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Hurraß J, Heinzow B, Walser-Reichenbach S, Aurbach U, Becker S, Bellmann R, Bergmann KC, Cornely OA, Engelhart S, Fischer G, Gabrio T, Herr CE, Joest M, Karagiannidis C, Klimek L, Köberle M, Kolk A, Lichtnecker H, Lob-Corzilius T, Mülleneisen N, Nowak D, Rabe U, Raulf M, Steinmann J, Steiß JO, Stemler J, Umpfenbach U, Valtanen K, Werchan B, Willinger B, Wiesmüller GA. AWMF mold guideline "Medical clinical diagnostics for indoor mold exposure" - Update 2023 AWMF Register No. 161/001. Allergol Select 2024; 8:90-198. [PMID: 38756207 PMCID: PMC11097193 DOI: 10.5414/alx02444e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
- Julia Hurraß
- Section for Hygiene in Healthcare Facilities, Division of Infection Control and Environmental Hygiene, Cologne Health Department, Cologne
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Birger Heinzow
- Formerly: State Agency for Social Services (LAsD) Schleswig-Holstein, Kiel
- Co-author
| | - Sandra Walser-Reichenbach
- Formerly: State Agency for Social Services (LAsD) Schleswig-Holstein, Kiel
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Ute Aurbach
- Laboratory Dr. Wisplinghoff
- ZfMK – Center for Environment, Hygiene and Mycology Cologne, Cologne
- Co-author
| | - Sven Becker
- Department for Otorhinolaryngology, Head and Neck Surgery, University Medical Center Tübingen, Tübingen, Germany
- Co-author
| | - Romuald Bellmann
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
- Co-author
| | - Karl-Christian Bergmann
- Institute of Allergology Charité, Charité – University Medicine Berlin, Berlin
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Oliver A. Cornely
- Institute for Translational Research, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany and Department I for Internal Medicine, Cologne University Hospital, Cologne
- Co-author
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Guido Fischer
- Baden-Württemberg State Health Office in the Stuttgart Regional Council, Stuttgart
- Co-author
| | - Thomas Gabrio
- Formerly: Baden-Württemberg State Health Office in the Stuttgart Regional Council, Stuttgart
- Co-author
| | - Caroline E.W. Herr
- Bavarian Health and Food Safety Authority, Munich
- Environmental Health and Prevention, Institute and Polyclinic for Occupational, Social and Environmental Medicine, University of Munich Hospital Ludwig-Maximilians-University, Munich
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Marcus Joest
- Allergological-Immunological Laboratory, Helios Lung and Allergy Center Bonn, Bonn
- Co-author
| | - Christian Karagiannidis
- Faculty of Health, Professorship for Extracorporeal Lung Replacement Procedures, University of Witten/Herdecke, Witten/Herdecke
- Lung Clinic Cologne Merheim, Clinics of the City of Cologne, Cologne
- Co-author
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Martin Köberle
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Annette Kolk
- Institute for Occupational Safety and Health (IFA) of the German Social Accident Insurance (DGUV), Unit Biological Agents, Sankt Augustin
- Co-author
| | - Herbert Lichtnecker
- Medical Institute for Environmental and Occupational Medicine MIU GmbH Erkrath, Erkrath
- Co-author
| | - Thomas Lob-Corzilius
- Scientific working group of environmental medicine of the German Society of Pediatric Allergology (GPAU)
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Norbert Mülleneisen
- Asthma and Allergy Center Leverkusen, Leverkusen
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Dennis Nowak
- Institute and Polyclinic for Occupational, Social and Environmental Medicine, member of the German Center for Lung Research, Hospital of the University of Munich, Munich
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Uta Rabe
- Center for Allergology and Asthma, Johanniter Hospital Treuenbrietzen, Treuenbrietzen
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Statutory Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Jörg Steinmann
- Center for Pediatrics and Adolescent Medicine, University Hospital Giessen and Marburg GmbH, Giessen
- Co-author
| | - Jens-Oliver Steiß
- Specialized Practice in Allergology and Pediatric Pulmonology in Fulda, Fulda
- Institute for Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Private Medical University Nuremberg Clinic, Nuremberg
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Jannik Stemler
- Institute for Translational Research, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany and Department I for Internal Medicine, Cologne University Hospital, Cologne
- Co-author
| | - Ulli Umpfenbach
- Doctor for Pediatrics and Adolescent Medicine, Pediatric Pulmonology, Environmental Medicine, Classical Homeopathy, Asthma Trainer, Neurodermatitis Trainer, Viersen
- Co-author
| | - Kerttu Valtanen
- FG II 1.4 Microbiological Risks, German Environment Agency, Berlin
- Co-author
| | - Barbora Werchan
- German Pollen Information Service Foundation (PID), Berlin, Germany
- Co-author
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology – Medical University of Vienna, Vienna, Austria, and
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
| | - Gerhard A. Wiesmüller
- Laboratory Dr. Wisplinghoff
- ZfMK – Center for Environment, Hygiene and Mycology Cologne, Cologne
- Institute for Occupational, Social and Environmental Medicine, Uniclinic RWTH Aachen, Aachen, Germany
- Co-author
- Member of a scientific medical society, a society or a medical association with voting rights
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Murphy J, Tharumakunarajah R, Holden KA, King C, Lee AR, Rose K, Hawcutt DB, Sinha IP. Impact of indoor environment on children's pulmonary health. Expert Rev Respir Med 2023; 17:1249-1259. [PMID: 38240133 DOI: 10.1080/17476348.2024.2307561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION A child's living environment has a significant impact on their respiratory health, with exposure to poor indoor air quality (IAQ) contributing to potentially lifelong respiratory morbidity. These effects occur throughout childhood, from the antenatal period through to adolescence. Children are particularly susceptible to the effects of environmental insults, and children living in socioeconomic deprivation globally are more likely to breathe air both indoors and outdoors, which poses an acute and long-term risk to their health. Adult respiratory health is, at least in part, determined by exposures and respiratory system development in childhood, starting in utero. AREAS COVERED This narrative review will discuss, from a global perspective, what contributes to poor IAQ in the child's home and school environment and the impact that indoor air pollution exposure has on respiratory health throughout the different stages of childhood. EXPERT OPINION All children have the right to a living and educational environment without the threat of pollution affecting their health. Action is needed at multiple levels to address this pressing issue to improve lifelong respiratory health. Such action should incorporate a child's rights-based approach, empowering children, and their families, to have access to clean air to breathe in their living environment.
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Affiliation(s)
- Jared Murphy
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Karl A Holden
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Lab to Life Child Health Data Centre, Alder Hey Children's Hospital, Liverpool, UK
| | - Charlotte King
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Alice R Lee
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Lab to Life Child Health Data Centre, Alder Hey Children's Hospital, Liverpool, UK
| | - Katie Rose
- Department of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Groot J, Nielsen ET, Nielsen TF, Andersen PK, Pedersen M, Sigsgaard T, Loft S, Nybo Andersen AM, Keller A. Exposure to residential mold and dampness and the associations with respiratory tract infections and symptoms thereof in children in high income countries: A systematic review and meta-analyses of epidemiological studies. Paediatr Respir Rev 2023; 48:47-64. [PMID: 37482434 DOI: 10.1016/j.prrv.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Multiple reviews have been conducted on the associations between residential mold and dampness and respiratory outcomes in children, with few specifically investigating respiratory tract infections (RTIs). OBJECTIVE We aimed to review and synthesize the available epidemiological literature on mold and dampness and risk of RTIs and respiratory symptoms compatible with RTIs in children living in high-income countries. METHOD We performed a systematic search of literature available from MEDLINE, Embase, and Web of Science for observational studies. We conducted meta-analyses using two-level random effects (RE) and multi-level random effects (ML) models for contrasts of three exposure and three outcome categories, including multiple estimates reported by single studies. We report central estimates for pooled odds ratios (OR) and 95 % confidence intervals (CI).We conducted a risk of bias assessment using the Joanna Briggs Initiative (JBI) checklists for cross-sectional, case-control, and cohort studies. We additionally report on cumulative meta-analyses, leave-one-out analyses of single estimates, subgroup analyses by study quality and study design and inclusion of all effect estimates. RESULTS Of the 932 studies initially screened by title and abstract, we included 30 studies with 267 effect estimates that met the inclusion criteria. Most were cross-sectional (n = 22), with fewer cohort (n = 5) and case-control (n = 3) studies. Most of the studies were according to the bias assessment of poor or fair quality (n = 24). The main meta-analyses generally provided similar results regardless of statistical model and central estimates ranged from OR 1.28 (95 % CI; 1.08, 1.53) for dampness and RTIs to OR 1.76 (95 % CI; 1.64, 1.88) for mold and respiratory symptoms. Most analyses were of moderate heterogeneity. Funnel plots did not indicate strong publication bias. CONCLUSION Our results are compatible with a weak to moderate effect of residential mold and or dampness on risk of RTIs in children in high-income countries. However, these results are based primarily on cross-sectional studies.
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Affiliation(s)
- Jonathan Groot
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Emilie Tange Nielsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Trine Fuhr Nielsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Pedersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Torben Sigsgaard
- Environment, Work and Health, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amélie Keller
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Wafula ST, Nalugya A, Mendoza H, Kansiime WK, Ssekamatte T, Walekhwa AW, Mugambe RK, Walter F, Ssempebwa JC, Musoke D. Indoor air pollutants and respiratory symptoms among residents of an informal urban settlement in Uganda: A cross-sectional study. PLoS One 2023; 18:e0290170. [PMID: 37590259 PMCID: PMC10434877 DOI: 10.1371/journal.pone.0290170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Indoor air pollutants (IAP) and household conditions such as dampness, crowding and chemical exposures have been associated with acute and chronic respiratory infections. In Uganda, literature on the effects of IAP on respiratory outcomes in informal settlements is limited. METHODS We describe the baseline household characteristics of 284 adults and their children in an informal settlement in Uganda from April to May 2022. We monitored same-day indoor concentrations of particulate matter PM2.5, PM10, Carbon monoxide (CO), relative humidity %, and temperature from 9 am to 2 pm and interviewed caregivers/mothers about their respiratory symptoms and those of their children in the previous 30 days. We employed robust Poisson regressions to evaluate the associations between indoor air indicators and respiratory health symptoms. RESULTS Approximately 94.7% of households primarily used biomass fuels and 32.7% cooked from inside their dwelling rooms. The median PM2.5, PM10 and CO levels were 49.5 (Interquartile range (IQR) = 31.1,86.2) μg/m3, 73.6 (IQR = 47.3,130.5) μg/m3 and 7.70 (IQR = 4.1,12.5) ppm respectively. Among adults, a 10 unit increase in PM2.5 was associated with cough (Prevalence Ratio (PR) = 3.75, 95%CI 1.15-1.55). Dwelling unit dampness was associated with phlegm (PR = 2.53, 95%CI = 1.39-4.61) and shortness of breath (PR = 1.78, 95% CI 1.23-2.54) while cooking from outside the house was protective against shortness of breath (PR = 0.62, 95% CI = 0.44-0.87). In children, dampness was associated with phlegm (PR = 13.87, 95% CI 3.16-60.91) and cough (PR = 1.62, 95% CI 1.12-2.34) while indoor residual spraying was associated with phlegm (PR = 3.36, 95%CI 1.71-6.61). CONCLUSION Poor indoor air conditions were associated with respiratory symptoms in adults and children. Efforts to address indoor air pollution should be made to protect adults and children from adverse health effects.
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Affiliation(s)
- Solomon T. Wafula
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Hilbert Mendoza
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Winnifred K. Kansiime
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Abel W. Walekhwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Richard K. Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Florian Walter
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - John C. Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
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Sarno G, Stanisci I, Maio S, Williams S, Ming KE, Diaz SG, Ponte EV, Lan LTT, Soronbaev T, Behera D, Tagliaferro S, Baldacci S, Viegi G. Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries. Pulmonology 2023:S2531-0437(23)00083-1. [PMID: 37211526 DOI: 10.1016/j.pulmoe.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVE to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution. RESULTS Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education. CONCLUSIONS in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.
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Affiliation(s)
- G Sarno
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - I Stanisci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Maio
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Williams
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - K E Ming
- International Primary Care Respiratory Group (IPCRG), 19 Armour Mews, Larbert FK5 4FF, Scotland, United Kingdom
| | - S G Diaz
- Universidad Autónoma de Nuevo León, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Av. Dr. José Eleuterio González 235, Mitras Centro, 64460 Monterrey, N.L., Mexico
| | - E V Ponte
- Faculdade de Medicina de Jundiaí - Department of Internal Medicine, R. Francisco Teles, 250, Vila Arens II, Jundiaí SP, 13202-550, Brazil
| | - L T T Lan
- University Medical Center, 217 Hong Bang, dist.5, Ho Chi Minh City 17000, Vietnam
| | - T Soronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Togolok Moldo str., Bishkek 720040, Kyrgyzstan
| | - D Behera
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Sri Aurobindo Marg Near Qutub Minar, Mehrauli, New Delhi 110030, India
| | - S Tagliaferro
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - S Baldacci
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy
| | - G Viegi
- CNR Institute of Clinical Physiology (IFC), Via Trieste, 41, 56126 Pisa, Italy.
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Rocco I, Cilluffo G, Ferrante G, Cibella F, Marcon A, Marchetti P, Ricci P, Minicuci N, La Grutta S, Corso B. Investigating the Relationship between Parental Education, Asthma and Rhinitis in Children Using Path Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14551. [PMID: 36361431 PMCID: PMC9654957 DOI: 10.3390/ijerph192114551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Parental socioeconomic position (SEP) is a known determinant of a child's health. We aimed to investigate whether a low parental education, as proxy of SEP, has a direct effect on physician-diagnosed asthma, current asthma and current allergic rhinitis in children, or whether associations are mediated by exposure to other personal or environmental risk factors. This study was a secondary data analysis of two cross-sectional studies conducted in Italy in 2006. Data from 2687 adolescents (10-14 years) were analyzed by a path analysis model using generalized structural equation modelling. Significant direct effects were found between parental education and family characteristics (number of children (coefficient = 0.6229, p < 0.001) and crowding index (1.1263, p < 0.001)) as well as with exposure to passive smoke: during pregnancy (maternal: 0.4697, p < 0.001; paternal: 0.4854, p < 0.001), during the first two years of children's life (0.5897, p < 0.001) and currently (0.6998, p < 0.001). An indirect effect of parental education was found on physician-diagnosed asthma in children mediated by maternal smoking during pregnancy (0.2350, p < 0.05) and on current allergic rhinitis mediated by early environmental tobacco smoke (0.2002; p < 0.05). These results suggest the importance of promotion of ad-hoc health policies for promoting smoking cessation, especially during pregnancy.
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Affiliation(s)
- Ilaria Rocco
- Neuroscience Institute (IN), National Research Council (CNR), 35121 Padova, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, 90123 Palermo, Italy
| | - Giuliana Ferrante
- Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Pediatric Unit, Verona University Medical School, 37134 Verona, Italy
| | - Fabio Cibella
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, 37134 Verona, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, c/o Istituti Biologici II, 37134 Verona, Italy
| | - Paolo Ricci
- UOC Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, 46100 Mantova, Italy
| | - Nadia Minicuci
- Neuroscience Institute (IN), National Research Council (CNR), 35121 Padova, Italy
| | - Stefania La Grutta
- Institute of Traslational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
| | - Barbara Corso
- Neuroscience Institute (IN), National Research Council (CNR), 35121 Padova, Italy
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7
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Malizia V, Ferrante G, Cilluffo G, Gagliardo R, Landi M, Montalbano L, Fasola S, Profita M, Licari A, Marseglia GL, La Grutta S. Endotyping Seasonal Allergic Rhinitis in Children: A Cluster Analysis. Front Med (Lausanne) 2022; 8:806911. [PMID: 35155483 PMCID: PMC8825866 DOI: 10.3389/fmed.2021.806911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Seasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children. Methods This cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL. Results Out of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; Cluster 3 showed higher levels of IL-17, IL-23, and IFN-γ and intermediate levels of IL-5. Cluster 1 showed intermediate values of nasal pH and nasal nitric oxide (nNO), and a lower percentage of neutrophils at nasal cytology than Clusters 2 and 3. Cluster 2 had a lower level of nasal pH, a higher nNO, higher scores in the ocular domain of PRQLQ, and worse sleep quality than Clusters 1 and 3. Cluster 3 showed a higher percentage of neutrophils at nasal cytology than Clusters 1 and 2. Conclusions Our study identified three endotypes based on the evaluation of cytokines in NL, highlighting that childhood SAR is characterized by heterogeneous inflammatory cytokines.
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Affiliation(s)
- Velia Malizia
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Paediatric Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Giovanna Cilluffo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Rosalia Gagliardo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Massimo Landi
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy.,Pediatric National Healthcare System, Turin, Italy
| | - Laura Montalbano
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Salvatore Fasola
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Mirella Profita
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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Cilluffo G, Sottile G, La Grutta S, Muggeo VM. The Induced Smoothed lasso: A practical framework for hypothesis testing in high dimensional regression. Stat Methods Med Res 2019; 29:765-777. [PMID: 30991902 DOI: 10.1177/0962280219842890] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper focuses on hypothesis testing in lasso regression, when one is interested in judging statistical significance for the regression coefficients in the regression equation involving a lot of covariates. To get reliable p-values, we propose a new lasso-type estimator relying on the idea of induced smoothing which allows to obtain appropriate covariance matrix and Wald statistic relatively easily. Some simulation experiments reveal that our approach exhibits good performance when contrasted with the recent inferential tools in the lasso framework. Two real data analyses are presented to illustrate the proposed framework in practice.
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Affiliation(s)
- Giovanna Cilluffo
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Gianluca Sottile
- Dipartimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Palermo, Italy
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Vito Mr Muggeo
- Dipartimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Palermo, Italy
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9
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Järvi K, Hyvärinen A, Täubel M, Karvonen AM, Turunen M, Jalkanen K, Patovirta R, Syrjänen T, Pirinen J, Salonen H, Nevalainen A, Pekkanen J. Microbial growth in building material samples and occupants' health in severely moisture-damaged homes. INDOOR AIR 2018; 28:287-297. [PMID: 29151276 DOI: 10.1111/ina.12440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
There is no commonly approved approach to detect and quantify the health-relevant microbial exposure in moisture-damaged buildings. In 39 single-family homes with severe moisture damage, we studied whether concentrations of viable microbes in building material samples are associated with health among 71 adults and 68 children, and assessed with symptoms questionnaires, exhaled NO, and peak expiratory flow (PEF) variability. Symptoms were grouped into three scores: upper respiratory symptoms, lower respiratory symptoms, and general symptoms. The homes were divided into three groups based on viable counts of fungi, actinomycetes, and total bacteria cultivated from building material samples. Highest group of actinomycete counts was associated with more general symptoms, worse perceived health, and higher daily PEF variability (aOR 12.51; 1.10-141.90 as compared to the lowest group) among adults, and with an increase in lower respiratory symptoms in children, but the confidence intervals were wide. We observed significant associations of fungal counts and total microbial score with worse perceived health in adults. No associations with exhaled NO were observed.
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Affiliation(s)
- K Järvi
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- School of Engineering, Aalto University, Espoo, Finland
| | - A Hyvärinen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - M Täubel
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - A M Karvonen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - M Turunen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - K Jalkanen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - R Patovirta
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Syrjänen
- The Organisation for Respiratory Health in Finland, Helsinki, Finland
| | - J Pirinen
- The Organisation for Respiratory Health in Finland, Helsinki, Finland
- Ministry of Environment, Helsinki, Finland
| | - H Salonen
- School of Engineering, Aalto University, Espoo, Finland
| | - A Nevalainen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - J Pekkanen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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10
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Montalbano L, Cilluffo G, Gentile M, Ferrante G, Malizia V, Cibella F, Viegi G, Passalacqua G, La Grutta S. Development of a nomogram to estimate the quality of life in asthmatic children using the Childhood Asthma Control Test. Pediatr Allergy Immunol 2016; 27:514-20. [PMID: 27018497 DOI: 10.1111/pai.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric Asthma Quality of Life Questionnaire (PAQLQ) provides detailed information on QoL in asthmatic children, whereas Childhood Asthma Control Test (C-ACT) Questionnaire is the most validated instrument for asthma control. No study assessed the relationship between C-ACT and QoL in children by means of those instruments. The aim of this study was to determine whether a QoL estimation is possible using the C-ACT questionnaire in asthmatic children. METHODS Medical history, spirometry, C-ACT, and PAQLQ were assessed in 144 (60% male) outpatient asthmatic children from September 2011 to November 2014. A generalized linear model (GLM) for the prediction of PAQLQ was obtained through a stepwise procedure starting from a full model with all C-ACT items, and predictive nomograms were created. RESULTS Fifty-five (38%) well-controlled (WC) asthma, 37 (26%) partially controlled (PC) asthma, and 52 (36%) uncontrolled asthma (UA) patients were enrolled. Persistent asthmatics (PA) were significantly more uncontrolled (p < 0.0001). A significant reduction in FEV1 , FEV1 /FVC, and FEF25-75 (p = 0.005, p < 0.0001, and p < 0.001, respectively) was found in WC vs. UA. Through a stepwise process, a reduced model showed a positive relationship between the PAQLQ and the four items of C-ACT. The regression equations for predicted PAQLQ were ln(PAQLQ) = 1.17 + 0.05*C-ACT2 + 0.03*C-ACT3 + 0.04*C-ACT6 + 0.03*C-ACT7. Thus, a nomogram was constructed. CONCLUSION The designed nomogram provides a highly predictive assessment of QoL in individual patients, facilitating a more comprehensive assessment of asthmatic children in usual clinical care.
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Affiliation(s)
- Laura Montalbano
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Department of Psychological Educational and Training Sciences, University of Palermo, Palermo, Italy
| | - Giovanna Cilluffo
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Department of Economics, Statistics and Business Sciences, University of Palermo, Palermo, Italy
| | - Manuel Gentile
- Institute for Educational Technologies, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Department of Science for Health promotion and Mother and Child care, University of Palermo, Palermo, Italy
| | - Velia Malizia
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Fabio Cibella
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Giovanni Viegi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy.,Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, National Research Council of Italy, Pisa, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Genoa, Italy
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
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11
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Lefeuvre D, Delmas MC, Marguet C, Chauvin P, Vandentorren S. Asthma-Like Symptoms in Homeless Children in the Greater Paris Area in 2013: Prevalence, Associated Factors and Utilization of Healthcare Services in the ENFAMS Survey. PLoS One 2016; 11:e0153872. [PMID: 27082960 PMCID: PMC4833414 DOI: 10.1371/journal.pone.0153872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Asthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation. MATERIALS AND METHODS A cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0-12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS. RESULTS The prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions. CONCLUSION ALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.
