Arsenic Methyltransferase and Apolipoprotein E Polymorphism in Pregnant Women Exposed to Inorganic Arsenic in Drinking Water in Western Romania.

Previous studies have shown that inorganic arsenic (iAs) exposure may be associated with genotoxic and cytotoxic effects. The aim of this study was to evaluate the relationship between several polymorphisms in AS3MT and APOE genes and urinary As and the relationship between these polymorphisms and pregnancy loss. We determined urinary As concentrations and performed genotyping analysis in 50 cases of spontaneous pregnancy loss and 50 controls, matched to cases on gestational age. The most frequently identified AS3MT polymorphisms in both cases and controls were in rs10748835 (80% cases and 68% controls), rs3740400 (78% cases and 64% controls), rs7085104 (74% cases and 48% controls), and rs1046778 (62% cases and 54% controls). We identified 30 different haplotypes in AS3MT SNPs, with four predominant haplotypes (>8%). Cases with Haplotype 1 had four-fold higher urinary DMA and two-fold higher MMA concentration than those without this haplotype, the MMA levels were lower in cases and controls with Haplotype 4 compared to Haplotype 1, and the DMA levels were significantly lower in cases with Haplotype 4 compared to Haplotype 3. Cases with Haplotype 1 had higher levels of all analyzed biomarkers, suggesting that Haplotype 1 may be associated with greater exposure to iAs and tobacco smoke. Our results suggest the importance of the AS3MT gene in iAs metabolism among pregnant women with low-level drinking water iAs exposure.

Differential effect of the duration of exposure on the carcinogenicity of cadmium in MCF10A mammary epithelial cells.

The carcinogenic role of cadmium (Cd2+) in breast cancer is still debatable. Current data points to duration of exposure as the most important element. In our study, we designed an in vitro model to investigate the effects of 3 weeks versus 6 weeks of low-level CdCl2 exposure on MCF10A cells. Our results demonstrated that after 3 weeks of CdCl2 exposure the cells displayed significant changes in the DNA integrity, but there was no development of malignant features. Interestingly, after 6 weeks of exposure, the cells significantly increased their invasion, migration and colony formation capacities. Additionally, MCF10A cells exposed for 6 weeks to CdCl2 had many dysregulated genes (4905 up-regulated and 4262 down-regulated). As follows, Cd-induced phenotypical changes are accompanied by a profound modification of the transcriptomic landscape. Furthermore, the molecular alterations driving carcinogenesis in MCF10A cells exposed to CdCl2 were found to be influenced by the duration of exposure, as in the case of MEG8. This long non-coding RNA was down-regulated at 3 weeks, but up-regulated at 6 weeks of exposure. In conclusion, even very low levels of Cd (0.5 µM) can have significant carcinogenic effects on breast cells in the case of subchronic exposure.

Urinary arsenic and spontaneous pregnancy loss - a hypothesis-generating case-control investigation in western Romania.

Arsenic occurs as a natural contaminant of drinking water supplies in arsenic endemic areas, posing a threat to public health. Our aim was to evaluate the relationship between urinary arsenic concentrations and spontaneous pregnancy loss in a population with low-moderate level drinking water arsenic exposure (mostly <10 µg/L). We enrolled 150 women with incident spontaneous pregnancy losses and 150 controls with ongoing pregnancies matched by gestational age. We measured arsenic species in urine using high performance liquid chromatography paired to inductively coupled plasma mass spectrometry. Urinary arsenic was not related to spontaneous pregnancy loss in conditional logistic regression models adjusted for confounding factors. However, a 10 µg/L increase in urinary arsenic (III + V) salt concentrations was associated with 8.00-fold (95% CI: 0.68, 3.35 × 105) greater odds of spontaneous loss among women using prenatal vitamins in an interaction model (P for interaction = 0.07), although the effect estimate was imprecise. In an additional interaction model, prenatal vitamin use was associated with lower odds of loss (OR = 0.30; 95% CI: 0.13, 0.66), although the association was diminished in the presence of a 10 µg/L increase in urinary inorganic arsenic (OR = 0.44; 95% CI: 0.70, 3.22). Total urinary arsenic was associated with 1.48-fold (95% CI: 0.20, 11.35) greater odds for loss among women with urinary cotinine >50 µg/L in another interaction model (P for interaction = 0.07). These results suggest a potential modest increase in the odds of pregnancy loss associated with increased total urinary arsenic among women smoking during pregnancy (urinary cotinine >50 µg/L). Prenatal vitamin use may act as a protective factor for arsenic exposure associated pregnancy loss, but appears to be less protective with increasing urinary inorganic arsenic concentrations.

