Global patterns of asthma burden related to environmental risk factors during 1990-2019: an age-period-cohort analysis for global burden of disease study 2019.

BACKGROUND: Change in asthma burden attributed to specific environmental risk factor has not been evaluated. OBJECTIVE: We aimed to explore the age, period, and cohort effects on asthma burden attributable to smoking and occupational asthmagens in different socio-demographic index (SDI) regions and the region and sex disparities. METHODS: Risk factor-specific asthma deaths and disability-adjusted life years (DALYs) rates were extracted from Global Burden of Disease study 2019, estimated by standard Combined Cause of Death Model and DisMod-MR 2.1 modeling tool. Age-period-cohort analysis was conducted to decompose age, period, and cohort effects on asthma burden. RESULTS: Smoking- and occupational asthmagens-related asthma deaths and DALYs rates dropped by > 45% during 1990-2019. In 2019, Africa, South and Southeast Asia had higher asthma burden than other regions. Male had higher asthma burden than female. Among nearly all age groups, low-middle SDI region had the highest smoking-related asthma burden, and low SDI region had the highest occupational asthmagens-related asthma burden. Inverse "V" shaped trend was observed in the above regions with increasing age. For smoking-related asthma deaths and DALYs rates, the most significant improvement of period rate ratio (RR) occurred in high SDI region, decreased from 1.67 (1.61, 1.74) to 0.34 (0.33, 0.36) and 1.61 (1.57, 1.66) to 0.59 (0.57, 0.61), respectively, as well as the cohort effect on smoking-related asthma burden. For occupational asthmagens-related asthma deaths and DALYs rates, the most sharply decrease of period and cohort RR appeared in the high and high-middle SDI regions. Low SDI region showed least progress in period and cohort RR of smoking- and occupational asthmagens-linked asthma burden. CONCLUSION: Smoking- and occupational asthmagens-related asthma burden sharply decreases, but region and sex disparities exist. Policy makers from low SDI region should reinforce tobacco control and prioritize workplace protection.

Emerging and traditional organophosphate esters in office air from Hangzhou, East China: Seasonal variations, influencing factors and human exposure assessment.

Eight emerging and six traditional organophosphate esters (OPEs) were investigated in office air from Hangzhou China with all the traditional OPEs and 5 out of 8 emerging OPEs detected. The median concentrations of ∑traditional OPEs and ∑emerging OPEs were 61,200 and 5.81 pg/m3, respectively. Butylphenyl diphenyl phosphate (BPDPP) and trisisopropyltrisphenyl phosphate (TIPPP) were observed for the first time in indoor air and Chinese office, respectively. The levels of ∑traditional OPEs decreased in the following order: summer > autumn > spring > winter. Conversely, no obvious trends were observed for emerging OPEs. ∑traditional OPEs (p < 0.001) and tri(chloroisopropyl) phosphate (TCIPP) (p < 0.01) concentrations were positively correlated with temperature. Interestingly, ∑emerging OPEs and the individual emerging OPEs analytes had no significant correlations with temperature (p > 0.05). ∑traditional OPEs, tris(2-chloroethyl) phosphate (TCEP) and TCIPP levels were significantly positively correlated with relative humidity (p < 0.05), while ∑emerging OPEs levels were negatively correlated with relative humidity (p < 0.05). Median intakes of traditional OPEs were estimated to be several orders of magnitude lower than the corresponding Reference Dose (RfD) values. The distinct environmental behaviors of emerging OPEs compared to traditional OPEs, coupled with the lack of established RfD values for them, underscore the need for their risk evaluations in future.

Organohalogenated flame retardants and organophosphate esters from home and preschool dust in Sweden: Pollution characteristics, indoor sources and intake assessment.

