PM10 Air Pollution and Acute Hospital Admissions for Cardiovascular and Respiratory Causes in Ostrava.

BACKGROUND AND AIM: The city of Ostrava and its surroundings belong to the most long-therm polluted areas in the Czech Republic and Europe. For identification of health risk, the World Health Organization recommends a theoretical estimation of increased short-term PM10 concentrations effect on hospital admissions for cardiac complaints based on a 0.6% increase per 10 µg.m-3 PM10 and 1.14% increase for respiratory causes. The goal of the present study is to verify the percentage increase of morbidity due to cardiovascular and respiratory causes, as per WHO recommendations for health risk assessment, in the population of Ostrava. METHOD: The input data include data on PM10 air pollution, meteorological data, the absolute number of hospital admissions for acute cardiovascular and respiratory diseases in the period 2010-2012. To examine the association between air pollution and health outcomes the time series Poisson regression adjusted for covariates was used. RESULTS: A significant relationship was found between the cardiovascular hospital admissions (percentage increase of 1.24% per 10 µg.m-3) and values of PM10 less than 150 µg.m-3 in the basic model, although after adjustment for other factors, this relationship was no longer significant. A significant relationship was also observed for respiratory causes of hospital admissions in the basic model. Contrary to cardiovascular hospitalization, the relationship between respiratory hospital admissions and PM10 values below 150 µg.m-3 (percentage increase of 1.52%) remained statistically significant after adjustment for other factors. CONCLUSIONS: The observed significant relationship between hospital admissions for respiratory causes was consistent with the results of large European and American studies.

Analysis of Histopathological Findings of Lung Carcinoma in Czech Black Coal Miners in Association with Coal Workers' Pneumoconiosis.

Coal miners with coal workers' pneumoconiosis (CWP, J60 according to ICD-10) were previously found to have a significantly higher risk of lung carcinoma compared to the general male population. The presented study aimed to analyze the (i) incidence of lung carcinoma in miners, (ii) histopathological findings in cohorts with and without CWP, and (iii) effect of smoking cessation on the histopathological profile. Analyzed cohorts consisted of miners with (n = 3476) and without (n = 6687) CWP. Data on personal and working history obtained from the medical records were combined with information on lung cancer from the Czech Oncological Register and histopathological findings. Statistical analysis was performed using non-parametric tests and the incidence risk ratio at the significance level of 5%. In 1992-2015, 180 miners (2.7%) without CWP and 169 (4.9%) with CWP, respectively, were diagnosed with lung carcinoma. The risk of lung cancer in miners with CWP was 1.82 (95% CI: 1.48-2.25) times higher than in those without CWP. Squamous cell carcinoma (37%) was the most common histopathological type, followed by adenocarcinoma (22%) and small cell carcinoma (21%). A statistically significant difference between the cohorts (p = 0.003) was found in the histopathological subtypes, with the incidence of small cell carcinoma being 2 times higher in miners without CWP than in those with CWP. Only a few individuals with lung carcinoma were non-smokers. The incidence of small cell carcinoma, which is strongly associated with smoking, is significantly higher in miners without CWP. Smoking constitutes the most important risk factor for developing lung carcinoma even in that cohort. However, CWP remains a very important risk factor.

Maternal smoking during pregnancy and childhood obesity: results from the CESAR Study.

Childhood obesity is a worldwide public health concern. Recent studies from high income countries have demonstrated associations between maternal smoking during pregnancy and children's excess body weight. We examine associations between maternal smoking during pregnancy and children's overweight or obesity, in six countries in the less affluent Central/Eastern European region. Questionnaire data were analysed, for 8,926 singleton children aged 9-12 years. Country-specific odds ratios for effects of maternal smoking during pregnancy on being overweight, and on obesity, were estimated using logistic regression. Heterogeneity between country-specific results, and mean effects (allowing for heterogeneity) were estimated. Positive associations between maternal smoking and overweight were seen in all countries but Romania. While not individually statistically significant, the mean odds ratio was 1.26 (95% CI 1.03-1.55), with no evidence of between-country heterogeneity. Obese children were few (2.7%), and associations between obesity and maternal smoking during pregnancy were more heterogeneous, with odds ratios ranging from 0.71 (0.32-1.57) in Poland to 5.49 (2.11-14.30) in Slovakia. Between-country heterogeneity was strongly related to average persons-per-room, a possible socioeconomic indicator, with stronger associations where households were less crowded. Estimates of dose-response relationships tended to be small and non-significant, even when pooled. Our results provide evidence of a link between maternal smoking in pregnancy and childhood overweight. Associations with obesity, though strong in some countries, were less consistent. Maternal smoking may confer an addition to a child's potential for obesity, which is more likely to be realised in affluent conditions.

