Development of methods for citizen scientist mapping of residential woodsmoke in small communities.

BACKGROUND: Residential wood burning is a major source of fine particulate matter (PM2.5) during winter and a leading contributor to air pollution. Exposure to woodsmoke PM2.5 is associated with many health effects, so it is important to characterize the magnitude and spatial variability in exposures. However, high infrastructure and maintenance costs of regulatory monitoring stations limit their spatial resolution and make monitoring infeasible for many small communities where woodsmoke may be prevalent. METHODS: Mobile monitoring was conducted with a nephelometer and multi-wavelength aethalometer, capable of identifying woodsmoke PM2.5, to capture spatially resolved data. This Combined Aethalometer and Nephelometer for Assessment of Woodsmoke (CANAW) method was evaluated in three pairs of communities in British Columbia, Canada. Measurements were also taken at fixed-site monitoring stations. Light scattering measured by a nephelometer (Bsp) was compared with gravimetric filter-based and beta-attenuation measures of PM2.5. The difference in absorbance of 370 nm and 880 nm wavelengths as measured by an aethalometer (delta C), was compared with the chemical woodsmoke tracer levoglucosan. RESULTS: Fixed site measurements of Bsp and delta C were comparable with established methods of monitoring PM2.5 and woodsmoke, respectively. Correlations in each tested relationship across all locations were high (r ≥ 0.93 in all cases). Mobile monitoring captured high spatial variation in woodsmoke PM2.5 and maps of average concentrations during monitoring were created to identify woodsmoke hotspots. CONCLUSION: Following the successful implementation of the mobile CANAW method, training materials were created and tested with lay volunteers along with an online mapping application. Volunteers were able to effectively operate the equipment, collect valuable data on woodsmoke concentrations, and map spatial patterns across their communities using the application. The CANAW method is a valuable option for advancing cost-effective data collection for residential woodsmoke in otherwise unmonitored communities, and to add spatial context to existing monitoring networks.

Snowfall, Temperature, and the Risk of Death From Myocardial Infarction: A Case-Crossover Study.

Previous research has associated snowfall with risk of myocardial infarction (MI). Most studies have been conducted in regions with harsh winters; it remains unclear whether snowfall is associated with risk of MI in regions with milder or more varied climates. A case-crossover design was used to investigate the association between snowfall and death from MI in British Columbia, Canada. Deaths from MI among British Columbia residents between October 15 and March 31 from 2009 to 2017 were identified. The day of each death from MI was treated as the case day, and each case day was matched to control days drawn from the same day of the week during the same month. Daily snowfall amount was assigned to case and control days at the residential address, using weather stations within 15 km of the residence and 100 m in elevation. In total, 3,300 MI case days were matched to 10,441 control days. Compared with days that had no snowfall, odds of death from MI increased 34% (95% confidence interval: 0%, 80%) on days with heavy snowfall (≥5 cm). In stratified analysis of deaths from MI as a function of both maximum temperature and snowfall, risk was significantly increased on snowfall days when the temperature was warmer.

Implementation of a Venous Thromboembolism Prophylaxis Protocol Using the Caprini Risk Assessment Model in Patients Undergoing Mastectomy.

BACKGROUND: Guidelines for venous thromboembolism (VTE) prophylaxis are not well-established for breast surgery patients. An individualized VTE prophylaxis protocol using the Caprini score was adopted at our institution for patients undergoing mastectomy ± implant-based reconstruction. In this study, we report our experience during the first year of implementation. METHODS: In August 2016, we adopted a VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction. We used the Caprini score, a validated risk assessment tool for VTE, to determine each patient's perioperative prophylaxis regimen. Detailed chart review was performed to record patient and treatment details, the Caprini score, pharmacologic VTE prophylaxis administration, and 30-day incidence of VTE and bleeding complications. We performed univariate analysis to identify factors associated with protocol compliance. RESULTS: Overall, 522 patients met the inclusion criteria. Median age was 51 years, 486 (93.1%) patients had malignancy, 234 (44.8%) underwent bilateral mastectomy, and 350 (67.0%) underwent reconstruction. Caprini scores ranged from 2 to 11, with 431 (82.6%) patients having a score from 5 to 7. Overall protocol compliance was 60.5%, and was associated with bilateral mastectomy (p = 0.02), reconstruction (p = 0.03), and longer procedures (p < 0.001). The rate of VTE was 0.2% (95% confidence interval [CI] 0.03-1.1%), rate of reoperation for hematoma was 2.7% (95% CI 1.6-4.5%), and rate of blood transfusion was 0.4% (95% CI 0.1-1.4%). CONCLUSIONS: The implementation of an individualized VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction is safe and feasible. Despite a high-risk cohort, the incidence of VTE was very low and bleeding complications were consistent with reported rates for breast surgery. Continued evaluation of this strategy is warranted.

