Environmental Health and Preventive Medicine最新文献

Backgrounds: Associations between adverse childhood experiences (ACEs) and catastrophic health expenditures (CHEs) among middle-aged or older Chinese individuals remain inadequately documented. In addition, the role of chronic diseases is not entirely clear. This study used data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate the association of ACEs with hospital visits and medical expenditures and the mediating effect of chronic diseases.

Methods: Data were collected from CHARLS in 2014 and 2015 (N = 11,072). Zero-inflated negative binomial regression was used to assess associations of the ACEs with the number of outpatient visits and inpatient hospital days. Logistic regression was used to assess associations between the ACEs and CHEs. The influence of chronic diseases was examined through mediation analysis.

Results: The prevalence of each ACE indicator ranges from 0.27% (incarcerated household member) to 31.5% (emotional neglect). Our analysis revealed a significant dose-response relationship between cumulative ACE score and CHEs (P for trend < 0.001), but not for the number of outpatient visits and inpatient hospital days. The average causal mediation effects (ACME) and average direct effects (ADE) are presented. Chronic diseases served as a mediating factor between ACEs and CHE (ACME = 0.000904, P = 0.03; ADE = 0.00813, P < 0.001).

Conclusions: ACE has the capacity to predict CHE, and the findings of this study reinforce the potential pathway through which ACE may exert its influence on CHE via the burden of chronic diseases. Measures should be implemented to prevent ACEs and mitigate the risk of chronic diseases to lessen the economic burden on individuals and families as well as the adverse impact of national financial risk.

Background: Olfactory stimulation with hinoki cypress essential oil reportedly reduces stress hormones and enhances parasympathetic activity, which may in turn increase salivary secretion and facilitate swallowing. However, its effects on swallowing in older adults with dysphagia remain unclear.

Methods: In this placebo-controlled, single-blind, randomized crossover study, older adults with dysphagia (Food Intake Level Scale ≤9) underwent 5-minute olfactory stimulation with hinoki cypress essential oil or rice oil (placebo) in two sessions one week apart. Repetitive saliva swallowing test (RSST), 3 mL modified water swallowing test (MWST), 30 mL water swallowing test (WST), saliva secretion for 5 minutes, blood pressure, and heart rate were measured before and after each stimulation. Changes from pre- to post-stimulation were compared within each condition and between conditions using Wilcoxon's signed-rank test.

Results: Thirty-four participants (47% women; 80 ± 10 years) were included. Hinoki cypress essential oil significantly improved RSST (median difference 0.5, 95% CI 0.0-1.0; p = 0.004), MWST (0.5, 95% CI 0.0-1.0; p = 0.003), and saliva secretion (1.0 mL, 95% CI 0.5-2.0; p = 0.002), whereas placebo produced no significant change (all p > 0.05). Improvements in swallowing function were greater with hinoki than with placebo. The increase in saliva secretion following hinoki stimulation was not associated with changes in RSST or MWST scores.

Conclusions: Brief olfactory stimulation with hinoki cypress essential oil improved swallowing function and increased saliva secretion in older adults with dysphagia compared with placebo in a randomized crossover design. Hinoki cypress essential oil inhalation may represent a simple, noninvasive adjunctive strategy for dysphagia management, warranting confirmation in larger and longer trials.

Trial registration: This study was registered in the UMIN Clinical Trials Registry (UMIN-CTR) under registration number UMIN000053271.

Background: This letter highlights the importance of clinical epidemiology in COVID-19 prevention and control, based on experiences at a core hospital in northern Okinawa, Japan, and relevant literature.

Methods: Using data from 5,097 COVID-19 patients, we conducted: (1) a descriptive cross-sectional study analyzing cases by person, time, and place; (2) an analytical cross-sectional study linking health checkup data to identify factors associated with severity (published in Environmental Health and Preventive Medicine); and (3) a cohort study of healthcare workers exploring determinants of post-vaccination antibody titers (published in Journal of Clinical Virology Plus).

Results: The descriptive study showed cases rose from 70 in 2020 to 891 in 2021 and 3,995 in 2022, before declining to 141 in 2023. In the analytical cross-sectional study (n = 1,353), protective factors against severity included vaccination (odds ratio [OR] [2 doses vs. 0 or one doses]: 0.223, 95% confidence interval [CI] 0.114-0.436; OR [≥3 doses vs. 0 or one doses]: 0.090, 95% CI 0.035-0.229) and regular exercise (OR ["yes" vs. "no"]: 0.458, 95% CI 0.242-0.866). In the cohort study (n = 354), lower antibody titers (lowest quartile) were more likely among older adults (hazard ratio [HR] 5.82 for 40s vs. 20s, 95% CI 2.05-16.51; HR 9.96 for 60s vs. 20s, 95% CI 3.07-32.34) and drinking habits (HR 2.26 for "daily" vs. "never", 95% CI 1.17-4.34).

