Impact of a cleaner‐burning cookstove intervention on blood pressure in Nicaraguan women

Few studies have evaluated the cardiovascular‐related effects of indoor biomass burning or the role of characteristics such as age and obesity status, in this relationship. We examined the impact of a cleaner‐burning cookstove intervention on blood pressure among Nicaraguan women using an open fire at baseline; we also evaluated heterogeneity of the impact by subgroups of the population. We evaluated changes in systolic and diastolic blood pressure from baseline to post‐intervention (range: 273–383 days) among 74 female cooks. We measured indoor fine particulate matter (PM_2.5; N = 25), indoor carbon monoxide (CO; N = 32), and personal CO (N = 30) concentrations. Large mean reductions in pollutant concentrations were observed for all pollutants; for example, indoor PM_2.5 was reduced 77% following the intervention. However, pollution distributions (baseline and post‐intervention) were wide and overlapping. Although substantial reductions in blood pressure were not observed among the entire population, a 5.9 mmHg reduction [95% confidence interval (CI): ?11.3, ?0.4] in systolic blood pressure was observed among women aged 40 or more years and a 4.6 mmHg reduction (95% CI: ?10.0, 0.8) was observed among obese women. Results from this study provide an indication that certain subgroups may be more likely to experience improvements in blood pressure following a cookstove intervention.     

Exposures to PM₂.₅ components and heart rate variability in taxi drivers around the Beijing 2008 Olympic Games

Background

Carbonaceous and metallic components of particles have been shown to play a role in particles' effects on cardiac autonomic function as measured by heart rate variability (HRV). Previously we reported the association of HRV with marked changes in traffic-related particulate air pollution around the Beijing 2008 Olympic Games in a panel of taxi drivers.

Objective

We further investigated the relationship between exposures to the carbonaceous and metallic components of traffic-related particles and HRV in the same population.

Methods

Repeated measurements of in-car exposures to particulate matter ≤ 2.5 μm in aerodynamic diameter (PM_2.5), carbon monoxide and nitrogen oxides were conducted in a group of 14 taxi drivers for one work shift in four study periods around the Beijing 2008 Olympics. The quantities of organic/elemental carbons and 27 elements of the in-car PM_2.5 mass were determined laboratorially. Linear mixed-effects models were used to evaluate the impact of exposures to different PM_2.5 components on HRV while controlling for potential confounders.

Results

Taxi drivers' exposures to in-car PM_2.5 and its components showed dramatic changes across the four study periods around the Beijing 2008 Olympics. Differences in associations of in-car PM_2.5 components with HRV were found. An interquartile range (IQR: 917.9 ng/m³) increase in calcium was associated with a 5.48 millisecond [ms, 95% confidence interval (CI): 0.71, 10.24] increase in standard deviations of normal-to-normal (SDNN) intervals, while an IQR (4.1 ng/m³) increase in nickel was associated with a 1.53 ms (95% CI: 0.14, 2.92) increase in SDNN index. Additionally, a decline of 8.11 ms (95% CI: − 15.26, − 0.97) in SDNN per IQR (481.4 ng/m³) increase in iron was also found.

Conclusion

The results support associations of PM_2.5 metallic components with HRV in younger healthy individuals. Future studies are needed to clarify the interaction among different PM_2.5 components or the role of PM_2.5 mixtures.     

Association of size‐fractionated indoor particulate matter and black carbon with heart rate variability in healthy elderly women in Beijing

