Health Benefits of Air Pollution Reduction

In-depth analysis of ambient air pollution changes due to the COVID-19 pandemic in the Asian Monsoon region

The COVID-19 pandemic has given a chance for researchers and policymakers all over the world to study the impact of lockdowns on air quality in each country. This review aims to investigate the impact of the restriction of activities during the lockdowns in the Asian Monsoon region on the main criteria air pollutants. The various types of lockdowns implemented in each country were based on the severity of the COVID-19 pandemic. The concentrations of major air pollutants, especially particulate matter (PM) and nitrogen dioxide (NO2), reduced significantly in all countries, especially in South Asia (India and Bangladesh), during periods of full lockdown. There were also indications of a significant reduction of sulfur dioxide (SO2) and carbon monoxide (CO). At the same time, there were indications of increasing trends in surface ozone (O3), presumably due to nonlinear chemistry associated with the reduction of oxides of nitrogens (NOX). The reduction in the concentration of air pollutants can also be seen in satellite images. The results of aerosol optical depth (AOD) values followed the PM concentrations in many cities. A significant reduction of NO2 was recorded by satellite images in almost all cities in the Asian Monsoon region. The major reductions in air pollutants were associated with reductions in mobility. Pakistan, Bangladesh, Myanmar, Vietnam, and Taiwan had comparatively positive gross domestic product growth indices in comparison to other Asian Monsoon nations during the COVID-19 pandemic. A positive outcome suggests that the economy of these nations, particularly in terms of industrial activity, persisted during the COVID-19 pandemic. Overall, the lockdowns implemented during COVID-19 suggest that air quality in the Asian Monsoon region can be improved by the reduction of emissions, especially those due to mobility as an indicator of traffic in major cities.

Paeoniflorin attenuates particulate matter-induced acute lung injury by inhibiting oxidative stress and NLRP3 inflammasome-mediated pyroptosis through activation of the Nrf2 signaling pathway

Particulate matter (PM), the main component of air pollutants, emerges as a research hotspot, especially in the area of respiratory diseases. Paeoniflorin (PAE), known as anti-inflammatory and immunomodulatory effects, has been reported to alleviate acute lung injury (ALI). However, the effect of PAE on PM-induced ALI and the underlying mechanisms are still unclear yet. In this study, we established the PM-induced ALI model using C57BL/6J mice and BEAS-2B cells to explore the function of PAE. In vivo, mice were intraperitoneally injected with PAE (100 mg/kg) or saline 1 h before instilled with 4 mg/kg PM intratracheally and were euthanized on the third day. For lung tissues, HE staining and TUNEL staining were used to evaluate the degree of lung injury, ELISA assay was used to assess inflammatory mediators and oxidative stress level, Immunofluorescence staining and western blotting were applied to explore the role of pyroptosis and Nrf2 signaling pathway. In vitro, BEAS-2B cells were pretreated with 100 μM PAE before exposure to 200 μg/ml PM and were collected after 24h for the subsequent experiments. TUNEL staining, ROS staining, and western blotting were conducted to explore the underlying mechanisms of PAE on PM-induced ALI. According to the results, PAE can attenuate the degree of PM-induced ALI in mice and reduce PM-induced cytotoxicity in BEAS-2B cells. PAE can relieve PM-induced excessive oxidative stress and NLRP3 inflammasome-mediated pyroptosis. Additionally, PAE can also activate Nrf2 signaling pathway and inhibition of Nrf2 signaling pathway can impair the protective effect of PAE by aggravating oxidative stress and pyroptosis. Our findings demonstrate that PAE can attenuate PM-induced ALI by inhibiting oxidative stress and NLRP3 inflammasome-mediated pyroptosis, which is mediated by Nrf2 signaling pathway.

Ambient particulate matter exposure induces ferroptosis in hippocampal cells through the GSK3B/Nrf2/GPX4 pathway

Epidemiological studies have established a robust correlation between exposure to ambient particulate matter (PM) and various neurological disorders, with dysregulation of intracellular redox processes and cell death being key mechanisms involved. Ferroptosis, a cell death form characterized by iron-dependent lipid peroxidation and disruption of antioxidant defenses, may be involved in the neurotoxic effects of PM exposure. However, the relationship between PM-induced neurotoxicity and ferroptosis in nerve cells remains to be elucidated. In this study, we utilized a rat model (exposed to PM at a dose of 10 mg/kg body weight per day for 4 weeks) and an HT-22 cell model (exposed to PM at concentrations of 50, 100, and 200 μg/mL for 24 h) to investigate the potential induction of ferroptosis by PM exposure. Furthermore, RNA sequencing analysis was employed to identify hub genes that potentially contribute to the process of ferroptosis, which was subsequently validated through in vivo and in vitro experiments. The results revealed that PM exposure increased MDA content and Fe2+ levels, and decreased SOD activity and GSH/GSSG ratio in rat hippocampal and HT-22 cells. Through RNA sequencing analysis, bioinformatics analysis, and RT-qPCR experiments, we identified GSK3B as a possible hub gene involved in ferroptosis. Subsequent investigations demonstrated that PM exposure increased GSK3B levels and decreased Nrf2, and GPX4 levels in vivo and in vitro. Furthermore, treatment with LY2090314, a specific inhibitor of GSK3B, was found to mitigate the PM-induced elevation of MDA and ROS and restore SOD activity and GSH/GSSG ratio. The LY2090314 treatment promoted the upregulation of Nrf2 and GPX4 and facilitated the nuclear translocation of Nrf2 in HT-22 cells. Moreover, treatment with LY2090314 resulted in the upregulation of Nrf2 and GPX4, along with the facilitation of nuclear translocation of Nrf2. This study suggested that PM-induced ferroptosis in hippocampal cells may be via the GSK3B/Nrf2/GPX4 pathway.

Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea

OBJECTIVES

Excess mortality associated with long-term exposure to fine particulate matter (PM2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM2.5 by considering the potential non-linear concentration-response relationship in Korea.

METHODS

Daily cause-specific mortality rates and PM2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM2.5 concentrations below 15 μg/m3. Overall deaths attributable to short-term PM2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM2.5 exposure.

RESULTS

Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM2.5. The estimated number of all-cause excess deaths due to short-term PM2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472).

CONCLUSIONS

Our findings indicate an association between short-term PM2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM2.5.

Particulate matter 2.5 causally increased genetic risk of autism spectrum disorder

BACKGROUND

Growing evidence suggested that particulate matter (PM) exhibit an increased risk of autism spectrum disorder (ASD). However, the causal association between PM and ASD risk remains unclear.

METHODS

We performed two-sample Mendelian randomization (MR) analyses, using instrumental variables (IVs) sourced from the largest genome-wide association studies (GWAS) databases. We employed three MR methods: inverse-variance weighted (IVW), weighted median (WM), and MR-Egger, with IVW method serving as our primary MR method. Sensitivity analyses were performed to ensure the stability of these findings.

RESULTS

The MR results suggested that PM2.5 increased the genetic risk of ASD (β = 2.41, OR = 11.13, 95% CI: 2.54-48.76, P < 0.01), and similar result was found for PM2.5 absorbance (β = 1.54, OR = 4.67, 95% CI: 1.21-18.01, P = 0.03). However, no such association was found in PM10 (β = 0.27, OR = 1.30, 95% CI: 0.72-2.36, P = 0.38). After adjusting for the false discovery rate (FDR) correction, our MR results remain consistent. Sensitivity analyses did not find significant heterogeneity or horizontal pleiotropy.

CONCLUSIONS

Our findings indicate that PM2.5 is a potential risk factor for ASD. Effective strategies to mitigate air pollutants might lead to a reduced incidence of ASD.

Fine particulate matter 2.5 induces susceptibility to Pseudomonas aeruginosa infection via expansion of PD-L1high neutrophils in mice

BACKGROUND

Exposure to PM2.5 has been implicated in a range of detrimental health effects, particularly affecting the respiratory system. However, the precise underlying mechanisms remain elusive.

