Long-term PM2.5 exposure is associated with asthma prevalence and exhaled nitric oxide levels in children.

BACKGROUND: Exhaled nitric oxide concentration (FENO) is a marker of airway inflammation. This study aimed to evaluate the association of air pollution exposure with FENO levels and asthma prevalence with respiratory symptoms in school children. METHODS: We analyzed 4736 school children who reside in six townships near industrial areas in central Taiwan. We evaluated asthmatic symptoms, FENO, and conducted the environmental questionnaire. The personal exposure of PM2.5, NO, and SO2 was estimated using land-use regression models data on children's school and home addresses. RESULTS: Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma (OR = 1.595), exercise-induced wheezing (OR = 1.726), itchy eyes (OR = 1.417), and current nasal problems (OR = 1.334) (P < 0.05). FENO levels in the absence of infection were positively correlated with age, previous wheezing, allergic rhinitis, atopic eczema, near the road, and for children with high exposure to PM2.5 (P < 0.05). An increase of 1 µg/m3 PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels for children after adjusting for potential confounding variables, including exposures to NO and SO2. CONCLUSIONS: Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children. IMPACT: Annual exposure to PM2.5 was associated with increased odds of physician-diagnosed asthma and nasal problems and itchy eyes. Long-term exposures to PM2.5 were significantly associated with FENO levels after adjusting for potential confounding variables. This is first study to assess the association between FENO levels and long-term air pollution exposures in children near coal-based power plants. An increase of 1 µg/m3 annual PM2.5 exposure was significantly associated with a 1.0% increase in FENO levels. Long-term exposures to PM2.5 posed a significant risk of asthma prevalence and airway inflammation in a community-based population of children.

Extreme temperature increases the risk of stillbirth in the third trimester of pregnancy.

Epidemiological studies have reported the association between extreme temperatures and adverse reproductive effects. However, the susceptible period of exposure during pregnancy remains unclear. This study aimed to assess the impact of extreme temperature on the stillbirth rate. We performed a time-series analysis to explore the associations between temperature and stillbirth with a distributed lag nonlinear model. A total of 22,769 stillbirths in Taiwan between 2009 and 2018 were enrolled. The mean stillbirth rate was 11.3 ± 1.4 per 1000 births. The relative risk of stillbirth due to exposure to extreme heat temperature (> 29 °C) was 1.18 (95% CI 1.11, 1.25). Pregnant women in the third trimester were most susceptible to the effects of extreme cold and heat temperatures. At lag of 0-3 months, the cumulative relative risk (CRR) of stillbirth for exposure to extreme heat temperature (29.8 °C, 97.5th percentile of temperature) relative to the optimal temperature (21 °C) was 2.49 (95% CI: 1.24, 5.03), and the CRR of stillbirth for exposure to extreme low temperature (16.5 °C, 1st percentile) was 1.29 (95% CI: 0.93, 1.80). The stillbirth rate in Taiwan is on the rise. Our findings inform public health interventions to manage the health impacts of climate change.

County-Wide Mortality Assessments Attributable to PM2.5 Emissions from Coal Consumption in Taiwan.

Over one-third of energy is generated from coal consumption in Taiwan. In order to estimate the health impact assessment attributable to PM2.5 concentrations emitted from coal consumption in Taiwan. We applied a Gaussian trajectory transfer-coefficient model to obtain county-wide PM2.5 exposures from coal consumption, which includes coal-fired power plants and combined heat and power plants. Next, we calculated the mortality burden attributable to PM2.5 emitted by coal consumption using the comparative risk assessment framework developed by the Global Burden of Disease study. Based on county-level data, the average PM2.5 emissions from coal-fired plants in Taiwan was estimated at 2.03 ± 1.29 (range: 0.32-5.64) µg/m3. With PM2.5 increments greater than 0.1 µg/m3, there were as many as 16 counties and 66 air quality monitoring stations affected by coal-fired plants and 6 counties and 18 monitoring stations affected by combined heat and power plants. The maximum distances affected by coal-fired and combined heat and power plants were 272 km and 157 km, respectively. Our findings show that more counties were affected by coal-fired plants than by combined heat and power plants with significant increments of PM2.5 emissions. We estimated that 359.6 (95% CI: 334.8-384.9) annual adult deaths and 124.4 (95% CI: 116.4-132.3) annual premature deaths were attributable to PM2.5 emitted by coal-fired plants in Taiwan. Even in six counties without power plants, there were 75.8 (95% CI: 60.1-91.5) deaths and 25.8 (95%CI: 20.7-30.9) premature deaths annually attributable to PM2.5 emitted from neighboring coal-fired plants. This study presents a precise and effective integrated approach for assessing air pollution and the health impacts of coal-fired and combined heat and power plants.

