Health Impact Assessment of Air Pollution in São Paulo, Brazil

Impacts of PM2.5 exposure near cement facilities on human health and years of life lost: A case study in Brazil

Cement factories significantly contribute to atmospheric pollution by generating fine particulate matter (PM2.5), which can potentially increase the mortality risk. The lack of information on the health impacts of PM2.5 pollution from cement operations in Brazil prompted this investigation. We used corrected PM2.5 measurements from low-cost sensors from March 2021 to October 2022 in Rio Branco do Sul, city in the southern region of the country and home to Latin America's largest cement plant, to assess exposure data. Disability-adjusted life years (DALY) method was applied to estimate the years of life lost (YLL) and cost estimate due to deaths from non-accidental causes, cardiovascular and respiratory diseases. The total YLL attributable to PM2.5 concentration was estimated by calculating the attributable fraction (AF) through relative risk. We also collected PM2.5 using a Harvard impactor to evaluate health risks from toxic metals components. During the study period, the analysis of chemical characterization of PM2.5 showed enrichment factors for most elements and the possible influence of the calcination process facilities on the PM2.5 levels. The mean concentration of PM2.5 exceeded the annual WHO air quality guideline (AQG) level, accounted for 3.5%, 4.7%, and 4.3% of total YLL from all causes, cardiovascular, and respiratory diseases, which corresponded to 0.23 (95% CI: 0.17-0.26), 0.06 (95% CI: 0.05-0.07) and 0.03 (95% CI: 0.01-0.06) years loss in life expectancy, respectively. An indirect health cost attributable to PM2.5 resulted in US$ 1.4 million, equivalent to about 3.5% of the total local annual health costs in Rio Branco do Sul, underscoring the significant financial burden of PM2.5 exposures. The greatest economic loss was found in the male age group of 40-69 years and among those with cardiovascular disease, rather than those with respiratory disease. Despite this, the carcinogenic and non-carcinogenic risks from inhalation of hazardous elements were within safe ranges. This work demonstrated PurpleAir's potential for air quality and public health applications. Our findings indicate health and economic benefits from reducing PM2.5 levels by adopting WHO air pollution standards. The results can guide policies toward delivering more effective health care.

W, Bernardini S, Aguir K, Niederberger M, Longo E. The Role of Zn Ions in the Structural, Surface, and Gas-Sensing Properties of SnO2:Zn Nanocrystals Synthesized via a Microwave-Assisted Route

Although semiconducting metal oxide (SMOx) nanoparticles (NPs) have attracted attention as sensing materials, the methodologies available to synthesize them with desirable properties are quite limited and/or often require relatively high energy consumption. Thus, we report herein the processing of Zn-doped SnO2 NPs via a microwave-assisted nonaqueous route at a relatively low temperature (160 °C) and with a short treatment time (20 min). In addition, the effects of adding Zn in the structural, electronic, and gas-sensing properties of SnO2 NPs were investigated. X-ray diffraction and high-resolution transmission electron microscopy analyses revealed the single-phase of rutile SnO2, with an average crystal size of 7 nm. X-ray absorption near edge spectroscopy measurements revealed the homogenous incorporation of Zn ions into the SnO2 network. Gas sensing tests showed that Zn-doped SnO2 NPs were highly sensitive to sub-ppm levels of NO2 gas at 150 °C, with good recovery and stability even under ambient moisture. We observed an increase in the response of the Zn-doped sample of up to 100 times compared to the pristine one. This enhancement in the gas-sensing performance was linked to the Zn ions that provided more surface oxygen defects acting as active sites for the NO2 adsorption on the sensing material.

Is the expansion of the subway network alone capable of improving local air quality? A study case in São Paulo, Brazil

One of the policies adopted to reduce vehicular emissions is subway network expansion. This work fitted interrupted regression models to investigate the effects of the inauguration of subway stations on the mean, trend, and seasonality of the NO, NO2, NOx, and PM10 local concentrations. The regions investigated in the city of São Paulo (Brazil) were Pinheiros, Butantã, and St. Amaro. In Pinheiros, after the inauguration of the subway station, there were downward trends for all pollutants. However, these trends were not significantly different from the trends observed before. In Butantã, only regarding NO, there was a significant reduction and seasonal change after the subway station's inauguration. In St. Amaro, no trend in the PM10 concentration was noted. The absence of other transportation and land use policies in an integrative way to the subway network expansion may be responsible for the low air quality improvement. This study highlights that the expansion of the subway network must be integrated with other policies to improve local air quality.

Health Risk Assessment of Exposure to Air Pollutants Exceeding the New WHO Air Quality Guidelines (AQGs) in São Paulo, Brazil

We applied the AirQ+ model to analyze the 2021 data within our study period (15 December 2020 to 17 June 2022) to quantitatively estimate the number of specific health outcomes from long- and short-term exposure to atmospheric pollutants that could be avoided by adopting the new World Health Organization Air Quality Guidelines (WHO AQGs) in São Paulo, Southeastern Brazil. Based on temporal variations, PM_2.5, PM₁₀, NO₂, and O₃ exceeded the 2021 WHO AQGs on up to 54.4% of the days during sampling, mainly in wintertime (June to September 2021). Reducing PM_2.5 values in São Paulo, as recommended by the WHO, could prevent 113 and 24 deaths from lung cancer (LC) and chronic obstructive pulmonary disease (COPD) annually, respectively. Moreover, it could avoid 258 and 163 hospitalizations caused by respiratory (RD) and cardiovascular diseases (CVD) due to PM_2.5 exposure. The results for excess deaths by RD and CVD due to O₃ were 443 and 228, respectively, and 90 RD hospitalizations due to NO₂. Therefore, AirQ+ is a useful tool that enables further elaboration and implementation of air pollution control strategies to reduce and prevent hospital admissions, mortality, and economic costs due to exposure to PM_2.5, O₃, and NO₂ in São Paulo.

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.

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.

2030 Agenda: discussion on Brazilian priorities facing air pollution and climate change challenges

The advance of human activities in a disorderly way has accelerated in recent decades, intensifying the environmental impacts directly linked to these practices. The atmosphere, essential for the maintenance of life, is increasingly saturated with pollutants, offering risks to practically all the inhabitants of the planet, a process that, in addition to causing illness and early mortality, is related to serious financial losses (including in the production of goods), dangerous temperature increase and severe natural disasters. Although this perception is not recent, the global initiative to control the different mechanisms that trigger the commitment of biodiversity and irreversible climate changes arising from pollution is still very incipient, given that global initiatives on the subject emerged just over 50 years ago. Brazil is a territory that centralizes many of these discussions, as it still faces both political and economic obstacles in achieving a sustainable growth model as it was agreed through the United Nations 2030 Agenda. Even though there is little time left for the completion of these goals, much remains to be done, and despite the fulfillment of this deadline, the works will certainly need to be extended for much longer until an effective reorientation of consciousness occurs. Scientific researches and discussions are fundamental tools to the understanding of issues still little explored in this field.

Health impact assessment of air pollution in Lisbon, Portugal

BACKGROUND

Lisbon has about 500,000 inhabitants and it's the capital and the main economic hub of Portugal. Studies have demonstrated that exposure to Particulate Matter with an aerodynamic diameter<2.5 μm (PM_2.5) have strong association with health effects. Researchers continue to identify new harmful air pollutants effects in our health even in low levels.

OBJECTIVES

This study evaluates air pollution scenarios considering a Health Impact Assessment approach in Lisbon, Portugal.

METHODS

We have studied abatement scenarios of PM_2.5 concentrations and the health effects in the period from 2015 to 2017 using the APHEKOM tool and the associated health costs were assessed by Value of Life Year.

RESULTS

The mean concentration of PM_2.5 in Lisbon was 23 μg/m³ ± 10 μg/m³ (±Standard Deviation). If we consider that World Health Organization (WHO) standards of PM_2.5 (10 μg/m³) were reached, Lisbon would avoid more than 423 premature deaths (equivalent to 9,172 life years' gain) and save more than US$45 million annually. If Lisbon city could even diminish the mean of PM_2.5 by 5 μg/m³, nearly 165 deaths would be avoided, resulting in a gain of US$17 million annually.

CONCLUSION

According to our findings, if considered the worst pollution scenario, levels of PM2.5 could improve the life's quality and save a significant amount of economic resources.Implications: The manuscript addresses the health effects and costs of air pollution and constitutes an important target for improving public policies on air pollutants in Portugal. Although Portugal has low levels of air pollution, there are significant health and economic effects that, for the most part, are underreported. The health impact assessment approach associated with costs had not yet been addressed in Portugal, which makes this study more relevant in the analysis of policies aimed to drive stricter control on pollutants' emissions. Health costs are a fundamental element to support decision-making process and to orientate the trade-offs in investments for improving public policies so that to diminish health effects, which can impact the management of the local health services and the population's quality of life, especially after the pandemic period when resources are scarce.

Methodology for a Comprehensive Health Impact Assessment in Water Supply and Sanitation Programmes for Brazil

Based on the broader concept of health proposed by the Pan-American Health Organization/World Health Organization (PAHO/ WHO), 2018, and the absence in the literature of indices that translate the causal relationship between sanitation and health, a methodology for assessing the health impact of a water and sanitation programmes, known as a Health Impact Assessment (HIA), was developed, specifically in the Brazilian context, and focused on a school in the northeast of the country. Through exploratory and descriptive evidence, and using documentary research as a method, a retrospective survey was carried out from 2000 to 2022 using documents proposing evaluation methodologies. A single document was found to fit the research objective, which was used to develop the proposed HIA methodology. Development of the methodology consisted of two stages: definition of the health dimensions and selection of the indicators making up each dimension. The HIA methodology was then applied to a school in northeast Brazil to test its use, before a water-efficient management intervention was going to be used. The overall score of 46% indicated that there was room for improvement, which the new management approach could facilitate. This methodology is therefore proposed to be an instrument for the evaluation of public water and sanitation policies, thus assisting managers in the decision-making process and in guiding sanitation programs and plans.

Exposure to traffic-related fine particulate matter 2.5 causes respiratory damage via peroxisome proliferator-activated receptor gamma-regulated inflammation

Exposure to particulate matter 2.5 (PM2.5) potentially triggers airway inflammation. Peroxisome proliferator-activated receptor gamma (PPARγ) has been reported to regulate inflammatory responses in diverse cell types. Therefore, this work investigated the mechanisms of PPARγ in regulating traffic-related PM2.5-induced airway inflammation. Using the diffusion flame burner soot generation, traffic-related PM2.5 was generated and adsorbed. BALB/c male mice and human bronchial epithelial cells (16-HBE) were exposed to PM2.5 alone or co-treatment with rosiglitazone (RSG), an agonist of PPARγ. To the end of exposure, bronchoalveolar lavage fluid (BALF), venous blood and arterial blood, trachea, bronchus and lung tissues were collected. The levels of IL-1β, IL-6, and IL-17 were detected by ELISA, and the cell types in BALF were counted. Hematoxylin-eosin (H&E) assay were used to analyze the pathological conditions of lung, bronchus, and pulmonary artery. Apoptosis was detected by TUNEL, and PPARγ expression in lung and bronchus was detected by immunohistochemical (IHC) staining. Western Blot was used to detect PPARγ, NF-kB, AP-1 and STAT3 expression in lung and bronchus. The viability was detected by MTT method. PM2.5 exposure caused pathological damage to the lung, bronchus and pulmonary artery tissue, which induced apoptosis of bronchial epithelial cells. PM2.5 exposure caused local inflammation of the whole body and airway. PPARγ expression increased after PM2.5 exposure. PM2.5 exposure regulated the downstream signaling pathways to affect the inflammatory response through PPARγ. Exposure to traffic-related PM2.5 caused respiratory damage via PPARγ-regulated inflammation.

Unexpected reduction in ozone levels in a mid-size city during COVID-19 lockdown

The current study evaluated ozone levels through passive samplers installed in 4 different points in a medium-sized city (Rio Grande, Brazil) with naturally low NO₂ levels during a week of COVID-19 lockdown. Additionally, we evaluated the consequences of this response with regard to human health risk assessment and reduction of hospital admissions and ozone-related deaths. The reduction in ozone levels, one month after the implementation of containment measures, varied between 26 and 64% (average of 44%), in the different studied sites. The reduction of human mobility during the pandemic reduced the levels of ozone in Rio Grande city and consequently will bring benefits to health services in the municipality. This unexpected reduction in O₃ levels must be related to the low 'natural' levels of NO₂ in the city, which make the contribution of other precursors important for the fluctuation of O₃ levels.

