BACKGROUND:Limited evidence exists regarding the association between outdoor light at night (LAN) and atopic diseases in children and adolescents. We aim to identify the relationship of outdoor LAN exposure with atopic diseases in children and adolescents and to conduct an exploratory statistical mediation analysis involving sleep disorder. METHODS:This study collected data from 2012 to 2018 in China, recruiting 176,968 children and adolescents (6-18 years). LAN exposure was assessed using VIIRS/DNB data based on individual addresses. Atopic diseases were determined by self-reported doctor-diagnosed asthma, rhinitis, eczema and conjunctivitis during the past two years. We fitted generalized linear mixed-effects regression models to assess the association between LAN and atopic diseases and conducted mediation analysis to explore the role of sleep disorders in LAN exposure and atopic diseases. RESULTS:Higher quartiles of outdoor LAN were associated with higher odds of having atopic diseases (quartile 2, OR = 1.08 [95% CI: 1.05-1.12]; quartile 3, OR = 1.12 [95% CI: 1.08-1.16]; quartile 4, OR = 1.13 [95% CI: 1.08-1.17]) compared to quartile 1. Increased outdoor LAN exposure was also associated with increased odds for asthma, rhinitis, and eczema. Furthermore, greater ORs were found among children aged <12 years, boys, and higher per capita GDP. The proportion of the total association statistically explained by sleep disorder was 3.18% (95% CI: 0.27%-6.65%) for atopic diseases, 4.52% (95% CI: 0.23%-18.23%) for asthma, 2.38% (95% CI: 0.14%-4.88%) for rhinitis, and 4.07% (95% CI: 0.56%-14.88%) for eczema. CONCLUSION:Higher outdoor LAN was associated with higher odds of atopic diseases among school-aged children and adolescents. Exploratory analyses suggested a statistical contribution of sleep disorder to some of these associations.
BACKGROUND:Maternal biomarkers of organophosphates (OPs) and pyrethroids (PYR) have been associated with compromised child cognitive development. Visual expectation (VExP) evaluates infant processing speed as a foundation for subsequent cognition. Prenatal exposures to pesticides among children of Thai farmworkers are significantly higher than those in the US. OBJECTIVE:We evaluated the association of prenatal urinary OP and PYR metabolites with VExP reaction time (RT), intraindividual variability in reaction time (SDRT), and percent off task and anticipatory responses. METHODS:We analyzed urinary metabolites of OPs and PYR in composited urine samples representing each trimester of pregnancy in 306 Thai farmworkers. Offspring completed VExP at 7, 12, and 18 months. In adjusted regression models, we tested the associations of OP and PYR metabolites with VExP outcomes. RESULTS:Prenatal OP metabolites were not associated with RT at 7 or 18 months. Females aged 12 months had significantly slower RT associated with first and third trimester OP metabolites and significantly higher SDRT at 12 and 18 months associated with first trimester OPs. Significantly faster RT and lower percent off task were associated with the PYR metabolite concentration in 18-month old females. Significantly higher anticipatory and lower off task rates were associated with concentrations of OP metabolites among 12 and 18 month old males. DISCUSSION:Increased intraindividual variability among females is consistent with previous parental reports of attention symptoms associated with prenatal OP metabolites. No consistent adverse associations with PYR were observed. Faster processing and learning were also associated with higher OPs and PYR metabolites at different ages.PP.
Under the background of climate change, concurrent exposure to fine particulate matter (PM2.5), ozone (O3), and heat wave is becoming increasingly prevalent; however, their combined cardiovascular associations remain insufficiently characterized. We conducted a time-stratified case-crossover study including 499,996 cardiovascular disease (CVD) deaths during the warm season (May to September) in Heilongjiang Province, China, from 2013 to 2022. Conditional logistic regression models were applied to estimate short-term associations. Meteorological data and air pollutant concentrations were obtained from validated gridded datasets based on residential addresses. Under the P95_3d heat wave definition, the odds ratio (OR) of CVD mortality associated with heat wave-only exposure was 1.119 (95%CI: 1.103, 1.136). For heat wave-PM2.5 co-exposure, the relative excess odds due to interaction (REOI) was 0.048 (95%CI: 0.015, 0.080). For heat wave-O3 co-exposure, the REOI was 0.110 (95%CI: 0.078, 0.142). For heat wave-O3-PM2.5 triple co-exposure, the REOI was -0.023 (95%CI: -0.090, 0.044). Stratified analyses suggested higher co-exposure ORs among adults aged 65 years and older and females, although sex differences in additive interaction were not statistically significant. These findings suggest that compound exposure to heat wave and air pollution may be associated with an increased short-term CVD mortality burden in cold-region populations.
Electromagnetic fields (EMFs) are ubiquitous and include low-frequency magnetic fields (LF-MF) from alternating currents, low-frequency electric fields (LF-EF) from wiring and equipment, and high-frequency electric fields (HF-EF) from wireless technologies and broadcast antennas. Bus drivers are exposed to an EMF mixture and report higher rates of sleep disorders than the general population. This study aimed to examine associations between sleep disturbances and cumulative occupational EMF exposure over 12 months, considering individual components and the mixture. EMF exposure estimates from the Swiss bus-exposure matrix were matched to the occupational history of 351 TRAPHEAC study bus drivers. Sleep quality, insomnia, and excessive daytime sleepiness (EDS) were assessed using the Global Sleep Assessment Questionnaire. Associations with cumulative EMF exposure were evaluated using multivariable linear regression controlled for age, sex, occupational noise, and nightshift work, and heat exposure. Mixture effects were analyzed with Bayesian Kernel Machine Regression (BKMR), and the influence of non-occupational EMF exposure was examined via stratification. Multivariable linear regression showed positive associations of HF-EF, but not LF-EF or LF-MF, with insomnia and EDS, although models explained little variance. BKMR confirmed the predominance of HF-EF in the mixture effect, with a positive but statistically non-significant dose-response for the EMF mixture. Stratified analyses suggested stronger associations among drivers with low non-occupational EMF exposure. These findings suggest a dose-response relationship between occupational EMF mixture exposure and sleep disturbances, primarily driven by HF-EF. However, the overall variance explained by EMF exposure is small, highlighting the role of other risk factors in sleep disturbances among bus drivers.
BACKGROUND:Farmworkers in the United States are exposed to extreme heat and demanding physical labor, placing them at increased risk for heat-related illnesses (HRI). This study examined individual, occupational, and household factors associated with self-reported HRI among men and women farmworkers in Imperial Valley, California. METHODS:This cross-sectional study used a convenience and snowball sampling approach to recruit agricultural workers through a local community organization. Participants were administered an in-person interview on their experience with HRI and potential risk factors. A multivariate regression analysis was conducted to identify variables related to HRI. RESULTS:From 300 participants, 119 (39.7%) experienced HRI, defined as reporting at least three HRI symptoms. In the multivariate regression analysis, HRI odds were significantly increased in women (aOR: 2.36, 95%CI: 1.35-4.15), in those reporting heat-related sleep problems (aOR: 3.25, 95%CI: 1.50-7.02), face covering use (aOR: 1.94, 95%CI: 1.09-3.45) and those working more than 5 days per week (aOR: 2.19, 95%CI: 1.23-3.91). Older age had a modest association with lower odds of HRI (aOR: 0.98, 95%CI: 0.96-0.99) and more than one break per day (aOR: 0.59, 95%CI: 0.35-1.00, p = 0.053) was associated with marginally lower HRI odds. CONCLUSIONS:As climate change continues to intensify occupational heat exposure among agricultural workers, interventions should extend beyond purely workplace-focused efforts and address cumulative exposure, non-occupational factors and structural constraints. Report of heat-related sleep problems has been associated with HRI relatively recently. Future research should establish the occupational, structural, and biological pathways contributing to the increased HRI odds for women farmworkers.
Accurate measurement of sanitation access is essential for tracking progress toward universal sanitation under the Sustainable Development Goals, yet current indicators focus on household-level access and rarely capture how sanitation is used within households or facility quality. We conducted a cross-sectional survey of 36,860 rural households in 14 low- and middle-income countries, assessing differences in open defecation practices among household members and sanitation facility quality. Heads of household reported where adult men, adult women, boys, and girls usually defecated, while enumerators directly observed sanitation facilities. We then developed alternative estimates of sanitation service levels that accounted for these dimensions. Despite access to a sanitation facility, 14.1% of households reported that at least one member practiced open defecation, including 2.9% of households classified as having basic sanitation. Children (12.6%) were more likely than adults (9.2% of men and 8.9% of women) to practice open defecation. Only 2.0% of sanitation facilities met the study's hygiene criteria, largely because 80.1% lacked a nearby handwashing facility with soap and water, 45.4% had visible flies, and 79.9% lacked appropriate anal cleansing materials. Structural deficiencies included cracked or damaged pedestals (26.3%), unusable floors (11.6%), non-functional facilities (5.7%), and lack of privacy (18.8%). Accounting for these factors yielded substantially lower estimates of basic sanitation coverage (2.2%) compared to the standard Joint Monitoring Programme (JMP) classification (31.8%), highlighting a gap between reported access and effective service delivery. Routine collection of disaggregated data on sanitation use and standardized measures of facility quality could improve monitoring of effective sanitation coverage.
The impact of per- and polyfluoroalkyl substances (PFAS) on hyperlipidemia and the potential modifying role of overall lifestyle remain underexplored. We examined six serum PFAS and a composite lifestyle score among 192 propensity score-matched case-control pairs. Individual and joint associations were evaluated using conditional logistic regression, quantile g-computation, and Bayesian kernel machine regression. A composite healthy lifestyle score was constructed based on smoking, alcohol drinking, physical activity, body shape, and diet. Per interquartile range (IQR) increase in ln-transformed concentrations, perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), 6:2 chlorinated polyfluorinated ether sulfonate (6:2 Cl-PFESA), and perfluoroundecanoic acid (PFUnDA) were associated with 89%, 110%, 67%, 49%, and 42% higher odds of hyperlipidemia, respectively. Mixture analyses revealed a joint positive association (OR = 1.57; 95% CI: 1.22, 2.02), driven predominantly by PFNA, the emerging alternative 6:2 Cl-PFESA, and PFHxS. Among participants with an unhealthy lifestyle (defined as a composite score ≤2 based on the population median), higher levels of PFOA, PFHxS, and PFNA were associated with significantly elevated odds of hyperlipidemia. However, for 6:2 Cl-PFESA, perfluorodecanoic acid (PFDA), and PFUnDA, these associations were generally weaker in participants adhering to a relatively healthy lifestyle, as supported by significant multiplicative interactions. Negative additive interactions were also observed for 6:2 Cl-PFESA and PFNA. Our findings demonstrate that adherence to a healthy lifestyle was associated with substantially weaker associations between 6:2 Cl-PFESA and PFDA exposures and hyperlipidemia, highlighting lifestyle modification may serve as a potential public health strategy to reduce environmental metabolic hazards.
Heavy metals can adversely affect neurodevelopment, immune function, and overall health during early childhood. However, few studies have evaluated heavy metal exposure in children. Therefore, we assessed urinary metal concentrations in Korean children and their association with allergic rhinitis. The study included 648 preschool children aged 3-5 years who participated in the Korean National Environmental Health Survey (KoNEHS, 2021-2023) Cycle 5. Urinary Hg was measured using a mercury analyzer, whereas V, Mn, Ni, Mo, Cd, Sb, Pb, and Cr were analyzed using inductively coupled plasma mass spectrometry. The geometric mean concentrations of Ni (3.33 μg/L), Mo (113 μg/L), and Sb (0.088 μg/L) were more than 1.5-fold higher than those reported in international biomonitoring surveys. Ni was positively correlated with Mo (r = 0.531) and Cd (r = 0.573). Urinary Ni concentrations differed significantly based on allergic rhinitis status (p = 0.006), whereas Mo showed a marginally significant association(p = 0.054). Logistic regression analysis showed that a 1-unit increase in log-transformed urinary Ni concentration was associated with a 37% increase in the odds of allergic rhinitis (OR = 1.37, 95% CI = 1.09-1.73). In the multivariable model including Ni, Cd, and Mo, the odds of allergic rhinitis increased by 34% (OR = 1.34, 95% CI: 1.02-1.76). After adjusting for sex, age, and ponderal index, the association remained statistically significant, with 35% increased odds ratio (OR = 1.35, 95% CI: 1.02-1.77). The association between urinary Ni concentration and allergic rhinitis was consistent across models. These findings support continued monitoring of heavy metal exposure and associated health effects in Korean children.
Per- and polyfluoroalkyl substances (PFAS), including emerging alternatives, have been implicated in type 2 diabetes (T2D), but epidemiological evidence remains inconsistent and the underlying mechanisms are unclear. We aimed to investigate the associations of individual and mixed PFAS exposure with T2D risk and to explore the roles of triglyceride-glucose (TyG)-related indices and metabolomic alterations. A total of 1647 participants (749 participants with T2D and 898 controls) were included. Multivariable logistic regression and weighted quantile sum (WQS) regression were used to evaluate the associations of single PFAS and mixed PFAS with T2D risk, respectively. Mediation analyses were conducted for TyG-related indices, and untargeted metabolomics and sequential mediation analyses were further performed in a nested case-control subset. Most individual PFAS were positively associated with T2D risk. Mixed-exposure analyses consistently showed that PFAS mixture was associated with increased T2D risk, with 6:2 FTS, PFNS, and PFPeS identified as the main contributors. Mediation analyses indicated that TyG-related indices (TyG, TyG-BMI, TyG-WC, and TyG-WHtR) were significantly associated with both PFAS mixture and T2D. Metabolomic analyses identified 35 shared metabolites associated with both PFAS mixture and T2D, mainly enriched in lipid-related pathways. Sequential mediation analyses further suggested that palmitic acid, stearic acid, and glutamine, together with TyG, might be involved in the pathways in the association between PFAS exposure and T2D risk. PFAS exposure was associated with T2D, with TyG-related indices and metabolites potentially involved in this association.
The study assessed temporal trends and spatial variation in serum concentrations of PCDD/Fs and dl-PCBs in the general population before and after the commissioning of an energy recovery plant (ERP) in northern Spain (2017-2023). A longitudinal observational design included 154 adults living either near the ERP or in a control area. Serum concentrations of PCDD/Fs and dl-PCBs were measured in the same participants and compared within them at two time points (before and after the ERP began operations). Linear mixed models were applied to evaluate the effects of study period and area of residence, adjusting for sociodemographic, anthropometric, lifestyle, and dietary variables. Among them, 54.5% resided in the vicinity of the ERP, 53.2% reported not consuming alcohol, 11% were non-smokers, and 40% reported consuming locally produced food. The mean serum concentration of PCDD/Fs + dl-PCB in TEQ-WHO2005, over the entire study period was 10.04 pg TEQ/g lipids. Slightly higher concentrations were observed in the post-startup phase (11.47 pg/g lipids), compared with the pre-startup period (10.56 pg/g lipids), although this difference was not statistically significant. Mixed models indicated higher PCDD/Fs + dl-PCB concentrations among residents of the exposed area in both periods. Men exhibited higher dl-PCB concentrations than women. Consumption of locally produced food was associated with higher PCDD/F concentrations. Although spatial differences suggest greater exposure near the ERP, no evidence indicates that its commissioning increased serum PCDD/F or dl-PCB levels. The levels observed are comparable to those recorded in other developed countries.
OBJECTIVES:We developed and evaluated a risk-based Air Quality Index (AQI) for Germany that harmonizes pollutant categories on risk equivalence, incorporates hourly concentrations, and improves health-relevant communication. METHODS:We identified pollutant-outcome pairs with causal or likely causal evidence, extracted effect estimates from systematic reviews and meta-analyses, and transformed daily mean effects into hourly effect estimates using German monitoring data. Equivalence coefficients were derived via Monte Carlo simulations and standardized to PM2.5 as the reference pollutant. PM2.5 thresholds were anchored in WHO Air Quality Guideline 2021 and the EU information threshold; risk-equivalent thresholds for PM10, NO2, O3, and SO2 were generated accordingly. An additional module was developed to account for concurrent elevation of multiple pollutants. The index was empirically evaluated using hourly data from German monitoring stations for 2019 and 2022, and the results were compared with the previous AQI. In sensitivity analyses, we assessed the effects of incorporating updated evidence and excluding asthma-related outcomes. RESULTS:Application of the risk-based AQI resulted in a marked shift from "very good" to "good" and "moderate" categories in comparison with the previous AQI, particularly for PM2.5 and O3, reflecting stricter concentration thresholds. "Poor" classifications increased modestly, while "very poor" remained rare. The multipollutant episodes module affected less than 1% of hours. CONCLUSION:Overall, the risk-based AQI represents a significant step toward health-based communication of air quality in Germany. By integrating scientific evidence into its design and providing tailored guidance, it enhances preventive public health protection. Its implementation may improve risk awareness and support behavioural changes that reduce exposure.
Rapid increases in pesticide use among smallholder farmers in Rwanda raise concerns about associated health impacts in human, animal and environmental systems. Women farmers warrant particular attention due to their substantial participation in agricultural labor and potential for distinct exposure patterns and health risks. We aimed to characterize pesticide use practices, safety knowledge, health effects and health concerns among Rwandan smallholder farmers using a gender-balanced, One Health-informed survey, which we administered to 109 male and 90 female smallholder farmers across 10 sectors of Rwanda's Eastern Province. Based on these self-reported data, we found pesticide use to be widespread and increasing, with more than 80% of participants reporting increased use within the past five years. The most used products were profenofos + cypermethrin insecticidal formulations and mancozeb-based fungicides, with 95% and 83% of participants reporting often or sometimes using these products, respectively. Self-reported symptoms potentially consistent with acute pesticides poisoning were also common, with 89% of participants reporting experiencing eye irritation, 83% rash, 73% headache and 67% breathing problems following pesticide use. Pesticide-related knowledge, concern, and safety behaviors were largely similar between men and women, including high levels of concern about health risks. Rwandan smallholder farmers increasingly rely on pesticides for crop protection, yet few receive formal training on safe application practices or protective behaviors. Our research identifies a consistent desire for additional pesticide health and safety training and important gaps in protective behaviors among the respondents, generating actionable insights for targeted interventions and safer agricultural practices.
BACKGROUND:While numerous studies have evaluated the effects of prenatal pesticide exposure on birth weight, few have examined associations with ultrasound measures of fetal growth, and none have focused on women living with HIV (WLHIV). Because children born to WLHIV face health vulnerabilities related to HIV infection and antiretroviral treatment, we conducted this study to determine whether pesticide exposure contributes further risk to fetal growth. OBJECTIVE:We assessed associations between prenatal exposure to 28 pesticide biomarkers and ultrasound-based fetal growth trajectories and traditional birth outcomes among WLHIV from Brazil and the U.S. METHODS:We evaluated 153 women living with HIV with prenatal ultrasounds, birth measurements, and urine specimens collected throughout pregnancy. Pesticide biomarkers (including herbicides, insect repellents, neonicotinoids, organophosphate insecticides, and pyrethroids) were quantified using mass spectrometry. Mixed effect linear regression models evaluated associations of geometric mean concentrations with fetal growth outcomes, and linear and logistic regression models assessed associations with birth outcomes. RESULTS:Most pesticides were not associated with meaningful decrements in fetal growth measures or birth outcomes. However, seven pesticides were linked to reductions in fetal growth measures persisting through birth. These included associations with smaller fetal and birth measurements, including head circumference, biparietal diameter, femur length, abdominal circumference, and birth weight Z-score. Two of these pesticides were also associated with increased odds of being small for gestational age. CONCLUSIONS:We found that certain pesticides increased the risk of suboptimal growth during pregnancy among WLHIV, highlighting possible additional health risks among children exposed to HIV and related treatments.
Firefighters suppressing wildland urban interface (WUI) fires may be exposed to smoke from burning vegetation as well as structures and vehicles. To better understand firefighters' internal dose exposures in the WUI environment, 250 firefighters from Southern California were enrolled into the Fire Fighter Cancer Cohort Study (FFCCS) in 2019, providing urine samples at enrollment and post-fire. One-hundred and twenty-five post-fire samples were collected from 89 participants. Samples were analyzed for metal(loid)s and metabolites of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and organophosphate esters (OPEs). We assessed the difference between creatinine-corrected urine concentrations for each chemical at enrollment compared with post-fire, controlling for the individual participant. We also compared these concentrations to the general U.S. population concentrations from the National Health and Nutrition Examination Survey (NHANES) and the American Conference of Governmental Industrial Hygienists Biological Exposure Indices (BEIs) when available. All seven PAH and 11 VOC metabolite concentrations increased significantly from enrollment to post-fire. Diphenyl phosphate, antimony, and cadmium also significantly increased from enrollment to post-fire. Maximum post-fire concentrations in firefighters also exceeded the BEI for 1-hydroxyprene and trans,trans-muconic acid (a metabolite of benzene). Firefighters assigned to structure defense had significantly higher increases in PAH metabolites compared to those assigned to wildland firefighting tasks. Personal protective equipment (PPE) usage was not evaluated in this study, but future studies could combine personal sampling with the collection of detailed PPE usage to develop effective practices and decontamination strategies during WUI fire responses.
Prenatal air pollution exposure has been associated with impaired fetal growth. However, the underlying biological mechanisms, potentially involving the placenta, remain poorly understood. This study aimed to investigate the effects of maternal air pollution exposure on placental biomarkers of oxidative stress and cellular ageing, and to determine whether these biomarkers contribute to the association between air pollution exposure and birth weight. The study included 499 participants from the Barcelona Life Study Cohort (BiSC), recruited between October 2018 and April 2021. Maternal exposure to nitrogen dioxide (NO2), black carbon, and particulate matter ≤2.5 μm (PM2.5) during pregnancy was estimated using hybrid Land Use Regression (LUR)-dispersion models. Placental relative mitochondrial DNA content (mtDNAcn) and telomere length (TL) were measured by qPCR, and associations between exposure and placental biomarkers were estimated using linear mixed-effects regression models adjusted for covariates. Increasing levels of NO2 and PM2.5 during the 1st and 3rd trimesters and across the entire pregnancy, as well as black carbon during the 3rd trimester, were significantly associated with an increase in placental mtDNAcn. No significant associations were observed between prenatal air pollution exposure and placental TL, nor between either placental biomarker and birth weight. In conclusion, prenatal air pollution exposure was associated with differences in placental mtDNAcn but not TL, and neither biomarker was significantly associated with birth weight.
Sewage contamination in high-income countries poses a serious public health concern due to the increased frequency of combined and sanitary sewer overflows. This might be due to aging infrastructure, climate change-driven extreme weather events, and insufficient regulatory enforcement. These events result in the discharge of untreated sewage into drinking and recreational waters, introducing pathogenic microorganisms that elevate the risk of gastrointestinal and other waterborne diseases, even in regions with advanced sanitation systems. This scoping review aims to map the evidence linking sewage overflows with waterborne disease incidence in high-income countries and to explore contributing structural (e.g., infrastructure failure, policy gaps) and environmental factors (e.g., extreme weather events). Literature searches were conducted across six databases and four grey literature sources, identifying 434 records. After screening and eligibility assessment, 20 studies published between 2007 and 2024 were included. The findings consistently associate combined sewer overflow events and water distribution system failures with elevated risks of gastrointestinal illness. High-volume sewage discharges following extreme rainfall were strongly linked to increased emergency room visits and outbreak incidence, with dose-response relationships observed in several studies, adding biological plausibility to these associations. However, the strength of this evidence must be interpreted with caution, as the majority of included studies were observational in design, limiting causal inference. Monitoring studies also revealed the presence of fecal indicator bacteria, viruses, protozoa, and antibiotic-resistant pathogens in affected water bodies. Underreporting of sewage spills and waterborne disease outbreaks emerged as a widespread limitation, impeding accurate public health risk assessment. Despite the availability of modern sanitation technologies, many high-income countries face persistent challenges due to deferred infrastructure upgrades and weak compliance mechanisms. This review emphasizes the importance of strengthening surveillance, implementing real-time water quality monitoring, and coordinating policy and infrastructure actions to mitigate sewage-related waterborne diseases resulting from inadequate wastewater management and changing environmental conditions.
BACKGROUND:Climate change is increasing drought frequency and severity, posing risks to potable water supply and public health including in high-income countries. Evidence on these risks remains fragmented, limiting preparedness and policy development. OBJECTIVES:This scoping review synthesises international evidence on health impacts of potable water supply disruptions during drought in high-income countries, with attention to population groups who are most exposed, and with a view to informing policy and practice in the United Kingdom. METHODS:Following PRISMA-ScR guidelines, seven databases were searched for English-language studies (1963-2024) addressing health outcomes linked to drought-related potable water disruption in high-income countries. Eligible designs included observational and experimental studies. Data were narratively synthesised and presented by topic theme and direction of health outcome. RESULTS:Of 19,105 citations screened, 33 studies met inclusion criteria. Most evidence originated from Australia, the USA, and Europe. Drought was associated with deterioration in water quality, notably elevated concentrations of arsenic, manganese, and nickel; and occasional bacterial contamination, particularly in private water supplies. Reported health outcomes included gastrointestinal illness, exacerbation of chronic conditions, and mixed evidence for cardiovascular risk. Mental health impacts, such as distress, anxiety, and reduced wellbeing, were consistently observed, especially among rural and farming populations and men. Risk was heightened for households reliant on private water supplies and socioeconomically disadvantaged groups. CONCLUSIONS:Potable water supply disruptions during drought represent an under-recognised public health hazard in high-income countries. Strengthening surveillance, infrastructure resilience, and cross-sector preparedness is critical as droughts intensify under climate change. Future research should standardise exposure definitions, quantify health impacts, and evaluate mitigation and adaptation strategies.
AIM:Emerging evidence suggests that early-life environmental conditions may induce long-term metabolic programming. We evaluated the association of the season of conception and periconceptional or perinatal climatic conditions with the adult Atherogenic Index of Plasma (AIP) in patients with Acute Coronary Syndrome (ACS) and matched controls. METHODS:In this life-course study, we analysed 833 patients with ACS and 833 age- and sex-matched controls. Individual data were linked with historical climatological records to determine mean temperature and diurnal temperature range (DTR) during the estimated month of conception, and sunshine hours during the month of birth. Adjusted multiple linear regression models identified predictors of adult AIP. RESULTS:ACS patients presented higher AIP than controls (0.15 ± 0.28 vs. 0.06 ± 0.29; p < 0.001). Summer conception predicted higher adult AIP in ACS patients (B = 0.042; 95% CI: 0.003-0.081; p = 0.035) and controls (B = 0.051; 95% CI: 0.006-0.097; p = 0.028). Higher mean temperature (B = 0.007; 95% CI: 0.001-0.014; p = 0.030) and wider DTR (B = 0.085; 95% CI: 0.002-0.169; p = 0.045) at conception also predicted higher adult AIP, with consistent findings across cohorts. No association was found with perinatal sunshine hours. CONCLUSIONS:Conception in summer and with higher ambient temperatures or wider DTR is associated with a pro-atherogenic lipid phenotype decades later. These findings suggest that environmental conditions at the very beginning of life may induce long-term metabolic programming of cardiovascular risk; an association increasingly important to understand given current global warming trends.
Phthalates and phenolic compounds are ubiquitous consumer chemicals, and children are particularly vulnerable to their potential health effects. In Thailand, however, information on children's exposure and regional variation remains limited. We recruited 250 children from two distinct regions of Thailand (Suphan Buri and Chiang Rai) in 2023, measured urinary concentrations of major metabolites of phthalates and alternative plasticizers as well as parent phenolic compounds, and administered questionnaires. The highest median concentrations were observed for the sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP, 73.2 ng/mL), followed by mono-n-butyl phthalate (MnBP, 72.2 ng/mL) and the sum of diisononyl phthalate metabolites (∑DiNP, 22.6 ng/mL). These levels were 1.4-3.4 times higher than those in German children (GerES V, 2014-2017) and 2.5-5.7 times higher than those in U.S. children (NHANES, 2017-2018). Significant regional differences were identified, with 16 of 26 metabolites showing higher concentrations in Chiang Rai children. These included metabolites of diisobutyl phthalate (DiBP), di-n-butyl phthalate (DnBP), DEHP, DiNP, and di(2-ethylhexyl) terephthalate (DEHTP) as well as benzophenone-3 and bisphenol S. Notably, DiNP metabolite levels in Chiang Rai were 1.9-2.6-fold higher than the highest levels reported elsewhere. Risk assessment showed 69.3% of children in Chiang Rai and 16.4% in Suphan Buri exceeded a cumulative hazard index of 1. Regardless of region, DnBP, DEHP, DiBP, and di(2-ethylhexyl) adipate (DEHA) were the primary contributors to risk. Sauce consumption and medication use were associated with higher phthalate levels. These findings highlight the need to develop targeted exposure-reduction strategies and regulatory interventions for Thai children.
BACKGROUND:Heatwaves are a significant public health concern linked to substantial excess mortality worldwide. Most deaths during heatwaves arise from the exacerbation of underlying chronic conditions rather than direct heat-related causes, making individual attribution challenging. Improving how heatwave-associated deaths are recorded and monitored is essential for enhancing data quality, comparability, and public health response. OBJECTIVE:To map and synthesise global practices for recording and monitoring heatwave-related mortality, including attribution methods, ICD coding, and integration of real-time surveillance. METHODS:A scoping review was conducted following Joanna Briggs Institute methodology and the Population-Concept-Context framework. Searches were performed in PubMed, Scopus, CINAHL, Embase, and Web of Science from inception. Two reviewers independently screened and extracted data on mortality attribution, ICD coding, recording systems, managing agencies, surveillance approaches, heatwave definitions, limitations, and recommendations. Findings were synthesized using tables, figures, conceptual maps, and narrative summaries. The protocol was registered in the Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/5AX4T. RESULTS:A total of 176 studies from 41 countries were included. Only 8.5% of the included studies used heat-specific ICD codes to identify direct heat-related death; real-time mortality monitoring systems were limited, fragmented, and inconsistent across jurisdictions. CONCLUSIONS:Heatwave-associated deaths are rarely coded as direct heat-related, reflecting the indirect and multifactorial pathways linking heat to mortality. Significant gaps in global mortality recording and surveillance systems highlight the need for improved attribution practices, standardised coding, integrated systems, and stronger institutional coordination to support public health preparedness in a warming climate.
