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1
Xie, Muxing, Chunrong Jia, Yawei Zhang, Beibei Wang, Ning Qin, Suzhen Cao, Liyun Zhao, Dongmei Yu, and Xiaoli Duan. "Household Exposure to Secondhand Smoke among Chinese Children: Status, Determinants, and Co-Exposures." International Journal of Environmental Research and Public Health 17, no. 15 (July 30, 2020): 5524. http://dx.doi.org/10.3390/ijerph17155524.
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Smoking prevalence stays high among adults in China, which also makes children exposed to secondhand smoke (SHS) in their households. This study aimed to investigate the status of SHS exposure among Chinese children, identify the influencing factors, and determine “co-exposure” to tobacco and other smokes in households. A total of 41,439 children aged 6–17 years were recruited from 30 provinces in Mainland China through the first Chinese Environmental Exposure-Related Human Activity Model Survey for Children (CEERHAPS-C). Information regarding children’s demographics, socioeconomic status, and exposures to SHS and solid fuel smoke (SFS) in households was collected using a comprehensive questionnaire. Factors that affected exposures to household smokes were identified using multivariable logistic regressions. The overall prevalence of household SHS exposure was 41.7%, and the average duration was 14.7 ± 14.6 min/day among the exposed participants. Prevalence of household SHS exposure increased among children in older age groups and with parents in lower education levels. Among SHS-exposed children, 34% had co-exposure to SFS, and they had a significantly higher risk of co-exposure than non-SHS exposed children (odds ratio = 1.12, 95% confidence interval: 1.061, 1.162). The prevalence of household SHS exposure remains high among school-age children, suggesting the need to develop and implement smoking-free home programs.
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Friedman, Esther, Vicki Freedman, and Sarah Patterson. "FAMILIES AND DEMENTIA: ESTIMATES AND EXPOSURES." Innovation in Aging 7, Supplement_1 (December 1, 2023): 106–7. http://dx.doi.org/10.1093/geroni/igad104.0346.
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Abstract Roughly 10 to 20% of older adults in the U.S. have dementia, which could have implications for their families and household members, who are likely to be called upon to provide care. Yet, it is not clear how many families and households include someone with dementia. This study provides national level estimates of families and households with an older adult with possible dementia using the 2017 Panel Study of Income Dynamics (PSID). Consistent with prior work, we find that 21.5% of older adults 65+ have possible dementia. Moreover, more than a quarter (26.3%) of households with an adult aged 65+ include an older adult with dementia, and 37.0% of extended family networks (with at least one adult aged 65+) have at least one older adult with dementia. Individual-level stratification of dementia by racial-ethnic group and socioeconomic status translates directly to household- and family-level patterns. For instance, households and families with an older adult who is either Black or Hispanic or does not hold a college degree are more likely to include at least one person with possible dementia. These findings have implications for the extent to which American families and households include someone with dementia, which comes with a risk of serving as a caregiver as well as possible implications for health and well-being. Our findings also establish important baseline estimates that can be measured against future estimates, for instance those post COVID-19.
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Arıcı, MA, D. Ozdemir, NC Oray, M. Buyukdeligoz, Y. Tuncok, and S. Kalkan. "Evaluation of caustics and household detergents exposures in an emergency service." Human & Experimental Toxicology 31, no. 6 (June 10, 2011): 533–38. http://dx.doi.org/10.1177/0960327111412803.
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Objective: The aim of this study was to analyse the caustic and household detergent exposure cases were admitted to the Department of Emergency Medicine at Dokuz Eylul University Hospital (EMDEU) between 1993 and 2008. Methods: Age, sex, reason of exposure, clinical signs, rate of endoscopy in oral exposures, treatment attempts, length of hospital stay and outcome were evaluated. A chi-square test was used to analyse statistical differences. Results: Caustic exposures accounted for 8.5% (1160 cases) and 4.1% (1988 cases) of all poisonings in children and adults, respectively. Female/male ratio of caustic exposure poisonings was 0.8. Most of the exposures were unintentional (158, 86.8%). Intentional exposures were common in cases between 19 and 29 years old (χ2 = 25.685, p < 0.001). The most common caustic substance was alkaline (106, 58.3%) followed by acidic (47, 25.8%) and other household detergents (28, 15.4%). Vomiting (35.7%), nausea (14.8%) and sore throat (13.1%) were the most common clinical signs. The patients who had endoscopy, the most frequent finding was first-degree damage (58.7%). A 48-year-old man died from intentional hydrochloric acid ingestion. Conclusion: Because of the large number of unintentional caustic exposures, parent education is very important to decrease the caustic exposures in children.
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Abe, Makoto. "A Household-Level Television Advertising Exposure Model." Journal of Marketing Research 34, no. 3 (August 1997): 394–405. http://dx.doi.org/10.1177/002224379703400308.
