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Vo
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3
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Ass
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tran
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ted
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ts.
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e
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2
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o
2
0
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c
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b
o
t
h
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rm
a
l
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n
d
i
n
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rm
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c
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0
5
1
re
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fi
v
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st
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m
e
t
th
e
in
c
lu
si
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n
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rit
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ria,
o
rig
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n
a
ti
n
g
fro
m
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in
a
a
n
d
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e
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f
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s
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e
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sin
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lt
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t
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n
d
tra
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sla
ti
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n
(
O
HA
T
)
risk
o
f
b
ias
to
o
l
.
Th
e
fin
d
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n
g
s
d
e
m
o
n
stra
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a
c
o
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siste
n
t
a
ss
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c
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twe
e
n
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x
p
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s
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re
a
n
d
a
n
in
c
re
a
se
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risk
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y
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o
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p
a
rti
c
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l
a
rl
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in
p
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rl
y
v
e
n
ti
late
d
wo
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k
e
n
v
iro
n
m
e
n
ts.
T
h
e
se
re
su
lt
s
u
n
d
e
rsc
o
re
th
e
im
p
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rtan
c
e
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f
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ro
v
i
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rk
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lac
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a
ir
q
u
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li
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m
a
n
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g
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m
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n
t,
stre
n
g
th
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n
in
g
e
x
p
o
s
u
re
m
o
n
it
o
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in
g
,
a
n
d
imp
lem
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n
ti
n
g
p
r
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v
e
n
ti
v
e
o
c
c
u
p
a
ti
o
n
a
l
h
e
a
lt
h
stra
t
e
g
ies
.
K
ey
w
o
r
d
s
:
A
ir
p
o
llu
tio
n
H
ype
r
ten
tio
n
N
itro
g
en
d
io
x
id
e
Occ
u
p
atio
n
al
ex
p
o
s
u
r
e
W
o
r
k
er
s
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Ay
u
d
h
ia
R
ac
h
m
awa
ti
Dep
ar
tm
en
t o
f
E
n
v
ir
o
n
m
e
n
tal
Hea
lth
,
Facu
lty
o
f
Pu
b
lic
Hea
l
th
,
Mu
lawa
r
m
an
Un
i
v
er
s
ity
Sam
ar
in
d
a,
I
n
d
o
n
esia
E
m
ail:
r
ac
h
m
awa
tiay
u
d
h
ia@
f
k
m
.
u
n
m
u
l.a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
Air
p
o
llu
tio
n
r
em
ai
n
s
a
cr
itical
g
lo
b
al
en
v
ir
o
n
m
e
n
tal
h
ea
lth
ch
allen
g
e,
d
r
iv
en
b
y
th
e
in
cr
ea
s
in
g
co
m
p
lex
ity
o
f
h
u
m
an
ac
tiv
ities
an
d
r
a
p
id
in
d
u
s
tr
ializatio
n
.
T
h
e
ex
ten
s
iv
e
r
elian
ce
o
n
f
o
s
s
il
f
u
els
to
s
u
p
p
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t
in
d
u
s
tr
ial,
en
er
g
y
,
an
d
tr
an
s
p
o
r
tatio
n
s
ec
to
r
s
h
as
le
d
to
a
s
u
b
s
tan
tial
r
is
e
in
atm
o
s
p
h
er
ic
em
is
s
io
n
s
[
1
]
-
[
3
]
.
Fu
r
th
er
m
o
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e
,
ac
ce
ler
ated
u
r
b
an
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th
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ab
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as
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a
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icles,
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air
q
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ality
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elev
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p
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h
ea
lth
r
is
k
s
[
4
]
,
[
5
]
.
T
h
e
State
o
f
Glo
b
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Air
2
0
2
4
r
e
p
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t in
d
icate
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p
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ap
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1
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2
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2
1
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an
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air
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d
s
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W
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H
ea
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Or
g
an
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s
r
ec
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m
m
en
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s
af
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r
esh
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ld
s
[
6
]
.
T
h
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s
itu
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alig
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s
with
th
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in
cr
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in
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p
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f
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in
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is
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s
es,
an
d
lu
n
g
ca
n
ce
r
[
7
]
-
[
9
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
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A
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869
Nitr
o
g
en
d
io
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id
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(
NO₂)
is
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f
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m
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t
p
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t
g
aseo
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s
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tan
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p
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an
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in
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ac
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[
6
]
,
[
1
0
]
.
NO₂
is
ch
ar
ac
ter
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b
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[
1
1
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.
I
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p
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s
[
1
2
]
,
[
1
3
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.
Occ
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ly
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ies
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i
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an
d
weld
in
g
o
p
e
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atio
n
s
[
1
4
]
,
[
1
5
]
.
Pre
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s
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ies
h
av
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s
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y
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o
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with
in
5
0
0
m
eter
s
o
f
in
d
u
s
tr
ial
s
ites
[
1
6
]
.
NO₂
ex
p
o
s
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e
co
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tr
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o
x
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ativ
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d
in
f
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lead
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g
to
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d
o
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h
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n
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n
d
im
p
air
ed
n
itric
o
x
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d
e
(
NO)
b
io
av
ailab
ilit
y
[
1
7
]
.
R
ed
u
ce
d
NO
p
r
o
d
u
ctio
n
s
u
b
s
eq
u
en
tly
lim
its
v
aso
d
ilatio
n
,
i
n
cr
ea
s
es
v
ascu
lar
r
esis
tan
ce
,
an
d
elev
ates
b
lo
o
d
p
r
ess
u
r
e,
th
er
eb
y
co
n
tr
ib
u
tin
g
to
h
y
p
e
r
ten
s
io
n
an
d
o
th
e
r
ca
r
d
io
v
ascu
lar
co
m
p
licatio
n
s
[
1
8
]
-
[
2
0
]
.
Alth
o
u
g
h
th
e
h
ea
lth
im
p
ac
ts
o
f
air
p
o
llu
tio
n
h
av
e
b
ee
n
wid
ely
ex
am
in
ed
,
ev
i
d
en
ce
s
p
ec
if
ically
ad
d
r
ess
in
g
th
e
ass
o
ciatio
n
b
etwe
en
NO₂
ex
p
o
s
u
r
e
an
d
h
y
p
e
r
ten
s
io
n
am
o
n
g
wo
r
k
er
s
r
em
ain
s
lim
ited
.
W
o
r
k
er
s
r
ep
r
esen
t
a
v
u
ln
er
a
b
le
p
o
p
u
lat
io
n
wh
o
s
e
ex
p
o
s
u
r
e
lev
els
ar
e
d
eter
m
in
ed
b
y
d
u
r
atio
n
,
i
n
ten
s
ity
,
f
r
eq
u
en
cy
o
f
co
n
tact,
an
d
wo
r
k
p
lace
en
v
ir
o
n
m
en
tal
co
n
d
itio
n
s
[
2
1
]
,
[
2
2
].
Pro
lo
n
g
e
d
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
e
to
NO₂
m
ay
h
eig
h
ten
th
e
r
is
k
o
f
h
y
p
er
te
n
s
io
n
an
d
ca
r
d
io
v
ascu
lar
im
p
air
m
en
t,
wh
ich
i
n
tu
r
n
ca
n
s
ig
n
if
ican
tly
af
f
ec
t
wo
r
k
f
o
r
ce
p
r
o
d
u
ctiv
ity
[
2
3
]
,
[
2
4
]
.
E
x
is
tin
g
ep
id
em
io
lo
g
ical
s
tu
d
ies
h
av
e
r
ep
o
r
te
d
ass
o
ciatio
n
s
b
etwe
en
NO₂
ex
p
o
s
u
r
e
an
d
elev
ated
b
lo
o
d
p
r
ess
u
r
e;
h
o
wev
er
,
th
eir
f
in
d
i
n
g
s
r
em
ain
in
co
n
s
is
ten
t
b
ec
au
s
e
o
f
d
if
f
er
en
ce
s
in
o
cc
u
p
atio
n
al
s
ettin
g
s
,
ex
p
o
s
u
r
e
ass
ess
m
en
t
m
eth
o
d
s
,
s
t
u
d
y
p
o
p
u
latio
n
s
,
an
d
h
y
p
e
r
ten
s
io
n
o
u
tco
m
e
m
ea
s
u
r
em
en
ts
.
So
m
e
s
tu
d
ies h
av
e
r
elied
o
n
am
b
ien
t a
ir
m
o
n
ito
r
in
g
,
wh
e
r
ea
s
o
th
er
s
h
av
e
esti
m
ated
in
d
iv
id
u
al
o
cc
u
p
atio
n
al
e
x
p
o
s
u
r
e,
r
esu
lt
in
g
in
co
n
s
id
er
ab
le
m
eth
o
d
o
l
o
g
ical
h
eter
o
g
en
eity
.
M
o
r
eo
v
er
,
m
o
s
t
av
ailab
le
ev
id
en
ce
o
r
ig
i
n
ates
f
r
o
m
o
b
s
er
v
atio
n
al
s
tu
d
ies
co
n
d
u
ct
ed
in
s
p
ec
if
ic
in
d
u
s
tr
ial
s
ec
to
r
s
,
lim
itin
g
th
e
g
en
er
aliza
b
ilit
y
o
f
th
eir
f
in
d
in
g
s
ac
r
o
s
s
d
iv
er
s
e
o
cc
u
p
ati
o
n
al
en
v
ir
o
n
m
en
ts
.
Pre
v
io
u
s
r
ev
iews
h
av
e
p
r
im
ar
i
ly
f
o
cu
s
ed
o
n
th
e
b
r
o
ad
er
ca
r
d
io
v
ascu
lar
ef
f
ec
ts
o
f
air
p
o
llu
t
io
n
o
r
o
n
en
v
ir
o
n
m
en
tal
NO₂
ex
p
o
s
u
r
e
in
th
e
g
e
n
er
al
p
o
p
u
latio
n
,
with
lim
ited
atten
tio
n
to
o
cc
u
p
atio
n
ally
e
x
p
o
s
ed
wo
r
k
er
s
.
C
o
n
s
eq
u
en
tly
,
th
ey
h
av
e
n
o
t
co
m
p
r
eh
e
n
s
iv
ely
ev
al
u
ated
h
o
w
o
cc
u
p
atio
n
al
e
x
p
o
s
u
r
e
ch
ar
ac
ter
is
tics
,
in
clu
d
in
g
ex
p
o
s
u
r
e
i
n
ten
s
ity
,
d
u
r
atio
n
,
an
d
wo
r
k
p
lace
c
o
n
tex
t,
in
f
l
u
en
ce
th
e
r
elatio
n
s
h
ip
b
etwe
en
NO₂
ex
p
o
s
u
r
e
an
d
h
y
p
e
r
ten
s
io
n
.
T
h
is
g
ap
lim
its
th
e
cu
r
r
en
t
u
n
d
er
s
tan
d
in
g
o
f
o
cc
u
p
ati
o
n
-
s
p
ec
if
ic
ca
r
d
io
v
ascu
lar
r
is
k
s
an
d
h
in
d
e
r
s
th
e
d
e
v
elo
p
m
en
t
o
f
ev
i
d
en
ce
-
b
ased
wo
r
k
p
lace
p
r
ev
en
tio
n
s
tr
ateg
ies.
T
h
er
ef
o
r
e,
th
is
s
y
s
tem
atic
r
ev
iew
aim
s
to
s
y
n
th
esize
an
d
cr
itically
e
v
alu
ate
th
e
a
v
ailab
le
ev
i
d
en
ce
o
n
th
e
ass
o
ciatio
n
b
etwe
en
o
cc
u
p
atio
n
al
NO₂
ex
p
o
s
u
r
e
an
d
h
y
p
er
ten
s
io
n
am
o
n
g
wo
r
k
er
s
.
