1
|
Silvestrini P, Lloyd-Bradley B, Glanemann B, Barker EN, Badham H, Tappin S, Pascual M, Haines A, Mas A, Roura X, Piviani M. Clinical presentation, diagnostic investigations, treatment protocols and outcomes of dogs diagnosed with tick-borne diseases living in the United Kingdom: 76 cases (2005-2019). J Small Anim Pract 2023; 64:392-400. [PMID: 36727469 DOI: 10.1111/jsap.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/24/2022] [Accepted: 12/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To report the presence of tick-borne diseases in dogs living in the United Kingdom. MATERIALS AND METHODS Dogs with a final diagnosis of tick-borne diseases made between January 2005 and August 2019 at seven referral institutions in the United Kingdom were included in the study. RESULTS Seventy-six dogs were included: 25 were diagnosed with ehrlichiosis, 23 with babesiosis, eight with Lyme borreliosis and six with anaplasmosis. Fourteen dogs had co-infections with two or three pathogens. Except for those dogs with anaplasmosis and Lyme borreliosis, most dogs with tick-borne diseases had a history of travel to or from endemic countries. However, three dogs with ehrlichiosis, and one dog each infected with Babesia canis and Babesia vulpes did not have any history of travel. A variety of non-specific clinical signs and laboratory abnormalities were reported. Targeted treatment was successful at achieving clinical remission in 64 (84%) dogs. CLINICAL SIGNIFICANCE Even in non-endemic areas, veterinary surgeons should consider tick-borne diseases in dogs with compatible clinical presentation and laboratory findings and especially where there is a history of travel. As autochthonous transmission of tick-borne-pathogens does occur, an absence of travel should not rule out tick-borne diseases. Specific diagnostic testing is required to confirm infection, and this enables prompt targeted treatment and often a positive outcome.
Collapse
Affiliation(s)
- P Silvestrini
- Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - B Lloyd-Bradley
- Small Animal Teaching Hospital, University of Liverpool, Neston, UK
- Dick White Referrals, Six Mile Bottom, UK
| | - B Glanemann
- Queen Mother Hospital for Animals, Royal Veterinary College - University of London, Hatfield, UK
| | - E N Barker
- Small Animal Hospital, Langford Vets, University of Bristol, Langford, UK
| | - H Badham
- Davies Veterinary Specialists, Hitchin, UK
| | - S Tappin
- Dick White Referrals, Six Mile Bottom, UK
| | - M Pascual
- Dick White Referrals, Six Mile Bottom, UK
| | - A Haines
- Animal Health Trust, Newmarket, UK
| | - A Mas
- Anderson Moores Veterinary Specialists, Winchester, UK
| | - X Roura
- Hospital Clinic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - M Piviani
- Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Haines A, Wesolowski J, Paumet F. Chlamydia trachomatis Subverts Alpha-Actinins To Stabilize Its Inclusion. Microbiol Spectr 2023; 11:e0261422. [PMID: 36651786 PMCID: PMC9927245 DOI: 10.1128/spectrum.02614-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Chlamydia trachomatis is the leading cause of sexually transmitted bacterial disease and a global health burden. As an obligate intracellular pathogen, Chlamydia has evolved many strategies to manipulate its host and establish its intracellular niche called the inclusion. C. trachomatis reorganizes the host actin cytoskeleton to form scaffolds around the inclusion and reinforce the growing inclusion membrane. To control the kinetics and formation of actin scaffolds, Chlamydia expresses the effector InaC/CT813, which activates the host GTPase RhoA. Here, we have discovered that InaC stabilizes actin scaffolds through the host actin cross-linking proteins α-actinins 1 and 4. We demonstrate that α-actinins are recruited to the inclusion membrane in an InaC-dependent manner and associate with actin scaffolds that envelop the inclusion. Small interfering RNA (siRNA)-mediated knockdown of α-actinins differentially regulate the frequency of actin scaffolds and impair inclusion stability, leaving them susceptible to rupture and to nonionic detergent extraction. Overall, our data identify new host effectors that are subverted by InaC to stabilize actin scaffolds, highlighting the versatility of InaC as a key regulator of the host cytoskeletal network during Chlamydia infection. IMPORTANCE Despite antibiotics, recurrent C. trachomatis infections cause significant damage to the genital tract in men and women. Without a preventative vaccine, it is paramount to understand the virulence mechanisms that Chlamydia employs to cause disease. In this context, manipulation of the host cytoskeleton is a critical component of Chlamydia development. Actin scaffolds reinforce the integrity of Chlamydia's infectious vacuole, which is a critical barrier between Chlamydia and the host environment. Having previously established that InaC co-opts RhoA to promote the formation of actin scaffolds around the inclusion, we now show that Chlamydia hijacks a new class of host effectors, α-actinins, to cross-link these scaffolds and further stabilize the inclusion. We also establish that a core function of the chlamydial effector InaC is the regulation of cytoskeletal stability during Chlamydia infection. Ultimately, this work expands our understanding of how bacterial pathogens subvert the actin cytoskeleton by targeting fundamental host effector proteins.
Collapse
Affiliation(s)
- A. Haines
- Department of Immunology and Microbiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J. Wesolowski
- Department of Immunology and Microbiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - F. Paumet
- Department of Immunology and Microbiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Pozzer A, Anenberg SC, Dey S, Haines A, Lelieveld J, Chowdhury S. Mortality Attributable to Ambient Air Pollution: A Review of Global Estimates. Geohealth 2023; 7:e2022GH000711. [PMID: 36636746 PMCID: PMC9828848 DOI: 10.1029/2022gh000711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/16/2022] [Accepted: 12/14/2022] [Indexed: 05/31/2023]
Abstract
Since the publication of the first epidemiological study to establish the connection between long-term exposure to atmospheric pollution and effects on human health, major efforts have been dedicated to estimate the attributable mortality burden, especially in the context of the Global Burden of Disease (GBD). In this work, we review the estimates of excess mortality attributable to outdoor air pollution at the global scale, by comparing studies available in the literature. We find large differences between the estimates, which are related to the exposure response functions as well as the number of health outcomes included in the calculations, aspects where further improvements are necessary. Furthermore, we show that despite the considerable advancements in our understanding of health impacts of air pollution and the consequent improvement in the accuracy of the global estimates, their precision has not increased in the last decades. We offer recommendations for future measurements and research directions, which will help to improve our understanding and quantification of air pollution-health relationships.
Collapse
Affiliation(s)
- A. Pozzer
- Max Planck Institute for ChemistryMainzGermany
- The Cyprus InstituteNicosiaCyprus
| | - S. C. Anenberg
- Milken Institute School of Public HealthWashington UniversityWashingtonDCUSA
| | - S. Dey
- Indian Institute of Technology DelhiDelhiIndia
| | - A. Haines
- London School of Hygiene and Tropical MedicineLondonUK
| | - J. Lelieveld
- Max Planck Institute for ChemistryMainzGermany
- The Cyprus InstituteNicosiaCyprus
| | - S. Chowdhury
- Max Planck Institute for ChemistryMainzGermany
- CICERO Center for International Climate ResearchOsloNorway
| |
Collapse
|
4
|
Mendis R, Haines A, Williams L, Mitchener K, Grimaldi F, Phillips M, Shaw M, Nguyen TPH, Dabscheck A, Spruijt O, Coperchini M. Palliative care and COVID-19 in the Australian context: a review of patients with COVID-19 referred to palliative care. AUST HEALTH REV 2021; 45:667-674. [PMID: 34446150 DOI: 10.1071/ah21157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
ObjectivePalliative care has played a key role in the response to the coronavirus disease 2019 (COVID-19) pandemic in Australia. This review of consecutive patients with COVID-19 referred to the palliative care consultancy service of a tertiary health service in Melbourne describes the palliative care experience with COVID-19 in Australia.MethodsThe experiences of 55 patients (median age 86 years; interquartile range (IQR) 81-90 years; 55% male; median Charlson comorbidity score 6 (IQR 5-8); 85% with Australia-modified Karnofsky Performance Status ≤50; 67% from residential aged care facilities) were reviewed to collect relevant data points.ResultsMost patients were referred for end-of-life care with symptoms including dyspnoea (80%) and agitation/delirium (60%). Continuous subcutaneous infusions were commenced in 71% of patients, with the most frequent medications being opioids and benzodiazepines in relatively small doses; 81% required ≤20mg subcutaneous morphine equivalent and 64% required ≤10mg subcutaneous midazolam over 24h. Fifty patients (91%) died in hospital and the median time from palliative care referral to death was 3 days (IQR 1-5 days). Five patients were discharged back to residential aged care facilities. Overall, 80% of referrals were from the aged care team.ConclusionOur patients had similar demographics, symptoms, medication needs and outcomes to patients in similar settings overseas. We found the symptom management of patients with COVID-19 to be generally straightforward. However, the psychosocial needs of patients were predominant and contributed to complexity. This study highlights the need for well-integrated relationships between the palliative care consultancy service and the diverse range of key treating teams involved in the delivery of pandemic health care.What is known about the topic?Palliative care has played a key role in the response to the COVID-19 pandemic in Australia. There is limited research describing the Australian palliative care experience with the COVID-19 pandemic.What does this paper add?Patients with COVID-19 referred to a hospital-based palliative care consultancy service in Australia had similar demographic characteristics, symptoms, medication needs and outcomes to patients with COVID-19 referred to other palliative care services in the UK and the US. There were significant psychosocial issues affecting patients, families and staff in the context of the pandemic.What are the implications for practitioners?This study highlights the need for well-functioning working relationships between the palliative care consultancy service and other hospital teams that can be leveraged at a time of crisis, such as a pandemic, to provide optimal palliative care to patients.
