Search

Use of wood for residential heating is regaining popularity in developed countries. Currently, over 11 million US homes are heated with a wood stove. Although wood stoves reduce heating costs, wood smoke may adversely impact child health through the emission of gaseous and particulate air pollutants. Our purpose is to raise awareness of this environmental health issue among pediatricians. To summarize the state of the science, we performed a narrative review of articles published in PubMed and Web of Science. We identified 36 studies in developed countries that reported associations of household wood stove use and/or community wood smoke exposure with pediatric health outcomes. Studies primarily investigated respiratory outcomes, with no evaluation of cardiometabolic or neurocognitive health. Studies found community wood smoke exposure to be consistently associated with adverse pediatric respiratory health. Household wood stove use was less consistently associated with respiratory outcomes. However, studies of household wood stoves always relied on participant self-report of wood stove use, while studies of community wood smoke generally assessed air pollution exposure directly and more precisely in larger study populations. In most studies, important potential confounders, such as markers of socioeconomic status, were unaccounted for and may have biased results. We conclude that studies with improved exposure assessment, that measure and account for confounding, and that consider non-respiratory outcomes are needed. While awaiting additional data, pediatricians can refer patients to precautionary measures recommended by the US Environmental Protection Agency (EPA) to mitigate exposure. These include replacing old appliances with EPA-certified stoves, properly maintaining the stove, and using only dry, well-seasoned wood. In addition, several studies have shown mechanical air filters to effectively reduce wood stove pollution exposure in affected homes and communities. [ABSTRACT FROM AUTHOR]

Objective To assess the relations between measures of activity with dyspnea and satisfaction with life in chronic spinal cord injury (SCI). Design Cross-sectional survey. Setting Five SCI centers. Participants Between July 2012 and March 2015, subjects (N=347) with traumatic SCI ≥1 year after injury who used a manual wheelchair or walked with or without an assistive device reported hours spent away from home or yard on the previous 3 days, sports participation, and planned exercise. Interventions Not applicable. Main Outcome Measures Satisfaction with Life Scale (SWLS) and dyspnea. Dyspnea was defined as shortness of breath when hurrying on the level or going up a slight hill, going slower than people the same age on the level because of breathlessness, or stopping for breath when going at your own pace, or after about 100yd (or after a few minutes) on the level. Results Dyspnea prevalence was 30%. Adjusting for asthma or chronic obstructive pulmonary disease, mobility mode, race, and season, there was a significant linear trend between greater SWLS scores and quartiles of time spent away from the home or yard ( P =.0002). SWLS score was greater if participating in organized sports ( P =.01), although was not significantly greater with planned exercise ( P =.093). Planned exercise was associated with a reduced odds ratio (OR) of dyspnea (.57; 95% confidence interval [CI], .34–.95; P =.032), but organized sports was not ( P =.265). Dyspnea was not significantly increased in persons who spent the fewest hours outside their home or yard (≤7h) compared with people who spent the most hours outside their home or yard (>23h) (OR=1.69; 95% CI, 0.83–3.44; P =.145). Conclusions In SCI, a planned exercise program is associated with less dyspnea. An active lifestyle characterized by greater time spent away from home or yard and sports participation is associated with greater SWLS scores. [ABSTRACT FROM AUTHOR]

Objective To identify associations between objective and self-reported measures of physical activity (PA) and relationships with depression and satisfaction with life (SWL) in persons with spinal cord injury (SCI). Design Retrospective, cross-sectional study of objectively measured wheelchair propulsion (WCP) from 2 studies in which an odometer was attached to participants' wheelchairs to record daily speed and distance. Self-reported data were collected in a separate study examining dyspnea, PA, mood, and SWL. Setting Outpatient clinic in a rehabilitation center. Participants Individuals (N=86) with traumatic SCI who use a manual wheelchair. Interventions Not applicable. Main Outcome Measures Objective measures of PA included average daily distance and speed of WCP measured by an odometer. Self-report questionnaires included demographics, the 24-hour recall of transfers, Physical Activity Recall Assessment for People with SCI, the Patient Health Questionnaire-2 (PHQ-2) to document depressive symptoms, and the Satisfaction With Life Scale (SWLS). Results Both objective measures of WCP, average daily distance and speed, were predicted by the combination of self-reported daily time away from home/yard and lower frequency of car transfers ([ r =.367, P =.002] and [ r =.434, P <.001], respectively). Daily distance of WCP was negatively correlated with depression (PHQ-2) ( r =−.309, P =.004). Time in leisure PA was the only significant predictor of SWLS scores ( r =.321, P =.003). Conclusions Short-term recall of hours away from home/yard not spent driving or riding in a vehicle is suggested as a self-report measure that is moderately related to overall WCP PA in this population. Results of this study suggest that depression is related to decreased PA and WCP activity, while SWL is related to leisure PA. [ABSTRACT FROM AUTHOR]

