[Urban air pollution and hospital admissions for asthma and acute respiratory disease in Murcia city (Spain)]

Regional impact assessment of air quality improvement: The air quality lifecourse assessment tool (AQ-LAT) for the West Midlands combined authority (WMCA)

Poor air quality is the largest environmental health risk in England. In the West Midlands, UK, ∼2.9 million people are affected by air pollution with an average loss in life expectancy of up to 6 months. The 2021 Environment Act established a legal framework for local authorities in England to develop regional air quality plans, generating a policy need for predictive environmental impact assessment tools. In this context, we developed a novel Air Quality Lifecourse Assessment Tool (AQ-LAT) to estimate electoral ward-level impacts of PM2.5 and NO2 exposure on outcomes of interest to local authorities, namely morbidity (asthma, coronary heart disease (CHD), stroke, lung cancer), mortality, and associated healthcare costs. We apply the Tool to assess the health economic burden of air pollutant exposure and estimate benefits that would be generated by meeting WHO 2021 Global Air Quality Guidelines (AQGs) (annual average concentrations) for NO2 (10 μg/m3) and PM2.5 (5 μg/m3) in the West Midlands Combined Authority Area. All West Midlands residents live in areas which exceed WHO AQGs, with 2070 deaths, 2070 asthma diagnoses, 770 CHD diagnoses, 170 lung cancers and 650 strokes attributable to air pollution exposure annually. Reducing PM2.5 and NO2 concentrations to WHO AQGs would save 10,700 lives reducing regional mortality by 1.8%, gaining 92,000 quality-adjusted life years (QALYs), and preventing 20,500 asthma, 7400 CHD, 1400 lung cancer, and 5700 stroke diagnoses, with economic benefits of £3.2 billion over 20 years. Significantly, we estimate 30% of QALY gains relate to reduced disease burden. The AQ-LAT has major potential to be replicated across local authorities in England and applied to inform regional investment decisions.

[Burning of sugarcane biomass and hospitalizations of children and older adults for respiratory problems in Pernambuco State, Brazil]

This study aimed to analyze the relationship between hospitalizations for respiratory problems and the regular burning of sugarcane in Pernambuco State, Brazil. This is an ecological time series study corresponding to the period from 2008 to 2018. The rates of hospitalizations for respiratory diseases in children aged under 5 years and in adults older than 60 years in sugarcane-producing and non-producing municipalities were compared using nonparametric Mann-Whitney statistical analysis. Together, we observed the monthly distribution of the hot spots occurrences in the case and control municipalities and applied Pearson's correlation to analyze the association between both variables. For both age groups, hospitalization rates are higher in sugarcane-producing municipalities, with a statistically significant difference p < 0.005. The rate of hospitalization in older adults is 28% higher in the case municipalities, and is even higher in children aged under 5 years whose ratio of the medians is 40%. However, the seasonal behavior of hospitalizations for respiratory diseases differs from that observed in the monthly distribution of hot spots, without statistically significant correlation. These findings suggest a possible association with chronic exposure to particulates emitted by biomass burning, compromising the health of vulnerable groups, and endorse the need to replace fires in the monoculture of sugarcane and to structure public policies to protect human and environmental health.

Short-term effects of air pollution on hospital admissions of respiratory diseases in Hamadan, Iran, 2015 to 2021

The short-term effects of air pollution on respiratory diseases have been reported in many countries. Urban areas are most affected because of the many sources of pollution and the large number of people living there. This study aims to investigate the effect of short-term exposure to air pollutants on respiratory hospital admissions in the city of Hamadan. In this ecological study, daily hospital admission data were collected from Shahid Beheshti Hospital in Hamadan. Daily information on air pollutants (CO, SO2, NO2, O3, PM2.5 and PM10) from Hamadan Department of Environment (DoE) organization and of climate factors from Hamadan Meteorological Office were collected. A negative binomial regression model was used to examine the effect of air pollution on daily respiratory hospitalizations. The effect of exposure to pollutants was measured whit different time lags (0-7 days). Furthermore, the effect of meteorological variables was controlled. Subgroup analyses were performed by sex and age group. A total of 12,454 hospitalizations for respiratory diseases were recorded. Results showed a strong and immediate effect of CO on respiratory hospital admissions with highest association at lag 7 (relative risk (RR) = 1.38, 95% CI: 1.33, 1.42). The effects of CO and SO2 on respiratory hospitalizations are greater for men than women. Regarding the short-term effects of PM2.5, SO2 and O3, adults (aged less than 65) were more prone to hospitalization for respiratory diseases. These results show that exposure to air pollution, particularly CO, may increase hospital admissions due to respiratory illness. So reducing the concentration of these pollutants can reduce the number of hospital admissions.

Spatial distribution of hospital admissions for asthma in the central area of Asturias, Northern Spain

BACKGROUND

Asturias is one of the communities with the highest rates of hospital admission for asthma in Spain. The environmental pollution or people lifestyle are some of the factors that contribute to the appearance or aggravation of this illness. The aim of this study was to show the spatial distribution of asthma admissions risks in the central municipalities of Asturias and to analyze the observed spatial patterns.