Associations of soluble metals and lung and liver toxicity in mice induced by fine particulate matter originating from a petrochemical complex.

Adverse health effects have been observed in nearby residents due to exposure to petrochemical-derived chemicals. The objective of this study was to examine associations of soluble metals with lung and liver toxicity in fine particulate matter (PM2.5) in the vicinity of a petrochemical complex. PM2.5 was collected in the vicinity of a petrochemical complex of Mailiao Township (Yunlin County, Taiwan) to investigate lung and liver toxicity in BALB/c mice. The PM2.5 concentration was 30.2 ± 11.2 µg/m3, and the PM2.5 was clustered in major local emissions (19.1 µg/m3) and minor local emissions (14.1 µg/m3) using a k-means clustering model. The PM2.5 (50 and 150 µg/kg) and PM2.5-equivalent soluble nickel (Ni), vanadium (V), and lead (Pb) concentrations were intratracheally instilled into BALB/c mice. PM2.5 and V significantly decreased the tidal volume after exposure (p < 0.05). The peak expiratory flow (PEF) and peak inspiratory flow (PIF)/PEF ratio were significantly altered by 150 µg/kg V (p < 0.05). V and Pb significantly increased total protein and lactate dehydrogenase (LDH) levels in bronchoalveolar lavage fluid (BALF) (p < 0.05). Interleukin (IL)-6 in BALF significantly increased after exposure to Pb (p < 0.05) accompanied by lung inflammatory infiltration. PM2.5 and Pb significantly increased levels of 8-isoprostane (p < 0.05). The level of caspase-3 activity significantly increased after exposure to Pb (p < 0.05). LDH in the liver was significantly increased by PM2.5 (p < 0.05). 8-Isoprostane in the liver was significantly increased by PM2.5 and Pb (p < 0.05). IL-6 in the liver was significantly increased by PM2.5, Ni, V, and Pb after exposure (p < 0.05), accompanied by liver inflammatory infiltration. Our results demonstrated that V in PM2.5 was associated with an increase in 8-isoprostane for all emissions and major local petrochemical emissions. In conclusion, V contributes to in vivo liver toxicity induced by PM2.5 in the vicinity of a petrochemical complex.

Health impact assessment of PM2.5 from a planned coal-fired power plant in Taiwan.

PURPOSE: To investigate the impact of a planned coal-fired power plant (CFPPT) in Shenao on air quality and health at subnational levels in Taiwan. METHODS: We applied the Gaussian trajectory transfer-coefficient (GTx) model to estimate annual average PM2.5 (particulate matter with aerodynamic diameter less than 2.5 µm) increments in 19 Taiwanese cities and counties caused by CFPPT operation. A population health risk assessment was performed by incorporating evidence of the health effects of PM2.5 provided by prospective studies and estimating long-term PM2.5 exposure. Additionally, we considered ischemic heart disease, stroke, lung cancer, and chronic obstruct pulmonary disease as the primary outcomes. The population-attributable fraction was used to estimate the county-level mortality burden attributable to CFPPT-generated PM2.5 in 2025. RESULTS: The estimated annual PM2.5 increments ranged from 0.004 µg/m3 (Taitung County) to 0.28 µg/m3 (Hsinchu County) due to the Shenao CFPPT. The total and premature deaths attributable to PM2.5 from Shenao CFPPT operation in Taiwan during 2025-2040 would be 576 (95% confidence interval [CI]: 537-619) and 145 (95% CI: 136-155), respectively. Notably, we estimated 198 (95% CI: 169-234) deaths and 58 (95% CI: 51-66) premature deaths, respectively, in New Taipei City, which accounted for over a quarter of the total deaths. Overall, the mortality rate attributable to the Shenao CFPPT in Taiwan was 6 per 10,000. CONCLUSION: A scientific approach should be adopted for assessing the impacts of CFPPT operation on population health, which can serve as a valuable policymaking reference for the government.

