Effect of air pollutants on ambulatory blood pressure.

BACKGROUND AND METHODOLOGY: Air pollutants have a significant impact on public health. The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM10, PM2.5, NO2 and SO2). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients≥18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3km. RESULTS AND CONCLUSIONS: The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM10 concentrations the day before ABPM. For each increase of 10µg/m3 of PM10, an increase of 1.37mmHg 24-h DBP and 1.48mmHg daytime DBP was observed. No relationship was found between PM2.5, NO2 and SO2 and ambulatory BP, nor between any pollutant and clinical BP. The concentration of PM10 the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP.

Effect of air pollutants on ambulatory blood pressure / Efectos de los contaminantes aéreos en la presión arterial ambulatoria

Background and methodology: Air pollutants have a significant impact on public health. The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM10, PM2.5, NO2 and SO2). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients≥18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3km. Results and conclusions: The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM10 concentrations the day before ABPM. For each increase of 10μg/m3 of PM10, an increase of 1.37mmHg 24-h DBP and 1.48mmHg daytime DBP was observed. No relationship was found between PM2.5, NO2 and SO2 and ambulatory BP, nor between any pollutant and clinical BP. The concentration of PM10 the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP. (AU)

Antecedentes y metodología: Los contaminantes aéreos tienen un impacto importante en la salud pública. El objetivo del estudio era conocer la relación entre la presión arterial ambulatoria medida mediante monitorización ambulatoria de la presión arterial (MAPA) de 24h y los contaminantes atmosféricos que se miden regularmente (PM10, PM2,5, NO2 y SO2). Se realizó un estudio observacional de medidas temporales y geográficas de pacientes individuales (case-time series design) en centros de atención primaria y unidades de hipertensión del área metropolitana de Barcelona. Se incluyeron 2.888 pacientes hipertensos≥18 años, no tratados, con una primera MAPA válida realizada entre 2005-2014 y al menos con una estación de contaminación atmosférica en un radio<3km. Resultados y conclusiones: La media de edad fue de 54,3 (DE 14,6) años. El 50,1% eran mujeres y el 16,9% de la muestra eran fumadores. La presión arterial (PA) de 24h fue de 128,0 (12,7)/77,4 (9,7)mmHg. Tras ajustarse por la temperatura ambiental media y por los diferentes factores de riesgo se halló una asociación significativa entre PA diastólica (PAD) ambulatoria y las concentraciones de PM10 del día anterior a la MAPA. Por cada incremento de 10μg/m3 de PM10 se observaba un aumento de 1,37mmHg PAD 24h y de 1,48mmHg PAD diurna. No se halló relación entre PM2,5, NO2 y SO2 y PA ambulatoria, ni entre ningún contaminante y PA clínica. La concentración de PM10 del día anterior a la realización de la MAPA se asocia significativamente con un aumento de PAD 24h y PAD diurna. (AU)

Medioambiente y salud cardiovascular: causas, consecuencias y oportunidades en prevención y tratamiento / Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment

El medioambiente es un gran determinante de la salud cardiovascular. La cardiología ambiental estudia la contribución de las exposiciones ambientales con el objetivo de minimizar las influencias nocivas de la contaminación y promover la salud cardiovascular mediante estrategias preventivas o terapéuticas específicas. La presente revisión se centra en el material particulado y los metales, contaminantes con la evidencia científica más sólida, e incluye las posibles intervenciones. La legislación, la mitigación y el control de los contaminantes en el aire, el agua y los alimentos y las políticas ambientales de espacios cardiosaludables son medidas clave para la salud cardiovascular. Entre las estrategias individuales, cabe reseñar la quelación de metales divalentes como el plomo y el cadmio, que solamente pueden eliminarse del cuerpo vía quelación. El ensayo clínico TACT (NCT00044213) demostró el beneficio cardiovascular en pacientes con un infarto de miocardio previo, especialmente en los diabéticos. Actualmente, el ensayo TACT2 (NCT02733185) está reproduciendo los resultados del TACT en personas con diabetes. Datos de Estados Unidos y Argentina también han mostrado la posible utilidad de la quelación en la enfermedad arterial periférica grave. Más investigación y acción en cardiología ambiental podría contribuir sustancialmente a mejorar la prevención y el tratamiento de las enfermedades cardiovasculares.(AU)

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.(AU)

Environment and cardiovascular health: causes, consequences and opportunities in prevention and treatment.

The environment is a strong determinant of cardiovascular health. Environmental cardiology studies the contribution of environmental exposures with the aim of minimizing the harmful influences of pollution and promoting cardiovascular health through specific preventive or therapeutic strategies. The present review focuses on particulate matter and metals, which are the pollutants with the strongest level of scientific evidence, and includes possible interventions. Legislation, mitigation and control of pollutants in air, water and food, as well as environmental policies for heart-healthy spaces, are key measures for cardiovascular health. Individual strategies include the chelation of divalent metals such as lead and cadmium, metals that can only be removed from the body via chelation. The TACT (Trial to Assess Chelation Therapy, NCT00044213) clinical trial demonstrated cardiovascular benefit in patients with a previous myocardial infarction, especially in those with diabetes. Currently, the TACT2 trial (NCT02733185) is replicating the TACT results in people with diabetes. Data from the United States and Argentina have also shown the potential usefulness of chelation in severe peripheral arterial disease. More research and action in environmental cardiology could substantially help to improve the prevention and treatment of cardiovascular disease.

Association between particulate matter, sulphur dioxide, nitrogen dioxide, ozone, benzo[a]pyrene air concentrations, suicide and suicide attempts in Poland

Background and objectives: Certain air pollutants are associated with mental health conditions, like cognitive decline, depression and suicide. The aim of the study was to assess the relationship between long-term exposure to airborne concentrations of particulate matter (PM), sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), benzo[a]pyrene (BaP) and suicide rates, suicide attempts and suicide attempts among people with mental disorder.MethodsThe data used covered the years 2013–2016 of 27 regions in Poland, came from the Chief Inspectorate for Environmental Protection, the Provincial Police Headquarters and the Central Statistical Office. Univariate and multivariate linear regression analyses had been performed.ResultsResults of the study indicate that ozone is correlated with the rate of suicide attempts, the rate of total suicides and attempts at suicide attempts among people with mental disorder (r = 0.548, p < 0.001; r = 0.371, p < 0.01; r = 0.422, p < 0.01, respectively). Independent predictors of suicide attempts were high ozone concentration (β = 0.00216, p < 0.001), high feminisation and a small number of beneficiaries of environmental social welfare per 10,000 population. Completed suicide rate was associated with increased air concentrations of PM10 particulate matter (b = 0.0003, p = 0.001; β = 0.003, p < 0.001), a high number of employees and a high level of total pollutant emissions (β = 0.00027, p = 0.031). Finally, suicide attempts among people with psychiatric disorder were linked to high ozone concentration (b = 0.0005; p < 0.001; β = 0.0003; p = 0.004) and low SO2 concentration (b = − 0.0011; p < 0.001; β = − 0.0008; p = 0.002).ConclusionsAir pollutions' impact on suicidality is comparable to some adverse demographic factors and it should be considered as a strong predictor for suicidal behaviour. (AU)

Antecedentes y objetivos: Algunos contaminantes del aire están asociados a ciertos estados de salud mental, tales como deterioro cognitivo, depresión y suicidio. El objetivo del estudio fue evaluar la relación entre la exposición a largo plazo a las concentraciones aerotransportadas de materia particulada (PM), dióxido de sulfuro (SO2), dióxido de nitrógeno (NO2), ozono (O3), benzo[a]pireno (BaP) y tasas de suicidio, intentos de suicidio y tentativas de suicidio entre las personas con trastornos mentales.MétodosLos datos utilizados abarcaron los años 2013 a 2016 en 27 regiones de Polonia, y procedieron del Cuerpo de Inspectores de Protección Medioambiental, el Cuartel General de la Policía Provincial y la Oficina Estadística Central. Se realizaron análisis de regresión lineal univariante y multivante.ResultadosLos resultados del estudio indican que el ozono está correlacionado con la tasa de intentos de suicidio, la tasa de suicidios totales y las tentativas de suicidio entre las personas con trastornos mentales (r = 0,548, p < 0,001; r = 0,371, p < 0,01; r = 0,422 y p < 0,01, respectivamente). Los factores predictivos independientes de los intentos de suicidio fueron la alta concentración de ozono (β = 0,00216, p < 0,001), la alta feminización y el pequeño número de beneficiarios del bienestar social medioambiental por cada 10.000 habitantes. La tasa de suicidios completados se asoció al incremento de las concentraciones en aire de materia particulada PM10 (b = 0,0003, p = 0,001; β = 0,003, p < 0,001), el elevado número de empleados y el alto nivel de emisiones de contaminantes totales (β = 0,00027, p = 0,031). Por último, las tentativas de suicidio entre las personas con trastornos psiquiátricos estuvieron vinculadas a la alta concentración de ozono (b = 0,0005; p < 0,001; β = 0,0003; p = 0,004) y la baja concentración de SO2 (b = − 0,0011; p < 0,001; β = −0,0008; p = 0,002). (AU)

Relación de PM2, 5 y Enfermedad Respiratoria Aguda en un territorio de Colombia: Modelos Aditivos Generalizados / Relationship between PM2. 5 and Acute Respiratory Disease in a Colombian region: Generalized Additive Models

Introducción: El efecto deletéreo de material particulado fino exterior sobre la salud respiratoria de la población de niños y de adultos mayores, es de interés en salud pública. Objetivo: Establecer el efecto de la contaminación por Material Particulado de menos de 2,5 μm de diámetro (PM2,5), sobre la Enfermedad Respiratoria Aguda (ERA) en los menores de 5 y personas de mínimo 65 años, ajustado por variables meteorológicas y climáticas, en los municipios del Área Metropolitana del Valle de Aburrá (Colombia), 2008 a 2015. Materiales y métodos: Estudio ecológico con información de la red de vigilancia de calidad del aire y de registros de prestación de servicios de salud. Se construyeron Modelos Aditivos Generalizados con función de enlace Poisson y suavización spline. Para cada rezago distribuido se calculó la medida de la asociación e intervalo de confianza. Resultados: Los casos de ERA aumentaron significativamente en los menores de 5 años en Envigado y Caldas (43,3% vs 29,6%) y en los de 65 y más años, en Medellín (13,2%) por cada incremento de 10 µg/m3 en PM2,5 al día quince a partir de la exposición. Conclusiones: Los eventos diarios respiratorios tuvieron especial frecuencia en Medellín y en municipios de la zona sur.

Introduction: The harmful effect of fine particulate matter on the respiratory health of child and elderly populations is a concern for public health. Objective: To establish the effect of pollution by less than 2.5 μm in diameter (PM2.5) particulate matter on Acute Respiratory Disease (ARD) during 2008-2015 in children younger than 5 and adults older than 65 from the Metropolitan Area of the Aburrá Valley (Colombia), adjusting for meteorological and climate variables. Materials and methods: Ecological study with information from the air quality surveillance network and individual records of health providers. Generalized Additive Models were developed using smoothing spline Poisson models. The assessment of the association and confidence intervals were calculated for each distributed lag. Results: For each 10 µg/m3 increment in PM2,5 and the day 15 post-exposure, ARD cases increased significantly in populations who are younger than 5 and older than 65 in Envigado and Caldas (43.3% vs. 29.6%) and Medellín (13.2%), respectively. Conclusions: Daily respiratory events had a special frequency in Medellín and the municipalities of the southern region.

Relación genética entre las enfermedades pulmonares de origen ambiental u ocupacional y la osteoporosis: un enfoque bioinformático / Genetic relationship between pulmonary diseases of environmental or occupational origin and osteoporosis: a bioinformatic approach

Objetivo: Identificación de biomarcadores que relacionan la osteoporosis con enfermedades pulmonares ocupacionales y ambientales. Material y métodos: Mediante bases de datos de terminología médica unificada se obtuvieron enfermedades relacionadas con enfermedades pulmonares que, junto con la osteoporosis, fueron analizadas en DisGeNET para obtener los genes asociados a cada enfermedad y formar una red de interacción proteína-proteína (PPI) mediante el uso de STRING dentro de Cytoscape. A través de la aplicación de diferentes algoritmos de centralidad utilizando CythoHubba en Cytoscape, se seleccionaron las 5 proteínas de la red con el mayor grado de centralidad. Resultados: 9 enfermedades fueron incluidas en el grupo de enfermedades pulmonares. Se obtuvieron 2.698 genes asociados a enfermedades pulmonares y a osteoporosis. Los genes vinculados con osteoporosis y con al menos dos de las enfermedades pulmonares incluidas dieron lugar a una red PPI con 152 nodos y 1.378 ejes. Las proteínas con mayor grado de centralidad de la red fueron AKT1, ALB, IL6, TP53 y VEGFA. Conclusiones: Existe una elevada relación entre la osteoporosis y las enfermedades pulmonares ambientales estudiadas, a través de genes con una implicación dual. Nosotros proponemos cinco genes importantes que vinculan estas enfermedades y que podrían constituir una base coherente para investigaciones más profundas en este campo. (AU)

Objetives: Identifying biomarkers that relate osteoporosis to occupational and environmental lung diseases. Material and methods: Using integrated medical terminology databases, diseases related to lung diseases were obtained which, together with osteoporosis, were analyzed in DisGeNET to obtain the genes associated with each disease and form a protein-protein interaction network (PPI) through the Cytoscape StringApp. Applying different centrality algorithms using CythoHubba in Cytoscape, the 5 network proteins with the highest degree of centrality were selected. Results: 9 diseases were included in the group of pulmonary diseases. 2,698 genes associated with lung diseases and osteoporosis were obtained. Genes associated with osteoporosis and with at least two of the included lung diseases resulted in a PPI network with 152 nodes and 1,378 axes. The proteins with the highest degree of network centrality were AKT1, ALB, IL6, TP53 and VEGFA. Conclusions: There is a significant relationship between osteoporosis and the environmental lung diseases studied, through genes with dual involvement. We propose five important genes that link these diseases. This could provide a coherent basis for further research in this field. (AU)

Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution.

