Association between gas cooking and respiratory disease in children.

A four-year longitudinal study of the prevalence of respiratory symptoms and disease in schoolchildren and related environmental and socio-economic factors is in progress. We report results for the first year of this study (1973). A total of 5758 children aged 6 to 11 years from 28 randomly selected areas of England and Scotland were examined. In an analysis of the effects on health of possible indoor pollutants, boys and girls from homes in which gas was used for cooking were found to have more cough, "colds going to the chest", and bronchitis than children from homes where electricity was used. The girls also had more wheeze if their families used gas for cooking. This "cooking effect" appeared to be independent of the effects of age, social class, latitude, population density, family size, overcrowding, outdoor levels of smoke and sulphur dioxide and types of fuel used for heating. It was concluded that elevated levels of oxides of nitrogen arising from the combustion of gas might be the cause of the increased respiratory illness.     

Effects of some indoor environmental factors on respiratory symptoms and lung function in a sample of young non smokers in North Italy

Summary We evaluated the effects of some indoor environmental factors in a non smoking subsample (n=381, age 8–19 years) of the general population living in the Po River Delta. Each subject completed an interviewer-administered standardized questionnaire on respiratory symptoms and risk factors. Acceptable maneuvers of forced vital capacity and slope of alveolar plateau of nitrogen were obtained in 96% and 59% of the subjects, respectively. In the houses there were more frequently natural gas for cooking (86%) than bottled gas (14%) and central heating (82%) than stove (18%). As regards passive smoking exposure, 18% of subjects had both parents smoking, 50% had one parent smoking. Significantly higher prevalence rates of wheeze, dyspnea, diagnosis of asthma were found in subjects of both sexes using bottled gas for cooking in comparison to those using natural gas, when also exposed to passive smoking. An insignificant trend towards higher symptom rates was shown by those using stove, instead of central heating. Lung function was affected only in females: those with both parents smoking had reduced forced expirograms, those with bottled gas for cooking or stove for heating had a decreased peak expiratory flow. Interactions of stove and passive smoking on peak expiratory flow and on slope of alveolar plateau were statistically significant. These findings confirm the mild adverse respiratory effects of certain home environment factors shown by other epidemiologic surveys in North Europe and in the USA. They have been a basis for the implementation, under the auspices of National Research Council and Electric Energy Authority, of future specific studies in which continuous monitoring of indoor pollutants and repeated recording of symptoms and lung function in North and Central Italy will be performed.     

Influence of passive smoking on admissions for respiratory illness in early childhood.

An association was sought between passive smoking and inpatient admissions for respiratory illness in 1058 children born between 1 June and 31 December 1981 and living in the neighborhoods of Nan-Jing Western Road and Yan-An Western Road in Jing-An District, Shanghai. The admission rate for first episodes of respiratory illness was positively correlated with the total daily cigarette consumption of family members during the children''s first 18 months of life. The relative risk of developing a first episode of respiratory illness was 1.80 for children living in families including people who smoked 10 or more cigarettes a day compared with those living in non-smoking families. Multiple logistic regression analysis showed that the effect of passive smoking on inpatient admission for respiratory illness was independent of the child''s birth weight, type of feeding, father''s education, size of the home, and chronic respiratory disease among adults in the family. The adjusted odds ratios compared with the non-smoking group were 1.17 in families smoking 1.9 cigarettes daily and 1.89 in families smoking 10 or more cigarettes daily. These data suggest that exposure to household cigarette smoke of children in early life increases the risk of severe respiratory illness.     

Socio-economic factors affecting the conservation of natural woodlands in Central Riyadh Area – Saudi Arabia

This study aimed to identify some socioeconomic factors affecting local people in central Riyadh area for the utilization of wood and other energy sources in cooking and heating in order to develop some recommendations for conserving woodlands. The study results revealed that gas is the most common energy source used for cooking with a mean usage level of 2.79 (SD = 0.58). On the other hand, wood ranked first for heating with the highest mean, usage level of 1.90 (SD = 1.06). However, electricity and gas as sources of energy for heating ranked second and third with mean usage level of 1.81 and 0.80 respectively. The study revealed that local people with the university education were significantly making higher use of electricity for both cooking and heating and those with no formal education ranked the highest on wood use for both cooking and heating. In addition, those living in traditional houses significantly used more wood for cooking than those living in villas and apartments. Also, local people with high income levels significantly were using more electricity for heating than others. The study recommended conducting extension and environmental awareness raising programs to enhance local residents’ adoption of wood substitutes, promoting employment opportunities for unemployed locals, and subsidizing prices of alternative energy sources.     

Breast feeding and lower respiratory tract illness in the first year of life. Group Health Medical Associates.

OBJECTIVE--To assess the relation between breast feeding and subsequent experience of lower respiratory tract illness. DESIGN--Prospective (from well child visits) and retrospective (from maternal recall) study of breast feeding and prospective assessment by paediatricians of lower respiratory tract illness in infants during first year of life. SETTING--Health maintenance organisation. PARTICIPANTS--Over 1000 infants who were healthy at birth and whose parents used the paediatricians of a local health maintenance organisation. MAIN OUTCOME MEASURES--Duration of breast feeding and type of lower respiratory tract illness (wheezing and non-wheezing) at different age intervals during the first year of life. RESULTS--Breast feeding was associated with a decreased incidence of wheezing illnesses only in the first four months of life. Interactions existed between breast feeding and sharing a room, being Mexican American, and being a boy. Multivariate techniques showed that after controlling for a variety of factors children who received minimal breast milk had a greater risk of early wheezing illnesses; the risk was further increased by simultaneous exposure to sharing a room. CONCLUSION--Breast feeding seems to protect against wheezing respiratory tract illnesses in the first four months of life, particularly when other risk factors are present.     

Respiratory illness and home environment of ethnic groups

Factors contributing to differences in the prevalences of respiratory symptoms and diseases among ethnic groups were studied in primary schoolchildren living in 20 inner city areas of England in 1983. The raised prevalences of respiratory symptoms in these groups were compared with results from a national representative sample of children studied in 1982. Data on age, sex, respiratory illness, and social and environmental variables were obtained by questionnaire for 4815 children living in inner cities. The children were classified as white, Afro-Caribbean, Urdu, Gujarati, Punjabi, other Asian, or “other.” Significant differences in the prevalence of respiratory conditions were found among the ethnic groups after allowance was made for the effects of interfering variables. Except for asthma all conditions were most prevalent in Afro-Caribbeans and whites. In these two ethnic groups respiratory illness was significantly associated with belonging to a one parent family and the combined use of gas cookers and paraffin heaters at home.Respiratory illness was found to vary in prevalence among ethnic groups but may be perceived differently by different groups. Further studies, measuring lung function, are necessary.     

Neonatal respiratory distress: potential for prevention.

A prospective study was conducted of 100 consecutive admissions to the neonatal intensive care unit of the Hospital for Sick Children, Toronto, of infants with respiratory distress syndrome or transient tachypnea of the newborn. It was found that in 15% of cases the illness was completely preventable, being the result of unintentionally premature termination of pregnancy. Significant intrapartum asphyxia occurred in 44% of the infants in whom respiratory distress syndrome developed. Factors placing the pregnancy at high risk were present antenatally in most cases, and most of the deliveries took place in hospitals without adequate facilities or staff, or both, for the requirements of the infant at and following birth.     

Cross sectional study of primary care groups in London: association of measures of socioeconomic and health status with hospital admission rates

ObjectivesTo calculate socioeconomic and health status measures for the primary care groups in London and to examine the association between these measures and hospital admission rates.DesignCross sectional study.Setting66 primary care groups in London, total list size 8.0 million people.ResultsStandardised hospital admission ratios varied from 74 to 116 for total admissions and from 50 to 124 for emergency admissions. Directly standardised admission rates for asthma varied from 152 to 801 per 100 000 (mean 364) and for diabetes from 235 to 1034 per 100 000 (mean 538). There were large differences in the mortality, socioeconomic, and general practice characteristics of the primary care groups. Hospital admission rates were significantly correlated with many of the measures of chronic illness and deprivation. The strongest correlations were with disability living allowance (R=0.64 for total admissions and R=0.62 for emergency admissions, P<0.0001). Practice characteristics were less strongly associated with hospital admission rates.ConclusionsIt is feasible to produce a range of socioeconomic, health status, and practice measures for primary care groups for use in needs assessment and in planning and monitoring health services. These measures show that primary care groups have highly variable patient and practice characteristics and that hospital admission rates are associated with chronic illness and deprivation. These variations will need to be taken into account when assessing performance.     

Patterns of respiratory illness in the first year of life.

This paper describes a study of respiratory illness during the first year of life in a cohort of infants who were born between 1975 and 1978 to mothers who were registered with two inner London group general practices. The types of respiratory illness and their relation to the season of the year and season of birth of the child are examined. The relations among the frequency and type of respiratory illness and several social and family factors that have previously been shown to be associated with high levels of respiratory morbidity are also described.     

Costs and benefits of a community special care baby service

Between January 1981 and December 1986 3829 low birthweight (<2500 g) infants and 1980 other high risk infants were cared for at home after they were discharged from hospital by a specialist neonatal nursing service. Of the infants who were referred to this service, 720 (12%) weighed under 2000 g and 1919 (33%) under 2250 g at the time of discharge home. The infants were visited by the community neonatal sisters on an average of 11 occasions, but the number of visits varied from six to over 100 depending on the needs of the child and parents. There was close liaison with other community and hospital staff. Two hundred and thirty (4%) referred infants were readmitted to hospital while under the care of the specialist nursing service. In 1985 the cost of the service was £127 000, or £123 for each infant referred. Providing this specialist support at home allowed much earlier discharge of low birthweight infants from hospital. When compared with the cost of providing continuing inpatient neonatal care earlier discharge was estimated to have saved roughly £250 000 in 1985.Low birthweight infants have an increased risk of serious illness or death that extends beyond the neonatal period. Many are born to young and socially disadvantaged parents who can benefit from expert guidance and support at home. A community neonatal nursing service has advantages for high risk infants and their parents, is cost effective, and allows more efficient use of limited hospital resources.     

Late morbidity of very low birthweight infants.

The use of hospitals in the first year after term was studied in a geographically based group of 111 very low birthweight infants in Liverpool. This was compared with that of 216 term infants without perinatal complications. Of the group with very low birth weight, 59 (53%) were readmitted, with three deaths, compared with 21 (10%) of the term infants. Of the admissions, 67 (40%) related to sequels of neonatal illness or its management. The admissions were repeated and of long duration, resulting in a 16-fold increased load of inpatients, an eightfold increase in surgical procedures, and a twofold increase in attendance by outpatients at the local children''s hospitals compared with the term group. This population of infants after intensive care represented a high risk group with specific problems and requirements in infancy, even when problems were not apparent at discharge from the neonatal unit.     

Ethnic and family factors of some common diseases in early childhood

The primary purpose of the present study was to examine the comparative incidence of some common diseases with unknown genetic components (e.g. newborn jaundice, urinary and respiratory tract infections) in infants of Israeli families of mixed and non-mixed ethnic origin. We also studied possible relationships between risk of these diseases and a number of anthropometric and demographic factors. Only the group of infants whose parents originated from North Africa and Middle East showed statistically significant differences: namely an increased level of total morbidity, of various comparisons of specific disease frequencies, and in total illness frequency, between infants from "mixed" and "non-mixed" families. In general, however, there was a positive correlation between frequency of healthy infants in "mixed" group and genetic distance between parents. Our findings also indicated a significant association between weight and head circumference of newborn infants respectively, and their illnesses, especially jaundice.     

Prevalence of Herpes and Respiratory Viruses in Induced Sputum among Hospitalized Children with Non Typical Bacterial Community-Acquired Pneumonia

Objective

Few comprehensive studies have searched for viruses in infants and young children with community-acquired pneumonia (CAP) in China. The aim of this study was to investigate the roles of human herpes viruses (HHVs) and other respiratory viruses in CAP not caused by typical bacterial infection and to determine their prevalence and clinical significance.

Methods

Induced sputum (IS) samples were collected from 354 hospitalised patients (infants, n = 205; children, n = 149) with respiratory illness (CAP or non-CAP) admitted to Wenling Hospital of China. We tested for HHVs and respiratory viruses using PCR-based assays. The epidemiological profiles were also analysed.

