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Zauli-Sajani S, Marchesi S, Boselli G, Broglia E, Angella A, Maestri E, Marmiroli N, Colacci A. Effectiveness of a Protocol to Reduce Children's Exposure to Particulate Matter and NO 2 in Schools during Alert Days. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11019. [PMID: 36078735 PMCID: PMC9517784 DOI: 10.3390/ijerph191711019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Reducing children's exposure to air pollutants should be considered a primary goal, especially for the most vulnerable subjects. The goal of this study was to test the effectiveness of applying a protocol in the event of alert days, i.e., days with forecasted PM10 levels above the EU limit value (50 µg/m3). The test was conducted, before the onset of SARS-CoV-2 restrictions, in a classroom of a primary school in Parma (Italy)-a highly polluted area in Northern Italy. The protocol included indications for the frequency of opening windows and doors, as well as the activation of an air purifier. Teachers and students were asked to apply the protocol only in the event of alert days, while no indications were provided for non-alert days. A monitoring system measuring PM1, PM2.5, PM10, CO2, and NO2 was deployed in the classroom. Measurements of the same parameters were also performed outdoors near the school. The application of the protocol reduced the indoor/outdoor (I/O) ratio for all toxic pollutants. The reduction was also remarkable for PM10-the most critical air quality parameter in the study area (1.5 and 1.1 for non-alert and alert days, respectively). Indoor concentrations of PM10-especially during non-alert days-were often higher than outdoors, showing a major contribution from resuspension due to the movement of people and personal cloud. The protocol did not cause any increase in indoor CO2 levels. Our findings showed that the application of a ventilation protocol together with the contribution of an air purifier may represent an effective way to reduce children's exposure to air pollution during severe air pollution episodes. Considering the onset of COVID-19 and the airborne transmission of pathogens, this protocol now has more meaningful implications for children's welfare, and can be integrated with protocols designed as measures against the spread of SARS-CoV-2.
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Affiliation(s)
- Stefano Zauli-Sajani
- Regional Agency for Prevention Environment and Energy of Emilia-Romagna (Arpae), 40139 Bologna, Italy
| | - Stefano Marchesi
- Regional Agency for Prevention Environment and Energy of Emilia-Romagna (Arpae), 40139 Bologna, Italy
| | - Giuseppe Boselli
- Regional Agency for Prevention Environment and Energy of Emilia-Romagna (Arpae), 40139 Bologna, Italy
| | | | | | - Elena Maestri
- Consorzio Interuniversitario Nazionale per le Scienze Ambientali (CINSA), Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Nelson Marmiroli
- Consorzio Interuniversitario Nazionale per le Scienze Ambientali (CINSA), Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, 43124 Parma, Italy
| | - Annamaria Colacci
- Regional Agency for Prevention Environment and Energy of Emilia-Romagna (Arpae), 40139 Bologna, Italy
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Kwon D, Choe YJ, Kim SY, Chun BC, Choe SA. Ambient Air Pollution and Kawasaki Disease in Korean Children: A Study of the National Health Insurance Claim Data. J Am Heart Assoc 2022; 11:e024092. [PMID: 35475377 PMCID: PMC9238605 DOI: 10.1161/jaha.121.024092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Kawasaki disease (KD) is a systemic vasculitis of unknown etiology that primarily affects children under 5 years of age. Some researchers suggested a potential triggering effect of air pollution on KD, but the findings are inconsistent and limited by small sample size. We investigated the association between ambient air pollution and KD among the population of South Korea younger than 5 years using the National Health Insurance claim data between 2007 and 2019. Methods and Results We obtained the data regarding particulate matter ≤10 or 2.5 µm in diameter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone from 235 regulatory monitoring stations. Using a time‐stratified case‐crossover design, we performed conditional logistic regression to estimate odds ratios (OR) of KD according to interquartile range increases in each air pollutant concentration on the day of fever onset after adjusting for temperature and relative humidity. We identified 51 486 children treated for KD during the study period. An interquartile range increase (14.67 μg/m3) of particulate matter ≤2.5 µm was positively associated with KD at lag 1 (OR, 1.016; 95% CI, 1.004–1.029). An interquartile range increase (2.79 ppb) of sulfur dioxide concentration was associated with KD at all lag days (OR, 1.018; 95% CI, 1.002–1.034 at lag 0; OR, 1.022; 95% CI, 1.005–1.038 at lag 1; OR, 1.017; 95% CI, 1.001–1.033 at lag 2). Results were qualitatively similar in the second scenario of different fever onset, 2‐pollutant model and sensitivity analyses. Conclusions In a KD‐focused national cohort of children, exposure to particulate matter ≤2.5 µm and sulfur dioxide was positively associated with the risk of KD. This finding supports the triggering role of ambient air pollution in the development of KD.
