Environmental Interventions Research Articles

Growth and Cognitive Development in Tanzanian Children are Associated with Timing of Birth in Relation to Seasonal Malnutrition

To evaluate in a rural Tanzanian birth cohort the association between birth timing in relation to the pre-harvest lean season and early-life growth and cognitive development STUDY DESIGN: Children were enrolled within 14 days of birth and followed for 18 months. Child anthropometry was measured every three months. The Malawi Developmental Assessment Test (MDAT) was administered at the end of follow-up. We estimated the association between timing of birth in the context of other early childhood risk factors and both growth and MDAT scores. Children born in the pre-harvest months September and October had the lowest cognitive scores at 18 months, compared with birth in July and August (-1.05 change in overall MDAT development-for-age Z score (DAZ), 95% CI: -1.23, -0.86). This association was observed for the language (-1.67 change in DAZ; 95% CI: -1.93, -1.40) and fine motor subcomponent scores (-1.67; 95% CI: -1.96, -1.38) but not for gross motor (-0.07; 95% CI: -0.23, 0.10) or social subcomponents (-0.07; 95% CI: -0.23, 0.10). Children born in September and October were the longest at birth but had the flattest growth trajectories in the first six months. There was a strong association between birth at the beginning of the pre-harvest season and poor growth and cognitive development. If these associations were mediated by the pre-harvest postnatal environment, targeted maternal and child interventions for children born during high-risk periods may improve these outcomes.

The evolution of SNAP-Ed: policy, systems and environment (PSE) interventions to enhance nutrition security and health equity in the United States

Purpose This study uses a comprehensive literature review and analysis of recent research, policy documents and program evaluations related to Supplemental Nutrition Assistance Program Education (SNAP-Ed) and policy, systems and environmental (PSE) strategies. Key sources include peer-reviewed articles, the 2025 SNAP-Ed Plan Guidance and case studies of successful PSE interventions. The Social-Ecological Model serves as a framework to organize and analyze the multilevel impacts of PSE interventions. The method involves identifying relevant information, synthesizing key themes and patterns and critically examining the potential impact of PSE strategies on nutrition security and health equity. Design/methodology/approach This paper examines the evolution of the SNAP-Ed from direct nutrition education to a comprehensive approach integrating PSE change strategies. It aims to analyze the rationale, implementation and potential impact of PSE approaches in SNAP-Ed on nutrition security and health equity in the USA. The study explores how these strategies address social determinants of health, promote sustainable population-level changes in nutrition environments, and their capacity to reduce health disparities in low-income communities. It seeks to identify challenges, opportunities and future research directions in implementing PSE strategies within SNAP-Ed. Findings The review reveals that PSE strategies in SNAP-Ed show promise in creating sustainable, population-level changes in nutrition environments and health outcomes. Successful examples, such as healthy corner store initiatives and workplace wellness programs, demonstrate the potential of PSE approaches to improve access to healthy food options and physical activity opportunities. The integration of PSE strategies has enhanced SNAP-Ed’s capacity to address social determinants of health and promote health equity. However, challenges including resource constraints, political opposition and the need for cross-sector collaboration persist. The effectiveness of PSE interventions relies heavily on community engagement, partnerships and supportive policies. Practical implications The findings underscore the importance of adopting comprehensive, multilevel approaches in nutrition education and obesity prevention programs. For SNAP-Ed implementers, this implies a need to develop expertise in PSE strategies, foster cross-sector partnerships and engage communities in intervention design and implementation. Policymakers should consider increasing support and resources for PSE approaches within SNAP-Ed and similar programs. Public health practitioners can use these insights to design more effective, equitable interventions that address root causes of nutrition insecurity. The study also highlights the need for improved evaluation methods to assess the long-term impact of PSE strategies on population health outcomes. Social implications This study highlights the importance of addressing social determinants of health, such as poverty and access to healthy food options, to promote equitable health outcomes. It underscores the potential of community-driven, multilevel interventions in building a more just and equitable food system accessible to all. Originality/value This paper provides a comprehensive analysis of the shift toward PSE strategies in SNAP-Ed, offering valuable insights into the program’s evolution and its potential to address complex public health challenges. By examining both successes and challenges, it contributes to the growing body of evidence on the effectiveness of multilevel interventions in promoting nutrition security and health equity. The study’s emphasis on the role of community engagement and partnerships in PSE implementation offers practical guidance for program planners and policymakers.

Food for Thought: Nourishing Cardiovascular Health Amidst the Exposome.

The cumulative exposures of an individual during their lifetime, known as the exposome, encompass environmental exposures and lifestyle factors that significantly impact cardiovascular health. The exposome concept aims to provide a comprehensive framework for understanding how various exposures combine to influence disease risk and health outcomes over a lifetime. Diet is a well-studied aspect of the exposome, recognized as a critical contributor to cardiovascular health and influencing various other health metrics and behaviors. Furthermore, understanding agricultural food systems and their interrelationships with dietary choice and impacts on environmental and human health requires a systems approach. Through a review of the literature, this publication will (1) elucidate the interconnections between the exposome and cardiovascular diseases through the lens of agricultural systems and environmental health; (2) examine the effect of diet on cardiovascular health; (3) examine the influence of socioeconomic and cultural factors on the agricultural food system and dietary choices; and (4) highlight the importance of adopting a systems approach that integrates dietary interventions with sustainable agricultural practices, emphasizing the need for holistic strategies to address the root causes of cardiovascular health issues through balanced human and environmental health interventions.

A Longitudinal Multi-Method Inquiry of Educational Workers’ Use of Interventions for Positive Mental Wellbeing

Background and Objectives: Compassion fatigue and burnout are two distinct forms of mental health distress faced by educational workers. Researchers have shown a high level of both phenomena across the field of education; however, a better understanding of what educational workers already do for positive mental and emotional health is needed. Methods: This research study examined three years of data, collected via survey, inquiring into the various interventions, namely supports and resources, that educational workers use to support positive mental health. Results: Quantitative data analysis via descriptive and inferential statistics revealed that educational workers relied heavily on their personal support network followed distantly by medical professionals and other interventions, revealing a gap that needs to be addressed by employers. Qualitative thematic analysis revealed a trend towards increased use of environmental interventions to promote positive mental wellbeing. Conclusions: The data analysis suggested areas of focus required to ensure workplace wellbeing, and that programs too focused on individual or self-directed interventions would not be well received by educators. Suggestions for other interventions that might be helpful for leaders and policy-makers are provided.

Effectiveness of environmental nutrition program on student dietary intake in boarding schools

Background The Environmental Nutrition Program (ENP) as an environmental intervention offers voluntary involvement with students, but persists in exposure. This study aimed to investigate the effect of ENP on students’ dietary intake and nutritional knowledge. Methods A quasi-experimental study was conducted with a control school. ENP comprises four activities: the use of uniform food serving tools, nutrition fact displays, food and nutrition information displays, and body weighing awareness. The ENP emphasized voluntary involvement with students but persisted in exposure for over 8-weeks. Multiple passes of 24-hour food recall and validated questionnaires were used in the assessments by a nutritionist. Multiple linear regressions were performed to analyze the effectiveness of ENP. Results A total of 113 female high school students, with a median age of 16 years, were recruited. At baseline, all students had a lower dietary intake than the national recommendation. Except for the stipend, no differences in the characteristics were found among the students. The students’ carbohydrate intake and nutritional knowledge significantly increased after the ENP in the intervention school (p < 0.001). Total energy, protein, and fat intake also improved after ENP. Conclusion ENP activities effectively increased students’ daily carbohydrate intake and nutritional knowledge. Thus, ENP may be appropriate for enhancing nutrition literacy among female students. Future studies with a longer time frame are encouraged to yield sustained, favorable dietary practices.

BEYOND EARTH: THE CHALLENGES OF PEDIATRIC PHYSIOLOGY AND GROWTH IN SPACE

As humanity expands the horizons of space exploration, understanding how microgravity and cosmic radiation affect the growth and development of children becomes paramount. Childrens physiology is distinct from adults, requiring tailored medical research and interventions for space environments. This paper examines the physiological challenges pediatricians will face in space, focusing on bone density, muscle growth, cardiovascular regulation, immune response, and radiation exposure. We emphasize the need for further research to develop countermeasures that ensure the health of young space travelers.

Clinical Outcomes of Tube Feeding vs. Hand Feeding in Advanced Dementia.

Dementia is a growing public health issue, with the number of cases projected to triple by 2050 as society ages. Although the American Geriatrics Society recommends careful hand feeding over tube feeding for patients with advanced dementia, an increasing proportion of patients are receiving tube feeding. Although decisions regarding tube feeding are often based on the physician, recent studies have shown that tube feeding has significant implications for clinical outcomes and quality of life. Tube feeding is associated with an increased risk of mortality, pneumonia and the use of restraints. Although tube feeding may reduce caregiver burden, it does not improve survival or nutritional status and incurs significant financial costs. Caregivers that hand feed patients often experience stress, particularly in regions where support services are limited. However, there are various strategies available to promote hand feeding which include environmental interventions, mealtime assistance and caregiver training. Although hand feeding is the most comfortable option for patients, the frequency of mealtimes and financial and mental health impact on caregivers requires the physician to conduct a holistic assessment of the patient when deciding on the mode of feeding for patients with advanced dementia.

Environment, climate, socio-economics & restrictions impact on COVID-19 in Northen Italy

Abstract Up to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, and most of them focused on viral spread rather than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. Our population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (n.68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021. Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. Several significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. Our findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly. Key messages • Evaluating simultaneously four exposure domains on COVID-19 outcomes informs public health policy for future pandemic management. • The comprehension of risk factors associated with severe outcomes, such as hospitalization and mortality, is pivotal for planning responses to similar health emergencies in the future.

Watery traces and absences: sensations and speculative histories of an ancient well and a carse landscape

This paper explores how mighty earth processes, aquatic agencies and human practical, political, religious, technological, commercial and environmental interventions have shaped and reshaped a now obscure Scottish holy well and the carse landscape to which it belongs. More specifically, I detail the historic pagan rituals, vigilant religious policing, romantic redesign and extensive terraforming that have informed the changing uses and symbolic associations of these watery realms, demonstrating how they testify to ceaselessly changing human-water relations. I explore how an awareness of particular historical events garnered from diverse texts can be supplemented with affective and sensory engagements with the non-human agencies, vestiges and absences of place. Together, they foster intimations and speculative imaginaries that conjure up speculative watery histories and conjectural futures.

Implementation of organizational health literacy depending on school characteristics in Germany

Abstract Background Children and adolescents are important target groups for health promotion measures to sustain a healthy upbringing. Organizational health literacy in schools is a promising environmental intervention to strengthen health literacy in school children. This study examines the relationship between school characteristics and the implementation of organizational health literacy. Methods School principals in Germany were invited to complete a 20-minute online survey between November 2022 and July 2023. An 8-item self-report tool was used to measure organizational health literacy in schools (OHLS-Q-SF) that comprehends eight different areas within schools to become health literate. A hierarchical cluster analysis was carried out to identify groups according to the composition of the socioeconomic status of the student body. Descriptive statistics, Mann-Whitney-U tests, and Kruskal-Wallis tests were performed. Results 598 school principals (73.6% female, Ø 52.3 years old) who worked at primary schools (49.1%), secondary schools (37%), and special education schools (13.9%) completed the survey. Cluster analysis revealed two groups. The first one (36.8%) contains schools with mainly students with lower socioeconomic status, and the second group (63.2%) contains schools with more students from middle or higher socioeconomic status. The socioeconomic status of students within the schools showed no significant results for any area of organizational health literacy, whereas all eight areas are more likely implemented if the schools already participate in a school health promotion program or network (p < 0.001). Conclusions Participating in a school health promotion program was associated with higher levels of implementation in all areas of organizational health literacy in schools. This finding highlights the importance of those programs. Integrating organizational health literacy into those interventions can be a beneficial approach to sustaining health literate schools. Key messages • Participating in a school health promotion program or network might facilitate schools to become health literate organizations. • In Germany, the socioeconomic status of the students within the schools is not associated with the implementation of organizational health literacy.

Indoor Environmental Quality in Portuguese Office Buildings: Influencing Factors and Impact of an Intervention Study

Office workers spend a considerable part of their day at the workplace, making it vital to ensure proper indoor environmental quality (IEQ) conditions in office buildings. This work aimed to identify significant factors influencing IEQ and assess the effectiveness of an environmental intervention program, which included the introduction of indoor plants, carbon dioxide (CO2) sensors, ventilation, and printer relocation (source control), in six modern office buildings in improving IEQ. Thirty office spaces in Porto, Portugal, were randomly divided into intervention and control groups. Indoor air quality, thermal comfort, illuminance, and noise were monitored before and after a 14-day intervention implementation. Occupancy, natural ventilation, floor type, and cleaning time significantly influenced IEQ levels. Biophilic interventions appeared to decrease volatile organic compound concentrations by 30%. Installing CO2 sensors and optimizing ventilation strategies in an office that mainly relies on natural ventilation effectively improved air renewal and resulted in a 28% decrease in CO2 levels. The implementation of a source control intervention led to a decrease in ultrafine particle and ozone concentrations by 14% and 85%, respectively. However, an unexpected increase in airborne particle levels was detected. Overall, for a sample of offices that presented acceptable IEQ levels, the intervention program had only minor or inconsistent impacts. Offices with declared IEQ problems are prime candidates for further research to fully understand the potential of environmental interventions.

Interaction of perceived Chinese campus walkability and psychosocial factors on college students’ walking behavior

Walking, a physical activity beneficial for both physical and mental health, is influenced by various factors. Although previous studies have acknowledged that walking behavior is influenced by environmental and psychosocial factors, little is known about their interactions. Based on a socio-ecological model and focusing on Chinese college students, the purpose of this study was to examine the influence of campus walkability and psychosocial factors on college students’ walking behavior, including the interactions between these factors. This study seeks to enhance understanding of how to promote walking behavior through campus environmental design and psychological interventions. Multiple regression analysis was conducted on the questionnaire data. Findings revealed that campus walkability significantly influenced both walking behaviors, alongside psychosocial factors such as attitude, self-efficacy, perceived benefits, perceived barriers, and subject norms. Additionally, significant differences in interaction effects between these factors were observed for purposeful versus recreational walking behaviors. These interactions suggest that campus walkability more substantially promotes walking behavior in students with negative psychosocial factors, whereas its impact is less pronounced in those with positive psychosocial factors. The results underscore the need to focus not only on developing walkable environments but also on understanding the synergies with the psychosocial factors of target populations, offering crucial insights for campus planning and health promotion practices.

Association of Ambient Air Pollution Exposure With Incident Glaucoma: 12-Year Evidence From the UK Biobank Cohort.

Glaucoma is the leading cause of irreversible blindness worldwide. Despite growing concerns about air quality and its impact on ocular health, there remains a knowledge gap regarding the long-term association between air pollution and glaucoma risk. This study investigates the relationship between exposure to ambient air pollution and incidence of glaucoma. In this prospective study, we used land use regression models to estimate levels of various air pollutants, including fine particulate matter (PM2.5), PM2.5 absorbance, PM2.5-10, PM10, nitrogen dioxide (NO2), and nitrogen oxides (NOx). Incidents of glaucoma were ascertained through routinely collected hospital admission records. Multivariate Cox proportional hazards models were used to examine the associations between air pollution exposure and glaucoma incidence, adjusting for potential confounding sociodemographic, physical, and lifestyle factors. Data from 481,113 participants were included. Over a median follow-up of 12.8 years, 9224 incident cases of glaucoma were identified. In the maximally adjusted model, per interquartile range increase in PM2.5 was associated with a 3% greater risk of developing glaucoma (hazard ratio [HR] = 1.03, 95% confidence interval [CI] = 1.00 to 1.06, P = 0.048). Participants in the highest quartile had a 10% increased risk of developing glaucoma compared to those in the lowest quartile (HR = 1.10, 95% CI = 1.03 to 1.17, P = 0.005). Higher levels of exposure to ambient air pollutants, particularly PM2.5, are associated with an increased risk of developing glaucoma. These results highlight the potential public health impact of ambient air pollution on glaucoma risk and underscore the urgent need for further research into targeted environmental interventions in this domain.

The effectiveness of stage-matched interventions in changing waste source separation behaviour: Evidence from a consecutive quasi-experiment.

In many developing countries, inefficient waste source separation poses a significant challenge to sustainable waste management systems, hindering progress towards a circular economy. Previous research has shown mixed results regarding the effectiveness of informational interventions and has not thoroughly evaluated regulatory measures. This study innovatively employs a quasi-experimental design, enhanced by successive surveys, to assess the impact of targeted interventions on behavioural changes in waste separation practices. Utilizing the Health Action Process Approach, we introduced three interventions - posters, educational lectures and a supervision policy - over 8 weeks among university students. Our results indicate stepwise improvements in waste separation accuracy: posters modestly increased awareness without significantly altering behaviours; educational lectures led to a 40% increase in the food waste separation rate and supervision achieved over 90% separation purity, but with an increase in 'fly-dumping'. The interventions incurred costs of 36, 60 and 365 RMB per capita annually. This research underlines the importance of customized informational interventions and the costs and challenges of initial regulatory measures in waste management, offering crucial empirical evidence and insights for creating impactful environmental behaviour change interventions.

Assessment of soil erosion risk and vulnerability in the transboundary Sio-Malaba-Malakisi watershed in Kenya and Uganda

Persistent soil erosion poses a significant threat to water quality, ecosystem viability and soil health in many regions of the world. Addressing this challenge requires a comprehensive understanding of local soil erosion rates, including the identification of vulnerable areas, to facilitate effective and integrated environmental management. In East Africa, however, many affected regions are data poor and lack measured hydrological data from which soil erosion estimates can be derived. This study used the physically based Revised Universal Soil Loss Equation (RUSLE) model to estimate the annual rate of soil erosion in the transboundary Sio-Malaba-Malakisi catchment, straddling Kenya and Uganda. Soil erosion events were quantified by integrating input factors derived from physical datasets using a Geographical Information System (GIS). The Analytical Hierarchy Process (AHP) technique was then used to assess the importance of selected physical factors influencing the soil erosion process in order to identify regions of increasing environmental vulnerability. The results obtained indicate a wide range of soil erosion rates across the region, with an estimated mean annual rate of 250 t ha−1 yr−1 for the whole catchment. Upstream areas characterized by intensive agricultural activity had erosion rates of up to 2000 t ha−1 yr−1, while downstream areas recorded erosion rates below 600 t ha−1 yr−1. Areas with intensive agriculture, unprotected soils, and a soil loss tolerance value above 12 t ha−1 yr−1 were found to be most vulnerable. Rainfall and vegetation cover were identified as key factors influencing erosion susceptibility. Regions with soil erosion rates above 50 t ha−1 yr−1 were identified as high priority regions for targeted soil and water conservation measures. The identification of vulnerability zones, including the classification of their severity, provides an opportunity to prioritize sustainable environmental management interventions; a process that can be replicated for such affected regions elsewhere.

Nurse-Involved Policy, Systems, and Environmental School-Based Interventions for Supporting Healthy Nutrition and Obesity Prevention Among Children and Adolescents: A Systematic Review.

Overweight and obesity are common in school-age children. Policy, system, and environmental (PSE) approaches-which entail making upstream changes to a school's context-can be leveraged to reduce childhood obesity. Nurses can advance PSE approaches in schools to promote healthy living habits. This review examines the effect of nurse-involved PSE interventions globally to promote healthy nutrition and reduce obesity in schools. We conducted a literature search using multiple databases from 2010 to 2023 for nurse-involved studies that implemented interventions focused on PSE change related to promoting healthy nutrition or reducing obesity in school settings. Twenty interventions globally were included in the systematic review synthesis. Improvements in anthropometrics, health and nutrition knowledge, attitudes, and beliefs were observed. PSE interventions can be leveraged to promote healthy nutrition and reduce obesity in school settings. Nurses in varying roles are uniquely qualified to advocate for and implement school-based interventions focused on PSE change.

What causes Emergency Medical Services (EMS) delay? Unravel high-risk buildings using citywide ambulance trajectory data

Emergency Medical Services (EMS) delay poses a challenge to public health, especially in ultra-dense cities and aging societies. The potential relationship between the built environment and the ambulance response time (ART) has not been thoroughly investigated at the building-level. This impedes the unraveling of high-risk buildings for EMS delay, and thus the precise optimization of urban EMS systems. Our study develops a quantitative-qualitative approach to construct a building-level ART prediction model and then validated it with ambulance drivers' experiences. A comprehensive theoretical framework is tailored for ART prediction incorporating neglected built environment factors of land use and development intensity. Based on 73,129 ambulance trajectories, a machine learning model is constructed and then employed to predict the ART for each of the 253,475 buildings in central Shanghai under multiple combinations of traffic periods and weather conditions. The results show that the accuracy of high-risk buildings for EMS delay achieves 91%. Moreover, three of the neglected built environment factors, medical POIs density, business POIs density and floor area ratio, rank high in the factor importance. The ambulance drivers’ experiences validate the importance of these built environment factors and emphasize the value of bus priority lanes for ambulance to borrow for swift access. In addition, to illustrate potential applications, we simulated the effects of built environment interventions in case areas predicted to concentrate high-risk buildings. This work provides a new computer-based tool to pinpoint the service blind spots of such urban emergency systems and to develop built environment interventions.

Home environments in an age of precarity

Environment-behavior research prior to the 2000s often portrayed homes as relatively self-contained, insular settings that provided residents refuge from the demands and distractions of the outside world—a kind of safe haven for domestic activities and family life. Residential security was viewed largely in relation to personal assets and the nearby environment, including one's capacity to afford high quality housing, defensible space design of the dwelling, and the absence of nearby threats such as fire and flood hazards, seismic risks, and undesirable land uses like oil drilling sites, landfills, and congested roadways. These proximal sources of residential precarity still play a role in people's lives, but their impacts on people are amplified nowadays by a variety of increasingly pervasive threats situated at societal and global levels such as climate change and extreme weather events, disease pandemics, rampant cybercrime, and growing worries about the spread of nuclear weapons. Also, the modern home has become a polyfunctional hub for both household and non-domestic activities, owing to the infusion of work, educational, and recreational activities into residences via their online connections to the outside world. We offer a social ecological analysis of the changing meanings and functions of home environments in the early 21st Century, and a conception of domestic precarity that highlights its links to broader existential concerns driven by societal and global forces. Future policies and environmental interventions to effectively curb residential precarity will require collaboration among individuals from multiple fields and between diverse organizations and institutions working at municipal, state, national and international levels.

Environmental, climatic, socio-economic factors and non-pharmacological interventions: A comprehensive four-domain risk assessment of COVID-19 hospitalization and death in Northern Italy

IntroductionUp to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, most of them focused on viral spread than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. MethodsOur population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (no. 68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021.Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. ResultsSeveral significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. ConclusionsOur findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.

Associations between polychlorinated biphenyls and cancer risk among type 2 diabetes: The modifying effects of lifestyle

A growing percentage of diabetes-related deaths has been attributed to cancer, with environmental factors playing important contributions. Thus, we studied the potential relationship between endocrine disruptors polychlorinated biphenyls (PCBs) and cancer risk in diabetes. We aimed to evaluate the association between serum seven indicator-PCB (PCB-28/52/101/118/138/153/180) levels and incident cancer, and further explore the possible modifying role of lifestyle. A total of 2806 type 2 diabetes mellitus (T2DM) cases were included from the Dongfeng-Tongji cohort at the baseline in 2008 and tracked until December 2018, and 320 incident cancers were identified during about 10-year follow-up. Cox proportional hazards models and competing risk regression models were used to reveal associations of baseline concentrations of PCBs with total cancer and specific cancer, respectively. Lifestyle score was determined by body mass index, waist circumference, physical activity, smoking, alcohol drinking, and diet. Each interquartile range (IQR) increment of non-dioxin-like PCBs (NDL-PCBs) generated an 8%–30% increase in cancer incidence. Individuals in the highest quartile for PCB-52, PCB-101, PCB-138, and lowly chlorinated PCBs had 1.44- to 1.68-fold higher cancer risk compared to those in the lowest quartile. Restricted cubic spline analyses and the quantile g-computation model showed similar results. Significant interactions were found between PCBs and fasting blood glucose or simplified insulin resistance assessment indicators. NDL-PCBs were positively and significantly associated with gastrointestinal cancer and respiratory cancer, especially with liver cancer, colorectal cancer, and lung cancer. Higher PCBs showed a significant increase in total cancer risk among participants with an unhealthy lifestyle, however, no associations were observed in those with a relatively healthy lifestyle (Pinteraction < 0.05). Our findings indicated an increased cancer risk associated with NDL-PCBs, highlighted the role of a healthy lifestyle in potentially reducing adverse impact, and provided preliminary data for environmental and public health interventions to alleviate the risk of cancer among diabetes.