Air pollution and emergency room visits due to chronic lower respiratory diseases in the elderly: an ecological time-series study in São Paulo, Brazil

Self-reported prevalence of asthma symptoms in adults living in a port city

Air pollution is a worldwide health problem, and exposure to the pollution can cause damage to the human body, especially to the respiratory and cardiovascular systems. Asthma is the third most common chronic disease in Brazil, presenting high prevalence in some areas. The aim of this study was to evaluate the self-report the prevalence of asthma symptoms in Santos city, Brazil, and its associated factors in the adult population (between 18 and 59 years old). A cross-sectional study was applied in two different areas of the city. The participants of this study were selected by zip code estimated on a random sample. The ECHRS and a demographic questionnaire were used to collect data. Associations between categorical variables were tested using Pearson's chi-square test or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for asthma. Georeferencing was implemented to distribute the cases. The highest prevalence of asthma was found in Ponta da Praia neighborhood (16.4%; p=0.019), as well as waking up with a coughing crisis in the last 12 months (26.4%; p <0.001). The risk factors for asthma were the following: living next Santos Port area (OR: 2.90; 95%CI 1.13-7.44); and the presence of O₃ (OR = 2.63; 95%CI 0.86-7.96). This pioneering study demonstrated that living near the port area increases the chances of adults having self-reported asthma symptoms.

Associations of air pollutants with pneumonia hospital admissions in Qingdao, China: a prospective cohort study

Studies about the pneumonia morbidity effects of various air pollution exposure are still limited in China. We aimed to explore the short-term effect of air pollutants exposure on pneumonia admission and identify the vulnerable groups in Qingdao, China. From January 2015 to October 2017, a prospective cohort involving 433,032 participants across 3 counties in Qingdao were enrolled in the study. Distributed lag nonlinear model (DLNM) was applied to assess the associations between air pollutants and pneumonia hospitalizations. There were 636 cases of pneumonia, with an annual incidence density of 54.33 per 100,000 person-years (95% CI: 50.11, 58.56). A 10 μg/m³ increment of sulfur dioxide (SO₂) distributed at a 4-week lag in Qingdao was associated with increased pneumonia hospitalizations, with a risk ratio of 2.10 (95% CI: 1.06, 4.13). Subgroup analyses indicate that PM ≤ 2.5 μm in aerodynamic diameter and SO₂ showed stronger effects on pneumonia in females than males, whereas people in urban regions were more vulnerable to nitrogen dioxide and ozone (O₃) than the others. We also observed distinct acute effects and harvesting effects of SO₂ and O₃ on pneumonia in urban areas. Strategies should be taken to further reduce levels of ambient PM_2.5, SO₂, and O₃.

COVID-19 Lockdown and the Behavior Change on Physical Exercise, Pain and Psychological Well-Being: An International Multicentric Study

Objective: To evaluate the impact of the COVID-19 pandemic and the following lockdown on physical exercise (PEx) practice, pain, and psychological well-being. Methods: A cross-sectional multicentric study was performed using a nonrandom convenience sampling from the general population (≥18 years-old) of 6 countries (Brazil, Italy, France, Portugal, Germany, and Spain) adopting social isolation (SI). The validated self-administered online survey (PEF-COVID19) was used. The tests T-test and Chi-square with Bonferroni correction were used for statistical analysis and a multivariate logistic regression model (p ˂ 0.05). Results: We included 3194 replies and ~80% of the respondents were in SI. Brazilian sample was highly influenced by the pandemic considering PEx practice and habits, pain, anxiety, and stress (p ˂ 0.05). Among the European countries, Italy presented the major changes. The model to predict the non-practice of PEx during SI showed that the variables countries, smoking, SI, and PEx level were significant predictors (p ˂ 0.001). Conclusion: The pandemic changed the PEx practice and habits, and the psychological well-being of populations in different manners. Countries, smoking, SI, and PEx level were predictors for the non-practice of PEx. Public health strategies are suggested to avoid sedentary lifestyles and quality of life decrease.

Environmental air pollution: respiratory effects

Environmental air pollution is a major risk factor for morbidity and mortality worldwide. Environmental air pollution has a direct impact on human health, being responsible for an increase in the incidence of and number of deaths due to cardiopulmonary, neoplastic, and metabolic diseases; it also contributes to global warming and the consequent climate change associated with extreme events and environmental imbalances. In this review, we present articles that show the impact that exposure to different sources and types of air pollutants has on the respiratory system; we present the acute effects-such as increases in symptoms and in the number of emergency room visits, hospitalizations, and deaths-and the chronic effects-such as increases in the incidence of asthma, COPD, and lung cancer, as well as a rapid decline in lung function. The effects of air pollution in more susceptible populations and the effects associated with physical exercise in polluted environments are also presented and discussed. Finally, we present the major studies on the subject conducted in Brazil. Health care and disease prevention services should be aware of this important risk factor in order to counsel more susceptible individuals about protective measures that can facilitate their treatment, as well as promoting the adoption of environmental measures that contribute to the reduction of such emissions.

External Environmental Pollution as a Risk Factor for Asthma

Air pollution is a worrisome risk factor for global morbidity and mortality and plays a special role in many respiratory conditions. It contributes to around 8 million deaths/year, with outdoor exposure being responsible for more than 4.2 million deaths throughout the world, while more than 3.8 million die from situations related to indoor pollution. Pollutant agents induce several respiratory symptoms. In addition, there is a clear interference in numerous asthma outcomes, such as incidence, prevalence, hospital admission, visits to emergency departments, mortality, and asthma attacks, among others. The particulate matter group of pollutants includes coarse particles/PM₁₀, fine particles/PM_2.5, and ultrafine particles/PM_0.1. The gaseous components include ground-level ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide. The timing, load, and route of allergen exposure are other items affecting allergic disease phenotypes. The complex interaction between pollutant exposures and human host factors has an implication in the development and rise of asthma as a public health problem. However, there are hiatuses in the understanding of the pathways in this disease. The routes through which pollutants induce asthma are multiple, and include the epigenetic changes that occur in the respiratory tract microbiome, oxidative stress, and immune dysregulation. In addition, the expansion of the modern Westernized lifestyle, which is characterized by intense urbanization and more time spent indoors, resulted in greater exposure to polluted air. Another point to consider is the different role of the environment according to age groups. Children growing up in economically disadvantaged neighborhoods suffer more important negative health impacts. This narrative review highlights the principal polluting agents, their sources of emission, epidemiological findings, and mechanistic evidence that links environmental exposures to asthma.

UK COVID-19 lockdown: 100 days of air pollution reduction?

