Emergency department visits and "vog"-related air quality in Hilo, Hawai'i

An Integrated Data Mining Framework for Organizational Resilience Assessment and Quality Management Optimization in Trauma Centers

Every second counts for patients with life-threatening injuries, and trauma centers deliver timely emergency care to patients with traumatic injuries. Quality assessment and improvement are some of the most fundamental concerns in trauma centers. In this study, a comprehensive organizational resilience approach is proposed to evaluate performance in trauma centers using the European Foundation for Quality Management as a fundamental and strategic approach. We propose a unique intelligent algorithm composed of parametric and non-parametric statistical methods to determine the type and the extent of influence within the organizational resilience and quality management perspectives. We use structural equation modeling to examine the reliability and validity of the input data. The efficiency of each trauma center is then measured using a machine learning method with genetic programming, support vector regression, and Gaussian process regression. The mean absolute percentage error is used to determine the optimal model, and a fuzzy data envelopment analysis model is used to verify and validate the results obtained from the optimal model. The results show that customer results, human capital results, and key performance results have the highest importance weights and positive influence on quality management. Cognitive resources, roles and responsibilities, and self-organization have the highest importance weights and positive influence on organizational resilience.

Influence of PM1 exposure on total and cause-specific respiratory diseases: a systematic review and meta-analysis

An increasing number of studies examined the potential effects of PM1 (submicronic particulate matter with an aerodynamic diameter ≤ 1 μm) on the risk of respiratory diseases; however, the results have been inconclusive. This study aimed to determine the overall association between PM1 with total and cause-specific respiratory diseases. A systematic review and meta-analysis was conducted with 68 related articles retrieved, and six articles met the full inclusion criteria for the final analysis. For a 10 μg/m3 increase in PM1, the pooled odds ratio (OR) was 1.05 (95% CI 0.98-1.12) for total respiratory diseases, 1.25 (95% CI 1.00-1.56) for asthma, and 1.07 (95% CI 1.04-1.10) for pneumonia with the I2 value of 87%, 70%, and 0%, respectively. Subgroup analyses showed that long-term exposure to PM1 was associated with increased risk of asthma (OR 1.47, 95% CI 1.33-1.63) with an I2 value of 0%, while short-term exposure to PM1 was not associated with asthma (OR 1.07, 95% CI 0.89-1.27) with the I2 value of 0%. Egger's test showed that publication bias existed (P = 0.041); however, the funnel plot was symmetrical with the inclusion of the moderator. In conclusion, elevated levels of PM1 may increase morbidity in total and cause-specific respiratory diseases in the population.

Quantitative Retrieval of Volcanic Sulphate Aerosols from IASI Observations

We developed a new retrieval algorithm based on the Infrared Atmospheric Sounding Interferometer (IASI) observations, called AEROIASI-H2SO4, to measure the extinction and mass concentration of sulphate aerosols (binary solution droplets of sulphuric acid and water), with moderate random uncertainties (typically ∼35% total uncertainty for column mass concentration estimations). The algorithm is based on a self-adapting Tikhonov–Phillips regularization method. It is here tested over a moderate-intensity eruption of Mount Etna volcano (18 March 2012), Italy, and is used to characterise this event in terms of the spatial distribution of the retrieved plume. Comparisons with simultaneous and independent aerosol optical depth observations from MODIS (Moderate Resolution Imaging Spectroradiometer), SO2 plume observations from IASI and simulations with the CHIMERE chemistry/transport model show that AEROIASI-H2SO4 correctly identifies the volcanic plume horizontal morphology, thus providing crucial new information towards the study of volcanic emissions, volcanic sulphur cycle in the atmosphere, plume evolution processes, and their impacts. Insights are given on the possible spectroscopic evidence of the presence in the plume of larger-sized particles than previously reported for secondary sulphate aerosols from volcanic eruptions.

Asthma prevalence disparities and differences in sociodemographic associations with asthma, between Native Hawaiian/Other Pacific Islander, Asian, and White adults in Hawaii - Behavioral Risk Factor Surveillance System (BRFSS), 2001-2010

OBJECTIVES

Despite high asthma prevalence, relatively little is known about the epidemiology of asthma in Hawaii or among Native Hawaiian/Other Pacific Islanders (NHOPI). We sought to better characterize racial/ethnic differences in asthma prevalence and in sociodemographic factors associated with asthma among Hawaii adults.

DESIGN

We conducted multivariable logistic regression using 2001-2010 Behavioral Risk Factor Surveillance System data from Hawaii, and computed adjusted prevalence and ratios.

RESULTS

Asthma prevalence markedly varied between self-identified census categories of race in Hawaii, with NHOPI having the highest estimates of both lifetime (20.9%, 95% confidence interval [CI]: 19.5%-22.4%) and current (12.2%, CI: 11.2%-13.3%) asthma. Highest asthma prevalence among NHOPI persisted after controlling for potential confounders and within most sociodemographic categories. Among females Asians reported the lowest asthma prevalence, whereas among males point estimates of asthma prevalence were often lowest for Whites. Females often had greater asthma prevalence than males of the same race, but the degree to which gender modified asthma prevalence differed by both race and sociodemographic strata. Gender disparities in asthma prevalence were greatest and most frequent among Whites, and for current asthma among all races. Sociodemographic factors potentially predictive of adult asthma prevalence in Hawaii varied by race and gender.

CONCLUSION

Asthma disproportionately affects or is recognized more often among women and NHOPI adults in Hawaii, and occurs less or is under-reported among Asian women. The sociodemographic characteristics included in this study's model did not explain asthma disparities between races and/or gender. This investigation provides a baseline with which to plan additionally needed prevention programs, epidemiological investigations, and surveillance for asthma in Hawaii.

Influence of sulfur dioxide on the respiratory system of Miyakejima adult residents 6 years after returning to the island

BACKGROUND

Mount Oyama, on the Japanese island of Miyakejima, began erupting in June 2000, necessitating the evacuation of 3,000 island residents. Volcanic gas emissions, primarily consisting of sulfur dioxide (SO2), gradually decreased and residents returned to the island after the evacuation order was lifted in February 2005.

OBJECTIVES

To assess the exposure-effect and exposure-response relationships between SO2 exposure and effects on respiratory system in adult Miyakejima residents.

METHOD

Health checkups focusing on pulmonary function and respiratory/irritative symptoms were conducted six times every November from 2006 to 2011. The study population comprised 168 subjects who underwent all health checkups. SO2 concentrations were measured at six fixed monitoring stations in inhabitable areas.

RESULT

Based on the annual mean SO2 concentration, inhabitable areas were classified into three categories; namely, lower (L), higher (H-1), and highest (H-2) areas. Average SO2 concentrations (ppb) during 3 months prior to each health checkup dropped from 11.3 to 3.29, 32.2 to 13.4 and 75.1 to 12.6 from 2006 to 2010/2011 in L, H-1, and H-2. No significant declines in pulmonary function were observed in all areas. However, prevalence of subjective symptoms such as "Cough," "Irritation and/or pain in throat," "Irritation, runny nose, and/or nasal sniffles," and "Irritation and/or pain in the eyes," dependently increased on SO2 concentration. Odds ratios were statistically significant at approximately 70 ppb of SO2 or above.

CONCLUSION

Adult residents of Miyakejima island showed no deterioration in pulmonary function at SO2 levels, but complained of respiratory/irritative symptoms in an SO2 concentration-dependent manner.

Effects of sulfur dioxide on the respiratory system of Miyakejima child residents 6 years after returning to the island

OBJECTIVES

This study investigated the health effects of volcanic gas, mainly sulfur dioxide (SO2), exposure on the children of Miyakejima Island.

METHODS

Health checkups were conducted in November from 2006 to 2011. Health effects were evaluated through a self-administered questionnaire on respiratory and irritative symptoms, and spirometry. SO2 was measured continuously from February 2005 onward at six fixed monitoring stations in inhabitable areas. Based on mean SO2 concentration during 3 months before each health checkup, inhabitable areas were classified into three categories: (1) lower (area L); (2) higher (area H-1); and (3) highest (area H-2).

RESULTS

Average concentrations (ppb) of SO2 decreased year-by-year and ranged from 11.3 to 2.47 in area L, from 32.2 to 12.2 in area H-1, and from 75.1 to 12.1 in area H-2, respectively. In general, prevalence of respiratory and irritative symptoms was higher in area H-2, and the prevalence decreased year-by-year in all three areas by Cochran-Armitage test for trend. We defined a study population in area L in 2008 as a reference population because we had no unexposed population. Applying a logistic regression model, age-, sex-, and hypersusceptibility-adjusted prevalence odds ratios to the reference population showed clear exposure-dependent increases in some irritative symptoms such as "Irritation and/or pain in throat" and "in eyes," and approximately 30 ppb seemed to be the threshold concentration. Spirometry did not show any significant differences.

CONCLUSIONS

Though no pulmonary functions were affected, some subjective symptoms were detected dose-dependently by SO2 exposure concentration in child residents during the 6 years after the eruption.

Tree and forest effects on air quality and human health in the United States

Trees remove air pollution by the interception of particulate matter on plant surfaces and the absorption of gaseous pollutants through the leaf stomata. However, the magnitude and value of the effects of trees and forests on air quality and human health across the United States remains unknown. Computer simulations with local environmental data reveal that trees and forests in the conterminous United States removed 17.4 million tonnes (t) of air pollution in 2010 (range: 9.0-23.2 million t), with human health effects valued at 6.8 billion U.S. dollars (range: $1.5-13.0 billion). This pollution removal equated to an average air quality improvement of less than one percent. Most of the pollution removal occurred in rural areas, while most of the health impacts and values were within urban areas. Health impacts included the avoidance of more than 850 incidences of human mortality and 670,000 incidences of acute respiratory symptoms.

Race and asthma control in the pediatric population of Hawaii

OBJECTIVES

The racially unique population of Hawaii has one of the highest prevalences of childhood asthma in America. We estimate the prevalence of impaired asthma control among asthmatic children in Hawaii and determine which factors are associated with impaired control.

PATIENTS AND METHODS

We analyzed data from 477 asthmatic children living in Hawaii participating in the 2006-2008 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-Back Surveys. Impaired asthma control was modeled after 2007 National Asthma Education and Prevention Program guidelines. Univariate and multivariate analyses were used to identify factors associated with impaired asthma control.

RESULTS

Children (53.8%) with asthma were either part or full Native Hawaiian/Pacific Islander. While 35.6% of asthmatic children met criteria for impaired asthma control, being part or full Native Hawaiian/Pacific Islander was not associated with impaired control. Only 31.1% of children with impaired control reported the use of inhaled corticosteroids despite >80% having had a routine checkup for asthma in the past year and receipt of asthma education from a healthcare provider.

CONCLUSION

A large proportion of asthmatic children in Hawaii have impaired asthma control that does not appear to be associated with race but may be associated with inadequate pharmacologic therapy. While a significant percentage reported receiving routine asthma care and asthma education, a minority reported using inhaled corticosteroids. Reasons for this discrepancy between asthma assessment and treatment are unclear. However, additional education on part of the physician, community, and healthcare system are likely to improve management and reduce morbidity in this population.

An indoor air quality assessment for vulnerable populations exposed to volcanic vog from Kilauea Volcano

The Ka'u District of Hawaii is exposed to sulfurous air pollution called vog from the ongoing eruption of Kilauea Volcano. Increased volcanic activity in 2008 prompted an indoor air quality assessment of the district's hospital and schools. All indoor sulfur dioxide concentrations were above the World Health Organization's average 24-hour recommendation. Indoor penetration ratios were up to 94% of ambient levels and dependent upon building construction or the use of air-conditioning. Health-promotion efforts for vulnerable populations at the hospital and schools are under way to improve indoor air quality and respond to those affected by vog exposure.

The Kilauea Volcano adult health study

BACKGROUND

Millions of people reside near active volcanoes, yet data are limited on effects to human health. The Kilauea Volcano is the largest point source for sulfur dioxide in the United States, releasing air pollution on nearby communities since 1983.

OBJECTIVE

: The objectives of this study were to provide the first population-based epidemiological estimates and qualitative descriptions of cardiorespiratory health effects associated with volcanic air pollution.

METHODS

An environmental-epidemiological design was used. Exposure levels of Kilauea's air pollutants were determined by environmental sampling. Prevalence estimates of cardiorespiratory health effects in adults were measured (N = 335) and compared between an exposed and nonexposed reference community. Descriptions of the human-environment interaction with the long-standing eruption were recorded from informants in the natural setting.

RESULTS

Ambient and indoor concentrations of volcanic air pollution were above the World Health Organization's recommended exposure levels. There were statistically significant increased odds associated with exposure for self-reported cough, phlegm, rhinorrhea, sore and dry throat, sinus congestion, wheezing, eye irritation, and diagnosed bronchitis. Thirty-five percent of the informants perceived that their health was affected by the eruption, mainly current and former smokers and those with chronic respiratory disease.

DISCUSSION

Hypotheses were supported regarding particulate air pollution and the association with adverse cardiovascular functioning. This emerging environmental health issue is under continuing investigation.

Effects of SO2 on respiratory system of adult Miyakejima resident 2 years after returning to the island

BACKGROUND

Mt. Oyama in Miyakejima Island erupted in June, 2000. All Miyake villagers were forced to evacuate from the island in September, 2000, due to continuous eruptions and emissions of unsafe amounts of volcanic gas, mainly SO2. From February, 2005, Miyake villagers returned to the island despite volcanic gas still being emitted.

OBJECTIVES

This study examines the 2-yr changes in Miyake residents' respiratory systems from autumn 2004 to November 2006.

METHODS

The study population was 823 Miyake adult residents who participated in the health check-up in 2006. Respiratory effects were evaluated by a questionnaire for respiratory symptoms and spirometry. SO2 has been continuously monitored at 7 sampling points of the inhabited area. The mean SO2 concentration from February 2005 to November 2006 was 0.031 ppm. The area was categorized into 4 areas by SO2 concentration, namely, areas L, H-1, H-2 and H-3, where average SO2 concentrations were 0.019, 0.026, 0.032, and 0.045 ppm, respectively.

RESULTS

The study subjects showed no deterioration in lung function. Prevalence of cough and phlegm among all participants were significantly higher in 2006 than in 2004, and age-, sex- and smoking-adjusted odds ratios of cough and phlegm were 1.75 (95%CI 1.33-2.30) and 1.44 (1.12-1.87). Prevalence of chronic bronchitis-like symptoms among normosusceptive subjects in 2006 was 4.1% which was significantly higher than that of 2.1% in 2004 (p=0.035). Compared to area L, the frequencies of phlegm and irritation of the nose were significantly increased in areas H-2 and H-3.

CONCLUSION

SO2 exposure-related respiratory symptoms were observed in adult Miyakejima residents after returning to the island.

Cardiorespiratory health effects associated with sulphurous volcanic air pollution

OBJECTIVE

To investigate cardiorespiratory health effects associated with chronic exposure to volcanogenic sulphur dioxide (SO2) and fine sulphate particle (< or = 0.3 microm) air pollution emitted from Kilauea Volcano, Hawaii.

STUDY DESIGN

Environmental-epidemiological cross-sectional study.

METHODS

An air study was conducted to measure exposure levels in the downwind area, and to confirm non-exposure in a reference area. Cross-sectional health data were collected from 335 adults, > or = 20 years of age, who had resided for > or = 7 years in the study areas. Prevalence was estimated for cardiorespiratory signs, and self-reported symptoms and diseases. Logistic regression analysis estimated effect measures between exposed and unexposed groups considering potential confounding including age, gender, race, smoking, dust and body mass index (BMI). Student's t-tests compared mean differences in blood pressure (BP), pulse and respiratory rates.

RESULTS

There were statistically significant positive associations between chronic exposure and increased prevalence of cough, phlegm, rhinorrhoea, sore/dry throat, sinus congestion, wheezing, eye irritation and bronchitis. The magnitude of the associations differed according to SO2 and fine sulphate particulate exposure. Group analyses found no differences in pulse rate or BP; however, significantly faster mean pulse rates were detected in exposed non-medicated, non-smoking participants with BMI <25, and in participants aged > or = 65 years. Higher mean systolic BP was found in exposed participants with BMI <25.

CONCLUSIONS

Long-term residency in active degassing volcanic areas may have an adverse effect on cardiorespiratory health in adults. Further study at Kilauea is recommended, and the authors encourage investigations in communities near active volcanoes worldwide. Public health interventions of community education, and smoking prevention and cessation are suggested.