Results

High rate of virus detection (more than 98%) and co-infection (more than 80%) were found among IS samples from 354 hospitalised infants and children with respiratory illness in this study. Of 273 CAP samples tested, CMV (91.6%), HHV-6 (50.9%), RSV (37.4%), EBV (35.5%), HBoV (28.2%), HHV-7 (18.3%) and rhinovirus (17.2%) were the most commonly detected viruses. Of 81 non- CAP samples tested, CMV (63%), RSV (49.4%), HHV-6 (42%), EBV (24.7%), HHV-7 (13.6%) and HBoV (8.6%) were the dominant viruses detected. The prevalence of several viral agents (rhinovirus, bocavirus, adenovirus and CMV) among IS samples of CAP were significantly higher than that of non-CAP control group. We also found the prevalence of RSV coinfection with HHVs was also higher among CAP group than that of non-CAP control.

Conclusions

With sensitive molecular detection techniques and IS samples, high rates of viral identification were achieved in infants and young children with respiratory illness in a rural area of China. The clinical significance of rhinovirus, bocavirus, adenovirus and HHV (especially CMV) infections should receive greater attention in future treatment and prevention studies of CAP in infants and children.     

Acute Respiratory Infections in Children: Part II. A Trial of Polyvalent Virus Vaccine

A new polyvalent respiratory virus vaccine has been evaluated in a double-blind trial involving infants and children. Five hundred and sixteen healthy infants and children were given either nine-strain polyvalent respiratory virus vaccine or placebo. The vaccine contained four Influenza strains, three Adenovirus strains and two Parainfluenza strains. Serologic studies revealed that persistent protective antibody levels were achieved with only the Asian Influenza component.The children were followed up clinically for a one-year period and each respiratory illness was recorded. No protection appeared to have been conferred by the vaccine, and indeed a significantly greater number of respiratory illnesses occurred among the vaccinated group.     

An assessment of dead space in pulmonary ventilation of the toad Bufo schneideri

The respiratory cycles of Rana and Bufo has been disputed in relation to flow patterns and to the respiratory dead-space of the buccal volume. A small tidal volume combined with a much larger buccal space motivated the "jet steam" model that predicts a coherent expired flow within the dorsal part of the buccal space. Some other studies indicate an extensive mixing of lung gas within the buccal volume. In Bufo schneideri, we measured arterial, end-tidal and intrapulmonary PCO(2) to evaluate dead-space by the Bohr equation. Dead-space was also estimated as: V(D)=(total ventilation-effective ventilation)/f(R), where total ventilation and f(R) were measured by pneumotachography, while effective ventilation was derived from the alveolar ventilation equation. These approaches were consistent with a dead space of 30-40% of tidal volume, which indicates a specific pathway for the expired lung gas.     

GST genotypes and lung cancer susceptibility in Asian populations with indoor air pollution exposures: a meta-analysis

About half of the world's population is exposed to smoke from heating or cooking with coal, wood, or biomass. These exposures, and fumes from cooking oil use, have been associated with increased lung cancer risk. Glutathione S-transferases play an important role in the detoxification of a wide range of human carcinogens in these exposures. Functional polymorphisms have been identified in the GSTM1, GSTT1, and GSTP1 genes, which may alter the risk of lung cancer among individuals exposed to coal, wood, and biomass smoke, and cooking oil fumes. We performed a meta-analysis of 6 published studies (912 cases; 1063 controls) from regions in Asia where indoor air pollution makes a substantial contribution to lung cancer risk, and evaluated the association between the GSTM1 null, GSTT1 null, and GSTP1 105Val polymorphisms and lung cancer risk. Using a random effects model, we found that carriers of the GSTM1 null genotype had a borderline significant increased lung cancer risk (odds ratio (OR), 1.31; 95% confidence interval (CI), 0.95-1.79; p=0.10), which was particularly evident in the summary risk estimate for the four studies carried out in regions of Asia that use coal for heating and cooking (OR, 1.64; 95% CI, 1.25-2.14; p=0.0003). The GSTT1 null genotype was also associated with an increased lung cancer risk (OR, 1.49; 95% CI, 1.17-1.89; p=0.001), but no association was observed for the GSTP1 105Val allele. Previous meta- and pooled-analyses suggest at most a small association between the GSTM1 null genotype and lung cancer risk in populations where the vast majority of lung cancer is attributed to tobacco, and where indoor air pollution from domestic heating and cooking is much less than in developing Asian countries. Our results suggest that the GSTM1 null genotype may be associated with a more substantial risk of lung cancer in populations with coal exposure.     

