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Congenital cytomegalovirus (CMV) affects ~1 of 150 births and is a leading cause of hearing loss and intellectual disability. It has been suggested that transmission may occur via contaminated surfaces. CMV AD169 in filtered human saliva, applied to environmental surfaces, was recovered at various time points. Samples were evaluated by culture and real-time polymerase chain reaction. CMV was found viable on metal and wood to 1 hour, glass and plastic to 3 hours, and rubber, cloth, and cracker to 6 hours. CMV was cultured from 83 of 90 wet and 5 of 40 dry surfaces. CMV was more likely to be isolated from wet, highly absorbent surfaces at earlier time points. [ABSTRACT FROM AUTHOR]

The gut microbiome is impacted by certain types of dietary fibre. However, the type, duration, and dose needed to elicit gut microbial changes, and whether these changes also influence microbial metabolites, remains unclear. This study investigated the effects of supplementing healthy participants with two types of non-digestible carbohydrates (resistant starch (RS) and polydextrose (PD)), on the stool microbiota and microbial metabolite concentrations in plasma, stool, and urine, as secondary outcomes in the Dietary Intervention Stem Cells and Colorectal Cancer (DISC) Study.The DISC Study was a double-blind, randomised controlled trial that supplemented healthy participants with RS and/or PD or placebo for 50 days in a 2*2 factorial design. DNA was extracted from stool samples collected pre- and post-intervention, and V4 16S rRNA gene sequencing was used to profile the gut microbiota. Metabolite concentrations were measured in stool, plasma, and urine by high-performance liquid chromatography.A total of 58 participants with paired samples available were included. After 50 days, no effects of RS or PD were detected on composition of the gut microbiota diversity (alpha- and beta-diversity), on genus relative abundance, or on metabolite concentrations. However, Drichlet's multinomial mixture clustering-based approach suggests that some participants changed microbial enterotype post-intervention.The gut microbiome and faecal, plasma, and urinary microbial metabolites were stable in response to a 50-day fibre intervention in middle aged adults. Larger and longer studies, including those which explore the effects of specific fibre sub-types, may be required to determine the relationships between fibre intake, the gut microbiome, and host-health.

