Association between atmospheric pollutants and hospital admissions in Lisbon

The association of long-term exposure to outdoor air pollution with all-cause GP visits and hospital admissions by ethnicity and country of birth in the United Kingdom

BACKGROUND

Air pollution is associated with poor health. Yet, more research is needed to reveal the association of long-term exposure to outdoor air pollution with less studied health outcomes like hospital admissions and general-practitioner (GP) visits and whether this association is stronger for ethnic minorities compared to the rest of population. This study investigates the association between air pollution and all-cause GP visits and hospital admissions by ethnicity in the United-Kingdom (UK).

METHODS

We used individual-level longitudinal data from the "UK Household Longitudinal Study" including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) outdoor pollution using the Lower Super Output Area (LSOA) of residence for each individual. Multilevel mixed-effects ordered logistic models were used to assess the association between air pollution and all-cause GP visits and hospital admissions.

RESULTS

We found higher odds of hospital admissions per 1 μg/m3 increase in annual concentrations of NO2 (OR = 1.008; 95%CI = 1.004-1.012), SO2 (OR = 1.048; 95%CI = 1.014-1.083), PM10 (OR = 1.011; 95%CI = 1.003-1.018), and PM2.5 (OR = 1.018; 95%CI = 1.007-1.029) pollutants. Higher odds of GP visits were also observed with increased exposure to NO2 (OR = 1.010; 95%CI = 1.006-1.014) and SO2 (OR = 1.114; 95%CI = 1.077-1.152) pollutants. The observed associations did not differ across ethnic groups, but by country of birth, they were more pronounced in individuals born outside UK than those born in UK.

CONCLUSION

This study supports an association between higher exposure to outdoor air pollution and increased all-cause hospital admissions and GP visits. Further longitudinal studies with longer follow-up time periods may be able to reveal more definite conclusions on the influence of ethnicity on the association between long-term outdoor air pollution and both hospital admissions and GP visits.

Forecasting hospital-level COVID-19 admissions using real-time mobility data

BACKGROUND

For each of the COVID-19 pandemic waves, hospitals have had to plan for deploying surge capacity and resources to manage large but transient increases in COVID-19 admissions. While a lot of effort has gone into predicting regional trends in COVID-19 cases and hospitalizations, there are far fewer successful tools for creating accurate hospital-level forecasts.

METHODS

Large-scale, anonymized mobile phone data has been shown to correlate with regional case counts during the first two waves of the pandemic (spring 2020, and fall/winter 2021). Building off this success, we developed a multi-step, recursive forecasting model to predict individual hospital admissions; this model incorporates the following data: (i) hospital-level COVID-19 admissions, (ii) statewide test positivity data, and (iii) aggregate measures of large-scale human mobility, contact patterns, and commuting volume.

RESULTS

Incorporating large-scale, aggregate mobility data as exogenous variables in prediction models allows us to make hospital-specific COVID-19 admission forecasts 21 days ahead. We show this through highly accurate predictions of hospital admissions for five hospitals in Massachusetts during the first year of the COVID-19 pandemic.

CONCLUSIONS

The high predictive capability of the model was achieved by combining anonymized, aggregated mobile device data about users' contact patterns, commuting volume, and mobility range with COVID hospitalizations and test-positivity data. Mobility-informed forecasting models can increase the lead-time of accurate predictions for individual hospitals, giving managers valuable time to strategize how best to allocate resources to manage forthcoming surges.

Circulatory health risks from additive multi-pollutant models: short-term exposure to three common air pollutants in Canada

Numerous studies have reported adverse health effects of ambient air pollution on circulatory health outcomes mainly based on single-pollutant models. However, limited studies have focused on adjusted effect of multi-pollutant exposures on public health. This study aimed to examine short-term effects of three common air pollutants-ground-level ozone (ozone), nitrogen dioxide (NO2), and fine particulate matter (PM2.5)-through multi-pollutant models for mixed effect of adjustment. Daily data (circulatory hospitalization and mortality) and hourly data (air pollutants and temperature) were collected for 24 Canadian cities for 2001-2012. We applied generalized additive over-dispersion Poisson regression models with 1, 2, or 3 pollutants for city-specific risks, and Bayesian hierarchical models for national risks. This study found little mixed effect of adjustment through multi-pollutant models (ozone and/or NO2 and/or PM2.5) for circulatory hospitalization or mortality in Canada for 2001-2012, indicating that the 1-pollutant model did not result in considerable under- or over-estimates. It seemed weak-to-moderate correlations among air pollutants did not change the significant effect of one air pollutant after accounting for others. Inconsistent findings between other previous studies and this study indicate the need of comparable study design for multi-pollutant effect analysis.

Associations between ambient air pollution, meteorology, and daily hospital admissions for ischemic stroke: a time-stratified case-crossover study in Beijing

Air pollution and ischemic stroke (IS) are both vital factors affecting the health of Beijing citizens. This study aims at exploring the associations between air pollution, meteorology, and the hospital admission of IS (IS HA). Information on 476,659 IS inpatients in secondary and higher hospitals in Beijing from 2013 to 2018 were collected. A time-stratified case-crossover design with the generalized additive model and the distributed lag nonlinear model were used. In the single-pollutant models, an inter-quartile range increase in O_3, SO₂, CO, and NO₂ resulted in a significant highest increase in IS HA by 2.23% (95% CI: 1.56%, 2.90%), 1.53% (95% CI: 1.12%, 1.95%), 1.05% (95% CI: 0.70%, 1.40%), and 0.51% (95% CI: 0.24%, 0.79%) on the day of pollution, so did PM_2.5 and PM₁₀ by 1.13% (95% CI: 0.68%, 1.59%) and 1.19% (95% CI: 0.74%, 1.64%) at a lag of 0-5 days. There was a nonlinear relationship between meteorology and IS HA. In the multivariate model, the cumulative relative risks with a maximum lag time of 21 days of PM_2.5 and NO₂ were 1.11 (95% CI: 1.04, 1.19) and 0.88 (95% CI: 0.82, 0.94), while the effects of SO₂, O₃, and meteorology were insignificant. The findings suggested that particulate pollutants could increase the risk of IS, and the elderly were more sensitive to it, while the results of gaseous pollutants are still discordant. The control of air pollution and the protection of susceptible populations should receive higher attention from policymakers.

Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal

OBJECTIVE

To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact.

RESULTS

Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution.

CONCLUSIONS

Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

Streptococcus strain C17T as a potential probiotic candidate to modulate oral health

In the microbiome, probiotics modulate oral diseases. In this study, Streptococcus strain C17^T was isolated from the oropharynx of a five-year-old healthy child, and its potential probiotic properties were analysed using human bronchial epithelial cells (16-HBE) used as an in vitro oropharyngeal mucosal model. The results demonstrated that the C17^T strain showed tolerance to moderate pH ranges of 4-5 and 0.5-1% bile. However, it was more tolerant to 0.5% bile than 1% bile. It also demonstrated an ability to accommodate maladaptive oropharyngeal conditions (i.e., tolerating lysozyme at 200 μg mL-1) . It was also resistant to hydrogen peroxide at 0.8 mM . In addition, we found out that the strain possesses inhibitory activities against various common pathogenic bacteria. Furthermore, C17^T was not cytotoxic to 16-HBE cells at different multiplicities of infection. Scanning electron microscopy disclosed that C17^T adhesion to 16-HBE cells. Competition, exclusion, and displacement assays showed that it had good anti-adhesive effect against S. aureus. The present study revealed that Streptococcus strain C17^T is a potentially efficacious oropharyngeal probiotic.

Modeling of PM10 emissions from motor vehicles at signalized intersections and cumulative model validation

Motor vehicle emissions especially occur at signalized intersections during idling, acceleration, and deceleration phases. The reduction of exhaust emissions from motor vehicles is on the focus of environmental studies. The main targets of this paper are the modeling of motor vehicle particulate matter (PM₁₀) emissions by American Meteorological Society/Environmental Protection Agency Regulatory Model (AERMOD) and California Line Source for Queuing and Hot Spot Calculations (CAL3QHCR) models and investigating the effectiveness of a hypothetical green wave scenario as a pollution reduction strategy. The portion of D010 State Road in Zonguldak (Turkey) is selected. Vehicle counting is applied for determining the traffic volume. Then, the PM₁₀ emission inventory is prepared. After that, PM₁₀ pollution distribution maps at signalized intersections are created by running air quality models. Next, the CAL3QHCR model is run again for the green wave scenario which assumes free flow at signalized intersections. The maximum PM₁₀ concentrations predicted by AERMOD and CAL3QHCR models are 16.8 µg/m³ and 14.9 µg/m³, respectively. Although these values are below the threshold value, it can be said that air quality may pose a threat to public health in the existence of other sources. With the implementation of signal optimization, the PM₁₀ pollution is reduced by 10-50% at intersections. Cumulative model validation is employed including other PM₁₀ sources in the study area. PM₁₀ contribution of other sources at Zonguldak air quality monitoring station is determined by the AERMOD model. Finally, the sum of model outputs is validated against measured concentrations. According to the validation, both models are found as satisfactory and AERMOD performed better than CAL3QHCR.

The Study of Airborne Particulate Matter in Dalnegorsk Town

Mines, quarries, dumps, and tailings are the sources of air pollution. In the Dalnegorsk District (Primorsky Krai, Russia), there are 20 polymetallic deposits. This study aimed to evaluate the particle size and material composition of ambient particulate matter (PM) in Dalnegorsk town and verify the influence of mining and chemical industry facilities on the composition of PM. Ambient particulates were analyzed in samples of snow cover and washout from vegetation (conifer tree needles). According to particle size distribution data, the relative content of particles with a diameter up to 10 microns (PM₁₀) reaches 40% in three snow samples taken in the central part of the town. Among ore minerals, pyrite and arsenopyrite predominated in the samples. In addition, sphalerite, galena, cassiterite, and iron–chromium–nickel formations of various shapes were found in the studied particles. The presence of these metals in airborne PM can negatively affect the incidence rate of PM-associated diseases and the determination of their levels are very useful for air pollution prevention strategies.

Air Pollution and Emergency Hospital Admissions—Evidences from Lisbon Metropolitan Area, Portugal

The relevance of air pollution in the public health agenda has recently been reinforced—it is known that exposure to it has negative effects in the health of individuals, especially in big cities and metropolitan areas. In this article we observed the evolution of air pollutants (CO, NO, NO2, O3, PM10) emissions and we confront them with health vulnerabilities related to respiratory and circulatory diseases (all circulatory diseases, cardiac diseases, cerebrovascular disease, ischemic heart disease, all respiratory diseases, chronic lower respiratory diseases, acute upper respiratory infections). The study is supported in two databases, one of air pollutants and the other of emergency hospital admissions, in the 2005–2015 period, applied to the Lisbon Metropolitan Area. The analysis was conducted through Ordinary Least Squares (OLS) regression, while also using semi-elasticity to quantify associations. Results showed positive associations between air pollutants and admissions, tendentially higher in respiratory diseases, with CO and O3 having the highest number of associations, and the senior age group being the most impacted. We concluded that O3 is a good predictor for the under-15 age group and PM10 for the over-64 age group; also, there seems to exist a distinction between the urban city core and its suburban areas in air pollution and its relation to emergency hospital admissions.

Determination of Pb and Mg accumulation in some of the landscape plants in shrub forms

Heavy metals have a separate precaution in the air pollution components as they are not easily deteriorated in nature, they tend to bioaccumulate, they are carcinogenic or poisonous, and they can be toxic even at low concentrations. Therefore, monitoring of heavy metal pollution is of great importance. Plants are frequently used as biomonitors to monitor the heavy metal pollution. However, the heavy metal accumulation capacities of plants can vary considerably depending on the plant species, as well as on the organelle basis and the amount of particulate matter in the environment. It is also very important to determine how much of the heavy metal concentrations found in plants are derived from the plant species and how much from the particulate matter on the organ. In this study, it was aimed to determine the change of heavy metal accumulation in some landscape plants grown in the city center of Kastamonu depending on plant type, plant organism, washing status, and traffic density. For this purpose, leaf and branch samples were collected from individuals of Ligustrum vulgare L., Euonymus japonica Thunb., Biota orientalis L., Juniperus sabina L., Berberis thunbergii DC, Mahonia aquifolium (Pursh) Nutt., and Buxus sempervirens L., which are frequently used in urban landscape designs growing in areas with heavy, low dense, and no traffic. Some of the collected samples were washed, and heavy metal analyses were conducted to determine the amount of Pb and Mg concentrations. It was remarkable that Pb concentration was higher in branches than in the leaves for all the species. And the alteration depending on traffic density on the base of the factors studied was in different proportion depending on the metals.

Air quality of an urban school in São Paulo city

A major campaign was carried out in indoor and outdoor environments in a school located in the university campus of the city of São Paulo. Elements, PAH, oxy-PAH, water-soluble ions and black carbon were determined and compared with preliminary campaigns. The results indicated that the concentrations of particles and organic compounds were higher indoors. Some high molecular weight compounds, attributed to vehicular emissions, were more abundant outdoors. The associated health risk was found to be low. 2-Methylanthraquinone and benzo(a)anthracene-7,12-dione were detected in the indoor samples, denoting the infiltration of vehicle exhaust. The observation of black carbon also corroborates the contribution of traffic emissions. For most of the elements, except for chromium, iron and manganese, the concentrations obtained in indoors were higher than outdoors, mainly due to soil resuspension. Chromium and manganese likely derived from emissions of the vehicle powered by mixtures of ethanol and gasoline. Water-soluble inorganic ions species denoted the influence of soil resuspension and human activities.

Fine particulate matter alters the microecology of the murine respiratory tract

Fine particulate matter is a global challenge to human health. We investigated the effects and potential mechanisms of fine particulate matter on respiratory tract microecology in a lung injury mouse model. BALB/c mice were randomized into exposed and control groups. We found that the levels of soluble tumor necrosis factor receptor I was increased following the PM2.5 exposure. 16S rRNA sequencing of respiratory tract lavage fluid confirmed that the composition of the respiratory tract microecology was altered by the exposure. Lactobacillus was the most abundant of bacterial species present. Collectively, these results establish a link between exposure to fine particulate matter and alterations to the respiratory tract microecology. Elucidation of the underlying mechanisms may lead to treatment strategies in lung injury.

Stroke: Temporal Trends and Association with Atmospheric Variables and Air Pollutants in Northern Spain

Stroke, the second cause of death and the most frequent cause of severe disability among adults in developed countries, is related to a large variety of risk factors. This paper assesses the temporal patterns in stroke episodes in a city in Northern Spain during a 12-year period and analyzes the possible effects that atmospheric pollutants and meteorological variables may have on stroke on a daily scale. Our results show that there is an increase in stroke admissions (r = 0.818, p = 0.001) especially in patients over 85 years old. On a weekly scale, the number of hospital admissions due to stroke remains stable from Monday to Friday, whereas it abruptly decreases during the weekends, reaching its minimum values on Sunday (p < 0.005); however, mortality in patients admitted to the hospital is higher on Sundays than on other days of the week. Finally, a statistically significant positive correlation between the number of stroke hospital admissions and NO₂ levels (p = 0.012) and an inverse correlation with relative humidity (p = 0.032) were found. The analysis of the relationship between ischemic strokes and atmospheric circulation shows a higher frequency of the former in Santander with enhanced negative air pressure anomalies over western Spain; the fact that under these conditions the region studied registers very low values of relative humidity is in line with the aforementioned inverse correlation, which has not been described elsewhere in the literature. This study could be a first step for implementing stroke alert protocols depending on air pollution levels and circulation patterns forecasts.

Foliar heavy metal uptake, toxicity and detoxification in plants: A comparison of foliar and root metal uptake

Anthropologic activities have transformed global biogeochemical cycling of heavy metals by emitting considerable quantities of these metals into the atmosphere from diverse sources. In spite of substantial and progressive developments in industrial processes and techniques to reduce environmental emissions, atmospheric contamination by toxic heavy metals and associated ecological and health risks are still newsworthy. Atmospheric heavy metals may be absorbed via foliar organs of plants after wet or dry deposition of atmospheric fallouts on plant canopy. Unlike root metal transfer, which has been largely studied, little is known about heavy metal uptake by plant leaves from the atmosphere. To the best of our understanding, significant research gaps exist regarding foliar heavy metal uptake. This is the first review regarding biogeochemical behaviour of heavy metals in atmosphere-plant system. The review summarizes the mechanisms involved in foliar heavy metal uptake, transfer, compartmentation, toxicity and in plant detoxification. We have described the biological and environmental factors that affect foliar uptake of heavy metals and compared the biogeochemical behaviour (uptake, translocation, compartmentation, toxicity and detoxification) of heavy metals for root and foliar uptake. The possible health risks associated with the consumption of heavy metal-laced food are also discussed.

Inflammatory response and endothelial dysfunction in the hearts of mice co-exposed to SO2 , NO2 , and PM2.5

SO₂ , NO₂ , and PM_2.5 are typical air pollutants produced during the combustion of coal. Increasing evidence indicates that air pollution has contributed to the development and progression of heart-related diseases over the past decades. However, little experimental data and few studies of SO₂ , NO₂ , and PM_2.5 co-exposure in animals exist; therefore, the relevant mechanisms underlying this phenomenon are unclear. An important characteristic of air pollution is that co-exposure persists at a low concentration throughout a lifetime. In the present study, we treated adult mice with SO₂ , NO₂ , and PM_2.5 at various concentrations (0.5 mg/m³ SO₂ , 0.2 mg/m³ NO₂ 6 h/d, with intranasal instillation of 1 mg/kg PM_2.5 every other day during these exposures; or 3.5 mg/m³ SO₂ , 2 mg/m³ NO₂ 6 h/d, and 10 mg/kg PM_2.5 for 28 d). Blood pressure (BP), heart rate (HR), histopathological damage, and inflammatory and endothelial cytokines in the heart were assessed. The results indicate that co-exposure caused endothelial dysfunction by elevating endothelin-1 (ET-1) expression and repressing the endothelial nitric oxide synthase (eNOS) level as well as stimulating the inflammatory response by increasing the levels of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Additionally, these alterations were confirmed by histological staining. Furthermore, we observed decreased BP and increased HR after co-exposure. Our results indicate that co-exposure to SO₂ , NO₂ , and PM_2.5 may be a major risk factor for cardiac disease and may induce injury to the hearts of mammals and contribute to heart disease. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 1996-2005, 2016.

Source apportionment of indoor PM10 in Elderly Care Centre

Source contribution to atmospheric particulate matter (PM) has been exhaustively modelled. However, people spend most of their time indoors where this approach is less explored. This evidence worsens considering elders living in Elderly Care Centres, since they are more susceptible. The present study aims to investigate the PM composition and sources influencing elderly exposure. Two 2-week sampling campaigns were conducted-one during early fall (warm phase) and another throughout the winter (cold phase). PM10 were collected with two TCR-Tecora(®) samplers that were located in an Elderly Care Centre living room and in the correspondent outdoor. Chemical analysis of the particles was performed by neutron activation analysis for element characterization, by ion chromatography for the determination of water soluble ions and by a thermal optical technique for the measurement of organic and elemental carbon. Statistical analysis showed that there were no statistical differences between seasons and environments. The sum of the indoor PM10 components measured in this work explained 57 and 53 % of the total PM10 mass measured by gravimetry in warm and cold campaigns, respectively. Outdoor PM10 concentrations were significantly higher during the day than night (p value < 0.05), as well as Ca(2+), Fe, Sb and Zn. The contribution of indoor and outdoor sources was assessed by principal component analysis and showed the importance of the highways and the airport located less than 500 m from the Elderly Care Centre for both indoor and outdoor air quality.

The Effects of Air Pollution on Ischemic Stroke Admission Rate

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2±13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O₃ levels amplifies this risk, while a transient increase in NO₂ (p<0.001) and SO₂ (p<0.001) levels has the same effect. Long-term changes in PM₁₀ (p<0.001) and PM_2.5 (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

PM2.5 and Cardiovascular Diseases in the Elderly: An Overview

Background: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in the elderly and the ambient concentration of PM_2.5 has been associated with several cardiovascular diseases. Methods: We describe the present state of planetary air pollution, analyze epidemiological studies linking PM_2.5 and CVD, and discuss multiple pathophysiological mechanisms linking PM_2.5 and CVD. Results: A few epidemiological studies show that the elderly appear specifically susceptible to adverse cardiovascular effects triggered by PM_2.5 exposure. Plausible pathophysiological mechanisms include inflammatory dysfunction, oxidative stress, abnormal activation of the hemostatic system and disturbance of the autonomic nervous system. Conclusions: An in-depth knowledge of the chemical compounds, pathophysiological mechanisms, and epidemiological studies of PM_2.5 are recommended to understand this important and modifiable factor contributing to geriatric CVD burden. We offer public health recommendations to reduce this preventable cause of disease and death.

Chemical characterization of atmospheric particles and source apportionment in the vicinity of a steelmaking industry

The objective of this work was to provide a chemical characterization of atmospheric particles collected in the vicinity of a steelmaking industry and to identify the sources that affect PM10 levels. A total of 94 PM samples were collected in two sampling campaigns that occurred in February and June/July of 2011. PM2.5 and PM2.5-10 were analyzed for a total of 22 elements by Instrumental Neutron Activation Analysis and Particle Induced X-ray Emission. The concentrations of water soluble ions in PM10 were measured by Ion Chromatography and Indophenol-Blue Spectrophotometry. Positive Matrix Factorization receptor model was used to identify sources of particulate matter and to determine their mass contribution to PM10. Seven main groups of sources were identified: marine aerosol identified by Na and Cl (22%), steelmaking and sinter plant represented by As, Cr, Cu, Fe, Ni, Mn, Pb, Sb and Zn (11%), sinter plant stack identified by NH4(+), K and Pb (12%), an unidentified Br source (1.8%), secondary aerosol from coke making and blast furnace (19%), fugitive emissions from the handling of raw material, sinter plant and vehicles dust resuspension identified by Al, Ca, La, Si, Ti and V (14%) and sinter plant and blast furnace associated essentially with Fe and Mn (21%).