Association between air pollution and mortality due to respiratory diseases in children in São Paulo, Brazil: a preliminary report

A new strategy for risk assessment of PM2.5-bound elements by considering the influence of wind regimes

For regulatory purposes, air pollution has been reduced to management of air quality control regions (AQCR), by inventorying pollution sources and identifying the receptors significantly affected. However, beyond being source-dependent, particulate matter can be physically and chemically altered by factors and elements of climate during transport, as they act as local environmental constraints, indirectly modulating the adverse effects of particles on the environment and human health. This case study, at an industrial site in a Brazilian coastal city - Joinville, combines different methodologies to integrate atmospheric dynamics in a strategic risk assessment approach whereby the influence of different wind regimes on environmental and health risks of exposure to PM_2.5-bound elements, are analysed. Although Joinville AQCR has been prone to stagnation/recirculation events, distinctly different horizontal wind circulation patterns indicate two airsheds within the region. The two sampling sites mirrored these two conditions and as a result we report different PM_2.5 mass concentrations, chemical profiles, geo-accumulation, and ecological and human health risks. In addition, feedback mechanisms between the airsheds seem to aggravate the air quality and its effects even under good ventilation conditions. Recognizably, the risks associated with Co, Pb, Cu, Ni, Mn, and Zn loadings were extremely high for the environment as well as being the main contributors to elevated non-carcinogenic risks. Meanwhile, higher carcinogenic risks occurred during stagnation/recirculation conditions, with Cr as the major threat. These results highlight the importance of integrating local airshed characteristics into the risk assessment of PM_2.5-bound elements since they can aggravate air pollution leading to different risks at a granular scale. This new approach to risk assessment can be employed in any city's longer-term development plan since it provides public authorities with a strategic perspective on incorporating environmental constraints into urban growth planning and development zoning regulations.

A Multi-Pollutant and Meteorological Analysis of Cardiorespiratory Mortality among the Elderly in São Paulo, Brazil-An Artificial Neural Networks Approach

Traditionally, studies that associate air pollution with health effects relate individual pollutants to outcomes such as mortality or hospital admissions. However, models capable of analyzing the effects resulting from the atmosphere mixture are demanded. In this study, multilayer perceptron neural networks were evaluated to associate PM₁₀, NO₂, and SO₂ concentrations, temperature, wind speed, and relative air humidity with cardiorespiratory mortality among the elderly in São Paulo, Brazil. Daily data from 2007 to 2019 were considered and different numbers of neurons on the hidden layer, algorithms, and a combination of activation functions were tested. The best-fitted artificial neural network (ANN) resulted in a MAPE equal to 13.46%. When individual season data were analyzed, the MAPE decreased to 11%. The most influential variables in cardiorespiratory mortality among the elderly were PM₁₀ and NO₂ concentrations. The relative humidity variable is more important during the dry season, and temperature is more important during the rainy season. The models were not subjected to the multicollinearity issue as with classical regression models. The use of ANNs to relate air quality to health outcomes is still very incipient, and this work highlights that it is a powerful tool that should be further explored.

First Lidar Campaign in the Industrial Sites of Volta Redonda-RJ and Lorena-SP, Brazil

We report on the first aerosol profiling campaign in the Paraíba valley, a hub connecting the region between the two largest Brazilian metropolitan areas, São Paulo and Rio de Janeiro. São Paulo Sanitation Technology Company (CETESB) air quality and Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) data show homogeneous behavior of the atmosphere throughout the region. A more detailed description of the particulate material in the local atmosphere, including its temporal dependence, can be obtained by using ground-based lidars. Measurements were carried out with a backscatter lidar system in two industrial cities, Volta Redonda and Lorena. The aerosol backscatter profiles present several peaks at different altitudes, indicating the presence of aerosol in several atmospheric layers. In addition, The Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) air-mass back-trajectories indicate a possible detection of long-range aerosol transported from biomass burning areas of South America. The present study emphasizes the importance of investigating and monitoring the emission of particulate matter at this important hub connection between two dense populated regions of Brazil.

Alternative fuel technologies emissions for road heavy-duty trucks: a review

Many alternative fuel technologies have been studied for the transport sector to increase its sustainability while reducing costs, greenhouse gases (GHG), and air pollution emissions. Nevertheless, conventional diesel is still the predominant fuel for heavy-duty trucks. Road freight transport consumes 25% of the world's energy and is responsible for emissions with local health impacts and the global greenhouse effect. In this context, this paper reviewed items from 2015 to 2020 to analyze the technologies available for the road freight transport regarding pollutant and GHG emissions. Results are presented in two parts: first quantitatively, quantitative data was extracted from reviewed papers and statistically treated and, second, qualitatively through a comparative chart, which shows the impact on air pollutants from the use of a different type of fuels. In general, papers are mostly concerned with particulate matter (PM), carbon monoxide (CO), nitrogen oxides (NOx), and hydrocarbons (HC) emissions due to its impact on public health, with a low number of papers covering GHG emissions. The trade-off between different fuels and how this process can impact emissions, sometimes increasing or decreasing specific pollutants, is discussed. According to the analyzed papers, the main characteristics that affect the pollutant emissions are, in general, the fuel oxygen content and the combustion chamber temperature.

Environmental air pollution: respiratory effects

Environmental air pollution is a major risk factor for morbidity and mortality worldwide. Environmental air pollution has a direct impact on human health, being responsible for an increase in the incidence of and number of deaths due to cardiopulmonary, neoplastic, and metabolic diseases; it also contributes to global warming and the consequent climate change associated with extreme events and environmental imbalances. In this review, we present articles that show the impact that exposure to different sources and types of air pollutants has on the respiratory system; we present the acute effects-such as increases in symptoms and in the number of emergency room visits, hospitalizations, and deaths-and the chronic effects-such as increases in the incidence of asthma, COPD, and lung cancer, as well as a rapid decline in lung function. The effects of air pollution in more susceptible populations and the effects associated with physical exercise in polluted environments are also presented and discussed. Finally, we present the major studies on the subject conducted in Brazil. Health care and disease prevention services should be aware of this important risk factor in order to counsel more susceptible individuals about protective measures that can facilitate their treatment, as well as promoting the adoption of environmental measures that contribute to the reduction of such emissions.

Blood markers among residents from a coal mining area

Coal extraction and processing generate environmental contamination, which has several negative impacts on human health. Hematological and biochemical parameters are effective biomarkers of the exposure of a population to air pollutants. Thus, this study aimed to evaluate hematological and biochemical parameters in adult residents in a coal mining region in the largest national reserve in Brazil, as well as to investigate their relations with air quality. The study included three cities in the south of Brazil, which are located near an important power plant and coal mine. The air quality was analyzed by PM10, NOx, and SO₂ at five air quality monitoring stations, socioeconomic and demographic characteristics were evaluated with a questionnaire, and biochemical parameters were assessed in blood samples. The mean PM10 in the study area was 19.18 μg/m³. The air quality varied among the five monitoring stations, and the Candiota station exceeded the reference limit by 63.3%. In general, participants had lived more than 10 years in the municipality and had hepatic and renal parameters within the reference values. A higher prevalence of alterations was found in hematological parameters (43.1%) and liver function (30%). Among the three cities, the population of Pedras Altas seems to have a greater impairment of the blood parameters evaluated. The only parameter that was correlated with PM10 was the hematocrit level (r = 0.33; P < 0.001).

