Biomonitoring of phthalate metabolites in the Canadian population through the Canadian Health Measures Survey (2007–2009)

Human exposure to phthalates occurs through multiple sources and pathways. In the Canadian Health Measures Survey 2007–2009, 11 phthalate metabolites, namely, MMP, MEP, MnBP, MBzP, MCHP, MCPP, MEHP, MEOHP, MEHHP, MnOP, and MiNP were measured in urine samples of 6–49 year old survey respondents (n = 3236). The phthalate metabolites biomonitoring data from this nationally-representative Canadian survey are presented here. The metabolites MEP, MnBP, MBzP, MCPP, MEHP, MEOHP and MEHHP were detected in >90% of Canadians while MMP, MCHP, MnOP and MiNP were detected in <20% of the Canadian population. Step-wise regression analyses were carried out to identify important predictors of volumetric concentrations (μg/L) of the metabolites in the general population. Individual multiple regression models with covariates age, sex, creatinine, fasting status, and the interaction terms age × creatinine, age × sex and fasting status × creatinine were constructed for MEP, MnBP, MBzP, MCPP, MEHP, MEOHP and MEHHP. The least square geometric mean (LSGM) estimates for volumetric concentration (μg/L) of the metabolites derived from respective regression models were used to assess the patterns in the metabolite concentrations among population sub-groups. The results indicate that children had significantly higher urinary concentrations of MnBP, MBzP, MEHP, MEHHP, MEOHP and MCPP than adolescents and adults. Moreover, MEP, MBzP, MnBP and MEOHP concentrations in females were significantly higher than in males. We observed that fasting status significantly affects the concentrations of MEHP, MEHHP, MEOHP, and MCPP metabolites analyzed in this study. Moreover, our results indicate that the sampling time could affect the DEHP metabolite concentrations in the general Canadian population.     

Do People Favor Artificial Intelligence Over Physicians? A Survey Among the General Population and Their View on Artificial Intelligence in Medicine

ObjectivesTo investigate the general population’s view on artificial intelligence (AI) in medicine with specific emphasis on 3 areas that have experienced major progress in AI research in the past few years, namely radiology, robotic surgery, and dermatology.MethodsFor this prospective study, the April 2020 Online Longitudinal Internet Studies for the Social Sciences Panel Wave was used. Of the 3117 Longitudinal Internet Studies For The Social Sciences panel members contacted, 2411 completed the full questionnaire (77.4% response rate), after combining data from earlier waves, the final sample size was 1909. A total of 3 scales focusing on trust in the implementation of AI in radiology, robotic surgery, and dermatology were used. Repeated-measures analysis of variance and multivariate analysis of variance was used for comparison.ResultsThe overall means show that respondents have slightly more trust in AI in dermatology than in radiology and surgery. The means show that higher educated males, employed or student, of Western background, and those not admitted to a hospital in the past 12 months have more trust in AI. The trust in AI in radiology, robotic surgery, and dermatology is positively associated with belief in the efficiency of AI and these specific domains were negatively associated with distrust and accountability in AI in general.ConclusionsThe general population is more distrustful of AI in medicine unlike the overall optimistic views posed in the media. The level of trust is dependent on what medical area is subject to scrutiny. Certain demographic characteristics and individuals with a generally positive view on AI and its efficiency are significantly associated with higher levels of trust in AI.     

Influence of changes in the Spanish labor market during the economic crisis (2007–2011) on perceived health

Purpose

We analyze the influence of the dramatic changes in the Spanish labor market during the crisis on the perceived health of the Spanish population.

Methods

We use the longitudinal Living Conditions Survey database and multilevel longitudinal logistic models between 2007 and 2011, before and during the economic crisis in one of the European countries most affected by its consequences.

Results

Unemployment (OR 1.75; p?<?0.001), job insecurity (OR 1.38; p?<?0.001), and being part of a household with severe material deprivation (OR 1.87; p?=?0.004) increase the risk of having worsened perceived health. Available income, on the other hand, is a protective factor (OR 0.72; p?<?0.001). Public expenditure policies have little impact on the perceived health. Labor market reforms reducing the degree of job insecurity and unemployment, together with income transfers to those at greater risk of social deprivation, can be more effective in improving the health of the population than the increase of aggregated social or health care expenditure.

Conclusions

This study provides evidence of the influence that unemployment, job insecurity, and poverty exert on the perceived health of individuals, with data collected in Spain after the onset of the financial crisis. In addition, after analyzing public social expenditure, only expenditure on FPS seems to influence self-reported health, although to a very limited degree.