Associations between size‐fractionated indoor particulate matter (PM) and black carbon (BC) and heart rate variability (HRV) and heart rate (HR) in elderly women remain unclear. Twenty‐nine healthy elderly women were measured for 24‐hour HRV/HR indices. Real‐time size‐fractionated indoor PM and BC were monitored on the same day and on the preceding day. Mixed‐effects models were applied to investigate the associations between pollutants and HRV/HR indices. Increases in size‐fractionated indoor PM were significantly associated with declines in power in the high‐frequency band (HF), power in the low‐frequency band (LF), and standard deviation of all NN intervals (SDNN). The largest decline in HF was 19% at 5‐minute moving average for an interquartile range (IQR) increase (24 μg/m³) in PM_0.5. The results showed that smaller particles could lead to greater reductions in HRV indices. The reported associations were modified by body mass index (BMI): Declines in HF at 5‐minute average for an IQR increase in PM_0.5 were 34.5% and 1.0% for overweight (BMI ≥25 kg/m²) and normal‐weight (BMI <25 kg/m²) participants, respectively. Moreover, negative associations between BC and HRV indices were found to be significant in overweight participants. Increases in size‐fractionated indoor PM and BC were associated with compromised cardiac autonomic function in healthy elderly women, especially overweight ones.     

Prevalence and risk factors associated with nonspecific building‐related symptoms in office employees in Japan: relationships between work environment,Indoor Air Quality,and occupational stress

A nationwide cross‐sectional study of 3335 employees was conducted in 320 offices in Japan to estimate the prevalence of building‐related symptoms (BRSs) and determine the risk factors related to work environment, Indoor Air Quality, and occupational stress. Data were collected through self‐administered questionnaires. The prevalences of general symptoms, eye irritation, and upper respiratory symptoms were 14.4%, 12.1%, and 8.9%, respectively. Multiple logistic regression analyses revealed that eye irritation was significantly associated with carpeting [odds ratio (OR), 1.73; 95% confidence interval (CI), 1.24–2.41], coldness perception (OR, 1.28; 95% CI, 1.13–1.45), and air dryness perception (OR, 1.61; 95% CI, 1.42–1.82). General symptoms were significantly associated with unpleasant odors (OR, 1.37; 95% CI, 1.13–1.65), amount of work (OR, 1.24; 95% CI, 1.06–1.45), and interpersonal conflicts (OR, 1.44; 95% CI, 1.23–1.69). Upper respiratory symptoms were significantly associated with crowded workspaces (OR, 1.36; 95% CI, 1.13–1.63), air dryness perception (OR, 2.07; 95% CI, 1.79–2.38), and reported dustiness on the floor (OR, 1.39; 95% CI, 1.16–1.67). Although psychosocial support is important to reduce and control BRSs, maintaining appropriate air‐conditioning and a clean and uncrowded workspace is of equal importance.     

Combined use of an electrostatic precipitator and a high‐efficiency particulate air filter in building ventilation systems: Effects on cardiorespiratory health indicators in healthy adults

High‐efficiency particulate air (HEPA) filtration in combination with an electrostatic precipitator (ESP) can be a cost‐effective approach to reducing indoor particulate exposure, but ESPs produce ozone. The health effect of combined ESP‐HEPA filtration has not been examined. We conducted an intervention study in 89 volunteers. At baseline, the air‐handling units of offices and residences for all subjects were comprised of coarse, ESP, and HEPA filtration. During the 5‐week long intervention, the subjects were split into 2 groups, 1 with just the ESP removed and the other with both the ESP and HEPA removed. Each subject was measured for cardiopulmonary risk indicators once at baseline, twice during the intervention, and once 2 weeks after baseline conditions were restored. Measured indoor and outdoor PM_2.5 and ozone concentrations, coupled with time‐activity data, were used to calculate exposures. Removal of HEPA filters increased 24‐hour mean PM_2.5 exposure by 38 (95% CI: 31, 45) μg/m³. Removal of ESPs decreased 24‐hour mean ozone exposure by 2.2 (2.0, 2.5) ppb. No biomarkers were significantly associated with HEPA filter removal. In contrast, ESP removal was associated with a ?16.1% (?21.5%, ?10.4%) change in plasma‐soluble P‐selectin and a ?3.0% (?5.1%, ?0.8%) change in systolic blood pressure, suggesting reduced cardiovascular risks.     

