Effects of ambient air pollution on the hospitalization risk and economic burden of mental disorders in Qingdao, China.

OBJECTIVE: The aim of this study was to examine the impacts of short-term exposure to air pollutants on hospitalizations for mental disorders (MDs) in Qingdao, a Chinese coastal city, and to assess the corresponding hospitalization risk and economic cost. METHODS: Daily data on MD hospitalizations and environmental variables were collected from January 1, 2015, to December 31, 2019. An overdispersed generalized additive model was used to estimate the association between air pollution and MD hospitalizations. The cost of illness method was applied to calculate the corresponding economic burden. RESULTS: With each 10 µg/m3 increase in the concentration of fine particulate matter (PM2.5) at lag05, inhalable particulate matter (PM10) at lag0, sulfur dioxide (SO2) at lag06 and ozone (O3) at lag0, the corresponding relative risks (RRs) and 95% confidence intervals (CIs) were 1.0182 (1.0035-1.0332), 1.0063 (1.0001-1.0126), 1.0997 (1.0200-1.1885) and 1.0099 (1.0005-1.0194), respectively. However, no significant effects of nitrogen dioxide (NO2) or carbon monoxide (CO) were found. Stratified analysis showed that males were susceptible to SO2 and O3, while females were susceptible to PM2.5. Older individuals (≥ 45 years) were more vulnerable to air pollutants (PM2.5, PM10, SO2 and O3) than younger individuals (< 45 years). Taking the Global Air Quality Guidelines 2021 as a reference, 8.71% (2,168 cases) of MD hospitalizations were attributable to air pollutant exposure, with a total economic burden of 154.36 million RMB. CONCLUSION: Short-term exposure to air pollution was associated with an increased risk of hospitalization for MDs. The economic advantages of further reducing air pollution are enormous.

Cost-Effectiveness Analysis of Trastuzumab Deruxtecan Versus Trastuzumab Emtansine for Patients With Human Epidermal Growth Factor Receptor 2 Positive Metastatic Breast Cancer in the United States.

OBJECTIVES: To assess the cost-effectiveness of trastuzumab deruxtecan compared with trastuzumab emtansine as second-line therapy for patients with human epidermal growth factor receptor 2 positive metastatic breast cancer from a US healthcare sector perspective. METHODS: A 3-state partitioned survival model was developed to estimate the cost-effectiveness of trastuzumab deruxtecan compared with trastuzumab emtansine. For both treatments, modeled patients were administered treatment intravenously every 3 weeks indefinitely or until disease progression. Transition parameters were principally derived from the updated DESTINY-Breast03 phase III randomized clinical trial. Costs include drug costs extracted from Centers for Medicare and Medicaid Services average sales price and administrative, adverse event, and third-line therapy costs derived from published literature, measured in 2022 US dollars. Health utilities for health states and disutilities for adverse events were sourced from published literature. Effects were measured in quality-adjusted life years (QALYs). We conducted both probabilistic sensitivity analysis and comprehensive scenario analysis to test model assumptions and robustness, while utilizing a lifetime horizon. RESULTS: In our base-case analysis, total costs for trastuzumab deruxtecan were $1 266 945, compared with $820 082 for trastuzumab emtansine. Total QALYs for trastuzumab deruxtecan were 5.09, compared with 3.15 for trastuzumab emtansine. The base-case incremental cost-effectiveness ratio was $230 285/QALY. Probabilistic sensitivity analysis indicated that trastuzumab deruxtecan had an 11.1% probability of being cost-effective at a $100 000 per QALY willingness-to-pay threshold. CONCLUSIONS: Despite the higher efficacy of trastuzumab deruxtecan in patients with human epidermal growth factor receptor 2 positive metastatic breast cancer, our findings raise concern regarding its value at current prices.

Dietary cadmium health risk assessment for the Chinese population.

Cadmium (Cd) has high rates of soil-to-plant transference, coupled with its non-biodegradability and persistence; long-term management of Cd in agriculture is thus required to ensure better soil and food security and safety. Identifications of regions with high soil Cd concentration or high dietary Cd intakes are critical public health priorities. Human health risk assessment for dietary Cd intake was thus undertaken by employing three approaches: FCA (food chain approach), TDA (total diet approach), and FQA (food quality approach). The correlation between green/total vegetable consumption rates and dietary Cd intake from vegetables was statistically significant. For consumption, the hazard quotients (HQs) calculated by FCA and TDA were all less than 1 except for Hunan and Sichuan province. For rice consumption, the HQs derived by FCA or TDA approach for eight provinces exceeded 1. Residents in Hubei, Guangxi, Jilin, Zhejiang, Liaoning, Shanghai, Sichuan, and Guangxi were more vulnerable due to their notable higher consumption rates.Weighted rankings of the health risk levels were determined to derive the comparative risk management priority. For Cd intake from vegetables, four provinces/cities have high relative priority; for Cd intake from grains, three provinces have high relative priority. The comparative risk management priority for Hunan and Sichuan was high for dietary intake from vegetables or rice. Weighted average HQs were derived to determine the integrated dietary Cd intake health risk levels for dietary intake from vegetables or grains. The risk levels for Hunan, Guangxi, Sichuan, and Zhejiang are high, so effective measures should be taken to reduce Cd dietary intakes to ensure health protection.It is envisaged that the methodology employed in this study could provide useful insights into how various approaches can be integrated to determine human health risk levels for Cd intake, so more effective and targeted measures can be taken accordingly for the relevant regions.

