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Journal of Affective Disorders Mar 2020Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium concentration in drinking water and suicide mortality in the general population.
METHODS
A systematic search was conducted in Web of Knowledge, PubMed, ScienceDirect, and Scopus to find papers reporting the crude relationship between drinking water lithium and suicide incidence in the general population until June 2019. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model.
RESULTS
We retrieved 308 English original articles, of which 13 ecologic studies with a total sample size of 939 regions and one cohort study with a sample size of 3,740,113 people were eligible for the meta-analysis. A significant relationship was found between the lithium concentration in drinking water and reduced suicide mortality (OR= 0.42; 95% CI: 0.27-0.67; p-value <0.01). Ten studies reported gender-specific responses to lithium, with the pooled estimates as follows: OR= 0.54; 95% CI: 0.35-0.84; p-value <0.01 for men, OR= 0.70; 95% CI: 0.48-1.01; p-value =0.057 for women, and OR= 0.63; 95% CI: 0.47-0.83; p-value <0.01 for total.
LIMITATIONS
The study was limited to the assessment of the crude relationship between lithium exposure and suicide rate without considering the role of confounders.
CONCLUSIONS
Lithium in drinking water is dose-dependently associated with reduced suicide mortality at least in ecological studies. However, we need well-designed clinical trials to confirm the protective effect of drinking water lithium intake against suicide.
Topics: Cohort Studies; Drinking Water; Female; Humans; Lithium; Male; Odds Ratio; Suicide
PubMed: 32056756
DOI: 10.1016/j.jad.2019.12.027 -
PloS One 2020Microplastics (MPs) are omnipresent in the environment, including the human food chain; a likely important contributor to human exposure is drinking water.
BACKGROUND
Microplastics (MPs) are omnipresent in the environment, including the human food chain; a likely important contributor to human exposure is drinking water.
OBJECTIVE
To undertake a systematic review of MP contamination of drinking water and estimate quantitative exposures.
METHODS
The protocol for the systematic review employed has been published in PROSPERO (PROSPERO 2019, Registration number: CRD42019145290). MEDLINE, EMBASE and Web of Science were searched from launch to the 3rd of June 2020, selecting studies that used procedural blank samples and a validated method for particle composition analysis. Studies were reviewed within a narrative analysis. A bespoke risk of bias (RoB) assessment tool was used.
RESULTS
12 studies were included in the review: six of tap water (TW) and six of bottled water (BW). Meta-analysis was not appropriate due to high statistical heterogeneity (I2>95%). Seven studies were rated low RoB and all confirmed MP contamination of drinking water. The most common polymers identified in samples were polyethylene terephthalate (PET) and polypropylene (PP), Methodological variability was observed throughout the experimental protocols. For example, the minimum size of particles extracted and analysed, which varied from 1 to 100 μm, was seen to be critical in the data reported. The maximum reported MP contamination was 628 MPs/L for TW and 4889 MPs/L for BW, detected in European samples. Based on typical consumption data, this may be extrapolated to a maximum yearly human adult uptake of 458,000 MPs for TW and 3,569,000 MPs for BW.
CONCLUSIONS
This is the first systematic review that appraises the quality of existing evidence on MP contamination of drinking water and estimates human exposures. The precautionary principle should be adopted to address concerns on possible human health effects from consumption of MPs. Future research should aim to standardise experimental protocols to aid comparison and elevate quality.
Topics: Drinking Water; Environmental Monitoring; Food Chain; Microplastics; Polyethylene Terephthalates; Polypropylenes; Public Health; Water Pollutants, Chemical
PubMed: 32735575
DOI: 10.1371/journal.pone.0236838 -
Chemosphere Jul 2024Estrogenic compounds are the endocrine disruptors that receive major attention because of their ability to imitate the natural female hormone, 17β-estradiol and cause...