OBJECTIVE: To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. DEVELOPMENT: We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. CONCLUSIONS: Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution.

Recomendaciones de la Sociedad Española de Neurología para la prevención del ictus. Actuación sobre los hábitos de vida y la contaminación atmosférica / Recommendations of the Spanish Society of Neurology for the prevention of stroke. Interventions on lifestyle and air pollution

Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología relativas a la actuación sobre los hábitos de vida para la prevención del ictus.DesarrolloSe ha realizado una revisión de los estudios más recientes relacionados con los hábitos de vida y el riesgo de ictus, incluyendo ensayos clínicos aleatorizados, estudios poblacionales y metaanálisis. Se ha analizado el riesgo de ictus asociado con determinados hábitos de vida como el tabaquismo, el consumo de alcohol, el estrés, la dieta, la obesidad y el sedentarismo, también se ha revisado el potencial beneficio que la modificación de esos hábitos de vida puede aportar en la prevención del ictus. Asimismo, se ha revisado el riesgo de ictus asociado a la exposición a la contaminación atmosférica. A partir de los resultados obtenidos se han redactado unas recomendaciones sobre cada uno de los hábitos de vida analizados.ConclusionesLa actuación sobre los hábitos de vida constituye una piedra angular en la prevención primaria y secundaria del ictus. La abstinencia o cese del hábito tabáquico, el cese del consumo excesivo de alcohol, evitar la exposición a estrés crónico, evitar el sobrepeso o la obesidad, seguir una dieta mediterránea suplementada con aceite de oliva y frutos secos, así como la práctica regular de actividad física son medidas fundamentales para reducir el riesgo de sufrir un ictus. Además, se aconseja desarrollar políticas encaminadas a disminuir la contaminación atmosférica. (AU)

Objective: To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention.DevelopmentWe reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed.ConclusionsLifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution. (AU)

Relación entre contaminación atmosférica y consultas por enfermedades respiratorias en atención primaria de urgencia / Relationship between air pollution and respiratory disease consultations in primary emergency care

Resumen La presente investigación indaga la relación entre los niveles de contaminación ambiental por material particulado 2,5 y consultas respiratorias según tipo de enfermedad respiratoria y edad de los usuarios que consultaron en los Servicios de Atención Primaria de Urgencia de 2 comunas de la Región de Ñuble, Chile, entre los años 2016 y 2017 mediante un diseño de tipo ecológico. La unidad de análisis correspondió a medias agrupadas (promedios) de consultas diarias por enfermedades respiratorias y de concentración de material particulado 2,5. Los análisis estadísticos utilizados fueron Anova, test estadístico Dickey-Fuller, análisis inferencial basado en correlación de Spearman y Cross-Correlation. Se observó una correlación positiva entre los niveles de contaminación ambiental y consultas por enfermedades respiratorias registrados al día siguiente y al noveno día posterior a un episodio de emergencia ambiental. Desde la entrada en vigencia del Plan de Prevención y Descontaminación Atmosférica no se observan diferencias significativas en las concentraciones de MP2,5 entre los años 2016 y 2017. Los mayores niveles de contaminación ambiental se concentran entre los meses de abril a septiembre. En conclusión, existe relación entre los niveles de contaminación ambiental por MP2,5 con el número de consultas por enfermedades respiratorias y la edad de los usuarios.

The present investigation inquires the relation between the levels of environmental pollution by air borne particulate matter 2,5 and respiratory-related consultatons according to type of respiratory disease and age of the users who were admitted in the Primary Healthcare Emergency Services in two communes in Chile's Ñuble Region, between 2016 and 2017 through an ecological design. The unit of analysis corresponded to pooled means (averages) of daily consultations for respiratory diseases and concentration of particulate matter 2.5. The statistical methods used were: Anova, statistical test Dickey-Fuller, inferential analysis based on Spearman's correlation and Cross-Correlation. A positive correlation was observed between environmental pollution and consultations related to respiratory diseases recorded the next day and the ninth day after an environmental emergency episode. Since the entry into force of the Atmospheric Prevention and Decontamination Plan, no significant differences have been observed in the concentrations of PM2.5 between 2016 and 2017. The highest levels of environmental pollution are concentrated between the months of April to September. In conclusion, there is a relation between the levels of environmental pollution by PM2.5, the number of respiratory diseases consultatons and the age of users.

