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Stieb D, Shutt RH, Kauri LM, Mason-Renton S, Chen L, Szyszkowicz M, Dobbin NA, Rigden M, Jovic B, Mulholland M, Green MS, Liu L, Pelletier G, Weichenthal SA, Dales RE, Andrade J, Luginaah I. Associations between air pollution and cardio-respiratory physiological measures in older adults exercising outdoors. Int J Environ Health Res 2021; 31:901-914. [PMID: 31829725 DOI: 10.1080/09603123.2019.1699506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
We examined whether exercising indoors vs. outdoors reduced the cardio-respiratory effects of outdoor air pollution. Adults ≥55 were randomly assigned to exercise indoors when the Air Quality Health Index was ≥5 and outdoors on other days (intervention group, n = 37), or outdoors everyday (control group, n = 35). Both groups completed cardio-respiratory measurements before and after exercise for up to 10 weeks. Data were analyzed using linear mixed effect regression models. In the control group, an interquartile range increase in fine particulate matter (PM2.5) was associated with increases of 1.4% in heart rate (standard error (SE) = 0.7%) and 5.6% (SE = 2.6%) in malondialdehyde, and decreases of 5.6% (SE = 2.5%) to 16.5% (SE = 7.5%) in heart rate variability measures. While the hypothesized benefit of indoor vs. outdoor exercise could not be demonstrated due to an insufficient number of intervention days (n = 2), the study provides evidence of short-term effects of air pollution in older adults. ISRCTN #26552763.
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Affiliation(s)
- David Stieb
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Robin H Shutt
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Lisa M Kauri
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- Controlled Substances and Cannabis Branch (current), Health Canada, Ottawa, Canada
| | - Sarah Mason-Renton
- Department of Geography, Western University, London, Canada
- Lystek International Inc. (current), Cambridge, Canada
| | - Li Chen
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Mieczyslaw Szyszkowicz
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Nina A Dobbin
- Air Health Science Division, Water and Air Quality Bureau, Health Canada, Ottawa, Canada
- Chemical Emergency Preparedness and Response Unit (current), Health Canada, Vancouver, Canada
| | - Marc Rigden
- Hazard Identification Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Branka Jovic
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | | | | | - Ling Liu
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Guillaume Pelletier
- Hazard Identification Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Scott A Weichenthal
- Air Health Science Division, Water and Air Quality Bureau, Health Canada, Ottawa, Canada
- Environmental Epidemiology Research Group, McGill University, Montreal, Canada
| | - Robert E Dales
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Julie Andrade
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
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Dales R, Lee DS, Wang X, Cakmak S, Szyszkowicz M, Shutt R, Birnie D. Do acute changes in ambient air pollution increase the risk of potentially fatal cardiac arrhythmias in patients with implantable cardioverter defibrillators? Environ Health 2020; 19:72. [PMID: 32552837 PMCID: PMC7301471 DOI: 10.1186/s12940-020-00622-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/08/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Daily changes in ambient air pollution have been associated with cardiac morbidity and mortality. Precipitating a cardiac arrhythmia in susceptible individuals may be one mechanism. We investigated the influence of daily changes in air pollution in the Province of Ontario, Canada on the frequency of discharges from implantable cardio defibrillators (ICDs) which occur in response to potentially life threatening arrhythmias. METHODS Using a case- crossover design, we compared ambient air pollution concentrations on the day of an ICD discharge to other days in the same month and year in 1952 patients. We adjusted for weather, lagged the exposure data from 0 to 3 days, and stratified the results by several patient-related characteristics. RESULTS Median (interquartile range) for ozone (O3), fine particulate matter (PM2.5), sulphur dioxide (SO2) and nitrogen dioxide (NO2) were 26.0 ppb (19.4, 33.0), 6.6 μg/m3 (4.3, 10.6), 1.00 ppb (0.4,2.1), 10.0 ppb (6.0,15.3) respectively. Unlagged odds ratios (95%) for an ICD discharge associated with an interquartile range increase in pollutant were 0.97 (0.86, 1.09) for O3, 0.99 (0.92, 1.06) for PM2.5, 0.97 (0.91, 1.03) for SO2, and 1.00 (0.89, 1.12) for NO2. CONCLUSION We found no evidence that the concentrations of ambient air pollution observed in our study were a risk factor for potentially fatal cardiac arrhythmias in patients with ICDs.
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Affiliation(s)
- Robert Dales
- Environmental Health Science and Research Bureau, Health Canada, and Ottawa Hospital Research Institute, University of Ottawa, 101 Tunney’s Pasture Driveway, Ottawa, ON K1A 0K9 Canada
| | - Douglas S. Lee
- ICES, Peter Munk Cardiac Centre of University Health Network, University of Toronto, Toronto, Canada
| | | | - Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | | | - Robin Shutt
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - David Birnie
- Arrhythmia Service, Department of Medicine, Heart Institute, University of Ottawa, Ottawa, Canada
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Liu L, Urch B, Szyszkowicz M, Evans G, Speck M, Van Huang A, Leingartner K, Shutt RH, Pelletier G, Gold DR, Brook JR, Godri Pollitt K, Silverman FS. Metals and oxidative potential in urban particulate matter influence systemic inflammatory and neural biomarkers: A controlled exposure study. Environ Int 2018; 121:1331-1340. [PMID: 30420132 PMCID: PMC6396878 DOI: 10.1016/j.envint.2018.10.055] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Oxidative stress and inflammation are considered to be important pathways leading to particulate matter (PM)-associated disease. In this exploratory study, we examined the effects of metals and oxidative potential (OP) in urban PM on biomarkers of systemic inflammation, oxidative stress and neural function. METHODS Fifty-three healthy non-smoking volunteers (mean age 28 years, twenty-eight females) were exposed to coarse (2.5-10 μm, mean 213 μg/m3), fine (0.15-2.5 μm, 238 μg/m3), and/or ultrafine concentrated ambient PM (<0.3 μm, 136 μg/m3). Exposures lasted 130 min, separated by ≥2 weeks. Metal concentrations and OP (measured by ascorbate and glutathione depletion in synthetic airway fluid) in PM were analyzed. Blood and urine samples were collected pre-exposure, and 1-h and 21-h post exposure for assessment of biomarkers. We used mixed-regression models to analyze associations adjusting for PM size and mass concentration. RESULTS Results for metals were expressed as change (%) from daily pre-exposure biomarker levels after exposure to a metal at a level equivalent to the mean concentration. Exposure to various metals (silver, aluminum, barium, copper, iron, potassium, lithium, nickel, tin, and/or vanadium) was significantly associated with increased levels of various blood or urinary biomarkers. For example, the blood inflammatory marker vascular endothelia growth factor (VEGF) increased 5.3% (95% confidence interval: 0.3%, 10.2%) 1-h post exposure to nickel; the traumatic brain injury marker ubiquitin C-terminal hydrolase L1 (UCHL1) increased 11% (1.2%, 21%) and 14% (0.3%, 29%) 1-h and 21-h post exposure to barium, respectively; and the systemic stress marker cortisol increased 1.5% (0%, 2.9%) and 1.5% (0.5%, 2.8%) 1-h and 21-h post exposure to silver, respectively. Urinary DNA oxidation marker 8‑hydroxy‑deoxy‑guanosine increased 14% (6.4%, 21%) 1-h post exposure to copper; urinary neural marker vanillylmandelic acid increased 29% (3%, 54%) 1-h post exposure to aluminum; and urinary cortisol increased 88% (0.9%, 176%) 1-h post exposure to vanadium. Results for OP were expressed as change (%) from daily pre-exposure biomarker levels after exposure to ascorbate-related OP at a level equivalent to the mean concentration, or for exposure to glutathione-related OP at a level above the limit of detection. Exposure to ascorbate- or glutathione-related OP was significantly associated with increased inflammatory and neural biomarkers including interleukin-6, VEGF, UCHL1, and S100 calcium-binding protein B in blood, and malondialdehyde and 8-hydroxy-deoxy-guanosine in urine. For example, UCHL1 increased 9.4% (1.8%, 17%) in blood 21-h post exposure to ascorbate-related OP, while urinary malondialdehyde increased 19% (3.6%, 35%) and 8-hydroxy-deoxy-guanosine increased 24% (2.9%, 48%) 21-h post exposure to ascorbate- and glutathione-related OP, respectively. CONCLUSION Our results from this exploratory study suggest that metal constituents and OP in ambient PM may influence biomarker levels associated with systemic inflammation, oxidative stress, perturbations of neural function, and systemic physiological stress.