Competing Interests: Declaration of interests Thirteen of the authors (ZA, S-CH, LJ, AM, CO, MO, JP, YP-S, DS, LB-V, MRo, MW, and HW) were compensated for their time while drafting and developing the Lancet Countdown's report. LC was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health. CD received funding from the European Research Council (FLORA, grant number 101039402). RD was supported by a grant from the High Tide Foundation and subcontracts on funds from the Wellcome Trust and US Centers for Disease Control and Prevention. GG-S received funding from the UK National Institute for Health and Care Research for the Global Health Research Group on Diet and Activity (NIHR133205, with sub-award contract number G109900-SJ1/171 with the University of Cambridge). SHG's research was supported by the National Research Foundation, Prime Minister's Office, Singapore, under its Campus for Research Excellence and Technological Enterprise programme (grant number NRF2019-THE001-0006). JJH was supported by two grants from the Wellcome Trust and a grant from the US National Science Foundation. RH, RK, and MSo acknowledge funding from Academy of Finland projects HEATCOST (grant 334798) and VFSP-WASE (grant 359421), together with EU Horizon projects FirEUrisk (grant number 101003890) and EXHAUSTION (grant number 820655). OJ was supported by grants from the National Health Medical Research Council (Heat and Health: building resilience to extreme heat in a warming world, GNT1147789); Wellcome Trust (Heat stress in ready-made garment factories in Bangladesh and the Heat inform pregnant study); and Resilience New South Wales (A new heat stress scale for general public); holds a patent for the Environmental Measurement Unit; and has received consulting fees from the National Institutes of Health. HM received funding from the Oak Foundation to support work on climate change through RealZero, is partly funded by the National Institute for Health Research's Comprehensive Biomedical Research Centre at University College London Hospitals, and received fees from Bayer Pharmaceuticals and Chiesl for sustainability consulting. JM-U was supported by grants PID2021-127107NB-I00 from Ministerio de Ciencia e Innovación (Spain) and 2021 SGR 00526 from Generalitat de Catalunya (Spain). JRo's work is supported by the Alexander von Humboldt foundation. RL, JRo, and MRo were supported by Horizon Europe through the IDAlert project (101057554) and UK Research and Innovation (reference number 10056533). RNS reports a contract with Massachusetts General Hospital. MSo and AU were supported by the Finnish Foreign Ministry project IBA-ILMA (grant number VN/13798/2023). MSp was supported by funding from the Wellcome Trust, through Our Planet Our Health (Livestock, Environment and People, award number 205212/Z/16/Z) and a Wellcome Career Development Award (Towards the full cost of diets, award number 225318/Z/22/Z). JDSh was supported by the Canadian Institutes of Health Research, the Commonwealth Fund, and the Emergency Care Research Institute and has received consulting fees from the Institute for Healthcare Research. JT was supported by the Research Council of Finland (T-Winning Spaces 2035 project), the UK Medical Research Council (PICNIC project), and the Finnish Ministry of the Environment (SEASON project). JB is employed as a consultant by the Global Climate and Health Alliance. ML received consulting fees from YarCom for advisory services and was supported by general use gifts awarded to the Center on Global Energy Policy at Columbia University, USA. JMil acknowledges consulting fees from the C40 Climate Leadership Group. CZ-C received a consultancy from the University of Alberta and was supported by contracts with her university (Universidad Peruana Cayetano Heredia), University of Leeds, WHO, and the Wellcome Trust; she was also supported by a letter of agreement between her university and the Food and Agriculture Organization's Indigenous Peoples Unit. MD was supported by the Wellcome Trust via the Complex Urban Systems for Sustainability and Health project (grants 205207/Z/16/Z and 209387/Z/17/Z). IH, S-CH, MRo, CT, and RL were supported by the Horizon Europe CATALYSE project (CATALYSE grant number 101057131, HORIZON-HLTH-2021-ENVHLTH-02, with UK Research and Innovation reference number 10041512). The work of YH, YL, DT, and QZ was supported by the National Aeronautics and Space Administration's Earth Action programme (grant number 80NSSC21K0507). AJP was supported by the Bezos Earth Fund and the Schmidt Family Foundation. ER and SD were supported by a Process-based models for climate impact attribution across sectors (PROCLIAS) grant (COST Action PROCLIAS grant CA19139), funded by European Cooperation in Science and Technology. All other authors declare no competing interests.

Smoke from wildfires poses a substantial threat to health in communities near and far. To mitigate the extent and potential damage of wildfires, prescribed burning techniques are commonly employed as land management tools; however, they introduce their own smoke-related risks. This study investigates the impact of prescribed fires on daily average PM 2.5 and maximum daily 8-h averaged O 3 (MDA8-O 3 ) concentrations and estimates premature deaths associated with short-term exposure to prescribed fire PM 2.5 and MDA8-O 3 in Georgia and surrounding areas of the Southeastern US from 2015 to 2020. Our findings indicate that over the study domain, prescribed fire contributes to average daily PM 2.5 by 0.94 ± 1.45 μg/m 3 (mean ± standard deviation), accounting for 14.0% of year-round ambient PM 2.5 . Higher average daily contributions were predicted during the extensive burning season (January-April): 1.43 ± 1.97 μg/m 3 (20.0% of ambient PM 2.5 ). Additionally, prescribed burning is also responsible for an annual average increase of 0.36 ± 0.61 ppb in MDA8-O 3 (approximately 0.8% of ambient MDA8-O 3 ) and 1.3% (0.62 ± 0.88 ppb) during the extensive burning season. We estimate that short-term exposure to prescribed fire PM 2.5 and MDA8-O 3 could have caused 2665 (95% confidence interval (CI): 2249-3080) and 233 (95% CI: 148-317) excess deaths, respectively. These results suggest that smoke from prescribed burns increases the mortality. However, refraining from such burns may escalate the risk of wildfires; therefore, the trade-offs between the health impacts of wildfires and prescribed fires, including morbidity, need to be taken into consideration in future studies.

