Epidemiology of Oral Cancer in Taiwan: A Population-Based Cancer Registry Study.

Oral cancer (OC) is one of the most common cancers worldwide, and its incidence has regional differences. In this study, the cancer registry database obtained from 1980 to 2019 was used to analyze the characteristic of incidence of OC by average annual percentage change (AAPC) and an age-period-cohort model. Spearman's correlation was used to analyze the relationship between the age-standard incidence rates (ASR) of OC and related risk factors. Our results showed that the ASR of OC increased from 4.19 to 27.19 per 100,000 population with an AAPC of 5.1% (95% CI = 3.9-6.3, p value < 0.001) in men and from 1.16 to 2.8 per 100,000 population with an AAPC of 3.1% (95% CI = 2.6-3.6, p value < 0.001) in women between 1980-1984 and 2015-2019. The age-period-cohort model reported a trend of rising then declining for the rate ratio in men, with peaks occurring in the 1975 cohort, with a rate ratio of 6.80. The trend of incidence of oral cancer was related to changes in the consumption of cigarettes and alcohol and production of betel quid, with r values of 0.952, 0.979 and 0.963, respectively (all p values < 0.001). We strongly suggest avoiding these risk factors in order to prevent OC.

Secular Trends in Incidence of Esophageal Cancer in Taiwan from 1985 to 2019: An Age-Period-Cohort Analysis.

In Taiwan, the age-standardized incidence of EC, especially esophageal squamous cell carcinoma (ESCC), has increased substantially during the past thirty years. We described the incidence trends of EC from 1985−2019 by an average annual percentage change (AAPC) and age-period-cohort model by using Taiwan Cancer Registry data. Age-period-cohort modeling was used to estimate the period and cohort effects of ESCC and esophageal adenocarcinoma (EAC). The Spearman's correlation coefficient was used to analyze the correlation between age-adjusted incidence rates of EC and the prevalence of risk factors from national surveys. The results showed the incidence rate of ESCC in men (AAPC = 4.2, 95% CI = 3.1−5.4, p < 0.001) increased prominently from 1985−1989 to 2015−2019 while that of EAC in men (AAPC = 1.2, 95% CI = 0.9−1.5, p < 0.001) and ESCC in women (AAPC = 1.7, 95% CI = 1.4−2.1, p < 0.001) increased to a lesser degree. Increased period effects were observed in ESCC in men, ESCC in women, and EAC in men. High correlations were found between the risk factors and the increased birth-cohort effects of ESCC (p < 0.05). To conclude, the incidence of ESCC in both sex and EAC in men increased with statistical significance in recent decades. The increased prevalence of risk factors from approximately 1970−1995 could explain the increased cohort effects of ESCC.

Ranking the environmental factors of indoor air quality of metropolitan independent coffee shops by Random Forests model.

Independent coffee shops are the alternative workplaces for people working remotely from traditional offices but are not concerned about their indoor air quality (IAQ). This study aimed to rank the environmental factors in affecting the IAQ by Random Forests (RFs) models. The indoor environments and human activities of participated independent coffee shops were observed and recorded for 3 consecutive days including weekdays and weekend during the business hours. The multi-sized particulate matter (PM), particle-bound polycyclic aromatic hydrocarbons (p-PAHs), total volatile organic compounds (TVOCs), CO, CO2, temperature and relative humidity were monitored. RFs models ranked the environmental factors. More than 20% of the 15-min average concentrations of PM10, PM2.5, and CO2 exceeded the World Health Organization guidelines. Occupant density affected TVOCs, p-PAHs and CO2 concentrations directly. Tobacco smoking dominated PM10, PM2.5, TVOCs and p-PAHs concentrations mostly. CO concentration was affected by roasting bean first and tobacco smoking secondly. The non-linear relationships between temperature and these pollutants illustrated the relative low concentrations happened at temperature between 22 and 24 °C. Tobacco smoking, roasting beans and occupant density are the observable activities to alert the IAQ change. Decreasing CO2 and optimizing the room temperature could also be the surrogate parameters to assure the IAQ.

Investigation of Microenvironmental Exposures to Particle-Bound Polycyclic Aromatic Hydrocarbons for Elementary School Children.