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The author proposes a household-level television advertising exposure model for media planning that is based on household exposure records. Consistent with the industry practice, managerial input of advertising for the model is gross rating points (GRP) for each “daypart” and week. Exposures of each household within each daypart during each week follow a Poisson process with a distinct rate, which is inferred from the household's past exposure history after accounting for the advertising intensity. Because exposure pattern is computed at the household-level, the model accounts for audience accumulation of dayparts combination, which has a considerable managerial importance in media planning. The model is shown to fit the observed exposure pattern well at both disaggregate and aggregate levels. Applications illustrate the effect of changing the level of GRP on reach and frequency and advertising efficacy of different day-parts. The author implements reallocation of the current level of GRP among dayparts using the “greedy algorithm” to improve reach.
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Thornton, Stephen L., Lisa Oller, Kathy White, Doyle Coons, and Elizabeth Silver. "2020 Annual Report of the Kansas Poison Control Center at The University of Kansas Health System." Kansas Journal of Medicine 15, no. 2 (May 17, 2022): 160–69. http://dx.doi.org/10.17161/kjm.vol15.16291.
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Introduction. This is the 2020 Annual Report of the Kansas Poison Control Center (KSPCC) at The University of Kansas Health System. The KSPCC receives calls from the public, law enforcement, health care professionals, and public health agencies.Methods. Encounters reported to the KSPCC from 01/01/2020 through 12/31/2020 were analyzed for caller location, demographics, exposure substance, nature of exposure, route of exposure, interventions, medical outcome, and location of care. Encounters were classified as human or animal exposure, confirmed non-exposure, or information call (no exposure).Results. There were 19,780 total encounters, including 18,492 human exposure cases. These cases were primarily female (53.6%, n = 9,911) and pediatric (19 years of age or less). (59.5%, n = 10,995). Acute cases (82.7%, n = 15,294), unintentional exposures (73.8%, n = 13,643) and ingestions (85.9%, n = 15,901) were most common. The most common reported substance was household cleaning products (n = 937) in pediatric (children ≤ 5) and analgesics (n = 1,335) in adults. An increase in exposures to disinfectants and household cleaning products was seen. Moderate (n = 1,812) or major (n=482) clinical outcomes were seen in 12.4% of cases. There were 18 deaths in 2020 reported to the KSPCC.Conclusions. Over 18,400 exposures were managed by the KSPCC in 2020. Pediatric exposures remained the most common encounter. An increase in exposures to disinfectants and other household cleaning products was seen. This report supports the continued value of the KSPCC to both public and acute health care in the state of Kansas.
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Hurd-Kundeti, Glorietta, Anne Berit Petersen, Khamphithoun Somsamouth, and Pramil N. Singh. "Air Pollution in a Nationally Representative Sample: Findings from the National Adult Tobacco Survey of Lao PDR." International Journal of Environmental Research and Public Health 16, no. 18 (September 19, 2019): 3500. http://dx.doi.org/10.3390/ijerph16183500.
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In Southeast Asia, household air pollution (HAP) from solid fuel use is the leading cause of disability-adjusted life years (DALYs), a risk which is compounded by exposure to other sources of indoor and outdoor air pollution including secondhand tobacco smoke (SHS). The purpose of this study was to measure the individual and combined prevalence of exposure to household and community sources of air pollution in a national sample of adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR—a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Our findings indicate a high prevalence of exposure to household air pollution from cooking fires (78%) and SHS exposure in the home (74.5%). More than a third (32.8%) reported exposure to both inside the home. Exposure to outdoor sources of smoke from cooking, trash, and crop fires was substantial (30.1% to 56.0%). The aggregation of exposures from multiple sources of household air pollution raises the need for initiatives that establish programmatic linkages in the health, environmental, and agricultural sectors to provide a comprehensive strategy to reduce risk factors for respiratory disease in Lao PDR and the region.
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Chowdhury, Sourangsu, Sagnik Dey, Sarath Guttikunda, Ajay Pillarisetti, Kirk R. Smith, and Larry Di Girolamo. "Indian annual ambient air quality standard is achievable by completely mitigating emissions from household sources." Proceedings of the National Academy of Sciences 116, no. 22 (April 15, 2019): 10711–16. http://dx.doi.org/10.1073/pnas.1900888116.
