Understanding the environmental factors related to the decrease in Pediatric Emergency Department referrals for acute asthma during the SARS-CoV-2 pandemic.

BACKGROUND: Lockdown measures during the SARS-CoV-2 pandemic determined radical changes to behavioral and social habits, that were reflected by a reduction in the transmission of respiratory pathogens and in anthropogenic atmospheric emissions. OBJECTIVE: This ecological study aims to provide a descriptive evaluation on how restrictive measures during the SARS-CoV-2 pandemic impacted Pediatric Emergency Department (PED) referrals for asthma exacerbations, and their potentially associated environmental triggers in Bologna, a densely populated urban area in Northern Italy. METHODS: Files of children evaluated for acute asthma during 2015 to 2020 at the PED of Sant'Orsola University Hospital of Bologna were retrospectively reviewed. Historical daily concentration records of particulate (PM2.5 , PM10 ) and gaseous (NO2 , C6 H6 ) air pollutants, and pollen were concurrently evaluated, including specific PM chemical tracers for traffic-related air pollution (TRAP). RESULTS: In 2020, asthma-related PED referrals decreased compared to referral rates of the previous 5 years (p < 0.01). This effect was particularly marked during the first lockdown period (March to May), when the drastic drop in PED referrals was associated with a reduction of high-priority cases up to 85% and by 54%, on average. A concomitant reduction in the concentrations of traffic-related air pollutants was observed in the range of 40%-60% (p < 0.01). CONCLUSIONS: The lower rate of asthma exacerbations in childhood was in this study paralleled with reduced TRAP levels during the pandemic. Synergic interactions of the multiple consequences of lockdowns likely contributed to the reduced exacerbations, including decreased exposure to ambient pollutants and fewer respiratory infections, identified as the most important factor in the literature.

Source-related components of fine particulate matter and risk of adverse birth outcomes in Northern Italy.

BACKGROUND/AIM: The aim of the present study was to assess the association between PM2.5, its sources, and preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) in a large open residential cohort (Supersito Project in the Emilia-Romagna Region - Northern Italy). METHODS: We collected 2012-2014 pregnancy and childbirth data from Birth Assistance Certificates and selected the pregnancies of interest. PTBs (gestational age < 37 weeks), LBW (weight < 2500 g), and SGA (newborns weighing ≤ 10th age and pregnancy week-specific percentile) were considered. Three-year measurements of daily concentrations and constituents of PM2.5 were available at four sites and were analyzed through a source apportionment approach identifying 6 sources (traffic, biomass burning, oil combustion, anthropogenic mix, and two secondary factors). Exposure to PM2.5 and sources was calculated at address level. Using logistic regression models, associations between exposure and outcomes were derived, applying single-pollutant and two-pollutant models, to verify the independent effect of each source. RESULTS: The study included 23,708 neonates born to 23,415 women, among whom 1,311 PTB, 424 LBW, and 1,354 SGA occurred. PTB was the only outcome associated with PM2.5 mass (OR 1.03, 95% CI 1.002-1.058 per 1 µg/m3). Traffic, oil combustion and secondary sulfates and organics showed independent effects on PTB. Exposure to secondary nitrates was associated with a lower risk of PTB. There was no association between LBW or SGA and source-specific PM2.5 components or the residual PM2.5 related to all other sources. CONCLUSION: This study found an association between PTB and PM2.5. Traffic, secondary sulfates, and organic and oil combustion were the sources with most consistent association.

Higher health effects of ambient particles during the warm season: The role of infiltration factors.

A large number of studies have shown much higher health effects of particulate matter (PM) during the warm compared to the cold season. In this paper we present the results of an experimental study carried out in an unoccupied test apartment with the aim of understanding the reasons behind the seasonal variations of the health effects due to ambient PM2.5 exposure. Measurements included indoor and outdoor PM2.5 mass and chemical composition as well as particle size distribution of ultrafine particles. Monitoring campaigns were carried out during summer and winter following a ventilation protocol developed to replicate typical occupant behaviour according to a questionnaire-based survey. Our findings showed that seasonal variation of the relationship between ambient and indoor mass concentrations cannot entirely explain the apparent difference in PM toxicity between seasons and size distribution and chemical composition of particles were identified as other possible causes of changes in the apparent PM toxicity. A marked decrease of ultrafine particles (<100 nm) passing from outdoors to indoors was observed during winter; this resulted in higher indoor exposure to nanoparticles (<50 nm) during summer. With regards to the chemical composition, a pooled analysis showed infiltration factors of chemical species similar to that obtained for PM2.5 mass with values increasing from 0.73 during winter to 0.90 during summer and few deviations from the pooled estimates. In particular, significantly lower infiltration factors and sink effect were found for nitrates and ammonium during winter. In addition, a marked increase in the contribution of indoor and outdoor sulfates to the total mass was observed during summer.

