Air pollution and non-respiratory health hazards for children

The effect of PM2.5 on acute sinusitis: A population-based study

KEY POINTS

PM2.5 exposure is a risk factor for the development of acute sinusitis. PM2.5 exposure affects acute sinusitis in a dose response fashion.

Exposure assessment of metal(loids) in indoor air and biomonitoring in six urban residential areas in Iran

Exposure to metal(loid)s can cause adverse health effects. This study evaluated the concentrations of aluminum, arsenic, cadmium, chromium, mercury, nickel, and lead in particulate matter <10 μm (PM10) and in the urine of 100 participants from urban residential areas in Iran. A total of 100 residential buildings (one adult from each household) in six cities across Iran were recruited for this study. The levels of metal(loid)s in PM10 and the urine of participants were measured using acid digestion followed by inductively coupled plasma mass spectrometry (ICP-MS). The average (±SE) PM10 concentration in the buildings was 51.7 ± 3.46 μg/m3. Aluminum and cadmium had the highest and lowest concentrations among the metal(loid)s, averaging 3.74 ± 1.26 μg/m3 and 0.01 ± 0.001 μg/m3, respectively. In 85 % of the samples, the concentration of metal(loid)s in indoor air exceeded WHO air quality standards. Cadmium and lead had the highest and lowest numbers of indoor air samples exceeding the recommended standards, respectively. A significant correlation was found between the concentration of metal(loid)s in urine samples and indoor PM10 levels, as well as the wealth index of participants. There was also a significant direct relationship between the concentrations of nickel, arsenic, lead, and mercury in urine and the age of participants. Factors such as building location, type of cooling systems, use of printers at home, and natural ventilation influenced the concentration and types of metal(loid)s in the indoor air.

Increased vascular stiffness in children exposed in utero but not children exposed postnatally to emissions from a coal mine fire

Background

Chronic, low-intensity air pollution exposure has been consistently associated with increased atherosclerosis in adults. However, there was limited research regarding the implications of acute, high-intensity air pollution exposure during childhood. We aimed to determine whether there were any associations between early-life exposure to such an episode and early-life vascular function changes.

Methods

We conducted a prospective cohort study of children (<9 years old) who lived in the vicinity of the Hazelwood coal mine fire (n = 206). Vascular function was measured using noninvasive diagnostic methods including carotid intima-media thickness and pulse wave velocity (PWV). Exposure estimates were calculated from prognostic models and location diaries during the exposure period completed by each participant's parent. Linear mixed-effects models were used to determine whether there were any associations between exposure and changes in vascular outcomes at the 3- and 7-year follow-ups and over time.

Results

At the 7-year follow-up, each 10 μg/m3 increase in daily PM2.5 in utero was associated with increased PWV (β = 0.13 m/s; 95% confidence interval [CI] = 0.02, 0.24; P = 0.02). The association between in utero exposure to daily PM2.5 was not altered by adjustment for covariates, body mass index, and maternal fire stress. Each 1 µg/m3 increase in background PM2.5 was associated with increased PWV (β = 0.68 m/s; 95% CI = 0.10, 1.26; P = 0.025), in children from the in utero exposure group. There was a trend toward smaller PWV (β = -0.17 m/s; 95% CI = -0.366, 0.02) from the 3- to 7-year follow-up clinic suggesting that the deficits observed previously in children exposed postnatally did not persist.

Conclusion

There was a moderate improvement in vascular stiffness of children exposed to PM2.5 from a local coal mine fire in infancy. There was a mild increase in vascular stiffness in children exposed to PM2.5 from a local coal mine fire while their mothers were pregnant.

Navigating Nigeria's Health Landscape: Population Growth and Its Health Implications

This comprehensive analysis examines the multifaceted impacts of population growth on public health in Nigeria. Drawing parallels with Omran's epidemiological transition model (that focuses on the intricate means that patterns of health and illness are changing, as well as the relationships that exist between these patterns and the sociological, demographic, and economic factors that influence them) and referencing experiences from Chile and Ceylon. The study highlights a substantial rise in Nigeria's population causing a double burden of infectious and non-communicable diseases, leading to higher morbidity, and mortality rates, increased healthcare costs, decreased productivity, and health inequalities, posing significant challenges to the country's healthcare system. Furthermore, the correlation between low education levels and health outcomes underscores the importance of addressing systemic deficiencies in Nigeria's educational sector. The article emphasizes the urgent need for strategic interventions to mitigate the adverse effects of population growth on health. Recommendations include revitalizing primary healthcare centers, fostering public-private partnerships to enhance healthcare accessibility, leveraging technological advancements like telemedicine, and promoting initiatives to improve nutrition and environmental sustainability. Moreover, prioritizing education on reproductive health and family planning emerges as a crucial strategy to manage population growth sustainably. In conclusion, the article underscores the imperative for collaborative efforts across sectors to navigate Nigeria's evolving health landscape amidst increasing population growth. By implementing targeted policies and interventions, Nigeria can strive toward achieving universal health coverage, enhancing health outcomes, and ultimately raising the standard of living for its populace.

Associations between plasma metabolites and heavy metal exposure in residents of environmentally polluted areas

Heavy metals are commonly released into the environment through industrial processes such as mining and refining. The rapid industrialization that occurred in South Korea during the 1960s and 1970s contributed significantly to the economy of the country; however, the associated mining and refining led to considerable environmental pollution, and although mining is now in decline in South Korea, the detrimental effects on residents inhabiting the surrounding areas remain. The bioaccumulation of toxic heavy metals leads to metabolic alterations in human homeostasis, with disruptions in this balance leading to various health issues. This study used metabolomics to explore metabolomic alterations in the plasma samples of residents living in mining and refining areas. The results showed significant increases in metabolites involved in glycolysis and the surrounding metabolic pathways, such as glucose-6-phosphate, phosphoenolpyruvate, lactate, and inosine monophosphate, in those inhabiting polluted areas. An investigation of the associations between metabolites and blood clinical parameters through meet-in-the-middle analysis indicated that female residents were more affected by heavy metal exposure, resulting in more metabolomic alterations. For women, inhabiting the abandoned mine area, metabolites in the glycolysis and pentose phosphate pathways, such as ribose-5-phosphate and 3-phosphoglycerate, have shown a negative correlation with albumin and calcium. Finally, Mendelian randomization(MR) was used to determine the causal effects of these heavy metal exposure-related metabolites on heavy metal exposure-related clinical parameters. Metabolite biomarkers could provide insights into altered metabolic pathways related to exposure to toxic heavy metals and improve our understanding of the molecular mechanisms underlying the health effects of toxic heavy metal exposure.

Health effects of shrinking hyper-saline lakes: spatiotemporal modeling of the Lake Urmia drought on the local population, case study of the Shabestar County

Climate change and its respective environmental impacts, such as dying lakes, is widely acknowledged. Studies on the impact of shrinking hyper-saline lakes suggest severe negative consequences for the health of the affected population. The primary aim was to investigate the relationship between changes in the water level of the hyper-saline Lake Urmia, along with the associated salt release, and the prevalence of hypertension and the general state of health of the local population in Shabestar County north of the lake. Moreover, we sought to map the vulnerability of the local population to the health risks associated with salt-dust scatter using multiple environmental and demographic characteristics. We applied a spatiotemporal analysis of the environmental parameters of Lake Urmia and the health of the local population. We analyzed health survey data from local health care centers and a national STEPS study in Shabestar County, Iran. We used a time-series of remote sensing images to monitor the trend of occurrence and extent of salt-dust storms between 2012 and 2020. To evaluate the impacts of lake drought on the health of the residences, we investigated the spatiotemporal correlation of the lake drought and the state of health of local residents. We applied a GIScience multiple decision analysis to identify areas affected by salt-dust particles and related these to the health status of the residents. According to our results, the lake drought has significantly contributed to the increasing cases of hypertension in local patients. The number of hypertensive patients has increased from 2.09% in 2012 to 19.5% in 2019 before decreasing slightly to 16.05% in 2020. Detailed results showed that adults, and particularly females, were affected most by the effects of the salt-dust scatter in the residential areas close to the lake. The results of this study provide critical insights into the environmental impacts of the Lake Urmia drought on the human health of the residents. Based on the results we suggest that detailed socioeconomic studies might be required for a comprehensive analysis of the human health issues in this area. Nonetheless, the proposed methods can be applied to monitor the environmental impacts of climate change on human health.

