Residential Exposure Research Articles

Air pollution exposure is associated with widespread cortical thinning in cognitively unimpaired older women

AbstractBackgroundLate‐life ambient air pollution exposures are associated with increased Alzheimer’s disease (AD) risk1. Cortical thinning in temporal areas vulnerable to AD is associated with memory decline, neuropathological changes, and increased AD risk. However, most neuroimaging studies on air pollution neurotoxicity analyzed volumetric indices that are not sensitive to early cortical changes, and focused on discrete regions of interest (ROI) selected a priori rather than taking an ROI approach across the whole brain. Therefore, the mechanisms linking exposures to early neuropathological processes in older age are poorly understood.MethodWe examined data from 1068 cognitively unimpaired women from the Women’s Health Initiative Memory Study who underwent neuroimaging in 2005‐6 (Meanage = 77.8±3.7). Long‐term residential exposures to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were quantified as the 3‐year average of monthly estimates prior to MRI using spatiotemporal models with regionalized universal kriging. Brain scans were processed using FreeSurfer‐v.5.3.0 to estimate cortical thickness in 34 bilateral regions parcellated with the Desikan‐Killiany atlas. Exposure effects on AD‐vulnerable regions were assessed by calculating an AD signature (higher value representing thicker cortices) of surface‐area‐weighted thickness in the bilateral entorhinal, fusiform, inferior temporal, and middle temporal cortices2. We used linear mixed models to estimate exposure effects on standardized regional cortical thickness and the AD signature, adjusting for sociodemographic, lifestyle, and clinical characteristics, and a random effect for scanner manufacturer.ResultAfter adjusting for covariates and multiple comparisons using the False discovery rate (FDR) method, higher exposures to PM2.5 and NO2 were associated with thinner cortices in at least 31 brain regions (FDR‐adjusted p’s<0.05). There were also significant adverse effects of PM2.5 (β = ‐0.055, 95%CI = [‐0.07,‐0.04] per 1µg/m3) and NO2 (β = ‐0.022, 95%CI = [‐0.03,‐0.01] per 1ppb) on the AD signature, equivalent to 1.1 and 0.5 years of aging, respectively. Across all analyses the strongest effects were observed in the frontal lobe, especially the motor cortex.ConclusionIn cognitively unimpaired older women, higher exposures to PM2.5 and NO2 were associated with widespread cortical thinning, including regions sensitive to AD. However, the strongest associations in the frontal lobe suggest a greater impact of air pollution neurotoxicity on brain aging rather than AD risk.

Sociodemographic inequalities in long-term exposure to air pollution, road traffic noise, and greenness: A population-based cohort study of women.

Recent evidence suggests environmental health inequalities both within and between European countries and socially deprived groups may be more susceptible to pollution. However, evidence is still inconclusive and additional studies are warranted. This study aims to investigate sociodemographic inequalities in long-term residential exposure to air pollution, road traffic noise, and greenness, taking lifestyle and degree of urbanization into account. In total 20,407 women, born 1914-48 residing in Uppsala County, Sweden, were followed between 1997 and 2017. Time-varying sociodemographic variables were obtained from registers, and questionnaires provided lifestyle information. Generalized estimating equations were used to compute beta-coefficients (β) and 95% confidence intervals (95% CI) for associations between sociodemographic and lifestyle variables and spatial-temporal modeled particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), road traffic noise and greenness. All models were additionally stratified by urbanization type. Urban area residency was the most important predictor of high exposure to air pollution and noise, and to low greenness. For instance, β for NO2 was -2.92 (95% CI = -3.00, -2.83) and -3.10 (95% CI = -3.18, -3.01) µg/m3 in suburban and rural areas, respectively, compared with urban areas. For greenness, the opposite held true with corresponding β of 0.059 (95% CI = 0.056, 0.062) and 0.095 (95% CI = 0.092, 0.098). Within urban areas, elderly, unmarried and well-educated women had the highest environmental burden. However, less pronounced, and even reversed associations were found in suburban and rural areas. This study provides evidence of a mixed pattern of environmental health inequalities across sociodemographic groups in urban areas.