Mortalidad aguda asociada con partículas suspendidas finas y gruesas en habitantes de la Zona Metropolitana de Monterrey / Mortality associated with fine and coarse suspended particles, in inhabitants of Monterrey Metropolitan Area

Resumen Objetivo: Estimar el riesgo de mortalidad asociado con la exposición a partículas finas (PM2.5) y gruesas (PM2.5-10) en la Zona Metropolitana de Monterrey (ZMM). Material y métodos: Estudio ecológico con análisis retrospectivo de series de tiempo (2004-2014) de mortalidad total y específica diaria, y promedio de PM2.5y PM2.5-10. Modelos aditivos generalizados Poisson con rezagos distribuidos ajustados por tendencia, estacionalidad, día de la semana, condiciones meteorológicas y contaminantes gaseosos. Resultados: El promedio (DE) de PM2.5y PM2.5-10fue 26.59 (11.06) y 48.83 (21.15) μg/m3. Cada 10 μg/m3de aumento de PM2.5(lag 0) incrementó el riesgo de mortalidad respiratoria en menores de cinco años 11.16٪ (IC95% 1.03-21.39) y de neumonía e influenza en mayores de cinco años 11.16٪ (IC95% 3.91-9.37). El riesgo de mortalidad asociado con las PM2.5-10fue menor. Conclusiones: Se observaron asociaciones positivas y significativas entre exposición a material particulado y la mortalidad diaria en población de la ZMM.

Abstract Objective: To estimate the mortality risk of fine (PM2.5) and coarse (PM2.5-10) particles in the Metropolitan Area of Monterrey (MAM). Materials and methods: A retrospective ecological time-series analysis (2000-2014) was conducted using total and specific causes of mortality, and daily mean PM2.5and PM2.5-10. Generalized additive distributed lag models controlling for trend, seasonality, day of the week, meteorological conditions and gaseous pollutants. Results: Mean (SD) PM2.5and PM2.5-10concentrations were 26.59 μg/m3 (11.06 μg/m3) and 48.83 μg/m3(21.15 μg/m3). An increase of 10 μg/m3 of PM2.5 (lag 0) was associated with 11.16% (95%CI:1.03-21.39) increased risk of respiratory mortality in children <=5 years old and 6.6% (95%CI 3.31-9.37) increased risk of pneumonia-influenza in adults >=65 years old. The risk of mortality associated with the concentration of coarse particles was lower. Conclusions: Positive and significant associations were observed between exposure to particulate matter and daily mortality in the MAM´s population.

Impacto del Material Particulado aéreo (MP 2, 5 ) sobre las hospitalizaciones por enfermedades respiratorias en niños: estudio caso-control alterno / Impact of Particulate Matter (PM 2, 5 ) and children's hospitalizations for respiratory diseases: a case cross-over study

INTRODUCCIÓN: Santiago de Chile con 7 millones de habitantes alcanza elevados niveles de contaminación atmosférica en invierno, el material particulado habitualmente excede los estándares de la OMS. OBJETIVO: Evaluar la influencia de la contaminación atmosférica por material particulado en las hospitalizaciones por enfermedades respiratorias en niños, entre 2001 y 2005 en la Región Metropolitana de Chile, independientemente de la presencia ambiental de virus sincicial respiratorio (VRS). MATERIAL Y MÉTODO: 72.479 hospitalizaciones públicas y privadas por enfermedades respiratorias de niños menores de 15 años residentes en la región del estudio se analizaron con un diseño de caso control alternante, con estratificación temporal. Se evaluó principalmente: hospitalizaciones por enfermedades respiratorias (J00-J99), neumonía (J12-J18); asma (J21.0 - J21.9) y bronquiolitis (J45 - J46). Recopilándose diariamente temperatura, MP10, MP2,5, ozono, virus respiratorios (VRS) y humedad ambientales. RESULTADOS: Los promedios de MP10 y MP2,5 fueron 81,5 y 41,2 pg/m3 respectivamente. El promedio de temperatura fue 12,8 °C y de la humedad del aire 72,6 %. Un aumento de 10 pg/m3 de MP25 con 1 y 2 días de rezago se asoció con un incremento de las hospitalizaciones por enfermedades respiratorias cercano a 2%, este porcentaje aumentó a 5% cuando la exposición fue con 8 días de rezago, reflejando sinergismo entre material particulado y virus respiratorio (VRS). CONCLUSIÓN: La exposición breve a contaminación atmosférica puede provocar hospitalizaciones por enfermedades respiratorias en niños.

INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2,5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2.5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.

