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Exposure to toxic occupations and their association with Parkinson's disease: a systematic review with meta-analysis. 接触有毒职业及其与帕金森病的关系:一项荟萃分析的系统综述。
IF 3.9 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-03-28 DOI: 10.1515/reveh-2021-0111
Tamara Chambers-Richards, Yingying Su, Batholomew Chireh, Carl D'Arcy

Objectives: Earlier longitudinal reviews on environmental and occupational toxins and Parkinson's disease (PD) risk have limitations. This study aimed to determine the strength of association between three types of toxic occupational exposures and the occurrence of PD by diagnostic methods.

Methods: A search was conducted of EMBASE, PubMed/Medline, Toxnet, LILACS, and Cochrane Library databases for longitudinal studies that assessed toxic occupational exposure, Parkinsonian, or related disorders, diagnosed by International Classification of Diseases (ICD) codes, medical records, or confirmation by a neurologist/nurse, and published in the English language from January 1990 to July 2021. Pooled risk ratios (RR) estimates were produced using random-effects models. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. High-quality articles that met the inclusion criteria were analyzed.

Results: Twenty-four articles were used in the analyses. The pooled RR for electromagnetic exposure and PD were (RR=1.03, 95% confidence interval [CI] 0.91-1.16) while the pooled RR between PD and metal and pesticide exposure were (RR=1.07, 95% CI 0.92-1.24) and (RR=1.41, 95% CI 1.20-1.65), respectively. Pooled RR for methods of diagnosis and their associations with PD were: confirmation by a neurologist or nurse (RR=2.17, 95% CI 1.32-3.54); ICD codes (RR=1.14, 95% CI 1.03-1.26), and medical records (RR=1.06, 95% CI 0.92-1.21).

Conclusions: Our systematic review provides robust evidence that toxic occupational exposures are significant risk factors for PD especially those diagnosed by neurologists or nurses using standardized methods.

目的:早期关于环境和职业毒素与帕金森病(PD)风险的纵向综述有局限性。本研究旨在通过诊断方法确定三种有毒职业暴露与PD发生的关联强度。方法:对EMBASE、PubMed/Medline、Toxnet、LILACS和Cochrane图书馆数据库进行了纵向研究,这些研究评估了毒性职业暴露、帕金森病或相关疾病,这些研究由国际疾病分类(ICD)代码诊断、医疗记录或由神经科医生/护士确认,并于1990年1月至2021年7月以英语发表。综合风险比(RR)估计采用随机效应模型。系统回顾和荟萃分析综合了这些结果。对研究质量、异质性和发表偏倚进行了检查。对符合纳入标准的高质量文章进行分析。结果:共纳入24篇文献。电磁暴露与PD的合并RR为(RR=1.03, 95%可信区间[CI] 0.91 ~ 1.16), PD与金属和农药暴露的合并RR为(RR=1.07, 95% CI 0.92 ~ 1.24)和(RR=1.41, 95% CI 1.20 ~ 1.65)。诊断方法及其与PD相关性的合并RR为:由神经科医生或护士确认(RR=2.17, 95% CI 1.32-3.54);ICD代码(RR=1.14, 95% CI 1.03-1.26)和医疗记录(RR=1.06, 95% CI 0.92-1.21)。结论:我们的系统综述提供了强有力的证据,表明有毒职业暴露是PD的重要危险因素,特别是那些由神经科医生或护士使用标准化方法诊断的PD。
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引用次数: 6
Children's exposure to polycyclic aromatic hydrocarbon (PAHs): a review on urinary 1-hydroxypyrene and associated health effects. 儿童接触多环芳烃(PAHs):尿中1-羟基芘及其相关健康影响的研究进展
IF 3.9 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-03-28 DOI: 10.1515/reveh-2021-0013
Nur Hazirah Hisamuddin, Juliana Jalaludin