This study analysed settled dust samples in Sweden to assess children's combined exposure to 39 organohalogenated flame retardants (HFRs) and 11 organophosphate esters (OPEs) from homes and preschools. >94 % of the targeted compounds were present in dust, indicating widespread use of HFRs and OPEs in Swedish homes and preschools. Dust ingestion was the primary exposure pathway for most analytes, except BDE-209 and DBDPE, where dermal contact was predominant. Children's estimated intakes of ∑emerging HFRs and ∑legacy HFRs from homes were 1-4 times higher than from preschools, highlighting higher exposure risk for HFRs in homes compared to preschools. In a worst-case scenario, intakes of tris(2-butoxyethyl) phosphate (TBOEP) were 6 and 94 times lower than the reference dose for children in Sweden, indicating a potential concern if exposure from other routes like inhalation and diet is as high. The study also found significant positive correlations between dust concentrations of some PBDEs and emerging HFRs and the total number of foam mattresses and beds/m2, the number of foam-containing sofas/m2, and the number of TVs/m2 in the microenvironment, indicating these products as the main source of those compounds. Additionally, younger preschool building ages were found to be linked to higher ΣOPE concentrations in preschool dust, suggesting higher ΣOPE exposure. The comparison with earlier Swedish studies indicates decreasing dust concentrations for some banned and restricted legacy HFRs and OPEs but increasing trends for several emerging HFRs and several unrestricted OPEs. Therefore, the study concludes that emerging HFRs and OPEs are replacing legacy HFRs in products and building materials in homes and preschools, possibly leading to increased exposure of children.

Screening of organophosphate esters in different indoor environments: Distribution, diffusion, and risk assessment.

ANALYSIS: of air conditioner (AC) filter dust can reveal the level of organophosphate ester (OPE) pollution in indoor environments, but comprehensive research on this topic remains lacking. This study combined non-targeted and targeted analysis to screen and analyze 101 samples of AC filter dust, settled dust, and air obtained in 6 indoor environments. Phosphorus-containing organic compounds account for a large proportion of the organic compounds found in indoor environments, and OPEs might be the main pollutants. Using toxicity data and traditional priority polycyclic aromatic hydrocarbons for toxicity prediction of OPEs, 11 OPEs were prioritized for further quantitative analysis. The concentration of OPEs in AC filter dust was highest, followed in descending order by that in settled dust and that in air. The concentration of OPEs in AC filter dust in the residence was two to seven times greater than that in the other indoor environments. More than 56% of the OPEs in AC filter dust showed significant correlation, while those in settled dust and air were weakly correlated, suggesting that large amounts of OPEs collected over long periods could have a common source. Fugacity results showed that OPEs were transferred easily from dust to air, and that dust was the main source of OPEs. The values of both the carcinogenic risk and the hazard index were lower than the corresponding theoretical risk thresholds, indicating low risk to residents through exposure to OPEs in indoor environments. However, it is necessary to remove AC filter dust in a timely manner to prevent it becoming a pollution sink of OPEs that could be rereleased and endanger human health. This study has important implications for comprehensive understanding of the distribution, toxicity, sources, and risks of OPEs in indoor environments.

Temporal Variability of Cumulative Risk Assessment on Phthalates in Chinese Pregnant Women: Repeated Measurement Analysis.

The assessment of the combined effects of multiple phthalate exposures at low levels is a newly developed concept to avoid underestimating their actual cumulative health risk. A previous study included 3455 Chinese pregnant women. Each woman provided up to three urine samples (in total 9529). This previous study characterized the concentrations of phthalate metabolites. In the present study, the data from 9529 samples was reanalyzed to examine the cumulative risk assessment (CRA) with two models: (1) the creatinine-based and (2) the volume-based. Hazard index (HI) values for three phthalates, dibutyl phthalate, butyl benzyl phthalate, and di(2-ethylhexyl) phthalate, in the first, second, and third trimesters of pregnancy, were calculated, respectively. In creatinine-based model, 3.43%, 14.63%, and 17.28% of women showed HI based on the European Food Safety Authority tolerable daily intake exceeding 1 in the first, second, and third trimester of pregnancy, respectively. The intraclass correlation coefficient of HI was 0.49 (95% confidence interval: 0.46-0.53). Spearman correlations between HI of the creatinine model and ∑androgen disruptor (a developed potency weighted approach) ranged from 0.824 to 0.984. In summary, this study suggested a considerable risk of cumulative exposure to phthalates during the whole gestation in Chinese pregnant women. In addition, moderate temporal reproducibility indicated that single HI, estimated by the phthalate concentration in single spot of urine, seemed representative to describe the throughout pregnancy CRA. Finally, strong correlation between HI of the creatinine model and ∑androgen disruptor revealed that the creatinine-based model was more appropriate to evaluate the CRA.

Cumulative risk assessment of phthalates associated with birth outcomes in pregnant Chinese women: A prospective cohort study.

A prospective cohort study of a Chinese population of mother-neonate pairs (n = 3103) was conducted to investigate the relationship between the cumulative hazard index (HI) of combined diethyl phthalate (DEP), dibutyl phthalate (DBP), dibenzyl phthalate (BBzP) and di(2-ethylhexyl) phthalate (DEHP) exposure and birth outcomes. The estimated HI for phthalates was based on phthalate metabolite concentrations in urine collected between 5th and 14th gestational weeks. The median HI values according to the European Food Safety Authority tolerable daily intake (HITDI) and U.S. Environmental Protection Agency reference dose (HIRfD) were 0.358 and 0.187, respectively. A total of 16.3% and 1.9% of the women exhibited HITDI and HIRfD exceeding the value of one, respectively. In unadjusted models, the categories (low < P25, median P25-P50, high > P75) of HITDI were associated with decreased birth weight (ß = -26.34 g, p = 0.021) and head circumference (ß = -0.09 cm, p = 0.029), whereas those for HIRfD were negatively associated with birth weight (ß = -31.74 g, p = 0.005), birth length (ß = -0.11 cm, p = 0.032), head circumference (ß = -0.13 cm, p = 0.003) and chest circumference (ß = -0.10 cm, p = 0.021) in all neonates. Adjustment for potential confounders revealed that HIRfD was inversely associated with head circumference (ß = -0.10 cm, p = 0.020). Stratification by gender indicated that HIRfD was associated with decreased birth length (ß = -0.17 cm, p = 0.041) in infant boys and HITDI was associated with decreased birth weight (ß = -33.12 g, p = 0.036) and head circumference (ß = -0.13 cm, p = 0.027) in girls. This is the first study on the cumulative risk assessment of phthalate exposures in pregnant Chinese women. We found that the HI values of multiple phthalate co-exposure were sex-specifically related to birth outcomes.

Quality assessment of traditional Chinese medicine herb couple by high-performance liquid chromatography and mass spectrometry combined with chemometrics.

This study was designed to develop a simple, specific and reliable method to overall analyze the chemical constituents in clematidis radix et rhizome/notopterygii rhizome et radix herb couple using high-performance liquid chromatography coupled with tandem mass spectrometry and multiple chemometric analysis. First, the separation and qualitative analysis of herb couple was achieved on an Agilent Zorbax Eclipse Plus C18 column (250 mm × 4.6 mm, 5 µm), and 69 compounds were unambiguously or tentatively identified. Moreover, in quantitative analysis, eight ingredients including six coumarins and two triterpenoid sapogenins were quantified by high-performance liquid chromatography coupled with tandem mass spectrometry. In terms of good linearity (r(2) ≥ 0.9995) with a relatively wide concentration range, recovery (85.40-102.50%) and repeatability (0.99-4.45%), the validation results suggested the proposed method was reliable, and successfully used to analyze ten batches of herb couple samples. Then, hierarchical cluster analysis and principal component analysis were used to classify samples and search significant ingredients. The results showed that ten batches of herb couple samples were classified into three groups, and six compounds were found for its better quality control.

Inverse Correlation between Vitamin D and C-Reactive Protein in Newborns.