In 2023 human populations experienced multiple record-breaking climate events, with widespread impacts on human health and well-being. These events include extreme heat domes, drought, severe storms, flooding, and wildfires. Due to inherent lags in the climate system, we can expect such extremes to continue for multiple decades after reaching net zero carbon emissions. Unfortunately, despite these significant current and future impacts, funding for research in climate and health has lagged behind that for other geoscience and biomedical research. While some initial efforts from funding agencies are evident, there is still a significant need to increase the resources available for multidisciplinary research in the face of this issue. As a group of experts at this important intersection, we call for a more concerted effort to encourage interdisciplinary and policy-relevant investigations into the detrimental health effects of continued climate change., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2024 The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

Background: Over 120 million people in the USA live in areas with unsafe ozone (O3) levels. Studies among adults have linked exposure to worse lung function and higher risk of asthma and chronic obstructive pulmonary disease (COPD). However, few studies have examined the effects of O3 in children, and existing studies are limited in terms of their geographic scope or outcomes considered., Methods: We leveraged a dataset of encounters at 42 US children's hospitals from 2004-2015. We used a one-stage case-crossover design to quantify the association between daily maximum 8-hour O3 in the county in which the hospital is located and risk of emergency department (ED) visits for any cause and for respiratory disorders, asthma, respiratory infections, allergies and ear disorders., Results: Approximately 28 million visits were available during this period. Per 10 ppb increase, warm-season (May through September) O3 levels over the past three days were associated with higher risk of ED visits for all causes (risk ratio [RR]: 0.3% [95% confidence interval (CI): 0.2%, 0.4%]), allergies (4.1% [2.5%, 5.7%]), ear disorders (0.8% [0.3%, 1.3%]) and asthma (1.3% [0.8%, 1.9%]). When restricting to levels below the current regulatory standard (70 ppb), O3 was still associated with risk of ED visits for all-cause, allergies, ear disorders and asthma. Stratified analyses suggest that the risk of O3-related all-cause ED visits may be higher in older children., Conclusions: Results from this national study extend prior research on the impacts of daily O3 on children's health and reinforce the presence of important adverse health impacts even at levels below the current regulatory standard in the USA., (© The Author(s) 2024; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Competing Interests: Declaration of interests 14 of the authors (MRo, MWa, LJ, MBO'H, CO, HW, CdN, HK, PL, DS, CG, ZA, MY-G, and KRvD) were compensated for their time while drafting and developing the Lancet Countdown's report. OG was supported by the EU Horizon Grant: Climate Action To Advance Healthy Societies in Europe (Project 101057131–CATALYSE), for which there is overlap of data collection and preprocessing with the materials submitted in this report. MSp was supported by the Wellcome Trust Livestock, Environment and People (grant number 205212/Z/16/Z) and Wellcome Trust (grant number 225318/Z/22/Z). JT was supported by the Academy of Finland grants for the T-Winning (grant number 353327). CD was supported by the UK Natural Environment Research Council Independent Research Fellowship (grant number NE/N01524X/1), which ended in 2021, and by the European Research Council starting grant FLORA (grant number 101039402). OJ was supported by the NHMRC Investigator Grant entitled Heat and Health: Building resilience to extreme heat in a warming world (GNT20009507), the Wellcome Trust grant Heat stress in ready-made garment factories in Bangladesh (216059/Z/19/Z), and the Resilience New South Wales grant A new heat stress scale for general public (PJ-0000850). YL was supported by funding from the National Aeronautics and Space Administration (grant number: 80NSSC21K0507) for the wildfire population exposure and fire danger indicators. TO and IH were supported by the UK Research and Innovation Engineering and Physical Sciences Research Council Centre for Research in Energy Demand Solutions (grant number EP/R035288/1). MRo was supported by funding from IDAlert project (UK Research and Innovation project reference number 10056533). KB was supported by funding from the National Institute for Health and Care Research (NIHR) Centre on Non-communicable Diseases and Environmental Change (NIHR203247). All other authors declare no competing interests. The authors alone are responsible for the views expressed in this Commission, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