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Affiliation(s)
- Dayoon Kwon
- Department of Epidemiology UCLA Fielding School of Public Health Los Angeles CA
| | - Young June Choe
- Department of Pediatrics Korea University Anam Hospital Seoul Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health Graduate School of Cancer Science and Policy National Cancer Center Goyang-si Gyeonggi-do Korea
| | - Byung Chul Chun
- Department of Epidemiology & Health Informatics Graduate School of Public Health Korea University Seoul Korea.,Department of Preventive Medicine Korea University College of Medicine Seoul Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine Korea University College of Medicine Seoul Korea.,Division of Life Sciences Korea University Seoul Korea
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3
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Stieb D, Shutt RH, Kauri LM, Mason-Renton S, Chen L, Szyszkowicz M, Dobbin NA, Rigden M, Jovic B, Mulholland M, Green MS, Liu L, Pelletier G, Weichenthal SA, Dales RE, Andrade J, Luginaah I. Associations between air pollution and cardio-respiratory physiological measures in older adults exercising outdoors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:901-914. [PMID: 31829725 DOI: 10.1080/09603123.2019.1699506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
We examined whether exercising indoors vs. outdoors reduced the cardio-respiratory effects of outdoor air pollution. Adults ≥55 were randomly assigned to exercise indoors when the Air Quality Health Index was ≥5 and outdoors on other days (intervention group, n = 37), or outdoors everyday (control group, n = 35). Both groups completed cardio-respiratory measurements before and after exercise for up to 10 weeks. Data were analyzed using linear mixed effect regression models. In the control group, an interquartile range increase in fine particulate matter (PM2.5) was associated with increases of 1.4% in heart rate (standard error (SE) = 0.7%) and 5.6% (SE = 2.6%) in malondialdehyde, and decreases of 5.6% (SE = 2.5%) to 16.5% (SE = 7.5%) in heart rate variability measures. While the hypothesized benefit of indoor vs. outdoor exercise could not be demonstrated due to an insufficient number of intervention days (n = 2), the study provides evidence of short-term effects of air pollution in older adults. ISRCTN #26552763.
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Affiliation(s)
- David Stieb
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Robin H Shutt
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Lisa M Kauri
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- Controlled Substances and Cannabis Branch (current), Health Canada, Ottawa, Canada
| | - Sarah Mason-Renton
- Department of Geography, Western University, London, Canada
- Lystek International Inc. (current), Cambridge, Canada
| | - Li Chen
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Mieczyslaw Szyszkowicz
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Nina A Dobbin
- Air Health Science Division, Water and Air Quality Bureau, Health Canada, Ottawa, Canada
- Chemical Emergency Preparedness and Response Unit (current), Health Canada, Vancouver, Canada
| | - Marc Rigden
- Hazard Identification Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Branka Jovic
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | | | | | - Ling Liu
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Guillaume Pelletier
- Hazard Identification Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Scott A Weichenthal
- Air Health Science Division, Water and Air Quality Bureau, Health Canada, Ottawa, Canada
- Environmental Epidemiology Research Group, McGill University, Montreal, Canada
| | - Robert E Dales
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Julie Andrade
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
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4
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Janjua S, Powell P, Atkinson R, Stovold E, Fortescue R. Individual-level interventions to reduce personal exposure to outdoor air pollution and their effects on people with long-term respiratory conditions. Cochrane Database Syst Rev 2021; 8:CD013441. [PMID: 34368949 PMCID: PMC8407478 DOI: 10.1002/14651858.cd013441.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND More than 90% of the global population lives in areas exceeding World Health Organization air quality limits. More than four million people each year are thought to die early due to air pollution, and poor air quality is thought to reduce an average European's life expectancy by one year. Individuals may be able to reduce health risks through interventions such as masks, behavioural changes and use of air quality alerts. To date, evidence is lacking about the efficacy and safety of such interventions for the general population and people with long-term respiratory conditions. This topic, and the review question relating to supporting evidence to avoid or lessen the effects of air pollution, emerged directly from a group of people with chronic obstructive pulmonary disease (COPD) in South London, UK. OBJECTIVES 1. To assess the efficacy, safety and acceptability of individual-level interventions that aim to help people with or without chronic respiratory conditions to reduce their exposure to outdoor air pollution. 2. To assess the efficacy, safety and acceptability of individual-level interventions that aim to help people with chronic respiratory conditions reduce the personal impact of outdoor air pollution and improve health outcomes. SEARCH METHODS We identified studies from the Cochrane Airways Trials Register, Cochrane Central Register of Controlled Trials, and other major databases. We did not restrict our searches by date, language or publication type and included a search of the grey literature (e.g. unpublished information). We conducted the most recent search on 16 October 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies (NRS) that included a comparison treatment arm, in adults and children that investigated the effectiveness of an individual-level intervention to reduce risks of outdoor air pollution. We included studies in healthy individuals and those in people with long-term respiratory conditions. We excluded studies which focused on non-respiratory long-term conditions, such as cardiovascular disease. We did not restrict eligibility of studies based on outcomes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Two review authors independently selected trials for inclusion, extracted study characteristics and outcome data, and assessed risk of bias using the Cochrane Risk of Bias tool for RCTs and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) as appropriate. One review author entered data into the review; this was spot-checked by a second author. We planned to meta-analyse results from RCTs and NRS separately, using a random-effects model. This was not possible, so we presented evidence narratively. We assessed certainty of the evidence using the GRADE approach. Primary outcomes were: measures of air pollution exposure; exacerbation of respiratory conditions; hospital admissions; quality of life; and serious adverse events. MAIN RESULTS We identified 11 studies (3372 participants) meeting our inclusion criteria (10 RCTs and one NRS). Participants' ages ranged from 18 to 74 years, and the duration of studies ranged from 24 hours to 104 weeks. Six cross-over studies recruited healthy adults and five parallel studies included either people with pre-existing conditions (three studies) or only pregnant women (two studies). Interventions included masks (e.g. an N95 mask designed to filter out airborne particles) (five studies), an alternative cycle route (one study), air quality alerts and education (five studies). Studies were set in Australia, China, Iran, the UK, and the USA. Due to the diversity of study designs, populations, interventions and outcomes, we did not perform any meta-analyses and instead summarised results narratively. We judged both RCTs and the NRS to be at risk of bias from lack of blinding and lack of clarity regarding selection methods. Many studies did not provide a prepublished protocol or trial registration. From five studies (184 participants), we found that masks or altered cycle routes may have little or no impact on physiological markers of air pollution exposure (e.g. blood pressure and heart rate variability), but we are very uncertain about this estimate using the GRADE approach. We found conflicting evidence regarding health care usage from three studies of air pollution alerts, with one non-randomised cross-over trial (35 participants) reporting an increase in emergency hospital attendances and admissions, but the other two randomised parallel trials (1553 participants) reporting little to no difference. We also gave the evidence for this outcome a very uncertain GRADE rating. None of our included trials reported respiratory exacerbations, quality of life or serious adverse events. Secondary outcomes were not well reported, but indicated inconsistent impacts of air quality alerts and education interventions on adherence, with some trials reporting improvements in the intervention groups and others reporting little or no difference. Symptoms were reported by three trials, with one randomised cross-over trial (15 participants) reporting a small increase in breathing difficulties associated with the mask intervention, one non-randomised cross-over trial (35 participants) reporting reduced throat and nasal irritation in the lower-pollution cycle route group (but no clear difference in other respiratory symptoms), and another randomised parallel trial (519 participants) reporting no clear difference in symptoms between those who received a smog warning and those who did not. AUTHORS' CONCLUSIONS The lack of evidence and study diversity has limited the conclusions of this review. Using a mask or a lower-pollution cycle route may mitigate some of the physiological impacts from air pollution, but evidence was very uncertain. We found conflicting results for other outcomes, including health care usage, symptoms and adherence/behaviour change. We did not find evidence for adverse events. Funders should consider commissioning larger, longer studies, using high-quality and well-described methods, recruiting participants with pre-existing respiratory conditions. Studies should report outcomes of importance to people with respiratory conditions, such as exacerbations, hospital admissions, quality of life and adverse events.