Some studies suggested that adequate vitamin D might reduce inflammation in adults. However, little is known about this association in early life. We aimed to determine the relationship between cord blood 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) in neonates. Cord blood levels of 25(OH)D and CRP were measured in 1491 neonates in Hefei, China. Potential confounders including maternal sociodemographic characteristics, perinatal health status, lifestyle, and birth outcomes were prospectively collected. The average values of cord blood 25(OH)D and CRP were 39.43 nmol/L (SD = 20.35) and 6.71 mg/L (SD = 3.07), respectively. Stratified by 25(OH)D levels, per 10 nmol/L increase in 25(OH)D, CRP decreased by 1.42 mg/L (95% CI: 0.90, 1.95) among neonates with 25(OH)D <25.0 nmol/L, and decreased by 0.49 mg/L (95% CI: 0.17, 0.80) among neonates with 25(OH)D between 25.0 nmol/L and 49.9 nmol/L, after adjusting for potential confounders. However, no significant association between 25(OH)D and CRP was observed among neonates with 25(OH)D ≥50 nmol/L. Cord blood 25(OH)D and CRP levels showed a significant seasonal trend with lower 25(OH)D and higher CRP during winter-spring than summer-autumn. Stratified by season, a significant linear association of 25(OH)D with CRP was observed in neonates born in winter-spring (adjusted ß = -0.11, 95% CI: -0.13, -0.10), but not summer-autumn. Among neonates born in winter-spring, neonates with 25(OH)D <25 nmol/L had higher risk of CRP ≥10 mg/L (adjusted OR = 3.06, 95% CI: 2.00, 4.69), compared to neonates with 25(OH)D ≥25 nmol/L. Neonates with vitamin D deficiency had higher risk of exposure to elevated inflammation at birth.

A systematic review and quantitative assessment of sleep-disordered breathing during pregnancy and perinatal outcomes.

PURPOSE: Previous investigations have suggested a strong association between sleep-disordered breathing (SDB) during pregnancy and perinatal outcomes. However, the results of the following replication studies were not always concordant. Therefore, this meta-analysis was conducted to evaluate the more reliable estimate. METHODS: A systematic literature search was performed on PubMed, Springer Link, and EMBASE to identify all eligible studies published before August 2013. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed or random effects model. RESULTS: A total of 24 publications met the inclusion criteria and were included in this meta-analysis. Findings demonstrated that moderate-to-severe SDB during pregnancy was associated with gestational diabetes mellitus (OR=1.78; 95% CI, 1.29 to 2.46), pregnancy-related hypertension (OR=2.38; 95% CI, 1.63 to 3.47), preeclampsia (OR=2.19; 95% CI, 1.71 to 2.80), preterm delivery (OR=1.98; 95% CI, 1.59 to 2.48), low birth weight (OR=1.75; 95% CI, 1.33 to 2.32), neonatal intensive care unit (NICU) admission (OR=2.43; 95% CI, 1.61 to 3.68), intrauterine growth restriction (OR=1.44; 95% CI, 1.22 to 1.71), and Apgar score of <7 at 1 min (OR=1.78; 95% CI, 1.10 to 2.91) based on all studies but not gestational age and birth weight. CONCLUSIONS: This meta-analysis revealed that moderate-to-severe SDB during pregnancy may be associated with most of adverse perinatal outcomes. Further well-designed studies are warranted to confirm our findings.

The influence of health-promoting lifestyles on the quality of life of retired workers in a medium-sized city of Northeastern China.