Routes of transmission of influenza A H1N1, SARS CoV,and norovirus in air cabin: Comparative analyses

Identifying the exact transmission route(s) of infectious diseases in indoor environments is a crucial step in developing effective intervention strategies. In this study, we proposed a comparative analysis approach and built a model to simulate outbreaks of 3 different in‐flight infections in a similar cabin environment, that is, influenza A H1N1, severe acute respiratory syndrome (SARS) coronavirus (CoV), and norovirus. The simulation results seemed to suggest that the close contact route was probably the most significant route (contributes 70%, 95% confidence interval [CI]: 67%‐72%) in the in‐flight transmission of influenza A H1N1 transmission; as a result, passengers within 2 rows of the index case had a significantly higher infection risk than others in the outbreak (relative risk [RR]: 13.4, 95% CI: 1.5‐121.2, P = .019). For SARS CoV, the airborne, close contact, and fomite routes contributed 21% (95% CI: 19%‐23%), 29% (95% CI: 27%‐31%), and 50% (95% CI: 48%‐53%), respectively. For norovirus, the simulation results suggested that the fomite route played the dominant role (contributes 85%, 95% CI: 83%‐87%) in most cases; as a result, passengers in aisle seats had a significantly higher infection risk than others (RR: 9.5, 95% CI: 1.2‐77.4, P = .022). This work highlighted a method for using observed outbreak data to analyze the roles of different infection transmission routes.     

Heavy incense burning in temples promotes exposure risk from airborne PMs and carcinogenic PAHs

We present the mechanistic-based exposure and risk models, appraised with reported empirical data, to assess how the human exposure to airborne particulate matters (PMs) and carcinogenic polycyclic aromatic hydrocarbons (PAHs) during heavy incense burning episodes in temples. The models integrate size-dependent PM levels inside a temple from a published exploratory study associated with a human expiratory tract (HRT) model taking into account the personal exposure levels and size distributions in the HRT. The probabilistic exposure profiles of total-PAH levels inside a temple and internal PAHs doses are characterized by a physiologically based pharmacokinetic (PBPK) model with the reconstructed dose-response relationships based on an empirical three-parameter Hill equation model, describing PAHs toxicity for DNA adducts formation and lung tumor incidence responses in human white blood cells and lung. Results show that the alveolar-interstitial (AI) region has a lower mass median diameter (0.29 microm) than that in extrathoracic (ET(1), 0.37 microm), brochial (BB, 0.36 microm) and bronchiolar (bb, 0.32 microm) regions. The 50% probability (risk=0.5) of exceeding the DNA adducts frequency (DA(f)) ratio of 1.28 (95% CI: 0.55-2.40) and 1.78 (95% CI: 0.84-2.95) for external exposure of B[a]P and B[a]P(eq), respectively. The 10% (risk=0.1) probability or more of human affected by lung tumor is approximately 7.62x10(-5)% (95% CI: 3.39x10(-5)-1.71x10(-4)%) and 3.87x10(-4)% (95% CI: 1.72x10(-4)-8.69x10(-4)%) for internal exposure of B[a]P and B[a]P(eq), respectively. Our results implicate that exposure to smoke emitted from heavy incense burning may promote lung cancer risk. Our study provides a quantitative basis for objective risk prediction of heavy incense burning exposure in temples and for evaluating the effectiveness of management.     

Indoor fine particulate matter and demographic,household, and wood stove characteristics among rural US homes heated with wood fuel

Household heating using wood stoves is common practice in many rural areas of the United States (US) and can lead to elevated concentrations of indoor fine particulate matter (PM_2.5). We collected 6-day measures of indoor PM_2.5 during the winter and evaluated household and stove-use characteristics in homes at three rural and diverse study sites. The median indoor PM_2.5 concentration across all homes was 19 µg/m³, with higher concentrations in Alaska (median = 30, minimum = 4, maximum = 200, n = 10) and Navajo Nation homes (median = 29, minimum = 3, maximum = 105, n = 23) compared with Montana homes (median = 16, minimum = 2, maximum = 139, n = 59). Households that had not cleaned the chimney within the past year had 65% higher geometric mean PM_2.5 compared to those with chimney cleaned within 6 months (95% confidence interval [CI]: −1, 170). Based on a novel wood stove grading method, homes with low-quality and medium-quality stoves had substantially higher PM_2.5 compared to homes with higher-quality stoves (186% higher [95% CI: 32, 519] and 161% higher; [95% CI:27, 434], respectively). Our findings highlight the need for, and complex nature of, regionally appropriate interventions to reduce indoor air pollution in rural wood-burning regions. Higher-quality stoves and behavioral practices such as regular chimney cleaning may help improve indoor air quality in such homes.     

