Introduction:Within the framework of the SINPHONIE study, this study aimed to examine the dose-response relationship between increasing endotoxin concentrations and reduced lung function parameters, seeking potential threshold effects and accounting for regional differences. Methods:Spirometry data from 3870 schoolchildren across 21 European countries were analysed to assess the impact of endotoxin exposure on lung function parameters. A general additive model was applied, adjusting for country, age, height, weight and sex. Additionally, a linear regression model with random effects was employed, treating country as a panel variable. In that latter model, "asthma ever" was also included as a possible moderator of endotoxin effects. Results:For most parameters, a linear decline in lung function was observed with increasing endotoxin levels, with no clear threshold effect. For example, forced expiratory volume in 1 s decreased by 4.8 mL per an increase in endotoxin concentration of 1000 EU·m-2 and peak expiratory flow by 10 mL·s-1 (both p<0.001). However, some parameters showed a plateau at higher endotoxin concentrations. The association remained mostly unchanged and statistically significant across most spirometry values except for forced vital capacity, when adjusting for country as a panel variable. "Asthma ever" was reported for 272 (7.3%) of 3737 children. While these children performed significantly worse in the lung-function test, "asthma ever" did not increase vulnerability to endotoxin. Conclusion:The school environment in general and endotoxin levels in particular, have an impact on children's respiratory health, calling for additional efforts for improvements, including improved cleaning measures and ventilation.

Background: Few studies have simultaneously assessed the health impact of school and home environmental factors on children, since handling multiple highly correlated environmental variables is challenging. In this study, we examined indoor home and school environments in relation to health outcomes using machine learning methods and logistic regression. Methods: We used the data collected by the SINPHONIE (Schools Indoor Pollution and Health: Observatory Network in Europe) project in Romania, a multicenter European research study that collected comprehensive information on school and home environments, health symptoms in children, smoking, and school policies. The health outcomes were categorized as: any health symptoms, asthma, allergy and flu-like symptoms. Both logistic regression and random forest (RF) methods were used to predict the four categories of health outcomes, and the methods prediction performance was compared. Results: The RF method we employed for analysis showed that common risk factors for the investigated categories of health outcomes, included: environmental tobacco smoke (ETS), dampness in the indoor school environment, male gender, air freshener use, residence located in proximity of traffic (<200 m), stressful schoolwork, and classroom noise (contributions ranged from 7.91% to 23.12%). Specificity, accuracy and area under the curve (AUC) values for most outcomes were higher when using RF compared to logistic regression, while sensitivity was similar in both methods.& nbsp; Conclusion: This study suggests that ETS, dampness in the indoor school environment, use of air fresheners, living in proximity to traffic (<200 m) and noise are common environmental risk factors for the investigated health outcomes. RF pointed out better predictive values, sensitivity and accuracy compared to logistic regression. (c) 2021 Elsevier B.V. All rights reserved.

Aims and objectives: Lighting constitutes a critical issue in school design because of its importance as a strong enabler of performance, which is crucial for child development. However, data on light impacts on school performance are scarce. The main objective of this study was to assess the relationship between daylighting conditions in classrooms and mathematical and logical test scores. Methods: The population-based SINPHONIE (Schools Indoor Pollution and Heath: Observatory Network in Europe) study provides information on relationships between lighting conditions and school performance for 2670 elementary schoolchildren, aged 8–13 years from 155 classrooms in 53 schools across 12 European countries. These data were acquired through direct physical assessments and questionnaires completed by teachers, schoolchildren, and their parents, allowing for estimations of multiple objective daylight indicators, as well as subjective parameters such as the perception of lighting. Schoolchildren performed an attention/concentration exam that included simple mathematical exercises in addition to a logical ciphering test. The corresponding performance scores were compared against multiple daylighting parameters. Results: A positive relationship was found between performance scores and type of window shading, latitude, percentage of window facing south, and window glazing, with the highest impact due to the window-to-floor area ratio. Conclusion: Data collected in the SINPHONIE study across 12 European countries indicate that daylighting parameters are relevant to schoolchildren’s performance. As SINPHONIE was not designed specifically with lighting in mind, dedicated studies covering a wide range of classroom configurations would be enlightening.