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Affiliation(s)
- Delphine Lefeuvre
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France
| | | | | | - Pierre Chauvin
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France
| | - Stéphanie Vandentorren
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France
- French Institute for Public Health Surveillance, Saint-Maurice, France
- Observatoire du Samusocial de Paris, Paris, France
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12
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[Local allergic rhinitis to Alternaria alternata : Evidence for local IgE production exclusively in the nasal mucosa]. HNO 2016; 63:364-72. [PMID: 25929891 DOI: 10.1007/s00106-015-0005-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In a subgroup of patients with symptoms of allergic rhinitis (AR), no systemic sensitization can be detected in skin tests or serum. These patients are considered to be afflicted with so-called "local allergic rhinitis" (LAR) with IgE-production exclusively at the site of the nasal mucosa. Patients without any positive allergy test results but seasonal (intermittent) or perennial (persistent) allergic symptoms were often misdiagnosed as having "non-allergic rhinitis" (NAR) in the past.However, there is evidence for a specific IgE-production in the nasal mucosa in these patients without systemic sensitization. The diagnosis of LAR is confirmed by clinical symptoms, the detection of specific IgE production in the nasal mucosa and/or nasal provocation tests.We report on two cases of LAR to Alternaria alternata with symptoms of persistent allergic rhinitis that have been diagnosed by positive allergenspecific nasal challenge tests and specific IgE determinations in nasal secretions.According to an actual literature research, this is the second report published on LAR caused by Alternaria alternata.
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13
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Rosa MJ, Benedetti C, Peli M, Donna F, Nazzaro M, Fedrighi C, Zoni S, Marcon A, Zimmerman N, Wright R, Lucchini R. Association between personal exposure to ambient metals and respiratory disease in Italian adolescents: a cross-sectional study. BMC Pulm Med 2016; 16:6. [PMID: 26754125 PMCID: PMC4709999 DOI: 10.1186/s12890-016-0173-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background Release of ambient metals during ferroalloy production may be an important source of environmental exposure for nearby communities and exposure to these metals has been linked to adverse respiratory outcomes. We sought to characterize the association between personal air levels of metals and respiratory health in Italian adolescents living in communities with historic and current ferroalloy activity. Methods As part of a study in the industrial province of Brescia, Italy, 410 adolescents aged 11–14 years were recruited. Participants were enrolled from three different communities with varying manganese (Mn) levels: Bagnolo Mella which has current ferroalloy activity, Valcamonica, which has historic ferroalloy activity and Garda Lake which has no history of ferroalloy activity. Particulate matter <10 μm in diameter (PM10) was collected for 24 h in filters using personal sampling. Mn, nickel (Ni), zinc (Zn), chromium (Cr) and iron (Fe) were measured in filters using x-ray fluorescence. Data on respiratory health was collected through questionnaire. Data for 280 adolescents were analyzed using a modified Poisson regression, and risk ratios were calculated for an interquartile (IQR) range increase in each pollutant. Results In adjusted models including PM10 as a co-pollutant, we found significant associations between concentrations of Mn (RR: 1.09, 95 % CI [1.00, 1.18] per 42 ng/m3 increase), Ni (RR: 1.11, 95 % CI [1.03, 1.21] per 4 ng/m3 increase) and Cr (RR: 1.08, 95 % CI [1.06, 1.11] per 9 ng/m3 increase) and parental report of asthma. We also found significant associations between increased Mn and Ni and increased risk of asthma medication use in the past 12 months (RR: 1.13, 95 % CI [1.04, 1.29] and (RR: 1.13, 95 % CI [1.01, 1.27] respectively). Conclusions Our findings suggest that exposure to ambient Mn, Ni and Cr may be associated with adverse respiratory outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0173-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria José Rosa
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Chiara Benedetti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy.
| | - Marco Peli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy. .,Department of Civil, Environmental, Architectural Engineering and Mathematics of the University of Brescia, Brescia, Italy.
| | - Filippo Donna
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy.
| | - Marco Nazzaro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy.
| | - Chiara Fedrighi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy.
| | - Silvia Zoni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy.
| | - Alessandro Marcon
- Department of Diagnostics and Public Health, Unit of Epidemiology & Medical Statistics, University of Verona, Verona, Italy.
| | - Neil Zimmerman
- School of Health Sciences, Purdue University, West Lafayette, IN, USA.
| | - Rosalind Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. .,Department of Pediatrics, Pulmonary and Critical Care, Icahn School of Medicine at 'Mount Sinai, New York, NY, USA.
| | - Roberto Lucchini
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA. .,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Occupational Medicine, University of Brescia, Brescia, Italy.
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14
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Shiue I. IgE antibodies and urinary trimethylarsine oxide accounted for 1-7% population attributable risks for eczema in adults: USA NHANES 2005-2006. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:18404-18409. [PMID: 26233738 DOI: 10.1007/s11356-015-5084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 07/16/2015] [Indexed: 06/04/2023]
Abstract
Population attributable risks from serum IgE and dust miteallergen concentrations and environmental chemicals for eczema are unclear. Therefore, it was aimed to examine serum IgE and allergen concentrations and environmental chemicals for eczema in adults and to calculate population attributable risks in a national and population-based setting. Data retrieved from the National Health and Nutrition Examination Survey, 2005-2006, was analyzed. Information on demographics and self-reported ever eczema was obtained by household interview. Bloods and urines (sub-sample) were also collected during the interview. Adults aged 20-85 were included. Statistical analyses were using chi-square test, t test, survey-weighted logistic regression modeling, and population attributable risk (PAR) estimation. Of all the included American adults (n = 4979), 310 (6.2%) reported ever eczema. Moreover, more eczema cases were observed in female adults but fewer cases in people born in Mexico. There were no significant associations observed between commonly known biomarkers (including vitamin D) and eczema or between dust mite allergens and eczema. Serum D. Farinae (PAR 1.0%), D. Pteronyssinus (PAR 1.1%), cat (PAR 1.8%), dog (PAR 1.6%), and muse (PAR 3.2%) IgE antibodies were associated with eczema. Adults with ever eczema were found to have higher levels of urinary trimethylarsine oxide concentrations (PAR 7.0%) but not other speciated arsenic concentrations. There were no clear associations between other environmental chemicals including heavy metals, phthalates, phenols, parabens, pesticides, nitrate, perchlorate, polycyclic hydrocarbons and eczema as well. Elimination of environmental risks might help delay or stop eczema up to 7% in the adult population.
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Affiliation(s)
- Ivy Shiue
- Faculty of Health and Life Sciences, Northumbria University, NE7 7XA, Newcastle upon Tyne, England, UK.
- Owens Institute for Behavioral Research, University of Georgia, Athens, GA, USA.
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15
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Crawford JA, Rosenbaum PF, Anagnost SE, Hunt A, Abraham JL. Indicators of airborne fungal concentrations in urban homes: understanding the conditions that affect indoor fungal exposures. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 517:113-24. [PMID: 25725196 DOI: 10.1016/j.scitotenv.2015.02.060] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 05/23/2023]
Abstract
Indoor fungal exposure can compromise respiratory health. Low-income urban areas are of concern because of high asthma and allergy rates and housing disrepair. Understanding the conditions that affect indoor fungal exposures is important for assessing health risks and for developing mitigation strategies. We examined the types and concentrations of airborne fungi inside and outside of homes in low-income areas of Syracuse, NY as well as the effect of snow cover on fungal levels. At 103 homes, air samples for viable fungi were collected, occupants were interviewed and homes were inspected for visible mold, musty odors, water problems and other factors. Multivariable logistic regression was used to relate high fungal levels to home conditions. Predominant indoor fungi included Cladosporium, Penicillium, Aspergillus, Alternaria and hyaline unknowns. Basidiomycetes and an uncommon genus Acrodontium were also found frequently due to analysis methods developed for this project. With snow cover, outdoor total fungal levels were depressed and indoor concentrations were three times higher than outdoor on average with a maximum of 29 times higher. Visible mold was related to elevated levels of Penicillium (OR 4.11 95% CI 1.37-14.0) and bacteria (OR 3.79 95% CI 1.41-11.2). Musty, moldy odors were associated with elevated concentrations of total fungi (OR 3.48 95% CI 1.13-11.6) and basidiomycetes. Cockroaches, an indicator of moisture, were associated with elevated levels of Penicillium (OR 3.66 95% CI 1.16-13.1) and Aspergillus (OR 4.36 95% CI 1.60-13.4). Increasing relative humidity was associated with higher concentrations of Penicillium, yeasts and basidiomycetes. Visible mold, musty odors, indoor humidity and cockroaches are modifiable factors that were important determinants of indoor fungal exposures. Indoor air investigators should interpret indoor:outdoor fungal ratios cautiously when snow cover is present.
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Affiliation(s)
- Judith A Crawford
- Graduate Program in Environmental Science, State University of New York (SUNY) College of Environmental Science and Forestry, Baker Laboratory, 1 Forestry Drive, Syracuse, NY 13210, United States.
| | - Paula F Rosenbaum
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, United States.
| | - Susan E Anagnost
- Department of Sustainable Construction Management & Engineering, SUNY College of Environmental Science and Forestry, 1 Forestry Drive, Syracuse, NY 13210, United States.
| | - Andrew Hunt
- Department of Earth and Environmental Sciences, University of Texas at Arlington, 500 Yates Street, Box 19049, Arlington, TX 76019-0049, United States.
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, United States.
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16
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Baldacci S, Maio S, Cerrai S, Sarno G, Baïz N, Simoni M, Annesi-Maesano I, Viegi G. Allergy and asthma: Effects of the exposure to particulate matter and biological allergens. Respir Med 2015; 109:1089-104. [PMID: 26073963 DOI: 10.1016/j.rmed.2015.05.017] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/08/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
The prevalence of asthma and allergies including atopy has increased during the past decades, particularly in westernized countries. The rapid rise in the prevalence of such diseases cannot be explained by genetic factors alone. Rapid urbanization and industrialization throughout the world have increased air pollution and population exposures, so that most epidemiologic studies are focusing on possible links between air pollution and respiratory diseases. Furthermore, a growing body of evidence shows that chemical air pollution may interact with airborne allergens enhancing the risk of atopic sensitization and exacerbation of symptoms in sensitized subjects. These phenomena are supported by current in vitro and animal studies showing that the combined exposure to air pollutants and allergens may have a synergistic or additive effect on asthma and allergies, although there is an insufficient evidence about this link at the population level. Further research is needed in order to elucidate the mechanisms by which pollutants and biological allergens induce damage in exposed subjects. The abatement of the main risk factors for asthma and allergic diseases may achieve huge health benefits. Thus, it is important to raise awareness of respiratory allergies as serious chronic diseases which place a heavy burden on patients and on society as a whole.
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Affiliation(s)
- S Baldacci
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, CNR, Pisa, Italy.
| | - S Maio
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - S Cerrai
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - G Sarno
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - N Baïz
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institute Pierre Louis of Epidémiology and Public Health, Epidemiology of Allergic and Respiratory Diseases Department, Paris, France; INSERM, UMR-S 1136, IPLESP, EPAR Department, Paris, France
| | - M Simoni
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - I Annesi-Maesano
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institute Pierre Louis of Epidémiology and Public Health, Epidemiology of Allergic and Respiratory Diseases Department, Paris, France; INSERM, UMR-S 1136, IPLESP, EPAR Department, Paris, France
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
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17
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Hamilton I, Milner J, Chalabi Z, Das P, Jones B, Shrubsole C, Davies M, Wilkinson P. Health effects of home energy efficiency interventions in England: a modelling study. BMJ Open 2015; 5:e007298. [PMID: 25916488 PMCID: PMC4420956 DOI: 10.1136/bmjopen-2014-007298] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess potential public health impacts of changes to indoor air quality and temperature due to energy efficiency retrofits in English dwellings to meet 2030 carbon reduction targets. DESIGN Health impact modelling study. SETTING England. PARTICIPANTS English household population. INTERVENTION Three retrofit scenarios were modelled: (1) fabric and ventilation retrofits installed assuming building regulations are met; (2) as with scenario (1) but with additional ventilation for homes at risk of poor ventilation; (3) as with scenario (1) but with no additional ventilation to illustrate the potential risk of weak regulations and non-compliance. MAIN OUTCOME Primary outcomes were changes in quality adjusted life years (QALYs) over 50 years from cardiorespiratory diseases, lung cancer, asthma and common mental disorders due to changes in indoor air pollutants, including secondhand tobacco smoke, PM2.5 from indoor and outdoor sources, radon, mould, and indoor winter temperatures. RESULTS The modelling study estimates showed that scenario (1) resulted in positive effects on net mortality and morbidity of 2241 (95% credible intervals (CI) 2085 to 2397) QALYs per 10,000 persons over 50 years follow-up due to improved temperatures and reduced exposure to indoor pollutants, despite an increase in exposure to outdoor-generated particulate matter with a diameter of 2.5 μm or less (PM₂.₅). Scenario (2) resulted in a negative impact of -728 (95% CI -864 to -592) QALYs per 10,000 persons over 50 years due to an overall increase in indoor pollutant exposures. Scenario (3) resulted in -539 (95% CI -678 to -399) QALYs per 10,000 persons over 50 years follow-up due to an increase in indoor exposures despite the targeting of pollutants. CONCLUSIONS If properly implemented alongside ventilation, energy efficiency retrofits in housing can improve health by reducing exposure to cold and air pollutants. Maximising the health benefits requires careful understanding of the balance of changes in pollutant exposures, highlighting the importance of ventilation to mitigate the risk of poor indoor air quality.
