Advances in understanding bioaerosol release characteristics and potential hazards during aerobic composting

Bioaerosol emissions and their associated risks are attracting increasing attention. Bioaerosols are generated during the pretreatment, fermentation, and screening of mature compost when processing various types of solid waste at composting plants (e.g., municipal sludge and animal manure). In this review, we summarize research into bioaerosols at different types of composting plants by focusing on the methods used for sampling bioaerosols, stages when emissions potentially occur, major components of bioaerosols, survival and diffusion factors, and possible control strategies. The six-stage Andersen impactor is the main method used for sampling bioaerosols in composting plants. In addition, different composting management methods mainly affect bioaerosol emissions from composting plants. Studies of the components of bioaerosols produced by composting plants mainly focused on bacteria and fungi, whereas few considered others such as endotoxin. The survival and diffusion of bioaerosols are influenced by seasonal effects due to changes in environmental factors, such as temperature and relative humidity. Finally, three potential strategies have been proposed for controlling bioaerosols in composting plants. Improved policies are required for regulating bioaerosol emissions, as well as bioaerosol concentration diffusion models and measures to protect human health.

The impact of co-exposure to air and noise pollution on the incidence of metabolic syndrome from a health checkup cohort

Previous studies have found associations between the incidence of metabolic syndrome (MetS) and exposure to air pollution or road traffic noise. However, investigations on environmental co-exposures are limited. This study aimed to investigate the association between co-exposure to air pollution and road traffic noise and MetS and its subcomponents. Participants living in Taipei City who underwent at least two health checkups between 2010 and 2016 were included in the study. Data were sourced from the MJ Health database, a longitudinal, large-scale cohort in Taiwan. The monthly traffic noise exposure (Lden and Lnight) was computed using a dynamic noise map. Monthly fine particulate data at one kilometer resolution were computed from satellite imagery data. Cox proportional hazards regression models with month as the underlying time scale were used to estimate hazard ratios (HRs) for the impact of PM2.5 and road traffic noise exposure on the risk of developing MetS or its subcomponents. Data from 10,773 participants were included. We found significant positive associations between incident MetS and PM2.5 (HR: 1.88; 95% CI 1.67, 2.12), Lden (HR: 1.10; 95% CI 1.06, 1.15), and Lnight (HR: 1.07; 95% CI 1.02, 1.13) in single exposure models. Results further showed significant associations with an elevated risk of incident MetS in co-exposure models, with HRs of 1.91 (95% CI 1.69, 2.16) and 1.11 (95% CI 1.06, 1.16) for co-exposure to PM2.5 and Lden, and 1.90 (95% CI 1.68, 2.14) and 1.08 (95% CI 1.02, 1.13) for co-exposure to PM2.5 and Lnight. The HRs for the co-exposure models were higher than those for models with only a single exposure. This study provides evidence that PM2.5 and noise exposure may elevate the risk of incident MetS and its components in both single and co-exposure models. Therefore, preventive approaches to mitigate the risk of MetS and its subcomponents should consider reducing exposure to PM2.5 and noise pollution.

Moderate low-cost modifications in diet prevent a substantial number of deaths and mitigate environmental impacts in Brazil

PURPOSE

This study aimed to estimate the health, economic, and environmental impacts of moderate simulated interventions on dietary intake in Brazil.

METHODS

Data on food price and consumption were obtained from three nationwide surveys. Baseline dietary intake was estimated for 33,859 individuals aged 25 years and older. Counterfactual intakes were based on six hypothetical intervention scenarios, by changing the weekly frequency and serving size in low or high consumers of fruit and vegetables (FV), milk, whole grains, red and processed meats, and sugar-sweetened beverages. For each scenario, we estimated the attributable number of deaths and disability-adjusted life years (DALY), monetary cost, environmental impacts (14 midpoint indicators), and environmentally-mediated health impacts.

RESULTS

Compared with the baseline intake and cost, the most expensive intervention (+ 8.3%) was to increase FV intake (+ 125 g), resulting in a 1.2% reduction in all-cause mortality (16,307 deaths/year). The cheapest (- 9.9%) was to reduce red and processed meat intake (- 40 g), resulting in a 1.1% reduction in all-cause mortality (14,272 deaths/year). The combined intervention was, on average, 3.7% cheaper than the baseline cost, resulting in an increase in diet cost for 30% of the population (45-22% in the lower- and higher-income groups); all-cause mortality would be reduced by 3.8% (49,488 deaths/year). Interventions targeting red and processed meats would reduce emissions and resource use by 35-55%, in addition to reducing 2300 DALYs/year.

CONCLUSION

A meaningful number of deaths can be avoided and environmental impacts reduced through moderate and potentially affordable diet modifications.

Assessment of the health impacts of air pollution exposure in East African countries

The health effects of air pollution remain a public concern worldwide. Using data from the Global Burden of Disease 2019 report, we statistically analyzed total mortality, disability-adjusted life years (DALY), and years of life lost (YLL) attributable to air pollution in eight East African countries between 1990 and 2019. We acquired ambient ozone (O3), PM2.5 concentrations and household air pollution (HAP) from the solid fuel from the State of Global Air report. The multilinear regression model was used to evaluate the predictability of YLLs by the air pollutants. We estimated the ratio rate for each health burden attributable to air pollution to compare the country's efforts in the reduction of air pollution health burden. This study found that the total number of deaths attributable to air pollution decreased by 14.26% for 30 years. The drop came from the reduction of 43.09% in mortality related to Lower Respiratory tract Infection (LRI). However, only five out of eight countries managed to decrease the total number of deaths attributable to air pollution with the highest decrease observed in Ethiopia (40.90%) and the highest increase in Somalia (67.49%). The linear regression model showed that HAP is the pollutant of the most concern in the region, with a 1% increase in HAP resulting in a 31.06% increase in regional YLL (R2 = 0.93; p < 0.05). With the increasing ground-level ozone, accompanied by the lack of adequate measures to reduce particulate pollutants, the health burdens attributable to air pollution are still a threat in the region.

The experiences and perceptions of people with chronic and rare diseases during political-economic sanctions in Iran: a qualitative study

BACKGROUND

Economic sanctions aim to exert pressure on political and economic foundations. Hypothesizing that sanctions might affect various aspects of population health, this study, as a component of a broader investigation to ascertain the trend effects of sanctions on selected health outcomes in Iran, seeks to explore the experiences of Iranian citizens associated with the imposed sanctions.

METHODS

This is a qualitative study. We conducted 31 semi-structured interviews with randomly selected patients diagnosed with at least one chronic and rare disease from diverse backgrounds across four provinces in Iran. We analyzed data using an inductive content analysis approach, facilitated by the MAXQDA10 software.

RESULTS

We identified three primary themes: direct effects, side effects, and coping strategies. The immediate effects were perceived to be manifested through the restriction of healthcare service availability and affordability for citizens. The side effects included the economic hardships experienced in individuals' lives and the perceived devastation caused by these difficulties. Some coping mechanisms adopted by patients or their families/relatives included prioritizing comorbidities, prioritizing health needs within families with multiple ill members, and readjusting health/illness requirements in light of daily living needs.

CONCLUSION

In addition to the inherent burden of their illness, patients faced substantial healthcare costs as a result of sanctions, restricted access to medications, and availability of low-quality medications. We advocate considering these challenges within the healthcare system resilience framework as a crucial first step for policymakers, aiming to determine actionable measures and mitigate the adverse effects of sanctions on citizens, particularly the most vulnerable groups.

Assessing the health consequences of northern Ethiopian armed conflict, 2022

Armed conflict is a complicated topic with multidimensional impact on population health. This study aimed to assess of the health consequences of the northern Ethiopian conflict, 2022. We used a mixed method study design with a retrospective cross-sectional study supplemented by a qualitative study conducted from May to June 2022. We interviewed 1806 individuals from 423 households and conducted 100 in-depth interviews and focused group discussion. We identified 224 people who self-reported cases of illness (124/1000 people) with only 48 (21%) people who fell ill visited a health institution. We also detected 27 cases of deaths (15/1000 people) during the conflict. The collapse of the health system, evacuation of health personnel, and shortage of medical supplies, and instability with a lack of transportation were consequences of the conflict. The northern Ethiopian conflict has greatly affected the community's health through the breakdown of the health system and health-supporting structures.

Microplastics and associated chemicals in drinking water: A review of their occurrence and human health implications

Microplastics (MPs) have entered drinking water (DW) via various pathways, raising concerns about their potential health impacts. This study provides a comprehensive review of MP-associated chemicals, such as oligomers, plasticizers, stabilizers, and ultraviolet (UV) filters that can be leached out during DW treatment and distribution. The leaching of these chemicals is influenced by various environmental and operating factors, with three major ones identified: MP concentration and polymer type, pH, and contact time. The leaching process is substantially enhanced during the disinfection step of DW treatment, due to ultraviolet light and/or disinfectant-triggered reactions. The study also reviewed human exposure to MPs and associated chemicals in DW, as well as their health impacts on the human nervous, digestive, reproductive, and hepatic systems, especially the neuroendocrine toxicity of endocrine-disrupting chemicals. An overview of MPs in DW, including tap water and bottled water, was also presented to enable a background understanding of MPs-associated chemicals. In short, certain chemicals leached from MPs in DW can have significant implications for human health and demand further research on their long-term health impacts, mitigation strategies, and interactions with other pollutants such as disinfection byproducts (DBPs) and per- and polyfluoroalkyl substances (PFASs). This study is anticipated to facilitate the research and management of MPs in DW and beverages.