Epilepsy and Pregnancy: A Report from the Oxford Record Linkage Study

The files of the Oxford Record Linkage Study were used to identify 223 infants delivered to 168 epileptic women as the result of 218 pregnancies. There were six stillbirths, two of which were grossly malformed. It was shown that the population of epileptic mothers differed significantly from the total reproducing population in respect of social class. Each pregnancy resulting in a livebirth was therefore matched exactly for social class, civil status, maternal age, parity, hospital, and year of delivery with three control deliveries resulting in livebirths. The defects noted at birth were abstracted from the Record Linkage files, and any subsequent hospital admissions or deaths of the children were also abstracted.There were highly significant excesses of congenital abnormalities among the infants born to epileptic mothers (13·8% of livebirths had some degree of defect of congenital origin compared with 5·6% of controls, P <0·0005). It was shown that neither the frequency with which the mother had fits nor the length of time she had had the epilepsy seemed to bear any relation to the frequency of defects in the offspring—with the exception of the two mothers who developed epilepsy in the first     

A comparative analysis of biomass and clean fuel exposure on pulmonary function during cooking among rural women in Tamilnadu,India

It is of interest to document data on the comparative analysis of biomass and clean fuel exposure on pulmonary function during cooking among rural women. The study consisted of 100 biomass and 100 LPG fuel using women with no smoking habits and other related illness Parameters such as FVC, FEV1, FEV1/FVC, PEFR, FEF25-75%were obtained using the computerized spirometry to assess the pulmonary function in these subjects. The collected data were analyzed using the Student t-test method and Pearson correlation. The exposure index for biomass fuel users is 69.78±27.25 showing high exposure duration during cooking. The parameters for pulmonary functions significantly declined in FVC (42.34±13.6), FEV1 (45.55±15.98), PEFR (34.11±14.78) and FEF25-75% (45.56±23.00) for biomass fuel user. However, this is not true for FEV1/FVC ratio (107.56±16.9). The increase in PFT suggests the restrictive and obstructive patterns of pulmonary diseases. There was a negative correlation between increased duration of cooking and the value of FEV1/FVC (r = -0.2961), FEF25-75% (r = -0.3519) and PEFR (r = -0.2868). Thus, the deformation of pulmonary function due to extended exposure of biomass fuel for cooking women in rural Tamilnadu is shown using parameter features such as high exposure index, overcrowded area and improper ventilated houses.     

Poor Growth and Pneumonia Seasonality in Infants in the Philippines: Cohort and Time Series Studies

Children with poor nutrition are at increased risk of pneumonia. In many tropical settings seasonal pneumonia epidemics occur during the rainy season, which is often a period of poor nutrition. We have investigated whether seasonal hunger may be a driver of seasonal pneumonia epidemics in children in the tropical setting of the Philippines. In individual level cohort analysis, infant size and growth were both associated with increased pneumonia admissions, consistent with findings from previous studies. A low weight for age z-score in early infancy was associated with an increased risk of pneumonia admission over the following 12 months (RR for infants in the lowest quartile of weight for age z-scores 1.28 [95% CI 1.08 to 1.51]). Poor growth in smaller than average infants was also associated with an increased risk of pneumonia (RR for those in the lowest quartile of growth in early infancy 1.31 [95%CI 1.02 to 1.68]). At a population level, we found that seasonal undernutrition preceded the seasonal increase in pneumonia and respiratory syncytial virus admissions by approximately 10 weeks (pairwise correlation at this lag was −0.41 [95%CI −0.53 to −0.27] for pneumonia admissions, and −0.63 [95%CI −0.72 to −0.51] for respiratory syncytial virus admissions). This lag appears biologically plausible. These results suggest that in addition to being an individual level risk factor for pneumonia, poor nutrition may act as a population level driver of seasonal pneumonia epidemics in the tropics. Further investigation of the seasonal level association, in particular the estimation of the expected lag between seasonal undernutrition and increased pneumonia incidence, is recommended.