OBJECTIVES: The aim of this study was to clarify the actual state of retired workers' lifestyles and quality of life (QOL) in a medium-sized city of Northeastern China and to assess the relationship between these according to differences between gender groups. METHODS: The Chinese version of the Health Promotion Lifestyle Profile II (HPLP-II), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and demographic variables were used to measure 343 (aged 50-79 years) retired workers' lifestyles and QOL. The results were analyzed using the t test, one-way analysis of variance, correlation analysis, and multiple linear regression analysis. RESULTS: Among the six lifestyle subscales of HPLP-II, the highest mean score was for Interpersonal Relations (IR) and the lowest was for Health Responsibility (HR), which has not been reported previously. The youngest group (50-60 years) had higher scores for lifestyles and QOL than the other age groups. When the results were analyzed based on financial situation, the lowest income group (below ¥2000) had the poorest scores. Analysis according to gender group revealed different tendencies for the scores of lifestyle and QOL, as well as in the multiple regression analysis between variables. CONCLUSION: Our results suggest that an effective approach to maintain a desirable lifestyle and QOL for retired workers at the regional level would be to introduce daily activities to improve HR and to maintain and enhance social support for the low-income populations. Further research is needed to understand the complex causal pathways between regional health and welfare factors, health behavior, and QOL.

[Analysis on physical and mental health and related influential factors among those 'left behind' adolescents in Anhui province].

OBJECTIVE: To explore the physical and mental health status on the 'left behind' students in Anhui province and the related influential factors. METHODS: Stratified cluster sampling method was used to investigate the 682 out of 3421 students from 7 middle schools in both south and north Anhui province, using multidimensional sub-health questionnaire of adolescents (MSQA) and mental health test (MHT), for assessment of the general condition, physical and mental health status. RESULTS: 14.22% of the 'left behind' students were in sub-health condition compared to 11.28% among the normal students, and the mental sub-health status represented 13.64% for the former and 10.84% for the latter. In addition, the 'left behind' students appeared less content with their life than those of staying with their parents (P < 0.05). MHT scores in the subjects were positively correlated with the scores on MSQA and showed significant difference (P < 0.01). RESULTS: from the multiple linear regression analysis showed that the mental health condition among the left behind students was in linear regression relationship with the decreased physical activity (ß = 1.456, P = 0.001), emotional problems (ß = 1.096, P = 0.000) and problems of social adaptation (ß = 1.011, P = 0.006). The status of physical sub-health in the Anhui province showed that there was no significant difference in each of the study group (P > 0.05). CONCLUSION: Decreased physical activity and emotion aporia as well as difficult social adaptation were major factors leading to degenerated mental health levels in the 'left-behind' adolescents. The findings suggested that the mental health status could be improved in this population through better management on their body-health condition.

Effects of growth environments and two environmental endocrine disruptors on children with idiopathic precocious puberty.

OBJECTIVE: The incidence of idiopathic precocious puberty (IPP) might have an increasing trend. But the causes and risk factors of IPP are unknown. The objective of our study is to evaluate the effects of growth environments and two environmental endocrine disruptors (EDCs), zearalenone (ZEA), and 1,1-dichloro-2,2,bisethylene (p,p'-DDE), on patients with IPP. DESIGN: Case-control study. METHODS: The study consisted of 78 IPP patients at diagnosis and 100 control children matched for age and sex. A questionnaire was designed to collect data on growth environments, and serum ZEA and p,p'-DDE were tested in all subjects. We analyzed data on growth environments, two EDCs, and biological interaction between growth environments and EDCs. RESULTS: In growth environments, small for gestational age, maternal physical disease during pregnancy, early maternal menarche, early puberty of same-degree relatives, and father's absence in 4- to 6-year olds were risk factors for children with IPP (P<0.05). Serum ZEA concentration, ZEA, and p,p'-DDE-positive rates in the IPP group were significantly higher than those in the control group (P<0.05). There was a biological interaction between growth environments and ZEA (relative excess risk due to interaction =34.562, attributable proportion due to interaction =0.745, synergy index =4.193). CONCLUSIONS: Results suggest possible effects of growth environments and two EDCs on the development of IPP. In addition, growth environments and ZEA have biological interaction that might increase the risk of developing IPP.

Self-assessment of pubertal Tanner stage by realistic colour images in representative Chinese obese and non-obese children and adolescents.