Collapse
Affiliation(s)
- Ruwani Mendis
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia; and Department of Medicine, Western Health, The University of Melbourne, 176 Furlong Road, St. Albans, Vic. 3021, Australia; and Corresponding author.
| | - Anita Haines
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| | - Loretta Williams
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| | - Kirsten Mitchener
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| | - Fiona Grimaldi
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| | - Marianne Phillips
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| | - Margaret Shaw
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia; and Mercy Palliative Care, 3 Devonshire Road, Sunshine, Vic. 3020, Australia
| | - Thy Pham Hoai Nguyen
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia; and School of BioSciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Adrian Dabscheck
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| | - Odette Spruijt
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia; and Faculty of Medicine, Dentistry and Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Maria Coperchini
- Western Health, 176 Furlong Road, St Albans, Melbourne, Vic. 3021, Australia
| |
Collapse
|
5
|
Vicedo-Cabrera AM, Scovronick N, Sera F, Royé D, Schneider R, Tobias A, Astrom C, Guo Y, Honda Y, Hondula DM, Abrutzky R, Tong S, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Lavigne E, Correa PM, Ortega NV, Kan H, Osorio S, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti N, Pascal M, Schneider A, Katsouyanni K, Samoli E, Mayvaneh F, Entezari A, Goodman P, Zeka A, Michelozzi P, de’Donato F, Hashizume M, Alahmad B, Diaz MH, De La Cruz Valencia C, Overcenco A, Houthuijs D, Ameling C, Rao S, Ruscio FD, Carrasco-Escobar G, Seposo X, Silva S, Madureira J, Holobaca IH, Fratianni S, Acquaotta F, Kim H, Lee W, Iniguez C, Forsberg B, Ragettli MS, Guo YLL, Chen BY, Li S, Armstrong B, Aleman A, Zanobetti A, Schwartz J, Dang TN, Dung DV, Gillett N, Haines A, Mengel M, Huber V, Gasparrini A. The burden of heat-related mortality attributable to recent human-induced climate change. Nat Clim Chang 2021; 11:492-500. [PMID: 34221128 PMCID: PMC7611104 DOI: 10.1038/s41558-021-01058-x] [Citation(s) in RCA: 196] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/20/2021] [Indexed: 05/19/2023]
Abstract
Climate change affects human health; however, there have been no large-scale, systematic efforts to quantify the heat-related human health impacts that have already occurred due to climate change. Here, we use empirical data from 732 locations in 43 countries to estimate the mortality burdens associated with the additional heat exposure that has resulted from recent human-induced warming, during the period 1991-2018. Across all study countries, we find that 37.0% (range 20.5-76.3%) of warm-season heat-related deaths can be attributed to anthropogenic climate change and that increased mortality is evident on every continent. Burdens varied geographically but were of the order of dozens to hundreds of deaths per year in many locations. Our findings support the urgent need for more ambitious mitigation and adaptation strategies to minimize the public health impacts of climate change.
Collapse
Affiliation(s)
- A. M. Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - N. Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - F. Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Department of Statistics, Computer Science and Applications ‘G. Parenti’, University of Florence, Florence, Italy
| | - D. Royé
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - R. Schneider
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Φ-Lab, European Space Agency (ESA-ESRIN), Frascati, Italy
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- European Centre for Medium-Range Weather Forecast (ECMWF), Reading, UK
| | - A. Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - C. Astrom
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Y. Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Y. Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - D. M. Hondula
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - R. Abrutzky
- Facultad de Ciencias Sociales, Instituto de Investigaciones Gino Germani, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - S. Tong
- Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | | | | | - E. Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - P. Matus Correa
- Department of Public Health, Universidad de los Andes, Santiago, Chile
| | - N. Valdes Ortega
- Department of Public Health, Universidad de los Andes, Santiago, Chile
| | - H. Kan
- School of Public Health, Fudan University, Shanghai, China
| | - S. Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - J. Kyselý
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - A. Urban
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - H. Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - E. Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - J. J. K. Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Finnish Meteorological Institute, Helsinki, Finland
| | - N. Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - M. Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - A. Schneider
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - K. Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- MRC-PHE Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - E. Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - F. Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - A. Entezari
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - P. Goodman
- School of Physics, Technological University Dublin, Dublin, Ireland
| | - A. Zeka
- Institute for Environment, Health and Societies, Brunel University London, London, UK
| | - P. Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - F. de’Donato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - M. Hashizume
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - B. Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - M. Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico
| | - C. De La Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico
| | - A. Overcenco
- Laboratory of Management in Science and Public Health, National Agency for Public Health of the Ministry of Health, Chisinau, Republic of Moldova
| | - D. Houthuijs
- Centre for Sustainability and Environmental Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - C. Ameling
- Centre for Sustainability and Environmental Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - S. Rao
- Norwegian Institute of Public Health, Oslo, Norway
| | - F. Di Ruscio
- Norwegian Institute of Public Health, Oslo, Norway
| | - G. Carrasco-Escobar
- Health Innovation Laboratory, Institute of Tropical Medicine ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - X. Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - S. Silva
- Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal
| | - J. Madureira
- Department of Enviromental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - I. H. Holobaca
- Faculty of Geography, Babes-Bolay University, Cluj-Napoca, Romania
| | - S. Fratianni
- Department of Earth Sciences, University of Torino, Turin, Italy
| | - F. Acquaotta
- Department of Earth Sciences, University of Torino, Turin, Italy
| | - H. Kim
- Graduate School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - W. Lee
- Graduate School of Public Health & Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - C. Iniguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Statistics and Computational Research, Universitat de Valencia, Valencia, Spain
| | - B. Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M. S. Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Y. L. L. Guo
- Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan,Taiwan
| | - B. Y. Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan,Taiwan
| | - S. Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - B. Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A. Aleman
- Department of Preventive Medicine, School of Medicine, University of the Republic, Montevideo, Uruguay
| | - A. Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - J. Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - T. N. Dang
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - D. V. Dung
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - N. Gillett
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, British Colombia, Canada
| | - A. Haines
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Φ-Lab, European Space Agency (ESA-ESRIN), Frascati, Italy
| | - M. Mengel
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - V. Huber
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Department of Physical, Chemical and Natural Systems, Universidad Pablo de Olavide, Seville, Spain
| | - A. Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
6
|
Aleksandrowicz L, Green R, Joy EJM, Harris F, Hillier J, Vetter SH, Smith P, Kulkarni B, Dangour AD, Haines A. Environmental impacts of dietary shifts in India: A modelling study using nationally-representative data. Environ Int 2019; 126:207-215. [PMID: 30802638 PMCID: PMC6437131 DOI: 10.1016/j.envint.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 05/15/2023]
Abstract
Food production is a major driver of environmental change, and unhealthy diets are the leading cause of global disease burden. In high-income countries (HICs), modelling studies suggest that adoption of healthy diets could improve population health and reduce environmental footprints associated with food production. We assessed whether such benefits from dietary change could occur in India, where under-nutrition and overweight and obesity are simultaneously prevalent. We calculated the potential changes in greenhouse gas (GHG) emissions, blue and green water footprints (WFs), and land use (LU), that would result from shifting current national food consumption patterns in India to healthy diets (meeting dietary guidelines) and to "affluent diets" (those consumed by the wealthiest quartile of households, which may represent future purchasing power and nutritional trajectories). Dietary data were derived from the 2011-12 nationally-representative household expenditure survey, and we assessed dietary scenarios nationally and across six Indian sub-regions, by rural or urban location, and for those consuming above or below recommended dietary energy intakes. We modelled the changes in consumption of 34 food groups necessary to meet Indian dietary guidelines, as well as an affluent diet representative of those in the highest wealth quartile. These changes were combined with food-specific data on GHG emissions, calculated using the Cool Farm Tool, and WF and LU adapted from the Water Footprint Network and Food and Agriculture Organization, respectively. Shifting to healthy guidelines nationally required a minor increase in dietary energy (3%), with larger increases in fruit (18%) and vegetable (72%) intake, though baseline proportion of dietary energy from fat and protein was adequate and did not change significantly. Meeting healthy guidelines slightly increased environmental footprints by about 3-5% across GHG emissions, blue and green WFs, and LU. However, these national averages masked substantial variation within sub-populations. For example, shifting to healthy diets among those with dietary energy intake below recommended guidelines would result in increases of 28% in GHG emissions, 18 and 34% in blue and green WFs, respectively, and 41% in LU. Decreased environmental impacts were seen among those who currently consume above recommended dietary energy (-6 to -16% across footprints). Adoption of affluent diets by the whole population would result in increases of 19-36% across the environmental indicators. Specific food groups contributing to these shifts varied by scenario. Environmental impacts also varied markedly between six major Indian sub-regions. In India, where undernutrition is prevalent, widespread adoption of healthy diets may lead to small increases in the environmental footprints of the food system relative to the status quo, although much larger increases would occur if there was widespread adoption of diets currently consumed by the wealthiest quartile of the population. To achieve lower diet-related disease burdens and reduced environmental footprints of the food system, greater efficiency of food production and reductions in food waste are likely to be required alongside promotion of healthy diets.
Collapse
Affiliation(s)
- L Aleksandrowicz
- Dept. of Population Health, London School of Hygiene & Tropical Medicine, UK; Leverhulme Centre for Integrative Research on Agriculture & Health, UK.
| | - R Green
- Dept. of Population Health, London School of Hygiene & Tropical Medicine, UK; Leverhulme Centre for Integrative Research on Agriculture & Health, UK
| | - E J M Joy
- Dept. of Population Health, London School of Hygiene & Tropical Medicine, UK; Leverhulme Centre for Integrative Research on Agriculture & Health, UK
| | - F Harris
- Dept. of Population Health, London School of Hygiene & Tropical Medicine, UK
| | - J Hillier
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, UK
| | - S H Vetter
- Institute of Biological and Environmental Sciences, University of Aberdeen, UK
| | - P Smith
- Institute of Biological and Environmental Sciences, University of Aberdeen, UK
| | - B Kulkarni
- Clinical Division, National Institute of Nutrition, India
| | - A D Dangour
- Dept. of Population Health, London School of Hygiene & Tropical Medicine, UK; Leverhulme Centre for Integrative Research on Agriculture & Health, UK
| | - A Haines
- Dept. of Population Health, London School of Hygiene & Tropical Medicine, UK; Dept. of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
| |
Collapse
|
7
|
Lelieveld J, Klingmüller K, Pozzer A, Burnett RT, Haines A, Ramanathan V. Effects of fossil fuel and total anthropogenic emission removal on public health and climate. Proc Natl Acad Sci U S A 2019; 116:7192-7197. [PMID: 30910976 PMCID: PMC6462052 DOI: 10.1073/pnas.1819989116] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Anthropogenic greenhouse gases and aerosols are associated with climate change and human health risks. We used a global model to estimate the climate and public health outcomes attributable to fossil fuel use, indicating the potential benefits of a phaseout. We show that it can avoid an excess mortality rate of 3.61 (2.96-4.21) million per year from outdoor air pollution worldwide. This could be up to 5.55 (4.52-6.52) million per year by additionally controlling nonfossil anthropogenic sources. Globally, fossil-fuel-related emissions account for about 65% of the excess mortality, and 70% of the climate cooling by anthropogenic aerosols. The chemical influence of air pollution on aeolian dust contributes to the aerosol cooling. Because aerosols affect the hydrologic cycle, removing the anthropogenic emissions in the model increases rainfall by 10-70% over densely populated regions in India and 10-30% over northern China, and by 10-40% over Central America, West Africa, and the drought-prone Sahel, thus contributing to water and food security. Since aerosols mask the anthropogenic rise in global temperature, removing fossil-fuel-generated particles liberates 0.51(±0.03) °C and all pollution particles 0.73(±0.03) °C warming, reaching around 2 °C over North America and Northeast Asia. The steep temperature increase from removing aerosols can be moderated to about 0.36(±0.06) °C globally by the simultaneous reduction of tropospheric ozone and methane. We conclude that a rapid phaseout of fossil-fuel-related emissions and major reductions of other anthropogenic sources are needed to save millions of lives, restore aerosol-perturbed rainfall patterns, and limit global warming to 2 °C.
Collapse
Affiliation(s)
- J Lelieveld
- Department of Atmospheric Chemistry, Max Planck Institute for Chemistry, 55128 Mainz, Germany;
- Energy, Environment and Water Research Center, The Cyprus Institute, 1645 Nicosia, Cyprus
| | - K Klingmüller
- Department of Atmospheric Chemistry, Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - A Pozzer
- Department of Atmospheric Chemistry, Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - R T Burnett
- Population Studies Division, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - A Haines
- Department of Public Health, London School of Hygiene and Tropical Medicine, London WC1 9SH, United Kingdom
| | - V Ramanathan
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA 92093-0221
| |
Collapse
|
8
|
Montgomery HE, Haines A, Marlow N, Pearson G, Mythen MG, Grocott MPW, Swanton C. The future of UK healthcare: problems and potential solutions to a system in crisis. Ann Oncol 2018; 28:1751-1755. [PMID: 28453610 DOI: 10.1093/annonc/mdx136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The UK's Health System is in crisis, central funding no longer keeping pace with demand. Traditional responses-spending more, seeking efficiency savings or invoking market forces-are not solutions. The health of our nation demands urgent delivery of a radical new model, negotiated openly between public, policymakers and healthcare professionals. Such a model could focus on disease prevention, modifying health behaviour and implementing change in public policy in fields traditionally considered unrelated to health such as transport, food and advertising. The true cost-effectiveness of healthcare interventions must be balanced against the opportunity cost of their implementation, bolstering the central role of NICE in such decisions. Without such action, the prognosis for our healthcare system-and for the health of the individuals it serves-may be poor. Here, we explore such a new prescription for our national health.
Collapse
Affiliation(s)
- H E Montgomery
- Department of Medicine, University College London, London
| | - A Haines
- Departments of Social and Environmental Health Research and of Population Health, London.,School of Hygiene and Tropical Medicine, London
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London
| | - G Pearson
- Department of Paediatric Intensive Care, Birmingham Children's Hospital, Birmingham
| | - M G Mythen
- Department of Anaesthesia and Critical Care, University College London, London
| | - M P W Grocott
- Department of Anaesthesia and Critical Care, University Hospitals Southampton NHS Foundation Trust and University of Southampton, Southampton
| | - C Swanton
- UCL Cancer Institute, CRUK Lung Cancer Centre of Excellence, London, UK
| |
Collapse
|
9
|
Abstract
AbstractWe conducted a pilot randomised trial of computerised templates for the management of asthma and diabetes in general practice in six general practices in North London. Uptake of the guidelines by general practitioners and practice nurses was assessed using qualitative (semi-structured interviews designed to assess the users’ views) and quantitative (change in use of the template during the study period) outcome measures. The practice nurses used the templates frequently but general practitioners rarely used them. Several reasons were offered for non-use of the templates, such as the length of the template and non-involvement in the care of asthma or diabetes. Despite this, however, health professionals were favourably disposed to the use of templates for general clinical care. Pilot investigations of computerised templates are best achieved by observational or quasi-experimental methods rather than a randomised controlled trial. The use of both qualitative and quantitative methods in this study allowed exploration of the barriers to use of computers.