Health effects of air pollutant mixtures (volatile organic compounds, particulate matter, sulfur and nitrogen oxides) - a review of the literature.

The health risks associated with individual air pollutant exposures have been studied and documented, but in real-life, the population is exposed to a multitude of different substances, designated as mixtures. A body of literature on air pollutants indicated that the next step in air pollution research is investigating pollutant mixtures and their potential impacts on health, as a risk assessment of individual air pollutants may actually underestimate the overall risks. This review aims to synthesize the health effects related to air pollutant mixtures containing selected pollutants such as: volatile organic compounds, particulate matter, sulfur and nitrogen oxides. For this review, the PubMed database was used to search for articles published within the last decade, and we included studies assessing the associations between air pollutant mixtures and health effects. The literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A number of 110 studies were included in the review from which data on pollutant mixtures, health effects, methods used, and primary results were extracted. Our review emphasized that there are a relatively small number of studies addressing the health effects of air pollutants as mixtures and there is a gap in knowledge regarding the health effects associated with these mixtures. Studying the health effects of air pollutant mixtures is challenging due to the complexity of components that mixtures may contain, and the possible interactions these different components may have.

Emerging roles and mechanisms of semaphorins activity in cancer.

Semaphorins are regulatory molecules that are linked to the modulation of several cancer processes, such as angiogenesis, cancer cell invasiveness and metastasis, tumor growth, as well as cancer cell survival. Semaphorin (SEMA) activity depends on the cancer histotypes and their particularities. In broad terms, the effects of SEMAs result from their interaction with specific receptors/co-receptors - Plexins, Neuropilins and Integrins - and the subsequent effects upon the downstream effectors (e.g. PI3K/AKT, MAPK/ERK). The present article serves as an integrative review work, discussing the broad implications of semaphorins in cancer, focusing on cell proliferation/survival, angiogenesis, invasion, metastasis, stemness, and chemo-resistance/response whilst highlighting their heterogeneity as a family. Herein, we emphasized that semaphorins are largely implicated in cancer progression, interacting with the tumor microenvironment components. Whilst some SEMAs (e.g. SEMA3A, SEMA3B) function widely as tumor suppressors, others (e.g. SEMA3C) act as pro-tumor semaphorins. The differences observed in terms of the biological structure of SEMAs and the particularities of each cancer histotypes require that each semaphorin be viewed as a unique entity, and its roles must be researched accordingly. A more in-depth and comprehensive view of the molecular mechanisms that promote and sustain the malignant behavior of cancer cells is of utmost importance.

Specific lifestyle factors and in vitro fertilization outcomes in Romanian women: a pilot study.

Background: Infertility is an important health concern worldwide. Although lifestyle habits and behaviors have been widely reported as predictors of IVF outcomes by previous studies, they have not been reported for Romanian women undergoing IVF. In this regard, our pilot study aimed to begin to address the data gap by assessing lifestyle predictors of in vitro fertilization (IVF) outcomes in Romanian women. Study design: Our pilot study included 35 participants who completed a first IVF cycle at a single infertility center. We evaluated individual self-reported lifestyle habits and behaviors as predictors of IVF outcomes, and employed principal component analysis (PCA) to characterize multiple lifestyle habits and behaviors into personal care product (PCP) use, and healthy diet and physical activity patterns as predictors of IVF outcomes. Results: Our PCA analysis showed that greater use of PCPs was associated with lower probabilities of pregnancy (RR: 0.92, 95% CI [0.87-0.98]) and live birth (RR: 0.94, 95% CI [0.88-1.01]) while, the healthy dietary habits and physical activity were associated with a higher likelihood of pregnancy, although without statistical significance (RR: 1.10, 95% CI [0.93-1.30]). Conclusions: In this pilot study we identified associations between IVF outcomes among Romanian women and certain lifestyle habits and behaviors including stress, diet and physical activity, and certain PCP use. We also estimated the joint effects of multiple lifestyle factors using PCA and found that PCP use, healthy dietary habits and physical activity were associated with IVF outcomes.