Cluster analysis of fine particulate matter (PM2.5) emissions and its bioreactivity in the vicinity of a petrochemical complex.

This study evaluated associations between the bioreactivity of PM2.5in vitro and emission sources in the vicinity of a petrochemical complex in Taiwan. The average PM2.5 was 30.2 µg/m3 from 9 February to 23 March 2016, and the PM2.5 was clustered in long-range transport (with major local source) (12.8 µg/m3), and major (17.3 µg/m3) and minor industrial emissions (4.7 µg/m3) using a k-means clustering model. A reduction in cell viability and increases in the cytotoxicity-related lactate dehydrogenase (LDH), oxidative stress-related 8-isoprostane, and inflammation-related interleukin (IL)-6 occurred due to PM2.5 in a dose-dependent manner. The PM2.5 from major industrial emissions was significantly correlated with increased 8-isoprostane and IL-6, but this was not observed for long-range transport or minor industrial emissions. The bulk metal concentration was 9.52 ng/m3 in PM2.5. We further observed that As, Ba, Cd, and Se were correlated with LDH in the long-range transport group. Pb in PM2.5 from the major industrial emissions was correlated with LDH, whereas Pb and Se were correlated with 8-isoprostane. Sr was correlated with cell viability in the minor industrial emissions group. We demonstrated a new approach to investigate particle bioreactivity, which suggested that petrochemical-emitted PM2.5 should be a concern for surrounding residents' health.

Increased cancer incidence of Changhua residents living in Taisi Village north to the No. 6 Naphtha Cracking Complex.

BACKGROUND/PURPOSE: Cancer risks of residents living north to the No. 6 Naphtha Cracking Complex has not been studied before. METHODS: Our study subjects were recruited in 2014-16 from three zones north to the No. 6 Naphtha Cracking Complex, which included 229 participants from the Taisi Village (average 5.5 km from the complex), 1333 participants from the other 14 villages in Dacheng Township (9.2 km), and 372 participants from the Zhutang Township (19.9 km). Their occurrence of cancer in years-post-complex-operation (YPO) was defined by having a new cancer recorded (ICD-9: 140-208) in National Health Insurance Research Database since 1999. Poisson regression was conducted to compare incidence rate ratio among three zones in 10-16 YPO. RESULTS: We found that all-cause cancer incidence of 10-16 YPO (per 1,000 person-years) in Taisi Village (8.44) was higher than that in Dacheng (3.42) and Zhutang (2.72). Taisi residents had significantly higher concentrations of V, Cr, Mn, Ni, Cu, As, Cd, and Tl than Dacheng and Zhutang residents. The all-cause cancer incidence rate ratio between 10-16 and 0-9 YPO was 8.44 for Taisi residents. All-cause cancer incidence rate of Taisi residents was 2.55 times higher than Dacheng residents (95% CI: 1.89-3.45) and 2.43 times higher than Zhutang residents (95% CI: 1.54-3.84) in 10-16 YPO. CONCLUSION: We conclude that all-cause cancer risk was significantly increased for Taisi residents living near the No. 6 Naphtha Cracking Complex for 10-16 years after the complex began operating.

Probabilistic integrated risk assessment of human exposure risk to environmental bisphenol A pollution sources.

Environmental bisphenol A (BPA) exposure has been linked to a variety of adverse health effects such as developmental and reproductive issues. However, establishing a clear association between BPA and the likelihood of human health is complex yet fundamentally uncertain. The purpose of this study was to assess the potential exposure risks from environmental BPA among Chinese population based on five human health outcomes, namely immune response, uterotrophic assay, cardiovascular disease (CVD), diabetes, and behavior change. We addressed these health concerns by using a stochastic integrated risk assessment approach. The BPA dose-dependent likelihood of effects was reconstructed by a series of Hill models based on animal models or epidemiological data. We developed a physiologically based pharmacokinetic (PBPK) model that allows estimation of urinary BPA concentration from external exposures. Here we showed that the daily average exposure concentrations of BPA and urinary BPA estimates were consistent with the published data. We found that BPA exposures were less likely to pose significant risks for infants (0-1 year) and adults (male and female >20 years) with <10(-6)-fold increase in uterus weight and immune response outcomes, respectively. Moreover, our results indicated that there was 50 % risk probability that the response outcomes of CVD, diabetes, and behavior change with or without skin absorption would increase 10(-4)-10(-2)-fold. We conclude that our approach provides a powerful tool for tracking and managing human long-term BPA susceptibility in relation to multiple exposure pathways, and for informing the public of the negligible magnitude of environmental BPA pollution impacts on human health.

