Weather Variability and COPD: A Risk Estimation Identified a Vulnerable Sub-population in Hungary.

BACKGROUND/AIM: Chronic obstructive pulmonary disease (COPD) is a major public health concern, affecting over 200 million people worldwide in 2019. The prevalence of COPD has risen by 40% from 1990 to 2010 and continued to increase by 13% from 2010 to 2019, causing over 3 million deaths globally in 2019, ranking it as the third leading cause of death. This study explored how daily weather changes relate to the number of COPD-related emergency department (ED) visits. MATERIALS AND METHODS: We collected data on daily COPD-related ED visits in 2017 in Pécs along with corresponding meteorological data to analyze this connection. RESULTS: High diurnal temperature range (DTR) and day-to-day variability in dew point were linked to a 4.5% increased risk of more COPD-related ED visits. Notably, DTR had a stronger impact on males, contributing to a 6.3% increase, while dew point variability significantly affected males with an odds ratio (OR) of 1.083. (OR=1.083). Stratifying by age revealed heightened risks for those aged 30-39 (43.5% increase) and 50-59 (7.6% increase). Females aged 30-39 and 50-59 faced elevated risks of 42.7% and 9.1%, respectively, whereas males aged 60-69 showed a 9.8% increase. CONCLUSION: Our findings highlight the influence of weather variations on COPD-related ED visits, with nuanced effects based on age and sex.

Registration of a pregnant woman in the maternity hospital (optimally at 36th-37th weeks) at the Olomouc University Hospital in 2022.

OBJECTIVE: The aim of the study was to analyse the results of the implementation of the new health service Registration of a pregnant woman in the maternity hospital (optimally at 36th-37th weeks) provided as part of outpatient/ambulatory health care at Olomouc University Hospital (OUH). MATERIALS AND METHODS: A prospective cohort study. In 2022, a total of 2,271 women gave birth in OUH, and 2,010 of them were Registered in the maternity hospital, defined specific risks were identified and a pregnancy termination strategy was established/determined. RESULTS: The health service was provided to 88.5% of women giving birth (2,010/2,271). The age of the mothers was 15-56 years (mean 31.3 years; median 31 years), their body mass index was 13.4-53.1 kg/m2 (mean 24.6 kg/m2; median 23.2 kg/m2). 43.6% of them (877/2,010) were Low-risk pregnancies and 56.4% (1,133/2,010) were Pregnancies with a defined specific risk. The most frequently identified risks were as follows: RhD negative blood group (18.4%), diabetes mellitus (13.9%), history of caesarean section (12.0%), hypertensive disorders (6.5%), small fetus/fetal growth restriction (6.3%), risk the development of hemolytic disease in the fetus and the newborn (2.5%), multiple pregnancy (1.6%), congenital malformation of the fetus (1.3%) and placentation disorders (0.5%). In 63.4% of them (1,275/2,010), the pregnancy termination strategy was determined by spontaneous vaginal delivery, in 18.0% (361/2,010) by pre-induction of vaginal delivery and in 14.2% (285/2,010) by caesarean section. In 4.4% (89/2,010) the health service was not implemented correctly because no strategy was established. CONCLUSION: The implementation of the new health service will make it possible to replace activity (more frequent antenatal care contacts/visits and routine antenatal cardiotocography) with efficiency (risk identification, determination of the optimal strategy for outpatient/ambulatory antenatal care and timing and mode of delivery) and thereby provide better and safer health care (from a medical, organizational, legislative and economic points of view).

Spine Injuries in Household Environments: A Comprehensive Analysis.

Introduction Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.

Contributors to reductions of PM2.5-bound heavy metal concentrations and health risks in a Chinese megacity during 2013, 2016 and 2019: An advanced method to quantify source-specific risks from various directions.

PM2.5-bound heavy metals were measured in a Chinese megacity (Tianjin) in 2013, 2016 and 2019, and analyzed by a new RSDA method (source directional apportionment of risks). Through combining the receptor model, cluster analysis of back trajectories, and risk assessment, the RSDA was developed in this work to quantify source-specific risks from each direction. Concentrations of PM2.5 and most species (especially for heavy metals) underwent various reductions, and the incremental lifetime cancer risk (ILCR) and non-cancer risk (HQ) declined by more than 80% from 2013 to 2019. Pb was the highest contributor to the reduction of HMs mass concentration (58.6%), while Cr (85.5% for cancer risk) and As (26.0% for non-cancer risk) were more prominent for the reduction of HM risks. The coal combustion and industrial emissions were vital contributors to the reduction of both PM2.5 mass concentrations (contributed 34.0% and 7.8% to the reduction respectively) and health risks (contributed 36.1% and 25.7% to the cancer risk reduction respectively). Although the percentage mass contribution of traffic emissions increased (7.7% in 2013 and 21.9% in 2019), the associated risks decreased (contributed 26.8% to the cancer risk reduction). Furthermore, the results of RSDA consistently implied that coal combustion, industrial emissions and traffic emissions controls in the northeast/north-northeast, south and southwest of the studied area played important roles in the risk reductions, which mainly due to the risk reduction of air masses from NE/NNE, S and SW, and their strong influence to Tianjin. The RSDA method can quantify the health risks from different sources and directions, and the evaluation of contributors to the reductions of risks in this work would provide a meaningful reference for policy maker to control PM2.5 emissions and protect population health.

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants-not just cochlear implant-specific benefits-Perspective.

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8-9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Size distribution, meteorological influence and uncertainty for source-specific risks: PM2.5 and PM10-bound PAHs and heavy metals in a Chinese megacity during 2011-2021.

This study aims at exploring size distribution, meteorological influence and uncertainty for source-specific risks of atmospheric particulate matter (PM), which can improve risk-mitigation strategies for health protection. Heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) in PM2.5 and PM10 were detected in a Chinese megacity during 2011-2021. A new method named as PMFBMR, which combines the Positive Matrix Factorization, Bootstrapping, Mote Carlo and Risk assessment model, was developed to estimate uncertainty of source-specific risks. It was found that PAH risks concentrated in fine PM, while HMs showed high risks in both fine and coarse PMs. For PM2.5, HQ (non-cancer risk hazard quotient) of gasoline combustion (GC), diesel and heavy oil combustion (DC), coal combustion (CC), industrial source (IS), resuspended dust (RD) and secondary and transport PM (ST) were 0.6, 1.4, 0.9, 1.6, 0.3, and 0.3. ILCR (lifetime cancer risk) of sources were IS (9.2E-05) > DC (2.6E-05) = CC (2.6E-05) > RD (2.2E-05) > GC (1.7E-05) > ST (6.4E-06). PM2.5 from GC, DC, CC and IS caused higher risks than coarse PM, while coarse PM from RD caused higher risks. Source-specific risks were influenced not only by emissions, but also by meteorological condition and dominant toxic components. Risks of GC and DC were usually high during stable weather. Some high risks of CC, IS and RD occurred at strong WS due to transport or wind-blown resuspension. GC and DC risks (influenced by both PAHs and HMs) showed strong relationship with T, while IS and RD risks (dominated by HMs) showed weak link with meteorological conditions. For uncertainty of source-specific risks, HQ and ILCR were sensitive for different variables, because they were dominated by components with different uncertainties. When using source-specific risks for risk-mitigation strategies, the focused toxic components, used toxic values, PM sizes and uncertainty are necessary to be considered.

Seasonal source identification and source-specific health risk assessment of pollutants in road dust.

Humans who are exposed to metals in road dust may have potential health risks through touching, ingesting, and inhaling the suspended road dust. There were limited studies to link seasonal emission sources to health risks from metals in road dust. In this study, metals in road dust from different functional areas were seasonally monitored. The contributions of the pollutant sources in study areas varied with seasons. By combining the source apportionment model (PMF), road dust emission model, and health risk models (HI: hazard index and ILCR: incremental lifetime carcinogenic risk), industrial and construction activity was identified as the crucial source of both the pollutants in road dust (29-47%), and the HI for adults (27-45%) and children (41-50%) in different seasons. The traffic non-exhaust emission dominated in the carcinogenic risks for children in spring (45%) and summer (36%). Factors such as seasons, particle size, metal bioavailability, human exposure time, and exposure area were all taken into consideration to avoid overestimating or underestimating health risks. The carcinogenic risks for children (1.6 E-06) and adults (2.8 E-06) exposed to Cr both exceed the minimum threshold (10-6). It means that the potential risks were acceptable but could not be completely neglected. Measured metals mainly posed hazard to human health through ingestion route. Pb and Mn, Fe and Mn were the main harmful elements that induced non-carcinogenic risks for adults and children, respectively. Effectively identifying the source-specific health risks in different seasons will help in the formulation of adaptive strategies to diminish the potential risks.

