11-28
  • Issues with incorrect computing of population attributable fraction (PAF) in a global perspective on coal-fired power plants and burden of lung cancer
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-06-13
    Ahmad Khosravi; Mohammad Ali Mansournia

    All observational studies are liable to confounding and Levin’s formula becomes useless in practice for unbiasedly estimating PAF. With respect to causal interpretation of PAF in public health setting, unbiased estimation of PAF requires several assumptions which are ignored in practice. We recommend using Miettinen PAF formula with careful consideration about possibility of bias in study design and analysis.

    更新日期:2019-11-28
  • Temperature as a risk factor of emergency department visits for acute kidney injury: a case-crossover study in Seoul, South Korea
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-06-14
    Satbyul Estella Kim; Hyewon Lee; Jayeun Kim; Young Kyu Lee; Minjin Kang; Yasuaki Hijioka; Ho Kim

    Previous studies show that escalations in ambient temperature are among the risk factors for acute kidney injury (AKI). However, it has not been adequately studied in our location, Seoul, South Korea. In this study, we aimed to examine the association between ambient temperatures and AKI morbidity using emergency department (ED) visit data. We obtained data on ED visits from the National Emergency Medical Center for 21,656 reported cases of AKI from 2010 to 2014. Time-stratified case-crossover design analysis based on conditional logistic regression was used to analyze short-term effects of ambient temperature on AKI after controlling for relevant covariates. The shape of the exposure–response curve, effect modification by individual demographic characteristics, season, and comorbidities, as well as lag effects, were investigated. The odds ratio (OR) per 1 °C increase at lag 0 was 1.0087 (95% confidence interval [CI]: 1.0041–1.0134). Risks were higher during the warm season (OR = 1.0149; 95% CI: 1.0065–1.0234) than during the cool season (OR = 1.0059; 95% CI: 1.0003–1.0116) and even higher above 22.3 °C (OR = 1.0235; 95% CI: 1.0230–1.0239). This study provides evidence that ED visits for AKI were associated with ambient temperature. Early detection and treatment of patients at risk is important in both clinical and economic concerns related to AKI.

    更新日期:2019-11-28
  • Smoking-induced risk of future cardiovascular disease is partly mediated by cadmium in tobacco: Malmö Diet and Cancer Cohort Study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-06-14
    Huiqi Li; Björn Fagerberg; Gerd Sallsten; Yan Borné; Bo Hedblad; Gunnar Engström; Lars Barregard; Eva M. Andersson

    Smoking is a strong risk factor for cardiovascular disease (CVD) and causes exposure to cadmium, which is a pro-atherosclerotic metal. Cadmium exposure has also been shown to increase the risk of CVD, even after adjustment for smoking. Our hypothesis was that part of the risk of CVD in smokers may be mediated by cadmium exposure from tobacco smoke. We examined this hypothesis in a mediation analysis, trying to assess how much of the smoking-induced CVD risk could be explained via cadmium. We used prospective data on CVD (incidence and mortality) in a Swedish population-based cohort of 4304 middle-aged men and women (the Malmö Diet and Cancer Study). Blood cadmium was analyzed in base-line samples from 1991, and clinical events were followed up for 16–19 years based on registry data. Mediation analysis was conducted to evaluate the indirect effect (via cadmium) of smoking on CVD. Survival was analyzed by the accelerated failure time (AFT) model and the Aalen additive hazard model. The mean blood cadmium level in the study population was 0.43 μg/L (median 0.24 μg/L) and increased with recent and current smoking. As expected, shorter survival time (AFT model) and higher incidence rate (Aalen model) were found in current smokers for all CVD outcomes and this effect seemed to be partly mediated by cadmium. For the sum of acute myocardial infarction, bypass grafts and percutaneous coronary intervention, and death in ischemic heart disease, about half of the increased risk of such events in current smokers was mediated via cadmium, with similar results for the AFT and Aalen models. Cadmium plays an important role in smoking-induced CVDs. This provides evidence for mechanisms and is of importance for both individuals and policy makers.

    更新日期:2019-11-28
  • Exposure to polychlorinated biphenyls and organochlorine pesticides and risk of dementia, Alzheimer’s disease and cognitive decline in an older population: a prospective analysis from the Canadian Study of Health and Aging
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-06-14
    Thierry Comlan Marc Medehouenou; Pierre Ayotte; Pierre-Hugues Carmichael; Edeltraut Kröger; René Verreault; Joan Lindsay; Éric Dewailly; Suzanne L. Tyas; Alexandre Bureau; Danielle Laurin

    Little attention has been paid to neurotoxicants on the risk of dementia. Exposure to known neurotoxicants such as polychlorinated biphenyls (PCBs) and organochlorine (OC) pesticides is suspected to have adverse cognitive effects in older populations. To assess whether plasma concentrations of PCBs and OC pesticides are associated with the risk of cognitive decline, Alzheimer’s disease (AD) and of all-cause dementia in the Canadian older population. Analyses were based on data from the Canadian Study of Health and Aging, a 3-phase, 10-year population-based study of individuals aged 65+ years. Analyses included 669 clinically assessed subjects, of which 156 developed dementia including 108 incident cases of AD. Subjects were screened at each phase with the 100-point Modified Mini-Mental State Examination (3MS), a measurement of global cognitive function. Statistical analyses included Cox proportional hazards model when the outcome was dementia or AD, and a repeated-measure mixed model when the outcome was the 3MS score. No association of PCB and OC pesticides with the risk of dementia and AD was observed. Elevated concentrations of PCB congeners nos 118, 153, 156, 163, and OC pesticides 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p’-DDT) and its metabolite 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p’-DDE) were significantly associated with cognitive decline as assessed with the 3MS. A posteriori analyses suggested that only p,p’-DDE was significantly related to a higher cognitive decline in time based on the 3MS among incident cases of dementia compared to subjects remaining nondemented. PCB and OC pesticide plasma concentrations were not related to the incident diagnosis of neither dementia, nor AD. Using the 3MS scores as the outcome, higher concentrations of four PCB congeners and two OC pesticides were associated with lower cognitive performances in subjects. The association of p,p’-DDE with cognitive decline in time in incident cases of dementia merits further investigation.

    更新日期:2019-11-28
  • Biomass fuel as a risk factor for esophageal squamous cell carcinoma: a systematic review and meta-analysis
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-01
    Samson Okello; Suzan Joan Akello; Emmanuel Dwomoh; Emmanuel Byaruhanga; Christopher Kenneth Opio; Ruyang Zhang; Kathleen E. Corey; Winnie R. Muyindike; Ponsiano Ocama; David D. Christiani

    The link between use of solid biomass fuel (wood, charcoal, coal, dung, and crop residues) for cooking and/or heating and esophageal squamous cell carcinoma (ESCC) is inconclusive. We systematically reviewed the literature and performed a meta-analysis to determine whether cooking fuel type influences esophageal squamous cell carcinoma. We searched MEDLINE, EMBASE, Web of Knowledge and Cochrane Database of Systematic Reviews for studies investigating cooking fuel and ESCC from 2000 until March 2019. We performed random effects meta-analysis stratified by the continent, World Bank’s country income classifications and fuel type and calculated pooled odds ratios and 95% CIs for the risk of esophageal squamous cell carcinoma in biomass fuel users compared with non-users. Our analysis included 16 studies (all case-control) with 16,189 participants (5233 cases and 10,956 controls) that compared risk of ESCC among those using nonsolid fuels and biomass fuels. We found use of biomass fuel was associated with Esophageal squamous cell carcinoma with a pooled odds ratio (OR) 3.02 (95% CI 2.22, 4.11, heterogeneity (I2) = 79%). In sub-group analyses by continent, Africa (OR 3.35, 95%CI 2.34, 4.80, I2 = 73.4%) and Asia (OR 3.08, 95%CI 1.27, 7.43, I2 = 81.7%) had the highest odds of ESCC. Use of wood as fuel had the highest odds of 3.90, 95% CI 2.25, 6.77, I2 = 63.5%). No significant publication bias was detected. Biomass fuel is associated with increased risk of Esophageal squamous cell carcinoma. Biomass fuel status should be considered in the risk assessment for Esophageal squamous cell carcinoma.

    更新日期:2019-11-28
  • Assessing the national capacity for disaster research response (DR2) within the NIEHS Environmental Health Sciences Core Centers
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-04
    Nicole A. Errett; Erin N. Haynes; Nancy Wyland; Ali Everhart; Claire Pendergrast; Edith A. Parker

    Disaster research response (DR2) is necessary to answer scientific questions about the environmental health impacts of disasters and the effectiveness of response and recovery strategies. This research explores the preparedness and capacity of National Institute of Environmental Health Sciences (NIEHS) P30 Core Centers (CCs) to conduct DR2 and engage with communities in the context of disasters. In early 2018, we conducted an online survey of CC Directors (n = 16, 69.5% response rate) to identify their DR2 relevant scientific assets, capabilities, and activities. Summary statistics were calculated. We also conducted in-depth, semi-structured interviews with 16 (69.5%) CC Community Engagement Core directors to identify facilitators and barriers of DR2 community engagement. Interview notes were coded and thematically analyzed. Survey: While 56% of responding CCs reported prior participation in DR2 and preparedness to repurpose funding to support DR2, less than one third reported development of a disaster-specific data collection protocol, deployment plan, or concept of operations plan, participation in an exercise to test DR2 capacity, development of academic partnerships to conduct DR2, development of a process for fast-tracking institutional review board approvals for DR2, or maintenance of formal agreements with state, local, or community-based partner(s). A number of CCs reported developing or considering developing capacity in these areas. Barriers to, and tools and resources to enhance, CC engagement in DR2 were identified. Interviews: Four key components for community engaged DR2 were identified: pre-existing community relationships, responsive research that benefits communities, coordination among researchers, and coordination with community response partners. Several roles for, benefits of, and barriers to Community Engagement Rapid Response Teams (CERRT) were described. CCs have significant scientific assets and community partnerships that can be leveraged for DR2; however, additional planning is necessary to ensure that these scientific assets and community partnerships are leveraged when disasters strike.

