Ivy Shiue

Urinary environmental chemical concentrations and vitamin D are associated with vision, hearing, and balance disorders in the elderly.

BACKGROUND Acute exposure to environmental chemicals can result in loss of consciousness and upon recovery neurological symptoms, but little evidence exists in large epidemiological human studies. Hence, it was aimed to determine the relationships between urinary environmental chemicals (including heavy metals, environmental bisphenols, pesticides, arsenic, and phthalates) concentrations and vision, hearing, and balance disorders in a national population-based setting. METHODS United States National Health and Nutrition Examination Surveys is a national population-based multi-year cross-sectional study. Information on demographics and vision, hearing, and balance disorders was obtained by household interview using questionnaires in the 2003-2004 cohort (aged 50 and above). Urinary environmental chemicals were detected by mass spectrometry in selected but representative people. Analyses involved logistic regression models. RESULTS Urinary cadmium, molybdenum, and tungsten concentrations, which are commonly associated with heart disease, were associated with vision disorder. Urinary 2,4,5-trichlorophenol and arsenic acid concentrations and circulating mono-n-butyl phthalate, mono-benzyl phthalate, and mono-(3-carboxypropyl) phthalate metabolites were significantly associated with hearing disorder. Moreover, urinary barium and 4-tert-octyl-phenol concentrations were associated with balance disorder. People who had ears ringing, roaring, or buzzing in the past year tended to have higher urinary barium, 2,4-dichlorophenol, and mono-benzyl phthalate concentrations. DISCUSSION Significant correlations were observed in urinary environmental chemicals and neurobehavioural impairment for the first time. However, the causation cannot be established due to its cross-sectional study design. Future studies with a longitudinal aspect and/or in clinical trials are warranted to clearly understand the biological mechanism along the pathway before drawing a firm conclusion on these relationships.

Self and environmental exposures to drinking, smoking, gambling or video game addiction are associated with adult hypertension, heart and cerebrovascular diseases, allergy, self-rated health and happiness: Japanese General Social Survey, 2010

BACKGROUND It was aimed to study the relationships between addiction behaviors and human health and well-being in East Asians in a national and population-based setting. METHODS Data were retrieved from Japanese General Social Survey, 2010. Information on demographics, lifestyle factors, addiction behaviors and self-reported health conditions and well-being in Japanese adults was obtained by household interview. Analysis included chi-square test, logistic and multi-nominal regression modeling. RESULTS Of 5003 Japanese adults (aged 20-89) included in the study cohort, 13.8%, 14.7%, 4.8% and 5.5% were addicted to drinking, smoking, gambling and video games, respectively while 10.6%, 13.8%, 4.3% and 11.4% were exposed to co-residing family members drinking, smoking, gambling and video game addiction behaviors, respectively. People who reported addiction to drinking had poor self-rated health, hypertension and food allergy. People who reported addiction to smoking had fair to poor self-rated health, unhappiness, cerebrovascular disease and itchy skin. People who reported addiction to gambling had fair to poor self-rated health and unhappiness. People who reported addiction to video games had poor self-rated health and heart disease. People who were exposed to addiction to drinking, smoking, gambling and video games from co-residing family member(s) also reported hay fever, poor self-rated health and unhappiness. CONCLUSION Self and environmental exposures to drinking, smoking, gambling or video game addiction are associated with adult hypertension, heart and cerebrovascular diseases, allergy, self-rated health and happiness. Future public health programs continuing to minimize self and environmental exposures to addiction behaviors tackling health concerns would still be encouraged.

Duration of daily TV/screen watching with cardiovascular, respiratory, mental and psychiatric health: Scottish Health Survey, 2012-2013.

BACKGROUND The link of duration of TV and/or screen watching and chronic health conditions by subtypes is unclear. Therefore, the relationship between TV and/or screen watching hours and cardiovascular, respiratory, mental and psychiatric health and well-being (happiness) was assessed in an independent population-based survey to identify correlations of various hours with health conditions. METHODS Data was retrieved from the Scottish Health Survey, 2012-2013. Information on demographics, lifestyle factors, self-reported health conditions and TV and/or screen watching duration in both Scottish adults and children was collected by annual household interviews. Chi-square test and survey weighted logistic and multi-nominal modelling were performed. RESULTS 5527 (57.0%) Scottish adults aged 16-99 watched TV and/or screen daily for 3 + h on average. There was a trend toward more hypertension, angina, stroke, diabetes, chronic obstructive pulmonary disease and poor self-rated health and mental health. Reporting watching TV and/or screen for 4 + h, for 5 + h and for 8 + h was associated with higher rates of heart attack, heart murmur or other heart troubles and abnormal heart rhythms, respectively. 414 (20.7%) Scottish children aged 4-12 watched TV and/or screen for 3h or more. They tended to have poor self-rated health and life difficulties perceived as emotional and behavioural problems. CONCLUSION There were associations between various hours of TV and/or screen watching (3+h) and poor health observed both in Scottish adults and children. Future educational and public health programmes minimising TV and/or screen watching in order to protect cardiovascular, respiratory, mental and psychiatric health might be considered.

Physically equivalent temperature and mental and behavioural disorders in Germany in 2009–2011

Abstract Background: We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to common mental and behavioural disorders in a national setting in recent years. Methods: This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5 235 600) were extracted from Statistisches Bundesamt, Germany. We identified F01-F51 mental ad behavioural disorders by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations covering 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). We then plotted two-way fractional-polynomial regression. Results: For the most subtypes, the highest admissions were recorded in spring. There were small peaks in autumn or late winter for a few subtypes as well. Admissions of delirium peaked when PET was at 0 °C. Admissions of personality disorders peaked at the coldest – when PET was at − 10 °C. Admissions of schizophrenia and nonorganic sleep disorder peaked when PETs were between 0 and −10 °C while admissions of eating disorders dropped when PETs were above 10 °C. Admissions of depression and anxiety disorder did not vary much across PETs. Moreover, admissions of reaction to stress and dissociate disorder peaked when PETs were between 0 and 10 °C as well. Conclusions: More medical resources could have been needed for mental health on days when PETs were <10 °C than on other days.

Associated social factors of hypertension in adults and the very old: UK Understanding Society cohort, 2009–2010

Highbloodpressure (HBP) is themost important risk factorworldwide for the development of cardiovascular disease and beyond [1]. It has been known that inverse associations exist between cardiovascular risk factors and socioeconomic status, whether being measured by occupation, incomeor education. Back in the 1980s, itwas hypothesised that initiating factors for the pathogenesis of essential hypertension could be from social environment, such as weight gain and environmental stress [2,3]. Reductions in health and social inequalities could play an important role in impressive declines in cardiovascular disease-related incidence, biomarkers, and mortality [4]. Since social determinants of hypertension in adults and the very old people have received less attention and measures of them were not addressed comprehensively previously, we aimed to study the role of socioeconomic circumstances in hypertension for adults and the very old in a national, population-based setting. Datawere extracted and analysed in the UK Longitudinal Household Survey (Understanding Society, access available via: http://www.understandingsociety.org.uk/) Wave 1, 2009–2010, being a national, population-based, multi-year study among people above 16 years old. Study design and sampling method were described and published in detail in the working paper series [5]. Information on demographics, living and work conditions, and self-reported HBP (Has as doctor or health professional ever told you that you have any of the condition listed? What age were you when you were first told you had it?) was obtained by household interview. Study variables which aimed to describe potential social determinants of hypertension included age, sex, birthplace, body mass index, education, marital status, salary (proxy of occupation), and willingness to stay in the current neighbourhood (proxy of perception on neighbourhood satisfaction). Likert scale was used for assessing neighbourhood satisfaction [6]. In the subsequent analysis, we also examined regional variance. Analysis involved chi-square test, t-test, and logistic regression modelling. Adjustments weremade to control for covariates mentioned above and age of onset (binary: 0 = ex-hypertension, 1 = new onset hypertension) [6]. Effects were estimated by using odds ratios (OR) and 95% confidence intervals (CI), with p value b0.05 considered statistically significant. Statistical software STATA version 12.0 (STATA, College Station, Texas, USA) was used to perform all the analyses. Since it is a secondary data analysis in the present study, no further ethics approval is required. Of 50,994 people included in the cohort, 8706 (18.3%) had ever HBP and 508 (1.0%) people had their first hypertension (incident hypertension) at the agewhen theywere interviewed. Table 1 shows the demographic and social characteristics of the study cohort. In Table 2a, we have shown that female sex (OR 2.05, 95%CI 1.58–2.66, P b 0.001), born in the North Ireland (OR 0.39, 95%CI 0.20–0.77, P =0.01) and body mass index (OR 2.21, 95%CI 1.51–3.25, P b 0.001 for being overweight and OR 1.56, 95%CI 1.20–2.05, P = 0.001 for being obese) were significantly associated with hypertension in the very old aged 80 and above. In the middle-aged adults (aged 40–79), female sex (OR 0.84, 95%CI 0.75–0.95, P = 0.004), less education (OR 1.14, 95%CI 1.01–1.28, P = 0.04), body mass index (OR 2.26, 95%CI 1.73–2.95, P b 0.001 for underweight, OR 1.95, 95%CI 1.68–2.26, P b 0.001 for being overweight, and OR 3.41, 95%CI 2.92–3.99, P b 0.001 for being obese), and marital status (OR 1.24, 95%CI 1.03–1.48, P = 0.02 for married/registered

