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Huan Jing Ke Xue ; 41(1): 262-272, 2020 Jan 08.
Artigo em Chinês | MEDLINE | ID: mdl-31854927


Water is an important pathway for human exposure to heavy metals. Accurate assessment of the health risks that are related to exposure to heavy metals in drinking and household water are required for the preparation of targeted health risk prevention measures. This study explores and identifies the health risks related to exposure to heavy metals via drinking and household water pathways in Xigu District, Lanzhou, northwestern China, using household water samples and survey data obtained during July-September 2015 (wet season) and December 2015-January 2016 (dry season). During each period, drinking water and household water that were available for use by children aged 0-5 and 6-17 years were sampled and a questionnaire on water-related behavior patterns was completed for each household. Cd, Cr, Pb, and As concentrations were analyzed in all water samples, and were used along with water-related exposure factors from the questionnaires to estimate exposure doses and associated health risks using models recommended by the United States Environmental Protection Agency (US EPA). The results showed that the concentrations of Cd, Cr, Pb, and As in both drinking and household water samples did not exceed the relative thresholds defined in China's national water quality standards. The concentrations of heavy metals in household water were more affected by seasonal factors than of those of drinking water. The non-cancer and cancer risks were in the ranges of 2.82×10-8-2.43×10-2 and 7.55×10-9-3.62×10-5, respectively, which are within acceptable levels, although the non-cancer and cancer risks from drinking water were both higher than of those determined for household water. Furthermore, the non-cancer and cancer risks from household water for children aged 0-5 years were lower than of those for children aged 6-17 years in each period. However, the cancer risk from drinking water for children aged 0-5 years was lower than of that for children aged 6-17 years, whereas the reverse was found for non-cancer risks. This study indicates that Cd, Cr, Pb, and As in drinking and household water did not pose significant detrimental effects to human health, and that the refined exposure assessment used could reduce uncertainties in health risk assessments.

Água Potável/química , Monitoramento Ambiental , Metais Pesados/análise , Poluentes Químicos da Água/análise , Adolescente , Criança , Pré-Escolar , China , Humanos , Lactente , Recém-Nascido , Medição de Risco , Estações do Ano
Huan Jing Ke Xue ; 40(10): 4345-4354, 2019 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-31854801


Atmospheric particulate matter was collected during the heating period and the non-heating period of a typical steel industrial process in Northeast China to study the following:① the size-depended distribution and enrichment characteristics of polycyclic aromatic hydrocarbons (PAHs); ② the deposition concentrations of PAHs of different particle sizes in various organs of the human respiratory system; and 3 the risk from human respiratory exposure. The 14 priority PAHs in the samples were determined by high-performance liquid chromatography (HPLC), and respiratory exposure assessment was conducted by combining the atmospheric particle size fractionation sampling technique with an internal deposition model. The results showed that the PAH concentrations during the heating periods (743.9 ng·m-3) were higher than those during the non-heating periods (169.0 ng·m-3). Most PAH contributions (86.3%-89.9%) were related to fine particles with a diameter ≤ 2.06 µm; medium and low molecular weight PAHs showed two concentration peaks in 1.07-2.06 µm and 7.04-9.99 µm range, respectively. In contrast, high molecular weight PAHs showed a unimodal peak in 1.07-2.06 µm range. Four-ring PAHs accounted for 40% of the total PAHs concentrations. With respect to human exposure, 53.3% and 55.3% of the granular PAHs were deposited in the lungs during the heating and non-heating periods, respectively. The incremental lifetime cancer risk (R) of particulate PAHs in the population was calculated using the concentration in the human respiratory system and the total concentration associated with the particulate matter. The R values for adults ranged between 1.3×10-5 and 2.9×10-5 during the heating period, and between 3.1×10-6 and 6.0×10-6 during the non-heating period. The R values for children during the heating period ranged between 1.0×10-5 and 2.3×10-5, and between 2.4×10-6 and 4.8×10-6 during the non-heating period. The results indicated that particle size greatly affected the concentrations of particles deposited in the respiratory system and the level of carcinogenic risk. The combination of the grading sampling technique and the respiratory system settlement model can effectively avoid the over-evaluation of human respiratory exposure.

Cancer Res Treat ; 48(2): 753-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26511808


PURPOSE: In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives. MATERIALS AND METHODS: Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated. RESULTS: Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients' poor condition after late referral was the main barrier to missing EOL discussions; however, family members' concerns about patient's distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively. CONCLUSION: Our results suggested that the use of advance directive promote patient participation in EOL discussion.

Diretivas Antecipadas/psicologia , Participação do Paciente/psicologia , Assistência Terminal/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Adulto Jovem
J Palliat Med ; 18(3): 278-81, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25679915


BACKGROUND: Cough is a distressing symptom in advanced cancer. Opioids are used to relieve respiratory symptoms including dyspnea and cough. In addition to a central mechanism, opioids are thought to work peripherally via opioid receptors of the lung. Therefore, direct inhalation of morphine has been investigated in chronic lung disease or cancer. We report our experience of a nebulized form of morphine to control intractable cough in patients with advanced cancer. METHODS AND RESULTS: Case 1 is a 63-year-old female with terminal lung cancer complaining of a severe dry cough with dyspnea and sleeplessness. Case 2 is a 53-year-old female with thymic carcinoma with multiple lung metastases suffering from severe cough accompanying chest pain and dyspnea. With usual treatment, cough did not improve in these patients. We then administered a nebulized form of morphine: hydrochloro-morphine 5 mg mixed with 3 mL normal saline inhaled by mouth using a nebulizer. When the morphine dose was increased to 10 mg and 15 mg, the patients' cough was relieved to a symptom level of moderate and mild, respectively. Without experiencing any severe systemic side effects of opioids, the patients continued nebulized morphine until death or discharge. CONCLUSION: Nebulized morphine was effective in controlling intractable cough due to cancer and it was convenient and safe.

Analgésicos Opioides/administração & dosagem , Tosse/tratamento farmacológico , Tosse/etiologia , Neoplasias Pulmonares/complicações , Morfina/administração & dosagem , Neoplasias do Timo/complicações , Administração por Inalação , Feminino , Humanos , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Resultado do Tratamento
J Korean Med Sci ; 30(2): 151-4, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25653485


To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

Diretivas Antecipadas/estatística & dados numéricos , Hospitais para Doentes Terminais/estatística & dados numéricos , Neoplasias/mortalidade , Cuidados Paliativos , Assistência Terminal , Adolescente , Adulto , Diretivas Antecipadas/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , República da Coreia , Adulto Jovem