    更新日期:2019-11-28
  • Population allocation at the housing unit level: estimates around underground natural gas storage wells in PA, OH, NY, WV, MI, and CA
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-08
    Drew R. Michanowicz; Samuel R. Williams; Jonathan J. Buonocore; Sebastian T. Rowland; Katherine E. Konschnik; Shaun A. Goho; Aaron S. Bernstein

    Spatially accurate population data are critical for determining health impacts from many known risk factors. However, the utility of the increasing spatial resolution of disease mapping and environmental exposures is limited by the lack of receptor population data at similar sub-census block spatial scales. Here we apply an innovative method (Population Allocation by Occupied Domicile Estimation – ABODE) to disaggregate U.S. Census populations by allocating an average person per household to geospatially-identified residential housing units (RHU). We considered two possible sources of RHU location data: address point locations and building footprint centroids. We compared the performance of ABODE with the common proportional population allocation (PPA) method for estimating the nighttime residential populations within 200 m radii and setback areas (100 – 300 ft) around active underground natural gas storage (UGS) wells (n = 9834) in six U.S. states. Address location data generally outperformed building footprint data in predicting total counts of census residential housing units, with correlations ranging from 0.67 to 0.81 at the census block level. Using residentially-sited addresses only, ABODE estimated upwards of 20,000 physical households with between 48,126 and 53,250 people living within 200 m of active UGS wells – likely encompassing the size of a proposed UGS Wellhead Safety Zone. Across the 9834 active wells assessed, ABODE estimated between 5074 and 10,198 more people living in these areas compare to PPA, and the difference was significant at the individual well level (p = < 0.0001). By either population estimation method, OH exhibits a substantial degree of hyperlocal land use conflict between populations and UGS wells – more so than other states assessed. In some rare cases, population estimates differed by more than 100 people for the small 200 m2 well-areas. ABODE’s explicit accounting of physical households confirmed over 50% of PPA predictions as false positives indicated by non-zero predictions in areas absent physical RHUs. Compared to PPA – in allocating identical population data at sub-census block spatial scales –ABODE provides a more precise population at risk (PAR) estimate with higher confidence estimates of populations at greatest risk. 65% of UGS wells occupy residential urban and suburban areas indicating the unique land use conflicts presented by UGS systems that likely continue to experience population encroachment. Overall, ABODE confirms tens of thousands of homes and residents are likely located within the proposed UGS Wellhead Safety Zone – and in some cases within state’s oil and gas well surface setback distances – of active UGS wells.

    更新日期:2019-11-28
  • Using web data to improve surveillance for heat sensitive health outcomes
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-09
    Jihoon Jung; Christopher K. Uejio; Chris Duclos; Melissa Jordan

    Elevated and prolonged exposure to extreme heat is an important cause of excess summertime mortality and morbidity. To protect people from health threats, some governments are currently operating syndromic surveillance systems. However, A lack of resources to support time- and labor- intensive diagnostic and reporting processes make it difficult establishing region-specific surveillance systems. Big data created by social media and web search may improve upon the current syndromic surveillance systems by directly capturing people’s individual and subjective thoughts and feelings during heat waves. This study aims to investigate the relationship between heat-related web searches, social media messages, and heat-related health outcomes. We collected Twitter messages that mentioned “air conditioning (AC)” and “heat” and Google search data that included weather, medical, recreational, and adaptation information from May 7 to November 3, 2014, focusing on the state of Florida, U.S. We separately associated web data against two different sources of health outcomes (emergency department (ED) and hospital admissions) and five disease categories (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease). Seasonal and subseasonal temporal cycles were controlled using autoregressive moving average-generalized autoregressive conditional heteroscedasticity (ARMA-GARCH) and generalized linear model (GLM). The results show that the number of heat-related illness and dehydration cases exhibited a significant positive relationship with web data. Specifically, heat-related illness cases showed positive associations with messages (heat, AC) and web searches (drink, heat stroke, park, swim, and tired). In addition, terms such as park, pool, swim, and water tended to show a consistent positive relationship with dehydration cases. However, we found inconsistent relationships between renal illness and web data. Web data also did not improve the models for cardiovascular and respiratory illness cases. Our findings suggest web data created by social medias and search engines could improve the current syndromic surveillance systems. In particular, heat-related illness and dehydration cases were positively related with web data. This paper also shows that activity patterns for reducing heat stress are associated with several health outcomes. Based on the results, we believe web data could benefit both regions without the systems and persistently hot and humid climates where excess heat early warning systems may be less effective.

    更新日期:2019-11-28
  • The association of early-life exposure to ambient PM2.5 and later-childhood height-for-age in India: an observational study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-09
    Dean Spears; Sagnik Dey; Sourangsu Chowdhury; Noah Scovronick; Sangita Vyas; Joshua Apte

    Children in India are exposed to high levels of ambient fine particulate matter (PM2.5). However, population-level evidence of associations with adverse health outcomes from within the country is limited. The aim of our study is to estimate the association of early-life exposure to ambient PM2.5 with child health outcomes (height-for-age) in India. We linked nationally-representative anthropometric data from India’s 2015–2016 Demographic and Health Survey (n = 218,152 children under five across 640 districts of India) with satellite-based PM2.5 exposure (concentration) data. We then applied fixed effects regression to assess the association between early-life ambient PM2.5 and subsequent height-for-age, analyzing whether deviations in air pollution from the seasonal average for a particular place are associated with deviations in child height from the average for that season in that place, controlling for trends over time, temperature, and birth, mother, and household characteristics. We also explored the timing of exposure and potential non-linearities in the concentration-response relationship. Children in the sample were exposed to an average of 55 μ g/m3 of PM2.5 in their birth month. After controlling for potential confounders, a 100 μg/m3 increase in PM2.5 in the month of birth was associated with a 0.05 [0.01–0.09] standard deviation reduction in child height. For an average 5 year old girl, this represents a height deficit of 0.24 [0.05–0.43] cm. We also found that exposure to PM2.5 in the last trimester in utero and in the first few months of life are significantly (p < 0.05) associated with child height deficits. We did not observe a decreasing marginal risk at high levels of exposure. India experiences some of the worst air pollution in the world. To our knowledge, this is the first study to estimate the association of early-life exposure to ambient PM2.5 on child height-for-age at the range of ambient pollution exposures observed in India. Because average exposure to ambient PM2.5 is high in India, where child height-for-age is a critical challenge in human development, our results highlight ambient air pollution as a public health policy priority.

    更新日期:2019-11-28
  • Urinary trace metals, maternal circulating angiogenic biomarkers, and preeclampsia: a single-contaminant and mixture-based approach
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-12
    Paige A. Bommarito; Stephani S. Kim; John D. Meeker; Rebecca C. Fry; David E. Cantonwine; Thomas F. McElrath; Kelly K. Ferguson

    Exposures to toxic metals and deficiencies in essential metals disrupt placentation and may contribute to preeclampsia. However, effects of exposure to combinations of metals remain unknown. We investigated the relationship between urinary trace metals, circulating angiogenic biomarkers, and preeclampsia using the LIFECODES birth cohort. Urine samples collected during pregnancy were analyzed for 17 trace metals and plasma samples were analyzed for soluble fms-like tyrosine-1 (sFlt-1) and placental growth factor (PlGF). Cox proportional hazard models were used to estimate the hazard ratios (HR) of preeclampsia associated with urinary trace metals. Linear regression models were used to estimate the relationship between urinary trace metals and angiogenic biomarkers. Principal components analysis (PCA) was used to identify groups of metals and interactions between principal components (PCs) loaded by toxic and essential metals were examined. In single-contaminant models, several toxic and essential metals were associated with lower PlGF and higher sFlt-1/PlGF ratio. Detection of urinary chromium was associated with preeclampsia: HR (95% Confidence Interval [CI]) = 3.48 (1.02, 11.8) and an IQR-increase in urinary selenium was associated with reduced risk of preeclampsia (HR: 0.28, 95% CI: 0.08, 0.94). Using PCA, 3 PCs were identified, characterized by essential metals (PC1), toxic metals (PC2), and seafood-associated metals (PC3). PC1 and PC2 were associated with lower PlGF levels, but not preeclampsia risk in the overall cohort. Trace urinary metals may be associated with adverse profiles of angiogenic biomarkers and preeclampsia.

