Lithium in the Public Water Supply and Suicide Mortality in Greece

The purpose of the present study was to evaluate the association between lithium levels in the public water supply and prefecture-based suicide rates in Greece. Analyses were conducted with respect to lithium levels in 149 samples from 34 prefectures of Greece. The average lithium level was 11.10 μg/l (range 0.1 to 121 μg/l). The results indicate that there is a tendency for lower suicide rates in the prefectures with high levels of lithium in drinking water. Ecological studies explained by researchers Schrauzer and Shrestha have revealed the existence of statistically significant inverse associations between the lithium levels in drinking water and the incidence of suicides, homicides, rapes, possession of narcotic drugs, and in juveniles, the rates of runaway from home. Such a result of inverse relationship was not proven by Kabacs et al., most likely because the differences of the lithium levels in the selection of their case–control samples were not large enough. In addition, probably the selection of random regions in Japan and East England might have been biased. Thus, the addition of small amounts of lithium to the drinking water could provide an effective means to lower the incidence of these conditions in the general population. Furthermore, the nutritional importance of lithium in the form of the carbonate named lithium carbonate (Li₂CO₃) is currently still viewed primarily as a pharmacological agent. The study by Al-Chalabi et al. state that the therapeutic activity of lithium in amyotrophic lateral sclerosis (ALS) is worth investigating. Any drug that can be shown to slow the course of ALS in a clinically significant way and to be safe and well tolerated will be an important advance for patients with this disease.     

Lithium and Other Elements in Scalp Hair of Residents of Tokyo Prefecture as Investigational Predictors of Suicide Risk

The high suicide rates in Japan and several reports of inverse associations of suicide rates with the levels of lithium (Li) in drinking water prompted determinations of Li along with other elements in samples of scalp hair of 100 male and 100 female residents of Tokyo Prefecture. In more than half of the samples of both genders, Li levels were below the instrumental detection limit or below or the lower limit of the laboratory reference ranges. Among other elements, the concentrations namely of cobalt were also frequently below the laboratory reference range, suggesting that low circulating levels of vitamin B(12) were common in this study population. As vitamin B(12) deficiency is associated with depression and other psychiatric conditions, and there is evidence of interactions between Li and vitamin B(12), Li deficiency as well as suboptimal vitamin B(12) status must be considered as potential suicide risk factors. In view of its established positive effects on mood and brain function, an adequate supply of selenium (Se) is important as well. Although the analytical results suggested that the Se status of the subjects was generally adequate, as seafood was a major dietary source of Se, much of it was actually sequestered by mercury and only a fraction was bio-available. In addition, the hair samples were found to contain not insignificant levels of As, Cd, Ni, and Pb, arising from the adventitious presence of these elements in foods and the environment. As these elements also interact with Se in vivo and are known to adversely affect mood and behavior, in investigational studies, subjects at risk need to be evaluated also with respect to these elements.     

Heredity counseling

Abstract

An ecological analysis of infant mortality rates is conducted using data on Texas counties for the years 1968–72. It is found that when counties along the Texas‐Mexico border (which have unreasonably low infant death rates and which are economically less advantaged than the remainder of the counties) are excluded from the analysis, the associations between socioeconomic status variables and infant mortality rates improve considerably. A significant negative correlation between neonatal mortality and per cent Spanish surname is retained and does not disappear when the effects of other relevant variables (per cent Negro, per cent urban, and per cent below poverty) are controlled using partial correlation and regression analysis. Possible explanations for this unexpected finding are suggested, and implications for further research are discussed.     

Toxic cyanobacteria (blue-green algae) in Finnish fresh and coastal waters

A survey of the occurrence of toxic blooms of cyanobacteria in Finnish fresh and coastal waters was made during 1985 and 1986. Toxicity of the freeze-dried water bloom samples was tested by mouse-bioassay (i.p.). Forty-four per cent (83/188) of the bloom samples were found to be lethally toxic. Hepatotoxic blooms (54) were almost twice as common as neurotoxic ones (29). Anabaena was the most frequently found genus in toxic and non-toxic blooms and it was present in all neurotoxic samples. Statistical associations were found between hepatotoxicity and incidence of Microcystis aeruginosa, M. viridis, M. wesenbergii, Anabaena flos-aquae and Anabaena spiroides. Neurotoxicity was statistically associated with Anabaena lemmermannii, Anabaena flos-aquae and Gomphosphaeria naegeliana. Isolation of strains of cyanobacteria confirmed the occurrence of hepatotoxic and neurotoxic strains of Anabaena, as well as hepatotoxic strains of Microcystis and Oscillatoria species.Toxic blooms caused cattle poisonings at three different lakes during the study period. Toxic blooms also occurred in drinking water sources. Our study shows that toxic cyanobacteria are more common in Finnish lakes than would be expected on the basis of animal poisonings. The results of this study show the existence of toxic cyanobacteria in Finnish water supplies and the need for their continued study as agents of water based disease.     

Suicide and net migration in Texas counties, 1970 and 1980

Abstract

Recent research has examined the consequences of migration, with much of this work focusing on “boom” towns. This literature provides a useful framework for studying the consequences of population growth in other settings, however. The boom‐town literature has generally used the social disruption hypothesis, which predicts social disruptions in communities growing rapidly through migration, to explain the results of migration in these communities. Suicide is one social disruption indicator which has not received much empirical attention. According to the social disruption hypothesis, a positive relationship is expected between the net migration and suicide rates. We examine this hypothesis using data from Texas nonmetropolitan counties for the last two decades. We also present separate analyses for metropolitan counties. The results fail to provide support for the hypothesis. There is generally no relationship between net migration and suicide rates in both nonmetropolitan and metropolitan counties. Alternative explanations fail to alter this finding.     

Suicide and net migration in Texas counties, 1970 and 1980

Recent research has examined the consequences of migration, with much of this work focusing on "boom" towns. This literature provides a useful framework for studying the consequences of population growth in other settings, however. The boom-town literature has generally used the social disruption hypothesis, which predicts social disruptions in communities growing rapidly through migration, to explain the results of migration in these communities. Suicide is one social disruption indicator which has not received much empirical attention. According to the social disruption hypothesis, a positive relationship is expected between the net migration and suicide rates. We examine this hypothesis using data from Texas nonmetropolitan counties for the last two decades. We also present separate analyses for metropolitan counties. The results fail to provide support for the hypothesis. There is generally no relationship between net migration and suicide rates in both nonmetropolitan and metropolitan counties. Alternative explanations fail to alter this finding.     

War, mental disorder and suicide

War as a human disaster of major significance has led to an increase in the number of suicides committed by people suffering from mental disorders. Considering the results of similar research, we were particularly interested in the effect that war has on the incidence of suicide among of people with mental disorders. The research included 16,362 patients with mental disorders, treated at the Clinic for Psychiatry at the Clinical Hospital Split during the nine-year timeframe which were divided into pre-war (April 6th 1988- April 7rh 1991), wartime (April 6th 1991 -April 7rh 1994) and post-war (April 6th 1997 - April 7th 2000) periods. We studied the effects of how wartime events upon people with mental disorders in terms of their suicide rates, taking into account gender, age group, and the diagnosis under which they were treated. In our research, we found a statistically significant difference in suicide incidence between three observed periods (prewar April 6th 1988 April 7th 1991; wartime April 6th 1991 -April 7th 1994; and postwar April 6th 1997 -April 7th 2000) with the incidence being the highest during the wartime period (chi2 =9.98: p=0.007). Out of 16,362 patients treated at the clinic during the observed timeframe, a total of 78 people committed suicide. Twenty-two patients committed suicide during the first three year pre-war period; 36, during the three year wartime period; and 20, during the third three year post-war period. With this research we intended to offer a better understanding of the complexity of the suicide problem of mental patients as a phenomenon.     