Substantial knowledge is available on the association of the indoor school environment and its effect among schoolchildren. In the same context, the SINPHONIE (School indoor pollution and health: Observatory network in Europe) conducted a study to collect data and determine the distribution of several indoor air pollutants (IAPs), physical and thermal parameters and their association with eye, skin, upper-, lower respiratory and systemic disorder symptoms during the previous three months. Finally, data from 115 schools in 54 European cities from 23 countries were collected and included 5175 schoolchildren using a harmonized and standardized protocol. The association between exposures and the health outcomes were examined using logistic regression models on the environmental stressors assessed in classroom while adjusting for several confounding factors; a VOC (volatile organic compound) score defined as the sum of the number of pollutants to which the children were highly exposed (concentration > median of the distribution) in classroom was also introduced to evaluate the multiexposure - outcome association. Schoolchildren while adjusting for several confounding factors. Schoolchildren exposed to above or equal median concentration of PM2.5, benzene, limonene, ozone and radon were at significantly higher odds of suffering from upper, lower airways, eye and systemic disorders. Increased odds were also observed for any symptom (sick school syndrome) among schoolchildren exposed to concentrations of limonene and ozone above median values. Furthermore, the risks for upper and lower airways and systemic disorders significantly increased with the VOCs score. Results also showed that increased ventilation rate was significantly associated with decreased odds of suffering from eye and skin disorders whereas similar association was observed between temperature and upper airways symptoms. The present study provides evidence that exposure to IAPs in schools is associated with various health problems in children. Further investigations are needed to confirm our findings.

In this study, we investigated the interactions between household pollutants and dietary habits on children’s respiratory health. Our cross-sectional study collected self-reported information including health symptoms (allergy-like, asthma-like, and flu-like symptoms), home characteristics, dietary habits, and demographic information from questionnaires administered to parents of 280 school children in Romania. Unconditional logistic regression and stratified analyses were used to assess the interactions between dietary factors and environmental exposures on health symptoms among children, controlling for sociodemographic characteristics and co-exposures. We found that frequency of fruit consumption had significant interaction with residing near heavy traffic on allergy-like symptoms among children (p = 0.036). However, no association was observed by frequency of fruit consumption. Although no significant interaction was observed, we found that students with infrequent fruit consumption and residing near heavy traffic roads had elevated odds of asthma-like (POR 6.37; 95% CI 1.22, 33.29) and flu-like symptoms (POR 3.75; 95% CI 1.12, 11.86) than those who frequently consumed fruits. Likewise, low vegetable consumption was associated with increased asthma-like symptoms (POR 2.93; 95% CI 1.04, 8.24). Increased odds of asthma-like symptoms were observed among school children that resided near heavy traffic roads and frequently consumed milk (POR 2.80; 95% CI 1.24, 6.31) and yoghurt (POR 2.86; 95% CI 1.05, 7.75) compared to those that infrequently consumed dairy. Our findings suggest that frequent fruit and vegetable consumption may mitigate the negative effects of exposure to heavy traffic near dwelling on respiratory symptoms in Romanian children.

Our study assessed the exposure to formaldehyde of Romanian school children in relation to the classroom indoor environment characteristics and respiratory and allergic symptoms reported in a questionnaire survey, using the data collected in the SINPHONIE (Schools Indoor Pollution and Health: Observatory Network in Europe) project. Measurements of formaldehyde and microclimate parameters were conducted in three classrooms per school, in five schools, together with one outdoor measurement at each school. Questionnaires were used to collect information on classroom characteristics and health effects among children. The indoor formaldehyde levels for a school week varied between 15.5 and 66.2 μg/m3, with a median value of 34.8 μg/m3. The adjusted odds ratios for allergy-like, asthma-like, and flu-like symptoms were 3.23 (95% CI 1.31–8.00), 2.69 (95% CI 1.04–6.97), and 2.39 (95% CI 1.04–5.50), respectively, when exposed to higher formaldehyde levels (≥ 35 μg/m3) during a school week, compared to lower formaldehyde level exposure (< 35 μg/m3). Higher levels of indoor formaldehyde were significantly associated with health symptoms in children. The high indoor formaldehyde levels were related to the use of water-resistant paint for ceiling coverings, moisture damage signs, and lower classroom natural ventilation rates.

Background Environmental research involving children often relies on the self-report or parental report of symptoms and environmental issues. While previous studies explored the agreements between child and parental reports, few of them were conducted in younger children and in developing countries. In this study, we addressed the research gaps by assessing the agreement between child and parental report on respiratory symptoms and school environment in Romanian primary schools. Methods Two hundred and eighty students from five schools and their parents participated in this study. Information on child's respiratory symptoms and perceptions of school environment was collected via both student and parent questionnaires. Agreement between the two questionnaires was assessed by absolute agreement rates and kappa statistics. Prevalence index (PI), bias index (BI) and maximum attainable kappas were calculated to identify potential sources of disagreements. Results The agreement between student and parent questionnaires was low. Compared to the student's report, parents often reported more symptoms than their children, particularly flu-like symptoms, and school environment problems. Parent and child tend to agree when there was no symptom reported, but disagreements often occurred when symptoms were reported. After adjusting for the PI, the agreements for asthma and allergic symptoms improved substantially. Disagreement on reporting of flu-like symptoms was strongly affected by pre-existing causes, such as different understandings of the questions between students and parents. Conclusion Parental report may have a higher sensitivity in capturing a child's respiratory symptoms and school environment problems compared to self-report among young children in developing countries.