Source apportionment of mass concentration and inhalation risk with long-term ambient PCDD/Fs measurements in an urban area.

This study applies a receptor model to quantify source contributions to ambient concentration of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and inhalation cancer risk in Taipei from 2003 through 2009. Seventeen PCDD/F congeners were used in the effective variance solution to the Chemical Mass Balance equations to estimate source-specific mass contributions and inhalation risks. The average total PCDD/F concentration was 0.611pg/Nm(3) (0.036pg I-TEQ/Nm(3)). Traffic emissions contributed the most to the PCDD/F concentration (55.7%), followed by waste incinerators (18.6%) and joss stick burning (9.6%). For the inhalation cancer risk, the average was 1.1×10(-6) with traffic, waste incinerators, and joss paper burning as the main contributors (67.3%, 19.4%, and 6.3%, respectively). The mass and risk contributions of waste incinerators decreased significantly from 2003 to 2009 and were higher at downwind sites than at upwind sites. Reducing PCDD/F emissions from traffic and waste incinerators would provide the greatest health benefit. Policies that reduce the uncontrolled burning of joss stick and joss paper also need to be implemented.

The distance-to-source trend in vanadium and arsenic exposures for residents living near a petrochemical complex.

Biological monitoring of vanadium (V) and arsenic (As) for residents living near a big petrochemical complex has not been previously studied. This study aims to investigate distance-to-source trends in urinary levels and dispersion-estimated concentrations of V and As in areas surrounding a petrochemical complex in central Taiwan. Our study subjects were 1424 residents living in the townships up to ~40 km from the petrochemical complex, and categorized as near (Zone A), further (Zone B) and furthest (Zone C) from the complex. Urinary and ambient V and As levels were analyzed by inductively coupled plasma mass spectrometry. Two-stage dispersion model was used to estimate V and As concentrations at each study subject's address. Multiple linear regression models were used to study the effects of distance-to-source and estimated air concentrations of V and As on the urinary V and As levels of study subjects. Area-wide levels of both V and As showed a high-to-low trend in urinary levels (µg/g-creatinine) from Zone A (V with 2.86±2.30 and As with 104.6±147.9) to Zone C (V with 0.73±0.72 and As with 73.8±90.8). For study subjects, urinary V and As levels were decreased by 0.09 and 1.17 µg/g-creatinine, respectively, with 1 km away from the emission source of the petrochemical complex, and urinary V levels were significantly elevated by 0.38 µg/g-creatinine with a 1 ng/m(3) increase in estimated ambient V concentrations at their addresses. Our study concludes a distance-to-source gradient in V and As exposures exists for residents living near a petrochemical complex with oil refineries and coal-fired power plants and two-stage dispersion model can predict such a trend for V when inhalation is the major exposure route, but not for As that exposure may be from multiple sources and exposure routes.

Probabilistic framework for assessing the arsenic exposure risk from cooked fish consumption.

Geogenic arsenic (As) contamination of groundwater is a major ecological and human health problem in southwestern and northeastern coastal areas of Taiwan. Here, we present a probabilistic framework for assessing the human health risks from consuming raw and cooked fish that were cultured in groundwater As-contaminated ponds in Taiwan by linking a physiologically based pharmacokinetics model and a Weibull dose-response model. Results indicate that As levels in baked, fried, and grilled fish were higher than those of raw fish. Frying resulted in the greatest increase in As concentration, followed by grilling, with baking affecting the As concentration the least. Simulation results show that, following consumption of baked As-contaminated fish, the health risk to humans is <10(-6) excess bladder cancer risk level for lifetime exposure; as the incidence ratios of liver and lung cancers are generally acceptable at risk ranging from 10(-6) to 10(-4), the consumption of baked As-contaminated fish is unlikely to pose a significant risk to human health. However, contaminated fish cooked by frying resulted in significant health risks, showing the highest cumulative incidence ratios of liver cancer. We also show that males have higher cumulative incidence ratio of liver cancer than females. We found that although cooking resulted in an increase for As levels in As-contaminated fish, the risk to human health of consuming baked fish is nevertheless acceptable. We suggest the adoption of baking as a cooking method and warn against frying As-contaminated fish. We conclude that the concentration of contaminants after cooking should be taken into consideration when assessing the risk to human health.

Assessing vanadium and arsenic exposure of people living near a petrochemical complex with two-stage dispersion models.

The goal of this study is to demonstrate that it is possible to construct a two-stage dispersion model empirically for the purpose of estimating air pollution levels in the vicinity of petrochemical plants. We studied oil refineries and coal-fired power plants in the No. 6 Naphtha Cracking Complex, an area of 2,603-ha situated on the central west coast of Taiwan. The pollutants targeted were vanadium (V) from oil refineries and arsenic (As) from coal-fired power plants. We applied a backward fitting method to determine emission rates of V and As, with 192 PM10 filters originally collected between 2009 and 2012. Our first-stage model estimated emission rates of V and As (median and 95% confidence intervals at 0.0202 (0.0040-0.1063) and 0.1368 (0.0398-0.4782) g/s, respectively. In our second stage model, the predicted zone-average concentrations showed a strong correlation with V, but a poor correlation with As. Our findings show that two-stage dispersion models are relatively precise for estimating V levels at residents' addresses near the petrochemical complex, but they did not work as well for As levels. In conclusion, our model-based approach can be widely used for modeling exposure to air pollution from industrial areas in countries with limited resources.

The association between enterovirus 71 infections and meteorological parameters in Taiwan.

BACKGROUND: Enterovirus 71 (EV71) infections are a significant cause of neurological disorder and death in children worldwide. Seasonal variations in EV71 infections have been recognized, but the mechanisms responsible for this phenomenon remain unknown. The purpose of this study was to examine the relationship between meteorological parameters and EV71 infection. METHODS AND FINDINGS: We analyzed the number of EV71 infections and daily climate data collected in Taiwan between 1998 and 2008 and used Poisson regression analysis and case-crossover methodology to evaluate the association between weather variability and the incidence of EV71 infection. A total of 1,914 EV71-infected patients were reported between 1998 and 2008. The incidence of EV71 infections reflected significant summertime seasonality (for oscillation, p<0.001). The incidence of EV71 infections began to rise at temperatures above 13°C (r(2) = 0.76, p<0.001); at temperatures higher than approximately 26°C (r(2) = 0.94, p<0.05), the incidence began to decline, producing an inverted V-shaped relationship. The increase in the incidence with increasing relative humidity was positive and linear (r(2) = 0.68, p<0.05). EV71 infection was most highly correlated with temperature and relative humidity in the period that likely preceded the infection. CONCLUSION: Our study provides quantitative evidence that the rate of EV71 infection increased significantly with increasing mean temperature and relative humidity in Taiwan.

Use of seasonal influenza virus titer and respiratory symptom score to estimate effective human contact rates.

BACKGROUND: We linked viral titers and respiratory symptom scores for seasonal influenza to estimate the effective contact rate among schoolchildren. METHODS: We analyzed 274 diary-based questionnaires. In addition, 2 sets of influenza data from published studies were used to investigate the relationship between viral titer, total symptom score, and normalized contact rate in children. RESULTS: The mean number (SD) of contacts for children in grades 7 to 9 ranged from 9.44 ± 8.68 to 11.18 ± 7.98 person⁻¹ day⁻¹; contact behavior was similar across school grades. The mean number of contacts was 5.66 ± 6.23 person⁻¹ day⁻¹ (range, 0 to 44 person⁻¹ day⁻¹) for the age group of 13 to 19 years. Estimated contact age, household size, contact duration, and contact frequency were the variables most strongly associated with total number of contacts. We also found that a reduction in total respiratory symptom scores among infected individuals had a positive correlation with an increase in the normalized contact rate. CONCLUSIONS: The relationship between daily virus titer and respiratory symptom score can be used to estimate the effective contact rate in explaining the spread of an airborne transmissible disease. The present findings can be incorporated into population-dynamic models of influenza transmission among schoolchildren.

