Diss. (sammanfattning) Stockholm : Karol. inst., 1999. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 6 uppsatser.

Background Indoor air pollution due to use of biomass fuels (BMF) for household cooking and heating is a known risk factor of morbidity and mortality in children under the age of five years. A recent study in India suggested an association between biomass fuel smoke exposure anaemia and stunting among children under the age of five. The aim of this study was to investigate the association between BMF use, stunting and anaemia in children aged 12-59 months who participated in the 2006-2007 Swaziland Demographic and Health Survey (SDHS), whilst adjusting for potential confounders. Methods The study was cross-sectional and based on secondary data analysis of data collected through the household and women’s questionnaires in the 2006-2007 SDHS, which employed a multistage random sampling. Anthropometric measurements taken in the SDHS and the World Health Organization (WHO) 2006 Multi-Centre Child growth reference standards were used to ascertain children’s health status and the stunting outcome variable. A child, whose height-for-age ratio was below three standard deviations (SD) from the median of the WHO reference population in terms of height-for-age, was severely stunted or short for his/her age. A child, whose height-for-age ratio was between three and two SD below the median of the WHO reference population in terms of height-for-age, was mildly stunted. The exposure to BMF smoke variable was ascertained indirectly by type of fuel used for cooking. The exposure was a three category variable of cleaner fuel, outdoor BMF and indoor BMF use. All statistical analysis was done in STATA version 10. The relationship between BMF use and stunting or anaemia was determined using multinomial logistic regression analyses, whilst adjusting for potential confounding factors, identified in previous research. Results Of the 1612 children included in the study, 37% were anaemic. Nineteen percent were mildly and 18% were moderate to severely anaemic. Indoor BMF use, child age, low birth weight, mother’s age at birth, iron supplementation during pregnancy and mother’s anaemia status was significantly associated with child anaemia in univariate analysis. Outdoor BMF exposure, low birth weight, child age, mother’s anaemia status and wealth index was associated with child anaemia after adjusting for potential confounding. Overall 31% of children were stunted. Twenty percent were mildly stunted and 11% were moderate to severely stunted. Child sex, age, birth order, preceding birth interval, low birth weight, diarrhoea in preceding two weeks, anaemia status, iron supplementation during pregnancy, mother’s age at birth ,mother’s body mass index, mother’s education, wealth index, indoor BMF exposure and household crowding were each independently associated with stunting in univariate analysis. Only child sex, low birth weight and child age were significantly associated with stunting after adjusting for potential confounding. There was no evidence of an association between indoor BMF smoke exposure and child stunting after adjusting for all potential confounding factors. Conclusion This study did not find sufficient evidence to suggest that indoor BMF use is a statistically significant risk factor for anaemia or stunting in children aged 12-59 months participating in the 2006-2007 SDHS. There was however an evidence that, use of BMF outdoors significantly confers a protective effect against moderate to severe anaemia. Prospective research into these potential relationships are necessary, particularly the collection of primary data and accurate measurement of exposure to smoke emitted during BMF use for cooking and heating.