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Affiliation(s)
- Ian Hamilton
- UCL Energy Institute, University College London, London, UK
| | - James Milner
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Zaid Chalabi
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Payel Das
- UCL Institute for Environmental Design and Engineering, University College London, London, UK
| | - Benjamin Jones
- Department of Architecture and Built Environment, University of Nottingham, Nottingham, UK
| | - Clive Shrubsole
- UCL Institute for Environmental Design and Engineering, University College London, London, UK
| | - Mike Davies
- UCL Institute for Environmental Design and Engineering, University College London, London, UK
| | - Paul Wilkinson
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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18
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Chen CH, Chao HJ, Chan CC, Chen BY, Guo YL. Current asthma in schoolchildren is related to fungal spores in classrooms. Chest 2014; 146:123-134. [PMID: 24676386 DOI: 10.1378/chest.13-2129] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The presence of visible mold in households is associated with asthma. However, the role of "classroom fungus" in the development of childhood asthma, as well as the fungal species that may lead to asthma, remains controversial. This nationwide school survey was conducted to investigate the correlation between fungal spores in classrooms and asthma in schoolchildren. METHODS From April to May 2011, a cross-sectional survey was conducted to assess allergic/asthmatic conditions in schoolchildren aged 6 to 15 years old in 44 schools across Taiwan. Personal histories and current asthmatic conditions were collected using a modified International Study of Asthma and Allergies in Childhood questionnaire. Fungal spores in classroom were collected using a Burkard Personal Air Sampler and counted under light microscopy. Three-level hierarchical modeling was used to determine the complex correlation between fungal spores in classrooms and childhood asthma. RESULTS The survey was completed by 6,346 out of 7,154 parents (88.7%). The prevalences of physician-diagnosed asthma, current asthma, and asthma with symptoms reduced on holidays or weekends (ASROH) were 11.7%, 7.5%, and 3.1%, respectively. The geometric mean spore concentrations of total fungi, Aspergillus/Penicillium, and basidiospores were 2,181, 49, and 318 spores/m3. Aspergillus/Penicillium and basidiospores were significantly correlated with current asthma and ASROH after adjusting for personal and school factors. Of those with current asthma, 41% reported relief of symptoms during weekends. CONCLUSIONS Classroom Aspergillus/Penicillium and basidiospores are significantly associated with childhood asthma and ASROH. Government health policy should explore environmental interventions for the elimination of fungal spores in classrooms to reduce the prevalence of childhood asthma.
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Affiliation(s)
- Chi-Hsien Chen
- Department of Environmental and Occupational Medicineqs, National Taiwan University College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - H Jasmine Chao
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chang-Chuan Chan
- Department of Environmental and Occupational Medicineqs, National Taiwan University College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - Bing-Yu Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - Yue Leon Guo
- Department of Environmental and Occupational Medicineqs, National Taiwan University College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
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Cibella F, Ferrante G, Cuttitta G, Bucchieri S, Melis MR, La Grutta S, Viegi G. The burden of rhinitis and rhinoconjunctivitis in adolescents. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:44-50. [PMID: 25553262 PMCID: PMC4274469 DOI: 10.4168/aair.2015.7.1.44] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/11/2014] [Accepted: 04/16/2014] [Indexed: 12/18/2022]
Abstract
Purpose Rhinitis and conjunctivitis are common diseases worldwide that are frequently associated. Nevertheless, the risk factors for rhinoconjunctivitis are not well-described and the impact of conjunctivitis on rhinitis and asthma in children remains unknown. This study explored the different risk factors and evaluated the burden of rhinoconjunctivitis among adolescents. Methods This was a cross-sectional study conducted on a random sample of schoolchildren, aged 10-17 years, using skin prick tests and a self-administered questionnaire on respiratory health investigating the impact of rhinitis and rhinoconjunctivitis on daily activities. Results A complete evaluation was obtained for 2,150 children. The prevalence of rhinitis alone was 18.2% and rhinitis associated with conjunctivitis was 20.5%. Rhinoconjunctivitis was more frequently associated with females, a parental history of atopy, domestic exposure to mold/dampness, passive smoke exposure, and reported truck traffic in residential streets. Moreover, rhinoconjunctivitis was associated with a higher level of allergic sensitization. The prevalence of current asthma was 1.7% in subjects without rhinitis or rhinoconjunctivitis, 5.1% in rhinitis and 10.7% in rhinoconjunctivitis. In a logistic model, rhinoconjunctivitis yielded a 2-fold risk for current asthma with respect to rhinitis. Subjects with rhinoconjunctivitis had poorer quality of life (QoL); there was an impact on daily activities in 4.6% of rhinitis and 10.7% of rhinoconjunctivitis. Conclusions Ocular symptoms increase the role of rhinitis as a risk factor for asthma and its impact on daily activities in children.
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Affiliation(s)
- Fabio Cibella
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Giuliana Ferrante
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Giuseppina Cuttitta
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Salvatore Bucchieri
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Mario R Melis
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Stefania La Grutta
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Giovanni Viegi
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
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Chae Y, Hahm MI, Ahn K, Kim J, Kim WK, Lee SY, Park YM, Han MY, Lee KJ, Kwon HJ. Indoor environmental factors associated with wheezing illness and asthma in South Korean children: phase III of the International Study of Asthma and Allergies in Childhood. J Asthma 2014; 51:943-9. [PMID: 24986252 DOI: 10.3109/02770903.2014.930879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relationship between exposure to indoor environmental pollutants and incidence of asthma and wheezing illness in children is unclear. This study aimed to clarify this relationship by identifying the risk factors associated with these conditions in South Korean children aged 6-7 years. METHODS The parents or guardians of 3810 children aged 6-7 years who had participated in the International Study of Asthma and Allergies in Childhood and met the study criteria completed validated questionnaires regarding their children's asthma and wheezing illness, risk factors and exposure to indoor pollutants. The data were subjected to chi-square and multivariate logistic regression analysis to identify the factors significantly associated with asthma and wheezing illness. RESULTS Parental history of allergic disease (odds ratio [OR]: 1.729; 95% confidence interval [CI]: 1.447-2.066), living on the basement or semi-basement floor (OR: 1.891; 95% CI: 1.194-2.996) and living in housing that had been remodeled within the last 12 months (OR: 1.376; 95% CI: 1.101-1.720) were found to be significantly associated with wheezing illness. Parental history of allergic disease (OR: 2.189; 95% CI: 1.483-3.231), male sex (OR: 1.971; 95% CI: 1.369-2.838) and positive skin prick test (SPT) result (OR: 1.583; 95% CI: 1.804-3.698) were found to be significantly associated with current asthma. CONCLUSIONS Although the risk factors for current asthma appear to be more related to the non-modifiable risk factors like sex, parental history of allergic diseases, SPT, the two groups are associated with exposure to modifiable indoor environmental factors.
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Affiliation(s)
- Yoomi Chae
- Department of Occupational and Environmental Medicine, College of Medicine, Dankook University Hospital , Chenonan , Korea
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Cable N, Kelly Y, Bartley M, Sato Y, Sacker A. Critical role of smoking and household dampness during childhood for adult phlegm and cough: a research example from a prospective cohort study in Great Britain. BMJ Open 2014; 4:e004807. [PMID: 24747796 PMCID: PMC4010851 DOI: 10.1136/bmjopen-2014-004807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine independent associations between childhood exposures to smoking and household dampness, and phlegm and cough in adulthood. DESIGN A prospective cohort study. PARTICIPANTS 7320 of the British cohort who were born during 1 week in 1970 and had complete data for childhood and adult information. MAIN OUTCOME MEASURES Experiences of phlegm and coughing over the previous 3 months were assessed using questions from the Medical Research Council (MRC) Questionnaire on respiratory symptoms when the cohort participants were 29 years of age. 4 response patterns (no symptoms, phlegm only, cough only, both symptoms present) were created based on the responses to these questions. RESULTS Childhood smoking and exposure to marked household dampness at age 10 were associated with phlegm (childhood smoking: relative risk ratio (RRR)=1.45, 95% CI 1.02 to 2.05; dampness: RRR=2.05, 95% CI 1.07 to 3.91) and co-occurring cough and phlegm (childhood smoking: RRR=1.35. 95% CI 1.08 to 1.67; dampness: RRR=2.73, 95% CI 1.88 to 3.99), while exposure to two or more adult smokers in the household was associated with cough-related symptoms (cough only: RRR=1.28, 95% CI 1.04 to 1.58; phlegm and cough: RRR=1.32, 95% CI 1.06 to 1.64). These associations were independent from adult smoking, childhood phlegm and cough, early social background and sex. Current smoking at age 29 contributed to all symptom patterns; however, a substantial association between household dampness and co-occurring phlegm and cough suggest long-term detrimental effects of childhood environmental exposures. CONCLUSIONS Our findings give support to current public health interventions for adult smoking and raise concerns about the long-term effects of a damp home environment on the respiratory health of children.
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Affiliation(s)
- Noriko Cable
- International Centre for Life Course Studies in Society and Health (ICLS), Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Yvonne Kelly
- International Centre for Life Course Studies in Society and Health (ICLS), Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mel Bartley
- International Centre for Life Course Studies in Society and Health (ICLS), Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Yuki Sato
- Centre for Environmental Health Sciences, National Institute for Environmental Studies, Tsukuba-city, Ibaragi, Japan
| | - Amanda Sacker
- International Centre for Life Course Studies in Society and Health (ICLS), Research Department of Epidemiology and Public Health, University College London, London, UK
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Rivier A, Guillaso M, Flabbée J. Contamination fongique de l’habitat Lorrain : enquête préliminaire au domicile des patients. REVUE FRANCAISE D ALLERGOLOGIE 2014. [DOI: 10.1016/j.reval.2013.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mészáros D, Burgess J, Walters EH, Johns D, Markos J, Giles G, Hopper J, Abramson M, Dharmage SC, Matheson M. Domestic airborne pollutants and asthma and respiratory symptoms in middle age. Respirology 2014; 19:411-8. [PMID: 24517719 DOI: 10.1111/resp.12245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/28/2013] [Accepted: 12/10/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE The role of indoor air pollution as a risk factor for asthma and respiratory symptoms in middle age is unclear. We investigated associations between indoor air pollution sources and (i) asthma phenotypes and (ii) asthma-related respiratory symptoms in middle-aged adults. METHODS Subjects (n = 5729) who participated in the 2004 survey of the Tasmanian Longitudinal Health Study completed respiratory and home environment questionnaires. Associations between indoor air pollution sources, and asthma phenotypes and asthma-related respiratory symptoms were estimated. RESULTS Recent mould in the home was associated with current asthma (odds ratio (OR) 1.26; 95% confidence interval 1.06-1.50), wheeze (OR 1.34; 1.17-1.54) and nocturnal chest tightness (OR 1.30; 1.12-1.51). Stratified by atopy and gender, recent mould was associated with current non-atopic asthma only in males (OR 3.73; 1.29-10.80). More rooms affected by mould were associated with significant trends for current asthma, wheeze and nocturnal chest tightness. Home environmental tobacco smoke was associated with doctor-diagnosed asthma (OR 1.25; 1.02-1.53), wheeze (OR 1.69; 1.41-2.03), nocturnal chest tightness (OR 1.54; 1.26-1.88), with current asthma only in non-smokers (OR 2.09; 95%: 1.30-3.35) and with current asthma only in males (OR 1.74; 95%: 1.25-2.42). Among heating appliances, reverse cycle air conditioning was negatively associated with doctor-diagnosed asthma (OR 0.84; 0.70-1.00). Neither electric nor gas stove use was associated with either asthma phenotype or with asthma-related respiratory symptoms. CONCLUSIONS In middle age, reducing home exposure to mould and environmental tobacco smoke might reduce asthma and asthma-related respiratory symptoms.
