Effect of Personal Exposure to PM2.5 on Respiratory Health in a Mexican Panel of Patients with COPD

Background: Air pollution is a problem, especially in developing countries. We examined the association between personal exposure to particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) on respiratory health in a group of adults with chronic obstructive pulmonary disease (COPD). Methods: All participants resided in Mexico City and during follow-up, personal exposure to PM2.5, respiratory symptoms, medications, and daily activity were registered daily. Peak expiratory flow (PEF) was measured twice daily, from February through December, 2000, in 29 adults with moderate, severe, and very severe COPD. PEF changes were estimated for each 10 µg/m3 increment of PM2.5, adjustment for severity of COPD, minimum temperature, and day of the sampling. Results: For a 10-µg/m3 increase in the daily average of a two-day personal exposure to PM2.5, there was a significant 33% increase in cough (95% CI, range, 5‒69%), and 23% in phlegm (95% CI, range, 2‒54%), a reduction of the PEF average in the morning of −1.4 L/min. (95% CI , range, −2.8 to −0.04), and at night of −3.0 L/min (95% CI, range, −5.7 to −0.3), respectively. Conclusions: Exposure to PM2.5 was associated with reductions in PEF and increased respiratory symptoms in adults with COPD. The PEF reduction was observed both at morning and at night

Health as a Social-technical Enterprise Anchored in Social-ecological Justice and Stakeholder Collaboration: Insights from Mexico-Lerma-Cutzamala Hydrological Region

Part of the Climate Change Management seriesHuman health and wellbeing depend on the health and integrity of ecosystems we co-inhabit with other species and the ways we use natural capital in our economy. They depend on the ways people are able (or not) to satisfy basic needs: breathing clean air, drinking clean water, eating healthy food, and having access to healthy housing, a safe and secure neighborhood, a stable livelihood, and healthcare. Science grapples with deciphering how environmental, biological, and lifestyle/behavioral factors interact to co-determine health. Meanwhile, major promoting and degrading factors are highly unevenly distributed across populations and landscapes; significant social-ecological health injustice prevails. We present four innovations to address recognized limitations of existing health research and practice: (1) an integrative framework to tackle innate conundrums and conceptualize important domains; (2) an integrative operational process for designing health-water-ecology-climate projects that enable multi-component research and its translation; (3) coupled mixed methods systems modeling-GIS/geospatial analysis, plus exposure vs. response/risk curves for groups with differential vulnerability to stressors—to reveal promoters and degraders of health, and structural injustices; and (4) a social-technical capacity building enterprise model to frame health-sustainability projects based on prior successful multi-stakeholder experience in Mexico. Our ongoing project—“Climate Change Impacts & Resilience in the Mexico-Lerma-Cutzamala Hydrological Region”—illustrates their application. We argue health, sustainability and climate resilience challenges be reframed as opportunities to co-create social-technical enterprises at different spatial, temporal and human scales, firmly anchored in the moral pursuit of social-ecological justice, and enabled by stakeholder partnerships

Validez en el registro del pico espiratorio máximo de niños asmáticos de la Ciudad de México Validity of peak flow record in asthmatic children residing in Mexico City

OBJETIVO: Determinar la concordancia entre el pico espiratorio forzado (PEF) registrado por padres de niños asmáticos y el PEF electrónico que es el almacenado en el AirWatch (PEFe). MATERIAL Y MÉTODOS: Se obtuvo el PEF de 42 niños de 5 a 15 años de edad del Hospital Infantil de México Federico Gómez de la Ciudad de México entre octubre de 1998 y 1999. Los padres registraron el valor máximo del PEF en un diario de salud. Se calculó la correlación de Spearman entre el PEFe y el PEFr. Utilizamos un modelo logístico de efectos mixtos. RESULTADOS: La correlación del PEFe y el PEFr fue r= 0.96 (p<0.05) en niños con diagnóstico de asma moderada o severa y r= 0.40 (p< 0.05) en niños con asma leve. El tiempo de seguimiento y severidad del asma, el género y edad del niño y sus interacciones eran predictores de las diferencias entre el PEFe y el PEFr. CONCLUSIONES: Los padres de niños de 6 a 8 años con asma moderada o severa reportan mejor el PEF en el diario de salud a lo largo del seguimiento que los padres de otros grupos.<br>OBJECTIVE: To determine the concordance between maximum peak expiratory flow records (PEFr) reported by the parents of asthmatic children and the electronic values stored by the AirWatch device (PEFe). MATERIAL AND METHODS: Records of PEF measurements between October 1998 and 1999 were obtained from 42 asthmatic children 5 to 15 years of age recruited at the Hospital Infantil de Mexico Federico Gomez, in Mexico City. Parents recorded the maximum value in the health diary. Spearman correlation was calculated between PEFe and PEFr and a mixed-effects logistic model was used. RESULTS: The correlation between PEFe and PEFr was r=0.96 (p<0.05) among children with a diagnosis of moderate or severe asthma and r=0.40 (p<0.05) among children diagnosed with mild asthma. Follow-up time, asthma severity, gender and age of the child and their interactions were predictors of the differences between PEFe and PEFr. CONCLUSIONS: Parents of children with moderate or severe asthma from 6 to 8 years of age report PEF values with greater accuracy during follow-up than others

Validez en el registro del pico espiratorio máximo de niños asmáticos de la Ciudad de México

Objetivo. Determinar la concordancia entre el pico espiratorio forzado (PEF) registrado por padres de niños asmáticos y el PEF electrónico que es el almacenado en el AirWatch (PEFe). Material y métodos. Se obtuvo el PEF de 42 niños de 5 a 15 años de edad del Hospital Infantil de México Federico Gómez de la Ciudad de México entre octubre de 1998 y 1999. Los padres registraron el valor máximo del PEF en un diario de salud. Se calculó la correlación de Spearman entre el PEFe y el PEFr. Utilizamos un modelo logístico de efectos mixtos. Resultados. La correlación del PEFe y el PEFr fue r= 0.96 (p<0.05) en niños con diagnóstico de asma moderada o severa y r= 0.40 (p< 0.05) en niños con asma leve. El tiempo de seguimiento y severidad del asma, el género y edad del niño y sus interacciones eran predictores de las diferencias entre el PEFe y el PEFr. Conclusiones. Los padres de niños de 6 a 8 años con asma moderada o severa reportan mejor el PEF en el diario de salud a lo largo del seguimiento que los padres de otros grupos

Morbilidad infantil por causas respiratorias y su relación con la contaminación atmosférica en Ciudad Juárez, Chihuahua, México Infant morbidity caused by respiratory diseases and its relation with the air pollution in Juarez City, Chihuahua, Mexico

OBJETIVO: Evaluar el impacto de los contaminantes atmosféricos sobre la salud respiratoria de la población infantil de Ciudad Juárez, Chihuahua, México, considerando diferentes grupos etáreos. MATERIAL Y MÉTODOS: Se obtuvieron datos sobre consultas a urgencias de hospitales por afecciones de vías respiratorias altas, bajas y asma, en unidades del IMSS, de niños menores de 17 años de edad entre 1997 y 2001, y se estratificó por grupos etáreos (5 años). Se obtuvieron datos diarios sobre contaminantes aéreos (Ozono y PM10) y condiciones meteorológicas de la Red de Monitoreo en Ciudad Juárez. Para el análisis estadístico de los datos, se utilizó un Modelo Aditivo Generalizado, asumiendo una distribución de Poisson. RESULTADOS: Las concentraciones de ozono, pero no de PM10, se asociaron significativamente con las consultas a urgencias por afecciones respiratorias, principalmente en niños de 5 años o menores. En este grupo, un incremento de 20 ppb en 1 hr máxima de ozono se asociaron con un incremento de 8.3% en las consultas por afecciones de vías respiratorias superiores, con un retraso en la exposición de tres días, y un incremento de 12.7% en las consultas por infecciones de las vías respiratorias inferiores cuando se consideró un retraso de cuatro días en la exposición en el promedio móvil máximo de ocho horas. El efecto mayor para la muestra total, al igual que para el grupo de niños de 6 a 16 años, se observó en el retraso de tres días (5.1% para un aumento de 20 ppb en un máximo de una hora). Para este grupo no se observó un efecto significativo entre los niveles ambientales de ozono y el riesgo de contraer enfermedades de las vías respiratorias inferiores. CONCLUSIÓN: La amplitud del riesgo es de suma importancia, ya que puede representar un incremento en los costos de atención en el sistema de salud y la sociedad en general. Nuestros resultados destacan la necesidad de instrumentar acciones preventivas y de control de la contaminación atmosférica para evitar que empeore la situación actual.OBJECTIVE: To assess the impact of atmospheric pollutants on the respiratory health of children of different age groups in Juarez City, Chihuahua, Mexico. MATERIAL AND METHODS: Data on emergency room visits between 1997 and 2001 for respiratory diseases in children less than 17 years old were obtained from hospitals in the Juarez City belonging to the Mexican Social Security Institute (IMSS). Diseases were classified into three groups according to ICD 9th and 10th codes: a) upper respiratory diseases, b) lower respiratory diseases, and c) asthma attacks. This information was stratified by age group (5 years). Daily air pollution data (ozone and PM10) and weather conditions were obtained from the Monitoring Network System in Juarez City. Statistical analysis was carried out using a Generalized Additive Model assuming a Poisson distribution. RESULTS: Ozone concentrations, but not PM10, were statistically associated with emergency room visits for respiratory diseases, mainly among children 5 years old or younger. In this group, an increase of 20 ppb 1-hr maximum for ozone was associated with an increase of 8.3% in the number of emergency room visits for upper respiratory diseases, with a 3-day exposure lag; and an increase of 12.7% in the number of emergency room visits for lower respiratory diseases when considering a 4-day exposure lag in a maximum 8-hr mobile average. The largest effect for the complete sample and for the group 6 to 16 years of age was observed for 3-day lag (5.1% for an increase of 20 ppb 1-hr maximum for ozone). For the 6 to16 year old group we did not find a significant effect. CONCLUSION: The wide range of risk is quite important and might represent a substantial cost for the health system as well as for the society. Our results emphasize the need to implement preventive and control measures for air pollution and avoid the worsening of the present situation

Assessment of personal exposure to ozone in asthmatic children residing in Mexico City Evaluación de la exposición personal a ozono en niños asmáticos de la Ciudad de México

OBJECTIVE: A study was conducted to evaluate personal ozone exposure (O3p) among asthmatic children residing in Mexico City. MATERIAL AND METHODS: A total of 158 chil-dren were recruited from December 1998 to April 2000. On average, three O3p measurements were obtained per child using passive badges. Time-activity patterns were recorded in a diary. Daily ambient ozone measurements (O3a) were obtained from the fixed station, according to children’s residence. Levels of O3a and ozone, weighted by time spent in different micro-environments (O3w), were used as independent variables in order to model O3p concentrations using a mixed-effects model. RESULTS: Mean O3p was 7.8 ppb. The main variables in the model were: time spent indoors, distance between residence and fixed station, follow-up group, and two interaction terms (overall R²=0.50, pOBJETIVO: Realizamos este estudio para evaluar la exposición personal a ozono (O3p) en niños asmáticos de la Ciudad de México. MATERIAL Y MÉTODOS: Se incluyeron 158 niños entre diciembre de 1998 y abril de 2000. En promedio se obtuvieron tres mediciones por niño, utilizando filtros pasivos para medir O3p. Se caracterizaron los patrones de actividad y las concentraciones ambientales diarias de ozono (O3a) se obtuvieron de estaciones fijas cercanas a la residencia del niño. Los niveles promedio de O3a y las concentraciones ponderadas por el tiempo en diferentes microambientes (O3w) fueron usados como variables independientes para modelar las concentraciones de O3p, utilizando modelos de efectos mixtos. RESULTADOS: La media de O3p fue 7.8 ppb. Las principales variables en el modelo fueron: tiempo en exteriores, distancia, periodo de seguimiento y dos términos de interacción (R²=0.50, p<0.05). CONCLUSIONES: Las concentraciones de O3w pueden usarse como "proxi" de O3p, tomando en cuenta patrones de actividad y lugar de residencia

Ozone exposure, vitamin C intake, and genetic susceptibility of asthmatic children in Mexico City: a cohort study

<p>Abstract</p> <p>Background</p> <p>We previously reported that asthmatic children with <it>GSTM1</it> null genotype may be more susceptible to the acute effect of ozone on the small airways and might benefit from antioxidant supplementation. This study aims to assess the acute effect of ozone on lung function (FEF_25-75) in asthmatic children according to dietary intake of vitamin C and the number of putative risk alleles in three antioxidant genes: <it>GSTM1</it>, <it>GSTP1</it> (rs1695), and <it>NQO1</it> (rs1800566).</p> <p>Methods</p> <p>257 asthmatic children from two cohort studies conducted in Mexico City were included. Stratified linear mixed models with random intercepts and random slopes on ozone were used. Potential confounding by ethnicity was assessed. Analyses were conducted under single gene and genotype score approaches.</p> <p>Results</p> <p>The change in FEF_25-75 per interquartile range (60 ppb) of ozone in persistent asthmatic children with low vitamin C intake and <it>GSTM1</it> null was −91.2 ml/s (p = 0.06). Persistent asthmatic children with 4 to 6 risk alleles and low vitamin C intake showed an average decrement in FEF_25-75 of 97.2 ml/s per 60 ppb of ozone (p = 0.03). In contrast in children with 1 to 3 risk alleles, acute effects of ozone on FEF_25-75 did not differ by vitamin C intake.</p> <p>Conclusions</p> <p>Our results provide further evidence that asthmatic children predicted to have compromised antioxidant defense by virtue of genetic susceptibility combined with deficient antioxidant intake may be at increased risk of adverse effects of ozone on pulmonary function.</p