Sex differential effects on the joint contribution of air pollution and biological aging on cognitive performance in individuals at risk of Alzheimer’s disease

AbstractBackgroundAir pollution is associated with cognitive performance, risk for AD and may accelerate biological aging. Biological aging due to telomere shortening has been associated with cognitive impairment. However, few studies have looked at the link between air pollution, telomere length, and cognitive performance among sexes. In this study, we investigated the joint effect of sex, air pollution, and leukocyte telomere length (LTL), on cognitive performance in cognitively unimpaired (CU) individuals at risk of AD.MethodThe study included 1,472 middle‐aged CU adults with increased risk of AD from the ALFA study [Table 1]. Residential exposure to air pollutants including nitrogen dioxide (NO2) and particulate matter (PM2.5, PM10) was estimated by land use regression models. LTL was determined by qPCR from DNA extracted from peripheral blood leukocytes. LTL was residualized against chronological age and sex (rLTL). A cognitive battery was administered to assess verbal memory, psychomotor speed, visual processing and executive function. Further, episodic memory (EM), executive function and Preclinical Alzheimer Cognitive Composite (PACC) composites were calculated by averaging normalized raw scores of the subtests. Models were corrected by chronological age, years of education and APOE‐ε4 status. Sex‐specific effects were investigated by adjusting interaction models.ResultThere was no overall effect of neither rLTL nor air pollution on cognitive performance, but crossover interactions with sex were found. Exposure to higher levels of NO2 and PM2.5 were associated with worse EM only in men [Figure 1]. Three‐way interaction models revealed longer rLTL and lower levels of air pollution were associated with better performance on PACC (for PM2.5, PM10 and NO2) and EM (for PM10 and NO2) among men. In women, these associations were only observed at higher exposure levels of air pollution [Figure 2].ConclusionThe results show that lower levels of air pollution allow for the protective effect of rLTL on cognitive performance only in men for whom air pollution had a stronger negative impact. In women, the results show different mechanisms through which air pollution and rLTL affect cognitive performance. Further analyses will be conducted to gain insight into the observed effects.

Defining the clinical and procedural opportunities available to residents during rural rotations.

Many emergency medicine (EM) residency programs include clinical rotations in rural emergency departments ("rural rotations") as part of their curriculum. These rotations are designed to expose residents to clinical scenarios that are less frequently encountered in tertiary centers. The objective of this study was to determine the rate at which residents were exposed to certain clinical and procedural experiences (CPEs) while on rural rotations compared to their usual academic training hospital. We conducted a retrospective chart review of all patient encounters involving EM residents at a large academic hospital in Rochester, Minnesota, compared with two rural hospitals in Austin, Minnesota, and Albert Lea, Minnesota, from July 1, 2019, to June 30, 2020. The frequency of each CPE was calculated and expressed as the number of CPEs encountered per 100 clinical hours worked. These values were compared between the rural and academic sites. A total of 33,417 patient encounters over a total of 41,700 resident clinical hours were analyzed between the three study sites. The two settings (rural vs. academic) had significant differences in baseline patient demographics including age, acuity, and admission rates. Several CPEs were found to occur at a higher frequency in the rural hospitals versus the academic hospital: ambulance necessity documentation (9.3/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001), laceration repair (3.39/100 h rural vs. 2.0/100 h academic, p = 0.0004), and splint/cast application (1.53/100 h rural vs. 0.07/100 h academic, p ≤ 0.0001). Rural EM rotations provide residents exposure to a variety of valuable educational experiences. These rotations may provide residents with superior exposures to some clinical experiences compared to academic hospitals, particularly out-of-ED transfers and orthopedic procedures. Residency programs without a current rural rotation should consider creating this as an option for their trainees.

The Use of Virtual Reality in Surgical Training: Implications for Education, Patient Safety, and Global Health Equity

As medicine becomes more complex, there is pressure for new and more innovative educational methods. Given the economic burden associated with in-person simulation, healthcare, including the realm of surgical education, has begun employing virtual reality (VR). Potential benefits of the addition of VR to surgical learning include increased pre-operative resident exposure to surgical techniques and procedures and better patient safety outcomes. However, these new technological advances, such as VR, may not replicate organic tissues or accurately simulate medical care and surgical scenarios, creating unrealistic pseudo-environments. Similarly, while advancements have been made, there are ongoing disparities concerning the utilization of these technologies. These disparities include aspects such as the availability of stable internet connections and the cost of implementing these technologies. In accordance with other innovative technologies, VR possesses upfront economic costs that may preclude equitable use in different academic centers around the world. As such, VR may further widen educational quality between high- and low-resource nations. This analysis integrates recent innovations in VR technology with existing discourse on global health and surgical equality. In doing so, it offers preliminary guidance to ensure that the implementation of VR occurs in an equitable, safe, and sustainable fashion.

