Programa de salud y enfoque sociocultural en comunidades rurales de Ancash, Perú / Health Program and Sociocultural Approach in Rural Communities of Ancash, Peru

Introducción: En intervenciones con tecnologías apropiadas, orientadas a mejorar la salud respiratoria, predomina el precepto de que en comunidades rurales, su sola aplicación resuelve los problemas de salud. Aun cuando la educación socio-cultural ha adquirido una alta prioridad, sigue ocupando una importancia menor. Objetivo: Comprender cómo las particularidades y las semejanzas de los programas de salud con tecnología apropiada, de ayer y de hoy, impactan en la calidad de vida de las mujeres rurales. Métodos: Se realizó un estudio con diseño cualitativo. En un primer momento, en tres grupos de La Esperanza, se evaluaron tres propuestas: Grupo 1 (Cocina Mejorada-Programa Educativo), Grupo 2 (Cocina Mejorada) y Grupo 3 (Programa Educativo). Cada grupo estuvo conformado por 15 mujeres. La información se obtuvo a partir de los cambios observados y las notas de campo. En un segundo momento, se analizaron las percepciones sobre cocinas mejoradas recientemente implementadas, a través de la realización de entrevistas a tres mujeres residentes en Chamana. Resultados: En La Esperanza, el grupo 1 alcanzó cambios ostensibles en todas las variables. El grupo 2 mantuvo prácticas inadecuadas. El grupo 3 logró cambios en las variables no vinculadas con la tecnología apropiada. En Chamana, debido a una capacitación insuficiente, las mujeres no reconocen las buenas prácticas para el uso de las cocinas mejoradas ni su impacto en la salud. Conclusiones: Una implementación con cocina mejorada acompañada con un pertinente programa educativo resulta cualitativamente superior. La presunción de que las tecnologías apropiadas por sí solas, podrían generar los cambios deseados, es cuestionable a todas luces(AU)

Introduction: In interventions with appropriate technologies, aimed at improving respiratory health, the precept that in rural communities their application alone solves health problems predominates. Although socio-cultural education has acquired a high priority, it is still of lesser importance. Objective: To understand how the particularities and similarities of health programs with past and present appropriate technology impact the quality of life of rural women. Methods: A qualitative study was conducted. Initially, three proposals were evaluated in three groups of La Esperanza: Group 1 (Improved Cooking-Educational Program), Group 2 (Improved Cooking) and Group 3 (Educational Program). Each group consisted of 15 women. Information was obtained from observed changes and field notes. In a second moment, perceptions about recently implemented improved cookstoves were analyzed, through interviews with three women living in Chamana. Results: In La Esperanza, group 1 achieved significant changes in all variables. Group 2 maintained inadequate practices. Group 3 achieved changes in variables not linked to appropriate technology. In Chamana, due to insufficient training, women do not recognize good practices for the use of improved cookstoves and their impact on health. Conclusions: An implementation with improved cooking accompanied by a relevant educational program is qualitatively superior. The presumption that appropriate technologies alone could bring about the desired changes is clearly questionable(AU)

Consultas por enfermedades respiratorias agudas en la población pediátrica y su relación con el material particulado atmosférico en Bahía Blanca: un estudio ecológico / Consultations for acute respiratory diseases in the pediatric population and their relationship with atmospheric particulate matter in Bahía Blanca: an ecological study

Introducción. El material particulado (PM) es uno de los contaminantes del aire que mayor implicación tienen en la aparición o exacerbación de cuadros respiratorios en niños. Objetivo. Describir las características de las consultas por enfermedades respiratorias agudas en menores de 15 años, los niveles de PM en el aire, y analizar la asociación existente entre ellos en un sector de Bahía Blanca entre abril de 2019 y marzo de 2020. Población y métodos. Estudio ecológico de series temporales y grupos múltiples. Análisis descriptivo de consultas totales, por área, diagnóstico, y del PM. Modelo de correlación y regresión lineal generalizado para determinar la relación entre las variables. Se utilizó el programa SPSS®. Resultados. Se recopilaron 4787 consultas. Un 38,6 % (1846) correspondieron a rinitis y un 21,1 % (1011) a broncoespasmo. El PM de 10 nm (PM10) superó su valor límite el 31 % (115) de los días de estudio y el de 2,5 nm (PM2,5) un 3 % (8). Un aumento del 10 % del PM2,5 demostró incrementos de 1,3 % en las consultas totales; el incremento llegó al 2,1 % en el área más cercana al sector industrial (p <0,05). En esta última, el aumento del 10 % de los valores de PM10 se asoció al aumento del 1,8 % de las consultas (p <0,05). Conclusión. Se demostró asociación positiva entre las consultas por enfermedad respiratoria aguda y los niveles de PM del aire, sobre todo con el PM2,5 y en el área más cercana al sector industrial.

Introduction. Particulate matter (PM) is one of the air pollutants most involved in the onset or exacerbation of respiratory conditions in children. Objective. To describe the characteristics of consultations for acute respiratory diseases in children younger than 15 years and the levels of PM in the air and to analyze their association in a sector of Bahía Blanca between April 2019 and March 2020. Population and methods. Ecological, time-series study with multiple groups. Descriptive analysis of total number of consultations, by area, diagnosis, and PM. Generalized linear correlation and regression model to determine the relationship among variables. The SPSS® software was used. Results. Data from 4787 consultations were collected. Of these, 38.6% (1846) were related to rhinitis and 21.1% (1011), to bronchospasm. PM of 10 nm (PM10) exceeded its limit value on 31% (115) of the study days, and PM of 2.5 nm (PM2.5), on 3% (8). A 10% increase in PM2.5 showed increases of 1.3% in total consultations; the increase reached 2.1% in the area closest to the industrial sector (p < 0.05). In the latter, a 10% increase in PM10 was associated with an increase of 1.8% in consultations (p < 0.05). Conclusion. A positive association was evidenced between consultations for acute respiratory diseases and PM levels in the air, especially with PM2.5 and in the area closest to the industrial sector.

Ambient fine particulate matter and cardiopulmonary health risks in China / 中华医学杂志(英文版)

In China, the level of ambient fine particulate matter (PM 2.5 ) pollution far exceeds the air quality standards recommended by the World Health Organization. Moreover, the health effects of PM 2.5 exposure have become a major public health issue. More than half of PM 2.5 -related excess deaths are caused by cardiopulmonary disease, which has become a major health risk associated with PM 2.5 pollution. In this review, we discussed the latest epidemiological advances relating to the health effects of PM 2.5 on cardiopulmonary diseases in China, including studies relating to the effects of PM 2.5 on mortality, morbidity, and risk factors for cardiovascular and respiratory diseases. These data provided important evidence to highlight the cardiopulmonary risk associated with PM 2.5 across the world. In the future, further studies need to be carried out to investigate the specific relationship between the constituents and sources of PM 2.5 and cardiopulmonary disease. These studies provided scientific evidence for precise reduction measurement of pollution sources and public health risks. It is also necessary to identify effective biomarkers and elucidate the biological mechanisms and pathways involved; this may help us to take steps to reduce PM 2.5 pollution and reduce the incidence of cardiopulmonary disease.

Study on the association between air pollution and respiratory disease of primary school students in Chongqing City / 中华预防医学杂志

To analyze the association between exposure to air pollution and respiratory disease of primary school students in Chongqing City. Eight districts and counties were randomly selected based on the air pollution situation in Chongqing City. In each selected district and county, one primary school was randomly selected. A questionnaire survey was conducted on all primary school students in Grades 3-5 by the end of 2019. Air quality data from the nearest environmental monitoring sites were collected. A logistic regression model was used to analyze the impact of the living environment, lifestyle and air pollution on the respiratory disease of surveyed students. This study included 5 918 primary school students, with a prevalence rate of respiratory disease of 21.54%. The prevalence rates of boys and girls were 23.38% and 19.59%, respectively. The average Air quality index (AQI) of the surveyed school was 67, and the rates of exceeding standards of PM10, PM2.5, NO2 and O3 were 1.16%, 6.92%, 0.99% and 5.65%, respectively. The level of SO2 and CO did not exceed the standard. After adjusting for relevant factors, logistic regression analysis showed that primary school students in areas with high exposure to air pollution (OR=2.52), using air pollution related-chemicals at home (OR=1.47), passive smoking (OR=1.27), and keeping pets at home (OR=1.18) had a higher risk of respiratory disease (all P<0.05). In addition, the average annual values of AQI (OR=1.18), PM10 (OR=1.20), PM2.5 (OR=1.35), and NO2 (OR=1.11) increased the risk of respiratory diseases in primary school students (all P<0.05). In conclusion, the respiratory disease of primary school students in Chongqing City is related to the living environment, behavior habits and ambient air quality. The increased exposure concentration of PM10, PM2.5 and NO2 in air pollutants can lead to an increased risk of respiratory disease among primary school students.

Study on revision of standard limits for nitrogen dioxide in "Standards for indoor air quality（GB/T 18883-2022）" in China / 中华预防医学杂志

Nitrogen dioxide (NO2) is an important indoor air pollutant, with both outdoor and indoor sources contributing to indoor NO2 exposure levels. Considering the association of high NO2 exposure with adverse health effects, the Standards for indoor air quality (GB/T 18883-2022) have been revised to further restrict indoor NO2 limit values. The 1-h average concentration limit value for NO2 has been reduced from 0.24 mg/m3 to 200 μg/m3.This study analyzed the technical contents related to the determination of the limits of indoor NO2 in Standards for Indoor Air Quality (GB/T 18883-2022), including source, exposure level, health effects, and the process and evidence basis for determining the limit value. It also proposed prospects for the direction for the implementation of the indoor NO2 standard.

Study on the association between air pollution and respiratory disease of primary school students in Chongqing City / 中华预防医学杂志

To analyze the association between exposure to air pollution and respiratory disease of primary school students in Chongqing City. Eight districts and counties were randomly selected based on the air pollution situation in Chongqing City. In each selected district and county, one primary school was randomly selected. A questionnaire survey was conducted on all primary school students in Grades 3-5 by the end of 2019. Air quality data from the nearest environmental monitoring sites were collected. A logistic regression model was used to analyze the impact of the living environment, lifestyle and air pollution on the respiratory disease of surveyed students. This study included 5 918 primary school students, with a prevalence rate of respiratory disease of 21.54%. The prevalence rates of boys and girls were 23.38% and 19.59%, respectively. The average Air quality index (AQI) of the surveyed school was 67, and the rates of exceeding standards of PM10, PM2.5, NO2 and O3 were 1.16%, 6.92%, 0.99% and 5.65%, respectively. The level of SO2 and CO did not exceed the standard. After adjusting for relevant factors, logistic regression analysis showed that primary school students in areas with high exposure to air pollution (OR=2.52), using air pollution related-chemicals at home (OR=1.47), passive smoking (OR=1.27), and keeping pets at home (OR=1.18) had a higher risk of respiratory disease (all P<0.05). In addition, the average annual values of AQI (OR=1.18), PM10 (OR=1.20), PM2.5 (OR=1.35), and NO2 (OR=1.11) increased the risk of respiratory diseases in primary school students (all P<0.05). In conclusion, the respiratory disease of primary school students in Chongqing City is related to the living environment, behavior habits and ambient air quality. The increased exposure concentration of PM10, PM2.5 and NO2 in air pollutants can lead to an increased risk of respiratory disease among primary school students.

Study on revision of standard limits for nitrogen dioxide in "Standards for indoor air quality（GB/T 18883-2022）" in China / 中华预防医学杂志

Nitrogen dioxide (NO2) is an important indoor air pollutant, with both outdoor and indoor sources contributing to indoor NO2 exposure levels. Considering the association of high NO2 exposure with adverse health effects, the Standards for indoor air quality (GB/T 18883-2022) have been revised to further restrict indoor NO2 limit values. The 1-h average concentration limit value for NO2 has been reduced from 0.24 mg/m3 to 200 μg/m3.This study analyzed the technical contents related to the determination of the limits of indoor NO2 in Standards for Indoor Air Quality (GB/T 18883-2022), including source, exposure level, health effects, and the process and evidence basis for determining the limit value. It also proposed prospects for the direction for the implementation of the indoor NO2 standard.

Association between airborne particulate matter（PM 2.5） concentration and the incidence of allergic rhinitis in Shanghai / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the impact of PM 2.5 concentration in Shanghai on the incidence of allergic rhinitis（AR） in the population, and provide strategies for early warning and prevention of AR. Methods:Collect daily average concentrations of atmospheric pollutants monitored in Shanghai from January 1, 2017 to December 31, 2019, and clinical data of AR patients from five hospitals in Shanghai during the same period. We used a time-series analysis additive Poisson regression model to analyze the correlation between PM 2.5 levels and outpatient attendance for AR patients. Results:During the study period, a total of 56 500 AR patients were included, and the daily average concentration of PM 2.5 was（35.28±23.07）μg/m³. There is a correlation between the concentration of PM 2.5 and the number of outpatient attendance for AR cases. There is a positive correlation between the daily average number of outpatient for AR and levels of PM 2.5 air pollution（（P<0.05）） . We found that every 10 μg/m³ increase in PM 2.5, the impact of on the number of AR visits was statistically significant on the same day, the first day behind, and the second day behind, with the strongest impact being the exposure on the same day. Every 10 μg/m³ increases in PM 2.5, the number of outpatient visits increased by 0.526% on the same day（95%CI 1.000 50-1.010 04）. Conclusion:The atmospheric PM 2.5 concentration in Shanghai is positively correlated with the number of outpatient for AR, and PM 2.5 exposure is an independent factor in the onset of AR. This provides an important theoretical basis for AR.

Caracterización y biomonitoreo de contaminantes orgánicos e inorgánicos en una zona ladrillera de San Luis Potosí / Characterization and biomonitoring of organic and inorganic contaminants in a brick-making area of San Luis Potosí

Resumen El sector ladrillero se caracteriza por la elaboración del ladrillo de forma artesanal donde utilizan técnicas rudimentarias, hornos de baja tecnología y diversos combustibles de poca calidad generando humos negros con gran cantidad de contaminantes. Por lo que el objetivo de este estudio fue caracterizar los metales en suelo, HAPs en aire y biomonitoreo de HAPs en trabajadores de la zona ladrillera "Las Terceras" San Luis Potosí, México. Con el fin de conocer la exposición laboral se determinó la concentración de HAPs en partículas PM10, se caracterizó el suelo de la zona de trabajo y se realizó un biomonitoreo de me-tabolitos hidroxilados HAPs (OH-HAPs) en orina de los trabajadores. En aire se encontraron 14 de los 16 HAPs prioritarios por la Agencia de Protección Ambiental en la fracción de PM10, con una concentración media de 5293,05 gg/m3 (3,11-10510,81). Los resultados del análisis químico de los polvos mostraron que están constituidos principalmente de cuarzo (SiO2) y arcillas (SiAlOx) con presencia de óxidos de Fe-Ti, fosfatos de tierras raras (Lantano, Cerio, Neodimio Torio), silicatos de zirconio, sulfatos de bario, óxidos de zinc. En el biomonitoreo participaron 42 trabajadores ladrilleros, los resultados de la exposición a OH-HAPs en orina demostraron la media total de los OH-HAPs de 15,7 (6,92-195) ng/ml. Estos resultados muestran que el monitoreo ocupa-cional de las zonas ladrilleras es importante debido al escenario de riesgo y a las condiciones precarias de este trabajo, además de la alta exposición a contaminantes que afectan la salud de los trabajadores y sus familias, así como la propuesta de estrategias que ayuden a minimizar los impactos ambientales y prevenir los efectos en salud de las poblaciones.

Abstract The brick-making sector is characterized by artisanal brick production using rudimentary techniques, low-tech kilns and various low-quality fuels that generate black fumes with a large amount of pollutants. Therefore, the objective of this study was to characterize metals in soil, PAHs in air and biomonitoring of PAHs in workers of the "Las Terceras" brick area in San Luis Potosí, Mexico. In order to know the occupational exposure, the concentration of PAHs in PM10 particles was determined, the soil of the work area was characterized and a biomonitoring of hydroxylated PAH metabolites (OH-HAPs) in the urine of the workers was carried out. In air, 14 of the 16 PAHs prioritized by the Environmental Protection Agency were found in the PM10 fraction, with an average concentration of 5293.05 gg/m3 (3.11-10510.81). The results of the chemical analysis of the dusts showed that they are mainly constituted of quartz (SiO2) and clays (SiAlOx) with presence of Fe-Ti oxides, rare earth phosphates (Lanthanum, Cerium, Neodymium Thorium), zirconium silicates, barium sulfates, zinc oxides. The biomonitoring involved 42 brick workers, the results of OH-HAPs exposure in urine showed the mean total OH-HAPs of 15.7 (6.92-195) ng/ml. These results show that occupational moni-toring of brick-making areas is important due to the risk scenario and the precarious conditions of this work, in addition to the high exposure to pollutants that affect the health of workers and their families, as well as the proposal of strategies that help minimize environmental impacts and prevent health effects on populations.

Impact of Air Pollutant on Heart Rate Variability in Healthy Young Adults

Abstract Background: Air pollution and sex independently affect cardiac autonomic control, which can be assessed by heart rate variability (HRV). The research hypothesis is that individuals exposed to low concentrations of pollution have higher cardiac autonomic modulation compared to those exposed to high concentrations and that women have better cardiac autonomic control than men. Objective: To analyze the impact of exposure to air pollutants, specifically smoke, and sex on HRV in healthy young people exposed to different concentrations of pollution over an average period of 22 years. Methods: From April to September 2011, 36 participants of both sexes (20-30 years old) were selected, grouped by levels of air pollution exposure according to indices provided by the Environmental Company of São Paulo State. The R-R intervals (R-Ri) of the electrocardiogram were captured using a heart rate monitor during supine rest. HRV was analyzed by spectral analysis and conditional entropy. The Queen's College step test was used to characterize functional capacity. A between-group comparison was performed using the two-way ANOVA statistical test (post hoc Tukey) and p<0.05. Results: Significant differences were found in mean R-Ri (p<0.01) and cardiac parasympathetic modulation between sexes in the same city (p=0.02) and between groups exposed to different air pollution concentrations (p<0.01). Conclusion: Our results suggest that long-term exposure to air pollutants, specifically smoke, has an unfavorable impact on HRV, with reduced cardiac vagal autonomic modulation in healthy young adults, especially females.

Prevalencia del síndrome del edificio enfermo en trabajadores de la industria manufacturera / Prevalence of sick building syndrome in manufacturing industry workers

El síndrome del edificio enfermo, se refiere a un conjunto de síntomas generales en mucosa (ocular y/o respiratoria) y piel que presentan los ocupantes de edificaciones con calidad ambiental deficientes, exponiendo a sus ocupantes a factores de riesgos físicos, mecánicos, químicos, biológicos y psicosociales, que puede afectar negativamente la salud y productividad de las personas. Con el propósito de determinar la frecuencia de los síntomas de los ocupantes de una industria manufacturera del Perú, se realizó estudio transversal aplicándose a 237 trabajadores, estratificados por áreas laborales, el cuestionario sugerido por el Instituto Nacional de Higiene y Seguridad en el Trabajo, además de evaluar la condición ambiental mediante la determinación de bioaerosoles cultivables y contables. Los resultados mostraron prevalencia superior al 20% en síntomas como: sequedad en ojos y garganta, picor en garganta congestión nasal, dolor de cabeza y debilidad general. Se tomaron, cuantificaron y caracterizaron 164 muestras de bioaerosoles, los microrganismos encontrados con mayor porcentaje fueron, Aspergillus sp. 54,68% (68) en el área administrativa, mientras que en las áreas de producción y almacén predomino Penicillium sp. con 87,10% (108) y 62,21% (77) respectivamente. Otros géneros encontrados en mayor porcentajes, en las tres áreas fueron: Trichoderma, Acremonium, Monilia, Cladosporium, entre otros. Los hallazgos se correlacionan con lo reportado en diversas investigaciones, la presencia de mencionados hongos, sugiere que existe una inadecuada calidad ambiental y aunada a la prevalencia obtenida en cuanto a sintomatología, se puede clasificar la edificación objeto de estudio con el Síndrome del edificio enfermo(AU)

Sick building syndrome refers to a set of general mucosal (ocular and/or respiratory) and skin symptoms presented by occupants of buildings with poor environmental quality, exposing their occupants to physical, mechanical, chemical, biological and psychosocial, which can negatively affect the health and productivity of people. In order to determine the frequency of the symptoms of the occupants of a manufacturing industry in Peru, a cross-sectional study was carried out, applying to 237 workers, stratified by work areas, the questionnaire suggested by the National Institute of Hygiene and Safety at Work, in addition to to evaluate the environmental condition by determining cultivable and countable bioaerosols. The results showed a prevalence greater than 20% in symptoms such as: dry eyes and throat, itchy throat, nasal congestion, headache and general weakness. 164 samples of bioaerosols were taken, quantified and characterized, the microorganisms found with the highest percentage were Aspergillus sp. 54.68% (68) in the administrative area, while in the production and storage areas, Penicillium sp. with 87.10% (108) and 62.21% (77) respectively. Other genera found in higher percentages in the three areas were: Trichoderma, Acremonium, Monilia, Cladosporium, among others. The findings correlate with what has been reported in various investigations, the presence of these fungi suggests that there is an inadequate environmental quality and, together with the prevalence obtained in terms of symptoms, the building under study can be classified with the Sick Building Syndrome(AU)

Cardiovascular and Cerebrovascular Diseases Induced by Air Pollution / 中国医学科学院学报

Air pollution has severe detrimental effects on public health.A substantial number of studies have demonstrated that air pollution exposure is a risk factor for the occurrence of cardiovascular and cerebrovascular diseases and a cause of non-communicable diseases.Both long-term and short-term exposure to air pollution are associated with respiratory diseases,stroke,coronary artery disease,and diabetes.Aiming to better understand the association,we reviewed the latest studies about the association of air pollution with cardiovascular and cerebrovascular diseases,especially stroke,coronary heart disease,arrhythmia,hypertension,and heart failure,and summarized the underlying mechanisms of the health damage caused by long-term and short-term exposure to air pollution.

Contaminación atmosférica por dióxidos de nitrógeno en Región Metropolitana y su impacto sobre la salud / Air pollution with nitrogen dioxide and its impact on health

BACKGROUND: The Chilean Metropolitan region is exposed to nitrogen dioxide levels that are above the WHO Air Quality Guidelines. AIM: To report the exposure to nitrogen dioxide levels and to estimate the damage that these levels can cause in health. MATERIAL AND METHODS: Description of nitrogen dioxide levels in the Chilean Metropolitan Region between 2016 and 2018 and the attributable risk of these levels on the population health. RESULTS: The average hourly levels of nitrogen dioxide exceeded 40 pg/m3. In the three years studied, 11,686 attributable health problems were estimated, including deaths, hospitalizations, and attendance to emergency rooms. CONCLUSIONS: We provide valid information to review and adjust primary air quality standards for nitrogen dioxide. The exposed population should be educated about the risk of this exposure to promote self-care.

Effect of Gaseous Pollutant Concentration on the Number of Daily Outpatient Visits for Acne in Lanzhou / 中国医学科学院学报

Objective To determine the relationship between air pollutants [SO

Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants

BACKGROUND@#Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants.@*METHODS@#We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM@*RESULTS@#A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM@*CONCLUSIONS@#Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM

Outdoor air pollution and diminished ovarian reserve among infertile Korean women

BACKGROUND@#Mounting evidence implicates an association between ambient air pollution and impaired reproductive potential of human. Our study aimed to assess the association between air pollution and ovarian reserve in young, infertile women.@*METHODS@#Our study included 2276 Korean women who attended a single fertility center in 2016-2018. Women's exposure to air pollution was assessed using concentrations of particulate matter (PM@*RESULTS@#The mean age was 36.6 ± 4.2 years and AMH level was 3.3 ± 3.1 ng/mL in the study population. Average AMH ratio was 0.8 ± 0.7 and low AMH was observed in 10.3% of women (n=235). The average concentration of six air pollutants was not different between the normal ovarian reserve and low AMH groups for all averaging periods. In multivariable models, an interquartile range (IQR)-increase in 1 month-average PM@*CONCLUSIONS@#In a cohort of infertile Korean women, there was a suggestive evidence of the negative association between ambient PM concentration and ovarian reserve, highlighting the potential adverse impact of air pollution on women's fertility.