Human health risks and benefits assessment based on OCPs, PCBs, toxic elements and fatty acids in the pelagic fish species from the Adriatic Sea.

Benefits and risks of the fish consumption should be assessed to balance the ingestion of healthy omega-3 fatty acids and adverse chemicals. Persistent organic pollutants-POPs (organochlorine pesticides-OCPs and polychlorinated biphenyls-PCB), macro- and micro-elements and fatty acid contents were determined in six fish species from the Adriatic Sea to assess health risks for consumers (worst-case scenario, diseases development risks and benefit-risk). 16 element, 24 POPs and 14 fatty acid contents were determined in six pelagic species which can be used in human diet. Element concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS), POPs by high-resolution gas chromatography and fatty acid content by gas-liquid chromatography. Diet based on chub mackerel and round sardinella showed lower daily intake (DI) of POPs and highest DI of essential omega-3 fatty acids than other investigated species. Lower ingestion of toxic elements can be observed by consuming anchovy and round sardinella. Based on POP concentrations, there was not observed non-carcinogenic (HI) nor carcinogenic (CR) risks for consumers. Based on element concentrations, there was low HI (0.1 ≥ HI ≥ 1), while the maximum HIs and outlier values (horse mackerel and anchovy samples) implied the presence of HI (HI > 1). The most significant contributor to total non-carcinogenic and carcinogenic risks was inorganic arsenic (inorganic As). Acceptable CR for consumers was assessed, but maximum CR for consumers of horse mackerel and anchovy (CR ≥ 1 × 10-6) showed adverse effects on human health. There were low HIs for developing cardiovascular, nervous, and reproductive diseases, and maximum HIs were higher than 1. Acceptable (1 × 10-4≥CR ≥ 1 × 10-6) risks were observed for developing cancer of nervous system and reproductive organs. Among investigated fish samples, those with higher Æ©BR (benefit-risks) and BR for arsenic (As) than median value have a higher risk than benefits in the human diet.

Source-specific ecological and health risks of potentially toxic elements in agricultural soils in Southern Yunnan Province and associated uncertainty analysis.

Source-specific risk apportionment is critical to prevent and control soil potentially toxic element (PTE) pollution. This study explored source-specific ecological and human health risks of soil PTEs in Southern Yunnan Province. Geochemical baseline values were determined to assess the pollution level of PTEs; then source-specific risk was apportioned combining positive matrix factorization (PMF) with ecological and human health risk assessment. Obvious accumulation of As, Cd, Pb, and Zn was observed in this area, especially Cd in 21.33% of the samples exhibited significant enrichment. Four sources were quantified based on PMF assisted with GIS-mapping: natural sources (41.49%), traffic emissions (24.70%), industrial activities (17.48%), and agricultural activities (16.33%). Industrial activities were the largest source (64.55%) to ecological risk. Agricultural activities were regarded as the major contributor to non-carcinogenic (adults: 75.93%, children: 62.33%) and carcinogenic risks (adults: 55.97%, children: 56.36%). Non-carcinogenic and carcinogenic risks for children were higher than adults, and their health risks showed similar trend. Thus, agricultural activities should be regarded as a priority to reduce health risk, whereas industrial activities should be given priority to control ecological risk. Although source-specific risk was quantified, combination with bioavailability and interactions of PTEs are necessary to obtain more accurate results in future.

Comprehensive screen the lead and other toxic metals in total environment from a coal-gas industrial city (NW, China): Based on integrated source-specific risks and site-specific blood lead levels of 0-6 aged children.

A new integrated source-specific risk model and site-specific blood lead levels (BLLs) of 0-6 children were introduced to comprehensive understand the status of the toxic metals in soil-dust-plant total environment from a Coal-Gas industrial city, NW China. 144 samples were collected and ten toxic metals (As, Ba, Co, Cr, Cu, Mn, Ni, Sr, Pb, and Zn) were screened by XRF and ICP-MS. It was found that the occurrences of toxic metals deferred in the different medium, such as Co, Cu, Pb, and Zn observed the trend of accumulating in soil and plant compared to clustered distributions of Cr, Mn and Ni preferred to accumulate in dust. However, few bioaccumulations observed in Ulmus pumila L. Toxic metals distributions in majority of sites influenced by coal combustion mixed sources and industrial activities posed the high integrated ecological risks and caused significant non-carcinogenic and carcinogenic integrated risks for local 0-6 children identified by new integrated source-specific risk model, especially observed in the priority contaminants Co and Pb. The site-specific BLLs confirmed that younger children fewer than 4 lived in the north region were more vulnerable to priority Pb pollution as their BLLs above 50 µg/L, almost up to 80 µg/L. Although proportions of source-specific risks to toxic metals changed in soil and dust, the critical sources from coal combustions and industrial activities posed the most important contribution to the local risks. Therefore, effective strategies targeting at critical sources on coal industries should be conducted to reduce risks, and mostly emphasize on the north hotspot areas.

Size distributions of source-specific risks of atmospheric heavy metals: An advanced method to quantify source contributions to size-segregated respiratory exposure.

Heavy metals in size-segregated particulate matter (PM) were investigated in a Chinese megacity, and an advanced model was developed to quantify source-specific risks focusing on size-segregated respiratory exposure. Incremental lifetime cancer risk (ILCR) and non-cancer risk (hazard quotient: HQ) based on deposition concentrations of heavy metals displayed a peak at 4.7-5.8 µm. The percentage contributions to cancer risk were as follows: industrial emission (IE, 34%) > secondary and transport (ST, 29%) > resuspended dust (RD, 21%) > coal combustion (CC, 11%) > traffic emission (TE, 4%) during spring and summer (SS), and CC (31%) > ST (26%) > IE (21%) > RD (11%) ≈ TE (11%) during autumn and winter (AW). RD (41% of HQ during SS, 28% during AW) and IE (45% of HQ during SS, 35% during AW) dominated non-cancer risk. ILCR and HQ of CC were high at sizes 1.1-2.1 µm and 0.43-0.65 µm; those of RD were high at sizes > 3.3 µm; and those of IE were bimodal at fine (<2.1 µm) and coarse (>2.1 µm) sizes, respectively. Cancer risk was more susceptible to small particles than non-cancer risk, partly because higher ILCR was from CC, but higher HQ was attributed by RD.

Source-specific risks of synchronous heavy metals and PAHs in inhalable particles at different pollution levels: Variations and health risks during heavy pollution.

Synchronous heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) in inhalable particulate matter (PM10) were measured during 2009-2012 and 2015-2016 in a Chinese megacity (Chengdu) to understand the variations in source-specific health risks during haze episodes. Samples were divided into four mass concentration levels: PM10 ≤ 150 µg m-3 (L1), 150 µg m-3 < PM10 ≤ 250 µg m-3 (L2), 250 µg m-3 < PM10 ≤ 350 µg m-3 (L3), and PM10 > 350 µg m-3 (L4). The percentages of some HMs and PAHs (accounting for PM10) decreased from L1 to L4, indicating that they exhibited lower growth rates than other species during heavy pollution. The combined cancer risk (R) for HMs and PAHs was higher at L1 and L4, and the combined non-cancer risk (HQ) was significantly high at L4. The HMs and PAHs combined source-specific risk apportion (HP-SRA) model was employed to quantify the source-specific risks. The relative contributions of (i) diesel and gasoline vehicles to the R, and (ii) crustal dust to the HQ increased during heavy pollution (L3 and L4). The relative contribution of industrial source declined from 81% (L1) to 60% (L4) for the HQ, and from 49% (L1) to 36% (L4) for the R, implying that the control of industrial emissions during heavy pollution events could alleviate risk growth as a co-benefit of controlling PM mass concentration. However, the risks associated with industrial emissions should also be considered during 'clean' days.