On the 23 March 2020, a country-wide COVID-19 lockdown was imposed on the UK. The following 100 days saw anthropogenic movements quickly halt, before slowly easing back to a "new" normality. In this short communication, we use data from official UK air-quality sensors (DEFRA AURN) and the UK Met Office stations to show how lockdown measures affected air quality in the UK. We compare the 100 days post-lockdown (23 March to 30 June 2020) with the same period from the previous 7 years. We find, as shown in numerous studies of other countries, the nitrogen oxides levels across the country dropped substantially (∼ 50%). However, we also find the ozone levels increased (∼ 10%), and the levels of sulphur dioxide more than doubled across the country. These changes, driven by a complex balance in the air chemistry near the surface, may reflect the influence of low humidity as suggested by Met Office data, and potentially, the reduction of nitrogen oxides and their interactions with multiple pollutants.

Brazil before and during COVID-19 pandemic: Impact on the practice and habits of physical exercise

INTRODUCTION

The goal of this study was to investigate the practice and habits of physical exercise impact due to COVID-19 social isolation before and during the outbreak in Brazil and its mains macro-regions, which have social and economic disparities.

METHODS

This is an observational cross-sectional study through an online questionnaire survey. A self-administered survey (PEF-COVID19) was applied in the Brazilian general population, age ≥ 18 years. T-test for independent samples and Chi-square tests were used to compare Brazil and different macro-regions, p˂0.05.

RESULTS

1,977 participants filled the survey and 1,845 were included; 80% of the included ones were in social isolation. In general, the self-related physical exercise practice before and during the COVID-19 pandemic and exercise characteristics were highly affected by the pandemic (p˂0.05). Sedentary behavior increased significantly (14.9 vs. 29.8%) and between the active ones, the frequency of PEx per week and duration of the PEx practice decreased significantly. The motivation to exercise also changed considering performance and health before and during the pandemic, respectively (10 vs. 5.6% and 72.4 vs. 79.1%). Also, the sample started to exercise less in the night and more in the afternoon, respectively (33.7 vs. 25.3% and 19.1 vs. 31.5%).

CONCLUSIONS

The COVID-19 pandemic highly influenced the physical exercise practice and habits (frequency, duration, motivation, period to exercise) in Brazil and its main macro-regions. These results can be used to create measures, as home-based exercise programs, to avoid the harm of sedentary behaviors and mental health impact during and after the pandemic.

NOS.E: A New Fast Response Electronic Nose Health Monitoring System

We present a practical electronic nose (e-nose) sys-tem, NOS.E, for the rapid detection and identification of human health conditions. By detecting the changes in the composition of an individual's respiratory gases, which have been shown to be linked to changes in metabolism, e-nose systems can be used to characterize the physical health condition. We demonstrated our system's viability with a simple data set consists of breath collected under three different scenarios from one volunteer. Our preliminary results show the popular classifier SVM can discriminate NOS.E's responses under the three scenarios with high performance. In future work, we will aim to gather a more varied data set to test NOS.E's abilities.

Effects of environment pollution on the ocular surface

The twenty-first century is fraught with dangers like climate change and pollution, which impacts human health and mortality. As levels of pollution increase, respiratory illnesses and cardiovascular ailments become more prevalent. Less understood are the eye-related complaints, which are commonly associated with increasing pollution. Affected people may complain of irritation, redness, foreign body sensation, tearing, and blurring of vision. Sources of pollution are varied, ranging from gases (such as ozone and NO₂) and particulate matter produced from traffic, to some other hazards associated with indoor environments. Mechanisms causing ocular surface disease involve toxicity, oxidative stress, and inflammation. Homeostatic mechanisms of the ocular surface may adapt to certain chronic changes in the environment, so affected people may not always be symptomatic. However there are many challenges associated with assessing effects of air pollution on eyes, as pollution is large scale and difficult to control. Persons with chronic allergic or atopic tendencies may have a pre-existing state of heightened mucosal immune response, hence they may have less tolerance for further environmental antigenic stimulation. It is beneficial to identify vulnerable people whose quality of life will be significantly impaired by environmental changes and provide counter measures in the form of protection or treatment. Better technologies in monitoring of pollutants and assessment of the eye will facilitate progress in this field.

Saharan dust and the impact on adult and elderly allergic patients: the effect of threshold values in the northern sector of Gran Canaria, Spain

Gran Canaria Island is frequently impacted by Saharan dust, a health hazard of particular concern to the island population and health agencies. Airborne mineral dust has the severest impact on the higher age groups of the population, and those with respiratory conditions; despite that, on average, the ambient particulate matter (PM) concentrations fall within international PM guidelines. During 2010 and 2011, an epidemiological survey, in parallel with an air quality study, was conducted at the Dr Negrín hospital in Gran Canaria. This included the quarterly monitoring of outpatients and recording of emergency patients with respiratory diseases, together with the measurement of aerosol, meteorological, and PM-related air quality levels. The finer more toxic particles were collected with PM_2.5 (particulate matter with aerodynamic diameter less than 2.5 μm) aerosol samplers. The filter samples were gravimetrically and chemically analyzed for their elemental, water-soluble ions, carbon, and mineralogical contents. Individual particle morphology was measured by Scanning Electron Microscopy. Statistical analysis of the chemical and clinical data included the analysis of variance and calculation of Spearman correlation coefficients. No statistically significant relations were found between the allergic control group, the emergency room admissions, pulmonary conditions, medication, and elevated Saharan dust levels. However, changing environmental conditions, such as an increase in humidity or a reduction in ambient air temperature made a significant difference to the outcomes recorded on the health statements of the allergic and respiratory illness groups of the Gran Canary population.

Outdoor Air Pollution and COPD-Related Emergency Department Visits, Hospital Admissions, and Mortality: A Meta-Analysis

A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM_2.5), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM_2.5 of 10 ug/m³ was associated with a 2.5% (95% CI: 1.6-3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m³ in NO₂ was associated with a 4.2% (2.5-6.0%) increase, and an increase of 10 ug/m³ in SO₂ was associated with a 2.1% (0.7-3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM_2.5, NO₂, and SO₂ were significantly and positively associated with both COPD-related morbidity and mortality.

Epidemiologia de desfechos na saúde humana relacionados à poluição atmosférica no Brasil: uma revisão sistemática

ResumoO presente artigo revisa e discute aspectos da situação da pesquisa epidemiológica relacionados aos desfechos de saúde decorrentes da poluição atmosférica. Foi realizada uma revisão sistemática de estudos que avaliou os efeitos de poluentes do ar na saúde humana. A qualidade metodológica dos trabalhos também foi avaliada. A revisão identificou 432 estudos que abordaram a temática, dos quais 56 atendem aos critérios de inclusão previamente estabelecidos. Além de evidenciarem um cenário de pesquisa epidemiológica pautado na relação causa-efeito, os resultados apontam para a necessidade de revisão de parâmetros ambientais e expõem desafios e contribuições à pesquisa epidemiológica em saúde ambiental.

