PM10, and children's respiratory symptoms and lung function in the PATY study.

Studies of the impact of long-term exposure to outdoor air pollution on the prevalence of respiratory symptoms and lung function in children have yielded mixed results, partly related to differences in study design, exposure assessment, confounder selection and data analysis. We assembled respiratory health and exposure data for >45,000 children from comparable cross-sectional studies in 12 countries. 11 respiratory symptoms were selected, for which comparable questions were asked. Spirometry was performed in about half of the children. Exposure to air pollution was mainly characterised by annual average concentrations of particulate matter with a 50% cut-off aerodynamic diameter of 10 µm (PM(10)) measured at fixed sites within the study areas. Positive associations were found between the average PM(10) concentration and the prevalence of phlegm (OR per 10 µg · m(-3) 1.15, 95% CI 1.02-1.30), hay fever (OR 1.20, 95% CI 0.99-1.46), bronchitis (OR 1.08, 95% CI 0.98-1.19), morning cough (OR 1.15, 95% CI 1.02-1.29) and nocturnal cough (OR 1.13, 95% CI 0.98-1.29). There were no associations with diagnosed asthma or asthma symptoms. PM(10) was not associated with lung function across all studies combined. Our study adds to the evidence that long-term exposure to outdoor air pollution, characterised by the concentration of PM(10), is associated with increased respiratory symptoms.

Parental education and lung function of children in the PATY study.

Studies of the relationships between low socio-economic status and impaired lung function were conducted mainly in Western European countries and North America. East-West differences remain unexplored. Associations between parental education and lung function were explored using data on 24,010 school-children from eight cross-sectional studies conducted in North America, Western and Eastern Europe. Parental education was defined as low and high using country-specific classifications. Country-specific estimates of effects of low parental education on volume and flow parameters were obtained using linear and logistic regression, controlling for early life and other individual risk factors. Meta-regressions were used for assessment of heterogeneity between country-specific estimates. The association between low parental education and lung function was not consistent across the countries, but showed a more pronounced inverse gradient in the Western countries. The most consistent decrease associated with low parental education was found for peak expiratory flow (PEF), ranging from -2.80 to -1.14%, with statistically significant associations in five out of eight countries. The mean odds ratio for low PEF (<75% of predicted) was 1.34 (95% CI 1.06-1.70) after all adjustments. Although social gradients were attenuated after adjusting for known risk factors, these risk factors could not completely explain the social gradient in lung function.

Maternal smoking during pregnancy and childhood obesity: results from the CESAR Study.

Childhood obesity is a worldwide public health concern. Recent studies from high income countries have demonstrated associations between maternal smoking during pregnancy and children's excess body weight. We examine associations between maternal smoking during pregnancy and children's overweight or obesity, in six countries in the less affluent Central/Eastern European region. Questionnaire data were analysed, for 8,926 singleton children aged 9-12 years. Country-specific odds ratios for effects of maternal smoking during pregnancy on being overweight, and on obesity, were estimated using logistic regression. Heterogeneity between country-specific results, and mean effects (allowing for heterogeneity) were estimated. Positive associations between maternal smoking and overweight were seen in all countries but Romania. While not individually statistically significant, the mean odds ratio was 1.26 (95% CI 1.03-1.55), with no evidence of between-country heterogeneity. Obese children were few (2.7%), and associations between obesity and maternal smoking during pregnancy were more heterogeneous, with odds ratios ranging from 0.71 (0.32-1.57) in Poland to 5.49 (2.11-14.30) in Slovakia. Between-country heterogeneity was strongly related to average persons-per-room, a possible socioeconomic indicator, with stronger associations where households were less crowded. Estimates of dose-response relationships tended to be small and non-significant, even when pooled. Our results provide evidence of a link between maternal smoking in pregnancy and childhood overweight. Associations with obesity, though strong in some countries, were less consistent. Maternal smoking may confer an addition to a child's potential for obesity, which is more likely to be realised in affluent conditions.

[Workers' exposure to selected biological agents in libraries of Upper Silesia]. / Narazenie pracowników na wybrane szkodliwe czynniki biologiczne w bibliotekach województwa slaskiego.

The aim of this study was to assess the exposure of library workers to biological agents based on quantitative and qualitative characteristics of airborne and settled dust microflora supplemented with the analysis of dust mite allergens. The bioaerosol sampling was carried out using a 6-stage Andersen impactor. The settled dust samples were collected from book covers using cotton swabs and vacuum cleaner. Isolated microbial colonies were identified to the genus and/or species level. Moreover, the concentration of guanine as a predictor of dust mite allergen content was determined with the semi-quantitative Acarex test. The bioaerosol concentrations were low and they did not exceed the proposed Polish reference limits. The presence of air-conditioning or ventilating system resulted in the decreased biological contamination in libraries. The identification ofmicroorganisms in bioaerosol and settled dust samples revealed the presence of strains classified into group 2 according to their risk of infection. The level of dust mite allergens was elevated. Inhalation exposure to molds and dust mite allergens may result in the occurrence of allergic reactions and SBS symptoms.

