Association between EMS calls and fine particulate air pollution in Utah

Multiple studies have noted an association between ambient air pollution and cardiovascular and pulmonary disease. Our goal was to investigate the potential relationship between fine particulate air pollution and emergency medical services (EMS) calls with a particular focus on cardiovascular and respiratory complaints. Utilizing a database of 911 emergency calls from the National EMS Information System, we analyzed 322,097 eligible EMS encounters in Utah over a 4-year period. We evaluated the relationship between the health emergency, as noted by the EMS provider’s primary impression, and short-term exposure to fine particulate matter (aerodynamic diameter ≤2.5-μm cut point (PM_2.5)), as recorded by the United States Environmental Protection Agency (EPA) Air Quality System (AQS). Using a case crossover design and conditional logistic regression, we analyzed the association between health emergencies and PM_2.5 concentrations over varying time exposures. At the 95 % confidence level, we found significant associations only between pollution exposure and EMS calls for diabetic symptoms (using pollution from the concurrent day) and syncope/fainting (using pollution from the concurrent day and from 2- to 5-day lagged moving averages). We found no other significant positive associations between health emergencies and PM_2.5 concentration. In particular, we noted no association between daily PM_2.5 concentration and EMS calls for cardiac arrest, chest pain, or respiratory distress. We found limited association between ambient air pollution and health emergencies, as classified by the EMS provider’s impression. We noted no association with primary cardiovascular or respiratory complaints.     

Variations in microbial indicator densities in beach waters and health-related assessment of bathing water quality

Daily and hourly variations in microbial indicators densities in the beach-waters of Hong Kong have been described. The levels of Escherichia coli at a number of beaches was observed to be influenced by tide, and for staphylococci, by bather numbers. The tidal influence was most obvious during spring tides; and for the effect of bathers, during neap tides. Both organisms are present in high densities in external sources of faecal pollution of bathing beaches, with the average staphylococci to E. coli ratios being 0.04-3. Staphylococci may serve as an indicator of bather density and the risk of cross-infection amongst bathers (rather than as another indicator of faecal contamination) when the average staphylococci to E. coli ratio for a bathing beach is considerably higher than 3. The variability of microbial indicator densities means the routine sampling of bathing beaches should be carried out on weekend days with maximum numbers of swimmers exposed to the water, and spread throughout the bathing season.     

Assessment of somatic complaints in environmental health

In patients attributing their health complaints to environmental factors (EnvPat) evidence based medical diagnostics usually do not confirm environmental and somatic causes of symptoms. Many symptoms remain unexplained. Aim of the study was the systematic assessment of medically unexplained physical symptoms (MUPS) in EnvPat and comparison to symptom rates reported by subjects of an environmental study exposed to environmental odors (EnvExp). This specific exposure was chosen, as odors are associated by an unclear mechanism with physical symptoms. By this we aimed to enlighten the open question as to likeliness that MUPS of EnvPat are caused by hitherto unrevealed environmental exposures or result from somatization. MUPS were measured with SOMS-2 in EnvPat n=92, patients presenting in a university environmental outpatients clinic, and different study groups exposed to environmental odors (EnvExp). These were: (1) subjects exposed to annoying odors and medically relevant concentrations of bioaerosols, such as airborne microorganisms (EnvExp-1, n=74), and (2) subjects exposed to odors alone (EnvExp-2, n=282) as well as unexposed controls (Controls, n=235). Logistic regression and analysis of variance were applied to analyze rates of single complaints and the sum index of complaints (SOMS-CoIx). In EnvPat rates of MUPS were highest - significant (p<0.05) adjusted OR in 23 of 25 MUPS compared to controls - and highest SOMS-CoIx (mean 15.3 (S.D. +/-9.3). Rates of MUPS were lower in environmentally exposed subjects with difference in the two strata: while EnvExp-1 differed in several complaints, i.e., nausea and SOMS-CoIx (mean 7.2, S.D. +/-6.9) from controls (p<0.05), EnvExp-2 (SOMS-CoIx mean 4.8, S.D. +/-5.2) showed relevant differences only in two single complaints and not in the SOMS-CoIx from controls, SOMS-CoIx mean 3.9, S.D. +/-5.0. This remained when adjusting for age, gender, and school education. Rates of MUPS in environmental patients were clearly higher than in subjects with actual environmental exposure, making it unlikely that their symptoms are due to undetected environmental factors. MUPS of EnvPat show similarities to psychosomatic patients. In the environmental survey symptom assessment by SOMS-2 was sensitive to different environmental scenarios, i.e., higher rates of physical complaints were only found in subjects with hazardous residential bioaerosols pollution as well as an annoying odor exposure and interestingly not in subjects exposed to annoying odors alone. This underlines that questionnaire data of somatic complaints need to be interpreted on the basis of exposure assessment in order to unjustly attribute health complaints to annoyance.     

