Adverse Environmental Exposure and Respiratory Health in Children

Housing conditions and the health and wellbeing impacts of climate change: A scoping review

Housing conditions are emerging as an important consideration in climate change adaptation. Housing modifications have the potential to improve health outcomes by reducing exposure to changing weather conditions and extreme events. This scoping review aimed to explore the existing evidence examining the contribution of housing conditions to the impacts of climate change on health and identify any research gaps. Literature searches were conducted in Scopus and PubMed from January 2013 to September 2023 and data were analysed using thematic analysis. The review included 38 articles consisting of original studies, reviews, and reports, with broad geographical coverage. The most common focus among included articles was on heat-health impacts; housing conditions found to improve heat-health health outcomes included air conditioning, ventilation, and window shading, and there was support for multifaceted housing adaptations rather than single fixes. Ventilation was found to be a priority for improving indoor air quality, while inappropriate insulation and excessive air tightness were found to increase indoor heat and reduce indoor air quality. The scoping review reveals a need for more empirical and qualitative research into indoor heat in homes, climate change hazards other than heat, and intervention studies to inform climate change adaptation policies around housing and improve public health outcomes.

Association analysis of maternal exposure to air pollution during pregnancy and offspring asthma incidence

BACKGROUND

Air pollution has a significant negative impact on human health. Pregnant mothers and children are typical susceptible groups, and environmental exposure has a crucial impact on children's health. We established a childhood asthma cohort to analyze the factors influencing the development of asthma in offspring, with a focus on prenatal exposure to air pollutants. The goal was to explore potential early preventive measures to reduce the incidence of childhood asthma.

METHODS

This nested case-control study included mothers who were registered and delivered at Lianyungang Maternal and Child Health Hospital between 2015 and 2018, covering pre-pregnancy, first, second, and third trimesters. Children diagnosed with asthma before the age of four were included in the asthma group. To assess environmental exposure, we gathered data from 29 national and provincial air pollution monitoring stations and 16 meteorological monitoring sites in Lianyungang and surrounding areas. We used spatial interpolation with inverse distance weighting (IDW) to estimate individual exposure to air pollutants, including particulate matter (PM2.5, PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3). Univariate and multivariate regression analyses were conducted to examine the association between maternal exposure during pregnancy and the risk of childhood asthma.

RESULTS

A total of 292 mother-child pairs in the asthma group and 1423 mother-child pairs in the healthy control group were included. The second (AOR = 1.04, 95%CI 1.01-1.06) and whole gestation (AOR = 1.06, 95%CI 1.03-1.10) exposure to PM2.5 was associated with higher odds of childhood-onset asthma. Exposure during the third trimester (AOR = 1.02, 95%CI 1.01-1.03) and whole gestation (AOR = 1.02, 95%CI 1.01-1.04) of PM10 was associated with higher odds of childhood-onset asthma. The first (AOR = 1.06, 95%CI 1.02-1.09) and second (AOR = 0.95, 95%CI 0.92-0.98) trimesters exposure to NO2 was associated with higher and lower odds of childhood-onset asthma, respectively. SO2 whole pregnancy exposure (AOR = 1.04, 95%CI 1.01-1.07) was associated with higher odds of childhood-onset asthma.

CONCLUSIONS

Exposure to PM2.5, PM10, and SO2 during pregnancy can lead to an elevated risk of childhood asthma. Reducing or avoiding exposure to pollutants during pregnancy can reduce the incidence of childhood asthma. We should protect the environment and reduce the harm of environmental pollution to health.

Toxic metals and pediatric clinical immune dysfunction: A systematic review of the epidemiological evidence

BACKGROUND

Children are at high risk for exposure to toxic metals and are vulnerable to their effects. Significant research has been conducted evaluating the role of these metals on immune dysfunction, characterized by biologic and clinical outcomes. However, there are inconsistencies in these studies. The objective of the present review is to critically evaluate the existing literature on the association between toxic metals (lead, mercury, arsenic, and cadmium) and pediatric immune dysfunction.

METHODS

Seven databases (PubMed (NLM), Embase (Elsevier), CINAHL (Ebsco), Web of Science (Clarivate Analytics), ProQuest Public Health Database, and ProQuest Environmental Science Collection) were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in February 2024. Rayaan software identified duplicates and screened by title and abstract in a blinded and independent review process. The remaining full texts were reviewed for content and summarized. Exclusions during the title, abstract, and full-text reviews included: 1) not original research, 2) not epidemiology, 3) did not include toxic metals, 4) did not examine an immune health outcome, or 5) not pediatric (>18 years). This systematic review protocol followed the PRISMA guidelines. Rayaan was used to screen records using title and abstract by two blinded and independent reviewers. This process was repeated for full-text article screening selection.

RESULTS

The search criteria produced 7906 search results; 2456 duplicate articles were removed across search engines. In the final review, 79 studies were included which evaluated the association between toxic metals and outcomes indicative of pediatric immune dysregulation.

CONCLUSIONS

The existing literature suggests an association between toxic metals and pediatric immune dysregulation. Given the imminent threat of infectious diseases demonstrated by the recent COVID-19 epidemic in addition to increases in allergic disease, understanding how ubiquitous exposure to these metals in early life can impact immune response, infection risk, and vaccine response is imperative.

Cold waves and fine particulate matter in high-altitude Chinese cities: assessing their interactive impact on outpatient visits for respiratory disease

BACKGROUND

Extreme weather events like heatwaves and fine particulate matter (PM2.5) have a synergistic effect on mortality, but research on the synergistic effect of cold waves and PM2.5 on outpatient visits for respiratory disease, especially at high altitudes in climate change-sensitive areas, is lacking.

METHODS

we collected time-series data on meteorological, air pollution, and outpatient visits for respiratory disease in Xining. We examined the associations between cold waves, PM2.5, and outpatient visits for respiratory disease using a time-stratified case-crossover approach and distributional lag nonlinear modeling. Our analysis also calculated the relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (S). We additionally analyzed cold waves over time to verify climate change.

RESULTS

Under different definitions of cold waves, the odds ratio for the correlation between cold waves and outpatient visits for respiratory disease ranged from 0.95 (95% CI: 0.86, 1.05) to 1.58 (1.47, 1.70). Exposure to PM2.5 was significantly associated with an increase in outpatient visits for respiratory disease. We found that cold waves can synergize with PM2.5 to increase outpatient visits for respiratory disease (REOI > 0, AP > 0, S > 1), decreasing with stricter definitions of cold waves and longer durations. Cold waves' independent effect decreased over time, but their interaction effect persisted. From 8.1 to 21.8% of outpatient visits were due to cold waves and high-level PM2.5. People aged 0-14 and ≥ 65 were more susceptible to cold waves and PM2.5, with a significant interaction for those aged 15-64 and ≥ 65.

CONCLUSION

Our study fills the gap on how extreme weather and PM2.5 synergistically affect respiratory disease outpatient visits in high-altitude regions. The synergy of cold waves and PM2.5 increases outpatient visits for respiratory disease, especially in the elderly. Cold wave warnings and PM2.5 reduction have major public health benefits.

Indoor Particle's Pollution in Bucharest, Romania

Air pollution risk factor on human health was surpassed only by high blood pressure, tobacco use and poor diet. Total number of deaths due to air pollution worldwide was estimated to 6.67 million people in 2019. In the European Union, 97% of the urban population is exposed to levels of fine particulate matter above the latest guideline levels set by the World Health Organization. Air pollution accounts for 20% of newborn deaths worldwide, most related to complications of low birth weight and preterm birth. Low birth weight and preterm birth are responsible for 1.8 million deaths worldwide. Bucharest is the capital city of Romania and one of the most polluted cities in Europe, ranking in the 9th position out of 96 of the top cities from Europe and in the 4th position out of 32 of the top cities in Eastern Europe, data from June 2022. The aim of this study was to measure the real time level of indoor particulate pollution levels in different indoor environments from Bucharest, during the pandemic period. The PM_2.5/PM₁₀ ratio and its rate of change were also determined for the measured data. The PM_2.5/PM₁₀ ratio and its rate of change were also calculated based on the measurement data. The PM_2.5/PM₁₀ ratio showed an upward trend on weekends compared to weekdays, suggesting a relationship with outdoor PM where leisure activities and traffic infiltrated the indoors. The fluctuation range of the PM_2.5/PM₁₀ ratio was 0.44~0.95, and low measured values were detected on weekdays. Of the seasons, the proportion of particulate in autumn and its rate of change tended to be higher than in summer. It was suggested that outdoor air may have permeated the room. In addition, the relationship was considered, such as it is a holiday period, there are few rainy days, the concentration of coarse particles is high, and the number of residents in the city decreases. When it comes to indoor air quality, the higher this ratio, the more serious the air pollution. PM₁₀ concentrations decreased by 29.1% in the absence of human activity and increased by 35.1% in the presence of humans. PM_2.5 concentration decreased by 30.3% without human activity and increased by 3.1% with the presence of humans. Certain trends were suggested for the resumption of human activity and an increase in PM_2.5 concentrations. The average relative difference between October 2021, a pandemic period, and October 2022, a post pandemic period, was 64% for PM₁₀ and 47% for PM_2.5. The pandemic period brought a significantly better indoor air quality from the particulate pollution point of view.

Pediatric Preventive Care in Middle-High Resource Countries-The Padova Chart for Health in Children

Importance

The Padova Chart for Health in Children (PCHC) aims to gather the evidence of healthcare promotion and protection for chidren and adolescents (i.e., aged <18 y) into a single document in order to guide families, healthcare providers and social actors on healthy choices. No more than 2% of Europeans and North Americans aged <30 y have a healthy lifestyle. This, together with metabolic and brain plasticity during childhood, creates the ideal opportunity to implement preventive strategies. Guided interventions promoting healthy lifestyle in children and families therefore have a key role in abating the unprecedented pandemic of non-communicable diseases (NCDs) in adulthood.

Observations

The PCHC is divided into four sections: nutrition, cardiovascular health, respiratory health, and mental and social health. Each section is structured in an ALICE approach (assessment, lobbying, intervention, call-for-action, evaluation): assessment of necessity, describing relevance to healthcare; lobbying to identify those who can effect the proposed interventions; interventions involving family, school and peers; a call-for-action to define priorities among the proposed interventions; and objective evaluation measures that can be applied on a population basis.

Conclusions and Relevance

Interventions promoting health in childhood require joint action from multiple institutional, local and family representatives, with the shared goal of promoting health across the entire age group. These lifestyle interventions have the potential to change the lifetime risk trajectory for NCDs.

Impact of prenatal and early life environmental exposures on normal human development

The global burden and pattern of disease has changed in recent decades, with fewer early childhood deaths and longer lives complicated by chronic disease. Disruption of normal human growth and development by adverse environmental exposures, especially during foetal development and early postnatal life increase life-long risk of chronic disease. The developmental timing and method of adverse exposure determines the likely impact on health and development. While many organ systems are structurally and functionally mature at birth, the CNS, respiratory and immune systems are not and undergo prolonged periods of postnatal growth and development. As such, these organ systems are vulnerable to adverse effects of both prenatal and postnatal environmental exposures. While the precise mechanisms underlying chronic disease are unknown, epigenetic mechanisms and the induction of oxidative stress are likely to be involved. An understanding of these processes is necessary to develop mitigation strategies aimed at reducing chronic disease prevalence.