    更新日期:2019-11-28
  • Associations between short-term exposure to gaseous pollutants and pulmonary heart disease-related mortality among elderly people in Chengdu, China
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-15
    Jianyu Chen; Jie Zeng; Chunli Shi; Ruicong Liu; Rong Lu; Suling Mao; Li Zhang

    Pulmonary heart disease (PHD) has become a global burden, especially in low- and middle-income countries. However, very few studies have assessed the influence of air pollution on PHD. This is the first study to explore the association between gaseous pollutants and PHD-related mortality in the central Sichuan Basin of southwestern China. Data on PHD-related mortality among elderly people (aged 60 and older) from 2013 to 2017 were collected from the Population Death Information Registration and Management System (PDIRMS). Data on air pollutants were collected from all 24 Municipal Environmental Monitoring Sites in Chengdu, and data on daily temperature, relative humidity, and atmospheric pressure were collected from the Chengdu Municipal Meteorological Bureau. An epidemiological design of time-stratified case-crossover was conducted to assess the association between short-term exposure to ambient gaseous pollutants and PHD-related mortality among elderly people. About 54,920 PHD-related deaths among people aged 60 and older were reported. After controlling for daily temperature, relative humidity, and atmospheric pressure, an IQR concentration increase in levels of sulfur dioxide (SO2) (13 μg/m3), nitrogen dioxide (NO2) (17 μg/m3), and ozone (O3) (74 μg/m3) was associated with 7.8, 6.2, and 5.5% increases in PHD-related mortality in people aged 60 and older, respectively. People over age 70 might have even higher susceptibility to PHD-related mortality associated with SO2, NO2, and O3. Females and individuals with alternative marital statuses (widowed, divorced, or never married) had twice and more than twice the PHD-related mortality risk associated with SO2 and NO2 than males and married individuals, respectively. Increased concentrations of ambient SO2, NO2, and O3 were significantly and positively associated with PHD-related mortality in Chengdu, China. Sociodemographic factors – including gender, age, and marital status – may modify the acute health effects of gaseous pollutants.

    更新日期:2019-11-28
  • Susceptibility of prediabetes to the health effect of air pollution: a community-based panel study with a nested case-control design
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-15
    Yiqun Han; Yanwen Wang; Weiju Li; Xi Chen; Tao Xue; Wu Chen; Yunfei Fan; Xinghua Qiu; Tong Zhu

    Recent studies suggest that people with diabetes or who are at risk of developing diabetes, i.e. prediabetic (preDM), are potentially susceptible to air pollution, but the underlying mechanisms remain unclear because the existing epidemiological studies did not include healthy control groups and only focused on limited health outcomes. We hypothesized that acute exposure to ambient fine particles (PM2.5) will lead to enhanced pulmonary and cardiometabolic changes in preDM than healthy individuals. We recruited 60 preDM and 60 healthy individuals from a community of 22,343 adults in Beijing China, and arranged each subject to complete up to seven repeated clinical visits with measures of 6 cardiopulmonary biomarkers, 6 cytokines, 4 blood pressure and endothelial function outcomes and 4 glucose metabolism biomarkers.. Moving averaged daily ambient PM2.5 in preceding 1–14 days was matched to each subject and the PM2.5 associated effect on multiple biomarkers was estimated and compared between PreDM and healthy subjects based on linear mixed effect model. All the subjects exhibited significant acute elevation of exhaled nitric oxide, white blood cells, neutrophils, interleukin-1α, and glycated haemoglobin with increased exposure to PM2.5. PreDM subjects had significant stronger adverse changes compared to healthy subjects in 6 cardiometabolic biomarkers, namely, interleukin-2, interleukin-8, systolic and diastolic blood pressure, augmentation pressure, and glucose. The maximum elevation of these 6 biomarkers in PreDM subjects were 8.6% [CI: 4.1–13.3%], 10.0% [CI: 3.9–16.4%], 1.9% [CI: 0.2–3.6%], 1.2% [CI: − 0.1-2.4%], 5.7% [CI: − 0.1-11.8%], 2.4% [CI: 0.7–4.2%], respectively, per an interquartile increase of ambient PM2.5 (61.4 μg m− 3) throughout the exposure window of the preceding 1–14 days. No significant difference was observed for the changes in pulmonary biomarkers between the two groups. PreDM individuals are more susceptible to the acute cardiometabolic effect of air pollution than the healthy individuals. A considerable public health burden can be inferred, given the high prevalence of prediabetes and the ubiquity of air pollution in China and worldwide.

    更新日期:2019-11-28
  • Neurocognitive impact of metal exposure and social stressors among schoolchildren in Taranto, Italy
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-19
    Roberto G. Lucchini; Stefano Guazzetti; Stefano Renzetti; Michele Conversano; Giuseppa Cagna; Chiara Fedrighi; Augusto Giorgino; Marco Peli; Donatella Placidi; Silvia Zoni; Giovanni Forte; Costanza Majorani; Anna Pino; Oreste Senofonte; Francesco Petrucci; Alessandro Alimonti

    Metal exposure is a public health hazard due to neurocognitive effects starting in early life. Poor socio-economic status, adverse home and family environment can enhance the neurodevelopmental toxicity due to chemical exposure. Disadvantaged socio-economic conditions are generally higher in environmentally impacted areas although the combined effect of these two factors has not been sufficiently studied. The effect of co-exposure to neurotoxic metals including arsenic, cadmium, manganese, mercury, lead, selenium, and to socio-economic stressors was assessed in a group of 299 children aged 6–12 years, residing at incremental distance from industrial emissions in Taranto, Italy. Exposure was assessed with biological monitoring and the distance between the home address and the exposure point source. Children’s cognitive functions were examined using the Wechsler Intelligence Scale for Children (WISC) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear mixed models were chosen to assess the association between metal exposure, socio-economic status and neurocognitive outcomes. Urinary arsenic, cadmium and hair manganese resulted inversely related to the distance from the industrial emission source (β − 0.04; 95% CI -0.06, − 0.01; β − 0.02; 95% CI -0.05, − 0.001; β − 0.02 95% CI -0.05, − 0.003) while the WISC intellectual quotient and its sub-scores (except processing speed index) showed a positive association with distance. Blood lead and urinary cadmium were negatively associated with the IQ total score and all sub-scores, although not reaching the significance level. Hair manganese and blood lead was positively associated with the CANTAB between errors of spatial working memory (β 2.2; 95% CI 0.3, 3.9) and the reaction time of stop signal task (β 0.05; 95% CI 0.02, 0.1) respectively. All the other CANTAB neurocognitive tests did not show to be significantly influenced by metal exposure. The highest socio-economic status showed about five points intellectual quotient more than the lowest level on average (β 4.8; 95% CI 0.3, 9.6); the interaction term between blood lead and the socio-economic status showed a significant negative impact of lead on working memory at the lowest socio-economic status level (β − 4.0; 95% CI -6.9, − 1.1). Metal exposure and the distance from industrial emission was associated with negative cognitive impacts in these children. Lead exposure had neurocognitive effect even at very low levels of blood lead concentration when socio-economic status is low, and this should further address the importance and prioritize preventive and regulatory interventions.

    更新日期:2019-11-28
  • Correction to: Exposure to arsenic in utero is associated with various types of DNA damage and micronuclei in newborns: a birth cohort study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-24
    Panida Navasumrit; Krittinee Chaisatra; Jeerawan Promvijit; Varabhorn Parnlob; Somchamai Waraprasit; Chalida Chompoobut; Ta Thi Binh; Doan Ngoc Hai; Nguyen Duy Bao; Nguyen Khac Hai; Kyoung-Woong Kim; Leona D. Samson; Joseph H. Graziano; Chulabhorn Mahidol; Mathuros Ruchirawat

    Following publication of the original article [1], the author reported that incorrect version of Tables 1, 3, 5 and 6 were published.

    更新日期:2019-11-28
  • CYP1A1 methylation mediates the effect of smoking and occupational polycyclic aromatic hydrocarbons co-exposure on oxidative DNA damage among Chinese coke-oven workers
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-07-29
    Yanli Liu; Xuejing Li; Bin Zhang; Ye Fu; Aimin Yang; Hongjie Zhang; Huitao Zhang; Yingying Niu; Jisheng Nie; Jin Yang

    Multiple factors, including co-exposure between lifestyle and environmental risks, are important in susceptibility to oxidative DNA damage. However, the underlying mechanism is not fully understood. This study was undertaken to evaluate whether Cytochrome P4501A1 (CYP1A1) methylation can mediate the co-exposure effect between smoking and occupational polycyclic aromatic hydrocarbons (PAH) in development of oxidative DNA damage. We explored the associations between smoking and occupational PAH co-exposure effect, CYP1A1 methylation and oxidative DNA damage among 500 workers from a coke-oven plant in China. Urine biomarkers of PAH exposure (1-hydroxypyrene, 1-OHP; 2-hydroxynaphthalene, 2-NAP; 2-hydroxyfluorene, 2-FLU; and 9-hydroxyphenanthren, 9-PHE) and a marker of oxidative DNA damage (8-hydroxy- 2′- deoxyguanosine, 8-OHdG) were measured by high performance liquid chromatography. CYP1A1 methylation was measured by pyrosequencing. Finally, mediation analysis was performed to investigate whether CYP1A1 methylation mediated smoking and occupational PAH co-exposure effect on oxidative DNA damage. We observed significant associations of smoking and 1-OHP co-exposure with CYP1A1 hypomethylation (OR: 1.87, 95% CI: 1.01–3.47) and high 8-OHdG (OR: 2.13, 95% CI: 1.14–3.97). There was a significant relationship between CYP1A1 hypomethylation and high 8-OHdG (1st vs. 3rd tertile = 1.58, 95% CI: 1.01–2.47, P for trend = 0.046). In addition, mediation analysis suggested CYP1A1 hypomethylation could explain 13.6% of effect of high 8-OHdG related to smoking and 1-OHP co-exposure. Our findings suggested that the co-exposure effect of smoking and occupational PAH could increase the risk of oxidative DNA damage by a mechanism partly involving CYP1A1 hypomethylation.