Short-term relationships between emergency hospital admissions for respiratory and cardiovascular diseases and fine particulate air pollution in Beirut, Lebanon

High levels of major outdoor air pollutants have been documented in Lebanon, but their health effects remain unknown. The Beirut Air Pollution and Health Effects study aimed to determine the relationship between short-term variations in ambient concentrations of particulate matter (PM10 and PM2.5) and emergency hospital admissions in the city of Beirut, and whether susceptible groups are more greatly affected. An autoregressive Poisson model was used to evaluate the association between daily concentrations of particulate matter and respiratory and cardiovascular emergency hospital admissions after controlling for confounders. All variables were measured during 1 year from January 2012 to December 2012. Relative risks of admissions for respiratory and cardiovascular diseases were calculated for an increase in 10 μg.m(-3) of pollutant concentrations. Total respiratory admissions were significantly associated with the levels of PM10 (1.012 [95% CI 1.004-1.02]) per 10 μg.m(-3) rise in daily mean pollutant concentration for PM10 and 1.016 [95% CI 1.000-1.032] for PM2.5 on the same day. With regard to susceptible groups, total respiratory admissions were associated with PM2.5 and PM10 within the same day in children (relative risk (RR), 1.013 and 1.014; 95% confidence interval, 0.985-1.042 and 1.000-1.029 for PM2.5 and PM10, respectively). Moreover, a nearly significant association was found between particles and total circulatory admissions for adults and elderly groups in the same day. These results are similar to other international studies. Therefore, air pollution control is expected to reduce the number of admissions of these diseases in Lebanon.

Air pollution and percent emphysema identified by computed tomography in the Multi-Ethnic study of Atherosclerosis

BACKGROUND

Air pollution is linked to low lung function and to respiratory events, yet little is known of associations with lung structure.

OBJECTIVES

We examined associations of particulate matter (PM2.5, PM10) and nitrogen oxides (NOx) with percent emphysema-like lung on computed tomography (CT).

METHODS

The Multi-Ethnic Study of Atherosclerosis (MESA) recruited participants (45-84 years of age) in six U.S. states. Percent emphysema was defined as lung regions < -910 Hounsfield Units on cardiac CT scans acquired following a highly standardized protocol. Spirometry was also conducted on a subset. Individual-level 1- and 20-year average air pollution exposures were estimated using spatiotemporal models that included cohort-specific measurements. Multivariable regression was conducted to adjust for traditional risk factors and study location.

RESULTS

Among 6,515 participants, we found evidence of an association between percent emphysema and long-term pollution concentrations in an analysis leveraging between-city exposure contrasts. Higher concentrations of PM2.5 (5 μg/m3) and NOx (25 ppb) over the previous year were associated with 0.6 (95% CI: 0.1, 1.2%) and 0.5 (95% CI: 0.1, 0.9%) higher average percent emphysema, respectively. However, after adjustment for study site the associations were -0.6% (95% CI: -1.5, 0.3%) for PM2.5 and -0.5% (95% CI: -1.1, 0.02%) for NOx. Lower lung function measures (FEV1 and FVC) were associated with higher PM2.5 and NOx levels in 3,791 participants before and after adjustment for study site, though most associations were not statistically significant.

CONCLUSIONS

Associations between ambient air pollution and percentage of emphysema-like lung were inconclusive in this cross-sectional study, thus longitudinal analyses may better clarify these associations with percent emphysema.

Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality

BACKGROUND

The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations.

MATERIALS AND METHODS

We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matters (PM2.5 and PM10) using monthly data measurements from air-monitoring stations in North Carolina in 1993-2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population) calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths.

RESULTS

Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths-with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths-with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD)-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only the underlying causes of deaths were used, and when mortality and air-quality data were analyzed on the county level. In each case, the results of sensitivity analyses demonstrated stability. The importance of analysis of pneumonia as an underlying cause of death was also highlighted.

CONCLUSION

Significant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina.

Effects of ambient levels of traffic-derived air pollution on the ocular surface: analysis of symptoms, conjunctival goblet cell count and mucin 5AC gene expression

PURPOSE

To quantify ocular symptoms, goblet cells (GC) and mucin 5AC (MUC5AC) gene expression on the conjunctiva of healthy subjects exposed to ambient levels of traffic-derived air pollution and to estimate its correlation with NO2 and particulate matter smaller than 2.5 μm (PM2.5) levels.

METHODS

Twenty-one taxi drivers or traffic controllers were assessed with the Ocular Surface Disease Index (OSDI) questionnaire and conjunctival impression cytology. MUC5AC mRNA levels were determined based on the cytology of the right eye, and GC density was assessed based on the cytology of the left eye. Mean individual levels of 24-h NO2 and PM2.5 exposure were assessed the day before examination. Possible associations between NO2 or PM2.5 levels, OSDI scores, GC densities and MUC5AC mRNA levels were verified.

RESULTS

The subjects were exposed to mean PM2.5 levels of 35±12 μg/m(3) and mean NO2 levels of 189±47 μg/m(3). OSDI scores were low (7.4±8) and GC densities were 521±257 and 782±322 cell/mm(2) on the bulbar and tarsal conjunctivas, respectively. The mean GC-derived MUC5AC mRNA expression was 14±7 fM/μg of total RNA. A significant and positive correlation was observed between MUC5AC mRNA levels and tarsal GC density (p=0.018). A trend toward association between PM2.5 levels and tarsal GC cell density (p=0.052) was found.

CONCLUSION

Exposure to ambient levels of air pollution impacts conjunctival GC density. An increase in MUC5AC mRNA levels may be part of an adaptive ocular surface response to long-term exposure to air pollution.

A systematic review of the physical and chemical characteristics of pollutants from biomass burning and combustion of fossil fuels and health effects in Brazil

The aim of this study was to carry out a review of scientific literature published in Brazil between 2000 and 2009 on the characteristics of air pollutants from different emission sources, especially particulate matter (PM) and its effects on respiratory health. Using electronic databases, a systematic literature review was performed of all research related to air pollutant emissions. Publications were analyzed to identify the physical and chemical characteristics of pollutants from different emission sources and their related effects on the respiratory system. The PM2.5 is composed predominantly of organic compounds with 20% of inorganic elements. Higher concentrations of metals were detected in metropolitan areas than in biomass burning regions. The relative risk of hospital admissions due to respiratory diseases in children was higher than in the elderly population. The results of studies of health effects of air pollution are specific to the region where the emissions occurred and should not be used to depict the situation in other areas with different emission sources.

