text:
A selection of varied healthy and low-fat vegetable recipes.
Here we offer you a selection of healthy and delicious recipes for you to try at home where different vegetables are at the core of each dish. You can choose your favourite between our choice of hot and cold snacks that include salads, stir-fries and Indian-style samosas.
Red cabbage and carrot salad
This is an alternative to coleslaw for lovers of red cabbage. It is very refreshing as it contains orange segments, but if you are watching the calories, use low-fat mayonnaise instead.
1 lb (455 g) of red cabbage
8 oz (225 g) of grated carrots
2 large oranges
2 oz (55 g) of raisins
4 tbsp of
salt and pepper
Chop the red cabbage into small pieces or shred in an electric food processor and place into a large mixing bowl.
Add the grated carrots and the raisins.
Grate a little orange rind and set aside.
Peel the oranges and remove as much pith as possible. Divide the oranges into segments and cut in half.
Add the orange pieces to the salad and mix all of the ingredients together.
Mix the reserved orange rind with the mayonnaise and then add to the salad.
Stir well and season with a little salt and pepper.
Chill in the refrigerator until needed.
Russian salad
This is a popular "tapa" or appetiser served in Spain, which is similar to
potato salad
. Serve with fresh crusty bread.
1 lb (455 g) of boiled potatoes
4 oz (115 g) cooked sliced carrots
4 oz (115 g) of cooked peas
2 chopped sticks of celery
2 chopped gherkins
handful of capers
For the dressing
¼ pint (150 ml) of mayonnaise
2 tbsp of
olive oil
1 tbsp of white wine vinegar
pinch of sugar
salt and pepper
Cut the potatoes into small cubes and place into a large mixing bowl.
Add the sliced carrots, peas, celery and gherkin and stir all of the ingredients together.
In a small mixing bowl blend all of the dressing ingredients together with a spoon.
Add the dressing to the potato mixture and stir well.
Sprinkle with a handful of capers and chill in the refrigerator until required.
Vegetable samosas
A healthy alternative to the popular meat samosas but just as tasty. These samosas can be frozen for later use.
7 oz (200 g) of filo pastry
5 oz (150 g) of frozen peas
1 sweet potato, peeled and diced
1 red chilli, deseeded and diced
1 small onion, diced
½ pepper, cored and deseeded
1 oz (30 g) of melted butter
2 tbsp of vegetable oil
1 crushed clove of garlic
1 cm of freshly grated root ginger
1 tbsp of freshly chopped
2 tsp of black mustard seeds
1 tsp of ground
Grease 2 large baking sheets with a little vegetable oil.
Heat the 2 tbsp of vegetable oil in a large frying pan on a medium heat.
Add the chilli, sweet potato, pepper, onion, garlic, ginger, mustard seeds and cumin and stir well.
Cook over a medium heat for about 10 minutes, stirring frequently so that the ingredients do not burn.
Add the frozen peas and stir.
Cover the pan with a lid and cook for a further 5 minutes. Stir occasionally.
Remove the pan from the heat and stir in the chopped coriander. Allow to cool.
Preheat the oven to 375°F (190°C)
Cut the sheets of filo pastry in half lengthways and brush the edges with the melted butter.
Place a spoonful of the vegetable mixture into the centre of the pastry and then fold the pastry over to form a triangle.
Brush the top of the pastry and the edges with a little more melted butter.
Continue with the rest of the filling and pastry and arrange on the greased baking trays.
Place into the preheated oven and bake for 12 - 15 minutes or until the samosas have turned a golden brown colour.
Remove from the oven and serve hot or allow to cool and serve cold.
Roasted Mediterranean vegetables
This dish is extremely colourful and tasty. It is a great way to serve lots of vegetables in one go and a wonderful accompaniment to any meat, fish or poultry dish.
2 courgettes
2 Spanish onions
2 beef tomatoes
1 red pepper
1 yellow pepper
1 aubergine
1 fennel bulb
8 cloves of garlic
2 tbsp of olive oil
rosemary sprigs
salt and pepper
lemon wedges
Cut the peppers in half and core and deseed them. Cut into large chunks.
Peel the onions and cut into quarters.
Wash the aubergine and courgettes but do not peel them. Cut into large chunks.
Cut the fennel into thick slices.
Lightly oil a ceramic ovenproof dish with olive oil and arrange the prepared vegetables in a single layer in the dish.
Preheat the oven to 425°F (220°C).
Halve the tomatoes and place amongst the vegetables in the dish.
Peel the garlic cloves and place amongst the vegetables.
Drizzle the olive oil over the top of the vegetables and tuck the sprigs of rosemary amongst the vegetable pieces.
Season with a little salt and black pepper.
Place the dish into the oven and roast the vegetables for 20 - 25 minutes. Turn the vegetables over halfway through cooking time.
Remove from the oven and serve with your main meal with some lemon wedges.
Chicken and vegetable stir-fry Asian-style
This low-fat stir-fry is very quick to prepare and tastes delicious. It can be served on its own or with rice or noodles.
10 oz (285 g) of chicken, thinly sliced
4 oz (115 g) of green beans
1 oz (30 g) of crushed peanuts
½ red pepper, deseeded and sliced
½ green pepper, deseeded and sliced
4 chopped spring onions
2 carrots, cut into matchsticks
2 tbsp of sunflower oil
2 tbsp of
1 large clove of garlic
1 piece of lemongrass
1 cm piece of fresh root ginger
½ tsp of sugar
salt and pepper
Heat the oil in a large frying pan or wok over a medium - high heat.
In the meantime, thinly slice the lemongrass and the ginger and finely chop the ginger.
Add to the frying pan and fry for 30 seconds or until brown.
Add the sliced chicken and fry for 3 minutes or until browned slightly.
Add all of the prepared vegetables and stir-fry for 5 minutes or until the chicken is done.
Add the crushed peanuts and stir well.
Stir in the oyster sauce and the sugar.
Season with salt and pepper.
Cook for a further minute and then remove from the heat and serve immediately.
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text: I still see every day how much this country suffers because of your bombs, Steve, because I live over here...>> Just because you live there doesn't mean you know jack. Nixon didn't train the leaders of the K-Rouge in communism and bogo-existentialist bullshit a la' Proust, Heidegger and Sartre; the loser post-Vichy French intellectuals did. Kissinger didn't form the party cadres; the Vietnamese did, with the help of the above pseudo-intellectual genocidal monsters who formed the K-Rouge. The American bombs didn't teach twelve year old boys to machine gun little old ladies; Saloth Sar and his band of leftist intellectual losers did. The American multinational corporations didn't empty the cities. The U.S. Air Force didn't starve people to death for living in cities. The American Army didn't shoot people with glasses. Yeah, you can see the damage American bombs did. But you can't see the damage that the Khmer Rouge did, because all they left behind were the bones of the dead in national monuments. Have you gone to one of those lately? And don't tell me I don't know what I'm talking about. I've seen genocide close up too--leftist genocide--as genocide ALWAYS has been this last hundred years. Thank you for not blaming the United States. We were trying to stop what happened; the fact that we failed, and NOT the fact that we tried, is ultimately our guilt.

subset: commoncrawl


text:
Overloaded Networks Disrupted Boston Cell Service
Whenever something traumatic happens, cell service is almost immediately toast. Everyone reaches for their phone, and networks are overwhelmed.
Today's events in Boston were no different: Carriers including Sprint and AT&T confirmed to the Boston Globe that customers were likely experiencing problems. Verizon recommended everyone keep all non-emergency communiques to text, to free up capacity, and WiFi worked, too.
But at first, there were questions whether cell phone service might have been shut off, rather than merely swamped. Read More


text:
The completion of a joint industry project (JIP) to improve existing standards and regulations around subsea lifting operations has resulted in a new recommended practice (RP).
Polarcus Limited has signed a letter of intent with Perenco Oil & Gas Gabon S.A. for a 3D marine seismic acquisition project offshore West Africa.
The project,
Royal Boskalis Westminster N.V., in partnership with Volker Stevin International (VolkerWessels), has been awarded a contract by Iberdrola Renewables Offshore Deutschland
The U.S. Coast Guard missions and operations in the Southeast remain unchanged. The Coast Guard strongly discourages attempts to illegally enter the country by taking to the sea.
The U.S. Coast Guard (USCG) issued a statement today stating that the United States' Cuba policy change will not impact its missions annd operations.
"Coast Guard
An Italian shipping firm based in Genoa, Italy, pleaded guilty to violating the Act to Prevent Pollution from Ships by falsifying required ships' documents to hide


text:
Photo of the Day:
KPF NYC: Paul Katz, FAIA, is the Kohn Pedersen Fox Associates principal designing the next building to rise over New York's High Line: 500 West 21st Street. James Gardner observes the breaks in the rhythmic geometry of the building: "[O]ne suspects a trace of mannerism in the way in which the bottom level appears to be crushed beneath the weight of the higher levels. At the same time, the top level, lacking the limestone accents on the roof, appears to dissipate into thin air." [The Real Deal]
Lone Star Landscape: The Contemporary Austin has named Reed Hilderbrand Landscape Architecture to master-plan its Laguna Gloria campus. The 12-acre site will include educational, exhibition, and community space, along with the contemporary art museum's sculpture park. [The Contemporary]
Quote of the Day: "Now cities are being made by developers, not architects, or not urban planners."—Shigeru Ban, winner of this year's Pritzker Prize. [Dezeen]
Tweet of the Day:
big congratulations to @IngaSaffron, on her well-deserved pulitzer for criticism.— mark lamster (@marklamster) April 14, 2014
big congratulations to @IngaSaffron, on her well-deserved pulitzer for criticism.
Infographic of the Day: This chart from FiveThirtyEight shows that even though adding bike lanes takes away road space for cars, the increase in traffic congestion won't be all that noticeable—unless the street was already snagged. [FiveThirtyEight]
Credit: FiveThirtyEight
5 More Stories for Tuesday:
What San Francisco's Golden Gate Bridge could have looked like, had this "boat tunnel" come to fruition. [The Atlantic Cities]
The pros and cons of building giant mirrors to bring sunshine to Norway's most shadowy cities. Pros: light and art! Cons: … [The New York Times]
Massimo Morozzi, Archizoom Associati cofounder and Edra art director, died at 73. [Dezeen]
Tour the inside of art museums without leaving your chair. [Curbed DC]
A conversation with Nikil Saval, author of "Cubed: A Secret History of the Workplace." [The Atlantic]
Step Up, Step Down:
Wright & Wright will replace David Chipperfield Architects as architects for the Geffrye Museum renovation in East London, after the local council rejected the David Chipperfield design. [Architects' Journal]
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text:
Philip Morris
Indoor Air Pollution in Developing Countries
Date: 19900000/P
Length: 12 pages
Jump To Images
Length: 12 pages
Jump To Images
- Author
- Chen, B.H.
- Hong, C.J.
- Pandey, M.R.
- Smith, K.R.
- Area
- Type
- Site
- Request
- Stmn/R1-048
- Named Organization
- Shanghai Symposium on Environmental Heal
- 2nd Natl Conference on Environmental Hea
- Programme Support Service
- Shanghai Medical Univ
- Who, World Health Org
- Named Person
- Chang, K.M.