Development of a New Eco-Friendly Copolymer Based on Chitosan for Enhanced Removal of Pb and Cd from Water.

Worldwide, concerns about heavy metal contamination from manmade and natural sources have increased in recent decades. Metals released into the environment threaten human health, mostly due to their integration into the food chain and persistence. Nature offers a large range of materials with different functionalities, providing also a source of inspiration for scientists working in the field of material synthesis. In the current study, a new type of copolymer is introduced, which was synthesized for the first time by combining chitosan and poly(benzofurane-co-arylacetic acid), for use in the adsorption of toxic heavy metals. Such naturally derived materials can be easily and inexpensively synthesized and separated by simple filtration, thus becoming an attractive alternative solution for wastewater treatment. The new copolymer was investigated by solid-state nuclear magnetic resonance, thermogravimetric analysis, scanning electron microscopy, Fourier transform infrared spectroscopy, and X-ray photon electron microscopy. Flame atomic absorption spectrometry was utilized to measure heavy metal concentrations in the investigated samples. Equilibrium isotherms, kinetic 3D models, and artificial neural networks were applied to the experimental data to characterize the adsorption process. Additional adsorption experiments were performed using metal-contaminated water samples collected in two seasons (summer and winter) from two former mining areas in Romania (Roșia Montana and Novaț-Borșa). The results demonstrated high (51-97%) adsorption efficiency for Pb and excellent (95-100%) for Cd, after testing on stock solutions and contaminated water samples. The recyclability study of the copolymer indicated that the removal efficiency decreased to 89% for Pb and 58% for Cd after seven adsorption-desorption cycles.

Targeting Cell Death Mechanism Specifically in Triple Negative Breast Cancer Cell Lines.

Triple negative breast cancer (TNBC) is currently associated with a lack of treatment options. Arsenic derivatives have shown antitumoral activity both in vitro and in vivo; however, their mode of action is not completely understood. In this work we evaluate the response to arsenate of the double positive MCF-7 breast cancer cell line as well as of two different TNBC cell lines, Hs578T and MDA-MB-231. Multimodal experiments were conducted to this end, using functional assays and microarrays. Arsenate was found to induce cytoskeletal alteration, autophagy and apoptosis in TNBC cells, and moderate effects in MCF-7 cells. Gene expression analysis showed that the TNBC cell lines' response to arsenate was more prominent in the G2M checkpoint, autophagy and apoptosis compared to the Human Mammary Epithelial Cells (HMEC) and MCF-7 cell lines. We confirmed the downregulation of anti-apoptotic genes (MCL1, BCL2, TGFß1 and CCND1) by qRT-PCR, and on the protein level, for TGFß2, by ELISA. Insight into the mode of action of arsenate in TNBC cell lines it is provided, and we concluded that TNBC and non-TNBC cell lines reacted differently to arsenate treatment in this particular experimental setup. We suggest the future research of arsenate as a treatment strategy against TNBC.

Predicting environmental risk factors in relation to health outcomes among school children from Romania using random forest model - An analysis of data from the SINPHONIE project.

BACKGROUND: Few studies have simultaneously assessed the health impact of school and home environmental factors on children, since handling multiple highly correlated environmental variables is challenging. In this study, we examined indoor home and school environments in relation to health outcomes using machine learning methods and logistic regression. METHODS: We used the data collected by the SINPHONIE (Schools Indoor Pollution and Health: Observatory Network in Europe) project in Romania, a multicenter European research study that collected comprehensive information on school and home environments, health symptoms in children, smoking, and school policies. The health outcomes were categorized as: any health symptoms, asthma, allergy and flu-like symptoms. Both logistic regression and random forest (RF) methods were used to predict the four categories of health outcomes, and the methods prediction performance was compared. RESULTS: The RF method we employed for analysis showed that common risk factors for the investigated categories of health outcomes, included: environmental tobacco smoke (ETS), dampness in the indoor school environment, male gender, air freshener use, residence located in proximity of traffic (<200 m), stressful schoolwork, and classroom noise (contributions ranged from 7.91% to 23.12%). Specificity, accuracy and area under the curve (AUC) values for most outcomes were higher when using RF compared to logistic regression, while sensitivity was similar in both methods. CONCLUSION: This study suggests that ETS, dampness in the indoor school environment, use of air fresheners, living in proximity to traffic (<200 m) and noise are common environmental risk factors for the investigated health outcomes. RF pointed out better predictive values, sensitivity and accuracy compared to logistic regression.

