Epidemiological update of cystic echinococcosis in livestock and assessment of practices related to its control in the Mediterranean area.

Cystic echinococcosis (CE), caused by the tapeworm Echinococcus granulosus, is a zoonotic parasitic disease that still represents a serious threat to human and animal health worldwide. The Mediterranean basin is recognized as one of the major hotspots of CE due to several factors, including the presence of diverse intermediate host species as well as socio-economic and cultural conditions of local communities. This study aims to take a closer look at epidemiological data on CE in the Mediterranean area and assess the knowledge attitudes and practices of shepherds towards this disease in four countries (Algeria, Greece, Italy and Tunisia), highly endemic for CE, with the final goal of identifying highly endemic risk areas and practices in use which might potentially allow the persistence of E. granulosus infection in these areas. To update the epidemiological scenario of CE in Mediterranean areas, a comprehensive review of peer-reviewed literature on CE prevalence data published during the 2017-2023 period was carried out and, through a geographical information system (GIS), a map displaying the current CE distribution in the Mediterranean area was generated. In addition, a questionnaire survey was conducted through in-depth interviews of the farmers to collect information on their management system as well as knowledge attitudes and practices towards CE. From the farmer-participatory survey some risky practices emerged including the non-regular deworming of dogs or the use of ineffective drugs or dosing, as well as the provision of uncooked animal viscera to dogs. Finally, lower levels of knowledge and awareness of the disease was observed among farmers from North Africa compared with those of European countries. In conclusion, the results obtained highlight that CE is still a very serious problem in Mediterranean areas and increased efforts are needed to promote awareness among farmers and to turn research results into policy in order to reduce the spread of this disease, according to the One Health perspective.

Access to healthcare for migrants in Tunisia in 2023-2024: Current situation and ethical challenges.

INTRODUCTION: Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health. AIM: This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it. RESULTS: Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves. Ethical questioning is constant to determine how to do well and not harm. The reflection on this more humane "social medicine" comprehending the patient in its entirety, is only in its beginnings. The critical health status of the poorest populations and their extreme vulnerability do not only call for adapted and specific care measures but also a more comprehensive questioning of social ties and the place that our society grants to the weakest and excluded. CONCLUSION: Migration must be considered as a central issue of the ethics of the health of a population in order to provide quality care without prejudice.

An update on the access to inpatient rehabilitation facilities across Tunisia in 2023.

INTRODUCTION: Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated. AIM: To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023. METHODS: Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites. RESULTS: The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia. CONCLUSION: This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.

Flexing with lines or pipes: Techno-economic comparison of renewable electricity import options for European research facilities.

Where local resources for renewable electricity are scarce or insufficient, long-distance electricity imports will be required in the future. Even across long distances, the variable availability of renewable energy sources needs to be managed for which dedicated storage options are usually considered. Other alternatives could be demand-side flexibility and concentrated solar power with integrated thermal energy storage. Here their influence on the cost of imported electricity is explored. Using a techno-economic linear capacity optimization, exports of renewable electricity from Morocco and Tunisia to CERN in Geneva, Switzerland in the context of large research facilities are modeled. Two different energy supply chains are considered, direct imports of electricity by HVDC transmission lines, and indirect imports using H2 pipelines subsequent electricity generation. The results show that direct electricity exports ranging from 58 EUR/MWh to 106 EUR/MWh are the more economical option compared to indirect H2-based exports ranging from 157 EUR/MWh to 201 EUR/MWh. Both demand-side flexibility and CSP with TES offer significant opportunities to reduce the costs of imports, with demand-side flexibility able to reduce costs for imported electricity by up to 45%. Research institutions in Central Europe could initiate and strengthen electricity export-import partnerships with North Africa to take on a leading role in Europe's energy transition and to secure for themselves a long-term, sustainable electricity supply at plannable costs.

Assessment of gamma absorbed doses and radiological risk indexes from soil radioactivity around the phosphate area in south Tunisia.