Individuals with chronic traumatic spinal cord injury (SCI) develop progressive multi-system health problems that result in clinical illness and disability. Systemic inflammation is associated with many of the common medical complications and acquired diseases that accompany chronic SCI, suggesting that it contributes to a number of comorbid pathological conditions. However, many of the mechanisms that promote persistent systemic inflammation and its consequences remain ill-defined. This review describes the significant biological factors that contribute to systemic inflammation, major organ systems affected, health risks, and the potential treatment strategies. We aim to highlight the need for a better understanding of inflammatory processes, and to establish appropriate strategies to address inflammation in SCI. [Display omitted] • Chronic SCI results in persistent systemic inflammation. • Unresolved inflammation incites multi-organ dysfunction. • Dysfunction and deterioration of body systems lead to accelerated disease risk and mortality. [ABSTRACT FROM AUTHOR]

Summary: Background: Baseline values for daily step counts in US adults with COPD and knowledge of its accurate measurement, natural change over time, and independent relationships with measures of COPD severity are limited. Methods: 127 persons with stable COPD wore the StepWatch Activity Monitor (SAM) for 14 days, and 102 of them wore it a median 3.9 months later. SAM counts were compared to manual counts in the clinic. We assessed change over time, the effect of season, and relationships with forced expiratory volume in 1 s (FEV1) % predicted, 6-min walk test (6MWT) distance, the modified Medical Research Council (MMRC) dyspnea score, and the St. George''s Respiratory Questionnaire Total Score (SGRQ-TS). Results: 98% of subjects were males, with mean age 71 ± 8 years and FEV1 1.48 ± 0.54 L (52 ± 19% predicted). All 4 GOLD stages were represented, with the most subjects in GOLD II (44%) and GOLD III (37%). The SAM had >90% accuracy in 99% of subjects. Average step count was 5680 steps/day, which decreased with increasing GOLD stage (p = 0.0046). Subjects walked 645 fewer steps/day at follow-up, which was partly explained by season of monitoring (p = 0.013). In a multivariate model, FEV1 % predicted, 6MWT distance and MMRC score were weakly associated with daily step counts, while SGRQ-TS was not. Conclusions: These findings will aid the design of future studies using daily step counts in COPD. Accurately measured, daily step counts decline over time partly due to season and capture unique information about COPD status. [Copyright &y& Elsevier]

Abstract: Norweg A, Ni P, Garshick E, O''Connor G, Wilke K, Jette AM. A multidimensional computer adaptive test approach to dyspnea assessment. Objectives: To develop and test a prototype dyspnea computer adaptive test (CAT). Design: Prospective study. Setting: Two outpatient medical facilities. Participants: A convenience sample of adults (N=292) with chronic obstructive pulmonary disease (COPD). Interventions: Not applicable. Main Outcome Measure: We developed a modified and expanded item bank and CAT for the Dyspnea Management Questionnaire (DMQ), an outcome measure consisting of 4 dyspnea dimensions: dyspnea intensity, dyspnea anxiety, activity avoidance, and activity self-efficacy. Results: Factor analyses supported a 4-dimensional model underlying the 71 DMQ items. The DMQ item bank achieved acceptable Rasch model fit statistics, good measurement breadth with minimal floor and ceiling effects, and evidence of high internal consistency reliability (α=.92–.98). With the use of CAT simulation analyses, the DMQ-CAT showed high measurement accuracy compared with the total item pool (r=.83–.97, P<.0001) and evidence of good to excellent concurrent validity (r=–.61 to –.80, P<.0001). All DMQ-CAT domains showed evidence for known-groups validity (P≤.001). Conclusions: The DMQ-CAT reliably and validly captured 4 distinct dyspnea domains. Multidimensional dyspnea assessment in COPD is needed to better measure the effectiveness of pharmacologic, pulmonary rehabilitation, and psychosocial interventions in not only alleviating the somatic sensation of dyspnea but also reducing dysfunctional emotions, cognitions, and behaviors associated with dyspnea, especially for anxious patients. [Copyright &y& Elsevier]