METHODS

To address this objective, we collected ambient PM2.5 and administered intranasal challenges to mice, followed by single-cell RNA sequencing (scRNA-seq) to unravel the heterogeneity of neutrophils and unveil their gene expression profiles. Flow cytometry and immunofluorescence staining were subsequently conducted to validate the obtained results. Furthermore, we assessed the phagocytic potential of neutrophils upon PM2.5 exposure using gene analysis of phagocytosis signatures and bacterial uptake assays. Additionally, we utilized a mouse pneumonia model to evaluate the susceptibility of PM2.5-exposed mice to Pseudomonas aeruginosa infection.

RESULTS

Our study revealed a significant increase in neutrophil recruitment within the lungs of PM2.5-exposed mice, with subclustering of neutrophils uncovering subsets with distinct gene expression profiles. Notably, exposure to PM2.5 was associated with an expansion of PD-L1high neutrophils, which exhibited impaired phagocytic function dependent upon PD-L1 expression. Furthermore, PM2.5 exposure was found to increase the susceptibility of mice to Pseudomonas aeruginosa, due in part to increased PD-L1 expression on neutrophils. Importantly, monoclonal antibody targeting of PD-L1 significantly reduced bacterial burden, dissemination, and lung inflammation in PM2.5-exposed mice upon Pseudomonas aeruginosa infection.

CONCLUSIONS

Our study suggests that PM2.5 exposure promotes expansion of PD-L1high neutrophils with impaired phagocytic function in mouse lungs, contributing to increased vulnerability to bacterial infection, and therefore targeting PD-L1 may be a therapeutic strategy for reducing the harmful effects of PM2.5 exposure on the immune system.

Addressing adverse synergies between chemical and biological pollutants at schools-The 'SynAir-G' hypothesis

While the number and types of indoor air pollutants is rising, much is suspected but little is known about the impact of their potentially synergistic interactions, upon human health. Gases, particulate matter, organic compounds but also allergens and viruses, fall within the 'pollutant' definition. Distinct populations, such as children and allergy and asthma sufferers are highly susceptible, while a low socioeconomic background is a further susceptibility factor; however, no specific guidance is available. We spend most of our time indoors; for children, the school environment is of paramount importance and potentially amenable to intervention. The interactions between some pollutant classes have been studied. However, a lot is missing with respect to understanding interactions between specific pollutants of different classes in terms of concentrations, timing and sequence, to improve targeting and upgrade standards. SynAir-G is a European Commission-funded project aiming to reveal and quantify synergistic interactions between different pollutants affecting health, from mechanisms to real life, focusing on the school setting. It will develop a comprehensive and responsive multipollutant monitoring system, advance environmentally friendly interventions, and disseminate the generated knowledge to relevant stakeholders in accessible and actionable formats. The aim of this article it to put forward the SynAir-G hypothesis, and describe its background and objectives.

Particulate Matter in Human Elderly: Higher Susceptibility to Cognitive Decline and Age-Related Diseases

This review highlights the significant impact of air quality, specifically particulate matter (PM), on cognitive decline and age-related diseases in the elderly. Despite established links to other pathologies, such as respiratory and cardiovascular illnesses, there is a pressing need for increased attention to the association between air pollution and cognitive aging, given the rising prevalence of neurocognitive disorders. PM sources are from diverse origins, including industrial activities and combustion engines, categorized into PM10, PM2.5, and ultrafine PM (UFPM), and emphasized health risks from both outdoor and indoor exposure. Long-term PM exposure, notably PM2.5, has correlated with declines in cognitive function, with a specific vulnerability observed in women. Recently, extracellular vesicles (EVs) have been explored due to the interplay between them, PM exposure, and human aging, highlighting the crucial role of EVs, especially exosomes, in mediating the complex relationship between PM exposure and chronic diseases, particularly neurological disorders. To sum up, we have compiled the pieces of evidence that show the potential contribution of PM exposure to cognitive aging and the role of EVs in mediating PM-induced cognitive impairment, which presents a promising avenue for future research and development of therapeutic strategies. Finally, this review emphasizes the need for policy changes and increased public awareness to mitigate air pollution, especially among vulnerable populations such as the elderly.

COPD and multimorbidity: recognising and addressing a syndemic occurrence

Most patients with chronic obstructive pulmonary disease (COPD) have at least one additional, clinically relevant chronic disease. Those with the most severe airflow obstruction will die from respiratory failure, but most patients with COPD die from non-respiratory disorders, particularly cardiovascular diseases and cancer. As many chronic diseases have shared risk factors (eg, ageing, smoking, pollution, inactivity, and poverty), we argue that a shift from the current paradigm in which COPD is considered as a single disease with comorbidities, to one in which COPD is considered as part of a multimorbid state-with co-occurring diseases potentially sharing pathobiological mechanisms-is needed to advance disease prevention, diagnosis, and management. The term syndemics is used to describe the co-occurrence of diseases with shared mechanisms and risk factors, a novel concept that we propose helps to explain the clustering of certain morbidities in patients diagnosed with COPD. A syndemics approach to understanding COPD could have important clinical implications, in which the complex disease presentations in these patients are addressed through proactive diagnosis, assessment of severity, and integrated management of the COPD multimorbid state, with a patient-centred rather than a single-disease approach.

Modulation of the Cardiovascular Effects of Polycyclic Aromatic Hydrocarbons: Physical Exercise as a Protective Strategy

Exposure to polycyclic aromatic hydrocarbons (PAHs) present in air pollution increases cardiovascular risk. On the contrary, physical exercise is a widely used therapeutic approach to mitigate cardiovascular risk, but its efficacy in an environment of air pollution, particularly with PAHs, remains unclear. This study investigates the effects of exercise on inflammation, endothelial dysfunction, and REDOX imbalance due to PAH exposure using a mouse model. Twenty male BALB/c mice were subjected to a mixture of PAHs (phenanthrene, fluoranthene, pyrene) in conjunction with aerobic exercise. The investigation evaluated serum levels of inflammatory cytokines, gene expression linked to inflammatory markers, endothelial dysfunction, and REDOX imbalance in aortic tissues. Furthermore, the study evaluated the expression of the ICAM-1 and VCAM-1 proteins. Exercise led to notable changes in serum inflammatory cytokines, as well as the modulation of genes associated with endothelial dysfunction and REDOX imbalance in aortic tissue. In turn, exercise produced a modulation in the protein expression of ICAM-1 and VCAM-1. The findings implicate the potential of exercise to counter PAH-induced damage, as demonstrated by changes in markers. In conclusion, exercise could mitigate the adverse effects related to exposure to PAHs present in air pollution, as evidenced by changes in inflammatory markers, endothelial dysfunction, and REDOX imbalance.

Global Chronic obstructive pulmonary disease burden attributable to air pollution from 1990 to 2019

BACKGROUND

The disease burden attributable to chronic obstructive pulmonary disease (COPD) is significant worldwide. Some studies have linked exposure to air pollution to COPD, but there has been little research on this.

METHODS

We aimed to assess the COPD-related disease burden attributable to air pollution from multiple epidemiological perspectives. This study conducted a three-stage analysis. Firstly, we reported on the burden of disease worldwide in 2019 by different subgroups including sex, age, region, and country. Secondly, we studied the trends in disease burden from 1990 to 2019. Finally, we explored the association of some national indicators with disease burden to look for risk factors.

RESULTS

In 2019, the death number of COPD associated with air pollution accounted for 2.32% of the total global death, and the number of DALY accounted for 1.12% of the global DALY. From 1990 to 2019, the death number of COPD associated with air pollution increased peaked at 1.41 million in 1993, fluctuated, and then declined. We found the same temporal pattern of DALY. The corresponding age-standardized rates had been falling. At the same time, the burden of COPD associated with air pollution was also affected by some national indicators.

CONCLUSIONS

This study indicated that air pollution-related COPD contributed to a significant global disease burden. We called for health policymakers to take action and interventions targeting vulnerable countries and susceptible populations.

Reduction of household air pollution through clean fuel intervention and recovery of cellular immune balance

BACKGROUND

We conducted a clean fuel intervention trial (Bangladesh Global Environmental and Occupational Health (GEOHealth) (NCT02824237) with liquefied petroleum gas (LPG) for 26 months among rural Bangladeshi women chronically exposed to household air pollution (HAP) from biomass fuel (BMF) use. We aimed to evaluate the effect of HAP reduction following LPG intervention on immune response outcome.

METHODS

We supplied LPG cook stove and refills in cylinder in 200 households for 26 months. We measured personal exposure to HAP [particulate matter 2.5 (PM2·5), black carbon (BC) and carbon monoxide (CO)] in 200 women (main cook) by personal monitors at pre- and post-intervention. Immune function was assessed before and after intervention, in blood collected within 2 weeks of HAP measurements. Primary endpoints included reduction in HAP, lymphocyte proliferation and oxidative stress response, and alterations in T and B cell proportions.

FINDINGS

Exclusive LPG use for 26 months resulted in significant reduction in PM2·5 (43.5%), BC (13%) and CO (48%) exposure in the women. For one unit decrease in BC, Treg cells and memory B cells increased by 7% and 34% respectively, in the peripheral circulation. One unit decrease in CO was significantly associated with increase in early B cells and plasmablasts by 66% and 5% respectively. For one unit decrease in BC, percent-dividing cells, proliferation and expansion indices increased by 2%, 0.4%, and 1%, respectively.

INTERPRETATION

Reduced personal exposure to HAP through clean fuel intervention was related to a return towards cellular immune balance.

[Sustainability and climate protection : Implications on patient-centered care in radiology]

BACKGROUND

Sustainability and patient-centered radiology (PCR) include a multivariant, complex network of synergic and opportunistic elements. PCR is a subfactor of the social element, climate protection is part of the ecological element, and sustainable economics are part of the financial element.

OBJECTIVES

We aimed to identify PCR-symbiotic and PCR-opposed elements of sustainability using literature research. This article will provide an overview of the core sustainability elements and innovative concepts for supporting PCR.

MATERIALS AND METHODS

A digital literature search was carried out to identify scientific publications about sustainability and PCR via Medline. Results are provided as a narrative summary.

RESULTS

In particular, the social component and parts of the ecological element of sustainability support PCR. Climate protection and a natural environment show a positive correlation with health and patient satisfaction. Patient contact improves the quality of the diagnostic report and promotes satisfaction of patients and radiologists. However, increasing economization is often conditionally compatible with the social core element of sustainability and especially with PCR. Digital tools can ease communication and improve reports in times of increasing workload.

CONCLUSION

Socially and environmentally sustainable radiology supports the well-being of both employees and patients. Innovative concepts are necessary to balance the ecological elements of sustainability with employees' and patients' interests.

Ambient Anthropogenic Carbons and Pediatric Respiratory Infections: A Case-Crossover Analysis in the Megacity Beijing

Carbon loading in airway cells has shown to worsen function of antimicrobial peptides, permitting increased survival of pathogens in the respiratory tract; however, data on the impacts of carbon particles on childhood acute respiratory infection (ARI) is limited. We assembled daily health data on outpatient visits for ARI (bronchitis, pneumonia, and total upper respiratory infection [TURI]) in children aged 0-14 years between 2015 and 2019 in Beijing, China. Anthropogenic carbons, including black carbon (BC) and its emission sources, and wood smoke particles (delta carbon, ultra-violet absorbing particulate matter, and brown carbon) were continuously monitored. Using a time-stratified case-crossover approach, conditional logistic regression was performed to derive risk estimates for each outcome. A total of 856,899 children were included, and a wide range of daily carbon particle concentrations was observed, with large variations for BC (0.36-20.44) and delta carbon (0.48-57.66 μg/m3). Exposure to these particles were independently associated with ARI, with nearly linear exposure-response relationships. Interquartile range increases in concentrations of BC and delta carbon over prior 0-8 days, we observed elevation of the odd ratio of bronchitis by 1.201 (95% confidence interval, 1.180, 1.221) and 1.048 (95% CI, 1.039, 1.057), respectively. Stronger association was observed for BC from traffic sources, which increased the odd ratio of bronchitis by 1.298 (95% CI, 1.273, 1.324). Carbon particles were also associated with elevated risks of pneumonia and TURI, and subgroup analyses indicated greater risks among children older than 6 years. Our findings suggested that anthropogenic carbons in metropolitan areas may pose a significant threat to clinical manifestations of respiratory infections in vulnerable populations.

Lifestyle practices that reduce seasonal PM2.5 exposure and their impact on COPD

Particulate matter (PM) is a major air pollutant that has led to global health concerns and can cause and exacerbate chronic obstructive pulmonary disease (COPD). We asked patients with COPD to complete a detailed questionnaire about their lifestyle practices to reduce PM_2.5 exposure and analyzed the relationship between ambient PM_2.5 concentrations and lifestyle practices. We prospectively enrolled 104 COPD patients from four hospitals in different areas of Korea. They completed detailed questionnaires twice (at enrollment and the end of the study) and Internet of Things-based sensors were installed in their homes to continuously measure PM_2.5 for 1 year. The relationship between PM_2.5 concentrations, lifestyle practices, and COPD exacerbations were analyzed in each season. The PM_2.5 concentration was higher outdoors than indoors in all seasons except summer, and the difference was largest in winter. The six lifestyle practices that significantly lowered the annual indoor PM_2.5 concentration compared with the outdoors. The higher the economic status and educational level of patients, the lower the indoor PM_2.5 concentration. Some lifestyle practices were associated with reduced small airway resistance, presented as R5-R20 determined by impulse oscillometry, and scores of the St. George's Respiratory Questionnaire. Some lifestyle practices are associated with reduced indoor PM_2.5 concentrations and can even affect clinical outcomes, including small airway resistance and quality of life of COPD patients.

Cleaner outdoor air diminishes the overall risk of intracerebral hemorrhage but brings differential benefits to subpopulations: a time-stratified case-crossover study

BACKGROUND

Short-term air pollution exposure and intracerebral hemorrhage (ICH) risk are related. However, the impact of the pollutant levels decline on this relationship, which attributes to clean air policy implementation and the COVID-19 pandemic lockdown, is unclear. In the present research, we explored the influence of different pollutant levels on ICH risk during eight years in a southwestern China megacity.

METHODS

Our research used a time-stratified case-crossover design. We retrospectively analyzed ICH patients in a teaching hospital from January 1, 2014, to December 31, 2021, and divided 1571 eligible cases into two groups (1st group: 2014-2017; 2nd group: 2018-2021). We observed the trend of every pollutant in the entire study period and compared the pollution levels in each group, using air pollutants data (PM2.5, PM10, SO2, NO2, CO, and O3) documented by the local government. We further established a single pollutant model via conditional logistic regression to analyze the association between short-term air pollutants exposure and ICH risk. We also discussed the association of pollution levels and ICH risk in subpopulations according to individual factors and monthly mean temperature.

RESULTS

We found that five air pollutants (PM2.5, PM10, SO2, NO2, CO) exhibited a continuous downward trend for the whole duration, and the daily concentration of all six pollutants decreased significantly in 2018-2021 compared with 2014-2017. Overall, the elevation of daily PM2.5, SO2, and CO was associated with increased ICH risk in the first group and was not positively associated with risk escalation in the second group. For patients in subgroups, the changes in the influence of lower pollutant levels on ICH risk were diverse. In the second group, for instance, PM2.5 and PM10 were associated with lower ICH risk in non-hypertension, smoking, and alcohol-drinking participants; however, SO2 had associations with increased ICH risk for smokers, and O3 had associations with raised risk in men, non-drinking, warm month population.

CONCLUSIONS

Our study suggests that decreased pollution levels diminish the adverse effects of short-term air pollutants exposure and ICH risk in general. Nevertheless, the influence of lower air pollutants on ICH risk in subgroups is heterogeneous, indicating unequal benefits among subpopulations.

Critical review on emerging health effects associated with the indoor air quality and its sustainable management

Indoor air quality (IAQ) is one of the fundamental elements affecting people's health and well-being. Currently, there is a lack of awareness among people about the quantification, identification, and possible health effects of IAQ. Airborne pollutants such as volatile organic compounds (VOCs), particulate matter (PM), sulfur dioxide (SO2), carbon monoxide (CO), nitrous oxide (NO), polycyclic aromatic hydrocarbons (PAHs) microbial spores, pollen, allergens, etc. primarily contribute to IAQ deterioration. This review discusses the sources of major indoor air pollutants, molecular toxicity mechanisms, and their effects on cardiovascular, ocular, neurological, women, and foetal health. Additionally, contemporary strategies and sustainable methods for regulating and reducing pollutant concentrations are emphasized, and current initiatives to address and enhance IAQ are explored, along with their unique advantages and potentials. Due to their longer exposure times and particular physical characteristics, women and children are more at risk for poor indoor air quality. By triggering many toxicity mechanisms, including oxidative stress, DNA methylation, epigenetic modifications, and gene activation, indoor air pollution can cause a range of health issues. Low birth weight, acute lower respiratory tract infections, Sick building syndromes (SBS), and early death are more prevalent in exposed residents. On the other hand, the main causes of incapacity and early mortality are lung cancer, chronic obstructive pulmonary disease, and cardiovascular disorders. It's crucial to acknowledge anticipated research needs and implemented efficient interventions and policies to lower health hazards.

Associations between Air Pollution Exposure and Blood Pressure during Pregnancy among PRINCESA Cohort Participants

High blood pressure (BP) is a risk factor for hypertensive disease during pregnancy. Exposure to multiple toxic air pollutants can affect BP in pregnancy but has been rarely studied. We evaluated trimester-specific associations between air pollution exposure and systolic (SBP) and diastolic BP (DBP). Ozone (O3), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), and particulate matter less than 10 and 2.5 μm in aerodynamic diameter (PM10, PM2.5) in the Pregnancy Research on Inflammation, Nutrition, & City Environment: Systematic Analyses (PRINCESA) study. Multipollutant generalized linear regression models with each pollutant and O3 were fit. Due to nonlinear pollution/BP associations, results are presented for "below the median" or "above the median", where the beta estimate is the change in BP at a pollutant's median versus BP at the pollutant's minimum or maximum, respectively. Associations varied across trimesters and pollutants, and deleterious associations (higher blood pressure with higher pollution) were found only at pollutant values below the median: for SBP with NO2 in the second and third trimesters, and PM2.5 during the third trimester, and for DBP, PM2.5, and NO2 in the second and third trimesters. Findings suggest that minimizing prenatal exposure to air pollution may reduce the risks of changes in BP.

Air pollution and COPD: GOLD 2023 committee report

Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.

Ozone and childhood respiratory health: A primer for US pediatric providers and a call for a more protective standard

Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters. Further, the current US air quality standard for ozone does not adequately protect children. In this nonsystematic review, we present basic background information for healthcare providers caring for children's respiratory health, review the US process for setting air quality standards, discuss the respiratory harms of ozone for healthy children and those with underlying respiratory disease, highlight the urgent need for a more protective ozone standard to adequately protect children's respiratory health, review impacts of climate change on ozone levels, and provide information for discussion in clinical encounters.

Effect of particulate matter (PM2.5 and PM10) on health indicators: climate change scenarios in a Brazilian metropolis

Recife is recognized as the 16th most vulnerable city to climate change in the world. In addition, the city has levels of air pollutants above the new limits proposed by the World Health Organization (WHO) in 2021. In this sense, the present study had two main objectives: (1) To evaluate the health (and economic) benefits related to the reduction in mean annual concentrations of PM₁₀ and PM_2.5 considering the new limits recommended by the WHO: 15 µg/m³ (PM₁₀) and 5 µg/m³ (PM_2.5) and (2) To simulate the behavior of these pollutants in scenarios with increased temperature (2 and 4 °C) using machine learning. The averages of PM_2.5 and PM₁₀ were above the limits recommended by the WHO. The scenario simulating the reduction in these pollutants below the new WHO limits would avoid more than 130 deaths and 84 hospital admissions for respiratory or cardiovascular problems. This represents a gain of 15.2 months in life expectancy and a cost of almost 160 million dollars. Regarding the simulated temperature increase, the most conservative (+ 2 °C) and most drastic (+ 4 °C) scenarios predict an increase of approximately 6.5 and 15%, respectively, in the concentrations of PM_2.5 and PM₁₀, with a progressive increase in deaths attributed to air pollution. The study shows that the increase in temperature will have impacts on air particulate matter and health outcomes. Climate change mitigation and pollution control policies must be implemented for meeting new WHO air quality standards which may have health benefits.

Association between long-term exposure to air pollution and the risk of incident laryngeal cancer: a longitudinal UK Biobank-based study

We assessed the association between long-term joint exposure to ambient air pollutants and the risk of laryngeal cancer and whether this risk was modified by genetic susceptibility. We used a multivariable Cox proportional hazards regression model to analyze data from UK Biobank to determine the relationship between long-term exposure to air pollutants-nitric oxide (NO), nitrogen dioxide (NO₂), and 2.5-µm and 10-µm particulate matter (PM_2.5 and PM₁₀) and the risk of laryngeal cancer. In multivariable-adjusted models, in model 3 and compared with the participants with lower quintile scores for air pollution, the participants with the highest quintile scores for air pollution had a higher laryngeal cancer risk. The observed association was more pronounced among the participants who were female, were smokers, had a systolic blood pressure equal to or greater than 120 mmHg, and had diabetes. Compared with the participants with a low GRS and the lowest quintile score for air pollution exposure, those with an intermediate GRS and the highest quintile score for air pollution exposure had a higher risk of laryngeal cancer. Long-term exposure to NO₂, NO, or PM_2.5, individually or jointly, was associated with a risk of incident laryngeal cancer, especially in the participants with an intermediate GRS.

Prevalence of childhood cough in epidemiological studies depends on the question used: findings from two population-based studies

BACKGROUND

Epidemiological studies use different questions to assess recurrent cough in children. In two independent population-based studies, we assessed how prevalence estimates of cough vary depending on the questions parents are asked about their child's cough and how answers to the different questions overlap.

METHODS

We analysed cross-sectional data from two population-based studies on respiratory health: LuftiBus in the School (LUIS), conducted in 2013-2016 among 6- to 17-year-school children in the Canton of Zurich, Switzerland, and the 1998 Leicester Respiratory Cohort (LRC) study, UK where we used data from 6- to 8-year-old children from the 2003 follow-up survey. Both studies used parental questionnaires that included the same three questions on the child's cough, namely cough without a cold, dry cough at night and coughing more than others. We assessed how the prevalence of cough varied depending on the question and how answers to the different questions on cough overlapped. We also assessed how results were influenced by age, sex, presence of wheeze and parental education.

RESULTS

We included 3457 children aged 6-17 years from LUIS and 2100 children aged 6-8 years from LRC. All respiratory outcomes - cough, wheeze and physician-diagnosed asthma - were reported twice as often in the LRC as in LUIS. We found large differences in the prevalence of parent-reported cough between the three cough questions. In LUIS, 880 (25%) parents reported cough without a cold, 394 (11%) dry night cough, and 159 (5%) reported that their child coughed more than other children. In the LRC, these numbers were 1003 (48%), 527 (25%) and 227 (11%). There was only partial overlap of answers, with 89 (3%) answering yes to all questions in LUIS and 168 (8%) in LRC. Prevalence of all types of cough and overlap between the cough questions was higher in children with current wheeze.

CONCLUSION

In both population-based studies prevalence estimates of cough depended strongly on the question used to assess cough with only partial overlap of responses to different questions. Epidemiological studies on cough can only be compared if they used exactly the same questions for cough.

Gentrification and Air Quality in a Large Urban County in the United States

Introduction: Increases in industrialization and manufacturing have led to worsening pollution in some components of air quality. In addition, gentrification is occurring in large cities throughout the world. As these socioeconomic and demographic changes occur, there have been no studies examining the association of gentrification with air quality. To investigate this association, we studied the trends of gentrification, changes in racial distribution and changes in air quality in each zip code of a large urban county over a 40-year period. Methods: We conducted a retrospective longitudinal study over 40 years in Wayne County, Michigan using socioeconomic and demographic data from the National Historical Geographic Information System (NHGIS) and air quality data from the United States Environmental Protection Agency (EPA). To assess gentrification, longitudinal analyses were performed to examine median household income, percentage with a college education, median housing value, median gross rent and employment level. The racial distribution was evaluated in each zip code during the time period. Gentrification was studied in relation to air quality using nonparametric 2-sample Wilcon-Mann-Whitney tests and Binomial Generalized Linear Regression models. Results: Although air quality improved overall over the 40-year period, there was a lesser rate of improvement in gentrified areas. Furthermore, gentrification was strongly associated with racial distribution. The most substantial gentrification occurred from 2010 to 2020, in which a specific cluster of adjacent zip codes in downtown Detroit experienced intense gentrification and a drop in the percentage of African-American residents. Conclusions: Gentrified areas seem to have a less pronounced improvement in air quality over time. This reduction in air quality improvement is likely associated with demolitions and the construction of new buildings, such as sporting arenas and accompanying traffic density. Gentrification is also strongly associated with an increase in non-minority residents in an area. Although previous definitions of gentrification in the literature have not included racial distribution, we suggest that future definitions should include this metric given the strong association. Minority residents who are displaced as a result of gentrification do not experience the improvements in housing quality, accessibility to healthy foods and other associations of gentrification.

Risk-Reducing Measures for Cancer Prevention

Cancer, or malignancy, continues to be one of the most serious health problems in the world, leading to death and disability. Unlike in previous years, where new cases of cancer were predominant in developed nations, the number of cases of cancer and the resultant deaths are increasing in low- and middle-income countries. This is partially attributable to the current trend of adopting a Western lifestyle, substantial urbanization, and the rise in infections, such as the human papillomavirus (HPV) and hepatitis B virus (HBV), which together account for over 30% of cancer cases in underdeveloped and developing nations. The deleterious impact of cancer, as cases multiply worldwide, is multi-dimensional. Cancer exerts serious physical, psychological, and monetary burdens, not only on cancer patients but also on their family members, close friends, health care systems, and society at large. Importantly, over half of all cancer types can be prevented globally by mitigating the risk and causative factors as well as prompt adherence to scientifically recommended prevention measures. This review provides various scientifically based and people-centered strategies that every individual could adopt to reduce their risk of developing cancer in the future. It is recommended that, for these cancer prevention strategies to be effective, there should be a strong political will from the governments of individual countries to enact specific laws and implement policies that will significantly reduce sedentary lifestyles and unhealthy eating among the general public. Likewise, HPV and HBV vaccines, as well as cancer screenings, should be made available, affordable, and accessible on a timely basis for those who are eligible to take them. Finally, intensified campaigns and numerous informative and educational programs that promote cancer prevention should be initiated globally.

Spatial Aspects of Health-Developing a Conceptual Framework

Numerous studies and models address the determinants of health. However, in existing models, the spatial aspects of the determinants are not or only marginally taken into account and a theoretical discussion of the association between space and the determinants of health is missing. The aim of this paper is to generate a framework that can be used to place the determinants of health in a spatial context. A screening of the current first serves to identify the relevant determinants and describes the current state of knowledge. In addition, spatial scales that are important for the spatial consideration of health were developed and discussed. Based on these two steps, the conceptual framework on the spatial determinants of health was derived and subsequently discussed. The results show a variety of determinants that are associated with health from a spatial point of view. The overarching categories are global driving forces, policy and governance, living and physical environment, socio-demographic and economic conditions, healthcare services and cultural and working conditions. Three spatial scales (macro, meso and micro) are further subdivided into six levels, such as global (e.g., continents), regional (e.g., council areas) or neighbourhood (e.g., communities). The combination of the determinants and spatial scales are presented within a conceptual framework as a result of this work. Operating mechanisms and pathways between the spatial levels were added schematically. This is the first conceptual framework that links the determinants of health with the spatial perspective. It can form the working basis for future analyses in which spatial aspects of health are taken into account.

Changing trends in the air pollution-related disease burden from 1990 to 2019 and its predicted level in 25 years

In the twenty-first century, exposure to air pollution has become a threat to human health worldwide due to industrial development. Timely, comprehensive, and reliable assessment and prediction of disease burden can help mitigate the health hazards of air pollution. This study conducted a two-stage analysis. First, we reported the air pollution-related disease burden globally and for different subgroups like socio-demographic index (SDI), sex, and age. We analyzed the trend of the disease burden from 1990 to 2019. In addition, we explored whether and how some national indicators modified the disease burden. Second, we predicted the number and the age-standardized rates of death and disability-adjusted life years (DALYs) attributable to air pollution from 2020 to 2044 by the autoregressive integrated moving average (ARIMA) model and exponential smoothing model. The age-period-cohort (APC) model in the maximum likelihood framework and the Bayesian APC model integrated nested Laplace approximations (INLAs) were further applied to perform sensitivity analysis. In 2019, air pollution accounted for 11.62% of death and 0.84% of DALY worldwide. The corresponding age-standardized rate was 85.62 (95% uncertainty interval (UI): 75.71, 96.07) and 2791.08 (95% UI: 2468.81, 3141.39) per 100,000 population. From 1990 to 2019, the number of death attributable to air pollution remained stable, and the number of DALY exhibited a downward trend. The corresponding age-standardized rates both declined. In some countries with larger population densities, higher proportions of elders, and lower proportions of females, the disease burden attributable to air pollution was lower. The predicted results showed that the number of air pollution-related death and DALY would increase. This study comprehensively assessed and predicted the air pollution-related disease burden worldwide. The results indicated that the disease burden would remain very serious in the future. Hence, some relevant policies should be developed to prevent and manage air pollution.

High Levels of PM10 Reduce the Physical Activity of Professional Soccer Players

The aim of this study is to determine the impact of air quality, analyzed on the basis of the PM10 parameter in three regions of Poland, on the physical activity of soccer players from the Polish Ekstraklasa. The study material consisted of 4294 individual match observations of 362 players during the 2019/2020 domestic season. The measured indices included the parameter of air quality-PM10-and players' physical activities: total distance (TD) and high-speed running (HSR). Poland was divided into three regions (North, Central, South). The statistical analysis of particulate matter (PM) and athletes' physical activities, compared by region, revealed the effects in relation to the PM10 (H = 215.6566(2); p = 0.0001) and TD (H = 28.2682(2); p = 0.0001). Players performed better in regards to physical parameters in the North Region, where air pollution is significantly lower than in other regions. This means that even a short stay in more polluted regions can reduce the performance of professional footballers, which can indirectly affect the outcome of the match. Therefore, greater actions should be taken to improve air quality, especially through changes in daily physical activity, as this will reduce the carbon footprint.

The Effect of Sustained Poor Air Quality on EMS Call Volume and Characteristics: A Time-Stratified Case-Crossover Study

OBJECTIVES

As wildfires and air pollution become more common across the United States, it is increasingly important to understand the burden they place on public health. Previous studies have noted relationships between air quality and use of Emergency Medical Services (EMS), but until now, these studies have focused on day-to-day air quality. The goal of this study is to investigate the effect of sustained periods of poor air quality on EMS call characteristics and volume.

METHODS

Using a time-stratified case-crossover design, the effect of exposure to periods of poor air quality on number and type of EMS calls in California, USA from 2014-2019 was observed. Poor air quality periods greater than three days were identified at the United States Environmental Protection Agency's (EPA's) Air Quality Index (AQI) levels of Unhealthy for Sensitive Groups (AQI 100) and Unhealthy (AQI 150). Periods less than three days apart were combined. Each poor air quality period was matched with two one-week controls, the first being the closest preceding week that did not intersect a different case. The second control was the closest week at least three days after the case and not intersecting with a different case. Due to seasonal variation in EMS usage, from the initial cases, cases were used only if it was possible to identify controls within 28 days of the case. A conditional Poisson regression calculated risk ratios for EMS call volume.

RESULTS

Comparing the case periods to the controls, significant increases were found at AQI >100 for total number of calls, and the primary impressions categories of emotional state or behavior, level of consciousness, no patient complaint, other, respiratory, and abdominal. At an AQI >150, significance was found for the primary impressions categories of other, pain, respiratory, and digestive.

CONCLUSION

These data demonstrate increased EMS calls during sustained poor air quality, and that several EMS primary impression categories are disproportionately affected. This study is limited by the imprecision of the primary impression's classification provided by the EMS clinician responding to the EMS call. More research is needed to understand the effects of periods of poor air quality on the EMS system for more efficient deployment of resources.

Ambient Air Quality and Emergency Hospital Admissions in Singapore: A Time-Series Analysis

Air pollution exposure may increase the demand for emergency healthcare services, particularly in South-East Asia, where the burden of air-pollution-related health impacts is high. This article aims to investigate the association between air quality and emergency hospital admissions in Singapore. Quasi-Poisson regression was applied with a distributed lag non-linear model (DLNM) to assess the short-term associations between air quality variations and all-cause, emergency admissions from a major hospital in Singapore, between 2009 and 2017. Higher concentrations of SO₂, PM_2.5, PM₁₀, NO₂, and CO were positively associated with an increased risk of (i) all-cause, (ii) cardiovascular-related, and (iii) respiratory-related emergency admissions over 7 days. O₃ concentration increases were associated with a non-linear decrease in emergency admissions. Females experienced a higher risk of emergency admissions associated with PM_2.5, PM₁₀, and CO exposure, and a lower risk of admissions with NO₂ exposure, compared to males. The older adults (≥65 years) experienced a higher risk of emergency admissions associated with SO₂ and O₃ exposure compared to the non-elderly group. We found significant positive associations between respiratory disease- and cardiovascular disease-related emergency hospital admissions and ambient SO₂, PM_2.5, PM₁₀, NO₂, and CO concentrations. Age and gender were identified as effect modifiers of all-cause admissions.

Air Pollution from Global Health to Individual Risk Factor—Is It Time for Enviropathies in Everyday Clinical Practice?

While the link between cardiovascular and respiratory conditions and air pollution is well-known, recent studies provided a growing body of evidence that polluted air, particularly air with high levels of particulate matter with a diameter smaller than 2.5 micrometers (PM 2.5), can have a range of negative impacts on health, both in terms of mortality and morbidity. It is time to emphasize the role of environmental factors as contributory factors or determinants of both global and individual health levels, and to consider them together as a health priority, as enviropathies (meant as pathologies caused, triggered or worsened by environmental exposure). Bringing attention to harmful air pollution exposure has fostered population studies, which developed accurate quantification of environmental exposure in polluted regions, aiding our understanding of the dose-response relationship between pollutants and diseases. Those efforts have influenced local and global health policy strategies. Now we face the challenge of controlling environmental pollution and limiting individual exposure to prevent or avoid serious health risks. Is it time for enviropathies in everyday clinical practice?

Ozone-Induced Models of Airway Hyperreactivity and Epithelial Injury

Ozone (O₃), a criterion air pollutant produced as a product of internal combustion, generates increased inflammation, lung permeability, and airway hyperreactivity when exposed to rodents in laboratory settings. Airway hyperreactivity is defined as an exaggerated acute obstructive response of the airways to one or more nonspecific stimuli. Lung permeability is a measure of barrier functions that separate internal and external environments to limit access of pathogens and other noxious material. By modeling in vivo O₃ exposure in rodents, this allows investigators to explore pulmonary and nonpulmonary O₃ effects as a means of understanding its impact on human health and lung function. Furthermore, direct effects of O₃ on epithelial permeability can be defined using in vitro exposures to airway epithelial cells. This chapter will focus on methods of generating O₃ and then exposing rodents and cultured epithelial cells in laboratory settings.

Countrywide cardiovascular disease prevention and control in 49 countries with different socio‐economic status

Background

Cardiovascular disease (CVD) is the major noncommunicable disease (NCD) accounting for 17.9 million deaths. If current trends continue, the annual number of deaths from CVD will rise to 22.2 million by 2030. The United Nations General Assembly adopted a sustainable development goal (SDG) by 2030 to reduce NCD mortality by one‐third. The purpose of this study was to analyze the CVD mortality trends in different countries implementing World Health Organization (WHO) NCD Action Plan and emphasize effective ways to achieve SDG.

Methods

WHO statistics, based on the Member‐States unified mortality and causes‐of‐death reports were used for analyzing trends and different interventions.

Results

Reduction of CVD mortality from 2000 to 2016 in 49 countries was achieved for stroke at 43% and ischemic heart disease at 30%. Smoking prevalence and raised blood pressure (RBP) decreased in 84% and 55% of the countries. Eighty‐nine percent of high‐income countries (HIC) demonstrated a decline in tobacco smoking against 67% in middle‐income countries (MIC). Sixty‐nine percent of HIC demonstrated a decline in RBP against 15% in MIC. CVD management, tobacco, and unhealthy diet reduction measures are significantly better in HIC. The air pollution level was higher in MIC.

Conclusion

Building partnerships between countries could enhance their efforts for CVD prevention and successful achievement of SDG.

Cardiovascular disease (CVD) is the major noncommunicable disease (NCD). Reduction of CVD mortality from 2000 to 2016 in 49 countries was achieved for stroke at 43% and ischemic heart disease at 30%. This decline is associated with decreasing prevalence of smoking and raised blood pressure. CVD management, tobacco, and unhealthy diet reduction measures are significantly better in high‐income countries. The air pollution level was higher in middle‐income countries. Building partnerships among countries with different economic development could enhance their efforts for CVD prevention and control to achieve the UN sustainable development goals by 2030 and reduce NCD mortality by one‐third.

Global climate change and human health: Pathways and possible solutions

Global warming has been changing the planet's climate pattern, leading to increasing frequency, intensity and duration of extreme weather events and natural disasters. These climate-changing events affect various health outcomes adversely through complicated pathways. This paper reviews the main signs of climate change so far, e.g., suboptimal ambient temperature, sea-level rise and other conditions, and depicts the interactive pathways between different climate-changing events such as suboptimal temperature, wildfires, and floods with a broad range of health outcomes. Meanwhile, the modifying effect of socioeconomic, demographic and environmental factors on the pathways is summarised, such that the youth, elderly, females, poor and those living in coastal regions are particularly susceptible to climate change. Although Earth as a whole is expected to suffer from climate change, this review article discusses some potential benefits for certain regions, e.g., a more liveable environment and sufficient food supply. Finally, we summarise certain mitigation and adaptation strategies against climate change and how these strategies may benefit human health in other ways. This review article provides a comprehensive and concise introduction of the pathways between climate change and human health and possible solutions, which may map directions for future research.

Risk of Cerebro-Cardiovascular Diseases among Police Officers and Firefighters: A Nationwide Retrospective Cohort Study

PURPOSE

Police officers and firefighters are exposed to risk factors for cerebro-cardiovascular diseases, and the actual risk is expected to increase compared with other occupational groups. The present study aimed to estimate the risks of cerebro-cardiovascular diseases in police officers and firefighters compared to other occupational groups.

MATERIALS AND METHODS

Using the National Health Insurance Service data, we constructed a retrospective cohort of public officers. Three-year consecutive health insurance registration data were used to identify police officers and firefighters. Cerebro-cardiovascular diseases consisted of acute myocardial infarction, other ischemic heart disease, cardiac arrhythmia, and stroke. We compared the incidences of cerebro-cardiovascular diseases between each of the two occupational groups (police officers and firefighters) and other public officers by calculating standardized incidence ratios (SIRs).

RESULTS

SIRs and 95% confidence intervals of all cerebro-cardiovascular diseases for police officers and firefighters were 1.71 (1.66-1.76) and 1.22 (1.12-1.31), respectively, as compared with all public officers. The incidence ratios remained significantly higher compared to general and education officers. Subgroup analyses for myocardial infarction, stroke, and cardiac arrhythmia exhibited significant increases in incidence ratios among police officers and firefighters.

CONCLUSION

This study suggests that both police officers and firefighters are at high risk of cerebro-cardiovascular diseases. Therefore, medical protection measures for these occupational groups should be improved.

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

OBJECTIVE

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

RESULTS

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

CONCLUSIONS

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

Occurrence and in vitro toxicity of organic compounds in urban background PM2.5

This study describes the chemical composition and in vitro toxicity of the organic fraction of fine particulate matter (PM_2.5) at an urban background site, which receives emissions either from Frankfurt international airport or the city centre, respectively. We analysed the chemical composition of filter extracts (PM_2.5) using ultrahigh-performance liquid chromatography coupled to a high-resolution mass spectrometer, followed by a non-target analysis. In parallel, we applied the bulk of the filter extracts to a Microtox and acetylcholinesterase-inhibition assay for in vitro toxicity testing. We find that both the chemical composition and toxicity depend on the prevailing wind directions, and the airport operating condition, respectively. The occurrence of the airport marker compounds tricresyl phosphate and pentaerythritol esters depends on the time of the day, reflecting the night flight ban as well as an airport strike event during November 2019. We compared the organic aerosol composition and toxicity from the airport wind-sector against the city centre wind-sector. We find that urban background aerosol shows a higher baseline toxicity and acetylcholinesterase inhibition compared to rural PM_2.5 that is advected over the airport. Our results indicate that the concentration and individual composition of PM_2.5 influence the toxicity. Suspected drivers of the acetylcholinesterase inhibition are i.e. organophosphorus esters like triphenyl phosphate and cresyldiphenyl phosphate, and the non-ionic surfactant 4-tert-octylphenol ethoxylate. However, further research is necessary to unambiguously identify harmful organic air pollutants and their sources and quantify concentration levels at which adverse effects in humans and the environment can occur.

The impact of social disadvantage on autonomic physiology of latinx adolescents: The role of environmental risks

The experience of poverty embodies complex, multidimensional stressors that may adversely affect physiological and psychological domains of functioning. Compounded by racial/ethnic discrimination, the financial aspect of family poverty typically coincides with additional social and physical environmental risks such as pollution exposure, housing burden, elevated neighborhood unemployment, and lower neighborhood education levels. In this study, we investigated the associations of multidimensional social disadvantage throughout adolescence with autonomic nervous system (ANS) functioning at 17 years. Two hundred and twenty nine low-income Mexican-American adolescents (48.6% female) and their parents were assessed annually between the ages of 10 and 16. Participants' census tracts were matched with corresponding annual administrative data of neighborhood housing burden, education, unemployment, drinking water quality, and fine particulate matter. We combined measures of adolescents' electrodermal response and respiratory sinuses arrhythmia at rest and during a social exclusion challenge (Cyberball) to use as ANS indices of sympathetic and parasympathetic activity, respectively. Controlling for family income-to-needs, youth exposed to greater cumulative water and air pollution from ages 10-16 displayed altered patterns of autonomic functioning at rest and during the social challenge. Conversely, youth living in areas with higher housing burden displayed healthy patterns of autonomic functioning. Altogether, results suggest that toxin exposure in youths' physical environments disrupts the ANS, representing a plausible mechanism by which pollutants and social disadvantage influence later physical and mental health.

Association of improved air quality with lower dementia risk in older women

Late-life ambient air pollution is a risk factor for brain aging, but it remains unknown if improved air quality (AQ) lowers dementia risk. We studied a geographically diverse cohort of older women dementia free at baseline in 2008 to 2012 (n = 2,239, aged 74 to 92). Incident dementia was centrally adjudicated annually. Yearly mean concentrations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were estimated using regionalized national universal kriging models and averaged over the 3-y period before baseline (recent exposure) and 10 y earlier (remote exposure). Reduction from remote to recent exposures was used as the indicator of improved AQ. Cox proportional hazard ratios (HRs) for dementia risk associated with AQ measures were estimated, adjusting for sociodemographic, lifestyle, and clinical characteristics. We identified 398 dementia cases during follow up (median = 6.1 y). PM2.5 and NO2 reduced significantly over the 10 y before baseline. Larger AQ improvement was associated with reduced dementia risks (HRPM2.5 0.80 per 1.78 μg/m3, 95% CI 0.71-0.91; HRNO2 0.80 per 3.91 parts per billion, 95% CI 0.71-0.90), equivalent to the lower risk observed in women 2.4 y younger at baseline. Higher PM2.5 at baseline was associated with higher dementia risk (HRPM2.5 1.16 per 2.90 μg/m3, 95% CI 0.98-1.38), but the lower dementia risk associated with improved AQ remained after further adjusting for recent exposure. The observed associations did not substantially differ by age, education, geographic region, Apolipoprotein E e4 genotypes, or cardiovascular risk factors. Long-term AQ improvement in late life was associated with lower dementia risk in older women.

The effect of using personal-level indoor air cleaners and respirators on biomarkers of cardiorespiratory health: a systematic review

BACKGROUND

Emerging studies have investigated potential cardiovascular and respiratory health impacts from the use of personal-level intervention equipment against air pollution exposure. The objective of this systematic review is to assess the efficacy of personal-level air pollution intervention on mitigating adverse health effects from air pollution exposure by using portable air cleaner or wearing respirator.

METHODS

In this systematic review, we searched PubMed and Web of Science for published literatures up to May 31, 2020, focusing on personal-level air pollution intervention studies. Among these studies, we investigated the impacts on cardio-respiratory responses to the use of these interventions. The intervention of review interest was the use of personal-level equipment against air pollution, including using portable air cleaner indoors or wearing respirator outdoors. The outcome of review interest was impacts on cardio-respiratory health endpoints following interventions, including level changes in blood pressure, heart rate variability (HRV), lung function, and biomarkers of inflammation and oxidative stress. Weighted mean differences or percent changes were pooled in meta-analyses for these health endpoints. The heterogeneity across studies was assessed using the Cochran's Q-statistic test, and the individual study quality was assessed using the Cochrane risk of bias tool version 2 (RoB 2). We further applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method to evaluate the certainty of evidence.

RESULTS

From systematic literature search and screening, we identified 29 related eligible intervention studies, including 21 studies on indoor portable air cleaner use and 8 studies on respirator use. For portable air cleaner intervention, we observed suggestive evidence of beneficial changes on cardio-respiratory health endpoints. Collectively in these studies, we found significantly beneficial changes of 2.01% decreases (95% CI: 0.50%, 3.52%) in systolic blood pressure, as well as non-significantly beneficial changes of 3.04% increases (95% CI: -2.65%, 8.74%) in reactive hyperemia index and 0.24% increases (95% CI: -0.82%, 1.31%) in forced expiratory volume in 1 s. We also observed non-significant reductions in levels of inflammation and oxidative stress biomarkers, including C-reactive protein, interleukin-6, fibrinogen, fractional exhaled nitric oxide and malondialdehyde. For respirator intervention, we observed some beneficial changes on cardiovascular health endpoints, such as significant increases in HRV parameters [SDNN (2.20%, 95% CI: 0.54%, 3.86%)], as well as non-significant decreases in blood pressure [SBP (0.63 mmHg, 95% CI: -0.39, 1.66)]; however, no sufficient data were available for meta-analyses on lung function and biomarkers. RoB 2 assessments suggested that most intervention studies were with a moderate to high overall risk of bias. The certainty of evidence for intervention outcome pairs was graded very low for either portable air cleaner or respirator intervention. The common reasons to downgrade study evidence included loss to follow-up, lack of blinding, lack of washout period, small sample size, and high heterogeneity across studies.

CONCLUSIONS

The uses of indoor portable air cleaner and respirator could contribute to some beneficial changes on cardiovascular health, but with much limited evidence on respiratory health. Low certainty of the overall study evidence shed light on future research for larger sample size trials with more rigorous study design.

Climate Solutions Double as Health Interventions

The climate crisis threatens to exacerbate numerous climate-sensitive health risks, including heatwave mortality, malnutrition from reduced crop yields, water- and vector-borne infectious diseases, and respiratory illness from smog, ozone, allergenic pollen, and wildfires. Recent reports from the Intergovernmental Panel on Climate Change stress the urgent need for action to mitigate climate change, underscoring the need for more scientific assessment of the benefits of climate action for health and wellbeing. Project Drawdown has analyzed more than 80 solutions to address climate change, building on existing technologies and practices, that could be scaled to collectively limit warming to between 1.5° and 2 °C above preindustrial levels. The solutions span nine major sectors and are aggregated into three groups: reducing the sources of emissions, maintaining and enhancing carbon sinks, and addressing social inequities. Here we present an overview of how climate solutions in these three areas can benefit human health through improved air quality, increased physical activity, healthier diets, reduced risk of infectious disease, and improved sexual and reproductive health, and universal education. We find that the health benefits of a low-carbon society are more substantial and more numerous than previously realized and should be central to policies addressing climate change. Much of the existing literature focuses on health effects in high-income countries, however, and more research is needed on health and equity implications of climate solutions, especially in the Global South. We conclude that adding the myriad health benefits across multiple climate change solutions can likely add impetus to move climate policies faster and further.

Effects of the implementation of a mass rapid transit system on mortality rates attributed to cardiorespiratory complications in Taipei

Although Taipei City has encountered a fall in ambient air pollutant levels since 1996, the year its mass rapid transit (MRT) system commenced operation, no apparent study investigated changes in risks of death attributed to respiratory, cardiovascular, and cerebrovascular diseases in Taipei during this 23-year period. In order to examine the relationship between MRT and occurrence of respiratory and cardiovascular illnesses attributed to air contaminants, exposure over the 23 year duration was subdivided into the following periods: reference period 1 (1992-1995); period 2 (1996-2004), a time when there was a total track length of 67 km; period 3 (2005-2015), when the total track length was lengthened to 131.1 km; and period 4 (2016-2020), when it was further extended to 146.2 km. Taichung City, no MRT system, was used as an external reference population. The effect of Taipei's MRT system on rates of cause-specific death rates was analyzed using robust generalized Poisson regression models. After adjusting for age-standardized rates (ASRs), a decrease in relative risks (RRs) was found for non-trauma death and respiratory disease from periods 2 to 4. Even though the RRs were greater than 1.0 for cardiovascular and cerebrovascular diseases for periods 2 to 4, a downward trend was still noted in these RRs in Taipei. These findings suggest a relationship exists between air pollutant exposure and mortality. In addition, data demonstrated that implementation of the MRT in Taipei exerted beneficial health effects as evidenced by lower mortality rates.

How to achieve the UN Sustainable Development Goals in the field of noncommunicable diseases by 2030, according to research in 49 countries

Goal. To analyze chronic noncommunicable diseases (NCD) mortality dynamics and associated efforts to reach UN sustainable development goals (SDG) in the area of NCD “by 2030, reduce by one third premature mortality from NCD through prevention and treatment“.

Methods. WHO statistics, based on the unified mortality and cause -of- death reports of Member-States countries along with the latest information from global WHO programmes, were used to evaluate NCD mortality trends in 49 countries in 2000, 2010 and 2016 and make comparisons and assessments of different types of community -based, country-wide interventions. Only countries with multiple years of national death registration data and high completeness and quality of cause-of-death assignments were included in the analysis. Cardiovascular disease (CVD) ischemic heart disease (IHD) and stroke, chronic respiratory disease (CRD) bronchial asthma and chronic obstructive pulmonary disease (COPD) lung cancer and diabetes mortality were analysed in 36 high income countries (HIC) and 13 middle income countries (MIC).

Results. The most visible decline was achieved for bronchial asthma 54%, stroke 43% IHD 30% and COPD 29%. Lung cancer and diabetes mortality decline were not statistically significant. Prevalence of tobacco smoking gradually declined in 84% of countries, 55% of countries demonstrated declining prevalence of raised blood pressure. Obesity prevalence was increasing in all countries. CVD and CRD mortality were higher in MIC. HIC better implemented tobacco and diet reduction measures. Same concerns NCD management approach. Air pollution level was higher in MIC.

Conclusions. NCD mortality decline is associated with multiple WHO global life style modifications campaigns, global coordinated prevention and control programmes for hypertension, asthma and COPD and WHO developed “best buy” approach. In order to achieve better results in lung cancer mortality together with early detection, more efforts should be concentrated on early diagnosis, strengthening tobacco cessation, clean air and diet actions. Diet and physical activities along with adequate management and patient education remain key elements to improve diabetes prognosis by the year 2030. Air pollution control could also facilitate achievement of the UN SDG 3.4.

Climate Change and Global Issues in Allergy and Immunology

The steady increase in global temperatures, resulting from the combustion of fossil fuels and the accumulation of greenhouse gases (GHG), continues to destabilize all ecosystems worldwide. Although annual emissions must halve by 2030 and reach net-zero by 2050 to limit some of the most catastrophic impacts associated with a warming planet, the world's efforts to curb GHG emissions fall short of the commitments made in the 2015 Paris Agreement (1). To this effect, July 2021 was recently declared the hottest month ever recorded in 142 years (2). The ramifications of these changes on global temperatures are complex and further promote outdoor air pollution, pollen exposure, and extreme weather events. Besides worsening respiratory health, air pollution, promotes atopy and susceptibility to infections. The GHG effects on pollen affect the frequency and severity of asthma and allergic rhinitis. Changes in temperature, air pollution, and extreme weather events exert adverse multisystemic health effects and disproportionally affect disadvantaged and vulnerable populations. This article is an update for allergists and immunologists about the health impacts of climate change, already evident in our daily practices. It is also a call to action and advocacy, including integrating climate change-related mitigation, education, and adaptation measures to protect our patients and avert further injury to our planet.

Planetary Health, Climate Change, and Lifestyle Medicine: Threats and Opportunities

Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as "threat multipliers," especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.

Health impacts of indoor air pollution from household solid fuel on children and women

The inefficient and incomplete combustion of solid fuel (SF) is associated with high levels of indoor air pollutants leading to 3.55 million deaths annually. The risk is higher in women and children, due to their higher exposure duration and unique physical properties. The current article aims to provide a critical overview regarding the use of solid fuel, its associated pollutants, their toxicity mechanisms and, most importantly the associated health impacts, especially in women and children. Pollutants associated with SF mostly include polycyclic aromatic hydrocarbons, particulate matter, nitrous oxide, carbon monoxide and sulfur dioxide, and their concentrations are two- to threefold higher in indoor environments. These pollutants can lead to a variety of health risks by inducing different toxicity mechanisms, such as oxidative stress, DNA methylation, and gene activation. Exposed children have an increased prevalence of low birth weight, acute lower respiratory tract infections, anemia and premature mortality. On the other hand, lung cancer, chronic obstructive pulmonary disease and cardiovascular diseases are the major causes of disability and premature death in women. Indoor air pollution resulting from SF combustion is a major public health threat globally. To reduce the risks, it is important to identify future research gaps and implement effective interventions and policies.