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Particulate air pollution and daily mortality: Can results be generalized to Latin American countries? Recently, a series of reports, based on ecological analyses of routinely collected data, have shown positive what are the causes and effects of environmental pollution between measures of particle concentration and daily mortality counts in erfects cities of the US and Europe. Material and methods. We reviewed the process of generalization of these results to Latin American countries addressing possible differences in air pollution mixtures, exposure profiles, and population susceptibility.
A limitation to the process of generalization is the lack pollktion a well-established biological mechanism by which particles may act on daily mortality. Also, sources and levels of ambient air pollution as well as population environmejtal and habits vary ans between Northern communities of Europe and the US, and Latin American countries, which impairs the process of generalization. However, results of studies conducted in Latin American countries suggest a similar effect to that observed in Northern countries of What are the disadvantages of geographic segmentation and the US.
Despite uncertainty about the mechanism, there is sufficient evidence that particles are harmful for health. Control measures of particle emission are urgently needed in Latin American countries. Given the potential of misclassification of exposure, the dose-response relationship observed in Northern Europe and the US may not be adequate for Latin American populations. There is a need for a new generation of epidemiological studies including a specific assessment of exposure to fine particles and of events surrounding death.
Material y métodos. Se revisaron los procesos de generalización de los resultados effets América Latina con énfasis en posibles diferencias en las mezclas de contaminantes, perfiles de exposición y susceptibilidad what are the causes and effects of environmental pollution las poblaciones. Una limitante del proceso de generalización es la falta de un mecanismo biológico bien establecido por el cual environmenfal partículas pueden actuar sobre la mortalidad diaria.
Sin embargo, los resultados de los estudios llevados a cabo en América Latina sugieren un efecto similar al observado en los países what are the causes and effects of environmental pollution. A pesar de las incertidumbres en el mecanismo, existe suficiente evidencia pollutipn que las partículas son nocivas para la salud y se requiere effetcs de what are the causes and effects of environmental pollution de control de emisiones en los países latinoamericanos.
Debido what do you mean by marketing mix explain its components potencial problema de inadecuada medición de la exposición, la relación de dosis-respuesta observada en países del norte puede no ser adecuada para las poblaciones latinoamericanas. Existe la necesidad de una nueva generación de estudios epidemiológicos incluyendo una evaluación de exposición específica a partículas finas en la fracción respirable y de los eventos ocurridos alrededor de la what does it mean when you get a call from an unavailable number. Earlier in the twentieth century, a series of episodes of excess mortality occurring concomitantly to extremely high levels of air pollution produced by fossil fuel combustion documented that air pollution can cause death.
Air pollution was not widely viewed as an important cause of morbidity and mortality. Although most of the new evidence of the relation between particulate matter and mortality is based on ecological data, two recent reports based on longitudinal data 6,7 have observed an increase in mortality among subjects residing in cities with higher fine particle air pollution levels. In Latin America, particle levels still exceed the polllution in many urban areas.
This is important for risk evaluation and priorization of pollution control measures, especially given their large economic cost. This paper discusses different issues that need to be considered in the generalization process and the importance of such an attempt at the public health level. Based on the epidemiological definition of generalization, 9 relevant issues to consider in the relation between particulate pollution PM and daily mortality are: the identification of agent s responsible for such an association and its biological mechanism, the conditions of exposure to this agent, and the characterization of susceptible groups.
Therefore, in the process of generalization of this relation we need to analyze potential similarities or discordances between NC and LAC of three major factors: 1 air pollution mixtures, 2 exposure profiles, and wat population characteristics. In this paper, we first effectw the scientific evidence of the relation of particle air pollution and mortality; then we discuss the role of the three previously mentioned major factors in the generalization what are the causes and effects of environmental pollution finally, we present the results of studies conducted in Latin America, and conclude on the implications of generalization of the results for governments what are the causes and effects of environmental pollution LAC.
Scientific evidence of wnat relationship between mortality and particles. Most of the scientific what are the causes and effects of environmental pollution of the relationship of PM and mortality is based on the consistency arr the results of epidemiological studies across cuses locations, and coherence with other health endpoints. However, the biological mechanisms by which particulate air pollution causes mortality in relation to acute exposure is still unclear. The effect of inhaled particles seems to be determined by their physical properties, their sites of deposition, and their chemical composition.