Abstract: Morse LR, Lazzari AA, Battaglino R, Stolzmann KL, Matthess KR, Gagnon DR, Davis SA, Garshick E. Dual energy x-ray absorptiometry of the distal femur may be more reliable than the proximal tibia in spinal cord injury. Objective: To evaluate the precision of dual energy x-ray absorptiometry scanning at 2 skeletal sites at the knee (proximal femur and distal tibia) in people with SCI. Design: Cross-sectional. Setting: Veterans Affairs Medical Center. Participants: Subjects (N=20) with chronic SCI. Interventions: Not applicable. Main Outcome Measures: Precision as determined by root mean square coefficient of variation (RMS-CV) and root mean square standard deviation (RMS-SD). Results: At the distal femur the root RMS-CV was 3.01% and the RMS-SD was 0.025g/cm2. At the proximal tibia the RMS-CV was 5.91% and the RMS-SD was 0.030g/cm2. Conclusions: Precision at the distal femur is greater than at the proximal tibia and we recommend it as the preferred site for the longitudinal assessment of bone mineral density at the knee in chronic SCI. [Copyright &y& Elsevier]

Abstract: Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury. Objective: To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized. Design: Prospective cohort study. Setting: Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts. Participants/Data Sources: Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database. Interventions: Not applicable. Main Outcome Measures: Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression. Results: Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m2). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors. Conclusions: Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations. [Copyright &y& Elsevier]

Abstract: Stepp EL, Brown R, Tun CG, Gagnon DR, Jain NB, Garshick E. Determinants of lung volumes in chronic spinal cord injury. Objective: To characterize determinants of lung volumes in chronic spinal cord injury (SCI). Design: Cross-sectional. Setting: VA Boston Healthcare System. Participants: White men (N=330) with chronic SCI. Interventions: Not applicable. Main Outcome Measures: Questionnaire responses and measurements of lung volumes. Results: Adjusted for SCI severity and stature, greater body mass index (BMI) was associated (all P<.05) with lower total lung capacity (TLC) (−38.7mL·kg−1·m−2), functional residual capacity (FRC) (−73.9mL·kg−1·m−2), residual volume (RV) (−40.4mL·kg−1·m−2), and expiratory reserve volume (ERV) (−32.2mL·kg−1·m−2). The effect of BMI on RV was most pronounced in quadriplegia (−72mL·kg−1·m−2). Lifetime smoking was associated with a greater FRC (5.3mL/pack-year) and RV (3.1mL/pack-years). The effects of lifetime smoking were also greatest in quadriplegia (11mL/pack-year for FRC; 7.8mL/pack-year for RV). Time since injury, independent of age, was associated with a decrease in TLC, FRC, ERV, and RV (P<.05). Age was not a predictor of TLC once time since injury was considered. Conclusions: Determinants of FRC, TLC, ERV, and RV in chronic SCI include factors related and unrelated to SCI. The mechanisms remain to be determined but likely involve the elastic properties and muscle function of the respiratory system and perhaps the effects of systemic inflammation related to adiposity. Addressing modifiable factors such as obesity, muscle stiffness, and smoking may improve respiratory morbidity and mortality in SCI by improving pulmonary function. [Copyright &y& Elsevier]

Abstract: Morse LR, Stolzmann K, Nguyen HP, Jain NB, Zayac C, Gagnon D, Tun CG, Garshick E. Association between mobility mode and C-reactive protein levels in men with chronic spinal cord injury. Objective: To assess clinical determinants of systemic inflammation in persons with chronic spinal cord injury (SCI). Design: Cross-sectional survey. Setting: Veterans Affairs medical center. Participants: As part of an epidemiologic study assessing SCI-related health conditions, 63 men with chronic SCI provided a blood sample and information regarding locomotive mode and personal habits. Interventions: Not applicable. Main Outcome Measure: Plasma high-sensitivity C-reactive protein (CRP). Results: The mean ± standard deviation age was 56±14y, and participants were assessed 21±13y after injury. Adjusting for heart disease, hypertension, and body mass index (BMI), the mean CRP in 12 motorized wheelchair users (5.11mg/L) was not significantly greater than 23 participants who used a manual wheelchair (2.19mg/L) (P=.085) but was significantly greater than the 17 who walked with an assistive device (1.41mg/L) (P=.005) and the 12 who walked independently (1.63mg/L) (P=.027). CRP was significantly greater in participants with obesity but was not related to age, smoking, or SCI level and severity. CRP was elevated in participants reporting a urinary tract infection (UTI) or pressure ulcer within a year, but adjustment for this did not account for the elevated CRP in motorized wheelchair users. Conclusions: These results suggest that CRP in chronic SCI is independently related to locomotive mode, BMI, and a history of pressure ulcers and UTI. It is suggested that future studies in SCI investigate whether modifying these factors influence systemic inflammation and cardiovascular health. [Copyright &y& Elsevier]

