Indoor inhalation intake fractions of fine particulate matter: review of influencing factors.

Exposure to fine particulate matter (PM2.5 ) is a major contributor to the global human disease burden. The indoor environment is of particular importance when considering the health effects associated with PM2.5 exposures because people spend the majority of their time indoors and PM2.5 exposures per unit mass emitted indoors are two to three orders of magnitude larger than exposures to outdoor emissions. Variability in indoor PM2.5 intake fraction (iFin,total ), which is defined as the integrated cumulative intake of PM2.5 per unit of emission, is driven by a combination of building-specific, human-specific, and pollutant-specific factors. Due to a limited availability of data characterizing these factors, however, indoor emissions and intake of PM2.5 are not commonly considered when evaluating the environmental performance of product life cycles. With the aim of addressing this barrier, a literature review was conducted and data characterizing factors influencing iFin,total were compiled. In addition to providing data for the calculation of iFin,total in various indoor environments and for a range of geographic regions, this paper discusses remaining limitations to the incorporation of PM2.5 -derived health impacts into life cycle assessments and makes recommendations regarding future research.

The INDEX project: executive summary of a European Union project on indoor air pollutants.

The prevalence of allergies, asthma and other respiratory diseases in large populations has increased in recent decades. Among other factors, this phenomenon has been connected to adverse health effects of air pollution. Although some causal links between occupational exposures and their health effects are shown, still little is known about the health risks of lifelong exposure to indoor air pollutants. To assess the health risks of indoor air pollutants at prevailing concentration levels in Europe, the Joint Research Centre of the European Commission carried out a project called "Critical Appraisal of the Setting and Implementation of Indoor Exposure Limits in the EU" (INDEX). The aims of the project were: (1) to assess health risks of indoor-originated chemical pollutants that might be regulated in the EU and (2) to provide suggestions and recommendations on potential exposure limits or other risk management measures. The results of the INDEX project should contribute to the development of an EU strategy for the management of indoor air quality. The highest priority was given in this study to: formaldehyde, nitrogen dioxide, carbon monoxide, benzene and naphthalene. Exposure limits, recommendations and management options were also given to minimize the health risks for these compounds.

Intake fraction distributions for indoor VOC sources in five European cities.

UNLABELLED: Distributions of intake fractions for indoor air emissions were estimated for five cities in the EXPOLIS study (Athens, Basel, Helsinki, Oxford, and Prague). Intake fractions are an expression of the mass of a pollutant that reaches a target compared with the mass emitted by a source. They facilitate direct comparisons of the relative impact of different sources on individual or population exposure and dose. The computation of the distributions was obtained through Monte Carlo simulations, based on distributions of residence volume, air exchange rates and time-activity data, calculated from the EXPOLIS database, as well as on distributions from the literature. Some approximations were made that are valid for persistent pollutants and continuous sources, such as emissions from building materials, pesticides, molds, as well as for certain non-continuous sources such as cooking or cleaning products. For these categories of sources, intake fractions are approximately independent of the actual indoor concentrations and irrespective of the source. Intake fractions in the five populations examined followed approximately lognormal distributions. The mean individual intake fractions exhibited some variability across cities, ranging from 1.5x10(-3) in Athens to 4.5x10(-3) in Helsinki. Intake fractions for all the people in a household followed similar distributions, with mean values ranging from 4.6x10(-3) in Athens to 11.8x10(-3) in Helsinki. This modest variability mostly reflects the differences in climates and consequent air-tightness of the buildings. The 95th percentile of the distributions were two to three times the mean values, indicating substantial homogeneity within each population as well. These results compare well with previous estimates for environmental tobacco smoke and cooking, and are two to three orders of magnitude larger than estimates for outdoor sources. PRACTICAL IMPLICATIONS: Emissions from indoor sources were estimated to be approximately 1000 times more likely to reach a human target than emissions from outdoor sources. Strategies to reduce exposure to indoor sources can only realistically focus on reducing the strength of the emissions.

Risk characterization and proposal of exposure thresholds to indoor chemical agents: the Index European project.

