Air pollution and public health: emerging hazards and improved understanding of risk

Public risk perception and willingness to mitigate climate change: city smog as an example

Climate change harms people's health and ecosystems. Encouraging the public to adopt behaviors that help to combat climate change can, at the same time, contribute to efforts to control and solve related serious environmental problems. This study aims to ascertain the way in which the public perceives risks related to climate change and adopts behaviors to respond to the issue. Using city smog as an example, this study proposes a conceptual model that integrates the theory of planned behavior (TPB), smog knowledge and risk perception. It aims to elucidate determinants of smog-reduction behavior. Data were obtained through questionnaire surveys. The results confirm the relationships among the core variables of the TPB and risk perception. Firstly, they confirm that TPB is an effective model for predicting responses to city smog, and secondly, they show that risk perception is significantly positive in predicting attitude and behavioral intention. In addition, our analysis confirms that knowledge about smog is a positive antecedent variable in risk perception, attitude, and perceived behavioral control. The paper contributes to the extension of the TPB model and to the enrichment of its application in the context of city smog. It also has practical implications both for people experiencing city smog, and for authorities such as local governments and environmental organizations. Governments and organizations need to make efforts to spread information concerning the harmful effects of city smog, because in doing so they can strengthen people's intention to participate in smog-reduction behavior.

Can portable air quality monitors protect children from air pollution on the school run? An exploratory study

With air quality issues in urban areas garnering increasing media attention, concerned citizens are beginning to engage with the technology as a means of identifying and responding to the environmental risks posed. However, while much has been written about the accuracy of the units, little research has been conducted into its effects on users. As such, this research deploys coping theory to explore the specific ways in which portable air quality sensors influence user behaviour. This is done using a qualitative exploratory design, targeting parents and carers of children on the school run. Drawing from survey and interview responses, the article illustrates the decision-making pathways underpinning engagement with monitors and the ways in which they influence behaviour and disrupt misconceptions around air pollution. The study demonstrates that personal environmental monitors can play a role in protecting children from air pollution on the school run. They can raise awareness about air pollution and disrupt misconceptions about where does and does not occur. They can also encourage the public to change their behaviour in an attempt to mitigate and manage risks. However, the findings additionally reveal that sensor technology does not generate a simple binary response among users, of behavioural change or not. When attempts at behavioural change fail to reduce risk, resulting negative feelings can lead to inaction. Hence, the relationship between the technology and the individual is entwined with various social circumstances often beyond a parent or carer's control. Thus, top-down support aimed at tackling air pollution at source is essential if this bottom-up technology is to fulfil its full potential.

The impact of population mobility on estimates of environmental exposure effects in a case-control study

In many studies of environmental risk factors for disease, researchers use the location at diagnosis as a geographic reference for environmental exposures. However, many environmental pollutants change continuously over space and time. The dynamic characteristics of these pollutants coupled with population mobility in the United States suggest that for diseases with long latencies like cancer, historic exposures may be more relevant than exposure at the time of diagnosis. In this article, we evaluated to what extent the commonly used assumption of no population mobility results in increased bias in the estimates of the relationship between environmental exposures and long-latency health outcomes disease in a case-control study. We conducted a simulation study using the residential histories of a random sample from the National Institutes of Health-AARP (formerly American Association of Retired Persons) Diet and Health Study. We simulated case-control status based on subject exposure and true exposure effects that varied temporally. We compared estimates from models using only subject location at diagnosis to estimates where subjects were assumed to be mobile. Ignoring population mobility resulted in underestimates of subject exposure, with largest deviations observed at time points further away from study enrollment. In general, the effect of population mobility on the bias of the estimates of the relationship between the exposure and the outcome was more prominent with exposures that showed substantial spatial and temporal variability. Based on our results, we recommend using residential histories when environmental exposures and disease latencies span a long enough time period that mobility is important.

Air pollution and cardiovascular disease: car sick

The cardiovascular effects of inhaled particle matter (PM) are responsible for a substantial morbidity and mortality attributed to air pollution. Ultrafine particles, like those in diesel exhaust emissions, are a major source of nanoparticles in urban environments, and it is these particles that have the capacity to induce the most significant health effects. Research has shown that diesel exhaust exposure can have many detrimental effects on the cardiovascular system both acutely and chronically. This review provides an overview of the cardiovascular effects on PM in air pollution, with an emphasis on ultrafine particles in vehicle exhaust. We consider the biological mechanisms underlying these cardiovascular effects of PM and postulate that cardiovascular dysfunction may be implicated in the effects of PM in other organ systems. The employment of multiple strategies to tackle air pollution, and especially ultrafine particles from vehicles, is likely to be accompanied by improvements in cardiovascular health.

Evaluate Air Pollution by Promethee Ranking in Yangtze River Delta of China

A series of problems that are related to population, resources, environment, and ecology have emerged in recent years with the advancement of industrialization and urbanization in China. Especially, air pollution has become a severe trouble that directly endangers the health of residents. Accordingly, it is a need to make the assessment of air quality among cities, so that corresponding measures can be taken. For this purpose, ten major cities are selected as the research objects in Yangtze River Delta. Additionally, this study gathers and processes the data of five main air pollutants PM_2.5, PM₁₀, SO₂, O₃, and NO₂, respectively. Furthermore, the maximizing deviation method is used to obtain the respective weight of these pollutants and the preference ranking organization method for enrichment evaluations (PROMETHEE) is introduced into the assessment of air quality among ten cities. As a result, the ranking of air quality in Ningbo, Wenzhou, Shanghai, and Shaoxing was at the fore from 2014 to 2017. Meanwhile, the performance of Ningbo has always kept the top two and Shaoxing’s ranking has risen since 2015. In addition, the air quality of Changzhou, Suzhou and Hangzhou was at an average level in the past four years. Moreover, the performance of Nanjing, Wuxi, and Zhenjiang was terrible when compared to other cities. Some useful suggestions have been proposed to control air quality based on the ranking results.

Laser scanning microscopy for control of skin decontamination efficacy from airborne particulates using highly absorbent textile nanofiber material in combination with PEG-12 dimethicone

BACKGROUND

The decontamination of the skin is indispensable if airborne particulate contaminants deposit on the skin surface. Skin washing can have adverse effects as by skin rubbing the particles can be transferred deeply into the hair follicles, where they can be entrapped for a period of more than 10 days. Thus, alternative skin decontamination strategies are necessary.

MATERIALS AND METHODS

For imaging the contaminants in the skin, sodium fluorescein-labeled soot particles of submicron size (≈600 nm) were visualized using laser scanning microscopy.

RESULTS

In the present ex vivo pilot study on porcine ear skin, it was shown that sodium fluorescein-labeled soot particles of submicron size (≈600 nm) could be efficiently removed from the skin with highly absorbent textile nanofiber material, whose efficacy could be further increased by spraying the contaminated skin area with the viscous fluid PEG-12 dimethicone before textile application.

CONCLUSION

In case of skin contamination with particulates, the contact washing should be avoided due to rubbing particles deeply into the hair follicles, where they can accumulate for a long time and induce negative consequences. Efficient skin decontamination could include pretreatment of skin surface with the viscous fluid PEG-12 dimethicone and subsequent application of highly absorbent textile nanofiber material.