An assessment of PM1 levels based on indicative PM1 measurements and relationships with PM10 and PM2.5 concentrations, for the analysis of hospital admissions and mortality in the Moravian region.

BACKGROUND: Particulate matter (PM) air pollution is a serious concern in the city of Ostrava. Thus, in 2018, a project entitled "Validation of the relationships between PM10, PM2.5 and PM1 concentrations, and morbidity and mortality, in the heavily polluted region in the Czech Republic," was launched. The relationship between hospital admissions and mortality in the said region is based primarily on short-term PM10 and PM2.5 concentrations and indicative PM1 measurement. The analysis of spatiotemporal variations and the relationship between PM10, PM2.5 and PM1 data from 3 measurement sites within the city of Ostrava is presented. MATERIAL AND METHODS: The analysis was based on the daily average PM concentrations for 5 and 6 months at 2 sites, and on the annual average values (2018-2019) at the baseline station. The correlations of and variability between PM fractions, seasonal differences and explanation of the differences found were the objectives of a detailed analysis. Especially, the potential PM1 variability and its causes were analyzed with respect to the location of the site. RESULTS: The study findings confirmed good correlations between the PM fractions. Compared to PM10, PM2.5 concentrations were more predictive for PM1 concentrations. The annual means of PM10, PM2.5 and PM1 reached 37.5, 29.9 and 27.1 µg/m3 in 2018, respectively, and 25.8, 19.9 and 17.9 µg/m3 in 2019, respectively. The concentration levels in the non-heating season were significantly lower than in the heating season in the 2 years under consideration. The levels of PM10, PM2.5 and PM1 were significantly correlated (the correlation coefficient, r > 0.96). The levels of PM2.5 represented about 0.82-0.86 of PM10, and the levels of PM1 about 0.92-0.93 of PM2.5. These ratios were found to differ in the heating and non-heating seasons, with the PM2.5-PM10 ratio ranging 0.61-0.63 in the non-heating seasons. CONCLUSIONS: The correlations found will be used for indicative PM1 measurements in other areas of the region. Seasonal variability should be taken into account as well. Med Pr. 2021;72(3):249-58.

Comparison of lung cancer risk in black-coal miners based on mortality and incidence.

BACKGROUND: Cancer risk (especially as regards lung cancer) in black-coal miners is mainly analyzed on the basis of mortality. The risk calculated based on mortality may differ from the values based on incidence. The aim of the study was to compare cancer risk in black-coal miners with and without coal workers' pneumoconiosis (CWP), based on data on mortality and the incidence of lung cancer in the Czech Republic in 1992-2013. MATERIAL AND METHODS: The cohort without CWP was composed of 6687 miners, and the cohort with CWP of 3476 miners. Information on the incidence of lung cancer was obtained from the Czech National Oncological Register (NOR), and information on mortality from the National Population Register. The risk of lung cancer incidence was compared with the general male population in the Czech Republic using the standardized incidence ratio (SIR), and the risk of lung cancer mortality using the standardized mortality ratio (SMR), with the 95% CI. RESULTS: In miners with CWP, a lower SMR value was found, SMR = 1.70 (95% CI: 1.41-2.04), compared with the SIR value, SIR = 2.01 (95% CI: 1.70-2.36). In miners without CWP, this was opposite, the value of SIR = 0.81 (95% CI: 0.69-0.94) was lower than the value of SMR = 0.83 (95% CI: 0.70-0.98). In miners without CWP, 17 cases of lung cancer (out of 176 cases in total) were not registered in NOR. In miners with CWP, the share of not registered cases was significantly lower (p = 0.018), and it was represented by 3% of not registered lung cancer cases, out of 156 cases with the diagnosis of lung cancer. CONCLUSIONS: In spite of the difference between SIR and SMR, the results of both indicators were consistent with the resulting relationship between the lung cancer risk and CWP. Med Pr. 2020;71(5):513-8.

The Effects of a Workplace Health Promotion Program to Decrease Cadmium Exposure Levels in Nickel-Cadmium Battery Workers.

OBJECTIVE: Cadmium exposure is a common problem in the production of nickel-cadmium batteries. However, keeping the respective legislative occupational and safety policies is essential, but there are problems with compliance. We analysed the effect of strategies to increase compliance with precautions during 20132015 on 59 workers at a nickel-cadmium battery factory. MATERIAL AND METHODS: A health promotion program was implemented in two phases. The first phase included comprehensive education on the importance of appropriate behaviour and changes to the sanitation program. The second phase included renovation of sanitary facilities and modernization of the air exhaust ventilation. RESULTS: The initial median cadmium urinary level in workers was 1.9 µg/g creatinine. After the first phase of interventions, levels dropped to 1.0 µg/g creatinine. After the second phase no significant further decrease was observed. CONCLUSION: Comprehensive education and changes in the sanitation program were able to halve cadmium levels and can be considered a useful and cost-effective preventive tool.

A response to the Comment on Tomaskova et al. Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013. Int. J. Environ. Res. Public Health, 2017, 14, 269 by the Author Mei Yong.

At first, we would like to thank Mei Yong for the comments on our article Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013 [...].

Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013.

While working underground, miners are exposed to a number of risk factors that have a negative impact on their health and may be a cause of an increased mortality in miners. The aim of the study was to compare total and specific mortality in black coal miners with acknowledged coal-workers' pneumoconiosis (CWP) and without CWP, and the mortality of the general male population in the Czech Republic in the period 1992-2013. The sample consisted of 3476 coal miners with CWP and 6687 ex-coal miners without CWP, who were removed after achieving the maximum permissible exposure (MPE). The mortality risk differences were analyzed with the use of the standardized mortality ratio (SMR) and 95% confidence interval. Significantly higher total mortality (SMR = 1.10; 95% CI: 1.02-1.17), and mortality from malignant neoplasm (SMR = 1.16; 95% CI: 1.03-1.30), lung cancers (SMR = 1.70; 95% CI: 1.41-2.04), and non-malignant respiratory diseases (SMR = 2.78; 95% CI: 2.32-3.31) were found in the sample of coal miners with CWP. In this sample, the severity of CWP was assessed, and the SMR increased with the severity of CWP. The total (SMR = 0.86; 95% CI: 0.82-0.91) and specific mortality of miners without CWP were not higher compared with the general population. In the case where the miners were removed from underground work after achieving the MPE (without CWP), their mortality was not higher than that of the general population, but the mortality of miners with CWP was higher compared to the general population. This mortality was affected by malignant and non-malignant respiratory diseases.

Parental smoking and children's respiratory health: independent effects of prenatal and postnatal exposure.

OBJECTIVES: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children's health. Uncertainties remain about the relative importance of smoking at different periods in the child's life. We investigate this in a pooled analysis, on 53,879 children from 12 cross-sectional studies--components of the PATY study (Pollution And The Young). METHODS: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, "woken by wheeze", bronchitis, nocturnal cough, morning cough, "sensitivity to inhaled allergens" and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools. RESULTS: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations. CONCLUSIONS: Adverse effects of both pre- and postnatal parental smoking on children's respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children's respiratory health and needs to be reduced urgently.

Cancer incidence in Czech black coal miners in association with coalworkers' pneumoconiosis.

OBJECTIVE: The aim of the study was comparison of cancer incidence risk of lungs, stomach, colon, bladder and kidneys from ex-miners of black coal mines and the general male population of the Czech Republic. MATERIALS AND METHODS: The analysis was conducted in two cohorts of ex-miners according to the presence of coalworkers' pneumoconiosis (CWP). The first cohort included the miners without CWP (N = 6705), and the second cohort included the miners who were compensated for CWP (N = 2158). Personal and occupational data was merged with the data in the National Population Register and the National Oncological Register for the period from 1992 to 2006. Cancer risk in miners in comparison to the general male population of the Czech Republic was evaluated by SIR (Standardized Incidence Ratio) and 95% confidence interval (CI). RESULTS: About twice as high risk of lung cancer was found in miners with CWP (SIR = 2.21; 95% CI: 1.75-2.76). Lung cancer risk correlated with the severity of CWP (simple CWP SIR=1.96; 95% CI: 1.48-2.56, progressive massive fibrosis SIR = 4.29; 95% CI: 2.09-7.87). No increased risk of lung cancer was found in ex-miners without CWP. The risk of malignant neoplasm at the other selected sites was comparable with the risk in the general male population of the Czech Republic. CONCLUSIONS: This study found increased lung cancer risk in coal miners with CWP, but not in those without CWP, comparing with the general population. These results served as the basis for the inclusion of lung cancer in association with CWP into a new Czech list of occupational diseases.

Czech socio-economic deprivation index and its correlation with mortality data.

OBJECTIVES: The aim of the study was to create an index of socio-economic deprivation (SESDI) and to analyse correlation between SESDI and mortality data. METHODS: The SESDI components were selected from the census data (2001) at enumeration district and district level. Two methods were used for creating the SESDI: 1/ a sum of Z-scores of specific components (INDEX1); and 2/ standardized score - average values of specific components were divided by a maximum value of the specific component at the corresponding geographical level (INDEX2). Pearson's correlation coefficient was used for assessing the relationship between indices, and between indices and mortality data (SMR). RESULTS: The final indices were applied to districts in the Czech Republic (N = 77). The correlation of INDEX1 and INDEX2 was high (r = 0.99). Analysis of relationships between degree of deprivation and total and selected specific SMR in the Czech Republic confirmed that mortality was associated with degree of deprivation. CONCLUSION: The use of socio-economic deprivation indices in analysis of routinely collected mortality data in public health might help to explain health inequalities.

Socio-economic Predictors of Life Style. A pilot study.

In epidemiological studies there exists the evidence of relationship between socio-economic status (SES) and health. The suspicious cause of these differences is life-style. The aim of the presented study was to identify the relationship between SES, demographic characteristics and the life-style in an industrial region. A structured questionnaire was distributed to a random sample of some 3,000 aged 25-70 and collected by postal delivery. The SES and demographic factors being analysed were sex, age, education, marital status and economic situation of the family in the relationship with a wide range of information on life style. The data was analysed using the chi-square test and logistic regression. The total number of analysed questionnaires was 634. The lowest response-rate was in the group with the basic education. Significant differences were found by sex in education (less women with university degree) and household income (more women in the lowest income category, men in the highest one). A detail analysis of the aggregated variables (adjusted for all SES variables) found: passivity and contentment were in adverse correlation with the level of education and economic situation; psychical well-being was correlated with family status and economic situation, risk behaviour was correlated with all SES factors except sex and education. Among the analysed factors economical situation of respondents, family and education were the most significant determinants of the differences in life-style.

Methodical approach to data processing from a questionnaire survey.

For conducting questionnaire studies there exist generally recommended methods that were also respected during the project funded by the Grant Agency MoH CR - "Subjective approach of inhabitants of Ostrava to their health in association with their life-style, socio-economic status and education". The preparatory phase included the collection of literature and information on the investigated theme. The questionnaire had got five parts - A. General questions, B. Employment, C. Way of life, D. Health state and E. Personality. The validity of questionnaire was tested in the pre-research. In the main questionnaire study 3,000 questionnaires were sent. The total response rate was 21.1% (634 completed questionnaires). In the sample there were no differences in percentage rate by sex and age, but there are differences in the educational structure. After realizing the main questionnaire study, the repeatability study was carried out to find out the reliability of the answers. The response rate was 60.3% (181 questionnaires). The Kappa index and the total percentage of agreement were used for the evaluation of the repeatability study. The agreement was almost perfect and good in the total of 62.3 % of the questions. The quality of data was ensured by double data entry and by choosing the appropriate software. The selection of data for the complex analysis was based on the results of the repeatability study. On the basis of individual information from the questionnaire, new groups of individuals were generated. These groups of individuals were analysed further in relation to health and life-style by socio-economic factors in the models.