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Wu TD. Portable Air Purifiers to Mitigate the Harms of Wildfire Smoke for People with Asthma. Am J Respir Crit Care Med 2024; 209:126-128. [PMID: 38047880 PMCID: PMC10806428 DOI: 10.1164/rccm.202311-2012ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/01/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Tianshi David Wu
- Section of Pulmonary, Critical Care, and Sleep Medicine Baylor College of Medicine Houston, Texas
- Center for Innovations in Quality, Effectiveness, and Safety Michael E. DeBakey Veterans Affairs Medical Center Houston, Texas
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2
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Ijaz MK, Sattar SA, Nims RW, Boone SA, McKinney J, Gerba CP. Environmental dissemination of respiratory viruses: dynamic interdependencies of respiratory droplets, aerosols, aerial particulates, environmental surfaces, and contribution of viral re-aerosolization. PeerJ 2023; 11:e16420. [PMID: 38025703 PMCID: PMC10680453 DOI: 10.7717/peerj.16420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
During the recent pandemic of COVID-19 (SARS-CoV-2), influential public health agencies such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have favored the view that SARS CoV-2 spreads predominantly via droplets. Many experts in aerobiology have openly opposed that stance, forcing a vigorous debate on the topic. In this review, we discuss the various proposed modes of viral transmission, stressing the interdependencies between droplet, aerosol, and fomite spread. Relative humidity and temperature prevailing determine the rates at which respiratory aerosols and droplets emitted from an expiratory event (sneezing, coughing, etc.) evaporate to form smaller droplets or aerosols, or experience hygroscopic growth. Gravitational settling of droplets may result in contamination of environmental surfaces (fomites). Depending upon human, animal and mechanical activities in the occupied space indoors, viruses deposited on environmental surfaces may be re-aerosolized (re-suspended) to contribute to aerosols, and can be conveyed on aerial particulate matter such as dust and allergens. The transmission of respiratory viruses may then best be viewed as resulting from dynamic virus spread from infected individuals to susceptible individuals by various physical states of active respiratory emissions, instead of the current paradigm that emphasizes separate dissemination by respiratory droplets, aerosols or by contaminated fomites. To achieve the optimum outcome in terms of risk mitigation and infection prevention and control (IPAC) during seasonal infection peaks, outbreaks, and pandemics, this holistic view emphasizes the importance of dealing with all interdependent transmission modalities, rather than focusing on one modality.
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Affiliation(s)
- M. Khalid Ijaz
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, NJ, United States of America
| | - Syed A. Sattar
- Department of Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Stephanie A. Boone
- Water & Energy Sustainable Technology Center, University of Arizona, Tucson, AZ, United States of America
| | - Julie McKinney
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, NJ, United States of America
| | - Charles P. Gerba
- Water & Energy Sustainable Technology Center, University of Arizona, Tucson, AZ, United States of America
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3
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Faridi S, Allen RW, Brook RD, Yousefian F, Hassanvand MS, Carlsten C. An updated systematic review and meta-analysis on portable air cleaners and blood pressure: Recommendations for users and manufacturers. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 263:115227. [PMID: 37421892 DOI: 10.1016/j.ecoenv.2023.115227] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/10/2023]
Abstract
Fine particulate matter (PM2.5) air pollution is a leading contributor to the global burden of cardiovascular disease (CVD). One important underlying mechanism is an increase in blood pressure (BP). A growing number of studies have reported a beneficial effect of portable air cleaners (PACs) on systolic and diastolic BP; SBP and DBP. We conducted an updated systematic review and meta-analysis of studies using true versus sham mode filtration reporting the effects on BP. Of 214 articles identified up to February 5, 2023, seventeen (from China, USA, Canada, South Korea and Denmark) enrolling approximately 880 participants (484 female) met the inclusion criteria for meta-analyses. Aside from studies conducted in China, research on PACs and BP has been conducted in relatively low pollution settings. Mean indoor PM2.5 concentrations during the active and sham mode purification were 15.9 and 41.2 µg/m3, respectively. The mean efficiency of PACs against indoor PM2.5 was 59.8 % (ranging from 23 % to 82 %). True mode filtration was associated with a pooled mean difference of - 2.35 mmHg (95 % confidence interval [CI]: - 4.5, - 0.2) and - 0.81 mmHg (95 % CI: - 1.86, 0.24) in SBP and DBP, respectively. After removing the studies with high risk of bias, the magnitude of the pooled benefits on SBP and DBP increased to - 3.62 mmHg (95 % CI: - 6.69, - 0.56) and - 1.35 mmHg (95 % CI: - 2.29, - 0.41), respectively. However, there are several barriers to the use of PACs, specifically in low- and middle-income countries (LMICs), such as the initial purchase cost and filter replacements. There may be several avenues to help overcome these economic burdens and improve cost effectiveness, such as implementing government or other subsidized programs to distribute PACs targeting vulnerable and higher-risk individuals. We propose that environmental health researchers and healthcare providers should be better trained to educate the public regarding the use of PACs to reduce the impacts of PM2.5 on cardiometabolic diseases globally.