Estrogenic compounds are the endocrine disruptors that receive major attention because of their ability to imitate the natural female hormone, 17β-estradiol and cause adverse effects on the reproductive system of animals. The presence of estrogenic compounds in drinking water is a warning to assess the risks to which human beings are exposed. The present work has the objectives of carrying out a systematic review of studies that investigated estrogenic compounds in drinking water around the world and estimate the human health and estrogenic activity risks, based on the concentrations of each compound reported. The systematic review returned 505 scientific papers from the Web of Science®, SCOPUS® and PubMED® databases and after careful analysis, 45 papers were accepted. Sixteen estrogenic compounds were identified in drinking water, from the classes of hormones, pharmaceutical drugs and personal care products, plasticizers, corrosion inhibitors, pesticides and surfactants. Di-(2-ethylhexyl) phthalate (DEHP) was the compound found at the highest concentration, reaching a value of 1.43 mg/L. Non-carcinogenic human health risk was classified as high for 17α-ethynilestradiol and DEHP, medium for dibutyl phthalate, and low for bisphenol A. The estrogenic activity risks were negligible for all the compounds, except DEHP, with a low risk. None of the estrogenic compounds presented an unacceptable carcinogenic risk, due to estrogenic activity. However, the risk assessment did not evaluate the interactions between compounds, that occurs in drinking water and can increase the risks and adverse effects to human health. Nonetheless, this study demonstrates the need for improvement of drinking water treatment plants, with more efficient technologies for micropollutant removal.
Topics: Drinking Water; Water Pollutants, Chemical; Estrogens; Endocrine Disruptors; Humans; Risk Assessment; Animals
PubMed: 38821126
DOI: 10.1016/j.chemosphere.2024.142463 -
The Cochrane Database of Systematic... Sep 2015Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of schoolchildren and the vast majority of adults. Milk may... (Review)
Review
BACKGROUND
Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of schoolchildren and the vast majority of adults. Milk may provide a relatively cost-effective vehicle for fluoride delivery in the prevention of dental caries. This is an update of a Cochrane review first published in 2005.
OBJECTIVES
To assess the effects of milk fluoridation for preventing dental caries at a community level.
SEARCH METHODS
We searched the Cochrane Oral Health Group Trials Register (inception to November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 10), MEDLINE via OVID (1946 to November 2014) and EMBASE via OVID (1980 to November 2014). We also searched the U.S. National Institutes of Health Trials Register (https://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (http://apps.who.int/trialsearch) for ongoing trials. We did not place any restrictions on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs), with an intervention and follow-up period of at least two years, comparing fluoridated milk with non-fluoridated milk.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial risk of bias and extracted data. We used standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
We included one unpublished RCT, randomising 180 children aged three years at study commencement. The setting was nursery schools in an area with high prevalence of dental caries and a low level of fluoride in drinking water. Data from 166 participants were available for analysis. The study carried a high risk of bias. After three years, there was a reduction of caries in permanent teeth (mean difference (MD) -0.13, 95% confidence interval (CI) -0.24 to -0.02) and in primary teeth (MD -1.14, 95% CI -1.86 to -0.42), as measured by the decayed, missing and filled teeth index (DMFT for permanent teeth and dmft for primary teeth). For primary teeth, this is a substantial reduction, equivalent to a prevented fraction of 31%. For permanent teeth, the disease level was very low in the study, resulting in a small absolute effect size. The included study did not report any other outcomes of interest for this review (adverse events, dental pain, antibiotic use or requirement for general anaesthesia due to dental procedures).
AUTHORS' CONCLUSIONS
There is low quality evidence to suggest fluoridated milk may be beneficial to schoolchildren, contributing to a substantial reduction in dental caries in primary teeth. Due to the low quality of the evidence, further research is likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There was only one relatively small study, which had important methodological limitations on the data for the effectiveness in reducing caries. Furthermore, there was no information about the potential harms of the intervention. Additional RCTs of high quality are needed before we can draw definitive conclusions about the benefits of milk fluoridation.
Topics: Animals; Cariostatic Agents; Child; Child, Preschool; Dental Caries; Fluoridation; Fluorides; Humans; Milk; Randomized Controlled Trials as Topic
PubMed: 26334643
DOI: 10.1002/14651858.CD003876.pub4 -
The Cochrane Database of Systematic... Aug 2015Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of schoolchildren and the vast majority of adults. Milk may... (Review)
Review
BACKGROUND
Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of schoolchildren and the vast majority of adults. Milk may provide a relatively cost-effective vehicle for fluoride delivery in the prevention of dental caries. This is an update of a Cochrane review first published in 2005.
OBJECTIVES
To assess the effects of milk fluoridation for preventing dental caries at a community level.
SEARCH METHODS
We searched the Cochrane Oral Health Group Trials Register (inception to November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 10), MEDLINE via OVID (1946 to November 2014) and EMBASE via OVID (1980 to November 2014). We also searched the U.S. National Institutes of Health Trials Register (https://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (http://apps.who.int/trialsearch) for ongoing trials. We did not place any restrictions on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs), with an intervention and follow-up period of at least two years, comparing fluoridated milk with non-fluoridated milk.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial risk of bias and extracted data. We used standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
We included one unpublished RCT, randomising 180 children aged three years at study commencement. The setting was nursery schools in an area with high prevalence of dental caries and a low level of fluoride in drinking water. Data from 166 participants were available for analysis. The study carried a high risk of bias. After three years, there was a reduction of caries in permanent teeth (mean difference (MD) -0.13, 95% confidence interval (CI) -0.24 to -0.02) and in primary teeth (MD -1.14, 95% CI -1.86 to -0.42), as measured by the decayed, missing and filled teeth index (DMFT for permanent teeth and dmft for primary teeth). For primary teeth, this is a substantial reduction, equivalent to a prevented fraction of 31%. For permanent teeth, the disease level was very low in the study, resulting in a small absolute effect size. The included study did not report any other outcomes of interest for this review (adverse events, dental pain, antibiotic use or requirement for general anaesthesia due to dental procedures).
AUTHORS' CONCLUSIONS
There is low quality evidence to suggest fluoridated milk may be beneficial to schoolchildren, contributing to a substantial reduction in dental caries in primary teeth. Due to the low quality of the evidence, further research is likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There was only one relatively small study, which had important methodological limitations on the data for the effectiveness in reducing caries. Furthermore, there was no information about the potential harms of the intervention. Additional RCTs of high quality are needed before we can draw definitive conclusions about the benefits of milk fluoridation.
Topics: Animals; Cariostatic Agents; Child, Preschool; Dental Caries; Fluoridation; Fluorides; Humans; Milk; Randomized Controlled Trials as Topic
PubMed: 26329305
DOI: 10.1002/14651858.CD003876.pub3 -
Presence of heavy metals in drinking water resources of Iran: a systematic review and meta-analysis.Environmental Science and Pollution... Jun 2021Water quality is one of the most important indices for public health especially for drinking water consumptions. This study was conducted to survey the presence of heavy... (Meta-Analysis)
Meta-Analysis Review
Water quality is one of the most important indices for public health especially for drinking water consumptions. This study was conducted to survey the presence of heavy metals in drinking water resources of Iran using a systematic review and meta-analysis. The literature search was conducted in data bases of PubMed, Web of Science, EMBASE, Scopus, Google Scholar, and some Persian databases up to 31 July 2018. Of all the articles reviewed (1151 articles), 61 papers were eligible for systematic review. Results indicated variable heterogeneity between studies for different pollutants (I between 0 and 100). A subgroup analysis was performed for three different types of water resources such as drinking water, groundwater, and surface water to find the possible source of the heterogeneity. The pooled mean concentration level of iron was the highest at 255.8 (95% CI = 79.48-432.13 μg/l) and vanadium the lowest at 3.21 (95% CI = 1.45-4.98 μg/l). The sequence of metal concentration (μg/l) in descending order is as follows: Fe (255.8) > B (159.81) > Al (158.5) > Zn (130.73) > As (85.85) > Mn (51.61) > Cu (47.98) > Se (42.68) > Pb (37.22) > Co (22.76) > Mo (18.92) > Ni (16.79) > Cr (13.47) > Hg (4.49) > Cd (4.19) > V (3.21). The mean pooled concentration level of Al, As, Se, Pb, and Cd was higher than the WHO guideline and Iran Standard, and the rest of the metals had lower mean pooled concentration level. Pb and Cd were the common heavy metals that existed in all subgroups. As a recommendation, the relationship assessment of water parameters and heavy metals could be addressed in future studies of Iran's water resources.