B
y
c
o
m
p
a
r
in
g
f
i
n
d
in
g
s
ac
r
o
s
s
d
if
f
er
en
t
o
cc
u
p
atio
n
al
s
ettin
g
s
,
ex
p
o
s
u
r
e
ass
ess
m
en
t
ap
p
r
o
ac
h
es,
an
d
s
tu
d
y
m
eth
o
d
o
lo
g
ie
s
,
th
is
r
ev
iew
s
ee
k
s
to
id
en
tify
co
n
s
is
ten
t
p
atter
n
s
,
ex
p
lain
d
is
cr
ep
an
cies
in
th
e
ex
is
tin
g
liter
atu
r
e,
an
d
p
r
o
v
id
e
a
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
o
cc
u
p
atio
n
al
NO₂
-
r
elate
d
h
y
p
er
ten
s
io
n
.
T
h
is
r
ev
iew
als
o
ex
ten
d
s
p
r
ev
io
u
s
ev
id
en
ce
b
y
s
p
ec
if
ically
f
o
cu
s
in
g
o
n
o
cc
u
p
atio
n
al
p
o
p
u
latio
n
s
,
th
er
eb
y
ad
d
r
ess
in
g
an
im
p
o
r
tan
t
g
ap
th
at
h
as
r
ec
eiv
ed
lim
ited
atten
tio
n
in
e
ar
lier
s
y
s
tem
atic
r
ev
iews.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
em
p
lo
y
e
d
a
s
y
s
tem
atic
r
ev
iew
d
esig
n
g
u
i
d
e
d
b
y
th
e
p
r
ef
e
r
r
ed
r
e
p
o
r
tin
g
item
s
f
o
r
s
y
s
tem
atic
r
ev
iews
an
d
m
eta
-
an
aly
s
es
(
PR
I
SMA)
.
A
s
y
s
t
em
atic
r
ev
iew
r
ep
r
esen
ts
a
r
ig
o
r
o
u
s
,
s
tr
u
ct
u
r
e
d
ef
f
o
r
t
to
co
llect,
cr
itically
ev
al
u
ate,
s
y
n
th
esize,
an
d
p
r
esen
t
f
in
d
in
g
s
f
r
o
m
m
u
ltip
le
r
esear
c
h
s
tu
d
ies
to
ad
d
r
ess
a
p
r
e
d
ef
in
ed
r
esear
ch
o
b
jectiv
e
[
2
5
]
.
Prio
r
to
d
ata
c
o
llectio
n
,
th
e
s
tu
d
y
p
r
o
to
co
l
was
r
eg
is
ter
ed
in
t
h
e
in
ter
n
atio
n
al
p
r
o
s
p
ec
tiv
e
r
eg
is
ter
o
f
s
y
s
tem
atic
r
ev
iews
(
PR
OSPER
O)
u
n
d
er
th
e
I
D
C
R
D4
2
0
2
5
1
1
5
3
6
2
9
.
T
h
e
r
ev
iew
p
r
o
ce
s
s
f
o
llo
wed
th
e
PR
I
SM
A
f
r
am
ewo
r
k
,
wh
ich
in
clu
d
ed
f
o
u
r
s
eq
u
en
tial
s
tag
es:
id
en
tific
atio
n
,
s
cr
ee
n
in
g
,
elig
ib
ilit
y
ass
ess
m
en
t,
an
d
f
in
a
l
in
clu
s
io
n
o
f
e
lig
ib
le
s
tu
d
ies
.
Sev
er
al
s
tag
e
s
wer
e
u
n
d
er
tak
en
d
u
r
in
g
th
e
d
ata
c
o
llectio
n
p
r
o
c
ess
,
in
clu
d
in
g
:
2
.
1
.
Select
io
n o
f
da
t
a
ba
s
es a
nd
k
ey
wo
rds
T
h
e
liter
atu
r
e
s
ea
r
ch
was
co
n
d
u
cted
u
s
in
g
elec
tr
o
n
ically
p
u
b
lis
h
ed
r
esear
ch
ar
ticles
f
r
o
m
n
atio
n
al
an
d
in
te
r
n
atio
n
al
jo
u
r
n
als
in
d
ex
ed
in
Go
o
g
le
Sch
o
lar
,
Pu
b
Me
d
,
an
d
Scien
ce
Dir
ec
t
f
o
r
th
e
p
er
io
d
2
0
2
0
–
2
0
2
5
.
Key
wo
r
d
f
o
r
m
u
latio
n
was
b
a
s
ed
o
n
in
clu
s
io
n
cr
iter
ia
s
tr
u
ctu
r
ed
u
s
in
g
th
e
PICO
f
r
am
e
wo
r
k
as
s
h
o
wn
in
T
ab
le
1
.
T
h
e
PICO
m
o
d
el
was
ap
p
lied
to
g
u
i
d
e
th
e
r
esear
c
h
q
u
esti
o
n
an
d
elig
ib
ilit
y
cr
ite
r
ia,
wh
ile
PR
I
SMA
en
s
u
r
ed
a
tr
a
n
s
p
ar
en
t a
n
d
s
y
s
tem
atic
r
ep
o
r
tin
g
p
r
o
ce
s
s
.
T
h
e
in
clu
s
io
n
cr
iter
ia
co
n
s
is
ted
o
f
:
i)
Ar
ticles wr
itten
in
I
n
d
o
n
esian
o
r
E
n
g
lis
h
;
ii)
Pu
b
lis
h
ed
b
etwe
en
2
0
2
0
a
n
d
2
0
2
5
;
iii)
Acc
ess
ib
le
in
f
u
ll tex
t;
i
v
)
E
m
p
l
o
y
i
n
g
o
b
s
e
r
v
a
t
i
o
n
a
l
s
t
u
d
y
d
e
s
i
g
n
s
,
i
n
c
l
u
d
i
n
g
c
r
o
s
s
-
s
e
ct
i
o
n
a
l
,
c
o
h
o
r
t
,
c
a
s
e
s
t
u
d
y
,
o
r
e
c
o
lo
g
i
c
a
l
s
t
u
d
i
e
s
;
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
3
,
Sep
tem
b
er
20
26
:
8
6
8
-
878
870
v)
Stu
d
y
p
o
p
u
latio
n
s
f
o
c
u
s
ed
o
n
wo
r
k
er
s
in
f
o
r
m
al
o
r
in
f
o
r
m
al
s
ec
to
r
s
;
v
i)
Ar
ticles
ex
am
in
in
g
NO₂
ex
p
o
s
u
r
e
(
ex
p
o
s
u
r
e
v
ar
ia
b
le)
,
h
y
p
er
ten
s
io
n
(
o
u
tco
m
e
v
ar
iab
le)
,
an
d
th
e
r
elatio
n
s
h
ip
b
etwe
en
th
e
two
.
T
h
e
ex
clu
s
io
n
cr
iter
ia
in
clu
d
ed
r
ev
iew
ar
ticles,
co
n
f
er
en
c
e
p
r
o
ce
ed
in
g
s
,
ed
ito
r
ials
,
co
m
m
en
tar
ies,
s
tu
d
y
p
r
o
to
co
ls
,
ar
ticles
with
o
u
t
f
u
ll
-
tex
t
ac
ce
s
s
,
d
u
p
licate
p
u
b
lica
tio
n
s
,
an
d
s
tu
d
ies
th
at
d
id
n
o
t r
ep
o
r
t
o
cc
u
p
atio
n
al
NO₂
ex
p
o
s
u
r
e
o
r
h
y
p
er
ten
s
io
n
o
u
tco
m
es r
elev
a
n
t to
th
e
r
ev
i
ew
o
b
jectiv
e
.
T
ab
le
1
.
PICO in
d
icato
r
s
f
o
r
k
ey
wo
r
d
f
o
r
m
u
latio
n
P
I
C
O
i
n
d
i
c
a
t
o
r
C
r
i
t
e
r
i
a
P
o
p
u
l
a
t
i
o
n
W
o
r
k
er
s
I
n
t
e
r
v
e
n
t
i
o
n
Ni
t
rog
en
d
i
o
x
i
d
e
ex
p
o
su
re
C
o
m
p
ar
i
s
o
n
Vari
at
i
o
n
i
n
NO
₂
ex
p
o
su
re
co
n
ce
n
t
r
at
i
o
n
s
amo
n
g
work
ers
O
u
t
c
o
m
e
R
i
s
k
o
f
h
y
p
e
r
t
e
n
si
o
n
2
.
2
.
Da
t
a
s
ea
rc
hin
g
T
h
e
liter
atu
r
e
s
ea
r
ch
was
p
er
f
o
r
m
ed
u
s
in
g
I
n
d
o
n
esian
k
e
y
wo
r
d
s
(
“NO
₂”
OR
“Nitr
o
g
en
Dio
k
s
id
a”
AND
“Hip
er
ten
s
i”
OR
“T
ek
an
an
Dar
ah
”
AND
“Pek
er
ja”)
an
d
E
n
g
lis
h
k
e
y
wo
r
d
s
(
“NO
₂”
OR
“Nitr
o
g
en
Dio
x
id
e”
AND
“Hy
p
er
ten
s
io
n
”
OR
“Bl
o
o
d
Pre
s
s
u
r
e”
AND
“Wo
r
k
er
”)
with
in
th
e
2
0
2
0
–
2
0
2
5
p
u
b
licatio
n
r
an
g
e.
T
h
e
ar
ticle
id
en
tific
atio
n
p
r
o
ce
s
s
ad
h
e
r
ed
s
tr
ictly
to
P
R
I
SMA
g
u
id
elin
es.
All
r
ec
o
r
d
s
r
etr
iev
ed
f
r
o
m
t
h
e
s
elec
ted
d
atab
ases
wer
e
ex
p
o
r
ted
a
n
d
co
m
p
iled
f
o
r
s
cr
ee
n
in
g
.
Du
p
licate
r
ec
o
r
d
s
id
en
tifie
d
a
cr
o
s
s
d
atab
ases
wer
e
r
e
m
o
v
e
d
p
r
io
r
to
th
e
s
cr
ee
n
in
g
p
r
o
ce
s
s
.
Su
b
s
eq
u
e
n
tly
,
two
in
d
ep
en
d
en
t
r
ev
iewe
r
s
s
cr
ee
n
ed
th
e
titl
es
an
d
ab
s
tr
ac
ts
o
f
th
e
r
em
ain
i
n
g
ar
ticles
ag
ain
s
t
th
e
p
r
ed
ef
in
e
d
in
clu
s
io
n
an
d
ex
cl
u
s
io
n
cr
it
er
ia.
Ar
ticles
th
at
wer
e
clea
r
ly
u
n
r
elate
d
to
o
cc
u
p
atio
n
a
l
NO₂
ex
p
o
s
u
r
e
o
r
h
y
p
er
ten
s
io
n
am
o
n
g
w
o
r
k
er
s
wer
e
ex
clu
d
e
d
at
t
h
is
s
tag
e.
T
h
e
f
u
ll
tex
ts
o
f
p
o
ten
tially
e
lig
ib
le
s
tu
d
ies
wer
e
th
en
r
etr
ie
v
ed
a
n
d
ass
ess
ed
in
d
ep
en
d
en
tly
b
y
b
o
th
r
e
v
iewe
r
s
to
d
eter
m
in
e
th
eir
elig
i
b
ilit
y
.
Stu
d
ies
th
at
f
u
lf
illed
all
in
cl
u
s
io
n
cr
iter
i
a
wer
e
in
cl
u
d
ed
in
th
e
f
in
al
q
u
alitativ
e
s
y
n
th
esis
,
wh
er
ea
s
s
tu
d
ies
with
in
s
u
f
f
icien
t
d
ata,
ir
r
elev
an
t
o
u
tco
m
es,
o
r
p
o
p
u
latio
n
s
o
u
ts
id
e
th
e
r
ev
iew
s
co
p
e
wer
e
ex
clu
d
ed
.