衰弱对住院老年冠心病患者短期预后的影响:前瞻性队列研究

目的探讨衰弱对住院老年冠心病患者短期预后的影响。方法前瞻性收集并分析2017年12月至2018年11月在北京协和医院住院治疗的老年冠心病患者临床资料。根据是否合并衰弱,将患者分为衰弱组和非衰弱组。对两组患者随访,终点事件包括非常规就诊、主要不良心脑血管事件(major adverse cardiac and cerebral events,MACCE)、全因死亡。采用多因素Cox回归分析衰弱与冠心病患者预后的关系。绘制两组无MACCE的Kaplan-Meier生存曲线,并采用Log-Rank检验进行比较。结果共345例符合纳入和排除标准的老年冠心病患者入选本研究,包括稳定性冠心病250例,急性冠状动脉综合征95例。衰弱组74例(21.4%),其中轻度衰弱38例、中度衰弱36例,非衰弱组271例(78.6%)。中位随访时间351(300, 394)d,失访3例。与非衰弱组比较,衰弱组非常规就诊发生率(36.1%比21.5%)、全因死亡率(11.1%比4.1%)均升高(P均<0.05),MACCE发生率(9.7%比4.8%)无显著差异(P>0.05)。多因素Cox回归分析结果显示,轻度和中度衰弱是稳定性冠心病患者全因死亡的危险因素(HR=4.169,95%CI:1.055～16.474,P=0.042),对其非常规就诊(HR=1.704,95%CI:0.947～3.066,P=0.075)、MACCE(HR=1.268,95%CI:0.331～4.863,P=0.729)无显著影响。在急性冠状动脉综合征患者中,轻度和中度衰弱对其非常规就诊(HR=1.159,95%CI:0.342～3.924,P=0.812)、MACCE(HR=0.822,95%CI:0.092～7.369,P=0.861)及全因死亡(HR=1.445,95%CI:0.210～9.964,P=0.708)均无显著影响。Kaplan-Meier生存曲线显示,衰弱组和非衰弱组患者的无MACCE生存曲线无显著差异(P>0.05)。结论住院老年冠心病患者合并轻中度衰弱的比率较高,其可能增加稳定性冠心病患者近期死亡风险。     

Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold

Using a semi-quantitative mold exposure index, the National Institute for Occupational Safety and Health (NIOSH) investigated 13 college buildings to examine whether building-related respiratory symptoms among employees are associated with environmental exposure to mold and dampness in buildings. We collected data on upper and lower respiratory symptoms and their building-relatedness, and time spent in specific rooms with a self-administered questionnaires. Trained NIOSH industrial hygienists classified rooms for water stains, visible mold, mold odor, and moisture using semi-quantitative scales and then estimated individual exposure indices weighted by the time spent in specific rooms. The semi-quantitative exposure indices significantly predicted building-related respiratory symptoms, including wheeze [odds ratio (OR) = 2.3; 95% confidence interval (CI) = 1.1-4.5], chest tightness (OR = 2.2; 95% CI = 1.1-4.6), shortness of breath (OR = 2.7; 95% CI = 1.2-6.1), nasal (OR = 2.5; 95% CI = 1.3-4.7) and sinus (OR = 2.2; 95% CI = 1.2-4.1) symptoms, with exposure-response relationships. We found that conditions suggestive of indoor mold exposure at work were associated with building-related respiratory symptoms. Our findings suggest that observational semi-quantitative indices of exposure to dampness and mold can support action to prevent building-related respiratory diseases. PRACTICAL IMPLICATIONS: Current air sampling methods have major limitations in assessing exposure to mold and other biological agents that may prevent the demonstration of associations of bioaerosol exposure with health. Our study demonstrates that semi-quantitative dampness/mold exposure indices, based solely on visual and olfactory observation and weighted by time spent in specific rooms, can predict existence of excessive building-related respiratory symptoms and diseases. Relative extent of water stains, visible mold, mold odor, or moisture can be used to prioritize remediation to reduce potential risk of building-related respiratory diseases. From a public health perspective, these observational findings justify action to correct water leaks and repair water damage in order to prevent building-related respiratory diseases. This approach can also be a basis for developing practical building-diagnostic tools for water-incursion.     