Overview of perimenopausal contraception.

The perimenopause is accompanied by important biological and psychosocial changes. The choice of contraceptive methods for women in the perimenopause, none of which is limited by age alone, will depend on the efficacy, safety, tolerability, and potential benefit of each method in relation to the biopsychosocial profile of the individual woman. Copper intrauterine devices are highly effective in the typical user and are a very safe method with, in general, good tolerability but are of limited use in women with heavy menstrual bleeding and subserous myomata. An additional benefit of copper intrauterine devices is protection against endometrial cancer. All progestogen-based methods share a favorable cardiovascular profile, making their use safe in most perimenopausal women. Long-acting implants and intrauterine systems are user independent and highly effective. Injectables and pills depend on user compliance. There is no evidence of a significant impact on breast cancer. Their impact on the endometrium can be either a negative side-effect (irregularity) or a benefit regarding reduction of heavy menstrual bleeding. Combined hormonal contraceptives have the highest cardiovascular risk. They can act as a promoting factor for breast cancer and cervical cancer, but they have the strongest potential regarding benefits (protection against endometrial and ovarian cancer, positive effect on bone mineral density, menstrual complaints, hyperandrogenic symptoms, hot flushes, and reduced risk regarding benign ovarian cysts and benign breast tumors).

Mitigation of disease- and treatment-related risks in patients with psoriatic arthritis.

Psoriatic arthritis is a part of the family of diseases referred to as spondyloarthropathies, a diverse group of chronic inflammatory disorders with common clinical, radiographic, and genetic features. Peripheral arthritis is the most common symptom of psoriatic arthritis and patients also frequently experience involvement of the entheses, spine, skin, and nails. Due to the diverse clinical spectrum of disease severity, tissues affected, and associated comorbidities, the treatment of psoriatic arthritis can be challenging and it is necessary to mitigate risks associated with both the disease and its treatment. These risks include disease-specific, treatment-related, and psychological risks. Disease-specific risks include those associated with disease progression that can limit functional status and be mitigated through early diagnosis and initiation of treatment. Risks also arise from comorbidities that are associated with psoriatic arthritis such as cardiovascular disease, obesity, diabetes mellitus, and gastrointestinal inflammation. Patient outcomes can be affected by the treatment strategy employed and the pharmacologic agents administered. Additionally, it is important for physicians to be aware of risks specific to each therapeutic option. The impact of psoriatic arthritis is not limited to the skin and joints and it is common for patients to experience quality-of-life impairment. Patients are also more likely to have depression, anxiety, and alcoholism. This article reviews the many risks associated with psoriatic arthritis and provides guidance on mitigating these risks.

The association between parental and adolescent substance misuse: findings from the Irish CASE study.

BACKGROUND: Self-report data from 2716 adolescents aged 15-17 years old in Irish schools were analysed to consider the association between psycho-social factors and the presence of adolescent substance and alcohol abuse, with an emphasis on family circumstances. METHODS: Data were collected using the 'Lifestyle and Coping Questionnaire' which includes questions about lifestyle, coping, problems, alcohol and drug use, deliberate self-harm, depression, anxiety, impulsivity and self-esteem. Two additional questions were added to the standard questionnaire regarding parental substance misuse. RESULTS: Adolescent substance abuse was more common in boys; parental substance misuse increased the risk of adolescent abuse of alcohol and drugs; the increased risk was marginally higher if the parental substance abuse was maternal rather than paternal; the increased risk was higher if the parental substance abuse affected both rather than one of the parents, especially regarding adolescent drug abuse; the magnitude of the increased risk was similar for boys and girls. Parental substance misuse increased the risk of adolescent substance abuse even after adjusting for other family problems and the adolescent's psychological characteristics. CONCLUSIONS: This study indicates that parental substance misuse affects the development of both alcohol and drug misuse in adolescent children independent of other family problems and the psychological characteristics of the adolescent. A wider perspective is needed, including societal and family issues, especially parental behaviour, when attempting to reduce risk of adolescent addiction. The impact on children of parental substance misuse also needs consideration in clinical contexts.