Health effects of mycotoxins in indoor air: a critical review

Industrial hygienists (IHs) are called upon to investigate exposures to mold in indoor environments, both residential and commercial. Because exposure standards for molds or mycotoxins do not exist, it is important for the industrial hygienist to have a broad knowledge of the potential for exposure and health effects associated with mold in the indoor environment. This review focuses on the toxic effects of molds associated with the production of mycotoxins, and the putative association between health effects due to mycotoxin exposure in the indoor environment. This article contains background information on molds and mycotoxins, and a brief summary and review of animal exposure studies, case reports, and epidemiological studies from the primary literature concerning inhalation of mycotoxins or potentially toxin-producing molds. The relevance of the findings in the reviewed articles to exposures to mold in indoor, non-agricultural environments is discussed. Although evidence was found of a relationship between high levels of inhalation exposure or direct contact to mycotoxin-containing molds or mycotoxins, and demonstrable effects in animals and health effects in humans, the current literature does not provide compelling evidence that exposure at levels expected in most mold-contaminated indoor environments is likely to result in measurable health effects. Even though there is general agreement that active mold growth in indoor environments is unsanitary and must be corrected, the point at which mold contamination becomes a threat to health is unknown. Research and systematic field investigation are needed to provide an understanding of the health implications of mycotoxin exposures in indoor environments.     

Exploring interaction effects in small samples increases rates of false-positive and false-negative findings: results from a systematic review and simulation study

ObjectiveTo give a comprehensive comparison of the performance of commonly applied interaction tests.MethodsA literature review and simulation study was performed evaluating interaction tests on the odds ratio (OR) or the risk difference (RD) scales: Cochran Q (Q), Breslow–Day (BD), Tarone, unconditional score, likelihood ratio (LR), Wald, and relative excess risk due to interaction (RERI)-based tests.ResultsReview results agreed with results from our simulation study, which showed that on the OR scale, in small sample sizes (eg, number of subjects ≤ 250) the type 1 error rates of the LR test was 0.10; the BD and Tarone tests showed results around 0.05. On the RD scale, the LR and RERI tests had error rates around 0.05. On both scales, tests did not differ regarding power. When exposure prevented the outcome RERI-based tests were relatively underpowered (eg, N = 100; RERI power = 5% vs. Wald power = 18%). With increasing sample size, difference decreased.ConclusionIn small samples, interaction tests differed. On the OR scale, the Tarone and BD tests are recommended. On the RD scale, the LR and RERI-based tests performed best. However, RERI-based tests are underpowered compared with other tests, when exposure prevents the outcome, and sample size is limited.     

Long-term effects of ambient air pollution on lung function: a review

Lung function is an important measure of respiratory health and a predictor of cardiorespiratory morbidity and mortality. Over the past 2 decades, more than 50 publications have investigated long-term effects of ambient air pollution on lung function with most finding adverse effects. Several studies have also suggested effects from traffic-related air pollution. There is strong support for air pollution effects on the development of lung function in children and adolescents. It remains unclear whether subjects with slower development of lung function compensate by prolonging the growth phase, or whether they end their development at a lower plateau, thus entering the decline phase with a reduced lung function. In adults, the evidence for long-term air pollution effects is mostly based on cross-sectional comparisons. One recent longitudinal study observed that decreasing pollution attenuated the decline of lung function in adults. Earlier inconclusive cohort studies were based on limited data. There is great diversity in study designs, markers of air pollution, approaches to the measurement of exposure, and choices in lung function measures. These limit the comparability of studies and impede quantitative summaries. New studies should use individual-level exposure assessment to clarify the role of traffic and to preclude potential community-level confounding. Further research is needed on the relevance of specific pollution sources, particularly with regard to susceptible populations and relevant exposure periods throughout life.     

Calcium absorption in infants and small children: methods of determination and recent findings

Determining calcium bioavailability is important in establishing dietary calcium requirements. In infants and small children, previously conducted mass balance studies have largely been replaced by stable isotope-based studies. The ability to assess calcium absorption using a relatively short 24-hour urine collection without the need for multiple blood samples or fecal collections is a major advantage to this technique. The results of these studies have demonstrated relatively small differences in calcium absorption efficiency between human milk and currently available cow milk-based infant formulas. In older children with a calcium intake typical of Western diets, calcium absorption is adequate to meet bone mineral accretion requirements.     