Systemic Th17/IL-17A response appears prior to hippocampal neurodegeneration in rats exposed to low doses of ozone. / La respuesta sistémica Th17/IL-17A aparece antes del proceso neurodegenerativo en el hipocampo de ratas expuestas a bajas dosis de ozono.

INTRODUCTION: Exposure to low doses of O3 leads to a state of oxidative stress. Some studies show that oxidative stress can modulate both the CNS and systemic inflammation, which are important factors in the development of Alzheimer disease (AD). OBJECTIVE: This study aims to evaluate changes in the frequency of Th17-like cells (CD3+CD4+IL-17A+), the concentration of IL-17A in peripheral blood, and hippocampal immunoreactivity to IL-17A in rats exposed to low doses of O3. METHODS: One hundred eight male Wistar rats were randomly assigned to 6 groups (n=18) receiving the following treatments: control (O3 free) or O3 exposure (0.25ppm, 4hours daily) over 7, 15, 30, 60, and 90 days. Twelve animals from each group were decapitated and a peripheral blood sample was taken to isolate plasma and mononuclear cells. Plasma IL-17A was quantified using LUMINEX, while Th17-like cells were counted using flow cytometry. The remaining 6 rats were deeply anaesthetised and underwent transcardial perfusion for immunohistological study of the hippocampus. RESULTS: Results show that exposure to O3 over 7 days resulted in a significant increase in the frequency of Th17-like cells and levels of IL-17A in peripheral blood. However, levels of Th17/IL-17A in peripheral blood were lower at day 15 of exposure. We also observed increased IL-17A in the hippocampus beginning at 30 days of exposure. CONCLUSION: These results indicate that O3 induces a short-term, systemic Th17-like/IL-17A effect and an increase of IL-17A in the hippocampal tissue during the chronic neurodegenerative process.

On the nexus of air pollution and health expenditures: new empirical evidence.

OBJECTIVE: To analyse the impact of per capita income and environmental air quality variables on health expenditure determinants. METHOD: In this study, we analyse the relationship between air pollution and health expenditure in 29 OECD countries over the period 1995-2014. In addition, we test whether our findings differ between countries with higher or lower incomes. RESULTS: The econometric results show that per capita income has a positive effect on health expenditure, but is not as statistically significant as expected when lag-time is incorporated. In addition, an anchorage effect is observed, which implies that about 80%-90% of previous expenditure explain current expenditure. Our empirical results are quite consistent between groups and when compared with the full sample. Nevertheless, there appear to be some differences when broken down by financing scheme (total, public, and private). CONCLUSIONS: Overall, our findings could be used to clarify the appropriate health expenditure level or to obtain better environmental quality and social well-being. That is, empirical support is provided on how health management and policy makers should include more considerations for the use of cleaner fuels in developed countries.

[Air pollution, cardiovascular risk and hypertension]. / Contaminación atmosférica, riesgo cardiovascular e hipertensión arterial.

Air pollution is a worrying factor and has an impact on public health. Multiple studies relate exposure to air pollutants with an increase in cardiovascular events, cardiovascular mortality and mortality for all causes. A relationship has also been demonstrated between increased pollution and high blood pressure, as well as a higher prevalence of hypertension. Pollutants that play a more relevant role in this association are particulate matters, nitrogen dioxide and sulphur dioxide. The objective of this review is to understand the mechanisms involved in this increase and to find the most recent publications that relate pollution, cardiovascular risk and hypertension.

[Exposure to nitrogen dioxide and respiratory health at 2 years in the INMA-Valencia cohort]. / Exposición ambiental a dióxido de nitrógeno y salud respiratoria a los 2 años en la Cohorte INMA-Valencia.

OBJECTIVE: To analyze the association between exposure to nitrogen dioxide (NO2) during pregnancy and the postnatal period up to the age of 2 years old and the incidence of respiratory problems in children from the INMA-Valencia cohort. METHODS: The study population included 624 children from the INMA-Valencia cohort. Individual exposure to NO2 was estimated in different environments outside the home during pregnancy and up to the age of 2 using empirical measurement and data from geo-statistical methods. Respiratory symptoms were obtained from a questionnaire applied at the age of two. The association between NO2 exposure and respiratory symptoms was performed using multivariate logistic regression. RESULTS: The cumulative incidence was 16.3% for persistent cough, 34.9% for wheezing and 27.6% for lower respiratory tract infections. No association was found between respiratory symptoms and exposure to NO2 in any of the children. However an association between NO2 exposure and persistent cough was found at two years of life in the children with a parental history of allergy. CONCLUSION: NO2 exposure would lead to persistent cough in children with a parental history of allergies.

