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Beyond GDP: a review and conceptual framework for measuring sustainable and inclusive wellbeing 超越国内生产总值:衡量可持续和包容性福祉的审查和概念框架
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00147-5
Annegeke Jansen MSc , Ranran Wang PhD , Paul Behrens PhD , Rutger Hoekstra PhD

Policy making has long focused on economic growth as measured by gross domestic product (GDP), diverting attention from sustainable wellbeing for all. Despite high-quality proposals to go beyond GDP, their integration into policy and societal discourse remains limited. A new UN initiative, Valuing What Counts, provides an opportunity for establishing and institutionalising global measurement of metrics beyond GDP, a crucial step to enable a transition into a safe and just space for humanity. Here, we inform this process by consolidating 50 years of literature on Beyond GDP metrics, addressing three core challenges. First, we resolve the lack of interdisciplinary collaboration by integrating five scientific schools of thought in one measurement approach. Second, we alleviate confusion arising from numerous Beyond GDP alternatives, offering a structured analysis of 65 metrics, delineating their measurement objectives. Finally, we bridge the divide between scientific proposals and country-specific approaches. We unite country-specific needs with a standardised and interdisciplinary measurement approach, presenting a dashboard for sustainable and inclusive wellbeing.

长期以来,政策制定一直侧重于以国内生产总值(GDP)衡量的经济增长,从而转移了对全民可持续福祉的关注。尽管提出了超越 GDP 的高质量建议,但将其纳入政策和社会讨论的程度仍然有限。联合国的一项新倡议--"重视有价值的东西"--为建立超越 GDP 的全球衡量标准并使之制度化提供了一个机会,这是使人类过渡到安全和公正空间的关键一步。在此,我们通过整合 50 年来有关超越 GDP 的衡量标准的文献,为这一进程提供信息,并解决三个核心挑战。首先,我们通过将五大科学流派整合为一种衡量方法,解决了缺乏跨学科合作的问题。其次,我们对 65 个衡量标准进行了结构化分析,明确了它们的衡量目标,从而缓解了因众多超越 GDP 的替代方法而产生的混淆。最后,我们弥合了科学建议与国别方法之间的鸿沟。我们将各国的具体需求与标准化的跨学科衡量方法结合起来,为可持续和包容性福祉提供了一个仪表板。
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引用次数: 0
Planetary health learning objectives: foundational knowledge for global health education in an era of climate change 行星健康学习目标:气候变化时代全球健康教育的基础知识
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00167-0
Prof Kathryn H Jacobsen PhD , Prof Caryl E Waggett PhD , Pamela Berenbaum MSc , Brett R Bayles PhD , Gail L Carlson PhD , René English MBchB PhD , Carlos A Faerron Guzmán MD , Meredith L Gartin PhD , Prof Liz Grant PhD , Thomas L Henshaw PhD , Prof Lora L Iannotti PhD , Prof Philip J Landrigan MD , Nina Lansbury PhD , Prof Hao Li PhD , Prof Maureen Y Lichtveld MD , Ketrell L McWhorter PhD , Prof Jessica E Rettig PhD , Cecilia J Sorensen MD , Prof Eric J Wetzel PhD , Dawn Michele Whitehead PhD , Keith Martin MD

Planetary health is an emerging field that emphasises that humans depend on a healthy Earth for survival and, conversely, that the sustainability of Earth systems is dependent on human behaviours. In response to member demands for resources to support teaching and learning related to planetary health, the Consortium of Universities for Global Health (CUGH) convened a working group to develop a set of planetary health learning objectives (PHLOs) that would complement the existing ten CUGH global health learning objectives. The eight PHLOs feature Earth system changes, planetary boundaries, and climate change science; ecological systems and One Health; human health outcomes; risk assessment, vulnerability, and resilience; policy, governance, and laws (including the UN Framework Convention on Climate Change and the Paris Agreement); roles and responsibilities of governments, businesses, civil society organisations, other institutions, communities, and individuals for mitigation, adaptation, conservation, restoration, and sustainability; environmental ethics, human rights, and climate justice; and environmental literacy and communication. Educators who use the PHLOs as a foundation for teaching, curriculum design, and programme development related to the health–environment nexus will equip learners with a knowledge of planetary health science, interventions, and communication that is essential for future global health professionals.

