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Objective@#The Risk-Rescue Rating Scale (RRRS) is generally implemented to predict the lethality of suicide attempts, whereas the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scoring system is applied as an accurate measure of the severity of patient condition of patients admitted to intensive care units (ICUs). Using the RRRS and APACHE-II scores, in this study, we aimed to investigate the factors related to ICU admissions of deliberate self-poisoning (DSP) patients admitted to emergency departments (EDs). @*Methods@#The epidemiologic and psychologic factors, electronic medical records, and laboratory tests of DSP patients were prospectively collected and analyzed. We divided the patients into two groups, an ICU admission group and a nonICU admission group. @*Results@#This study included 387 patients, 333 (86.0%) of which were in the non-ICU group and 54 (14.0%) in the ICU admission group. Multivariate logistic analysis was conducted to independently associate the ICU admissions with RRRS (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.27-1.55; P<0.01), APACHE-II scores (OR, 1.11; 95% CI, 1.03- 1.21; P=0.01), and amylase values (OR, 1.01; 95% CI, 1.00-1.01; P=0.02). A receiver operating characteristics (ROC) curve analysis of the decision for admission to the ICU yielded the following scores for RRRS and APACHE II—cutoff values of 39.5 and 8.5, sensitivity of 96% and 66.0%, specificity of 74.0% and 75.1%, and area under the ROC curve (AUC) values of 0.95 and 0.74, respectively (P<0.01). @*Conclusion@#The RRRS and APACHE-II scores could be used to determine ICU admissions in DSP patients admitted to the ED.
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Background@#Chronic exposure to low-dose persistent organic pollutants (POPs) can induce mitochondrial dysfunction. This study evaluated the association between serum POP concentrations and oxygen consumption rate (OCR) as a marker of mitochondrial function in humans and in vitro cells. @*Methods@#Serum concentrations of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) were measured in 323 adults. The OCRs of platelets and peripheral blood mononuclear cells (PBMCs) were assessed in 20 mL of fresh blood using a Seahorse XF analyzer. Additionally, the in vitro effects of Arochlor-1254, β-hexachlorocyclohexane, and p,p´-dichlorodiphenyltrichloroethane at concentrations of 0.1 pM to 100 nM were evaluated in human platelets, human PBMCs, and Jurkat T-cells. @*Results@#The association between serum POP concentrations and OCR differed depending on the cell type. As serum OCP concentrations increased, basal platelet OCR levels decreased significantly; according to the OCP quintiles of summary measure, they were 8.6, 9.6, 8.2, 8.0, and 7.1 pmol/min/μg (P trend=0.005). Notably, the basal PBMC OCR levels decreased remarkably as the serum PCB concentration increased. PBMC OCR levels were 46.5, 34.3, 29.1, 16.5, and 13.1 pmol/min/μg according to the PCB quintiles of summary measure (P trend <0.001), and this inverse association was consistently observed in all subgroups stratified by age, sex, obesity, type 2 diabetes mellitus, and hypertension, respectively. In vitro experimental studies have also demonstrated that chronic exposure to low-dose POPs could decrease OCR levels. @*Conclusion@#The findings from human and in vitro studies suggest that chronic exposure to low-dose POPs can induce mitochondrial dysfunction by impairing oxidative phosphorylation.
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BACKGROUND: Lack of sunlight exposure is the primary reason for the worldwide epidemic of vitamin D deficiency. Although recommended sunlight exposure guidelines exist, there is no evidence regarding whether current guidelines are optimal for increasing vitamin D levels among individuals with vitamin D deficiency.METHODS: Sixty Korean adults aged 20–49 years with serum 25-hydroxyvitamin D (25[OH]D) levels of < 20 ng/mL were randomly assigned to three groups: sunlight exposure (n = 20), vitamin D supplementation groups (n = 20), and daily living (n = 20) for 1 month. The sunlight exposure group had sunlight exposure on 20% to 30% of their body surface areas for 30–60 minutes per day, 3 times a week during the summer season. Vitamin D supplementation was prescribed with 800 IU/day of vitamin D. The serum levels of 25(OH)D were measured at baseline and at 1-month follow-up examinations.RESULTS: The largest change in serum 25(OH)D was observed among the vitamin D supplementation group (+3.5 ng/mL, P < 0.001). The sunlight exposure group showed a slight increase in serum 25(OH)D level, but the absolute increase was less than one-third that of the vitamin D supplementation group (+0.9 ng/mL, P = 0.043). Only two participants in the sunlight exposure reached serum concentrations of 25(OH)D ≥ 20 ng/mL at follow-up. The daily living group showed no difference in vitamin D levels (−0.7 ng/mL, P = 0.516).CONCLUSION: Sunlight exposure was not sufficient to overcome vitamin D insufficiency or deficiency in the current study subjects. Effectiveness of current sunlight exposure guidelines among various populations should be reassessed in larger clinical studies.TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0002671
Subject(s)
Adult , Humans , Body Surface Area , Follow-Up Studies , Information Services , Seasons , Solar System , Sunlight , Vitamin D Deficiency , Vitamin D , VitaminsABSTRACT
Objectives@#This study was conducted to explore recent trends in the prevalence of pediatric elevated blood pressure and hypertension (HTN) in Korea and the United States, applying the new HTN reference values for adolescents. @*Methods@#This study analyzed 17 339 (8755 Korean and 8584 American) adolescents aged 10 to 17 who participated in the Korea National Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey, respectively, between 2005 and 2016. HTN was defined using percentile-based reference values for non-overweight adolescents from 7 nations, and obesity was defined by body mass index (BMI) based on country-specific growth charts. All analyses were stratified by sex and year-over-year changes were evaluated by calculating the p for trend. @*Results@#Systolic blood pressure showed a statistically meaningful upward trend in Korean boys and girls, while diastolic blood pressure did not show any significant changes. Both systolic and diastolic blood pressure levels declined among United States boys and girls. The prevalence of elevated blood pressure and HTN remained similar in Korean adolescents, but declined in both sexes among United States adolescents. BMI increased in both sexes among Korean adolescents, although the overweight and obesity rates stayed the same. No significant trends were found in any obesity indices among United States adolescents. The prevalence of elevated blood pressure and HTN by obesity level was higher among Korean adolescents than among their United States peers in both sexes, and the gap became higher at more severe levels of obesity. @*Conclusions@#Despite the strong correlation between obesity and HTN, recent trends in the prevalence of HTN and obesity among Korean and United States adolescents were strikingly different. Follow-up studies are necessary to determine why the prevalence of HTN was more than twice as high among Korean adolescents than among their United States counterparts.
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Background@#Low-dose persistent organic pollutants (POPs), especially organochlorine pesticides (OCPs), have emerged as a new risk factor of many chronic diseases. As serum concentrations of POPs in humans are mainly determined by both their release from adipose tissue to circulation and their elimination from circulation, management of these internal pathways may be important in controlling the serum concentrations of POPs. As habitual physical activity can increase the elimination of POPs from circulation, we evaluated whether chronic physical activity is related to low serum POP concentrations. @*Methods@#A cross-sectional study of 1,850 healthy adults (age ≥20 years) without cardio-metabolic diseases who participated in the U.S. National Health and Nutrition Examination Survey 1999 to 2004 was conducted. Information on moderate or vigorous leisure-time physical activity was obtained based on questionnaires. Serum concentrations of OCPs and polychlorinated biphenyls were investigated as typical POPs. @*Results@#Serum concentrations of OCPs among physically active subjects were significantly lower than those among physically inactive subjects (312.8 ng/g lipid vs. 538.0 ng/g lipid, P<0.001). This difference was maintained after adjustment for potential confounders. When analyses were restricted to physically active subjects, there were small decreases in the serum concentrations of OCPs with increasing duration of physical activity, showing a curvilinear relationship over the whole range of physical activity (Pquadratic <0.001). In analyses stratified by age, sex, body mass index, and smoking status, a strong inverse association was similarly observed among all subgroups. @*Conclusion@#Physical activity may assist in decreasing serum concentrations of lipophilic chemical mixtures such as OCPs.