Air pollution and health: a synthesis of longitudinal panel studies published from 1987 to 1998]

This article presents a synthetic study of 31 epidemiological panel investigations (published between 1987 and 1998) analyzing how air pollution and health may be related. First, the methodology of these studies is described: choice of population, exposure and health assessment, confounding factors and statistical methods. The main results are presented as follows: for pulmonary performance, respiratory symptoms and medication use per pollutant (PM10 and particles, SO2, O3, NO2). Then the interactions among pollutants or implying other environmental factors are analyzed. Most of the time, an association with particles is found, no matter the health indicator considered. An O3 effect is more often observed with lung function tests than with respiratory symptoms or medication use, the latter being linked first to particles and secondly to SO2. A NO2 effect is more rarely shown. Pulmonary performances are affected by all pollutants. Respiratory symptoms related to air pollution are mostly low respiratory symptoms and cough, particularly with particles and O3. The paper ends by discussing the interest and limits of these studies. It also emphasizes the importance of exposure assessment. Indeed, in order to improve exposure assessment, an essential step in every epidemiological study, new tools need to be developed.     

Alveolar macrophages as biomarkers of pulmonary irritation in kitchen workers

OBJECTIVES: Alveolar macrophages (AM) are used as a biomarker of pulmonary irritation due to occupational exposure in the AM test. The aim of this study was to investigate whether there is a co-variation between the number of AM and exposure to cooking fumes. MATERIALS AND METHODS: The study group consisted of 62 volunteers. People who worked in a kitchen preparing hot meals were considered as occupationally exposed (35 persons). The exposed group was further divided into highly and slightly exposed persons according to the levels of fat aerosols and aldehydes in the working atmosphere. People who were not preparing hot meals were considered as unexposed (27 persons). The number of AM was counted in smears prepared from expectorate samples from each participant. Samples were taken on three different days. RESULTS: Highly occupationally exposed persons had a higher number of AM in their samples than both slightly occupationally exposed persons and unexposed persons. Highly exposed smokers had a statistically significantly higher number of AM compared with both slightly and unexposed smokers (P < or = 0.05). CONCLUSION: The results suggest an increase in the number of AM due to exposure to cooking fumes and a synergistic effect between occupational exposure and smoking.     

Association between exhaled nitric oxide, ambient air pollution and respiratory health in school children

OBJECTIVES: The aim of the study was to investigate whether the level of exhaled nitric oxide (eNO) provides a more sensitive measure to assess adverse pulmonary effects of air pollution than conventional lung function indices. METHOD: The non-selected cohort studied consisted of 68 children (aged 10-11 years) living in an urban environment. For 7 weeks respiratory complaints were reported daily by these children in a diary, and lung function measures and eNO levels were determined in the children once a week on days with various level of air pollution. RESULTS: During the study the increase in the levels of the various air pollutants was positively associated with eNO (6% to 31% increase; P<0.05) but not with lung function measures. In contrast to the lung function measures, the prevalence of respiratory symptoms such as "sore throat", "runny nose", "having a cold", and "sick at home" were positively associated with the level of eNO measured in the following week. CONCLUSIONS: Though clinically very meaningful, functional pulmonary measures appear to be too course to detect relatively mild clinical symptoms in response to exposure to air pollution. In an epidemiological setting the increase in eNO may represent a more suitable measure to assess such adverse effects.     