Bioinorganic Nanoparticles for the Remediation of Environmental Pollution: Critical Appraisal and Potential Avenues

Nowadays, environmental pollution has become a critical issue for both developed and developing countries. Because of excessive industrialization, burning of fossil fuels, mining and exploration, extensive agricultural activities, and plastics, the environment is being contaminated rapidly through soil, air, and water. There are a variety of approaches for treating environmental toxins, but each has its own set of restrictions. As a result, various therapies are accessible, and approaches that are effective, long-lasting, less harmful, and have a superior outcome are extensively demanded. Modern research advances focus more on polymer-based nanoparticles, which are frequently used in drug design, drug delivery systems, environmental remediation, power storage, transformations, and other fields. Bioinorganic nanomaterials could be a better candidate to control contaminants in the environment. In this article, we focused on their synthesis, characterization, photocatalytic process, and contributions to environmental remediation against numerous ecological hazards. In this review article, we also tried to explore their recent advancements and futuristic contributions to control and prevent various pollutants in the environment.

Synergistic or Antagonistic Health Effects of Long- and Short-Term Exposure to Ambient NO2 and PM2.5: A Review

Studies on adverse health effects associated with air pollution mostly focus on individual pollutants. However, the air is a complex medium, and thus epidemiological studies face many challenges and limitations in the multipollutant approach. NO₂ and PM_2.5 have been selected as both originating from combustion processes and are considered to be the main pollutants associated with traffic; moreover, both elicit oxidative stress responses. An answer to the question of whether synergistic or antagonistic health effects of combined pollutants are demonstrated by pollutants monitored in ambient air is not explicit. Among the analyzed studies, only a few revealed statistical significance. Exposure to a single pollutant (PM_2.5 or NO₂) was mostly associated with a small increase in non-accidental mortality (HR:1.01-1.03). PM_2.5 increase of <10 µg/m³ adjusted for NO₂ as well as NO₂ adjusted for PM_2.5 resulted in a slightly lower health risk than a single pollutant. In the case of cardiovascular heart disease, mortality evoked by exposure to PM_2.5 or NO₂ adjusted for NO₂ and PM_2.5, respectively, revealed an antagonistic effect on health risk compared to the single pollutant. Both short- and long-term exposure to PM_2.5 or NO₂ adjusted for NO₂ and PM_2.5, respectively, revealed a synergistic effect appearing as higher mortality from respiratory diseases.

Recent Advanced in MXene Research toward Biosensor Development

MXene is a rapidly emerging group of two-dimensional (2D) multifunctional nanomaterials, drawing huge attention from researchers of a broad scientific field. Reporting the synthesis of MXene was the following breakthrough in 2D materials following the discovery of graphene. MXene is considered the most recent developments of materials, including transition metal carbonitrides, nitrides, and carbides synthesized by etching or mechanical-based exfoliation of selective MAX phases. MXene has a plethora of prodigious properties such as unique interlayer spacing, high ion and electron transport, large surface area, excellent thermal and electrical conductivity, exceptional volumetric capacitance, thermal shock, and oxidation resistance, easily machinable and inherently hydrophilic, and biocompatibility. Owing to the abundance of tailorable surface function groups, these properties can be further enhanced by surface functionalization with covalent and non-covalent modifications via numerous surface functionalization methods. Therefore, MXene finds their way to a plethora of applications in numerous fields including catalysis, membrane separation, energy storage, sensing, and biomedicine. Here, the focus is on reviewing the structure, synthesis techniques, and functionalization methods of MXene. Furthermore, MXene-based detection platforms in different sensing applications are survived. Great attention is given to reviewing the applications of MXene in the detection of biomolecules, pathogenic bacteria and viruses, cancer biomarkers food contaminants and mycotoxins, and hazardous pollutants. Lastly, the future perspective of MXene-based biosensors as a next-generation diagnostics tool is discussed. Crucial visions are introduced for materials science and sensing communities to better route while investigating the potential of MXene for creating innovative detection mechanisms.

How Does Government Efficiency Affect Health Outcomes? The Empirical Evidence from 156 Countries

This paper uses the unbalanced panel data of 156 countries during the period of 2002 to 2018 to explore the possible impact of government efficiency on health outcomes. Firstly, we used the fixed-effect model to examine the relationship between government efficiency and health outcomes and found that the increase in government efficiency can significantly improve health outcomes. Then, a series of robustness checks were carried out, which confirmed the reliability of the above result. Thirdly, this paper conducted a heterogeneity analysis from the perspective of life cycle. Fourthly, this paper investigated the mechanisms of the impact of government efficiency on health outcomes from the perspectives of economic growth, health innovation, education and corruption control. Finally, this paper studied the moderating effects of the ruling party’s ideology and democracy on the relationship between government efficiency and health outcomes. The findings of this study provide some references for governments to improve health outcomes.

Improving the air quality with Functionalized Carbon Nanotubes: Sensing and remediation applications in the real world

With the world developing exponentially every day, the collateral damage to air is incessant. There are many methods to purify the air but using carbon nanotubes (CNTs) as adsorbents remains one of the most efficient and reliable methods, due to their high maximum adsorption capacity which renders them extremely useful for removing pollutants from the air. The different types of CNTs, their synthesis, functionalization, purification, functioning, and advantages over conventional filters are deliberated along with diverse types of CNTs like single-walled (SWCNTs), multiwalled (MWCNTs), and others, which can be functionalized and deployed for the removal of harmful gases like oxides of nitrogen and sulphur, and ozone, and volatile organic compounds (VOCs), among others. A comprehensive description of CNTs is provided in this overview with illustrative examples from the past five years. The fabrication methods and target gases of many CNTs-based gas sensors are highlighted, in addition to the comparison of their properties, mainly sensitivity. The effect of functionalization on sensors has been discussed in detail for various composites targeting specific gases, including the future outlook of functionalized CNTs in assorted practical applications.

Air Quality, Pollution and Sustainability Trends in South Asia: A Population-Based Study

Introduction: Worsening air quality and pollution lead to numerous environmental health and sustainability issues in the South Asia region. This study analyzes India, Nepal, Bangladesh, Pakistan, Sri Lanka, and Nepal for air quality data trends and sustainability indicators. Methodology: By using a population-based study design, six South Asian countries were analyzed using a step-wise approach. Data were obtained from government websites and publicly available repositories for region dynamics and key variables. Results: Between 1990 and 2020, air quality data indicated the highest rise in CO₂ emissions in India (578.5 to 2441.8 million tons) (MT), Bangladesh, Nepal, and Pakistan. Greenhouse gas emissions, from 1990 to 2018, nearly tripled in India (1990.4 to 3346.6 MT of CO₂-equivalents), Nepal (20.6 to 54.6 MT of CO₂-equivalents), and Pakistan, and doubled in Bangladesh. Methane emissions rose the highest in Pakistan (70.4 to 151 MT of CO₂-equivalents), followed by Nepal (17 to 31 MT of CO₂-equivalents) and India (524.8 to 669.3 MT of CO₂-equivalents). Nitrous oxide nearly doubled in Bangladesh (16.5 to 29.3 MT of CO₂-equivalents), India (141.6 to 256.9 MT of CO₂-equivalents), Nepal (17 to 31 MT of CO₂-equivalents), and more than doubled in Pakistan (27 to 61 MT of CO₂-equivalents). On noting particulate matter 2,5 annual exposure, India saw the highest rise from 81.3 µg/m³ (in 1990) to 90.9 µg/m³ (2017), whereas trends were steady in Pakistan (60.34 to 58.3 µg/m³). The highest rise was noted in Nepal (87.6 to 99.7 µg/m³) until 2017. During the coronavirus disease 19 pandemic, the pre-and post-pandemic changes between 2018 and 2021 indicated the highest PM_2.5 concentration in Bangladesh (76.9 µg/m³), followed by Pakistan (66.8 µg/m³), India (58.1 µg/m³), Nepal (46 µg/m³) and Sri Lanka (17.4 µg/m³). Overall, South Asian countries contribute to the worst air quality and sustainability trends regions worldwide. Conclusions: Air pollution is prevalent across a majority of South Asia countries. Owing to unsustainable industrial practices, pollution trends have risen to hazardous levels. Economic, environmental, and human health impacts have manifested and require urgent, concerted efforts by governing bodies in the region.