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Affiliation(s)
- Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Ryan W Allen
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Christopher Carlsten
- Air Pollution Exposure Lab and Legacy for Airway Health, Vancouver Coastal Health Research Institute and University of British Columbia, Vancouver, Canada.
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4
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Abstract
Despite recent advances in treatment and prevention, stroke remains a leading cause of morbidity and mortality. There is a critical need to identify novel modifiable risk factors for disease, including environmental agents. A body of evidence has accumulated suggesting that elevated levels of ambient air pollutants may not only trigger cerebrovascular events in susceptible people (short-term exposures) but also increase the risk of future events (long-term average exposures). This review assesses the updated evidence for both short and long-term exposure to ambient air pollution as a risk factor for stroke incidence and outcomes. It discusses the potential pathophysiologic mechanisms and makes recommendations to mitigate exposure on a personal and community level. The evidence indicates that reduction in air pollutant concentrations represent a significant population-level opportunity to reduce risk of cerebrovascular disease.
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Affiliation(s)
- Erin R Kulick
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA (E.R.K.)
| | - Joel D Kaufman
- Department of Medicine, University of Washington, Seattle (J.D.K., C.S.)
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle (J.D.K., C.S.)
- Department of Epidemiology, University of Washington, Seattle (J.D.K.)
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle (J.D.K., C.S.)
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle (J.D.K., C.S.)
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5
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Health burden and economic loss attributable to ambient PM 2.5 in Iran based on the ground and satellite data. Sci Rep 2022; 12:14386. [PMID: 35999246 PMCID: PMC9399101 DOI: 10.1038/s41598-022-18613-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/16/2022] [Indexed: 01/02/2023] Open
Abstract
We estimated mortality and economic loss attributable to PM2·5 air pollution exposure in 429 counties of Iran in 2018. Ambient PM2.5-related deaths were estimated using the Global Exposure Mortality Model (GEMM). According to the ground-monitored and satellite-based PM2.5 data, the annual mean population-weighted PM2·5 concentrations for Iran were 30.1 and 38.6 μg m-3, respectively. We estimated that long-term exposure to ambient PM2.5 contributed to 49,303 (95% confidence interval (CI) 40,914-57,379) deaths in adults ≥ 25 yr. from all-natural causes based on ground monitored data and 58,873 (95% CI 49,024-68,287) deaths using satellite-based models for PM2.5. The crude death rate and the age-standardized death rate per 100,000 population for age group ≥ 25 year due to ground-monitored PM2.5 data versus satellite-based exposure estimates was 97 (95% CI 81-113) versus 116 (95% CI 97-135) and 125 (95% CI 104-145) versus 149 (95% CI 124-173), respectively. For ground-monitored and satellite-based PM2.5 data, the economic loss attributable to ambient PM2.5-total mortality was approximately 10,713 (95% CI 8890-12,467) and 12,792.1 (95% CI 10,652.0-14,837.6) million USD, equivalent to nearly 3.7% (95% CI 3.06-4.29) and 4.3% (95% CI 3.6-4.5.0) of the total gross domestic product in Iran in 2018.
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6
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Faridi S, Brook RD, Yousefian F, Hassanvand MS, Nodehi RN, Shamsipour M, Rajagopalan S, Naddafi K. Effects of respirators to reduce fine particulate matter exposures on blood pressure and heart rate variability: A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 303:119109. [PMID: 35271952 PMCID: PMC10411486 DOI: 10.1016/j.envpol.2022.119109] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
Particulate-filtering respirators (PFRs) have been recommended as a practical personal-level intervention to protect individuals from the health effects of particulate matter exposure. However, the cardiovascular benefits of PFRs including improvements in key surrogate endpoints remain unclear. We performed a systematic review and meta-analysis of randomized studies (wearing versus not wearing PFRs) reporting the effects on blood pressure (BP) and heart rate variability (HRV). The search was performed on January 3, 2022 to identify published papers until this date. We queried three English databases, including PubMed, Web of Science Core Collection and Scopus. Of 527 articles identified, eight trials enrolling 312 participants (mean age ± standard deviation: 36 ± 19.8; 132 female) met our inclusion criteria for analyses. Study participants wore PFRs from 2 to 48 h during intervention periods. Wearing PFRs was associated with a non-significant pooled mean difference of -0.78 mmHg (95% confidence interval [CI]: -2.06, 0.50) and -0.49 mmHg (95%CI: -1.37, 0.38) in systolic and diastolic BP (SBP and DBP). There was a marginally significant reduction of mean arterial pressure (MAP) by nearly 1.1 mmHg (95%CI: -2.13, 0.01). The use of PFRs was associated with a significant increase of 38.92 ms2 (95%CI: 1.07, 76.77) in pooled mean high frequency (power in the high frequency band (0.15-0.4 Hz)) and a reduction in the low (power in the low frequency band (0.04-0.15Hz))-to-high frequency ratio [-0.14 (95%CI: -0.27, 0.00)]. Other HRV indices were not significantly changed. Our meta-analysis demonstrates modest or non-significant improvements in BP and many HRV parameters from wearing PFRs over brief periods. However, these findings are limited by the small number of trials as well as variations in experimental designs and durations. Given the mounting global public health threat posed by air pollution, larger-scale trials are warranted to elucidate more conclusively the potential health benefits of PFRs.
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Affiliation(s)
- Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh Nodehi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Kharel M, Chalise S, Chalise B, Sharma KR, Gyawali D, Paudyal H, Neupane BB. Assessing volatile organic compound level in selected workplaces of Kathmandu Valley. Heliyon 2021; 7:e08262. [PMID: 34765781 PMCID: PMC8571507 DOI: 10.1016/j.heliyon.2021.e08262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 01/24/2023] Open
Abstract
Volatile organic compounds (VOCs) are one of the major contributors to poor indoor air quality. Due to advancements in sensor technologies, continuous if not regular monitoring total VOC (TVOC) and or some specific VOC in potential high risk workplaces is possible even in resource limited settings. In this study, we implemented a portable VOC sensor to measure concentration of TVOC and formaldehyde (HCHO) in six types of potential high risk workplaces (n = 56 sites) of Katmandu Valley. For comparison, concentration was also measured in immediate surroundings (n = 56) of all the sites. To get preliminary information on safety practices, a survey study was also conducted. The mean TVOC and HCHO concentration in the sites ranged from 1.5‒8 mg/m3 and <0.01–5.5 mg/m3, respectively. The indoor: outdoor TVOC and HCHO ratio (I/O) was found to be significantly higher (I/O > 1.5 and p < 0.05) in 34 (~61%) and 47 sites (∼84%), respectively. A strong positive correlation between HCHO and TVOC concentration was observed in furniture industry (R = 0.91) and metal workshops (R = 0.98). Interestingly, we found TVOC and HCHO concentration higher than WHO safe limit in ∼64% and ∼32% sites, respectively. A rough estimate of chronic daily intake (CDI) of formaldehyde showed that CDI is higher than WHO limit in four sites. These findings suggested that indoor air quality in the significant number of the workplaces is poor and possible measures should be taken to minimize the exposure.
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Affiliation(s)
- Madhav Kharel
- Central Department of Chemistry, Tribhuvan University, Kathmandu, Nepal
| | - Surendra Chalise
- Central Department of Chemistry, Tribhuvan University, Kathmandu, Nepal
| | - Baburam Chalise
- Central Department of Chemistry, Tribhuvan University, Kathmandu, Nepal
| | - Khaga Raj Sharma
- Central Department of Chemistry, Tribhuvan University, Kathmandu, Nepal
| | - Deepak Gyawali
- Central Department of Chemistry, Tribhuvan University, Kathmandu, Nepal.,Ministry of Forests and Environment, Department of Environment, Government of Nepal, Nepal
| | - Hari Paudyal
- Central Department of Chemistry, Tribhuvan University, Kathmandu, Nepal
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8
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Reduced Fine Particulate Matter Air Pollution Exposures Using In-Home Portable Air Cleaners: PILOT RESULTS OF THE CARDIAC REHABILITATION AIR FILTER TRIAL (CRAFT). J Cardiopulm Rehabil Prev 2021; 40:276-279. [PMID: 32604256 DOI: 10.1097/hcr.0000000000000516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Fine particulate matter (PM2.5) air pollution is a leading risk factor for cardiovascular disease. Even low levels common to millions of Americans pose health risks. However, no study has tested protective measures such as in-home portable air cleaners (PACs) among at-risk cardiac patients. We conducted a pilot phase of the Cardiac Rehabilitation Air Filter Trial (CRAFT)-a randomized, double-blind, crossover study of outpatient cardiac rehabilitation patients at Michigan Medicine. METHODS During a routine visit, patients were provided with 2 PACs to run continuously for 5 d in both the bedroom and the main living space. PACs were randomized as active (with HEPA filter) versus sham. On day 4, subjects wore a personal PM2.5 monitor for 24-hr without activity restrictions. After a 1-wk washout, patients crossed over to the opposite mode. RESULTS Patients (n = 20; 4 women) were elderly (70.8 ± 9.6 yr) nonsmokers with cardiovascular disease living near the facility (10.7 ± 6.0 mi). Compared with sham, active in-home PAC use significantly lowered personal-level 24-hr PM2.5 exposures by 43.8% (-12.2 μg·m; 95% CI, -24.2 to -0.2). Sensitivity analyses corroborated the reductions in most patients. CONCLUSION An inexpensive in-home PAC can effectively lower personal PM2.5 exposures in cardiac patients. These benefits occurred even in a region with overall good air quality and if maintained over the long-term could translate into major reductions in cardiovascular events.
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9
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Liu Y, Zhou B, Wang J, Zhao B. Health benefits and cost of using air purifiers to reduce exposure to ambient fine particulate pollution in China. JOURNAL OF HAZARDOUS MATERIALS 2021; 414:125540. [PMID: 33684813 DOI: 10.1016/j.jhazmat.2021.125540] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Understanding the cost-effectiveness of possible interventions to reduce air pollution levels is crucial to developing sustainable mitigation and adaption strategies. Although people spend more than 80% of their time indoors, the role of air purifiers in mitigating personal exposure to indoor PM2.5 of outdoor origin has not yet been quantified, especially in under-developed regions. Here, we performed a comprehensive simulation at the 10 km × 10 km geographical resolution in mainland China to quantify the health benefits and costs of indoor air purification in four intervention scenarios, S1 to S4, where target indoor PM2.5 concentrations were 35, 25, 15, and 10 μg/m3. In intervention scenarios S1 to S4, 93,200 (95% uncertainty interval 78,900-113,600), 115,300 (97,700-140,800), 163,400 (138,300-198,800), and 207,900 (176,300-251,800) deaths that cost 82, 175, 438, and 798 billion Chinese Yuan can be avoided and 93%, 80%, 53%, and 26% of the cities have a positive net monetary benefit. We found that achieving indoor PM2.5 concentration of 35 or 25 μg/m3 using air purifiers is cost-effective at reducing PM2.5 related deaths and PM2.5 concentration of 25 μg/m3 is a suitable indoor PM2.5 target for China. Multifaceted efforts are necessary to ensure equitable access to air purifiers and the knowledge to effectively operate them to make sure the benefits reach the whole population.
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Affiliation(s)
- Yumeng Liu
- Department of Building Science, School of Architecture, Tsinghua University, Beijing 100084, China
| | - Bin Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London W2 1PG, United Kingdom
| | - Jianghao Wang
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China; Sustainable Urbanization Lab, Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Bin Zhao
- Department of Building Science, School of Architecture, Tsinghua University, Beijing 100084, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing 100084, China.
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10
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Faridi S, Yousefian F, Janjani H, Niazi S, Azimi F, Naddafi K, Hassanvand MS. The effect of COVID-19 pandemic on human mobility and ambient air quality around the world: A systematic review. URBAN CLIMATE 2021; 38:100888. [PMID: 36536793 PMCID: PMC9750834 DOI: 10.1016/j.uclim.2021.100888] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 05/19/2023]
Abstract
We conducted this systematic review to identify and appraise studies investigating the coronavirus disease 2019 (COVID-19) effect on ambient air pollution status worldwide. The review of studies was conducted using determined search terms via three major electronic databases (PubMed, Web of Science, and Scopus) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A total of 26 full-text studies were included in our analysis. The lockdown measures related to COVID-19 pandemic caused significant decreases in the concentrations of PM2.5, NO2, PM10, SO2 and CO globally in the range of 2.9%-76.5%, 18.0%-96.0%, 6.0%-75.0%, 6.8%-49.0% and 6.2%-64.8%, respectively. However, O3 concentration increased in the range of 2.4%-252.3%. The highest decrease of PM2.5 was found in 16 states of Malaysia (76.5%), followed by Zaragoza (Spain) with 58.0% and Delhi (India) with 53.1%. The highest reduction of NO2 was found in Salé city (Morocco) with 96.0%, followed by Mumbai (India) with 75.0%, India with 70.0%, Valencia (Spain) with 69.0%, and São Paulo (Brazil) with 68.0%, respectively. The highest increase of O3 was recorded for Milan (Italy) with 252.3% and 169.9% during the first and third phases of lockdown measures, and for Kolkata (India) with 87% at the second phase of lockdown measures. Owing to the lockdown restrictions in the studied countries and cities, driving and public transit as a proxy of human mobilities and the factors affecting emission sources of ambient air pollution decreased in the ranges of 30-88% and 45-94%, respectively. There was a considerable variation in the reduction of ambient air pollutants in the countries and cities as the degree of lockdown measures had varied there. Our results illustrated that the COVID-19 pandemic had provided lessons and extra motivations for comprehensive implementing policies to reduce air pollution and its health effects in the future.
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Affiliation(s)
- Sasan Faridi
- Centre for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Hosna Janjani
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Niazi
- Queensland University of Technology (QUT), Faculty of Science, School of Earth and Atmospheric Siences, Brisbane 4001, Australia
| | - Faramarz Azimi
- Department of Environment Health Engineering, Environmental Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kazem Naddafi
- Centre for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Centre for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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11
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Cardiovascular health effects of wearing a particulate-filtering respirator to reduce particulate matter exposure: a randomized crossover trial. J Hum Hypertens 2021; 36:659-669. [PMID: 34031547 DOI: 10.1038/s41371-021-00552-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/23/2021] [Accepted: 05/13/2021] [Indexed: 12/07/2022]
Abstract
This randomized crossover trial sought to determine whether wearing a high-efficiency particulate-filtering respirator (PFR) improves cardiovascular function over 48 h among healthy college students in Tehran. This trial was conducted from February 14th to 23rd, 2019 and twenty-six participants completed two 48-h intervention periods. Brachial blood pressure (BP) measured by 24-h ambulatory monitoring was the primary health outcome. Secondary outcomes included 48-h heart rate variability (HRV) indices, high-sensitive cardiac troponin (hs-TnT) and other biomarkers. The participants wore the PFR between 10.2 and 11.1 h while awake during the interventions. More than 80% of participants reported increased respiratory resistance while wearing the PFR due to a lack of an exhalation valve. There were no significant differences in brachial BP levels between subjects who wore PFR respirator and those did not. Except for high frequency (HF) power and heart rate (HR), no significant differences between interventions were observed for other HRV metrics. Wearing the PFR led to an increase of 66.0 ms2 (95% confidence interval [CI], 9.6-110.5) and 79.6 ms2 (95% CI, 19.0-140.1) in HF power during the first day when the two groups of participants wore the PFR. Night-time HR was significantly increased during the PFR intervention period. Other secondary outcomes were not significantly different between interventions. It is plausible that incomplete exposure reduction due to wearing the PFR less than half of the time or increased respiratory resistance mitigated potential health benefits. Additional trials are warranted to validate the CV protection of wearing PFRs in heavily-polluted cities.
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12
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Newman JD, Bhatt DL, Rajagopalan S, Balmes JR, Brauer M, Breysse PN, Brown AGM, Carnethon MR, Cascio WE, Collman GW, Fine LJ, Hansel NN, Hernandez A, Hochman JS, Jerrett M, Joubert BR, Kaufman JD, Malik AO, Mensah GA, Newby DE, Peel JL, Siegel J, Siscovick D, Thompson BL, Zhang J, Brook RD. Cardiopulmonary Impact of Particulate Air Pollution in High-Risk Populations: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2878-2894. [PMID: 33303078 PMCID: PMC8040922 DOI: 10.1016/j.jacc.2020.10.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
Fine particulate air pollution <2.5 μm in diameter (PM2.5) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM2.5 as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM2.5 can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention.
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Affiliation(s)
- Jonathan D Newman
- Division of Cardiology and the Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, New York, USA.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/DLBhattMD
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - John R Balmes
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick N Breysse
- National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Durham, North Carolina, USA
| | - Gwen W Collman
- National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrian Hernandez
- Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA
| | - Judith S Hochman
- New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Jerrett
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Bonnie R Joubert
- Population Health Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Joel D Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ali O Malik
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jeffrey Siegel
- Department of Civil and Mineral Engineering, and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Siscovick
- Division of Research, Evaluation, and Policy, The New York Academy of Medicine, New York, New York, USA
| | - Betsy L Thompson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Junfeng Zhang
- Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Robert D Brook
- Division of Cardiovascular Diseases, Wayne State University, Detroit, Michigan, USA
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13
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Rajagopalan S, Brauer M, Bhatnagar A, Bhatt DL, Brook JR, Huang W, Münzel T, Newby D, Siegel J, Brook RD. Personal-Level Protective Actions Against Particulate Matter Air Pollution Exposure: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e411-e431. [PMID: 33150789 DOI: 10.1161/cir.0000000000000931] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since the publication of the last American Heart Association scientific statement on air pollution and cardiovascular disease in 2010, unequivocal evidence of the causal role of fine particulate matter air pollution (PM2.5, or particulate matter ≤2.5 μm in diameter) in cardiovascular disease has emerged. There is a compelling case to provide the public with practical personalized approaches to reduce the health effects of PM2.5. Such interventions would be applicable not only to individuals in heavily polluted countries, high-risk or susceptible individuals living in cleaner environments, and microenvironments with higher pollution exposures, but also to those traveling to locations with high levels of PM2.5. The overarching motivation for this document is to summarize the current evidence supporting personal-level strategies to prevent the adverse cardiovascular effects of PM2.5, guide the use of the most proven/viable approaches, obviate the use of ineffective measures, and avoid unwarranted interventions. The significance of this statement relates not only to the global importance of PM2.5, but also to its focus on the most tested interventions and viable approaches directed at particulate matter air pollution. The writing group sought to provide expert consensus opinions on personal-level measures recognizing the current uncertainty and limited evidence base for many interventions. In doing so, the writing group acknowledges that its intent is to assist other agencies charged with protecting public health, without minimizing the personal choice considerations of an individual who may decide to use these interventions in the face of ongoing air pollution exposure.
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Allen RW, Barn P. Individual- and Household-Level Interventions to Reduce Air Pollution Exposures and Health Risks: a Review of the Recent Literature. Curr Environ Health Rep 2020; 7:424-440. [PMID: 33241434 PMCID: PMC7749091 DOI: 10.1007/s40572-020-00296-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW We reviewed recent peer-reviewed literature on three categories of individual- and household-level interventions against air pollution: air purifiers, facemasks, and behavior change. RECENT FINDINGS High-efficiency particulate air/arresting (HEPA) filter air purifier use over days to weeks can substantially reduce fine particulate matter (PM2.5) concentrations indoors and improve subclinical cardiopulmonary health. Modeling studies suggest that the population-level benefits of HEPA filter air purification would often exceed costs. Well-fitting N95 and equivalent respirators can reduce PM2.5 exposure, with several randomized crossover studies also reporting improvements in subclinical cardiovascular health. The health benefits of other types of face coverings have not been tested and their effectiveness in reducing exposure is highly variable, depends largely on fit, and is unrelated to cost. Behavior modifications may reduce exposure, but there has been little research on health impacts. There is now substantial evidence that HEPA filter air purifiers reduce indoor PM2.5 concentrations and improve subclinical health indicators. As a result, their use is being recommended by a growing number of government and public health organizations. Several studies have also reported subclinical cardiovascular health benefits from well-fitting respirators, while evidence of health benefits from other types of facemasks and behavior changes remains very limited. In situations when emissions cannot be controlled at the source, such as during forest fires, individual- or household-level interventions may be the primary option. In most cases, however, such interventions should be supplemental to emission reduction efforts that benefit entire communities.
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Affiliation(s)
- Ryan W Allen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Prabjit Barn
- Legacy for Airway Health, Vancouver Coastal Health, Vancouver, BC, Canada
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15
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Newman JD, Rajagopalan S, Levy P, Brook RD. Clearing the air to treat hypertension. J Hum Hypertens 2020; 34:759-763. [PMID: 32439971 PMCID: PMC7665990 DOI: 10.1038/s41371-020-0358-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jonathan D Newman
- Division of Cardiology and the Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, USA
| | - Sanjay Rajagopalan
- Division of Cardiovascular Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Phillip Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, New York, NY, USA.
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Neupane BB, Chaudhary RK, Sharma A. A smartphone microscopic method for rapid screening of cloth facemask fabrics during pandemics. PeerJ 2020; 8:e9647. [PMID: 32821549 PMCID: PMC7396138 DOI: 10.7717/peerj.9647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/12/2020] [Indexed: 01/10/2023] Open
Abstract
Background In pandemics, because of increased demand and subsequent shortage of commercial facemasks, people need to use cloth facemasks, although such masks are reported to provide reduced protection. These masks can be prepared in local levels from different fabric materials. In developing countries, cloth masks are preferable because of low cost and added advantages of reusability. The filtering performance of a cloth facemask depends on the facial fit and on the material properties of fabrics such as porosity, yarn spacing or packing, and pore size. In resource limited settings, an affordable and easy to implement method that can assess the surface properties of cloth facemask fabrics would be important. Methods In this work, we developed a smartphone microscopic method for rapid screening of fabric quality. We measured the field of view of the microscope and as a proof of concept, we implemented the method to examine surfaces of sixteen locally available cloth mask fabrics. Results Out of the 16 masks examined, we found very diverse yarn packing and pore morphology (pore size and shape) in the fabrics. The pore size ranged from ~80 to 720 μm; much larger than respiratory droplet and bio-aerosol. This observation partly explains why such cloth facemasks provide reduced protection to the user during pandemics. The performance of a cloth facemask partly depends on the material properties of fabric such as yarn packing, pore size, porosity. Therefore, the surface properties of fabrics obtained from the smartphone method can be used to get preliminary idea on the facemask quality. We believe that the method can be an affordable and rapid method for selection of better fabrics for cloth facemask during pandemics.
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Affiliation(s)
- Bhanu B Neupane
- Central Department of Chemistry, Tribhuvan University, Kathamndu, Nepal
| | | | - Amita Sharma
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, Nepal
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17
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Brook RD, Rajagopalan S. Inhaling Hypertension: Clearing the Air to Prevent Cardiometabolic Diseases. Hypertension 2020; 76:32-34. [PMID: 32520617 PMCID: PMC7291790 DOI: 10.1161/hypertensionaha.120.14613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Faridi S, Nodehi RN, Sadeghian S, Tajdini M, Hoseini M, Yunesian M, Nazmara S, Hassanvand MS, Naddafi K. Can respirator face masks in a developing country reduce exposure to ambient particulate matter? JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:606-617. [PMID: 32317771 DOI: 10.1038/s41370-020-0222-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 05/16/2023]
Abstract
Respirator face masks (RFMs) as a personal-level intervention is increasingly being utilized to reduce ambient particulate matter (PM) exposure, globally. We tested the effectiveness of 50 commercially available ones in reducing the exposure of ambient particle number concentrations (PNC), PM10, PM2.5, and PM1 (PM ≤ 10, 2.5, and 1 μm in diameter, respectively) in a traffic-affected urban site in Tehran. To examine the efficiency of RFMs, we applied a specific experimental setup including vacuum pumps, dummy heads, connecting tubes, glass chambers, and GRIMM Aerosol Spectrometer to measure all metrics after dummy heads. The average effectiveness of RFMs was in the range of 0.7-83.5%, 3.5-68.1%, 0.8-46.1%, and 0.4-32.2% in reducing ambient PNC, PM10, PM2.5, and PM1, respectively. Considering all metrics, the highest effectiveness was observed always for Biomask, followed by 3 M 9332, due to their well-designed physical characteristics (e.g., adjustable nose clip for any face/nose shape, and size, soft inner material in the nose panel to provide a secure seal against leakage, adjustable or elasticated straps/ear loops to better adjust on any face). Biomask reduced ambient PM10 with a mean value of 94.6 μg m-3 (minimum-maximum: 51.7-100.3 μg m-3), whereas it filtered on average just 29.0 μg m-3 (25.7-43.5 μg m-3) of ambient PM2.5 and 18.2 μg m-3 (14.7-21.8 μg m-3) of PM1. A fuzzy analytical hierarchy process to find the most important design-related factors of RFMs affecting their effectiveness, which showed the exhalation valve and its diaphragm (20.4%), nose clip (19.7%), and cheek flaps (18.6%) are ranked as the main design-related variables. The fuzzy technique for order preference by similarity to ideal solution indicated that Biomask and 3M 9332 had scores of 1 and 0.97, the highest scores compared with other RFMs. This study provides crucial evidence-based results to elucidate the effectiveness and design-related factors of RFMs in real-environmental circumstances.
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Affiliation(s)
- Sasan Faridi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh Nodehi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hoseini
- Research Center for Health Sciences, Institute of Health, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research Methodology and Data Analysis (CRMDA), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Nazmara
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
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Rajagopalan S, Al-Kindi S. Getting in Shape for the World's Leading Environmental Risk Factor. J Am Coll Cardiol 2020; 75:718-721. [PMID: 32081279 PMCID: PMC7579749 DOI: 10.1016/j.jacc.2019.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
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20
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Global Heart: The Prime Journal for Global Cardiovascular Research Findings, Implementation and Interpretation. Glob Heart 2019; 14:1-2. [PMID: 31036301 DOI: 10.1016/j.gheart.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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