More than half of the world's population live in urban areas, and most children spend about 40 hours a week at school. We conducted a systematic review of 28 studies to assess the impact of exposure to green or blue spaces on child neurodevelopment. We found that most studies focused on cognitive and academic performance, with passive exposure to green/blue spaces studied more than active exposure. The results show mixed evidence of a protective relationship between exposure to green/blue spaces and neurodevelopment, with some improvements seen in cognitive/academic performance, attention restoration, behavior, and impulsivity. Renaturalizing school spaces and promoting greener school environments could help improve children's neurodevelopment. However, there was great variation in the methodologies and adjustment for confounding factors across studies, suggesting a need for a standardized approach to delivering school environmental health interventions to benefit children's development.

Citation: Diaz-Martinez F, Sanchez-Sauco MF, Cabrera-Rivera LT, Ojeda Sanchez C, Hidalgo-Albadalejo MD, Claudio L, Ortega-Garcia JA.  Systematic Review: Neurodevelopmental benefits of active/passive school exposure to green and/or blue spaces in children and adolescents. Int J Environ Res Public Health 2023, 20 (5) 3958.

Our recent paper is the featured article of the April 2023 issue of the journal Pediatric Research.  Here's a summary:

This commentary highlights the critical link between social determinants of health and the prevalence of congenital heart disease, a common condition among newborns. The research suggests that children from low-income families, particularly those living in low- and middle-income countries, are more likely to be affected by this condition due to factors such as exposure to air pollutants from cooking stoves and cigarettes. The paper highlights the impact of environmental and socioeconomic factors on the health of children, particularly those who are socioeconomically disadvantaged, and provides compelling evidence for the need for preventive action.

The research sheds light on the disproportionate burden that low-income families endure around the world and highlights the need for urgent action to address preventable environmental and socioeconomic inequities that lead to health disparities. The study underscores the potential beneficial impacts of two interventions: 1) investing in clean cooking fuels and efficient cooking stoves to reduce exposure to indoor air pollution, and 2) the need for smoking cessation programs to help pregnant women quit smoking. Ultimately, the study's findings underscore the need for a multi-sectoral approach that addresses the social determinants of health and promotes health equity, particularly among children.

Citation: Claudio L, Ortega-García JA, Rodríguez Villamizar LA. Social inequities hurt babies' hearts: a commentary on Forero-Manzano, MJ, et al. Pediatr Res. 2022 Dec 2. doi: 10.1038/s41390-022-02363-7. Epub ahead of print.  Pediatr Res. 2023 Feb 17;: PMID: 36460740.

SUMMARY: Misinformation has real-world implications on population health in today's fast-changing pandemic environment. Traditionally, professional middlemen such as reporters and formal media outlets were placed between information creators and the public. We no longer have these intermediates, allowing disinformation to spread. Public health information is frequently not customized to the needs of those most at risk, exacerbating health inequities and increasing suspicion and skepticism.
While public health authorities sometimes employ community-based organizations (CBOs) for outreach activities, they lose opportunities to actively engage them in all phases of the Health Communication Cycle. Fighting the infodemic requires many steps, including understanding what information is required, producing suitable and relevant messages, and sharing these messages in ways that are tailored to the recipients. Community-based organizations are already trustworthy bodies thoroughly engaged in the communities they serve and can help counteract disinformation. As a result of their unique and intangible characteristics and inroads in the communities they serve, CBOs are ideally positioned to play an active part in the health communication cycle, encouraging health equality. Thus, to successfully communicate and fight against health misinformation, particularly in groups with deep-seated mistrust or inadequate health literacy, we must incorporate and engage CBOs in all parts of health communication. 
In this new opinion paper, co-written by our research team and our  community partners, we provide background to support engaging CBOs in addressing health literacy and ehealth equity.

In the News: Air Pollution Linked to Increased Risk of Autoimmune DiseasesAir contaminated by traffic fumes, dust, soot, and smoke may make you more likely to develop rheumatoid arthritis and other autoimmune conditions, a new study suggests.
 