Poluição atmosférica e internações hospitalares por doenças respiratórias em crianças e adolescentes em Cubatão, São Paulo, Brasil, entre 1997 e 2004

O objetivo deste estudo foi avaliar os efeitos dos poluentes atmosféricos e suas estruturas de defasagem sobre a morbidade respiratória de crianças e adolescentes, na cidade de Cubatão, São Paulo, Brasil, entre 1997 e 2004. Um estudo ecológico de séries temporais foi realizado, analisando internações nos hospitais do Sistema Único de Saúde por doenças respiratórias de crianças e adolescentes residentes no município. Foram utilizados modelos lineares generalizados de regressão de Poisson, controlando-se para sazonalidade, temperatura, umidade e tendência de curta duração. PM10 e ozônio estiveram positiva e estatisticamente associados com as internações por doenças respiratórias. No grupo de crianças, aumentos de um interquartil nas médias móveis de sete dias do PM10 (56,5µg/m³) e de cinco dias do ozônio (46,7µg/m³) levaram a aumentos nas internações hospitalares de 9,6% (IC95%: 3,0%-16,1%) e 2,4% (IC95%: 0,1%-4,7%), respectivamente. Esforços para redução das concentrações dos poluentes do ar ainda precisam ser implementados para minimizar os seus efeitos adversos sobre crianças e adolescentes em Cubatão.

Differential susceptibility according to gender in the association between air pollution and mortality from respiratory diseases

This study analyzed the association between air pollution and deaths from respiratory diseases, considering differential susceptibility according to gender. The authors used daily deaths from respiratory diseases (ICD-10, J00-J99), PM10, SO2, and O3 levels, and meteorological indicators in Volta Redonda, Rio de Janeiro State, Brazil, from January 2002 to December 2006. The association was estimated by Poisson regression using generalized additive models, where the increase in risk of deaths from PM10 to lag 1 was 10.01% (95%CI: 1.81-18.88%) in the total female population and 10.04% (95%CI: 0.90-20.02%) in elderly women. The increase in risk of deaths from PM10 to lag 9 was 8.25% in the total male population (95%CI: 0.86-16.18%) and 10.80% (95%CI: 2.18-20.15%) in elderly men. For exposure to SO2 and O3, the risk was significant in the total male population and the elderly, respectively. The results emphasize the need for further studies, focusing on modification of the effects of air pollution on health.

Meta-analysis of the Association between Short-Term Exposure to Ambient Ozone and Respiratory Hospital Admissions

Ozone is associated with health impacts including respiratory outcomes; however, results differ across studies. Meta-analysis is an increasingly important approach to synthesizing evidence across studies. We conducted meta-analysis of short-term ozone exposure and respiratory hospitalizations to evaluate variation across studies and explore some of the challenges in meta-analysis. We identified 136 estimates from 96 studies and investigated how estimates differed by age, ozone metric, season, lag, region, disease category, and hospitalization type. Overall results indicate associations between ozone and various types of respiratory hospitalizations; however, study characteristics affected risk estimates. Estimates were similar, but higher, for the elderly compared to all ages and for previous day exposure compared to same day exposure. Comparison across studies was hindered by variation in definitions of disease categories, as some (e.g., asthma) were identified through ≥3 different sets of ICD codes. Although not all analyses exhibited evidence of publication bias, adjustment for publication bias generally lowered overall estimates. Emergency hospitalizations for total respiratory disease increased 4.47% (95% interval 2.48, 6.50%) per 10ppb 24-hr ozone among the elderly without adjustment for publication bias and 2.97% (1.05, 4.94%) with adjustment. Comparison of multi-city study results and meta-analysis based on single-city studies further suggested publication bias.

A review of low-level air pollution and adverse effects on human health: implications for epidemiological studies and public policy

The aim of this study was to review original scientific articles describing the relationship between atmospheric pollution and damage to human health. We also aimed to determine which of these studies mentioned public policy issues. Original articles relating to atmospheric pollution and human health published between 1995 and 2009 were retrieved from the PubMed database and analyzed. This study included only articles dealing with atmospheric pollutants resulting primarily from vehicle emissions. Three researchers were involved in the final selection of the studies, and the chosen articles were approved by at least two of the three researchers. Of the 84 non-Brazilian studies analyzed, 80 showed an association between atmospheric pollution and adverse effects on human health. Moreover, 66 showed evidence of adverse effects on human health, even at levels below the permitted emission standards. Three studies mentioned public policies aimed at changing emission standards. Similarly, the 29 selected Brazilian studies reported adverse associations with human health, and 27 showed evidence of adverse effects even at levels below the legally permitted emission standards. Of these studies, 16 mentioned public policies aimed at changing emission standards. Based on the Brazilian and non-Brazilian scientific studies that have been conducted, it can be concluded that, even under conditions that are compliant with Brazilian air quality standards, the concentration of atmospheric pollutants in Brazil can negatively affect human health. However, as little discussion of this topic has been generated, this finding demonstrates the need to incorporate epidemiological evidence into decisions regarding legal regulations and to discuss the public policy implications in epidemiological studies.

Mortalidade por doenças cardiorrespiratórias em idosos no estado de Mato Grosso, 1986 a 2006

OBJETIVO: Descrever a evolução temporal da mortalidade por doenças cardiorrespiratórias em idosos. MÉTODOS: Estudo epidemiológico descritivo com delineamento ecológico de séries temporais realizado no estado do Mato Grosso, de 1986 a 2006. Foram utilizados dados sobre doenças dos aparelhos respiratório e circulatório obtidos do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Modelos de regressão linear simples foram ajustados para avaliar a tendência das taxas específicas de mortalidade por grupos específicos de idade (60 a 69, 70 a 79 e 80 ou mais anos) e sexo. RESULTADOS: Houve aumento na proporção de óbitos por doenças respiratórias e diminuição por doenças cardiovasculares. Na comparação de taxas entre os sexos, as mulheres apresentaram taxas 15% menores para as causas cardiovasculares e taxas similares ao sexo masculino para as causas respiratórias. Foi observada taxa elevada de mortalidade por doenças respiratórias e cardiovasculares, com importante tendência de incremento entre os grupos mais longevos. Em idosos com idade > 80 anos o aumento anual médio na taxa de mortalidade por doenças respiratórias foi de 1,99 óbitos e de 3,43 por doenças do aparelho circulatório. CONCLUSÕES: O estado de Mato Grosso apresenta elevada taxa de mortalidade por doenças respiratórias e cardiovasculares em idosos, com importante tendência de incremento entre os grupos mais longevos.

Air pollution and hospital admissions for pneumonia: are there potentially sensitive groups?