T
h
e
c
o
m
p
lete
s
tu
d
y
s
elec
tio
n
p
r
o
ce
s
s
is
p
r
esen
ted
in
th
e
PR
I
SMA
f
lo
w
d
ia
g
r
am
as sh
o
wn
in
Fig
u
r
e
1
.
2
.
3
.
Art
icle
a
pp
ra
is
a
l
Ar
ticle
ap
p
r
aisal
was
co
n
d
u
ct
ed
to
ass
ess
s
tu
d
y
q
u
ality
an
d
p
o
ten
tial
r
is
k
o
f
b
ias
b
y
two
in
d
ep
en
d
e
n
t
r
ev
iewe
r
s
(
MCT
an
d
MA
F).
Stu
d
y
q
u
ality
was
ev
al
u
ated
u
s
in
g
th
e
J
B
I
C
r
itical
Ap
p
r
ai
s
al
C
h
ec
k
lis
t,
wh
ile
r
is
k
o
f
b
ias
was
ass
es
s
ed
u
s
in
g
th
e
o
f
f
ice
o
f
h
ea
lt
h
ass
ess
m
en
t
an
d
tr
an
s
latio
n
(
OHAT
)
r
is
k
o
f
b
ias
to
o
l
.
A
Kap
p
a
Ag
r
ee
m
en
t
Valu
e
was
s
u
b
s
eq
u
en
tly
ca
lcu
lated
to
d
eter
m
in
e
th
e
lev
el
o
f
in
te
r
-
r
ev
iewe
r
ag
r
ee
m
e
n
t
in
ev
alu
atin
g
s
tu
d
y
q
u
ality
an
d
r
i
s
k
o
f
b
ias.
An
y
d
is
ag
r
ee
m
en
ts
b
etwe
en
th
e
two
r
e
v
iewe
r
s
d
u
r
in
g
t
h
e
s
cr
ee
n
in
g
,
elig
ib
ilit
y
ass
e
s
s
m
en
t,
q
u
ality
ap
p
r
aisal,
o
r
r
is
k
o
f
b
ias
ev
alu
atio
n
wer
e
r
eso
lv
ed
th
r
o
u
g
h
d
is
cu
s
s
io
n
u
n
til
co
n
s
en
s
u
s
was
r
ea
ch
ed
.
W
h
e
n
n
ec
ess
ar
y
,
a
th
ir
d
r
ev
iewe
r
was
co
n
s
u
lted
to
en
s
u
r
e
c
o
n
s
is
ten
cy
in
th
e
s
tu
d
y
s
elec
tio
n
an
d
ap
p
r
aisal p
r
o
c
es
s
.
3.
RE
SU
L
T
S
B
ased
o
n
th
e
liter
atu
r
e
s
ea
r
ch
co
n
d
u
cte
d
b
etwe
en
2
0
2
0
a
n
d
2
0
2
5
r
eg
ar
d
in
g
n
itr
o
g
en
d
io
x
id
e
(
NO₂)
ex
p
o
s
u
r
e
an
d
th
e
r
is
k
o
f
h
y
p
er
ten
s
io
n
am
o
n
g
wo
r
k
er
s
,
f
iv
e
ar
ticles
wer
e
id
en
tifie
d
th
at
m
et
th
e
p
r
ed
ef
in
e
d
elig
ib
ilit
y
cr
iter
ia.
T
h
ese
ar
ticles
u
n
d
er
wen
t
th
e
th
r
ee
-
s
tag
e
PR
I
SMA
s
cr
ee
n
in
g
p
r
o
ce
s
s
,
as
illu
s
tr
ated
in
Fig
u
r
e
1
.
Su
b
s
eq
u
en
tl
y
,
ea
ch
ar
ticle
was
s
u
b
jecte
d
to
q
u
ality
ass
es
s
m
en
t
an
d
r
is
k
-
of
-
b
ias
ev
alu
atio
n
b
y
two
in
d
ep
en
d
en
t
r
e
v
iewe
r
s
(
MCT
an
d
MA
F).
Ov
er
all,
th
e
q
u
ality
ap
p
r
aisal
in
d
icate
d
t
h
at
all
f
iv
e
s
t
u
d
ies
d
em
o
n
s
tr
ated
g
o
o
d
m
eth
o
d
o
l
o
g
ical
q
u
ality
,
ea
c
h
ac
h
iev
in
g
a
s
co
r
e
o
f
1
0
0
%.
T
h
e
in
t
er
-
r
ater
r
eliab
ilit
y
an
aly
s
is
u
s
in
g
th
e
Kap
p
a
Ag
r
ee
m
en
t
Valu
e
y
ield
ed
a
s
co
r
e
o
f
1
.
0
(
in
d
icatin
g
p
er
f
ec
t
ag
r
ee
m
en
t
b
etwe
en
r
ev
iewe
r
s
)
,
with
a
p
-
v
alu
e
o
f
0
.
0
2
5
.
T
h
e
r
is
k
-
of
-
b
ias
ass
ess
m
en
t
s
h
o
wed
th
at
all
in
cl
u
d
ed
a
r
ticles
wer
e
ca
teg
o
r
ized
as
h
av
i
n
g
a
“lo
w
lik
elih
o
o
d
o
f
b
ias.”
T
h
e
co
r
r
esp
o
n
d
in
g
Kap
p
a
Ag
r
ee
m
en
t
Valu
e
f
o
r
t
h
is
ass
es
s
m
en
t w
as 0
.
5
(
in
d
icatin
g
m
o
d
e
r
ate
ag
r
ee
m
e
n
t b
etwe
e
n
r
ev
iewe
r
s
)
,
with
a
p
-
v
alu
e
o
f
0
.
0
1
2
.
T
h
e
co
n
s
is
ten
tly
h
ig
h
-
q
u
ality
s
co
r
es
wer
e
p
r
im
ar
ily
attr
ib
u
ted
to
th
e
f
ac
t
th
at
all
in
clu
d
ed
s
tu
d
ies
clea
r
ly
d
ef
in
ed
t
h
eir
s
tu
d
y
p
o
p
u
latio
n
s
,
ex
p
o
s
u
r
e
v
ar
i
ab
les,
an
d
h
y
p
er
ten
s
io
n
o
u
tco
m
es,
em
p
lo
y
ed
ap
p
r
o
p
r
iate
o
b
s
er
v
atio
n
al
s
tu
d
y
d
esig
n
s
,
a
n
d
r
e
p
o
r
ted
s
tatis
t
ical
an
aly
s
es
th
at
ad
eq
u
ately
ad
d
r
ess
ed
th
e
r
esear
ch
o
b
jectiv
es.
Fu
r
th
er
m
o
r
e,
th
e
s
tu
d
ies
p
r
o
v
id
e
d
s
u
f
f
i
cien
t
m
eth
o
d
o
lo
g
ical
d
etail
r
e
g
ar
d
in
g
p
a
r
ticip
an
t
s
elec
tio
n
,
ex
p
o
s
u
r
e
ass
ess
m
en
t,
an
d
o
u
tco
m
e
m
ea
s
u
r
em
en
t,
s
u
p
p
o
r
tin
g
th
eir
o
v
er
all
m
e
th
o
d
o
lo
g
ical
r
ig
o
r
.
T
h
e
lo
w
r
is
k
-
of
-
b
ias
r
atin
g
s
in
d
icate
th
at
th
e
in
clu
d
e
d
s
tu
d
ies
wer
e
co
n
s
id
er
ed
r
eliab
le
s
o
u
r
ce
s
o
f
ev
i
d
en
ce
,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
s
s
o
cia
tio
n
b
etw
ee
n
o
cc
u
p
a
ti
o
n
a
l NO₂ e
xp
o
s
u
r
e
a
n
d
h
y
p
erten
s
io
n
r
is
k:
… (
A
yu
d
h
i
a
R
a
ch
ma
w
a
ti
)
871
alth
o
u
g
h
d
if
f
er
e
n
ce
s
in
ex
p
o
s
u
r
e
ass
es
s
m
en
t
m
eth
o
d
s
an
d
s
tu
d
y
s
ettin
g
s
r
em
ain
ed
p
o
ten
tial
s
o
u
r
ce
s
o
f
m
eth
o
d
o
l
o
g
ical
h
eter
o
g
e
n
eity
.
T
h
ese
r
esu
lts
af
f
ir
m
th
at
th
e
in
clu
d
ed
s
tu
d
ies
p
o
s
s
ess
s
tr
o
n
g
m
eth
o
d
o
lo
g
ical
r
ig
o
r
an
d
a
r
elativ
ely
lo
w
r
is
k
o
f
b
ias,
s
u
p
p
o
r
tin
g
th
eir
s
u
itab
ilit
y
f
o
r
in
clu
s
io
n
in
th
e
p
r
esen
t
s
y
s
tem
atic
r
ev
iew.
Fig
u
r
e
1
.
Flo
w
d
ia
g
r
am
o
f
th
e
ar
ticle
s
cr
ee
n
in
g
p
r
o
ce
s
s
A
s
u
m
m
ar
y
o
f
th
e
liter
atu
r
e
s
ea
r
ch
r
esu
lts
f
r
o
m
th
e
f
i
v
e
ar
t
icles
ex
am
in
in
g
n
itr
o
g
en
d
io
x
id
e
(
NO₂)
ex
p
o
s
u
r
e
an
d
th
e
r
is
k
o
f
h
y
p
e
r
ten
s
io
n
am
o
n
g
wo
r
k
er
s
d
u
r
i
n
g
th
e
p
er
io
d
2
0
2
0
–
2
0
2
5
is
p
r
esen
ted
in
T
ab
le
2
.
T
h
e
d
is
tr
ib
u
tio
n
o
f
p
u
b
licatio
n
y
ea
r
s
s
h
o
ws th
at
r
elev
an
t stu
d
ies we
r
e
n
o
t p
u
b
lis
h
ed
an
n
u
all
y
.
On
e
ar
ticle
was
p
u
b
lis
h
ed
in
2
0
2
2
,
o
n
e
in
2
0
2
4
,
an
d
th
r
ee
in
2
0
2
5
.
I
n
ter
m
s
o
f
s
tu
d
y
lo
ca
tio
n
,
th
e
m
ajo
r
it
y
o
f
r
esear
ch
was
co
n
d
u
cte
d
in
C
h
in
a
(
f
o
u
r
ar
t
icles).
Ov
er
th
e
p
ast
s
ev
er
al
d
ec
ad
es,
C
h
in
a
h
as
u
n
d
er
g
o
n
e
r
ap
id
ec
o
n
o
m
ic
ex
p
an
s
io
n
ch
ar
ac
te
r
ized
b
y
i
n
ten
s
iv
e
in
d
u
s
tr
ial
ac
tiv
ity
,
wh
ich
h
as
co
n
tr
ib
u
ted
to
in
cr
e
ased
en
v
ir
o
n
m
e
n
tal
p
o
llu
tio
n
,
i
n
clu
d
in
g
h
eig
h
ten
e
d
NO₂
lev
els in
am
b
ien
t a
ir
[
2
6
]
.
Of
th
e
f
iv
e
i
n
clu
d
e
d
s
tu
d
ies,
th
r
ee
em
p
lo
y
ed
a
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
,
w
h
ile
two
u
tili
ze
d
co
h
o
r
t
d
esig
n
s
.