- Chen, B.H.
- Hong, C.J.
- Lin, H.S.
- Wang, J.
- Wong, C.J.
- Yang, X.
- Document File
- 2501154504/2501155174/Ets and Lung Cancer in Nonsmokers Volume II
- Litigation
- Stmn/Produced
- Author (Organization)
- Bir Hospital Kathmansu
- Environment + Policy Inst
- Shanghai Medical Univ
- Un Environment Programme
- Who, World Health Org
- Master ID
- 2501154505/5173
- 2501154505-4511 Ets and Lung Cancer in Nonsmokers Volume II
- 2501154513-4525 Criticisms of the Epidemiologic Studies on Ets and Lung Cancer
- 2501154526 1
- 2501154527-4537 Environmental Tobacco Smoke and Lung Cancer: A Critical Assessment
- 2501154538 2
- 2501154539-4542 Misclassification of Environmental Tobacco Smoke Exposure: Its Potential Influence on Studies of Environmental Tobacco Smoke and Lung Cancer
- 2501154543 3
- 2501154544 Lung Cancer and Passive Smoking
- 2501154545-4548 Towards A Reduction in Publication Bias
- 2501154549 4
- 2501154550-4559 Questionnaire Assessment of Lifetime and Recent Exposure to Environmental Tobacco Smoke
- 2501154560-4562 A Personal Monitoring Study to Assess Workplace Exposure to Environmental Tobacco Smoke
- 2501154563 5
- 2501154564-4568 Variability of Measures of Exposure to Environmental Tobacco Smoke in the Home
- 2501154569 6
- 2501154570-4576 Increase Risk of Lung Cancer in Non-Smokers Married to Smokers: A Result of Ets Exposure or of Bias?. An Introduction to the Study of Smoking Using Urinary Hydroxyproline
- 2501154577 7
- 2501154578-4579 Indoor Air Quality Symposium 881206 - 881207 San Carlos De Bariloche Argentina
- 2501154580-4595 Epidemiology: Its Scope and Limitations for Indoor Air Quality
- 2501154596 8
- 2501154597-4601 Passive Smoking and Kung Cancer: A Reanalysis of Hirayama's Data. What Is the Epidemiologic Evidence for Passive Smoking - Lung Cancer Association?
- 2501154602 9
- 2501154603-4604
- 2501154605
- 2501154606 10
- 2501154607-4613 Passive Smoking
- 2501154614 11
- 2501154615-4622 Age As A Modifying Factor in the Association Between Lung Cancer in Non-Smoking Women and Their Husbands Smoking Status
- 2501154623 12
- 2501154624-4631 An Example of Extra - Poison Variation Suggesting An Under - Specified Model.
- 2501154632-4647 Model Specification Effects in Ets / Nutrition Research
- 2501154648 13
- 2501154649-4650
- 2501154651 14
- 2501154652
- 2501154653 15
- 2501154654-4657 Assessing the Validity of A Japanese Cohort Study
- 2501154658 16
- 2501154659 Non-Smoking Wives of Heavy Smokers Have A Higher Risk of Lung Cancer
- 2501154660 17
- 2501154661 Non-Smoking Wives of Heavy Smokers Have A Higher Risk of Lung Cancer
- 2501154662 18
- 2501154663-4665 Contributions to Epidemiology and Biostatistics Vol. 6
- 2501154666 19
- 2501154667 Probleme Mit Dem Passivrauchen
- 2501154668-4691 the Problems of Passive Smoking
- 2501154692 20
- 2501154693-4702 Passive Smoking and Lung Cancer: Reanalyses of Hirayamas Data
- 2501154703 21
- 2501154704-4710 Meta-Analyses on Passive Smoking and Lung Cancer
- 2501154711 22
- 2501154712-4728 Lung Cancer From Passive Smoking: Hypothesis or Convincing Evidence?
- 2501154729 23
- 2501154730 Lung Cancer and Passive Smoking
- 2501154732-4744 Confounding Factors
- 2501154745 1
- 2501154746 Environmental Tobacco Smoke and Lung Cancer
- 2501154747 2
- 2501154748-4752 Letters to the Editor An Estimate of Adult Mortality in the United States From Passive Smoking. A Response
- 2501154753 3
- 2501154766 4
- 2501154767 Lung Cancer in South China
- 2501154768-4773 Meeting Report Mutagenesis and Carcinogenesis by Nitropyrenes and Cancer Chemotherapeutics
- 2501154774 5
- 2501154775-4778 on the Relationships Between Smoking and Female Lung Cancer
- 2501154779 6
- 2501154780-4783 Lung Cancer and Indoor Air Pollution in Xuan Wei, China
- 2501154784 7
- 2501154785-4790 the Epidemiology of Lung Cancer in Xuan Wei, China: Current Progress, Issues, and Research Strategies
- 2501154791 8
- 2501154792-4797 Indoor Air Pollution and Woman Lung Cancer
- 2501154798 9
- 2501154799-4801 Abstracts From the Second Annual Meeting of the International Society for Environmental Epidemiology. Part I. Berkeley, California: 900813 - 900815 An Epidemiological Study of Lung Cancer in Xuan Wei County, China: Current Progress (1)
- 2501154802-4807 Smoking and Other Risk Factors for Lung Cancer in Xuanwei, China
- 2501154808 10
- 2501154809 Analysis of Risk Factors for Female Lung Adenocarcinoma in Haerbin: Indoor Air Pollution
- 2501154810-4816 Analysis of Risk Factors for Female Lung Adenocarcimo,A in Haerbin City - Indoor Air Pollution
- 2501154817 11
- 2501154818-4823 Lung Cancer Among Women in North-East China
- 2501154824 12
- 2501154825-4831 Smoking, Air Pollution, and the High Rates of Lung Cancer in Shenyang, China
- 2501154832 13
- 2501154833-4841 A Case - Control Study of Lung Cancer in Nonsmoking Women
- 2501154842 14
- 2501154843-4854 Passive Smoking Among Nonsmoking Women and the Relationship Between Indoor Air Pollution and Lung Cancer Incidence -- Results of A Multicenter Case Controlled Study.
- 2501154855 15
- 2501154856-4861 Lung Cancer Among Chinese Women
- 2501154862 16
- 2501154863-4880 Dietary Habits and Lung Cancer Risk Among Chinese Females in Hong Kong Never Smoked
- 2501154881-4890 Life - History Correlates of Environmental Tobacco Smoke: A Study on Nonsmoking Hong Kong Chinese Wives with Smoking Versus Nonsmoking Husbands
- 2501154891-4901 Environmental Tobacco Smoke and Lung Cancer : Is It the Smoke or the Diet?
- 2501154902 17
- 2501154903-4913 Lung Cancer Risk and Mutagenicity of Tea
- 2501154914 18
- 2501154915-4919 Dietary Intake of Carotene in Nonsmokers with and Without Passive Smoking at Home
- 2501154920 Effects on Socioeconomic Status and Smoking on Serum Beta-Carotene
- 2501154921 19
- 2501154922-4924 for Debate: Pet Birds As An Independent Risk Factor for Lung Cancer
- 2501154926-4930 Use of Meta-Analysis: Epidemiologic Studies on Ets and Lung Cancer
- 2501154931 1
- 2501154932-4937 Does Breathing Other People's Tobacco Smoke Cause Lung Cancer?
- 2501154938 2
- 2501154939-4946 Passive Smoking and Lung Cancer
- 2501154947 3
- 2501154948-4964 An Estimate of Adult Mortality in the United States From Passive Smoking
- 2501154965 4
- 2501154966-4969 Meta-Analyses on Passive Smoking and Lung Cancer
- 2501154970 5
- 2501154971-4983 Meta-Analysis in Epidemiology, with Special Reference to Studies of the Association Between Exposure to Environmental Tobacco Smoke and Lung Cancer: A Critique
- 2501154984-4988 Meta-Meta-Analysis: Unanswered Questions About Aggregating Data
- 2501154990-4993 Risk Estimates for Nonsmoker Lung Cancer Based Upon Modeling Procedures
- 2501154994 1
- 2501154995-5014 A Quantitative Estimate of Nonsmokers' Lung Cancer Risk From Passive Smoking
- 2501155015 2
- 2501155016-5029 Nonsmoker Lung Cancer Risks From Tobacco Smoke Exposure: An Evaluation of Repace and Lowrey's Phenomenological Model
- 2501155030 3
- 2501155031-5048 Never Smoker Lung Cancer Risks From Exposure to Particulate Tobacco Smoker
- 2501155049 4
- 2501155050-5056 the Potential Association of Lung Cancer with Passive Smoking
- 2501155057-5059 Indoor Air Quality Containing Papers From the Third International Conference on Indoor Air Quality and Climate Stockholm, Sweden, 840000
- 2501155060-5068 Health Risks of Passive Smoking: Problems of Interpretation
- 2501155069 5
- 2501155070-5076 Lung Cancer and Passive Smoking: Predicted Effects From A Mathematical Model for Cigarette Smoking and Lung Cancer
- 2501155077 6
- 2501155078-5079 Lung Cancer and Passive Smoking
- 2501155081-5089 Ets and Cancer of Sites Other Than the Lung
- 2501155090 1
- 2501155091-5094 Cancer, Passive Smoking and Nonemployed and Employed Wives
- 2501155095 2
- 2501155096-5099 Abstracts of Papers Presented at the Twentieth Annual Meeting of the Society for Epidemiologic Research
- 2501155100 3
- 2501155101-5105 Deaths From All Causes in Non-Smokers Who Lived with Smokers
- 2501155106-5107 Risk to Passive Smokers
- 2501155108 4
- 2501155109-5114 Cancer Risk in Adulthood From Early Life Exposure to Parents' Smoking
- 2501155115 5
- 2501155116-5118 Breast Cancer, Cigarette Smoking, and Passive Smoking
- 2501155119 6
- 2501155120-5125 Bladder Cancer in Nonsmokers
- 2501155126 7
- 2501155127-5133 Risk of Bladder Cancer by Source and Type of Tobacco Exposure: A Case Control Study
- 2501155134 8
- 2501155135-5146 Passive Smoking in Adulthood and Cancer Risk
- 2501155147 9
- 2501155148-5154 Cigarette Smoking and Exposure to Passive Smoke Are Risk Factors for Cervical Cancer
- 2501155155 10
- 2501155156-5162 Environmental Factors in the Etiology of Rhabdomyosarcoma in Childhood
- 2501155163 11
- 2501155164-5173 Prenatal Exposure to Parents Smoking and Childhood Center
Related Documents:
Document Images
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INDOOR AIR POLLUTION IN DEVELOPING COUNTRIES 9 . H. Chen. C. J. Ftong! M. R PandeY & K. R. Smith` A r pollution in general and indoor air pollution in particular have txen associated in many people's mind with mdustnalitat+on and urbam2atton and, thuS. with the cities of developed countries where most of the measurements have been made. Rt- cently. however, the UtvEPNVHO Global Environment Monitoring System IGEMSY has demonstrated quite convincingly that the worst ambient Conditions re- ported today obtam in the cit3es of developing coun- tries, In a similar fashion, although most studies of indoor air quality have been carried out in devel- oped-country bwldings. for many important pol- lutants the largest +ndoor.pol3utant concentrations and exposures are also found in the developing countnes in both rural and urban households. Worldwide, there are four principal classes of indoor pollutants 111, those dertved from: (r) combust on e g- carbon monoxide. particulates, and sulfur and nitrogen oxides from cooktng 6SOves. faace neaters and cigarettes (environ mental tobaL'.o smoke-ETS); rt buitd ng materials, furnishings and themrcal pxoductss e.g pest+ctdes, volatile organic trom- pountls, formaldehyde: (ut) the ground vnder the bwidrng. i.e. radon: trvl biotog cal processes. e.g, mold- mildew, mites. As with ambient em ssions. the impact of indoor emissions on Concentrat3ons depends directly on vG7ttiatuon tairliow and mixing volumel. In generaf, most housing in developed countrne5 lies tn tem- pera*e IaLtudes ano thuS has relatively low air ex- chant)e rates.s i e tvp4cally one air change per hour or less. Under these condittons, even rather small emission rates can result tn indoor concentrations that exceed those outdoors, considering also that indoor air qualtty is affected by outdoor levels. Since people spend a great proport on of time indoors. typ+Ca3ly 90% or more, +ndoor pollution is lrequently the predominant factor in total exposure. In the developing world. however, much housing