An accurate assessment of pollutants’ exposure and precise evaluation of the clinical outcomes pose two major challenges to the contemporary environmental health research. The common methods for exposure assessment are based on residential addresses and are prone to many biases. Pollution levels are defined based on monitoring stations that are sparsely distributed and frequently distanced far from residential addresses. In addition, the degree of an association between outdoor and indoor air pollution levels is not fully elucidated, making the exposure assessment all the more inaccurate. Clinical outcomes’ assessment, on the other hand, mostly relies on the access to medical records from hospital admissions and outpatients’ visits in clinics. This method differentiates by health care seeking behavior and is therefore, problematic in evaluation of an onset, duration, and severity of an outcome. In the current paper, we review a number of novel solutions aimed to mitigate the aforementioned biases. First, a hybrid satellite-based modeling approach provides daily continuous spatiotemporal estimations with improved spatial resolution of 1 × 1 km² and 200 × 200 m² grid, and thus allows a more accurate exposure assessment. Utilizing low-cost air pollution sensors allowing a direct measurement of indoor air pollution levels can further validate these models. Furthermore, the real temporal-spatial activity can be assessed by GPS tracking devices within the individuals’ smartphones. A widespread use of smart devices can help with obtaining objective measurements of some of the clinical outcomes such as vital signs and glucose levels. Finally, human biomonitoring can be efficiently done at a population level, providing accurate estimates of in-vivo absorbed pollutants and allowing for the evaluation of body responses, by biomarkers examination. We suggest that the adoption of these novel methods will change the research paradigm heavily relying on ecological methodology and support development of the new clinical practices preventing adverse environmental effects on human health.

Background. Parkinson’s disease (PD) is believed to develop from epigenetic modulation of gene expression through environmental factors that accounts for up to 85% of all PD cases. The main objective of this study was to examine the association between PD onset and a cumulative exposure to potentially modifiable ambient exposures. Methods. The study population comprised 3343 incident PD cases and 31,324 non-PD controls in Southern Israel. The exposures were determined based on the monitoring stations and averaged per year. Their association with PD was modeled using a distributed lag non-linear model and presented as an effect of exposure to the 75th percentile as compared to the 50th percentile of each pollutant, accumulated over the span of 5 years prior to the PD. Results. We recorded an adverse effect of particulate matter of size ≤10 μm in diameter (PM₁₀) and solar radiation (SR) with odds ratio (OR) = 1.06 (95%CI: 1.02; 1.10) and 1.23 (95%CI: 1.08; 1.39), respectively. Ozone (O₃) was also adversely linked to PD, although with a borderline significance, OR: 1.12 (95%CI: 0.99; 1.25). Immigrants arriving in Israel after 1989 appeared to be more vulnerable to exposure to O₃ and SR. The dose response effect of SR, non-existent for Israeli-born (OR = 0.67, 95%CI: 0.40; 1.13), moderate for immigrants before 1989 (OR = 1.17, 95%CI: 0.98; 1.40) and relatively high for new immigrants (OR = 1.25, 95%CI: 1.25; 2.38) indicates an adaptation ability to SR. Conclusions. Our findings supported previous reports on adverse association of PD with exposure to PM₁₀ and O₃. Additionally, we revealed a link of Parkinson’s Disease with SR that warrants an extensive analysis by research groups worldwide.

Background: Less invasive surfactant administration (LISA) is increasingly used in preterm infants with respiratory distress syndrome (RDS). Understanding its safety profile compared to the INtubation‐SURfactant‐Extubation (INSURE) or endotracheal tube (ETT) techniques is essential. Objective: To evaluate the safety profile of LISA compared to INSURE/ETT in preterm infants with RDS using evidence from randomized and non‐randomized studies. Methods: A systematic literature review identified studies in MEDLINE, EMBASE, and CENTRAL (2010–2024). Arm‐level pooled incidence estimates were generated across RCTs and non‐randomized studies, and pairwise comparisons of LISA versus INSURE/ETT were conducted in randomized controlled trials (RCTs). Analyses utilized Generalized Linear Mixed Models with random‐effects. Subgroups included gestational age (≤ 34 weeks), surfactant type, antenatal steroid exposure (≥ 50%) and sedation and premedication use. Results: Nineteen RCTs (2460 infants) and 26 non‐randomized studies (2360 infants) met inclusion criteria. Pairwise comparisons revealed no statistically significant differences between LISA and INSURE/ETT for apnea, bradycardia, cough, hypoxemia, or need for ≥ 2 attempts for successful catheter/ETT placement attempts; however, surfactant regurgitation/reflux occurred more frequently with LISA (OR = 2.29, 95% CI = 1.21–4.33). Adverse event rates were generally higher in non‑randomized studies, with hypoxemia the most frequently reported event across study types (≥ 24%). Subgroup findings were consistent with overall results. Conclusion: To our knowledge, this is the first meta‐analysis evaluating LISA safety outcomes across both RCTs and non‐randomized studies. LISA demonstrates a safety profile broadly comparable to INSURE/ETT for most outcomes. Differences observed in observational studies likely reflect variability in reporting and clinical practice. Standardized training and procedure optimization may further enhance safety.

Background: Less invasive surfactant administration (LISA) is increasingly used to treat respiratory distress syndrome (RDS) in preterm infants, but variation in treatment effects across clinical subgroups remains unclear. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials published between 2010 and 2024 in MEDLINE, EMBASE, and CENTRAL comparing LISA with INtubation-SURfactant-Extubation (INSURE) in preterm infants with RDS. Random-effects generalized linear mixed models estimated pooled odds ratios with 95% confidence intervals. Prespecified subgroup analyses evaluated gestational age, surfactant type, antenatal corticosteroid exposure, and sedation. Results: Twenty-one trials including 2656 infants were analyzed. LISA was associated with lower odds of bronchopulmonary dysplasia, death, BPD or death, intubation or mechanical ventilation, and severe intraventricular hemorrhage. Greater benefits were observed in infants ≤ 34 weeks and those with higher antenatal steroid exposure. Conclusion: LISA improves key outcomes compared with INSURE and may provide greater benefits in specific clinical subgroups.