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      Association with Ambient Air Pollutants and School Absence Due to Sickness in Schoolchildren: A Case-Crossover Study in a Provincial Town of Japan

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          Abstract

          The effect of ambient air pollutants and Asian dust (AD) on absence from school due to sickness has not been well researched. By conducting a case-crossover study, this study investigated the influence of ambient air pollutants and desert sand dust particles from East Asia on absence from school due to sickness. From November 2016 to July 2018, the daily cases of absence due to sickness were recorded in five elementary schools in Matsue, Japan. During the study period, a total of 16,915 absence cases were recorded, which included 4865 fever cases and 2458 cough cases. The relative risk of overall absence in a 10-μg/m 3 increment of PM 2.5 and a 0.1-km −1 of desert sand dust particles from East Asia were found with 1.28 (95%CI: 1.15–1.42) and 2.15 (1.04–4.45) at lag0, respectively. The significant influence of PM 2.5 persisted at lag5 and that of desert sand dust particles at lag2. NO 2 had statistically significant effects at lag2, lag3, and lag4. However, there was no evidence of a positive association of O x and SO 2 with absence from school. These results suggested that PM 2.5, NO 2, and AD increased the risk of absence due to sickness in schoolchildren.

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          Air Pollution and Non-Communicable Diseases: A review by the Forum of International Respiratory Societies’ Environmental Committee. Part 2: Air pollution and organ systems

          Although air pollution is well known to be harmful to the lung and airways, it can also damage most other organ systems of the body. It is estimated that about 500,000 lung cancer deaths and 1.6 million COPD deaths can be attributed to air pollution, but air pollution may also account for 19% of all cardiovascular deaths and 21% of all stroke deaths. Air pollution has been linked to other malignancies, such as bladder cancer and childhood leukemia. Lung development in childhood is stymied with exposure to air pollutants, and poor lung development in children predicts lung impairment in adults. Air pollution is associated with reduced cognitive function and increased risk of dementia. Particulate matter in the air (particulate matter with an aerodynamic diameter < 2.5 μm) is associated with delayed psychomotor development and lower child intelligence. Studies link air pollution with diabetes mellitus prevalence, morbidity, and mortality. Pollution affects the immune system and is associated with allergic rhinitis, allergic sensitization, and autoimmunity. It is also associated with osteoporosis and bone fractures, conjunctivitis, dry eye disease, blepharitis, inflammatory bowel disease, increased intravascular coagulation, and decreased glomerular filtration rate. Atopic and urticarial skin disease, acne, and skin aging are linked to air pollution. Air pollution is controllable and, therefore, many of these adverse health effects can be prevented.
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            Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias.

            The case-crossover design has been widely used to study the association between short-term air pollution exposure and the risk of an acute adverse health event. The design uses cases only; for each individual case, exposure just before the event is compared with exposure at other control (or "referent") times. Time-invariant confounders are controlled by making within-subject comparisons. Even more important in the air pollution setting is that time-varying confounders can also be controlled by design by matching referents to the index time. The referent selection strategy is important for reasons in addition to control of confounding. The case-crossover design makes the implicit assumption that there is no trend in exposure across the referent times. In addition, the statistical method that is used-conditional logistic regression-is unbiased only with certain referent strategies. We review here the case-crossover literature in the air pollution context, focusing on key issues regarding referent selection. We conclude with a set of recommendations for choosing a referent strategy with air pollution exposure data. Specifically, we advocate the time-stratified approach to referent selection because it ensures unbiased conditional logistic regression estimates, avoids bias resulting from time trend in the exposure series, and can be tailored to match on specific time-varying confounders.
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              World Health Organization

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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                20 June 2021
                June 2021
                : 18
                : 12
                : 6631
                Affiliations
                [1 ]Division of Internal Medicine, Motomachi Hospital, 1895-1 Agarimichi-cho, Sakaiminato 684-0033, Japan; junkurajun@ 123456gmail.com
                [2 ]Department of Data Science, Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo 190-8562, Japan; noma@ 123456ism.ac.jp
                [3 ]Department of Internal Medicine, Yasugi Daiichi Hospital, Yasugicho 899-1, Yasugi 692-0011, Japan; eugene.aleuc@ 123456gmail.com
                [4 ]Allergy Center, Kindai University Hospital, Ohnohigashi 377-2, Osakasayama 589-0014, Japan; hsano@ 123456med.kindai.ac.jp
                Author notes
                [* ]Correspondence: navijinsei@ 123456gmail.com ; Tel.: +81-859-44-0101
                Author information
                https://orcid.org/0000-0002-2520-9949
                Article
                ijerph-18-06631
                10.3390/ijerph18126631
                8296492
                34203021
                c19e8fc4-2a15-4e54-aa08-84eef223a09e
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 21 May 2021
                : 19 June 2021
                Categories
                Article

                Public health
                ambient air pollutants,asian dust,cough,fever,school absence,sickness
                Public health
                ambient air pollutants, asian dust, cough, fever, school absence, sickness

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