R
eg
ar
d
in
g
wo
r
k
e
r
c
ateg
o
r
ies,
th
r
ee
ar
ticles
f
o
cu
s
ed
o
n
s
p
ec
if
ic
o
cc
u
p
atio
n
al
g
r
o
u
p
s
,
n
am
ely
o
il
m
in
in
g
wo
r
k
e
r
s
,
co
al
m
in
in
g
wo
r
k
er
s
,
an
d
r
o
ad
s
id
e
wo
r
k
er
s
(
in
clu
d
in
g
d
r
iv
e
r
s
,
co
n
d
u
cto
r
s
,
s
tr
ee
t
lab
o
r
er
s
,
an
d
v
en
d
o
r
s
)
.
T
h
e
tr
an
s
p
o
r
tat
io
n
s
ec
to
r
is
r
ec
o
g
n
ized
as
a
m
ajo
r
co
n
tr
ib
u
to
r
to
o
u
td
o
o
r
air
p
o
llu
tio
n
,
wh
er
e
f
o
s
s
il
-
f
u
el
co
m
b
u
s
tio
n
g
en
e
r
a
tes
NO₂
em
i
s
s
io
n
s
.
S
im
ilar
ly
,
m
in
in
g
ac
tiv
ities
ar
e
also
s
ig
n
if
ican
t
s
o
u
r
ce
s
o
f
NO₂,
wh
ich
m
ay
ar
is
e
f
r
o
m
c
o
al
ex
tr
ac
tio
n
an
d
tr
an
s
p
o
r
tatio
n
p
r
o
ce
s
s
es
as
well
as
em
is
s
io
n
s
f
r
o
m
d
iesel
-
p
o
wer
ed
m
ac
h
i
n
er
y
[
2
7
]
,
[
2
8
]
.
C
o
llectiv
ely
,
th
ese
ch
ar
ac
ter
is
tics
i
llu
s
tr
ate
th
at
o
cc
u
p
atio
n
al
en
v
ir
o
n
m
en
ts
with
h
ig
h
r
elian
ce
o
n
f
u
el
co
m
b
u
s
tio
n
an
d
h
ea
v
y
in
d
u
s
tr
ial
o
p
er
atio
n
s
p
o
s
e
s
u
b
s
tan
tial
r
is
k
s
f
o
r
NO₂
ex
p
o
s
u
r
e,
th
er
eb
y
u
n
d
er
s
co
r
i
n
g
th
e
r
elev
an
ce
o
f
e
x
am
in
in
g
h
y
p
er
ten
s
io
n
o
u
tco
m
es
am
o
n
g
e
x
p
o
s
ed
w
o
r
k
er
p
o
p
u
latio
n
s
.
Acr
o
s
s
th
e
in
clu
d
ed
s
tu
d
ies,
s
ev
er
al
co
n
s
is
ten
t
p
atter
n
s
em
er
g
ed
.
First,
all
s
tu
d
ies
r
ep
o
r
ted
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
e
to
N
O₂
in
en
v
ir
o
n
m
e
n
ts
ch
ar
ac
ter
ized
b
y
co
m
b
u
s
tio
n
-
r
elate
d
em
is
s
io
n
s
,
s
u
ch
as
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
3
,
Sep
tem
b
er
20
26
:
8
6
8
-
878
872
m
in
in
g
o
p
er
atio
n
s
,
in
d
u
s
tr
ial
ac
tiv
ities
,
an
d
r
o
ad
s
id
e
o
cc
u
p
atio
n
s
.
Seco
n
d
,
d
esp
ite
s
u
b
s
tan
tial
d
if
f
er
en
ce
s
in
NO₂
co
n
ce
n
tr
atio
n
s
ac
r
o
s
s
o
c
cu
p
atio
n
al
s
ettin
g
s
,
ea
ch
s
tu
d
y
co
n
s
is
ten
tly
s
u
g
g
ested
a
n
a
s
s
o
ciatio
n
b
etwe
en
NO₂
ex
p
o
s
u
r
e
an
d
ad
v
er
s
e
ca
r
d
io
v
ascu
lar
o
u
tco
m
es,
p
ar
ti
cu
lar
ly
h
y
p
e
r
ten
s
io
n
o
r
elev
a
ted
b
lo
o
d
p
r
ess
u
r
e.
T
h
ese
f
in
d
in
g
s
s
u
p
p
o
r
t
th
e
b
io
lo
g
ical
p
lau
s
ib
ilit
y
th
at
p
r
o
lo
n
g
e
d
o
cc
u
p
atio
n
al
e
x
p
o
s
u
r
e
to
NO₂
m
ay
co
n
tr
ib
u
te
to
ca
r
d
i
o
v
ascu
lar
d
y
s
f
u
n
ctio
n
th
r
o
u
g
h
o
x
i
d
ativ
e
s
tr
ess
,
s
y
s
tem
ic
in
f
lam
m
atio
n
,
an
d
en
d
o
th
elial
im
p
air
m
en
t.
Nev
er
th
eless
,
co
n
s
id
er
ab
le
h
e
ter
o
g
en
eity
was
o
b
s
er
v
e
d
am
o
n
g
th
e
in
clu
d
ed
s
tu
d
ies.
T
h
e
r
ep
o
r
ted
NO₂
co
n
ce
n
tr
atio
n
s
v
ar
ied
m
a
r
k
ed
ly
,
r
an
g
i
n
g
f
r
o
m
less
th
an
2
µ
g
/m
³
am
o
n
g
r
o
ad
s
id
e
w
o
r
k
er
s
in
Nig
er
ia
to
2
,
1
4
0
µ
g
/m
³
am
o
n
g
u
n
d
e
r
g
r
o
u
n
d
co
al
m
in
er
s
in
C
h
in
a.
L
ik
ewise,
h
y
p
er
ten
s
io
n
p
r
ev
ale
n
c
e
r
an
g
ed
f
r
o
m
7
.
2
%
to
7
1
.
3
%,
r
e
f
lectin
g
d
if
f
e
r
en
c
es
in
o
cc
u
p
atio
n
al
en
v
ir
o
n
m
e
n
ts
,
ex
p
o
s
u
r
e
d
u
r
atio
n
,
w
o
r
k
er
ch
ar
ac
ter
is
tics
,
an
d
ex
p
o
s
u
r
e
ass
ess
m
en
t
m
eth
o
d
s
.
W
h
i
le
s
o
m
e
s
tu
d
ies
esti
m
ated
lo
n
g
-
ter
m
am
b
ien
t
NO₂
ex
p
o
s
u
r
e,
o
th
er
s
m
ea
s
u
r
ed
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
e
d
ir
ec
tly
with
in
in
d
u
s
tr
ial
s
ettin
g
s
,
m
ak
in
g
d
ir
ec
t
q
u
an
t
itativ
e
co
m
p
ar
is
o
n
ch
allen
g
in
g
.
I
n
ad
d
itio
n
,
o
n
e
s
tu
d
y
ev
alu
ated
o
cu
lar
h
y
p
er
ten
s
io
n
r
ath
er
th
a
n
s
y
s
tem
i
c
h
y
p
er
te
n
s
io
n
,
in
d
icatin
g
v
ar
iatio
n
in
o
u
tco
m
e
d
ef
in
itio
n
s
ac
r
o
s
s
th
e
av
aila
b
le
ev
id
en
ce
.
T
ab
le
2
.
Su
m
m
a
r
y
o
f
ar
ticles in
clu
d
ed
i
n
th
e
s
tu
d
y
No
A
u
t
h
o
r
T
i
t
l
e
L
o
c
a
t
i
o
n
R
e
s
e
a
rc
h
d
e
s
i
g
n
R
e
s
u
l
t
s
D
i
s
c
u
s
s
i
o
n
1
G
o
n
g
e
t
a
l.
[
29
]
T
h
e
I
mpa
ct
o
f
B
l
o
o
d
L
ea
d
an
d
I
t
s
I
n
t
erac
t
i
o
n
wi
t
h
Occu
p
at
i
o
n
al
F
ac
t
o
rs
an
d
A
i
r
P
o
l
l
u
t
i
o
n
on
Hyp
ert
en
si
o
n
P
rev
al
en
ce
C
h
i
n
a
C
r
o
s
s
-
s
e
c
t
i
o
n
a
l
F
ro
m
a
t
o
t
a
l
o
f
2
2
,
0
2
2
work
ers,
2
,
8
0
5
i
n
d
i
v
i
d
u
a
l
s
(12
.
7
5
%)
were
i
d
en
t
i
fi
ed
as
h
av
i
n
g
h
y
p
ert
en
si
o
n
,
wi
t
h
a
mea
n
(st
an
d
ard
d
ev
i
ati
o
n
)
NO
₂
ex
p
o
su
re
o
f
2
9
.
1
6
µg
/
m³
(6.
2
9
µg
/
m³).
T
h
ere
was
a
si
g
n
i
fi
ca
n
t
i
n
t
erac
t
i
o
n
effect
o
f
NO
₂
b
et
ween
b
l
o
o
d
l
ea
d
l
ev
el
s
an
d
t
h
e
p
rev
al
en
ce
o
f
h
y
p
ert
en
si
o
n
(P
i
nt
e
r
a
c
t
i
o
n
=
0
.
0
4
).
2
Li
e
t
a
l
.
[
30
]
E
ff
ec
t
s
o
f
a
i
r
p
o
l
l
u
t
i
o
n
an
d
n
o
i
se
ex
p
o
su
re
o
n
o
c
c
u
p
a
t
i
o
n
a
l
h
e
a
r
i
n
g
l
o
ss
i
n
o
i
l
work
ers:
a
p
rosp
ec
t
i
v
e
co
h
o
rt
st
u
d
y
C
h
i
n
a
C
o
h
o
r
t
F
ro
m
1
,
1
7
9
o
i
l
mi
n
i
n
g
work
ers,
1
8
5
i
n
d
i
v
i
d
u
a
l
s
(15
.
7
0
%)
were
i
d
en
t
i
fi
ed
as
h
av
i
n
g
h
y
p
ert
en
si
o
n
,
wi
t
h
a
mea
n
(st
an
d
ard
d
ev
i
ati
o
n
)
NO
₂
ex
p
o
su
re
o
f
4
1
.
2
0
µg
/
m³
(8.
9
0
µg
/
m³).
L
o
n
g
-
t
erm
ex
p
o
su
re
t
o
n
i
t
rog
en
d
i
o
x
i
d
e
(N
O₂)
i
s
si
g
n
i
fi
ca
n
t
l
y
asso
ci
a
t
ed
wi
t
h
an
i
n
crea
sed
ri
sk
o
f
h
ea
ri
n
g
i
mpa
i
rmen
t
an
d
h
y
p
ert
en
s
i
o
n
t
h
rou
g
h
mec
h
an
i
sms
i
n
v
o
l
v
i
n
g
o
x
i
d
ati
v
e
st
ress
an
d
sy
st
emi
c
i
n
fl
ammat
i
o
n
,
whi
c
h
co
n
t
ri
b
u
t
e
t
o
en
d
o
t
h
e
l
i
a
l
d
y
sfun
ct
i
o
n
an
d
e
l
ev
at
ed
b
l
o
o
d
p
ressu
re.
3
C
h
en
et
a
l
.
[
31
]
A
s
s
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
C
o
mbi
n
ed
E
x
p
o
su
re
t
o
U
n
d
er
g
ro
u
n
d
A
i
r
P
o
l
l
u
t
a
n
t
s
an
d
Hyp
ert
en
si
o
n
in
C
o
al
M
i
n
ers:
A
C
ross
-
S
e
c
t
i
o
n
a
l
S
t
u
d
y
C
h
i
n
a
C
r
o
s
s
-
sec
t
i
o
n
a
l
F
ro
m
3
,
4
3
2
co
al
mi
n
ers,
6
3
0
i
n
d
i
v
i
d
u
al
s
(18
.
