Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review.

BACKGROUND: Individuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD. METHODS: In this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.). RESULTS: Our searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD. CONCLUSIONS: This systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.

Status of TNF-α and IL-6 as pro-inflammatory cytokines in exhaled breath condensate of late adolescents with asthma and healthy in the dust storm and non-dust storm conditions.

Exposure to airborne particulate matter (PM) can be considered as an important risk factor for human health. Some cytokines have been recognized as the biomarkers of exposure to air pollution. Experimental studies indicate that PM exposure could be associated with inflammation. Thus, the purpose of this study was to evaluate whether the exposure to air PM is associated with biomarkers of inflammation. The specific aim of this study was to determine the correlation between airborne PM levels and IL-6 and TNF-α as airway inflammation biomarkers among two groups of late adolescents in northwest of Iran. This study included 46 subjects, comprising 23 asthmatic subjects and 23 non-asthmatic persons. Environmental PM (PM10, PM2.5 and PM1) levels were measured in dust storm and non-dust storm days during both cold and warm seasons. Following the sampling of PM, Two pro-inflammatory cytokines of IL-6 and TNF-α in exhaled breath condensate (EBC) were also determined in the EBC samples via commercial ELISA kits. Daily mean ambient air PM10, PM2.5 and PM1 concentrations during the dust storm days was 221.79, 93.13 and 25.52 µg m-3 and in non-dusty days 48.37, 18.54 and 6.1 µg m-3, respectively. Biomarkers levels were significantly (p < 0.001) higher in asthmatic students compared to the non-asthmatic subjects. EBC cytokines levels were increased in dust storm days compared to the non-dusty days (p < 0.001) and were positively correlated with different size of ambient PM concentration. Dust storm conditions can increase the pro-inflammatory cytokines and cause adverse effects on pulmonary health and lung tissue damage.

Proinflammatory effects of dust storm and thermal inversion particulate matter (PM10) on human peripheral blood mononuclear cells (PBMCs) in vitro: a comparative approach and analysis.

Particulate matter (PM) as the carcinogenic air pollutants can lead to aggravated health outcomes. Epidemiological studies demonstrated that PM can be engaged in different diseases such as cardiovascular, respiratory and cancer. The in vitro secretion of proinflammatory cytokines by human peripheral blood mononuclear cells (PBMCs) has been used to assess the effects of PM with an aerodynamic diameter < 10 µm (PM10). This study compared the proinflammatory cytokines tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and interleukin 1-beta (IL1-ß) secretions of PBMCs exposed to PM10 of dust storm and inversion. We collected PM10 samples during the spring and autumn seasons in two locations. Isolated PBMCs were exposed separately to 50, 150, and 300 µg/ml of different type of PM10 for 4 and 24 h. The mean concentrations of TNF-α for the PM of dust storm and inversion were 6305.61 ± 2421 and 6651.74 ± 2820, respectively. Also the mean concentrations of IL1-ß for the PM of dust storm and inversion were 556.86 ± 162 and 656.35 ± 196, respectively. Furthermore, these values for the production of IL-6 were 12,655 ± 5661 and 16,685 ± 8069, respectively. Although no significant difference was observed between the PM of dust storm and that of inversion with regard to PBMCs, the results showed a significant increase in the proinflammatory cytokine secretion of both PMs compared with the controls. Moreover, TNF-α, IL1-ß, and IL-6 secreted in cells exposed to PM10 of dust storm were about 10 times more than the controls, these values for cells exposed to PM10 of inversion were around 10, 12, and 14 times more than the controls, respectively. It can be concluded that the PM10 of both dust storm and inversion can play a significant role in proinflammatory cytokine secretion due to its harmful effect on human health. Graphical abstractThis picture shows the Proinflammatory cytokine producing potential of PM10 with two sources (dust storm and urban air pollution) in exposure with human PBMCs in vitro.

Enhancing photo-degradation of ciprofloxacin using simultaneous usage of eaq- and OH over UV/ZnO/I- process: Efficiency, kinetics, pathways, and mechanisms.

The aim of this study is to develop the process relies on the UV irradiation of ZnO and I-, i.e. UV/ZnO /I- (UZI), to create both oxidizer and reducer agents simultaneously for photo-degradation of the Ciprofloxacin (CIP). This paper shows that while applying UV irradiation, UV/ZnO and UV/I- for 20 min can lead to achieve 37.5%, 58.12%, and 61.4% photo-degradation of 100 mg L-1 CIP at pH 7, respectively. Moreover, the UZI treatment can provide 91.54% photo-degradation efficiency. The LC-MS analysis of the UZI effluent indicates that 10 min process was adequate to degrade CIP into simple ring-shaped metabolites while 15 min treatment, mostly of CIP intermediates were linear and biodegradable organic compounds. Furthermore, fourteen little fragments were identified in the CIP photo-degradation via UZI, during the photoreaction time of 2.5 to 20 min. Then, a pseudo first-order kinetics equation was utilized to model the observed photo-degradation process. Finally, the computational results show that the increased concentration of the CIP solution from 100 to 400 mg L-1 decreases the observed rate constant (kobs) from 0.4125 to 0.2189 min-1 while increases the photoreaction rate (robs) from 41.25 to 87.56 mg L-1 min-1.

Correction to: Investigation and Comparison of In Vitro Genotoxic Potency of PM10 Collected in Rural and Urban Sites at Tehran in Different Metrological Conditions and Different Seasons.

The original version of this article unfortunately contained a mistake. Figure 6 caption should be "The light microscopic image (a) and transmission electron microscopic image (b) of A549 cell after 24 h of exposure to PM10 (150 µg/ml).

Investigation and Comparison of In Vitro Genotoxic Potency of PM10 Collected in Rural and Urban Sites at Tehran in Different Metrological Conditions and Different Seasons.

The particulate matter has become a serious health problem in some large cities in the world. These particles are a complex mixture of chemical compounds which change based on location and time and, consequently, can cause different health-related effects. The exact mechanism of the effect of these particles is not yet known for certain. However, it seems that numerous mechanisms through the production of ROS and, eventually, DNA destruction, which are related to a wide range of diseases, are among the causes of particles' health-related effects. The present study is aimed to evaluate and compare the genotoxicity potential of particles collected in Tehran, Iran, in urban and rural regions during spring and autumn as well as dusty and inversion conditions. These effects were examined using the comet assay on human pulmonary epithelial cells (A549). Results showed that all the particles had the potential for genotoxicity at the concentration used in this study (75,150 and 300 µg/ml). Moreover, DNA destruction changed with season, site, and even dusty and inversion atmospheric conditions. These changes mostly belonged to urban particles. In general, urban particles in autumn and, specifically, on days with inversion had higher genotoxicity (p < 0.01). Difference was observed between dusty and regular days so that regular days were more potent (p < 0.05). A strong correlation was observed between the effects of most PAH compounds and other metals such as Cr, Co, Cd, Mn, As, and also SO4, which were mostly the result of combustion in vehicle engines in urban regions. No difference was observed for rural particles at different conditions and seasons.

Short-term effects of particle size fractions on lung function of late adolescents.

Although ambient air pollution has been linked to reduced lung function in healthy students, longitudinal studies that compare the response of asthmatic and healthy adolescents are lacking. To evaluate lung function responses to short-term ambient air particulate matter (PM10, PM2.5, and PM1) levels, we conducted a study on high school students aged 15-18 years. The aim of this study was to assess effects of acute exposure to ambient air particulate matter (PM) on lung function in healthy and asthmatic late adolescents. We examined associations of lung function indices and ambient PM levels in 23 asthmatic and 23 healthy students. Paired-samples T test was used to evaluate the association of exposure to airborne PM concentrations with lung function test results (FVC, FEV1, FEV1/FVC, and FEF25-75). We observed negative impact of exposure to an increased concentration of ambient air PM10, PM2.5, and PM1 on lung function parameters of asthmatic and healthy late adolescents. These findings are consistent with other similar short-term studies which have confirmed the adverse effect of PM air pollution. These associations were stronger in asthmatic subjects compared with those in healthy ones. There are significant adverse effects of ambient air PM on pulmonary function of adolescents, especially asthmatics.

Physiochemical characteristics and oxidative potential of ambient air particulate matter (PM10) during dust and non-dust storm events: a case study in Tehran, Iran.

