The possible effect of different types of ventilation on reducing operation theatre infections: a meta-analysis.

INTRODUCTION: The relation between type of ventilation used in the operating theatre and surgical site infection has drawn considerable attention. It has been reported that there is a possible relationship between the type of ventilation used in the operation theatre and surgical site infection. This meta-analysis was performed to evaluate this relationship. METHODS: Through a systematic literature search up to May 2020, 14 studies describing 590,121 operations, 328,183 were performed under laminar airflow ventilation and 2,611,938 were performed under conventional ventilation. Studies were identified that reported relationships between type of ventilation with its different categories and surgical site infection (10 studies were related to surgical site infection in total hip replacement, 7 in total knee arthroplasties and 3 in different abdominal and open vascular surgery). Odds ratios with 95% confidence intervals were calculated comparing surgical site infection prevalence and type of theatre ventilation using the dichotomous method with a random or fixed-effect model. FINDINGS: No significant difference was found between surgery performed under laminar airflow ventilation and conventional ventilation in total hip replacement (OR 1.23; 95% CI 0.97-1.56, p = 0.09), total knee arthroplasties (OR 1.14; 95% CI 0.62-2.09, p = 0.67) or different abdominal and open vascular surgery (OR 0.75; 95% CI 0.43-1.33, p = 0.33). The impact of the type of theatre ventilation may have no influence on surgical site infection as a tool for decreasing its occurrence. CONCLUSIONS: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.

Analysis of pre- and intraoperative clinical for successful operating room extubation after living donor liver transplantation: a retrospective observational cohort study.

BACKGROUND: Early extubation after liver transplantation is safe and accelerates patient recovery. Patients with end-stage liver disease undergo sarcopenic changes, and sarcopenia is associated with postoperative morbidity and mortality. We investigated the impact of core muscle mass on the feasibility of immediate extubation in the operating room (OR) after living donor liver transplantation (LDLT). METHODS: A total of 295 male adult LDLT patients were retrospectively reviewed between January 2011 and December 2017. In total, 40 patients were excluded due to emergency surgery or severe encephalopathy. A total of 255 male LDLT patients were analyzed in this study. According to the OR extubation criteria, the study population was classified into immediate and conventional extubation groups (39.6 vs. 60.4%). Psoas muscle area was estimated using abdominal computed tomography and normalized by height squared (psoas muscle index [PMI]). RESULTS: There were no significant differences in OR extubation rates among the five attending transplant anesthesiologists. The preoperative PMI correlated with respiratory performance. The preoperative PMI was higher in the immediate extubation group than in the conventional extubation group. Potentially significant perioperative factors in the univariate analysis were entered into a multivariate analysis, in which preoperative PMI and intraoperative factors (i.e., continuous renal replacement therapy, significant post-reperfusion syndrome, and fresh frozen plasma transfusion) were associated with OR extubation. The duration of ventilator support and length of intensive care unit stay were shorter in the immediate extubation group than in the conventional extubation group, and the incidence of pneumonia and early allograft dysfunction were also lower in the immediate extubation group. CONCLUSIONS: Our study could improve the accuracy of predictions concerning immediate post-transplant extubation in the OR by introducing preoperative PMI into predictive models for patients who underwent elective LDLT.

Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study.

BACKGROUND: It is very rare but challenging to perform emergency airway management for accidental extubation in a patient whose head and neck are fixed in the prone position when urgently turning the patient to the supine position would be unsafe. The authors hypothesized that tracheal intubation with a videolaryngoscope would allow effective airway rescue in this situation compared with a supraglottic airway device and designed a randomized crossover manikin study to test this hypothesis. METHODS: The authors compared airway rescue performances of the 3 devices-the ProSeal laryngeal mask airway (PLMA; Teleflex Medical, Westmeath, Ireland) as a reference; the Pentax AWS (AWS; Nihon Kohden, Tokyo, Japan) as a channeled blade-type videolaryngoscope; and the McGRATH videolaryngoscope (McGRATH; Medtronic, Minneapolis, MN) as a nonchanneled blade type in a manikin fixed to the operating table in the prone position. Twenty-one anesthesiologists performed airway management on the prone manikin with the 3 devices, and the time required for intubation/ventilation and the success rates were recorded. RESULTS: The median (range) intubation/ventilation times with the PLMA, AWS, and McGRATH were 24.5 (13.5-89.5) s, 29.9 (17.1-79.8) s, and 46.7 (21.9-211.7) s, respectively. There was no significant difference in intubation/ventilation times between the PLMA and AWS. The AWS permitted significantly faster tracheal intubation than did the McGRATH (P = 0.006). The success rates with the PLMA (100%) and AWS (100%) were significantly greater than that with the McGRATH (71.4%). Airway management performance of the PLMA and AWS was comparable between devices and better than that of the McGRATH in the prone position. CONCLUSIONS: Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position.