METHODS

Urgent hospital admissions for asthma and status asthmaticus occurred between 2016 to 2018 on the public hospitals of the central area of Asturias were used. Population data were assigned in 5 age groups. Standardised admission ratio (SAR), smoothed relative risk (SRR) and posterior risk probability (PP) were calculated for each census tract (CT). A spatial trend analysis was run, a spatial autocorrelation index (Morans I) was calculated and a cluster and outlier analysis (Anselin Local Morans I) was finally performed in order to analyze spatial clusters.

RESULTS

The total number of hospital urgent asthma admissions during the study period was 2324, 1475 (63.46%) men and 849 (36.56%) women. The municipalities with the highest values of SRR and PP were located on the northwest area: Avilés, Gozón, Carreño, Corvera de Asturias, Castrillón and Illas. A high risk cluster was found for the municipalities of Avilés, Gozón y Corvera de Asturias.

CONCLUSIONS

The spatial analysis showed high risk of hospitalization for asthma on the municipalities of the northwest area of the study, which highlight the existence of spatial inequalities on the distribution of urgent hospital admissions.

Environmental gaseous pollutants are related to increase of acute coronary syndrome in Valencia region

INTRODUCTION AND AIMS

Environmental pollution are one of the most relevant risk factors to atherosclerosis. To know awareness about the importance of urban air pollution as a trigger for hospital admission due to acute coronary syndrome (ACS), this study analyzed levels of different gaseous air pollutants in the air and its correlation with number of ACS.

METHODS

Epidemiological data of patients admitted for ACS in five towns during the years 2006-2008 were recovered. Clinical data regarding admissions for ACS were obtained from the hospital admission services. Measures of seven air contaminants were recovered from the environmental stations. Mixed model including sex, age, location, and the average levels of air pollutants contaminants as fixed effects and its interaction were performed.

RESULTS

The incidence rate of ACS is higher in man than woman, and higher in older people than young. The maximum ACS were in the last trimester of the year, was the most elevated levels of gaseous pollutants have been found. Levels of NO₂, NO, and CO are positively correlated between them, and negatively correlated with O₃ levels. All air pollutants analyzed increase the number of ACS hospital admission in the five locations evaluated.

CONCLUSIONS

Levels of gaseous pollutants are related between them, being the levels of NO₂, NO, and CO, positively correlated, and negatively correlated with levels of O₃. Number of ACS hospital admission increases with levels of five air gaseous pollutants studied.

Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid)

OBJECTIVES

To analyze whether the high levels of air pollutants are related to a greater severity of decompensated heart failure (HF).

METHOD

Patients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona and 3 in Madrid were included. Clinical data (age, sex, comorbidities, baseline functional status), atmospheric (temperature, atmospheric pressure) and pollutant data (SO₂, NO₂, CO, O₃, PM₁₀, PM_2.5) were collected in the city on the day of emergency care. The severity of decompensation was estimated using 7-day mortality (primary indicator) and the need for hospitalization, in-hospital mortality, and prolonged hospitalization (secondary indicators). The association adjusted for clinical, atmospheric and city data between pollutant concentration and severity was investigated using linear regression (linearity assumption) and restricted cubic spline curves (no linearity assumption).

RESULTS

A total of 5292 decompensations were included, with a median age of 83 years (IQR=76-88) and 56% women. The medians (IQR) of the daily pollutant averages were: SO₂=2.5μg/m³ (1.4-7.0), NO₂=43μg/m³ (34-57), CO=0.48mg/m³ (0.35-0.63), O₃=35μg/m³ (25-48), PM₁₀=22μg/m³ (15-31) and PM_2.5=12μg/m³ (8-17). Mortality at 7 days was 3.9%, and hospitalization, in-hospital mortality, and prolonged hospitalization were 78.9, 6.9, and 47.5%, respectively. SO₂ was the only pollutant that showed a linear association with the severity of decompensation, since each unit of increase implied an OR for the need for hospitalization of 1.04 (95% CI 1.01-1.08). The restricted cubic spline curves study also did not show clear associations between pollutants and severity, except for SO₂ and hospitalization, with OR of 1.55 (95% CI 1.01-2.36) and 2.71 (95% CI 1.13-6.49) for concentrations of 15 and 24μg/m³, respectively, in relation to a reference concentration of 5μg/m³.

CONCLUSION

Exposure to ambient air pollutants, in a medium to low concentration range, is generally not related to the severity of HF decompensations, and only NO₂ may be associated with an increased need for hospitalization.

Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents

Today more than half of the world's population lives in urban areas. Children spend about 40 h a week in the school environment. Knowing the influence of school exposure to green/blue spaces could improve the children's health, creating healthier environments and preventing exposure to legal/illegal drugs. This systematic review summarized the main results of published studies on active or passive exposure to green or blue spaces in different domains of child neurodevelopment. In August 2022, five databases were searched and twenty-eight eligible studies were included in the analysis. Cognitive and/or academic performance was the most frequently studied (15/28). Most studies evaluate passive exposure to green/blue spaces (19/28) versus active exposure (9/28). Only three studies addressed the relationship between blue space and neurodevelopment. The main results point toward mixed evidence of a protective relationship between green/blue space exposure and neurodevelopment, especially in improving cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting "greener" capacities for school environmental health could improve children's neurodevelopment. There was great heterogeneity in methodologies and adjustment for confounding factors across studies. Future research should seek a standardized approach to delivering school environmental health interventions beneficial to children's development.

Subjective well-being, happiness, and environmental health factors related to women planning a pregnancy or pregnant, using mobile health intervention

Objectives

To compare the environmental health results in women trying to get pregnant or pregnant using a mobile health application (Green Page) through healthcare professionals or self-completed by women, and to explore the relationship between the subjective well-being of these women with their lifestyles and environmental factors.

Methods

A descriptive study with mixed methods was conducted in 2018. A mobile health survey was used in two phases. Phase 1 was a cross-sectional study through professionals (n  =  1100) followed by phase 2, a convenience sampling through women's self-reporting (n  =  3425). A personalized report was downloadable with health recommendations for the well-being of the mother and child.

Results

Of the 3205 participants (mean age  =  33 years, SD  =  0.2 years), 1840 were planning a pregnancy and 1365 were pregnant. One in five pregnant women had a low level of happiness. Globally, subjective well-being and happiness were found to be negatively associated with lack of contact with nature, sedentary lifestyle, excess weight, environmental exposure, and older age in pregnancy. Precisely 45%, 60%, and 14% of women were exposed to tobacco, alcohol, and illegal drugs, respectively. The women self-reported levels of risk factors higher than when the tool was used by or through professionals.

Conclusions

The use of mobile health interventions focused on environmental health during planning or pregnancy periods could help improve the quality of healthcare and foster greater involvement of women in their self-care process, thus promoting empowerment, healthier environments, and lifestyles. Ensuring equity of access and data protection are global challenges to be addressed.

Short-term exposure to gaseous air pollutants and daily hospitalizations for acute upper and lower respiratory infections among children from 25 cities in China

To examine the short-term association between gaseous air pollutants (CO, NO₂, SO₂, and O₃) and all-cause respiratory disease, acute upper respiratory infections (AURIs) as well as acute lower respiratory infections (ALRIs) among children, we conducted the study from 25 major cities in China. Hospitalization records of children aged 0-18 years due to all-cause respiratory diseases (889,926), AURIs (97,858), and ALRIs (642,154) from 2016 to 2019 were extracted. Concentrations of CO, NO₂, SO₂, and O₃ were averaged across monitoring stations. Generalized additive models were used to estimate the associations between gaseous air pollutants and daily hospitalizations for all-cause respiratory disease, AURIs, and ALRIs. The meta-analysis was used to combine the city-specific estimates. A 10 mg/m³ increase in CO at lag01, and a 10 μg/m³ increase in NO₂, SO₂, and O₃ at lag01 were associated with 1.65% (95%CI, 0.41-2.91), 0.54% (95%CI, 0.30-0.79), 0.60% (95%CI, 0.22-0.99), and 0.23% (95%CI, 0.06-0.39) increase of hospitalizations due to all-cause respiratory disease, respectively. For the disease subtype, O₃ only had adverse effects on AURIs, CO and SO₂ mainly on ALRIs, and NO₂ on both AURIs and ALRIs. Children aged 4-6years were more vulnerable to the effects of CO and NO₂, but those aged <1year were more susceptible to SO₂ and O₃. Besides, the O₃ effect was stronger in the warm season than in the cold season. The study indicated that short-term exposure to CO, NO₂, SO_2, and O₃ was associated with increased hospitalization for pediatric respiratory disease, and the association may vary by position of the respiratory tract, age, and season.

A long short-term memory-fully connected (LSTM-FC) neural network for predicting the incidence of bronchopneumonia in children

Bronchopneumonia is the most common infectious disease in children, and it seriously endangers children's health. In this paper, a deep neural network combining long short-term memory (LSTM) layers and fully connected layers was proposed to predict the prevalence of bronchopneumonia in children in Chengdu based on environmental factors and previous prevalence rates. The mean square error (MSE), mean absolute error (MAE), and Pearson correlation coefficient (R) were used to detect the performance of the deep learning model. The values of MSE, MAE, and R in the test dataset are 0.0051, 0.053, and 0.846, respectively. The results show that the proposed model can accurately predict the prevalence of bronchopneumonia in children. We also compared the proposed model with three other models, namely, a fully connected (FC) layer neural network, a random forest model, and a support vector machine. The results show that the proposed model achieves better performance than the three other models by capturing time series and mitigating the lag effect.