Urban air pollution and cardiovascular disease

Atmospheric pollution is not considered to be a factor of cardiovascular risk in the same way as passive smoking, arterial hypertension or coronary heredity. Passive smoking is now recognised as a factor of high cardiovascular death rate and must provoke public authorities to reinforce the measures to ban smoking in public places. With regard to other pollutants, carbon monoxide, by chronic hypoxia, has been incriminated in destabilisation of high risk patients--coronary or cardiac insufficiency. The responsibility of other polluting agents on cardiovascular death rate, NO2, SO2, or O3 has not been shown clearly, because many confusing factors intervene, especially in the matter of coronary atherosclerosis.     

Poverty and ill health: time to review the link

There is now considerable evidence to indicate that there is a relationship between poverty and morbidity/mortality. The changes in community care are not perceived by carers as having a positive impact upon their needs. The nurse is best placed to act as client advocate.     

Association between air pollution and low birth weight: a community-based study

The relationship between maternal exposure to air pollution during periods of pregnancy (entire and specific periods) and birth weight was investigated in a well-defined cohort. Between 1988 and 1991, all pregnant women living in four residential areas of Beijing were registered and followed from early pregnancy until delivery. Information on individual mothers and infants was collected. Daily air pollution data were obtained independently. The sample for analysis included 74,671 first-parity live births were gestational age 37-44 weeks. Multiple linear regression and logistic regression were used to estimate the effects of air pollution on birth weight and low birth weight (< 2,500 g), adjusting for gestational age, residence, year of birth, maternal age, and infant gender. There was a significant exposure-response relationship between maternal exposures to sulfur dioxide (SO2) and total suspended particles (TSP) during the third trimester of pregnancy and infant birth weight. The adjusted odds ratio for low birth weight was 1.11 (95% CI, 1.06-1.16) for each 100 micrograms/m3 increase in SO2 and 1.10 (95% CI, 1.05-1.14) for each 100 micrograms/m3 increase in TSP. The estimated reduction in birth weight was 7.3 g and 6.9 g for each 100 micrograms/m3 increase in SO2 and in TSP, respectively. The birth weight distribution of the high-exposure group was more skewed toward the left tail (i.e., with higher proportion of births < 2,500 g) than that of the low-exposure group. Although the effects of other unmeasured risk factors cannot be excluded with certainty, our data suggests that TSP and SO2, or a more complex pollution mixture associated with these pollutants, contribute to an excess risk of low birth weight in the Beijing population.     

Urban air pollution and emergency admissions for asthma in four European cities: the APHEA Project

BACKGROUND: A study was undertaken to assess the combined association between urban air pollution and emergency admissions for asthma during the years 1986-92 in Barcelona, Helsinki, Paris and London. METHODS: Daily counts were made of asthma admissions and visits to the emergency room in adults (age range 15-64 years) and children (< 15 years). Covariates were short term fluctuations in temperature and humidity, viral epidemics, day of the week effects, and seasonal and secular trends. Estimates from all the cities were obtained for the entire period and separately by warm or cold seasons using Poisson time-series regression models. Combined associations were estimated using meta-analysis techniques. RESULTS: Daily admissions for asthma in adults increased significantly with increasing ambient levels of nitrogen dioxide (NO2) (relative risk (RR) per 50 micrograms/m3 increase 1.029, 95% CI 1.003 to 1.055) and non-significantly with particles measured as black smoke (RR 1.021, 95% CI 0.985 to 1.059). The association between asthma admissions and ozone (O3) was heterogeneous among cities. In children, daily admissions increased significantly with sulphur dioxide (SO2) (RR 1.075, 95% CI 1.026 to 1.126) and non-significantly with black smoke (RR 1.030, 95% CI 0.979 to 1.084) and NO2, though the latter only in cold seasons (RR 1.080, 95% CI 1.025 to 1.140). No association was observed for O3. The associations between asthma admissions and NO2 in adults and SO2 in children were independent of black smoke. CONCLUSIONS: The evidence of an association between air pollution at current urban levels and emergency room visits for asthma has been extended to Europe. In addition to particles, NO2 and SO2--by themselves or as a constituent of a pollution mixture--may be important in asthma exacerbations in European cities.     