Collapse
|
10
|
Shindell D, Borgford-Parnell N, Brauer M, Haines A, Kuylenstierna JCI, Leonard SA, Ramanathan V, Ravishankara A, Amann M, Srivastava L. A climate policy pathway for near- and long-term benefits. Science 2018; 356:493-494. [PMID: 28473553 DOI: 10.1126/science.aak9521] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- D Shindell
- Nicholas School of the Environment, Duke University, Durham, NC 27708, USA.
| | - N Borgford-Parnell
- Institute for Governance and Sustainable Development, Washington, DC 20008, USA
| | - M Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - A Haines
- London School of Hygiene and Tropical Medicine, London WCIH 9SH, UK
| | | | - S A Leonard
- United Nations Environment Programme, 75015 Paris, France
| | - V Ramanathan
- Scripps Institution of Oceanography, University of California at San Diego, La Jolla, CA 92093, USA
| | | | - M Amann
- International Institute for Applied Systems Analysis, Laxenburg, A-2361 Austria
| | - L Srivastava
- TERI University, Vasant Kunj, New Delhi 110 070, India
| |
Collapse
|
11
|
Hajat S, Haines A, Sarran C, Sharma A, Bates C, Fleming LE. The effect of ambient temperature on type-2-diabetes: case-crossover analysis of 4+ million GP consultations across England. Environ Health 2017; 16:73. [PMID: 28701216 PMCID: PMC5506566 DOI: 10.1186/s12940-017-0284-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/03/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Given the double jeopardy of global increases in rates of obesity and climate change, it is increasingly important to recognise the dangers posed to diabetic patients during periods of extreme weather. We aimed to characterise the associations between ambient temperature and general medical practitioner consultations made by a cohort of type-2 diabetic patients. Evidence on the effects of temperature variation in the primary care setting is currently limited. METHODS Case-crossover analysis of 4,474,943 consultations in England during 2012-2014, linked to localised temperature at place of residence for each patient. Conditional logistic regression was used to assess associations between each temperature-related consultation and control days matched on day-of-week. RESULTS There was an increased odds of seeking medical consultation associated with high temperatures: Odds ratio (OR) = 1.097 (95% confidence interval = 1.041, 1.156) per 1 °C increase above 22 °C. Odds during low temperatures below 0 °C were also significantly raised: OR = 1.024 (1.019, 1.030). Heat-related consultations were particularly high among diabetics with cardiovascular comorbidities: OR = 1.171 (1.031, 1.331), but there was no heightened risk with renal failure or neuropathy comorbidities. Surprisingly, lower odds of heat-related consultation were associated with the use of diuretics, anticholinergics, antipsychotics or antidepressants compared to non-use, especially among those with cardiovascular comorbidities, although differences were not statistically significant. CONCLUSIONS Type-2 diabetic patients are at increased odds of medical consultation during days of temperature extremes, especially during hot weather. The common assumption that certain medication use heightens the risk of heat illness was not borne-out by our study on diabetics in a primary care setting and such advice may need to be reconsidered in heat protection plans.
Collapse
Affiliation(s)
- S. Hajat
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - A. Haines
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | |
Collapse
|
12
|
Bluford J, Gauthier D, Colasanto M, Rhodes M, Vogelbein W, Haines A. Identification of virulence genes in Vibrio spp. isolates from the 2009 Bermuda reef fish mortality event. J Fish Dis 2017; 40:597-600. [PMID: 27553461 DOI: 10.1111/jfd.12532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Affiliation(s)
- J Bluford
- Department of Biology, Norfolk State University, Norfolk, VA, USA
| | - D Gauthier
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA
| | - M Colasanto
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - M Rhodes
- Department of Aquatic Health Science, College of William and Mary, Virginia Institute of Marine Science, Williamsburg, VA, USA
| | - W Vogelbein
- Department of Aquatic Health Science, College of William and Mary, Virginia Institute of Marine Science, Williamsburg, VA, USA
| | - A Haines
- Department of Biology, Norfolk State University, Norfolk, VA, USA
| |
Collapse
|
13
|
Finotello R, Monné Rodriguez JM, Vilafranca M, Altimira J, Ramirez GA, Haines A, Ressel L. Immunohistochemical expression of MDR1-Pgp 170 in canine cutaneous and oral melanomas: pattern of expression and association with tumour location and phenotype. Vet Comp Oncol 2016; 15:1393-1402. [DOI: 10.1111/vco.12281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/16/2016] [Accepted: 10/02/2016] [Indexed: 12/21/2022]
Affiliation(s)
- R. Finotello
- Small Animal Teaching Hospital, Institute of Veterinary Sciences; University of Liverpool; Neston UK
| | - J. M. Monné Rodriguez
- Section of Veterinary Pathology, Institute of Veterinary Sciences; University of Liverpool; Neston UK
| | - M. Vilafranca
- Laboratorio de Diagnóstico Histopatológico Histovet; Avda Països Catalans; Barcelona Spain
| | - J. Altimira
- Laboratorio de Diagnóstico Histopatológico Histovet; Avda Països Catalans; Barcelona Spain
| | - G. A. Ramirez
- Laboratorio de Diagnóstico Histopatológico Histovet; Avda Països Catalans; Barcelona Spain
| | - A. Haines
- Institute of Veterinary Sciences; University of Liverpool; Neston UK
| | - L. Ressel
- Section of Veterinary Pathology, Institute of Veterinary Sciences; University of Liverpool; Neston UK
| |
Collapse
|
14
|
Patino-Lugo D, Lavis J, Perel P, Wu Y, Haines A, Ranson M, Panisset U, Bosch-Capblanch X, Brouwers M. P208 How Could Who Better Support National And Subnational Governments In Their Efforts To Adapt And Implement Global Recommendations And Decisions? A Systematic Analysis Of Health Systems Guidance And World Health Assembly Resolutions. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Affiliation(s)
- Pem Fine
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | | | | |
Collapse
|
16
|
Ellison S, Lamb J, Haines A, O'Dell S, Thomas G, Sethi S, Ratcliffe J, Chisholm S, Vaughan J, Mahadevan V. A guide for identification and continuing care of adult congenital heart disease patients in primary care. Int J Cardiol 2013; 163:260-265. [DOI: 10.1016/j.ijcard.2011.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/05/2011] [Indexed: 11/26/2022]
|
17
|
Mehraban F, Haines A, Dolly JO. Monoclonal and polyclonal antibodies against dendrotoxin: Their effects on its convulsive activity and interaction with neuronal acceptors. Neurochem Int 2012; 9:11-22. [PMID: 20493095 DOI: 10.1016/0197-0186(86)90026-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/1985] [Accepted: 01/14/1986] [Indexed: 10/27/2022]
Abstract
Three stable hybrid cell lines have been established that secrete monoclonal antibodies of G(1) sub-class to dendrotoxin, a convulsant polypeptide (M(r) = 7000). Using [(125)I]labelled dendrotoxin the resultant ascitic fluids were found to show no cross-reactivity with homologous toxins (toxins 1, B and E from Dendroaspis polylepis, toxin Dv-14 from Dendroaspis viridis and ?-bungarotoxin from Bungarus multicinctus). In contrast, polyclonal antibodies raised against dendrotoxin cross-reacted to varying degrees with its congeners; most importantly, the rank order of cross-reactivities was in accordance with their potencies in eliciting convulsions when injected intracerebroventricularly into rat brain. All the antibodies prevented significantly the binding of dendrotoxin to its protein acceptor in brain synaptic membranes. Moreover, when they were injected into rat brain together with lethal doses of dendrotoxin they delayed, or in some cases prevented, the onset of convulsive symptoms. Ultracentrifugation of the complexes formed by [(125)I]labelled dendrotoxin and one or more of the monoclonal antibodies showed only a single peak of radioactivity with an S(20.w) of 7S, indicating that all these mono-specific antibodies are directed to the same or overlapping epitope(s). Conversely, polyclonal antisera produced larger complexes with the antigen, revealing the presence of at least two determinants on this molecule. Such antibodies are proving helpful in identifying regions of the toxin responsible for the neurotoxicity and associated interaction with its acceptor, a putative constituent of A-current K(+)-channels.
Collapse
Affiliation(s)
- F Mehraban
- Department of Biochemistry, Imperial College, London SW7 2AZ, U.K
| | | | | |
Collapse
|
18
|
|
19
|
|
20
|
Bhaskaran K, Hajat S, Haines A, Smeeth L. Response to Peter Joseph. Heart 2010. [DOI: 10.1136/hrt.2009.189290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
21
|
Abstract
CONTEXT While the effects of weather and, in particular, ambient temperature on overall mortality are well documented, the strength of the evidence base for the effects on acute myocardial infarction (MI) are less clear. OBJECTIVE To systematically review studies specifically focusing on the effects of temperature on MI. DATA SOURCES Medline, Embase, and GeoBase publication databases, as well as reference lists, and the websites of a number of relevant public organisations. STUDY SELECTION Studies of original data in which ambient temperature was an exposure of interest and MI a specific outcome were selected. DATA EXTRACTION The reported effects of ambient temperature on the risk of MI, including effect sizes and confidence intervals, where possible, were recorded. Methodological details were also extracted, including study population, location and setting, ascertainment of MI events, adjustment for potential confounders and consideration of lagged effects. RESULTS 19 studies were identified, of which 14 considered the short-term effects of temperature on a daily timescale, the remainder looking at longer-term effects. Overall, 8 of the 12 studies which included relevant data from the winter season reported a statistically significant short-term increased risk of MI at lower temperatures, while increases in risk at higher temperatures were reported in 7 of the 13 studies with relevant data. A number of differences were identified between studies in the population included demographics, location, local climate, study design and statistical methodology. CONCLUSION A number of studies, including some that were large and relatively well controlled, suggested that both hot and cold weather had detrimental effects on the short-term risk of MI. However, further research with consistent methodology is needed to clarify the magnitude of these effects and to show which populations and individuals are vulnerable.
