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De Vita A, Belmusto A, Di Perna F, Tremamunno S, De Matteis G, Franceschi F, Covino M. The Impact of Climate Change and Extreme Weather Conditions on Cardiovascular Health and Acute Cardiovascular Diseases. J Clin Med 2024; 13:759. [PMID: 38337453 PMCID: PMC10856578 DOI: 10.3390/jcm13030759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Climate change is widely recognized as one of the most significant challenges facing our planet and human civilization. Human activities such as the burning of fossil fuels, deforestation, and industrial processes release greenhouse gases into the atmosphere, leading to a warming of the Earth's climate. The relationship between climate change and cardiovascular (CV) health, mediated by air pollution and increased ambient temperatures, is complex and very heterogeneous. The main mechanisms underlying the pathogenesis of CV disease at extreme temperatures involve several regulatory pathways, including temperature-sympathetic reactivity, the cold-activated renin-angiotensin system, dehydration, extreme temperature-induced electrolyte imbalances, and heat stroke-induced systemic inflammatory responses. The interplay of these mechanisms may vary based on individual factors, environmental conditions, and an overall health background. The net outcome is a significant increase in CV mortality and a higher incidence of hypertension, type II diabetes mellitus, acute myocardial infarction (AMI), heart failure, and cardiac arrhythmias. Patients with pre-existing CV disorders may be more vulnerable to the effects of global warming and extreme temperatures. There is an urgent need for a comprehensive intervention that spans from the individual level to a systemic or global approach to effectively address this existential problem. Future programs aimed at reducing CV and environmental burdens should require cross-disciplinary collaboration involving physicians, researchers, public health workers, political scientists, legislators, and national leaders to mitigate the effects of climate change.
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Affiliation(s)
- Antonio De Vita
- Università Cattolica del Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.B.); (F.D.P.); (F.F.); (M.C.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Antonietta Belmusto
- Università Cattolica del Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.B.); (F.D.P.); (F.F.); (M.C.)
| | - Federico Di Perna
- Università Cattolica del Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.B.); (F.D.P.); (F.F.); (M.C.)
| | - Saverio Tremamunno
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Giuseppe De Matteis
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Francesco Franceschi
- Università Cattolica del Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.B.); (F.D.P.); (F.F.); (M.C.)
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Marcello Covino
- Università Cattolica del Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.B.); (F.D.P.); (F.F.); (M.C.)
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
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Chu L, Chen K, Crowley S, Dubrow R. Associations between short-term temperature exposure and kidney-related conditions in New York State: The influence of temperature metrics across four dimensions. ENVIRONMENT INTERNATIONAL 2023; 173:107783. [PMID: 36841184 DOI: 10.1016/j.envint.2023.107783] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Evidence describing the relationship between short-term temperature exposure and kidney-related conditions is insufficient. It remains unclear how temperature specification affects estimation of these associations. This study aimed to assess associations between short-term temperature exposure and seven kidney-related conditions and to evaluate the influence of temperature specification. METHODS We obtained data on hospital encounters in New York State (2007-2016). We assessed associations with a case-crossover design using conditional logistic regression with distributed lag non-linear models. We compared model performance (i.e., AIC) and association curves using 1) five temperature spatial resolutions; 2) temperature on an absolute versus relative scale; 3) seven temperature metrics incorporating humidity, wind speed, and/or solar radiation; and 4) five intraday temperature measures (e.g., daily minimum and daytime mean). RESULTS We included 1,209,934 unplanned adult encounters. Temperature metric and intraday measure had considerably greater influence than spatial resolution and temperature scale. For outcomes not associated with temperature exposure, almost all metrics or intraday measures showed good model performance; for outcomes associated with temperature, there were meaningful differences in performance across metrics or intraday measures. For parsimony, we modelled daytime mean outdoor wet-bulb globe temperature, which showed good performance for all outcomes. At lag 0-6 days, we observed increased risk at the 95th percentile of temperature versus the minimum morbidity temperature for acute kidney failure (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.09, 1.69), urolithiasis (OR = 1.41, 95% CI: 1.16, 1.70), dysnatremia (OR = 1.26, 95% CI: 1.01, 1.59), and volume depletion (OR = 1.88, 95% CI: 1.41, 2.51), but not for glomerular diseases, renal tubulo-interstitial diseases, and chronic kidney disease. CONCLUSIONS High-temperature exposure over one week is a risk factor for acute kidney failure, urolithiasis, dysnatremia, and volume depletion. The differential model performance across temperature metrics and intraday measures indicates the importance of careful selection of exposure metrics when estimating temperature-related health burden.