Identity,activity, and the well-being of adolescents and youths: lessons from young people in a Micronesian society

Comparative studies of the health, well-being, and social functioning of adolescents and youths have, in the past two decades, been focused on young people in developing countries where rapid social, cultural, and economic changes have been associated with dramatic increases in the rates of social problems indicative of poorer mental health. Young people in many Pacific Island societies suffer from some of the highest rates of social problems like suicide and substance abuse in the world. It is generally agreed that the increases in rates of social problems among youths in this region result from increases in psychosocial stress, anger, and frustration surrounding intergenerational conflict within the family. Much less is known about the aspects of everyday experiences of young people in the Pacific that can lead to psychosocial stress and the angry episodes of interpersonal conflict that often precede suicide attempts and binge drinking. This paper examines 40 cases of interpersonal conflict in young men's and women's experiences in the islands of Chuuk of the Federated States of Micronesia to better understand what can lead to elevated levels of psychosocial stress for youths in the Pacific. This study shows that the emotional crises of young people in Chuuk often emerge from the incongruence in their pursuit of valued personal and social identities within the family, the community, and the peer group. Thus youths who experience more incongruity in their engagements across the multiple activity settings of everyday life are at greater risk for stressful experiences.     

Distribution of trace elements in the Houston environment: relationship to mortality from arteriosclerotic heart disease.

The relationship of trace elements to arteriosclerotic heart disease (AHD) was assessed. Samples of water supplies in the Houston area were analyzed periodically for cadmium, lithium, iron and zinc. Mortality data for each of the sampling areas, delineated according to boundary of water service, were used to compute average annual age-adjusted death rates for white males aged 35 to 64 during the years 1969 to 1971. Linear regression analyses were performed on the chemical constituents for the age-adjusted death rates due to AHD. Positive correlation coefficients for lithium and zinc were found to be statistically significant at the 0.05 probability level.     

Presence of Giardia cysts and Cryptosporidium oocysts in drinking water supplies in northern Spain

AIMS: To evaluate the prevalence of Cryptosporidium and Giardia in surface water supplies from the province of Alava, northern Spain, and to investigate possible associations among the presence of these pathogenic protozoa with microbiological, physicochemical and atmospheric parameters. METHODS AND RESULTS: A total of 284 samples of drinking and recreational water supplies were analysed. Cryptosporidium oocysts were found in 63.5% of river samples, 33.3% of reservoirs samples, 15.4% and 22.6% of raw water samples from conventional and small water treatment facilities (respectively), 30.8% of treated water from small treatment facilities, and 26.8% of tap water from municipalities with chlorination treatment only. Giardia cysts were found in 92.3% of river samples, 55.5% of reservoirs samples, 26.9% and 45.2% of raw water samples from conventional and small water treatment facilities (respectively), 19.2% of treated water from small treatment facilities, and 26.8% of tap water from municipalities with chlorination treatment only. The presence of Cryptosporidium and Giardia had significant Pearson's correlation coefficients (P < 0.01) with the turbidity levels of the samples, and a number of significant associations were also found with the count levels for total coliforms and Escherichia coli. The samples were positive for Cryptosporidium significantly (P < 0.05) more frequently during the autumn season than during the spring and winter seasons. No significant differences were found in the seasonal pattern of Giardia. A moderate association (r = 0.52) was found between rainfall and the presence of Cryptosporidium oocysts. CONCLUSIONS: Cryptosporidium and Giardia are consistently found at elevated concentrations in surface waters for human consumption from the province of Alava, northern Spain. SIGNIFICANCE AND IMPACT OF THE STUDY: Water treatments based on rapid filtration process and/or chlorination only are often unsatisfactory to provide safe drinking water, a situation that represents an important public health problem for the affected population because of the risk of waterborne outbreaks.     

