Mental health burden amongst inhabitants of an arsenic-affected area in Inner Mongolia, China

Inner Mongolia, China, is an area with high levels of arsenic. The adverse health effects resulting from chronic arsenic exposure include skin keratosis, vascular diseases and cancers. However, the effects of arsenic exposure on mental health have not received much attention. The purpose of this study was to examine the effects of arsenic poisoning on the mental health of the inhabitants of an arsenic-affected area. We performed a cross-sectional study at two villages in Hetao Plain, Inner Mongolia. The populations of both villages were similar in age, sex, lifestyle, socioeconomic conditions, and geographic location. One hundred and thirty four (93.7%) of the 143 inhabitants in the arsenic-affected village and 36 (76.6%) of the 47 inhabitants in the arsenic-free village participated in the study. Subjects with a 30-item version of General Health Questionnaire score of 9 or more were defined as having symptoms of distress. The multiple logistic analyses showed that the mental health of the subjects in the arsenic-affected village was worse than in those in the arsenic-free village (OR=2.5, 95% CI=1.1-6.0). The effect of arsenic on mental health in arsenic-affected areas deserves further investigation. The mental health burden in arsenic-affected areas should be considered in the wider context of public and community health.     

Levels of arsenic in drinking-water and cutaneous lesions in Inner Mongolia

The most common health effects from drinking-water containing dissolved arsenic are skin abnormalities and lesions that are typically diagnosed as keratosis and pigment disorder. It was previously reported that the prevalence of cutaneous lesions was about 44% in arsenic-affected villages. However, there has been little research on the relationship between levels of arsenic in drinking-water and cutaneous lesions in Inner Mongolia. One study examined the association between the prevalence of keratosis and levels of arsenic exposure and the relationship between pigment disorder and levels of arsenic exposure among villagers aged 18 years or older in the arsenic-affected village of Hetao Plain in Inner Mongolia, PR China. The study included 227 participants who were affected by cutaneous lesions and 221 participants who were not affected by cutaneous lesions diagnosed in 1996 and 1998. Well-water drunk by the participants was collected to analyze arsenic content. Adjusting for age, sex, and smoking, logistic regression was applied to calculate the risks that arsenic in drinking-water will lead to cutaneous lesions. The results from the logistic regression showed that, with the increase of arsenic concentration in water, the risk of pigment disorder also increased (odds ratio [OR]=5.25, 95% confidence interval [CI] 1.32-83.24 for 50-199 microg/L; OR=10.97, 95% CI 1.50-79.95 for 200-499 [microg/L; OR=10.00, 95% CI 1.39-71.77 for > or = 500 microg/L (p=0.000), but the association between risk of keratosis and levels of arsenic was not significant (p=0.346). The findings suggest that keratosis is an early feature of arsenic poisoning, and the development of pigment disorder depends on higher doses of arsenic intake rather than keratosis. Further studies are needed to confirm that cutaneous lesions and other adverse health effects occur at low levels of arsenic exposure.     

Arsenic in drinking water and peripheral nerve conduction velocity among residents of a chronically arsenic-affected area in Inner Mongolia

BACKGROUND: It remains unclear whether chronic ingestion of arsenic in drinking water affects the peripheral nervous system. We examined the effects of arsenic exposure on nerve conduction velocity using electromyography. METHODS: A cross-sectional study was conducted of a population living in an arsenic-affected village in Hetao Plain, Inner Mongolia, China. A total of 134 (93.7%) of 143 inhabitants took part in the study, and 36 (76.6%) of 47 inhabitants in a low-arsenic exposed village were recruited as a control group. Of the participants, 109 inhabitants in the arsenic-affected village and 32 in the low-arsenic exposed village aged > or =18 years were used for the analyses. An expert physician performed skin examinations, and median nerve conduction velocity was examined by electromyography. Arsenic levels in tube-well water and urine were measured. A mean level of arsenic in tube-well water in the arsenic-affected village was 158.3 microg/L, while that in the low-arsenic exposed village was 5.3 microg/L. RESULTS: No significant differences in the means of the motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) were observed in relation to arsenic levels in tube wells, urine, and the duration of tube-well use. Further, no differences in mean MCV or SCV were found between the subjects with and without arsenic dermatosis, with mean SCV of 52.8 m/s (SD 6.3) in those without and 54.6 m/s (5.2) in subjects with arsenic dermatosis (p=0.206). CONCLUSION: These findings suggest that chronic arsenic poisoning from drinking water is unlikely to affect nerve conduction velocity, at least within the range of arsenic in drinking water examined in the present study.     

Arsenic in drinking water and the prevalence of respiratory effects in West Bengal, India

BACKGROUND: A large population in West Bengal, India has been exposed to naturally occurring inorganic arsenic through their drinking water. A cross-sectional survey involving 7683 participants of all ages was conducted in an arsenic-affected region between April 1995 and March 1996. The main focus of the study was skin keratoses and pigmentation alterations, two characteristic signs of ingested inorganic arsenic. Strong exposure-response gradients were found for these skin lesions. The study also collected limited information concerning respiratory system signs and symptoms, which we report here because increasing evidence suggests that arsenic ingestion also causes pulmonary effects. METHODS: Participants were clinically examined and interviewed, and the arsenic content in their current primary drinking water source was measured. There were few smokers and analyses were confined to non-smokers (N = 6864 participants). RESULTS: Among both males and females, the prevalence of cough, shortness of breath, and chest sounds (crepitations and/or rhonchi) in the lungs rose with increasing arsenic concentrations in drinking water. These respiratory effects were most pronounced in individuals with high arsenic water concentrations who also had skin lesions. Prevalence odds ratio (POR) estimates were markedly increased for participants with arsenic-induced skin lesions who also had high levels of arsenic in their current drinking water source (> or = 500 microg/l) compared with individuals who had normal skin and were exposed to low levels of arsenic (<50 microg/l). In participants with skin lesions, the age-adjusted POR estimates for cough were 7.8 for females (95% CI : 3.1-19.5) and 5.0 for males (95% CI : 2.6-9.9); for chest sounds POR for females was 9.6 (95% CI : 4.0-22.9) and for males 6.9 (95% CI : 3.1-15.0). The POR for shortness of breath in females was 23.2 (95% CI : 5.8-92.8) and in males 3.7 (95% CI : 1.3-10.6). CONCLUSION: These results add to evidence that long-term ingestion of inorganic arsenic can cause respiratory effects.     

Chronic arsenic exposure and urinary 8-hydroxy-2'-deoxyguanosine in an arsenic-affected area in Inner Mongolia, China

OBJECTIVE: Recent studies have shown that generation of reactive oxidants during arsenic metabolism can play an important role in arsenic-induced injury. The purpose of this study was to examine the relationship between arsenic in drinking water and oxidative stress in humans by measuring 8-Hydroxy-2'-deoxyguanosine (8-OHdG). METHODS: We performed a cross-sectional study in an arsenic-affected village in Hetao Plain, Inner Mongolia, China. A total of 134 of the 143 inhabitants (93.7%) of the village participated in the study. The levels of 8-OHdG, arsenic and its metabolites were measured in urine collected from the participants. Regression analyses were performed to investigate the relationship between arsenic species and 8-OHdG levels in urine. RESULTS: In the polluted village, monomethylarsenic was significantly higher in subjects with arsenic dermatosis than those without dermatosis despite no difference in mean levels of arsenic in well water between both types of subject. For subjects with arsenic dermatosis, arsenic species and metabolites in urine are significantly associated with 8-OHdG, while there was no statistically significant relationship for subjects without arsenic dermatosis. For all residents of the polluted village, the levels of dimethylarsenic and 8-OHdG were significantly higher for those who had been exposed to well water for more than 12 years. CONCLUSIONS: These results provide evidence of a link between exposure to arsenic from drinking water and oxidative stress, which may play an important role in arsenic-involved injuries.     

中山市高尿酸血症的流行概况及其危险因素分析

目的 分析中山市高尿酸血症的流行情况以及其危险因素,并进一步探讨预测高尿酸血症发生的可能的指标因素。方法 于2016年在广东省中山市应用多阶段随机抽样的方法进行现况调查,实际抽取7 174名居民进行问卷调查、体格检查及实验室检测,并采用多因素logistic回归分析各影响因素。结果 中山市总体高尿酸血症患病率为31.91%。多因素logistic回归分析表明,男性(OR = 1.783, 95%CI :1.544～2.059)、偶尔饮酒(OR = 1.198, 95%CI :1.030～1.394)、经常饮酒(OR = 1.388, 95%CI:1.186～1.623)、患高胆固醇血症(OR = 1.267, 95%CI :1.054～1.521)、超重/肥胖(OR = 1.901, 95%CI :1.657～2.181)、患中心性肥胖(OR = 1.311, 95%CI :1.139～1.509)、血压高(OR = 1.321, 95%CI :1.170～1.491)、空腹TG含量≥1.7 mmol/L(OR = 2.016, 95%CI:1.772～2.295)、空腹HDL - C含量＜1.0mmol/L(OR = 1.439, 95%CI: 1.088 ～1.903)等是中山市常住居民患高尿酸血症的独立危险因素。结论 中山市成年居民高尿酸血症患病率已经达到较高水平,应对其危险因素进行干预,减少中山市高尿酸血症发生的风险。     

昆明市农村超重和肥胖患病率及影响因素分析

目的 分析昆明地区农村超重和肥胖患病现状及村庄与个体间的影响因素.方法 选择石林县作为农村的代表,采用PPS抽样方法对6006名45岁及以上村民通过问卷调查和体格检查获取所需资料;并应用多水平logistic模型分析影响超重和肥胖患病的村庄与个体因素.结果 该地区村民超重率为12.10%,其中男性13.60%,女性10.71%;村民肥胖率为2.15%,其中男性2.82%,女性1.52%;男性的超重率和肥胖率均高于女性.个体和村级因素均与肥胖有关,而超重仅与个体因素有关.在影响超重的因素中,随着年龄的增长患超重的可能性变小(OR=0.95,955% CI:0.83～0.97),男性比女性更容易患超重(OR=0.89,95% CI:0.78～0.98).在影响肥胖的因素中,随着年龄增长患肥胖的可能性变小(OR=0.93,95% CI:0.82～0.96),男性比女性更容易患肥胖(OR=0.87,95% CI:0.78～0.97),收入水平越低者和村庄整体收入水平越低者患肥胖的可能性越大(OR值分别为0.81和0.92;95% CI分别为0.73～0.95和0.85～0.98).结论 对肥胖的干预措施应同时考虑个体和村级水平,肥胖的预防和干预工作应放在村庄整体收入水平较低的村民.     

基于两水平Logistic回归分析模型分析我国成人尿石症影响因素

目的  探讨我国成人尿石症患病的影响因素。 方法  于2013年5月-2014年7月,采用多阶段分层整群随机抽样,在全国随机抽7个省/直辖市,14个区/县的11个社区和19个自然村进行面对面问卷调查,包括泌尿系超声检查、血常规、尿常规和血液生化检查等。 结果  有效问卷9 310例中,尿石症患者1 447例,患病率为15.5%(1 447/9 310);在14个地区之间的患病率有差异(χ²=711.523,P < 0.001),最低为山西农村(0.76%),最高为广东农村(35.99%)。零模型结果显示各地区尿石症患病有统计学聚集性(t=2.48,P=0.027),且组内相关系数ICC=48.74%。随机效应模型结果显示男性(OR=1.235,95%CI：1.082~1.411,P=0.005)、年龄增长(OR=1.101,95%CI：1.047~1.158,P=0.001)、糖尿病史(OR=1.411,95%CI：1.192~1.670,P=0.001)、结石家族史(OR=1.867,95%CI：1.500~2.323,P < 0.001)、低密度脂蛋白(low density lipoprotein,LDL)(OR=1.150,95%CI：1.050~1.260,P=0.006)、饮咖啡(OR=1.352,95%CI：1.065~1.716,P=0.017)、饮碳酸饮料(OR=1.547,95%CI：1.203~1.990,P=0.002)等为尿石症发生的危险因素,食醋酸(OR=0.567,95%CI：0.498~0.645,P < 0.001)和适量食用豆类(OR=0.726,95%CI：0.628~0.839,P < 0.001)等为尿石症发生的保护因素。 结论  尿石症患病具有地方聚集性,生活环境和饮食习惯影响尿石症的形成。     

农村居民空腹血糖受损及糖尿病患病调查

目的 调查吉林延边地区农村居民空腹血糖受损和糖尿病检出率及其相关因素。方法 对延边地区30～60岁常住居民5 335人进行现况调查。结果 朝鲜族和汉族空腹血糖受损(IFG)粗检出率分别为6.1%(159/2 600)和5.9%(161/2 735),其标化检出率分别为5.5%和5.5%;糖尿病(DM)粗患病率分别为7.2%(186/2 600)和5.7%(156/2 735),其标化患病率分别为6.1%和4.9%:不同性别、不同年龄IFG和DM检出率差异均有统计学意义;多因素分析显示,IFG患病与性别、饮酒、腹型肥胖(OR=1.329,95%CI=1.022～1.730)、高甘油三酯血症(OR=1.745,95%CI=1.333～2.283)、高胆固醇血症(OR=2.033,95%CI=1.497～2.761)和代谢综合征(OR=6.630,95%CI=5.106～8.608)密切相关(均P<0.05):DM患病与性别、年龄、文化程度、腹型肥胖(OR=1.855,95%CI=1.407～2.446)、高胆固醇血症(OR=1.864,95%CI=1.379～2.520)、高甘油三酯血症(OR=2.281,95%CI=1.737～2.996)和代谢综合征(OR=7.779,95%CI=5.937～10.191)密切相关(均P=0.000),其中年龄和文化程度对DM影响具有计量反应关系。结论 延边地区农村居民空腹血糖受损和糖尿病分别与性别、年龄(DM)、饮酒(IFG)、文化程度(DM)、腹型肥胖、高胆固醇血症、高甘油三酯血症和代谢综合征密切相关。     

Decrements in lung function related to arsenic in drinking water in West Bengal, India

During 1998-2000, the authors investigated relations between lung function, respiratory symptoms, and arsenic in drinking water among 287 study participants, including 132 with arsenic-caused skin lesions, in West Bengal, India. The source population involved 7,683 participants who had been surveyed for arsenic-related skin lesions in 1995-1996. Respiratory symptoms were increased among men with arsenic-caused skin lesions (versus those without lesions), particularly "shortness of breath at night" (odds ratio (OR) = 2.8, 95% confidence interval (CI): 1.1, 7.6) and "morning cough" (OR = 2.8, 95% CI: 1.2, 6.6) in smokers and "shortness of breath ever" (OR = 3.8, 95% CI: 0.7, 20.6) in nonsmokers. Among men with skin lesions, the average adjusted forced expiratory volume in 1 second (FEV1) was reduced by 256.2 ml (95% CI: 113.9, 398.4; p < 0.001) and the average adjusted forced vital capacity (FVC) was reduced by 287.8 ml (95% CI: 134.9, 440.8; p < 0.001). In men, a 100-microg/liter increase in arsenic level was associated with a 45.0-ml decrease (95% CI: 6.2, 83.9) in FEV1 (p = 0.02) and a 41.4-ml decrease (95% CI: -0.7, 83.5) in FVC (p = 0.054). Women had lower risks than men of developing skin lesions and showed little evidence of respiratory effects. In this study, consumption of arsenic-contaminated water was associated with respiratory symptoms and reduced lung function in men, especially among those with arsenic-related skin lesions.     

海南省中老年人肝功能异常状况及其影响因素分析

目的  了解海南省中老年人的肝功能异常检出情况,并探讨相关影响因素。方法  利用2020年“海南自然人群慢性病前瞻性队列研究”中的基线调查数据,选取海南省35~＜75岁的常住居民共5 826人作为研究对象,采用问卷调查和血生化检测中的肝功能指标：丙氨酸氨基转移酶(alanine aminotransferase, ALT),天冬氨酸氨基转移酶(aspartate aminotransferase, AST)及γ-谷氨酰转移酶(γ-glutamyltransferase, GGT)描述肝功能异常的检出率及分布特征。采用χ²检验和二元logistic回归分析模型对肝功能异常相关因素进行分析。结果  5 826名研究对象中肝功能异常检出率为22.6%(1 318/5 826)。性别、民族、年龄、地理位置、学历、职业、烟酒习惯、患有慢性病、服用药物、居住地及睡眠满意度与肝功能异常差异均有统计学意义(均P < 0.05)。多因素logistic回归分析模型显示男性(OR=5.239, 95% CI：4.189~6.552)、黎族(OR=3.510, 95% CI：2.233~5.517)、高龄(OR=1.015, 95% CI：1.006~1.024)、服用药物(OR=1.717, 95% CI：1.284~2.295)、农村居民(OR=1.931, 95% CI：1.570~2.375)、吸烟[偶尔吸烟比不吸烟(OR=1.503, 95% CI：1.210~1.866);经常吸烟比不吸烟(OR=1.606, 95% CI：1.330~1.940)]、饮酒[偶尔饮酒比不饮酒(OR=2.127, 95% CI：1.733~2.611);经常饮酒比不饮酒(OR=3.123, 95% CI：2.493~3.915)]是肝功能异常的主要危险因素。结论  海南省肝功能异常整体检出率较高,高龄、男性、黎族、服用药物、农村地区、吸烟和饮酒是肝功能异常的主要危险因素,建议加强海南省少数民族地区老年人的健康教育。     

Symptoms of Raynaud's phenomenon in an inner-city African-American community: prevalence and self-reported cardiovascular comorbidity.

The objective of this study was to determine the prevalence of symptoms and the morbidity associated with Raynaud's phenomenon (RP) among African Americans. A total of 2196 randomly selected residents of an inner-city community, in Baltimore, completed a health-assessment survey. Symptoms of RP consisted of cold sensitivity plus cold-induced white or blue digital color change. One third (n = 703) reported cold sensitivity and 14% (n = 308) reported digital color change; 84 residents with symptoms of RP were identified, yielding an overall prevalence rate of 3.8% (95% confidence interval [CI] 3.0-4.6). RP was associated with poor or fair health status (odds ratio [OR] = 1.82, CI 1.18-2.81), heart disease (OR = 2.32, CI 1.39-3.87), and stroke (OR = 2.20, CI 1.17-4.15), after adjustment for age, gender, and physician-diagnosed arthritis. The prevalence of symptoms of RP in this African-American community is comparable to published reports from other populations. These community-based data suggest that identification of RP among African Americans should raise consideration of possible comorbidity, particularly cardiovascular disease.     

Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders in Massage Practitioners

INTRODUCTION: Massage practitioners are at high risk for work-related musculoskeletal disorders (WMSDs). We investigated the prevalence and risk factors. METHODS: We randomly selected 161 visually impaired practitioners. Demographics, musculoskeletal symptoms, and working postures were analyzed with multivariate logistic regression. RESULTS: Results indicated that about 71.4% had at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%; shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%; and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3). Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95% CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate working-table height. CONCLUSION: WMSDs were prevalent among massage practitioners.     

Lung cancer and arsenic concentrations in drinking water in Chile

Cities in northern Chile had arsenic concentrations of 860 microg/liter in drinking water in the period 1958-1970. Concentrations have since been reduced to 40 microg/liter. We investigated the relation between lung cancer and arsenic in drinking water in northern Chile in a case-control study involving patients diagnosed with lung cancer between 1994 and 1996 and frequency-matched hospital controls. The study identified 152 lung cancer cases and 419 controls. Participants were interviewed regarding drinking water sources, cigarette smoking, and other variables. Logistic regression analysis revealed a clear trend in lung cancer odds ratios and 95% confidence intervals (CIs) with increasing concentration of arsenic in drinking water, as follows: 1, 1.6 (95% CI = 0.5-5.3), 3.9 (95% CI = 1.2-12.3), 5.2 (95% CI = 2.3-11.7), and 8.9 (95% CI = 4.0-19.6), for arsenic concentrations ranging from less than 10 microg/liter to a 65-year average concentration of 200-400 microg/liter. There was evidence of synergy between cigarette smoking and ingestion of arsenic in drinking water; the odds ratio for lung cancer was 32.0 (95% CI = 7.2-198.0) among smokers exposed to more than 200 microg/liter of arsenic in drinking water (lifetime average) compared with nonsmokers exposed to less than 50 microg/liter. This study provides strong evidence that ingestion of inorganic arsenic is associated with human lung cancer.     

辽宁省成年人糖尿病患病现况及其影响因素分析

目的 描述辽宁省成年人糖尿病患病情况并探索相关影响因素,为制定适合本省的防治策略提供科学依据。方法 采用多阶段分层随机整群抽样的方法,对辽宁省17 857名成年居民进行问卷调查及体格检查,应用Logistic回归模型对糖尿病患病的相关因素进行分析。结果 辽宁省成年人糖尿病患病率为13.00%,糖尿病知晓率为61.84%,治疗率为71.31%,控制率为35.16%。年龄（45~岁：OR=1.824,95%CI：1.526~2.181;≥60岁：OR=2.077,95%CI：1.730~2.492）、体质指数（body mass index,BMI）分级（超重：OR=1.213,95%CI：1.096~1.343;肥胖：OR=1.547,95%CI：1.338~1.787）、自报血脂异常（OR=2.686,95%CI：2.308~3.126）和患高血压（OR=1.807,95%CI：1.630~2.004）是糖尿病患病的危险因素,农村居民（OR=0.866,95%CI：0.788~0.952）、受教育程度较高（高中：OR=0.859,95%CI：0.756~0.975;大专及以上：OR=0.678,95%CI：0.576~0.798）、中等收入水平（OR=0.738,95%CI：0.585~0.931）及饮酒（OR=0.779,95%CI=0.682~0.890）是糖尿病患病的保护因素。结论 辽宁省成年人糖尿病患病率和知晓率较高,治疗率和控制率较低,应针对重点人群采取有效措施积极干预。     

社区居民代谢综合征膳食影响因素分析

目的 探讨社区居民代谢综合征患病情况及膳食相关影响因素,为疾病防治提供依据。方法 采用多级分层抽样方法,通过问卷调查、体格检查及实验室检查,对江苏省徐州市社区成人代谢综合征患病情况进行分析,并采用Logistic回归模型分析相关影响因素。结果 共调查徐州市社区居民2 947人,其中男性1 674人,女性1 273人,代谢综合征患病率为10.32%,随着年龄增长患病率呈上升趋势;患者既往高血压和糖尿病患病率分别为55.6%和20.7%;多因素Logistic回归分析表明,代谢综合征的危险因素为年龄>60岁(OR=1.280,95% CI=1.059~1.548)、男性(OR=1.769,95% CI=1.237~2.528)、每周饮用白酒>200 mL(OR=1.961,95% CI=1.288~2.985)、每月盐摄入>300 g(OR=1.990,95% CI=1.365~2.901)、有既往高血压史(OR=6.868,95% CI=5.056~9.328)和糖尿病史(OR=7.506,95% CI=4.665~12.079);保护因素为食用营养补充剂(OR=0.685,95% CI=0.476~0.986);多因素模型的预测概率为90.9%。结论 控制酒、盐的摄入量,适当食用营养补充剂对代谢综合征有一定预防作用。     

Geographical variation in antibiotic-resistant Escherichia coli isolates from stool, cow-dung and drinking water

Little information is available on relationships between the biophysical environment and antibiotic resistance. This study was conducted to investigate the antibiotic resistance pattern of Escherichia coli isolated from child stool samples, cow-dung and drinking water from the non-coastal (230 households) and coastal (187 households) regions of Odisha, India. Susceptibility testing of E. coli isolates (n = 696) to the following antibiotics: tetracycline, ampicillin/sulbactam, cefuroxime, cefotaxime, cefixime, cotrimoxazole, amikacin, ciprofloxacin, norfloxacin and nalidixic acid was performed by the disk diffusion method. Ciprofloxacin minimum inhibitory concentration (MIC) values were determined for ciprofloxacin-resistant isolates (n = 83). Resistance to at least one antibiotic was detected in 90% or more of the E. coli isolates. Ciprofloxacin MIC values ranged from 8 to 32 μg/mL. The odds ratio (OR) of resistance in E. coli isolates from children's stool (OR = 3.1, 95% CI 1.18-8.01), cow-dung (OR = 3.6, 95% CI 1.59-8.03, P = 0.002) and drinking water (OR = 3.8, 95% CI 1.00-14.44, P = 0.049) were higher in non-coastal compared to coastal region. Similarly, the co-resistance in cow-dung (OR = 2.5, 95% CI 1.39-4.37, P = 0.002) and drinking water (OR = 3.2, 95% CI 1.36-7.41, P = 0.008) as well as the multi-resistance in cow-dung (OR = 2.2, 95% CI 1.12-4.34, P = 0.022) and drinking water (OR = 2.7, 95% CI 1.06-7.07, P = 0.036) were also higher in the non-coastal compared to the coastal region.     

Nutritional factors and susceptibility to arsenic-caused skin lesions in West Bengal, India

There has been widespread speculation about whether nutritional deficiencies increase the susceptibility to arsenic health effects. This is the first study to investigate whether dietary micronutrient and macronutrient intake modulates the well-established human risk of arsenic-induced skin lesions, including alterations in skin pigmentation and keratoses. The study was conducted in West Bengal, India, which along with Bangladesh constitutes the largest population in the world exposed to arsenic from drinking water. In this case-control study design, cases were patients with arsenic-induced skin lesions and had < 500 microg/L arsenic in their drinking water. For each case, an age- and sex-matched control was selected from participants of a 1995-1996 cross-sectional survey, whose drinking water at that time also contained < 500 microg/L arsenic. Nutritional assessment was based on a 24-hr recall for major dietary constituents and a 1-week recall for less common constituents. Modest increases in risk were related to being in the lowest quintiles of intake of animal protein [odds ratio (OR) = 1.94; 95% confidence interval (CI), 1.05-3.59], calcium (OR = 1.89; 95% CI, 1.04-3.43), fiber (OR = 2.20; 95% CI, 1.15-4.21), and folate (OR = 1.67; 95% CI, 0.87-3.2). Conditional logistic regression suggested that the strongest associations were with low calcium, low animal protein, low folate, and low fiber intake. Nutrient intake was not related to arsenic exposure. We conclude that low intake of calcium, animal protein, folate, and fiber may increase susceptibility to arsenic-caused skin lesions. However, in light of the small magnitude of increased risks related to these dietary deficiencies, prevention should focus on reducing exposure to arsenic.     

Arsenic exposure from drinking water and risk of premalignant skin lesions in Bangladesh: baseline results from the Health Effects of Arsenic Longitudinal Study

Millions of persons around the world are exposed to low doses of arsenic through drinking water. However, estimates of health effects associated with low-dose arsenic exposure have been extrapolated from high-dose studies. In Bangladesh, many persons have been exposed to a wide range of doses of arsenic from drinking water over a significant period of time. The authors evaluated dose-response relations between arsenic exposure from drinking water and premalignant skin lesions by using baseline data on 11,746 participants recruited in 2000-2002 for the Health Effects of Arsenic Longitudinal Study in Araihazar, Bangladesh. Several measures of arsenic exposure were estimated for each participant based on well-water arsenic concentration and usage pattern of the wells and on urinary arsenic concentration. In different regression models, consistent dose-response effects were observed for all arsenic exposure measures. Compared with drinking water containing <8.1 microg/liter of arsenic, drinking water containing 8.1-40.0, 40.1-91.0, 91.1-175.0, and 175.1-864.0 microg/liter of arsenic was associated with adjusted prevalence odds ratios of skin lesions of 1.91 (95% confidence interval (CI): 1.26, 2.89), 3.03 (95% CI: 2.05, 4.50), 3.71 (95% CI: 2.53, 5.44), and 5.39 (95% CI: 3.69, 7.86), respectively. The effect seemed to be influenced by gender, age, and body mass index. These findings provide information that should be considered in future research and policy decisions.     

Arsenic exposure from drinking water, dietary intakes of B vitamins and folate, and risk of high blood pressure in Bangladesh: a population-based, cross-sectional study

The authors performed a cross-sectional analysis to evaluate the association between arsenic exposure from drinking water and blood pressure using baseline data of 10,910 participants in the Health Effects of Arsenic Longitudinal Study in Bangladesh (October 2000-May 2002). A time-weighted well arsenic concentration (TWA) based on current and past use of drinking wells was derived. Odds ratios for high pulse pressure (> or = 55 mmHg) by increasing TWA quintiles (< or = 8, 8.1-40.8, 40.9-91.0, 91.1-176.0, and 176.1-864.0 microg/liter) were 1.00 (referent), 1.39 (95% confidence interval (CI): 1.14, 1.71), 1.21 (95% CI: 0.99, 1.49), 1.19 (95% CI: 0.97, 1.45), and 1.19 (95% CI: 0.97, 1.46). Among participants with a lower than average dietary intake level of B vitamins and folate, the odds ratios for high pulse pressure by increasing TWA quintiles were 1.00 (referent), 1.84 (95% CI: 1.07, 3.16), 1.89 (95% CI: 1.11, 3.20), 1.83 (95% CI: 1.09, 3.07), and 1.89 (95% CI: 1.12, 3.20). The odds ratios for systolic hypertension suggest a similar but weaker association. No apparent associations were observed between TWA and general or diastolic hypertension. These findings indicate that the effect of low-level arsenic exposure on blood pressure is nonlinear and may be more pronounced in persons with lower intake of nutrients related to arsenic metabolism and cardiovascular health. Future research is needed to evaluate the effect of low-level arsenic exposure on specific cardiovascular outcomes.