Urinary arsenic, pesticides, heavy metals, phthalates, polyaromatic hydrocarbons, and polyfluoroalkyl compounds are associated with sleep troubles in adults: USA NHANES, 2005–2006

Links between environmental chemicals and human health have emerged, but the effects on sleep health were less studied. Therefore, the aim of the present study was to investigate the relationships of different sets of environmental chemicals and common sleep troubles in a national and population-based setting. Data were retrieved from the United States National Health and Nutrition Examination Surveys, 2005–2006 including demographics, serum measurements, lifestyle factors, self-reported sleep troubles, and urinary environmental chemical concentrations. Statistical analyses including descriptive statistics, t-test, chi-square test, and survey-weighted logistic regression models were performed. Of all 5563 Americans aged 18–85, 2331 (42.0%) had wake-up at night, 2914 (52.5%) felt unrested during the day, 740 (13.4%) had leg jerks while sleeping, and 1059 (19.1%) had leg cramps for 2+ times a month. Higher levels of urinary arsenic, phthalates, and polyfluoroalkyl compounds were associated with wake-up at night. Higher levels of urinary 4-tert-octylphenol and polyfluoroalkyl compounds were associated with being unrested during the day. Higher levels of urinary arsenic, polyaromatic hydrocarbons, and polyfluoroalkyl compounds were associated with leg jerks while sleeping. Higher levels of urinary pesticides, heavy metals, phthalates, and polyaromatic hydrocarbons were associated with leg cramps while sleeping. However, there were no significant associations with other environmental chemicals such as parabens, bisphenol A, benzophenone-3, triclosan, perchlorate, nitrate, or thiocyanate. Eliminating arsenic, heavy metals, phthalate, pesticides, polyaromatic hydrocarbons, and polyfluoroalkyl compounds to improve sleep health might be considered while understanding the biological pathway with a longitudinal or experimental approach in future research would be suggested.

A pilot study of quality of life in German prehospital emergency care physicians

Background: Quality of life in patients represents an important area of assessment. However, attention to health professionals should be equally important. The literature on the quality of life (QOL) of emergency physicians is scarce. This pilot study investigated QOL in emergency physicians in Germany. Materials and Methods: We conducted a cross-sectional study from January to June in 2015. We approached the German Association of Emergency Medicine Physicians and two of the largest recruitment agencies for emergency physicians in Germany and invited their members to participate. We used the WHO Q-BREF to obtain QOL scores in four domains that included physical, mental, social, and environmental health. Results: The 478 German emergency physicians included in the study held board certifications in general medicine (n = 40; 8.4%), anesthesiology (n = 243; 50.8%), surgery (n = 63; 13.2%), internal medicine (n = 81; 17.0%), or others (n = 51; 10.7%). The women surveyed tended to report a better QOL but worse general health than the men. Regarding specific domains, women scored worse in physical health, particularly energy during everyday work (relative risk ratio [RRR]: 1.98 [1.21–3.24]). Both men and women scored worse in psychological health than general health, particularly young women. Women were also more likely to view their safety (RRR: 1.87 [1.07–3.28]) and living place (RRR: 2.51 [1.10–5.73]) as being poor than their male counterparts. Conclusion: QOL in German prehospital emergency care physicians is satisfactory for the included participants; however, there were some negative effects in the psychological health domain. This is particularly obvious in young female emergency physicians.