Human beings are constantly exposed to the radiations coming from the environment. This work assesses the radiological hazards of natural radioactivity in soil samples taken at four locations around the phosphate area in south Tunisia. Concentrations of primordial radionuclides were measured by gamma spectrometer using an HPGe detector. The overall mean values of 40K, 226Ra and 232Th concentrations were 264, 27 and 13 Bq kg-1, respectively. From the radioactivity measurements, radiation hazard indices specified by the United Nation Scientific Committee on the Effect of Atomic Radiation such as radium equivalent activity (Raeq), absorbed dose rates ($ {\dot{\text D}} $) and annual effective dose (AED) to the population for outdoor environment were determined. The mean values for the abovementioned parameters were 64 Bq kg-1, 33 nGy h-1 and 40 µSv y-1, respectively.

Spatial assessment of soil erosion by water using RUSLE model, remote sensing and GIS: a case study of Mellegue Watershed, Algeria-Tunisia.

Soil erosion is an important global phenomenon that can cause many impacts, like morphometry and hydrology alteration, land degradation and landslides. Moreover, soil loss has a significant effect on agricultural production by removing the most valuable and productive top soil's profile, leading to a reduction in yields, which requires a high production budget. The detrimental impact of soil erosion has reached alarming levels due to the exacerbation of global warming and drought, particularly in the arid climates prevalent in Tunisia and Algeria and other regions of North Africa. The influence of these environmental factors has been especially evident in the catchment of Mellegue, where profound vegetation loss and drastic changes in land use and cover, including the expansion of urban areas and altered agricultural practices, have played a significant role in accelerating water-induced soil loss between 2002 and 2018. The ramifications of these developments on the fragile ecosystems of the region cannot be overlooked. Accordingly, this study aimed to compare soil losses between 2002 and 2018 in the catchment of Mellegue, which is a large cross-border basin commonly shared by Tunisian-Algerian countries. The assessment and mapping of soil erosion risk were carried out by employing the Revised Universal Soil Loss Equation (RUSLE). This widely recognised equation provided valuable insights into the potential for erosion. Additionally, changes in land use and land cover during the same period were thoroughly analysed to identify any factors that may have contributed to the observed risk. By integrating these various elements, a comprehensive understanding of soil erosion dynamics was achieved, facilitating informed decision-making for effective land management and conservation efforts. It requires diverse factors that are integrated into the erosion process, such as topography, soil erodibility, rainfall erosivity, anti-erosion cultivation practice and vegetation cover. The computation of the various equation factors was applied in a GIS environment, using ArcGIS desktop 10.4. The results show that the catchment has undergone significant soil water erosion where it exhibits the appearance of approximately 14,000 new areas vulnerable to erosion by water in 2018 compared to 2002. Average erosion risk has also increased from 1.58 t/ha/year in 2002 to 1.78 in 2018, leading to an increase in total estimated soil loss of 54,000 t/ha in 2018 compared to around 25,500 t/ha in 2002. Maps of erosion risk show that highly eroded areas are more frequent downstream of the basin. These maps can be helpful for decision-makers to make better sustainable management plans and for land use preservation.

Examining multiple funding flows to public healthcare providers in low- and middle-income countries - results from case studies in Burkina Faso, Kenya, Morocco, Nigeria, Tunisia and Vietnam.

Provider payment methods are traditionally examined by appraising the incentive signals inherent in individual payment mechanisms. However, mixed payment arrangements, which result in multiple funding flows from purchasers to providers, could be better understood by applying a systems approach that assesses the combined effects of multiple payment streams on healthcare providers. Guided by the framework developed by Barasa et al. (2021) (Barasa E, Mathauer I, Kabia E et al. 2021. How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them. Health Policy and Planning  36: 861-8.), this paper synthesizes the findings from six country case studies that examined multiple funding flows and describes the potential effect of multiple payment streams on healthcare provider behaviour in low- and middle-income countries. The qualitative findings from this study reveal the extent of undesirable provider behaviour occurring due to the receipt of multiple funding flows and explain how certain characteristics of funding flows can drive the occurrence of undesirable behaviours. Service and resource shifting occurred in most of the study countries; however, the occurrence of cost shifting was less evident. The perceived adequacy of payment rates was found to be the strongest driver of provider behaviour in the countries examined. The study results indicate that undesirable provider behaviours can have negative impacts on efficiency, equity and quality in healthcare service provision. Further empirical studies are required to add to the evidence on this link. In addition, future research could explore how governance arrangements can be used to coordinate multiple funding flows, mitigate unfavourable consequences and identify issues associated with the implementation of relevant governance measures.