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Affiliation(s)
- Ling Liu
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada.
| | - Bruce Urch
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada
| | | | - Greg Evans
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada
| | - Mary Speck
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Van Huang
- Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada
| | - Karen Leingartner
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Robin H Shutt
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Guillaume Pelletier
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Diane R Gold
- The Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey R Brook
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada; Environment and Climate Change Canada, Toronto, Ontario, Canada
| | | | - Frances S Silverman
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada; Divisions of Occupational Medicine and Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Liu L, Urch B, Szyszkowicz M, Speck M, Leingartner K, Shutt R, Pelletier G, Gold DR, Scott JA, Brook JR, Thorne PS, Silverman FS. Influence of exposure to coarse, fine and ultrafine urban particulate matter and their biological constituents on neural biomarkers in a randomized controlled crossover study. Environ Int 2017; 101:89-95. [PMID: 28117141 PMCID: PMC5348252 DOI: 10.1016/j.envint.2017.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Epidemiological studies have reported associations between air pollution and neuro-psychological conditions. Biological mechanisms behind these findings are still not clear. OBJECTIVES We examined changes in blood and urinary neural biomarkers following exposure to concentrated ambient coarse, fine and ultrafine particles. METHODS Fifty healthy non-smoking volunteers, mean age 28years, were exposed to coarse (2.5-10μm, mean 213μg/m3) and fine (0.15-2.5μm, mean 238μg/m3) concentrated ambient particles (CAPs), and filtered ambient and/or medical air. Twenty-five participants were exposed to ultrafine CAP (mean size 59.6nm, range 47.0-69.8nm), mean (136μg/m3) and filtered medical air. Exposures lasted 130min, separated by ≥2weeks, and the biological constituents endotoxin and β-1,3-d-glucan of each particle size fraction were measured. Blood and urine samples were collected pre-exposure, and 1-hour and 21-hour post-exposure to determine neural biomarker levels. Mixed-model regressions assessed associations between exposures and changes in biomarker levels. RESULTS Results were expressed as percent change from daily pre-exposure biomarker levels. Exposure to coarse CAP was significantly associated with increased urinary levels of the stress-related biomarkers vanillylmandelic acid (VMA) and cortisol when compared with exposure to filtered medical air [20% (95% confidence interval: 1.0%, 38%) and 64% (0.2%, 127%), respectively] 21hours post-exposure. However exposure to coarse CAP was significantly associated with decreases in blood cortisol [-26.0% (-42.4%, -9.6%) and -22.4% (-43.7%, -1.1%) at 1h and 21h post-exposure, respectively]. Biological molecules present in coarse CAP were significantly associated with blood biomarkers indicative of blood brain barrier integrity. Endotoxin content was significantly associated with increased blood ubiquitin C-terminal hydrolase L1 [UCHL1, 11% (5.3%, 16%) per ln(ng/m3+1)] 1-hour post-exposure, while β-1,3-d-glucan was significantly associated with increased blood S100B [6.3% (3.2%, 9.4%) per ln(ng/m3+1)], as well as UCHL1 [3.1% (0.4%, 5.9%) per ln(ng/m3+1)], one-hour post-exposure. Fine CAP was marginally associated with increased blood UCHL1 when compared with exposure to filtered medical air [17.7% (-1.7%, 37.2%), p=0.07] 21hours post-exposure. Ultrafine CAP was not significantly associated with changes in any blood and urinary neural biomarkers examined. CONCLUSION Ambient coarse particulate matter and its biological constituents may influence neural biomarker levels that reflect perturbations of blood-brain barrier integrity and systemic stress response.
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Affiliation(s)
- Ling Liu
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada.
| | - Bruce Urch
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada
| | | | - Mary Speck
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karen Leingartner
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Robin Shutt
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Guillaume Pelletier
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Diane R Gold
- The Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James A Scott
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey R Brook
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada; Environment and Climate Change Canada, Toronto, Ontario, Canada
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Frances S Silverman
- Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research (SOCAAR), Toronto, Ontario, Canada; Divisions of Occupational Medicine and Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Abstract
OBJECTIVES The objective of this study was to present a technique for estimating the effect of ambient air pollution mix on health outcomes. MATERIAL AND METHODS We created a technique of indexing air pollution mix as a cause of the increased odds of health problems. As an illustrative example, we analyzed the impact of pollution on the frequency of emergency department (ED) visits due to colitis among young patients (age < 15 years, N = 11 110). Our technique involves 2 steps. First, we considered 6 ambient air pollutants (carbon monoxide, nitrogen dioxide, sulphur dioxide, ozone, and 2 measures of particulate matter) treating each pollutant as a single exposure. Odds ratios (ORs) for ED visits associated with a standard increase (interquartile range - IQR) in the pollutants levels were calculated using the case-crossover technique. The ORs and their 95% confidence intervals (95% CIs) were also found for lagged exposures (for lags 1-9 days). Second, we defined a Health Air Study Index (HASI) to represent the combined impact of the 6 air pollutants. RESULTS We obtained positive and statistically significant results for individual air pollutants and among them the following estimations: OR = 1.06 (95% CI: 1.02-1.1, NO2 lag 3, IQR = 12.8 ppb), OR = 1.04 (95% CI: 1.01-1.07, SO2 lag 4, IQR = 2.3 ppb), OR = 1.04 (95% CI: 1-1.06, PM lag 3, IQR = 6.2 μg/m3). Among the re-calculated ORs with the HASI values as an exposure, the highest estimated value was OR = 1.37 (95% CI: 1.12-1.68, for 1 unit of the HASI, lag 3). CONCLUSIONS The proposed index (HASI) allows to confirm the pattern of associations for lags obtained for individual air pollutants. In the presented example the used index (HASI) indicates the strongest relation with the exposure lagged by 3 days.
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Szyszkowicz M, Thomson E, Shutt R, Kousha T, Rowe B, Colman I. Association of Ambient Air Pollution with Emergency Department Visits for Epistaxis, Substance Use Disorders and Lower Respiratory Disease. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Liu L, Urch B, Poon R, Szyszkowicz M, Speck M, Gold DR, Wheeler AJ, Scott JA, Brook JR, Thorne PS, Silverman FS. Effects of ambient coarse, fine, and ultrafine particles and their biological constituents on systemic biomarkers: a controlled human exposure study. Environ Health Perspect 2015; 123:534-40. [PMID: 25616223 PMCID: PMC4455587 DOI: 10.1289/ehp.1408387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 01/14/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Ambient coarse, fine, and ultrafine particles have been associated with mortality and morbidity. Few studies have compared how various particle size fractions affect systemic biomarkers. OBJECTIVES We examined changes of blood and urinary biomarkers following exposures to three particle sizes. METHODS Fifty healthy nonsmoking volunteers, mean age of 28 years, were exposed to coarse (2.5-10 μm; mean, 213 μg/m3) and fine (0.15-2.5 μm; mean, 238 μg/m3) concentrated ambient particles (CAPs), and filtered ambient and/or medical air. Twenty-five participants were exposed to ultrafine CAP (< 0.3 μm; mean, 136 μg/m3) and filtered medical air. Exposures lasted 130 min, separated by ≥ 2 weeks. Blood/urine samples were collected preexposure and 1 hr and 21 hr postexposure to determine blood interleukin-6 and C-reactive protein (inflammation), endothelin-1 and vascular endothelial growth factor (VEGF; vascular mediators), and malondialdehyde (lipid peroxidation); as well as urinary VEGF, 8-hydroxy-deoxy-guanosine (DNA oxidation), and malondialdehyde. Mixed-model regressions assessed pre- and postexposure differences. RESULTS One hour postexposure, for every 100-μg/m3 increase, coarse CAP was associated with increased blood VEGF (2.41 pg/mL; 95% CI: 0.41, 4.40) in models adjusted for O3, fine CAP with increased urinary malondialdehyde in single- (0.31 nmol/mg creatinine; 95% CI: 0.02, 0.60) and two-pollutant models, and ultrafine CAP with increased urinary 8-hydroxydeoxyguanosine in single- (0.69 ng/mg creatinine; 95% CI: 0.09, 1.29) and two-pollutant models, lasting < 21 hr. Endotoxin was significantly associated with biomarker changes similar to those found with CAPs. CONCLUSIONS Ambient particles with various sizes/constituents may influence systemic biomarkers differently. Endotoxin in ambient particles may contribute to vascular mediator changes and oxidative stress.