Topics: Drinking Water; Environmental Monitoring; Iran; Metals, Heavy; Risk Assessment; Water Pollutants, Chemical; Water Resources
PubMed: 33791963
DOI: 10.1007/s11356-021-13293-y -
The Science of the Total Environment Feb 2021Regular monitoring of drinking water in China is carried out by the Centers for Disease Control and Prevention at all levels and some articles were published for the...
Regular monitoring of drinking water in China is carried out by the Centers for Disease Control and Prevention at all levels and some articles were published for the public to understand the status of drinking water. However, these published articles were limited to small areas and reported almost exclusively in Chinese. In order to give the public a comprehensive understanding of the situation of drinking water sanitation in China and provide specific directions for ensuring drinking water safety in the future, we review the sanitation status of drinking water in different regions of China from 2007 to 2018, the changes over time and the factors affecting drinking water quality by means of systematic review for the first time. Our results show that the quality of drinking water in China has shown an upward trend from 2007 to 2018. The qualification rate of urban drinking water (85.51%) was much higher than that of rural drinking water (51.12%), and the dry season (56.93%) was higher than the wet season (50.54%), and the terminal tap water (59.88%) was higher than the outlet water of waterworks (55.87%). In addition, the regions with low qualification rate of water quality in China were mainly distributed in several southern provinces, such as Yunnan, Guizhou, Hainan, etc. What's more, the qualified rate of the three microbiological indicators was the lowest, all below 85%. All the results indicate that the sanitation status of drinking water in China is unsatisfactory, and the biggest risk affecting water safety is microbial pollution. The central and local governments should work hard to improve people's drinking water quality and continue to strengthen the treatment and supervision of drinking water, especially in rural areas and undeveloped southern areas.
Topics: China; Drinking Water; Humans; Rural Population; Sanitation; Water Quality; Water Supply
PubMed: 33310571
DOI: 10.1016/j.scitotenv.2020.143923 -
International Journal of Environmental... May 2022Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for... (Review)
Review
Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for these outbreaks has yet to be published. Here, we systematically review the published literature on cholera outbreaks in India between 2011 and 2020. We searched studies in English in three databases (MEDLINE, EMBASE, and Web of Science) and the Integrated Disease Surveillance Program that tracks cholera outbreaks throughout India. Two authors independently extracted data and assessed the quality of the included studies. Quantitative data on the modes of transmission reviewed in this study were assessed for any change over time between 2011-2015 and 2016-2020. Our search retrieved 10823 records initially, out of which 81 full-text studies were assessed for eligibility. Among these 81 studies, 20 were eligible for inclusion in this review. There were 565 reported outbreaks between 2011 and 2020 that led to 45,759 cases and 263 deaths. Outbreaks occurred throughout the year; however, they exploded with monsoons (June through September). In Tamil Nadu, a typical peak of cholera outbreaks was observed from December to January. Seventy-two percent (33,089/45,759) of outbreak-related cases were reported in five states, namely Maharashtra, West Bengal, Punjab, Karnataka, and Madhya Pradesh. Analysis of these outbreaks highlighted the main drivers of cholera including contaminated drinking water and food, inadequate sanitation and hygiene (including open defecation), and direct contact between households. The comparison between 2011-2015 and 2016-2020 showed a decreasing trend in the outbreaks that arose due to damaged water pipelines. Many Indians still struggle with open defecation, sanitation, and clean water access. These issues should be addressed critically. In addition, it is essential to interrupt cholera short-cycle transmission (mediated by households, stored drinking water and foodstuffs) during an outbreak. As cholera is associated with deprivation, socio-economic development is the only long-term solution.