GIS-based multicriteria and artificial neural network (ANN) investigation for the assessment of groundwater vulnerability and pollution hazard in the Braga shallow aquifer (Central Tunisia): A critical review of generic and modified DRASTIC models.

Groundwater vulnerability and pollution hazard in the Braga shallow aquifer were assessed through an integrated GIS-based multicriteria analysis and Artificial Neural Network (ANN) approach, using DRASTIC and DRASTIC-LU models. The DRASTIC model integrates seven geological parameters. The DRASTIC-LU model includes an eighth parameter in addition to the previous ones. This parameter is the land use that represents the human source of groundwater pollution. The DRASTIC map showed four classes: very low (12.06%), low (81.88%), moderate (5.16%) and high (0.9%), where the vulnerability index ranged between 43 and 159. The DRASTIC-LU vulnerability index ranged between 53 and 204 and showed five classes: very low (3.10%), low (14.06%), moderate (17.11%), high (27.08%) and very high (38.65%). The DRASTIC-LU vulnerability map indicated that the high pollution risk is imposed by the intensive vegetable cultivation and the domestic wastewater. The pollution hazard index (PHI) was calculated based on the ANN modelling, using the land-use as an input and the vulnerability as a hidden layer. The DRASTIC model-based PHI map showed six classes: rare hazard (8.6%), very low (30.97%), low (6.18%), moderate (51.45%), high (2.43%) and very high (0.37%). While, The DRASTIC-LU model-based PHI map (PHILU) showed seven classes: rare hazard (2.91%), very low (11.9%), low (12.33%), moderate (13.78%), high (9.23%), very high (15.46%) and extremely hazardous (34.39%). The validation of these maps indicated that the DRSTIC-LU-based PHI is more reliable as it accurately identifies the hazardous zones.

Preparations for sustainability and transition from Global Fund support in the Eastern Mediterranean Region.

Background: HIV, tuberculosis and malaria (HTM) services receive financial support from the Global Fund and need to plan for sustainability and transition from external funding. Aim: To recommend actions for addressing key sustainability and transition issues in 15 countries receiving Global Fund grants in the WHO Eastern Mediterranean (EMR) Region. Methods: We reviewed documents, interviewed key informants, and conducted case studies in Sudan and Tunisia to highlight key considerations for sustainability and transition from Global Fund that is tailored to the EMR and the health system building blocks. Sustainability considerations should align with the health system building blocks, including governance, financing, service delivery, workforce and health product management, with the addition of considerations for key and vulnerable populations because of their particular importance for HIV and tuberculosis services. Conclusion: While hoping for economic growth and reduction of the burden of HTM, EMR countries need to prepare for transition from Global Fund support. Proactive steps that are tailored to the health system building blocks and address the needs of key and vulnerable populations should progressively increase national capabilities as well as resources dedicated to HTM.

Implementation and evaluation of different techniques to modify DRASTIC method for groundwater vulnerability assessment: a case study from Bouficha aquifer, Tunisia.