Assessment of Gaps in Hematology Education in Canadian Internal Medicine Residency Programs

Background Across Canadian Internal Medicine residency programs, a resident's clinical exposure to hematologic disorders is highly heterogeneous depending on the residency program's curriculum, ethnic diversity of the local patient population, and access to resources. Despite this variability in clinical exposure to hematology, there is a paucity of data assessing Internal Medicine residents' competence in the various subspecialties of hematology and whether they are fulfilling the Royal College of Physicians and Surgeons' expected competencies by the end of residency 1. Through this study, our primary aim was to assess Canadian Internal Medicine residents' perceptions of their hematology training to identify gaps in hematology education in residency curricula. Methods We administered a cross-sectional survey using REDCap to all Internal Medicine residents (PGY1 to PGY5) from participating sites across Canada. The survey was distributed to residents electronically by email. To increase response rates, the survey was distributed three times (every 2 weeks) over a 6-week period. An incentive ($10 Starbucks gift card) was provided to improve response rates. The survey questions were designed based on the Royal College objectives which outline expected competencies by the end of Internal Medicine residency (Table 1). It consisted of 16 questions assessing 4 domains: respondent demographics, competence in diagnosis and management of specific hematologic disorders, competence in management of hematologic emergencies, and resident perceptions on hematology education in their program. Survey responses were anonymous and consisted of a combination of dichotomous (yes/no) and ordinal variables (Likert scale). The study was approved by the University of Toronto Research and Ethics Board (REB). Generalized linear regression analysis was used to compare survey questions between residents in different subgroups. p<0.05 was considered statistically significant. Least square mean (LSM) difference (with standard error SE) and 95% confidence intervals (CI) were calculated, with positive LSM indicating a higher Likert score. Results Of the 17 Internal Medicine programs that were invited to participate, 13 programs participated in the survey. 208 residents responded, with 92.31% (192/208) complete responses and 7.69% (16/208) incomplete responses. The overall response rate was 15.02% (208/1,385), with breakdown as follows: 31.5% (436/1,385) PGY1s, 30.5% (423/1,385) PGY2s, 30.9% (428/1,385) PGY3s, 4.5% (62/1,385) PGY4s, and 1.6% (22/1,385) PGY5s. 84.46% (163/208) of residents felt that there was a need for more hematology education in their residency program (Table 2). Specifically, residents felt that there was a need for more education in thrombosis (62.5%, 120/208), hemostasis (75.5%, 145/208), apheresis (75.0%, 144/208), sickle cell disease (79.2%, 152/208), transfusion medicine (84.4%, 162/208), and malignant hematology (78.7%, 151/208). A simulation/workshop was rated to be the most beneficial intervention (mean score of 4.25 +/- 0.80 on Likert scale) for learning. Conclusion Based on a cross-national survey of Internal Medicine residents in Canada, there are significant gaps in hematology education in Canadian Internal Medicine residency programs, most pronounced in transfusion medicine, sickle cell disease, and hemostasis. Interventions targeting these gaps should be designed to improve competence in the diagnosis and management of hematologic disorders and emergencies.

Increased Environmental Temperature Is an Emerging Health Risk That Correlates with Rates of Acute Lymphoblastic Leukemia in Europe

Background: The World Meteorological Organization (WMO) has calculated that European temperatures have increased at more than double the global average over the last 30 years 1. Besides research in radiation, little research has focused on how this might connect to the mechanisms initiating mutations in ALL. Both latitude and solar irradiance are potential risk factors in the development of ALL 2,3. Latitude covaries with the intensity of solar irradiance and ambient temperature, and both could therefore influence the risk of ALL. Furthermore, high ambient temperature during pregnancy was found to be associated with increased likelihood of childhood ALL 4. Global increases in temperature escalate the likelihood of extreme heat events, which in mammals increases reactive oxygen species, increases DNA damage, and suppresses the immune system 5. Few studies have evaluated changes in ambient temperature as a risk factor for ALL in Europe. We also included chronic lymphocytic leukemia (CLL) for comparison. Objective:To investigate the relationship between population-weighted country centroids (location of greatest population density), average country yearly temperature, solar irradiance and ALL and CLL rates in 40 European countries between the years 2010 and 2019. Design/Method:Incidence and prevalence rates for ALL and CLL (Age-standardized data with males and females) were obtained from the Global Health Data Exchange (GHDx) database. Population-weighted latitude/longitude centroids for Europe 6 were obtained from Baylor University and input into the Global Solar Atlas to obtain the average yearly global horizontal irradiance values. European temperature data was obtained from the Climatic Research Unit at the University of East Anglia (Copernicus Climate Data Store) 7. ALL and CLL incidence and prevalence rates per 100,000 people for 40 European countries were compared by linear regression to each country's temperature or solar irradiance at the population centroids. Statistical analyses were performed using GraphPad Prism and Excel. Results:After2010, we detected a significant positive correlation between ALL incidence and prevalence rates with mean annual temperature across countries for each year of analysis (for example in 2014 the ALL prevalence p-value = 0.01 and R= 0.4, see Figure 1). There was also an increase in the significance of this relationship over time between 2010 and 2019 (Figure 1B). We also detected a significant positive correlation between the increase in mean annual temperature across Europe and an increase in ALL over the past decade (Figure 1B). However, no relationship was established in this study for solar irradiance or population-weighted latitude and CLL prevalence and incidence rates. Conclusions:Increasing mean annual temperatures may increase the risk of developing ALL. We speculate this may be connected through increases in extreme weather events impacting oxidative stress, DNA damage, and/or suppression of the immune system. Considering the global climate crisis, the WMO finding of higher European temperature increases and our finding of significance between temperature and ALL rates, these relationships should be functionally studied. Finally, these studies should be expanded to countries outside of Europe. References 1 World Meteorological Organization. Temperatures in Europe increase more than twice global average. (2022). 2 Pordanjani, S. R., Kavousi, A., Mirbagheri, B., Shahsavani, A. & Etemad, K. Temporal trend and spatial distribution of ALL in Iranian children during 2006-2014: a mixed ecological study. Epidemiol. Health42, (2020). 3 Coste, A. et al. Residential exposure to UV light and risk of precursor B-cell ALL: assessing the role of individual risk factors, the ESCALE and ESTELLE studies. Cancer Causes Control28, 1075-1083 (2017). 4 Rogne, T. et al. High Ambient Temperature in Pregnancy and Risk of Childhood ALL. medRxiv (2023) 5 Chauhan, S. S., Rashamol, V. P., Bagath, M., Sejian, V. & Dunshea, F. R. Impacts of heat stress on immune responses and oxidative stress in farm animals and nutritional strategies for amelioration. Int. J. Biometeorol.65, 1231-1244 (2021). 6 Hamerly, G. Population-weighted European state centers. (2006). 7 Climatic Research Unit, U. of E. A. Temperature and precipitation gridded data for global and regional domains derived from in-situ and satellite observations. (2023).

Novel field data for exposure of bystanders and residents towards spray drift during application of plant protection products in orchards

Exposure to pesticide spray drift during the application of plant protection products (PPP) in orchards poses potential health risks to bystanders and residents. To address this concern, this study aimed to gather novel field data on exposure to spray drift in orchards. The research was conducted by the Julius Kuehn-Institute (JKI), the Federal Office of Consumer Protection and Food Safety (BVL), and the German Federal Institute for Risk Assessment (BfR). From 2018 to 2021, the method for conducting the field trials and analysis was implemented. The data from multiple series of performed field trials conducted between 2021 and 2022 allowed for collecting data on potential dermal exposure (PDE), inhalation exposure, and ground sediment. The trials considered various distances from the treatment area and drift-reducing techniques. Adult and child mannequins were used to simulate bystanders’ exposure, and petri dishes were used to measure ground sediment. The results showed that drift reduction settings (75% drift reduction) considerably reduced exposure levels on the mannequins. Furthermore, a strong correlation between PDE values for adults and children located next to each other at the same distance was observed. This finding suggests a possibility to convert exposure results from adult to child mannequins. The study produced realistic exposure data for bystanders and residents next to a treated area. It contributes to a better understanding of exposure risks from PPP application and includes data for different distances and spray drift reducing technique. If taken into account for further development of the current risk assessment models, new risk management options for the safe application of PPP, including buffer strips or application of drift reducing systems, might be available in near future.

Exposure to ambient air toxicants and the risk of amyotrophic lateral sclerosis (ALS): A matched case control study

BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with few risk factors identified and no known cure. Gene-environment interaction is hypothesized especially for sporadic ALS cases (90–95%) which are of unknown etiology. We aimed to investigate risk factors for ALS including exposure to ambient air toxics. MethodsThis population-based case-control study included 267 ALS cases (from the United States [U.S.] Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry National ALS Registry and Biorepository) and 267 age, sex, and county-matched controls identified via a commercial database. Exposure assessment for 34 ambient air toxicants was performed by assigning census tract-level U.S. Environmental Protection Agency (EPA) 2011 National Air Toxics Assessment (NATA) data to participants’ residential ZIP codes. Conditional logistic regression was used to compute adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for individual compounds, chemical classes, and overall exposure. Sensitivity analyses using both conditional logistic regression and Bayesian grouped weighted quartile sum (GWQS) models were performed to assess the integrity of findings. ResultsUsing the 2011 NATA, the highest exposure quartile (Q4) compared to the lowest (Q1) of vinyl chloride (aOR = 6.00, 95% CI: 1.87–19.25), 2,4-dinitrotoluene (aOR = 5.45, 95% CI: 1.53–19.36), cyanide (aOR = 4.34, 95% CI: 1.52–12.43), cadmium (aOR = 3.30, 95% CI: 1.11–9.77), and carbon disulfide (aOR = 2.98, 95% CI: 1.00–8.91) was associated with increased odds of ALS. Residential air selenium showed an inverse association with ALS (second quartile [Q2] vs. Q1: aOR = 0.38, 95% CI: 0.18–0.79). Additionally, residential exposure to organic/chlorinated solvents (Q4 vs Q1: aOR = 2.62, 95% CI: 1.003–6.85) was associated with ALS. ConclusionsOur findings using the 2011 NATA linked by census tract to residential area provide evidence of increased ALS risk in cases compared to controls for 2,4-dinitrotoluene, vinyl chloride, cyanide, and the organic/chlorinated solvents class. This underscores the importance of ongoing surveillance of potential exposures for at-risk populations.

Home-produced eggs: An important pathway of methylmercury exposure for residents in mercury mining areas, southwest China

In light of the documented elevated concentrations of total mercury (Hg) and methylmercury (MeHg) in poultry originating from Hg-contaminated sites, a knowledge gap persists regarding the levels of Hg found in home-produced eggs (HPEs) and the associated dietary exposure risks in regions affected by Hg mining. To address this knowledge gap, a comprehensive investigation was undertaken with the primary objectives of ascertaining the concentrations of THg and MeHg in HPEs and evaluating the potential hazards associated with the consumption of eggs from the Wanshan Hg mining area in Southwest China. The results showed that THg concentrations in HPEs varied within a range of 10.5–809 ng/g (with a geometric mean (GM) of 64.1 ± 2.7 ng/g), whereas MeHg levels spanned from 1.3 to 291 ng/g (GM, 23.1 ± 3.4 ng/g). Remarkably, in half of all eggs, as well as those collected from regions significantly impacted by mining activities, THg concentrations exceeded the permissible maximum allowable value for fresh eggs (50 ng/g). Consumption of these eggs resulted in increased exposure risks associated with THg and MeHg, with GM values ranging from 0.024 to 0.17 µg/kg BW/day and 0.0089–0.066 µg/kg BW/day, respectively. Notably, the most substantial daily dosage was observed among children aged 2–3 years. The study found that consuming HPEs could result in a significant IQ reduction of 34.0 points for the whole mining area in a year. These findings highlight the potential exposure risk, particularly concerning MeHg, stemming from the consumption of local HPEs by residents in mining areas, thereby warranting serious consideration within the framework of Hg exposure risk assessment in mining locales.

Air pollution and oxidative stress in adults suffering from airway diseases. Insights from the Gene Environment Interactions in Respiratory Diseases (GEIRD) multi-case control study

Air pollution is a leading risk factor for global mortality and morbidity. Oxidative stress is a key mechanism underlying air-pollution-mediated health effects, especially in the pathogenesis/exacerbation of airway impairments. However, evidence lacks on subgroups at higher risk of developing more severe outcomes in response to air pollution. This multi-centre study aims to evaluate the association between air pollution and oxidative stress in healthy adults and in patients affected by airway diseases from the Italian GEIRD (Gene Environment Interactions in Respiratory Diseases) multi-case control study. Overall, 1841 adults (49 % females, 20–83 years) were included from four Italian centres: Pavia, Sassari, Turin, and Verona. Following a 2-stage screening process, we identified 1273 cases of asthma, chronic bronchitis, rhinitis, or COPD and 568 controls. Systemic oxidative stress was quantified by urinary 8-isoprostane and 8-OH-dG. Individual residential exposures to NO2, PM10, PM2.5, and O3 were derived using an innovative five-stage machine-learning-based approach. Linear mixed regression models tested the association between oxidative stress biomarkers and air pollution tertiles, adjusting by age, sex, BMI, smoking, education and season, with recruiting centres as random intercept. Only cases exhibited higher levels of log-transformed 8-isoprostane and 8-OH-dG in association with NO2 (β: 0.30 95 % CI: 0.08–0.52 and 0.20 95 % CI: 0.03–0.37), PM10 (0.34 95 % CI: 0.12–0.55 and 0.21 95 % CI: 0.05–0.37) and PM2.5 (0.27 95 % CI: 0.09–0.49 and 0.18 95 % CI: 0.02–0.34) as compared to the first tertile of exposure. No significant associations were observed for summer O3. Our findings suggest that exposure to air pollution may increase systemic oxidative stress levels in people suffering from airway diseases. This introduces a potential novel approach available for future epidemiological studies and Public Health for effective prevention strategies oriented at the quantification of early biological effects in susceptible people, whose additional risk level might be currently underrated. Air-pollution-mediated exacerbations, driven by oxidative stress, still deserve our attention.