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Affiliation(s)
- Ling Liu
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
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Szyszkowicz M, Shutt R, Kousha T, Rowe B. Air pollution and emergency department visits for epistaxis. Clin Otolaryngol 2014; 39:345-51. [DOI: 10.1111/coa.12296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Szyszkowicz
- Population Studies Division; Health Canada; Ottawa ON Canada
| | - R. Shutt
- Population Studies Division; Health Canada; Ottawa ON Canada
| | - T. Kousha
- Population Studies Division; Health Canada; Ottawa ON Canada
| | - B.H. Rowe
- Department of Emergency Medicine and School of Public Health; University of Alberta; Edmonton AB Canada
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Szyszkowicz M, Kousha T. Emergency department visits for asthma in relation to the Air Quality Health Index: a case-crossover study in Windsor, Canada. Can J Public Health 2014; 105:e336-41. [PMID: 25365267 DOI: 10.17269/cjph.105.4539] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/05/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In this study, associations of short-term changes in ambient air pollution with emergency department (ED) visits for asthma were examined in hospitals in the area of Windsor, Ontario. Ambient air pollution quality was represented by the Air Quality Health Index(AQHI), calculated using a formula that combines the concentrations and the relative health impacts of three ambient air pollutants: ozone , nitrogen dioxide and fine particulate matter. METHODS Data on ED visits were retrieved from the National Ambulatory Care Reporting System. Only patients two years of age and older were considered. A time-stratified case-crossover design was applied to 6,697 ED visits for asthma for the period of April 2004 to December 2010. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) for ED visits associated with increased (by one unit) levels of AQHI were calculated by applying conditional logistic regression. RESULTS Positive and statistically significant results were observed between AQHI levels and ED visits for asthma. For all patients the largest value, OR=1.17 (CI: 1.09, 1.26), was obtained for exposures lagged by 9 days in the warm season (April-September). Effects among children 2 to 14 years of age were observed for same-day exposure (lag 0), with an OR=1.11(CI: 1.01, 1.21). CONCLUSION Exposure to ambient air pollution in Windsor increases the risk of ED visits for asthma. When the adverse effects of air pollutants are increased, patient visits to the ED depend on the patient's age.