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Background@#Seroprevalence studies of coronavirus disease 2019 (COVID-19) from many countries have shown that the number of undiagnosed missing cases is much larger than that of confirmed cases, irrespective of seroprevalence levels. Considering the strategy of Korea entailing massive testing and contact tracing from the beginning of epidemic, the number of undiagnosed missing cases in Korea may be negligible. This study was conducted to estimate the seroprevalence of COVID-19 among individuals who were never diagnosed with COVID-19 in Daegu, the epicenter of COVID-19 epidemic in Korea. @*Methods@#Serologic testing for immunoglobulin G antibody based on immunochromatographic assay was conducted in 103 patients and 95 guardians aged 18 to 82 years without any history of COVID-19 diagnosis, who visited outpatient clinics of a single university-affiliated hospital from May 25 to June 5, 2020. @*Results@#The estimated seroprevalence was 7.6% (95% confidence interval, 4.3%–12.2%) with 15 positive cases. Among them, only one had a polymerase chain reaction (PCR)-confirmed case among their close contacts and 13 did not experience COVID-19-related symptoms. Seroprevalence was similar between patients and guardians. Based on this figure, the number of undiagnosed missing cases in Daegu was estimated to be a dozen times more than the number of confirmed cases based on PCR testing. @*Conclusion@#Despite the limitation of a small and unrepresentative sample, this is the first study on seroprevalence of COVID-19 in Korea. Our study suggested that the number of undiagnosed missing cases was substantial even with the stringent strategy adopted in Korea, similar to that of other countries.
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BACKGROUND@#Lack of sunlight exposure is the primary reason for the worldwide epidemic of vitamin D deficiency. Although recommended sunlight exposure guidelines exist, there is no evidence regarding whether current guidelines are optimal for increasing vitamin D levels among individuals with vitamin D deficiency.@*METHODS@#Sixty Korean adults aged 20–49 years with serum 25-hydroxyvitamin D (25[OH]D) levels of < 20 ng/mL were randomly assigned to three groups: sunlight exposure (n = 20), vitamin D supplementation groups (n = 20), and daily living (n = 20) for 1 month. The sunlight exposure group had sunlight exposure on 20% to 30% of their body surface areas for 30–60 minutes per day, 3 times a week during the summer season. Vitamin D supplementation was prescribed with 800 IU/day of vitamin D. The serum levels of 25(OH)D were measured at baseline and at 1-month follow-up examinations.@*RESULTS@#The largest change in serum 25(OH)D was observed among the vitamin D supplementation group (+3.5 ng/mL, P < 0.001). The sunlight exposure group showed a slight increase in serum 25(OH)D level, but the absolute increase was less than one-third that of the vitamin D supplementation group (+0.9 ng/mL, P = 0.043). Only two participants in the sunlight exposure reached serum concentrations of 25(OH)D ≥ 20 ng/mL at follow-up. The daily living group showed no difference in vitamin D levels (−0.7 ng/mL, P = 0.516).@*CONCLUSION@#Sunlight exposure was not sufficient to overcome vitamin D insufficiency or deficiency in the current study subjects. Effectiveness of current sunlight exposure guidelines among various populations should be reassessed in larger clinical studies.TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0002671
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Objective@#Alcohol use is associated with high levels of morbidity and mortality. Alcohol problems are common in emergency departments (EDs). This study investigated the effect of screening and a new brief intervention (BI) protocol on alcohol consumption of ED patients. @*Methods@#The participants of this study were those aged 18 years or older who visited the ED due to injury over 12 weeks. BI was offered to patients with a score of 8 or higher on alcohol use disorders identification test (AUDIT) screening. Follow-up telephone assessments were conducted at one week, one month, and three months. @*Results@#The risk drinker (RD) group (AUDIT 8–15) comprised 101 patients, and the alcohol use disorder (AUD) group (AUDIT >16) comprised 41 patients. Before the BI, the weekly mean alcohol intake amount for the RD group was 180.90±98.34 g and for the AUD group was 358.00± 110.62 g. Alcohol consumption was reduced to 132.39±75.87 g in the RD group and 181.86± 78.11 g in the AUD group in the 3-month follow-up assessment. Alcohol consumption in the AUD group reduced significantly compared to the RD group (P<0.001). @*Conclusion@#Alcohol screening and BI contributed to alcohol intake reduction in ED patients. Specifically, the BI effect was greater in the AUD group than the RD group. The ED can be an effective place to begin implementing screening and intervention for alcohol use patients at risk.
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BACKGROUND@#Lack of sunlight exposure is the primary reason for the worldwide epidemic of vitamin D deficiency. Although recommended sunlight exposure guidelines exist, there is no evidence regarding whether current guidelines are optimal for increasing vitamin D levels among individuals with vitamin D deficiency.@*METHODS@#Sixty Korean adults aged 20–49 years with serum 25-hydroxyvitamin D (25[OH]D) levels of < 20 ng/mL were randomly assigned to three groups: sunlight exposure (n = 20), vitamin D supplementation groups (n = 20), and daily living (n = 20) for 1 month. The sunlight exposure group had sunlight exposure on 20% to 30% of their body surface areas for 30–60 minutes per day, 3 times a week during the summer season. Vitamin D supplementation was prescribed with 800 IU/day of vitamin D. The serum levels of 25(OH)D were measured at baseline and at 1-month follow-up examinations.@*RESULTS@#The largest change in serum 25(OH)D was observed among the vitamin D supplementation group (+3.5 ng/mL, P < 0.001). The sunlight exposure group showed a slight increase in serum 25(OH)D level, but the absolute increase was less than one-third that of the vitamin D supplementation group (+0.9 ng/mL, P = 0.043). Only two participants in the sunlight exposure reached serum concentrations of 25(OH)D ≥ 20 ng/mL at follow-up. The daily living group showed no difference in vitamin D levels (−0.7 ng/mL, P = 0.516).@*CONCLUSION@#Sunlight exposure was not sufficient to overcome vitamin D insufficiency or deficiency in the current study subjects. Effectiveness of current sunlight exposure guidelines among various populations should be reassessed in larger clinical studies.TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0002671
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Objective@#Alcohol use is associated with high levels of morbidity and mortality. Alcohol problems are common in emergency departments (EDs). This study investigated the effect of screening and a new brief intervention (BI) protocol on alcohol consumption of ED patients. @*Methods@#The participants of this study were those aged 18 years or older who visited the ED due to injury over 12 weeks. BI was offered to patients with a score of 8 or higher on alcohol use disorders identification test (AUDIT) screening. Follow-up telephone assessments were conducted at one week, one month, and three months. @*Results@#The risk drinker (RD) group (AUDIT 8–15) comprised 101 patients, and the alcohol use disorder (AUD) group (AUDIT >16) comprised 41 patients. Before the BI, the weekly mean alcohol intake amount for the RD group was 180.90±98.34 g and for the AUD group was 358.00± 110.62 g. Alcohol consumption was reduced to 132.39±75.87 g in the RD group and 181.86± 78.11 g in the AUD group in the 3-month follow-up assessment. Alcohol consumption in the AUD group reduced significantly compared to the RD group (P<0.001). @*Conclusion@#Alcohol screening and BI contributed to alcohol intake reduction in ED patients. Specifically, the BI effect was greater in the AUD group than the RD group. The ED can be an effective place to begin implementing screening and intervention for alcohol use patients at risk.
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Mitochondrial function is crucial for the maintenance of cellular homeostasis under physiological and stress conditions. Thus, chronic exposure to environmental chemicals that affect mitochondrial function can have harmful effects on humans. We argue that the concept of hormesis should be revisited to explain the non-linear responses to mitochondrial toxins at a low-dose range and develop practical methods to protect humans from the negative effects of mitochondrial toxins. Of the most concern to humans are lipophilic chemical mixtures and heavy metals, owing to their physical properties. Even though these chemicals tend to demonstrate no safe level in humans, a non-linear dose-response has been also observed. Stress response activation, i.e., hormesis, can explain this non-linearity. Recently, hormesis has reemerged as a unifying concept because diverse stressors can induce similar stress responses. Besides potentially harmful environmental chemicals, healthy lifestyle interventions such as exercise, calorie restriction (especially glucose), cognitive stimulation, and phytochemical intake also activate stress responses. This conceptual link can lead to the development of practical methods that counterbalance the harm of mitochondrial toxins. Unlike chemical hormesis with its safety issues, the activation of stress responses via lifestyle modification can be safely used to combat the negative effects of mitochondrial toxins.
Subject(s)
Humans , Dementia , Diabetes Mellitus, Type 2 , Environmental Exposure , Environmental Pollutants , Homeostasis , Hormesis , Life Style , Metals, Heavy , Mitochondria , Nonlinear Dynamics , Organic ChemicalsABSTRACT
OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.
Subject(s)
Adult , Humans , Alcohol-Related Disorders , Alcoholism , Drinking , Korea , Nutrition Surveys , ROC Curve , World Health OrganizationABSTRACT
BACKGROUND: Suicide is a significant public health problem worldwide. Suicide rates among elderly persons (≥ 65 years of age) are three times higher than those of younger people in Korea. The emergency department is an important entry of drug-related suicide attempt patients. In this study, we compared the frequency of drug types by age subgroup. Furthermore, we provide suggestions for preventing suicide attempts in the elderly. METHODS: We investigated 433 patients who were admitted to the emergency department for drug-related suicide attempts between 1 May 2015 and 30 April 2017. RESULTS: The proportion of patients who overdosed on antidepressants was 32.5% in the non-elderly age group and 8.0% in the elderly group (≥ 65 years of age) (P < 0.001). Among the elderly, the most commonly ingested agent was hypnotics (59.1%) (P < 0.001). Compared with the non-elderly, the results showed that the elderly used fewer antidepressants (P < 0.001) and analgesics (P < 0.001). Meanwhile, the elderly used more hypnotics (P < 0.001). Over-the-counter drugs and other medications showed similar usage trends in both age groups (P = 0.664, P = 0.193). CONCLUSION: The categories of drugs ingested for suicide attempts vary widely between different age groups. Younger people used antidepressants more frequently in suicide attempts, while the elderly used hypnotics more frequently. And the elderly required longer hospital stays. Suicide ideation and depressive mood in older patients who are prescribed hypnotics for various reasons should not be neglected. Further prevention efforts are needed to prevent suicide among the elderly.
Subject(s)
Aged , Humans , Analgesics , Antidepressive Agents , Emergency Service, Hospital , Hypnotics and Sedatives , Korea , Length of Stay , Nonprescription Drugs , Public Health , SuicideABSTRACT
Evidence has emerged that endocrine-disrupting chemicals (EDCs) can produce adverse effects, even at low doses that are assumed safe. However, systemic reviews and meta-analyses focusing on human studies, especially of EDCs with short half-lives, have demonstrated inconsistent results. Epidemiological studies have insuperable methodological limitations, including the unpredictable net effects of mixtures, non-monotonic dose-response relationships, the non-existence of unexposed groups, and the low reliability of exposure assessment. Thus, despite increases in EDC-linked diseases, traditional epidemiological studies based on individual measurements of EDCs in bio-specimens may fail to provide consistent results. The exposome has been suggested as a promising approach to address the uncertainties surrounding human studies, but it is never free from these methodological issues. Although exposure to EDCs during critical developmental periods is a major concern, continuous exposure to EDCs during non-critical periods is also harmful. Indeed, the evolutionary aspects of epigenetic programming triggered by EDCs during development should be considered because it is a key mechanism for developmental plasticity. Presently, living without EDCs is impossible due to their omnipresence. Importantly, there are lifestyles which can increase the excretion of EDCs or mitigate their harmful effects through the activation of mitohormesis or xenohormesis. Effectiveness of lifestyle interventions should be evaluated as practical ways against EDCs in the real world.
Subject(s)
Humans , Epidemiologic Studies , Epidemiology , Epigenomics , Life Style , PlasticsABSTRACT
OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and used widely in clinical settings. This paper provides evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining the cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, the cut-off value of at-risk drinking proposed by the World Health Organization was applied and the study sample was divided into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for the AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and the optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under the receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions was increased from one to four. The differences in the AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four, the AUROC increased to a statistically significant level. The cut-off values for the abbreviated versions of AUDIT were similar in South Korea to other countries.
Subject(s)
Adult , Humans , Alcohol-Related Disorders , Alcoholism , Drinking , Korea , Nutrition Surveys , ROC Curve , World Health OrganizationABSTRACT
PURPOSE: Activated charcoal (AC) has been widely used as a universal antidote. Currently, emergency medical centers in Korea cannot administer AC due to discontinuation of the supply of commercial ready-mixed AC suspension. This study was conducted to investigate the proportion of emergency medical centers that administer AC to poisoning patients and provide basic information for emergency physicians and toxicologists. METHODS: A prospective telephone survey of all of the included emergency medical institutions was conducted. The type of emergency medical institution, average annual number of patients admitted to the emergency department, annual average number of patients who were poisoned and whether the hospital currently utilizes gastric lavage and administration of AC were determined. RESULTS: AC was administered to poisoning patients in 40% of regional emergency medical centers, 59.3% of local emergency medical centers, and 45.9% of local emergency medical rooms. Overall, 37% of total emergency medical institutions did not administer AC due to discontinuation of the commercial ready-mixed AC suspension. Additionally, 77% of emergency physicians in institutions without AC knew AC is necessary for poisoning patients. The rate of vomiting experienced by the medical staff according to types of charcoal showed that the average rate of vomiting was 33% for commercial ready-mixed activated charcoal suspension and 51% for self-prepared charcoal powder (p=0.02). CONCLUSION: AC should be secured promptly in emergency medical institutions. Before the supply of commercial ready-mixed AC suspension becomes again it is essential to develop a standardized regimen for self-preparation of charcoal powder and to educate emergency physicians and toxicologists to its use.
Subject(s)
Humans , Charcoal , Emergencies , Emergency Service, Hospital , Gastric Lavage , Korea , Medical Staff , Poisoning , Prospective Studies , Telephone , VomitingABSTRACT
OBJECTIVE: This study aims to compare liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma glutamyl transferase [GGT]) among males who work with lead, organic solvents, or both lead and organic solvents, under the permissible exposure limit (PEL). METHODS: A total of 593 (out of 2,218) male workers who agreed to share their personal health information for medical research were selected for this study. Those excluded were hepatitis B carriers, individuals exposed to occupational risk factors other than lead and organic solvents, and individuals without liver function results. The 593 were divided into five groups: a lead-exposed group, an organic solvent-exposed group exposed to trichloroethylene (TCE co-exposed solvent group), an organic solvent-exposed group not exposed to trichloroethylene (TCE non-exposed solvent group), a lead and organic solvent-exposed group (mixed exposure group), and a non-exposed group (control group). We performed a one way-analysis of variance (one way-ANOVA) test to compare the geometric means of liver function indices among the groups, using a general linear model (GLM) to adjust for age, work duration, body mass index (BMI), smoking, and alcohol intake. In addition, we performed a binary logistic regression analysis to compare the odds ratios among groups with an abnormal liver function index, according to a cut-off value. RESULTS: The ALT and AST of the mixed exposure group were higher than those of the other groups. The GGT of the mixed exposure group was higher than the TCE co-exposed solvent group, but there was no difference among the control group, TCE non-exposed solvent group, lead-exposed group, and mixed exposure group. The same result was evident after adjusting by GLM for age, work duration, BMI, smoking, and alcohol intake, except that ALT from the mixed exposure group showed no difference from the TCE co-exposed solvent group. When the cut-off values of the AST, ALT, and GGT were 40 IU/L, 42 IU/L, and 63 IU/L, respectively, a logistic regression analysis showed no differences in the odds ratios of those who had an abnormal liver function index among the groups. However, if the cut-off values of the AST, ALT, and GGT were 30 IU/L, 30 IU/L, and 40 IU/L, respectively, the odds ratio of the AST in the mixed exposure group was 4.39 (95% CI 1.86-10.40) times higher than the control. CONCLUSION: This study indicates that a mixed exposure to lead and organic solvents is dangerous, even if each single exposure is safe under the permissible exposure limit. Therefore, to ensure occupational health and safety in industry, a continuous efforts to study the effects from exposure to mixed chemicals is needed.
Subject(s)
Humans , Male , Alanine Transaminase , Body Mass Index , Hepatitis B , Linear Models , Liver Function Tests , Liver , Logistic Models , Occupational Health , Odds Ratio , Risk Factors , Smoke , Smoking , Solvents , Transferases , TrichloroethyleneABSTRACT
There are substantial variations of relative risks (RR) in smoking-related mortality by country and time. We hypothesized the RRs in smoking-related mortality might differ depending on serum concentrations of persistent organic pollutants (POPs). We evaluated the associations of cigarette smoking with total mortality in 610 elderly (aged > or = 70 yr) (702 elderly for organochlorine pesticides [OCPs]) after stratification by serum concentration of POPs, in the National Health and Nutrition Examination Survey (NHANES) 1999-2004 followed through 2006. Summary measures of POPs subclasses showed significant or marginally significant interaction with cigarette smoking on the risk of total mortality. P values for interaction were 0.069 for polychlorinated dibenzo-p-dioxins (PCDDs), 0.008 for polychlorinated biphenyls (PCBs), and 0.024 for OCPs. The effect of smoking on total mortality showed different patterns according to the serum concentration of some POPs. Former or current smokers had 1.4 to 2.9 times higher mortality rates compared with never smokers among participants with higher serum concentrations of POPs (2nd or 3rd tertiles). However, when the level of PCBs or OCPs were low (1st tertile), there were little positive associations between smoking and mortality. Our study suggests that the background exposure to several POPs may be related to variability in smoking-related total mortality.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Environmental Exposure , Environmental Pollutants/blood , Hydrocarbons, Chlorinated/blood , Nutrition Surveys , Pesticides/blood , Polychlorinated Biphenyls/blood , Proportional Hazards Models , Risk , Smoking/mortality , Polychlorinated Dibenzodioxins/analogs & derivativesABSTRACT
There are substantial variations of relative risks (RR) in smoking-related mortality by country and time. We hypothesized the RRs in smoking-related mortality might differ depending on serum concentrations of persistent organic pollutants (POPs). We evaluated the associations of cigarette smoking with total mortality in 610 elderly (aged > or = 70 yr) (702 elderly for organochlorine pesticides [OCPs]) after stratification by serum concentration of POPs, in the National Health and Nutrition Examination Survey (NHANES) 1999-2004 followed through 2006. Summary measures of POPs subclasses showed significant or marginally significant interaction with cigarette smoking on the risk of total mortality. P values for interaction were 0.069 for polychlorinated dibenzo-p-dioxins (PCDDs), 0.008 for polychlorinated biphenyls (PCBs), and 0.024 for OCPs. The effect of smoking on total mortality showed different patterns according to the serum concentration of some POPs. Former or current smokers had 1.4 to 2.9 times higher mortality rates compared with never smokers among participants with higher serum concentrations of POPs (2nd or 3rd tertiles). However, when the level of PCBs or OCPs were low (1st tertile), there were little positive associations between smoking and mortality. Our study suggests that the background exposure to several POPs may be related to variability in smoking-related total mortality.