Health effects associated with exposure to residential organic dust

BACKGROUND: This study aimed at relating self-reported health complaints to bioaerosol pollution in the residential outdoor air and to duration of storing organic waste indoors. METHODS: In a cross-sectional study, double blinded to ongoing environmental microbial measurements, physicians collected questionnaires in a neighborhood with a composting site and in unexposed controls. Self-reported prevalence of health complaints, physician diagnoses as well as residential odor annoyance and home hygiene were assessed. RESULTS: An elevation of reports of irritative airway complaints was associated with residency in an area with highest bioaerosol exposure but not with odor annoyance. Longer indoor storage of organic waste was associated with skin related symptoms. Atopic subjects were at higher risk. Airway-related health problems were not associated with longer storage of organic wastes in homes. CONCLUSIONS: Exposure to organic dust in residential air affects airways of residents while exposure in homes due to organic wastes affects the skin.     

Carbon and hemosiderin-laden macrophages in sputum of traffic policeman exposed to air pollution.

In this study, we evaluated (a) quantitative modifications of dust cells and siderocytes and (b) qualitative modifications (i.e., cellular changes and inflammatory infiltrate) in sputum of 164 traffic policemen occupationally exposed to environmental pollution in an urban area. Such modifications were correlated with time of exposure and smoking habits. Seventy-three (45%) of the policemen were smokers, and a control group of 119 nonexposed individuals (24% smokers) who resided in a rural district near Perugia, Italy, were examined. The sputa, which was collected for 3 d, were smeared on glass slides stained according to Papanicolaou's and Perl's methods. The mean numbers of dust cells in the sputa policemen and the rural population were 103.8 and 12.48, respectively (p < .0001). The numbers of dust cells were highest in policemen who smoked (relative risk = 3.95; p < .006). The mean numbers of siderocytes in policemen and the rural population were 0.99 and 5.31, respectively (not statistically significant, Mann-Whitney test). The difference between the number of subjects with hemosiderin-laden macrophages in traffic policemen and in the control group was small, but it was significant statistically (p < .004). In traffic policemen, it was related to smoking and time of exposure to air pollution, whereas in the control population it was related to heart-pulmonary diseases. In this study, we observed a synergistic effect between smoking and environmental pollution. In addition, less than 5 y of exposure can caused significantly increased (a) numbers of macrophages and (b) inflammatory infiltrate in sputa. The results of the cytological diagnosis revealed a statistically significant difference between policemen and the rural population (p < .001). The cytological exam of sputa and correlations with smoking within each population were not statistically significant. In conclusion, macrophage count in sputum is a sensitive and reproducible method for investigators to verify pulmonary changes that may be observed before they can be measured by functional tests.     

Comparative effects of inhaled silica or synthetic graphite dusts on rat alveolar cells

Alterations in population profiles, morphology, and phagocytic activity of lung cells followingin vivo exposure of Fischer 344 rats to a single dose of silica, were compared to similar changes following exposure to synthetic graphite. The effect of silica exposure on alveolar macro-phage mycocidal activity was also measured. Acute exposure by inhalation to 100 mg/m³ silica dust produced persistent pulmonary inflammation, as well as long-term changes in pulmonary alveolar macrophages (AM) typical of macrophage activation. Both particles were steadily cleared from the lungs; AM from the silica study, as well as from the 100 and 500 mg/m³ graphite studies, contained ingested particles throughout the entire 3 month experimental period. Lavaged pulmonary cells showed no reduction in viability as a result of exposure to either of the dusts. After silica inhalation, the following changes were observed constantly in bronchopulmonary lavage cell samples: increased numbers of polymorphonuclear leukocytes (PMN), hypersegmented PMN, binucleated AM, increased AM phagocytic indices and capacities, and increased mycocidal activity. Following inhalation of 1–100 mg/m³ synthetic graphite the above-mentioned effects were not seen. Exposure to 500 mg/m³ graphite produced transient inflammation and AM activation for about 24–48 hr.     

Subjective fatigue and stress hormone levels in urine according to duration of shiftwork

To determine the associations between urinary catecholamines and cortisol and subjective complaints of fatigue in shiftworkers, we conducted a field survey of 113 male shiftworkers at a manufacturing company in South Korea from late October to late November in 1999. The shiftwork system in the company was the backward rapidly rotating 4-crew 3-shift, with the morning shift starting at 7:30 AM. Using a self-report questionnaire, we assayed demographic characteristics, past medical history and working hours, as well as subjective complaints of fatigue in 3 categories of questionnaire. We found that, among workers with less than 5 yr of shiftwork experience, the concentrations of norepinephrine, epinephrine (Epi), and dopamine during the afternoon shift were positively correlated with Set II (difficulties in concentration) and Set III (projection of disintegration) of subjective fatigue symptoms. In addition, Epi concentrations were positively correlated with Set I (drowsiness and dullness), II, and III of subjective fatigue symptoms during the night shift. However, among workers with 5 or more years of shiftwork experience, there was no significant positive correlation between urinary catecholamine and subjective fatigue symptoms. In the long term shiftwork experience group, only the complaints scores of Set II fatigue symptoms (difficulties in concentration) during the morning shift were significantly higher than those of the short-term shiftwork experience group within the same shift.     

