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Honda A, Inoue KI, Tamura S, Tanaka M, Wang Z, Tanaka T, Hirai S, Okuda T, Ueda K, Takano H. Effects of Streamer Discharge on PM2.5 Containing Endotoxins and Polyaromatic Hydrocarbons and Their Biological Responses In Vitro. Int J Mol Sci 2022; 23:ijms232415891. [PMID: 36555530 PMCID: PMC9785658 DOI: 10.3390/ijms232415891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
Experimental and epidemiological studies have demonstrated that fine particulate matter with a diameter of <2.5 μm (PM2.5) affects both the respiratory and immune systems. However, effective approaches to reduce PM2.5-induced hazardous effects have not been discovered yet. Streamer discharge is a category of plasma discharge in which high-speed electrons collide with oxygen and nitrogen molecules. Although streamer discharge can reportedly eliminate bacteria, molds, chemical substances, and allergens, its ability to decontaminate PM2.5 has not been previously demonstrated. The present study explored whether streamer discharge treatment could reduce PM2.5-induced inflammatory responses by employing an in vitro system. PM2.5 was collected under four conditions (Bangkok (Sep.−Dec.), Bangkok (Dec.−Mar.), Singapore, and Taipei). Airway epithelial cells and antigen-presenting cells exposed to non-treated PM2.5 in several conditions resulted in inflammatory responses. Streamer-discharged PM2.5 (Bangkok (Sep.−Dec.)) decreased the expression of interleukin (IL)-6 and IL-8 compared to non-treated PM2.5. Moreover, composition analysis demonstrated that streamer discharge reduced some compounds, such as endotoxins and polycyclic aromatic hydrocarbons, included in PM2.5 that can elicit inflammatory responses. Streamer discharge treatment can reduce endotoxins, polycyclic aromatic hydrocarbons, and the subsequent inflammatory responses induced by PM2.5 in vitro.
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Affiliation(s)
- Akiko Honda
- Graduate School of Global Environmental Studies, Kyoto University, Kyoto 615-8530, Japan
- Graduate School of Engineering, Kyoto University, Kyoto 615-8510, Japan
| | - Ken-ichiro Inoue
- School of Nursing, University of Shizuoka, Shizuoka 422-8526, Japan
- Correspondence: ; Tel.: +81-54-264-5460
| | - Shin Tamura
- Graduate School of Engineering, Kyoto University, Kyoto 615-8510, Japan
| | - Michitaka Tanaka
- Faculty of Pharmaceutical Sciences, Hiroshima International University, Hiroshima 737-0112, Japan
| | - Zaoshi Wang
- Graduate School of Engineering, Kyoto University, Kyoto 615-8510, Japan
| | - Toshio Tanaka
- Technology and Innovation Centre, Daikin Industries, Ltd., Osaka 566-8585, Japan
| | - Seitarou Hirai
- Technology and Innovation Centre, Daikin Industries, Ltd., Osaka 566-8585, Japan
| | - Tomoaki Okuda
- Faculty of Science and Technology, Keio University, Yokohama 223-8522, Japan
| | - Kayo Ueda
- Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Hirohisa Takano
- Graduate School of Global Environmental Studies, Kyoto University, Kyoto 615-8530, Japan
- Graduate School of Engineering, Kyoto University, Kyoto 615-8510, Japan
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Huang J, Yang X, Fan F, Hu Y, Wang X, Zhu S, Ren G, Wang G. Outdoor air pollution and the risk of asthma exacerbations in single lag0 and lag1 exposure patterns: a systematic review and meta-analysis. J Asthma 2021; 59:2322-2339. [PMID: 34809505 DOI: 10.1080/02770903.2021.2008429] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To synthesize evidence regarding the relationship between outdoor air pollution and risk of asthma exacerbations in single lag0 and lag1 exposure patterns.Methods: We performed a systematic literature search using PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials, China National Knowledge Internet, Chinese BioMedical, and Wanfang databases. Articles published until August 1, 2020 and the reference lists of the relevant articles were reviewed. Two authors independently evaluated the eligible articles and performed structured extraction of the relevant information. Pooled relative risks (RRs) and 95% confidence intervals (CIs) of lag0 and lag1 exposure patterns were estimated using random-effect models.Results: Eighty-four studies met the eligibility criteria and provided sufficient information for meta-analysis. Outdoor air pollutants were associated with increased risk of asthma exacerbations in both single lag0 and lag1 exposure patterns [lag0: RR (95% CI) (pollutants), 1.057(1.011, 1.103) (air quality index, AQI), 1.007 (1.005, 1.010) (particulate matter of diameter ≤ 2.5 μm, PM2.5), 1.009 (1.005, 1.012) (particulate matter of diameter, PM10), 1.010 (1.006, 1.014) (NO2), 1.030 (1.011, 1.048) (CO), 1.005 (1.002, 1.009) (O3); lag1:1.064(1.022, 1.106) (AQI), 1.005 (1.002, 1.008) (PM2.5), 1.007 (1.004, 1.011) (PM10), 1.008 (1.004, 1.012) (NO2), 1.025 (1.007, 1.042) (CO), 1.010 (1.006, 1.013) (O3)], except SO2 [lag0: RR (95% CI), 1.004 (1.000, 1.007); lag1: RR (95% CI), 1.003 (0.999, 1.006)]. Subgroup analyses revealed stronger effects in children and asthma exacerbations associated with other events (including symptoms, lung function changes, and medication use).Conclusion: Outdoor air pollution increases the asthma exacerbation risk in single lag0 and lag1 exposure patterns.Trial registration: PROSPERO, CRD42020204097. https://www.crd.york.ac.uk/.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2008429 .
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Affiliation(s)
- Junjun Huang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyu Yang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Hu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xi Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Guanhua Ren
- Department of Library, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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Tham KW, Parshetti GK, Anand P, Cheong DKW, Sekhar C. Performance characteristics of a fan filter unit (FFU) in mitigating particulate matter levels in a naturally ventilated classroom during haze conditions. INDOOR AIR 2021; 31:795-806. [PMID: 33215777 DOI: 10.1111/ina.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
The performance of a low-cost fan filter unit (FFU) in mitigating hazardous particulate matter (PM) levels in a naturally ventilated school classroom is presented. The FFU can be considered as a simplified mechanical ventilation and air-conditioning system without heating and cooling functions. The FFU improves indoor air quality through introduction of cleaned outdoor air to flush out internally generated heat and moisture and reducing infiltration by maintaining indoor pressurization. Indoor particle number concentrations were reduced between 85% and 95%. The particle removal performance (PRFFFU ) of the FFU is determined and incorporated into the augmented façade penetration factor (Paug ). A case-specific recursive dynamic mass balance model is used to characterize the infiltration factor (FINF ), deposition rate (K), and the penetration efficiency (Paug ) from continuously monitored indoor and outdoor mass concentration levels. Computed "Paug " (0.07, 0.09, and 0.13) and "FINF " (0.06, 0.08, and 0.11), respectively, for PM10, PM2.5, and PM1 suggest that exposure to PM was significantly reduced indoors. The effectiveness of the FFU for reduced "FINF " and "Paug " may be attributed to its superior filtration, dilution, and exfiltration mechanisms. In comparison with alternative PM mitigation solutions, the FFU is effective, affordable, and sustainable.