Abstract: Jain NB, Brown R, Tun CG, Gagnon D, Garshick E. Determinants of forced expiratory volume in 1second (FEV1), forced vital capacity (FVC), and FEV1/FVC in chronic spinal cord injury. Objective: To assess factors that influence pulmonary function, because respiratory system dysfunction is common in chronic spinal cord injury (SCI). Design: Cross-sectional cohort study. Setting: Veterans Affairs Boston SCI service and the community. Participants: Between 1994 and 2003, 339 white men with chronic SCI completed a respiratory questionnaire and underwent spirometry. Interventions: Not applicable. Main Outcome Measures: Forced expiratory volume in 1second (FEV1), forced vital capacity (FVC), and FEV1/FVC. Results: Adjusting for SCI level and completeness, FEV1 (–21.0mL/y; 95% confidence interval [CI], –26.3 to –15.7mL/y) and FVC (–17.2mL/y; 95% CI, –23.7 to –10.8mL/y) declined with age. Lifetime cigarette use was also associated with a decrease in FEV1 (–3.8mL/pack-year; 95% CI, –6.5 to –1.1mL/pack-year), and persistent wheeze and elevated body mass index were associated with a lower FEV1/FVC. A greater maximal inspiratory pressure (MIP) was associated with a greater FEV1 and FVC. FEV1 significantly decreased with injury duration (–6.1mL/y; 95% CI, –11.7 to –0.6mL/y), with the greatest decrement in the most neurologically impaired. The most neurologically impaired also had a greater FEV1/FVC, and their FEV1 and FVC were less affected by age and smoking. Conclusions: Smoking, persistent wheeze, obesity, and MIP, in addition to SCI level and completeness, were significant determinants of pulmonary function. In SCI, FEV1, FVC, and FEV1/FVC may be less sensitive to factors associated with change in airway size and not reliably detect the severity of airflow obstruction. [Copyright &y& Elsevier]

Abstract: Grandas NF, Jain NB, Denckla JB, Brown R, Tun CG, Gallagher ME, Garshick E. Dyspnea during daily activities in chronic spinal cord injury. Objective: To assess factors associated with breathlessness in chronic spinal cord injury (SCI) during daily activities. Design: Cross-sectional survey. Settings: Veterans Affairs SCI service and the community. Participants: Four hundred forty-one participants 1 or more years post-SCI, and without acute illness, were recruited between 1994 and 2003 and were categorized according to their ability to walk unassisted, walk with an aid, or to move about by either hand-propelled wheelchair or motorized wheelchair (MWC). Interventions: Assessment of injury extent, respiratory symptoms, cigarette smoking, comorbid medical conditions, and spirometry. Main Outcome Measures: Breathlessness during talking, eating, or dressing. Results: Breathlessness was more common in MWC users (20/85 users, 24%) than in nonusers (20/356, 6%). The main activity associated with breathlessness in 15 MWC users was talking (18%). In MWC users, the risk of breathlessness was related to lifetime cigarette smoking (odds ratio [OR]=1.02; 95% confidence interval [CI], 1.00–1.03 per pack year), and reports of chronic cough (OR=7.8; 95% CI, 2.0–32.7), and wheeze (OR=3.5; 95% CI, 1.04–13.6). SCI level, percentage of predicted forced vital capacity and forced expiratory volume in 1 second, and maximal inspiratory pressures were not related to breathlessness. Conclusions: Breathlessness during selected daily activities (most commonly talking) was greatest in SCI participants who were most impaired with regard to mobility and was associated with reports of coughing, wheezing, and cigarette smoking. [Copyright &y& Elsevier]

Kuwait and the Gulf region have a desert, hyper-arid and hot climate that makes outdoor air sampling challenging. The region is also affected by intense dust storms. Monitoring challenges from the harsh climate have limited data needed to inform appropriate regulatory actions to address air pollution in the region. To compare gravimetric measurements with existing networks that rely on beta-attenuation measurements in a desert climate; determine the annual levels of PM 2.5 and PM 10 over a two-year period in Kuwait; assess compliance with air quality standards; and identify and quantify PM 2.5 sources. We custom-designed particle samplers that can withstand large quantities of dust without their inlet becoming overloaded. The samplers were placed in two populated residential locations, one in Kuwait City and another near industrial and petrochemical facilities in Ali Sabah Al-Salem (ASAS) to collect PM 2.5 and PM 10 samples for mass and elemental analysis. We used positive matrix factorization to identify PM 2.5 sources and apportion their contributions. We collected 2339 samples during the period October 2017 through October 2019. The beta-attenuation method in measuring PM 2.5 consistently exceeded gravimetric measurements, especially during dust events. The annual levels for PM 2.5 in Kuwait City and ASAS were 41.6 ± 29.0 and 47.5 ± 27.6 μg/m3, respectively. Annual PM 2.5 levels in Kuwait were nearly four times higher than the U.S. National Ambient Air Quality Standard. Regional pollution was a major contributor to PM 2.5 levels in both locations accounting for 44% in Kuwait City and 46% in ASAS. Dust storms and re-suspended road dust were the second and third largest contributors to PM 2.5 , respectively. The premise that frequent and extreme dust storms make air quality regulation futile is dubious. In this comprehensive particulate pollution analysis, we show that the sizeable regional anthropogenic particulate sources warrant national and regional mitigation strategies to ensure compliance with air quality standards. [Display omitted] • Beta-attenuation measurements in a desert environment tend to overestimate PM 2.5. • Annual PM 2.5 levels in Kuwait are nearly four times higher than the U.S. standard. • Regional anthropogenic pollution contributes to 44% of PM 2.5 in Kuwait City. • Dust storms and road dust combined contribute to 37.4% of PM 2.5 in Kuwait City. • Although dust is ubiquitous, anthropogenic sources are substantial and need to be tackled nationally and regionally. [ABSTRACT FROM AUTHOR]

[Display omitted] • A random forest machine learning and a mixed effect models were used. • PM 2.5 exposures from 2001 to 2018 for Kuwait and Iraq were assessed. • The study region had very high PM 2.5 concentrations. Iraq and Kuwait are in a region of the world known to be impacted by high levels of fine particulate matter (PM 2.5) attributable to sources that include desert dust and ambient pollution, but historically have had limited pollution monitoring networks. The inability to assess PM 2.5 concentrations have limited the assessment of the health impact of these exposures, both in the native populations and previously deployed military personnel. As part of a Department of Veterans Affairs Cooperative Studies Program health study of land-based U.S. military personnel who were previously deployed to these countries, we developed a novel approach to estimate spatially and temporarily resolved daily PM 2.5 exposures 2001–2018. Since visibility is proportional to ground-level particulate matter concentrations, we were able to take advantage of extensive airport visibility data that became available as a result of regional military operations over this time period. First, we combined a random forest machine learning and a generalized additive mixed model to estimate daily high resolution (1 km × 1 km) visibility over the region using satellite-based aerosol optical depth (AOD) and airport visibility data. The spatially and temporarily resolved visibility data were then used to estimate PM 2.5 concentrations from 2001 to 2018 by converting visibility to PM 2.5 using empirical relationships derived from available regional PM 2.5 monitoring stations. We adjusted for spatially resolved meteorological parameters, land use variables, including the Normalized Difference Vegetation Index, and satellite-derived estimates of surface dust as a measure of sandstorm activity. Cross validation indicated good model predictive ability (R2 = 0.71), and there were considerable spatial and temporal differences in PM 2.5 across the region. Annual average PM 2.5 predictions for Iraq and Kuwait were 37 and 41 μg/m3, respectively, which are greater than current U.S. and WHO standards. PM 2.5 concentrations in many U.S. bases and large cities (e.g. Bagdad, Balad, Kuwait city, Karbala, Najaf, and Diwaniya) had annual average PM 2.5 concentrations above 45 μg/m3 with weekly averages as high as 150 μg/m3 depending on calendar year. The highest annual PM 2.5 concentration for both Kuwait and Iraq were observed in 2008, followed by 2009, which was associated with extreme drought in these years. The lowest PM 2.5 values were observed in 2014. On average, July had the highest concentrations, and November had the lowest values, consistent with seasonal patterns of air pollution in this region. This is the first study that estimates long-term PM 2.5 exposures in Iraq and Kuwait at a high resolution based on measurements data that will allow the study of health effects and contribute to the development of regional environmental policies. The novel approach demonstrated may be used in other parts of the world with limited monitoring networks. [ABSTRACT FROM AUTHOR]

• Exposures to low-dose environmental radiation emitted from particulate matter is associated with a reduction in hemoglobin levels in elderly men. • The effects of air pollutants on hemoglobin levels may depend on their physicochemical properties. • Environmental ionizing radiation released from particulate matter may contribute to the development of anemia. Although ionizing radiation is known to have detrimental effects on red blood cells, the effect of environmental radioactivity associated with ambient particulate matter (PM) is unknown. We hypothesized that exposure to ambient PM-associated beta particle radioactivity (PR β) would be associated with a lower hemoglobin concentration. We studied 1.704 participants from the Normative Aging Study (NAS) over 36 years (1981–2017) who lived in Eastern, MA and the surrounding area. Exposures to PR β was assessed using USEPA's RadNet monitoring network that measures gross beta radiation associated with ambient PM. Mixed effect models with a random intercept adjusting for potential confounders was used, including ambient black carbon (BC) and particulate matter ≤2.5 μm (PM 2.5) concentrations. Greater cumulative PR β activities at 7-, 14-, 21- and 28-days before the hemoglobin determination were associated with lower hemoglobin concentrations. The greatest effect was for a 28-day moving average. An IQR of 0.83 × 10−4 Bq/m3 of ambient PR β was associated with a 0.12 g/dL decrease in hemoglobin concentration (95%CI: −0.18 to −0.05). The effects of PR β were similar when the models were adjusted for ambient BC or PM 2.5. This is the first study to demonstrate an association between environmental ionizing radiation released from particulate matter with a lower hemoglobin concentration, suggesting that ambient radiation may contribute to the development of anemia. [ABSTRACT FROM AUTHOR]