Health impacts of PM2.5-bound metals and PAHs in a medium-sized Brazilian city

Rio Grande is a medium-sized industrial city located in the extreme south of Brazil, and previous studies in this city have shown contamination by metal(loids) and polycyclic aromatic hydrocarbons (PAHs) in water, soil, and sediment and in the atmosphere. In Brazil, the incorporation of PM_2.5 monitoring in environmental legislation is recent (2018) and, like other developing countries, the number of studies is still small. This study aimed to investigate the levels of PM_2.5 in the industrial and urban area of Rio Grande, to determine the concentration of metal(loid)s As, Cd, Cu, and Pb and of 16 PAHs in the samples of PM_2.5, to perform the health risk assessment for these contaminants and the health impact assessment for two possible scenarios of reduction of PM_2.5 levels. Our main findings regarding the PM_2.5 samples include the following: (1) The levels of this pollutant in the city of Rio Grande were higher than those allowed in current Brazilian legislation, in both the industrial and urban areas; (2) the existence of non-carcinogenic and carcinogenic risks for metals present in all samples; (3) the absence of carcinogenic risk for the assessed PAHs; and (4) the reduction scenarios proposed pointed to a reduction of up to 22 deaths annually in conjunction with reductions in health-related expenditures. Thus, these results may serve as a basis for the development of public health policies aimed at improving air quality, jointly assisting health surveillance and directing future studies towards a better intrinsic approach to the problem.

The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil

BACKGROUND

Currently, more than half of the global population lives in cities. Contemporary urban planning practices result in environmental risk factors (e.g. air pollution, noise, lack of green space, excess heat) that put health and well-being of city dwellers at risk and contribute to chronic diseases and premature death. Despite a growing body of evidence on adverse health impacts related to current urban and transport planning practices, especially for cities in the Global North, not much is known about associated health impacts in South American cities. Therefore, we estimated the mortality burden attributable to breaching internationally-recommended or locally-preferable exposure levels of urban planning related environmental exposures in Sao Paulo, Brazil.

METHODS

We carried out a health impact assessment study, following the comparative risk assessment framework, to assess preventable mortality impacts of breaching exposure recommendations for air pollution, green spaces and temperature at the census tract (CT) level (n = 18,363). We also assessed the distribution thereof by socioeconomic vulnerability.

RESULTS

We estimated that annually 11,372 (95% CI: 7921; 15,910) attributable deaths could be prevented by complying with recommended exposure levels. The largest proportion of preventable mortality was due to breaching air pollution limits (i.e. 8409 attributable deaths), followed by insufficient green space (i.e. 2593), and excess heat (i.e. 370). Adverse health impacts were larger in CTs of lower socioeconomic vulnerability, due to demographic profile, traffic density and residential area configurations.

DISCUSSION

Not complying with the health limits for air pollution, green space and temperature exposures resulted in a considerable preventable mortality burden (i.e. 17% of total expected deaths) in Sao Paulo. This burden can be reduced by improving current urban and transport planning practices.

Long-Term Air Pollution Exposure and Ischemic Heart Disease Mortality Among Elderly in High Aging Asian Economies

In the epidemiological literature, the impact of environmental pollution on cardiac mortality has been well documented. There is, however, a paucity of evidence on the impact of air pollution exposure on ischemic heart disease (IHD) mortality among the Asian aged population. In response, this research seeks to investigate the degree of proximity between exposure to ambient PM2.5, household PM2.5, ground-level ozone (O3), and IHD mortality in the top seven Asian economies with the highest aging rates. This investigation is held in two phases. In the first phase, grey modeling is employed to assess the degree of proximity among the selected variables, and then rank them based on their estimated grey weights. In addition, a grey-based Technique for Order of Preference by Similarity to Ideal Solution (G-TOPSIS) is adopted to identify the key influencing factor that intensifies IHD mortality across the selected Asian economies. According to the estimated results, South Korea was the most afflicted nation in terms of IHD mortality owing to ambient PM2.5 and ground-level O3 exposure, whereas among the studied nations India was the biggest contributor to raising IHD mortality due to household PM2.5 exposure. Further, the outcomes of G-TOPSIS highlighted that exposure to household PM2.5 is a key influencing risk factor for increased IHD mortality in these regions, outweighing all other air pollutants. In conclusion, this grey assessment may enable policymakers to target more vulnerable individuals based on scientific facts and promote regional environmental justice. Stronger emission regulations will also be required to mitigate the adverse health outcomes associated with air pollution exposure, particularly in regions with a higher elderly population.

Health impact assessment of air pollution in an area of the largest coal mine in Brazil

Coal exploration and burning activities are among the activities with the greatest potential to cause atmospheric pollution due to the combustion process of this mineral and the consequent release of particles that, in significant quantities, can pose a potential health risk, mainly respiratory and cardiovascular diseases. The Candiota region, in the extreme south of Brazil, concentrates 40% of the national reserves of mineral coal, and its burning is capable of releasing air pollutants, including particulate matter (PM). Some environmental and epidemiological studies have been carried out in the region, but so far, there is no investigation to estimate the impact of PM on health outcomes. The current study aimed to estimate the mortality attributed to the PM, as well as the benefits in health indicators associated with the reduction of air pollution to the limits set forth in local legislation and the WHO. Daily data on PM levels collected from an air quality monitoring station over a year were used, as well as population data and health indicators from 7 cities influenced by mining activities, such as total mortality and cardiovascular diseases and hospitalizations for cardiac and respiratory problems. In a scenario where PM levels are within legal limits, a percentage greater than 11% of cardiovascular deaths was attributed to pollution by PM2.5, and the reduction in PM10 and PM2.5 levels may be responsible for the increase in the expectation of life in up to 17 months and monetary gains of more than $ 24 million, due to the reduction in hospitalizations and mortality. Studies of this nature should be important tools made available to decision-makers, with a view to improving environmental laws and a consequent improvement in the quality of life and health indicators of the population.

Bronchial eosinophils, neutrophils, and CD8 + T cells influence asthma control and lung function in schoolchildren and adolescents with severe treatment-resistant asthma

BACKGROUND

Studies in adult severe treatment-resistant asthma (STRA) have demonstrated heterogeneous pathophysiology. Studies in the pediatric age group are still scarce, and few include bronchial tissue analysis.

OBJECTIVE

We investigated 6-18-year-old patients diagnosed with STRA in Sao Paulo, Brazil, by characterizing the different lung compartments and their correlations with asthma control and lung function.

METHODS

Inflammatory profiles of 13 patients with a confirmed diagnosis of STRA were analyzed using blood, induced sputum, bronchoalveolar lavage, viral and bacterial screens and endobronchial biopsy. Inflammatory cells, cytokines, and basement membrane thickening were tested for correlations with the asthma control test (ACT) and spirometry and plethysmography parameters.

RESULTS

Endobronchial biopsy specimens from 11 patients were viable for analysis. All biopsies showed eosinophilic infiltration. Submucosal (SM) eosinophils and neutrophils were correlated with worse lung function (pre-BD FEV1), and SM neutrophils were correlated with fixed obstruction (post-BD FEV1). Intraepithelial (IE) neutrophils were positively correlated with lung function (pre-BD sGaw). CD8 + T cells had the highest density in the IE and SM layers and were positively correlated with ACT and negatively correlated with the cytokines IL1β, IL2, IL5, IL7, IL10, IL12, IL17, GCSF, MCP-1, INF-δ, and TNFα in sputum supernatant. The ASM chymase + mast cell density correlated positively with quality-of-life score (pAQLQ) and ACT.

CONCLUSION

Eosinophils and SM neutrophils correlated with worse lung function, while IE neutrophils correlated with better lung function. Most importantly, CD8 + T cells were abundant in bronchial biopsies of STRA patients and showed protective associations, as did chymase + mast cells.

Effects of intrauterine exposure to concentrated ambient particles on allergic sensitization in juvenile mice

Intrauterine exposure to particulate matter (PM) has been associated with an increased risk of asthma development, which may differ by the age of asthma onset, sex, and pollutant concentration. To investigate the pulmonary effects of in utero exposure to concentrated urban ambient particles (CAPs) in response to house dust mite (HDM) sensitization in juvenile mice. Mice were exposed to CAPs (600 μg/m³ PM_2.5) during the gestational period. Twenty-two-day postnatal mice were sensitized with HDM (100 μg, intranasally, 3 times per week). Airway responsiveness (AHR), serum immunoglobulin, and lung inflammation were assessed after 43 days of the postnatal period. Female (n = 47) and male (n = 43) mice were divided into four groups as follows: (1) FA: not exposed to CAPs; (2) CAPs: exposed to CAPs; (3) HDM: sensitized to HDM; and (4) CAPs+HDM: exposed to CAPs and HDM-sensitized. PM_2.5 exposure did not worsen lung hyperresponsiveness or allergic inflammation in sensitized animals. The levels of the lung cytokines IL-4, TNF-α, and IL-2 were differentially altered in male and female animals. Males presented hyporesponsiveness and increased lung macrophagic inflammation. There were no epigenetic changes in the IL-4 gene. In conclusion, intrauterine exposure ambient PM_2.5 did not worsened allergic pulmonary susceptibility but affected the pulmonary immune profile and lung function, which differed by sex.

The Built Environment and Health in Low- and Middle-Income Countries: a Review on Quantitative Health Impact Assessments

PURPOSE OF REVIEW

Features and attributes of the built environment (BE) impact positively and negatively on health, especially in cities facing unprecedented urban population growth and mass motorization. A common approach to assess the health impacts of built environment is health impact assessment (HIA), but it is rarely used in low- and middle-income countries (LMICs) where urbanization rates are fastest. This article reviews selected HIA case studies from LMICs and reports the methods and tools used to support further implementation of quantitative HIAs in cities of LMICs.

RECENT FINDINGS

In total, 24 studies were reviewed across Algeria, Brazil, China, India, Iran, Kenya, Thailand, Turkey, and Mauritius. HIAs examine specific pathways through which the built environment acts: air pollution, noise, physical activity, and traffic injury. Few HIAs of BE addressed more than one exposure pathway at a time, and most studies focused on air pollution across the sectors of transport and energy. A wide number of tools were used to conduct exposure assessment, and different models were applied to assess health impacts of different exposures. Those HIAs rely on availability of local concentration data and often use models that have set exposure-response functions (ERFs). ERFs were not adapted to local populations except for HIAs conducted in China. HIAs of BE are being successfully conducted in LMICs with a variety of tools and datasets. Scaling and expanding quantitative health impact modeling in LMICs will require further study on data availability, adapted models/tools, low technical capacity, and low policy demand for evidence from modeling studies. As case studies with successful use of evidence from modeling emerge, the uptake of health impact modeling of BE is likely to increase in favor of people and planet.

Health impact assessment of air pollutants during the COVID-19 pandemic in a Brazilian metropolis

Studies around the world have revealed reduced levels of atmospheric particulate matter in periods of greatest human mobility restriction to contain the spread of SARS-CoV-2 during the COVID-19 pandemic. The present study aimed to carry out a health impact assessment in Recife, Brazil, hypothesizing a scenario in which the levels of PM₁₀ and PM_2.5 remained, throughout the year, as in the most restrictive period of human mobility. Particular material data (PM₁₀ and PM_2.5) were measured during the pandemic and population and health (mortality, hospital admissions for heart and respiratory problems) data from 2018 were used. We observed a reduction in the concentration of PM_2.5 in up to 43.7% and PM₁₀ up to 29.5% during the period of social isolation in the city of Recife. The reduction in PM_2.5 would avoid 106 annual deaths from non-external causes and 58 annual deaths from cardiovascular diseases. In this scenario, $ 294.88 million would be saved ($ 114.88 million from heart problems and $ 180 million from non-external causes). When considering hospitalizations avoided by the decrease in PM₁₀, we observed 57 fewer hospitalizations for respiratory diseases, 42 for heart diseases and a reduction of 37 deaths due to non-external causes. The reduction in spending on respiratory and cardiovascular hospitalizations would exceed $ 330,000. Therefore, the reduction of particulate matter could prevent hospital admissions, deaths and consequently there would be a reduction in disease burden in developing countries where economic resources are scarce. In this sense, governments should seek to reduce levels of pollution in order to improve the life quality and health of the population.

