Yudan Zheng , Lei Zhao , Yuming Zheng , Wenya Bai , Xuefeng Lai , Liangle Yang , Xiaomin Zhang , Miao Liu
{"title":"A longitudinal panel study exploring associations of urinary phthalate metabolites mixture with renal function in Chinese children","authors":"Yudan Zheng , Lei Zhao , Yuming Zheng , Wenya Bai , Xuefeng Lai , Liangle Yang , Xiaomin Zhang , Miao Liu","doi":"10.1016/j.heha.2024.100116","DOIUrl":"10.1016/j.heha.2024.100116","url":null,"abstract":"<div><div>Evidence from longitudinal studies examining the associations between urinary phthalate metabolites (mPAEs) and early kidney damage in children has been limited, and the underlying mechanisms still remain unclear. We carried out a longitudinal panel study involving up to 3 repeated visits, and each visit across 4 consecutive days, with 142 children aged 4-12 years from Guangzhou. mPAEs were determined in morning urine of each day and early kidney damage indicators were detected on the 4<sup>th</sup> day. We employed linear mixed-effect models (LMEs), and Bayesian kernel machine regression (BKMR) models to evaluate associations of mPAEs as individual and mixture with early kidney damage, and the interaction of thyroid hormones with mPAEs in such associations. We found that each 1-fold increment of mono-n-butyl phthalate (MBP) at health examination day (Lag0) was significantly associated with 4.734% (95% confidence interval: 1.313%, 8.155%) reduction of Cystatin-C (CysC)-based estimated glomerular filtration rate (eGFR<sub>CysC</sub>) (FDR< 0.05) and such relationships were in dose-response manner. Meanwhile, BKMR models showed the relations of mPAEs mixture with increased CysC and Beta-2-microglobulin (β2MG), and reduced eGFR<sub>CysC</sub> were dominated by MBP. Moreover, thyroid hormones were linked to early kidney damage, and free thyroxin (FT4) modified the associations of MBP and β2MG, which was more obvious in children with low level of FT4. Interactions of age group and gender with MBP were significant, the effect of MBP on early kidney damage was stronger in primary school children and boys. In summary, our findings indicated that urinary mPAEs as individual and mixture were associated with early kidney damage indicators, which contributed to MBP were modified by FT4.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David B. Olawade , Ojima Z. Wada , Abimbola O. Ige , Bamise I. Egbewole , Adedayo Olojo , Bankole I. Oladapo
{"title":"Artificial intelligence in environmental monitoring: Advancements, challenges, and future directions","authors":"David B. Olawade , Ojima Z. Wada , Abimbola O. Ige , Bamise I. Egbewole , Adedayo Olojo , Bankole I. Oladapo","doi":"10.1016/j.heha.2024.100114","DOIUrl":"10.1016/j.heha.2024.100114","url":null,"abstract":"<div><div>The application of Artificial Intelligence (AI) in environmental monitoring offers accurate disaster forecasts, pollution source detection, and comprehensive air and water quality monitoring. This article provides an overview of the value of environmental monitoring, the challenges of conventional methods, and potential AI-based solutions. Several significant AI applications in environmental monitoring are highlighted, showcasing their contributions to effective environmental management. AI technologies enhance environmental monitoring by enabling better understanding, prediction, and mitigation of environmental risks. However, realizing the full potential of AI faces hurdles such as a shortage of specialized AI experts in the environmental sector and challenges related to data access, control, and privacy. These issues are more pronounced in regions with developing technological infrastructure. The paper advocates for proactive data governance measures by governments to protect sensitive information. Despite these challenges, the future of AI in environmental monitoring remains promising, with advancements in AI algorithms, data collection techniques, and computing power expected to further improve accuracy and efficiency in pollution monitoring and management.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xin Meng , Qiaoyi Hua , Ruiwei Xu , Yunxiu Shi , Yi Zhang , Meilin Yan , Wu Chen , Yifan Xu , Yunfei Fan , Yuan Yao , Teng Wang , Yidan Zhang , Haonan Li , Yaqi Yu , Xiaoyu Cui , Qianqian Chai , Ailin Li , Mengshuang Sheng , Rui Tang , Ruohong Qiao , Tong Zhu
{"title":"A prospective study on the cardiorespiratory effects of air pollution among residents of the Tibetan Plateau","authors":"Xin Meng , Qiaoyi Hua , Ruiwei Xu , Yunxiu Shi , Yi Zhang , Meilin Yan , Wu Chen , Yifan Xu , Yunfei Fan , Yuan Yao , Teng Wang , Yidan Zhang , Haonan Li , Yaqi Yu , Xiaoyu Cui , Qianqian Chai , Ailin Li , Mengshuang Sheng , Rui Tang , Ruohong Qiao , Tong Zhu","doi":"10.1016/j.heha.2024.100115","DOIUrl":"10.1016/j.heha.2024.100115","url":null,"abstract":"<div><div>The Tibetan Plateau is characterized by high ozone concentration which poses a significant public health concern. However, the causal evidence linking ozone pollution to adverse cardiopulmonary health impacts, as well as the understanding of its underlying biological mechanisms, remains limited. Additionally, exposure levels to particulate and other gaseous air pollutants along with their associated health effects in this region are largely unknown. To address these gaps, we conducted a prospective follow-up study in Tibet from May 2021 to November 2021. In consideration of the potential synergistic effects of chronic hypobaric hypoxia, two Tibetan cities with different altitudes, Lhasa (3650 m) and Nyingchi (3000 m), were chosen to implement atmospheric monitoring and health measurement. We employed cutting-edge, high-precision instruments at stationary monitoring sites to measure ambient air pollution and collected particle samples. Portable devices were used to monitor personal exposure levels of ozone and black carbon. A total of 212 healthy Tibetan college students participated in up to four clinical visits, yielding 774 visits in total, during which functional endpoints were measured and biological samples were collected. The primary aim of this study is to evaluate the cardiorespiratory effects of ambient ozone under hypoxic conditions, where its impact may be amplified due to the region's unique environmental characteristics. The secondary aim is to provide a comprehensive assessment of other air pollutants, including their exposure levels, sources, and health effects. By addressing these aims, the study offers valuable insights into air quality and its health implications in this unique high-altitude setting. This paper outlines the research motivation, measurement framework, and preliminary findings.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142536251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruiqiang Li , Xiaoyi Lin , Tingyu Lu , Jiao Wang , Ying Wang , Lin Xu
{"title":"Associations between exposure to multiple environmental chemicals and metabolic syndrome: A mixture analysis","authors":"Ruiqiang Li , Xiaoyi Lin , Tingyu Lu , Jiao Wang , Ying Wang , Lin Xu","doi":"10.1016/j.heha.2024.100112","DOIUrl":"10.1016/j.heha.2024.100112","url":null,"abstract":"<div><div>Exposure to environmental chemicals is prevalent. While previous studies reported associations between multiple chemical exposures and metabolic syndrome (MetS), they did not comprehensively account for correlations among exposures. We used machine learning methods including Boruta algorithm and least absolute shrinkage and selection operator (LASSO) regression, combined with weighted quartiles sum (WQS) regression to investigate the associations of phenols, polycyclic aromatic hydrocarbons (PAHs), metals, and phthalates with MetS and its components. Data were drawn from the 2005–2012 National Health and Nutrition Examination Survey (NHANES). The mean (standard deviation (SD)) age of 2596 participants was 48.4 (17.9) years. After adjusting for age, sex, body mass index, race/ethnicity, marital status, education, poverty income ratio, physical activity, smoking, and alcohol, higher 2-Phenanthrene (2-PHE) and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) concentrations were associated with a higher odds of the MetS (odds ratio (OR) = 4.26, 95 % confidence interval (CI) 2.40–7.58 per ng/mL, and 3.24, 1.75–6.02 per ng/L, respectively). WQS index for environmental chemicals was positively associated with the MetS (OR = 1.31, 95 % CI 1.09–1.57). Moreover, we observed consistent and stronger positive associations with MetS (OR = 1.54, 95 % CI 1.04–2.30) in current smokers. Exposure to phenols, PAHs, metals, and phthalates was positively associated with an increase in metabolic syndrome and its components, which was more pronounced in current smokers.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Boubakari Ibrahimou , Ning Sun , Sophie Dabo-Niang
{"title":"Assessing the multi-dimensional effects of air pollution on maternal complications and birth outcomes: A structural equation modeling approach","authors":"Boubakari Ibrahimou , Ning Sun , Sophie Dabo-Niang","doi":"10.1016/j.heha.2024.100113","DOIUrl":"10.1016/j.heha.2024.100113","url":null,"abstract":"<div><h3>Objective</h3><div>This cross-sectional study aims to investigate the direct and indirect relationships between exposure to a metal mixture in air and adverse pregnancy outcomes across gestational stages.</div></div><div><h3>Methods</h3><div>With 46,829 births in 2021 in two Florida counties and Air Quality System data, structural equation modeling was used to construct latent metal mixtures in PM<sub>2.5</sub> and unravel their effects on pregnancy complications (preeclampsia and gestational diabetes) and birth outcomes (low birth weight and preterm birth risks).</div></div><div><h3>Results</h3><div>A latent variable featuring seven metals (Aluminum, Calcium, Iron, Magnesium, Manganese, Silicon, Vanadium) was identified through the measurement model. The latent metal mixture exposure had direct effects on gestational diabetes and preterm birth (1st trimester, 2nd trimester), low birth weight (1st trimester), and preeclampsia (2nd trimester). When considering total effects, the effects on low birth weight in the 1st trimester and on preeclampsia in 2nd trimester were masked, and the latent metal mixture increased the low-birth-weight risk in 2nd trimester by 2 % (OR = 1.02, 95 % CI = [1.00, 1.03]).</div></div><div><h3>Conclusion</h3><div>This study reveals time-dependent associations between a metal mixture in PM<sub>2.5</sub> exposure and adverse pregnancy outcomes, highlights the need to address dust in PM<sub>2.5</sub>, and provides additional evidence for understanding the pathway of the pollution effects on fetal health.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ke Zhang , Gongbo Chen , Wan Liu , Jie He , Mengnan Pan , Zhongyang Chen , Jiahui Tong , Feifei Liu , Hao Xiang
{"title":"Metabolism disruption induced by high ambient temperature","authors":"Ke Zhang , Gongbo Chen , Wan Liu , Jie He , Mengnan Pan , Zhongyang Chen , Jiahui Tong , Feifei Liu , Hao Xiang","doi":"10.1016/j.heha.2024.100111","DOIUrl":"10.1016/j.heha.2024.100111","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have assessed the cardiovascular risk attributable to high ambient temperature. However, the mechanisms underly acute cardiovascular responses associated with high ambient temperature remain incompletely understood.</div></div><div><h3>Objective</h3><div>To identify acute cardiovascular responses associated with high temperature, and to understand the underlying mechanisms using metabolomics.</div></div><div><h3>Methods</h3><div>We conducted a prospective panel study on young adults, organizing participants to undergo blood collection and temperature monitoring tautologically. Levels of 10 cardiovascular biomarkers and 4473 serum metabolites were measured. Levels of ambient temperature exposure were recorded by wearing personal monitors. We employed linear mixed-effect models to identify acute cardiovascular responses associated with ambient temperature, including differential biomarkers and metabolites. KEGG pathway analysis was performed on the differential metabolites to identify temperature-associated metabolic processes.</div></div><div><h3>Results</h3><div>Exposure to elevated ambient temperature was associated with acute cardiovascular responses, including alterations in high-density lipoprotein, interleukin-6, C-reactive protein, diastolic pressure, and heart rate. These observed acute cardiovascular responses are probably attributed to metabolism disturbances, as 129 differential serum metabolites, accompanied by disruptions in 18 pathways, were identified. These differential metabolites and pathways primarily involve glycerophospholipid metabolism, which activates inflammation cytokines and subsequently induces adverse cardiovascular effects.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that elevated ambient temperature could potentially lead to cardiovascular responses among young adults in China. We propose that high ambient temperature exposure may contribute to acute cardiovascular effects by regulating the glycerophospholipid metabolism pathway.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Avishek Talukdar , Sayan Bhattacharya , Saptarshi Pal , Pracheta Pal , Soumyajit Chowdhury
{"title":"Positive and negative impacts of COVID-19 on the environment: A critical review with sustainability approaches","authors":"Avishek Talukdar , Sayan Bhattacharya , Saptarshi Pal , Pracheta Pal , Soumyajit Chowdhury","doi":"10.1016/j.heha.2024.100107","DOIUrl":"10.1016/j.heha.2024.100107","url":null,"abstract":"<div><div>Coronavirus, which practically brought the world to a standstill, is a member of the Coronaviridae family of the order Nidovirales, and was termed as the \"severe acute respiratory syndrome coronavirus 2″ (SARS-CoV-2) by the International Committee on Taxonomy of Viruses. The COVID-19 pandemic was probably the most critical healthcare and scientific challenge of this century. Apart from health concerns, the pandemic has also resulted in certain long-lasting social, economic, and environmental issues. The article, for the first time, executes a multidisciplinary assessment of the effects of COVID-19 on the environment, highlighting future research approaches and the possible ways to achieve sustainability in the post-COVID era. Both positive and negative impacts of COVID-19 pandemic are discussed in this context. While there are certain positive impacts of COVID-19 on the environment (including reduced air, water and noise pollution with cleaner landscapes), the negative impacts (increased production and consumption of plastics, increase in waste generation because of online consumption, decrease in waste recycling, energy consumption in vaccine manufacturing) pose considerable threats to the environment. We highlight urgent research priorities, and also discuss potential means of tackling any such pandemic in the future without hampering sustainable lifestyle or jeopardizing the environment and ecosystem dynamics. The findings will help to identify the possible areas of concern of pandemic management and can help in formulation of policies which will be helpful to reduce the impact of future pandemics on the environment.