Collapse
Affiliation(s)
- K Bhaskaran
- London School of Hygiene and Tropical Medicine, London WC1B 3DP, UK.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
CONTEXT Short-term fluctuations in air pollution have been associated with changes in both overall and cardiovascular mortality. OBJECTIVE To consider the effects of air pollution on myocardial infarction (MI) risk by systematically reviewing studies looking at this specific outcome. DATA SOURCES Medline, Embase and TOXNET publication databases, as well as reference lists and the websites of relevant public organisations. STUDY SELECTION Studies presenting original data with MI as a specific outcome and one or more of the following as an exposure of interest were included: particulate matter (PM), black carbon/black smoke, ozone, carbon monoxide, nitrogen oxides, sulphur dioxide and traffic exposure. DATA EXTRACTION The effects of each pollutant on risk of MI, including effect sizes and confidence intervals, were recorded where possible. Methodological details were also extracted including study population, location and setting, ascertainment of MI events, adjustment for potential confounders and consideration of lagged effects. RESULTS 26 studies were identified: 19 looked at the short-term effects of pollution on a daily timescale; the remaining 7 at longer-term effects. A proportion of studies reported statistically significant detrimental effects of PM with diameter <2.5 microm (3/5 studies, risk increase estimates ranging from 5 to 17% per 10 microg/m(3) increase), PM <10 microm (3/10, 0.7-11% per 10 microg/m(3)), CO (6/14, 2-4% per ppm), SO(2) (6/13, effect estimates on varied scales) and NO(2 )(6/13, 1-9% per 10 ppb). Increasing ozone levels were associated with a reduction in MI risk in 3/12 studies. A number of differences in location, population and demographics and study methodology between studies were identified that might have affected results. CONCLUSION There is some evidence that short-term fluctuations in air pollution affect the risk of MI. However, further studies are needed to clarify the nature of these effects and identify vulnerable populations and individuals.
Collapse
Affiliation(s)
- K Bhaskaran
- London School of Hygiene and Tropical Medicine, London WC1B 3DP, UK.
| | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Abstract
It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways--eg, as a result of increased frequency and intensity of heat waves, reduction in cold-related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases, and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries might also be adversely affected. Adaptation to climate change requires public-health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing the use of a number of renewable energy technologies should improve health in the near term by reducing exposure to air pollution.
Collapse
Affiliation(s)
- A Haines
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | |
Collapse
|
25
|
Haines A, Kovats RS, Campbell-Lendrum D, Corvalan C. Climate change and human health: impacts, vulnerability and public health. Public Health 2006; 120:585-96. [PMID: 16542689 DOI: 10.1016/j.puhe.2006.01.002] [Citation(s) in RCA: 260] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 11/10/2005] [Indexed: 11/19/2022]
Abstract
It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways, for example as a result of increased frequency and intensity of heat waves, reduction in cold related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries may also be adversely affected. Adaptation to climate change requires public health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing a number of uses of the renewable energy technologies should improve health in the near-term by reducing exposure to air pollution.
Collapse
Affiliation(s)
- A Haines
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, UK.
| | | | | | | |
Collapse
|
26
|
Abstract
OBJECTIVE To investigate asymptomatic vagino-rectal carriage of group B streptococcus (GBS) in pregnant women. METHODS Women in the final trimester of pregnancy were recruited. A single vagino-rectal swab was taken, with consent, for culture of GBS. Two microbiological methods for isolation of GBS from vagino-rectal swabs were compared. The distribution of capsular serotypes of the GBS identified was determined. Epidemiological data for a subset (n = 167) of the pregnant women participating were examined. RESULTS 21.3% were colonised vagino-rectally with GBS. Risk factors for neonatal GBS disease (maternal fever, prolonged rupture of membranes, and preterm delivery) were present in 34 of 167 women (20.4%), and the presence of these factors correlated poorly with GBS carriage. Capsular serotypes III (26.4%), IA (25.8%), V (18.9%), and IB (15.7%) were prevalent in the GBS isolates. Selective broth culture of vagino-rectal swabs was superior to selective plate culture, but the combination of both methods was associated with increased detection of GBS (7.5%). An algorithm for the identification of GBS from vagino-rectal swabs was developed. CONCLUSIONS GBS carriage is prevalent in pregnant women in Oxfordshire, UK. The poor correlation between risk factors and GBS carriage requires further investigation in larger groups, given that the identification of these surrogate markers is recommended to guide administration of intrapartum antibiotic prophylaxis by the Royal College of Obstetricians of the UK. A selective broth culture detected more GBS carriers than a selective plate culture.
Collapse
Affiliation(s)
- N Jones
- Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
| | | | | | | | | |
Collapse
|
27
|
Wallace P, Barber J, Clayton W, Currell R, Fleming K, Garner P, Haines A, Harrison R, Jacklin P, Jarrett C, Jayasuriya R, Lewis L, Parker S, Roberts J, Thompson S, Wainwright P. Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations. Health Technol Assess 2005; 8:1-106, iii-iv. [PMID: 15546515 DOI: 10.3310/hta8500] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To test the hypotheses that virtual outreach would reduce offers of hospital follow-up appointments and reduce numbers of medical interventions and investigations, reduce numbers of contacts with the health care system, have a positive impact on patient satisfaction and enablement, and lead to improvements in patient health status. To perform an economic evaluation of virtual outreach. DESIGN A randomised controlled trial comparing joint teleconsultations between GPs, specialists and patients with standard outpatient referral. It was accompanied by an economic evaluation. SETTING The trial was centred on the Royal Free Hampstead NHS Trust, London, and the Royal Shrewsbury Hospital Trust in Shropshire. The project teams recruited and trained a total of 134 GPs from 29 practices and 20 consultant specialists. PARTICIPANTS In total, 3170 patients were referred, of whom 2094 consented to participate in the study and were eligible for inclusion. In all, 1051 patients were randomised to the virtual outreach group and 1043 to standard outpatient appointments. The patients were followed 6 months after their index consultation. INTERVENTIONS Patients randomised to virtual outreach underwent a joint teleconsultation, in which they attended the general practice surgery where they and their GP consulted with a hospital specialist via a videolink between the hospital and the practice. MAIN OUTCOME MEASURES Outcome measures included offers of follow-up outpatient appointments, numbers of tests, investigations, procedures, treatments and contacts with primary and secondary care, patient satisfaction (Ware Specific Visit Questionnaire), enablement (Patient Enablement Instrument) and quality of life (Short Form-12 and Child Health Questionnaire). An economic evaluation of the costs and consequences of the intervention was undertaken. Sensitivity analysis was used to test the robustness of the results. RESULTS Patients in the virtual outreach group were more likely to be offered a follow-up appointment. Significant differences in effects were observed between the two sites and across different specialities. Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ENT and orthopaedics than in the other specialities. Fewer tests and investigations were ordered in the virtual outreach group, by an average of 0.79 per patient. In the 6-month period following the index consultation, there were no significant differences overall in number of contacts with general practice, outpatient visits, accident and emergency contacts, inpatient stays, day surgery and inpatient procedures or prescriptions between the randomised groups. Tests of interaction indicated that virtual outreach decreased the number of tests and investigations, particularly in patients referred to gastroenterology, and increased the number of outpatient visits, particularly in those referred to orthopaedics. Patient satisfaction was greater after a virtual outreach consultation than after a standard outpatient consultation, with no heterogeneity between specialities or sites. However, patient enablement after the index consultation, and the physical and psychological scores of the Short Form-12 for adults and the scores on the Child Health Questionnaire for children under 16, did not differ between the randomised groups at 6 months' follow-up. NHS costs over 6 months were greater for the virtual outreach consultations than for conventional outpatients, pound 724 and pound 625 per patient, respectively. The index consultation accounted for this excess. Cost and time savings to patients were found. Estimated productivity losses were also less in the virtual outreach group. CONCLUSIONS Virtual outreach consultations result in significantly higher levels of patient satisfaction than standard outpatient appointments and lead to substantial reductions in numbers of tests and investigations, but they are variably associated with increased rates of offer of follow-up according to speciality and site. Changes in costs and technological advances may improve the relative position of virtual consultations in future. The extent to which virtual outreach is implemented will probably be dependent on factors such as patient demand, costs, and the attitudes of staff working in general practice and hospital settings. Further research could involve long-term follow-up of patients in the virtual outreach trial to determine downstream outcomes and costs; further study into the effectiveness and costs of virtual outreach used for follow-up appointments, rather than first-time referrals; and whether the costs of virtual outreach could be substantially reduced without adversely affecting the quality of the consultation if nurses or other members of the primary care team were to undertake the hosting of the joint teleconsultations in place of the GP. Qualitative work into the attitudes of the patients, GPs and hospital specialists would also be valuable.
Collapse
Affiliation(s)
- P Wallace
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Felton T, Harris GC, Pinder SE, Snead DRJ, Carter GI, Bell JA, Haines A, Kollias J, Robertson JFR, Elston CW, Ellis IO. Identification of carcinoma cells in peripheral blood samples of patients with advanced breast carcinoma using RT-PCR amplification of CK7 and MUC1. Breast 2004; 13:35-41. [PMID: 14759714 DOI: 10.1016/s0960-9776(03)00126-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Accepted: 06/17/2003] [Indexed: 10/26/2022] Open
Abstract
We have undertaken a pilot study to attempt to identify circulating carcinoma cells in a series of patients with advanced breast carcinoma, using reverse transcription-polymerase chain reaction (RT-PCR) to amplify mRNA of epithelial specific antigens. Using this method to amplify mRNA of MUC1 and cytokeratin 7 (CK7) the sensitivity of the technique was demonstrated by means of diluted concentrations of "spiked MCF7" cells in whole blood, showing a detection limit of 1 in 10(6) (CK7) and 1 in 10(5) (MUC1). Positive results were obtained from the peripheral blood of all nine female patients with advanced breast cancer for CK7 and eight of the nine patients for MUC1. CK7 was however detected in five of 11 healthy controls (eight females, three males) and MUC1 in one of the 11 controls. None of the control group were positive for both CK7 and MUC1, in contrast to eight of the nine patients with advanced breast carcinoma who were positive for both markers. The RT-PCR method thus appears sufficiently sensitive to identify circulating tumour cells in peripheral blood samples from patients with advanced breast carcinoma. However a high proportion of false-positive results was seen in the control population. More extensive investigation is required before the technique is likely to be of benefit clinically.
Collapse
Affiliation(s)
- T Felton
- Department of Histopathology, The City Hospital NHS Trust, Nottingham, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Jacklin PB, Roberts JA, Wallace P, Haines A, Harrison R, Barber JA, Thompson SG, Lewis L, Currell R, Parker S, Wainwright P. Virtual outreach: economic evaluation of joint teleconsultations for patients referred by their general practitioner for a specialist opinion. BMJ 2003; 327:84. [PMID: 12855528 PMCID: PMC164917 DOI: 10.1136/bmj.327.7406.84] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the hypotheses that, compared with conventional outpatient consultations, joint teleconsultation (virtual outreach) would incur no increased costs to the NHS, reduce costs to patients, and reduce absences from work by patients and their carers. DESIGN Cost consequences study alongside randomised controlled trial. SETTING Two hospitals in London and Shrewsbury and 29 general practices in inner London and Wales. PARTICIPANTS 3170 patients identified; 2094 eligible for inclusion and willing to participate. 1051 randomised to virtual outreach and 1043 to standard outpatient appointments. MAIN OUTCOME MEASURES NHS costs, patient costs, health status (SF-12), time spent attending index consultation, patient satisfaction. RESULTS Overall six months costs were greater for the virtual outreach consultations ( pound 724 per patient) than for conventional outpatient appointments ( pound 625): difference in means pound 99 ($162; 138) (95% confidence interval pound 10 to pound 187, P=0.03). If the analysis is restricted to resource items deemed "attributable" to the index consultation, six month costs were still greater for virtual outreach: difference in means pound 108 ( pound 73 to pound 142, P < 0.0001). In both analyses the index consultation accounted for the excess cost. Savings to patients in terms of costs and time occurred in both centres: difference in mean total patient cost pound 8 ( pound 5 to pound 10, P < 0.0001). Loss of productive time was less in the virtual outreach group: difference in mean cost pound 11 ( pound 10 to pound 12, P < 0.0001). CONCLUSION The main hypothesis that virtual outreach would be cost neutral is rejected, but the hypotheses that costs to patients and losses in productivity would be lower are supported.
Collapse
Affiliation(s)
- P B Jacklin
- Department of Public Health Policy, London School of Hygiene and Tropical Medicine, London WC1 7HT.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Wallace PG, Haines A, Harrison R, Barber J, Thompson S, Jacklin P, Roberts J, Lewis L, Wainwright P. Design and performance of a multicentre, randomized controlled trial of teleconsulting. J Telemed Telecare 2002; 8 Suppl 2:94-5. [PMID: 12217154 DOI: 10.1177/1357633x020080s243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have designed and performed a multicentre, randomized controlled trial of teleconsulting. The trial investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing as an alternative to general practitioner referral to a hospital specialist. The participating general practitioners referred a total of 3170 patients who satisfied the entry criteria. Of these, 1040 (33%) failed to provide consent or otherwise refused to participate in the trial. Of the patients recruited to the trial, a total of 1902 (91%) completed and returned the baseline questionnaire. Although the trial was successful in recruiting sufficient patients and in obtaining high questionnaire response rates, the findings will require careful interpretation to take account of the limits which the protocol placed on the ability of general practitioners to select patients for referral.
Collapse
Affiliation(s)
- P G Wallace
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Wallace PG, Haines A, Harrison R, Barber J, Thompson S, Jacklin P, Roberts J, Lewis L, Wainwright P. Design and performance of a multicentre, randomized controlled trial of teleconsulting. J Telemed Telecare 2002. [DOI: 10.1258/135763302320302208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
32
|
Hajat S, Haines A. Associations of cold temperatures with GP consultations for respiratory and cardiovascular disease amongst the elderly in London. Int J Epidemiol 2002; 31:825-30. [PMID: 12177030 DOI: 10.1093/ije/31.4.825] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The relationships between cold temperatures and cardio-respiratory mortality in the elderly are well documented. We wished to determine whether similar relationships exist with consultations in the primary care setting and to assess the lag time at which the effects were observed. METHODS Generalized additive models were used to regress time-series of daily numbers of general practitioner (GP) consultations by the elderly against temperature, after control for possible confounders and adjustment for overdispersion and serial correlation. Consultation data were available from between 38 452 and 42 772 registered patients aged >or=65 years from 45-47 London practices contributing to the General Practice Research Database between January 1992 and September 1995. RESULTS There was little relationship between consultations for respiratory disease and mean temperature on the same day as the day of consultation. However, a strong association was apparent with temperature levels up to 15 days previously, with an increase in consultations being observed particularly as temperatures drop below 5 degrees C. Every 1 degrees C decrease in mean temperatures below 5 degrees C was associated with a 10.5% (95% CI: 7.6%, 13.4%) increase in all respiratory consultations. No relationship was observed between cold temperatures and GP consultations for cardiovascular disease. CONCLUSIONS Our study suggests a delayed effect of a drop in temperature on consultations for respiratory disease in the primary care setting. Information such as this could be used to help prepare practices to anticipate increases in respiratory consultation rates associated with low temperatures.
Collapse
Affiliation(s)
- S Hajat
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
| | | |
Collapse
|
33
|
Wallace P, Haines A, Harrison R, Barber J, Thompson S, Jacklin P, Roberts J, Lewis L, Wainwright P. Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial. Lancet 2002; 359:1961-8. [PMID: 12076550 DOI: 10.1016/s0140-6736(02)08828-1] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The current model of general practitioner referral of patients to hospital specialists in the UK is sometimes associated with unnecessary duplication of investigations and treatments. We aimed to compare joint teleconsultations between general practitioners, specialists, and patients (virtual outreach) with standard outpatient referral. METHODS Virtual outreach services were established in London and Shrewsbury. The general practitioners referred 3170 patients, of whom 2094 consented to participate in the study and were eligible for inclusion. 1051 patients were randomly assigned virtual outreach, and 1043 standard outpatient appointments. We followed up the patients for 6 months after their index consultation. The primary outcome measure was the offer of a follow-up outpatient appointment. Analysis was by intention to treat. FINDINGS More patients in the virtual outreach group than the standard group were offered a follow-up appointment (502 [52%] vs 400 [41%], odds ratio 1.52 [95% CI 1.27-1.82], p<0.0001). Significant differences in effects were observed between the two sites (p=0.009) and across different specialties (p<0.0001). Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ear, nose, and throat surgery and orthopaedics than in the other specialties. Fewer tests and investigations were ordered in the virtual outreach group by an average of 0.79 per patient (0.37-1.21, p=0.0002). Patients' satisfaction (analysed per protocol) was greater after a virtual outreach consultation than after a standard outpatient consultation (mean difference 0.33 scale points [95% CI 0.23-0.43], p<0.0001), with no heterogeneity between specialties or sites. INTERPRETATION The trial showed that allocation of patients to virtual outreach consultations is variably associated with increased offers of follow-up appointments according to site and specialty, but leads to significant increases in patients' satisfaction and substantial reductions in tests and investigations. Efficient operation of such services will require appropriate selection of patients, significant service reorganisation, and provision of logistical support.