Acute bronchitis and volcanic air pollution: a community-based cohort study at Kilauea Volcano, Hawai'i, USA

Eruption at Kilauea Volcano, Hawai'i, has continued since 1983, emitting sulfurous air pollution into nearby communities. The purpose of this cohort study was to estimate the relative risk (RR) of acute bronchitis over a period from January 2004 to December 2006 in communities exposed to the volcanic air pollution. A community-based case review was conducted using medical records from clinics and emergency rooms in exposed and unexposed study areas. Initial visits by local residents for diagnosed acute bronchitis were clinically reviewed. The cumulative incidence rate for the 3-yr period was 117.74 per 1000 in unexposed communities and 184.63 per 1000 in exposed communities. RR estimates were standardized for age and gender, revealing an elevated cumulative incidence ratio (CIR) of 1.57 (95% CI = 1.36-1.81) for acute bronchitis in the exposed communities. Highest risk [CIR: 6.56 (95% CI = 3.16-13.6)] was observed in children aged 0-14 yr who resided in the exposed communities. Exposed middle-aged females aged 45-64 yr had double the risk for acute bronchitis than their unexposed counterparts. These findings suggest that communities continuously exposed to sulfurous volcanic air pollution may have a higher risk of acute bronchitis across the life span.

Health hazards from volcanic gases: a systematic literature review

Millions of people are potentially exposed to volcanic gases worldwide, and exposures may differ from those in anthropogenic air pollution. A systematic literature review found few primary studies relating to health hazards of volcanic gases. SO2 and acid aerosols from eruptions and degassing events were associated with respiratory morbidity and mortality but not childhood asthma prevalence or lung function decrements. Accumulations of H2S and CO2 from volcanic and geothermal sources have caused fatalities from asphyxiation. Chronic exposure to H2S in geothermal areas was associated with increases in nervous system and respiratory diseases. Some impacts were on a large scale, affecting several countries (e.g., Laki fissure eruption in Iceland in 1783-4). No studies on health effects of volcanic releases of halogen gases or metal vapors were located. More high quality collaborative studies involving volcanologists and epidemiologists are recommended.

Airborne particulates and asthma: a Maine case study

Maine currently has the second fastest growing asthma rate in the nation 9.4% of the adult population has asthma and one out of eight children is affected. The factors behind this increase are poorly understood, but previous reports suggest that biologically soluble metal ions from particulate matter (PM10) may play a role in asthma episodes. In an effort to study this issue, we first identified geographic and temporal trends in Maine asthma hospitalizations. Clinical data show a strong fall peak in asthma admissions with weaker peaks in January and May, and a summer low in asthma admissions. Asthma admissions are also higher in the cities than in the rural areas in Maine. We then analysed PM10 collected by the Maine Department of Environmental Protection in three different Maine locations in the years 2000 and 2001, at times when clinical asthma data showed peaks and during the summer low period. We also collected soil samples in the same locations. The PM10 and soils were analysed for 10 metals by acid extraction to determine total metal content and then with cell culture medium, DMEM/F12+CCS growth medium, to determine metal biosolubility. Our results showed that Mn, Cu, Pb, As, V, Ni and Al were present in the Maine PM samples. V, Ni and Pb showed seasonal variation, while the others were relatively constant throughout the year. Pb and Al did not appear to be soluble in the biological medium. There was also variation from location to location with the urban area showing the highest concentrations for most metals. Aluminium was present in the highest concentration in soil samples, followed by Mn and V. Only Cu was biologically available in soils. We determined from M/Al ratios that most of the PM10 did not originate from local crustal material.

Volcano Related Atmospheric Toxicants in Hilo and Hawaii Volcanoes National Park: Implications for Human Health

Volcanic fog (vog) from Kilauea volcano on the island of Hawaii includes a variety of chemical species including sulfur compounds and traces of metals such as mercury. The metal species seen tended to be in the nanograms per cubic meter range, whereas oxides of sulfur: SO2 and SO3 and sulfate aerosols, were in the range of micrograms per cubic meter and rarely even as high as a few milligrams per cubic meter of air (nominally ppb to ppm). These sulfur species are being investigated for associations with both acute and chronic changes in human health status. The sulfate aerosols tend to be less than 1 microm in diameter and tend to dominate the mass of this submicron size mode. The sulfur chemistry is dynamic, changing composition from predominantly sulfur dioxide and trioxide gasses near the volcano, to predominantly sulfate aerosols on the west side of the island. Time, concentration and composition characteristics of submicron aerosols and sulfur dioxide are described with respect to the related on-going health studies and public health management concerns. Exposures to sulfur dioxide and particulate matter equal to or less than 1 microm in size were almost always below the national ambient air quality standards (NAAQS). These standards do not however consider the acidic nature and submicron size of the aerosol, nor the possibility of the aerosol and the sulfur dioxide interacting in their toxicity. Time series plots, histograms and descriptive statistics of hourly averages give the reader a sense of some of the exposures observed.