Biological monitoring of styrene: a review

Recent literature about the biological monitoring of styrene-exposed workers is reviewed. Styrene primarily exhibits its toxicity on the central and peripheral nervous systems, although its mutagenicity and chromosome damaging ability also may be relevant. Uptake, transformation and excretion of styrene show that beside the usual biological indicators, such as urinary mandelic and phenylglyoxylic acids (main metabolites), other indicators also may be of interest. These include styrene in expired air, in blood or in urine. Moreover, intermediate or final metabolites such as styrene glycol or mandelic acid in blood also have been proven to be useful in the interpretation of individual values. The most widely used analytical methods for these indicators are gas or high performance liquid chromatography. Correlations between exposure and the different biological indicators mentioned above show that the most reliable indicators are mandelic acid (MA) in urine sampled at the end of the work shift (but not the first day of the week) and the sum of mandelic and phenylglyoxylic acids (MA + PGA) in urine sampled 16 hr after exposure (before the next shift). The biological exposure limit values corresponding to the threshold limit value-time-weighted average (TLV-TWA) of 50 ppm of styrene are 850 mg MA/g creatinine in the end-of-shift sample and 330 mg MA + PGA/g creatinine in the next-morning sample. Other biological indexes, such as styrene glycol (phenyl ethylene glycol) in blood or styrene in urine, look promising but require further research in field situations.     

Societal costs of air pollution-related health hazards: A review of methods and results

This paper aims to provide a critical and systematic review of the societal costs of air pollution-related ill health (CAP), to explore methodological issues that may be important when assessing or comparing CAP across countries and to suggest ways in which future CAP studies can be made more useful for policy analysis. The methodology includes a systematic search based on the major electronic databases and the websites of a number of major international organizations. Studies are categorized by origin – OECD countries or non-OECD countries – and by publication status. Seventeen studies are included, eight from OECD countries and nine from non-OECD countries. A number of studies based on the ExternE methodology and the USA studies conducted by the Institute of Transportation are also summarized and discussed separately. The present review shows that considerable societal costs are attributable to air pollution-related health hazards. Nevertheless, given the variations in the methodologies used to calculate the estimated costs (e.g. cost estimation methods and cost components included), and inter-country differences in demographic composition and health care systems, it is difficult to compare CAP estimates across studies and countries. To increase awareness concerning the air pollution-related burden of disease, and to build links to health policy analyses, future research efforts should be directed towards theoretically sound and comprehensive CAP estimates with use of rich data. In particular, a more explicit approach should be followed to deal with uncertainties in the estimations. Along with monetary estimates, future research should also report all physical impacts and source-specific cost estimates, and should attempt to estimate 'avoidable cost' using alternative counterfactual scenarios.     

中国水环境中全氟化合物的污染水平及控制策略

全氟化合物（PFCs）是一类新型持久性有机污染物,广泛应用于工业生产和日常生活。这类化合物稳定性高,易与蛋白质结合并在生物体内蓄积,因此广泛存在于环境和生物中。孕妇血液、脐血、羊水和母乳中均可检出该类物质,提示子代胎儿期即可暴露于PFCs。目前,针对母亲孕期PFCs暴露对子代健康的影响已经开展了较多流行病学研究,研究结局包括子代出生结局、神经行为发育、免疫系统疾病及生殖健康。并且有研究发现产前暴露于PFCs可能会降低子代出生体重,造成神经发育异常、免疫力降低以及延迟生殖发育,但是另外一些研究并未观察到一致的结果。既往研究纳入的人群特征不同,PFCs暴露水平差异较大,采用的结局指标也不尽相同,可能是研究结论不一致的原因。目前尚不能确定人类妊娠期PFCs暴露对子代生长发育的确切影响,仍需开展大样本量的队列研究,以明确PFCs暴露和子代生长发育的关系。     

Panel discussion review: session four--assessing biological plausibility of epidemiological findings in air pollution research

In December 2006, the U.S. Environmental Protection Agency (EPA) sponsored a 2-day workshop on "Interpretation of Epidemiologic Studies of Multipollutant Exposure and Health Effects" in Chapel Hill, NC. The final session at this workshop was devoted to assessing the biological plausibility of epidemiological findings with regard to criteria air pollutants. The presentations and the panel contributions of this last session primarily focused on controlled exposure studies and led to wide-ranging discussions, some of which were provocative. The panel summary provides some guidance to future evaluations of the biological plausibility of the epidemiological reports on criteria pollutants and is intended to stimulate thinking, without drawing any definitive conclusions. This paper does not approach, nor was it intended to approach, the more formal analytical approach such as that used in EPA's development of its Science Assessment Document for the criteria pollutants.     

大气PM_(2.5)长期暴露对健康影响的队列研究进展

大气PM_(2.5)污染是危害人类健康的重要因素,已经成为全球热点问题。长期暴露于大气PM_(2.5)污染与疾病的发生和死亡密切相关,特别是心血管疾病和呼吸系统疾病,但不同研究的结论并不一致。基于人群的队列研究是评价大气污染慢性效应的重要方法。该文从暴露估计方法、健康效应评估两方面综述了大气PM_(2.5)长期暴露对健康影响的队列研究进展,指出了现有研究存在的问题,并提出了今后开展此类研究的建议。     

Interactive effects of antioxidant genes and air pollution on respiratory function and airway disease: a HuGE review

Susceptibility to the respiratory effects of air pollution varies between individuals. Although some evidence suggests higher susceptibility for subjects carrying variants of antioxidant genes, findings from gene-pollution interaction studies conflict in terms of the presence and direction of interactions. The authors conducted a systematic review on antioxidant gene-pollution interactions which included 15 studies, with 12 supporting the presence of interactions. For the glutathione S-transferase M1 gene (GSTM1) (n=10 studies), only 1 study found interaction with the null genotype alone, although 5 observed interactions when GSTM1 was evaluated jointly with other genes (mainly NAD(P)H dehydrogenase [quinone] 1 (NQO1)). All studies on the glutathione S-transferase P1 (GSTP1) Ile105Val polymorphism (n=11) provided some evidence of interaction, but findings conflicted in terms of risk allele. Results were negative for glutathione S-transferase T1 (GSTT1) (n=3) and positive for heme oxygenase 1 (HMOX-1) (n=2). Meta-analysis could not be performed because there were insufficient data available for any specific gene-pollutant-outcome combination. Overall the evidence supports the presence of gene-pollution interactions, although which pollutant interacts with which gene is unclear. However, issues regarding multiple testing, selective reporting, and publication bias raise the possibility of false-positive findings. Larger studies with greater accuracy of pollution assessment and improved quality of conduct and reporting are required.     

空气污染对人群认知功能和神经行为影响的研究进展

认知功能和神经行为的发育、发展受多种内外因素的综合影响。近年来,许多研究表明空气污染物暴露会对人群认知功能和神经行为产生不良影响。该文综述了空气污染的概念与分类、空气污染物暴露对人群认知功能和神经行为影响的可能机制及相关研究,为深入探讨空气污染对认知功能和神经行为的影响及公众健康防护提供科学依据。     

Biological features of women's alcohol use: a review

Sensitivity to gender issues in the research community has generated a modest but growing amount of data on the biological effects of alcohol consumption on women. Data generally indicate that the same amounts of alcohol have greater effects on women and that women develop more severe alcohol problems than men over shorter drinking histories. Despite a number of studies, however, there are no clear differences between women and men in the impact of alcohol consumption on cognitive processes. Although the findings are mixed, the data point toward greater physiological deterioration among women as compared with men who have similar drinking histories. These differences may be related to the differences in patterns of social recognition and reaction that occur in instances of alcoholism among women. Such differences are confirmed by other data that indicate greater social isolation and general disorganization among female alcoholics than among male alcoholics. The risks of fetal alcohol syndrome that are associated with heavy alcohol consumption among women during pregnancy have been established, and a complex of other relationships between alcohol consumption and reproductive-related systems and behaviors exists. Linkages between sexual dysfunction, sexual satisfaction, and alcohol consumption appear to exist, but have not yet become clearly understood. It appears that alcohol may be used as a self-medication to cope with perceived problems of sexuality. It also appears that heavy alcohol consumption can contribute to sexual dysfunction and dissatisfaction. A growing body of sophisticated experimental research has established relationships between patterns of alcohol metabolism and phases of the menstrual cycle, with this literature offering some of the clearest indications of distinctive differences between the sexes in the biological consequences and correlates of alcohol consumption.     

Biological interactions of N-nitroso compounds: a review.

There have been efforts to acquire information on the carcinogenic hazards of environmental materials to which humans are exposed since the earliest indications that chemicals can induce cancer in man. N-Nitroso compounds represent a major class of important chemical carcinogens and mutagens that have been implicated as hazardous substances in the environment. This review discusses the relevant chemistry and biotransformation of N-nitroso compounds. It also considers the interaction of these compounds with biological material. Nitrosamines and nitrosamides have been shown to be versatile tools for the study of mutagenic and carcinogenic processes and also lend themselves to structure/activity studies. Attention is drawn to recent developments concerning the relationship between mammalian metabolism of N-nitroso compounds and the relative susceptibility to carcinogenesis and mutagenesis. The usefulness of nitrosamines and nitrosamides in mutagenicity and carcinogenicity studies has been amply demonstrated, and continued work with these substances can lead to a better understanding and evaluation of the potential risks of chemicals in the environment.     

Manganese and Parkinson's disease: a critical review and new findings

The goal of this review was to examine whether chronic Mn exposure produces dopamine neuron degeneration and PD or whether it has a distinct neuropathology and clinical presentation. I reviewed available clinical, neuroimaging, and neuropathological studies in humans and nonhuman primates exposed to Mn or other human conditions that result in elevated brain Mn concentrations. Human and nonhuman primate literature was examined to compare clinical, neuroimaging, and neuropathological changes associated with Mn-induced parkinsonism. Clinical, neuroimaging, and neuropathological evidence was used to examine whether Mn-induced parkinsonism involves degeneration of the nigrostriatal dopaminergic system as is the case in PD. The overwhelming evidence shows that Mn-induced parkinsonism does not involve degeneration of midbrain dopamine neurons and that l-dopa is not an effective therapy. New evidence is presented on a putative mechanism by which Mn may produce movement abnormalities. Confirmation of this hypothesis in humans is essential to make rational decisions about treatment, devise effective therapeutic strategies, and set regulatory guidelines.     

Trachoma survey methods: a literature review

Reliable population-based prevalence data are essential for planning, monitoring and evaluating trachoma control programmes and understanding the scale of the problem, yet they are not currently available for 22 out of 56 trachoma-endemic countries. Three survey methods have been advocated for trachoma: cluster random sampling (CRS); trachoma rapid assessment (TRA); and acceptance sampling trachoma rapid assessment (ASTRA). Our review highlights the benefits of CRS being simple, efficient, repeatable and giving population-based prevalence estimates of all signs of trachoma. There are limitations to TRA, which include: non-representative sampling; does not estimate prevalence; and lacks consistency and accuracy. ASTRA advocates small sample sizes but it is relatively complex, may result in imprecise prevalence estimates and does not estimate cicatricial signs of trachoma. We conclude that CRS should therefore remain the “gold” standard for trachoma surveys. However, among the CRS surveys reviewed, we also found several methodological deficiencies of sample-size calculations, standardization of trachoma graders, reporting of confidence intervals of prevalence estimates, variability of age groups for presentation of age-specific prevalence, and lack of estimation of district prevalence estimates. Properly conducted surveys will be crucial if the objective of global elimination of blinding trachoma is to be charted and realized. Harmonization of survey methods will enhance the conduct and comparability of trachoma surveys needed for reliable mapping of prevalence within endemic countries. Consistent with WHO recommendations, we advocate for continued use of CRS as the survey design of choice for trachoma control programmes and propose ways of improving future surveys based on this method.     

3种空气消毒方法效果的比较

目的 评价3种消毒方法对空气的消毒效果。方法 分别用紫外线、戊二醛和臭氧3种消毒方法消毒空气,用3种不同的评价方法按消毒前后同步采样进行消毒效率的评价。结果 消毒前细菌本底撞击法的高峰在10：00,冲击法在9：00,平皿法在10：00;3种消毒方法之间差异有显性,按撞击法评价时戊二醛消毒率最高,消毒后3h细菌恢复率43．4％－55．8％,按冲击法评价时戊二醛效果较好,消毒后3h细菌恢复率21．8％－35．7％,按平皿沉降法评价时紫外线效果较好,消毒后3h细菌恢复率42．1％－60．6％,但相互之间差别无显性;在实验过程中,温度和相对湿度对紫外线强度略有副影响,对其它几乎无影响。结论 戊二醛消毒法和臭氧消毒法能够代替紫外线消毒法。     

Health-related research among Amish women: a review of findings

The objective of this literature review is to explore and synthesize research related to Amish women's health issues. Literature searches were conducted on an extensive list of Internet-based databases, with a total of 767 articles identified. Inclusion criteria consisted of published, gender-based, and evidence-based research. The research reviewed covered a broad spectrum of health-related topics, and nearly all authors cited cultural factors as an explanation for the differences in Amish and non-Amish populations. However, the lack of evidence-based research and diversity of the topics prevented clear patterns of health-related issues to be discussed. Many researchers made broad-sweeping generalizations about the Amish, which can perpetuate the stereotypes and myths associated with their way of life. It is imperative that more evidence-based research be conducted to determine the cultural aspects and other factors that may influence health in this population.     

Costs and effects of a 'healthy living' approach to community development in two deprived communities: findings from a mixed methods study

Background  

Inequalities in health have proved resistant to 'top down' approaches. It is increasingly recognised that health promotion initiatives are unlikely to succeed without strong local involvement at all stages of the process and many programmes now use grass roots approaches. A healthy living approach to community development (HLA) was developed as an innovative response to local concerns about a lack of appropriate services in two deprived communities in Pembrokeshire, West Wales. We sought to assess feasibility, costs, benefits and working relationships of this HLA.