Collapse
Affiliation(s)
- P Wallace
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
STUDY OBJECTIVE This study investigated the relation between heat and mortality in London to determine the temperature threshold at which death rates increase and to quantify the effect of extreme temperatures on mortality. DESIGN Daily data on all cause mortality and temperature were obtained for a 21 year period and the relation between them investigated both graphically and by using non-parametric time series methods of analysis. SETTING Greater London. PARTICIPANTS Daily mortality counts in Greater London between January 1976 and December 1996. MAIN RESULTS A plot of the basic mortality-temperature relation suggested that a rise in heat related deaths began at about 19 degrees C. Average temperatures above the 97th centile value of 21.5 degrees C (excluding those days from a 15 day "heatwave" period in 1976) resulted in an increase in deaths of 3.34% (95% CI 2.47% to 4.23%) for every one degree increase in average temperature above this value. It was found that the 1976 heatwave resulted in a particularly large number of deaths in comparison with other hot periods. CONCLUSIONS These results suggest that heat related deaths in London may begin at relatively low temperatures. Hot days occurring in the early part of any year may have a larger effect than those occurring later on; and analysis of separate heatwave periods suggest that episodes of long duration and of highest temperature have the largest mortality effect.
Collapse
Affiliation(s)
- S Hajat
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | |
Collapse
|
35
|
Abstract
STUDY OBJECTIVE This study investigated the relation between heat and mortality in London to determine the temperature threshold at which death rates increase and to quantify the effect of extreme temperatures on mortality. DESIGN Daily data on all cause mortality and temperature were obtained for a 21 year period and the relation between them investigated both graphically and by using non-parametric time series methods of analysis. SETTING Greater London. PARTICIPANTS Daily mortality counts in Greater London between January 1976 and December 1996. MAIN RESULTS A plot of the basic mortality-temperature relation suggested that a rise in heat related deaths began at about 19 degrees C. Average temperatures above the 97th centile value of 21.5 degrees C (excluding those days from a 15 day "heatwave" period in 1976) resulted in an increase in deaths of 3.34% (95% CI 2.47% to 4.23%) for every one degree increase in average temperature above this value. It was found that the 1976 heatwave resulted in a particularly large number of deaths in comparison with other hot periods. CONCLUSIONS These results suggest that heat related deaths in London may begin at relatively low temperatures. Hot days occurring in the early part of any year may have a larger effect than those occurring later on; and analysis of separate heatwave periods suggest that episodes of long duration and of highest temperature have the largest mortality effect.
Collapse
Affiliation(s)
- S Hajat
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | |
Collapse
|
36
|
Hajat S, Anderson HR, Atkinson RW, Haines A. Effects of air pollution on general practitioner consultations for upper respiratory diseases in London. Occup Environ Med 2002; 59:294-9. [PMID: 11983844 PMCID: PMC1740279 DOI: 10.1136/oem.59.5.294] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Few published studies have examined the effect of air pollution on upper respiratory conditions. Furthermore, most epidemiological studies on air pollution focus on mortality or hospital admissions as the main health outcomes, but very rarely consider the effect in primary care. If pollution effects do exist then the public health impact could be considerable because of the many patient contacts involved. We investigated the relation between air pollution and upper respiratory disease as reflected in number of consultations made at family practices in London. METHODS The study used non-parametric methods of analysis of time series data, adjusting for seasonal factors, day of the week, holiday effects, influenza, weather, pollen concentrations, and serial correlation. RESULTS It was estimated that a 10-90th percentile change (13-31 microg/m(3)) in sulphur dioxide (SO(2)) measures resulted in a small increase in numbers of childhood consultation: 3.5% (95% confidence interval (95% CI 1.4% to 5.8%). Stronger associations were found in the case of a 10-90th percentile change (16-47 microg/m(3)) in fine particles (PM(10)) in adults aged 15-64 5.7% (2.9% to 8.6%), and in adults aged 65 and over: 10.2% (5.3% to 15.3%). In general, associations were strongest in elderly people, weakest in the children, and were largely found in the winter months for these two age groups, and in the summer months for adults aged 15-64. An apparent decrease in consultations was associated with ozone concentrations but this was most pronounced in colder months when ozone concentrations were at their lowest. CONCLUSIONS The results suggest an adverse effect of air pollution on consultations for upper respiratory symptoms, in particular in the case of PM(10) and SO(2). The effects are relatively small; however, due to the many consultations made in primary care, the impact on demand for services could be considerable.
Collapse
Affiliation(s)
- S Hajat
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | |
Collapse
|
37
|
Abstract
Because of the workings of health care systems, new, important, and cost-effective treatments sometimes do not become routine care while well-marketed products of equivocal value achieve widespread adoption. Should policymakers attempt to influence clinical behavior and correct for these inefficiencies? Implementation methods achieve a certain level of behavioral change but cost money to enact. These factors can be combined with the cost-effectiveness of treatments to estimate an overall policy cost-effectiveness. In general, policy cost-effectiveness is always less attractive than treatment cost-effectiveness. Consequently trying to improve the uptake of underused cost-effective care or reduce the overuse of new and expensive treatments may not always make economic sense. In this article, we present a method for calculating policy cost-effectiveness and illustrate it with examples from a recent trial, conducted during 1997 and 1998, of educational outreach by community pharmacists to influence physician prescribing in England.
Collapse
Affiliation(s)
- J Mason
- Centre for Health Services Research, University of Newcastle Upon Tyne, Newcastle Upon Tyne, England.
| | | | | | | | | | | |
Collapse
|
38
|
Armstrong B, Coleman M, Davies C, Elbourne D, Fletcher A, Grundy E, Haines A, Hall A, Kirkwood B, Lamping D, Miles M, Roberts I, Sondorp E. Plight of Afghan people must not be forgotten. BMJ 2001; 323:755. [PMID: 11576993 PMCID: PMC1121306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
|
39
|
Armstrong B, Coleman M, Davies C, Elbourne D, Fletcher A, Grundy E, Haines A, Hall A, Kirkwood B, Lamping D, Miles M, Roberts I, Sondorp E. Plight of Afghan people must not be forgotten. West J Med 2001. [DOI: 10.1136/bmj.323.7315.755b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
40
|
Murray E, Davis H, Tai SS, Coulter A, Gray A, Haines A. Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care. BMJ 2001; 323:493-6. [PMID: 11532845 PMCID: PMC48138 DOI: 10.1136/bmj.323.7311.493] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2001] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether a decision aid on benign prostatic hypertrophy influences decision making, health outcomes, and resource use. DESIGN Randomised controlled trial. SETTING 33 general practices in the United Kingdom. PARTICIPANTS 112 men with benign prostatic hypertrophy. INTERVENTION Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES Patients' and general practitioners' perceptions of who made the decision, decisional conflict scores, treatment choice and prostatectomy rate, American Urological Association symptom scale, costs, anxiety, utility, and general health status. RESULTS Both patients and general practitioners found the decision aid acceptable. A higher proportion of patients (32% v 4%; mean difference 28%, 95% confidence interval 14% to 41%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group. Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months (2.3 v 2.6; -0.3, -0.5 to -0.1, P<0.01) and this was maintained at nine months. No differences were found between the groups for anxiety, general health status, prostatic symptoms, utility, or costs (excluding costs associated with the video disc equipment). CONCLUSIONS The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decision making. Such programmes could be delivered cheaply by the internet, and there are good arguments for coordinated investment in them, particularly for conditions in which patient utilities are important.
Collapse
Affiliation(s)
- E Murray
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London N19 3UA
| | | | | | | | | | | |
Collapse
|
41
|
Murray E, Davis H, Tai SS, Coulter A, Gray A, Haines A. Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care. BMJ 2001; 323:490-3. [PMID: 11532844 PMCID: PMC48137 DOI: 10.1136/bmj.323.7311.490] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes. DESIGN Randomised controlled trial. SETTING 26 general practices in the United Kingdom. PARTICIPANTS 205 women considering hormone replacement therapy. INTERVENTION Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES Patients' and general practitioners' perceptions of who made the decision, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status. RESULTS Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference -0.3, 95% confidence interval -0.5 to -0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than in the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; -12%, -23% to -0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used. CONCLUSIONS An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.
