Airborne Avian Influenza Virus in Ambient Air in the Winter Habitats of Migratory Birds.

Outbreaks of avian influenza virus (AIV) have raised public concerns recently. Airborne AIV has been evaluated in live poultry markets and case farms; however, no study has discussed airborne AIV in ambient air in the winter habitats of migratory birds. Therefore, this study aimed to evaluate airborne AIV, specifically H5, H7, and H9, in a critical winter habitat of migratory birds and assess the factors influencing airborne AIV transmission in ambient air to provide novel insights into the epidemiology of avian influenza. A total of 357 ambient air samples were collected in the Aogu Wetland, Taiwan, Republic of China, between October 2017 and December 2019 and analyzed using quantitative real-time polymerase chain reaction. The effects of environmental factors including air pollutants, meteorological factors, and the species of the observed migratory birds on the concentration of airborne AIV were also analyzed. To our knowledge, this is the first study to investigate the relationship between airborne AIV in ambient air and the influence factors in the winter habitats of migratory birds, demonstrating the benefits of environmental sampling for infectious disease epidemiology. The positive rate of airborne H7 (12%) was higher than that of H5 (8%) and H9 (10%). The daily mean temperature and daily maximum temperature had a significant negative correlation with influenza A, H7, and H9. Cold air masses and bird migration were significantly associated with airborne H9 and H7, respectively. In addition, we observed a significant correlation between AIV and the number of pintails, common teals, Indian spot-billed ducks, northern shovelers, Eurasian wigeons, tufted ducks, pied avocets, black-faced spoonbills, and great cormorants. In conclusion, we demonstrated the potential for alternative surveillance approaches (monitoring bird species) as an indicator for influenza-related risks and identified cold air masses and the presence of specific bird species as potential drivers of the presence and/or the airborne concentration of AIV.

Impact of the synergistic effect of pneumonia and air pollutants on newly diagnosed pulmonary tuberculosis in southern Taiwan.

BACKGROUND: An increased incidence of pulmonary tuberculosis (PTB) among patients with pulmonary diseases exposed to air pollution has been reported. OBJECTIVE: To comprehensively investigate the association between pneumonia (PN) and air pollution with PTB through a large-scale follow-up study. METHODS: We conducted a retrospective study using data from the Kaohsiung Medical University Hospital Research Database and the Taiwan Air Quality Monitoring Database. We included adult patients with PN, PTB and other comorbidities according to ICD-9 codes. Control subjects without PN were matched by age, sex and ten comorbidities to each PN patient at a ratio of 4:1. RESULTS: A total of 82,590 subjects were included. The PTB incidence rate was significantly higher in the PN group (2,391/100,000) than in the control group (1,388/100,000). The crude hazard ratio (HR) of PN-associated PTB incidence decreased with time, and the overall 7 years the HR (95% confidence interval; CI) was 1.74 (1.55-1.96). The overall adjusted HR and 95% CI of PN-related PTB in the multivariate Cox regression analysis was 3.38 (2.98-3.84). In addition, there was a cumulative lag effect of all air pollutants within 30 days of exposure. The peak adjusted HRs for PTB were noted on the 3rd, 8th, 12th and 12th days of PM2.5, O3, SO2 and NO exposure, respectively. The overall peak HRs (95% CI) of PM2.5, O3, SO2 and NO were 1.145 (1.139-1.152), 1.153 (1.145-1.161), 1.909 (1.839-1.982) and 1.312 (1.259-1.367), respectively, and there was a synergistic effect with pneumonia on the risk of PTB. CONCLUSIONS: A strong association was found between past episodes of PN and the future risk of PTB. In addition, air pollutants including PM2.5, SO2, O3 and NO, together with previous episodes of PN, had both long-term and short-term impact on the incidence of PTB.

Ambient ozone exposure and hospitalization for substance abuse: A time-stratified case-crossover study in Taipei.

A number of studies investigating the possibility that air pollutant exposures increases the risk of adverse effects on mental health including frequency of suicide and depression, is a major growing public health concern. Human data demonstrated that exposure to various ambient air contaminants including ozone (O3) adversely affected nervous system functions. It is also well-established that substance abuse produces central nervous system dysfunctions with resultant increase in suicide rates. However, the role of substance abuse in combination with O3 exposure on mental health remained to be determined. The aim of this investigation was to conduct a time-stratified case-crossover study to examine the possible correlation between short-term ambient O3 exposure and daily hospital admissions for substance abuse, including alcohol dependence syndrome and non-dependent abuse of drugs, in Taipei from 2009 to 2013. In our single pollutant model, a 35% rise in interquartile (IQR) O3 levels on cool days and a 12% elevation on warm days was associated with increase in mental health hospitalizations. In our two-pollutant models, O3 remained significantly associated with elevated number of hospitalizations after adding any one of possible air pollutants, PM10, PM2.5, SO2, NO2, and CO, to our model on cool and warm days. Data suggested that temperature may affect the association between outdoor ambient air O3 exposure and enhanced risk of hospitalization for substance abuse. Further study is needed to better understand these findings.

Relationship between fine particulate air pollution exposure and human adult life expectancy in Taiwan.

Among the air pollutants, particulate matter with an aerodynamic diameter less than 2.5 um (PM2.5) is of particular interest to environmental medicine as epidemiologic studies consistently reported that long-term exposure to PM2.5 is associated with increased risk of premature death in adults. Life expectancy is a well-documented and important measure of overall public health policy. However, few investigators examined the relationship between PM2.5 levels and adult life expectancy. In this Taiwan-wide study, county-level annual mean PM2.5 concentrations data were collected concomitantly with potential confounding variables including demographic and socioeconomic status, as well as smoking prevalence. Subsequently, these PM2.5 data were analyzed with respect to county-level adult life expectancy data for the period 2010 to 2017. Linear regression was used to determine the relationship between PM2.5 and life expectancy in adults. Residents residing in the counties characterized as containing higher levels of PM2.5 exhibited significantly reduced life expectancy after controlling for potential confounders. For each 10 ug/m3 increase in PM2.5 there was an estimated mean decrease in life expectancy in adults of 0.3 years. The results of this study shed light on the relationship between fine particulate air pollution exposure and risk to human health in Taiwan.

Protective effects of elafin against adult asthma.

BACKGROUND: Elafin inhibits serine proteases, such as human neutrophil elastase and proteinase 3, to prevent excessive damage during inflammation. However, the relationship between elafin and asthma is still unclear. Microarray technology was used to evaluate smoking- and asthma-related biomarkers in a discovery-driven manner. We identified candidate genes, e.g., proteinase inhibitor 3 (PI3), related to asthma and smoking from gene expression microarray data sets and evaluated their potential as biomarkers for asthma. METHODS: We used human genome microarray data sets from smoking- and asthma-related gene expression data sets and performed real-time quantitative polymerase chain reaction to measure and validate differences in gene expression. We also recruited adult patients with asthma and age- and sex-matched control patients who were administered a structured questionnaire and evaluated for lung function and plasma elafin levels, which are encoded by the PI3 gene. RESULTS: Six significantly altered candidate genes, PI3, protein kinase C iota, phosphoserine phosphatase, IQ motif-containing GTPase activating protein 1, interleukin 13 receptor α 1, and signal transducing adaptor molecule SH3 domain and ITAM motif 2, were identified from comparisons across the four asthma- and four smoking-related data sets included in this study. An in vitro study of human airway epithelial cells (A549) and a human monocytic cell line (THP-1) demonstrated that PI3 messenger RNA levels were significantly altered by nicotine exposure. Elafin concentration was significantly higher in control patients than in patients with asthma (p < 0.001). The plasma elafin concentration in the highest quartile (≥12.69 ng/mL) was inversely associated with asthma (adjusted odds ratio 0.122 [95% confidence interval, 0.053-0.278]) compared with the lowest quartile (<5.82 ng/mL) after adjusting for age, sex, smoking status, waist-to-hip ratio, percentage predicted forced expiratory volume in 1 second, cockroaches in the home, incense burning, and family history. CONCLUSION: Our study revealed that high elafin levels identified in smoking- and asthma-related microarray data sets and an epidemiologic study significantly reduced the risk of asthma. Further studies of elafin as a potential therapy for asthma are warranted.