4
0
%)
were
i
d
en
t
i
fi
ed
as
h
av
i
n
g
h
y
p
ert
en
si
o
n
,
wi
t
h
an
av
erag
e
N
O₂
ex
p
o
su
re
l
ev
el
o
f
2
,
1
4
0
µg
/
m³.
T
h
ere
was
a
st
ron
g
an
d
si
g
n
i
fi
ca
n
t
co
n
t
r
i
b
u
t
i
o
n
o
f
NO
₂
ex
p
o
su
re
t
o
h
y
p
ert
en
si
o
n
ri
sk
,
wi
t
h
an
o
d
d
s
ra
t
i
o
(O
R
)
o
f
1
.
6
8
,
co
mpa
red
wi
t
h
C
O₂
an
d
NO.
4
Hua
n
g
et
a
l
.
[
32
]
L
o
n
g
-
t
erm
amb
i
en
t
ai
r
p
o
l
l
u
t
i
o
n
e
x
p
o
s
u
r
e
a
n
d
D
N
A
met
h
y
l
ati
o
n
o
f
p
eri
p
h
eral
b
rai
n
-
d
eri
v
ed
n
eu
rot
rop
h
i
c
fact
o
r
p
romo
t
er
C
h
i
n
a
C
o
h
o
r
t
I
n
2
0
1
1
,
amo
n
g
1
0
1
work
ers,
7
2
i
n
d
i
v
i
d
u
al
s
(71
.
3
0
%)
were
i
d
en
t
i
fi
ed
as
h
av
i
n
g
h
y
p
ert
en
si
o
n
,
wi
t
h
a
mea
n
(st
an
d
ard
d
ev
i
ati
o
n
)
NO
₂
ex
p
o
su
re
o
f
6
0
.
1
7
µg
/
m³
(2.
1
7
µg
/
m³)
i
n
2
0
1
1
an
d
5
7
.
6
6
µg
/
m³
(2
.
3
2
µg
/
m³)
i
n
2015.
L
o
n
g
-
t
erm
NO
₂
ex
p
o
su
re
i
s
asso
ci
at
ed
wi
t
h
si
g
n
i
fi
ca
n
t
al
t
erati
o
n
s
i
n
B
rai
n
-
Deri
v
ed
Neu
rot
rop
h
i
c
F
ac
t
o
r
(B
DN
F
)
p
romo
t
er
met
h
y
l
ati
o
n
l
ev
el
s
,
co
n
t
ri
b
u
t
i
n
g
t
o
an
i
n
crea
sed
ri
sk
o
f
h
y
p
ert
en
si
o
n
amo
n
g
work
ers.
5
N
w
a
k
a
mm
a
e
t
a
l
.
[
33
]
I
n
fl
u
en
ce
o
f
Ai
r
P
o
l
l
u
t
an
t
s
o
n
Ocu
l
ar
Heal
t
h
Am
o
n
g
R
o
ad
T
ran
sp
o
rt
W
o
rke
r
s
i
n
I
mo
S
t
at
e,
Ni
g
eri
a
N
i
g
e
r
i
a
C
r
o
s
s
-
sec
t
i
o
n
a
l
F
ro
m
3
7
4
roa
d
si
d
e
work
ers,
2
7
i
n
d
i
v
i
d
u
a
l
s
(7.
2
2
%)
were
i
d
en
t
i
fi
ed
as
h
av
i
n
g
o
cu
l
ar
h
y
p
ert
en
si
o
n
,
wi
t
h
mea
n
(st
an
d
ard
d
ev
i
ati
o
n
)
NO
₂
ex
p
o
su
re
l
ev
el
s
at
t
h
ree
l
o
ca
t
i
o
n
s
mea
su
ri
n
g
0
.
7
9
µg
/
m³
(1.
0
4
µg
/
m³),
1
.
9
0
µg
/
m³
(0.
5
0
µg
/
m³),
an
d
1
.
7
9
µg
/
m³
(1.
1
0
µg
/
m³).
R
o
ad
si
d
e
work
ers
who
ad
o
p
t
ed
p
rev
en
t
i
v
e
mea
su
res
were
s
i
g
n
i
fi
ca
n
t
l
y
l
ess
l
i
k
e
l
y
t
o
ex
p
eri
en
ce
o
cu
l
ar
p
rob
l
ems,
i
n
cl
u
d
i
n
g
o
cu
l
ar
h
y
p
ert
en
si
o
n
,
co
mpa
red
wi
t
h
t
h
o
se
who
d
i
d
n
o
t
i
mpl
eme
n
t
su
ch
mea
su
res
(O
R
=
0
.
0
6
;
p
=
0
.
0
0
1
,
χ²
=
1
4
2
.
8
9
,
d
f
=
1
).
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
s
s
o
cia
tio
n
b
etw
ee
n
o
cc
u
p
a
ti
o
n
a
l NO₂ e
xp
o
s
u
r
e
a
n
d
h
y
p
erten
s
io
n
r
is
k:
… (
A
yu
d
h
i
a
R
a
ch
ma
w
a
ti
)
873
B
ased
o
n
th
e
m
ag
n
itu
d
e
o
f
NO₂
ex
p
o
s
u
r
e
am
o
n
g
wo
r
k
er
s
,
th
e
s
tu
d
y
b
y
C
h
en
et
a
l
.
[
31
]
r
ep
o
r
ted
th
e
h
ig
h
est
ex
p
o
s
u
r
e
lev
el
at
2
,
1
4
0
µg
/m
³,
wh
er
ea
s
th
e
s
tu
d
y
b
y
Nwa
k
am
m
a
et
a
l.
[
33
]
d
o
c
u
m
en
ted
th
e
lo
west
ex
p
o
s
u
r
e
r
a
n
g
e
at
0
.
7
9
–
1
.
9
0
µg
/m
³.
T
h
ese
two
s
tu
d
ies
wer
e
co
n
d
u
cted
in
m
ar
k
ed
ly
d
i
f
f
er
en
t
s
ettin
g
s
,
with
th
e
h
ig
h
est NO₂
co
n
ce
n
tr
atio
n
s
o
b
s
er
v
ed
at
co
al
m
in
in
g
s
ites
.
Alth
o
u
g
h
th
e
m
ag
n
itu
d
e
o
f
ex
p
o
s
u
r
e
d
if
f
er
ed
s
u
b
s
tan
tially
a
cr
o
s
s
s
tu
d
ies,
th
e
d
ir
ec
tio
n
o
f
th
e
f
in
d
in
g
s
r
em
ain
ed
lar
g
ely
co
n
s
is
ten
t.
Stu
d
ies
in
v
o
lv
in
g
h
i
g
h
er
o
cc
u
p
atio
n
al
NO₂
ex
p
o
s
u
r
e
g
e
n
er
ally
r
ep
o
r
ted
a
g
r
ea
te
r
b
u
r
d
e
n
o
f
h
y
p
er
te
n
s
io
n
o
r
s
tr
o
n
g
er
s
tatis
tical
ass
o
ciat
io
n
s
b
etwe
en
NO₂
ex
p
o
s
u
r
e
an
d
h
y
p
er
ten
s
io
n
-
r
elate
d
o
u
tco
m
es.
C
o
n
v
er
s
ely
,
s
tu
d
ies
co
n
d
u
cted
i
n
lo
wer
-
ex
p
o
s
u
r
e
s
ettin
g
s
r
ep
o
r
ted
lo
wer
p
r
e
v
al
en
ce
esti
m
ates
b
u
t
s
till
id
en
tifie
d
ad
v
er
s
e
h
ea
lth
ef
f
ec
ts
ass
o
ciate
d
with
NO₂
e
x
p
o
s
u
r
e.
T
h
is
o
v
er
all
co
n
s
is
ten
cy
s
tr
en
g
th
en
s
t
h
e
ev
id
en
ce
s
u
p
p
o
r
tin
g
an
ass
o
ciatio
n
b
etwe
en
o
cc
u
p
atio
n
a
l
NO₂
ex
p
o
s
u
r
e
an
d
h
y
p
e
r
ten
s
io
n
,
wh
ile
also
h
ig
h
lig
h
ti
n
g
th
at
d
if
f
er
en
ce
s
in
o
cc
u
p
atio
n
al
s
ettin
g
,
s
tu
d
y
d
esig
n
,
an
d
ex
p
o
s
u
r
e
ass
ess
m
en
t
co
n
tr
ib
u
te
to
v
ar
iab
ilit
y
in
th
e
r
ep
o
r
ted
ef
f
e
ct
s
izes.
Fu
r
th
er
m
o
r
e,
th
e
p
r
e
v
alen
ce
o
f
h
y
p
e
r
ten
s
io
n
am
o
n
g
wo
r
k
er
s
r
e
p
o
r
ted
ac
r
o
s
s
th
e
f
iv
e
in
clu
d
e
d
s
tu
d
ies
r
an
g
ed
f
r
o
m
7
.
2
%
to
7
1
.
3
%,
d
ep
e
n
d
in
g
o
n
th
e
o
cc
u
p
atio
n
al
s
ec
to
r
an
d
d
u
r
atio
n
o
f
e
x
p
o
s
u
r
e
as sh
o
wn
in
Fig
u
r
e
2
.
Y.
Go
n
g
et
a
l
(
2
0
2
4
)
[
2
9
]
(
n
=
2
2
.
0
2
2
)
Z
.
L
i
et
a
l.
,
(
2
0
2
5
)
[
3
0
]
(
n
=
1
.
1
7
9
)
Q.
C
h
en
et
a
l.,
(
2
0
2
5
)
[
3
1
]
(
n
=
3
.
4
3
2
)
H.
Hu
an
g
et
a
l.
,
(
2
0
2
2
)
[
3
2
]
(
n
=
1
0
1
)
G.
I
.
Nwa
k
am
m
a
et
a
l.,
(
2
0
2
5
)
[
3
3
]
(
n
=
3
7
4
)
0%
20%
40%
60%
80%
100%
Hy
p
er
ten
s
io
n
No
n
-
h
y
p
er
te
n
s
io
n
Fig
u
r
e
2
.
Pre
v
alen
ce
o
f
h
y
p
er
t
en
s
io
n
am
o
n
g
wo
r
k
er
s
b
ased
o
n
th
e
r
e
v
iewe
d
r
esear
ch
ar
ticles
4.
DIS
CU
SS
I
O
N
4
.
1
.
I
nte
rpre
t
a
t
io
n o
f
f
ind
ing
s
Ov
er
all,
all
r
ev
iewe
d
ar
ticles
co
n
s
is
ten
tly
r
ep
o
r
te
d
a
s
ig
n
if
i
ca
n
t
ass
o
ciatio
n
b
etwe
en
NO₂
ex
p
o
s
u
r
e
an
d
an
in
cr
ea
s
ed
r
is
k
o
f
h
y
p
er
ten
s
io
n
am
o
n
g
w
o
r
k
er
s
ac
r
o
s
s
v
ar
io
u
s
o
cc
u
p
atio
n
al
s
ec
t
o
r
s
.
T
h
ese
f
in
d
in
g
s
alig
n
with
th
e
s
tu
d
y
b
y
M
eo
et
a
l.
[
3
4
]
,
wh
ich
d
em
o
n
s
tr
ated
th
at
en
v
ir
o
n
m
e
n
tal
p
o
llu
ta
n
ts
s
u
ch
as
PM₂.
₅,
PM₁₀
,
NO₂,
SO₂,
an
d
VOCs
s
i
g
n
if
ican
tly
elev
ate
h
y
p
er
te
n
s
io
n
r
is
k
.