Nanomaterials for Remediation of Environmental Pollutants

Today, environmental contamination is a big concern for both developing and developed countries. The primary sources of contamination of land, water, and air are extensive industrialization and intense agricultural activities. Various traditional methods are available for the treatment of different pollutants in the environment, but all have some limitations. Due to this, an alternative method is required which is effective and less toxic and provides better outcomes. Nanomaterials have attracted a lot of interest in terms of environmental remediation. Because of their huge surface area and related high reactivity, nanomaterials perform better in environmental clean-up than other conventional approaches. They can be modified for specific uses to provide novel features. Due to the large surface-area-to-volume ratio and the presence of a larger number of reactive sites, nanoscale materials can be extremely reactive. These characteristics allow for higher interaction with contaminants, leading to a quick reduction of contaminant concentration. In the present review, an overview of different nanomaterials that are potential in the remediation of environmental pollutants has been discussed.

Climate change, environment pollution, COVID-19 pandemic and mental health

Converging data would indicate the existence of possible relationships between climate change, environmental pollution and epidemics/pandemics, such as the current one due to SARS-CoV-2 virus. Each of these phenomena has been supposed to provoke detrimental effects on mental health. Therefore, the purpose of this paper was to review the available scientific literature on these variables in order to suggest and comment on their eventual synergistic effects on mental health. The available literature report that climate change, air pollution and COVID-19 pandemic might influence mental health, with disturbances ranging from mild negative emotional responses to full-blown psychiatric conditions, specifically, anxiety and depression, stress/trauma-related disorders, and substance abuse. The most vulnerable groups include elderly, children, women, people with pre-existing health problems especially mental illnesses, subjects taking some types of medication including psychotropic drugs, individuals with low socio-economic status, and immigrants. It is evident that COVID-19 pandemic uncovers all the fragility and weakness of our ecosystem, and inability to protect ourselves from pollutants. Again, it underlines our faults and neglect towards disasters deriving from climate change or pollution, or the consequences of human activities irrespective of natural habitats and constantly increasing the probability of spillover of viruses from animals to humans. In conclusion, the psychological/psychiatric consequences of COVID-19 pandemic, that currently seem unavoidable, represent a sharp cue of our misconception and indifference towards the links between our behaviour and their influence on the "health" of our planet and of ourselves. It is time to move towards a deeper understanding of these relationships, not only for our survival, but for the maintenance of that balance among man, animals and environment at the basis of life in earth, otherwise there will be no future.

Sustainable Urban Mobility Plan and Health Security

The topic of sustainable mobility is now a priority at the urban level. Today’s cities are often very busy, polluted, and dangerous. Therefore, to encourage sustainable mobility is important; it brings territorial development, environment, health, society, and economy benefits. The corona virus disease-19 (COVID) emergency, which occurred at the beginning of 2020, highlighted the already critical situation in many cities and how our mobility habits were not, even before, so sustainable. Within sustainable mobility, the concept of safety and security is important to consider. In the literature, safe mobility is often associated with the theme of accidents. The pandemic has highlighted the need to consider safety also from a health point of view. Municipalities, as known, also according to European guidelines, have a specific tool at their disposal to promote sustainable mobility: the Sustainable Urban Mobility Plan (SUMP). This paper intends to propose a methodological approach aimed at integrating the health security aspect in the SUMP. In this research, in order to promote safe mobility, different aspects were considered: accidents, risk perception, and health emergencies. For each aspect, specific indicators and good practices were proposed for the achievement and monitoring of the expected results. The paper refers to the European context with particular attention to Italy; La Spezia was chosen as a case study.

Detection of Particulate Matters with a Field-Portable Microscope Using Side-Illuminated Total Internal Reflection

Field-portable observation and analysis of particulate matter (PM) is required to enhance healthy lives. Various types of the PM measurement methods are in use; however, each of these methods has significant limitations in that real time measurement is impossible, the detection system is bulky, or the measurement accuracy is insufficient. In this work, we introduce an optical method to perform a fast and accurate PM analysis with a higher-contrast microscopic image enabled by a side-illuminated total internal reflection (TIR) technique to be implemented in a compact device. The superiority of the proposed method was quantitatively demonstrated by comparing the signal-to-noise ratio of the proposed side-illuminated TIR method with a traditional halogen lamp-based transmission microscope. With the proposed device, signal-to-noise ratios (SNRs) for microbeads (5~20 µm) and ultrafine dust particles (>5 µm) increased 4.5~17 and 4~10 dB, respectively, compared to the conventional transmission microscope. As a proof of concept, the proposed method was also applied to a low-cost commercial smartphone toy microscope enabling field-portable detection of PMs. We believe that the proposed side-illuminated TIR PM detection device holds significant advantages over other commonly used systems due to its sufficient detection capability along with simple and compact configuration as well as low cost.

Independent and joint contributions of economic, social and physical environmental characteristics to mortality in the Detroit Metropolitan Area: A study of cumulative effects and pathways

OBJECTIVE

Previous studies have demonstrated associations between race-based residential segregation, neighborhood socioeconomic and physical environmental characteristics, and mortality. Relatively few studies have examined independent and joint effects of these multiple neighborhood characteristics and mortality, including potential mediating pathways. In this study we examine the extent to which associations between race-based residential segregation and all-cause mortality may be explained by multiple socioeconomic indicators and exposure to air pollutants.

METHODS

Drawing on data from multiple sources, we assessed bivariate associations between race-based residential segregation (operationalized as percent non-Hispanic Black), education (percent with graduate equivalency degree), poverty (percent below poverty), income inequality (GINI coefficient) and air pollution (ambient PM2.5) and age adjusted all-cause, all race mortality (henceforth all cause mortality) at the census tract level in the Detroit Metropolitan Area. We used inequality curves to assess the (in)equitable distribution of economic and environmental characteristics by census tract racial composition. Finally, we used generalized estimating equations (GEE) to examine independent and joint associations among percent NHB, education, income inequality, and air pollution to all-cause mortality, and test for mediating effects.

RESULTS

Bivariate associations between racial composition, education, poverty, income inequality, PM2.5 and all-cause mortality were statistically significant. Census tracts with higher concentrations of NHB residents had significantly lower educational attainment, higher poverty, and greater exposure to PM2.5. In multivariate models, education, income inequality and PM2.5 fully attenuated associations between racial composition and all-cause mortality.

CONCLUSIONS

Results are consistent with the hypothesis that race-based residential segregation is associated with heightened all-cause mortality, and that those effects are mediated by education, income inequality, and exposure to air pollution at the census tract level. Public health and cross-sector interventions to eliminate race-based residential segregation or to eliminate the maldistribution of educational and economic resources, and environmental exposures, across census tracts could substantially reduce regional inequities in all-cause mortality.

Adolescent Haze-Related Knowledge Level Study: A Cross-Sectional Survey With Sensitivity Analysis

Objective: This study aimed to investigate the level of haze-related knowledge adolescents have and to explore relevant influencing factors. Methods: From June 2015 to January 2016, researchers randomly selected 2 districts from the 20 districts of Baoding, China. Then, researchers randomly selected two middle schools from two districts. By conducting a stratified cluster sampling and considering one class as a unit, researchers randomly selected, from the other middle school, five first-grade classes, five second-grade classes, five third-grade classes from the one middle school, and three first-grade classes, two second-grade classes, and two third-grade classes. Finally, 1,100 adolescents were investigated by using the demographic questionnaire and the Adolescent Haze-Related Knowledge Awareness Assessment Scale (AHRKAAS). Multiple linear regressions were conducted to explore factors affecting the adolescent haze-related knowledge. Sensitivity analysis was used to confirm associations between influencing factors and AHRKAAS scores. Results: The AHRKAAS score rate was 69.9%. The dimension of human factors of haze formation was the highest (score rate = 85.6%). The dimension of haze harms on the human body was the lowest (score rate = 57.1%). Compared with the group (monthly expenses <300 yuan), the group (monthly expenses ≥ 600 yuan) had a higher AHRKAAS score (β = 4.882, 95% CI: 0.979, 8.784). Compared with the group (Do not live with parents), the group (Live with parents) had a higher AHRKAAS score (β = 14.675, 95% CI: 9.494, 19.855). Compared with the group (Never undergo a physical examination), the group (Once a year) (β = 7.444, 95% CI: 2.922, 11.966) and the group (A few times a year) (β = 7.643, 95% CI: 2.367, 12.919) had a higher AHRKAAS score. Compared with the group (Know nothing), the group (Know most) (β = 9.623, 95% CI: 2.929, 16.316) and the group (Know very well) (β = 15.367, 95% CI: 7.220, 23.515) had a higher AHRKAAS score. These associations were still reliable and consistent in different sensitivity analysis models. Conclusion: The level of adolescent haze-related knowledge is low and is affected by monthly expenses, living condition, physical examination frequency, and knowledge of respiratory system diseases. Government bodies, schools, and research institutions should strengthen cooperation of health publicity and health education to improve adolescent haze-related knowledge.

Environmental and Health Impacts of Air Pollution: A Review

One of our era's greatest scourges is air pollution, on account not only of its impact on climate change but also its impact on public and individual health due to increasing morbidity and mortality. There are many pollutants that are major factors in disease in humans. Among them, Particulate Matter (PM), particles of variable but very small diameter, penetrate the respiratory system via inhalation, causing respiratory and cardiovascular diseases, reproductive and central nervous system dysfunctions, and cancer. Despite the fact that ozone in the stratosphere plays a protective role against ultraviolet irradiation, it is harmful when in high concentration at ground level, also affecting the respiratory and cardiovascular system. Furthermore, nitrogen oxide, sulfur dioxide, Volatile Organic Compounds (VOCs), dioxins, and polycyclic aromatic hydrocarbons (PAHs) are all considered air pollutants that are harmful to humans. Carbon monoxide can even provoke direct poisoning when breathed in at high levels. Heavy metals such as lead, when absorbed into the human body, can lead to direct poisoning or chronic intoxication, depending on exposure. Diseases occurring from the aforementioned substances include principally respiratory problems such as Chronic Obstructive Pulmonary Disease (COPD), asthma, bronchiolitis, and also lung cancer, cardiovascular events, central nervous system dysfunctions, and cutaneous diseases. Last but not least, climate change resulting from environmental pollution affects the geographical distribution of many infectious diseases, as do natural disasters. The only way to tackle this problem is through public awareness coupled with a multidisciplinary approach by scientific experts; national and international organizations must address the emergence of this threat and propose sustainable solutions.

Glutathione Transferase P1-1 an Enzyme Useful in Biomedicine and as Biomarker in Clinical Practice and in Environmental Pollution

Glutathione transferase P1-1 (GSTP1-1) is expressed in some human tissues and is abundant in mammalian erythrocytes (here termed e-GST). This enzyme is able to detoxify the cell from endogenous and exogenous toxic compounds by using glutathione (GSH) or by acting as a ligandin. This review collects studies that propose GSTP1-1 as a useful biomarker in different fields of application. The most relevant studies are focused on GSTP1-1 as a biosensor to detect blood toxicity in patients affected by kidney diseases. In fact, this detoxifying enzyme is over-expressed in erythrocytes when unusual amounts of toxins are present in the body. Here we review articles concerning the level of GST in chronic kidney disease patients, in maintenance hemodialysis patients and to assess dialysis adequacy. GST is also over-expressed in autoimmune disease like scleroderma, and in kidney transplant patients and it may be used to check the efficiency of transplanted kidneys. The involvement of GSTP in the oxidative stress and in other human pathologies like cancer, liver and neurodegenerative diseases, and psychiatric disorders is also reported. Promising applications of e-GST discussed in the present review are its use for monitoring human subjects living in polluted areas and mammals for veterinary purpose.

Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis

BACKGROUND

Multiple sclerosis (MS) is one of the most common neurological disorders and is one of the main causes of disability. The prevalence and incidence of MS in Iran is reported to range from 5.3 to 89/ 100,000and 7 to 148.1/ 100,000, respectively. There are no systematic and meta-analysis studies on MS in Iran. Therefore, this study was conducted to investigate the prevalence and incidence of MS in Iran using meta-analysis.

METHOD

A systematic review of the present study focused on MS epidemiology in Iran based on PRISMA guidelines for systematic review and meta-analysis. We searched eight international databases including Scopus, PubMed, Science Direct, Cochrane Library, Web of Science, EMBASE, PsycINFO, Google Scholar search engine and six Persian databases for peer-reviewed studies published without time limit until May 2018. Data were analyzed using Comprehensive meta-analysis ver. 2 software. The review protocol has been registered in PROSPERO with ID: CRD42018114491.

RESULTS

According to searching on different databases, 39 (15%) articles finalized. The prevalence of MS in Iran was estimated 29.3/ 100,000 (95%CI: 25.6-33.5) based on random effects model. The prevalence of MS in men and women was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and 44.8/ 100,000 (95%CI: 36.3-61.6), respectively. The incidence of MS in Iran was estimated to be 3.4/ 100,000 (95%CI: 1.8-6.2) based on random effects model. The incidence of MS in men was estimated to be 16.5/ 100,000 (95%CI: 13.7-23.4) and the incidence of MS in women was 44.8/ 100,000 (95%CI: 36.3-61.6). The meta-regression model for prevalence and incidence of MS was significantly higher in terms of year of study (p<0.001).

CONCLUSIONS

The results of this study can provide a general picture of MS epidemiology in Iran. The current meta-analysis showed that the prevalence and incidence of MS in Iran is high and is rising over time.

Independent and Joint Contributions of Fine Particulate Matter Exposure and Population Vulnerability to Mortality in the Detroit Metropolitan Area

Fine particulate matter is associated with adverse health outcomes. Exposure to fine particulate matter may disproportionately affect urban communities with larger numbers of vulnerable residents. We used multilevel logistic regression models to estimate the joint effects of fine particulate matter (PM_2.5) and population vulnerabilities on cardiopulmonary mortality (CPM). We estimated the health benefits of reductions in PM_2.5 across census tracts in the Detroit metropolitan area with varying levels of population vulnerability, using cluster-specific odds ratios scaled to reflect PM_2.5-attributable cardiopulmonary risk. PM_2.5 and population vulnerability were independently associated with odds of CPM. Odds of CPM and the number of deaths attributable to PM_2.5 were greatest in census tracts with both high PM_2.5 exposures and population vulnerability. Reducing PM_2.5 in census tracts with high PM_2.5 would lead to an estimated 18% annual reduction in PM_2.5-attributable CPM. Between 78–79% of those reductions in CPM would occur within census tracts with high population vulnerabilities. These health benefits of reductions in PM_2.5 occurred at levels below current U.S. reference concentrations. Focusing efforts to reduce PM_2.5 in the Detroit metropolitan area in census tracts with currently high levels would also lead to greater benefits for residents of census tracts with high population vulnerabilities.

Multiple sclerosis-A disease on a dramatically rising trend in Iran: Review of possible reasons

There has been a global rising trend in recent years in the incidence of multiple sclerosis (MS). Despite being an MS low-risk region, this disease has also been recently on the rise in the Middle East. As part of the Middle East, Iran has not been spared either; however, the cause of this dramatic increase remains to be discovered. This study reviews possible reasons for this increase in Iran. Although many factors such as the increased rate of smoking, lifestyle changes, modernization, and contact with toxic solvents can be proposed as reasons for this sudden rise in the prevalence of MS in Iran, these factors cannot be taken as definite causes and further studies are required to prove their impact.

Trends in health burden of ambient particulate matter pollution in Iran, 1990-2010: findings from the Global Burden of Disease study 2010

This paper aims to report the assessment of trends in deaths and disability-adjusted life years (DALYs) attributed to ambient particulate matter (PM) pollution from 1990 to 2010 by sex and age in Iran. We used the data of the Global Burden of Disease (GBD) 2010 Study, and then we extracted its data on Iran for the years 1990, 2005, and 2010. The proportion of deaths and the DALYs caused by specific risk factors were assessed by using the comparative risk assessment and calculating the attributed burden of exposure level to each risk factor compared with the theoretical minimum level of risk exposure. Uncertainties in distribution of exposure, relative risks, and relevant outcomes calculation were disseminated into the estimates of the attributable deaths and DALYs. We found that the age-standardized death rate attributed to ambient PM pollution decreased to 27.90 cases per 100,000 populations from 1990 to 2010 [86, 95% uncertainty interval (UI) 76-97 to 62; 95% UI 54-71 per 100,000 populations, respectively]. This was mainly because of greater decrease in cardiovascular diseases (CVDs) than in the other diseases attributed to PM pollution. Despite a decrease in the total DALYs and mortality rate attributed to PM pollution, the death percent increased by 6.94%, 95% UI 6.06-7.90% from 1990 to 2010. The number of the DALYs and death in age groups of more than 70 years increased in 2010 compared to that in 1990. The median percent change of the DALYs and death for all age groups shows that the DALYs and death increased by 6% (95% UI 8-19%) and 45% (95% UI 30-60%), respectively, in 2010 in comparison to that in 1990. The increase in the DALYs and mortality attributable to PM pollution emphasizes the necessity of the effective interventions for improving air quality, as well as for increasing the public awareness to reduce the exposure of vulnerable age groups to PM pollution.

The Evaluation of Multiple Sclerosis Dispersal in Iran and Its Association with Urbanization, Life Style and Industry

BACKGROUND

Multiple Sclerosis (MS) is an autoimmune disease with unknown factor. The prevalence and incidence rate of this disease had an upward trend in many regions in the world such as Middle east and consequently in Iran over the recent years. As the risk factors of this increased trend and high-prevalence is unknown in Iran, the current study has been designed to evaluate the correlation between MS dispersal with urbanization, life style and industry, as an ecological research.

METHODS

This retrospective study was designed as an ecological approach in 2011. Data were collected from three databases by high precision (CI95%) from national registry plans. The subjects of study were provinces of Iran (n=31). The linear regression was used to perform statistical analyses.

RESULTS

The obtained results indicated an ascendant trend of MS during the recent years, as the incidence of this disease reached from 26.24/100000 (CI95%) people in 2006 to 44.53/100000 (CI95%) in 2011. There is a direct correlation (P<0.05) between the percentage of urbanization and the percentage of male smokers with the prevalence of MS in provinces.

CONCLUSION

The role of smoking was more highlighted in this study as a probable factor in increasing risk and causing MS disease. Urbanization could be introduced as an augmentative factor, but this is a combination of several complex factors that this effect must be appraised with smaller scale in other researches.

First report on the association of drinking water hardness and endothelial function in children and adolescents

INTRODUCTION

This study aims to investigate the relationship of water hardness and its calcium and magnesium content with endothelial function in a population-based sample of healthy children and adolescents.

MATERIAL AND METHODS

This case-control study was conducted in 2012 among 90 individuals living in two areas with moderate and high water hardness in Isfahan County, Iran. The flow-mediated dilatation (FMD) of the brachial artery and the serum levels of soluble adhesion molecules (sICAM-1, sVCAM-1) were measured as surrogate markers of endothelial function, and high-sensitivity C-reactive protein (hs-CRP), as a marker of inflammation.

RESULTS

Data of 89 participants (51% boys, mean age 14.75 (2.9) years) were complete. Those participants living in the area with high water hardness had higher FMD, hs-CRP, and soluble adhesion molecules (sICAM-1, sVCAM-1) than their counterparts living in the area with moderate water hardness. Multiple linear regression analysis showed that after adjustment for confounding factors of age, gender, body mass index, healthy eating index and physical activity level, total water hardness, as well as water content of calcium and magnesium, had a significant positive relationship with FMD. The corresponding associations were inverse and significant with soluble adhesion molecules (p < 0.05).

CONCLUSIONS

This study, which to the best of our knowledge is the first of its kind in the pediatric age group, suggests that water hardness, as well as its calcium and magnesium content, may have a protective role against early stages of atherosclerosis in children and adolescents.

Effect of particulate air pollution and passive smoking on surrogate biomarkers of endothelial dysfunction in healthy children

BACKGROUND

This study aimed to determine the association of ambient particulate matter (PM) on surrogate markers of endothelial function and inflammation in healthy children with or without exposure to second-hand smoke.

METHODS

This cross-sectional study was conducted in 2011 in Isfahan, which is the second largest and second most air-polluted city in Iran. The areas of the city with lowest and highest air pollution were determined, and in each area, 25 pre-pubescent boys with or without exposure to daily tobacco smoke at home were selected, i.e. 100 children were studied in total. Serum levels of C-reactive protein (CRP) and nitric oxide (NO) were measured.

RESULTS

Mean (SD) NO concentration was 7·87 (2·18) and 7·75 (2·04) μmol/L for participants not exposed and exposed to passive smoking, respectively, which is not statistically significant. The corresponding figures for CRP concentrations were 1·69 (0·89) and 2·13 (1·19) μg/ml (P = 0·04). Mean (SD) CRP concentration was significantly higher in children living in the highly polluted area than in those in the area of low pollution [2·11 (1·91) vs 1·60 (1·43) μg/ml, respectively, P = 0·02]. This difference was not significant for NO concentration. The regression analysis that examined the association between PM concentration (as independent variable) and CRP and NO levels (as dependent variables) in children not exposed to passive smoking demonstrated that increased PM was associated with a decrease in NO and an increase in CRP concentration. This finding shows that, regardless of passive smoking, PM10 concentration has a significant independent association with serum CRP and is inversely associated with NO levels.

CONCLUSION

The findings suggest that in healthy children PM concentration has a significant independent association with biomarkers of endothelial dysfunction and inflammation.

Expression of cord blood cytochrome P450 1A1 gene according to the air pollution level of the maternal residence area

BACKGROUND

This study aimed to compare the cytochrome P450 1A1 (CYP1A1) gene expression in the cord blood of infants born from mothers living in low- and high-air polluted areas.

MATERIALS AND METHODS

The study was conducted in Spring 2012 in Isfahan, the second large and air-polluted city in Iran. The study comprised 60 neonates, consisting of 30 infants born from mothers residing in areas with high levels of air pollution and an equal number of infants born in areas with a lower air pollution level. The umbilical cord blood sample was taken immediately after birth. The relative gene expression levels of CYP1A1 were examined using real time-polymerase chain reaction method.

RESULTS

CYP1A1 gene expression level was 3.3-fold higher in the group living in areas with higher pollution level than in the other group (P = 0.01). No significant difference existed in the mean values of maternal age, gestational age, the newborns' birth weight, and the gender distribution between the two groups.

CONCLUSION

This study provides confirmatory evidence of prenatal health hazards of ambient air pollution and highlights the need for pollution prevention programs to protect women of childbearing age and their children. The clinical implications of this study finding should be confirmed in future longitudinal studies.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.

Independent association between air pollutants and vitamin D deficiency in young children in Isfahan, Iran

OBJECTIVES

To determine the association between air pollution and vitamin D status in young children living in a sunny region.

METHODS

This cross-sectional study of 100 children aged 4-10 years in Isfahan was conducted during 2011-2012. This industrial city has an arid climate and is the second most air-polluted city in Iran. Children were selected by random cluster sampling from various areas with different levels of air pollution. The air quality index (AQI) was recorded and demographic variables, dietary habits and levels of physical activity were determined by validated questionnaires. Serum concentrations of 25-hydroxyvitamin D [25(OH)D], calcium, phosphate, alkaline phosphatase and parathyroid hormone were measured. The P for trend for median (interquartile range) of variables was assessed across the AQI quartiles. The associations between AQI and biochemical values were assessed by multiple linear regression after adjustment for age, gender, BMI, diet and pattern of physical activity.

RESULTS

Ninety-seven children (46.4% boys) completed the study. The median (interquartile range, IQR) of serum 25(OH) D was 37.4 (22.5, 81.6) nmol/L. Median dietary vitamin D intake was 11.7 μg/day, i.e. 78% of the required daily amount. Vitamin D deficiency and insufficiency were detected in 37.9% and 46.3% of children, respectively. Median (IQR) exposure to ultraviolet B radiation in the AQI Quartile 4 area was significantly lower than in the Quartile 1 area [0.36 (0.35-0.38) watts per square metre (W/m(2)) vs 0.41 (0.39-0.44) W/m(2), respectively, P = 0.04]. Likewise, the corresponding figure for serum 25(OH)D was 35.2 (22.5-45.2) vs 52.7 (44.9-81.6) nmol/L, respectively, P = 0.04. AQI was inversely associated with serum 25(OH)D, which remained significant after adjustment for the above-mentioned confounding factors (β = 0.61, P = 0.01).

CONCLUSION

The independent inverse association of AQI with 25(OH)D explains the high prevalence of vitamin D deficiency in children in Isfahan. Dietary intake of vitamin D was not sufficiently low to explain the very low level of serum 25(OH)D. In regions with plenty of sunlight, air pollution should be considered to be a factor in the causation of hypovitaminosis D.

Association of air pollution on birth outcomes in New Delhi - a pilot study on the potential of HMIS data for environmental public health tracking

OBJECTIVES

The study objective was to assess the gaps in current hospital health management information systems (ie. paper based records of prenatal, delivery, neonatal, discharge data) for environmental studies. This study also considers the feasibility of linking patient-level hospital data with ambient air pollution data recorded in real time by air quality monitoring stations.

METHODS

This retrospective hospital based cohort study used a semi-ecologic design to explore the association of air pollution with a neonate's birth weight and gestational age. Maternal and neonatal data from 2007-2012 were encoded and linked with air pollution data based on distance to the nearest air quality monitoring station. Completeness and accuracy of neonatal anthropometric measures, maternal demographic information, nutritional status and maternal risk factors (gestational diabetes, anaemia, hypertension, etc.) were assessed.

RESULTS

The records of 10,565 births in Sir Ganga Ram hospital in New Delhi were encoded and linked with real time air quality data. These were records of women who reported a New Delhi address during the time of delivery. The distance of each address to all the monitoring stations were recorded. Birth records were assigned pollution exposure levels averaged across records from monitoring stations within 10 kilometers of the address during the pregnancy period.

CONCLUSION

This pilot study will highlight the potential of hospital management information system in linking administrative hospital record data with information on environmental exposure. The linked health-exposure dataset can then be used for studying the impact of various environmental exposures on health outcomes. Mother's educational attainment, occupation, residential history, nutritional status, tobacco and alcohol use during pregnancy need to be documented for better health risk assessments or case management. Health institutions can provide data for public health researchers and environmental scientists and can serve as the backbone of an environmental public health tracking system.

Rye grains and the soil derived from under the organic and conventional rye crops as a potential source of biological agents causing respiratory diseases in farmers

Introduction

Introduction: Due to the specific work environment, farmers are exposed to various biological occupational hazard. Among these factors significant are fungi present in the grain and also in the soil. The fungi may be the cause of human diseases including skin infections, asthma, allergic rhinitis and many others.

Aim

The aim of this study was to quantify and identify species of fungi colonizing rye grain samples and the soil under cultivation.

Material and methods

The material consisted of grain and soil samples from two agricultural systems: organic and conventional. To determine the concentration and composition of fungi in collected samples, two media: Malt Agar (MA, Becton, Dickinson and Company) and Potato Dextrose Agar (PDA, Becton, Dickinson and Company) were used. The composition of species in fungal flora was determined using macroscopic and microscopic methods. The isolates of fungi were ranked in the appropriate classes of biosafety BSL.

Results

The most frequently isolated fungi from organic rye grain, regardless of the media used, were species: Aureobasidium pullulans and Alternaria alternata. In conventional farms, most species isolated from rye grain were: Aureobasidium pullulans, Cladosporium oxysporum, Alternaria alternata and yeast-like fungi. Most often species isolated from the soil was Penicillium citreo-viride.

Conclusions

All the results of the research demonstrate the potential hazard to the health of people working in agriculture. Significant exposure of this professional group is associated with the presence of harmful biological agents present in the grain and soil from its cultivation.

Grain dust originating from organic and conventional farming as a potential source of biological agents causing respiratory diseases in farmers

Introduction

Agricultural producers are exposed to a number of different health risks associated with their work environment.

Aim

The objective of the study was to assess the degree of colonization by fungi in terms of quantity and in terms of variety of species the samples taken from the settled dust from combine threshing of rye cultivation from organic and conventional farms in the Province of Lublin.

Material and methods

This paper is a preliminary quantitative assessment of the species of fungi colonizing the samples of settled dust collected during combine threshing from organic and conventional farms in the Province of Lublin. One of the stages of the project was the classification of biosafety BSL (biosafety level) of selected isolates and API ZYM tests to evaluate the potential ability of isolates to cause adverse health effects. To determine the concentration and composition of fungi in collected samples plate dilution method was used with two media: Malt Agar and Potato Dextrose Agar.

Results

Most commonly isolated fungi in settled dust samples collected during combine threshing from organic farms, on PDA medium were: Alternaria alternata and Aureobasidium pullulans. Cultures on MA medium were dominated by Alternaria alternata, Mycelia sterilia and Fusarium poae. In samples of dust from conventional crops, the predominant species was Alternaria alternata on PDA medium and on MA medium.

Conclusions

The obtained results show a potential risk of people involved in agricultural work.

The normal growth of the tracheal wall in human foetuses

INTRODUCTION

Tracheal wall thickness is a substantial indicator in various pathological changes. The present study was performed to compile normative data and formulae for the tracheal wall thickness and volume at varying gestational age.

MATERIAL AND METHODS

Using anatomical dissection, digital image analysis and statistics a range of the wall thickness, proximal internal-to-external cross-sectional area ratio, and wall volume for the trachea in 73 spontaneously aborted human fetuses aged 14-25 weeks was examined.