lies in tropical and Subtropical regions and typically has much higher ventilation rates. In these ctrcum- ftances, it takes fa rly high emission rates to pro- duct significant pollutant fevets. Unfortunately, there seem to W many situations in which suoh strong mdoor sources exist. f>noreover, in spite of be ng a mtnortty, several hundred million people in develop tnq countrtes reqwre space healing for a significant part of the year, and thus share with developed antanat.onal sroqrarnete en Lr»n+cN saMev. worfe rMam+ Orqan+rat.on. GeMwq School of tnote N.aet+. Snsr,gns. r~Aed" i/n+vwsay. Snanqna.. Lama ~ 6,r Nofpnl/ Kltnnynay. NeO4t EmHOrtnem ano Pohcr rmtAUte. East^west Canter, MonolulY. M..w0,1, und.d States ot A+n..xa Gtowt f n no ~ ent Monno-q Syar.m assa»m.nr of v.aart aN awwy un-:ee Matroms EAnronment Praqren,n,.AVanE tbaith jorqJNtatson. lqsa IunokwyM0 OOCurMntl countries the d Ntcult trade-off between space- heattng fuel efficiency, ventilation and indoor air quality. This review focuses on indoor combusttondenved pollutants, principally because comparatively little work has been publ shed on the Other three Cat egortes in developing sountnes. Although the ma n purpose is to review the available ep3demtotogical studies, the relevant sources and pollutants will be briefly discussed frrst Indoorsouross Due to the generally higher ventilation rates. ETS has riot been singled out in developingtountry studies to date. Wstn the siarmtng increase in smok ing rates and the chang ng housing stock in some developing CDuntr es, however, suCh research may well be warranted Although such minor Combustion sources as incense and mosouito cotis have otca s onally been exam,ned, most efforts have ton- Centrateo on cooking and heating stoves. After tobacco, the most common indoor pollution source ot concern in develooed-country ttudies nas been gas cookstoves In the g obal context. however, gas stoves are near the upper end of an evolution in the pualtty of household fuels. sometimes called the energy ladder (2). Although dependent on local con- ditions. at the lowest rung might he those house- holds that rely on tlried an~mal dung and scavenged tw gs and grass for cooking The next step might be crop residues followed by wood, and then Charcoal. The first nonbiomass fuel might be kerosene, as in Indta, or coal, as in China Highest on the ladder lie bottted and piped gases and. for some rich com muntties. eiectractty, In general, each step involves an increase in the Cooking system's levels of technology, cleani,ness. eff{ae,~cy and cost. O,n- a--glob_al scale, it is esttm~ted that more tt~an half Ot tnt worid't h0usehDlqCDOk d~t~ wtth u~- processed solid fuels._i.e,biofuels or coal. An un 1cnOwn- Dut tign~litlnt,._.ps_Opottton of thas activity akes Dlace in condtupns where mu~Q~h~~ ~ornt___e_f_iluent is ;eleese_d +nto the living srei. A~lthougrl ventdation rates are_oha~ rtlatively hi9h, t~s emttsion f~ctcrt ior such fuelsara _so 9reat that indoor concentrittons antl eapos_ur~s t~n be qutt: siqnificant. Comoared with ga+;tovts, foi t:a~ie, av_e sioves usin one of the cleaner biotuels. wood. tYpiclly telease 50 t+mes more pol utton tn coo rng ~ii.~~ vva n m AfLp.u~n lest_ DrlyiSnL~pac! *uting wtth un- p_rocesseCsolid tue_Is csn a-IS~1tad to htoh indoor ai~ollution levels. For part of the year in the htgh- a~tttu~@~1lei ~v3foQtng Countnt; inlli major _, reqions tAs~a. Afrita, lstm Amenca and Oceeniaf, unrerted sntt:_t~at,n~ wqth bomiss_fucls iscon+mon. In addition, in much of temperate China, V7I ~ Jp+qr F,WS 48 1111901 2501154754
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significant indoor Concentrations result because of the high emission rates of coal fuels in s+mple stoves. although the pollution is itss serlous with venting, as is the csse in most Chinese Cutles. 72E - JEpidtn+ioloyy Adhough. by internatuonal comparlson. the *x- posures received in households in many developing eountroes are large. epidemiological studies are stdf difficult. Expected shortterm lacutel efiects. such as acute respiratory infections tARlt, have many Other important risk factors. some Of which Correlate with pollution exposures. Longlatency tffects, Such as cancer and chronic obstructrve lung olsease ICOLDI. also involve other risk factors I4loreover. it is tl/f ficult to associate these effects with previous ex posures because Of the Iong Intervsl between these exposures and the onset of rllness tthe appearance of symptomsl (5). Physiological and biochemical markets. such as lung function and immunological status. are only indicators of the particular path- ology. for the sake of conciseness this review focuses on developingcountry studles published since 1980 and which intlude a healthrelat+d endpoint. Most of the early studies are nted. but not discussed in detail. and purely environmental studles are only men- tioned occaslonally. i.e. those that looked only at exposures' The studies have been divided according to general category of source. biomass or coal, and the health-related tndpornt being examined. Most have been done either in South Asia with rural populatoons using biomass. or in China with urban groups using coal. It is impossible at this po/nt to tlenve a reliable estimate of the total developing-country population exposed to what m+ght be termed -excesslve" in- door concentratlons, partly because there are few internstlonallvreco9nmted standards for household concentrations. Assuming that they would be at least as stringent as outdoor standards, the total number of people exposed clearly rivals or exceeds that exposed to excessive ambient concentrations in all the world's ntles.' i.e. several hundred million. Given the greater time spent indoors and the known magnitude of concentrations in many situations however, the total global dose-eDurvalent Umount actually inhaledl is probably hlgher for some impor- tant pollutants. e.g. partlculates 137. Pinpointing the actual sources of exposure rf further compllcsted in many urban and even same rural ereu, because indoor concentrations are influenced by outside as well as inside sources. Pollutants In spne of the long history of fasunat on with fire and hundreds of years Of sclentllic ettort. the ability to predlct the detailed behaviour of combustion in any but the simplest configurations of fuel and air has eluded us. tUevertheless. empirical evidence has shown that unprocessed solld fuels produce hun- dreds of chemical compounds because of the incom- plete combustlon that occurs under the operating conditions of simple cooksloves. which are Ohen little more than three-rOcks Of a small open-ended box Of Clay, $oth coal and blomass act this way, although the mix of compounds from each is signlfi- cantly dlfferent. Unlike cos/, biomass generally con tarns few intrinsic Contaminants. such as sulfur, trace metals and ash. and thus can, under proper oon- dltlons, be burned with no releases other than the products of complete combustlon. i.e. carbon dioxide and water. kJntortunately, it has turned out to be difficult to reliably create these eondrttons in modestly-priced household dewces. As with tobacco smoke, which is also the result of open biomass combustion, :uch cbokstove smoktjs. ~ comollcated matyrl. 0f aeio;gl_tdrqpie_tf__tln~t__lQhd partic~s/ and pases. §iomass ul+ok+ eo_ntins_31Q- t~ifi~nt amounts o~v~al D{ tht imDOriAt ool lutaIIts. for whleh most countrles heve set stsndsrdr. arbon manoxide aniculates. h dr_txsrbons and, to a i+sser extent, nitrogen ozld+s. Perhspf more im- portsnt however is that the a+rpsol contains many organic compounds that are thought to be toxic. carcinogenic. mutagenlc or otherwise worrisome Isf. Coal smoke conta/ns all this plus additional poi- iutants. e.g. sulfur ox,des, inorganic ash particles and heavy metals such es lead. it is difficuh to make generalizations about the relative amounts of each kind of pollutant however, because emissions can change with relatively small changes in fuel quality, configuration and combustion, and Compsratively little detaded research has focused on such con- ditions. 'i.r a revrw M e5twsun nueys rNn.9 rs s0Tw.. tr" felplMce /iL ter tneN euTMMne GW/. Mf WeNenr't 1e1. Biornass-SourA Asia. Africa. Guatemala and Papua New Guines The vest maJority of rural inhabitants in these parts of the world use unprocessed biomass fuels. Although significant in some communltt+s, the utili- tation of these fuels in Cities has been dropping as households move up the energy ladder, i.e. to ker- osene and bottled gss. Proport+onately, household coal use is minor, but it involves tens of millions Of people and seems to be on the increase as tht availability of biomass fuels dwindles and petroleum fuels remain relatively expensive. Carboxyhsemo9rob+n 1hrbCD/. In a study of osrbon monoxide IC01 concentrations in 130 biomass- burning kitchens of two Guatemalan villages at dif- ferent elevations II50 m and 1350 m1. Dsry tt at.171 also determined HDCO blood concentrations in women. They found lower NbCO levels in women cooking in well-ventilated kftchens. but no tllfferente in concentratUons between houses having similar ventrtatlon but situated at different attnudes. In both well-ventilated and poorly-vent+lated ktt- chens. how+ver, there were higher HDCO levels in the hlghenalt/tude village. with blood reaching 34% iibCO in some wom+n as s result Of conclntrst,ons of 30-SO ppm during the cootang period. In other words, at the Same CO Concentration, exposures at higher elevations produced higher NbCO levels, a finding consistent with known physiological mach- anisms and significant consideration in those many high.attltude areas of the developing world where solid fuels are burned for space heattng wrthout ventilation. Lung function. To test for the effea of domestic smok+. Pandey et al. (d) used a dry poRable eplro meter to measure lung function in a random sample of 150 women aged 30-44 years living in a rural area on the Outskirts of 1Cathmandu valley at an elevation a" iKa< sow w,Mr r I"" 2501154755