Characterization and health risk assessment of airborne pollutants in commercial restaurants in northwestern China: Under a low ventilation condition in wintertime.

Impacts on indoor air quality of dining areas from cooking activities were investigated in eight categories of commercial restaurants including Szechwan Hotpot, Hunan, Shaanxi Noodle, Chinese Barbecue, Chinese Vegetarian, Korean Barbecue, Italian, and Indian, in Northwestern China during December 2011 to January 2012. Chemical characterization and health risk assessment for airborne carbonyls, and particulate-bound polycyclic aromatic hydrocarbons (PAHs) and heavy metals were conducted under low ventilation conditions in wintertime. The highest total quantified carbonyls (Σcarbonyls) concentration of 313.6µgm-3 was found in the Chinese Barbecue, followed by the Szechwan Hotpot (222.6µgm-3) and Indian (221.9µgm-3) restaurants. However, the highest Σcarbonyls per capita was found at the Indian restaurant (4500µgcapita-1), suggesting that cooking methods such as stir-fly and bake for spices ingredients released more carbonyls from thermal cooking processes. Formaldehyde, acetaldehyde, and acetone were the three most abundant species, totally accounting for >60% of mass concentrations of the Σcarbonyls. Phenanthrene, chrysene, and benzo[a]anthracene were the three most abundant PAHs. Low molecular weight fraction (ΣPAHs≤178) had the highest contributions accounting for 40.6%-65.7%, much greater than their heaver counterparts. Diagnostic PAHs ratios suggest that cooking fuel and environmental tobacco smoke (ETS) contribute to the indoor PAHs profiles. Lead was the most abundant heavy metal in all sampled restaurants. High quantity of nickel was also found in samples due to the emissions from stainless-steel made kitchen utensils and cookware and ETS. Cancer risk assessments on the toxic substances demonstrate that the working environment of dining areas were hazard to health. Formation of reactive organic species (ROS) from the cooking activities was evidenced by measurement of hydroxyl radical (OH) formed from simulating particulate matter (PM) react with surrogate lung fluid. The highest OH concentration of 294.4ngm-3 was detected in Chinese Barbecue. In addition, the elevation of the concentrations of PM and OH after non-dining periods implies that the significance of formation of oxidizing-active species indoor at poor ventilation environments.

The risk of lung cancer among cooking adults: a meta-analysis of 23 observational studies.

PURPOSE: Cooking has been regarded as a potential risk factor for lung cancer. We aim to investigate the evidence of cooking oil fume and risk of lung cancer. METHODS: Medline and Embase were searched for eligible studies. We conducted a meta-analysis to summarize the evidences of case-control or cohort studies, with subgroup analysis for the potential discrepancy. Sensitivity analysis was employed to test the robustness. RESULTS: We included 23 observational studies, involving 9411 lung cancer cases. Our meta-analysis found that, for cooking female, the pooled OR of cooking oil fume exposure was 1.98 (95% CI 1.54, 2.54, I 2 = 79%, n = 15) among non-smoking population and 2.00 (95% CI 1.46, 2.74, I 2 = 75%, n = 10) among partly smoking population. For cooking males, the pooled OR of lung cancer was 1.15 (95% CI 0.71, 1.87; I 2 = 80%, n = 4). When sub grouped by ventilation condition, the pooled OR for poor ventilation was 1.20 (95% CI 1.10, 1.31, I 2 = 2%) compared to good ventilation. For different cooking methods, our results suggested that stir frying (OR = 1.89, 95% CI 1.23, 2.90; I 2 = 66%) was associated with increased risk of lung cancer while not for deep frying (OR = 1.41, 95% CI 0.87, 2.29; I 2 = 5%). Sensitivity analysis suggested our results were stable. CONCLUSION: Cooking oil fume is likely to be a risk factor for lung cancer for female, regardless of smoking status. Poor ventilation may increase the risk of lung cancer. Cooking methods may have different effect on lung cancer that deep frying may be healthier than stir frying.

Assessing Acute Symptoms Related to Occupational Exposures Among Nail Salon Technicians.