On
e
o
f
th
e
m
o
s
t im
p
o
r
tan
t f
in
d
in
g
s
o
f
th
is
s
y
s
tem
atic
r
ev
iew
is
th
e
co
n
s
is
ten
cy
o
f
th
e
d
ir
ec
tio
n
o
f
th
e
ass
o
ci
atio
n
ac
r
o
s
s
s
tu
d
ies
d
esp
ite
co
n
s
id
er
ab
le
h
eter
o
g
en
eity
in
s
tu
d
y
d
esig
n
,
o
cc
u
p
atio
n
al
s
ettin
g
s
,
a
n
d
ex
p
o
s
u
r
e
lev
els.
Alth
o
u
g
h
t
h
e
in
clu
d
e
d
s
tu
d
ies
d
if
f
er
ed
in
wo
r
k
er
p
o
p
u
latio
n
s
,
m
eth
o
d
s
o
f
NO₂
ex
p
o
s
u
r
e
a
s
s
es
s
m
en
t,
an
d
h
y
p
e
r
ten
s
io
n
o
u
tco
m
e
d
e
f
in
itio
n
s
,
all
co
n
s
is
ten
tly
in
d
icate
d
th
at
o
cc
u
p
atio
n
al
NO₂
ex
p
o
s
u
r
e
was
ass
o
ciate
d
with
ad
v
er
s
e
ca
r
d
io
v
ascu
la
r
o
u
tco
m
es.
T
h
is
co
n
s
is
ten
cy
s
tr
en
g
th
en
s
th
e
o
v
er
all
b
o
d
y
o
f
ev
id
e
n
ce
an
d
s
u
g
g
ests
th
at
th
e
o
b
s
er
v
e
d
ass
o
ciatio
n
is
u
n
lik
ely
to
b
e
at
tr
ib
u
tab
le
s
o
lely
to
d
if
f
er
e
n
ce
s
in
s
tu
d
y
m
eth
o
d
o
l
o
g
y
.
E
v
id
en
ce
f
u
r
t
h
er
in
d
icate
s
th
at
NO₂
i
s
f
o
u
r
tim
es
m
o
r
e
t
o
x
ic
th
an
NO;
u
n
d
er
n
o
r
m
al
am
b
ien
t
co
n
d
itio
n
s
,
NO
r
ea
d
ily
o
x
id
iz
es in
to
NO₂,
wh
ich
i
s
m
o
r
e
h
az
ar
d
o
u
s
[
35
]
,
[
36
].
NO₂,
p
r
im
ar
ily
g
en
er
ated
f
r
o
m
f
o
s
s
il
f
u
el
co
m
b
u
s
tio
n
,
is
p
a
r
ticu
lar
ly
co
n
ce
n
tr
ate
d
in
o
cc
u
p
atio
n
al
en
v
ir
o
n
m
en
ts
with
h
ig
h
em
is
s
io
n
s
o
u
r
ce
s
s
u
ch
as
m
in
in
g
,
tr
an
s
p
o
r
tatio
n
,
an
d
h
ea
v
y
in
d
u
s
tr
y
,
lead
in
g
to
elev
ated
ex
p
o
s
u
r
e
lev
els
b
o
th
o
u
td
o
o
r
s
an
d
in
co
n
f
in
ed
wo
r
k
s
p
ac
es
[
30
]
,
[
3
1
]
,
[
3
3
].
Sev
e
r
al
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
NO₂
co
n
ce
n
tr
atio
n
s
ex
ce
ed
in
g
1
0
0
p
p
m
ca
n
b
e
leth
al
f
o
r
m
o
s
t
lab
o
r
ato
r
y
an
im
als,
with
n
ea
r
ly
9
0
%
o
f
d
ea
th
s
attr
ib
u
ted
to
p
u
lm
o
n
ar
y
e
d
em
a.
Acu
te
NO₂
ex
p
o
s
u
r
e
d
am
ag
e
s
ce
llu
lar
m
em
b
r
an
es
with
in
lu
n
g
tis
s
u
e
an
d
ca
u
s
es
air
way
co
n
s
tr
ictio
n
[
36
]
,
[
37
]
.
I
n
h
alati
o
n
o
f
NO₂
tr
ig
g
e
r
s
m
u
ltip
le
p
ath
o
lo
g
ical
r
esp
o
n
s
es,
in
clu
d
in
g
s
y
s
tem
ic
in
f
la
m
m
atio
n
,
o
x
id
ativ
e
s
tr
ess
,
en
d
o
th
elial
d
y
s
f
u
n
ctio
n
,
an
d
a
u
to
n
o
m
ic
n
er
v
o
u
s
s
y
s
tem
im
b
alan
ce
[
34
]
,
[
38
].
On
ce
in
h
aled
,
NO₂
d
is
s
o
lv
es
with
in
th
e
ep
ith
elia
l
lin
in
g
f
lu
id
o
f
th
e
lu
n
g
s
,
g
en
er
atin
g
r
ea
ctiv
e
n
itro
g
en
s
p
ec
ies
(
R
NS)
an
d
r
ea
ctiv
e
o
x
y
g
en
s
p
ec
ies
(
R
OS
)
.
E
lev
ated
R
OS
lev
els
p
r
o
m
o
te
o
x
id
ativ
e
s
tr
ess
,
d
am
ag
e
v
a
s
cu
lar
en
d
o
th
elial
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I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
3
,
Sep
tem
b
er
20
26
:
8
6
8
-
878
874
ce
lls
,
an
d
s
tim
u
late
t
h
e
r
elea
s
e
o
f
p
r
o
-
in
f
lam
m
ato
r
y
cy
to
k
in
e
s
s
u
ch
as
in
ter
le
u
k
in
-
6
(
I
L
-
6
)
an
d
tu
m
o
r
n
ec
r
o
s
is
f
ac
to
r
-
α
(
T
NF
-
α
)
,
u
ltima
tely
im
p
air
in
g
e
n
d
o
th
elial
f
u
n
ctio
n
an
d
d
is
r
u
p
ti
n
g
v
ascu
lar
h
o
m
e
o
s
tasi
s
[
39
]
-
[
41
].
T
h
e
r
ea
ctio
n
b
etwe
en
NO
a
n
d
s
u
p
e
r
o
x
id
e
p
r
o
d
u
ce
s
p
er
o
x
y
n
itrite
(
O
NOO⁻)
,
a
h
i
g
h
l
y
r
ea
ctiv
e
n
itro
g
en
s
p
ec
ies th
at
o
x
id
izes te
tr
ah
y
d
r
o
b
io
p
ter
i
n
(
B
H₄)
,
an
ess
en
tial c
o
f
ac
to
r
f
o
r
n
itric
o
x
id
e
s
y
n
th
ase
(
NOS)
[
42
].
T
h
is
o
x
id
atio
n
u
n
co
u
p
les
NOS,
ca
u
s
in
g
it
to
g
en
er
ate
s
u
p
er
o
x
id
e
in
s
tead
o
f
n
itric
o
x
id
e
(
NO)
,
th
e
r
eb
y
r
ed
u
cin
g
NO
b
io
av
ailab
ilit
y
.
R
ed
u
ce
d
NO
lev
els
im
p
air
en
d
o
th
elial
r
elax
atio
n
,
in
cr
ea
s
e
v
ascu
lar
r
esis
tan
ce
,
an
d
co
n
s
eq
u
e
n
tly
elev
ate
b
lo
o
d
p
r
ess
u
r
e
[
43
]
,
[
44
].
E
n
d
o
th
elial
in
ju
r
y
d
im
in
is
h
es
v
as
cu
lar
elasticity
an
d
p
r
o
m
o
tes
v
aso
co
n
s
tr
ictio
n
,
c
o
n
tr
ib
u
tin
g
to
ch
r
o
n
ic
h
y
p
er
ten
s
io
n
[
2
0
]
,
[
45
].
Ad
d
itio
n
a
lly
,
NO₂
ex
p
o
s
u
r
e
d
is
r
u
p
ts
au
to
n
o
m
ic
r
e
g
u
latio
n
b
y
en
h
an
cin
g
s
y
m
p
ath
etic
ac
tiv
ity
an
d
s
u
p
p
r
ess
in
g
p
a
r
asy
m
p
ath
etic
to
n
e,
f
u
r
th
er
i
n
cr
ea
s
in
g
h
ea
r
t
r
ate
a
n
d
b
lo
o
d
p
r
ess
u
r
e
[
46
]
.
Giv
e
n
th
at
NO
p
lay
s
a
ce
n
tr
al
r
o
le
i
n
v
ascu
lar
d
i
latio
n
an
d
b
lo
o
d
p
r
ess
u
r
e
r
e
g
u
latio
n
,
r
ed
u
ce
d
NOS
ac
tiv
ity
in
ev
it
ab
ly
lead
s
to
v
aso
co
n
s
tr
ictio
n
an
d
h
y
p
er
te
n
s
io
n
[
36
]
,
[
47
]
.
T
h
ese
m
ec
h
a
n
is
m
s
co
llectiv
ely
ex
p
lain
th
e
s
tr
o
n
g
b
io
lo
g
ical
lin
k
b
etwe
en
lo
n
g
-
t
er
m
NO₂
ex
p
o
s
u
r
e
an
d
h
eig
h
ten
ed
h
y
p
e
r
ten
s
io
n
r
is
k
in
wo
r
k
er
s
ex
p
o
s
ed
to
p
o
o
r
air
q
u
ality
[
34
]
,
[
48
].
Sev
er
al
s
tu
d
ies
al
s
o
h
ig
h
lig
h
t
th
e
cu
m
u
lativ
e
an
d
s
y
n
er
g
is
tic
ef
f
ec
ts
o
f
NO₂
w
ith
o
th
er
p
o
llu
tan
ts
s
u
ch
as
C
O,
PM₂.
₅,
a
n
d
O₃.
C
h
en
et
a
l.
[
3
1
]
r
ep
o
r
ted
th
at
co
m
b
in
e
d
e
x
p
o
s
u
r
e
to
m
u
ltip
le
p
o
llu
tan
ts
in
u
n
d
er
g
r
o
u
n
d
m
in
i
n
g
en
v
ir
o
n
m
en
ts
co
n
tr
ib
u
ted
s
ig
n
if
ica
n
tly
to
h
y
p
e
r
ten
s
io
n
r
is
k
,
with
an
o
d
d
s
r
atio
o
f
1
.
6
8
—
s
u
b
s
tan
tially
h
ig
h
er
th
an
ex
p
o
s
u
r
e
to
NO₂
alo
n
e.
T
h
is
f
i
n
d
i
n
g
u
n
d
er
s
co
r
es
th
e
i
n
ten
s
if
ied
to
x
icity
o
f
NO₂
in
p
o
o
r
ly
v
en
tilated
wo
r
k
s
p
ac
es.
Similar
ly
,
Hu
an
g
et
a
l.
[
3
2
]
id
en
tifie
d
ass
o
ciatio
n
s
b
etwe
en
lo
n
g
-
ter
m
NO₂
ex
p
o
s
u
r
e
an
d
alter
atio
n
s
in
b
r
ain
-
d
er
iv
e
d
n
eu
r
o
tr
o
p
h
ic
f
ac
to
r
(
B
DNF)
p
r
o
m
o
ter
m
eth
y
lati
o
n
,
s
u
g
g
esti
n
g
th
at
NO₂
m
ay
ex
e
r
t
ep
ig
e
n
etic
e
f
f
ec
ts
in
f
lu
en
cin
g
n
eu
r
o
r
eg
u
l
ato
r
y
p
ath
way
s
ass
o
ciate
d
w
ith
b
lo
o
d
p
r
ess
u
r
e
co
n
tr
o
l
.
T
h
e
in
clu
d
ed
s
tu
d
ies
also
i
n
d
icate
th
at
o
cc
u
p
atio
n
al
co
n
t
ex
t
m
ay
s
u
b
s
tan
tially
m
o
d
i
f
y
ex
p
o
s
u
r
e
lev
els
an
d
ass
o
ciate
d
h
ea
lth
r
is
k
s
.