Assessing the potential risks to zebrafish posed by environmentally relevant copper and silver nanoparticles.

The manufacture of large quantities of engineered nanomaterials (NMs) may lead to unintended contamination of aquatic ecosystems. Biologically based monitoring techniques need to be developed to detect these emerging NMs. The purpose of this study was to develop a risk-based probability model to predict the potential hazards of nanoecotoxicity toward aquatic organisms posed by waterborne copper and silver nanoparticles (Cu/Ag NPs). Published experimental evidence based on Cu/Ag NP-zebrafish (Danio rerio) systems was adopted as the study data. A Hill model was used to reconstruct a concentration-mortality response profile. A cumulative Weibull predictive model was employed to estimate exposure thresholds. The derived probabilistic model can predict the potential risk of environmentally relevant Cu/Ag NPs for major Taiwanese rivers with predicted environmental concentrations of 0.06 (95% confidence interval (CI): 0.01-0.92) mgL(-1) for Cu NPs and 0.04 (0.01-0.11) mgL(-1) for Ag NPs. The results indicated that estimated thresholds were 0.10-0.48mgL(-1) (95% CI) for Cu NPs and 2.69-2.73mgL(-1) for Ag NPs. The probabilities of a risk quotient (RQ) of >1 ranged 17%-81% for zebrafish exposed to Cu NPs. This study found that Ag NP exposure scenarios posed no significant risks to zebrafish (RQ≪0.1).

A probabilistic transmission and population dynamic model to assess tuberculosis infection risk.

The purpose of this study was to examine tuberculosis (TB) population dynamics and to assess potential infection risk in Taiwan. A well-established mathematical model of TB transmission built on previous models was adopted to study the potential impact of TB transmission. A probabilistic risk model was also developed to estimate site-specific risks of developing disease soon after recent primary infection, exogenous reinfection, or through endogenous reactivation (latently infected TB) among Taiwan regions. Here, we showed that the proportion of endogenous reactivation (53-67%) was larger than that of exogenous reinfection (32-47%). Our simulations showed that as epidemic reaches a steady state, age distribution of cases would finally shift toward older age groups dominated by latently infected TB cases as a result of endogenous reactivation. A comparison of age-weighted TB incidence data with our model simulation output with 95% credible intervals revealed that the predictions were in an apparent agreement with observed data. The median value of overall basic reproduction number (R0) in eastern Taiwan ranged from 1.65 to 1.72, whereas northern Taiwan had the lowest R0 estimate of 1.50. We found that total TB incidences in eastern Taiwan had 25-27% probabilities of total proportion of infected population exceeding 90%, whereas there were 36-66% probabilities having exceeded 20% of total proportion of infected population attributed to latently infected TB. We suggested that our Taiwan-based analysis can be extended to the context of developing countries, where TB remains a substantial cause of elderly morbidity and mortality.

Assessing trends and predictors of tuberculosis in Taiwan.

BACKGROUND: Variety of environmental and individual factors can cause tuberculosis (TB) incidence change. The purpose of this study was to assess the characteristics of TB trends in the period 2004 - 2008 in Taiwan by month, year, gender, age, temperature, seasonality, and aborigines. METHODS: The generalized regression models were used to examine the potential predictors for the monthly TB incidence in regional and national scales. RESULTS: We found that (i) in Taiwan the average TB incidence was 68 per 100,000 population with mortality rate of 0.036 person-1 yr-1, (ii) the highest TB incidence rate was found in eastern Taiwan (116 per 100,000 population) with the largest proportion of TB relapse cases (8.17%), (iii) seasonality, aborigines, gender, and age had a consistent and dominant role in constructing TB incidence patterns in Taiwan, and (iv) gender, time trend, and 2-month lag maximum temperature showed strong association with TB trends in aboriginal subpopulations. CONCLUSIONS: The proposed Poisson regression model is capable of forecasting patterns of TB incidence at regional and national scales. This study suggested that assessment of TB trends in eastern Taiwan presents an important opportunity for understanding the time-series dynamics and control of TB infections, given that this is the typical host demography in regions where these infections remain major public health problems.

Fluctuation analysis-based risk assessment for respiratory virus activity and air pollution associated asthma incidence.

Asthma is a growing epidemic worldwide. Exacerbations of asthma have been associated with bacterial and viral respiratory tract infections and air pollution. We correlated the asthma admission rates with fluctuations in respiratory virus activity and traffic-related air pollution, namely particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3). A probabilistic risk assessment framework was developed based on a detrended fluctuation analysis to predict future respiratory virus and air pollutant associated asthma incidence. Results indicated a strong association between asthma admission rate and influenza (r=0.80, p<0.05) and SO2 level (r=0.73, p<0.05) in Taiwan in the period 2001-2008. No significant correlation was found for asthma admission and PM10, O3, NO2, and CO. The proposed fluctuation analysis provides a simple correlation exponent describing the complex interactions of respiratory viruses and air pollutants with asthma. This study revealed that there was a 95% probability of having exceeded 2987 asthma admissions per 100,000 population. It was unlikely (30% probability) that the asthma admission rate exceeded 3492 per 100,000 population. The probability of asthma admission risk can be limited to below 50% by keeping the correlation exponent of influenza to below 0.9. We concluded that fluctuation analysis based risk assessment provides a novel predictor of asthma incidence.

Lung cancer risk in relation to traffic-related nano/ultrafine particle-bound PAHs exposure: a preliminary probabilistic assessment.

Exposures to carcinogenic polycyclic aromatic hydrocarbons (PAHs) have been linked to human lung cancer. The purpose of this study was to assess lung cancer risk caused by inhalation exposure to nano/ultrafine particle-bound PAHs at the population level in Taiwan appraised with recent published data. A human respiratory tract model was linked with a physiologically based pharmacokinetic model to estimate deposition fraction and internal organic-specific PAHs doses. A probabilistic risk assessment framework was developed to estimate potential lung cancer risk. We reanalyzed particle size distribution, total-PAHs, particle-bound benzo(a)pyrene (B[a]P) and PM concentrations. A dose-response profile describing the relationships between external B[a]P concentration and lung cancer risk response was constructed based on population attributable fraction (PAF). We found that 90% probability lung cancer risks ranged from 10(-5) to 10(-4) for traffic-related nano and ultrafine particle-bound PAHs, indicating a potential lung cancer risk. The particle size-specific PAF-based excess annual lung cancer incidence rate due to PAHs exposure was estimated to be less than 1 per 100,000 population, indicating a mild risk factor for lung cancer. We concluded that probabilistic risk assessment linked PAF for limiting cumulative PAHs emissions to reduce lung cancer risk plays a prominent role in future government risk assessment program.

Quantitative links between arsenic exposure and influenza A (H1N1) infection-associated lung function exacerbations risk.

The objective of this study was to link arsenic exposure and influenza A (H1N1) infection-induced respiratory effects to assess the impact of arsenic-contaminated drinking water on exacerbation risk of A (H1N1)-associated lung function. The homogeneous Poisson process was used to approximate the related processes between arsenic exposure and influenza-associated lung function exacerbation risk. We found that (i) estimated arsenic-induced forced expiratory volume in 1 second (FEV(1) ) reducing rates ranged from 0.116 to 0.179 mL/µg for age 15-85 years, (ii) estimated arsenic-induced A (H1N1) viral load increasing rate was 0.5 mL/µg, (iii) estimated A (H1N1) virus-induced FEV(1) reducing rate was 0.10 mL/logTCID50, and (iv) the relationship between arsenic exposure and A (H1N1)-associated respiratory symptoms scores (RSS) can be described by a Hill model. Here we showed that maximum RSS at day 2 postinfection for Taiwan, West Bengal (India), and the United States were estimated to be in the severe range of 0.83, 0.89, and 0.81, respectively, indicating that chronic arsenic exposure and A (H1N1) infection together are most likely to pose potential exacerbations risk of lung function, although a 50% probability of lung function exacerbations risk induced by arsenic and influenza infection was within the mild and moderate ranges of RSS at day 1 and 2 postinfection. We concluded that avoidance of drinking arsenic-containing water could significantly reduce influenza respiratory illness and that need will become increasingly urgent as the novel H1N1 pandemic influenza virus infects people worldwide.