ALBERT

Description: The purpose of this study was to investigate the effect of two-hour exposure to a forest environment on cytokine, anti-oxidant and stress levels among university students and to compare the results to those measured in urban environments. Forty-one subjects were recruited. For our crossover design, subjects were divided into two groups based on similar demographic characteristics. Group A remained in the urban environment and was asked to perform regular breathing for 2 h. Blood samples were collected and the serum levels of cytokines including interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), and glutathione peroxidase (GPx) were examined. Subjects were moved to a small town in a rural area for an equal amount of time to exclude carryover effects, and then remained for another 2 h in a forest environment. The second set of blood samples was collected to assess the effect of exposure to the forest environment. Using the same method, Group B was first exposed to the forest environment, followed by exposure to the urban environment. Blood samples collected after the subjects were exposed to the forest environment showed significantly lower levels of IL-8 and TNF-α compared to those in samples collected after urban environment exposure (10.76 vs. 9.21, t = 4.559, p 〈 0.001, and 0.97 vs. 0.87, t = 4.130, p 〈 0.001). The GPx concentration increased significantly after exposure to the forest environment (LnGPx = 5.09 vs. LnGPx = 5.21, t = −2.039, p 〈 0.05).

Description: An association between exposure to air pollution and liver enzymes in certain areas or older people has been reported in the literature; however, it cannot be generalized to the general population. We investigated the association between air pollution, liver enzyme levels, and alcohol consumption using nationwide data of South Korean adults. Air pollutants included particulate matter with an aerodynamic diameter ≤10 µm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO). Liver enzymes included alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Exposure to air pollutants were significantly associated with elevation of log ALT and log AST, especially increases from 0.0073 IU/L (95% confidence interval (CI) = 0.0042, 0.0104) to 0.0251 IU/L (95% CI = 0.0132, 0.0371) per interquartile range (IQR) increase of each pollutant (all pollutants: p 〈 0.001). Association of the liver enzymes with PM10 (β (95% CI) = 0.0285 IU/L (0.0201, 0.0368) for log ALT; β (95% CI) = 0.0139 IU/L (0.0079, 0.0198) for log AST) and CO (β (95% CI) = 0.0247 IU/L (0.0182, 0.0311) for log ALT; β (95% CI) = 0.0164 IU/L (0.0118, 0.0210) for log AST) were only significant among drinkers. Our findings suggest that chronic exposure to PM10 and CO is a risk factor for liver enzymes increases among the general adult population who admitted to drinking alcohol.

Description: Currently, low-cost, sensor-based fine dust measurement devices are commercially available in South Korea. This study evaluated the reliability of three such devices—Yi Shan A4, Plantower PMS7003, and Plantower PMS7003—in comparison to long-term consecutive monitoring systems for discharge and prevention facilities regarding fine dust control. The performance of these devices for concentration intervals over time was examined through real-time comparison using a GRIMM (Model: 11-A, dust spectrometer from Grimm Technologies) as a reference; this included a correction factor (C-Factor), calculated by a gravimetric method and an equivalence test. For comparison, the reference and target devices were installed in a chamber with fine dust concentrations of 2 µg/m3, with temperature and humidity maintained at 20 °C and 40%, respectively. The fine particulate matter (PM)2.5 concentrations were classified into five intervals: ≤40 µg/m3, 40–80 µg/m3, 80–120 µg/m3, 120–160 µg/m3, and 200–230 µg/m3. Statistical analysis was performed using data obtained from national stations for monitoring and controlling fine dust released from facilities under high fine dust loading conditions. The results showed that the measurements of all target devices, which were corrected according to the reference device, provided accurate values at PM2.5 concentrations of ≥40 µg/m3. The statistical analysis results suggest that the evaluated devices are more reliable than the conventional numerical-analysis-based monitoring system