By Lisa Rapaport
March 17, 2022

Car exhaust and other airborne contaminants have long been connected to heart and lung ailments, as well as rheumatoid arthritis, an immune system disorder that causes chronic swelling and joint pain.  Our own studies have shown the relationship with indicators of cognitive deficiencies in children.
In a study I reviewed, researchers from the University of Verona, Italy, reviewed medical records of over 81,000 elderly Italians treated by over 3,500 clinicians. They looked at the association between particulate of less than 2.5 micrometers in diameter that can come from burning gasoline, oil, and wood. Particulate matter (PM) is also a term used to describe dust from construction, agriculture, landfills and wildfires.
They found that 12% of the patients had an autoimmune illness during the research and that pollution exposure enhanced the likelihood of this diagnosis. Each extra 10 mcg/m3 of average PM10 was related with a 7% increased risk of autoimmune illness.
The study revealed that in the study area the average yearly PM2.5 and PM10 exposure levels were 16 and 25 mcg/m3, respectively. The WHO recommends 25 mcg/m3 for PM2.5 and 20 mcg/m3 for PM10.
The study found that those with autoimmune illnesses had a 12-13% increased chance of being diagnosed with these diseases if they were exposed to levels higher than the WHO's guidelines.
The study shows that air pollution can contribute to autoimmune illnesses, says Luz Claudio, PhD, preventive medicine and public health professor at Mount Sinai's Icahn School of Medicine.  In addition to the lungs, Dr. Claudio adds air pollution affects numerous other organs as well.
People can't escape filthy air, but they can lobby for stronger environmental standards, Claudio adds. They can also urge for greater monitoring of local air quality.
“Having a strong surveillance system in high pollution locations is quite important, especially for vulnerable individuals,” Claudio explains. “On polluted days, individuals should avoid outdoor activities.”

The COVID-19 epidemic has swamped healthcare systems globally, especially in communities of color with high prevalence of pre-existing conditions. Many state governments and healthcare organizations responded by expanding telemedicine capabilities and developing illness tracking smartphone apps. Based on our observations, many state-sponsored eHealth technologies did not involve community participation, thereby contributing to the growing digital health inequities. We propose that as the use of eHealth tools grows, more emphasis be paid to their equitable distribution, accessibility, and use. We offer our experience engaging in a Community Advisory Board working on the dissemination of the COVID Alert NY mobile app to show the relevance of public participation in app development. We also offer suggestions for involving community members in the app development process. We argue that involving communities in the app creation process enhances buy-in, trust, and utilization of digital technology in communities where it is most needed.

CITATION: 
Araya F, Stingone JA, Claudio L. Inequalities in exposure to ambient air neurotoxicants and disparities in markers of neurodevelopment in children by maternal nativity status. Int J. Environ Res Public Health 2021, 18 (14) 7512   https://doi.org/10.3390/ijerph18147512

SUMMARY: Exposure to hazardous air pollutants (HAPs) varies greatly amongst populations. Inequities in HAP exposure among groups can lead to disparities in neurodevelopmental outcomes in children. Our study's goal was to see if HAP exposure was influenced by maternal nativity, a demographic characteristic generally disregarded in health disparities research. We also looked at whether unequal HAP exposure levels may affect young children's neurodevelopment.
To do this, we used data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative sample of children born in 2001 (n = 4750). Early cognitive development was assessed using Bayley's Short Form–Research Edition (BSF–R), a standardized test often used to assess brain development.
We found that participants at age nine months were exposed to ten possibly neurotoxic HAPs in their homes. Using linear regression models, we found that maternal nativity and HAP exposure had a synergistic effect on neurodevelopment. For instance, 32 percent of children born to foreign-born mothers were exposed to high levels of HAPs, compared to 21 percent of children born to U.S.-born moms.
One example of a particular HAP was the air pollutant isophorone, a measure of industrial pollution.  After adjusting for socioeconomic characteristics, both isophorone exposure and maternal nativity status were linked with worse BSF-R mental scores in children. There was no statistically significant interaction between nativity status and isophorone exposure, but the change in mental scores was higher in children of foreign-born mothers than in children of U.S.-born mothers (0.12, vs. 0.03, p = 0.2).
In conclusion, children of foreign-born mothers were more likely than US-born mothers to be exposed to HAPs in the highest levels, showing disparities in pollutant exposure by nativity status within metropolitan populations. Exposures linked to nativity status may harm children's neurodevelopment.

 In a new study we published this week in The Journal of Clinical Investigation, our multidisciplinary team of computer scientists, physicians, and epidemiologists at the Icahn School of Medicine at Mount Sinai developed a novel machine-learning algorithm. We used this new machine learning method to identify previously unknown mixtures of toxic air pollutants that appear to be linked to poor asthma outcomes in children.  
     The issue we addressed with this investigation was that most studies assess the toxicity of pollutants one at a time. But in the real world, people are exposed to mixtures of pollutants that cause different health effects. Gaurav Pandey, PhD, Assistant Professor of Genetics and Genomic Sciences and a senior author of the study, said: "Traditionally, for technical reasons, it has been difficult to study the health effects of more than one toxic at a time. We overcame this by tapping into the power of machine learning algorithms."    
     To do this, we examined early exposure to dozens of pollutants to which 151 children with mild to severe asthma were potentially exposed early in their lives, as measured by the Environmental Protection Agency's National Air Toxics Assessment resource. We developed and applied a novel algorithm, named "Data-driven ExposurE Profile (DEEP) Extraction, to determine the possible ways that each pollutant, alone or in combination with others, could explain asthma outcomes in the children. The algorithm development was led by Yan-Chak Li, MPhil, a bioinformatician, and Hsiao-Hsien Leon Hsu, ScD, Assistant Professor of Environmental Medicine and Public Health. 
     We found that some disease cases could be linked to an individual chemical. One example of an individual chemical showing an effect was the ammonia-scented waterproofing agent trimethylamine, which raised the chances that a child with asthma would spend a night in the hospital.
     Other pollutants could act alone or in mixtures. One example was acrylic acid, a chemical used in plastics, coatings, medical products, and detergents. Exposure to acrylic acid raised the chances that a child would need daily medication. Exposure to acrylic acid combined with other chemicals further increased this possibility, and in addition, it boosted the chances of emergency room visits and overnight hospitalizations among the asthmatic children who participated in the study. (See illustration)  
     In all, 34 individual chemicals were found to be linked to poor asthma outcomes. Importantly, some asthma cases appeared to be linked to mixtures of pollutants that had never been associated with asthma.   
      "As a physician who treats children with asthma, I was struck by how many potential air toxics are not on our radar," said Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, and a senior author of the study. "These results changed my view of the heightened risk some children face."  
     "Our study is an example of how machine learning has the potential to alter medical research," said Dr. Pandey. "It is allowing us to understand how a wide variety of environmental factors—or the exposome—influences our health. In the future, we plan to use DEEP and other computer science techniques to tackle environmental factors associated with other complex disorders."  
     This work was supported by the Department of Genetics and Genomic Sciences at Mount Sinai, Scientific Computing at Icahn Mount Sinai, and the National Institutes of Health (AI118833, HG011407, HL147328, OD023337, and ES023515).
Article
Citation: Li, Y.C., Hsu, H.H.L., Chun Y, Chiu PH, Arditi Z, Claudio L, Pandey G, Bunyavanich S. Machine learning-driven identification of early-life air toxic combinations associated with childhood asthma outcomes. Journal of Clinical Investigation, October 5, 2021, DOI: 10.1172/JCI152088

• A new study found that almost half of the cosmetic products tested contain potentially harmful chemicals.
• These chemicals, called per- and polyfluoroalkyl substances (PFAS), have been linked in early research to cancer, reproductive harm, and damage to the immune system.
• PFAS are often used to increase a product’s durability, spreadability, and wear.

The researchers tested 231 products purchased from retailers in the United States and Canada and found these forever chemicals in 48 percent of the products.
Two-thirds of liquid lipsticks, two-thirds of foundations, and three-fourths of waterproof mascaras contained high levels of fluorine, one of these chemicals.
In addition, another in-depth look of 29 products found that 28 of the products in which PFAS were identified did not disclose the chemicals on their product labels.
The findings were published as a group of senators introduced a bill to ban the use of PFAS in personal care products.
Though the Food and Drug Administration (FDA) regulates cosmetic products, the agency does not evaluate or approve the ingredients for safety.
In addition, the FDATrusted Source technically requires cosmetic companies to disclose all ingredients used in their products. However, many loopholes have allowed companies to not disclose all of the ingredients included on the product labels.
In the United States, “Cosmetics and personal care products are not closely regulated to ensure that they do not contain toxic chemicals,” said Luz Claudio, PhD, a professor of environmental medicine and public health at the Icahn School of Medicine at Mount Sinai.

To read the full article, click HERE.  

Juan A. Ortega-Garcia, Manuel Ruiz-Marin, Alberto Carceles-Alvarez, Ferran Campillo i Lopez, Luz Claudio. Environmental Research 189 (2020) 109957.
At one point during the global novel coronavirus pandemic, Spain was the epicenter of infection.  Yet, not all regions of the country had the same rates of hospital emergency visits during this time.  The region of Murcia flattened the curve quickly while other regions of the country had overwhelmed hospital capacity. This was attributed to a robust, community-based, social media campaign promoting tele-medicine and social distancing within health care centers. 
In this rapid communication, we describe the actions taken in Murcia that may have contributed to a more favorable outcome as compared to other regions.  One important action was the coalition of activists, community leaders, physicians and researchers working as amplifiers of an educational campaign using a variety of social media and outreach strategies. 

A successful internship can be the key to a thriving and fulfilling career. However, there are several things you need to consider before accepting any offers. 
In this article, 7 experts were asked how should candidates accept an internship.  My response:

A good acceptance letter from an intern should be informative and appreciative
Informative, because some internship programs may accept a number of interns at the same time. Make sure to include a summary of your skills in your letter. State very clearly in bulleted form what skills you will bring to the internship and how this makes you a great candidate.

If you have a good idea of the project or topic of the internship project that you’d like to do, this will also demonstrate that you have done your homework regarding the projects that will be meaningful for the organization that is offering you the internship.
Finally, the acceptance letter should be appreciative. Don’t sound like you had taken it for granted that you would be accepted to the internship. Make sure to state that you appreciate the opportunity and that you are committed to doing a great job.