The European INDEX project was finalised to identify priorities and to assess the needs for an European Community strategy and action plan in the area of indoor air pollution. A list of 5 chemicals, with potential of high indoor concentrations, uncontested health impacts, and effective risk management, were selected to be regulated with priority: Formaldehyde, Carbon Monoxide, Nitrogen Dioxide, Benzene and Naphtalene. For each compound, guideline values and management options were suggested.

ExpoFacts--an overview of European exposure factors data.

European exposure factor data have been collected in one centrally available, freely accessible site on the Internet: the ExpoFacts database (http://www.ktl.fi/expofacts/). The process of compiling the database required locating the exposure factor data and evaluating its general applicability and public availability. The scope of the ExpoFacts database covers 30 European countries, often each with its own approach for data generation and publication. The database includes information on food intake, time use, physiology, housing, and demographic parameters, as available. Information included in the database, as well as the challenges in collecting and compiling this information, are summarized. Data were found to be unavailable for ExpoFacts for a number of reasons: (1) data have not been collected, (2) collected data are not published, (3) the publishing format or language makes the data hard to locate and use, (4) copyright restrictions prevent presenting the data in an open access website, or (5) data exist, but are too expensive to acquire. Improving accessibility and harmonization of existing data would enhance the information base for exposure and risk assessments. In addition, the ExpoFacts project demonstrates a successful process for acquiring, storing, and sharing exposure factors data.

Reduction potential of urban PM2.5 mortality risk using modern ventilation systems in buildings.

UNLABELLED: Urban PM2.5 (particulate matter with aerodynamic diameter smaller than 2.5 microm) is associated with excess mortality and other health effects. Stationary sources are regulated and considerable effort is being put into developing low-pollution vehicles and environment-friendly transportation systems. While waiting for technological breakthroughs in emission controls, the current work assesses the exposure reductions achievable by a complementary means: efficient filtration of supply air in buildings. For this purpose infiltration factors for buildings of different ages are quantified using Exposures of Adult Urban Populations in Europe Study (EXPOLIS) measurements of indoor and outdoor concentrations in a population-based probability sample of residential and occupational buildings in Helsinki, Finland. These are entered as inputs into an evaluated simulation model to compare exposures in the current scenario with an alternative scenario, where the distribution of ambient PM2.5 infiltration factors in all residential and occupational buildings are assumed to be similar to the subset of existing occupational buildings using supply air filters. In the alternative scenario exposures to ambient PM2.5 were reduced by 27%. Compared with source controls, a significant additional benefit is that infiltration affects particles from all outdoor sources. The large fraction of time spent indoors makes the reduction larger than what probably can be achieved by local transport policies or other emission controls in the near future. PRACTICAL IMPLICATIONS: It has been suggested that indoor concentrations of ambient particles and the associated health risks can be reduced by using mechanical ventilation systems with supply air filtering in buildings. The current work quantifies the effects of these concentration reductions on population exposures using population-based data from Helsinki and an exposure model. The estimated exposure reductions suggest that correctly defined building codes may reduce annual premature mortality by hundreds in Finland and by tens of thousands in the developed world altogether.

Fine PM measurements: personal and indoor air monitoring.

This review compiles personal and indoor microenvironment particulate matter (PM) monitoring needs from recently set research objectives, most importantly the NRC published "Research Priorities for Airborne Particulate Matter (1998)". Techniques and equipment used to monitor PM personal exposures and microenvironment concentrations and the constituents of the sampled PM during the last 20 years are then reviewed. Development objectives are set and discussed for personal and microenvironment PM samplers and monitors, for filter materials, and analytical laboratory techniques for equipment calibration, filter weighing and laboratory climate control. The progress is leading towards smaller sample flows, lighter, silent, independent (battery powered) monitors with data logging capacity to store microenvironment or activity relevant sensor data, advanced flow controls and continuous recording of the concentration. The best filters are non-hygroscopic, chemically pure and inert, and physically robust against mechanical wear. Semiautomatic and primary standard equivalent positive displacement flow meters are replacing the less accurate methods in flow calibration, and also personal sampling flow rates should become mass flow controlled (with or without volumetric compensation for pressure and temperature changes). In the weighing laboratory the alternatives are climatic control (set temperature and relative humidity), and mechanically simpler thermostatic heating, air conditioning and dehumidification systems combined with numerical control of temperature, humidity and pressure effects on flow calibration and filter weighing.