     

Orthostatic Hypotension in the Elderly: A Marker of Clinical Frailty?

Background

Orthostatic hypotension (OH) has high prevalence in frail older adults. However, its effect on mortality, disability, and hospitalization in frail older adults is poorly investigated. Thus, we assessed the relationship between the prevalence of OH and its effect on mortality, disability, and hospitalization in noninstitutionalized older adults stratified by frailty degree.

A Troubled Past? Reassessing Ethics in the History of Tissue Culture

Recent books, articles and plays about the ‘immortal’ HeLa cell line have prompted renewed interest in the history of tissue culture methods that were first employed in 1907 and became common experimental tools during the twentieth century. Many of these sources claim tissue cultures like HeLa had a “troubled past” because medical researchers did not seek informed consent before using tissues in research, contravening a long held desire for self-determination on the part of patients and the public. In this article, I argue these claims are unfair and misleading. No professional guidelines required informed consent for tissue culture during the early and mid twentieth century, and popular sources expressed no concern at the widespread use of human tissues in research. When calls for informed consent did emerge in the 1970s and 1980s, moreover, they reflected specific political changes and often emanated from medical researchers themselves. I conclude by arguing that more balanced histories of tissue culture can make a decisive contribution to public debates today: by refuting a false dichotomy between science and its publics, and showing how ethical concepts such as informed consent arise from a historically specific engagement between professional and social groups.     

HIV Diagnoses and Prevalence in the Southern Region of the United States, 2007–2010

On a number of leading health indicators, including HIV disease, individuals in the southern states of the United States fare worse than those in other regions. We analyzed data on adults and adolescents diagnosed with HIV infection through December 2010, and reported to the Centers for Disease Control and Prevention (CDC) through June 2011 from 46 states with confidential name-based HIV reporting since January 2007 to describe the impact of HIV in the South. In 2010 46.0 % of all new diagnoses of HIV infection occurred in the South. Compared to other regions, a higher percentage of diagnoses in the South were among women (23.8 %), blacks/African Americans (57.2 %), and among those in the heterosexual contact category (15.0 % for males; 88.5 % for females). From 2007 to 2010 the estimated number and rate of diagnoses of HIV infection decreased significantly in the South overall (estimated annual percentage change [EAPC] = ?1.5 % [95 %CI ?2.3 %, ?0.7 %] and ?2.1 % [95 % CI ?4.0 %, ?0.2 %], respectively) and among most groups of women, but there was no change in the number or rate of diagnoses of HIV infection among men overall. Significant decreases in men 30–39 and 40–49 years of age were offset by increases in young men 13–19 and 20–29 years of age. A continued focus on this area of high HIV burden is needed to yield success in the fight against HIV disease.     

Prevalence and socio-demographic correlates of daily cigarette smoking in Poland: Results from the Global Adult Tobacco Survey (2009–2010)

Objectives

The aim of the study was to evaluate the prevalence and socio-demographic correlates of daily cigarette smoking among adults in Poland.

Materials and Methods

A nationally representative household study was implemented between 2009 and 2010 to explore smoking pattern among the population aged 15 years and older. The smoking status and socio-demographic data were determined based on the Global Adult Tobacco Survey (GATS) questionnaire. Out of the 14000 households selected for the survey, 7840 sampled persons completed the interviews, including 2162 respondents who declared daily smoking of cigarettes. Logistic regression models were applied to assess factors related to daily cigarette smoking.

Results

Over 33% of men and 21% of women (p < 0.01) reported tobacco smoking on a daily basis. The significantly higher risk of smoking on a daily basis was observed among the male and female 20–59 years of age compared to the 60 or older population (p < 0.05). For men and women with the lower educational (primary/vocational/secondary) level, the risk of smoking was significantly higher than for the subjects with university degree (p < 0.05). The unemployed men smoked daily significantly more frequently than the employed ones (OR = 1.8; 95% CI: 1.4–2.4). This association was not observed among women (p > 0.05). The residents of urban areas smoked significantly more frequently than people living in rural settings (p < 0.05).

Conclusions

Actions to tackle socio-economic inequalities in smoking need to be intensified. The antismoking efforts should be focused on the population of Poles at large and people with lower educational levels, unemployed men, and residents of large urban settings in particular. The tobacco control interventions should also address the population of women at reproductive age.

     

Epidemiologic Features of Kawasaki Disease in Japan: Results of the 2007–2008 Nationwide Survey

Background

The most recent epidemiologic features of Kawasaki disease (KD) are unknown.

Methods

The 20th nationwide survey of KD was conducted in 2009, and included patients treated for the disease in 2007 and 2008. Hospitals specializing in pediatrics, and hospitals with pediatric departments and 100 or more beds, were asked to report all patients with KD during the 2 survey years.

Results

From a total of 1540 departments and hospitals, 23 337 patients (11 581 in 2007 and 11 756 in 2008) were reported: 13 523 boys and 9814 girls. The annual incidence rates were 215.3 and 218.6 per 100 000 children aged 0–4 years in 2007 and 2008, respectively. These were the highest annual KD incidence rates ever recorded in Japan. The monthly number of patients peaked during the winter months; smaller increases were noted in the summer months. The age-specific incidence rate showed a monomodal distribution with a peak at age 9–11 months. The prevalences of both cardiac lesions during the acute phase of the disease and cardiac sequelae were higher among infants and older age groups.

Conclusions

The incidence rate and number of patients with KD in Japan continue to increase.Key words: mucocutaneous lymph node syndrome, incidence, cardiovascular diseases, immunoglobulin, intravenous, epidemiology     

Prevalence of cerebral palsy in The Netherlands (1977–1988)

Children with cerebral palsy (CP) and their families often make strong demands on diagnostic, therapeutic, technical and social facilities. Prevalence estimates are needed to improve treatment and services. As recent Dutch data are not available, the present study aimed to assess the population prevalence of CP in the Netherlands. A representative Dutch area with 1.2 million inhabitants of which 172,000 were born between 1977 and 1988 was studied. To ascertain the children with CP from these birth years, medical practices (such as rehabilitation centres, paediatric and child neurological departments) were consecutively asked to contact their (supposed) CP cases. Next, a parents' organisation and finally regional news media assisted in the ascertainment. In total, 170 supposed CP cases underwent an expert examination. Of these 170, 127 children proved to be definite CP-cases, yielding a crude average prevalence of 0.74 per 1000 inhabitants (95% CI: 0.61–0.87). Under-ascertainment was recognised and quantified. Accordingly, the population prevalence of CP over the birth year period 1977–1988 was calculated as 1.51 per 1000 inhabitants (average over the 12 birth years). The calculated CP prevalence rose significantly over time: from 0.77 (1977–1979) to 2.44 (1986–1988). This trend is in accordance with other studies.     

Ten-year trends in compliance with the current Spanish nutritional objectives in Balearic Islands adult population (2000–2010)

ObjectiveThe Balearic Islands, a well-known Spanish tourist destination for Europeans, is undergoing profound social events, which are reflected in the current food patterns of this population. The aim of this study was to assess 10-year trends (2000–2010) in compliance with the current Spanish nutritional objectives among the adult population of the Balearic Islands.MethodsTwo independent cross-sectional dietary surveys were carried out among the adult population (16–65 y) of the Balearic Islands in 2000 (n = 1200) and 2010 (n = 1350). Dietary habits were assessed by means of two non-consecutive 24-h diet recalls.ResultsThe proportion of adults complying with the nutritional objectives for consumption of dietary fiber, folate, saturated fatty acids, cholesterol, carbohydrate, and fruit has increased over the 10-y span. In 2009 and 2010, 25% of participants met the nutritional objectives for folate, calcium, monounsaturated fatty acid, cholesterol, and fruit. These results are not affected by age, occupational status, or birthplace.ConclusionsThe percentage of compliers with the Spanish nutritional objectives has increased for 6 to 11 items over the 10-y period. A reduction in saturated fatty acid and cholesterol intake, and an increase in dietary fiber, carbohydrate, fruit, vegetables, folate, and calcium intake should be recommended.     