Polycyclic aromatic hydrocarbons (PAHs) are formed when organic matters incompletely combust and get distributed into the air in the form of vapor or the particular phase of absorption or condensation on the surface of respirable particles. Certain PAHs are considered as carcinogenic and mutagenic, and are primarily associated with the particulate phase. Therefore, the characterization of exposure to particle-bound PAHs (p-PAHs) is critical to assessing the health risks in our daily life. A panel study was conducted during the years 2004 and 2005 to assess microenvironmental exposures to p-PAHs for elementary school children living in Taipei metropolitan area. During the study, integrated filter samples were collected by a dust monitor (model 1.108, Grimm) for 17 p-PAH species analysis using gas chromatography with mass spectrometry (GC/MS). The sampling durations were five days. Overall, 52 samples for children's microenvironmental exposures were included in the data analysis. Results showed that geometric mean (GM) levels (and geometric standard deviation) of p-PAH exposures were 4.443 (3.395) ng/m3 for children. The top three highest proportions of p-PAH components were indeno[1,2,3-cd]pyrene (IND) (21.7%), benzo[g,h,i]perylene (BghiP) (18.5%), and dibenz[a,h]anthracene (DBA) (9.1%), all of which are 5- or 6-ring p-PAHs. In addition, results from diagnostic ratios and principal component analysis (PCA) found that traffic pollution, incense burning, and cooking emission were the major p-PAH exposure sources for children. The total benzo[a]pyrene equivalent (BaPeq) concentration was 1.07 ± 0.80 ng/m3 (mean ± standard deviation), with a GM of 0.84 ng/m3. The GM value of the inhalation carcinogenic risk was 7.31 × 10-5 with the range of 2.23 × 10-5 to 3.11 × 10-4, which was higher than the U.S. Environmental Protection Administration guideline limit of 10-6. DBA accounted for 45.1% of the excess cancer risk, followed by benzo[a]pyrene (BaP) (33.5%) and IND (10.7%). In conclusion, the current study demonstrated that inhalational cancer risk due to the p-PAH exposures for children is not negligible, and more efficient technical and management policies should be adopted to reduce the PAH pollutant sources.

Effects of Personal Exposures to Micro- and Nano-Particulate Matter, Black Carbon, Particle-Bound Polycyclic Aromatic Hydrocarbons, and Carbon Monoxide on Heart Rate Variability in a Panel of Healthy Older Subjects.

As a non-invasive method, heart rate variability (HRV) has been widely used to study cardiovascular autonomous control. Environmental epidemiological studies indicated that the increase in an average concentration of particulate matter (PM) would result in a decrease in HRV, which was related to the increase of cardiovascular mortality in patients with myocardial infarction and the general population. With rapid economic and social development in Asia, how air pollutants, such as PM of different sizes and their components, affect the cardiovascular health of older people, still need to be further explored. The current study includes a 72 h personal exposure monitoring of seven healthy older people who lived in the Taipei metropolitan area. Mobile equipment, a portable electrocardiogram recorder, and the generalized additive mixed model (GAMM) were adopted to evaluate how HRV indices were affected by size-fractionated PM, particle-bound polycyclic aromatic hydrocarbons (p-PAHs), black carbon (BC), and carbon monoxide (CO). Other related confounding factors, such as age, sex, body mass index (BMI), temperature, relative humidity (RH), time, and monitoring week were controlled by fixed effects of the GAMM. Statistical analyses of multi-pollutant models showed that PM2.5-10, PM1, and nanoparticle (NP) could cause heart rate (HR), time-domain indices, and frequency-domain indices to rise; PM1-2.5 and BC would cause the frequency-domain index to rise; p-PAHs would cause HR to rise, and CO would cause time-domain index and frequency-domain index to decline. In addition, the moving average time all fell after one hour and might appear at 8 h in HRVs' largest percentage change caused by each pollutant, results of which suggested that size-fractionated PM, p-PAHs, BC, and CO exposures have delayed effects on HRVs. In conclusion, the results of the study showed that the increase in personal pollutant exposure would affect cardiac autonomic control function of healthy older residents in metropolitan areas, and the susceptibility of cardiovascular effects was higher than that of healthy young people. Since the small sample size would limit the generalizability of this study, more studies with larger scale are warranted to better understand the HRV effects of simultaneous PM and other pollution exposures for subpopulation groups.