RESULTS

No significant male-female differences were found. The values of tracheal wall thickness ranged from 0.36 ±0.01 mm for the 14-week group to 1.23 ±0.17 mm for the 25-week group of gestation, according to the linear function y = -0.823 + 0.083 × age ± 0.087. The tracheal lumen rate, expressed as the proximal internal-to-external cross-sectional area ratio, decreased from 42.61 ±1.11% to 26.78 ±4.95%, according to the function y = 62.239 - 1.487 × age ±3.119. The tracheal wall volume rose from 16.28 ±4.18 mm(3) in fetuses aged 14 weeks to 269.22 ±29.26 mm(3) in fetuses aged 25 weeks, according to the quintic function y = 0.000052 × age(4.894).

CONCLUSIONS

The tracheal wall parameters show no sexual dimorphism. The tracheal wall grows linearly in its length, and according to a quintic function in its volume. A relative decrease in the tracheal lumen at the expense of an increase in both the wall thickness and wall volume of the trachea is found during gestation.

Determinants of hypovitaminosis d in pregnant women and their newborns in a sunny region

Introduction. This study aims to assess the factors associated with 25-hydroxy vitamin D (25(OH)D) levels in pregnant women and their newborns in a sunny region. Materials and Methods. This cross-sectional study was conducted in 2012 in Isfahan, Iran. It comprised 100 nulliparous singleton pregnant women, selected by random cluster sampling. Laboratory tests were assessed before delivery in mothers and after delivery in their infants' umbilical cord blood. The P for trend of variables was assessed across the air quality index (AQI) quartiles. The associations of AQI and 25(OH)D were assessed by multiple linear regression after adjustment for age, body mass index, and dietary intake. Results. Sera of 98 mothers and an equal number of newborns were analyzed. The median (interquartile range, IQR) of serum 25(OH)D of mothers and neonates was 15.1(12.6, 18.2) ng/mL in mothers and 15.7(12.0, 18.1) ng/mL in neonates, respectively. AQI had an inverse association with serum 25(OH)D (Beta = -0.58, P = 0.04). The corresponding figure was also inverse and significant for newborns (Beta (SE)= -0.51(0.04), P = 0.01). Conclusion. The independent inverse association of 25(OH)D with air quality can explain the high prevalence of hypovitaminosis D in pregnant women living in this sunny region.

Role of environmental chemicals in obesity: a systematic review on the current evidence

The purpose of this paper is to systematically review the experimental and human studies on obesogenic chemicals and their mechanisms of action to provide a comprehensive view on the multifactorial aspects of obesity. The literatures were searched in available databases. The relevant papers were selected in three phases. After quality assessment, two reviewers extracted the data while another checked their extracted data. In this review, we summarized information regarding environmental chemicals that can be associated with obesity. Most evidence comes from experimental and laboratory studies; however a growing number of human studies also support the role of obesogenic chemicals. The current evidence proposes that the systemic responses to exposure to environmental factors could potentially increase the risk of excess weight. The effects of exposure to these chemicals are of crucial importance during developmental phases of life, when preprogramming for an adipogenic outcome may occur. By considering the adverse transgenerational effects of obesogen chemicals on human health, the global obesity epidemic should be considered as a multifactorial complex disorder necessitating the emphasis of public health interventions for environmental protection.

Synergistic effects of genetic polymorphism and air pollution on markers of endothelial dysfunction in children

BACKGROUND

This study aims to determine the association of some genetic polymorphisms in the relationship of air pollutants on the serum levels of thrombomodulin (TM) and tissue factor (TF) in a population-based sample of children and adolescents.

MATERIALS AND METHODS

This cross-sectional study was conducted among 110 participants (52.8% girls) with a mean age of 12.7 + 2.3 years, in Isfahan, Iran. Genotypes of TM G33-A and + 5466A > G polymorphisms were determined by the polymerase chain reaction - restriction length fragment polymorphism method (PCR-RFLP). The enzyme-linked immunosorbent assay (ELISA) was used for measurement of serum TM and TF.

RESULTS

THE FOLLOWING GENOTYPES WERE IDENTIFIED FOR TM: GG in 69.2%, GA in27.2%, and AA in 3.6% of the participants. Considering TF, 108 participants were homozygous for the + 5466A allele, and two subjects had + 5466AG genotype. The mean pollution standards index (PSI) value was at a moderate level; the mean particulate matter measured up to 10 μm (PM(10)); and ozone (O(3)), nitrogen dioxide, and sulfur dioxide were considerably high. The mean serum TF and TM levels were not significantly different among the participants with the aforementioned genotypes. Among participants exposed to high quartiles of O(3), PM(10), and PSI, the TM-33G / A polymorphism (GA + AA genotype) increased the Odds ratio (OR) of the low serum TM level. There was no statistically significant association in the areas of low pollution.

CONCLUSION

The findings of our study support the synergistic effect of the TM-33G / A polymorphism and air pollutants on factors associated with the onset of the atherosclerosis. This might be confirmatory evidence for gene-environment interaction, and related effects on atherogenesis from early life.

Ambient air pollution and allergic diseases in children

The prevalence of allergic diseases has increased worldwide, a phenomenon that can be largely attributed to environmental effects. Among environmental factors, air pollution due to traffic is thought to be a major threat to childhood health. Residing near busy roadways is associated with increased asthma hospitalization, decreased lung function, and increased prevalence and severity of wheezing and allergic rhinitis. Recently, prospective cohort studies using more accurate measurements of individual exposure to air pollution have been conducted and have provided definitive evidence of the impact of air pollution on allergic diseases. Particulate matter and ground-level ozone are the most frequent air pollutants that cause harmful effects, and the mechanisms underlying these effects may be related to oxidative stress. The reactive oxidative species produced in response to air pollutants can overwhelm the redox system and damage the cell wall, lipids, proteins, and DNA, leading to airway inflammation and hyper-reactivity. Pollutants may also cause harmful effects via epigenetic mechanisms, which control the expression of genes without changing the DNA sequence itself. These mechanisms are likely to be a target for the prevention of allergies. Further studies are necessary to identify children at risk and understand how these mechanisms regulate gene-environment interactions. This review provides an update of the current understanding on the impact of air pollution on allergic diseases in children and facilitates the integration of issues regarding air pollution and allergies into pediatric practices, with the goal of improving pediatric health.

Association of particulate air pollution and secondhand smoke on endothelium-dependent brachial artery dilation in healthy children

BACKGROUND

This study aimed to determine the association of particulate matters with endothelial function, measured by flow mediated dilation (FMD) of brachial artery, in children with or without exposure to secondhand smoke.

METHODS

This cross-sectional study was conducted from January to March 2011 in Isfahan, which is the second large and air-polluted city in Iran. The areas of the city with lowest and highest air pollution were determined, and in each area, 25 prepubescent boys with or without exposure to daily tobacco smoke in home were selected, i.e. 100 children were studied in total.

RESULTS

FMD was significantly smaller in those living in high-polluted area and those exposed to secondhand smoke. Multiple linear regression analysis, adjusted for age and body mass index, showed that both passive smoking status and living area in terms of particulate air pollution were effective determinants of the brachial artery diameter. The standardized coefficient of passive smoking status was -0.36 (SD = 0.09, P < 0.0001) showing negative association with percent increase in FMD. Likewise, the percent increase in brachial artery diameter was lower in passive smoker children. Similar relationship was documented for PM(10) concentration with a regression coefficient of -0.32 (SD = 0.04, P < 0.0001). Without considering passive smoking variable, PM(10) concentration has significant independent effect on FMD level.

CONCLUSION

Our findings provide evidence on the association of environmental factors on endothelial dysfunction from early life. Studying such associations among healthy children may help identify the underlying mechanisms. The clinical implications of environmental factors on early stages of atherosclerosis should be confirmed in longitudinal studies.