School environment may have an impact on children's health, but few studies have focused on indoor comfort factors such as temperature, humidity, and noise in relation with potential effects on children's health. Our cross-sectional study used data from the European Schools Indoor Pollution and Health Observatory Network in Europe (SINPHONIE) project to assess children's allergy, asthma-like symptoms, and flu-like symptoms in relation with classroom comfort and environmental factors. The study used self-reported data from three questionnaires to identify classroom conditions and student health outcomes for 280 students. We used backwards variable selection and unconditional logistic regression to assess the outcome-environment relationship while controlling for demographics, family history of allergy, and home exposures. We found increased risks for allergy and flu-like symptoms associated with hot classrooms in the heating season, increased risks for asthma-like symptoms associated with noisy classrooms, and a protective effect for allergy associated with good outdoor air quality. Romanian classrooms rely on natural ventilation, which may contribute to increased temperature and humidity in the heating season. Further research warrants the use of SINPHONIE's measurement data to validate our findings.

BACKGROUND:Exposure to indoor air pollutants at home was found to be associated with respiratory diseases. As lifestyle changes with rapid economic growth in Romania, the aim of our study is to describe the characteristics of Romanian homes and their impact on children's respiratory health. METHODS:Self-reported information on respiratory symptoms was collected from 280 Romanian elementary school students in 2011, and the symptoms were categorized into allergy, asthma-like, and flu-like symptoms. Home characteristics and demographic information were collected from questionnaires answered by parents. The association between home characteristics and respiratory health was assessed through multivariate logistic regression controlling for school indoor exposure. RESULTS:As compared to U.S. households, Romanian homes have a higher percentage of smokers, limited use of indoor climate control, and higher use of iron stoves. Exposure to environmental tobacco smoke was associated with both asthma and allergy symptoms. Additional risk factors identified for allergy symptoms include living in apartments, near pesticide sprayed areas, and the use of incense sticks. The significantly higher risk of flu-like symptoms was associated with mold and dampness issues, the use of air conditioner, gas heater/iron stove in children's bedroom. CONCLUSION:Our findings suggest that an increase in respiratory symptoms among Romanian school-age children can be partly related to their environmental exposure at home. Since most of the identified risk factors are preventable, our results provide critical information and evidence for policymakers, to develop target intervention and education strategies.

Few studies have evaluated teachers’ respiratory health, especially its relationship with school/home environment, and school policies. This study assessed asthma and smoking prevalence among teachers in Romania, teacher’s perception and knowledge of the school environment, policies and asthma management, and how school and home environment affected asthma, allergy, and respiratory infection symptoms.

This document was produced under the SINPHONIE (Schools Indoor Pollution and Health – Observatory Network in Europe) project, funded by the European Parliament and carried out under a contract with the European Commission’s Directorate-General for Health and Consumers (DG SANCO) (SANCO/2009/C4/04, contract SI2.570742). The co-authors of this report wish to express their deep gratitude to all of their collaborators for their outstanding contribution to the execution of the SINPHONIE project and the preparation of the guidelines for healthy environments within European schools. Special recognition goes to the teachers, pupils and parents who participated in the SINPHONIE project, for their enthusiasm and close cooperation.

Aims The mechanism aims to support prioritization of possible remedial measures based on costs and expected health gains and is available for national and local authorities, builders, school staff, pupils and parents to improve indoor air quality in schools. Methods In 25 European countries, the indoor air quality in schools and childcare settings and respective international (WHO) and national IAQ guidelines and (policy) measures were reviewed. Based on communalities and differences, prioritization criteria were set up and implemented into a cost-benefit mechanism. Results In total, four prioritization criteria were defined to categorize possible remedial measures on the basis of costs and benefits. By describing the effectiveness, proportionality, practicality and monitorability, possible measures were categorized into five groups: 1) Hygiene, 2) Awareness rising, 3) Use of products/materials, 4) Technical intervention and 5) Monitoring IAQ. Possible measures, like, cleaning practices, ventilation, avoidance of the use of certain building materials or installation of a CO2 monitor were qualitative exemplified in tabular format. Conclusions The scope, level of detail and degree of implementation of IAQ measures differ among countries. Some measures are mandatory while others are recommendations. The current mechanism supports authorities and school stakeholders to improve indoor school environments by developing best-fitting strategies accustomed to national and local situations. It is recommended that the European Commission develops harmonized international guidelines on indoor school environments. Acknowledgement This document was produced under the SINPHONIE project, which is financed by the Directorate General for Health and Consumers of the European Commission (October 2010- November 2012). Contract reference is SANCO/2009/C4/04. Project website:http://www.sinphonie.eu.