How atmospheric pollutants impact the development of chronic obstructive pulmonary disease and lung cancer: A var-based model

The impact of air pollution on humans is a worrisome factor that has gained prominence over the years due to the importance of the topic to society. Lung cancer and chronic obstructive pulmonary disease are among the diseases associated with pollution that increase the mortality rate in Brazil and worldwide. Therefore, this study aimed to determine the impacts of air pollutants on mortality rates from chronic obstructive pulmonary disease (COPD) and lung cancer (LC) using vector autoregressive (VAR) modeling. The adjusted model was a VAR(1) and, according to the Granger causality test, the air pollutants selected were PM₁₀, O₃, CO, NO₂, and SO₂. The shocks applied to the variables O₃, using the impulse response function, negatively impacted COPD; in the eighth period, which is stabilized. The LC variable suffered more significant variations from O₃ and after a shock in this variable, an initially negative response in LC occurred and the series stabilized in period nine. After one year, 20.19% of COPD variance was explained by O₃. After twelve months, the atmospheric pollutant O₃ represented 5.00% and NO₂ represented 4.02% of LC variance. Moreover, the variables that caused the highest impact on COPD and LC mortality rates were O₃ and NO₂, indicating that air pollution influences the clinical state of people who have these diseases and even contributes to their development. The VAR model was able to identify the air pollutants that have the most significant impact on the diseases analyzed and explained the interrelationship between them.

Application of neural network to simulate the behavior of hospitalizations and their costs under the effects of various polluting gases in the city of São Paulo

This work aims to obtain an artificial neural network to simulate hospitalizations for respiratory diseases influenced by pollutant gaseous such as CO, PM₁₀, PM_2.5, NO₂, O₃, and SO₂ emitted from 2011 to 2017, in the city of São Paulo. The hospitalization costs were also be calculated. MLP and RBF neural networks have been tested by varying the number of neurons in the hidden layer and the type of equation of the output function. The following pollutants and its concentration range were collected considering the supervision of Alto Tiete station set, in several neighborhoods in the city of São Paulo, from in the period 2011 to 2017: 28-63 µg/m³ of PM_2.5, 52-110 µg/m³ of PM₁₀, 49-135 µg/m³ of O₃, 0.8-2.6 ppm CO, 41-98 µg/m³ of NO₂, and 3-16 µg/m³ of SO₂. Results showed that a RBF neural network with 6 input neurons, 13 hidden layer neurons, and 1 output neuron, using BFGS algorithm and a Gaussian function to neuronal activation, was the best fitted to the experimental datasets. So, knowing the monthly concentration of gaseous pollutions was possible to predict the hospitalization of 1464 to 3483 ± 510 patients, with costs between 570,447 and 1,357,151 ± 198,171 USD per month. This way, it is possible to use this neural network to predict the costs of hospitalizing patients for respiratory diseases and to contribute to the decision-making of how much the government should spend on health care.

Avoidable mortality by implementing more restrictive fine particles standards in Brazil: An estimation using satellite surface data

A growing number of epidemiological studies have been affirming the linking between fine particles (PM_2.5) and deaths due to diverse causes as a result of long-term exposure. This work demonstrates the benefits of improving air quality policies by evaluating the impact of PM_2.5 in terms of avoidable mortality due to all causes, cardiopulmonary causes, and lung cancer, between 2014 and 2018, for 5570 Brazilian cities. Satellite annual surface PM_2.5 concentrations were compared with available monitoring measurements and used as the baseline scenario. Each phase of the Brazilian air quality legislation (CONAMA 491/2018) was used as a control scenario. The satellite PM_2.5 annual surface levels were slightly lower than the monitoring concentrations, with an average mean bias of -2.7 μg/m³. No annual mean PM_2.5 concentration above 20 μg/m³ was observed in any city in 2014 and 2018. In 2016, 23% of cities exceeded the annual mean concentration of 10 μg/m³. A weak positive correlation was found between city-level PM_2.5 and population, vehicle fleet, number of fire outbreaks, urban area size, Growth Domestic Product per capita, Human Development Index, and life expectancy. During the five years, a total of 48,700 ± 7570 deaths due to all causes, 24,100 ± 3260 due to cardiopulmonary causes, and 1780 ± 435 due to lung cancer could be avoided if the maximum PM_2.5 annual concentration of 10 μg/m³ was not exceeded. Less restrictive standards lead to much lower avoidable deaths. For example, considering the maximum annual concentration of 20 μg/m³, 1335 ± 175 deaths due to all causes could be avoided between 2015 and 2017. Our results indicate the importance of adopting more restrictive air quality standards in Brazil. If the current levels do not protect life as they should be, an effort regarding control emissions, monitoring, and modeling is essential to construct an effective air quality management for the country, aiming to comprehend the current PM_2.5 concentration and to achieve lower standards.

Years of life lost due to premature deaths associated with air pollution: an ecological time-series study

BACKGROUND

Exposure to air pollutants is associated with hospital admissions due to cardiovascular diseases and premature deaths.

OBJECTIVE

To estimate years of life lost (YLL) due to premature deaths and their financial costs.

DESIGN AND SETTING

Ecological time-series study carried out in São José dos Campos, Brazil, in 2016.

METHODS

Data on deaths among residents of this city in 2016 were assessed to estimate the financial cost of premature deaths associated with air pollution. The diagnoses studied were ischemic heart disease, congestive heart failure and cerebrovascular disease, according to YLL. The fractions attributable to deaths associated with air pollutant exposure and to each potential year of life lost were calculated using negative binomial regression with lags of 0-7 days between exposure and outcome. Nitrogen dioxide, particulate matter (PM10) and ozone concentrations were included in the model and adjusted for temperature, humidity and seasonality.

RESULTS

Exposure to particulate matter was significant at lag 3 days. There were 2177 hospitalizations over the study period, with 201 deaths (9.2%). Premature deaths led to 2035.69 years of life lost. A 10 μg/m3 increase in PM10 concentrations was correlated with 8.0% of the hospitalizations, which corresponded to 152.67 YLL (81.67 for males and 71.00 for females). The cost generated was approximately US$ 9.1 million in 2016.

CONCLUSION

In this first study conducted in a medium-sized Brazilian city, using the YLL methodology, we identified an excess expense attributable to air pollution.

Air Pollution and Emergency Hospital Admissions—Evidences from Lisbon Metropolitan Area, Portugal

The relevance of air pollution in the public health agenda has recently been reinforced—it is known that exposure to it has negative effects in the health of individuals, especially in big cities and metropolitan areas. In this article we observed the evolution of air pollutants (CO, NO, NO2, O3, PM10) emissions and we confront them with health vulnerabilities related to respiratory and circulatory diseases (all circulatory diseases, cardiac diseases, cerebrovascular disease, ischemic heart disease, all respiratory diseases, chronic lower respiratory diseases, acute upper respiratory infections). The study is supported in two databases, one of air pollutants and the other of emergency hospital admissions, in the 2005–2015 period, applied to the Lisbon Metropolitan Area. The analysis was conducted through Ordinary Least Squares (OLS) regression, while also using semi-elasticity to quantify associations. Results showed positive associations between air pollutants and admissions, tendentially higher in respiratory diseases, with CO and O3 having the highest number of associations, and the senior age group being the most impacted. We concluded that O3 is a good predictor for the under-15 age group and PM10 for the over-64 age group; also, there seems to exist a distinction between the urban city core and its suburban areas in air pollution and its relation to emergency hospital admissions.

Trends and health impacts of major urban air pollutants in Kazakhstan

The air quality in cities in Kazakhstan has been poorly investigated despite the worsening conditions. This study evaluates national air pollution monitoring network data (Total Suspended Particle-TSP, NO₂, SO₂, and O₃) from Kazakhstan cities and provides estimates of excess mortality rates associated with PM_2.5 exposure using the Global Exposure Mortality Model (GEMM) concentration-response function. Morbidity rates associated with PM₁₀ exposure were also estimated. Annual average (2015-2017) population-weighted concentrations were Kazakhstan cities was 157, 51, 29, and 41 μg m^-3 for TSP, NO₂, SO₂, and O₃ respectively. We estimated a total of 8134 adult deaths per year attributable to PM_2.5 (average over 2015-2017) in the selected 21 cities of Kazakhstan. The leading causes of death were ischemic heart disease (4080), stroke (1613), lower respiratory infections (662), chronic obstructive pulmonary disease (434), lung cancer (332). The per capita mortality rate attributable to ambient air pollution (per 10⁵ adults per year) was less than 150 in nine cities, between 150 and 204 in nine cities, and between 276 and 373 in three industrial cities (Zhezkazgan, Temirtau, and Balkhash). Implications: Quantitative information on the health impacts of air pollution can be useful for decision-makers in Kazakhstan to justify environmental policies and identify policy and funding priorities for addressing air pollution issues. This information can also be useful for policymakers by improving the quality of government-funded environmental reports and strategic documents, as they have many shortcomings in terms of the selection of air quality indicators, identification of priority pollutants, and identification of sources of pollution. This study has high significance due to the lack of data and knowledge in Central Asia, especially Kazakhstan.

Air pollution and its impact on the concentration of airborne fungi in the megacity of São Paulo, Brazil

In the context of megacities in an urban environment, air quality is an important issue, due to the direct correlation to population's health. The biomonitoring of pollutants can indicate subtle environmental alterations, for that, anemophilous fungi can be monitored for changes in atmospheric conditions related to pollution. In the present study, the concentration of fungi and bacteria in the atmosphere was measured during a specific vehicle fleet reduction in the city of São Paulo, Brazil, from May 24 to 30, 2018, using impactor air samplers. The number of isolated developed colonies was related to atmospheric conditions and the concentration of other air pollutants constantly monitored. Aspergillus, Curvularia, Penicillium, Neurospora, Rhizopus and Trichoderma were identified. The number of colony-forming units increased by approximately 80% during the sampling period in response to environmental changes favored by the fleet reduction. This result implies the relation between fuel emissions, concentration of atmospheric pollutants, and the presence of viable fungal spores in the urban environment, which highlights the importance of combined public policies for air quality in large cities.

90 Days of COVID-19 Social Distancing and Its Impacts on Air Quality and Health in Sao Paulo, Brazil

The COVID-19 pandemic has imposed a unique situation for humanity, reaching up to 5623 deaths in Sao Paulo city during the analyzed period of this study. Due to the measures for social distancing, an improvement of air quality was observed worldwide. In view of this scenario, we investigated the air quality improvement related to PM10, PM2.5, and NO2 concentrations during 90 days of quarantine compared to an equivalent period in 2019. We found a significant drop in air pollution of 45% of PM10, 46% of PM2.5, and 58% of NO2, and using a relative-risk function, we estimated that this significant air quality improvement avoided, respectively, 78, 337, and 387 premature deaths, respectively, and prevented approximately US $720 million on health costs. Moreover, we estimated that 5623 deaths by COVID-19 represent an economic health loss of US $10.5 billion. Both health and economic gains associated with air pollution reductions give a positive perspective of the efforts towards keeping air pollution reduced even after the pandemic, highlighting the importance of improving the strategies of air pollution mitigation actions, as well as the crucial role of adopting efficient measures to protect human health both during and after the COVID-19 global health crisis.

Surface Electrical Stimulation for Persistent Stuttering and Concomitant Orofacial Disorders: A Multiple Case Study

This multiple case study analysis describes the immediate effects on speech fluency of transcutaneous electrical nerve stimulation (TENS) applied to participants with persistent stuttering and concomitant orofacial disorders. Study participants were 14 adolescents and adults who stuttered and had jaw clenching bruxism or mouth breathing. Participants experienced low-frequency TENS applied at mild motor level for 20 minutes with electrodes placed at the lower third of the face (Area A), submandibular region (Area B), posterior neck (Area C), or shoulder girdle (Area D), with speech fluency assessed immediately before and after each stimulation.For participants with stuttering and bruxism, AB stimulation reduced the median frequency of syllables stuttered by 27% and reduced the median duration of the three highest stuttering moments by 29%. In addition, for participants with stuttering and mouth breathing, CD stimulation reduced the median duration of the three highest stuttering moments by 28% and increased their median speech rate by 113%. As a single session of TENS may help participants with stuttering and concomitant orofacial disorders better use fluency shaping techniques, the therapeutic potential of TENS for treating stuttering should be further investigated.

Urban health: an example of a "health in all policies" approach in the context of SDGs implementation

BACKGROUND

Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis.

AIM

The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America.

METHODS

We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies.

RESULTS

A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco.

CONCLUSIONS

By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.