Groundwater vulnerability assessment has nowadays evolved into an essential tool towards proper groundwater protection and management, while the DRASTIC method is included among the most widely applied vulnerability assessment methods. However, the high uncertainty of the DRASTIC method mainly associated with the subjectivity in assigning parameters ratings and weights has driven many researchers to apply various methods for improving its efficiency. In this context, in the present study, different techniques were implemented with the aim of modifying the DRASTIC framework and thus enhancing its performance for groundwater vulnerability assessment in the Bouficha aquifer, Tunisia. In a first stage, the land use type (L) was incorporated as an additional parameter in the typical DRASTIC framework, thus taking into consideration the impact of anthropogenic activities on groundwater vulnerability. Subsequently, the rating and weighting systems of the developed DRASTIC-L framework were modified through the application of statistical methods (DRASTIC-L-SA) and genetic algorithms (GA) (DRASTIC-L-GA) in an attempt to investigate and compare both linear and nonlinear modifications. To evaluate the various vulnerability frameworks, correlation between vulnerability values and nitrate concentrations, expressed as Spearman's rank correlation coefficient (ρ) and Correlation Index (CI), was examined. The results revealed that the DRASTIC-L-GA framework developed by applying a fully GA-based optimization procedure provided the highest values in terms of the performance metrics used, making it the most suitable for the study area. In addition, the aquifer under study was found to be less vulnerable to pollution when employing the typical DRASTIC framework instead of the modified ones, leading to the conclusion that the former substantially underestimates pollution potential in the study area.

An assessment of the influence of clean energy and service development on environmental degradation: evidence for a non-linear ARDL approach for Tunisia.

This paper investigates the nexus among renewable energy consumption, carbon dioxide emissions, economic development, and service growth in Tunisia under the linear and non-linear autoregressive distributed lags techniques and the Granger causality tests, for the 1980-2020 period. The empirical linear findings proved that renewable energy and service growth positively affect carbon emissions in the long term. The non-linear findings proved that a negative energy shock positively influences environmental quality in the long term. More prominently, in the long run, unilateral causalities from all the modeled variables to carbon emissions have been revealed. To mitigate climate change and get the economy back on track for more prosperity, the Tunisian government must develop an efficient strategy friendly to the environment and further explore the relationship between new technologies and renewable energy. Indeed, we propose to policymakers to encourage and promote the use of innovative clean technologies in the production of renewable energy.

Analysis of hydrochemical characteristics and assessment of organic pollutants (PAH and PCB) in El Fahs plain aquifer, northeast of Tunisia.

The availability of good quality groundwater constitutes a major concern in many developing countries. The El Fahs shallow aquifer, northeastern Tunisia, is an important source of water supply for various economic sectors in the agricultural region. The intensive exploitation of this groundwater has led to its quality degradation. In fact, assessment of water quality degradation is very useful in planning the conservation and management practices of water resources in this watershed. This research aims to evaluate the groundwater quality and its suitability for irrigation uses, identify the main processes to assess their chemical composition, and investigate the potential sources of persistent organic pollutants (POPs). The hydrogeochemical investigation is thus conducted by collecting groundwater samples and analyzing their physicochemical characteristics. Polycyclic aromatic hydrocarbons (16 PAHs) and polychlorinated biphenyls (7 PCBs) were determined in groundwaters from nine stations. The sampling took place in July 2020. The relative abundance of ions was Na > Mg > Ca > K for cations and Cl > SO4 > HCO3 for anions. The groundwater exhibits two predominant hydrochemical facies: Ca-Mg-Cl/SO4 and Na-Cl. The relevant recorded pollutant is nitrate, which was generally far above values of pollution thresholds indicating the influence by the intensive agricultural activity. The suitability for irrigation purposes was assessed using several parameters (EC, SAR, %Na, TH, PI, Mh, and Kr). As a matter of fact, the results mentioned that the majority of the samples are unsuitable for irrigation uses. An analysis of the organic pollutants indicates that the total PAH and PCB concentrations are above the permissible values. Therefore, a considerable predominance of naphthalene and PCB28 was observed in order to discriminate between pyrolitic and petrogenic PAH sources; low-molecular-weight (LPAH)/high-molecular-weight (HPAH) ratio was calculated. Results showed that PAHs were mainly of petrogenic origin. The results revealed also that the chemical composition of groundwater is influenced by evaporation process, ion exchange, and water-rock interaction during the flow. A high risk of organic contamination has been highlighted linked to anthropogenic activities which have exerted increasing pressure on groundwater quality. The presence of organic pollutants in groundwater is becoming a serious threat to the environment and human health.

