Dust storms and the risk of asthma admissions to hospitals in Kuwait

Models to evaluate the pulmonary toxicity of desert dust and what we have learned from them so far: a mini-review

Millions of people worldwide are exposed to aerosolised desert dust and are at risk of the adverse respiratory health effects it causes. This mini-review gives an overview of the study types that can be used to assess the respiratory toxicity of desert dust and the insights gained from these studies. We highlight the main advantages and disadvantages of epidemiological, in vivo, and in vitro studies. Regarding in vitro studies, we discuss models of increasing complexity, i.e., traditional submerged cell cultures, air-liquid interface cultures, organ-on-a-chip models, organoids, and precision-cut lung slices. Epidemiological studies have shown increased short-term mortality and exacerbated acute and chronic respiratory diseases after desert dust events. In contrast, a connection to the onset of chronic diseases is more difficult to prove. In vivo and in vitro studies have particularly addressed the cellular and molecular effects of desert dust. It was found that desert dust activates immune cells and induces the expression of inflammatory cytokines and oxidative stress markers. The specific effects and their extent vary between dust samples from different sources. The investigation of the role of the composition is still immature and needs further effort including more extensive screenings. The advancement of easy-to-handle and realistic pulmonary in vitro models is required to automate screenings, support mechanistic insights, and enable the assessment of long-term exposure scenarios. In agreement with striving to develop new approach methodologies, such advancements can reduce and replace animal experiments and strongly benefit the translatability of research outcomes to human health protection.

Non-communicable diseases in Saudi adolescents: prevalence, risk factors, and implications for public health

Objectives

This study aimed to assess the prevalence of non-communicable diseases (NCDs) among Saudi adolescents, focusing on obesity, conduct disorder, asthma, and anxiety, and to identify potential risk factors associated with these conditions.

Methods

A retrospective cross-sectional analysis was conducted using data from 2,160 adolescents sourced from official government databases and peer-reviewed literature. Statistical methods included one-way ANOVA, chi-square tests, logistic regression, and Pearson's correlation coefficient, with significance set at p < 0.05 and a 95% confidence interval.

Results

The prevalence of NCDs among Saudi adolescents was 11.8%. Obesity was the most common condition (odds ratio [OR] = 1.24, p = 0.006), followed by conduct disorder (OR = 1.12, p = 0.041), asthma (OR = 1.09, p = 0.036), and anxiety (OR = 1.06, p = 0.042). Pearson's correlation revealed significant associations between these disorders and adolescence stages.

Conclusion

Obesity, conduct disorder, asthma, and anxiety are significant health challenges for Saudi adolescents. These findings highlight the role of lifestyle factors such as diet and physical inactivity. Targeted interventions are needed to promote healthy behaviors and mitigate the long-term risks of these conditions.

The effect and burden of sand-dust storms on asthma hospitalization: Evidence from cities with arid climate in China

Evidence concerning the impact of sand-dust storms (SDS) on asthma is limited, and little is known about the associated public health burden, especially in regions with arid climate. Therefore, this study seeks to evaluate the effect of SDS on asthma hospitalization and quantify the associated hospital and economic burden in multiple cities with typical arid climate. We collected provincial asthma hospitalization, air pollutants and meteorological data of 14 cities in Gansu province. The space-time-stratified case-crossover design combined with a conditional quasi-Poisson regression was used to estimate the association between SDS and asthma hospitalization during 2018-2022. We further explored the interactive effect of SDS and low temperature, and explored potential effect modifications of gender, age, seasons and regions by stratified analyses. Finally, we calculated the hospital and economic burden of asthma attributed to SDS. A total of 54,134 hospitalization records for asthma and 791 SDS events were recorded during the study period. Northwestern area with arid climate displayed more frequent SDS events and asthma hospitalization compared with regions with subtropical or temperate monsoon climate. The relative risk (RR) of asthma hospitalization increased with SDS, with the greatest RR at lag1, which was 1.164 with a 95% confidence interval (CI) of 1.101-1.231. We further found that low temperature had an interactive effect with SDS to trigger asthma hospitalization. Stronger associations were observed in males, school-aged children, cold season and northwestern area. The total fraction of asthma hospitalization attributable to SDS was 1.64 % (95% CI: 1.06%-2.18%), and a conservative estimate of relative healthcare costs was 4.49 (95% CI: 2.92 to 5.99) million China Yuan. Our findings suggest the necessity of controlling SDS and implementing region-specific public health policies as well as personal protective measures against SDS.

Long-term trend of dust event duration over Northwest China

Dust events in Northwest China have become more variable under regional climate change. Prior research has largely overlooked the spatial-temporal distribution of dust event duration (DED) and its long-term trend. This study systematically analyzed the spatial and temporal variations of DED in Northwest China and explored their associated factors using satellite-derived air quality datasets during 2000-2021. We find that dust event frequency (DEF) and DED generally showed a significant decreasing trend since 2000, but in 2013, DEF and DED started to rebound, with DED in particular, showing a more pronounced rebound in most parts of Northwest China. Correlation analysis with many factors suggests that the rise in near-surface wind speed since 2013 may primarily account for the increase in DEF and DED by enhancing dust generation and suppressing dust dry deposition processes. Further projections reveal that regions close to dust sources are likely to have more frequent and prolonged dust events, while areas far from dust sources will experience a decrease in DEF and DED in the future. These findings are crucial for understanding dust event variations and for guiding local dust management strategies.

Effects of climate and environmental factors on childhood and adolescent asthma: A systematic review based on spatial and temporal analysis evidence

BACKGROUND

Asthma is a prevalent chronic respiratory disease among children, influenced by various climate and environmental factors. Despite its prevalence, the specific effects of these factors on asthma remain unclear. This study aims to systematically assess the epidemiological evidence using spatial and temporal methods on the impact of climate and environmental factors on childhood asthma.

METHODS

A systematic review was conducted to analyse the impact of climate and environmental factors on childhood asthma and wheezing, focusing on spatial and temporal trends. Searches were carried out in PubMed, Embase, and CINAHL databases for studies published from January 2000 to April 2024, using key search terms 'asthma/wheezing', 'extreme weather, 'green space', 'air pollution' and 'spatial or temporal analyses".

RESULTS

The systematic review analysed 28 studies, with six employing spatial and 22 using temporal analysis methods; however, none incorporated spatio-temporal analysis in their models. The findings reveal that extreme weather events, including heatwaves and heavy rainfall, elevate childhood asthma risks across various climates, with significant effects observed during summer and winter months. Dust storms in arid and subtropical regions are linked to immediate spikes in hospital admissions due to asthma exacerbations. The effects of green spaces on childhood asthma are mixed, with some studies indicating protective effects while others suggest increased risks, influenced by local environmental factors. Air pollutants such as PM2.5, NO2, and ozone can exacerbate asthma symptoms and along with other environmental factors, contribute to seasonal effects. High temperatures generally correlate with increased asthma risks, though the effects vary by age, sex, and climate.

CONCLUSION

Future research should integrate spatial and temporal methods to better understand the effects of environmental and climate changes on childhood asthma.

