Project 7

Background:

Many studies have shown that small particles (PM2,5) represent a risk factor for both chronic lung and cardiovascular diseases. These studies have contributed to issuing the EPA Guide of PM in the USA (recommended outdoor values 1 year ave. <0.012 mg/m3, 24 h ave. < 0.035 mg/m3). Other studies clearly show the positive relationship between elevated levels of PM pollution and air pollution caused by smoking (SHS, third HS). Thus, PM2,5-even if considered a non-specific marker, is widely used in demonstrating air pollution due to smoking and has had an impact on the legislation regarding smoking in many countries. The Romanian law in this field is still permissive, permitting smoking in public places. However, effectively enforcing the Romanian law remains a challenge, therefore populations are still exposed to SHS. In this study we have targeted a population that is vulnerable to SHS exposure: the young people attending universities.

A WHO project initiated in 2004, tries to identify and reduce the number of smoking third year university students attending medical training in Medicine, Dentistry, Pharmaceutical sciences as these participants can become role models that patients can look up to. In our study, we proposed to make a general view regarding smoking and exposure to smoke within our medical University, in contrast with the existing legislation regarding smoking within public institutions of the Universities. Along with the investigations held at our university we extended these to other tree, non medical universities.

 

Research Question:

  1. Effectiveness of nonsmoking policies in universities in Romania for protection of student: Does the medical University respect the tobacco related policy better than non-medical?
  2. Does the proposed intervention reduce the PM 2.5 measurement at TgM Medical University in comparison to Sapientia and Petru Maior University?

 

Goals:

1. Evaluate air quality (PM2.5) in universities to determine SHS exposure of students and staff.

  • Target: spaces where students and staff study, work and breathe
  • Ecological framework: location, season, time of day, holiday/didactic

2. Decrease SHS exposure of students and staff.

  • Target: students and staff
  • Ecological framework: students & staff, collaborators, administration, media and scientific community

 

Project leader:

Zsuzsánna Ágnes Szász M.D., PhD., Lecturer at University of Medicine and Pharmacy Târgu Mureș and Mureș County Hospital - Occupational Medicine Department

 

Team members:

Annamária Demeter-Iclănzan M.D., PhD. student at University of Medicine and Pharmacy Târgu Mureș

Horațiu Remus Moldovan M.D., PhD, Lecturer at University of Medicine and Pharmacy Târgu Mureș and Mureș County Hospital – Occupational Medicine Department

Levente Bíró M.D., Mureș County Hospital – Pneumology Department

Vladimir Bacârea M.D., PhD, Associate Profesor at University of Medicine and Pharmacy Târgu Mureș - Epidemiology Department

 

Team Mentors:

Cindy Hauser PhD. Associate Professor at Davidson College – Chemistry Department, North Carolina USA

Todd Rogers PhD. Research Program Director at Public Health Institute – Oklahoma, California USA

 

Media Communications:

April 2014

http://www.erdely.tv/hirek/nema-gyilkos-dohanyzas - air quality monitoring presentation in a short film

http://www.tvmures.ro/stiri-locale/eveniment/detalii-eveniment/article/n...

http://www.radiomures.ro/stiri/colegiul_medicilor_invita_institu_iile_pu...

http://www.zi-de-zi.ro/fumatul-tot-mai-descurajat/

http://www.realitatea.net/un-medic-face-dezvaluiri-socante-despre-tabagi...

http://www.agerpres.ro/sanatate/2014/04/01/prof-dr-gabriela-jimborean-si...

http://www.sanatateabuzoiana.ro/ofensiva-anti-fumat-in-institutiile-publ...

http://sanatate.bzi.ro/medic-tabagismul-este-o-boala-41939

http://www.med-farm.ro/colegiul-medicilor-mures-in-lupta-impotriva-fumat...

