Lung function and symptoms among indigenous Mayan women exposed to high levels of indoor air pollution.

SETTING: Indoor air pollution from burning of biomass fuel in open fires is a known risk factor for chronic obstructive pulmonary disease (COPD) in developing countries. OBJECTIVE: To estimate the prevalence of respiratory symptoms and lung function among women in rural Guatemala and to describe the methods and practical issues associated with the assessment of respiratory health. DESIGN: Information about respiratory symptoms, lung function and individual measurement of exposure was collected cross-sectionally among 350 Mayan-Indian women aged 15-50 years who used traditional open fires. RESULTS: These women, exposed to indoor air pollution since birth, had a relatively high prevalence of cough (22.6%), phlegm (15.1%), wheeze (25.1%) and tightness in the chest (31.4%). Respiratory symptoms were positively associated with exposure levels. Lung function was higher than the most feasible reference population (average above predicted forced expiratory volume in 1 s [FEV(1)] +4.5% and forced vital capacity [FVC] +4.2%). Only one woman had a FEV(1)/FVC ratio lower than 70%. CONCLUSIONS: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, almost one third of these young non-smoking women were at risk (stage 0) of developing COPD. The methodological issues encountered during the study highlight the importance of standardising approaches to local adaptation of established questionnaires to study respiratory health in rural areas of developing countries.

Atopy in Norwegian and Russian adults: a population-based study from the common border area.

BACKGROUND: Several studies have concluded that atopy is more common in Western than in Eastern Europe. We aimed to study whether a similar difference exists between Norwegian and Russian adults living in geographically adjacent areas. METHODS: A cross-sectional population-based study was performed in Sør- Varanger municipality (Norway) and in the cities of Nikel and Zapolyarny (Russia). The Russian cities are heavily polluted by sulfur dioxide from local nickel industry. In addition to questionnaire information, results on IgE sensitization (S-Phadiatop, Pharmacia & Upjohn, Uppsala, Sweden) were obtained from 3134 Norwegian and 709 Russian participants. RESULTS: A positive Phadiatop was found in 20.7% of the Norwegians (men 21.9%, women 19.7%) and in 27.5% of the Russians (men 35.7%, women 23.0%); the sex- and age-adjusted relative risk of testing positive in Russia being 1.49 (95% CI 1.23-1.81). The Norwegian participants reported more atopic dermatitis and hay fever, although this difference was statistically significant only for atopic dermatitis in women. CONCLUSION: IgE sensitization was more common in Russia than in Norway, unlike findings from other east-west European studies. The Russians did not, however, report more atopic diseases. This discrepancy might reflect different awareness of allergies in the two countries and demonstrates the need for objective markers of atopy when comparing prevalence in different populations.

Sulphur dioxide exposure and lung function in a Norwegian and Russian population living close to a nickel smelter.

The Norwegian-Russian border area is polluted by sulphur dioxide (SO2) emitted from a Russian nickel smelter in the city of Nikel. We studied the effects of daily variations in SO2 on the lung function levels of people on both sides of the border. A cross-sectional population-based study was performed among adults in Sør-Varanger, Norway (n = 3438) and Nikel, Russia (n = 1613). All subjects were assigned 24 h mean SO2 concentrations for their day of screening and the day before on basis of residency. The SO2-concentrations were compared with the daily recordings of forced expiratory volume in one second expressed as percentage of the predicted value (FEV1% predicted). In Sør-Varanger, no significant associations between SO2 and FEV1% predicted were found. In Nikel, FEV1% predicted was exceeded non-systematically in some of the exposure categories (10-50, 50-90, or > 90 micrograms/m3) compared to the reference exposure group (0-10 micrograms/m3). In conclusion, neither of the study populations suffered from a measurable reduction in lung function when SO2 increased above the reference level.

Nickel allergy and its relationship with local nickel pollution, ear piercing, and atopic dermatitis: a population-based study from Norway.

BACKGROUND: The north-Norwegian population of Sør-Varanger lives close to 2 Russian nickel smelters. OBJECTIVE: We studied the importance of the local nickel pollution, as well as ear piercing and atopic dermatitis, on the prevalence of nickel allergy in Sør-Varanger. METHODS: We patch-tested 1767 adults who were randomly selected from 2 different cross-sectional studies; in Sør-Varanger and the reference city of Tromsø, which has no nickel-polluting industry. RESULTS: Nickel allergy was diagnosed in 27.5% and 31.1% of the women in Sør-Varanger and Tromsø, respectively, and in 5.1% and 5.0% of the men. In women, ear piercing was a strong risk factor (relative risk = 3.30; 95% confidence interval = 2.01 to 5.43). A history of atopic dermatitis was not associated with nickel sensitization. We found no increased risk of nickel allergy in Sør-Varanger compared with Tromsø in adjusted multivariate analyses. CONCLUSION: The high prevalence of nickel allergy found in Sør-Varanger could not be attributed to pollution from the nearby nickel industry.

Urinary nickel excretion in populations living in the proximity of two russian nickel refineries: a Norwegian-Russian population-based study.

The Russian nickel refineries located in the cities of Nikel and Zapolyarny close to the Norwegian border are responsible for extensive sulfur dioxide and nickel pollution, as well as severe ecological damage in both countries. The aim of our study was to investigate human nickel exposure in the populations living on both sides of the Norwegian-Russian border. The design was a cross-sectional population-based study of adults aged 18-69 years residing in Sor-Varanger municipality, Norway, and Nikel and Zapolyarny, Russia, during 1994 and 1995. Individual exposure to nickel was assessed by measurements of nickel in urine using electrothermal atomic absorption spectrometry. For controls, urine was collected from adults in the Russian cities of Apatity and Umba (Kola Peninsula) and the Norwegian city of Tromso, all of which are locations without nearby point sources of nickel. Altogether 2,233 urine specimens were analysed for nickel. People living in Nikel had the highest concentrations (median 3.4 microg/l), followed by Umba (median 2.7 microg/l), Zapolyarny (median 2.0 microg/l), Apatity (median 1.9 microg/l), Tromso (median 1.2 microg/l), and Sor-Varanger (median 0.6 microg/l). Regardless of geographical location, the Russian study groups all had a higher urinary-nickel average than those in Norway (p<0.001). With the exception of Nikel, neither the Russian nor the Norwegian urinary-nickel levels were associated with residence location near a Russian nickel refinery. We concluded that industrial nickel pollution alone could not explain the observed discrepancy between Norway and Russia; we also discuss other possible nickel exposure sources that may account for the high urinary levels found in Russia.

Self-reported mental distress under the shifting daylight in the high north.

BACKGROUND: The validity of the concept of seasonal affective disorder and the causal link to lack of daylight in winter is controversial. There is a need for investigations in large samples of the general population at different latitudes and within general research contexts to avoid selective response bias and sensitization of the population. METHODS: During a study of health effects of the air pollution from Russia in a small community at 70 degrees north, a self-administered questionnaire was filled in by 3736 inhabitants, 60.8% of the total population between 18 and 69 years. Three questions concerned depression, sleeping problems and other problems related to the two contrasting seasons with regard to daylight. RESULTS: Twenty-seven per cent reported to have some kind of problem in the dark period. Most frequently reported were sleeping problems during winter, in 19.9% of women and 11.2% of men. Self-reported depression in winter was found in 11.1% of women and 4.8%% of men. Sleeping problems increased with age, while depression was most often reported by middle-aged people. The only other reported problem in winter was fatigue. The adjusted relative risk (RR) for winter depression in women compared to men was 2.5 (95% confidence interval: 1.9-3.2). Very few had problems in summer. CONCLUSIONS: In the high north, one-third of the women and one-fifth of the men experience problems with sleep, mood or energy related to season. The prevalence of self-reported depression was surprisingly low in winter considering the lack of daylight.

Human nickel exposure in an area polluted by nickel refining: the Sør-Varanger study.

Sør-Varanger municipality in northern Norway is located close to two Russian nickel refineries that cause nickel and sulfur dioxide pollution. To investigate individual nickel exposure and possible health effects from the pollution, the authors invited all adults who were 18-69 y of age to a health survey in 1994. Urine samples were collected from 3671 participants (participation rate = 59.4%), and nickel concentrations were determined for 902 of them. Mean and median nickel concentrations were 0.9 microg/l and 0.6 microg/l, respectively. Individuals who lived in the rural areas closest to the refineries had lower nickel concentrations than individuals who lived in the more urban areas. Independent risk factors for nickel concentrations in urine were (a) being an urban dweller and (b) living close to areas with high-density traffic. The authors concluded that nickel exposure attributable to air pollution from Russian refineries was of minor importance for people who lived in Sør-Varanger.