Research and Faculty

Environ Int. 2024 Nov 13;194:109145. doi: 10.1016/j.envint.2024.109145. Online ahead of print.

ABSTRACT

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are fluorinated chemicals linked to adverse pregnancy and birth outcomes. However, the underlying mechanisms, specifically their effects on maternal inflammatory processes, are not well characterized.

OBJECTIVE: We examined associations between prenatal PFAS exposure and repeated measures of inflammatory biomarkers, including C-reactive protein (CRP) and four cytokines [Interleukin-10 (IL-10), IL-1β, IL-6, and tumor necrosis factor-α (TNF-α)].

METHODS: We analyzed data from 469 pregnant women in a nested case-control study of preterm birth at Brigham and Women’s Hospital in Boston, Massachusetts (2006-2008). We measured nine PFAS in early pregnancy plasma samples (median gestation: 10 weeks), with inflammatory biomarkers measured at median gestations of 10, 18, 26, and 35 weeks. We used linear mixed models for repeated measures and multivariable regression for visit-specific analysis to examine associations between each PFAS and inflammation biomarker, adjusting for maternal demographics, pre-pregnancy BMI, and parity. We examined the effects of PFAS mixture using sum of all PFAS (∑PFAS) and quantile-based g-computation approaches.

RESULTS: We observed consistent inverse associations between most PFAS and cytokines, specifically IL-10, IL-6, and TNF-α, in both single pollutant and mixture analyses. For example, an interquartile range increase in perfluorooctanesulfonic acid was associated with -10.87 (95% CI: -19.75, -0.99), -13.91 (95% CI: -24.11, -2.34), and -8.63 (95% CI: -14.51, -2.35) percent change in IL-10, IL-6, and TNF-α levels, respectively. Fetal sex, maternal race, and visit-specific analyses showed associations between most PFAS and cytokines were generally stronger in mid-pregnancy and among women who delivered males or identified as African American.

CONCLUSIONS: The observed suppression of both regulatory (IL-10) and pro-inflammatory (TNF-α) cytokines suggests that PFAS may alter maternal inflammatory processes or immune functions during pregnancy. Further research is needed to understand the effects of both legacy and newer PFAS on inflammatory pathways and their broader clinical implications.

PMID:39550829 | DOI:10.1016/j.envint.2024.109145

Environ Epidemiol. 2024 Nov 12;8(6):e353. doi: 10.1097/EE9.0000000000000353. eCollection 2024 Dec.

ABSTRACT

Environmental epidemiologists are increasingly evaluating whether and how human exposure to vegetation (greenspace) can benefit health. Relatedly, scientists and policymakers have highlighted the need to integrate efforts to address the dual crises of accelerating climate change and rapid loss of biodiversity, including nature-based solutions. Greenspace is one solution that can protect humans from climate-related exposures, including heat, air pollution, and flooding. However, most environmental epidemiology research on greenspace occurs in high-income countries, and adverse birth outcomes, previously associated with greenspace, disproportionately occur in low- and middle-income countries (LMICs). Although epidemiology research using existing survey or administrative data and satellite imagery is important for documenting broad patterns, such research is lacking in LMICs. Further, complementary, community-engaged research to inform interventions and policies is needed so that nature-based solutions with co-benefits for climate mitigation and health are adopted effectively and equitably. We provide suggestions for future research that would increase impact and call for better representation of LMICs and vulnerable communities within high-income countries in research and action on greenspace and climate-sensitive birth outcomes.

PMID:39539756 | PMC:PMC11560118 | DOI:10.1097/EE9.0000000000000353

Environ Epidemiol. 2024 Nov 12;8(6):e353. doi: 10.1097/EE9.0000000000000353. eCollection 2024 Dec.

ABSTRACT

Environmental epidemiologists are increasingly evaluating whether and how human exposure to vegetation (greenspace) can benefit health. Relatedly, scientists and policymakers have highlighted the need to integrate efforts to address the dual crises of accelerating climate change and rapid loss of biodiversity, including nature-based solutions. Greenspace is one solution that can protect humans from climate-related exposures, including heat, air pollution, and flooding. However, most environmental epidemiology research on greenspace occurs in high-income countries, and adverse birth outcomes, previously associated with greenspace, disproportionately occur in low- and middle-income countries (LMICs). Although epidemiology research using existing survey or administrative data and satellite imagery is important for documenting broad patterns, such research is lacking in LMICs. Further, complementary, community-engaged research to inform interventions and policies is needed so that nature-based solutions with co-benefits for climate mitigation and health are adopted effectively and equitably. We provide suggestions for future research that would increase impact and call for better representation of LMICs and vulnerable communities within high-income countries in research and action on greenspace and climate-sensitive birth outcomes.