Dust storms and cardiorespiratory emergency department visits in three Southwestern United States: application of a monitoring-based exposure metric

Climate change is projected to increase the risk of dust storms, particularly in subtropical dryland, including the southwestern US. Research on dust storm's health impacts in the US is limited and hindered by challenges in dust storm identification. This study assesses the potential link between dust storms and cardiorespiratory emergency department (ED) visits in the southwestern US. We acquired data for 2005-2016 from eight IMPROVE (Interagency Monitoring of PROtected Visual Environments) sites in Arizona, California, and Utah. We applied a validated algorithm to identify dust storm days at each site. We acquired patient-level ED visit data from state agencies and ascertained visits for respiratory, cardiovascular, and cause-specific subgroups among patients residing in ZIP codes within 50 km of an IMPROVE site. Using a case-crossover design, we estimated short-term associations of ED visits and dust storms, controlling for temporally varying covariates. During 2005-2016, 40 dust storm days occurred at the eight IMPROVE sites. Mean PM10 and PM2.5 levels were three to six times greater on dust storm days compared to non-dust storm days. Over the study period, there were 2 524 259 respiratory and 2 805 925 cardiovascular ED visits. At lags of 1, 2, and 3 days after a dust storm, we observed 3.7% (95% CI: 1.0%, 7.6%), 4.9% (95% CI: 1.1%, 8.9%), and 5.0% (95% CI: 1.3%, 8.9%) elevated odds of respiratory ED visits compared to non-dust storm days. Estimated associations of dust storm days and cardiovascular disease ED visits were largely consistent with the null. Using a monitoring-based exposure metric, we observed associations among dust storms and respiratory ED visits. The results add to growing evidence of the health threat posed by dust storms. The dust storm metric was limited by lack of daily data; future research should consider information from satellite and numerical models to enhance dust storm characterization.

Factors by which global warming worsens allergic disease

Increased use of fossil fuels has led to global warming with concomitant increases in the severity and frequency of extreme weather events such as wildfires and sand and dust storms. These changes have led to increases in air pollutants such as particulate matter and greenhouse gases. Global warming is also associated with increases in pollen season length and pollen concentration. Particulate matter, greenhouse gases, and pollen synergistically increase the incidence and severity of allergic diseases. Other indirect factors such as droughts, flooding, thunderstorms, heat waves, water pollution, human migration, deforestation, loss of green space, and decreasing biodiversity (including microbial diversity) also affect the incidence and severity of allergic disease. Global warming and extreme weather events are expected to increase in the coming decades, and further increases in allergic diseases are expected, exacerbating the already high health care burden associated with these diseases. There is an urgent need to mitigate and adapt to the effects of climate change to improve human health. Human health and planetary health are connected and the concept of One Health, which is an integrated, unifying approach to balance and optimize the health of people, animals, and the environment needs to be emphasized. Clinicians are trusted members of the community, and they need to take a strong leadership role in educating patients on climate change and its adverse effects on human health. They also need to advocate for policy changes that decrease the use of fossil fuels and increase biodiversity and green space to enable a healthier and more sustainable future.

Acute exposure to total and source-specific ambient fine particulate matter and risk of respiratory disease hospitalization in Kuwait

Many epidemiologic studies concerned with acute exposure to ambient PM2.5 have reported positive associations for respiratory disease hospitalization. However, few studies have investigated this relationship in Kuwait and extrapolating results from other regions may involve considerable uncertainty due to variations in concentration levels, particle sources and composition, and population characteristics. Local studies can provide evidence for strategies to reduce risks from episodic exposures to high levels of ambient PM2.5 and generating hypotheses for evaluating health risks from chronic exposures. Therefore, using speciated PM2.5 data from local samplers, we analyzed the impact of daily total and source-specific PM2.5 exposure on respiratory hospitalizations in Kuwait using a case-crossover design with conditional quasi-Poisson regression. Total and source-specific ambient PM2.5 were modeled using 0-5-day cumulative distributed lags. For total PM2.5, we observed a 0.16% (95% confidence interval [CI] = 0.05, 0.27%) increase in risk for respiratory hospitalization per 1 μg/m3 increase in concentration. Of the source factors assessed, dust demonstrated a statistically significant increase in risk (0.16%, 95% CI = 0.04, 0.29%), and the central estimate for regional PM2.5 was positive (0.11%) but not statistically significant (95% CI = -0.11, 0.33%). No effect was observed from traffic emissions and 'other' source factors. When hospitalizations were stratified by sex, nationality, and age, we found that female, Kuwaiti national, and adult groups had higher effect estimates. These results suggest that exposure to ambient PM2.5 is harmful in Kuwait and provide some evidence of differential toxicity and effect modification depending on the PM2.5 source and population affected.

Human biomonitoring of environmental contaminants in Gulf Countries - current status and future directions

BACKGROUND

This systematic review aimed to evaluate the status of Human Biomonitoring (HBM) in the Gulf Cooperation Council (GCC) region and provide recommendations for future research, considering the increased environmental contaminants that pose a threat to human health in this rapidly industrializing area.

METHODS

A thorough search was performed in PubMed and Web of Science databases up to February 2023 to identify biomonitoring studies on human exposure and levels in the GCC region. Two independent reviewers assessed study eligibility, conducted data extraction and risk of bias assessment. The NIH Quality Assessment Tools and PRISMA guidelines were utilized for quality evaluation and reporting of results.

RESULTS

A total of 38 eligible articles were included in this systematic review out of 662 articles screened. The majority of the publications were from Saudi Arabia (n = 24) and Kuwait (n = 10), while limited representation was found from Qatar (n = 3) and the UAE (n = 1). No articles were identified from Oman and Bahrain. The studies focused on metals, organohalogen compounds, pesticides, polycyclic aromatic hydrocarbons, and phthalates. The findings revealed elevated levels of metals and established correlations between metal exposure and adverse health effects, including infant neurodevelopmental issues, vitamin D deficiency, and oxidative stress. The presence of organohalogen compounds and pesticides was prevalent in the GCC region, with significant associations between exposure to these compounds and negative health outcomes. Notably, high levels of perchlorate were observed in the Kuwaiti population, and a study from Saudi Arabia found an association between per- and polyfluorinated substances and increased odds of osteoporosis.

CONCLUSIONS

This review emphasizes the need to address environmental health challenges in the GCC region through improved HBM research methods and strategies. Implementing biomonitoring programs, conducting cohort studies, investing in tools and expertise, promoting collaboration, and engaging the community are crucial for reliable HBM data in the GCC.

Health-based strategies for overcoming barriers to climate change adaptation and mitigation

Climate change poses an unequivocal threat to the respiratory health of current and future generations. Human activities-largely through the release of greenhouse gases-are driving rising global temperatures. Without a concerted effort to mitigate greenhouse gas emissions or adapt to the effects of a changing climate, each increment of warming increases the risk of climate hazards (eg, heat waves, floods, and droughts) that that can adversely affect allergy and immunologic diseases. For instance, wildfires, which release large quantities of particulate matter with a diameter of less than 2.5 μm (an air pollutant), occur with greater intensity, frequency, and duration in a hotter climate. This increases the risk of associated respiratory outcomes such as allergy and asthma. Fortunately, many mitigation and adaptation strategies can be applied to limit the impacts of global warming. Adaptation strategies, ranging from promotions of behavioral changes to infrastructural improvements, have been effectively deployed to increase resilience and alleviate adverse health effects. Mitigation strategies aimed at reducing greenhouse gas emissions can not only address the problem at the source but also provide numerous direct health cobenefits. Although it is possible to limit the impacts of climate change, urgent and sustained action must be taken now. The health and scientific community can play a key role in promoting and implementing climate action to ensure a more sustainable and healthy future.

Extreme weather and asthma: a systematic review and meta-analysis

BACKGROUND

Climate change's influence on extreme weather events poses a significant threat to the morbidity and mortality of asthma patients. The aim of this study was to examine associations between extreme weather events and asthma-related outcomes.

METHODS

A systematic literature search for relevant studies was performed using the PubMed, EMBASE, Web of Science and ProQuest databases. Fixed-effects and random-effects models were applied to estimate the effects of extreme weather events on asthma-related outcomes.

