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Palacio LC, Pachajoa DC, Echeverri-Londoño CA, Saiz J, Tobón C. Air Pollution and Cardiac Diseases: A Review of Experimental Studies. Dose Response 2023; 21:15593258231212793. [PMID: 37933269 PMCID: PMC10625734 DOI: 10.1177/15593258231212793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
Air pollution is associated with around 6.5 million premature deaths annually, which are directly related to cardiovascular diseases, and the most dangerous atmospheric pollutants to health are as follows: NO2, SO2, CO, and PM. The mechanisms underlying the observed effects have not yet been clearly defined. This work aims to conduct a narrative review of experimental studies to provide a more comprehensive and multiperspective assessment of how the effect of atmospheric pollutants on cardiac activity can result in the development of cardiac diseases. For this purpose, a review was carried out in databases of experimental studies, excluding clinical trials, and epidemiological and simulation studies. After analyzing the available information, the existence of pathophysiological effects of the different pollutants on cardiac activity from exposure during both short-term and long-term is evident. This narrative review based on experimental studies is a basis for the development of recommendations for public health.
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Affiliation(s)
| | | | | | - Javier Saiz
- Universitat Politècnica de València, Valencia, Spain
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2
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Gao P, Wu Y, He L, Wang L, Fu Y, Chen J, Zhang F, Krafft T, Martens P. Adverse short-term effects of ozone on cardiovascular mortalities modified by season and temperature: a time-series study. Front Public Health 2023; 11:1182337. [PMID: 37361179 PMCID: PMC10288843 DOI: 10.3389/fpubh.2023.1182337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Ambient ozone pollution becomes critical in China. Conclusions on the short-term effects of ozone on cardiovascular mortality have been controversial and limited on cause-specific cardiovascular mortalities and their interactions with season and temperature. This research aimed to investigate the short-term effects of ozone and the modifications of season and temperature on cardiovascular mortality. Methods Cardiovascular death records, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were analyzed. Daily 1-h maximum of ozone and daily maximum 8-h moving average of ozone were studied. Generalized additive models (GAMs) were applied to evaluate their associations with cardiovascular mortalities in sex and age groups. Effect modifications were assessed by stratifying season and temperature. Results Distributed lag impacts of ozone on total cardiovascular deaths and cumulative effects on mortality due to ischemic heart disease (IHD) were most significant. Population under 65 years old was most susceptible. Majority of significant effects were found in warm season, at high temperature, and at extreme heat. Ozone-associated risks in total deaths caused by hypertensive diseases reduced in warm season, while risks in IHD in males increased at high temperature. Extreme heat enhanced ozone effects on deaths caused by CVDs and IHD in the population under 65 years old. Discussion The revealed cardiovascular impacts of ozone below current national standard of air quality suggested improved standards and interventions in China. Higher temperature, particularly extreme heat, rather than warm season, could significantly enhance the adverse effects of ozone on cardiovascular mortality in population under 65 years old.
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Affiliation(s)
- Panjun Gao
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lihuan He
- China National Environmental Monitoring Centre, Beijing, China
| | - Li Wang
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Yingbin Fu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jinrong Chen
- China National Environmental Monitoring Centre, Beijing, China
| | - Fengying Zhang
- China National Environmental Monitoring Centre, Beijing, China
| | - Thomas Krafft
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Pim Martens
- University College Venlo, Maastricht University, Venlo, Netherlands
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3
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Ambient air pollution exposure and radiographic pulmonary vascular volumes. Environ Epidemiol 2021; 5:e143. [PMID: 33870015 PMCID: PMC8043731 DOI: 10.1097/ee9.0000000000000143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022] Open
Abstract
Supplemental Digital Content is available in the text. Exposure to higher levels of ambient air pollution is a known risk factor for cardiovascular disease but long-term effects of pollution exposure on the pulmonary vessels are unknown.
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Huang J, Song Y, Chu M, Dong W, Miller MR, Loh M, Xu J, Yang D, Chi R, Yang X, Wu S, Guo X, Deng F. Cardiorespiratory responses to low-level ozone exposure: The inDoor Ozone Study in childrEn (DOSE). ENVIRONMENT INTERNATIONAL 2019; 131:105021. [PMID: 31349208 DOI: 10.1016/j.envint.2019.105021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Indoor air pollution has emerged as a significant environmental and public health concern in recent years. However, evidence regarding the cardiorespiratory effects of indoor ozone is limited, and the underlying biological mechanisms are unclear, especially in children. Our study aimed to assess the cardiorespiratory responses to indoor ozone exposure in children. METHODS A repeated-measure study was conducted in 46 middle-school children in Beijing, China. Real-time concentrations of ozone, along with co-pollutants including particulate matter (PM) and black carbon (BC), were monitored in classrooms from Monday to Friday. Three repeated health measurements of cardiorespiratory functions, including ambulatory electrocardiogram (ECG), blood pressure, fractional exhaled nitric oxide (FeNO) and lung function, were performed on each participant. Mixed-effect models were used to evaluate the effects of indoor ozone exposure. RESULTS The mean (SD) indoor ozone concentration was 8.7 (6.6) ppb during the study period, which was largely below the current guideline and standards. However, even this low-level ozone exposure was associated with reduced cardiac autonomic function and increased heart rate (HR) in children. For instance, per interquartile range (IQR) increase in ozone at 2-hour moving average was associated with -7.8% (95% CI: -9.9%, -5.6%) reduction in standard deviation of all normal-to-normal intervals (SDNN), and 2.6% (95% CI: 1.6%, 3.6%) increment in HR. In addition, the associations were stronger at high BC levels (BC ≥ 3.7 μg/m3). No significant associations were found for airway inflammation and pulmonary function. CONCLUSIONS Exposure to low-level indoor ozone that is not associated with respiratory effects was significantly related to disturbed cardiac autonomic function and increased HR in children, which suggested a possible mechanism through which ozone may affect cardiovascular health in children, and indicated more protective measures should be taken to alleviate the acute adverse effects of indoor ozone in this susceptible population.
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Affiliation(s)
- Jing Huang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Mengtian Chu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Wei Dong
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Mark R Miller
- University/BHF Centre for Cardiovascular Science, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Miranda Loh
- Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh, UK
| | - Junhui Xu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Di Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Rui Chi
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Xuan Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.
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Rich DQ, Balmes JR, Frampton MW, Zareba W, Stark P, Arjomandi M, Hazucha MJ, Costantini MG, Ganz P, Hollenbeck-Pringle D, Dagincourt N, Bromberg PA. Cardiovascular function and ozone exposure: The Multicenter Ozone Study in oldEr Subjects (MOSES). ENVIRONMENT INTERNATIONAL 2018; 119:193-202. [PMID: 29980042 DOI: 10.1016/j.envint.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/08/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND To date, there have been relatively few studies of acute cardiovascular responses to controlled ozone inhalation, although a number of observational studies have reported significant positive associations between both ambient ozone levels and acute cardiovascular events and long-term ozone exposure and cardiovascular mortality. OBJECTIVES We hypothesized that short-term controlled exposure to low levels of ozone in filtered air would induce autonomic imbalance, repolarization abnormalities, arrhythmia, and vascular dysfunction. METHODS This randomized crossover study of 87 healthy volunteers 55-70 years of age was conducted at three sites using a common protocol, from June 2012 to April 2015. Subjects were exposed for 3 h in random order to 0 ppb (filtered air), 70 ppb ozone, and 120 ppb ozone, alternating 15 min of moderate exercise with 15 min of rest. A suite of cardiovascular endpoints was measured the day before, the day of, and up to 22 h after each exposure. Mixed effect linear and logit models evaluated the impact of exposure to ozone on pre-specified primary and secondary outcomes. Site and time were included in the models. RESULTS We found no significant effects of ozone exposure on any of the primary or secondary measures of autonomic function, repolarization, ST segment change, arrhythmia, or vascular function (systolic blood pressure and flow-mediated dilation). CONCLUSIONS In this multicenter study of older healthy women and men, there was no convincing evidence for acute effects of 3-h, relatively low-level ozone exposures on cardiovascular function. However, we cannot exclude the possibility of effects with higher ozone concentrations, more prolonged exposure, or in subjects with underlying cardiovascular disease. Further, we cannot exclude the possibility that exposure to ambient ozone and other pollutants in the days before the experimental exposures obscured or blunted cardiovascular biomarker response to the controlled ozone exposures.
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Affiliation(s)
- David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - John R Balmes
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Mark W Frampton
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Wojciech Zareba
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Paul Stark
- New England Research Institute, Watertown, MA, United States of America
| | - Mehrdad Arjomandi
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
| | - Milan J Hazucha
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, United States of America
| | | | - Peter Ganz
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
| | | | | | - Philip A Bromberg
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC, United States of America
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Tran H, Kim J, Kim D, Choi M, Choi M. Impact of air pollution on cause-specific mortality in Korea: Results from Bayesian Model Averaging and Principle Component Regression approaches. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 636:1020-1031. [PMID: 29729505 DOI: 10.1016/j.scitotenv.2018.04.273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
Health effects related to air pollution are a major global concern. Related studies based on reliable exposure assessment methods would potentially enable policy makers to propose appropriate environmental management policies. In this study, integrated Bayesian Model Averaging (BMA) and Principle Component Regression (PCR) were adopted to assess the severity of air pollution impacts on mortality related to circulatory, respiratory and skin diseases in 25 districts of Seoul, South Korea for the years 2005-2015. These methods were consistent in determining the best regression models and most important pollutants related to mortality in those highly susceptible to poor air quality. Specifically, the results demonstrated that pneumonia was highly associated with air pollution, with a large determination coefficient (BMA: 0.46, PCR: 0.51) and high model's posterior probability (0.47). The most reliable prediction model for pneumonia was indicated by the lowest Bayesian Information Criterion. Among the pollutants, particulate matter with an aerodynamic diameter of 10 μm or less (PM10) was associated with serious health risks on evaluation, with the highest posterior inclusion probabilities (range, 80.20 to 100.00%) and significantly positive correlation coefficients (range, 0.14 to 0.34, p < 0.05). In addition, excessive PM10 concentration (approximately 2.54 times the threshold) and a continuous increase in mortality due to respiratory diseases (approximately 1.50-fold in 10 years) were also exhibited. Overall, the results of this study suggest that currently, socio-environmental policies and international collaboration to mitigate health effects of air pollution is necessary in Seoul, Korea. Moreover, consideration of uncertainty of the regression model, which was verified in this research, will facilitate further application of this approach and enable optimal prediction of interactions between human and environmental factors.
