Environmental Causes Of Disease Research Articles

Knowledge, attitudes and practices about air pollution and its health effects in 6th to 11th-grade students in Colombia: a cross-sectional study.

Globally, air pollution is the leading environmental cause of disease and premature death. Raising awareness through environmental education and adequate communication on air quality could reduce the adverse effects. We aimed to assess the knowledge, attitudes, and practices (KAP) regarding air pollution and health and determine the factors associated with these KAP in children and adolescents. In 2019-2020, a cross-sectional study was conducted on 6th-11th grade high school students in five municipalities in Colombia. Variables collected included: age, sex, private or public school, any medical history, emergency room visits due to respiratory symptoms in the last year, and whether students played sports. The main exposure was the School Environmental Project. The outcomes were the KAP scale [0% (the lowest score) to 100% (the highest score)]. The factors associated with KAP levels were evaluated with independent mixed regressions due to the multilevel structure of the study (level 1: student; level 2: school), and the exponential coefficients (95% confidence interval-CI) were reported. Among 1,676 students included, 53.8% were females. The median knowledge score about air pollution and its health effects was 33.8% (IQR: 24.0-44.9), 38.6% knew the air quality index, 30.9% knew the air quality alerts that occurred twice a year in these municipalities and 5.3% had high self-perceived knowledge. Positive attitudes, pro-environmental practices, being female, grade level, attending a private school, having respiratory diseases, and the school environmental project importance were associated with higher knowledge scores. The median attitudes score was 78.6% (IQR: 71.4-92.9). Pro-environmental attitudes were associated with knowledge-increasing, being female, attending a private school, and the school environmental project. The median pro-environmental practices score was 28.6% (IQR: 28.6-42.9). During air quality alerts, 11.6% had worn masks, 19% had reduced the opening time of windows and 15.9% avoided leaving home. Pro-environmental practices were associated with knowledge-increasing and attitudes-increasing, and lower practices with higher grade levels, visiting a doctor in the last year, and practicing sports. Children and adolescents have low knowledge scores and inadequate pro-environmental practices scores regarding air pollution. However, they demonstrate positive attitudes towards alternative solutions and express important concerns about the planet's future.

Contribution of Particulates to Airborne Disease Transmission and Severity: A Review.

The emergence of coronavirus disease 2019 (COVID-19) has catalyzed great interest in the spread of airborne pathogens. Airborne infectious diseases are classified into viral, bacterial, and fungal infections. Environmental factors can elevate their transmission and lethality. Air pollution has been reported as the leading environmental cause of disease and premature death worldwide. Notably, ambient particulates of various components and sizes are harmful pollutants. There are two prominent health effects of particles in the atmosphere: (1) particulate matter (PM) penetrates the respiratory tract and adversely affects health, such as heart and respiratory diseases; and (2) bioaerosols of particles act as a medium for the spread of pathogens in the air. Particulates contribute to the occurrence of infectious diseases by increasing vulnerability to infection through inhalation and spreading disease through interactions with airborne pathogens. Here, we focus on the synergistic effects of airborne particulates on infectious disease. We outline the concepts and characteristics of bioaerosols, from their generation to transformation and circulation on Earth. Considering that microorganisms coexist with other particulates as bioaerosols, we investigate studies examining respiratory infections associated with airborne PM. Furthermore, we discuss four factors (meteorological, biological, physical, and chemical) that may impact the influence of PM on the survival of contagious pathogens in the atmosphere. Our review highlights the significant role of particulates in supporting the transmission of infectious aerosols and emphasizes the need for further research in this area.