A proposed case-control framework to probabilistically classify individual deaths as expected or excess during extreme hot weather events.

BACKGROUND: Most excess deaths that occur during extreme hot weather events do not have natural heat recorded as an underlying or contributing cause. This study aims to identify the specific individuals who died because of hot weather using only secondary data. A novel approach was developed in which the expected number of deaths was repeatedly sampled from all deaths that occurred during a hot weather event, and compared with deaths during a control period. The deaths were compared with respect to five factors known to be associated with hot weather mortality. Individuals were ranked by their presence in significant models over 100 trials of 10,000 repetitions. Those with the highest rankings were identified as probable excess deaths. Sensitivity analyses were performed on a range of model combinations. These methods were applied to a 2009 hot weather event in greater Vancouver, Canada. RESULTS: The excess deaths identified were sensitive to differences in model combinations, particularly between univariate and multivariate approaches. One multivariate and one univariate combination were chosen as the best models for further analyses. The individuals identified by multiple combinations suggest that marginalized populations in greater Vancouver are at higher risk of death during hot weather. CONCLUSIONS: This study proposes novel methods for classifying specific deaths as expected or excess during a hot weather event. Further work is needed to evaluate performance of the methods in simulation studies and against clinically identified cases. If confirmed, these methods could be applied to a wide range of populations and events of interest.

Chronic Diseases Associated With Mortality in British Columbia, Canada During the 2021 Western North America Extreme Heat Event.

Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1,614 deaths from 25 June to 02 July 2021 with 6,524 deaths on the same dates from 2012 to 2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non-heat-related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high-risk individuals based on underlying chronic conditions.

Hot weather and death related to acute cocaine, opioid and amphetamine toxicity in British Columbia, Canada: a time-stratified case-crossover study.

BACKGROUND: Previous research has shown that cocaine-associated deaths occur more frequently in hot weather, which has not been described for other illicit drugs or combinations of drugs. The study objective was to evaluate the relation between temperature and risk of death related to cocaine, opioids and amphetamines in British Columbia, Canada. METHODS: We extracted data on all deaths with cocaine, opioid or amphetamine toxicity recorded as an underlying or contributing cause from BC vital statistics for 1998-2017. We used a time-stratified case-crossover design to estimate the effect of temperature on the risk of death associated with acute drug toxicity during the warmer months (May through September). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each 10°C increase in the 2-day average maximum temperature at the residential location. RESULTS: We included 4913 deaths in the analyses. A 10°C increase in the 2-day average maximum temperature was associated with an OR of 1.43 (95% CI 1.11-1.86) for deaths with only cocaine toxicity recorded (n = 561), an OR of 1.15 (95% CI 0.99-1.33) for deaths with opioids only (n = 1682) and an OR of 1.11 (95% CI 0.60-2.04) for deaths with amphetamines only (n = 133). There were also elevated effects when toxicity from multiple drugs was recorded. Sensitivity analyses showed differences in the ORs by sex, by climatic region, and when the location of death was used instead of the location of residence. INTERPRETATION: Increasing temperatures were associated with higher odds of death due to drug toxicity, especially for cocaine alone and combined with other drugs. Targeted interventions are necessary to prevent death associated with toxic drug use during hot weather.

Modeling population exposure to community noise and air pollution in a large metropolitan area.