Respiratory gases, air pollution and epilepsy

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

Air Quality Standards and Extreme Ozone Events in the São Paulo Megacity

Ozone events in South America might be triggered by increasing air temperatures and dry conditions, leading to vulnerable population exposure. The current air quality standards and attention levels in São Paulo state, Brazil, are 40% higher and 25% higher, respectively, than the limits recommended by the World Health Organization (WHO). We simulated an extreme ozone event in the São Paulo megacity using the Weather Research and Forecast/Chemistry model during an extreme event characterized by positive anomalies of air temperature and solar radiation. Results were evaluated using the different air quality limits from São Paulo state and the WHO, also with socioeconomic vulnerability data from the Brazilian census and cost analysis for the public health system from the extreme episode. More than 3 million people in vulnerability conditions, such as low income and families with an above-average percentage of children, live in areas where ozone concentrations exceeded the attention levels of the WHO during the episode, which is ignored by the lenient SP state environmental laws. WHO air quality guidelines must be adopted urgently in developing nations in order to provide a more accurate basis for cost analysis and population exposure, particularly the for vulnerable population groups.

Systematic Literature Review of Health Impact Assessments in Low and Middle-Income Countries

Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study systematically focuses on those that have been successfully conducted across all regions of the world, nor do they highlight factors that may enable or hinder their implementation. Our objectives are to (1) systematically review, geographically map, and characterize HIA activity in LMICs; and (2) apply a process evaluation method to identify factors which are important to improve HIA implementation in LMICs. A systematic review of peer-reviewed HIAs in 156 LMICs was performed in Scopus, Medline, Web of Science, Sociological abstracts, and LILACs (Latin American and Caribbean Health Sciences) databases. The search used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and covered HIAs across all type of interventions, topics, and health outcomes. HIAs were included if they reported a clear intervention and health outcome to be assessed. No time restriction was applied, and grey literature was not included. The eligible studies were subjected to six process evaluation criteria. The search yielded 3178 hits and 57 studies were retained. HIAs were conducted in 26 out of 156 countries. There was an unequal distribution of HIAs across regions and within LMICs countries. The leading topics of HIA in LMICs were air pollution, development projects, and urban transport planning. Most of the HIAs reported quantitative approaches (72%), focused on air pollution (46%), appraised policies (60%), and were conducted at the city level (36%). The process evaluation showed important variations in the way HIAs have been conducted and low uniformity in the reporting of six criteria. No study reported the time, money, and staff used to perform HIAs. Only 12% of HIAs were based on participatory approaches; 92% of HIAs considered multiple outcomes; and 61% of HIAs provided recommendations and fostered cross-national collaboration. The limited transparency in process, weak participation, and inconsistent delivery of recommendations were potential limitations to HIA implementation in low and middle-income countries. Scaling and improving HIA implementation in low and middle-income countries in the upcoming years will depend on expanding geographically by increasing HIA governance, adapting models and tools in quantitative methods, and adopting better reporting practices.

Chronic obstructive pulmonary disease exacerbations and progression in relation to ambient air pollutants exposure

Background

The information for the impact of air pollutants on the severity of chronic obstructive pulmonary disease (COPD) and hospital admissions in Bulgaria is scarce. The aim of the study is to assess the relationship between some ambient air pollution and exacerbations levels as well as hospital admissions of patients with COPD in Bulgaria.

Methods

A multi-center, prospective, one-year observational study was conducted among 426 COPD patients. Data from pollution monitoring are collected from the Executive Environment Agency (EEA).

Results

The results showed that the pollution with sulfur dioxide (SO₂) is less than limit concentrations recommended by the European Union and World Health Organization (WHO), while the pollution with PM exceeds limits values of WHO two times. The mean rate of exacerbations in selected towns are between 0.5-3, the number of exacerbations with hospitalization are between 0.2-1.8 and length of hospital stay is between 1-14 days.

Conclusions

The study confirms that air pollution leads to increased number of exacerbations and hospital stay. The patients with mild level of COPD have 0.86 exacerbations and 2.61 days in hospital per year, while in case of very severe COPD these values increase 4 times. Outside pollutions lead to worsening of the disease severity and hospitalizations due to a higher rate of COPD exacerbations.

Estimating Ground-Level Concentrations of Multiple Air Pollutants and Their Health Impacts in the Huaihe River Basin in China

Air pollutants existing in the environment may have negative impacts on human health depending on their toxicity and concentrations. Remote sensing data enable researchers to map concentrations of various air pollutants over vast areas. By combining ground-level concentrations with population data, the spatial distribution of health impacts attributed to air pollutants can be acquired. This study took five highly populated and severely polluted provinces along the Huaihe River, China, as the research area. The ground-level concentrations of four major air pollutants including nitrogen dioxide (NO₂), sulfate dioxide (SO₂), particulate matters with diameter equal or less than 10 (PM₁₀) or 2.5 micron (PM_2.5) were estimated based on relevant remote sensing data using the geographically weighted regression (GWR) model. The health impacts of these pollutants were then assessed with the aid of co-located gridded population data. The results show that the annual average concentrations of ground-level NO₂, SO₂, PM₁₀, and PM_2.5 in 2016 were 31 µg/m³, 26 µg/m³, 100 µg/m³, and 59 µg/m³, respectively. In terms of the health impacts attributable to NO₂, SO₂, PM₁₀, and PM_2.5, there were 546, 1788, 10,595, and 8364 respiratory deaths, and 1221, 9666, 46,954, and 39,524 cardiovascular deaths, respectively. Northern Henan, west-central Shandong, southern Jiangsu, and Wuhan City in Hubei are prone to large health risks. Meanwhile, air pollutants have an overall greater impact on cardiovascular disease than respiratory disease, which is primarily attributable to the inhalable particle matters. Our findings provide a good reference to local decision makers for the implementation of further emission control strategies and possible health impacts assessment.

Evaluation of cardiovascular risk factors in women referring to health centers in Tabriz, Iran, 2017

Background: Cardiovascular disease (CVD) is the leading cause of mortality among men and women around the world. The aim of this study was to investigate major cardiovascular risk factors in women living in the Tabriz petrochemical region, Iran during spring 2017.