Collapse
Affiliation(s)
- E Murray
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London N19 3UA.
| | | | | | | | | | | |
Collapse
|
42
|
Luo P, Haines A, Dessem D. Elucidation of neuronal circuitry: protocol(s) combining intracellular labeling, neuroanatomical tracing and immunocytochemical methodologies. Brain Res Brain Res Protoc 2001; 7:222-34. [PMID: 11431123 DOI: 10.1016/s1385-299x(01)00065-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We describe a protocol combining either intracellular biotinamide staining or anterograde biotinylated dextran amine (BDA) tracing with retrograde horseradish peroxidase (HRP) labeling and immunocytochemistry in order to map physiologically identified neuronal pathways. Presynaptic neurons including their boutons are labeled by either intracellular injection of biotinamide or extracellular injection of BDA while postsynaptic neurons are labeled with HRP via retrograde transport. Tissues are first processed to detect HRP using a tetramethylbenzidine and sodium-tungstate method. Biotinamide or BDA staining is then visualized using an ABC-diaminobenzidine-Ni method and finally the tissue is immunocytochemically stained using choline acetyltransferase (ChAT) or parvalbumin antibodies and a peroxidase-anti-peroxidase method. After processing, biotinamide, BDA, HRP and immunocytochemical staining can readily be distinguished by differences in the size, color and texture of their reaction products. We have utilized this methodology to explore synaptic relationships between trigeminal primary afferent neurons and brainstem projection and motoneurons at both the light and electron microscopic levels. This multiple labeling methodology could be readily adapted to characterize the physiological, morphological and neurochemical properties of other neuronal pathways.
Collapse
Affiliation(s)
- P Luo
- Department of Oral and Craniofacial Biological Sciences, University of Maryland, 666 West Baltimore Street, Baltimore, MD 21201, USA
| | | | | |
Collapse
|
43
|
Haines A. What author really said about malaria and climate change. BMJ 2001; 322:1429. [PMID: 11397761 PMCID: PMC1120488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
|
44
|
Pearl M, Haines A. Report from University College London (UCL). Scand J Prim Health Care 2001; 19:69-70. [PMID: 11482416 DOI: 10.1080/028134301750235259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- M Pearl
- Department of Primary Care and Population Sciences at the Royal Free and University College Medical School, UCL, London, UK
| | | |
Collapse
|
45
|
Abstract
OBJECTIVE To determine the relation between psychological characteristics and subsequent fatal ischaemic heart disease (IHD) events. DESIGN Prospective study of participants in the Northwick Park heart study (NPHS) recruited between 1972 and 1978 and followed up for fatal events until 1997. SETTING Three occupational groups in north west London. SUBJECTS 1408 white men without a history of myocardial infarction aged 40-64 years at entry who completed a Crown-Crisp experiential index form (CCEI). MAIN OUTCOME MEASURE Fatal IHD during follow up. RESULTS A one point increase in the score on the obsessionality/obsessional neurosis subscale was associated with a relative risk of fatal IHD of 1.08 (95% confidence interval (CI) 1.02 to 1.15). For the functional somatic complaint subscale the relative risk was also 1.08 (95% CI 1.02 to 1.15). In the case of the total score the relative risk of fatal IHD was 1.28 (95% CI 1.09 to 1.50) for a 10 point increase. The associations were independent of age, social class, and known cardiovascular risk factors. In the case of phobic anxiety, which had previously been found to be associated with fatal IHD in NPHS, the association was evident in the first 10 years of follow up but overall the relative risk was only 1.07 (95% CI 0.99 to 1.15) for a one point increase in the score. CONCLUSION Scores on two of the subscales of the CCEI and the total score are significantly associated with fatal IHD on long term follow up independently of other known risk factors.
Collapse
Affiliation(s)
- A Haines
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK.
| | | | | |
Collapse
|
46
|
Hajat S, Haines A, Atkinson RW, Bremner SA, Anderson HR, Emberlin J. Association between air pollution and daily consultations with general practitioners for allergic rhinitis in London, United Kingdom. Am J Epidemiol 2001; 153:704-14. [PMID: 11282799 DOI: 10.1093/aje/153.7.704] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Few published studies have looked at the health effects of air pollution in the primary care setting, and most have concentrated on lower rather than upper respiratory diseases. The authors investigated the association of daily consultations with general practitioners for allergic rhinitis with air pollution in London, United Kingdom. Generalized additive models were used to regress time series of daily numbers of patients consulting for allergic rhinitis against 1992--1994 measures of air pollution, after control for possible confounders and adjustment for overdispersion and serial correlation. In children, a 10th--90th percentile increase in sulfur dioxide (SO(2)) levels 4 days prior to consultation (13-31 microg/m(3)) was associated with a 24.5% increase in consultations (95% confidence interval: 14.6, 35.2; p < 0.00001); a 10th--90th percentile increase in averaged ozone (O(3)) concentrations on the day of consultation and the preceding 3 days (6--29 parts per billion) was associated with a 37.6% rise (95% confidence interval: 23.3, 53.5; p < 0.00001). For adults, smaller effect sizes were observed for SO(2) and O(3). The association with SO(2) remained highly significant in the presence of other pollutants. This study suggests that air pollution worsens allergic rhinitis symptoms, leading to substantial increases in consultations. SO(2) and O(3) seem particularly responsible, and both seem to contribute independently.
Collapse
Affiliation(s)
- S Hajat
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Dramatic economic growth over the last 50 years has been accompanied by widening inequalities world-wide in wealth and energy consumption, diminished life expectancy in some countries, and deteriorating indices of environmental sustainability including loss of bio-diversity. Raised output of carbon dioxide (CO2) and other greenhouse gases due to increased economic and industrial activity is causing progressive climate change, leading in turn to direct and indirect adverse effects on health. Emissions of greenhouse gases can be lowered by increased use of renewable energy sources, for example, wind power in the United Kingdom (UK), greater energy efficiency and other measures to promote sustainability. The experience of some developing countries shows that favourable indicators of health and development can accompany a low output of greenhouse gases. It is unclear whether contemporary political and social systems can deliver improved human development without increased use of fossil fuels and other resources.
Collapse
Affiliation(s)
- A Haines
- Royal Free and University College Medical School, London
| |
Collapse
|
48
|
Nazareth I, Burton A, Shulman S, Smith P, Haines A, Timberal H. A pharmacy discharge plan for hospitalized elderly patients--a randomized controlled trial. Age Ageing 2001; 30:33-40. [PMID: 11322670 DOI: 10.1093/ageing/30.1.33] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES to investigate the effectiveness of a pharmacy discharge plan in elderly hospitalized patients. DESIGN randomized controlled trial. SUBJECTS AND SETTINGS we randomized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care. INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient. A copy was given to the patient and to all relevant professionals and carers. This was followed by a domiciliary assessment by a community pharmacist. In the control group, patients were discharged from hospital following standard procedures that included a discharge letter to the general practitioner listing current medications. OUTCOMES the primary outcome was re-admission to hospital within 6 months. Secondary outcomes included the number of deaths, attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period, together with patients' general well-being, satisfaction with the service and knowledge of and adherence to prescribed medication. RESULTS we recruited 362 patients, of whom 181 were randomized to each group. We collected hospital and general practice data on at least 91 and 72% of patients respectively at each follow-up point and interviewed between 43 and 90% of the study subjects. There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months. There were no significant differences in any of the secondary outcomes. CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes.
Collapse
Affiliation(s)
- I Nazareth
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, UK.
| | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Abstract
A prospective study of 7079 people aged 45-74 recruited through general practices in South Wales, Herefordshire and Edinburgh, Scotland was undertaken to test the hypothesis that faecal bile acids are implicated in the causation of large bowel cancer. The population was recruited between 1974 and 1980 and the response rate for stool collection was 67%. Bile acid analyses were performed on those cases that presented by 1990. It was decided in advance to examine the hypothesis separately for left- and right-sided bowel cancer because of known epidemiological differences between the two sites and to exclude the cases presenting within 2 years of the stool sample from the analyses because the cancer could have been present at recruitment and might have possibly affected faecal bile acid concentrations. Each case (n = 51 left-sided and 8 right-sided) was matched with three controls by age (within 5 years), sex, place of residence and time of providing the stool sample (within 3 months). Statistical analyses using conditional logistic regression showed no significant differences between the left-sided cases and controls for any of the concentrations of individual bile acids, total bile acid concentrations, faecal neutral steroids, percentage bacterial conversion and the ratio of lithocholic acid to deoxycholic acid concentrations. There was a statistically significant (P = 0.021) association of the presence of chenodeoxycholic acid (5/8 samples) in the right-sided cases compared with the controls (3/23), odds ratio 6.26 (95% confidence interval 1.19, 32.84). A high proportion of primary bile acids has also been found in other studies of patients with a genetic predisposition to proximal bowel cancer, however this pattern may also occur in low risk groups, such as Indian vegetarians, suggesting that they may predispose to right-sided bowel cancer only in the presence of other, as yet unknown factors. If bile acids are involved in the causation of large bowel cancer, they may be part of a complex set of interacting factors.
Collapse
Affiliation(s)
- A Haines
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|