Short-term effects of fine particulate air pollution on hospital admissions for cardiovascular diseases: a case-crossover study in a tropical city.

This study was undertaken to determine whether there was an association between fine particles (PM2.5) levels and hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD (including ischemic heart disease [IHD], stroke, congestive heart failure [CHF], and arrhythmias) and ambient air pollution data for Kaohsiung were obtained for the period from 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), elevated number of admissions for CVD were significantly associated with higher PM2.5 levels only on cool days (<25°C), with an interquartile range rise associated with a 47% (95% CI = 39-56%), 48% (95% CI = 40-56%), 47% (95% CI = 34-61%), and 51% (95% CI = 34-70%) increase in IHD, stroke, CHF, and arrhythmias admissions, respectively. No significant associations between PM2.5 and hospital admissions for CVD were observed on warm days. In the two-pollutant models, PM2.5 levels remained significant even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5 enhance the risk of hospital admissions for CVD in Kaohsiung, Taiwan.

Airborne Influenza Virus in Daycare Centers.

In this study, we investigated the concentration of airborne influenza virus in daycare centers and influencing factors, such as common cold prevalence, air pollutants, and meteorological factors. A total of 209 air samples were collected from daycare centers in Kaohsiung and the influenza virus was analyzed using real-time quantitative polymerase chain reaction. Air pollutants and metrological factors were measured using real-time monitoring equipment. Winter had the highest positive rates of airborne influenza virus and the highest prevalence of the common cold, followed by summer and autumn. The concentration of CO was significantly positively correlated with airborne influenza virus. Daycare center A, with natural ventilation and air condition systems, had a higher concentration of airborne influenza A virus, airborne fungi, and airborne bacteria, as well as a higher prevalence of the common cold, than daycare center B, with a mechanical ventilation system and air purifiers, while the concentrations of CO2, CO, and UFPs in daycare center A were lower than those in daycare center B. We successfully detected airborne influenza virus in daycare centers, demonstrating that aerosol sampling for influenza can provide novel epidemiological insights and inform the management of influenza in daycare centers.

Temperature, nitrogen dioxide, circulating respiratory viruses and acute upper respiratory infections among children in Taipei, Taiwan: a population-based study.

OBJECTIVE: This study investigated whether outpatient visits of acute upper respiratory infections for children aged less than 15 years are associated with temperature, air pollutants and circulating respiratory viruses in Taipei, Taiwan, from 2003 to 2007. METHODS: Outpatient records for acute upper respiratory infections (ICD9 CM codes: 460, 462, 463,464, 465.9 and 487) in a randomly selected sample (n=39,766 children in 2005) was used to estimate the cumulative relative risks (RR) associated with average temperature lasting for 8 days (lag 0-7 days), air pollutants (NO2, O3 and PM(2.5)) lasting for 6 days (lag 0-5 days), and virus-specific positive isolation rate lasting for 11 days (lag 0-10 days) using distributed lag non-linear models after controlling for relative humidity, wind speed, day of week, holiday effects and long-term trend. RESULTS: Average temperature of 33 °C was associated with the lowest risk for outpatient visits of acute upper respiratory infections. Relative to 33 °C, cumulative 8-day RR was highest at 15 °C of ambient average temperature [RR=1.94; 95% confidence interval (CI): 1.78, 2.11]. With the first quartile as reference, cumulative 6-day RRs were 1.25 (95% CI: 1.21, 1.29) for NO2, 1.04 (95% CI: 1.01, 1.06) for O3, and 1.00 (95% CI: 0.98, 1.03) for PM(2.5) at the 95th percentile. Per-standard deviation (SD) increase of virus-specific isolation rate for influenza type A (SD=13.2%), type B (SD=8.76%), and adenoviruses (SD=5.25%) revealed statistical significance for overall 11-day RRs of 1.02 (95% CI: 1.01, 1.03), 1.05 (95% CI: 1.03, 1.06) and 1.04 (95% CI: 1.03, 1.05), respectively. CONCLUSIONS: Current study suggested a positive association between outpatient visits for acute upper respiratory infections and ambient environment factors, including average temperature, air pollutants, and circulating respiratory viruses.