The Impact of the Media and Environmental Pollution on the Economy and Health Using a Modified Meta 2-Stage EBM Malmquist Model

China's pursuit of economic growth, rapid industrialization, and urbanization over the past few decades has resulted in high energy consumption, which in turn has caused serious environmental pollution problems, such as CO₂ and PM_2.5 emissions, the long-term exposure to which can seriously affect resident health. To resolve these air pollution problems, the Chinese government has put in place several policies to reduce air and environmental pollution. Past studies on energy and environmental efficiency have been mostly static, have ignored the dynamic changes over time and regional differences, and have rarely considered human health factors. Therefore, this study employed a modified meta 2-stage Epsilon-Based Measure (EBM) Malmquist model to explore the relationships between the economy, energy, the environment, health and media, and the regional differences in 31 Chinese cities from 2014 to 2016. It was found that (1) Haikou and Lhasa's efficiencies were 1 and were the best in all 3 years, and Shijiazhuang, Jinan and Shenyang's were the most improved; (2) there was a gap between the eastern, central and western technological frontiers, with Chengdu, Hohhot, Chongqing, and Nanchang having technological gap ratios below 0.70 in the western and central Chinese regions, and Haikou, Guangzhou, and Shanghai in eastern China having technological gap ratios above 0.90 in all 3 years; and (3) the variations in the health treatment stage were greater than in the production stage, indicating that technological changes and efficiency improvements in the health treatment stages in each city were not stable.

Relationships between airborne pollutants, serum albumin adducts and short-term health outcomes in an experimental crossover study

Exposure to air pollution can have both short-term and long-term effects on health. However, the relationships between specific pollutants and their effects can be obscured by characteristics of both the pollution and the exposed population. One way of elucidating the relationships is to link exposures and internal changes at the level of the individual. To this end, we combined personal exposure monitoring (59 individuals, Oxford Street II crossover study) with mass-spectrometry-based analyses of putative serum albumin adducts (fixed-step selected reaction monitoring). We attempted to infer adducts' identities using data from another, higher-resolution mass spectrometry method, and were able to detect a semi-synthetic standard with both methods. A generalised least squares regression method was used to test for associations between amounts of adducts and pollution measures (ambient concentrations of nitrogen dioxide and particulate matter), and between amounts of adducts and short-term health outcomes (measures of lung health and arterial stiffness). Amounts of some putative adducts (e.g., one with a positive mass shift of ∼143 Da) were associated with exposure to pollution (11 associations), and amounts of other adducts were associated with health outcomes (eight associations). Adducts did not appear to provide a link between exposures and short-term health outcomes.

The Relationship Between the Actual Level of Air Pollution and Residents' Concern about Air Pollution: Evidence from Shanghai, China

This study explored the relationship between the actual level of air pollution and residents’ concern about air pollution. The actual air pollution level was measured by the air quality index (AQI) reported by environmental monitoring stations, while residents’ concern about air pollution was reflected by the Baidu index using the Internet search engine keywords “Shanghai air quality”. On the basis of the daily data of 2068 days for the city of Shanghai in China over the period between 2 December 2013 and 31 July 2019, a vector autoregression (VAR) model was built for empirical analysis. Estimation results provided three interesting findings. (1) Local residents perceived the deprivation of air quality and expressed their concern on air pollution quickly, within the day on which the air quality index rose. (2) A decline in air quality in another major city, such as Beijing, also raised the concern of Shanghai residents about local air quality. (3) A rise in Shanghai residents’ concern had a beneficial impact on air quality improvement. This study implied that people really cared much about local air quality, and it was beneficial to inform more residents about the situation of local air quality and the risks associated with air pollution.

How Energy Consumption and Pollutant Emissions Affect the Disparity of Public Health in Countries with High Fossil Energy Consumption

Public health issues are a global focus, but recent research on the links between fossil energy consumption, pollutant emissions, and public health in different regions have presented inconsistent conclusions. In order to quantify the effect of fossil energy use and pollutant emissions on public health from the global perspective, this paper investigates 33 countries with high GDP and fossil energy consumption from 1995 to 2015 using a fixed effect model. Further, this paper utilizes heterogeneity analysis to characterize the disparity of countries with different features. Empirical results indicate that total fossil energy consumption is beneficial to the life expectancy of the population (LEP), but pollutant emissions (PM10 concentration and greenhouse gas scale) have a negative effect on LEP. Moreover, the heterogeneity test indicates that pollutant emissions lowers LEP in net energy importers more than in net energy exporters, and the effect of such emissions in low- and middle-income countries on public health is more harmful than that in high-income countries. These findings suggest that it is a greater priority for governments to strengthen the control of pollutant emissions through enhancing the efficiency of energy consumption, rather than by reducing its scale of use in low- and middle-income, and net energy importing countries. Additionally, governments also need to focus on the volatility of pollutant emissions in high-income countries with necessary control measures.

Impact of Media Reports and Environmental Pollution on Health and Health Expenditure Efficiency

Over the past few decades, China’s rapid economic, energy, and industrial developments have caused serious environmental damage. However, as there are large resource, energy use, economic, and environmental damage differences across Chinese regions, the Chinese government is seeking to reduce city pollution across the country. Most previous analyses have only looked at these issues on a single level; for example, the impact of environmental pollution on health, or energy and environmental efficiency analyses, but there have been few studies that have conducted overall analyses. Further, many of the methods that have been used in previous research have employed one-stage radial or non-radial analyses without considering regional differences. Therefore, this paper developed a meta undesirable two-stage EBM DEA model to analyze the energy, environment, health, and media communication efficiencies in 31 Chinese cities, from which it was found that the productivity efficiency in most cities was better than the health treatment efficiencies, the GDP and fixed asset efficiency improvements were small, the air quality index (AQI) and CO₂ efficiencies varied widely between the cities, media report and governance inputs were generally inefficient, the birth rate efficiencies were better than the respiratory disease efficiencies, and the technical gap was best in Guangzhou, Shanghai, and Lhasa. Also, it found that high-income cities have a higher technology gap than upper middle–income cities, and media reports efficiency have a high correlation with respiratory diseases and CO₂.

PM2.5 and NOx exposure promote myopia: clinical evidence and experimental proof

Myopia is caused by complex genetic and environmental factors. However, information regarding the effect of long-term exposure to air pollutants on the risk of development of myopia is lacking. We collected data from two linked databases: the Taiwan National Health Insurance Research Database (NHIRD) and the Taiwan Air Quality-Monitoring Database (TAQMD). A total of 15,822 children (16.3%) were diagnosed with myopia within the cohort. The incidence rate of myopia increased with exposure to increasing concentrations of particulate matter (PM2.5) and nitrogen oxides (NOx), increasing from 15.8 to 24.5 and from 13.7 to 34.4, per 1000 person-years, respectively. The adjusted hazard ratio for myopia increased with elevated PM2.5 and NOx exposure concentrations in Q4 to 1.57 and 2.60, respectively, compared to those exposed to the corresponding concentrations in Q1. In the animal experiments, PM2.5 induced myopia in hamsters by enhancing inflammation and was inhibited by resveratrol treatment compared to the control group. The change in axial length in the PM2.5 group was 0.386 ± 0.069 mm versus 0.287 ± 0.086 mm in the control group and 0.257 ± 0.059 mm in the PM2.5 + resveratrol group. We provide both clinical and experimental correlations that exposure to ambient air pollutants is associated with the pathogenesis of myopia.

Three-wavelength polarization Scheimpflug lidar system developed for remote sensing of atmospheric aerosols

Multiple-wavelength polarization lidar techniques have been of great interest for the studies of aerosol backscattering color ratio, Ångström exponent, particle size distribution, hygroscopic growth, etc. Conventional lidar techniques are mainly based on the time-of-flight principle. In this paper, a three-wavelength polarization Scheimpflug lidar (SLidar) system, based on the Scheimpflug imaging principle, has been developed for studying optical properties of atmospheric aerosols. The SLidar system utilizes low-cost, compact, multimode laser diodes as light sources and two complementary metal oxide semiconductor (CMOS) sensors as detectors. The depolarization ratio was measured at the 808 nm band by successively detecting atmospheric backscattering signals from two orthogonally polarized laser beams with a polarization CMOS camera, while the 520 nm and the 405 nm backscattering signals were recorded by a second CMOS camera based on the time-multiplexing scheme. Atmospheric remote measurements were carried out in May and July 2019 on a near-horizontal path. The aerosol extinction coefficient, linear volume depolarization ratio, and the Ångström exponent have been retrieved and evaluated to study aerosol properties during different atmospheric conditions, which were in good agreement with optical properties reported by previous studies.

Achieving renewable energy, climate, and air quality policy goals: Rural residential investment in solar panel

Heavy dependence on fossil fuels among rural households contributes to GHG emissions and air pollution while increasing landfill loads in Poland. This study examines benefits from the renewable energy utilization support program that subsidized household purchase and installation of thermal solar panels. This review of synergy between energy, climate, and air quality policies focuses on solar panel subsidies funded through the European Union and county governments in Mazowieckie Voivodship in Poland. County government offices, using the unpublished list of households receiving subsidies for thermal solar panel installation, mediated in the implementation of the survey and collected 123 completed questionnaires in May and June 2015. The heteroscedasticity-corrected OLS estimates two equations identifying and quantifying factors influencing the purchase price of solar panels and rural household monthly energy bill savings after installation using the gathered data. Among sociodemographic variables, increasing age was associated with an increasing price paid for the panels, but education was associated with paying a lower price for solar panels and lower self-reported energy bill savings. Panel purchase price increased if the respondent was a farmer, viewed subsidies as important, and preferred domestically manufactured panels. Location of household increased the price as compared to the reference county. Savings on monthly energy bills increased if respondent had a positive view of solar energy, expected a decrease in the bill following the purchase of panels, and heated large areas in the house. Subsidy programs have been important in increased household solar energy utilization, especially among farm households, while self-reported energy bill savings increased with positive attitudes towards renewable energy and the larger heated areas in rural residences.

Illuminating Stakeholder Perspectives at the Intersection of Air Quality Health Risk Communication and Cardiac Rehabilitation

There is ample evidence of adverse cardiovascular health outcomes associated with exposure to air pollution and cardiac rehabilitation patients are at increased risk for future adverse health events related to air quality. Risk communication and health messaging about recommended behaviors to reduce exposure to air pollution can be integrated into existing care routines and structures. How this can be achieved most appropriately and effectively is not well understood. A focus group design is used to investigate cardiovascular patient and provider experiences, attitudes and beliefs about the risks of air pollution, related health risk messaging and factors that may influence integrating that topic into patient care and communication. Three discussions were hosted, one with cardiac patients, a second with non-physician cardiac rehabilitation providers and a third with physicians who treat cardiac patients. A within-case thematic inductive analysis of each discussion is used to understand the nature of communication, logistics, guidance and overall substance of the cardiac rehabilitation educational experience. Results suggest that air pollution may be an unrecognized risk factor for cardiac patients and cardiac rehabilitation is a prime setting for communicating air pollution health risk messaging. However, to effectively integrate air quality health risk messaging into cardiac rehabilitation, it is critical to account for the existing knowledge-base and behaviors of both providers and patients.

Associations Between Sub-Clinical Markers of Cardiometabolic Risk and Exposure to Residential Indoor Air Pollutants in Healthy Adults in Perth, Western Australia: A Study Protocol

BACKGROUND

A growing body of epidemiological and clinical evidence has implicated air pollution as an emerging risk factor for cardiometabolic disease. Whilst individuals spend up to two-thirds of daily time in their domestic residential environment, very few studies have been designed to objectively measure the sub-clinical markers of cardiometabolic risk with exposure to domestic indoor air pollutants. This cross-sectional study aims to investigate associations between the components of domestic indoor air quality and selected sub-clinical cardiometabolic risk factors in a cohort of healthy adults living in Perth, Western Australia.

METHODS

One hundred and eleven non-smoking adults (65% female) living in non-smoking households who were aged between 35-69 years were recruited for the project. Study subjects were invited to participate in all sections of the study, which included: Domestic indoor air monitoring along with the concurrent 24 h ambulatory monitoring of peripheral and central blood pressure and measures of central hemodynamic indices, standardized questionnaires on aspects relating to current health status and the domestic environment, a 24 h time-activity diary during the monitoring period, and clinic-based health assessment involving collection of blood and urine biomarkers for lipid and glucose profiles, as well as measures of renal function and an analysis of central pulse wave and pulse wave velocity.

RESULTS

This study provides a standardized approach to the study of sub-clinical cardiometabolic health effects that are related to the exposure to indoor air pollution.

CONCLUSION

The findings of this study may provide direction for future research that will further contribute to our understanding of the relationship that exists between indoor air pollution and sub-clinical markers of cardiometabolic risk.

Air pollution and DNA methylation: effects of exposure in humans

Air pollution exposure is estimated to contribute to approximately seven million early deaths every year worldwide and more than 3% of disability-adjusted life years lost. Air pollution has numerous harmful effects on health and contributes to the development and morbidity of cardiovascular disease, metabolic disorders, and a number of lung pathologies, including asthma and chronic obstructive pulmonary disease (COPD). Emerging data indicate that air pollution exposure modulates the epigenetic mark, DNA methylation (DNAm), and that these changes might in turn influence inflammation, disease development, and exacerbation risk. Several traffic-related air pollution (TRAP) components, including particulate matter (PM), black carbon (BC), ozone (O₃), nitrogen oxides (NO_x), and polyaromatic hydrocarbons (PAHs), have been associated with changes in DNAm; typically lowering DNAm after exposure. Effects of air pollution on DNAm have been observed across the human lifespan, but it is not yet clear whether early life developmental sensitivity or the accumulation of exposures have the most significant effects on health. Air pollution exposure-associated DNAm patterns are often correlated with long-term negative respiratory health outcomes, including the development of lung diseases, a focus in this review. Recently, interventions such as exercise and B vitamins have been proposed to reduce the impact of air pollution on DNAm and health. Ultimately, improved knowledge of how exposure-induced change in DNAm impacts health, both acutely and chronically, may enable preventative and remedial strategies to reduce morbidity in polluted environments.

ATR-FTIR Spectral Analysis and Soluble Components of PM10 And PM2.5 Particulate Matter over the Urban Area of Palermo (Italy) during Normal Days and Saharan Events

Several epidemiological studies have shown a close relationship between the mass of particulate matter (PM) and its effects on human health. This study reports the identification of inorganic and organic components by attenuated total reflectance-Fourier-transform infrared spectroscopy (ATR-FTIR) analysis in PM₁₀ and PM_2.5 filters collected from three air quality monitoring stations in the city of Palermo (Sicily, Italy) during non-Saharan dust events and Saharan events. It also provides information on the abundance and types of water-soluble species. ATR-FTIR analysis identified sulfate, ammonium, nitrate, and carbonate matter characterized by vibrational frequencies at 603, 615, 670, and 1100 cm^–1 (SO₄^2–); at 1414 cm^–1 (NH₄⁺); at 825 and 1356 cm^–1 (NO₃^–); and at 713, 730, and 877 cm^–1 (CO₃^2–) in PM₁₀ and PM_2.5 filters. Moreover, aliphatic hydrocarbons were identified in the collected spectra. Stretching frequencies at 2950 cm^–1 were assigned to CH₃ aliphatic carbon stretching absorptions, while frequencies at 2924 and 2850 cm^–1 indicated CH₂ bonds. In filters collected during Saharan dust events, the analysis also showed the presence of absorbance peaks typical of clay minerals. The measurement of soluble components confirmed the presence of a geogenic component (marine spray and local rocks) and secondary particles ((NH₄)₂SO₄, NH₄NO₃) in the PM filters. ATR-FTIR characterization of solid surfaces is a powerful analytical technique for identifying inorganic and organic compounds in samples of particulate matter.

The association of PM2.5 with airway innate antimicrobial activities of salivary agglutinin and surfactant protein D

Fine particulate matter ≤2.5 μm (PM_2.5) is a prominent global public health risk factor that can cause respiratory infection by downregulating the amounts of antimicrobial proteins and peptides (AMPs). Both salivary agglutinin (SAG) and surfactant protein D (SPD) are important AMPs in respiratory mucosal fluid, providing protection against airway pathogen invasion and infection by inducing microbial aggregation and enhancing pathogen clearance. However, the relationship between PM_2.5 and these AMPs is unclear. To better understand the relationship between PM_2.5 and airway innate immune defenses, we review the respiratory antimicrobial activities of SAG and SPD, as well as the adverse effects of PM_2.5 on airway innate antimicrobial defense. We speculate there exists a dual effect between PM_2.5 and respiratory antimicrobial activity, which means that PM_2.5 suppresses respiratory antimicrobial activity through downregulating airway AMPs, while airway AMPs accelerate PM_2.5 clearance by inducing PM_2.5 microbial aggregation. We propose further research on the relationship between PM_2.5 and these AMPs.

Temperature as a risk factor of emergency department visits for acute kidney injury: a case-crossover study in Seoul, South Korea

BACKGROUND

Previous studies show that escalations in ambient temperature are among the risk factors for acute kidney injury (AKI). However, it has not been adequately studied in our location, Seoul, South Korea. In this study, we aimed to examine the association between ambient temperatures and AKI morbidity using emergency department (ED) visit data.

METHODS

We obtained data on ED visits from the National Emergency Medical Center for 21,656 reported cases of AKI from 2010 to 2014. Time-stratified case-crossover design analysis based on conditional logistic regression was used to analyze short-term effects of ambient temperature on AKI after controlling for relevant covariates. The shape of the exposure-response curve, effect modification by individual demographic characteristics, season, and comorbidities, as well as lag effects, were investigated.

RESULTS

The odds ratio (OR) per 1 °C increase at lag 0 was 1.0087 (95% confidence interval [CI]: 1.0041-1.0134). Risks were higher during the warm season (OR = 1.0149; 95% CI: 1.0065-1.0234) than during the cool season (OR = 1.0059; 95% CI: 1.0003-1.0116) and even higher above 22.3 °C (OR = 1.0235; 95% CI: 1.0230-1.0239).

CONCLUSIONS

This study provides evidence that ED visits for AKI were associated with ambient temperature. Early detection and treatment of patients at risk is important in both clinical and economic concerns related to AKI.

Assessing Ecological Risks from Atmospheric Deposition of Nitrogen and Sulfur to US Forests Using Epiphytic Macrolichens

Critical loads of atmospheric deposition help decision-makers identify levels of air pollution harmful to ecosystem components. But when critical loads are exceeded, how can the accompanying ecological risk be quantified? We use a 90% quantile regression to model relationships between nitrogen and sulfur deposition and epiphytic macrolichens, focusing on responses of concern to managers of US forests: Species richness and abundance and diversity of functional groups with integral ecological roles. Analyses utilized national-scale lichen survey data, sensitivity ratings, and modeled deposition and climate data. We propose 20, 50, and 80% declines in these responses as cut-offs for low, moderate, and high ecological risk from deposition. Critical loads (low risk cut-off) for total species richness, sensitive species richness, forage lichen abundance and cyanolichen abundance, respectively, were 3.5, 3.1, 1.9, and 1.3 kg N and 6.0, 2.5, 2.6, and 2.3 kg S ha⁻¹ yr⁻¹. High environmental risk (80% decline), excluding total species richness, occurred at 14.8, 10.4, and 6.6 kg N and 14.1, 13, and 11 kg S ha⁻¹ yr⁻¹. These risks were further characterized in relation to geography, species of conservation concern, number of species affected, recovery timeframes, climate, and effects on interdependent biota, nutrient cycling, and ecosystem services.

Association of Air Pollution Exposure With Psychotic Experiences During Adolescence

IMPORTANCE

Urbanicity is a well-established risk factor for clinical (eg, schizophrenia) and subclinical (eg, hearing voices and paranoia) expressions of psychosis. To our knowledge, no studies have examined the association of air pollution with adolescent psychotic experiences, despite air pollution being a major environmental problem in cities.

OBJECTIVES

To examine the association between exposure to air pollution and adolescent psychotic experiences and test whether exposure mediates the association between urban residency and adolescent psychotic experiences.

DESIGN, SETTING, AND PARTICIPANTS

The Environmental-Risk Longitudinal Twin Study is a population-based cohort study of 2232 children born during the period from January 1, 1994, through December 4, 1995, in England and Wales and followed up from birth through 18 years of age. The cohort represents the geographic and socioeconomic composition of UK households. Of the original cohort, 2066 (92.6%) participated in assessments at 18 years of age, of whom 2063 (99.9%) provided data on psychotic experiences. Generation of the pollution data was completed on October 4, 2017, and data were analyzed from May 4 to November 21, 2018.

EXPOSURES

High-resolution annualized estimates of exposure to 4 air pollutants-nitrogen dioxide (NO2), nitrogen oxides (NOx), and particulate matter with aerodynamic diameters of less than 2.5 (PM2.5) and less than 10 μm (PM10)-were modeled for 2012 and linked to the home addresses of the sample plus 2 commonly visited locations when the participants were 18 years old.

MAIN OUTCOMES AND MEASURES

At 18 years of age, participants were privately interviewed regarding adolescent psychotic experiences. Urbanicity was estimated using 2011 census data.

RESULTS

Among the 2063 participants who provided data on psychotic experiences, sex was evenly distributed (52.5% female). Six hundred twenty-three participants (30.2%) had at least 1 psychotic experience from 12 to 18 years of age. Psychotic experiences were significantly more common among adolescents with the highest (top quartile) level of annual exposure to NO2 (odds ratio [OR], 1.71; 95% CI, 1.28-2.28), NOx (OR, 1.72; 95% CI, 1.30-2.29), and PM2.5 (OR, 1.45; 95% CI, 1.11-1.90). Together NO2 and NOx statistically explained 60% of the association between urbanicity and adolescent psychotic experiences. No evidence of confounding by family socioeconomic status, family psychiatric history, maternal psychosis, childhood psychotic symptoms, adolescent smoking and substance dependence, or neighborhood socioeconomic status, crime, and social conditions occurred.

CONCLUSIONS AND RELEVANCE

In this study, air pollution exposure-particularly NO2 and NOx-was associated with increased odds of adolescent psychotic experiences, which partly explained the association between urban residency and adolescent psychotic experiences. Biological (eg, neuroinflammation) and psychosocial (eg, stress) mechanisms are plausible.

Estimation of health benefits from air quality improvement using the MODIS AOD dataset in Seoul, Korea

BACKGROUND

Exposure to fine particles in the atmosphere can adversely affect health and even lead to premature death. Recently, South Korea has attracted attention because of its rapid increase in the concentration of Particulate Matter (PM).

OBJECTIVES

We estimated the economic benefits of reducing PM₁₀ in Seoul, South Korea, based on MODerate-resolution Imaging Spectroradiometer (MODIS) Aerosol Optical Depth (AOD). Based on the retrieved PM₁₀ data, we estimated its effects on overall health in each district of Seoul, Korea between 2014 and 2015.

METHODS

The relationships between MODIS AOD and ground-based PM₁₀ data were identified in different seasons in South Korea between 2012 and 2013 using the linear regression model. The health benefits were estimated by the Benefits Mapping and Analysis Program (Benmap) using the scenarios from the World Health Organization (WHO).

RESULTS

The correlation between MODIS AOD and PM₁₀ concentration differed with the season. There was a higher correlation between MODIS AOD and PM₁₀ concentration in winter (R = 0.57) than there was in other seasons. Based on the MODIS AOD, the average annual PM₁₀ concentration in Seoul was higher in 2014 than it was in 2015, at values of 45.7 μg/m³, and 41.6 μg/m³, respectively. The greatest economic benefit of reducing PM₁₀ concentration (WHO annual standard of 20 μg/m³) was in 2014. This benefit was estimated to be 7022 (95% CI: 599, 20496), 2617 (95% CI: 216, 7750), and 1328 (95% CI: -159, 4679) billion KRW for all-cause, cardiovascular, and respiratory mortalities in 2014 and 2015, respectively.

CONCLUSIONS

These results demonstrate that, despite considerable improvements in air quality in recent decades, there is still a need for countermeasures to prevent economic loss due to air pollution in Seoul.

Spatio-Temporal Variation in the Concentration of Inhalable Particulate Matter (PM10) in Uganda

Long-term particulate matter (PM10) measurements were conducted during the period January 2016 to September 2017 at three sites in Uganda (Mbarara, Kyebando, and Rubindi) representing a wide range of urbanization. Spatial, temporal and diurnal variations are assessed in this paper. Particulate matter (PM10) samples were collected for 24-h periods on PTFE filters using a calibrated pump and analyzed gravimetrically to determine the average density. Particulate levels were monitored simultaneously using a light scattering instrument to acquire real time data from which diurnal variations were assessed. The PM10 levels averaged over the sampling period at Mbarara, Kyebando, and Rubindi were 5.8, 8.4, and 6.5 times higher than the WHO annual air quality guideline of 20 µg·m-3, and values exceeded the 24-h mean PM10 guideline of 50 µg·m-3 on 83, 100, and 86% of the sampling days. Higher concentrations were observed during dry seasons at all sites. Seasonal differences were statistically significant at Rubindi and Kyebando. Bimodal peaks were observed in the diurnal analysis with higher morning peaks at Mbarara and Kyebando, which points to the impact of traffic sources, while the higher evening peak at Rubindi points to the influence of dust suspension, roadside cooking and open-air waste burning. Long-term measurement showed unhealthy ambient air in all three locations tested in Uganda, with significant spatial and seasonal differences.

Evaluation of the effect of nickel clusters on the formation of incipient soot particles from polycyclic aromatic hydrocarbons via ReaxFF molecular dynamics simulations

In the present study, the ReaxFF reactive molecular dynamics simulation method was applied to investigate the effect of a small nickel cluster (Ni13) on the formation of nascent soot from polycyclic aromatic hydrocarbon (PAH) precursors. A series of NVT simulations was performed for systems of a Ni13 cluster and various PAH monomers, namely, naphthalene, anthracene, pyrene, coronene, ovalene, and circumcoronene, at temperatures from 400 to 2500 K. At low temperatures, the PAHs form soot particles via binding and stacking around nickel clusters. Larger soot particles are formed due to the early initiation of clustering provided by nickel compared to those observed in homogenous PAH systems. At 1200-1600 K, the PAH monomers show a chemisorption tendency onto the nickel surface, which results in incipient soot particles. Chemical nucleation was observed at 2000 K where nickel-assisted dehydrogenation and chemisorption of PAH led to the growth of stable soot particles, which did not occur in the absence of Ni-clusters. At a high temperature (2500 K), nickel significantly accelerates the ring-opening and graphitization of PAH molecules and increases the size of the fullerene-type soot as compared to that of homogenous systems.

Emissions from a fast-pyrolysis bio-oil fired boiler: Comparison of health-related characteristics of emissions from bio-oil, fossil oil and wood

There is currently great interest in replacing fossil-oil with renewable fuels in energy production. Fast pyrolysis bio-oil (FPBO) made of lignocellulosic biomass is one such alternative to replace fossil oil, such as heavy fuel oil (HFO), in energy boilers. However, it is not known how this fuel change will alter the quantity and quality of emissions affecting human health. In this work, particulate emissions from a real-scale commercially operated FPBO boiler plant are characterized, including extensive physico-chemical and toxicological analyses. These are then compared to emission characteristics of heavy fuel-oil and wood fired boilers. Finally, the effects of the fuel choice on the emissions, their potential health effects and the requirements for flue gas cleaning in small-to medium-sized boiler units are discussed. The total suspended particulate matter and fine particulate matter (PM₁) concentrations in FPBO boiler flue gases before filtration were higher than in HFO boilers and lower or on a level similar to wood-fired grate boilers. FPBO particles consisted mainly of ash species and contained less polycyclic aromatic hydrocarbons (PAH) and heavy metals than had previously been measured from HFO combustion. This feature was clearly reflected in the toxicological properties of FPBO particle emissions, which showed less acute toxicity effects on the cell line than HFO combustion particles. The electrostatic precipitator used in the boiler plant efficiently removed flue gas particles of all sizes. Only minor differences in the toxicological properties of particles upstream and downstream of the electrostatic precipitator were observed, when the same particulate mass from both situations was given to the cells.

The Evaluation of Air Quality in Albania by Moss Biomonitoring and Metals Atmospheric Deposition

The air quality of Albania is evaluated by trace metals atmospheric deposition using moss biomonitoring method. Bryophyte moss (Hypnum cupressiforme Hedw.) samples were collected during August and September 2015 from 55 sampling points distributed over the entire territory of Albania. The concentrations of Cr, Cu, Fe, Ni, Pb, V, and Zn in moss samples was determined by ICP-AES, ETAAS (As and Cd), and CVAAS (Hg) analysis. Spatial distribution and temporal trend of the moss elements is discussed in this study. Different variability was found in moss metal concentrations that may reflect their spatial distribution patterns and may identify the location of the areas with high contamination of each element. Compared with the measurements of moss collected in 2010, significant differences were found in the concentrations of As, Cr, Cu, Hg, Ni, Pb, and Zn. The differences between two moss surveys may reflect changes in the bioavailability of the elements resulting from wet and dry deposition respectively during 2015 and 2010 moss biomonitoring survey. The pollution loading index that was applied to judge the content of metal contamination indicated moderate pollution throughout Albania. Examination of the potential ecological risk found that As, Cd, Cr, Hg, Ni, and Pb pose the highest potential ecological risks particularly in the areas with high metal contents. Factor analysis applied to investigate the probable sources of metals in the environment suggested that Al and Fe likely originated from natural sources. As, Cd, Hg, Pb, Cu, Zn, Ni, and Cr likely originated from anthropogenic sources associated with long-range transport, transboundary pollution and local emission sources.

Risk of concentrations of major air pollutants on the prevalence of cardiovascular and respiratory diseases in urbanized area of Kuala Lumpur, Malaysia

Rapid urbanisation in Malaysian cities poses risks to the health of residents. This study aims to estimate the relative risk (RR) of major air pollutants on cardiovascular and respiratory hospitalisations in Kuala Lumpur. Daily hospitalisations due to cardiovascular and respiratory diseases from 2010 to 2014 were obtained from the Hospital Canselor Tuanku Muhriz (HCTM). The trace gases, PM₁₀ and weather variables were obtained from the Department of Environment (DOE) Malaysia in consistent with the hospitalisation data. The RR was estimated using a Generalised Additive Model (GAM) based on Poisson regression. A "lag" concept was used where the analysis was segregated into risks of immediate exposure (lag 0) until exposure after 5 days (lag 5). The results showed that the gases could pose significant risks towards cardiovascular and respiratory hospitalisations. However, the RR value of PM₁₀ was not significant in this study. Immediate effects on cardiovascular hospitalisations were observed for NO₂ and O₃ but no immediate effect was found on respiratory hospitalisations. Delayed effects on cardiovascular and respiratory hospitalisations were found with SO₂ and NO₂. The highest RR value was observed at lag 4 for respiratory admissions with SO₂ (RR = 1.123, 95% CI = 1.045-1.207), followed by NO₂ at lag 5 for cardiovascular admissions (RR = 1.025, 95% CI = 1.005-1.046). For the multi-pollutant model, NO₂ at lag 5 showed the highest risks towards cardiovascular hospitalisations after controlling for O₃ 8 h mean lag 1 (RR = 1.026, 95% CI = 1.006-1.047), while SO₂ at lag 4 showed highest risks towards respiratory hospitalisations after controlling for NO₂ lag 3 (RR = 1.132, 95% CI = 1.053-1.216). This study indicated that exposure to trace gases in Kuala Lumpur could lead to both immediate and delayed effects on cardiovascular and respiratory hospitalisations.

A Two-stage Dynamic Undesirable Data Envelopment Analysis Model Focused on Media Reports and the Impact on Energy and Health Efficiency

Past research on energy and environmental issues in China has generally focused on energy and environmental efficiencies with no models having included the public health associations or the role of the media. Therefore, to fill this research gap, this paper used a modified Undesirable Dynamic Network model to analyze the efficiency of China’s energy, environment, health and media communications, from which it was found that the urban production efficiency stage was better than the health treatment stage, and that the energy efficiencies across the Chinese regions varied significantly, with only Beijing, Guangzhou, Lhasa and Nanning being found to have high efficiencies. Large urban gaps and low efficiencies were found for health expenditure, with the best performances being found in Fuzhou, Guangzhou, Haikou, Hefei, Nanning, and Urumqi. The regions with the best media communication efficiencies were Fuzhou, Guangzhou, Haikou, Hefei, Lhasa, Nanning and Urumqi, and the cities with the best respiratory disease efficiencies were Fuzhou, Guangzhou, Haikou, Lhasa, Nanning, Wuhan, Urumqi, Xian, and Yinchuan. Overall, significant efficiency improvements were needed in health expenditure and in particular in respiratory diseases as there were major differences across the country.

Demographic Inequities in Health Outcomes and Air Pollution Exposure in the Atlanta Area and its Relationship to Urban Infrastructure

Environmental burdens such as air pollution are inequitably distributed with groups of lower socioeconomic statuses, which tend to comprise of large proportions of racial minorities, typically bearing greater exposure. Such groups have also been shown to present more severe health outcomes which can be related to adverse pollution exposure. Air pollution exposure, especially in urban areas, is usually impacted by the built environment, such as major roadways, which can be a significant source of air pollution. This study aims to examine inequities in prevalence of cardiovascular and respiratory diseases in the Atlanta metropolitan region as they relate to exposure to air pollution and characteristics of the built environment. Census tract level data were obtained from multiple sources to model health outcomes (asthma, chronic obstructive pulmonary disease, coronary heart disease, and stroke), pollution exposure (particulate matter and nitrogen oxides), demographics (ethnicity and proportion of elderly residents), and infrastructure characteristics (tree canopy cover, access to green space, and road intersection density). Conditional autoregressive models were fit to the data to account for spatial autocorrelation among census tracts. The statistical model showed areas with majority African-American populations had significantly higher exposure to both air pollutants and higher prevalence of each disease. When considering univariate associations between pollution and health outcomes, the only significant association existed between nitrogen oxides and COPD being negatively correlated. Greater percent tree canopy cover and green space access were associated with higher prevalence of COPD, CHD, and stroke. Overall, in considering health outcomes in connection with pollution exposure infrastructure and ethnic demographics, demographics remained the most significant explanatory variable.

Environmental Burden of Childhood Disease in Europe

Background: Environmental factors determine children's health. Quantifying the health impacts related to environmental hazards for children is essential to prioritize interventions to improve health in Europe. Objective: This study aimed to assess the burden of childhood disease due to environmental risks across the European Union. Methods: We conducted an environmental burden of childhood disease assessment in the 28 countries of the EU (EU28) for seven environmental risk factors (particulate matter less than 10 micrometer of diameter (PM10) and less than 2.5 micrometer of diameter (PM2.5), ozone, secondhand smoke, dampness, lead, and formaldehyde). The primary outcome was disability-adjusted life years (DALYs), assessed from exposure data provided by the World Health Organization, Global Burden of Disease project, scientific literature, and epidemiological risk estimates. Results: The seven studied environmental risk factors for children in the EU28 were responsible for around 211,000 DALYs annually. Particulate matter (PM10 and PM2.5) was the main environmental risk factor, producing 59% of total DALYs (125,000 DALYs), followed by secondhand smoke with 20% of all DALYs (42,500 DALYs), ozone 11% (24,000 DALYs), dampness 6% (13,000 DALYs), lead 3% (6200 DALYs), and formaldehyde 0.2% (423 DALYs). Conclusions: Environmental exposures included in this study were estimated to produce 211,000 DALYs each year in children in the EU28, representing 2.6% of all DALYs in children. Among the included environmental risk factors, air pollution (particulate matter and ozone) was estimated to produce the highest burden of disease in children in Europe, half of which was due to the effects of PM10 on infant mortality. Effective policies to reduce environmental pollutants across Europe are needed.

Pollution and Sun Exposure: A Deleterious Synergy. Mechanisms and Opportunities for Skin Protection

BACKGROUND

Pollutants are diverse chemical entities, including gases such as ozone and particulate matter PM. PM contains toxic chemicals such as polycyclic aromatic hydrocarbons (PAHs). Some PAHs can induce strong oxidative stress under UVA exposure. Pollution aggravates some skin diseases such as atopy or eczema, but epidemiological data also pointed to a correlation with early occurrence of (photo)-aging markers.

OBJECTIVE

This paper aims at reviewing current literature dealing with dermatological effects of pollution, either on in vitro models or using in vivo approaches (including humans). It particularly focuses on the probable deleterious synergy between pollutants and sunlight.

RESULTS

An exhaustive analysis of literature suggests that skin may be impacted by external stress through oxidation of some of its surface components. However, pollutants detected in plasma may also be provided to deep skin by the circulation of the blood. Oxidative stress, inflammation and metabolic impairments are among the most probable mechanisms of pollution- derived dermatological hazards. Moreover these stresses should be amplified by the deleterious synergy between pollution and sunlight. Some experiments from our lab identified few PAHs inducing a huge toxic stress, at nanomolar concentrations, when exposed to long UVA wavelengths. Prevention strategies should thus combine surface protection (long UVA sunscreens, antioxidants) and enhanced skin tissue resistance through stimulation of the natural antioxidation/detoxification pathway Nrf2.

CONCLUSION

In people exposed to highly polluted environments, pollutants and sunlight may synergistically damage skin, requiring a specific protection.

COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution

PURPOSE OF REVIEW

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide with no known cure and an increasing number of triggers that exacerbate symptoms and speed up progression. This review aims to summarize the evidence for COPD patients being more vulnerable to air pollution exposure assessed as acute effects.

RECENT FINDINGS

Several recent systematic reviews show consistently increased risks for COPD mortality and COPD hospital admission, ranging between 2 and 3% with increasing PM_2.5 or PM₁₀. Similar adverse impacts were shown for NO_2. Also_, adverse health effects among COPD patients were also found for other gaseous pollutants such as ozone and SO₂; most of these studies could not be included in the meta-analysis we reviewed. Data from ten panel studies of COPD patients reported a small but statistically significant decline of FEV1 [- 3.38 mL (95% CI - 6.39 to - 0.37)] per increment of 10 μg/m³ PM₁₀, supporting an impact on respiratory health with increasing PM₁₀ exposure. The combined information from systematic reviews and more recent findings lead us to conclude that COPD patients are more vulnerable to ambient air pollution than healthier people.

Extended Risk Factors for Stroke Prevention

Stroke causes disability and high mortality, while it can be prevented by increasing public awareness of risk factors. The common known risk factors are hypertension, atrial fibrillation, heart failure, smoking, alcohol consumption, low physical activity, overweight and hypercholesterolemia. However, the deep understanding of risk factors is limited. Moreover, more risk factor emerges in recent years. To further increase the awareness of risk factors for stroke prevention, this review indicates the reasonable application of antihypertensive agents according to the age-dependent changes of hypertension, and some new risk factors including chronic kidney disease, obstructive sleep apnea, migraine with aura, working environment, genetic factors and air pollution. Therefore, internal risk factors (e.g. heredity, hypertension, hyperglycemia) and external risk factors (e.g. working environment, air pollution) are both important for stroke prevention. All of these are reviewed to provide more information for the pre-hospital prevention and management, and the future clinical studies.

Effects of Food Contamination on Gastrointestinal Morbidity: Comparison of Different Machine-Learning Methods

Morbidity prediction can be useful in improving the effectiveness and efficiency of medical services, but accurate morbidity prediction is often difficult because of the complex relationships between diseases and their influencing factors. This study investigates the effects of food contamination on gastrointestinal-disease morbidities using eight different machine-learning models, including multiple linear regression, a shallow neural network, and three deep neural networks and their improved versions trained by an evolutionary algorithm. Experiments on the datasets from ten cities/counties in central China demonstrate that deep neural networks achieve significantly higher accuracy than classical linear-regression and shallow neural-network models, and the deep denoising autoencoder model with evolutionary learning exhibits the best prediction performance. The results also indicate that the prediction accuracies on acute gastrointestinal diseases are generally higher than those on other diseases, but the models are difficult to predict the morbidities of gastrointestinal tumors. This study demonstrates that evolutionary deep-learning models can be utilized to accurately predict the morbidities of most gastrointestinal diseases from food contamination, and this approach can be extended for the morbidity prediction of many other diseases.

Acute respiratory infection related to air pollution in Bamenda, North West Region of Cameroon

Introduction

Air pollution is a global health problem. It's responsible for over 4 million deaths each year and constitutes a risk factor for acute respiratory infections (ARI). The aims of this study was to assess knowledge about air pollution, and to determine environmental risk factors associated with ARIs occurence in the city of Bamenda, Cameroon.

Methods

We conducted a cross sectional study and performed a rectrospective analysis of ARI consultation within the period March 2016 to July 2016 in the Bamenda Health District. We interviewd 201 patients and recorded 1849 cases from hospital registers of patients diagnosed ARI from January 2013 to April 2016. Epi-info 7.2 was used for data entry and analysis. Logistic regression analysis was conducted to determine the importance of the different environmental risk factors.

Results

Over 70% of the participants used at least a form of solid fuel for cooking. The Odds of developing an ARI was 3.62 greater among those exposed to indoor cooking compared to the unexposed (OR 3.62, CI 1.45-4.90). Participants exposed to open fire burning were 1.91 times more like to develop ARI compared to unexposed (OR: 1.91, CI 1.03-3.55: p : 0.03). Particulate Matter (PM 2.5) levels was 13.2 times higher than the World Health Organization (WHO) recommended levels. Dry and dusty weathers increased the risk of ARIs (OR 3.24; CI 1.47-7.13). The prevalence of ARIs in the Bamenda Health District was 6% of all consultations.

Conclusion

Using solid fuels in poorly ventilated homes increase the total air particle suspension indoor. Inhalling this poor air irritates the repiratory tract, eyes while longterm exposure increases the odds of cancers. Ventilating homes with indoor cooking space reduces exposure while using clean fuels like electricity reduces the odds of ARI associated with pollution.

The effect of evidence and theory-based health advice accompanying smartphone air quality alerts on adherence to preventative recommendations during poor air quality days: A randomised controlled trial

Although poor air quality can have a negative impact on human health, studies have shown suboptimal levels of adherence to health advice associated with air quality alerts. The present study compared the behavioural impact of the UK Air Quality Index (DAQI) with an alternative message format, using a 2 (general population vs. at-risk individuals) X 2 (usual DAQI messages vs. behaviourally enhanced messages) factorial design. Messages were sent via a smartphone application. Eighty-two participants were randomly allocated to the experimental groups. It was found that the enhanced messages (targeting messages specificity and psychosocial predictors of behaviour change) increased intentions to make permanent behavioural changes to reduce exposure, compared to the control group (V = 0.23). This effect was mediated by a reduced perception of not having enough time to follow the health advice received (b = -0.769, BCa CI [-2.588, 0.533]). It was also found that higher worry about air pollution, perceived severity, perceived efficacy of the recommended behaviour and self-efficacy were predictive of self-reported behaviour change at four weeks. In response to a real moderate air quality alert, among those with a pre-existing lung condition, more respondents in the intervention group reported to have used their preventer inhaler compared to the control group (V = 0.49). On the other hand, the two message formats performed similarly when intentions were collected in relation to a hypothetical high air pollution scenario, with all groups showing relatively high intentions to change behaviours. This study expands the currently limited understanding of how to improve the behavioural impact of existing air quality alerts.

Ambient air pollution exposures and risk of drug-resistant tuberculosis

BACKGROUND

Few epidemiological studies have explored the effects of air pollution on the risk of drug-resistant tuberculosis (DR-TB).

OBJECTIVE

To investigate the short and long term residential concentrations of ambient air pollutants (particulate matter <10 μm in diameter (PM₁₀) and particulate matter≤2.5 μm in diameter (PM_2.5), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO)) in relation to the risk of DR-TB in a typical air pollution city, Jinan city, China.

METHODS

A total of 752 new culture-confirmed TB cases reported in TB prevention and control institutions of Jinan from January 1, 2014 to December 31, 2015 were included. Average individual-level concentrations of air pollution for 5 different exposure windows, vary from 90 days to 720 days to diagnosis were estimated using measurements from monitor closest to the patient home addresses. Logistic regression model adjusted for potential confounders was employed to evaluate correlation between air pollution and DR-TB risk at different five exposure windows individually.

RESULTS

There were substantially increased mono-drug resistance and poly-drug resistance risks for ambient PM_2.5, PM₁₀, O₃, and CO exposures. High exposure to PM_2.5, PM₁₀, and CO was also significantly associated with increased incidence of multi-drug resistance (MDR) both in the single- and multi-pollutants regression models. The dominant positive associations for PM_2.5was observed at 540 days exposure, for O₃ was observed at 180 days exposure, and for PM₁₀ and CO was observed from 90 days to 540 days exposures.

CONCLUSIONS

Our finding suggest that exposure to ambient air pollution (PM_2.5, PM₁₀, O₃, and CO) are associated with increased risk of DR-TB. We provided epidemiological evidence of association between pollution exposure and mono-, poly- and multi-drug resistance.

In vivo and in vitro evidence for the involvement of Nrf2-antioxidant response element signaling pathway in the inflammation and oxidative stress induced by particulate matter (PM10): the effective role of gallic acid

Environmental pollution is one of the risk factors for respiratory diseases. The nuclear factor erythroid 2-related factor 2 (Nrf2) is the major mechanisms contributing to cellular defense against oxidative damage. Gallic acid (GA) is regarded as potent anti-inflammatory and antioxidant agents. The aim was to evaluate the role of Nrf2 pathway in particulate matter (PM₁₀) exposure on lung and epithelial cells with an emphasis on the role of GA. In in vivo part, the rats were divided as control, GA (30 mg/kg), particulate matter (PM) (0.5, 2.5, and 5 mg/kg), and PM + GA. In in vitro study, the cells were divided as control, PM₁₀ (100, 250, and 500 µg/ml), GA (50 µmol/L) and PM₁₀+GA. Inflammation, oxidative stress and Nrf2-pathway factors were assessed. PM₁₀ groups showed a considerable increase in the epithelial permeability and inflammatory parameters. We also found a significant decrease in the expression of Nrf2 and its up-stream regulators genes. Accordingly, the biosynthesis of glutathione (GSH) and other antioxidant activities significantly decreased. Gallic acid was identified to restore the antioxidant status to the normal levels. Our findings approved that Nrf2 is involved in PM₁₀-induced oxidative damages and showed that Nrf2 activation by natural agents could ameliorate respiratory injuries induced by PM₁₀.

Exploration of NO2 and PM2.5 air pollution and mental health problems using high-resolution data in London-based children from a UK longitudinal cohort study

Air pollution is a worldwide environmental health issue. Increasingly, reports suggest that poor air quality may be associated with mental health problems, but these studies often use global measures and rarely focus on early development when psychopathology commonly emerges. To address this, we combined high-resolution air pollution exposure estimates and prospectively-collected phenotypic data to explore concurrent and longitudinal associations between air pollutants of major concern in urban areas and mental health problems in childhood and adolescence. Exploratory analyses were conducted on 284 London-based children from the Environmental Risk (E-Risk) Longitudinal Twin Study. Exposure to annualized PM_2.5 and NO₂ concentrations was estimated at address-level when children were aged 12. Symptoms of anxiety, depression, conduct disorder, and attention-deficit hyperactivity disorder were assessed at ages 12 and 18. Psychiatric diagnoses were ascertained from interviews with the participants at age 18. We found no associations between age-12 pollution exposure and concurrent mental health problems. However, age-12 pollution estimates were significantly associated with increased odds of major depressive disorder at age 18, even after controlling for common risk factors. This study demonstrates the potential utility of incorporating high-resolution pollution estimates into large epidemiological cohorts to robustly investigate associations between air pollution and youth mental health.

The Impact of Economic Growth and Air Pollution on Public Health in 31 Chinese Cities

The rapid economic growth of China in the last twenty years has caused a commensurate rise in atmospheric pollution which has had an impact on both the environment and public health. Since 2013, SO₂, CO₂ and nitrogen oxide levels have reached a level that may cause climate change and have adverse effects on the health of the local residents. Past environmental efficiency analyses have rarely examined economic development, air pollution and health as interacting systems; therefore, this study used a new two-stage DEA model, the Modified Undesirable EBM Two Stage DEA (Epsilon-Based Measure) to explore the environmental, economic and health efficiencies in thirty-one major cities in China. The results were as follows: while all cities needed to improve their GDP, the environmental efficiencies were continuing to rise in most cities. The health efficiency index indicated that disease efficiency had increased in most cities but declined in one third; therefore, it is necessary to strengthen treatment. The respiratory disease treatment efficiency in most cities was rising, and the room for improvement had significantly reduced. There were improvements in the mortality rate in 15 cities; however, the mortality rate treatment efficiency declined in 11 cities.

Autophagy in exposure to environmental chemicals

Autophagy is a catabolic pathway, which breaks down old and damaged cytoplasmic material into basic biomolecules through lysosome-mediated digestion thereby recycling cellular material. In this way, autophagy prevents the accumulation of damaged cellular components inside cells and reduces metabolic stress and toxicity. The basal level of autophagy is generally low but essential for maintaining the turnover of proteins and other molecules. The level is, however, increased in response to various stress conditions including chemical stress. This elevation in autophagy is intended to restore energy balance and improve cell survival in stress conditions. However, aberrant and/or deficient autophagy may also be involved in the aggravation of chemical-caused insults. Thus, the overall role of autophagy in chemical-induced toxicity is complex and only a limited number of environmental chemicals have been studied from this point of view. Autophagy is associated with many of the chemical-caused cytotoxic mechanisms, including mitochondrial dysfunction, DNA damage, oxidative stress, changes in the endoplasmic reticulum, impairment of lysosomal functions, and inflammation. This mini-review describes autophagy and its involvement in the responses to some common environmental exposures including airborne particulate matter, nanoparticles and tobacco smoke as well as to some common single environmental chemicals.

Gestational Exposure to Particulate Matter 2.5 (PM2.5) Leads to Spatial Memory Dysfunction and Neurodevelopmental Impairment in Hippocampus of Mice Offspring

Prenatal exposure to air pollutants has long-term impact on growth retardation of nervous system development and is related to central nervous system diseases in children. However, it is not well-characterized whether gestational exposure to air pollutants affects the development of nervous system in offspring. Here, we investigated the effects of gestational exposure to particulate matter 2.5 (PM_2.5) on hippocampus development in mice offspring, through neurobehavioral, ultrastructural, biochemical and molecular investigations. We found that spatial memory in mice offspring from PM_2.5 high-dosage group was impaired. Next, hippocampal ultrastructure of the mice offspring in puberty exhibited mitochondrial damage related to PM_2.5 exposure. Interestingly, EdU-positive cells in the subgranular zone (SGZ) of offspring from PM_2.5 high-dosage group decreased, with NeuN⁺/EdU⁺cells reduced significantly. Furthermore, the numbers of NeuN⁺/TUNEL⁺, GFAP⁺/TUNEL⁺, and Iba1⁺/TUNEL⁺ double-labeled cells increased with PM_2.5 exposure in a dosage-dependent manner. In addition, gestational exposure to PM_2.5 resulted in increased levels of both mRNAs and proteins involved in apoptosis, including caspase-3, -8, -9, p53, and c-Fos, and decreased Bcl-2/Bax ratios in the hippocampus of mice offspring. Moreover, gestational exposure to PM_2.5 was dosage-dependently associated with the increased secretions of inflammatory proteins, including NF-κB, TNF-α, and IL-1β. Collectively, our results suggest that gestational exposure to PM_2.5 leads to spatial memory dysfunction and neurodevelopmental impairment by exerting effects on apoptotic and neuroinflammatory events, as well as the neurogenesis in hippocampus of mice offspring.

Impact of rice husk nanoparticle on the performance and emission aspects of a diesel engine running on blends of pine oil-diesel

With the increase in vehicle density, the amount of pollution along with the dependence on the diesel fuel also increases, which might be on the verge of depletion. The increase in fuel price is an important economical factor. Hence, finding a suitable substitute energy source which is economic and also meets the energy necessity is of great need. During this study, the utilization of pine oil biofuel in which rice husk (RH) nanoparticles was added as an additive was proposed. The test was carried out in a single cylinder, diesel engine at 1500 rpm. Fuel is blended at two ratios (B10, B20) and 0.1% of RH nano-additive is added with each blend and their characteristics in terms of performance and emission are analyzed for varied load conditions. At full load condition for B10-0.1% RH, there is a slight reduction of about 3.04% for BTE and 4.1% increase in BSFC than diesel fuel was observed. Likewise, for B20-0.1% RH at full load condition CO and HC decreases about 27.27% and 19.64% respectively, with a rise in CO₂ and a slight increase of NOx level at 15.63%, 8.76% respectively than diesel fuel. This small replacement of diesel fuel by biodiesel helps in reducing the increasing cost and also the complete dependency on the fossil-based fuel. Thus, pine oil with additive can perform well without any engine modifications and helps in reducing the pollutions.

Effect of global atmospheric aerosol emission change on PM2.5-related health impacts

Background: Previous research has highlighted the importance of major atmospheric aerosols such as sulfate, through its precursor sulfur dioxide (SO2), black carbon (BC), and organic carbon (OC), and their effect on global climate regimes, specifically on their impact on particulate matter measuring ≤ 2.5 μm (PM2.5). Policy regulations have attempted to address the change in these major active aerosols and their impact on PM2.5, which would presumably have a cascading effect toward the change of health risks. Objective: This study aimed to determine how the change in the global emissions of anthropogenic aerosols affects health, particularly through the change in attributable mortality (AN) and years of life lost (YLL). This study also aimed to explore the importance of using AM/YLL in conveying air pollution health impact message. Methods: The Model for Interdisciplinary Research on Climate was used to estimate the gridded atmospheric PM2.5 by changing the emission of SO2, BC, and OC. Next, the emissions were utilized to estimate the associated cause-specific risks via an integrated exposure-response function, and its consequent health indicators, AM and YLL, per country. Results: OC change yielded the greatest benefit for all country income groups, particularly among low-middle-income countries. Utilizing either AM or YLL did not alter the order of benefits among upper-middle and high-income countries (UMIC/HIC); however, using either health indicator to express the order of benefit varied among low- and low-middle-income countries (LIC/LMIC). Conclusions: Global and country-specific mitigation efforts focusing on OC-related activities would yield substantial health benefits. Substantial aerosol emission reduction would greatly benefit high-emitting countries (i.e. China and India). Although no difference is found in the order of health outcome benefits in UMIC/HIC, caution is warranted in using either AM or YLL for health impact assessment in LIC/LMIC.

A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic

INTRODUCTION

A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic.

MATERIAL AND METHODS

We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017.

RESULTS

In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e.

CONCLUSIONS

Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.