The indoor air and children''s health study: methods and incidence rates

The effect of chronic alcohol (33 mM ethanol) on Ca2+ signals elicited by glutamate receptor agonists (quisqualate and NMDA) was examined in developing cerebellar Purkinje and granule neurons in culture. The neurons were exposed to alcohol during the second week in culture, the main period of morphological and physiological development. The Ca2+ signals were measured with fura-2 based microscopic video imaging. Chronic exposure to alcohol during development significantly reduced the peak amplitude of the Ca2+ signals to quisqualate (1 microM; Quis) in both the somatic and dendritic regions of the Purkinje neurons. The dendritic region was affected to a greater extent than the somatic region. Granule neurons also showed a reduced somatic Ca2+ signal to Quis (dendrites not measured) in the alcohol-treated cultures, indicating that the effect was not limited to Purkinje neurons. In addition to the effects on in the response to Quis, the peak amplitude of the Ca2+ signals to NMDA (100 microM) was reduced by chronic alcohol exposure during development in both the cultured Purkinje and granule neurons. Resting Ca2+ levels were not consistently affected by alcohol treatment in either neuronal type. These results indicate that Ca2+ signaling linked to glutamate receptor activation is an important target of alcohol in the developing nervous system and could be a contributing factor in the altered CNS function and development observed in animal models of fetal alcohol syndrome.     

Assessment of respiratory effect of air pollution: study design on general population samples

The aim of this paper is to describe an epidemiological model to investigate the relationship between respiratory diseases and environmental air pollution. In the Po Delta prospective study, subjects were investigated before and after a large thermoelectric power plant began operating, in 1980 to 1982 and in 1988 to 1991, respectively. The Pisa prospective study was performed in 1986 to 1988 and in 1991 to 1993, before and after the construction of a new expressway that encircles the city from the North to the Southeast. In each survey, subjects completed the interviewer-administered standardized CNR questionnaire on respiratory symptoms/diseases and risk factors, and performed lung function tests. In the second survey of each study, skin prick tests, total serum IgE determination, methacholine challenge test and biomarkers (such as sister chromatide exchanges, micronuclei, chromosomal abnormalities, DNA and hemoglobin adducts) were also performed. Concentrations of total suspended particulate and SO2 in both surveys were higher in urban than in rural areas, as well as symptom/disease prevalences and bronchial reactivity. Subgroups of subjects from the two samples were enrolled to perform a specific study on the acute respiratory effects of indoor pollution; the daily presence of symptoms and measurements of peak expiratory flow (PEF), daily activity pattern, and assessment of the indoor air quality (particulates < 2.5 mu and NO2) were evaluated. Higher symptom prevalences and PEF variability level were observed in subjects with the highest levels of NO2 or particulates, especially asthmatics. In conclusion, these studies represent a basis for further analyses to better define the relationship between respiratory health and indoor/outdoor pollutant levels.     

Respiratory changes due to long-term exposure to urban levels of air pollution: a histopathologic study in humans

STUDY OBJECTIVES: To evaluate the potential associations between long-term exposure to air pollution and histopathologic evidence of damage to the lungs in humans. DESIGN: Lung tissue samples were collected during necropsies of individuals who died due to violent causes, selected on the basis of their exposure background. PATIENTS: The exposed group was composed of individuals who lived in Guarulhos, an area with high mean levels of inhalable particles. The control group was composed of individuals who lived in two cities with economies based on agricultural activities: Ribeir?o Preto and Ourinhos. Interventions: Information about cigarette smoking and occupational exposure was obtained from family members. MEASUREMENTS AND RESULTS: Morphometric evaluation of the main bronchus was conducted to determine the volume ratio of submucosal glands. Histopathologic alterations of the bronchioli were evaluated by scoring the presence of inflammatory reaction, wall thickening, and secretory hyperplasia. The number of spots of carbon deposition was counted along the regions of lymphatic drainage (visceral pleura and axial connective tissue around bronchi and blood vessels). Statistical analysis was done by means of regression models controlled for age, smoking, and occupational exposure. Lungs collected from the high pollution area presented evidence of more histopathologic damage in comparison to those from the clean environments. These effects were observed even after controlling for individual differences in age, sex, and cigarette smoking levels. CONCLUSIONS: These results suggest that long-term exposure to air pollution may contribute to the pathogenesis of airway disease, and that urban levels of air pollution have adverse effects on the respiratory tract.     

Sound pollution, noise pollution, and health: Community parameters.