Epidemiologic studies have shown that both air pollution and community noise are associated with cardiovascular disease mortality. Because road traffic is a major contributor to these environmental pollutants in metropolitan areas, it is plausible that the observed associations may be confounded by coexistent pollutants. As part of a large population-based cohort study to address this concern, we used a noise prediction model to assess annual average community noise levels from transportation sources in metropolitan Vancouver, Canada. The modeled annual average noise level was 64 (inter quartile range 60-68) dB(A) for the region. This model was evaluated by comparing modeled annual daytime A-weighted equivalent continuous noise levels (L(day)) with measured 5-min daytime A-weighted equivalent continuous noise levels (L(eq,day,5 min)) at 103 selected roadside sites in the study region. On average, L(day) was 6.2 (95% CI, 6.0-7.9) dB(A) higher than, but highly correlated (r=0.62; 95% CI, 0.48-0.72) with, L(eq,day,5 min). These results suggest that our model-based noise exposure assessment could approximately reflect actual noise exposure in the study region. Overall, modeled noise levels were not strongly correlated with land use regression estimates of traffic-related air pollutants including black carbon, particulate matter with aerodynamic diameter ≤2.5 µm (PM(2.5)), NO(2) and NO; the highest correlation was with black carbon (r=0.48), whereas the lowest correlation was with PM(2.5) (r=0.18). There was no consistent effect of traffic proximity on the correlations between community noise levels and traffic-related air pollutant concentrations. These results, consistent with previous studies, suggest that it is possible to assess potential adverse cardiovascular effects from long-term exposures to community noise and traffic-related air pollution in prospective epidemiologic studies.

Analysis of community deaths during the catastrophic 2021 heat dome: Early evidence to inform the public health response during subsequent events in greater Vancouver, Canada.

BACKGROUND: British Columbia, Canada, was impacted by a record-setting heat dome in early summer 2021. Most households in greater Vancouver do not have air conditioning, and there was a 440% increase in community deaths during the event. Readily available data were analyzed to inform modifications to the public health response during subsequent events in summer 2021 and to guide further research. METHODS: The 434 community deaths from 27 June through 02 July 2021 (heat dome deaths) were compared with all 1,367 community deaths that occurred in the same region from 19 June through 09 July of 2013-2020 (typical weather deaths). Conditional logistic regression was used to examine the effects of age, sex, neighborhood deprivation, and the surrounding environment. Data available from homes with and without air conditioning were also used to illustrate the indoor temperatures differences. RESULTS: A combined index of material and social deprivation was most predictive of heat dome risk, with an adjusted odds ratio of 2.88 [1.85, 4.49] for the most deprived category. Heat dome deaths also had lower greenness within 100 m than typical weather deaths. Indoor temperatures in one illustrative home without air conditioning ranged between 30°C and 40°C. CONCLUSIONS: Risk of death during the heat dome was associated with deprivation, lower neighborhood greenness, older age, and sex. High indoor temperatures likely played an important role. Public health response should focus on highly deprived neighborhoods with low air conditioning prevalence during extreme heat events. Promotion of urban greenspace must continue as the climate changes.

The Canadian Optimized Statistical Smoke Exposure Model (CanOSSEM): A machine learning approach to estimate national daily fine particulate matter (PM2.5) exposure.

Exposure to biomass smoke has been associated with a wide range of acute and chronic health outcomes. Over the past decades, the frequency and intensity of wildfires has increased in many areas, resulting in longer smoke episodes with higher concentrations of fine particulate matter (PM2.5). There are also many communities where seasonal open burning and residential wood heating have short- and long-term impacts on ambient air quality. Understanding the acute and chronic health effects of biomass smoke exposure requires reliable estimates of PM2.5 concentrations during the wildfire season and throughout the year, particularly in areas without regulatory air quality monitoring stations. We have developed a machine learning approach to estimate PM2.5 across all populated regions of Canada from 2010 to 2019. The random forest machine learning model uses potential predictor variables integrated from multiple data sources and estimates daily mean (24-hour) PM2.5 concentrations at a 5 km × 5 km spatial resolution. The training and prediction datasets were generated using observations from National Air Pollution Surveillance (NAPS) network. The Root Mean Squared Error (RMSE) between predicted and observed PM2.5 concentrations was 2.96 µg/m3 for the entire prediction set, and more than 96 % of the predictions were within 5 µg/m3 of the NAPS PM2.5 measurements. The model was evaluated using 10-fold, leave one-region-out, and leave-one-year-out cross-validations. Overall, CanOSSEM performed well but performance was sensitive to removal of large wildfire events such as the Fort McMurray interface fire in May 2016 or the extreme 2017 and 2018 wildfire seasons in British Columbia. Exposure estimates from CanOSSEM will be useful for epidemiologic studies on the acute and chronic health effects associated with PM2.5 exposure, especially for populations affected by biomass smoke where routine air quality measurements are not available.