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Affiliation(s)
- Desiree Mészáros
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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Yu KP, Huang YT, Yang SC. The antifungal efficacy of nano-metals supported TiO₂ and ozone on the resistant Aspergillus niger spore. JOURNAL OF HAZARDOUS MATERIALS 2013; 261:155-162. [PMID: 23921178 DOI: 10.1016/j.jhazmat.2013.07.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/26/2013] [Accepted: 07/13/2013] [Indexed: 06/02/2023]
Abstract
Recently, antimicrobial efficacy of nano-metals has been extensively investigated. However, most of the related studies focused on the bactericidal effectiveness. Molds, especially their spores, are more resistant than bacteria, and can build a high concentration in houses due to dampness. Therefore, a comprehensive evaluation of the antifungal effectiveness of nano-metals is necessary. In this study, the nano-metals (Ag, Cu and Ni) supported catalysts were successfully prepared by the incipient wetness impregnation method, while the titanium dioxide (Degussa (Evonik) P25) nanoparticle was served as the support. The antifungal experiments of Aspergillus niger spores were conducted on two surfaces (quartz and putty) in the darkness with and without ozone exposure, respectively. The critical Ag concentration to inhibit the germination and growth of A. niger spores of 5 wt% nano Ag catalyst was 65 mg/mL, lower than several cases in previous studies. The inactivation rate constants (k) of A. niger spores on nano-metals supported catalysts in the presence of ozone (k=0.475-0.966 h(-1)) were much higher than those in the absence of ozone (k=0.001-0.268 h(-1)). However, on the surface of TiO₂ particles, no antifungal effect was observed until 6-h exposure to ozone. Consequently, ozone has a synergetic effect on nano-metals antifungal efficacy.
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Affiliation(s)
- Kuo-Pin Yu
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, No. 155, Li-Nong Street, Section 2, Taipei 11221, Taiwan, ROC.
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La Grutta S, Indinnimeo L, di Coste A, Ferrante G, Landi M, Pelosi U, Rusconi F. Environmental risk factors and lung diseases in children: from guidelines to health effects. Early Hum Dev 2013; 89 Suppl 3:S59-62. [PMID: 23972292 DOI: 10.1016/j.earlhumdev.2013.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
During the last decades research all over the world has highlighted the deleterious effects of outdoor and indoor pollution on respiratory health of adults and children. The World Health Organization (WHO) "Air quality guidelines for Europe" played a fundamental role in providing information and guidance to authorities involved in the air pollution field and they are considered the key source on which the European Commission's directive on air quality is based. Children appear to be most vulnerable to the harmful effects of outdoor pollutants, which can cause both acute exacerbations, as well as chronic respiratory symptoms and diseases. Possible mechanisms include the induction of oxidative stress, and/or allergic sensitization, as well as increased susceptibility to infections. Cigarette smoke is one of the environmental pollutant influencing morbidity and death rate in childhood as responsible for adverse health effects in both prenatal and postnatal. There is growing epidemiological evidence that indoor allergen exposure may contribute to the development of allergic respiratory symptoms. In Italy the housing and social situation, with regard to the aspects related to exposure to secondhand smoke or the presence of fungal spores, moisture linked to household vapor and poor ventilation of the rooms are problems still not completely resolved. From a medical point of view the field of pediatrics has certainly made great strides in promoting the health of children and pediatricians to have a central role for pursuing this objective.
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Affiliation(s)
- Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, IBIM, National Research Council, CNR, Palermo, Italy.
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Stellman SD, Thomas PA, S Osahan S, Brackbill RM, Farfel MR. Respiratory health of 985 children exposed to the World Trade Center disaster: report on world trade center health registry wave 2 follow-up, 2007-2008. J Asthma 2013; 50:354-63. [PMID: 23414223 DOI: 10.3109/02770903.2013.776073] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The World Trade Center (WTC) disaster of September 11, 2001, has been associated with early respiratory problems including asthma in workers, residents, and children. Studies on adults have documented persistence of longer term, 9/11-related respiratory symptoms. There are no comparable reports on children. METHODS We surveyed 985 children aged 5-17 years who enrolled in the WTC Health Registry in 2003-04, and who were re-surveyed in 2007-08. Health data were provided by parents in both surveys and focused on respiratory symptoms suggestive of reactive airway impairment (wheezing or the combination of cough and shortness of breath) in the preceding 12 months. At follow-up, adolescents aged 11-17 years completed separate surveys that screened for post-traumatic stress symptoms and behavior problems (Strengths and Difficulties Questionnaire, SDQ). Associations between respiratory symptoms in the prior 12 months with 9/11 exposures and behavioral outcomes were evaluated with univariate and multivariate methods. RESULTS Of the 985 children, 142 (14.4%) children reported respiratory symptoms in the prior 12 months; 105 (73.9%) children with respiratory symptoms had previously been diagnosed with asthma. Among children aged 5-10 years, respiratory symptoms were significantly elevated among African-Americans (adjusted odds ratio, (aOR) 3.8; 95% confidence interval (CI) 1.2-11.5) and those with household income below $75,000 (aOR 1.9; CI 1.0-3.7), and was more than twice as great in children with dust cloud exposure (aOR 2.2; CI 1.2-3.9). Among adolescents aged 11-17 years, respiratory symptoms were significantly associated with household income below $75,000 (aOR 2.4; CI 1.2-4.6), and with a borderline or abnormal SDQ score (aOR 2.7, 95% CI 1.4-5.2). Symptoms were reported more than twice as often by adolescents with vs. without dust cloud exposure (24.8% vs. 11.5%) but the adjusted odds ratio was not statistically significant (aOR 1.7; CI 0.9-3.2), CONCLUSIONS Most Registry children exposed to the 9/11 disaster in New York City reported few respiratory problems. Respiratory symptoms were associated with 9/11 exposures in younger children and with behavioral difficulties in adolescents. Our findings support the need for continued surveillance of 9/11 affected children as they reach adolescence and young adulthood, and for awareness of both physical and behavioral difficulties by treating clinicians.
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Affiliation(s)
- Steven D Stellman
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Queens, NY, USA.
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Jaakkola MS, Quansah R, Hugg TT, Heikkinen SAM, Jaakkola JJK. Association of indoor dampness and molds with rhinitis risk: a systematic review and meta-analysis. J Allergy Clin Immunol 2013; 132:1099-1110.e18. [PMID: 24028857 DOI: 10.1016/j.jaci.2013.07.028] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 07/01/2013] [Accepted: 07/16/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND A substantial proportion of the world's population is exposed to indoor dampness-related exposures. Since the 1990s, studies have assessed the relation between indoor dampness and mold and rhinitis, but the evidence has been inconclusive. No previous meta-analysis has been reported on this topic. OBJECTIVE We conducted a systematic review and meta-analysis of studies on the relations between indoor dampness and mold and the risk of different types of rhinitis and investigated whether these relations differ according to the type of exposure. METHODS A systematic search of the Ovid MEDLINE and EMBASE databases was conducted (1950 through August 2012), and reference lists of relevant articles were reviewed. Cross-sectional, case-control, and cohort studies in children or adults were selected according to a priori criteria and evaluated by 3 authors independently. RESULTS Thirty-one studies on rhinitis, allergic rhinitis (AR), or rhinoconjunctivitis were included. In meta-analyses the largest risk was observed in relation to mold odor (rhinitis: 2.18 [95% CI, 1.76-2.71]; AR: 1.87 [95% CI, 0.95-3.68]). The risk related to visible mold was also consistently increased (rhinitis: 1.82 [95% CI, 1.56-2.12]; AR: 1.51 [95% CI, 1.39-1.64]; rhinoconjunctivitis: 1.66 [95% CI, 1.27-2.18]). In addition, exposure to dampness was related to increased risk of all types of rhinitis. CONCLUSION This meta-analysis provides new evidence that dampness and molds at home are determinants of rhinitis and its subcategories. The associations were strongest with mold odor, suggesting the importance of microbial causal agents. Our results provide evidence that justifies prevention and remediation of indoor dampness and mold problems, and such actions are likely to reduce rhinitis.
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Affiliation(s)
- Maritta S Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland; Respiratory Medicine Unit, Institute of Clinical Medicine, University of Oulu, Oulu, Finland; Respiratory Medicine Unit, Department of Medicine, Oulu University Hospital, Oulu, Finland.
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Wang H, Li B, Yang Q, Yu W, Wang J, Liu Y, Ou Y, Sundell J. Dampness in dwellings and its associations with asthma and allergies among children in Chongqing: A cross-sectional study. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s11434-013-5774-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schmitz R, Atzpodien K, Schlaud M. Prevalence and risk factors of atopic diseases in German children and adolescents. Pediatr Allergy Immunol 2012; 23:716-23. [PMID: 22882467 DOI: 10.1111/j.1399-3038.2012.01342.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atopic diseases became an important health problem in affluent Western societies. METHODS To study the prevalence and factors associated with the risk of atopic diseases in Germany, data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analysed (n = 17,450). Standardized, computer-assisted personal interviews with parents and parent-administered questionnaires provided physician diagnoses of allergic rhinoconjunctivitis, atopic dermatitis and asthma as well as data on demographic characteristics, migration background, birth order, age at the beginning of nursery, atopic diseases of parents, parents' smoking status, parents' occupation, breastfeeding and living environment. RESULTS The life-time prevalence of atopic dermatitis was 13.2% (95% confidence limit: 12.5-13.9%), 10.7% (10.1-11.3%) for allergic rhinoconjunctivitis and 4.7% (4.3-5.1%) for asthma. At least one atopic disease in parents was the strongest factor associated with atopic diseases in the offspring, with a prevalence ratio of up to 2.6. High and middle socio-economic status (prevalence ratio, 95% confidence limit: 1.28, 1.12-1.46; 1.15, 1.01-1.32) were associated with the risk of atopic dermatitis, whereas a two-sided background of migration reduced the risk (0.76, 0.65-0.88). Factors that reduced the risk of allergic rhinoconjunctivitis were parents working as self-employed farmers (0.48, 0.30-0.76) and older siblings (0.80, 0.71-0.89), whereas the beginning of nursery school at older age was associated with an increased risk in children who were cared for outside the family before school age (1.05, 1.00-1.10). Living in mould-infested rooms (1.64, 1.23-2.19), an urban living environment (1.20, 1.02-1.42) and a smoking mother and/or father (1.20, 1.02-1.40) were associated with the risk of asthma. CONCLUSIONS Our results are in line with the so-called 'hygiene hypothesis', which emphasizes the role of environmental factors in addition to a genetic predisposition in the development of atopic diseases. Research on factors associated with atopic diseases can facilitate decisions on preventive strategies. Further studies are needed to explore trends in prevalence and risk factors for atopic diseases.
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Affiliation(s)
- Roma Schmitz
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany.
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Moyes CD, Clayton T, Pearce N, Asher MI, Ellwood P, Mackay R, Mitchell E, Pattemore P, Stewart AW, Crane J. Time trends and risk factors for rhinoconjunctivitis in New Zealand children: an International Study of Asthma and Allergies in Childhood (ISAAC) survey. J Paediatr Child Health 2012; 48:913-20. [PMID: 22897723 DOI: 10.1111/j.1440-1754.2012.02518.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate prevalence, time trends and factors associated with rhinitis and rhinoconjunctivitis not related to acute infections in New Zealand. METHODS The International Study of Asthma and Allergies in Childhood (ISAAC) surveyed children aged 6-7 and 13-14 years for symptoms of these conditions. Five New Zealand centres were surveyed on two occasions (Phase One and Phase Three) 8-10 years apart. In Phase Three, questions were included on environmental factors, which might be associated with rhinoconjunctivitis. We report findings related to symptoms of rhinoconjunctivitis among 24 190 New Zealand children. RESULTS Symptoms of rhinoconjunctivitis in the past year were reported in 11.4% of 6- to 7-year-old children and 18% of 13- to 14-year-old adolescents in Phase Three compared with 9.5 and 19.1%, respectively, in Phase One. Severe symptoms of rhinoconjunctivitis were reported in 0.5% of children and 0.8% of adolescents. Current symptoms were more common in males at 6-7 years and in females of 13-14 years, and Māori and Pacific Island ethnic groups had higher prevalence compared with those of European descent, especially in the older age group. For immigrant children, there was a very strong positive relationship between symptoms and length of time resident in New Zealand, supporting the probable importance of environmental factors. A positive association was found between symptoms and use of paracetamol in infancy or in the last year, and weaker associations were noted for antibiotic use, exercise, and regular pasta ingestion. CONCLUSIONS Further study of environmental factors is recommended.
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Affiliation(s)
- Chris D Moyes
- Bay of Plenty District Health Board, Whakatane, New Zealand
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Haverinen-Shaughnessy U. Prevalence of dampness and mold in European housing stock. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2012; 22:461-7. [PMID: 22617720 DOI: 10.1038/jes.2012.21] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 12/22/2011] [Accepted: 02/10/2012] [Indexed: 05/22/2023]
Abstract
An assessment of the prevalence of dampness and mold in European housing stock was carried out. It is based on general indicators of dampness and mold in dwellings reported in the literature. The assessment relies on recent studies, taking into account regional and climatic differences, as well as differences in study design, methodology, and definitions. Data were available from 31 European countries. Weighted prevalence estimates are 12.1% for damp, 10.3% for mold, 10.0% for water damage, and 16.5% for a combination of any one or more indicators. Significant (up to 18%) differences were observed for dampness and mold prevalence estimates depending on survey factors, region, and climate. In conclusion, dampness and/or mold problems could be expected to occur in one of every six of the dwellings in Europe. Prevalence and occurrence of different types of problems may vary across geographical areas, which can be partly explained by differences in climate.
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Hayes D, Jhaveri MA, Mannino DM, Strawbridge H, Temprano J. The effect of mold sensitization and humidity upon allergic asthma. CLINICAL RESPIRATORY JOURNAL 2012; 7:135-44. [PMID: 22524711 DOI: 10.1111/j.1752-699x.2012.00294.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Humidity is commonly associated with increased airway hyperresponsiveness in asthma. OBJECTIVE To examine mold sensitization in patients with allergic asthma or allergic rhinitis and self-reports of humidity as exacerbating factors of clinical symptoms. METHODS A retrospective, cross-sectional study at a University hospital outpatient allergy and asthma clinic was performed. A total of 106 patients with either allergic asthma or allergic rhinitis completed standard prick-puncture skin testing with 17 allergens and controls and completed standardized forms addressing trigger factors for clinical symptoms. RESULTS Allergic asthmatics sensitized to Cladosporium were more likely to have a more severe asthma severity class (odds ratio = 4.26, confidence interval = 1.30-16.93). Sensitization to Alternaria, Cladosporium, Helminthosporium, Aspergillus and Dermatophagoides pteronyssinus in asthma was associated with higher likelihood for previous hospitalization, while sensitization to Cladosporium, Helminthosporium, Aspergillus, Dermatophagoides pteronyssinus and cockroach in asthma was associated with higher likelihood of having reduced pulmonary function based on forced expiratory volume in 1s. Furthermore, allergic asthmatics more commonly reported humidity as an exacerbating factor of symptoms than did patients only with allergic rhinitis (68.42% vs 42.86%, respectively; P < 0.05). CONCLUSION Mold sensitization is highly associated with more severe asthma, while humidity is more of an exacerbating factor in patients with allergic asthma as compared with allergic rhinitis alone. Further delineation between mold sensitization and humidity is needed to determine whether these are independent factors in asthma.
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Affiliation(s)
- Don Hayes
- Departments of Pediatrics and Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
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Hulin M, Moularat S, Kirchner S, Robine E, Mandin C, Annesi-Maesano I. Positive associations between respiratory outcomes and fungal index in rural inhabitants of a representative sample of French dwellings. Int J Hyg Environ Health 2012; 216:155-62. [PMID: 22465486 DOI: 10.1016/j.ijheh.2012.02.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 02/08/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
Our study aims at estimating exposure to molds at home, based on microbial Volatile Organic Compounds (MVOCs) assessment, and evaluating its effect on respiratory diseases in a representative sample of dwellings. In the framework of a national campaign, indoor pollution was monitored in a sample of the 24 million dwellings of metropolitan France (n=567). 727 subjects answered to a standardized questionnaire on respiratory diseases and had MVOCs sampled in their bedrooms and a fungal index (FI) defined. Among the 431 dwellings with complete data, one out of three was contaminated by molds as assessed by a positive FI: 27.0% in urban, 38.2% in periurban and 34.9% in rural dwellings respectively. Positive associations were observed between fungal index and current asthma (8.6%) and chronic bronchitis-like symptoms (8.4%), especially in rural areas (OR=2.95, 95%CI (1.10; 7.95) and 3.35, 95%CI (1.33; 8.48) respectively). Our study, based on objective assessments of fungal contamination, is in agreement with previous results suggesting mold-related respiratory effects. Moreover associations found among rural population could indicate specific pollution and impact in this environment.
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Affiliation(s)
- M Hulin
- INSERM, U 707, EPAR, Paris, France.
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Gene-gene and gene-environmental interactions of childhood asthma: a multifactor dimension reduction approach. PLoS One 2012; 7:e30694. [PMID: 22355322 PMCID: PMC3280263 DOI: 10.1371/journal.pone.0030694] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/22/2011] [Indexed: 01/24/2023] Open
Abstract
Background The importance of gene-gene and gene-environment interactions on asthma is well documented in literature, but a systematic analysis on the interaction between various genetic and environmental factors is still lacking. Methodology/Principal Findings We conducted a population-based, case-control study comprised of seventh-grade children from 14 Taiwanese communities. A total of 235 asthmatic cases and 1,310 non-asthmatic controls were selected for DNA collection and genotyping. We examined the gene-gene and gene-environment interactions between 17 single-nucleotide polymorphisms in antioxidative, inflammatory and obesity-related genes, and childhood asthma. Environmental exposures and disease status were obtained from parental questionnaires. The model-free and non-parametrical multifactor dimensionality reduction (MDR) method was used for the analysis. A three-way gene-gene interaction was elucidated between the gene coding glutathione S-transferase P (GSTP1), the gene coding interleukin-4 receptor alpha chain (IL4Ra) and the gene coding insulin induced gene 2 (INSIG2) on the risk of lifetime asthma. The testing-balanced accuracy on asthma was 57.83% with a cross-validation consistency of 10 out of 10. The interaction of preterm birth and indoor dampness had the highest training-balanced accuracy at 59.09%. Indoor dampness also interacted with many genes, including IL13, beta-2 adrenergic receptor (ADRB2), signal transducer and activator of transcription 6 (STAT6). We also used likelihood ratio tests for interaction and chi-square tests to validate our results and all tests showed statistical significance. Conclusions/Significance The results of this study suggest that GSTP1, INSIG2 and IL4Ra may influence the lifetime asthma susceptibility through gene-gene interactions in schoolchildren. Home dampness combined with each one of the genes STAT6, IL13 and ADRB2 could raise the asthma risk.
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Girardi P, Marcon A, Rava M, Pironi V, Ricci P, de Marco R. Spatial analysis of binary health indicators with local smoothing techniques The Viadana study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 414:380-386. [PMID: 22100254 DOI: 10.1016/j.scitotenv.2011.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION When pollution data from a monitoring network is not available, mapping the spatial distribution of disease can be useful to identify populations at risk and to suggest a potential role for suspected emission sources. We aimed at obtaining a continuous spatial representation of the prevalence of symptoms that are potentially associated with the exposure to the pollutants emitted from the wood factories in the children who live in the district of Viadana (Northern Italy). METHODS In 2006, all the parents of the children aged 3-14 years residing in the Viadana district (n = 3854), filled in a questionnaire on respiratory symptoms, irritation symptoms of the eyes and skin, use of health services. The children's residential addresses were also collected and geocoded. Generalized additive models and local weighted regression (LOWESS) were used to estimate the distribution of the symptoms, to test for spatial trends of the symptoms' prevalence and to control for potential confounders. Permutation tests were used to identify the areas of significantly increased risk ("hot spots"). RESULTS The prevalence of respiratory symptoms, eye symptoms and the use of health services showed a statistically significant spatial variation (p < 0.05), but skin symptoms did not. Symptoms' prevalence was lower in the northern part of the district, where no wood factories were present, and it was higher in the southern part, where the two big chipboard industries were located. Hot spots were identified fairly near to one of the two chipboard industries in the district. CONCLUSIONS The north-to-south trend in the prevalence of respiratory and eye symptoms, but not of skin symptoms, as well as the location of hot spots, are consistent with the potential exposure to air pollutants both emitted by the wood factories and related to traffic. In these "high risk areas" monitoring of pollution and preventive actions are clearly needed.
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Affiliation(s)
- Paolo Girardi
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
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Reynolds KA, Boone S, Bright KR, Gerba CP. Occurrence of household mold and efficacy of sodium hypochlorite disinfectant. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:663-669. [PMID: 23016564 DOI: 10.1080/15459624.2012.724650] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The occurrence and distribution of mold on household surfaces and the efficacy of bleach-based (sodium hypochlorite, NaOCl) disinfectants on mold viability and allergenicity was documented. Household microenvironments prone to increased moisture were specifically targeted. Using the sticky tape method, 1330 samples were collected from non-porous indoor surfaces of 160 homes across the United States, and analyzed for mold. Homes were randomly selected and recruited via phone interviews. Culture and immunoassays were used to measure the viability and reduction of allergenic properties of Aspergillus fumigatus following 2.4% NaOCl treatment. All homes and 72.9% of surfaces tested positive for mold. Windowsills were the most frequently contaminated site (87.5%) and Cladosporium the most commonly identified mold (31.0%). Five-minute exposures to 2.4% NaOCl resulted in a >3 to >6-log₁₀ reduction of culturable mold counts in controlled laboratory studies. Organisms were nonculturable after 5- and 10-min contact times on non-porous and porous ceramic carriers, respectively, and A. fumigatus spore-eluted allergen levels were reduced by an average 95.8% in 30 sec, as indicated by immunoassay. All homes are contaminated with some level of mold, and regrowth is likely in moisture-prone microenvironments. The use of low concentrations (2.4%) of NaOCl for the reduction of culturable indoor mold and related allergens is effective and recommended.
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Affiliation(s)
- Kelly A Reynolds
- Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Ave.,Tucson, AZ 85724, USA.
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Tosca MA, Ciprandi G, Silvestri M, D'Annunzio G, Lorini R, Rossi GA. T1 diabetes and allergic diseases in children: correspondence to the paper of Thomsen et al., Allergy 2011; 66: 645-647. Allergy 2011; 66:1612-3; author reply 1613-4. [PMID: 21797884 DOI: 10.1111/j.1398-9995.2011.02680.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomsen SF, Duffy DL, Kyvik KO, Skytthe A, Backer V. Type 1 diabetes and allergic diseases in children - response to Tosca et al. Allergy 2011. [DOI: 10.1111/j.1398-9995.2011.02746.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Larsson M, Hägerhed-Engman L, Moniruzzaman S, Janson S, Sundell J, Bornehag CG. Can we trust cross-sectional studies when studying the risk of moisture-related problems indoor for asthma in children? INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2011; 21:237-247. [PMID: 21745019 DOI: 10.1080/09603123.2010.533368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Most studies studying dampness as a risk factor for asthma are of a cross-sectional design. The aim of this study was to investigate if the association between moisture-related problems indoor and asthma found in cross-sectional questionnaire data can be confirmed in longitudinal analyses. The Dampness in Building and Health (DBH) study started in 2000 in Värmland, Sweden, with a baseline questionnaire to all children aged 1-5 y (n = 14,077) and five years later a follow-up questionnaire was distributed to children aged 6-8 y (n = 7,509). Moisture-related problems that were associated with asthma in cross-sectional analysis decreased or disappeared in the longitudinal analysis. However, the association between reports of moldy odor in the homes at baseline and incident asthma remained and became stronger. Our results suggest that cross-sectional data showing associations between moisture-related problems in homes and asthma in children partly can be explained by reporting bias.
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Affiliation(s)
- Malin Larsson
- Public Health Sciences, Karlstad University, Sweden.
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Moularat S, Hulin M, Robine E, Annesi-Maesano I, Caillaud D. Airborne fungal volatile organic compounds in rural and urban dwellings: detection of mould contamination in 94 homes determined by visual inspection and airborne fungal volatile organic compounds method. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 409:2005-2009. [PMID: 21439610 DOI: 10.1016/j.scitotenv.2011.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 02/03/2011] [Accepted: 02/22/2011] [Indexed: 05/30/2023]
Abstract
Moulds can both degrade the materials and structures they colonise and contribute to the appearance of symptoms and diseases in the inhabitants of contaminated dwellings. Only few data have compared the levels of contamination in urban and rural environments and the results are not consistent. The aim of this study was to use a fungal contamination index, based on the detection of specific Microbial Volatile Organic Compounds (MVOC), to determine the exposure to moulds of individuals living in urban and rural dwellings. For this purpose, 94 dwellings (47 in an urban setting in Clermont-Ferrand and 47 in rural areas of the Auvergne region, France) were studied. By demonstrating marked disparities between the proportion of visible contamination (19%) and that of active, visible and/or hidden contamination (59%) and the fact that almost all visible contamination was identified by MVOC, we were able to show that use of the index seemed relevant to confirm the actual presence of fungal contamination in a dwelling. Furthermore, it was possible to demonstrate a relationship between moulds and the presence of water on surfaces (condensation, infiltrations, water damage, etc.). A higher proportion of positive fungal contamination index in rural homes was observed compared to the proportion in urban ones (68% versus 49%; p<0.05).
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Affiliation(s)
- Stéphane Moularat
- Département Energie Santé Environnement, Division Santé, Laboratoire de Recherche et d'Innovation pour l'Hygiène des Bâtiments, 77447 Marne-la-Vallée, France.
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Jones R, Recer GM, Hwang SA, Lin S. Association between indoor mold and asthma among children in Buffalo, New York. INDOOR AIR 2011; 21:156-164. [PMID: 21204984 DOI: 10.1111/j.1600-0668.2010.00692.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Asthma is a leading chronic disease among children and places a significant burden on public health. Exposure to indoor mold has been associated with asthma symptoms. However, many mold assessments have relied on visual or other identification of damp conditions and mold presence, thus have not examined associations with specific fungal genera. The objective of this case-control study was to examine the relationship between airborne mold concentrations and asthma status among children and to identify the contribution from specific mold genera in air. Participants completed a questionnaire of home environmental conditions and underwent indoor air sampling in the home, from which viable and total-count fungal spores were quantified. The most prevalent fungi in the homes were the allergenic molds Cladosporium (98% and 87% of homes from viable and total count samples, respectively) and Penicillium (91% and 73%). There were no significant differences in mean fungal concentrations between the homes of cases and controls, although the observed rate of exposure to several molds was higher among the cases. Among children who lacked a family history of asthma, cases had significantly higher exposures to viable Aspergillus. Measured humidity levels in the home corresponded with some self-reported indicators of mold and dampness. PRACTICAL IMPLICATIONS The results of this study support existing literature that indoor fungal exposures play a role in current asthma status and that some qualitative assessments of mold exposure correspond to fungi present in indoor air.
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Affiliation(s)
- R Jones
- New York State Department of Health, Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, Troy, NY 12180, USA.
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Cibella F, Cuttitta G, La Grutta S, Melis MR, Lospalluti ML, Uasuf CG, Bucchieri S, Viegi G. Proportional Venn diagram and determinants of allergic respiratory diseases in Italian adolescents. Pediatr Allergy Immunol 2011; 22:60-8. [PMID: 20825572 DOI: 10.1111/j.1399-3038.2010.01097.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Large variations in prevalence of atopy and allergic diseases are reported worldwide in children, but in epidemiological studies the use of skin prick tests (SPT) and spirometry along with questionnaires is not common in the Mediterranean Area. The present work was aimed at evaluating the prevalence of current asthma (CA), rhinoconjunctivitis (RC), and eczema (E), with atopy and respiratory function, and the role of risk factors for allergic respiratory diseases. A total of 2150 Italian schoolchildren were cross-sectionally investigated through respiratory questionnaire, SPT, and spirometry. A proportional Venn diagram quantified the distribution of CA, RC, and E, stratifying for allergic sensitization to show differences in prevalence of allergic diseases among subjects with and without positive SPT. CA prevalence was 4.2%, RC 17.9%, and E 5.3%. CA and RC increased, while E decreased, with respect to previous local studies. Allergic sensitization prevalence (evaluated as positive response to at least one SPT) was 39.2%. A double Venn diagram identified 15 categories. Atopic CA was threefold more frequent than non-atopic CA. Atopic vs non-atopic RC and E were 9.6% vs 10.3% and 2.0% vs 3.3%, respectively. Atopic vs non-atopic RC associated with CA were 1.6% vs 0.5%; the same figures for RC associated with E were 0.8% vs 1.3%. Asymptomatic atopic subjects were 27.0%. Atopy, RC, parental asthma, and environmental risk factors were associated with CA. Atopy and environmental factors were risk factors also for RC. Asthma and traffic exposure were linked to reduced lung function. Respiratory allergic diseases are still increasing and largely concomitant in Italian adolescents. Atopy is more important for CA than RC. Avoiding exposures to measured environmental risk factors would prevent 41% of current asthma and 34% of rhinoconjunctivitis.
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Affiliation(s)
- Fabio Cibella
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare, Palermo, Italy
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Marcon A, Cazzoletti L, Rava M, Gisondi P, Pironi V, Ricci P, de Marco R. Incidence of respiratory and allergic symptoms in Italian and immigrant children. Respir Med 2010; 105:204-10. [PMID: 20934316 DOI: 10.1016/j.rmed.2010.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/24/2010] [Accepted: 09/05/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immigration usually implies a complete change of the environment where one lives. Hence, studies on immigrants may help to disentangle genetic and environmental determinants of disease. We investigated whether the incidence of allergic and respiratory symptoms differed for Italian and immigrant children living in one area of Northern Italy. METHODS In December 2006, all the children (3-14 years) living in the Viadana district were surveyed through a parental questionnaire (response rate = 99%, n = 3854). Retrospective incidences of several symptoms were compared across different ethnic groups. RESULTS Parental asthma, allergic rhinitis and eczema were less frequent in immigrant children than in Italian children. Wheezing and eczema incidences were lower in children born to foreign parents (especially if born abroad, incidence rate ratio (IRR) = 0.47, 95% CI: 0.26-0.82 and IRR = 0.43, 95% CI: 0.23-0.83, respectively), with respect to Italian children, while the occurrence of nasal allergies was similar among the ethnic groups. The greatest incidence of persistent cough/phlegm was observed in children born in Italy to foreign parents (IRR = 1.98, 95% CI: 1.06-3.71) and in children whose parents had chronic bronchitis (IRR = 2.57, 95% CI: 1.52-4.33). CONCLUSIONS Considering the distribution of parental atopic diseases and the low disease prevalence in the immigrants' countries of origin, we suggest that nasal allergies may be more sensitive than wheezing or eczema to the change in the environment related to migration. Genetic or environmental factors clustered into families seem to have a role on chronic bronchitis.
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Affiliation(s)
- Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Italy.
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Saijo Y, Nakagi Y, Ito T, Sugioka Y, Endo H, Yoshida T. Dampness, food habits, and sick building syndrome symptoms in elementary school pupils. Environ Health Prev Med 2010; 15:276-84. [PMID: 21432556 DOI: 10.1007/s12199-010-0139-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 02/26/2010] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES We investigated dampness/mold in schools and dwellings, and food habits and subjective symptoms in elementary school pupils, in order to clarify the effect of dampness and food habits on subjective symptoms in elementary school pupils. METHODS Questionnaires were used to investigate dampness in classrooms and dwellings in Hokkaido, Japan, and its effect on subjective symptoms in 1,077 pupils in 8 elementary schools. We used a dampness index for both the home and classroom; the index was the sum of the presence of four dampness indicators: (1) visible mold, (2) moldy odor, (3) water leakage, and (4) condensation on windowpanes. The questionnaire also contained queries about food habits, as follows: the frequency of eating breakfast, whether the energy provided by the school lunch was sufficient, and whether eating too many snacks and/or sweets were consumed. Adjusted logistic regression was used to determine whether dampness and food habits were related to the subjective symptoms. RESULTS In fully adjusted models, the home dampness index was significantly related to cough, general symptoms, and having at least one symptom; the classroom dampness index was significantly related to nasal symptoms. In addition, usually not eating breakfast was significantly related to eye symptoms, and too many snacks and/or sweets was significantly related to eye, nasal, and general symptoms. CONCLUSIONS Both home and classroom dampness can affect pupils' health. Home dampness, in particular, was significantly related to cough and general symptoms, and classroom dampness was significantly related to nasal symptoms. Furthermore, favorable food habits have a positive effect on pupils' subjective symptoms.
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Affiliation(s)
- Yasuaki Saijo
- Department of Health Science, Asahikawa Medical College, Midorigaoka, E2-1-1-1 Asahikawa, Hokkaido, 078-8510, Japan.
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Lombardi E, Simoni M, La Grutta S, Viegi G, Bisanti L, Chellini E, Dell'Orco V, Migliore E, Petronio MG, Pistelli R, Rusconi F, Sestini P, Forastiere F, Galassi C. Effects of pet exposure in the first year of life on respiratory and allergic symptoms in 7-yr-old children. The SIDRIA-2 study. Pediatr Allergy Immunol 2010; 21:268-76. [PMID: 20444167 DOI: 10.1111/j.1399-3038.2009.00910.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The effects of pet exposure on the development of respiratory symptoms have recently been the matter of vivid discussion. Our objective was to determine the effects of exposure to cat or dog in the first year of life on subsequent respiratory/allergic symptoms in children in a large Italian multicentre study. As part of the SIDRIA-2 Study (Studi Italiani sui Disturbi Respiratori dell'Infanzia e l'Ambiente 2002), the parents of 20016 children (median age 7 yr) provided information on indoor exposures at different times in life and respiratory/allergic symptoms through questionnaires. Logistic regression analyses were performed taking into account cat or dog exposure at different times in life and adjusting for the presence of the other pet, mould exposure, gender, age, parental education, maternal smoking during the first year of life, current passive smoking, family history of asthma/rhinitis/eczema and other potential confounders. Neither significant effects of dog exposure in the first year of life nor in other periods were found on respiratory/allergic symptoms after adjusting for the other covariates. Cat exposure in the first year of life was significantly and independently associated with current wheezing [OR (95% CI) 1.88 (1.33-2.68), p < 0.001] and current asthma [1.74 (1.10-2.78), p < 0.05] and border-line associated with current rhinoconjunctivitis [1.43 (0.97-2.11), p = 0.07]. No other effects of cat exposure were found on respiratory/allergic symptoms. Cat, but not dog, exposure in the first year of life is an independent risk factor for current wheezing, current asthma and current rhinoconjunctivitis at the age of 7.
