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      The Novel Relationship between Urban Air Pollution and Epilepsy: A Time Series Study

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          Abstract

          Background and purpose

          The data concerning the association between environmental pollution and epilepsy attacks are limited. The aim of this study was to explore the association between acute air pollution exposure and epilepsy attack.

          Methods

          A hospital record-based study was carried out in Xi’an, a heavily-polluted metropolis in China. Daily baseline data were obtained. Time-series Poisson regression models were applied to analyze the association between air pollution and epilepsy.

          Results

          A 10 μg/m 3 increase of NO 2, SO 2, and O 3 concentrations corresponded to 3.17% (95%Cl: 1.41%, 4.93%), 3.55% (95%Cl: 1.93%, 5.18%), and -0.84% (95%Cl: -1.58%, 0.09%) increase in outpatient-visits for epilepsy on the concurrent days, which were significantly influenced by sex and age. The effects of NO 2 and SO 2 would be stronger when adjusted for PM 2.5. As for O 3, a -1.14% (95%Cl: -1.90%, -0.39%) decrease was evidenced when adjusted for NO 2. The lag models showed that the most significant effects were evidenced on concurrent days.

          Conclusions

          We discovered previously undocumented relationships between short-term air pollution exposure and epilepsy: while NO 2 and SO 2 were positively associated with outpatient-visits of epilepsy, O 3 might be associated with reduced risk.

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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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            Ecologic studies in epidemiology: concepts, principles, and methods.

            An ecologic study focuses on the comparison of groups, rather than individuals; thus, individual-level data are missing on the joint distribution of variables within groups. Variables in an ecologic analysis may be aggregate measures, environmental measures, or global measures. The purpose of an ecologic analysis may be to make biologic inferences about effects on individual risks or to make ecologic inferences about effects on group rates. Ecologic study designs may be classified on two dimensions: (a) whether the primary group is measured (exploratory vs analytic study); and (b) whether subjects are grouped by place (multiple-group study), by time (time-trend study), or by place and time (mixed study). Despite several practical advantages of ecologic studies, there are many methodologic problems that severely limit causal inference, including ecologic and cross-level bias, problems of confounder control, within-group misclassification, lack of adequate data, temporal ambiguity, collinearity, and migration across groups.
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              Scientific and medical aspects of ozone therapy. State of the art.

              V. Bocci (2006)
              The aim of this review is to dispel misconceptions and skepticism regarding ozone therapy and to clarify the biochemical and pharmacological mechanisms of action of ozone dissolved in biological fluids. The work performed in the last decade in our laboratory allows drawing a comprehensive framework for understanding and recommending ozone therapy in some diseases. It is hoped that this report will open a dialogue among clinical scientists and will inform physicians about the beneficial effects of ozone therapy.
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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
                29 August 2016
                2016
                : 11
                : 8
                : e0161992
                Affiliations
                [1 ]Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
                [2 ]Information Department Medical Record Room, Second Affiliated Hospital, Fourth Military Medical University, Xi’an, China
                [3 ]Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
                [4 ]School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
                [5 ]School of Public Health, Fourth Military Medical University, Xi'an, China
                University of Catanzaro, ITALY
                Author notes

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

                • Conceptualization: TJC ALJ.

                • Data curation: CX TJC.

                • Formal analysis: CX HDK RJC JHL.

                • Funding acquisition: TJC YZ YFL.

                • Investigation: YNF TJC.

                • Methodology: HDK RJC TJC.

                • Project administration: TJC ALJ.

                • Resources: YNF TJC.

                • Supervision: TJC.

                • Validation: YZ YFL.

                • Visualization: TJC.

                • Writing – original draft: CX TJC ALJ JHL YZ YFL.

                Author information
                http://orcid.org/0000-0003-3188-6265
                Article
                PONE-D-16-13619
                10.1371/journal.pone.0161992
                5003346
                27571507
                2c2176de-9bd0-4f19-bf8f-02abf06ddb6a
                © 2016 Xu 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
                : 5 April 2016
                : 16 August 2016
                Page count
                Figures: 3, Tables: 3, Pages: 11
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81372952
                Award Recipient : Tongjian Cai
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81202220
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81472190
                Award Recipient :
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Neurology
                Epilepsy
                Engineering and Technology
                Environmental Engineering
                Pollution
                Air Pollution
                Physical Sciences
                Chemistry
                Environmental Chemistry
                Pollutants
                Ecology and Environmental Sciences
                Environmental Chemistry
                Pollutants
                Earth Sciences
                Atmospheric Science
                Meteorology
                Humidity
                People and Places
                Geographical Locations
                Asia
                China
                Medicine and Health Sciences
                Health Care
                Patients
                Outpatients
                Earth Sciences
                Atmospheric Science
                Meteorology
                Weather
                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
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                All relevant data are within the paper and its Supporting Information.

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