Previously, we demonstrated that infants residing in homes with higher Environmental Relative Moldiness Index were at greater risk for developing asthma by age seven. The purpose of this analysis was to identify the family and home characteristics associated with higher moldiness index values in infants' homes at age one. Univariate linear regression of each characteristic determined that family factors associated with moldiness index were race and income. Home characteristics associated with the moldiness index values were: air conditioning, carpet, age of the home, season of home assessment, and house dust mite allergen. Parental history of asthma, use of dehumidifier, visible mold, dog and cat allergen levels were not associated with moldiness index. Results of multiple linear regression showed that older homes had 2.9 units higher moldiness index (95% confidence interval [CI]=0.4, 5.4), whereas homes with central air conditioning had 2.5 units lower moldiness index (95% CI=-4.7, -0.4). In addition, higher dust mite allergen levels and carpeting were positively and negatively associated with higher moldiness index, respectively. Because older homes and lack of air conditioning were also correlated with race and lower income, whereas carpeting was associated with newer homes, the multivariate analyses suggests that lower overall socioeconomic position is associated with higher moldiness index values. This may lead to increased asthma risk in homes inhabited by susceptible, vulnerable population subgroups. Further, age of the home was a surrogate of income, race and carpeting in our population; thus the use of these factors should carefully be evaluated in future studies.

As a consequence of over 500 years of mining and smelting activities (1490-1995), and of its natural geological occurrence, the soil in the Idrija region is highly contaminated with Hg. In order to assess the present situation regarding the Hg levels in local food samples, concentrations of total mercury (THg) and monomethyl mercury (MeHg) were determined in selected vegetables, mushrooms and fish from the Idrija Hg mine area. Hg levels in the foodstuffs analysed were not very high but were elevated compared to the levels in food from non-contaminated areas. The study showed that THg accumulates in mushrooms (X=5680ng/g dry weight, Min=346ng/g dry weight, Max=17,100 dry weight) and chicory (X=1950ng/g dry weight, Min=86ng/g dry weight, Max=17,100ng/g dry weight). In addition, Se and Cd concentrations were determined by ICP-MS in those vegetable and mushroom species in which the highest Hg levels were found. The levels of Cd and Se were below the threshold levels. Based on data from previous studies, we can conclude that the levels of Hg in food have not diminished significantly during the past 15 years after closure of the Hg mine. Special attention should be given to vegetables such as chicory, representing a local seasonal vegetable eaten frequently.

Methylmercury (MeHg) strongly bioaccumulates in aquatic food webs resulting in exposure to humans and wildlife through consumption of fish. Production of MeHg is promoted by anaerobic conditions and the supply of inorganic Hg (Hg(2+)), sulfate (SO4(2-)), and labile organic carbon. The anaerobic sediments of stratified lakes are particularly active zones for methylation of Hg(2+) and can be an important source of MeHg to the water column during summer anoxia and fall turnover. Nitrate (NO3(-)) addition has recently been proposed as a novel approach for the control of MeHg accumulation in the hypolimnia of Hg-contaminated lakes. In 2011, a whole-lake NO3(-) addition pilot test was conducted in Hg-contaminated Onondaga Lake, NY with the objective of limiting release of MeHg from the pelagic sediments to the hypolimnion through maintenance of NO3(-)-N concentrations >1mgN/L. A liquid calcium-nitrate solution was added to the hypolimnion as a neutrally buoyant plume approximately three times per week during the summer stratification interval. Maximum hypolimnetic concentrations of MeHg and soluble reactive phosphorus (SRP) decreased 94% and 95% from 2009 levels, suggesting increased sorption to Fe and Mn oxyhydroxides in surficial sediments as the regulating mechanism. Increased MeHg concentrations in the upper waters during fall turnover, which had been a generally recurring pattern, did not occur in 2011, resulting in decreased exposure of aquatic organisms to MeHg. Over the 1992-2011 interval, the hypolimnetic NO3(-) supply explained 85% and 95% of the interannual variations in hypolimnetic accumulations of SRP and MeHg, respectively.