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Affiliation(s)
- Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA.
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Susan Crowley
- Department of Medicine (Nephrology), Yale University School of Medicine, New Haven, CT 06520, USA; Veterans Administration Health Care System of Connecticut, West Haven, CT 06516, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA; Yale Center on Climate Change and Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
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Khraishah H, Alahmad B, Ostergard RL, AlAshqar A, Albaghdadi M, Vellanki N, Chowdhury MM, Al-Kindi SG, Zanobetti A, Gasparrini A, Rajagopalan S. Climate change and cardiovascular disease: implications for global health. Nat Rev Cardiol 2022; 19:798-812. [PMID: 35672485 DOI: 10.1038/s41569-022-00720-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. .,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Environmental & Occupational Health Department, Faculty of Public Health, Kuwait University, Hawalli, Kuwait
| | | | - Abdelrahman AlAshqar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nirupama Vellanki
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammed M Chowdhury
- Department of Vascular and Endovascular Surgery, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sadeer G Al-Kindi
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Antonio Gasparrini
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Rajagopalan
- University Hospitals, Harrington Heart & Vascular Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Milani GP, Lo Leggio A, Castellazzi ML, Agostoni C, Bianchetti MG, Carugno M. Outdoor temperature and circulating sodium in children with acute gastroenteritis. Pediatr Res 2022; 92:1270-1273. [PMID: 35177815 DOI: 10.1038/s41390-022-01947-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dysnatremias are frequent in acute gastroenteritis. High outdoor temperatures have been associated with hyponatremia in both adults and the elderly, but no data are available among children with gastroenteritis. METHODS Children <10 years of age admitted to the emergency department of the Policlinico Hospital, Milan (Italy) between 2009 and 2019 with acute moderate-severe gastroenteritis were enrolled. The association between hyponatremia (sodium < 135 mmol/L) and daily mean levels of temperature or apparent temperature from day of admission up to 14 days before was analyzed by multivariable logistic regression models. RESULTS In 202 included children (46% females), we observed an increased risk of hyponatremia per unit increase in outdoor temperature of the sixth, eighth and ninth day before admission [Odds Ratio = 1.24 (95% Confidence Interval: 1.04-1.47), 1.14 (1.01-1.28), and 1.14 (1.01-1.28), respectively]. Analyses considering average temperature levels of the ten days preceding admission returned similar findings as well as those on apparent temperature. CONCLUSIONS Our data suggest the existence of an association between outdoor temperature and circulating sodium levels in children with acute gastroenteritis. The role of meteorological conditions on electrolyte imbalance should be further explored in the context of climate change. IMPACT The role of meteorological variables in the development of dysnatremias has been demonstrated in children and adolescents with cystic fibrosis. This study shows for the first time that higher outdoor temperatures are associated with a higher risk of hyponatremia in children with gastroenteritis. In the context of climate change, the role of external climate conditions on the risk of electrolyte imbalance in children should be more and more considered and explored in future studies.
