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The extensive literature has reported adverse effects on environmental tobacco smoke (ETS) on children's health. We aim to analyze associations of ETS with dry night cough, croup, pneumonia, and frequent common cold and to disentangle the effects of prenatal, infancy and childhood exposure by multilevel logistic regression. A cross-sectional study was conducted among 41,176 children aged 3–8 years in 8 major cities of China during 2010–2011, and obtained demographic information, smoke exposure information, and respiratory outcomes. Parents' smoking habit and indoor tobacco smoke odor were considered as two indicators of ETS. The prevalences of respiratory outcomes were 6.0% for croup, 9.5% for frequency common cold, 17.1% for dry night cough and 32.3% for pneumonia respectively in the study. The associations between respiratory outcomes and parental smoking were not obvious, while indoor tobacco smoke odor was clearly and strongly associated with most respiratory outcomes, with adjusted odds ratios ranging from 1.06 to 1.95. Both infancy and childhood exposure to tobacco smoke odor were independent risk factors, but infancy exposure had a higher risk. The results explore that ETS increased the risk of respiratory outcomes in children, highlighting the need for raising awareness about the detrimental effects of tobacco smoke exposure. [ABSTRACT FROM AUTHOR]

Purpose: In the past 60 years, the prevalences of asthma and allergy among children have increased around the world. Neither genetic nor outdoor environmental factors can explain this increase. Methods: We performed a cross-sectional study of 7366 children in Tianjin, China, on associations of home environment and lifestyles with asthma and allergy. Results: The prevalences of diagnosed asthma, rhinitis and eczema among 0- to 8-year-old children in the Tianjin area were 4%, 9% and 39%. Home environment and lifestyle, together with infections, were strong risk factors. For asthma and allergy, the population attributable fraction (PAF) due to modern floors and wall coverings (i.e., laminated wooden floors and painted walls compared to tile floors and lime-coated walls) was 22%. Window condensation in winter and air conditioner use in summer, both of which are proxies for less ventilation, accounted for 7–17% of rhinitis and eczema. Cesarean delivery accounted for 10% of eczema symptoms. We developed a modern life index from appropriate home characteristics and lifestyle and food consumption habits and found it to have a clear dose–response relationship with asthma and allergy in Tianjin children. Conclusions: The results indicate that a "modern" home environment together with a modern lifestyle is associated with increased prevalences of asthma and allergies among children. Appropriate indoor environmental interventions and education of children's caregivers are important in the management of childhood asthma and allergy. [ABSTRACT FROM AUTHOR]

In order to evaluate the perceived home indoor air quality, as well as sick building syndrome (SBS) in areas with typical arid continental climate such as Urumqi, northwest of China, a cross-sectional study including 4,260 parents of children (1-8 years) was performed by a questionnaire survey in winter season in 2011. The sensation of air dryness (weekly/sometimes) in the last 3 months had the highest proportion of reports by more than half of the parents (57.4 %), followed by perceived stuffy odor (40.6 %), unpleasant odor (27.0 %), tobacco smoke odor (25.5 %), sensation of humid air (17.9 %), pungent odor (11.7 %) and moldy odor (9.5 %), respectively. The prevalence of SBS symptoms in the same time period was 40.4 % for general symptom, 47.7 % for mucosal symptom and 9.5 % for skin symptom, respectively. There were significant associations between perceived odors/sensation of air dryness and SBS symptoms (ORs range 1.39-1.42). Additionally, the OR values increased with an increase of the OH score ( P < 0.05). Dampness, the presence of cockroaches and mosquitoes/flies, prenatal exposure to decoration and close to traffic were all risk factors of SBS symptoms. However, frequently putting bedding to sunshine was potentially a protective factor. In conclusion, adults' perceptions of odors and sensation of air dryness are related to SBS symptoms and home environmental factors in Urumqi, China. [ABSTRACT FROM AUTHOR]

To assess associations between home indoor air environments and asthma, allergies and pneumonia, children aged 1-8 years were surveyed from 12 kindergartens in the city of Xi'an. 2,020 questionnaires were responded with a response rate of 83.5 %. The prevalences of doctor diagnosed asthma, hay fever, and pneumonia were 2.9 %, 3.6 %, and 28.3 %, respectively. Living close to a highway was a risk factor for current rhinitis (AOR 1.5, 95 % CI 1.2-1.8), eczema (AOR 1.7, 95 % CI 1.2-2.5), and diagnosed pneumonia (AOR 1.3, 95 % CI 1.0-1.6). Dampness problems in the home were associated with 50 %-130 % increases in the prevalences of asthma and allergy. Airing bed linen under sun-shine was protective, especially against rhinitis. Pet avoidance was consistently and significantly associated with asthma and allergy (AOR 1.3-2.4). Decoration of the home during children's early life is a risk factor for current rhinitis (AOR 1.9, 95 % CI 1.3-2.9) and eczema (AOR 1.9, 95 % CI 1.1-3.6). Risk factors for pneumonia were living in an apartment (AOR 1.4, 95 % CI 1.1-1.8), latex wall paint (AOR 1.3, 95 % CI 1.0-1.7), dampness (AOR 1.4-1.5), breast feeding <3 months (AOR 1.3, 95 % CI 1.0-1.7), never airing bed linen in sunshine (AOR 1.3, 95 % CI 1.3-1.6), and cleaning children's room less frequently than once per day (AOR 1.4, 95 % CI 1.1-1.7). This study demonstrates that home indoor environmental and life style factors may influence the health of children in Xi'an. [ABSTRACT FROM AUTHOR]

Whether indoor environmental smoke is harmful for preschool children’s respiratory health in a society where female smoking is rare has not been determined. This study is part of a cross-sectional study (CCHH study-phase one in Shanghai) and investigated associations between parental smoking and incense-burning and respiratory symptoms among 4–6 year old children in Shanghai, China. A number of 13335 valid questionnaires (response rate: 85.3%) were analyzed. A number of 56.1% (as reported by a parent) of preschool children in Shanghai are exposed to environmental tobacco smoke (ETS). A number of 40.3% of fathers and 0.9% of mothers are smokers. A number of 53.7% and 12.6% of Shanghai residents have used mosquito-repellent incense and incensation respectively. Children exposed to any parental smoking have higher prevalence of wheeze and croup than those not exposed. Current maternal smoking has a significant and positive association with wheeze (in the last 12 months, AOR, 95% CI: 1.83, 1.11–2.99). However, paternal smoking either currently or at child’s birth had only weak associations with wheeze and croup. Incense-burning (mosquito-repellent incense and incensation) had significant and negative association with doctor-diagnosed asthma (AOR, 95% CI: 0.85, 0.73–0.99) and hay fever (AOR, 95% CI: 0.80, 0.70–0.93). The results indicate that maternal smoking perhaps is a stronger risk factor for children’s respiratory health than paternal smoking. [ABSTRACT FROM AUTHOR]

Atopic eczema is a common health problem in children. The prevalence has increased in the past decades. Besides a genetic predisposition, lifestyle factors, dietary habits and indoor environments are thought to be related to its high prevalence. A cross-sectional questionnaire study was carried out in 2011 in the Wuhan area to study associations between home environments and children’s health. The questionnaires were replied to by parents of 2193 children 1–8 years old and the response rate was 91.4% (2193/2400). The results show: (1) The prevalence of “eczema symptom ever that lasted for 6 months” was 23.2%; “eczema symptom in the last 12 months” 7.4% and “awake at night due to itchy rash” 3.4%. (2) Risk factors: Closer to business area (AOR 1.4), moisture related problems (AOR 1.3–2.2), moldy and stuffy odor perception (AOR 1.5), mice observed (AOR 1.8), pet keeping (AOR 1.3), exposure to environmental tobacco smoke (AOR 1.3) and incense (AOR 1.8) were significant risk factors for atopic eczema symptoms ever. Living in an apartment, compared to single family house, was related to more eczema symptom in the last 12 months. Damp clothing/bed sheets and perception of stuffy odor were risk factors for both “eczema symptom in the last 12 months” and “awake due to itchy rash (severe eczema)”. The odds ratio of mice observed for severe eczema was 3.1 (95% CI: 1.4–6.7). It suggests that urbanization, life style and dampness problems at home were significant risk factors for eczema symptoms among children in Wuhan, China. [ABSTRACT FROM AUTHOR]

The city of Chongqing has high outdoor temperatures and humidity throughout the year and consequently a high risk of dampness and mold problems in dwellings. As part of the China, Children, Homes, Health (CCHH), associations between home characteristics and children’s asthma, allergies, and related symptoms were investigated in Chongqing, China. A cross-sectional questionnaire survey on home characteristics including dampness and symptoms of asthma and allergies in 5299 children was performed. Data for 4754 children (3–6 years) and their homes were analyzed. Results showed that 35.1% of homes were reported to have “damp bedding”, 14.3% “condensation on window panes (higher than 5 cm)”, 11.6% “mouldy odor”, 9.3% “water leakage”, 8.3% “damp stains” and 5.3% “visible mould”. Wheezing and rhinitis ever were reported for 27.0% and 51.1% children respectively, and rhinitis, wheezing, cough at night and eczema in the last 12 months were reported for 38.1%, 20.5%, 18.9% and 13.2% respectively. Doctor-diagnosed asthma was reported for 8.3% of children, and doctor-diagnosed rhinitis for 6.2%. Dampness in homes was generally strongly associated with asthma and allergies among Chongqing children. The strongest association was found between “visible mould” and doctor-diagnosed rhinitis, and the adjusted Odds Ratio (OR A) was 2.27 (95% CI: 1.48, 3.49). “Damp bedding” was significantly associated with all asthma and allergic symptoms, but doctor-diagnosed asthma and rhinitis. The behavior of “putting bedding to sunshine” could effectively reduce the prevalence of asthma and allergic symptoms, and the risk of bedding affected with damp was reduced significantly when bedding was put to sunshine frequently. [ABSTRACT FROM AUTHOR]

Indoor environmental quality is suspected to be at least part of the cause of the increasing prevalence of childhood asthma and allergy. This study is part of the China, Children, Homes, Health (CCHH) project, which was designed to identify the risk factors indoors that are associated with prevalence of asthma and allergy among children in China. A cross-sectional questionnaire study was carried out in Wuhan in 2011. The questionnaire was a modified (to Chinese building characteristics) version of a questionnaire used first in Sweden. The parents of 2193 children, aged 1–8 years, replied, a response rate of 91.4% (2193/2400). Prevalences of asthma and allergic symptoms were calculated, and a Chi-square test and multiple logistic regression were used to identify risk factors. Prevalences of health outcomes are “wheezing last 12 months” 18.5%, “cough at night last 12 months” 15.4%, “doctor-diagnosed asthma” 6.0%, “rhinitis last 12 months” 48.7%, “doctor-diagnosed allergic rhinitis” 17.5%. Factors associated with increased risk for asthma, allergy and related symptoms include living in an urban area, dampness (significant), use of gas for cooking, new dwelling decoration (paint and furniture obtained during pregnancy), keeping pets and breast feeding less than 3 months. Factors associated with reduced risk as installing an exhaust fan in the bathroom. Home environmental factors are significantly associated with the prevalence of childhood asthma and rhinitis in Wuhan. Urbanization and dampness problems at home are significant risk factors for doctor diagnosed asthma and allergic rhinitis among children in Wuhan. [ABSTRACT FROM AUTHOR]

Prenatal and early life home environment might be related to children’s asthma or allergic diseases later in life. A cross-sectional epidemiological study was designed and a questionnaire survey was performed in 3700 preschool children in urban areas in Taiyuan, Shanxi Province, China. Questions on children’s asthma and allergic diseases from the International Study on Asthma and Allergies in Childhood (ISAAC) were integrated with questions on home environment from the Swedish Dampness in Buildings and Health (DBH) study, appropriately modified for Chinese life habits. By multivariate regression analyses controlling for age, gender, heredity, location in urban/suburban or rural areas, environmental tobacco smoke (ETS) and breastfeeding, we found that home new furniture (HNF) before birth (referring to 1 year before pregnancy and during pregnancy) was positively associated with wheezing ever (odds ratio(OR) 1.23 with 95% CI of 1.03–1.48) and wheezing last 12 months (1.24,1.00–1.54), allergic rhinitis (AR) (1.26,1.06–1.51), and eczema (1.42,1.01–1.99). HNF between 0–1 years old was also positively associated with wheezing last 12 months. Home new decoration (HND) during 0–1 years old was positively associated with AR symptoms and eczema symptoms, more in the last 12 months. Stronger positive associations were found for signs of home mold and dampness with almost all children’s asthmatic and allergic symptoms (OR ranging from 1.23–1.85, P<0.05). By mutual adjustment between HNF before children’s birth and home mold or dampness, all the significance remained unchanged. Prenatal HNF and home mold or dampness was independently associated with children’s asthmatic and allergic diseases later in life. [ABSTRACT FROM AUTHOR]

The prevalence and risk factors of sick building syndrome (SBS) symptoms in domestic environments were studied by a questionnaire survey on the home environment. Parents of 5299 3-6 years old children from randomly selected kindergartens in Chongqing, China returned completed questionnaires between December 2010 and April 2011. The prevalence of parents’ SBS symptoms (often (every week) compared with never) were: 11.4% for general symptoms, 7.1% for mucosal symptoms and 4.4% for skin symptoms. Multiple logistic regressions were applied controlling for gender and asthma/allergic rhinitis/eczema. Living near a main road or highway was a strong risk factor for general symptoms (adjusted odds ratio, aOR=2.16, P<0.001), skin symptoms (aOR=2.69, P<0.001), and mucosal symptoms (aOR=1.63, P<0.01). Redecoration was a risk factor for general symptoms (aOR=2.00, P<0.001), skin symptoms (aOR=1.66, P<0.01), and mucosal symptoms (aOR=1.66, P<0.05). New furniture was a risk factor for general symptoms (aOR=2.16, P<0.001) and skin symptoms (aOR=1.67, P<0.01). Dampness related problems (mould spot, damp stain, water damage and condensation) were all risk factors for SBS symptoms, as was the presence of cockroaches, rats, and mosquitoes/flies and use of incense. Protective factors include cleaning the child’s bedroom every day and frequently exposing bedding to sunshine. In conclusion, adults’ SBS symptoms were related to factors of the home environment. [ABSTRACT FROM AUTHOR]

Prevalence of allergic rhinitis has rapidly increased among Chinese children, but the reasons are unclear. Recent findings have suggested that exposure to outdoor air pollutants may increase the risk of allergic rhinitis, but the results were inconsistent. This study further investigated the effect of outdoor air pollutants on allergic rhinitis among preschool children. A standardized questionnaire on health, home and environmental factors was conducted for 4988 children aged 1–8 in the city of Changsha, and the concentrations of PM 10 (particle diameter ⩽10 μm), sulfur dioxide (SO 2) and nitrogen dioxide (NO 2) during 2006–2011 were acquired from the official web of Changsha Environmental Protection Agency. Results showed that the prevalence of children’s doctor diagnosed rhinitis was 8.4% (95% confidence interval [CI] 7.0%–10.0%). It was found that the prevalence of rhinitis was not associated with site-specific background concentrations of air pollutants, but significantly positively correlated with age-related accumulative personal exposure of PM 10, SO 2 and NO 2. We conclude that age-related accumulative personal exposure to ambient air pollution may play an important role in the development of rhinitis. [ABSTRACT FROM AUTHOR]

In order to evaluate the prevalence of childhood asthma, allergic diseases and pneumonia in Urumqi City, China, as well as its associations with housing and home characteristics, a cross-sectional study was performed in 4618 children (81.7% response rate, average age 4.7±0.9 year, boys accounting for 53.7%). Questions on children’s asthma and allergic diseases were from the International Study on Asthma and Allergies in Childhood (ISAAC) and were integrated with questions on the home environment from the Dampness in Buildings and Health (DBH) study, slightly modified to account for Chinese building characteristics and life habits. The prevalences of physician diagnosed asthma, allergic rhinitis (AR) and pneumonia were 3.6%, 8.7% and 40.9%, respectively. One fourth of children reported wheezing and more than 40% AR symptoms in the last 12 months. Controlling for confounding factors, positive associations were found for home mold/dampness and wheezing (adjusted odds ratio, aOR 1.33, 95% CI 1.07–1.66), AR symptoms (1.34, 1.09–1.64) last 12 months and physician diagnosed pneumonia (1.33, 1.09–1.62). Floor material by wood, PVC or carpeting; and walls by wallpaper, painting or wood material, were positively associated with AR symptoms. Home environmental tobacco smoke (ETS) was positively associated with wheezing (1.23, 1.04–1.46) and pneumonia (1.25, 1.07–1.45). In conclusion, there was a relatively high prevalence of asthmatic and AR symptoms and diagnosed pneumonia in preschool children in Urumqi. Home signs of mold growth or dampness, windowpane condensation, as well as ETS and interior surface materials emitting chemicals were risk factors for allergic symptoms and pneumonia. [ABSTRACT FROM AUTHOR]

Pneumonia is a major cause of childhood morbidity in China. Many studies of rural areas have found an association between pneumonia and air pollution from burning of bio-mass. The present study is of children living in urban, modern homes without burning of bio-mass. In order to investigate potential home risk factors associated with children’s pneumonia, China Child Home Health (CCHH) questionnaires were randomly distributed to parents of 6461 children in 23 kindergartens in all 11 districts of Nanjing, covering urban, suburban, and industrial areas. The 4014 valid questionnaires (response rate 65.7%) were returned and have been analyzed. The lifetime incidence of pneumonia in Nanjing children 1–8 years old is 26.7%. The incidence of croup, asthma and frequent common colds was strongly associated with pneumonia, as was a history of allergies in the family, and persons other than parents (for example grandparents or nanny) taking care of the child. Several home environmental factors, namely, dampness, lack of ventilation, using coal or natural gas (electricity as reference) for cooking, new furniture, and “modern” floor and wall covering materials were also significantly associated with pneumonia. The indoor environment typical of modern apartments in China was a risk factor for pneumonia among children. [ABSTRACT FROM AUTHOR]

Whether early pet-keeping is a risk factor for children’s asthma and allergies remains controversial. To investigate associations between asthma, allergies and airway symptoms among children and the indoor environment, a cross-sectional study was conducted in 5 districts of Shanghai. A number of 13335 questionnaires (response rate: 85.3%) of 4-6 year old children were analyzed. Families in urban areas have more pets except for dogs than families in suburbs. Fish are the most common pets in urban districts. The prevalence of doctor-diagnosed asthma was 10.3%, wheeze (ever) 28.3%, rhinitis (ever) 54.1%, doctor-diagnosed hay fever 12.6% and eczema (ever) 22.9%. In logistic regression analyses, early furred pet-keeping was positively associated with most of the symptoms and significantly with rhinitis (ever, adjusted OR=1.41, 95% CI=1.14–1.76) and doctor-diagnosed hay fever (1.38, 1.02–1.88). Current furred pet-keeping was significantly negatively associated with doctor-diagnosed asthma (0.57, 0.39–0.83). Persistent furred pet-keeping was significantly positively associated with rhinitis on pet or pollen exposure. However, current pet-keeping is not randomly distributed in the population. Children in families with “allergy” or with “pet avoidance behavior” (due to allergies in the family) have more symptoms, but have avoided cats and dogs, leading to the conclusion that such animals are “protective”, namely the “Healthy Pet-Keeping” effect. Moreover, rodents and birds are risks for children’s health. Fish-keeping is also seemingly a risk. This study indicates that early pet-keeping is a risk factor for asthma and allergies in families with a history of allergies, and part of residents in Shanghai have pet-avoidance behavior. [ABSTRACT FROM AUTHOR]

This study evaluated the prevalence and risk factors for asthma, allergy and related symptoms; and breastfeeding patterns and durations for 5479 Beijing children aged 3–6. Parents of children in randomly selected kindergartens wrote responses to a questionnaire used previously. The study aimed to evaluate trends in the prevalence of asthma and related illnesses, and to determine whether “more” breastfeeding, defined as exclusive, > 6 months, was associated with reduced prevalence. Asthma has increased in this age group between 1990 and 2011, with the steepest increase in the last 2–3 years. Of the total, 14.2% (779) children were breastfed exclusively for > 6 months. The efficacy of “more” breastfeeding was tested in a subset with two strong risk factors, positive family history (for asthma and/or allergy) and male gender. “More” breastfeeding was found to be significantly protective (aOR 0.42, P < 0.05) for this subset against Doctor-diagnosed asthma (D-asthma). Protection that did not reach statistical significance was also found for this subset against Wheeze ever, Cough at night, Rhinitis ever, Doctor-diagnosed rhinitis (D-rhinitis) and Eczema. The greatest protective effects were found for girls with no family history of asthma or allergy, reaching statistical significance for Wheeze ever (aOR 0.48, P < 0.01), Cough at night (aOR 0.47, P < 0.01), D-asthma (aOR 0.14, P < 0.01) and Rhinitis ever (aOR 0.67, P < 0.05). “More” breastfeeding was not consistently associated with either a protective or risk effect for Eczema. [ABSTRACT FROM AUTHOR]

Since altered heart rate (HR) fluctuations provide prognostic information in heart failure, we examined the associations between HR dynamics, myocardial efficiency and perfusion, among patients with dilated cardiomyopathy. Sixteen patients with dilated cardiomyopathy were enrolled. Patients received supervised strength and aerobic training for 5 months ( n = 9) or standard care ( n = 7). The short-term scaling exponent (α1) and frequency domain measures of HR behavior were assessed at baseline and after 5 months of intervention. The left ventricular (LV) function measured using echocardiography and oxidative metabolism measured using positron emission tomography (PET) and [11C]-acetate were used to estimate the myocardial efficiency. Short-term fractal exponent α1 correlated significantly with LV myocardial efficiency ( r = 0.77, p = 0.002) at baseline. After the intervention period, the majority of patients showed improved myocardial efficiency and small or marked change in HR dynamics toward the natural fractal-like organization (α1 value close 1). Parallel change in fractal properties of HR and myocardial efficiency after intervention was observed in 78% of the patients. Intervention had no significant effect on any other HR fluctuation indices. The present study suggests that short-term fractal scaling exponent α1, an important prognostic marker in heart failure, is related to LV myocardial efficiency. [ABSTRACT FROM AUTHOR]

Purpose: Right ventricular (RV) performance is known to have prognostic value in patients with congestive heart failure (CHF). Cardiac resynchronisation therapy (CRT) has been found to enhance left ventricular (LV) energetics and metabolic reserve in patients with heart failure. The interplay between the LV and RV may play an important role in CRT response. The purpose of the study was to investigate RV oxidative metabolism, metabolic reserve and the effects of CRT in patients with CHF and left bundle brach block. In addition, the role of the RV in the response to CRT was evaluated. Methods: Ten patients with idiopathic dilated cardiomyopathy who had undergone implantation of a biventricular pacemaker 8±5 months earlier were studied under two conditions: CRT ON and after CRT had been switched OFF for 24 h. Oxidative metabolism was measured using [11C]acetate positron emission tomography (Kmono). The measurements were performed at rest and during dobutamine-induced stress (5 μg/kg per minute). LV performance and interventricular mechanical delay (interventricular asynchrony) were measured using echocardiography. Results: CRT had no effect on RV Kmono at rest (ON: 0.052±0.014, OFF: 0.047±0.018, NS). Dobutamine-induced stress increased RV Kmono significantly under both conditions but oxidative metabolism was more enhanced when CRT was ON (0.076±0.026 vs 0.065±0.027, p=0.003). CRT shortened interventricular delay significantly (45±33 vs 19±35 ms, p=0.05). In five patients the response to CRT was striking (32% increase in mean LV stroke volume, range 18-36%), while in the other five patients no response was observed (mean change +2%, range -6% to +4%). RV Kmono and LV stroke volume response to CRT correlated inversely (r=-0.66, p=0.034). None of the other measured parameters, including all LV parameters and electromechanical parameters, were associated with the response to CRT. In responders, RV Kmono with CRT OFF was significantly lower than in non-responders (0.036±0.01 vs 0.058± 0.02, p=0.047). Conclusion: CRT appears to enhance RV oxidative metabolism and metabolic reserve during stress. Patients responding to CRT appear to have lower RV oxidative metabolism at rest, suggesting that the RV plays a significant role in the response to CRT. [ABSTRACT FROM AUTHOR]