More Related Content
Similar to לראות את הנולד - מה ידוע על זיהום אוויר ותחלואת ילדים ?
Similar to לראות את הנולד - מה ידוע על זיהום אוויר ותחלואת ילדים ? (14)
More from הקואליציה לבריאות הציבור
More from הקואליציה לבריאות הציבור (20)
לראות את הנולד - מה ידוע על זיהום אוויר ותחלואת ילדים ?
- 1. 1
¯
5 ' "
6 (M.P.H)
7
89 : 1.1 1
10 1.2
10 1.3
11 ¯ ¯ 1.4
12 ? : 2.1 2
12 13 2.2
13 ? : 2.3
13 2.4
14 16 , ,(IUGR) : 2.5
17 22 2.6
23 26 ¯ 2.7
27 30 , 2.8
31 , 2.9
32 33 , , 2.10
34 ¯ ¯ 2.11
35 38 ¯ 2.12
39 ¯ 2.13
40 ¯ 2.14
41 2.15
42 46 2.16
47 50 2007–2002 ¯ , ¯ 3.1 3
51 53 2007–2002 3.2
54 58 , 2008 2007 ¯ 3.3
59 2006–1995 4.1 4
60 4.2
61 62 4.3
2006–2004
63 5.1 5
63 5.2
63 64 ¯ 5.3
65 ¯ 6.1 6
65 6.2
66 ¯ 6.3
66 6.4
67 69 7.1 7
69 71 ¯ 7.2
72 7.3
72 74 7.4
75 ¯ 7.5
76 80 8
1
- 2. 2
: '
89 1
11 ¯ 2
18 3
35 ¯ ¯ 4
37 ¯ " 1 ¯ ¯ 5
38 6
45 14–0 1000 7
46 ¯ 8
49 ¯ 9
52 2007–2002 ( – / ) 10
60 2002 1998 5 14 4–0 11
67 69 : 12
74 (2005 ) ,2004 13
: '
19 2000–1994 1
20 ¯ , 80% ¯ 18 2
2000–1994
48 – 2002 3
51 ) 2007–2002 , , 4
(
51 ( ) 2007–2002 , , SO2 5
52 2007 6
53 2007 ¯ 7
53 " 2007 2006 PM10 ¯ 8
55 .2008 ¯ 9
55 .2008 ¯ 10
55 .2008 2007 ¯ 11
56 .2008 2007 ¯ 12
56 2008 2007 ¯ 13
56 .2008 2007 PAH's ¯ ¯ 14
57 .2008 2007 / ¯ 15
59 .2002–1998 4–0 16
60 .2002–1998 14–5 17
61 .2006–2004 4–0 18
61 .2006–2004 14–5 19
62 .2006–2004 ¯ 4–0 20
72 . " 20 2000 (PM10) ¯ 21
73 . " 2001 (PM10) ¯ 22
73 . 19 1998 (PM10) ¯ 23
74 . " 2007 (PM10) ¯ 24
: '
: (3.4.2009 ) : 1
3 ( " ) 2
10 : ' 3
17 embryology 4
22 : 5
42 : 6
43 : 2009 , ¯ 7
44 : ¯ 8
48 : 2009 , 9
49 : 2009 , ¯ 10
2
- 3. 3
24.6.2009 6.6.1972 , " ¯
, ¯ "
"
[' , ¯ ]
"
, , ¯ ,
.37 ,
¯ , ¯,¯
." "
, ¯ ¯,¯
. ¯
, ¯ ¯
¯ ¯
. ,
¯ .
, " ¯ .
.
. , ¯
, .
. ¯ ¯ ,
, ( ") . ¯ ¯ , ¯ ¯
, , . –
¯ , ¯ –
, :
.
" "
3
- 4. 4
: , , ¯
. " ¯ , "
. " ¯
." " ¯ ¯ ' "
, ' :
. " " , ¯
' ," ¯" :
. " . ,
, ' ," "
.
: , :
" ¯,
.
. ¯ ¯ ' ' :
. "
" : ,
. ,
¯ , " :" "
. – "
, :
.
, ' , " , ' " :
¯ – , " , '
. " ¯
, ¯ " " " " ¯ "
¯ ,
. ¯
, "
" " . ©" " ¯ ¯
. ¯ , ¯ ,
. ¯
. ¯ ¯
.
' ¯ ¯ .
, " ". ¯
/ .
. / , ¯ ,
4
- 5. 5
' " –
¯
2006 .
," " ¯,
¯ . – ¯
' ' . ' , ¯ ' : "
¯ ¯ .
: (Faroe Islands) ¯ ,¯ .
¯ . ¯ 200 ¯ "Prenatal Programming and Toxicity"
. ¯
¯ ¯ ¯
"Basic and Clinical Pharmacology and Toxicology" ¯
.2008
) ¯
, , , ¯, ¯ ¯ ¯ : (
PM2.5 ,PAH's ,PCB's
¯ ¯ ¯ ¯ .
. ¯ ¯
¯ ¯ ¯, , ¯.
) ¯ ¯ ¯ ,
¯ . (
. 10,000
, , ¯ ¯ .
– , ¯ .
. ¯ ¯ ¯
¯
– ¯ .
, . ¯
¯ , ¯ ¯
. , ¯. ,
. – ,
" – ' "
5
- 6. 6
–
¯ , . ¯ ,
, .
, . ¯ ¯
¯ ¯ . ¯
. – ¯
¯ ¯ ¯ ¯ ¯ . ¯
,
¯ ¯ .
, ¯.
– ¯. ¯ ¯
, ¯ ? , !
, ,
. :
" ¯ .
¯. ,(2005)
, ¯
, . ¯
, ¯ ¯ ?
¯ ¯ ¯ " " ,
¯ , ¯
¯ 2008 " ,
, ¯ , . "
¯ ¯ . ¯
. ¯ ¯ ¯
¯ "
¯ ,
.
(M.P.H) ¯ –
6
- 7. 7
¯ , . ¯
¯ , ¯ , ¯ ¯ ¯ ,
1
¯ WHO (Europe) " .
. ¯
¯ , .
.
.
¯ ¯ 2008 2007
. ¯, PAH's , , ,
¯ , ¯
. ¯
,
¯.
¯ ¯ .
¯ ¯ . ¯ ¯.
. ¯ ¯ ¯ ¯ , ¯
: ¯ ¯
. ¯ .1
. ¯, , ¯ ¯ .2
2
." ¯ " ¯ .3
. ¯ , .4
. ¯ .5
. ¯ – BAT .6
. ¯ , , .7
. .8
. , ¯ ¯ .9
. ¯ .10
1
[10] (2005) "
2
.15 g/m3 PM2.5
7
- 8. 8
: .1
[1] 1.1
. .
, , ¯
¯ . , ,
¯ ¯ .
, , ,(YOLL) : ¯
, , , ¯
, ¯ . ¯
, ¯ ¯ ¯ . ¯
.
¯ ¯ ¯ "¯ "
¯ ¯ ¯ .
. 1 .
1
¯
¯ : TSP
¯ , ¯
. . . ,
,
, ¯
. ¯
¯ ¯ : PM10
¯ ¯ . . 1/6 ¯ .
.
.
-: PM2.5
¯ , , ¯ ¯ ¯.
: , ¯ , , , , ,
. ¯
. , ( " 2.5 )
,DNA
.
¯¯ . ¯ ,
¯,
,
.
8
- 9. 9
¯
, , : O3
. ¯ ¯ ,
¯ ¯ ¯ )
. .(
¯ :
. . , ¯. SO2
, ¯ ¯
¯ ¯ ,
. ¯
, . ¯ . ¯ ¯ : Pb
¯ . , ¯
¯ .
¯ . ¯ ¯
, ¯
IQ , ¯
[2] .
¯ ¯ (NO) ¯ NOx
, ¯ . :NO2
. , ¯
.
, ¯ ) .
,(
.
, : Dioxins/Furans
TCDD . ¯
¯ ¯ . .
¯ . ¯ .
, ¯
¯ ¯ ¯ ¯
. ¯ .
. ¯ ,
.
2,3,7,8-tetrachlorodibenzo-p-dioxin
TCDD :
, , ¯ ¯ : ¯ (VOC's)
¯ , ¯ , , ¯ .
. ¯ ¯ . , ,
¯ ¯ , ,
¯ , ¯ ,
) [3]
. ,( .( )
¯ : (PAH's)
. . ¯
.
, ¯ , ¯ )
IQ– ¯ ¯ ,(' ¯ ¯ ¯ ,
.[4] . ¯
. ¯ ¯ : ¯ PCBs
. ¯ . ¯
" , ¯
. , , ¯
(7.1 7.3 , )
9
- 10. 10
.1.2
. ¯
. , ¯
¯ .
, ¯, ¯ . ¯ ¯
¯ ¯ . ¯ , ¯
. ¯ ,
.( ) ( ) ¯ ¯ ¯
, ¯
¯ .
. ¯ ,
¯ ¯ ¯
¯ .
. ¯ ¯
.1.3
,
:( ¯ ¯ , )
¯¯ , ,
¯ ¯ ¯ .[5 6] –
– , ¯ ¯
¯ ¯) , ¯ ¯ ¯
.[8–7] ( ¯ ¯
10
- 11. 11
¯ ¯ .1.4
.[9] ,
: .
. , ,
: , ¯ , , ¯
30% ¯ , 100% , .EAF
¯ . 10% , 5% ,
54.9 ¯ ¯ ,
.( 2 )!
2
¯
$ ¯
43,000,000,000
2,000,000,000
300,000,000
9,200,000,000
54,900,000,000 ¯"
3% ¯ :
, ¯ ! ¯
.
¯ . " ¯ , ¯
. ¯ ¯ ¯
¯ ¯ .1.4.1
. ¯ ¯
20 ¯ ¯ 399 ¯
.[1] ¯ ,
¯– ¯ ¯ .1.4.2
¯ ¯
¯ ¯ ¯ .
, 20 .( ) 1970
22.2
.[1] .1:42 ¯, 0.523
11
- 12. 12
– .2
? 2.1
, ¯
¯ 2005 " .
¯ " ¯ .[10]
¯ ¯" :[11]
¯ ¯ .
( ) ¯ . ¯
: ¯
, . ,( ¯ )
3
, ¯ .
¯ . , ¯
¯.
¯ .
¯ ¯ ¯ . ¯
¯ (POP's)
¯.
." ,
, ¯ ¯
' 7.4 ) ¯ . PCB's
, . ¯ " :(72
, .
– ¯ ¯
, ¯ , ¯ ¯ ¯ ,
."
2.2
¯ ¯
¯ : ¯ .
¯ ¯ .
. ¯
, ¯ . ,
3
, , 30 ¯ ¯ ¯
) ¯ . ¯
.(
12
- 13. 13
¯ , 50%–20%
, ¯ .
.[12 ] ¯
¯ ¯ , :
.
, , ¯ ,
¯ . ¯ ¯, ¯
¯ .
.
? : 2.3
.[13]
( )
¯ ,
. ¯ ¯
. ¯
.
, " ¯ 2002 , ¯ .
. ¯ ¯
, , ?
, .
. ¯ .
¯ , , ¯
. ¯ ¯ ¯
.2.4
, , ¯ ,
. " " ¯
.[14] ¯ ¯ , ,
. ¯ ¯ ¯
13
- 14. 14
, :(IUGR) 2.5
[10]
: ¯
(IUGR) , , ,
, . .
¯ . ¯
, ¯. ,
(IUGR) ,
, ¯ . ¯ ¯
) 2 ¯ , ¯ ¯ , ,
, .(
:[27–14 ' ,10]
2.5.1
60
¯ . ( )
. 1% 10%
.1991 1989 ,
1.1 ¯ ¯
, . ¯ ( )
PM10 ¯
RR=1.26) (SIDS) ¯ .( ¯ RR=1.40)
40% .( ¯
. 26%
. ¯' , , ¯
2.5.2
4
' ¯ SO2 TSP
5
.(time series )
SO2 ¯ 100 g/m3 . "
4
. ¯ ¯ , ¯" =TSP
. 50 20 ¯
5
¯¯ / , ¯:
. : . ¯ ,
14
- 15. 15
,( ) 11% ¯
.( ) 10% ¯ TSP ¯
SO2 TSP ¯'
SO2 ¯ 50 g/m3 ¯ .
50 g/m3 ¯ ,( ) 20% ¯
.( ) 15% ¯
6
¯
86
¯ , .( )
. . ¯
2.5.3
( ¯ )
. SO2 ,TSP
.( ) 1.18 ¯ TSP ¯
. TSP ¯ ,SO2 ¯
¯ , SO2 ¯ 50 g/m3
¯ ¯. , ( ) 1.27
3
50 g/m ! 27%
O3 ,NO2 ,CO ,PM10 :
(PM10) ¯ 50 g/m3 ¯ .
.( ) 16% ¯
PM10 ¯ 50 g/m3
.( ) 20% ¯ ,
.
7
(IUGR) 2.5.4
PM2.5 PM10 ¯'
¯ .( )
( ) ¯ ,27 g/m3 PM2.5
.(IUGR)
( ) ¯ ,40 g/m3 PM10
6
¯, :
=IUGR 7
15
- 16. 16
¯ PM10 20 g/m3 .IUGR
!IUGR ( ) 50%
[15]
. , ¯ :
¯ .(PM10<40 g/m3) , ¯
.IUGR ( ) 1.44 ¯ (40 g/m3<PM10< 50 g/m3)
( ) 2.14 ¯ (PM10> 50 g/m3)
¯) PAH's ¯ ! IUGR
¯ ,IUGR (benzo(a)Pyrene
.IUGR ( ) 60% ¯ PAH's
( ) 2.15 ¯ PAH's
10ng/m3 PAH's ¯ ¯ .IUGR
.( ) 22% IUGR ¯
2.5.5
. ¯ ,
O3 ,NO2 ,CO ,PM10 [16]
.1993 1987
CO
( ) 2.95 ¯ .
¯ ¯. ¯
!2.68 / ¯ (O3)
¯ .[17]
PM10
,(atrial septa) ( ) 2.3 ¯ ,
,SO2 . ¯
: ( ,2.17 ) ¯ ¯
.isolated ventricular septal defects
16
- 17. 17
[10] 2.6
3
] All rights reservedwww.embryology.ch/anglais/rrespiratory/phasen07.html Copyright © [.
, . 24 ¯ , ¯ ¯
¯ , ¯
. ¯
2.6.1
¯ ,( 3 ) , ¯
: .
.25–22 ¯ ,20–18
. ¯
: ( , , ) ¯
8
¯ ( ) , , ¯
, ¯ ! ¯ 20 . ¯
, ¯ ,
) ¯ . ¯
, , ¯ ¯ ,(
.
. ¯ ¯
( ¯) ¯
. ¯ ¯
8
, ¯
17
- 18. 18
,
.[134–108 ' ,10]
2.6.2
. ¯ .
. ,
! .
¯ ¯ ,
, ¯ . ,
¯ ¯ . ,
.
¯
, . , ¯
.( )
: ,3
3
Forced Vital Capacity = ¯ FVC
.( ) , ¯ ¯
Forced Expiratory Volume 1 = ¯ FEV1
, ¯ ¯
.
Forced Expiratory Flow = ¯ FEF
. ¯ ¯
Peak Expiratory Flow = PEF
Maximum Mid-ExpiratoryFlow ¯ = ¯ MMEF
.( ) ¯
2.6.3
(NHANESII) 24–6
¯¯ ¯ ,( ) FEV1- FVC O3 ,NO2 ,1TSP ¯
1
. ¯ ¯ , ¯" =TSP
. 20 50 ¯
18
- 19. 19
.FEV1 ,FVC ,
, 24 12–8 ,
, ,O3 ,PM10
PM10 17.3 g/m3 .
. FEV1 2.1% , FVC 2.4% :
– ( ) 2.6.4
975
¯ , .
,PM10 10 g/m3 ¯ .
) " 329 ¯ ,(FEV1 ) " 84
. ,(MMEF
¯
.[18] 12 1,759 ,(Gauderman)
¯.
. ¯
.NO2 ,O3 ,PM2.5
1 . ,
: 12
1
2000–1994
[18] 12
Copyright © [2004, NEJM 351(11):1057-1067] Massachusetts Medical Society. All rights reserved
,NO2 ,PM2.5
.18 (FEV1)
9
. ,
9
. , . :
19
- 20. 20
10
4.9 ¯ 18
.[! 1.6% 7.6%] ¯ ,PM2.5
11
¯ ¯
,18–10
.2 .FEV1 ,
2
¯ , 80% ¯ 18
[18] 2000–1994
Copyright © [2004, NEJM 351(11):1057-1067] Massachusetts Medical Society. All rights reserved
10
. FEV1 FEV1 ¯ , FEV1 ¯
. 80% ¯ ¯
11
," ¯ " ¯ ,1970 ¯
¯ . ¯
!
20
- 21. 21
2–1
¯ (UP RV ,ML ¯) ¯¯
.(FEV1 ) 80% ¯ 18
.
¯ ¯ : ¯
.NO2 ,( ) ,PM2.5
.MMEF FVC ¯
,
. ¯ PM2.5
,
¯ ¯ , ,
! ¯
.
¯ ¯
¯,
¯ , ¯
¯ ! ¯
¯ ¯ ¯ ¯ ,
.
¯ , (Dockery & Pope ) .
FEV1 0.15% ,10 g/m3 PM10 ¯
.[19] PEF 0.08%
– ¯ 2.6.5
¯ ¯, ¯
¯ ¯ ¯
! ?
¯
. 2000 (MMEF ,FEV1)
3 3
,25 g/m 79 -g/m TSP ¯ :(1990 )
. 14–11 2500
.(1999–1998 ,1996–1995 ,1993–1992 : ) FEV1 FVC
21
- 22. 22
110 ,
, ¯ .[20]
. , ,
. / ¯, ¯¯
, ¯. PEFR- ,MMEF ,FEV1
. ¯
© :
22
- 23. 23
[10] ¯ 2.7
(ARI) ¯
¯ . ¯
. ¯ 2001
¯ ¯ ¯ ¯ ¯ ¯
, . ,
.
.[62–51 ' ,10]
. ¯ ¯
:
, .(URTI) ¯ .1
¯ ¯
¯, ,( ) :
.
.(LRTI) ¯ .2
, : ¯ ( )
. , , ¯ ,
¯ ¯
. ¯
¯ 2.7.1
. ¯ SO2 ¯
¯
.
. ¯
12
¯
.
13
¯ ¯
¯ .
, ¯,
12
ciliostasis 13
23
- 24. 24
, . ¯ ¯
¯ . / / ¯ ¯ ¯
15 14
. ¯
.[51–45 ' ,10 ] ¯ '
¯ ¯ 2.7.2
PM10, O3, SO2, CO, NO2
. ¯
.[21] 1997–1993 (19–0) ¯ ,
¯ .' ¯ , , ¯
–0 ¯ . ¯
3
¯ 35 g/m . ¯ 2
. ¯ 9% PM10
. ¯
¯ 2.7.3
¯ NO2 SO2 ,TSP
6,000 ¯ . ¯
3
10 g/m ¯ . ¯ 4,500 ,
NO2 70 g/m3 ¯ !27% ¯ TSP
©. .28% ¯
" " . ¯
¯ NO2
¯ ¯ .15 g/m3–
, ¯
1.6 , 2 ,
.
¯ " "
¯ )
.(
14
= '
15
, :
, ¯ : .
. ¯
24