Effects of environmental tobacco smoke on respiratory health of boys and girls from kindergarten: results from 15 districts of northern China

The effects of childhood environmental tobacco smoke (ETS) exposure on respiratory symptoms were investigated in 6053 kindergarten-aged children residing in 15 districts of northern China. Responses to a self-administered questionnaire completed by parents of children from 30 kindergartens were used to ascertain children with persistent cough, persistent phlegm, asthma symptom, current asthma, wheeze and wheeze without asthma. In first 2 years ETS exposure and current ETS exposure were associated with increased prevalence of persistent cough, persistent phlegm, wheeze and wheeze without asthma. Among boys, ETS exposure was associated with more respiratory symptoms and diseases than in girls. ETS exposure during pregnancy was associated with asthma symptom [odds ratio (OR), 3.00; 95% confidence interval (CI): 1.28-7.03], current asthma (OR, 3.38; 95% CI: 1.25-9.14), persistent cough (OR, 1.64; 95% CI: 1.13-2.37), persistent phlegm (OR, 1.74; 95% CI: 1.01-3.01), wheeze (OR, 1.75; 95% CI: 1.15-2.68), and wheeze without asthma (OR, 1.46; 95% CI: 1.01-2.37) only among boys. In boys, the adjusted ORs for increased risk of asthma symptom and current asthma for household exposures (> or =10 cigarettes smoked per day vs. none smoked) during workday were 2.04 (95% CI: 1.01-3.89) and 2.76 (95% CI: 1.06-9.58), respectively. We conclude that ETS exposure increases the occurrence of respiratory symptoms and diseases during childhood. Boys may be more susceptible to ETS than girls. PRACTICAL IMPLICATIONS: Environmental tobacco smoke (ETS) is a highly prevalent respiratory irritant. In agreement with previous cross-sectional studies, our study indicates that exposure to ETS may increase the occurrence of respiratory symptoms and diseases in children, and the association of ETS exposure and respiratory health of children increased in strength with number of cigarettes smoked inside the house per day during workday and day-off. Boys may be more susceptible to ETS than girls. These findings support the view that measures should be taken to reduce ETS exposure for children.     

The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China

Background

Because epidemiological studies have yielded different results, the association between exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) and acute events of cardiovascular diseases (CVD) is unknown. Additionally, no research has been conducted to explore the association between PM_2.5 and hospital emergency room (ER) visits of cardiovascular diseases in Beijing, China.

Objective

To explore the association between PM_2.5 and the hospital ER visits in Beijing, China for CVD {(International Classification of Diseases, 10th vision (ICD-10): I00~I99)}.

Methods

We collected data for daily hospital ER visits for CVD from the Peking University Third Hospital, daily ambient PM_2.5 data from a fixed monitor site at Peking University, and data on the daily level of gaseous air pollutants {sulfur dioxide (SO₂) and nitrogen dioxide (NO₂)} from the Beijing Municipal Environmental Monitoring Center between June 1, 2004 and December 31, 2006. A time-stratified case-crossover design was used to evaluate associations between CVD health outcomes and ambient air pollutants.

Results

8377 hospital ER visits of CVD were collected in our study. After adjusting the temperature and the relative humidity, the associations for 10 μg/m³ increases in levels of PM_2.5, SO₂, or NO₂ and hospital ER visits for cardiovascular diseases were statistically significant with odds ratios (ORs) of 1.005{95% confidence interval (CI): 1.001-1.009}, 1.014(95% CI: 1.004-1.024), and 1.016(95% CI: 1.003-1.029), respectively.

Conclusion

These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD in Beijing, China.     