The methodology of quantitative risk assessment studies

Once an external factor has been deemed likely to influence human health and a dose response function is available, an assessment of its health impact or that of policies aimed at influencing this and possibly other factors in a specific population can be obtained through a quantitative risk assessment, or health impact assessment (HIA) study. The health impact is usually expressed as a number of disease cases or disability-adjusted life-years (DALYs) attributable to or expected from the exposure or policy. We review the methodology of quantitative risk assessment studies based on human data. The main steps of such studies include definition of counterfactual scenarios related to the exposure or policy, exposure(s) assessment, quantification of risks (usually relying on literature-based dose response functions), possibly economic assessment, followed by uncertainty analyses. We discuss issues and make recommendations relative to the accuracy and geographic scale at which factors are assessed, which can strongly influence the study results. If several factors are considered simultaneously, then correlation, mutual influences and possibly synergy between them should be taken into account. Gaps or issues in the methodology of quantitative risk assessment studies include 1) proposing a formal approach to the quantitative handling of the level of evidence regarding each exposure-health pair (essential to consider emerging factors); 2) contrasting risk assessment based on human dose-response functions with that relying on toxicological data; 3) clarification of terminology of health impact assessment and human-based risk assessment studies, which are actually very similar, and 4) other technical issues related to the simultaneous consideration of several factors, in particular when they are causally linked.

Acute and chronic risk assessment of BTEX in the return water of hydraulic fracturing operations in Marcellus Shale

Environmental pollution caused by human activities is a pressing issue in developed countries. In this context, it is vital to establish methodologies for the early and reliable estimation of the health risks posed by potential pollutants. Flowback and produced water (return water) from shale gas operations can contain toxic compounds, of which BTEX (benzene, toluene, ethylbenzene, and xylenes) are of concern due to their toxicity and frequent presence above regulatory limits. The return water generated by these operations is stored in ponds or tanks before reaching its final destination. Over time, the composition of this water changes, and leaks or inadequate contact can harm the environment and human health. Here we developed a risk assessment framework to evaluate the temporal evolution of chronic and acute BTEX exposure risks caused by accidental return water leakage. We applied the approach to a hydraulic fracturing operation in the Marcellus Shale Formation. Starting with a time series of BTEX concentrations in the return water, our method deploys transport models to assess risk to health. Our approach compares exposure levels with regulatory limits for inhalation, ingestion, and dermal contact. By identifying the risk levels, exposure pathways, and control parameters in the case study for a range of periods after leakage, our study supports the implementation of appropriate risk mitigation strategies. In addition, by examining risk variation under arid, semi-arid, and humid climate scenarios, the study reveals the impact of climate change on soil characteristics and BTEX transport. The development and application of this methodology is an important step in addressing concerns regarding shale gas operations. The approach proposed paves the way for sustainable practices that prioritise the protection of human health and the environment.

Evaluating the health impact of increased linseed consumption in the Danish population

Consumption of linseeds has been suggested to have beneficial effects on human health. However, toxic constituents of linseed may compromise these benefits. We conducted a quantitative risk-benefit assessment to evaluate the overall health impact of increasing linseed intake up to 45 g/day in the Danish population (15-74 years). We quantified the risks associated with increased cadmium exposure and the benefits associated with increased intake of dietary fibre. Increased intakes of alpha-linoleic acid (ALA) were included in a sensitivity analysis. The overall health impact of different linseed intake scenarios was estimated in terms of Disability-Adjusted Life Years (DALYs). We found that the beneficial effects of linseed due to increased intake of dietary fibre outweighed the adverse health effects due to increased cadmium exposure in all scenarios. Up to 670 DALYs/100,000 individuals could be averted per year by increasing linseed consumption in the Danish population. The estimated beneficial health impact increased further when including ALA in the assessment. Different sources of uncertainty might affect the results, and more research is needed on both the health effects associated with intake of linseed and its constituents, and the bioavailability of ALA and cadmium from linseed to further improve the risk-benefit assessment.

A literature review addressing midwakh and e-cigarette use in the Gulf region

A notable decrease in conventional cigarette smoking has been witnessed on a global scale. However, this decrease has been accompanied by an equally striking global increase in the consumption of alternative tobacco products (ATPs), namely e-cigarettes and midwakh in the Arabian Gulf region. A literature review was used to outline the chemical composition of these two ATPs and review their impacts on health. The study was conducted using databases like PubMed, Google Scholar, MDPI, and WorldCat. The literature search included terms such as "e-cigarettes," "midwakh," "dokha," "heath impacts," "psychological effects," "social influences," and "cigarette smoking" with emphasis on literature from the Arabian Gulf region. Data shows that midwakh contains markedly high levels of tar, nicotine, and various compounds of notable effects on the human body. Similarly, it was found that e-cigarettes contain non-negligible amounts of nicotine and other chemical compounds that may not have been extensively investigated. Alarming reports of system-specific effects brought about by midwakh, and e-cigarette consumption, have been reported, although further research is needed to deduce the mechanism. We also discussed some of the social and psychological factors leading to their consumption within this population. Hence, this review raises questions around the safety of these two types of ATPs and encourages comprehensive studies globally and regionally.

Increased ground-level O3 during the COVID-19 pandemic in China aggravates human health risks but has little effect on winter wheat yield

In January 2020, the novel coronavirus (COVID-19) outbreak emerged in China, prompting the enforcement of stringent lockdown measures nationwide to contain its spread. Multiple studies have demonstrated that these measures successfully reduced the levels of air pollutants except for ozone (O3). However, the potential risks of nationwide O3 changes during this period remain uncertain. To address this gap, we evaluated the ecological and health effects of O3 using hourly O3 data from 1 January to 17 June in both 2020 and 2019. Our results indicated that all health and ecological indicators, except SUM06 (sum of all hourly O3 over 60 ppb), during the COVID-19 pandemic in 2020 increased most obviously in Stages 2 and 3 with the strictest control measures, compared to the same period in 2019. The national premature deaths due to short-term O3 exposure during Stages 2-3 in 2020 totaled 146,558 (95% CI: 79,386-213,730) for all non-accidental causes and 82,408 (95% CI: 30,522-134,295) for cardiovascular diseases, increasing by 18.78% and 18.76% in 2019, respectively. The most significant increase in health risks occurred in Hubei, followed by Jiangxi, Zhejiang, Hunan, and Shaanxi. In addition, the estimated national winter wheat production losses (WWPL) attributable to O3 amounted to 50.6 and 51.1 million metric tons for 2019 and 2020, respectively. Among the major winter wheat-producing provinces, Anhui and Jiangsu experienced a larger increase in WWPL, while Shandong and Hebei suffered a greater decrease in 2020 compared to 2019, resulting in little overall change in WWPL between the two years. These findings provided direct evidence of the harmful effects of O3 during the COVID-19 pandemic and serve as a valuable reference for future air pollution control.

A large survey on COVID-19 vaccination in patients with Parkinson's disease and healthy population

BACKGROUND

A full rollout of COVID-19 vaccination offers the most promising prospect of bringing the pandemic to an end. This study aimed to compare the coverage, safety, and confidence of COVID-19 vaccination between patients with Parkinson's disease (PD) and healthy individuals so as to give suggestions for future immunization programs.

METHODS

A web-based, nationwide, multicenter survey was carried out in China from 2021 to 2022. The age and sex-standardized vaccination rate was calculated. Multivariate stepwise logistic regression models were used to estimate the influencing factors of vaccination status. We also investigated vaccination safety, willingness, confidence, and reasons for hesitancy with some ad hoc questions.

RESULTS

A total of 962 PD patients and 1208 healthy individuals participated in this survey with a vaccination rate of 71.1% vs 94.4% respectively. PD patients living in first-tier cities, with comorbidities, experiencing unstable PD with a longer course and levodopa use were less likely to get vaccinated, while healthy individuals living in first-tier cities and feeling physically poor exhibited a lower vaccination rate. For PD patients, concern about the adverse impact on existing illness and disagreement from doctors were the most common reasons for vaccination hesitancy. Whereas, no evidence was present that they experienced any local or systematic adverse events more frequently or seriously than healthy individuals, or their state of PD and comorbidities was seriously exacerbated after vaccination. A prominent transition from a little concerned to unconcerned about the security and efficacy of vaccines was evident among both two populations from pre-vaccination to post-vaccination.

CONCLUSIONS

The COVID-19 vaccination rate was remarkably lower in PD patients than healthy individuals in China. The approved vaccines have shown an acceptable safety profile. Our findings would offer a reference to guide future clinical decision-making of COVID-19 vaccination and improve the immunization management of PD patients.

The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study

BACKGROUND

The global increase in mean body mass index has resulted in a substantial increase of non-communicable diseases (NCDs), including in many low- and middle-income countries such as Kenya. This paper assesses four interventions for the prevention and control of overweight and obesity in Kenya to determine their potential health and economic impact and cost effectiveness.

METHODS

We reviewed the literature to identify evidence of effect, determine the intervention costs, disease costs and total healthcare costs. We used a proportional multistate life table model to quantify the potential impacts on health conditions and healthcare costs, modelling the 2019 Kenya population over their remaining lifetime. Considering a health system perspective, two interventions were assessed for cost-effectiveness. In addition, we used the Human Capital Approach to estimate productivity gains.

RESULTS

Over the lifetime of the 2019 population, impacts were estimated at 203,266 health-adjusted life years (HALYs) (95% uncertainty interval [UI] 163,752 - 249,621) for a 20% tax on sugar-sweetened beverages, 151,718 HALYs (95% UI 55,257 - 250,412) for mandatory kilojoule menu labelling, 3.7 million HALYs (95% UI 2,661,365-4,789,915) for a change in consumption levels related to supermarket food purchase patterns and 13.1 million HALYs (95% UI 11,404,317 - 15,152,341) for a change in national consumption back to the 1975 average levels of energy intake. This translates to 4, 3, 73 and 261 HALYs per 1,000 persons. Lifetime healthcare cost savings were approximately United States Dollar (USD) 0.14 billion (USD 3 per capita), USD 0.08 billion (USD 2 per capita), USD 1.9 billion (USD 38 per capita) and USD 6.2 billion (USD 124 per capita), respectively. Lifetime productivity gains were approximately USD 1.8 billion, USD 1.2 billion, USD 28 billion and USD 92 billion. Both the 20% tax on sugar sweetened beverages and the mandatory kilojoule menu labelling were assessed for cost effectiveness and found dominant (health promoting and cost-saving).

CONCLUSION

All interventions evaluated yielded substantive health gains and economic benefits and should be considered for implementation in Kenya.

Health status assessment of people adjacent to temporary waste disposal sites in Khulna city, Bangladesh

Despite rapid population growth, urbanization, and economic development in Bangladesh, there is a lack of evidence to measure the impact of dumpsites on human health and the environment. This study sought to assess the health impact of temporary disposal sites in Khulna city on residents living nearby. Data was collected through self-administered questionnaire surveys surrounding the dumpsite areas. Altogether 180 households were surveyed by random sampling approach from >50 m (close to the dumpsites, CD) and 50-300 m radius (away from the dumpsites, AD) of the dumpsite. The participants were mostly employed with low income ( Collapse

Key Words

• Environmental problem
• Health impact
• Proximities
• Waste disposal site

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MESH Headings Collapse

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Affiliation(s)

Afra Tanjim Shammi Environmental Science Discipline, Khulna University, Khulna-9208, Bangladesh
Nazia Hassan Environmental Science Discipline, Khulna University, Khulna-9208, Bangladesh
Md Rony Golder Fisheries and Marine Resource Technology Discipline, Khulna University, Khulna-9208, Bangladesh
Hriday Molla Urban and Rural Planning Discipline, Khulna University, Khulna-9208, Bangladesh
Shikder Saiful Islam Fisheries and Marine Resource Technology Discipline, Khulna University, Khulna-9208, Bangladesh

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A review on the occurrence, analytical methods, and impact of microplastics in the environment

Nowadays, microplastic pollution is one of the globally urgent concerns as a result of discharging plastic products into the atmosphere, aquatic and soil environments. Microplastics have average size of less than 5 mm, are non-biodegradable, accumulative, and highly persistent substances. Thousands of tons of microplastics are still accumulated in various environments, posing an enormous threat to human health and living creatures. Here, we review the occurrence and analytical methods, and impact of microplastics in the environments including soil, aquatic media, and atmosphere. Analytical methods including visual observation, Fourier-transform infrared spectroscopy, Raman spectroscopy, scanning electron microscopy, and pyrolysis-gas chromatography-mass spectrometry were evaluated. We elucidated the environmental and human health impacts of microplastics with emphasis on life malfunction, immune disruption, neurotoxicity, diseases and other tangible health risks. This review also found some shortages of analytical equivalence and/or standardization, inconsistence in sampling collection and limited knowledge of microplastic toxicity. It is hopeful that the present work not only affords a more insight into the potential dangers of microplastics on human health but also urges future researches to establish new standardizations in analytical methods.

Particulate matter concentration effects on attention to environmental issues: a cross-sectional study among residents in Korea's Pohang Industrial Complex

Background

With modernization, air pollution has become increasingly serious, and its effects on health have been revealed. As a result, public interest in environmental pollution has become critical for regulating air pollution. In our study, we aim to evaluate the impact of air pollution levels on public attention to environmental issues and examine whether awareness of the residential environment's impact on health acts as a mediator in this relationship.

Methods

We conducted an analysis on 400 individuals surveyed in the preliminary feasibility study on adverse health effects in the Pohang Industrial Complex, to examine the relationship between particulate matter 2.5 (PM2.5) and attention to environmental issues. Logistic regression analysis was performed, and mediation analysis was used to determine whether awareness of the residential environment's impact on health mediated the relationship.

Results

The logistic regression analysis results showed that PM2.5 levels were associated with attention to environmental issues (adjusted odds ratio [AOR]: 2.1; 95% confidence interval [CI]: 1.3-3.5; p = 0.003) and awareness of health impacts (AOR: 3.4; 95% CI: 1.6-7.1; p = 0.001). The PM2.5 levels showed 9.9% (95% CI: 5.4-14.0) increase in the prevalence of high attention to environmental issues, of which, only 1.0% (95% CI: 0.2-2.3) were mediated by health impact awareness. In the overall analysis, 10% of the total effect of PM2.5 on attention to environmental issues was mediated by health impact awareness.

Conclusions

According to this study's results, there was a correlation between air pollution levels and attention to environmental issues. Awareness of the health impacts of air pollution partially mediated the effect of air pollution levels on attention to environmental issues. In future studies, it is recommended to identify other mediators to further understand this structure.

New tuberculosis vaccines in India: modelling the potential health and economic impacts of adolescent/adult vaccination with M72/AS01E and BCG-revaccination

BACKGROUND

India had an estimated 2.9 million tuberculosis cases and 506 thousand deaths in 2021. Novel vaccines effective in adolescents and adults could reduce this burden. M72/AS01E and BCG-revaccination have recently completed phase IIb trials and estimates of their population-level impact are needed. We estimated the potential health and economic impact of M72/AS01E and BCG-revaccination in India and investigated the impact of variation in vaccine characteristics and delivery strategies.

METHODS

We developed an age-stratified compartmental tuberculosis transmission model for India calibrated to country-specific epidemiology. We projected baseline epidemiology to 2050 assuming no-new-vaccine introduction, and M72/AS01E and BCG-revaccination scenarios over 2025-2050 exploring uncertainty in product characteristics (vaccine efficacy, mechanism of effect, infection status required for vaccine efficacy, duration of protection) and implementation (achieved vaccine coverage and ages targeted). We estimated reductions in tuberculosis cases and deaths by each scenario compared to the no-new-vaccine baseline, as well as costs and cost-effectiveness from health-system and societal perspectives.

RESULTS

M72/AS01E scenarios were predicted to avert 40% more tuberculosis cases and deaths by 2050 compared to BCG-revaccination scenarios. Cost-effectiveness ratios for M72/AS01E vaccines were around seven times higher than BCG-revaccination, but nearly all scenarios were cost-effective. The estimated average incremental cost was US$190 million for M72/AS01E and US$23 million for BCG-revaccination per year. Sources of uncertainty included whether M72/AS01E was efficacious in uninfected individuals at vaccination, and if BCG-revaccination could prevent disease.

CONCLUSIONS

M72/AS01E and BCG-revaccination could be impactful and cost-effective in India. However, there is great uncertainty in impact, especially given the unknowns surrounding the mechanism of effect and infection status required for vaccine efficacy. Greater investment in vaccine development and delivery is needed to resolve these unknowns in vaccine product characteristics.

Air pollution and associated health impact and economic loss embodied in inter-provincial electricity transfer in China

As the largest producer and consumer of coal in the world, China heavily relies on coal resources for thermal power generation. Owing to the unbalanced distribution of energy resources, electricity transfer among regions in China plays a key role in promoting economic growth and ensuring energy safety. However, little is known about air pollution and the related health impacts resulting from electricity transfer. This study assessed PM_2.5 pollution and related health and economic losses attributable to the inter-provincial electricity transfer in mainland China in 2016. The results show that a large amount of virtual air pollutant emissions were transferred from energy-abundant northern, western and central China to well-developed and populated eastern coastal regions. Correspondingly, the inter-provincial electricity transfer dramatically reduced the atmospheric levels of PM_2.5 and related health and economic losses in eastern and southern China, while increasing those in northern, western and central China. The health benefits attributable to inter-provincial electricity transfer were mainly found in Guangdong, Liaoning, Jiangsu and Shandong, whereas the extra health loss is concentrated in Hebei, Shanxi, Inner Mongolia, and Heilongjiang. Overall, the inter-provincial electricity transfer led to an extra increase of 3600 (95 % CI: 3200-4100) PM_2.5-related deaths and 345 (95 % CI: 294-389) million USD of economic loss in China in 2016. The results could assist air pollution mitigation strategies for the thermal power sector in China by strengthening the cooperation between suppliers and consumers of electricity.