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Affiliation(s)
- Hien Tran
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 440-746, Republic of Korea
| | - Jeongyeong Kim
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 440-746, Republic of Korea
| | - Daeun Kim
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 440-746, Republic of Korea
| | - Minyoung Choi
- Department of Medical Business Administration, Kyunghee University, Republic of Korea
| | - Minha Choi
- Graduate School of Water Resources, Sungkyunkwan University, Suwon 440-746, Republic of Korea.
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Li H, Wu S, Pan L, Xu J, Shan J, Yang X, Dong W, Deng F, Chen Y, Shima M, Guo X. Short-term effects of various ozone metrics on cardiopulmonary function in chronic obstructive pulmonary disease patients: Results from a panel study in Beijing, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 232:358-366. [PMID: 28987568 DOI: 10.1016/j.envpol.2017.09.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/09/2017] [Accepted: 09/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Short-term exposure to ambient air pollution has been associated with lower pulmonary function and higher blood pressure (BP). However, controversy remains regarding the relationship between ambient multiple daily ozone (O3) metrics and cardiopulmonary health outcomes, especially in the developing countries. OBJECTIVES To investigate and compare the short-term effects of various O3 metrics on pulmonary function, fractional exhaled nitric oxide (FeNO) and BP in a panel study of COPD patients. METHODS We measured pulmonary function, FeNO and BP repeatedly in a total of 43 patients with COPD for 215 home visits. Daily hourly ambient O3 concentrations were obtained from central-monitoring stations close to subject residences. We calculated various O3 metrics [daily 1-h maximum (O3-1 h max), maximum 8-h average (O3-8 h max) and 24-h average (O3-24 h avg)] based on the hourly data. Daily indoor O3 concentrations were estimated based on estimated indoor/outdoor O3 ratios. Linear mixed-effects models were used to estimate associations of various O3 metrics with cardiopulmonary function variables. RESULTS An interquartile range (IQR) increase in ambient O3-8 h max (80.5 μg/m3, 5-d) was associated with a 5.9% (95%CI: -11.0%, -0.7%) reduction in forced expiratory volume in 1 s (FEV1) and a 6.2% (95%CI: -10.9%, -1.5%) reduction in peak expiratory flow (PEF). However, there were no significant negative associations between ambient O3-1 h max, O3-24 h avg and FEV1, PEF. An IQR increase in ambient O3-1 h max (85.3 μg/m3, 6-d) was associated with a 6.7 mmHg (95%CI: 0.7, 12.7) increase in systolic BP. The estimated indoor O3 were still significantly associated with reduction of FEV1 and PEF. No significant associations were found between various O3 metrics and FeNO. CONCLUSIONS Our results provide clues for the adverse cardiopulmonary effects associated with various O3 metrics in COPD patients and highlight that O3-8 h max was more closely associated with respiratory health variables.
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Affiliation(s)
- Hongyu Li
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Lu Pan
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Junhui Xu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Jiao Shan
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Xuan Yang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Wei Dong
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China.
| | - Yahong Chen
- Respiratory Department, Peking University Third Hospital, Beijing, China
| | - Masayuki Shima
- Department of Public Health, Hyogo College of Medicine, Hyogo, Japan
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
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A Monitoring System for Laying Hens That Uses a Detection Sensor Based on Infrared Technology and Image Pattern Recognition. SENSORS 2017; 17:s17061195. [PMID: 28538654 PMCID: PMC5492731 DOI: 10.3390/s17061195] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/20/2017] [Accepted: 05/20/2017] [Indexed: 11/17/2022]
Abstract
In Italy, organic egg production farms use free-range housing systems with a big outdoor area and a flock of no more than 500 hens. With additional devices and/or farming procedures, the whole flock could be forced to stay in the outdoor area for a limited time of the day. As a consequence, ozone treatments of housing areas could be performed in order to reduce the levels of atmospheric ammonia and bacterial load without risks, due by its toxicity, both for hens and workers. However, an automatic monitoring system, and a sensor able to detect the presence of animals, would be necessary. For this purpose, a first sensor was developed but some limits, related to the time necessary to detect a hen, were observed. In this study, significant improvements, for this sensor, are proposed. They were reached by an image pattern recognition technique that was applied to thermografic images acquired from the housing system. An experimental group of seven laying hens was selected for the tests, carried out for three weeks. The first week was used to set-up the sensor. Different templates, to use for the pattern recognition, were studied and different floor temperature shifts were investigated. At the end of these evaluations, a template of elliptical shape, and sizes of 135 × 63 pixels, was chosen. Furthermore, a temperature shift of one degree was selected to calculate, for each image, a color background threshold to apply in the following field tests. Obtained results showed an improvement of the sensor detection accuracy that reached values of sensitivity and specificity of 95.1% and 98.7%. In addition, the range of time necessary to detect a hen, or classify a case, was reduced at two seconds. This result could allow the sensor to control a bigger area of the housing system. Thus, the resulting monitoring system could allow to perform the sanitary treatments without risks both for animals and humans.
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Zaninelli M, Redaelli V, Tirloni E, Bernardi C, Dell'Orto V, Savoini G. First Results of a Detection Sensor for the Monitoring of Laying Hens Reared in a Commercial Organic Egg Production Farm Based on the Use of Infrared Technology. SENSORS 2016; 16:s16101757. [PMID: 27775658 PMCID: PMC5087541 DOI: 10.3390/s16101757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 11/30/2022]
Abstract
The development of a monitoring system to identify the presence of laying hens, in a closed room of a free-range commercial organic egg production farm, was the aim of this study. This monitoring system was based on the infrared (IR) technology and had, as final target, a possible reduction of atmospheric ammonia levels and bacterial load. Tests were carried out for three weeks and involved 7 ISA (Institut de Sélection Animale) brown laying hens. The first 5 days was used to set up the detection sensor, while the other 15 days were used to evaluate the accuracy of the resulting monitoring system, in terms of sensitivity and specificity. The setup procedure included the evaluation of different color background (CB) thresholds, used to discriminate the information contents of the thermographic images. At the end of this procedure, a CB threshold equal to an increase of 3 °C from the floor temperature was chosen, and a cutoff level of 196 colored pixels was identified as the threshold to use to classify a positive case. The results of field tests showed that the developed monitoring system reached a fine detection accuracy (sensitivity = 97.9% and specificity = 94.9%) and the IR technology proved to be a possible solution for the development of a detection sensor necessary to reach the scope of this study.
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Affiliation(s)
- Mauro Zaninelli
- Università Telematica San Raffaele Roma, Via di Val Cannuta 247, Rome 00166, Italy.
| | - Veronica Redaelli
- Freelance Certified Infrared Thermal Technician, Oggiono (LC) 23848, Italy.
| | - Erica Tirloni
- Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, Milan 20133, Italy.
| | - Cristian Bernardi
- Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, Milan 20133, Italy.
| | - Vittorio Dell'Orto
- Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, Milan 20133, Italy.
| | - Giovanni Savoini
- Department of Health, Animal Science and Food Safety (VESPA), Università degli Studi di Milano, Via Celoria 10, Milan 20133, Italy.