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Affiliation(s)
- Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | | | - Richard Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Stovold
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Fortescue
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
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5
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Zhao N, Wu W, Feng Y, Yang F, Han T, Guo M, Ren Q, Li W, Li J, Wang S, Zhang Y. Polymorphisms in oxidative stress, metabolic detoxification, and immune function genes, maternal exposure to ambient air pollution, and risk of preterm birth in Taiyuan, China. ENVIRONMENTAL RESEARCH 2021; 194:110659. [PMID: 33359674 DOI: 10.1016/j.envres.2020.110659] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/06/2020] [Accepted: 12/20/2020] [Indexed: 05/27/2023]
Abstract
Exposure to air pollutants may be associated with preterm birth (PB) through oxidative stress, metabolic detoxification, and immune system processes. However, no study has investigated the interactive effects of maternal air pollution and genetic polymorphisms in these pathways on risk of PB. The study included 126 PB and 310 term births. A total of 177 single nucleotide polymorphisms (SNPs) in oxidative stress, immune function, and metabolic detoxification-related genes were examined and analyzed. The China air quality index (AQI) was used as an overall estimation of ambient air pollutants. Among 177 SNPs, four SNPs (GPX4-rs376102, GLRX-rs889224, VEGFA-rs3025039, and IL1A-rs3783550) were found to have significant interactions with AQI on the risk of PB (Pinteraction were 0.001, 0.003, 0.03, and 0.04, respectively). After being stratified by the maternal genotypes in these four SNPs, 1.38 to 1.76 times of the risk of PB were observed as per interquartile range increase in maternal AQI among women who carried the GPX4-rs376102 AC/CC genotypes, the GLRX-rs889224 TT genotype, the VEGFA-rs3025039 CC genotype, or the IL1A-rs3783550 GT/TT genotypes. After adjustment for multiple comparisons, only GPX4-rs376102 and AQI interaction remained statistically significant (false discovery rate (FDR)=0.17). After additional stratification by preeclampsia (PE) status, a strongest association was observed in women who carried the GPX4-rs376102 AC/CC genotypes (OR, 2.26; 95% CI, 1.41-3.65, Pinteraction=0.0002, FDR=0.035) in the PE group. Our study provided the first evidence that association between maternal air pollution and PB risk may be modified by the genetic polymorphisms in oxidative stress and immune function genes. Future large studies are necessary to replicate and confirm the observed associations.
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Affiliation(s)
- Nan Zhao
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Weiwei Wu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yongliang Feng
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Feifei Yang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tianbi Han
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Mengzhu Guo
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qingwen Ren
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wangjun Li
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinbo Li
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Suping Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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6
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Mitchell R, Braithwaite J. Evidence-informed health care policy and practice: using record linkage to uncover new knowledge. J Health Serv Res Policy 2020; 26:62-67. [PMID: 32326762 DOI: 10.1177/1355819620919793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Record linkage of health data has been beneficial to inform the design, delivery and evaluation of health care practices, and to improve the quality of clinical care and patient outcomes. We discuss some of the key strengths and limitations of using record linkage as the basis of an evidentiary approach for improved health services, and for conducting health services research. We illustrate the benefits of linking information from disparate administrative data collections, uncovering new knowledge, and influencing health policy or clinical practice, or both. Continued advancement of data methods and models, infrastructure to support research, and, above all, making administrative data accessible, will help ensure more effective delivery of health care services.