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Affiliation(s)
- Kwok Wai Tham
- Department of Building, Centre for Integrated Building Energy and Sustainability in the Tropics (CiBEST), School of Design and Environment, National University of Singapore, Singapore City, Singapore
| | - Ganesh Kashinath Parshetti
- Department of Building, Centre for Integrated Building Energy and Sustainability in the Tropics (CiBEST), School of Design and Environment, National University of Singapore, Singapore City, Singapore
| | - Prashant Anand
- Department of Building, Centre for Integrated Building Energy and Sustainability in the Tropics (CiBEST), School of Design and Environment, National University of Singapore, Singapore City, Singapore
| | - David Kok Wai Cheong
- Department of Building, Centre for Integrated Building Energy and Sustainability in the Tropics (CiBEST), School of Design and Environment, National University of Singapore, Singapore City, Singapore
| | - Chandra Sekhar
- Department of Building, Centre for Integrated Building Energy and Sustainability in the Tropics (CiBEST), School of Design and Environment, National University of Singapore, Singapore City, Singapore
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4
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Lee SW, Huang YC, Lin CY, Huang HY, Liu CW, Hsieh MT, Lee CL, Chung WY, Chung KF, Wang CH, Kuo HP. Impact of Annual Exposure to Polycyclic Aromatic Hydrocarbons on Acute Exacerbation Frequency in Asthmatic Patients. J Asthma Allergy 2021; 14:81-90. [PMID: 33542635 PMCID: PMC7853411 DOI: 10.2147/jaa.s288052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/23/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Exposure to polycyclic aromatic hydrocarbons (PAHs) associated with ambient air particulate matter (PM) poses significant health concerns. Increased acute exacerbation (AE) frequency in asthmatic patients has been associated with ambient PAHs, but which subgroup of patients are particularly susceptible to ambient PAHs is uncertain. We developed a new model to simulate grid-scale PM2.5-PAH levels in order to evaluate whether the severity of asthma as measured by the Global Initiative of Asthma (GINA) levels of treatment is related to cumulative exposure of ambient PAHs. Methods Patients with asthma residing in the northern Taiwan were reviewed retrospectively from 2014 to 2017. PM2.5 were sampled and analysed for PAHs twice a month over a 72-hour period, in addition to collecting the routinely monitored air pollutant data from an established air quality monitoring network. In combination with correlation analysis and principal component analysis, multivariate linear regression models were performed to simulate hourly grid-scale PM2.5-PAH concentrations (ng/m3). A geographic information system mapping approach with ordinary kriging interpolation method was used to calculate the annual exposure of PAHs (ng/m). Results Among the 387 patients with asthma aged 18 to 93 (median 62), 97 subjects were treated as GINA step 5 (24%). Asthmatics in GINA 5 subgroup with high annual PAHs exposure were likely to have a higher annual frequency of any AE (1 (0–12), p<0.0001). Annual PAHs exposure was correlated with the annual frequency of any exacerbation (r=0.11, p=0.02). This was more significant in the GINA 5 subgroup (r=0.29, p=0.005) and in the GINA 5 subgroup with severe acute exacerbations (r=0.51, p=0.002). Annual PAHs exposure, severe acute exacerbation and GINA steps were independent variables that predict annual frequency of any exacerbation. Conclusion Asthmatic patients in the GINA 5 subgroup with acute exacerbations were more susceptible to the effect of environmental PAHs on their exacerbation frequency. Reducing environmental levels of PAHs will have the greatest impact on the more severe asthma patients.
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Affiliation(s)
- Shih-Wei Lee
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung Memorial University, Taoyuan, Taiwan
| | - Chun-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung Memorial University, Taoyuan, Taiwan
| | - Hung-Yu Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung Memorial University, Taoyuan, Taiwan
| | - Chi-Wei Liu
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Ming-Tsuen Hsieh
- Department of Marine Environment and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chon-Lin Lee
- Department of Marine Environment and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Aerosol Science and Research Center, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Applied Chemistry, Providence University, Taichung, Taiwan
| | - Wen-Yu Chung
- Department of Computer Science and Information Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Kian Fan Chung
- Experimental Studies, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.,College of Medicine, Chang Gung Memorial University, Taoyuan, Taiwan
| | - Han-Pin Kuo
- Pulmonary Medicine Research Center, Taipei Medical University, Taipei, Taiwan.,Department of Thoracic Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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5
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Sultan ZM, Pantelic J, Tham KW. Infiltration of fine particles in urban daycares. INDOOR AIR 2020; 30:955-965. [PMID: 32304116 DOI: 10.1111/ina.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 03/16/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Singapore is a tropical country with a high density of day-care facilities whose indoor environments may be adversely affected by outdoor fine particle (PM2.5 ) air pollution. To reduce this problem requires effective, evidence-based exposure-reduction strategies. Little information is available on the penetration of outdoor PM2.5 into day-care environments. Our study attempted to address the following objectives: to measure indoor infiltration factor (Finf ) of PM2.5 from outdoor PM2.5 and to determine the building parameters that modify the indoor PM2.5 . We collected indoor/outdoor 1-min PM2.5 from 50 day-care classrooms. We noted mean Finf ± SD of 0.65 ± 0.22 in day-care rooms which are naturally ventilated and lower Finf ± SD values of 0.47 ± 0.18 for those that are air-conditioned: values which are lower than those reported in Singapore residences. The air exchange rates were higher in naturally ventilated rooms (1.47 vs 0.86 h-1 ). However, fine particle deposition rates were lower for naturally ventilated rooms (0.67 ± 0.43 h-1 ) compared with air-conditioned ones (1.03 ± 0.55 h-1 ) presumably due to composite rates linked to the filters within the split unit air-conditioners, higher recirculation rates, and interior surfaces in the latter. Our findings indicate that children remaining indoor in daycares where air-conditioning is used can reduce their PM2.5 exposures during outdoor pollution episodes.
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Affiliation(s)
- Zuraimi M Sultan
- Berkeley Education Alliance for Research in Singapore (BEARS) Limited, Singapore, Singapore
| | - Jovan Pantelic
- Center for the Built Environment, University of California Berkeley, Berkeley, CA, USA
| | - Kwok Wai Tham
- Department of Building, National University of Singapore, Singapore, Singapore
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6
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Experience from Integrated Air Quality Management in the Mexico City Metropolitan Area and Singapore. ATMOSPHERE 2019. [DOI: 10.3390/atmos10090512] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than half of the world’s population now lives in cities as a result of unprecedented urbanization during the second half of the 20th century. The urban population is projected to increase to 68% by 2050, with most of the increase occurring in Asia and Africa. Population growth and increased energy consumption in urban areas lead to high levels of atmospheric pollutants that harm human health, cause regional haze, damage crops, contribute to climate change, and ultimately threaten the society’s sustainability. This article reviews the air quality and compares the policies implemented in the Mexico City Metropolitan Area (MCMA) and Singapore and offers insights into the complexity of managing air pollution to protect public health and the environment. While the differences in the governance, economics, and culture of the two cities greatly influence the decision-making process, both have made much progress in reducing concentrations of harmful pollutants by implementing comprehensive integrated air quality management programs. The experience and the lessons learned from the MCMA and Singapore can be valuable for other urban centers, especially in the fast-growing Asia-Pacific region confronting similar air pollution problems.