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Amegah AK, Rezza G, Jaakkola JJK. Temperature-related morbidity and mortality in Sub-Saharan Africa: A systematic review of the empirical evidence. ENVIRONMENT INTERNATIONAL 2016; 91:133-149. [PMID: 26949867 DOI: 10.1016/j.envint.2016.02.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) contributes very little to overall climate change and yet it is estimated to bear the highest burden of climate change, with 34% of the global DALYs attributable to the effects of climate change found in SSA. With the exception of vector-borne diseases, particularly malaria, there is very limited research on human health effects of climate change in SSA, in spite of growing awareness of the region's vulnerability to climate change. OBJECTIVES Our objective is to systematically review all studies investigating temperature variability and non-vector borne morbidity and mortality in SSA to establish the state and quality of available evidence, identify gaps in knowledge, and propose future research priorities. METHODS PubMed, Ovid Medline and Scopus were searched from their inception to the end of December 2014. We modified the GRADE guidelines to rate the quality of the body of evidence. RESULTS Of 6745 studies screened, 23 studies satisfied the inclusion criteria. Moderate evidence exists to associate temperature variability with cholera outbreaks, cardiovascular disease hospitalization and deaths, and all-cause deaths in the region. The quality of evidence on child undernutrition is low, and for diarrhea occurrence, meningitis, Ebola, asthma and respiratory diseases, and skin diseases, very low. CONCLUSIONS The evidence base is somehow weakened by the limited number of studies uncovered, methodological limitations of the studies, and notable inconsistencies in the study findings. Further research with robust study designs and standardized analytical methods is thus needed to produce more credible evidence base to inform climate change preparedness plans and public health policies for improved adaptive capacity in SSA. Investment in meteorological services, and strengthening of health information systems is also required to guarantee timely, up-to-date and reliable data.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana; Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
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11
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Goodman JE, Prueitt RL, Sax SN, Pizzurro DM, Lynch HN, Zu K, Venditti FJ. Ozone exposure and systemic biomarkers: Evaluation of evidence for adverse cardiovascular health impacts. Crit Rev Toxicol 2016; 45:412-52. [PMID: 25959700 DOI: 10.3109/10408444.2015.1031371] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The US Environmental Protection Agency (EPA) recently concluded that there is likely to be a causal relationship between short-term (< 30 days) ozone exposure and cardiovascular (CV) effects; however, biological mechanisms to link transient effects with chronic cardiovascular disease (CVD) have not been established. Some studies assessed changes in circulating levels of biomarkers associated with inflammation, oxidative stress, coagulation, vasoreactivity, lipidology, and glucose metabolism after ozone exposure to elucidate a biological mechanism. We conducted a weight-of-evidence (WoE) analysis to determine if there is evidence supporting an association between changes in these biomarkers and short-term ozone exposure that would indicate a biological mechanism for CVD below the ozone National Ambient Air Quality Standard (NAAQS) of 75 parts per billion (ppb). Epidemiology findings were mixed for all biomarker categories, with only a few studies reporting statistically significant changes and with no consistency in the direction of the reported effects. Controlled human exposure studies of 2 to 5 hours conducted at ozone concentrations above 75 ppb reported small elevations in biomarkers for inflammation and oxidative stress that were of uncertain clinical relevance. Experimental animal studies reported more consistent results among certain biomarkers, although these were also conducted at ozone exposures well above 75 ppb and provided limited information on ozone exposure-response relationships. Overall, the current WoE does not provide a convincing case for a causal relationship between short-term ozone exposure below the NAAQS and adverse changes in levels of biomarkers within and across categories, but, because of study limitations, they cannot not provide definitive evidence of a lack of causation.
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Zúñiga J, Tarajia M, Herrera V, Urriola W, Gómez B, Motta J. Assessment of the Possible Association of Air Pollutants PM10, O3, NO2 With an Increase in Cardiovascular, Respiratory, and Diabetes Mortality in Panama City: A 2003 to 2013 Data Analysis. Medicine (Baltimore) 2016; 95:e2464. [PMID: 26765444 PMCID: PMC4718270 DOI: 10.1097/md.0000000000002464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In recent years, Panama has experienced a marked economic growth, and this, in turn, has been associated with rapid urban development and degradation of air quality. This study is the first evaluation done in Panama on the association between air pollution and mortality. Our objective was to assess the possible association between monthly levels of PM10, O3, and NO2, and cardiovascular, respiratory, and diabetes mortality, as well as the seasonal variation of mortality in Panama City, Panama.The study was conducted in Panama City, using air pollution data from January 2003 to December 2013. We utilized a Poisson regression model based on generalized linear models, to evaluate the association between PM10, NO2, and O3 exposure and mortality from diabetes, cardiovascular, and respiratory diseases. The sample size for PM10, NO2, and O2 was 132, 132, and 108 monthly averages, respectively.We found that levels of PM10, O3, and NO2 were associated with increases in cardiovascular, respiratory, and diabetes mortality. For PM10 levels ≥ 40 μg/m3, we found an increase in cardiovascular mortality of 9.7% (CI 5.8-13.6%), and an increase of 12.6% (CI 0.2-24.2%) in respiratory mortality. For O3 levels ≥ 20 μg/m3 we found an increase of 32.4% (IC 14.6-52.9) in respiratory mortality, after a 2-month lag period following exposure in the 65 to <74 year-old age group. For NO2 levels ≥20 μg/m3 we found an increase in respiratory mortality of 11.2% (IC 1.9-21.3), after a 2-month lag period following exposure among those aged between 65 and <74 years.There could be an association between the air pollution in Panama City and an increase in cardiovascular, respiratory, and diabetes mortality. This study confirms the urgent need to improve the measurement frequency of air pollutants in Panama.
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Affiliation(s)
- Julio Zúñiga
- From the Gorgas Memorial Institute for Health Studies (JZ, VH, BG, JM); Centro de Biología Molecular y Celular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (MT); Región de Panamá Oeste, Caja de Seguro Social, Panama City, Panama (MT); and Institute of Specialized Analysis of the University of Panama, Miraflores, Panama City, Panama (WU)
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13
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Frampton MW, Pietropaoli A, Dentler M, Chalupa D, Little EL, Stewart J, Frasier L, Oakes D, Wiltshire J, Vora R, Utell MJ. Cardiovascular effects of ozone in healthy subjects with and without deletion of glutathione-S-transferase M1. Inhal Toxicol 2015; 27:113-9. [PMID: 25600221 DOI: 10.3109/08958378.2014.996272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Exposure to ozone has acute respiratory effects, but few human clinical studies have evaluated cardiovascular effects. OBJECTIVE We hypothesized that ozone exposure alters pulmonary and systemic vascular function, and cardiac function, with more pronounced effects in subjects with impaired antioxidant defense from deletion of the glutathione-S-transferase M1 gene (GSTM1 null). METHODS Twenty-four young, healthy never-smoker subjects (12 GSTM1 null) inhaled filtered air, 100 ppb ozone and 200 ppb ozone for 3 h, with intermittent exercise, in a double-blind, randomized, crossover fashion. Exposures were separated by at least 2 weeks. Vital signs, spirometry, arterial and venous blood nitrite levels, impedance cardiography, peripheral arterial tonometry, estimation of pulmonary capillary blood volume (Vc), and blood microparticles and platelet activation were measured at baseline and during 4 h after each exposure. RESULTS Ozone inhalation decreased lung function immediately after exposure (mean ± standard error change in FEV1, air: -0.03 ± 0.04 L; 200 ppb ozone: -0.30 ± 0.07 L; p < 0.001). The immediate post-exposure increase in blood pressure, caused by the final 15-min exercise period, was blunted by 200 ppb ozone exposure (mean ± standard error change for air: 16.7 ± 2.6 mmHg; 100 ppb ozone: 14.5 ± 2.4 mmHg; 200 ppb ozone: 8.5 ± 2.5 mmHg; p = 0.02). We found no consistent effects of ozone on any other measure of cardiac or vascular function. All results were independent of the GSTM1 genotype. CONCLUSIONS We did not find convincing evidence for early acute adverse cardiovascular consequences of ozone exposure in young healthy adults. The ozone-associated blunting of the blood pressure response to exercise is of unclear clinical significance.
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14
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Goodman JE, Prueitt RL, Sax SN, Lynch HN, Zu K, Lemay JC, King JM, Venditti FJ. Weight-of-evidence evaluation of short-term ozone exposure and cardiovascular effects. Crit Rev Toxicol 2015; 44:725-90. [PMID: 25257961 DOI: 10.3109/10408444.2014.937854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a relatively large body of research on the potential cardiovascular (CV) effects associated with short-term ozone exposure (defined by EPA as less than 30 days in duration). We conducted a weight-of-evidence (WoE) analysis to assess whether it supports a causal relationship using a novel WoE framework adapted from the US EPA's National Ambient Air Quality Standards causality framework. Specifically, we synthesized and critically evaluated the relevant epidemiology, controlled human exposure, and experimental animal data and made a causal determination using the same categories proposed by the Institute of Medicine report Improving the Presumptive Disability Decision-making Process for Veterans ( IOM 2008). We found that the totality of the data indicates that the results for CV effects are largely null across human and experimental animal studies. The few statistically significant associations reported in epidemiology studies of CV morbidity and mortality are very small in magnitude and likely attributable to confounding, bias, or chance. In experimental animal studies, the reported statistically significant effects at high exposures are not observed at lower exposures and thus not likely relevant to current ambient ozone exposures in humans. The available data also do not support a biologically plausible mechanism for CV effects of ozone. Overall, the current WoE provides no convincing case for a causal relationship between short-term exposure to ambient ozone and adverse effects on the CV system in humans, but the limitations of the available studies preclude definitive conclusions regarding a lack of causation. Thus, we categorize the strength of evidence for a causal relationship between short-term exposure to ozone and CV effects as "below equipoise."
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15
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Arjomandi M, Wong H, Donde A, Frelinger J, Dalton S, Ching W, Power K, Balmes JR. Exposure to medium and high ambient levels of ozone causes adverse systemic inflammatory and cardiac autonomic effects. Am J Physiol Heart Circ Physiol 2015; 308:H1499-509. [PMID: 25862833 DOI: 10.1152/ajpheart.00849.2014] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/31/2015] [Indexed: 01/03/2023]
Abstract
Epidemiological evidence suggests that exposure to ozone increases cardiovascular morbidity. However, the specific biological mechanisms mediating ozone-associated cardiovascular effects are unknown. To determine whether short-term exposure to ambient levels of ozone causes changes in biomarkers of cardiovascular disease including heart rate variability (HRV), systemic inflammation, and coagulability, 26 subjects were exposed to 0, 100, and 200 ppb ozone in random order for 4 h with intermittent exercise. HRV was measured and blood samples were obtained immediately before (0 h), immediately after (4 h), and 20 h after (24 h) each exposure. Bronchoscopy with bronchoalveolar lavage (BAL) was performed 20 h after exposure. Regression modeling was used to examine dose-response trends between the endpoints and ozone exposure. Inhalation of ozone induced dose-dependent adverse changes in the frequency domains of HRV across exposures consistent with increased sympathetic tone [increase of (parameter estimate ± SE) 0.4 ± 0.2 and 0.3 ± 0.1 in low- to high-frequency domain HRV ratio per 100 ppb increase in ozone at 4 h and 24 h, respectively (P = 0.02 and P = 0.01)] and a dose-dependent increase in serum C-reactive protein (CRP) across exposures at 24 h [increase of 0.61 ± 0.24 mg/l in CRP per 100 ppb increase in ozone (P = 0.01)]. Changes in HRV and CRP did not correlate with ozone-induced local lung inflammatory responses (BAL granulocytes, IL-6, or IL-8), but changes in HRV and CRP were associated with each other after adjustment for age and ozone level. Inhalation of ozone causes adverse systemic inflammatory and cardiac autonomic effects that may contribute to the cardiovascular mortality associated with short-term exposure.
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Affiliation(s)
- Mehrdad Arjomandi
- Human Exposure Laboratory, Division of Occupational and Environmental Medicine, San Francisco General Hospital Medical Center, San Francisco, California; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, California; Pulmonary Research Group, San Francisco Veterans Affairs Medical Center, San Francisco, California;
| | - Hofer Wong
- Human Exposure Laboratory, Division of Occupational and Environmental Medicine, San Francisco General Hospital Medical Center, San Francisco, California
| | - Aneesh Donde
- Human Exposure Laboratory, Division of Occupational and Environmental Medicine, San Francisco General Hospital Medical Center, San Francisco, California
| | - Jessica Frelinger
- Human Exposure Laboratory, Division of Occupational and Environmental Medicine, San Francisco General Hospital Medical Center, San Francisco, California; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, California; Pulmonary Research Group, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sarah Dalton
- Pulmonary Research Group, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Wendy Ching
- Pulmonary Research Group, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Karron Power
- Human Exposure Laboratory, Division of Occupational and Environmental Medicine, San Francisco General Hospital Medical Center, San Francisco, California
| | - John R Balmes
- Human Exposure Laboratory, Division of Occupational and Environmental Medicine, San Francisco General Hospital Medical Center, San Francisco, California; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, California; School of Public Health, University of California Berkeley, Berkeley, California
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16
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Bates ML, Brenza TM, Ben-Jebria A, Bascom R, Eldridge MW, Ultman JS. Pulmonary function responses to ozone in smokers with a limited smoking history. Toxicol Appl Pharmacol 2014; 278:85-90. [PMID: 24747805 DOI: 10.1016/j.taap.2014.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022]
Abstract
In non-smokers, ozone (O3) inhalation causes decreases in forced expiratory volume (FEV1) and dead space (VD) and increases the slope of the alveolar plateau (SN). We previously described a population of smokers with a limited smoking history that had enhanced responsiveness to brief O3 boluses and aimed to determine if responsiveness to continuous exposure was also enhanced. Thirty smokers (19M, 11F, 24±4 years, 6±4 total years smoking,4±2 packs/week) and 30 non-smokers (17M, 13F, 25±6 years) exercised for 1h on a cycle ergometer while breathing 0.30ppm O3. Smokers and non-smokers were equally responsive in terms of FEV1 (-9.5±1.8% vs -8.7±1.9%). Smokers alone were responsive in terms of VD (-6.1±1.2%) and SN (9.1±3.4%). There was no difference in total delivered dose. Dead space ventilation (VD/VT) was not initially different between the two groups, but increased in the non-smokers (16.4±2.8%) during the exposure, suggesting that the inhaled dose may be distributed more peripherally in smokers. We also conclude that these cigarette smokers retain their airway responsiveness to O3 and, uniquely, experience changes in VD that lead to heterogeneity in airway morphometry and an increase in SN.
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Affiliation(s)
- Melissa L Bates
- Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802, USA; Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
| | - Timothy M Brenza
- Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802, USA
| | - Abdellaziz Ben-Jebria
- Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802, USA; Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802, USA
| | - Rebecca Bascom
- Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Marlowe W Eldridge
- Department of Pediatrics, Critical Care Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53792, USA; Department of Bioengineering, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - James S Ultman
- Interdisciplinary Graduate Degree Program in Physiology, Pennsylvania State University, University Park, PA 16802, USA; Department of Chemical Engineering, Pennsylvania State University, University Park, PA 16802, USA
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17
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Brink CB, Pretorius A, van Niekerk BP, Oliver DW, Venter DP. Studies on cellular resilience and adaptation following acute and repetitive exposure to ozone in cultured human epithelial (HeLa) cells. Redox Rep 2013; 13:87-100. [DOI: 10.1179/135100008x259187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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18
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Anderson GB, Krall JR, Peng RD, Bell ML. The authors reply. Am J Epidemiol 2013; 177:1460-2. [PMID: 23894752 DOI: 10.1093/aje/kwt080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G. Brooke Anderson
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
| | - Jenna R. Krall
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
| | - Roger D. Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT 06511
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19
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Abstract
Background—
Evidence of an association between the exposure to air pollution and overall cardiovascular morbidity and mortality is increasingly found in the literature. However, results from studies of the association between acute air pollution exposure and risk of out-of-hospital cardiac arrest (OHCA) are inconsistent for fine particulate matter, and, although pathophysiological evidence indicates a plausible link between OHCA and ozone, none has been reported. Approximately 300 000 persons in the United States experience an OHCA each year, of which >90% die. Understanding the association provides important information to protect public health.
Methods and Results—
The association between OHCA and air pollution concentrations hours and days before onset was assessed by using a time-stratified case-crossover design using 11 677 emergency medical service–logged OHCA events between 2004 and 2011 in Houston, Texas. Air pollution concentrations were obtained from an extensive area monitor network. An average increase of 6 µg/m
3
in fine particulate matter 2 days before onset was associated with an increased risk of OHCA (1.046; 95% confidence interval, 1.012–1.082). A 20-ppb ozone increase for the 8-hour average daily maximum was associated with an increased risk of OHCA on the day of the event (1.039; 95% confidence interval, 1.005–1.073). Each 20-ppb increase in ozone in the previous 1 to 3 hours was associated with an increased risk of OHCA (1.044; 95% confidence interval, 1.004–1.085). Relative risk estimates were higher for men, blacks, or those aged >65 years.
Conclusions—
The findings confirm the link between OHCA and fine particulate matter and introduce evidence of a similar link with ozone.
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20
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Tankersley CG, Georgakopoulos D, Tang WY, Abston E, Bierman A, Sborz N. Effects of ozone and particulate matter on cardiac mechanics: role of the atrial natriuretic peptide gene. Toxicol Sci 2012; 131:95-107. [PMID: 22977167 DOI: 10.1093/toxsci/kfs273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A positive association between air pollution exposure and increased human risk of chronic heart disease progression is well established. In the current study, we test two hypotheses: (1) the cardiac compensatory changes in response to air pollution are dependent on its composition and (2) specific cardiac adaptations are regulated by atrial natriuretic peptide (ANP). We address these hypotheses by initially examining the exposure effects of ozone (O(3)) and/or particulate matter (PM) on cardiac function in C57Bl/6J (B6) mice. Subsequently, the results are compared with cardiac functional changes to the same exposures in Nppa (the precursor gene for ANP) knockout (KO) mice. Separate groups of mice underwent 3 consecutive days of the same exposure sequence for 3h each consisting of the following: (1) 6h of filtered air (FAFA), (2) O(3) then FA (O(3)FA), (3) FA then carbon black (FACB), or (4) O(3) then CB. Cardiac function was assessed using a conductance catheter to generate cardiac pressure-volume loops 8-10h following each exposure sequence. As compared with FAFA, each sequence led to a substantial drop (as much as 33%) in stroke volume and cardiac output. However, these losses of cardiac function occurred by different compensatory mechanisms dependent on the pollutant composition. For example, O(3)FA exposure led to reductions in both end-systolic and end-diastolic left ventricular (LV) volumes, whereas FACB exposure led an increase in end-diastolic LV volume. These same cardiac compensatory changes were largely abolished in Nppa KO mice following O(3)FA or FACB exposure. These results suggest that cardiac functional changes in response to air pollution exposure are strongly dependent on the pollutant constituents, especially related to O(3) and/or PM. Furthermore, ANP regulation appears to be crucial to these cardiac compensatory mechanisms induced by air pollution.
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Affiliation(s)
- Clarke G Tankersley
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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21
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Devlin RB, Duncan KE, Jardim M, Schmitt MT, Rappold AG, Diaz-Sanchez D. Controlled exposure of healthy young volunteers to ozone causes cardiovascular effects. Circulation 2012; 126:104-11. [PMID: 22732313 DOI: 10.1161/circulationaha.112.094359] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent epidemiology studies have reported associations between short-term ozone exposure and mortality. Such studies have previously reported associations between airborne particulate matter pollution and mortality, and support for a causal relationship has come from controlled-exposure studies that describe pathophysiological mechanisms by which particulate matter could induce acute mortality. In contrast, for ozone, almost no controlled-human-exposure studies have tested whether ozone exposure can modulate the cardiovascular system. METHODS AND RESULTS Twenty-three young healthy individuals were exposed in a randomized crossover fashion to clean air and to 0.3-ppm ozone for 2 hours while intermittently exercising. Blood was obtained immediately before exposure, immediately afterward, and the next morning. Continuous Holter monitoring began immediately before exposure and continued for 24 hours. Lung function was performed immediately before and immediately after exposure, and bronchoalveolar lavage was performed 24 hours after exposure. Immediately after ozone exposure, we observed a 98.9% increase in interleukin-8, a 21.4% decrease in plasminogen activator inhibitor-1, a 51.3% decrease in the high-frequency component of heart rate variability, and a 1.2% increase in QT duration. Changes in interleukin-1B and plasminogen activator inhibitor-1 were apparent 24 hours after exposure. In agreement with previous studies, we also observed ozone-induced drops in lung function and an increase in pulmonary inflammation. CONCLUSIONS This controlled-human-exposure study shows that ozone can cause an increase in vascular markers of inflammation and changes in markers of fibrinolysis and markers that affect autonomic control of heart rate and repolarization. We believe that these findings provide biological plausibility for the epidemiology studies that associate ozone exposure with mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01492517.
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Affiliation(s)
- Robert B Devlin
- National Health and Environmental Effects, Research Laboratory MD 58D, US EPA, Research Triangle Park, NC 27711, USA.
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22
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Farraj AK, Hazari MS, Winsett DW, Kulukulualani A, Carll AP, Haykal-Coates N, Lamb CM, Lappi E, Terrell D, Cascio WE, Costa DL. Overt and latent cardiac effects of ozone inhalation in rats: evidence for autonomic modulation and increased myocardial vulnerability. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:348-54. [PMID: 22138703 PMCID: PMC3295357 DOI: 10.1289/ehp.1104244] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/02/2011] [Indexed: 05/22/2023]
Abstract
BACKGROUND Ozone (O₃) is a well-documented respiratory oxidant, but increasing epidemiological evidence points to extrapulmonary effects, including positive associations between ambient O₃ concentrations and cardiovascular morbidity and mortality. OBJECTIVE With preliminary reports linking O₃ exposure with changes in heart rate (HR), we investigated the hypothesis that a single inhalation exposure to O₃ will cause concentration-dependent autonomic modulation of cardiac function in rats. METHODS Rats implanted with telemeters to monitor HR and cardiac electrophysiology [electrocardiography (ECG)] were exposed once by whole-body inhalation for 4 hr to 0.2 or 0.8 ppm O₃ or filtered air. A separate cohort was tested for vulnerability to aconitine-induced arrhythmia 24 hr after exposure. RESULTS Exposure to 0.8 ppm O₃ caused bradycardia, PR prolongation, ST depression, and substantial increases in atrial premature beats, sinoatrial block, and atrioventricular block, accompanied by concurrent increases in several HR variability parameters that were suggestive of increased parasympathetic tone. Low-O₃ exposure failed to elicit any overt changes in autonomic tone, heart rhythm, or ECG. However, both 0.2 and 0.8 ppm O₃ increased sensitivity to aconitine-induced arrhythmia formation, suggesting a latent O₃-induced alteration in myocardial excitability. CONCLUSIONS O₃ exposure causes several alterations in cardiac electrophysiology that are likely mediated by modulation of autonomic input to the heart. Moreover, exposure to low O₃ concentrations may cause subclinical effects that manifest only when triggered by a stressor, suggesting that the adverse health effects of ambient levels of air pollutants may be insidious and potentially underestimated.
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Affiliation(s)
- Aimen K Farraj
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA.
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23
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Spencer-Hwang R, Knutsen SF, Soret S, Ghamsary M, Beeson WL, Oda K, Shavlik D, Jaipaul N. Ambient air pollutants and risk of fatal coronary heart disease among kidney transplant recipients. Am J Kidney Dis 2011; 58:608-16. [PMID: 21778006 DOI: 10.1053/j.ajkd.2011.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 05/09/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is increasing evidence that specific ambient air pollutants are associated with coronary heart disease (CHD) morbidity and mortality. Because kidney transplant recipients have prevalent traditional and nontraditional risk factors, they may constitute a sensitive subgroup. STUDY DESIGN Retrospective cohort. SETTING & PARTICIPANTS This study includes 32,239 nonsmoking adult kidney transplant recipients who underwent transplant in 1997-2003, identified through the US Renal Data System and living in the United States within 50 km of an air pollution monitoring station. PREDICTOR Long-term ambient pollutant ozone and particulate matter ≤10 μm (PM(10)), assessed from monthly concentrations of ozone and PM(10) calculated from ambient monitoring data by the US Environmental Protection Agency Air Quality System and interpolated to zip code centroids according to patients' residence. OUTCOMES Outcomes of interest were death from CHD and natural-cause mortality. RESULTS For the entire transplant cohort, average pollutant levels for ozone and PM(10) were 25.5 ± 4.4 parts per billion (ppb) and 25.3 ± 6.4 μg/m(3), respectively. Correlation between ozone and PM(10) values was low, but statistically significant (P < 0.001). There were deaths from CHD (n = 267) and natural causes (n = 2,076) during the 7-year study period. For each 10-ppb increase in ozone, the risk of fatal CHD increased by 35% (RR, 1.35; 95% CI, 1.04-1.77) in the single-pollutant model and 34% (RR, 1.34; 95% CI, 1.03-1.76) in the 2-pollutant model. No independent association was found between CHD and PM(10). No significant association was identified for PM(10) or ozone level and natural-cause mortality (RR, 1.09; 95% CI, 0.99-1.21). LIMITATIONS Exposure assignment based on only residential location. CONCLUSIONS For kidney transplant recipients, ambient ozone levels potentially are associated with higher risk of fatal CHD. These findings may have implications for regulations governing air pollution and the development of individual CHD risk-reduction strategies.
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Affiliation(s)
- Rhonda Spencer-Hwang
- Department of Epidemiology and Biostatistics, Loma Linda University, CA 92354, USA.
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24
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Tankersley CG, Peng RD, Bedga D, Gabrielson K, Champion HC. Variation in echocardiographic and cardiac hemodynamic effects of PM and ozone inhalation exposure in strains related to Nppa and Npr1 gene knock-out mice. Inhal Toxicol 2010; 22:695-707. [PMID: 20540624 DOI: 10.3109/08958378.2010.487549] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elevated levels of ambient co-pollutants are associated with adverse cardiovascular outcomes shown by epidemiology studies. The role of particulate matter (PM) and ozone (O3) as co-pollutants in this association is unclear. We hypothesize that cardiac function following PM and O3 exposure is variably affected by genetic determinants (Nppa and Npr1 genes) and age. Heart function was measured before and after 2 days each of the following exposure sequence; (1) 2-h filtered air (FA) and 3-h carbon black (CB; 0.5 microg/m(3)); (2) 2-h O3 (0.6 ppm) and 3-h FA; (3) 5-h FA; and, (4) 2-h O3 and 3-h CB. Two age groups (5 and 18 months old (mo)) were tested in C57Bl/6J (B6) and 129S1/SvImJ (129) mice using echocardiographic (echo) and in vivo hemodynamic (IVH) measurements. With echo, posterior wall thickness was significantly (P < 0.01) greater in 129 relative to B6 mice at baseline. With CB exposure, young B6 and older 129 mice show significant (P < 0.01) reductions in fractional shortening (FS) compared to FA. With O3 exposure, FS was significantly (P < 0.01) diminished in young 129, which was attributable to significant increases in end-systolic left ventricular diameter. With O3 and CB combined, notable (P < 0.01) declines in heart rate and end-systolic posterior wall thickness occurred in young 129 mice. The IVH measurements showed striking (P < 0.05) compromises in cardiac function after CB and O3 exposure; however, strain differences were undetectable. These results suggest that PM and O3 exposures, alone and combined, lead to different cardiac functional changes, and these unique changes are age-specific and dependent on Nppa and Npr1 genes.
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Affiliation(s)
- Clarke G Tankersley
- Department of Environmental Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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25
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McClellan RO, Frampton MW, Koutrakis P, McDonnell WF, Moolgavkar S, North DW, Smith AE, Smith RL, Utell MJ. Critical considerations in evaluating scientific evidence of health effects of ambient ozone: a conference report. Inhal Toxicol 2010; 21 Suppl 2:1-36. [PMID: 19731972 DOI: 10.1080/08958370903176735] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The U.S. Environmental Protection Agency (EPA), under the authority of the Clean Air Act (CAA), is required to promulgate National Ambient Air Quality Standards (NAAQSs) for criteria air pollutants, including ozone. Each NAAQS includes a primary health-based standard and a secondary or welfare-based standard. This paper considers only the science used for revision of the primary standard for ozone in 2008. This paper summarizes deliberations of a small group of scientists who met in June 2007 to review the scientific information informing the EPA Administrator's proposed revision of the 1997 standard. The Panel recognized that there is no scientific methodology that, in the absence of judgment, can define the precise numerical level, related averaging time, and statistical form of the NAAQS. The selection of these elements of the NAAQS involves policy judgments that should be informed by scientific information and analyses. Thus, the Panel members did not feel it appropriate to offer either their individual or collective judgment on the specific numerical level of the NAAQS for ozone. The Panel deliberations focused on the scientific data available on the health effects of exposure to ambient concentrations of ozone, controlled ozone exposure studies with human volunteers, long-term epidemiological studies, time- series epidemiological studies, human panel studies, and toxicological investigations. The deliberations also dealt with the issue of background levels of ozone of nonanthropogenic origin and issues involved with conducting formal risk assessments of the health impacts of current and prospective levels of ambient ozone. The scientific issues that were central to the EPA Administrator's 2008 revision of the NAAQS for ozone will undoubtedly also be critical to the next review of the ozone standard. That review should begin very soon if it is to be completed within the 5-year cycle specified in the CAA. It is hoped that this Report will stimulate discussion of these scientific issues, conduct of additional research, and conduct of new analyses that will provide an improved scientific basis for the policy judgment that will have to be made by a future EPA Administrator in considering potential revision of the ozone standard.
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Affiliation(s)
- Roger O McClellan
- Toxicology and Human Health Risk Analysis, Albuquerque, NM 87111, USA.
