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December 2011

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  • Secondhand smoke linked to adults' aspirin-exacerbated respiratory diseases
    Posted: 12/29/2011
    From Medical News Today:

    A first-of-its-kind study is giving smokers one more reason to quit as a New Year's resolution. The study, which will be published in the January 2012 issue of Annals of Allergy, Asthma & Immunology has shown that adults with aspirin-exacerbated respiratory disease are three times more likely to have been exposed to second-hand smoke during their childhood compared with those without the condition.

    Approximately 10% of asthma sufferers and one third of asthmatics with chronic sinus inflammation are affected by aspirin-exacerbated respiratory disease (AERD). Most are unable to take aspirin without suffering an attack or other respiratory symptoms, even though they were able to take it previously.

    Lead author Jinny Chang, MD, ACAAI member said:

    "More than half of U.S. children are exposed to second-hand smoke, and this study adds to the evidence that it is a health threat. Second-hand smoke exposure during childhood has been linked to a variety of diseases, including heart disease and cancer, and this study shows it also is associated with aspirin-exacerbated respiratory disease."

    Researchers surveyed a total of 260 couples (520 individuals), one partner in each couple suffered from asthma and AERD whilst the other did not. They report that those suffering from AERD were over three times more likely to have been exposed to second-hand smoke as children, and five times as likely to have suffered exposure as children and adults, compared with those who did not suffer from the disease.

    They also found that those who smoked had a one-and-a-half time higher risk of AERD compared with those who never smoked.

    Co-author of the study and ACAAI member Donald Stevenson, MD, declared:

    "There is no safe level of exposure to second-hand smoke. Smokers need to realize that they are putting their children and spouses at risk of serious health problems, including asthma associated with AERD."

    To take a relief-self test to check your asthma symptoms, you can obtain a personalized plan on how to get relief and find an allergist at AllergyAndAsthmaRelief.org.
    Read More »
  • Lower asthma risk in chubby tots who slim down: study
    Posted: 12/21/2011
    From Reuters:

    Overweight preschoolers who keep their extra weight as they grow have a greater asthma risk at the age of seven, but the baby fat doesn't seem to matter for children who later slim down, according to a study.

    Researchers writing in Pediatrics found that of more than 2,000 Swedish children they followed to the age of eight, those who were overweight or obese at age seven were more likely to have asthma than their thinner peers.

    By contrast, children who were heavy as toddlers or at age four, but not at age seven, were no more prone to asthma than children who'd always been of normal weight.

    "High body mass index (BMI) during the first 4 years does not increase the risk of asthma at school age among children who have developed a normal weight by age seven," wrote Jessica Magnusson, at the Karolinska Institute in Stockholm, who led the study.

    "However, high BMI at age seven years is associated with an increased risk of asthma and sensitization to inhalant allergens."

    Body mass index is a measure of weight relative to height.

    A number of studies have found that heavy children have a higher risk of asthma, or more severe symptoms, but whether the extra pounds are the cause remains unclear.

    "We don't think we can say that overweight is causally associated with asthma -- that is, that overweight causes asthma," Magnusson said.

    Overall, six percent of the eight-year-olds followed in the study had asthma, while 10 percent of the children who were overweight at age seven did.

    The researchers considered other factors, such as the parents' history of allergies and whether a mother smoked during pregnancy. They found that being overweight at age seven was linked to a doubling in the risk of asthma.

    That was true of seven-year-olds who'd been of normal weight earlier in life, as well as those who'd been heavy at age four.

    At any age, there were about 300 children of the 2,000 who were overweight, but fewer were persistently heavy. Only some 122 remained overweight from the age of one to age seven.

    So parents should feel reassured, Magnusson said, that those early extra pounds often do not last - and that children whose weight normalizes may not have an increased asthma risk.

    Reporting from New York by Amy Norton at Reuters Health; Editing by Elaine Lies and Robert Birsel)
    Read More »
  • Differential expression of genes appear in lung disease patients
    Posted: 12/21/2011
    From Annals of Allergy, Asthma & Immunology:

    Abstract

    Background

    Bronchodilators are drugs of choice in the combined therapy of bronchial asthma and chronic obstructive pulmonary disease (COPD). However, the therapeutic sensitivity is variable between patients, probably because of structural features of regulating molecules or variation in key genes' expression.