Description: The aim of this study was to support management of airborne bacteria in facilities used by pollution-sensitive individuals (in daycares, medical facilities, elder care facilities, and postnatal care centers). A field survey was conducted on 11 facilities from October 2017 to April 2018. Elder care facilities in industrial, urban, and forested areas were excluded. Two indoor, and one outdoor, measuring points were selected per facility. These points were located in areas most often used by the residents. Measurements were taken at random time-points before February 2018 and at specific times in the morning and afternoon thereafter. The relationships among bacterial counts, carbon dioxide concentrations, dust levels, temperature, relative humidity, and ventilation were examined. The pooled average bacterial counts at the daycares, medical facilities, elder care facilities, and postnatal care centers were 540.25 CFU m−3, 245.49 CFU m−3, 149.63 CFU m−3, and 169.65 CFU m−3, respectively. Considering the upper 95% confidence interval, the bacterial counts in many daycares may in fact be 〉800 CFU m−3, which is the threshold set by the Korean Ministry of the Environment. The pooled average indoor: outdoor bacterial count ratio was 1.13. Indoor airborne bacterial counts were influenced mainly by their sources. This study found no significant correlations among indoor temperature, relative humidity, carbon dioxide concentration, dust levels, and airborne bacterial counts, unlike previous studies. Airborne bacteria management at daycares should be a top priority. The sources of airborne bacteria must also be identified, and a management plan must be developed to control them.

Description: Phthalate exposure was reported to be associated with diabetes mellitus (DM) and cardiovascular disease (CVD). Yet, reported associations and the potential sex differences are inconsistent. We conducted a cross-sectional study involving 2330 participants in the Fall of 2012. Urinary metabolites of 10 phthalates were measured. The status of having DM and CVD-related outcomes were self-reported. In the overall study population, the logistic regression analyses showed that the urinary levels of mono-2-ethyl-5-oxohexyphthalate (MEOHP), mono-2-ethyl-5-hydroxyhexylphthalate(MEHHP) and mono-2-ethyl-5-carboxypentylphthalate (MECPP) were positively associated with DM. Higher urinary levels of monomethyl phthalate (MMP) and mono-2-carboxymethyl-hexyl phthalate (MCMHP) were associated with increased odds of hyperlipidemia, while mono-2-ethylhexylphthalate (MEHP) was significantly inverse-associated with hyperlipidemia. We did not observe significant associations for other CVD-related outcomes with phthalate metabolites. When stratifying by sex, MEHHP, MEOHP, MECPP, MCMHP and the micromolar sums of the oxidative metabolites of DEHP (ΣDEHPox) were all significantly related to DM in males, but not in females. No significant sex differences were found in CVD-related outcomes, except the sporadic associations between phthalates and hyperlipidemia. These findings highlight the importance of investigating the sex-specific relationship between phthalates exposure and DM.

Description: IJERPH, Vol. 15, Pages 1178: Hospital-Acquired Pneumonia among Inpatients via the Emergency Department: A Propensity-Score Matched Analysis International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15061178 Authors: Jin-young Min Hye-Jin Kim Chungsik Yoon Kiyoung Lee Myoungsouk Yeo Kyoung-bok Min Background: Hospital-acquired pneumonia (HAP) is an inflammatory condition of the lung that develops at least 48–72 h after admission. HAP is contracted by both intensive care unit (ICU) and non-ICU patients, but no studies have examined the risk of HAP in patients admitted to the emergency department (ED). This study investigated the risk of developing HAP in ED patients and compared the occurrence of HAP 3–10 days after the first day of hospitalization in patients hospitalized via ED with those hospitalized via outpatient clinics. Methods: We analyzed the 2010 National Inpatient Sample data collected by the Health Insurance Review and Assessment Service in South Korea. After propensity score matching for age, sex, residential area, hospital, and diseases, 153,130 inpatients (76,565 admitted via ED and 76,565 admitted via outpatient clinics) were included in the analysis. The diagnosis of pneumonia was based on the International Classification of Diseases and Related Health Problems 10th Revision (Pneumonia, all (J12–J18); Pneumonia, bacterial (J13–J15); Pneumonia, non-bacterial (J12, J16, J17); and Pneumonia, unspecified (J18)). Results: The percentage of newly diagnosed cases of pneumonia in inpatients admitted via ED was significantly higher than that in inpatients admitted via outpatient clinics. After propensity score matching for baseline characteristics, the likelihood of developing pneumonia (excluding the category of ‘Pneumonia, non-bacterial’) in inpatients hospitalized via ED was significantly increased by 1.33–1.97-fold. The cumulative incidence of pneumonia was also significantly higher in patients admitted via ED than in those hospitalized via outpatient clinics. Conclusions: ED visits may be an important risk factor for the development of HAP.