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773049224000205/pdfft?md5=09f664e89679e1f8e4613f3697d38a36&pid=1-s2.0-S2773049224000205-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Occupational chemical safety and management: A case study to identify best practices for sustainable advancement of Bangladesh","authors":"Amit Hasan Anik , Mohammad Toha , Shafi M Tareq","doi":"10.1016/j.heha.2024.100110","DOIUrl":"10.1016/j.heha.2024.100110","url":null,"abstract":"<div><p>Bangladesh has experienced numerous tragedies and casualties in the chemical industry, resulting in unparalleled losses in terms of human, social, and economic adversity, primarily attributed to the absence of effective occupational health and safety management. Despite having various sectoral legislative frameworks, there is a notable absence of a comprehensive legal framework specifically addressing chemical safety management issues. Moreover, the existing regulations have not successfully established a nexus between chemical safety, employee well-being, potential opportunities, and task performance. This highlights the insufficient attention given to occupational health and chemical safety issues at the policy level, with limited research dedicated to these critical concerns. Consequently, this critical review aims to identify optimal strategies for the long-term sustainable development of Bangladesh in the realm of occupational chemical safety and management. The review critically evaluates the current state of Bangladesh's national chemical management, offering a policy trajectory for consideration. It meticulously analyzes the disjunctions and incongruities between prescribed guidelines and actual practices in chemical management within the Bangladeshi context. Furthermore, it establishes a comprehensive framework for a nationwide chemical management system, aligning with global best practices and guidelines. The study also delineates existing gaps and challenges while outlining future priorities that warrant immediate government attention and sustained commitment to enhance chemical safety management. Therefore, this study serves as a foundational reference for policymakers not only in Bangladesh but also for those in other developing economies grappling with escalating chemical demands, providing guidance for constructing an appropriate infrastructure and legal framework for enduring chemical management.</p></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773049224000230/pdfft?md5=c11a758857e7fdba9fa43884960952d5&pid=1-s2.0-S2773049224000230-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Black box analysis with linear regression on global warming","authors":"Yoshiyasu Takefuji","doi":"10.1016/j.heha.2024.100109","DOIUrl":"10.1016/j.heha.2024.100109","url":null,"abstract":"<div><p>This paper demonstrates that the conclusions drawn from datasets on global temperature anomaly and atmospheric CO2 from NOAA can vary depending on the range of investigated periods. By examining the data from both macroscopic and microscopic perspectives, the study reveals that different levels of analysis can produce different outcomes from the same datasets based on statistics.</p></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773049224000229/pdfft?md5=8dea976b9745ec91f3c29a1401fbba02&pid=1-s2.0-S2773049224000229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Expansion of a versatile pathogen: Clostridioides difficile","authors":"Tereena Lucas , Brent Brown","doi":"10.1016/j.heha.2024.100108","DOIUrl":"10.1016/j.heha.2024.100108","url":null,"abstract":"<div><p><em>Clostridioides difficile</em> is a gram positive and spore forming bacterium responsible for significant global morbidity and mortality. There is increasing incidence of <em>C. difficile</em> disease that constitutes a deviation from the traditionally understood toxin-mediated colonic disease. Comprehensive literature review has determined a conservative increase of over 600 cases of <em>C. difficile</em> extra–intestinal and small–intestinal disease detailed in >200 papers over the past 20 years. Chronic colonization with increased intestinal permeability that permits the translocation of toxins and metabolites may partially explain this expanded disease manifestation. Currently there is little evidence in support of a role for toxins however, and greater evidence to support the role of metabolites in extra-intestinal disease pathogenesis. Specifically, increased levels of p-cresol, p-cresyl sulfate, indoxyl sulfate and ammonia are associated with <em>C. difficile</em>colonization. One important health consideration involves ongoing biotransformation of such metabolites, together with the overall metabolic load from all endogenous and exogenous sources, that can result in glutathione depletion. Chronic glutathione depletion in turn increases oxidative stress and is correlated with neurological compromise across all age groups, and a host of other conditions. Key factors supporting chronic colonization with <em>C. difficile</em> in susceptible hosts include widespread and indiscriminate use of antimicrobials, pharmaceuticals, pesticides, intensive agricultural practices, diet, food additives, and gastrointestinal disturbances. Appreciation of the role of the exposome in <em>C. difficile</em> disease expansion will further emphasize the importance of decreasing environmental contamination, antimicrobial resistance, inter-species transmission, and individual toxic metabolite burdens.</p></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"12 ","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773049224000217/pdfft?md5=b73b3f0a28575f48f0f30efede611fe6&pid=1-s2.0-S2773049224000217-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142149609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}