(1) Background: The COVID-19 pandemic brought the key issues of food security, food safety, and food waste into sharp focus. Türkiye is in the enviable position of being among the top ten agricultural economies worldwide, with a wide diversity of food production. This survey was undertaken in order to gain insights into consumer behaviour and attitudes in Türkiye with respect to these issues. The objective was to highlight strengths and weaknesses, identify areas for improvement, and present strategies for the future. (2) Methods: This survey was carried out between April and May 2022 in 12 provinces throughout Türkiye. Face-to-face interviews were performed with 2400 participants representing a cross-section of ages, educational attainment, and socio-economic categories. The findings were evaluated statistically. (3) Results: The results provide an insight into attitudes and behaviours, both pre-COVID-19 and during the pandemic. In several ways, the pandemic enhanced knowledge and improved behaviour, leading to improvements in diet and reductions in food waste. However, worrying concerns about food safety persist. Specific attention has been given to understanding patterns of bread consumption, particularly in consideration of waste. (4) Conclusions: It is hoped that the results of this survey will increase dialogue between the components of the food sector, encourage education initiatives, and contribute to improving food safety and security and reducing food waste in Türkiye and beyond.

Global climate change has sparked efforts to adapt to increasing temperatures, especially in urban areas that experience increased day and nighttime temperatures due to the urban heat island effect. The addition of greenspace has been suggested as a possible means for urban centers to respond to increasing urban temperatures. Thus, it is important for urban planning and policymakers to have access to data on greenspace specific at a fine spatial resolution. This dataset consists of information on peak and annual average 1 × 1 km Normalized Difference Vegetation Index (NDVI) for over 1,000 global urban centers, which is an objective satellite-based measure of vegetation. Population-weighted values for both peak and annual average NDVI and include an indicator of greenness, with seven levels ranging from extremely low to extremely high are provided. Additional information regarding the climate zone (using the Köppen-Geiger climate classification) and level of development (using the Human Development Index or HDI) for each city is included. Analyses were repeated in 2010, 2015, and 2020 to provide the ability to track urban greenness over time. Data are provided in tabular format with summaries presented in both tables and graphics. These data can be used to inform policy and planning and can be used as an indicator for a variety of climate and health investigations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change., (© 2022 The Author(s). Published by IOP Publishing Ltd.)

Increases in wildfire activity across the Western US pose a significant public health threat. While there is evidence that wildfire smoke is detrimental for respiratory health, the impacts on cardiovascular health remain unclear. This study evaluates the association between fine particulate matter (PM 2.5 ) from wildfire smoke and unscheduled cardiorespiratory hospital visits in California during the 2004-2009 wildfire seasons. We estimate daily mean wildfire-specific PM 2.5 with Goddard Earth Observing System-Chem, a global three-dimensional model of atmospheric chemistry, with wildfire emissions estimates from the Global Fire Emissions Database. We defined a "smoke event day" as cumulative 0-1-day lag wildfire-specific PM 2.5 ≥ 98th percentile of cumulative 0-1 lag day wildfire PM 2.5 . Associations between exposure and outcomes are estimated using negative binomial regression. Results indicate that smoke event days are associated with a 3.3% (95% CI: [0.4%, 6.3%]) increase in visits for all respiratory diseases and a 10.3% (95% CI: [2.3%, 19.0%]) increase for asthma specifically. Stratifying by age, we found the largest effect for asthma among children ages 0-5 years. We observed no significant association between exposure and overall cardiovascular disease, but stratified analyses revealed increases in visits for all cardiovascular, ischemic heart disease, and heart failure among non-Hispanic white individuals and those older than 65 years. Further, we found a significant interaction between smoke event days and daily average temperature for all cardiovascular disease visits, suggesting that days with high wildfire PM 2.5 concentrations and high temperatures may pose greater risk for cardiovascular disease. These results suggest substantial increases in adverse outcomes from wildfire smoke exposure and indicate the need for improved prevention strategies and adaptations to protect vulnerable populations., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2022 The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

From the heated debates over the airborne transmission of the novel coronavirus to the abrupt Earth system changes caused by the sudden lockdowns, the dire circumstances resulting from the coronavirus disease 2019 (COVID-19) pandemic have brought the field of GeoHealth to the forefront of visibility in science and policy. The pandemic has inadvertently provided an opportunity to study how human response has impacted the Earth system, how the Earth system may impact the pandemic, and the capacity of GeoHealth to inform real-time policy. The lessons learned throughout our responses to the COVID-19 pandemic are shaping the future of GeoHealth., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2021. The Authors. GeoHealth published by Wiley Periodcals LLC on behalf of American Geophysical Union.)

There is strong evidence that foods containing dietary fibre protect against colorectal cancer, resulting at least in part from its anti-proliferative properties. This study aimed to investigate the effects of supplementation with two non-digestible carbohydrates, resistant starch (RS) and polydextrose (PD), on crypt cell proliferative state (CCPS) in the macroscopically normal rectal mucosa of healthy individuals. We also investigated relationships between expression of regulators of apoptosis and of the cell cycle on markers of CCPS. Seventy-five healthy participants were supplemented with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design in a randomised, double-blind, placebo-controlled trial (the Dietary Intervention, Stem cells and Colorectal Cancer (DISC) Study). CCPS was assessed, and the expression of regulators of the cell cycle and of apoptosis was measured by quantitative PCR in rectal mucosal biopsies. SCFA concentrations were quantified in faecal samples collected pre- and post-intervention. Supplementation with RS increased the total number of mitotic cells within the crypt by 60 % (P = 0·001) compared with placebo. This effect was limited to older participants (aged ≥50 years). No other differences were observed for the treatments with PD or RS as compared with their respective controls. PD did not influence any of the measured variables. RS, however, increased cell proliferation in the crypts of the macroscopically-normal rectum of older adults. Our findings suggest that the effects of RS on CCPS are not only dose, type of RS and health status-specific but are also influenced by age.

Background: Substantial increases in wildfire activity have been recorded in recent decades. Wildfires influence the chemical composition and concentration of particulate matter ≤2.5 μm in aerodynamic diameter (PM 2.5 ). However, relatively few epidemiologic studies focus on the health impacts of wildfire smoke PM 2.5 compared with the number of studies focusing on total PM 2.5 exposure., Objectives: We estimated the associations between cardiorespiratory acute events and exposure to smoke PM 2.5 in Colorado using a novel exposure model to separate smoke PM 2.5 from background ambient PM 2.5 levels., Methods: We obtained emergency department visits and hospitalizations for acute cardiorespiratory outcomes from Colorado for May-August 2011-2014, geocoded to a 4 km geographic grid. Combining ground measurements, chemical transport models, and remote sensing data, we estimated smoke PM 2.5 and non-smoke PM 2.5 on a 1 km spatial grid and aggregated to match the resolution of the health data. Time-stratified, case-crossover models were fit using conditional logistic regression to estimate associations between fire smoke PM 2.5 and non-smoke PM 2.5 for overall and age-stratified outcomes using 2-day averaging windows for cardiovascular disease and 3-day windows for respiratory disease., Results: Per 1 μg/m 3 increase in fire smoke PM 2.5 , statistically significant associations were observed for asthma (OR = 1.081 (1.058, 1.105)) and combined respiratory disease (OR = 1.021 (1.012, 1.031)). No significant relationships were evident for cardiovascular diseases and smoke PM 2.5 . Associations with non-smoke PM 2.5 were null for all outcomes. Positive age-specific associations related to smoke PM 2.5 were observed for asthma and combined respiratory disease in children, and for asthma, bronchitis, COPD, and combined respiratory disease in adults. No significant associations were found in older adults., Discussion: This is the first multi-year, high-resolution epidemiologic study to incorporate statistical and chemical transport modeling methods to estimate PM 2.5 exposure due to wildfires. Our results allow for a more precise assessment of the population health impact of wildfire-related PM 2.5 exposure in a changing climate., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background : We assessed the association of groundwater chemicals with systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: Blood pressure data for ≥35-year-olds were from the Bangladesh Demographic and Health Survey in 2011. Groundwater chemicals in 3534 well water samples from Bangladesh were measured by the British Geological Survey (BGS) in 1998-1999. Participants who reported groundwater as their primary source of drinking water were assigned chemical measures from the nearest BGS well. Survey-adjusted linear regression methods were used to assess the association of each groundwater chemical with the log-transformed blood pressure of the participants. Models were adjusted for age, sex, body mass index, smoking status, geographical region, household wealth, rural or urban residence, and educational attainment, and further adjusted for all other groundwater chemicals. Results: One standard deviation (SD) increase in groundwater magnesium was associated with a 0.992 (95% confidence interval (CI): 0.986, 0.998) geometric mean ratio (GMR) of SBP and a 0.991 (95% CI: 0.985, 0.996) GMR of DBP when adjusted for covariates except groundwater chemicals. When additionally adjusted for groundwater chemicals, one SD increase in groundwater magnesium was associated with a 0.984 (95% CI: 0.972, 0.997) GMR of SBP and a 0.990 (95% CI: 0.979, 1.000) GMR of DBP. However, associations were attenuated following Bonferroni-correction for multiple chemical comparisons in the full-adjusted model. Groundwater concentrations of calcium, potassium, silicon, sulfate, barium, zinc, manganese, and iron were not associated with SBP or DBP in the full-adjusted models. Conclusions: Groundwater magnesium had a weak association with lower SBP and DBP of the participants.

