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UK: Babies exposed to air pollution have greater risk of death - study

Via The Guardian: Babies exposed to air pollution have greater risk of death. Excerpt:

Babies living in areas with high levels of air pollution have a greater risk of death than those surrounded by cleaner air, a study has found. 

It is not the first study to investigate the link between air pollution and infant mortality , but thestudydrew particular focus on different pollutants and its analysis at different points in babies’ lives.  

Dr Sarah Kotecha , a researcher at Cardiff University, said the results were difficult for pregnant women and their families to do much about.

“You live where you live and you can’t avoid pollution day in day out,” she said, adding that it was down to policymakers to reduce pollution levels and for researchers to unpick how pollutants affect health. “If you can find out some of the mechanisms you can look at potential interventions,” she added. 

A growing body of research has revealed links between different components of air pollution and health issues, including lung problems, heart disease, mental health problems, dementia and low birthweight. 

The latest study, yet to be peer-reviewed or published, will be presented at the European Respiratory Society international congress in Madrid. 

Kotecha said the research was based on data for almost 8 million live births in England and Wales between 2001 and 2012.  

The team divided England and Wales into 35,000 areas, each containing approximately 1,500 residents, and looked at the annual death rates for babies up to one-year-old, together with the average annual levels for three pollutants. These were particulate matter known as PM10, which comes from sources including vehicles and waste incineration, nitrogen dioxide (NO2), and sulphur dioxide (SO2), which is released through burning of fossil fuels in power stations and refineries as well as metal extraction. 

For each pollutant the team compared the death rate for babies in the worst fifth of polluted areas with those in the best fifth.  

Once factors such as maternal age, deprivation level for the area and birthweight were taken into account, the team said that babies aged up to one year had a greater chance of dying living in areas with the worst air pollution compared with areas with the cleanest air. 

The results held across all three pollutants, with the odds of death 7% worse for NO2, 4% worse for PM10 and 19% worse for SO2. Further analysis suggested that of the three pollutants, only SO2 was associated with deaths within a baby’s first 28 days. 

The study was unable to prove whether high levels of air pollution were to blame for the increased risk of death in those areas. It also did not take into account levels of indoor air pollution.

Indonesia: 10 million children at risk from air pollution due to wild forest fires

Via ReliefWeb, UNICEF has published: Indonesia: 10 million children at risk from air pollution due to wild forest fires.

Jakarta (Indonesia), 23 September 2019 – Wild forest and peatland fires across Kalimantan and Sumatra in Indonesia are putting nearly 10 million children under 18 at risk from air pollution, said UNICEF today. 

Small children are especially vulnerable to air pollution because they breathe more rapidly, and their physical defenses and immunities are not fully developed. It is estimated that 2.4 million children under five live in the areas most affected by the haze and wild fires, which have been burning in Indonesia since July 2019. 

UNICEF warns that air pollution affects babies even before they are born. Research has shown that babies born to mothers exposed to high levels of pollution during pregnancy are more likely to experience reduced growth while in utero, low birth weight, and be delivered preterm. 

“Poor air quality is a severe and growing challenge for Indonesia,” said Debora Comini, UNICEF Representative. “Every year, millions of children are breathing toxic air that threatens their health and causes them to miss school – resulting in lifelong physical and cognitive damage.”  

According to the Ministry of Education and Culture, more than 46,000 school are currently affected by poor air quality, impacting more than 7.8 million students. Many schools have had to be closed in the most affected areas, depriving learning opportunities from children. 

While forest and peatland fires are common in Indonesia during the dry season, the situation is made worse this year because of a combination of factors, including extended droughts and global warming. 

“It is vital that families and children receive accurate information regarding their exposure to toxic air pollution, as this will help them to protect themselves", said Comini. 

UNICEF offers support to Indonesian authorities as they work on measures to mitigate the impact of poor air quality on children.

