Publications by authors named "Balmes J"

Climate change is a major driver of the frequency and severity of wildfires caused by extended periods of drought and hotter, drier weather superimposed on the legacy of fire suppression in the Mountain West of the United States. In recent years, increased wildfire smoke has negated the improvements in air quality made by clean energy transitions. Wildfire smoke is a complex mixture of gases and solids, a chief constituent of which is fine particulate matter (PM).

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  • Fine particulate matter (PM) exposure can lead to immune system issues through epigenetic changes, potentially impacting pregnancy outcomes.
  • The study used advanced profiling techniques to link PM exposure with altered immune responses and specific histone modifications in immune cells of both pregnant and nonpregnant women.
  • Findings suggest that high maternal PM exposure correlates with lower IL-27 levels in newborns and affects the inflammatory response in pregnant women, indicating possible pathways for complications during pregnancy.
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Background: Cooking-related emissions contribute to air pollutants in the home and may influence children's health outcomes.

Objective: In this pilot study, we investigate the effects of a cooking ventilation intervention in homes with gas stoves, including a video-based educational intervention and range hood replacement (when needed) in children's homes.

Methods: This was a pilot (n = 14), before-after trial (clinicaltrials.

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Introduction: Air pollution is widely acknowledged as a significant factor in respiratory outcomes, including coughing, wheezing, emergency department (ED) visits, and even death. Although several literature reviews have confirmed the association between air pollution and respiratory outcomes, they often did not standardize associations across different studies and overlooked other increasingly impactful pollutants such as trace metals. Recognizing the importance of consistent comparison and emissions of non-exhaust particles from road traffic, this study aims to comprehensively evaluate the standardized effects of various criteria pollutants and trace metals on respiratory health.

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  • Coccidioidomycosis, also known as Valley fever, is a fungal infection linked to wet winters following drought periods, with a significant spike in cases seen in California in 2023 due to wetter conditions after a statewide drought from 2020-2022.
  • The California Department of Public Health (CDPH) issued alerts due to the anticipated rise in infections, leading to nearly 9,054 reported cases in 2023 and forecasts for continued high risk in 2024-2025.
  • An ensemble model predicts that California could see over 12,000 cases in 2024-2025, especially in regions like the Southern San Joaquin Valley and Southern Coast, highlighting the seasonal peak in cases expected
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  • The study investigates air pollution exposure in disadvantaged communities using advanced machine learning to create detailed maps of nitrogen dioxide, fine particulate matter, and ozone levels across California from 2012 to 2019.
  • Findings indicate that disadvantaged communities consistently experienced higher pollution levels, although they also saw significant reductions in NO and PM, while advantaged areas faced rising ozone levels.
  • The research also highlights decreasing day-to-day exposure variations for NO and ozone, a reduction in NO disparity, persistent O inequality, and increased variations in PM due to more frequent and intense wildfires impacting mainly advantaged suburban and rural neighborhoods.
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Background: Primary graft dysfunction (PGD) contributes substantially to both short- and long-term mortality after lung transplantation, but the mechanisms that lead to PGD are not well understood. Exposure to ambient air pollutants is associated with adverse events during waitlisting for lung transplantation and chronic lung allograft dysfunction, but its association with PGD has not been studied. We hypothesized that long-term exposure of the lung donor and recipient to high levels of ambient air pollutants would increase the risk of PGD in lung transplant recipients.

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Previous studies of air pollution and respiratory disease often relied on aggregated or lagged acute respiratory disease outcome measures, such as emergency department (ED) visits or hospitalizations, which may lack temporal and spatial resolution. This study investigated the association between daily air pollution exposure and respiratory symptoms among participants with asthma and chronic obstructive pulmonary disease (COPD), using a unique dataset passively collected by digital sensors monitoring inhaled medication use. The aggregated dataset comprised 456,779 short-acting beta-agonist (SABA) puffs across 3,386 people with asthma or COPD, between 2012 and 2019, across the state of California.

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  • Approximately 3 billion people, mainly in low- and middle-income countries, use unclean fuels for everyday energy needs, leading to significant health issues like pneumonia and chronic lung disease.
  • A multidisciplinary group conducted a review of recent trials on clean cooking interventions to combat household air pollution (HAP) and reached 14 consensus recommendations for policy makers and practitioners.
  • While some interventions showed reduced exposure to HAP, there was no clear agreement on their effectiveness in improving health outcomes, highlighting the need for continued research and collaboration with policymakers.
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Indoor sources of air pollution worsen indoor and outdoor air quality. Thus, identifying and reducing indoor pollutant sources would decrease both indoor and outdoor air pollution, benefit public health, and help address the climate crisis. As outdoor sources come under regulatory control, unregulated indoor sources become a rising percentage of the problem.

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Background: Diesel exhaust and respirable dust exposures in the mining industry have not been studied in depth with respect to non-malignant respiratory disease including chronic obstructive pulmonary disease (COPD), with most available evidence coming from other settings.

Objectives: To assess the relationship between occupational diesel exhaust and respirable dust exposures and COPD mortality, while addressing issues of survivor bias in exposed miners.

Methods: The study population consisted of 11,817 male workers from the Diesel Exhaust in Miners Study II, followed from 1947 to 2015, with 279 observed COPD deaths.

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Background: Cooking-related biomass smoke is a major source of household air pollution (HAP) and an important health hazard. Prior studies identified associations between HAP exposure and childhood stunting; less is known for underweight and wasting. Few studies had personal HAP measurements.

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Purpose: Exposures to ambient air pollutants may prime the lung enhancing risk of acute respiratory distress syndrome (ARDS) in sepsis. Our objective was to determine the association of short-, medium-, and long-term pollutant exposures and ARDS risk in critically ill sepsis patients.

Methods: We analyzed a prospective cohort of 1858 critically ill patients with sepsis, and estimated short- (3 days), medium- (6 weeks), and long- (5 years) term exposures to ozone, nitrogen dioxide (NO), sulfur dioxide (SO), carbon monoxide (CO), particulate matter < 2.

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  • Fossil fuel combustion is driving climate change, leading to severe respiratory health issues and increased suffering, particularly in vulnerable populations.
  • Hotter, drier climates cause longer wildfires, poor air quality, and increased allergens, all contributing to chronic respiratory diseases.
  • Climate change impacts healthcare delivery and may increase the spread of viral infections, making children and the elderly particularly susceptible to these health risks.
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  • The American Thoracic Society (ATS) currently supports using race and ethnicity-specific equations for interpreting pulmonary function tests (PFTs), but there’s growing concern that this approach may reinforce false racial differences and overlook the impact of varying exposures.
  • A workshop convened by ATS in 2021 found that using race as a factor in PFT interpretation lacks biological validity and suggested switching to race-neutral average reference equations to better reflect individual health without bias.
  • Recommendations included re-evaluating the use of PFTs in clinical and insurance decisions, involving a broader range of stakeholders, and emphasizing ongoing research and education to understand the implications of these changes.
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Background: Because fine particulate matter [PM, with aerodynamic diameter ()] is a ubiquitous environmental exposure, small changes in cognition associated with exposure could have great societal costs. Prior studies have demonstrated a relationship between exposure and cognitive development in urban populations, but it is not known whether these effects are similar in rural populations and whether they persist into late childhood.

Objectives: In this study, we tested for associations between prenatal exposure and both full-scale and subscale measures of IQ among a longitudinal cohort at age 10.

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Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters.

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