Conclusion: These findings, supported by related literature, demonstrate that clinical epidemiology played vital roles in monitoring infection trends, evaluating diagnostic and preventive measures, establishing treatment strategies, optimizing healthcare resources, and guiding policy. Its continued application will be essential for preparedness against future emerging infectious diseases.

Background: Optimizing nutrient intake is crucial for the health and development of preschool children. While previous studies assessed the risks and benefits of selenium (Se) from fish and seafood, few have examined its intake from common foods and its association with children's growth.

Objective: In this study, we evaluated optimal foods for achieving a dietary Se surplus and the implications for the growth performance of preschool children.

Methods: Mercury (Hg) and Se concentrations were analyzed in 108 commercially available foods to conduct a dietary risk-benefit assessment of Se intake. Hg exposure was evaluated using hair samples from 349 preschool children enrolled between August 2017 and July 2022. Information on food consumption frequencies and nutrient compositions was obtained through dietary surveys.

Results: Overall, 42.4% of children had hair Hg levels above the US Environmental Protection Agency's reference dose of 1 µg/g, showing that Hg exposure among preschool children in Taiwan remains a significant issue. The risk-benefit assessment revealed that eggs and fish are superior sources of Se compared to other animal- and plant-based foods. Although marine fish contained higher Hg concentrations than eggs, their relatively high Se and ω-3 polyunsaturated fatty acid (PUFA) contents supported a favorable nutritional profile when consumed in moderation. The minor negative health benefit value of Se (HBV_Se) observed for fruit does not pose a health concern, as it is offset by other Se-rich foods in the diet. The cumulative HBV_Se across food groups indicated that the children's overall dietary Se intake was positive and nutritionally advantageous. Dietary Se, mainly from fish and eggs, was positively associated with weight and height development, whereas excessive fruit consumption may slightly reduce Se intake and adversely affect growth.

Conclusions: Moderate consumption of fish and eggs should be encouraged to support optimal growth and neurodevelopment. Overall, dietary patterns of Taiwanese preschool children provide beneficial levels of Se and ω-3 fatty acids while maintaining low Hg-related risks, emphasizing the need for continued monitoring of Hg levels in locally consumed foods to ensure dietary safety.

Background: Mass gatherings during the peak summer months pose a notable risk for heat-related illnesses due to extreme heat and humidity. We aimed to identify trends in preventive measures taken against heat-related illnesses at mass gathering rock festivals in Japan during the summer of 2023, in terms of associations with online sources regarding the event details and heat risk communication; daily maximum wet bulb globe temperature (WBGT) values; and emergency heat-related illness transport data.

Methods: Four rock festivals (festivals A-D), held in July and August 2023, were analyzed. Publicly available online sources were reviewed to examine the event details, heat risk communication, and preventive measures. Daily maximum WBGT values were obtained from the meteorological observation points closest to each festival venue. Emergency heat-related illness transport data were assessed to identify trends during the rock festivals.

Results: Three festivals (festivals A, B, and D) recorded daily maximum WBGT values at or above the "Danger" threshold (≥31 °C), while festival C reached the "Severe Warning" level (≥28 °C and <31 °C). Despite the high WBGT, no heat advisories were issued on the websites of festivals A and B. Festival C gave a basic advisory on heat precautions. Festival D implemented more comprehensive countermeasures, including public warnings and recommendations to carry hats, towels, and portable fans. Notably, emergency transport for heat-related illnesses increased in the regions hosting festivals B and D.

Conclusions: All festivals posed substantial heat-related health risks. Enhanced public risk communication and consistent preventive measures are essential for mitigating preventable incidents during mass gatherings in extreme heat.

Background: Per- and polyfluoroalkyl substances (PFAS) have raised significant health concerns. In 2019, drinking water source was changed due to PFAS contamination in the Tama region, Tokyo, Japan. This study aims to determine the PFAS exposure levels after reduction in drinking water contamination, and to estimate the half-lives of linear isomers of perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorooctanoic acid (PFOA) in serum samples from residents.

Methods: 17 participants in 2020 and 2023 from Tama region, Tokyo, Japan (all females, age 53-83 years) were examined. PFAS concentrations in serum in 2023 were measured using gas chromatography-mass spectrometry. Biological half-lives were estimated using first-order kinetics model.

Results: The investigated population was exposed to six PFAS at levels associated with potential health risks, with 95% of them having total PFAS concentrations exceeding 20 ng/mL in 2023. Serum PFOS, PFHxS and PFOA levels decreased from 2000 to 2023 (p < 0.05 by paired t-test). The estimated half-lives for PFOS, PFHxS, and PFOA were 3.9 years (95% CI: 3.4-4.6), 5.7 years (95% CI: 4.6-7.5), and 8.0 years (95% CI: 6.0-10.0), respectively. After subtraction of background values in Japan, the estimated half-lives were 2.7 years (95% CI: 2.3-3.4) for PFOS, 5.6 years (95% CI: 4.5-7.4) for PFHxS, and 5.1 years (95% CI: 4.1-6.8) for PFOA.