Recurrent urinary tract infections in infancy: relapses or reinfections?

Seventeen infants with an index episode of pyelonephritis caused by Escherichia coli were monitored for 18 months for recurrent urinary tract infections (UTIs). All the infants had at least 1 recurrent UTI caused by the same pathogen. Twenty-six recurrent UTI episodes were recorded. The 40 E. coli strains available were analyzed by multiplex polymerase chain reaction for 3 alleles (classes I-III) of the papG gene and by pulsed-field gel electrophoresis (PFGE) after genomial digestion by XbaI. Of the 17 index strains, 12 (71%) carried the papG gene; 67% of these strains had class II alleles. In recurrent UTI isolates, the papG-positive E. coli appeared in 16 (70%) of 23 isolates. The proportion of all recurrent isolates available that represented a strain previously encountered (indistinguishable or highly similar in PFGE) in the same infant was 65%. Our results suggest that most recurrent UTIs in infants are endogenous relapses rather than reinfections caused by new organisms.

Exposures to nitrogen dioxide in EXPOLIS-Helsinki: microenvironment, behavioral and sociodemographic factors.

Personal exposures to nitrogen dioxide (NO(2)) were monitored for 176 randomly selected inhabitants (25-55 years old) of Helsinki Metropolitan area as a part of the EXPOLIS (Air Pollution Exposure Distributions Within Adult Urban Populations in Europe) study between October 1996 and December 1997. NO(2) measurements were 48-h averages collected by Palmes passive sampler tubes. Differences in personal exposures to NO(2) were analyzed between sub-populations stratified by microenvironment, behavioral, socioeconomic and demographic factors. Factors significantly associated with differences in exposures to NO(2) were home and work location, housing characteristics, traffic volume near home, season and keeping windows open at home. Exposure to environmental tobacco smoke (ETS) and use of gas stove were also associated with increased personal exposures, although only few participants had a gas stove in Helsinki, and other gas appliances are non-existent. Single adults had higher average exposures to NO(2) than married or cohabiting participants, suggesting differences in living conditions between these two groups. Increased education was associated with decreased exposures to NO(2) and employed men were more exposed than unemployed men. Increased exposures to NO(2) were not associated with age or occupational status in Helsinki. Thus, behavioral and sociodemographic factors may have significant impact on personal exposures to NO(2) and should be considered in addition to environmental determinants in any monitoring program.

Predictive factors associated with significant urinary tract abnormalities in infants with pyelonephritis.

BACKGROUND: Major urinary tract abnormalities are detected in 20 to 40% of infants with acute pyelonephritis (APN). Early detection of structural defects is essential for protecting the kidneys from reinfection and subsequent scarring. The purpose of this study was to investigate whether any factors present during the acute phase of infection could predict the presence of existing significant urinary tract abnormalities in infants. METHODS: A prospective study of 180 infants, aged 1 to 24 months, with APN was conducted. Blood and urine samples were collected. Renal ultrasound (US) was performed within 0 to 6 days from admission. Final diagnosis of the urinary tract anatomy was elucidated using the results of two or more radiologic imaging studies. RESULTS: Risk factors for the presence of significant urinary tract abnormalities in infants were pathogens other than Escherichia coli in urine [relative risk (RR) 3.4, 95% confidence interval (CI) 2.2 to 5.3; P = 0.001], positive blood culture (RR 2.3, 95% CI 1.3 to 4.0; P = 0.039), young age (1 to 6 months) (RR 2.2, 95% CI 1.3 to 3.9; P = 0.004), lack of papG adhesin genes of E. coli in urine (RR 2.1, 95% CI 1.2 to 3.9; P = 0.016) and abnormal renal US (RR 2.0, 95% CI 1.2 to 3.4; P = 0.008). CONCLUSIONS: Infants 1 to 6 months of age with APN caused by bacteria other than E. coli or by papG-negative E. coli strain, positive blood culture and abnormal renal US carry an increased risk for significant urinary tract abnormalities and need enforced follow-up.

Evaluation of VOC measurments in the EXPOLIS study. Air Pollution Exposure Distributions within Adult Urban Urban Populations in Europe.