Interviewed a random sample of 2,130 detroit, michigan and 496 los angeles, california families by telephone to explore urban parameters of noise and sound pollution. An adult member of the family reported the health status and sound-noise exposure of all family members. Results suggest (a) a possible association between sound exposure and increased prevalence of both acute and chronic illness; (b) the exposure of males to noise more frequently than females; (c) the interpretation of machine, plane, and traffic sounds as noise, and musical and children's sounds as sound; (d) the interpretation of sounds at work as noise and sounds at home as sound; and (e) the regular annoyance by sounds of approximately 1/4 of the women and 1/3 of the men in our society. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oxygen saturation, pulse rate, and particulate air pollution: A daily time-series panel study

Although epidemiological studies have linked particulate air pollution with cardiopulmonary mortality, underlying biological mechanisms remain largely unknown. Unexplored pathophysiological pathways include transient declines in blood oxygenation and/or changes in cardiac rhythm following particulate exposure. In this study, blood oxygen saturation using pulse oximetry (SpO2) and pulse rate were measured daily on a panel of 90 elderly subjects during the winter of 1995-1996 in Utah Valley. Associations of SpO2 and pulse rate with respirable particulate pollution (particles with an aerodynamic diameter 相似文献   

Indoor air pollutants and sick building syndrome: a case study and implications for the community health nurse

Indoor air pollutants and sick building syndrome are only recently gaining recognition as a public health concern. Unfortunately, however, most nurses feel ill equipped to address such environmental health issues. This article begins with a review of literature on indoor air pollutants and sick building syndrome, followed by a case study of occupant illness in a school since the onset of a school construction and renovation project. Included in the case study is an in-depth analysis of Material Safety Data Sheets (MSDSs) and Product Data Sheets, conducted to examine the potential health effects resulting from product use in the indoor environment. The results of the analysis indicate that a significant number of products used in the project may have induced the reported occupant symptoms. The conclusion of the case study is that building occupants were exposed to multiple products that have numerous acute overexposure health effects and unknown long-term effects, and thereby placed occupants at an ill-defined health risk. The review of literature and case study findings demonstrate the imminent need for community health nurses to assume a proactive role in promoting environmental health. nursing implications are provided to guide the community health nurse's role in cases of sick building syndrome.     

A paradigm for single-case research: The time series study of a long-term psychotherapy for depression.

Articulates a paradigm for single-case research in psychotherapy. A patient diagnosed as having major depressive disorder was seen in an intensive, twice-weekly psychodynamic psychotherapy for 2.5 years. Each session was videotaped, and assessments of patient change were obtained at regular intervals. A time-series analysis was used to model fluctuations in the therapy process to take into account time and the effect of previous events on subsequent changes, thereby preserving the context-determined meaning for therapist and patient actions. A bidirectional analysis of causal effects shows that the influence processes between therapist and patient are mutual and reciprocal and suggests that the effect of the patient on the therapist and on the process has not been made sufficiently explicit in previous models of process and change. The potential of intensive single-case designs for uncovering causal effects in psychotherapy is demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speed limitation and motorway casualties: a time series count data regression approach

The paper deals with the effect of a lowered speed limit on the number of accidents in which there are fatalities, injuries and vehicle damage on Swedish motorways. Two models extending the Poisson and negative binomial count data models are used for estimation. The extended models account for both overdispersion and potential dependence between successive counts. The inferences of the parameters depend on the assumed form of overdispersion. It is found that the speed limit reduction has decreased the number of accidents involving minor injuries and vehicle damage. Furthermore, the models allowing for serial correlation are shown to have the best ex ante forecasting performance.     

Increased plasma viscosity during an air pollution episode: a link to mortality?

BACKGROUND: Air pollution episodes have been consistently associated with increased mortality, and most strikingly with mortality due to cardiovascular disease. One hypothesis to explain this association is that inflammation of the peripheral airways caused by pollution might increase blood coagulability. We have tested this hypothesis in a cross-sectional study by comparing measurements of plasma viscosity during a severe episode of air pollution during 1985 with those made on less polluted days. METHODS: Plasma viscosity was measured as part of the MONICA Augsburg survey during the winter of 1984-85 in 3256 randomly selected men and women aged 25-64 years. Daily mean concentrations of air pollutants and meteorological variables were measured in Augsburg as part of the automated Bavarian air-quality network. We compared measurements of plasma viscosity made in 324 people who attended for screening during the pollution episode and in 2932 people screened during the remainder of the survey period. FINDINGS: In January, 1985, high concentrations of sulphur dioxide (mean 200 micrograms/m3) and total suspended particles (mean 98 micrograms/m3) were recorded during a 13-day period in Augsburg. In men, the odds ratio for plasma viscosity above the 95th percentile of the distribution (1.38 mPa s) was 3.6 (95% CI 1.6-8.1) comparing measurements during the air pollution episode with non-episode measurements after adjustment for cardiovascular risk factors and meteorological variables. The corresponding odds ratio for women (95th percentile of plasma viscosity 1.37 mPa s) was 2.3 (1.0-5.3). High concentrations of carbon monoxide were also associated with increased plasma viscosity in women. INTERPRETATION: During the 1985 air pollution episode, an increased risk of extreme values of plasma viscosity was observed in both men and women. Altered blood rheology due to inflammatory processes in the lung that induce an acute-phase reaction might therefore be part of the pathological mechanisms linking air pollution to mortality.     

Scales of geography, time, and population: the study of violence as a public health problem

OBJECTIVES: In this study, data on violent deaths in the Bronx, New York City, from the 1970, 1980, and 1990 censuses were analyzed. METHODS: The incidence and areal density of intentional deaths were mapped by health area. Simple and stepwise regressions between violent death measures and other factors were performed. RESULTS: The incidence of deaths at levels of those in the highest 1970 quintile spread so that by 1990 only 2 areas saw incidences at levels of the lowest 1970 quintile. Overcrowding, socioeconomic status, population, population change, and drug deaths in simple regressions and overcrowding, socioeconomic status, and low-weight births in stepwise regressions correlated significantly with violent death incidence or density. CONCLUSIONS: Understanding the spatiotemporal development of violence can contribute to public policy on violence.     

Cerebral hypoxia during cardiopulmonary bypass: a magnetic resonance imaging study

BACKGROUND: Neurocognitive deficits after open heart operations have been correlated to jugular venous oxygen desaturation on rewarming from hypothermic cardiopulmonary bypass (CPB). Using a porcine model, we looked for evidence of cerebral hypoxia by magnetic resonance imaging during CPB. Brain oxygenation was assessed by T2*-weighted imaging, based on the blood oxygenation level-dependent effect (decreased T2*-weighted signal intensity with increased tissue concentrations of deoxyhemoglobin). METHODS: Pigs were placed on normothermic CPB, then cooled to 28 degrees C for 2 hours of hypothermic CPB, then rewarmed to baseline temperature. T2*-weighted, imaging was undertaken before CPB, during normothermic CPB, at 30-minute intervals during hypothermic CPB, after rewarming, and then 15 minutes after death. Imaging was with a Bruker 7.0 Tesla, 40-cm bore magnetic resonance scanner with actively shielded gradient coils. Regions of interest from the magnetic resonance images were analyzed to identify parenchymal hypoxia and correlated with jugular venous oxygen saturation. Post-hoc fuzzy clustering analysis was used to examine spatially distributed regions of interest whose pixels followed similar time courses. Attention was paid to pixels showing decreased T2* signal intensity over time. RESULTS: T2* signal intensity decreased with rewarming and in five of seven experiments correlated with the decrease in jugular venous oxygen saturation. T2* imaging with fuzzy clustering analysis revealed two diffusely distributed pixel groups during CPB. One large group of pixels (50% +/- 13% of total pixel count) showed increased T2* signal intensity (well-oxygenated tissue) during hypothermia, with decreased intensity on rewarming. Changes in a second group of pixels (34% +/- 8% of total pixel count) showed a progressive decrease in T2* signal intensity, independent of temperature, suggestive of increased brain hypoxia during CPB. CONCLUSIONS: Decreased T2* signal intensity in a diffuse spatial distribution indicates that a large proportion of cerebral parenchyma is hypoxic (evidenced by an increased proportion of tissue deoxyhemoglobin) during CPB in this porcine model. Neuronal damage secondary to parenchymal hypoxia may explain the postoperative neuropsychological dysfunction after cardiac operations.     

A multifactorial study of patients with asthma. Part 2: air pollution, animal dander and asthma symptoms

As part of a multifactorial computer-assisted study of patients with asthma, the relationship between air pollution, animal dander and asthma symptoms was evaluated. No association was found between four major air pollutants (carbon monoxide, ozone, nitrogen oxides and sulfur dioxide) and asthma symptoms. Patients who owned cats and dogs reported more severe asthma symptoms (p less than .01) than patients who did not own cats and dogs. The evaluations completed to date indicate that daily exposure to cats and dogs accounts for more of the asthma symptoms differences between patients than daily exposure to air pollutants.