    Objectives

    The aim of this study was to evaluate the β2-adrenoceptor (ADRB2) and M3-cholinoreceptor (CHRM3) gene expression in bronchial mucosa in patients with COPD and different severity of asthma.

    Methods

    Biopsy specimens of right middle lobar bronchus were obtained from 59 asthma patients (10 patients with severe brittle phenotype, 14 patients with severe asthma with persistent airflow limitation, 27 patients with moderate asthma, and 8 patients with mild asthma) and 10 COPD patients with or without bronchial hyperresponsiveness (BHR). The messenger RNA (mRNA) levels for the ADRB2 and CHRM3 genes in bronchial mucosa were revealed using quantitative reverse transcription polymerase chain reaction (RT-PCR) and compared between groups.

    Results

    An increase of the ADRB2 genes expression was demonstrated in patients with severe asthma and COPD as compared with patients with mild and moderate disease. Significantly higher levels of ADRB2 mRNA were observed in patients with severe asthma with persistent airflow limitation. Significantly lower levels of the CHRM3 mRNA were observed in patients with COPD as compared with asthma patients. Also, CHRM3 gene expression was significantly elevated in COPD patients with BHR as compared with patients without BHR.

    Conclusions

    The results of the study suggest that the differential expression of the ADRB2 and CHRM3 genes is associated with asthma and COPD clinical subtypes.
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  • Asthma drugs in pregnancy may raise risk for kids
    Posted: 12/19/2011
    From USA Today:

    Infants born to mothers who use inhaled glucocorticoids - a class of steroids - to treat asthma during pregnancy may be at risk for endocrine and metabolic disorders, a new study indicates.

    Researchers looked at more than 65,000 mother-child pairs from the Danish National Birth Cohort who were followed from early pregnancy into childhood.

    Of the women in the study, about 61,000 (94 percent) had no asthma during pregnancy while almost 4,100 (6 percent) did have asthma during pregnancy. At the end of follow-up, the median age for the children was about 6, with an age range of about 3.5 to 9.

    For mothers who used the asthma inhalers, budesonide (Pulmicort) was the most common glucocorticoid.

    The use of inhaled glucocorticoids during pregnancy was not associated with an increased risk of most diseases in children, with the exception of endocrine and metabolic disorders.

    "Our data are mostly reassuring and support the use of inhaled glucocorticoids during pregnancy," wrote first author Marion Tegethoff, an associate faculty member in clinical psychology and psychiatry at the University of Basel, Switzerland, and colleagues.

    The study appears online ahead of print in the American Journal of Respiratory and Critical Care Medicine.

    Asthma is common in pregnant women and glucocorticoids are the recommended treatment, the researchers noted.

    "This is the first comprehensive study of potential effects of glucocorticoid inhalation during pregnancy on the health of offspring, covering a wide spectrum of pediatric diseases," study co-author author Gunther Meinlschmidt, an associate faculty member in clinical psychology and epidemiology, said in a journal news release. "While our results support the use of these widely used asthma treatments during pregnancy, their effect on endocrine and metabolic disturbances during childhood merits further study."

    Although the study found an association between inhaler use and certain disorders, it did not show cause and effect.
    Read More »
  • Scientists Uncover Evidence on How Drug-Resistant Tuberculosis Cells Form
    Posted: 12/16/2011
    From Harvard School of Public Health:

    Boston, MA - A new study led by Harvard School of Public (HSPH) researchers provides a novel explanation as to why some tuberculosis cells are inherently more difficult to treat with antibiotics. The discovery, which showed that the ways mycobacteria cells divide and grow determine their susceptibility to treatment with drugs, could lead to new avenues of drug development that better target tuberculosis cells.

    The study appears December 15, 2011 in an advance online edition of Science.

    "We have found that the consequences of the simple and unexpected patterning of mycobacterial growth and division means some bacterial cells have the capacity to survive in the face of antibiotics," said Bree Aldridge, a postdoctoral fellow at HSPH and co-first author of the study.

    Tuberculosis is an infectious disease that kills more than 1.5 million people annually. It is a difficult disease to treat; people are prescribed a combination of antibiotics to be taken daily for six to nine months, a regimen that is hard for patients to follow and for nurses and doctors to administer. Even after beginning appropriate treatment, it appears that some of the infectious cells survive for long periods of time.

    The HSPH researchers, led by Aldridge, co-first author and visiting scientist Marta Fernandez-Suarez, and senior author Sarah Fortune, assistant professor of immunology and infectious diseases, along with colleagues from Massachusetts General Hospital, set out to determine what distinguishes a cell that lives from one that dies. They designed a unique microfluidic chamber in which they grew Mycobacterium smegmatis cells (which behave similarly to Mycobacterium tuberculosis cells) and filmed their growth with a live-cell imaging system.

    The researchers thought that the M. smegmatis cells would divide evenly into similar-sized daughter cells, as bacteria such as E. coli do. Instead, they were surprised to find that the M. smegmatis daughter cells were incredibly diverse, with highly variable sizes and growth rates. They found that this diversity arises because M. smegmatis grow in an unusual fashion, elongating from only one end. When an asymmetric mother cell divides, it creates daughter cells that are very different from one another in fundamental ways, including their growth properties.

    The researchers speculated that these physiologically distinct subpopulations of cells would translate into differences in their susceptibility to antibiotics, which target processes essential for growth and division. To test this hypothesis, they treated the cells with different classes of antibiotics and observed how subpopulations of daughter cells responded.

    The results showed that the different daughter cells exhibited varying susceptibilities to the treatments, strong evidence that populations of mycobacterial cells contain cells that are inherently tolerant of antibiotics and providing an important piece to the puzzle of why tuberculosis is such a difficult disease to treat.

    "It is surprising to discover that mycobacteria differ from other bacteria such as E. coli in such a fundamental way," said Fortune. "It is easy to assume that most bacteria work in a similar fashion. While that?s true sometimes, this study shows that bacterial species, such as TB, may be strikingly different from each other."
    Read More »
  • Proper medication cures asthma attacks
    Posted: 12/15/2011
    From The Times of India:

    Adhering to medication as per prescription can prevent one-quarter of severe asthma attacks, a new study has suggested.

    Moreover, an asthma attack was only significantly reduced when patients used at least 75 per cent of their prescribed dose, according to the study.

    Patients often poorly take their medication based on the onset and degree of symptoms.

    Henry Ford researchers have said that this is the first time that asthma medication use has been tracked closely over time and related to the likelihood of severe asthma attacks.

    "Our findings demonstrated a relationship between medication adherence and asthma events in a manner that accounts for the changing patterns of inhaler use over time," said lead author Keoki Williams, M.D., MPH, an Internal Medicine physician and associate director of Henry Ford's Center for Health Policy and Health Service Research.

    Inhaled corticosteroid (ICS) medication is the most effective treatment for controlling symptoms and preventing attacks, which can lead to a visit to the emergency department or hospitalization or death if left untreated.

    Working from their theory that ICS use changes with the episodic nature of asthma, Dr. Williams and his team of researchers measured changes in medication use over time and to estimate the effect of ICS use on asthma attacks among 298 patients. Patients were followed on average for two years and had 435 asthma attacks during that time.

    "We found that every 25 percent increase in ICS adherence was associated with an 11 percent decrease in asthma attacks."

    "But most importantly, we found that causal use of these medications is not enough, especially among patients whose asthma is not controlled. Patients must use their asthma controller medication as prescribed if they want to have the best chance of preventing serious asthma attacks," Dr. Williams added.

    The study has been recently published online in The Journal of Allergy and Clinical Immunology.
    Read More »
  • Teens swapping cigarettes for flavored mini cigars
    Posted: 12/13/2011
    From The Washington Post:

    By Lena H. Sun

    They come in ice cream flavors such as strawberry, watermelon, vanilla and chocolate. They are packaged in colorful wrappers. "Little cigars" are finding a niche among teens, who like the price - about a dollar - and the taste.

    Young smokers say these cigarette-size little cigars and cigarillos - slimmer versions of big cigars - look better and can be bought one at a time instead of spending more than $5 for a pack of cigarettes. Many teens also think that they are less addictive.

    That's a problem.

    "You have the same cancer-causing chemicals but wrapped in flavors that don't let you experience the harsh sensation of cigar or tobacco use," said Donald Shell, interim director for Maryland's Center for Health Promotion, Education, Tobacco Use Prevention and Cessation.

    Maryland is one of several states where the increase in youth cigar smoking has been large enough that it has caught up with and in some cases surpassed cigarette use in that age group, according to state and federal health data and anti-tobacco groups.

    To fight back, the state will launch ads on billboards, buses and trains starting next week. The home page of the campaign Web site, thecigartrap.com, shows youngsters running to an ice cream truck with a giant cigar on its roof. "No matter how they sugarcoat it . . . cigars kill," a warning reads.

    Little cigars look like cigarettes but are wrapped in a brown paperlike substance that contains some tobacco leaf.

    The Food and Drug Administration banned flavored cigarettes in 2009, but no such ban applies to cigars. Selling tobacco products to anyone younger than 18 is illegal, but not all stores check identification.

    Some teens and young adults said the smaller cigars were appealing on several levels. Several said the most popular brand is Black & Mild, whose cigarillos come in wine and creme in addition to regular flavors.

    Marcus Hunter, 18, said he started smoking cigarillos when he was 14 or 15. "I thought it would help me with stress, you know, from school and stuff," said Hunter during a brief interview outside the Gallery Place Metro station in the District. Hunter, who attended Potomac High School in Oxon Hill, said he stopped smoking a year ago.

    Nick Beirne, 20, said he started smoking cigarillos when he turned 18. "It's a social thing," said Beirne, who said he smokes them once or twice a week. A graduate of Yorktown High School in Arlington County, he said teens smoke them "because they think they're less addictive, it looks better and it's cheaper" than cigarettes.

    A 21-year-old who spoke on the condition of anonymity said that when he was at Calvert High School in Prince Frederick, he and many of his friends thought "the whole cigar thing was way more big to smoke pot," explaining how brands like Swisher Sweets and Black & Mild would be hollowed out and filled with marijuana.

    Between 2000 and 2010, cigarette smoking decreased by nearly 40 percent among Maryland high school students, but cigar use jumped more than 11 percent, according to the Maryland Youth Tobacco Survey, a survey of high school students conducted every two years.

    Nationally, cigar smoking is the second-most-common form of tobacco use among youth, after cigarettes, according to the Centers for Disease Control and Prevention.
    Read More »
  • More Children Using Preventive Asthma Drugs: Study
    Posted: 12/7/2011
    From HealthDay:

    About one in three children with asthma is currently using a preventive medication, according to new research. That number is up from about 18 percent of kids during the late 1980s.

    Preventive asthma medications help control the airway disease before symptoms flare up, and guidelines from the U.S. National Asthma Education and Prevention Program recommend their use.

    "The main finding from our study was that over 20 years, the use of medicines to prevent asthma has increased among children with asthma," said the study's lead author, Dr. Brian Kit, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

    Commenting on the study, Dr. Shean Aujla, a pediatric pulmonologist at the Children's Hospital of Pittsburgh, said, "I think it's encouraging that there's been an increase in the use of preventive medications, but it's still only about one-third of kids with asthma using these drugs. I still think there's underdiagnosis and undertreatment of asthma."

    Results of the study were released online Dec. 5, and will be published in the January 2012 issue of Pediatrics.

    Preventive medications for asthma include inhaled corticosteroids, such as Pulmicort (budesonide) and Flovent (fluticasone); leukotriene-receptor antagonists, such as Singulair and Accolate; long-acting beta agonists, such as Serevent and Foradil; mast-cell stabilizers, such as Intal; and methylxanthines, such as Theo-Dur, according to the study.

    Not everyone with asthma needs to take a daily preventive medication, Aujla noted. For example, youngsters with exercise-induced asthma often don't need to take a medication every day, just when they might have symptoms. But, many children with asthma can benefit from daily preventive medications, she said.

    For the study, Kit and his colleagues used data from the U.S. National Health and Nutrition Examination Survey. They used information collected during three time periods: 1988 to 1994, 1999 to 2002 and 2005 to 2008.

    The survey included data from nearly 2,500 children from across the United States, who were between the ages of 1 and 19 years. All of these children reported having asthma currently.

    During 1988 to 1994, about 18 percent of children and teens with asthma used a preventive medication. By 1999 to 2002, that number had risen to 21 percent, and by 2005 to 2008, nearly 35 percent of children and teens were using a preventive asthma medication.

    The researchers found that preteens and teenagers had the lowest use of preventive medications. In 2005 to 2008, about 43 percent of kids between the ages of 1 and 5 years old used preventive drugs. In kids from 6 to 11 years old, about 45 percent used a preventive medication. But, in 12 to 19 year olds, the use of preventive medication dropped to less than 25 percent.

    "Teens may be 'under-perceivers.' They may have severe asthma, but if they can still do activities, they may not report it. And, while families may think their teen is responsible enough to take care of their medications, they're often not," Aujla said.
    Read More »
  • Whooping cough outbreak hits McHenry County
    Posted: 12/5/2011
    From ABC7 News:

    The number of whooping cough cases in Illinois keeps growing.

    McHenry County has been hit hardest with 164 reported cases in 13 communities. But the disease is spreading to other counties in the Chicago area, too.

    Hailey Davis and her mother Cheryl arrived at the McHenry County Health Department Thursday night, eager to raise awareness about whooping cough, which is highly contagious.

    "I would cough a lot and sometimes it would be hard to breathe," said Hailey Davis.

    Hailey was sick for a month, forcing her relatives to protect themselves.

    "The doctor...said, 'go ahead and get a prescription for the rest of the family,'" said Cheryl Davis.

    The highest number of whooping cough cases in McHenry County is in Cary. Health officials say there are 54 cases in the community, most of them at Cary Grove High School.

    "It did start, as I mentioned, with the cheerleaders, it moved to the football team, the cross country team and the band. It spread pretty much throughout the high school," said Mary Lou Ludicky, McHenry County, communicable disease coordinator.

    Health officials say don't ignore the symptoms, get tested, stay home five days when you take antibiotics, and get vaccinated.

    "Our main concern is with infants and babies that haven't been fully vaccinated because they get hit the hardest when it comes to having pertussis," said Ludicky.

    Whooping cough cases are up in Lake, Suburban Cook, and DuPage County.

    "I'm perfectly fine now," said Hailey Davis.
    Read More »
  • Tobacco control can save states big money
    Posted: 12/5/2011
    From UPI:

    A San Francisco economist says states are being shortsighted by shifting tobacco control programs to cut spending because smoking cessation saves so much money.

    Sudip Chattopadhyay of the San Francisco State University and David R. Pieper at University of California, Berkeley, said funding tobacco control programs at recommend levels could save 14 to 20 times more than the cost of implementing the programs.

    The study, published in the journal Contemporary Economic Policy, said the costs of smoking are felt by the states, mostly through medical costs, Medicaid payments and lost productivity by workers. The researchers used data from 1991 to 2007, when states paid for the tobacco control programs with the help of the tobacco taxes, public and private initiatives and funds from the Tobacco Master Settlement Agreement between the nation's four largest tobacco companies and 46 states.

    State tobacco control programs have a "sustained and steadily increasing long-run impact" on the demand for cigarettes, Chattopadhyay and Pieper said, but in tough economic times, many states have turned to tobacco control funds and taxes to help balance state budgets.

    Funding has dropped since 2002 and states, on average, spent 17 percent of the Centers for Disease Control and Prevention's recommended levels in 2010 for smoking cessation, state smoke-free laws, regulating tobacco products and advertising.

    "Almost all states are facing financial crisis, and they are really diverting their funds," the researchers said in a statement. "If tobacco control funding was restored, states "would save money in terms of reduced Medicaid, and reduced medical and productivity costs - costs that are only going to go up."

    Read More »
  • CBA limits players' use of smokeless tobacco
    Posted: 12/1/2011
    From Sports Illustrated:

    WASHINGTON (AP) -- Baseball's new labor deal will limit the use of smokeless tobacco by players, but not ban it during games, as some public health groups had sought.

    A baseball union summary obtained by The Associated Press says that players have agreed not to carry tobacco packages and tins in their back pockets or use tobacco during pregame or postgame interviews, and at team functions.

    But it falls short of the call by some advocates, including members of Congress, who argued that a ban on chewing tobacco and dip during games was needed to protect impressionable kids watching on TV.

    "Our members understand that this is a dangerous product, there are serious risks associated with using it," union head Michael Weiner told The Associated Press. "Our players felt strongly that those were appropriate measures to take but that banning its use on the field was not appropriate under the circumstances."

    The players union has also agreed to join forces with the Partnership at DrugFree.org to create a nationwide public service announcement campaign. In addition, several players have agreed to a public outreach campaign, including Curtis Granderson, Jeremy Guthrie and C.J. Wilson. The union will start a Tobacco Cessation Center for its players, and players will be provided with training on how to give up the habit.

    Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, one of the groups that led the anti-tobacco push, said that while he would have preferred a ban at games and on camera, the restrictions represent real progress.

    "The new Major League Baseball contract takes an historic first step toward getting smokeless tobacco out of the ballgame, and makes significant progress toward protecting the health of big-league players and millions of young fans who look up to them," he said in a statement.

    "Baseball players have been using tobacco since the earliest days of the game. This forward step marks the first time ever that the league and the players have recognized that it is time to break this unhealthy connection."

    Four U.S. senators who had urged the union to adopt a ban on the eve of this year's World Series had a similar take.

    "Major League Baseball made the right decision today in choosing to implement stricter rules for smokeless tobacco on the field and off the field," said Dick Durbin of Illinois, the No. 2 Democrat in the Senate, and fellow Democrats Frank Lautenberg of New Jersey, Richard Blumenthal of Connecticut and Senate Health Committee Chairman Tom Harkin of Iowa. "This is a welcome acknowledgement by players and owners that tobacco use of any kind is no longer a tradition that should be upheld."

    They said they were hopeful the restrictions would eventually lead to a complete ban on smokeless tobacco.

    Major League Baseball did not immediately respond to requests for comment.

    Weiner said that players aren't running from the idea that kids see them as role models.

    "Prominent players have agreed to go out there and talk," he said. "But maybe the message that's being sent by the combination of things here is a realistic one: When kids grow up they're going to have choices to make, just like players have choices."
    Read More »
  • City Smog Linked to Cognitive Deficits in Children
    Posted: 12/1/2011
    From the Atlantic Cities:

    For all the benefits of growing up urban, there are some considerable health risks too. In an upcoming issue of the journal Brain and Cognition, an international team of researchers reports that exposure to urban air pollutants "may perturb the trajectory of cerebral development and result in cognitive deficits during childhood." Simply put, the kids in cities may not be all right.

    The researchers, led by Lilian Calderón-Garcidueñas of the National Institute of Paediatrics, in Mexico City, and the University of Montana, studied a group of 30 children aged 7 or 8 who had lived in Mexican cities their whole lives. Some came from Mexico City, a place known for its extremely high levels of air pollutants, while others lived in Polotitlán, a city with a strong air quality rating.

    The researchers tracked the children for two years, using an array of tools - including brain scans - to measure volume of white matter, neuroinflammation, and cognitive performance in the youths. They found that the brains of kids from cleaner Polotitlán looked healthier than those of Mexico City children, and performed better too. On tests of complex reasoning, knowledge integration, and verbal and working memory skills, the Mexico City kids scored lower than did the other children. The researchers conclude:

    "Children who appeared to be healthy and had no risk factors for neurological or cognitive deficits, but who are residents in a highly polluted atmosphere, exhibited selective impairment in IQ subscales tapping on attention, short term memory and learning abilities. ...

    If cognitive abilities are reduced during the critical childhood developmental years as a result of air pollution, it will have enormous detrimental effects on society."

    While scientists have a good sense of how city smog harms the lungs and the heart, its impact on brain functioning has been poorly understood until late. The recent work of Calderón-Garcidueñas and others in her field is starting to inform this knowledge gap. In a study from 2008, Calderón-Garcidueñas and colleagues found that 56 percent of otherwise healthy Mexico City kids had lesions of the prefrontal cortex, compared with less than 8 percent of youths from a low-polluted region. At a recent professional meeting, covered by science reporter Janet Raloff, Calderón-Garcidueñas noted a troubling similarity between the types of brain abnormalities she's finding and the hallmarks of Alzheimer's disease.

    The problem isn't unique to Mexico City. In other work from 2008, Harvard researchers studied about 200 children from Boston and found a connection between black carbon - the type of soot kicked up by heavy city traffic - and decreased performance "across assessments of verbal and nonverbal intelligence and memory constructs." A 2009 study out of Brescia, Italy, noticed a link between airborne manganese particles and impaired motor coordination and olfactory functions.

    Read More »

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