Assessing secondhand and thirdhand tobacco smoke exposure in Canadian infants using questionnaires, biomarkers, and machine learning.

BACKGROUND: As smoking prevalence has decreased in Canada, particularly during pregnancy and around children, and technological improvements have lowered detection limits, the use of traditional tobacco smoke biomarkers in infant populations requires re-evaluation. OBJECTIVE: We evaluated concentrations of urinary nicotine biomarkers, cotinine and trans-3'-hydroxycotinine (3HC), and questionnaire responses. We used machine learning and prediction modeling to understand sources of tobacco smoke exposure for infants from the CHILD Cohort Study. METHODS: Multivariable linear regression models, chosen through a combination of conceptual and data-driven strategies including random forest regression, assessed the ability of questionnaires to predict variation in urinary cotinine and 3HC concentrations of 2017 3-month-old infants. RESULTS: Although only 2% of mothers reported smoking prior to and throughout their pregnancy, cotinine and 3HC were detected in 76 and 89% of the infants' urine (n = 2017). Questionnaire-based models explained 31 and 41% of the variance in cotinine and 3HC levels, respectively. Observed concentrations suggest 0.25 and 0.50 ng/mL as cut-points in cotinine and 3HC to characterize SHS exposure. This cut-point suggests that 23.5% of infants had moderate or regular smoke exposure. SIGNIFICANCE: Though most people make efforts to reduce exposure to their infants, parents do not appear to consider the pervasiveness and persistence of secondhand and thirdhand smoke. More than half of the variation in urinary cotinine and 3HC in infants could not be predicted with modeling. The pervasiveness of thirdhand smoke, the potential for dermal and oral routes of nicotine exposure, along with changes in public perceptions of smoking exposure and risk warrant further exploration.

Economic Analysis of Specialist Referral Patterns in Mackay, Queensland Following HealthPathways Implementation.

INTRODUCTION: HealthPathways is a clinical information portal developed in New Zealand that enables general practitioners to manage and refer their patients in a local context. We analyzed specialist outpatient appointment costs in Mackay, Queensland before and after HealthPathways implementation. METHODS: We retrospectively examined specialist outpatient costs for patients referred by Mackay general practitioners for conditions with varying levels of HealthPathways implementation. Ranked from most clinical pathways available to none, chronic diabetes, cardiology, respiratory, and urology visits from January to March 2015, pre-pathways, and January to March 2017, post-pathways, were assessed. Monte Carlo simulation was used to estimate cost changes. Per-visit costs were multiplied by visit numbers to estimate policy impact. RESULTS: The mean cost per visit increased from $220 to $305 for diabetes and $270 to $323 for respiratory, and decreased from $296 to $257 for cardiology and $444 to $293 for urology. The policy impact for each disease group over 3 months after accounting for visit numbers was a likely saving of $30 360 for diabetes and $10 270 for cardiology, and a likely cost increase of $24 449 for respiratory and $20 536 for urology. CONCLUSIONS: We observed that conditions with more comprehensive clinical pathways cost Mackay HHS substantially less following implementation. Costs for low and no pathway implementation referrals increased slightly over the same period.

Staying Ahead of the Epidemiologic Curve: Evaluation of the British Columbia Asthma Prediction System (BCAPS) During the Unprecedented 2018 Wildfire Season.

