Exposure to outdoor air pollution and its human health outcomes: A scoping review

Mechanistic insights regarding neuropsychiatric and neuropathologic impacts of air pollution

Air pollution is a significant environmental health risk for urban areas and developing countries. Air pollution may contribute to the incidence of cardiopulmonary and metabolic diseases. Evidence also points to the role of air pollution in worsening or developing neurological and neuropsychiatric conditions. Inhaled pollutants include compositionally differing mixtures of respirable gaseous and particulate components of varied sizes, solubilities, and chemistry. Inhalation of combustibles and volatile organic compounds (VOCs) or other irritant particulate matter (PM) may trigger lung sensory afferents which initiate a sympathetic stress response via activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes. Activation of SAM and HPA axes are associated with selective inhibition of hypothalamic-pituitary-gonadal (HPG) and hypothalamic-pituitary-thyroid (HPT) axes following exposure. Regarding chronic exposure in susceptible hosts, these changes may become pathological by causing neuroinflammation, neurotransmitter, and neuroendocrine imbalances. Soluble PM, such as metals and nano-size particles may translocate across the olfactory, trigeminal, or vagal nerves through retrograde axonal transport, or through systemic circulation which may disrupt the blood-brain barrier (BBB) and deposit in neural tissue. Neuronal deposition of metallic components can have a negative impact through multiple molecular mechanisms. In addition to systemic translocation, the release of pituitary and stress hormones, altered metabolic hormonal status and resultant circulating metabolic milieu, and sympathetically and HPA-mediated changes in immune markers, may secondarily impact the brain through a variety of regulatory adrenal hormone-dependent mechanisms. Several reviews covering air pollution as a risk factor for neuropsychiatric disorders have been published, but no reviews discuss the in-depth intersection between molecular and stress-related neuroendocrine mechanisms, thereby addressing adaptation and susceptibility variations and link to peripheral tissue effects. The purpose of this review is to discuss evidence regarding neurochemical, neuroendocrine, and molecular mechanisms which may contribute to neuropathology from air pollution exposure. This review also covers bi-directional neural and systemic interactions which may raise the risk for air pollution-related systemic illness.

Human sperm mitochondrial DNA copy numbers and deletion rates: Comparing persons living in two urban industrial agglomerations differing in sources of air pollution

Persons living in industrial environments are exposed to levels of air pollution that can affect their health and fertility. The Czech capital city, Prague, and the Ostrava industrial agglomeration differ in their major sources of air pollution. In Prague, heavy traffic produces high levels of nitrogen oxides throughout the year. In the Ostrava region, an iron industry and local heating are sources of particulate matter (PM) and benzo[a]pyrene (B[a]P), especially in the winter. We evaluated the effects of air pollution on human sperm mitochondrial DNA (mtDNA). Using real-time PCR, we analysed sperm mtDNA copy number and deletion rate in Prague city policemen in two seasons (spring and autumn) and compared the results with those from Ostrava. In Prague, the sperm mtDNA deletion rate was significantly higher in autumn than in spring, which is the opposite of the results from Ostrava. The sperm mtDNA copy number did not show any seasonal differences in either of the cities; it was correlated negatively with sperm concentration, motility, and viability, and with sperm chromatin integrity (assessed with the Sperm Chromatin Structure Assay). The comparison between the two cities showed that the sperm mtDNA deletion rate in spring and the sperm mtDNA copy number in autumn were significantly lower in Prague vs. Ostrava. Our study supports the hypothesis that sperm mtDNA deletion rate is affected by the composition of air pollution. Sperm mtDNA abundance is closely associated with chromatin damage and standard semen characteristics.

Factors Affecting Anemia among Women of Reproductive Age in Mexico: A Mixed-Methods Country Case Study

BACKGROUND

In Mexico, anemia prevalence among women of reproductive age (WRA) decreased from 16.4% in 2006 to 11.6% in 2012, only to increase to 18.3% in 2016. The factors associated with this fluctuation are uncertain.

OBJECTIVE

We conducted a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in Mexico between 2006 and 2018.

METHODS

Using multivariate stepwise linear regression, we analyzed Mexico's Encuesta Nacional de Salud y Nutrición (ENSANUT) surveys from 2006, 2012, and 2018 to identify determinants of WRA anemia. We also conducted a review of anemia-relevant programs and policies, including financing documents, and conducted in-depth interviews and focus group discussions with key stakeholders in Mexico.

RESULTS

Among non-pregnant women (NPW) 15-49 years, mean hemoglobin (Hb) increased from 13.8 g/dL in 2006 to 14.0 g/dL in 2012, decreasing to 13.2 g/dL in 2018 (p<0.001). Inequities by geographical region and household wealth persisted throughout this period, with household wealth, urban residence and gravidity emerging as significant predictors of Hb among NPW. Qualitative analyses generally supported these findings. The most discussed program was Progresa-Oportunidades-Prospera (POP), where most resources for health were invested and most participants acknowledged that its cancellation in 2019 would lead to worsening in health and nutrition among the poor. Financing analyses showed a drop of funding for nutrition-related programs between 2014 and 2018. Cultural norms around gender roles were still prevalent, along with increasing rates of teenage pregnancy.

CONCLUSIONS

Anemia prevention efforts need to refocus on poverty alleviation, continuity of adequate coverage and financing of nutrition programs, especially with safety nets, and increase in uptake of family planning, especially among adolescent girls.

Can the aerosol pollution extreme events be revealed by global reanalysis products?

Extreme aerosol pollution poses significant risks to the climate, environment, and human health. To investigate the formation and impacts of aerosol pollution extreme events (APEE), the reanalysis product presents meticulous spatiotemporal information on the three-dimensional distribution of aerosols. However, there is a lack of comprehensive evaluation and information regarding the data quality of reanalysis products employed in APEE research, as well as limited understanding of their spatial and temporal distribution, variation, and long-term trends. To address this scientific gap, we conducted a global study for distribution and variation patterns of APEE using two widely-used reanalysis products, MERRA-2 (Modern-Era Retrospective Analysis for Research-2) and CAMS (Copernicus Atmospheric Monitoring Service). The APEE was defined here as a day when the daily aerosol optical depth (AOD) exceeding its 90th percentile for a given station and month. Eleven distinct land regions worldwide were selected for evaluation by comparing both reanalysis products with MODIS satellite products and ground-based observations in terms of frequency, intensity, and temporal trends of APEE. The analysis indicates that MERRA-2 and CAMS exhibit high matching rates (70 % and 80 %, respectively) in terms of occurrence timeline for APEE at monthly and seasonal scales, while also exhibiting strong monthly correlation coefficients (>0.65) with ground-based observations over selected regions. The total AOD (-0.002 ∼ -0.123 decade-1), APEE AOD (-0.004 ∼ -0.293 decade-1), and APEE frequency (-0.264 ∼ -1.769 day month-1 decade-1) of both observations and reanalysis products in most regions showed a decreasing trend with various magnitude, except for some regions such as South Asia where the trend is increasing. Based on the aforementioned evaluation, it is evident that reanalysis products are effective and useful in identifying the temporal trends associated with APEE.

Is Pollution the Primary Driver of Infectious Syndemics?

Syndemics, the adverse interaction of two or more coterminous diseases or other negative health conditions, have probably existed since human settlement, plant and animal domestication, urbanization, and the growth of social inequality beginning about 10-12,000 years ago. These dramatic changes in human social evolution significantly increased opportunities for the spread of zoonotic infectious diseases in denser human communities with increased sanitation challenges. In light of a growing body of research that indicates that anthropogenic air pollution causes numerous threats to health and is taking a far greater toll on human life and wellbeing than had been reported, this paper proposes the possibility that air pollution is now the primary driver of infectious disease syndemics. In support of this assertion, this paper reviews the growth and health impacts of air pollution, the relationship of air pollution to the development and spread of infectious diseases, and reported cases of air pollution-driven infectious disease syndemics, and presents public health recommendations for leveraging the biosocial insight of syndemic theory in responding to infectious disease.

Long-term exposure to air pollution and risk of stroke by ecoregions: The REGARDS study

Several cohort studies have found associations between long-term exposure to air pollution and stroke risk. However, it is unclear whether the surrounding ecology may modify these associations. This study evaluates associations of air pollution with stroke risk by ecoregions, which are areas of similar type, quality, and quantity of environmental resources in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. We assessed the incidence of stroke in 26,792 participants (45+ yrs) from the REGARDS study, a prospective cohort recruited across the contiguous United States. One-yr and 3-yr means of PM2.5, PM10, O3, NO2, SO2, and CO were estimated at baseline using data from the Center for Air, Climate, & Energy Solution, and assigned to participants at the census block group level. Incident stroke was ascertained through September 30, 2020. Relations of air pollutants with the risk of incident stroke were estimated using Cox proportional hazards models, adjusting for relevant demographics, behavioral risk factors, and neighborhood urbanicity. Models were stratified by EPA designated ecoregions. A 5.4 μg/m3 (interquartile range) increase in 1-yr PM10 was associated with a hazard ratio (95 %CI) for incident stroke of 1.07 (1.003, 1.15) in the overall study population. We did not find evidence of positive associations for PM2.5, O3, NO2, SO2, and CO in the fully adjusted models. In our ecoregion-specific analysis, associations of PM2.5 with stroke were stronger in the Great Plains ecoregion (HR = 1.44) than other ecoregions, while associations for PM10 were strongest in the Eastern Temperate Forests region (HR = 1.15). The associations between long-term exposure to air pollution and risk of stroke varied by ecoregion. Our results suggests that the type, quality, and quantity of the surrounding ecology can modify the effects of air pollution on risk of stroke.

Association of air pollution exposure with overweight or obesity in children and adolescents: A systematic review and meta-analysis

Childhood overweight and obesity is a global problem. 38 million children under five years old were reported as being overweight/obese in 2019. However, current evidence regarding the effects of air pollution on children weight status remains scarce and inconsistent. This study aimed to determine the association between air pollutants and the weight status of children and adolescents. Four databases were searched up to August 9, 2023. Adjusted merged odds ratios (ORs), regression coefficients (β), and their 95 % confidence intervals (95 % CIs) were calculated and pooled. A total of 27 studies were included. The results showed that air pollutants had adverse effects on the body weight of children and adolescents. Exposure to PM1, PM2.5, PMcoarse, and PM10 were associated with increased risk of overweight/obesity, with pooled ORs (95 % CI) of 1.23 (1.09, 1.40), 1.18 (1.10, 1.28), 1.04 (1.03, 1.05) and 1.11 (1.06, 1.17) per 10 μg/m3 increment, respectively. Individuals with higher exposure levels to NOX, O3, SO2 and CO (per 10 μg/m3 increment) were associated with 12 %, 6 %, 28 % and 1 % increased odds of being overweight/obese, respectively. With respect to the level of body mass index, the pooled β (95 % CIs) for each 10 μg/m3 increase in PM1, PM2.5, PM10, and NOX exposure were 0.15 (0.12, 0.18), 0.11 (0.06, 0.16), 0.07 (0.03, 0.10), and 0.03 (0.01, 0.04), respectively. PM1 has relatively strong adverse effects on body weight status. The subgroup analysis revealed a significantly increase in the risk of overweight/obesity when the concentrations of PM2.5, PM10, and NO2 exceeded 35 μg/m3, 50 μg/m3, and 40 μg/m3, respectively. Exposure to PM2.5, PM10 and NOX increased the risk of overweight/obesity, especially in Asia. This study provides evidence of the association between air pollution and being overweight/obese in children and adolescents.

An overview of atmospheric aerosol and their effects on human health

Epidemiologic investigations have previously been published in more than 200 papers, and several studies have examined the impacts of particle air pollution on health. The main conclusions now being made about the epidemiological evidence of particle pollution-induced health impacts are discussed in this article. Although there is no universal agreement, most reviewers conclude that particulate air pollution, particularly excellent combustion-cause contamination prevalent in many municipal and manufacturing environments, is a significant risk for cardiopulmonary sickness and mortality. Most epidemiological research has concentrated on the impacts of acute exposure, although the total public health implications of chronic acquaintance's outcome may be more extraordinarily significant. According to some reviewers, prolonged, repeated exposure raises the risk of cardiorespiratory death and chronic respiratory illness. A more general (but still universal) agreement is that short-term particle pollution exposure has been shown to aggravate pre-existing pulmonary and cardiovascular diseases and increase the number of community members who become sick, require medical treatment, or die. Several in-depth studies conducted in the global and Indian regions are addressed.

Comparison of 6 DNA extraction methods for isolation of high yield of high molecular weight DNA suitable for shotgun metagenomics Nanopore sequencing to detect bacteria

BACKGROUND

Oxford Nanopore Technologies (ONT) offers an accessible platform for long-read sequencing, which improves the reconstruction of genomes and helps to resolve complex genomic contexts, especially in the case of metagenome analysis. To take the best advantage of long-read sequencing, DNA extraction methods must be able to isolate pure high molecular weight (HMW) DNA from complex metagenomics samples, without introducing any bias. New methods released on the market, and protocols developed at the research level, were specifically designed for this application and need to be assessed.

RESULTS

In this study, with different bacterial cocktail mixes, analyzed as pure or spiked in a synthetic fecal matrix, we evaluated the performances of 6 DNA extraction methods using various cells lysis and purification techniques, from quick and easy, to more time-consuming and gentle protocols, including a portable method for on-site application. In addition to the comparison of the quality, quantity and purity of the extracted DNA, the performance obtained when doing Nanopore sequencing on a MinION flow cell was also tested. From the obtained results, the Quick-DNA HMW MagBead Kit (Zymo Research) was selected as producing the best yield of pure HMW DNA. Furthermore, this kit allowed an accurate detection, by Nanopore sequencing, of almost all the bacterial species present in a complex mock community.

CONCLUSION

Amongst the 6 tested methods, the Quick-DNA HMW MagBead Kit (Zymo Research) was considered as the most suitable for Nanopore sequencing and would be recommended for bacterial metagenomics studies using this technology.

Meaning Making Mechanisms in Women Survivors of Childhood Sexual Abuse: A Scoping Review

Childhood sexual abuse (CSA) is a complex and prevalent problem with devastating long-term consequences for survivors. Despite these consequences, some survivors seem to find a source of meaning and fulfillment throughout their recovery process, which may facilitate resilience and posttraumatic growth (PTG). However, little is known from the literature about the specific meaning making mechanisms that CSA survivors experience. A scoping review was conducted by searching relevant journals and several online databases such as EbscoHost, Scopus, ProQuest, ScienceDirect, and Google Scholar. Studies published in English and that discussed meaning making as a topic of recovery from CSA in the context of women survivors' experiences were included, where a total of 57 articles were selected including qualitative (n = 32), quantitative (n = 9), mixed method (n = 9), and review (n = 7) articles. Using thematic analysis, the results of the scoping review found four mechanisms of meaning making and seven sources of meaning describing the meaning making processes of women survivors of CSA. The mechanisms were identified as being benevolent; restoring and empowering the inner self; mobilizing external and social resources; and lastly actively integrating the trauma narrative. This study contributes toward the global knowledge base on meaning making mechanisms of women survivors of CSA by providing the first known summary of studies to date. Future research is recommended to further confirm these findings to inform treatment interventions for women survivors of CSA.

Effects of various environments on epigenetic settings and chromosomal damage

Air pollution is a dominant environmental exposure factor with significant health consequences. Unexpectedly, research in a heavily polluted region of the Czech Republic, with traditional heavy industry, revealed repeatedly the lowest frequency of micronuclei in the season with the highest concentrations of air pollutants including carcinogenic benzo[a]pyrene (B[a]P). Molecular findings have been collected for more than 10 years from various locations of the Czech Republic, with differing quality of ambient air. Preliminary conclusions have suggested adaptation of the population from the polluted locality (Ostrava, Moravian-Silesian Region (MSR)) to chronic air pollution exposure. In this study we utilize the previous findings and, for the first time, investigate micronuclei (MN) frequency by type: (i) centromere positive (CEN+) MN, representing chromosomal losses, and (ii) centromere negative (CEN-) MN representing chromosomal breaks. As previous results indicated differences between populations in the expression of XRCC5, a gene involved in the non-homologous end-joining (NHEJ) repair pathway, possible variations in epigenetic settings in this gene were also investigated. This new research was conducted in two seasons in the groups from two localities with different air quality levels (Ostrava (OS) and Prague (PG)). The obtained new results show significantly lower frequencies of chromosomal breaks in the OS subjects, related to the highest air pollution levels (p < 0.001). In contrast, chromosomal losses were comparable between both groups. In addition, significantly lower DNA methylation was found in 14.3% of the analyzed CpG loci of XRCC5 in the population from OS. In conclusion, the epigenetic adaptation (hypomethylation) in XRCC5 involved in the NHEJ repair pathway in the population from the polluted region, was suggested as a reason for the reduced level of chromosomal breaks. Further research is needed to explore the additional mechanisms, including genetic adaptation.

A Multi-Pollutant and Meteorological Analysis of Cardiorespiratory Mortality among the Elderly in São Paulo, Brazil-An Artificial Neural Networks Approach

Traditionally, studies that associate air pollution with health effects relate individual pollutants to outcomes such as mortality or hospital admissions. However, models capable of analyzing the effects resulting from the atmosphere mixture are demanded. In this study, multilayer perceptron neural networks were evaluated to associate PM₁₀, NO₂, and SO₂ concentrations, temperature, wind speed, and relative air humidity with cardiorespiratory mortality among the elderly in São Paulo, Brazil. Daily data from 2007 to 2019 were considered and different numbers of neurons on the hidden layer, algorithms, and a combination of activation functions were tested. The best-fitted artificial neural network (ANN) resulted in a MAPE equal to 13.46%. When individual season data were analyzed, the MAPE decreased to 11%. The most influential variables in cardiorespiratory mortality among the elderly were PM₁₀ and NO₂ concentrations. The relative humidity variable is more important during the dry season, and temperature is more important during the rainy season. The models were not subjected to the multicollinearity issue as with classical regression models. The use of ANNs to relate air quality to health outcomes is still very incipient, and this work highlights that it is a powerful tool that should be further explored.

Driving factors behind the continuous increase of long-term PM2.5-attributable health burden in India using the high-resolution global datasets from 2001 to 2020

Air pollution is the fourth leading global risk factor, whereas in India air pollution is reported as the highest risk factor with millions of premature deaths every year. Despite implementation of several air pollution control plans, PM_2.5 levels over India have not noticeably reduced. PM_2.5-associated health burdens in India have increased significantly in past decades. A fine resolution (0·01° × 0·01°) analysis of PM_2.5-attribulable premature deaths (rather than the coarse-level analysis) may elucidate the reason for this increase and inform and effective start-of-the-art state-level and national emission control strategies. This study quantified the spatiotemporal dynamics of PM_2.5-attributable premature deaths from 2001 to 2020 and applied a decomposition analysis to dissect the contribution of various associated parameters, such as PM_2.5 concentration, population distribution and disease-specific baseline death rate. Results show significant spatiotemporal variations of PM_2.5 and associated health burden in India. During the study period, population weighted PM_2.5 value increased from 46.0 to 59.5 μg/m³ and associated non-communicable death increased around 87.6 %, from 1050 [95 % (CI): 880-1210] thousand to 1970 (95 % CI: 1658-2259) thousand. The states of Uttar Pradesh, Bihar, West Bengal, Maharashtra, Rajasthan, and Madhya Pradesh had the highest PM_2.5-attributable deaths. In these states, non-accidental deaths increased from 232.1, 112.7, 81.4, 79.1, 66.3 and 58.5 thousand in 2001 to 424.1, 226.7, 156.2, 154.5, 123.3 and 119.7 thousand in 2020. In per capita population (/10⁵ population), the highest PM_2.5-attributable deaths were observed in Delhi, Uttar Pradesh, Bihar, Haryana and Punjab. Throughout the study period, demographic changes outweighed the health burden and were responsible for ~62.8 % increase of PM_2.5-related non-accidental deaths across India, whereas the change in PM_2.5 concentration influenced only 18.7 %. The change in baseline mortality rate impacts differently for the estimation of disease-specific mortality changes. Our findings suggest more dynamic and comprehensive policies at state-specific level, especially for North India is very indispensable for the overall decrease of PM_2.5-related deaths in India.

Effects of Air Pollution on the Health of Older Adults during Physical Activities: Mapping Review

Atmospheric pollutants present environmental threats to health and have been investigated in different environments, such as highways, squares, parks, and gyms. These environments are frequented by older adults, who are considered fragile to the harmful impacts of pollution present in the air. The aim was to analyze the state of the art on the effects of air pollution on the health of older adults during physical activities (PAs) through a mapping review. The search was performed in PubMed, Web of Science, Scopus, and Cinahl databases until June 2022. Of the 10,109 studies initially identified, 58 met the inclusion criteria. The most investigated health outcome was cardiovascular disease, followed by respiratory outcomes. Particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3) were the most investigated pollutants. Of the 75 health outcomes investigated, in 29, air pollution had harmful effects on the health of the older adults during the practice of PA, more frequently in cardiovascular diseases. In 25 outcomes, the beneficial effects of PA to the health of the older adults remained, despite exposure to high and low concentrations of pollutants, most often in terms of mental disorders. We conclude that poor air quality is a harmful factor for the health of older adults during the practice of PAs, more frequently in cardiovascular and respiratory diseases. On the other hand, for mental-health-related outcomes (depression and cognition), in most studies, the beneficial effects of PA in older adults were maintained, even after exposure to pollutants.

Health Status and Quality of Life in the Population near Zhezkazgan Copper Smelter, Kazakhstan

Background

The industrial city of Zhezkazgan is one of the most important cities in the industrial sector and the most polluted city in the Republic of Kazakhstan. There is placed Kazakhstan's largest copper smelter. The entire technological process (extraction, crushing, grinding, purification, and smelting of pure ingots) of the production of the copper smelter releases into the environment mainly various kinds of solid particles, sulfur oxides (SOx), and various carcinogenic elements. Emissions from the industrial facilities extend to a significant area around the city, combined with other sources of environmental pollution (motor transport, thermal power plant, individual heating systems, and others).

Objective

This study assessed the health status of residents of villages near Zhezkazgan by screening, quality of life studies, and official medical statistics.

Methods

This study assessed the health status and quality of life of residents near Zhezkazgan city. The cohort included residents from Talap village (main group) and Malshybai village (comparison group) from the Ulytau district in the Karaganda region. The sampling for the health check and quality of life survey covered 260 adult residents of Talap village and 146 adult residents of Malshybai village. Univariate analysis was used to calculate the odds ratio (OR) with a 95% confidence interval (95% CI).

Results

In the city district of Zhezkazgan, the overall mortality rate and mortality from diseases of the circulatory system, neoplasms, and respiratory diseases were much higher than in the Karaganda region and the Republic of Kazakhstan from 2015-2020. Residents of the Talap settlement had higher rates of coronary heart disease (CHD) (OR 1.30; 95% CI: 0.70-2.39; and p < 0.05), arterial hypertension (AH) (OR 1.84; 95% CI: 1.11-3.03; and p < 0.05), decreased hemoglobin (OR 1.89; 95% CI: 1.17-3.07; and p < 0.05), and endocrine diseases (diabetes mellitus, obesity, and thyrotoxicosis) (OR 1.76; 95% CI: 1.12-2.79; and p < 0.05) at registration than residents of the Malshybai settlement. Residents of both settlements expressed dissatisfaction with the quality of drinking water and the presence of the area where launch vehicles fell.

Conclusion

Indicators of pollution in the city, statistics of official mortality, and differences in morbidity indicated the negative impact of hazardous emissions from industrial facilities of the copper smelter on public health.

Biological monitoring and personal exposure to traffic-related air pollutants of elementary school-age children living in a metropolitan area

An ever-growing burden of scientific evidence links air pollution to different aspects of human health even at very low concentrations; the impact increases for those living in urban environments, especially the youngest and the elderly. This study investigated the exposure to air pollution of urban school children of Milan, Italy, by personal and biological monitoring, in the frame of the MAPS-MI project. A total of 128 primary school children (7-11 years) were involved in a two-season monitoring campaign during spring 2018 and winter 2019. Personal exposure to airborne VOCs and eBC, and biological monitoring of urinary benzene (BEN-U) and methyl-tert-butyl ether (MTBE-U) were performed. Time-activity patterns, environmental tobacco smoke (ETS), spatial, and meteorological information were evaluated as determinants in mixed effects regression analysis. Children personal exposure was mostly quantifiable with median (5th-95th percentile) levels 1.9 (0.8-7.5) μg/m³ for eBC, and 1.1 (<0.6-3.4) and 0.8 (0.3-1.8) μg/m³ for benzene and MTBE, respectively; with values 2-3-fold higher in winter than in spring. In urine, median (5th-95th) BEN-U and MTBE-U levels were 44.9 (25.7-98.6) and 11.5 (5.0-35.5) ng/L, respectively. Mixed effect regression models explained from 72 to 93 % of the total variability for air pollutants, and from 58 to 61 % for biomarkers. Major contributors of personal exposure were season, wind speed, mobility- or traffic-related variables; biomarkers were mostly predicted by airborne exposure and ETS. Our results suggest that traffic-mitigation actions, together with parents' educational interventions on ETS and commuting mode, should be undertaken to lower children exposure to air pollution.

Short-term association between ambient air pollution and cardio-respiratory mortality in Rio de Janeiro, Brazil

BACKGROUND

Several epidemiological studies have reported associations between ambient air pollution and mortality. However, relatively few studies have investigated this relationship in Brazil using individual-level data.

OBJECTIVES

To estimate the short-term association between exposure to particulate matter <10 μm (PM10) and ozone (O3), and cardiovascular and respiratory mortality in Rio de Janeiro, Brazil, between 2012 and 2017.

METHODS

We used a time-stratified case-crossover study design with individual-level mortality data. Our sample included 76,798 deaths from cardiovascular diseases and 36,071 deaths from respiratory diseases. Individual exposure to air pollutants was estimated by the inverse distance weighting method. We used data from seven monitoring stations for PM10 (24-hour mean), eight stations for O3 (8-hour max), 13 stations for air temperature (24-hour mean), and 12 humidity stations (24-hour mean). We estimated the mortality effects of PM10 and O3 over a 3-day lag using conditional logistic regression models combined with distributed lag non-linear models. The models were adjusted for daily mean temperature and daily mean absolute humidity. Effect estimates were presented as odds ratios (OR) with their 95% confidence interval (CI) associated with a 10 μg/m3 increase in each pollutant exposure.

RESULTS

No consistent associations were observed for both pollutant and mortality outcome. The cumulative OR of PM10 exposure was 1.01 (95% CI 0.99-1.02) for respiratory mortality and 1.00 (95% CI 0.99-1.01) for cardiovascular mortality. For O3 exposure, we also found no evidence of increased mortality for cardiovascular (OR 1.01, 95% CI 1.00-1.01) or respiratory diseases (OR 0.99, 95% CI 0.98-1.00). Our findings were similar across age and gender subgroups, and different model specifications.

CONCLUSION

We found no consistent associations between the PM10 and O3 concentrations observed in our study and cardio-respiratory mortality. Future studies need to explore more refined exposure assessment methods to improve health risk estimates and the planning and evaluation of public health and environmental policies.

Losses Associated With Childhood Sexual Abuse in Women Survivors: A Scoping Review

METHOD

This article reports the findings of a scoping review designed to identify research exploring the losses associated with childhood sexual abuse in women survivors. A systematic search of databases for articles published between 1983 and 2019 were conducted using keywords related to loss and women survivors of childhood sexual abuse.

FINDINGS

Twenty studies were selected for review using predefined inclusion criteria: studies that include adult women survivors of childhood sexual abuse, studies that include child/childhood sexual abuse, studies that include stigmatized loss, studies that indicate stigmatized loss in adult women survivors of childhood sexual abuse. Sources were subject to quality appraisal and data were extracted in line with the review question.

DISCUSSION AND CONTRIBUTION

Findings acknowledged and extended on Bloom's model of stigmatized loss and suggested that female survivors of childhood sexual abuse may experience an overall loss of self-efficacy, presenting as a loss of personal agency, interpersonal agency, and sexual agency. The results of this research suggest that loss be considered in support interventions with women self-reporting childhood sexual abuse. It is recommended that further research be conducted to confirm these findings so that they may advocate for inclusion in childhood sexual abuse treatment interventions.

Air pollution and public health in Latin America and the Caribbean (LAC): a systematic review with meta-analysis

Background

Over the years, air pollution has garnered increased attention from researchers who continue to provide studies and suggestive data that prove there is an ever-increasing risk of air pollution on the health of humans, terrestrial, and aquatic animals. A measurement involved in the quantity of certain traceable particles within the air, namely: Particulate Matter (PM) 2.5 and 10, ozone (O₃), Nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and carbon monoxide (CO) emissions, all converted to Air Quality Index. Most studies are predominantly from developed nations with limited research conducted in developing nations such as those in Latin America and the Caribbean.

Main body

In this systematic review, we examined the impact of air pollution on public health. A database search produced 1,118 studies, of which four were selected for a quantitative meta-analysis that explored hazard ratios concerning exposure to elevated levels of PM2.5. The meta-analysis results show that exposure to PM2.5 increases the risk of an adverse health event by as much as 2% five days after exposure. Results also indicated a consensus on the negative impacts of air pollution on public health. The results also suggest that more can be done within the region to combat or at the very least minimize the impact of air pollution to public health.

Conclusion

The pooled data from the studies reviewed show that there is an increased risk of an adverse health event on the day of exposure to PM2.5 and every subsequent day after exposure. A pattern exists between hospitalization and air pollution due to increased susceptibility to respiratory infections and asthma development. Combating the harmful effects of air pollution should be a top priority in Latin America and the Caribbean.

Interactive short-term effects of meteorological factors and air pollution on hospital admissions for cardiovascular diseases

A substantial number of studies have demonstrated the association between air pollution and adverse health effects. However, few studies have explored the potential interactive effects between meteorological factors and air pollution. This study attempted to evaluate the interactive effects between meteorological factors (temperature and relative humidity) and air pollution ([Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]) on cardiovascular diseases (CVDs). Next, the high-risk population susceptible to air pollution was identified. We collected daily counts of CVD hospitalizations, air pollution, and weather data in Nanning from January 1, 2014, to December 31, 2015. Generalized additive models (GAMs) with interaction terms were adopted to estimate the interactive effects of air pollution and meteorological factors on CVD after controlling for seasonality, day of the week, and public holidays. On low-temperature days, an increase of [Formula: see text] in [Formula: see text], [Formula: see text], and [Formula: see text] was associated with increases of 4.31% (2.39%, 6.26%) at lag 2; 2.74% (1.65%, 3.84%) at lag 0-2; and 0.13% (0.02%, 0.23%) at lag 0-3 in CVD hospitalizations, respectively. During low relative humidity days, a [Formula: see text] increment of lag 0-3 exposure was associated with increases of 3.43% (4.61%, 2.67%) and 0.10% (0.04%, 0.15%) for [Formula: see text] and [Formula: see text], respectively. On high relative humidity days, an increase of [Formula: see text] in [Formula: see text] was associated with an increase of 5.86% (1.82%, 10.07%) at lag 0-2 in CVD hospitalizations. Moreover, elderly (≥ 65 years) and female patients were vulnerable to the effects of air pollution. There were interactive effects between air pollutants and meteorological factors on CVD hospitalizations. The risk that [Formula: see text], [Formula: see text], and [Formula: see text] posed to CVD hospitalizations could be significantly enhanced by low temperatures. For [Formula: see text] and [Formula: see text], CVD hospitalization risk increased in low relative humidity. The effects of [Formula: see text] were enhanced at high relative humidity.

Environmental factors linked to hospital admissions in young children due to acute viral lower respiratory infections: A bidirectional case-crossover study

OBJECTIVE

This study evaluated the association of the short-term exposure to environmental factors (relative humidity, temperature, NO₂, SO₂, O₃, PM₁₀, and CO) with hospital admissions due to acute viral lower respiratory infections (ALRI) in children under two years before the COVID-19 era.

METHODS

We performed a bidirectional case-crossover study in 30,445 children with ALRI under two years of age in the Spanish Minimum Basic Data Set (MBDS) from 2013 to 2015. Environmental data were obtained from Spain's State Meteorological Agency (AEMET). The association was assessed by conditional logistic regression.

RESULTS

Lower temperature one week before the day of the event (hospital admission) (q-value = 0.012) and higher relative humidity one week (q-value = 0.003) and two weeks (q-value<0.001) before the day of the event were related to a higher odds of hospital admissions. Higher NO₂ levels two weeks before the event were associated with hospital admissions (q-value<0.001). Moreover, higher concentrations on the day of the event for SO₂ (compared to lag time of 1-week (q-value = 0.026) and 2-weeks (q-value<0.001)), O₃ (compared to lag time of 3-days (q-value<0.001), 1-week (q-value<0.001), and 2-weeks (q-value<0.001)), and PM₁₀ (compared to lag time of 2-weeks (q-value<0.001)) were related to an increased odds of hospital admissions for viral ALRI.

CONCLUSION

Short-term exposure to environmental factors (climatic conditions and ambient air contaminants) was linked to a higher likelihood of hospital admissions due to ALRI. Our findings emphasize the importance of monitoring environmental factors to assess the odds of ALRI hospital admissions and plan public health resources.

Outdoor Physical Activity in an Air Polluted Environment and Its Effect on the Cardiovascular System-A Systematic Review

Air pollution is a global public health threat. Evidence suggests that increased air pollution leads to increased cardiovascular morbidity and mortality. The aim of this review was to systematically review and synthesize scientific evidence to understand the effect of performing outdoor physical activity (PA) in a polluted environment on cardiovascular outcomes. This review was developed and reported in accordance with the PRISMA guidelines. Electronic searches in Embase, Web of Science, and PubMed were undertaken through March 2021 initially, and later updated through to 31st January 2022, for observational studies published in peer-reviewed journals that report cardiovascular mortality or morbidity due to outdoor PA in air polluted environment. These searches yielded 10,840 citations. Two reviewers independently reviewed each citation for its eligibility. Seven studies were found to be eligible. Of these, five were cohort studies and two were cross-sectional studies. Pollutants measured in the selected studies were Particulate Matter (PM)-PM10, PM2.5, nitrogen oxides (NO_x), and ozone (O₃). The most common study outcome was myocardial infarction, followed by cardiovascular mortality, hypertension and heart rate variability. Six studies emphasized that the PA has beneficial effects on cardiovascular outcomes, though air pollutants attenuate this effect to an extent. Two studies showed that walking, even in the polluted environment, significantly reduced the heart rate and heart rate variability indices. The beneficial effects of outdoor PA outweigh the harmful effects of air pollution on cardiovascular health, though the benefits reduce to an extent when PA is carried out in a polluted environment. Because a limited number of studies (n = 7) were eligible for inclusion, the review further emphasizes the critical need for more primary studies that differentiate between outdoor and indoor PA and its effect on cardiovascular health.

Comparison Process of Blood Heavy Metals Absorption Linked to Measured Air Quality Data in Areas with High and Low Environmental Impact

Air pollution is a problem shared by the entire world population, and researchers have highlighted its adverse effects on human health in recent years. The object of this paper was the relationship between the pollutants’ concentrations measured in the air and the quantity of pollutant itself inhaled by the human body. The area chosen for the study has a high environmental impact given the significant presence on the territory of polluting activities. The Acerra area (HI) has a waste-to-energy plant and numerous industries to which polluting emissions are attributed. This area has always been the subject of study as the numbers of cancer patients are high. A survey on male patients to evaluate the heavy metals concentrations in the blood was conducted in the two areas and then linked to its values aero-dispersed. Using the air quality data measured by the monitoring networks in two zones, one with high environmental impact (HI) and one with low environmental impact (LI), the chronicle daily intake (CDI) of pollutants inhaled by a single person was calculated. The pollutants considered in this study are PM10 and four heavy metals (As, Cd, Ni, Pb) constituting the typical particulates of the areas concerned. The CDI values calculated for the two zones are significantly higher in the HI zone following the seasonal pollution trend.

Screening-level assessment of cancer risk associated with ambient air exposure in Aamjiwnaang First Nation

The manuscript reports findings from a screening-level assessment of cancer risk from outdoor air in Aamjiwnaang First Nation. Ambient air pollution can contribute to cardiovascular/respiratory diseases, and certain types of cancer. Certain communities may be at higher risk to the negative health impacts due to their geographical proximity to pollution sources. Outdoor air concentrations were mapped and the Lifetime Excess Cancer Risks (LECR) associated with long-term exposure to known carcinogens were estimated. LECR results for both benzene and 1,3-butadiene were above one per million. The LECR for benzene was 6.4 per million when the Health Canada slope factor was applied and 12.0 when using the US EPA. For 1,3-butadiene the LECR estimate was 8.8 per million. This work provides a better understanding of environmental exposures and potential associated cancer risks for residents in the Aamjiwnaang community and highlights the need for further air monitoring and a more detailed risk assessment.

Air Pollution and the Risk of Parkinson's Disease: A Review

Parkinson's disease, as well as other neurodegenerative disorders, are primarily characterized by pathological accumulation of proteins, inflammation, and neuron loss. Although there are some known genetic risk factors, most cases cannot be explained by genetics alone. Therefore, it is important to determine the environmental factors that confer risk and the mechanisms by which they act. Recent epidemiological studies have found that exposure to air pollution is associated with an increased risk for development of Parkinson's disease, although not all results are uniform. The variability between these studies is likely due to differences in what components of air pollution are measured, timing and methods used to determine exposures, and correction for other variables. There are several potential mechanisms by which air pollution could act to increase the risk for development of Parkinson's disease, including direct neuronal toxicity, induction of systemic inflammation leading to central nervous system inflammation, and alterations in gut physiology and the microbiome. Taken together, air pollution is an emerging risk factor in the development of Parkinson's disease. A number of potential mechanisms have been implicated by which it promotes neuropathology providing biological plausibility, and these mechanisms are likely relevant to the development of other neurodegenerative disorders such as Alzheimer's disease. This field is in its early stages, but a better understanding of how environmental exposures influence the pathogenesis of neurodegeneration is essential for reducing the incidence of disease and finding disease-modifying therapies. © 2022 International Parkinson and Movement Disorder Society.

Controlled human exposure to diesel exhaust: results illuminate health effects of traffic-related air pollution and inform future directions

Air pollution is an issue of increasing interest due to its globally relevant impacts on morbidity and mortality. Controlled human exposure (CHE) studies are often employed to investigate the impacts of pollution on human health, with diesel exhaust (DE) commonly used as a surrogate of traffic related air pollution (TRAP). This paper will review the results derived from 104 publications of CHE to DE (CHE-DE) with respect to health outcomes. CHE-DE studies have provided mechanistic evidence supporting TRAP’s detrimental effects on related to the cardiovascular system (e.g., vasomotor dysfunction, inhibition of fibrinolysis, and impaired cardiac function) and respiratory system (e.g., airway inflammation, increased airway responsiveness, and clinical symptoms of asthma). Oxidative stress is thought to be the primary mechanism of TRAP-induced effects and has been supported by several CHE-DE studies. A historical limitation of some air pollution research is consideration of TRAP (or its components) in isolation, limiting insight into the interactions between TRAP and other environmental factors often encountered in tandem. CHE-DE studies can help to shed light on complex conditions, and several have included co-exposure to common elements such as allergens, ozone, and activity level. The ability of filters to mitigate the adverse effects of DE, by limiting exposure to the particulate fraction of polluted aerosols, has also been examined. While various biomarkers of DE exposure have been evaluated in CHE-DE studies, a definitive such endpoint has yet to be identified. In spite of the above advantages, this paradigm for TRAP is constrained to acute exposures and can only be indirectly applied to chronic exposures, despite the critical real-world impact of living long-term with TRAP. Those with significant medical conditions are often excluded from CHE-DE studies and so results derived from healthy individuals may not apply to more susceptible populations whose further study is needed to avoid potentially misleading conclusions. In spite of limitations, the contributions of CHE-DE studies have greatly advanced current understanding of the health impacts associated with TRAP exposure, especially regarding mechanisms therein, with important implications for regulation and policy.

Communicating respiratory health risk among children using a global air quality index

Air pollution poses a serious threat to children's respiratory health around the world. Satellite remote-sensing technology and air quality models can provide pollution data on a global scale, necessary for risk communication efforts in regions without ground-based monitoring networks. Several large centers, including NASA, produce global pollution forecasts that may be used alongside air quality indices to communicate local, daily risk information to the public. Here we present a health-based, globally applicable air quality index developed specifically to reflect the respiratory health risks among children exposed to elevated outdoor air pollution. Additive, excess-risk air quality indices were developed using 51 different coefficients derived from time-series health studies evaluating the impacts of ambient fine particulate matter, nitrogen dioxide, and ozone on children's respiratory morbidity outcomes. A total of four indices were created which varied based on whether or not the underlying studies controlled for co-pollutants and in the adjustment of excess risks of individual pollutants. Combined with historical estimates of air pollution provided globally at a 25 × 25 km² spatial resolution from the NASA's Goddard Earth Observing System composition forecast (GEOS-CF) model, each of these indices were examined in a global sample of 664 small and 140 large cities for study year 2017. Adjusted indices presented the most normal distributions of locally-scaled index values, which has been shown to improve associations with health risks, while indices based on coefficients controlling for co-pollutants had little effect on index performance. We provide the steps and resources need to apply our final adjusted index at the local level using freely-available forecasting data from the GEOS-CF model, which can provide risk communication information for cities around the world to better inform individual behavior modification to best protect children's respiratory health.

The impacts of urban structure on PM2.5 pollution depend on city size and location

Many cities across the world face the challenge of severe fine particulate matter (PM_2.5) pollution. Among the many factors that affect PM_2.5 pollution, there is an increasing interest in the impacts of urban structure. However, quantifying these impacts in China has been difficult due to differences of study area and scale in existing research, as well as limited sample sizes. Here, we conducted a continental study focusing on 301 prefectural cities in mainland China to investigate the effects of urban structure, including urban size and urban compactness, on PM_2.5 concentrations. Based on PM_2.5 raster and land cover data, we used quantile regression and a general multilinear model to estimate the effects and relative contributions of urban size and urban compactness on urban PM_2.5 pollution, with explicit consideration for pollution level, urban size and geographical location. We found: (1) nationwide, the larger and more compact that cities were, the heavier the PM_2.5 pollution tended to be. Additionally, this relationship became stronger with increasing levels of pollution. (2) In general, urban size played a more important role than urban form, and there were no significant interactive effects between the two metrics on urban PM_2.5 concentrations at the national scale. (3) The impacts of urban size and form varied by city size and geographical location. The impacts of urban size were only significant for small or medium-large cities but not for large cities. Among large cities, only urban form had a significantly positive effect on urban PM_2.5 concentrations. The further north and west that cities were, the more dependent PM_2.5 pollution was on urban form, whereas the further south and east that cities were, the greater the impact of urban size. These results provide insights into how urban design and planning can be used to alleviate air pollution.

Health and Economic Impacts Assessment of O3 Exposure in Mexico

Health effects related to exposure to air pollution such as ozone (O₃) have been documented. The World Health Organization has recommended the use of the Sum of O₃ Means Over 35 ppb (SOMO35) to perform Health Impact Assessments (HIA) for long-term exposure to O₃. We estimated the avoidable mortality associated with long-term exposure to tropospheric O₃ in 14 cities in Mexico using information for 2015. The economic valuation of avoidable deaths related to SOMO35 exposure was performed using the willingness to pay (WTP) and human capital (HC) approaches. We estimated that 627 deaths (95% uncertainty interval (UI): 227–1051) from respiratory diseases associated with the exposure to O₃ would have been avoided in people over 30 years in the study area, which confirms the public health impacts of ambient air pollution. The avoidable deaths account for almost 1400 million USD under the WTP approach, whilst the HC method yielded a lost productivity estimate of 29.7 million USD due to premature deaths. Our findings represent the first evidence of the health impacts of O₃ exposure in Mexico, using SOMO35 metrics.

Association between Exposure to Particulate Matter during Pregnancy and Multidimensional Development in School-Age Children: A Cross-Sectional Study in Italy

Air pollutants can potentially affect the development of children. However, data on the effect of exposure to air pollution during pregnancy and developmental outcomes in school children are rare. We investigated the link between prenatal exposure to particulate matters smaller than 10 microns (PM₁₀) and the development of school-age children in multiple domains. Cross-sectional data were collected in Italy between 2013 and 2014. Children aged between 5 and 8 years (n = 1187) were assessed on cognitive, communication, socio-emotional, adaptive, and motor developmental domains using the Developmental Profile 3 questionnaire. The monthly average concentration of PM₁₀ during the entire fetal period was linked to the municipality of residence of the children. The increase in the prenatal PM₁₀ was associated with a decrease in the cognitive score during the second (+13.2 µg/m³ PM₁₀ increase: −0.30 points; 95%CI: −0.12–−0.48) and third trimesters of pregnancy (−0.31 points; 95%CI: −0.11–−0.50). The communicative domain was also negatively influenced by PM₁₀ increases in the second trimester. The development of cognitive and communicative abilities of children was negatively associated with the exposure to PM₁₀ during the period of fetal development, confirming that exposure to air pollution during pregnancy can potentially hinder the development of the brain.

Climate change, women's health, and the role of obstetricians and gynecologists in leadership

Climate change is one of the major global health threats to the world's population. It is brought on by global warming due in large part to increasing levels of greenhouse gases resulting from human activity, including burning fossil fuels (carbon dioxide), animal husbandry (methane from manure), industry emissions (ozone, nitrogen oxides, sulfur dioxide), vehicle/factory exhaust, and chlorofluorocarbon aerosols that trap extra heat in the earth's atmosphere. Resulting extremes of weather give rise to wildfires, air pollution, changes in ecology, and floods. These in turn result in displacement of populations, family disruption, violence, and major impacts on water quality and availability, food security, public health and economic infrastructures, and limited abilities for civil society to maintain citizen safety. Climate change also has direct impacts on human health and well-being. Particularly vulnerable populations are affected, including women, pregnant women, children, the disabled, and the elderly, who comprise the majority of the poor globally. Additionally, the effects of climate change disproportionally affect disadvantaged communities, including low income and communities of color, and lower-income countries that are at highest risk of adverse impacts when disasters occur due to inequitable distribution of resources and their socioeconomic status. The climate crisis is tilting the risk balance unfavorably for women's sexual and reproductive health and rights as well as newborn and child health. Obstetrician/gynecologists have the unique opportunity to raise awareness, educate, and advocate for mitigation strategies to reverse climate change affecting our patients and their families. This article puts climate change in the context of women's reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue that needs our attention now for the health and well-being of this and future generations. FIGO joins a broad coalition of international researchers and the medical community in stating that the current climate crisis presents an imminent health risk to pregnant people, developing fetuses, and reproductive health, and recognizing that we need society-wide solutions, government policies, and global cooperation to address and reduce contributors, including fossil fuel production, to climate change.

Effects of air pollution on health: A mapping review of systematic reviews and meta-analyses

BACKGROUND

There has been a notable increase in knowledge production on air pollution and human health.

OBJECTIVE

To analyze the state of the art on the effects of air pollution on human health through a mapping review of existing systematic reviews and meta-analyses (SRs and MAs).

METHODS

The systematic mapping review was based on the recommendations for this type of scientific approach in environmental sciences. The search was performed using PubMed, Web of Science, Scopus, Cinahl, and Cochrane Library databases, from their inception through June 2020.

RESULTS

Among 3401 studies screened, 240 SRs and MAs satisfied the inclusion criteria. Five research questions were answered. There has been an overall progressive increase in publications since 2014. The majority of the SRs and MAs were carried out by researchers from institutions in China, the US, the UK, and Italy. Most studies performed a meta-analysis (161). In general, the reviews support the association of air pollution and health outcomes, and analyzed the effects of outdoor air pollution. The most commonly investigated health outcome type was the respiratory (mainly asthma and COPD), followed by cardiovascular outcomes (mainly stroke). Particulate matter (with a diameter of 2.5 μm (PM_2.5) and 10 μm (PM₁₀) or less) and nitrogen dioxide (NO₂) were the most widely investigated pollutants in the reviews. The general population was the most common sample in the reviews, followed by children, and adults. The majority of the reviews investigated health outcomes of respiratory diseases in children, as well as cardiovascular diseases in all ages. Combining health outcomes and air pollutants, PM_2.5 was included in a higher number of reviews in eight health outcomes, mainly cardiovascular diseases.

DISCUSSION

The majority of SRs and MAs showed that air pollution has harmful effects on health, with a focus on respiratory and cardiovascular outcomes. Future studies should extend the analysis to psychological and social aspects influenced by air pollution.

Long-term residential exposure to air pollution is associated with hair cortisol concentration and differential leucocyte count in Flemish adolescent boys

BACKGROUND

Exposure to air pollution and traffic noise are associated with adverse health outcomes in adolescents. Chronic endocrine stress and systemic inflammation have been hypothesized to underlie the adverse health effects. Simultaneous assessment of inflammation and chronic endocrine stress in epidemiological studies is lacking. The aim of the study was to investigate biomarkers of chronic endocrine stress and inflammation in relation to long-term residential exposure to air pollution and traffic noise in adolescents.

METHODS

In Flemish adolescents (14-15 years), we determined hair cortisol concentration (HCC) as a chronic stress biomarker in 3-cm scalp-near hair sections (n = 395), and leucocyte and leucocyte subtype counts (neutrophils, monocytes, lymphocytes) as inflammatory biomarkers in peripheral blood (n = 385). Daily particulate matter (PM_2.5, PM₁₀), nitrogen dioxide (NO₂) and black carbon (BC) concentrations were modelled at the residential address and averaged over 3-month and 1-year periods prior to sampling. Residential traffic noise level was estimated and classified in 5 dB intervals. Sex-specific associations between residential exposures and effect biomarkers were studied using linear regression models, adjusted for a priori selected covariates.

RESULTS

In boys, HCC increased with a factor 1.30 (95% CI: 1.10, 1.54) for an increase in 1-year mean NO₂ from the 25th to 75th percentile (p75/p25), after adjustment for age, BMI, personal and neighborhood socioeconomic status. The corresponding estimate for PM₁₀ was 1.24 (95% CI: 1.02, 1.51). Total leucocyte count in boys, adjusted for the aforementioned covariates and recent health complaints, was positively associated with PM_2.5, PM₁₀, NO₂ and BC. In particular, the neutrophil count increased with a factor 1.11 (95% CI: 1.03, 1.19) for a (p75/p25)-factor increase in 1-year mean BC, corresponding estimates for PM_2.5, PM₁₀ and NO₂ were 1.10 (95% CI: 1.01, 1.19), 1.10 (95% CI: 1.01, 1.20) and 1.08 (95% CI: 1.00, 1.16). Lymphocyte count increased with a factor 1.05 (95% CI: 1.01, 1.10) for a (p75/p25)-factor increase in 1-year mean NO₂. Similar results were observed for 3-month mean exposures. Results were robust to adjustment for recent air pollution exposure. In girls, air pollutants were not associated with HCC or differential leucocyte count. Residential traffic noise level was not associated with HCC or leucocyte counts in boys nor girls.

CONCLUSIONS

Long-term residential exposure to air pollutants was positively associated with chronic endocrine stress and inflammation in adolescent boys, not in girls. This study may contribute to a better understanding of the early pathophysiological changes that may underlie adverse health effects of air pollution exposure in adolescents.

Exploring smoke: an ethnographic study of air pollution in rural Malawi

Air pollution adversely affects human health, and the climate crisis intensifies the global imperative for action. Low-/middle-income countries (LMIC) suffer particularly high attributable disease burdens. In rural low-resource settings, these are linked to cooking using biomass. Proposed biomedical solutions to air pollution typically involve ‘improved cooking technologies’, often introduced by high-income country research teams. This ethnography, set in a rural Malawian village, aimed to understand air pollution within its social and environmental context. The results provide a multifaceted account through immersive participant observations with concurrent air quality monitoring, interviews and participatory workshops. Data included quantitative measures of individuals’ air pollution exposures paired with activity, qualitative insights into how smoke is experienced in daily life throughout the village, and participants’ reflections on potential cleaner air solutions. Individual air quality monitoring demonstrated that particulate levels frequently exceeded upper limits recommended by the WHO, even in the absence of identified sources of biomass burning. Ethnographic findings revealed the overwhelming impact of economic scarcity on individual air pollution exposures. Scarcity affected air pollution exposures through three pathways: daily hardship, limitation and precarity. We use the theory of structural violence, as described by Paul Farmer, and the concept of slow violence to interrogate the origins of this scarcity and global inequality. We draw on the ethnographic findings to critically consider sustainable approaches to cleaner air, without re-enacting existing systemic inequities.

The Diamond League athletic series: does the air quality sparkle?

Urban air pollution can have negative short- and long-term impacts on health, including cardiovascular, neurological, immune system and developmental damage. The irritant qualities of pollutants such as ozone (O₃), nitrogen dioxide (NO₂) and particulate matter (PM) can cause respiratory and cardiovascular distress, which can be heightened during physical activity and particularly so for those with respiratory conditions such as asthma. Previously, research has only examined marathon run outcomes or running under laboratory settings. This study focuses on elite 5-km athletes performing in international events at nine locations. Local meteorological and air quality data are used in conjunction with race performance metrics from the Diamond League Athletics series to determine the extent to which elite competitors are influenced during maximal sustained efforts in real-world conditions. The findings from this study suggest that local meteorological variables (temperature, wind speed and relative humidity) and air quality (ozone and particulate matter) have an impact on athletic performance. Variation between finishing times at different race locations can also be explained by the local meteorology and air quality conditions seen during races.

Reducing Prenatal Exposure to Toxic Environmental Agents: ACOG Committee Opinion, Number 832

ABSTRACT

There is emerging evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes. Toxic exposures related to reproductive and developmental health primarily have been associated with infertility and miscarriage, obstetric outcomes such as preterm birth and low birth weight, neurodevelopmental delay such as autism and attention deficit hyperactivity disorder, and adult and childhood cancer. Although there is substantial overlap in the type of exposure and the associated health outcomes, for the purposes of this document, exposures generally can be grouped into the following categories: toxic chemicals, air pollution, and climate change-related exposures. Obstetric care clinicians do not need to be experts in environmental health science to provide useful information to patients and refer patients to appropriate specialists, if needed, when a hazardous exposure is identified. It is important for obstetrician-gynecologists and other obstetric care clinicians to become knowledgeable about toxic environmental exposures that are endemic to their specific geographic areas, such as local water safety advisories (eg, lead-contaminated water), local air quality levels, and patients' proximity to power plants and fracking sites. Although exposure to toxic environmental agents is widespread across populations, many environmental factors that are harmful to reproductive health disproportionately affect underserved populations and are subsumed in issues of environmental justice. Clinical encounters offer an opportunity to screen and counsel patients during the prepregnancy and prenatal periods-particularly individuals most disproportionately affected-about opportunities to reduce toxic environmental health exposures. This Committee Opinion is revised to integrate more recent literature regarding reducing prepregnancy and prenatal toxic environmental exposures.

Contribution of Aerosol Sources to Health Impacts

Atmospheric aerosol is one of the major leading environmental risk factors for human health worldwide, potentially causing several million premature deaths per year [...]

Exploring Challenges and Opportunities of Biophilic Urban Design: Evidence from Research and Experimentation

Global health emergencies such as Covid-19 have highlighted the importance of access to nature and open spaces in our cities for social, physical, and mental health. However, there continues to be a disconnect between our need for nature and our daily lived experience. Recent research indicates that our connectedness and relationship with nature, and in particular biophilic design, may be key for improving both health and quality of life. Rather than relying on abstract universal ideas of “nature”, using evidence-based biophilic design and policy at a building, neighborhood, and city scale, to link our daily lives with biodiversity, may encourage sense of place and make environmental action more meaningful. Then, improving our natural capital in the urban built environment might help address the current climate and disease crisis, as well as improving our physical and mental health. Drawing from emerging research and innovative practice, the paper describes key research and design paradigms that influence the way we understand the benefits of nature for different environments, including the workplace, neighborhood, and city, and explains where biophilic design theory sits in this field. Examples from recent research carried out in London and Chicago are provided, aiming at demonstrating what kind of research can be functional to what context, followed by a detailed analysis of its application supporting both human and ecological health. The study concludes indicating key policy and design lessons learned around regenerative design and biophilia as well as new directions for action, particularly with regard to climate change, sense of place, and well-being.

NO2 and PM2.5 Exposures and Lung Function in Swiss Adults: Estimated Effects of Short-Term Exposures and Long-Term Exposures with and without Adjustment for Short-Term Deviations

BACKGROUND

The impact of nitrogen dioxide (NO2) and particulate matter with an aerodynamic diameter of less than or equal to 2.5. microns (PM2.5) exposures on lung function has been investigated mainly in children and less in adults. Furthermore, it is unclear whether short-term deviations of air pollutant concentration need to be considered in long-term exposure models.

OBJECTIVES

The aims of this study were to investigate the association between short-term air pollution exposure and lung function and to assess whether short-term deviations of air pollutant concentration should be integrated into long-term exposure models.

METHODS

Short-term (daily averages 0-7 d prior) and long-term (1- and 4-y means) NO2 and PM2.5 concentrations were modeled using satellite, land use, and meteorological data calibrated on ground measurements. Forced expiratory volume within the first second (FEV1) of forced exhalation and forced vital capacity (FVC) were measured during a LuftiBus assessment (2003-2012) and linked to exposure information from the Swiss National Cohort for 36,085 adults (ages 18-95 y). We used multiple linear regression to estimate adjusted associations, and additionally adjusted models of long-term exposures for short-term deviations in air pollutant concentrations.

RESULTS

A 10μg/m3 increase in NO2 and PM2.5 on the day of the pulmonary function test was associated with lower FEV1 and FVC (NO2: FEV1 -8.0 ml [95% confidence interval: -13.4, -2.7], FVC -16.7 ml [-23.4, -10.0]; PM2.5: FEV1 -15.3 ml [-21.9, -8.7], FVC -18.5 ml [-26.5, -10.5]). A 10μg/m3 increase in 1-y mean NO2 was also associated with lower FEV1 (-7.7 ml; -15.9, 0.5) and FVC (-21.6 ml; -31.9, -11.4), as was a 10μg/m3 increase in 1-y mean PM2.5 (FEV1: -42.2 ml; -56.9, -27.5; FVC: -82.0 ml; -100.1, -63.9). These associations were robust to adjustment for short-term deviations in the concentration of each air pollutant.

CONCLUSIONS

Short- and long-term air pollution exposures were negatively associated with lung function, in particular long-term PM2.5 exposure with FVC. Our findings contribute substantially to the evidence of adverse associations between air pollution and lung function in adults. https://doi.org/10.1289/EHP7529.

Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study

BACKGROUND

3 billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional, and national health burden associated with exposure to household air pollution.

METHODS

For the systematic review and meta-analysis, we systematically searched four databases for studies published from database inception to April 2, 2020, that evaluated the risk of adverse cardiorespiratory, paediatric, and maternal outcomes from exposure to household air pollution, compared with no exposure. We used a random-effects model to calculate disease-specific relative risk (RR) meta-estimates. Household air pollution exposure was defined as use of polluting fuels (coal, wood, charcoal, agricultural wastes, animal dung, or kerosene) for household cooking or heating. Temporal trends in mortality and disease burden associated with household air pollution, as measured by disability-adjusted life-years (DALYs), were estimated from 2000 to 2017 using exposure prevalence data from 183 of 193 UN member states. 95% CIs were estimated by propagating uncertainty from the RR meta-estimates, prevalence of household air pollution exposure, and disease-specific mortality and burden estimates using a simulation-based approach. This study is registered with PROSPERO, CRD42019125060.

FINDINGS

476 studies (15·5 million participants) from 123 nations (99 [80%] of which were classified as low-income and middle-income) met the inclusion criteria. Household air pollution was positively associated with asthma (RR 1·23, 95% CI 1·11-1·36), acute respiratory infection in both adults (1·53, 1·22-1·93) and children (1·39, 1·29-1·49), chronic obstructive pulmonary disease (1·70, 1·47-1·97), lung cancer (1·69, 1·44-1·98), and tuberculosis (1·26, 1·08-1·48); cerebrovascular disease (1·09, 1·04-1·14) and ischaemic heart disease (1·10, 1·09-1·11); and low birthweight (1·36, 1·19-1·55) and stillbirth (1·22, 1·06-1·41); as well as with under-5 (1·25, 1·18-1·33), respiratory (1·19, 1·18-1·20), and cardiovascular (1·07, 1·04-1·11) mortality. Household air pollution was associated with 1·8 million (95% CI 1·1-2·7) deaths and 60·9 million (34·6-93·3) DALYs in 2017, with the burden overwhelmingly experienced in low-income and middle-income countries (LMICs; 60·8 million [34·6-92·9] DALYs) compared with high-income countries (0·09 million [0·01-0·40] DALYs). From 2000, mortality associated with household air pollution had reduced by 36% (95% CI 29-43) and disease burden by 30% (25-36), with the greatest reductions observed in higher-income nations.

INTERPRETATION

The burden of cardiorespiratory, paediatric, and maternal diseases associated with household air pollution has declined worldwide but remains high in the world's poorest regions. Urgent integrated health and energy strategies are needed to reduce the adverse health impact of household air pollution, especially in LMICs.

FUNDING

British Heart Foundation, Wellcome Trust.

Marine harmful algal blooms and human health: A systematic scoping review

Exposure to harmful algal blooms (HABs) can lead to well recognised acute patterns of illness in humans. The objective of this scoping review was to use an established methodology and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting framework to map the evidence for associations between marine HABs and observed both acute and chronic human health effects. A systematic and reproducible search of publications from 1985 until May 2019 was conducted using diverse electronic databases. Following de-duplication, 5301 records were identified, of which 380 were included in the final qualitative synthesis. The majority of studies (220; 57.9%) related to Ciguatera Poisoning. Anecdotal and case reports made up the vast majority of study types (242; 63.7%), whereas there were fewer formal epidemiological studies (35; 9.2%). Only four studies related to chronic exposure to HABs. A low proportion of studies reported the use of human specimens for confirmation of the cause of illness (32; 8.4%). This study highlighted gaps in the evidence base including a lack of formal surveillance and epidemiological studies, limited use of toxin measurements in human samples, and a scarcity of studies of chronic exposure. Future research and policy should provide a baseline understanding of the burden of human disease to inform the evaluation of the current and future impacts of climate change and HABs on human health.

Effects of air pollutants on the transmission and severity of respiratory viral infections

Particulate matter, sulfur dioxide, nitrogen oxides, ozone, carbon monoxide, volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) are among the outdoor air pollutants that are major factors in diseases, causing especially adverse respiratory effects in humans. On the other hand, the role of respiratory viruses in the pathogenesis of severe respiratory infections is an issue of great importance. The present literature review was aimed at assessing the potential effects of air pollutants on the transmission and severity of respiratory viral infections. We have reviewed the scientific literature regarding the association of outdoor air pollution and respiratory viruses on respiratory diseases. Evidence supports a clear association between air concentrations of some pollutants and human respiratory viruses interacting to adversely affect the respiratory system. Given the undoubted importance and topicality of the subject, we have paid special attention to the association between air pollutants and the transmission and severity of the effects caused by the coronavirus named SARS-CoV-2, which causes the COVID-19. Although to date, and by obvious reasons, the number of studies on this issue are still scarce, most results indicate that chronic exposure to air pollutants delays/complicates recovery of patients of COVID-19 and leads to more severe and lethal forms of this disease. This deserves immediate and in-depth experimental investigations.

Simulation of nanoparticle transport and adsorption in a microfluidic lung-on-a-chip device

The effect of air-borne nanoparticles (NPs) on human health is an active area of research, with clinical relevance evidenced by the current COVID-19 pandemic. As in vitro models for such studies, lung-on-a-chip (LOAC) devices can represent key physical and physiological aspects of alveolar tissues. However, widespread adoption of the LOAC device for NP testing has been hampered by low intra-laboratory and inter-laboratory reproducibility. To complement ongoing experimental work, we carried out finite-element simulations of the deposition of NPs on the epithelial layer of a well-established LOAC design. We solved the Navier-Stokes equations for the fluid flow in a three-dimensional domain and studied the particle transport using Eulerian advection-diffusion for fine NPs and Lagrangian particle tracking for coarse NPs. Using Langmuir and Frumkin kinetics for surface adsorption and desorption, we investigated NP adsorption under different exercise and breath-holding patterns. Conditions mimicking physical exercise, through changes in air-flow volume and breathing frequency, enhance particle deposition. Puff profiles typical of smoking, with breath-holding between inhalation and exhalation, also increase particle deposition per breathing cycle. Lagrangian particle tracking shows Brownian motion and gravitational settling to be two key factors, which may cooperate or compete with each other for different particle sizes. Comparisons are made with experimental data where possible and they show qualitative and semi-quantitative agreement. These results suggest that computer simulations can potentially inform and accelerate the design and application of LOAC devices for analyzing particulate- and microbe-alveolar interactions.

The Effects of Fine Dust, Ozone, and Nitrogen Dioxide on Health

BACKGROUND

Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 μg/m3 for fine dust particles smaller than 2.5 μm [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany.

METHODS

This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS).

RESULTS

Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mor- tality rises approximately 7% for every incremental long-term exposure to 5 μg/m3 PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 µg/m3 of PM2.5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits.

CONCLUSION

It is very important for public health that the current EU standards for rkedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO.

A Bibliometric Analysis of the Impacts of Air Pollution on Children

In recent years, many researchers have investigated the association between air pollution and children. However, there has been little research to provide a macroscopic overview in this field. The aim of this study is to characterize the scientific production around the world in this area and map the trends. The relevant literature was searched from 1999 to 2018. To guarantee the quality of the literature, we combined the PubMed and WoS databases. The built-in statistics tools of the Web of Science website were used to display the trend of articles published by year and the distribution of journals. By CiteSpace (5.5.R2), the reference co-citation and burst keywords were extracted. In total, 15,999 target English documents were obtained. We summarized the characteristics of published documents, of research institutes' cooperation, and of the contents. As part of a research hotspot, ten clusters are presented, four popular topics are elaborated. Twenty-four burst words were obtained and analyzed. China has received more attention in recent years. Researchers in this field could carry out more cohorts' studies and fine particulate matter is one good air pollution index. Household air pollution exposure and children's lung function should be paid more attention.