Indoor fungal diversity and asthma: a meta-analysis and systematic review of risk factors.

BACKGROUND: Indoor dampness increases the risk of indoor fungal growth. A complex interaction between occupant behaviors and the built environment are thought to affect indoor fungal concentrations and species diversity, which are believed to increase the risk of having asthma, exacerbation of asthma symptoms, or both. To date, no systematic review has investigated this relationship. OBJECTIVE: This review aims to assess the relationship between exposure to indoor fungi identified to the genera or species level on asthma outcomes in children and adults. METHODS: Ten databases were systematically searched on April 18, 2013, and limited to articles published since 1990. Reference lists were independently screened by 2 reviewers, and authors were contacted to identify relevant articles. Data were extracted from included studies meeting our eligibility criteria by 2 reviewers and quality assessed by using the Newcastle-Ottawa scale designed for assessment of case-control and cohort studies. RESULTS: Cladosporium, Alternaria, Aspergillus, and Penicillium species were found to be present in higher concentrations in homes of asthmatic participants. Exposure to Penicillium, Aspergillus, and Cladosporium species were found to be associated with increased risk of reporting asthma symptoms by a limited number of studies. The presence of Cladosporium, Alternaria, Aspergillus, and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates. Studies were of medium quality and showed medium-high heterogeneity, but evidence concerning the specific role of fungal species was limited. CONCLUSION: Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.

Physically equivalent temperature and mental and behavioural disorders in Germany in 2009-2011.

BACKGROUND: We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to common mental and behavioural disorders in a national setting in recent years. METHODS: This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified F01-F51 mental ad behavioural disorders by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations covering 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). We then plotted two-way fractional-polynomial regression. RESULTS: For the most subtypes, the highest admissions were recorded in spring. There were small peaks in autumn or late winter for a few subtypes as well. Admissions of delirium peaked when PET was at 0 °C. Admissions of personality disorders peaked at the coldest - when PET was at -10 °C. Admissions of schizophrenia and nonorganic sleep disorder peaked when PETs were between 0 and -10 °C while admissions of eating disorders dropped when PETs were above 10 °C. Admissions of depression and anxiety disorder did not vary much across PETs. Moreover, admissions of reaction to stress and dissociate disorder peaked when PETs were between 0 and 10 °C as well. CONCLUSIONS: More medical resources could have been needed for mental health on days when PETs were <10 °C than on other days.

Hospital admissions due to diseases of arteries and veins peaked at physiological equivalent temperature -10 to 10 °C in Germany in 2009-2011.

We aimed to understand relationships of the weather as biometeorological and hospital admissions due to diseases of arteries and veins by subtypes, which have been scarcely studied, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1,618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I70-I79 Diseases of arteries, arterioles and capillaries and I80-I89 Diseases of veins, lymphatic vessels and lymph nodes by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German states including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95 % confidence intervals. For most of the subtypes from diseases of arteries and veins, hospital admissions slightly peaked in spring and dropped when PET was at 10 °C. There were no other large differences across 12 months. Admissions of peripheral vascular diseases, arterial embolism and thrombosis, phlebitis and thrombophlebitis, oesophageal varices and nonspecific lymphadenitis peaked when PET was between 0 and -10 °C, while others peaked when PET was between 0 and 10 °C. More medical resources could have been needed on days when PETs were at -10 to 10 °C than on other days. Adaptation to such weather change for health professionals and the general public would seem to be imperative.

Hospital admissions of hypertension, angina, myocardial infarction and ischemic heart disease peaked at physiologically equivalent temperature 0°C in Germany in 2009-2011.

We aimed to understand and to provide evidence on relationships of the weather as biometeorological and hospital admissions due to hypertension, angina, myocardial infarction and ischemic heart disease in a national setting in recent years that might help indicate when to expect more admissions for health professionals and the general public. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I11 hypertensive heart disease, I13 hypertensive heart and renal disease, I15 secondary hypertension, I20 angina pectoris, I21 acute myocardial infarction and I25 chronic ischemic heart disease by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95% confidence intervals. Hospital admissions of hypertension, angina, myocardial infarction, heart disease peaked in winter and early spring when PETs were around 0°C. Admissions had an apparent drop when PETs reached 10°C. More medical resources could have been needed on days when PETs were around 0°C than on other days. While adaptation to such weather change for health professionals and the general public would seem to be imperative, future research with a longitudinal monitoring would still be needed.

Relationships of physiologically equivalent temperature and hospital admissions due to I30-I51 other forms of heart disease in Germany in 2009-2011.

We aimed to understand relationships of the weather as biometeorological and hospital admissions due to other forms of heart disease by subtypes, which have been paid less attention, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions of the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I30-I51 other forms of heart disease by the International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that have covered 13 German states, including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure, were obtained and generated into physiologically equivalent temperature (PET). Admissions due to other diseases of pericardium, nonrheumatic mitral valve disorders, nonrheumatic aortic valve disorders, cardiomyopathy, atrioventricular and left bundle-branch block, other conduction disorders, atrial fibrillation and flutter, and other cardiac arrhythmias peaked when PET was between 0 and 10 °C. Complications and ill-defined descriptions of heart disease admissions peaked at PET 0 °C. Cardiac arrest and heart failure admissions peaked when PET was between 0 and -10 °C while the rest did not vary significantly. A common drop of admissions was found when PET was above 10 °C. More medical resources could have been needed for heart health on days when PETs were <10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative.

Inverted U-shape relationships of the weather as biometeorological and hospital admissions due to carcinoma in situ and benign neoplasm in Germany in 2009-2011.

We aimed to understand the relationships of the weather as biometeorological and hospital admissions due to carcinoma in situ and benign neoplasms, which have been less paid attention to, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January, 2009 and 31 December, 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified D00-D48 in situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behaviour by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German states including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). For most subtypes, peaks of admissions were observed in spring and late autumn. There could be four groups of phenomenon among these admissions. To be specific, D06, D16, D21, D24-25, D35 and D39 peaked when PET was at 0 °C. D46 peaked when PET was at 5-10 °C. D03, D04 and D33 had linear relationships. Other admissions peaked when PET was between 0 and 5 °C. All admissions were in common with a drop when PET reached 10 °C or higher. More medical resources could have been needed on days when PETs were at 0-10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative.