Prenatal exposure to ambient air pollution and the risk of preterm birth and stillbirth:synergy among air pollutants in causing preterm birth

Abstract Previous studies provided little evidence related to low-level air pollution exposure on the risk of preterm birth (PTB). Epidemiologic studies on the synergistic effects of different air pollutants on the risk of PTB are scarce. In addition, the evidence from initial studies of prenatal exposure to ambient air pollution and stillbirth is equivocal. This project assessed the independent and joint effects of prenatal exposure to ambient air pollution on the risk of PTB, and summarized the existing evidence on the relationship between ambient air pollution and the risk of stillbirth through a systematic review and meta-analysis. The study population comprised 2,568 members of the Espoo Cohort Study, born between 1984 and 1990, living in Espoo, Finland. Individual-level ambient air pollution concentrations were assessed by using dispersion modelling and the land-use regression-based method. PubMed, Scopus and Web of Science databases were searched for studies investigating air pollution and stillbirth. Results show that the joint effect of PM2.5 and O3 exposure during the entire pregnancy (long-term) was substantially higher with an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM2.5 and 1.34 for O3) and the relative excess risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57). This indicates long-term exposure to PM2.5 and O3 may act synergistically potentiating each other’s adverse effects on the risk of PTB. The highest levels of exposure to PM2.5, PM10 and NO2 in the week just before delivery (short-term) were related to 67% (95% CI: 14%, 146%), 60% (95%CI: 9%, 134%) and 65% (95% CI: 14%, 137%) increased in the risk of PTB, respectively. There were no significant joint effects of different air pollutant exposure during the week prior to the delivery (short-term) on the risk of PTB. The meta-analysis indicated that prenatal exposure to ambient air pollution increased the risk of stillbirth. In order to prevent ambient air pollution induced PTB and stillbirth, improvements in air quality are required by implementing laws and regulations and introducing measures to reduce multiple pollutants even in those less pollutant regions of the world.Tiivistelmä Aiempien tutkimusten perusteella oli vain vähän tietoa alhaisen ilmansaastealtistuksen vaikutuksista ennenaikaisen synnytyksen riskiin. Myöskään eri ilmansaasteiden yhteisvaikutuksia ennenaikaiseen synnytykseen ei ollut aiemmin tutkittu. Tutkimustulokset raskaudenaikaisen ilmansaastealtistuksen vaikutuksista olivat vähäiset ja ristiriitaisia. Tässä tutkimushankkeessa arvioitiin ilmansaasteiden raskaudenaikaisen altistumisen riippumattomia ja yhteisvaikutuksia ennenaikaisen synnytyksen riskiin sekä vedettiin yhteen tutkimustieto raskaudenaikaisen ilmansaastealtistuksen vaikutuksista kohtukuolemariskiin toteuttamalla systemaattinen kirjallisuuskatsaus ja siihen pohjautuva meta-analyysi. Tutkimuspopulaatio käsitti Espoon kohorttitutkimuksen 2568 espoolaista jäsentä, jotka syntyivät vuosien 1984 ja 1990 välillä. Tutkimuksessa arvioitiin yksilökohtaisesti ilmansaasteiden pitoisuudet käyttäen leviämismalleja ja maankäyttötietoja regressiomalleja hyödyntäen. Ilmansaasteiden vaikutuksia kohtukuolemaan selvitettiin systemaattisesti PubMed-, Scopus- ja Web of Science-tietokannoista haettujen alkuperäisjulkaisujen pohjalta. Pienhiukkasten (PM2.5) ja otsonin raskauden aikaisen altistuksen yhteisvaikutus oli selvästi suurempi, vakioitu riskisuhde (RR) 3.63 (95 % luottamusväli: 2.16, 6.10), kuin yksittäisten ilmansaasteiden riippumattomat vaikutukset antoivat odottaa (PM2.5 RR=0.99 ja otsoni RR=1.34). Yhteisvaikutuksesta aiheutuva suhteellinen ylimääräisen riskin estimaatti (RERI) oli 2.30 (95 % luottamusväli 0.95, 4.57). Näiden tulosten perusteella PM2.5 ja otsonialtistuksella saattaa olla synergistisiä vaikutuksia ennenaikaiseen synnytykseen. Suurimmat altistumiset ilmansaasteille PM2.5, PM10 ja NO2 synnytystä edeltävällä viikolla (lyhytaikainen altistus) nostivat ennenaikaisen synnytyksen riskiä 67 % (95 % CI: 14 %, 146 %), 60 % (95 %CI: 9 %, 134 %) ja 65 % (95 % CI: 14 %, 137 %), kukin erikseen. Ennenaikaista synnytystä edeltävän viikon aikaisilla ilmansaastealtistuksilla ei havaittu tilastollisesti merkitseviä yhteisvaikutuksia. Meta-analyysin perusteella raskaudenaikainen altistus ilmansaasteille lisää kohtukuoleman riskiä. Ilmansaasteiden aiheuttaman ennenaikaisen synnytyksen ja kohtukuoleman riskien ehkäisemiseksi tulisi yhdyskuntailman laatua pyrkiä parantamaan lainsäädännön ja ilmansuojeluohjeiden tuella. Tarvitaan keinoja vähentää samanaikaisesti esiintyvien ilmansaasteiden määrää myös maailman vähemmän saastuneilla alueilla

Obesity and abdominal obesity in Indian population:findings from a nationally representative study of 698,286 participants

Abstract This study aims to determine and compare the prevalence and correlates of obesity and abdominal obesity in India among participants aged 18–54 years. Data were acquired from the nationally representative National Family Health Survey 2019–21. Age and sex standardized descriptive analyses were conducted to determine the prevalence of obesity and abdominal obesity, and multivariable multilevel logistic regression was performed to identify the factors associated with these conditions. Gender-specific analyses were also conducted. The sample weight was adjusted throughout. The final sample size for this study was 698,286. The prevalence of obesity and abdominal obesity was 13.85% and 57.71%, respectively. Older age, being female, increased educational status and increased wealth index, being married at any point, and residing in an urban area all increased the odds of both obesity and abdominal obesity. Being a resident of the North zone and having a current alcohol intake increased the odds of abdominal obesity. On the other hand, being a resident of the South zone of India increased the odds of obesity. Targeting these high-risk groups can be a strategy for public health promotion programs

Short-term exposure to pollen and the risk of allergic and asthmatic manifestations:a systematic review and meta-analysis

Abstract Background: Several studies have assessed effects of short-term exposure to pollen on allergic and asthmatic manifestations. The evidence is inconclusive, and no meta-analysis has been published. Objective: To synthesise the evidence on the relations between short-term pollen exposure and the risk of allergic and asthmatic manifestations. Methods: We performed a systematic literature search of PubMed and Scopus databases up to the end of August 2018. In addition, we reviewed the reference lists of relevant articles. Two authors independently evaluated the eligible articles and extracted relevant information in a structured form. We calculated summary effect estimates (EE) based on the study-specific ORs and regression coefficients (β) by applying both fixed-effects and random-effects models. Results: 26 studies met the a priori eligibility criteria, and 12 of them provided sufficient information for the meta-analysis. The summary EE related to 10 grains per m³ increase in pollen exposure showed an 1% increase (EE 1.01, 95% CI 1.00 to 1.02) in the risk of lower respiratory symptoms and a 2% increase (EE 1.02, 95% CI 1.01 to 1.03) in the risk of any allergic or asthmatic symptom. Correspondingly, the risk of upper respiratory symptoms and ocular symptoms increased 7% (EE 1.07, 95% CI 1.04 to 1.09) and 11% (EE 1.11, 95% CI 1.05 to 1.17), respectively, in relation to such pollen exposure. Short-term exposure to pollen did not show any significant effect on daily lung function levels. Conclusion: Our results provide new evidence that short-term pollen exposure significantly increases the risks of allergic and asthmatic symptoms

COVID-19 vaccination intent and willingness to pay in Bangladesh:a cross-sectional study

Abstract This article reports the intent to receive a SARS-COV-2 vaccine, its predictors and willingness to pay in Bangladesh. We carried out an online cross-sectional survey of 697 adults from the general population of Bangladesh in January 2021. A structured questionnaire was used to assess vaccination intent. The questionnaire included sociodemographic variables and health belief model constructs which may predict vaccination intent. Among the participants, 26% demonstrated a definite intent, 43% probable intent, 24% probable negative, and 7% a definite negative intention. Multivariable logistic regression analyses suggest an association between definite intent and previous COVID-19 infection (OR: 2.86; 95% CI: 1.71–4.78), perceiving COVID-19 as serious (OR: 1.93; 1.04–3.59), the belief that vaccination would make them feel less worried about catching COVID-19 (OR: 4.42; 2.25–8.68), and concerns about vaccine affordability (OR: 1.51; 1.01–2.25). Individuals afraid of the side effects (OR: 0.34; 0.21–0.53) and those who would take the vaccine if the vaccine were taken by many others (OR: 0.44; 0.29–0.67) are less likely to have a definite intent. A definite negative intent is associated with the concern that the vaccine may not be halal (OR: 2.03; 1.04–3.96). Furthermore, 68.4% are willing to pay for the vaccine. The median amount that they are willing to pay is USD 7.08. The study findings reveal that the definite intent to receive the SARS-CoV-2 vaccination among the general population varies depending on their COVID-19-related health beliefs and no significant association was found with sociodemographic variables

Synergistic effects of prenatal exposure to fine particulate matter (PM₂.₅) and ozone (O₃) on the risk of preterm birth:a population-based cohort study

Abstract Background: There is some evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but little is known about synergistic effects of different pollutants. Objectives: We assessed the independent and joint effects of prenatal exposure to air pollution during the entire duration of pregnancy. Methods: The study population consisted of the 2568 members of the Espoo Cohort Study, born between 1984 and 1990, and living in the City of Espoo, Finland. We assessed individual-level prenatal exposure to ambient air pollutants of interest at all the residential addresses from conception to birth. The pollutant concentrations were estimated both by using regional-to-city-scale dispersion modelling and land-use regression–based method. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI) by comparing the risk of PTB among babies with the highest quartile (Q₄) of exposure during the entire duration of pregnancy with those with the lower exposure quartiles (Q₁-Q₃). We adjusted for season of birth, maternal age, sex of the baby, family’s socioeconomic status, maternal smoking during pregnancy, maternal exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (only in multi-pollutant models) in the analysis. Results: In a multi-pollutant model estimating the effects of exposure during entire pregnancy, the adjusted RR was 1.37 (95% CI: 0.85, 2.23) for PM₂.₅ and 1.64 (95% CI: 1.15, 2.35) for O₃. The joint effect of PM₂.₅ and O₃ was substantially higher, an adjusted RR of 3.63 (95% CI: 2.16, 6.10), than what would have been expected from their independent effects (0.99 for PM₂.₅ and 1.34 for O₃). The relative risk due to interaction (RERI) was 2.30 (95% CI: 0.95, 4.57). Discussion: Our results strengthen the evidence that exposure to fairly low-level air pollution during pregnancy increases the risk of PTB. We provide novel observations indicating that individual air pollutants such as PM₂.₅ and O₃ may act synergistically potentiating each other’s adverse effects

Short-term prenatal exposure to ambient air pollution and risk of preterm birth:a population-based cohort study in Finland

Abstract Background: Previous studies have provided evidence that prenatal exposure to low-level air pollution increases the risk of preterm birth (PTB), but the findings of the effects of short-term exposure have been inconclusive. Moreover, there is little knowledge on potential synergistic effects of different combinations of air pollutants. Objectives: To assess independent and joint effects of prenatal exposure to air pollutants during the week prior to the delivery on the risk of PTB. Methods: The study population included 2568 members of the Espoo Cohort Study, living in the City of Espoo, Finland, born between 1984 and 1990. We assessed individual-level prenatal exposure to ambient air pollutants of interest based on maternal residential addresses, while taking into account their residential mobility. We used both regional-to-city-scale dispersion modelling and land-use regression–based method to estimates the pollutant concentrations. We contrasted the risk of PTB in the highest quartile (Q₄) of exposure to the lower exposure quartiles (Q₁-Q₃) during the specific periods of pregnancy. We applied Poisson regression analysis to estimate the adjusted risk ratios (RRs) with their 95% confidence intervals (CI), adjusting for season of birth, maternal age, sex of the baby, family’s socioeconomic status, maternal smoking, and exposure to environmental tobacco smoke during pregnancy, single parenthood, and exposure to other air pollutants (this in multi-pollutant models). Results: The risk of PTB was related to exposures to PM2.5, PM₁₀ and NO₂ during the week prior to the delivery with adjusted RRs of 1.67 (95%CI: 1.14, 2.46), 1.60 (95% CI: 1.09, 2.34) and 1.65 (95% CI: 1.14, 2.37), from three-pollutant models respectively. There were no significant joint effects for these different air pollutants (during the week prior to the delivery). Conclusion: Our results provide evidence that exposure to fairly low-level air pollution may trigger PTB, but synergistic effects of different pollutants are not likely

Web search engine misinformation notifier extension (SEMiNExt):a machine learning based approach during COVID-19 pandemic

Abstract Misinformation such as on coronavirus disease 2019 (COVID-19) drugs, vaccination or presentation of its treatment from untrusted sources have shown dramatic consequences on public health. Authorities have deployed several surveillance tools to detect and slow down the rapid misinformation spread online. Large quantities of unverified information are available online and at present there is no real-time tool available to alert a user about false information during online health inquiries over a web search engine. To bridge this gap, we propose a web search engine misinformation notifier extension (SEMiNExt). Natural language processing (NLP) and machine learning algorithm have been successfully integrated into the extension. This enables SEMiNExt to read the user query from the search bar, classify the veracity of the query and notify the authenticity of the query to the user, all in real-time to prevent the spread of misinformation. Our results show that SEMiNExt under artificial neural network (ANN) works best with an accuracy of 93%, F1-score of 92%, precision of 92% and a recall of 93% when 80% of the data is trained. Moreover, ANN is able to predict with a very high accuracy even for a small training data size. This is very important for an early detection of new misinformation from a small data sample available online that can significantly reduce the spread of misinformation and maximize public health safety. The SEMiNExt approach has introduced the possibility to improve online health management system by showing misinformation notifications in real-time, enabling safer web-based searching on health-related issues

Effects of air pollution on the risk of low birth weight in a cold climate

Abstract There is accumulating evidence that prenatal exposure to air pollution disturbs fetal growth and development, but little is known about these effects in cold climates or their season-specific or joint effects. Our objective was to assess independent and joint effects of prenatal exposure to specific air pollutants on the risk of low birth weight (LBW). We utilized the 2568 children of the Espoo Cohort Study, born between 1984 and 1990 and living in the City of Espoo. We conducted stratified analyses for births during warm and cold seasons separately. We analyzed the effect estimates using multi-pollutant Poisson regression models with risk ratio (RR) as the measure of effect. The risk of LBW was related to exposure to CO (adjusted RR 1.44, 95% confidence interval [CI]: 1.04–2.00) and exposure to O₃ in the spring–summer season (1.82, 1.11–2.96). There was also evidence of synergistic effects between CO and O₃ (relative risk due to interaction (RERI), all year 1.08, 95% CI: 0.27–4.94, spring–summer 3.97, 2.17–25.85) and between PM2.5 and O₃ (all year 0.72, −0.07–3.60, spring–summer 2.80, 1.36–19.88). We present new evidence of both independent and joint effects of prenatal exposure to low levels of air pollution in a cold climate on the risk of LBW

Depression among the non-native international undergraduate students studying dentistry in Bangladesh

Abstract Background: Bangladesh has been attracting international students with interests in various subjects recently. Every year students from different parts of the world come to study undergraduate and postgraduate courses, mostly at private universities in Bangladesh. This study evaluates the depression status among international students who are studying dentistry in Bangladesh. Methods: This cross-sectional survey was conducted among International undergraduate dental students who enrolled in the Bachelor of Dental Surgery program in nine public and private dental colleges in Bangladesh. Participants were selected using a convenience sampling method. A total of 206 students completed the survey where 78.5% of them were female students and 21.5% students were male, and a CES-D 10-item Likert scale questionnaire was used for data collection. The Cronbach alpha for the 10-item CES-D scale for this population is 0.812. Results: The majority of the students (79.5%) are below 24 years of age with a mean age of 23.22 years and standard deviation of 2.3, and are students who cannot communicate well in Bengali (Bangla), about 60% of them have experienced depression. About 77.3% (p < 0.00) of the international students having financial difficulties exhibited depression. The international students who went through financial problems were two times more likely to suffer from depression (OR = 2.38; p-value < 0.01). Conclusion: This study tried to highlight the struggles faced by international students in Bangladesh studying dentistry. It is evident from the findings that several factors influence students’ mental well-being during demanding dental education years