A multi-institutional study from the US ROPE consortium examining factors associated with endocrine surgery exposure for general surgery residents

BackgroundPrior analyses of general surgery resident case logs have indicated a decline in the number of endocrine procedures performed during residency. This study aimed to identify factors contributing to the endocrine operative experience of general surgery residents and compare those who matched in endocrine surgery fellowship with those who did not. MethodsWe analyzed the case log data of graduates from 18 general surgery residency programs in the US Resident Operative Experience Consortium over an 11-year period. ResultsOf the 1,240 residents we included, 17 (1%) matched into endocrine surgery fellowships. Those who matched treated more total endocrine cases, including more thyroid, parathyroid, and adrenal cases, than those who did not (81 vs 37, respectively, P < .01). Program-level factors associated with increased endocrine volume included endocrine-specific rotations (+10, confidence interval 8–12, P < .01), endocrine-trained faculty (+8, confidence interval 7–10, P < .01), and program co-location with otolaryngology residency (+5, confidence interval 2 –8, P < .01) or endocrine surgery fellowship (+4, confidence interval 2–6, P < .01). Factors associated with decreased endocrine volume included bottom 50th percentile in National Institute of Health funding (–10, confidence interval –12 to –8, P < .01) and endocrine-focused otolaryngologists (–3, confidence interval –4 to –1, P < .01). ConclusionSeveral characteristics are associated with a robust endocrine experience and pursuit of an endocrine surgery fellowship. Modifiable factors include optimizing the recruitment of dedicated endocrine surgeons and the inclusion of endocrine surgery rotations in general surgery residency.

Short-term exposure to ambient air pollution and hospital admissions for angina among older adults in South China

Ambient air pollution has been linked to an increased risk of various acute cardiovascular outcomes; however, its effects on hospital admissions for angina are yet to be evaluated. We conducted a time-stratified case-crossover study with conditional logistic regression models among 46,687 adults 60 years or older who were admitted to hospital for angina in Guangzhou, China during 2016–2019 to investigate the association of exposure to ambient particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) with hospital admissions for angina. Daily residential air pollutant exposures were extracted from a grid dataset. Each 10 μg/m3 increase of lag 0-day exposure to PM10, SO2, NO2, CO, and O3 was significantly associated with a 0.80% (95% confidential interval: 0.32%, 1.28%), 4.04% (0.34%, 7.89%), 2.47% (1.81%, 3.12%), 0.13% (0.07%, 0.19%), and −0.38% (−0.74%, −0.01%) increase in odds of admission, respectively. The association for NO2 exposure remained stable, while the associations for PM10, SO2, CO, and O3 became insignificant with adjustment for other air pollutants. The association for NO2 exposure was stronger in cool season. We estimated that up to 9.12% of angina admissions were attributable to NO2 exposure. Our findings suggest that ambient NO2 may trigger hospital admissions for angina in Chinese older adults, which highlights the importance to prevent angina by reducing individual NO2 exposures.

Exposure hazards of particles and volatile organic compounds emitted from material extrusion 3D printing: Consolidation of chamber study data

Ultrafine particles and volatile organic compounds (VOCs) have been detected from material extrusion 3D printing, which is widely used in non-industrial environments. This study consolidates data of 447 particle emission and 58 VOC emission evaluations from a chamber study using a standardized testing method with various 3D printing scenarios. The interquartile ranges of the observed emission rates were 109–1011 #/h for particles and 0.2–1.0 mg/h for total VOC. Print material contributed largely to the variations of particle and total VOC emissions and determined the most abundantly emitted VOCs. Printing conditions and filament specifications, included printer brand, print temperature and speed, build plate heating setup, filament brand, color and composite, also affected emissions and resulted in large variations observed in emission profiles. Multiple regression showed that particle emissions were more impacted by various print conditions than VOC emissions. According to indoor exposure modeling, personal and residential exposure scenarios were more likely to result in high exposure levels, often exceeding recommended exposure limits. Hazardous VOCs commonly emitted from 3D printing included aromatics, aldehydes, alcohols, ketones, esters and siloxanes, among which were various carcinogens, irritants and developmental and reproductive toxins. Therefore, 3D printing emits a complex mixture of ultrafine particles and various hazardous chemicals, exposure to which may exceed recommended exposure limits and potentially induce acute, chronic, or developmental health effects for users depending on exposure scenarios.

Epidemiological trend of lung cancer burden caused by residential radon exposure in China from 1990 to 2019.

This study employed time series data to assess long-term changes in the burden of lung cancer (LC) caused by residential radon exposure, an important environmental risk factor, so as to develop evidence-based strategies for future public health management. Based on the open data from the Global Burden of Disease (GBD 2019) database, we conducted an analysis of the residential radon exposure-caused LC mortality, disability-adjusted life years (DALYs), and corresponding crude rates and age-standardized rates (ASRs) for various age groups. We employed the employed age-period-cohort (APC) model to investigate the age, period, and cohort effects of the data, allowing us to discern the trends in LC disease burden attributable to radon exposure in residential settings over time. From 1990 to 2019, age-standardized mortality rates (ASMR) and age-standardized DALYs rates of LC caused by residential radon exposure in China demonstrated an overall increasing trend, with males higher than females. The CMR and crude DALYs rate for males were higher than those for females across all age groups. The APC analysis revealed that the local drift of LC death and DALYs rates in males and females showed a decreasing trend before 60 and an increasing trend after 60. The persistent presence of residential radon exposure as a crucial risk factor for LC underscores the need for public health authorities and policymakers to take more proactive measures to reduce radon exposure. Particularly, attention should be paid on the elderly population and male patients.

Calibrating thermal sensation vote scales for different short-term thermal histories using ensemble learning

The urban heat island effect intensifies, leading to increased thermal exposure for city residents. Variations in thermal sensation are observed among individuals with different short-term thermal experiences, challenging the reliability of Thermal Sensation Vote (TSV) scales. This study investigates TSV disparities in Shanghai, China, between two groups: individuals with Short-Term Air Conditioning Usage Experience (STACUE) and those Lacking Short-Term Air Conditioning Usage Experience (LSTACUE). Through questionnaire surveys and environmental monitoring, the study evaluates the performances of various ensemble learning models for predicting TSV. The selected Random Forest Regressor is employed to calibrate TSV scales for Physiologically Equivalent Temperature, Standard Effective Temperature (SET*), Universal Thermal Climate Index, and Perceived Temperature. Using Shapley values from game theory, we reveal how environmental variables contribute to TSV differences among individuals with varying short-term thermal histories. Results indicate higher Thermal Unacceptable Vote and greater Environmental Expectation Vote for STACUE individuals versus LSTACUE ones. Calibrated TSV scales, particularly SET*, exhibit significant enhancements over original scales: a 35.04 % increase in prediction accuracy percentage and a 0.57 correlation increase. Explainable analysis underscores that air temperature (28.8%) has a stronger impact on TSV among STACUE individuals, whereas mean radiant temperature (32.2%) is the primary factor affecting TSV among LSTACUE. Furthermore, we found gender interacts with thermal environmental parameters concerning TSV. This study sheds light on how short-term thermal history influences TSV among residents, informing customized urban thermal management strategies.

Middle-term nitrogen dioxide exposure and electrocardiogram abnormalities: A nationwide longitudinal study

BackgroundRecently, professionals, such as those from the World Health Organization, have recommended a rigorous standard for nitrogen dioxide (NO2), a typical urban air pollutant affected by regular traffic emissions, based on its short-term and long-term cardiorespiratory effects. However, the association between middle-term NO2 exposure and cardiovascular disorders remains unknown. ObjectivesThis study was conducted to examine the relationship between NO2 exposure and its middle-term cardiovascular risks indicated by electrocardiogram (ECG) abnormalities. MethodWe included 61,094 subjects (132,249 visits) with repeated ECG observations based on longitudinal data from the China National Stroke Screening Survey (CNSSS). The NO2 exposure concentration was derived from a predictive model, measured as the monthly average concentration in the 6 months of preceding the ECG measurement. We used the generalized estimation equation to assess the association between NO2 exposure and ECG abnormalities. ResultFor each 10 µg/m3 increase in monthly average NO2 concentration, the odds ratio of ECG abnormalities was 1.10 (95% confidence interval [CI] 1.09–1.12) after multiple adjustments. Stratified regression analyses of urban and rural residents showed associations between middle-term NO2 exposure and ECG abnormalities in urban (OR 1.09 [95% CI 1.08–1.11]) and rural residents (OR 1.14 [95% CI 1.10–1.19]). The association was robust within different subpopulations. Associations generally remained statistically significant (OR 1.03 [95% CI 1.02–1.05]) after extra adjustment for PM2.5. Exposure-response relationship analysis revealed a nearly linear relationship between NO2 exposure and the risk for ECG abnormalities. ConclusionUsing the variation in ECG signals as a potentially reversible indicator for subclinical risk in cardiovascular systems, our study provides additional evidence on the increased risk posed by middle-term NO2 exposure. Our study showed that policies controlling for NO2 concentrations are beneficial to prevent cardiovascular diseases among Chinese adults.