The prevalence of asthma and allergic diseases has increased rapidly in urban China since 2000. There has been limited study of associations between home environmental and lifestyle factors with asthma and symptoms of allergic disease in China. In a cross-sectional analysis of 2214 children in Beijing, we applied a two-step hybrid Least Absolute Shrinkage and Selection Operator (LASSO) algorithm to identify environmental and lifestyle-related factors associated with asthma, rhinitis and wheeze from a wide range of candidates. We used group LASSO to select variables, using cross-validation as the criterion. Effect estimates were then calculated using adaptive LASSO. Model performance was assessed using Area Under the Curve (AUC) values. We found a number of environmental and lifestyle-related factors significantly associated with asthma, rhinitis or wheeze, which changed the probability of asthma, rhinitis or wheeze from −5.76% (95%CI: −7.74%, −3.79%) to 27.4% (95%CI: 16.6%, 38.3%). The three factors associated with the largest change in probability of asthma were short birth length, carpeted floor and paternal allergy; for rhinitis they were maternal smoking during pregnancy, paternal allergy and living close to industrial area; and for wheeze they were carpeted floor, short birth length and maternal allergy. Other home environmental risk factors identified were living close to a highway, industrial area or river, sharing bedroom, cooking with gas, furry pets, cockroaches, incense, printer/photocopier, TV, damp, and window condensation in winter. Lifestyle-related risk factors were child caretakers other than parents, and age<3 for the day-care. Other risk factors included use of antibiotics, and mother's occupation. Major protective factors for wheeze were living in a rural/suburban region, air conditioner use, and mother's occupation in healthcare. Our findings suggest that changes in lifestyle and indoor environments associated with the urbanization and industrialization of China are associated with asthma, rhinitis, and wheeze in children. Image 1 • We investigated home environmental and lifestyle factors associated with children's allergy. • We used a global variable procedure (LASSO) to select potential influencing factors. • We assessed associated factors in common for asthma, wheeze and rhinitis. • We calculated the probability change due to each risk factor. • Our model has sufficient statistic power and strong predicting performance. [ABSTRACT FROM AUTHOR]

Abstract: This study analyzed the workplace area concentrations and the personal exposure concentrations to fine particulate (PM2.5), elemental carbon (EC), and organic carbon (OC) measured during the winter period in trucking companies. The averaged personal exposure concentrations at breathing zones of workers are much greater than those of the microenvironment concentrations. The highest difference between the area (microenvironment) and personal exposure concentrations was in the PM2.5 concentrations followed by the OC concentrations. The area concentrations of PM2.5, EC, and OC at a large terminal were higher than those at a small one. The highest area concentrations of PM2.5, EC, and OC were observed in the shop areas followed by pick-up and delivery (P&D) areas. The area concentrations and personal exposure to PM2.5, EC, and OC in the shop and P&D areas which are highly affected by diesel engine exhaust emissions were much higher than those in the docks which are significantly affected by liquefied petroleum gas (LPG) engine exhaust emissions. The highest EC fraction to the total carbon (EC+OC) concentrations was observed in the shops, while the lowest one was identified in the offices. The personal exposure of the smoking workers to PM2.5 and OC was much higher than that of the non-smoking workers. However, the smoking might not significantly contribute to the personal exposure to EC. There were significant correlations between the PM2.5 and OC concentrations in both the area and personal exposure concentrations. However, significant correlations between the PM2.5 and EC concentrations and between the OC and EC concentrations were not identified. [Copyright &y& Elsevier]