Environmental and health impacts of PFAS: Sources, distribution and sustainable management in North Carolina (USA)

Poly- and perfluoroalkyl substances (PFAS) are a class of manufactured chemicals that have recently attracted a great deal of attention from environmental regulators and the general public because of their high prevalence, resistance to degradation, and potential toxicity. This review summarizes the current state of PFAS and its effects on the environment of North Carolina, USA. Specific emphasis has been placed to identify i) the sources of PFAS in North Carolina ii) distribution of PFAS in different environmental segments of North Carolina, including surface water, groundwater, air, and sediment iii) drinking water contamination iv) impact of PFAS on human health v) PFAS accumulation in fish and other biota vi) status of PFAS removal from drinking water and finally vi) socioeconomic impact of PFAS uncertainties. Continuous discharges of PFAS occur in the North Carolina environment from direct and indirect sources, including manufacturing sites, firefighting foam, waste disposal and treatment plants, landfill leachate, and industrial emissions. PFAS are widespread in many environmental segments of North Carolina. They are more likely to be detected in surface and groundwater sediments and can enter aquatic bodies through direct discharge and wet and dry deposition of emissions. Eventually, some adverse effects of PFAS have already been reported in North Carolina residents who could have been exposed to the chemicals through contaminated drinking water. Furthermore, PFAS were also found in blood samples from fish and alligators. PFAS were confirmed to be present in water, sediment, organic compounds, and aquatic species at all levels of the food web. However, there is still a substantial amount of work to be done to understand the actual contamination by PFAS in North Carolina comprehensively.

Harmonized approach to estimate the burden of disease of dietary exposure to four chemical contaminants - A French study

Exposure to chemical contaminants found in foods has been associated with various adverse health effects. Burden of disease studies are increasingly used to estimate the public health impact of such exposures. The aims of this study were to estimate the burden of disease due to dietary exposure to four chemicals in France in 2019 (lead (Pb), cadmium (Cd), methylmercury (MeHg), and inorganic arsenic (i-As)), and to develop harmonized methods that can be applied for other chemicals and countries. We used national food consumption data from the third French national food consumption survey, chemical food monitoring data from the Second French Total Diet Study (TDS), dose-response data and disability weights from scientific literature, and disease incidence and demographics from national statistics. We adopted a risk assessment approach to estimate disease burden, incidence, mortality, and Disability-Adjusted Life Years (DALYs) attributable to dietary exposure to the chemicals. In all models, we harmonized food classification and exposure assessment. We propagated uncertainty through the calculations using Monte Carlo simulation. We estimated that, among these chemicals, i-As and Pb were responsible for the highest disease burden. i-As was estimated to cause 820 DALYs, or approximately 1.25 DALYs per 100,000 inhabitants. The estimated burden of Pb was 1834 to 5936 DALYs, or 2.7 (lower bound) to 8.96 (upper bound) DALYs/100,000. The burden of MeHg (192 DALYs), and Cd (0 DALY) was substantially lower. The foods contributing most to disease burden was drinks (30 %), "other foods" (mostly composite dishes) (19 %), and fish and seafood (7 %). Interpretation of estimates needs to consider all underlying uncertainties, linked with data and knowledge gaps. The harmonized models are the first to make use of data from TDS, which are available in several other countries. Thus, they can be applied to estimate the burden and to rank food-associated chemicals at national level.

Impact, cost-effectiveness, and budget implications of HPV vaccination in Kenya: A modelling study

BACKGROUND

Sub-Saharan Africa has the highest rate of cervical cancer cases and deaths worldwide. Kenya introduced a quadrivalent HPV vaccine (GARDASIL, hereafter referred to as GARDASIL-4) for ten-year-old girls in late 2019 with donor support from Gavi, the Vaccine Alliance. As Kenya may soon graduate from Gavi support, it is important to evaluate the potential cost-effectiveness and budget impact of the current HPV vaccine, and potential alternatives.

METHODS

We used a proportionate outcomes static cohort model to evaluate the annual budget impact and lifetime cost-effectiveness of vaccinating ten-year-old girls over the period 2020-2029. We included a catch-up campaign for girls aged 11-14 years in 2020. We estimated cervical cancer cases, deaths, disability adjusted life years (DALYs), and healthcare costs (government and societal perspective) expected to occur with and without vaccination over the lifetimes of each cohort of vaccinated girls. For each of the four products available globally (CECOLIN©, CERVARIX©, GARDASIL-4©, and GARDASIL-9 ©), we estimated the cost (2021 US$) per DALY averted compared to no vaccine and to each other. Model inputs were obtained from published sources, as well as local stakeholders.

RESULTS

We estimated 320,000 cases and 225,000 deaths attributed to cervical cancer over the lifetimes of the 14 evaluated birth cohorts. HPV vaccination could reduce this burden by 42-60 %. Without cross-protection, CECOLIN had the lowest net cost and most attractive cost-effectiveness. With cross-protection, CERVARIX was the most cost-effective. Under either scenario the most cost-effective vaccine had a 100 % probability of being cost-effective at a willingness-to-pay threshold of US$ 100 (5 % of Kenya's national gross domestic product per capita) compared to no vaccination. Should Kenya reach its target of 90 % coverage and graduate from Gavi support, the undiscounted annual vaccine program cost could exceed US$ 10 million per year. For all three vaccines currently supported by Gavi, a single-dose strategy would be cost-saving compared to no vaccination.

CONCLUSION

HPV vaccination for girls is highly cost-effective in Kenya. Compared to GARDASIL-4, alternative products could provide similar or greater health benefits at lower net costs. Substantial government funding will be required to reach and sustain coverage targets as Kenya graduates from Gavi support. A single dose strategy is likely to have similar benefits for less cost.

Mortality and morbidity assessment attributed to short- and long-term exposure to fine particles in ambient air of Agadir city, Morocco: The AirQ model approach

It is well established that respiratory mortality and morbidity are associated with high concentrations of fine particles such as PM2.5. The aim of this study was to evaluate the long- and short-term impacts of PM2.5 on the population of Agadir, Morocco, using AirQ 2.1.1 software. The mean PM2.5 values were obtained from data collected at three sites. Baseline incidence data were obtained from the literature, and relative risk (RR) values were referenced from the World Health Organization. This study quantified long-term total mortality (LT-TM), lung cancer mortality (LT-LC), morbidity from acute lower respiratory tract infections (LT-ALRI), and morbidity from chronic obstructive pulmonary disease (LT-COPD), as well as short-term total mortality (ST-TM). The attributable proportions (AP) of LT-TM and LT-LC were estimated to 14.19% and 18.42%, respectively. Their excess deaths were estimated to 279 and 11 persons, respectively, and their RRs to 1.16 (95% CI: 1.10-1.22) and 1.23 (95% CI: 1.12-1.37), respectively. Furthermore, the AP of LT-ALRI and LT-COPD were estimated to 14.36% and 15.68%, respectively, their excess deaths to 33 and 4, and their RRs to 1.17 (95% CI: 1.11-1.31) and 1.19 (95% CI: 1.00-1.02), respectively. In comparison, the AP of ST-TM was estimated to 1.27%, with a 25-person excess death rate. This study was conducted to inform decision-making and to promote local policies on ambient air quality.

Rising of a global silent killer: critical analysis of chronic kidney disease of uncertain aetiology (CKDu) worldwide and mitigation steps

Chronic kidney disease of uncertain aetiology (CKDu) is an advanced version of chronic kidney disease (CKD) which bears a high burden on the world health economy. More than 200 articles were analysed to understand the disease responsible for more than 30,000 deaths per year. CKDu is a non-communicable occupational disease that has a progressive deterioration of the kidney in the absence of CKD risk factors such as hypertension, diabetes and glomerulonephritis, while the diagnosis is only possible at the later stages when kidney function is no longer effective. Published evidence for the existence of CKDu was found for around 35 countries. This is a growing health issue in Asia, Central America, Africa and Middle East with identified hot spots. Despite many research studies over decades, the exact root causes are still uncertain. Six main suspected causative factors are identified. Those are heat stress, strenuous labour, dehydration, use of agrochemicals, exposure to heavy metals and the use of polluted water and agricultural lands. This review summarizes four key areas which are CKDu and its general medical background, worldwide prevalence, suspected causative factors and potential circumventing steps to mitigate against CKDu. The importance of further studies addressing early detection and surveillance methods, contribution of nephrotoxins in environmental health, soil chemistry on transporting nephrotoxins, geological parameters which influence the prevalence of the disease and other related sectors to overcome the mysterious nature is highlighted. Mitigation steps to lessen the burden of CKDu are also identified.