Methods: In this cross-sectional study, a sample of 152 women aged 30-55 years was selected from who attended health center in Tabriz, Iran. Anthropometric measurements, blood pressure,daily dietary intakes and fasting serum lipid profile, oxidized LDL (ox-LDL) and high sensitivity C-reactive protein (hs-CRP) were evaluated.

Results: The prevalence of overweight, general and abdominal obesity (based on Body mass index [BMI] and waist circumference [WC]) was 34.2%, 52.6%, and 73.7%, respectively. Eleven point two percent and 4.6% of women had pre-hypertension based on systolic blood pressure (SBP)and diastolic blood pressure (DBP). High serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C)were determined in 32.5%, 25.7%, 17.8% and 56.6% of subjects, respectively. The median of serum ox-LDL concentration was 3181.5 ng/L. Sixty-five point eight percent of participants hadhigh hs-CRP levels. In the multiple-adjusted quintile regression analysis, significant relationships were found between serum ox-LDL and age (B = 96.7, P = 0.003) and between serum hs-CRP with diastolic blood pressure (B = 0.1, P = 0.083) and TG (B = 0.01, P = 0.088).

Conclusion: The high prevalence of cardiovascular risk factors in the studied women warrants more public health attention. The results also suggest that aging was associated with high serumox-LDL and increased serum hs-CRP levels, which may reflect enhanced DBP and serum TG.

Urban particulate matter induces the expression of receptors for early and late adhesion molecules on human monocytes

Exposure to urban particulate matter (PM) is correlated with increases in the emergence of health services due to adverse events and deaths and is mainly related to cardiorespiratory complications. The translocation of particles from the lung into circulation has been proposed as a factor that may trigger systemic effects. Monocytes may be exposed to PM, and if the monocytes are activated, then they are likely to adhere to endothelial cells in a distant organ due to the expression of receptors for adhesion molecules. In the present study, we evaluated the expression of receptors for adhesion molecules (sLe^x, PSGL-1, LFA-1, VLA-4 and α_Vβ₃) in monocytes (U937 cells) exposed for 3 or 18 h to PM₁₀ (0.001, 0.003, 0.010, 0.030, 0.300, 3 or 30 µg/mL). Exposed cells were co-cultured with human endothelial cells that were naive or previously exposed to the same particles. When U937 cells were exposed to PM₁₀, similar levels of expression for early and late receptors for adhesion molecules were observed from 30 ng/mL as those induced by TNF-α. Cells exposed to particles at concentrations above 30 ng/mL were more adhesive to naive or exposed human endothelial cells. Taken together, our results suggest that it is plausible that activated monocytes may play a role in systemic effects induced by PM₁₀ due to the size distribution of the particles and the concentrations required to trigger the expression of receptors for adhesion molecules in monocytes.

The gains in life expectancy by ambient PM2.5 pollution reductions in localities in Nigeria

Global burden of disease estimates reveal that people in Nigeria are living shorter lifespan than the regional or global average life expectancy. Ambient air pollution is a top risk factor responsible for the reduced longevity. But, the magnitude of the loss or the gains in longevity accruing from the pollution reductions, which are capable of driving mitigation interventions in Nigeria, remain unknown. Thus, we estimate the loss, and the gains in longevity resulting from ambient PM_2.5 pollution reductions at the local sub-national level using life table approach. Surface average PM_2.5 concentration datasets covering Nigeria with spatial resolution of ∼1 km were obtained from the global gridded concentration fields, and combined with ∼1 km gridded population of the world (GPWv4), and global administrative unit layers (GAUL) for territorial boundaries classification. We estimate the loss or gains in longevity using population-weighted average pollution level and baseline mortality data for cardiopulmonary disease and lung cancer in adults ≥25 years and for respiratory infection in children under 5. As at 2015, there are six "highly polluted", thirty "polluted" and one "moderately polluted" States in Nigeria. People residing in these States lose ∼3.8-4.0, 3.0-3.6 and 2.7 years of life expectancy, respectively, due to the pollution exposure. But, assuming interventions achieve global air quality guideline of 10 μg/m³, longevity would increase by 2.6-2.9, 1.9-2.5 and 1.6 years for people in the State-categories, respectively. The longevity gains are indeed high, but to achieve them, mitigation interventions should target emission sources having the highest population exposures.

The health burden and economic costs averted by ambient PM2.5 pollution reductions in Nagpur, India

National estimates of the health and economic burdens of exposure to ambient fine particulate matter (PM_2.5) in India reveal substantial impacts. This information, often lacking at the local level, can justify and drive mitigation interventions. Here, we assess the health and economic gains resulting from attainment of WHO guidelines for PM_2.5 concentrations - including interim target 2 (IT-2), interim target 3 (IT-3), and the WHO air quality guideline (AQG) - in Nagpur district to inform policy decision making for mitigation. We conducted a detailed assessment of concentrations of PM_2.5 in 9 areas, covering urban, peri-urban and rural environments, from February 2013 to June 2014. We used a combination of hazard and survival analyses based on the life table method to calculate attributed annual number of premature deaths and disability-adjusted life years (DALYs) for five health outcomes linked to PM_2.5 exposure: acute lower respiratory infection for children <5years, ischemic heart disease, chronic obstructive pulmonary disease, stroke and lung cancer in adults ≥25years. We used GBD 2013 data on deaths and DALYs for these diseases. We calculated averted deaths, DALYs and economic loss resulting from planned reductions in average PM_2.5 concentration from current level to IT-2, IT-3 and AQG by the years 2023, 2033 and 2043, respectively. The economic cost for premature mortality was estimated as the product of attributed deaths and value of statistical life for India, while morbidity was assumed to be 10% of the mortality cost. The annual average PM_2.5 concentration in Nagpur district is 34±17μgm^-3 and results in 3.3 (95% confidence interval [CI]: 2.6, 4.2) thousand premature deaths and 91 (95% CI: 68, 116) thousand DALYs in 2013 with economic loss of USD 2.2 (95% CI: 1.7, 2.8) billion in that year. It is estimated that interventions that achieve IT-2, IT-3 and AQG by 2023, 2033 and 2043, would avert, respectively, 15, 30 and 36%, of the attributed health and economic loss in those years, translating into an impressively large health and economic gain. To achieve this, we recommend an exposure-integrated source reduction approach.

Addressing Environmental Health Inequalities

Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), “Addressing Environmental Health Inequalities—Proceedings from the ISEE Conference 2015”, we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics.