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      Association between Diurnal Variation of Ozone Concentration and Stroke Occurrence: 24-Hour Time Series Study

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          Abstract

          Background and Purpose

          Increasing ozone concentrations have been known to damage human health and ecosystems. Although ozone tends to display diurnal variation, most studies have reported only on the association between daily ozone concentrations and ischemic stroke occurrence on the same day, or with a 1-day lag. We investigated the effect of the diurnal variation of ozone on ischemic stroke occurrence during the same day.

          Methods

          We included a consecutive series of 1,734 patients from January 1, 2008, to December 31, 2014, at a single tertiary hospital in Seoul, South Korea. We evaluated differences between temperature and pollutants at the time of stroke onset for each time interval and averaged those parameters across the 7-year study period.

          Results

          During the interval from 13:00 to 16:59, we found a positive association between ischemic stroke occurrence and ozone concentration relative to other time periods. Upper median ozone levels from 13:00 to 16:59 were positively correlated with ischemic stroke (odds ratio, 1.550; 95% confidence intervals, 1.220 to 1.970; P = <0.001) when compared with lower median levels.

          Conclusions

          The results show diurnal patterns of ischemic stroke occurrence based on upper and lower median ozone levels for a 24-hour period, which extends understanding of the association between stroke occurrence and environmental influences.

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          Most cited references33

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          Short term exposure to air pollution and stroke: systematic review and meta-analysis

          Objective To review the evidence for the short term association between air pollution and stroke. Design Systematic review and meta-analysis of observational studies Data sources Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions. Eligibility criteria Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality. Main outcome measures Admission to hospital and mortality from stroke. Results From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m3 (1.011 to 1.012) and 1.003 per 10 µg/m3 (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM2·5. Conclusion Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke. Systematic review registration PROSPERO-CRD42014009225.
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            Inhalation of fine particulate air pollution and ozone causes acute arterial vasoconstriction in healthy adults.

            Fine particulate air pollution and ozone are associated with increased cardiovascular events. To help explain the mechanism behind these observations, we investigated the effect of air pollution exposure on vascular function. Twenty-five healthy adults underwent a randomized, double-blind, crossover study comparing the vascular response to the 2-hour inhalation of approximately 150 microg/m(3) of concentrated ambient fine particles (CAP) plus ozone (120 ppb) versus the response to the inhalation of filtered air. High-resolution vascular ultrasonography was used to measure alterations in brachial artery diameter, endothelial-dependent flow-mediated dilatation (FMD) and endothelial-independent nitroglycerin-mediated dilatation (NMD). Exposure to CAP plus ozone caused a significant brachial artery vasoconstriction compared with filtered air inhalation (-0.09+/-0.15 mm versus +0.01+/-0.18 mm, P=0.03). There were no significant differences in FMD (+0.29+/-4.11% versus -0.03+/-6.63%, P=0.88), NMD (+3.87+/-5.43% versus +3.46+/-7.92%, P=0.83), or blood pressure responses between exposures. Short-term inhalation of fine particulate air pollution and ozone at concentrations that occur in the urban environment causes acute conduit artery vasoconstriction.
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              Climate change, air quality, and human health.

              Weather and climate play important roles in determining patterns of air quality over multiple scales in time and space, owing to the fact that emissions, transport, dilution, chemical transformation, and eventual deposition of air pollutants all can be influenced by meteorologic variables such as temperature, humidity, wind speed and direction, and mixing height. There is growing recognition that development of optimal control strategies for key pollutants like ozone and fine particles now requires assessment of potential future climate conditions and their influence on the attainment of air quality objectives. In addition, other air contaminants of relevance to human health, including smoke from wildfires and airborne pollens and molds, may be influenced by climate change. In this study, the focus is on the ways in which health-relevant measures of air quality, including ozone, particulate matter, and aeroallergens, may be affected by climate variability and change. The small but growing literature focusing on climate impacts on air quality, how these influences may play out in future decades, and the implications for human health is reviewed. Based on the observed and anticipated impacts, adaptation strategies and research needs are discussed.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 March 2016
                2016
                : 11
                : 3
                : e0152433
                Affiliations
                [1 ]Department of Neurosurgery, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
                [2 ]Department of Neurology, Hanyang University Medical Center, 222–1, Wangsimni-ro, Seongdong-gu, Seoul, Korea
                [3 ]Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471–701, Gyonggi-do, Korea
                National Health Research Institutes, TAIWAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: HJY Young-Seo Kim. Performed the experiments: MHH. Analyzed the data: MHH. Contributed reagents/materials/analysis tools: YK Young-Soo Kim. Wrote the paper: MHH. Re-examined and revised the paper: YK Young-Soo Kim.

                Article
                PONE-D-15-37433
                10.1371/journal.pone.0152433
                4807846
                27015421
                018146c0-a994-49a1-b603-77fd6883bec8
                © 2016 Han et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 August 2015
                : 14 March 2016
                Page count
                Figures: 3, Tables: 3, Pages: 14
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Earth Sciences
                Atmospheric Science
                Atmospheric Chemistry
                Greenhouse Gases
                Ozone
                Physical Sciences
                Chemistry
                Environmental Chemistry
                Atmospheric Chemistry
                Greenhouse Gases
                Ozone
                Ecology and Environmental Sciences
                Environmental Chemistry
                Atmospheric Chemistry
                Greenhouse Gases
                Ozone
                Medicine and Health Sciences
                Neurology
                Cerebrovascular Diseases
                Stroke
                Ischemic Stroke
                Medicine and Health Sciences
                Vascular Medicine
                Stroke
                Ischemic Stroke
                Medicine and Health Sciences
                Neurology
                Cerebrovascular Diseases
                Stroke
                Medicine and Health Sciences
                Vascular Medicine
                Stroke
                Engineering and Technology
                Environmental Engineering
                Pollution
                Air Pollution
                Biology and Life Sciences
                Behavior
                Diurnal Variations
                Physical Sciences
                Chemistry
                Environmental Chemistry
                Pollutants
                Ecology and Environmental Sciences
                Environmental Chemistry
                Pollutants
                Physical Sciences
                Materials Science
                Materials by Structure
                Mixtures
                Particulates
                People and places
                Geographical locations
                Asia
                South Korea
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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