The relationship between extreme ambient temperature and small for gestational age: A cohort study of 1,436,480 singleton term births in China.

Studies have shown that exposure to extreme ambient temperature can contribute to adverse pregnancy outcomes, however, results across studies have been inconsistent. We aimed to evaluate the relationships between trimester-specific extreme temperature exposures and fetal growth restriction indicated by small for gestational age (SGA) in term pregnancies, and to assess whether and to what extent this relationship varies between different geographic regions. We linked 1,436,480 singleton term newborns (2014-2016) in Hubei Province, China, with a sub-district-level temperature exposures estimated by a generalized additive spatio-temporal model. Mixed-effects logistic regression models were employed to estimate the effects of extreme cold (temperature ≤5th percentile) and heat exposures (temperature >95th percentile) on term SGA in three different geographic regions, while adjusting for the effects of maternal age, infant sex, the frequency of health checks, parity, educational level, season of birth, area-level income, and PM2.5 exposure. We also stratified our analyses by infant sex, maternal age, urban‒rural type, income categories and PM2.5 exposure for robustness analyses. We found that both cold (OR:1.32, 95% CI: 1.25-1.39) and heat (OR:1.17, 95% CI: 1.13-1.22) exposures during the third trimester significantly increased the risk of SGA in the East region. Only extreme heat exposure (OR:1.29, 95% CI: 1.21-1.37) during the third trimester was significantly related to SGA in the Middle region. Our findings suggest that extreme ambient temperature exposure during pregnancy can lead to fetal growth restriction. Governments and public health institutions should pay more attention to environmental stresses during gestation, especially in the late stage of the pregnancy.

Effects of exposure to chlorinated paraffins on human health: A scoping review.

Chlorinated paraffins (CPs) belong to an emerging class of persistent organic pollutants (POPs) widely detected in environmental matrices and human samples. The potential health risks of CPs on humans have initiated intense concerns but there have been few studies focusing on the said topic. Addressing the gap, we make a scoping review on the current global body of evidence from epidemiological and toxicological studies. Furthermore, the management strategies and regulations related to CPs are presented and discussed. There were 70 articles among 11,280 records, including four epidemiological studies, one case report, another twenty-nine studies reporting human body burden, and thirty-six toxicological studies, finally included in this review. Additionally, twenty-three management regulation relevant documents/websites were included. CPs exist in human blood, breast milk, placenta, and other tissues. Population-based and laboratory studies suggest that CPs may cause liver and kidney toxicity, developmental toxicity, neurotoxicity, endocrine disorder, immune dysfunction, and reproductive toxicity. CPs with shorter carbon chains and higher chlorine content may be more harmful. In particular, the combined effect of CPs with other pollutants is of great concern. Population-based studies are far from sufficient at present, and most of them are conducted in China or developed countries. Besides, the toxicity assessment studies of CPs are inadequate. In addition, most studies focus on short-chain CPs (SCCPs) while few studies explored the effect of long-chain CPs (LCCPs). Thus, conducting more epidemiological studies in larger populations and toxicological studies combined with new technology methods are of great significance for better understanding the adverse health effects of CPs, which may promote CPs management regulations.

Safety of Vitamin D Food Fortification and Supplementation: Evidence from Randomized Controlled Trials and Observational Studies.

The safety considerations of food-based solutions for vitamin D deficiency prevention, such as fortification and supplementation, are critical. On the basis of collective data from 20 randomized controlled trials (RCTs) and 20 national healthy surveys, as well as prospective cohort studies (PCSs) across the ODIN project ("Food-based solutions for optimal vitamin D nutrition and health through the life cycle", FP7-613977), we analyzed the potential safety issues arising from vitamin D intakes and/or supplementation. These adverse consequences included high serum 25-hydroxyvitamin D (S-25(OH)D) concentrations (>125 nmol/L), high serum calcium concentrations, and vitamin D intakes in excess of the tolerable upper intake levels (ULs). In the RCTs (n = 3353, with vitamin D doses from 5-175 µg/day), there were no reported adverse effects. The prevalence of high S-25(OH)D was <10% when vitamin D supplements were administered, and <0.1% for fortified foods. Elevated serum calcium was observed among <0.5% in both administration types. No ODIN RCT participants exceeded the age-specific ULs. In observational studies (n = 61,082), the prevalence of high 25(OH)D among children/adolescents, adults, and older adults was <0.3%, with no evidence of adverse effects. In conclusion, high S-25(OH)D concentrations >125 nmol/L were rare in the RCTs and PCSs, and no associated adverse effects were observed.

Adverse Health Effects of Frailty: Systematic Review and Meta-Analysis of Middle-Aged and Older Adults With Implications for Evidence-Based Practice.

BACKGROUND: Scholars have noted that frailty easily leads to functional deterioration and proneness to complications. Little literature addresses the stages of frailty in middle-aged and older adults and the effects of frailty on overall health. AIMS: This study explores the effect of different stages of frailty on the prospective health (falls, bone fractures, disability, dementia, hospitalization, and death) of middle-aged and older adults. In addition, different frailty indicators were compared to determine their usefulness in predicting future adverse health outcomes. METHODS: The authors of this study separately reviewed and extracted data from the literature obtained while searching the following keywords: "frailty" OR "frail" and "fall" OR "disability" OR "fracture" OR "hospitalization" OR "mortality" OR "cognitive function" "dementia" OR "Alzheimer's disease" and "middle-aged people" OR "older people" OR "elderly" OR "geriatric" OR "senior." The literature search was performed from January 2001 to November 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Specifically, we performed a systematic literature search in multiple databases-Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library-and analyzed all obtained literature results using a random-effects model. RESULTS: We collected a total of 29 prospective studies for the systematic literature review and meta-analysis. The main results indicated that the frail groups had significantly higher risks of adverse health effects (falls, bone fractures, disability, dementia, hospitalization, and death) than the robust or prefrail groups. LINKING EVIDENCE TO ACTION: Frailty is a crucial healthcare topic among geriatric syndromes. Considering that older adults with frailty are most likely to develop severe adverse health outcomes, professional nursing personnel should assess frailty among middle-aged and older adults and offer relevant care strategies to reduce the adverse effects of frailty in this population.

The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea.

The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices.

Joint effect of multiple air pollutants on daily emergency department visits in Chengdu, China.

Existing studies have typically investigated only the association between single pollutants and health outcomes. However, in the real world, people are exposed to multiple air pollutants simultaneously. The effect of air pollutants on emergency department (ED) visits has not been previously studied in the Sichuan Basin, which is one of the most polluted areas. We collected nonaccidental, respiratory and cardiovascular daily ED visits and daily concentrations of PM2.5, PMc, CO, SO2, NO2 and O3 in Chengdu, China, from 2014 to 2016. A weighted variable for the combination of multiple air pollutants was constructed to assess the joint adverse health effects. Each air pollutant was assigned a health-related weight, which indicated the pollutant's relative contribution to the joint effect. The effects on specific subpopulations (males and females; 15-65 years old and >65 years old) were also examined. With an increase of 10 µg/m3 of the combined multiple air pollutants, the daily ED visits for nonaccidental, respiratory and cardiovascular causes increased by 0.96% (95% CI: 0.51%-1.39%), 1.19% (95% CI: 0.53%, 1.85%) and 4.36% (95% CI: 1.06%, 7.76%) at lag 1, respectively. Males presented more pronounced effects, except for cardiovascular disease, than females. Elderly individuals were found to be more sensitive than young individuals. For nonaccidental and respiratory diseases, the contributions of particulate matter (PM) were dominant among the air pollutants, whereas cardiovascular disease was mainly affected by gaseous air pollutants. The combination of multiple air pollutants was significantly associated with ED visits in the Sichuan Basin, China. The joint effect of the combination of multiple air pollutants was highest for cardiovascular disease at lag 1. The relative contributions of individual pollutants varied by disease and subpopulation. These findings suggest that under different pollution scenarios, preventive strategies should target those with different diseases and different subpopulations.

Thallium exposure at low concentration leads to early damage on multiple organs in children: A case study followed-up for four years.

Thallium (TI) is one of the most toxic heavy metals and priority pollutant metals. The emerging TI environmental pollution worldwide has posed a great threat to human health. However, based on the World Health Organization (WHO), the risk and severity of adverse health effects of TI in the range of 5-500 µg/L are uncertain. Moreover, evidence regarding the adverse impacts of TI on children's health is still insufficient. Herein, we aim to investigate the early adverse effects of TI on children's health and provide references for the WHO to establish stricter safety limits of TI. From 2015 to 2019, urinary TI and many clinical laboratory parameters related to blood routine, hepatic, renal, myocardial, coagulation function and serum electrolyte were measured in six children aged 1-9 years. The urinary TI concentration ranged from 13.4 µg/L to 60.1 µg/L with a mean of 36.1 µg/L and a median of 34.8 µg/L in six children in 2015. Although only four children felt a little poor appetite, several laboratory abnormalities indicated early damage in liver, renal, and myocardial functions in all children in 2015. After treatment and following up for four years, although the children's TI concentration decreased below 5 µg/L, their liver and renal functions did not completely recover, and their myocardial function worsened. Results indicated that impaired liver, renal, and myocardial functions were closely associated with elevated urinary TI concentration in children. Considering the increasing use of TI in high-technology industries and emerging TI environmental-contamination zones worldwide, establishing stricter safety limits of TI and paying more attention to the adverse health effects of TI on children are urgently required. SUMMARY: We found that a relatively low concentration of thallium (13.4 µg/L to 60.1 µg/L) impaired liver, renal, and myocardial function in six children. After treatment and following up these children for four years, although their urinary TI concentration decreased below 5 µg/L, their liver and renal functions did not completely recover, and their myocardial function worsened.

Endocrine Disruptors: Adverse Health Effects Mediated by EGFR?

Although endocrine disruptors represent a serious concern to human health, the underlying molecular mechanisms leading to diseases such as cancer remain poorly understood. Recent work has uncovered the epidermal growth factor receptor (EGFR) as a possible mediator of these adverse health effects, with important implications for the role of endocrine disruptors in human diseases.