行星健康是一个新兴领域,它强调人类的生存依赖于健康的地球,反之,地球系统的可持续性也依赖于人类的行为。为了满足成员对资源的需求,以支持与行星健康有关的教学,全球健康大学联盟(CUGH)召集了一个工作组,以制定一套行星健康学习目标(PHLOs),作为现有的十个全球健康大学联盟全球健康学习目标的补充。这八个 PHLOs 包括地球系统变化、地球边界和气候变化科学;生态系统和 "一体健康";人类健康成果;风险评估、脆弱性和复原力;政策、治理和法律(包括《联合国气候变化框架公约》和《巴黎协定》);政府、企业、民间社会组织、其他机构、社区和个人在减缓、适应、保护、恢复和可持续性方面的作用和责任;环境伦理、人权和气候正义;以及环境扫盲和交流。教育者如果将 PHLOs 作为与健康与环境关系相关的教学、课程设计和计划开发的基础,就能让学习者掌握行星健康科学、干预和交流方面的知识,这些知识对于未来的全球健康专业人员来说至关重要。
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引用次数: 0
Effects of ambient heat exposure on risk of all-cause mortality in children younger than 5 years in Africa: a pooled time-series analysis 环境热暴露对非洲 5 岁以下儿童全因死亡风险的影响:汇总时间序列分析。
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00160-8
Chloe Brimicombe PhD , Katharina Wieser BSc , Tobias Monthaler BSc , Prof Debra Jackson PhD , Jeroen De Bont PhD , Prof Matthew F Chersich PhD , Prof Ilona M Otto PhD

Background

Reducing child mortality is a Sustainable Development Goal, and climate change constitutes numerous challenges for Africa. Previous research has shown an association between leading causes of child mortality and climate change. However, few studies have examined these effects in detail. We aimed to explore the effects of ambient heat on neonate, post-neonate, and child mortality rates.

Methods

For this pooled time-series analysis, health data were obtained from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Health and Demographic Surveillance System. We included data from 29 settlements from 13 countries across Africa, collected via monthly surveys from Jan 1, 1993, to Dec 31, 2016. Climate data were obtained from ERA5, collected from Jan 1, 1991, to Dec 31, 2019. We pooled these data for monthly mean daily maximum wet bulb globe temperature (WBGT) and downscaled to geolocations. Due to data heaping, we pooled our health data on a monthly temporal scale and a spatial scale into six different climate regions (ie, Sahel [ie, Burkina Faso and northern Ghana], Guinea [ie, southern Ghana, Côte d'Ivoire, and Nigeria], Senegal and The Gambia, eastern Africa [ie, Kenya, Malawi, Tanzania, Mozambique, and Uganda], South Africa, and Ethiopia). Our outcomes were neonate (ie, younger than 28 days), post-neonate (ie, aged 28 days to 1 year), and child (ie, older than 1 year and younger than 5 years) mortality. To assess the association between WBGT and monthly all-cause mortality, we used a time-series regression with a quasi-Poisson, polynomial-distributed lag model.

Findings

Between Jan 1, 1993, and Dec 31, 2016, there were 44 909 deaths in children younger than 5 years across the 29 sites in the 13 African countries: 10 078 neonates, 14 141 post-neonates, and 20 690 children. We observed differences in the association of heat with neonate, post-neonate, and child mortality by study region. For example, for Ethiopia, the relative risk ratio of mortality at the 95th percentile compared with median heat exposure during the study period was 1·14 (95% CI 1·06–1·23) for neonates, 0·99 (0·90–1·07) for post-neonates, and 0·79 (0·73–0·87) for children. Across the whole year, there was a significant increase in the relative risk of increased mortality for children in eastern Africa (relative risk 1·27, 95% CI 1·19–1·36) and Senegal and The Gambia (1·11, 1·04–1·18).

Interpretation

Our results show that the influence of extreme heat on mortality risk in children younger than 5 years varies by age group, region, and season. Future research should explore potentially informative ways to measure subtleties of heat stress and the factors contributing to vulnerability.

Funding

EU Horizons as part of the Heat Indicators for Global Health (HIGH) Horizons project.

背景:降低儿童死亡率是一项可持续发展目标,而气候变化给非洲带来了诸多挑战。以往的研究表明,儿童死亡的主要原因与气候变化有关。然而,很少有研究对这些影响进行详细研究。我们旨在探讨环境温度对新生儿、新生儿后期和儿童死亡率的影响:在这项汇总时间序列分析中,健康数据来自国际人口及其健康状况评估网络(INDEPTH)的健康与人口监测系统。我们纳入了来自非洲 13 个国家 29 个定居点的数据,这些数据是通过 1993 年 1 月 1 日至 2016 年 12 月 31 日的月度调查收集的。气候数据来自ERA5,收集时间为1991年1月1日至2019年12月31日。我们汇集了这些数据的月平均日最大湿球温度(WBGT),并对地理位置进行了降尺度处理。由于数据堆积,我们按月时间尺度和空间尺度将健康数据汇集到六个不同的气候区域(即萨赫勒[即布基纳法索和加纳北部]、几内亚[即加纳南部、科特迪瓦和尼日利亚]、塞内加尔和冈比亚、非洲东部[即肯尼亚、马拉维、坦桑尼亚、莫桑比克和乌干达]、南非和埃塞俄比亚)。我们的研究结果是新生儿(即小于 28 天)、新生儿后(即 28 天至 1 岁)和儿童(即 1 岁以上 5 岁以下)死亡率。为了评估 WBGT 与每月全因死亡率之间的关系,我们采用了准泊松、多项式分布滞后模型进行时间序列回归:1993年1月1日至2016年12月31日期间,13个非洲国家的29个地点共有44 909名5岁以下儿童死亡:其中新生儿 10 078 例,新生儿后 14 141 例,儿童 20 690 例。我们观察到,不同研究地区的高温与新生儿、新生儿后期和儿童死亡率的关系存在差异。例如,在埃塞俄比亚,与研究期间的热暴露中位数相比,第 95 百分位数的新生儿死亡率的相对风险比为 1-14 (95% CI 1-06-1-23),新生儿后死亡率的相对风险比为 0-99 (0-90-1-07),儿童死亡率的相对风险比为 0-79 (0-73-0-87)。从全年来看,东非(相对风险 1-27,95% CI 1-19-1-36)、塞内加尔和冈比亚(1-11,1-04-1-18)的儿童死亡率相对风险显著增加:我们的研究结果表明,极端高温对 5 岁以下儿童死亡风险的影响因年龄组、地区和季节而异。未来的研究应探索潜在的信息方法,以测量热应激的微妙性和导致脆弱性的因素:作为全球健康热指标(HIGH)地平线项目一部分的欧盟地平线项目。
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引用次数: 0
Policy approaches to decarbonising the transport sector in Aotearoa New Zealand: modelling equity, population health, and health-system effects 新西兰奥特亚罗瓦交通部门去碳化的政策方法:公平、人口健康和健康系统效应建模
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00171-2
Caroline Shaw PhD , Anja Mizdrak DPhil , Ryan Gage MPH , Melissa McLeod PhD , Rhys Jones MPH , Prof Alistair Woodward PhD , Linda Cobiac PhD
<div><h3>Background</h3><p>Health co-benefits are a key potential advantage of transport decarbonisation policy. However, health effects will occur in the context of existing transport–health inequities and decarbonisation policies will themselves affect inequities. This research examines the effects of national decarbonisation pathways for transport on population health, health inequity, and health-system costs in Aotearoa New Zealand.</p></div><div><h3>Methods</h3><p>We modelled the health, health-system, and environmental impacts of two pathways to net zero for transport developed by the New Zealand Climate Change Commission using a proportional multistate lifetable model. The behaviour pathway emphasises a mixed approach, including reduced driving, increased cycling and use of public transport, and light vehicle electrification, and the technology pathway focuses on vehicle electrification. We used data from transport, environmental, population health, and health-care sources to populate the model. We simulated changes in health effects through the pathways of physical activity, air pollution (PM<sub>2·5</sub> and NO<sub>2</sub>), and injury for the Aotearoa New Zealand population from 2018 to 2050. We modelled impacts for Māori (the Indigenous People of Aotearoa) and non-Māori. For each pathway to net zero, we calculated changes in overall health-adjusted life-years (HALYs), age-standardised HALYs, and rate ratios for Māori and non-Māori. We also calculated changes in health-system costs and transport greenhouse gas emissions. 95% uncertainty intervals (95% UIs) were derived for all model outputs by use of a Monte Carlo simulation.</p></div><div><h3>Findings</h3><p>Both pathways show improvements in population health, reductions in health-system costs, and reduced lifecycle greenhouse gas emissions compared with baseline, although health gains were substantially larger in the behaviour pathway. For example, an extra 2100 HALYs (95% UI 1500–3100) were gained in the behaviour scenario compared with baseline. Health gains were 20–30% larger for Māori than non-Māori in both pathways, although more HALYs were gained by Māori in the behaviour pathway. For the cohort aged 0–4 years in 2018, healthy life expectancy differences between Māori and non-Māori reduced by 0·5% in the behaviour pathway over their lifetime. HALYs gained by Māori and non-Māori were altered substantially depending on assumptions about the equity of the implemented pathway.</p></div><div><h3>Interpretation</h3><p>Decarbonising transport might improve overall population health, save the health system money, and reduce health inequities between Māori and non-Māori. Pathways that increase physical activity have a larger effect on population health than those that rely on low-emission vehicles. The effects on inequity between Māori and non-Māori are larger in the behaviour pathway than in the technology pathway but dependent on how equitably policies supporting decarbonisation are
背景健康共同效益是交通脱碳政策的一个关键潜在优势。然而,健康效应将在现有交通-健康不平等的背景下产生,而去碳化政策本身也会影响不平等。本研究探讨了国家交通去碳化途径对新西兰奥特亚罗瓦地区人口健康、健康不平等和健康系统成本的影响。方法我们使用比例多州生命表模型,模拟了新西兰气候变化委员会制定的两种交通净零碳化途径对健康、健康系统和环境的影响。行为路径强调混合方法,包括减少驾驶、增加骑自行车和使用公共交通以及轻型车辆电气化,而技术路径则侧重于车辆电气化。我们使用了来自交通、环境、人口健康和医疗保健方面的数据来构建模型。我们通过体育活动、空气污染(PM2-5 和二氧化氮)和伤害等途径,模拟了 2018 年至 2050 年新西兰奥特亚罗瓦人口的健康影响变化。我们模拟了对毛利人(奥特亚罗瓦土著人)和非毛利人的影响。对于实现净零的每种途径,我们计算了毛利人和非毛利人的总体健康调整寿命年数(HALYs)、年龄标准化健康调整寿命年数(HALYs)和比率比的变化。我们还计算了健康系统成本和交通温室气体排放量的变化。与基线相比,两种途径都能改善人口健康、降低健康系统成本和减少生命周期温室气体排放,但行为途径的健康收益要大得多。例如,与基线相比,行为方案额外增加了 2100 HALYs(95% UI 1500-3100)。在两种途径中,毛利人的健康收益都比非毛利人高出 20-30%,但在行为途径中,毛利人获得了更多的 "HALYs"。对于2018年0-4岁的人群,毛利人和非毛利人在行为途径上的健康预期寿命差异在其一生中减少了0-5%。毛利人和非毛利人获得的健康预期寿命年数会有很大变化,这取决于对所实施路径的公平性的假设。与依赖低排放车辆的道路相比,增加体育锻炼的道路对人口健康的影响更大。行为途径对毛利人和非毛利人之间不平等的影响大于技术途径,但取决于支持去碳化的政策如何公平实施。
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引用次数: 0
Why gender matters for addressing chemical pollution 为什么性别问题对解决化学污染至关重要
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00176-1
Mengjiao Wang , Angeliki Balayannis , Hanna-Andrea Rother , Minu Hemmati , Anna Holthaus , Vania Zuin Zeidler
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引用次数: 0
Expert judgement reveals current and emerging UK climate-mortality burden 专家判断揭示了英国当前和新出现的气候死亡负担
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00175-X
Prof Dann Mitchell PhD , Y T Eunice Lo PhD , Emily Ball PhD , Joanne L Godwin PhD , Oliver Andrews PhD , Prof Rosa Barciela PhD , Prof Lea Berrang Ford PhD , Claudia Di Napoli PhD , Prof Kristie L Ebi PhD , Neven S Fučkar PhD , Prof Antonio Gasparrini PhD , Prof Brian Golding PhD , Celia L Gregson MRCP PhD , Gareth J Griffith PhD , Sara Khalid PhD , Caitlin Robinson PhD , Prof Daniela N Schmidt PhD , Charles H Simpson PhD , Prof Sir Robert Stephen John Sparks PhD , Josephine G Walker PhD