AIM: This investigation aims to evaluate the validity of self-assessment of pubertal Tanner stage in representative Chinese children and adolescents. METHODS: The study is a nationally representative cross-sectional survey in eight research sites in the large project entitled 'China Puberty Research Collaboration'. Weight, height, self-assessed pubertal Tanner stage and physical examination of pubic hair in each gender, breast development in girls and genital development in boys from were analysed. Realistic colour images of pubertal rating were used as self-assessment of pubertal stage. RESULTS: A large proportion of subjects aged 7.9-18.9 years old were capable of identifying their own pubertal Tanner stage accurately or close to the rater's assessments. Obese group tends to overestimate their pubertal development compared to non-obese peers, except for genital assessment in boys. The k values for non-obese and obese girls were 0.619 (p < 0.0001) and 0.527 (p < 0.0001), respectively, while the k values for non-obese and obese boys were 0.503 (p < 0.0001) and 0.352 (p < 0.0001). CONCLUSIONS: Self-assessment of the pubertal stage by using realistic colour images could be a better alternative assessment tool for large epidemiological puberty research compared with Tanner's original black and white pictures.

Periconceptional folic acid supplementation among women attending antenatal clinic in Anhui, China: data from a population-based cohort study.

OBJECTIVES: to examine the rate of periconceptional and optimal folic acid supplementation, and to characterise their patterns and determinants among antenatal women in central China. DESIGN: data from 4290 women in the Anhui Birth Defects and Child Development Cohort Study recruited between October 2008 and September 2009 were analysed. SETTING: seven Maternal and Child Health Centres of two cities (Hefei and Maanshan) in Anhui province of central China. PARTICIPANTS: women initiating prenatal care were included and asked to complete a structured questionnaire regarding folic acid supplementation. FINDINGS: sixty-eight per cent (2905/4290) of pregnant women reported taking folic acid supplementation periconceptionally (i.e. at some point before or during early pregnancy), and 32.8% (1405/4290) and 65.2% (2797/4290) had taken it before or during early pregnancy, respectively. However, only 16.1% (690/4290) used it optimally (i.e. regularly from four weeks before pregnancy throughout four weeks after pregnancy). Use of periconceptional folic acid was significantly associated with educational level, household income, registered residence, age, gestational age at recruitment, and planning of pregnancy. CONCLUSION: optimal folic acid supplementation was relatively low. IMPLICATIONS FOR PRACTICE: further efforts are needed to inform the population and promote the use of folic acid supplementation.

Deliberate self-harm behaviors in Chinese adolescents and young adults.

The aim of this paper was to describe the prevalence of deliberate self-harm (DSH) and to determine the socio-demographic, behavioral, and psychological correlates of DSH behaviors in Chinese adolescents and young adults in a representative sample of the general population. The data were obtained from an epidemiologic study involving adolescents and young adults from junior and senior schools and colleges located in eight provinces of China. A total of 17,622 cases were retained for analysis. The relationship between the explanatory variables with self-harm was analyzed using a Pearson χ (2) test and a multinomial logistic regression model. A total of 3,001 (17.0%) students reported that they had harmed themselves deliberately in the past 12 months. The act of DSH occurring 1 and >2 times accounted for 4.2% (742) and 12.8% (2,259) of all respondents, respectively. The most frequently reported form of DSH was self-hitting. If the reference category was No DSH, the findings indicated that family composition, father's education, perceived family economic status, cigarette use, perceived body image, and higher scores in depression scales were important concomitants of repeat-incidents of DSH. The students, in western areas, who were younger, reported that having unhealthy weight control behaviors, and alcohol use had a higher risk for both types of DSH. Regarding students of age 15-18 years perceived body image (too fat), having unhealthy weight control behaviors or a high level of depression symptoms demonstrated an elevated risk for repeat-incident DSH when single-incident DSH was used as the reference category, whereas the students in middle area reported family composition (both parents), education of the father (less than college) or alcohol use had a decreased risk for repeat-incident DSH. The results of this study suggest that both types of DSH are associated with other wide-ranging problems in the students' lives. Despite their common features, these phenomena also differed from each other. It is necessary to investigate the possible neurobiologic underpinnings of DSH within a longitudinal study to enhance the knowledge of this behavior.