Particulate matter inside of the alveolar macrophage / Material particulado dentro del macrófago alveolar

The inhalation of toxic environmental particles is a worldwide public health issue. To avoid the pulmonary damage, the lungs contain the alveolar macrophages, which are the primary defense of the innate immune system, since it engulfs the toxic or allergic particles. Morphologically, particulate matter inside of macrophage is observed as numerous round dark granules of vari­ous size. In guinea pig, the inhalation of fine particles in real time showed single round dark granules inside of the macrophages. After particles exposure, the alveolar macrophage can activate some cytokines such as TNF-α, IL-1β, IL-6, IL-8, and GM-CSF, which increases the inflammatory response or to activate the Th2 response. The alveolar macrophage interacts with bronchial and bronchiolar epithelium, heart, and blood vessels producing a variety of problems, such as nonfatal heart attacks, irregular heartbeat, decreased lung function, and increases respiratory symptoms such as irritation of the airways, coughing or difficulty breathing, ag­gravated asthma, and produce premature death in people with heart or lung disease.

La inhalación de partículas tóxicas ambientales es un problema de salud pública en todo el mundo. Para prevenir el daño, los pulmones contienen a los macrófagos alveolares, los cuales son la defensa primaria del sistema inmune, ya que fagocitan los tóxicos o partículas alérgicas. Morfológicamente, el material particulado dentro de los macrófagos alveolares se observa como numerosos gránulos redondos de varios tamaños. En cobayos, la inhalación de partículas finas en tiempo real mostró gránulos re­dondos oscuros dentro de los macrófagos. Después de la exposición a las partículas, el macrófago alveolar puede activar algunas citocinas como TNF-α, IL-1β, IL-6, IL-8, and GM-CSF, las cuales incrementan la respuesta inflamatoria o activan la respuesta Th2. El macrófago alveolar interactúa con el epitelio bronquial y bronquiolar, corazón y vasos sanguíneos, produciendo una variedad de problemas, tales como afecciones cardíacas, arritmias, disminución de la función pulmonar, e incrementa los síntomas res­piratorios como irritación de las vías respiratorias, tos, dificultad para respirar, agrava el asma y produce muertes prematuras en personas con enfermedades cardiacas y pulmonares.

Expresión del síndrome metabólico frente a factores ambientales / Expression of metabolic syndrome against environmental factors / Expressão da síndrome metabólica frente a fatores ambientais

El Síndrome Metabólico (SM) se define como la asociación de alteraciones metabólicas e inflamatorias a nivel molecular, celular o hemodinámico, que pueden presentarse en forma simultánea o secuencial en un mismo individuo. Esto imprime un mayor riesgo de desarrollar diabetes y enfermedades cardiovasculares, teniendo como base la resistencia insulínica. Su diagnóstico se presenta cuando existe obesidad abdominal y dos o más componentes adicionales: triglicéridos elevados, lipoproteína de alta densidad (HDL) baja, alteración en la regulación de la glucemia y presión arterial alta. En este contexto, y dada su relación con los factores ambientales, el objetivo del presente trabajo fue evaluar la relación del SM en poblaciones expuestas a diferentes niveles de contaminación atmosférica, determinando dicha asociación mediante las respuestas obtenidas de una encuesta socioeconómica, de antecedentes de salud, y contrastándolas con análisis sanguíneos. Finalmente, los resultados obtenidos evidencian intercurrencias entre el grado de contaminación atmosférica y el SM.

The metabolic syndrome (MS) is defined as the association of metabolic disorders and inflammatory diseases at molecular, cellular or hemodynamic levels, which may occur simultaneously or sequentially in the same individual. This adds an increased risk of developing diabetes and cardiovascular disease, based on insulin resistance. MS diagnosis is made when there are two or more additional components and abdominal obesity: elevated triglycerides, high density lipoprotein (HDL) low, altered regulation of blood glucose and high blood pressure. In this context, and given its relationship with environmental factors, the objective of this study was to evaluate the relationship of MS in populations exposed to different levels of air pollution,determining the association with the responses obtained from a socio-economic survey and health history, and contrasting them with a blood test. Finally, the results show intercurrences between the degree of air pollution and SM.

A síndrome metabólica (SM) é definida como a associação de alterações metabólicas e inflamatórias em nível molecular, celular ou hemodinâmico, que podem ocorrer em forma simultânea ou sequencial num mesmo indivíduo. Isto adiciona um maior risco de desenvolver diabetes e doenças cardiovasculares, tendo como base a resistência à insulina. Seu diagnóstico ocorre quando há obesidade abdominal e dois ou mais componentes adicionais: aumento dos triglicerídeos, lipoproteína de alta densidade (HDL) baixa, alteração na regulação da glicemia e pressão arterial elevada. Neste contexto, e devido a sua relação com os fatores ambientais, o objetivo desse estudo foi avaliar a relação da SM em populações expostas a diferentes níveis de poluição do ar, determinando tal associação através das respostas obtidasa em um levantamento socioeconômico, histórico de saúde e em contraste com análises de sangue. Por fim, os resultados mostram intercorrências entre o grau de poluição do ar e a SM.