Background/objectives: Renewed dietary recommendations for carbohydrates have recently been published by various international health authorities. The present work (1) reviews the methods and processes (systematic approach/review, inclusion of public consultation) used to identify, select and grade the evidence underpinning the recommendations, particularly for total carbohydrate (CHO), fibre and sugar consumption, and (2) examines the extent to which variation in the methods and processes applied relates to any differences in the final recommendations., Subjects/methods: A search of WHO, US, Canada, Australia and European sources identified 19 documents from 13 authorities with the desired detailed information. Processes and methods applied to derive recommendations were compiled and compared., Results: (1) A relatively high total CHO and fibre intake and limited intake of (added or free) sugars are generally recommended. (2) Even where recommendations are similar, the specific justifications for quantitative/qualitative recommendations differ across authorities. (3) Differences in recommendations mainly arise from differences in the underlying definitions of CHO exposure and classifications, the degree to which specific CHO-providing foods and food components were considered, and the choice and number of health outcomes selected. (4) Differences in the selection of source material, time frames or data aggregation and grading methods appeared to have minor influence., Conclusions: Despite general consistency, apparent differences among the recommendations of different authorities would likely be minimized by: (1) More explicit quantitative justifications for numerical recommendations and communication of uncertainty, and (2) greater international harmonization, particularly in the underlying definitions of exposures and range of relevant nutrition-related outcomes.

Background: Caring for young children is a known risk factor for cytomegalovirus (CMV) infection mainly through exposure to their saliva and urine. In a previous study, 36 CMV-seropositive children 2 mo. to 4 years old were categorized as CMV shedders (n = 23) or non-shedders (n = 13) based on detection of CMV DNA in their saliva and urine. The current study evaluated the presence of CMV on surfaces in homes of the children., Methods: Study staff made 4 visits to homes of the 36 enrolled children over 100 days. Saliva was collected by swabbing the mouth and urine was collected on filter paper inserted into diapers. In addition, five surface specimens were collected: three in contact with children's saliva (spoon, child's cheek, washcloth) and two in contact with children's urine (diaper changing table, mother's hand). Samples were tested by PCR and viral culture to quantify the presence of CMV DNA and viable virus., Results: A total of 654 surface samples from 36 homes were tested; 136 were CMV DNA positive, 122 of which (90%) were in homes of the children shedding CMV (p < 0.001). Saliva-associated samples were more often CMV positive with higher viral loads than urine-associated samples. The higher the CMV viral load of the child in the home, the more home surfaces that were PCR positive (p = 0.01) and viral culture positive (p = 0.05)., Conclusions: The main source for CMV on surfaces in homes was saliva from the child in the home. Higher CMV viral loads shed by children correlated with more viable virus on surfaces which could potentially contribute to viral transmission.

Background: An estimated 1 in 150 infants is born each year with congenital cytomegalovirus (CMV); nearly 1 in 750 suffers permanent disabilities. Congenital CMV is the result of a pregnant woman becoming infected with CMV. Educating pregnant women about CMV is currently the best approach to prevention. Limited research is available on how to effectively communicate with women about CMV. We conducted formative research on fear appeals theory-based messages about CMV and prevention with U.S. women. Fear appeal theories suggest that message recipients will take action if they feel fear., Methods: First, we conducted in-depth interviews (N = 32) with women who had young children who tested positive for CMV. Second, we conducted eight focus groups (N = 70) in two phases and two cities (Phase 2: Atlanta, GA; Phase 3: San Diego, CA) with pregnant women and non-pregnant women who had young children. Few participants knew about CMV before the focus groups. Participants reviewed and gave feedback on messages created around fear appeals theory-based communication concepts. The following concepts were tested in one or more of the three phases of research: CMV is severe, CMV is common, CMV is preventable, CMV preventive strategies are similar to other behavior changes women make during pregnancy, CMV preventive strategies can be incorporated in moderation to reduce exposure, and CMV is severe but preventable., Results: Participants recommended communicating that CMV is common by using prevalence ratios (e.g., 1 in 150) or comparing CMV to other well-known disabilities. To convey the severity of CMV, participants preferred stories about CMV along with prevention strategies. Participants also welcomed prevention strategies when it included a message about risk reduction. In general, participants said messages were motivating, even if they felt that it could be difficult to make certain behavior changes., Conclusions: Findings from this research can contribute to future efforts to educate pregnant women about CMV, especially regarding use of fear appeals-based messages. Pregnant women may face certain challenges to practicing prevention strategies but, overall, are motivated make changes to increase their chances of having a healthy baby.

Overwhelming evidence has shown that, from the Industrial Revolution to the present, human activities influence ground-level ozone (O 3 ) concentrations. Past studies demonstrate links between O 3 exposure and health. However, knowledge gaps remain in our understanding concerning the impacts of climate change mitigation policies on O 3 concentrations and health. Using a hybrid downscaling approach, we evaluated the separate impact of climate change and emission control policies on O 3 levels and associated excess mortality in the US in the 2050s under two Representative Concentration Pathways (RCPs). We show that, by the 2050s, under RCP4.5, increased O 3 levels due to combined climate change and emission control policies, could contribute to an increase of approximately 50 premature deaths annually nationwide in the US. The biggest impact, however, is seen under RCP8.5, where rises in O 3 concentrations are expected to result in over 2,200 additional premature deaths annually. The largest increases in O 3 are seen in RCP8.5 in the Northeast, the Southeast, the Central, and the West regions of the US. Additionally, when O 3 increases are examined by climate change and emissions contributions separately, the benefits of emissions mitigation efforts may significantly outweigh the effects of climate change mitigation policies on O 3 -related mortality., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: To better understand potential transmission risks from contact with the body fluids of children, we monitored the presence and amount of CMV shedding over time in healthy CMV-seropositive children., Methods: Through screening we identified 36 children from the Atlanta, Georgia area who were CMV-seropositive, including 23 who were shedding CMV at the time of screening. Each child received 12 weekly in-home visits at which field workers collected saliva and urine. During the final two weeks, parents also collected saliva and urine daily., Results: Prevalence of shedding was highly correlated with initial shedding status: children shedding at the screening visit had CMV DNA in 84% of follow-up saliva specimens (455/543) and 28% of follow-up urine specimens (151/539); those not shedding at the screening visit had CMV DNA in 16% of follow-up saliva specimens (47/303) and 5% of follow-up urine specimens (16/305). Among positive specimens we found median viral loads of 82,900 copies/mL in saliva and 34,730 copies/mL in urine (P=0.01), while the viral load for the 75th percentile was nearly 1.5 million copies/mL for saliva compared to 86,800 copies/mL for urine. Younger age was significantly associated with higher viral loads, especially for saliva (P<0.001). Shedding prevalence and viral loads were relatively stable over time. All children who were shedding at the screening visit were still shedding at least some days during weeks 11 and 12, and median and mean viral loads did not change substantially over time., Conclusions: Healthy CMV-seropositive children can shed CMV for months at high, relatively stable levels. These data suggest that behavioral prevention messages need to address transmission via both saliva and urine, but also need to be informed by the potentially higher risks posed by saliva and by exposures to younger children.

