[Parental smoking and exposure of pre-school children to tobacco smoke]. / Kourení rodicu a expozice predskolních detí tabákovému kouri.

BACKGROUND: During studies on the health of children aged 3 or 4.5 years in Teplice and Prachatice districts of the Czech Republic, we focused also on the extent of smoking in the families and exposure of children to environmental tobacco smoke. METHODS AND RESULTS: In 1128 questionnaires administered to mothers of children born in 1994-1998, 35.6% of mothers indicated that they smoked and 48.9% of fathers/partners (N = 1075) were smokers. Including other family members, there were 41.6% families without any smoker, 30.1% of families with one smoker and 24% families with two smokers (out of 1061 households). Urine samples of 523 pairs of mothers and children (aged 4.5 years) were assayed for cotinine using a RIA radioimmunoassay. Concentration of cotinine was higher than 500 ng cotinine/mg creatinine (the cut-off value for smoking) in 199 of 523 mothers (38%). Exposure of children to environmental tobacco smoke (cotinine levels over 20ng/mg creatinine) was detected in 48.2% of 523 children. There were more children with cotinine levels over 20 ng in Teplice (59.2% of 287 children) than in Prachatice district (34.7% of 236 children). CONCLUSIONS: Cotinine levels in child's urine were significantly positively associated with maternal cotinine levels as well as with smoking of mother and father, and were lower in children visiting kindergarten.

Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project.

Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons > or = 65 yrs were investigated. Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) and black smoke (BS), as well as the daily number of deaths among persons > or = 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied. The per cent increase (95% confidence intervals), associated with a 10 microg x m(-3) increase in PM10, in the elderly daily number of deaths was 0.8%, (0.7-0.9%) and the corresponding number for BS was 0.6%, (0.5-0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects). These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.

[Environmental pollution and childhood morbidity]. / Znecistené ovzdusí a nemocnost detí.

BACKGROUND: A study of morbidity of children aged 0 to 3 years was organized in two districts in the Czech Republic. Comparisons were drawn between children living in district Teplice, known for its high air pollution, and those living in Practice, the district with consistently lower particulate and SO2 exposures. METHODS AND RESULTS: 452 children of the follow up study were born between May 1994 and December 1996. Childhood morbidity during the first three years of life was obtained from their pediatric records. Diagnoses were coded using the International Classification of Diseases--the 10th edition, and categorized into broad groups. Children born in Teplice experienced a significantly higher rate of otitis media (and otalgia), gastrointestinal infections, upper respiratory infections, and pneumonia, but they did not differ in the risk of bronchitis or that of viral infections such as varicella. These findings remained valid after the multiple linear regression models were calculated and adjusted for education, maternal age, maternal smoking, and other smokers in the household, breastfeeding, and attendance at the day care. CONCLUSIONS: Air pollution may alter early childhood susceptibility to infection, but other differences between the districts have to be considered: systematic diagnostic differences for several health outcomes between pediatricians in Teplice and Practice, differences in health-care seeking approach of parents, and some hitherto unidentified factors.

Childhood morbidity and air pollution in the Teplice program.

BACKGROUND: A study of morbidity of children aged 0 to 3 years was conducted in two districts in the Czech Republic. Comparisons were made between children living in Teplice district, known for its high air pollution, and children living in Practice, a district with consistently lower particulate and SO2 exposures. METHODS AND RESULTS: The children were selected for the follow up based on deliveries from May 1994 to December 1966. Childhood morbidity during the first three years of life of 452 children was extracted from their pediatric records. Diagnoses were coded using the International Classification of Diseases--10th edition, and categorized into broad groupings. Children born in Teplice experienced a significantly higher rate of otitis media and otalgia, gastrointestinal infections, upper respiratory infections, and pneumonia, but did not differ in their risk for bronchitis or for viral infections such as varicella. These findings remained after multiple linear regression models adjusted for education, maternal age, maternal smoking, and other smokers in the household, breastfeeding, and attendance at day care. CONCLUSIONS: Air pollution may alter early childhood susceptibility to infection, but other differences between the districts must be considered: systematic diagnostic differences for several health outcomes comparing pediatricians in Teplice vs. Practice, differences in health-care seeking behavior by the parents, and inadequate control for confounding.

[Treatment of iodine deficiency in pregnant women in the Teplice District]. / Resení jódového deficitu u tehotných zen v okrese teplice.

BACKGROUND: Sufficient supply of the population with iodine becomes again a world problem. Particularly the iodine deficiency during pregnancy may have serious negative effects on the foetal development. Estimation of the level of iodine supply of pregnant women became therefore the aim of the study. Investigation was done in the district Teplice. METHODS AND RESULTS: The cohort was formed by 348 pregnant women (age 17 to 45 years), who received during the pregnancy iodine supplementation in the daily dose of 130 respective 100 micrograms (Materna, Jod 100). Control group consisted of 231 women (age 18 to 35 years). Average ioduria of pregnant women at the beginning of gestation (not affected by supplementation) was 127 micrograms I/l, median 115 micrograms I/l of urine. Ioduria of non-pregnant women of the control group was 100 micrograms I/l median 84 micrograms I/l of urine. Low ioduria (below 100 micrograms I/l) was found in 40% of pregnant and 62% fertile women of the control group. Supplementation resulted in the statistically significant increase of ioduria in the 20th week (average value was 186 micrograms I/l, median 156 micrograms I/l); low values had found only 20% of women. The fourth day after delivery, ioduria was statistically lower than in the 20th week (121 micrograms I/l, median 99 micrograms I/l), however, 76% of women finished with supplementation after the childbirth. Values of ioduria were still higher in supplemented than in non-supplemented women. CONCLUSIONS: Iodine intake in the group of pregnant and non-pregnant women was not optimal. Even during the recommended iodine supplementation (100 and 130 micrograms), 20% of women had lower values of ioduria. Health education, which first of all involves the risk groups, is therefore highly recommended.

[Daily mortality and air pollution in the northern Czech Republic]. / Denní úmrtnost a znecistení ovzdusí v severních cechách.

BACKGROUND: Several studies have demonstrated that the increase of air pollutants is related to the increase of the diurnal mortality. The aim of the work was to find correlation among the diurnal mortality and changes in the concentration of SO2, total suspended particles (TSP), and dust particles with aerodynamic diameter smaller than 10 microns (PM10) and smaller than 2.5 microns (PM2.5) in the external air of the North Bohemian brown-coal basin. METHODS AND RESULTS: All that died in 1982-1994 in coal-basin districts of the North Bohemia region were included into the data set. Method of long time series and the model of logistic regression were applied with correction to long-term trends, seasons, respiratory diseases and meteorological condition. Investigating the described relation regardless to age and sex, the increase of TSP by 100 micrograms/m3 was connected with significant increase of the total diurnal mortality by 3.4%. Significant differences between males and females were found. Meanwhile the mortality of males younger than 65 years increased, that of equally old females decreased. Contrary to it, in population of females older than 65 mortality increased and that males significantly decreased. CONCLUSION: Monitoring of the diurnal mortality and air pollution in relation to the sex reveals important for the identification of sensitive and vulnerable population subgroups. Illogic and difficult to explain is the decrease of mortality in conditions of increased air pollutants. Authors recommend repeating the analysis also in different epidemiological studies in order to distinguish whether the presented results are accidental or have a more general significance.

Daily mortality and air pollution in northern Bohemia: different effects for men and women.

UNLABELLED: The association between short term changes in ambient air concentrations of TSP and SO2 and day to day fluctuations in mortality was analyzed in the highly polluted Northern Bohemia region inhabited by approximately 630,000 people. A logistic regression model was adjusted for long term trends, seasonal cycles, influenza epidemics and weather parameters. The pollution and mortality data were available from 1982 to 1994. When the association was evaluated regardless of gender and age, 100 micrograms/m3 increase of TSP, but not SO2, was associated with a 3.4% increase of daily mortality lagged by 2 days. Evident differences in this association have been found between men and women. A significant increase in daily total and CVD mortality was observed in men below 65 while in women of the same age we found no association or even significant decrease in daily mortality. For the population over 65 the differences between genders were again apparent. The mortality in women increased significantly while in men significant decrease was demonstrated. CONCLUSIONS: The evaluation with respect to gender might contribute to identifying susceptible subgroups.

Associations between mortality and air pollution in central Europe.

Increased mortality has been observed in association with elevated concentrations of air pollutants in European cities and in the United States. We reassessed the effects of particulate matter in Central Europe. Mortality and air pollution data were obtained for a highly polluted region of the Czech Republic and a rural region in Germany. Poisson regression analyses were conducted considering trend, season, meteorology, and influenza epidemics as confounders in both a parametric and a nonparametric approach. The Czech Republic had a 3.8% increase in mortality [95% confidence interval (CI), 0.8-6.9%] in association with 100 microg/m(3) total suspended particles (TSP) (lagged 2 days) for the time period 1982-1994. During the last 2 years of study, 68% of the TSP consisted of particulate matter [less than/equal to] 10 microm in aerodynamic diameter (PM(10)). An increase of 100 microg/m(3) TSP (lagged 1 day) was associated with a 9.5% increase in mortality (CI, 1.2-18.5%) and 100 microg/m(3) PM(10 )(lagged 1 day) showed a 9.8% increase in mortality (CI, 0.7-19.7%). We found no evidence for an association between mortality and particulate matter in the rural area in Germany at the Czech border. Data from the coal basin in the Czech Republic suggested an increase in mortality associated with the concentration of particulate matter in a highly polluted setting in Central Europe that is consistent with the associations observed in other western European cities and in the United States.

[In towns there is a higher prevalence of asthmatic symptoms in children than in rural areas]. / Ve mestech je vetsí prevalence príznaku astmatu detí nez ve venkovských oblastech.

The authors assessed the prevalence of symptoms of bronchial asthma by means of a standardized questionnaire used in the international survey PEACE (Pollution Effect on Asthmatic Children in Europe). The questions about complaints were addressed to children aged 6-13 years (the questionnaires were completed with the parents assistance). In urban areas 5669 children participated from Prague 5, i.e. 35% of all elementary school children, in Teplice 2489 (21% children), in rural areas: in the Benesov district 5619, i.e. 61% children, in the Prachatice district 1983, i.e. 37% children. The response rate of questionnaires in the urban areas was 86-88%, in rural areas 93%. In urban areas the annual prevalence of wheezing in the chest or dyspnoea or possibly both symptoms was within the range of 3.8-13.8% and differed significantly from the prevalence in rural areas where it was 2.4-3.6%. The most frequent symptom was nocturnal dry cough without a cold (in urban areas 14.1-36.7%, in rural areas 6.0-10.6%). Rural areas differed from urban ones by a lower contamination of the atmosphere, a lower density of the population as well as some parameters caused by a different lifestyle.

Risk assessment of the common air pollutants in Teplice, Czech Republic.

In the framework of the systematic investigation of the environment of the district of Teplice (Northern Bohemia), one of the most polluted regions in Europe, an attempt was made to estimate health risks to the inhabitants posed by the most common air contaminants (SO2, NOx, particulate matter). A meta-analysis of data published in recent papers dealing with health effects was performed. At first we weighed the number of positive and negative findings focusing on the following health indicators: prevalence of symptoms (coughing, wheezing), decreased respiratory function, prevalence of respiratory illness, and acute mortality. Only those categories in which the positive findings prevailed were taken into consideration and median values for LOAELs were calculated from the data referring to positive dose-response relationships. The exposure assessment was based upon a series of data on daily concentrations of the air contaminants in Teplice since 1975. Due to the somatic and respiration parameters, as well as to their habits, children between the ages of 8 and 10 appeared the most heavily exposed of all age groups. It was concluded that in real concentrations the risk is posed mainly from sulphur dioxide and, above all, from particulate matter.

Pulmonary functions of school children in highly polluted northern Bohemia.

The purpose of this study was to ascertain whether pulmonary function in children who were lifetime residents of the highly polluted district of Teplice in northern Bohemia was lower than that for children who were lifetime residents of the cleaner district of Prachatice in southern Bohemia. Forced expiratory spirometry was measured twice (February/March and April) in approximately 235 eighth-grade students in each district. On both testing occasions, height-adjusted forced expiratory volume in 1 s and forced expiratory flow between 25% and 75% forced vital capacity were significantly lower (p < .001) in children from Teplice than in those from Prachatice. These differences were not associated with parental smoking habits, presence of pets, heating/cooking fuels, private home/apartment residency, or rural/urban residency. In Teplice, no differences were observed between lung functions measured at the end of the high pollution season (February/March) and those measured after the children breathed much cleaner air for a 4-wk period (April). This result was suggestive of a condition of chronically depressed lung function. No differences across times were observed in Prachatice, indicating that our measurements were reliable.

Teplice program--the impact of air pollution on human health.

The aim of the Teplice Program is to investigate and assess the impact of air pollution on the health of the population in the district of Teplice, Czech Republic. Characterization of the air pollutants demonstrated unusually high concentrations during winter inversions of fine particles dominated by acidic sulfates, genotoxic organic compounds, and toxic trace elements. The major source of airborne fine particles is the burning of coal for heating and power. Human exposure and biomarker studies demonstrated large seasonal variations in air pollution within the Teplice District and higher seasonal average pollution levels than the comparative district, Prachatice. Personal exposures to fine particles and organic carcinogens [e.g., polycyclic aromatic hydrocarbons (PAH)] were correlated with excretion of PAH metabolites in urine, several trace metals in blood, and DNA adducts in white blood cells. Respiratory and neurobehavioral studies of school children were conducted using questionnaires and clinical measures. A significantly higher prevalence of adverse respiratory symptoms and decreased lung function were found in the Teplice district than in Prachatice. The neurobehavioral studies indicated significantly higher teacher referrals for clinical assessment in Teplice, but the majority of objective performance measures did not differ. Reproductive studies were conducted in both males and females. A study of the effects of exposure on pregnancy and birth found an excess prevalence of low birth weight and premature births in Teplice; these adverse effects were more common in infants conceived in the winter and whose mothers were smokers. Based on questionnaires and medical examination, the reproductive development of young men was not different between districts and seasons, however, measures of semen quality suggest that exposure to high levels of air pollution are associated with transient decrements in semen quality.

[Total serum cholesterol in children 8-15 years of age]. / Celkový cholesterol v séru detí ve veku 8-15 let.

The authors evaluated the difference in the health status of two groups of boys and girls aged 8-15 years, a total of 1037 children. The larger group, 790 children is from Teplice and the other group, a total of 347 children from Roudnice nad Labem. The authors discuss the total serum cholesterol level in the two groups. They provide information on mean serum cholesterol levels in children of comparable age and the significance of differences in relation to age and sex. The assembled values made it possible to calculate percentile values at the 90th and 95th percentile level for children of both areas and thus to examine and evaluate larger groups of children incl. their relatives and to detect critical total cholesterol levels calling for treatment and intervention.

[Epidemiologic study of symptoms of minimal brain dysfunction. 1. Design and testing of methods--the incidence of symptoms in the study group]. / Epidemiologický výzkum znaku lehkých mozkových dysfunkcí. 1. etapa: konstrukce a overení metody--výskyt znaku ve zkoumaném souboru.

The authors inform on the elaboration of a screening method for recording of symptoms of minimal brain dysfunction and its initial verification in the research problem "Incidence of signs of minimal brain dysfunctions in children in the North Bohemian region". In the first stage a population group of children in the second form of primary school in three districts was examined, a total of 5080 children, and data were assembled from their 9000 parents. The authors describe the elaboration of the method which comprises rating scales which evaluate specific striking features in the behaviour, dysfunction in school skills (the forms were completed by teachers and mothers) and performance tests administered by the children themselves. Results of statistical analyses which confirmed the satisfactory consistency, composition, empirical and postdictive validity of the method are presented. The analyses revealed that the method used detects disorders included under the term of minimal brain dysfunctions and probably also disorders with the incidence of some identical symptoms (disorders of intellect, behavioural disorders in the wider sense of the word). The authors inform on the method of calculation and the ratio of the detected problem child population which was 14.8%. The group comprises 4.8% children which were unable to keep up with the first form of primary school and attend some special school. The method used detected, however, another 10% population with identical values. The authors discuss problems of screening diagnosis of specific developmental learning and behavioural disorders which form part of minimal brain dysfunctions. Problems associated with the evaluation of the assembled findings are discussed.

Chromosomal abnormalities in soft coal open-cast mining workers.

Chromosome aberration tests on cultured peripheral blood lymphocytes were carried out in two groups of open-cast mining workers engaged in stripping operations (Group I) and digging operations (Group II), in a group of coal cleaning plant workers used as a positive control, and in a group of nonexposed subjects serving as matching controls. Peripheral blood samples in group I and group II miners were collected in March and June of 1984, the antimutagenic potential of long-term prophylactic vitamin administrations (1 g of ascorbic acid given daily for a period of 3 months and 100 mg of vitamin A a day for two 5-day cycles) initiated after the first blood sampling was tested in group II miners. The frequency of aberrant cells (% AB.C.) found in the cultured lymphocytes of group I miners was increased at both times of measurement (2.41% AB.C. and 2.29% AB.C.), in group II miners given the vitamin prophylaxis it dropped significantly (P greater than 0.01) from the initial 3.16% AB.C. in March to 1.77% AB.C. in June, and in the group of coal cleaning plant workers (1.30% AB.C.) it was more or less equal to that of matching controls (1.21% AB.C.). Implicitly, coal dust alone can hardly be made responsible for the rise in % AB.C. It appears that the increase in frequency of chromosome aberrations observed in soft coal open-cast mining workers rather reflects an increased risk of genetic injury due to exposure to ever-present fumes and fire hazards that may give rise to the mutagenic chemicals belonging to a class of polycyclic aromatic hydrocarbons. The antimutagenic effect of ascorbic acid prophylaxis was characterized by a significant drop in % AB.C. and a speed-up of the lymphocyte cell cycle expressed as the proliferating rate index (PRI) whose value rose from the original 1.41 to 1.69, thus reaching the PRI value of matching controls (1.63).

Cytogenetic analysis of peripheral blood lymphocytes in glass workers occupationally exposed to mineral oils.

Chromosome aberration tests were carried out in a group of 31 pressed glass makers operating an automatic line of press-and-blow machines known to release mineral oil mists containing relatively high concentrations of the mutagenic chemicals belonging to a class of polycyclic aromatic hydrocarbons (PAH). The workers were exposed to the mineral oil aerosol levels that did not exceed the Czechoslovak maximum allowable concentration limit of 5 mg . m-1 of air. The tests revealed that the frequency of aberrant cells (% AB.C.) and the value of breaks per cell (B/C) ratio found in mineral oil-exposed workers were increased significantly, accounting for 4.65 +/- 0.29% AB.C. (0.0532 B/C) vs. 1.13 +/- 0.19% AB.C. (0.0113 B/C) seen in matching controls. Also, a higher rate of dicentrics, reciprocal translocations and cells with pulverization was observed in this group of glass workers. These finding are considered as evidence suggesting that these workers might experience an increased risk of genetic injury due to exposure to mineral oil mists.