Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

sources and effects of ionizing radiation

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.

National Asthma Education and Prevention Program.

Standardized diagnostic criteria determined by the International Restless Legs Syndrome Study Group were used to investigate the current prevalence of restless legs syndrome (RLS). Possible associations between RLS and neuropsychiatric and somatic complaints were also investigated. A random sample of 4,000 men living in central Sweden were sent a questionnaire that included questions about sleep habits, symptoms of sleepiness, and somatic and neuropsychiatric complaints. Four symptom questions accepted as minimal diagnostic criteria for RLS were also included. Odds (OR) ratios and 95% confidence interval (CI) for different variables were calculated by means of multivariate logistic regression; 5.8% of the men suffered from RLS. The prevalence of RLS increased with age. Sleep-related complaints were more frequent among the RLS sufferers. Complaints of headache at awakening and daytime headache were reported three to five times more frequently among RLS sufferers and there was a tendency toward reported social isolation related to RLS. Subjects with RLS more frequently reported depressed mood (OR, 2.6; 95% CI, 1.8–3.8), and complained more often of reduced libido (OR, 2.2; 95% CI, 1.4–3.3). RLS sufferers more frequently reported hypertension (OR, 1.5; 95% CI, 0.9–2.4) and heart problems (OR, 2.5; 95% CI, 1.4–4.3). Results show that restless legs syndrome is common among men. It is hypothesized that RLS may be associated with several somatic and neuropsychiatric symptoms. © 2001 Movement Disorder Society.

Prevalence of restless legs syndrome among men aged 18 to 64 years: An association with somatic disease and neuropsychiatric symptoms

Prevalence of Restless Legs Syndrome among men aged 18-64 years. An association with somatic disease and neuropsychiatric symptoms.

Background : Radioactive radon is an inert gas that can migrate from soils and rocks and accumulate in enclosed areas, such as homes and underground mines. Studies of miners show that exposure to radon decay products causes lung cancer. Consequently, it is of public health interest to estimate accurately the consequences of daily, low-level exposure in homes to this known carcinogen. Epidemiologic studies of residential radon exposure are burdened by an inability to estimate exposure accurately, low total exposure, and subsequent small excess risks. As a result, the studies have been inconclusive to date. Estimates of the hazard posed by residential radon have been based on analyses of data on miners, with recent estimates based on a pooling of four occupational cohort studies of miners, including 360 lung cancer deaths. Purpose : To more fully describe the lung cancer risk in radon-exposed miners, we pooled original data from 11 studies of radon-exposed underground miners, conducted a comprehensive analysis, and developed models for estimating radon-associated lung cancer risk. Methods : We pooled original data from 11 cohort studies of radon-exposed underground miners, including 65 000 men and more than 2700 lung cancer deaths, and fit various relative risk (RR) regression models. Results : The RR relationship for cumulative radon progeny exposure was consistently linear in the range of miner exposures, suggesting that exposures at lower levels, such as in homes, would carry some risk. The exposure-response trend for never-smokers was threefold the trend for smokers, indicating a greater RR for exposure in never-smokers. The RR from exposure diminished with time since the exposure occurred. For equal total exposure, exposures of long duration (and low rate) were more harmful than exposures of short duration (and high rate). Conclusions: In the miners, about 40% of all lung cancer deaths may be due to radon progeny exposure, 70% of lung cancer deaths in never-smokers, and 39% of lung cancer deaths in smokers. In the United States, 10% of all lung cancer deaths might be due to indoor radon exposure, 11% of lung cancer deaths in smokers, and 30% of lung cancer deaths in never-smokers. This risk model estimates that reducing radon in all homes exceeding the U. S. Environmental Protection Agency's recommended action level may reduce lung cancer deaths about 2%-4%. These estimates should be interpreted with caution, because concomitant exposures of miners to agents such as arsenic or diesel exhaust may modify the radon effect and, when considered together with other differences between homes and mines, might reduce the generalizability of findings in miners. [J Natl Cancer Inst 87 :817-827, 1995]

Lung Cancer in Radon-Exposed Miners and Estimation of Risk From Indoor Exposure

Background Poor indoor air quality has been suggested to be related to the increase in the prevalence of asthma that has occurred in the western world, especially among children and young persons. Apart from the home, school is the most important indoor environment for children. Objectives The aims were to study the prevalence of current asthma among secondary pupils and its relationship to the school environment, but also to personal factors and domestic exposures. Methods Data on asthmatic symptoms, other health aspects, and domestic exposures were gathered using a questionnaire which was sent to 762 pupils in the seventh form (13-14 years old) in 11 randomly chosen schools in the county of Uppsala in Sweden. Pupils answering 'yes' to having had asthma diagnosed by a physician, and having had recent asthma attacks, or who used asthma medication were defined as having current asthma. Data on exposures at school were gathered by measurements in 28 classrooms. The relationship between asthma and exposures was analysed by multiple logistic regression. Results The questionnaire was completed by 627 (82%). Current asthma was found among 40 pupils (6.4%). Current asthma was more common in those who had an atopic disposition, or food allergy, or who had attended a day care centre for several years. Controlling for these factors, current asthma was related to several factors in the school environment. There were more pupils with current asthma in schools that were larger, had more open shelves, lower room temperature, higher relative air humidity, higher concentrations of formaldehyde or other volatile organic compounds, viable moulds or bacteria or more cat allergen in the settled dust. Conclusions Although the pupils attended school for a minor part of their time, our study indicates that the quality of the school environment is of importance and may affect asthmatic symptoms.

Asthma among secondary schoolchildren in relation to the school environment.

Possible relations between incidence and prevalence of sick building syndrome (SBS), indoor exposures, and personal factors were studied in a four year longitudinal study among personnel (n = 129) in six primary schools. The mean concentration of carbon dioxide was above the recommended value of 0.08 microliter/l (800 ppm) in all schools, indicating a poor outdoor air supply. Indoor concentration of volatile hydrocarbon (VOC) was enhanced at high room temperatures. Respirable dust, but not concentration of VOC was enhanced at lower ventilation rates and high air humidity. Chronic SBS was related to VOC, previous wall to wall carpeting in the schools, hyper-reactivity, and psychosocial factors. Incidence of new SBS was related to concentration of respirable dust, current smoking, and the psychosocial climate. Remission of hyperreactivity, decrease in sick leave owing to airway illness, removal of carpeting in the schools, and moving from new to old dwellings resulted in a decrease in SBS score. It is concluded that SBS is of multifactorial origin, related to a variety of factors and exposures. The total concentration of hydrocarbons is a simple and convenient measure of exposure, which also seems to be a predictor of chronic symptoms. Further investigations on the effect of temperature, ventilation, and air humidity on SBS should consider how these factors may influence the chemical composition of the air. Because poor air quality in schools could also affect the children, it may have implications for the state of health of a large proportion of the population.

https://oem.bmj.com/content/oemed/47/11/733.full.pdf

Christer Edling

Papers

Prevalence of restless legs syndrome among men aged 18 to 64 years: An association with somatic disease and neuropsychiatric symptoms

Prevalence of Restless Legs Syndrome among men aged 18-64 years. An association with somatic disease and neuropsychiatric symptoms.

Lung Cancer in Radon-Exposed Miners and Estimation of Risk From Indoor Exposure

Asthma among secondary schoolchildren in relation to the school environment.

Volatile organic compounds, respirable dust, and personal factors related to prevalence and incidence of sick building syndrome in primary schools.