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Smith KR, Jerrett M, Anderson HR, Burnett RT, Stone V, Derwent R, Atkinson RW, Cohen A, Shonkoff SB, Krewski D, Pope CA, Thun MJ, Thurston G. Public health benefits of strategies to reduce greenhouse-gas emissions: health implications of short-lived greenhouse pollutants. Lancet 2009; 374:2091-2103. [PMID: 19942276 PMCID: PMC4059357 DOI: 10.1016/s0140-6736(09)61716-5] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this report we review the health effects of three short-lived greenhouse pollutants-black carbon, ozone, and sulphates. We undertook new meta-analyses of existing time-series studies and an analysis of a cohort of 352,000 people in 66 US cities during 18 years of follow-up. This cohort study provides estimates of mortality effects from long-term exposure to elemental carbon, an indicator of black carbon mass, and evidence that ozone exerts an independent risk of mortality. Associations among these pollutants make drawing conclusions about their individual health effects difficult at present, but sulphate seems to have the most robust effects in multiple-pollutant models. Generally, the toxicology of the pure compounds and their epidemiology diverge because atmospheric black carbon, ozone, and sulphate are associated and could interact with related toxic species. Although sulphate is a cooling agent, black carbon and ozone could together exert nearly half as much global warming as carbon dioxide. The complexity of these health and climate effects needs to be recognised in mitigation policies.
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Affiliation(s)
- Kirk R Smith
- School of Public Health, University of alifornia, Berkeley, CA, USA.
| | - Michael Jerrett
- School of Public Health, University of alifornia, Berkeley, CA, USA
| | - H Ross Anderson
- Division of Community Health Sciences, MRC-HPA Centre for Environment and Health, St George's, University of London, London, UK; Environmental Research Group, MRC-HPA Centre for Environment and Health, King's College, London, UK
| | | | | | | | - Richard W Atkinson
- Division of Community Health Sciences, MRC-HPA Centre for Environment and Health, St George's, University of London, London, UK
| | | | - Seth B Shonkoff
- School of Public Health, University of alifornia, Berkeley, CA, USA; Department of Environmental Science, Policy, and Management, University of alifornia, Berkeley, CA, USA
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Schwean-Lardner K, Dahiya J, Olkowski A, Barber E, Riddell C, Classen H. Effect of adding ozone into an intensive broiler production unit on performance, mortality, ammonia levels, and bacterial levels as compared with a non-ozone-treated broiler unit. J APPL POULTRY RES 2009. [DOI: 10.3382/japr.2008-00049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Perepu RSP, Garcia C, Dostal D, Sethi R. Enhanced death signaling in ozone-exposed ischemic-reperfused hearts. Mol Cell Biochem 2009; 336:55-64. [PMID: 19809794 DOI: 10.1007/s11010-009-0265-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 09/15/2009] [Indexed: 11/29/2022]
Abstract
Although numerous advancements made in the field of human health have resulted in reduced deaths due to cardiovascular diseases (CVD), many patients with cardiac disease show no established risk. Therefore, other unknown factors may be responsible for the pathophysiology of CVD. Out of 350,000 sudden cardiac deaths each year in the United States, 60,000 deaths have been related to air pollution, suggesting a detrimental role of environmental pollutants in the development of CVD. The present study tested our hypothesis that chronic ozone exposure enhances the sensitivity to ischemia-reperfusion (I/R) injury in isolated perfused hearts. Sprague-Dawley rats were continuously exposed for 8 h/day for 28 and 56 days to filtered air or 0.8 ppm ozone. Isolated hearts were subjected to 30 min of global ischemia followed by 60 min of reperfusion. Cardiac function after I/R measured as left ventricular developed pressure (LVDP), +dP/dt, -dP/dt, and left ventricular end diastolic pressure (LVEDP) was significantly decreased and increased respectively in ozone-exposed I/R hearts compared to I/R hearts exposed to filtered air. The enhanced sensitivity to I/R injury upon ozone exposure was associated with increased myocardial TNF-alpha levels and lipid peroxidation and decreased myocardial activities of superoxidase dismutase (SOD) and IL-10. These data suggest that ozone-induced sensitivity to myocardial I/R injury may be due to promoting levels of oxidative stress as well as inflammatory mediators.
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Stylianou M, Nicolich MJ. Cumulative effects and threshold levels in air pollution mortality: data analysis of nine large US cities using the NMMAPS dataset. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2009; 157:2216-2223. [PMID: 19447534 DOI: 10.1016/j.envpol.2009.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 04/02/2009] [Accepted: 04/09/2009] [Indexed: 05/27/2023]
Abstract
We examined the existence of thresholds, cumulative effects and the homogeneity of five air pollutants on the relative risk of three mortality outcomes using data from nine major US cities using data from NMMAPS. Overall, PM(10) (usually 200-day accumulation) and ozone (3-day accumulation) were the two important predictors of outcome but their effect was not uniform across the nine cities. Many models exhibited thresholds (25-45 microm g/m(3) for PM(10), and 10-45 ppb for O(3)). Our preliminary exploratory analyses suggest that the use of a linear, no threshold, model for pollution studies is not consistent with the observed data. The heterogeneity in the risk estimates across the nine cities suggests combining the local risk estimates to obtain a national risk estimate may not be justifiable and the estimate is likely to be confounded.
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Chuang GC, Yang Z, Westbrook DG, Pompilius M, Ballinger CA, White CR, Krzywanski DM, Postlethwait EM, Ballinger SW. Pulmonary ozone exposure induces vascular dysfunction, mitochondrial damage, and atherogenesis. Am J Physiol Lung Cell Mol Physiol 2009; 297:L209-16. [PMID: 19395667 DOI: 10.1152/ajplung.00102.2009] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
More than 100 million people in the United States live in areas that exceed current ozone air quality standards. In addition to its known pulmonary effects, environmental ozone exposures have been associated with increased hospital admissions related to cardiovascular events, but to date, no studies have elucidated the potential molecular mechanisms that may account for exposure-related vascular impacts. Because of the known pulmonary redox and immune biology stemming from ozone exposure, we hypothesized that ozone inhalation would initiate oxidant stress, mitochondrial damage, and dysfunction within the vasculature. Accordingly, these factors were quantified in mice consequent to a cyclic, intermittent pattern of ozone or filtered air control exposure. Ozone significantly modulated vascular tone regulation and increased oxidant stress and mitochondrial DNA damage (mtDNA), which was accompanied by significantly decreased vascular endothelial nitric oxide synthase protein and indices of nitric oxide production. To examine influences on atherosclerotic lesion formation, apoE-/- mice were exposed as above, and aortic plaques were quantified. Exposure resulted in significantly increased atherogenesis compared with filtered air controls. Vascular mitochondrial damage was additionally quantified in ozone- and filtered air-exposed infant macaque monkeys. These studies revealed that ozone increased vascular mtDNA damage in nonhuman primates in a fashion consistent with known atherosclerotic lesion susceptibility in humans. Consequently, inhaled ozone, in the absence of other environmental toxicants, promotes increased vascular dysfunction, oxidative stress, mitochondrial damage, and atherogenesis.
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Affiliation(s)
- Gin C Chuang
- Department of Pathology, University of Alabama at Birmingham, USA
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Hamade AK, Tankersley CG. Interstrain variation in cardiac and respiratory adaptation to repeated ozone and particulate matter exposures. Am J Physiol Regul Integr Comp Physiol 2009; 296:R1202-15. [PMID: 19158411 DOI: 10.1152/ajpregu.90808.2008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increased ambient particulate matter (PM) is associated with adverse cardiovascular and respiratory outcomes, as demonstrated by epidemiology studies. Several studies have investigated the role of copollutants, such as ozone (O(3)), in this association. It is accepted that physiological adaptation involving the respiratory system occurs with repeated exposures to O(3). We hypothesize that adaptation to PM and O(3) varies among different inbred mouse strains, and cardiopulmonary adaptation to O(3) is a synchronized response between the cardiac and respiratory systems. Heart rate (HR), HR variability (HRV), and the magnitude and pattern of breathing were simultaneously measured by implanted telemeters and by plethysmography in three inbred mouse strains: C57Bl/6J (B6), C3H/HeJ (HeJ), and C3H/HeOuJ (OuJ). Physiological responses were assessed during dual exposures to filtered air (FA), O(3) (576 +/- 32 parts/billion), and/or carbon black (CB; 556 +/- 34 mug/m(3)). Exposures were repeated for 3 consecutive days. While each strain showed significant reductions in HR during CB with O(3) preexposure (O(3)CB) on day 1, prominent HRV responses were observed in only HeJ and OuJ mice. Each strain also differed in their adaptation profile in response to repeated O(3)CB exposures. Whereas B6 mice showed rapid adaptation in HR after day 1, HeJ mice generally showed more moderate HR and HRV adaptation after day 2 of exposure. Unlike either B6 or HeJ strains, OuJ mice showed little evidence of HR or HRV adaptation to repeated O(3)CB exposure. Adaptation profiles between HR regulation and breathing characteristics were strongly correlated, but these associations also varied significantly among strains. These findings suggest that genetic factors determine the responsivity and adaptation of the cardiac and respiratory systems to repeated copollutant exposures. During O(3)CB exposure, adaptation of cardiac and respiratory systems is markedly synchronized, which may explain a potential mechanism for adverse effects of PM on heart function.
