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Many countries have dedicated to the mitigation of air pollution in the past several decades. However, evidence of beneficial effects of air quality improvement on chronic kidney disease (CKD) remains limited. We thus investigated the effects of dynamic changes (including deterioration and improvement) in air quality on the incidence of CKD in a longitudinal study in Taiwan. During 2001-2016, this study recruited a total of 163,197 Taiwanese residents who received at least two standard physical examinations. The level of fine particle matter (PM 2.5 ) was estimated using a high-resolution (1 km 2 ) satellite-based spatio-temporal model. We defined changes of PM 2.5 concentrations (ΔPM 2.5 ) as the difference between the two-year average measurements during follow-up and during the immediately preceding visit. The time-dependent Cox regression model was adopted to evaluate the relationships between ΔPM 2.5 and the incidence of CKD after adjusting for a series of covariates. The concentrations of PM 2.5 in Taiwan peaked around 2004 and began to decrease since 2005. We observed an approximate linear concentration-response relationship of ΔPM 2.5 with CKD incidence. Every 5 μg/m 3 decrease in the ambient concentration of PM 2.5 was associated with a 25% reduced risk of CKD development [hazard ratio (HR): 0.75; 95% CI: 0.73, 0.78]. In conclusion, this study demonstrated that the improvement of PM 2.5 air quality might be associated with a lower risk of CKD development. Our findings indicate that reducing air pollution may effectively prevent the development of CKD.

Background: Air pollution has been associated with an increase in cardiovascular diseases incidence. To evaluate whether air pollution can accelerate atherogenic processes, we assessed the effects of air pollution on important surrogate markers of atherosclerosis [brachial flow-mediated dilation (FMD) and carotid intima-media thickness (IMT)]., Methods: A total of 1656 Han Chinese (mean age 46.0 + 11.2 years; male 47%) in Hong Kong, Macau, Pun Yu, Yu County and the 3-Gorges Territories (Yangtze River) were studied between 1996 and 2007 [Chinese Atherosclerosis in the Aged and Young Project (the CATHAY Study)]. Cardiovascular risk profiles were evaluated. Particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) parameters were computed from satellite sensors. Brachial FMD and carotid IMT were measured by ultrasound., Results: Health parameters [age, gender, body mass index, waist : hip ratio (WHR) and glucose)] were similar in lowest and highest PM2.5 exposure tertiles, systolic and diastolic blood pressures and triglycerides were higher (P < 0.001) and low-density cholesterol (LDL-C) was lower in the top PM2.5 tertile (P < 0.001). Brachial FMD [7.84 ± 1.77, 95% confidence interval (CI) 7.59-8.10%, vs 8.50 ± 2.52, 95% CI 8.23-8.77%, P < 0.0001) was significantly lower and carotid IMT (0.68 ± 0.13 mm, 95% CI 0.67-0.69 mm vs 0.63 mm ± 0.15 mm 95% CI 0.62-0.64 mm; P < 0.0001) was significantly thicker in the top PM2.5 tertile compared with the lowest tertile. On multiple regression, FMD was inversely related to PM2.5 (beta = 0.134, P = 0.015) independent of gender, age and blood pressure (model R2 = 0.156, F-value = 7.6, P < 0.0001). Carotid IMT was significantly correlated with PM2.5 exposure (beta = 0.381, P < 0.0001) independent of age, location, gender, WHR, blood pressure and LDL-C (model R2 = 0.408, F-value = 51.4, P-value <0.0001)., Conclusions: Air pollution is strongly associated with markers of early atherosclerosis, suggesting a potential target for preventive intervention., (© The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Background: It is crucial to have simple and appropriate measures to identify people with adiposity-related risk. We compared the associations of mortality with body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and body fat percentage (BF%) in a prospective cohort., Methods: A total of 463,002 adults were recruited between 1996 and 2017. Vital data were obtained from the National Death Registry System in Taiwan. Cox proportional hazards model was used to assess the associations of BMI, WC, WHtR, and BF% with mortality., Result: Clear U-shape relationships were observed for all four parameters. In both men and women, the lowest risk of mortality was observed in the BMI category of 23.5-24.9 kg/m 2 . Regarding WC, men in the third quintile (79.0-82.9 cm) and women in the fourth quintile (70.0-74.9 cm) had the lowest risk of mortality. For WHtR, men in the third quintile (0.46-0.49) and women in the fourth quintile (0.45-0.48) had the lowest risk of mortality. For BF%, both men and women in the fourth quintile (24.0-27.2% and 28.7-32.8%, respectively) had the lowest risk of mortality. The WC, WHtR, and BF% exhibited slightly associations with the risk of mortality across the three BMI categories [low (10.8-20.9 kg/m 2 ), normal (21.0-27.4 kg/m 2 ) and high (27.5-51.7 kg/m 2 )]. C-statistics of the four parameters ranged from 0.51 to 0.69., Conclusion: Our results suggest that BMI should remain the primary marker for screening excessive adiposity. However, our findings also support the use of the WC, WHtR, and/or BF%, in addition to BMI when assessing the risk of mortality., Competing Interests: Conflict of interest The authors declare that they have no conflicting interests related to this manuscript., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Although the effects of meteorological factors on severe air pollution have been extensively investigated, quantitative decomposition of the contributions of meteorology and anthropogenic factors remains a big challenge. The novel coronavirus disease 2019 (COVID-19) pandemic affords a unique opportunity to test decomposition method. Based on a wind decomposition method, this study outlined an improved method to differentiate complex meteorological and anthropogenic effects. The improved method was then applied to investigate the cause of unanticipated haze pollution in China during the COVID-19 lockdown period. Results from the wind decomposition method show that weakened winds increased PM 2.5 concentrations in the Beijing-Tianjin area and northeastern China (e.g., by 3.19 μg/m 3 in Beijing). Using the improved decomposition method, we found that the combined meteorological effect (e.g., drastically elevated humidity levels and weakened airflow) substantially increased PM 2.5 concentrations in northern China: the most substantial increases were in the Beijing-Tianjin-Hebei region (e.g., by 26.79 μg/m 3 in Beijing). On excluding the meteorological effects, PM 2.5 concentrations substantially decreased across China (e.g., by 21.84 μg/m 3 in Beijing), evidencing that the strict restrictions on human activities indeed decreased PM 2.5 concentrations. The unfavorable meteorological conditions, however, overwhelmed the beneficial effects of emission reduction, causing the severe haze pollution. These results indicate that the integrated meteorological effects should be considered to differentiate the meteorological and anthropogenic effects on severe air pollution., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Elsevier Ltd. All rights reserved.)

Background: The incidence of cancer is higher among patients with end-stage renal disease but it remains uncertain whether a mild decrease in renal function affects cancer., Objective: To measure the effect of impaired renal function, represented by the estimated glomerular filtration rate (eGFR), personal health behaviors, and long-term exposure to fine particulate matter (PM 2.5 ) on the risk of urothelial carcinoma (UC) incidence., Design Setting and Participants: We performed a population-based cohort study of 372 008 participants aged ≥30 yr with no prior cancer history using the MJ health examination database (2000-2015) and UC diagnosis data from the Taiwan Cancer Registry database., Outcome Measurements and Statistical Analysis: Cox proportional hazards models were used to quantify the association between eGFR and UC incidence., Results and Limitations: We detected 383 UC cases during a median follow-up of 10.3 yr. Low eGFR was significantly associated with UC ( p value for trend <0.01): compared to eGFR ≥90 ml/min/1.73 m 2 , the adjusted hazard ratio (HR) was 1.36 (95% confidence interval [CI] 0.98-1.88), 1.86 (95% CI 1.22-2.84), and 1.95 (95% CI 1.06-3.56) for eGFR strata of 60-89, 45-59, and <45 ml/min/1.73 m 2 , respectively. The risk remained elevated after stratifying the follow-up duration to check for reverse causality, and the dose-response relationship was stronger for women than for men. Current smoking (HR 1.34, 95% CI 1.02-1.77) and long-term exposure to PM 2.5 concentrations ≥25.1 μg/m 3 (HR 1.54, 95% CI 1.14-2.09) both significantly increased the risk of UC incidence. A significant dose-response relationship between PM 2.5 and UC was also noted ( p trend < 0.01). Limitations include the retrospective design and limited information on medical history., Conclusions: Lower renal function showed a dose-response relationship in elevating UC risk. Long-term exposure to PM 2.5 is also a possible UC risk factor., Patient Summary: People with kidney function that is lower than normal should monitor the health of their kidneys and other organs in the urinary system. Our study confirmed that as well as smoking, exposure to fine particulate matter in the air may be a risk factor for cancers of the urinary system., (© 2021 The Author(s).)

Novel corona virus disease 2019 (COVID-19), which first emerged in December 2019, has become a pandemic. This study aimed to investigate the associations between meteorological factors and COVID-19 incidence and mortality worldwide. This study included 1,908,197 confirmed cases of and 119,257 deaths from COVID-19 from 190 countries between 23 January and 13 April, 2020. We used a distributed lag non-linear model with city-/country-level random intercept to investigate the associations between COVID19 incidence and daily temperature, relative humidity, and wind speed. A series of confounders were considered in the analysis including demographics, socioeconomics, geographic locations, and political strategies. Sensitivity analyses were performed to examine the robustness of the associations. The COVID-19 incidence showed a stronger association with temperature than with relative humidity or wind speed. An inverse association was identified between the COVID-19 incidence and temperature. The corresponding 14-day cumulative relative risk was 1.28 [95% confidence interval (CI), 1.20-1.36] at 5 °C, and 0.75 (95% CI, 0.65-0.86) at 22 °C with reference to the risk at 11 °C. An inverse J-shaped association was observed between relative humidity and the COVID-19 incidence, with the highest risk at 72%. A higher wind speed was associated with a generally lower incidence of COVID-19, although the associations were weak. Sensitivity analyses generally yielded similar results. The COVID-19 incidence decreased with the increase of temperature. Our study suggests that the spread of COVID-19 may slow during summer but may increase during winter., Competing Interests: Declaration of competing interest The authors declared that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study aimed to evaluate the global incidence and mortality trends of breast cancer among females by region and age in the past decade. We retrieved country-specific incidence and mortality data from the Global Cancer Observatory up to 2018 and Cancer Incidence in Five Continents volumes I-XI, the Nordic Cancer Registries, the Surveillance, Epidemiology, and End Results, and WHO mortality database up to 2016. The temporal patterns were using Average Annual Percent Change (AAPC) with the 95% confidence interval (CI) by joinpoint regression analysis. Most countries showed an increasing trend in incidence. For the older population aged ≥ 50 years, Japan (5.63, 4.90-6.36), Slovakia (3.63, 3.03-4.22), China (2.86, 2.00-3.72) reported the most prominent increase. For young females (<50 years), Japan (AAPC=3.81, 95% CI=2.71-4.93), Germany (AAPC=2.60, 95% CI=1.41-3.81) and Slovakia (1.91, 1.13-2.69) reported the most drastic rise. Similarly, 12 countries showed an incidence increase among women aged <40 years. As for mortality, the Philippines (4.36, 3.65-5.07), Thailand (4.35, 3.12-5.59), Colombia (0.75, 0.08-1.42), and Brazil (0.44, 0.19-0.68) reported a significant increase. The disease burden of breast cancer showed an increasing trend in a large number of populations. More preventive efforts are recommended for these countries. Further research should explore the underlying reasons for these epidemiological trends.

Background & Aims: We evaluated global and regional burdens of, risk factors for, and epidemiologic trends in pancreatic cancer among groups of different sexes and ages., Methods: We used data from the GLOBOCAN database to estimate pancreatic cancer incidence and mortality in 184 countries. We examined the association between lifestyle and metabolic risk factors, extracted from the World Health Organization Global Health Observatory database, and pancreatic cancer incidence and mortality by univariable and multivariable linear regression. We retrieved country-specific age-standardized rates (ASRs) of incidence and mortalities from cancer registries from 48 countries through 2017 for trend analysis by joinpoint regression analysis., Results: The highest incidence and mortality of pancreatic cancer were in regions with very high (ASRs, 7.7 and 4.9) and high human development indexes (ASRs, 6.9 and 4.6) in 2018. Countries with higher incidence and mortality were more likely to have higher prevalence of smoking, alcohol drinking, physical inactivity, obesity, hypertension, and high cholesterol. From 2008 to 2017, 2007 to 2016, or 2003 to 2012, depending on the availability of the data, there were increases in incidence among men and women in 14 (average annual percent changes [AAPCs], 8.85 to 0.41) and 17 (AAPCs, 6.04 to 0.87) countries, respectively. For mortality, the increase was observed in 8 (AAPCs, 4.20 to 0.55) countries among men and 14 (AAPCs, 5.83 to 0.78) countries among women. Although the incidence increased in 18 countries (AAPCs, 7.83 to 0.91) among individuals 50 years or older, an increasing trend in pancreatic cancer was also identified among individuals younger than 50 years and 40 years in 8 (AAPCs, 8.75 to 2.82) and 4 (AAPCs, 11.07 to 8.31) countries, respectively., Conclusions: In an analysis of data from 48 countries, we found increasing incidence and mortality trends in pancreatic cancer, especially among women and populations 50 years or older, but also among younger individuals. More preventive efforts are recommended for these populations., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

This study aimed to examine the global burden, risk factors, and trends of esophageal cancer based on age, sex, and histological subtype. The data were retrieved from cancer registries database from 48 countries in the period 1980-2017. Temporal patterns of incidence and mortality were evaluated by average annual percent change (AAPC) using joinpoint regression. Associations with risk factors were examined by linear regression. The highest incidence of esophageal cancer was observed in Eastern Asia. The highest incidence of adenocarcinoma (AC) was found in the Netherlands, the United Kingdom, and Ireland. A higher AC/squamous cell carcinoma (SCC) incidence ratio was associated with a higher prevalence of obesity and elevated cholesterol. We observed an incidence increase (including AC and SCC) in some countries, with the Czech Republic (female: AAPC 4.66), Spain (female: 3.41), Norway (male: 3.10), Japan (female: 2.18), Thailand (male: 2.17), the Netherlands (male: 2.11; female: 1.88), and Canada (male: 1.51) showing the most significant increase. Countries with increasing mortality included Thailand (male: 5.24), Austria (female: 3.67), Latvia (male: 2.33), and Portugal (male: 1.12). Although the incidence of esophageal cancer showed an overall decreasing trend, an increasing trend was observed in some countries with high AC/SCC incidence ratios. More preventive measures are needed for these countries.

Background: To evaluate and compare the effectiveness of four types of non-pharmaceutical interventions (NPIs) to contain the time-varying effective reproduction number (Rt) of coronavirus disease-2019 (COVID-19)., Methods: This study included 1,908,197 confirmed COVID-19 cases from 190 countries between 23 January and 13 April 2020. The implemented NPIs were categorised into four types: mandatory face mask in public, isolation or quarantine, social distancing and traffic restriction (referred to as mandatory mask, quarantine, distancing and traffic hereafter, respectively)., Results: The implementations of mandatory mask, quarantine, distancing and traffic were associated with changes (95% confidence interval, CI) of -15.14% (from -21.79% to -7.93%), -11.40% (from -13.66% to -9.07%), -42.94% (from -44.24% to -41.60%) and -9.26% (from -11.46% to -7.01%) in the Rt of COVID-19 when compared with those without the implementation of the corresponding measures. Distancing and the simultaneous implementation of two or more types of NPIs seemed to be associated with a greater decrease in the Rt of COVID-19., Conclusion: Our study indicates that NPIs can significantly contain the COVID-19 pandemic. Distancing and the simultaneous implementation of two or more NPIs should be the strategic priorities for containing COVID-19., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There is limited information on the association between habitual physical activity (PA) and renal function., Objective: To report the longitudinal association between self-reported habitual PA and measures of renal function in a large cohort in Taiwan., Methods: A total of 199 421 participants (aged ≥20 years) were selected from a Taiwan cohort between 1996 and 2014. All participants underwent at least two standardised medical examinations between 1996 and 2014. Self-administrated questionnaires were used to collect information on habitual PA. We used a generalised linear mixed model to investigate the associations between habitual PA and yearly change in estimated glomerular filtration rate (eGFR). The Cox proportional hazard regression model was used to investigate the associations between habitual PA and incident chronic kidney disease (CKD)., Results: Participants had a median follow-up duration of 4.2 years (0.2-18.9). The yearly mean (±SD) decrease in eGFR in participants with baseline very low-PA, low-PA, moderate-PA and high-PA was 0.46±1.01, 0.36±0.97, 0.30±0.94 and 0.27±0.91 mL/min/1.73 m 2 , respectively. Relative to the participants with very low-PA, the coefficients of yearly eGFR change were -43.93 (95% CI -79.18 to -8.68), 35.20 (95% CI -2.56 to 72.96) and 53.56 (95% CI 10.42 to 96.70) µL / min/1.73 m 2 , respectively, for the participants with low-PA, moderate-PA and high-PA, after controlling for a wide range of covariates. Relative to the very low-PA participants, those who had low-PA, moderate-PA and high-habitual PA had HRs of 0.93 (95% CI 0.88 to 0.98), 0.94 (95% CI 0.89 to 0.99) and 0.91 (95% CI 0.85 to 0.96) to develop CKD, respectively, after controlling for the covariates., Conclusions: A higher level of habitual PA is associated with a smaller decrease in the level of eGFR and a lower risk of developing CKD., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The novel coronavirus disease 2019 (COVID-19), which first emerged in Hubei province, China, has become a pandemic. However, data regarding the effects of meteorological factors on its transmission are limited and inconsistent. A mechanism-based parameterisation scheme was developed to investigate the association between the scaled transmission rate (STR) of COVID-19 and the meteorological parameters in 20 provinces/municipalities located on the plains in China. We obtained information on the scale of population migrated from Wuhan, the world epicentre of the COVID-19 outbreak, into the study provinces/municipalities using mobile-phone positioning system and big data techniques. The highest STRs were found in densely populated metropolitan areas and in cold provinces located in north-eastern China. Population density had a non-linear relationship with disease spread (linearity index, 0.9). Among various meteorological factors, only temperature was significantly associated with the STR after controlling for the effect of population density. A negative and exponential relationship was identified between the transmission rate and the temperature (correlation coefficient, -0.56; 99% confidence level). The STR increased substantially as the temperature in north-eastern China decreased below 0 °C (the STR ranged from 3.5 to 12.3 when the temperature was between -9.41 °C and -13.87 °C), whilst the STR showed less temperature dependence in the study areas with temperate weather conditions (the STR was 1.21 ± 0.57 when the temperature was above 0 °C). Therefore, a higher population density was linearly whereas a lower temperature (<0 °C) was exponentially associated with an increased transmission rate of COVID-19. These findings suggest that the mitigation of COVID-19 spread in densely populated and/or cold regions will be a great challenge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: We investigated the joint associations of habitual physical activity (PA) and long-term exposure to fine particulate matter (PM 2.5 ) with the development of hypertension in a longitudinal cohort in Taiwan., Methods: We selected 140 072 adults (≥18 years of age) without hypertension who joined a standard medical screening program with 360 905 medical examinations between 2001 and 2016. PM 2.5 exposure was estimated at each participant's address using a satellite data-based spatiotemporal model with 1 km 2 resolution. Information on habitual PA and a wide range of covariates was collected using a standard self-administered questionnaire. We used the Cox regression model with time-dependent covariates to examine the joint associations., Results: The mean age of all observations was 41.7 years, and 48.8% were male. The mean value for systolic and diastolic blood pressure was 112.5 and 68.7mm Hg, respectively. Approximately 34.2% of all observations were inactive (0 metabolic equivalence values-hours), 29.8% had moderate-PA (median [interquartile range]; 3.75 [3.38 to 4.38] metabolic equivalence values-hours), and 36.0% had high-PA (15.7 [10.3 to 24.8] metabolic equivalence values-hours). The mean±SD of PM 2.5 was 26.1±7.3 μg/m 3 . The prevalence of cardiovascular disease, diabetes mellitus, and cancer was 2.1%, 2.9%, and 1.5%, respectively. After adjusting for a wide range of covariates (including a mutual adjustment for PA or PM 2.5 ), a higher PA level was associated with a lower risk of hypertension (hazard ratio [HR] for the moderate- and high-PA was 0.93 [95% CI, 0.89-0.97] and 0.92 [95% CI, 0.88-0.96], respectively, as compared with the inactive-PA), whereas a higher level of PM 2.5 was associated with a higher risk of hypertension (HR for the moderate- and high-PM 2.5 was 1.37 [95% CI, 1.32-1.43] and 1.92 [95% CI, 1.81-2.04], respectively, as compared with the low-PM 2.5 group]. No significant interaction was observed between PA and PM 2.5 (HR 1.01 [95% CI, 1.00-1.02])., Conclusions: A high-PA and low PM 2.5 exposure were associated with a lower risk of hypertension. The negative association between PA and hypertension remained stable in people exposed to various levels of PM 2.5 , and the positive association between PM 2.5 and hypertension was not modified by PA. Our results indicated that PA is a suitable hypertension prevention strategy for people residing in relatively polluted regions.

We aimed to examine the global prevalences of central obesity according to age, sex, race, place of residence, geographical region, national income level, and the definitions of central obesity. MEDLINE and Embase were searched. Studies with sample size of ≥ 500 and investigated individuals aged ≥ 15 years were included. Metaprop (a Stata command) was adopted to conduct a meta-analysis of prevalence, and the Freeman-Tukey Double Arcsine Transformation was used to stabilize the variances. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of central obesity. There were 288 studies involving 13,233,675 individuals in this analysis. The overall prevalence of central obesity was 41.5% (95% CI 39.9-43.2%). A higher prevalence was found in older individuals, female subjects, urban residents, Caucasians, and populations of higher income level countries. Regarding regional variations, the highest prevalence was found in Sothern America (55.1%, 95% CI 45.8-64.3%) and Central American (52.9%, 95% CI 32.7-72.7%). Its prevalence was rapidly rising from 1985 to 2014. From 1985-1999 to 2010-2014, younger subjects aged 15-40 years showed a more drastic rise in prevalence (16.3 to 33.9%) than subjects aged > 40 years (43.6 to 57.9%). Male individuals have a more drastic rise (25.3 to 41.6%) than females (38.6 to 49.7%). Major increasing in prevalence of the condition in the past three decades, particularly in certain subgroups. These findings could act as a useful reference to inform public health strategies to minimize the impact of central obesity on population health.

Background: Physical activity (PA) increases a person's inhalation of air pollutants due to greater ventilation, possibly leading to larger adverse health effects. This study aims to investigate the combined effects of long-term exposure to fine particulate matter (PM 2.5 ) and habitual PA on lung function in adults., Methods: This was a longitudinal cohort study that included 278,065 Taiwan residents with an age of 20 years old or above who joined a standard medical screening programme between 2001 and 2014. Each participant received at least one medical examination (including spirometric, blood, and urinary tests and a standard self-administered questionnaire survey) during the study period. We estimated the 2-year average PM 2.5 concentrations at each participant's address using a new physical model based on observational data. Information on the participants' PA was collected using the standard self-administrated questionnaire. Generalised linear mixed models were used to investigate the combined effects of PM 2.5 and PA on pulmonary function. We also performed stratified analyses by different levels of PM 2.5 exposure and habitual PA., Results: Each 10 MET-h increase in PA was associated with a higher level of 0.20%, 0.16%, and 0.19% in forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1 ), and maximum mid-expiratory flow (MMEF), respectively, after adjusting for PM 2.5 exposure and a wide range of covariates including age, sex education, body mass index, lifestyles, and health conditions. Each 10 μg/m 3 increase in PM 2.5 was associated with a lower FVC, FEV 1 , and MMEF (2.43%, 2.78% and 3.10%, respectively). Negative interactions were observed, and PM 2.5 exposure was associated with a greater reduction in lung function among the participants with higher PA levels., Conclusions: We found significant negative interaction effects between long-term exposure to PM 2.5 and habitual PA, suggesting that the increased intake of PM 2.5 due to PA may attenuate the benefits of habitual PA on lung function. However, the PA benefits generally remained stable at different stratum of PM 2.5 in the stratified analyses, and habitual PA may still be recommended to people residing in relatively polluted regions.

Background: The effects of dietary factors on prognosis of esophageal cancer remain unclear. This systematic review and meta-analysis aimed to assess the association between dietary intake and the risk of mortality among patients with esophageal cancer., Methods: Six electronic databases (PubMed, Web of Science, OVID, ProQuest, CNKI and Wanfang) were searched for studies published up to Oct. 2019 that examined the association between dietary intake and all-cause mortality, esophageal cancer-specific mortality and esophageal cancer recurrence. The pooled hazard ratio (HR) with 95% confidence interval (CI) were derived by comparing the highest with the lowest categories of each dietary item and by using random effect models., Results: A total of 15 cohort studies were included in this study and all reported pre-diagnosis dietary exposure; two focused on dietary folate, 12 on alcohol consumption and three on other dietary components (sugary beverages, phytochemicals and preserved vegetables). When comparing the highest with the lowest categories, dietary folate intake was associated with a reduced risk of esophageal cancer-specific mortality in patients with esophageal squamous cell carcinoma (HR: 0.41, 95% CI: 0.25-0.69), with low heterogeneity (I 2  = 0%, P = 0.788). When comparing the highest with the lowest categories of alcohol consumption, alcohol consumption was associated with an increased risk of all-cause mortality in patients with esophageal squamous cell carcinoma (HR: 1.29, 95% CI: 1.07-1.55; heterogeneity: I 2  = 53%, P = 0.030), but this increased risk was not significant in patients with esophageal adenocarcinoma (HR = 1.05, 95% CI: 0.84-1.32)., Conclusions: This review with pre-diagnostic dietary exposure showed that dietary folate intake was associated with a reduced risk of mortality of esophageal squamous cell carcinoma, whereas alcohol consumption was associated with an increased risk. More studies are needed to investigate effect of dietary factors, especially post-diagnosis dietary consumption, on esophageal cancer prognosis.

Human exposure to PM 2.5 , represented by population-weighted mean PM 2.5 concentration (c ρ ), declines under three conditions: (1) mean PM 2.5 concentration declines, (2) PM 2.5 concentration within urban areas goes through more of a decrease than within rural areas, or (3) city planning relocates people into cleaner areas. Decomposing these effects on human exposure is essential to guide future environmental policies. The lack of ground PM 2.5 observations limits the assessment of human exposure to PM 2.5 over China. This study proposed a novel diagnostic framework using satellite observations to decompose the variation in c ρ resulting from change in the mean PM 2.5 concentration, spatial difference in PM 2.5 change, and demographic change. In this framework, we decomposed c ρ into mean PM 2.5 concentration (c 0 ) and pollution-population-coincidence induced PM 2.5 exposure (PPCE). We then used this framework to decompose the variation in c ρ over China within three recent Five-Year Plans (FYPs) (2001-2015). The results showed that the decline in c 0 reduced c ρ in most provinces within the eleventh and twelfth FYPs. The spatial difference in PM 2.5 change reduced the PPCE and c ρ in most provinces within the tenth and twelfth FYPs, with the most substantial reduction rate of -3.64 μg m -3 ·yr -1 in Tianjin within the twelfth FYP. Rural-to-urban migration resulting from rapid urbanization, however, increased the PPCE and c ρ (by as much as 0.22 μg m -3 ·yr -1 ) in all provinces except Taiwan within all three FYPs. The demographic change reduced c ρ in Taiwan because of the migration of population into less polluted areas. To better reduce human exposure, it is recommended that control efforts further target populous residential areas and urbanization planning relocates people into less polluted areas. Our decomposition framework paves a new way to decompose the human exposure to other air pollutants in China and other regions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The association between long-term exposure to ambient fine particulate matter with aerodynamic diameter ≤ 2.5 μ m ( PM 2.5 ) and lung function in young people remains uncertain, particularly in Asia, where air pollution is generally a serious problem., Objectives: This study investigated the association between long-term exposure to ambient PM 2.5 and lung function in Taiwanese children, adolescents, and young adults., Methods: This study comprised 24,544 participants 6-24 years of age, with 33,506 medical observations made between 2000 and 2014. We used a spatiotemporal model to estimate PM 2.5 concentrations at participants' addresses. Spirometry parameters, i.e., forced vital capacity (FVC), forced expiratory volume in 1 s ( FEV 1 ), and maximum midexpiratory flow (MMEF), were determined. A generalized linear mixed model was used to examine the associations between long-term exposure to ambient PM 2.5 and lung function. The odds ratios (ORs) of poor lung function were also calculated after adjusting for a range of covariates., Results: Every 10 - μ g / m 3 increase in the 2-y average PM 2.5 concentration was associated with decreases of 2.22% [95% confidence interval (CI): - 2.60 , - 1.85 ], 2.94 (95% CI: - 3.36 , - 2.51 ), and 2.79% (95% CI: - 3.15 , - 2.41 ) in the FVC, FEV 1 , and MMEF, respectively. Furthermore, it was associated with a 20% increase in the prevalence of poor lung function (OR: 1.20; 95% CI: 1.12, 1.29)., Conclusions: Two-year ambient PM 2.5 concentrations were inversely associated with lung function and positively associated with the prevalence of poor lung function in children, adolescents, and young adults in Taiwan. https://doi.org/10.1289/EHP5220.

Many countries dedicated in mitigation of air pollution in the past several decades. However, little is known about how air quality improvement affects health. Therefore, we conducted current study to investigate dynamic changes in long-term exposure to ambient particulate matter (PM 2.5 ) and incidence of hypertension in a large longitudinal cohort. We recruited 134 978 adults aged 18 years or above between 2001 and 2014. All the participants received a series of standard medical examinations, including measurements of blood pressure. The PM 2.5 concentration was estimated using a satellite-based spatiotemporal model at a high resolution (1×1 km 2 ). The change in long-term exposure to PM 2.5 (ΔPM 2.5 ) was defined as the difference between the values measured during follow-up and during the immediately preceding visit, and a negative value indicated an improvement in PM 2.5 air quality. Time-varying Cox model was used to examine the associations between ΔPM 2.5 and the development of hypertension. The results show that PM 2.5 concentrations increased in 2002, 2003, and 2004, but began to decrease in 2005. Every 5 µg/m 3 change in exposure to PM 2.5 (ie, a ΔPM 2.5 of 5 µg/m 3 ) was associated with a 16% change in the incidence of hypertension (hazard ratio, 0.84; 95% CI, 0.82-0.86). Both stratified and sensitivity analyses generally yielded similar results. We found that an improvement in PM 2.5 exposure is associated with a decreased incidence of hypertension. Our findings demonstrate that air pollution mitigation is an effective strategy to reduce the risk of cardiovascular disease.

Aims: To evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG)., Methods: 44 828 Chinese adults aged 20-80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor., Results: After 214 148 person-years of follow-up, we observed an inverse dose-response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P<0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P<0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area., Conclusions: Our results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: Animal experiments indicate that exposure to particulate matter (PM) can induce hepatotoxic effects but epidemiological evidence is scarce. We aimed to investigate the associations between long-term exposure to PM air pollution and liver enzymes, which are biomarkers widely used for liver function assessment., Methods: A cross-sectional analysis was performed among 351 852 adult participants (mean age: 40.1 years) who participated in a standard medical screening programme in Taiwan. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) levels were measured. A satellite-based spatio-temporal model was used to estimate the concentrations of ambient fine particles (PM with an aerodynamic diameter ≤2.5 µm, PM 2.5 ) at each participant's address. Linear and logistic regression models were used to investigate the associations between PM 2.5 and the liver enzymes with adjustment for a wide range of potential confounders., Results: After adjustment for confounders, every 10 µg/m 3 increment in 2-year average PM 2.5 concentration was associated with 0.02%(95% CI: -0.04% to 0.08%), 0.61% (95% CI: 0.51% to 0.70%) and 1.60% (95% CI: 1.50% to 1.70%) increases in AST, ALT and GGT levels, respectively. Consistently, the odds ratios of having elevated liver enzymes (>40 IU/L) per 10 µg/m 3 PM 2.5 increment were 1.06 (95% CI: 1.04 to 1.09), 1.09 (95% CI: 1.07 to 1.10) and 1.09 (95% CI: 1.07 to 1.11) for AST, ALT and GGT, respectively., Conclusions: Long-term exposure to PM 2.5 was associated with increased levels of liver enzymes, especially ALT and GGT. More studies are needed to confirm our findings and to elucidate the underlying mechanisms., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Evidence of the effects of long-term exposure to fine particulate matter (PM 2.5 ) air pollution on the development of dyslipidaemia is limited. This study aimed to investigate the association between long-term exposure to ambient PM 2.5 and incident dyslipidaemia in a large cohort., Methods: We studied 66,702 participants aged ≥18 years belonging to a cohort from a standard medical examination programme conducted in Taiwan between 2001 and 2014. The PM 2.5 concentration at each participant's address was estimated using a satellite-based spatiotemporal model at a high resolution (1 km 2 ). A time-varying Cox regression model was used to examine the association between long-term exposure to ambient PM 2.5 and the development of dyslipidaemia. Additionally, sensitivity analyses were conducted to examine the stability of these associations., Results: Compared with participants exposed to the 1st tertile of PM 2.5 , participants exposed to the 2nd and 3rd tertiles of PM 2.5 had respective hazard ratios of 1.02 [95% confidence interval (CI): 0.98-1.06] and 1.08 (95%CI: 1.04-1.13) for incident dyslipidaemia. Sensitivity analyses generally yielded similar results., Conclusion: Long-term exposure to ambient PM 2.5 is associated with a higher risk of dyslipidaemia. Global strategies for reducing air pollution are needed to prevent the development of dyslipidaemia., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aims/hypothesis: Information on the associations of long-term exposure to fine particulate matter (with an aerodynamic diameter less than 2.5 μm; PM 2.5 ) with the development of type 2 diabetes is scarce, especially for south-east Asia, where most countries are experiencing serious air pollution. This study aimed to investigate the long-term effects of exposure to ambient PM 2.5 on the incidence of type 2 diabetes in a population of Taiwanese adults., Methods: A total of 147,908 participants without diabetes, at least 18 years of age, were recruited in a standard medical examination programme between 2001 and 2014. They were encouraged to take medical examinations periodically and underwent at least two measurements of fasting plasma glucose (FPG). Incident type 2 diabetes was identified as FPG ≥7 mmol/l or self-reported physician-diagnosed diabetes in the subsequent medical visits. The PM 2.5 concentration at each participant's address was estimated using a satellite-based spatiotemporal model with a resolution of 1 × 1 km 2 . The 2 year average of PM 2.5 concentrations (i.e. the year of and the year before the medical examination) was treated as an indicator of long-term exposure to ambient PM 2.5 air pollution. We performed Cox regression models with time-dependent covariates to analyse the long-term effects of exposure to PM 2.5 on the incidence of type 2 diabetes. A wide range of covariates were introduced in the models to control for potential effects, including age, sex, education, season, year, smoking status, alcohol drinking, physical activity, vegetable intake, fruit intake, occupational exposure, BMI, hypertension and dyslipidaemia (all were treated as time-dependent covariates except for sex)., Results: Compared with the participants exposed to the first quartile of ambient PM 2.5 , participants exposed to the second, third and fourth quartiles of ambient PM 2.5 had HRs of 1.28 (95% CI 1.18, 1.39), 1.27 (95% CI 1.17, 1.38) and 1.16 (95% CI 1.07, 1.26), respectively, for the incidence of type 2 diabetes. Participants who drank occasionally or regularly (more than once per week) or who had a lower BMI (<23 kg/m 2 ) were more sensitive to the long-term effects of exposure to ambient PM 2.5 ., Conclusions/interpretation: Long-term exposure to ambient PM 2.5 appears to be associated with a higher risk of developing type 2 diabetes in this Asian population experiencing high levels of air pollution.

Background: Incense burning is an important source of indoor air pollution in many Asian regions. We investigated the associations between household incense burning and lung function, lung function growth and respiratory diseases and symptoms in primary school children in Hong Kong., Methods: A total of 4041 children (mean age: 9.1 years) were recruited from 27 primary schools in Hong Kong. Information on incense burning and medical history of respiratory diseases and symptoms was collected by questionnaire. Spirometry tests were performed to measure the children's lung function. A follow-up study was carried out after 1-year interval. Linear and logistic regression models were used to investigate the associations between incense burning, lung function, and lung function growth, and respiratory diseases and symptoms, respectively., Results: At baseline, incense burning was associated with 48.6 mL/min [95% confidence interval (CI): -96.7, -0.5] lower maximum mid-expiratory flow (MMEF) in boys. In follow-up, incense burning was associated with reduced peak expiratory flow (PEF) growth in all participants. We also found that incense burning was associated with increased prevalence of bronchitis [odds ratio (OR) = 1.39, 95%CI: 1.11, 1.72] and bronchiolitis (OR = 1.72, 95%CI: 1.14, 2.56). Incense burning was also associated with higher prevalence of pneumonia (OR = 2.79, 95%CI: 1.10, 6.87) and wheezing (OR = 1.49, 95%CI: 1.08, 2.05) in boys, but not in girls., Conclusions: We found that incense burning may adversely affect children's respiratory health. Further studies are warranted to elucidate the underlying mechanisms., (© 2019 Wiley Periodicals, Inc.)

Variations in aerosol characteristics play an essential role in satellite remote sensing of PM 2.5 concentrations. The lack of measurement of aerosol characteristics, however, limits the assessment of their effects. This study presented an observation-based model that directly considered the effects of aerosol characteristics. In this model, we used an integrated humidity coefficient (γ') and an integrated reference value ( K) to delineate the effects of aerosol characteristics. We then investigated the effects of the long-term variations in aerosol characteristics on satellite remote sensing of PM 2.5 concentration in Hong Kong from 2004 to 2012. The results show that the γ' value peaked in 2009 because the percentages of highly hygroscopic components (e.g., sulfate and nitrate) in aerosols reached their peaks. The K value increased from 2004 to 2011 because of the increasing percentages of strong light-extinction components (e.g., organic matter) and the decreasing fine mode fraction in aerosols. The accuracy of PM 2.5 retrieval improved greatly after accounting for the long-term variations in aerosol characteristics (e.g., correlation coefficient increased from 0.56 to 0.80). The results underscore the need to incorporate the variations in aerosol characteristics in the PM 2.5 estimation models.

Study Objectives: Little information is available regarding the effect of sleep on the development of chronic kidney disease (CKD). This large-cohort study aimed to investigate the association between sleep and the incidence of CKD., Methods: We recruited 194,039 participants without CKD aged 20 years or older between 1996 and 2014. Incident CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m 2 . Information about sleep duration and quality was obtained from a questionnaire and used to generate a score reflecting the sleep profile. Cox proportional hazards regression models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for CKD associations with sleep duration, quality, and score categories., Results: Regarding sleep duration, participants who slept for fewer than 4 hours (HR 1.45, 95% CI 1.22-1.71), 4 to 6 hours (1.07, 1.02-1.14), or more than 8 hours (1.12, 1.04-1.21) had an increased risk of incident CKD, compared to those who slept 6 to 8 hours. Regarding sleep quality, participants who fell asleep but awoke easily (1.13, 1.07-1.19), had difficulty falling asleep (1.14, 1.06-1.22), or used sleeping pills or sedatives (1.14, 1.20-1.66) had a higher risk of incident CKD, compared to those who slept well. Furthermore, participants with sleep scores of 4 to 6 (1.07, 1.02-1.13) and less than 4 (1.61, 1.37-1.89) had an increased risk of incident CKD, compared to those with a sleep score higher than 6., Conclusions: A poor sleep profile is associated with increased risk of CKD development. Therefore, sleep duration and quality should be considered when developing strategies to improve sleep and thus prevent CKD., Commentary: A commentary on this article appears in this issue on page 371., (© 2019 American Academy of Sleep Medicine.)

Long-term exposed to ambient particulate matter (PM) has been recognized as a risk factor for cardiovascular diseases (CVDs) mortality but few studies examine the utility of WHO's interim targets (2006) concerning PM control on CVD mortality. This review aimed to synthesize the long-term exposed to ambient PM exposures on overall CVD mortality according to WHO's interim targets; meanwhile, subgroup analysis by ethnicity, smoking status and PM assessment method were also conducted. We systematically searched studies published between January 1974 and Jul 2017 in PubMed and Embase. Quality of each study was assessed using Critical Appraisal Skill Programme (CASP) checklist. Fixed-effects or random-effects model of meta-analysis was determined by the test of heterogeneity. Subgroup analyses were conducted according to ethnicity, smoking status, PM assessment method and interim PM targets of WHO guidelines. Overall, 16 eligible studies were included, covering 15,511,997 participants and 542,991 CVD deaths. Five studies concerning PM2.5 were rated as good quality. The pooled hazard ratio (HR) of every 10μg/m3 increment of PM2.5 exposure for CVD mortality was 1.12 (95%CI = 1.08-1.16), but it was not significant for PM10 (HR = 1.02, 95%CI = 0.89-1.16). Compared with the annual PM2.5 exposure level within WHO's interim targets (1.11-1.16), significantly smaller HR was observed for subjects with an exposure level below WHO's air quality guideline (HR = 1.03, 95%CI = 1.02-1.04). The pooled HR was relatively higher for studies in Asian and with at least 11 years' follow-up and those adopting relatively poor methods (category 1) in assessing PM2.5, whilst the risk was similar regardless of smoking status. Egger and Begg's tests showed no evidence for publication bias. Long-term ambient PM2.5 exposure level was positively associated with the overall CVD mortality. Different interim targets above the WHO's Air Quality Guideline level exerted a similar scale of CVD risk, but there is no evidence for a threshold., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Chronic kidney disease (CKD) is a serious global public health challenge, but there is limited information on the connection between air pollution and risk of CKD., Objective: The aim of this study was to investigate the association between long-term exposure to particulate matter (PM) with an aerodynamic diameter of less than [Formula: see text] ([Formula: see text]) and the development of CKD in a large cohort., Methods: A total of 100,629 nonCKD Taiwanese residents age 20 y or above were included in this study between 2001 and 2014. Ambient [Formula: see text] concentration was estimated at each participant's address using a satellite-based spatiotemporal model. Incident CKD cases were identified by an estimated glomerular filtration rate (eGFR) of less than [Formula: see text]. We collected information on a wide range of potential confounders/modifiers during the medical examinations. Cox proportional hazard regression was applied to calculate hazard ratios (HRs)., Results: During the follow-up, 4,046 incident CKD cases were identified, and the incidence rate was 6.24 per 1,000 person-years. In contrast with participants with the first quintile exposure of [Formula: see text], participants with the fourth and fifth quintiles exposure of [Formula: see text] had increased risk of CKD development, adjusting for age, sex, educational level, smoking, drinking, body mass index, systolic blood pressure, fasting glucose, total cholesterol, and self-reported heart disease or stroke, with an HR [95% confidence interval (CI)] of 1.11 (1.02, 1.22) and 1.15 (1.05, 1.26), respectively. A significant concentration-response trend was observed ([Formula: see text]). Every [Formula: see text] increment in the [Formula: see text] concentration was associated with a 6% higher risk of developing CKD (HR: 1.06, 95% CI: 1.02, 1.10). Sensitivity and stratified analyses yielded similar results., Conclusions: Long-term exposure to ambient [Formula: see text] was associated with an increased risk of CKD development. Our findings reinforce the urgency to develop global strategies of air pollution reduction to prevent CKD. https://doi.org/10.1289/EHP3304.

Background: The prothrombotic effects of particulate matter (PM) may underlie the association of air pollution with increased risks of cardiovascular disease. This study aimed to investigate the association between long-term exposure to PM with an aerodynamic diameter ≤2.5 μm (PM 2.5 ) and platelet counts, a marker of coagulation profiles., Methods: The study participants were from a cohort consisting of 362,396 Taiwanese adults who participated in a standard medical examination program between 2001 and 2014. Platelet counts were measured through Complete Blood Count tests. A satellite-based spatio-temporal model was used to estimate 2-year average ambient PM 2.5 concentration at each participant's address. Mixed-effects linear regression models were used to investigate the association between PM 2.5 exposure and platelet counts., Results: This analysis included 175,959 men with 396,248 observations and 186,437 women with 397,877 observations. Every 10-μg/m 3 increment in the 2-year average PM 2.5 was associated with increases of 0.42% (95% CI: 0.38%, 0.47%) and 0.49% (95% CI: 0.44%, 0.54%) in platelet counts in men and women, respectively. A series of sensitivity analyses, including an analysis in participants free of cardiometabolic disorders, confirmed the robustness of the observed associations. Baseline data analyses showed that every 10-μg/m 3 increment in PM 2.5 was associated with higher risk of 17% and 14% of having elevated platelet counts (≥90th percentile) in men and women, respectively., Conclusions: Long-term exposure to PM 2.5 appears to be associated with increased platelet counts, indicating potential adverse effects on blood coagulability., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Household cleaning products are widely used by the public, but limited data have been obtained on whether their use induces allergic dermatitis in children., Objective: This study investigated the association between exposure to household cleaning products and allergic dermatitis in primary-school children., Methods: A prospective cohort study of Hong Kong primary-school children was conducted between 2012 and 2014. A baseline survey was administered to 1812 students who did not have allergic dermatitis. Information on respiratory symptoms, exposure to household chemical cleaning products and other topics was collected using a self-administered questionnaire. A cumulative chemical burden (CCB) score was calculated for each student by summing the duration of exposure to 14 chemical cleaning products. Principal component analysis was used to identify patterns in the use of these cleaning products. Logistic regression was performed to calculate relative risk (RR) with 95% confidence intervals (CIs) after adjusting for potential confounders., Results: Eighty-nine (4.9%) of the students surveyed had dermatitis during the follow-up. However, exposure to individual chemical cleaning products was not found to be associated with the children's allergic dermatitis (all P > 0.05). In contrast to those in the lowest tertile, neither CCB scores in the middle tertile (RR: 1.16, 95% CI: 0.67 to 2.00) nor those in the highest tertile (RR: 1.24, 95% CI: 0.73 to 2.14) were significantly associated with the risk of allergic dermatitis. The adjusted RR for every 5-unit increment in CCB score was 1.01 (95% CI: 0.98 to 1.03). Four patterns of cleaning-product use were derived, but none were found to be associated with the risk of dermatitis (all P > 0.05)., Conclusion: The use of household chemical cleaning products is not associated with the risk of dermatitis in primary-school children., (© 2017 European Academy of Dermatology and Venereology.)

Background: Information on the effects of long-term exposure to fine particulate matter with an aerodynamic diameter of 2·5 μm or less (PM 2·5 ) on lung health is scarce. We aimed to investigate the associations between long-term exposure to PM 2·5 , lung function, and chronic obstructive pulmonary disease (COPD) in a large-scale longitudinal cohort., Methods: We included 285 046 participants aged 20 years or older from the Taiwan MJ Health Management Institution cohort, who were recruited between 2001 and 2014 and had spirometric tests during the medical examination visit. We used a satellite-based spatiotemporal model to estimate the 2-year average ground concentration of PM 2·5 (for the calendar year of each participant's medical examination and for the previous year) at each participant's address. We used the generalised linear mixed model to examine the associations between PM 2·5 concentrations and lung function and the Cox proportional hazard regression model with time-dependent covariates to investigate the PM 2·5 effects on COPD development., Findings: Every 5 μg/m 3 increment in PM 2·5 was associated with a decrease of 1·18% for forced vital capacity (FVC), 1·46% for forced expiratory volume in 1 s (FEV 1 ), 1·65% for maximum mid-expiratory flow (MMEF), and 0·21% for FEV 1 :FVC ratio. The decrease accelerated over time. Additional annual declines were observed for FVC (0·14%), FEV 1 (0·24%), MMEF (0·44%), and FEV 1 :FVC ratio (0·09%). Compared with the participants exposed to the first quartile of PM 2·5 , participants exposed to the fourth, third, and second quartiles of PM 2·5 had a hazard ratio of 1·23 (95% CI 1·09-1·39), 1·30 (1·16-1·46), and 1·39 (1·24-1·56) for COPD development, respectively., Interpretation: Long-term exposure to ambient PM 2·5 is associated with reduced, and faster declines in, lung function. Long-term exposure to ambient PM 2·5 is also associated with an increased risk of the incidence of COPD. This study reinforces the urgency of global strategies to mitigate air pollution for improvement of pulmonary health and prevention of COPD., Funding: Environmental Health Research Fund of the Chinese University of Hong Kong and PhD Studentship of the Chinese University of Hong Kong., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Environmental exposure to chemicals has been considered a potential factor contributing to deteriorated semen quality. However, previous literature on exposure to air pollution and semen quality is inconsistent. We therefore investigated the health effects of short-term and long-term exposure to fine particulate matter (PM 2.5 ) on semen quality in Taiwanese men from the general population., Methods: A cross-sectional study was conducted among 6475 male participants aged 15-49 years who participated in a standard medical examination programme in Taiwan between 2001 and 2014. Semen quality was assessed according to the WHO 1999 guidelines, including sperm concentration, total motility, progressive motility and morphology. Three-month and 2-year average PM 2.5 concentrations were estimated at each participant's address using a spatiotemporal model based on satellite-derived aerosol optical depth data. Multivariable linear and logistic regressions were used to examine the associations between PM 2.5 and semen quality., Results: A robust association was observed between exposure to PM 2.5 and decreased normal morphology. Every increment of 5 µg/m 3 in 2-year average PM 2.5 was significantly associated with a decrease of 1.29% in sperm normal morphology and a 26% increased risk of having the bottom 10% of sperm normal morphology, after adjusting for a wide range of potential confounders (p<0.001). On the other hand, an increment of 5 µg/m 3 in 2-year average PM 2.5 was associated with an increase of 1.03×10 6 /mL in sperm concentration and a 10% decreased risk of being the bottom 10% of sperm concentration (both p<0.001). Similar results were found for 3-month PM 2.5 ., Conclusions: Exposure to ambient PM 2.5 air pollution is associated with a lower level of sperm normal morphology and a higher level of sperm concentration., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Long-term exposure to particulate matter (PM) air pollution may increase blood pressure and the risk of hypertension. However, epidemiological evidence is scarce and inconsistent., Objectives: We investigated the associations between long-term exposure to PM with an aerodynamic diameter <2.5μm (PM 2.5 ), blood pressure, and incident hypertension in a large Taiwanese cohort., Methods: We studied 361,560 adults ≥18y old from a large cohort who participated in a standard medical examination program during 2001 to 2014. Among this group, 125,913 nonhypertensive participants were followed up. A satellite-based spatiotemporal model was used to estimate the 2-y average PM 2.5 concentrations at each participant's address. Multivariable linear regression was used in the cross-sectional data analysis with the 361,560 participants to investigate the associations between PM 2.5 and systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), and Cox proportional hazard regression was used in the cohort data analysis with the 125,913 participants to investigate the associations between PM 2.5 and incident hypertension., Results: Each 10-μg/m 3 increment in the 2-y average PM 2.5 concentration was associated with increases of 0.45 mmHg [95% confidence interval (CI): 0.40, 0.50], 0.07 mmHg (95% CI: 0.04, 0.11), and 0.38 mmHg (95% CI: 0.33, 0.42) in SBP, DBP, and PP, respectively, after adjusting for a wide range of covariates and possible confounders. Each 10-μg/m 3 increment in the 2-y average PM 2.5 concentration was associated with an increase of 3% in the risk of developing hypertension [hazard ratio=1.03 (95% CI: 1.01, 1.05)]. Stratified and sensitivity analyses yielded similar results., Conclusions: Long-term exposure to PM 2.5 air pollution is associated with higher blood pressure and an increased risk of hypertension. These findings reinforce the importance of air pollution mitigation strategies to reduce the risk of cardiovascular disease. https://doi.org/10.1289/EHP2466.

Study Objectives: There is limited information on the relationship between risk of cardiovascular disease and the joint effects of sleep quality and sleep duration, especially from large, prospective, cohort studies. This study is to prospectively investigate the joint effects of sleep quality and sleep duration on the development of coronary heart disease., Methods: This study examined 60,586 adults aged 40 years or older. A self-administered questionnaire was used to collect information on sleep quality and sleep duration as well as a wide range of potential confounders. Events of coronary heart disease were self-reported in subsequent medical examinations. Two types of Sleep Score (multiplicative and additive) were constructed to reflect the participants' sleep profiles, considering both sleep quality and sleep duration. The Cox regression model was used to estimate the hazard ratio (HR) and the 95% confidence interval (CI)., Results: A total of 2,740 participants (4.5%) reported new events of coronary heart disease at follow-up. For sleep duration, participants in the group of < 6 h/d was significantly associated with an increased risk of coronary heart disease (HR: 1.13, 95% CI: 1.04-1.23). However, the association in the participants with long sleep duration (> 8 h/d) did not reach statistical significance (HR: 1.11, 95% CI: 0.98-1.26). For sleep quality, both dreamy sleep (HR: 1.21, 95% CI: 1.10-1.32) and difficult to fall asleep/use of sleeping pills or drugs (HR: 1.40, 95% CI: 1.25-1.56) were associated with an increased risk of the disease. Participants in the lowest quartile of multiplicative Sleep Score (HR: 1.31, 95% CI: 1.16-1.47) and of additive sleep score (HR: 1.31, 95% CI: 1.16-1.47) were associated with increased risk of coronary heart disease compared with those in the highest quartile., Conclusions: Both short sleep duration and poor sleep quality are associated with the risk of coronary heart disease. The association for long sleep duration does not reach statistical significance. Lower Sleep Score (poorer sleep profile) increases the risk of coronary heart disease, suggesting the importance of considering sleep duration and sleep quality together when developing strategies to improve sleep for cardiovascular disease prevention., (© 2018 American Academy of Sleep Medicine)

Background: The protective effects of physical activity (PA) against chronic disease can be partially ascribed to its anti-inflammatory effects. On the other hand, long-term exposure to particulate matter with an aerodynamic diameter less than 2.5μm (PM 2.5 ) may induce systemic inflammation., Objective: To investigate the joint effects of habitual PA and long-term exposure to PM 2.5 on systemic inflammation in a large cohort of Taiwanese adults., Methods: We studied 359,067 adult participants from a cohort consisting of Taiwanese residents who participated in a standard medical examination program from 2001 to 2014. Peripheral white blood cell (WBC) and differential counts were measured as indicators of systemic inflammation. Two-year average concentration of PM 2.5 was estimated at each participant's address using a satellite-based spatio-temporal model. Habitual PA level was assessed by questionnaire (inactive, low, moderate and high). Mixed-effects linear regression model was used to examine the associations of WBC counts with PM 2.5 and PA., Results: Compared with inactive participants, those with low, moderate or high PA levels had 0.36% [95% confidence interval (CI): 0.31%, 0.41%], 0.70% (95%CI: 0.65%, 0.76%) and 1.16% (95%CI: 1.11%, 1.22%) lower WBC counts, respectively, after adjusting for PM 2.5 exposure and a wide range of confounders. Long-term PM 2.5 exposure was associated with increased WBC counts at all PA levels. Analyses for differential counts generated similar results. No significant interaction was observed between PA and PM 2.5 exposure (P for interaction=0.59)., Conclusions: Habitual PA was associated with statistically significant lower markers of systemic inflammation across different levels of PM 2.5 . Effects of PA and PM 2.5 exposure on systemic inflammation are independent., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

We examined the correlation between lung cancer incidence/mortality and country-specific socioeconomic development, and evaluated its most recent global trends. We retrieved its age-standardized incidence rates from the GLOBOCAN database, and temporal patterns were assessed from global databases. We employed simple linear regression analysis to evaluate their correlations with Human Development Index (HDI) and Gross Domestic Product (GDP) per capita. The average annual percent changes (AAPC) of the trends were evaluated from join-point regression analysis. Country-specific HDI was strongly correlated with age-standardized incidence (r = 0.70) and mortality (r = 0.67), and to a lesser extent GDP (r = 0.24 to 0.55). Among men, 22 and 30 (out of 38 and 36) countries showed declining incidence and mortality trends, respectively; whilst among women, 19 and 16 countries showed increasing incidence and mortality trends, respectively. Among men, the AAPCs ranged from -2.8 to -0.6 (incidence) and -3.6 to -1.1 (mortality) in countries with declining trend, whereas among women the AAPC range was 0.4 to 8.9 (incidence) and 1 to 4.4 (mortality) in countries with increasing trend. Among women, Brazil, Spain and Cyprus had the greatest incidence increase, and all countries in Western, Southern and Eastern Europe reported increasing mortality. These findings highlighted the need for targeted preventive measures.

Objectives: The metabolic impact of inadequate sleep has not been determined in healthy individuals outside laboratories. This study aims to investigate the impact of sleep duration on five metabolic syndrome components in a healthy adult cohort., Methods: A total of 162121 adults aged 20-80 years (men 47.4%) of the MJ Health Database, who were not obese and free from major diseases, were recruited and followed up from 1996 to 2014. Sleep duration and insomnia symptoms were assessed by a self-administered questionnaire. Incident cases of five metabolic syndrome components were identified by follow-up medical examinations. Cox proportional hazard ratios (HRs) were calculated for three sleep duration categories "< 6 hours/day (short)," "6-8 hours/day (regular)," and "> 8 hours/day (long)" with adjustment for potential confounding factors. Analyses were stratified by insomnia symptoms to assess whether insomnia symptoms modified the association between sleep duration and metabolic syndrome., Results: Compared to regular sleep duration, short sleep significantly (p < .001) increased the risk for central obesity by 12% (adjusted HR 1.12 [1.07-1.17]), for elevated fasting glucose by 6% (adjusted HR 1.06 [1.03-1.09]), for high blood pressure by 8% (adjusted HR 1.08 [1.04-1.13]), for low high-density lipoprotein-cholesterol by 7% (adjusted HR 1.07 [1.03-1.11]), for hypertriglyceridemia by 9% (adjusted HR 1.09 [1.05-1.13]), and for metabolic syndrome by 9% (adjusted HR 1.09 [1.05-1.13]). Long sleep decreased the risk of hypertriglyceridemia (adjusted HR 0.89 [0.84-0.94]) and metabolic syndrome (adjusted HR 0.93 [0.88-0.99]). Insomnia symptoms did not modify the effects of sleep duration., Conclusions: Sleep duration may be a significant determinant of metabolic health., (© Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Spatiotemporal analysis is an important tool to monitor changes of tuberculosis (TB) epidemiology, identify high-risk regions and guide resource allocation. However, there are limited data on the contributing factors of TB incidence. This study aimed to investigate the spatiotemporal pattern of TB incidence and its associated factors in mainland China during 2005-2013. Global Moran's I test, Getis-Ord Gi index and heat maps were used to examine the spatial clustering and seasonal patterns. Generalized Linear Mixed Model was applied to identify factors associated with TB incidence. TB incidence presented high geographical variations with two main hot spots, while a generally consistent seasonal pattern was observed with a peak in late winter. Furthermore, we found province-level TB incidence increased with the proportion of the elderly but decreased with Gross Demographic Product per capita and the male:female ratio. Meteorological factors also influenced TB incidence. TB showed obvious spatial clustering in mainland China and both the demographic and socio-economic factors and meteorological measures were associated with TB incidence. These results provide the related information to identify the high-risk districts and the evidence for the government to develop corresponding control measures.

Purpose: To examine the age and gender heterogeneities in the association between socioeconomic status (SES) and the risk of metabolic syndrome (MetS) with biomarker data from Taiwan., Methods: Subjects included 102,201 men and 112,015 women aged 25 and above, from the 2005-2013 MJ Health Survey in Taiwan. SES was measured by education and family income. MetS was defined by the Adult Treatment Panel III criteria for Asian population. Logistic regression analyses were performed by age and gender groups., Results: (1) Higher education level was associated with significantly lower risk of MetS. (2) Higher income was associated with lower MetS risk among women aged under 65, but no association among men of all ages. (3) SES gradients were generally much stronger among women than among men of the same age group. (4) SES gradients reduced over the life course with the exception that income gradient remains flat among men of all ages., Conclusions: Among Chinese in Taiwan, the gender and age heterogeneities in the SES gradients in MetS are similar to those reported for Western societies. This cross-cultural convergence is broadly consistent with the general hypothesis that social conditions are fundamental causes of diseases and health disparities., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This study was to investigate the association between dietary patterns and rhinitis in primary school children. 1,599 students without rhinitis at baseline survey were selected from a primary school children cohort. Information on food consumption, respiratory symptoms, and confounders was collected using questionnaires. Dietary patterns were defined using principal component analysis. Logistic regression was performed to calculate odds ratio (OR) with 95% confidence intervals (95% CI). The incidence of rhinitis during 12 months follow-up was 21.2%. Three patterns were extracted and labeled as pattern I, II and III. Dietary pattern II which had higher factor loadings of legumes, butter, nuts and potatoes was associated with an increased risk of rhinitis (OR: 1.34, 95% CI: 1.01-1.87) when the highest tertile of pattern score was compared to the lowest tertile, after adjusted for confounders. Besides, every 1-unit increase of score of pattern II was also associated with an increased risk of rhinitis (OR: 1.19, 95% CI: 1.05-1.35). Neither pattern I nor Pattern III was observed to be associated with risk of rhinitis. A diet with higher levels of consumption of legumes, butter, nuts and potatoes may increase the risk of allergic rhinitis in primary school children.

Introduction: Metabolic syndrome (MetS) is a public health problem in postmenopausal women. Whole soy foods are rich in unsaturated fats, high quality plant protein and various bioactive phytochemicals that may have a beneficial role in the management of MetS. The aim of the study is to examine the effect of whole soy replacement diet on the features of MetS among postmenopausal women., Methods and Analysis: This will be a 12-month, randomised, single-blind, parallel controlled trial among 208 postmenopausal women at risk of MetS or with early MetS. After 4 weeks' run-in, subjects will be randomly allocated to one of two intervention groups, whole soy replacement group or control group, each for 12 months. Subjects in the whole soy group will be required to include four servings of whole soy foods (containing 25 g soy protein) into their daily diet iso-calorically, replacing red or processed meat and high fat dairy products. Subjects in the control group will remain on a usual diet. The outcome measures will include metabolic parameters as well as a 10-year risk for ischaemic cardiovascular disease. We hypothesise that the whole soy substitution diet will notably improve features of MetS in postmenopausal women at risk of MetS or with early MetS. The study will have both theoretical and practical significance. If proven effective, the application of the whole soy replacement diet model will be a safe, practical and economical strategy for MetS prevention and treatment., Ethics and Dissemination: Ethics approval has been obtained from the Ethics Committee of the Chinese University of Hong Kong. The results will be disseminated via conference presentations and papers in academic peer reviewed journals. Data files will be deposited in an accessible repository., Trial Registration Number: NCT02610322., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Despite the popular use of household cleaning products worldwide, there is no published study investigating the health effects of these products on rhinitis in children., Objective: We sought to investigate the household use of cleaning products and rhinitis patterns in Chinese children., Methods: A total of 2299 children were recruited from 21 primary schools with wide geographic coverage in Hong Kong. Self-administered questionnaires were completed by parents/guardians to collect detailed information on respiratory symptoms and household use of 14 types of chemical cleaning products, as well as clean water. Students were categorized into 4 mutually exclusive rhinitis patterns (never, occasional, frequent, and persistent). The total chemical burden (TCB) score was used as the exposure indicator by calculating the total time of exposure to the 14 cleaning products. Multinomial logistic regression was used to assess the relationship between rhinitis patterns and the use of household cleaning products., Results: Every 10-unit increment of TCB score was associated with an increase in the odds of occasional (odds ratio [OR], 1.21; 95% CI, 1.05-1.41), frequent (OR, 1.36; 95% CI, 1.13-1.60), and persistent (OR, 1.21; 95% CI, 1.01-1.56) rhinitis after adjustment for a wide range of potential confounders. Compared with the children within the lowest tertile of TCB scores, the adjusted ORs of occasional, frequent, and persistent rhinitis in children within the highest tertile were 1.29 (95% CI, 1.01-1.65), 1.97 (95% CI, 1.40-2.76), and 1.67 (95% CI, 1.10-2.54), respectively., Conclusion: Frequent use of chemical cleaning products at home is associated with an increase in the odds of rhinitis in Chinese primary school children., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To study the chemical constituents of the stems from Altingia chinensis., Methods: The stems from Altingia chinensis were extracted with 95% ethanol for reflux,and the extract were evaporated. The chemical constituents were isolated by silica gel chromatography and Sephadex LH-20 column chromatography from petrol ether part and ethyl acetate part of extract. Their structures were identified on the basis of physico-chemical characters and spectroscopic analysis., Results: Eleven compounds were obtained from the stems from Altingia chinensis,which identified as myrsinene( 1),oleanonic aldehyde( 2),3β,23,28-trihydroxyolean-12-ene( 3),ursolic acid-3β-octadecanoate( 4),arjunglucoside Ⅱ( 5),β-sitosterol( 6),daucosterol( 7),trans-resveratrol-3-O-β-D-glucopyranoside( 8),ellagic acid 3,3’-dimethylether( 9),lyoniside( 10) and 3,3’-O-dimethylellagic acid-4’-O-α-L-rhamnoside( 11)., Conclusion: All the compounds are isolated from Altingia chinensis for the first time.

Background: Social changes and economic development are associated with obesity epidemic. This study is to investigate the trends of socio-economic disparity in obesity from 2002 to 2010 in a Chinese population experiencing the world's fastest economic development., Methods: Four standardized surveys were conducted in a population of 85 million residents in Guangdong, China between 2002 and 2010. Multistage random cluster sampling was used to recruit representative samples. Information on socio-economic status (SES), proxied by education, occupation and residential area, was collected by face-to-face interviews. The weight, height and waist circumference of the participants were also measured., Results: Women with low education had an increased BMI of 0.85 kg/m(2), while women with high education had a decreased BMI of 0.16 kg/m(2) (p = 0.032 for interaction test). Similar trends were observed by using occupation and residential area as the SES indicators. Analysis in men yielded similar patterns. Waist circumference increased from 73.7 to 78.4 cm, and the increasing trends of statistical significance (p < 0.01) were observed in both genders and across all SES levels, with the magnitudes of increase in low SES levels being more pronounced. The impact of gradient in food attainment and occupational physical activity across the SES levels may wear off with further economic development, while factors such as health awareness, diet pattern and leisure activity may become increasingly important in driving the disparity., Conclusion: The impact of gradient in food attainment and occupational physical activity across the SES levels may wear off with further economic development, while factors such as health awareness, diet pattern and leisure activity may become increasingly important in driving the disparity. Our findings suggest that health education should focus on the disadvantaged populations on health awareness for adopting healthier diet pattern and increasing physical activity.

Background: Obesity epidemic is related to industrialization and urbanization that have lead to changes in nutrition, lifestyle and socio-economic status. However, information on the trajectory of the obesity epidemic in populations experiencing rapid economic development is limited. We therefore investigate trends in obesity from 2002 to 2010 in a southern Chinese population experiencing world's fastest economic development., Methods: Between 2002 and 2010 four standardized surveys were conducted in a population of 85 million residents in Guangdong, China. Multistage cluster sampling was adopted to recruit representative samples. Weight, height and waist circumference of the participants were measured in a standardized way. The analysis included residents aged between 18 and 69 years. The number of participants included in the present analysis for Surveys conducted in 2002, 2004, 2007 and 2010 were 13058, 7646, 6441 and 8575, respectively., Results: From year 2002 to 2010, the age-standardized Body mass index (BMI) insignificantly changed from 21.7  kg m(-2) to 22.3  kg m(-2), and the prevalence of overweight and overall obesity from 15.8 to 16.6% (both P>0.05). The age-standardized waist circumference increased from 73.7 to 78.4 cm, and prevalence of abdominal obesity increased from 12.9 to 23.7% (both P<0.001). In urban areas, BMI and overall obesity changed little during the 8-year period (BMI increased from 22.6 to 22.7  kg m(-2) and overall obesity changed from 23.7 to 21.4%), whereas there were slight increases of the same in rural areas (BMI increased from 20.8 to 22.1 kg m(-2)and overall obesity increased from 8.2 to 13.3%). Waist circumference and abdominal obesity increased significantly in both areas, but the increase was more pronounced in rural areas (in urban area, waist circumference increased from 75.1 to 78.5 cm and abdominal obesity from 16.8 to 26.5%; in rural area, waist circumference from 72.2 to 78.3 and abdominal obesity from 8.8 to 22.0%)., Conclusions: BMI and overall obesity in this population, which has experienced the world's fastest economic development over the past three decades, has been leveling-off, while waist circumference and abdominal obesity, independent predictors of cardiovascular risk, have continued to rise. Our findings suggest that obesity epidemic transition in rapidly developing populations may be much faster than what has been observed in Western countries.

Current evidence is mixed regarding the association between antihypertensive prescriptions and cancer mortality. We evaluated this association in a large Chinese hypertensive population. We followed for five years all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 in a public healthcare sector of Hong Kong. The association between antihypertensive drug class and cancer mortality was evaluated by Cox proportional hazard models with propensity score matching. Age, gender, socioeconomic status, service settings, district of residence, proportion of days covered reflecting medication adherence, and the number of comorbidities were adjusted. From 217,910 eligible patients, 9500 (4.4%) died from cancer within five years after their first-ever antihypertensive prescription. Most cancer deaths occurred in the digestive (38.9%) and respiratory system (30.4%); the breast (6.2%); and the lympho-hematopoietic tissues (5.3%). The proportion of patients who died from cancer was the highest in the calcium channel blocker (CCB) group (6.5%), followed by thiazide diuretics (4.4%), angiotensin converting enzyme inhibitors (4.2%) and β-blockers (2.6%). When compared with β-blockers, patients prescribed CCBs (Adjusted Hazard Ratio [AHR]=1.406, 95% C.I. 1.334-1.482, p<0.001) were more likely to die from cancer. Thiazide users were also more likely to suffer from cancer deaths (AHR=1.364, 95% C.I. 1.255-1.483, p<0.001), but became insignificant in stratified analysis. The association between cancer mortality and use of CCB, and perhaps thaizide, may alert physicians to the need for more meticulous and comprehensive care of these patients in clinical practice. We recommend prospective studies to evaluate cause-and-effect relationships of these associations., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The objective of this study was to investigate the neurobehavioral effects of long-term occupational exposure to low levels of organic solvent among male printing workers in Hong Kong. A total of 115 printing workers exposed to organic solvents were recruited from the printing divisions of 3 printing factories, and 101 workers from the binding divisions of the same factories constituted the comparison group. Active and passive samplings were used to assess the occupational exposures to solvents. The World Health Organization Neurobehavioral Core Test Battery (WHO-NCTB) was applied to assess the neurobehavioral functions. Both active and passive sampling results showed that solvent levels were higher in the printing divisions than the binding divisions. The scores of Digit Symbol and Pursuit Aiming were poorer among workers in the printing divisions (all p values < .05). There were no significant differences found between the 2 divisions for other WHO-NCTB tests. The scores of Digit Symbol and Pursuit Aiming showed exposure-response relationship with various solvent exposure indices. Prolonged occupational exposure to low levels of organic solvents was associated with adverse neurobehavioral effects among male printing workers in Hong Kong.

Background: Perindopril and lisinopril are two common ACE inhibitors prescribed for management of hypertension. Few studies have evaluated their comparative effectiveness to reduce mortality. This study compared the all-cause and cardiovascular related mortality among patients newly prescribed ACE inhibitors., Methods: All adult patients newly prescribed perindopril or lisinopril from 2001 to 2005 in all public clinics or hospitals in Hong Kong were retrospectively evaluated, and followed up until 2010. Patients prescribed the ACE inhibitors for less than a month were excluded. The all-cause mortality and cardiovascular-specific (i.e. coronary heart disease, heart failure and stroke) mortality were compared. Cox proportional hazard regression model was used to assess the mortality, controlling for age, sex, socioeconomic status, patient types, the presence of comorbidities, and medication adherence as measured by the proportion of days covered. An additional model using propensity scores was performed to minimize indication bias., Results: A total of 15,622 patients were included in this study, in which 6910 were perindopril users and 8712 lisinopril users. The all-cause mortality (22.2% vs. 20.0%, p<0.005) and cardiovascular mortality (6.5% vs. 5.6%, p<0.005) were higher among lisinopril users than perindopril users. From regression analyses, lisinopril users were 1.09-fold (95% C.I. 1.01-1.16) and 1.18-fold (95% C.I. 1.02-1.35) more likely to die from any-cause and cardiovascular diseases, respectively. Age-stratified analysis showed that this significant difference was observed only among patients aged >70 years. The additional models controlled for propensity scores yielded comparable results., Conclusions: The long-term all-cause and cardiovascular related mortality rates of lisinopril users was significantly different from those of perindopril users. These findings showed that intra-class variation on mortality exists among ACE inhibitors among those aged 70 years or older. Future studies should consider a longer, large-scale randomized controlled trial to compare the effectiveness between different medications in the ACEI class, especially among the elderly., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)