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Affiliation(s)
- Gregorio P Milani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Agnese Lo Leggio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. .,Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Mario G Bianchetti
- Faculty of Biomedical Science, Università della Svizzera Italiana, Lugano, Switzerland
| | - Michele Carugno
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Qu Y, Zhang W, Boutelle AYM, Ryan I, Deng X, Liu X, Lin S. Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease. Am J Kidney Dis 2022; 81:507-516.e1. [PMID: 36241010 DOI: 10.1053/j.ajkd.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
RATIONALE & OBJECTIVE Extreme heat exposure is associated with multiple diseases. However, our current understanding of the specific impact of extreme heat exposure on kidney disease is limited. STUDY DESIGN Case-crossover study. SETTING & PARTICIPANTS 1,114,322 emergency department (ED) visits with a principal diagnosis of kidney disease were identified in New York state, 2005-2013. EXPOSURE Extreme heat exposure was defined as when the daily temperature exceeded the 90th percentile temperature of that month during the study period in the county. OUTCOME ED visits with a principal diagnosis of kidney disease and its subtypes (ICD-9 [International Classification of Diseases, Ninth Revision] codes 580-599, 788). ANALYTICAL APPROACH Extreme heat exposure on the ED visit days was compared with extreme heat exposure on control days using a conditional logistic regression model, controlling for humidity, air pollutants, and holidays. The excess risk of kidney disease was calculated for a week (lag days 0-6) after extreme heat exposure during the warm season (May through September). We also stratified our estimates by sociodemographic characteristics. RESULTS Extreme heat exposure was associated with a 1.7% (lag day 0) to 3.1% (lag day 2) higher risk of ED visits related to kidney disease; this association was stronger with a greater number of extreme heat exposure days in the previous week. The association with extreme heat exposure lasted for an entire week and was stronger in the transitional months (ie, May and September; excess rates ranged from 1.8% to 5.1%) rather than the summer months (June through August; excess rates ranged from 1.5% to 2.7%). The strength of association was greater among those with ED visits related to acute kidney injury, kidney stones, and urinary tract infections. Age and sex may modify the association between extreme heat exposure and ED visits. LIMITATIONS Individual exposure to heat-how long people were outside or whether they had access to air conditioning-was unknown. CONCLUSIONS Extreme heat exposure was significantly associated with a dose-dependent greater risk of ED visits for kidney disease.
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Infusino E, Caloiero T, Fusto F, Calderaro G, Brutto A, Tagarelli G. Characterization of the 2017 Summer Heat Waves and Their Effects on the Population of an Area of Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030970. [PMID: 33499298 PMCID: PMC7908494 DOI: 10.3390/ijerph18030970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
Knowledge of bioclimatic comfort is paramount for improving people’s quality of life. To this purpose, several studies related to climatic comfort/discomfort have been recently published. These studies mainly focus on the analysis of temperature and relative humidity, i.e., the main variables influencing the environmental stress in the human body. In this context, the present work aims to analyze the number of visits to the hospital emergency department made by the inhabitants of the Crati River valley (Calabria region, southern Italy) during the heat waves that accompanied the African anticyclone in the summer of 2017. The analysis of the bioclimatic comfort was performed using the humidity index. Results showed that greater the index, the higher the number of accesses to the emergency department, in particular by the most vulnerable population groups, such as children and the elderly.
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Affiliation(s)
- Ernesto Infusino
- Department of Environmental Engineering (DIAm), University of Calabria, Via P. Bucci 41C, 87036 Rende, Italy;
| | - Tommaso Caloiero
- National Research Council—Institute for Agricultural and Forest Systems in Mediterranean (CNR—ISAFOM), Via Cavour 4/6, 87036 Rende, Italy;
- Correspondence: ; Tel.: +39-0984-841-464
| | - Francesco Fusto
- Multi-Risk Functional Center, Regional Agency for Environmental Protection of Calabria, Viale degli Angioini 143, 88100 Catanzaro, Italy;
| | - Gianfranco Calderaro
- Health Protection Department of the Calabria Region, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy; (G.C.); (A.B.)
| | - Angelo Brutto
- Health Protection Department of the Calabria Region, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy; (G.C.); (A.B.)