Effects of air pollution on children from a socioecological perspective

Background

Country-level inequality in life expectancy (ILE) and deaths of children under age five due to air pollution (DCAP) can be influenced by country-level income per capita, solid fuel, electrification, and natural resource depletion. The ILE and DCAP in the short-term are useful indicators that can help in developing ways to reduce environmental threats. This study confirms evidence for ILE and DCAP as the effects of environmental threats by country-level income, energy, and natural resource levels from a socioecological approach.

Methods

This study based on life expectancy and children data on 164 countries acquired from the United Nations Development Programme. We obtained the country-level socioecological data from the United Nations and the World Bank database. We assessed the associations between ILE, DCAP, and the country-level indicators applying correlations coefficient and the regression models.

Results

These study findings showed considerable correlations between ILE and country-level socioecological indicators: gross national income per capita (GNI), non-solid fuel (NSF), electrification rate (ER), and natural resource depletion (NRD). The DCAP in short-term predictors were low NSF and low ER (R² = 0.552), and ILE predictors were low GNI, NSF, and ER and higher NRD (R² = 0.816). Thus, the countries with higher incomes and electrification rates and more sustainable natural resources had lower expected DCAP in the short-term and ILE in the long-term.

Conclusions

Based on our results, we confirmed that country-level income, energy, and natural resource indicators had important effects on ILE in long-term and DCAP in short-term. We recommend that countries consider targeting high standards of living and national incomes, access to non-solid fuel and electricity as energy sources, and sustainable natural resources to reduce ILE and DCAP in short-term.

Air Pollution and Noncommunicable Diseases: A Review by the Forum of International Respiratory Societies' Environmental Committee, Part 1: The Damaging Effects of Air Pollution

Air pollution poses a great environmental risk to health. Outdoor fine particulate matter (particulate matter with an aerodynamic diameter < 2.5 μm) exposure is the fifth leading risk factor for death in the world, accounting for 4.2 million deaths and > 103 million disability-adjusted life years lost according to the Global Burden of Disease Report. The World Health Organization attributes 3.8 million additional deaths to indoor air pollution. Air pollution can harm acutely, usually manifested by respiratory or cardiac symptoms, as well as chronically, potentially affecting every organ in the body. It can cause, complicate, or exacerbate many adverse health conditions. Tissue damage may result directly from pollutant toxicity because fine and ultrafine particles can gain access to organs, or indirectly through systemic inflammatory processes. Susceptibility is partly under genetic and epigenetic regulation. Although air pollution affects people of all regions, ages, and social groups, it is likely to cause greater illness in those with heavy exposure and greater susceptibility. Persons are more vulnerable to air pollution if they have other illnesses or less social support. Harmful effects occur on a continuum of dosage and even at levels below air quality standards previously considered to be safe.

Air Pollution and Human Health in Kolkata, India: A Case Study

Urban air quality in most megacities has been found to be critical and Kolkata Metropolitan City is no exception to this. An analysis of ambient air quality in Kolkata was done by applying the Exceedance Factor (EF) method, where the presence of listed pollutants’ (RPM, SPM, NO2, and SO2) annual average concentration are classified into four different categories; namely critical, high, moderate, and low pollution. Out of a total of 17 ambient air quality monitoring stations operating in Kolkata, five fall under the critical category, and the remaining 12 locations fall under the high category of NO2 concentration, while for RPM, four record critical, and 13 come under the high pollution category. The causes towards the high concentration of pollutants in the form of NO2 and RPM have been identified in earlier studies as vehicular emission (51.4%), followed by industrial sources (24.5%) and dust particles (21.1%). Later, a health assessment was undertaken with a structured questionnaire at some nearby dispensaries which fall under areas with different ambient air pollution levels. Three dispensaries have been surveyed with 100 participants. It shows that respondents with respiratory diseases (85.1%) have outnumbered waterborne diseases (14.9%) and include acute respiratory infections (ARI) (60%), chronic obstructive pulmonary diseases (COPD) (7.8%), upper track respiratory infection (UTRI) (1.2%), Influenza (12.7%), and acid fast bacillus (AFB) (3.4%). Although the pollution level has been recorded as critical, only 39.3% of the respondents have felt that outdoor (air) pollution has affected their health.

The association between particulate air pollution and respiratory admissions among young children in Hanoi, Vietnam

While the effects of ambient air pollution on health have been studied extensively in many developed countries, few studies have been conducted in Vietnam, where the population is exposed to high levels of airborne particulate matter. The aim of our study was to examine the short-term effects of PM₁₀, PM_2.5, and PM₁ on respiratory admissions among young children in Hanoi. Data on daily admissions from the Vietnam National Hospital of Paediatrics and daily records of PM₁₀, PM_2.5, PM₁ and other confounding factors as NO₂, SO₂, CO, O₃ and temperature were collected from September 2010 to September 2011. A time-stratified case-crossover design with individual lag model was applied to evaluate the associations between particulate air pollution and respiratory admissions. Significant effects on daily hospital admissions for respiratory disease were found for PM₁₀, PM_2.5 and PM₁. An increase in 10μg/m³ of PM₁₀, PM_2.5 or PM₁ was associated with an increase in risk of admission of 1.4%, 2.2% or 2.5% on the same day of exposure, respectively. No significant difference between the effects on males and females was found in the study. The study demonstrated that infants and young children in Hanoi are at increased risk of respiratory admissions due to the high level of airborne particles in the city's ambient air.

Epidemiologia de desfechos na saúde humana relacionados à poluição atmosférica no Brasil: uma revisão sistemática

ResumoO presente artigo revisa e discute aspectos da situação da pesquisa epidemiológica relacionados aos desfechos de saúde decorrentes da poluição atmosférica. Foi realizada uma revisão sistemática de estudos que avaliou os efeitos de poluentes do ar na saúde humana. A qualidade metodológica dos trabalhos também foi avaliada. A revisão identificou 432 estudos que abordaram a temática, dos quais 56 atendem aos critérios de inclusão previamente estabelecidos. Além de evidenciarem um cenário de pesquisa epidemiológica pautado na relação causa-efeito, os resultados apontam para a necessidade de revisão de parâmetros ambientais e expõem desafios e contribuições à pesquisa epidemiológica em saúde ambiental.

Do pollution and climate influence respiratory tract infections in children?

To review if pollution and climate changes can influence respiratory tract infections in children.

DATA SOURCE

Articles published on the subject in PubMed, SciELO, Bireme, EBSCO and UpTodate were reviewed. The following inclusion criteria were considered: scientific papers between 2002 and 2012, study design, the pediatric population, reference documents such as the CETESB and World Health Organization Summary of the data: We analyzed research that correlated respiratory viruses and climate and/or pollution changes. Respiratory syncytial virus has been the virus related most to changes in climate and humidity. Other "old and new" respiratory viruses such as Human Bocavirus, Metapneumovirus, Parechovirus and Parainfuenza would need to be investigated owing to their clinical importance. Although much has been studied with regard to the relationship between climate change and public health, specific studies about its influence on children's health remain scarce.

Exposure to traffic and early life respiratory infection: A cohort study

We examined whether proximity to a major roadway and traffic density around the home during pregnancy are associated with risk of early life respiratory infection in a pre-birth cohort in the Boston area. We geocoded addresses for 1,263 mother-child pairs enrolled during the first trimester of pregnancy in Project Viva during 1999-2002. We calculated distance from home to nearest major roadway and traffic density in a 100 m buffer around the home. We defined respiratory infection as maternal report of ≥1 doctor-diagnosed pneumonia, bronchiolitis, croup, or other respiratory infection from birth until the early childhood visit (median age 3.3). We used relative risk regression models adjusting for potential confounders to estimate associations between traffic exposures and risk of respiratory infection. Distance to roadway during pregnancy was associated with risk of respiratory infection. In fully adjusted models, relative risks (95% CI) for respiratory infection were: 1.30 (1.08, 1.55) for <100 m, 1.15 (0.93, 1.41) for 100 to <200 m, and 0.95 (0.84, 1.07) for 200 to <1,000 m compared with living ≥1,000 m away from a major roadway. Each interquartile range increase in distance to roadway was associated with an 8% (95% CI 0.87, 0.98) lower risk, and each interquartile range increase in traffic density was associated with a 5% (95% CI 0.98, 1.13) higher risk of respiratory infection. Our findings suggest that living close to a major roadway during pregnancy may predispose the developing lung to infection in early life. Pediatr Pulmonol. 2015; 50:252-259. © 2014 Wiley Periodicals, Inc.

Time course of pulmonary burden in mice exposed to residual oil fly ash

Residual oil fly ash (ROFA) is a common pollutant in areas where oil is burned. This particulate matter (PM) with a broad distribution of particle diameters can be inhaled by human beings and putatively damage their respiratory system. Although some studies deal with cultured cells, animals, and even epidemiological issues, so far a comprehensive analysis of respiratory outcomes as a function of the time elapsed after exposure to a low dose of ROFA is wanted. Thus, we aimed to investigate the time course of mechanical, histological, and inflammatory lung changes, as well as neutrophils in the blood, in mice exposed to ROFA until 5 days after exposure. BALB/c mice (25 ± 5 g) were randomly divided into 7 groups and intranasally instilled with either 10 μL of sterile saline solution (0.9% NaCl, CTRL) or ROFA (0.2 μg in 10 μL of saline solution). Pulmonary mechanics, histology (normal and collapsed alveoli, mononuclear and polymorphonuclear cells, and ultrastructure), neutrophils (in blood and bronchoalveolar lavage fluid) were determined at 6 h in CTRL and at 6, 24, 48, 72, 96, and 120 h after ROFA exposure. ROFA contained metal elements, especially iron, polycyclic aromatic hydrocarbons (PAHs), and organochlorines. Lung resistive pressure augmented early (6 h) in the course of lung injury and other mechanical, histological and inflammatory parameters increased at 24 h, returning to control values at 120 h. Blood neutrophilia was present only at 24 and 48 h after exposure. Swelling of endothelial cells with adherent neutrophils was detected after ROFA instillation. No neutrophils were present in the lavage fluid. In conclusion, the exposure to ROFA, even in low doses, induced early changes in pulmonary mechanics, lung histology and accumulation of neutrophils in blood of mice that lasted for 4 days and disappeared spontaneously.

Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality

BACKGROUND

The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations.

MATERIALS AND METHODS

We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matters (PM2.5 and PM10) using monthly data measurements from air-monitoring stations in North Carolina in 1993-2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population) calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths.

RESULTS

Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths-with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths-with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD)-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only the underlying causes of deaths were used, and when mortality and air-quality data were analyzed on the county level. In each case, the results of sensitivity analyses demonstrated stability. The importance of analysis of pneumonia as an underlying cause of death was also highlighted.

CONCLUSION

Significant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina.

Respiratory toxicity of repeated exposure to particles produced by traffic and sugar cane burning

We compared the toxicity of subchronic exposure to equivalent masses of particles from sugar cane burning and traffic. BALB/c mice received 3 intranasal instillations/week during 1, 2 or 4 weeks of either distilled water (C1, C2, C4) or particles (15μg) from traffic (UP1, UP2, UP4) or biomass burning (BP1, BP2, BP4). Lung mechanics, histology and oxidative stress were analyzed 24h after the last instillation. In all instances UP and BP groups presented worse pulmonary elastance, airway and tissue resistance, alveolar collapse, bronchoconstriction and macrophage influx into the lungs than controls. UP4, BP2 and BP4 presented more alveolar collapse than UP1 and BP1, respectively. UP and BP had worse bronchial and alveolar lesion scores than their controls; BP4 had greater bronchial lesion scores than UP4. Catalase was higher in UP4 and BP4 than in C4. In conclusion, biomass particles were more toxic than those from traffic after repeated exposures.

High accumulation of PCDD, PCDF, and PCB congeners in marine mammals from Brazil: a serious PCB problem

Blubber samples from three delphinid species (false killer whale, Guiana and rough-toothed dolphin), as well as liver samples from franciscana dolphins were analyzed for dioxins and related compounds (DRCs). Samples were collected from 35 cetaceans stranded or incidentally captured in a highly industrialized and urbanized area (Southeast and Southern Brazilian regions). Dioxin-like PCBs accounted for over 83% of the total TEQ for all cetaceans. Non-ortho coplanar PCBs, for franciscanas (82%), and mono-ortho PCBs (up to 80%), for delphinids, constituted the groups of highest contribution to total TEQ. Regarding franciscana dolphins, significant negative correlations were found between total length (TL) and three variables, ΣTEQ-DRCs, ΣTEQ-PCDF and ΣTEQ non-ortho PCB. An increasing efficiency of the detoxifying activity with the growth of the animal may be a plausible explanation for these findings. This hypothesis is reinforced by the significant negative correlation found between TL and PCB126/PCB169 concentration ratio. DRC concentrations (ng/g lipids) varied from 36 to 3006, for franciscana dolphins, as well as from 356 to 30,776, for delphinids. The sum of dioxin-like and indicator PCBs varied from 34,662 to 279,407 ng/g lipids, for Guiana dolphins from Rio de Janeiro state, which are among the highest PCB concentrations ever reported for cetaceans. The high concentrations found in our study raise concern not only on the conservation of Brazilian coastal cetaceans, but also on the possibility of human health problem due to consumption of fish from Brazilian estuaries.

Ambient particulate air pollution and acute lower respiratory infections: a systematic review and implications for estimating the global burden of disease

Acute lower respiratory infections (ALRI) account for nearly one fifth of mortality in young children worldwide and have been associated with exposures to indoor and outdoor sources of combustion-derived air pollution. A systematic review was conducted to identify relevant articles on air pollution and ALRI in children. Using a Bayesian approach to meta-analysis, a summary estimate of 1.12 (1.03, 1.30) increased risk in ALRI occurrence per 10 μg/m³ increase in annual average PM_2.5 concentration was derived from the longer-term (subchronic and chronic) effects studies. This analysis strengthens the evidence for a causal relationship between exposure to PM_2.5 and the occurrence of ALRI and provides a basis for estimating the global attributable burden of mortality due to ALRI that is not influenced by the wide variation in regional case fatality rates. Most studies, however, have been conducted in settings with relatively low levels of PM_2.5. Extrapolating their results to other, more polluted, regions will require a model that is informed by evidence from studies of the effects on ALRI of exposure to PM_2.5 from other combustion sources, such as secondhand smoke and household solid fuel use.

Urban air pollution: a representative survey of PM(2.5) mass concentrations in six Brazilian cities

In urban areas of Brazil, vehicle emissions are the principal source of fine particulate matter (PM(2.5)). The World Health Organization air quality guidelines state that the annual mean concentration of PM(2.5) should be below 10 μg m(-3). In a collaboration of Brazilian institutions, coordinated by the University of São Paulo School of Medicine and conducted from June 2007 to August 2008, PM(2.5) mass was monitored at sites with high traffic volumes in six Brazilian state capitals. We employed gravimetry to determine PM(2.5) mass concentrations, reflectance to quantify black carbon concentrations, X-ray fluorescence to characterize elemental composition, and ion chromatography to determine the composition and concentrations of anions and cations. Mean PM(2.5) concentrations and proportions of black carbon (BC) in the cities of São Paulo, Rio de Janeiro, Belo Horizonte, Curitiba, Recife, and Porto Alegre were 28.1 ± 13.6 μg m(-3) (38% BC), 17.2 ± 11.2 μg m(-3) (20% BC), 14.7 ± 7.7 μg m(-3) (31% BC), 14.4 ± 9.5 μg m(-3) (30% BC), 7.3 ± 3.1 μg m(-3) (26% BC), and 13.4 ± 9.9 μg m(-3) (26% BC), respectively. Sulfur and minerals (Al, Si, Ca, and Fe), derived from fuel combustion and soil resuspension, respectively, were the principal elements of the PM(2.5) mass. We discuss the long-term health effects for each metropolitan region in terms of excess mortality risk, which translates to greater health care expenditures. This information could prove useful to decision makers at local environmental agencies.

Ambient air pollution and apnea and bradycardia in high-risk infants on home monitors

BACKGROUND

Evidence suggests that increased ambient air pollution concentrations are associated with health effects, although relatively few studies have specifically examined infants.

OBJECTIVE

We examined associations of daily ambient air pollution concentrations with central apnea (prolonged pauses in breathing) and bradycardia (low heart rate) events among infants prescribed home cardiorespiratory monitors.

METHODS

The home monitors record the electrocardiogram, heart rate, and respiratory effort for detected apnea and bradycardia events in high-risk infants [primarily premature and low birth weight (LBW) infants]. From August 1998 through December 2002, 4,277 infants had 8,960 apnea event-days and 29,450 bradycardia event-days in > 179,000 days of follow-up. We assessed the occurrence of apnea and bradycardia events in relation to speciated particulate matter and gaseous air pollution levels using a 2-day average of air pollution (same day and previous day), adjusting for temporal trends, temperature, and infant age.

RESULTS

We observed associations between bradycardia and 8-hr maximum ozone [odds ratio (OR) = 1.049 per 25-ppb increase; 95% confidence interval (CI), 1.021-1.078] and 1-hr maximum nitrogen dioxide (OR =1.025 per 20-ppb increase; 95% CI, 1.000-1.050). The association with ozone was robust to different methods of control for time trend and specified correlation structure. In secondary analyses, associations of apnea and bradycardia with pollution were generally stronger in infants who were full term and of normal birth weight than in infants who were both premature and LBW.

CONCLUSIONS

These results suggest that higher air pollution concentrations may increase the occurrence of apnea and bradycardia in high-risk infants.

Differential susceptibility according to gender in the association between air pollution and mortality from respiratory diseases

This study analyzed the association between air pollution and deaths from respiratory diseases, considering differential susceptibility according to gender. The authors used daily deaths from respiratory diseases (ICD-10, J00-J99), PM10, SO2, and O3 levels, and meteorological indicators in Volta Redonda, Rio de Janeiro State, Brazil, from January 2002 to December 2006. The association was estimated by Poisson regression using generalized additive models, where the increase in risk of deaths from PM10 to lag 1 was 10.01% (95%CI: 1.81-18.88%) in the total female population and 10.04% (95%CI: 0.90-20.02%) in elderly women. The increase in risk of deaths from PM10 to lag 9 was 8.25% in the total male population (95%CI: 0.86-16.18%) and 10.80% (95%CI: 2.18-20.15%) in elderly men. For exposure to SO2 and O3, the risk was significant in the total male population and the elderly, respectively. The results emphasize the need for further studies, focusing on modification of the effects of air pollution on health.

Pre and post-natal exposure to ambient level of air pollution impairs memory of rats: the role of oxidative stress

The aims of this study were to evaluate whether air pollution during pre-natal and post-natal phases change habituation and short-term discriminative memories and if oxidants are involved in this process. As secondary objectives, it was to evaluate if the change of filtered to nonfiltered environment could protect the cortex of rats against oxidative stress as well as to modify the behavior of these animals. Wistar, male rats were divided into four groups (n = 12/group): pre and post-natal exposure until adulthood to filtered air (FA); pre-natal period to nonfiltered air (NFA-FA); until (21st post-natal day) and post-natal to filtered air until adulthood (PND21); pre-natal to filtered air until PND21 and post-natal to nonfiltered air until adulthood (FA-NFA); pre and post-natal to nonfiltered air (NFA). After 150 days of air pollution exposure, animals were tested in the spontaneous object recognition test to evaluate short-term discriminative and habituation memories. Rats were euthanized; blood was collected for metal determination; cortex dissected for oxidative stress evaluation. There was a significant increase in malondialdehyde (MDA) levels in the NFA group when compared to other groups (FA: 1.730 +/- 0.217; NFA-FA: 1.101 +/- 0.217; FA-NFA: 1.014 +/- 0.300; NFA: 5.978 +/- 1.920 nmol MDA/mg total proteins; p = 0.007). NFA group presented a significant decrease in short-term discriminative (FA: 0.603 +/- 0.106; NFA-FA: 0.669 +/- 0.0666; FA-NFA: 0.374 +/- 0.178; NFA: -0.00631 +/- 0.106 sec; p = 0.006) and an improvement in habituation memories when compared to other groups. Therefore, exposure to air pollution during both those periods impairs short-term discriminative memory and cortical oxidative stress may mediate this process.

The time course of vasoconstriction and endothelin receptor A expression in pulmonary arterioles of mice continuously exposed to ambient urban levels of air pollution

The present study aimed to verify the time course of the effects of environmental levels of urban air pollution toxicity on lung arterioles. BALB/c mice (n=56) were continuously exposed to selective chambers equipped with (filtered, F) or without (non-filtered, NF) filter devices for particles and toxic gases for 24h/day, over 14, 21, 30 or 45 days. After exposure, we evaluated the lumen-wall relationship (an estimator of arteriolar narrowing), endothelial nitric oxide synthase (eNOS) and endothelin type A receptor (ETAr) expression in the vascular wall and inflammatory influx of the peribronchiolar area. Concentrations of fine particulate matter (PM Collapse

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MESH Headings

• Air Pollutants/toxicity
• Animals
• Arterioles/drug effects
• Arterioles/metabolism
• Atmosphere Exposure Chambers
• Cities
• Inhalation Exposure/analysis
• Lung/blood supply
• Lung/drug effects
• Lung/metabolism
• Male
• Mice
• Mice, Inbred BALB C
• Nitrogen Dioxide/toxicity
• Particulate Matter/toxicity
• Receptor, Endothelin A/drug effects
• Receptor, Endothelin A/metabolism
• Smoke
• Time
• Toxicity Tests
• Vasoconstriction/drug effects

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Affiliation(s)

Giselli Matsumoto Laboratory of Experimental Air Pollution, Department of Pathology, University of Sao Paulo, Sao Paulo, Brazil
Naomi Kondo Nakagawa
Rodolfo de Paula Vieira
Thais Mauad
Luis Fernando Ferraz da Silva
Carmen Diva Saldiva de André
Regiani Carvalho-Oliveira
Paulo Hilário Nascimento Saldiva
Maria Lucia Bueno Garcia

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Effect of air pollution on lung function in schoolchildren in Rio de Janeiro, Brazil

OBJECTIVE

To assess the association between daily exposure to air pollution and lung function in school children.

METHODS

Panel study with a random sample of 118 students (between 6 and 15 years of age), enrolled in a public school of the city of Rio de Janeiro, state of Rio de Janeiro, and living within 2 km of the study site. Data on students' characteristics were obtained with a questionnaire, including the International Study of Asthma and Allergies in Childhood - ISAAC. Daily peak expiratory flow measurements were taken to measure lung function. Daily data on PM10, SO2, O3, NO2 and CO levels, temperature and humidity were provided by a portable monitor. Repeated measurements of lung function were associated with pollutant levels with a multilevel model adjusted for time trend, temperature, air humidity, exposure to smoking at home, presence of asthma, height, sex, weight and age of children.

RESULTS

Mean peak expiratory flow was 243.5 l/m (sd=58.9). The lowest mean peak expiratory flow was 124 l/m, and the highest, 450 l/m. For the 10 microg/m(3) increase in PM10, there was a 0.34 l/min decrease in mean peak flow on the third day. For the 10 microg/m(3) increase in NO2, there was a decrease between 0.23 l/min and 0.28 l/min in mean peak flow after exposure. CO and SO2 effects on students' peak flow were not statistically significant. O3 showed a protective result: an increase in 10 microg/m(3) of O3 would be associated, after a day of exposure, with a 0.2 l/min increase in mean lung function.

CONCLUSIONS

Even within acceptable levels most of the time, air pollution, especially PM10 and NO2, was associated with a decrease in lung function in children living in the city of Rio de Janeiro.

Association between micronuclei frequency in pollen mother cells of Tradescantia and mortality due to cancer and cardiovascular diseases: a preliminary study in Sao José dos Campos, Brazil

The present study was designed to explore the correlation between the frequency of micronuclei in Trad-MN, measured across 28 biomonitoring stations during the period comprised between 11 of May and 2 of October, 2006, and adjusted mortality rates due to cardiovascular, respiratory diseases and cancer in Sao José dos Campos, Brazil, an area with different sources of air pollution. For controlling purposes, mortality rate due to gastrointestinal diseases (an event less prone to be affected by air pollution) was also considered in the analysis. Spatial distribution of micronuclei frequency was determined using average interpolation. The association between health estimators and micronuclei frequency was determined by measures of Pearson's correlation. Higher frequencies of micronuclei were detected in areas with high traffic and close to a petrochemical pole. Significant associations were detected between micronuclei frequency and adjusted mortality rate due to cardiovascular diseases (r=0.841, p=0.036) and cancer (r=0.890, p=0.018). The association between mortality due to chronic obstructive pulmonary diseases was positive but did not reach statistical significance (r=0.640, p=0.172), probably because of the small number of events. Gastrointestinal mortality did not exhibit significant association with micronuclei frequency. Because the small number of observations and the nature of an ecological study, the present findings must be considered with caution and considered as preliminary. Further studies, performed in different conditions of contamination and climate should be done before considering Trad-MN in the evaluation of human health risk imposed by air pollutants.

Comparative respiratory toxicity of particles produced by traffic and sugar cane burning

The impact of particle emissions by biomass burning is increasing throughout the world. We explored the toxicity of particulate matter produced by sugar cane burning and compared these effects with equivalent mass of traffic-derived particles. For this purpose, BALB/c mice received a single intranasal instillation of either distilled water (C) or total suspended particles (15 microg) from an urban area (SP group) or biomass burning-derived particles (Bio group). Lung mechanical parameters (total, resistive and viscoelastic pressures, static elastance, and elastic component of viscoelasticity) and histology were analyzed 24h after instillation. Trace elements and polycyclic aromatic hydrocarbons (PAHs) metabolites of the two sources of particles were determined. All mechanical parameters increased similarly in both pollution groups compared with control, except airway resistive pressure, which increased only in Bio. Both exposed groups showed significantly higher fraction area of alveolar collapse, and influx of polymorphonuclear cells in lung parenchyma than C. The composition analysis of total suspended particles showed higher concentrations of PAHs and lower concentration of metals in traffic than in biomass burning-derived particles. In conclusion, we demonstrated that a single low dose of ambient particles, produced by traffic and sugar cane burning, induced significant alterations in pulmonary mechanics and lung histology in mice. Parenchymal changes were similar after exposure to both particle sources, whereas airway mechanics was more affected by biomass-derived particles. Our results indicate that biomass particles were at least as toxic as those produced by traffic.

Exploring uncertainty of the change from ICD-9 to ICD-10 on acute mortality effects of air pollution

The change in ICD coding from ICD-9 to ICD-10 may produce inconsistencies and discontinuities in cause-specific mortality, thus impacting on effects estimates of air pollution on mortality. The current study was conducted in Wuhan, China. We examined the concordant rates and Kappa statistics using the mortality data from the year 2002 coded with both ICD-9 and ICD-10 codes and compared the estimated effects of air pollution using the Generalized Additive Model in R. We found high concordant rates (>99.3%) and Kappa statistics close to 1.0 (>0.98). Little difference was identified in the estimated effects of air pollution on daily cardiovascular, stroke, cardiac, cardiopulmonary, and respiratory mortality. This study provides evidence that, based on the wide definitions of cause-specific morality typically used in the studies of time-series air pollution mortality, the change in the ICD coding does not significantly affect the estimated effects of air pollution.

Focusing on children's inhalation dosimetry and health effects for risk assessment: an introduction

Substantial effort has been invested in improving children's health risk assessment in recent years. However, the body of scientific evidence in support of children's health assessment is constantly advancing, indicating the need for continual updating of risk assessment methods. Children's inhalation dosimetry and child-specific adverse health effects are of particular concern for risk assessment. When focusing on this topic within children's health, key issues for consideration include (1) epidemiological evidence of adverse effects following children's exposure to air pollution, (2) ontogeny of the lungs and effects on dosimetry, (3) estimation and variability of children's inhalation rates, and (4) current risk assessment methodologies for addressing children. In this article, existing and emerging information relating to these key issues are introduced and discussed in an effort to better understand children's inhalation dosimetry and adverse health effects for risk assessment. While much useful evidence is currently available, additional research and methods are warranted for improved children's health risk assessment.

Children's response to air pollutants

It is important to focus on children with respect to air pollution because (1) their lungs are not completely developed, (2) they can have greater exposures than adults, and (3) those exposures can deliver higher doses of different composition that may remain in the lung for greater duration. The undeveloped lung is more vulnerable to assault and less able to fully repair itself when injury disrupts morphogenesis. Children spend more time outside, where concentrations of combustion-generated air pollution are generally higher. Children have higher baseline ventilation rates and are more physically active than adults, thus exposing their lungs to more air pollution. Nasal breathing in adults reduces some pollution concentrations, but children are more typically mouth-breathers--suggesting that the composition of the exposure mixture at the alveolar level may be different. Finally, higher ventilation rates and mouth-breathing may pull air pollutants deeper into children's lungs, thereby making clearance slower and more difficult. Children also have immature immune systems, which plays a significant role in asthma. The observed consequences of early life exposure to adverse levels of air pollutants include diminished lung function and increased susceptibility to acute respiratory illness and asthma. Exposure to diesel exhaust, in particular, is an area of concern for multiple endpoints, and deserves further research.

Efeitos das queimadas na Amazônia: método de seleção dos municípios segundo indicadores de saúde

INTRODUÇÃO: Na Amazônia é intensa a queima de biomassa decorrente do desmatamento nos meses de seca. No entanto, os efeitos à saúde humana decorrentes da poluição atmosférica derivada das queimadas são pouco estudados. OBJETIVOS: Descrever o método de seleção dos municípios prioritários, orientado pelos indicadores de morbidade e mortalidade por doenças respiratórias para o estudo da "avaliação do efeito das queimadas do desmatamento à saúde humana" na região da Amazônia. MATERIAL E MÉTODOS: Estudo ecológico dos indicadores de morbidade hospitalar e mortalidade por doenças do aparelho respiratório em menores de cinco de idade no período de 2000 a 2004. Análise de: proporção de óbitos; taxa de internação e proporção de internações por doença do aparelho respiratório em menores de 5 anos para o cálculo dos escores e definição do ranking dos municípios. Foi considerada a localização geográfica dos municípios, tipo de bioma, estrutura da rede de serviços de saúde, número de habitantes, registros de dados ambientais prévios sobre poluentes atmosféricos e de dados meteorológicos. RESULTADOS: Foram selecionados os municípios de Alta Floresta e de Tangará da Serra no Estado de Mato Grosso para o desenvolvimento da pesquisa em razão destes alcançarem as piores classificações em termos de morbimortalidade. CONCLUSÃO: Os indicadores de saúde mostram consistência e orientam a análise integrada de saúde e ambiente.

Association of daily cause-specific mortality with ambient particle air pollution in Wuhan, China

In Asia, limited literature has been published on the association between daily mortality and ambient air pollution. We examined the associations of daily cause-specific mortality with daily mean concentrations of particulate matter (PM) with a mass median aerodynamic diameter less than 10 microm (PM(10)) in Wuhan, China using 4 years of data (2001-2004). There are approximately 4.5 million residents in Wuhan who live in the city core area of 201 km(2) where air pollution levels are higher and pollution ranges are wider than the majority of cities in the published literature. We use quasi-likelihood estimation within the context of the generalized additive models (GAMs) (natural spline (NS) models in R) to model the natural logarithm of the expected daily death counts as a function of the predictor variables. We found consistent PM(10) effects on mortality with the strongest effects on lag 0 day. Every 10 microg/m(3) increase in PM(10) daily concentration at lag 0 day was significantly associated with an increase in non-accidental (0.36%; 95% CI 0.19-0.53%), cardiovascular (0.51%; 95% CI 0.28-0.75%), stroke (0.44%; 95% CI 0.16-0.72%), cardiac (0.49%; 95% CI 0.08-0.89%), respiratory (0.71%; 95% CI 0.20-1.23%), and cardiopulmonary (0.46%; 95% CI 0.23-0.69%). In general, these effects were stronger among the elderly (65 years > or = 45 years) than among the young. The exploration of exposure-response relationships between PM(10) and cause-specific mortality suggests the appropriateness of assuming linear relationships, where the PM(10) concentration in Wuhan ranged from 24.8 to 477.8 microg/m(3). We conclude that there is consistent evidence of acute effects of PM(10) on cardiopulmonary mortality. A linear no threshold exposure-response relationship is suggested between PM(10) and the studied cause-specific mortality.

[Clinical repercussions of exposure to atmospheric pollution]

Atmospheric pollution is a topic of extensive discussion the world over. The clinical repercussions of exposure to the principal atmospheric pollutants are summarized herein. According to the American Environmental Protection Agency, air quality standards for these agents are set based on their primary and half-life values. The respiratory effects of the burning of fossil fuels and biomass are succinctly presented, with a special focus on alerting health care professionals of the increased morbidity related to environmental pollution.

Ambient particulate air pollution from vehicles promotes lipid peroxidation and inflammatory responses in rat lung

Oxidative stress plays a major role in the pathogenesis of particle-dependent lung injury. Ambient particle levels from vehicles have not been previously shown to cause oxidative stress to the lungs. The present study was conducted to a) determine whether short-term exposure to ambient levels of particulate air pollution from vehicles elicits inflammatory responses and lipid peroxidation in rat lungs, and b) determine if intermittent short-term exposures (every 4 days) induce some degree of tolerance. Three-month-old male Wistar rats were exposed to ambient particulate matter (PM) from vehicles (N = 30) for 6 or 20 continuous hours, or for intermittent (5 h) periods during 20 h for 4 consecutive days or to filtered air (PM <10 microm; N = 30). Rats continuously breathing polluted air for 20 h (P-20) showed a significant increase in the total number of leukocytes in bronchoalveolar lavage compared to control (C-20: 2.61 x 105 +/- 0.51;P-20: 5.01 x 105 +/- 0.81; P < 0.05) and in lipid peroxidation ([MDA] nmol/mg protein: C-20: 0.148 +/- 0.01; P-20: 0.226 +/- 0.02; P < 0.05). Shorter exposure (6 h) and intermittent 5-h exposures over a period of 4 days did not cause significant changes in leukocytes. Lipid damage resulting from 20-h exposure to particulate air pollution did not cause a significant increase in lung water content. These data suggest oxidative stress as one of the mechanisms responsible for the acute adverse respiratory effects of particles, and suggest that short-term inhalation of ambient particulate air pollution from street with high automobile traffic represents a biological hazard.

Biodirected mutagenic chemical assay of PM(10) extractable organic matter in Southwest Mexico City

The concentration of breathable particles (PM(10)) in urban areas has been associated with increases in morbidity and mortality of the exposed populations, therein the importance of this study. Organic compounds adsorbed to PM(10) are related to the increased risk to human health. Although some studies have shown the lack of correlation between specific mutagenic compounds in an organic complex mixture (OCM) and the mutagenic response in several bioassays, the same organic compounds selectively separated in less complex groups can show higher or lower mutagenic responses than in the OCM. In this study, we fractionated the OCM, from the PM(10) in four organic fractions of increasing polarity (F1-F4). The Salmonella bioassay with plate incorporation was applied for each one using TA98, with and without S9 (mammalian metabolic activation), and YG1021 (without S9) strains. The most polar fraction (F4) contained the greatest mass followed by F1 (non-polar), F2 and F3 (moderately polar). The concentrations of the OCM as well as the F4 were the only variables correlated with PM(10), atmospheric thermal inversions, fire-prone area, NO(2), SO(2), CO, rain and relative humidity. This indicated that polar organic compounds were originated in gas precursors formed during the atmospheric thermal inversions as well as the product of the incomplete combustion of vehicular exhausts and of burned vegetation. The percentages of the total PAH, and the individual PAH with molecular weight > or = 228 g mol(-1) (except retene) correlated with the percentages of indirect-acting mutagenicity in TA98+S9. The percentages of the total nitro-PAH and most of the analyzed individual nitro-PAH correlated with percentages of the direct-acting mutagenicity in both TA98-S9 and YG1021, the latter being more sensitive. In general, the highest mutagenic activity (indirect and direct) was found in F3 (moderately polar) and in F4 (polar). The non-polar fraction (F1) did not exhibit any kind of mutagenicity. In 77% of the cases, mutagenic activity was higher in the sum fractions with respect to their OCM. The combinations between F1, F2 and F4, with F3 under different or equal proportions suggested that mutagenicity reduction, in the combined matter of January (with TA98+S9 and YG1021) and of May (with YG1021), was due to concentrations of mutagens and non-mutagens in each fraction, and not to an antimutagenic effect. The organic compounds present in the non-polar fractions showed no antagonism, inhibition or reduction in the most mutagenic fractions in both indirect- and direct-acting mutagenicity, and the less polar organic compounds in F3 reduced mutagenicity in F4, in both months.

Outdoor Air Pollution: Nitrogen Dioxide, Sulfur Dioxide, and Carbon Monoxide Health Effects

Nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide are important ambient air pollutants. High-intensity, confined space exposure to NO2 has caused catastrophic injury to humans, including death. Ambient NO2 exposure may increase the risk of respiratory tract infections through the pollutant's interaction with the immune system. Sulfur dioxide (SO2) contributes to respiratory symptoms in both healthy patients and those with underlying pulmonary disease. Controlled human exposure studies have demonstrated that experimental SO2 exposure causes changes in airway physiology, including increased airways resistance. Both acute and chronic exposure to carbon monoxide are associated with increased risk for adverse cardiopulmonary events, including death. However, studies have not demonstrated a clear dose-dependent health risk response to increasing amounts of these pollutants except at high concentrations. In addition, a number of studies examining the effects of ambient level exposure to NO2, SO2, and CO have failed to find associations with adverse health outcomes.

Aerosols: the environmental harmful effect

Aerosols as end products of ambient indoor and outdoor pollution have some potential harmful effect. Children are especially at risk due to their developing organ systems. This is mainly true for the lungs, but may also be true for other organ systems, such as the immune system.

The effects of air pollution on cardiovascular diseases: lag structures

OBJECTIVE: To assess the lag structure between air pollution exposure and elderly cardiovascular diseases hospital admissions, by gender. METHODS: Health data of people aged 64 years or older was stratified by gender in São Paulo city, Southeastern Brazil, from 1996 to 2001. Daily levels of air pollutants (CO, PM10, O3, NO2, and SO2) , minimum temperature, and relative humidity were also analyzed. It were fitted generalized additive Poisson regressions and used constrained distributed lag models adjusted for long time trend, weekdays, weather and holidays to assess the lagged effects of air pollutants on hospital admissions up to 20 days after exposure. RESULTS: Interquartile range increases in PM10 (26.21 mug/m³) and SO2 (10.73 mug/m³) were associated with 3.17% (95% CI: 2.09-4.25) increase in congestive heart failure and 0.89% (95% CI: 0.18-1.61) increase in total cardiovascular diseases at lag 0, respectively. Effects were higher among female group for most of the analyzed outcomes. Effects of air pollutants for different outcomes and gender groups were predominately acute and some "harvesting" were found. CONLUSIONS: The results show that cardiovascular diseases in São Paulo are strongly affected by air pollution.

Air pollution and infant death in southern California, 1989-2000

OBJECTIVE

We evaluated the influence of outdoor air pollution on infant death in the South Coast Air Basin of California, an area characterized by some of the worst air quality in the United States.

METHODS

Linking birth and death certificates for infants who died between 1989 and 2000, we identified all infant deaths, matched 10 living control subjects to each case subject, and assigned the nearest air monitoring station to each birth address. For all subjects, we calculated average carbon monoxide, nitrogen dioxide, ozone, and particulate matter < 10 microm in aerodynamic diameter exposures experienced during the 2-week, 1-month, 2-month, and 6-month periods before a case subject's death.

RESULTS

The risk of respiratory death increased from 20% to 36% per 1-ppm increase in average carbon monoxide levels 2 weeks before death in early infancy (age: 28 days to 3 months). We also estimated 7% to 12% risk increases for respiratory deaths per 10-microg/m3 increase in particulate matter < 10 microm in aerodynamic diameter exposure experienced 2 weeks before death for infants 4 to 12 months of age. Risk of respiratory death more than doubled for infants 7 to 12 months of age who were exposed to high average levels of particulates in the previous 6 months. Furthermore, the risk of dying as a result of sudden infant death syndrome increased 15% to 19% per 1-part per hundred million increase in average nitrogen dioxide levels 2 months before death. Low birth weight and preterm infants seemed to be more susceptible to air pollution-related death resulting from these causes; however, we lacked statistical power to confirm this heterogeneity with formal testing.

CONCLUSIONS

Our results add to the growing body of literature implicating air pollution in infant death from respiratory causes and sudden infant death syndrome and provide additional information for future risk assessment.

Coal home heating and environmental tobacco smoke in relation to lower respiratory illness in Czech children, from birth to 3 years of age

OBJECTIVE

The objective of this study was to evaluate how indoor pollution from tobacco and home heating may adversely affect respiratory health in young children.

DESIGN

A birth cohort was followed longitudinally for 3 years to determine incidence of lower respiratory illness (LRI).

PARTICIPANTS

A total of 452 children born 1994-1996 in two districts in the Czech Republic participated.

EVALUATIONS

Indoor combustion exposures were home heating and cooking fuel, mother's smoking during pregnancy, and other adult smokers in the household. Diagnoses of LRI (primarily acute bronchitis) from birth to 3 years of age were abstracted from pediatric records. Questionnaires completed at delivery and at 3-year follow-up provided covariate information. LRI incidence rates were modeled with generalized linear models adjusting for repeated measures and for numerous potential confounders.

RESULTS

LRI diagnoses occurred more frequently in children from homes heated by coal [vs. other energy sources or distant furnaces ; rate ratio (RR) = 1.45 ; 95% confidence interval (CI) , 1.07-1.97]. Maternal prenatal smoking and other adult smokers also increased LRI rates (respectively: RR = 1.48 ; 95% CI, 1.10-2.01 ; and RR = 1.29 ; 95% CI, 1.01-1.65) . Cooking fuels (primarily electricity, natural gas, or propane) were not associated with LRI incidence. For children never breast-fed, coal home heating and mother's smoking conferred substantially greater risks: RR = 2.77 (95% CI, 1.45-5.27) and RR = 2.52 (95% CI, 1.31-4.85) , respectively.

CONCLUSIONS

Maternal smoking and coal home heating increased risk for LRI in the first 3 years of life, particularly in children not breast-fed.

RELEVANCE

Few studies have described effects of coal heating fuel on children's health in a Western country. Breast-feeding may attenuate adverse effects of prenatal and childhood exposures to combustion products.

Influence of Cooking and Heating Fuel Use on 1–59 Month Old Mortality in South Africa

OBJECTIVES

To determine the association between the combustion of wood, animal dung, coal and paraffin (polluting fuels) for cooking and heating and 1-59 month old mortality in South Africa, whilst adjusting for a number of confounders.

METHODS

Data from 3,556 children (142 deaths) living in 2,828 households were extracted from the 1998 South African Demographic and Health Survey (SADHS) database. The SADHS was the first national health survey conducted across the entire country and provided the opportunity to examine the prevalence and determinants of various morbidity and mortality outcomes in a representative national population.

RESULTS

The results suggest that exposure to cooking and heating smoke from polluting fuels is significantly associated with 1-59 month mortality, after controlling for mother's age at birth, water source, asset index and household crowdedness (RR=1.95; 95% CI=1.04, 3.68).

CONCLUSIONS

Although there is potential for residual confounding despite adjustment, the better documented evidence on outdoor air pollution and mortality suggest this association may be real. As nearly half of households in South Africa still rely on polluting fuels and women of childbearing age perform most cooking tasks, the attributable risk arising from this association, if confirmed, could be substantial. It is trusted that more detailed analytical intervention studies will scrutinise these results in order to develop integrated intervention programmes to reduce children's exposure to air pollution emanating from cooking and heating fuels.

The impact of sugar cane-burning emissions on the respiratory system of children and the elderly

We analyzed the influence of emissions from burning sugar cane on the respiratory system during almost 1 year in the city of Piracicaba in southeast Brazil. From April 1997 through March 1998, samples of inhalable particles were collected, separated into fine and coarse particulate mode, and analyzed for black carbon and tracer elements. At the same time, we examined daily records of children (<13 years of age) and elderly people (>64 years of age) admitted to the hospital because of respiratory diseases. Generalized linear models were adopted with natural cubic splines to control for season and linear terms to control for weather. Analyses were carried out for the entire period, as well as for burning and nonburning periods. Additional models were built using three factors obtained from factor analysis instead of particles or tracer elements. Increases of 10.2 microg/m3 in particles<or=2.5 microm/m3 aerodynamic diameter (PM2.5) and 42.9 microg/m3 in PM10 were associated with increases of 21.4% [95% confidence interval (CI), 4.3-38.5] and 31.03% (95% CI, 1.25-60.21) in child and elderly respiratory hospital admissions, respectively. When we compared periods, the effects during the burning period were much higher than the effects during nonburning period. Elements generated from sugar cane burning (factor 1) were those most associated with both child and elderly respiratory admissions. Our results show the adverse impact of sugar cane burning emissions on the health of the population, reinforcing the need for public efforts to reduce and eventually eliminate this source of air pollution.

A new model for investigating the mortality effects of multiple air pollutants in air pollution mortality time-series studies

Because the U.S. Environmental Protection Agency regulates air pollutants independently, the majority of time-series studies on air pollution and mortality have focused on estimating the adverse health effects of a single pollutant. However, due to the sometimes high correlation between air pollutants, the results from studies that focus on a single air pollutant can be difficult to interpret. In addition, the high correlation between air pollutants can produce problems of interpretation for the standard method of investigating the adverse health effects due to multiple air pollutants. The standard method involves simultaneously including the multiple air pollutants in a single statistical model. Because of this, the development of new models to concurrently estimate the adverse health effects of multiple air pollutants has recently been identified as an important area of future research. In this article, a new model for disentangling the joint effects of multiple air pollutants in air pollution mortality time-series studies is introduced. This new model uses the time-series data to assign each air pollutant a weight that indicates the pollutant's contribution to the air pollution mixture that affects mortality and to estimate the effect of this air pollution mixture on mortality. This model offers an improvement in statistical estimation precision over the standard method. It also avoids problems of interpretation that can occur if the standard method is used. This new model is then illustrated by applying it to time-series data from two U.S. counties.

The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City

Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and São Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration-response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children's medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly 21 to 165 billion Dollars (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration-response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies.

The German view: effects of nitrogen dioxide on human health--derivation of health-related short-term and long-term values

The presented overview concerning health relevant effects caused by nitrogen dioxide (NO2) resumes the current state of results from animal experiments and human studies (epidemiology and short-term chambers studies). NO2 concentrations applied in animal experiments were mostly considerably higher than in ambient air. Therefore, short- and long-term limit values were derived from human data. Experimental studies conducted with humans demonstrate effects after short-term exposure to concentrations at or above 400 microg NO2/m3. Effects on patients with light asthma could not be observed after short-term exposure to concentrations below 200 microg/m3. On basis of epidemiological long-term studies a threshold below which no effect on human health is expected could not be specified. Two short-term limit values have been proposed to protect public health: a 1-h value of 100 microg/m3 and a 24-h mean value of 50 microg/m3. Due to the limitations of epidemiological studies to disentangle effects of single pollutants, a long-term limit value cannot be easily derived. However, applying the precautionary principle, it is desirable to adopt an annual mean of 20 microg NO2/m3 as a long-term mean standard to protect public health.