Background and Purpose: Despite the recent growing interest in the cancer–stroke association, the long-term effect, and organ-specific association with stroke incidence in subjects with cancer have not been clearly defined.Methods: Data were obtained from the Korean National Health Insurance Service National Sample Cohort database between 2002 and 2015. To investigate the effects of cancer on stroke incidence, subjects were classified into cancer and non-cancer groups based on the period after cancer diagnosis and origin organ of cancer. To minimize the effects of selection bias, we performed a propensity score matching analysis with covariates of demographic data, vascular risk factors, antithrombotics use and statin use. Incident stroke was diagnosed based on operational definition and classified into ischemic stroke and hemorrhagic stroke.Results: Data of 20,707 subjects with cancer and 675,594 without cancer were analyzed for 7 follow-up years. The subjects with cancer had higher risk of any stroke  than those without cancer. Similar trend was found for ischemic stroke , but not for hemorrhagic stroke. The risk of stroke was increased in subjects with cancer in the digestive organ, respiratory and intrathoracic organ, and “others ” in 3 years; however, the association disappeared thereafter except those with “others” cancer. Chemotherapy increased the risk of ischemic stroke .Conclusions: Cancer increases the risk of stroke at 3 years after the diagnosis of cancer, and the effect was maintained for 7 years. The association between cancer and stroke incidence depends on the organ from which the cancer originated and chemotherapy. Thromboembolism, a well-known complication affecting 7–18% of cancer patients, is among the major causes of death . TraditiTherefore, we investigated the effects of cancer on stroke incidence over a 7 year period considering the time from the index cancer diagnosis and cancer location using data from a nationwide cohort, the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database, which represents the entire Korean population .The study analyses used the NHIS-NSC database in South Korea, which contains a population-based cohort of >1,000,000 subjects established by the NHIS . BecauseAs NHIS-NSC database is a publicly opened data, the institutional review board of our institution approved the waive of reviewing this study (SMC 2016-07-168).N = 1,041,441). The inclusion criterion was the presence of at least one NHIS record during that period. Among them, patients aged <20 years, those who had a history of cancer or stroke between 2002 and 2005, or those who died at the index year and month were excluded. The eligible subjects were classified into a cancer group and a non-cancer group.We selected the target population among those who were included in the NHIS-NSC database between January 1, 2006, and December 31, 2008  and V193 code of the Health Insurance Review and Assessment Service. Cancer group was subdivided according to the original organ location of the cancer: “lip, oral cavity, and pharynx”; “digestive organs”; “respiratory and intrathoracic organs”; and “others.” NHIS in Korea does not provide information about detailed cancer originated from genital organ or breast due to sensitive personal information issue.For the diagnosis of stroke, we developed an appropriate operational definition  as follows: those who had an ICD-10 code of I60–I63, who had been admitted for ≥3 days, and who underwent computed tomography (CT) or magnetic resonance imaging (MRI) in the brain . SubjectVascular risk factors used in this study included hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, heart failure, and atrial fibrillation. The detailed operational definitions used in this study are provided in the To determine the independent association between cancer and stroke, details of anticoagulant, antiplatelet agent, and statin use before stroke onset were also obtained. We classified the cancer group into those treated by chemotherapy and those not-treated by chemotherapy to investigate the effect of chemotherapy in stroke risk. We used drug classification code according to purpose which was provided by Korean Health Insurance Review and Accessment Service (HIRA). The list is composed of 2,949 anti-cancer drugs (based on drug product name) including both angiogenesis inhibitors and hormone agents. To clarify the association between chemotherapy and stroke incidence, only administration of anti-cancer drug before the onset of stroke was considered as chemotherapy group among stroke group.http://www2.sas.com/proceedings/sugi29/165-29.pdf). Among these matched-pair data, we performed a stratified subdistribution hazard analysis, conditional logistic regression analysis, or Bowker's test as appropriate. All statistical analyses were conducted using the Statistical Analysis System (SAS) software version 9.4 , and statistical significance was considered at two-sided p < 0.05.The primary objective of this study was to examine the difference in stroke incidence between the cancer and non-cancer groups. To do this, a patient's index date was defined as the date of the first diagnosis in the cancer group, whereas those in the non-cancer group was the date of the first visit for medical attention after January 1, 2006. In both groups, events within 7 years were captured until the end of the study, which was defined as the last visit in the past 7 years from the index date. As death is a common competing risk in patients with cancer, a risk survival analysis was performed to calculate the cumulative stroke incidence in both groups and then compared using Gray's test for an equality of cumulative incidence functions. Meanwhile, the relative risk of stroke was assessed using a proportional hazard model for subdistribution proposed by Fine and Gray with a competing risk in the analysis. To improve the analytical robustness, we considered both unadjusted and adjusted models with covariates . The baseline characteristics of the study subjects are presented as frequency and proportion, whereas comparisons of the proportions between cancer and control groups were performed using the chi-square test. To minimize the effects of selection bias, we performed a propensity score matching analysis with a 1:1 intergroup ratio. The propensity score was calculated using a multiple logistic regression model with covariates of sex, age group, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, heart failure, atrial fibrillation, and medication use . Matching for propensity score was performed by 5 Greedy methods using OneToManyMATHCH algorithm  and ischemic stroke  in covariate-adjusted models with or without the consideration of death as a competing event. However, the difference in hemorrhagic stroke failed to reach statistical significance in the covariate-adjusted models.During the study period, subjects in cancer group had 613 (2.96%) ischemic strokes, 67 (0.32%) hemorrhagic strokes, and 29 (0.14%) both ischemic and hemorrhagic strokes, respectively. In contrast, those in the non-cancer group had 526 (2.54%) ischemic strokes, 77 (0.37%) hemorrhagic strokes, and 26 (0.13%) both ischemic and hemorrhagic strokes, respectively. The cumulative incidences for any, ischemic, and hemorrhagic strokes and death were higher in the cancer group than in the non-cancer group on univariate analysis . The sigp for interaction = 0.7347; In the subgroup analysis of subjects with data about smoking status, no significant interaction was observed between smoking status and cancer for ischemic stroke (p < 0.0001) and multivariate analyses . Furthermore, a significant statistical difference was observed in an adjusted model with a competing risk analysis . Ischemic stroke showed a similar pattern of association with the cancer group . However, hemorrhagic stroke was not associated with cancer as observed in the analysis of the original population cohort.A total of 20,707 pairs of cancer and non-cancer subjects were selected by propensity score matching. The baseline characteristics were well-balanced after matching . During In the original cohort, the significant intergroup difference in the relative HR for any and ischemic strokes was maintained during the first 3 years . HoweverThe trends were the same in matched cohort. The significant effects of cancer on the occurrence of any or ischemic stroke was maintained for 3 years and 1 year, respectively. Hemorrhagic stroke was not affected by cancer from the first year after the diagnosis.After the 7 years follow-up, the digestive organs (C15–C26) were most frequently affected by cancer, followed by the group categorized as “others” (C50–C58) and respiratory/intrathoracic organs (C30–C39). During the total follow-up period, only “others” showed a significant difference in ischemic stroke compared to the matched controls. However, considering the elapsed time after cancer diagnosis, the digestive organs (C15–C26), respiratory/intrathoracic organs (C30–C39), and “others” categories were significantly associated with the occurrence of ischemic stroke in the first year .The cumulative risk of death at 7 years was higher in subjects with any, ischemic, and hemorrhagic strokes than those without . The relAmong the subjects with cancer, 6,211 (30.0%) had been administered with chemotherapeutic agents at least once. The distribution of vascular risk factors between those with and without chemotherapy groups according to age group is presented in In this nationwide cohort study, the cumulative incidence, and relative hazard for ischemic stroke were higher in the cancer than non-cancer group in Korean population. The higher risk for stroke in the cancer group was maintained for 3 year since the diagnosis of cancer, and this early difference in risk remained constant up to 7 years. The co-morbid cancer with stroke resulted in higher risk of death than those without stroke. Besides, the history of chemotherapy was independently associated with the incident stroke.Recently, a growing body of evidence regarding the association between cancer and stroke has been accumulated. However, most of studies are limited to comparisons between the vascular risk factors or stroke patterns and speculation of its pathogenesis. Although several epidemiological approaches have been attempted, they covered only specific cancer type or featured short follow-up durations , 22, 23.As in the previously described studies, the association between cancer and stroke incidence was time-dependent. The higher risk for ischemic stroke in cancer group persisted until 3 years. However, the difference in the risk of stroke disappeared between subjects with and without cancer at each