Environmental Health Perspectives Research Articles

Abstract 859: Development of non-smoking lung cancers by indoor carcinogenic aerosols through epigenetic reprogramming of lung stem cells: Bioinformatics and artificial intelligence analysis

Abstract Several scientific studies discovered the toxic effects of indoor aerosols on different organs’ adult stem cells of the human body. The most importantly, the indoor toxic aerosols comprised of numerous carcinogens namely, sodium dodecyl sulfate, phthalic acids from floor cleaners, formaldehyde, acetaldehyde, benzene, toluene, ethyl benzene, xylenes, from air fresheners, Hydramethylnon, Pyrethrins, imiprothrin, cypermethrin, tetramethrin, prallethrin and permethrin from ant and roach Killer. However, there was a lack of analysis revealing the mechanism of toxic effects and epigenetic reprogramming of human lung stem cells and development of non-smoking lung cancers. In this study, we analyzed the toxic effects of these chemicals and the mechanism of epigenetic reprograming on lung epithelial cells using Comparative Toxico-genomics Database (CTD), database of Environmental Health Perspectives (EHP), National Institute of Environmental Health Sciences (NIEHS), Google search browser with generative artificial intelligence (AI) and other biological informatics methods (Reactome, Cytoscape PSICQUIC services, and ChEMBL database). We observed from CTD analysis that the chemical gene interactions as risk factors from indoor aerosols showed transcriptionally highly expressed of 31 common genes, by phthalic acids, sodium dodecyl sulfate, from the total of 1347 genes, 107 common genes by formaldehyde, acetaldehyde from the total of 4193 genes and all other toxic ingredients of indoor aerosols. The epigenetic mechanism of histone modifications (H3K4me3, H3K9me3, H3K27me3, H3K27ac, H3K36me3, H3K4me1, Hsa-mir-1301 of lung epithelial, and miRNAs have been revealed by NIH Roadmap Epigenomics Mapping Consortium and the lung tissue arrays were analyzed with AI and matplotlib program. The heterogenic adult stem cell reprogramming is regulated by epigenetic bivalent histone modifications at transcript starts sequences (TSS) of target genes and our current study revealed that CD44, CD80, ALDH2, ALDH3A1, ALDH3B2 are epigenetically reprogrammed with close interaction of other genes by these toxic ingredients of indoor aerosols. Therefore, our results are significant for the carcinogenic effects of indoor aerosols causing for development of lung cancer epigenetically, which may give a clue for the prevention and treatment of nonsmoking lung cancer. Citation Format: Juan Anderson, Mariah Delgado, Malcolm Lovett, Maya Saunders, Geovannie Lake, Samuel Darko, Rose M. Stiffin, Ayivi Huisso, Marilyn Sherman, Latoya Appleton, Amalya Mihnea, Swarnava Das, Mohammad M. Algahtani, Ravi Vadapalli, Biswarup Basu, Arunima Biswas, Noor Neha, Madhumita Das, Marco A. Ruiz, Mayur Doke, Jayanta K. Das. Development of non-smoking lung cancers by indoor carcinogenic aerosols through epigenetic reprogramming of lung stem cells: Bioinformatics and artificial intelligence analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 859.

Is Candida auris the first multidrug-resistant fungal zoonosis emerging from climate change?

The emergence and evolutionary path of Candida auris poses an intriguing scientific enigma. Its isolation from a pet dog's oral cavity in Kansas, reported by White et al. (T. C. White, B. D. Esquivel, E. M. Rouse Salcido, A. M. Schweiker, et al., mBio 15:e03080-23, 2024, https://doi.org/10.1128/mbio.03080-23), carries significant implications. This discovery intensifies concerns about its hypothetical capacity for zoonotic transmission, particularly considering the dog's extensive human contact and the absence of secondary animal/human cases in both animals and humans. The findings challenge established notions of C. auris transmissibility and underscore the need for further investigation into the transmission dynamics, especially zooanthroponotic pathways. It raises concerns about its adaptability in different hosts and environments, highlighting potential role of environmental and animal reservoirs in its dissemination. Critical points include the evolving thermal tolerance and the genetic divergence in the isolate. This case exemplifies the necessity for an integrated One Health approach, combining human, animal, and environmental health perspectives, to unravel the complexities of C. auris's emergence and behavior.

