Meaningful Public Health Research Articles

What’s in a word? Defining “gene therapy medicines”

Gene therapy medicinal products (GTMPs) have emerged as a transformative class of medicines. Defining what a certain class of medicines encompasses, and what it does not, is key, with ample implications and consequential regulatory requirements. In April 2023, the European Commission proposed new pharmaceutical legislation safeguarding the public health within the European Union with a new, broader definition of GTMP, including genome editing medicines and nucleic acids of either source, regulating, replacing, or adding a genetic sequence that mediates its effect by transcription or translation. This definition is all-encompassing for any "genetic" intervention and is agnostic to mechanism of action, duration of action, location of action, and associated risk. Here, we take this as a paradigm to discuss how terminology and definitions are more than just words and can have meaningful regulatory, scientific, and public health implications.

Air pollution: an emerging risk factor for autism spectrum disorder

The global surge in air pollution poses an increasingly concerning environmental risk factor for neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Recent epidemiological studies have revealed compelling associations between exposure to specific air pollutants, including fine particulate matter (PM), nitrogen oxides (NO, NO2), sulfur dioxide (SO2) and ozone (O3), and increased ASD risk. While the rising global ASD prevalence, now affecting 1%–1.5% of the population, partially reflects expanded diagnostic criteria and enhanced screening, mounting evidence points to the critical role of gene–environment interactions in ASD etiology. Air pollutants can trigger multiple pathogenic mechanisms, including neuroinflammation, oxidative/nitrosative stress, epigenetic modifications, and glutamatergic/GABAergic neurotransmitter system disruption. The timing of exposure appears crucial, with heightened vulnerability during prenatal development and early childhood when critical neurodevelopmental processes, such as neuronal migration, synaptogenesis, and myelination occur. Research priorities should focus on how air pollutants affect brain development in genetically susceptible individuals, especially during pregnancy and early childhood. Better ways are needed to identify individuals at the highest risk and develop practical protective measures. Given the rising global pollution levels, this knowledge will help shape meaningful public health policies to protect future generations from environmental factors that may contribute to ASD.

Scanning the horizon- environmental health indicator surveillance

Abstract Aim This work aimed to conduct a comprehensive literature review with narrative synthesis of evidence in relation to the surveillance of environmental health indicators by Public Health agencies internationally. This will strengthen the All-Hazards approach to Health Protection in Ireland. Methods The project proposal was registered on PROSPERO. Preferred Reporting Systems for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. A systematic search was conducted across five databases. In addition, relevant websites, reference lists and the grey literature were searched. Data were extracted following TIDieR-PHP guidelines. Risk of bias was considered and quality appraisal was performed using SANRA and AGREE-HS tools. A narrative synthesis of the evidence was completed. Results 12 papers were included in the final review. Four were narrative review articles describing European and worldwide initiatives and the remaining eight described a single health system. Only three papers were deemed high quality. The number of indicators monitored varied widely from one in Italy to over 400 in the USA. The most established programmes described the use of a framework such as Drivers-Pressures-States-Exposures-Effects-Actions (DPSEEA) and indicator selection criteria were applied. The papers described a variety of public health actions arising from the surveillance of environmental health indicators. The knowledge provided by this review can inform the implementation process. Establishment of a project team, and beginning with monitoring one domain is suggested. Air quality is the most frequently monitored domain internationally. The DPSEEA framework is recommended, and Briggs’ indicator selection criteria should be applied to any indicator under consideration. The system should measure both hazard and outcome measures. Finally, meaningful public health action should result from the monitoring. Key messages • Environmental health indicator surveillance is essential to all-hazards health protection. • Few public health agencies internationally are systematically monitoring environmental health outcomes.

Co-design of digital public health substance use resources: A collaboration between young people and experts.

Substance use and mental illness remain critical issues for young Australians, however, engagement with evidence-based health resources is challenging among this age group. This study aimed to develop engaging, useful digital health resources, underpinned by neuroscience principles, to build awareness of the harms of electronic cigarettes (e-cigarettes) and concurrent alcohol and antidepressant use. A mixed-methods approach was adopted to co-design two evidence-based videos resources. The resources were co-designed with the Matilda Centre's Youth Advisory Board Centre's Youth Advisory Board through a series focus groups and individual feedback reviews. Young people residing in New South Wales were then invited to complete a survey to evaluate the usefulness, relatability and impact on perceived harms associated with each substance pre- and post-viewing resources. A total of 100 participants completed the survey (mean age = 21.5 years, SD = 2.77, 42% Female, 2% Non-binary). The animated videos were well received, with the large majority (91% and 87% respectively) of participants rating them 'excellent' or 'very good'. After viewing the videos, there was a significant increase in the perception of harm associated with e-cigarette use, monthly (t(99) = 2.76, p = .003), weekly (t(99) = 4.82, p < .001) and daily (t(99) = 4.92, p < .001), and consuming alcohol whilst taking antidepressants both weekly (t(100) = 2.93, p = .004) and daily (t(100) = 3.13, p = .002). This study describes a successful co-design process demonstrating how meaningful involvement of young people, alongside traditional research methods, can produce substance use prevention resources that are useful, engaging and increase knowledge of harms among young people. SO WHAT?: To achieve meaningful public health impact researchers, experts and digital creators can work together to co-create substance use educational materials that are engaging, well-liked, while imparting important health knowledge.

Introduction to the Special Track on Artificial Intelligence and COVID-19 (Abstract Reprint)

The human race is facing one of the most meaningful public health emergencies in the modern era caused by the COVID-19 pandemic. This pandemic introduced various challenges, from lock-downs with significant economic costs to fundamentally altering the way of life for many people around the world. The battle to understand and control the virus is still at its early stages yet meaningful insights have already been made. The uncertainty of why some patients are infected and experience severe symptoms, while others are infected but asymptomatic, and others are not infected at all, makes managing this pandemic very challenging. Furthermore, the development of treatments and vaccines relies on knowledge generated from an ever evolving and expanding information space. Given the availability of digital data in the modern era, artificial intelligence (AI) is a meaningful tool for addressing the various challenges introduced by this unexpected pandemic. Some of the challenges include: outbreak prediction, risk modeling including infection and symptom development, testing strategy optimization, drug development, treatment repurposing, vaccine development, and others.

Environmental Interventions for Preventing Atopic Diseases.

In this review, we detail the exposome (consisting of environmental factors such as diet, microbial colonization, allergens, pollutants, and stressors), mechanistic and clinical research supporting its influence on atopic disease, and potentiation from climate change. We highlight contemporary environmental interventions and available evidence substantiating their roles in atopic disease prevention, from observational cohorts to randomized controlled trials, when available. Early introduction to allergenic foods is an effective primary prevention strategy to reduce food allergy. Diverse dietary intake also appears to be a promising strategy for allergic disease prevention, but additional study is necessary. Air pollution and tobacco smoke are highly associated with allergic disease, among other medical comorbidities, paving the way for campaigns and legislation to reduce these exposures. There is no clear evidence that oral vitamin D supplementation, prebiotic or probiotic supplementation, daily emollient application, and antiviral prophylaxis are effective in preventing atopic disease, but these interventions require further study. While some environmental interventions have a well-defined role in the prevention of atopic disease, additional study of many remaining interventions is necessary to enhance our understanding of their role in disease prevention. Alignment of research findings from randomized controlled trials with public policy is essential to develop meaningful public health outcomes and prevent allergic disease on the population level.

Development of a University-Government Partnership for Public Health Response and Workforce Development in the State of Oregon.

The COVID-19 pandemic exposed and exacerbated a public health workforce shortage and national strategies have called for the development of clear occupational pathways for students to enter the public health workforce and meaningful public health careers. In response to the immediate need for public health workers during the pandemic, several universities and academic hospitals rapidly mobilized students and employees and partnered with local or state health departments. However, many of those partnerships were based on short-term volunteer effort to support critical COVID-19 public health efforts. In this article, we document the development of Oregon's Public Health Practice Team, a student, staff, and faculty workforce developed at the Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health in close collaboration with the Oregon Health Authority (OHA). This project contributed significant effort to several phases of Oregon's statewide public health response to COVID-19, and over time developed into a lasting, multi-purpose, inter-agency collaborative public health practice program. Health equity has been centered at every stage of this work. We describe the phases of the partnership development, the current team structure and operations, and highlight key challenges and lessons learned. This provides a case-study of how an innovative and flexible university-government partnership can contribute to immediate pandemic response needs, and also support ongoing public health responses to emerging needs, while contributing to the development of a skilled and diverse public health workforce.

Introduction to the Special Track on Artificial Intelligence and COVID-19

The human race is facing one of the most meaningful public health emergencies in the modern era caused by the COVID-19 pandemic. This pandemic introduced various challenges, from lock-downs with significant economic costs to fundamentally altering the way of life for many people around the world. The battle to understand and control the virus is still at its early stages yet meaningful insights have already been made. The uncertainty of why some patients are infected and experience severe symptoms, while others are infected but asymptomatic, and others are not infected at all, makes managing this pandemic very challenging. Furthermore, the development of treatments and vaccines relies on knowledge generated from an ever evolving and expanding information space. Given the availability of digital data in the modern era, artificial intelligence (AI) is a meaningful tool for addressing the various challenges introduced by this unexpected pandemic. Some of the challenges include: outbreak prediction, risk modeling including infection and symptom development, testing strategy optimization, drug development, treatment repurposing, vaccine development, and others.

PS-P03-11: EFFECT OF CLEANER COOKING FUEL (LPG) ON CARDIOPULMONARY HEALTH IN WOMEN FROM RURAL MAHARASHTRA

Background and Objective: Air pollution generated due to the use of solid fuels is recognized to be an environmental and health risk globally, especially in developing countries. Exposure to household air pollution is estimated to kill 3.8 million people worldwide. Major victims are women who are the immediate users. In an attempt to address this issue, the Indian government launched the Pradhan Mantri Ujjwala Yojana (PMUY) which provides clean LPG cooking gas to first-time users. However, it is majorly being promoted as a scheme about providing cooking gas to those who don’t have it but the health benefits of the scheme are not being focused. Accordingly, this study aimed to evaluate the effect of LPG on cardiopulmonary health in women. Design and method: A total of 997 healthy women participants (808 primary cooks and 189 secondary cooks) who cooked either with biomass or with LPG were enrolled. Systolic (SBP) and diastolic blood pressure (DBP), blood glucose was measured in all study participants and data on 24-hour personal exposure to fine particulate matter &lt; 2.5 μm (PM2.5) and lung function (by spirometry) were measured on a subset using a standard protocol. Socio-demographic data, cooking practices and other information were collected using a validated questionnaire. Descriptive analysis was done in SPSS v26. Results: Results highlighted that SBP, DBP, mean arterial pressure, pulse pressure and glucose level were significantly higher in the biomass group compared to the LPG group in both primary and secondary cooks. The prevalence of hypertension in primary and secondary cooks was 29.5 and 33.6 respectively in biomass users compared to 21.1 and 13.4 in LPG users. Higher number of obstructive airway pattern (n = 10; 6.4% vs n = 2 1.3%), restrictive airway pattern (n = 31; 19.7 % vs n = 19; 12.5 %) and small airway obstruction (n = 55; 35.0 % vs n = 22; 14.4 %) was observed in biomass group compared to LPG group respectively. After adjusting for age, BMI and study group, it was seen that biomass exposure index (odds ratio [OR] 2.288; 95% confidence interval [CI] 1.169, 4.479, P = 0.016) and PM2.5 levels (OR 1.065; 95% CI 1.035, 1.096, P &lt; 0.001) significantly increased the odds of having hypertension. Conclusions: Based on preliminary analysis, it can be concluded that the use of biomass is significantly associated with an increased risk of hypertension and impaired lung function. Thus, adoption of cleaner cooking fuels like LPG will have meaningful clinical and public health benefits.

Publication and Impact of Preprints Included in the First 100 Editions of the CDC COVID-19 Science Update: Content Analysis.

BackgroundPreprints are publicly available manuscripts posted to various servers that have not been peer reviewed. Although preprints have existed since 1961, they have gained increased popularity during the COVID-19 pandemic due to the need for immediate, relevant information.ObjectiveThe aim of this study is to evaluate the publication rate and impact of preprints included in the Centers for Disease Control and Prevention (CDC) COVID-19 Science Update and assess the performance of the COVID-19 Science Update team in selecting impactful preprints.MethodsAll preprints in the first 100 editions (April 1, 2020, to July 30, 2021) of the Science Update were included in the study. Preprints that were not published were categorized as “unpublished preprints.” Preprints that were subsequently published exist in 2 versions (in a peer-reviewed journal and on the original preprint server), which were analyzed separately and referred to as “peer-reviewed preprint” and “original preprint,” respectively. Time to publish was the time interval between the date on which a preprint was first posted and the date on which it was first available as a peer-reviewed article. Impact was quantified by Altmetric Attention Score and citation count for all available manuscripts on August 6, 2021. Preprints were analyzed by publication status, publication rate, preprint server, and time to publication.ResultsOf the 275 preprints included in the CDC COVID-19 Science Update during the study period, most came from three servers: medRxiv (n=201, 73.1%), bioRxiv (n=41, 14.9%), and SSRN (n=25, 9.1%), with 8 (2.9%) coming from other sources. Additionally, 152 (55.3%) were eventually published. The median time to publish was 2.3 (IQR 1.4-3.7). When preprints posted in the last 2.3 months were excluded (to account for the time to publish), the publication rate was 67.8%. Moreover, 76 journals published at least one preprint from the CDC COVID-19 Science Update, and 18 journals published at least three. The median Altmetric Attention Score for unpublished preprints (n=123, 44.7%) was 146 (IQR 22-552) with a median citation count of 2 (IQR 0-8); for original preprints (n=152, 55.2%), these values were 212 (IQR 22-1164) and 14 (IQR 2-40), respectively; for peer-review preprints, these values were 265 (IQR 29-1896) and 19 (IQR 3-101), respectively.ConclusionsPrior studies of COVID-19 preprints found publication rates between 5.4% and 21.1%. Preprints included in the CDC COVID-19 Science Update were published at a higher rate than overall COVID-19 preprints, and those that were ultimately published were published within months and received higher attention scores than unpublished preprints. These findings indicate that the Science Update process for selecting preprints had a high fidelity in terms of their likelihood to be published and their impact. The incorporation of high-quality preprints into the CDC COVID-19 Science Update improves this activity’s capacity to inform meaningful public health decision-making.

Local Legal Strategies to Increase Vaccination During the COVID-19 Pandemic - Lessons from New York City.

Vaccine mandates played a critical role in the success of New York City's COVID-19 response. By relying on evidence as a substantive basis for the mandates and adhering to procedural requirements and precedent, New York City leveraged its position and expertise as a local governmental authority to devise mandatory vaccine policies that withstood numerous legal challenges. New York City's experience highlights the role of municipal government in mounting a meaningful public health response, and the strategies adopted by NYC may provide a blueprint for municipalities around the world facing the ongoing COVID-19 pandemic and the threat of future public health emergencies.

Cigarette Price Increases, Advertising Ban, and Pictorial Warnings as Determinants of Youth Smoking Initiation in Poland.

Europe's Beating Cancer Plan aims to create a "Tobacco-Free Generation" by 2040. To generate meaningful public health policy to achieve this target, we must understand more clearly the determinants of youth smoking initiation. We examine the determinants of cigarette-smoking initiation in Poland using survival analysis techniques and data from four youth smoking surveys: the 2003, 2009, and 2016 Global Youth Tobacco Surveys (GYTS) and the 2019 PolNicoYouth survey (number of person-period observations N = 164 807). Split-population duration models are employed. The hazard of smoking initiation is modeled as a function of cigarette prices, nonprice tobacco-control measures, and socioeconomic variables. Our study finds a negative and significant relationship between cigarette prices and the hazard of smoking initiation in all models (hazard ratio from 0.86 to 0.91). Lower hazards of smoking initiation were also associated with a comprehensive advertising ban (hazard ratio from 0.69 to 0.70) and with the introduction of pictorial warnings (hazard ratio from 0.65 to 0.68). This study concludes that cigarette price increases, such as from higher cigarette excise taxes, could further significantly reduce cigarette youth smoking initiation in Poland. Removing promotional and advertising elements from cigarette packs and making the health warning more noticeable through plain packaging laws would further accelerate the reduction in smoking initiation. The European Union is currently formally reconsidering the Tobacco Tax Directive. This makes this analysis of the impact of cigarette prices on youth smoking initiation both timely and germane. As ever more countries implement standardized cigarette packaging, findings here provide support for this measure that removes advertising elements from the packs and makes the health warning more noticeable.

An Intervention Study to Increase the Medication Compliance of 60 Years and Older Individuals

Abstract Background In older age, taking medication at the desired level contributes to the health and well-being, and therefore, constitutes an essential part of the effectiveness of treatment and ultimately desired public health impact and reduced healthcare budgets. However, it is known that medication compliance among older persons is frequently not at a desired level. Therefore, in this study, it was aimed to increase medication compliance through an educational intervention for patients aged 60 and over, who applied to two healthcare facilities in Ankara, Turkey. Methods This intervention study was implemented in two public health hospitals between March and June 2019. 315 people aged 60 and over participated in the study. The intervention tool was the “teach-back” method. SPSS program was used for data entry and analysis. P value less than 0.05 was indicated for statistical significance. Results Mean age of the participants was found to be 70.16±7.9 for the control group and 70.27±7.4 for the intervention group. In the intervention group, a statistically significant increase was found in the capacity of learning the long-term benefits of drugs, their side effects and storage conditions, and knowing when the drugs shouldn't be taken, and repeating information about the drugs used (p = 0.000). Conclusions This study has revealed that medication compliance among older individuals can be increased with an appropriate communication and training method in healthcare settings. Time allocated by health workers in this regard has a potential to respond to the compliance-related needs. With the “Teach-back” method utilized in the interactions between older patients and health workers, it is possible to attain meaningful, large-scale and cost-effective public health outcomes that contribute to the clinical benefits of treatments and the effectiveness of health systems. Key messages Older people are open to receive information on the actual health needs. A well-structured interaction between healthcare workers and patients involving “teach-back” method contributes to medication compliance among the elderly.

Nutritional Interventions and the Gut Microbiome in Children.

The gut microbiome plays an integral role in health and disease, and diet is a major driver of its composition, diversity, and functional capacity. Given the dynamic development of the gut microbiome in infants and children, it is critical to address two major questions: (a) Can diet modify the composition, diversity, or function of the gut microbiome, and (b) will such modification affect functional/clinical outcomes including immune function, cognitive development, and overall health? We synthesize the evidence on the effect of nutritional interventions on the gut microbiome in infants and children across 26 studies. Findings indicate the need to study older children, assess the whole intestinal tract, and harmonize methods and interpretation of findings, which are critical for informing meaningful clinical and public health practice. These findings are relevant for precision health, may help identify windows of opportunity for intervention, and may inform the design and delivery of such interventions.

A Decade of Drinking: Temporal Trends in Apparent Household Beer Intake and Standard Drink Consumption in the United States

Beer remains the greatest source of per capita alcohol consumption in the United States, and increasing market availability and consumer demand for higher alcohol has meaningful public health consequences. Objectives: To determine whether apparent alcohol intake from beer changed among households over time, we used nationally-representative US Nielsen Consumer Panel purchasing data from 2004 to 2014, and incorporated information on percent alcohol by volume (ABV) to compute the number of standard drinks of alcohol consumed from beer as a result. Methods: We queried external data sources (e.g. official manufacture, consumer beer-related websites) to obtain beer-specific ABVs, merged this information with Nielsen consumer-level data, and calculated the average rate of beer and standard drink consumption per household per year. We used joinpoint regression to estimate annual percentage changes and annual absolute changes in intake over time, with separate piecewise linear segments fit between years if a significant deviation in trend was detected. Results: Higher alcohol content beer consumption increased steadily across the decade, accounting for 9.6% of total intake in 2004 compared to 21.6% of total intake by 2014. Standard drink intake from beer declined sharply post-2011 by 3.04% annually (95% CI: −5.93, −0.06) or by 4.52 standard drinks (95% CI: −8.69, −0.35) yearly – coinciding with several beer industry transitions, market share fluctuations, and consumer preference changes for beer occurring around that time. Conclusions: Despite consistent increases in higher alcohol content beer intake across the decade, households do not appear to be consuming more standard drinks of alcohol from beer as a result. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1928208 .

Electronic dental record-based surveillance of non-communicable conditions

ObjectiveThe objective of the study is to demonstrate that electronic dental records (EDRs) can be used to mine meaningful public health information. Study designRetrospective electronic dental chart-based reporting of disease prevalence. MethodsUsing dental EDRs (N = 104,768), the authors assessed the prevalence of common non-communicable medical conditions among unique patients seen at a United States (U.S.) dental college. ResultsThe prevalence of following conditions in patients visiting a U.S. dental college increased steadily with increasing age: hypertension, angina, stroke, myocardial infarction, congestive heart failure, diabetes, cancer, kidney disease, thyroid disease, and allergies. Prevalence of these conditions was several-fold higher in the 66+ years group than among younger adults. Prevalence of many of the assessed conditions approximated published national estimates. ConclusionsIn addition to the indispensable use of EDRs in dental education and patient management, EDRs can be mined to report on prevalence of non-communicable medical conditions among patients/population receiving dental care. Completeness and accuracy of entered information will significantly improve the usefulness of EDR for disease surveillance and research applications.

Online Mental Health Animations for Young People: Qualitative Empirical Thematic Analysis and Knowledge Transfer.

BackgroundMental ill-health is one of the most significant health and social issues affecting young people globally. To address the mental health crisis, a number of cross-sectoral research and action priorities have been identified. These include improving mental health literacy, translating research findings into accessible public health outputs, and the use of digital technologies. There are, however, few examples of public health–oriented knowledge transfer activities involving collaborations between researchers, the Arts, and online platforms in the field of youth mental health.ObjectiveThe primary aim of this project was to translate qualitative research findings into a series of online public mental health animations targeting young people between the ages of 16 and 25 years. A further aim was to track online social media engagement and viewing data for the animations for a period of 12 months.MethodsQualitative data were collected from a sample of 17 youth in Ireland, aged 18-21 years, as part of the longitudinal population-based Adolescent Brain Development study. Interviews explored the life histories and the emotional and mental health of participants. The narrative analysis revealed 5 thematic findings relating to young people’s emotional and mental health. Through a collaboration between research, the Arts, and the online sector, the empirical thematic findings were translated into 5 public health animations. The animations were hosted and promoted on 3 social media platforms of the Irish youth health website called SpunOut. Viewing data, collected over a 12-month period, were analyzed to determine the reach of the animations.ResultsNarrative thematic analysis identified anxiety, depression, feeling different, loneliness, and being bullied as common experiences for young people. These thematic findings formed the basis of the animations. During the 12 months following the launch of the animations, they were viewed 15,848 times. A majority of views occurred during the period of the social media ad campaign at a cost of €0.035 (approximately US $0.042) per view. Animations on feeling different and being bullied accounted for the majority of views.ConclusionsThis project demonstrates that online animations provide an accessible means of translating empirical research findings into meaningful public health outputs. They offer a cost-effective way to provide targeted online information about mental health, coping, and help-seeking to young people. Cross-sectoral collaboration is required to leverage the knowledge and expertise required to maximize the quality and potential reach of any knowledge transfer activities. A high level of engagement is possible by targeting non–help-seeking young people on their native social media platforms. Paid promotion is, therefore, an important consideration when budgeting for online knowledge translation and dissemination activities in health research.

Social Isolation and Loneliness: Translating Current Research into Health Care Practices and Improving Awareness

This paper examines the evidence to support the need to translate current research into health care practices about social isolation and loneliness (SIL) among older adults. The health care system may be in the best position to identify those at highest risk—namely, older adults, whose only interactions are with members of the health care system. This paper reviews recommendations related to periodic assessments, including the use of validated tools to identify those at highest risk. Through this identification, clinicians and health care researchers may be able to use these findings to better target meaningful clinical and public health interventions. Additionally, a critical step toward preventing, mitigating, or eliminating negative health impacts will be to improve awareness about the problem and impact of SIL within the older adult population. This paper reviews recommendations for improving overall awareness by including SIL in national health strategies and public campaigns. Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.