Geographic variations in prevalent cardiovascular disease subtypes: UK Understanding Society cohort, 2009-2010.

Sex Male 23,202 (45.5%) Female 27,792 (54.5%) Age (mean ± SD), years 45.6 ± 18.2 16–39 20,858 (40.9%) 40–59 17,396 (34.1%) 60–79 10,849 (21.3%) ≥8

Social correlates of clotting disorders in adults and the very old: UK Understanding Society cohort, 2009–2010.

Dear Editor, In spite of biological risk factors for coagulopathy [1], social correlates could also play a role. However, research in this area is rather scarce, and national population-based studies are limited. Therefore, it was aimed to understand social correlates of clotting disorders for adults and the very old in two compatible country-wide population-based studies in the UK (Scottish Health Survey and Health Survey for England in 2003). Study design and sampling method were described and published in detail elsewhere [2, 3]. Information on demographics, living and work conditions, and selfreported clotting disorders was obtained by household interview (Question: May I just check, do you have a clotting or clotting disorder or are currently on anticoagulant drugs such as Warfarin?). In the current analysis, only participants aged 16 and above were included. Analysis included logistic regression modeling. Adjustments were made to control for covariates mentioned above. Effects were estimated by using odds ratios (OR) and 95 % confidence intervals (CI) with P value <0.05 considered statistically significant. Statistical software STATA version 12.0 (STATA, College Station, TX, USA) was used to perform all the analyses. Since it is a secondary data analysis in the present study, no further ethics approval is required. In the year 2003, there were 316 (1.9 %) people who had ever clotting disorders. In Table 1a, unfortunately, social factor was not observed to be associated with clotting disorders among the very olds. In adults aged 16–79 (see Table 1b), however, it was shown that body mass index (BMI) ≥30 (OR 1.62, 95 % CI 1.09–2.39, P =0.02), being widowed (OR 2.28, 95 % CI 1.19–4.37, P =0.01), and not having regular exercise (OR 2.01, 95 % CI 1.41–2.88, P <0.001) were significantly associated with higher risk of clotting disorders. On the other hand, a protective effect from annual household income was noted. People whose annual household income was in the range of £18,200–52,000 (OR 0.52, 95 % CI 0.36–0.74, P < 0.001) or £52,000–99,999 (OR 0.42, 95 % CI 0.22–0.83, P = 0.01) had a lower risk of clotting disorders compared to those whose annual household income was in the range of £0–18, 200. In the present study, recent evidence on significant associated social factors for clotting disorders among adults and the very olds in Scotland and England was provided. Although it is not new to know that BMI and physical activity are related to risk of clotting disorders, additionally, it was observed that marital status also played a role in risk of clotting disorders in adults for the first time. To be specific, widowed people tended to be older and less physically active. Methodologically, this has revealed that in previous studies, marital status was not carefully examined and blinded by the advancing age and/or physical activity. After regrouping the study participants into adults aged 16–79 and the very old aged 80 and above, we have observed a significant effect of marital status on adults aged 16–79 in our study. From a public health perspective, intervention programs or supportive groups targeting helping relieve pains and grieves I. Shiue (*) School of the Built Environment, Heriot–Watt University, Riccarton, EH14 4AS Edinburgh, Scotland, UK e-mail: i.shiue@hw.ac.uk

Associated social factors of thyroid disorders in adults and the very old in the UK

Recently, it was observed that the incidence and prevalence of thyroid disease are higher than previously noted [1]. In addition to clinical pathology concerns [2, 3], social determinants of thyroid in adults and the very old have received little attention and measures of them were not addressed comprehensively. Socioeconomic indicates may imply different social mechanisms for social inequalities in the society, and understanding the role of social factors could further lead to the proper establishment of appropriate policy for reducing the impact on human health [4]. Therefore, in this context, it was aimed to study social determinants of thyroid disorders, including hypothyroidism and hyperthyroidism, in adults and the very old in a national and population-based setting.