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Affiliation(s)
- Ali K Hamade
- Department of Environmental Health Sciences, John Hopkins University, Baltimore, MD 21205, USA
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Alexis NE, Lay JC, Haczku A, Gong H, Linn W, Hazucha MJ, Harris B, Tal-Singer R, Peden DB. Fluticasone propionate protects against ozone-induced airway inflammation and modified immune cell activation markers in healthy volunteers. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:799-805. [PMID: 18560537 PMCID: PMC2430237 DOI: 10.1289/ehp.10981] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 02/27/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ozone exposure induces airway neutrophilia and modifies innate immune monocytic cell-surface phenotypes in healthy individuals. High-dose inhaled corticosteroids can reduce O(3)-induced airway inflammation, but their effect on innate immune activation is unknown. OBJECTIVES We used a human O(3) inhalation challenge model to examine the effectiveness of clinically relevant doses of inhaled corticosteroids on airway inflammation and markers of innate immune activation in healthy volunteers. METHODS Seventeen O(3)-responsive subjects [>10% increase in the percentage of polymorphonuclear leukocytes (PMNs) in sputum, PMNs per milligram vs. baseline sputum] received placebo, or either a single therapeutic dose (0.5 mg) or a high dose (2 mg) of inhaled fluticasone proprionate (FP) 1 hr before a 3-hr O(3) challenge (0.25 ppm) on three separate occasions at least 2 weeks apart. Lung function, exhaled nitric oxide, sputum, and systemic biomarkers were assessed 1-5 hr after the O(3) challenge. To determine the effect of FP on cellular function, we assessed sputum cells from seven subjects by flow cytometry for cell-surface marker activation. RESULTS FP had no effect on O(3)-induced lung function decline. Compared with placebo, 0.5 mg and 2 mg FP reduced O(3)-induced sputum neutrophilia by 18% and 35%, respectively. A similar effect was observed on the airway-specific serum biomarker Clara cell protein 16 (CCP16). Furthermore, FP pretreatment significantly reduced O(3)-induced modification of CD11b, mCD14, CD64, CD16, HLA-DR, and CD86 on sputum monocytes in a dose-dependent manner. CONCLUSIONS This study confirmed and extended data demonstrating the protective effect of FP against O(3)-induced airway inflammation and immune cell activation.
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Affiliation(s)
- Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, North Carolina 27599-7310, USA.
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Ballester F, Rodríguez P, Iñíguez C, Saez M, Daponte A, Galán I, Taracido M, Arribas F, Bellido J, Cirarda FB, Cañada A, Guillén JJ, Guillén-Grima F, López E, Pérez-Hoyos S, Lertxundi A, Toro S. Air pollution and cardiovascular admissions association in Spain: results within the EMECAS project. J Epidemiol Community Health 2006; 60:328-36. [PMID: 16537350 PMCID: PMC2566168 DOI: 10.1136/jech.2005.037978] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the short term effect of air pollution on cardiovascular admissions in 14 Spanish cities METHODS The period under study was from 1995 to 1999. Daily emergency admissions for all cardiovascular diseases (CVD) and heart diseases (HD) were obtained from hospital records, and the corresponding daily levels of particulates, SO2, NO2, CO, and ozone were recorded. The magnitude of association was estimated using Poisson generalised additive models controlling for confounding and overdispersion. For each cause, lagged effects, up to three days, of each pollutant were examined and combined estimates were obtained. For ozone the analyses were restricted to the warm period. One and two pollutant models were performed. RESULTS Associations were more consistent in lag 0 (concurrent day) and 1 (lag 0-1), except in the case of ozone where there was a more delayed relation (lag 2-3). For combined estimates an increase of 10 microg/m3 in the PM10 levels in lag 0-1 was associated with an increase of 0.9% (95% CI: 0.4 to 1.5%) in the number of hospital admissions for CVD, and 1.6% (0.8 to 2.3%) for HD. For ozone the corresponding estimates for lag 2-3 were 0.7% (0.3 to 1.0) for CVD, and 0.7% (0.1 to 1.2) for HD. An increase of 1 mg/m3 in CO levels was associated with an increase of 2.1% (0.7 to 3.5%) in CVD admissions, and 4.2% (1.3 to 7.1%) in HD admissions. SO2 and NO2 estimates were more sensitive in two pollutant models CONCLUSIONS A short term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases, with specificity for heart diseases, has been described in Spanish cities.
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Affiliation(s)
- F Ballester
- Epidemiology and Statistics Unit, Escola Valenciana d'Estudis en Salut-EVES (Valencian School of Health Studies), c/Joan de Garay 21, 46017 Valencia, Spain.
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Abstract
Environmental factors are considered key determinants of cardiovascular disease. Although lifestyle choices such as smoking, diet, and exercise are viewed as major environmental influences, the contribution of pollutants and environmental chemicals is less clear. Accumulating evidence suggests that exposure to pollutants and chemicals could elevate the risk of cardiovascular disease. Many epidemiological studies report that exposure to fine particles present in ambient air is associated with an increase in cardiovascular mortality. Statistically significant relationships between particulate air pollution and ischemic heart disease, arrhythmias, and heart failure have been reported. Animal studies show that exposure to ambient air particles increases peripheral thrombosis and atherosclerotic lesion formation. Exposures to arsenic, lead, cadmium, pollutant gases, solvents, and pesticides have also been linked to increased incidence of cardiovascular disease. Mechanistically, these effects have been attributed to changes in the synthesis or reactivity of nitric oxide that may be caused by environmental oxidants or increased endogenous production of reactive oxygen species. Additional studies are urgently needed to: identify the contribution of individual pollutants to specific aspects of cardiovascular disease; establish causality; elucidate the underlying physiological and molecular mechanisms; estimate the relative susceptibility of diseased and healthy individuals and that of specific population groups; and determine whether pollutant exposure are risk correlates, that is, whether they influence major risk factors, such as hypertension, cholesterol, or diabetes, or whether they contribute to the absolute risk of heart disease. Collectively, these investigations could contribute to the emergent field of environmental cardiology.
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Affiliation(s)
- Aruni Bhatnagar
- Institute of Molecular Cardiology, Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA.
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Sarnat SE, Coull BA, Schwartz J, Gold DR, Suh HH. Factors affecting the association between ambient concentrations and personal exposures to particles and gases. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:649-54. [PMID: 16675415 PMCID: PMC1459914 DOI: 10.1289/ehp.8422] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 12/15/2005] [Indexed: 05/08/2023]
Abstract
Results from air pollution exposure assessment studies suggest that ambient fine particles [particulate matter with aerodynamic diameter
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Affiliation(s)
- Stefanie Ebelt Sarnat
- Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Santucci D, Sorace A, Francia N, Aloe L, Alleva E. Prolonged prenatal exposure to low-level ozone affects aggressive behaviour as well as NGF and BDNF levels in the central nervous system of CD-1 mice. Behav Brain Res 2005; 166:124-30. [PMID: 16263182 DOI: 10.1016/j.bbr.2005.07.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 07/19/2005] [Accepted: 07/20/2005] [Indexed: 11/24/2022]
Abstract
The long-term effects on isolation-induced aggressive behaviour and central NGF and BDNF levels of gestational exposures to ozone (O(3)) were evaluated in adult CD-1 mice. Females were exposed to O(3), at the dose of 0.0, 0.3 or 0.6 ppm from 30 days prior the formation of breeding pairs until gestational day 17. Litters were fostered at birth to untreated dams and, at adulthood, male offspring underwent five successive daily encounters (15 min each) with a standard opponent of the same strain, sex, weight and age. The encounters on day 1, 3 and 5 were videotaped and agonistic and non-agonistic behavioural items finely scored. O(3)-exposed mice showed a significant increase in freezing and defensive postures, a decrease in nose-sniffing behaviour and reduced progressively the aggressive behavioural profile displayed on day 1. Reduced NGF levels in the hippocampus and increased BDNF in the striatum were also found upon O(3) exposure.
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Affiliation(s)
- Daniela Santucci
- Section of Behavioural Neurosciences, Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, I-00161 Rome, Italy.
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Urch B, Silverman F, Corey P, Brook JR, Lukic KZ, Rajagopalan S, Brook RD. Acute blood pressure responses in healthy adults during controlled air pollution exposures. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:1052-5. [PMID: 16079078 PMCID: PMC1280348 DOI: 10.1289/ehp.7785] [Citation(s) in RCA: 230] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Exposure to air pollution has been shown to cause arterial vasoconstriction and alter autonomic balance. Because these biologic responses may influence systemic hemodynamics, we investigated the effect of air pollution on blood pressure (BP). Responses during 2-hr exposures to concentrated ambient fine particles (particulate matter < 2.5 microm in aerodynamic diameter; PM2.5) plus ozone (CAP+O3) were compared with those of particle-free air (PFA) in 23 normotensive, nonsmoking healthy adults. Mean concentrations of PM2.5 were 147 +/- 27 versus 2 +/- 2 microg/m3, respectively, and those of O3 were 121 +/- 3 versus 8 +/- 5 ppb, respectively (p < 0.0001 for both). A significant increase in diastolic BP (DBP) was observed at 2 hr of CAP+O3 [median change, 6 mm Hg (9.3%); binomial 95% confidence interval (CI), 0 to 11; p = 0.013, Wilcoxon signed rank test] above the 0-hr value. This increase was significantly different (p = 0.017, unadjusted for basal BP) from the small 2-hr change during PFA (median change, 1 mm Hg; 95% CI, -2 to 4; p = 0.24). This prompted further investigation of the CAP+O3 response, which showed a strong association between the 2-hr change in DBP (and mean arterial pressure) and the concentration of the organic carbon fraction of PM2.5 (r = 0.53, p < 0.01; r = 0.56, p < 0.01, respectively) but not with total PM2.5 mass (r < or = 0.25, p > or = 0.27). These findings suggest that exposure to environmentally relevant concentrations of PM2.5 and O3 rapidly increases DBP. The magnitude of BP change is associated with the PM2.5 carbon content. Exposure to vehicular traffic may provide a common link between our observations and previous studies in which traffic exposure was identified as a potential risk factor for cardiovascular disease.
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Affiliation(s)
- Bruce Urch
- Gage Occupational and Environmental Health Unit, St. Michael's Hospital, Toronto, Ontario, Canada.
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Gong H, Linn WS, Clark KW, Anderson KR, Geller MD, Sioutas C. Respiratory responses to exposures with fine particulates and nitrogen dioxide in the elderly with and without COPD. Inhal Toxicol 2005; 17:123-32. [PMID: 15788373 DOI: 10.1080/08958370590904481] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Elderly people, with and without chronic obstructive pulmonary disease (COPD), may be susceptible to particulate matter (PM) air pollution. However, the respiratory impacts of inhaled PM combined with copollutant(s) in controlled exposure studies are unclear and warrant investigation since exposures to PMgas mixtures constitute realistic scenarios. Thus, we exposed 6 healthy subjects and 18 volunteers with COPD (mean age 71 yr) on separate days to (a) filtered air (FA); (b) 0.4 ppm NO2; (c) concentrated ambient particles (CAP), predominantly in the fine (PM2.5) size range, at concentrations near 200 microg/m3; and (d) CAP and NO2 together. Each 2-h exposure included exercise for 15 min every half hour. Most respiratory responses, including symptoms, spirometry, and total and differential counts of induced sputum cells, showed no statistically significant responses attributable to separate or combined effects of CAP and NO2. However, maximal mid-expiratory flow and arterial O2 saturation (measured by pulse oximetry) showed small but statistically significant decrements associated with CAP, greater in healthy than COPD subjects. CAP exposure was also associated with decreased percentages of columnar epithelial cells in sputum. The results suggest that the respiratory effect of the PMNO2 mixture may be primarily PM driven since coexposure to NO2 did not significantly enhance the responses. In conclusion, older adults exposed to urban fine particles may experience acute small-airways dysfunction with impaired gas exchange. Healthy subjects appear more susceptible, suggesting that the respiratory effect may be related to efficient penetration and deposition of inhaled toxic particles in distal small airways. More clinical investigation of the elderly population is warranted.
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Affiliation(s)
- Henry Gong
- Environmental Health Service, Los Amigos Research and Education Institute, Downey, California 90242, USA.
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Sarnat JA, Brown KW, Schwartz J, Coull BA, Koutrakis P. Ambient Gas Concentrations and Personal Particulate Matter Exposures. Epidemiology 2005; 16:385-95. [PMID: 15824556 DOI: 10.1097/01.ede.0000155505.04775.33] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data from a previous study conducted in Baltimore, MD, showed that ambient fine particulate matter less than 2.5 mum in diameter (PM2.5) concentrations were strongly correlated with corresponding personal PM2.5 exposures, whereas ambient O3, NO2, and SO2 concentrations were weakly correlated with their personal exposures to these gases. In contrast, many of the ambient gas concentrations were reasonable surrogates of personal PM2.5 exposures. METHODS Personal multipollutant exposures and corresponding ambient air pollution concentrations were measured for 43 subjects living in Boston, MA. The cohort consisted of 20 healthy senior citizens and 23 schoolchildren. Simultaneous 24-hour integrated PM2.5, O3, NO2, and SO2 personal exposures and ambient concentrations were measured. All PM2.5 samples were also analyzed for SO4 (sulfate). We analyzed personal exposure and ambient concentration data using correlation and mixed model regression analyses to examine relationships among (1) ambient PM2.5 concentrations and corresponding ambient gas concentrations; (2) ambient PM2.5 and gas concentrations and their respective personal exposures; (3) ambient gas concentrations and corresponding personal PM2.5 exposures; and (4) personal PM2.5 exposures and corresponding personal gas exposures. RESULTS We found substantial correlations between ambient PM2.5 concentrations and corresponding personal exposures over the course of time. Additionally, our results support the earlier finding that summertime gaseous pollutant concentrations may be better surrogates of personal PM2.5 exposures (especially personal exposures to PM2.5 of ambient origin) than they are surrogates of personal exposures to the gases themselves. CONCLUSIONS Particle health effects studies that include both ambient PM2.5 and gaseous concentrations as independent variables must be analyzed carefully and interpreted cautiously, since both parameters may be serving as surrogates for PM2.5 exposures.
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Affiliation(s)
- Jeremy A Sarnat
- Department of Environmental and Occupational Health, Rollins School of Public Health of Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Berhane K, Gauderman WJ, Stram DO, Thomas DC. Statistical Issues in Studies of the Long-Term Effects of Air Pollution: The Southern California Children’s Health Study. Stat Sci 2004. [DOI: 10.1214/088342304000000413] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kim SY, Lee JT, Hong YC, Ahn KJ, Kim H. Determining the threshold effect of ozone on daily mortality: an analysis of ozone and mortality in Seoul, Korea, 1995-1999. ENVIRONMENTAL RESEARCH 2004; 94:113-119. [PMID: 14757374 DOI: 10.1016/j.envres.2003.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many studies have shown a positive association between ambient ozone levels and mortality. Typically, these findings are based on models that assume a linear relationship between log mortality and ozone level. In this study, we adapted generalized additive models in which ozone effects are presumed to occur in three different ways: as a simple linear term, as a cubic natural spline term, and as a combination of two linear terms (a threshold model). We applied these models to daily time-series data for Seoul, Korea for the years 1995-1999 and found that the threshold model always fits best among the three. A 2.6% (95% CI: 1.7-3.5) increase of estimated relative risk (RR) in the total mortality associated with a 21.5 ppb increase of daily 1-h maximum ozone lagged by 1 day was observed by linear Poisson's regression. However, a 3.4% (95% CI: 2.3-4.4) increase in the estimated RR was observed using the threshold model. Adjustments for other ambient pollutants caused little changes to these results; 2.4-2.5% in the linear models and 3.2-3.4% in the threshold models. In addition, the largest difference in the estimated RRs of the linear and threshold models was observed in the summer: 1.9% (95% CI: 0.5-3.3) by the linear model and 3.8% (95% CI: 2.0-5.7) by the threshold model. These findings indicate that the conventional time-series Poisson regression model, which dose not take threshold into consideration, could underestimate the true risk of the ozone effect on daily mortality.
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Affiliation(s)
- Sun-Young Kim
- Department of Epidemiology and Biostatistics, School of Public Health, and Institute of Health and Environment, Seoul National University, 28 Yongon Dong, Chongro-Gu, Seoul 110-799, South Korea
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Abstract
Ozone (O3) is an air pollutant produced by sunlight-driven reactions involving the oxides of nitrogen and volatile organic compounds. The population of many large metropolitan areas in the US is exposed to high levels of O3, particularly in the summer months. Individuals exposed to O3 levels in human experiments at higher than common ambient levels develop reversible reductions in lung function often associated with symptoms, such as airway hyperreactivity and lung inflammation. Animal models have helped characterize potential mechanisms of lung injury from O3 exposure. Defining the adverse effects of chronic exposure to ambient levels of O3 on lung function and disease have been challenging, in part due to the presence of co-pollutants, such as particulate matter. The US Environmental Protection Agency's 1997 revised standard for O3 (0.08 ppm averaged over 8 hours) is designed to provide better protection to susceptible individuals. The revised standard is being implemented following the failure of court challenges.
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Affiliation(s)
- Nevin Uysal
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin and Zablocki Veterans Affairs Medical Center, Milwaukee, 53295, USA.
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43
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Abstract
The number of studies conducted on the health effects of air pollution has increased exponentially. Important methodological advances include the application of novel observational study designs, in particular the multi-city design, and the development and application of airborne particle concentrators for use in experimental human exposure studies and toxicological studies. Experimental data are validating and providing insight into some surprising observational findings.
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Affiliation(s)
- Sverre Vedal
- Division of Environmental and Occupational Health Sciences, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
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Sorace A, de Acetis L, Alleva E, Santucci D. Prolonged exposure to low doses of ozone: short- and long-term changes in behavioral performance in mice. ENVIRONMENTAL RESEARCH 2001; 85:122-134. [PMID: 11161662 DOI: 10.1006/enrs.2000.4097] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Two separate experiments were designed to assess the effects of ozone exposure on outbred CD-1 mice. In the first experiment, adult males were exposed continuously to O3 at 0, 0.3, or 0.6 ppm for 30 days and their behavior was assessed in a 5-min open-field test on exposure days 4 and 19 and on day 3 after the end of the exposure phase. In addition, mice performed a Morris water maze task from exposure day 24 to 28. In the second experiment, adult females were exposed from 30 days prior to the formation of breeding pairs until gestational day 17 to the same doses used in the first experiment. Litters were fostered at birth to untreated dams and neurobehavioral development of the offspring was investigated until adulthood. Specifically, somatic and sensorimotor development [postnatal day (PND) 2-20], homing performance (PND 12), motor activity (PND 21), passive avoidance (PND 22-23), water maze performances (PND 70-74), and response to a nociceptive stimulus (PND 100) were assessed. Results from both experiments confirm that exposure to O3 slightly but selectively affected neurobehavioral performance in rodents. Exposure to O3 did not grossly affect neurobehavioral development, whereas it consistently impaired reversal learning in the Morris water maze test in both prenatally and adult exposed mice. Moreover, longer latency to step-through in the first trial of the passive avoidance test and a decrease in wall rearing in the hot-plate test were recorded in O3 prenatally exposed mice. Except for the first open-field test, altered responses were observed only in animals exposed at the intermediate concentration of the gas. Adaptation and/or onset of compensatory mechanisms might be responsible for the lack of linear dose-response relationships.
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Affiliation(s)
- A Sorace
- Section of Behavioural Pathophysiology, Laboratorio di Fisiopatologia di Organo e di Sistema, Istituto Superiore di Sanità, Rome, Italy
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