Health complaints in relation to quality of swimming water in participants of a triathlon]

Participants in a triathlon in Alphen aan den Rijn, the Netherlands, reported gastrointestinal symptoms to the local health authority. A study was performed to establish the number of complaints and the relation with the microbiological water quality at the surface water swimming site, which met current standards. An epidemiological survey was carried out with a questionnaire among 629 participants, with non-participating relatives as controls. Faecal samples of patients and water samples were investigated by conventional methods. 439 participants and 217 controls completed the questionnaire. 140 participants had at least one gastro-intestinal symptom and 28 (6.4%) had highly credible gastroenteritis. Participants had an odds ratio for gastro-enteritis of 14.7 (95% CI: 2.39-604.45). Electron microscopic examination in six of 12 patients showed viruses able to cause such symptoms. Water samples showed considerable faecal pollution at the time of the triathlon (geometric mean counts: thermotolerant coliforms 725/100 ml; faecal streptococci 23/100 ml). The most likely source is the effluent discharge of the nearby waste water treatment plant. A surface water swimming site meeting current standards does not exclude health complaints among tri-athletes.     

Chronic obstructive pulmonary disease in iron-steel and ferrochrome industry workers

Metallurgical industry workers in developing countries are often exposed to high concentrations of dusts and fumes that affect pulmonary function. The aim of this cross-sectional study is to assess the prevalence and severity of chronic obstructive pulmonary disease (COPD), the prevalence of symptoms, as well as, the link between work-place air pollution and COPD. A standardized questionnaire was used to collect data about smoking and socioeconomic status, past history of pulmonary diseases, current respiratory symptoms, education, and other variables. We have identified and assessed all risk factors and also have performed measurements of dynamic pulmonary function in 459 subjects - 90% of iron-steel and ferrochrome industry workers. The prevalence of COPD oscillated from 19.6% up to 25.7% while severity varied from mild to very severe. Symptoms: prevalence varied from 12.0% to 46.3% while relative risk for developing COPD was 2.1-5.5 that of non-industry controls. Exposure markers' concentrations: for total suspended particles (TSP) oscillated from 0.375-25.5 mg/m3, particulate matter (PM10) from 0.25 to 10.5 mg/m3, and sulfur dioxide from 0.19-18.69 mg/m3. In majority of cases its average exceeded threshold limit values. Our conclusion was that COPD prevalence and its symptoms are high in the population studied, and that there exists a well established occupational risk between work-place air pollution and COPD.     

Dimensions of negative affectivity, self-reported somatic symptoms, and health-related behaviors

This study focused on the relationship between personality dispositions, self-reported somatic symptoms, and health-related behaviors in undergraduate students. Findings are presented which indicate systematic correlations between health complaints and negative affectivity (NA), a common and pervasive mood disposition. Generally, there was a stronger relationship between NA and self-reported somatic symptoms than between NA and variables reflecting health-related behaviors, lifestyle, and general fitness. Significant correlations between health complaints and capacity for imaginative involvement (absorption), as well as self-reported measures of emotional inhibition, were also demonstrated. However, it is uncertain whether absorption and emotional inhibition properly belong to the NA construct. The results also indicated differences with respect to the strength of the associations between various dimensions of NA and particular types or classes of health complaints. For example, cognitive anxiety (e.g. worry, ruminations, disturbing thoughts) was more strongly related to somatic complaints than behavioral (social avoidance) components of anxiety. Moreover, diffuse and widespread symptoms (e.g. weakness and fatigue) were more strongly associated with NA than more specific and localized symptoms, particularly musculo-skeletal complaints, although complaints belonging to the musculoskeletal category obtained the highest group mean score. The results strongly suggest that a differentiated approach to the study of NA-symptom connections should be adopted.     

Humiliation: the invisible trauma of war for Palestinian youth

OBJECTIVES: To investigate the influence of exposure to humiliation in war-like conditions on health status in 10th- and 11th-grade students living in the Ramallah District, West Bank, Occupied Palestinian Territory. STUDY DESIGN: A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District. METHODS: Survey questions were derived from the World Health Organization's Health Behaviour in School-aged Children Survey, the Gaza Community Mental Health Programme Traumatic Event Checklist, and focus group discussions with young people. The survey questionnaire was completed by students in their classrooms, under the supervision of a trained field worker. RESULTS: There was a significant association between a high number of subjective health complaints and demographic variables, particularly for females compared with males, and refugee camp dwellers compared with village dwellers. In addition, exposure to humiliation was significantly associated with an increased number of subjective health complaints. Students experiencing three forms of humiliation were found to be 2.5 times more likely to report a high number of subjective health complaints compared with those who had never been exposed to humiliation (52% vs 21%), while those experiencing four forms of humiliation were three times more likely to report a high number of subjective health complaints (62% vs 21%). A multiple logistic regression model revealed that humiliation was significantly associated with a high number of subjective health complaints, even after adjusting for sex, residence and other measures of exposure to violent events. The odds ratio of reporting a high number of subjective health complaints increased as the number of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for reporting a high number of subjective health complaints when exposed to one, two, three or four forms of humiliation, respectively, compared with those who had never been exposed to humiliation. CONCLUSIONS: The results of this study demonstrate that humiliation induced by conflict and war-like conditions constitutes an independent traumatic event that is associated with negative health outcomes in its own right, regardless of exposure to other violent/traumatic events. Based on these findings, it is proposed that humiliation should be included as an indicator of mental health status in research that investigates the consequences of war and conflict on the health of populations.     

Secondary spontaneous pneumothorax in rapidly progressive forms of silicosis: characterization of pulmonary function measurements and clinical patterns

BACKGROUND: A secondary spontaneous pneumothorax is a complication of an underlying pulmonary disease. In recent years, there have been only a few scattered reports of patients with silicosis also having a pneumothorax. Silicosis, a form of disabling pulmonary fibrosis, is a well-known occupational disease resulting from high-level exposure to silica or silica-containing dusts. The objective of the present study was to elucidate any associations between the occurrence of a pneumothorax, and pulmonary function tests and clinical observations performed prior to the pneumothorax; these two factors may be predictors for a pneumothorax among workers exposed primarily to silica-containing respirable dust. METHODS: A diagnosis of silicosis was made on several factors: silica dust exposure, appropriate interval of time after exposure, clinical findings, pulmonary function tests and chest radiological findings. A checklist was designed for collecting data of occupational history, respiratory signs, and symptoms from onset of dust exposure to the occurrence of a pneumothorax. Spirometery was conducted in accordance to the recommendations of standard protocols and guidelines posited by the American Thoracic Society. Autopsies were performed in three cases where the patient had suffered a pneumothorax due to silicosis. Mann-Whitney U-tests and Fisher's exact tests were used to determine any associations between pneumothorax and predictor factors. RESULTS: An association between a progressive decrease in pulmonary function test values and a pneumothorax was observed. The occurrence of a pneumothorax was associated with complaints of pleuretic chest pain, resting dyspnea, respiratory distress, paroxysmal nocturnal dyspnea, orthopnea and crackle. CONCLUSION: A characteristic decline in pulmonary function test values and the severity of respiratory impairment may facilitate the occurrence of a pneumothorax in silicosis.     

Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus castus

A multicentric noninterventional trial (open study without control) to investigate the efficacy and tolerance of a drug in a large number of patients under routine medical conditions was performed for a new solid preparation from an extract of the fruit of Vitex agnus castus (VAC, Vitex, chaste tree, Chasteberry) in 1634 patients suffering from premenstrual syndrome (PMS). A specific questionnaire was developed for determining the effect of Vitex on psychic and somatic complaints, on the four characteristic PMS symptom complexes depression, anxiety, craving, and hyperhydration (DACH), and on single groups of symptoms. After a treatment period of three menstrual cycles 93% of patients reported a decrease in the number of symptoms or even cessation of PMS complaints. To a certain extent, this effect was observed within all symptom complexes and correlated with the global assessment of therapeutic efficacy. Whereas 85% of physicians rated it as good or very good, 81% of patients assessed their status after treatment as very much or much better. Analysis of frequency and severity of mastodynia as the predominant symptom revealed that complaints still present after 3 months of therapy were mostly less severe. Ninety-four percent of patients assessed the tolerance of Vitex treatment as good or very good. Adverse drug reactions were suspected by physicians in 1.2% of patients, but there were no serious adverse drug reactions. Hence, the risk/benefit ratio of the new Vitex preparation can be rated as very good, with significant efficacy for all aspects of the multifaceted and inhomogeneous clinical picture of PMS, with a safety profile comparable to other Vitex preparations.     