The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001–2007

To evaluate the prevalence, trends, timing and duration of exposure to antiviral medications during pregnancy within a US cohort of pregnant women and to evaluate the proportion of deliveries with a viral infection diagnosis among women given antiviral medication during pregnancy. Live-born deliveries between 2001 and 2007, to women aged 15–45 years, were included from the Medication Exposure in Pregnancy Risk Evaluation Program, a collaborative research program between the U.S. Food and Drug Administration and eleven health plans. They were evaluated for prevalence, timing, duration, and temporal trends of exposure to antiviral medications during pregnancy. We also calculated the proportion of deliveries with a viral infection diagnosis among those exposed to antiviral medications. Among 664,297 live births, the overall prevalence of antiviral exposure during pregnancy was 4 % (n = 25,155). Between 2001 and 2007, antiviral medication exposure during pregnancy doubled from 2.5 to 5 %. The most commonly used antiviral medication was acyclovir, with 3 % of the deliveries being exposed and most of the exposure occurring after the 1st trimester. Most deliveries exposed to antiviral medications were exposed for less than 30 days (2 % of all live births). Forty percent of the women delivering an infant exposed to antiviral medications had a herpes diagnosis. Our findings highlight the increased prevalence of women delivering an infant exposed to antiviral medications over time. These findings support the need for large, well-designed studies to assess the safety and effectiveness of these medications during pregnancy.     

Anorexia Nervosa—What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011–2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.     

Factors associated with the blood and urinary selenium concentrations in the Canadian population: Results of the Canadian Health Measures Survey (2007–2011)

Objective

The objective of the present work is to assess the factors associated with whole blood and urinary selenium (Se) concentrations in Canadians aged 6–79 years old, and to interpret the data in the context of exposure guidance values.

Increased Prevalence of low High-density Lipoprotein Cholesterol (HDL-C) Levels in Korean Adults: Analysis of the Three Korean National Health and Nutrition Examination Surveys (KNHANES 1998–2005)

Objectives

High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for cardiovascular diseases that has shown a remarkable increase, but little is known about the prevalence of low HDL-C in Korea. This study aimed to evaluate changing trends of low HDL-C prevalence, and indicate other risk factors associated with low HDL-C.

Methods

We selected subjects aged ≥20 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 1998, 2001, and 2005 (n = 7962, 6436, and 6412). The mean level of HDL-C and the prevalence of low HDL-C was calculated, and cardiovascular risk factors associated with low HDL-C, as well as demographic, anthropometric, lifestyle, and nutrition factors, were assessed using the KNHANES 2005 data.

Results

Mean HDL-C levels in men and women between KNHANES 1998 and 2005 decreased significantly, from 48.1 to 42.3 and from 51.6 to 47.1 mg/dL, respectively (both p < 0.001). The decrease was slightly less for women compared with men for the same period, and women had higher HDL-C levels at all periods. Covariate-adjusted OR revealed that body mass index, waist circumference, and non-alcohol drinker in both men and women were associated with low HDL-C levels by KNHANES 2005, as were employed and light physical activity in men and low fat intake in women.

Conclusion

The prevalence of low HDL-C increased significantly from KNHANES 1998 to 2001 and 2005 (p < 0.001) in both men and women. body mass index, waist circumference, and non-alcohol drinker were identified as associated with low HDL-C in Korean adults.     

Prevalence of bovine cysticercosis in the state of S?o Paulo (Brazil)]

A retrospective study of Cysticercus bovis in cattle raised and slaughtered in the State of S. Paulo, Brazil, during the year of 1986, was undertaken on the basis of official records of the Brazilian Meat Inspection Service. The analysis of its special distribution was carried out in accordance with the political-administrative division adopted by the State Government, composed of 11 Administrative Regions (ARs) and one Metropolitan Region (MR), subdivided into 42 Governmental Regions (GRs), totaling 572 municipalities. The prevalence rates of each political-administrative unit were statistically compared using the "Z" test of two proportions. From records relating to 896,654 head, 48,957 cases of cysticercosis were detected, equivalent to a prevalence of 5.5% in the State. The prevalence results were obtained for 385 municipalities, in 42 GRs, 11 ARs and in the MR. Statistically significant prevalence values were observed in 97 municipalities, in 14 GRs and 4 ARs.     

Prevalence of Musculoskeletal Symptoms Among Agricultural Workers in the United States: An Analysis of the National Health Interview Survey, 2004–2008

Ergonomic risks from agricultural tasks can compromise musculoskeletal health of workers. This study estimated prevalence of musculoskeletal symptoms in a sample representing almost 2 million US agricultural industry workers. This study used National Health Interview Survey data from 2004 to 2008. Weighted prevalence was calculated by demographic and employment factors. Prevalence ratios were calculated using generalized linear models with the Poisson distribution assumption. Prevalence rates of low back and neck pain in the previous 3 months were 24.3% and 10.5%, respectively, among agricultural workers. Monthly prevalence of joint pain was 17.0% for hips/knees, 9.8% for shoulders, 9.5% for wrists/hands, 5.4% for elbows, and 4.7% for ankles/toes. Agricultural workers had a significantly higher prevalence of shoulder pain than all other industry workers (prevalence ratios [PR] = 1.28, 95% confidence interval [CI]: 1.02–1.61). This study provides detailed national estimates of musculoskeletal symptom prevalence to understand the burden and the need for intervention among agricultural workers.     