| | - Giuseppe Tagarelli
- National Research Council—Institute for Agricultural and Forest Systems in Mediterranean (CNR—ISAFOM), Via Cavour 4/6, 87036 Rende, Italy;
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The Impact of Heat Waves on Emergency Department Admissions in Charlottesville, Virginia, U.S.A. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071436. [PMID: 29986505 PMCID: PMC6068980 DOI: 10.3390/ijerph15071436] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Abstract
Heat waves have been linked to increases in emergency-related morbidity, but more research is needed on the demographic and disease-specific aspects of these morbidities. Using a case-crossover approach, over 700,000 daily emergency department hospital admissions in Charlottesville, Virginia, U.S.A. from 2005–2016 are compared between warm season heat wave and non-heat wave periods. Heat waves are defined based on the exceedance, for at least three consecutive days, of two apparent temperature thresholds (35 °C and 37 °C) that account for 3 and 6% of the period of record. Total admissions and admissions for whites, blacks, males, females, and 20–49 years old are significantly elevated during heat waves, as are admissions related to a variety of diagnostic categories, including diabetes, pregnancy complications, and injuries and poisoning. Evidence that heat waves raise emergency department admissions across numerous demographic and disease categories suggests that heat exerts comorbidity influences that extend beyond the more well-studied direct relationships such as heat strokes and cardiac arrest.
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Sheffield PE, Herrera MT, Kinnee EJ, Clougherty JE. Not so little differences: variation in hot weather risk to young children in New York City. Public Health 2018; 161:119-126. [PMID: 29960726 DOI: 10.1016/j.puhe.2018.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/16/2018] [Accepted: 06/05/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES High ambient temperatures are associated with significant health risk in the United States. The risk to children has been minimally explored, and often young children are considered as a single age group despite marked physiologic and social variation among this population from infancy through preschool. This study explored the heterogeneity of risk of heat among young children. STUDY DESIGN Using a time-stratified, case-crossover design, we evaluated associations between maximum daily temperature (Tmax) and ED visits (n = 1,002,951) to New York City (NYC) metropolitan area hospitals for children aged 0-4 years in May-September, 2005-2011. METHODS Conditional logistic regression analysis estimated risks for an interquartile range of Tmax for 0-6 lag days. Stratified analyses explored age strata by year, race/ethnic groups, and diagnostic codes. Sensitivity analyses controlled for same day ambient ozone, particulate matter <2.5 microns, and relative humidity and, separately, explored race groups without ethnicity and different diagnostic code groupings. RESULTS Children ages 0-4 years had increased risk of emergency department visits with increased Tmax on lag days 0, 1, and 3. The association was strongest on lag day 0, when an increase in Tmax of 13 °F conferred an excess risk of 2.6% (95% confidence interval [CI]: 2.2-3.0). Stratifying by age, we observed significant positive associations for same-day exposures, for 1-4 year olds. Children less than 1 year of age showed a significant positive association with Tmax only on lag day 3. The race/ethnicity stratified analysis revealed a similar lag pattern for all subgroups. The diagnostic group analysis showed percent excess risk for heat-specific diagnoses (16.6% [95% CI: 3.0-31.9]); general symptoms (10.1% [95% CI: 8.2-11.9]); infectious (4.9% [95% CI: 3.9-5.9]); and injury (5.1% [95% CI: 3.8-6.4]) diagnoses. CONCLUSION We found a significant risk of ED visits in young children with elevated Tmax. Risk patterns vary based on age with infants showing delayed risk and toddlers and preschoolers with same day risk. In addition, the finding of increased risk of injury associated with higher temperatures is novel. Altogether, these findings suggest a need for a tailored public health response, such as different messages to caregivers of different age children, to protect children from the effects of heat. Next steps include examining specific subcategories of diagnoses to develop protective strategies and better anticipate the needs of population health in future scenarios of climate change.
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Affiliation(s)
- Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - M Teresa Herrera
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ellen J Kinnee
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15219, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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