Background: The modular British Columbia Asthma Prediction System (BCAPS) is designed to reduce information burden during wildfire smoke events by automatically gathering, integrating, generating, and visualizing data for public health users. The BCAPS framework comprises five flexible and geographically scalable modules: (1) historic data on fine particulate matter (PM2.5) concentrations; (2) historic data on relevant health indicator counts; (3) PM2.5 forecasts for the upcoming days; (4) a health forecasting model that uses the relationship between (1) and (2) to predict the impacts of (3); and (5) a reporting mechanism. Methods: The 2018 wildfire season was the most extreme in British Columbia history. Every morning BCAPS generated forecasts of salbutamol sulfate (e.g., Ventolin) inhaler dispensations for the upcoming days in 16 Health Service Delivery Areas (HSDAs) using random forest machine learning. These forecasts were compared with observations over a 63-day study period using different methods including the index of agreement (IOA), which ranges from 0 (no agreement) to 1 (perfect agreement). Some observations were compared with the same period in the milder wildfire season of 2016 for context. Results: The mean province-wide population-weighted PM2.5 concentration over the study period was 22.0 µg/m3, compared with 4.2 µg/m3 during the milder wildfire season of 2016. The PM2.5 forecasts underpredicted the severe smoke impacts, but the IOA was relatively strong with a population-weighted average of 0.85, ranging from 0.65 to 0.95 among the HSDAs. Inhaler dispensations increased by 30% over 2016 values. Forecasted dispensations were within 20% of the observed value in 71% of cases, and the IOA was strong with a population-weighted average of 0.95, ranging from 0.92 to 0.98. All measures of agreement were correlated with HSDA population, where BCAPS performance was better in the larger populations with more moderate smoke impacts. The accuracy of the health forecasts was partially dependent on the accuracy of the PM2.5 forecasts, but they were robust to over- and underpredictions of PM2.5 exposure. Conclusions: Daily reports from the BCAPS framework provided timely and reasonable insight into the population health impacts of predicted smoke exposures, though more work is necessary to improve the PM2.5 and health indicator forecasts.

Evaluating an Air Quality Health Index (AQHI) amendment for communities impacted by residential woodsmoke in British Columbia, Canada.

Smoke from burning biomass is an important source of fine particulate matter (PM2.5), but the health risks may not be fully captured by the Canadian Air Quality Health Index (AQHI). In May 2018, the province of British Columbia launched an evidence-based amendment (AQHI-Plus) to improve AQHI performance for wildfire smoke, but the AQHI-Plus was not developed or tested on data from the residential woodsmoke season. This study assesses how the AQHI and AQHI-Plus are associated with acute health outcomes during the cooler seasons of 2010-2017 in British Columbia, Canada. Monthly and daily patterns of temperature and PM2.5 concentrations were used to identify Local Health Areas (LHAs) that were impacted by residential woodsmoke. The effects of the AQHI and AQHI-Plus on five acute health outcomes (including non-accidental mortality, outpatient physician visits, and medical dispensations for cardiopulmonary conditions) were estimated using generalized linear mixed effect models with Poisson distributions adjusted for long- and short-term temperature trends. Values of the Akaike information criterion (AIC) were compared to evaluate whether the AQHI or AQHI-Plus was better fitted to each health outcome. Eleven LHAs were categorized as woodsmoke-impacted. In these LHAs, the AQHI and AQHI-Plus associations with acute health outcomes were sensitive to temperature adjustments. After temperature adjustments, the most consistent associations were observed for the two asthma-specific outcomes where the AQHI-Plus was better fitted than the AQHI. The improved performance of the AQHI-Plus for susceptible populations with asthma is consistent between communities impacted by residential woodsmoke and wildfire smoke. Implications: Canada's Air Quality Health Index (AQHI) is a three pollutant index used to communicate the short term health impact of degraded air quality. As fine particulate matter (PM2.5) is the lowest weighted pollutant in the AQHI, the index is poorly reflective of woodsmoke impacts. The present analysis found that an AQHI amendment developed for improved sensitivity to PM2.5 during wildfire seasons (AQHI-Plus) is also more predictive of acute asthma-related health outcomes in communities impacted by residential woodsmoke. The BC Ministry of Environment and Climate Change Strategy has piloted the AQHI-Plus year-round. Other jurisdictions should consider whether their air quality indices are reflective of the risks posed by woodsmoke.

Early life exposure to phthalates in the Canadian Healthy Infant Longitudinal Development (CHILD) study: a multi-city birth cohort.

BACKGROUND: Few studies have examined phthalate exposure during infancy and early life, critical windows of development. The Canadian Healthy Infant Longitudinal Development (CHILD) study, a population-based birth cohort, ascertained multiple exposures during early life. OBJECTIVE: To characterize exposure to phthalates during infancy and early childhood. METHODS: Environmental questionnaires were administered, and urine samples collected at 3, 12, and 36 months. In the first 1578 children, urine was analyzed for eight phthalate metabolites: mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-3-carboxypropyl phthalate (MCPP). Geometric mean (GM) concentrations were calculated by age, together with factors that may influence concentrations. Trends with age were examined using mixed models and differences within factors examined using ANOVA. RESULTS: The highest urinary concentration was for the metabolite MBP at all ages (GM: 15-32 ng/mL). Concentrations of all phthalate metabolites significantly increased with age ranging from GM: 0.5-15.1 ng/mL at 3 months and 1.9-32.1 ng/mL at 36 months. Concentrations of all metabolites were higher in the lowest income categories except for MEHP at 3 months, among children with any breastfeeding at 12 months, and in urine collected on dates with warmer outdoor temperatures (>17 °C), except for MBzP at 3 months and MEHP at 3 and 12 months. No consistent differences were found by gender, study site, or maternal age. CONCLUSIONS: Higher phthalate metabolite concentrations were observed among children in lower income families. Examination of factors associated with income could inform interventions aimed to reduce infant phthalate exposure.

Establishing Heat Alert Thresholds for the Varied Climatic Regions of British Columbia, Canada.

Following an extreme heat event in 2009, a Heat Alert and Response System (HARS) was implemented for the greater Vancouver area of British Columbia (BC), Canada. This system has provided a framework for guiding public health interventions and assessing population response and adaptation to extreme heat in greater Vancouver, but no other parts of BC were covered by HARS. The objective of this study was to identify evidence-based heat alert thresholds for the Southwest, Southeast, Northwest, and Northeast regions to facilitate the introduction of HARS across BC. This was done based on a national approach that considers high temperatures on two consecutive days and the intervening overnight low, referred to as the high-low-high approach. Daily forecast and observed air temperatures and daily mortality counts for May through September of 2004 through 2016 were obtained. For each date (dayt), dayt-2 forecasts were used to assign high temperatures for dayt and dayt+1 and the overnight low. A range of high-low-high threshold combinations was assessed for each region by finding associations with daily mortality using time-series models and other considerations. The following thresholds were established: 29-16-29 °C in the Southwest; 35-18-35 °C in the Southeast; 28-13-28 °C in the Northwest; and 29-14-29 °C in the Northeast. Heat alert thresholds for all regions in BC provide health authorities with information on dangerously hot temperature conditions and inform the activation of protective public health interventions.

Respiratory hospital admissions in young children living near metal smelters, pulp mills and oil refineries in two Canadian provinces.

BACKGROUND: Industrial plants emit air pollutants like fine particles (PM2.5), sulfur dioxide (SO2) and nitrogen dioxide (NO2) that may affect the health of individuals living nearby. OBJECTIVE: To assess the effects of community exposure to air emissions of PM2.5, SO2, and NO2 from pulp mills, oil refineries, metal smelters, on respiratory hospital admissions in young children in Quebec (QC) and British Columbia (BC), Canada. METHODS: We assessed QC, BC and pooled associations between the following estimates of exposure and hospital admissions for asthma and bronchiolitis in children aged 2-4years for the years 2002-2010: i) Crude emission exposures at the residential postal codes of children, calculated by multiplying estimated daily emissions of PM2.5, SO2, or NO2 from all nearby (<7.5km) pulp mills, oil refineries, metal smelters emitting yearly ≥50t and their total emissions, by the percent of the day each postal code was downwind; ii) Daily levels of these pollutants at central ambient monitoring stations nearby the industries and the children's residences. RESULTS: Seventy-one major industries were selected between QC and BC, with a total of 2868 cases included in our analyses. More cases were exposed to emissions from major industries in QC than in BC (e.g. 2505 admissions near SO2 industrial emitters in QC vs 334 in BC), although air pollutant levels were similar. Odds ratios (ORs) for crude refinery and smelter emissions were positive in QC but more variable in BC. For example with PM2.5 in QC, ORs were 1.13 per 0.15t/day (95% CI: 1.00-1.27) and 1.03 (95% CI: 0.99-1.07) for refinery and smelter emissions, respectively. Pooled results of QC and BC for crude total SO2 emissions from all sources indicated a 1% increase (0-3%) in odds of hospital admissions per 1.50t/day increase in exposure. Associations with measured pollutant levels were only seen in BC, with SO2 and NO2. CONCLUSION: Hospital admissions for wheezing diseases in young children were associated with community exposure to industrial air pollutant emissions. Future work is needed to better assess the risk of exposure to complex mixture of air pollutants from multiple industrial sources.