Assessment of trace elements and fluoride originating from phosphogypsum in the sediment of Gulf of Gabes (southeastern Tunisia): what are the potential sources of accumulation and bioavailability?

To assess potential impacts of industrial activities on the pollution status of Gulf of Gabes, twenty sediment and water samples along with phytoplankton enumeration were achieved at different stations with specific features. Comparing trace element concentrations in sediment to applicable SQG standards, we were intrigued by an accumulation of Zn, Cr, Ni, and especially Cd, which exhibited relatively high content compared to these standards. Moreover, trace metal bioavailability was high in front of industrial discharge areas. The chemical speciation pointed out a high affinity of Pb, Zn, Cr, Mn, Ni, Co, and Fe for the residual fraction of the sediment. Bioavailability of trace elements was confirmed in surface sediment by the presence of a potential toxic fraction especially in front of industrial discharge areas. Toxicity assessment performed for the first time in the Gulf of Gabes through SEM and AVS models pointed to a high potential risk near both Ghannouch and Gabes Ports. Finally, the correlations between phytoplankton species and the labile fraction inferred potential phytoplankton bioaccumulation of Zn, Cu, and Cd both in the seawater and in the labile fraction.

Organochlorine pesticides and polychlorinated biphenyls in raw bovine milk from various dairy farms in Beja, Tunisia: contamination status, dietary intake, and health risk assessment for the consumers.

We determined organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in raw bovine milk taken directly from the milking equipment for different animals and various farms in Béja region, which is one of the largest milk producing areas in Tunisia. All milk samples were contaminated with one or more pesticides and exhibited measurable concentrations of some PCB congeners. The residue levels are generally marked by the predominance of dichlorodiphenyltrichloroethanes (DDTs) (median: 17.60 ng g-1 fat), followed by hexachlorobenzene (HCB) (median: 14.31 ng g-1 fat), PCBs (median: 4.71 ng g-1 fat), and hexachlorocyclohexanes (HCHs) (median: 0.77 ng g-1 fat). DDT/DDE ratios across the samples vary between 0.09 to 32.24 and exhibit the hypothesis of sustaining illegal use of the banned pesticide. The historical or recent use of OCPs and possible emission sources of PCBs identified near studied farms may lead to increased levels of these contaminants in produced milk. The estimated daily intake (EDI) values were several orders of magnitude below the tolerable daily intake (TDI) fixed by FAO/WHO, though recorded concentration in some samples exceeded the maximum residue limits (MRLs) fixed by the EU, especially for OCPs. According to health risk assessments, consumption of raw milk did not pose an obvious cancer risk or other health problems for local inhabitants.

Economic growth, social, and welfare development during COVID-19 pandemic: do country-specific characters matter in the MENA region?

The coronavirus disease 2019 (COVID-19) pandemic has generated major shocks that have crippled the economic development of many countries and regions. The COVID-19 pandemic has hampered not only economic development but also global countries from achieving their sustainable development goals through various channels. Given their first experience, many countries have no guidelines for measuring the true impact of the pandemic on their economic and social development, either at the global, regional, or country level. Amid the current slow research development in this area, this study investigates the medium- and long-run impact of the COVID-19 pandemic on the United Nation's achievement of sustainable development goals. The sample in the study comprises the Middle East and North African countries, including Algeria, Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunisia, United Arab Emirates, and Yemen. The social development goals are approximated by economic growth and human development index, which play as the dependent variables representing two models, respectively. From another aspect, independent variables are derived from three primary sectors: government, households, and healthcare providers. In estimating the model, the study implements the panel regression estimation method using multiple variance estimators. The study findings will help policymakers formulate deliberate policy plans to stabilize economic and social fluctuations in the region and to improve the performance of basic macroeconomic parameters.

The inequalities reduction through healthcare decentralisation in low-middle income countries: The case of Tunisia.

Healthcare decentralisation is a model of public service management founds on the wider distribution of the decisional power about healthcare. The decision power is split by central government also with the local health authorities. Since the 1980s, at worldwide level this reform has being applied for guaranteeing equity, efficiency, quality and financial sustainability in the healthcare services provision. In the last years, healthcare decentralisation is happening especially in low-middle income countries. With regard to the analysis of the effectiveness of decentralisation in healthcare, the obtained results are mixed. This study aims to investigate the contribution of management in the first steps of decentralisation's implementation for reducing health inequalities in Tunisia. To have the management's point of view, a survey was sent to all directors of the Tunisian regional hospitals. Health management was able to offer operative and timely solutions to the homogenisation and the improvement of healthcare services supply in Tunisia. For healthcare managers the guarantee of an equal and effective Tunisian healthcare system is into the application of a differentiated decentralisation. The differentiated decentralisation of healthcare system allows to resolve regional issues in Tunisia. These interventions permit to obtain consistent positive results about the satisfaction of Tunisian population health needs. The differentiated decentralisation of healthcare system could also be useful for similar countries, for example, of MENA are of low-middle income countries.

Does improvement in capital intensity facilitate the transition to renewable energies? Evidence from Tunisia.

The objective of this study is to investigate the potential role of capital deepening in promoting the transition to renewable energy in Tunisia. To this end, the long and short run effects of capital deepening on the renewable energy transition were explored using the vector error correction model (VECM) and the Johansen cointegration technique, along with a linear and nonlinear causality test in the context of Tunisia for the period 1990 to 2018. In particular, we found that capital deepening contributes positively to the transition to clean energy resources. In fact, the results of the linear and nonlinear causality tests confirm a unidirectional causal relationship between capital intensity and the transition to renewable energy. This explains that the increase in capital intensity ratio conducts technical change towards renewable energy, which constitutes a capital-intensive technology. Moreover, these results enable us to draw a conclusion about the energy policies in Tunisia and the developing countries in general. In fact, the renewable energy substitution depends on capital intensity, through the development of specific energy policies, such as renewable energy policies. Gradual substitution of fossil fuel subsidies with renewable energy subsidies is essential to faster the transition to renewable energy and promote capital-intensive production methods.

Hydrocarbons in the atmospheric gas phase of a coastal city in Tunisia: Levels, gas-particle partitioning, and health risk assessment.

Many studies have focused on aliphatic hydrocarbons and polycyclic aromatic hydrocarbons (AHs and PAHs) in different environmental compartments, especially atmospheric particles (aerosols), due to their adverse effects on the environment and human health. However, much less information is currently available on the content of AHs and PAHs in the atmospheric gas phase, which is a major reservoir of volatile and photoreactive compounds. Here, for the first time, we assessed the levels, gas-particle partitioning, human health risks and seasonal variations of AHs and PAHs in the atmospheric gas-phase of Bizerte city (Tunisia, North Africa) over a one-year period (March 2015-January 2016). Σ34PAH concentration in the gas phase over the period ranged from 6.7 to 90.6 ng m-3 and on average was 2.5 times higher in the cold season than in the warm season. Σ28AH concentration in the gas phase over the period ranged from 14.0 to 35.9 ng m-3, with no clear seasonal variations. In the gas phase, hydrocarbons were dominated by low-molecular-weight (LMW) compounds, i.e. 3- and 4-ring for PAHs and < n-C24 for AHs. Gas-phase concentrations of PAHs and AHs accounted for up to 80 % of the total (gas + particle phases) atmospheric concentrations of PAHs and AHs. Further analysis of gas-particle partitioning showed that LMW hydrocarbons preferential accumulated in the gas phase, and that gas-particle partitioning was not in equilibrium but dominated by absorption processes into the aerosol organic matter. Benzo[a]pyrene toxic equivalency quotient (BaP-TEQ) in the gas phase represented on average 37 % of the total atmospheric BaP-TEQ concentration, which was always higher in the cold season. Atmospheric gas is a significant factor in the risks of cancer associated with inhalation of ambient air. The Monte Carlo simulation-based exposure assessment model predicted that outdoor air exposure to PAHs does not pose a cancer risk to infants, but the children, adolescent, and adult populations may face a lower cancer risk during the warm season and a higher risk in the cold season.