OBJECTIVES:This study aimed to evaluate the associations of air pollution with disease activity and flare rate in patients with rheumatoid arthritis (RA). METHODS:This prospective cohort study included patients with RA who were treated at a tertiary medical centre in South Korea between January 2021 and December 2024. Air pollution exposure was estimated using monthly mean concentrations of 6 air pollutants (sulfur dioxide, nitrogen dioxide, ozone, carbon monoxide, particulate matter [PM]10, and PM2.5). Disease activity and flares were recorded longitudinally at each outpatient visit. Associations between air pollution and RA disease activity or flare were analysed using linear and logistic generalised estimating equations, adjusting for demographic characteristics, serologic status, medication use, socioeconomic factors, and meteorological variables. As a sensitivity analysis, a case-crossover design using daily air pollutant concentrations preceding each visit was applied, with conditional logistic regression to assess within the same patient. RESULTS:A total of 12,583 outpatient visits from 1070 patients were analysed. Among 6 pollutants, PM2.5 was significantly associated with an increased risk of flare (adjusted odds ratio [OR]: 1.113 [95% CI: 1.017-1.218]) and with higher Disease Activity Score based on 28 joints (DAS28) with C-reactive protein (CRP), Clinical Disease Activity Index, 28-tender joint count, and 28-swollen joint count. In addition, the association between PM2.5 and DAS28-CRP was more pronounced among women and nonsmokers. In the case-crossover analysis, prolonged cumulative exposure to PM2.5 over >2 weeks was associated with an increased risk of RA flare. CONCLUSIONS:Exposure to air pollutants, particularly PM2.5, was associated with increased RA disease activity and flare risk. Further studies are warranted to determine whether improving air quality can reduce disease activity in patients with RA.
Extreme weather events (EWE) may elevate HIV risk across Sub-Saharan Africa by worsening resource insecurities, yet limited research has included adolescent girls and young women (AGYW). We examined associations between EWE exposure, resource insecurities, and HIV vulnerabilities among AGYW in Kenya. We conducted a community-based cross-sectional survey with a purposive sample of AGYW aged 16–24 in Nairobi and Kisumu. We used latent profile analysis (LPA) to identify resource insecurity profiles based on food, water, and sanitation access; multinomial logistic regression to assess associations between past-year EWE exposure and profile membership; and multivariable regression to assess associations between profile membership and HIV vulnerabilities (transactional sex, intimate partner violence [IPV], adolescent sexual and reproductive health stigma [ASRH-S], sexual relationship power [SRP]). LPA categorized participants (n = 597; mean age: 20.13 years) into three profiles: mild, moderate, and severe insecurity. Multiple EWE exposure (vs. 1 EWE) was associated with increased odds of moderate (2–4 EWEs: Adjusted Relative Risk Ratio [aRRR]: 1.71, 95
Stroke remains a rare but life-threatening complication of pregnancy, with significant implications for both maternal and fetal health. Current stroke prevention and treatment guidelines offer limited guidance for managing stroke in pregnant and postpartum patients. Despite advances in obstetric and neurological care, the diagnosis and management of pregnancy-associated stroke continue to be challenged by delayed recognition, a lack of tailored clinical guidelines, and persistent disparities in outcomes. This scientific statement represents a multidisciplinary effort to synthesize current knowledge of the risk factors and diverse causes of stroke in pregnancy and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery. Nearly half of all US pregnancy-associated stroke hospitalizations occur in the setting of hypertensive disorders. Primary stroke prevention strategies include risk factor modification, aggressive hypertension management and prompt treatment of severe hypertension in pregnancy and postpartum, and antithrombotic therapy in some high-risk groups. Secondary stroke prevention strategies in pregnancy depend on the mechanism of the prior stroke. Pregnancy should not delay evidence-based treatments for acute stroke. The use of telemedicine can facilitate early consultation with a vascular neurologist and a maternal-fetal medicine specialist in cases of acute pregnancy-related stroke, helping to guide initial decision-making. Computed tomography, computed tomography angiography, and magnetic resonance imaging without contrast are all safe neuroimaging modalities for rapid evaluation of pregnant patients with acute stroke symptoms. Acute stroke alone is not an indication for immediate delivery, and stabilization of the mother should come first. Vaginal delivery after stroke is preferred when feasible because it avoids the surgical risks and hemodynamic stress associated with cesarean delivery. Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and breastfeeding and require support from a multidisciplinary rehabilitation team. Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes.
Extracorporeal membrane oxygenation (ECMO) is increasingly being utilized for life-threatening cardiac and/or respiratory failure refractory to conventional treatment. Acute kidney injury (AKI) and fluid balance disorders commonly occur both before and during ECMO, with approximately half of cases receiving treatment with continuous renal replacement therapy (CRRT). Acute kidney injury, fluid balance disorders, and CRRT influence both short- and long-term outcomes in this population. The 36th Acute Disease Quality Initiative (ADQI) meeting was held in June 2025 to develop multidisciplinary international expert recommendations for AKI, fluid balance, and CRRT during ECMO across the age spectrum. This work encompassed five working groups: 1) epidemiology, risk factors, and outcomes of AKI and CRRT, 2) fluid management and outcomes, 3) indications for CRRT and fluid removal during ECMO, 4) best practices for performing CRRT during ECMO, and 5) biomarkers, extracorporeal blood purification, and drug pharmacokinetics and pharmacodynamics. As part of this work, knowledge gaps and research priorities were identified.
Ambient air pollution drives cardiovascular disease (CVD), yet single-pollutant models overlook how risk emerges within broader environmental and structural contexts. This review applies the Public Health Exposome (PHE) framework, which integrates natural, built, social, and policy environments, to show how multilevel systems shape CVD vulnerability. Extreme heat, humidity, and climate variability modify pollutant toxicity, while structural inequities, discriminatory policies, and inadequate planning intensify exposures in marginalized communities. Cumulative psychosocial stress further amplifies inflammatory responses, activating the endo-exposome. Multi-omics studies reveal that pollution alters epigenomic, transcriptomic, and metabolomic pathways linked to inflammation, oxidative stress, and endothelial dysfunction. Emerging tools like machine learning, high-resolution exposure modeling, graph-based analytics, and wearable sensing, enable integration of environmental data and support systems-level approaches. The PHE framework illustrates how layered environmental and structural stressors accumulate to elevate CVD risk. Reducing this burden requires coupling PHE science with equitable public policy.
