Increase in Medical Emergency Calls and Calls for Central Nervous System Symptoms During a Severe Air Pollution Event, January 2013, Jinan City, China:

Analyzing the Maharashtra Ambulance Service "108": The Prospect and Challenges

The utilization of digital health in India is playing a crucial role in enhancing healthcare services by transitioning from the current inadequate public health structure to a more efficient and patient-centric system. Digital health includes various digital tools, such as electronic health records (EHRs), telemedicine, mobile health applications, health information exchange systems, and other technological advancements to improve access, efficiency, and quality of healthcare delivery. This study investigates the prospects and challenges encountered by the newly-digitized Maharashtra Emergency Medical Services (MEMS). Utilizing the 38,823 MEMS calls from November 2022, this study investigates the current status of emergency service delivery mechanisms in Maharashtra. Through spatial analyses, this study also explores the causes behind calls. The findings of the study show that calls for 108 ambulance services were distributed across the districts and had variable service delivery time periods. Current challenges to the system arise from various urban and healthcare infrastructure problems, as well as socio-cultural challenges. Implementation of the digitized MEMS system reveals key factors that influence the service's success, assisting the policymakers and health administrators in identifying and further improving the service.

Association of outdoor air and noise pollution with unprovoked seizures and new onset epilepsy: A systematic review and meta-analysis

Research has indicated that certain environmental exposures may increase the risk of unprovoked seizures and new onset epilepsy. This study aimed to synthesize the literature that has estimated the associations between short- and long-term exposure to outdoor air and noise pollution and the risk of unprovoked seizures and new onset epilepsy. We searched Embase, MEDLINE, Scopus, Web of Science, BIOSIS Previews, Latin American and Caribbean Health Sciences Literature, Proquest Dissertations and Theses, conference abstracts, and the gray literature and conducted citation tracing in June 2023. Observational and ecological studies assessing the associations of air and noise pollution with unprovoked seizures or new onset epilepsy were eligible. One reviewer extracted summary data. Using fixed and random effects models, we calculated the pooled risk ratios (RRs) for the studies assessing the associations between short-term exposure to air pollution and unprovoked seizures. Seventeen studies were included, 16 assessing the association of air pollution with seizures and one with epilepsy. Eight studies were pooled quantitatively. Ozone (O3; RR = .99, 95% confidence interval [CI] = .99-.99) and nitrogen dioxide (NO2) exposure adjusted for particulate matter (RR = 1.02, 95% CI = 1.01-1.02) on the same day, and carbon monoxide (CO) exposure 2 days prior (RR = 1.12, 95% CI = 1.02-1.22), were associated with seizure risk. A single study of air pollution and epilepsy did not report a significant association. The risk of bias and heterogeneity across studies was moderate or high. Short-term exposure to O3, NO2, and CO may affect the risk of seizures; however, the effect estimates for O3 and NO2 were minimal. Additional research should continue to explore these and the associations between outdoor air pollution and epilepsy and between noise pollution and seizures and epilepsy.

The Environment and Headache: a Narrative Review

PURPOSE OF REVIEW

In this narrative review, we summarize the peer-reviewed literature published between 2017 and 2022 that evaluated ambient environmental risk factors for primary headache disorders, which affect more than half of the population globally. Primary headache disorders include migraine, tension-type headache (TTH), and trigeminal and autonomic cephalalgias (TAC).

RECENT FINDINGS

We identified 17 articles that met the inclusion criteria via PubMed or Google Scholar. Seven studies (41%) relied on data from US populations. The remaining studies were conducted in China, Taiwan, Germany, Ghana, Japan, the Netherlands, South Korea, and Turkey. Air pollution was the most frequently assessed environmental risk factor. Most studies were cross-sectional and focused on all-cause or migraine headaches; one study included TTH, and none included TAC. Short-term exposure to fine particulate matter (PM2.5) was not consistently associated with headache endpoints, but long-term exposure to PM2.5 was associated with migraine headache prevalence and severity across multiple studies. Elevated ambient temperature, changes in weather, oil and gas well exposure, and less natural greenspace, but not noise pollution, were also associated with headache. No studies considered water pollution, metal exposure, ultrafine particulate matter, or wildfire smoke exposure. There is a need for ongoing research focused on headache and the environment. Study designs with the greatest explanatory power may include longitudinal studies that capture the episodic nature of headache and case-crossover analysis, which control for time-invariant individual-level confounders by design. There is also a clear need for research that considers comorbid psychiatric illness and socioeconomic position as powerful modifiers of the effect of the environment on headache.

The Combined Effects of High Temperatures and Ozone Pollution on Medical Emergency Calls - Jinan City, Shandong Province, China, 2013-2019

What is already known about this topic?

Studies have extensively documented the separate and independent effects of extreme temperature and ozone on morbidity and mortality associated with respiratory and circulatory diseases.

What is added by this report?

The study revealed a significant association between elevated temperature, ozone pollution, and the combined effect of high temperature and ozone pollution with an increased risk of all-cause medical emergency calls (MECs) and MECs specifically related to neurological diseases.

What are the implications for public health practice?

Interventional measures should be implemented to mitigate exposure to high temperatures and ozone levels. Specifically, during the warm season, it is crucial for relevant authorities to focus on disseminating scientific information regarding the health impacts of elevated temperatures and ozone pollution. Additionally, timely public health advisories should be issued to alert the public effectively.

Air Pollution and Hospital Admission for Epilepsy in Kerman, Iran

Background: This study aimed to investigate the relation between air pollution and epilepsy admissions in Kerman, Iran. Methods: In this ecological study, the concentrations of ambient air pollutants and meteorological data were obtained from Kerman Environmental Protection Agency and Kerman Meteorology Organization, respectively. Additionally, epilepsy admission data were obtained from Kerman’s Shafa hospital epilepsy registry. Generalized additive models with lags up to 7 days were used to estimate rate ratios (RRs). Results: Within 2008 to 2020, 894 epilepsy admissions occurred in Kerman, 498 cases (55.7%) of whom were male. The strongest relations of epilepsy admission were observed in the over 59-year group for carbon monoxide (CO) in lag 0 (RR = 2.1455, 95% CI: 1.5823 - 2.9091), nitrogen dioxide (NO2) in lag 0 (RR = 1.0409, 95% CI: 1.0282 - 1.0537), and particulate matter under 2.5 microns (PM2.5) in lag 5 (RR = 1.0157, 95% CI: 1.0062 - 1.0252). There were also significant associations for particulate matter under 10 microns (PM10) in the under 18-year group in lag 2 (RR = 1.0064, 95% CI: 1.0029 - 1.0098), ozone in lag 0 (RR = 0.9671, 95% CI: 0.9581 - 0.9761), and sulfur dioxide in lag 5 (RR = 0.9937, 95% CI: 0.9891 - 0.9983). Conclusions: Exposure to CO, NO2, PM2.5, or PM10 air pollutants might be a risk factor for epilepsy admissions in Kerman. Epilepsy patients should better stay away from exposure to polluted air. Staying at home on polluted days or residing in areas with less air pollution might be an option.

Environmental Pollutants and Oxidative Stress in Terrestrial and Aquatic Organisms: Examination of the Total Picture and Implications for Human Health

There is current great international concern about the contribution of environmental pollution to the global burden of disease particularly in the developing, low- and medium-income countries. Industrial activities, urbanization, developmental projects as well as various increased anthropogenic activities involving the improper generation, management and disposal of pollutants have rendered today's environment highly polluted with various pollutants. These pollutants include toxic metals (lead, cadmium, mercury, arsenic), polycyclic aromatic hydrocarbons, polychlorinated biphenyls, pesticides and diesel exhaust particles most of which appear to be ubiquitous as well as have long-term environmental persistence with a wide range of toxicities such as oxidative stress among others. Oxidative stress, which may arise from increased production of damaging free radicals emanating from increased pollutant burden and depressed bioavailability of antioxidant defenses causes altered biochemical and physiological mechanisms and has been implicated in all known human pathologies most of which are chronic. Oxidative stress also affects both flora and fauna and plants are very important components of the terrestrial environment and significant contributors of nutrients for both man and animals. It is also remarkable that the aquatic environment in which sea animals and creatures are resident is also highly polluted, leading to aquatic stress that may affect the survival of the aquatic animals, sharing in the oxidative stress. These altered terrestrial and aquatic environments have an overarching effect on human health. Antioxidants neutralize the damaging free radicals thus, they play important protective roles in the onset, progression and severity of the unmitigated generation of pollutants that ultimately manifest as oxidative stress. Consequently, human health as well as that of aquatic and terrestrial organisms may be protected from environmental pollution by mitigating oxidative stress and employing the principles of nutritional medicine, essentially based on antioxidants derived mainly from plants, which serve as the panacea of the vicious state of environmental pollutants consequently, the health of the population. Understanding the total picture of oxidative stress and integrating the terrestrial and aquatic effects of environmental pollutants are central to sustainable health of the population and appear to require multi-sectoral collaborations from diverse disciplinary perspectives; basically the environmental, agricultural and health sectors.

Differential expression of long non-coding RNAs in the hippocampus of mice exposed to PM2.5 in Dalian, China

Evidence is mounting that PM_2.5 exposure could lead to learning disability, memory deficits, and cognitive impairment; however, the underlying mechanisms are still not well demonstrated yet. Long non-coding RNAs (LncRNAs) play a crucial role in many human diseases. Although the relationship of Alzheimer's disease (AD) and lncRNAs have been discovered, the role of lncRNA in AD-like phenotype induced by PM_2.5 needs further exploration. In this study, we profiled the expression of messenger RNAs (mRNAs) and lncRNAs in hippocampus after confirming the AD-like changes in mice. Compared with the control group, a total of 478 mRNAs and 151 lncRNAs were dysregulated after PM_2.5 exposure. ECM-receptor interaction, focal adhesion, complement and coagulation cascades, and AGE-RAGE signaling pathway were found dysregulated through lncRNA-co-expressed genes analysis based on the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Meanwhile, the genes related to microglia were significantly altered, such as CX3CR1, CD163, lncRNA Gm44750, and lncRNA Gm43509. Above evidences suggested that microglia-related lncRNAs dysregulation probably plays a crucial role in PM_2.5exposure-associated learning and memory deficits.

Fine particulate matter induces endoplasmic reticulum stress-mediated apoptosis in human SH-SY5Y cells

Exposure to ambient fine particulate matter (PM_2.5) may contribute to brain injury, however, the molecular mechanisms have not yet been fully described. In this study, the human SH-SY5Y cells were treated with PM_2.5 with different concentrations (0, 25, 100, and 250 μg/mL) for 24 h to investigate the cell apoptosis mediated by endoplasmic reticulum (ER) stress. The ratio of apoptosis, Ca²⁺ level, biomarkers of ER stress and apoptosis were determined. The results revealed that PM_2.5 triggered the increase of apoptosis ratio and cellular Ca²⁺ levels. Compared with control, the expression of GRP78 and phosphorylation of IER1α and p38 were enhanced significantly in the cells under the conditions of PM_2.5 exposure for activating ER stress signals. Besides, the key genes (CHOP/DR5/Caspase8/Caspase12) in ER stress-induced apoptosis signals were up-regulated after the PM_2.5 treatment compared to the control. The results suggested PM_2.5 induced apoptosis in SH-SY5Y cells by the stimulation of ER stress, which may be the potential mechanism of neurological diseases incurred by PM_2.5.

The effect of weather, air pollution and seasonality on the number of patient visits for epileptic seizures: A population-based time-series study

OBJECTIVE

The objective of the study was to explore the influences of seasonality, meteorological conditions, and air pollution exposure on the number of patients who visit the hospital due to seizures.

METHODS

Outpatient and inpatient data from the National Health Insurance Database of Taiwan from 2009 to 2013, meteorological data from the Meteorological Bureau, and air pollution exposure data from the Taiwan Air Quality Monitoring Stations were collected and integrated into daily time series data. The following data processing and analysis results are based on the mean of the 7 days' lag data of the 18 meteorological condition/air pollution exploratory factors to identify the critical meteorological conditions and air pollution exposure factors by executing univariate analysis. The average hospital visits for seizure per day by month were used as an index of observation. The effect of seasonality has also been examined.

RESULTS

The average visits per day by month had a significant association with 10 variables. Overall, the number of visits due to these factors has been estimated to be 71.529 (13.7%). The most obvious factors affecting the estimated number of visits include ambient temperature, CH₄, and NO. Six air pollutants, namely CH₄, NO, CO, NO₂, PM2.5, and NMHC had a significantly positive correlation with hospital visits due to seizures. Moreover, the average daily number of hospital visits was significantly high in January and February (winter season in Taiwan) than in other months (R² = 0.422).

CONCLUSION

The prediction model obtained in this study indicates the necessity of rigorous monitoring and early warning of these air pollutants and climate changes by governments. Additionally, the study provided a firm basis for establishing prediction models to be used by other countries or for other diseases.

Brain Disorders and Chemical Pollutants: A Gap Junction Link?

The incidence of brain pathologies has increased during last decades. Better diagnosis (autism spectrum disorders) and longer life expectancy (Parkinson's disease, Alzheimer's disease) partly explain this increase, while emerging data suggest pollutant exposures as a possible but still underestimated cause of major brain disorders. Taking into account that the brain parenchyma is rich in gap junctions and that most pollutants inhibit their function; brain disorders might be the consequence of gap-junctional alterations due to long-term exposures to pollutants. In this article, this hypothesis is addressed through three complementary aspects: (1) the gap-junctional organization and connexin expression in brain parenchyma and their function; (2) the effect of major pollutants (pesticides, bisphenol A, phthalates, heavy metals, airborne particles, etc.) on gap-junctional and connexin functions; (3) a description of the major brain disorders categorized as neurodevelopmental (autism spectrum disorders, attention deficit hyperactivity disorders, epilepsy), neurobehavioral (migraines, major depressive disorders), neurodegenerative (Parkinson's and Alzheimer's diseases) and cancers (glioma), in which both connexin dysfunction and pollutant involvement have been described. Based on these different aspects, the possible involvement of pollutant-inhibited gap junctions in brain disorders is discussed for prenatal and postnatal exposures.

Ambient air pollution and its influence on human health and welfare: an overview

Human health is closely related to his environment. The influence of exposure to air pollutants on human health and well-being has been an interesting subject and gained much volume of research over the last 50 years. In general, polluted air is considered one of the major factors leading to many diseases such as cardiovascular and respiratory disease and lung cancer for the people. Besides, air pollution adversely affects the animals and deteriorates the plant environment. The overarching objective of this review is to explore the previous researches regarding the causes and sources of air pollution, how to control it and its detrimental effects on human health. The definition of air pollution and its sources were introduced extensively. Major air pollutants and their noxious effects were detailed. Detrimental impacts of air pollution on human health and well-being were also presented.

Analyses of air pollution control measures and co-benefits in the heavily air-polluted Jinan city of China, 2013-2017

China has made great efforts in air pollution control since 2013. However, there is a lack of evaluation of environmental, health and economic co-benefits associated with the national and local air pollution control measures at a city level. We analyzed local air pollution control policies and implementation in Jinan, one of the most heavily air-polluted cities in China between 2013 and 2017. We assessed the changes in exhaust emissions, air quality, mortality and morbidity of associated specific-diseases, and related economic benefits. We also projected the future scenarios of PM_2.5 concentration dropped to 15 μg/m³. There were significant decreases in exhaust emissions of SO₂ and NO_x in Jinan during the study period. Annual reductions in ambient air pollution were 72.6% for SO₂, 43.1% for PM_2.5, and 34.2% for PM₁₀. A total of 2,317 (95%CI: 1,533-2,842) premature deaths and 15,822 (95%CI: 8,734-23,990) related morbidity cases had been avoided in 2017, leading to a total of US$ 317.7 million (95%CI: 227.5-458.1) in economic benefits. Decreasing PM_2.5 concentrations to 15 μg/m³ would result in reductions of 70% in total PM_2.5-related non-accidental mortality and 95% in total PM_2.5-related morbidity, which translates into US$ 1,289.5 million (95%CI: 825.8-1,673.6) in economic benefits. The national and local air pollution control measures have brought significant environmental, health and economic benefits to a previously heavy polluted Chinese city.

Respiratory gases, air pollution and epilepsy

A growing number of studies have shown that exposure to air pollutants such as particulate matter and gases can cause cardiovascular, neurodegenerative and psychiatric diseases. The severity of the changes depends on several factors such as exposure time, age and gender. Inflammation has been considered as one of the main factors associated with the generation of these diseases. Here we present some cellular mechanisms activated by air pollution that may represent risk factors for epilepsy and drug resistance associated to epilepsy.

A review of the possible associations between ambient PM2.5 exposures and the development of Alzheimer's disease

PM2.5 particles in air pollution have been widely considered associated with respiratory and cardiovascular diseases. Recent studies have shown that PM2.5 can also cause central nervous system (CNS) diseases, including a variety of neurodegenerative diseases, such as Alzheimer's disease (AD). Activation of microglia in the central nervous system can lead to inflammatory and neurological damage. PM2.5 will reduce the methylation level of DNA and affect epigenetics. PM2.5 enters the human body through a variety of pathways to have pathological effects on CNS. For example, PM2.5 can destroy the integrity of the blood-brain barrier (BBB), so peripheral systemic inflammation easily crosses BBB and reaches CNS. The olfactory nerve is another way for PM2.5 particles to enter the brain. Surprisingly, PM2.5 can also enter the gastrointestinal tract, causing imbalances in the intestinal microecology to affect central nervous system diseases. The current work collected and discuss the mechanisms of PM2.5-induced CNS damage and PM2.5-induced neurodegenerative diseases.

Effect and threshold of PM2.5 on population mortality in a highly polluted area: a study on applicability of standards

For assessing the effect and threshold of PM_2.5 on mortality in highly polluted areas and further studying the standard applicability, daily data on meteorological factors, air pollutants, and mortality were obtained in Jinan, China, from 2011 to 2017. A generalized additive model (GAM) and a distributed lag non-linear model (DLNM) were employed to assess the nonlinearity and the hysteresis of associations. We further explored the breakpoints to evaluate the existence of the threshold. The correlation between mortality and PM_2.5 was nonlinear. The impact of average PM_2.5 on non-accidental mortality (RR = 1.11; 95% CI = 1.06, 1.16), cardiovascular disease (CVD) mortality (RR = 1.17; 95% CI = 1.10, 1.24), and respiratory disease (RD) mortality (RR = 1.17; 95% CI = 1.10, 1.24) reached the highest in the current day (lag 0). The excess risks of PM_2.5 at secondary standard level to non-accidental, CVD, and RD mortality are 8.79% (95% CI = 3.84, 13.98), 14.41% (95% CI = 7.79, 21.43), 15.35% (95% CI = 1.76, 30.74), respectively. The saturation points exist in highly polluted areas. Above the saturation points of 247 μg/m³ for non-accidental mortality, 245 μg/m³ for CVD mortality, and 250 μg/m³ for RD mortality, the model of all three relationships presented a harvesting effect. This study underscores the necessity of the ongoing efforts of reducing particulate air pollution and the adjustment of the standards in seriously polluted areas to adapt to regional conditions. At the same time, for highly polluted areas, it is advocated to strengthen personal protection to decrease the saturation point and control the concentration of pollutants as much as possible, which will substantially save more cost that benefits the public.

The association between high ambient air pollution exposure and respiratory health of young children: A cross sectional study in Jinan, China

There is growing concern about health effects of high air pollution in less-developed countries. Children represent a population at increased risk for air pollution-related respiratory conditions. This study investigated the relationship between high ambient air pollution exposure and respiratory health of young schoolchildren. From 2014 to 2016 in Jinan, China, 2532 primary school children in grades three to five from two different schools with different levels of air pollution were included in the study. Levels of ambient air pollution exposure including PM₁₀, PM_2.5, NO₂, SO₂, CO and O₃ were measured continuously at the two schools. A questionnaire about children's respiratory health was conducted every year. Among them, about 150 randomly selected children also performed lung function tests two times a year at the beginning of November and middle of December. Annual average exposure levels of PM_2.5 (66.8-79.1 vs 90.0-107.7 μg/m³), PM₁₀ (129.5-177.3 vs 198.1-218.6 μg/m³), NO₂ (45.3-53.2 vs 45.0-56.2 μg/m³), SO₂ (29.8-56.5 vs 40.5-80.3 μg/m³), CO (1.3-1.5 vs 1.4-1.7 mg/m³) and O₃ (84.8-120.2 vs 61.1-128.1 μg/m³) in the heavy pollution primary school were significantly higher than the light one. The higher air pollution exposure was related to increased prevalence of respiratory diseases of young children in the last year, especially allergic rhinitis. The increased odds of lung function impairment associated with exposure to higher air pollution, could be up to 171.5% (aOR = 2.715; 95% CI = 1.915-3.849) for PEF < 75% predicted in 2014. However, after short-term exposure for 1.5 month or a week, paired comparison for parameters of the same child showed different results. The association between high ambient air pollution exposure and respiratory health of young children is closely related to exposure time and dose and may be fluctuate and complex.

Impacts of air pollution wave on years of life lost: A crucial way to communicate the health risks of air pollution to the public

Limited studies have explored the impacts of exposure to sustained high levels of air pollution (air pollution wave) on mortality. Given that the frequency, intensity and duration of air pollution wave has been increasing in highly polluted regions recently, understanding the impacts of air pollution wave is crucial. In this study, air pollution wave was defined as 2 or more consecutive days with air pollution index (API) > 100. The impacts of air pollution wave on years of life lost (YLL) due to non-accidental, cardiovascular and respiratory deaths were evaluated by considering both consecutive days with high levels of air pollution and daily air pollution levels in Tianjin, China, from 2006 to 2011. The results showed the durational effect of consecutive days with high levels of air pollution was substantial in addition to the effect of daily air pollution. For instance, the durational effect was related to an increase in YLL of 116.6 (95% CI: 4.8, 228.5) years from non-accidental deaths when the air pollution wave was sustained for 4 days, while the corresponding daily air pollution's effect was 121.2 (95% CI: 55.2, 187.1) years. A better interpretation of the health risks of air pollution wave is crucial for air pollution control policy making and public health interventions.