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.     

A Weibull-PBPK model for assessing risk of arsenic-induced skin lesions in children

Chronic arsenic exposure and skin lesions (keratosis and hyperpigmentation) are inextricably linked. This paper was to quantify the children skin lesions risks and to further recommend safe drinking water arsenic standard based on reported arsenic epidemiological data. We linked the Weibull dose-response function and a physiologically based pharmacokinetic (PBPK) model to estimate safe drinking water arsenic concentrations and to perform the risk characterization. We calculated odds ratios (ORs) to assess the relative magnitude of the effect of the arsenic exposure on the likelihood of the prevalence of children skin lesions by calculating proposed Weibull-based prevalence ratios of exposed to control groups associated with the age group-specific PBPK model predicted dimethylarsinite (MMA(III)) levels in urine. Positive relationships between arsenic exposures and cumulative prevalence ratios of skin lesions were found using Weibull dose-response model (r2=0.91-0.96). We reported that the safe drinking water arsenic standards were recommended to be 2.2 and 1 microg/L for male and 6 and 2.8 microg/L for female in 0-6 and 7-18 years age groups, respectively, based on hyperpigmentation with an excess risk of 10(-3) for a 75 years lifetime exposure. Risk predictions indicate that estimated ORs have 95% confidence intervals of 1.33-5.12, 1.74-19.15, and 2.81-19.27 based on mean drinking water arsenic contents of 283.19, 282.65, and 468.81 microg/L, respectively, in West Bengal, India, Bangladesh, and southwestern Taiwan. Our findings also suggest that increasing urinary monomethylarsonic acid (MMA) levels are associated with an increase in risks of arsenic-induced children skin lesions.     

Indoor Environmental Risk Factors for Respiratory Health in Children

Abstract The indoor environment of 80 houses in the Latrobe Valley, Victoria, Australia was assessed during six visits performed bi-monthly over a period of one year. Children between 7 and 14 years of age residing in the houses were included, resulting in 148 study children, 53 of whom were asthmatic. A respiratory health questionnaire was completed and skin prick tests performed. Significant risk factors for asthma were: exposure to a gas stove (OR=3.15, 95% CI 1.28-7.72), and indoor pets (OR = 2.68, 95% CI 1.07-6.70). Exposure to airborne Aspergillus spores (+10 CFU/m³, OR=1.51, 95% CI 1.05-2.18) was a risk factor for atopy, while exposure to a gas stove (OR=2.32, 95% CI 1.04-5.18) was a risk factor for respiratory symptoms. In conclusion, exposure to gas stoves, fungal spores and pets in the home were identified as statistically significant risk factors for respiratory health in children.     

Building dampness and mold in European homes in relation to climate,building characteristics and socio‐economic status: The European Community Respiratory Health Survey ECRHS II

We studied dampness and mold in homes in relation to climate, building characteristics and socio‐economic status (SES) across Europe, for 7127 homes in 22 centers. A subsample of 3118 homes was inspected. Multilevel analysis was applied, including age, gender, center, SES, climate, and building factors. Self‐reported water damage (10%), damp spots (21%), and mold (16%) in past year were similar as observed data (19% dampness and 14% mold). Ambient temperature was associated with self‐reported water damage (OR=1.63 per 10°C; 95% CI 1.02‐2.63), damp spots (OR=2.95; 95% CI 1.98‐4.39), and mold (OR=2.28; 95% CI 1.04‐4.67). Precipitation was associated with water damage (OR=1.12 per 100 mm; 95% CI 1.02‐1.23) and damp spots (OR=1.11; 95% CI 1.02‐1.20). Ambient relative air humidity was not associated with indoor dampness and mold. Older buildings had more dampness and mold (P<.001). Manual workers reported less water damage (OR=0.69; 95% CI 0.53‐0.89) but more mold (OR=1.27; 95% CI 1.03‐1.55) as compared to managerial/professional workers. There were correlations between reported and observed data at center level (Spearman rho 0.61 for dampness and 0.73 for mold). In conclusion, high ambient temperature and precipitation and high building age can be risk factors for dampness and mold in homes in Europe.     