Exposure to fine particulate matter causes oxidative and methylated DNA damage in young adults: A longitudinal study.

An increased understanding is needed of the physiological effects and plausible biological mechanisms that link PM2.5 (particulate matter with an aerodynamic diameter below 2.5µm) exposure to mortality and morbidities such as atherosclerosis and respiratory disease. PM2.5 causes carcinogenic health effects. Biomonitoring in humans has suggested that 8-oxo-7, 8-dihydro-2-deoxyguanosine (8-oxodG) and N7-methylguanine (N7-MeG) are correlated with oxidative and methylated DNA damage. Thus, it is meaningful to explore the mechanisms of mutagenesis and carcinogenesis associated with oxidative and methylated DNA damage by simultaneously measuring these two markers. We recruited 72 participants from 2 areas (residential and commercial as well as residential and industrial) in the greater Taipei metropolitan area at baseline. Personal samplers were used to collect 24-hour PM2.5-integrated samples. All participants completed an interview, and blood and urine samples were collected the next morning. All collection procedures were repeated twice after a two-month follow-up period. Urinary 8-oxodG and N7-MeG were assayed as biomarkers of oxidative and methylated DNA damage, respectively. Plasma superoxide dismutase (SOD) and glutathione peroxidase-1 (GPX-1) were measured as biomarkers of antioxidants. Urinary 1-hydroxypyrene (1-OHP) was used as a biomarker of exposure to polycyclic aromatic hydrocarbons (PAHs). The mean PM2.5 level was 37.3µg/m3 at baseline. PM2.5 concentrations were higher during winter than during spring and summer. After adjusting for confounds through a generalized estimating equation (GEE) analysis, N7-MeG was significantly increased by 8.1% (ß=0.034, 95% CIs=0.001-0.068) per 10µg/m3 increment in PM2.5. 8-oxodG levels were positively correlated with N7-MeG according to both cross-sectional and longitudinal analyses, and 1-OHP was significantly associated with increasing 8-oxodG and N7-MeG concentrations. Exposure to PM2.5 increases methylated DNA damage. The mean level of urinary N7-MeG was 1000-fold higher than that of 8-oxodG.

Allergens, air pollutants, and childhood allergic diseases.

BACKGROUND: The synergistic effect of allergens and air pollutants on the risk of allergic diseases is unclear. OBJECTIVE: To evaluate the joint effect of outdoor pollutants and indoor allergens on the risk of allergic diseases. METHODS: We enrolled 2661 kindergarten children from the CEAS cohort. Data on allergic diseases and environmental exposure were collected. Skin prick tests were performed. Individual exposure to air pollution was estimated using a geographic information system with the mean concentration of air pollutants. Multiple logistic regression analysis was performed to estimate the association between air pollutants, allergen exposure and the risk of allergic diseases with adjustments for potential confounders. RESULTS: Overall, 12.6% of the children had asthma, 30.0% had allergic rhinitis (AR), and 14.4% had atopic dermatitis (AD). Mite sensitization significantly increased the risk of AD, AR, and asthma (OR (95%CI) 2.15 (1.53-3.03), 1.94 (1.46-2.58), and 2.31 (1.63-3.29), respectively). Exposure to PM10, PM(2.5), CO, and O(3) was associated with asthma (OR (95% CI) 1.39 (1.03-1.87), 1.45 (1.07-1.97), 1.36 (1.01-1.83), and 0.68 (0.51-0.92), respectively). PM(2.5) may have increased the risk of AR (OR (95% CI) 1.54 (1.03-2.32). Mite sensitization showed a synergistic effect with PM(2.5) on the development of asthma (p < 0.001). Moreover, mite allergens may modify the effect of air pollutants on allergic diseases. CONCLUSION: Dust mites and PM(2.5) play an important role on the risk of asthma and AR. Exposure to PM(2.5) and mite allergens had a synergistic effect on the development of asthma. Avoiding co-exposure to allergens and air pollutants is important.

Seasonal Changes in Endotoxin Exposure and Its Relationship to Exhaled Nitric Oxide and Exhaled Breath Condensate pH Levels in Atopic and Healthy Children.