This article reviewed the published studies on the environmental exposure to polycyclic aromatic hydrocarbons (PAHs) among children and assessed the urinary 1-hydroxypyrene (1-OHP) level as a biomarker of exposure to PAHs. The current knowledge of the potential health effects of increased 1-OHP in children was reviewed. Additionally, the influence of genetic polymorphism on the urinary 1-OHP level was discussed in this review. The assembled data showed that children who are attending schools or living close to industrial and polluted urban areas might have greater exposure to higher concentrations of PAHs with a higher level of urinary 1-OHP when compared to those children living in rural areas. Urinary 1-OHP may be a reliable biomarker for determining the genotoxic effects, oxidative stress and inflammation caused by exposure to PAHs. Strong research evidence indicated that the total body burden of PAHs should be evaluated by biomonitoring of 1-OHP in line with other urinary PAHs metabolites (with 2-3 rings) to evaluate recent total exposure to PAHs. Overall, the study suggests implementing a mitigation plan to combat air pollution to provide a cleaner environment for children.

本文综述了儿童多环芳烃(PAHs)环境暴露的相关研究,并评价了尿中1-羟基芘(1-OHP)水平作为多环芳烃暴露的生物标志物。综述了目前对儿童1-OHP升高的潜在健康影响的认识。此外,本文还讨论了遗传多态性对尿1-OHP水平的影响。综合数据显示,与生活在农村地区的儿童相比,上学或生活在工业和污染城市地区附近的儿童可能接触到浓度较高的多环芳烃,尿液1-OHP水平也较高。尿1-OHP可能是确定暴露于多环芳烃引起的遗传毒性效应、氧化应激和炎症的可靠生物标志物。强有力的研究证据表明,应该通过生物监测1-OHP和其他尿液多环芳烃代谢物(2-3环)来评估多环芳烃的总体负荷,以评估最近的多环芳烃总暴露。总的来说,该研究建议实施一项缓解空气污染的计划,为儿童提供一个更清洁的环境。
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引用次数: 5
The radionuclides contamination in eggs as an environmental marker: a systematic review. 鸡蛋中放射性核素污染作为环境标志的系统综述。
IF 3.9 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-03-28 DOI: 10.1515/reveh-2021-0167
Parisa Sadighara, Afsaneh Mohajer, Ehsan Shamloo, Nader Akbari, Naiema Vakili Saatloo

Foods are contaminated with natural and man-made radionuclides. The aim of this systematic review was to determine the amount and type of radionuclides in eggs, as well as the biomarker capability of eggs. The research studies with keywords radionuclide, radioisotopes, contamination and egg were searched in PubMed, Scopus, and Science Direct databases, regardless of publication time. A number of 70 studies were obtained and only 13 articles were finally selected according to exclusion, inclusion criteria and quality assessment results. Studies which detected radionuclide in the hen eggs were selected. The highest frequency of radionuclides belonged to Ra-226 and Cs-137. The index of natural radionuclides is Ra-226 and the index of synthetic radionuclides is Cs-137. The local eggs, in addition to determining food contamination, can also be a good biomarker for identifying environmental contamination.

食物受到天然和人造放射性核素的污染。本系统综述的目的是确定鸡蛋中放射性核素的数量和类型,以及鸡蛋的生物标志物能力。在PubMed、Scopus和Science Direct数据库中检索以放射性核素、放射性同位素、污染和鸡蛋为关键词的研究,不考虑发表时间。根据排除标准、纳入标准和质量评价结果,共获得70篇研究,最终筛选出13篇。选择在鸡蛋中检测到放射性核素的研究。放射性核素的频率最高的是Ra-226和Cs-137。天然放射性核素的指数为Ra-226,合成放射性核素的指数为Cs-137。当地的鸡蛋,除了确定食物污染外,也可以作为识别环境污染的良好生物标志物。
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引用次数: 0
Frontmatter 头版头条
4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-03-01 DOI: 10.1515/reveh-2023-frontmatter1
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引用次数: 0
How does formal and informal industry contribute to lead exposure? A narrative review from Vietnam, Uruguay, and Malaysia. 正规和非正规工业如何导致铅暴露?来自越南、乌拉圭和马来西亚的叙述性综述。
IF 3 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-02-06 Print Date: 2024-06-25 DOI: 10.1515/reveh-2022-0224
Kritika Poudel, Atsuko Ikeda, Hisanori Fukunaga, Marie-Noel Brune Drisse, Lesley Jayne Onyon, Julia Gorman, Amalia Laborde, Reiko Kishi

Introduction: Lead industries are one of the major sources of environmental pollution and can affect human through different activities, including industrial processes, metal plating, mining, battery recycling, etc. Although different studies have documented the various sources of lead exposure, studies highlighting different types of industries as sources of environmental contamination are limited. Therefore, this narrative review aims to focus mainly on lead industries as significant sources of environmental and human contamination.

Content: Based on the keywords searched in bibliographic databases we found 44 relevant articles that provided information on lead present in soil, water, and blood or all components among participants living near high-risk areas. We presented three case scenarios to highlight how lead industries have affected the health of citizens in Vietnam, Uruguay, and Malaysia.

Summary and outlook: Factories conducting mining, e-waste processing, used lead-acid battery recycling, electronic repair, and toxic waste sites were the primary industries for lead exposure. Our study has shown lead exposure due to industrial activities in Vietnam, Uruguay, Malaysia and calls for attention to the gaps in strategic and epidemiologic efforts to understand sources of environmental exposure to lead fully. Developing strategies and guidelines to regulate industrial activities, finding alternatives to reduce lead toxicity and exposure, and empowering the public through various community awareness programs can play a crucial role in controlling exposure to lead.

导言:铅工业是环境污染的主要来源之一,可通过工业加工、金属电镀、采矿、电池回收等不同活动对人类造成影响。虽然不同的研究记录了铅暴露的各种来源,但强调不同类型工业是环境污染源的研究却很有限。因此,这篇叙述性综述旨在主要关注作为环境和人类污染重要来源的铅工业:根据在文献数据库中搜索的关键词,我们找到了 44 篇相关文章,这些文章提供了居住在高风险地区附近的参与者在土壤、水和血液中或所有成分中铅含量的信息。我们介绍了三个案例,以强调铅工业如何影响越南、乌拉圭和马来西亚公民的健康:进行采矿的工厂、电子废物处理、废旧铅酸电池回收、电子维修和有毒废物处理场是铅暴露的主要行业。我们的研究表明,越南、乌拉圭和马来西亚的铅暴露源于工业活动,并呼吁人们关注战略和流行病学工作中的差距,以充分了解环境中的铅暴露源。制定监管工业活动的战略和指导方针,寻找降低铅毒性和铅暴露的替代品,以及通过各种社区宣传计划增强公众的能力,在控制铅暴露方面可以发挥至关重要的作用。
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引用次数: 0
Mechanisms of cholera transmission via environment in India and Bangladesh: state of the science review. 印度和孟加拉国霍乱通过环境传播的机制:科学现状综述。
IF 3 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-01-16 Print Date: 2024-06-25 DOI: 10.1515/reveh-2022-0201
Debbie Shackleton, Fayyaz A Memon, Gordon Nichols, Revati Phalkey, Albert S Chen

Objectives: Cholera has a long history in India and Bangladesh, the region where six out of the past seven global pandemics have been seeded. The changing climate and growing population have led to global cholera cases remaining high despite a consistent improvement in the access to clean water and sanitation. We aim to provide a holistic overview of variables influencing environmental cholera transmission within the context of India and Bangladesh, with a focus on the mechanisms by which they act.

Content: We identified 56 relevant texts (Bangladesh n = 40, India n = 7, Other n = 5). The results of the review found that cholera transmission is associated with several socio-economic and environmental factors, each associated variable is suggested to have at least one mediating mechanism. Increases in ambient temperature and coastal sea surface temperature support cholera transmission via increases in plankton and a preference of Vibrio cholerae for warmer waters. Increased rainfall can potentially support or reduce transmission via several mechanisms.

Summary and outlook: Common issues in the literature are co-variance of seasonal factors, limited access to high quality cholera data, high research bias towards research in Dhaka and Matlab (Bangladesh). A specific and detailed understanding of the relationship between SST and cholera incidence remains unclear.

目的:霍乱在印度和孟加拉国有着悠久的历史,在过去的七次全球大流行中,有六次都发生在这一地区。不断变化的气候和不断增长的人口导致全球霍乱病例居高不下,尽管清洁水和卫生条件持续改善。我们旨在全面概述影响印度和孟加拉国环境霍乱传播的各种变量,重点关注这些变量的作用机制:我们确定了 56 篇相关文章(孟加拉国 40 篇,印度 7 篇,其他 5 篇)。综述结果发现,霍乱的传播与多个社会经济和环境因素有关,每个相关变量至少有一个中介机制。环境温度和沿海海面温度的升高会增加浮游生物的数量,霍乱弧菌也更喜欢温暖的水域,从而支持霍乱的传播。降雨量增加有可能通过多种机制支持或减少传播:文献中存在的共同问题是季节性因素的共变性、获取高质量霍乱数据的途径有限、对达卡和马特拉布(孟加拉国)研究的高度偏倚。对 SST 与霍乱发病率之间关系的具体和详细了解仍不清楚。
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引用次数: 0
Exposure to Polycyclic Aromatic Hydrocarbons and adverse reproductive outcomes in women: current status and future perspectives. 接触多环芳烃与妇女的不良生殖后果:现状与未来展望。
IF 3 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-01-02 Print Date: 2024-06-25 DOI: 10.1515/reveh-2022-0182
Ata Rafiee, Mohammad Hoseini, Sadaf Akbari, E Melinda Mahabee-Gittens

Objectives: Polycyclic Aromatic Hydrocarbons (PAHs) are ubiquitous, toxic environmental chemicals that can cause adverse reproductive health effects. The objectives of this mini-review are to highlight the adverse reproductive outcomes due to PAH exposure with the main focus on polycystic ovary syndrome (PCOS) and premature ovarian failure (POF) and to provide perspectives on future research needs.

Content: We reviewed studies that have reported the adverse reproductive outcomes associated with PAHs exposures in women through a comprehensive search of bibliographic databases and gray literature sources. In addition, potentially modifiable sources of exposure to PAHs and associated reproductive outcomes were also investigated.

Summary: A total of 232 papers were retrieved through a comprehensive search of bibliographic databases, out of which three studies met the eligibility criteria and were included in the review. Results showed that exposure to PAHs is associated with adverse reproductive outcomes defined as PCOS, POF, and reproductive hormone imbalance. Sources of PAH exposure associated with adverse reproductive outcomes include active and passive tobacco smoking, specific cooking methods, and pesticides.

Outlook: Future studies are warranted to examine the mechanisms by which PAHs result in adverse reproductive endpoints in women. Further, environmental exposures that are potentially modifiable such as exposure to tobacco smoke, may contribute to PAH exposure, and these exposures should be targeted in future policies and interventions.

目标:多环芳烃(PAHs)是一种无处不在的有毒环境化学物质,可对生殖健康造成不良影响。本微型综述旨在强调多环芳烃暴露导致的不良生殖后果,重点关注多囊卵巢综合症(PCOS)和卵巢早衰(POF),并对未来的研究需求提出展望:内容:通过对文献数据库和灰色文献来源的全面检索,我们对报道了与女性多环芳烃暴露相关的不良生殖后果的研究进行了回顾。此外,我们还调查了多环芳烃潜在的可改变暴露源及相关生殖结果。摘要:通过对文献数据库的全面检索,我们共检索到 232 篇论文,其中有三项研究符合资格标准并被纳入综述。结果显示,多环芳烃暴露与多囊卵巢综合症、宫外孕和生殖激素失衡等不良生殖结果有关。与不良生殖结果相关的多环芳烃暴露源包括主动和被动吸烟、特定烹饪方法和杀虫剂:未来有必要开展研究,探讨多环芳烃导致女性不良生殖结局的机制。此外,烟草烟雾等潜在可改变的环境暴露可能会导致多环芳烃暴露,未来的政策和干预措施应针对这些暴露。
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引用次数: 0
A systematic review on environmental perspectives of monkeypox virus. 关于猴痘病毒环境前景的系统综述。
IF 3 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2023-01-02 Print Date: 2024-06-25 DOI: 10.1515/reveh-2022-0221
Sara Hemati, Fazel Mohammadi-Moghadam

Monkeypox (MPX) is one of the common infections between humans and animals that caused by a virus belonging to the Orthopoxvirus genus. The Monkeypox virus (MPXV) outbreak is a global crisis triggered by environmental factors (virus, wastewater, surface, air) and amplified by the decisions of government officials and communities. The aim of this systematic review is to describe the environmental perspectives of MPXV with emphasis on risk assessment to prevent and control a new pandemic. Five online databases including Web of Science, PubMed, Scopus, Science Direct and Google Scholar were searched from 1990 to October 2022. Among 120 records, after the screening, four studies were included in the systematic review. The systematic review revealed that the possibility of MPXV transmission through wastewater, air, and the contaminated surfaces is a significant concern and its detection and destroying will play a major role in controlling the spread of the virus. Poxviruses have a high environmental stability, but are sensitive to all common chemical disinfectants. In conclusion, this study revealed that the environmental surveillance can be used as a complementary tool for detecting pathogens circulation in communities. This implies that the monitoring of environmental perspectives of MPXV can provide new awareness into virus transmission routes as well as the role of stakeholders and public health policies in MPXV risk management.

猴痘(MPX)是人与动物之间常见的传染病之一,由一种属于正痘病毒属的病毒引起。猴痘病毒(MPXV)的爆发是一场全球性危机,由环境因素(病毒、废水、地表、空气)引发,并因政府官员和社区的决策而扩大。本系统综述旨在从环境角度描述 MPXV,重点是风险评估,以预防和控制新的大流行病。我们检索了 1990 年至 2022 年 10 月期间的五个在线数据库,包括 Web of Science、PubMed、Scopus、Science Direct 和 Google Scholar。经过筛选,在 120 条记录中,有 4 项研究被纳入系统综述。系统综述显示,MPXV 通过废水、空气和受污染表面传播的可能性是一个值得关注的重大问题,其检测和消灭将在控制病毒传播方面发挥重要作用。痘病毒具有高度的环境稳定性,但对所有常见的化学消毒剂都很敏感。总之,这项研究表明,环境监测可作为检测社区病原体循环的补充工具。这意味着,从环境角度监测 MPXV 可使人们对病毒传播途径以及利益相关者和公共卫生政策在 MPXV 风险管理中的作用有新的认识。
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引用次数: 0
Review of the scientific evidence on the individual sensitivity to electromagnetic fields (EHS). 个人电磁场敏感性的科学证据综述。
IF 3.9 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2022-09-27 DOI: 10.1515/reveh-2021-0038
Dariusz Leszczynski

Part of the population considers themselves as sensitive to the man-made electromagnetic radiation (EMF) emitted by powerlines, electric wiring, electric home appliance and the wireless communication devices and networks. Sensitivity is characterized by a broad variety of non-specific symptoms that the sensitive people claim to experience when exposed to EMF. While the experienced symptoms are currently considered as a real life impairment, the factor causing these symptoms remains unclear. So far, scientists were unable to find causality link between symptoms experienced by sensitive persons and the exposures to EMF. However, as presented in this review, the executed to-date scientific studies, examining sensitivity to EMF, are of poor quality to find the link between EMF exposures and sensitivity symptoms of some people. It is logical to consider that the sensitivity to EMF exists but the scientific methodology used to find it is of insufficient quality. It is time to drop out psychology driven provocation studies that ask about feelings-based non-specific symptoms experienced by volunteers under EMF exposure. Such research approach produces only subjective and therefore highly unreliable data that is insufficient to prove, or to disprove, causality link between EHS and EMF. There is a need for a new direction in studying sensitivity to EMF. The basis for it is the notion of a commonly known phenomenon of individual sensitivity, where individuals' responses to EMF depend on the genetic and epigenetic properties of the individual. It is proposed here that new studies, combining provocation approach, where volunteers are exposed to EMF, and high-throughput technologies of transcriptomics and proteomics are used to generate objective data, detecting molecular level biochemical responses of human body to EMF.