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Kaplan GG, Dixon E, Panaccione R, Fong A, Chen L, Szyszkowicz M, Wheeler A, MacLean A, Buie WD, Leung T, Heitman SJ, Villeneuve PJ. Effect of ambient air pollution on the incidence of appendicitis. CMAJ 2009; 181:591-7. [PMID: 19805497 DOI: 10.1503/cmaj.082068] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The pathogenesis of appendicitis is unclear. We evaluated whether exposure to air pollution was associated with an increased incidence of appendicitis. METHODS We identified 5191 adults who had been admitted to hospital with appendicitis between Apr. 1, 1999, and Dec. 31, 2006. The air pollutants studied were ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, and suspended particulate matter of less than 10 micro and less than 2.5 micro in diameter. We estimated the odds of appendicitis relative to short-term increases in concentrations of selected pollutants, alone and in combination, after controlling for temperature and relative humidity as well as the effects of age, sex and season. RESULTS An increase in the interquartile range of the 5-day average of ozone was associated with appendicitis (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.03-1.25). In summer (July-August), the effects were most pronounced for ozone (OR 1.32, 95% CI 1.10-1.57), sulfur dioxide (OR 1.30, 95% CI 1.03-1.63), nitrogen dioxide (OR 1.76, 95% CI 1.20-2.58), carbon monoxide (OR 1.35, 95% CI 1.01-1.80) and particulate matter less than 10 micro in diameter (OR 1.20, 95% CI 1.05-1.38). We observed a significant effect of the air pollutants in the summer months among men but not among women (e.g., OR for increase in the 5-day average of nitrogen dioxide 2.05, 95% CI 1.21-3.47, among men and 1.48, 95% CI 0.85-2.59, among women). The double-pollutant model of exposure to ozone and nitrogen dioxide in the summer months was associated with attenuation of the effects of ozone (OR 1.22, 95% CI 1.01-1.48) and nitrogen dioxide (OR 1.48, 95% CI 0.97-2.24). INTERPRETATION Our findings suggest that some cases of appendicitis may be triggered by short-term exposure to air pollution. If these findings are confirmed, measures to improve air quality may help to decrease rates of appendicitis.
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Affiliation(s)
- Gilaad G Kaplan
- Division of Gastroenterology, Department of Medicine, University of Calgary, Teaching Research and Wellness Center, Calgary, Alta.
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Stieb DM, Szyszkowicz M, Rowe BH, Leech JA. Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis. Environ Health 2009; 8:25. [PMID: 19515235 PMCID: PMC2703622 DOI: 10.1186/1476-069x-8-25] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 06/10/2009] [Indexed: 05/19/2023]
Abstract
BACKGROUND Relatively few studies have been conducted of the association between air pollution and emergency department (ED) visits, and most of these have been based on a small number of visits, for a limited number of health conditions and pollutants, and only daily measures of exposure and response. METHODS A time-series analysis was conducted on nearly 400,000 ED visits to 14 hospitals in seven Canadian cities during the 1990 s and early 2000s. Associations were examined between carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), and particulate matter (PM 10 and PM2.5), and visits for angina/myocardial infarction, heart failure, dysrhythmia/conduction disturbance, asthma, chronic obstructive pulmonary disease (COPD), and respiratory infections. Daily and 3-hourly visit counts were modeled as quasi-Poisson and analyses controlled for effects of temporal cycles, weather, day of week and holidays. RESULTS 24-hour average concentrations of CO and NO2 lag 0 days exhibited the most consistent associations with cardiac conditions (2.1% (95% CI, 0.0-4.2%) and 2.6% (95% CI, 0.2-5.0%) increase in visits for myocardial infarction/angina per 0.7 ppm CO and 18.4 ppb NO2 respectively; 3.8% (95% CI, 0.7-6.9%) and 4.7% (95% CI, 1.2-8.4%) increase in visits for heart failure). Ozone (lag 2 days) was most consistently associated with respiratory visits (3.2% (95% CI, 0.3-6.2%), and 3.7% (95% CI, -0.5-7.9%) increases in asthma and COPD visits respectively per 18.4 ppb). Associations tended to be of greater magnitude during the warm season (April - September). In particular, the associations of PM 10 and PM2.5 with asthma visits were respectively nearly three- and over fourfold larger vs. all year analyses (14.4% increase in visits, 95% CI, 0.2-30.7, per 20.6 microg/m3 PM 10 and 7.6% increase in visits, 95% CI, 5.1-10.1, per 8.2 microg/m3 PM2.5). No consistent associations were observed between three hour average pollutant concentrations and same-day three hour averages of ED visits. CONCLUSION In this large multicenter analysis, daily average concentrations of CO and NO2 exhibited the most consistent associations with ED visits for cardiac conditions, while ozone exhibited the most consistent associations with visits for respiratory conditions. PM 10 and PM2.5 were strongly associated with asthma visits during the warm season.
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Affiliation(s)
- David M Stieb
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Postal locator 4903C, 269 Laurier Ave West Ottawa, Ontario, K1A 0K9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Room 3105, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Mieczyslaw Szyszkowicz
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Postal locator 4903C, 269 Laurier Ave West Ottawa, Ontario, K1A 0K9, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Room 1G1.43 WMC, University of Alberta Hospital, 8440-112th Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Judith A Leech
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Postal locator 4903C, 269 Laurier Ave West Ottawa, Ontario, K1A 0K9, Canada
- Department of Medicine, University of Ottawa, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
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Abstract
BACKGROUND No extensive studies exist on the relation between ambient air pollution and health outcomes such as migraine or headache. From other side, existing publications indicated that air pollutants can trigger migraine or headache. OBJECTIVE To examine associations between emergency department (ED) visits for headache and environmental conditions: ambient air pollution concentrations adjusted for weather factors (atmospheric pressure, temperature, and relative humidity). DESIGN AND METHODS This is a time-series study of 8012 ED visits for headache (International Classification for Diseases ninth revision: 784) recorded at an Ottawa hospital between 1992 and 2000. The generalized linear mixed models technique is used to model relation between daily counts of ED visits for headache and ambient air pollutants (gases: sulphur dioxide [SO(2)], nitrogen dioxide [NO(2)], carbon monoxide [CO]). The counts of visits for all patients, male and female patients, are analyzed separately. RESULTS The percentage increase in daily ED visits for headache was 4.2% (95% CI: 0.2, 6.4) and 4.9% (95% CI: 1.2, 8.8) for 1-day and 2-day lagged exposure to SO(2) for an increase in the interquartile range (IQR, IQR = 3.9 ppb). The positive statistically significant associations were also observed for exposure to NO(2) and CO for all and male ED visits for headache. CONCLUSIONS Presented findings provide support for the hypothesis that ED visits for headache are related to ambient air pollution.
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Liu L, Ruddy TD, Dalipaj M, Szyszkowicz M, You H, Poon R, Wheeler A, Dales R. Influence of Personal Exposure to Particulate Air Pollution on Cardiovascular Physiology and Biomarkers of Inflammation and Oxidative Stress in Subjects With Diabetes. J Occup Environ Med 2007; 49:258-65. [PMID: 17351511 DOI: 10.1097/jom.0b013e31803220ef] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We investigated whether personal exposure to particulate matter </= 10 microm in diameter (PM10) contributes to impaired cardiovascular function and increased systemic inflammation and oxidative stress in diabetic patients. METHODS We monitored 25 patients' personal exposure to PM10 for 24 hours and then measured their heart rate, blood pressure, brachial arterial diameter, flow-mediated vasodilation (FMD), plasma cytokines, and thiobarbituric acid reactive substances (TBARS), which is an oxidative stress marker. We repeated this procedure for 7 weeks on each subject. We tested the associations using mixed-effects models. RESULTS PM10 was significantly positively associated with FMD and TBARS but inversely associated with end-systolic basal brachial arterial diameter (P < 0.05). Moreover, in subjects not taking vasoactive medications, PM10 was significantly positively associated with blood pressure but inversely associated with artery flow. CONCLUSION Elevated PM10 may contribute to oxidative stress and impaired cardiovascular function in patients with diabetes mellitus.
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Affiliation(s)
- Ling Liu
- Health Canada, Ottawa.Ontario, Canada.
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16
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Abstract
BACKGROUND Self-reported surveys have indicated that weather can trigger migraine headaches. However, to date, we know of no previous study that has examined the relationship between weather and emergency room (ER) visits for this condition. OBJECTIVE To examine associations between ER visits for migraines and selected meteorological conditions within the 24 hours preceding the visit. DESIGN AND METHODS A case-crossover design was used to study 4039 visits for migraines (ICD-9: 346) that occurred at an Ottawa hospital between 1993 and 2000. Meteorological conditions were defined using hourly readings from a fixed-site monitoring station. Conditional logistic regression was used to compare the occurrence of meteorological conditions during the 24 hours leading up to the time of the visit to control periods occurring 1 week before and after. RESULTS Precipitation-related weather events (fog, snow, rain, thunder) were not associated with migraine visits. Similarly, no associations were observed with changes in atmospheric pressure, wind speed, and relative humidity during the 24 hours preceding presentation. No statistically significant differences in the frequency distribution of clusters defined by relative humidity, atmospheric pressure, and temperature were found between case and control intervals. Conversely, a mean wind speed in excess of 19 km per hour was associated with a reduction in ER visits 8 to 12 hours later. CONCLUSIONS Our findings provide little support for the hypothesis that ER visits for migraines are related to weather conditions occurring within the 24 hours preceding presentation. These results should be interpreted cautiously as some comparisons are based on a small number of cases, and ER visits for migraine may represent a highly selective group of patients who suffer from this condition.
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Affiliation(s)
- P J Villeneuve
- Air Health Effects Division, Health Canada, Ottawa, Ontario, Canada
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Szyszkowicz M. Life expectancy. Can J Public Health 1997; 88:153. [PMID: 9260352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Krewski D, Gaylor DW, Soms AP, Szyszkowicz M. An overview of the report: correlation between carcinogenic potency and the maximum tolerated dose: implications for risk assessment. Risk Anal 1993; 13:383-398. [PMID: 8234946 DOI: 10.1111/j.1539-6924.1993.tb00738.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Current practice in carcinogen bioassay calls for exposure of experimental animals at doses up to and including the maximum tolerated dose (MTD). Such studies have been used to compute measures of carcinogenic potency such as the TD50 as well as unit risk factors such as q1 * for predicting low-dose risks. Recent studies have indicated that these measures of carcinogenic potency are highly correlated with the MTD. Carcinogenic potency has also been shown to be correlated with indicators of mutagenicity and toxicity. Correlation of the MTDs for rats and mice implies a corresponding correlation in TD50 values for these two species. The implications of these results for cancer risk assessment are examined in light of the large variation in potency among chemicals known to induce tumors in rodents.
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Affiliation(s)
- D Krewski
- Health Protection Branch, Health and Welfare Canada Ottawa, Ontario, Canada
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Abstract
Estimates of risk associated with exposure to low levels of carcinogenic substances present in the environment are generally obtained by linear extrapolation from higher exposure levels at which risks can be estimated directly. In this paper, we examine the scientific basis for the assumption of low-dose linearity in carcinogenic risk assessment and the different statistical methods that have been proposed for linear extrapolation. A model-free approach to linear extrapolation is described and illustrated using epidemiological data on radiation carcinogenesis. The statistical properties of this method are empirically assessed using 572 selected sets of bioassay data.
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Affiliation(s)
- D Krewski
- Health Protection Branch, Health and Welfare Canada, Ottawa, Ontario
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Abstract
The quantitative assessment of toxicological data on the carcinogenic potential of chemicals requires consideration of a number of factors, including mathematical models of the mechanism of carcinogenic action and pharmacokinetic models for the metabolic activation of the parent compound to its reactive metabolite. In this article, the use of such models in estimating carcinogenic potency and in predicting risks at low levels of exposure is discussed, along with other factors involved in the evaluation of carcinogen bioassay data. The Carcinogenic Potency Database (CPDB) established by Gold et al. (1984, Environ. Health Perspect. 58, 9-322) is used to illustrate the application of quantitative approaches to carcinogenic risk assessment and to examine the variation in the potency of chemical carcinogens. Based on an analysis of 585 experiments selected from the CPDB, the risk-specific (10(-6) doses (RSDs) obtained by linear extrapolation from the TD50 were generally within a factor of 5-10 of those derived from the linearized multistage model. The RSDs obtained by linear extrapolation from the TD50 are roughly log-normally distributed with a median of about 20-90 ng/kg/day, depending on the subset of the CPDB considered. This distribution has been used by Rulis (1986, in Food Protection Technology (C. W. Felix, Ed.), pp. 29-37, Lewis, Chelsea, MI) to explore the concept of a threshold of regulation for chemical carcinogens present in the environment at low levels.
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Affiliation(s)
- D Krewski
- Health Protection Branch, Health and Welfare Canada, Ottawa, Ontario
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