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Affiliation(s)
- Rebecca Mitchell
- Associate Professor, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Jeffrey Braithwaite
- Professor of Health Systems Research, Australian Institute of Health Innovation, Macquarie University, Australia
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7
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Sugg MM, Fuhrmann CM, Runkle JD. Perceptions and experiences of outdoor occupational workers using digital devices for geospatial biometeorological monitoring. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:471-483. [PMID: 31811392 DOI: 10.1007/s00484-019-01833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/03/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Wearable devices have the potential to track and monitor a wide range of biometeorological conditions (e.g., temperature, UV, air quality) and health outcomes (e.g., mental stress, physical activity, physiologic strain, and cognitive impairments). These sensors provide the potential for personalized environmental exposure information that can be harnessed for at-risk populations. Personalized environmental exposure information is of particular importance for populations that are continuously exposed to hazardous environmental conditions or with underlying health conditions. Yet, for these devices to be effective, individuals must be willing to monitor their health and, if prompted, adhere to warnings or notifications. To date, no study has examined the perceptions and use of digital devices and wearable sensors among vulnerable outdoor working populations. This study evaluated digital device use and perceptions among a population of groundworkers in three diverse geographic sites in the southeastern USA (Boone, NC, Raleigh, NC, and Starkville, MS). Our results demonstrate that biometeorological health interventions should focus on smartphone technology as a platform for monitoring environmental exposure and associated health outcomes. It was encouraging to find that those study participants were very likely to wear sensors and utilize global positioning system technology despite potential privacy issues. In addition, 3 out of 4 workers indicated that they would change their behavior if given a personalized heat preventive warning. Future development of wearable sensors and smartphone applications should integrate personalized weather warnings and ensure privacy to facilitate the use of these technologies among vulnerable populations.
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Affiliation(s)
- Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, P.O. Box 32066, Boone, NC, 28608, USA.
| | - Christopher M Fuhrmann
- Department of Geosciences, Mississippi State University, P.O. Box 5448, Mississippi State, MS, 39762, USA
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, USA
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8
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Youens D, Moorin R, Harrison A, Varhol R, Robinson S, Brooks C, Boyd J. Using general practice clinical information system data for research: the case in Australia. Int J Popul Data Sci 2020; 5:1099. [PMID: 34164582 PMCID: PMC8188523 DOI: 10.23889/ijpds.v5i1.1099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
General practice is often a patient’s first point of contact with the health system and the gateway to specialist services. In Australia, different aspects of the health system are managed by the Commonwealth Government and individual state / territory governments. Although there is a long history of research using administrative data in Australia, this split in the management and funding of services has hindered whole-system research. Additionally, the administrative data typically available for research are often collected for reimbursement purposes and lack clinical information. General practices collect a range of patient information including diagnoses, medications prescribed, results of pathology tests ordered and so on. Practices are increasingly using clinical information systems and data extraction tools to make use of this information. This paper describes approaches used on several research projects to access clinical, as opposed to administrative, general practice data which to date has seen little use as a resource for research. This information was accessed in three ways. The first was by working directly with practices to access clinical and management data to support research. The second involved accessing general practice data through collaboration with Primary Health Networks, recently established in Australia to increase the efficiency and effectiveness of health services for patients. The third was via NPS MedicineWise’s MedicineInsight program, which collects data from consenting practices across Australia and makes these data available to researchers. We describe each approach including data access requirements and the advantages and challenges of each method. All approaches provide the opportunity to better understand data previously unavailable for research in Australia. The challenge of linking general practice data to other sources, currently being explored for general practice data, is discussed. Finally, we describe some general practice data collections used for research internationally and how these compare to collections available in Australia.
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Affiliation(s)
- D Youens
- School of Public Health, Curtin University, Perth, Australia
| | - R Moorin
- School of Public Health, Curtin University, Perth, Australia.,School of Population and Global Health, University of Western Australia
| | - A Harrison
- School of Public Health, Curtin University, Perth, Australia
| | - R Varhol
- School of Public Health, Curtin University, Perth, Australia
| | - S Robinson
- School of Public Health, Curtin University, Perth, Australia
| | - C Brooks
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - J Boyd
- Health Systems & Economics, School of Public Health, Curtin University.,Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University
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9
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The Evolution of Sustainable Development Theory: Types, Goals, and Research Prospects. SUSTAINABILITY 2019. [DOI: 10.3390/su11247158] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sustainable development (SD) has become a fundamental strategy to guide the world’s social and economic transformation. However, in the process of practice, there are still misinterpretations in regards to the theory of SD. Such misinterpretations are highlighted in the struggle between strong and weak sustainable development paths, and the confusion of the concept of intra-generational and inter-generational justice. In this paper, the literature survey method, induction method, and normative analysis were adopted to clarify the gradual evolution and improvement process of the concept and objective of SD, to strengthen the comprehensive understanding of the SD theory. Moreover, we also tried to bring in the situation and concepts of China. The results show that the theory of SD has gone through three periods: the embryonic period (before 1972), the molding period (1972–1987), and the developing period (1987–present). SD is gradually implemented into a global action from the initial fuzzy concept, including increasing practical wisdom. The goal of SD evolves from pursuing the single goal of sustainable use of natural resources to Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs). This paper argues that the theory of strong sustainability should be the accepted concept of SD. Culture, good governance, and life support systems are important factors in promoting SD.
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10
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Caillaud D, Annesi-Maesano I, Bourin A, Chinet T, Colette A, De Blay F, Dixsaut G, Housset B, Kleinpeter J, Malherbe L, Roussel I, Dalphin JC, Charpin D. [Outdoor pollution and its effects on lung health in France. Expert document from the Groupe Pathologies pulmonaires professionnelles environnementales et iatrogéniques (PAPPEI) of the Société de pneumologie de langue française (SPLF)]. Rev Mal Respir 2019; 36:1150-1183. [PMID: 31676143 DOI: 10.1016/j.rmr.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Caillaud
- Service de pneumologie, CHU Clermont-Ferrand, Inra, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
| | - I Annesi-Maesano
- Sorbonne universités, UPMC Univ Paris 06, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMR S 1136), épidémiologie des maladies allergiques et respiratoires, faculté de médecine Saint-Antoine, 75012 Paris, France
| | - A Bourin
- Sciences de l'atmosphère et génie de l'environnement, IMT, Lille, 59650 Douai, France
| | - T Chinet
- Service de pneumologie et oncologie thoracique, CHU Ambroise-Paré, université de Versailles SQY, 92100 Boulogne-Billancourt, France
| | - A Colette
- Unité de modélisation atmosphérique et de cartographie environnementale, INERIS, 60550 Verneuil-en-Halatte, France
| | - F De Blay
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, Fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg , France
| | - G Dixsaut
- Service de physiologie explorations fonctionnelles, hôpital Cochin Hôtel Dieu et Fondation du Souffle contre les maladies respiratoires, 75014 Paris, France
| | - B Housset
- Service de pneumologie et pathologie professionnelle, centre hospitalier intercommunal de Créteil, département hospitalo-universitaire A-TVB, unité Inserm 955, Institut santé travail Paris-Est, université Paris-Est, 94000 Créteil, France
| | - J Kleinpeter
- Association agréée de Surveillance de la qualité de l'Air de la région Grand Est (ATMO Grand Est), 5, rue de Madrid, 67300 Schiltigheim, France; Association de surveillance de la pollution atmosphérique en Alsace (ASPA), 5, rue de Madrid, 67300 Schiltigheim, France
| | - L Malherbe
- Unité de modélisation atmosphérique et de cartographie environnementale, INERIS, 60550 Verneuil-en-Halatte, France
| | - I Roussel
- Faculté de Lille, 59000 Lille, France
| | - J-C Dalphin
- Service de pneumologie, CHU de Besançon, UMR CNRS 6249 chrono-environnement, université de Franche-Comté, 25000 Besançon, France
| | - D Charpin
- Unité de pneumologie, groupe hospitalier de la Timone, Aix-Marseille université et Association pour la prévention de la pollution atmosphérique, 13000 Marseille, France
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11
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Mehiriz K, Gosselin P. Evaluation of the Impacts of a Phone Warning and Advising System for Individuals Vulnerable to Smog. Evidence from a Randomized Controlled Trial Study in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101817. [PMID: 31121903 PMCID: PMC6571566 DOI: 10.3390/ijerph16101817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 12/11/2022]
Abstract
Smog warning systems are components of adaptation strategies that are adopted by governments around the world to protect their citizens from extreme episodes of air pollution. As part of a growing research stream on the effectiveness of these systems, this article presents the results of a study on the impacts of an automated phone warning and advising system for individuals vulnerable to air pollution. A sample of 1328 individuals were recruited and randomly assigned to treatment and control groups. The treatment group received smog warning while the control group did not. Data were collected via three phone surveys, two before and one after issuing the smog warning. The comparison between treatment and control groups indicates that exposure to a smog warning improved information on the occurrence of smog episodes (n = 484, OR = 5.58, p = 0.00), and knowledge on protective behaviors. Furthermore, members of treatment group were more likely to avoid exposure to smog episodes by spending more time inside with the windows closed than usual (n = 474, OR = 2.03, p = 0.00). Members of treatment group who take medication in the form of aerosol pumps also kept these devices on themselves more frequently than those of control group (n= 109, OR = 2.15, p = 0.03). The system however had no discernible effects on the awareness of air pollution risks, reduction of health symptoms related to smog and the use of health system services. The absence of health benefits could be related to the lower actual exposure to air pollution of such vulnerable groups during winter.
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Affiliation(s)
- Kaddour Mehiriz
- Doha Institute for Graduate Studies, School of Public Administration and Development Economics, P.O. Box: 200592, Zone 70, Al Tarfa Street Al-Daayen, Doha, Qatar.
| | - Pierre Gosselin
- Institut National de la Santé Publique and Ouranos, 945 Avenue Wolfe, Québec, QC G1V 5B3, Canada.
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Griauzde DH, Kullgren JT, Liestenfeltz B, Richardson C, Heisler M. A mobile phone-based program to promote healthy behaviors among adults with prediabetes: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:48. [PMID: 29449958 PMCID: PMC5810019 DOI: 10.1186/s40814-018-0246-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Rates of participation in Diabetes Prevention Programs (DPPs) are low. This may be due, in part, to low levels of autonomous motivation (i.e., motivation that arises from internal sources and sustains healthy behaviors over time) to prevent type 2 diabetes (T2DM) among many individuals with prediabetes. Mobile health (mHealth) technologies that incorporate principles from the Self-Determination Theory offer an effective and scalable approach to increase autonomous motivation levels. One promising mobile phone-based application is JOOL Health, which aims to help users connect certain health behaviors (e.g., sleep and diet) with personal values in specific life domains (e.g., family and work). The first aim of this study is to estimate whether JOOL Health can increase autonomous motivation to prevent T2DM among individuals with prediabetes who declined DPP participation. The second aim of this pilot study is to examine the intervention’s feasibility and acceptability. Methods This is a 12-week, three-arm pilot randomized controlled trial. We will recruit 105 individuals with prediabetes who did not engage in a DPP despite invitation from their health plan to participate in face-to-face or web-based programs at no out-of-pocket-cost. Participants will be randomized to one of three study arms: (1) a group that receives information on prediabetes, evidence-based strategies to decrease progression to T2DM, and a list of resources for mHealth tools for monitoring diet, physical activity, and weight (comparison group); (2) a group that receives the JOOL Health application; and (3) a group that receives the JOOL Health application as well as a Fitbit activity tracker and wireless-enabled scale. Our primary outcome is change in autonomous motivation to prevent T2DM (measured using the Treatment Self-Regulation Questionnaire). We will also collect data related to the intervention’s feasibility (recruitment and retention rates) and acceptability (adherence and qualitative experience) as well as changes in psychosocial outcomes, hemoglobin A1c, and weight. Discussion To our knowledge, this is the first study that aims to promote positive health behaviors among individuals with prediabetes who previously declined to participate in a DPP. Our results will inform a larger trial to test the effect of JOOL Health on clinically relevant outcomes, including weight loss, physical activity, and DPP engagement. Trial registration NCT03025607. Registered February 2017. Electronic supplementary material The online version of this article (10.1186/s40814-018-0246-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dina H Griauzde
- 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI USA.,2VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800 USA.,3University of Michigan Medical School, Ann Arbor, MI USA
| | - Jeffrey T Kullgren
- 2VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800 USA.,3University of Michigan Medical School, Ann Arbor, MI USA.,4University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
| | | | - Caroline Richardson
- 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI USA.,3University of Michigan Medical School, Ann Arbor, MI USA.,4University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
| | - Michele Heisler
- 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI USA.,2VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800 USA.,3University of Michigan Medical School, Ann Arbor, MI USA.,4University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
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13
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Samet JM. Do air quality alerts benefit public health? New evidence from Canada. Lancet Planet Health 2018; 2:e6-e7. [PMID: 29615208 DOI: 10.1016/s2542-5196(17)30184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Jonathan M Samet
- Colorado School of Public Health, University of Colorado, Aurora, CO 80045, USA.
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D’Antoni D, Smith L, Auyeung V, Weinman J. Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review. Environ Health 2017; 16:100. [PMID: 28938911 PMCID: PMC5610416 DOI: 10.1186/s12940-017-0307-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/05/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings. METHOD In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework. RESULTS Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices, being exposed to health messages that reduced both concern about air pollution and perceived susceptibility, as well as perceived lack of self-efficacy/locus of control, reliance on sensory cues and lack of time. CONCLUSION We found frequent suboptimal adherence rates to health advice accompanying air quality alerts. Several psychosocial facilitators and barriers of adherence were identified. To maximise their health effects, health advice needs to target these specific psychosocial factors.
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Affiliation(s)
- Donatella D’Antoni
- King’s College London, Institute of Pharmaceutical Sciences, 150 Stamford Street, London, SE1 9NH UK
| | - Louise Smith
- King’s College London, Department of Psychological Medicine, De Crespigny Park, London, UK
| | - Vivian Auyeung
- King’s College London, Institute of Pharmaceutical Sciences, 150 Stamford Street, London, SE1 9NH UK
| | - John Weinman
- King’s College London, Institute of Pharmaceutical Sciences, 150 Stamford Street, London, SE1 9NH UK
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City housing atmospheric pollutant impact on emergency visit for asthma: A classification and regression tree approach. Respir Med 2017; 132:1-8. [PMID: 29229079 DOI: 10.1016/j.rmed.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Particulate matter, nitrogen dioxide (NO2) and ozone are recognized as the three pollutants that most significantly affect human health. Asthma is a multifactorial disease. However, the place of residence has rarely been investigated. We compared the impact of air pollution, measured near patients' homes, on emergency department (ED) visits for asthma or trauma (controls) within the Provence-Alpes-Côte-d'Azur region. METHODS Variables were selected using classification and regression trees on asthmatic and control population, 3-99 years, visiting ED from January 1 to December 31, 2013. Then in a nested case control study, randomization was based on the day of ED visit and on defined age groups. Pollution, meteorological, pollens and viral data measured that day were linked to the patient's ZIP code. RESULTS A total of 794,884 visits were reported including 6250 for asthma and 278,192 for trauma. Factors associated with an excess risk of emergency visit for asthma included short-term exposure to NO2, female gender, high viral load and a combination of low temperature and high humidity. CONCLUSION Short-term exposures to high NO2 concentrations, as assessed close to the homes of the patients, were significantly associated with asthma-related ED visits in children and adults.
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