 

Oral presentation at Conferences

1. Sesiunea Științifică a Cadrelor Didactice Decembrie 2012

Algorithm occurrence of respiratory diseases in exposure to NOx and NH3 vapors and particulates

Zsuzsanna Szász1,2, Z.Ábrám2, H.Moldovan1,2, Annamária Demeter1, V. Nădăşan2, I. Bálint2, L. Ferencz2

1 Spital Clinic Judeţean Mureş - Compartiment Clinic Medicina Muncii

2 UMF Tg.-Mureş, Disciplina de Igienă şi Medicina Muncii

Introduction. The iritative effect of ammonia and nitrogen oxizes that manifest itself through acute and chronic pulmonar diseases is influented by the regenerative capacity of the airway mucosa and other factors: the habit of smoking, length of exposure, exposure dose, constitutional factors. Material and Methods. The prospective cohort study was performed in the april 2010 - december 2011 timeframe on two samples: 196 workers from a chemical plant considered less exposed and 150 workers more exposed to to gases, vapors and irritating dust. The grouping criteria was based on measurements from the working enviroments. The health state of the workers was evaluated through medical history, occupational medical history, clinical examination (thereby, workers with acute pulmonary affections were excluded from the study), spirometry, the measurements being repeted after 12 months. The investigations were performed after 12 hours of rest period. Results. The mean concentration of ammonia in the section with the highest exposure was 7,175 mg/m3 versus 1,582 mg/m3 mean concentration in the other sections. Also, in the sections belonging to the first group the ammonia concentrations and particulate matter levels exceeded sygnificantly more often the MAC, respectivelly the 10 mg/m3 levels. Following the evolution of functional pulmonary tests in the two groups, reevaluating after 1 year, we found significant statistical differences in the case of VEMS and IPB measurements. We studied the association between exposure and parameters that decreased bellow 80%, between exposure length in years, smoking habit, respectivelly different constitutional factors. Conclusions. The worsening in just one year of the functional pulmonary tests in the case of the more exposed workers is surprising, eventough the existence of patological values was constated.

 

2. Sesiunea Științifică ai Studenților Maghiari Martie 2013:

Dózisfüggő porexpozíció légzőrendszeri hatásai

Szerzők: Biro L. Témavezető: Dr.Szász Zsuzsanna, egyetemi tanársegéd, Munkaorvostan Tanszék

Bevezetés: A környezeti légszennyezés napjaink aktuális problémája, mivel ezek belégzése közvetlen módon hatással vannak az emberei szervezet légzőrendszerére. Célkitűzés:   a levegőben levő por  és a legzésfunkciók paraméterek közötti összefuggések megállapítása. Anyag és módszer: A munkánk során felmérést végeztunk a marosvásárhelyi műtrágyagyártással foglalkozó vegyi üzem dolgozói  és munkakörülmenyei között. Ezen munkások egészségügyi állapota anamnézissel és légzésfunkciós vizsgálat által lett felmérve, illetve por meghatározás történt az üzem adott részein. A magas porkoncentriációban dolgozó 98 páciensnek 1 évre követően a spirometria megismétlődött. Eredmények: A szűrővizsgálaton részt vett munkások FVC és FEV1% értékei szignifikáns eltérést mutatnak, azon dolgozók között akik magas porkoncentrációnak lettek kitéve, illetve azon kontrol csoport kozott akik nem. A megkérdezettek 53%-a dohányzik, de nem találtunk szignifikans összefüggést a dohányzás es a csökkent FEV1% között. A magas porkoncentrációnak kitett  paciensek megismételt spirometriai vizsgálata szignifikáns PEF csökkenést mutatott. Jelentős eltérés mutatható ki az adott korcsoportokra nézve, 50 év felett szignifikáns a legzésfunkciós paraméterek csökkenése. Következtetés: A magas porkoncentrációban dolgozók körülményeik kedvezőtlen módon hatnak a légzőrendszerre.  A dohányzás bár nem hozható kizárolagos összefüggésbe, de kofaktorként hozzájárul az utólagos paraméterek csökkenéséhez.    