High-resolution dispersion modelling of PM2.5, PM10, NOx and NO2 exposure in metropolitan areas in Sweden 2000‒2018 – large health gains due to decreased population exposure

AbstractAmbient air pollution remains the major environmental cause of disease. Accurate assessment of population exposure and small-scale spatial exposure variations over long time periods is essential for epidemiological studies. We estimated annual exposure to fine and coarse particulate matter (PM2.5, PM10), and nitrogen oxides (NOx, NO2) with high spatial resolution to examine time trends 2000‒2018, compliance with the WHO Air Quality Guidelines, and assess the health impact. The modelling area covered six metropolitan areas in Sweden with a combined population of 5.5 million. Long-range transported air pollutants were modelled using a chemical transport model with bias correction, and locally emitted air pollutants using source-specific Gaussian-type dispersion models at resolutions up to 50 × 50 m. The modelled concentrations were validated using quality-controlled monitoring data. Lastly, we estimated the reduction in mortality associated with the decrease in population exposure. The validity of modelled air pollutant concentrations was good (R2 for PM2.5 0.84, PM10 0.61, and NOx 0.87). Air pollution exposure decreased substantially, from a population weighted mean exposure to PM2.5 of 12.2 µg m−3 in 2000 to 5.4 µg m−3 in 2018. We estimated that the decreased exposure was associated with a reduction of 2719 (95% CI 2046–3055) premature deaths annually. However, in 2018, 65%, 8%, and 42% of residents in the modelled areas were still exposed to PM2.5, PM10, or NO2 levels, respectively, that exceeded the current WHO Air Quality Guidelines for annual average exposure. This emphasises the potential public health benefits of reductions in air pollution emissions.

Is Lead Exposure Still The Best Explanation For Beethoven’s Deafness?

Objectives: An article in Current Biology in March 2023 suggested that lead poisoning does not apply to Beethoven because the Hiller lock was found to be inauthentic. In addition, bone samples that contained high levels of lead have also been discovered to be inauthentic. This communication is a response to this as well as other challenges to the article in The Laryngoscope in 2013 about lead and the hearing loss of Ludwig van Beethoven. Methods: An in-depth review of these articles was accomplished to assess whether lead poisoning is still a viable theory for Beethoven’s hearing loss. Results: A substantial review of over 2000 cases in 2016 showed uniformly abnormal auditory brainstem responses with chronic lead poisoning that correlate well with the shrunken cochlear nerves found at Beethoven’s autopsy. An article published in 2017 postulated a new reason for Paget’s Disease, but has serious deficiencies. The current case of lead poisoning in The Laryngoscope in 2020 supports lead as a cause significant hearing loss. In 2022 a suggestion of congenital syphilis was found to lack substantial evidence. Although the article in Current Biology in March 2023 suggested that lead poisoning does not apply to Beethoven because the Hiller lock was found to be inauthentic, no authentic samples have ever been tested for lead. Therefore, this is a premature opinion. Conclusion: Future directions listed in the Current Biology article include testing for exposure to environmental causes of disease. We will therefore wait with great anticipation to the analyses of authentic hair samples. It may not be surprising that these will also show high levels of lead. If they do not, all of the suggested reasons for Beethoven’s hearing loss will have major problems, and we may never fulfill his wish to discover the etiology of his loss.

Rationale and Design of a Study to Test the Effect of Personal Protective Aids on Hypertension and Diabetes in People Living With High Levels of Air Pollution—Study Protocol

Air pollution is the largest environmental cause of disease and premature death in the world today, disproportionally affecting low- and middle-income countries (LMIC) such as India. Studies have shown that exposure to particulate matter <2.5 μm (PM2.5) can contribute to cardiovascular disease and increase mortality. We hypothesise that the use of personal protective aids (home indoor air purifiers/N95 masks) can decrease systolic blood pressure (SBP) in people with hypertension and decrease fasting blood glucose levels (FBG) in those with diabetes. This is a prospective randomised crossover study in Dalkhola, India-an area of high ambient PM2.5 levels. Participants between 18-70 years of age with hypertension (n=128) and diabetes (n=33) will be invited to participate in the study. They will be randomised to either an intervention or control arm for 4 weeks, after which they will cross over to the other arm following a 2-week washout period. The intervention will consist of using an indoor air purifier at night and N95 mask when outdoors. The control period will involve using an identical air purifier and N95 mask with the filter removed (sham filtration). Participants and outcome assessors will be blinded to study arm assignment. The primary outcome of the study is the absolute reduction in SBP among people with hypertension and absolute reduction in FBG among people with diabetes. This is the first randomised controlled trial to evaluate the use of personal protective aids as a therapeutic measure in people with hypertension and diabetes exposed to high levels of PM2.5. Given the high burden of air pollution in LMIC, there is an urgent need for adaptation measures targeting people at high risk for mortality from this exposure. The results of our study will demonstrate whether personal protective aids can be a viable adaptation measure for people living with hypertension and diabetes in areas with a high burden of air pollution. This is clinicaltrials.gov Identifier: NCT04854187.

Air pollution and health – the importance of air monitoring and burden of disease for attaining SDGs

Abstract Pollution is the worldwide largest environmental cause of disease and premature death, being also considered a risk for planetary health, a cause of ecosystems destruction and intimately linked to global climate change. Pollution is considered costly, with attributable diseases resulting in health-care costs that are responsible for 1.7% of annual health spending in high-income countries. Moreover, in utero and early childhood exposures are responsible for health effects in children. The importance of air pollution as a cause of disease is well reflected in the Sustainable Development Goals (SDG), mainly in the SDG 3, SDG 11, and SDG 15, but indirectly in all the SDGs. To tackle this issue, an integrative and holistic approach linking human and environmental health such as One Health is needed, to provide evidence-based data to support the establishment of reduced air pollutants’ maximum admissible levels. A case-study developed in Portugal in the scope of PMCardImpact project, regarding the exposure of population to particulate matter with a diameter of 2.5 μm or less (PM2.5) and the associated number of cases of cardiovascular diseases will be presented herewith. Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario. This assessment is the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal. With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies. This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020).

Nature versus nurture-on the origins of a specious argument.

The concept of heritability parses out genetic and environmental causes of diseases and does not fit the underlying biology of complex diseases that arise from interactions among genetics and environment. Exposomics places environment on a similar scale as genomics and allows for more modern research approaches that estimate time-varying genome by exposome interactions. By addressing the biological underpinnings of disease comprehensively, we will find the “missing heritability” which is not solely based on genetic variation but is instead driven by time, life stage, and geographic variability in our exposome as it interacts with our genome.

Utilizing a Biology-Driven Approach to Map the Exposome in Health and Disease: An Essential Investment to Drive the Next Generation of Environmental Discovery.

Background:Recent developments in technologies have offered opportunities to measure the exposome with unprecedented accuracy and scale. However, because most investigations have targeted only a few exposures at a time, it is hypothesized that the majority of the environmental determinants of chronic diseases remain unknown.Objectives:We describe a functional exposome concept and explain how it can leverage existing bioassays and high-resolution mass spectrometry for exploratory study. We discuss how such an approach can address well-known barriers to interpret exposures and present a vision of next-generation exposomics.Discussion:The exposome is vast. Instead of trying to capture all exposures, we can reduce the complexity by measuring the functional exposome—the totality of the biologically active exposures relevant to disease development—through coupling biochemical receptor-binding assays with affinity purification–mass spectrometry. We claim the idea of capturing exposures with functional biomolecules opens new opportunities to solve critical problems in exposomics, including low-dose detection, unknown annotations, and complex mixtures of exposures. Although novel, biology-based measurement can make use of the existing data processing and bioinformatics pipelines. The functional exposome concept also complements conventional targeted and untargeted approaches for understanding exposure-disease relationships.Conclusions:Although measurement technology has advanced, critical technological, analytical, and inferential barriers impede the detection of many environmental exposures relevant to chronic-disease etiology. Through biology-driven exposomics, it is possible to simultaneously scale up discovery of these causal environmental factors. https://doi.org/10.1289/EHP8327