Assessing sustainability of microalgae-based wastewater treatment: Environmental considerations and impacts on human health

An integrated life cycle assessment (LCA) and quantitative microbial risk assessment (QMRA) were conducted to assess microalgae-mediated wastewater disinfection (M-WWD). M-WWD was achieved by replacing ultraviolet disinfection with a microalgal open raceway pond in an existing sewage treatment plant (STP) in India. Regarding impacts on human health, both M-WWD and STP yielded comparable life cycle impacts, around 0.01 disability-adjusted life years (DALYs) per person per year. However, QMRA impacts for M-WWD (0.053 DALYs per person per year) were slightly lower than that for STP while considering exposure to E. coli O157:H7 and adenovirus. Additionally, a comparative LCA resolved the dilemma about the appropriate utilization of microalgal biomass. Among biodiesel, biocrude, and biogas production, the lowest impacts of 0.015 DALYs per person per year were obtained for biocrude for 1 m3 water treated by M-WWD. Electricity consumption in microalgae cultivation was a major environmental hotspot. Overall, M-WWD, followed by production of microalgal biocrude, emerged as a sustainable alternative from environmental and public health perspectives. These findings set the foundation for pilot-scale M-WWD system development, testing, and economic evaluation. Such comprehensive investigations, encompassing LCA, QMRA, and resource recovery scenarios, offer crucial insights for stakeholders and decision-makers in wastewater treatment and environmental management.

Enhanced phytoremediation of metal contaminated soils aimed at decreasing the risk of antibiotic resistance dissemination

The enhanced phytoremediation of metal contaminated soils holds great promise for the recovery of soil health and functionality, while providing a range of co-benefits, from an environmental and human health perspective, derived from the revegetation of the degraded sites and the concomitant delivery of ecosystem services. Due to diverse evolutionary co-selection mechanisms between metal resistance and antibiotic resistance in bacteria, metal contaminated soils are considered potential reservoirs of antibiotic resistant bacteria (ARB) which can contribute to the existing antibiotic resistance crisis. During the enhanced phytoremediation of metal contaminated soils, the application of organic wastes (e.g., manure, slurry, sewage sludge) as soil amendments can aggravate the risk of antibiotic resistance spread, because they often contain ARB which harbor antibiotic resistance genes (ARGs) that can then be propagated among soil bacterial populations through horizontal gene transfer (HGT). Due to the magnitude and criticality of the antibiotic resistance crisis, as well as the higher risk of spread and dispersal of ARB and ARGs (they make copies of themselves) compared to metals, it is proposed here to aim enhanced phytoremediation strategies towards decreasing the soil resistome (and, hence, the risk of its potential link with the human resistome), while reducing total and/or bioavailable metal concentrations and restoring soil health and the delivery of ecosystem services. To this purpose, a decalogue of practices is tentatively suggested. Finally, a proper management of plant and soil microbial compositions is a most crucial aspect, together with the selection of the right organic wastes and phytoremediation practices.

The Ubiquity, Importance and Harmful Effects of Microorganisms: an Environmental and Public Health Perspective

The Ubiquity, Importance and Harmful Effects of Microorganisms: an Environmental and Public Health Perspective

Elucidating the Role of Honey Bees as Biomonitors in Environmental Health Research.

Recently, the One Health concept, which recognizes the interconnectedness of environmental, animal, and human health, has gained popularity. To collect data on environmental pollutants potentially harmful to human health over time, researchers often turn to natural organisms known as biomonitors. Honey bees, in particular, prove to be exceptionally valuable biomonitors due to their capacity to accumulate pollutants from the air, soil, and water within a specific radius during their foraging trips. This systematic literature review summarizes the previous application of the bee species Apis mellifera in pollutant monitoring in articles published during the period of 2010-2020. Nineteen studies were included in this systematic literature review. Of these studies, the majority (n = 15) focused on the detection of heavy metals in honey bees and beehive products, while 4 studies focused on air pollution by polycyclic aromatic hydrocarbons or particulate matter. The matrix most often applied was the whole honey bee. The included studies demonstrated that honey bees and hive products deliver quantitative and qualitative information about specific pollutants. In this regard, the whole honey bee was found to be the most reliable biomonitor. We found that the included studies differed in design and the methods used. Standardized studies could foster a more consistent interpretation of the levels detected in beehive matrices from an environmental health perspective.

Nanomaterials and their role in advancing biodiesel feedstock production: A comprehensive review

Sustainable socio-economic development largely depends on the sustainability of the energy supply from economic, environmental, and public health perspectives. Fossil fuel combustion only meets the first element of this equation and is hence rendered unsustainable. Biofuels are advantageous from a public health perspective, but their environmental and economic sustainability might be questioned considering the conflicts surrounding their feedstocks, including land use change and fuel vs. food conflict. Therefore, it is imperative to put more effort into addressing the downsides of biofuel production using advanced technologies, such as nanotechnology. In light of that, this review strives to scrutinize the latest developments in the application of nanotechnology in producing biodiesel, a promising alternative to fossil diesel with proven environmental and health benefits. The main focus is placed on nanotechnology applications in the feedstock production stage. First, the latest findings concerning the application of nanomaterials as nanofertilizers and nanopesticides to improve the performance of oil crops are presented and critically discussed. Then, the most promising results reported recently on applying nanotechnology to boost biomass and oil production by microalgae and facilitating microalgae harvesting are reviewed and mechanistically explained. Finally, the promises held by nanomaterials to enhance animal fat production in livestock, poultry, and aquaculture systems are elaborated. Despite the favorable features of using nanotechnology in biodiesel feedstock production, the presence of nanoparticles in living systems is also associated with important health and environmental challenges, which are critically covered and discussed in this work.

Bibliometric analysis of the association between drinking water pollution and bladder cancer.

Bladder cancer has become an increasingly intractable health problem worldwide. Long-term drinking water pollution is known to promote its occurrence. This study aimed to analyze the research status, hot spots, and future trends of drinking water pollution and bladder cancer through extensive bibliometric examination to provide reference data for better prevention and management of bladder cancer. The Scopus database developed by Elsevier was browsed for articles that met the predefined criteria using the search terms related to drinking water and bladder cancer. Included articles were further evaluated by year of publication, subject category, institution, article type, source journal, authors, co-authorship networks, and text mining of titles by R software packages tm, ggplot2 and VOSviewer software. In total, 687 articles were selected after a comprehensive literature search by the Scopus database, including 491 research articles, 98 review articles, 26 conference papers, 23 letters and 49 other documents. The total number of articles published showed an upward trend. The United States has the largest number of published articles (345 articles), institutions (7/10) and funding sponsors (top 5). The journal with the most publications was Environmental Health Perspectives, with 46 published. The highest number of citations up to 2330 times for a single article published in 2007 on the journal of Mutation Research. Professor Cantor K.P. was the highest number of publications with 35 articles and Smith A.H. was the most cited author with the number of citations reaching 6987 times overall and 225 times per article. The most frequent keywords excluding the search subject were "arsenic", "chlorination", "trihalomethane", and "disease agents". This study is the first systematic bibliometric study of the literature publications on drinking water pollution and bladder cancer. It offers an overall and intuitive understanding of this topic in the past few years, and points out a clear direction research hotspots and reveals the trends for further in-depth study in future.

The motivations and practices of vegetarian and vegan Saudis

In the Middle East, particularly in Saudi Arabia, the offering of a meat dish to guests is a deeply embedded cultural tradition, and a meat-based diet is the standard in Saudi Arabia. Thus, the rise of veganism and vegetarianism within Saudi Arabia is surprising and worthy of attention, as is understanding the perceptions and motivations behind this phenomenon, particularly as they relate to food and sustainability. This research was designed to investigate this emerging phenomenon and to identify key differences in dietarian identity between Saudi vegetarians and vegans using Rosenfeld and Burrow's Dietarian Identity Questionnaire. Among other results, the vegan group scored significantly higher on the prosocial motivation construct, suggesting the desire to help society as a whole is a stronger motivating factor for vegans. As well, the vegan cohort scored higher in the personal motivation category. From an environmental and public health perspective, understanding the key factors motivating individuals to adopt a vegetarian or vegan diet in a meat-based culture like Saudi Arabia can be used to encourage others to pursue more healthy and sustainable food behaviors.

Environmental health perceptions of urban youth from low-income communities: A qualitative photovoice study and framework.

Children are amongst the most susceptible groups to environmental exposures, for both immediate and life-course health outcomes. Despite their increased susceptibility, children's knowledge, experiencesand voices are understudied. A deeper understanding of children's environmental health perceptions has the potential to better inform policy, develop targeted interventionsand improve public health outcomes. In this study, our community-academic partnership used the Photovoice research method to examine how urban children from low-income communities perceive environmental influences on their health. Twenty children, ages 10-12, took photographs and participated in focus group interviews regarding their perspectives on how the environment influences their health. Qualitative analyses revealed five major thematic categories: environmental exposures, environmental health sentiments, environmental health outcomes, interest in environmental healthand environmental health solutions. We used the findings to develop an environmental health perspective theoretical framework that can inform future work designed to promote the environmental health and well-being of children from low-income communities in urban communities. Photovoice enabledchildren from low-income communities to capture and communicate their environmental health perceptions. These findings have the potential to inform and identify potential targets and opportunities for environmental health interventions and promotion in their communities. Partnerships with community-based organizations were central to the present study. By design, these community-based partners were involved in the conduct and procedures of the study.

Organic chemicals associated with rubber are more toxic to marine algae and bacteria than those of thermoplastics

The current study investigated the chemical complexity of fifty plastic (36) and elastomer/rubber (14) methanol extracts from consumer products, focusing on the association with toxicity in two screening assays (bacteria luminescence and marine microalgae). The chemical composition varied considerably between the products and polymers. The most complex sample (car tire rubber) contained 2456 chemical features and the least complex (disposable water bottle) only 39 features, with a median of 386 features across all products. Individual extract toxicity also varied significantly across the products and polymers, with the two toxicity assays showing comparable results in terms of defining low and high toxicity extracts, and correlation between medium toxicity extracts. Chemical complexity and abundance both correlated with toxicity in both assays. However, there were strong differences in toxicity between plastic and elastomer extracts. Overall, 86–93 % of the 14 elastomer extracts and only 33–36 % of other polymer extracts (n = 36) were more toxic than the median. A range of compounds were tentatively identified across the sample set, with several concerning compounds being identified, mostly in the elastomers. While the current focus on plastic chemicals is towards thermoplastics, we show that elastomers may be of more concern from an environmental and human health perspective.

Invited Perspective: Still Hazy? Air Pollution and Acute Kidney Injury.

Invited Perspective: Still Hazy? Air Pollution and Acute Kidney Injury.

Precursor to Dengue: Projecting Effects of Climate Change on Mosquito Density in Southeast Asia