PMID:39539756 | PMC:PMC11560118 | DOI:10.1097/EE9.0000000000000353

Heliyon. 2024 Oct 23;10(21):e39767. doi: 10.1016/j.heliyon.2024.e39767. eCollection 2024 Nov 15.

ABSTRACT

Experiencing a hurricane during pregnancy is associated with increased risk of adverse birth outcomes and poor mental health. Pregnant people from marginalized communities are more susceptible to adverse effects, as they have fewer resources to overcome hardships at a time when shelter and nutrition are essential. When Hurricane Maria (HM) devastated Puerto Rico in September 2017, the archipelago was already burdened with high poverty, health disparities, environmental contamination, and fragile utility infrastructure. We aimed to compare biomarkers of environmental exposures among pregnant participants in the PROTECT cohort before and after HM and to identify hurricane-related sources of exposure. Metals, PAHs, phthalate metabolites, and phenols were measured in urine samples collected from participants at three prenatal visits (2011-2019). Samples were categorized as before, <3 months, 3-6 months, and >6 months after HM. Using linear mixed effects models, we found that in the 6 months after HM, participants had higher Co, Ni, and DEHPTP concentrations, indicating increased exposure, and lower concentrations of PAHs, several metals, and phthalates, suggesting decreased exposure, compared to pre-HM levels. Biomarkers were not associated with potential exposure sources assessed through questionnaire or previously measured tap water contaminants. This study provides insight into how extreme weather events may alter environmental exposures among pregnant people in Puerto Rico. As climate change has increased the frequency and magnitude of such events, additional research is needed to clarify the implications for maternal and child health and to identify sources of related environmental exposures within this vulnerable population.

PMID:39524775 | PMC:PMC11546135 | DOI:10.1016/j.heliyon.2024.e39767

Int J Occup Saf Ergon. 2024 Nov 11:1-10. doi: 10.1080/10803548.2024.2414577. Online ahead of print.

ABSTRACT

Objectives. Facing risk of contracting COVID-19, adopting individual health and safety behaviors to prevent infection was critical for first responders to ensure personal and public safety. This study assessed direct and indirect relationships between safety leadership, safety behaviors and the effect of risk perceptions on these relationships among aircraft rescue and firefighting (ARFF) personnel during the COVID-19 pandemic. Method. A total of 127 ARFF frontline personnel participated in an online survey. COVID-19-specific constructs of safety leadership, safety behaviors and risk perceptions were assessed using a structural model with moderation and serial mediation analysis using the mixed-model method. Results. Safety leadership had significant direct effects on safety compliance and indirect effects on safety participation and mask use. ARFF personnel’s perceived severity of the virus had significant direct effects on mask use and indirect effects on safety compliance and participation behaviors. The interaction of safety leadership and perceived susceptibility to the virus had significant direct effects on safety compliance behaviors and indirect effects on safety participation and mask use. Conclusion. There are practical implications to strengthen safety compliance behaviors through leadership. This study contributes to the literature on leadership and safety behaviors among ARFF personnel during exceptional circumstances and times of crisis.

PMID:39523892 | DOI:10.1080/10803548.2024.2414577

Lancet. 2024 Nov 16;404(10466):1955-1988. doi: 10.1016/S0140-6736(24)01925-1. Epub 2024 Nov 4.

ABSTRACT

BACKGROUND: Stillbirth is a devastating and often avoidable adverse pregnancy outcome. Monitoring stillbirth levels and trends-in a comprehensive manner that leaves no one uncounted-is imperative for continuing progress in pregnancy loss reduction. This analysis, completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, methodically accounted for different stillbirth definitions with the aim of comprehensively estimating all stillbirths at 20 weeks or longer for 204 countries and territories from 1990 to 2021.

METHODS: We extracted data on stillbirths from 11 412 sources across 185 of 204 countries and territories, including 234 surveys, 231 published studies, 1633 vital statistics reports, and 10 585 unique location-year combinations from vital registration systems. Our final dataset comprised 11 different definitions, which were adjusted to match two gestational age thresholds: 20 weeks or longer (reference) and 28 weeks or longer (for comparisons). We modelled the ratio of stillbirth rate to neonatal mortality rate with spatiotemporal Gaussian process regression for each location and year, and then used final GBD 2021 assessments of fertility and all-cause neonatal mortality to calculate total stillbirths. Secondary analyses evaluated the number of stillbirths missed with the more restrictive gestational age definition, trends in stillbirths as a function of Socio-demographic Index, and progress in reducing stillbirths relative to neonatal deaths.

FINDINGS: In 2021, the global stillbirth rate was 23·0 (95% uncertainty interval [UI] 19·7-27·2) per 1000 births (stillbirths plus livebirths) at 20 weeks’ gestation or longer, compared to 16·1 (13·9-19·0) per 1000 births at 28 weeks’ gestation or longer. The global neonatal mortality rate in 2021 was 17·1 (14·8-19·9) per 1000 livebirths, corresponding to 2·19 million (1·90-2·55) neonatal deaths. The estimated number of stillbirths occurring at 20 weeks’ gestation or longer decreased from 5·08 million (95% UI 4·07-6·35) in 1990 to 3·04 million (2·61-3·62) in 2021, corresponding to a 39·8% (31·8-48·0) reduction, which lagged behind a global improvement in neonatal deaths of 45·6% (36·3-53·1) for the same period (down from 4·03 million [3·86-4·22] neonatal deaths in 1990). Stillbirths in south Asia and sub-Saharan Africa comprised 77·4% (2·35 million of 3·04 million) of the global total, an increase from 60·3% (3·07 million of 5·08 million) in 1990. In 2021, 0·926 million (0·792-1·10) stillbirths, corresponding to 30·5% of the global total (3·04 million), occurred between 20 weeks’ gestation and 28 weeks’ gestation, with substantial variation at the country level.

INTERPRETATION: Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third-close to 1 million in total-are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations. Addressing inequities in universal maternal health coverage, strengthening the quality of maternal health care, and improving the robustness of data systems are urgently needed to reduce the global burden of stillbirths.

FUNDING: Bill & Melinda Gates Foundation.

PMID:39510107 | DOI:10.1016/S0140-6736(24)01925-1

Front Public Health. 2024 Oct 3;12:1427116. doi: 10.3389/fpubh.2024.1427116. eCollection 2024.

ABSTRACT

INTRODUCTION: Many school buildings have inadequate ventilation, rudimentary if any air filtration, and aging and poorly maintained mechanical systems, all of which can lead to poor indoor air quality (IAQ). These issues are especially acute in environmental justice (EJ) communities where schools are located in polluted areas. This community-based participatory research examines how IAQ in naturally ventilated school buildings is affected by the use of air purifiers, air change rates, outdoor pollution levels, and teacher and staff behavior.

METHODS: IAQ assessments were performed at two schools in Detroit, Michigan, which included building walk-through inspections and continuous indoor and outdoor measurements of black carbon (BC), particulate matter (PM₁₀ and PM_2.5), carbon dioxide (CO₂), air change rates (ACRs), temperature, humidity, and sound pressure levels. Air purifiers with usage monitors were then installed, and the IAQ assessments were repeated. Teachers were surveyed before and after purifier deployment.

RESULTS: At baseline, classrooms had low ACRs (0.58-1.38 h^-1), moderate PM_2.5 levels (2.8-8.9 μg/m³), highly variable PM₁₀ concentrations (4.7-37.5 μg/m³), and elevated BC levels (0.3-0.7 μg/m³), reflecting emissions from local traffic, industry and other sources. The installation and use of purifiers reduced pollutant levels and the overall performance matched the predictions of a single compartment model. However, daily reductions varied widely among classrooms, reflecting differences in teacher behavior regarding the frequency of opening windows and the operation of purifiers, including differences in purifier fan speed settings and whether purifiers were used at night. Survey responses indicated that many teachers were aware of IAQ problems. The higher rates reported for health symptoms and dissatisfaction at one school may have lowered the teachers’ tolerance to noise and reduced purifier use.

DISCUSSION: The study helps explain the variation reported in prior studies using purifiers, and it reinforces the need to monitor IAQ and purifier use, use enhanced filtration and increase ventilation, and engage with teachers and school staff to support and maintain IAQ programs in schools.

PMID:39421817 | PMC:PMC11483887 | DOI:10.3389/fpubh.2024.1427116

Chemosphere. 2024 Oct;366:143468. doi: 10.1016/j.chemosphere.2024.143468. Epub 2024 Oct 4.

ABSTRACT

Polycyclic aromatic hydrocarbons (PAHs) are widespread environmental contaminants produced through the combustion of organic matter, with sources ranging from traffic pollution to diet. Although PAH exposure has been associated with adverse health effects, few studies have examined its impact on neurodevelopmental delay (NDD). Thus, our study aims to investigate the effect of prenatal PAH exposure on the odds of NDD. We measured 7 hydroxylated PAH metabolites in spot urine samples collected up to three times during pregnancy in the PROTECT birth cohort. NDD was identified using score cutoffs from the Ages and Stages Questionnaire, 3rd edition offered in Spanish, across five domains at 12, 24, 36, and 48 months. We utilized logistic regression and mixed effects logistic regression models to assess associations between prenatal PAH concentrations and NDD. Our results showed mostly lower odds of NDD with higher PAH exposure (p < 0.05). However, male children showed higher odds of NDD in relation to PAH exposure, particularly in the Fine Motor domain. For example, 1-hydroxypyrene was associated with 1.11 (1.01, 1.23) times odds of delay in fine motor function in male children versus 0.91 (0.82, 1.00) times odds in female children. Our preliminary sex-specific results suggest that PAH exposure may impact neurodevelopment in male children and prompt further investigation into the potential sex-specific mechanisms of PAHs on motor function.

PMID:39369740 | DOI:10.1016/j.chemosphere.2024.143468

EBioMedicine. 2024 Nov;109:105383. doi: 10.1016/j.ebiom.2024.105383. Epub 2024 Oct 5.

ABSTRACT

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is linked to ageing and genetic and environmental risk factors, yet underlying mechanisms are incompletely understood. We aimed to evaluate epigenetic age acceleration (EAA), i.e., DNA methylation (DNAm) age acceleration, and its association with ALS case status and survival.

METHODS: In this study, we included 428 ALS and 288 control samples collected between 2011 and 2021. We calculated EAA using the GrimAge residual method from ALS and control blood samples and grouped participants with ALS into three ageing groups (fast, normal, slow). We associated EAA with ALS case status and survival, stratified by sex, and correlated it with environmental and biological factors through occupational exposure assessments, immune cell proportions, and transcriptome changes.

FINDINGS: Participants with ALS had higher average EAA by 1.80 ± 0.30 years (p < 0.0001) versus controls. Participants with ALS in the fast ageing group had a hazard ratio of 1.52 (95% confidence interval 1.16-2.00, p = 0.0028) referenced to the normal ageing group. In males, this hazard ratio was 1.55 (95% confidence interval 1.11-2.17, p = 0.010), and EAA was positively correlated with high-risk occupational exposures including particulate matter (adj.p < 0.0001) and metals (adj.p = 0.0087). Also, in male participants with ALS, EAA was positively correlated with neutrophil proportions and was negatively correlated with CD4+ T cell proportions. Pathways dysregulated in participants with ALS with fast ageing included spliceosome, nucleocytoplasmic transport, axon guidance, and interferons.

INTERPRETATION: EAA was associated with ALS case status and, at least in males, with shorter survival after diagnosis. The effect of EAA on ALS was partially explained by occupational exposures and immune cell proportions in a sex-dependent manner. These findings highlight the complex interactions of ageing and exposures in ALS.

FUNDING: NIH, CDC/National ALS Registry, ALS Association, Dr. Randall Whitcomb Fund for ALS Genetics, Peter Clark Fund for ALS Research, Sinai Medical Staff Foundation, Scott L. Pranger ALS Clinic Fund, NeuroNetwork Therapeutic Discovery Fund, NeuroNetwork for Emerging Therapies.

PMID:39369616 | PMC:PMC11491892 | DOI:10.1016/j.ebiom.2024.105383

Lancet. 2024 Oct 5;404(10460):1305. doi: 10.1016/S0140-6736(24)01505-8.

NO ABSTRACT

PMID:39368840 | DOI:10.1016/S0140-6736(24)01505-8