Association between urinary arsenic and diabetes mellitus in the Korean general population according to KNHANES 2008

Introduction

We present data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008 on the associations between urinary arsenic and diabetes mellitus in a representative sample of the adult Korean population.

Methods

This study was based on data obtained in KNHANES 2008, which was conducted for three years (2007-2009) using a rolling sampling design involving a complex, stratified, multistage, probability-cluster survey of a representative sample of the noninstitutionalized civilian population of South Korea.

Results

Geometric means of total urinary arsenic concentration in females and total participants with diabetes mellitus were significantly higher than in participants without diabetes mellitus after adjustment for covariates, including age, seafood consumption, body mass index (BMI), hypertension, area of residence, regional area, education level, and smoking and drinking status. Multiple regression analysis after similar adjustment showed that total urinary arsenic concentration was associated with diabetes status in the females and total participants. In addition, after similar adjustment, the odds ratios (ORs) for diabetes mellitus in female participants and all participants were 1.502 (95% CI, 1.038-2.171) and 1.312 (95% CI, 1.040-1.655), respectively, for doubling of the level of urinary total arsenic concentration.

Conclusion

This study showed an association between total urinary arsenic concentration and the prevalence of diabetes mellitus in a representative sample of the adult population, especially women, with environmental arsenic exposure after adjustment for seafood intake and relevant diabetes risk factors.     

输注血液制品与心脏术后结局相关性的系统分析

目的　系统评价心脏围术期输血与术后近远期结局的关系。方法　检索中英文文献数据库中1990年1月至2014年12月关于输血和心脏术后结局关系的回顾性病例对照研究，使用RevMan 5.3软件，应用Meta分析方法对所纳入文献的研究结果进行定量综合分析。结果　本研究共纳入13项回顾性病例对照临床研究，总样本量88 808例，其中输血组42 991例，未输血组45 817例。输血组和未输血组的各心脏术后结局指标差异均有统计学意义：30 d死亡率（OR=2.39，95% CI：1.71~3.34，P＜0.000 01），1年死亡率（OR=3.08，95% CI：2.18~4.35，P＜0.000 01），5年死亡率（OR=1.90，95% CI：1.42~2.56，P＜0.0001），缺血事件（OR=2.23，95% CI：1.71~2.90，P＜0.000 01)，感染（OR=2.18，95% CI：1.74~2.75，P＜0.000 01）。结论　围术期输血与心脏手术后近远期死亡率和缺血事件、感染的发生具有明显相关性。     

Indoor air pollution and self-reported diseases - a case study of NCT of Delhi

People in modern societies often spend 80-90% of their time in indoor environments. It is, therefore, imperative to analyze indoor air quality (IAQ) and its determinants and to consider the contribution of IAQ to possible health outcomes at the household level. Based on empirical data collected from 5949 households from 35 wards of Delhi, it can be summarized that higher proportions of residents live in degraded indoor environmental conditions. The highest risks to health were attached to use of traditional fuels (64%), lack of a kitchen (59%), exposure to environmental tobacco smoke (ETS) (55%), and poor ventilation (55%). Acute respiratory infections (43%) were identified as one of the most prevalent health problems confronted by residents and are strongly associated with use of traditional fuels (adjusted OR 2.7, 95% CI 2.3-3.1). Asthma shows a significant relationship with the use of traditional fuels (adjusted OR 3.8, 95% CI 3.4-4.3), exposure to ETS (adjusted OR 2.5, 95% CI 2.2-2.7), and poor ventilation (adjusted OR 1.26, 95% CI 1.13-1.41). Lung cancer (adjusted OR 1.54, 95% CI 1.38-1.71) and cardiovascular diseases (adjusted OR 2.25, 95% CI 2.01-2.53) also show a strong relationship with ETS exposure. More research is needed. PRACTICAL IMPLICATIONS: The present study can help to create new insights in understanding the gravity of indoor air quality problems in Delhi and can therefore provide interesting material to social scientists, public health officers, planners, and decision makers. The information can be utilized to help formulate comprehensive policies and planning with a humanistic approach for proper urban indoor environments that will be applicable at all administrative levels, viz. local, national, and international, and will also provide an important background for additional research in this area.     

Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building

We investigated the associations of fungal and endotoxin levels in office dust with respiratory health in 888 (67% participation) occupants of a water-damaged building. We analyzed floor and chair dusts from 338 workstations for culturable fungi and endotoxin. Based on averages, we ranked each floor of the building as low, medium, or high for occupants' exposure to each of these agents. Multivariate logistic regression models for building-related symptoms included this ranking of fungi and endotoxin, age, gender, race, smoking status, and duration of occupancy. Using floor dust measures, we found significantly increased odds for lower respiratory symptoms [wheeze, chest tightness, attacks of shortness of breath, and attacks of cough: odds ratios (OR) = 1.7 (95% confidence interval (CI): 1.02-2.77) to 2.4 (95% CI: 1.29-4.59)], throat irritation [OR = 1.7, (95% CI: 1.06-2.82)], and rash/itchy skin [OR = 3.0, (95% CI: 1.47-6.19)] in the highest fungal exposure group compared to the lowest, with generally linear exposure-response relationships. Nonlinear relationships were observed for many of these symptoms and endotoxin in floor dust. Interaction models showed that endotoxin modified effects of fungi on respiratory symptoms. Our findings of exposure interactions and exposure-response relationships of fungal and endotoxin with increased risk of building-related symptoms contribute to an understanding of the role of microbial agents in building-related asthma and respiratory and systemic symptoms. PRACTICAL IMPLICATIONS: Our demonstration of exposure-response relationships between measurements of fungi and/or endotoxin in floor dusts and building-related symptoms implies that microbial agents in floor dust may be a good surrogate measure for dampness-related bioaerosol exposure, considering that measurements of microbial agents in air often fail to demonstrate the associations between exposure and health. In addition, our finding that endotoxin exposure may change the effect of fungal exposure (and vice versa) on respiratory heath suggests that exposure to both fungi and endotoxin should be assessed in epidemiological investigations examining the effect of fungal or endotoxin exposure on respiratory health in indoor environments.     

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.     

Motor alterations associated with exposure to manganese in the environment in Mexico

Overexposure to manganese (Mn) causes neurotoxicity (a Parkinson-like syndrome) or psychiatric damage ("manganese madness"). Several studies have shown alterations to motor and neural behavior associated with exposure to Mn in the workplace. However, there are few studies on the effects of environmental exposure of whole populations. We studied the risk of motor alterations in people living in a mining district in Mexico. We studied 288 individual people (168 women and 120 men) from eight communities at various distances from manganese extraction or processing facilities in the district of Molango. We measured manganese concentrations in airborne particles, water, soil and crops and evaluated the possible routes of Mn exposure. We also took samples of people's blood and determined their concentrations of Mn and lead (Pb). We used "Esquema de Diagnóstico Neuropsicológico" Ardila and Ostrosky-Solís's neuropsychological battery to evaluate motor functions. Concentrations of Mn in drinking water and maize grain were less than detection limits at most sampling sites. Manganese extractable by DTPA in soils ranged between 6 and 280 mg kg(-1) and means were largest close to Mn extraction or processing facilities. Air Mn concentration ranged between 0.003 and 5.86 microg/m(3); the mean value was 0.42 microg/m(3) and median was 0.10 microg/m(3), the average value (geometric mean) resulted to be 0.13 microg/m(3). Mean blood manganese concentration was 10.16 microg/l, and geometric mean 9.44 microg/l, ranged between 5.0 and 31.0 mcrog/l. We found no association between concentrations of Mn in blood and motor tests. There was a statistically significant association between Mn concentrations in air and motor tests that assessed the coordination of two movements (OR 3.69; 95% CI 0.9, 15.13) and position changes in hand movements (OR 3.09; CI 95% 1.07, 8.92). An association with tests evaluating conflictive reactions (task that explores verbal regulations of movements) was also found (OR 2.30; CI 95% 1.00, 5.28). It seems from our results that people living close to the manganese mines and processing plants suffer from an incipient motor deficit, as a result of their inhaling manganese-rich dust.     

Urinary arsenic methylation capability and carotid atherosclerosis risk in subjects living in arsenicosis-hyperendemic areas in southwestern Taiwan

Long-term exposure to inorganic arsenic from artesian drinking well water is associated with carotid atherosclerosis in the Blackfoot Disease (BFD)-hyperendemic area in Taiwan. The current study examined the arsenic methylation capacity and its risk on carotid atherosclerosis. A total of 304 adults (158 men and 146 women) residing in the BFD-hyperendemic area were included. The extent of carotid atherosclerosis was assessed by duplex ultrasonography. Chronic arsenic exposure was estimated by an index of cumulative arsenic exposure (CAE) and the duration of artesian well water consumption. Urinary levels of inorganic arsenite [As(III)], arsenate [As(V)], monomethylarsonic acid [MMA(V)] and dimethylarsinic acid [DMA(V)] were determined by high performance liquid chromatography linked on-line to a hydride generator and atomic absorption spectrometry (HPLC-HG-AAS). The percentage of arsenic species, primary methylation index [PMI = MMA(V) / (As(III) + As(V)] and secondary methylation index [SMI = DMA(V) / MMA(V)] were calculated and employed as indicators of arsenic methylation capacity. Results showed that women and younger subjects had a more efficient arsenic methylation capacity than did men and the elderly. Carotid atherosclerosis cases had a significantly greater percentage of MMA(V) [%MMA(V)] and a lower percentage of DMA [%DMA (V)] compared to controls. Subjects in the highest two tertiles of PMI with a median of CAE > 0 mg/L-year had an odds ratio (OR) and a 95% confidence interval (CI) of carotid atherosclerosis of 2.61 and 0.98-6.90 compared to those in the highest two tertiles of PMI with a CAE = 0 mg/L-year. We conclude that individuals with greater exposure to arsenic and lower capacity to methylate inorganic arsenic may be at a higher risk to carotid atherosclerosis.     

Lung cancer risks among lead smelter workers also exposed to arsenic.

Recent publications indicate an increased incidence of lung cancer in non-ferrous smelter workers exposed to lead. The present study provides further data on selected subgroups in one such cohort. The cohort was based on 3979 smelter workers employed for at least 1 year between 1928 and 1979, and also exposed to lead and included in the Blood Lead Register that was started at the smelter in 1950. Two subcohorts were formed from the original cohort. One consists of 710 workers employed at the lead departments (Lead subcohort 1), and the other of 383 workers employed at the lead departments (Lead subcohort 2), but never at other works where an excess lung cancer risk was previously identified. Standardized Cancer Incidence Rates (SIR) 1958-1987 were calculated relative to county rates. In the subcohorts, arsenic exposure in lung cancer cases was assessed in detail based on occupational hygiene information from the company. Lung cancer incidence was raised in both subcohorts (Lead subcohort 1: SIR 2.4; 95% CI 1.2-4.5; Lead subcohort 2: SIR 3.6; 95% CI 1.2-8.3). Total cancer incidence in the cohorts was not increased. A detailed study of arsenic exposure in the 10 lung cancer cases in these two subcohorts revealed that all but one of these cases had a significant exposure also to arsenic. An elevated incidence of lung cancer was observed in smelter workers exposed to lead. However, considerable arsenic exposure also occurred in a majority of the lung cancer cases in the investigated subcohorts. In this multifactorial exposure situation it has not been possible to separate the carcinogenic effects of lead and arsenic, but a possible interaction between these metals may be involved in explaining the carcinogenic risks.     

Variability of total exposure to PM2.5 related to indoor and outdoor pollution sources Krakow study in pregnant women

The study is a part of an ongoing prospective cohort study on the relationship between the exposure to environmental factors during pregnancy and birth outcomes and health of newborns. We have measured personal PM(2.5) level in the group of 407 non-smoking pregnant women during the 2nd trimester of pregnancy. On average, the participants from the city center were exposed to higher exposure than those from the outer city area (GM=42.0 microg/m(3), 95% CI: 36.8-48.0 vs. 35.8 microg/m(3), 95% CI: 33.5-38.2 microg/m(3)). More than 20% of study subjects were affected by high level of PM(2.5) pollution (above 65 microg/m(3)). PM(2.5) concentrations were higher during the heating season (GM=43.4 microg/m(3), 95% CI: 40.1-46.9 microg/m(3)) compared to non-heating season (GM=29.8 microg/m(3), 95% CI: 27.5-32.2 microg/m(3)). Out of all potential outdoor air pollution sources (high traffic density, bus depot, waste incinerator, industry etc.) considered in the bivariate analysis, only the proximity of industrial plant showed significant impact on the personal exposure (GM=54.3 microg/m(3), 95% CI: 39.4-74.8 microg/m(3)) compared with corresponding figure for those who did not declare living near the industrial premises (GM=36.2 microg/m(3), 95% CI: 34.1-38.4 microg/m(3)). The subjects declaring high exposure to ETS (>10 cigarettes daily) have shown very high level of personal exposure (GM=88.8 microg/m(3), 95% CI: 73.9-106.7 microg/m(3)) compared with lower ETS exposure (< or =10 cigarettes) (GM=46.3 microg/m(3), 95% CI: 40.0-53.5 microg/m(3)) and no-ETS exposure group (GM=33.9 microg/m(3), 95% CI: 31.8-36.1 microg/m(3)). The contribution of the background ambient PM(10) level was very strong determinant of the total personal exposure to PM(2.5) and it explained about 31% of variance between the subjects followed by environmental tobacco smoke (10%), home heating by coal/wood stoves (2%), other types of heating (2%) and the industrial plant localization in the proximity of household (1%).     

Arsenic groundwater contamination and its health effects in the state of Uttar Pradesh (UP) in upper and middle Ganga plain, India: a severe danger

This communication presents results of our 2-year survey on groundwater arsenic contamination in three districts Ballia, Varanasi and Gazipur of Uttar Pradesh (UP) in the upper and middle Ganga plain, India. Analyses of 4,780 tubewell water samples revealed that arsenic concentrations in 46.5% exceeded 10 microg/L, in 26.7%, 50 microg/L and in 10% 300 microg/L limits. Arsenic concentrations up to 3,192 microg//L were observed. The age of tubewells (n=1,881) ranged from less than a year to 32 years, with an average of 6.5 years. Our study shows that older tubewells had a greater chance of contamination. Depth of tubewells (n=3,810) varied from 6 to 60.5 m with a mean of 25.75 m. A detailed study in three administrative units within Ballia district, i.e. block, Gram Panchayet, and village was carried out to assess the magnitude of the contamination. Before our survey the affected villagers were not aware that they were suffering from arsenical toxicity through contaminated drinking water. A preliminary clinical examination in 11 affected villages (10 from Ballia and 1 from Gazipur district) revealed typical arsenical skin lesions ranging from melanosis, keratosis to Bowens (suspected). Out of 989 villagers (691 adults, and 298 children) screened, 137 (19.8%) of the adults and 17 (5.7%) of the children were diagnosed to have typical arsenical skin lesions. Arsenical neuropathy and adverse obstetric outcome were also observed, indicating severity of exposure. The range of arsenic concentrations in hair, nail and urine was 137-10,900, 764-19,700 microg/kg, and 23-4,030 microg/L, respectively. The urine, hair and nail concentrations of arsenic correlated significantly (r=0.76, 0.61, and 0.55, respectively) with drinking water arsenic concentrations. The similarity to previous studies on arsenic contamination in West Bengal, Bihar and Bangladesh indicates that people from a significant part of the surveyed areas in UP are suffering and this will spread unless drives to raise awareness of arsenic toxicity are undertaken and an arsenic safe water supply is immediately introduced.     

A case-control study of childhood leukemia in Woburn,Massachusetts: the relationship between leukemia incidence and exposure to public drinking water

A 1981 Massachusetts Department of Public Health study confirmed a childhood leukemia cluster in Woburn, Massachusetts. Our follow-up investigation attempts to identify factors potentially responsible for the cluster. Woburn has a 130-year industrial history that resulted in significant local deposition of tannery and chemical manufacturing waste. In 1979, two of the city's eight municipal drinking water wells were closed when tests identified contamination with solvents including trichloroethylene. By 1986, 21 childhood leukemia cases had been observed (5.52 expected during the seventeen year period) and the case-control investigation discussed herein was begun. Nineteen cases and 37 matched controls comprised the study population. A water distribution model provided contaminated public water exposure estimates for subject residences. Results identified a non-significant association between potential for exposure to contaminated water during maternal pregnancy and leukemia diagnosis, (odds ratio = 8.33, 95% CI 0.73-94.67). However, a significant dose-response relationship (P < 0.05) was identified for this exposure period. In contrast, the child's potential for exposure from birth to diagnosis showed no association with leukemia risk. Wide confidence intervals suggest cautious interpretation of association magnitudes. Since 1986, expected incidence has been observed in Woburn including 8 consecutive years with no new childhood leukemia diagnoses.     

Current wheeze,asthma, respiratory infections,and rhinitis among adults in relation to inspection data and indoor measurements in single‐family houses in Sweden—The BETSI study

In the Swedish Building Energy, Technical Status and Indoor environment study, a total of 1160 adults from 605 single‐family houses answered a questionnaire on respiratory health. Building inspectors investigated the homes and measured temperature, air humidity, air exchange rate, and wood moisture content (in attic and crawl space). Moisture load was calculated as the difference between indoor and outdoor absolute humidity. Totally, 7.3% were smokers, 8.7% had doctor’ diagnosed asthma, 11.2% current wheeze, and 9.5% current asthma symptoms. Totally, 50.3% had respiratory infections and 26.0% rhinitis. The mean air exchange rate was 0.36/h, and the mean moisture load 1.70 g/m³. Damp foundation (OR=1.79, 95% CI 1.16‐2.78) was positively associated while floor constructions with crawl space (OR=0.49, 95% CI 0.29‐0.84) was negatively associated with wheeze. Concrete slabs with overlying insulation (OR=2.21, 95% CI 1.24‐3.92) and brick façade (OR=1.71, 95% CI 1.07‐2.73) were associated with rhinitis. Moisture load was associated with respiratory infections (OR=1.21 per 1 g/m³, 95% CI 1.04‐1.40) and rhinitis (OR=1.36 per 1 g/m³, 95% CI 1.02‐1.83). Air exchange rate was associated with current asthma symptoms (OR=0.85 per 0.1/h, 95% CI 0.73‐0.99). Living in homes with damp foundation, concrete slabs with overlying insulation, brick façade, low ventilation flow, and high moisture load are risk factors for asthma, rhinitis, and respiratory infections.     

Association of air-conditioning with respiratory symptoms in office workers in tropical climate

To evaluate the association of heating, ventilation and air-conditioning systems (HVAC) and respiratory symptoms in a tropical city, self-administered questionnaires were given to 2000 individuals working in air-conditioned office buildings and to 500 control workers in naturally ventilated buildings. Reported symptoms from the two populations were analyzed using chi-square tests, univariate and multiple logistic regressions models. Symptoms were the outcome variable and the odds ratios were adjusted by gender, age, accumulated work time, smoking habits and atopic background. There was a 79.8% response rate and there was a positive association of nasal symptoms (odds ratio, OR = 1.59, 95% confidence interval, CI = 1.11-2.28), naso-ocular symptoms (OR = 1.58, 95% CI = 1.05-2.38), persistent cough (OR = 3.04, 95% CI = 2.00-4.63) sinusitis symptoms (OR = 1.85, 95% CI = 1.27-2.71) and building-related worsening of the symptoms (OR = 4.92, 95% CI = 2.93-8.27) with working in air-conditioned buildings. In conclusion, our study suggests that artificial air-conditioning is a matter of concern for respiratory symptoms in cities with hot and humid climate. PRACTICAL IMPLICATIONS: This study suggests that indoor air-related respiratory symptoms are a matter of concern in places with hot and humid climate. The regression models were adjusted by confounders that could be used in further reanalysis of indoor air quality related symptoms and ventilation systems with expanded variety of climatic conditions.     

Risk factors associated with bedbug (Cimex spp.) infestations among Hong Kong households: a cross-sectional study

To investigate the risk factors associated with bedbug infestations among Hong Kong households, self-reported questionnaires in Chinese were distributed online between June 2019 and July 2020. The questionnaire collected data on participants’ sociodemographics, history of bedbug infestation, and housing situation. Among the 663 participants who completed the questionnaire, 422 (63.7%) have experienced bedbug infestations in the past year, they were concentrated around the Kowloon region. Weighted bivariate and multivariate binary logistic regression were performed to identify the statistically significant (p value?<?0.05) factors associated with bedbug infestations. Bivariate analysis shows a positive correlation between the number of reported dilapidated housing features and bedbug infestation. For multivariate analysis, those aged 45–64 (OR?=?2.53, 95% CI 1.30–4.91), have primary education or below (OR?=?9.43, 95% CI 3.12–28.44), and monthly household income?≤?HKD30,000 (OR?=?1.69, 95% CI 1.15–2.5) were more likely to have bedbug infestation compared to their respective reference groups, i.e.,?≥?65, tertiary education, and?>?HKD30,000; housing risk factors identified are living in subdivided flats (OR?=?16.53, 95% CI 1.01–269.72), crowded household (OR?=?1.55, 95% CI 1.06–2.28), having second-hand furniture (OR?=?2.97, 95% CI 1.16–7.58), housing cleanliness issues (OR?=?2.66, 95% CI 1.13–6.25), and presence of bedbugs in neighbouring residential units (OR?=?3.32, 95% CI 1.57–7.04) or on the streets (OR?=?1.9, 95% CI 1.12–3.23). This study has identified lower income, lower education level, crowded household, living in subdivided flats, and certain dilapidated housing features to be risk factors of bedbug infestations; efforts and policies should prioritise vulnerable groups and focus on addressing the housing risk factors identified in this study.

     

Arsenic-contaminated cold-spring water in mountainous areas of Hui County, Northwest China: a new source of arsenic exposure

Although pump-well is the primary drinking water source in rural areas of China, there are still 8.4% of villages reliant on cold-spring. In this study, a survey of arsenic concentration in cold-springs and pump-wells was carried out in Hui County, Northwest China. A total of 352 drinking water samples, including 177 cold-springs and 175 pump-wells, were collected. The maximum arsenic concentrations in cold-springs and pump-wells were 0.482 mg/L and 0.067 mg/L, respectively. We found that 15.8% (28) of total cold-springs and 1.1% (2) of total pump-wells had arsenic concentrations exceeding the maximum allowable concentration of arsenic in drinking water of rural China (0.05 mg/L). Our findings show that 5 cold spring-contaminated villages are located in the mountainous areas of Hui County and 2224 inhabitants may be at risk of high arsenic exposure. This paper indicates that arsenic contamination of cold-springs may be more serious than expected in mountainous areas of Northwest China and extensive surveys and epidemiological studies should be carried out to investigate the potential contaminated areas and affected population.     

Pre‐ and postnatal exposure to tobacco smoke and respiratory outcomes during the first year

The different role of prenatal and postnatal exposure to tobacco smoke in respiratory outcomes in infants has not yet been clearly established. Our objective is to assess the effects of these exposures on the risk of respiratory outcomes during the first year of life of infants from a Spanish multicenter cohort study. A total of 2506 women were monitored until delivery. About 2039 infants made up the final population. The outcomes were caused by the occurrence of the following: otitis, cough persisting for more than 3 weeks, lower respiratory tract symptoms (wheezing or chestiness), and lower respiratory tract infections (bronchitis, bronchiolitis, or pneumonia). The relationship between prenatal and postnatal exposure and health outcomes was explored using logistic regression analysis. Maternal smoking during pregnancy increased the odds for wheezing (OR: 1.41, 95% CI: 0.99–2.01) and chestiness (OR: 1.46, 95% CI: 1.03–2.01). Postnatal exposure from fathers was associated with otitis (OR: 1.25, 95% CI: 1.01–1.54). Passive exposure at work of non‐smoking mothers during pregnancy was related to cough (OR: 1.62, 95% CI: 1.05–2.51). Exposure to tobacco smoke was related to a higher risk of experiencing respiratory outcomes in young infants. Prenatal exposure was that most clearly associated with the respiratory outcomes analyzed.