Dust exposure and lung function of workers in the brick and clay pottery factories in the Northeast of Thailand

This study aimed to determine the particulate matter concentrations (PM10) in workplace air and personal dust, and their effects on the respiratory health of exposed workers. The lung function of 449 exposed workers was examined. The concentration of PM10 in workplace air and personal dust exposure was measured. Spirometry was used to evaluate the lung function capacity included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory volume ratio (FEV%) and peak expiratory flow rate (PEF). The forced expiratory flow at 25% to 75% of the FVC (FEF 25-75%) was determined. The PM10 concentration in workplace air (6 study sites) and personal dust (4 study sites) exceeded the standard (REL) of 0.12 mg/m3. The results of this study showed a decrease in the mean values and percent predicted value of FVC, FEV1, FEV1%, PEF and FEF 25-75%. The lung capacity of participants revealed that 24.50%, 4.45% and 7.13% had mildly, moderately restrictive and small airway disease. The respiratory symptoms were dyspnoea (22.49%), wheezing (10.69%), chest pain (10.69%) and chronic cough (2.90%). Factors influencing lung capacity included mask usage (Adj.OR: 0.44 CI: 0.25-0.79 p-value: 0.006) and chest pain (Adj.OR: 2.68 CI: 1.14-6.30 p-value: 0.024).     

Effectiveness of Portable Indoor Air Cleaners: Sensory Testing Results

The objective of this study was to test the effectiveness of individual commercially available portable indoor air cleaning units in removing dust particulates, tobacco smoke particulate and vapor phase constituents (nicotine and vinyl pyridine), viable and total fungal spores, pollen, and gaseous contaminants (carbon monoxide[CO], nitrogen dioxide[NO²], and formaldehyde[HCHO]), in a clean air test chamber. The air cleaner chamber results presented here represent initial-use results. In general, High Efficiency Particulate Air (HEPA) and electrostatic precipitator systems demonstrated the highest efficiencies with respect to particulate, contaminants, followed closely by electret filter systems. Ionizers and ozone generators were least effective in particulate removal. Systems which included sufficient sorbent material (i.e. activated carbon or potassium permanganate) were marginally effective at gaseous contaminant removal. None of the systems tested were effective at carbon monoxide removal. Sensory testing was conducted to discern potential correlation between human perceptive response and measured air cleaner performance (with respect to tobacco smoke removal). An electret filter (EF) loaded with carbon sorbent received the best ratings with respect to odor strength, nasal irritation, eye irritation, and overall air acceptability.     

The relationship between particulate air pollution and emergency hospital visits for hypertension in Beijing, China

Background

A number of epidemiological studies have examined the adverse effect of air pollution on mortality and morbidity. Also, several studies have investigated the associations between air pollution and specific-cause diseases including arrhythmia, myocardial infarction, and heart failure. However, little is known about the relationship between air pollution and the onset of hypertension.

Objective

To explore the risk effect of particulate matter air pollution on the emergency hospital visits (EHVs) for hypertension in Beijing, China.

Methods

We gathered data on daily EHVs for hypertension, fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5), particulate matter less than 10 μm in aerodynamic diameter (PM₁₀), sulfur dioxide, and nitrogen dioxide in Beijing, China during 2007. A time-stratified case-crossover design with distributed lag model was used to evaluate associations between ambient air pollutants and hypertension. Daily mean temperature and relative humidity were controlled in all models.

Results

There were 1,491 EHVs for hypertension during the study period. In single pollutant models, an increase in 10 μg/m³ in PM_2.5 and PM₁₀ was associated with EHVs for hypertension with odds ratios (overall effect of five days) of 1.084 (95% confidence interval (CI): 1.028, 1.139) and 1.060% (95% CI: 1.020, 1.101), respectively.

Conclusion

Elevated levels of ambient particulate matters are associated with an increase in EHVs for hypertension in Beijing, China.     

Exposure to household air pollution from biomass‐burning cookstoves and HbA1c and diabetic status among Honduran women

Household air pollution from biomass cookstoves is estimated to be responsible for more than two and a half million premature deaths annually, primarily in low and middle‐income countries where cardiometabolic disorders, such as Type II Diabetes, are increasing. Growing evidence supports a link between ambient air pollution and diabetes, but evidence for household air pollution is limited. This cross‐sectional study of 142 women (72 with traditional stoves and 70 with cleaner‐burning Justa stoves) in rural Honduras evaluated the association of exposure to household air pollution (stove type, 24‐hour average kitchen and personal fine particulate matter [PM_2.5] mass and black carbon) with glycated hemoglobin (HbA1c) levels and diabetic status based on HbA1c levels. The prevalence ratio (PR) per interquartile range increase in pollution concentration indicated higher prevalence of prediabetes/diabetes (vs normal HbA1c) for all pollutant measures (eg, PR per 84 μg/m³ increase in personal PM_2.5, 1.49; 95% confidence interval [CI], 1.11‐2.01). Results for HbA1c as a continuous variable were generally in the hypothesized direction. These results provide some evidence linking household air pollution with the prevalence of prediabetes/diabetes, and, if confirmed, suggest that the global public health impact of household air pollution may be broader than currently estimated.     

Ambient air pollution and daily mortality in Anshan, China: a time-stratified case-crossover analysis

Few case-crossover studies were conducted in China to investigate the acute health effects of air pollution. We conducted a time-stratified case-crossover analysis to examine the association between air pollution and daily mortality in Anshan, a heavily-polluted industrial city in northeastern China. Daily mortality, air pollution, and weather data in 2004-2006 in Anshan were collected. Time-stratified case-crossover approach was used to estimate the effect of air pollutants (PM₁₀, SO₂, NO₂ and CO) on total and cardiopulmonary mortality. Controls were selected as matched days of the week in the same month. Potential effect modifiers, such as gender and age, were also examined. We found significant associations between air pollution and daily mortality from cardiovascular diseases in Anshan. A 10 μg/m³ elevation of 2-day moving average (lag 01) concentration in PM₁₀, SO₂, NO₂ and CO corresponded to 0.67% (95% CI: 0.29%, 1.04%), 0.38% (95% CI: −0.06%, 0.83%), 2.11% (95% CI: 0.22%, 4.00%) and 0.04% (95% CI: 0.01%, 0.07%) increase of cardiovascular mortality. The associations for total and respiratory mortality were generally positive but statistically insignificant. The air pollution health effects were significantly modified by age, but not by gender. Conclusively, our study showed that short-term exposure to air pollution was associated with increased cardiovascular mortality in Anshan. These findings may have implications for local environmental and social policies.     

24小时尿钠排泄与难治性高血压患者血压达标状态的相关性:单中心横断面研究

目的分析24 h尿钠排泄与难治性高血压(resistant hypertension,RH)患者诊室血压及家庭自测血压(home blood pressure monitoring,HBPM)达标状态的关系。方法通过北京协和医院心内科门诊RH数据库,收集2017年10月至2018年3月间在北京协和医院心内科门诊就诊的RH患者临床资料,进行横断面调查。检测患者24 h尿钠,记录患者同期诊室血压、HBPM水平及临床用药情况,以所有患者24 h尿钠水平四分位数为分界点,将研究对象分为低尿钠、低-中尿钠、中-高尿钠及高尿钠4组。采用多因素Logistic回归,分析影响RH血压达标状态的危险因素。结果共202例RH患者入选本研究,男性107例,女性95例,平均年龄(59. 87±16. 30)岁。24 h尿钠平均水平为(198. 92±96. 59) mmol,年轻患者及体质量指数高者尿钠水平更高(P均<0. 001)。随尿钠升高,降压药物的服用种类显著增多(P=0. 001),早晨及上午的HBPM达标率低(P=0. 040,0. 032)。多因素Logistic回归分析显示,24 h尿钠水平与诊室血压(OR=2. 356,95%CI:1. 004～5. 533,P=0. 049),HBPM早晨血压(OR=2. 408,95%CI:1. 026～5. 650,P=0. 030)及HBPM上午血压(OR=2. 299,95%CI:1. 031～5. 129,P=0. 033)达标状态独立相关,而与下午及夜间HBPM血压达标状态无显著相关(P均>0. 05)。结论 24 h尿钠是RH患者诊室血压及HBPM早晨及上午血压达标的独立相关因素,限制钠盐摄入对减少RH患者血压波动、促进血压达标有重要作用。     