Background: Congenital cytomegalovirus (CMV) is the leading infectious cause of birth defects in the United States. To better understand factors that may influence CMV transmission risk, we compared viral and immunological factors in healthy children and their mothers., Methods: We screened for CMV IgG antibodies in a convenience sample of 161 children aged 0-47 months from the Atlanta, Georgia metropolitan area, along with 32 mothers of children who screened CMV-seropositive. We assessed CMV shedding via PCR using saliva collected with oral swabs (children and mothers) and urine collected from diapers using filter paper inserts (children only)., Results: CMV IgG was present in 31% (50/161) of the children. Half (25/50) of seropositive children were shedding in at least one fluid. The proportion of seropositive children who shed in saliva was 100% (8/8) among the 4-12 month-olds, 64% (9/14) among 13-24 month-olds, and 40% (6/15) among 25-47 month-olds (P for trend=0.003). Seropositive mothers had a lower proportion of saliva shedding (21% [6/29]) than children (P<0.001). Among children who were shedding CMV, viral loads in saliva were significantly higher in younger children (P <0.001); on average, the saliva viral load of infants (i.e., <12 months) was approximately 300 times that of two year-olds (i.e., 24-35 months). Median CMV viral loads were similar in children's saliva and urine but were 10-50 times higher (P<0.001) than the median viral load of the mothers' saliva. However, very high viral loads (> one million copies/mL) were only found in children's saliva (31% of those shedding); children's urine and mothers' saliva specimens all had fewer than 100,000 copies/mL. Low IgG avidity, a marker of primary infection, was associated with younger age (p=0.03), higher viral loads in saliva (p=0.02), and lower antibody titers (p=0.005)., Conclusions: Young CMV seropositive children, especially those less than one year-old may present high-risk CMV exposures to pregnant women, especially via saliva, though further research is needed to see if this finding can be generalized across racial or other demographic strata.

Congenital cytomegalovirus (CMV) transmission can occur when women acquire CMV while pregnant. Infection control guidelines may reduce risk for transmission. We studied the duration of CMV survival after application of bacteria to the hands and after transfer from the hands to surfaces and the effectiveness of cleansing with water, regular and antibacterial soaps, sanitizer, and diaper wipes. Experiments used CMV AD169 in saliva at initial titers of 1 × 10(5) infectious particles/ml. Samples from hands or surfaces (points between 0 and 15 min) were placed in culture and observed for at least 2 weeks. Samples were also tested using CMV real-time PCR. After application of bacteria to the hands, viable CMV was recovered from 17/20 swabs at 0 min, 18/20 swabs at 1 min, 5/20 swabs at 5 min, and 4/20 swabs at 15 min. After transfer, duration of survival was at least 15 min on plastic (1/2 swabs), 5 min on crackers and glass (3/4 swabs), and 1 min or less on metal and cloth (3/4 swabs); no viable virus was collected from wood, rubber, or hands. After cleansing, no viable virus was recovered using water (0/22), plain soap (0/20), antibacterial soap (0/20), or sanitizer (0/22). Viable CMV was recovered from 4/20 hands 10 min after diaper wipe cleansing. CMV remains viable on hands for sufficient times to allow transmission. CMV may be transferred to surfaces with reduced viability. Hand-cleansing methods were effective at eliminating viable CMV from hands.