Exposición de peatones a la contaminación del aire en vías con alto tráfico vehicular / Pedestrian exposure to air pollution on routes with heavy vehicular traffic

Objetivo Este estudio piloto tuvo como objetivo caracterizar la contaminación del aire a la que están expuestos los peatones en inmediaciones de tres vías con alto tráfico vehicular en la ciudad de Bogotá (carrera novena, carrera séptima y carrera once). Método Como indicador de la calidad del aire se utilizó el carbono elemental (BC), dado que es un compuesto reconocido como trazador de las emisiones provenientes de fuentes móviles. Las concentraciones de BC fueron registradas de forma continua y en tiempo real con un Micro Aethalometro portátil Modelo AE51 que era portado por las personas que realizaban los recorridos de 1.6 kilómetros en cada vía, al tiempo que diligenciaban un formato de actividades en el que consignaban los eventos relevantes percibidos durante el recorrido. Resultados Se encontró una relación directa (observada) entre los picos de concentración de BC a los que están expuestos los peatones y los eventos documentados en cada trayecto. Si bien en los tres corredores viales estudiados se registraron concentraciones de BC que indican un aire de inadecuada calidad, se encontraron distintas distribuciones de las concentraciones para cada vía estudiada. Los autores atribuyen este resultado a la diferencia en el volumen de tráfico pesado (buses y busetas principalmente), siendo la Carrera Once la vía con mayor flujo de vehículos de este tipo y más altas concentraciones de BC. Conclusión La evidencia recolectada refuerza la importancia de involucrar la variable calidad del aire al momento de diseñar infraestructura orientada a modos de transporte no motorizado.(AU)

Objective This pilot study aimed to characterize pedestrians' exposure to air pollution alongside three routes with high traffic in Bogota, Colombia (ninth avenue, eleventh avenue and seventh avenue). Method Black carbon (BC) was used as an air quality indicator since it is recognized as a tracer compound for emissions from mobile sources. The concentrations of BC were recorded continuously with a portable Micro Aethalometer Model AE51. The instrument was carried by the people doing the 1.5 kilometer-long routes, while they filled in an activity form that recorded the events occurring during the walk. Results A direct (observed) relationship between BC concentration peaks and documented events at each route was found. Although BC concentrations at all three studied corridors indicate an inadequate air quality, different concentration distributions were found for each route. The authors attribute this result to the difference in the volume of heavy traffic (mainly buses and minibuses). Eleventh Avenue was the route with the greatest flow of such vehicles and higher concentrations of BC. Conclusion The collected evidence reinforces the importance of involving air quality as a critical variable when designing non-motorized transport oriented infrastructure.(AU)

Influence of meteorological conditions on hospital admission in patients with acute coronary syndrome with and without ST-segment elevation: Results of the AIRACOS study. / Influencia de las condiciones meteorológicas en el ingreso hospitalario en pacientes con síndrome coronario agudo con y sin elevación del segmento ST: resultados del estudio AIRACOS.

OBJECTIVE: Evaluate whether the meterological parameters affecting revenues in patients with ST-segment and non-ST-segment elevation ACS. DESIGN: A prospective cohort study was carried out. SETTING: Coronary Care Unit of Hospital Universitario de Canarias PATIENTS: We studies a total of 307 consecutive patients with a diagnosis of ST-segment and non-ST-segment elevation ACS. We analyze the average concentrations of particulate smaller than 10 and 2.5µm diameter, particulate black carbon, the concentrations of gaseous pollutants and meteorological parameters (wind speed, temperature, relative humidity and atmospheric pressure) that were exposed patients from one day up to 7 days prior to admission. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic, clinical, atmospheric particles, concentrations of gaseous pollutants and meterological parameters. RESULTS: A total of 138 (45%) patients were classified as ST-segment and 169 (55%) as non-ST-segment elevation ACS. No statistically significant differences in exposure to atmospheric particles in both groups. Regarding meteorological data, we did not find statistically significant differences, except for higher atmospheric pressure in ST-segment elevation ACS (999.6±2.6 vs. 998.8±2.5 mbar, P=.008). Multivariate analysis showed that atmospheric pressure was significant predictor of ST-segment elevation ACS presentation (OR: 1.14, 95% CI: 1.04-1.24, P=.004). CONCLUSIONS: In the patients who suffer ACS, the presence of higher number of atmospheric pressure during the week before the event increase the risk that the ST-segment elevation ACS.