Personal exposures and microenvironment concentrations of 30 target VOCs were measured for 401 participants living in five European cities as a part of the EXPOLIS (Air Pollution Exposure Distributions within Adult Urban Populations in Europe) study. Measurements in Basel used an active charcoal (Carbotech) adsorbent as opposed to the Tenax TA used in the other study centres. In addition, within each centre, personal and microenvironment VOC sampling required different sampling pumps and, because of different sampling durations, different sampling flow rates. Thus, careful testing of the sampling and analysis procedures was required to ensure accuracy and comparability of collected data. Monitor comparison tests using Tenax TA showed a mean VOC concentration ratio of 0.95 between the personal and microenvironment monitors. The LODs for the target VOCs using Tenax TA ranged from 0.7 to 5.2 microg m(-3). The LODs for the 14 target compounds quantifiable using Carbotech ranged from 0.9 to 3.2 microg m(-3). Tenax TA field blanks showed no remarkable contamination with the target VOCs, except benzaldehyde, a known artefact with this adsorbent. Thus, the diffusion barrier system used prevented contamination of Tenax TA samples by passive diffusion during non-sampling periods. Duplicate and parallel evaluations of the Tenax TA and Carbotech showed an average difference of < 17% in VOC concentrations within the sampling methods, but a systematic difference between the methods (Tenax TA: Carbotech concentration ratio = 1.18-2.36). These field evaluations and quality assurance tests showed that interpretation and comparison of the results in any VOC monitoring exercise should be done on a compound by compound basis. It is also apparent that carefully planned and realised QA and QC (QA/QC) procedures are needed in multi-centre studies, where a common sampling method and laboratory analysis technique are not used, to strengthen and simplify the interpretation of observed VOC levels between participating centres.

Personal exposure levels and microenvironmental concentrations of formaldehyde and acetaldehyde in the Helsinki metropolitan area, Finland.

Personal 48-hr exposures to formaldehyde and acetaldehyde of 15 randomly selected participants were measured during the summer/autumn of 1997 using Sep-Pak DNPH-Silica cartridges as a part of the EXPOLIS study in Helsinki, Finland. In addition to personal exposures, simultaneous measurements of microenvironmental concentrations were conducted at each participant's residence (indoor and outdoor) and workplace. Mean personal exposure levels were 21.4 ppb for formaldehyde and 7.9 ppb for acetaldehyde. Personal exposures were systematically lower than indoor residential concentrations for both compounds, and ambient air concentrations were lower than both indoor residential concentrations and personal exposure levels. Mean workplace concentrations of both compounds were lower than mean indoor residential concentrations. Correlation between personal exposures and indoor residential concentrations was statistically significant for both compounds. This indicated that indoor residential concentrations of formaldehyde and acetaldehyde are a better estimate of personal exposures than are concentrations in ambient air. In addition, a time-weighted exposure model did not improve the estimation of personal exposures above that obtained using indoor residential concentrations as a surrogate for personal exposures. Correlation between formaldehyde and acetaldehyde was statistically significant in outdoor microenvironments, suggesting that both compounds have similar sources and sinks in ambient urban air.

Nitrogen dioxide exposure assessment and cough among preschool children.

The association between exposure to ambient air nitrogen dioxide and cough was evaluated in a panel study among 162 children aged 3-6 y. The weekly average nitrogen dioxide exposure was assessed with Palmes-tube measurements in three ways: (1) personally, (2) outside day-care centers, and (3) inside day-care centers. Ambient air nitrogen dioxide concentrations were obtained from the local network that monitored air quality. The parents recorded cough episodes daily in a diary. The risk of cough increased significantly (relative risk = 3.63; 95% confidence interval = 1.41, 9.30) in the highest personal nitrogen dioxide exposure category in winter, and a nonsignificant positive trend was noted for the other assessment groups. In spring, risk increased nonsignificantly in all exposure-assessment groups, except for the fixed-site monitoring assessment. It is important that investigators select an exposure-assessment method sufficiently accurate to reflect the effective pollutant dose in subjects.

Population sampling in European air pollution exposure study, EXPOLIS: comparisons between the cities and representativeness of the samples.

A personal air pollution exposure study, EXPOLIS, was accomplished in six European cities among 25- to 55-year-old citizens. In order to compare the exposure results and different microenvironmental concentrations between the cities it is crucial to know the extent and effects of the population bias that has developed in sampling procedure and the sociodemographic characteristics of each measured population sample. In each participating city a random Base sample of 2000 to 3000 individuals was drawn from the census and a Short Questionnaire (SQ) was mailed to them. Two subsamples of the Respondents of the mailed questionnaire were randomly drawn: Diary sample for 48-h time--microenvironment--activity diary and extensive exposure questionnaires, and Exposure sample for the same plus personal exposure and microenvironmental monitoring. Significant differences existed between the EXPOLIS cities in the population-sampling procedure. Population-sampling bias was evaluated by comparing the Respondents with the total city populations. The share of women and individuals with more than 14 years of education is higher among the Respondents than the overall population except in Athens. Men, younger (25-34 years old) and unmarried individuals were hardest to get to participate in the study at least in Helsinki. The two subsamples differ from Respondents in having more employed and higher- educated individuals. The largest sample bias occurred at the first and easiest step of responding to the mailed Short Screening Questionnaire, and not at the last and most demanding stage of participating in the exposure measurements. Exposure data from some of EXPOLIS cities can only be compared to other cities with caution considering their large population bias or different sample selections. However the selection bias is not necessarily a problem for analyses about predictors of personal exposures or analyses within a city.

Sociodemographic descriptors of personal exposure to fine particles (PM2.5) in EXPOLIS Helsinki.

Demographic and socioeconomic differences between population sub-groups were analyzed, as a component of the EXPOLIS (Air Pollution Exposure Distributions Within Adult Urban Populations in Europe) Helsinki study, to explain variation in personal exposures to fine particles (PM2.5). Two-hundred one individuals were randomly selected among 25--55-year-old inhabitants of Helsinki Metropolitan area. Personal exposure samples and residential indoor, residential outdoor and workplace indoor microenvironment measurements of PM2.5 were collected between October 1996 and December 1997. Variation in PM2.5 personal exposures, between sociodemographic sub-groups, was best described by differences in occupational status, education and age. Lower occupational status, less educated and young participants had greater exposures than upper occupational status, more educated and older participants. Different workplace concentrations explained most of the socioeconomic differences, and personal day and night exposures and concentrations in home (but not workplace or outdoor concentrations) caused the PM2.5 exposure differences between age groups. Men had higher exposures and much larger exposure differences between the sociodemographic groups than women. No gender, socioeconomic or age differences were observed in home outdoor concentrations between groups. Exposure to tobacco smoke did not seem to create new differences between the sociodemographic groups; instead, it amplified the existing differences.

Validity of ambient levels of fine particles as surrogate for personal exposure to outdoor air pollution--results of the European EXPOLIS-EAS Study (Swiss Center Basel).

To evaluate the validity of fixed-site fine particle levels as exposure surrogates in air pollution epidemiology, we considered four indicator groups: (1) PM2.5 total mass concentrations, (2) sulfur and potassium for regional air pollution, (3) lead and bromine for traffic-related particles, and (4) calcium for crustal particles. Using data from the European EXPOLIS (Air Pollution Exposure Distribution within Adult Urban Populations in Europe) study, we assessed the associations between 48-hr personal exposures and home outdoor levels of the indicators. Furthermore, within-city variability of fine particle levels was evaluated. Personal exposures to PM2.5 mass were not correlated to corresponding home outdoor levels (n = 44, rSpearman (Sp) = 0.07). In the group reporting neither relevant indoor sources nor relevant activities, personal exposures and home outdoor levels of sulfur were highly correlated (n = 40, rSp = 0.85). In contrast, the associations were weaker for traffic (Pb: n = 44, rSp = 0.53; Br: n = 44, rSp = 0.21) and crustal (Ca: n = 44, rSp = 0.12) indicators. This contrast is consistent with spatially homogeneous regional pollution and higher spatial variability of traffic and crustal indicators observed in Basel, Switzerland. We conclude that for regional air pollution, fixed-site fine particle levels are valid exposure surrogates. For source-specific exposures, however, fixed-site data are probably not the optimal measure. Still, in air pollution epidemiology, ambient PM2.5 levels may be more appropriate exposure estimates than total personal PM2.5 exposure, since the latter reflects a mixture of indoor and outdoor sources.