The state of lipid exchange in persons living in the territory of environmental illusion

Introduction. Currently, it is important to consider the issues of diagnosing nonspecific disorders occurred due to exposure of residents to chemicals in cities with chemical industry enterprises on the territory.&#x0D; Materials and methods. Working 30–60 year men, permanently residing downwind from the industrial site of LLC “Usolekhimprom” in the territory exposed to mercury in the city of Usolye-Sibirskoye, were examined.&#x0D; Results. The maximum concentration of total cholesterol (TCH) was 8.7 mmol/L, cholesterol (CH) of low density lipoproteins (LDL) – 6.0 mmol/L, triglycerides (TG) – 2.3 mmol/L, phospholipids – 5.5 mmol/L. The minimum content of high-density lipoprotein cholesterol (HDL cholesterol) was 0.5 mmol/L. In terms of the prevalence of disorders, hypercholesterolemia held the first place – 63% of cases, the second – a high level of LDL cholesterol – 59%, the third – an increase in ApoB – 45%. Hyperphospholipidemia occurred in 35%, hypertriglyceridemia – in 23%. Reduced HDL cholesterol was recorded in 5.3%. Low concentration of Apo A1 was registered in 20% of cases. A high level of atherogenic index was common among 16%. The prevalence of high LDL-CH was consistent with that of hypercholesterolemia, as evidenced by the correlation coefficient between the indices (R=0.77) and between the level of TCH and Apo B (R=0.80). A HDL cholesterol high level does not always indicate the antiatherogenic ability of lipoproteins, and therefore the revealed low prevalence of hypoalphacholesterolemia in the examined individuals (lower than in Russia - 16%) does not indicate antiatherogenic changes. The triglyceridemia level was associated with the ApoB concentration, which indicates its contribution to the development of proatherogenic disorders. A possible mechanism of hyperphospholipidemia is the formation of a compensatory-adaptive stimulus to the phospholipids synthesis in response to hypercholesterolemia and hypertriglyceridemia.&#x0D; Limitations. Male persons. Age 30–60 years.&#x0D; Conclusion. In persons living in the ecological trouble zone, a high frequency of lipid metabolism disorders was revealed. This fact can be considered as one of the main predisposing factors for the development of cardiovascular diseases in this cohort.

A survey of exposure to the use of Xiaflex for the treatment of Peyronie's disease among United States urology residency programs.

Xiaflex® (collagenase clostridium histolyticum) is a Food and Drug Administration-approved treatment for patients with Peyronie's disease. Despite its approval and implementation, there is concern that urologists in training are offered minimal exposure to its use. Thus, the purpose of this study was to evaluate the exposure of urology residents to Peyronie's disease and its management, particularly Xiaflex®. A Google Forms survey regarding the exposure of residents to Peyronie's disease and use of Xiaflex® was created and disseminated through email to urology programs. Overall, 47 institutional responses were received. At 45 institutions (95.7%), residents receive training in directly evaluating and caring for patients with Peyronie's disease. At 46 institutions (97.9%), residents receive training in observing and/or performing surgical procedures for Peyronie's disease. Residents at 31 institutions (66.0%) receive observational or procedural training for non-surgical management of Peyronie's disease, specifically Xiaflex®. Residents receive non-surgical training from an academic faculty who is fellowship trained in sexual medicine at 25 institutions and an academic faculty not trained in sexual medicine at six institutions. There exists a glaring disparity in residency exposure to Xiaflex®. Further research is warranted to elucidate how programs can provide residents with further exposure to the use of Xiaflex® in patients with Peyronie's disease.

Residential proximity to vines and risk of childhood embryonal tumours in France - GEOCAP case-control study, 2006–2013

BackgroundExposure to pesticides has been suggested as a potential risk factor for childhood embryonal tumour. The existing literature has mainly focused on parental occupational exposure and domestic use of pesticides, and is very limited for residential exposures to agricultural pesticides. The study aimed to test the hypothesis of an increased risk of embryonal tumour in children living close to viticultural plots, likely to be subject to frequent pesticide applications. MethodsThe study is part of the French national registry-based GEOCAP program. We included 2761 cases of neuroblastoma, retinoblastoma, Wilms tumour and rhabdomyosarcoma diagnosed before the age of 15 years in the 2006–2013 period, and 40,196 controls representative of the same age population during this period. Indicators of proximity to vines, the presence of vines and viticulture density within 1000 m of the geocoded addresses of residence, were evaluated combining three sources of data on agricultural land use in a geographic information system. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regressions and carried out several sensitivity analyses to test the stability of the results. ResultsApproximately 10% of the controls lived within 1000 m of vines, with regional variations ranging from <1% to 38%. We observed a 5% increase in the risk of neuroblastoma for a 10% increase in viticulture density (OR = 1.05, 95% CI: 0.98–1.13), with a regional heterogeneity. The indicators of proximity to vines were not associated with the other non-CNS embryonal tumours. ConclusionThe study showed a slight increase in the risk of neuroblastoma in children living close to vines, suggesting that residential exposure to agricultural pesticides may be involved in the occurrence of these tumours.