Overweight, air and noise pollution: Universal risk factors for pediatric pre-hypertension

Pediatric pre-hypertension (pre-HTN) has a complex multifactorial etiology. Although most cases are secondary to other disorders, a substantial number of children and adolescents have primary or essential HTN and pre-HTN. The gene-gene and gene-environment interactions should be considered in this context. The strong relationship of pre-HTN with environmental factors such as air pollution, noise pollution and passive smoking and obesity suggest that its prevalence will be escalating.Exposure to ambient particulate matters may increase blood pressure (BP) within hours to days. The underlying biologic pathways include autonomic nervous system imbalance and arterial vascular dysfunction or vasoconstriction because of systemic oxidative stress and inflammation. Likewise, tobacco smoke exposure of pregnant mothers increases systolic BP of their offspring in early infancy. Parental smoking also independently affects systolic BP among healthy preschool children. Noise exposure, notably in night, is associated with catecholamine secretion, increased BP and a pre-HTN state even in pre-school age children.Excess weight is associated with dysfunction of the adipose tissue, consisting of enlarged hypertrophied adipocytes, increased infiltration by macrophages and variations in secretion of adipokines and free fatty acids. These changes would result in chronic vascular inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone system and sympathetic response, and ultimately to pre-HTN from childhood.Prevention and control of the modifiable risk factors of pre-HTN from prenatal period can have long-term health impact on primordial and primary prevention of chronic non-communicable diseases. This review presents a general view on the diagnosis, prevalence and etiology of pre-HTN along with practical measures for its prevention and control.

Genetic variation in the association of air pollutants with a biomarker of vascular injury in children and adolescents in Isfahan, Iran

BACKGROUND

Some experimental studies revealed that exposure to air pollution increases the expression of tissue factor (TF) in atherosclerotic lesions. We aimed to investigate the role of TF +5466A>G (rs3917643) polymorphism in the association of air pollution on serum levels of TF as a biomarker of vascular injury in children.

METHODS

This cross-sectional study was conducted among 110 children, consisting of 58 (52.8%) girls and 52 (47.2%) boys with a mean age of 12.7 ± 2.3 years, living in Isfahan, Iran. Enzyme-linked immunosorbent assay were used for measurement of serum TF. Genotype of +5466A>G (rs3917643) polymorphism was determined by the polymerase chain reaction-restriction length fragment polymorphism (PCR-RFLP) method.

RESULTS

We identified 2 individuals with +5466AG genotype and 108 homozygous for the +5466A allele (no +5466GG homozygotes). The mean pollution standards index (PSI) value was at moderate level, the mean particular matter measuring up to 10 μm (PM(10)) was more than twice the normal level. Multiple linear regression analysis showed that after adjustment for confounding factors (weight status, dietary and physical activity pattern), serum TF level had significant relationship with PSI (beta: 0.55, SE: 0.07, p<0.000) and PM(10) (beta: 0.51, SE: 0.03, p=0.001).

CONCLUSIONS

In spite of similar genetic polymorphism of TF, air pollutants might have an independent association with systemic inflammatory and coagulation responses. The harmful effects of air pollutants on the first stages of atherosclerosis in the pediatric age group should be underscored in primordial and primary prevention of chronic diseases.

The relationship of air pollution and surrogate markers of endothelial dysfunction in a population-based sample of children

Background

This study aimed to assess the relationship of air pollution and plasma surrogate markers of endothelial dysfunction in the pediatric age group.

Methods

This cross-sectional study was conducted in 2009-2010 among 125 participants aged 10-18 years. They were randomly selected from different areas of Isfahan city, the second large and air-polluted city in Iran. The association of air pollutants' levels with serum thrombomodulin (TM) and tissue factor (TF) was determined after adjustment for age, gender, anthropometric measures, dietary and physical activity habits.

Results

Data of 118 participants was complete and was analyzed. The mean age was 12.79 (2.35) years. The mean pollution standards index (PSI) value was at moderate level, the mean particular matter measuring up to 10 μm (PM₁₀) was more than twice the normal level. Multiple linear regression analysis showed that TF had significant relationship with all air pollutants except than carbon monoxide, and TM had significant inverse relationship with ozone. The odds ratio of elevated TF was significantly higher in the upper vs. the lowest quartiles of PM₁₀, ozone and PSI. The corresponding figures were in opposite direction for TM.

Conclusions

The relationship of air pollutants with endothelial dysfunction and pro-coagulant state can be an important factor in the development of atherosclerosis from early life. This finding should be confirmed in future longitudinal studies. Concerns about the harmful effects of air pollution on children's health should be considered a top priority for public health policy; it should be underscored in primordial and primary prevention of chronic diseases.

What health professionals should know about the health effects of air pollution and climate change on children and pregnant mothers

BACKGROUND

Health professionals face the adverse health effects of climate change and air pollution in their practices. This review underscores the effects of these environmental factors on maternal and children's health, as the most vulnerable groups to climate change and air pollution.

METHODS

We reviewed electronic databases for a search of the literature to find relevant studies published in English from 1990 to 2011.

RESULTS

Environmental factors, notably climate change and air pollution influence children's health before conception and continue during pregnancy, childhood, and adolescence. Experts have suggested that such health hazards may represent the greatest public health challenge that humanity has faced. The accumulation of greenhouse gases such as carbon dioxide, primarily from burning fossil fuels, results in warming which has an impact on air pollution particularly on levels of ozone and particulates. Heat-related health effects include increased rates of pregnancy complications, pre-eclampsia, eclampsia, low birth weight, renal effects, vector-borne diseases as malaria and dengue, increased diarrheal and respiratory disease, food insecurity, decreased quality of foods (notably grains), malnutrition, water scarcity, exposures to toxic chemicals, worsened poverty, natural disasters and population displacement. Air pollution has many adverse health effects for mothers and children. In addition to short-term effects like premature labour, intrauterine growth retardation, neonatal and infant mortality rate, malignancies (notably leukaemia and Hodgkin lymphoma), respiratory diseases, allergic disorders and anaemia, exposure to criteria air pollutants from early life might be associated with increase in stress oxidative, inflammation and endothelial dysfunction which in turn might have long-term effects on chronic non-communicable diseases.

CONCLUSIONS

Health professionals have an exclusive capability to help prevent and reduce the harmful effects of environmental factors for high-risk groups, and should consider this capacity in their usual practice.

Effects of exercise in polluted air on the aerobic power, serum lactate level and cell blood count of active individuals

OBJECTIVES

The purpose of this study was to assess the effects of exercise on the aerobic power, serum lactate level, and cell blood count among active individuals in the environments with similar climatic characteristics differing in their level of air pollution.

METHODS

This trial comprised 20 volunteer students of Physical education in The University of Isfahan, Iran. Two places with the same climate (altitude, temperature, and humidity), but low and high level of air pollutants air were selected in Isfahan, Iran. Participants underwent a field Cooper test with a 12-minute run for fitness assessment. Then the aerobic power, serum lactate, and cell blood counts were measured and compared between the two areas.

RESULTS

The study participants had a mean (SD) age of 21.70 (2.10) years and body mass index (BMI) of 24.44 (2.32) Kg/m2. We found a significant decrease in mean Vo2 max, red blood cell count, hemoglobin, hematocrit, and mean corpuscular hemoglobin, as well as significant increase in mean lactate level, white blood cell count and mean corpuscular volume in the higher-polluted than in the lower-polluted area. No significant difference was documented for other parameters as platelet counts or maximum heart rate.

CONCLUSIONS

Exercise in high-polluted air resulted in a significant reduction in the performance at submaximal levels of physical exertion. Therefore, the acute exposure to polluted air may cause a significant reduction in the performance of active individuals. The clinical importance of these findings should be assessed in longitudinal studies.