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- 129 - pf 1600 m, The area rs tota+ly free from industrial and atmospher3c pollutlon antl women spend con- siderable time near the hearth, which is used for both cooking and heating Smoke concentrations ere high because dwellings are ill-ventilated and without ch+mneys. The selected sample comprised 6 groups of 25 subjects in each of 3 se3f-reportetl durations of daily smoke exposure for both srnokers and non- smokers. All the spirometric tests IFVC, FEVI and FMEF 25-751 were pertormed in the standard way recommended by the American Thoracic Socltty, Variat ons in age. height, arm-span and weight be- tween [t1e three levels of exposure to domestic smoke in Doth the smokers and non-smokers were compared but no Srgn+ficent differences were found. There was a fall of mean FVC, FEVI and FMEF 25-75, however, as duration of exposure +ncreased. This decline was found to be statistically significant among the sr+tokers but not among the non- smokers, Similar results were found after adjusting for age and height. Respirarory symaroms tn Ahmedabad, western India, studies of the incidence or cough, cough with expectoration, dyspnoea and lung abnormalities round a statistically significant IP < 0.051 higher inci- dence among women cooking with smoky fuels r91i1 The rnvestigators also noted complaints by the women about the irritating effect of the smoke, D:rtrru V*lv on the eyes in a three-year prospective study of clinical morbid. rty ind air pollution in three areas ot Bombay city and in one rural area nearby Karnat et al. 1721 found that the rural sublects were smaller in s te. had lower lung function for their body stature and a n,gher rnc dencp of cough ana dysDnoei Many of the resp-ratory syT*rptorns eih,b+ted by the rural Dopu1Y,1+9'n were s milar tD those of the moderately o* severely polluted urban areas rather than the non-oolluted areas. Use of wood for kitchen fuel is one of the explanations given by the authors for this fndng, In a study conducted in tadakh, lKe,th 6311, personal commurncationl a high prevalence of chronic respir- atory symptoms was noted, particularly among women, which rrses steeply with age to affect the malOrity of Dltler people, About One-OuaRer of men and one-third of women over 50 have lung functipns s:,qqrst>>re of obstrutrve avwavs disease, and this becomes worse in .nnttr. Tobacco smoking itas so far developed only in about 20% of the men but is virtually unseen in women. It has been suggested that domestic pollution, which is significant through- out much of the year in this high-altitude area, appears to play a part in creating this pattern. Chronic obstructive lung disease in a survey carried out in a housing complex in Chand garh {Ind3al and in a nearby v llage, a study was made of the records of 2 180 women aged over 20, working with d fferent domestic fuels (73). Ssxty-six women 13'ti1 had symp- toms of chronic brOnchitrs, the highest number be ng in those who used the chulla Itraditional un- vented cookstovel for co0ktng, The cooking fuels were categorized in the following groupsI-liquefied Petroleum gas ILP(3); 8-kerosene; 1ll-toal: and IV-chuJt4 (wood and cow dungl. Five per cent of the sub)ects in group IV had ohronic bronchitis compar- ed to 1.5% and 1.3% in groups I and II, respectively. This difference was statisUcally s/gnificant IP < 0.011. Analysis of peak expiratory flow rate showed it to be low in subjects in group tV, but after adjusting for age end height, no d Nerence was found between the four groups. Hospital statistics in Ntpat showed an unusually high propoR+on 14{y.S of cor pulmonale in hospital card sc admrss ons 1141, indicating the need for field studies to determine the d str but on and magnitude of chronic bronch t s and chron c cor putmona7e, and to identify the factors respons ble f15/ Four sites wert selected for this purpose' urban Kathmandu. nearby vallages from Kathmandu Valley in the h lls reg on, a village district in the plains region iterail near India, and a d str,ct in the mounta ns. A survey of the prevalence of chronic bronchitis in the area of the hill villages was used to determine the reflulred sample size in other areas. In the plains village, a simple random sampl+ng method was used to select the sample. Two-stage random sampling was done in the urban areas and in the mountatn district. In all the study areas. houses wert rll-vent,lated and without ch3mneys. fvtast of the houses had only two or three rooms, but many had two floors. Cooking was done on traditional stoves in a corner of one of the grountlfloor rooms in the morning and evening rthe villagers take only two main meals a oay1. Most houses in the hills and mountains were customanly heated by means of an open fire in a fireplace known as an agerto dug into the floor of a ground- floor room. Members of the fam iy sit around the ageno in the morning and evening to keep them- selves warm. The ageno is also used for prepanng canle fodder in the mornmg and snacks for family members Except in urban Kathmandu, tnere was no general industrial air pollution. A Cuestronnarre, mod{fied sl,ghtly for different s+tes, recorded demographic rnformat on and exposure- related information such as smok ng hab+ts, location of kitchen, type of fuel used for cooking and heat3ng and average t me spent daily near the fireplace. along w th the information required to diagnose chronac bronchitis according to the British Medical Research Council criteria. Emphysema end Cnronic cor pulmonate were d~agnosed accord ng to the WHO Expert Committee criteria. The tndivrduals were classified as srnokers. past smokers. or non- Smokers and inio various strata according to self- reported number of hours spent da ly near tht stove wher'e- presumabiy, the highest fmoke con- centrations are found. This study (75) found a high prevalence icrude and age-adlustedl of crude chron c bronch t3s and cor purmonale f 10-30',:1. A str,k ng feature was the sim- ilar ty of rates in men and women, The difference in prevalence rate between the sexes was not stattsU csny significant in any study area (P > 0,10 - > 0.98). This conflicts with most other ;tudies, which have shown a lower prevalence rate among women. Tobacco smoking is common in both men and women in all but the urban area, where the smoking rate among women was only 14%. In all areas. however, women were light smokers fless than 10 ngarettes or equrvalent per day). Heavy smoking among men was much more prevalent and the difference was statist cally signlficant ,n all three rural areas fP < 0.05 - c 0 0013 although not in urban Kathmandu This suggests that the high pre- valence of chronic bronchitis in women is primarily occupat3onat since women engaged in cooking meals for the family are exposed for proportionately longer hours at higher concentrations of domestic smoke pollution than men. The difference in smoke w.r..w.u..er«r o»o, 2501154756
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- 130 - exposure hours was significantly higher IP < 0.0011 in women in ali the study areas. In the hill vdlagesm a stat+strcaiiy significant iP ! 0.0011 pos t3ve correlation was found between prevalence of chronrc bronchitis and exposure to domestac smoke poliutron in both smokers and non- smOkers IFrpi1. This supports earlier studies in India and Papua New Guinea (i6T91 wr3mh suggest ed the poss t)rllty of a relationship between chronic bronchatis and domestic smoke po,luttOn. The trend of increasing prevalence rates with increasing smoke exposure persisted even after elimination of the age eHect (20). A srmdar stat strcauy significant correfs tion was also found in other study sltes. In the mountain vrllage, it was not possible to compare the prevalenct between exposed and nonexposed groups, because everybody was exposed to do- mestit smoka trom space heating. Unlike in other erees, hovvever, many were exposed more than !8 hours per day. This provided an opportunity to test for an effect at longer hours of exposure. A s3gnlfi- cant correlation between bronchitis and smoke ex- posure was noted also beyond hours of exposure among the smokers of both sexes. Hence, thert seems to be a doseresponse relationship between domestic smoke pollution antl chronic bronchitis. All the cases of chronic cor pufmonale identified in this study wert complications of chronic bronchrcrs. Although most of the women Smokers were light `werna "eanh 0+qsnke3,on ature rtsZrrarorr rn/Kr,one in r~roron flbss e, Af4 3 0l t*e Resmraroh Infecr.ons Progrmrr,e a~d Ine rrogr.Tme Suaoon Se+v+ce Gen.w. tss? smokers. the stuoy recoroed similarity of prevalence ot chronic cor pufmonart in the two sexes. This suggests that domestic smoke polJut3on is an rmpor tant factor in producing cot pu+monale Childhood aCute respiratory rnlecrrons lAA!!. Se- tween A and 5 m;313on chddren c$ dre in the world each year from ARI, mostly ,n develooing countrres Most ARI studres have focused on the important issues of microbral causative agents. case management with antrbrotocs, and eNectweness of vacetnaUon. Research on risk factors has been ludged to be of lesser tmponance in spite of the dom nance of rrskfactor reduction in the h stary of API control in the developed countr,es. Domestic smoke pollutran has been assumed to be n Impor tant risk tactor for ARI in many parts of the devetop rng world$ but there have been few studies. Par- ticulary of tht relationship with pneumonia, whreh is nearly always involved in fatal cases. In a study carrled out before 1980 ,in Papua New Gu+nes. Anderson 1271 failed to f+nd an effect of environmental differences. rnclud+ng househola smoke, on acute respiratory symptoms among schoolchrldren. In a study of younger chrldren in South Afriea. Kossove e22) found that 70, o! Zulu infants wrtn respiratory symptOms lived in npuseholds with Cookfrre smoke, COmpared to 33'i of a partlally matched group wno did not have such symptoms This was significant at the P:0.005 level, altnough there was no significant d+fierence in me maternauy reported exposure times for the groups. No con- founding factors were 3nvest gated. F7G.I PREVALENCE OF CwRONtC ©RONCMITIS IN NEPALESE MILL YILLAGES ACCORDING TO SELF-REPORTED DAILY TIME SPENT NEAR COOKING lfEATING STZ7VE. AROUND 1%s' PREVALENCE DE LA E6tONCNITE CtIRONtOUE DANS LES VILLAGES NEPALAIS DE MONTAGNE EN FONCTION Ot! TEkiPS PASSf WAR JOUR A PROXIMITE DU POELE (CUtSINE+CMAUt=FAGE). VERS 1034' a-0 +.1s :}s .. w«rs r,ee wwe.. ea ens.n ra r rw r iwr r..n v+.wf -r.+ r,rerf u.~ rr~..n © hwss -srr+n ... -w~.wr..w -*~'se "+er TM r'lr8 OaoMd'{ Me sVr4rta+4 fyMMVJ.u ,e.0007, w/ V-PMS H! IN 0MVn M'r N*W7 I}A - u" 1YROM rl/M eSr lrR*M/M.e fwMi/ul rA oot, .ws I ,"-++ an ,~ .r sa. s r_~ I. " ..... pft rto+ ++r wwww wr.r N+. ..w O r»ec 2501154757
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As part ot WNO-sponsored indoor air pollution studies in Kenya and the Gambu (23,"1, ARI incr dence in Kenyan Children c 5 was monitored b+- week)y in 36 houses for 92 weeks. During this period, stationary indoor 24-hour monitoring was conducted twice in each housew for nitrogen dioxide and suspended panicutates. Although respirable par tUCUlate concentrations wett quite high /maan of 1 t mfl,mJl. no correlation was found between ARI ,ncrdence and indoor concentrations of erther poi- lutant. or with eaposures of the Ohrldren, as deter- minetl from the ConZentratrons and time spans con- structed by interviewing the mothers. tNoreover, the measured concentrations were quite homogeneously distributed among the households. Indeed. the rntra-household variation between the two measurement days was greater than the rnter- household variation, although households were randomly chosen from four groups stratified on the basis of h0use characteristics, roof type and kitchen arrangement. thought to influence ventilation, and tnus ,ndoor air Oualtty. As the authors point Out. given Ihe apparent Iack of natural variation in tx- posure among nousenolds, it would be quite difficult to esiablrsh smoxe as a risk factor with this type of study design. in the Gambia. on the other hand, where indoor woodsmOke levels were also high, but homo- geneousiy d stributed. there seemed to be significant d,fferences in exposures because some young children are carried on their mother s back during cooking Based on a multiple logist c regression. Ca'npbel) et a1 i?IJ report an adjusted odds ratio of 2 5 fa 8a So1aeS of breathing difficulty among 280 children carried by their mothers The Only other signif cant risk factor was paternal smoking. A sem-9uantrtatrve epidemiological study was ton- ducted in Nepal by Pandey et a1. (25). to assess the relation between maternally-repor2ed hours spent per day near the hearth by infants and ch ldren c 2, ano ep,sodes of Iife-threatenmg. moderate and severe ARIL in the study area. a hill region of Nepal, tradit onsl stoves burn nfl biorrmass fuels. ma n)y wood and crop res dues. are used for Cooking and heating in unventilattd houses with no chimneys. *ne area is totally free from industrial pollution. The first Substudy was conducted during a s+x- rs+ontfi per od in 1984 A statrst calfy s gn,ficant -P ~ 0 01) assocrat on was found when the exposed group was compared with the non-exposed in the two age strata i.e. c 1 year fF,g. Is1 and 1-2 years. In oraer to confirm and validate the findings, an addi- t,onal three-month substudy was conducted in the same poputat on. This Substudy employed separate groups of observers to determine AR) ep sodes and smoke exposure trmes, thereby assuring igreater degree of independence in observation of the two variables A statistically significant (P < 0.011 associ- at on was found in this second substudy as well rf+g. 2b1. There were no obvious confounding factors that might account for these findings. 5ocioeconomic condition is not an important factor as more than 98% of the population live within a subsistence , w0"0 M!)Irn Oqam7J1,0n MbOOr sn OYIriM M rHe l1yse Irea. rne Gume.a iOocu+nenr GEr+eSr+EaLS ws+O's'EP.la 3 tsssr w.n0. J i Lt+er. # M Iftu N+awncs of au sarwan an -unO'opK1/ yorlnNror{ 0 cru41ren1 shanQRM WdfGi uni. .enIrr. 1917 IGr06wre rMS+er ta+ C+Mee+ar. :+v.~ i-avt wwr_ a nMOi economy, and nearly a11 the houses are similar in eonstrucUon. This preliminary study seems to suggest that domest,c smoke p011ut3on is a risk factor of ARI. As -th all available stud+es. however, there were insufficient resources to fully monitor exposure, measure and correct for confounding vari. ab3es, and to conduct the many expensive and time- consumrnq qualrtyeontrol procedures needed tor ful)-sUJe modern environmental epidemiology rn vest+gatrons. Cosl - East Asia In China, Coa1 is and will rema n for decades the main energy source. Particulates and sulfur Oxides emitted from coal combustion are two of the ma n urban atmospheric pollutantsIn $hanghat, some 6% af total coal consumption is used for domestic cook- ing, making 4 the most rmportsnt urban cooking fuel. For example, until 1987 Tian)in was the only c ty where all the families used gas stoves and in Beijing, only 701% of the families used gas or t+que- f,ed petroleum gas, while in $han9ha about half of the population use toal-cake stoves Little indoor air quality research has been done in rural areas where most of the population uses crop residues and wood. Research On indoor pollution and its health effects was rnitiated in China towards the end of tne 1970s and over 100 papers have been pub)isneo f51 on the subiect. A series Of epitlem olOgical surveys have been carried out to evaluate the effect of indoor pollution on human health. In contrast to stud es in developed countries. the gas-user group is usually tonsidered as the unexposed control group. and the coal-user group as tne exposure group. Immunolo9iCS7 function. The influence of indoor air pollution on immunological function was rnvestegat- ed in grbups of pr,maryschool students aged 10-13 exposed (or not) to coal smoke at home and at school 1251. Compared to the control group. the amount of SIgA in sauva of the exposure group decreased by 32.5%, and the ict vrty of IysoEnzyme by 17.3'1.. There were no difterences in d-stributron of age, sex and ETS exposure between the groups tP values, ell > 0.051. Wang & Chen monitored the immunological pars- meters of primaryschoo3 pupils from families using different fuels for cooking: The resulls were stat+stic- atly significant 1< 0.051 for white blood-ceu Count (mean reduction: 13y.). saliva lysoenzyme t13..1, transfer of lymphocyte l50'>.1. !gG (29%). tgM 128%) and IqA f5dY.3. but not in the Pt1A skin test. Carboxyltaemoglobin lHbC01. The blood f'lbCO con- centration in women using coal stoves was 2.1 s 0.9%. compared to those using gas stoves at 1.+1 t 1.0% iP < 0.01). Women using coal stoves without chimnEys had a.3'!., while thOst usrng Ch3m- neys hao 3.0% {27). A study by Mu & Liu of 450 suburban schoolchildren < 13 near Beijing f28) found significantly higher HbCO levels in those living in traditional housing where pit stoves were used for heating and cooking, t:ompared to those residing in modern buildings with stoves and Chimneys. At 41% and 2.8%. how- ever, both groups vrere high. The authors compare 2509'154758
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-732- FtG. 2 ACUTE RESPIRATORY INFECTIONS iN INFANTS (0-1) IN TN£ HILL REGION OF NEPAL LISTED BY SEVERITY AND MATERNALLY REPORTED DAILY TIME NEAR STOVE' INFECTIONS RESPIRATOMES AIGUES CHEZ LES NOURRISSONS (ot AN) DANS LA REGION DE MONTAGNE Du NEPAL, CLASSEE5 SELON LA GRAW7E ET SELON LE TEMPS PASSE PRES DU POELE CMAOUE JOUR AU DIRE DE LA YERE' A S.uc on;a rno^rs ma ooto=n 798+ 2i3 Rss3 - Su h taee des ornes wri+i~ i^ 196a s r une prrst D! io moe ~3 rsxrsv~c / 200 _ r n - I!0 ~25 ~td ats aso a 2s 11 oz 7, ...~.L_~t 1.10 1311, aa a 4 4. .a0r W 9/t !1. M~ f.! - i'MIVa Mme" lt V. MM0 Y!M0 @ Saseo on tMree montns' caca cojj.neo in 19e9..atn tne ssme populacion (217 infantsl ts7t +ntn stDarait ttaP+s oiag++ostfg ARI ar4 oeceM+jnmq e=posure - Sur Ia Uase oes oonnees recvvl~ts en 1989 sur une penooe oe ttatf ino.f aa'7s li rM}+b p0ou1at1on 1247 noumssons). aes eau+aes oisrinents Can3 cna,qees ot ouqnost quef tes IRA tt Oe txtermmer rtsposmon %f9sn.0 'aat 1n, M7 NI Ow. - -4V" Y"M Y IM i iMM am IMr n n i4a an" Km11-w bI1ft tYWe 11 iYMrlr rSIM WaM oI - Ci ~1OMa Mo Ni fo ao ews qrs.w r.m Me . Cr V+"M wwe r M M ~ nrswws.a~.+ra~+ws.~~+s~Mi-wsr~wss..nqnNraw.rsrsN.r+tf1 these results with an earf3er urban ftudyl wlfsre HbCO levels of a,3x. 3,0% and 1.1% were found for residents in homes heated by stoves without fiuWs, by stoves with flues, and by circulating hot water respectively. This study also found other sffeots. There were siyn ficsnt differences in the incidence of lower respiratory diseases among girls iRR.3. p. < 0,05) but not for boys nor for upper respiratory diseases. Small or nons gn3ficant d fferences wert found for immune and eye responses and lung functron. after correctrng for height, age, werght, family income and parentsl smoking (28). - Chane >< M, /An a00.m oroqKl/ siutlY pn neeo. M io+wna+). f.eond Nstiona Conrer.nee .n fnv,roa»nenw Nsem. OnaD.+ 1064. Ne++pn9 t1n Lhintia. Although sma3Jscale combustion of all coal and biomass fuel is often associated with high CO emrssions, poor combustion of a1l unprocessed b9o- mass and highvolatile coals also emits large amounts of hydrocarbon serosot and gas. e.y. eldehydes. A1thDugh these may have long-term health effeets because of the intense irritation they Cause, they act in the short term to warn when CO concentrations approach acutely toxic levels. In other words, it is extremely rare for someone to die from acuts CO poisoning from such tuels. Even though measured CO concentrations can somebmeJ approach dangerous ievels. the irrttst,on due to hydrocarbons will awaten householdeR and prompt them to escape or open a window (4). +ra.r v.+r. w«. aw .w.. af r*ww 250'i'I 54759
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- 133 - Unfortunately. this is not the case with the three principal !ow-v0latile solid fuels' charcoal, naturally low-volauie coal such as anthracite, and processed idevolat33i=edl coal. These may release no more CCt than the high-volat le soLd fuels. but they do so with little of the irritating hydrocarbons that provide warning. As a rasutt apparenNy, hundreds if not thousands of people die every year in northern China, Korea. the Islamic Republic of Iran and other developing countries where overnight space hest+ng is provided by such fuels irnafn3y coall, along with excessive leakage of combustron gases into living areas. compounded by poor household ventilation. A study in Korea, for example, has shown a strong seasonai var at,on in hospital admissions for CO poisoning, peaking during the cold season where heating s used (29). Mortality +s not the only effect- hrgh, but subietha3, exposures can cause serious poisoning. Lung function. Li b}iongr monitored the lung func- t,ons /FVC. FEVI, FEV1.1 of 213 women aged 5070 years, including 167 women us ng coal and 46 using gas for cooking. Even after adlustment for potential confounding factors, i.e. age, body wefght, he ght and ETS, there was e statistically significant dff'fer- ence between the coal group antl the gas group in all lung functions tested. In another study, the FEV1IFVC of Dersons using coal Stoves was lower than those using gas stoves, while tne reverse relat onship was found for tvfEF25. MEF50 aRo MEF75 Thfs was possibly due to higher NOx concentrat ons in homes using gas. In Xuanwei County, Yunnan Provtnce lsouthern Chinal. the airway resistance of farmers snd school- children in homes where poor9ratle bituminous toal waS used for cooking was higher than in homes where wood and straw were used for cook ny IP < 0.001) G?01. Respiratory syrnptams and non-csncer resprryrory d,seases There seems to be an increase in resp ra tory symptoms and prevalence of respiratory dfs- eases in coalusrng families, A studY was conducted in two areas of Shanghai with populsUons of about 77 000 and 17 000 respectively. Two samples were selected, using cluster sampimg 1 316 usfng coal- cake stoves and 721 using gas stoves. The respira tory symptoms and prevalence Of resprratory d,s eases were found to be 79% and !4'/t, respectively, for people using coal