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Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea
Hyunmee Kim, Woojin Kim, Jee eun Choi, Changsoo Kim, Jungwoo Sohn
J Prev Med Public Health. 2018;51(6):265-274.   Published online October 29, 2018
DOI: https://doi.org/10.3961/jpmph.18.153
  • 5,771 View
  • 232 Download
  • 6 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
A positive association between air pollution and both the incidence and prevalence of diabetes mellitus (DM) has been reported in some epidemiologic and animal studies, but little research has evaluated the relationship between air pollution and diabetic coma. Diabetic coma is an acute complication of DM caused by diabetic ketoacidosis or hyperosmolar hyperglycemic state, which is characterized by extreme hyperglycemia accompanied by coma. We conducted a time-series study with a generalized additive model using a distributed-lag non-linear model to assess the association between ambient air pollution (particulate matter less than 10 μm in aerodynamic diameter, nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and ozone) and emergency department (ED) visits for DM with coma in Seoul, Korea from 2005 to 2009.
Methods
The ED data and medical records from the 3 years previous to each diabetic coma event were obtained from the Health Insurance Review and Assessment Service to examine the relationship with air pollutants.
Results
Overall, the adjusted relative risks (RRs) for an interquartile range (IQR) increment of NO2 was statistically significant at lag 1 (RR, 1.125; 95% confidence interval [CI], 1.039 to 1.219) in a single-lag model and both lag 0-1 (RR, 1.120; 95% CI, 1.028 to 1.219) and lag 0-3 (RR, 1.092; 95% CI, 1.005 to 1.186) in a cumulative-lag model. In a subgroup analysis, significant positive RRs were found for females for per-IQR increments of NO2 at cumulative lag 0-3 (RR, 1.149; 95% CI, 1.022 to 1.291).
Conclusions
The results of our study suggest that ambient air pollution, specifically NO2, is associated with ED visits for diabetic coma.
Summary
Korean summary
본 연구에서는 대기오염물질의 단기적인 영향을 확인하기 위하여 당뇨병성 혼수로 인한 응급실 내원을 시계열적으로 분석하였다. 분석 결과 이산화질소 상승이 노출 1일 후의 응급실 방문을 1.25% 상승시켰다(RR, 1.125; 95% CI 1.039-1.219). 또한, 노출 3일 후까지 누적 결과도 유의한 상관관계를 보였다(RR 1.092; 95% CI, 1.005-1.186).

Citations

Citations to this article as recorded by  
  • Criteria air pollutants and diabetes mortality classified by different subtypes and complications: A nationwide, case-crossover study
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The Impact of Air Pollution, Including Asian Sand Dust, on Respiratory Symptoms and Health-related Quality of Life in Outpatients With Chronic Respiratory Disease in Korea: A Panel Study
Motoyuki Nakao, Yoko Ishihara, Cheol-Hong Kim, In-Gyu Hyun
J Prev Med Public Health. 2018;51(3):130-139.   Published online May 9, 2018
DOI: https://doi.org/10.3961/jpmph.18.021
  • 8,184 View
  • 243 Download
  • 25 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
Air pollution is a growing concern in Korea because of transboundary air pollution from mainland China. A panel study was conducted to clarify the effects of air pollution on respiratory symptoms and health-related quality of life (HR-QoL) in outpatients with and without chronic obstructive pulmonary disease (COPD) in Korea.
Methods
Patients filled out a questionnaire including self-reported HR-QoL in February and were followed up in May and July. The study was conducted from 2013 to 2015, with different participants each year. Air quality parameters were applied in a generalized estimating equation as independent variables to predict factors affecting HR-QoL.
Results
Lower physical fitness scores were associated with Asian sand dust events. Daily activity scores were worse when there were high concentrations of particulate matter (PM) less than 10 μm in diameter (PM10). Lower social functioning scores were associated with high PM less than 2.5 μm in diameter and nitrogen dioxide (NO2) concentrations. High NO2 concentrations also showed a significant association with mental health scores. Weather-related cough was prevalent when PM10, NO2, or ozone (O3) concentrations were high, regardless of COPD severity. High PM10 concentrations were associated with worsened wheezing, particularly in COPD patients.
Conclusions
The results suggest that PM, NO2, and O3 cause respiratory symptoms leading to HR-QoL deterioration. While some adverse effects of air pollution appeared to occur regardless of COPD, others occurred more often and more intensely in COPD patients. The public sector, therefore, needs to consider tailoring air pollution countermeasures to people with different conditions to minimize adverse health effects.
Summary

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Physical Activity- and Alcohol-dependent Association Between Air Pollution Exposure and Elevated Liver Enzyme Levels: An Elderly Panel Study
Kyoung-Nam Kim, Hyemi Lee, Jin Hee Kim, Kweon Jung, Youn-Hee Lim, Yun-Chul Hong
J Prev Med Public Health. 2015;48(3):151-169.   Published online May 15, 2015
DOI: https://doi.org/10.3961/jpmph.15.014
  • 9,605 View
  • 125 Download
  • 42 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The deleterious effects of air pollution on various health outcomes have been demonstrated. However, few studies have examined the effects of air pollution on liver enzyme levels.
Methods
Blood samples were drawn up to three times between 2008 and 2010 from 545 elderly individuals who regularly visited a community welfare center in Seoul, Korea. Data regarding ambient air pollutants (particulate matter ≤2.5 μm [PM2.5], nitrogen dioxide [NO2], ozone [O3], carbon monoxide, and sulfur dioxide) from monitoring stations were used to estimate air pollution exposure. The effects of the air pollutants on the concentrations of three liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and γ-glutamyltranspeptidase [γ-GTP)]) were evaluated using generalized additive and linear mixed models.
Results
Interquartile range increases in the concentrations of the pollutants showed significant associations of PM2.5 with AST (3.0% increase, p=0.0052), ALT (3.2% increase, p=0.0313), and γ-GTP (5.0% increase, p=0.0051) levels; NO2 with AST (3.5% increase, p=0.0060) and ALT (3.8% increase, p=0.0179) levels; and O3 with γ-GTP (5.3% increase, p=0.0324) levels. Significant modification of these effects by exercise and alcohol consumption was found (p for interaction <0.05). The effects of air pollutants were greater in non-exercisers and heavy drinkers.
Conclusions
Short-term exposure to air pollutants such as PM2.5, NO2, and O3 is associated with increased liver enzyme levels in the elderly. These adverse effects can be reduced by exercising regularly and abstinence from alcohol.
Summary

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English Abstract
Effects of Personal Exposure to Nitrogen Dioxide on Peak Expiratory Flow in Asthmatic Patients.
Ho Jang Kwon, Sang Gyu Lee, Young Koo Jee, Sang Rok Lee, Seung Sik Hwang
J Prev Med Public Health. 2007;40(1):59-63.
DOI: https://doi.org/10.3961/jpmph.2007.40.1.59
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AbstractAbstract PDF
OBJECTIVES
Nitrogen dioxide (NO2) has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of NO2 exposure in asthmatics by examining the association between changes in lung function and concentrations of NO2 which were personally measured. METHODS: Peak expiratory flow (PEF) and daily personal exposures to NO2 were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal NO2 exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. RESULTS: The personal NO2 exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for NO2 was 1.48. The personal NO2 exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. CONCLUSIONS: Among the asthmatic adults who participated in this study, we found no apparent impact of personal NO2 exposures on the peak expiratory flow.
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Citations

Citations to this article as recorded by  
  • The statistical evaluation and comparison of ADMS-Urban model for the prediction of nitrogen dioxide with air quality monitoring network
    Audrius Dėdelė, Auksė Miškinytė
    Environmental Monitoring and Assessment.2015;[Epub]     CrossRef
  • Acute effects of air pollution on peak expiratory flow rates and symptoms among asthmatic patients in Chiang Mai, Thailand
    Phongtape Wiwatanadate, Chalerm Liwsrisakun
    International Journal of Hygiene and Environmental Health.2011; 214(3): 251.     CrossRef

JPMPH : Journal of Preventive Medicine and Public Health