Abstract P066: Rationale And Design Of A Study To Test The Effect Of Personal Protective Aids On Hypertension And Diabetes In People Exposed To High Levels Of Air Pollution

Background: Air pollution is the largest environmental cause of disease and premature death in the world today, disproportionally affecting low- and middle-income countries (LMICs) such as India. Numerous studies have shown that exposure to particulate matter &lt;2.5 μm (PM2.5) can contribute to cardiovascular disease and mortality, which is partially attributable to the development of cardiometabolic conditions such as hypertension and diabetes. We hypothesize that the use of personal protective aids (home air-purifier and N-95 mask) can decrease systolic blood pressure (SBP) in people with hypertension and decrease fasting blood glucose (FBG) in those with diabetes. Method: This is a prospective randomized cross-over study in Dalkhola, India- an area of high ambient PM2.5 levels. Participants between 18 and 70 years of age with hypertension (n=130) and diabetes (n=33) will be invited to participate in the study. They will be randomized to either an intervention or control arm for 4 weeks, after which they will cross over to the other arm following a 2-week washout period. The intervention period will consist of using an indoor air-purifier at night and an N-95 mask when outdoors. Control period will involve using an identical air purifier and facemask, with the filter removed (sham filtration). Participants and outcome assessors will be blinded. Outcome evaluation: The primary outcome of the study is the absolute reduction in SBP among people with hypertension and absolute reduction in FBG among people with diabetes. Discussion: This is the first randomized controlled trial to evaluate personal protective aids as a therapeutic measure in people with hypertension and diabetes exposed to high levels of PM2.5. Given the high burden of air pollution in LMICs, there is an urgent need for adaptation measures targeting people at high risk for mortality from this exposure. The results of our study will demonstrate if personal protective aids can be a viable adaptation measure for people living with hypertension and diabetes in areas with a high burden of air pollution.

Health Risk Assessment of PM2.5 and PM2.5-Bound Trace Elements in Thohoyandou, South Africa.

We assessed the health risks of fine particulate matter (PM2.5) ambient air pollution and its trace elemental components in a rural South African community. Air pollution is the largest environmental cause of disease and disproportionately affects low- and middle-income countries. PM2.5 samples were previously collected, April 2017 to April 2018, and PM2.5 mass determined. The filters were analyzed for chemical composition. The United States Environmental Protection Agency’s (US EPA) health risk assessment method was applied. Reference doses were calculated from the World Health Organization (WHO) guidelines, South African National Ambient Air Quality Standards (NAAQS), and US EPA reference concentrations. Despite relatively moderate levels of PM2.5 the health risks were substantial, especially for infants and children. The average annual PM2.5 concentration was 11 µg/m3, which is above WHO guidelines, but below South African NAAQS. Adults were exposed to health risks from PM2.5 during May to October, whereas infants and children were exposed to risk throughout the year. Particle-bound nickel posed both non-cancer and cancer risks. We conclude that PM2.5 poses health risks in Thohoyandou, despite levels being compliant with yearly South African NAAQS. The results indicate that air quality standards need to be tightened and PM2.5 levels lowered in South Africa.

Human Health and Ocean Pollution.

Human Health and Ocean Pollution.

Hypertension Editors' Picks: Air Pollution.

Hypertension Editors' Picks: Air Pollution.

Intricacies of aetiology in intrafamilial degenerative disease.

The genetic underpinnings of late-onset degenerative disease have typically been determined by screening families for the segregation of genetic variants with the disease trait in affected, but not unaffected, individuals. However, instances of intrafamilial etiological heterogeneity, where pathogenic variants in a culprit gene are not shared among all affected family members, continue to emerge and confound gene-discovery and genetic counselling efforts. Discordant intrafamilial cases lacking a mutation shared by other affected family members are described as disease phenocopies. This description often results in an over-simplified acceptance of an environmental cause of disease in the phenocopy cases, while the role of intrafamilial genetic heterogeneity, shared de novo mutations or epigenetic aberrations in such families is often ignored. On a related note, it is now evident that the same disease-associated variant can be present in individuals exhibiting clinically distinct phenotypes, thereby genetically uniting seemingly unrelated syndromes to form a spectrum of disease. Herein, we discuss the intricacies of determining complex degenerative disease aetiology and suggest alternative mechanisms of disease transmission that may account for the apparent missing heritability of disease.

An Emerging Frontier: Metal(loid) Soil Pollution Threat Under Global Climate Change.

An Emerging Frontier: Metal(loid) Soil Pollution Threat Under Global Climate Change.

There are good clinical, scientific, and social reasons to strengthen links between biomedical and environmental research

Clinical epidemiology rarely addresses biological, clinical, epidemiological, environmental, economic, and other social and scientific issues posed by environmental chemical contaminants such as endocrine-disrupting chemicals. There is a considerable gap between research and practice in clinical medicine and in environmental health. Organizations often fail to appreciate the human and economic costs of the diseases that environmental chemical contaminants contribute to cause. Also, the relative lack of attention to environmental causes of disease by researchers in medicine and clinical epidemiology cannot be explained just on scientific grounds. Many scientists have shown the virtues of integrative research. Knowledge on the causes of disease is often secondary in clinical practice, but in other instances, to help patients, clinicians tackle causes of diseases. We can better address how environmental contaminants influence negatively not just the occurrence of disease but its course. To do so, we can generate better evidence and strengthen the social conversation on environmental influences on all dimensions of health and disease.

Health and Environmental Sustainability:Public health issues for present and future

The medical definition of environmental causes of diseases would be all those factors that are not genetic. Environmental factors include all those factors those affect human health mediated by social conditions and individual choice or environment. ‘Sustainable’ includes the environmental issues and ‘development’ includes the economic issues. Climate change alters or disrupts natural systems, making it possible for vector, water, and food-borne diseases to spread or emerge. Climate change can affect the incidence of diseases associated with air pollutants and aeroallergens. Clean air is considered to be a basic requirement of human health and well-being. Poverty increases vulnerability to climatesensitive health outcomes directly by reducing the capacity to adapt to changing conditions. For countries in the early stages of development the major environmental hazards to health are associated with widespread poverty and severe lack of public infrastructure, such as access to drinking water, sanitation, and lack of health care as well as emerging problems of industrial pollution and also urban waste based pollution. A healthy population is a prerequisite for a productive and creative society, which in turn is needed to sustain national development. Social determinants affect the environmental conditions of an individual and may contribute to the fact that specific individuals or population groups more often experience less adequate or potentially harmful environmental conditions; may directly affect exposure beyond and in addition to the exposure. Enhancing environmental sustainability, through reducing carbon emissions, curtailing waste, and managing resources efficiently, will deliver healthy outcome, and provide broader social and economic benefits.

Novel approach to integrated DNA adductomics for the assessment of in vitro and in vivo environmental exposures

Adductomics is expected to be useful in the characterization of the exposome, which is a new paradigm for studying the sum of environmental causes of diseases. DNA adductomics is emerging as a powerful method for detecting DNA adducts, but reliable assays for its widespread, routine use are currently lacking. We propose a novel integrated strategy for the establishment of a DNA adductomic approach, using liquid chromatography-triple quadrupole tandem mass spectrometry (LC-QqQ-MS/MS), operating in constant neutral loss scan mode, screening for both known and unknown DNA adducts in a single injection. The LC-QqQ-MS/MS was optimized using a representative sample of 23 modified 2'-deoxyribonucleosides reflecting a range of biologically relevant DNA lesions. Six internal standards (ISTDs) were evaluated for their ability to normalize, and hence correct, possible variation in peak intensities arising from matrix effects, and the quantities of DNA injected. The results revealed that, with appropriate ISTDs adjustment, any bias can be dramatically reduced from 370 to 8.4%. Identification of the informative DNA adducts was achieved by triggering fragmentation spectra of target ions. The LC-QqQ-MS/MS method was successfully applied to in vitro and in vivo studies to screen for DNA adducts formed following representative environmental exposures: methyl methanesulfonate (MMS) and five N-nitrosamines. Interestingly, five new DNA adducts, induced by MMS, were discovered using our adductomic approach-an added strength. The proposed integrated strategy provides a path forward for DNA adductomics to become a standard method to discover differences in DNA adduct fingerprints between populations exposed to genotoxins, and facilitate the field of exposomics.

Insights and Tracking of Pollution Awareness Using Google Trends.

Although pollution is the largest environmental cause of disease and premature death in the world today, it does not receive consistent and commensurate public attention. This paper quantifies this phenomenon, tracks recent efforts, and offers strategies for improving pollution awareness. Google Trends allows a user to compare up to five terms or topics simultaneously. Results are displayed as a set of time series. The values displayed are not the actual search counts but percentages relative to the total searches across the specified geography (worldwide, country, state/province, and city) and time period. The resulting numbers are then scaled from 0 to 100 (to create an Interest Index) based on the proportion to all searches on all terms or topics. Pollution interest can be quite different at a country level compared with the worldwide view. Predictably, pollution interest is highest in many of the countries most affected by pollution. However, many of the wealthiest countries show low interest in pollution. Solving any problem begins with awareness, which generates concern and understanding, followed by action. Determining what issues people are searching on provides a reliable barometer of the true interest in and awareness of an issue. Google Trends provides a mechanism to help track ongoing pollution problems and solutions. The author serves as the Chief Technical Officer of Pure Earth. The author had no role in the review of or decision to accept this manuscript. The author declares no competing financial interests.

SPE-IMS-MS: An automated platform for sub-sixty second surveillance of endogenous metabolites and xenobiotics in biofluids

Characterization of endogenous metabolites and xenobiotics is essential to deconvoluting the genetic and environmental causes of disease. However, surveillance of chemical exposure and disease-related changes in large cohorts requires an analytical platform that offers rapid measurement, high sensitivity, efficient separation, broad dynamic range, and application to an expansive chemical space. Here, we present a novel platform for small molecule analyses that addresses these requirements by combining solid-phase extraction with ion mobility spectrometry and mass spectrometry (SPE-IMS-MS). This platform is capable of performing both targeted and global measurements of endogenous metabolites and xenobiotics in human biofluids with high reproducibility (CV⩽3%), sensitivity (LODs in the pM range in biofluids) and throughput (10-s sample-to-sample duty cycle). We report application of this platform to the analysis of human urine from patients with and without type 1 diabetes, where we observed statistically significant variations in the concentration of disaccharides and previously unreported chemical isomers. This SPE-IMS-MS platform overcomes many of the current challenges of large-scale metabolomic and exposomic analyses and offers a viable option for population and patient cohort screening in an effort to gain insights into disease processes and human environmental chemical exposure.

Can robots handle your healthcare?

So are robots the future of healthcare? At least for routine tasks, it looks as if they are likely to become common in healthcare settings. As machine learning expert Anthony Goldbloom recently argued, robots are well-suited to absorbing a large number of examples or books on a subject and applying that knowledge to a situation. Often with more precision than a human, they can navigate obstacles, perform repetitive tasks to a specification, identify and remember patterns and be designed to go places where humans cannot. Although their appearances and behaviours may eventually become indistinguishable from those of humans, some believe they will always lack the human ability to think creatively and 'out of the box.' In the healthcare context, this raises the question of whether robots will ever be able to truly replace caregivers - will they be able to empathise with a patient or be able to identify environmental causes for disease? Such questions remain to be answered, but the scope for mobile service robots is certainly an area to keep an eye on.