period after 3 years. Several speculations address the cause of the association between cancer and ischemic stroke that was apparent only during the early period after the diagnosis.First, tumor-related hypercoagulability could be attributed to the occurrence of stroke because early cancer should have a high tumor burden. Therefore, the finding that increased stroke risk until 3 years may reflect that most cancer patients either have achieved cure or long-term remission or have died by 3 years. Second, in a study that used population-based claims data from the Taiwan NHI, after the cancer diagnosis, the increased stroke risk was the greatest within the first 6 months. The authors conjectured that the high fatality rate in the late stage could have resulted in the higher stroke risk at the early period after the diagnosis . HoweverAnother interesting finding was that the risk of ischemic stroke was limited to the specific cancer type. Previous studies reported that lung , 10, colIn this study, the occurrence of cancer was differentially associated with stroke, showing that only ischemic stroke was increased by the occurrence of cancer, whereas hemorrhagic stroke was not. Previous studies reported conflicting data. In Taiwan National Health Insurance, lung cancer and head and neck cancer increased the risk of hemorrhagic stroke , 7. HoweThis study has several limitations. First, as this study was based on medical insurance claims database (NHIS-NSC), the diagnostic accuracy of cancer or stroke cannot be guaranteed. In South Korea, all cancer patients are registered in the National Cancer Registration and Statistics system, and a governmental reimbursement policy for cancer patients is specifically regulated by the NHIS, which can improve the cancer diagnosis reliability. In terms of stroke diagnosis, we aimed to improve the diagnostic reliability by excluding patients who had a stroke history of at least 5 years, which minimizes the possibility of carrying the previous diagnosis of stroke. Furthermore, an operational definition was used for the diagnosis of stroke. Similar strategies were used in previous studies that used NHIS-NSC database data . Second,In despite of those limitations, several strong points enhance the value of this study. This is the first report revealing the significant association between cancer and stroke incidence for the entire population in Korea. We followed up the subjects until 7 years after the diagnosis of stroke without missing data because of the thorough nature of the NHIS. All kinds of cancers were included, which demonstrates organ specificity. In addition, the hypothetical influence of chemotherapy on ischemic stroke incidence was validated by subgroup analysis.Our study showed that stroke risk increased in the cancer group compared with the control group, the risk was significantly high in the first 3 years, and its difference of stroke risk remained constant during the follow-up period such as a legacy effect. The risk of stroke was different according to organs where cancers originated from. Chemotherapy was independently associated with increased risk of ischemic stroke.Because of the policy of National Health Insurance Service of Korea, dataset are not permitted to be taken out of the NHIS.W-KS and JL supervised the project. H-SJ, JC, JS, J-WC, OB, G-MK, W-KS, and JL designed the study. JC, W-KS, and JL acquired and analyzed the data. H-SJ, JS, J-WC, OB, and G-MK interpreted the results. H-SJ and JC drafted the manuscript, and JS, J-WC, OB, G-MK, W-KS, and JL made critical revision of the manuscript.W-KS received honoraria for lectures from Pfizer, Sanofi-Aventis, Otsuka Korea, Dong-A Pharmaceutical Co., Ltd, Beyer, Daewoong pharmaceutical co. Ltd., Daiichi Sankyo Korea Co., Ltd. Boryung pharmaceutical, study grant from Daiichi Sankyo Korea Co., Ltd., and consulting fee from OBELAB Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The aim of this study was to determine if the problem-solving therapy (PST) helps control metabolic variables in patients with type 2 diabetes mellitus (T2DM) who show depressive and anxiety symptoms.1c) concentrations and poor metabolic control.T2DM is a chronic-degenerative multifactorial disease. It is considered one of the main public health problems in the world, and it represents an important social and economic burden. It is frequently associated with major depression and anxiety disorders, which are related with high glycated hemoglobin , the Beck Depression Inventory, and the Beck Anxiety Inventory were applied at the beginning and, to those who continued, at the end of the PST, as well as four months later.We initially included 123 patients diagnosed with T2DM from five primary care centers (PCC) in Mexico City. HbAP<0.001), as well as in total cholesterol (P=0.002), HbA1c (P=0.05), and low-density lipoprotein (LDL) (P=0.022). The PST helps reduce depressive and anxiety symptoms and may help stabilize glucose and cholesterol up to four months. Further studies on this area are recommended. If our findings are confirmed, the PST could help improve the quality of life of thousands of individuals with psychiatric-metabolic co-morbidity who only visit PCC.In total, 36 patients completed the PST and the follow-up. There was a significant decrease in depressive and anxiety symptoms ( It is considered one of the main public health problems in the world, as it represents an important social and economic burden, and one of the leading causes of disability and premature death >7%), which is a risk factor for vascular disease   was confirmed in individuals aged 35 years or older with previous diabetes  . However, current treatments also require psychosocial interventions that have been shown to be effective. The World Health Organization recommends the problem-solving therapy (PST) for depression disorders treatment and to reduce depressive symptomatology  have also been evaluated; the Collaborative Care is a model that has proven to be effective for chronic-degenerative diseases; it involves both training and consultation-liaison by a team of quasi-specialists  who work with the patient and advice of General Practitioners (GPs) in PCC in order to improve the quality of healthcare  at five PCC in Mexico City. Informed consent was obtained. Enrollment was consecutive, according to their scheduled appointment at the PCC. Recruitment and enrollment was done by students of Medicine on their last year of Medical School who worked during one year in the PCC. This research was approved by the Ethics and Scientific Committees of an institute specialized in psychiatry, located in Mexico City.Once patients arrived to the CCD at the PCC, their clinical mental health history was completed and the Kessler psychological distress scale (K-10) was applied as a screening tool to determine if they were probable cases or not (see Instruments section). Those who scored ⩾21 on the K-10 were invited to participate in the PST (probable cases). In total, 123 patients met inclusion criteria, 36 decided to participate and completed the study, 34 accepted but dropped out during the study, and 53 decided not to participate in the PST but they accepted completing the basal clinimetric instruments and metabolic measurements.The Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used for those with K-10 score of 21 or higher. Patients that participated in the PST received it weekly, for 6–8 weeks. At the end of the therapy, and at follow-up four months after the completion of the therapy, the same clinimetric instruments were administered.1c, central glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. They were taken at the same stages of the clinimetric instruments . Subjects with K-10⩽20 points  =3,329, P=0.039], mainly between the lost to follow-up and refused to participate groups; educational attainment  and marital status  did not show differences between the three groups; however, employment was significantly different between groups  =0,401, P=0.671]; however type of treatment showed statistical differences for insulin , metformin , and other drugs used for diabetes co-morbidity , but not for glibenclamide   completed the study, 34 (27.64%) dropped out, and 53 (43.09%) did not participated in the PST. The percentage of women was similar in the three groups; there were more women (83.74%) than men; age showed statistical difference between groups [P=0.007] , mainly P=0.918] .Table 1SF=0.435, P=0.649]; BDI ; BAI ; HbA1c ; central glucose ; total cholesterol ; LDL ; HDL ; triglycerides  =38.375, P<0.001]; BDI ; BAI ; and total cholesterol . There was also a decrease in HbA1c  and LDL . The rest of the variables showed a decrease, but it was not statistically significant: glucose ; triglycerides ; HDL had no significant increase in three measurements   was 30.43%, at the end of the therapy 50% and four month later (end of the follow-up) 56.25%.Basal glycemic control . Most of the original sample study participants  did not accept to participate in the PST or dropped out during the study. Reasons maybe related to money. Patients with Regarding age, we found statistical differences between the group that dropped out (mean=49.2) and the group that did not accept the PST (mean=53.8), although we do not know the reason for this difference.The drugs most commonly used for diabetes were insulin, metformin, and drugs to treat co-morbidity.In basal measurements we found significant differences in triglycerides mainly between those who completed (mean=166.91) and those who dropped out (mean=240.30), but we do not know the reasons of these differences.1c, total cholesterol, and LDL. As slight increase was identified for HDL, without representing a significant difference, but some other variables were not significantly different . A larger number of patients may be needed to confirm this result , and that this collaboration improves primary healthcare  in order to have results available to other investigators. In addition, we followed the CONSORT recommendations for clinical trials to obtain results that can be extrapolated.One of the major limitations of the studies in primary care in Mexico is that it is difficult to periodically and routinely assess all important metabolic variables such as LDL, HDL, and triglycerides. This is because the PCC do not have adequate infrastructure or inputs required for all studies; on the other hand, patients who attend these PCC belong to a low economic level, so often they cannot afford the studies.These barriers, typical of the study population, limit long-term monitoring. They were disclosed to authorities for decision-making and modifications thereof, but changes require long-term strategies.


Background: Parental educational attainment is shown to be protective against health problems; the Minorities’ Diminished Returns theory, however, posits that these protective effects tend to be smaller for socially marginalized groups particularly blacks than whites. Aims: To explore racial differences in the effect of parental educational attainment on body mass index (BMI) in a national sample of US adolescents. Methods: In this cross-sectional study, we used baseline data of 10,701 (8678 white and 2023 black) 12–17 years old adolescents in the Population Assessment of Tobacco and Health . Parental educational attainment was the predictor. Youth BMI (based on self-reported weight and height) was the dependent variable. Age, gender, ethnicity, and family structure were covariates. Race was the focal moderator. Results: Overall, higher parental educational attainment was associated with lower youth BMI. Race, however, moderated the effect of parental educational attainment on BMI, suggesting that the protective effect of parental educational attainment on BMI is significantly smaller for black than white youth. Conclusions: In the United States, race alters the health gains that are expected to follow parental educational attainment. While white youth who are from highly educated families are fit, black youth have high BMI at all levels of parental educational attainment. This means, while the most socially privileged group, whites, gain the most health from their parental education, blacks, the least privileged group, gain the least. Economic, social, public, and health policymakers should be aware that health disparities are not all due to lower socioeconomic status (SES) of the disadvantaged group but also diminished returns of SES resources for them. Black–white health disparities exist across all high socioeconomic status (SES) levels. Body Mass Index (BMI) is now universally considered a marker of health ,2. High Compared to white youth, black youth have higher BMI in the US ,8,9. EpiSimilarly, black youth have a higher risk of overweight and obesity compared to their white counterparts ,25,26. DGiven the protective effect of high socioeconomic status (SES) against high BMI in youth ,32,33, aMinorities’ Diminished Returns (MDRs) ,45 propoIn a cross-sectional study that used data from the National Survey of Children’s Health , 67,610 white and 9095 black children of 2–17 years old were compared for the effect of parental income on childhood obesity. This study showed that family income reduces the odds of obesity for white but not black children . In a 1-We conducted this study to test whether race shows an interaction with parental educational attainment on youth BMI in the US. In line with the MDRs literature ,39,46, wThis is a secondary analysis of wave 1 of the Population Assessment of Tobacco and Health (PATH) youth data. Funded by the NIH and FDA, PATH is a state-of-the-art study on health problems such as tobacco use, substance use, and related behavioral issues among US adolescents and adults. Overall, PATH has enrolled 53,178 individuals who were 12 years or older at baseline. From this sample, 13,650 were youth (12–17 years old). Wave 1 data were collected between 2013 and 2014. Although PATH has also recruited adults, this analysis is only focused on youth. We were interested in the association between SES and BMI rather than a change in BMI, we limited our analysis to cross-sectional data (Wave 1) of the PATH study. We used the publicly available PATH data set.The PATH study’s population of interest in Wave 1 was the civilian, non-institutionalized US population of 12–17 years old individuals in the US. The PATH study used a four-stage stratified area probability sample design. Stage one was the selection of a stratified sample of geographical primary sampling units (156 PSUs). These PSUs were either a county or a group of counties. Stage two formed and sampled smaller geographical segments in each PSU. Stage three sampled residential addresses, using the US Postal Service Computerized Delivery Sequence Files. The fourth stage was the selection of one person from each sampled household.The current analysis is limited to youth who had complete data on age, gender, parental education, race, ethnicity, and BMI. Our final analytical sample was 10,701 (8678 white and 2023 black) adolescents. For the purpose of this study, the sample was specifically restricted to white and black respondents. .The study variables include age, gender, race, ethnicity, parental educational attainment, marital status of the parents (family structure), and BMI.Age was a dichotomous variable as below: (1) 12 to 15 years old, and (2) 16 to 17 years old. Public PATH data set does not provide more granular data on age.Race was self-identified and operationalized as a dichotomous variable: blacks versus whites. Ethnicity was also self-identified and operationalized as a dichotomous variable: Non-Hispanic versus Hispanic.Parental educational attainment was a five-level variable as below: (1) less than high school, (2) high school graduate or equivalent, (3) some college including no degree or an associate degree, (4) Bachelor’s degree, and (5) advanced degree. This was a continuous measure ranging between 1 and 5.The study calculated the BMI using participants’ height and weight. First, height and weight were recorded in feet/inches and pounds, respectively. In the second step, height and weight were calculated in meters and kilograms. BMI was calculated by dividing weight (kilograms) by height squared (meters squared).Built on the MDRs, our study is mainly focused on the interaction between race and parental educational attainment (SES). As a result, the main predictor of interest is parental educational attainment. The outcome of interest is BMI. The moderating variable is race. We expect high parental educational attainment to be associated with lower BMI in the overall sample, however, we expect this effect to be weaker in black compared to white youth. We call weaker effects of SES indicators in the non-white group as diminished returns of SES.We analyzed the data using SPSS 23.0 . We applied survey design weights. SPSS uses a Taylor series linearization to re-estimate standard errors (SE) of the survey data. For bivariate analysis, we tested the bivariate correlations between our study variable using the Pearson correlation test. No two variables had correlation coefficients equal or larger than 0.50 so we ruled out any collinearity between our independent variables. This strategy was taken for the full sample and also racial groups.Model 1 did not have the interaction term. Model 2 included the interaction term. Model 3 was specific to white youth. Model 4 was specific to black youth. From our models, we reported regression coefficient (b), Standard Error (SE), 95% Confidence Interval (CI), and p-value. We did not impute data. Complete data cases were entered into our analysis.For multivariable analysis, we applied linear regression models. Overall, we ran four models. We ran the first two models in the pooled sample. Then we ran two additional models across racial groups. We tested the assumptions and requirements for linear regression models. This includes ruling out the multicollinearity between the independent variables. We also confirmed the near to normal distribution of error terms of our linear regression models.We did not control for income for methodological and conceptual reasons. Some evidence suggests that income may be the reason educational attainment does not generate the very same health across racial and ethnic groups ,48. ThusAll youth who participated in the PATH study provided assent. All their parents/guardians/caregivers provided written informed consent. The PATH study protocol was approved by the Westat institutional review board.n = 8,678, 81.1%) or black .This study included 10,701 US adolescents who were either white (p <0.01), have parents with higher educational attainment , and married parents . We did not find significant differences in age and gender between white and black youth. On average, black youth had higher BMI than white youth  ( < 0.01) .Model 1 was the non-interactive model that entered the main effects of educational attainment and race in addition to the covariates. Model 2 also added an interaction term between race and educational attainment. Covariates were the same in these two models.Model 1, high educational attainment was associated with lower BMI. In this model, being black was also associated with higher BMI. Model 2 revealed an interaction between race and parental educational attainment on BMI, suggesting that high parental educational attainment has a smaller protective effect on BMI for black than white youth. This was evident by a regression coefficient which was negative for the main effect of parental educational attainment (Model 1) and a regression coefficient which was positive for the interaction term between race and parental educational attainment (Model 2) (Based on Model 2) .Model 3 and Model 4 were estimated in whites and blacks, respectively.Model 3, high educational attainment was associated with lower BMI in whites. Model 4, however, did not show the same pattern of association for blacks. That is, high educational attainment showed a statistically significant protective effect on BMI for whites but not blacks  . There iWe need to better understand the role of unsafe environment , food deWe see race as a political and social rather than a biological construct . Social The results may have some implications for public, economic, social, and health policies. First, we argue that policymakers should not assume that SES indicators are equally protective against health problems including high BMI for various racial groups. As new policies are being implemented, there is a need for “impact analysis” to track effects on the population overall, as well as sub-population differences in such effects. Given the limited benefit of high SES on BMI among black youths, providing incentives for health in predominantly black areas may be required. An enhancement to the quality of education and schooling in predominantly black areas are also needed. We need programs that enable black communities, with the translation of educational attainment, to obtain tangible health outcomes. Finally, the elimination of racism and segregation is needed if we want to help black families be able to turn their educational attainment to health outcomes. Societal interventions, through public policies, would probably be more effective than individual-level interventions that overemphasize individual choices and preferences and ignore social stratification .National and local policies are needed to reduce the racial/ethnic and SES disparities in BMI, including those that are due to MDRs ,68,98,99There is also a need to conduct further studies that help us understand, based on race, why some youth with highly educated parents remain susceptible to obesity and high BMI. Research should assess how the density of healthy and unhealthy food, the walkability of living areas, availability of green spaces and parks, and other structural determinants of obesity, mediate or moderate the MDRs observed in this study. There is also a need to test the efficacy of various policies in reducing MDR-related disparities in health.This study had some methodological and conceptual limitations. First, given the cross-sectional design of our data, causal inferences are not plausible. The sample size was imbalanced across racial groups, which is a common pattern in national surveys. In addition, we did not have access to a wide range of other SES indicators of the household such as income, employment, and occupation type. Finally, this study used an over-simplistic measure of BMI. Several other indicators such as waist to hip ratio, sub-cutaneous adiposity, and other indicators need to be studied. The results should be interpreted with knowing that we did not compare non-Hispanic white and non-Hispanic blacks but all groups of whites and blacks. However, our robustness analysis did not show any difference in the interaction term when we limited the sample to non-Hispanic whites and blacks. Finally, we did not include area-level SES indicators. Despite these limitations, we believe that this study extends the existing literature on race, SES, and BMI. We had previously shown similar findings in the Fragile Families and Child Well-being Study (FFCWS) data. However, FFCWS was a non-representative study composed of economically at-risk families who were only selected from large cities. The results of the current study, however, are generalizable to the US youth sample, given the nationally representative nature of the sample.In the United States, racial minority status limits the health gains that follow parental educational attainment. While high parental educational attainment helps people stay healthy and avoid high risk behaviors such as smoking, the most privileged group gains the most and the least privileged groups gain the least from such potential. As a result, we should expect an additional risk of high BMI and obesity in middle-class blacks. Researchers should not take a minimalistic and over-simplistic approach by focusing on health disparities among blacks of low SES. They should consider that health inequalities and disparities can be observed across all SES levels, and the SES gap is only a part of the story. Given that health disparities are also faced by middle-class blacks, health disparity solutions should focus on other sections of black communities, that may not be low SES but still have increased risk of poor health outcomes. Policymakers should also go beyond equalizing SES and address the barriers that are more common in the lives of blacks and hinder their ability to turn their available resources into tangible health outcomes.


Little is known about the impact of the school environmental context on the emerging trend of childhood obesity in Africa. We examined the association of the schools’ contextual factors with body mass index (BMI), abdominal obesity and overweight (including obesity) in urban Ghana.Using cross-sectional data from 543 school children aged 8–11 years attending 14 primary schools, we applied multilevel logistic regressions and linear regression models to investigate the association of child- and school level attributes with overweight, abdominal obesity, and BMI.p <  0.05), abdominal obesity , and overweight , with school contextual levels accounting for 19.7, 20.6, and 30.0% of the total variability observed in BMI, abdominal obesity and overweight respectively. Attending high socioeconomic (SES) level school, private school and school with increased after-school recreational facilities were associated with higher BMI. Children were more likely to be overweight if they attended a high SES level school, had access to healthful foods at school, and after-school recreational facilities. With regards to abdominal obesity, attending a school with increased physical activity facilities decreased the odds of abdominal obesity; however the odds increased if they attended a school with access to after-school recreational facilities.We observed significant variance of the random effects of schools in BMI (2.65, A number of school-level factors were associated with BMI, overweight and abdominal obesity of children in the present study. Our results provide support for improved school environment to reduce overweight. Obesity among children presents a significant public health concern globally , 2 makinSchools are identified as one of the potential settings to deliver nutrition and physical activity interventions aimed at reducing childhood obesity , 9 as scThis was a school-based cross-sectional study with data collected in 543 school children aged 8–11 years in the Adentan Municipality of Greater Accra Region, an urban area in Ghana. We used a two-stage random sampling method to select schools and recruit the study participants. Briefly, 14 schools (eight private and six public) were selected from 148 basic schools  in the Municipality. Five hundred and sixty-two (562) healthy children aged 8–11 years who provided parental and child approval were enrolled from the selected schools. Anthropometric data was collected by objective methods. Child- and school- level variables were obtained by self-report.The outcome variable was child weight status, defined as BMI, overweight (including obesity), and abdominal obesity.2. BMI-for-age Z-score (zBMI) was computed with the WHO AnthroPlus v.1.0.4 and used to categorise pupils into overweight (zBMI > = 1.0 SD) or not overweight (zBMI < 1.0 SD) ; availability of cafeterias [2.66 ] and shops [3.47 ] at the schools; and after-school recreational facilities [1.82 ] were significantly associated with abdominal obesity in the univariable analyses. In the mutually adjusted model, additional variables that tended to be related to abdominal obesity  in the univariable analyses were included. For every extra unit increase in PA facility index, the likelihood of abdominal obesity significantly decreased by 0.78 , whereas the availability and accessibility of after-school recreational facilities increased the odds by 1.64 . Individual level variables were not significantly associated with the odds of abdominal obesity.As shown in Table p < 0.05). The ICC was 0.197, indicating that 19.7% of the total variance observed in child BMI existed at the school level. In model 2 , none of the variables  were significantly associated with BMI. At the school level, model 3, school level SES , private school , availability of school cafeteria  and shops , healthful foods , less healthful foods  and after-school recreational facilities  predicted child BMI. In model 4, , child age , school level SES , private school , and after-school recreational facilities  predicted BMI. At the individual level, none of the child level variables considered in the present study made substantial contributions to the overall variability in BMI. Nonetheless, in model 4, we observed a significant contribution of child age.Table Our results indicate that generally, private schools tended to have facilities that promote healthy choices , and also unhealthy options (food environment) compared to public schools, which were resource-constrained. The proportions of children with abdominal obesity and overweight (including obesity) were higher in private schools. We found that individual and school level factors are independently and jointly related to BMI, abdominal obesity and overweight in these children. The school context explained between 19.7 and 30.0% of the school level variability in weight status. We found significant associations of child weight status with school type, school-level SES, availability of school cafeterias  and school shops , healthful foods, less healthful foods, PA facilities index, availability and accessibility of after-school recreational facilities. With respect to individual level variables, only age was significantly related to BMI. School policies and practices on physical activity were unrelated to child weight status.School type explained the highest percentage of variability in individual child BMI. We observed that children attending private and higher SES schools have higher BMI, and increased odds of abdominal obesity and overweight compared to their peers attending public and lower SES schools. When controlling for individual and school-level variables, the association with school-level SES was seen with BMI and overweight, but not abdominal obesity. The school type continued to be linked with only BMI, but the direction of the association changed such that children attending private schools had lower BMI compared to their counterparts attending public schools. Our findings paralleled those from prior research among African populations that suggested that attending affluent, private or high SES school increases the odds of overweight and obesity , 24. On School food environment has a significant impact on children’s eating behaviours  and subsThis analysis adds to an earlier study that found that less healthful foods at school was positively associated with higher BMI and obesity/overweight , 12. PriAmong the physical activity environments considered in the present study, only PA facility index was significantly associated with abdominal obesity, but not overweight or BMI. Availability and accessibility to play equipment and resources provide children with the opportunities to be physically active during school hours. Children attending schools that had more PA facilities both on and off grounds tend to have lower odds of abdominal obesity than their counterparts who were attending schools that were poorly-resourced, consistent with existing research . In the After-school programmes may promote increased participation in extracurricular physical activity and related-health outcomes among children and adolescents . Our resStrengths of the present study include the application of multilevel modelling to account for the hierarchical nature of the data; and use of objective measures of height and weight. There are limitations of the present work which should be noted. The cross-sectional design of the study precludes the inferences of causal relationships. At best, we could say that associations exist between the examined variables and the outcome variables. Another potential source of limitation was that maternal educational, a significant predictor of child weight was not controlled for in the analysis. We did not report on dietary and physical activity behaviours of the children at school which could provide explanations to the observed variability since the present work focused on school environment and weight outcomes.A number of school-level factors were associated with BMI, overweight and abdominal obesity of the children in the present study. Unhealthy weight status was significantly higher in children in private compared to public schools. The fact that children spend significant amount of time in schools could present a window of opportunity to impact healthy lifestyle behaviours which are likely to be maintained through adulthood thereby reducing the prevalence of overweight. Our results add to the limited and inconsistent findings in this area and provide support for improved school environment to reduce the overweight epidemic.


In this study, potential protective effects of Bortezomib (Bort), as a proteasome inhibitor, were investigated on the uterus of ovariectomized rats by histological, morphometric and immunohistochemical methods.Sprague dawley strain female rats  were used. Animals in the control group  were not exposed to any treatment. Ovariectomy was performed on the experimental groups. They (n=12) were divided into ovariectomy  and Bortezomib  subgroups. Twelve weeks later, the rats were perfused. Then, uterine tissues were removed and examined by morphometrical, and light and electron microscopy methods. In addition, immunoreactivity of nuclear factor-kappa (NF-κB) was evaluated.In this study, 18 Morphometric and histopathological evaluations showed that Bort was effective in the uterus and protects the layer structures and the cells.In the light of these findings, we suggest that for proteasome inhibitor particularly Bort is thought to be useful through proteasome inhibition and NF-κB pathway. Biological aging is associated with gradual decrease of cell metabolism and basic functions; inevitably it is a process that resulted in death . AccordiNuclear factor-kappa (NF-κB) is a transcription factor; it promotes some cytokines, cell adhesion molecules, transcription of pro-angiogenic molecules and suppresses apoptosis , 11. It Ovariectomy is the surgical removal of the ovaries. Ovariectomy is an operation that may be performed in some diseases such as cancer or ovarian cysts or can be performed with prophylactic hysterectomy to reduce the chance of development of ovarian and breast cancer . HoweverBoth normal and the cancer cells contain proteasome. General duty of proteasomes includes degradation of damaged or useless proteins via running an enzyme that the procedure is named proteolysis. The primary function of the proteasome is to regularly degrade damaged proteins within the cell . ProteasBortezomib (Bort) has emerged as a rational approach for treatment of cancer  and it iIn the current study, to detect the possible protective effects of Bort, it was used as inhibitor on the uterus of the rats, which were subjected to ovariectomy procedure, and their uterus was investigated by histopathological and immunohistochemical methods. Experimental animalsAll experimental procedures were approved by the Institutional Committee on Animal Care, Use, and Research and performed according to the Guide for the Care and Use of Laboratory Animals .Sprague dawley) were used. The materials were obtained from Atatürk University Medical Experimental Research and Application Center (ATADEM). Animals were divided into three groups (n=6 per group) as follows: Group I (Cont): Healthy and untreated Control group. This group was perfused after 12 weeks of feeding in the same laboratory conditions without any application of experimental procedures. Group II (Ovt): Animals in this group were perfused after 12 weeks and ovariectomy operation, at the age of 24 weeks. Group III (Bort): After waiting for a healing process of 8 weeks, the ovariectomized rats in this group were administered with 0.2 mg / kg Bort intraperitoneally (IP) during the period of 4 weeks, 2 times in a week.Eighteen 12-weeks-old female rats  and xylazine  at the end of the experiment. After perfusion, the uterus tissues of all rats were removed. Immediately after taking the uterus biopsies, they were fixed in 10% formalin solution for 72 hours. Then, the obtained tissue samples were evaluated by routine histologic, immunohistochemical and stereology methods.Ovariectomy operation The second and third group female rats were under anesthesia with 20 mg/kg dose thiopental sodium. After that, 2-3 cm incision, reaching the ovaries, was made in the lateral side of abdomen, and the ovaries were taken unilaterally. Metimazole sodium was provided postoperatively for anesthesia, with a dose of 25 mg/kg. For a week, infection was prevented by giving appropriate doses of penicillin for rats every day and making wound dressings. After being ovariectomized, the rats were fed with normal diet and water for 8 weeks to apply aging; it has been adjusted to the required time. Bort application procedure was started after 8 weeks (60 days) from ovariectomy operation. For this purpose, 3.5 mg Bort was dissolved in 7 ml isotonic solution and 1 ml of the solution containing 0.5 mg Bort was divided into falcon tubes. This solution of 8 ml was injected to each rat in the Bort group. In other words, each rat was administered with IP 0.2 mg/kg Bort. This application was repeated two times a week for 1 month.The uteruses were then removed from all animals and processed by graded alcohols  and xylene . Then, they were immersed in paraffin series and embedded in fresh paraffin .Sections were cut into 5 μm thicknesses from the blocked uterus tissues by using a rotary microtome (Leica RM2125RT). Each slide was stained with hematoxylin–eosin dye (H–E) for light microscopic examination, and stereological analysis . For stereological analysis, a computer-assisted analysis system called Stereo Investigator software version 9.0 was used .Immunohistochemical procedure-1 citrate buffer (pH 6.8) for 10 min at high set in microwave. Waited at room temperature for 20 min with Ultra V block, tissues preincubated dropwise with primary antibody for an hour. Then, it was incubated for 20 min with secondary antibody labelled with biotin and 30 min with streptavidin peroxidase complex. Chromogen 3-amino-9-ethyl carbazole and Mayer hematoxylin were used for staining the floor. Before dropping primary antibody, similar processes were also applied for negative control.For the immunohistochemical evaluation, sections were taken to polylysine glass and were then stained for NF-κB (p65) using streptavidin-biotin-peroxidase method . After the process of sections deparaffinization, to block endogenous peroxidase activity, they were prepared in distilled water and incubated for 30 min in 10% hydrogen peroxidase. For removal of antigen, sections were boiled in 10 mmol lElectron microscopyWhen animals under anesthesia, 5% glutaraldehyde were dropped on the uterus and then uterine tissues were removed. Then, it was incubated for 1 hr in 5% glutaraldehyde solution. At the end of incubation time, it was washed with Millonig buffer 4 times for 15 mi. After washing with buffer, it was incubated with 1% osmium tetroxide for 1.5 hours in the dark. It was washed again with Millonig buffer 4 times for 15 min and the dehydration process was passed. For dehydration, the tissues were incubated in acetone series, propylene oxide and Araldite CY 212 , respectively. After polymerization, sections at 70 nm thickness were taken on the 200 mesh copper grids by an ultramicrotome . Then, the grids were examined and photographed under the electron microscope .Stereological analysesIn this study, morphological structure of the uterus was evaluated stereologically. For this purpose, the thickness of the endometrium, myometrium, and perimetrium layers was detected. Besides the total uterine volume, lumen of uterine, layer of endometrium, myometrium, perimetrium and volume of vessels located in this layer was calculated with Cavalieri principle. Furthermore, the mean diameter and area of uterine glands were calculated by using the Nucleator method.Volume estimation with the Cavalieri principleThe most commonly used method in stereological volume calculations is the Cavalieri principle. In this study, the volumes of sections taken from uterus samples were estimated using Cavalieri principle , 34. As  V=t x a/p x ΣPWhere V, is the mean volume of the uterus; t, the mean section thickness; a/p, the inter-point area; and ∑P, the total number of points hitting whole serial sections of the uterus.Estimating the average area of uterine gland with nucleator methodThe average area of the endometrial glands in all sections was calculated by computerized stereological analysis system. In this process, the basic principles of stereology “CE” were held in mind. Counting took place by considering the coefficent error value; after switching to other areas of respective field, randomly and step by step scanning the entire surface of a predetermined range of systematic section was started. After determining the appropriate step interval in the X-Y plane, range specified in this step area was used in the cross-sectional plane to perform measurements of uterine gland, and counting predetermined rules ‘counting frame’. At this point, average uterus gland area was estimated according to rules of counting frame and unbiased nucleator method.The average area of the uterine glands in this study was estimated for calculating the following sequence:1- Areas with the interested object (uterine glands) were determined on cross sections.2- Interested area was drawn between lines and calculated in Stereo-Investigator program in Stereo-Investigator program.3- Reference sectional area was multiplied by number of the steps that include equally spaced areas.Statistical analysispost hoc test to identify individual group differences. Differences were accepted statistically significant at P<0.05 level. Data are presented as Mean±SEM, and were statistically analysed. Differences among groups were assessed by ANOVA with Stereological results All morphometrical evaluations for each group (mean±SEM) are observed in P<0.01). However, Bort group, in comparison with Ovt group, had significantly thicker endometrium (P<0.05). When subjects of Ovt group was compared to the Cont group, it was observed that the thickness of the myometrium significantly reduced (P<0.01). There was no significant changes between Count and Bort groups in terms of the myometrium thickness (P>0.05). In comparison with the Cont group, subjects of Ovt group displayed significant reduction in thickness of the perimetrium (P<0.05). Between Cont and Bort groups, in terms of perimetrium thickness, no significant changes were observed (P>0.05). Compared to the Cont group, it was observed that the uterine endometrial thickness is significantly reduced in other groups (Volumetric resultsP<0.05). Bort group was found to have significantly increased volume of the endometrium in comparison with the Ovt group (P<0.05). Between Cont and Bort groups, no significant differences was observed (P>0.05). Compared to the Cont group, animals of Ovt group displayed significant reduction in mean uterine gland area (P<0.01). The mean area of the uterine gland significantly increased in Bort group compared to the Ovt group (P<0.05). No significant differences were observed between Cont and Bort groups in terms of the average area of the uterine gland (P>0.05). There were no significant differences among the groups in terms of the mean uterine gland volume (P>0.05). Also, a significant reduction was observed in myometrium volume of the Ovt and Bort groups compared to the Cont group (P<0.01). There was no significant difference between Bort and Cont group (P> 0.05) in terms of the myometrium volume. However, the volume of perimetrium was significantly increased in Bort group in comparison with the Ovt group (P<0.05). Volumetric values of perimetrium were observed to be significantly reduced in the Ovt and Bort groups in comparison with the Cont group (P<0.01). Between Ovt and Bort groups, there was no significant difference in terms of volumetric values of perimetrium (P>0.05).When Ovt group compared to the Cont group, there was significant reduction in endometrial volume  was evaluated in the Ovt group, simple columnar epithelial cells of endometrium in uterine gland showed positive staining. Similarly, immune-positivity was observed in circular and longitudinal smooth muscle layers of myometrium. Immunoreactivity was observed in the stratum vasculare and a plurality of blood vessels in the stroma and also appeared heavily in endothelial cells. In addition, a strong NF-κB involvement was observed in the stromal cells. Usually, this cellular involvement is found in cytoplasmic level and in nucleus.In the Bort group, NF-κB immunoreactivity was evident in epithelial and stromal cells. Positivity is observed with doughtily in cytoplasm of some stromal cells but weakly in nucleus. Immune-positivity was also observed in the gland epithelial cells and single layer epithelial of endometrium. In the vessels and between the muscle layers, significant immunoreactivity was detected. All immunohistochemical results are observed in the Electron microscopical resultsIn the Cont group, endometrium was normal in terms of the fine structure. Apical cytoplasm of epithelial cells included polyribosomes. Cell surface and lateral connections were consistent with the structure of normal epithelium. There were not any abnormalities in stromal cells and the connective tissue fibers in the lamina propria.In examination on uterine samples of Ovt group, a decrease of pinopodes in the surface epithelium in endometrium, the extension and the blunt, irregular apical cytoplasm was detected. In the cellular matrix, lateral and apical cell cytoplasm was more electron-dense in comparison with the Cont group, and an increase in the granular endoplasmic reticulum (GER) tubules was observed. However, there was an increase in the number of lysosomes. Junctional connections were observed by electron-dense content and borders to be joined were quite evident. Lamina propria was remarkable in irregular spaces. In stromal cells, some of the electrons in terms of both core and cell matrix were dense in appearance. The extracellular matrix between the stromal cells was poor compared to the Cont group in terms of connective tissue fibers. Connective tissue between the cells formed by fiber bundles was fine with electron-dense appearance.In the Bort group, the structure of the endometrial surface epithelium was normal in view. Organelles such as lysosomes and mitochondria with healthy appearance were remarkable in the cell cytoplasm. Specializations of the apical face of epithelial cells were also regular and normal view. Rarely electron-dense and notched cells having nuclei, between healthy epithelial cells, were observed. Cells in the space between the connective tissue fibers were also monitored as well.All electron microscopic results are shown in the Bort prevents proteasome functions and is known as an agent with antitumor properties , 37, 38.Bort seems to affect on mitogen-activated protein (MAP) kinase signaling pathway and inhibits cell proliferation through caspase-dependent apoptosis and inhibition of NF-κB. Also, it appears to decrease the expression of adhesion molecules , 42.th-7th days  conducted a study after ovariectomy of rats and showed that there is no histological changes in endometrium, and reported simple columnar epithelium, and myometrium. They also reported that thinning of the uterine wall was not observed in 57th days .In the uterine cycle, changes in myometrium and endometrium are observed. There are receptors belonging to the sex hormones in smooth muscle cells of myometrium. But, after menopause, both the number and size of smooth muscle cells in the myometrium could be decreased due to lack of sex hormones  . In the current study, the volume and thickness of the uterine layers were higher in the Cont group, but the minimum value was found in the Ovt group. According to findings of the present study, the thickness and volume of the uterine layers increased in Bort group. In the uterine gland area, the lowest values observed in the Ovt group and the highest values were obtained in the Bort group. Fawcett and Dean (1951) reported that atrophy was observed in uterus of ovariectomized rats . There wIn aging, some changes such as thickening in the basal lamina of the epithelium can be observed in endometrial epithelium. In our study, epithelial cells of Ovt group had electron-dense and shrunken nuclei and organelles. In addition, the cells in the Ovt group had deterioration of the structure in the lateral surface connections. In this case, cells are considered as a part of the death process. In Ovt group, lamina propria stromal cells were sparse and they were not in healthy structure, whereas the amount of collagen fiber bundles was smaller and they looked as electron-dense structure. Steroid hormones and growth factors regulate the actual growth in the endometrium, in addition to differentiation and apoptotic events. Deterioration of the balance between cell proliferation and apoptosis, due to aging, can lead to many problems such as endometrial cancer. In the literatures, high apoptotic index has been reported in the endometrium of aged rats .In the present study, we observed apoptotic cells in the Ovt group in endometrium, especially in the stroma.According to the results of this study, it is thought that Bort may have protective effect in both histopathologic and morphometric views. When we compared the Ovt and Bort groups, it was noticed that the native structure of the epithelium was maintained in Bort group. Among the effects of aging at the cellular level, NF-κB induction is claimed to be able to activate this atypical way .Findings showed that some complications due to aging could be treated by Bort therapy through preventing proteasome or inducing NF-κB pathways . Some stet al. (2010) demonstrated that the effects of proteasome inhibition are age-dependent and play roles in NF-κB-mediated inflammatory gene transcription, geriatric diseases and hyperactive dysfunction  could be considered as protective and curative agent on the endometrium. It is known that the ovariectomy has negative effects on the uterus. In this process, proteasome inhibition may have protective effects. In this study, the effects were shown by immunohistochemical and morphometric methods. At this point, further studies are needed to better understand the mechanisms of Bort effects on uterus of the ovariectomized rat.


Toxoplasma gondii. Infection to this parasite in immunocompetent patients is usually asymptomatic, but today it is believed that the infection can be a risk factor for a variety of diseases, including rheumatoid arthritis (RA). RA is an autoimmune disease and the most common type of inflammatory arthritis that is a major cause of disability. The aim of this systematic review and meta-analysis was to address the association between RA and toxoplasmosis in light of the available research.Toxoplasmosis is a cosmopolitan infection caused by an intracellular obligatory protozoan, Based on the keywords, a systematic search of eight databases was conducted to retrieve the relevant English-language articles. Then, the studies were screened based on the inclusion and exclusion criteria. The random effect model was used to calculate the odds ratio (OR) using forest plot with 95% confidence interval (CI).Overall, 4168 Individual, extracted from 9 articles were included for systematic review evaluation, with 1369 RA patients (46% positive toxoplasmosis) and 2799 individuals as controls (21% positive toxoplasmosis). Then, eight articles (10 datasets) were used for meta-analysis (1244 rheumatoid arthritis patients and 2799 controls). By random effect model, the combined OR was 3.30 (95% CI: 2.05 to 5.30) with P < 0.0001.T. gondii infection on induction or exacerbation of RA. Our study was registered at the International Prospective Register of Systematic Reviews .Although toxoplasmosis could be considered as a potential risk factor for rheumatoid arthritis, more and better quality studies are needed to determine the effect of  Toxoplasma gondii is an intracellular obligatory protozoan, which causes toxoplasmosis. T. gondii infection in immunocompetent individuals is mostly asymptomatic, but it may be reactivated as a result of immune disorders inducing serious complications. Rheumatoid arthritis (RA), as a complex autoimmune disease, is a major cause of significant and progressive disability, articular complications, and premature death. Studies confirmed an interaction between infections and environmental factors as the potential risk or protective factors determining the development of autoimmune diseases. In this study, we investigated the association between toxoplasmosis and RA. Toxoplasma gondii (T. gondii) [Toxoplasmosis is a parasitic disease with worldwide distribution caused by obligate intracellular coccidian protozoan  gondii) . It is e gondii) , 3. Huma gondii) .T. gondii remains in the infected host tissues perpetually [T. gondii has also been reported [petually . Most impetually . The mospetually . In congpetually . Myocardpetually . Furtherpetually . Polytenreported .Rheumatoid arthritis (RA) is a common autoimmune disease, which is a major cause of inflammation of the joints and the principal cause of disability that affects 0.5–1% of the population , 12. TheIn recent years, the role of infectious agents, especially bacteria and viruses, has been identified in the pathogenesis of autoimmune diseases, while the role of parasitic infections due to their vague effects on host immunity has not been well-investigated. Experimental evidence may support the protective effect of specific parasitic infections in the susceptibility to autoimmunity . Some geToxoplasma gondii”, “toxoplasmosis”, “seroprevalence”, “prevalence”, “rheumatoid arthritis”, “rheumatoid factor”, “meta-analysis”, and “systematic review”.This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and its checklist . IndividA literature review was carried out using English databases including “PubMed”, “Google Scholar”, “Science Direct”, “Scopus”, “Web of Science”, “EMBASE”, “CINAHL”, and “ProQuest”. The systematic search of articles was conducted from March 4 to December 31, 2017 by two researchers independently. Also, for completing the checklist, we investigated all the references lists of the selected articles manually. In this study, only English-language articles were analyzed; furthermore, unpublished studies were not evaluated.After completing the search, the selected articles were reviewed by the two researchers independently. All the duplicate and irrelevant studies were excluded after reviewing the title, abstract, and full text of the articles. Moreover, to prevent reprint bias, the results of the articles were carefully investigated and duplicates were omitted.In order to assess the quality of reporting of the studies, standard Strengthening the Reporting of Observational Studies in Epidemiology checklist (STROBE) was used . S1 Chec/or IgM antibodies against T. gondii in individuals with definitive diagnosis of RA, and (5) the studies providing details on the seroprevalence rate of toxoplasmosis and RA.Abstracts and full texts were assessed independently by the two researchers using a piloted form. The final decisions about the eligibility or exclusion of studies were made separately. Disagreements were resolved with provision for arbitration from a third reviewer. Following the removal of duplicate entries, articles were evaluated according to the following criteria: (1) cohort or case-control studies about the relationship between toxoplasmosis as an exposure and rheumatoid arthritis as a disease, (2) the studies conducted only on humans, (3) the presence of case and control groups, (4) the studies where toxoplasmosis was diagnosed by detecting IgG andThe exclusion criteria comprised: (1) studies that were only descriptive, (2) studies that only presented the final result and did not provide the raw data, (3) articles that were not available in English language, and (4) the studies conducted on animals.Articles were carefully studied and the following data were extracted: first author, year of publication, the number of patients and controls, the number and percentage of the positive and negative cases of serum IgG and IgM in patients and controls, as well as information about age and gender and laboratory results. In studies where two different populations were studied, data were extracted separately.http://statsdirect.com). For displaying the heterogeneity between studies, χ2-based Cochrane test (Q) and I2 index were applied [T. gondii infection (the significance of P<0.05). OR > 1 indicates the positive effect of Toxoplasma on RA and an OR < 1 shows that toxoplasmosis has a protective effect against RA. Publication bias was examined by funnel plots and the statistical significance was assessed by the Egger test [The meta-analysis was executed with the Stats Direct statistical software  was registered on the website of the International Prospective Register of Systematic Reviews (PROSPERO) .Our preliminary search of eight databases yielded 8234 papers. After a primary screening of the titles of the articles based on keywords, 124 studies were extracted. Sixty-five articles were also excluded from the study due to duplication. In the next step, by screening the abstracts of the articles and based on the inclusion/exclusion criteria, 43 other articles were excluded. After reading the full text of the articles, 10 other papers were omitted, and three studies were added to the collection after reviewing the references. After the final review of the articles, nine eligible studies , 22–28 wToxoplasma antibodies (IgG and IgM) in those studies, ELISA [Our meta-analysis was performed among 4168 people including 1369 RA patients and 2799 controls. In all the studies, blood samples were collected from patients and controls. To identify anti-s, ELISA , 26–28, s, ELISA , chemilus, ELISA  were useExcept for Fischer et al. , who onlAs shown in 2 = 72.5%) showed a relatively high heterogeneity in our meta-analysis.According to Begg and Egger tests were used to evaluate publication bias. Negligible publication bias was observed using both Begg test (P = 0.0286) and Egger test (P = 0.0446) in the included studies. The results of sensitivity analysis showed that the impact of each study on meta-analysis was not significant on overall estimates .Toxoplasma gondii is an important opportunistic parasite infecting one-third of the world’s human population and it is considered a silent threat [T. gondii antibodies was reported in patients with rheumatoid arthritis [Toxoplasma infection and RA, an autoimmune disease causing pain and disability [t threat . Though rthritis . Thus, wsability .Although few studies were included in our meta-analysis, our findings showed that the prevalence of toxoplasmosis in the control group was 21%, which is almost in agreement with the results obtained by Dubey and Beattie . This seT. gondii infection in this systematic review. The high heterogeneity index is suggestive of potential variation, which could be due to difference in genetic potential of humans, which is affected by lifestyle and environmental factors such as dietary habits, environmental pollution, exposure to ultraviolet radiation, various types of infections, and socioeconomic status [According to c status .T. gondii may trigger a pathologic process in individuals, which can ultimately lead to RA. This finding has been reported in other autoimmune diseases such as diabetes mellitus [T. gondii in people with chronic diseases can be explained by the following reasons: 1) toxoplasmosis can contribute to the progression of chronic diseases and 2) treatment of these diseases with immunosuppressive drugs increases the susceptibility of patients to infections, including toxoplasmosis [T. gondii may be used as ligands for TLRs, which can induce inflammatory response [Our findings suggest that mellitus , 35, lupmellitus , and autmellitus . The higlasmosis . Recent lasmosis , 38. On response .T. gondii increases the expression of interleukin 17 (IL-17) in patients [Also, studies show that patients , and sinpatients , a signiT. gondii can induce or exacerbate arthritis symptoms [RA patients have autoantibodies and rheumatoid factors in their blood . In two symptoms –45.Because in the studied articles the relationship of age and sex with the prevalence of toxoplasmosis was not evaluated, we avoided the meta-analysis of these risk factors. In addition, diversity in the quality of studies and methods of measuring antibodies limited the interpretation and analysis of these items. These two issues were the important limitations of our meta-analysis.T. gondii infection and RA in this systematic review and meta-analysis study, further studies are needed on the following grounds: 1) the limited sample sizes in the articles, 2) difference in the quality of the reports, 3) diverse methods of measuring anti-parasitic antibodies, and 4) lack of evaluation of various risk factors such as age and gender.Despite the significant relationship found between T. gondii infection affects about one-third of the world’s population and possibly causes and exacerbates the symptoms of RA, only few studies have addressed this subject. These studies were conducted only in Latin America, Europe, and few regions of Asia and Africa. Accordingly, further studies are needed to achieve accurate results from other parts of the world. Also, further studies will be necessary to clarify the pathogenesis of T. gondii in humans to understand whether T. gondii is a cofactor in the development of autoimmune diseases.One of the most important achievements of our study is that although S1 Checklist(DOCX)Click here for additional data file.S2 Checklist(DOC)Click here for additional data file.


Concentrations and spatial variations of the four cations Na, K, Mg and Ca are known to some extent for groundwater and to a lesser extent for drinking water. Using Denmark as case, the purpose of this study was to analyze the spatial and temporal variations in the major cations in drinking water. The results will contribute to a better exposure estimation in future studies of the association between cations and diseases. Spatial and temporal variations and the association with aquifer types, were analyzed with spatial scan statistics, linear regression and a multilevel mixed-effects linear regression model. About 65,000 water samples of each cation (1980–2017) were included in the study. Results of mean concentrations were 31.4 mg/L, 3.5 mg/L, 12.1 mg/L and 84.5 mg/L for 1980–2017 for Na, K, Mg and Ca, respectively. An expected west-east trend in concentrations were confirmed, mainly explained by variations in aquifer types. The trend in concentration was stable for about 31–45% of the public water supply areas. It is therefore recommended that the exposure estimate in future health related studies not only be based on a single mean value, but that temporal and spatial variations should also be included.  Drinking water based on groundwater resources contains geogenic elements which may be important long-term exposures to humans and may result in both harmful  or beneficial  health effects . ConcentThis study focusses on the four major cations in groundwater: sodium (Na), potassium (K), magnesium (Mg) and calcium (Ca) which are all geogenic and important for human health. The selected cations have all been related to cardiovascular diseases. For several decades, the positive association between high Na concentration in drinking water and increased risk of hypertension (HTN) has been studied . In a reIn a systematic review of the association between cardiovascular disease and drinking water (including studies on Mg and Ca) in 2008, Catling et al.  found anA taste-related limit of 200 mg/L Na is recommended by WHO and, for that reason, the Danish drinking water quality specification is 175 mg/L . WHO has“Natural baseline quality in European aquifers: a basis for aquifer management for the purpose of monitoring ground water quality” [Several studies have focused on defining baseline concentrations in groundwater (including major cations), e.g., for a chalk aquifer around Copenhagen  and in tquality” . Furtherquality” , Scandinquality”  and Germquality” . The typquality” .All tap water in Denmark is groundwater based  with theThe following is a list of the three most important aquifers in terms of extracted water volume: (1) Quaternary sand and gravel glacial deposits, (2) limestone and chalk from Upper Cretaceous and Danian, (3) and, quartz sand and micaceous sand from Upper Tertiary, with a distribution of approximately 58%, 24% and 10%, respectively . BornholNa (atomic number 11) and K (atomic number 19) are alkali metals and occur in nature in the +1 oxidation state. In many rock-forming minerals, Na and K occur as important constituents , in Denmtilizers ,18. Mg (atomic number 12) and Ca (atomic number 20) are chemically alkaline earth metals and occur in nature in a +2 oxidation state [ (MgCO3) , which a (MgCO3) .Chemical constituents are slowly infiltrated to or released in the aquifer, and the rate and amount of geochemical change is, among others, depending on groundwater recharge changes, anthropogenic input to the soil surface, atmospheric deposition, top soil type, water residence time and chemical weathering. In a Danish context, the three main processes in the aquifers regarding the four major cations are the carbonate system, solubility of minerals and cation exchange. 2, pH and the amount of available calcite. If the calcite buffer is depleted and acid  enters the aquifer, the pH can change, resulting in “aggressive water”, which is found in western Denmark [The carbonate system is a buffer system against acid entering a carbonate rich aquifer and in relation to Ca, the governing equation is:  Denmark . Clay minerals and organic material have the largest cation exchange capacity (CEC) and cations are exchanged according to concentrations in the water and the affinity order: >Na+>Li+ . AquiferThese processes can be anthropogenically enhanced, unintentional and intentional. During water abstraction, there is a risk of water table drawdown resulting in increased pyrite oxidation and thereby increasing Ca and Mg concentrations due to production of acidification. Furthermore, over exploitation can lead to intrusion of recent sea water or deeper connate water, resulting in increased Na concentrations . At the waterworks, concentrations can be changed during normal water treatment, e.g., where pH is controlled during treatment of acid water or in advanced water treatment as e.g., water softening. The water supply structure in Denmark is mainly decentralized . A totalThe concentration levels of Na, K, Mg and Ca in groundwater and drinking water in Denmark are known due to comprehensive monitoring, and collection in one single national database (Jupiter). When drinking water is used as exposure for diseases, it is important, especially for long term epidemiological studies, to know both the spatial and the temporal variations in exposure. However, the spatial variations and the stability of the concentrations across time in exclusively drinking water have not been studied before in a national Danish context. The aim of the present study is to examine the spatial and temporal changes in drinking water concentration of Na, K, Mg and Ca. The results will contribute with new knowledge for future studies in the field of environmental exposure assessment and impact on public health. Furthermore, the study contributes to the discussion on health effects of water softening, which has been requested lately by the consumers in Denmark , though Data on drinking water concentrations between 2 September 1892 and 29 June 2017 were extracted in end of June 2017 from the Jupiter database, administered by Geological Survey of Denmark and Greenland (GEUS). On waterworks-level, the database includes information on yearly water abstraction and water samples from both private and public waterworks   were manually validated. All analysis reports are stored in the Jupiter database. In case of extremely high or low concentrations these analysis reports were investigated for possible errors in decimal place. Furthermore, Na and K concentrations were compared with chloride (Cl) concentrations, and Mg and Ca concentrations where compared, since they are expected to be correlated. Extreme concentrations were excluded when no explanation was found for the measured concentration or when an error in decimal place was noticed.Waterworks were linked to WSAs by spatial join in Quantum GIS version 2.18.14  . When waDifference in cation concentrations between water samples from waterworks and water samples from water pipes were compared in a scatterplot and tested with a multilevel mixed-effects linear regression model adjusted for date and waterworks were entered as a random effect. Due to a right skewed distribution of Na, K, and Mg, concentrations for these three cations were square-root transformed prior to the analyses. To compare drinking water concentrations of Na, Ca, K and Mg, WSAs were linked to their primary groundwater aquifer type. In 1996, GEUS initiated the development of a National Hydrological Model (DK-model) . .For selected years , areas with significant high or low concentrations were identified using yearly mean concentrations for each of the cations Na, K, Mg and Ca. Spatial scan statistics with a normal probability model was used to evaluate significance and approximate location of clusters . An elliThe association between type of aquifer and concentrations of Na, K, Mg and Ca was analyzed using a multilevel mixed-effects linear regression model. The association was adjusted for calendar year and WSA was included as a random effect. The analyses were followed by a pairwise comparison of the estimated marginal means to rank the aquifer types according to mean concentrations. Due to a skewed distribution of the concentration of Na, K, Mg and Ca, different transformations were considered including log, Box-Cox, square-root and rank transformation. Prior to the analyses, drinking water concentration for each cation was square-root transformed to obtain nearly normal distributed data. The analyses are limited to WSAs that are assigned with only one aquifer type. To evaluate if the concentrations of Na, K, Mg and Ca were stable in the study period at WSA level, a temporal trend analysis was performed. Initially, scatterplots of concentration versus date of drinking water sample were created at WSA level for each cation. Each WSA was afterwards categorized into one of six trend categories  was significant (α = 0.05) and a degree of determination, R2 > 0.1Change-point: Two or more different, but constant concentration levels or a significant change-point was observed (two connected regression lines). The change-point analysis was performed using two analyses. First, a Bayesian analysis with Markov chain Monte Carlo simulation of a change point regression model estimating the change point, and two slopes [t-test.o slopes . SecondlParallel: Two or more constant concentration levels occurring at the same time were detected visually. Only WSAs which were not earlier categorized were included in the visual analysis.Fluctuating: WSAs that do not fit into categories 1–5.The total number of drinking water samples per year (1980–2016) for Na, K, Mg and Ca increased from 1980 to 2002, from where on it was approximately stable until 2016, at a level of roughly 2000 drinking water samples per year per cation . Data foThe mean concentrations of the cations Na, K, Mg and Ca were 31.4 mg/L, 3.5 mg/L, 12.1 mg/L and 84.5 mg/L . A totalWaterworks have been linked for 2539, 2537, 2539, and 2549 WSAs with concentrations of Na, K, Mg, and Ca, respectively. A total of 99% of the waterworks have been assigned to a WSA. The 1% missing was due to lack of geographical coordinates of the waterworks.p ≤ 0.004) high or low concentrations overlaid on the maps are presented.Spatial variations in yearly mean Na, K, Mg and Ca concentrations in drinking water for each WSA (2011–2015) are shown in The geographical variation in all four cations are similar, with generally higher concentrations in the eastern part of Denmark (Sjælland and southern islands) and lower concentrations in the western part of Denmark. Furthermore, higher concentrations of Na and Mg are present in the northernmost part of Denmark and Na concentrations tend to be higher along the west coast of Denmark compared to the other cations. Notice the large concentration interval in the upper quartiles. For seven WSAs, the mean Na concentration is above the national recommended upper limit of 175 mg/L.p-values for cluster analyses of Na, K, Mg and Ca are presented in Number of WSAs included in the clusters, mean concentrations and An aquifer type has been assigned for 2543 WSAs and the geographical range and number of WSAs for each aquifer type are presented in p-value ≤ 0.001), which again was higher than the mean concentration in Tertiary sand . The mean concentration of the K cation in the Hard rock aquifer was significantly higher than in the three other aquifers. For Mg, the concentration in Tertiary/Cretaceous limestone and Hard rock aquifer was higher than in the two sand aquifers. For Ca, the mean concentration was significantly lower in the Tertiary sand aquifer compared to the mean concentration in the three other types of aquifers. For Na, the mean concentration in the Hard rock aquifer was not significantly different from the mean concentrations in any of the other aquifers . Same overall results were obtained on log, square root and rank transformed data. The association between the four main aquifer types and drinking water concentrations of Na, K, Mg and Ca is shown in On a national scale the temporal variation in mean yearly concentration for all four cations is constant (1980–2016) . PercentToo few, Constant, Decreasing/increasing, Change-point, Parallel and Fluctuating) is similar for all four cations . Just 2% to 4% of the WSAs are categorized as Change-point and 2% to 6% are categorized as Parallel trend. The second largest category is Fluctuating and 20% to 31% of the WSAs are in this group.The result of the trend categorization shows that the number of WSAs in each category  and Mg . For both cations, the mean concentration was lowest in the water pipe system (5.4 mg/L for Na and 4.27 mg/L for Mg) compared to the waterworks, although only 146 and 148 measurements, respectively, were included in the analyses. For Mg, the difference was not statistically significant when the waterworks with highest concentrations (>40 mg/L) were excluded from the analysis, p-value = 0.132. Due to the low number of measurements and the fact that a small variation is expected because of time lag between the water samples at each waterworks, water samples from both waterworks and water pipes are included in the study.Drinking water samples taken at the outlet of waterworks, in the water pipe system, and at the inlet to households were included in the study. Comparison of the groups for each cation showed no visual difference. The results from the multilevel mixed-effects linear regression model showed, that the mean concentrations were significantly different between the two groups for Na  of the major cations Na, K, Mg and Ca in drinking water in Denmark are estimated at 31.4 mg/L, 3.5 mg/L, 12.1 mg/L and 84.5 mg/L, respectively. A strong association has been found between aquifer types and drinking water concentrations, with decreasing concentration in the order of Tertiary/Cretaceous limestone, Quaternary sand and Tertiary sand. Our study shows that the concentrations of Na, K, Mg and Ca in drinking water are constant in time for about 31% to 45% WSAs. Where concentrations vary, the main explanation is that several waterworks are supplying the same WSA. In future studies, concentrations of Na, K, Mg and Ca in drinking water can be reasonably estimated as a yearly mean, despite lack of concentrations in space and time with a few exceptions. However, precaution must be applied when estimating correct exposure for drinking water consumers in about 23−36% of WSAs where concentrations have been identified as fluctuating or with two parallel concentration levels.


India's rapidly increasing population and growing urbanization pose a great challenge for wastewater treatment efforts, leading to increased pollution of surrounding waterbodies.A field sampling-based study was conducted to analyze water quality, heavy metals and bioconcentration and bioaccumulation in the roots and shoots of naturally growing vegetation in an urban lake, Laxmi Taal. The lake receives domestic sewage from Jhansi city in Central India.Temperature, pH, electrical conductivity, turbidity, and water-soluble ions were measured with appropriate instruments. Plant accumulation of metals was measured with the bioconcentration factor (BCF), the ratio of metal concentration in the root to wastewater. The translocation factor (TF) was estimated as the ratio of metal concentration in the shoot to the root.Typha angustifolia and Echhornia crassipus were determined to be accumulator plants. The TF study revealed that translocation of all the metals studied were significant, except for manganese (Mn), where concentration was found to be below detection limit.Water quality and heavy metal concentrations were found to be within the prescribed limit as per Indian standards IS-2296 “D”. In the present study, BCF was assessed to be >1 and the plants Typha angustifolia and Echhornia crassipus could be used for bioremediation purposes in cases of urban waterbodies receiving varying amounts of domestic wastewaters which have relatively limited concentrations of toxic metals.The present study validated that The authors declare no competing financial interests Waterbodies consisting of turbid heterogeneous liquid with persistent chemicals pose serious challenges due to water-borne diseases and health hazards.5–7With increasing population and growing urbanization in India, wastewater generation is also increasing at a rapid pace. Lack of appropriate treatment facilities and inadequate policy planning at the local level has aggravated the issue and many rivers, lakes, wetlands, lakes and other waterbodies are polluted.Laxmi Taal in Jhansi, Bundelkhand (Uttar Pradesh) is a historical, previously rain-fed lake of about 32.52 hectares. Today, Laxmi Taal is encroached with an inflow of urban sewage, principally carrying domestic wastewater and runoff from surrounding settlements, temples, gardens and farmland without undergoing any treatment or sedimentation. Monitoring and assessment of water contamination, especially heavy metal accumulation, is a serious concern, as inhabitants depend on the lake for vegetable irrigation, drinking water for livestock and recreation. The consequences of pollution on plants and animals has been extensively studied in lentic and lotic ecosystems.Eucalyptus camaldulensis, Zea mays, Potamogeton pectinatus L., and Typha domingensis are some of the best candidate species as hyperaccumulators for phytoremediation of heavy-metal contaminated soils and water.16Phytoremediation can be used as an alternative solution for heavy metal remediation processes due to advantages as a cost-effective, efficient, environment- and eco-friendly technology based on the use of metal-accumulating plants.Typha angustifolia and Echhornia crassipus. These two species are commonly occurring pre-adopted, successful metal accumulators.Phytoremediation concerns have gained considerable attention in warm sub-tropical to semi-arid regions. In water scarce areas, surface waterbodies are the main source of water for ‘B’ grade use. The present study aims to provide an assessment of water quality, level of heavy metals and a comparative phytoremediation potential of 2. Laxmi Taal is located between latitude 25°27′20″- 25°27′50″N and longitude 78°35′20″- 78°35′45″E. With temples all along its boundary, it is a central part of the historical, cultural and recreational life of Jhansi city. It is approximately 32.52 hectares across with an average depth of 2.5 m and has a catchment area of 2370 hectares. The sewage carrying domestic wastewater of Jhansi city is dumped into Laxmi Taal through various nallas (channels), namely Kuberau nala, Kasai mandi nala, Laxmi gate nala, Jashiyana nala, Banglaghat nala and Bludgeon nala. A large influx of people in the last few decades around the fringe of the lake has resulted in rapid deterioration of water quality. Increased inflow of untreated sewage, disposal of municipal solid wastes, excessive use of fertilizers and pesticides are some of the major problems facing the lake environment.Laxmi Taal is a shallow, fresh water urban lake in the city of Jhansi, spreading over an area of about 0.162 kmBCFBioconcentration factorDODissolved oxygenTFTranslocation factorThe lake water samples were collected in precleaned, acid-treated high-density 3L polythene bottles, in triplicate at approximately 30-day intervals from each sampling location in the study area. The sampling area was divided into four zones: inlet lake interface, depicted as blue arrows in −1) by conductivity meter , turbidity (nephelometric turbidity units) was determined by a turbidity meter, water soluble ions (sodium (Na+) and potassium (K+) in the water sample were determined with the help of a flame photometer (Systronics-350), and calcium (Ca+) was determined by the versenate titration method using ethylenediaminetetraacetic-disodium salt solution as chelate). Additionally, magnesium (Mg+) in ppm, free carbon dioxide (CO2), dissolve oxygen (mg L−1), chemical oxygen demand (mg L−1), carbonate (CO3− mg L−1), bicarbonate (HCO3− mg L−1) and all other parameters were calculated by standard methods.20Temperature was measured with the help of thermometer, pH by a pH meter , electrical conductivity , the ratio of metal concentration in the root to wastewater. Translocation factor (TF) was estimated as the ratio of metal concentration in the shoot to the root.22Analysis of pH is an important parameter in an examination of water quality. In the present study, the pH value varied between 7.463 and 7.743 during the summer season. It was found to be close to the prescribed limit of surface water quality category-A (pH 8.5). Turbidity ranged from 16.10 to 46.183 (nephelometric turbidity units). Turbidity is the measurement of scattered light at 90° in a water system and can be a hindrance to submerged plant growth.−1) varied from 1399.66 to 1751.16 in Laxmi Taal during the summer season . Conductivity of water varies directly with the temperature and is proportional to dissolved mineral matter content. Dissolved oxygen (DO) is the most critical factor in determining water quality and reflects the physical and biological process prevailing in the water (nutrient load). In Laxmi Taal lake, the DO varied from 3.18 to 4.62 mg L−1 during the summer season. The high DO content in the surface water may be a result of direct contact of the surface water layer which enhances the dissolution of oxygen in water. A minimum of 4 mg/l of DO should be maintained in water for healthy growth of biota.−1 during the summer season. The chemical oxygen demand was high at the drainage inlet due to the demand of oxygen from the degradation of waste.Conductivity  and carbonate levels . Levels of carbon in this lake were found to be unusually high.Levels of free COTotal solids reflect the suspended and dissolved materials in inorganic and organic forms. The levels in the form of total solids, total dissolved solids and total suspended solids were collected. The total solid levels were 756.05, 697.63, 1031.40 and 745.33 mg/l. The increased levels in the present study may be due to increased mineralization and waste disposal activities. In this reflection, the concentrations of sodium, potassium, calcium, magnesium and chloride were at significant levels as shown in The BCF or enrichment coefficient is the ratio of concentration of element present in the surroundings to the plant tissue at the time of harvest as characterized by Typha angustifolia indicated favorable conditions. The enrichment coefficient study and translocation factor studies revealed that the bioconcentration factor was >1 in all of the cases. An enrichment coefficient of >1 indicates that the plant is an accumulator and an enrichment coefficient of <1 indicates an excluder plant. Typha angustifolia and Echhornia crassipus are accumulator plants. Heavy metals in decreasing sequence in T. angustifolia were found to be Ni>Pb>Fe>Zn>Cu in the root system, and in the shoot, accumulation of heavy metals was in the order of Fe>Ni>Pb> Zn>Cu. The TF value was found to be >1 in all cases except Mn, where concentration was found to be below detection limit.All the sampling values of heavy metals were lower than the prescribed values for surface water quality (IS: 2296). The luxuriant growth of Echhornia crassipus, concentrations in descending order of Fe>Pb>Zn>Ni>Cu were observed in the root system and Ni>Fe> Zn>Pb>Cu in the shoot system. The translocation factor was found to be >1 in all of the cases except Mn, where concentration was found to be below the detection limit.Regarding Toxic metal contamination is increasing and has become a worldwide public health concern.28Zinc poisoning leads to gastrointestinal effects, such as abdominal pain, diarrhea and vomiting.30–32Nickel allergy can show up in the form of contact dermatitis, lung fibrosis, nasal and lung cancers, cardiovascular and kidney diseases.41Typha angustifolia and Echhornia crassipus) concentrate toxic and heavy metals such as Mn, Cu, Zn, Pb, Ni and Fe up to 100–1000 times, compared to excluder plants.Soil and water quality degradation and adverse effects on the human and animal health are largely attributed to industrial pollution, as they bioaccumulate in the food chain.T. angustifolia and E. crassipus are primary bioaccumulator plants.The present study examined naturally growing vegetation in a domestic wastewater receiving lake, Laxmi Taal, in Jhansi, and indicated that parameters of wastewater in the lake were within the prescribed limit of water quality standard IS-2296 grade-D water. The bioconcentration factor study revealed that all of the values were approaching 1 or >1, thus T. angustifolia and E. crassipus. Heavy metals translocation from root to shoot was effective.Among the six heavy metals studied, Mn, Cu, Zn, Ni, Pb and Fe, the heavy metals TF value was found to be >1 in both T. angustifolia and E. crassipus was higher in shoots than other parts of the plant. For all heavy metals, rhizofiltration and phytoextraction mechanisms have been found to be effective.The heavy metal study revealed that accumulation of various metal ions by T. angustifolia and E. crassipus can be used effectively to help ensure waterbodies are free from toxic heavy metals dumped into waterways.High levels of heavy metals have detrimental effects on the health of humans and animals. Monitoring of exposures and remedial measures are necessary to mitigate these effects. Phytoremediation has been found to be helpful in limiting the exposure of human beings and animals to the toxicity of water from lake Laxmi Taal, and in decreasing potential soil pollution, thus limiting the flow of these heavy metals further up the food chain. Phytoremediation by