Vol. 131, No. 3 Science SelectionOpen AccessPrecursor to Dengue: Projecting Effects of Climate Change on Mosquito Density in Southeast Asiais accompanied byPredicting the Effects of Climate Change on Dengue Vector Densities in Southeast Asia through Process-Based Modeling Olayinka Osuolale Olayinka Osuolale https://orcid.org/0000-0001-6525-8502 Search for more papers by this author Published:22 March 2023CID: 034002https://doi.org/10.1289/EHP12772AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit AbstractChanges in local temperature and precipitation patterns are affecting the geographic range of disease vectors such as the Aedes mosquitoes that spread dengue, Zika, and chikungunya.1 Effectively preparing for a warmer future requires understanding the extent to which climate change could affect the future distribution of vectors, with possible consequences for infectious disease transmission. In a new study published in Environmental Health Perspectives, a team of researchers from Cambodia, Lao People’s Democratic Republic (PDR), France, and New Caledonia projected climate-related changes in the densities of Ae. aegypti and Ae. albopictus mosquitoes in Southeast Asia.2Changes in local temperature and precipitation patterns are affecting the geographic range and population densities of disease vectors such as Aedes aegypti (shown here) and Ae. albopictus mosquitoes, which spread dengue, Zika, and chikungunya. Image: © Cacio Murilo/stock.adobe.com.Global incidence of one mosquito-borne disease, dengue, has risen over the past two decades. Infections can range from asymptomatic to life-threatening.3 In 2000, just over 500,000 cases were reported to the World Health Organization, compared with 5.2 million reported infections in 2019.4 However, actual numbers could be many times higher, given that most cases are not severe enough to require medical care.5 Although dengue is endemic in dozens of countries, Asia bore approximately 70% of the global burden as of 2010.4The authors modeled seasonal variations of densities of Ae. aegypti and Ae. albopictus under current weather patterns and future climate scenarios (based on greenhouse gas emissions) over four periods: 2021–2040, 2041–2060, 2061–2080, and 2081–2100. The study area included the countries of Myanmar, Lao PDR, Thailand, Cambodia, and Vietnam, where dengue outbreaks occur frequently.6 They used a compartmental process-based model that was validated using density data from entomological surveys in the cities of Phnom Penh (Cambodia) and Vientiane (Lao PDR).Model estimates indicated that densities of both species would increase during the region’s coolest months (December–February) under all climate scenarios. The warmest months (April–June) saw elevated population densities of Ae. aegypti throughout most of the region, whereas Ae. albopictus showed marked increases and decreases in densities in the northern and southern parts of the study area, respectively, for all years and climate scenarios. Model projections also suggested that Aedes densities are more likely to be affected by changes in temperature than precipitation.Kristie Ebi, a Professor of Global Health and of Environmental and Occupational Health Sciences at the University of Washington, explains that process-based models are built from equations describing the dynamics of disease origins. “They generally simulate the impact of weather variables on the health outcomes of interest using equations describing disease burdens at daily or weekly time steps,” she says.In this case, the authors modeled mosquito densities without factoring in disease incidence or transmission. To do this, they simulated density variations of mosquitoes’ different life stages based on development and mortality rates and their established dependency on temperature and precipitation. Future vector densities were modeled using climate projections based on nine climate models and four scenarios of greenhouse gas emissions. Ebi, who was not involved in the study, says the model could apply to other Aedes-borne diseases such as Zika and chikungunya.Transmission of mosquito-borne diseases is a highly complex process. “For example, as temperature increases, the rate of virus development within the mosquito is increased, so it can take less time for the mosquito to be infectious, increasing transmission,” says Simon Hales, a research professor in the Department of Public Health at the University of Otago, Wellington. “But the mortality rate of the mosquito also increases above a certain temperature, which reduces transmission.”Although vector density is an important determinant of disease transmission,7 Hales notes that very low density could be sufficient to maintain transmission if other conditions are right, “so a linear relationship with vector density is not expected.” Hales was not involved in the new work.Lead author Lucas Bonnin, a postdoctoral associate with the French National Research Institute for Sustainable Development working in Nouméa, New Caledonia, points to the model’s usefulness for exploring the complexities of disease transmission. “The outputs of the model could be used to further investigate how vector density impacts disease dynamics,” he says, “and to predict how climate change would affect those dynamics.”Olayinka Osuolale, PhD, is an environmental health and microbiologist researcher and a senior lecturer at Elizade University, Ilara Mokin, Nigeria.

Invited Perspective: PFAS in Breast Milk and Infant Formula-It's Time to Start Monitoring.

Invited Perspective: PFAS in Breast Milk and Infant Formula-It's Time to Start Monitoring.

Invited Perspective: Leveraging Air Quality Research Advancements to Assess and Address Exposure Inequities.

Invited Perspective: Leveraging Air Quality Research Advancements to Assess and Address Exposure Inequities.

Breaking New Ground: Space Agencies and Epidemiologists Partner Up on Particulates

Breaking New Ground: Space Agencies and Epidemiologists Partner Up on Particulates

Heavy metal distribution in wheat plant components following foliar Cd application

Atmospheric deposition of Cd, from anthropogenic activities, can be directly deposited onto and absorbed into wheat plants, yet, how foliar absorbed Cd is translocated in wheat plants is not well understood. A pot experiment investigated foliar Cd application on the accumulation and distribution of heavy metals in various wheat parts. Wheat was grown in a Cd/heavy metal contaminated soil, and from grain heading to the filling stage, 0, 10, 20, 30 and 40 mg kg−1 Cd solution was sprayed repeatedly on leaves (grain heads were covered). Foliar Cd application had no effect on grain yield and Cd concentration (3.01–3.51 mg kg−1 for all treatments), while increased flag leaf blade and sheath Cd concentrations by 1.06–2.77 and 0.00–0.66 times, respectively. Cadmium concentration in the center of the peduncle, from the 40 mg kg−1 Cd solution treatment, was 1.41 times that of the control (10.3 vs 7.30 mg kg−1). Foliar Cd application also increased Cd accumulation (concentration × mass) of the flag leaf blade and sheath. Rachis and grain Pb concentrations were reduced, while stem Pb concentration was increased by Cd application. Cadmium application negatively affected whole plant Ni accumulation and concentration of certain wheat parts; Ni absorption inhibition may have occurred in roots via the downward transport of Cd. Overall results implied that the predominant portion of foliar applied Cd was retained in leaves, while lesser portions migrated to peduncle or root and affected the absorption/distribution of other metals in wheat plants. These results are important for further discerning the mechanism of wheat grain Cd accumulation, especially when grain is raised in areas where atmospheric deposition of Cd (e.g., near smelting facilities) is an issue from an environmental and human health perspective.

Unfulfilled Promise: Pollinator Declines, Crop Deficits, and Diet-Associated Disease.

Unfulfilled Promise: Pollinator Declines, Crop Deficits, and Diet-Associated Disease.

Invited Perspective: Environmental Health Interventions Are Only as Good as Their Adoption.

Vol. 131, No. 1 Invited PerspectiveOpen AccessInvited Perspective: Environmental Health Interventions Are Only as Good as Their Adoptionis companion ofAdoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review Karen Levy Karen Levy Address correspondence to Karen Levy, Department of Environmental and Occupational Health Sciences, University of Washington, Box 351618, 2980 15th Ave. NE, Seattle, WA 98195 USA. Telephone: (206) 543-4341. Email: E-mail Address: [email protected] https://orcid.org/0000-0002-0968-9401 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA Search for more papers by this author Published:30 January 2023CID: 011303https://doi.org/10.1289/EHP11906AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit “I have not failed. I’ve just found 10,000 ways that will not work.” –Thomas EdisonScientists and engineers often come up with brilliant ideas, but in the end technology is only as good as its adoption and proper use. This is true for regardless of how complicated or simple the technology.Household water treatment, also commonly referred to as point-of-use (POU) water treatment, is a strategy to improve access to safe water that was introduced within the water, sanitation, and hygiene (WASH) field1 because many communities in lower- and middle-income country (LMIC) settings lack access to a full-scale water treatment plant. With POU treatment, residents can conduct at least some elements of treatment (coagulation and sedimentation, filtration, ultraviolet disinfection, or chemical inactivation) in their own homes, offering them the capacity to disinfect their own water. Treating water in the home also has the benefit of minimizing recontamination after collection, a well-documented phenomenon in locations where people fetch their water from locations outside the home.2,3Chlorination has been seen as a particularly promising POU approach because it leaves a residual disinfectant in the water to address microbial intrusion during storage.4 In LMICs, many studies have been carried out on the effectiveness of household drinking water chlorination for preventing diarrhea. A recent systematic review found that, compared with untreated drinking water from an unimproved source, risk of diarrhea was reduced by 44% with POU chlorination of water [lowercase italic n equals 25n=25 studies; 0.66 (0.56–0.77)].5However, although understanding the potential health impact of a technology is important, understanding whether and why people use, or do not use, a proposed technology is equally important. In their review in this issue of Environmental Health Perspectives, Crider et al. do just this, addressing barriers to the adoption of POU chlorination for household drinking water treatment by 46 target populations.6Considering users’ needs and interests is essential to adoption of a technology. For example, the authors found that bad taste, smell, or appearance of treated water was cited by a large percentage of households, as was lack of time to spend on disinfection (a time burden usually placed on women). Most of the intervention groups received chlorination products for free; households in the groups that did not cited price or availability of products as a barrier to repurchase and continued use.In addition to the identification of specific barriers to adoption two other aspects stood out in the review. First, the authors identified a sheer lack of information on barriers to adoption. “Much of the time, the reasons for low adoption are poorly understood simply because the relevant data are not systematically collected,” they stated. The authors excluded 27 of 63 otherwise-eligible studies because quantitative measures of adoption were not reported. Among those that did report a measure of adoption, there was no consensus definition of adoption, and several studies emphasized reasons for use rather than nonuse.Second, lack of attention in the field to user adoption as a signal of intervention success is also belied by the language that researchers use to describe it. Different words used in the literature to describe what Crider et al. appropriately refer to as “adoption” of water chlorination practices range from “adherence” or “compliance” to “use/usage” or “uptake.”6 Public health inherited the language of “compliance” and “adherence” from medicine, where it describes how often patients follow through with a medication regimen.7,8 Although subtle, this language is important because the medical words put the burden of failed adoption on the user, whereas “adoption,” “use/usage,” and “uptake” put this burden on the implementer.Time and again we see environmental health–based interventions fail because we are not focused enough on the actual uptake of a technology. This is also true for other areas of environmental health, such as household air pollution (HAP).9,10 The WASH and HAP fields are increasingly recognizing the importance of applying approaches from systems science and implementation science to increase the chances of success for environmental health interventions.10,11This work is critical. Our practices, and our language, must center on users’ needs and interests if we hope for adoption of new technologies to improve population health related to environmental conditions.

Incorporando la bioética ambiental a los cuidados materno perinatales para disminuir los riesgos de la Pan-Sindemia en el proceso reproductivo.

Until now, the bioethical approach to maternal perinatal care is projected from the integral vision of bio-psycho-social health, the perspective of Human Rights and the gender perspective. In general, the ecological bioethics that arises from the perspective of environmental health has not been incorporated into maternal-perinatal care with regard to “global ethics”, environmental bioethics, the perspective of “consilience” and the importance of the healthy environment as a human right. The current global crisis situation due to the combination of the COVID 19 Pandemic and the Global Syndemic, characterized as Pan Syndemic, increases the risks and damages in the reproductive process, especially in populations violated in their rights. JUSTIFICATION It is necessary to minimize the effect of the Pan Syndemic on the human reproductive process. On the global agenda, humanity must reverse the causes of the Pan Syndemic. Meanwhile, health professionals and teams must reformulate their role when it comes to maternal-perinatal care, incorporating into the clinic the right to a healthy environment for reproduction. PERSPECTIVES Modifications in the clinical practice of sexual and reproductive health teams should be aimed at: incorporate ecological bioethics into maternal perinatal care from training to clinical practice; develop a comprehensive approach to major perinatal obstetric syndromes, prematurity and fetal growth restriction, to minimize the impact of the Pan Syndemic on the human reproductive process.