Vertical variation of PM2.5 mass and chemical composition, particle size distribution, NO2, and BTEX at a high rise building.

Substantial efforts have been made in recent years to investigate the horizontal variability of air pollutants at regional and urban scales and epidemiological studies have taken advantage of resulting improvements in exposure assessment. On the contrary, only a few studies have investigated the vertical variability and their results are not consistent. In this study, a field experiment has been conducted to evaluate the variation of concentrations of different particle metrics and gaseous pollutants on the basis of floor height at a high rise building. Two 15-day monitoring campaigns were conducted in the urban area of Bologna, Northern Italy, one of the most polluted areas in Europe. Measurements sites were operated simultaneously at 2, 15, 26, 44 and 65 m a.g.l. Several particulate matter metrics including PM2.5 mass and chemical composition, particle number concentration and size distribution were measured. Time integrated measurement of NO2 and BTEX were also included in the monitoring campaigns. Measurements showed relevant vertical gradients for most traffic related pollutants. A monotonic gradient of PM2.5 was found with ground-to-top differences of 4% during the warm period and 11% during the cold period. Larger gradients were found for UFP (∼30% during both seasons) with a substantial loss of particles from ground to top in the sub-50 nm size range. The largest drops in concentrations for chemical components were found for Elemental Carbon (-27%), iron (-11%) and tin (-36%) during winter. The ground-to-top decline of concentrations for NO2 and benzene during winter was equal to 74% and 35%, respectively. In conclusion, our findings emphasize the need to include vertical variations of urban air pollutants when evaluating population exposure and associated health effects, especially in relation to some traffic related pollutants and particle metrics.

Is particulate air pollution at the front door a good proxy of residential exposure?

The most advanced epidemiological studies on health effects of air pollution assign exposure to individuals based on residential outdoor concentrations of air pollutants measured or estimated at the front-door. In order to assess to what extent this approach could cause misclassification, indoor measurements were carried out in unoccupied rooms at the front and back of a building which fronted onto a major urban road. Simultaneous measurements were also carried out at adjacent outdoor locations to the front and rear of the building. Two 15-day monitoring campaigns were conducted in the period June-December 2013 in a building located in the urban area of Bologna, Italy. Particulate matter metrics including PM2.5 mass and chemical composition, particle number concentration and size distribution were measured. Both outdoor and indoor concentrations at the front of the building substantially exceeded those at the rear. The highest front/back ratio was found for ultrafine particles with outdoor concentration at the front door 3.4 times higher than at the rear. A weak influence on front/back ratios was found for wind direction. Particle size distribution showed a substantial loss of particles within the sub-50 nm size range between the front and rear of the building and a further loss of this size range in the indoor data. The chemical speciation data showed relevant reductions for most constituents between the front and the rear, especially for traffic related elements such as Elemental Carbon, Iron, Manganese and Tin. The main conclusion of the study is that gradients in concentrations between the front and rear, both outside and inside the building, are relevant and comparable to those measured between buildings located in high and low traffic areas. These findings show high potential for misclassification in the epidemiological studies that assign exposure based on particle concentrations estimated or measured at subjects' home addresses.

Identification of pathway-based toxicity in the BALB/c 3T3 cell model.

The particulate matter represents one of the most complex environmental mixtures, whose effects on human health and environment vary according to particles characteristics and source of emissions. The present study describes an integrated approach, including in vitro tests and toxicogenomics, to highlight the effects of air particulate matter on toxicological relevant endpoints. Air samples (PM2.5) were collected in summer and winter at different sites, representative of different levels of air pollution. Samples organic extracts were tested in the BALB/c 3T3 CTA at a dose range 1-12m(3). The effect of the exposure to the samples at a dose of 8m(3) on the whole-genome transcriptomic profile was also assessed. All the collected samples induced dose-related toxic effects in the exposed cells. The modulated gene pathways confirmed that toxicity was related to sampling season and sampling site. The analysis of the KEGG's pathways showed modulation of several gene networks related to oxidative stress and inflammation. Even if the samples did not induce cell transformation in the treated cells, gene pathways related to the onset of cancer were modulated as a consequence of the exposure. This integrated approach could provide valuable information for predicting toxic risks in humans exposed to air pollution.

Particulate matter and gaseous pollutants in the Mediterranean Basin: results from the MED-PARTICLES project.