Pesticide exposure in urban low-income residential environments may be elevated as a result of persistent application due to severe pest infestation. Children living in this environment may be a sensitive subpopulation for these non-dietary exposures, due to their physiological and behavioral differences. In this study, we provide an exposure modeling framework to simulate exposures for children in this environment and assess dominant exposure routes and sources of exposure variability, in order to characterize factors that influence risk. We use a dataset of pesticide measurements collected in 42 low-income dwellings, including vacuum dust and floor wipe samples from kitchens and living rooms. We fit distributions to the concentration measurements for the organophosphates measured, chlorpyrifos and diazinon, and the most prevalent pyrethroids (permethrin, cypermethrin, and cyfluthrin), and simulated 1000 homes from the distributions. Concentration measurements were then connected with activity pattern data, short-term dermal and ingestion exposures and absorbed doses were simulated for children ages 1-5 years. For both pesticide groups, exposure values ranged widely, with concentration values contributing most significantly to exposure variability, although approximately 20-fold variability was attributable to exposure factors alone. In addition, upper percentile exposed children usually had both higher concentrations as well as greater influences from exposure and dose factors. Differences were also seen across pesticide groups in dominant exposure pathways. Our analyses indicate a profile of factors that describe individuals likely to receive high doses of one or multiple pesticides and could allow for more targeted intervention strategies. More generally, this work provides a standard framework to evaluate and describe exposures to prevalent residential pesticides via multiple pathways.

Air pollution has been linked to acute and chronic health effects. However, the majority of evidence is based in North America and Europe, with a growing number of studies in Asia and Latin America. Nepal is one of the many South Asian countries where little such research has been conducted. We summarized the state of scientific evidence and identify research gaps based on the existing literature on air pollution and human health in Nepal. We performed a systematic literature search to identify relevant studies. Studies were categorized as those that estimate: (1) health impacts of indoor air pollution, (2) health impacts of outdoor air pollution, (3) health burdens from outdoor air pollution in Nepal based on existing concentration-response relationships from elsewhere, or (4) exposure and air quality but do not link to health. We identified 89 studies, of which 23 linked air pollution to health impacts. The remainder focused on exposure and air quality, demonstrating high pollution levels. The few health studies focused mainly on indoor air (n=15), especially in rural areas and during cooking. Direct exposure measurements were for short time periods; most studies used indirect exposure methods (e.g., questionnaire). Most health studies had small sample sizes with almost all focusing on respiratory health. Although few studies have examined air pollution and health in Nepal, the existing studies indicate high pollution levels and suggest large health impacts. Nepal's dearth of scientific research on air pollution and health is not unique and likely is similar to that of many other developing regions. Future research with larger studies and more health outcomes is needed. Key challenges include data availability.

PURPOSE:

To estimate the association between environmental temperatures and the occurrence of emergency department visits for heat-related illness in North Carolina, a large Southern state with 85 rural and 15 urban counties; approximately half the state's population resides in urban counties.

METHODS:

County-level daily emergency department visit counts and daily mean temperatures for the period 1/1/2007-12/31/2008 were merged to form a time-series data structure. Incidence rates were calculated by sex, age group, region, day of week, and month. Incidence rate ratios were estimated using categorical and linear spline Poisson regression models and heterogeneity of the temperature-emergency department visit association was assessed using product interaction terms in the Poisson models.

RESULTS:

In 2007-2008, there were 2539 emergency department visits with heat-related illness as the primary diagnosis. Incidence rates were highest among young adult males (19-44 year age group), in rural counties, and in the Sandhills region. Incidence rates increased exponentially with temperatures over 15.6°C (60°F). The overall incidence rate ratio for each 1°C increase over 15.6°C in daily mean temperature was 1.43 (95%CI: 1.41, 1.45); temperature effects were greater for males than females, for 45-64 year olds, and for residents of rural counties than residents of urban counties.

CONCLUSIONS:

As heat response plans are developed, they should incorporate findings on climate effects for both mortality and morbidity. While forecast-triggered heat health warning systems are essential to mitigate the effects of extreme heat events, public health preparedness plans should not ignore the effects of more persistently observed high environmental temperatures like those that occur throughout the warm season in North Carolina.