Magnesium in drinking water modifies the association between nitrate ingestion and risk of death from esophageal cancer.

The objective of this study was to explore whether magnesium (Mg) levels in drinking water modified the effects of nitrate on esophageal cancer risk occurrence. A matched cancer case-control study was used to investigate the relationship between the risk of death from esophageal cancer and exposure to nitrate in drinking water in Taiwan. All esophageal cancer deaths of Taiwan residents from 2006 through 2010 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to cancer cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N) and Mg in drinking water were collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO(3)-N and Mg exposure via drinking water. Evidence of an interaction was noted between drinking water NO(3)-N and Mg intake. This is the first study to report effect modification by Mg intake originating from drinking water on an association between NO(3)-N exposure and increased risk mortality attributed to esophageal cancer.

Body composition modify the association between ambient particulate matter and lung function among asthma patients.

The effect of ambient PM10 and PM2.5 on lung function modified by body muscle and adipose tissue is not fully understood at present. Our aims were to investigate the association between seasonal average air pollutants and lung function in asthmatic patients modified by body composition indicators. In this cross-sectional study, we recruited 914 doctor-diagnosed asthmatic patients, and performed interaction and stratified analysis using the median values of total body muscle (TBM), total body fat (TBF), and percentage body fat (PBF) as well as body mass index (BMI) =25 as the cutoff points of the high/low body composition groups. The adjusted R2 values of the developed LUR models of PM2.5 and PM10 were 91.4% and 90.5% and also verified by cross-validation, respectively. After adjusting for confounding factors, we found that TBM significantly modified the association between PM10 and lung function among asthma patients (interaction P value <0.05). In the low TBM group, seasonal average concentrations of PM10 estimated by the LUR model increased by 10 µg/m3, and negative associations with lung function indicators were observed. For obese patients with BMI>25 and high TBF, the increase in PM10 was associated with the decrease in lung function. The asthma patients with obesity and low total body muscle were more susceptible to adverse effects of PM10 on lung function.

Investigating the associations between organophosphate flame retardants (OPFRs) and fine particles in paired indoor and outdoor air: A probabilistic prediction model for deriving OPFRs in indoor environments.

Contaminants of emerging concern such as organophosphate flame retardants (OPFRs) are associated with atmospheric fine particles (PM2.5), which pose the greatest health risk in the world. However, few surveys have explored the interaction between PM2.5 and OPFRs in residential paired indoor/outdoor environments. 11 priority OPFRs and PM2.5 were investigated across 178 paired indoor and outdoor air samples taken from 89 children's households in southern Taiwan, across cold and warm seasons. This involved exploring their associations with building characteristics, interior materials, and human activities. We developed a probabilistic predictive model for indoor OPFRs based on the indoor/outdoor (I/O) ratio of contaminants and an air quality index. The significant associations of paired indoor/outdoor OPFRs and PM2.5 were explored. The indoor level of OPFRs was greater than that of outdoor households, contrasting with PM2.5. The I/O OPFRs ratio was higher than 1 (except for TEHP, EHDPP, and TCP), which suggests that the sources of OPFRs were primarily emitted from indoors. Indoor TCEP was significantly positively associated with indoor and outdoor PM2.5. The OPFR level detected in apartments was higher than in houses due to the greater decoration, furniture and electronic devices. However, this was not the case for PM2.5. TCIPP was the dominant compound in paired indoor and outdoor air. The indoor OPFR predictive model obtained a high accuracy with an R2 value of 0.87. The material used in mattresses, the use of purifiers and heaters, and the total material area were the main influencing factors for indoor OPFRs in households. These findings could provide important evidence of the interaction between paired indoor/outdoor OPFRs and PM2.5 and interior equipment in different building types. In addition, it could prevent the potential risks posed by indoor/outdoor air pollutants and eliminate OPFR emissions through the selection of better construction and building materials.

The impact of the synergistic effect of SO2 and PM2.5/PM10 on obstructive lung disease in subtropical Taiwan.