What is the relationship between indoor air quality parameters and airborne microorganisms in hospital environments? A systematic review and meta-analysis

Airborne microorganisms in hospitals have been associated with several hospital-acquired infections (HAIs), and various measures of indoor air quality (IAQ) parameters such as temperature, relative humidity, carbon dioxide (CO₂), particle mass concentration, and particle size have been linked to pathogen survival or mitigation of pathogen spread. To investigate whether there are quantitative relationships between the concentration of airborne microorganisms and the IAQ in the hospital environment. Web of Science, Scopus and PubMed databases were searched for studies reporting airborne microbial levels and any IAQ parameter(s) in hospital environments, from database inception to October 2020. Pooled effect estimates were determined via random-effects models. Seventeen of 654 studies were eligible for the meta-analysis. The concentration of airborne microbial measured as aerobic colony count (ACC) was significantly correlated with temperature (r = 0.25 [95% CI = 0.06–0.42], p = 0.01), CO₂ concentration (r = 0.53 [95% CI = 0.40–0.64], p ˂ 0.001), particle mass concentration (≤5 µg/m³; r = 0.40 [95% CI = 0.04–0.66], p = 0.03), and particle size (≤5 and ˃5 µm), (r = 0.51 [95% CI = 0.12–0.77], p = 0.01 and r = 0.55 [95% CI = 0.20–0.78], p = 0.003), respectively, while not being significantly correlated with relative humidity or particulate matter of size >5 µm. Conversely, airborne total fungi (TF) were not significantly correlated with temperature, relative humidity, or CO₂ level. However, there was a significant weak correlation between ACC and TF (r = 0.31 [95% CI = 0.07–0.52], p = 0.013). Although significant correlations exist between ACC and IAQ parameters, the relationship is not definitive; the IAQ parameters may affect the microorganisms but are not responsible for the presence of airborne microorganisms. Environmental parameters could be related to the generating source, survival, dispersion, and deposition rate of microorganisms. Future studies should record IAQ parameters and factors such as healthcare worker presence and the activities carried out such as cleaning, sanitizing, and disinfection protocols. Foot traffic would influence both the generation of microorganisms and their deposition rate onto surfaces in the hospital environment. These data would inform models to improve the understanding of the likely concentration of airborne microorganisms and provide an alternative approach for real-time monitoring of the healthcare environment.     

Fine particulate air pollution and daily mortality in Shenyang, China

Fine particulate matter (PM_2.5) is not a criteria pollutant in China, and few studies were conducted in the country to investigate the health impact of PM_2.5. In this study, we did a time-stratified case-crossover analysis to examine the association between PM_2.5 and daily mortality in Shenyang, an industrial center in northeast China. Daily mortality, air pollution and weather data from August 1, 2006 to December 31, 2008 in Shenyang were collected. A time-stratified case-crossover approach was used to estimate the association of PM_2.5 with both total and cause-specific mortality. Controls were selected as matched days of the week in the same month. Potential effect modifiers, such as age, gender, and season, were also examined. We found significant associations between PM_2.5 and daily mortality in Shenyang. A 10 μg/m³ increment in the 2-day moving average (lag 01) concentrations of PM_2.5 corresponded to 0.49% (95% CI: 0.19%, 0.79%), 0.53% (95% CI: 0.09%, 0.97%), and 0.97% (95% CI: 0.01%, 1.94%) increase of total, cardiovascular, and respiratory mortality, respectively. The associations appeared to be stronger in older people (aged ≥ 75 years), in females and during the warm season. To our knowledge, this is the longest PM_2.5 health study in time duration in China. Our findings provide new information on the adverse health effects of PM_2.5, and may have implications for environmental policy making and standard setting in China.