Recent studies have shown that air pollution is a risk factor for hospitalization for pneumonia. However, there is limited evidence to suggest what subpopulations are at greater risk from air pollution. This study was undertaken to examine the modifying effect of specific secondary diagnosis (including hypertension, diabetes, asthma, and upper respiratory infections) on the relationship between hospital admissions for pneumonia and ambient air pollutants. Hospital admissions for pneumonia and ambient air pollution data for Kaohsiung were obtained for the period 1996-2006. The relative risk of hospital admission was estimated using a case-crossover approach. We found that an interquartile range (IQR) increase in PM(10), NO(2), and CO on warm days was associated with a 28% (95% confidence interval [CI], 11-48%), 40% (95% CI, 20-63%), and 31% (95% CI, 19-45%), respectively, increase in admissions for pneumonia with upper respiratory infections (URI), but only 23% (95% CI, 18-28%), 30% (95% CI, 25-36%), and 24% (95% CI, 21-28%), respectively, increase for persons without URI. An IQR increase in PM(10), SO(2), and CO on cool days was associated with a 70% (95% CI, 50-92%), 30% (95% CI, 15-47%), and 64% (95% CI, 47-83%), respectively, increase in admissions in persons with URI, and an increase of 64% (95% CI, 57-70%), 18% (95% CI, 14-22%), and 55% (95% CI, 50-60%), respectively, in admissions in persons without URI. Our findings provide evidence that patients with comorbid URI may increase the risk of hospital admissions for pneumonia, in relation to air pollutant levels.

Age-related changes in the expression and oxidation of bronchoalveolar lavage proteins in the rat

The incidence and severity of many lung diseases change with age. Some diseases, such as pneumonia, occur with increased frequency in children and the elderly. Proteins obtained by bronchoalveolar lavage (BAL) serve as the first line of defense against inhaled toxins and pathogens. Age-related changes in BAL protein expression and oxidative modification were examined in juvenile (1 mo), young adult (2 mo), and aged (18 mo) F344 rats using two-dimensional difference gel electrophoresis (2D-DIGE), matrix-assisted laser desorption ionization-time of flight/time of flight (MALDI-ToF/ToF) tandem mass spectrometry, and carbonyl immunoblotting. Using 2D-DIGE, we detected 563 protein spots, and MALDI-ToF/ToF identified 204 spots comprising 31 proteins; 21 changed significantly (17 increases) between juvenile and young adult or aged rats, but for 12 of these proteins, levels had a biphasic pattern, and levels in aged rats were less than in young adults. Relative carbonylation was determined by comparison of immunostaining with total protein staining on each oxidized protein blot. We found that aged rats had significantly increased oxidation in 13 proteins compared with juvenile rats. Many of the proteins altered in expression or oxidation level had functions in host defense, redox regulation, and protein metabolism. We speculate that low levels of expression of host defense proteins in juvenile rats and decreases in levels of these proteins between young adult and aged rats may predispose these groups to pneumonia. In addition, we have shown age-related increases in protein oxidation that may compromise host defense function in aged rats.

In vitro fertilization, embryo development, and cell lineage segregation after pre- and/or postnatal exposure of female mice to ambient fine particulate matter

OBJECTIVE

To evaluate effects of pre- and/or postnatal exposure to ambient fine particulate matter on fertilization, embryo development, and cell lineage segregation in preimplantation blastocysts using the IVF mouse model.

DESIGN

Animal model.

SETTING

Academic institution.

ANIMAL(S)

Six-week-old, superovulated mice.

INTERVENTION(S)

Pre- and postnatal exposure to filtered air (FA-FA), filtered-ambient air (FA-AA), or ambient air (AA-AA) in exposure chambers 24 hours a day for 9 weeks.

MAIN OUTCOME MEASURE(S)

Gestation length, litter size, sex ratio, ovarian response to superovulation, fertilization rate, embryo development, blastocyst and hatching rates, total cell count, and proportion of cell allocation to inner-cell mass (ICM) and trophectoderm (TE).

RESULT(S)

Gestation length, litter size and birth weight, live-birth index, and sex ratio were similar among exposure groups. Ovarian response was not affected by the exposure protocol. A multivariate effect for pre- and/or postnatal exposure to ambient fine particulate matter on IVF, embryo development, and blastocyst differential staining was found. Cell counts in ICM and ICM/TE ratios in blastocysts produced in the FA-FA protocol were significantly higher than in blastocysts produced in the FA-AA and AA-AA protocols. No difference in total cell count was observed among groups.

CONCLUSION(S)

Our study suggests that exposure to ambient fine particulate matter may negatively affect female reproductive health by disrupting the lineage specification at the blastocyst stage without interfering in early development of the mouse embryo.

Effects of nitrogen dioxide on human health: systematic review of experimental and epidemiological studies conducted between 2002 and 2006

In order to assess health effects in humans caused by environmental nitrogen dioxide (NO(2)) a systematic review of studies in humans was conducted. MEDLINE database was searched for epidemiological studies and experiments on adverse effects of NO(2) published between 2002 and 2006. The evidence with regard to NO(2) exposure limits was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) grading system and the modified three star system. Of the 214 articles retrieved 112 fulfilled the inclusion criteria. There was limited evidence that short-term exposure to a 1-h mean value below 200 microg NO(2)/m(3) is associated with adverse health effects provided by only one study on mortality in patients with severe asthma (*2+). The effect remained after adjusting for other air pollutants. There was moderate evidence that short-term exposure below a 24-h mean value of 50 microg NO(2)/m(3) at monitor stations increases hospital admissions and mortality (**2+). Evidence was also moderate when the search was restricted to susceptible populations (children, adolescents, elderly, and asthmatics). There was moderate evidence that long-term exposure to an annual mean below 40 microg NO(2)/m(3) was associated with adverse health effects (respiratory symptoms/diseases, hospital admissions, mortality, and otitis media) provided by generally consistent findings in five well-conducted cohort and case-control studies with some shortcomings in the study quality (**2+). Evidence was also moderate when the search was restricted to studies in susceptible populations (children and adolescents) and for the combination with other air pollutants. The most frequent reasons for decreased study quality were potential misclassification of exposure and selection bias. None of the high-quality observational studies evaluated was informative for the key questions due to the choice of the dose parameter (e.g., 1-week mean) and exposure levels above the limit values. Inclusion of study designs unlisted in the SIGN grading system did not bring additional evidence regarding exposures below the current air quality limit values for NO(2). As several recent studies reported adverse health effects below the current exposure limits for NO(2) particularly among susceptible populations regarding long-term exposure further research is needed. Apart from high-quality epidemiological studies on causality and the interaction of NO(2) with other air pollutants there is a need for double-blinded randomized cross-over studies among susceptible populations for further evaluation of the short-term exposure limits.

Health, environmental, and economic costs from the use of a stabilized diesel/ethanol mixture in the city of São Paulo, Brazil

In Greater Metropolitan São Paulo, Brazil, fossil fuel combustion in the transportation system is a major cause of outdoor air pollution. Air quality improvement requires additional policies and technological upgrades in fuels and vehicle engines. The current study thus simulated the environmental and social impacts resulting from the use of a stabilized diesel/ethanol mixture in the bus and truck fleet in Greater Metropolitan São Paulo. The evaluation showed reductions in air pollutants, mainly PM10, which would help avert a number of disease events and deaths, as estimated through dose-response functions of epidemiological studies on respiratory and cardiovascular diseases. Valuation of the impacts using an environmental cost-benefit analysis considered operational installation, job generation, potential carbon credits, and health costs, with an overall positive balance of US$ 2.851 million. Adding the estimated qualitative benefits to the quantitative ones, the project's benefits far outweigh the measured costs. Greater Metropolitan São Paulo would benefit from any form of biodiesel use, producing environmental, health and socioeconomic gains, the three pillars of sustainability.

Consequences of exposure to Asian dust storm events on daily pneumonia hospital admissions in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China travel to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of constituents of ADS with hospital pneumonia admissions of residents in Taipei, Taiwan, during the period 1996-2001. Fifty-four dust storm episodes were identified and were classified as index days. Daily pneumonia admissions on the index days were compared with admissions on comparison days. Two comparison days for each index day, 7 d before the index days and 7 d after the index days, were selected. The study results indicated a statistically significant association between ADS events and daily pneumonia admissions 1 d after the event. It is worthwhile to pay more attention to ADS events and health in the future based on the findings in this investigation.

Ambient levels of air pollution induce goblet-cell hyperplasia in human conjunctival epithelium

BACKGROUND

Ocular mucosa is exposed constantly to the external environment, and chronic exposure to air pollution may affect the ocular surface.

OBJECTIVE

We assessed the effect of air pollution on the ocular surface by combining determinations of individual exposure and conjunctival impression cytology.

METHODS

A panel study was conducted with 29 volunteers recruited in two locations with different pollution levels: São Paulo (n = 13) and Divinolândia (n = 16). We assessed mean individual levels of nitrogen dioxide (NO2) exposure for 7 days, using a passive sampler. Impression cytology samples were obtained from inferior tarsal conjunctiva. Comparisons between the two groups in terms of NO2 exposure and goblet-cell counts were performed using the Student t-test. Correlations between goblet-cells counts and corresponding individual NO2 exposure levels were determined using Spearman's correlation.

RESULTS

Individuals living in São Paulo received a significantly (p = 0.005) higher dose of NO2 (mean 32.47; SD 9.83) than those living in Divinolândia (mean 19.33; SD 5.24). There was a steady increase in goblet-cell counts, proportional to NO2 exposure (Spearman's correlation = 0.566, p = 0.001), with a dose-response pattern.

CONCLUSIONS

A positive and significant association between exposure to air pollution and goblet-cell hyperplasia in human conjunctiva was detected. The combination of simple measurements of exposure and impression cytology was an effective and noninvasive approach for characterizing human response to ambient levels of air pollution.

Air pollution and hospital admissions for pneumonia in a tropical city: Kaohsiung, Taiwan

This study was undertaken to determine whether there was an association between air pollutant levels and hospital admissions for pneumonia in Kaohsiung, Taiwan. Hospital admissions for pneumonia and ambient air pollution data for Kaohsiung were obtained for the period of 1996-2004. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days (= 25 degrees C) statistically significant positive associations were found for all pollutants. On cool days (< 25 degrees C), all pollutants were also significantly associated with number of pneumonia admissions. For the two-pollutant model, O3 and CO were significant in combination with each of the other four pollutants on warm days. On cool days, PM10 and NO2 remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient air pollutants increase the risk of hospital admissions for pneumonia. The effects of air pollutants on hospital admissions for pneumonia were temperature dependent.

Paradoxical ozone associations could be due to methyl nitrite from combustion of methyl ethers or esters in engine fuels

We review studies of the effects of low ambient ozone concentrations on morbidity that found a negative coefficient for ozone concentration. We call this a Paradoxical Ozone Association (POA). All studies were in regions with methyl ether in gasoline. All but one study carefully controlled for the effects of other criterion pollutants, so the phenomenon cannot be attributed to them. One was in southern California in mid-summer when ozone levels are highest. Because ozone is created by sunlight, the most plausible explanation for a POA would be an ambient pollutant that is rapidly destroyed by sunlight, such as methyl nitrite (MN). A previously published model of engine exhaust chemistry suggested methyl ether in the fuel will create MN in the exhaust. MN is known to be highly toxic, and closely related alkyl nitrites are known to induce respiratory sensitivity in humans. Support for the interpretation comes from many studies, including three linking asthma symptoms to methyl tertiary butyl ether (MTBE) and the observation that a POA has not been seen in regions without ether in gasoline. We also note that studies in southern California show a historical trend from more significant to less significant ozone-health associations. The timing of those changes is consistent with the known timing of the introduction of gasoline oxygenated with MTBE in that region.

[Clinical repercussions of exposure to atmospheric pollution]

Atmospheric pollution is a topic of extensive discussion the world over. The clinical repercussions of exposure to the principal atmospheric pollutants are summarized herein. According to the American Environmental Protection Agency, air quality standards for these agents are set based on their primary and half-life values. The respiratory effects of the burning of fossil fuels and biomass are succinctly presented, with a special focus on alerting health care professionals of the increased morbidity related to environmental pollution.

[Respiratory and cardiovascular hospitalizations associated with air pollution in the city of São Paulo, Brazil]

The recognition that current air pollution levels cause harmful health effects makes the definition of the air quality regulatory process imperative. This study examines the association between exposure to air pollution and hospital admissions in the city of São Paulo, aiming to support the development of measures to reduce such health risks. The authors conducted an ecological time series study of hospital admissions for respiratory and cardiovascular diseases in children and the elderly in relation to daily air pollution levels, using generalized additive Poisson regression models. All air pollutants except ozone showed a statistically significant association with admissions for respiratory and cardiovascular diseases. An increase of 10 microg/m3 in fine particulate matter was associated with a 4.6% increase in asthma admissions in children and a 4.3% increase in admissions for chronic obstructive pulmonary disease and 1.5% for ischemic heart disease in the elderly. These associations are consistent with a large body of literature in this area and indicate that the current air pollution levels in São Paulo have an important negative impact on the population's health.

Air pollution and emergency admissions in Boston, MA

STUDY OBJECTIVE

Many studies have shown that ambient particulate air pollution (PM) is associated with increased risk of hospital admissions and deaths for cardiovascular or respiratory causes around the world. In general these have been analysed in association with PM(10) and ozone, whereas PM(2.5) is now the particle measure of greatest health and regulatory concern. And little has been published on associations of hospital admissions and PM components.