Mortality analyses in the updated French cohort of uranium miners (1946–2007)

Purpose

The objectives are to analyze mortality risks in the extended follow-up of the French uranium miners’ cohort and to examine their potential relation to occupational exposure to ionizing radiation (IR).

Methods

The total cohort includes 5,086 uranium miners employed in the CEA-COGEMA group and followed up from 1946 to 2007. Vital status, causes of death, and cumulative radon exposures were recorded. The post-55 subcohort includes 3,377 miners first employed after 1955, for whom long-lived radionuclides (LLR) and external gamma-ray exposure were also recorded. External mortality analyses were performed by computing standardized mortality ratios (SMR). Excess relative risks (ERRs) due to IR exposures were estimated from Poisson regression models.

Results

The miners included in the total cohort were followed up for 35.4 years and exposed to 36.6 working level months (WLM) on average. There was no evidence of a difference in overall mortality between miners and the general French male population. Miners had a statistically significant excess mortality rate from lung cancer (SMR = 1.34 [95 % CI 1.16–1.53]) and from kidney cancer (SMR = 1.60 [1.03–2.39]). Cumulative radon exposure was significantly associated with lung cancer risk (ERR/100 WLM = 0.71 [0.31–1.30]) and cerebrovascular risk (ERR/100 WLM = 0.41 [0.04–1.03]). In the post-55 subcohort, this excess mortality from lung cancer remained associated with exposure to radon, and also with exposure to LLR and external gamma rays.

Conclusions

The analyses in the extended follow-up strengthen the results previously observed among French uranium miners about their excess risk of mortality and its association with their occupational IR exposure.

     

Arsenic Exposure and Prevalence of the Varicella Zoster Virus in the United States: NHANES (2003–2004 and 2009–2010)

Background

Arsenic is an immunotoxicant. Clinical reports observe the reactivation of varicella zoster virus (VZV) in people who have recovered from arsenic poisoning and in patients with acute promyelocytic leukemia that have been treated with arsenic trioxide.

Objective

We evaluated the association between arsenic and the seroprevalence of VZV IgG antibody in a representative sample of the U.S. population.

Methods

We analyzed data from 3,348 participants of the National Health and Nutrition Examination Survey (NHANES) 2003–2004 and 2009–2010 pooled survey cycles. Participants were eligible if they were 6–49 years of age with information on both VZV IgG and urinary arsenic concentrations. We used two measures of total urinary arsenic (TUA): TUA1 was defined as the sum of arsenite, arsenate, monomethylarsonic acid, and dimethylarsinic acid, and TUA2 was defined as total urinary arsenic minus arsenobetaine and arsenocholine.

Results

The overall weighted seronegative prevalence of VZV was 2.2% for the pooled NHANES sample. The geometric means of TUA1 and TUA2 were 6.57 μg/L and 5.64 μg/L, respectively. After adjusting for age, sex, race, income, creatinine, and survey cycle, odds ratios for a negative VZV IgG result in association with 1-unit increases in natural log-transformed (ln)-TUA1 and ln-TUA2 were 1.87 (95% CI: 1.03, 3.44) and 1.40 (95% CI: 1.0, 1.97), respectively.

Conclusions

In this cross-sectional analysis, urinary arsenic was inversely associated with VZV IgG seroprevalence in the U.S. population. This finding is in accordance with clinical observations of zoster virus reactivation from high doses of arsenic. Additional studies are needed to confirm the association and evaluate causal mechanisms.

Citation

Cardenas A, Smit E, Houseman EA, Kerkvliet NI, Bethel JW, Kile ML. 2015. Arsenic exposure and prevalence of the varicella zoster virus in the United States: NHANES (2003–2004 and 2009–2010). Environ Health Perspect 123:590–596; http://dx.doi.org/10.1289/ehp.1408731     

A Review of Patient-Reported Outcome Labeling in the United States (2011–2015)

Background

A review of new drug approvals (NDAs) by the Food and Drug Administration (FDA) for 2006 to 2010 showed that 24.1% of new drugs had patient-reported outcome (PRO) labeling.