Endotoxin, a component of the cell walls of gram-negative bacteria, is a contaminant in organic dusts (house dust) and aerosols. In humans, small amounts of endotoxin may cause a local inflammatory response. Exhaled nitric oxide (eNO) levels, an inflammation indicator, are associated with the pH values of exhaled breath condensate (EBC). This study evaluated seasonal changes on indoor endotoxin concentrations in homes and the relationships between endotoxin exposure and eNO/EBC pH levels for healthy children and children with allergy-related respiratory diseases. In total, 34 children with allergy-related respiratory diseases and 24 healthy children were enrolled. Indoor air quality measurements and dust sample analysis for endotoxin were conducted once each season inside 58 surveyed homes. The eNO, EBC pH levels, and pulmonary function of the children were also determined. The highest endotoxin concentrations were on kitchen floors of homes of children with allergy-related respiratory diseases and healthy children, and on bedroom floors of homes of asthmatic children and healthy children. Seasonal changes existed in endotoxin concentrations in dust samples from homes of children with allergic rhinitis, with or without asthma, and in EBC pH values among healthy children and those with allergy-related respiratory diseases. Strong relationships existed between endotoxin exposure and EBC pH values in children with allergic rhinitis.

Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

Long-term surveillance of air quality in medical center operating rooms.

BACKGROUND: Maintenance of adequate indoor air quality (IAQ) in operating rooms (ORs) is critical to the prevention of nosocomial infection in hospitalized patients. This study evaluated the characteristics of IAQ in various ORs in a medical center. METHODS: Air temperature, relative humidity, carbon dioxide (CO(2)), particulate matter (PM), and bacterial concentrations were monitored in the ORs, and monthly variations were noted. RESULTS: The mean CO(2) concentrations in the ORs were lower than the suggested level (600 ppm average over 8 hours) set by Taiwan's Environmental Protection Agency. Positive relationships were found among the number of persons, temperature (Spearman's rho coefficient [r(s)] = 0.19; P < .01), and CO(2) concentration (r(s) = 0.34; P < .01) in the OR. Bacterial concentration was significantly associated with PM level when adjusted for OR category and the number of persons in the room. Gram-positive bacteria (eg, Bacillus spp, Micrococcus spp, Staphylococcus spp) were frequently found in the monitored ORs. CONCLUSION: The IAQ in the ORs varied significantly from month to month. The number of persons in the OR affected IAQ, and a decreased PM level might indicate reduced microbial contamination in the OR.

A novel inspection protocol to detect volatile compounds in breast surgery electrocautery smoke.

BACKGROUND/PURPOSE: Electrocautery procedures generate malodorous smoke. This study quantified five volatile organic compounds detected in the smoke produced during breast surgery, and elucidated the factors that affect their chemical production. METHODS: All samplers were assembled in an acrylic chamber with a Tygon tube attached to the tip of a diathermy pencil. The electrocautery smoke was quantified by gas chromatography/mass spectrometry. RESULTS: In all samples, toluene was identified in concentrations of 2.48-5.50 mg/m(3). Higher concentrations were observed during modified radical mastectomy procedures. Patients with high body mass index revealed high toluene concentrations. Longer duration of electrocautery tended to produce more toluene. CONCLUSION: The sampling protocol enabled acquisition of smoke samples near the source without interrupting surgery. The findings suggest that type of surgery, patient body mass index and duration of electrocautery are factors that can alter production of chemicals.

Impact of patient visiting activities on indoor climate in a medical intensive care unit: a 1-year longitudinal study.

BACKGROUND: Bioaerosols from numerous sources have been implicated in respiratory diseases. This study evaluated the characteristics and weekly variations in indoor air in a medical intensive care unit (ICU) in northern Taiwan for 1 year. It also investigated the impact of patient visiting activities on the indoor climate in the medical ICU. METHODS: A 4-bed room with patients in the medical ICU was selected for long-term air monitoring. Air temperature, relative humidity, CO(2), particulate matter, bacteria, and fungi were measured. RESULTS: Approximately 90% of the CO(2) samples exceeded 1000 ppm, and 20% of the fine particle samples exceeded 35 microg/m(3). The levels of bacteria and fungi varied during the survey period. The measured values for all indoor air characteristics except bacterial concentrations were higher after patient visitation than before patient visitation. A significant association was found between the coarse particle concentration and the number of patient visitors. CONCLUSION: Patient visiting activity impacts the indoor air quality of the ICU environment, especially in terms of coarse particle concentrations. Periodic monitoring of ventilation system efficiency is needed to ensure optimal indoor air quality.