Abstract Background The health burden from exposure to air pollution has been studied in many parts of the world. However, there is limited research on the health effects of air quality in arid areas where sand dust is the primary particulate pollution source. Objective Study the risk of mortality from exposure to poor air quality days in Kuwait. Methods We conducted a time-series analysis using daily visibility as a measure of particulate pollution and non-accidental total mortality from January 2000 through December 2016. A generalized additive Poisson model was used adjusting for time trends, day of week, and temperature. Low visibility (yes/no), defined as visibility lower than the 25th percentile, was used as an indicator of poor air quality days. Dust storm events were also examined. Finally, we examined these associations after stratifying by gender, age group, and nationality (Kuwaitis/non-Kuwaitis). Results There were 73,748 deaths from natural causes in Kuwait during the study period. The rate ratio comparing the mortality rate on low visibility days to high visibility days was 1.01 (95% CI: 0.99–1.03). Similar estimates were observed for dust storms (1.02, 95% CI: 1.00–1.04). Higher and statistically significant estimates were observed among non-Kuwaiti men and non-Kuwaiti adolescents and adults. Conclusion We observed a higher risk of mortality during days with poor air quality in Kuwait from 2000 through 2016. Highlights • The health effects of air quality in arid areas are not well studied. • Studied the acute effect of poor air quality and dust storms on mortality in Kuwait • Time-series analysis using 2000-16 daily visibility and all nonaccidental mortality • People are in higher risk of dying during days with poor air quality in Kuwait. • Non-Kuwaiti people especially men and adults are in higher risk. [ABSTRACT FROM AUTHOR]

Objectives We assessed relationships between indoor black carbon (BC) exposure and urinary oxidative stress biomarkers, 8-hydroxy-2′-deoxyguanosine (8-OHdG) and malondialdehyde (MDA), in participants with chronic obstructive pulmonary disease (COPD). Methods Eighty-two participants completed in-home air sampling for one week prior to providing urine samples up to four times in a year. Weekly indoor and daily outdoor concentrations were used to estimate indoor daily lags and moving averages. There were no reported in-home BC sources, thus indoor levels closely represented outdoor BC infiltration. Mixed effects regression models with a random intercept for each participant were used to assess relationships between indoor BC and 8-OHdG and MDA, adjusting for age, race, BMI, diabetes, heart disease, season, time of urine collection, urine creatinine, and outdoor humidity and temperature. Results There were positive effects of BC on 8-OHdG and MDA, with the greatest effect the day before urine collection (6.9% increase; 95% CI 0.9–13.3%, per interquartile range: 0.22 μg/m 3 ) for 8-OHdG and 1 to 4 days before collection (8.3% increase; 95% CI 0.03–17.3% per IQR) for MDA. Results were similar in models adjusting for PM 2.5 not associated with BC and NO 2 (10.4% increase, 95% CI: 3.5–17.9 for 8-OHdG; 8.1% increase, 95% CI: −1.1–18.1 for MDA). Effects on 8-OHdG were greater in obese participants. Conclusions We found positive associations between BC exposure and 8-OHdG and MDA, in which associations with 8-OHdG were stronger in obese participants. These results suggest that exposure to low levels of traffic-related pollution results in lipid peroxidation and oxidative DNA damage in individuals with COPD. [ABSTRACT FROM AUTHOR]

Abstract: Spinal cord injury (SCI) causes profound bone loss due to muscle paralysis resulting in the inability to walk. Sclerostin, a Wnt signaling pathway antagonist produced by osteocytes, is a potent inhibitor of bone formation. Short-term studies in rodent models have demonstrated increased sclerostin in response to mechanical unloading that is reversed with reloading. Although sclerostin inhibition has been proposed as a potential therapy for bone loss, it is not known if sclerostin levels vary with duration of SCI in humans. We analyzed circulating sclerostin in 155 men with varying degrees of SCI who were 1year or more post-injury. We report that sclerostin levels are greatest in subjects with short-term SCI (≤5years post-injury) and decrease significantly over the first 5years post-injury. There was no association between sclerostin and injury duration in subjects with long-term SCI (>5years post-injury). In subjects with long-term SCI, sclerostin levels were positively associated with lower extremity bone density and bone mineral content. These data suggest that sclerostin levels are initially increased after SCI in response to mechanical unloading. This response is time-limited and as bone loss progresses, circulating sclerostin is lowest in subjects with severe osteoporosis. These findings support a dual role for sclerostin after SCI: a therapeutic target in acute SCI, and a biomarker of osteoporosis severity in chronic SCI. [Copyright &y& Elsevier]

Abstract: A case–control study of lung cancer mortality in U.S. railroad workers in jobs with and without diesel exhaust exposure is reanalyzed using a new threshold regression methodology. The study included 1256 workers who died of lung cancer and 2385 controls who died primarily of circulatory system diseases. Diesel exhaust exposure was assessed using railroad job history from the US Railroad Retirement Board and an industrial hygiene survey. Smoking habits were available from next-of-kin and potential asbestos exposure was assessed by job history review. The new analysis reassesses lung cancer mortality and examines circulatory system disease mortality. Jobs with regular exposure to diesel exhaust had a survival pattern characterized by an initial delay in mortality, followed by a rapid deterioration of health prior to death. The pattern is seen in subjects dying of lung cancer, circulatory system diseases, and other causes. The unique pattern is illustrated using a new type of Kaplan–Meier survival plot in which the time scale represents a measure of disease progression rather than calendar time. The disease progression scale accounts for a healthy-worker effect when describing the effects of cumulative exposures on mortality. [Copyright &y& Elsevier]

[Display omitted] • Diesel exhaust pollutants were evaluated for workers in the US trucking industry. • Metabolomic alterations were associated with elemental carbon and organic carbon. • No metabolites were associated with PM 2.5 exposure. • Exposure-associated metabolites were related to oxidative stress and nitric oxide production. • Gene and metabolite networks support associations with cardiopulmonary disease. Exposure to traffic-related pollutants, including diesel exhaust, is associated with increased risk of cardiopulmonary disease and mortality; however, the precise biochemical pathways underlying these effects are not known. To investigate biological response mechanisms underlying exposure to traffic related pollutants, we used an integrated molecular response approach that included high-resolution metabolomic profiling and peripheral blood gene expression to identify biological responses to diesel exhaust exposure. Plasma samples were collected from 73 non-smoking males employed in the US trucking industry between February 2009 and October 2010, and analyzed using untargeted high-resolution metabolomics to characterize metabolite associations with shift- and week-averaged levels of elemental carbon (EC), organic carbon (OC) and particulate matter with diameter ≤ 2.5 μm (PM 2.5). Metabolic associations with EC, OC and PM 2.5 were evaluated for biochemical processes known to be associated with disease risk. Annotated metabolites associated with exposure were then tested for relationships with the peripheral blood transcriptome using multivariate selection and network correlation. Week-averaged EC and OC levels, which were averaged across multiple shifts during the workweek, resulted in the greatest exposure-associated metabolic alterations compared to shift-averaged exposure levels. Metabolic changes associated with EC exposure suggest increased lipid peroxidation products, biomarkers of oxidative stress, thrombotic signaling lipids, and metabolites associated with endothelial dysfunction from altered nitric oxide metabolism, while OC exposures were associated with antioxidants, oxidative stress biomarkers and critical intermediates in nitric oxide production. Correlation with whole blood RNA gene expression provided additional evidence of changes in processes related to endothelial function, immune response, inflammation, and oxidative stress. We did not detect metabolic associations with PM 2.5. This study provides an integrated molecular assessment of human exposure to traffic-related air pollutants that includes diesel exhaust. Metabolite and transcriptomic changes associated with exposure to EC and OC are consistent with increased risk of cardiovascular diseases and the adverse health effects of traffic-related air pollution. [ABSTRACT FROM AUTHOR]

Previous studies have suggested increased risk of respiratory diseases and mortality following short-term exposures to ionizing radiation. However, the short-term respiratory effects of low-level environmental radiation associated with air pollution particles have not been considered. Although ambient particulate matter (PM) has been reproducibly linked to decreased lung function and to increased respiratory related morbidity, the properties of PM promoting its toxicity are uncertain. As such, we evaluated whether lung function was associated with exposures to radioactive components of ambient PM, referred to as particle radioactivity (PR). For this, we performed a repeated-measures analysis of 839 men to examine associations between PR exposure and lung function using mixed-effects regression models, adjusting for potential confounders. We examined whether PR-lung function associations changed after adjusting for PM 2.5 (particulate matter≤2.5 μm) or black carbon, and vice versa. PR was measured by the USEPA's radiation monitoring network. We found that higher PR exposure was associated with a lower forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1). An IQR increase in 28-day PR exposure was associated with a 2.4% lower FVC [95% confidence interval (CI): 1.4, 3.4% p < 0.001] and a 2.4% lower FEV 1 (95% CI: 1.3, 3.5%, p < 0.001). The PR-lung function associations were partially attenuated with adjustment for PM 2.5 and black carbon. This is the first study to demonstrate associations between PR and lung function, which were independent of and similar in magnitude to those of PM 2.5 and black carbon. If confirmed, future research should account for PR exposure in estimating respiratory health effects of ambient particles. Because of widespread exposure to low levels of ionizing radiation, our findings may have important implications for research, and environmental health policies worldwide. • Particulate matter (PM) adversely affects lung function but factors promoting its toxicity are uncertain. • The respiratory effects of low-level environmental radioactivity from PM are unknown. • We evaluate how particle-bound radioactivity (PR) is associated with lung function. • Independent of PM, we demonstrate that PR is associated with decreased FVC and FEV 1. • Our findings will have important implications for research and environmental health policy. [ABSTRACT FROM AUTHOR]