Public health: Quality of indoor residential air and health

About 90% of our time is spent indoors where we are exposed to chemical and biological contaminants and possibly to carcinogens. These agents may influence the risk of developing nonspecific respiratory and neurologic symptoms, allergies, asthma and lung cancer. We review the sources, health effects and control strategies for several of these agents. There are conflicting data about indoor allergens. Early exposure may increase or may decrease the risk of future sensitization. Reports of indoor moulds or dampness or both are consistently associated with increased respiratory symptoms but causality has not been established. After cigarette smoking, exposure to environmental tobacco smoke and radon are the most common causes of lung cancer. Homeowners can improve the air quality in their homes, often with relatively simple measures, which should provide health benefits.In North America, adults spend about 87% of their time in buildings, 6% in vehicles and 7% outdoors.¹ Leech and colleagues² have reported that Canadians spend similar amounts of time indoors. Typically, more time is spent indoors in very hot or cold climates. As a result, personal exposure to airborne substances is more closely related to indoor rather than outdoor pollution.^3,4 We review the sources, health effects and control strategies for several of the most important sources of residential biological and chemical contaminants.Although outdoor and indoor environments tend to be viewed as distinct entities, some outdoor pollutants enter the home. However, less air pollution enters tightly sealed homes, such as those found in colder and hotter climates where windows and doors are more regularly closed to retain conditioned air.⁵ In addition, economically disadvantaged families may be more likely than others to live close to roadways and industry, have lower-quality housing and have less access to air conditioning, which may result in poor indoor air quality.⁶ On days with high concentrations of particulate matter, cities with a high prevalence of air conditioner use report fewer hospital admissions for cardiovascular disease, chronic obstructive pulmonary disease and pneumonia compared with cities with lower air conditioner use.⁵Indoor air pollutants include carcinogens and biological and chemical contaminants. The latter category can be divided into combustion products and gases released from indoor materials (off-gassing emissions). Several guidelines for exposure limits for indoor air contaminents have been developed by the Canadian government (Open in a separate window     

Health and the city: physical health and mental health

In France, city size has very little bearing on the mortality rate as a function of age and life expectancy and it is in large cities that these indicators are the most favorable. No increase in maternal or infant mortality rates or deaths due to cancers has been observed in large cities. The lower mortality rate linked to respiratory and cardiovascular diseases in large urban areas contradicts the fears concerning the impact of air pollution. Deaths linked to lifestyle are less frequent in big cities, which could be due to social structures (socio-professional level: the proportion of white-collar workers and professionals is higher in bigger cities than in the suburbs or small cities). However, although the overall mortality rate is lower, it should be emphasized that there is in large cities a greater incidence of sexually transmitted diseases, AIDS and certain infectious diseases (because of social diversity and the fact that certain individuals seeking anonymity and marginality are drawn to large cities). In terms of mental health, the breakdown of family structures, instability, unemployment, the lack of parental authority and failing schools render adolescents vulnerable and hinder their social integration. When the proportion of adolescents at risk is high in a neighborhood, individual problems are amplified and social problems result. In order to restore mental and social health to these neighborhoods, ambitious strategies are necessary which take into account family and social factors as well as environmental ones. At the present time, when physical health is constantly improving, the most pressing problems are those related to lifestyle and mental health which depend for a large part on social factors.     

Conception of health: Space-Earth

A new approach for assessing the state of health of cosmonauts, athletes, pilots, drivers, operators, and persons exposed to occupational hazards is considered. It has been created and developed at the Institute of Biomedical Problems of the Russian Academy of Sciences under the direction of Academician A.I. Grigor’ev. The results of the work of the last decade performed in the Program of the Presidium of the Russian Academy of Sciences “Fundamental Sciences for Medicine” are presented. A new system for estimating the functional state of the body under stressful influences is provided. The methodology of remotely studying the influence of environmental factors on health that initiated a new branch of science and public health—environmental telemedicine—has been elaborated. Issues of the further introduction of the new concept of health and technologies of prenosological diagnostics in the practice of public health services are discussed.     

Leptospirosis: Public health perspectives

Leptospirosis, caused by a spirochete of genus Leptospira, is considered the most widespread zoonosis in the world. It has a global distribution with a higher incidence in the tropics and subtropics, ranging from 10 to 100 human cases per 100,000 individuals. Leptospirosis is considered an “emerging” zoonosis due to increased contact between animals and humans and the resulting human encroachment into wildlife habitat. Climate change and its associated environmental shifts can affect the degree of transmission of leptospirosis. Surveillance for leptospirosis is important for early detection of cases because early treatment is crucial to decrease morbidity and mortality. In June 2012, the Council of State and Territorial Epidemiologists approved reinstatement of leptospirosis as a Nationally Notifiable Condition. Reinstatement of national surveillance will facilitate the assessment of the incidence, geographic distribution, trends, and risk factors associated with human cases and the identification of outbreaks and potential new animal reservoirs.