Lithium in scalp hair of adults,students, and violent criminals

The lithium content of human hair shows an approximately linear response to extradietary lithium supplementation at dosage levels of up to 2000 μg/d. From the mean hair lithium concentration of 0.063 μg/g in 2648 predominantly American adults, and the reference hair lithium concentrations determined in the present study, the mean lithium intakes were calculated to be 730 μg/d. Hair lithium concentrations were extremely low in nearly 20% of the American samples, and in samples collected in Munich, Germany and Vienna, Austria. Hair lithium levels are low in certain pathological conditions, e.g., heart disease, in learning-disabled subjects, and in incarcerated violent criminals. The highest levels were observed in samples of a lithium-treated psychiatric patient. A statistically highly significant direct association was observed between the hair lithium and cobalt concentrations, which suggests a role of lithium in the transport and distribution of vitamin B₁₂. Interactions of lithium with other trace elements are also discussed.     

Down syndrome, water fluoridation, and maternal age

It has been claimed that there is a positive association between the frequency of Down syndrome and the fluoridation of drinking water. It has also been suggested that this association is most pronounced in young women. Recent congenital malformations data obtained from birth certificates from large U.S. cities have been analyzed. Some cities had fluoridated water supplies, while others had supplies deficient in fluoride. The rates of Down syndrome in the cities with fluoridated and in those with non-fluoridated water supplies were comparable. In addition, there was no indication of any maternal age-specific association.     

Lithium-Induced Hypothyroidism: Oxidative Stress and Osmotic Fragility Status in Rats

The present study was conducted to explore the possible effects of different doses of lithium carbonate on thyroid functions, erythrocyte oxidant–antioxidant status, and osmotic fragility. Twenty-four Wistar-type male rats were equally divided into three groups: groups I and II received 0.1 and0.2 % lithium carbonate in their drinking water, respectively, for 30 days. The rats in group III served as controls, drinking tap water without added lithium. At the end of the experimental period, the erythrocyte osmotic fragility and the levels of triiodothyronine (T₃), thyroxine (T₄), thyroid-stimulating hormone (TSH), malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) were measured in blood samples. Compared to controls, there was a statistically significant increase of TSH but decreases of the T₃ and T₄ levels in group II. Both experimental groups showed a statistically significant increase of the maximum osmotic fragility limit. The minimum osmotic fragility values of the animals in group II were statistically higher than those of controls. The standard hemolytic increment curve of both experimental groups was shifted to the right when compared to the curve obtained from the controls. Also, relative to controls, the activities of MDA and SOD were significantly higher and the GSH level lower in group II, but not so in group I. The results of the present study show that treatment with lithium carbonate may result in thyroid function abnormalities, increased oxidative damage, and possible compromise of the erythrocyte membrane integrity resulting from increased osmotic fragility.     

Measurement of HPRT mutations in splenic lymphocytes and haemoglobin adducts in erythrocytes of Lewis rats exposed to ethylene oxide

Young adult male Lewis rats were exposed to ethylene oxide (EO) via single intraperitoneal (i.p.) injections (10-80 mg kg-1) or drinking water (4 weeks at concentrations of 2, 5, and 10 mM) or inhalation (50, 100 or 200 ppm for 4 weeks, 5 days week-1, 6 h day-1) to measure induction of HPRT mutations in lymphocytes from spleen by means of a cloning assay. N-ethyl-N-nitrosourea (ENU) and N-(2-hydroxyethyl)-N-nitrosourea (HOENU) were used as positive controls. Levels of N-(2-hydroxyethyl)valine (HOEtVal) adducts in haemoglobin (expressed in nmol g-1 globin) were measured to determine blood doses of EO (mmol kg-1 h, mM h). Blood doses were used as a common denominator for comparison of mutagenic effects of EO administered via the three routes. The mean HPRT mutant frequency (MF) of the historical control was 4.3 x 10(-6). Maximal mean MFs for ENU (100 mg kg-1) and HOENU (75 mg kg-1) were 243 x 10(-6) and 93 x 10(-6), respectively. In two independent experiments, EO injections led to a statistically significant dose-dependent induction of mutations, with a maximal increase in MF by 2.3-fold over the background. Administration of EO via drinking water gave statistically significant increases of MFs in two independent experiments. Effects were, at most, 2.5-fold above the concurrent control. Finally, inhalation exposure also caused a statistically significant maximal increase in MF by 1.4-fold over the background. Plotting of mutagenicity data (i.e., selected data pertaining to expression times where maximal mutagenic effects were found) for the three exposure routes against blood dose as common denominator indicated that, at equal blood doses, acute i.p. exposure led to higher observed MFs than drinking water treatment, which was more mutagenic than exposure via inhalation. In the injection experiments, there was evidence for a saturation of detoxification processes at the highest doses. This was not seen after subchronic administration of EO. The resulting HPRT mutagenicity data suggest that EO is a relatively weak mutagen in T-lymphocytes of rats following exposure(s) by i.p. injection, in drinking water or by inhalation.     

Epidemiological,Clinical, and Biochemical Study of Endemic Dental and Skeletal Fluorosis in Punjab

The incidence of dental fluorosis in 46,000 children in the Punjab was assessed and compared with the fluoride content of their water supplies. Ten villages were selected for more detailed studies of skeletal as well as dental fluorosis.Factors other than the fluoride contect of the drinking water which were found to influence the incidence and the severity of fluorosis were the chemical composition of the water and in particular its calcium content; the duration of exposure; sex and occupation; nutritional status; and climatic and geological variations. The role of fluoride-containing foodstuffs has yet to be assessed.     

How Trace Element Levels of Public Drinking Water Affect Body Composition in Turkey

Since waterborne minerals appear in ionic form and are readily absorbed by the gastrointestinal tract, drinking water could be a crucial source of mineral intake. However, no comprehensive research has yet determined how trace elements in drinking water relate to body composition. We aimed to assess the relationship between clinically important trace elements in public drinking water and body composition in average, overweight and obese individuals in Turkey. The study’s population consisted of 423 participants: 143 overweight, 138 obese and 142 healthy control individuals, grouped according to clinical cutoff points of body mass index (BMI). We measured levels of lithium (Li), nickel (Ni), lead (Pb), silicon (Si), tin (Sn), strontium (Sr), boron (B), aluminium (Al), barium (Ba) and rubidium (Rb) in samples from wells of municipal water by using inductively coupled plasma mass spectrometry. We gauged all the participants’ body composition measurements with a BC-418 body composition analyser. In all the participants, body weight values showed significant positive correlations with Ni levels in drinking water, as did BMI values with Al levels and percentage of obesity with Ni, Si and B levels. In particular, Ni levels showed significant positive correlations with the basal metabolic rate, activity calories, and total activity of participants. Giving findings showing correlations between obesity-related parameters and Al, Si, B and Ni content in drinking water, we hope that these associations will be clarified with further studies including cellular, experimental and clinical studies. Hence, medical practitioners must be aware of trace element levels in drinking water for overweight and obese patients.     

A ten-year survey of Giardia cysts in drinking water supplies of Seoul, the Republic of Korea

To understand the distribution of Giardia cysts in drinking water supplies in Seoul, Korea, we collected water samples quarterly at 6 intakes in the Han River, its largest stream and 6 conventional water treatment plants (WTPs) serving drinking water, from 2000 to 2009. Giardia cysts in each of 10 L water were confirmed in 35.0% of intake water samples and the arithmetic mean was 1.65 cysts/10 L (range 0-35 cysts/10 L). The lowest cyst density was observed at Paldang and Kangbuk intakes, and the pollution level was higher at 4 intakes downstream. It seemed that these 4 intakes were under influence of Wangsuk stream at the end of which cysts were found in all samples with the mean of 140 cysts/10 L. The annual mean number of cysts was 0.21-4.21 cysts/10 L, and the cyst level at the second half of the 10 years was about 1/5 of that at first half on average. The cysts were more frequently found in winter, and their mean density was 3.74 cysts/10 L in winter and 0.80-1.08 cysts/10 L in other seasons. All finished water samples collected at 6 WTPs were negative for Giardia in each of 100 L sample for 10 years and cyst removal by physical process was average 2.9-log. It was concluded that conventional water treatment at 6 WTPs of Seoul appears to remove the cysts effectively under the present level of their source water. Domestic wastewater from the urban region could be an important source of Giardia pollution in the river.     