RESULTS

We observed that extreme weather events were associated with increasing risks of general asthma outcomes with relative risks of 1.18-fold for asthma events (95% CI 1.13-1.24), 1.10-fold for asthma symptoms (95% CI 1.03-1.18) and 1.09-fold for asthma diagnoses (95% CI 1.00-1.19). Extreme weather events were associated with increased risks of acute asthma exacerbation with risk ratios of asthma emergency department visits of 1.25-fold (95% CI 1.14-1.37), of asthma hospital admissions of 1.10-fold (95% CI 1.04-1.17), of asthma outpatient visits of 1.19-fold (95% CI 1.06-1.34) and of asthma mortality of 2.10-fold (95% CI 1.35-3.27). Additionally, an increase in extreme weather events increased risk ratios of asthma events by 1.19-fold in children and 1.29-fold in females (95% CI 1.08-1.32 and 95% CI 0.98-1.69, respectively). Thunderstorms increased the risk ratio of asthma events by 1.24-fold (95% CI 1.13-1.36).

CONCLUSIONS

Our study showed that extreme weather events more prominently increased the risk of asthma morbidity and mortality in children and females. Climate change is a critical concern for asthma control.

Burden of fine air pollution on mortality in the desert climate of Kuwait

BACKGROUND

Middle Eastern desert countries like Kuwait are known for intense dust storms and enormous petrochemical industries affecting ambient air pollution. However, local health authorities have not been able to assess the health impacts of air pollution due to limited monitoring networks and a lack of historical exposure data.

OBJECTIVE

To assess the burden of PM_2.5 on mortality in the understudied dusty environment of Kuwait.

METHODS

We analyzed the acute impact of fine particulate matter (PM_2.5) on daily mortality in Kuwait between 2001 and 2016. To do so, we used spatiotemporally resolved estimates of PM_2.5 in the region. Our analysis explored factors such as cause of death, sex, age, and nationality. We fitted quasi-Poisson time-series regression for lagged PM_2.5 adjusted for time trend, seasonality, day of the week, temperature, and relative humidity.

RESULTS

There was a total of 70,321 deaths during the study period of 16 years. The average urban PM_2.5 was estimated to be 46.2 ± 19.8 µg/m³. A 10 µg/m³ increase in a 3-day moving average of urban PM_2.5 was associated with 1.19% (95% CI: 0.59, 1.80%) increase in all-cause mortality. For a 10 µg/m³ reduction in annual PM_2.5 concentrations, a total of 52.3 (95% CI: 25.7, 79.1) deaths each year could be averted in Kuwait. That is, 28.6 (95% CI: 10.3, 47.0) Kuwaitis, 23.9 (95% CI: 6.4, 41.5) non-Kuwaitis, 9.4 (95% CI: 1.2, 17.8) children, and 20.9 (95% CI: 4.3, 37.6) elderly deaths each year.

IMPACT STATEMENT

The overwhelming prevalence of devastating dust storms and enormous petrochemical industries in the Gulf and the Middle East has intensified the urgency to address air pollution and its detrimental health effects. Alarmingly, the region's epidemiological research lags behind, hindered by a paucity of ground monitoring networks and historical exposure data. In response, we are harnessing the power of big data to generate predictive models of air pollution across time and space, providing crucial insights into the mortality burden associated with air pollution in this under-researched yet critically impacted area.

The shift of decadal trend in Middle East dust activities attributed to North Tropical Atlantic variability

The Middle East, as the world's second-largest dust source region, has dust emissions that significantly impact numerous populated areas, extending from North America to South Asia. Over the past two decades, dust activity in the Middle East has exhibited pronounced variability, with a notable trend shift from positive to negative around 2010. The underlying cause of this trend shift remains elusive. In this study, we employ multi-source datasets and global climate model simulations to demonstrate that the variability of Middle East dust activities is closely tied to changes in North Tropical Atlantic (NTA) sea surface temperature (SST). Specifically, a warm NTA SST anomaly generates an anomalous regional zonal cell characterized by ascending air motion above the NTA and descending air surrounding the Middle East. The associated surface high pressures around the Middle East subsequently induce hot and dry conditions accompanied by intensified Shamal winds in the north, which are favorable for dust emission and transport. The shift in SST trends from positive to negative in the NTA around 2010 is therefore responsible for the observed dust trend shift in the Middle East. This mechanism holds vital implications for predicting decadal dust variability over the Middle East region and further the project of global environment.

Mechanisms of climate change and related air pollution on the immune system leading to allergic disease and asthma

Climate change is considered the greatest threat to global health. Greenhouse gases as well as global surface temperatures have increased causing more frequent and intense heat and cold waves, wildfires, floods, drought, altered rainfall patterns, hurricanes, thunderstorms, air pollution, and windstorms. These extreme weather events have direct and indirect effects on the immune system, leading to allergic disease due to exposure to pollen, molds, and other environmental pollutants. In this review, we will focus on immune mechanisms associated with allergy and asthma-related health risks induced by climate change events. We will review current understanding of the molecular and cellular mechanisms by which the changing environment mediates these effects.

The Role of Climate Change in Asthma

Human activity and increased use of fossil fuels have led to climate change. These changes are adversely affecting human health, including increasing the risk of developing asthma. Global temperatures are predicted to increase in the future. In 2019, asthma affected an estimated 262 million people and caused 455,000 deaths. These rates are expected to increase. Climate change by intensifying climate events such as drought, flooding, wildfires, sand storms, and thunderstorms has led to increases in air pollution, pollen season length, pollen and mold concentration, and allergenicity of pollen. These effects bear implications for the onset, exacerbation, and management of childhood asthma and are increasing health inequities. Global efforts to mitigate the effects of climate change are urgently needed with the goal of limiting global warming to between 1.5 and 2.0 °C of preindustrial times as per the 2015 Paris Agreement. Clinicians need to take an active role in these efforts in order to prevent further increases in asthma prevalence. There is a role for clinician advocacy in both the clinical setting as well as in local, regional, and national settings to install measures to control and curb the escalating disease burden of childhood asthma in the setting of climate change.

Tracheitis hospital admissions are associated with Asia dust storm

The risks of tracheitis have been widely studied, but no investigation has yet to assess the impact of air pollutants on tracheitis hospital admissions. This research explores the relationship between Asia dust storm (ADS) and tracheitis hospital admissions, by using a Poisson time-series model on the 2000-2012 National Health Insurance Research Database (NHIRB) from Taiwan and linking air pollutants and temperature data. From a total of 126,013 tracheitis hospital admissions, the average number of daily tracheitis hospital admissions is 26.53 and increases 10% notably one day after ADS. The empirical result shows that ADS does significantly affect tracheitis hospital admissions 3 and 5 days after an event for the overall sample and 2-4 days after it for females. For the age group <45, the number significantly increases 3-4 days after ADS, revealing that ADS has a prolonged effect on tracheitis hospital admissions.

Air Pollution and Respiratory Hospital Admissions in Kuwait: The Epidemiological Applicability of Predicted PM2.5 in Arid Regions

Dust is a major component of fine particulate matter (PM_2.5) in arid regions; therefore, concentrations of this pollutant in countries such as Kuwait exceed air quality standards. There is limited understanding on the impact and burden of high PM_2.5 concentrations on morbidity in these countries. In this study, we explore the association of PM_2.5 and the risk of respiratory hospital admissions in Kuwait. A time-series regression model was used to investigate daily variations in respiratory admissions and PM_2.5 concentrations from 2010 to 2018. Due to the lack of historical air quality sampling in Kuwait, we used estimated daily PM_2.5 levels from a hybrid PM_2.5 prediction model. Individual and cumulative lag effects of PM_2.5 over a 5-day period were estimated using distributed lag linear models. Associations were stratified by sex, age, and nationality. There were 218,749 total respiratory admissions in Kuwait during the study period. Results indicate that for every 10 μg/m³ increase in PM_2.5, a 1.61% (95% CI = 0.87, 2.35%) increase in respiratory admissions followed over a 5-day cumulative lag. Our estimates show that a 10 μg/m³ reduction in average exposure will potentially avert 391 yearly respiratory admissions (95% CI = 211,571), with 265 fewer admissions among Kuwaitis (95% CI = 139,393) and 262 fewer admissions among children under 15 years of age (95% CI = 125,351). Different strata of the Kuwaiti population are vulnerable to respiratory hospitalization with short-term exposure to PM_2.5, especially those under 15 years of age. The findings are informative for public health authorities in Kuwait and other dust-prone countries.

Distribution and sources of PM2.5-bound free silica in the atmosphere of hyper-arid regions in Hotan, North-West China

The composition of atmospheric fine particulate matter (PM_2.5) is complex and exhibits strong regional differences. Free silica (α-SiO₂) in atmospheric particulate matter is carcinogenic and is an important component of respirable particulate matter in urban areas. Measurements determined that the concentration of silicon dioxide (α-SiO₂) in PM_2.5 in the urban area of Hotan City, China, was 8.02 μg·m^-3 during the dust period and exceeded 1.77 μg·m^-3 during the non-dust period. The proportion of α-SiO₂ in PM_2.5 was 8.07% during the dust period and 2.25% during the non-dust period. Atmospheric visibility during the dust period was mainly influenced by the content of atmospheric floating dust. Analysis of α-SiO₂ pollution sources during the dust period showed that the air masses containing sand and dust originated from the desert hinterland. Following passage through oasis areas, the air mass was effectively reduced in the concentration of α-SiO₂ in PM_2.5. During the dusty period, α-SiO₂ and PM_2.5 originated from the same source in Hotan City. Moreover, wind speed was the main influencing factor for the α-SiO₂ concentration. During the non-dust period, α-SiO₂ and PM_2.5 were not from the same source of pollution.

Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy

The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.

Forecasting PM2.5 concentration using artificial neural network and its health effects in Ahvaz, Iran

The main objective of the present study was to predict the associated health endpoint of PM_2.5 using an artificial neural network (ANN). The neural network used in this work contains a hidden layer with 27 neurons, an input layer with 8 parameters, and an output layer. First, the artificial neural network was implemented with 80% of data for training then with 90% of data for training. The value of R for the data validation of these two networks was 0.80 and 0.83 respectively. The World Health Organization AirQ ⁺ software was utilized for assessing Health effects of PM_2.5 levels. The mean PM_2.5 over the 9-year study period was 63.27(μg/m³), about six times higher than the WHO guideline. However, the PM_2.5 concentration in the last year decreased by about 25% compared to the first year, which is statistically significant (P-value = 0.0048). This reduced pollutant concentration led to a decrease in the number of deaths from 1785 in 2008 to 1059 in 2016. Moreover, a positive correlation was found between PM_2.5 concentration and temperature and wind speed. Considering the importance of predicting PM_2.5 concentration for accurate and timely decisions as well as the accuracy of the artificial neural network used in this study, the artificial neural network can be utilized as an effective instrument to reduce health and economic effects.

Severe asthma in Kuwait population: Phenotype-based approach

BACKGROUND

There is increasing recognition of marked phenotypic heterogeneity within severe asthma patients.

METHODS

Severe asthma patients on GINA step 4 or 5 treatment, followed up at Al-Rashed Allergy center Kuwait, were evaluated for: demographics (gender, age, age of asthma onset), comorbidities (allergic rhinitis (AR), chronic rhinosinusitis (CRS), chronic rhinosinusitis with nasal polyposis (CRSwNP), obesity), blood biomarkers (total serum Immunoglobulin E (IgE), peripheral eosinophils), and sensitization to inhalants allergens.

RESULTS

A total of 169 patients were candidates for biological treatment. Patients were divided in two groups based on level of total IgE as a "low" group with IgE<160 IU/ml (n = 55) and "high" group with IgE≥ 160 IU/ml (n = 114). Both groups were further divided in subgroups, "low" and "high", based on absolute number of eosinophils (Eos) in peripheral blood with <300 cells/μl or ≥ 300 cells/μl. Only 10% of patients were in low IgE/low Eos while majority (46%) were in the high IgE/high Eos group. Mean age of patients was 44.1 year with domination of females (n = 123). Majority of patients were obese. AR, CRS and CRSwNP were more common in group with IgE ≥160 IU/ml, while CRS and CRSwNP in group with Eos ≥300 cells/μl.

CONCLUSION

The majority of severe asthma patients in Kuwait are obese females with adult-onset asthma (>18 years of age) who were allergic with comorbid conditions including AR, CRS and CRSwNP, which correlates well with the level of Eos.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND

Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event.

OBJECTIVES

To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities.

METHODS

We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features.

RESULTS

We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50<PM<150) or high (≥150) PM10 levels.

CONCLUSIONS

We found evidence that SDDs carry a risk of emergency hospital admission from respiratory diseases in the Canary Islands.

Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus

The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.

Global Health Impacts of Dust Storms: A Systematic Review

BACKGROUND

Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue.

METHOD

In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table.

RESULTS

The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular.

CONCLUSION

The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.

Impacts of El Niño-Southern Oscillation on surface dust levels across the world during 1982-2019

Dust pollution has become a significant concern worldwide. Both human activities and climate conditions affect dust levels. This study investigates the influence of El Niño-Southern Oscillation (ENSO), an important large-scale climate phenomenon, on surface dust levels in different regions. We used surface dust concentrations from Retrospective analysis for Research and Applications version 2 reanalysis and Southern Oscillation index (SOI) as dust and ENSO indicators, respectively. First, we first described characteristics of the global surface dust concentrations spanning a period of 37 years (1982-2019). Subsequently, we investigated the associations between monthly surface dust concentrations and SOI in regions with relative high dust levels, (i.e., North Africa, Northwest China and Mongolia, the Middle East, and South Australia) using time-series generalized additive models, controlled for meteorological variables and normalized difference vegetation index (NDVI). In order to capture the delayed effects of ENSO on dust, we fitted the model for SOI with 13 different moving averages starting from 12 months before. The highest average surface dust concentration for our study regions was 306.68 μg/m3, observed in North Africa. The average dust concentrations in the Middle East, Northwest China, and South Australia were 193.18, 113.64, and 77.19 μg/m3, respectively. Our results showed that dust concentrations were positively related with SOI. The associations between dust and SOI were more significant and higher for North Africa and the Middle East. Our results indicated that for regions with high dust pollution, La Niña episodes are associated with increased dust concentrations, while El Niño events are associated with decreased dust concentrations.

Climate change, air pollution, and allergic respiratory diseases: a call to action for health professionals

Rising emissions of greenhouse gases in the atmosphere have warmed the planet substantially and are also accompanied by poor air quality. The increased prevalence of allergic airway disease worldwide can be partially attributed to those global environmental changes. Climate change and air pollution pose adverse impacts on respiratory allergies, and that the mechanisms are complex and interactive. Adverse weather conditions, such as extreme temperatures, can act directly on the respiratory tract to induce allergic respiratory illnesses. Thunderstorms and floods can alter the production and distribution of aeroallergens while wildfires and dust storms increase air pollution, and therefore indirectly enhance health risks. Concentrations of particulate matter and ozone in the air have been projected to increase with climate warming and air stagnation, and the rising temperatures and CO₂ increase pollen, molds, and spores, which escalate the risk of allergic respiratory diseases. The synergistic effects of extreme heat and aeroallergens intensify the toxic effect of air pollutants, which in turn augment the allergenicity of aeroallergens. With the Earth's climate change, migration of humans and plants shift the living environments and allergens of susceptible people. Urban residents are exposed to multiple factors while children are sensitive to environmental exposure. Since climate change may pose many unexpected and persistent effects on allergic respiratory diseases, health professionals should advocate for effective mitigation and adaptation strategies to minimize its respiratory health effects.

Modeling Desert Dust Exposures in Epidemiologic Short-term Health Effects Studies

Supplemental Digital Content is available in the text.

Desert dust is assumed to have substantial adverse effects on human health. However, the epidemiologic evidence is still inconsistent, mainly because previous studies used different metrics for dust exposure and its corresponding epidemiologic analysis. We aim to provide a standardized approach to the methodology for evaluating the short-term health effects of desert dust.

Housing Risk Factors Associated with Respiratory Disease: A Systematic Review

Cold, damp and mouldy housing arises from the degradation of the housing stock over time due to weathering and a lack of maintenance. Living in such houses is associated with many adverse impacts on human health, especially for those with existing health issues. This paper presents a systematic review, using the PRISMA protocol, consisting of an exploratory analysis of housing-related risk factors associated with respiratory disease. The review consisted of 360 studies investigating 19 risk factors associated with respiratory conditions. Each fall into one of four categories, namely, (1) outdoor environment-related factors; (2) indoor air pollution-related factors; (3) housing non-structure-related factors; or (4) housing structure-related factors. The results show that effects of poor housing conditions on occupants’ respiratory health is a growing research field, where poor indoor air quality, mainly due to a lack of adequate ventilation, was found to be the most influential risk factor. Usage of solid fuel and living in an urban area without a pollutant-free air filtration system are the main risk factors related to inadequate ventilation. Therefore, an adequate and reliable ventilation system with air-infiltration was considered to be the main mitigation solution to improve indoor air quality. It is suggested that government organisations and health practitioners could use the identified risk factors to measure the healthiness of existing dwellings and take measures to improve existing conditions and develop regulations for new housing construction to promote the healthy home concept. Further research is needed for risk mitigation strategies to reduce the respiratory health burden attributed to housing.

Climate change: A driver of future conflicts in the Persian Gulf Region?

Ongoing global change and its direct environmental impacts, in addition to securing economic transition to the post-oil era, could trigger complex socio-economic and political crises in oil-dependent economies of the Persian Gulf Region (PGR). To evaluate the role of climate change and related policies in degrading the environment and its socio-economic impacts in the PGR, we have used a variety of available global datasets and published data. The results show that the countries of the PGR pursue some types of socio-economic reforms to alleviate the impacts of climate change. However, it seems that these attempts are not compatible with the environment's capacity. The main problem stems from the fact that political differences between the PGR nations prevent them from managing the Persian Gulf environment as an integrated natural system and consequently they have to limit their efforts within their borders, regardless of what happens in other parts of the system. The shift to alternative revenue sources by the countries needs socioeconomic preparedness while there are environmental obstacles, political tensions and geopolitical rivalries. Unless there is a cooperative approach to mitigate the effects of climate change, accompanied by a reorientation of PGR economies, the situation is likely to worsen rather than improve. To address the challenges of climate change, integrated regional collaborations are needed. Collective action, such as more investment in regional research and development and education, is required if the PGR is to successfully transition from a commodity-based to a knowledge-based economy.

Machine Learning Based Algorithms for Global Dust Aerosol Detection from Satellite Images: Inter-Comparisons and Evaluation

Identifying dust aerosols from passive satellite images is of great interest for many applications. In this study, we developed five different machine-learning (ML) based algorithms, including Logistic Regression, K Nearest Neighbor, Random Forest (RF), Feed Forward Neural Network (FFNN), and Convolutional Neural Network (CNN), to identify dust aerosols in the daytime satellite images from the Visible Infrared Imaging Radiometer Suite (VIIRS) under cloud-free conditions on a global scale. In order to train the ML algorithms, we collocated the state-of-the-art dust detection product from the Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) with the VIIRS observations along the CALIOP track. The 16 VIIRS M-band observations with the center wavelength ranging from deep blue to thermal infrared, together with solar-viewing geometries and pixel time and locations, are used as the predictor variables. Four different sets of training input data are constructed based on different combinations of VIIRS pixel and predictor variables. The validation and comparison results based on the collocated CALIOP data indicate that the FFNN method based on all available predictor variables is the best performing one among all methods. It has an averaged dust detection accuracy of about 81%, 89%, and 85% over land, ocean and whole globe, respectively, compared with collocated CALIOP. When applied to off-track VIIRS pixels, the FFNN method retrieves geographical distributions of dust that are in good agreement with on-track results as well as CALIOP statistics. For further evaluation, we compared our results based on the ML algorithms to NOAA’s Aerosol Detection Product (ADP), which is a product that classifies dust, smoke, and ash using physical-based methods. The comparison reveals both similarity and differences. Overall, this study demonstrates the great potential of ML methods for dust detection and proves that these methods can be trained on the CALIOP track and then applied to the whole granule of VIIRS granule.

Dust Transport from Inland Australia and Its Impact on Air Quality and Health on the Eastern Coast of Australia during the February 2019 Dust Storm

Dust storms originating from Central Australia and western New South Wales frequently cause high particle concentrations at many sites across New South Wales, both inland and along the coast. This study focussed on a dust storm event in February 2019 which affected air quality across the state as detected at many ambient monitoring stations in the Department of Planning, Industry and Environment (DPIE) air quality monitoring network. The WRF-Chem (Weather Research and Forecast Model—Chemistry) model is used to study the formation, dispersion and transport of dust across the state of New South Wales (NSW, Australia). Wildfires also happened in northern NSW at the same time of the dust storm in February 2019, and their emissions are taken into account in the WRF-Chem model by using Fire Inventory from NCAR (FINN) as emission input. The model performance is evaluated and is shown to predict fairly accurate the PM2.5 and PM10 concentration as compared to observation. The predicted PM2.5 concentration over New South Wales during 5 days from 11 to 15 February 2019 is then used to estimate the impact of the February 2019 dust storm event on three health endpoints, namely mortality, respiratory and cardiac disease hospitalisation rates. The results show that even though as the daily average of PM2.5 over some parts of the state, especially in western and north western NSW near the centre of the dust storm and wild fires, are very high (over 900 µg/m3), the population exposure is low due to the sparse population. Generally, the health impact is similar in order of magnitude to that caused by biomass burning events from wildfires or from hazardous reduction burnings (HRBs) near populous centres such as in Sydney in May 2016. One notable difference is the higher respiratory disease hospitalisation for this dust event (161) compared to the fire event (24).

Spatio-temporal variations in bacterial and fungal community associated with dust aerosol in Kuwait

Kuwait is a country with a very high dust loading; in fact it bears the world's highest particulate matter concentration in the outdoor air. The airborne dust often has associated biological materials, including pathogenic microbes that pose a serious risk to the urban ecosystem and public health. This study has established the baseline taxonomic characterization of microbes associated with dust transported into Kuwait from different trajectories. A high volume air sampler with six-stage cascade impactor was deployed for sample collection at a remote as well as an urban site. Samples from three different seasons (autumn, spring and summer) were subjected to targeted amplicon sequencing. A set of ~ 50 and 60 bacterial and fungal genera, respectively, established the core air microbiome. The predominant bacterial genera (relative abundance ≥ 1%) were Brevundimonas (12.5%), Sphingobium (3.3%), Sphingopyxis (2.7%), Pseudomonas (2.5%), Sphingomonas (2.4%), Massilia (2.3%), Acidovorax (2.0%), Allorhizobium (1.8%), Halomonas (1.3%), and Mesorhizobium (1.1%), and the fungal taxa were Cryptococcus (12%) followed by Alternaria (9%), Aspergillus (7%), Candida (3%), Cladosporium (2.9%), Schizophyllum (1.6%), Fusarium (1.4%), Gleotinia (1.3%) and Penicillium (1.15%). Significant spatio-temporal variations were recorded in terms of relative abundances, α-diversities, and β-diversities of bacterial communities. The dissimilarities were less pronounced and instead the communities were fairly homogenous. Linear discrimant analysis revealed three fungal genera known to be significantly differentially abundant with respect to different size fractions of dust. Our results shed light on the spatio-temporal distribution of airborne microbes and their implications in general health.

Respiratory Health after Military Service in Southwest Asia and Afghanistan. An Official American Thoracic Society Workshop Report

Since 2001, more than 2.7 million U.S. military personnel have been deployed in support of operations in Southwest Asia and Afghanistan. Land-based personnel experienced elevated exposures to particulate matter and other inhalational exposures from multiple sources, including desert dust, burn pit combustion, and other industrial, mobile, or military sources. A workshop conducted at the 2018 American Thoracic Society International Conference had the goals of: 1) identifying key studies assessing postdeployment respiratory health, 2) describing emerging research, and 3) highlighting knowledge gaps. The workshop reviewed epidemiologic studies that demonstrated more frequent encounters for respiratory symptoms postdeployment compared with nondeployers and for airway disease, predominantly asthma, as well as case series describing postdeployment dyspnea, asthma, and a range of other respiratory tract findings. On the basis of particulate matter effects in other populations, it also is possible that deployers experienced reductions in pulmonary function as a result of such exposure. The workshop also gave particular attention to constrictive bronchiolitis, which has been reported in lung biopsies of selected deployers. Workshop participants had heterogeneous views regarding the definition and frequency of constrictive bronchiolitis and other small airway pathologic findings in deployed populations. The workshop concluded that the relationship of airway disease, including constrictive bronchiolitis, to exposures experienced during deployment remains to be better defined. Future clinical and epidemiologic research efforts should address better characterization of deployment exposures; carry out longitudinal assessment of potentially related adverse health conditions, including lung function and other physiologic changes; and use rigorous histologic, exposure, and clinical characterization of patients with respiratory tract abnormalities.

Associations Between Dust Storms and Intensive Care Unit Admissions in the United States, 2000-2015

Anthropogenic climate change is influencing the incidence of dust storms and associated human exposure to coarse particulate matter (PM2.5-10) in the United States. Studies have found adverse health consequences related to dust exposure. These consequences include respiratory disease exacerbations and premature mortality, resulting in increased health care utilization. However, the impact of dust storms on critical care demand has not been studied in the United States. We seek to quantify the relationship between dust storms and surges in critical care demand by investigating the association between dust storms and intensive care unit (ICU) admissions at nearby hospitals from 2000 to 2015. ICU data were acquired from Premier, Inc. and encompass 15-20% of all ICU admissions in the United States. Dust storm, meteorology, and air pollutant data were downloaded from the U.S. National Weather Service, the U.S. National Climatic Data Center, and the U.S. Environmental Protection Agency websites, respectively. Associations between ICU admission and dust storms, controlling for temperature, dew point temperature, ambient PM2.5 and ozone, as well as seasonally varying confounders, were estimated using a distributed lag conditional Poisson model with overdispersion. We found a 4.8% (95% CI: 0.4, 9.4; p = 0.033) increase in total ICU admissions on the day of the dust storm (Lag 0) and a 9.2% (95% CI: 1.8, 17.0; p = 0.013) and 7.5% (95% CI: 0.3, 15.2; p = 0.040) increase in respiratory admissions at Lags 0 and 5. North American dust storms are associated with increases in same day and lagged demand for critical care services at nearby hospitals.

Investigation of the Environmental and Socio-Economic Characteristics of Counties with a High Asthma Burden to Focus Asthma Action in Utah

Rising adult asthma prevalence (AAP) rates and asthma emergency room (AER) visits constitute a large burden on public health in Utah (UT), a high-altitude state in the Great Basin Desert, USA. This warrants an investigation of the characteristics of the counties with the highest asthma burden within UT to improve allocation of health resources and for planning. The relations between several predictor environmental, health behavior and socio-economic variables and two health outcome variables, AAP and AER visits, were investigated for UT’s 29 counties. Non-parametric statistical comparison tests, correlation and linear regression analysis were used to determine the factors significantly associated with AER visits and AAP. Regression kriging with Utah small area data (USAD) as well as socio-economic and pollution data enabled local Moran’s I cluster analysis and the investigation of moving correlations between health outcomes and risk factors. Results showed the importance of desert/mining dust and socio-economic status as AAP and AER visits were greatest in the south of the state, highlighting a marked north–south divide in terms of these factors within the state. USAD investigations also showed marked differences in pollution and socio-economic status associated with AAP within the most populous northern counties. Policies and interventions need to address socio-economic inequalities within counties and between the north and south of the state. Fine (PM_2.5) and coarse (PM₁₀) particulate matter monitors should be installed in towns in central and southern UT to monitor air quality as these are sparse, but in the summer, air quality can be worse here. Further research into spatiotemporal variation in air quality within UT is needed to inform public health interventions such as expanding clean fuel programs and targeted land-use policies. Efforts are also needed to examine barriers to routine asthma care.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND

Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event.

OBJECTIVES

To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities.

METHODS

We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features.

RESULTS

We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50

CONCLUSIONS

We found evidence that SDDs carry a risk of emergency hospital admission from respiratory diseases in the Canary Islands.

Collapse

Key Words

• African air intrusions
• Calima sahariana
• Enfermedades respiratorias
• Generalized additive model
• Hospital admissions
• Ingresos hospitalarios
• Intrusiones de aire africano
• Modelos aditivos generalizados
• Particulate matter
• Partículas en suspensión
• Respiratory diseases
• Saharan dust
• Series temporales
• Time-series

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Elena López-Villarrubia Dirección General de Salud Pública. Gobierno de Canarias, Alfonso XIII, 4, 35003 Las Palmas de Gran Canaria, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain.
Olga Costa Estirado Dirección General de Salud Pública. Gobierno de Canarias, Alfonso XIII, 4, 35003 Las Palmas de Gran Canaria, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain
Carmen Íñiguez Hernández Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain
Ferran Ballester Díez Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain; Department of Nursing, University of Valencia, C/ Jaume Roig, 46010 Valencia, Spain

Collapse

Impacts of meteorology and vegetation on surface dust concentrations in Middle Eastern countries

Severe dust events have occurred frequently in arid regions, which greatly impacted air quality, climate, and public health. The Middle East is one of the areas in the world impacted by intense dust storms. We investigated the characteristics of airborne dust levels in five Middle Eastern countries (Kuwait, Iraq, Iran, Saudi Arabia, and Syria) from 2001 to 2017. Surface level dust concentrations were determined using the Modern-Era Retrospective analysis for Research and Applications version 2. Kuwait was selected as an example to assess sources and other factors influencing dust levels in arid regions. We performed backward trajectory analysis to identify the dust transport pathways. We quantitatively assessed the impacts of meteorological parameters along with the Normalized Difference Vegetation Index (NDVI). Dust levels in Kuwait were higher than the other four countries, and had a distinct seasonal pattern, with the highest in summer and the lowest in winter. Our results showed that dust levels in Kuwait in January were influenced largely by local emissions, whereas in June they were affected more by emissions attributable to long-distance transport. There were significant positive associations between wind speed in the five countries, particularly Iraq, with dust levels in Kuwait, indicating the impact of nearby desert areas. Significant negative associations were observed between NDVI in Kuwait, Iraq, and Saudi Arabia with dust levels in Kuwait. Our result highlights that climatic variations and vegetation conditions are associated with changes in dust levels in arid regions.

Elemental and magnetic analyses, source identification, and oxidative potential of airborne, passive, and street dust particles in Asaluyeh County, Iran

One of the most important environmental issues in arid and semi-arid regions is deposition of dust particles. In this study, airborne, passive, and street dust samples were collected in Asaluyeh County, in August 2017, September 2017, and February 2018. The PM_2.5 and PM₁₀ concentrations for the sampling period ranged between 19.7 and 76.0 μg/m³ and 47.16-348 μg/m³ with an average of 46.4 μg/m³ and 143 μg/m³, respectively. Monthly dust deposition rates ranged from 5.2 to 26.1 g/m² with an average of 17.85 g/m². Positive Matrix Factorization (PMF) applied to the dust compositional data indicated that Sb, Zn, Pb, Mo, Cu, and As come from anthropogenic sources while Al, Fe, Ti, Mn, Ni, Cr, and Co originate mostly from geogenic sources. The PMF results indicated that the geogenic material was the major source of passive and airborne dust samples. Elemental compositions were similar for passive dust and local surface soil. Frequency-dependent magnetic susceptibility (χ_If and χ_fd%) showed that the local soil is entisol. Isothermal remanent magnetization (IRM_-100mT/IRM_1T) versus saturation IRM (SIRM) demonstrated that the background sample contains ferrimagnetic minerals, but with increasing SIRM, the concentration of soft magnetic magnetite-like phases increases and the magnetic particles are larger. Mrs./Ms. versus Bcr/Bc indicated that the magnetic particles sizes were probably between 120 and 1000 nm. Eu values and the mean Eu/Eu* and La/Al values clearly show that the airborne dust is most affected by oil industries, while passive dust samples primarily originated from local surface soils. These assumptions were confirmed by Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) model results. The samples display a moderate level of oxidation towards ascorbic acid (OP_AA) and glutathione (OP_GSH). Regarding the passive and airborne dust samples, backward Generalized Estimating Equations (GEE) modeling results display a significant positive relationship between geogenic material and oxidative potential (OP). It includes many redox-active transition metals. Alternatively, the street dust OP is strongly related to geogenic and industrial sources and OP_AA is marginally related to urban sources. It was shown that measured magnetic parameters can be used for OP estimation.

Exposure levels of air pollution (PM2.5) and associated health risk in Kuwait

It is well established that respiratory and cardiovascular mortality and morbidity rates are associated with poor air quality as measured by high concentrations of fine particulate matter such as PM_2.5 parameters. Since such information is lacking for the State of Kuwait, this study examined the exposure levels of PM_2.5 and the associated health risk as evaluated by five mortality measures embodied in ischemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease and acute lower respiratory infection as well as two morbidity outcomes related to both cardiovascular and respiratory diseases. The measurement models utilized in this investigation followed the WHO guidelines. Over a span of a four-year period (2014-2017), the annual PM_2.5 concentration levels ranged from 38.0 μg/m³ to 75.2 μg/m³. In general, exposure levels tended to fluctuate throughout the day with the higher levels recorded during rush hours (early morning and early evening), weekends (particularly Saturdays), and summer (i.e., August and September). The highest number of excess cases and attributable proportions of premature mortalities were related to ischemic heart disease and stroke at 352 (95% CI 275-426) and 70.8% (95% CI 39.7-85.2), respectively. In general, respiratory diseases showed a higher number of excess cases and attributable proportions than cardiovascular diseases. Relative to other findings on the global stage, the results emanating from Kuwait are emerging on the higher side. The study outcomes suggest that control strategies are in dire need to bend the pollution levels in Kuwait.

Urban Health Related Air Quality Indicators over the Middle East and North Africa Countries Using Multiple Satellites and AERONET Data

Air pollution is reported as one of the most severe environmental problems in the Middle East and North Africa (MENA) region. Remotely sensed data from newly available TROPOMI - TROPOspheric Monitoring Instrument on board Sentinel-5 Precursor, shows an annual mean of high-resolution maps of selected air quality indicators (NO2, CO, O3, and UVAI) of the MENA countries for the first time. The correlation analysis among the aforementioned indicators show the coherency of the air pollutants in urban areas. Multi-year data from the Aerosol Robotic Network (AERONET) stations from nine MENA countries are utilized here to study the aerosol optical depth (AOD) and Ångström exponent (AE) with other available observations. Additionally, a total of 65 different machine learning models of four categories, namely: linear regression, ensemble, decision tree, and deep neural network (DNN), were built from multiple data sources (MODIS, MISR, OMI, and MERRA-2) to predict the best usable AOD product as compared to AERONET data. DNN validates well against AERONET data and proves to be the best model to generate optimized aerosol products when the ground observations are insufficient. This approach can improve the knowledge of air pollutant variability and intensity in the MENA region for decision makers to operate proper mitigation strategies.

Acute effects of air pollution on mortality: A 17-year analysis in Kuwait

BACKGROUND

The health burden from exposure to air pollution has been studied in many parts of the world. However, there is limited research on the health effects of air quality in arid areas where sand dust is the primary particulate pollution source.

OBJECTIVE

Study the risk of mortality from exposure to poor air quality days in Kuwait.

METHODS

We conducted a time-series analysis using daily visibility as a measure of particulate pollution and non-accidental total mortality from January 2000 through December 2016. A generalized additive Poisson model was used adjusting for time trends, day of week, and temperature. Low visibility (yes/no), defined as visibility lower than the 25th percentile, was used as an indicator of poor air quality days. Dust storm events were also examined. Finally, we examined these associations after stratifying by gender, age group, and nationality (Kuwaitis/non-Kuwaitis).

RESULTS

There were 73,748 deaths from natural causes in Kuwait during the study period. The rate ratio comparing the mortality rate on low visibility days to high visibility days was 1.01 (95% CI: 0.99-1.03). Similar estimates were observed for dust storms (1.02, 95% CI: 1.00-1.04). Higher and statistically significant estimates were observed among non-Kuwaiti men and non-Kuwaiti adolescents and adults.

CONCLUSION

We observed a higher risk of mortality during days with poor air quality in Kuwait from 2000 through 2016.

The disappearing Salton Sea: A critical reflection on the emerging environmental threat of disappearing saline lakes and potential impacts on children's health

Changing weather patterns, droughts and competing water demands are dramatically altering the landscape and creating conditions conducive to the production of wind-blown dust and dust storms. In California, such factors are leading to the rapid shrinking of the Salton Sea, a 345 mile² land-locked "sea" situated near the southeastern rural border region known as the Imperial Valley. The region is anticipated to experience a dramatic increase in wind-blown dust and existing studies suggest a significant impact on the health and quality of life for nearby residents of this predominantly low-income, Mexican-American community. The discussion calls attention to the public health dimensions of the Salton Sea crisis. We know little about the possible long-term health effects of exposure to mobilized lakebed sediments or the numerous toxic contaminants that may become respirable on entrained particles. We draw on existing epidemiological literature of other known sources of wind-blown dust, such as desert dust storms, and related health effects to begin to understand the potential public health impact of wind-blown dust exposure. The increased production of wind-blown dust and environmental exposures to such non-combustion related sources of particulate matter are a growing health threat, due in part to drought coupled with increasing pressures on limited water resources. Recent population-based studies have linked dust storms with cardiovascular mortality, asthma hospitalization and decrease in pulmonary function in both adults and children. A growing number of studies provide evidence of the acute health effects of wind-blown dust exposures among children, which with repeated insults have the potential to influence respiratory health over time. The shrinking of the Salton Sea illustrates a public health and environmental justice crisis that requires action and attention to protect the health and well-being of local communities.

Preparedness components of health systems in the Eastern Mediterranean Region for effective responses to dust and sand storms: a systematic review

Background: Dust and Sand Storm (DSS), according to estimates by global reports, will increase dramatically in the Eastern Mediterranean Region (EMR). Numerous health problems caused by DSS will be severely affected regions and vulnerable groups. This study aimed to identify the components of the preparedness of health systems for the DSS phenomenon in EMR. Methods: In this systematic review, the peer-reviewed papers in four electronic databases, including Medline through PubMed, Scopus, ISI Web of Science and the Cochrane library, as well as available grey literature, were searched and selected. The research process was carried out by including papers whose results were related to the potential health effects caused by desert dusts in EMR. Was used the combination of three groups of keywords: the exposure factor, health effects as outcomes, and the countries located in EMR. The focus was on the PRISMA checklist, with no time limitations until December 2017. Finally, through 520 related citations, 30 articles were included. Descriptive and thematic content analyses were evaluated. Results: The preparedness components were divided into three and ten main categories and subcategories, respectively. The three categories covered the areas of DSS hazard identification, planning and policy-making, and risk assessment. Conclusions: Recognition of the health system preparedness factors for DSS in EMR will help policy-makers and managers perform appropriate measures when dealing with this hazard. More studies should be conducted to understand these factors in other parts of the world. Registration: PROSPERO registration number CRD42018093325.

Economic Impact and Risk Assessment of Sand and Dust Storms (SDS) on the Oil and Gas Industry in Kuwait

There is a lack of published research on the economic effect and the risk associated with sand and dust storms (SDS) worldwide. The objectives of this study are to estimate the economic impact of SDS on the oil and gas industry in Kuwait, to estimate a risk index for each loss, and to recommend a sustainable system for the mitigation of the damaging effects and economic losses of infrastructures. Hot spots of wind erosion, wind corridors, and dust frequency and severity formed the basis to locate the most susceptible oil and gas fields and operations. Ten sectors with potential loss vulnerabilities were evaluated: exploration, drilling, production, gas, marine, soil remediation, project management, water handling, maintenance, and research and development. Sand encroachment, although not a sector per se, was also considered. The results indicate that sand, and to lesser extent dust, are damaging and costly to the oil and gas infrastructure of Kuwait, with an economic cost estimation of US$9.36 million, a total of 5159 nonproductive lost hours, and 347,310 m3 of annual sand removal. A risk assessment identified three sectors with the highest risk indices (RI): drilling (RI = 25), project management (RI = 20), and maintenance (RI = 16). Sand encroachment also constituted a high risk (RI = 25). Mitigation of sand storms using a hybrid biological–mechanical system was shown to be cost-effective with an equivalent saving of 4.6 years of sand encroachment. The hazard implications of sand storm events continue to be a major concern for policy-makers given their detrimental economic impacts, and require that government officials wisely allocate investment budgets to effectively control and mitigate their damaging effects.

Short-term effects of desert and non-desert PM10 on mortality in Sicily, Italy

BACKGROUND

Increased PM₁₀ concentrations are commonly observed during Saharan dust advections. Limited epidemiological evidence suggests that PM₁₀ from anthropogenic and desert sources increase mortality. We aimed to evaluate the association between source-specific PM₁₀ (non-desert and desert) and cause-specific mortality in Sicily during 2006-2012 period.

METHODS

Daily PM₁₀ concentrations at 1-km² were estimated in Sicily using satellite-based data, fixed monitors and land use variables. We identified Saharan dust episodes using meteorological models, back-trajectories, aerosol maps, and satellite images. For each dust day, we estimated desert and non-desert PM₁₀ concentrations. We applied a time-series approach on 390 municipalities of Sicily to estimate the association between PM₁₀ (non-desert and desert) and daily cause-specific mortality.

RESULTS

33% of all days were affected by Saharan dust advections. PM₁₀ concentrations were 8 μg/m³ higher during dust days compared to other days. We found positive associations of both non-desert and desert PM₁₀ with cause-specific mortality. We estimated percent increases of risk (IR%) of non-accidental mortality equal to 2.3% (95% Confidence Interval [CI]: 1.4, 3.1) and 3.8% (3.2, 4.4), per 10 μg/m³ increases in non-desert and desert PM₁₀ at lag 0-5, respectively. We also observed significant associations with cardiovascular (2.4% [1.3, 3.4] and 4.5% [3.8, 5.3]) and respiratory mortality (8.1% [6.8, 9.5], and 6.3% [5.4, 7.2]). We estimated higher effects during April-September, with IR% = 4.4% (3.2, 5.7) and 6.3% (5.4, 7.2) for non-desert and desert PM₁₀, respectively.

CONCLUSIONS

Our results confirm previous evidence of harmful effects of desert PM₁₀ on non-accidental and cardio-respiratory mortality, especially during the warm season.

Ambient air quality and exposure assessment study of the Gulf Cooperation Council countries: A critical review

With rapid urbanization and economic growth, many developing countries have faced a greater share of air pollutants in recent years. An increasing number of exposure studies on air pollutants have been reported lately. However, due to lack of strict regulations and monitoring stations among developing countries, such as Gulf Cooperation Council (GCC) countries, limited air pollution and exposure assessment studies have been conducted in this region. Thus, the objective of this critical review was to identify the major sources of air pollutants in the region with hot and arid/semiarid climate for the main categories contributing to specific pollutants. Finally, a summary of the limitations and knowledge gaps were discussed. Additionally, the current available regulations, emission inventories and source apportionment studies in this region were discussed. In this study, the concentration levels of carbon dioxide (CO₂), carbon monoxide (CO), particulate matter (PM), metal elements, nitrogen oxides (NO_x), ozone (O₃), sulfur dioxide (SO₂), volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and persistent organic pollutants (POPs) were reviewed. Due to lack of scientific studies, various databases and indexed journals from early 2000 (sometimes prior that time) were considered. The review findings clearly indicated that the sand, dust (natural and anthropogenic, such as cement, metal, stone cutting industries), chemical industries (refinery, petrochemical, etc.) and transportation activities were the major contributors to the overall air pollution in the GCC countries. Besides, the study recommended that the difference between anthropogenic pollution and natural events in dust formation should be explored extensively. Furthermore, possible suggestions for future researches in the region were proposed.

Vitamin D status among adolescents in Kuwait: a cross-sectional study

OBJECTIVES

In Kuwait, as in many Arab states in the Gulf region, there are limited data on the prevalence of vitamin D deficiency among healthy adolescents. This study aimed to estimate the prevalence of vitamin D deficiency in a nationally representative sample of adolescents and investigate factors associated with vitamin D status.

METHODS

A cross-sectional study was conducted on 1416 adolescents aged 11-16 years, who were randomly selected from middle schools in all governorates of Kuwait. Data were collected from parents through self-administered questionnaire and from adolescents through face-to-face interview. Vitamin D was measured using liquid chromatography-tandem mass spectrometry. Logistic regression was used to investigate the independent factors associated with vitamin D status.

RESULTS

The prevalence of vitamin D deficiency was 81.21% (95% CI 71.61% to 90.81%), while severe deficiency was 39.48%. Only 3.60% of adolescents were vitamin D-sufficient. The prevalence of vitamin D deficiency was significantly higher among girls compared with boys (91.69% vs 70.32%; p<0.001). There was a significant inverse correlation between vitamin D and parathyroid hormone (Spearman correlation=-0.35; p<0.001). In the final model, gender, age, governorate, parental education, body mass index, vitamin D supplement and the number of times adolescents walk to schools per week were all significantly related to vitamin D deficiency.

CONCLUSION

High prevalence of vitamin D deficiency was noted among adolescents in Kuwait despite the abundant sunshine, which may reflect strong sun avoidance behaviour. Adequate outdoor daytime activities should be encouraged especially for girls. We call for locally tailored guidelines for vitamin D supplement in which girls should have a higher dose compared with boys.