W
o
r
k
er
s
em
p
lo
y
ed
in
u
n
d
er
g
r
o
u
n
d
m
in
in
g
,
o
il
ex
t
r
a
ctio
n
,
an
d
r
o
ad
s
id
e
o
cc
u
p
atio
n
s
ex
p
er
ien
ce
c
o
n
tin
u
o
u
s
ex
p
o
s
u
r
e
to
c
o
m
b
u
s
tio
n
-
r
elate
d
p
o
llu
tan
ts
o
v
er
p
r
o
lo
n
g
ed
p
er
i
o
d
s
.
T
h
ese
o
cc
u
p
atio
n
al
ch
a
r
ac
ter
is
tics
m
ay
ex
p
lain
th
e
h
ig
h
er
p
r
e
v
a
len
ce
o
f
h
y
p
e
r
ten
s
io
n
o
b
s
er
v
ed
in
s
ev
er
al
s
tu
d
ies
an
d
h
ig
h
lig
h
t
th
e
im
p
o
r
tan
c
e
o
f
co
n
s
id
er
in
g
wo
r
k
p
lace
-
s
p
ec
if
ic
ex
p
o
s
u
r
e
s
ce
n
ar
i
o
s
wh
en
ev
alu
atin
g
ca
r
d
io
v
ascu
lar
r
is
k
s
.
W
o
r
k
er
s
in
tr
a
n
s
p
o
r
tatio
n
an
d
m
in
in
g
s
ec
to
r
s
a
p
p
ea
r
to
c
ar
r
y
t
h
e
h
i
g
h
est
r
is
k
d
u
e
t
o
co
n
tin
u
o
u
s
p
r
o
x
im
ity
to
em
is
s
io
n
s
o
u
r
ce
s
an
d
i
n
s
u
f
f
icien
t
p
r
o
tectiv
e
m
ea
s
u
r
es
[
49
]
,
[
50
].
A
s
tu
d
y
f
r
o
m
Nig
er
ia
b
y
Nwa
k
am
m
a
et
a
l
.
[
3
3
]
r
e
p
o
r
t
ed
th
at
r
o
ad
s
id
e
wo
r
k
er
s
wh
o
co
n
s
is
ten
tly
u
s
ed
p
e
r
s
o
n
al
p
r
o
tectiv
e
eq
u
ip
m
en
t
(
PP
E
)
h
ad
s
ig
n
if
ican
tly
lo
wer
r
is
k
s
o
f
h
y
p
er
ten
s
io
n
an
d
o
c
u
lar
co
m
p
licatio
n
s
co
m
p
a
r
ed
with
th
o
s
e
wh
o
d
id
n
o
t a
d
o
p
t p
r
ev
en
tiv
e
s
tr
ateg
ies (
OR
=
0
.
0
6
; p
=
0
.
0
0
1
)
.
An
o
t
h
e
r
im
p
o
r
tan
t f
i
n
d
in
g
is
th
at
p
r
ev
en
tiv
e
m
ea
s
u
r
es
ap
p
ea
r
ed
to
r
ed
u
ce
a
d
v
er
s
e
h
ea
lth
o
u
tc
o
m
es
ev
e
n
in
o
cc
u
p
atio
n
s
with
u
n
av
o
i
d
ab
le
e
x
p
o
s
u
r
e.
T
h
is
s
u
g
g
ests
th
at
o
cc
u
p
atio
n
al
h
y
p
er
ten
s
io
n
r
elate
d
to
NO₂
ex
p
o
s
u
r
e
is
n
o
t
o
n
l
y
p
r
e
v
en
tab
le
t
h
r
o
u
g
h
em
is
s
io
n
r
ed
u
ctio
n
b
u
t
m
ay
also
b
e
m
itig
ated
th
r
o
u
g
h
wo
r
k
p
lace
in
te
r
v
en
tio
n
s
,
in
clu
d
in
g
en
g
i
n
ee
r
in
g
co
n
t
r
o
ls
,
ad
m
in
is
tr
ativ
e
co
n
tr
o
ls
,
an
d
co
n
s
is
ten
t PPE
u
s
e.
T
h
ese
f
in
d
in
g
s
r
ein
f
o
r
ce
th
e
im
p
o
r
tan
ce
o
f
in
teg
r
atin
g
ex
p
o
s
u
r
e
co
n
tr
o
l in
to
o
cc
u
p
atio
n
al
h
ea
lth
m
an
a
g
em
en
t sy
s
tem
s
r
ath
er
th
an
r
el
y
in
g
s
o
lely
o
n
m
e
d
ical
s
u
r
v
eillan
c
e
.
T
h
ese
r
esu
lts
em
p
h
asize
th
e
n
ee
d
f
o
r
b
o
th
b
e
h
av
io
r
al
an
d
tech
n
ical
in
te
r
v
en
tio
n
s
,
in
cl
u
d
in
g
PP
E
u
tili
za
tio
n
,
im
p
r
o
v
ed
v
en
tilatio
n
s
y
s
tem
s
,
an
d
r
o
u
tin
e
wo
r
k
p
lace
air
-
q
u
ality
m
o
n
ito
r
in
g
.
Geo
g
r
ap
h
ic
co
n
tex
t
also
p
lay
s
an
im
p
o
r
tan
t
r
o
le;
d
ev
elo
p
in
g
co
u
n
tr
ies
s
u
ch
as
C
h
in
a
an
d
Nig
er
ia
f
ac
e
ch
allen
g
es
in
o
cc
u
p
atio
n
al
air
-
p
o
llu
tio
n
c
o
n
tr
o
l
d
u
e
to
li
m
ited
m
o
n
ito
r
i
n
g
in
f
r
astru
ctu
r
e
an
d
lo
w
wo
r
k
er
awa
r
en
ess
.
T
h
ese
f
in
d
in
g
s
alig
n
with
th
e
W
o
r
ld
Hea
lth
Or
g
an
i
za
tio
n
(
2
0
2
3
)
r
ep
o
r
t
s
tatin
g
t
h
at
ev
er
y
1
0
µ
g
/m
³
in
c
r
ea
s
e
in
NO₂
co
n
ce
n
tr
atio
n
r
aises
h
y
p
er
ten
s
io
n
r
is
k
b
y
a
p
p
r
o
x
im
ately
3
–
5%
[
51
]
.
Fro
m
a
p
u
b
lic
h
ea
lth
p
er
s
p
ec
tiv
e
,
th
e
f
in
d
in
g
s
h
av
e
b
r
o
ad
e
r
im
p
licatio
n
s
b
ec
au
s
e
h
y
p
er
ten
s
io
n
r
em
ain
s
o
n
e
o
f
t
h
e
lead
in
g
r
is
k
f
ac
to
r
s
f
o
r
ca
r
d
io
v
ascu
lar
d
is
ea
s
e
an
d
p
r
em
atu
r
e
m
o
r
tality
wo
r
ld
wid
e.
Occ
u
p
atio
n
al
e
x
p
o
s
u
r
e
to
NO₂
th
er
e
f
o
r
e
r
ep
r
esen
ts
n
o
t
o
n
ly
an
en
v
ir
o
n
m
en
tal
is
s
u
e
b
u
t
also
an
im
p
o
r
tan
t
o
cc
u
p
atio
n
al
h
e
alth
co
n
ce
r
n
t
h
at
m
ay
co
n
tr
ib
u
te
to
t
h
e
g
r
o
win
g
b
u
r
d
e
n
o
f
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
es.
R
ed
u
cin
g
wo
r
k
p
la
ce
,
NO₂
ex
p
o
s
u
r
e
h
as
th
e
p
o
ten
tial
to
im
p
r
o
v
e
wo
r
k
er
s
'
ca
r
d
io
v
ascu
lar
h
ea
l
th
,
r
ed
u
ce
p
r
o
d
u
ctiv
ity
lo
s
s
es
ass
o
ciate
d
with
h
y
p
er
ten
s
io
n
,
an
d
d
ec
r
ea
s
e
h
ea
lth
ca
r
e
co
s
ts
attr
ib
u
tab
le
to
wo
r
k
-
r
elate
d
ch
r
o
n
ic
d
is
ea
s
es
.
C
o
n
s
eq
u
en
tly
,
co
m
p
r
eh
e
n
s
iv
e
p
r
ev
en
tio
n
an
d
co
n
tr
o
l
m
ea
s
u
r
es
ar
e
u
r
g
en
tly
n
ee
d
e
d
,
in
clu
d
in
g
o
cc
u
p
atio
n
al
h
ea
lth
p
o
licies,
air
-
q
u
ality
s
u
r
v
eillan
ce
,
an
d
en
h
an
ce
d
wo
r
k
er
an
d
in
d
u
s
tr
y
a
war
en
ess
r
eg
ar
d
in
g
p
o
llu
tio
n
h
az
ar
d
s
.
C
o
llectiv
ely
,
th
is
r
ev
iew
r
ei
n
f
o
r
ce
s
th
e
c
r
itical
r
o
le
o
f
NO₂
ex
p
o
s
u
r
e
c
o
n
tr
o
l
in
p
r
ev
e
n
tin
g
wo
r
k
-
r
elate
d
n
o
n
-
co
m
m
u
n
ica
b
le
d
is
ea
s
es,
p
ar
ticu
lar
ly
h
y
p
e
r
ten
s
io
n
.
T
h
e
f
in
d
i
n
g
s
also
s
u
p
p
o
r
t
s
tr
en
g
th
en
in
g
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
e
s
tan
d
a
r
d
s
an
d
in
co
r
p
o
r
atin
g
r
o
u
tin
e
en
v
ir
o
n
m
en
tal
m
o
n
ito
r
i
n
g
in
t
o
wo
r
k
p
lace
h
ea
lth
pr
o
g
r
a
m
s
,
p
ar
ticu
lar
ly
in
in
d
u
s
tr
ies
with
in
ten
s
iv
e
f
o
s
s
il
-
f
u
el
co
m
b
u
s
tio
n
.
Po
licy
m
ak
e
r
s
s
h
o
u
ld
en
co
u
r
ag
e
co
llab
o
r
atio
n
a
m
o
n
g
en
v
ir
o
n
m
en
tal
ag
en
cies,
o
cc
u
p
atio
n
a
l
h
ea
lth
s
er
v
ices,
an
d
em
p
lo
y
er
s
to
im
p
lem
en
t
ev
id
en
ce
-
b
ased
in
ter
v
en
ti
o
n
s
aim
ed
at
r
ed
u
ci
n
g
lo
n
g
-
ter
m
NO₂
ex
p
o
s
u
r
e
am
o
n
g
w
o
r
k
er
s
.
T
h
ese
f
in
d
in
g
s
p
r
o
v
id
e
a
s
tr
o
n
g
s
cien
tific
b
asis
f
o
r
in
co
r
p
o
r
atin
g
NO₂
ex
p
o
s
u
r
e
m
itig
atio
n
in
to
o
cc
u
p
atio
n
al
h
y
p
er
ten
s
io
n
p
r
ev
en
tio
n
s
tr
ateg
ies.
T
h
er
ef
o
r
e,
cr
o
s
s
-
s
ec
to
r
al
co
llab
o
r
atio
n
am
o
n
g
in
d
u
s
tr
y
,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
A
s
s
o
cia
tio
n
b
etw
ee
n
o
cc
u
p
a
ti
o
n
a
l NO₂ e
xp
o
s
u
r
e
a
n
d
h
y
p
erten
s
io
n
r
is
k:
… (
A
yu
d
h
i
a
R
a
ch
ma
w
a
ti
)
875
g
o
v
er
n
m
en
t,
a
n
d
o
cc
u
p
atio
n
al
h
ea
lth
p
r
o
f
ess
io
n
als
is
ess
en
t
ial
to
r
ed
u
ce
ai
r
-
p
o
llu
ta
n
t
ex
p
o
s
u
r
e
in
h
i
g
h
-
r
is
k
s
ec
to
r
s
s
u
ch
as m
in
in
g
an
d
tr
a
n
s
p
o
r
tatio
n
.
4
.
2
.
Clini
ca
l a
nd
re
s
ea
rc
h im
pli
ca
t
io
ns
T
h
e
f
in
d
in
g
s
o
f
t
h
is
s
y
s
tem
atic
r
ev
iew
s
u
g
g
est
th
at
o
cc
u
p
atio
n
al
e
x
p
o
s
u
r
e
to
NO₂
s
h
o
u
ld
b
e
r
ec
o
g
n
ized
as
a
n
im
p
o
r
tan
t
r
is
k
f
ac
to
r
f
o
r
h
y
p
er
ten
s
io
n
am
o
n
g
wo
r
k
er
s
,
p
ar
ticu
lar
ly
in
h
ig
h
-
ex
p
o
s
u
r
e
s
ec
to
r
s
s
u
ch
as
m
in
in
g
,
tr
an
s
p
o
r
tatio
n
,
an
d
in
d
u
s
tr
y
.
T
h
ese
r
esu
lts
h
ig
h
lig
h
t
th
e
n
ee
d
f
o
r
r
o
u
t
in
e
b
lo
o
d
p
r
ess
u
r
e
s
cr
ee
n
in
g
,
wo
r
k
p
lace
air
-
q
u
ality
m
o
n
ito
r
in
g
,
im
p
r
o
v
e
d
v
en
ti
latio
n
s
y
s
tem
s
,
an
d
co
n
s
is
ten
t
u
s
e
o
f
PP
E
as
p
ar
t
o
f
o
cc
u
p
atio
n
al
h
ea
lth
p
r
o
g
r
a
m
s
.
Fro
m
a
r
esear
ch
p
er
s
p
ec
tiv
e,
th
e
id
e
n
tifie
d
ass
o
ciatio
n
s
an
d
u
n
d
e
r
ly
in
g
b
io
lo
g
ical
m
ec
h
an
is
m
s
,
in
clu
d
in
g
o
x
id
ativ
e
s
tr
ess
,
in
f
lam
m
atio
n
,
en
d
o
th
elia
l
d
y
s
f
u
n
cti
o
n
,
a
n
d
e
p
ig
en
etic
ch
an
g
es
,
s
u
p
p
o
r
t
th
e
i
n
teg
r
ati
o
n
o
f
en
v
ir
o
n
m
en
tal
e
x
p
o
s
u
r
e
ass
es
s
m
en
t
in
to
ca
r
d
io
v
ascu
lar
r
is
k
ev
alu
atio
n
an
d
o
cc
u
p
atio
n
al
h
ea
lth
p
o
lici
es a
im
ed
at
p
r
ev
e
n
tin
g
wo
r
k
-
r
elate
d
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
e
ases
.
B
ey
o
n
d
clin
ical
p
r
ac
tice,
t
h
es
e
f
in
d
i
n
g
s
h
a
v
e
im
p
o
r
tan
t
im
p
licatio
n
s
f
o
r
o
cc
u
p
atio
n
al
h
ea
l
th
p
o
licy
.
R
eg
u
lar
en
v
ir
o
n
m
en
tal
m
o
n
it
o
r
in
g
,
i
n
teg
r
atio
n
o
f
air
-
q
u
alit
y
in
d
icato
r
s
in
to
w
o
r
k
p
lace
r
i
s
k
ass
es
s
m
en
ts
,
an
d
en
f
o
r
ce
m
e
n
t
o
f
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
e
s
tan
d
ar
d
s
s
h
o
u
ld
b
e
co
m
e
in
teg
r
al
co
m
p
o
n
en
ts
o
f
wo
r
k
p
lace
h
ea
lth
m
an
ag
em
en
t.
Fu
r
th
e
r
m
o
r
e
,
i
d
en
tify
in
g
NO₂
e
x
p
o
s
u
r
e
as
a
m
o
d
if
iab
le
o
cc
u
p
atio
n
al
r
is
k
f
ac
to
r
p
r
o
v
id
es
o
p
p
o
r
tu
n
ities
f
o
r
p
r
im
ar
y
p
r
ev
en
tio
n
s
tr
ateg
ies
th
at
m
ay
r
ed
u
ce
th
e
lo
n
g
-
ter
m
b
u
r
d
e
n
o
f
ca
r
d
io
v
ascu
lar
d
is
ea
s
es a
m
o
n
g
wo
r
k
er
s
.
4
.
3
.
Dire
ct
io
ns
f
o
r
f
uture
re
s
ea
rc
h
Fu
tu
r
e
s
tu
d
ies
s
h
o
u
ld
f
o
cu
s
o
n
lar
g
e
-
s
ca
le
lo
n
g
itu
d
in
al
an
d
m
u
lticen
ter
in
v
esti
g
atio
n
s
to
s
tr
en
g
th
en
ca
u
s
al
ev
id
en
ce
r
e
g
ar
d
i
n
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
o
cc
u
p
ati
o
n
al
NO₂
ex
p
o
s
u
r
e
an
d
h
y
p
er
t
en
s
io
n
.
R
esear
ch
is
also
n
ee
d
ed
to
d
ete
r
m
in
e
d
o
s
e
–
r
esp
o
n
s
e
r
elatio
n
s
h
ip
s
,
id
e
n
tify
s
af
e
e
x
p
o
s
u
r
e
th
r
esh
o
l
d
s
,
an
d
ev
alu
ate
th
e
co
m
b
in
ed
ef
f
ec
ts
o
f
NO₂
wit
h
o
th
er
w
o
r
k
p
lace
p
o
llu
tan
ts
s
u
ch
as
PM₂.
₅,
PM₁₀
,
C
O,
a
n
d
O₃.
I
n
a
d
d
itio
n
,
f
u
tu
r
e
s
tu
d
ies
s
h
o
u
ld
e
x
p
l
o
r
e
m
o
lecu
lar
an
d
e
p
ig
en
e
tic
m
ec
h
an
is
m
s
u
n
d
er
ly
in
g
p
o
llu
tan
t
-
in
d
u
ce
d
h
y
p
er
ten
s
io
n
wh
ile
ac
c
o
u
n
tin
g
f
o
r
p
o
ten
tial
co
n
f
o
u
n
d
in
g
f
ac
to
r
s
,
in
clu
d
in
g
s
m
o
k
in
g
,
l
if
esty
le,
an
d
p
r
e
-
ex
is
tin
g
h
ea
lth
co
n
d
itio
n
s
,
to
p
r
o
v
i
d
e
a
m
o
r
e
co
m
p
r
eh
en
s
i
v
e
u
n
d
e
r
s
tan
d
in
g
o
f
ca
r
d
io
v
a
s
cu
lar
r
is
k
s
am
o
n
g
ex
p
o
s
ed
w
o
r
k
e
r
s
.
Fu
tu
r
e
s
y
s
tem
atic
r
ev
iews
s
h
o
u
l
d
also
ex
p
lo
r
e
q
u
an
titativ
e
e
v
id
en
ce
th
r
o
u
g
h
m
eta
-
a
n
aly
s
is
wh
er
e
s
u
f
f
icien
t
h
o
m
o
g
e
n
eo
u
s
s
tu
d
ies
b
ec
o
m
e
av
ailab
le
.
Stan
d
ar
d
izatio
n
o
f
NO₂
ex
p
o
s
u
r
e
ass
ess
m
en
t
m
eth
o
d
s
an
d
h
y
p
e
r
ten
s
io
n
o
u
tco
m
e
d
ef
in
itio
n
s
ac
r
o
s
s
s
tu
d
ies
wo
u
l
d
im
p
r
o
v
e
c
o
m
p
a
r
ab
ilit
y
an
d
f
ac
ilit
ate
m
o
r
e
r
o
b
u
s
t e
s
tim
ates o
f
th
e
o
cc
u
p
atio
n
al
ca
r
d
io
v
ascu
lar
r
is
k
s
ass
o
ciate
d
with
NO₂
ex
p
o
s
u
r
e
.
5.
CO
NCLU
SI
O
N
T
h
is
s
y
s
tem
atic
r
ev
iew
p
r
o
v
id
es
co
m
p
r
eh
e
n
s
iv
e
ev
id
en
ce
th
at
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
e
to
NO₂
is
ass
o
ciate
d
with
an
in
cr
ea
s
ed
r
is
k
o
f
h
y
p
er
ten
s
io
n
am
o
n
g
wo
r
k
er
s
,
p
ar
ticu
lar
ly
in
h
ig
h
-
ex
p
o
s
u
r
e
s
ettin
g
s
s
u
ch
as
m
in
in
g
,
tr
a
n
s
p
o
r
tatio
n
,
an
d
in
d
u
s
tr
ial
s
ec
to
r
s
.
B
y
s
y
n
t
h
esizin
g
f
in
d
in
g
s
f
r
o
m
r
ec
en
t
s
tu
d
ies,
th
is
r
ev
iew
co
n
tr
ib
u
tes
to
th
e
g
r
o
win
g
b
o
d
y
o
f
ev
i
d
en
ce
lin
k
in
g
o
cc
u
p
atio
n
al
air
p
o
llu
tio
n
to
ca
r
d
io
v
ascu
lar
h
ea
lth
an
d
h
ig
h
lig
h
ts
p
o
ten
tial
b
io
l
o
g
ica
l
m
ec
h
an
is
m
s
in
v
o
lv
in
g
o
x
id
ativ
e
s
tr
ess
,
s
y
s
tem
ic
in
f
lam
m
atio
n
,
en
d
o
th
elial
d
y
s
f
u
n
ctio
n
,
an
d
ep
ig
en
etic
a
lter
atio
n
s
.
T
h
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
im
p
o
r
tan
c
e
o
f
in
t
eg
r
atin
g
air
-
q
u
ality
m
an
ag
em
en
t,
ex
p
o
s
u
r
e
m
o
n
it
o
r
in
g
,
an
d
ca
r
d
io
v
ascu
lar
h
ea
l
th
s
u
r
v
eillan
ce
in
t
o
o
cc
u
p
atio
n
al
h
ea
lth
p
r
o
g
r
am
s
to
r
ed
u
ce
th
e
b
u
r
d
e
n
o
f
w
o
r
k
-
r
elate
d
h
y
p
er
te
n
s
io
n
.
Fu
t
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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b
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Sci
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Vo
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15
,
No
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3
,
Sep
tem
b
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20
26
:
8
6
8
-
878
876
AUTHO
R
CO
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B
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[
1
]
F
.
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.
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3
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.
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.
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.
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.
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5
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C
.
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6
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H
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W
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2
3
]
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.
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.
[
2
4
]
M
.
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[
2
5
]
M
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[
2
6
]
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.
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[
2
7
]
C
.
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.
[
2
8
]
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[
29
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[
30
]
Z.
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1.
[3
1
]
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.
C
h
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t
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l
.
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ss
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c
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sec
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[3
2
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.
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.
[3
3
]
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.
I
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w
a
k
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m
ma
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[3
4
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s)
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.
[3
5
]
A
.
K
.
S
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n
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h
,
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En
v
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,
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:
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l
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u
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P
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;
2
0
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5
.
[3
6
]
L.
F
a
l
k
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a
,
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E
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G
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,
p
p
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3
3
–
3
8
,
2
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1
6
.
[3
7
]
M
.
M
e
z
y
e
n
,
N
.
B
i
t
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i
,
I
.
R
i
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E.
Ll
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O
p
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