Preface

The 19th Annual International Astrophysics Conference (AIAC) was held at the beautiful La Posada de Santa Fe Hotel, Santa Fe, New Mexico, USA from March 9 to 13, 2020. This year’s meeting was exceptionally challenging, coming immediately prior to the onset and shutdown of the U.S. in response to the then rapidly developing COVID-19 outbreak. Of course, our Asian, Oceania, African, and European friends and colleagues were already either in or about to enter their own shutdowns. In addition, organizations such as NASA and various universities imposed their own travel restrictions just before the start of the meeting. Faced with the chaos and absence of any meaningful public health advice at the time, we made the difficult decision to go forward with the meeting in a truncated form and at the last minute managed to introduce conference meeting technology Zoom to aid us with those speakers who could not physically be there. I would like to thank conference organizer Adele Corona of ICNS, her assistant Kathy Tolbert, and the entire staff at the La Posada for their immense and untiring efforts in making the meeting the success that it was. Their acute ability to adapt to these last-minute changes, and their efforts to ensure as safe an environment as possible for all our attendees was crucial. Little did we know that this worldwide crisis was simply a foretaste of much, much worse to come. Therefore, and not surprisingly, we have pushed the 20th AIAC meeting well back into Fall of 2021 and we sincerely hope that the world will have recovered some degree of normalcy that will allow us to return to social activities of the past!The theme of the 19th AIAC was “From the Sun’s Atmosphere to the Edge of the Galaxy: A Story of Connections” and had a format of 25-minute presentations punctuated by selected 40-minute invited talks that explored various themes in greater detail.The oldest and the newest heliospheric space missions are distinguished by being the farthest and closest human-made objects ever to the Sun. Plunging into the depths of the atmosphere of the Sun, the Parker Solar Probe, launched in August 12, 2018, had completed the first three closest encounter passes to the Sun, edging closer and closer with each orbit, at the time of the meeting. The venerable Voyager 1 spacecraft, launched in 1977, entered the very local interstellar medium on 25 August 2012 and at ∼141 astronomical units from the Sun is now further from the Earth than any other human-made object. Voyager 2, following suit, likewise entered the interstellar medium on 5 November 2018. It is astonishing that, since the start of the space age in October 1957, humankind is now reaching for the stars and reaching into a star itself. Despite the immense distance separating the Voyager spacecraft from the Sun, the Sun’s influence is still felt in the immensely cold distant very local interstellar medium. This conference addressed the connected story of how the Sun and interstellar medium collectively shape their environment.

Exposure to Particulate Matter Is Associated With Elevated Blood Pressure and Incident Hypertension in Urban India.

Ambient air pollution, specifically particulate matter of diameter <2.5 μm, is reportedly associated with cardiovascular disease risk. However, evidence linking particulate matter of diameter <2.5 μm and blood pressure (BP) is largely from cross-sectional studies and from settings with lower concentrations of particulate matter of diameter <2.5 μm, with exposures not accounting for myriad time-varying and other factors such as built environment. This study aimed to study the association between long- and short-term ambient particulate matter of diameter <2.5 μm exposure from a hybrid spatiotemporal model at 1-km×1-km spatial resolution with longitudinally measured systolic and diastolic BP and incident hypertension in 5342 participants from urban Delhi, India, within an ongoing representative urban adult cohort study. Median annual and monthly exposure at baseline was 92.1 μg/m3 (interquartile range, 87.6-95.7) and 82.4 μg/m3 (interquartile range, 68.4-107.0), respectively. We observed higher average systolic BP (1.77 mm Hg [95% CI, 0.97-2.56] and 3.33 mm Hg [95% CI, 1.12-5.52]) per interquartile range differences in monthly and annual exposures, respectively, after adjusting for covariates. Additionally, interquartile range differences in long-term exposures of 1, 1.5, and 2 years increased the risk of incident hypertension by 1.53× (95% CI, 1.19-1.96), 1.59× (95% CI, 1.31-1.92), and 1.16× (95% CI, 0.95-1.43), respectively. Observed effects were larger in individuals with higher waist-hip ratios. Our data strongly support a temporal association between high levels of ambient air pollution, higher systolic BP, and incident hypertension. Given that high BP is an important risk factor of cardiovascular disease, reducing ambient air pollution is likely to have meaningful clinical and public health benefits.