 

3. Sesiunea Științifică a Cadrelor Didactice Decembrie 2013

Air Quality Monitoring Among Universities in Tg-Mures

Szasz Zsuzsanna Agnes, Demeter Annamaria, Abram Z., Moldovan H., Biro L., Balint I., Kikeli P.

1 Department of Occupational Medicine, UMF Tirgu Mures

2 Department of Hygiene, UMF Tirgu Mure?

3 Department of Internal Medicine III and Family Medicine, UMF Tirgu Mures

Introduction: According to the WHO, approximately 6 million people die due to smoke; 5.5 million people from them are smokers and the rest of 500,000 die doe to passive smoking. The WHO initiated in 2004 a study project which until 2010 was extended over 50 countries. This project tries to identify and reduce the number of smoking third year university students attending medical training in Medicine, Stomatology, Pharmaceutical sciences as these participants can become role models that patients can look up to.  Objective: we proposed to make a general view regarding smoking and exposure to smoke within our University, in contrast with the existing legislation regarding smoking within public institutions of the Universities. Along with the investigations held at our university we extended these to other universities to find out how the non-smoking legislation is respected in public establishments of universities in our hometown.  Materials and methods: using an Aerosol Monitor unit to measure the total PM 2.5 (fraction that increases when the air is contaminated with cigarette smoke determined in mg/cubic meter) we determined the air quality in several target locations of our University in holiday season (through 3521 measurements collected) and during full didactical periods (through 1900 definitions). We included three other universities in this monitoring process. The average values were later compared and assessed in a series of statistical tests. Results: analyzing the holiday period our university head the most polluted air showing the P.M. 2.5 of 0.016 mg/m3 followed closely by the Petru Maior University with slightly smaller values and in third place came the Sapientia University with 0.014 mg/m3 and the smallest figures were registered at the Ecologic University Dimitrie Cantemir. In the fallowing there were analyzed the recordings from the didactic period where the registered values were significantly higher (p<0.0001) in comparison with the readings from the holiday season. From several points within the universities there were reading 7 times higher than in the holiday season (0.056 mg/m3 in comparison with 0.008 mg/m3). Conclusions: the results show two evident conclusion, that there is smoking within the buildings of the universities and within our university the non-smoking students are totally exposed to exhaled cigarette smoke. Our medical university is the third in our country in size and student count. These future graduates will become role models as doctors, dentists, pharmacists, in the country and abroad for thousands of patients. We can conclude that giving up on smoking and respecting the existing legislation are solemn duties of a conscious university student.

 

4. Sesiunea Științifică ai Studenților Maghiari Martie 2014

Elemi részecske (PM2,5) koncentráció vizsgálata különböző munkakörnyezetekben (Particulate Matter (PM2,5) Concentration in Different Workplaces)

Témavezető: Dr. Szász Zsuzsanna Ágnes, egyetemi tanársegéd, MOGYE. Szerző: Máthé Henriette, MOGYE, ÁOK, V. Év

Bevezetés: A 2,5 mikronnál kissebb elemi részecskék főleg égésifolyamatok során keletkeznek. Ilyen elemi részecskéke ttartalmaz a dohányfüstés a kipufogógáz. Ezen tényező hosszútávú expoziciója bizonyítottan növeli a légzőrendszeri és kardiovaszkuláris betegségek miatti elhalálozás veszélyét. Célkitűzés: Elemi részecske (PM2,5) koncentrációjának meghatározása, majd összehasonlítása szórakozóhelyen-mint munkahelyi expozíció az ott dolgozó szemályzet számára és autószerelőműhelyben, szemelött tartva a dohányzás tényezőjét és az expozició időtartamát. Módszer: A PM 2,5szint a TSI SidePak AM510 Personal Aerosol Monitorral volt mérve. Naponta, a munkaprogram alatt 3 mérés volt végezve, melyek időtartama 1 óra volt, mérési intervallum 30 másodperc. Az autószerelő műhelyben a dohányzás csak időnként történt, és egyidőben 1-2 cigaretta égett, többnyire autók üresjáratban voltak a szennyező források. A szórakozóhelyen folytonos volt a csoportos dohányzás. Eredmény: Az autószerelőműhelyben pénteki napon mért PM 2,5 átlagértéke 166 µg/m³, a három mérés átlagértékei 198µg/m³, 183 µg/m³ illetve 118µg/m³, keddi napon 233 µg/m³ (265 µg/m³, 228 µg/m³, 206 µg/m³), a szórakozóhelyenpedig 1140 µg/m³( 1423µg/m³, 1152 µg/m³, 845 µg/m³). A műhelyben végeztt referenciamérés tmunkaprogramon kívül 24 µg/m³ volt. Következtetés: Annak ellenére, hogy a műhelyben két szennyező tényező is jelen volt, a mérések alapján a PM 2,5 értéke a szórakozóhelyen hatszor, illettve négyszer nagyobb értéket mutatott, ami csakis a dohányfüstnek volt köszönhető. Úgy a vendégek, de főként az itt dolgozó személyzet expozíciója nagy méretű, súlyosan egészségkárosító!

 

5. European Congress of Society of Research Nicotine and Tabacco Santiago de Compostella, Spain 2014

Romanian Students Second Hand Smoke Related PM 2.5 Exposure

Szász Zs. A.a,b, Demeter A. b, Bíró L. a, Moldovan H. a,b, Hauser C.c, Ábrám Z.d, Boţianu P. b

a Department of Occupational Health Medicine, University of Medicine and Pharmacy Târgu Mureş, Romania, zsuzsannaagnes@yahoo.com

bDepartment of Occupational Health Medicine, Mureş County Hospital, Romania

c Department of Chemistry, Davidson College, NC, USA

d Department of Hygiene, University of Medicine and Pharmacy Târgu Mureş, Romania

Presentation form: Poster

Background:WHO estimates, about 6 million people die annually due to smoking, of which about 5.5 million are smokers, and the remaining 500,000 people are due to passive smoking. Cigarette combustion products are known to be small, suspended particles, those under 2.5 μm (fine particle - PM 2.5) penetrate deep in the alveoli. A significant association between these particles and premature mortality has been reported in several studies. A recent study performed in Romania identified smoking as an important issue among young adults aged over 19 years. Aims:Evaluate air quality (PM2.5) in universities to determine SHS exposure of students and staff, in contrast with the existing legislation regarding smoking within public institutions of the Universities, which allows smoking only in special places. We compare the obtained PM2.5 values at medical vs non-medical universities, when institution is on holiday vs during didactical period. Methods:using an TSI SidePak Aerosol Monitor to measure the total PM2.5 we determined the air quality in several target locations (staircases, toilets, halls, corridors) of two romanian universities: A-medical state held university, B-non medical state held university in holiday season (A-3521 mesurments, B-3426 measurments) and during full didactical periods (A-1916 measurments, B-1894 measurments). We didn’t find smoking-allowed places in either of the buildings. The average values were later compared and assessed in a series of statistical tests. Results:analyzing the holiday period we found no significant differencies between medical(0.0169mg/m3) and non-medical state institutions(0.0153mg/m3). During the didactic period, measurements at the medical university(0.0305mg/m3) and the non-medical university(0.0438mg/m3) were found to be significantly higher (p<0.0001) in comparison with the readings from the holiday season in both cases. Conclusions:results demonstrate that contrary to policy, there is evidence of smoking within the buildings of the universities and the non-smoker students are exposed to secondhand smoke. Results during the holiday period suggest that the university staff are also contributing to measured PM2.5 levels. Keywords:SMOKING, STUDENT, PM 2.5, SECOND HAND SMOKE EXPOSURE.

Research funding:Research reported in this publication was supported by the Fogarty International Center and the National Cancer Institute of the National Institutes of Health under Award Number R01 TW009280-01.