Havana syndrome: Exposure to neurotoxin may have been cause, study suggests

Via CBC News: Havana syndrome: Exposure to neurotoxin may have been cause, study suggests. Excerpt:

The mysterious ailments experienced by some 40 Canadian and U.S. diplomats and their families while stationed in Cuba may have had nothing to do with sonic "attacks" identified in earlier studies.  

According to a new Canadian study, obtained by Radio-Canada's investigative TV program Enquête, the cause could instead be neurotoxic agents used in pesticide fumigation.  

A number of Canadians and Americans living in Havana fell victim to an unexplained illness starting in late 2016, complaining of concussion-like symptoms, including headaches, dizziness, nausea and difficulty concentrating. Some described hearing a buzzing or high-pitched sounds before falling sick.  

In the wake of the health problems experienced over the past three years, Global Affairs Canada commissioned a clinical study by a team of multidisciplinary researchers in Halifax, affiliated with the Brain Repair Centre, Dalhousie University and the Nova Scotia Health Authority.  

"The working hypothesis actually came only after we had most of the results," Dr. Alon Friedman, the study's lead author, said in an interview. 

The researchers identified a damaged region of the brain that is responsible for memory, concentration and sleep-and-wake cycle, among other things, and then looked at how this region could come to be injured.  

"There are very specific types of toxins that affect these kinds of nervous systems ... and these are insecticides, pesticides, organophosphates — specific neurotoxins," said Friedman. "So that's why we generated the hypothesis that we then went to test in other ways." 

Twenty-six individuals participated in the study, including a control group of people who never lived in Havana. The researchers — comprised of 15 principal investigators and their teams — conducted a thorough assessment of the Canadians' symptoms, including blood tests and several brain imaging tests.

"[The results] all support the diagnosis of acquired brain injury in the Canadian diplomats and their families posted in Cuba," the study report says.  

The scientists were also able to test several of the subjects before and after they returned from Cuba, Friedman noted, and the team saw changes in the brain "that are definitely due to that time when they were in Havana."

Human health on an ailing planet: Historical perspectives on our future

Via NEJM: Human Health on an Ailing Planet — Historical Perspectives on Our Future. Excerpt from a must-read article:

What can we do when the patient needing emergency care is the earth? What life support can physicians offer our ailing planet? History can help us understand and answer these pressing questions.  

A deluge of recent reports document the degradation of Earth’s ecosystems. Local and national governments have declared climate emergencies, and it is ever harder to deny that global warming will have a dire impact on human well-being. This recognition has prompted calls to arms by medical doctors and public health experts. Andy Haines and Kristie Ebi demand that we heed “an imperative for climate action.”

“Frightened by the unfolding climate crisis,” Caren Solomon and Regina LaRocque call on Journal readers “to focus our efforts on areas where our voices are most powerful”: to foster climate action in medical schools, support divestment from the fossil-fuel industry, and advocate for fundamental changes in how we relate to our fragile environments. 

David Hunter, Howard Frumkin, and Ashish Jha envision a “preventive medicine for the planet and its peoples,” in which the health professions “use standard tools of health communication to explain the risks of climate change and the benefits of mitigation and adaptation.” 

Samuel Myers, director of the Planetary Health Alliance, seeks a “paradigm shift” in medicine and public health, requiring changes in how “we train, reward, promote, and fund the generation of health scientists who will be tasked with breaking out of their disciplinary silos to address this urgent constellation of health threats.” 

Under the new rubric of “planetary health,” physicians argue strenuously that the health of the human population depends on the health of our planet’s life-support systems. Has it therefore become the responsibility of everyone dedicated to preserving and restoring human health to care for the ailing earth? 

Advocates insist that the degradation of the planet’s ecosystems and global environmental changes demand an expansion of medical ethics and practice beyond their conventional focus on the relationships among patients, doctors, and societies. 

Some propose a whole-earth ethic for public health, one that attends to our relationship with the planet we inhabit, as well as an intergenerational ethic focused on caring for future humans who will otherwise inherit the wreckage we have left.

Brazil fires: As the Amazon burns, breathing problems spike

Via The Washington Post: Brazil fires: As the Amazon burns, breathing problems spike. Excerpt:

A haze of toxic smoke clouds the tropical city of Porto Velho. Now patients are flooding its health centers. 

During the first three weeks of August, the Cosme and Damião Children’s Hospital in Porto Velho admitted more than 400 children with respiratory problems — three times the average, according to officials. Brazil’s northwestern state of Acre reported 47,000 ­cases of respiratory illnesses during the same period. Lines at public health clinics are growing, and officials say they’re scrambling to hire more staff.  

As fires spike across the Amazon rainforest, an environmental challenge is becoming a public health hazard.  

“Every year we have some fires and issues with smoke, but this was the worst year of them all,” said Izaura de Campos, a pediatrician in Porto Velho. “This is the year when we are finally seeing what we are breathing.” 

 Children and the elderly are most susceptible to smoke-related illnesses, doctors say, but anyone who inhales the pollutants can be affected. The toxics can hinder breathing and oxygen flow and exacerbate chronic conditions such as asthma and bronchitis. Prolonged exposure can increase the risk of some cancers. 

“Just one day’s exposure to these pollutants has a critical impact on health,” said Marcos Abdo Arbex, a pulmonologist in Sao Paulo state who specializes in environmental diseases.

For those who live downwind of the flames, there’s no escape. Authorities in Porto Velho are telling residents to avoid exercise, stay inside and shut their windows.

Sarah Nachiro keeps her family inside and her windows closed. Still, she said, her 4-month-old son, Henrique, has suffered from coughing fits so strong he has turned purple. Weeks of colds and shortness of breath have left him on antibiotics. Sarah herself has been to the emergency room twice with asthma. She faults the government response for the effects on the country’s health. 

“It’s a crime,” she said. “A complete lack of respect for the population as a whole but especially with the children.”  

Campos said she has seen twice as many patients complaining of respiratory issues and colds as usual. The emergency room at her hospital is packed with children seeking oxygen, she said, and pharmacies have run out of saline solution.

Fires in the Amazon are common during the dry season, but this year has been exceptional. More than 25,000 fires have been spotted in the rainforest in August alone, a nine-year high, according to Brazil’s National Institute for Space Research.  

The fires can burn for months on end, sending smoke hundreds of miles. Sao Paulo, the hemisphere’s largest city, was covered in a blanket so thick last week that it blocked out the midday sun, turning day to night. 

In Porto Velho, some mornings Nachiro can’t see through the smoke in front of her house: “Everything is white.” 

The fires, many of them set by farmers and loggers to clear land, are at the center of a growing international dispute between Brazilian President Jair Bolsonaro and other world leaders. 

Bolsonaro campaigned for president last year on promises to open the rainforest to more development. The platform was popular in a country struggling through years of economic stagnation. 

Since his inauguration in January, deforestation has surged. He has blocked new environmental protections and is accused of lax enforcement.

The Amazon is on fire. So is central Africa

As if Ebola, cholera, and measles were not enough, The New York Times reports: The Amazon Is on Fire. So Is Central Africa. Excerpt:

As images of wildfires in South America’s Amazon region draw global attention, a large and potentially devastating series of fires is raging in Central Africa and parts of Southern Africa. 

Among the regions at risk is the Congo Basin forest, the second-largest tropical rainforest, after the Amazon, mostly in the Democratic Republic of Congo. The region absorbs tons of carbon dioxide, a key in the fight against climate change, and has been called the world’s “second lung,” following the Amazon.  

At the Group of 7 summit of political leaders this week, amid a global feud over how to handle the Brazil blazes, President Emmanuel Macron of France published a Twitter message acknowledging the Africa burns and saying he was considering an aid program to help. 

Fire experts, however, are cautioning against comparing the situations in Africa and South America too closely. While the fires are racing through environmentally critical rain forests in Brazil and Bolivia, in Central Africa, they are incinerating savanna and scrubbier land, and mostly licking at the edges of the rainforest, said Lauren Williams, a forest expert with Global Forest Watch who is based in Kinshasa, the Democratic Republic of Congo’s capital. 

In Central Africa, as in other parts of the world, many of the fires are typical for this time of year. While some ignite naturally in the dry season, others are deliberately set by farmers to clear land and improve crop yields. 

In South America the burns spilled into sensitive areas and grew out of control. In Africa, some experts fear the same outcome, and say that Central African governments may be inadequately prepared to fight the blazes.  

Irène Wabiwa Betoko, a forest manager with Greenpeace who is based in Kinshasa, said that regional governments are less equipped to fight these burns than their South American counterparts, both technically and financially.

"If it catches the rainforest in the Congo Basin, it will be worse than in South America,” she said in a telephone interview. “We are calling on governments to not be silent. Start acting now to make sure these fires are not getting out of control.”  

Data analyzed by Global Forest Watch show that Angola ranks first in the number of fire alerts by province right now, while Brazil ranks second, with Zambia and the Democratic Republic of Congo in third and fourth place.

After the wildfire: Treating the mental health crisis triggered by climate change

Via The Guardian: After the wildfire: treating the mental health crisis triggered by climate change. Excerpt:

The nightmares kept coming and David Leal knew he was in trouble. A navy veteran with a can-do attitude and a solidly middle-class IT job at a hospital in Santa Rosa, California, he didn’t think of himself as mentally vulnerable. But when the Tubbs fire snatched his house off the face of the earth in the early morning hours of 9 October 2017, it hit him hard. 

“Long story short, I went through a lot of PTSD,” Leal says, as we tour his nearly rebuilt home in Santa Rosa’s Coffey Park neighborhood. Wildfires are not uncommon in the mountains outside of this northern California town, but residents can’t remember one like this: the fire jumped six lanes of Highway 101, into the city, and licked up about 1,300 of the suburb’s 2,000 homes as if they’d just evaporated. Leal thought, I live in the city; it’s not supposed to burn

“Retiring from the navy, I had a lot of junk in my head,” he adds. After the fire, it all came up. “I was having nightmares of occurrences that I went through in the military – but it was going even further back. My brain was just unloading. Every traumatic issue I ever had in my life was coming back to me. There were things that I went through as a little boy that I was waking up going, ‘Whoa. Where did that come from?’” 

The climate crisis is manifesting as ever-bigger wildfires, hurricanes, floods and heat waves; and cities are just starting to grapple with the mental impact of the emergency. A climate task force of the American Psychological Association, citing scores of studies over the last decades, reports that survivors of these human-enhanced disasters are experiencing dramatic increases in depression, post-traumatic stress disorder (PTSD), anxiety disorders, suicide and suicidal thoughts, violent behavior and increased use of drugs and alcohol. A Rand study found that one-third of the adult survivors of California wildfires in 2003 suffered depression and one-quarter suffered PTSD.

Those with a history of mental or behavioral issues are particularly at risk. But many others are taken by surprise when they suddenly realize they can’t sleep or work, or can’t shake their sadness.  

“It’s a normal human response to a terrible thing,” said Adrienne Heinz, a researcher at the US Department of Veterans Affairs (VA) Center for PTSD who lives in Sonoma. 

 The mental health effects of climate change have been known for quite some time now: a 1991 meta-study found that as many as 40% of those directly impacted by climate-enhanced superstorms and fires suffer acute negative mental health effects, some of which become chronic. Puerto Rico, for example, has seen an epidemic of suicide, PTSD and depression after hurricanes Irma and Maria. After Hurricane Katrina, some people referred to the sense of generalized anxiety and depression common to survivors as “Katrina brain”.

Ambient particulate air pollution and daily mortality in 652 cities

Via NEJM: Ambient Particulate Air Pollution and Daily Mortality in 652 Cities. The abstract:

BACKGROUND 

The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.  

METHODS 

We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration–response curves from each city were pooled to allow global estimates to be derived.  

RESULTS 

On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration–response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations. 

CONCLUSIONS 

Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies.

Why is Lyme disease so hard to understand?

In The Atlantic, an important article by Meghan O'Rourke, a Lyme patient: Why Is Lyme Disease So Hard to Understand? Excerpt:

Even as changes in the climate and in land use are causing a dramatic rise in Lyme and other tick-borne diseases, the American medical establishment remains entrenched in a struggle over who can be said to have Lyme disease and whether it can become chronic—and if so, why. The standoff has impeded research that could help break the logjam and clarify how a wily bacterium, and the co-infections that can come with it, can affect human bodies. 

After 40 years in the public-health spotlight, Lyme disease still can’t be prevented by a vaccine; eludes reliable testing; and continues to pit patients against doctors, and researchers against one another. When I got my inconclusive diagnosis, I knew better than to dream of a quick cure. But I didn’t know how extreme the roller coaster of uncertainty would be. 

Lyme disease came into public view when an epidemic of what appeared to be rheumatoid arthritis began afflicting children in Lyme, Connecticut. A young rheumatologist at Yale named Allen Steere, who now conducts research at Massachusetts General Hospital, in Boston, studied the children. In 1976 he named the mysterious illness after its locale and described its main symptoms more fully: a bull’s-eye rash; fevers and aches; Bell’s palsy, or partial paralysis of the face, and other neurological issues; and rheumatological manifestations such as swelling of the knees. After much study, Steere realized that the black-legged ticks that live on mice and deer (among other mammals) might be harboring a pathogen responsible for the outbreak. 

In 1981, the medical entomologist Willy Burgdorfer finally identified the bacterium that causes Lyme, and it was named after him: Borrelia burgdorferi. 

B. burgdorferi is a corkscrew-shaped bacterium known as a spirochete that can burrow deep into its host’s tissue, causing damage as it goes and, in laboratory conditions at least, morphing as needed from corkscrew to cystlike blob to, potentially, slimy “biofilm” forms. Because of this ability, researchers describe it as an “immune evader.” Once it hits the human bloodstream, it changes its outer surface to elude an immune response, and then quickly moves from the blood into tissue, which poses problems for early detection. (Hard to find in the bloodstream and other body fluids, the B. burgdorferi spirochete is hard to culture, which is how bacterial infections are definitively diagnosed.) 

If it goes untreated, B. burgdorferi can make its way into fluid in the joints, into the spinal cord, and even into the brain and the heart, where it can cause the sometimes deadly Lyme carditis.

Air pollution and infant mortality: Evidence from Saharan dust

Via the National Bureau of Economic Research: Air Pollution and Infant Mortality: Evidence from Saharan Dust. The abstract:

Accurate estimation of air quality impacts on health outcomes is critical for guiding policy choices to mitigate such damages. Estimation poses an empirical challenge, however, because local economic activity can simultaneously generate changes in both air quality and in health impacts that are independent of air quality, confounding pollution-health estimates. 

To address this challenge, we leverage plausibly exogenous variation in local particulate matter exposure across sub-Saharan Africa due to dust export from the Bodele Depression, a remote Saharan region responsible for a substantial share of global atmospheric dust. Large scale transport of this dust is uncorrelated with local emissions sources and allows us to isolate the causal impact of air quality on infant mortality across Sub-Saharan Africa. 

Combining detailed information on nearly 1 million births with satellite measures of aerosol particulate matter, we find that a 10mg/m3 increase in local ambient PM2.5 concentration driven by distant dust emission causes a 22% increase in infant mortality across our African sample (95% CI: 10-35%), an effect comparable to quasi-experimental pollution-infant mortality estimates from wealthier countries. 

We also show that rainfall over the Bodele is a significant control on PM2.5 export and thus child health, and that future climate-change driven changes in Saharan rainfall could generate very large impacts on African child health through this pathway alone. 

We calculate that seemingly exotic proposals to pump and apply groundwater to the Bodele to reduce dust emission could be cost competitive with leading interventions aimed at improving child health.