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Objective:To investigate the prevalence of adult skeletal fluorosis caused by drinking tea-type endemic fluorosis in Yushu Tibetan Autonomous Prefecture (hereinafter referred to as Yushu Prefecture), Qinghai Province, and provide scientific basis for prevention and control of the disease.Methods:In August 2021, one village was selected as a survey site in six counties (cities) in Yushu Prefecture, including Nangqian, Chindu, Yushu, Zadoi, Qumarlêb, and Zhiduo. Drinking water samples and 10 brick tea samples were collected from each village to determine the fluoride content in water and brick tea; at least 100 permanent residents aged ≥ 25, who had a habit of drinking brick tea and had lived in the local area for more than 5 years, were selected for X-ray imaging to examine the prevalence of adult skeletal fluorosis.Results:A total of 75 samples of residential drinking water were collected, with a fluoride content of (0.21 ± 0.05) mg/L, ranging from 0.11 to 0.34 mg/L; 60 samples of brick tea, with a fluoride content of (626.70 ± 157.27) mg/kg, ranging from 324.00 to 2 102.00 mg/kg. A total of 1 136 adults were examined, and 318 cases of skeletal fluorosis were diagnosed, with a detection rate of 27.99%. Among them, the detection rates of mild, moderate, and severe skeletal fluorosis were 20.95% (238/1 136), 6.07% (69/1 136), and 0.97% (11/1 136), respectively, with mild symptoms being the main. The detection rates of skeletal fluorosis in males and females were 29.09% (121/416) and 27.36% (197/720), respectively, with no statistically significant difference between the gender (χ 2 = 0.39, P = 0.533). Comparison of the skeletal fluorosis in different gender, the differences were statistically significant (χ 2 = 22.31, P < 0.001). The detection rates of skeletal fluorosis in the age groups of 25 - 35, 36 - 45, 46 - 55, 56 - 65, 66 - 75, and ≥76 years old were 6.86% (7/102), 22.37% (51/228), 24.02% (92/383), 37.44% (73/195), 43.48% (70/161), and 37.31% (25/67), respectively. The differences between the groups were statistically significant (χ 2 = 59.84, P < 0.001). Moreover, there was a statistically significant difference in the composition of skeletal fluorosis among different age groups ( H = 37.66, P < 0.001). The Spearman correlation analysis results showed that the severity of adult skeletal fluorosis was positively correlated with age ( r = 0.34, P < 0.001). Conclusions:There is a certain degree of prevalence of adult skeletal fluorosis in Yushu Prefecture. And as age increases, the condition of skeletal fluorosis becomes more severe.
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Objective:To analyze the relationship between dietary composition of residents in endemic fluorosis areas and skeletal fluorosis.Methods:A case-control study was used to analyze the difference of dietary composition between patients with skeletal fluorosis (case group) and residents without skeletal fluorosis (control group). In August 2019, taking the drinking water-borne endemic fluorosis area in Wenshui County, Lvliang City, Shanxi Province as the survey site, a cluster sampling method was adopted to select local residents aged over 18 years old, and a questionnaire survey was conducted by face-to-face interview. The survey contents included gender, age and consumption frequency of various foods. Binary logistic regression was used to analyze the relationship between food consumption frequency and skeletal fluorosis. The diagnosis of skeletal fluorosis was made by using portable digital radiography (DR) to take X-ray films of forearm and lower leg, combining with clinical signs, and according to the Diagnostic Standard for Endemic Skeletal Fluorosis (WS/T 192-2008) to determine.Results:A total of 1 061 subjects were included in this study, including 376 in the case group and 685 in the control group. The age composition of patients in the case group (≤60, > 60 years old: 162, 214 cases) was significantly different from that in the control group (≤60, > 60 years old: 423, 261 cases, χ 2 = 34.52, P < 0.001). There was no statistically significant difference in gender ratio (χ 2 = 1.37, P = 0.251). The proportion of patients in the case group who ate meat and eggs > 1 time/week was lower than that in the control group (χ 2 = 8.06, 5.46, P < 0.05), the proportion of patients who ate milk > 1 time/week was higher than that in the control group (χ 2 = 4.01, P = 0.046), and the proportion of patients who ate seafood ≥1 time/week was lower than that in the control group (χ 2 = 4.16, P = 0.046). The results of binary logistic regression analysis showed that after adjusting for age, sex, and urinary fluoride, the frequency of eating meat, eggs or milk > 1 time/week and the frequency of eating seafood ≥1 time/week were not related to the risk of skeletal fluorosis ( P > 0.05); however, in the group ≤60 years old, the frequency of eating eggs > 1 time/week was associated with the risk of skeletal fluorosis [odds ratio ( OR) = 0.59, 95% confidence interval ( CI): 0.39, 0.88]. Conclusions:The consumption frequency of meat, milk, eggs and seafood is significantly different between the skeletal fluorosis patients and the control people. In the population ≤60 years old, consumption frequency of eggs > 1 time/week may reduce the risk of skeletal fluorosis.
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Objective:To study the prevalence of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region (Inner Mongolia), and to provide reference for further prevention and treatment of skeletal fluorosis at this stage.Methods:From March to October 2019, a survey of skeletal fluorosis was carried out in all diseased villages of the eight diseased leagues (cities) in Inner Mongolia, including Alxa, Bayannur, Baotou, Ordos, Hohhot, Hulunbeier, Ulanqab and Xilingol. Permanent residents aged 18 years and above in the diseased villeges were investigated. Face to face questionnaires were used to collect the basic data of age, sex, epidemiological history, etc. of all subjects, and clinical examination of skeletal fluorosis was carried out. Drinking water samples were collected from residents for fluoride content testing.Results:A total of 123 166 residents aged 18 years and above were investigated, 1 781 cases of skeletal fluorosis were detected, and the detection rate was 1.45%. The degree of skeletal fluorosis was mild, accounting for 72.26% (1 287/1 781); the others were moderate and severe, accounting for 20.38% (363/1 781) and 7.36% (131/1 781), respectively. There were statistically significant differences in the detection rates of skeletal fluorosis among people of different water fluoride content, age, gender and regions (χ 2 = 565.96, 671.32, 4.38, 17 283.80, P < 0.05). Among them, the detection rates of skeletal fluorosis in water fluoride content > 4.0 mg/L, ≥56 years old and female population were relatively high, which were 5.21% (49/941), 2.26% (1 428/63 188) and 1.52% (905/59 555), respectively. The detection rates of skeletal fluorosis in Xilingol League and Baotou City were significantly higher, 25.48% (745/2 924) and 24.32% (225/925), respectively. Conclusion:The situation of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia has been effectively controlled, but there are still relatively many patients with skeletal fluorosis in some areas, and further targeted prevention and control work is needed.
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Objective:To investigate the value of common clinical symptoms and signs of knee joint, elbow joint and lumbar spine in clinical diagnosis of endemic skeletal fluorosis.Methods:From August to October 2020, a cross-sectional survey of skeletal fluorosis was conducted in 8 administrative villages in Gaotai County and 5 administrative villages in Gaolan County, which were serious areas of drinking-water-borne endemic fluorosis in Gansu Province. Individuals aged ≥25 years old, residing for more than 1 year, and exhibiting symptoms and signs of the motor system in the affected villages were selected as the survey subjects. According to the X-ray diagnostic criteria in the "Diagnostic Standard for Endemic Skeletal Fluorosis" (WS/T 192-2021), they were divided into skeletal fluorosis group and non skeletal fluorosis group. The basic information of the two groups was collected, and orthopedic examination and digital radiography (DR) were performed. Multivariate logistic regression model was used to fit the effects of knee joint, elbow joint and lumbar spine related symptoms and signs on the diagnosis of skeletal fluorosis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive effectiveness of the model for skeletal fluorosis, and Kappa test was used to evaluate the consistency between the model and X-ray diagnosis (the gold standard for diagnosis of skeletal fluorosis). Results:A total of 970 subjects were included in the investigation, including 501 in the skeletal fluorosis group and 469 in the non skeletal fluorosis group. Multivariate logistic regression analysis showed that elbow joint flexion and extension range of motion (ROM) decreased by ≥45° [odds ratio ( OR) = 2.73, 95% confidence interval ( CI): 2.00 - 3.72], elbow joint rotation ROM decreased by ≥30° ( OR = 3.34, 95% CI: 1.96 - 5.68), ulnar nerve injury symptoms ( OR = 3.77, 95% CI: 3.21 - 4.42), intermittent claudication ( OR = 2.72, 95% CI: 1.48 - 4.99), and positive straight leg elevation test ( OR = 1.69, 95% CI: 1.09 - 2.61) had certain impact on the diagnosis of skeletal fluorosis. The area under the ROC curve was 0.88, and the model had a good predictive ability for the diagnosis of skeletal fluorosis. After Kappa test, the Kappa value was 0.61, which suggested that the prediction of skeletal fluorosis by this model was in good agreement with X-ray diagnosis. Conclusions:Elbow joint flexion and extension limitation, elbow joint rotation limitation, ulnar nerve injury, intermittent claudication, and positive straight leg elevation test have certain diagnostic value for skeletal fluorosis. The combined diagnosis of these signs has good predictive ability for skeletal fluorosis.
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Objective:To analyze the monitoring results of skeletal fluorosis in coal-burning type endemic fluorosis areas in Guizhou Province, and evaluate the effectiveness of comprehensive treatment of coal-burning type endemic fluorosis in the affected areas.Methods:In 2009, 2014, and 2019, monitoring of skeletal fluorosis was carried out in six counties (cities, districts) of Renhuai City, Qixingguan District, Dafang County, Qianxi City, Puding County, and Pu'an County in Guizhou Province. Age stratification was conducted in each county (city, district) for permanent residents aged 25 and above, and survey subjects were selected for X-ray examination of skeletal fluorosis.Results:The detection rates of skeletal fluorosis in 2009, 2014, and 2019 were 51.48% (798/1 550), 34.88% (308/883), and 6.51% (60/922), respectively, showing a decreasing trend year by year (χ 2trend = 505.83, P < 0.001), decreased by 44.97 percentage points from 2009 to 2019. The age distribution of patients with skeletal fluorosis was mainly in the age group of 55 years and older, with annual proportions of 53.88% (430/798), 56.49% (174/308), and 78.33% (47/60), all higher than 50%. In 2009, 2014, and 2019, 483, 222 and 21 cases of mild skeletal fluorosis were detected, and 315, 86, and 39 cases of moderate to severe skeletal fluorosis were detected. There was a statistically significant difference in disease grading among different years(χ 2 = 32.63, P < 0.001). Among them, there were statistically significant differences in the grading of skeletal fluorosis in Qixingguan District, Qianxi City, Puding County, and Pu'an County(χ 2 = 14.56, 12.24, 35.01, 23.35, P < 0.05). Conclusions:The detection rate of skeletal fluorosis in Guizhou Province decreases year by year, and the prevention and control effect is significant. Patients with skeletal fluorosis are mainly in the age group of 55 years and older, and the proportion of patients with moderate to severe skeletal fluorosis is increasing. We should continue to monitor and manage the treatment of current patients with skeletal fluorosis.
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Objective:To investigate the distribution of fluoride content in water and dental fluorosis in children and skeletal fluorosis in adults in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.Methods:From April to November 2021, all natural villages in the drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region were investigated on the status quo of water improvement and water fluoride monitoring. At the same time, all children aged 8 - 12 and adults aged 18 and older were examined for dental fluorosis and skeletal fluorosis, respectively, and the detection rates were calculated.Results:There were 9 465 villages in drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region, among which 8 920 villages had completed the water improvement, with a water improvement rate of 94.24% (8 920/9 465); 8 664 villages had completed the water improvement with qualified water fluoride, and the qualified rate of water improvement was 97.13% (8 664/8 920). A total of 80 915 children aged 8 - 12 in the villages underwent dental fluorosis examination, and 4 868 children were diagnosed with dental fluorosis, with a detection rate of 6.02%. A total of 3 545 915 adults aged 18 and older in the villages were examined for skeletal fluorosis, and 3 567 adults were diagnosed with skeletal fluorosis, with a detection rate of 0.10%.Conclusion:The water improvement rate and qualified rate of water improvement in drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region are high, while both of the detection rates of dental fluorosis in children and skeletal fluorosis in adults are relatively low.
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Endemic fluorosis is a common biogeochemical disease. Although the etiology is clear, its molecular mechanism is not fully understood. So far, there is no specific method to effectively treat fluorosis, mainly to prevent. In recent years, a large number of studies have confirmed that a variety of macro elements such as calcium, magnesium, phosphorus, and trace elements such as selenium and boron play a positive regulatory role in the occurrence and development of fluorosis, and have different degrees of influence in the body's antagonism against fluorosis. High levels of trace elements such as arsenic, lead, aluminum and chromium are risk factors for fluorosis. In view of the importance of a variety of macro and trace elements in human nutrition and health, this article reviews the latest developments in multiple elements and fluorosis, especially skeletal fluorosis and dental fluorosis, in order to further understand the causes of fluoride-induced health damage, and provide theoretical reference for improving the prevention strategies of fluorosis in a targeted manner.
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Objective:To understand the demographic characteristics and treatment intention, treatment status and therapeutic effect of patients with skeletal fluorosis in Inner Mongolia Autonomous Region (reffered to as Inner Mongolia) in order to provide a basis for next step treatment program.Methods:From March to June 2020, a face-to-face questionnaire survey was conducted among 3 570 patients with skeletal fluorosis in 11 leagues (cities) of Inner Mongolia to understand their basic information, treatment intention, treatment status and therapeutic effect. Patients with skeletal fluorosis of different demographic characteristics were compared with each other in their treatment intention and treatment status, and the therapeutic effects of different drugs were compared by χ 2 test. Results:A total of 3570 patients with skeletal fluorosis were investigated. There were slightly more women than men with skeletal fluorosis (1.29 ∶ 1.00, 2 014/1 556). The ages were mainly from 40 to 79 years old (95.4%, 3 406/3 570). Mongols patients accounted for 36.0% (1 285/3 570). Patients with low education (primary school and below) accounted for 82.2% (2 935/3 570). Eighty-five per cent (3 035/3 570) of the patients had drug treatment intention and 37.1% (1 325/3 570) of the patients had drug treatment. Thirty-seven point five per cent (1 338/3 570) of the patients had surgery intention and surgery was performed in 0.2% (8/3 570) of the patients. Combination therapy (98.5%, 194/197) and chondroprotective agents alone (98.3%, 173/176) were more effective than anti-inflammatory and analgesic agents alone (84.2%, 48/57) in the treatment of skeletal fluorosis ( P < 0.05). Surgery was effective (8/8). Conclusions:Most of the patients with skeletal fluorosis are middle-aged and elderly, and the patients with skeletal fluorosis in Mongols account for a certain proportion. At present, all the patients with skeletal fluorosis who have the will to be treated have not been effectively treated, and the means of treatment is relatively single. It should be advocated to carry out various forms of treatment of skeletal fluorosis, so that patients could relieve symptoms, reduce pain and improve their quality of life.
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Objective:To understand the prevalence of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region, and to provide a data basis for formulation of prevention and control measures.Methods:All administrative villages of 53 banners (counties) in 10 leagues (cities) of Inner Mongolia Autonomous Region were investigated for tea-drinking-borne fluorosis. The basic information and demographic information of each administrative village were collected, and 10 households were selected from each administrative village to investigate the basic information of family members and the drinking situation of brick tea, and collect household brick tea samples to determine the fluorine content. The prevalence of dental fluorosis in children aged 8 to 12 and skeletal fluorosis in adults over 16 years in the administrative villages were investigated.Results:There were 39 banners (counties) in Inner Mongolia Autonomous Region that had the habit of drinking brick tea, people who habitually drink brick tea a lot accounted for 70.22% of the total population (4.278 5 million/6.092 8 million). The per capita annual consumption of brick tea was 1.00 kg and the per capita daily intake of brick tea fluoride was 0.68 mg. A total of 24 282 brick tea samples were collected, and the samples with fluorine content exceeding the standard accounted for 74.77% (18 155/24 282). Except that the fluorine content of black brick tea was lower than the national health standard (300 mg/kg), other varieties of brick tea exceeded the standard. A total of 97 295 children aged 8 to 12 years were examined, and 6 558 cases of dental fluorosis were detected. The detection rate of dental fluorosis was 6.74%. Among them, 3 623 cases were very mild, 2 440 cases were mild, 489 cases were moderate and 6 cases were severe. There were significant differences in the detection rates of dental fluorosis in children of different regions and ages (χ 2 = 6 803.76, 30.82, P < 0.05). A total of 115 251 adults over 16 years old were examined, and 1 691 cases of skeletal fluorosis were detected. The detection rate of adult skeletal fluorosis was 1.47%; among them, 1 043 cases were mild, 481 cases were moderate and 167 cases were severe. There were statistically significant differences in the detection rates of skeletal fluorosis among adults of different regions and ages (χ 2 = 3 584.26, 562.67, P < 0.05). Conclusions:The fluoride content of brick tea consumed by residents in Inner Mongolia Autonomous Region seriously exceeds the standard. Moderate and severe patients with dental fluorosis in children aged 8 to 12 years and skeletal fluorosis in adults over 16 years old have been detected. The prevention and treatment of tea-drinking-borne fluorosis in Inner Mongolia Autonomous Region should be continuously strengthened.
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Objective:To analyze the epidemic range of tea-drinking-borne endemic fluorosis in Gansu Province and accurately grasp the information of tea-drinking-borne endemic fluorosis patients, so as to provide basis for popularizing low fluorine brick tea and carrying out patient rescue and treatment.Methods:From 2019 to 2020, 12 counties (cities) in Gansu Province with a history of drinking brick tea were selected as the survey points according to the "Investigation Plan of Endemic Fluorosis of Tea Drinking Type in China in 2019" and the relevant information in Gansu Province. A cross-sectional survey was conducted in all villages with the habit of drinking brick tea (including the investigation of the fluoride content in drinking water, tea, the fluoride intake of the population, the dental fluorosis and urinary fluoride content of children aged 8 to 12, and the skeletal fluorosis and urinary fluoride content of adults), and the survey results were analyzed.Results:The survey covered 125 townships in 12 counties (cities), with 8 625 households in 860 villages. One thousand six hundred and seventy-two drinking water samples were collected, and the fluoride content in water ranged from 0.01 to 1.81 mg/L. Six villages with fluoride content > 1.0 mg/L were screened. A total of 3 664 tea samples were collected, the average fluorine content of brick tea was 481.33 mg/kg, and the fluorine content ranged from 31.88 to 1 643.40 mg/kg. There were 1 076 tea samples with fluorine content less than 300 mg/kg, and the qualified rate of fluorine content in brick tea was 29.37% (1 076/3 664). Among the 12 counties (cities), 92 townships and 496 villages were still drinking brick tea. The drinking rate of brick tea in villages was 57.67% (496/860), and the annual per capita consumption of brick tea was 1.21 kg. The average daily intake of tea fluoride in adults was 1.57 mg/d. In Maqu County, Aksai County, Tianzhu County and Sunan County, the daily intake of tea fluoride of adults in 31 villages of 13 townships was more than 3.5 mg, involving 5 272 households and 15 272 people. Sixty-five patients with dental fluorosis were found in the above 31 villages. The detection rate of dental fluorosis was 3.50% (65/1 856), mainly in very mild and mild cases. Urine samples were collected from 326 children. The median of urinary fluoride was 1.44 mg/L. The clinical investigation of skeletal fluorosis was carried out in 2 189 adults. X-ray examination of bones and joints was performed in 123 patients with definite clinical symptoms and/or signs of skeletal fluorosis. Seven cases of skeletal fluorosis were positive, the detection rate was 0.32% (7/2 189). Urine samples were collected from 83 adults. The median of urinary fluoride was 1.83 mg/L. Two villages with moderate disease were identified as Yehuwan Village in Anyuan Town of Tianzhu County and Nannigou Village in Zhuaxixiulong Town. Four villages in the mild diseased areas were identified as Daiqian Village in Zhuaxixiulong Town, Xiding Village in Dahonggou Town, Tuta Village in Danma Township of Tianzhu County and Annanba Village in Akeqi Township of Akesai County.Conclusion:Most of the endemic areas of tea-drinking-borne endemic fluorosis in Gansu Province have been under control, but the risk of tea fluoride exposure still exists in some areas, so it is urgent to take targeted prevention and control measures.
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Objective:To study the epidemic status of drinking tea type endemic fluorosis in Qinghai Province.Methods:In 2019, in counties (cities, districts, referred to as counties) that had the habit of drinking brick tea in 8 cities (prefectures) of Qinghai Province, epidemiological investigation of drinking tea type endemic fluorosis was carried out in villages. Ten households were randomly selected from each village, to investigate the demographic data of each household and the drinking situation of brick tea, residents' drinking water and brick tea samples were collected to determine the fluorine content, and calculate the daily per capita tea fluorine intake. At the same time, skeletal fluorosis was examined in all adults over 25 years old, and dental fluorosis was examined in all children aged 8 to 12 years old in survey sites. The content of fluorine in tea and water was detected by ion selective electrode method; the diagnosis of skeletal fluorosis was based on "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008), the diagnosis of dental fluorosis was based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:The mean (range) of fluorine of the 3 602 water samples was 0.31 (0.20 - 1.00) mg/L. The geometric mean (range) of fluorine of the 31 067 brick tea samples was 646 (40 - 2 295) mg/kg, the fluorine content of the brick tea ≤300 mg/kg accounted for 7.80% (2 422/31 067) of the total samples. The proportion of drinking Fu brick-tea was 89.97% (27 952/31 067); and the daily per capita tea fluorine intake was 1.93 mg, the daily per capita tea fluorine intake in Guoluo, Yushu and Hainan prefectures were higher than the health standard (3.50 mg). The detection rate of skeletal fluorosis in adults was 0.16% (2 357/1 484 907), Yushu Prefecture was the highest [29.23% (592/2 025)], followed by Guoluo Prefecture, which was 8.21% (771/9 393). The detection rate of dental fluorosis in children was 4.79% (8 076/168 623), Yushu Prefecture was the highest [32.61% (1 562/4 790)].Conclusion:Drinking tea type endemic fluorosis is prevalent in Qinghai Province, with obvious regional characteristics, covering a large population. The disease is relatively popular in Yushu Prefecture and Guoluo Prefecture.
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Introduction:Endemic fluorosis remains a challenging and extensively studied national health problem in India. It not only affects the body of a person but also renders them socially, economically and culturally crippled.Objectives:The purpose of this study was to assess the awareness, knowledge and perception regarding water quality, socioeconomic and clinical aspect of Dental and skeletal fluorosis among families residing in endemic areas for Fluorosis in North Gujarat after receiving Dharoi water supply as mitigation measure to curb fluorosis. Methods:Apopulation based survey was done in hundred families of the ten villages of North Gujarat which were selected through Random Sampling techniqueResults:Around 100 families including 473 members were surveyed. Only 8 families have awareness about Fluorosis and 53% of families strongly agree that the water causes ugly teeth and joint pain. Nearly 89% and about 80% of families had agreed that skeletal Fluorosis severely reduced the capacity for work and earning income and Dental Fluorosis reduces self-confidence, especially in girls respectively. Around 70% of families responded that, there is no relief in joint and back pain at all after using Dharoi water supply. Conclusion:It can be concluded that Fluorosis is a major Public Health problem in these ten villages of North Gujarat affecting people physically, socially and economically, even after the introduction of Dharoi water supply. It can be attributed to irregular and insufficient utilization of Dharoi water supply along with various myths and ostentations attached to usage of this water.
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Objective To grasp the current situation of drinking water-borne endemic fluorosis in Shandong Province,and provide a scientific basis for formulating preventive strategies.Methods In 2016,according to the "National Surveillance Scheme of Drinking Water-Borne Endemic Fluorosis" and "Shandong Provincial Surveillance Scheme of Drinking Water-Borne Endemic Fluorosis",10 counties (cities,districts) were selected in Shandong Province,3-5 villages were selected in each county (city,district),to investigate the operation of water improvement and fluorine reduction project and the water fluorine,and 1 tap water sample in each village was collected to detect water fluorine.At the same time,dental fluorosis examination was performed on all children aged 8-12 years old and fluorosis X-ray examination was performed on adults aged ≥25 years old.Water fluorine was detected by ion selective electrode method;the water fluorine was determined according to "Standards for Drinking Water Quality" (GB 5749-2006);criteria for diagnosis,grading and epidemic intensity of dental fluorosis were based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011);the diagnostic and grading criteria for skeletal fluorosis were based on the "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008).Results All the 32 villages in 10 counties (cities,districts) changed water,water improvement and fluorine reduction project ran normally,24 villages had qualified water fluorine (≤ 1.20 mg/L),and 8 villages had water fluorine exceeding the standard.The detection rate of dental fluorosis in children was 25.75％ (419/1 627),and the difference between 10 counties (cities,districts) was statistically significant (x2 =288.55,P ＜ 0.01);the dental fluorosis index was 0.48,and the defect rate was 2.77％ (45/1 627).The detection rate of skeletal fluorosis in adults was 4.72％ (72/1 525),and the difference between 10 counties (cities,districts) was statistically significant (x2 =18.83,P ＜ 0.01).Conclusions The problem of water fluorine exceeding the standard in water improvement and fluorine reduction project in Shandong Province is still serious.The condition of fluorosis has not been fully controlled,and the prevention and treatment measures need to be further strengthened.
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@#Fluoride is an important trace element in the human body and has active chemical properties, but its safety range is narrow. Excessive intake of fluoride can easily lead to fluorosis and various metabolic disorders, mainly manifested as dental fluorosis and skeletal fluorosis. In recent years, an increasing number of scholars have studied traditional Chinese medicine (TCM) because of its long history, few side effects, convenient oral administration and abundant resources. This paper reviews the current research. The results of the literature review show that traditional Chinese medicine, such as asparagus, cistanche deserticola and quercetin, can effectively prevent and treat fluorosis diseases that affected soft and hard tissues of the body due to is antioxidant properties. Moreover, the protective effect of TCM on fluoride-excreting organs of the body can further restore the fluoride-excreting ability of the body and reduce the damage caused by excessive fluoride on tissues as well as reduce fluoride in tissues by combining with excessive fluoride in the body. TCM can effectively improve the pain and joint dysfunction caused by skeletal fluorosis. Traditional Chinese medicine has important value in the prevention and treatment of fluorosis by enhancing immunity, promoting metabolism, eliminating fluoride in vivo, and improving the self-regulation mechanism to prevent fluoride toxic damage in the body.
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Objective To investigate the status of coal-burning type endemic fluorosis in Ludian County of Yunnan Province,to evaluate the prevention and control effect.Methods Multi-stage sampling was adopted in 2016.Five townships from Ludian endemic fluorosis areas and 2 villages of each township were randomly selected.The condition (children's dental fluorosis,urinary fluoride,adult skeletal fluorosis),epidemic factors (use of stoves,fluoride content of main household foods,indoor air fluoride content),health education awareness of endemic fluorosis were investigated in the above mentioned villages.Results The dental fluorosis positive rate of children aged 8-12 was 10.14％ (51/503) while a total of 503 children were investigated,the index of dental fluorosis was 0.16,and adult skeletal fluorosis detection rate was 1.92％ (2/104) while a total of 104 adults were investigated.The geometric mean of urinary fluoride content of children was 0.39 mg/L,ranging from 0.02 to 2.54 mg/L.Totally 98,161,and 151 samples of pepper,rice,and corn were detected.The medians of fluoride content were 0.96,0.42,and 0.43 mg/kg,respectively,ranging from 0.26 to 13.46,0.13 to 2.20,and 0.21 to 2.54 mg/kg,respectively,in which the fluorine contents of pepper 48.98％ (48/98) was higher than 1.0 mg/kg.The correct drying rates of both corn and pepper were 100.00％ (201/201),and the correct preservation rates of corn and pepper was 99.50％ (200/201) and 100.00％ (201/201),respectively.The use rate of improved stove,rate of intact stove,correct use rate of intact stove were 100.00％ (201/201),96.02％ (193/201) and 100.00％ (193/193),respectively.The fluoride contents in the indoor air of the families (the fire period was 0.32 μg/m3 and the fire extinguishing period was 1.22 μg/m3) from the areas of fluorosis which had properly used the improved stoves were lower than that of the national hygienic limit content (the one-hour average concentration limit is 20 μg/m3).The knowledge of prevention and control of coal-burning type fluorosis among fifth-grade primary school students and household heads was investigated in 104 and 201 people,respectively,with the awareness rates of 80.77％ (252/312) and 86.23％ (520/603),respectively.Conclusion By implementing the comprehensive prevention and control measures,which mainly focus on the improvement of the stove and the health education,the coal-burning fluorosis in Ludian County has been effectively controlled,and the prevention and control work has achieved remarkable results.
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As a new animal model of vertebrate,zebratish has been widely used in the research of bone diseases,especially in osteoporosis.In the field of fluorosis research,existing studies have shown that fish are more sensitive than traditional animal models.In this paper,combine with fish fluorosis research results,the biological characteristics and osteogenic characteristics of zebrafish are introduced,the application status of zebrafish in bone research is summarized,and the application of zebrafish in the field of skeletal fluorosis is prospected.
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Objective To master the condition of drinking water fluorosis in Jiangsu Province and the operation of improved-water project,and to provide a scientific basis for further prevention and treatment of drinking water fluorosis.Methods In 2015,17 drinking water fluorosis counties were selected in Jiangsu Province,and 3 villages in each county were selected as monitoring sites,when the number of drinking water fluorosis villages was less than 3,all of the drinking water fluorosis villages were selected as monitoring sites.To know the progress and running conditions of the improved-water facilities,water samples were collected to determine the fluorosis level.All children aged 8-12 years were monitored for dental fluorosis.Two monitoring counties were selected to monitor the X-ray changes and urinary fluoride of adults with skeletal fluorosis.Results A total of 47 villages were surveyed,46 of which had water improved,and 1 had water unimproved.The rate of water improved was 97.87％ (46/47).The number of improved-water facilities that were operating normally was 45,and the rate was 97.83％ (45/46).The number of intermittent operation was 1.The number of improved-water facilities with qualified water fluoride was 42,and the rate was 91.30％ (42/46).In the villages with normal improved-water facilities,and qualified water fluoride,the total rate of dental fluorosis of children aged 8 to 12 was 15.56％ (600/3 855),and the dental fluorosis index was 0.29.In the villages with normal improved-water facilities,but unqualified water fluoride,the total rate of dental fluorosis of children aged 8 to 12 was 57.30％ (267/466),and the dental fluorosis index was 1.21.The range of water fluoride in water unimproved villages was 1.2-2.0 mg/L,and the total rate of dental fluorosis of children aged 8 to 12 was 40.91％ (36/88),and the dental fluomsis index was 0.66.The detection rate of skeletal fluorosis in adults was 5.16％(16/310),the geometric mean of urinary fluoride was 0.67 mg/L,and the range of urinary fluoride was 0.02-2.76 mg/L.Conclusions The improved-water projects in drinking-water fluorosis areas in Jiangsu Province have achieved a certain effect,but water fluoride is unqualified in some water projects.We should strengthen the maintenance and supervision of the water projects to ensure the normal operation of water projects.
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Objective To understand the prevalence state of drinking-tea type fluorosis in Hainan Prefecture,Qinghai Province,and provide scientific data for its prevention and control.Methods In 2016,a cross-sectional survey method was used to select five counties of Guide,Guinan,Xinghai,Gonghe and Tongde in Hainan according to "National Investigation Measure of Prevalence of Drinking-tea Type Fluorosis".In each county,5 villages (towns) were selected according to the directions of east,west,north,south and center positions,and 1 administrative village was randomly selected in each village (town) as the survey site.All the children aged 8 to 12 years old at the survey site and 60 adults aged 16 years old and older at each survey site were selected as the survey subjects.We investigated the volume of brick-tea water consumed per day among objective population with questionnaire,and collected water,brick-tea water and urine samples (if each region has one water source,we collected one water sample,if this place have different water sources,we collected all the water samples from each water source;brick-tea water samples were collected based on different locations;more than 12 urine samples were collected in each survey site).The fluoride concentration in water,urine and tea water were detected with fluoride ion-selective electrode,the dental fluorosis of children aged 8-12 years were diagnosed by "Diagnosis of Dental Fluorosis" (WS/T 208-2011),and clinic skeletal fluorosis of population was diagnosed based on the "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008).Results The medians of fluoride in drinking water,drinking-tea water were 0.29 and 1.43 mg/L,respectively.The mean of daily fluoride intake of each person was 1.82 mg,and the geometric mean of urinary fluoride was 0.83 mg/L;the rate of dental fluorosis among children was 14.06％ (559/3 975),its index was 0.24,the prevalence rate of clinic skeletal fluorosis among adult was 8.01％ (119/1 484).The rate of dental fluorosis among children in Tongde County was the highest,about 15.96％ (83/520),while the rate of dental fluorosis among children in Guinan County was the lowest,about 10.76％ (111/1 032).The prevalence rate of clinic skeletal fluorosis among adult in Xinghai County was the highest,about 10.87％ (30/276),while Tongde County was the lowest,about 5.75％ (15/261).Conclusions The prevalence of drinking-tea type fluorosis is relative low.However,the local population are still under the risk of brick-tea with high fluoride,so it is necessary to strengthen the health education propaganda to keep the population healthy.
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Objective To provide a basis for development of preventive measures through dynamical monitoring of the changing trends of endemic fluorosis areas and the prevalence of drinking-water-borne endemic fluorosis.Methods Using simple random sampling method,thirty monitoring villages in 11 counties of Inner Mongolia were selected as fixed monitoring villages from 2012 to 2016.The operation of water improvement projects was investigated,and water fluoride content was tested.Dental fluorosis of all 8 to 12-year-old students was diagnosed in the villages.Stratified random sampling by age was used to select 50 adults over 25-year-old in each monitoring village,and skeletal fluorosis was examined by X-ray.Results ①In 2012-2016,the water-improved rate of monitoring villages was 78.67％ (118/150).Of all the water-improved projects,normal operating projects accounted for 92.98％ (106/114).The exceeded rate of water fluoride in water-improved village was 31.36％ (37/118).②The detection rate of dental fluorosis and community fluorosis index (CFI) in children aged 8-12 of the villages with normal operating projects and qualified fluoride content were 20.88％ (533/2 553) and 0.41;the detection rate of dental fluorosis and CFI of the villages with water-improved projects under abnormal operation or excessive fluoride were 49.53％ (318/642) and 0.98;the detection rate of dental fluorosis and CFI of the villages without water-improved projects were 37.14％ (442/1 190) and 0.76.③The detection rate of X-ray skeletal fluorosis in adults of the villages with normal operating projects and qualified fluoride content was 18.97％ (140/738);the detection rate of X-ray skeletal fluorosis in adults of the villages with water-improved projects under abnormal operation or excessive fluoride was 31.53％ (111/352);the detection rate of X-ray in adults of the villages without water improvement projects was 31.17％ (96/308).Conclusions Up to now,in Inner Mongolia Autonomous Region,some villages have not yet improved their drinking water quality,water fluoride content in some projects has exceeded the standard seriously,the prevalence of dental fluorosis in children aged 8-12 is very mild,there are still moderate and severe endemic areas.So the orevention and control measures of the water-improved defluoridation need to be further strengthened.
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Objective To observe the efficacy and feasibility of transplanting autologous bone marrow mesenchymal stem cells (BMSCs) via articular cavity on skeletal fluorosis rabbits. Methods A total of 30 rabbits, half male and half female, were divided into control group (n=6) and experimental group (n=24) by random number table method. The two groups of rabbits were given drinking water containing NaF 0 or 300 mg/L, respectively. After 90 days, 24 rabbits were divided into single treatment group, multiple treatment group, spontaneous recovery group and treatment solvent control group (6 rabbits in each group, half male and half female). After isolation, the BMSCs from skeletal fluorosis rabbits were cultured and identified, autologous BMSCs were transplanted into rabbit bodies via articular cavity at once or at three different other times, respectively. After 60 days, femur image was observed through X-ray. Femur bone mineral density was measured with quantitative CT (QCT). Serum alkaline phosphatase (ALP) and osteocalcin (BGP) were also measured using enzyme linked immunosorbent assay (ELISA). Bone fluoride content was determined via the fluorine ion-selective electrode method. Histopathology changes of femur were observed through HE staining and the trabecular area was calculated. Results In the multiple treatment group, patchy high-density images of femur were disappeared and abnormal bone texture was recovered compared with that of before transplantation. Bone density [(536.91 ± 25.51) g/cm3], ALP concentration [(20.06 ± 6.25) U/L], BGP concentration [(1230.01 ± 119.50) μg/L], bone fluoride content [(1442.40 ± 458.54) mg/kg] and trabecular area [(27.81 ± 2.90) Tb.Ar] of the multiple treatment group were lower than those of spontaneous recovery group [(635.11 ± 93.42) g/cm3, (43.08 ± 2.82) U/L, (3207.73 ± 788.80) μg/L, (2557.65 ± 173.90) mg/kg, (38.52 ± 2.81) Tb.Ar], and th e differences were statistically significant (P<0.05). HE staining in the multiple treatment group showed that bone marrow cavity was enlarged, and the number of trabeculae was decreased, accompanied by some new generated, neatly arranged normal trabeculae. But similar results were not observed in the single treatment group. Conclusion After multiple transplantation via articular cavity, autologous BMSCs from skeletal fluorosis rabbits could repair the damaged bone tissue and improve the pathological damage of skeletal fluorosis with osteosclerosis.