Weather and climate patterns play an intrinsic role in societal health, yet a comprehensive synthesis of specific hazard–mortality causes does not currently exist. Country-level health burdens are thus highly uncertain, but harnessing collective expert knowledge can reduce this uncertainty, and help assess diverse mortality causes beyond what is explicitly quantified. Here, surveying 30 experts, we provide the first structured expert judgement of how weather and climate directly impact mortality, using the UK as an example. Current weather-related mortality is dominated by short-term exposure to hot and cold temperatures leading to cardiovascular and respiratory failure. We find additional underappreciated health outcomes, especially related to long-exposure hazards, including heat-related renal disease, cold-related musculoskeletal health, and infectious diseases from compound hazards. We show potential future worsening of cause-specific mortality, including mental health from flooding or heat, and changes in infectious diseases. Ultimately, this work could serve to develop an expert-based understanding of the climate-related health burden in other countries.

天气和气候模式对社会健康起着固有的作用,但目前还没有对具体的灾害-死亡原因进行全面综合。因此,国家层面的健康负担具有高度不确定性,但利用专家的集体知识可以减少这种不确定性,并有助于评估明确量化之外的各种死亡原因。在此,我们以英国为例,对 30 位专家进行了调查,首次提供了关于天气和气候如何直接影响死亡率的结构化专家判断。目前与天气相关的死亡率主要是短期暴露于高温和低温导致的心血管和呼吸系统衰竭。我们还发现了更多未被重视的健康后果,尤其是与长期暴露的危害有关的健康后果,包括与热有关的肾病、与冷有关的肌肉骨骼健康以及复合危害引起的传染病。我们显示了未来特定病因死亡率的潜在恶化,包括洪水或高温导致的心理健康以及传染病的变化。最终,这项工作将有助于专家了解其他国家与气候相关的健康负担。
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引用次数: 0
Effectiveness of Wolbachia-mediated sterility coupled with sterile insect technique to suppress adult Aedes aegypti populations in Singapore: a synthetic control study 沃尔巴克氏体介导的不育与昆虫不育技术对抑制新加坡埃及伊蚊成虫种群的有效性:一项合成控制研究
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00169-4
Somya Bansal MSc , Jue Tao Lim PhD , Chee-Seng Chong PhD , Borame Dickens PhD , Youming Ng BSc , Lu Deng BSc , Caleb Lee MSc , Li Yun Tan BSc , Evdoxia G Kakani PhD , Yanni Yoong BSc , David Du Yu PhD , Grace Chain BSc , Pei Ma MSc , Shuzhen Sim PhD , Lee Ching Ng PhD , Cheong Huat Tan PhD
<div><h3>Background</h3><p>Incompatible insect technique (IIT) coupled with sterile insect technique (SIT) via the release of sterile male <em>Wolbachia</em>-infected mosquitoes is a promising tool for <em>Aedes</em>-borne disease control. Yet, real-world evidence on the suppressive effectiveness of IIT-SIT on mosquito abundance remains mostly limited to small semi-rural village and suburban localities over short trial durations. However, a large proportion of <em>Aedes</em>-borne diseases occur in dense, urban, and high-rise locations, limiting the applicability of previous studies for these settings with high disease burden. The sustainability and use of this technology over multiple years is also unknown.</p></div><div><h3>Methods</h3><p>In this synthetic control study, we conducted a large-scale, field trial of IIT-SIT targeting <em>Aedes aegypti</em> among high-rise public housing estates in Singapore, an equatorial city state. Routinely collected data from a large, nationwide surveillance system of 57 990 unique mosquito traps, combined with a high-dimensional set of anthropogenic and environmental confounders were collected to ascertain mosquito abundance and its key drivers. Four townships were selected as the intervention groups (approximate population size of 607 872 residents as of 2022), wherein interventions that combined ITT with SIT over the course of the study period were conducted. Townships were subject to releases of <em>w</em>AlbB-SG male <em>A aegypti</em> mosquitoes twice a week. Data were assessed over the course of epidemiological weeks (EWs), which provide the finest temporal resolution of recorded <em>Wolbachia</em> release schedule and mosquito abundance data. A novel synthetic control framework was then developed to account for the non-randomised and staggered adoption setting of the intervention across trial sectors to identify the direct suppressive effectiveness of IIT-SIT on female <em>A aegypti</em> populations, the spillover effects in non-release areas, and the effect of the intervention on other mosquito populations such as <em>Aedes albopictus</em>. Furthermore, we recalculated effectiveness in terms of calendar time, time since intervention, and over multiple sites to examine heterogeneities in IIT-SIT effectiveness.</p></div><div><h3>Findings</h3><p>Between EW27 2018 and EW26 2022, <em>Wolbachia</em> releases were conducted across 117 sectors, of which 97 had sufficient trap data, which were collected between EW8 2019 and EW26 2022. We found that <em>Wolbachia</em>-based IIT-SIT reduced wild-type female <em>A aegypti</em> populations by a mean of 62·01% (95% CI 60·68 to 63·26) by 3 months, 78·40% (77·56 to 79·18) by 6 months, and 91·32% (90·95 to 91·66) by at least 18 months of releases. We also found a smaller but non-negligible spillover suppression effect that gradually increased over time (mean spillover intervention effectiveness 61·02% [95% CI 57·89 to 63·72] in adjacent, non-intervention sectors). Alt
背景不相容昆虫技术(IIT)与昆虫不育技术(SIT)相结合,通过释放受沃尔巴乔病毒感染的不育雄蚊,是一种很有前景的伊蚊传播疾病控制手段。然而,有关 IIT-SIT 对蚊子数量的抑制效果的实际证据,大多仍局限于半农村的小村庄和郊区的短时间试验。然而,大部分伊蚊传播的疾病都发生在人口稠密的城市和高层建筑中,这就限制了之前的研究对这些疾病负担重的环境的适用性。在这项合成对照研究中,我们针对新加坡(一个赤道城市州)高层公共住宅区的埃及伊蚊进行了一次大规模的现场 IIT-SIT 试验。我们从一个由 57 990 个独特蚊虫诱捕器组成的大型全国性监测系统中收集了常规数据,并结合一组高维度的人为和环境混杂因素,以确定蚊虫数量及其主要驱动因素。选定四个乡镇作为干预组(截至 2022 年,人口规模约为 607 872 人),在研究期间进行 ITT 与 SIT 相结合的干预。乡镇每周两次释放 wAlbB-SG 雄性埃及疟蚊。对流行病学周(EWs)的数据进行了评估,这提供了记录的沃尔巴克氏体释放时间表和蚊子数量数据的最精细的时间分辨率。然后,我们制定了一个新的合成控制框架,以考虑在各试验区采用干预措施的非随机和交错设置,从而确定 IIT-SIT 对雌性埃及伊蚊种群的直接抑制效果、非释放区的溢出效应以及干预措施对白纹伊蚊等其他蚊子种群的影响。此外,我们重新计算了日历时间、干预后时间以及多个地点的效果,以研究 IIT-SIT 效果的异质性。研究结果在 2018 年 EW27 至 2022 年 EW26 期间,在 117 个区进行了沃尔巴克氏体释放,其中 97 个区有足够的诱捕器数据,这些数据是在 2019 年 EW8 至 2022 年 EW26 期间收集的。我们发现,基于沃尔巴克氏体的 IIT-SIT 在释放 3 个月后可将野生型雌性埃及蝇的数量平均减少 62-01%(95% CI 60-68 至 63-26),在释放 6 个月后减少 78-40%(77-56 至 79-18),在释放至少 18 个月后减少 91-32%(90-95 至 91-66)。我们还发现了一个较小但不可忽略的溢出抑制效应,该效应随着时间的推移逐渐增强(在相邻的非干预区,平均溢出干预效果为 61-02% [95% CI 57-89 至 63-72])。尽管在释放沃尔巴克氏体后,四个干预乡镇的白纹伊蚊数量没有发生一致的变化,但所有释放区对白纹伊蚊数量的平均干预效果为-25-80%(95% CI -30-93至-21-05),其中两个乡镇的白纹伊蚊数量有所增加。这些干预措施在不同地理环境中的效果应在今后的工作中进行评估。资金来源新加坡财政部、可持续发展与环境部、国家环境局和国家机器人计划。
{"title":"Effectiveness of Wolbachia-mediated sterility coupled with sterile insect technique to suppress adult Aedes aegypti populations in Singapore: a synthetic control study","authors":"Somya Bansal MSc ,&nbsp;Jue Tao Lim PhD ,&nbsp;Chee-Seng Chong PhD ,&nbsp;Borame Dickens PhD ,&nbsp;Youming Ng BSc ,&nbsp;Lu Deng BSc ,&nbsp;Caleb Lee MSc ,&nbsp;Li Yun Tan BSc ,&nbsp;Evdoxia G Kakani PhD ,&nbsp;Yanni Yoong BSc ,&nbsp;David Du Yu PhD ,&nbsp;Grace Chain BSc ,&nbsp;Pei Ma MSc ,&nbsp;Shuzhen Sim PhD ,&nbsp;Lee Ching Ng PhD ,&nbsp;Cheong Huat Tan PhD","doi":"10.1016/S2542-5196(24)00169-4","DOIUrl":"10.1016/S2542-5196(24)00169-4","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Incompatible insect technique (IIT) coupled with sterile insect technique (SIT) via the release of sterile male &lt;em&gt;Wolbachia&lt;/em&gt;-infected mosquitoes is a promising tool for &lt;em&gt;Aedes&lt;/em&gt;-borne disease control. Yet, real-world evidence on the suppressive effectiveness of IIT-SIT on mosquito abundance remains mostly limited to small semi-rural village and suburban localities over short trial durations. However, a large proportion of &lt;em&gt;Aedes&lt;/em&gt;-borne diseases occur in dense, urban, and high-rise locations, limiting the applicability of previous studies for these settings with high disease burden. The sustainability and use of this technology over multiple years is also unknown.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;In this synthetic control study, we conducted a large-scale, field trial of IIT-SIT targeting &lt;em&gt;Aedes aegypti&lt;/em&gt; among high-rise public housing estates in Singapore, an equatorial city state. Routinely collected data from a large, nationwide surveillance system of 57 990 unique mosquito traps, combined with a high-dimensional set of anthropogenic and environmental confounders were collected to ascertain mosquito abundance and its key drivers. Four townships were selected as the intervention groups (approximate population size of 607 872 residents as of 2022), wherein interventions that combined ITT with SIT over the course of the study period were conducted. Townships were subject to releases of &lt;em&gt;w&lt;/em&gt;AlbB-SG male &lt;em&gt;A aegypti&lt;/em&gt; mosquitoes twice a week. Data were assessed over the course of epidemiological weeks (EWs), which provide the finest temporal resolution of recorded &lt;em&gt;Wolbachia&lt;/em&gt; release schedule and mosquito abundance data. A novel synthetic control framework was then developed to account for the non-randomised and staggered adoption setting of the intervention across trial sectors to identify the direct suppressive effectiveness of IIT-SIT on female &lt;em&gt;A aegypti&lt;/em&gt; populations, the spillover effects in non-release areas, and the effect of the intervention on other mosquito populations such as &lt;em&gt;Aedes albopictus&lt;/em&gt;. Furthermore, we recalculated effectiveness in terms of calendar time, time since intervention, and over multiple sites to examine heterogeneities in IIT-SIT effectiveness.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;p&gt;Between EW27 2018 and EW26 2022, &lt;em&gt;Wolbachia&lt;/em&gt; releases were conducted across 117 sectors, of which 97 had sufficient trap data, which were collected between EW8 2019 and EW26 2022. We found that &lt;em&gt;Wolbachia&lt;/em&gt;-based IIT-SIT reduced wild-type female &lt;em&gt;A aegypti&lt;/em&gt; populations by a mean of 62·01% (95% CI 60·68 to 63·26) by 3 months, 78·40% (77·56 to 79·18) by 6 months, and 91·32% (90·95 to 91·66) by at least 18 months of releases. We also found a smaller but non-negligible spillover suppression effect that gradually increased over time (mean spillover intervention effectiveness 61·02% [95% CI 57·89 to 63·72] in adjacent, non-intervention sectors). Alt","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e617-e628"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001694/pdfft?md5=fe8c04e9101cf515070255d742d01b09&pid=1-s2.0-S2542519624001694-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Planetary health diet and cardiovascular disease: results from three large prospective cohort studies in the USA 行星健康饮食与心血管疾病:美国三项大型前瞻性队列研究的结果
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00170-0
Caleigh M Sawicki PhD , Gautam Ramesh MD , Linh Bui MD , Nilendra K Nair PhD , Prof Frank B Hu MD , Prof Eric B Rimm ScD , Prof Meir J Stampfer MD , Prof Walter C Willett MD , Shilpa N Bhupathiraju PhD
<div><h3>Background</h3><p>In 2019, the EAT–<em>Lancet</em> Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease.</p></div><div><h3>Methods</h3><p>We included women from the Nurses’ Health Study (NHS I; 1986–2016), women from the Nurses’ Health Study II (NHS II; 1991–2017), and men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0–140. Higher scores indicated greater adherence to the PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.</p></div><div><h3>Findings</h3><p>Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78–0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74–0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78–0·95]; p-trend=0·0004) compared with the lowest quintile.</p></div><div><h3>Interpretation</h3><p>We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations suppor
背景2019年,EAT-Lancet可持续食品系统健康饮食委员会提出了一种旨在优化慢性疾病预防和全球环境健康的 "行星健康饮食"。在这项研究中,我们旨在研究基于 "行星健康饮食 "的饮食指数与心血管疾病风险之间的关联。方法我们纳入了护士健康研究(NHS I;1986-2016 年)中的女性、护士健康研究 II(NHS II;1991-2017 年)中的女性以及健康专业人员随访研究(HPFS;1986-2016 年)中的男性,他们在基线时都没有心血管疾病、癌症和糖尿病。饮食数据每 4 年使用经过验证的半定量食物频率调查问卷收集一次。行星健康饮食指数(PHDI)基于 15 个食物组:全谷物、蔬菜、水果、鱼类和贝类、坚果和种子、非大豆豆类、大豆食品和不饱和油类为正分;淀粉类蔬菜、乳制品、红肉或加工肉类、家禽、蛋类、饱和脂肪和反式脂肪以及添加糖类为负分。每组食物的得分相加得出 0-140 分的总分。分数越高,表明越遵守 PHDI。我们使用具有时变协变量的 Cox 比例危险度回归来评估 PHDI 分数(累计平均值)与心血管疾病(定义为致命和非致命心肌梗死和中风)之间的关系,并对所有提供数据的参与者的人口统计学、健康和生活方式混杂因素进行了调整。在 NHS I 纳入的 62 919 名女性、NHS II 纳入的 88 535 名女性和 HPFS 纳入的 42 164 名男性中,在 4 541 980 人年的随访中,共有 9831 例心血管疾病得到确诊。在 NHS I 中,最低五分位数与最高五分位数的 PHDI 平均得分介于 60-7 (SD 5-1) 到 90-6 (5-3) 之间;在 NHS II 中,最低五分位数与最高五分位数的 PHDI 平均得分介于 55-6 (4-9) 到 86-3 (6-3) 之间;在 HPFS 中,最低五分位数与最高五分位数的 PHDI 平均得分介于 59-6 (5-9) 到 94 (5-9) 之间。在经多变量调整的荟萃分析中,PHDI 评分最高的五分位参与者发生心血管疾病的风险低于最低的五分位参与者(危险比 [HR] 0-83 [95% CI 0-78-0-89];p-trend <0-0001)。当我们研究心血管疾病亚型时,与最低五分位数相比,PHDI 最高五分位数也与较低的冠心病风险(HR 0-81 [95% CI 0-74-0-88];p-trend <0-0001)和总中风风险(HR 0-86 [0-78-0-95];p-trend=0-0004)相关。解释我们发现,在美国的三个大型男性和女性队列中,坚持行星健康饮食(旨在成为更环保的可持续饮食模式)与较低的心血管疾病风险有关。这些观察结果表明,行星健康饮食是促进人类和地球健康的一种有前途的策略。
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引用次数: 0
Correction to Lancet Planet Health 2024; 8: e574–87 柳叶刀星球健康》更正 2024; 8: e574-87
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00205-5
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引用次数: 0
Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year period 环境空气污染对心血管和呼吸系统死亡率短期影响的时间变化:对 380 个城市地区 22 年间情况的汇总分析
IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/S2542-5196(24)00168-2
Maximilian Schwarz MSc , Prof Annette Peters PhD , Massimo Stafoggia PhD , Francesca de'Donato PhD , Francesco Sera PhD , Prof Michelle L Bell PhD , Prof Yuming Guo PhD , Prof Yasushi Honda PhD , Veronika Huber PhD , Prof Jouni J K Jaakkola PhD , Aleš Urban PhD , Ana Maria Vicedo-Cabrera PhD , Pierre Masselot PhD , Prof Eric Lavigne PhD , Souzana Achilleos PhD , Jan Kyselý PhD , Prof Evangelia Samoli PhD , Prof Masahiro Hashizume PhD , Chris Fook Sheng Ng PhD , Susana das Neves Pereira da Silva MSc , Antonella Zanobetti

