title: Environment and Health in Children Day Care Centres (ENVIRH) - Study rationale and protocol.
abstract: BACKGROUND
  Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects.
  This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A children's respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected.
  
  
  RESULTS
  In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children). Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and children's health. A building ventilation model will also be developed.
  
  
  CONCLUSIONS
  This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC.
authors.affiliation: CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal. Electronic address: jmartinsmed@yahoo.com.
authors.forename: J
authors.initials: J
authors.lastname: Araújo-Martins
authors.affiliation: CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal; Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Carreiro Martins
authors.affiliation: Laboratório Nacional de Engenharia Civil, Avenida do Brasil, 101, 1700-066 Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Viegas
authors.affiliation: Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Campus da Caparica, 2829-516 Caparica, Portugal.
authors.forename: D
authors.initials: D
authors.lastname: Aelenei
authors.affiliation: Instituto Nacional de Saúde Dr. Ricardo Jorge - Lisboa, Avenida Padre Cruz, 1649-016 Lisbon, Portugal.
authors.forename: M M
authors.initials: MM
authors.lastname: Cano
authors.affiliation: Instituto Nacional de Saúde Dr. Ricardo Jorge - Porto, Rua Alexandre Herculano, 321, 4000-055 Oporto, Portugal.
authors.forename: J P
authors.initials: JP
authors.lastname: Teixeira
authors.affiliation: CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Paixão
authors.affiliation: Departamento de Bioestatística e Informática, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Ceaul, Portugal; Centro de Investigação, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
authors.forename: A L
authors.initials: AL
authors.lastname: Papoila
authors.affiliation: CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal; Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Leiria-Pinto
authors.affiliation: CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Pedro
authors.affiliation: Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Rosado-Pinto
authors.affiliation: INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR (Epidemiology of Allergic and Respiratory Diseases), F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, F-75013 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Annesi-Maesano
authors.affiliation: CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal; Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
authors.forename: N
authors.initials: N
authors.lastname: Neuparth
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012140:Respiratory Tract Diseases / Q000209:etiology
keywords: Airway inflammation; Building ventilation; Children day care centers; Creches; Doença respiratória; Environmental exposure; Exposição ambiental; Indoor air quality; Inflamação das vias respiratórias; Qualidade do ar interior; Respiratory disease; Ventilação de edifícios
references.citation: Indoor Air. 2005 Aug;15(4):275-80
references.pmid: 15982274
references.citation: Eur Respir J. 2010 Jul;36(1):33-40
references.pmid: 20075054
references.citation: Environ Health. 2009 Apr 01;8:14
references.pmid: 19338672
references.citation: Eur Respir J. 2012 Oct;40(4):1033-45
references.pmid: 22790916
references.citation: J Environ Monit. 2012 Feb;14(2):429-39
references.pmid: 22027817
references.citation: Am J Public Health. 2011 Dec;101 Suppl 1:S238-45
references.pmid: 21836112
references.citation: Clin Exp Allergy. 2005 Oct;35(10):1279-87
references.pmid: 16238786
references.citation: J Clin Psychol Med Settings. 2010 Dec;17(4):357-65
references.pmid: 21086027
references.citation: Environ Health. 2008 May 14;7:16
references.pmid: 18479529
references.citation: Pediatr Pulmonol. 2006 Oct;41(10):929-36
references.pmid: 16871619
references.citation: Environ Monit Assess. 2011 May;176(1-4):501-16
references.pmid: 20635200
references.citation: Lancet. 2001 Jun 9;357(9271):1821-5
references.pmid: 11410189
references.citation: Rev Port Pneumol. 2008 Jul-Aug;14(4):487-507
references.pmid: 18622526
references.citation: Indoor Air. 2009 Oct;19(5):357-80
references.pmid: 19663921
references.citation: Arch Pediatr Adolesc Med. 2011 Aug;165(8):741-8
references.pmid: 21810636
references.citation: Int J Tuberc Lung Dis. 2004 Dec;8(12):1401-15
references.pmid: 15636485
references.citation: Eur Respir J. 2010 Apr;35(4):742-9
references.pmid: 20075060
references.citation: J Allergy Clin Immunol. 2014 Jan;133(1):77-84
references.pmid: 23910689
references.citation: Environ Technol. 2011 Dec;33(15-16):1983-9
references.pmid: 22439587
references.citation: Am J Respir Crit Care Med. 2002 Feb 1;165(3):358-65
references.pmid: 11818321
references.citation: BMC Public Health. 2013 Aug 16;13:764
references.pmid: 23953349
references.citation: Arch Pediatr. 2011 Jul;18(7):789-96
references.pmid: 21621987
references.citation: J Sch Health. 2010 Jun;80(6):280-6; quiz 321-3
references.pmid: 20573140
references.citation: J Asthma. 2008 May;45(4):319-23
references.pmid: 18446597
references.citation: Ann Pharm Fr. 2012 Jul;70(4):204-12
references.pmid: 22818262
references.citation: Indoor Air. 2007 Aug;17(4):317-27
references.pmid: 17661928
references.citation: Eur Respir J. 2009 Aug;34(2):316-23
references.pmid: 19251781
references.citation: Am J Respir Crit Care Med. 2003 Oct 1;168(7):790-7
references.pmid: 12893648
references.citation: J Toxicol Environ Health A. 2012;75(22-23):1371-80
references.pmid: 23095155
references.citation: Environ Geochem Health. 2011 Oct;33(5):455-68
references.pmid: 21042927
references.citation: Allergy Asthma Clin Immunol. 2008 Mar 15;4(1):29-36
references.pmid: 20525123
references.citation: Appl Occup Environ Hyg. 2000 Nov;15(11):824-34
references.pmid: 11062927
references.citation: Prog Brain Res. 2008;167:137-49
references.pmid: 18037012
references.citation: Environ Health Perspect. 2004 Oct;112(14):1393-7
references.pmid: 15471731
references.citation: Allergy. 1995 Feb;50(2):106-12
references.pmid: 7604931
references.citation: J Toxicol Environ Health A. 2013;76(6):400-8
references.pmid: 23557238
references.citation: Psychol Health Med. 2007 Mar;12(2):225-35; quiz 235-7
references.pmid: 17365902
references.citation: Allergy. 2009 Jul;64(7):1046-55
references.pmid: 19220225
references.citation: Indoor Air. 2001 Dec;11(4):257-69
references.pmid: 11761601
references.citation: Thorax. 2005 Jun;60(6):467-73
references.pmid: 15923246
references.citation: Eur Respir J. 2012 Feb;39(2):246-53
references.pmid: 21719492
references.citation: J Environ Monit. 2011 Mar;13(3):657-67
references.pmid: 21274462
references.citation: Allergy. 2006 Apr;61(4):447-53
references.pmid: 16512807
references.citation: Thorax. 1999 Dec;54(12):1070-4
references.pmid: 10567625
references.citation: Epidemiology. 1999 May;10(3):294-9
references.pmid: 10230841
references.citation: Thorax. 2004 Sep;59(9):746-51
references.pmid: 15333849
references.citation: Lancet. 2012 Mar 31;379(9822):e45-6
references.pmid: 22464390
references.citation: Biopsychosoc Med. 2010 Oct 07;4:12
references.pmid: 20929533
references.citation: J Air Waste Manag Assoc. 2012 Dec;62(12):1380-93
references.pmid: 23362757
references.citation: PLoS One. 2013 Jun 19;8(6):e66785
references.pmid: 23840530
references.citation: Environ Health Perspect. 1999 Sep;107(9):757-60
references.pmid: 10464077
references.citation: Environ Health Perspect. 2009 Feb;117(2):294-8
references.pmid: 19270802
references.citation: Clin Exp Allergy. 1998 Nov;28 Suppl 5:52-66; discussion 90-1
references.pmid: 9988448
references.citation: Int J Tuberc Lung Dis. 2010 Aug;14(8):1059-65
references.pmid: 20626953