stoves and gas stoves 1P < 0.05). The prevalence Of respiratory d seases among housewives aged s065 are 50% and 40%:, re- spectrvely, for coaius ng homes and gss-us3ng homes, where P < 0,05, and relative risk for coaj- uvng housewives is 1.9 (28). The prevalence of common cold smong persons using stoves with or without chimneys were 22% and 52% respectively; RR-2.0 (without chrmney), attributable risk - 25'. f311. The prevalence of chronic bronchitis, em- physems~ tough, productive sough and breathless- ness in women using coal stoves were significantly higher than among those using gas stoves There were no significant d0ferences in the prevalence of coronary heart disease, hypertension and a tight feeling in the chest between the coal- ano gasusrng groups. Another studv ,' carried out in Shanghai on 12 037 people, using the American Thoracic Society DLD7E questionnaire, found that in areas where atmos- phenc pollution was l,ght. the prevsknce of COLD was 9 6% in the gas-user group and 15 6': in tne coal-user group In heaviiy-polluted areas. these prev- afences were 12.8% and 17.3%, respecttvely. Multf- variate analysK indicated that indoor air pollutfon had a stronger impact than outdoor air pollution. Another survey of respiratory symptoms and dfs esstt was earr ed out among retired women and nonemploYed women aged A5 years and over 1321. Of the 393 women who responded to the auesnon- naire, 186 used gas for cooking and 207 coal Indoor pollutant toncentrations typically found in each type of home were determined, based on small represen tstive samples. The results are listed in Table 7. L,. L & Monq C. J 1Xrtehtn a.r poiruhon ana }rs Marrn tMtRSI SnangM. rNee'cai un,wrs,h. fsH iGr.owu tntsusi Ifn Cn,nsal LIn. N S t+ st frtaUr,on a/ nr po+uvran ano >+wnsn nfmn rn a +,qntr dtns,rv res,atnr,*l 0104 af SnanqnA,l SrIT+oo..0+n on {n-onTtntai Mtann, Tuyu.n. 1913 itn Cn,ntaa I .bnq C j a+ aI t5rya,es on .,r you,n,en and n: ,rr,aaa an ntann rn SMnpM,1. SMnsnar Meau1 unrrnsnr. tsss an Cnwaer. In order to determine whether factors other than indoor pollution isuch as age, living stanoard. tou- cation. ETS, kitchen Style and living space per per soni were important influences. a multifactor logistic regression analysis was conducted. The result showed that domestic smoke was an rmportant con- trnbuttng factor to chronrc bronchitis, emphysema. TAiIE 1. PltEVAIENCE OF RESM/1AT07lY SYM/TDMS AND DrfEAU; IN WDMEN UsrN6 ClFF£iIEWT FUEtA FOfI C001CIN4. tlaE TAtit.EAU 1, f 11tVA1ENCE DES SYMITOMES ET MALADIES RESMRATO/REf CNF2 LEf fEMMES tJnilsANT DIFFEi4ENTS TYPES DE tOMiUSTiiLES POUR LA CUISINg. tlES p.w.ww~w~wM G.awar.usitalur., Cwwenrr~to7cewf, y.yty" now*,M ~j.w~y~d,vnlM~alI1MtJ41 C-YytN+.NMMCN/fM1107W. f1IM-MI 0 M.,~.tr~M,ntrt % IN/VM-NM~ ti~ -4M.M ti +4ttrsa - Asttvey ......... . . . . i civOr.c txtx+CV:u - ertorrlria e*aoniptie 22 g onc*ooaatatan . . . . . . . . . . . . . 3 En+onrssrna - EmOr YsMte i Camary n.an bsaaa. - Careeoatme manaeynne . . . . . . . . . . . . . . . . 27 wyflat-nuon ................ 40 Ca+9n - Toua ......... .. .. _ 33 >xso.etorauon ...... . .... .. 2. Ct,est tqntneu - GinM resaraton .-.. 55 r+rV1tnw ot t,raatn - Essoutn.ner,l ... t! 3.3 ts 72 22 >D 05 ttti 31 ?s6 75 <DD1 144 13 623 a; <D DS 215 21 10.1 7.3 <00+ t..S 25 121 0.611 :oo 03 72.3 i6 31.3 0 03 >0D5 117 23 ipt 191 <001 112,111 53 254 75 c001 296 n 372 2.1. >005 9.611 53 25,111 13+ cOpOt t++. ~1.r..a +aN - A.rs iin. rML.o aws, wrM, e rtMN 2501154760
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F bronchod3lataUon, cough. expectoraUon and short- ness of breath. TResa conditions were 1.l1-4.5 times more common among the group exposed to coat smoke. No s,gn+f+cant difference was found for coronary heart d+sease. In Hong Kong, Koo et al. (33) found small 110-20X1 but stat+st+cally s+pn+ficant differences in nttrogen dioxide exposure levtls as well as reported resp+re- tory symptoms (allergic rh+nitis and bronchu+sl among non-smoking mothers in homes using piped gas ilower exposurN for cooking, =ompared to those using kerosene or bottied gas. A similar eNect was found for ancenseburninQ and kitchan ventilation. but not for rrmosau,to coifs or ETS No effect was . TAtLE 2. LUNO.CANCfR OODS RATlO 1014 Di fMOKiNG AND COOAING - CASELO>lTftOl ANALystS. 442 rArlkti. 1113111 TAtt.f..s.V 2, ODOf RAT1O 30R1 DE CANCER DV POUMON PAR EzPOSr110N AU TAIAC ET AUx Wra£fs of CUISINE - ANALYSE CALTEMOINS, ee2 PAiRES, ties r CA r : oill 11) s-NS-ENE ,..... t.0 t o t2/ NSNE .. ...... 031 rOC6 031 >005 Ctl SN ....... a+ <0 01 06 xo O6 Nl NS.E .......... t.a aOCS 3 a <005 (3) s-E . 42 c001 58 <o.0f , s found in children. 4s Canrer. fthough the lungcanar rfsb Df Dcw ss.+e. a......rr - s..... un .pat+onal exposures as wllt as act+ve srnoktng, ind to lesser extent ETS, have bNn extent+vtly document-_- ].' the rslatlon_betwesn lung tancer and ambient 'irlpollut+on remains uncertain. Indoor pollution, however, is now starting to be linked to lung cancer, especially among 'vi_cmen co_oking over coai-fired stoves, although their level of cigarette smok+ng~and occupatUona3 exposure is much lower than men's. showed that a hi h coal{onsum tnon index iHCCt .10.61, indoflr smo ollution in w+nt r : 75. 1 and low ceihnq height of the living room S.12.51 were the mam nsk actors for female luno adenocarcmoma. !t was further conf+rmed by +ndoor air monitoring that the average s+r con- centrat,ons of total suspended particulates ITSPI and benzotalpyrene in bedrooms in winter were 4.4 and 27 times higher then the respective maximum allow- able air concentrations in China. No s+ ndioant tAr- relation was found bttwesn fems_{ u q 6n carcinoma, and ciaarene smoking and TS. In another Xuanwe+ study, the standartl+zed lung- cancer mortality in 19731975 was 26 taer 100 000, hiflher than the average urban lung-cancer mortality in China. In Xuanwe+, lung-cancer prevalence was different in various regions, the highest being over 1 S0 per 100 000, wh le the lowest was under I p!r 100 D00, a difference of about a factor of 200. Although rare today, in the recent past hiflh-ter Qituminous Coal burned in open pits was the main domestic fuel used in hagh lung canclr qrevafence r o ns while ant r.cite coa! sn woo were us in iow- reval~ance r!.9 _i0,,.n~~s. The prevalence 0 unfl cancer 1mers was n+grler than among people in other occupations and there was lutle difference between sexes. This evidence suggests the presance of a stran carcino-enicfactos unt~To-Tun-canEFr +n nonempioye women I esearc Involving indoor air monitoring, ep+dem oloqica3 studies and animal exposure tests in siru have been conducted by the Chinese Academy of Preventive Medical Sciences and local public health and ant -ep+dem+c stations with assistance from the United States En- vironmental Protection Agency (39, 40). In Hon Kon , however, no si nificant association w s f und bltwsen iun tancer an eoakln us s (tf/ or a2/ The indoarpol utant concentrations were mucF~fess than those found in the above- mentioned lung-cancer studies in China. Although there have been reports linking domestic smoke with Ihe high rates of nasopharyngea! Cancer among southern Chinese populations 143, 441 and in other proups, e.g Kenya W, 46). most reviews have con- cluded that the risk must be small or non-existent compared to risk factors Such as diet (a 7). Ftuoross Increased ffuoroses induced by high eon- centrat+ons of fluoride in indoor air and food ong- inating from coal Combustlon has been rtporled recently (ad-517. In the suburbs of Xiangtan lHunan Provinoef the fluoride concentration in drinking- , water was less than I mg/htre. but in coal it was Xu et aL (3t/ analysed female lung-cancer preva- lenpe in 1~Chinasa metr ol+tin artai. eaeh with s papulat on over 500 000 and located at various lati- udes. The found that the correlation coe +c+ens E n ma e 1 n{anter rtvilence an latttude yyere statkSUCaIJV s30n+flcant. he h+4her the latitude, the higher the lung cancer prevelence. _Ying tt al:' compared teveril factors with t_h_e_h+Oh and low lun -Cancer revaltnC! re ions m uhan istanoard zed rases 26 vs. t p!r tOD 0003 to +nd that there were s~ ni icant d+ .erences in stove es and dens+ty, sul ur d ox+dt and nitrogen oxides, but ntt for esrpon monas>".-- 171 uamg2hou, titsre were 349 housewives amono 1 2femaie lun -cancer deaths l351. These women 128G) had no prev+ous occupat ona exposure, a, o t em wtrt non-smo ers, and none seemed to be tx osed to sigm ~cant outdoor air pollution. he _ep+dem+o oq+ta survey s owa t at ema,alun9 n r c rrenc was rt ated to ex osure to coal mb sUon and cookin 1351. The investigators monitored ketchens or sUSpended particulates, de- posited dust, and beniolalpyrane in deposited dust. They found las expected) that concentrations were much higher in k,tchens using coal compared to those using liquefied petroleum pat for oooking. Based on a case-contral analysis of 662 deaths (446 males and 216 females), the lung-cancer odds ratio 10R3 of smoking and cooking was analysed and is presented in Tab7e 2 f357. Exposure to cookin4_ was ,Spy,nd to b! an imooRant Contr+butln sct f to fem~~ lu_n~~n r u_i no_ito male iuno canq~r ombination of smokin9 and cooking exposure has a lsynergistic effect on the r+alencq of lung cancer in ~ both males and fsrnal Another matched casesontrol study and measure- rri ; of'indoori+r po7 utlon was urrie_ out in a northern Chinese Ci {Harbin) to anal et risk factors 4si fsmala auny adenoearcinoma f 1. he resutts rine. X n a/. IrM r.Yr1on ar ,ndoow br 9o+rwwn ind flwnan Msat+ a a+a++rY MaArt waifnpt> 9n Clt'niyl *nr,rennHmal r.,un. lss3 i/n cnny.e,. ..._.s..w.f ..- .unW a l+Zr1e+ 250ll54769
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r 190 330 mgrkq. Fluoride concentrauon originating from coal combustion was 0018-0.066 mgimJ in indoor air and 1.9-3.3 mg;kg in vegetables. The prevalence of dental fluoros+s thert was as high as 35% in residents of all ages. In a neighbouring area, the prevalence of dental fluorpsrs in a control group cook,ng with wood was only 4,9X. 1181. In the suburb of Luoyang (Nenan Province) the fluoride concentration of coal was 370-610 mgfkg, and the indoOr-air fluoride concentration was meas- ured at 0.016 mg/m3. The vegetable and grain fluoride concentration was 0.95-3.4mgikq. This sn- creased to 2.7-14mg.+kg after a half-year storage period indoors. There were 1 4$6 persons suffering from fluorosis among 2246 persons aged over 6. The prevalence rate was 66% f491. increased preva- lence of fluorosis due to coal combustion in residents has also been found in Xunwen (Sichuan Province), Ankang (5hanxi Province), Benxi (Liaoning Province) and Huangganq tHuba Prov,nce). Stroke A group of 957 men were followed for 12 years in a study of risk factors for heart disease and stroke carried out in Shanghai i521, During the study penod. 24 subjects died. In addition to high blood pressure. age and smoking, the study found ex- pasure to h0usehold coal smoke to be a significant r sk factor. A dose-response relationship was found with the relative risk of heavy exposure iorrly coal usel of nearly 11, after correction for the other major risk factors The sl ghbexposure groups lus ng both gas and coau had a relative risk of nearly 4. Conclusion Ava;lable ev dence in the devt3op+ng world would seem to argue strongly that indoor air pollution from cook-fire smoke is a risk factor for chronac lung zb3e)Se in adults, particularly women, and acute reSDrstorlr disease in young children. In addition, coal smote may be an imporiani risk factor for lung cancer in women. The total number of people ex- -135- posed to high concentra"Ons of smoke is likely to be several hundred million. However, too few resources have been allocated to such studies for it to be poss ble to quantify these eNects. Such efforts are needed, however. in order to determine the effectiveness Of smoke-exposure reduction measures in compar son with other ap- proaches for preventIng or mitigating these dis- tases. in particular, there is a need to link detailed sp - dem+ological study designs using internat3onally sc- cepted diagnostic procedures with detailed and sys- tematic exposure determinations. This is not sasy to do with cancer and chronic obstructive lung disease, since exposure histories going back severai decades must be established. One of the highest priorities for indoor air pollution epidemiology is to initiate a study of the risk factors for AR1, because of its importance as a cause of early chddhood morbidity and mortality in many developing countries, and in view of the high indoor exposures that stem to prevail in many areas. A longitudinal {ntervent10n study lasting at least two years and including all seasons before and after intervenhOn would most likely lead to resutts that are scientifically sound and useful for designing large-scate inten+ent,on programmes (53). A growing trend among those concerned with en- vironmental epidemiology is the reabLation that, in order to understand the impact of pollution on health, it is necessary to monitor dwelling places rather than tust the ambient environment. Total ex- pt?syra' assessment IS the term for tuch efforts. which are beginning to reveal important sources and Cantrol measures different from those on which past efforts have focused fill. Indeed, from a global stand- point, the present baiance of research, monitoring and control efforts in air pollution should perhaps be sh hed towards households using unprocessed solid fuels, which is where the largest number of suscept- ible persons can be found. SUMMARY Of tht four principal categories of indoor pollution lcombusuon produtis, chemicals, radon and bio- logacals), tKtarch tti developing countries has focused on combustion-generated pollutants, and principaliv those from sol3d-fuel-1ired cooking and heating stoves Such stoves are used in more than half the world's households and have been shown in many locations to produce high indoor eon- centrat,ons of particuiates, carbon monoxide and athe+ combustion-related pollutants. Although the proportion of all such household stoves that are used in poorly ventilated situations is uncertain, the tota1 population exposed to excessive concentrations is potentiatiy high, probably several hundred million. A number of studies were carried out in the 1980s to discover the health effects of such stove exposures. The ma)ority of such studies were done in South Asia in homes burning bromass fuels or in China with coal-burning homes, although a sprinkling of studies examining biomass-burning have been done in Oceania, Latin America and Africa. wr~w.e.wn_nnea Of the health effecis that might be expected from such exposures, little, if any, work seems to have been done on low birthweight ano eye problems. although there are anecdotal accounts making the connection. Decreased lung function has been noted in Nepali women reporting more time spent near the stOve as it has for Chinese women using toal stoves as compared to those using gas stoves. Respiratory distress symptoms have been associated with use of smoky fuels in West india, Ladakh and in several Chinese studies among different age groups, some with large population samples. Acute respiratory rnfeCtion in children, one of the chief Causes of infant and childhood morta3ity, has been associated with Nepali househo3d-smoks exposures. Studies of chronic disease endpoints are difficult because of the need to construct exposure histories over iong periods NtverMlless, chronic obstructive lung disease has been associated with the daily time spent near the stove for Nepali women and found to be slevated among coel-stove users compared to 1 1 2501154762
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136 - gasstove users in Shanghai. In tontrist to early reports, there seems to be ltttle or no risk of rtaso- pharyngeal cancer from cookttove smoke. Several studies in thina, however, have found smoke to be a strong r sk factor for lung cancer among non smoking women. In addition. severe fluoros s hss been observetl in several parts of China where cOSl fluoride levels are high. The high indoor concentrations and the potentially large 1also poor and thus vulnerablet populations at risk, argue for more resources to be devoted to ep dem3ological stud,es of large numbers of expostd populations, using appropriate ouafltytontrol meas- ures in order to generate reliable qusntrtative dose- response informsoon. In the meantime, however, enough is known to warrant household. Communtty and government efforts to reduce exposures through education and introduction of improved stoves. cleaner fuels and enhanced ventilation. RFStlME= Pollution de 1'air it I'interieur des habitations dans !es pays en diveloppement Des quatre princjoaux tYpes do potiution 1 I'interieur des habitat,ons Iproduits de combustion, substances chimiques, radon at substances biotog,quesl, Ia re- cherche dans las pays en developpement a privilegii les produwts de combust,on tt notamment ies pol- luants resuitant de I'utiIisat on de combust bles soli- des pour Is cuisson *1 le chauffage. Les postes incnmines sont en service dans plus de 1a moitlt des habitations du monde ei il a ete prouve tn de nombreux endrorts qu'ils etaient a Ibrigme de concentrations elevees de matieres particulaires, d'oxyde de carbone et d'autres polluants lies s la combustion, 8ien que I'on ne conna:sse pas evec precision Ia proportion de po+<les ainsi utilises dans des focaux ma aares. le nombre total de personnes exD.Ostes a des CarrZentratioes e=Ltssives de poit- tuanu est eleve, prcaaab~ent ptsrsieurs cent,sints dt millions. Dans Ie courant des annees 80. plusieurs etudes ont ete consacrees sux e+fets sur !a sante de !'exposaion i ces prodults do combust on. La plupart ant ete condunes en Asie merid onale dans des habitations ou sont utdises des oombustibies tires de la bio masse ou en thine Is ou I'on utifise du charbon, bien que ctrtarnes etudes sur I'utilisat on de Is bio- masse a ent ett fattes rn Gcsante, tn Amenrtue lstine tt sn Afrique. Parm Ies effets de ce type do pollution qui peuvent etre redoutes, ii semble que !'on n'a t prat quement pas ou pas du tout ttudie I'insuffisance ponderale a la na,ssanoe et Ies problemss ophtalmolog3ques, blen que Clrtains comptes rendus anecdotiques !as stni Is tesat+on e*+tre cts problemes et ct type do pollut+an. Une diminution do Is foncu0n putmonaire a ete rNevss chet des femmes nepalaises ayant signsle passer beausoup do temps aupres du po#1s ainsi que che2 des femmes ohinoises qui utitisent des ouismieres a charbon par rapport i celles qui ut lisent des cutsinieres a gaz Des symptdmes do detrtsse respiratoire ant ete associes s I'utilisation de combustibles prodwssnt de Is fumet dans I'puest do I9nde, au Ladakh et a I'issue de ptusieurs studes dhinoises ponant sur difterents groupes d'ige, eer taines aupres d'tchantillons importarits de popula- tion. Des cas d' nrections resp ratoires sigues ches Its enfants, I'une des pnnCipalts causes de mortaltt6 inisnto-tuvenile, ont ete associes a 1'exposition a Is tum4t dans des hab tatlons nepataises, d'apres ie temps passe par Ies enfants supres des posles. Les ftudes sur ies maladies chroniques sont diffici- les car iI est necessaire d etablir des antecedents d'exposiiion sur do longues periodes Neanmotns, Is rnaladit pulmonalre obstructive Ohron3que a tte as- societ au temps passe Chaque lour aupres du po4le pour des femmes nepala)ses et son taux d'rnadence a ete juge eleve parma les ut l satrnces do polles a charbon compare aux um satrices de po!!es a gat s $hangnai. Contrairement a ct qw avatt ete prK!- demment ind que. ta lumet degagee par les cuisi- nierts ne presentt, sembie-t-U, qut peu do risous do cancer du rhino-phsrynx. Toutefois, plusieurs etudes rnentes tn t:hine ont mOntrtt que la fumoe ltait t/n facttur de risque important pour It cancer du pou- mon chei les iemmes non-fumeuses. En outre, des oas graves tie fluorose ont ate observes dans plu- sieurs regions do Ch,nt ou Its taux de fluorure dans Ie chsrbon sant altves. Lss concentrations slevees de pallusnts s I'int.rieur des habitations et I'importance des populations exposees tegslement pauvres, donc vulnersblesllus- tif ent que des ressources accrues saient consacrees a dts etudes epidem ologiques d'echant,flOns ampor- tants de populat on tn prenant its mesures do cbn- tr81e do ia qualite necessaires i I'obtenUon do don- nets quantitat,ves fiablss sur Its rapports dose- rtponse. Ce1s etsnt, et que f'on sait devrta,i dljt suH,re s inciter Ies menages. Ies communautes et Its gouvernements s retloubler d'efforts pour reduire I'exposit,on i ces types dt pollution, par 1'lduuuon tt Yintroductaon de posles arneliores, do combusti- btts plus propres et do me+ileurs systemes d'sers- tion. REFSRENCES- RfF~RENCFS 1. $AnatT, J- M. ta .,i. Health effects and sources of indoor air pollution. American review of respira- tory d;sease, 136. 1t86-1508119871. 2. SMrt>,. K. R. indoor air pollution and the pollution transition. In: Kasuga, M. ted,l. Indoor.rr auslity. Berlin. Springer Verlag, 1990, ISupplement to the International archives of tnvironmtniaJ hea/rnt. 3. SMmt. K. A. Total exposure assessment: impli- cations for developing countries. Environmsnt: 30 001; 16-20: 26-35 119681. a... ..w.. .,rw &.,.. .w s f..r6' 2501154763


text:
Sex-specific analysis and reporting are not just "women's health" issues. Better data on women would be better data for everyone, Clancy said. Sex-specific data could allow guidelines to be more specific and allow clinicians to better tailor care to individuals.
Speakers also presented examples of the importance of sex-specific differences. One example of critical differences between males and females is drug-induced electrocardiographic changes. Parekh explained that several drugs withdrawn from the market were associated with prolongation of the QT interval (a measure of cardiac repolarization) and torsades de pointes (a potentially fatal form of polymorphic ventricular tachycardia). Women have a longer baseline QT interval and a higher propensity for drug-induced QT prolongation, and they are two to three times more likely to develop torsades than men. The effects of drugs being studied for cardiotoxicity, Parekh said, need to be looked at and understood in both men and women.
A more recent example of the importance of sex-based data is A Diabetes Outcome Progression Trial (ADOPT), a randomized controlled trial (RCT) that compared rosiglitazone with metformin and glyburide over several years. The overall fracture rate associated with rosiglitazone use was higher than that associated with glyburide and metformin, but analysis by sex showed that women had a rate of fractures twice that of men (Kahn et al., 2008). As a result, the label for rosiglitazone includes data on the increased fracture risk for women.
A 1992 GAO review of FDA policies and pharmaceutical-industry practices found that women were not adequately included in clinical studies and that data were not analyzed for sex differences with any consistency, and that consequently there was a lack of understanding of sex differences (GAO, 1992). As a result, Parekh said, FDA issued several new guidance documents and regulations. The 1977 policy that mentioned exclusion of women of childbearing potential was reversed through the 1993 guideline Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs, which recommended collection and analysis of data on sex differences in effectiveness, adverse effects, pharmacokinetics, and pharmacodynamics.
The 1998 investigational new drug (IND) application and new drug application (NDA) regulation, also called the demographic rule, requires NDA submissions to provide safety and effectiveness data and IND submissions to tabulate numbers of participants according to age,


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Introducing myself and my journal: Women and girls empowerment
About Me:
Woman's Hope was established in March 2007 with the aim of reaching out to women with relevant social-economic information that would be relevant in uplifting the living standards of the entire society. These is to be achieved through different approaches awareness raising through publications, economic empowerment and capacity building on current issues linked to development and the countries vision 2030.
Woman's hope also publishes magazines periodically that have addressed cross-cutting issues on women in Kenya and is currently on its 23rd issue. This started from humble beginning as a newsletter and now the organization publishes of a full color, glossy magazine. This has been made possible by our partners who supported us for the re-launch to the new look magazine. In highlighting major issues that directly affect Women including: Women Financial empowerment, Women's rights, Sexual and Gender Based Violence and Women Health, Woman's Hope plans to increase the published and distribution 1,000,000 copies to all identified location of easy access by women such as boutiques, shopping malls and convenient stores in major cities, towns and schools nationally.
Woman's Hope has conducted community awareness campaigns targeting slum areas with messages on cross-cutting issues affecting women in Kenya. It has been able to reach over 70,000 slum dwellers in Nairobi and its neighboring environments.
Woman's Hope has been able to run economic empowerment activities targeting women in middle and low economic abilities mostly in slum areas through provision of micro finance facilities, book keeping skills and marketing. Currently we have 200 enrolled women with a total of Kshs. 1,000,000 in circulation in the endowment fund for the Kuwinda slums.
Tens of thousands cases of women and girls have been reported to have fallen prey to much exploitation due to inadequate post abuse facilities such as safe houses. Nairobi, one of the largest cities in Africa, is only home to one safe house with limited capacity of 20 women against 4000 reported cases of violence against women annually. Woman's hope has opened the second shelter known as Hope Center to offer protection, psychosocial support and healing space to women and girls who have undergone abuse.
In built programs to offer vocational training to survivors while at the shelter helps in discovery of diverse skills that add value to the women's life as compared to violence mated against them. In the process of reintegration, women are usually enlightened on new skills of survival and business.
The end products of woman's hope intervention to abused women and girls
are "champions of hope". These are women and girls who become ambassadors of hope and able to rally other women to stand against abuse.
My Passions:
supporting women,girls and everyone in need the best way i can
My Challenges:
doing these by yourself is hard.Need to join hands
My Vision for the Future:
Nurturing a society of a social and economically empowered woman.
My Areas of Expertise:
Microfinance,awareness creation on social issues affecting women.
Wecome to the community!
Hello and welcome to the community!
It is so amazing what Woman's Hope is doing for so many women. Is there an online version of this magazine?
If you have not already checked out our member directory, there are plenty of women here from Kenya in particular that you might be interested in connecting with, and they're listed here: http://worldpulse.com/user/directory?country=39
If you would like some additional tips on making the most of what our site has to offer I encourage you to look through our Getting Started Guide, available here: http://worldpulse.com/pulsewire/about/guide
If you have needs or opportunities for others, I highly encourage you to make a post in our Resource Exchange so that people know that you have a need or opportunities! You can click here to do that: http://worldpulse.com/pulsewire/exchange/submit
You can also post upcoming Woman's Hope events here: https://worldpulse.com/pulsewire/events/submit
Thanks again for joining with us, and I wish you the best of luck with your organization.
Warm wishes,
World Pulse Online Community Management Volunteer


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Buyers Driving Housing Recovery, Not Investors
NEW YORK ( TheStreet) -- Investors may have kick-started the housing recovery, buyers are truly driving the market, research shows.
Recent reports point to strength in the non-distressed or conventional sales market, which is dominated by current homeowners and first-time home buyers.
According to the Campbell/Inside Mortgage Finance Survey released last week, investors accounted for just 21.8% of home sales in March. Investors accounted for only 13% of sales of non-distressed properties, the largest segment of the market. Current homeowners had a 50% market share and first-time homebuyers a 37% share of the non-distressed housing market.
Bank of America Merrill Lynch analyst Michelle Meyer noted in a report last week that while investors buy a disproportionate share of foreclosed homes -- making them relevant in markets with high levels of foreclosures -- primary homebuyers are still the largest share of the market.Significantly, she notes that while a third of the sales are "cash" purchases, not all cash-buyers are investors. "Over 20% of buyers who are looking to relocate (turnover) and 60% of second home buyers use only cash," according to Meyer." "As credit conditions gradually ease, which we anticipate, the housing market will open to a wider range of buyers, particularly first-time owners," she wrote. Former Morgan Stanley analyst Oliver Chang, who now runs his own single family rental business Sylvan Road Capital, studied the Atlanta housing market and was surprised to find that homebuyers and not investors are driving the recovery in both sales and prices. For all the stories about how investors are crowding out home buyers, "owner-occupied buyers are paying the highest prices for non-distressed properties by a wide margin, over the highest investor prices even after taking renovation costs into account," Chang's study revealed. The analysis adjusted for the mix of homes. Clearly buyers who are in it for the long haul are more willing to pay a higher price for a home than investors who are looking to profit from the housing recovery. All the studies are aimed at dispelling one concern in this housing recovery -- that big investors hungry for yield such as Blackstone (BX) and Colony Capital (CLNY) are driving up home prices, but will disappear from the market once the returns diminish. For more on this subject, see Real Estate Investor Math Changes As Rents Flatten. Given investors' relatively low share of the market, this fear may be overblown.
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All-star film version of Tom Clancy's exciting account of the contest between Soviet and American forces to get to a Soviet nuclear submarine headed for the coast of Maine.
Sean Connery plays Capt. Marko Ramius, the most brilliant commander in the Russian military. In a chance to defect, Ramius and his crew become a hunted sub by every country. Only one can help him, Jack Ryan (Alec Baldwin).
more The Hunt For Red October videos
Download the TV Guide app for iPhone, iPad and Android!


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Click Here to see recent news stories
C o n g r e s s M o n t h l y
Vol.75 No.4 July/August 2008
The Ethiopian Jews of Israel: The unfinished ExodusLetter from Wales
Report from Burma: Organizing for Disaster ReliefIn the Shadow of the Alps: The Jews of Annecy
Growing Up Jewish in Rhode Island: A Personal TaleAnd much more . . .
The American Jewish Congress sponsors Judaism: A Journal of Jewish Life and Thought as part of its basic policy to stimulate an informed awareness of Jewish affairs,encourageJewish scholarship and adequate opportunities for Jewish education, and generally foster the affirmation of Jewish religious, cultural and historic identity.
Judaism is an open, non-sectarian forum, dedicated to the creative discussion and exposition of the religious, moral and philosophical concepts of Judaism, and their relevance to modern society. Our readers are scholars, professionals and the general Jewish public.
issues No. 219/220 volume 55, Winter 2006
EDITOR'S CORNERShammai Engelmayer
The Passover Haagadah: Moses and the Human Role in RedemptionDavid Arnow
The Mysterious Disappearance of SarahDavid J. Zucker
The Assimilation of Judaism: Heschel and the 'Category Mistake'Byron L. Sherwin
Ben Zoma's Query on Genesis 1:7: Was it what drove him insane?Aron Pinker
And much more . . .


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A collection of relevant and timely media clips and resources.
Posted on June 2, 2008
If you like to take part in gator hunting then don`t forget to get your permit this week. The Florida Fish and Wildlife Conservation Commission will start selling the alligator harvest permits Tuesday morning.
Read Original at: Tampa Bays 10.com
Established in 1975, the Institute for Legislative Action (ILA) is the "lobbying" arm of the National Rifle Association of America. ILA is responsible for preserving the right of all law-abiding individuals in the legislative, political, and legal arenas, to purchase, possess and use firearms for legitimate purposes as guaranteed by the Second Amendment to the U.S. Constitution.READ MORE
© 2014 National Rifle Association of America. Institute for Legislative Action. This may be reproduced. It may not be reproduced for commercial purposes.11250 Waples Mill Rd. Fairfax, VA 22030 1800-392-8683(VOTE)


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CLAIRE MARTIN VOCALS, TBC PIANO, TBC BASS, TBC: DRUMS Linn recording artist and BBC Radio 3 presenter Claire Martin has spent the last 27 years honing the craft of jazz singing. To worldwide critical acclaim she has established herself as a tour de force on the UK jazz... find out more Tap to see more
Top UK Double Bass player leads the Late Late Show tonight with his quartet. Click The Video Below For A Taster Of The Late Late Show (actual band on the night varies!) "We haven't had anything like this in New York for over twenty years". Wynton Marsalis The Ronnie... find out more Tap to see more
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Reminder - Briefing on Prime Minister's Participation in Canada-EU Summit and Visits to the Netherlands, Croatia and Germany
(No. A/75 - April 30, 2010) Prime Minister Stephen Harper's Director of Communications, along with senior government officials, will hold a briefing on Monday, May 3, 2010, on the Prime Minister's participation in the Canada-EU Summit in Belgium on May 5, and his visits to the Netherlands, Croatia and Germany from May 6 to 8.
Officials will be available to respond to questions (not for cameras; attribution to senior government officials).
Media representatives not in Ottawa but interested in participating in the event should contact the Foreign Affairs Media Relations Office at 613-995-1874 to register to participate by teleconference.
Event: Technical briefing (open to media only)
Date: Monday, May 3, 2010
Time: 1 p.m. ET
Location: National Press Theatre, 150 Wellington Street, Ottawa, Ontario
For more information, please contact:
Foreign Affairs Media Relations Office
Foreign Affairs and International Trade Canada
- Date Modified: