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Abstract: Although outdoor air pollution first brought the issue of air pollution health effects to public attention, it is now indoor air pollution that likely has the greatest impact on children''s health. The World Health Organization estimates that the global burden of disease from indoor air pollution is far greater than the burden from outdoor air pollution. This review focuses on two indoor pollutants, one that has been well studied, and another that deserves additional study. There is very strong evidence about the harmful effects of tobacco. Policy to decrease children''s tobacco exposure and use should be implemented without delay. The emerging findings linking household inhalation of mould spores and infant pulmonary hemorrhage merit follow-up in other countries, because they may provide clues to some deaths from the sudden infant death syndrome. [Copyright &y& Elsevier]

Objectives. To evaluate NicAlert® immunoassay test strips and liquid chromatography atmospheric-pressure ionization tandem mass spectrometry (LC/MS/MS) for the measurement of saliva cotinine levels in pregnant Alaska Native women. Study Design. Cross-sectional study. Methods. Pregnant women completed a questionnaire about their tobacco use during pregnancy and that of others in the same household. Saliva samples were collected and tested using LC/MS/MS and NicAlert® immunoassay test strips. Results. Seventy-one women participated; 18 reported using tobacco products during pregnancy. Sixteen women reported smoking within the last 7 days of the interview. Median cotinine concentrations in the women who reported smoking in the last 7 days were 94.5 ng/mL using LC/MS/MS (N=13) and 87.5 ng/mL using NicAlert® (N=11). Twenty-two women reported that they did not use tobacco and had no exposure to secondhand smoke. Median cotinine concentrations among those with no reported exposure to secondhand smoke were 0.0605 ng/mL using LC/MS/MS (N=18) and 4.38 ng/mL using NicAlert® (N=17). Conclusion. NicAlert® strips can be used to quickly distinguish between users and nonusers of tobacco, but they are not adequately sensitive to detect and quantify lower concentrations of cotinine among nonsmokers with secondhand exposure. A more sensitive method such as LC/MS/MS is required for that purpose. [ABSTRACT FROM AUTHOR]

Abstract: Disease associated with exposure to mycotoxins is known as the “Great Masquerader” of the 21st century because of its complex natural history involving different tissues and resembling different diseases at each stage in its evolution. It can present with a variety of nonspecific clinical signs and symptoms such as rash, conjunctivitis, epistaxis, apnea, cough, wheezing, nausea, and vomiting. Some cases of vomiting illness, bone marrow failure, acute pulmonary hemorrhage, and recurrent apnea and/or “pneumonia” are associated with exposure to mycotoxins. Familiarity with the symptoms of exposure to the major classes of mycotoxins enables the clinician to ask pertinent questions about possible fungal exposures and to remove the infant or child from the source of exposure, which could be contaminated food(s), clothing and furniture, or the indoor air of the home. Failure to prevent recurrent exposure often results in recurrent illness. A variety of other conditions, including hepatocellular and esophageal cancer and neural tube defects, are associated with consumption of foods contaminated with mycotoxins. Awareness of the short- and long-term consequences of exposures to these natural toxins helps pediatricians to serve as better advocates for children and families. [Copyright &y& Elsevier]

Estimates of unintentional deaths from carbon monoxide (CO) poisoning can be obtained from national mortality data. We explored ways of accurately estimating CO-related deaths from International Classification of Diseases, 9th Revision (ICD-9) coded U.S. mortality data. We evaluated and identified CO-related ICD-9 codes and created five classes of codes for case ascertainment that represented a continuum of the degree of certainty that the ICD-coded death was truly CO-related. We conducted single (underlying) cause-of-death and multiple-cause-of-death analysis using 20 years of data (1979-1998), and calculated sensitivity and positive predictive value using different criteria for case ascertainment. Single-cause analysis provided accurate estimates only when we used CO-exclusive E-codes, however this method failed to identify approximately one third of the CO-related deaths over the study period. Single-cause analysis overestimated the number of CO-related deaths when we used E-codes that were not exclusive to CO exposure. Identification of true CO-related deaths required multiple cause-of-death analysis and use of the CO nature-of-injury code, N986, to confirm suspected cases. Sensitivity of N986 was 99.5%, and positive predictive value of the individual E-codes in single cause-of-death analysis ranged from 1.5% to 92%. Estimating CO-related deaths from ICD-coded data requires a thorough understanding of the ICD codes, coding rules, and of the limitations imposed by case selection criteria and single cause-of-death analysis. [ABSTRACT FROM AUTHOR]