The health effects of swimming at Sydney beaches. The Sydney Beach Users Study Advisory Group.

OBJECTIVES. The purpose of the study was to determine the health risks of swimming at ocean beaches in Sydney, Australia. METHODS. From people attending 12 Sydney beaches in the period from December 5, 1989 to February 26, 1990, we recruited a cohort of 8413 adults who agreed to participate in this study. Of these, 4424 were excluded either because they had been swimming in the previous 5 days or because they reported a current illness. Of the remainder, 2839 successfully completed a follow-up telephone interview conducted within 10 days after recruitment. We recorded reported respiratory, gastrointestinal, eye, and ear symptoms and fever that occurred within the 10 days between initial interview on the beach and the follow-up interview. RESULTS. A total of 683 participants (24.0%) reported experiencing symptoms in the 10 days following initial interview. Of these, 435 (63.7%) reported respiratory symptoms. Swimmers were almost twice as likely as nonswimmers to report symptoms. There was a linear relationship between water pollution and all reported symptoms with the exception of gastrointestinal complaints. CONCLUSIONS. Swimmers at Sydney ocean beaches are more likely to report respiratory, ear, and eye symptoms than beachgoers who do not swim. The incidence of these symptoms increases slightly with increasing levels of pollution.     

Effects of air pollution episodes on pulmonary function and respiratory symptoms

In January 1985, a decline of primary school children's pulmonary function was observed during an air pollution episode. Ambient 24 hour average levels of SO2, TSP and RSP were in the range of 200-250 micrograms/m3. The response persisted for at least two weeks. In January 1987, again a decline of school children's pulmonary function was observed associated with an air pollution episode. Levels of TSP were about as elevated as in the 1985 episode. Two weeks after the episode, lung function levels were even lower than during the episode. In June 1987 a long term study was started to investigate potential effects of winter and summer air pollution episodes on pulmonary function and occurrence of acute respiratory symptoms of primary school children. An important issue for this study is the characterization of short term variation of lung function in absence of air pollution. Exposure is characterized by ambient levels of several gases (SO2, NO2, O3, HNO3), PM10, TSP and components of particulate matter (SO4(2-), NO3-, H-, NH4+). Sampling is being conducted on a daily basis to obtain a continuous exposure estimate. In the winter of 1987/1988, no air pollution episodes were observed. The study will continue through the winters of 1988/1989, and 1989/1990.     

Air quality and acute respiratory disorders in children

OBJECTIVE: To assess the relationship between air pollution and acute respiratory disorders in children. METHODS: A time series ecological study was carried out in three public health posts in a region of the city of Rio de Janeiro (Southeastern Brazil), between April 2002 and March 2003. Data for PM10, SO2, NO2, CO and O3 were analyzed daily and as closure variables, a total of 45,595 emergency pediatric consultations for respiratory symptoms or specifically for disorders in the upper and lower airways. To control for confounders, other variables were included in the model including those relating to weather, seasonality, temperature, relative air humidity, rain volume, respiratory infections and the calendar effects (such as holidays and weekends). A Poisson regression was applied using generalized counting models to estimate the effects of pollutants and confusing factors. RESULTS: Only O3 had a positive and statistically significant effect, both among emergency consultations for respiratory problems and consultations for symptoms relating to the lower airways. Effect and exposure occurred on the same day (lag 0). A significant negative association was found with CO and pediatric consultations for respiratory complaints. Other air pollutants were not found to have a significant effect. CONCLUSIONS: There were found associations between outdoor air pollution and the number of emergency pediatric consultations for respiratory problems in the studied area, in spite of the fact that the levels of all pollutants monitored during the study period were below recommended levels.