Conflicts of interest:None

 

6. World Conference on Tobacco or Health, Abu Dhabi, United Arab Emirates March 2015

PM 2.5 Determination, an Indicator on Romanian Young Adults SHS Exposure

Szasz Agnes Zsuzsanna, Biro L, Moldovan H., Bacarea V., Hauser C., Demeter A., Botianu P., Abram Z.egory:

Accepted for Poster presentation.

Background: Many studies have shown that small particles (PM2,5) represent a risk factor for both chronic lung and cardiovascular diseases. These studies have contributed to issuing the EPA Guide of PM in the USA(recommended outdoor values 1 year ave. <0.012 mg/m3, 24 h ave. < 0.035 mg/m3). Other studies clearly show the positive relationship between elevated levels of PM pollution and air pollution caused by smoking (SHS, third HS). Thus, PM2,5-even if considered a non-specific marker, is widely used in demonstrating air pollution due to smoking and has had an impact on the legislation regarding smoking in many countries. The Romanian law in this field is still permissive, permitting smoking in public places. However, effectively enforcing the Romanian law remains a challenge, therefore populations are still exposed to SHS. In this study we have targeted a population that is vulnerable to SHS exposure: the young people attending universities. Aims: Comparative assessment of air quality (PM2,5) in presumably smoke free places of some Romanian universities, which could have an impact on enforcement of the law in the future. Design/Methods: Aerosol Monitor TSI SidePak was used to determine PM2,5 in 5 locations with a large population of students on two campuses in Romania: A-state medical university, B-a private non medical university. The measurements were made in the same location in each campus, in a time span of one year, covering both holiday – only staff activity (A-3521 measurements, B-3045 measurements) and teaching period – students activity (A-1916 measurements, B-1911 measurements). Measurements were scheduled for two busy time slots, 10 AM – 12 PM respectively 2 PM – 4 PM. The study analyzes the evolution in time of the measured values. Results: Significant differencies (p<0.0001) were found during holiday period between state medical (0.0168 mg/m3) and private non-medical institutions (0.0138 mg/m3) with values at university A as high as 0.600mg/m3, which can be correlated with physical observations of individuals smoking. During the teaching period concentrations at the medical University (0.0305 mg/m3) and non-medical university (0.0398 mg/m3) were found to be significantly higher (p<0.0001) in comparison with the readings from the holiday season. Conclusion: Evidence of smoking is prevelant in both universites. The smoke free policy appears to be less respected by the staff at the medical university demonstrated by holiday measurements. This should be an important issue for policy-makers and for institutes who are in charge of current law. 

Research funding: Research reported in this publication was supported by the Fogarty International Center and the National Cancer Institute of the National Institutes of Health under Award Number R01 TW009280-01.

Conflicts of interest: None..

 

In extenso articles:

1. Smoking Generated PM 2.5 Exposure Among Transylvanian Students

Zsuzsánna Szász, Annamária Demeter, L. Bíró, H. Moldovan, Z. Ábrám, P. Boţianu, and Paula Gliga

Published in final edited form as: Rev Med Chir Soc Med Nat Iasi. 2014 Jan-Mar; 118(1): 154–159. PMCID: PMC4068801. NIHMSID: NIHMS589019

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4068801/?report=classic

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4068801/pdf/nihms589019.pdf

http://www.revmedchir.ro/uploads/1/5/7/2/15722076/07_f_18_szasz_z_mip_ao...

 

2. The implications of hazardous waste neutralization on employees health: a case study.

Demeter A, Szász Z, Moldovan H, Abrám Z, Gliga M.

Rev Med Chir Soc Med Nat Iasi. 2014 Jan-Mar;118(1): 178-181.

http://www.ncbi.nlm.nih.gov/pubmed/24741796

http://www.revmedchir.ro/uploads/1/5/7/2/15722076/v_28_c_demeter_mpl_cc.pdf

 

Published 02.09.2014.
Last update: 09.10..2014.