Environmental exposures may increase a child's risk of developing asthma and also may increase the risk of asthma exacerbations. This article reviews several environmental exposures and suggests whether they contribute to asthma prevalence, asthma exacerbations, or both. Outdoor air exposures and violence are not likely to cause the increase in asthma prevalence. Exposure to outdoor air pollutants primarily leads to increased exacerbations, sometimes manifested as asthma clusters. Clinicians should be alert for space-time clusters of asthma exacerbations in the community, because these clusters may suggest a modifiable point-source exposure. Indoor air exposures are more strongly linked to the increase in asthma prevalence. Exposure to dust mites and tobacco smoke are risk factors for the development of asthma and may also exacerbate existing asthma. Effective measures to prevent exposures to these pollutants are available. With proper management, the amount of environmental exposures can be decreased. Whether decreasing these exposures will result in decreases in asthma prevalence and exacerbations is not yet documented. Pediatrics 2003;112:233-239; asthma, indoor air pollution, outdoor air pollution. [ABSTRACT FROM AUTHOR]

Presents information on a study which developed a mathematical model to predict serotype distribution of Salmonella isolates among humans on the basis of animal data. Information on the Salmonella species; Data on human serotypes; Results of the study.

Discusses the hazards posed by ultraviolet light to children. Effects on the skin; Effects on the eye; Effects on the immune system; Prevention; Recommendations.

Presents a comparative study regarding concentrations of carbon monoxide between area with oxygen-containing fuels and non-oxygen fuel using area. Description, properties and composition of gasoline; Method of study and parameters used with its corresponding results; States where the study was conducted.

Focuses on epidemiologic studies on the association of tobacco smoke exposure in children with increased rates of lower respiratory illness and increased rates of middle ear effusion, asthma and sudden infant death syndrome. Association of exposure in childhood with cancer development in adulthood; Effects of passive smoking.

Discusses the respiratory hazards faced by children due to ambient air pollution. List of the respiratory effects of ozone, an ambient air pollutant; Relationship between outdoor air pollution and adverse respiratory effects in children; Factor that increases children's vulnerability to airborne pollution; Recommendations to pediatricians.

Abstract. One hundred thirty-two children who attended a research day-care center were studied to determine whether passive tobacco smoke exposure was associated with an increased rate of otitis media with effusion or with an increased number of days with otitis media with effusion during the first 3 years of life. Based on preliminary studies, a serum cotinine concentration of is greater than or equal to 2.5 ng/mL was considered indicative of exposure to tobacco smoke. Otitis media with effusion was diagnosed using pneumatic otoscopy by nurse practitioners and pediatricians who reviewed the children's health status each weekday. The 87 children with serum cotinine concentrations is greater than or equal to 2.5 ng/mL had a 38% higher rate of new episodes of otitis media with effusion during the first 3 years of life than the 45 children with lower or undetectable serum cotinine concentrations (incidence density ratio = 1.38, 95% confidence interval 1.21 to 1.56). The average duration of an episode of otitis media with effusion was 28 days in the children with elevated cotinine concentrations and 19 days in the children with lower cotinine concentrations (P < .01). It is estimated that 8% of the cases of otitis media with effusion in this population and 17.6% of the days with otitis media with effusion may be attributable to exposure to tobacco smoke. [ABSTRACT FROM AUTHOR]

Presents the results of a study on carbon monoxide poisoning in New Mexico from 1980-1988 using the multiple-cause mortality files from the National Center for Health Statistics (NCHS). Sensibility of the NCHS data for surveying carbon monoxide poisoning; Identification of poisoning casualties; Attributes of unintentional carbon monoxide-related deaths.

The relative risk of coronary artery disease among never smokers exposed to environmental tobacco smoke (EPS) versus never smokers not exposed to ETS is approximately 1.2 based on more than a dozen epidemi-ologic studies. Most of these studies have controlled for the major heart disease risk factors, but residual or uncontrolled confounding remains a possible explanation for the epidemiologic findings. The authors studied 3, 338 never-smoking adults aged 17 years or older, who are representative of all US never smokers, in the 1988–1991 Third National Health and Nutrition Examination Survey (NHANES III) to determine whether selected risk factors for heart disease differ between ETS-exposed and -nonexposed persons. Both self-reported ETS exposure (at home and at work) and serum cotinine levels were available, the latter reflecting recent ETS exposure. After adjustments were made for age, sex, race, and education among adults aged 17 years or older, no significant differences were found between the ETS exposed and the nonexposed for any of 13 cardiovascular risk factors with the exception of dietary carotene, which was lower among the exposed. On the other hand, significant positive linear trends were found between serum cotinine and two risk factors (body mass index and alcohol consumption), and significant inverse trends were found with dietary carotene. There were also few differences between exposed and nonexposed never smokers among adults aged 40 years or older, who are most at risk of heart disease. In this group, however, there was an inverse linear trend between serum cotinine and high density lipoprotein cholesterol (p < 0.001). This finding could result from ETS exposure rather than be an indication of confounding; a similar inverse trend was found for children, confirming other results in the literature. Overall, these data suggest little potential for confounding by the heart disease risk factors studied here when ETS exposure is determined by self-report. Am J Epidemiol 1998; 147: 932–39. [ABSTRACT FROM PUBLISHER]

Epidemic asthma occurred in New Orleans, Louisiana, in the 1950s and 1960s, but its causes were never fully understood. Subsequently, similar outbreaks of epidemic asthma in Barcelona, Spain, were shown to be caused by the release of soy dust at the harbor. To investigate whether airborne soy dust may have contributed to epidemic asthma in New Orleans, the authors examined historical data on vessel cargo from the New Orleans harbor together with data on emergency department visits for asthma, for the period from 1957 through 1968. Days on which there were 64 or more visits for asthma were twice as likely to have occurred on days when a vessel carrying soy was at the harbor (odds ratio (OR) = 2.3, 95% confidence interval (CO 1.5–3.3). The association was stronger when the maximum wind speed was less than 12 miles/hour (19.3 km/hour) (OR = 4.0, 95% Cl 2.1–7.7) and strongest when wind speeds were low and the prevailing winds were from the south or southwest, the direction of two grain elevators from the hospital (OR = 6.7, 95% Cl 1.5–46.7). Various temporal and climatic factors that had been associated with the occurrence of asthma outbreaks did not appear to be important confounding factors. The association was specific to soy cargo; no association was observed between asthma-epidemic days and the presence of either wheat or corn in vessels at the harbor. The results of this analysis provide further evidence that ambient soy dust is very asthmogenic and that asthma morbidity in a community can be influenced by exposures in the ambient atmosphere. Am J Epidemiol 1997; 145: 432-8. [ABSTRACT FROM AUTHOR]

Background. Exposure to environmental tobacco smoke (ETS) has been identified as a risk factor for chronic disease among nonsmokers. Results of epidemiological surveys suggest that the majority of non-smokers have regular ETS exposure. However, little is known about the topography of exposure. Methods. An exposure diary was used by 186 nonsmokers to self-monitor ETS exposure over a 7-day period. Subjects also completed a questionnaire that assessed their patterns of ETS exposure. Results. The primary source of ETS exposure was the workplace, except when there was a smoker in the household, in which case the household was the primary source. The presence of a smoker in the household resulted in higher levels of exposure both at work and in other locations when compared with subjects without household exposure Subjects' assessments of exposure on the questionnaire were consistently lower than their self-monitored levels. This findings suggests that general exposure ratings underestimate exposure. Conclusions. This study provides a new understanding of the patterns of ETS exposure and may help guide the development of policies and interventions designed to reduce ETS exposure. [ABSTRACT FROM AUTHOR]

Objective: In November 1992 residents of Fairbanks, Alaska became concerned about the potential health effects of an oxygenated fuel program during which 15% (by volume) methyl tertiary butyl ether (MTBE) was added to gasoline. To address those concerns, we earlier completed a survey of occupational exposure to MTBE. We conducted a follow-up survey of workers' exposure to benzene from gasoline in Fairbanks. Design: Cross-sectional exposure survey. Methods: We examined blood concentrations of benzene from a convenience sample of workers taken in December 1992 during the oxygenated fuel program and from another convenience sample of workers taken in February 1993 after the program was suspended. Results: In December, the median blood benzene concentration of samples taken from four mechanics after their workshift (postshift) was 1.32 μg/l (range, 0.84-2.61 μg/l), and seven nonmechanics (drivers and other garage workers) had a median postshift blood benzene concentration of 0.27 μg/l (range, 0.09- 0.45 μg/l). In February, nine mechanics had a median postshift blood benzene concentration of 1.99 μg/l (range, 0.92-3.23 μg/l), and nine nonmechanics had a median postshift blood benzene concentration of 0.26 μg/l (range, 0.2-0.46 μg/l). Conclusion: Mechanics had higher blood benzene concentrations than did nonmechanics, but further study is needed to determine the impact of the oxygenated fuel program on exposure to benzene. [ABSTRACT FROM AUTHOR]

Between March and November of 1991, approximately 9000 workers from 43 different countries battled the burning oil wells in Kuwait. To document the exposure of persons in Kuwait during the oil well fires to volatile organic compounds (VOCs), we obtained samples of blood from 14 U.S. personnel in Kuwait City in May of 1991 (group I) and 40 American firefighters working in the oil fields in October of 1991 (group II). Concentrations of VOCs in group I and group II were compared with those of a random sample of 114 persons in the United States (reference group). The median concentrations of VOCs in group I were equal to or lower than those in the reference group. We found significant differences between the median concentrations of several VOCs in group 11 and the reference group. Median levels of ethylbenzene were about 10 times higher among group II than among the reference group (0.53 μg/I vs 0.052 μg/l). Median levels of benzene, m-/ p-xylene, o-xylene, styrene, and toluene among group II were more than double those of the reference group. Although firefighters had higher median concentrations of VOCs than the reference group, those American personnel in Kuwait not involved in fighting the oil fires had concentrations of VOCs comparable to those in the reference group. Blood VOC measurements indicate a significant increase in exposure to VOCs in firefighters, but do not demonstrate this in personnel in Kuwait City. [ABSTRACT FROM AUTHOR]

This article focuses on effects of smoking at workplace. Nonsmokers' exposure to Environmental Tobacco Smoke (ETS) has several sources including their homes and workplaces. Researchers recently examined the relationship between self-reported ETS exposure in several different locations and urinary levels of cotinine, a biochemical marker of ETS exposure. A dose-response relationship was found between the self-reported level of exposure in the workplace and cotinine concentrations. Results also indicated that nonsmokers exposed to ETS in social situations or in their homes had significantly higher cotinine concentrations than persons without exposure in these settings. Restrictive smoking policies at the workplace are currently regarded as a primary means of reducing nonsmokers' ETS exposure. Many states and localities have legislated restrictions on smoking in public places, often including the workplace. In response to these regulations, and in an effort to protect employees and equipment from exposure, an increasing number of companies are implementing restrictive smoking policies .

The environment in which children grow, play and learn has a profound effect on their health and well-being. Exposures to a polluted indoor environment do not result in the same outcomes for children as for adults because children may be exposed differently, children metabolize some chemicals differently than adults; and children have "windows of vulnerability" while they are growing and developing when their target organs may be more susceptible than the target organs of adults. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa (SSA) has been identified by the Intergovernmental Panel on Climate Change (IPCC) as being the most vulnerable region to climate change impacts. A major concern is the increase in extreme weather events (EWE) such as storms, floods, droughts, heatwaves, wildfires, and landslides in SSA and their potential to affect the health and well-being of children and adolescents. The objective of this systematic review is to examine the direct and indirect impacts of EWE on the mental health of children and adolescents living in SSA, in order to inform protective adaptation strategies and promote resilience. A meta-analysis will not be possible, since the assumption is that limited studies have been published on the EWE-associated mental health impacts on children and adolescents living in SSA and that those studies that are available are heterogenous. There is acknowledgement in the global literature of the need to highlight child and adolescent mental health more prominently in climate change health strategies and policies. It is vital that adaptation strategies are informed by research on risk prevention and promotion of resilience to ensure the mental health of children and adolescents is protected. [ABSTRACT FROM AUTHOR]