Introduction The problems associated with poor indoor air quality and the possible subsequent effects thereof on workers, as experienced by the Department of Health in the Regional office situated in the Karel Schoeman building (KSB) in Pretoria, were investigated and are discussed. The possible association between the physical indoor environmental conditions and the sick building syndrome (SBS) like symptoms as well as the seemingly low productivity and the above average rate of absenteeism are included in these discussions. To find a possible association between these poor physical environmental indoor conditions and the potential adverse affects on the health and motivation of workers, a cross sectional survey was conducted to assess the physical, biological and chemical quality of indoor air (Refer to as IAQ – Indoor Air Quality) as well as the chemical and biological quality of the drinking water. Objectives This research report documents a project to measure the environmental conditions which include CO(Carbon Monoxide), CO2(Carbon Dioxide), relative humidity( RH), temperature, air velocity, the microbial and chemical composition of the drinking water and culturable micro organisms in specific work environments within the KSB and to compare the outcome to standards for acceptable indoor working environments. The specific objectives of this study are:  To describe the environmental conditions CO, CO2, RH, temperature and air velocity exposures in specific work environments during the period 2003-2004;  To describe the microbial exposures to Legionellae (which is actually one of a group of similar diseases collectively known as Legionellosis.)  To compare measured environmental exposures to the Environmental Regulations for workplaces promulgated in terms of the Occupational Health and Safety Act 1993 (Act 85 of 1993) (OHSA), the National Institute for Occupational Safety and Health (NIOSH) standards and other national and internationally recognised standards and  To compare the microbial monitoring results including the evaluation results of the drinking water for culturable micro organisms and E.coli, to the NIOSH and other national and international recognized standards. Methods To control for confounding, samples of the drinking water as well as from a stagnant pool in the basement were taken and analysed for bacteriological and chemical compliance as well as identification of any microbes and chemicals that can contribute to SBS Environmental conditions which include CO, CO2, RH, temperature, air velocity, the microbial and chemical composition of the drinking water and culturable micro organisms including E.coli, in specific work environments were measured. Measurements were conducted in accordance with the procedures prescribed in the ASHRAE 41.6 of 1994, ACGIH (Handbook for industrial ventilation, EPA building Air quality guidelines, US Department of Labour –OHSA Technical manual),the respective manufacturers recommendations and the SABS Code 0400 of 1990 and sampling of the water in terms of the procedures prescribed by NIOH in the case of sampling for Legionellae and the Microbiological laboratory of the Rietvlei accredited water research laboratory with reference to sampling for identification of micro organisms including E.coli and the chemical composition. Appropriate recognized analytical methods were used to analyse and interpret the data generated from both the chemical and biological sampling results. Results Based on the outcome of the project results, it is clear that the air conditioning system does meet the mentioned minimum prescribed physical environmental national and international norms and standards for indoor air quality. The findings from the study indicate compliance of the physical environmental conditions to universally accepted standards and no association between those poor physical indoor environmental conditions and the sick building syndrome (SBS) like symptoms as well as the seemingly low productivity and the above average rate of absenteeism could therefore be made. The presence of coliform organisms above the norm in the air samples is however a concern. Discussion The OHSA requires employees to access the health and safety risks that hazards pose to their employees in their respective working environments and to take reasonably practicable steps towards eliminating or controlling these hazards. Like any other risks in a workplace environmental conditions need to be identified and controlled based on the principles of risk management. Conclusion The above high rate of absenteeism, as perceived by management, could not be associated with the environmental conditions covered in this project. It could however be ascribed, directly or indirectly to the following variables and assumptions which could be categorised under environmental conditions and the management thereof as well as the management of employees/workers located within the building. Environmental conditions such as substandard quality water supply, the management processes during the decommissioning of the old HVAC system and the commissioning of the replacement system, poor general housekeeping and unacceptable management principles of good quality clean working environments location of the building in the mid city centre of Pretoria and the possible contamination of indoor air by external sources bio quality could be variables contributing to the high rate of absenteeism. The seasonal occurrences of influenza and colds as well as home and external exposures could also possibly be considered as contributing factors in this regard. In addition poor general workers or people‟s management which could have resulted in low staff morale and personal motivation linked to poor supervision during a period of a very serious organizational restructuring which affected many workers could have also being considered as contributing factors to high absenteeism. Substandard ergonomics could have also played a role during this process.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Source: Masters Abstracts International, Volume: 47-06, page: 3475. Adviser: Thomas H. Stock. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

A artrite idiopática juvenil (AIJ) constitui um grupo heterogêneo de doenças que se caracteriza por inflamação crônica em uma ou mais articulações, com diagnóstico em menores de 16 anos de idade. A poluição atmosférica tem sido responsabilizada pelo aumento da morbidade e mortalidade em doenças cardiorrespiratórias, mas poucos estudos avaliaram os efeitos da exposição prolongada sobre doenças inflamatórias crônicas. Alguns estudos demonstram associação entre fumo e início da doença reumatológica em adultos e outros mostram associação de mães fumantes durante a gravidez com desenvolvimento de AIJ nos filhos. Entretanto, existem poucos estudos na literatura avaliando a exposição à poluição do ar e AIJ. Objetivo: avaliar a influência de poluentes ambientais inalatórios como fatores de risco no desenvolvimento da AIJ em pacientes residentes na Região Metropolitana de São Paulo, acompanhados em um serviço terciário de Reumatologia Pediátrica. Metodologia: Este foi um estudo retrospectivo, do tipo caso-controle, que incluiu 66 pacientes com AIJ e 124 controles saudáveis, semelhantes em idade e gênero, residentes na Região Metropolitana de São Paulo, desde a gestação até o diagnóstico da doença. Um questionário estruturado e com alto índice de confiabilidade (índice kappa para teste-reteste 0,80) avaliou dados demográficos, fatores relacionados à gestação e ao período perinatal, exposição ocupacional materna durante a gravidez a partículas inaláveis e/ou vapor volátil, exposição ao tabaco e exposição à inalação ambiental durante a gravidez e após o nascimento (presença de atividades industriais, pedreiras ou postos de gasolina perto do domiícilio/ trabalho/ creche/ escola). Foram também analisados poluentes troposféricos nos dois períodos: material particulado (PM10), dióxido de enxofre (SO2), dióxido de nitrogênio (NO2), ozônio (O3) e monóxido de carbono (CO). Resultados: Durante a gravidez, o fumo fetal (OR= 3,43, IC 95%: 1,45-8,12, p=0,005) e a exposição ocupacional materna (OR= 13,69, IC95%: 4,43-42,27, p < 0,001) se mostraram fatores de risco independentes para AIJ. Em contrapartida, o fato de a mãe trabalhar fora de casa (OR= 0,06, IC 95%: 0,02- 0,16, p < 0,001) e o ganho de peso ideal da mãe (OR = 0,36, IC 95%: 0,16-0,83, p= 0,017) apresentaram associação negativa. Para o período após o nascimento até o diagnóstico de AIJ, fumo passivo (OR= 3,6, IC 95%: 1,76- 7,31, p < 0,0001) e exposição ao ozônio durante o segundo ano de idade (OR= 2,76, IC 95%: 1,20-6,37, p= 0,017) foram fatores de risco independentes e significativos para o diagnóstico da AIJ. Conclusão: O fumo passivo, a exposição ao ozônio no segundo ano de vida e a exposição ocupacional materna são destacados como importantes fatores de risco para a AIJ / Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by chronic inflammation in one or more joints with onset in children under 16 years of age. Air pollution has been blamed for increased morbidity and mortality in cardiorespiratory diseases, but few studies have evaluated the effects of prolonged exposure on chronic inflammatory diseases. Some studies show an association between smoking and onset of rheumatologic illness in adults, and others show an association of smoking mothers during pregnancy with the development of JIA in children. However, there are few studies in the literature to date evaluating exposure to air pollution and JIA. Objective: To evaluate the influence of exposure to inhalable environmental factors during pregnancy and after birth until JIA diagnosis in residents of the São Paulo metropolitan area. Methods: Case-control study comprising 66 JIA patients and 124 healthy controls matched by age and gender, living in the Sao Paulo metropolitan area until JIA diagnosis, and whose mothers had resided in this region during pregnancy. A structured and reliable questionnaire (kappa index for test-retest was 0.80) assessed demographic data, gestational and perinatal-related factors, mothers\' work-related exposure during pregnancy to inhalable particles and / or volatile vapor, exposure to inhalable elements during pregnancy and after birth (work-related exposure to inhalable particles and/or volatile vapor, exposure to tobacco and the presence of industrial activities, quarries or gas stations near the home/ work/ daycare/ school). Tropospheric pollutants included: particulate matter (PM10), sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) and carbon monoxide (CO). Results: During pregnancy, fetal smoking (OR=3.43, 95%CI: 1.45-8.12, p=0.005) and mothers\' work-related exposure (OR=13.69, 95%CI: 4.43-42.27, p < 0.001) were independent significant risk factors for JIA diagnosis. In contrast, working mother (OR=0.06, 95% IC: 0.02-0.16, p < 0.001) and ideal mother weight gain (OR=0.36, 95% IC:0.16-0.83, p=0.017) presented a negative association. After birth until JIA diagnosis, secondhand smoking (OR=3.6, 95% IC: 1.76-7.31, p < 0.0001) and exposure to O3 during the second year of age (OR=2.76, 95% IC: 1.20-6.37, p=0.017) were independent and significant risk factors for JIA diagnosis. Conclusion: Secondhand smoking, exposure to O3 during the second year of age and mothers\' work-related exposure are highlighted as important risk factors to JIA