Contaminated small drinking water supplies and risk of infectious intestinal disease: a prospective cohort study

Background

This study sought to identify whether elevated risk of infectious intestinal disease (IID) exists in contaminated small water supply consumers compared with consumers drinking from small supplies complying with current standards and whether this effect is modified by age.

Methodology and Principal Findings

A prospective cohort study of 611 individuals receiving small supplies in England was conducted. Water supplies received sanitary inspection and examination for indicator bacteria and participants maintained a daily record of IID. Regression modeling with generalized estimating equations that included interaction terms between age and indicators of fecal pollution was performed. Crude IID prevalence was 9·3 days with symptoms/1000 person days (95%CI: 8·4, 10·1) and incidence was 3·2 episodes/1000 person days (95%CI, 2·7, 3·7) or 1·2 episodes per person year. Although there was no overall association between IID risk and indicator presence, there was strong interaction between age and indicator presence. In children under ten, relative risk (RR) of IID in those drinking from enterococci contaminated supplies was 4.8 (95%CI: 1.5, 15.3) for incidence and 8.9 (95%CI: 2.8, 27.5) for prevalence. In those aged 10 to 59, IID risk was lower but not statistically significant.

Conclusions

Contaminated small water supplies pose a substantial risk of IID to young children who live in homes reliant on these supplies. By contrast older children and adults do not appear to be at increased risk. Health care professionals with responsibility for children living in homes provided by very small water supplies should make parents aware of the risk.     

Uptake and transfer of lithium in pregnancy and lactation in the mouse

The uptake of lithium in pregnant and lactating mice as well as its transfer to their respective fetuses (18-day postcoitum) and nurslings (11- to 15-day postnatal) were quantified. Lithium carbonate in concentrations of 1 or 2 mg/ml given ad libitum in drinking water produced plasma levels in adults ranging from 0.46 to 1.7 meq/liter. In pregnancy, plasma lithium of the adult was twice that of the fetal plasma. However, there was no statistical difference in brain lithium content between adults and fetuses at the 1- or 2-mg dosage. A significant decrease in bone lithium content was found in fetuses as compared to adults at the 2-mg level. During lactation the plasma lithium of nurslings was one-fourth to one-sixth that of the mothers' plasma. Lithium content in brain and in bone of adults was significantly lower than those of nurslings at both drug concentrations. No apparent effects on adults, fetuses, or nurslings were noted in the short term.     

Prevention of bacterial diarrhea by pasteurization of drinking water in Kenya

Diarrheal disease is one of the major causes of morbidity and mortality in developing countries. Drinking water is a primary transmission route of infectious diarrheagenic bacteria in a rural area of Kenya (Microbiol. Immunol. 41: 773-778, 1997). We tried to prevent diarrhea at villages with approximately 1,500 households in Kenya by pasteurizing drinking water. A durable simple thermoindicator which changes color at 70 C was used as an indicator of pasteurization. The number of households in which drinking water was coliform bacteria-free increased from 10.7% to 43.1% after adoption of a pasteurization practice. Consequently, the incidence of severe diarrhea among people drinking pasteurized water was significantly lower than in people taking raw water (odds ratio=0.55, P=0.0016). The reduction ratio of the incidence after pasteurization was nearly equivalent with that after the adoption of a boiling method. Employment of women leaders as fieldworkers and demonstration of bacterial colony disappearance on agar plates by pasteurization also affected reduction of the diarrheal incidence.