    更新日期:2019-11-28
  • Acute effects of fine particulate matter (PM2.5) on hospital admissions for cardiovascular disease in Beijing, China: a time-series study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-01
    Endawoke Amsalu; Tianqi Wang; Haibin Li; Yue Liu; Anxin Wang; Xiangtong Liu; Lixin Tao; Yanxia Luo; Feng Zhang; Xinghua Yang; Xia Li; Wei Wang; Xiuhua Guo

    Air pollution and cardiovascular disease are increasing problems in China. However, the short-term association between fine particulate matter (PM2.5) and cardiovascular disease (CVD) is not well documented. The purpose of this study is to estimate the short-term effects of PM2.5 on CVD admissions in Beijing, China. In total, 460,938 electronic hospitalization summary reports for CVD between 2013 and 2017 were obtained. A generalized additive model using a quasi-Poisson distribution was used to investigate the association between exposure to PM2.5 and hospitalizations for total and cause-specific CVD, including coronary heart disease (CHD), atrial fibrillation (AF), and heart failure (HF) after controlling for the season, the day of the week, public holidays, and weather conditions. A stratified analysis was also conducted for age (18–64 and ≥ 65 years), sex and season. For every 10 μg/m3 increase in the PM2.5 concentration from the previous day to the current (lag 0–1) there was a significant increase in total CVD admissions (0.30, 95% CI: 0.20, 0.39%), with a strong association for older adults (aged ≥65 years), CHD (0.34, 95% CI: 0.22 to 0.45%) and AF (0.29, 95% CI, 0.03 to 0.55%). However, the observed increased risk was not statistically significant for HF hospitalizations. The associations in the single-pollutant models were robust to the inclusion of other pollutants in a two-pollutant model. No differences were found after stratification by sex and season. Exposure to PM2.5 increased the risk of hospitalizations from CVD, especially for CHD, and appeared to have more influence in the elderly. Precautions and protective measures and efforts to reduce exposure to PM2.5 should be strengthened, especially for the elderly.

    更新日期:2019-11-28
  • Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-07
    Ferdinando Luberto; Daniela Ferrante; Stefano Silvestri; Alessia Angelini; Francesco Cuccaro; Anna Maria Nannavecchia; Enrico Oddone; Massimo Vicentini; Francesco Barone-Adesi; Tiziana Cena; Dario Mirabelli; Lucia Mangone; Francesca Roncaglia; Orietta Sala; Simona Menegozzo; Roberta Pirastu; Danila Azzolina; Sara Tunesi; Elisabetta Chellini; Lucia Miligi; Patrizia Perticaroli; Aldo Pettinari; Vittoria Bressan; Enzo Merler; Paolo Girardi; Lucia Bisceglia; Alessandro Marinaccio; Stefania Massari; Corrado Magnani

    Despite the available information on cancer risk, asbestos is used in large areas in the world, mostly in the production of asbestos cement. Moreover, questions are raised regarding the shape of the dose response relation, the relation with time since exposure and the association with neoplasms in various organs. We conducted a study on the relationship between cumulative asbestos exposure and mortality from asbestos related diseases in a large Italian pool of 21 cohorts of asbestos-cement workers with protracted exposure to both chrysotile and amphibole asbestos. The cohort included 13,076 workers, 81.9% men and 18.1% women, working in 21 Italian asbestos-cement factories, with over 40 years of observation. Exposure was estimated by plant and period, and weighted for the type of asbestos used. Data were analysed with consideration of cause of death, cumulative exposure and time since first exposure (TSFE), and by gender. SMRs were computed using reference rates by region, gender and calendar time. Poisson regression models including cubic splines were used to analyse the effect of cumulative exposure to asbestos and TSFE on mortality for asbestos-related diseases. 95% Confidence Intervals (CI) were computed according to the Poisson distribution. Mortality was significantly increased for ‘All Causes’ and ‘All Malignant Neoplasm (MN)’, in both genders. Considering asbestos related diseases (ARDs), statistically significant excesses were observed for MN of peritoneum (SMR: men 14.19; women 15.14), pleura (SMR: 22.35 and 48.10), lung (SMR: 1.67 and 1.67), ovary (in the highest exposure class SMR 2.45), and asbestosis (SMR: 507 and 1023). Mortality for ARDs, in particular pleural and peritoneal malignancies, lung cancer, ovarian cancer and asbestosis increased monotonically with cumulative exposure. Pleural MN mortality increased progressively in the first 40 years of TSFE, then reached a plateau, while peritoneal MN showed a continuous increase. The trend of lung cancer SMRs also showed a flattening after 40 years of TSFE. Attributable proportions for pleural, peritoneal, and lung MN were respectively 96, 93 and 40%. Mortality for ARDs was associated with cumulative exposure to asbestos. Risk of death from pleural MN did not increase indefinitely with TSFE but eventually reached a plateau, consistently with reports from other recent studies.

    更新日期:2019-11-28
  • Long-term exposure to air pollution and hospitalization for dementia in the Rome longitudinal study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-09
    Francesco Cerza; Matteo Renzi; Claudio Gariazzo; Marina Davoli; Paola Michelozzi; Francesco Forastiere; Giulia Cesaroni

    Few studies have explored the role of air pollution in neurodegenerative processes, especially various types of dementia. Our aim was to evaluate the association between long-term exposure to air pollution and first hospitalization for dementia subtypes in a large administrative cohort. We selected 350,844 subjects (free of dementia) aged 65–100 years at inclusion (21/10/2001) and followed them until 31/12/2013. We selected all subjects hospitalized for the first time with primary or secondary diagnoses of various forms of dementia. We estimated the exposure at residence using land use regression models for nitrogen oxides (NOx, NO2) and particulate matter (PM) and a chemical transport model for ozone (O3). We used Cox models to estimate the association between exposure and first hospitalization for dementia and its subtypes: vascular dementia (Vd), Alzheimer’s disease (Ad) and senile dementia (Sd). We selected 21,548 first hospitalizations for dementia (7497 for Vd, 7669 for Ad and 7833 for Sd). Overall, we observed a negative association between exposure to NO2 (10 μg/m3) and dementia hospitalizations (HR = 0.97; 95% CI: 0.96–0.99) and a positive association between exposure to O3, NOx and dementia hospitalizations, (O3: HR = 1.06; 95% CI: 1.04–1.09 per 10 μg/m3; NOx: HR = 1.01; 95% CI: 1.00–1.02 per 20 μg/m3).H. Exposure to NOx, NO2, PM2.5, and PM10 was positively associated with Vd and negatively associated with Ad. Hospitalization for Sd was positively associated with exposure to O3 (HR = 1.20; 95% CI: 1.15–1.24 per 10 μg/m3). Our results showed a positive association between exposure to NOx and O3 and hospitalization for dementia and a negative association between NO2 exposure and hospitalization for dementia. In the analysis by subtype, exposure to each pollutants (except O3) demonstrated a positive association with vascular dementia, while O3 exposure was associated with senile dementia. The results regarding vascular dementia are a clear indication that the brain effects of air pollution are linked with vascular damage.

    更新日期:2019-11-28
  • Impact of the warm summer 2015 on emergency hospital admissions in Switzerland
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-15
    Martina S. Ragettli; Ana M. Vicedo-Cabrera; Benjamin Flückiger; Martin Röösli

    Only a few studies have examined the impact of a particular heat event on morbidity. The aim of this study was to evaluate the impact of the warm summer 2015 on emergency hospital admissions (EHA) in Switzerland. The summer 2015 ranks as the second hottest after 2003 in the history of temperature observation in Switzerland. Daily counts of EHA for various disease categories during summer 2015 were analyzed in relation to previous summers in Switzerland. Excess EHA for non-external causes during summer 2015 (June–August) were estimated by age group, gender, geographic region and disease category by comparing observed and expected cases. The latter were predicted from strata-specific quasi-Poisson regression models fitted to the daily counts of EHA for years 2012–2014. Over the three summer months in 2015, an estimated 2.4% (95% confidence interval [CI] 1.6–3.2%) increase in EHA (non-external causes) occurred corresponding to 2,768 excess cases. Highest excess EHA estimates were found in the warmest regions (Ticino [8.4%, 95% CI 5.1–11.7%] and the Lake Geneva region [4.8%, 95% CI 3.0–6.7%]) and among the elderly population aged ≥75 years (5.1%, 95% CI 3.7–6.5%). Increased EHA during days with most extreme temperatures were observed for influenza and pneumonia, certain infectious diseases and diseases of the genitourinary system. Summer 2015 had a considerable impact on EHA in Switzerland. The daily number of EHA mainly increased due to diseases not commonly linked to heat-related mortality. No excess morbidity was found for cardiovascular and most respiratory diseases. This suggests that current public health interventions should be reevaluated to prevent both heat-related illness and deaths.

