Early life exposure to atmospheric air pollutants and potential DNA damage: Consequences on development and childhood outcomes APPEAL

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The burden of heat-related mortality attributable to recent human-induced climate change

Publication . Vicedo-Cabrera, A.M.; Scovronick, N.; Sera, F.; Royé, D.; Schneider, R.; Tobias, A.; Astrom, C.; Guo, Y.; Honda, Y.; Hondula, D.M.; Abrutzky, R.; Tong, S.; Coelho, M. de Sousa Zanotti Stagliorio; Saldiva, P. H. Nascimento; Lavigne, E.; Correa, P. Matus; Ortega, N. Valdes; Kan, H.; Osorio, S.; Kyselý, J.; Urban, A.; Orru, H.; Indermitte, E.; Jaakkola, J.J.K.; Ryti, N.; Pascal, M.; Schneider, A.; Katsouyanni, K.; Samoli, E.; Mayvaneh, F.; Entezari, A.; Goodman, P.; Zeka, A.; Michelozzi, P.; de’Donato, F.; Hashizume, M.; Alahmad, B.; Diaz, M. Hurtado; Valencia, C. De La Cruz; Overcenco, A.; Houthuijs, D.; Ameling, C.; Rao, S.; Di Ruscio, F.; Carrasco-Escobar, G.; Seposo, X.; Silva, S.; Madureira, J.; Holobaca, I.H.; Fratianni, S.; Acquaotta, F.; Kim, H.; Lee, W.; Iniguez, C.; Forsberg, B.; Ragettli, M.S.; Guo, Y.L.L.; Chen, B.Y.; Li, S.; Armstrong, B.; Aleman, A.; Zanobetti, A.; Schwartz, J.; Dang, T.N.; Dung, D.V.; Gillett, N.; Haines, A.; Mengel, M.; Huber, V.; Gasparrini, A.

Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991–2018. Across all study countries, we find that 37.0% (range 20.5–76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.

2021-05-31Journal article

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Fighting occupational risks among Portuguese wildland firefighters: looking at cytogenetic effects

Publication . Esteves, Filipa; Slezakova, Klara; Madureira, Joana; Vaz, Josiana; Fernandes, Adília; Pereira, Maria do Carmo; Morais, Simone; Teixeira, João Paulo; Costa, Solange

Background:Evidence linking wildland firefighters’ occupational exposure and health outcomes is still limited. Cytogenetic endpoints have long been applied in the surveillance of human genotoxic exposures and early effects of genotoxic carcinogens. Therefore, it is of utmost importance to clarify the exposure-induced cytogenetic effects concerning wildland firefighters’ occupational exposure at different time points (Pre-fire season and fire season). Objective:Here, we aim to evaluate the cytogenetic levels in buccal cells among a group of wildland firefighters during a Pre-fire season, considering both the i) influence of self-reported variables (e.g., lifestyle) on buccal micronucleus cytome assay (BMCyt) outcomes and ii) the cytogenetic damage in exfoliated buccal cells considering the estimated inhalation doses to particulate matter (PM) in non-fire work settings. Methods:A total of 176 northern Portuguese wildland firefighters (82% males; mean age of 37.5 ± 10.9) were recruited during the pre-fire season of 2021. Relevant information was obtained through a self-administered questionnaire. Genomic instability was assessed for 172 northern Portuguese wildland firefighters by BMCyt. PM10 and PM2.5 inhalation doses (indoor/outdoor) were estimated for a group of 80 firefighters based on methods described elsewhere [1]. Results:Some lifestyle variables (e.g., daily consumption of vegetables) shown to have a protective role on some BMCyt endpoints (p<0.05), whereas others such coffee consumption or being partof Permanent Intervention Teams (full-time firefighters) presented a negative impact (p<0.05). No significant association was found between estimated inhaled doses of PM10and PM2.5 (mean 1.73 ± 0.43 μg kg-1and 0.53 ± 0.21 μg kg-1, correspondingly) and BMCyt endpoints. Conclusions:The characterization of a population is a very important step to have a broad perspective of the potential risk factors that may influence the studied endpoints in further analysis. Surveillance based on (bio)monitoring programs may be a crucial tool to identify firefighters at high risk for developing adverse health outcomes.

2023-04Conference object

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Short-Term Association between Sulfur Dioxide and Mortality: A Multicountry Analysis in 399 Cities

Publication . O’Brien, Edward; Masselot, Pierre; Sera, Francesco; Roye, Dominic; Breitner, Susanne; Ng, Chris Fook Sheng; de Sousa Zanotti Stagliorio Coelho, Micheline; Madureira, Joana; Tobias, Aurelio; Vicedo-Cabrera, Ana Maria; Bell, Michelle L.; Lavigne, Eric; Kan, Haidong; Gasparrini, Antonio; MCC Collaborative Research Network

Background: Epidemiological evidence on the health risks of sulfur dioxide (sulfur dioxide SO2) is more limited compared with other pollutants, and doubts remain on several aspects, such as the form of the exposure–response relationship, the potential role of copollutants, as well as the actual risk at low concentrations and possible temporal variation in risks. Objectives: Our aim was to assess the short-term association between exposure to sulfur dioxide SO2 and daily mortality in a large multilocation data set, using advanced study designs and statistical techniques. Methods: The analysis included 43,729,018 deaths that occurred in 399 cities within 23 countries between 1980 and 2018. A two-stage design was applied to assess the association between the daily concentration of sulfur dioxide SO2 and mortality counts, including first-stage time-series regressions and second-stage multilevel random-effect meta-analyses. Secondary analyses assessed the exposure–response shape and the lag structure using spline terms and distributed lag models, respectively, and temporal variations in risk using a longitudinal meta-regression. Bi-pollutant models were applied to examine confounding effects of particulate matter with an aerodynamic diameter of less than or equal to 10 micrometers≤10μm (particulate matter begin subscript 10 end subscriptPM10) and 2.5 micrometers2.5μm (particulate matter begin subscript 2.5 end subscriptPM2.5), ozone, nitrogen dioxide, and carbon monoxide. Associations were reported as relative risks (RRs) and fractions of excess deaths. Results: The average daily concentration of sulfur dioxideSO2 across the 399 cities was 11.7 micrograms per meter cubed11.7 μg/m3, with 4.7% of days above the World Health Organization (WHO) guideline limit (40 micrograms per meter cubed40 μg/m3, 24-h average), although the exceedances occurred predominantly in specific locations. Exposure levels decreased considerably during the study period, from an average concentration of 19.0 micrograms per meter cubed19.0 μg/m3 in 1980–1989 to 6.3 micrograms per meter cubed6.3 μg/m3 in 2010–2018. For all locations combined, a 10 microgram per meter cubed10-μg/m3 increase in daily sulfur dioxide SO2 was associated with an RR of mortality of 1.0045 [95% confidence interval (CI): 1.0019, 1.0070], with the risk being stable over time but with substantial between-country heterogeneity. Short-term exposure to sulfur dioxide SO2 was associated with an excess mortality fraction of 0.50% [95% empirical CI (eCI): 0.42%, 0.57%] in the 399 cities, although decreasing from 0.74% (0.61%, 0.85%) in 1980–1989 to 0.37% (0.27%, 0.47%) in 2010–2018. There was some evidence of nonlinearity, with a steep exposure–response relationship at low concentrations and the risk attenuating at higher levels. The relevant lag window was 0–3 d. Significant positive associations remained after controlling for other pollutants. Discussion: The analysis revealed independent mortality risks associated with short-term exposure to sulfur dioxideSO2, with no evidence of a threshold. Levels below the current WHO guidelines for 24-h averages were still associated with substantial excess mortality, indicating the potential benefits of stricter air quality standards.

2023-03-08Journal article

Open access

Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries

Publication . Alahmad, Barrak; Khraishah, Haitham; Royé, Dominic; Vicedo-Cabrera, Ana Maria; Guo, Yuming; Papatheodorou, Stefania I.; Achilleos, Souzana; Acquaotta, Fiorella; Armstrong, Ben; Bell, Michelle L.; Pan, Shih-Chun; Coelho, Micheline de Sousa Zanotti Stagliorio; Colistro, Valentina; Dang, Tran Ngoc; Dung, Do-Van; De' Donato, Francesca K.; Entezari, Alireza; Guo, Yue-Liang Leon; Hashizume, Masahiro; Honda, Yasushi; Indermitte, Ene; Íñiguez, Carmen; Jaakkola, Jouni J.K.; Kim, Ho; Lavigne, Eric; Lee, Whanhee; Li, Shanshan; Madureira, Joana; Mayvaneh, Fatemeh; Orru, Hans; Overcenco, Ala Vladimir; Ragettli, Martina S.; Ryti, Niilo R.I.; Saldiva, Paulo Hilario Nascimento; Scovronick, Noah; Seposo, Xerxes; Sera, Francesco; Silva, Susana; Stafoggia, Massimo; Tobias, Aurelio; Garshick, Eric; Bernstein, Aaron S.; Zanobetti, Antonella; Schwartz, Joel D.; Gasparrini, Antonio; Koutrakis, Petros

Background: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-speciﬁc cardiovascular deaths. Methods: We used uniﬁed data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of speciﬁc cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-speciﬁc daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we ﬁt case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. Results: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1–2.3) and 9.1 (95% eCI, 8.9–9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4–2.8) and 12.8 (95% eCI, 12.2–13.1) for every 1000 heart failure deaths, respectively. Conclusions: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.

2022-12-12Journal article

Open access

Assessment of indoor air exposure at residential homes: Inhalation dose and lung deposition of PM10, PM2.5 and ultrafine particles among newborn children and their mothers

Publication . Madureira, Joana; Slezakova, Klara; Silva, Ana Inês; Lage, Bruna; Mendes, Ana; Aguiar, Lívia; Pereira, Maria Carmo; Teixeira, João Paulo; Costa, Carla

Accurate assessment of particulate matter (PM) dose and respiratory deposition is essential to better understand the risks of exposure to PM and, consequently, to develop the respective risk-control strategies. In homes, this is especially relevant in regards to ultrafine particles (UFP; <0.1 μm) which origin in these environments is mostly due to indoor sources. Thus, this study aimed to estimate inhalation doses for different PM mass/number size fractions (i.e., PM10, PM2.5 and UFP) in indoor air of residential homes and to quantify the deposition (total, regional and lobar) in human respiratory tract for both newborn children and mothers. Indoor real-time measurements of PM10, PM2.5 and UFP were conducted in 65 residential homes situated in Oporto metropolitan area (Portugal). Inhalation doses were estimated based on the physical characteristics of individual subjects and their activity patterns. The multi-path particle dosimetry model was used to quantify age-specific depositions in human respiratory tract. The results showed that 3-month old infants exhibited 4-fold higher inhalation doses than their mothers. PM10 were primarily deposited in the head region (87%), while PM2.5 and UFP depositions mainly occurred in the pulmonary area (39% and 43%, respectively). Subject age affected the pulmonary region and the total lung deposition; higher deposition being observed among the newborns. Similarly, lower lobes (left lobe: 37% and right lobe: 30%) received higher PM deposition than upper and middle lobes; right lobes lung are prone to be more susceptible to respiratory problems, since asymmetric deposition was observed. Considering that PM-related diseases occur at specific sites of respiratory system, quantification of site-specific particle deposition should be predicted in order to better evidence the respective health outcomes resulting from inhaled PM.

2020-05-15Journal article

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