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7
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Luong LMT, Sly PD, Thai PK, Phung D. Impact of ambient air pollution and wheeze-associated disorders in children in Southeast Asia: a systematic review and meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2019; 34:125-139. [PMID: 30753165 DOI: 10.1515/reveh-2018-0079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
Several systematic reviews have been conducted so far to examine the effect of air pollution on respiratory diseases, but there has not been a corresponding meta-analysis to estimate the effect sizes for wheeze-associated diseases/disorders, which is one of the leading causes of emergency department visits and hospitalizations for children worldwide. The aim of this review is to systematically evaluate the relationship between air pollution and risk of wheeze-associated disorders in children in Southeast Asia. We searched the relevant computerized databases (PubMed, EMBASE, Web of Science, Scopus and Cochrane library) for indexed publications up to July 2018. Finally, eight studies were qualified for performing a random-effect meta-analysis to compute the pooled effect sizes. The results show that each increase of 10 μg/m3 in concentrations of PM2.5, PM1 was associated with 1-2% increase in risk of wheeze-associated disorders. Positive associations were found for PM10, SO2, NO2, NOx but no association was found for CO and O3. We confirmed the strong effect of fine particulate matters on respiratory health and recommend an updated meta-analysis should be done when more studies are available.
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Affiliation(s)
- Ly M T Luong
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health and Environment Program, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Environmental Sciences, VNU University of Science, Hanoi, Vietnam
| | - Peter D Sly
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health and Environment Program, The University of Queensland, Brisbane, Queensland, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Science (QAEHS), The University of Queensland, Brisbane, Queensland, Australia
| | - Dung Phung
- Centre for Environment and Population Health, School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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8
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Soh SE, Goh A, Teoh OH, Godfrey KM, Gluckman PD, Shek LPC, Chong YS. Pregnancy Trimester-Specific Exposure to Ambient Air Pollution and Child Respiratory Health Outcomes in the First 2 Years of Life: Effect Modification by Maternal Pre-Pregnancy BMI. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E996. [PMID: 29762532 PMCID: PMC5982035 DOI: 10.3390/ijerph15050996] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 11/16/2022]
Abstract
Prenatal exposure to air pollution is associated with childhood respiratory health; however, no previous studies have examined maternal pre-pregnancy body mass index (BMI) as a potential effect modifier. We investigated whether maternal pre-pregnancy BMI modified the association of trimester-specific air pollution divided into quartiles of exposure (Q1⁻4) on respiratory health in the Growing Up in Singapore towards healthy Outcomes (GUSTO) study (n = 953) in 2-year-old children. For episodes of wheezing, children of overweight/obese mothers and who were exposed to particulate matter less than 2.5 μm (PM2.5) in the first trimester had an adjusted incidence rate ratio (IRR) (95% confidence interval (CI)) of 1.85 (1.23⁻2.78), 1.76 (1.08⁻2.85) and 1.90 (1.10⁻3.27) in quartile (Q) 2⁻4, with reference to Q1. This association is seen in the second trimester for bronchiolitis/bronchitis. The risk of ear infection in the first year of life was associated with exposure to PM2.5 in the first trimester with adjusted Odds Ratio (adjOR) (95% CI) = 7.64 (1.18⁻49.37), 11.37 (1.47⁻87.97) and 8.26 (1.13⁻60.29) for Q2⁻4, and similarly in the second year with adjOR (95% CI) = 3.28 (1.00⁻10.73) and 4.15 (1.05⁻16.36) for Q2⁻3. Prenatal exposure to air pollution has an enhanced impact on childhood respiratory health, and differs according to maternal pre-pregnancy BMI.
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Affiliation(s)
- Shu-E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117549, Singapore.
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Anne Goh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore 229899, Singapore.
| | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore 229899, Singapore.
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117549, Singapore.
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117549, Singapore.
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117549, Singapore.
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore.
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Xu J, Tai X, Betha R, He J, Balasubramanian R. Comparison of physical and chemical properties of ambient aerosols during the 2009 haze and non-haze periods in Southeast Asia. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2015; 37:831-841. [PMID: 25503685 DOI: 10.1007/s10653-014-9667-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 12/07/2014] [Indexed: 06/04/2023]
Abstract
Recurrent smoke-haze episodes that occur in Southeast Asia (SEA) are of much concern because of their environmental and health impacts. These haze episodes are mainly caused by uncontrolled biomass and peat burning in Indonesia. Airborne particulate matter (PM) samples were collected in the southwest coast of Singapore from 16 August to 9 November in 2009 to assess the impact of smoke-haze episodes on the air quality due to the long-range transport of biomass and peat burning emissions. The physical and chemical characteristics of PM were investigated during pre-haze, smoke-haze, and post-haze periods. Days with PM2.5 mass concentrations of ≥35 μg m(-3) were considered as smoke-haze events. Using this criterion, out of the total 82 sampling days, nine smoke-haze events were identified. The origin of air masses during smoke-haze episodes was studied on the basis of HYSPLIT backward air trajectory analysis for 4 days. In terms of the physical properties of PM, higher particle surface area concentrations and particle gravimetric mass concentrations were observed during the smoke-haze period, but there was no consistent pattern for particle number concentrations during the haze period as compared to the non-haze period except that there was a significant increase at about 08:00, which could be attributed to the entrainment of PM from aloft after the breakdown of the nocturnal inversion layer. As for the chemical characteristics of PM, among the six key inorganic water-soluble ions (Cl(-), NO3(-), nss-SO4(2-), Na(+), NH4(+), and nss-K(+)) measured in this study, NO3(-), nss-SO4(2-), and NH4(+) showed a significant increase in their concentrations during the smoke-haze period together with nss-K(+). These observations suggest that the increased atmospheric loading of PM with higher surface area and increased concentrations of optically active secondary inorganic aerosols [(NH4)2SO4 or NH4HSO4 and NH4NO3] resulted in the atmospheric visibility reduction in SEA due to the advection of biomass and peat burning emissions.
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Affiliation(s)
- Jingsha Xu
- International Doctoral Innovation Centre, The University of Nottingham Ningbo China, Ningbo, 315100, China
- Department of Chemical and Environmental Engineering, The University of Nottingham Ningbo China, Ningbo, 315100, China
| | - Xuhong Tai
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore, Singapore
| | - Raghu Betha
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore, Singapore
| | - Jun He
- Department of Chemical and Environmental Engineering, The University of Nottingham Ningbo China, Ningbo, 315100, China.
| | - Rajasekhar Balasubramanian
- Department of Civil and Environmental Engineering, National University of Singapore, Singapore, Singapore.
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10
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Huang CC, Wen HJ, Chen PC, Chiang TL, Lin SJ, Guo YL. Prenatal air pollutant exposure and occurrence of atopic dermatitis. Br J Dermatol 2015. [PMID: 26202732 DOI: 10.1111/bjd.14039] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hereditary and environmental factors have been related to the occurrence of atopic dermatitis (AD) in early childhood. However, the role of prenatal and early postnatal exposure to air pollutants has not been totally elucidated. OBJECTIVES To evaluate the association between prenatal air pollutant exposure and occurrence of AD. METHODS In total 24 200 infant-mother pairs were recruited to participate in the Taiwan Birth Cohort Study in 2005 using multistage stratified sampling. Medical history, including physician-diagnosed AD, was inquired by questionnaire at the infant's age of 6 months. Monthly averages of five criteria air pollutants - NO2 , CO, O3 , SO2 and PM10 - were retrieved from 66 air-quality-monitoring stations, and interpolated to all administrative districts using the kriging method. Exposure data during each of the three gestational trimesters and three months after birth were calculated for each study subject, and odds ratios (ORs) of AD occurrence were calculated by logistic regression. RESULTS Among the participants, 16 686 mother-infant pairs were qualified for and included in the analysis. Among them, 1206 infants (7·2%) had been diagnosed as having AD before the age of 6 months, and the prevalence was higher in boys (8·3%) than in girls (6·1%). The occurrence of AD was significantly associated with CO exposure during the whole gestational period [adjusted OR (aOR) 1·37, 95% confidence interval (CI) 1·06-1·78] and the first trimester (aOR 1·51, 95% CI 1·16-1·97). We did not observe any significant association among the other air pollutants during either the whole gestational period or any period of the three trimesters and 3 months after birth. CONCLUSIONS Our study found a relationship between AD occurrence and gestational exposure to CO, where exposure during the first trimester seemed to be the most important.
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Affiliation(s)
- C C Huang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - H J Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - P C Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - T L Chiang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - S J Lin
- Department of Pediatrics, Chi Mei Hospital, Tainan, Taiwan
| | - Y L Guo
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
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11
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Zheng XY, Ding H, Jiang LN, Chen SW, Zheng JP, Qiu M, Zhou YX, Chen Q, Guan WJ. Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0138146. [PMID: 26382947 PMCID: PMC4575194 DOI: 10.1371/journal.pone.0138146] [Citation(s) in RCA: 269] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 08/25/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined. OBJECTIVE We sought to quantify the associations between short-term exposure to air pollutants [ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter ≤10 μm (PM10) and PM2.5] and the asthma-related emergency room visits (ERV) and hospitalizations. METHODS Systematic computerized searches without language limitation were performed. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) were estimated using the random-effect models. Sensitivity analyses and subgroup analyses were also performed. RESULTS After screening of 246 studies, 87 were included in our analyses. Air pollutants were associated with significantly increased risks of asthma ERVs and hospitalizations [O3: RR(95%CI), 1.009 (1.006, 1.011); I2 = 87.8%, population-attributable fraction (PAF) (95%CI): 0.8 (0.6, 1.1); CO: RR(95%CI), 1.045 (1.029, 1.061); I2 = 85.7%, PAF (95%CI): 4.3 (2.8, 5.7); NO2: RR(95%CI), 1.018 (1.014, 1.022); I2 = 87.6%, PAF (95%CI): 1.8 (1.4, 2.2); SO2: RR(95%CI), 1.011 (1.007, 1.015); I2 = 77.1%, PAF (95%CI): 1.1 (0.7, 1.5); PM10: RR(95%CI), 1.010 (1.008, 1.013); I2 = 69.1%, PAF (95%CI): 1.1 (0.8, 1.3); PM2.5: RR(95%CI), 1.023 (1.015, 1.031); I2 = 82.8%, PAF (95%CI): 2.3 (1.5, 3.1)]. Sensitivity analyses yielded compatible findings as compared with the overall analyses without publication bias. Stronger associations were found in hospitalized males, children and elderly patients in warm seasons with lag of 2 days or greater. CONCLUSION Short-term exposures to air pollutants account for increased risks of asthma-related ERVs and hospitalizations that constitute a considerable healthcare utilization and socioeconomic burden.
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Affiliation(s)
- Xue-yan Zheng
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Hong Ding
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Li-na Jiang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Shao-wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Jin-ping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Min Qiu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Ying-xue Zhou
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Wei-jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
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12
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Carmo CND, Hacon SDS. Estudos de séries temporais de poluição atmosférica por queimadas e saúde humana. CIENCIA & SAUDE COLETIVA 2013; 18:3245-58. [DOI: 10.1590/s1413-81232013001100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/02/2012] [Indexed: 11/21/2022] Open
Abstract
Queimadas e incêndios florestais de grandes proporções têm sido observados em diversas regiões do planeta. A exposição a altos níveis de poluentes atmosféricos emitidos por queimadas podem causar uma variedade de danos à saúde humana. Neste artigo, sumarizamos a literatura existente sobre estimação de efeitos agudos da poluição atmosférica por queimadas na saúde humana nas regiões em que estas estão concentradas em maior número no planeta, utilizando-se abordagem de séries temporais. Também se buscou identificar lacunas de conhecimento. O estudo consistiu de uma revisão narrativa, em que as características dos estudos selecionados foram agrupadas pelas regiões do planeta em que há maior incidência de queimadas: Amazônia, Estados Unidos, Austrália e Ásia. Os resultados apontaram concentração de estudos na Austrália, poucos estudos realizados na Amazônia e grande heterogeneidade nos resultados sobre efeitos significativos na saúde humana.
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13
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Ghosh D, Chakraborty P, Gupta J, Biswas A, Roy I, Das S, Gupta-Bhattacharya S. Associations between pollen counts, pollutants, and asthma-related hospital admissions in a high-density Indian metropolis. J Asthma 2013; 49:792-9. [PMID: 22978307 DOI: 10.3109/02770903.2012.716473] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The seasonal pattern of asthma-related hospitalization has often been correlated with ambient allergen/pollutant levels. OBJECTIVE To examine the relationship between asthma-related hospital admissions (ARHA) and outdoor pollen, spore, and pollutant levels for adult patients in a densely populated Indian megacity Kolkata. METHODS ARHA data were obtained from two major teaching hospitals of the city. Pollen and spores causing allergic sensitization were identified by skin prick tests (SPTs) among respiratory allergic subjects (N = 1353). Outdoor concentrations of aeroallergens were determined using a Burkard sampler for five consecutive years (2004-2009). Levels of NO(2), SO(2), suspended particulate matters (SPMs), and respirable particulate matters (RPMs) were made available by West Bengal Pollution Control Board (WBPCB, Government of West Bengal). Poisson multivariate Poisson regression (with adjustments for overdispersion) was used to model the data. Results. We found that ARHA in Kolkata increased with predictable regularity in March and September, while remaining low in January and July. SPT showed highly positive skin reactions with grass/weed and palm pollens in respiratory allergic patients, while Aspergilli spores also evoked good sensitivity. In our regression model, the airborne pollen types, Cheno-Amaranthaceae and Cyperaceae, and the inorganic pollutant, SO(2) and RPM, were significantly associated with ARHA (p < .05). CONCLUSION ARHA in the megacity of Kolkata shows two seasonal peaks that can be correlated with outdoor grass/weed pollen and RPM concentrations. In contrast, the city's ambient fungal spore counts were not found to be significantly associated.
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Affiliation(s)
- D Ghosh
- Division of Plant Biology, Bose Institute, Kolkata, India.
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14
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Takenoue Y, Kaneko T, Miyamae T, Mori M, Yokota S. Influence of outdoor NO2 exposure on asthma in childhood: meta-analysis. Pediatr Int 2012; 54:762-9. [PMID: 22640481 DOI: 10.1111/j.1442-200x.2012.03674.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND It has long been assumed that the development of childhood asthma is related to exposure to environmental chemicals, but it has thus far not been possible to unequivocally establish this suspected relationship using individual studies. Moreover, studies of children have been scanty and unreliable due to the large diversity of research environments and subject cohorts. The aim of the current study was to clarify this relationship for one factor by means of a meta-analysis of studies investigating the influence of NO(2) exposure on symptomatology of childhood asthma. METHODS Two electronic databases (MEDLINE and EMBASE) were searched for literature on relationships between environmental chemical exposure and development of childhood asthma using the MeSH terms 'nitrogen dioxide' and 'asthma'. This was done according to the MOOSE guidelines for meta-analyses of observational studies. RESULTS A total of 130 papers were retrieved, of which 12 met the selection criteria. These papers described observational studies from seven countries. Study subjects were 97,932 ordinary children aged 0-18 years. Using random model analysis, the odds ratio (OR) for asthma development due to an increment of 10 p.p.b. NO(2) was 1.135 with a 95% confidence interval [CI] of 1.031-1.251 (P= 0.01), while the OR for wheezing symptoms was 1.052 with a 95%CI of 1.020-1.085 (P= 0.001). It is therefore evident that NO(2) exposure does influence the development of asthma in ordinary children. CONCLUSIONS Exposure to NO(2) in the air significantly influences the development of childhood asthma and symptoms of wheezing.
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Affiliation(s)
- Yukiko Takenoue
- Department of Pediatrics, Advanced Medical Research Center, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
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Velasco E, Roth M. Review of Singapore's air quality and greenhouse gas emissions: current situation and opportunities. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2012; 62:625-641. [PMID: 22788101 DOI: 10.1080/10962247.2012.666513] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Singapore has many environmental accomplishments to its credit. Accessible data on air quality indicates that all criteria pollutants satisfy both U.S. Environmental Protection Agency (EPA) and World Health Organization (WHO) air quality standards and guidelines, respectively. The exception is PM2.5 (particles with an aerodynamic diameter < or = 2.5 microm), which is not currently considered a criteria pollutant in Singapore but may potentially be the major local air pollution problem and cause for health concern. Levels of other airborne pollutants as well as their physical and chemical processes associated with local formation, transformation, dispersion, and deposition are not known. According to available emission inventories, Singapore contribution to the total atmospheric pollution and carbon budget at the regional and global scales is small. Emissions per unit gross domestic product (GDP) are low compared with other countries, although Singapore's per-capita GDP and per-capita emissions are among the highest in the world. Some information is available on health effects, but the impacts on the ecosystem and the complex interactions of air pollution and climate change at a regional level are also unknown. This article reviews existing available information on atmospheric pollution and greenhouse gas emissions and proposes a multipollutant approach to greenhouse gas mitigation and local air quality. Singapore, by reducing its per-capita emissions, increasing the availability of information (e.g., through regularly publishing hourly and/or daily PM2.5 concentrations) and developing a research agenda in this area, would likely be seen to be a model of a high-density, livable, and sustainable city in Southeast Asia and other tropical regions worldwide.
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Affiliation(s)
- Erik Velasco
- Singapore-MITAlliance for Research and Technology (SMART), Center for Environmental Sensing and Modeling (CENSAM), S-16-05-08, 3 Science Drive 2, Singapore 117543.
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Agarwal R, Awasthi A, Mittal S, Singh N, Gupta PK. Effects of air pollution on respiratory parameters during the wheat-residue burning in Patiala. J Med Eng Technol 2010; 34:23-8. [PMID: 19824783 DOI: 10.3109/03091900903261258] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Effects of pollution produced by wheat-residue burning on respiratory parameters of healthy inhabitants were investigated for two consecutive wheat cultivation periods (February-July in 2007 and 2008) at Patiala city of Punjab, India. A total of 51 selected subjects of the age group 13-53 were selected from five sites of Patiala for pulmonary function tests (PFTs), including force vital capacity (FVC), force expiratory volume in one second (FEV(1)), peak expiratory flow (PEF) and force expiratory flow between 25 to 75% of FVC (FEF(25-75%)) using a spirometer. High volume samplers (HVS) and an Andersen cascade impactor were also used to measure the concentration of suspended particulate matter (SPM) and particulate matter (PM) of size less than 10 mum. PFTs show significant decrease and particulate matter shows a significant increase during the burning period of wheat residue. Decrease in FVC and FEV(1) did not recover even after completion of the exhaustive burning period this is a more serious concern then PEF and FEF(25-75%). The results showed that the public exposure to relatively high levels of pollutants during the exhaustive burning period of wheat residue influences the PFTs of even healthy inhabitants.
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Affiliation(s)
- R Agarwal
- Thapar University, Patiala-147004, Punjab, India.
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17
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Moura M, Junger WL, Mendonça GAES, Leon APD. Air quality and emergency pediatric care for symptoms of bronchial obstruction categorized by age bracket in Rio de Janeiro, Brazil. CAD SAUDE PUBLICA 2009; 25:635-44. [PMID: 19300852 DOI: 10.1590/s0102-311x2009000300018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 03/28/2008] [Indexed: 05/25/2023] Open
Abstract
The objective of this study was to estimate the association between levels of air pollutants and respiratory symptoms in children. An ecological time-series study was conducted between April 2002 and March 2003 with daily data on PM10, SO2, CO, NO2, and O3 and paediatric care in emergency rooms due to symptoms indicating bronchial obstruction. The potential confounding factors considered were: time trend, seasonality, meteorological variables, respiratory infections and the effects of weekends and holidays. A semi-parametric Poisson regression was used to model the time series. Splines (data smoothing functions), indicator variables and cubic polynomials were used to adjust the effects of the confounding variables. A 5% significance level was adopted for the study. A statistically significant increase of 6.7% in paediatric visits of children of less than 2 years of age was associated with PM10. A 3% positive association with O3 showed borderline significance (p < 0.06) in this age bracket. Our findings highlight the existence of an acknowledged public health problem in Rio de Janeiro, Brazil, and also emphasize the need to identify the principal sources of air pollutants.
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Affiliation(s)
- Marisa Moura
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
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18
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Rosa AM, Ignotti E, Hacon SDS, Castro HAD. Prevalence of asthma in children and adolescents in a city in the Brazilian Amazon region. J Bras Pneumol 2009; 35:7-13. [PMID: 19219325 DOI: 10.1590/s1806-37132009000100002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Accepted: 05/26/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the prevalence of asthma and asthma symptoms in students of two distinct age brackets residing in the city of Tangará da Serra, Brazil. METHODS Cross-sectional, population-based study of the prevalence of asthma in children from 6 to 7 years of age and adolescents from 13 to 14, using the standardized International Study of Asthma and Allergies in Childhood, phase 1 questionnaire, validated for use in Brazil. Students who responded affirmatively to question 2 (presence of wheezing in the preceding 12 months) were classified as suffering from asthma. RESULTS The study comprised 3,362 students, of whom 1,634 (48.6%) were children and 1,728 (51.4%) were adolescents. Of the 1,634 children, 816 (49.9%) were male, and 818 (50.1%) were female. Of the 1,728 adolescents, 773 (45.0%) were male, and 955 (55.0%) were female. The prevalence of asthma among the children was 25.2%, whereas that among the adolescents was 15.9% (chi2 = 8.34; p = 0.00). The children presented higher prevalences of the following symptoms of asthma than did the adolescents: wheezing ever (54.3%), nocturnal dry cough (43.9%), wheezing in the preceding 12 months (25.2%), and from 1 to 3 attacks of wheezing in the preceding 12 months (19.1%). There were no differences between the two groups regarding physician-diagnosed asthma (approximately 4.5%). There were no statistical differences regarding the prevalence of asthma by gender in the two groups. CONCLUSIONS Tangará da Serra has a high prevalence of asthma in children and adolescents, and this result is compatible with other studies carried out in Brazil and Latin America using the same methodology.