    更新日期:2019-11-28
  • Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-20
    Crystal M. North; Piers MacNaughton; Peggy S. Lai; Jose Vallarino; Samson Okello; Bernard Kakuhikire; Alexander C. Tsai; Marcia C. Castro; Mark J. Siedner; Joseph G. Allen; David C. Christiani

    Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7–27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1–10.0) but not men (AOR 1.3, 95%CI 0.4–4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01–6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1–14.4) participants. In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.

    更新日期:2019-11-28
  • Potential role of polycyclic aromatic hydrocarbons as mediators of cardiovascular effects from combustion particles
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-22
    Jørn A. Holme; Bendik C. Brinchmann; Magne Refsnes; Marit Låg; Johan Øvrevik

    Air pollution is the most important environmental risk factor for disease and premature death, and exposure to combustion particles from vehicles is a major contributor. Human epidemiological studies combined with experimental studies strongly suggest that exposure to combustion particles may enhance the risk of cardiovascular disease (CVD), including atherosclerosis, hypertension, thrombosis and myocardial infarction. In this review we hypothesize that adhered organic chemicals like polycyclic aromatic hydrocarbons (PAHs), contribute to development or exacerbation of CVD from combustion particles exposure. We summarize present knowledge from existing human epidemiological and clinical studies as well as experimental studies in animals and relevant in vitro studies. The available evidence suggests that organic compounds attached to these particles are significant triggers of CVD. Furthermore, their effects seem to be mediated at least in part by the aryl hydrocarbon receptor (AhR). The mechanisms include AhR-induced changes in gene expression as well as formation of reactive oxygen species (ROS) and/or reactive electrophilic metabolites. This is in accordance with a role of PAHs, as they seem to be the major chemical group on combustion particles, which bind AhR and/or is metabolically activated by CYP-enzymes. In some experimental models however, it seems as PAHs may induce an inflammatory atherosclerotic plaque phenotype irrespective of DNA- and/or AhR-ligand binding properties. Thus, various components and several signalling mechanisms/pathways are likely involved in CVD induced by combustion particles. We still need to expand our knowledge about the role of PAHs in CVD and in particular the relative importance of the different PAH species. This warrants further studies as enhanced knowledge on this issue may amend risk assessment of CVD caused by combustion particles and selection of efficient measures to reduce the health effects of particular matters (PM).

    更新日期:2019-11-28
  • Thyroid hormone levels associate with exposure to polychlorinated biphenyls and polybrominated biphenyls in adults exposed as children
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-23
    Sarah W. Curtis; Metrecia L. Terrell; Melanie H. Jacobson; Dawayland O. Cobb; Victoria S. Jiang; Michael F. Neblett; Sabrina A. Gerkowicz; Jessica B. Spencer; M. Elizabeth Marder; Dana Boyd Barr; Karen N. Conneely; Alicia K. Smith; Michele Marcus

    Michigan residents were directly exposed to endocrine-disrupting compounds, polybrominated biphenyl (PBB) and polychlorinated biphenyl (PCB). A growing body of evidence suggests that exposure to certain endocrine-disrupting compounds may affect thyroid function, especially in people exposed as children, but there are conflicting observations. In this study, we extend previous work by examining age of exposure’s effect on the relationship between PBB exposure and thyroid function in a large group of individuals exposed to PBB. Linear regression models were used to test the association between serum measures of thyroid function (total thyroxine (T4), total triiodothyronine (T3), free T4, free T3, thyroid stimulating hormone (TSH), and free T3: free T4 ratio) and serum PBB and PCB levels in a cross-sectional analysis of 715 participants in the Michigan PBB Registry. Higher PBB levels were associated with many thyroid hormones measures, including higher free T3 (p = 0.002), lower free T4 (p = 0.01), and higher free T3: free T4 ratio (p = 0.0001). Higher PCB levels were associated with higher free T4 (p = 0.0002), and higher free T3: free T4 ratio (p = 0.002). Importantly, the association between PBB and thyroid hormones was dependent on age at exposure. Among people exposed before age 16 (N = 446), higher PBB exposure was associated with higher total T3 (p = 0.01) and free T3 (p = 0.0003), lower free T4 (p = 0.04), and higher free T3: free T4 ratio (p = 0.0001). No significant associations were found among participants who were exposed after age 16. No significant associations were found between TSH and PBB or PCB in any of the analyses conducted. This suggests that both PBB and PCB are associated with thyroid function, particularly among those who were exposed as children or prenatally.

    更新日期:2019-11-28
  • An overview of methods to address distinct research questions on environmental mixtures: an application to persistent organic pollutants and leukocyte telomere length
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-28
    Elizabeth A. Gibson; Yanelli Nunez; Ahlam Abuawad; Ami R. Zota; Stefano Renzetti; Katrina L. Devick; Chris Gennings; Jeff Goldsmith; Brent A. Coull; Marianthi-Anna Kioumourtzoglou

    Numerous methods exist to analyze complex environmental mixtures in health studies. As an illustration of the different uses of mixture methods, we employed methods geared toward distinct research questions concerning persistent organic chemicals (POPs) as a mixture and leukocyte telomere length (LTL) as an outcome. With information on 18 POPs and LTL among 1,003 U.S. adults (NHANES, 2001–2002), we used unsupervised methods including clustering to identify profiles of similarly exposed participants, and Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) to identify common exposure patterns. We also employed supervised learning techniques, including penalized, weighted quantile sum (WQS), and Bayesian kernel machine (BKMR) regressions, to identify potentially toxic agents, and characterize nonlinear associations, interactions, and the overall mixture effect. Clustering separated participants into high, medium, and low POP exposure groups; longer log-LTL was found among those with high exposure. The first PCA component represented overall POP exposure and was positively associated with log-LTL. Two EFA factors, one representing furans and the other PCBs 126 and 118, were positively associated with log-LTL. Penalized regression methods selected three congeners in common (PCB 126, PCB 118, and furan 2,3,4,7,8-pncdf) as potentially toxic agents. WQS found a positive overall effect of the POP mixture and identified six POPs as potentially toxic agents (furans 1,2,3,4,6,7,8-hxcdf, 2,3,4,7,8-pncdf, and 1,2,3,6,7,8-hxcdf, and PCBs 99, 126, 169). BKMR found a positive linear association with furan 2,3,4,7,8-pncdf, suggestive evidence of linear associations with PCBs 126 and 169, and a positive overall effect of the mixture, but no interactions among congeners. Using different methods, we identified patterns of POP exposure, potentially toxic agents, the absence of interaction, and estimated the overall mixture effect. These applications and results may serve as a guide for mixture method selection based on specific research questions.

    更新日期:2019-11-28
  • Ambient air pollution is associated with pediatric pneumonia: a time-stratified case–crossover study in an urban area
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-28
    Chi-Yung Cheng; Shih-Yu Cheng; Chien-Chih Chen; Hsiu-Yung Pan; Kuan-Han Wu; Fu-Jen Cheng

    Pneumonia, the leading reason underlying childhood deaths, may be triggered or exacerbated by air pollution. To date, only a few studies have examined the association of air pollution with emergency department (ED) visits for pediatric pneumonia, with inconsistent results. Therefore, we aimed to elucidate the impact of short-term exposure to particulate matter (PM) and other air pollutants on the incidence of ED visits for pediatric pneumonia. PM2.5, PM10, and other air pollutant levels were measured at 11 air quality-monitoring stations in Kaohsiung City, Taiwan, between 2008 and 2014. Further, we extracted the medical records of non-trauma patients aged ≤17 years and who had visited an ED with the principal diagnosis of pneumonia. A time-stratified case–crossover study design was employed to determine the hazard effect of air pollution in a total of 4024 patients. The single-pollutant model suggested that per interquartile range increment in PM2.5, PM10, nitrogen dioxide (NO2), and sulfur dioxide (SO2) on 3 days before the event increased the odds of pediatric pneumonia by 14.0% [95% confidence interval (CI), 5.1–23.8%], 10.9% (95% CI, 2.4–20.0%), 14.1% (95% CI, 5.0–24.1%), and 4.5% (95% CI, 0.8–8.4%), respectively. In two-pollutant models, PM2.5 and NO2 were significant after adjusting for PM10 and SO2. Subgroup analyses showed that older children (aged ≥4 years) were more susceptible to PM2.5 (interaction p = 0.024) and children were more susceptible to NO2 during warm days (≥26.5 °C, interaction p = 0.011). Short-term exposure to PM2.5 and NO2 possibly plays an important role in pediatric pneumonia in Kaohsiung, Taiwan. Older children are more susceptible to PM2.5, and all children are more susceptible to NO2 during warm days.