Regional human health risk assessment of cadmium and hexachlorocyclohexane for agricultural land in China.

Widespread pollution of agricultural soil is posing great risks to food safety and human health. The absence of human health-based Generic Assessment Criteria (GAC) for agricultural land means Chinese farmers struggle to manage these risks efficiently and effectively. Cadmium (Cd) and hexachlorocyclohexane (HCH), two of the most concerned contaminants, demonstrate threshold toxicity meaning that background exposure (MDIoral) is considered when deriving soil Generic Assessment Criteria (GAC). The CLEA (Contaminated Land Exposure Assessment) model was used to derive GAC for Cd and HCH that reflect differences in diet and soil characteristics across 19 provinces/cities. For both cadmium and alpha-HCH, Sichuan had the lowest GAC of 0.379 mg kg-1 and 0.0136 mg kg-1, respectively, resulting from its significant high MDIoral values, which are approximately six to nine times larger than the average MDIoral for all the 19 provinces/cities. Jiangxi province had the highest GAC of 1.230 mg kg-1 and 0.0866 mg kg-1, respectively, for cadmium and alpha-HCH, caused by its notable low MDIoral values and low vegetable consumption rate. Human health risk assessment based on regional GAC for Cd revealed that agricultural land with very high to high risks is located in southern China, while very low-risk land is located in northern China. For HCH, alpha- and gamma-HCH pose negligible health risks, but beta-HCH poses some health risk in some of the provinces/cities. When applying the regional GAC for beta-HCH, agricultural land in Beijing and Sichuan posed the highest risk, and those in Heilongjiang and Jiangxi had the lowest risk. This reflects the significant influence of background and vegetable consumption pathway on the GAC. Regional GACs could simplify and speed up risk assessment of agricultural land in different regions of China, by avoiding the need to calculate site-specific assessment criteria, thus saving time and money by avoiding over or under remediation.

Generic assessment criteria for human health risk management of agricultural land scenario in Jiangsu Province, China.

The widespread of agricultural soil pollution in China is posing great risks to food safety and human health. Lack of human health-based generic assessment criteria (GAC) for Chinese agricultural land makes it impossible to efficiently screen and assess the risks unless site-specific risk assessments being carried out, which are both time-consuming and costly. This paper has thus derived the first set human health-based generic assessment criteria (GAC) for 13 substances of concern (including isomers) using the CLEA model for agricultural land scenario in Jiangsu province of China. As there is no authoritative human health risk assessment model in China yet, this paper has determined and demonstrated the applicability of the CLEA model to Chinese agricultural land exposure scenarios. The derived GAC are generally less stringent than the current two Chinese standards (i.e. GB 15618-2018, GB36600-2018) for most substances except for five substances (including cadmium, nickel, alpha-HCH, beta-HCH and gamma-HCH) for which the oral background intake accounts for 50% of the Total Daily Intake. This indicates that the two Chinese soil quality standards maybe over conservative, and oral background intake (i.e. MDIoral) can be a critical parameter when deriving regional GAC for Chinese agricultural land scenarios. Since there is a notable regional difference in MDIoral for some of the substances of concern, as well as in the vegetable consumption rates and vegetable varieties consumed, it is considered necessary to derive GAC for other provinces of China for agricultural land scenario, to further examine the sensitivity of MDIoral on GAC. In addition, the 13 substances of concern in this paper are some of the most prevalent contaminants in agricultural soils in China, but GAC for some emerging new contaminants, such as thallium, vanadium, should also be derived in further research.

Epidemiology, associated burden, and current clinical practice for the diagnosis and management of Alzheimer's disease in Japan.