DESIGN

This study analysed hospital admissions for myocardial infarction (15 578 patients), and pneumonia (24 857 patients) in associations with fine particulate air pollution, black carbon (BC), ozone, nitrogen dioxide (NO(2)), PM not from traffic, and carbon monoxide (CO) in the greater Boston area for the years 1995-1999 using a case-crossover analysis, with control days matched on temperature.

MAIN RESULTS

A significant association was found between NO(2) (12.7% change (95% CI: 5.8, 18)), PM(2.5) (8.6% increase (95% CI: 1.2, 15.4)), and BC (8.3% increase (95% CI: 0.2, 15.8)) and the risk of emergency myocardial infarction hospitalisation; and between BC (11.7% increase (95% CI: 4.8, 17.4)), PM(2.5) (6.5% increase (95% CI: 1.1, 11.4)), and CO (5.5% increase (95% CI: 1.1, 9.5)) and the risk of pneumonia hospitalisation.

CONCLUSIONS

The pattern of associations seen for myocardial infarction and pneumonia (strongest associations with NO(2), CO, and BC) suggests that traffic exposure is primarily responsible for the association with heart attacks.

Outdoor Air Pollution: Nitrogen Dioxide, Sulfur Dioxide, and Carbon Monoxide Health Effects

Nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide are important ambient air pollutants. High-intensity, confined space exposure to NO2 has caused catastrophic injury to humans, including death. Ambient NO2 exposure may increase the risk of respiratory tract infections through the pollutant's interaction with the immune system. Sulfur dioxide (SO2) contributes to respiratory symptoms in both healthy patients and those with underlying pulmonary disease. Controlled human exposure studies have demonstrated that experimental SO2 exposure causes changes in airway physiology, including increased airways resistance. Both acute and chronic exposure to carbon monoxide are associated with increased risk for adverse cardiopulmonary events, including death. However, studies have not demonstrated a clear dose-dependent health risk response to increasing amounts of these pollutants except at high concentrations. In addition, a number of studies examining the effects of ambient level exposure to NO2, SO2, and CO have failed to find associations with adverse health outcomes.

Urban air pollution and emergency visits for respiratory complaints in Pisa, Italy

Emergency room visits for respiratory complaints, considered an indicator of deterioration of respiratory health, have been positively correlated to traffic-related air pollution. This is an ecological study to evaluate the association between daily levels of urban air pollutants and emergency visits for respiratory complaints, in children and the elderly residing in Pisa, Italy. Daily records of emergency department visits for respiratory complaints were selected from computerized registries, and paper medical reports were identified. Pollutant daily means were computed from hourly values obtained from the public network. Poisson regression, allowing for overdispersion and autocorrelation, was used to evaluate the percent change in daily visits associated with variations of air pollution measures. Among children, an increase in emergency visits of 10% (95% CL: 2.3; 18.2) was associated with a 10-microg/m3 increase in PM10 concentrations of the previous day and an increase of 11.8% (95% CL:1.4; 23.3) was associated with an analogous increment of NO2 during the 2 previous days. Among elderly the same increment of PM10 level during the 2 previous days was correlated with a 8.5% (95% CL: 1.5; 16.1) increase in the risk of recurring emergency department visits for respiratory complaints; this risk increased to 26.5% (95% CL: 3.4; 54.8) if the daily level of CO over the 4 previous days increased by 1 mg/m3. Evidence of morbidity related to short- and long-term air pollution exposures provided in this small study and larger studies conducted in other countries suggests the need for actions to improve air quality in any urban context.

Associação entre poluição atmosférica e doenças respiratórias e cardiovasculares na cidade de Itabira, Minas Gerais, Brasil

A cidade de Itabira, Minas Gerais, Brasil, está localizada na Serra do Espinhaço, onde existem grandes jazidas de minério de ferro que são extraídas em lavra mecanizada a céu aberto. Este estudo foi realizado para avaliar os efeitos agudos do material particulado inalável (PM10) sobre os atendimentos em pronto-socorro por doenças respiratórias e cardiovasculares no Município de Itabira. Modelos aditivos generalizados de regressão de Poisson foram utilizados, controlando-se para temperatura, umidade e sazonalidades de longa e curta duração. Aumentos de 10µg/m³ no PM10 foram associados com aumentos nos atendimentos de pronto-socorro por doenças respiratórias de 4% (IC95%: 2,2-5,8), no dia e no dia seguinte, para crianças menores de 13 anos, e de 12% (IC95%: 8,5-15,5), nos três dias subseqüentes para os adolescentes entre 13 e 19 anos. Dentre os atendimentos por doenças cardiovasculares, o efeito foi agudo (4%; IC95%: 0,8-8,5), principalmente para os indivíduos com idade entre 45 e 64 anos. Esses resultados mostram que o PM10 gerado principalmente através de mineração a céu aberto pode acarretar prejuízos à saúde da população exposta.

The effects of air pollution on cardiovascular diseases: lag structures

OBJECTIVE: To assess the lag structure between air pollution exposure and elderly cardiovascular diseases hospital admissions, by gender. METHODS: Health data of people aged 64 years or older was stratified by gender in São Paulo city, Southeastern Brazil, from 1996 to 2001. Daily levels of air pollutants (CO, PM10, O3, NO2, and SO2) , minimum temperature, and relative humidity were also analyzed. It were fitted generalized additive Poisson regressions and used constrained distributed lag models adjusted for long time trend, weekdays, weather and holidays to assess the lagged effects of air pollutants on hospital admissions up to 20 days after exposure. RESULTS: Interquartile range increases in PM10 (26.21 mug/m³) and SO2 (10.73 mug/m³) were associated with 3.17% (95% CI: 2.09-4.25) increase in congestive heart failure and 0.89% (95% CI: 0.18-1.61) increase in total cardiovascular diseases at lag 0, respectively. Effects were higher among female group for most of the analyzed outcomes. Effects of air pollutants for different outcomes and gender groups were predominately acute and some "harvesting" were found. CONLUSIONS: The results show that cardiovascular diseases in São Paulo are strongly affected by air pollution.