Previous studies reported significant variability of air pollutants across Europe with the lowest concentrations generally found in Northern Europe and the highest in Southern European countries. Within the MED-PARTICLES project the spatial and temporal variations of long-term PM and gaseous pollutants data were investigated in traffic and urban background sites across Southern Europe. The highest PM levels were observed in Greece and Italy (Athens, Thessaloniki, Turin and Rome) while all traffic sites showed high NO2 levels, frequently exceeding the established limit value. High PM2.5/PM10 ratios were calculated indicating that fine particles comprise a large fraction of PM10, with the highest values found in the urban background sites. It seems that although in traffic sites the concentrations of both PM2.5 and PM10 are significantly higher than those registered in urban background sites, the coarse fraction PM2.5-10 is more important at the traffic sites. This fact is probably due to the high levels of resuspended road dust in sites highly affected by traffic, a phenomenon particularly relevant for Mediterranean countries. The long-term trends of air pollutants revealed a significant decrease of the concentration levels for PM, SO2 and CO while for NO2 no clear trend or slightly increasing trends were observed. This reduction could be attributed to the effectiveness of abatement measures and strategies and also to meteorological conditions and to the economic crisis that affected Southern Europe.

Ultrafine particle concentrations in the surroundings of an urban area: comparing downwind to upwind conditions using Generalized Additive Models (GAMs).

The aim of this study was to investigate the influence of an urban area on ultrafine particle (UFP) concentration in nearby surrounding areas. We assessed how downwind and upwind conditions affect the UFP concentration at a site placed a few kilometres from the city border. Secondarily, we investigated the relationship among other meteorological factors, temporal variables and UFP. Data were collected for 44 days during 2008 and 2009 at a rural site placed about 3 kilometres from Bologna, in northern Italy. Measurements were performed using a spectrometer (FMPS TSI 3091). The average UFP number concentration was 11 776 (±7836) particles per cm(3). We analysed the effect of wind direction in a multivariate Generalized Additive Model (GAM) adjusted for the principal meteorological parameters and temporal trends. An increase of about 25% in UFP levels was observed when the site was downwind of the urban area, compared with the levels observed when wind blew from rural areas. The size distribution of particles was also affected by the wind direction, showing higher concentration of small size particles when the wind blew from the urban area. The GAM showed a good fit to the data (R(2) = 0.81). Model choice was via Akaike Information Criteria (AIC). The analysis also revealed that an approach based on meteorological data plus temporal trends improved the goodness of the fit of the model. In addition, the findings contribute to evidence on effects of exposure to ultrafine particles on a population living in city surroundings.

Experimental evaluation of PCDD/Fs and PCBs release and mass balance of a WTE plant.

The behaviour of waste incineration plants with respect to organic toxic trace contaminants such as PCDDs, PCDFs and, to a minor extent, PCBs, is still a matter of concern for the public opinion and the decision makers. It is therefore very important, first, to evaluate the release of these organic toxic trace contaminants in the environment during waste incineration, not only through the stack gas emission but also with the solid and liquid residues, and then to compare the total release with the input through the treated waste in order to assess the plant behaviour as a "sink" rather than a "source" of organic toxic trace contaminants. The experimental investigation carried out on an Italian full scale incineration plant has shown a total 17 PCDD/Fs and 12 dioxin-like PCBs release of 5.5-27 µg WHO-TEQ per tonne of treated waste and an input flux of 1.6-44 µg WHO-TEQ per tonne of waste, with the difference between the input and the output fluxes rather small and the plant behaviour toward organic trace toxic contaminants in average neutral. Results are compared with similar evaluations conducted in the last decade on a number of waste-to-energy (WTE) plants operating in Italy.

[Simulation of children exposure to NO2 and pm10 in the urban area of Bologna (Italy)]. / Simulazioni di esposizione a NO2 e PM10 di bambini residenti nell'area urbana di Bologna.

OBJECTIVE: To estimate exposure to NO2 and PM10 of children living in a central area of the city of Bologna, Italy. DESIGN: Mean personal exposure was estimated for 333 school children as weighted average of the individual hourly exposure levels during the period 1.06.2004-31.05.2005. Four microenvironments (home indoor, school indoor, traffic, home outdoor) and three typical days (school day, holidays in schooling period, and summer holidays) has been considered in the model. MAIN OUTCOME MEASURES: Annual mean exposure to NO2 and PM10. RESULTS: Exposure levels in the sample were lower than mean concentrations recorded by the monitoring station located in the study area. During the school period, mean exposures to NO2 and to PM10 were respectively 20% and 40% higher than in holidays during school period and 30% and 50% higher than during summer holidays. Exposures of the most exposed children were 39 mg/m3 for NO2 and 18 mg/m3 for PM10, i.e. roughly 50% higher than the least exposed children. During the school period, the most important contributions to total exposure were those of the indoor and school micro-environments. DISCUSSION AND CONCLUSIONS: Compared to ambient levels measured at traffic oriented monitoring stations, exposures of school children are influenced by the length of time spent in the traffic microenvironment, as well as by the protection given by the time spent at school and at home. Exposure modelling can be used in order to estimate the consequences of policy options on exposure. However, a detailed empirical validation of the exposure model is needed.