Topics: Cholera; Disease Outbreaks; Drinking Water; Humans; India; Sanitation
PubMed: 35565133
DOI: 10.3390/ijerph19095738 -
International Journal of Hygiene and... Aug 2019Increasing the quantity of water available for consumption and hygiene is recognized to be among the most efficient interventions to reduce the risk of water-related...
BACKGROUND
Increasing the quantity of water available for consumption and hygiene is recognized to be among the most efficient interventions to reduce the risk of water-related infectious diseases in low and middle-income countries. Such impacts are often associated with water supply accessibility (e.g. distance or collection time) and used to justify investment in improving access.
OBJECTIVE
To assess the relationship between the water source location and the quantity of water available in households from low and middle-income countries by identifying the effects of interventions aiming to improve access, and to compare the indicators and measures used to collect information.
METHODS
We systematically searched seven databases (i.e. Cairn, Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Women's Studies International) along with grey literature for articles reporting indicators and measures of accessibility and quantity. We found 6492 records, of which 20 studies were retained that met the review's inclusion criteria.
RESULTS
Most studies were conducted in rural settings and provided suggestive findings to describe an inverse relationship between accessibility and quantity. Overall, a wide range of indicators and measures were used to assess water accessibility and quantity in the selected studies along with their association. The lack of consistency raised concerns regarding comparability and reliability of these methods.
CONCLUSIONS
The review findings support the hypothesis that the quantity of water available in households is a function of the source location, but the inconsistency in study outcomes highlights the need to further investigate the strength and effects of the relationship.
Topics: Developing Countries; Drinking Water; Humans; Water Resources
PubMed: 31320308
DOI: 10.1016/j.ijheh.2019.06.011 -
PloS One 2015Packaged water products provide an increasingly important source of water for consumption. However, recent studies raise concerns over their safety. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Packaged water products provide an increasingly important source of water for consumption. However, recent studies raise concerns over their safety.
OBJECTIVES
To assess the microbial safety of packaged water, examine differences between regions, country incomes, packaged water types, and compare packaged water with other water sources.
METHODS
We performed a systematic review and meta-analysis. Articles published in English, French, Portuguese, Spanish and Turkish, with no date restrictions were identified from online databases and two previous reviews. Studies published before April 2014 that assessed packaged water for the presence of Escherichia coli, thermotolerant or total coliforms were included provided they tested at least ten samples or brands.
RESULTS
A total of 170 studies were included in the review. The majority of studies did not detect fecal indicator bacteria in packaged water (78/141). Compared to packaged water from upper-middle and high-income countries, packaged water from low and lower-middle-income countries was 4.6 (95% CI: 2.6-8.1) and 13.6 (95% CI: 6.9-26.7) times more likely to contain fecal indicator bacteria and total coliforms, respectively. Compared to all other packaged water types, water from small bottles was less likely to be contaminated with fecal indicator bacteria (OR = 0.32, 95%CI: 0.17-0.58) and total coliforms (OR = 0.10, 95%CI: 0.05, 0.22). Packaged water was less likely to contain fecal indicator bacteria (OR = 0.35, 95%CI: 0.20, 0.62) compared to other water sources used for consumption.
CONCLUSIONS
Policymakers and regulators should recognize the potential benefits of packaged water in providing safer water for consumption at and away from home, especially for those who are otherwise unlikely to gain access to a reliable, safe water supply in the near future. To improve the quality of packaged water products they should be integrated into regulatory and monitoring frameworks.
Topics: Drinking Water; Escherichia coli; Feces; Humans; Product Packaging; Water Microbiology; Water Quality
PubMed: 26505745
DOI: 10.1371/journal.pone.0140899