International Journal of Environmental Research and Public Health — Open Access Journal

With accumulating evidence that exercise capacity decreases all-cause mortality independent of adiposity, benefits may be gained by developing cardiorespiratory fitness measures that are specifically and sensitively designed for use with pediatric populations when cardiorespiratory fitness may be a contributing factor for obesity. This study aimed to examine the criterion validity of the Modified Shuttle Test-Paeds (MSTP) as a measure of cardiorespiratory fitness in children, against the gold-standard reference; VO₂peak, compared to the commonly used field-test; 20-m Multi-Stage-Shuttle-Run-Test (20-m MSRT). A cross-sectional pilot study, with 25 school-aged children (age: 6–16 year; male/female: 19/5; BMI: 21 ± 9 kg/m²) was employed. Physical measures included: Bruininks-Oseretsky-Test-of-Motor-Proficiency-2nd Edition (BOT2), VO₂peak, 20-m MSRT, MSTP, body composition/anthropometry. The mean cardiorespiratory fitness of participants was: VO₂peak: 43.8 ± 11.2 (mL/kg/min); 20-m MSRT: 5.48 ± 2.96 (level); MSTP: 22.10 ± 3.05 (no.). A strong predictive relationship was found between the 20-m MSRT and VO₂peak (r² = 0.486, p < 0.001) whereas a very strong predictive relationship existed between the newly designed MSTP and VO₂peak (r² = 0.749, p < 0.001). Whilst further research with larger study cohorts is needed, this pilot study found the MSTP to have a very high predictive validity for estimating VO₂peak in children, suggesting it may be a valid child-specific indicator of cardiorespiratory fitness requiring only a simple equation that is clinically relevant. Full article

On 11 March 2011, Japan experienced a massive earthquake and tsunami that triggered the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, resulting in the release of large amounts of cesium-134 and -137 into the atmosphere. In addition to the food radioactivity control in the markets throughout the country, radiocesium concentrations in locally grown foods were voluntarily inspected and the results were shown to the residents by the local government to raise their awareness of the internal radiation contamination risk from low knowledge in Nihonmatsu City, Fukushima Prefecture. In this longitudinal study, local food products for in-home consumption were evaluated by seven different food radioactivity measuring devices in Nihonmatsu City from 2011–2017. Radiocesium was detected in local foods in Nihonmatsu City even six years after the FDNPP accident. The highest number of products tested was in 2012, with the number steadily decreasing thereafter. Most foods had contamination levels that were within the provisional regulation limits. As edible wild plants and mushrooms continue to possess high radiocesium concentrations, new trends in radioactivity in foods like seeds were discovered. This study highlights that the increased risk of radiation exposure could possibly be due to declining radiation awareness among citizens and food distributors. We recommend the continuation of food monitoring procedures at various points in the food processing line under the responsibility of the government to raise awareness for the reduction of future risks of internal exposure. Full article

The purpose of this study was to examine the effects of controlling teacher behavior on high school physical education students’ global intrinsic motivation, perceptions of the importance of the subject matter, intentions to be physically active, level of physical activity, and life satisfaction. The sample in this study was comprised of 416 Spanish high school students. Support for the study’s expectations was provided through structural regression analysis. The analysis revealed that a controlling teaching style was negatively associated with the global intrinsic motivation of the students. In turn, global intrinsic motivation predicted the perceived importance of the subject matter, which explained physical activity intentions. Physical activity intentions were positively associated with level of physical activity, which, in turn, explained life satisfaction. The knowledge obtained in this study can be of benefit to teachers and can be beneficial to the design of more adaptive learning environments for students. Full article

We hypothesized that poor sleep quality exacerbates glucose intolerance manifested as elevated glycosylated hemoglobin (HbA1c), which increases the risk for gestational diabetes. To test this, 38 pregnant and 22 non-pregnant (age, 18–35 years; body-mass index, 20–35 kg/m²) otherwise healthy women were enrolled in the study. Sleep quality was assessed during gestational week 24 (pregnant), or outside of the menstrual period (non-pregnant), using qualitative (Pittsburgh Sleep Quality Index) and objective (actigraphic wrist-watch) measures. Blood glucose, total cortisol, and depression status were evaluated. Eight pregnant and one non-pregnant women were lost to follow-up, or withdrew from the study. There was a higher incidence of poor sleep quality in pregnant (73%) relative to non-pregnant women (43%). Although actigraphic data revealed no differences in actual sleep hours between pregnant and non-pregnant women, the number of wake episodes and sleep fragmentation were higher in pregnant women. Poor sleep quality was positively correlated with higher HbA1c in both pregnant (r = 0.46, n = 26, p = 0.0151) and non-pregnant women (r = 0.50, n = 19, p = 0.0217), reflecting higher average blood glucose concentrations. In contrast, poor sleep was negatively correlated with cortisol responses in pregnant women (r = −0.46, n = 25, p = 0.0167). Three pregnant women had elevated one-hour oral glucose tolerance test results (>153 mg/dL glucose). These same pregnant women exhibited poor sleep quality. These results support the suggestion that poor sleep quality is an important risk factor that is associated with glucose intolerance and attendant health complications in pregnancy. Full article

In order to assess the pollution levels and health risks of PM_2.5-bound metals in Baoding City before and after the heating period, samples were collected in 2016 at Hebei University from September 25th to November 14th during the non-heating period, and November 15th to December 26th during the heating period, respectively. ICP-MS was applied to analyze seven heavy metals (Cr, Zn, Cu, Pb, Ni, Cd and Fe). The statistical analysis, enrichment factor (EF), pollution load index method, and Risk Assessment Method proposed by U.S. EPA were used to evaluate the non-carcinogenic risks of six of these heavy metals (Cr, Zn, Cu, Pb, Ni and Cd) and carcinogenic risks of three of these heavy metals (Cr, Ni and Cd). The results showed three main results. First, the average daily PM_2.5 concentrations of the national air monitoring stations was 155.66 μg·m⁻³ which was 2.08 times as high as that of the second level criterion in China (75 μg·m⁻³) during the observation period. Compared with the non-heating period, all heavy metals concentrations increased during heating period. The growth rates of Pb and Ni were the highest and the lowest, which were 88.03 and 5.11 percent, respectively. Second, the results of enrichment factor indicated that the EF values of all heavy metals were higher during the heating period in comparison with during the non-heating period, but the degree of enrichment of all heavy metals remained unchanged. Not only those, Cr and Ni were minimally enriched and were affected by both human and natural factors, Pb, Cu and Zn were significantly enriched and were mainly affected by human factors, the enrichment of Cd was much higher than that of the other heavy metals, exhibiting extremely high enrichment, mainly due to human factors during the whole sampling period. The results of the pollution load index indicated that the proportions of the number of highly and very highly polluted PM_2.5-bound metals were the highest during the heating period, while the proportion of moderately polluted PM_2.5-bound metals was the highest during the non-heating period. The combined pollution degree of heavy metals was more serious during the heating period. Third, according to the health risk assessment model, we concluded that the non-carcinogenic and carcinogenic risks caused by inhalation exposure were the highest and by dermal exposure were the lowest for all kinds of people. The overall non-carcinogenic risk of heavy metals via inhalation and subsequent ingestion exposure caused significant harm to children during the non-heating and the heating periods, and the risk values were 2.64, 4.47, 1.20 and 1.47, respectively. Pb and Cr exhibited the biggest contributions to the non-carcinogenic risk. All the above non-carcinogenic risks exceeded the standard limits suggested by EPA (HI or HQ < 1). The carcinogenic risk via inhalation exposure to children, adult men and women were 2.10 × 10⁻⁴, 1.80 × 10⁻⁴, and 1.03 × 10⁻⁴ during the non-heating period, respectively, and 2.52 × 10⁻⁴, 2.16 × 10⁻⁴ and 1.23 × 10⁻⁴ during the heating period, respectively. All the above carcinogenic risks exceeded the threshold ranges (10⁻⁶~10⁻⁴), and Cr posed a carcinogenic risk to all people. Full article

Background: For elderly trauma patients, a prognostic tool called the Geriatric Trauma Outcome Score (GTOS), where GTOS = (age) + (ISS × 2.5) + (22 if any packed red blood cells (pRBCs) were transfused within 24 h after admission), was developed for predicting mortality. In such calculation, a score of 22 was added in the calculation of GTOS regardless of the transfused units of blood. This study aimed to assess the effect of transfused blood units on the mortality outcomes of the elderly trauma patients who received blood transfusion (BT). Methods: Detailed data of 687 elderly trauma patients aged ≥65 years who were transfused with pRBCs within 24 h after admission into a level I trauma center between 1 January 2009 and 31 December 2016 were retrieved from the Trauma Registry System database. Based on the units of pRBCs transfused, the study population was divided into two groups to compare the mortality outcomes between these groups. Adjusted odds ratios (AORs) with its 95% confidence intervals (CIs) for mortality were calculated by adjusting sex, pre-existing comorbidities, and GTOS. Results: When the cut-off value of BT was set as 3 U of pRBCs, patients who received BT ≥ 3 U had higher odds of mortality than those who received BT < 3 U (OR, 3.0; 95% CI, 1.94–4.56; p < 0.001). Patients who received more units of pRBCs still showed higher odds of mortality than their counterparts. After adjusting for sex, pre-existing comorbidities, and GTOS, comparison revealed that the patients who received BT of 3 U to 6 U had a 1.7-fold adjusted odds of mortality than their counterparts. The patients who received BT ≥ 8 U and 10 U had a 2.1-fold (AOR, 2.1; 95% CI, 1.09–3.96; p < 0.001) and 4.4-fold (AOR, 4.4; 95% CI, 2.04–9.48; p < 0.001) adjusted odds of mortality than those who received BT < 8 U and <10 U, respectively. Conclusions: This study revealed that the units of BT did matter in determining the probability of mortality. For those who received more units of blood, the mortality may be underestimated according to the GTOS. Full article

This study aimed to evaluate the data quality of the Brazilian Epidemiological Surveillance System on Foodborne Diseases (VE-DTA) through the evaluation of the completeness of the record after 10-years of its implementation. The study evaluated the measurement of completeness by quantifying ignored, incomplete or blank responses of the data items filled. The evaluation used the percentage of completion of these items regarding the total number of notifications registered in the system. We organized the results according to the general Category of completeness of the database, by year of notification and region of occurrence. We also evaluated the overall completeness percentages of the database and the completeness levels according to the degree of recommendation of completion of each variable (mandatory, essential, and complementary) by the VE-DTA manual. The system presented 7037 outbreaks of foodborne diseases. According to the completeness classification, the database presented general classification as Category 1 since it has 82.1% (n = 5.777) of variables with the level of completion up to 75.1%. We observed that 8.6% of the database was classified as category 2; 9.2% as category 3 and 0.1% as category 4. The improvement on database quality regarding completeness can positively impact on public health and public policies, reducing the number of FBDs deaths. Full article

This study aimed to determine whether hospital competition is associated with improved in-hospital mortality in Shanxi, China. We included a total of 46,959 hospitalizations for acute myocardial infarction (AMI) and 44,063 hospitalizations for pneumonia from 2015 to 2017. Hospital competition was measured as Herfindahl–Hirschman Index based on the patient predicted flow approach. Two-level random-intercept logistic models were applied to explore the effects of hospital competition on quality for both AMI and pneumonia diagnoses. Hospital competition exerts negative or negligible effects on inpatient quality of care, and the pattern of competition effects on quality varies by specific diseases. While hospital competition is insignificantly correlated with lower AMI in-hospital mortality (odds ratio (OR): 0.94, 95% confidence interval (CI): 0.77–1.11), high hospital competition was, in fact, associated with higher in-hospital mortality for pneumonia patients (OR: 1.99, 95% CI: 1.51–2.64). Our study suggests that simply encouraging hospital competition may not provide effective channels to improve inpatient quality of health care in China’s current health care system. Full article

Price of tobacco products has traditionally been relevant both for the industry, to respond to policy changes, and for governments, as an effective tobacco control measure. However, monitoring prices across a wide range of brands and brand variants requires access to expensive commercial sales databases. This study aims to investigate the comparability of average tobacco prices from two commercial sources and an in-house monitoring database which provides daily data in real time at minimal cost. We used descriptive and regression analysis to compare the monthly average numbers of brands, brand variants, products and prices of cigarettes and hand-rolling tobacco using commercial data from Nielsen Scantrack and Kantar Worldpanel, and an online price database (OPD) created in Nottingham, for the period from May 2013 to February 2017. There were marked differences in the number of products tracked in the three data sources. Nielsen was the most comprehensive and Kantar Worldpanel the least. Though average prices were very similar between the three datasets, Nottingham OPD prices were the highest and Kantar Worldpanel the lowest. However, regression analysis demonstrated that after adjustment for differences in product range, price differences between the datasets were very small. After allowing for differences in product range these data sources offer representative prices for application in price research. Online price tracking offers an inexpensive and near real-time alternative to the commercial datasets. Full article