In the present study, we investigated the characteristics of metal(loid)s, polycyclic aromatic hydrocarbons (PAHs) and oxidative potential (OP) in PM10 during dust and non-dust days in a rural and an urban area in Tehran. Water-soluble ions, metal(loid)s, PAHs, and OP were measured using ion chromatography (IC), inductively coupled plasma optical emission spectrometer (ICP-OES) and gas chromatography/mass spectrometry (GC-MS), and dithiothreitol (DTT) assay respectively. The results showed that the average concentrations of ambient PM10 were 284 ± 90.4 and 123 ± 31.4 µg m-3 on dusty and regular days in urban areas respectively, and were 258 ± 48.3 and 124 ± 41.4 µg m-3 on dusty and regular days in rural areas, respectively; these values were 95% above the World Health Organization (WHO) guideline level. The crustal elements Na+, Mg2+, Ca2+, Al, Si, Fe and Ti were the dominant for PM10 on dusty days, and NO- 3 and SO4 2- were dominant for PM10 on regular days. The average ± SD concentrations of total PAHs were 34.3 ± 22.5 and 55.1 ± 28.3 ng m-3 on dusty and regular days, respectively, with the maximum value occurring on inversion days. The average OP was 8.90 ± 7.15 and 1.41 ± 0.35 and was 11.4 ± 3.97 and 19.9 ± 8.67 (nmol min-1 µg PM10 -1) for water and methanol extracts on dusty and regular days, respectively, with the lowest value occurring on dusty days. The OP was highly associated with Cu and Mn. Briefly; the results of this study demonstrate that OP is mass independent and consequence a promising proxy for PM mass.

Essential and toxic heavy metals in cereals and agricultural products marketed in Kermanshah, Iran, and human health risk assessment.

Levels of some essential and toxic heavy metals such as lead, cadmium, chromium, nickel, zinc and copper in cereals and agricultural products obtained from the markets in Kermanshah city, west Iran, were determined by inductively coupled plasma-optical emission spectrometry (ICP-OES). The average concentrations for lead and cadmium in some cereals were higher than the maximum levels set by the Codex Alimentarius. A potential human health risk assessment was conducted by calculating estimated weekly intake (EWI) of the metals from eating cereals and comparison of these values with provisional tolerable weekly intake (PTWI) values. In combination with recent cereal consumption data, the EWIs of heavy metals were calculated for the Kermanshah population. EWI data for the studied metals through cereal consumption were lower than the PTWI values. Cr, Ni, Zn and Cu levels in all samples analysed were within the ranges reported for similar cereals from various parts of the world.

Natural airborne dust and heavy metals: a case study for kermanshah, Western iran (2005-2011).

BACKGROUND: Dust pollution has become a serious environmental problem especially in recent decades. The present study aim was the investigation of the levels of PM10 concentration in Kermanshah, western Iran and also measured five important heavy metals (Pb, Cd, As, Hg and Cr) in some samples during 2005 to 2011. METHODS: A total 2277 samples were collected from air pollution measurement station belonging to the Department of Environment in Kermanshah. Furthermore, four samples were collected during dusty days to determine the selected heavy metals concentration. The samples were analyzed statistically using the SPSS Ver.16. RESULTS: The highest seasonal average concentration in spring was recorded in 2008 with 216.63µg/m(3), and the maximum values of 267.79 and 249.09µg/m(3) were observed in summer and winter in 2009, respectively. The maximum concentration of 127.1µg/m(3) was in autumn in 2010. The metals concentration (Pb, Cd, As, Hg and Cr) of samples were 42.32±5.40, 37.45±9.29, 3.51±2.07, 1.88±1.64 and 0µg/g in July, 2009, respectively. CONCLUSION: According to National Ambient Air Quality of USEPA guidelines, the most days with non-standard, warning, emergency and critical conditions were related to 2009 (120 days) while the least polluted days were recorded in 2006 (16 days). There are concerns about the increasing frequency and intensity trend of dust storms in recent years as a result of special condition in neighboring Western countries which it could endanger public health and environment. All measured heavy metals except mercury was higher than the standard level of WHO and USEPA.

Effect of fertilizer application on soil heavy metal concentration.

A large amount of chemicals is annually applied at the agricultural soils as fertilizers and pesticides. Such applications may result in the increase of heavy metals particularly Cd, Pb, and As. The objective of this study was to investigate the variability of chemical applications on Cd, Pb, and As concentrations of wheat-cultivated soils. Consequently, a study area was designed and was divided into four subareas (A, B, C, and D). The soil sampling was carried out in 40 points of cultivated durum wheat during the 2006-2007 periods. The samples were taken to the laboratory to measure their heavy metal concentration, soil texture, pH, electrical conductivity, cationic exchange capacity, organic matter, and carbonate contents. The result indicated that Cd, Pb, and As concentrations were increased in the cultivated soils due to fertilizer application. Although the statistical analysis indicates that these heavy metals increased significantly (P value<0.05), the lead and arsenic concentrations were increased dramatically compared to Cd concentration. This can be related to overapplication of fertilizers as well as the pesticides that are used to replant plant pests, herbs, and rats.