Distinct seasonal variability of source-dependent health risks from PM2.5-bound PAHs and related derivatives in a megacity, southwest China: Implications for the significance of secondary formation

In contrast to polycyclic aromatic hydrocarbons (PAHs) which have been regularly monitored, the source-dependent health risk of their derivatives in ambient environment has not been well understood, especially regarding seasonal variability. In this study, oxygenated and nitrated PAHs (OPAHs and NPAHs) in PM_2.5 samples from different seasons in urban Chongqing were analyzed and compared with PAHs from a human health perspective. Benzo[a]pyrene equivalent concentrations (BaP_eq) were annually averaged at 6.13 ± 8.97 ng/m³ (n = 118) in the present study, with highest levels in winter followed by spring, autumn, and summer. The BaP_eq values of OPAHs were higher than PAHs in spring and summer with seasonal averaged value up to 3.7 times of that for PAHs, manifesting significant underestimation of the health impact if only PAHs were considered. Incremental lifetime cancer risk (ILCR) model results suggested that the potential cancer risks were accumulated mostly from inhalation exposure during infancy and adulthood. Furthermore, in comparison with PAHs, OPAHs, mainly 6H-Benzo[c,d]pyren-6-one, had significant contribution to cancer risks (annually averaged at 58.3 %). Source-dependent cancer risks based on positive matrix factorization model denoted secondary formed PAH derivatives as a critical contributor to cancer risk, particularly in spring and summer (attributed to about 61 % of ILCR). The enhanced secondary formation of PAH derivatives during spring and summer was partially justified by diagnostic ratios and further analysis revealed that higher temperature, higher O₃ level, and lower relative humidity besides stronger solar intensity during these two seasons as the most likely causes of this seasonal variation. Results in this study emphasizes that more knowledge on the formation and toxicity of OPAHs is imperative, especially in the context of complex PM_2.5-ozone pollution in China.

Improved air quality from China's clean air actions alleviates health expenditure inequality

Clean air actions aimed at improving air quality in China have brought about significant health benefits, thereby generating substantial savings in air-pollution-related healthcare spending. Yet, uneven regional air quality improvements and economic developments may alter existing inequality in health expenditures in the context of scarce healthcare resources. Here, we developed an econometric model that resolves individual characteristics at the city level to examine the disparity of public health expenditures in air quality improvements across regions differing in economic development and healthcare coverages and projected a range of future health expenditure savings under different air quality targets. We find that of the estimation on four air-pollution-related diseases (COPD, LRI, IHD, and stroke) in 98 cities over the year 2015-2017, a decline of 8.26 % in average hospitalization days and 10.21 % in hospitalization expenses was achieved, leading to a reduction of 8.09 % in total health expenditures as the implementation of clean air actions. Improved air quality has declined health expenditure inequality in low-middle cities and cities with imbalanced healthcare coverage. For example, the total expenses for the four diseases declined significantly in the low (-11.31 %) and medium (-7.34 %) per capita GDP groups, as well as a remarkable decline in the fewer medical resources. Health savings in some future scenarios are significant, showing substantial health expenditure savings under different air quality targets, but the savings will be greatly offset by an aging society. For example, In the Low-Level Improvement Pathway of air quality targets with aging (LLIPA scenario), health expenditure savings will be about 3537, 464, and 311 million CNY in the eastern, central, and western regions in 2035, respectively. Our findings thus highlight the importance of strengthening air pollution control policies and considering the equality of alleviating regional public health costs.

Microplastics in different fish and shellfish species in the mangrove estuary of Bangladesh and evaluation of human exposure

The water bodies in Bangladesh thrive from plastic pollution. Estuaries are pools of environmental contaminants, and the world's largest mangrove forest, Sundarbans' estuary, is no exception. Thus, for the first time, we investigate MPs abundance in the muscle and gastrointestinal tract (GIT) of twenty estuarine species of fish and shellfish of the Sundarbans, as well as the human health risk. MPs abundance was evident in all the samples ranging from 5.37 ± 1.07 to 54.30 ± 16.53 MP items/g wet body weight (dw) in muscle samples and 7.33 ± 1.89 to 205.61 ± 136.88 MP items/g (dw) in GIT samples. The estimated health risk from MPs is substantial, where the average human intake will be 85,710.08 items of MPs per year per capita for the population of Bangladesh. The dominant polymer types observed using ATR-FTIR are PP and PE (17.5 %), PA (17.5 %) in the muscle tissues, and PP and PE (11.11 %), and EVA (11.11 %) in the GITs. Bottom-feeding species, such as demersal and benthic species, are more contaminated. However, the level of MPs in the species shows a negative correlation with the length and weight of the species. This study reveals that MP pollution is widespread and concerning in Bangladesh's Sundarban mangrove estuarine zone.

Air pollution-induced health impacts and health economic losses in China driven by US demand exports

Understanding how trade between regions or countries drives the transfer of air pollution has attracted considerable interest recently, but few studies have explored the various transfer pathways or evaluated economic losses due to the health impact of such air pollution. Here, we assess the air pollutant emissions and related health impacts and economic losses in China caused by export trade due to US demand by combining the linked multi-regional input-output (MRIO) model, GEOS-Chem model, integrated exposure-response model, and the willingness to pay method. We show that the air pollutant emissions embedded in China's export due to the US demand reached 5792.38 Kt in 2012 (2.48% of the total), which includes direct exports of intermediate (40.27%) and final (33.61%) products and indirect exports of intermediate products via domestic provinces (16.43%, domestic spillover) and other countries (9.69%, foreign spillover). The resulting increase in PM_2.5 (<2.8 μg m^-3) leads to additional 27,963 deaths in 30 provinces, with a higher death toll in coastal areas and the corresponding economic loss was higher in more developed regions and reached USD 2.08 billion. This study highlights the region-different air pollution and health impacts in China embedded in the US-demand trade, and provides a framework for the analysis of health and economic losses hidden in global trade, particularly between developing and developed countries.

How the Air Clean Plan and carbon mitigation measures co-benefited China in PM2.5 reduction and health from 2014 to 2020

China implemented a stringent Air Clean Plan (ACP) since 2013 to address environmental and health risks caused by ambient fine particulate matter (PM_2.5). However, the policy effectiveness of ACP and co-benefits of carbon mitigation measures to environment and health are still largely unknown. Using satellite-based PM_2.5 products produced in our previous study, concentration-response functions, and the logarithmic mean Divisia index (LMDI) method, we analyzed the spatiotemporal dynamics of premature deaths attributable to PM_2.5 exposure, and quantitatively estimated the policy benefits of ACP and carbon mitigation measures. We found the annual PM_2.5 concentrations in China decreased by 33.65 % (13.41 μg m^-3) from 2014 to 2020, accompanied by a decrease in PM_2.5-attributable premature deaths of 0.23 million (95 % confidence interval (CI): 0.22-0.27), indicating the huge benefits of China ACP for human health and environment. However, there were still 1.12 million (95 % CI: 0.79-1.56) premature deaths caused by the exposure of PM_2.5 in mainland China in 2020. Among all ACP measures, clean production (contributed 55.98 % and 51.14 % to decrease in PM_2.5 and premature deaths attributable to PM_2.5) and energy consumption control (contributed 32.58 % and 29.54 % to decrease in PM_2.5 and premature deaths attributable to PM_2.5) made the largest contribution during the past seven years. Nevertheless, the environmental and health benefits of ACP are not fully synergistic in different regions, and the effectiveness of ACP measures reduced from 2018 to 2020. The co-effects of CO₂ and PM_2.5 has become one of the major drivers for PM_2.5 and premature deaths reduction since 2018, confirming the clear environment and health co-benefits of carbon mitigation measures. Our study suggests, with the saturation of clean production and source control, more targeted region-specific strategies and synergistic air pollution-carbon mitigation measures are critical to achieving the WHO's Air Quality Guideline target and the UN's Sustainable Development Goal Target in China.

Long-term trends of atmospheric hot-and-polluted episodes (HPE) and the public health implications in the Pearl River Delta region of China

Air pollution and extreme heat have been responsible for more than a million deaths in China every year, especially in densely urbanized regions. While previous studies intensively evaluated air pollution episodes and extreme heat events, a limited number of studies comprehensively assessed atmospheric hot-and-polluted-episodes (HPE) - an episode with simultaneously high levels of air pollution and temperature - which have potential adverse synergic impacts on human health. This study focused on the Pearl River Delta (PRD) region of China due to its high temperature in summer and poor air quality throughout a year. We employed geostatistical downscaling to model meteorology at a spatial resolution of 1 km, and applied a machine learning algorithm (XGBoost) to estimate a high-resolution (1 km) daily concentration of particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5) and ozone (O₃) for June to October over 20 years (2000-2019). Our results indicate an increasing trend (∼50%) in the frequency of HPE occurrence in the first decade (2000-2010). Conversely, the annual frequency of HPE occurrence reduced (16.7%), but its intensity increased during the second decade (2010-2019). The northern cities in the PRD region had higher levels of PM_2.5 and O₃ than their southern counterparts. During HPEs, regional daily PM_2.5 exceeded the World Health Organization (WHO) and Chinese guideline levels by 75% and 25%, respectively, while the O₃ exceeded the WHO O₃ standard by up to 69%. Overall, 567,063 (95% confidence interval (CI): 510,357-623,770) and 52,231 (95%CI: 26,116-78,346) excessive deaths were respectively attributable to exposure to PM_2.5 and O₃ in the PRD region. Our findings imply the necessity and urgency to formulate co-benefit policies to mitigate the region's air pollution and heat problems.

Health and economic impacts of ambient air particulate matter (PM2.5) in Karaj city from 2012 to 2019 using BenMAP-CE

The present study aims to estimate the effects of PM_2.5 on the health and economy of Karaj city from 2012 to 2019. In this study, mortality attributed to long-term exposure to PM_2.5 and its spatial distribution in Karaj over the 2012-2019 period were estimated using the Global Exposure Mortality Model (GEMM) concentration-response function and BenMAP software. PM_2.5 hourly concentration data of air quality monitoring stations were used to estimate PM_2.5 for the whole city of Karaj. The economic effects of this pollutant were also assessed using the value of statistical life (VSL) method. The results showed that the annual average PM_2.5 concentration during the studied time increased and was higher than the air quality guideline levels recommended by the World Health Organization. Also, the annual number of deaths attributed to PM_2.5 in adults (older than 25 years) was estimated to be about 1200. The highest to lowest proportions of PM_2.5-related deaths were non-accidental mortality, ischemic heart attack, stroke, acute respiratory tract infection, chronic obstructive pulmonary disease (COPD), and lung cancer, in the order of their appearance. The results showed that the economic loss attributed to this pollutant was estimated at 380 to 504 million USD per year. Due to the effects of PM_2.5 on health and the economy in this city, we suggest conducting special planning to control and reduce the concentration of ambient air particulate matter by improving the public transportation system and updating industrial processes.

Spatiotemporal neural network for estimating surface NO2 concentrations over north China and their human health impact

Atmospheric nitrogen dioxide (NO₂) is an important reactive gas pollutant harmful to human health. The spatiotemporal coverage provided by traditional NO₂ monitoring methods is insufficient, especially in the suburban and rural areas of north China, which have a high population density and experience severe air pollution. In this study, we implemented a spatiotemporal neural network (STNN) model to estimate surface NO₂ from multiple sources of information, which included satellite and in situ measurements as well as meteorological and geographical data. The STNN predicted NO₂ with high accuracy, with a coefficient of determination (R²) of 0.89 and a root mean squared error of 5.8 μg/m³ for sample-based 10-fold cross-validation. Based on the surface NO₂ concentration determined by the STNN, we analyzed the spatial distribution and temporal trends of NO₂ pollution in north China. We found substantial drops in surface NO₂ concentrations ranging between 9.1% and 33.2% for large cities during the 2020 COVID-19 lockdown when compared to those in 2019. Moreover, we estimated the all-cause deaths attributed to NO₂ exposure at a high spatial resolution of about 1 km, with totals of 6082, 4200, and 18,210 for Beijing, Tianjin, and Hebei Provinces in 2020, respectively. We observed remarkable regional differences in the health impacts due to NO₂ among urban, suburban, and rural areas. Generally, the STNN model could incorporate spatiotemporal neighboring information and infer surface NO₂ concentration with full coverage and high accuracy. Compared with machine learning regression techniques, STNN can effectively avoid model overfitting and simultaneously consider both spatial and temporal correlations of input variables using deep convolutional networks with residual blocks. The use of the proposed STNN model, as well as the surface NO₂ dataset, can benefit air quality monitoring, forecasting, and health burden assessments.

Trends and characteristics of ozone and nitrogen dioxide related health impacts in Chinese cities

Ambient ozone pollution has been becoming severe and attributed to considerable health impacts in China. Nitrogen dioxide (NO₂) is involved in atmospheric ozone production while also affecting public health directly. Joint control ozone and NO₂ pollution would be of significance. This study quantitatively assessed the health impact attributed to ambient ozone and NO₂ pollution in 338 Chinese cities from 2015 to 2020. The results reveal the generally opposite trends of ozone- and NO₂-related health impacts in China. From 2015-2020, respiratory and chronic obstructive pulmonary disease (COPD) health impacts attributed to ozone in 338 cities increased by 65.30% and 63.98%. The NO₂-attributed health impacts decreased by 24.80% and 24.62%. In 2020, the ozone- and NO₂-related respiratory health impacts were 3.96 million DALYs (disability-adjusted life years) and 1.47 million DALYs. High health impacts are concentrated in big cities and city clusters. In 2020, the sum of ozone- and NO₂-related respiratory health impacts in the top 20 cities was 0.98 million DALYs and 0.44 million DALYs, accounting for 24.70% and 30.24% of the 338 cities. The population attribution fraction analysis identified the increasing distributional consistency of ozone and NO₂-related health impacts, emphasizing the necessity and possible efficiency of ozone-NO₂ joint control. Emission source analysis based on gridded data provided a reference for understanding health impacts and developing targeted strategies.

Explorations of tire and road wear microplastics in road dust PM2.5 at eight megacities in China

Tire and road wear microplastics (TRWMPs) in road dust are a key source of atmospheric particulate matter and have an adverse impact on human health and the environment. In this study, samples of particulate matter with a diameter of 2.5 μm or less (PM_2.5) in road dust were collected from eight megacities in China to determine the TRWMP content, including that of natural rubber (NR), styrene-butadiene rubber (SBR), and butadiene rubber (BR). The total abundance of TRWMPs was the highest in Lanzhou (174.7 ± 17.0 μg g^-1), followed by Xi'an (169.3 ± 23.8 μg g^-1), Beijing (107.5 ± 7.5 μg g^-1), Changchun (102.2 ± 8.4 μg g^-1), Chengdu (101.6 ± 12.9 μg g^-1), Guangzhou (98.8 ± 6.5 μg g^-1), Wuhan (96.0 ± 5.3 μg g^-1), and Shanghai (86.1 ± 30.1 μg g^-1). A considerably higher TRWMP fraction in road dust PM_2.5 was observed in the northern cities than in the southern cities and is attributable to the higher frictional resistance of roads subjected to less precipitation. The abundance of TRWMPs in the southern cities was dependent on road type, but this dependence was not observed in the northern cities. In the south, road dust PM_2.5 on main roads contained more TRWMPs than that on branch roads. Correlation analysis indicated that TRWMPs were associated with tire, road, and break wear. In relation to intracellular oxidative stress factors, higher correlations were observed between TRWMPs and lactate dehydrogenase (r = 0.83) than between TRWMPs and reactive oxygen species (r = 0.59), possibly because TRWMPs destroy the integrity of the cell membrane, with NR exhibiting a higher cytotoxicity than SBR or BR. This study provides evidence that TRWMPs have an adverse impact on human health by inducing cellular oxidative stress. Therefore, further research on TRWMPs in respirable road dust is required.

A refined and updated health impact assessment of the Global Programme to Eliminate Lymphatic Filariasis (2000-2020)

Background

Lymphatic filariasis (LF) is a neglected tropical disease (NTD). In 2000 the World Health Organization (WHO) established the Global Programme to Eliminate Lymphatic Filariasis (GPELF). A key component of this programme is mass drug administration (MDA). Between 2000 and 2020, the GPELF has delivered over 8.6 billion treatments to at-risk populations. The last impact assessment of the programme evaluated the treatments provided between 2000–2014. The goal of this analysis is to provide an updated health impact assessment of the programme, based on the numbers treated between 2000–2020.

Methods

We updated and refined a previously established model that estimates the number of clinical manifestations and disability-adjusted life years (DALYs) averted by the treatments provided by the GPELF. The model comprises three different population cohorts that can benefit from MDA provided (those protected from acquiring infection, those with subclinical morbidity prevented from progressing and those with clinical disease alleviated). The treatment numbers were updated for all participating countries using data from the WHO. In addition, data relating to the estimated number of individuals initially at risk of LF infection were updated where possible. Finally, the DALY calculations were refined to use updated disability weights.

Results

Using the updated model and corresponding treatment data, we projected that the total benefit cohort of the GPELF (2000–2020) would consist of approximately 58.5 million individuals and the programme would avert 44.3 million chronic LF cases. Over the lifetime of the benefit cohorts, this corresponded to 244 million DALYs being averted.

Conclusion

This study indicates that substantial health benefits have resulted from the first 20 years of the GPELF. It is important to note that the GPELF would have both additional benefits not quantified by the DALY burden metric as well as benefits on other co-endemic diseases (such as soil-transmitted helminths, onchocerciasis and scabies)—making the total health benefit underestimated. As with the past impact assessments, these results further justify the value and importance of continued investment in the GPELF.

Graphical Abstract

Impact of two commercially available hair dyes on germination, morpho-physiology, and biochemistry of Cicer arietinum L. and cytotoxicity study on Allium cepa L. root tip

Contamination of agricultural land and surface water by personal care products and pharmaceutical constituents is a potential environmental threat. The active ingredients of personal care products are life-threatening for users. Present work highlighted the efficacy of the different components of two commercially available hair dyes (synthetic and herbal) on germination, morpho-physiological, biochemical parameters of Cicer arietinum, and cytotoxicity study by Allium cepa root tip. Different treatments such as T1 (control), T2 (cream colour rich), T3 (developer) (The ingredients T2 and T3 are from the same hair dye), T4 (an equal mixture of T2 and T3), and T5 (herbal dye) were considered to run this experiment. The results revealed that all the treatments improve germination with respect to control. Moreover, GSI data suggests that T2 showed the highest germination speed and T3 showed the lowest with respect to other treatments. But root lengths are severely affected by the treatments T3 (100% developer of synthetic hair dye), T4 (an equal mixture of T2 (100% cream colour rich) and T3), and T5 (100% herbal hair dye) with respect to control.T2 also showed the highest root tolerance of all treatments other than control. Similarly, one-way ANOVA results revealed that both fresh weight of roots (p ≤ 0.03) and shoots (p ≤ 0.03) are statistically significant among the different treatments. Moreover, both proline and root ion leakage are higher in the treatment T4 and T5 with respect to control, respectively. On the other hand, the cytotoxicity study highlighted that treatments T3 and T4 showed a higher level of aberration and significantly lower mitotic index compared to treatment T5. Therefore, finally, it may be concluded that both individual and combined forms of ingredients of hair dyes are toxic with respect to cell division and overall plant growth and development.

Experiences of increased food insecurity, economic and psychological distress during the COVID-19 pandemic among Supplemental Nutrition Assistance Program-enrolled food pantry clients

OBJECTIVE

The COVID-19 pandemic initially doubled the rates of food insecurity across the USA and tripled rates among households with children. Despite the association among food insecurity, chronic disease and psychological distress, narratives depicting the experiences of already food insecure populations are notably underrepresented in the literature. The current study assessed the impact of COVID-19 on clients of a food pantry who were also enrolled in the Supplemental Nutrition Assistance Program (SNAP).

DESIGN

A qualitative study probing the effects of the pandemic on daily living, food needs, food buying and food insecurity. Interview transcripts were analysed using a combined deductive and inductive approach.

SETTING

Interviews were conducted via telephone between May and June of 2020.

PARTICIPANTS

Equal numbers of English- and Spanish-speaking clients (n 40 total).

RESULTS

Three main findings emerged: (1) the pandemic increased economic distress, such as from job loss or increased utility bills due to sustained home occupancy and (2) the pandemic increased food needs, food prices and food shortages. In combination with economic stressors, this led to greater food insecurity; (3) increased economic stress and food insecurity contributed to increased psychological stress, such as from fear of infection, isolation and children being confined at home.

CONCLUSIONS

Despite federal legislation and state and local programmes to alleviate food insecurity, COVID-19 exacerbated economic hardship, food insecurity and psychological distress among urban SNAP and food pantry clients. Additional research is needed to identify the most effective policies and programmes to ameliorate the short- and long-term health and economic inequities exacerbated by the pandemic.

Modeling the health and economic implications of adopting a 1-dose 9-valent human papillomavirus vaccination regimen in a high-income country setting: An analysis in the United Kingdom

Although no human papillomavirus (HPV) vaccine is indicated for single-dose administration, some observational evidence suggests that a 1-dose regimen might reduce HPV infection risk to that achieved with 2 doses. This study estimated the potential health and economic outcomes associated with switching from a 2-dose HPV vaccination program for girls and boys aged 13-14 years to an off-label 9-valent (9vHPV), 1-dose regimen, accounting for the uncertainty of the effectiveness and durability of a single dose. A dynamic HPV transmission infection and disease model was adapted to the United Kingdom and included a probabilistic sensitivity analysis using estimated distributions for duration of protection of 1-dose and degree of protection of 1 relative to 2 doses. One-way sensitivity analyses of key inputs were performed. Outcomes included additional cancer and disease cases and the difference in net monetary benefit (NMB). The 1-dose program was predicted to result in 81,738 additional HPV-related cancer cases in males and females over 100 years compared to the 2-dose program, ranging from 36,673 to 134,347 additional cases (2.5% and 97.5% quantiles, respectively), and had a 7.8% probability of being cost-effective at the £20,000/quality-adjusted life years willingness-to-pay (WTP) threshold. In one-way sensitivity analyses, the number of additional cancer cases was sensitive to the median of the duration of protection distribution and coverage rates. The differences in NMBs were sensitive to the median of the duration of protection distribution, dose price and discount rate, but not coverage variations. Across sensitivity analyses, the probability of 1 dose being cost-effective vs 2 doses was < 50% at the standard WTP threshold. Adoption of a 1-dose 9vHPV vaccination program resulted in more vaccine-preventable HPV-related cancer and disease cases in males and females, introduced substantial uncertainty in health and economic outcomes, and had a low probability of being cost-effective compared to the 2-dose program.

Does air pollution explain COVID-19 fatality and mortality rates? A multi-city study in São Paulo state, Brazil

Since air pollution compromise the respiratory system and COVID-19 disease is caused by a respiratory virus, it is expected that air pollution plays an important role in the current COVID-19 pandemic. Exploratory studies have observed positive associations between air pollution and COVID-19 cases, deaths, fatality, and mortality rate. However, no study focused on Brazil, one of the most affected countries by the pandemic. Thus, this study aimed to understand how long-term exposure to PM₁₀, PM_2.5, and NO₂ contributed to COVID-19 fatality and mortality rates in São Paulo state in 2020. Air quality data between 2015 and 2019 in 64 monitoring stations within 36 municipalities were considered. The COVID-19 fatality was calculated considering cases and deaths from the government's official data and the mortality rate was calculated considering the 2020 population. Linear regression models were well-fitted for PM_2.5 concentration and fatality (R² = 0.416; p = 0.003), NO₂ concentration and fatality (R² = 0.232; p = 0.005), and NO₂ concentration and mortality (R² = 0.273; p = 0.002). This study corroborates other authors' findings and enriches the discussion for having considered a longer time series to represent long-term exposure to the pollutants and for having considered one of the regions with the highest incidence of COVID-19 in the world. Thus, it reinforces measures to reduce the concentration of air pollutants which are essential for public health and will increase the chance to survive in future respiratory disease epidemics.

Using social security number to identify sub-populations vulnerable to the health impacts from extreme heat in Florida, U.S

BACKGROUND

Some socioeconomically vulnerable groups may experience disproportionately higher risk of extreme heat illness than other groups, but no study has utilized the presence/absence of a social security number (SSN) as a proxy for vulnerable sub-populations.

METHODS

This study focused on the warm season from 2008 to 2012 in Florida, U.S. With a total number of 8,256,171 individual level health outcomes, we devised separate case-crossover models for five heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease), type of health care visit (emergency department (ED) and hospitalization), and patients reporting/not reporting an SSN. Each stratified model also considered potential effect modification by sex, age, or race/ethnicity.

RESULTS

Mean temperature raised the odds of five heat-sensitive health outcomes with the highest odds ratios (ORs) for heat-related illness. Sex significantly modified heat exposure effects for dehydration ED visits (Males: 1.145, 95 % CI: 1.137-1.153; Females: 1.110, 95 % CI: 1.103-1.117) and hospitalization (Males: 1.116, 95 % CI: 1.110-1.121; Females: 1.100, 95 % CI: 1.095-1.105). Patients not reporting an SSN between 25 and 44 years (1.264, 95 % CI: 1.192-1.340) exhibited significantly higher dehydration ED ORs than those reporting an SSN (1.146, 95 % CI: 1.136-1.157). We also observed significantly higher ORs for cardiovascular disease hospitalization from the no SSN group (SSN: 1.089, 95 % CI: 1.088-1.090; no SSN: 1.100, 95 % CI: 1.091-1.110).

CONCLUSIONS

This paper partially supports the idea that individuals without an SSN could experience higher risks of dehydration (for those 25-45 years), renal disease, and cardiovascular disease than those with an SSN.

Assessing the health impacts attributable to PM2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020

China has effectively reduced the fine particulate (PM_2.5) pollution from 2015 to 2020. Ozone pollution and related health impacts have become severe contemporaneously. The coordinated control of PM_2.5 and ozone is becoming a new issue for China's air pollution control. This study quantitatively assessed the health impacts attributed to PM_2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020 and estimated the possible health benefits from achieving dual concentration targets during 2021-2025. Results show PM_2.5 caused a total health impact of 2.45 × 10⁷ disability-adjusted life years (DALYs) in 2020. All-cause and respiratory ozone-related health impact in 2020 was 1.04 × 10⁷ DALYs and 1.56 × 10⁶ DALYs. Between 2015 and 2020, the PM_2.5-related health impacts decreased by 14.97%, while those ozone-related increased by 94.61% and 96.54% for all-cause and respiratory. Cities in the North China Plain have suffered higher health impacts attributable to PM_2.5 and ozone pollution, indicating that the two-pollutant coordinated control is primarily needed. By achieving aggressive concentration target (decreasing 10%) between 2020 and 2025, China will reduce the PM_2.5-related health impacts in 338 cities by 1.56 × 10⁶ DALYs (improving 6.37%). By achieving general target (decreasing 10% or within the Interim target-1 of World Health Organization), the PM_2.5-related health benefit will be 7.98 × 10⁵ DALYs (improving 3.25%). The deteriorating ozone health risks will also be improved. Controlling air pollution in large cities and regional center cities can achieve remarkable health benefits. Due to the inter-region, inter-province, and inter-city difference of health impacts, targeted and differentiated pollution prevention and control need to be implemented.

A 10-year assessment of ambient fine particles and related health endpoints in a large Mediterranean city

Fine particles i.e., with an aerodynamic diameter lower than 2.5 μm (PM_2.5) have potentially the most significant effects on human health compared to other air pollutants. The main objectives of this study were to i) investigate the temporal variations of ambient PM_2.5 in Marseille (Southern France), where air pollution is again a major public health issue, and ii) estimate their short-term health effects and annual trend (Mann-Kendall test) over a 10-year period from 2010 to 2019. In Marseille, the main sources of PM_2.5 could be related to road traffic, industrial complexes, and oil refineries surrounded the city. The number of premature deaths and hospital admissions attributable to ambient PM_2.5 exposure for non-accidental causes, cardiovascular and respiratory diseases were estimated by using in-situ air quality data, city-specific relative risk values and baseline incidence. Despite significant reduction of PM_2.5 (- 0.80 μg m^-3 year^-1), Marseille citizens were exposed to PM_2.5 levels exceeding the World Health Organization (WHO) Air Quality Guideline for human health protection (10 μg m^-3) during entire study period. Exposure to ambient PM_2.5 substantially contributed to mortality and hospital admissions: 871 deaths for non-accidental causes, 515 deaths for cardiovascular diseases, 47 deaths for respiratory diseases, as well as 1034 hospital admissions for cardiovascular diseases and 834 for respiratory diseases were reported between 2010 and 2019. Compliance with WHO annual limit values can result in substantial socio-economic benefits by preventing premature deaths and hospital admissions. For instance, based on the value of a statistical life and average cost of a hospital admission, the associated benefit for healthcare would have been €131 million in 2019. Between 2010 and 2019, the number of PM_2.5-related non-accidental deaths decreased by 1.15 per 10⁵ inhabitants annually. Compared to 2010-2019, the restrictive measures associated to COVID-19 pandemic led to a reduction in PM_2.5 of 11% in Marseille, with 2.6 PM_2.5-related deaths averted in 2020.

Exploring the potential for planning support systems to bridge the research-translation gap between public health and urban planning

BACKGROUND

There is consensus that planning professionals need clearer guidance on the features that are likely to produce optimal community-wide health benefits. However, much of this evidence resides in academic literature and not in tools accessible to the diverse group of professionals shaping our cities. Incorporating health-related metrics into the planning support systems (PSS) provides an opportunity to apply empirical evidence on built environment relationships with health-related outcomes to inform real-world land use and transportation planning decisions. This paper explores the role of planning support systems (PSS) to facilitate the translation and application of health evidence into urban planning and design practices to create healthy, liveable communities.

METHODS

A review of PSS software and a literature review of studies featuring a PSS modelling built environmental features and health impact assessment for designing and creating healthy urban areas was undertaken. Customising existing software, a health impact PSS (the Urban Health Check) was then piloted with a real-world planning application to evaluate the usefulness and benefits of a health impact PSS for demonstrating and communicating potential health impacts of design scenarios in planning practice.

RESULTS

Eleven PSS software applications were identified, of which three were identified as having the capability to undertake health impact analyses. Three studies met the inclusion criteria of presenting a planning support system customised to support health impact assessment with health impacts modelled or estimated due to changes to the built environment. Evaluation results indicated the Urban Health Check PSS helped in four key areas: visualisation of how the neighbourhood would change in response to a proposed plan; understanding how a plan could benefit the community; Communicate and improve understanding health of planning and design decisions that positively impact health outcomes.

CONCLUSIONS

The use of health-impact PSS have the potential to be transformative for the translation and application of health evidence into planning policy and practice, providing those responsible for the policy and practice of designing and creating our communities with access to quantifiable, evidence-based information about how their decisions might impact community health.

Recent trends in premature mortality and health disparities attributable to ambient PM2.5 exposure in China: 2005-2017

In the past decade, particulate matter with aerodynamic diameter less than 2.5 μm (PM_2.5) has reached unprecedented levels in China and posed a significant threat to public health. Exploring the long-term trajectory of the PM_2.5 attributable health burden and corresponding disparities across populations in China yields insights for policymakers regarding the effectiveness of efforts to reduce air pollution exposure. Therefore, we examine how the magnitude and equity of the PM_2.5-related public health burden has changed nationally, and between provinces, as economic growth and pollution levels varied during 2005-2017. We derive long-term PM_2.5 exposures in China from satellite-based observations and chemical transport models, and estimate attributable premature mortality using the Global Exposure Mortality Model (GEMM). We characterize national and interprovincial inequality in health outcomes using environmental Lorenz curves and Gini coefficients over the study period. PM_2.5 exposure is linked to 1.8 (95% CI: 1.6, 2.0) million premature deaths over China in 2017, increasing by 31% from 2005. Approximately 70% of PM_2.5 attributable deaths were caused by stroke and IHD (ischemic heart disease), though COPD (chronic obstructive pulmonary disease) and LRI (lower respiratory infection) disproportionately affected poorer provinces. While most economic gains and PM_2.5-related deaths were concentrated in a few provinces, both gains and deaths became more equitably distributed across provinces over time. As a nation, however, trends toward equality were more recent and less clear cut across causes of death. The rise in premature mortality is due primarily to population growth and baseline risks of stroke and IHD. This rising health burden could be alleviated through policies to prevent pollution, exposure, and disease. More targeted programs may be warranted for poorer provinces with a disproportionate share of PM_2.5-related premature deaths due to COPD and LRI.

Spatiotemporal assessment of health burden and economic losses attributable to short-term exposure to ground-level ozone during 2015-2018 in China

BACKGROUND

Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension.

METHODS

Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3.

RESULTS

The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses.

CONCLUSIONS

There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.

Current research trends on micro- and nano-plastics as an emerging threat to global environment: A review

Micro-and nano-plastics (MNPs) (size < 5 mm/<100 nm) epitomize one of the emergent environmental pollutants with its existence all around the globe. Their high persistence nature and release of chemicals/additives used in synthesis of plastics materials may pose cascading impacts on living organism across the globe. Natural connectivity of all the environmental compartments (terrestrial, aquatic, and atmospheric) leads to migration/dispersion of MNPs from one compartment to others. Nevertheless, the information on dispersion of MNPs across the environmental compartments and its possible impacts on living organisms are still missing. This review first acquaints with dispersion mechanisms of MNPs in the environment, its polymeric/oligomeric and chemical constituents and then emphasized its impacts on living organism. Based on the existing knowledge about the MNPs' constituent and its potential impacts on the viability, development, lifecycle, movements, and fertility of living organism via several potential mechanisms, such as irritation, oxidative damage, digestion impairment, tissue deposition, change in gut microbial communities' dynamics, impaired fatty acid metabolism, and molecular damage are emphasized. Finally, at the end, the review provided the challenges associated with remediation of plastics pollutions and desirable strategies, policies required along with substantial gaps in MNPs research were recommended for future studies.

The Future of Meat: Health Impact Assessment with Randomized Evidence

Massive animal farming for meat production poses major problems in terms of resource use, environmental impact, and biodiversity. Furthermore, excessive meat consumption has been associated with multiple deleterious health consequences. However, more and better-designed randomized trials are needed to increase the level of evidence on the health impacts of meat. Novel meat alternatives, such as plant- and cell-based meat, are much less impactful to the environment and might replace traditional animal meat in the future, but, despite promising early data, the health consequences of these novel products need further study. This manuscript focuses on the health impacts of meat over 3 main sections: 1) overview of the evidence highlighting the association of meat consumption with health; 2) novel alternatives to meat, including plant-based and cell-based alternatives; and 3) examine the rationale for randomized studies to evaluate the effects of the novel meat alternatives compared with the standard animal meat.

Multizone airflow and pollution simulations of indoor emission sources

A health impact assessment of the indoor pollution was performed for various indoor sources: oven for heating, cooking, photocopy machine and smoke cigarettes. The mortality levels and hospital admissions associated with exposure to PM2.5 and NO₂ concentrations have been calculated. We have modelled a two level house in Madrid city center where the office and the living floors are in the same building. The people follow a predefined activity patterns (time profiles) in the outdoor and indoor environments. In this experiment, we have performed a full year simulation using the EnergyPlus model to obtain the following parameters: building energy use, thermal behavior, airflow and indoor air quality simultaneously. Outdoor air quality and meteorological conditions were provided by the output of running the very well-known model WRF/Chem. The health impacts of the indoor emitting sources are higher in the warm months due to the operation of the air conditioning system. The largest impact on health is produced by the emissions that are released during cooking. The results also show a high correlation between indoor and outdoor concentrations when indoor emissions are not considered.

The aggravated short-term PM2.5-related health risk due to atmospheric transport in the Yangtze River Delta

Severe fine particulate matter (PM_2.5) pollution and the associated health risks remain pressing issues in the Yangtze River Delta (YRD), although significant efforts have been made locally, such as the Clean Air Action since 2013. Regional transport is an important contributor to high PM_2.5 levels during haze episodes in the YRD, but its impact on human health is rarely analyzed. In this study, we evaluate the short-term PM_2.5-related health risks and associated economic losses due to different source regions by estimating daily mortality based on model results in the YRD. The results show that regional transport induces significant health risks in the YRD during haze days, contributing over 60% of daily premature mortality in Shanghai and Nanjing (major cities in the YRD). Moreover, in Hangzhou and Jiaxing, regional transport's contribution can be as high as 70%. The total daily mean economic loss in the YRD is estimated as 526.8 million Chinese Yuan (approximately 81.4 million U.S. dollar) in winter of 2015 and 2016, accounting for 1.4% of the daily averaged gross domestic product (GDP) of the YRD. Emission control (in accordance with the 13th Five-year Energy Conservation and Emission Reduction Plan) is an effective way to reduce health risks in the YRD, reducing premature deaths during haze days by 12-33%. More stringent emission control measures are suggested for further reduce PM_2.5-related health risks.