The expression of copper transporters associated with the ototoxicity induced by platinum-based chemotherapeutic agents.

BACKGROUND: Antitumor agents based on platinum have gained a well-established place in the treatment of several forms of cancer. Their efficiency is hampered by serious toxic effects against healthy tissues as well. Ototoxicity is a serious side effect leading to hearing impairment and represents an important issue affecting the patients' quality of life. The currently used platinum chemotherapeutics exert different toxicity towards cochlear cells. The aim of our study was to answer some questions regarding the differential uptake and cellular pharmacodynamics of Cisplatin (CDDP), Carboplatin (CBDCA) and Oxaliplatin (L-OHP) in the HEI-OC1 cochlear cell line. METHODS: We studied the expression of copper transporters CTR1, ATP7A and ATP7B which are presumably involved in the uptake, cellular transport and efflux of platinum compounds by immunofluorescence microscopy and flow-cytometry. The cellular uptake of the compounds was evaluated through the determination of intracellular platinum concentration by atomic absorption spectroscopy. The effects of the treatment of HEI-OC1 cells with platinum compounds were also evaluated: cytotoxicity with the Cell Titer Blue viability test, formation of reactive oxygen species with 2',7' -dichlorofluorescein diacetate, genotoxicity with the comet assay and apoptosis with the cleaved PARP ELISA test. RESULTS: CTR1, ATP7A and ATP7B were all expressed by HEI-OC1 cells. The treatment with the platinum compounds led to a modulation of their expression, manifested in a differential platinum uptake. Treatment with Cisplatin led to the highest intracellular concentration of platinum compared to Oxaliplatin and Carboplatin at the same dose. Treatment with CuSO4 reduced platinum uptake of all the compounds, significantly in the case of Cisplatin and Carboplatin. CDDP was the most cytotoxic against HEI-OC1 cells, with an IC50 = 65.79  µM, compared to 611.7 µM for L-OHP and 882.9 µM for CBDCA, at the same molar concentration. The production of ROS was the most intense after CDDP, followed by L-OHP and CBDCA. In the comet assay, at the 100 µM concentration, L-OHP and CBDCA induced DNA adducts while CDDP induced adducts as well as DNA strand breaks. CBDCA and L-OHP lead to a significant increase of cleaved PARP at 24h (p < 0.001), suggesting an important apoptotic process induced by these compounds at the used concentrations. CONCLUSIONS: The results obtained in the current study suggest that the modulation of copper transporters locally may represent a new strategy against platinum drugs ototoxicity.

Interactions between dietary habits and home environmental exposures on respiratory symptoms in Romanian school children: an analysis of data from the SINPHONIE project.

In this study, we investigated the interactions between household pollutants and dietary habits on children's respiratory health. Our cross-sectional study collected self-reported information including health symptoms (allergy-like, asthma-like, and flu-like symptoms), home characteristics, dietary habits, and demographic information from questionnaires administered to parents of 280 school children in Romania. Unconditional logistic regression and stratified analyses were used to assess the interactions between dietary factors and environmental exposures on health symptoms among children, controlling for sociodemographic characteristics and co-exposures. We found that frequency of fruit consumption had significant interaction with residing near heavy traffic on allergy-like symptoms among children (p = 0.036). However, no association was observed by frequency of fruit consumption. Although no significant interaction was observed, we found that students with infrequent fruit consumption and residing near heavy traffic roads had elevated odds of asthma-like (POR 6.37; 95% CI 1.22, 33.29) and flu-like symptoms (POR 3.75; 95% CI 1.12, 11.86) than those who frequently consumed fruits. Likewise, low vegetable consumption was associated with increased asthma-like symptoms (POR 2.93; 95% CI 1.04, 8.24). Increased odds of asthma-like symptoms were observed among school children that resided near heavy traffic roads and frequently consumed milk (POR 2.80; 95% CI 1.24, 6.31) and yoghurt (POR 2.86; 95% CI 1.05, 7.75) compared to those that infrequently consumed dairy. Our findings suggest that frequent fruit and vegetable consumption may mitigate the negative effects of exposure to heavy traffic near dwelling on respiratory symptoms in Romanian children.

Biological and molecular modifications induced by cadmium and arsenic during breast and prostate cancer development.

Breast and prostate cancer are two of the most common malignancies worldwide. Both cancers can develop into hormone -dependent or -independent subtypes and are associated to environmental exposure in the context of an inherited predisposition. As and Cd have been linked to the onset of both cancers, with the exception of As, which lacks a definitive association with breast carcinogenesis. The two elements exert an opposite effect dependent on acute versus chronic exposure. High doses of As or Cd were shown to induce cell death in acute experimental exposure, while chronic exposure triggers cell proliferation and viability, which is no longer limited by telomere shortening and apoptosis. The chronically exposed cells also increase their invasion capacity and tumorigenic potential. At molecular level, malignant transformation is evidenced mainly by up-regulation of BCL-2, MMP-2, MMP-9, VIM, Snail, Twist, MT, MLH and down-regulation of Casp-3, PTEN, E-CAD, and BAX. The signaling pathways most commonly activated are KRAS, p53, TGF-ß, TNF-α, WNT, NRF2 and AKT. This knowledge could potentially raise public awareness over the health risks faced by the human population living or working in a polluted environment and smokers. Human exposure to As and Cd should be minimize as much as possible. Healthcare policies targeting people belonging to these risk categories should include analysis of: DNA damage, oxidative stress, molecular alterations, and systemic level of heavy metals and of essential minerals. In this review, we present the literature regarding cellular and molecular alterations caused by exposure to As or Cd, focusing on the malignant transformation of normal epithelial cells after long-term intoxication with these two carcinogens.

Assessment of formaldehyde levels in relation to respiratory and allergic symptoms in children from Alba County schools, Romania.

Our study assessed the exposure to formaldehyde of Romanian school children in relation to the classroom indoor environment characteristics and respiratory and allergic symptoms reported in a questionnaire survey, using the data collected in the SINPHONIE (Schools Indoor Pollution and Health: Observatory Network in Europe) project. Measurements of formaldehyde and microclimate parameters were conducted in three classrooms per school, in five schools, together with one outdoor measurement at each school. Questionnaires were used to collect information on classroom characteristics and health effects among children. The indoor formaldehyde levels for a school week varied between 15.5 and 66.2 µg/m3, with a median value of 34.8 µg/m3. The adjusted odds ratios for allergy-like, asthma-like, and flu-like symptoms were 3.23 (95% CI 1.31-8.00), 2.69 (95% CI 1.04-6.97), and 2.39 (95% CI 1.04-5.50), respectively, when exposed to higher formaldehyde levels (≥ 35 µg/m3) during a school week, compared to lower formaldehyde level exposure (< 35 µg/m3). Higher levels of indoor formaldehyde were significantly associated with health symptoms in children. The high indoor formaldehyde levels were related to the use of water-resistant paint for ceiling coverings, moisture damage signs, and lower classroom natural ventilation rates.

Agreement between parental and student reports on respiratory symptoms and school environment in young Romanian children - evidence from the SINPHONIE project.

Background Environmental research involving children often relies on the self-report or parental report of symptoms and environmental issues. While previous studies explored the agreements between child and parental reports, few of them were conducted in younger children and in developing countries. In this study, we addressed the research gaps by assessing the agreement between child and parental report on respiratory symptoms and school environment in Romanian primary schools. Methods Two hundred and eighty students from five schools and their parents participated in this study. Information on child's respiratory symptoms and perceptions of school environment was collected via both student and parent questionnaires. Agreement between the two questionnaires was assessed by absolute agreement rates and kappa statistics. Prevalence index (PI), bias index (BI) and maximum attainable kappas were calculated to identify potential sources of disagreements. Results The agreement between student and parent questionnaires was low. Compared to the student's report, parents often reported more symptoms than their children, particularly flu-like symptoms, and school environment problems. Parent and child tend to agree when there was no symptom reported, but disagreements often occurred when symptoms were reported. After adjusting for the PI, the agreements for asthma and allergic symptoms improved substantially. Disagreement on reporting of flu-like symptoms was strongly affected by pre-existing causes, such as different understandings of the questions between students and parents. Conclusion Parental report may have a higher sensitivity in capturing a child's respiratory symptoms and school environment problems compared to self-report among young children in developing countries.

Telomere length, arsenic exposure and risk of basal cell carcinoma of skin.

Telomere length per se a heritable trait has been reported to be associated with different diseases including cancers. In this study, based on arsenic-exposed 528 cases with basal cell carcinoma (BCC) of skin and 533 healthy controls, we investigated effect of telomere length, measured by real-time PCR, on the disease risk. We observed a statistically significant association between decreased telomere length and increased BCC risk [odds ratio (OR) = 5.92, 95% confidence interval (CI) = 3.92 to 9.01, P < 0.0001]. Due to confounder effect of arsenic exposure, in a two-sample Mendelian randomization (MR), telomere length associated single-nucleotide polymorphisms as instrument variables violated valid assumptions; however, one-sample MR adjusted for arsenic exposure indicated an increased risk of BCC with short telomeres. The interaction between arsenic exposure and telomere length on BCC risk was statistically significant (P = 0.02). Within each tertile based on arsenic exposure, the individuals with shorter telomeres were at an increased risk of BCC, with highest risk being in the highest exposed group (OR = 16.13, 95% CI = 6.71 to 40.00, P < 0.0001), followed by those in medium exposure group and low exposure group. The combined effect of highest arsenic exposure and shortest telomeres on BCC risk (OR = 10.56, 95% CI = 5.14 to 21.70) showed a statistically significant departure from additivity (interaction contrast ratio 6.56, P = 0.03). Our results show that in the presence of arsenic exposure, decreased telomere length predisposes individuals to increased risk of BCC, with the effect being synergistic in individuals with highest arsenic exposure and shortest telomeres.

Assessment of heavy metals (total chromium, lead, and manganese) contamination of residential soil and homegrown vegetables near a former chemical manufacturing facility in Tarnaveni, Romania.

Our aim was to assess local population exposure to heavy metals resulting from soil and vegetable contamination in Tarnaveni, Romania, an area located near a former chemical factory. We collected residential soil and vegetable samples from Tarnaveni and measured chromium (Cr), lead (Pb), and manganese (Mn) levels by atomic absorption spectrometry. We evaluated the relationship between soil and vegetable metals and the distance from the shuttered chemical factory, and calculated the hazard index to assess local population metal exposure via contaminated vegetable ingestion. Soil metal concentrations ranged between 15.6 and 525.8 mg/kg for total Cr, between 25.4 and 559.5 mg/kg for Pb, and between 363.1 and 1389.6 mg/kg for Mn. We found average concentrations of 17.8 mg/kg for total Cr, 2.2 mg/kg for Pb, and 116.6 mg/kg for Mn in local vegetables. We found soil concentrations for all three metals that exceeded normal background levels according to Romanian regulations (Pb exceeded 100 mg/kg in some of the samples), as well as measurable concentrations of metals in all analyzed vegetable samples. These preliminary data underscore a need for a more extensive investigation into associated adverse health effects in the exposed population.

Assessing associations between indoor environment and health symptoms in Romanian school children: an analysis of data from the SINPHONIE project.

School environment may have an impact on children's health, but few studies have focused on indoor comfort factors such as temperature, humidity, and noise in relation with potential effects on children's health. Our cross-sectional study used data from the European Schools Indoor Pollution and Health Observatory Network in Europe (SINPHONIE) project to assess children's allergy, asthma-like symptoms, and flu-like symptoms in relation with classroom comfort and environmental factors. The study used self-reported data from three questionnaires to identify classroom conditions and student health outcomes for 280 students. We used backwards variable selection and unconditional logistic regression to assess the outcome-environment relationship while controlling for demographics, family history of allergy, and home exposures. We found increased risks for allergy and flu-like symptoms associated with hot classrooms in the heating season, increased risks for asthma-like symptoms associated with noisy classrooms, and a protective effect for allergy associated with good outdoor air quality. Romanian classrooms rely on natural ventilation, which may contribute to increased temperature and humidity in the heating season. Further research warrants the use of SINPHONIE's measurement data to validate our findings.

Evidence from SINPHONIE project: Impact of home environmental exposures on respiratory health among school-age children in Romania.

BACKGROUND: Exposure to indoor air pollutants at home was found to be associated with respiratory diseases. As lifestyle changes with rapid economic growth in Romania, the aim of our study is to describe the characteristics of Romanian homes and their impact on children's respiratory health. METHODS: Self-reported information on respiratory symptoms was collected from 280 Romanian elementary school students in 2011, and the symptoms were categorized into allergy, asthma-like, and flu-like symptoms. Home characteristics and demographic information were collected from questionnaires answered by parents. The association between home characteristics and respiratory health was assessed through multivariate logistic regression controlling for school indoor exposure. RESULTS: As compared to U.S. households, Romanian homes have a higher percentage of smokers, limited use of indoor climate control, and higher use of iron stoves. Exposure to environmental tobacco smoke was associated with both asthma and allergy symptoms. Additional risk factors identified for allergy symptoms include living in apartments, near pesticide sprayed areas, and the use of incense sticks. The significantly higher risk of flu-like symptoms was associated with mold and dampness issues, the use of air conditioner, gas heater/iron stove in children's bedroom. CONCLUSION: Our findings suggest that an increase in respiratory symptoms among Romanian school-age children can be partly related to their environmental exposure at home. Since most of the identified risk factors are preventable, our results provide critical information and evidence for policymakers, to develop target intervention and education strategies.

Teacher respiratory health symptoms in relation to school and home environment.

PURPOSE: Few studies have evaluated teachers' respiratory health, especially its relationship with school/home environment, and school policies. This study assessed asthma and smoking prevalence among teachers in Romania, teacher's perception and knowledge of the school environment, policies and asthma management, and how school and home environment affected asthma, allergy, and respiratory infection symptoms. METHODS: This cross-sectional study obtained information from 104 Romanian teachers utilizing teacher questionnaire data for Romania only, as part of the Schools Indoor Pollution and Health: Observatory Network in Europe (SINPHONIE) study, a multicenter European research project conducted between 2010 and 2012. The SINPHONIE questionnaire collected comprehensive information on school and home environment, respiratory symptoms, smoking, and school policies. We used unconditional logistic regression analysis to examine environment-outcome relationships while controlling for socio-demographics and co-exposures. RESULTS: Our results showed the prevalence of asthma-like symptoms and smoking among teachers in Romania was higher than in other SINPHONIE schools and among US teachers. Factors statistically associated with asthma, allergy, and respiratory infection (all p < 0.05) include perception of health related to poor air quality in school, inappropriate cleaning of ventilation systems, dwelling proximity to busy traffic, and multiple school/home exposures. We also found lack of asthma management and environmental policies in the investigated Romanian schools. CONCLUSION: We concluded that multiple school and home environmental factors were related to respiratory and allergic symptoms. High asthma burden and smoking are important public health problems in Romania. Future studies including larger sample size and exposure measurements are needed to confirm our findings.

Low-level arsenic exposure via drinking water consumption and female fecundity - A preliminary investigation.

High level arsenic exposure is associated with reproductive toxicity in experimental and observational studies; however, few data exist to assess risks at low levels. Even less data are available to evaluate the impact of low level arsenic exposure on human fecundity. Our aim in this pilot study was a preliminary evaluation of associations between low level drinking water arsenic contamination and female fecundity. This retrospective study was conducted among women previously recruited to a hospital-based case-control study of spontaneous pregnancy loss in Timis County, Romania. Women (n=94) with planned pregnancies of 5-20 weeks gestation completed a comprehensive physician-administered study questionnaire and reported the number of menstrual cycles attempting to conceive as the time to pregnancy (TTP). Drinking water samples were collected from residential drinking water sources and we determined arsenic levels using hydride generation-atomic absorption spectrometry (HG-AAS). Multivariable Cox-proportional hazards regression with Efron approximation was employed to evaluate TTP as a function of drinking water arsenic concentrations among planned pregnancies, adjusted for covariates. There was no main effect for drinking water arsenic exposure, yet the conditional probability for pregnancy was modestly lower among arsenic exposed women with longer TTPs, relative to women with shorter TTPs, and relative to unexposed women. For example, 1µg/L average drinking water arsenic conferred 5%, 8%, and 10% lower likelihoods for pregnancy in the 6th, 9th, and 12th cycles, respectively (P=0.01). While preliminary, our results suggest that low level arsenic contamination in residential drinking water sources may further impair fecundity among women with longer waiting times; however, this hypothesis requires confirmation by a future, more definitive study.