部分市民认为自己对电力线、电线、家用电器及无线通讯装置及网络发出的人造电磁辐射敏感。敏感的特点是敏感的人声称在接触电磁场时会出现各种各样的非特异性症状。虽然所经历的症状目前被认为是一种现实生活障碍,但引起这些症状的因素仍不清楚。到目前为止,科学家们还无法找到敏感人群所经历的症状与接触电磁场之间的因果关系。然而,正如本综述所述,迄今为止进行的关于电磁场敏感性的科学研究质量较差,无法发现电磁场暴露与某些人的敏感性症状之间的联系。合乎逻辑地认为,对电磁场的敏感性是存在的,但用于发现它的科学方法质量不足。现在是时候放弃心理学驱动的挑衅研究了,这些研究询问志愿者在电磁场暴露下经历的基于感觉的非特异性症状。这种研究方法只产生主观的,因此高度不可靠的数据,不足以证明或反驳EHS与EMF之间的因果关系。电动势敏感性的研究需要一个新的方向。它的基础是一种众所周知的个体敏感性现象的概念,其中个体对电磁场的反应取决于个体的遗传和表观遗传特性。本文提出了新的研究,结合激发方法,志愿者暴露于电磁场中,并使用高通量转录组学和蛋白质组学技术来生成客观数据,检测人体对电磁场的分子水平生化反应。
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引用次数: 13
The effect of long-term exposure to toxic air pollutants on the increased risk of malignant brain tumors. 长期暴露于有毒空气污染物对恶性脑肿瘤风险增加的影响。
IF 3.9 4区 医学 Q2 ENVIRONMENTAL SCIENCES Pub Date : 2022-06-28 Print Date: 2023-09-26 DOI: 10.1515/reveh-2022-0033
Yousef Nikmanesh, Mohammad Javad Mohammadi, Homayon Yousefi, Sara Mansourimoghadam, Masoume Taherian

Toxic air pollutants are one of the most agent that have many acute, chronic and non-communicable diseases (NCDs) on human health under long or short-term exposure has been raised from the past to the present. The aim of this study was investigation effect of long-term exposure to toxic air pollutants on the increased risk of malignant brain tumors. Databases used to for searched were the PubMed, Web of Science, Springer and Science Direct (Scopus) and Google Scholar. 71 papers based on abstract and article text filtered. In the end after sieve we selected 7 papers. Identify all relevant studies published 1970-2022. The literature showed that exposure to toxic air pollutants and their respiration can cause disorders in different parts of the brain by transmission through the circulatory system and other mechanisms. Various unpleasant abnormalities are caused by the inhalation of toxic air pollutants in the human body that some of the most common of them include chronic lung disease, coronary heart disease and heart attacks, strokes and brain diseases (Parkinson's, Alzheimer's and multiple Sclerosis), cancers (liver, blood, prostate and brain) and eventually death. According to the finding brain health and proper functioning can be easily disrupted by various genetic or external factors such as air pollution, causing a wide range of abnormalities in the brain and malignant brain tumors. The results of this study showed that reducing the concentration of toxic pollutants in the air, that exposure to them play an increasing role in the development of brain diseases can slow down the process of abnormalities in the brain and will have significant impacts on reducing the number of people affected by them.

有毒空气污染物是许多急性、慢性和非传染性疾病(NCDs)在长期或短期暴露下对人类健康影响最大的病原体之一,从过去到现在都有人提出。本研究的目的是调查长期暴露于有毒空气污染物对恶性脑肿瘤风险增加的影响。过去搜索的数据库有PubMed、Web of Science、Springer and Science Direct(Scopus)和Google Scholar。71篇论文基于摘要和文章文本进行过滤。最后筛选出7篇论文。确定1970-2022年发表的所有相关研究。文献表明,暴露于有毒空气污染物及其呼吸会通过循环系统和其他机制传播,导致大脑不同部位的紊乱。人体吸入有毒空气污染物会导致各种令人不快的异常,其中最常见的包括慢性肺病、冠心病和心脏病发作、中风和脑部疾病(帕金森氏症、阿尔茨海默氏症和多发性硬化症)、癌症(肝、血、前列腺和大脑),最终导致死亡。根据研究结果,大脑健康和正常功能很容易被各种遗传或外部因素(如空气污染)破坏,导致大脑出现广泛异常和恶性脑肿瘤。这项研究的结果表明,降低空气中有毒污染物的浓度,使其在脑部疾病的发展中发挥越来越大的作用,可以减缓大脑异常的过程,并将对减少受其影响的人数产生重大影响。
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引用次数: 5
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