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Hart JE, Laden F, Eisen EA, Smith TJ, Garshick E. Chronic obstructive pulmonary disease mortality in railroad workers. Occup Environ Med 2008; 66:221-6. [PMID: 19039098 DOI: 10.1136/oem.2008.040493] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is little information describing the risk of non-malignant respiratory disease and occupational exposure to diesel exhaust. METHODS US railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II. In a retrospective cohort study we examined the association of chronic obstructive pulmonary disease (COPD) mortality with years of work in diesel-exposed jobs. To examine the possible confounding effects of smoking, multiple imputation was used to model smoking history. A Cox proportional hazards model was used to estimate an incidence rate ratio, adjusted for age, calendar year, and length of follow-up after leaving work (to reduce bias due to a healthy worker survivor effect). RESULTS Workers in jobs with diesel exhaust exposure had an increased risk of COPD mortality relative to those in unexposed jobs. Workers hired after the introduction of diesel locomotives had a 2.5% increase in COPD mortality risk for each additional year of work in a diesel-exposed job. This risk was only slightly attenuated after adjustment for imputed smoking history. CONCLUSIONS These results support an association between occupational exposure to diesel exhaust and COPD mortality.
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Affiliation(s)
- J E Hart
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
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20
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Zuraimi MS, Tham KW, Chew FT, Ooi PL. The effect of ventilation strategies of child care centers on indoor air quality and respiratory health of children in Singapore. INDOOR AIR 2007; 17:317-27. [PMID: 17661928 DOI: 10.1111/j.1600-0668.2007.00480.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED This paper reports the effects of ventilation strategies on indoor air quality (IAQ) and respiratory health of children within 104 child care centers (CCCs) in a hot and humid climate. The CCCs were categorized by ventilation strategies: natural (NV), air-conditioned and mechanically ventilated (ACMV), air-conditioned using split units (AC), and hybrid (NV and AC operated intermittently). The concentration levels of IAQ parameters in NV CCCs are characterized by the influence of the outdoors and good dilution of indoor pollutants. The lower ventilation rates in air-conditioned CCCs result in higher concentrations of occupant-related pollutants but lower outdoor pollutant ingress. This study also revealed lower prevalence for most asthma and allergy, and respiratory symptoms in children attending NV CCCs. In multivariate analyses controlled for the effects of confounders, the risk of current rhinitis among children is significantly higher if they attend mechanically ventilated CCCs compared to NV CCCs. Air-conditioned CCCs were also associated with higher adjusted prevalence ratio of severe phlegm and cough symptoms and lower respiratory illness. Finally, children attending CCCs with hybrid ventilation are at high risk for almost all the respiratory symptoms studied. PRACTICAL IMPLICATIONS This large field study indicates that different ventilation strategies employed by child care centers can cause significant variations in the indoor air quality and prevalence of asthma, allergies and respiratory symptoms of attending children. The higher prevalence rates of allergic and respiratory symptoms among young children, whose immune system is still under-developed, in child care centers, whether fully or partially air-conditioned, suggest that ventilation and plausible growth and propagation mechanisms of allergens and infectious agents be further investigated.
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Affiliation(s)
- M S Zuraimi
- Department of Building, School of Design and Environment, National University of Singapore, Singapore.
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21
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Hart JE, Laden F, Schenker MB, Garshick E. Chronic obstructive pulmonary disease mortality in diesel-exposed railroad workers. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:1013-7. [PMID: 16835052 PMCID: PMC1513327 DOI: 10.1289/ehp.8743] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Diesel exhaust is a mixture of combustion gases and ultrafine particles coated with organic compounds. There is concern whether exposure can result in or worsen obstructive airway diseases, but there is only limited information to assess this risk. U.S. railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II, and by 1959, 95% of the locomotives were diesel. We conducted a case-control study of railroad worker deaths between 1981 and 1982 using U.S. Railroad Retirement Board job records and next-of-kin smoking, residential, and vitamin use histories. There were 536 cases with chronic obstructive pulmonary disease (COPD) and 1,525 controls with causes of death not related to diesel exhaust or fine particle exposure. After adjustment for age, race, smoking, U.S. Census region of death, vitamin use, and total years off work, engineers and conductors with diesel-exhaust exposure from operating trains had an increased risk of COPD mortality. The odds of COPD mortality increased with years of work in these jobs, and those who had worked >/= 16 years as an engineer or conductor after 1959 had an odds ratio of 1.61 (95% confidence interval, 1.12-2.30) . These results suggest that diesel-exhaust exposure contributed to COPD mortality in these workers. Further study is needed to assess whether this risk is observed after exposure to exhaust from later-generation diesel engines with modern emission controls.
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Affiliation(s)
- Jaime E Hart
- Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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LeVan TD, Koh WP, Lee HP, Koh D, Yu MC, London SJ. Vapor, dust, and smoke exposure in relation to adult-onset asthma and chronic respiratory symptoms: the Singapore Chinese Health Study. Am J Epidemiol 2006; 163:1118-28. [PMID: 16707657 PMCID: PMC1509764 DOI: 10.1093/aje/kwj144] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Occupational factors contribute to a significant fraction of respiratory disease and symptoms. The authors evaluated the role of occupational exposures in asthma, chronic bronchitis, and respiratory symptoms in the Singapore Chinese Health Study, a population-based cohort of adults aged 45-74 years at enrollment in 1993-1998. Information on occupations and occupational exposures was collected at enrollment for 52,325 subjects for whom respiratory outcomes were obtained via follow-up interviews in 1999-2004. Exposure to dusts from cotton, wood, metal, minerals, and/or asbestos was associated with nonchronic cough and/or phlegm (odds ratio (OR) = 1.19, 95% confidence interval (CI): 1.08, 1.30), chronic bronchitis (OR = 1.26, 95% CI: 1.01, 1.57), and adult-onset asthma (OR = 1.14, 95% CI: 1.00, 1.30). Cotton dust was the major contributor to respiratory symptoms. Vapor exposure from chemical solvents, dyes, cooling oils, paints, wood preservatives, and/or pesticides was associated with nonchronic cough or phlegm (OR = 1.14, 95% CI: 1.03, 1.27), chronic dry cough (OR = 1.55, 95% CI: 1.19, 2.01), and adult-onset asthma (OR = 1.34, 95% CI: 1.15, 1.56). Chemical solvents, cooling oils, and pesticides were the major contributors to respiratory symptoms. These data support the role of occupational exposures in the etiology of respiratory illness in a population-based cohort in Singapore with a low prevalence of atopic illness.
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Affiliation(s)
- Tricia D. LeVan
- Arizona Respiratory Center, University of Arizona, Tucson, AZ
| | - Woon-Puay Koh
- Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hin-Peng Lee
- Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Koh
- Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mimi C. Yu
- University of Minnesota Cancer Center, Minneapolis, MN
| | - Stephanie J. London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
- Corresponding Author: Stephanie J. London, M.D., Dr. P.H., National Institute of Environmental Health Sciences, P.O. Box 12233 Mail Drop A3-05, Research Triangle Park, NC 27709 Tel: 919.541.5772 Fax: 919.541.2511, E-mail:
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Lin S, Hwang SA, Pantea C, Kielb C, Fitzgerald E. Childhood asthma hospitalizations and ambient air sulfur dioxide concentrations in Bronx County, New York. ACTA ACUST UNITED AC 2005; 59:266-75. [PMID: 16201673 DOI: 10.3200/aeoh.59.5.266-275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The association between asthma hospitalizations and ambient sulfur dioxide (SO2) concentrations was examined in a case-control study in Bronx County, New York. Cases comprised 2629 children aged 0-14 yr who were admitted to hospitals for asthma. There were 2236 controls who were admitted for reasons other than asthma. Daily ambient SO2 concentrations were categorized into quartiles of both average and maximum levels and various exposure windows (i.e., day of admission and 1-, 2-, and 3-d lags). Cases were exposed to higher daily average concentrations of SO2 than controls. The authors compared the highest exposure quartile with the lowest, and the odds ratios were 1.66, 1.90, 2.05, and 2.21 (all p < 0.01 for same-day, 1-, 2-, and 3-d lags, respectively), with a similar finding for daily SO2 maximum exposure. The results suggest a consistent positive association between SO2 exposure and hospitalizations for childhood asthma.
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Affiliation(s)
- Shao Lin
- Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Troy, New York 12180, USA.
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Barnett AG, Williams GM, Schwartz J, Neller AH, Best TL, Petroeschevsky AL, Simpson RW. Air pollution and child respiratory health: a case-crossover study in Australia and New Zealand. Am J Respir Crit Care Med 2005; 171:1272-8. [PMID: 15764722 DOI: 10.1164/rccm.200411-1586oc] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The strength of the association between outdoor air pollution and hospital admissions in children has not yet been well defined. OBJECTIVES To estimate the impact of outdoor air pollution on respiratory morbidity in children after controlling for the confounding effects of weather, season, and other pollutants. METHODS The study used data on respiratory hospital admissions in children (three age groups: < 1, 1-4, and 5-14 years) for five cities in Australia and two in New Zealand. Time series of daily numbers of hospital admissions were analyzed using the case-crossover method; the results from cities were combined using a random-effects meta-analysis. MEASUREMENTS AND MAIN RESULTS Significant increases across the cities were observed for hospital admissions in children for pneumonia and acute bronchitis (0, 1-4 years), respiratory disease (0, 1-4, 5-14 years), and asthma (5-14 years). These increases were found for particulate matter with a diameter less than 2.5 microm (PM2.5) and less than 10 microm (PM10), nephelometry, NO2, and SO2. The largest association found was a 6.0% increase in asthma admissions (5-14 years) in relation to a 5.1-ppb increase in 24-hour NO2. CONCLUSIONS This study found strong and consistent associations between outdoor air pollution and short-term increases in childhood hospital admissions. A number of different pollutants showed significant associations, and these were distinct from any temperature (warm or cool) effects.
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Affiliation(s)
- Adrian G Barnett
- School of Population Health, University of Queensland, Herston, Australia
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Tham KW, Zuraimi MS. Size relationship between airborne viable bacteria and particles in a controlled indoor environment study. INDOOR AIR 2005; 15 Suppl 9:48-57. [PMID: 15910529 DOI: 10.1111/j.1600-0668.2005.00303.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED An attempt was made to determine the relationship between airborne viable bacteria (predominantly of human origin) and particle concentrations of different sizes in a controlled environmental chamber focusing on the effect of temperature setting. At temperature settings of 20 degrees and 26 degrees C, six subjects performed simulated office work for 2.5 h, and the particle and total bacteria concentrations at six aerodynamically corresponding size ranges were measured at 20-min intervals. The study revealed that the main contributor of viable bacteria was humans. Viable bacteria concentrations in the size range between 1 and 3 microm was higher at 20 degrees C than at 26 degrees C. Bacteria >7.5 microm showed good correlation with particles of similar minimum size, and it is postulated that this may be because of bacteria rafting on skin scales shed by the subjects. At sizes between 3 and 7.5 microm, the correlations indicated that bacteria exists as clumps, while at size ranges between 1.0 and 2 microm bacteria exists freely. At 26 degrees C, bacteria of size >7.5 microm correlated with exhaled carbon dioxide indicating nasal carriers. Viability of bacteria was shown to be affected by thermal effects. The percentages of particles that were viable bacteria at the different sizes were all found to be very low (<1%). PRACTICAL IMPLICATIONS Due to their respiratory health effects, determining exposure to airborne viable bacteria and particles of different sizes requires the study of their behavior in relation to each other. This study attempts to characterize the relationships of bacteria and particles that are predominantly of human origin. Findings of this work will help researchers in understanding how bacteria levels co-exist with particles of corresponding aerodynamic size across different size ranges between 20 degrees and 26 degrees C.
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Affiliation(s)
- K W Tham
- Department of Building, School of Design and Environment, National University of Singapore, Singapore.
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Boutin-Forzano S, Adel N, Gratecos L, Jullian H, Garnier JM, Ramadour M, Lanteaume A, Hamon M, Lafay V, Charpin D. Visits to the emergency room for asthma attacks and short-term variations in air pollution. A case-crossover study. Respiration 2004; 71:134-7. [PMID: 15031567 DOI: 10.1159/000076673] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Accepted: 09/04/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The 'case-crossover' design is a strategy fitted to studying transient effects of intermittent exposure on acute-onset disease occurring shortly after exposure. It has the important advantage of eliminating most confounding variables, allowing a stronger causality inference. OBJECTIVES The objective of the study was to evaluate the relationships between emergency room (ER) visits for asthma attacks and gaseous air pollution changes. METHODS The study included 549 individuals, 3-49 years old, visiting the ER during 1 year. Exposure to gaseous air pollutants (SO2, NO2, O3) on the same day and up to 4 days before was computed according to the patient's address. The statistical analysis included meteorological data as potential confounding variables. RESULTS No association could be shown between ER visits and SO2 or NO2 levels. In contrast, there was a statistically significant association between ER visits and mean O3 levels, on the day of admission and also on D -2 and D -3. For an increase of 10 microg/m3, the risk of requiring an ER admission increased by 6-10%. CONCLUSIONS Using this new strategy, we confirmed that ozone changes lead to a moderate increase in risk of requiring an ER admission in asthmatic subjects.
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Affiliation(s)
- S Boutin-Forzano
- Department of Chest Diseases and Allergy, Hopital Nord, and UPRES Equipe d'Accueil No. 1784 Biogénotoxicologie et mutagénèse environnementale - IFR 112: Pôle Méditerranéen des Sciences de l'Environnement, Marseille, France
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Bunn HJ, Kobzik L, Grigg J. MARCO expression on pediatric alveolar macrophages. CYTOMETRY PART B-CLINICAL CYTOMETRY 2004; 60:54-6. [PMID: 15221870 DOI: 10.1002/cyto.b.20011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phagocytosis of unopsonized pollutant particles by alveolar macrophages (AM) occurs via the macrophage receptor with collagenous structure (MARCO). In a previous study, we demonstrated that the laser scanning cytometer (LSC) can be used to characterize receptor expression in pediatric AM. Since we have demonstrated the presence of ultrafine carbon particles within AM obtained from young infants, we sought to determine MARCO expression by pediatric AM using the LSC, hypothesizing that MARCO expression, and hence the ability to phagocytize pollutant particles, is mature in early infancy. METHODS AM from 17 healthy children undergoing elective surgery, between 0.1 and 14.1 years of age, were obtained by bronchoalveolar lavage. Cytocentrifuged AM were dual immunostained with monoclonal antibodies to the panmacrophage marker CD68, and either MARCO or an appropriate isotypic control. Expression of MARCO was quantified using LSC and adjusted for cell area. Intensity of immunostaining was compared to each child's own isotypic control. RESULTS MARCO was present on 98% of pediatric AM. There was no association between age and either intensity of MARCO expression or the proportion of cells expressing MARCO. CONCLUSIONS We conclude that there is no developmental immaturity in the major receptor responsible for unopsonized particle uptake in healthy young children.
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Affiliation(s)
- Hazel J Bunn
- Department of Child Health, University of Leicester, Leicester, United Kingdom
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Burger J, Fleischer J, Jeitner C, Gochfeld M. Environmental concerns and diet in Singapore. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2003; 66:1405-1419. [PMID: 12857632 DOI: 10.1080/15287390306414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many factors affect how people perceive the world and their environment, and how such perceptions affect lifestyle decisions, yet the relationship between personal perceptions about environmental hazards and diet is rarely examined. In this study, environmental concerns on a local and global scale were examined, along with dietary patterns, to determine if there were associations and age-related differences. The hypothesis that concerns about water pollution might be reflected in choices about seafood consumption was examined. Many aspects of dietary choices varied significantly by age, including (1) younger people ate more "fast food" than others, (2) subjects aged 22-32 yr ate more meals in restaurants than older or younger people, (3) older individuals drank more tea than younger subjects, while younger people drank more soda than older people, and (4) there were few significant differences in total fish and shellfish meals, although young people ate more meals of other types of meat. Individuals who rated their health the best reported significantly fewer seafood meals than others. People who listed pollution as the major environmental problem did not consume seafood less often than others. While pollution was listed as the most important environmental problem globally, people distinguished between air and water pollution only for Singapore. Although Singapore, with its rapidly expanding economy, has reason to be concerned about both water and air pollution, only 14% of those listing pollution as the main Singapore environmental problem mentioned "water pollution." Singapore has been able to take measures to reduce water pollution from internal sources. Respondents considered air pollution a greater problem, perhaps reflecting recent haze disasters from deliberately set forest fires in Indonesia, which are beyond the direct control of Singapore or Singaporeans.
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Affiliation(s)
- Joanna Burger
- Division of Life Sciences, Consortium for Risk Evaluation with Stakeholder Participation, and Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey 08854-8082, USA.
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Lierl MB, Hornung RW. Relationship of outdoor air quality to pediatric asthma exacerbations. Ann Allergy Asthma Immunol 2003; 90:28-33. [PMID: 12546334 DOI: 10.1016/s1081-1206(10)63610-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although exposure to outdoor air pollutants has been shown to be associated with exacerbations of asthma, there are relatively few admissions for asthma to Cincinnati Children's Hospital, Cincinnati, OH during the summer months when air quality tends to be worst. OBJECTIVE The objective of this study was to determine the relationship of outdoor air quality parameters to asthma exacerbations in children. METHODS The number of emergency room visits and hospitalizations for asthma were determined by review of emergency department logs and the hospital computer database. Outdoor air concentrations of ozone, particulates of < 10 microm diameter (PM-10), pollens, and fungal spores were obtained from the Hamilton County Department of Environmental Services. Multiple regression analysis was performed, looking for relationships between the daily number of asthma visits and the air quality data for the same day and for 1 through 5 days before the visits. RESULTS A significant association was found between the number of asthma visits and the daily pollen count (P = 0.014, SE = 0.001). The effect was stronger for visits 1, 2, and 3 days after the pollen count (P < 0.001 for pollen count lagged 3 days). High PM-10 counts were synergistic with the pollen count as a predictor of asthma visits. There was no association between asthma visits and the ozone concentration or fungal spore count. CONCLUSIONS Exacerbations of asthma severe enough to require visits to the hospital were associated with elevated concentrations of airborne pollens and particulates, with a significant delayed effect. Ozone, in the concentrations measured here, was not a risk factor for severe asthma exacerbations in children.
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Affiliation(s)
- Michelle B Lierl
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Wang DY, Niti M, Smith JD, Yeoh KH, Ng TP. Rhinitis: do diagnostic criteria affect the prevalence and treatment? Allergy 2002; 57:150-4. [PMID: 11929419 DOI: 10.1034/j.1398-9995.2002.1s3402.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rhinitis is one of the world's most common health problems. Diagnostic criteria used in community surveys may affect reported prevalence and treatment. METHODS A proportionately stratified random sample study was performed to investigate the prevalence, comorbidities and management of community-based patients with rhinitis in the tropical urban city of Singapore. RESULTS The prevalence of at least one, two, three, or four nasal symptoms on most days during the past year in our study population was 25.5%, 13.1%, 6.5%, and 3.0%, respectively. Based on the definition of 'rhinitis' by the International Consensus Report (ICR), the prevalence was 13.1% in Singapore. There was significantly higher prevalence of self-reported allergy, asthma, and common cold/influenza-like illness among the rhinitis group. In the 53% of rhinitis subjects seeking for medical help, 71% visited a primary care physician and 20% an otolaryngologist. Treatments as reported by patients were decongestants (topical or oral) 27%, antibiotics 12%, antihistamines 6%, nasal steroids 3%, surgery 2%, traditional methods 28%, and 22% did not know what medication they had. Subjects considered the effectiveness of treatment unsatisfactory because the majority of them had only partial or no relief with any treatment. CONCLUSIONS The standardization of the definition of rhinitis in epidemiological studies is of crucial importance, especially when comparing the prevalence between studies. Appropriate patient education by physicians with a good understanding of the nature of rhinitis and the available treatment options (e.g. evidenced-based efficacy, safety, and a good cost-benefit ratio) will maximize patient compliance and treatment outcomes.
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Affiliation(s)
- D-Y Wang
- Department of Otolaryngology, National University of Singapore, Singapore
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Chew FT, Goh DY, Lee BW. Geographical comparison of the prevalence of childhood asthma and allergies in Singapore. ANNALS OF TROPICAL PAEDIATRICS 1999; 19:383-90. [PMID: 10716034 DOI: 10.1080/02724939992248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A previous study suggested that differences in the prevalence of respiratory illnesses such as asthma in school children in different regions of Singapore were not due to the influence of air pollution or environmental factors but possibly to cultural and socio-economic factors. The effects of socio-economic or demographic variables were, however, not shown in that study. In this study, we set out to discover whether regional differences in the prevalence of atopic diseases such as asthma, rhinitis and eczema in Singapore school children could be explained by different demographic profiles. The prevalence of asthma and allergies were evaluated in 6238 Singapore school children in two age groups (6-7 years [n = 2030] and 12-15 years [n = 4208]). They were from four regions, based on residential post codes. Demographic and socio-economic data were also obtained. The questionnaire of the International Study on Asthma and Allergies in Childhood (ISAAC) was used. The data showed that children residing in the northern regions of Singapore had a significantly lower prevalence of asthma and rhinitis than those in other regions. When controlled for demographic influences (age, sex and race) and socio-economic factors (type of housing), however, the differences between these regions were reduced. No geographical difference in the prevalence of eczema was observed. Thus, geographical differences in the prevalence of asthma and rhinitis in Singapore could in part be explained by demographic and socio-economic differences in the population.
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Affiliation(s)
- F T Chew
- Department of Paediatrics, National University of Singapore, Singapore.
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