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Affiliation(s)
- Enrico Lombardi
- Section of Respiratory Medicine, Department of Paediatrics, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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de Marco R, Marcon A, Rava M, Cazzoletti L, Pironi V, Silocchi C, Ricci P. Proximity to chipboard industries increases the risk of respiratory and irritation symptoms in children: the Viadana study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2010; 408:511-517. [PMID: 19896168 DOI: 10.1016/j.scitotenv.2009.10.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/07/2009] [Accepted: 10/08/2009] [Indexed: 05/28/2023]
Abstract
Emissions related to wood production processes are a recognized health hazard for professionally exposed subjects. The health effects of living close to wood industries are not known, particularly in the pediatric population. We aimed at investigating if living close to chipboard industries is a health hazard for the children in the Viadana district (Northern Italy). In December 2006, all the children (3-14 years) living in the Viadana district, where two big chipboard industries are located, were surveyed through a parental questionnaire (n=3854). The children were geocoded, and the distance of their houses/schools from the closest wood plant was computed. Independently of sex, age, nationality, residential area, traffic, parents' education, passive/parental smoking, questionnaire compiler and his/her environmental concern, the children living at <2 km from chipboard industries had a greater prevalence of respiratory (OR=1.33, 95%CI: 1.11, 1.60), cough/phlegm (OR=1.43, 95%CI: 1.08, 1.88), nose/throat/mouth (OR=1.47, 95%CI: 1.23, 1.75), eye (OR=1.24, 95%CI: 1.04, 1.48) symptoms, school-days lost (OR=1.24, 95%CI: 1.04, 1.48), and emergency (OR=2.14, 95%CI: 1.47, 3.11) and hospital (OR=2.21, 95%CI: 1.17, 4.18) admissions. There was an inverse dose-response relationship between the adverse health outcomes considered and the distance from the plants. The attributable fractions for the children living close to the chipboard industries were substantial, ranging from 13% (eye symptoms) to 27% (cough/phlegm). The present findings suggest that emissions from chipboard industries might have a serious impact on children's health status and should therefore be reduced and closely monitored.
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Affiliation(s)
- Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Italy.
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47
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Wilkinson P, Smith KR, Davies M, Adair H, Armstrong BG, Barrett M, Bruce N, Haines A, Hamilton I, Oreszczyn T, Ridley I, Tonne C, Chalabi Z. Public health benefits of strategies to reduce greenhouse-gas emissions: household energy. Lancet 2009; 374:1917-29. [PMID: 19942273 DOI: 10.1016/s0140-6736(09)61713-x] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Energy used in dwellings is an important target for actions to avert climate change. Properly designed and implemented, such actions could have major co-benefits for public health. To investigate, we examined the effect of hypothetical strategies to improve energy efficiency in UK housing stock and to introduce 150 million low-emission household cookstoves in India. Methods similar to those of WHO's Comparative Risk Assessment exercise were applied to assess the effect on health that changes in the indoor environment could have. For UK housing, the magnitude and even direction of the changes in health depended on details of the intervention, but interventions were generally beneficial for health. For a strategy of combined fabric, ventilation, fuel switching, and behavioural changes, we estimated 850 fewer disability-adjusted life-years (DALYs), and a saving of 0.6 megatonnes of carbon dioxide (CO(2)), per million population in 1 year (on the basis of calculations comparing the health of the 2010 population with and without the specified outcome measures). The cookstove programme in India showed substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischaemic heart disease. Calculated on a similar basis to the UK case study, the avoided burden of these outcomes was estimated to be 12 500 fewer DALYs and a saving of 0.1-0.2 megatonnes CO(2)-equivalent per million population in 1 year, mostly in short-lived greenhouse pollutants. Household energy interventions have potential for important co-benefits in pursuit of health and climate goals.
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Affiliation(s)
- Paul Wilkinson
- London School of Hygiene and Tropical Medicine, London, UK.
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48
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Impacto de un botadero a cielo abierto en el desarrollo de síntomas respiratorios y en costos familiares de atención en salud de niños entre 1 y 5 años en Cali, Colombia. BIOMEDICA 2009. [DOI: 10.7705/biomedica.v29i3.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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49
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Migliore E, Berti G, Galassi C, Pearce N, Forastiere F, Calabrese R, Armenio L, Biggeri A, Bisanti L, Bugiani M, Cadum E, Chellini E, Dell'Orco V, Giannella G, Sestini P, Corbo G, Pistelli R, Viegi G, Ciccone G. Respiratory symptoms in children living near busy roads and their relationship to vehicular traffic: results of an Italian multicenter study (SIDRIA 2). Environ Health 2009; 8:27. [PMID: 19534827 PMCID: PMC2708149 DOI: 10.1186/1476-069x-8-27] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 06/18/2009] [Indexed: 05/21/2023]
Abstract
BACKGROUND Epidemiological studies have provided evidence that exposure to vehicular traffic increases the prevalence of respiratory symptoms and may exacerbate pre-existing asthma in children. Self-reported exposure to road traffic has been questioned as a reliable measurement of exposure to air pollutants. The aim of this study was to investigate whether there were specific effects of cars and trucks traffic on current asthma symptoms (i.e. wheezing) and cough or phlegm, and to examine the validity of self-reported traffic exposure. METHODS The survey was conducted in 2002 in 12 centers in Northern, Center and Southern Italy, different in size, climate, latitude and level of urbanization. Standardized questionnaires filled in by parents were used to collect information on health outcomes and exposure to traffic among 33,632 6-7 and 13-14 years old children and adolescents. Three questions on traffic exposure were asked: the traffic in the zone of residence, the frequency of truck and of car traffic in the street of residence. The presence of a possible response bias for the self-reported traffic was evaluated using external validation (comparison with measurements of traffic flow in the city of Turin) and internal validations (matching by census block, in the cities of Turin, Milan and Rome). RESULTS Overall traffic density was weakly associated with asthma symptoms but there was a stronger association with cough or phlegm (high traffic density OR = 1.24; 95% CI: 1.04, 1.49). Car and truck traffic were independently associated with cough or phlegm. The results of the external validation did not support the existence of a reporting bias for the observed associations, for all the self-reported traffic indicators examined. The internal validations showed that the observed association between traffic density in the zone of residence and respiratory symptoms did not appear to be explained by an over reporting of traffic by parents of symptomatic subjects. CONCLUSION Children living in zones with intense traffic are at higher risk for respiratory effects. Since population characteristics are specific, the results of validation of studies on self-reported traffic exposure can not be generalized.
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Affiliation(s)
- Enrica Migliore
- Cancer Epidemiology Unit, AOU San Giovanni Battista Hospital – Center for Cancer Prevention (CPO Piedmont) and University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Giovanna Berti
- Regional Environmental Protection Agency, Piedmont Region, Via Sabaudia 164, 10095 Grugliasco (Turin), Italy
| | - Claudia Galassi
- Cancer Epidemiology Unit, AOU San Giovanni Battista Hospital – Center for Cancer Prevention (CPO Piedmont) and University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Neil Pearce
- Centre for Public Health Research, Massey University Wellington Campus, PO Box 756 Wellington 6140 NZ
- Department of Biomedical Sciences and Human Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Rome/E Local Health Authority, Via di S. Costanza 53, 00198 Rome, Italy
| | - Roberto Calabrese
- Cancer Epidemiology Unit, AOU San Giovanni Battista Hospital – Center for Cancer Prevention (CPO Piedmont) and University of Turin, Via Santena 7, 10126 Turin, Italy
- Department of Pediatrics, "Regina Margherita" Children's Hospital, University of Turin, P.zza Polonia 94, 10126 Turin, Italy
| | - Lucio Armenio
- I Pediatric Clinic, University of Bari, Piazza G. Cesare 11,70124 Bari, Italy
| | - Annibale Biggeri
- Department of Statistics, University of Florence, Viale Morgagni 59, 50134 Florence, Italy
- Unit of Biostatistics, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via San Salvi 12, 50135 Florence, Italy
| | - Luigi Bisanti
- Epidemiology Unit, Local Health Authority, Corso Italia 19, 20122 Milan, Italy
| | - Massimiliano Bugiani
- Unit of Pneumology and Allergology, Local Health Authority TO-2, Lungo Dora Savona 26, 10152 Turin, Italy
| | - Ennio Cadum
- Regional Environmental Protection Agency, Piedmont Region, Via Sabaudia 164, 10095 Grugliasco (Turin), Italy
| | - Elisabetta Chellini
- Unit of Environmental and Occupational Epidemiology, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via San Salvi 12, 50135 Florence, Italy
| | - Valerio Dell'Orco
- Department of Prevention, Rome/G Local Health Authority – Tivoli Corso Garibaldi 7, 00034 Colleferro (Rome), Italy
| | - Gabriele Giannella
- Unit of Preventive Medicine, Local Health Authority, Via Trento 6, 46100 Mantova, Italy
| | - Piersante Sestini
- Institute of Respiratory Diseases, University of Siena, Viale Bracci 3, 53100 Siena, Italy
| | - Giuseppe Corbo
- Department of Respiratory Physiology, Catholic University of Rome, Largo F.Vito 1, 00168 Rome, Italy
| | - Riccardo Pistelli
- Department of Respiratory Physiology, Catholic University of Rome, Largo F.Vito 1, 00168 Rome, Italy
| | - Giovanni Viegi
- CNR Institutes of Biomedicine and Molecular Immunology, Palermo, and of Clinical Physiology, Pisa. Via Ugo La Malfa 153, 90146 Palermo, Italy
| | - Giovannino Ciccone
- Cancer Epidemiology Unit, AOU San Giovanni Battista Hospital – Center for Cancer Prevention (CPO Piedmont) and University of Turin, Via Santena 7, 10126 Turin, Italy
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50
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Abstract
Moulds are responsible for diseases in humans through the three pathogenetic mechanisms of infection, allergy, and toxicity. Fungal infection is especially a risk factor for immunodeficient patients, but it occurs in immunocompetent patients as well. Fungal allergy is manifested as bronchial asthma, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, or allergic fungal sinusitis. Mycotoxicosis is almost exclusively the result of ingestion of mould-contaminated foodstuffs. In each case there is specificity for the etiologic mould. There is controversy regarding the ability of indoor airborne mould spores to cause human disease through non-specific toxicity via the inhalation route. Pulmonary mycotoxicosis is an established, although rare, occupational disease of farmers who inhale enormous quantities of mycotoxins, endotoxins, and other toxic chemicals from contaminated silage. Other conditions attributed to indoor airborne mycotoxin are unproven. These include infantile pulmonary hemosiderosis, epistaxis, 'toxic encephalopathy', immune dysregulation and a variety of subjective complaints without objective signs of pathology such as fatigue, headache, dyspnea, gastrointestinal distress, neuromuscular and skeletal complaints, etc. Non-specific irritation from moulds via the inhalation route is also a controversial subject that remains unproven. Published studies alleging an epidemiologic causal relationship are unconvincing.
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Affiliation(s)
- Abba I Terr
- UCSF Medical Center, San Francisco, California 94108, USA.
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