Yung-Ling Lee

Traffic related air pollution as a determinant of asthma among Taiwanese school children

Background: There is evidence that long term exposure to ambient air pollution increases the risk of childhood asthma, but the role of different sources and components needs further elaboration. To assess the effect of air pollutants on the risk of asthma among school children, a nationwide cross sectional study of 32 672 Taiwanese school children was conducted in 2001. Methods: Routine air pollution monitoring data for sulphur dioxide (SO2), nitrogen oxides (NOx), ozone (O3), carbon monoxide (CO), and particles with an aerodynamic diameter of 10 μm or less (PM10) were used. Information on individual characteristics and indoor environments was from a parent administered questionnaire (response rate 93%). The exposure parameters were calculated using the mean of the 2000 monthly averages. The effect estimates were presented as odds ratios (ORs) per 10 ppb changes for SO2, NOx, and O3, 100 ppb changes for CO, and 10 μg/m3 changes for PM10. Results: In a two stage hierarchical model adjusting for confounding, the risk of childhood asthma was positively associated with O3 (adjusted OR 1.138, 95% confidence interval (CI) 1.001 to 1.293), CO (adjusted OR 1.045, 95% CI 1.017 to 1.074), and NOx (adjusted OR 1.005, 95% CI 0.954 to 1.117). Against our prior hypothesis, the risk of childhood asthma was weakly or not related to SO2 (adjusted OR 0.874, 95% CI 0.729 to 1.054) and PM10 (adjusted OR 0.934, 95% CI 0.909 to 0.960). Conclusions: The results are consistent with the hypothesis that long term exposure to traffic related outdoor air pollutants such as NOx, CO, and O3 increases the risk of asthma in children.

Relation between air pollution and allergic rhinitis in Taiwanese schoolchildren

BackgroundRecent findings suggest that exposure to outdoor air pollutants may increase the risk of allergic rhinitis. The results of these studies are inconsistent, but warrant further attention. The objective of the study was to assess the effect of relation between exposure to urban air pollution and the prevalence allergic rhinitis among school children.MethodsWe conducted a nationwide cross-sectional study of 32,143 Taiwanese school children. We obtained routine air-pollution monitoring data for sulphur dioxide (SO2), nitrogen oxides (NOx), ozone (O3), carbon monoxide (CO), and particles with an aerodynamic diameter of 10 μm or less (PM10). A parent-administered questionnaire provided information on individual characteristics and indoor environments (response rate 92%). Municipal-level exposure was calculated using the mean of the 2000 monthly averages. The effect estimates were presented as odds ratios (ORs) per 10 ppb change for SO2, NOx, and O3, 100 ppb change for CO, and 10 μg/m3 change for PM10.ResultsIn two-stage hierarchical model adjusting for confounding, the prevalence of allergic rhinitis was significantly associated with SO2 (adjusted odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.25, 1.64), CO (aOR = 1.05, 95% CI: 1.04, 1.07), and NOx (aOR = 1.11, 95% CI: 1.08, 1.15). Contrary to our hypothesis, the prevalence of allergic rhinitis was weakly or not related to O3 (aOR = 1.05, 95% CI: 0.98, 1.12) and PM10 (aOR = 1.00, 95% CI: 0.99, 1.02).ConclusionPersistent exposure to NOx, CO, and SO2 may increase the prevalence of allergic rhinitis in children.

Traffic-Related Air Pollution, Climate, and Prevalence of Eczema in Taiwanese School Children

The prevalence of childhood eczema is increasing in many countries. Epidemiological studies, however, say little of its association to outdoor air pollution and climate factors. We conducted a nationwide survey of middle-school students in Taiwan from 1995 to 1996. The 12-month prevalence of eczema was compared with air monitoring station data of temperature, relative humidity, and criteria air pollutants. A total of 317,926 children attended schools located within 2 km of 55 stations. Prevalence rates of recurrent eczema were 2.4 and 2.3% in boys and girls, respectively, with prevalence rates of flexural eczema 1.7% in both sexes. After adjustment for possible confounders, flexural eczema was found to be associated with traffic-related air pollutants, including nitrogen oxides and carbon monoxide. Recurrent eczema was associated with traffic-related air pollution only in girls. There were no associations for the highest monthly means of temperature, whereas the annual means and the lowest monthly means of temperature were negatively related to flexural eczema, but only in girls. The lowest monthly mean relative humidity was positively related to eczema. The results suggest that air pollution and climatic factors, which showed stronger associations in girls than boys, may affect the prevalence of childhood eczema.

Time trend of asthma prevalence among school children in Taiwan: ISAAC phase I and III surveys

The standardized International Study of Asthma and Allergies in Childhood (ISAAC) is a valid tool in assessing prevalence of asthma indices. In order to determine the time trends of childhood asthma in Taiwan, we compared data from nationwide ISAAC surveys from a very large sample of Taiwanese 12‐ to 15‐year‐old school children, using ISAAC core written and video questionnaires. The number of participants was 44,104 in 1995–96 (phase I) and 11,048 in 2001 (phase III). We found a general tendency towards an increase in lifetime prevalence of physician‐diagnosed asthma and asthma symptoms between two surveys, more marked for girls than for boys. Most of the 12‐month prevalence of asthma symptoms decreased among boys but stabilized among girls. When comparing different severity levels, we also noted that the decreasing trends of current symptoms were more marked with regard to severe symptoms than mild symptoms in both sexes. A combination of both improved awareness and management of asthma might in part explain this circumstance. Over the past decade in Taiwan, the lifetime prevalence of childhood asthma was increasing, more marked among girls; however, the 12‐month prevalence of asthma symptoms was decreasing, mostly among boys. The exact reasons for such trends remain to be explored.

Changing prevalence of asthma in Taiwanese adolescents: two surveys 6 years apart

This study compared the prevalence of asthma among Taiwanese adolescents with individual‐level risk factors and municipal‐level air pollution and meteorology data to determine whether changes in these factors could explain the observed change in prevalence. We conducted two national surveys of respiratory illness and symptoms in Taiwanese middle‐school students in 1995–96 and 2001. The effects of personal and environmental factors were assessed and temporal changes of outdoor monitoring data were also compared with asthma prevalence difference. A total of 44,104 children from the 1995–96 survey and 11,048 children from the 2001 survey attended schools located within 1 km of 22 monitoring stations. Lifetime prevalences of physician‐diagnosed and questionnaire‐determined asthma increased during this period. After adjustment for potential risk factors, the prevalence differences were statistically unchanged. Although parental education level contributed most, changes in investigated personal and environmental factors might not explain the observed changes in asthma prevalence. Municipalities with higher temperature increase were significantly associated with prevalence difference in questionnaire‐determined asthma. We concluded that correlates of the investigated individual‐level factors, which have changed over time, still underlie changes in asthma prevalence. Increasing temperature might be the main reason for the rising trends of asthma in Taiwanese adolescents.

Associations of glutathione S‐transferase P1, M1, and environmental tobacco smoke with wheezing illness in school children

Background:  Polymorphisms at the glutathione S‐transferase (GST) were associated with asthma‐related phenotypes. We hypothesized that the GSTP1 and GSTM1 genotypes could modify the effects of household environmental tobacco smoke (ETS) on childhood wheezing illness.

Increasing prevalence of atopic eczema in Taiwanese adolescents from 1995 to 2001.

Background The prevalence of atopic eczema in adolescents has recently been reported as increasing in many countries, a phenomenon yet to be fully explained. This study compared the prevalence of atopic eczema among Taiwanese adolescents with individual‐level risk factors and community‐level data of temperature, relative humidity, and air pollutants to determine whether changes in these factors could explain the observed change in prevalence.

Association between cord blood IgE and genetic polymorphisms of interleukin-4, the β-subunit of the high-affinity receptor for IgE, lymphotoxin-α, and tumor Necrosis factor-α

High cord blood immunoglobulin E (cbIgE) is known to be associated with increased risks of atopic diseases in childhood. The relationship between genetic polymorphisms and high cbIgE has not been well documented. A cross‐sectional study was conducted to assess the association between cbIgE and genetic polymorphisms of interleukin (IL)‐4 ‐590C/T, the β‐subunit of the high‐affinity receptor for IgE (FcɛRI‐β) E237G, lymphotoxin (LT)‐αNcoI alleles, and tumor necrosis factor (TNF)‐α ‐308G/A. A total of 320 mother–neonate pairs were recruited from four maternity hospitals from different locations of Taiwan. Cord blood was obtained and assayed for cbIgE. Polymerase chain reaction followed by restriction fragment length polymorphism was used to assess the genotypes. Three hundred pairs of mothers and neonates were included in the final analysis. Infants with IL‐4 ‐590 C allele were found to have higher risk of elevated cbIgE (≥0.35 IU/ml, 24.3%) (p = 0.004). After adjusting for gender, birth order, maternal age, and history of allergic disease in maternal and paternal families, odds ratios for CC and CT genotypes were 4.41 and 3.16 (95% confidence interval 0.78–22.67, and 1.66–6.13), respectively, using TT genotype as reference. The genotypes of FcɛRI‐β, LT‐α, and TNF‐α were not associated with cbIgE before or after the adjustment. Our finding suggested a significant association of cbIgE with genetic polymorphism of IL‐4 ‐590C/T, but not with the genotypes of FcɛRI‐β, LT‐α, and TNF‐α.

Ergonomic and demographic issues reported by palliative care workers in southern Taiwan

Aim: To investigate ergonomic and demographic issues reported by palliative care workers in southern Taiwan. Method: A structured questionnaire was completed by staff members from 11 nursing homes within southern Taiwan. Questions focused on age, sex, height, weight, shift-work details, duration of current employment, nature of current employment, the presence of injury and pain during the past 12 months, the phase lag before the onset of injury, and sick leave details. Results: A total of 125 health-care workers were recruited. Most were female (89.3 percent) and employed full-time (64.8 percent) as patient care assistants (55.2 percent). Most workers were regularly involved in patient-handling tasks (61.6 percent). Almost half (36.8 percent) had suffered a musculoskeletal disorder within the previous year. Lower back injury was reported by 12.0 percent of all employees. Changing patients’ clothes and changing their bed linen were associated statistically with musculoskeletal injury (odds ratio (OR) 2.9, 95 percent confidence interval (CI) 1.4-6.3 and OR 2.8, 95 percent CI 1.4-6.1), respectively. Moving the patients was also related to injury during our research (OR 2.5, 95 percent CI 1.2-5.4). Conclusion: This study has revealed various ergonomic and demographic issues reported by palliative care workers in southern Taiwan for the first time. The prevalence of certain injuries and symptoms are different from other reports.

Air Pollution and Asthma in Asia

Summary of the Relationship Between Indoor and Outdoor Air Pollution and Asthma-Related Morbidity in Asian Countries Indoor and Outdoor Study Design Population (Age in years) Asthma-Related MorbidityCountry and Air PollutionReferenceIndoor Coal use cross-sectional nonsmoking adults (40–69)↓FVC and FEV 1 China [24]Coal use cross-sectional schoolchildren’s fathers↑frequency of wheeze, persistent cough and phlegm, and bronchitis China [27]ETS cross-sectional primary schoolchildren↑frequency of day or night cough, chronic cough, shortness of breath, and bronchitis Taiwan [31]↑frequency of all asthma-like symptoms Israel [32]Active smoke, ETS cross-sectional schoolchildren (11–16)↑frequency of wheezeTaiwan [30]Active smoke cross-sectional schoolchildren’s fathers↑frequency of wheeze, cough, phlegm, persistent cough and phlegm, and bronchitis China [27]Active smoke cross-sectional adults (15)↑frequency of all asthma-like symptoms China [40]Cooking fuels cross-sectional primary schoolchildren↑frequency of asthma*, wheeze, bronchitis, chronic cough, and chronic phlegm China [26]Cooking fuels self-controlled nonsmoking asthmatic women↓PEFRIndia [43]NO