Predominance of class II papG allele of Escherichia coli in pyelonephritis in infants with normal urinary tract anatomy.

P-fimbrial genotypes of Escherichia coli strains and their possible association with urinary tract abnormalities were studied in infants with pyelonephritis. A total of 153 urinary E. coli strains were analyzed by polymerase chain reaction for class I, II, and III alleles of the pyelonephritis-associated adhesin gene papG. Strains with any class II papG alleles were found significantly more often in infants with normal anatomy and function or in infants with clinically insignificant abnormalities than they were in infants with significant abnormalities (90 of 119 vs. 14 of 34 infants; P<. 001). On the other hand, strains without any papG alleles were found significantly more often in infants with major urinary tract abnormalities (11 of 34 vs. 17 of 119 infants; P=.016). Our genotypic findings indicate that, especially in infants with a normal urinary tract, infection is caused by more-virulent E. coli than is present in infants without a normal urinary tract. This virulence could be due to expression of pyelonephritogenic P fimbriae by an infecting E. coli strain.

Urban commuter exposure to particle matter and carbon monoxide inside an automobile.

In-vehicle exposures to different sizes of particles and carbon monoxide (CO) were determined while driving along a standardized route under a variety of traffic conditions in Kuopio, Finland during the 12-month period from January to December 1995. Arithmetic means of in-vehicle exposures during the morning rush hours were 5.7 parts per million (ppm) (geometric mean, GM = 3.1 ppm, geometric standard deviation, GSD = 1.7) for CO, 107 #/cm3 (GM = 75 #/cm3, GSD = 1.9) for fine particles (optical equivalent particle size range 0.3-1 micron) and 0.9 #/cm3 (GM = 0.6 #/cm3, GSD = 2.1) for coarse particles (optical equivalent particle size range 1-10 microns). Fine particles and CO behaved similarly in different weather and traffic conditions, while the behavior of coarse particles was usually different, and often opposite. The driving conditions that affected the passengers' exposures to CO and fine particles were the time of day (morning vs. afternoon) and average speed (decreasing). The meteorological parameters that affected the passengers' exposures to CO and fine particles were wind speed (decreasing) and relative humidity (increasing). Wind speed, relative humidity and driving speed all had opposite effects on the exposure levels to fine vs. coarse particles. Added exposures (due to commuting on top of the background levels) to CO and fine particles were considerably higher in the morning vs. the afternoon runs and also higher in the slower vs. the faster runs.

The methadone-maintained pregnancy.

Methadone treatment during pregnancy offers overwhelming advantages compared with the less acceptable option of medical detoxification or the unacceptably dangerous option of leaving heroin-addicted women dependent on street drugs. General agreement exists that pregnancy offers a unique opportunity to bring women into medical, obstetric, and drug treatment. Methadone maintenance in the setting of comprehensive service provision during pregnancy reduces maternal morbidity and mortality and promotes fetal stability and growth. With an accumulated experience of over 25 years, methadone maintenance has been shown to be an invaluable and often an essential ingredient in bettering the health of women during pregnancy, in improving the outcomes of those pregnancies, and in offering opiate-addicted women a chance to improve both their lives and the lives of their families.

Fine particle (PM25) measurement methodology, quality assurance procedures, and pilot results of the EXPOLIS study.

EXPOLIS is a European multicenter (Athens, Basel, Grenoble, Helsinki, Milan, and Prague) air pollution exposure study. It is the first international, population-based, large-scale study, where personal exposures to PM2.5 aerosol particles (together with volatile organic compounds and carbon monoxide) are being monitored. EXPOLIS is performed in six different centers across Europe, the sampled aerosol concentrations vary greatly, and the microenvironmental samples are not collected with the same equipment as the personal samples. Therefore careful equipment selection, methods development and testing, and thorough quality assurance and quality control (QA & QC) procedures are essential for producing reliable and comparable PM2.5 data. This paper introduces the equipment, the laboratory test results, the pilot results, the standard operating procedures, and the QA & QC procedures of EXPOLIS. Test results show good comparability and repeatability between personal and microenvironmental monitors for PM2.5 at different concentration levels measured across Europe in EXPOLIS centers.