Parental smoking and children's respiratory health: independent effects of prenatal and postnatal exposure.

OBJECTIVES: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children's health. Uncertainties remain about the relative importance of smoking at different periods in the child's life. We investigate this in a pooled analysis, on 53,879 children from 12 cross-sectional studies--components of the PATY study (Pollution And The Young). METHODS: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, "woken by wheeze", bronchitis, nocturnal cough, morning cough, "sensitivity to inhaled allergens" and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools. RESULTS: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations. CONCLUSIONS: Adverse effects of both pre- and postnatal parental smoking on children's respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children's respiratory health and needs to be reduced urgently.

Parental smoking and lung function in children: an international study.

RATIONALE: Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear. OBJECTIVE: To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America. METHODS: Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools. MAIN RESULTS: Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF < 75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50). CONCLUSIONS: Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.

[Assessment of respiratory health status in the population of middle school students]. / Ocena stanu ukladu oddechowego w populacji nastolatków uczeszczajacych do gimnazjów.

BACKGROUND: The aim of the study was to assess the prevalence of asthma and to identify the basic host and environmental risk factors for asthma and symptoms suggestive of asthma in Polish adolescents aged 15 years. MATERIALS AND METHODS: The study was performed as a cross-sectional questionnaire survey comprising population of 854 - 68.3% of all eligible students, attending schools located in Jaworzno. Parents or guardians filled the questionnaire, which contained questions on the occurrence of respiratory and allergic symptoms and diseases, family history of these pathologies, data on exposure to indoor factors and socioeconomic status of the family. Statistical analyses involved calculation of the prevalence of asthma and symptoms suggestive of asthma and identification of risk factors on the basis of multivariate logistic regression. RESULTS: Wheezing in the last year preceding the survey was reported in 44 (5.1%) adolescents, attacks of dyspnea with wheezing in 22 (2.6%), and asthma in 46 (5.4%) adolescents. The results of multivariate logistic regression revealed that the presence of atopy was the most important risk factor for asthma (odds ratio: OR - 7.8; p = 0.0001). Other statistically significant risk factors for asthma and symptoms suggestive of asthma were positive history of allergy in mothers (OR - 8.3; p = 0.04) and positive history of severe respiratory disease in early childhood (OR - 4.7; p = 0.007). CONCLUSIONS: The results of our study justify the need for activities aimed at proper job orientation in future for adolescents with the presence of atopy.

Fetal and postnatal exposure to tobacco smoke and respiratory health in children.

The aim of this paper was to find out whether fetal exposure to environmental tobacco smoke (ETS), as compared to postnatal ETS exposure, is an independent risk factor for respiratory symptoms and diseases in younger schoolchildren. The cross-sectional epidemiological study comprised population of 1,561 Polish schoolchildren, aged 9-11 years. Information on the exposure to tobacco smoke and other sources of indoor air pollution at home, respiratory and allergic health status, and socio-economic status of the family was obtained by questionnaire survey. The respiratory health status was described by presence of wheezing, attacks of dyspnoea (noted during the last year or ever), bronchitis, wheezy bronchitis and asthma, ever diagnosed by a physician. Multivariate logistic regression analysis with adjustment for age, sex, area of residence, household density, damp and mould stains found at home, use of coal-fired stove, co-habitant pets, mother's education and paternal current and past smoking habit was used to assess the effect of fetal and postnatal exposures on respiratory health outcomes. The results of the multivariate analyses revealed statistically significant associations between fetal exposure to ETS and wheezing ever: log OR = 1.4 (95% CI: 1.0-2.0), attacks of dyspnoea ever: log OR = 1.8 (95% CI: 1.1-2.9), bronchitis: log OR = 2.1 (95% CI: 1.5-2.9), and wheezy bronchitis: log OR = 1.8 (95% CI: 1.1-2.9). The effect of postnatal ETS was statistically significant only for bronchitis: log OR = 1.4 (95% CI: 1.1-1.9). The results of our study showed that fetal exposure to tobacco smoke is an independent risk factor for symptoms of wheeze and wheezy bronchitis in schoolchildren when compared to postnatal ETS exposure.

[Immunobiomarkers in healthy children from two Polish cities]. / Immunobiomarkery w populacji zdrowych dzieci z dwóch polskich miast.

Determination of lymphocyte subpopulation values and immunoglobulin concentrations is an important tool in the assessment of immunologic system. The only way to establish their reference values in pediatrics is to perform research on large populations of healthy children from different age ranges in various areas of the world. Such research was conducted within the framework of the Central European Study of Air pollution and Respiratory Health (CESAR). It involved examination of children 9-11 years old from six countries in Central-Eastern Europe. We present the results of the Polish section of CESAR and compare them to the data provided by different authors from all over the world. Our data are relatively numerous: we examined 80 children recruited from primary schools in two Polish cities, Swietochlowice and Pszczyna. The values are similar to those obtained by other researchers. There is a need to establish an extensive and uniform data base of immunobiomarkers for healthy children in different age groups.

[Passive smoking, atopy and respiratory health in schoolchildren]. / Bierne palenie tytoniu, atopia i stan ukladu oddechowego u dzieci szkolnych.

Aim of the study was to verify the hypothesis that the effect of passive smoking exposure on the occurrence of respiratory symptoms and diseases is higher in children with increased individual susceptibility defined on the basis of occurrence of symptoms of atopy. Project was performed as the cross-sectional epidemiological study which comprised population of 1,534 children attending primary schools in Swietochlowice, Kedzierzyn-Kozle, Pszczyna and Kielce. On the basis of standard questionnaire an information regarding occurrence of wheezing, attacks of dyspnea with wheezing, asthma and spastic bronchitis was collected. Atopy in child was defined on the basis of occurrence of symptoms of allergy to at least one of the following allergens: house dust mites, animal dander, pollens or symptoms of food allergy confirmed by physician's diagnosis. Exposure to tobacco smoke was assessed also on the basis of the information regarding smoking given by the parents in the questionnaire. The effect of interaction atopy * passive smoking was assessed on the basis of variable called "interaction" which had three levels: level A: when exposure to passive smoking and atopy = 0, level B: when exposure to passive smoking or atopy =1 and level C: when exposure to passive smoking and atopy =1. The results of our study revealed that statistically significant relationship between interaction atopy * passive smoking on the occurrence of analyses symptoms and diseases. The occurrence of symptom/disease increased with the presence of either atopy or exposure to passive smoking and was the highest when atopy and exposure to passive smoking was present. The results of simple analyses were conformed by multivariate analyses. The results of our study suggest that the effect of environmental exposures could be higher in children with atopy.

[Oxygen saturation in blood during bronchial histamine challenge]. / Wysycenie krwi tlenem w trakcie próby prowokacji oskrzeli histamina.

The aim of the study was to evaluate whether significant bronchial constriction which is consequence of histamine administration during the bronchial challenge is accompanied by drop in oxygen saturation in blood (SaO2). A practical aim was to answer the question whether monitoring of saturation by pulsoximetry during the bronchial challenge could improve its method. A study was performed in a group of 25 females and males with non-specific bronchial hyperreactivity. Results of this study revealed a statistically significant association between drop in FEV1 caused by administration of histamine and drop in oxygen saturation, and no association between drop in MEF50 and drop in SaO2. Drop in saturation in blood was not high which does not justify supplementary using of pulsoximetry during the bronchial challenge test.

[Occupational acute mercury intoxication--a case report]. / Ostre zawodowe zatrucie rtecia--opis przypadku.

The aim of this paper is to present a case of acute occupational mercury poisoning treated at the Clinical Department of Occupational Diseases. A welder, forty years old was employed at a large chemical plant in the dissembling department involved in the production of acetaldehyde. The patient was referred to the hospital by an occupational physician. During his shift; dissembling mercury-covered tubes a nausea, abdominal pain and elevated temperature occurred. He was also complaining of headache and symptoms of gingivitis, which lasted two weeks before hospitalization. Before admission to the Clinical Department, mercury concentrations in urine were measured twice. The urine mercury levels were very high, impossible to determine precisely. During hospitalization, the patient was complaining of head and gingiva pains. Since the symptoms persisted and high urine mercury levels (830 micrograms/l) were determined--DMPS--Heyl was administered. After treatment symptoms subsided and the concentration of mercury in urine was gradually returning to normal. The results of laboratory tests did not reveal any impairment of internal organs. Consultant in neurology found the presence of nystagmus and positive Romberg test in the patient. Neurological signs disappeared after a month. The measurements performed by the Department of Work Safety revealed high exceeded hygiene permissible limits of mercury vapors in the air. The information provided by the employer's technical services also showed that the patient was working with the face mask, but its absorber was not readjusted to mercury vapors. A control ambulatory examination (one and a half year later) did not reveal health effects of acute exposure to mercury vapors.