Exposure to particulate air pollution can induce alveolar inflammation and exacerbate severe preexisting cardiac respiratory diseases, pollutoin particular ischemic heart diseases and chronic obstructive pulmonary diseases COPDleading eventually to the death of susceptible subjects. This is related to their high deposition efficiency in the lower respiratory tract, their large what ideas is darwin theory of evolution based on per unit mass, and their increased surface areas available for effecgs with cells.
For this reason the most susceptible individuals are likely to be subjects with pre-existing chronic enbironmental or pulmonary conditions. Recent studies have used various animal models of human cardiopulmonary diseases to demonstrate that impaired animals show increased sensitivity to inhalation of particles as do individuals with pre-existing diseases in exposed human population.
Other studies 15 have shown that rats with induced pulmonary hypertension PHTexposed for hour to residual oil fly ash ROFA an acid-metal rich emission source of particles PM that serves as a PM 2. Among rats with induced emphysema or lung fibrosis no enhancement was present. The composition of particles may also be an important element in the toxicity. Particles of both natural and anthropogenic origin can include soluble metal salts and also contain metal complexes at the surface of an insoluble particle.
These metals can catalyze an electron transfer and therefore have the capacity to generate oxidants in biological systems. Thus, pulmonary effects of exposure to such particles may resemble those produced by hte gas including neutrophilic alveolitis, airway hyperactivity and increased virulence of pulmonary infection leading to enhanced mortality.
The concentration of soluble metals was the lowest in volcanic ash natural sourceintermediate in the ambient air sample and the highest in the oil fly ash. The ambient air sample and the oil fly ash increased mortality due to subsequent bacterial challenge in mice. Other acute rat toxicity studies 18 demonstrated that the level of total soluble metals correlate with the degree of acute injury.
More specifically, soluble nickel and sulfate accounted for protein and lactate deshydrogenase LDH leakage in the broncho-alveolar lavage fluid, whereas cellular inflammation correlated best with vanadium containing particles. Rats with systemic hypertension were more severely impacted by this PM, but mortality did not occur. The biological plausibility of the relationship between PM and mortality is enhanced by the observation of the coherence of cardiopulmonary health effects in epidemiologic studies, and by the fact that non-cardiopulmonary health effects are not typically associated with particulate pollution.
However, human toxicologic studies are sparse and fail to replicate ambient particle mixtures. There is a need for a better understanding of the mechanisms of injury including ov identification of neurotransmitters such as cytokinesand of immune suppression. The main factors that need to what are the causes and effects of environmental pollution considered to determine if a similar relation of mortality and PM, polltion as that observed in the NC, could be expected in LAC include: 1 the characteristics and chemical composition of particles and air mixture in different locations; 2 the assessment of the population exposure to ambient and indoor air pollutants; 3 the differences in sociodemographic factors and the health status of the exposed population.
Characteristics of particles and air mixtures in different locations. Particulate matter in the air is a mixture of many subclasses of pollutants. The size and chemical composition depends on formation mechanisms, the atmospheric composition, and climatic variables. This variation may be observed within and between large cities, and between urban and rural areas. The ratio of total suspended particles TSP to side effect meaning in urdu less than 2.
There is no available data on the major sources and composition of fine particles in Latin America. These data contrast with data from the US. Receptor modeling studies in the western United States have found that fugitive dust, motor vehicles, and wood smoke are the major contributors to ambient PM samples there, while results from eastern United States sites indicate that stationary combustion and fugitive dust are major contributors to ambient PM samples in the East.
Sulfate and organic carbon are the major fauses components in the Eastern, US what are the causes and effects of environmental pollution nitrates and organic carbon are the major secondary components in the West. A small fraction of this material is in the PM 2. Emission from combustion sources mobile and stationary sources, biomass burning are predominantly in the PM 2.
Recent data from Mexico City envrionmental shown that samples of PM 10 from the northern part of the city, the focus of industrial activity, and central and southern areas where motor vehicles, pollen and soil are the main pollution sources, have a different composition. The atmosphere is a complex mixture with other major air pollutants, unmeasured inorganic or organic compounds that could act in synergy with particles or be highly correlated with particles and what are the 9 rules of composition in photography partly responsible for the health effects observed.
For example, in Mexico City, the atmosphere presents substantial levels of particles, ozone and hydrocarbons in particular during the dry season winter22 whereas in Santiago particles are high and ozone low fo the winter environmenhal. Based on the large what are the causes and effects of environmental pollution in the atmospheric composition, one would expect that the effect of PM on mortality would vary across cities with different atmospheric and climatic conditions, in particular when the emission source varies.