Conclusions: This study demonstrates participants had still higher serum PFAS levels and these PFAS elimination half-lives in the investigated Japanese population are at years order.

Background: While advancements in cancer treatment have improved survival rates, some survivors continue to experience emotional difficulties that adversely affect overall well-being. Forest therapy, a nature-based intervention, has demonstrated potential in alleviating psychological and physiological stress.

Methods: This single-arm pre-post study evaluated a two-hour guided forest therapy session in a submontane forest in Taiwan. Participants were recruited via posters and online registration forms disseminated by the Linsen Chinese Medicine and Kunming Branch (LCMKB) of Taipei City Hospital and were screened for eligibility according to predefined inclusion and exclusion criteria. Outcomes included psychological measures-the Profile of Mood States 2nd Edition-Adult Short (POMS 2-A), Beck Depression Inventory-Second Edition (BDI-II), and Beck Anxiety Inventory (BAI)-along with physiological indicators (heart rate, blood pressure, heart rate variability, salivary cortisol).

Results: Of the 40 participants, 38 completed the program. Significant improvements were observed in mood disturbance (The Total Mood Disturbance of POMS 2-A: 4.0 → -8.0), anxiety (BAI: 5.0 → 3.5), depression (BDI-II: 5.5 → 4.0), and salivary cortisol levels (1.07 → 0.42 µg/dL), all with large effect sizes. Regression analyses suggested that baseline emotional status and certain demographic factors may have influenced outcomes. Participants with higher initial anxiety and depression, younger age, and shorter cancer duration appeared to show relatively greater improvements.

Conclusions: This first study of forest therapy among cancer survivors in Taiwan provides preliminary evidence that guided forest therapy may be a useful complementary approach for enhancing emotional well-being and reducing physiological stress. Significant improvements were observed across multiple psychological measures (POMS 2-A, BAI, BDI-II) and in salivary cortisol. Benefits were more pronounced among participants with higher baseline distress, younger age, or shorter cancer duration, underscoring the importance of considering baseline health profiles and demographic characteristics when designing interventions.

Trial registration: Approved by the Taipei City Hospital Research Ethics Committee (TCHIRB-11104010).

Clinicaltrials: gov Identifier: NCT06001723.

Background: This cohort study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the middle-aged and older Japanese women and examine the relationship of these derivative patterns with onset of metabolic syndrome (MetS).

Methods: A total of 794 women (mean age: 56.2 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA) and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify participant groups based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with the onset of MetS after adjusting for age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline.

Results: Four distinct groups were identified: Group A had low levels of the AA variable; group B accumulated a certain number or more steps primarily through MVAA; group C accumulated a certain number or more steps primarily through LIAA; and group D had high level of the AA variables. Over the course of the 5-year follow-up period, 61 participants (7.7%) developed MetS. The multivariate-adjusted odds ratio (95% confidence interval) for onset of MetS in groups B, C, and D relative to group A were 0.416 (0.166-1.218), 0.451 (0.223-0.914), and 0.933 (0.365-2.382), respectively. Group C had a significantly lower odds ratio of MetS onset than group A.

Conclusion: AA patterns accumulating a certain number or more steps, regardless of the intensity of AA, may help reduce the risk of MetS compared to inactive AA patterns.

Background: Ethylene oxide (EO) is a widely utilized industrial compound known to pose health hazards. Although its carcinogenic characteristics have been thoroughly investigated, recent findings indicate possible links to respiratory disease. The correlation between EO exposure and the likelihood of developing obstructive sleep apnea (OSA) in individuals remains unclear. The study aimed to explore the association between EO exposure and OSA within the broader US population.

Methods: From 2015 to 2020, 4355 participants were analyzed cross-sectionally in the National Health and Nutrition Examination Survey (NHANES). As the primary indicator of EO exposure, hemoglobin adducts of EO (HbEO) were used in this study. The relationship between EO exposure and OSA prevalence was assessed using weighted multivariable regression analysis and smoothing curve fitting. Using subgroup analysis and interaction tests, we investigated whether this association remained consistent across populations.

Results: According to the study, higher HbEO level was positively correlated with a higher prevalence of OSA. Compared to the first HbEO quartile (Q1), participants within the highest quartile (Q4) presented a higher OSA prevalence in the fully model (OR = 1.32, 95% CI: 1.08-1.62, P = 0.01, P for trend = 0.001). This correlation was particularly evident among females and individuals who are insufficiently physically active.

Conclusions: This research found a positive relationship between the extent of exposure to EO and OSA prevalence among a representative sample of Americans.