The burden of dementia in Japan is large and growing. With the world's fastest aging population, it is estimated that one in five elderly people will be living with dementia in Japan by 2025. The most common form of dementia is Alzheimer's disease (AD), accounting for around two-thirds of dementia cases. A systematic review was conducted to examine the epidemiology and associated burden of AD in Japan and to identify how AD is diagnosed and managed in Japan. English and Japanese language databases were searched for articles published between January 2000 and November 2015. Relevant Japanese sources, clinical practice guideline registers, and reference lists were also searched. Systematic reviews and cohort and case-control studies were eligible for inclusion, with a total of 60 studies included. The most recent national survey conducted in six regions of Japan reported the mean prevalence of dementia in people aged ≥65 years to be 15.75% (95% CI: 12.4, 22.2%), which is much higher than the previous estimated rate of 10% in 2010. AD was confirmed as the predominant type of dementia, accounting for 65.8% of all cases. Advancing age and low education were the most consistently reported risk factors for AD dementia. Japanese guidelines for the management of dementia were released in 2010 providing specific guidance for AD about clinical signs, image findings, biochemical markers, and treatment approaches. Pharmacotherapies and non-pharmacotherapies to relieve cognitive symptoms were introduced, as were recommendations to achieve better patient care. No studies reporting treatment patterns were identified. Due to population aging and growing awareness of AD in Japan, health care expenditure and associated burden are expected to soar. This review highlights the importance of early detection, diagnosis, and treatment of AD as strategies to minimize the impact of AD on society in Japan.

Determination of the potential implementation impact of 2016 ministry of environmental protection generic assessment criteria for potentially contaminated sites in China.

The Ministry of Environmental Protection of China issued a 3rd draft edition of risk-based Generic Assessment Criteria (the MEP-GAC) in March 2016. Since these will be the first authoritative GAC in China, their implementation is likely to have a significant impact on China's growing contaminated land management sector. This study aims to determine the potential implementation impact of the MEP-GAC through an in-depth analysis of the management context, land use scenarios, health criteria values adopted and exposure pathways considered. The MEP-GAC have been proposed for two broad categories of land use scenarios for contaminated land risk assessment, and these two categories of land use scenarios need to be further delved, and a MEP-GAC for Chinese cultivated land scenario ought to be developed, to ensure human health protection of Chinese farmers. The MEP-GAC have adopted 10-6 as the acceptable lifetime cancer risk, given the widespread extent and severe level of land contamination in China, consideration should be given to the decision on excess lifetime cancer risk of 10-5. During risk assessment process in practice, it is better to review the 20% TDI against local circumstances to determine their suitability before adopting it. The MEP-GAC are based on a SOM value of 1%, for regions with particularly high SOM, it might be necessary to develop regional GAC, due to SOM's significant impact on the GAC developed. An authoritative risk assessment model developed based on HJ25.3-2014 would help facilitate the DQRA process in practice. The MEP-GAC could better reflect the likely exposures of China's citizens due to vapour inhalation by using characteristics of Chinese exposure scenarios, including China-generic building stock, as inputs into the Johnson and Ettinger model as opposed to adoption of the US EPA parameters. The MEP-GAC once implemented will set the trajectory for the development of the investigation, assessment and remediation of land contamination for years.

A novel natural environment background model for Monte Carlo simulation and its application in the simulation of anticoincidence measurement.

This study proposes a novel natural environment background model by modeling brief environment conditions. It uses Geant4 program to simulate decays of (238)U, (232)Th, and (40)K in soil and obtains compositions of different-energy gamma rays in the natural environment background. The simulated gamma spectrum of the natural environment background agrees well with the experimental spectrum, particularly above 250 keV. The model is used in the simulation of anticoincidence measurement, indicating that the natural environment background can be decreased by approximately 88%, and the Compton attenuation factor is 2.22. The simulation of anticoincidence measurement can improve the minimum detectable activity (MDA) of the detection system.

Generic Assessment Criteria for human health risk assessment of potentially contaminated land in China.

Generic Assessment Criteria (GAC) are derived using widely applicable assumptions about the characteristics and behaviour of contaminant sources, pathways and receptors. GAC provide nationally consistent guidance, thereby saving money and time. Currently, there are no human health based Generic Assessment Criteria (GAC) for contaminated sites in China. Protection of human health is therefore difficult to ensure and demonstrate; and the lack of GAC makes it difficult to tell if there is potential significant risk to human health unless site-specific criteria are derived. This paper derived Chinese GAC (GAC) for five inorganic and eight organic substances for three regions in China for three land uses: urban residential without plant uptake, Chinese cultivated land, and commercial/industrial using the SNIFFER model. The SNIFFER model has been further implemented with a dermal absorption algorithm and the model default input values have been changed to reflect the Chinese exposure scenarios. It is envisaged that the modified SNIFFER model could be used to derive GAC for more contaminants, more Regions, and more land uses. Further research to enhance the reliability and acceptability of the GAC is needed in regional/national surveys in diet and working patterns.