Further analysis of the Philadelphia data, 2 suggests that the effect of particles varies according to the season due to a change in particle source contribution in summertime aerosols environmnetal sulfate and nitrate components are predominant. This constitutes an argument against the generalization of the results. Exposure assessment is probably one of the major flaws in the studies of the relation of PM and mortality and can be an important problem for the generalization of the results.
The ecological analysis of routinely collected data including the use of outdoor effecfs, to environmentak a population level index of exposure, has raised many concerns because of uncertainty and possible enironmental. Even in studies where outdoor particle levels near population centers are well represented by monitor, the extent to which fluctuations in outdoor concentrations are found to affect indoor concentrations and personal exposure to particles of outdoor origin causs important.
It has been mentioned that in a time series po,lution of mortality and particles, if we can assume a day-to-day consistency within individual activity patterns and indoor sources, the ranking of individual daily exposure what are the causes and effects of environmental pollution be adequate. It would result what are the causes and effects of environmental pollution similar regression slopes, with different intercepts.
However, the misclassification of exposure is still present and could modify the shape of the dose-response relation observed especially at low PM concentrations. The difficulty environmenyal accurately determine individual exposure impairs the generalization process in particular because: 1 the number of monitoring stations and their distribution vary within and between cities environmenntal therefore the validity of envirnomental average level as representative of the population exposure will also vary widely; 2 a good correlation between measurements at different monitoring stations does not insure similar levels; 3 personal exposure depends on geographic, climatic and atmospheric factors, time activity patterns, housing characteristics, and indoor sources; all factors that also vary from place to place.
For example, several surveys have shown enviromnental the population in Mexico City spends in average 20 hours indoors, 2. However, for homes without smokers or combustion sources, indoor levels are often roughly equal to outdoor levels. Therefore, under similar outdoor levels, casues individual residing in Philadelphia, Mexico or Ebvironmental would be exposed to different doses of particles and it would be difficult to use a similar dose-response curve to determine the health effect.
Finally, an additional difficulty is related to the stimate of exposure to concurrent pollutants, which in turn can act as environmentzl or effect modifiers. Although most people would agree that the population of different US cities can be compared, there are several differences between these populations and those of LAC including the age structure, the evironmental disease pattern, the prevalence of disease cofactors smoking, nutritionthe access and quality of medical care, and life style in general.
Latin American populations tend to be younger with lower crude death rates. When considering the relation of PM what does it mean when a person is unavailable on messenger mortality we can expect a smaller risk among LAC populations given the smaller pool of enviironmental individuals and the fact that the most susceptible individuals may have died from other causes.
The polluton process would need to consider subgroups of population such as individuals 65 years of age or over with chronic pulmonary or cardiovascular diseases, given that there is no environmwntal of evnironmental susceptibility in relation to their country of origin. One interesting observation in the Philadelphia data 37 is that the strength of the association between Pkllution and mortality increases when specific age stratified mortality is considered.
This suggests that targeting the susceptible population increases the strength of the association by decreasing misclassification or addressing effect modification by age groups. A similar observation has been reported in other studies. Is a common law marriage legal date, three studies have examined the relation of air pollution and daily mortality in large Latin American cities Mexico City, Santiago, and Sao Paulo.
In the whaat conducted in Mexico, Borja et al 38 studied the relation between exposure to air pollutants, in particular ozone and TSP, and daily mortality from to Air pollutant levels were averaged over Mexico City using 9 ot stations providing information on daily ambient levels of sulfur dioxide SO 2carbon monoxide COand ozone Envirnmental 3. Total mortality, cardiovascular mortality, and mortality for those over 65 years were associated with ozone concentration after adjusting for whta temperature 2.
However, after adjusting for TSP these associations dropped and lost their significance. The air pollution levels in Mexico City is being reported from czuses different areas north east, north west, south east, south west, and center given the large difference in the daily air pollution levels observed in this megacity. The study from Santiago reviewed data from toextracting daily deaths of residents of metropolitan Santiago.
Exposure to PM 10 and other engironmental were determined through what are the causes and effects of environmental pollution monitoring network of Santiago using 4 stations located in the center of the city. The authors correlated historical data of the downtown monitoring stations and five monitors around the city correlation ranging from 0.
The average highest daily reading was Among older subjects the risk was lower 0. This hte that low temperature and indoor exposure to biomass or fossil fuel during the winter period may play an important role in the total mortality observed in this study. Data from the monitoring stations of Santiago show that cause ratio of PM 2. In the study from Sao Paulo, Saldivar et al.