An Evaluation of the British Columbia Asthma Monitoring System (BCAMS) and PM2.5 Exposure Metrics during the 2014 Forest Fire Season.

The British Columbia Asthma Monitoring System (BCAMS) tracks forest fire smoke exposure and asthma-related health outcomes, identifying excursions beyond expected daily counts. Weekly reports during the wildfire season support public health and emergency management decision-making. We evaluated BCAMS by identifying excursions for asthma-related physician visits and dispensations of the reliever medication salbutamol sulfate and examining their corresponding smoke exposures. A disease outbreak detection algorithm identified excursions from 1 July to 31 August 2014. Measured, modeled, and forecasted concentrations of fine particulate matter (PM2.5) were used to assess exposure. We assigned PM2.5 levels to excursions by choosing the highest value within a seven day window centred on the excursion day. Smoky days were defined as those with PM2.5 levels ≥ 25 µg/m3. Most excursions (57%-71%) were assigned measured or modeled PM2.5 concentrations of 10 µg/m3 or higher. Of the smoky days, 55.8% and 69.8% were associated with at least one excursion for physician visits and salbutamol dispensations, respectively. BCAMS alerted most often when measures of smoke exposure were relatively high. Better performance might be realized by combining asthma-related outcome metrics in a bivariate model.

The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: assessment of environmental exposures.

The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3-4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set.

Calls to the British Columbia Drug and Poison Information Centre: A summary of differences by health service areas.

OBJECTIVES: Poison control centres provide information on the management of poisoning incidents. The British Columbia (BC) Drug and Poison Information Centre recently implemented an electronic database system for recording case information, making it easier to use case data as a potential source of population-based information on health services usage and health status. This descriptive analysis maps poisoning case rates in BC, highlighting differences in patient age, substance type, medical outcome, and caller location. METHODS: There were 50,621 human exposure cases recorded during 2012 and 2013. Postal code or city name was used to assign each case to a Health Service Delivery Area (HSDA). Case rates per 1,000 person-years were calculated, including crude rates, age-standardized rates, age-specific rates, and rates by substance type, medical outcome, and caller location. RESULTS: The lowest case rate was observed in Richmond, a city where many residents do not speak English as a first language. The highest rate was observed in the Northwest region, where the economy is driven by resource extraction. Pharmaceutical exposures were elevated in the sparsely populated northern and eastern areas. Calls from health care facilities were highest in the Northwest region, where there are many remote Aboriginal communities. CONCLUSIONS: Case rates were generally highest in the primarily rural northern and eastern areas of the province. Considering these results alongside contextual factors informs further investigation and action: addressing cultural and language barriers to accessing poison centre services, and developing a public health surveillance system for severe poisoning events in rural and remote communities.

Mutations in epigenetic regulators including SETD2 are gained during relapse in paediatric acute lymphoblastic leukaemia.

Relapsed paediatric acute lymphoblastic leukaemia (ALL) has high rates of treatment failure. Epigenetic regulators have been proposed as modulators of chemoresistance, here, we sequence genes encoding epigenetic regulators in matched diagnosis-remission-relapse ALL samples. We find significant enrichment of mutations in epigenetic regulators at relapse with recurrent somatic mutations in SETD2, CREBBP, MSH6, KDM6A and MLL2, mutations in signalling factors are not enriched. Somatic alterations in SETD2, including frameshift and nonsense mutations, are present at 12% in a large de novo ALL patient cohort. We conclude that the enrichment of mutations in epigenetic regulators at relapse is consistent with a role in mediating therapy resistance.