    更新日期:2019-11-28
  • Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-30
    Luigi Vimercati; Domenica Cavone; Maria Celeste Delfino; Luigi De Maria; Antonio Caputi; Giovanni Maria Ferri; Gabriella Serio

    Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy. A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here. Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos. The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos–containing materials are at risk for the development of a MMTVT and should be monitored.

    更新日期:2019-11-28
  • Making the invisible visible: results of a community-led health survey following PFAS contamination of drinking water in Merrimack, New Hampshire
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-30
    Bindu Panikkar; Benjamin Lemmond; Laurene Allen; Carol DiPirro; Shaina Kasper

    In March 2016, citizens of Merrimack, New Hampshire, learned that their public water supply was contaminated with perfluorooctanoic acid (PFOA). A subsequent state-led investigation revealed widespread contamination of both public and private well water with PFOA and several related chemicals, broadly termed per- and polyfluoroalkyl substances (PFAS). This research examines the local response to PFAS contamination of the public water system and well water in Merrimack and the results from the health survey administered by a local advocacy group, Merrimack Citizens for Clean Water (MCFCW). MCFCW designed and implemented a community health survey (n = 596) representing 213 households exposed to PFAS through drinking water. The surveys were conducted in the summer of 2017. Respondents used an online survey platform to report demographic information, exposure sources, and health conditions. Logistic regression was used to analyze the community-based health survey results . There were several important associations that warrant further investigation and more immediate attention, especially: 1) elevated incidence of developmental, autoimmune and kidney disorders among those under 18 years of age; 2) elevated levels of health concerns, multiple health concerns, autoimmune disorders, and reproductive disorders among women, 3) elevated levels of health concerns, multiple health conditions, cardiovascular, respiratory, reproductive, and liver disorders in those with industrial occupational exposures, and; 4) elevated incidence of health concerns, cardiovascular, and developmental disorders among those who have been living in Merrimack for a long time versus newer residents. The limitations inherent in the study design warrant caution in interpreting the results, however the associations found in this study merit further investigation. This health survey highlights foremost the critical gap in information—lack of access to blood testing, medical monitoring and physician guidance of PFAS-exposed residents. This study provides a model for conducting community-based health studies to advocate for pathways to state supported biomonitoring and medical monitoring for those exposed to industrial toxins and to take into consideration the human health burden in shaping the future of chemical regulation.

    更新日期:2019-11-28
  • Association of urinary concentrations of early pregnancy phthalate metabolites and bisphenol A with length of gestation
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-08-30
    Helen B. Chin; Anne Marie Jukic; Allen J. Wilcox; Clarice R. Weinberg; Kelly K. Ferguson; Antonia M. Calafat; D. Robert McConnaughey; Donna D. Baird

    Environmental exposure to phthalates and bisphenol A (BPA) may have endocrine disrupting effects that alter length of gestation. We assessed the association between the urinary concentrations of 11 phthalate metabolites and BPA with length of gestation in a cohort of women followed from before conception with daily 1st-morning urinary hormone measures that identified day of implantation. Pre-implantation and post-implantation urinary phthalate metabolites and BPA concentrations were measured in pooled urine samples designed to limit single-measure variability due to the likely episodic nature of these exposures and the short half-life of these compounds. We estimated associations between these exposure biomarkers early in pregnancy with length of gestation from implantation to spontaneous birth. Cox proportional hazards models were used to estimate the hazard of birth among 125 naturally-conceived, singleton live births with censoring for medical interventions that artificially shortened pregnancy. Higher concentrations of mono (2-ethyl-5-hydroxyhexyl) phthalate (a metabolite of di (2-ethylhexyl) phthalate (DEHP)) during the pre-implantation window were associated with reduced probability of birth, i.e., longer gestations (hazard ratio (HR): 0.55, 95% CI: 0.35, 0.86; p = 0.01). The HR for the molar sum of the four DEHP metabolites measured showed a similar association (HR: 0.67, 95% CI: 0.43, 1.05). Higher concentrations of mono (3-carboxypropyl) phthalate (MCPP), a non-specific metabolite of several high molecular-weight phthalates, measured post-implantation were associated with increased risk of earlier birth, i.e. shorter length of gestation, HR: 1.59, CI: 1.02, 2.49. Early gestational exposure to DEHP and possibly other high-molecular weight phthalates, (as reflected by urinary MCPP concentrations) may influence the length of pregnancy. Such effects could have consequences for neonatal and maternal health.

    更新日期:2019-11-28
  • Association between a urinary biomarker for exposure to PAH and blood level of the acute phase protein serum amyloid A in coke oven workers
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-09-02
    Niels Hadrup; Danuta Mielżyńska-Švach; Agnieszka Kozłowska; Manuela Campisi; Sofia Pavanello; Ulla Vogel

    Coke oven workers are exposed to both free and particle bound PAH. Through this exposure, the workers may be at increased risk of cardiovascular diseases. Systemic levels of acute phase response proteins have been linked to cardiovascular disease in epidemiological studies, suggesting it as a marker of these conditions. The aim of this study was to assess whether there was association between PAH exposure and the blood level of the acute phase inflammatory response marker serum amyloid A (SAA) in coke oven workers. A total of 87 male Polish coke oven workers from two different plants comprised the study population. Exposure was assessed by means of the individual post-shift urinary excretion of 1-hydroxypyrene, as internal dose of short-term PAH exposure, and by anti-benzo[a]pyrene diolepoxide (anti-B[a]PDE)-DNA), as a biomarker of long-term PAH exposure. Blood levels of acute phase proteins SAA and CRP were measured by immunoassay. C-reactive protein (CRP) levels were included to adjust for baseline levels of SAA. Multiple linear regression showed that the major determinants of increased SAA levels were urinary 1-hydroxypyrene (beta = 0.56, p = 0.030) and serum CRP levels (beta = 7.08; p < 0.0001) whereas anti-B[a]PDE-DNA, the GSTM1 detoxifying genotype, diet, and smoking were not associated with SAA levels. Urinary 1-hydroxypyrene as biomarker of short-term PAH exposure and serum levels of CRP were predictive of serum levels of SAA in coke oven workers. Our data suggest that exposure of coke oven workers to PAH can lead to increased systemic acute response and therefore potentially increased risk of cardiovascular disease.

    更新日期:2019-11-28
  • Changes in triggering of ST-elevation myocardial infarction by particulate air pollution in Monroe County, New York over time: a case-crossover study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-09-06
    Meng Wang; Philip K. Hopke; Mauro Masiol; Sally W. Thurston; Scott Cameron; Frederick Ling; Edwin van Wijngaarden; Daniel Croft; Stefania Squizzato; Kelly Thevenet-Morrison; David Chalupa; David Q. Rich

    Previous studies have reported that fine particle (PM2.5) concentrations triggered ST elevation myocardial infarctions (STEMI). In Rochester, NY, multiple air quality policies and economic changes/influences from 2008 to 2013 led to decreased concentrations of PM2.5 and its major constituents (SO42−, NO3−, elemental and primary organic carbon). This study examined whether the rate of STEMI associated with increased ambient gaseous and PM component concentrations was different AFTER these air quality policies and economic changes (2014–2016), compared to DURING (2008–2013) and BEFORE these polices and changes (2005–2007). Using 921 STEMIs treated at the University of Rochester Medical Center (2005–2016) and a case-crossover design, we examined whether the rate of STEMI associated with increased PM2.5, ultrafine particles (UFP, < 100 nm), accumulation mode particles (AMP, 100-500 nm), black carbon, SO2, CO, and O3 concentrations in the previous 1–72 h was modified by the time period related to these pollutant source changes (BEFORE, DURING, AFTER). Each interquartile range (3702 particles/cm3) increase in UFP concentration in the previous 1 h was associated with a 12% (95% CI = 3%, 22%) increase in the rate of STEMI. The effect size was larger in the AFTER period (26%) than the DURING (5%) or BEFORE periods (9%). There were similar patterns for black carbon and SO2. An increased rate of STEMI associated with UFP and other pollutant concentrations was higher in the AFTER period compared to the BEFORE and DURING periods. This may be due to changes in PM composition (e.g. higher secondary organic carbon and particle bound reactive oxygen species) following these air quality policies and economic changes.

    更新日期:2019-11-28
  • Geomagnetic disturbances driven by solar activity enhance total and cardiovascular mortality risk in 263 U.S. cities
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-09-11
    Carolina Leticia Zilli Vieira; Danilo Alvares; Annelise Blomberg; Joel Schwartz; Brent Coull; Shaodan Huang; Petros Koutrakis

    Short-term geomagnetic disturbances (GMD) driven by the quasi-periodic 11-year cycle of solar activity have been linked to a broad range of adverse health effects, including cardiovascular diseases (CVD) and total deaths. We conducted a large epidemiological study in 263 U.S. cities to assess the effects of GMD on daily deaths of total, CVD, myocardial infarction (MI), and stroke. We employed a two-step meta-analysis approach, in which we estimated city-specific and season-stratified mortality risk associated with a GMD parameter (Kp index) in 263 U.S. cities. In addition, sensitivity analysis was performed to assess whether effect modification of particulate matter (PM2.5) in the prior day changed Kp index effects on daily deaths after adjusting for confounders. We found significant association between daily GMD and total, CVD, and MI deaths. The effects were even stronger when we adjusted the models for 24-h PM2.5 for different seasons. For example, in the winter and fall one standard deviation of z-score Kp index increase was associated with a 0.13 and 0.31% increase in total deaths, respectively (Winter: p = 0.01, 95% CI: 0.02 to 0.24; Fall: p = 0.00001; 95% CI: 0.23 to 0.4), without adjusting for PM2.5. The effects of GMD on total deaths were also observed in spring and summer in the models without PM2.5 (p = 0.00001). When the models were adjusted for PM2.5 the total deaths increased 0.47% in winter (p = 0.00001, 95% CI: 0.3 to 0.65) and by 0.23% in fall (p = 0.001, 95% CI: 0.09 to 0.37). The effects of GMD were also significant associated with MI deaths and CVD. No positive significant association were found between Kp and stroke. The GMD effects on deaths were higher than for 24 h-PM2.5 alone, especially in spring and fall. Our results suggest that GMD is associated with total, CVD and MI deaths in 263 U. S cities. Increased mortality in the general population during GMD should be further investigated to determine whether those human physiological dynamics driven by variations in solar activity can be related to daily clinical cardiovascular observations.

    更新日期:2019-11-28
  • Low concentrations of fine particle air pollution and mortality in the Canadian Community Health Survey cohort
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-10
    Tanya Christidis; Anders C. Erickson; Amanda J. Pappin; Daniel L. Crouse; Lauren L. Pinault; Scott A. Weichenthal; Jeffrey R. Brook; Aaron van Donkelaar; Perry Hystad; Randall V. Martin; Michael Tjepkema; Richard T. Burnett; Michael Brauer

    Approximately 2.9 million deaths are attributed to ambient fine particle air pollution around the world each year (PM2.5). In general, cohort studies of mortality and outdoor PM2.5 concentrations have limited information on individuals exposed to low levels of PM2.5 as well as covariates such as smoking behaviours, alcohol consumption, and diet which may confound relationships with mortality. This study provides an updated and extended analysis of the Canadian Community Health Survey-Mortality cohort: a population-based cohort with detailed PM2.5 exposure data and information on a number of important individual-level behavioural risk factors. We also used this rich dataset to provide insight into the shape of the concentration-response curve for mortality at low levels of PM2.5. Respondents to the Canadian Community Health Survey from 2000 to 2012 were linked by postal code history from 1981 to 2016 to high resolution PM2.5 exposure estimates, and mortality incidence to 2016. Cox proportional hazard models were used to estimate the relationship between non-accidental mortality and ambient PM2.5 concentrations (measured as a three-year average with a one-year lag) adjusted for socio-economic, behavioural, and time-varying contextual covariates. In total, 50,700 deaths from non-accidental causes occurred in the cohort over the follow-up period. Annual average ambient PM2.5 concentrations were low (i.e. 5.9 μg/m3, s.d. 2.0) and each 10 μg/m3 increase in exposure was associated with an increase in non-accidental mortality (HR = 1.11; 95% CI 1.04–1.18). Adjustment for behavioural covariates did not materially change this relationship. We estimated a supra-linear concentration-response curve extending to concentrations below 2 μg/m3 using a shape constrained health impact function. Mortality risks associated with exposure to PM2.5 were increased for males, those under age 65, and non-immigrants. Hazard ratios for PM2.5 and mortality were attenuated when gaseous pollutants were included in models. Outdoor PM2.5 concentrations were associated with non-accidental mortality and adjusting for individual-level behavioural covariates did not materially change this relationship. The concentration-response curve was supra-linear with increased mortality risks extending to low outdoor PM2.5 concentrations.

    更新日期:2019-11-28
  • Prenatal maternal and childhood bisphenol a exposure and brain structure and behavior of young children
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-15
    Melody N. Grohs; Jess E. Reynolds; Jiaying Liu; Jonathan W. Martin; Tyler Pollock; Catherine Lebel; Deborah Dewey

    Bisphenol A (BPA) is commonly used in the manufacture of plastics and epoxy resins. In North America, over 90% of the population has detectable levels of urinary BPA. Human epidemiological studies have reported adverse behavioral outcomes with BPA exposure in children, however, corresponding effects on children’s brain structure have not yet been investigated. The current study examined the association between prenatal maternal and childhood BPA exposure and white matter microstructure in children aged 2 to 5 years, and investigated whether brain structure mediated the association between BPA exposure and child behavior. Participants were 98 mother-child pairs who were recruited between January 2009 and December 2012. Total BPA concentrations in spot urine samples obtained from mothers in the second trimester of pregnancy and from children at 3–4 years of age were analyzed. Children participated in a diffusion magnetic resonance imaging (MRI) scan at age 2–5 years (3.7 ± 0.8 years). Associations between prenatal maternal and childhood BPA and children’s fractional anisotropy and mean diffusivity of 10 isolated white matter tracts were investigated, controlling for urinary creatinine, child sex, and age at the time of MRI. Post-hoc analyses examined if alterations in white matter mediated the relationship of BPA and children’s scores on the Child Behavior Checklist (CBCL). Prenatal maternal urinary BPA was significantly associated with child mean diffusivity in the splenium and right inferior longitudinal fasciculus. Splenium diffusivity mediated the relationship between maternal prenatal BPA levels and children’s internalizing behavior (indirect effect: β = 0.213, CI [0.0167, 0.564]). No significant associations were found between childhood BPA and white matter microstructure. This study provides preliminary evidence for the neural correlates of BPA exposure in humans. Our findings suggest that prenatal maternal exposure to BPA may lead to alterations in white matter microstructure in preschool aged children, and that such alterations mediate the relationship between early life exposure to BPA and internalizing problems.

    更新日期:2019-11-28
  • Association of low-level blood lead with serum uric acid in U.S. adolescents: a cross-sectional study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-16
    Guiping Hu; Guang Jia; Shichuan Tang; Pai Zheng; Lihua Hu

    Uncertainty remains regarding the association between blood lead levels (BLL) and serum uric acid (SUA) with relatively low BLL exposure because of limited data in the adolescent population. We examined the association between BLL and SUA in U.S. adolescents. In this cross-sectional study, 8303 adolescents aged 12–19 years from NHANES 1999–2006 were analyzed. BLL was Ln-transformed for analysis for the skewed distribution. Elevated SUA was defined as ≥5.5 mg/dL. Multivariate linear and multiple logistic regression analyses were performed to evaluate the association of BLL with SUA and elevated SUA. Moreover, a generalized additive model (GAM) and a fitted smoothing curve (penalized spline method) were conducted. The overall mean BLL was 1.3 μg/dL. Multivariate linear regression analyses showed that LnBLL was independently and positively correlated with SUA level (β = 0.13, 95%CI: 0.09–0.17). Multiple logistic analyses showed that LnBLL was associated with a 24% increased prevalence of elevated SUA (OR = 1.24; 95% CI, 1.11–1.38). Analyses using restricted cubic spline confirmed that the associations of LnBLL with SUA and elevated SUA were linear. Subgroup analyses showed that stronger associations between LnBLL and SUA were detected in adolescents with lower levels of education and estimated glomerular filtration rate (eGFR) (all P for interaction < 0.05). BLL was independently and positively correlated with SUA level and elevated SUA among U.S. adolescents, particularly with lower levels of education and eGFR. The data suggest that there is no “safe” threshold level of exposure to lead.

    更新日期:2019-11-28
  • Impact of high drinking water nitrate levels on the endogenous formation of apparent N-nitroso compounds in combination with meat intake in healthy volunteers
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-17
    Simone G. van Breda; Karen Mathijs; Virág Sági-Kiss; Gunter G. Kuhnle; Ben van der Veer; Rena R. Jones; Rashmi Sinha; Mary H. Ward; Theo M. de Kok

    Nitrate is converted to nitrite in the human body and subsequently can react with amines and amides in the gastrointestinal tract to form N-nitroso compounds (NOCs), which are known to be carcinogenic in animals. Humans can be exposed to nitrate via consumption of drinking water and diet, especially green leafy vegetables and cured meat. The contribution of nitrate from drinking water in combination with meat intake has not been investigated thoroughly. Therefore, in the present pilot study, we examined the effect of nitrate from drinking water, and its interaction with the consumption of white and processed red meat, on the endogenous formation of NOCs, taking into account the intake of vitamin C, a nitrosation inhibitor. Twenty healthy subjects were randomly assigned to two groups consuming either 3.75 g/kg body weight (maximum 300 g per day) processed red meat or unprocessed white meat per day for two weeks. Drinking water nitrate levels were kept low during the first week (< 1.5 mg/L), whereas in week 2, nitrate levels in drinking water were adjusted to the acceptable daily intake level of 3.7 mg/kg bodyweight. At baseline, after 1 and 2 weeks, faeces and 24 h urine samples were collected for analyses of nitrate, apparent total N-nitroso compounds (ATNC), compliance markers, and genotoxic potential in human colonic Caco-2 cells. Urinary nitrate excretion was significantly increased during the high drinking water nitrate period for both meat types. Furthermore, levels of compliance markers for meat intake were significantly increased in urine from subjects consuming processed red meat (i.e. 1-Methylhistidine levels), or unprocessed white meat (i.e. 3-Methylhistidine). ATNC levels significantly increased during the high drinking water nitrate period, which was more pronounced in the processed red meat group. Genotoxicity in Caco-2 cells exposed to faecal water resulted in increased genotoxicity after the interventions, but results were only significant in the low drinking water nitrate period in subjects consuming processed red meat. Furthermore, a positive correlation was found between the ratio of nitrate/vitamin C intake (including drinking water) and the level of ATNC in faecal water of subjects in the processed red meat group, but this was not statistically significant. Drinking water nitrate significantly contributed to the endogenous formation of NOC, independent of the meat type consumed. This implies that drinking water nitrate levels should be taken into account when evaluating the effect of meat consumption on endogenous formation of NOC. Dutch Trialregister: 29707 . Registered 19th of October 2018. Retrospectively registered.

    更新日期:2019-11-28
  • Methodological limitations in experimental studies on symptom development in individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) – a systematic review
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-22
    Kristina Schmiedchen; Sarah Driessen; Gunnhild Oftedal

    Hypersensitivity to electromagnetic fields (EMF) is a controversial condition. While individuals with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) claim to experience health complaints upon EMF exposure, many experimental studies have found no convincing evidence for a physical relation. The aim of this systematic review was to evaluate methodological limitations in experimental studies on symptom development in IEI-EMF individuals that might have fostered false positive or false negative results. Furthermore, we compared the profiles of these limitations between studies with positive and negative results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the methodological conduct and reporting. Eligible were blinded experimental studies that exposed individuals with IEI-EMF to different EMF exposure levels and queried the development of symptoms during or after each exposure trial. Strengths and limitations in design, conduct and analysis of individual studies were assessed using a customized rating tool. Twenty-eight studies met the eligibility criteria and were included in this review. In many studies, both with positive and negative results, we identified methodological limitations that might have either fostered false or masked real effects of exposure. The most common limitations were related to the selection of study participants, the counterbalancing of the exposure sequence and the effectiveness of blinding. Many studies further lacked statistical power estimates. Methodically sound studies indicated that an effect of exposure is unlikely. Overall, the evidence points towards no effect of exposure. If physical effects exist, previous findings suggest that they must be very weak or affect only few individuals with IEI-EMF. Given the evidence that the nocebo effect or medical/mental disorders may explain the symptoms in many individuals with IEI-EMF, additional research is required to identify the various factors that may be important for developing IEI-EMF and for provoking the symptoms. We recommend the identification of subgroups and exploring IEI-EMF in the context of other idiopathic environmental intolerances. If further experimental studies are conducted, they should preferably be performed at the individual level. In particular, to increase the likelihood of detecting hypersensitive individuals, if they exist, we encourage researchers to achieve a high credibility of the results by minimizing sources of risk of bias and imprecision.

    更新日期:2019-11-28
  • Morbidity burden of respiratory diseases attributable to ambient temperature: a case study in a subtropical city in China
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-24
    Yiju Zhao; Zhao Huang; Shengyong Wang; Jianxiong Hu; Jianpeng Xiao; Xing Li; Tao Liu; Weilin Zeng; Lingchuan Guo; Qingfeng Du; Wenjun Ma

    There are significant associations between ambient temperature and respiratory disease mortality. However, few studies have assessed the morbidity burdens of various respiratory diseases that are attributable to different temperature ranges in subtropical regions. Daily outpatient visits, weather variables, and air pollution data were collected from January 2013 to August 2017 in a hospital in Dongguan city. A standard time series quasi-Poisson regression with a distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for total respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma. Attributable fractions were then calculated to quantify disease burden relative to different temperature components. Finally, we conducted stratified analysis by age group. Both low and high temperatures were associated with an increased risk of morbidity secondary to respiratory diseases. Compared with the optimum temperature, the accumulated relative risk (RR) during the seven lag days was 1.13 with a 95% confidence interval (CI) of 1.01–1.26 for extreme heat and 1.02 (95% CI: 0.99–1.05) for extreme cold. Heat-related respiratory morbidity risk was higher than cold-related risk for the total population, but an opposite result was observed for the elderly. About 8.4% (95% CI: 2.8–13.3%) of respiratory morbidity was attributable to non-optimal temperatures, and moderate heat was responsible for most of the excess respiratory morbidity (7.5, 95% CI: 2.4–12.2%). We found that exposure to non-optimal temperatures increased the risk of respiratory morbidity in subtropical region, and moderate heat contributed to most of the temperature-related respiratory morbidities. This indicates a need for further examination of moderate, rather than extreme, heat in subtropical region.

    更新日期:2019-11-28
  • Does the oxidative stress play a role in the associations between outdoor air pollution and persistent asthma in adults? Findings from the EGEA study
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-29
    Anaïs Havet; Zhen Li; Farid Zerimech; Margaux Sanchez; Valérie Siroux; Nicole Le Moual; Bert Brunekreef; Nino Künzli; Bénédicte Jacquemin; Raphaëlle Varraso; Régis Matran; Rachel Nadif

    Evidences that oxidative stress plays a role in the associations between outdoor air pollution and asthma are growing. We aimed to study the role of plasma fluorescent oxidation products levels (FlOPs; an oxidative stress-related biomarker), as potential mediators, in the associations between outdoor air pollution and persistent asthma. Analyses were conducted in 204 adult asthmatics followed up in the French case-control and family study on asthma (EGEA; the Epidemiological study of the Genetic and Environmental factors of Asthma). Persistent asthma was defined as having current asthma at EGEA2 (baseline, 2003–2007) and EGEA3 (follow-up, 2011–2013). Exposures to nitrogen dioxide, nitrogen oxides, road traffic, particulate matter with a diameter ≤ 10 μm (PM10) and ≤ 2.5 μm were estimated by ESCAPE models (2009–2010), and ozone (O3) by IFEN models (2004). We used a mediation analysis to assess the mediated effect by FlOPs levels and the interaction between FlOPs levels and air pollution. FlOPs levels increased with PM10 and O3 (adjusted β = 0.04 (95%CI 0.001–0.08), aβ = 0.04 (95%CI 0.009–0.07) per 10 μg/m3, respectively), and the risk of persistent asthma increased with FlOPs levels (aOR = 1.81 (95%CI 1.08–3.02)). The risk of persistent asthma decreased with exposures to NO2, NOx and PM2.5 (aOR ranging from 0.62 to 0.94), and increased with exposures to PM10, O3, O3-summer and road traffic, the greater effect being observed for O3 (aOR = 1.78, 95% CI 0.73–4.37, per 10 μg/m3). Using mediation analysis, we observed a positive total effect (aOR = 2.16, 95%CI 0.70–11.9), a positive direct effect of O3 on persistent asthma (OR = 1.68, 95%CI 0.57–7.25), and a positive indirect effect mediated by FIOPs levels (aOR = 1.28 (95%CI 1.01–2.29)) accounting for 41% of the total effect. Our results add insights on the role of oxidative stress in the association between air pollution and persistent asthma.

    更新日期:2019-11-28
  • Serum dioxin and DNA methylation in the sperm of operation ranch hand veterans exposed to Agent Orange
    Environ. Health-Glob. (IF 4.43) Pub Date : 2019-10-29
    Karl T. Kelsey; Matthew Rytel; Edward Dere; Rondi Butler; Melissa Eliot; Susan M. Huse; E. Andres Houseman; Devin C. Koestler; Kim Boekelheide

    Exposure to the herbicide Agent Orange during the Vietnam War was widespread and is associated with numerous adverse health outcomes. A continuing concern of veterans is the possibility that exposure to the dioxin-containing herbicide might induce adverse reproductive outcomes. We sought to assess whether exposure to Agent Orange in Vietnam was associated with changes in DNA methylation in sperm in a subset of Vietnam veterans who participated in the Air Force Health Study (AFHS). We studied 37 members of the AFHS chosen to have no, low, medium or high exposure to Agent Orange, based upon serum dioxin levels obtained during a series of examinations. DNA from stored semen was extracted and DNA methylation assessed on the Illumina 450 K platform. Initial epigenome-wide analysis returned no loci that survived control for false discovery. However, the TEAD3 gene had four different CpG sites that showed loss of DNA methylation associated with dioxin exposure. Analysis assessing regional DNA methylation changes revealed 36 gene regions, including the region of the imprinted gene H19 to have altered DNA methylation associated with high exposure compared to the low exposure group. Additional comparison of our data with sperm DNA methylation data from Russian boys exposed to dioxin found an additional 5 loci that were altered in both studies and exhibited a consistent direction of association. Studying a small number of sperm samples from veterans enrolled in the AFHS, we did not find evidence of significant epigenome-wide alterations associated with exposure to Agent Orange. However, additional analysis showed that the H19 gene region is altered in the sperm of Agent Orange-exposed Ranch Hand veterans. Our study also replicated several findings of a prior study of dioxin-exposed Russian boys. These results provide additional candidate loci for further investigation and may have implications for the reproductive health of dioxin-exposed individuals.

    更新日期:2019-11-28
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