Background: Chronic Obstructive lung diseases (COPD) are complex conditions influenced by various environmental, lifestyle, and genetic factors. Ambient air pollution has been identified as a potential risk factor, causing 4.2 million deaths worldwide in 2016, accounting for 25% of all COPD-related deaths and 26% of all respiratory infection-related deaths. This study aims to evaluate the associations among chronic lung diseases, air pollution, and meteorological factors. Methods: This cross-sectional study obtained data from the Taiwan Biobank and Taiwan Air Quality Monitoring Database. We defined obstructive lung disease as patients with FEV1/FVC < 70%. Descriptive analysis between spirometry groups was performed using one-way ANOVA and the chi-square or Fisher's exact test. A generalized additive model (GAM) was used to evaluate the relationship between SO2 and PM2.5/PM10 through equations and splines fitting. Results: A total of 2,635 participants were enrolled. Regarding environmental factors, higher temperature, higher relative humidity, and lower rainfall were risk factors for obstructive lung disease. SO2 was positively correlated with PM10 and PM2.5, with correlation coefficients of 0.53 (p < 0.0001) and 0.52 (p < 0.0001), respectively. Additionally, SO2 modified the relative risk of obstructive impairment for both PM10 [ß coefficient (ß) = 0.01, p = 0.0052] and PM2.5 (ß = 0.01, p = 0.0155). Further analysis per standard deviation (per SD) increase revealed that SO2 also modified the relationship for both PM10 (ß = 0.11, p = 0.0052) and PM2.5 (ß = 0.09, p = 0.0155). Our GAM analysis showed a quadratic pattern for SO2 (per SD) and PM10 (per SD) in model 1, and a quadratic pattern for SO2 (per SD) in model 2. Moreover, our findings confirmed synergistic effects among temperature, SO2 and PM2.5/PM10, as demonstrated by the significant associations of bivariate (SO2 vs. PM10, SO2 vs. PM2.5) thin-plate smoothing splines in models 1 and 2 with obstructive impairment (p < 0.0001). Conclusion: Our study showed high temperature, humidity, and low rainfall increased the risk of obstructive lung disease. Synergistic effects were observed among temperature, SO2, and PM2.5/PM10. The impact of air pollutants on obstructive lung disease should consider these interactions.

Case cluster shifting and contaminant source as determinants of melioidosis in Taiwan.

OBJECTIVES: To assess the geographical distribution of melioidosis contamination sources and the association between the location of melioidosis cases and positive sampling sites for Burkholderia pseudomallei in Taiwan. METHODS: Data on the location of melioidosis cases from 2002 to 2011 were combined with the geographical distribution of B. pseudomallei as indicated by the detection of specific flagella gene products measured from 2005 to 2011. Temporal and spatial analyses were used to determine the incidence, cluster shifts and associations between the two datasets. RESULTS: Melioidosis cases clustered in two 'hot-spot' areas with incidence rates that were significantly higher than in neighbouring towns. The incidence rates in the northern area gradually decreased, while the rates in the southern area increased and were temporally associated with the appearance of B. pseudomallei-specific flagella genes in water samples. CONCLUSIONS: Melioidosis hot-spot areas were present in Taiwan. Water contaminated with B. pseudomallei serves as a potential transmission vehicle and is correlated with an increase in melioidosis cases; this correlation was stronger than that for B. pseudomallei-contaminated soil.

Air pollution and hospital admissions for myocardial infarction: are there potentially sensitive groups?

Recent studies showed that air pollution is a risk factor for hospitalization for myocardial infarction (MI). However, there is limited evidence to suggest which subpopulations are at higher risk for MI arising from air pollution. This study was undertaken to examine the modifying effects of specific secondary cardiovascular diagnosis (including hypertension, diabetes, congestive heart failure, and arrhythmias) on the relationship between hospital admissions for MI and exposure to ambient air pollutants. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period 1999-2009. The relative risk of hospital admissions for MI was estimated using a case-crossover approach. None of the secondary diagnosis examined showed significant evidence of effect modification. It would appear that the correlation between air pollutant exposure and MI occurrence is not affected by predisposing factors present in other cardiovascular diseases.

Anxiety Is a Mediator between Heart Rate Variability and Quality of Life in Chronic Obstructive Pulmonary Disease.

Autonomic nervous system (ANS) dysregulation is an important pathophysiological mechanism in patients with chronic obstructive pulmonary disease (COPD). Heart rate variability (HRV) is a common index for ANS, and HRV has been used to explore the association between ANS and clinical illnesses. This study aimed to explore the group differences in HRV, depression, anxiety, and quality of life between participants with COPD and healthy controls (HC group), and whether emotion plays a mediating role between HRV and quality of life in participants with COPD. A total of ninety-six participants with COPD and 59 participants in the HC group completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Saint George's Respiratory Questionnaire (SGRQ). Assessment of spirometry pulmonary function and five minute lead II electrocardiography (ECG) were also performed under the resting baseline. The COPD group had higher depression scores (F = 4.10, p = 0.008), and a lower quality of life (F = 14.44, p < 0.001) and HRV indices (such as standard deviation of RR intervals (F = 5.49, p < 0.05) and low frequency (F = 3.03, p < 0.05)) compared to the HC group. Sympathetic activation was positively correlated with depression (r = 0.312, p < 0.01), anxiety (r = 0.420, p < 0.001), and poor quality of life (r = 0.467, p < 0.001) in the COPD group. After controlling for age and sex, anxiety (ß = 0.585, p < 0.001) and sympathetic activation (ß = 0.231, p < 0.05) positively predicted poor quality of life, and lung function (ß = −0.251, p < 0.01) negatively predicted poor quality of life. Therefore, anxiety is a mediator between sympathetic activation and quality of life. Emotional and HRV screening should be applied to COPD patients in clinical practice, and emotional management or HRV biofeedback training can be used to improve anxiety and HRV for future studies.

Traffic air pollution and risk of death from gastric cancer in Taiwan: petrol station density as an indicator of air pollutant exposure.

To investigate the relationship between air pollution and risk of death attributed to gastric cancer, a matched cancer case-control study was conducted using deaths that occurred in Taiwan from 2004 through 2008. Data for all eligible gastric cancer deaths were obtained and compared to a control group consisting of individuals who died from causes other than neoplasms and diseases that were associated with gastrointestinal (GIT) disorders. The controls were pair-matched to the cancer cases by gender, year of birth, and year of death. Each matched control was randomly selected from the set of possible controls for each cancer case. Data for the number of petrol stations in study municipalities were collected from two major petroleum supply companies. The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subject's exposure to benzene and other hydrocarbons present in ambient evaporative losses of petrol or to air emissions from motor vehicles. The exposed individuals were subdivided into three categories (≤25th percentile; 25th-75th percentile; >75th percentile) according to PSD in the residential municipality. Results showed that individuals who resided in municipalities with the highest PSD were at an increased risk of death attributed to gastric cancer compared to those subjects living in municipalities with the lowest PSD. The findings of this study warrant further investigation of the role of traffic air pollution exposure in the etiology of gastric cancer.

Does calcium in drinking water modify the association between nitrate in drinking water and risk of death from colon cancer?

The objective of this study was to explore whether calcium (Ca) levels in drinking water modified the effects of nitrate on colon cancer risk. A matched case-control study was used to investigate the relationship between the risk of death from colon cancer and exposure to nitrate in drinking water in Taiwan. All colon cancer deaths of Taiwan residents from 2003 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N) and Ca in drinking water have been collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's NO(3)-N and Ca exposure via drinking water. We observed evidence of an interaction between drinking water NO(3)-N and Ca intake via drinking water. This is the first study to report effect modification by Ca intake from drinking water on the association between NO(3)-N exposure and risk of colon cancer mortality.

The Impact of the Synergistic Effect of Temperature and Air Pollutants on Chronic Lung Diseases in Subtropical Taiwan.

Previous studies have suggested an association between air pollution and lung disease. However, few studies have explored the relationship between chronic lung diseases classified by lung function and environmental parameters. This study aimed to comprehensively investigate the relationship between chronic lung diseases, air pollution, meteorological factors, and anthropometric indices. We conducted a cross-sectional study using the Taiwan Biobank and the Taiwan Air Quality Monitoring Database. A total of 2889 participants were included. We found a V/U-shaped relationship between temperature and air pollutants, with significant effects at both high and low temperatures. In addition, at lower temperatures (<24.6 °C), air pollutants including carbon monoxide (CO) (adjusted OR (aOR):1.78/Log 1 ppb, 95% CI 0.98-3.25; aOR:5.35/Log 1 ppb, 95% CI 2.88-9.94), nitrogen monoxide (NO) (aOR:1.05/ppm, 95% CI 1.01-1.09; aOR:1.11/ppm, 95% CI 1.07-1.15), nitrogen oxides (NOx) (aOR:1.02/ppm, 95% CI 1.00-1.05; aOR:1.06/ppm, 95% CI 1.04-1.08), and sulfur dioxide (SO2) (aOR:1.29/ppm, 95% CI 1.01-1.65; aOR:1.77/ppm, 95% CI 1.36-2.30) were associated with restrictive and mixed lung diseases, respectively. Exposure to CO, NO, NO2, NOx and SO2 significantly affected obstructive and mixed lung disease in southern Taiwan. In conclusion, temperature and air pollution should be considered together when evaluating the impact on chronic lung diseases.

Trihalomethanes in drinking water and the risk of death from rectal cancer: does hardness in drinking water matter?

The objectives of this study were (1) to examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of rectal cancer development and (2) to determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of TTHM on risk of developing rectal cancer. A matched cancer case-control study was used to investigate the relationship between the risk of death attributed to rectal cancer and exposure to TTHM in drinking water in 53 municipalities in Taiwan. All rectal cancer deaths in the 53 municipalities from 1998 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each cancer case. Data on TTHM levels in drinking water were collected from the Taiwan Environmental Protection Administration. Information on the levels of Ca and Mg in drinking water was obtained from the Taiwan Water Supply Corporation. The municipality of residence for cancer cases and controls was presumed to be the source of the subject's TTHM, Ca, and Mg exposure via drinking water. Relative to individuals whose TTHM exposure level was <4.9 ppb, the adjusted OR (95% CI) for rectal cancer occurrence was 1.04 (0.88-1.22) for individuals who resided in municipalities served by drinking water with a TTHM exposure >or=4.9 ppb. There was no evidence of an interaction of drinking-water TTHM levels with low Ca intake via drinking water. However, evidence of an interaction was noted between drinking-water TTHM concentrations and Mg intake via drinking water. Our findings showed that the correlation between TTHM exposure and risk of rectal cancer is influenced by Mg in drinking water. Increased knowledge of the interaction between Mg and TTHM in reducing rectal cancer risk will aid in public policymaking and standard setting.

The effects of psychotherapy for depressed or posttraumatic stress disorder women with childhood sexual abuse history: Meta-analysis of randomized controlled trials.

BACKGROUND: Depression and posttraumatic stress disorder (PTSD) are the most common mental disorders of women suffered from childhood sexual abuse histories. It has been widely recognized that depression and PTSD may decrease patients' quality of life. The objective of this study is conducted to explore the effects of psychotherapy for depressed or PTSD women with childhood sexual abuse history. METHODS: We searched the PubMed and Cochrane Library from inception to June 30, 2019. The search strategy is (sexual assault OR sexual crime OR sexual abuse) AND (depression OR PTSD) AND (treatment OR intervention OR psychotherapy) with no restriction on language. Two authors independently selected the studies, assessed the quality of the included studies, and extracted data. RESULTS: Nine randomized control trials with 761 participants met the inclusion criteria. There were 340 participants in the psychotherapy group and 421 participants in the control group (usual treatment or waiting list). Compared to usual care, improvements were significantly greater in the psychotherapy group. The Beck depression inventory score for depression diagnosis of the psychotherapy group is lower from 4.27 to 8.96 (P < .05) than the control group. The client assessment protocols for PTSD, the diagnosis is also lower from 12.4 to 13.71 than the control group (P < .05). CONCLUSION: The results suggested that psychotherapy is effective in reducing depressed or PTSD women with childhood sexual abuse. Further large-scale high-quality randomized controlled trials with long-term follow-up are warranted for confirming this finding.