Air pollution effects on myocardial infarction

OBJECTIVE: Myocardial infarction is an acute and severe cardiovascular disease that generally leads to patient admissions to intensive care units and few cases are initially admitted to infirmaries. The objective of the study was to assess whether estimates of air pollution effects on myocardial infarction morbidity are modified by the source of health information. METHODS: The study was carried out in hospitals of the Brazilian Health System in the city of São Paulo, Southern Brazil. A time series study (1998-1999) was performed using two outcomes: infarction admissions to infirmaries and to intensive care units, both for people older than 64 years of age. Generalized linear models controlling for seasonality (long and short-term trends) and weather were used. The eight-day cumulative effects of air pollutants were assessed using third degree polynomial distributed lag models. RESULTS: Almost 70% of daily hospital admissions due to myocardial infarction were to infirmaries. Despite that, the effects of air pollutants on infarction were higher for intensive care units admissions. All pollutants were positively associated with the study outcomes but SO2 presented the strongest statistically significant association. An interquartile range increase on SO2 concentration was associated with increases of 13% (95% CI: 6-19) and 8% (95% CI: 2-13) of intensive care units and infirmary infarction admissions, respectively. CONCLUSIONS: It may be assumed there is a misclassification of myocardial infarction admissions to infirmaries leading to overestimation. Also, despite the absolute number of events, admissions to intensive care units data provides a more adequate estimate of the magnitude of air pollution effects on infarction admissions.

The avoidable health effects of air pollution in three Latin American cities: Santiago, São Paulo, and Mexico City

Urban centers in Latin American often face high levels of air pollution as a result of economic and industrial growth. Decisions with regard to industry, transportation, and development will affect air pollution and health both in the short term and in the far future through climate change. We investigated the pollution health consequences of modest changes in fossil fuel use for three case study cities in Latin American: Mexico City, Mexico; Santiago, Chile; and São Paulo, Brazil. Annual levels of ozone and particulate matter were estimated from 2000 to 2020 for two emissions scenarios: (1) business-as-usual based on current emissions patterns and regulatory trends and (2) a control policy aimed at lowering air pollution emissions. The resulting air pollution levels were linked to health endpoints through concentration-response functions derived from epidemiological studies, using local studies where available. Results indicate that the air pollution control policy would have vast health benefits for each of the three cities, averting numerous adverse health outcomes including over 156,000 deaths, 4 million asthma attacks, 300,000 children's medical visits, and almost 48,000 cases of chronic bronchitis in the three cities over the 20-year period. The economic value of the avoided health impacts is roughly 21 to 165 billion Dollars (US). Sensitivity analysis shows that the control policy yields significant health and economic benefits even with relaxed assumptions with regard to population growth, pollutant concentrations for the control policy, concentration-response functions, and economic value of health outcomes. This research demonstrates the health and economic burden from air pollution in Latin American urban centers and the magnitude of health benefits from control policies.

Decreased fertility in mice exposed to environmental air pollution in the city of Sao Paulo

It has largely been shown that air pollution can affect human health. Effects on human fertility have been shown mainly in males by a decrease in semen quality. Few studies have focused on the environmental effects on female fertility. The aim of the present study was to analyze the effects of air pollution in the city of Sao Paulo on mouse female fertility. Four groups of female Balb/c mice were placed in two chambers 10 days (newborn) or 10 weeks (adults) after birth. Mice were maintained in the chambers 24 h a day, 7 days a week, for 4 months. The first chamber received air that had passed through an air filter (clean chamber) and the second received ambient air (polluted chamber). We measured PM10 and NO2 inside both chambers. Mice belonging to the adult groups were bred to male mice after living for 3 months inside the chambers. The newborn groups mated after reaching reproductive age (12 weeks). After 19 days of pregnancy the numbers of live-born pups, reabsorptions, fetal deaths, corpora lutea, and implantation failures were determined. PM10 and NO2 concentrations in the clean chamber were 50% and 77.5% lower than in the polluted chamber, respectively. Differences in fertility parameters between groups were observed only in animals exposed to air pollution at an early age (10 days after birth). We observed a higher number of live-born pups per animal in the clean chamber than per animal from the polluted chamber (median=6.0 and 4.0, respectively; P=0.037). There was a higher incidence of implantation failures in the polluted group than in the clean group (median=3.5 and 2.0, respectively; P=0.048). There were no significant differences in the other reproductive parameters between groups. These results support the concept that female reproductive health represents a target of air pollutants.

An evaluation of air pollution health impacts and costs in São Paulo, Brazil

The need to determine cost estimates of the hazardous effects of diseases is important in order to establish the priorities of actions for prevention and health management. The evaluation of air pollution impacts on health, based on expenditures, has been carried out, but there are obvious comparison difficulties among countries, as the health-per-capita investment varies enormously. In order to achieve a standard indicator, we applied the Disability-Adjusted Life Years (DALY) method to estimate the health burden and cost estimate due to air pollution in São Paulo, Brazil. The basic methodology was the utilization of dose-response curves of epidemiological studies conducted in São Paulo to assess air pollution and its health effects. DALY attributable to air pollution in São Paulo added up to 28,212 years annually. An indirect health cost attributable to air pollution resulted in 3,222,676 US dollars. This estimate refers to the children and the elderly population. These results give a preliminary and underestimated value of the burden of diseases promoted by air pollution.

Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil

STUDY OBJECTIVE

To evaluate if the effects of particulate matter (PM(10)) on respiratory mortality of elderly people are affected by socioeconomic status.

DESIGN

Time series studies. The daily number of elderly respiratory deaths were modelled in generalised linear Poisson regression models controlling for long term trend, weather, and day of the week, from January 1997 to December 1999, in six different regions of São Paulo City, Brazil. The regions were defined according to the proximity of air pollution monitoring stations. Three socioeconomic indicators were used: college education, monthly income, and housing.

MAIN RESULTS

For a 10 micro g/m(3) increase in PM(10), the percentage increase in respiratory mortality varied from 1.4% (95% CI 5.9 to 8.7) to 14.2% (95% CI 0.4 to 28.0). The overall percentage increase in the six regions was 5.4% (95% CI 2.3 to 8.6). The effect of PM(10) was negatively correlated with both percentage of people with college education and high family income, and it was positively associated with the percentage of people living in slums.

CONCLUSIONS

These results suggest that socioeconomic deprivation represents an effect modifier of the association between air pollution and respiratory deaths.

[Trends in mortality due to respiratory diseases in elderly, Brazil, 1980 to 1998]

INTRODUCTION

The increase in life expectancy and the decline in mortality rates in Brazil have an impact on social programs to the elderly, especially related to health care. The objective of the study isto analyze the mortality trends for respiratory diseases in elderly.

METHODS

An ecological time series was carried out and mortality data was obtained from the Mortality Information System of the Ministry of Health (SIM/MS-DATA-SUS). it was analyzed the time trends of standardized mortality rates according to age groups (60 to 69, 70 to 79 and 80 years old and more) and gender, using linear regression models. The proportional mortality for this disease group compared to all causes of death was also studied.

RESULTS

There were increasing trends for mortality rates in both sexes, especially among males. The proportion of deaths due to respiratory diseases was higher among older ages.

CONCLUSION

Respiratory diseases are one of the main causes of hospitalization and death in the elderly population. Prevention and care for elderly, as well as further etiology studies should be a priority in Brazil.