OBJECTIVE: This cross-sectional field study evaluated potential associations between acute symptoms among nail technicians and exposure of chemical hazards in New Jersey salons. METHODS: In 2016, an in-person safety and health survey was conducted. Data were gathered on symptoms, demographics, work history, tobacco use, area and/or task ventilation, use of personal protective equipment, and safety training. Workplace hazards were identified by observational survey during site visit walk-throughs. RESULTS: Of the 68 respondents from 40 participating salons whose owners agreed to participate (35% salon-level participation), most were Asian females with a self-reported history of work-associated eye, nose, throat, and skin symptoms. Few workers used personal protective equipment. Most workers had not received training in their primary language. CONCLUSIONS: Nail salon workers need comprehensive chemical use training. More research is needed to determine extent of exposure.

Risk factors of chronic obstructive pulmonary disease among adults in Chinese mainland: A systematic review and meta-analysis.

BACKGROUND: Identifying risk factors is a key point for preventive strategies to reduce the incidence of COPD. The aim of this systematic review and meta-analysis was to determine the most important risk factors for COPD among adults in Chinese Mainland, so as to provide some precautions and interventions on this disease and preventing further recurrences. METHODS: A comprehensive literature review relating to risk factors for COPD through PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and VIP database was conducted before March 31, 2017. Odds ratio (OR) with 95% confidence interval (CI) was calculated after data combination to assess the associations between risk factors and COPD. Heterogeneity between the studies was assessed by I2 and Cochran's Q test. Egger's test was used to assess publication bias. RESULTS: A total of 13893 participants (6383 cases and 7510 controls) from 19 case-controls studies were included. 12 risk factors with significant differences found between COPD and control groups were listed as follows: male sex (OR = 1.467; 95%CI: 1.097-1.962), smoking (OR = 2.092; 95%CI: 1.707-2.565), low educational level (OR = 1.609; 95%CI: 1.206-2.147), low BMI (OR = 3.831; 95%CI: 2.223-6.603), family history of respiratory disease (OR = 2.068; 95%CI: 1.466-2.918), allergy history (OR = 2.381; 95%CI: 1.385-4.093), respiratory infection during childhood (OR = 2.695; 95%CI: 1.504-4.828), recurrent respiratory infection (OR = 15.015; 95%CI: 4.538-49.684), occupational dust exposure (OR = 1.791; 95%CI: 1.151-2.788), biomass burning (OR = 2.218; 95%CI: 1.308-3.762), poor housing ventilation (OR = 3.993; 95%CI: 1.244-12.820), and living around polluted area (OR = 1.631; 95%CI: 1.202-2.214). CONCLUSION: Twelve risk factors are associated with the occurrence of COPD in Chinese Mainland, which can be used to distinguish high-risk population. Health education and promotion campaigns should be designed in order to minimize or prevent the occurrence of COPD in Chinese Mainland.

Medical interventions and survival by gender of children with trisomy 18.

Research has typically shown limited aggressive medical interventions and low survival rates for children with full trisomy 18. Recent studies provide more positive results. This study examined 82 children with full trisomy 18 drawn from the Tracking Rare Incidence Syndromes (TRIS) project database. Children were classified into three groups according to the highest intervention received: "hospice or no intervention" (n = 5, 6.1%), "necessary interventions (enteral feeding, ventilator use)" (n = 46, 56.1%), and "aggressive interventions (surgery)" (n = 31, 37.8%). Seven of 14 male children (50%) and 52 of 68 female children (76.5%) were living at the time of survey completion. Additionally, information about any interventions used during the care of these children was also provided. It was found that three males (37.5%) and 28 females (48.3%) had used hospice care at some point; 12 males (85.7%) and 61 females (89.7%) received enteral feeding at some point; 7 males (58.3%) and 25 females (38.5%) had ventilator; and 7 males (50%) and 33 females (48.5%) underwent some form of surgery. These results suggest improved outcomes when given necessary and aggressive medical interventions. Implications and recommendations for further research are provided. © 2016 Wiley Periodicals, Inc.

Estimated effect of ventilation and filtration on chronic health risks in U.S. offices, schools, and retail stores.

We assessed the chronic health risks from inhalation exposure to volatile organic compounds (VOCs) and particulate matter (PM2.5) in U.S. offices, schools, grocery, and other retail stores and evaluated how chronic health risks were affected by changes in ventilation rates and air filtration efficiency. Representative concentrations of VOCs and PM2.5 were obtained from available data. Using a mass balance model, changes in exposure to VOCs and PM2.5 were predicted if ventilation rate were to increase or decrease by a factor of two, and if higher efficiency air filters were used. Indoor concentrations were compared to health guidelines to estimate percentage exceedances. The estimated chronic health risks associated with VOC and PM2.5 exposures in these buildings were low relative to the risks from exposures in homes. Chronic health risks were driven primarily by exposures to PM2.5 that were evaluated using disease incidence of mortality, chronic bronchitis, and non-fatal stroke. The leading cancer risk factor was exposure to formaldehyde. Using disability-adjusted life years (DALYs) to account for both cancer and non-cancer effects, results suggest that increasing ventilation alone is ineffective at reducing chronic health burdens. Other strategies, such as pollutant source control and the use of particle filtration, should also be considered.

Risk factors of childhood asthma in children attending Lyari General Hospital.

OBJECTIVE: To determine the factors associated with asthma in children. METHODS: The case-control study was conducted in the paediatrics clinic of Lyari General Hospital, Karachi, from May to October 2010. Children 1-15 years of age attending the clinic represented the cases, while the control group had children who were closely related (sibling or cousin) to the cases but did not have the symptoms of disease at the time. Data was collected through a proforma and analysed using SPSS 10. RESULTS: Of the total 346 subjects, 173(50%) each comprised the two groups. According to univariable analysis the risk factors were presence of at least one smoker (odds ratio: 3.6; 95% confidence interval: 2.3-5.8), resident of kacha house (odds ratio: 16.2; 95% confidence interval: 3.8-69.5),living in room without windows (odds ratio: 9.3; 95% confidence interval: 2.1-40.9) and living in houses without adequate sunlight (odds ratio: 1.6; 95% confidence interval: 1.2-2.4).Using multivariable modelling, family history of asthma (odds ratio: 5.9; 95% confidence interval: 3.1-11.6), presence of at least one smoker at home (odds ratio: 4.1; 95% confidence interval: 2.3-7.2), people living in a room without a window (odds ratio: 5.5; 95% confidence interval: 1.15-26.3) and people living in an area without adequate sunlight (odds ratio: 2.2; 95% confidence interval: 1.13-4.31) were found to be independent risk factors of asthma in children adjusting for age, gender and history of weaning. CONCLUSIONS: Family history of asthma, children living with at least one smoker at home, room without windows and people living in an area without sunlight were major risk factors of childhood asthma.

Non-smoker exposure to secondhand cannabis smoke II: Effect of room ventilation on the physiological, subjective, and behavioral/cognitive effects.

INTRODUCTION: Cannabis is the most widely used illicit drug. Many individuals are incidentally exposed to secondhand cannabis smoke, but little is known about the effects of this exposure. This report examines the physiological, subjective, and behavioral/cognitive effects of secondhand cannabis exposure, and the influence of room ventilation on these effects. METHODS: Non-cannabis-using individuals were exposed to secondhand cannabis smoke from six individuals smoking cannabis (11.3% THC) ad libitum in a specially constructed chamber for 1h. Chamber ventilation was experimentally manipulated so that participants were exposed under unventilated conditions or with ventilation at a rate of 11 air exchanges/h. Physiological, subjective and behavioral/cognitive measures of cannabis exposure assessed after exposure sessions were compared to baseline measures. RESULTS: Exposure to secondhand cannabis smoke under unventilated conditions produced detectable cannabinoid levels in blood and urine, minor increases in heart rate, mild to moderate self-reported sedative drug effects, and impaired performance on the digit symbol substitution task (DSST). One urine specimen tested positive at using a 50 ng/ml cut-off and several specimens were positive at 20 ng/ml. Exposure under ventilated conditions resulted in much lower blood cannabinoid levels, and did not produce sedative drug effects, impairments in performance, or positive urine screen results. CONCLUSIONS: Room ventilation has a pronounced effect on exposure to secondhand cannabis smoke. Under extreme, unventilated conditions, secondhand cannabis smoke exposure can produce detectable levels of THC in blood and urine, minor physiological and subjective drug effects, and minor impairment on a task requiring psychomotor ability and working memory.

Asthma and respiratory symptoms among hairdressers in Denmark: results from a register based questionnaire study.

BACKGROUND: Hairdressers are at risk of developing occupational respiratory disorders due to persulfates and other hairdressing chemicals. METHODS: A register based questionnaire study comprising 7,840 graduates from hairdressing vocational schools was conducted. The postal questionnaire concerned self-reported asthma, airway symptoms, occupation, smoking, and atopic dermatitis. RESULTS: A response rate of 67.9% was obtained. The hairdressers reported asthma (11.2%), cough (25.3%), nasal congestion (24.0%), and rhinitis (18.2%). Less than 1/3 of all hairdressers with suspected occupational asthma reported their asthma as an occupational disease to the authorities. In total, 27.3% were daily smokers; the smoking pattern was similar between hairdressers with and without asthma. Local exhaust ventilation was only used consistently by 63.8% for permanent waving and hair coloring procedures. CONCLUSIONS: Asthma and especially respiratory symptoms were commonly reported by hairdressers, but rarely reported as an occupational disease. Local exhaust ventilation was inconsistently used. Our results underline the need for improved measures to ascertain and prevent occupational asthma in hairdressers.

Risk factors for wheezing in infants born in Cuba.

BACKGROUND: Cuba is a unique country, and despite limited economic development, has an excellent health system. However, the prevalence of asthma symptoms in children in Havana, Cuba, is unusually high. AIM: As early life exposures are critical to the aetiology of asthma, we have studied environmental influences on the risk of wheezing in Cuban infants. DESIGN: Cross-sectional study. METHODS: A random sample of 2032 children aged 12-15 months living in Havana was selected for inclusion in the cohort. Data were collected using questionnaires administered by researchers. RESULTS: Of 2032 infants invited to participate, 1956 (96%) infants provided data. The prevalence of any wheeze was 45%, severe wheeze requiring use of emergency services was 30% and recurrent wheeze on three or more occasions was 20%. The largest adjusted risk factors for any wheeze were presence of eczema [odds ratio (OR) 2.09; 95% confidence interval (CI) 1.48-2.94], family history of asthma (OR 2.05; 95% CI 1.60-2.62), poor ventilation in the house (OR 1.99; 95% CI 1.48-2.67), attendance at nursery (OR 1.78; 95% CI 1.24-2.57), male sex (OR1.52; 95% CI 1.19-1.96) and the number of smokers in the house (P < 0.03 for trend), OR 1.64 (95% CI 1.17-2.31) for three or more smokers in the house compared to no smokers in the household. CONCLUSION: We have identified several risk factors for any wheeze in young infants living in modern day Cuba. As the prevalence of smoking in the house is high (51%), intervention studies are required to determine effective strategies to improve infant health.

Fine particle air pollution and secondhand smoke exposures and risks inside 66 US casinos.

Smoking bans often exempt casinos, exposing occupants to fine particles (PM(2.5)) from secondhand smoke. We quantified the relative contributions to PM(2.5) from both secondhand smoke and infiltrating outdoor sources in US casinos. We measured real-time PM(2.5), particulate polycyclic aromatic hydrocarbons (PPAH), and carbon dioxide (CO(2)) (as an index of ventilation rate) inside and outside 8 casinos in Reno, Nevada. We combined these data with data from previous studies, yielding a total of 66 US casinos with smoking in California, Delaware, Nevada, New Jersey, and Pennsylvania, developing PM(2.5) frequency distributions, with 3 nonsmoking casinos for comparison. Geometric means for PM(2.5) were 53.8 µg/m(3) (range 18.5-205 µg/m(3)) inside smoking casinos, 4.3 µg/m(3) (range 0.26-29.7 µg/m(3)) outside those casinos, and 3.1 µg/m(3) (range 0.6-9 µg/m(3)) inside 3 nonsmoking casinos. In a subset of 21 Reno and Las Vegas smoking casinos, PM(2.5) in gaming areas averaged 45.2 µg/m(3) (95% CI, 37.7-52.7 µg/m(3)); adjacent nonsmoking casino restaurants averaged 27.2 µg/m(3) (95% CI, 17.5-36.9 µg/m(3)), while PM(2.5) outside the casinos averaged 3.9 µg/m(3) (95% CI, 2.5-5.3 µg/m(3)). For a subset of 10 Nevada and Pennsylvania smoking casinos, incremental (indoor-outdoor) PM(2.5) was correlated with incremental PPAH (R(2)=0.79), with ventilation rate-adjusted smoker density (R(2)=0.73), and with smoker density (R(2)=0.60), but not with ventilation rates (R(2)=0.15). PPAH levels in 8 smoking casinos in 3 states averaged 4 times outdoors. The nonsmoking casinos' PM(2.5) (n=3) did not differ from outdoor levels, nor did their PPAH (n=2). Incremental PM(2.5) from secondhand smoke in approximately half the smoking casinos exceeded a level known to produce cardiovascular morbidity in nonsmokers after less than 2h of exposure, posing acute health risks to patrons and workers. Casino ventilation and air cleaning practices failed to control secondhand smoke PM(2.5). Drifting PM(2.5) from secondhand smoke contaminated unseparated nonsmoking areas. Smoke-free casinos reduced PM(2.5) to the same low levels found outdoors.

Chronic obstructive pulmonary disease in the absence of chronic bronchitis in China.

BACKGROUND AND OBJECTIVE: COPD has a variable natural history and not all individuals follow the same course. The aim of this study was to assess the prevalence of COPD in the absence of chronic bronchitis (CB) based on a population survey in China, and to identify the determinants of CB in patients with COPD. METHODS: A multi-stage cluster sampling strategy was used to survey a population from seven different provinces/cities of China. All residents over 40 years of age were interviewed using a standardized questionnaire and spirometry was measured. A post-bronchodilator FEV(1)/FVC < 70% was defined as the diagnostic criterion for COPD. All COPD patients who were screened were divided into two groups according to the presence or absence of CB. RESULTS: Of the population of 20,245 that was surveyed, 70% of the 1668 patients who were diagnosed with COPD reported no history of CB. The ages, BMI and comorbidities of COPD patients with or without CB were similar. Male gender, residence in a rural area, having a lower level of education, exposure to tobacco smoke or biomass fuels, poor ventilation in the kitchen and a family history of respiratory disease were all associated with a higher risk of COPD with CB. Patients without CB had less difficulty in walking and higher FEV(1)/FVC values than patients with CB, but were more likely to be underdiagnosed. The strongest predictors of CB were male gender, current smoking and severity of dyspnoea. CONCLUSIONS: This survey confirmed that there is a high prevalence of COPD in the absence of CB in China. It appears that CB is not essential to the diagnosis of COPD.

Secondhand smoke in Pennsylvania casinos: a study of nonsmokers' exposure, dose, and risk.

OBJECTIVES: I assessed air pollution, ventilation, and nonsmokers' risk from secondhand smoke (SHS) in Pennsylvania casinos exempted from a statewide smoke-free workplace law. METHODS: I measured respirable suspended particles (RSPs), particulate polycyclic aromatic hydrocarbons (PPAHs), and carbon dioxide inside and outside casinos; measured changes in patrons' urine cotinine after casino visits; and assessed SHS impact on workers and patrons, using exposure-response models, air quality standards, and odor and irritation thresholds. RESULTS: PPAH and RSP concentrations in casinos were, on average, 4 and 6 times, respectively, that of outdoor levels despite generous ventilation and low smoking prevalence. SHS infiltrated into nonsmoking gaming areas. Patrons' urine cotinine increased 1.9 ng/mL on average after about 4-hour visits. CONCLUSIONS: SHS-induced heart disease and lung cancer will cause an estimated 6 Pennsylvania casino workers' deaths annually per 10,000 at risk, 5-fold the death rate from Pennsylvania mining disasters. Casinos should not be exempt from smoke-free workplace laws.

[Association between indoor contamination and respiratory diseases in children living in Temuco and Padre Las Casas, Chile]. / Fuentes de contaminación intradomiciliaria y enfermedad respiratoria en jardines infantiles y salas cunas de Temuco y Padre Las Casas, Chile.

BACKGROUND: Indoor air pollution, is the main cause of population exposure to polluting agents. AIM: To establish an environmental profile of indoor contamination emission sources in families of children under 5 years that assist to kindergartens in Temuco and Padre Las Casas. To associate respiratory disease episodes in children with indoor contamination. MATERIAL AND METHODS: Cross sectional analysis of 355 family groups subjected to questionnaires about indoor contamination and number of respiratory disease episodes. RESULTS: Forty six percent of mothers or caregivers smoked, 37% smoked at home and 93% smoked one to two cigarettes per day. There was a significant association between respiratory diseases in children and drying clothes in the kitchen, using firewood for heating and the presence of humidity in the dwelling. Mothers identified as indoor contaminants the use of braziers in 76% of cases and firewood stoves in 24%. Ninety seven percent considered that these appliances were detrimental for respiratory health. CONCLUSIONS: The lack of awareness about indoor contamination among subjects of low socioeconomic status should prompt educational campaigns to modify behaviors in their dwellings.