Association of heart rate variability of the elderly with personal exposure to PM 1, PM 1-2.5, and PM 2.5-10.

Environmental epidemiologic studies have shown that elderly people are susceptible to particulate air pollution. The decreases in heart rate variability are important indices of health effect caused by particulate matter. The objective of this study was to investigate the effects of submicron particle (PM(1)), PM(1-2.5), and coarse particle (PM(2.5-10)) on heart rate variability parameters in the elderly. Results of our study indicated that short-term and medium-term PM exposures were associated with the reduction of heart rate variability in the elderly, with stronger effects found for coarse particles in comparison with particles of other size ranges.

Effects of personal particulate matter on peak expiratory flow rate of asthmatic children.

Many researches have shown that the particulate matter (PM) of air pollution could affect the pulmonary functions, especially for susceptible groups such as asthmatic children, where PM might decrease the lung function to different extents. To assess the effects of PM on health, most studies use data from ambient air monitoring sites to represent personal exposure levels. However, the data gathered from these fixed sites might introduce certain statistical uncertainties. The objectives of this study are to evaluate the effects of various size ranges of PM on peak expiratory flow rate (PEFR) of asthmatic children, and to compare the model performance of using different PM measurements (personal exposures versus fixed-site monitoring) in evaluation. Thirty asthmatic children, aged 6 to 12 years, who live near the fixed monitoring site in Sin-Chung City, Taipei County, Taiwan, were recruited for the study. Personal exposures to PM(1), PM(2.5), and PM(10) were measured continuously using a portable particle monitor (GRIMM Mode 1.108, Germany). In addition, an activity diary and questionnaires were used to investigate possible confounding factors in their home environments. The peak expiratory flow rate of each participant was monitored daily in the morning and in the evening for two weeks. Results showed several trends, although not necessarily statistically significant, between personal PM exposures and PEFR measurements in asthmatic children. In general, notable findings tend to implicate that not only fine particles (PM(2.5)) but also coarse particles (PM(2.5-10)) are likely to contribute to the exacerbation of asthmatic conditions. Stronger lagged effect and cumulative effect of PM on the decrements in morning PEFR were also found in the study. Finally, results of linear mixed-effect model analysis suggested that personal PM data was more suitable for the assessment of change in children's PEFR than ambient monitoring data.

The effect of urban air pollution on inflammation, oxidative stress, coagulation, and autonomic dysfunction in young adults.

RATIONALE: The biological mechanisms linking air pollution to cardiovascular events still remain largely unclear. OBJECTIVES: To investigate whether biological mechanisms linking air pollution to cardiovascular events occurred concurrently in human subjects exposed to urban air pollutants. METHODS: We recruited a panel of 76 young, healthy students from a university in Taipei. Between April and June of 2004 or 2005, three measurements were made in each participant of high-sensitivity C-reactive protein (hs-CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), plasminogen activator fibrinogen inhibitor-1 (PAI-1), tissue-type plasminogen activator (tPA) in plasma, and heart rate variability (HRV). Gaseous air pollutants were measured at one air-monitoring station inside their campus, and particulate air pollutants were measured at one particulate matter supersite monitoring station 1 km from their campus. We used linear mixed-effects models to associate biological endpoints with individual air pollutants averaged over 1- to 3-day periods before measurements were performed. MEASUREMENTS AND MAIN RESULTS: We found that increases in hs-CRP, 8-OHdG, fibrinogen, and PAI-1, and decreases in HRV indices were associated with increases in levels of particles with aerodynamic diameters less than 10 microm and 2.5 microm, sulfate, nitrate, and ozone (O(3)) in single-pollutant models. The increase in 8-OHdG, fibrinogen, and PAI-1, and the reduction in HRV remained significantly associated with 3-day averaged sulfate and O(3) levels in two-pollutant models. There were moderate correlations (r = -0.3) between blood markers of hs-CRP, fibrinogen, PAI-1, and HRV indices. CONCLUSIONS: Urban air pollution is associated with inflammation, oxidative stress, blood coagulation and autonomic dysfunction simultaneously in healthy young humans, with sulfate and O(3) as two major traffic-related pollutants contributing to such effects.