INTRODUCTION:

Toxic heavy metals have adverse effects on human health. However, the risk of hematuria caused by heavy metal exposure has not been evaluated.

METHODS:

Data from 4701 Korean adults were obtained in the Korean National Health and Nutritional Examination Survey (2008-2010). Blood levels of the toxic heavy metals cadmium, lead, and mercury were measured. Hematuria was defined as a result of ≥+1 on a urine dipstick test. The odds ratios (ORs) for hematuria were measured according to the blood heavy metal levels after adjusting for multiple variables.

RESULTS:

Individuals with blood cadmium levels in the 3rd and 4th quartiles had a greater OR for hematuria than those in the 1st quartile group: 3rd quartile, 1.35 (1.019-1.777; P=0.037); 4th quartile, 1.52 (1.140-2.017; P=0.004). When blood cadmium was considered as a log-transformed continuous variable, the correlation between blood cadmium and hematuria was significant: OR, 1.97 (1.224-3.160; Ptrend=0.005). In contrast, no significant correlations between hematuria and blood lead or mercury were found in the multivariate analyses.

DISCUSSION:

The present study shows that high cadmium exposure is associated with a risk of hematuria.

Environmental factors such as ambient air pollution have been associated with congenital heart defects. The aim of this study was to investigate the association between gestational exposure to air pollution and the risk of congenital heart defects. We conducted a registry-based cohort study with a total of 135,527 live- and still-births in the Tel-Aviv region during 2000-2006. We used a Geographic Information System-based spatiotemporal approach with weekly inverse distance weighting modeling to evaluate associations between gestational exposure to ambient air pollution during weeks 3-8 of pregnancy and the risk for congenital heart defects. The following pollutants were studied: carbon monoxide, nitrogen-dioxide, ozone, sulfur-dioxide and particulate matter with aerodynamic diameter smaller than 10μm and 2.5μm (PM10, PM2.5 respectively). Logistic models, adjusted for socio-demographic covariates were used to evaluate the associations. We found that maternal exposure to increased concentrations of PM10 was associated with multiple congenital heart defects (adjusted OR 1.05, 95% CI: 1.01 to 1.10 for 10μg/m(3) increment). An inverse association was observed between concentrations of PM2.5 and isolated patent ductus arteriosus (adjusted OR 0.78, 95% CI: 0.68 to 0.91 for 5µg/m(3) increment). Sensitivity analyses showed that results were consistent. Generally there were no evidence for an association between gaseous air pollutants and congenital heart defects.Our results for PM10 and congenital heart defects confirm results from previous studies. The results for PM2.5 need further investigations.

INTRODUCTION:

Environmental tobacco smoke (ETS) is a hazardous component of indoor air, and may increase the risk of respiratory diseases, atherosclerosis and otitis media in children. In this study, we explored the relationship between time inside the house, ETS exposure and urinary cotinine level, and also determined the association of time inside the house on asthma phenotypes when children exposed to ETS.

METHODS:

A total of 222 asthmatic children and 205 non-asthmatic controls were recruited in the Genetic and Biomarker study for Childhood Asthma (GBCA). Structured questionnaires and time-location pattern questionnaires were administered by face-to-face interview. Urinary cotinine was measured by liquid chromatography tandem mass spectrometry (LC/MS/MS). The level of household ETS exposure was assessed using the cotinine/creatinine ratio (CCR).

RESULTS:

In general, urinary cotinine and CCR were higher in subjects exposed to household ETS than those who never had ETS at home. A significant positive relationship was found between average time inside the house and urinary CCR in asthmatic children with current ETS at home (β=0.278, p=0.02). After adjustment for age and gender, average time inside the house was positively related to severe wheeze in asthmatic children with household ETS within 1 month (OR: 1.26, 95%: 1.02-1.64).

CONCLUSIONS:

Our study suggests that the major source of ETS exposure for children is due to longer period of exposures among children living with adult smokers at home. Home-smoking restrictions that effectively prevent children from being exposed to ETS would be worthwhile.