Background

Ambient air pollution, including particulate matter (such as PM10 and PM2·5) and nitrogen dioxide (NO2), has been linked to increases in mortality. Whether populations’ vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time.

Methods

We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO2, PM10, and PM2·5 on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models.

Findings

Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM10, PM2·5, or NO2 and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI –0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m3 increase in PM2·5. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO2.

Interpretation

Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility.

Funding

None.

背景环境空气污染,包括颗粒物(如 PM10 和 PM2-5)和二氧化氮(NO2),与死亡率上升有关。人们对这些污染物的易感性是否会随着时间的推移而发生变化尚不清楚,而且有关这一主题的研究并不包括多国分析。我们评估了空气污染物暴露的变化是否与死亡率效应估计值随时间推移而发生的变化有关。方法我们从多国多城市(MCC)合作研究网络数据库中提取了 1995 年至 2016 年间收集的特定病因死亡率和空气污染数据。我们采用两阶段方法,利用特定城市时间序列回归分析和多层次随机效应荟萃分析,分析了二氧化氮、可吸入颗粒物(PM10)和可吸入颗粒物(PM2-5)对特定病因死亡率的短期影响。我们使用以时间为线性固定项的纵向元回归评估了随时间推移而发生的变化,并探讨了潜在的异质性来源和双污染物模型。研究结果在研究期间,24 个国家的 380 个城市中有超过 2,160 万例心血管疾病和 700 万例呼吸系统疾病死亡病例被纳入分析范围。所有三种空气污染物的浓度均随时间推移而下降。汇总结果表明,单位接触 PM10、PM2-5 或 NO2 的效应估计值与死亡率之间没有明显的时间变化。然而,PM2-5每增加10微克/立方米,心血管死亡风险从1998年的0-37%(95% CI -0-05至0-80)增加到2012年的0-85%(0-55至1-16)。对于可吸入颗粒物组分,双污染物模型通常显示出与单污染物模型相似的结果,而对于二氧化氮则显示出时间差异。这一观察结果可能是由于空气污染的成分、毒性和来源以及其他因素造成的,如社会经济决定因素或人口分布和易感性的变化。
{"title":"Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year period","authors":"Maximilian Schwarz MSc ,&nbsp;Prof Annette Peters PhD ,&nbsp;Massimo Stafoggia PhD ,&nbsp;Francesca de'Donato PhD ,&nbsp;Francesco Sera PhD ,&nbsp;Prof Michelle L Bell PhD ,&nbsp;Prof Yuming Guo PhD ,&nbsp;Prof Yasushi Honda PhD ,&nbsp;Veronika Huber PhD ,&nbsp;Prof Jouni J K Jaakkola PhD ,&nbsp;Aleš Urban PhD ,&nbsp;Ana Maria Vicedo-Cabrera PhD ,&nbsp;Pierre Masselot PhD ,&nbsp;Prof Eric Lavigne PhD ,&nbsp;Souzana Achilleos PhD ,&nbsp;Jan Kyselý PhD ,&nbsp;Prof Evangelia Samoli PhD ,&nbsp;Prof Masahiro Hashizume PhD ,&nbsp;Chris Fook Sheng Ng PhD ,&nbsp;Susana das Neves Pereira da Silva MSc ,&nbsp;Antonella Zanobetti","doi":"10.1016/S2542-5196(24)00168-2","DOIUrl":"10.1016/S2542-5196(24)00168-2","url":null,"abstract":"<div><h3>Background</h3><p>Ambient air pollution, including particulate matter (such as PM<sub>10</sub> and PM<sub>2·5</sub>) and nitrogen dioxide (NO<sub>2</sub>), has been linked to increases in mortality. Whether populations’ vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time.</p></div><div><h3>Methods</h3><p>We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO<sub>2</sub>, PM<sub>10</sub>, and PM<sub>2·5</sub> on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models.</p></div><div><h3>Findings</h3><p>Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM<sub>10</sub>, PM<sub>2·5</sub>, or NO<sub>2</sub> and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI –0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m<sup>3</sup> increase in PM<sub>2·5</sub>. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO<sub>2</sub>.</p></div><div><h3>Interpretation</h3><p>Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility.</p></div><div><h3>Funding</h3><p>None.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 9","pages":"Pages e657-e665"},"PeriodicalIF":24.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542519624001682/pdfft?md5=28e586822af31df1557ea9d75dc0c6d4&pid=1-s2.0-S2542519624001682-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Lancet Planetary Health
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