Long-term exposure to high levels of heavy metals can lead to a variety of diseases. In recent years, researchers have paid more attention to mining and smelting areas, industrial areas, and so forth, but they have neglected to report on high geological background areas where heavy metal levels are higher than China’s soil environmental quality standard (GB 15618-2018). In our study, an investigation of heavy metals in paddy soil and rice in the high background area of Guizhou Province was carried out, and the factors affecting the absorption and utilization of heavy metals in rice were discussed. A total of 52 paddy soil and rice samples throughout the high geological background of Guizhou, China, were collected, and concentration(s) of arsenic, cadmium, copper, lead, and zinc were analyzed. The arithmetic mean values of paddy soil heavy metals were 19.7 ± 17.1, 0.577 ± 0.690, 40.5 ± 32.8, 35.5 ± 32.0, and 135 ± 128 mg kg⁻¹ for arsenic, cadmium, copper, lead, and zinc, respectively. Most of the heavy metals’ contents in the soil were above the soil standard value. The highest content of cadmium was 15.5 times that of the soil standard value. The concentration(s) of arsenic, cadmium, copper, lead, and zinc in rice were 0.09 ± 0.03, 0.01 ± 0.01, 1.57 ± 0.69, 0.002 ± 0.003, and 11.56 ± 2.61 mg kg⁻¹, respectively, which are all lower than those specified by Chinese food safety standards (GB 2762-2017). The results and discussion show that the bioavailability, pH, and soil organic matter are important factors that affect the absorption of heavy metals by rice. According to the consumption of rice in Guizhou Province, the risk of eating rice was considered. The results revealed that the hazard quotient is ranked in the order of copper > zinc > cadmium > arsenic > lead, and there is little risk of eating rice in the high geological background area of Guizhou Province. These findings provide impetus for the revision and improvement of this Chinese soil environmental quality standard. Full article

Standard statistical modelling has shown that the reallocation of sitting time to either standing or stepping may be beneficial for metabolic health. However, this overlooks the inherent dependency of time spent in all behaviours. The aim is to examine the associations between physical behaviours and markers of metabolic health (fasting glucose, fasting insulin, 2-h glucose, 2-h insulin, Homeostasis Model Assessment of Insulin Sensitivity (HOMA-IS), Matsuda Insulin Sensitivity Index (Matsuda-ISI) while quantifying the associations of reallocating time from one physical behaviour to another using compositional analysis. Objectively measured physical behaviour data were analysed (n = 435) using compositional analysis and compositional isotemporal substitutions to estimate the association of reallocating time from one behaviour to another in a population at high risk of type 2 diabetes mellitus (T2DM). Stepping time was associated with all markers of metabolic health relative to all other behaviours. Reallocating 30 min from sleep, sitting, or standing to stepping was associated with 5–6 fold lower 2-h glucose, 15–17 fold lower 2-h insulin, and higher insulin sensitivity (10–11 fold via HOMA-IS, 12–15 fold via Matsuda-ISI). Associations of reallocating time from any behaviour to stepping were maintained for 2-h glucose, 2-h insulin, and Matsuda-ISI after further adjusting for body mass index (BMI). Relocating time from stepping into sleep, sitting, or standing was associated with lower insulin sensitivity. Stepping time may be the most important behavioural composition when promoting improved metabolic health in adults at risk of T2DM. Full article

Background: Research has shown that suicide is a highly present phenomenon among the drug dependent population. Moreover, individuals with substance use disorder (SUD) present high psychopathological comorbidity. This study aimed to describe which clinical syndromes are linked to the presence of risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 patients who attended the Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide risk and drug related characteristics, were recorded. The risk of suicide was assessed with the Spanish version of “risk of suicide”. Complicated grief was assessed with the Spanish version of the Inventory of Complicated Grief. Clinical syndromes were measured with the Spanish version of MCMI-III. Results: The syndromes most frequently associated with the presence of risk of suicide were complicated grief, major depression and thought disorder. Conclusions: Different psychopathological syndromes were identified in relation to risk of suicide among patients with SUD. The present results highlight the importance of accurately diagnosing those individuals. Full article

Florida geologic units and soils contain a wide range in concentrations of naturally-occurring arsenic. The average range of bulk rock concentrations is 1 to 13.1 mg/kg with concentrations in accessary minerals being over 1000 mg/kg. Florida soils contain natural arsenic concentrations which can exceed 10 mg/kg in some circumstances, with organic-rich soils often having the highest concentrations. Anthropogenic sources of arsenic have added about 610,000 metric tons of arsenic into the Florida environment since 1970, thereby increasing background concentrations in soils. The anthropogenic sources of arsenic in soils include: pesticides (used in Florida beginning in the 1890’s), fertilizers, chromated copper arsenate (CCA)-treated wood, soil amendments, cattle-dipping vats, chicken litter, sludges from water treatment plants, and others. The default Soil Cleanup Target Level (SCTL) in Florida for arsenic in residential soils is 2.1 mg/kg which is below some naturally-occurring background concentrations in soils and anthropogenic concentrations in agricultural soils. A review of risk considerations shows that adverse health impacts associated with exposure to arsenic is dependent on many factors and that the Florida cleanup levels are very conservative. Exposure to arsenic in soils at concentrations that exceed the Florida default cleanup level set specifically for residential environments does not necessarily pose a meaningful a priori public health risk, given important considerations such as the form of arsenic present, the route(s) of exposure, and the actual circumstances of exposure (e.g., frequency, duration, and magnitude). Full article

The objective of this effort is to gather data to tailor interventions appropriately. Greater understanding of the correlates of socioeconomic status and obesogenic dietary behaviors was the focus of this manuscript. Using multistage sampling, women with varied education levels completed a baseline assessment in a longitudinal study of women aged 30 to 50 years. This study was conducted in low-SES areas of South King County, Washington State. This study included 530 Caucasian and 510 Hispanic women. Fruit and vegetable consumption was positively associated and soft drink consumption inversely associated with the level of education in Caucasian women. In contrast, percentage calories from fat was positively associated with the level of education in Hispanic women. In Hispanic women, level of education interacted significantly with food security in relation to percentage calories from fat, and with eating norms in relation to soft drink consumption. Neighborhood presence of ethnic food stores was associated with outcomes for Hispanic women, but for Caucasians, presence of fast food restaurants was important. Education was consistently associated with two of the three obesogenic dietary behaviors studied among Caucasian women. Education played a moderating role in the associations of food security and eating norms, independent of area level food availability, in two of three obesogenic dietary behaviors studied. However, these patterns differed for Hispanic women, indicating the need for more research into important variables to support change in Hispanic women. Women of differing ethnic groups did not respond similarly to environmental conditions and policy-relevant surroundings. These data have meaning for considering urban policy that impacts obesity levels in the population. Full article

Reducing sedentary behaviours can help prevent non-communicable diseases, particularly among young adolescents with long term illnesses or disabilities (LTID). Much of young people’s voluntary sedentary time is related to screen-time behaviours (STBs) such as TV viewing, playing computer games, and using the computer for other activities. Although public health data on adolescents’ STB is growing, information about adolescents with LTID is currently lacking in a European context. The purpose of this study is to compare time on STBs between adolescents with and without LTID in European Countries through the HBSC 2013/14 study. Young adolescents (n = 61,329; boys 47.8%) from 15 European countries reported the time spent on TV viewing, playing computer games, and using the computer for other purposes on weekdays and the weekend. STBs were dichotomised based on international recommendations of less than 2 h per day, and Chi-square tests of independence were performed to investigate differences. STB time was combined to produce a sum score as dependent variable in multiple analysis of covariance with age and family affluence as covariates. There were statistically significant differences in computer gaming among boys and other computer use among girls for both weekdays and weekends, whereby adolescents with LTID reported higher use. In addition, both boys and girls with LTID spent more time on STBs than their same sex peers without LTID (Boys, F = 28.17, p < 0.001; Girls, F = 9.60, p = 0.002). The results of this study indicate a need for preventive strategies to address high levels of STB among young adolescents with LTID and reduce the risk of poor health outcomes associated with higher levels of sedentary behaviour. Full article

Disasters have substantial consequences for population mental health. We used Twitter to (1) extract negative emotions indicating discomfort in New York City (NYC) before, during, and after Superstorm Sandy in 2012. We further aimed to (2) identify whether pre- or peri-disaster discomfort were associated with peri- or post-disaster discomfort, respectively, and to (3) assess geographic variation in discomfort across NYC census tracts over time. Our sample consisted of 1,018,140 geo-located tweets that were analyzed with an advanced sentiment analysis called ”Extracting the Meaning Of Terse Information in a Visualization of Emotion” (EMOTIVE). We calculated discomfort rates for 2137 NYC census tracts, applied spatial regimes regression to find associations of discomfort, and used Moran’s I for spatial cluster detection across NYC boroughs over time. We found increased discomfort, that is, bundled negative emotions after the storm as compared to during the storm. Furthermore, pre- and peri-disaster discomfort was positively associated with post-disaster discomfort; however, this association was different across boroughs, with significant associations only in Manhattan, the Bronx, and Queens. In addition, rates were most prominently spatially clustered in Staten Island lasting pre- to post-disaster. This is the first study that determined significant associations of negative emotional responses found in social media posts over space and time in the context of a natural disaster, which may guide us in identifying those areas and populations mostly in need for care. Full article

Individuals with intellectual disabilities (ID) are at high risk for high levels of sedentary behaviour. To inform the development of programmes to reduce sedentary behaviour, insight into the correlates is needed. Therefore, the aim of this study is to review the evidence on correlates of sedentary behaviour in adults with ID. We performed a systematic literature search in Ovid Medline, Ovid Embase, Web of Science and Google Scholar up to 19 January 2018, resulting in nine included studies that were published from 2011 to 2018. Correlates were categorized according to the ecological model. Studies predominantly focused on individual level correlates. Of those correlates studied in more than one study, having epilepsy was associated with less sedentary behaviour and inconsistent results were found for sex, genetic syndromes, weight status, physical health, mobility, level of ID, and mental health. Of the few interpersonal and environmental factors studied, only living arrangements were studied in more than one study, with inconsistent results. To date, we have limited and inconclusive evidence about correlates of sedentary behaviour in adults with ID. Only when future studies unravel correlates and determinants, across all domains of the ecological model, will the potential opportunities to improve health by reducing sedentary behaviour come within reach. Full article

With regional socio-economic development and increasing population, the structure and function of terrestrial ecosystem environments on the earth’s surface have changed markedly. Ecological shelter zone reconstruction (ESZR) is an ecosystem restoration and conservation project, which aims to ensure the safety of the ecological environments of—regions and basins. We selected the upper reaches of the Yangtze River (from Yibin to Chongqing) as the study area and determined the connotation of ESZR. At the same time, the planning scope and construction content of the ecological barrier in this specific region have been preliminarily explored. Meanwhile, a set of related planning methods was proposed, the ecological effects of which were quantitatively assessed and confirmed through the calculation of ESVs. Compared with the conditions in 2005, the study showed that the value of the services of the whole ecosystem augmented significantly under the slope classification, increasing by 103.23%. At the same time, the land use pattern has been optimized, and the vegetation coverage has been enhanced. The ESZR can effectively improve the ecosystem service function of slope land (mainly slope > 25°) and the regional ecological environment, solve the rocky desertification of the study area and provide an effective decision in relation to supporting regional green sustainable development. Full article

The aging population is a big challenge all over the world. However, there are few studies to date investigating the effects of trace element and mineral levels in drinking water and soil (especially in karst areas) on longevity. This study aims to examine temporal and spatial variations in longevity in Hechi (which is recognized as a longevity city) and to investigate relationships between longevity and trace element and mineral levels in drinking water and soils in this city (the karst landscape). Population data were collected from relevant literature and four national population censuses in 1982, 1990, 2000 and 2010. Drinking water and soil samples from Hechi were collected and analyzed. The results demonstrated an obvious clustered distribution for the longevity population in Hechi that has existed stably for decades. The longevity index tended to be significantly positively correlated with H₂SiO₃, Ca and Fe in drinking water and significantly negatively correlated with Sr in soil, indicating that drinking water characteristics contributed significantly to the observed regional longevity. The karst landscape is responsible for abundant trace elements in underground rivers in Hechi, which are beneficial to human health when consumed as drinking water. Good quality and slightly alkaline drinking water rich in trace elements such as H₂SiO₃, Ca, Fe, Na, Mg and low in heavy metals such as Pb and Cd might be an important factor contributing to the longevity phenomenon in Hechi. Full article