Assessing capabilities of conducted ambient air pollution health effects studies in 22 Eastern Mediterranean countries to adopt air quality standards: a review.

Purpose: The Eastern Mediterranean Region (EMR) countries suffer from exposure to high levels of ambient air pollutants due to dust storms and have unique climatic as well as topographic and socio-economic conditions which lead to adverse health effects on humans. The purpose of the review was to evaluate the quantity and quality of published articles on air pollution and health-based studies in 22 EMR countries to determine if they can be applied to adopting air quality standards. Methods: We designed a review based on a broad search of the literature in the Scopus, PubMed, and web of science (WOS) databases published from January 1, 2000, to January 2, 2022, using combinations of the following relevant terms: air pollution, health, and EMR countries. The generic eligibility criteria for this review were based on the population, exposure, comparator, outcome, and study design (PECOS) statement. Results: The search results showed that following the PRISMA approach, of 2947 identified articles, 353 studies were included in this review. The analysis of the types of studies showed that about 70% of the studies conducted in EMR countries were Health Burden Estimation studies (31%), Ecological and time trend ecological studies (23%), and cross-sectional studies (16%). Also, researchers from Iran participated in the most published relevant studies in the region 255 (~ 63%) and just 10 published documents met all the PECOS criteria. Conclusion: The lack of sufficient studies which can meet the PECOS appraising criteria and the lack of professionals in this field are some of the issues that make it impossible to use as potential documents in the WHO future studies and adopt air quality standards. Supplementary Information: The online version contains supplementary material available at 10.1007/s40201-023-00862-1.

Burden of diseases attributable to second-hand smoke exposure in Iran adolescents from 2009 to 2020.

Exposure to second-hand smoke (SHS) is prevalent in many countries, but the problem's scope is poorly understood globally, especially in developing countries. We aimed to estimate SHS exposure and its national and subnational burden of diseases in Iran, the second-largest country in the Middle East, during 2009-2020. The burden of diseases from SHS was estimated as disability-adjusted life years (DALYs) for adolescents (10-18) year's non-smokers. Using comparative risk assessment methodologies, the calculations were based on disease-specific relative risk estimates with national and subnational SHS exposure data, and the uncertainty and sensitivity analysis was performed. The results of study showed that the trend of exposure to SHS is increasing in Iran. The highest DALY was related to lower respiratory infection (LRI), asthma, and otitis media, respectively. The national average asthma burden (DALY/100,000) has increased from 17.4 (11.8_23.9) in 2009 to 21.3 (13.9_30) in 2020, LRI decreased from 25.8 (21.5_30.2) to 19.8 (16.7_23.1), and national average burden of otitis media (DALY/100,000) has increased from 3.1(1.9_4.6) to 3.9(2.4_5.6). The increasing trend of otitis media and asthma DALYs attributable to SHS exposure in Iran requires more attention from policymakers to protect the population.

Ambient Air Quality Standards and Policies in Eastern Mediterranean Countries: A Review.

Objectives: National ambient air quality standards (NAAQS) are critical tools for controlling air pollution and protecting public health. We designed this study to 1) gather the NAAQS for six classical air pollutants: PM2.5, PM10, O3, NO2, SO2, and CO in the Eastern Mediterranean Region (EMR) countries, 2) compare those with the updated World Health Organizations Air Quality Guidelines (WHO AQGs 2021), 3) estimate the potential health benefits of achieving annual PM2.5 NAAQS and WHO AQGs per country, and 4) gather the information on air quality policies and action plans in the EMR countries. Methods: To gather information on the NAAQS, we searched several bibliographic databases, hand-searched the relevant papers and reports, and analysed unpublished data on NAAQS in the EMR countries reported from these countries to the WHO/Regional office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE). To estimate the potential health benefits of reaching the NAAQS and AQG levels for PM2.5, we used the average of ambient PM2.5 exposures in the 22 EMR countries in 2019 from the Global Burden of Disease (GBD) dataset and AirQ+ software. Results: Almost all of the EMR countries have national ambient air quality standards for the critical air pollutants except Djibouti, Somalia, and Yemen. However, the current standards for PM2.5 are up to 10 times higher than the current health-based WHO AQGs. The standards for other considered pollutants exceed AQGs as well. We estimated that the reduction of annual mean PM2.5 exposure level to the AQG level (5 µg m-3) would be associated with a decrease of all natural-cause mortality in adults (age 30+) by 16.9%-42.1% in various EMR countries. All countries would even benefit from the achievement of the Interim Target-2 (25 µg m-3) for annual mean PM2.5: it would reduce all-cause mortality by 3%-37.5%. Less than half of the countries in the Region reported having policies relevant to air quality management, in particular addressing pollution related to sand and desert storms (SDS) such as enhancing the implementation of sustainable land management practices, taking measures to prevent and control the main factors of SDS, and developing early warning systems as tools to combat SDS. Few countries conduct studies on the health effects of air pollution or on a contribution of SDS to pollution levels. Information from air quality monitoring is available for 13 out of the 22 EMR countries. Conclusion: Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs and enhanced air quality monitoring are essential elements for reduction of air pollution and its health effects in the EMR.

Exposure to ambient gaseous air pollutants and adult lung function: a systematic review.

Exposure to hazardous air pollutants is identified as most obvious premature mortality factors in the world. Numerous epidemiological studies have estimated exposure to air pollutants may cause pulmonary toxicity and the incidence of respiratory diseases including chronic obstructive pulmonary disease (COPD), chronic bronchitis and asthma. The currently research was performed to evaluation the association between gaseous pollutants and lung function in healthy adults. Articles related to this study were selected from researches of Scopus, PubMed, and Web of Science databases. A total of 2,644 articles were retrieved and 39 records were reviewed after removing duplicates and excluding irrelevant studies. The result of this systematic review indicated that there is some evidence on decreasing lung function with exposure to gaseous air pollutants (NO2, SO2, and O3) which can have negative effects on human health. Although according to the evidence changes in lung function are mostly linked to the exposure to environmental pollutants including CO, O3, NO2 and SO2, the results should be interpreted with caution considering some following issues discussed in this review. Therefore, further studies are required considering well-designed studies in large scales to strengthen the evidence.

Effect of Early Bacillus Calmette-Guerin Vaccination of Pediatric Severe Combined Immunodeficiency Patients on the Outcome of Hematopoietic Stem Cell Transplantation Using a Reduced-Intensity Conditioning Regimen.

The eminence of Bacillus Calmette-Guerin (BCG) vaccine in newborn vaccination programs has been conspicuous throughout the years, especially in low-income developing countries where tuberculosis is prevalent; however, application of the BCG vaccine is not without constraints, especially in patients afflicted with immunodeficiency diseases, such as severe combined immunodeficiency (SCID). The present study aimed to evaluate whether the administration of BCG vaccine at birth could improve the outcomes of hematopoietic stem cell transplantation (HSCT) in pediatric patients with SCID. In this study, 30 SCID patients who underwent HSCT using a reduced-intensity conditioning regimen (RIC) were followed-up for 2 years post-HSCT. The outcomes of HSCT were evaluated in both non-BCG-vaccinated patients (n = 12) and BCG-vaccinated patients (n = 18). Our results show a higher incidence of acute graft-versus-host disease (aGVHD), but not of chronic GVHD, in the BCG-vaccinated patients, and a similar overall survival (OS) rate in the 2 groups. We speculate that the similar OS rate in the 2 groups, despite the risk of BGC vaccination, was because this group received an RIC conditioning regimen. There was no other difference between the 2 groups. Considering the effect of the BCG vaccine on HSCT outcome, we suggest that the administration of BCG vaccine be deferred until age 3 months so that APT testing without the interference of maternal antibodies can be performed. However, this study could benefit from a larger cohort to further validate our findings, as the possible reason for some factors not being statistically significant was our small sample size.

Increased allergic and asthmatic risks in children residing in industrial areas by surveying the pre-inflammatory (IgE, IL-4 and IL-13) biomarkers.

Toxic metal(loid)s can lead to high damages on human. This work was conducted to investigate the levels of metal(loid)s in PM2.5 and a total of 123 male children's (aged 6-9 years) blood chosen from different areas in Ahvaz and their association with the pre-inflammatory (Immunoglobulin E and cytokines: IgE, IL-4 and IL-13) responses in serum cells. Six metal(loid)s (arsenic, cadmium, chromium, mercury, nickel and lead) in three regions including industrial (Padad), vehicle traffic (Golestan) and reference (Kianpars) areas were studied. Results showed the concentrations of As, Cr, Cd, Ni and Hg in the ambient air of industrial area (Padad) (P < 0.001), and Pb in vehicle traffic area (Golestan) were higher (p < 0.001). Moreover, the mean levels of IgE (mean = 146.44 pg/200landa, P < 0.003), IL-4 (mean = 548.23 pg/200landa, P < 0.001) and IL-13 (mean = 53.21 pg/200landa, P < 0.001) in Padad were higher than Golestan and Kianpars. Our results suggest that living in industrial areas leads to accelerated synthesis of IgE, IL-4 and IL-13 in blood. The spatial distribution of children's serum IgE, IL-4 and IL-13 concentrations showed an abnormal increase of 240 to 400 pg/200landa for IgE, 950 to 1400 pg/200landa for IL-4 and 90 to 128 pg/200landa for IL-13. Our results indicate children in the industrial area are prone to asthma, allergy, miRNA mutation, and other chronic diseases.

Effect of portable air purifier on indoor air quality: reduced exposure to particulate matter and health risk assessment.

We sought to investigate the impact of air purifiers in the removal of particular matter (PM)10, PM2.5, PM1, and particle number concentration (PNC) in the indoor air of dormitories located at Iran's largest medical university, Tehran University of Medical Sciences. Twelve rooms were selected and randomly assigned to two rooms: sham air purifier system deployed room (SR) and true air purifier system deployed room (TR). All study samples were drawn simultaneously from assigned rooms using portable GRIMM dust monitors for 24 h. The PM monitors of air were positioned in the middle of each room next to the air purifier at the height of the breathing zone (1.5 m in height). The mean PM10, PM2.5, PM1, and PNC removal efficiency in rooms with and without a smoker were measured to be 40.7 vs 83.8%, 31.2 vs 78.4%, 29.9 vs 72.3%, and 44.3 vs 75.6%, respectively. The results showed that smoking is an important influencing factor on the indoor air quality; smoking lowered the removal efficiency of PM10, PM2.5, PM1, and PNC by 43%, 47%, 43%, and 31%, respectively. An air purifier could decline the PM10 and PM2.5 even lower than the WHO 24-h guideline level in non-smoker rooms. This study revealed that using household air purifiers in rooms with smokers and non-smokers significantly reduces the non-carcinogenic risks of exposure to PM10 and PM2.5.

Prenatal malaria exposure and risk of adverse birth outcomes: a prospective cohort study of pregnant women in the Northern Region of Ghana.

OBJECTIVE: Malaria remains endemic in most of sub-Saharan Africa and has a negative impact among pregnant women, resulting in morbidity and poor birth outcomes. The purpose of this study was to assess the relationship between malaria and adverse birth outcomes among prenatal women in the Northern Region of Ghana. DESIGN: This is a prospective cohort study of singleton pregnancies at 28 weeks of gestational age and above recruited between July 2018 and May 2019 from four public hospitals in the Northern Region of Ghana. OUTCOME MEASURES: Low birth weight (LBW), preterm birth and perinatal death. RESULTS: A total of 1323 pregnant women completed the study out of the 1626 recruited, with an average age of 27.3±5.2 years. The incidence of malaria in this population was 9.5% (95% CI 7.9 to 11.1). After adjusting for newborn admissions to the neonatal intensive care unit, parity, maternal age and glucose-6-phosphate dehydrogenase, women who were exposed to malaria during the third trimester of pregnancy had 2.02 times (95% CI 1.36 to 2.99) higher odds of premature delivery. Furthermore, they had 2.06 times (95% CI 1.09 to 3.93) higher chance of giving birth to babies with LBW, irrespective of their socioeconomic status. With an OR of 1.02 (95% CI 0.26 to 4.01), there was no difference in perinatal mortality between pregnant women with malaria and those without malaria after adjusting for caesarean section. CONCLUSION: This study confirms that prenatal malaria increases the odds of both preterm and LBW deliveries. A decisive policy to eradicate or minimise perinatal malaria is needed to contribute to the prevention of LBW and adverse pregnancy outcomes.

Health burden and economic loss attributable to ambient PM2.5 in Iran based on the ground and satellite data.

We estimated mortality and economic loss attributable to PM2·5 air pollution exposure in 429 counties of Iran in 2018. Ambient PM2.5-related deaths were estimated using the Global Exposure Mortality Model (GEMM). According to the ground-monitored and satellite-based PM2.5 data, the annual mean population-weighted PM2·5 concentrations for Iran were 30.1 and 38.6 µg m-3, respectively. We estimated that long-term exposure to ambient PM2.5 contributed to 49,303 (95% confidence interval (CI) 40,914-57,379) deaths in adults ≥ 25 yr. from all-natural causes based on ground monitored data and 58,873 (95% CI 49,024-68,287) deaths using satellite-based models for PM2.5. The crude death rate and the age-standardized death rate per 100,000 population for age group ≥ 25 year due to ground-monitored PM2.5 data versus satellite-based exposure estimates was 97 (95% CI 81-113) versus 116 (95% CI 97-135) and 125 (95% CI 104-145) versus 149 (95% CI 124-173), respectively. For ground-monitored and satellite-based PM2.5 data, the economic loss attributable to ambient PM2.5-total mortality was approximately 10,713 (95% CI 8890-12,467) and 12,792.1 (95% CI 10,652.0-14,837.6) million USD, equivalent to nearly 3.7% (95% CI 3.06-4.29) and 4.3% (95% CI 3.6-4.5.0) of the total gross domestic product in Iran in 2018.

Air pollution exposure and mammographic breast density in Tehran, Iran: a cross-sectional study.

BACKGROUND: Air pollution is one of the major public health challenges in many parts of the world possibly has an association with breast cancer. However, the mechanism is still unclear. This study aimed to find an association between exposure to six criteria ambient air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and mammographic breast density (MBD), as one of the strongest predictors for developing breast cancer, in women living in Tehran, Iran. METHODS: Participants were selected from women attending two university hospitals for screening mammography from 2019 to 2021. Breast density was rated by two expert radiologists. Individual exposures to 3-year ambient air pollution levels at the residence were estimated. RESULTS: The final analysis in 791 eligible women showed that low and high breast density was detected in 34.8 and 62.2 of participants, respectively. Logistic regression analysis after considering all possible confounding factors represented that an increase in each unit of NO2 (ppb) exposure was associated with an increased risk of breast density with an OR equal to 1.04 (95CI: 1.01 to 1.07). Furthermore, CO level was associated with a decreasing breast density (OR = 0.40, 95CI = 0.19 to 0.86). None of the other pollutants were associated with breast density. CONCLUSION: Higher MBD was associated with an increased level of NO2, as a marker of traffic-related air pollution. Furthermore, CO concentration was associated with a lower MBD, while other criteria air pollutants were not related to MBD. Further studies are needed to evaluate the association between ambient air pollutants with MBD.

Development and validation of an individual job performance questionnaire (IJPQ).

BACKGROUND: Developing reliable tools to tap into all the behavioral dimensions of individual job performance and identifying the right sub-dimensions is necessary for both research and practice. OBJECTIVE: This study aimed at developing and validating an IJPQ that addresses shortcomings of existing questionnaires. METHODS: After a comprehensive systematic literature review, a framework consisting of four dimensions, including task performance (TP), contextual performance (CP), counterproductive work behavior (CWB), and adaptive performance (AP) was structured for measuring IJP. As well, 45 sub-dimensions were identified for measuring IJP's dimensions. Content and face validity were evaluated, and item impact score (IS), content validity index (CVI), Kappa, and content validity ratio (CVR) were calculated. For reliability and confirmatory factor analysis (CFA), 525 workers completed the validated questionnaire and Cronbach alpha and goodness of fit indexes were determined, respectively. RESULTS: Of the 62 items generated to measure dimensions, 53 were approved. Based on item-level CVI, of the 53 items, only 45 items were accepted. Finally, the results of item level CVR led to the extraction of 27 questions to evaluate IJP. The obtained scale level CVI and scale level CVR were 0.91 and 0.68, respectively. Based on the results obtained from 525 Iranian workers, values of Cronbach's Alpha, X2/df, RMSEA, and P-value were in the acceptable range. CONCLUSIONS: Conclusively, a questionnaire containing 20 items was developed and validated for measuring IJP of Iranian worker's culture. The four dimensions of TP, CO, CWB, and AP consisted of 6, 5, 5, and 4 items each, respectively. Overall, IJPQ is a theory-based, reliable, and valid instrument for assessing job performance.

Evaluation of the relationship between psychological distress and sleep problems with annoyance caused by exposure to environmental noise in the adult population of Tehran Metropolitan City, Iran.

Purpose: The aim of this study was to investigate the association between the psychological distress and sleep problems with environmental noise annoyance in adult population. Methods: This is a cross-sectional study on 822 adult population of Tehran City in 2016. Integrated cluster stratified random sampling and Kish grid method were used. Noise annoyance, the day-night average sound level (Ldn), nighttime average sound level (Lnight), and daytime average sound level (Lday) were selected as noise exposure indicators. The prevalence of psychological distress and sleep problems were assessed using the Kessler Psychological Distress Scale (K10) and the PSQI questionnaire, respectively. Multiple logistic regression analysis was applied for data analysis. Results: Among the participants 46.03%% were exposed to a sound level higher than the daytime standard level (55 dB) and 84.6% were exposed to a level higher than the nighttime standard limit (45 dBA). According to the results, 49% of the subjects had poor sleep quality and 66% were highly sensitive to noise. In addition, 17.73% had a high risk of mental disorders and 16.48% were found to have a mild risk of mental disorders. There was found a statistically significant association between psychological distress and the noise annoyance at home (OR = 1.3 CI 95% (1.17-1.44)) and at work environment (OR = 1.18 CI 95% (1.08-1.28)). Conclusion: The findings indicated that the study population was highly sensitive to noise. In addition, the relatively high percentage of people who exposed to non-standard levels of sound indicates that this exposure has the potential to cause physical and mental consequences among them.

Effects of respirators to reduce fine particulate matter exposures on blood pressure and heart rate variability: A systematic review and meta-analysis.

Particulate-filtering respirators (PFRs) have been recommended as a practical personal-level intervention to protect individuals from the health effects of particulate matter exposure. However, the cardiovascular benefits of PFRs including improvements in key surrogate endpoints remain unclear. We performed a systematic review and meta-analysis of randomized studies (wearing versus not wearing PFRs) reporting the effects on blood pressure (BP) and heart rate variability (HRV). The search was performed on January 3, 2022 to identify published papers until this date. We queried three English databases, including PubMed, Web of Science Core Collection and Scopus. Of 527 articles identified, eight trials enrolling 312 participants (mean age ± standard deviation: 36 ± 19.8; 132 female) met our inclusion criteria for analyses. Study participants wore PFRs from 2 to 48 h during intervention periods. Wearing PFRs was associated with a non-significant pooled mean difference of -0.78 mmHg (95% confidence interval [CI]: -2.06, 0.50) and -0.49 mmHg (95%CI: -1.37, 0.38) in systolic and diastolic BP (SBP and DBP). There was a marginally significant reduction of mean arterial pressure (MAP) by nearly 1.1 mmHg (95%CI: -2.13, 0.01). The use of PFRs was associated with a significant increase of 38.92 ms2 (95%CI: 1.07, 76.77) in pooled mean high frequency (power in the high frequency band (0.15-0.4 Hz)) and a reduction in the low (power in the low frequency band (0.04-0.15Hz))-to-high frequency ratio [-0.14 (95%CI: -0.27, 0.00)]. Other HRV indices were not significantly changed. Our meta-analysis demonstrates modest or non-significant improvements in BP and many HRV parameters from wearing PFRs over brief periods. However, these findings are limited by the small number of trials as well as variations in experimental designs and durations. Given the mounting global public health threat posed by air pollution, larger-scale trials are warranted to elucidate more conclusively the potential health benefits of PFRs.

Burden of diseases attributed to traffic noise in the metropolis of Tehran in 2017.

Although road traffic noise is the most important source of environmental noise emission in large cities, little is known about health burden. The present study was conducted to estimate the burden of diseases attributed to traffic noise in the metropolis of Tehran in 2017. Using noise maps provided by the municipality of Tehran, we calculated population exposure distribution in term of Ldn and Lnight and the number of DALYs lost due to ischemic heart disease, hypertension, high sleep disturbance, annoyance and stroke endpoints based on the World Health Organization Environmental Noise Guidelines for the European Region. We applied published dose-response functions to estimate the traffic noise burden for high sleep disturbance and annoyance. We estimated 61,284 DALYs or 697 DALYs per 100,000 population attributed to traffic noise in Tehran for the reference year 2017. Highly sleep disturbance with a share of 58.74% of the DALYs was recognized as the most important contributor of disease burden, and noise annoyance with a share of 23.12% was ranked next. Ischemic heart disease (11.71%), stroke (5.12%), and hypertension (1.31%) were ranked third to fourth, respectively, in terms of the burden of disease caused by environmental noise. A considerable fraction of the population of Tehran lives in areas with an environmental noise higher than the standard level. The findings showed that traffic noise pollution is an important environmental risk factor in Tehran imposes the greatest burden on the community, mainly through highly sleep disturbance and noise annoyance endpoints.

Design and ergonomic assessment of a passive head/neck supporting exoskeleton for overhead work use.

Overhead work is an important risk factor associated with musculoskeletal disorders of the neck and shoulder region. This study aimed to propose and evaluate a passive head/neck supporting exoskeleton (HNSE) as a potential ergonomic intervention for overhead work applications. Fourteen male participants were asked to perform a simulated overhead task of fastening/unfastening nut in 4 randomized sessions, characterized by two variables: neck extension angle (40% and 80% of neck maximum range of motion) and exoskeleton condition (wearing and not wearing the HNSE). Using the HNSE, significantly alleviated perceived discomfort in the neck (p-value = 0.009), right shoulder (p-value = 0.05) and left shoulder (p-value = 0.02) and reduced electromyographic activity of the right (p-value = 0.005) and left (p-value = 0.01) sternocleidomastoid muscles. However, utilizing the exoskeleton caused a remarkable increase in right (p-value = 0.04) and left (p-value = 0.05) trapezius electromyographic activities. Performance was not significantly affected by the HNSE. Although the HNSE had promising effects with respect to discomfort and muscular activity in the static overhead task, future work is still needed to investigate its effect on performance and to provide support for the generalizability of study results.

Cardiovascular health effects of wearing a particulate-filtering respirator to reduce particulate matter exposure: a randomized crossover trial.

This randomized crossover trial sought to determine whether wearing a high-efficiency particulate-filtering respirator (PFR) improves cardiovascular function over 48 h among healthy college students in Tehran. This trial was conducted from February 14th to 23rd, 2019 and twenty-six participants completed two 48-h intervention periods. Brachial blood pressure (BP) measured by 24-h ambulatory monitoring was the primary health outcome. Secondary outcomes included 48-h heart rate variability (HRV) indices, high-sensitive cardiac troponin (hs-TnT) and other biomarkers. The participants wore the PFR between 10.2 and 11.1 h while awake during the interventions. More than 80% of participants reported increased respiratory resistance while wearing the PFR due to a lack of an exhalation valve. There were no significant differences in brachial BP levels between subjects who wore PFR respirator and those did not. Except for high frequency (HF) power and heart rate (HR), no significant differences between interventions were observed for other HRV metrics. Wearing the PFR led to an increase of 66.0 ms2 (95% confidence interval [CI], 9.6-110.5) and 79.6 ms2 (95% CI, 19.0-140.1) in HF power during the first day when the two groups of participants wore the PFR. Night-time HR was significantly increased during the PFR intervention period. Other secondary outcomes were not significantly different between interventions. It is plausible that incomplete exposure reduction due to wearing the PFR less than half of the time or increased respiratory resistance mitigated potential health benefits. Additional trials are warranted to validate the CV protection of wearing PFRs in heavily-polluted cities.

Skin biophysical assessments of four types of soaps by forearm in-use test.

BACKGROUND: While soaps are the most commonly used cleansing agents for human skin, they also damage the epidermal barrier and potentially increase the risk of disorders such as contact dermatitis. AIMS: This study set out to compare the potential skin irritancy of four types of soaps and their effects on the skin barrier function and biophysical parameters. METHODS: In a nonblinded comparative study, three types of soaps (alkaline, creamy, and glycerin soaps), and a syndet were applied to four different groups of 15 healthy subjects. Subjects washed their left forearm with the respective soap at home at least four times a day for seven days. Biophysical skin parameters, including transepidermal water loss (TEWL), erythema, friction, and pH, were measured at various time points using the Cutometer® MPA 580. RESULTS: After the first wash, a significant increase in TEWL was observed for all groups compared to the pre-intervention period. For the alkaline soap, a substantial increase in pH was observed at all time points compared to the baseline. Syndet, the only acidic soap in this study, showed a significant decrease in pH at the last time compared to all time points. The mean value of erythema was significantly higher in alkaline soap users than glycerin and creamy soap users. CONCLUSION: Our study showed that alkaline-based soaps could cause erythema and increase TEWL and skin pH due to their strong cleansing action, and the addition of compounds such as glycerin can modify these effects. A newer generation of soap containing a mild surfactant such as syndets causes less skin damage.

Assessment of burden of disease induced by exposure to heavy metals through drinking water at national and subnational levels in Iran, 2019.

The burden of disease attributable to exposure to heavy metals via drinking water in Iran (2019) was assessed at the national and regional levels. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease of heavy metals in drinking water were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), and nickel (Ni) in Iran were determined to be 2.3, 0.4, 12.1, 2.5, 0.7, and 19.7 µg/L, respectively, which were much lower than the standard values. The total average HQs of heavy metals in drinking water in the entire country, rural, and urban communities were 0.48, 0.65 and 0.45, respectively. At the national level, the average ILCRs of heavy metal in the entire country were in the following order: 1.06 × 10-4 for As, 5.89 × 10-5 for Cd, 2.05 × 10-5 for Cr, and 3.76 × 10-7 for Pb. The cancer cases, deaths, death rate (per 100,000 people), DALYs, and DALY rate (per 100,000 people) attributed to exposure to heavy metals in drinking water at the national level were estimated to be 213 (95% uncertainty interval: 180 to 254), 87 (73-104), 0.11 (0.09-0.13), 4642 (3793-5489), and 5.81 (4.75-6.87), respectively. The contributions of exposure to As, Cd, Cr, and Pb in the attributable burden of disease were 14.7%, 65.7%, 19.3%, and 0.2%, respectively. The regional distribution of the total attributable DALY rate for all heavy metals was as follows: Region 5> Region 4> Region 1> Region 3> Region 2. The investigation and improvement of relatively high exceedance of As levels in drinking water from the standard value, especially in Regions 5 and 3 as well as biomonitoring of heavy metals throughout the country were recommended.

Prevalence and Predictors of Pre-Existing Hypertension among Prenatal Women: A Cross-Sectional Study in Ghana.

BACKGROUND: We aimed to assess prevalence and predictors of pre-existing hypertension in pregnant women in three districts of Northern region, Ghana. METHODS: This cross-sectional study was conducted among 1626 women in the third trimester of pregnancy across four antenatal centers in 2018. A questionnaire was used to collect medical information including weight and height. We used descriptive statistics to characterize all qualitative variables and performed logistic regression analyses to estimate association of hypertension and other risk factors. RESULTS: We included 1626 women; mean age standard deviation (SD) of pregnant women was 27.4 (5.1) years. About 4.5% (95% confidence interval [CI]: 3.6-5.7) of pregnant women reported they had earlier been diagnosed of having hypertension by a doctor or midwife, before pregnancy. Obese pregnant women had 2.9 times increased adjusted odds of having hypertension relative to non-obese pregnant women (Odds Ratio (OR))=2.9, 95% [CI]: 1.39-5.85, P=0.004). Further, gestational diabetes was a predictor of pre-existing hypertension at an increased odds of 4.9 times relative to those without gestational diabetes (OR= 4.9, CI: 0.92-26.75, P=0.061). Women with two or more children had 3.2 times the adjusted odds of having hypertension (OR=3.2 CI: 1.59-6.69, P=0.001). CONCLUSION: Although the prevalence pre-existing hypertension was not too high, obesity, gestational diabetes and number of children were independent predictors of pre-existing hypertension in pregnant women.

Effect of ambient air PM2.5-bound heavy metals on blood metal(loid)s and children's asthma and allergy pro-inflammatory (IgE, IL-4 and IL-13) biomarkers.

BACKGROUND: We investigated the concentrations of metals in fine particulate matter PM2.5 in the outdoor air around the home sites of 123 male children from Ahvaz, average age 7.56, along with their blood samples to measure pro-inflammatory responses (Immunoglobulin E and cytokines: IgE, IL-4 and IL-13). METHODS: We measured 6 metals (As, Cd, Cr, Hg, Ni and Pb) in three Ahvaz's regions including industrial (Padad), vehicle traffic (Golestan) and control (Kianpars). RESULTS: The higher concentrations of metals in the Padad as the industrial ambient air i.e., arsenic, cadmium, chromium, mercury and nickel coincided with the higher concentrations of those metals in exposed children (P < 0.05) versus the controls. Children in Golestan, the high traffic air pollution area had the highest lead concentrations (p < 0.05). Also a significant association was shown in Padad between blood arsenic and IgE (ß = 26.59, P < 0.001), IL-4 (ß = 172.1, P < 0.001) and IL-13 (ß = 14.84, P < 0.001), blood chromium and IgE (ß = 10.38, P < 0.001), IL-4 (ß = 75.27, P < 0.001) and IL-13 (ß = 5.27, P < 0.001) and blood mercury and IgE (ß = 13.11, P < 0.001), IL-4 (ß = 108.09, P < 0.001) and IL-13 (ß = 7.96, P < 0.001) and blood lead and IgE(ß = 0.92, P = 0.025), IL-4(ß = 7.16, P < 0.001) and IL-13(ß = 0.58, P = 0.003). However, no significant relation was found for Cadmium, Nickel in blood with IgE, IL-4 and IL-13 levels. Moreover, children from industrial areas showed significantly higher concentrations of IgE (mean = 146.44 pg/200landa, P < 0.001), IL-4 (mean = 548.23 pg/200landa, P < 0.001) and IL-13 (mean = 52.93 pg/200landa, P < 0.001) versus Golestan and Kianpars. CONCLUSION: Children residing in an industrial area with high concentrations of metals in PM2.5 had high metals in blood and high production of IgE, IL-4 and IL-13, reflecting an immune dysregulation and brisk inflammatory responses.