Description: Benzophenone (BP) and N,N-diethyl-3-methylbenzamide (DEET) are two chemicals often used in personal care products (PCPs). There is a lack of systematic ecotoxicological evaluations about the two chemicals to aquatic organisms. In the present study, the acute toxic effects on Chlorella vulgaris, Daphnia Magana, and Brachydanio rerio were tested and the ecotoxicological risks were evaluated. For BP, the 96-h half-maximal effective concentration (EC50) on C. vulgaris was 6.86 mg/L; the 24-h median lethal concentration (LC50) on D. magana was 7.63 mg/L; the 96-h LC50 on B. rerio was 14.73 mg/L. For DEET, those were 270.72 mg/L, 40.74 mg/L, and 109.67 mg/L, respectively. The mixture toxicity of BP and DEET, on C. vulgaris, D. magana, and B. rerio all showed an additive effect. The induced predicted no-effect concentrations (PNECs) for BP and DEET by assessment factor (AF) method are 0.003 mg/L and 0.407 mg/L, respectively. Both are lower than the concentrations detected from environment at present, verifying that BP and DEET are low-risk chemicals to the environment.

Description: This study aimed to investigate the association between parks and green areas and hyperlipidemia in adults with groups stratified by moderate physical activity as a behavioral modification using the 2009 Korean Community Health Survey data and 212,584 participants enrolled in this study. The geographical codes of study participants were all matched on the basis of the amount of parks and green areas in each administrative district. Compared with participants living in the highest quartile of parks and green areas (Quartile 4), those living in the lowest quartile of green and park area (Quartile 1) were at an increased risk of physician-diagnosed hyperlipidemia and hyperlipidemia currently under treatment. Participants in the lowest quartile of parks and green areas were likely not to engage in any moderate physical activity. After classifying hyperlipidemia risk depending on the presence of moderate physical activity, those participating in moderate physical activity were less likely to have hyperlipidemia in all quartiles of parks and green areas than those not engaging in moderate physical activity. We found that parks and green areas were associated with decreased hyperlipidemia risk. Physical activity, which may benefit from the presence of parks and green areas, may reduce hyperlipidemia risk.

Description: Physical inactivity is a major risk factor for chronic diseases and premature death. The increased health risks associated with physical inactivity may also generate a heavier economic burden to society. We estimated the direct medical costs attributable to physical inactivity among adultsusing data from the 2002–2010 Korean National Health Insurance Service-National Sample Cohort. A total of 68,556 adults whose reported physical activity status did not change during the study period was included for this study. Propensity scores for inactive adults were used to match 23,645 inactive groups with 23,645 active groups who had similar propensity scores. We compared medical expenditures between the two groups using generalized linear models with a gamma distribution and a log link. Direct medical costs were based on the reimbursement records of all medical facilities from 2005 to 2010. The average total medical costs for inactive individuals were $1110.5, which was estimated to be 11.7% higher than the costs for physically active individuals. With respect to specific diseases, the medical costs of inactive people were significantly higher than those of active people, accounting for approximately 8.7% to 25.3% of the excess burden. Physical inactivity is associated with considerable medical care expenditures per capita among Korean adults.

Description: Due to an aging population, dementia incidence has rapidly increased in South Korea, heaping psychological and economic burdens upon families and the society. This study was aimed at investigating the associations of health insurance type and cardiovascular risk factors with the risk of dementia. The study was performed using data from 15,043 participants aged 60 years and above, enrolled in the Seoul Dementia Management Project in 2008 and followed up until 2012. Factors such as demographic data, health insurance type, lifestyle factors, and cardiovascular risk factors were subjected to Cox proportional hazard regression analysis to identify their associations with dementia incidence. During the follow-up, 495 participants (3.3%) developed dementia. Medical Aid beneficiaries were associated with an increase in the risk of dementia (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.421–2.215). Upon analyzing a composite cardiovascular risk score derived from all five cardiovascular risk factors, the risk for dementia incidence in participants increased from 1.56 for the presence of three risk factors to 2.55 for that of four risk factors (HR 2.55, 95% CI 1.174–5.546), compared with those who had no risk factors. The Medical Aid beneficiaries of health insurance type and the presence of multiple cardiovascular risk factors were found to be associated with a higher risk of dementia incidence.