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Exposures to ambient and household fine-particulate matter (PM2.5) together are among the largest single causes of premature mortality in India according to the Global Burden of Disease Studies (GBD). Several recent investigations have estimated that household emissions are the largest contributor to ambient PM2.5 exposure in the country. Using satellite-derived district-level PM2.5 exposure and an Eulerian photochemical dispersion model CAMx (Comprehensive Air Quality Model with Extensions), we estimate the benefit in terms of population exposure of mitigating household sources––biomass for cooking, space- and water-heating, and kerosene for lighting. Complete mitigation of emissions from only these household sources would reduce India-wide, population-weighted average annual ambient PM2.5 exposure by 17.5, 11.9, and 1.3%, respectively. Using GBD methods, this translates into reductions in Indian premature mortality of 6.6, 5.5, and 0.6%. If PM2.5 emissions from all household sources are completely mitigated, 103 (of 597) additional districts (187 million people) would meet the Indian annual air-quality standard (40 μg m−3) compared with baseline (2015) when 246 districts (398 million people) met the standard. At 38 μg m−3, after complete mitigation of household sources, compared with 55.1 μg m−3 at baseline, the mean annual national population-based concentration would meet the standard, although highly polluted areas, such as Delhi, would remain out of attainment. Our results support expansion of programs designed to promote clean household fuels and rural electrification to achieve improved air quality at regional scales, which also has substantial additional health benefits from directly reducing household air pollution exposures.
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Hosgood, H. Dean, Madelyn Klugman, Keitaro Matsuo, Alexandra J. White, Atsuko Sadakane, Xiao-Ou Shu, Ruy Lopez-Ridaura, et al. "The Establishment of the Household Air Pollution Consortium (HAPCO)." Atmosphere 10, no. 7 (July 23, 2019): 422. http://dx.doi.org/10.3390/atmos10070422.
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Household air pollution (HAP) is of public health concern, with ~3 billion people worldwide (including >15 million in the US) exposed. HAP from coal use is a human lung carcinogen, yet the epidemiological evidence on carcinogenicity of HAP from biomass use, primarily wood, is not conclusive. To robustly assess biomass’s carcinogenic potential, prospective studies of individuals experiencing a variety of HAP exposures are needed. We have built a global consortium of 13 prospective cohorts (HAPCO: Household Air Pollution Consortium) that have site- and disease-specific mortality and solid fuel use data, for a combined sample size of 587,257 participants and 57,483 deaths. HAPCO provides a novel opportunity to assess the association of HAP with lung cancer death while controlling for important confounders such as tobacco and outdoor air pollution exposures. HAPCO is also uniquely positioned to determine the risks associated with cancers other than lung as well as nonmalignant respiratory and cardiometabolic outcomes, for which prospective epidemiologic research is limited. HAPCO will facilitate research to address public health concerns associated with HAP-attributed exposures by enabling investigators to evaluate sex-specific and smoking status-specific effects under various exposure scenarios.
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Bennett, Breana, Tomomi Workman, Marissa N. Smith, William C. Griffith, Beti Thompson, and Elaine M. Faustman. "Characterizing the Neurodevelopmental Pesticide Exposome in a Children’s Agricultural Cohort." International Journal of Environmental Research and Public Health 17, no. 5 (February 25, 2020): 1479. http://dx.doi.org/10.3390/ijerph17051479.
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The exposome provides a conceptual model for identifying and characterizing lifetime environmental exposures and resultant health effects. In this study, we applied key exposome concepts to look specifically at the neurodevelopmental pesticide exposome, which focuses on exposures to pesticides that have the potential to cause an adverse neurodevelopmental impact. Using household dust samples from a children’s agricultural cohort located in the Yakima Valley of Washington state, we identified 87 individual pesticides using liquid chromatography-tandem mass spectrometry. A total of 47 of these have evidence of neurotoxicity included in the Environmental Protection Agency (EPA) (re)registration materials. We used a mixed effects model to model trends in pesticide exposure. Over the two study years (2005 and 2011), we demonstrate a significant decrease in the neurodevelopmental pesticide exposome across the cohort, but particularly among farmworker households. Additional analysis with a non-parametric binomial analysis that weighted the levels of potentially neurotoxic pesticides detected in household dust by their reference doses revealed that the decrease in potentially neurotoxic pesticides was largely a result of decreases in some of the most potent neurotoxicants. Overall, this study provides evidence that the neurodevelopmental pesticide exposome framework is a useful tool in assessing the effectiveness of specific interventions in reducing exposure as well as setting priorities for future targeted actions.
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Dai, Xin, Shyamali C. Dharmage, and Caroline J. Lodge. "The relationship of early-life household air pollution with childhood asthma and lung function." European Respiratory Review 31, no. 165 (September 7, 2022): 220020. http://dx.doi.org/10.1183/16000617.0020-2022.
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The increase in childhood asthma over the past few decades has made it an important public health issue. Poor lung function growth associated with some phenotypes of asthma compounds its long-term impact on the individual. Exposure to early-life household risk factors is believed to be linked with respiratory health while infants’ lungs are still developing. This review summarises epidemiological studies and mechanistic evidence focusing on the detrimental effects of early-life household air exposures on the respiratory health of children, in particular effects on asthma and lung function. Many early-life household air exposures, including tobacco smoke, gases from heating and cooking, mould/dampness and cleaning products are associated with childhood asthma development and lung function growth. These exposures may alter structural and mechanical characteristics of infants’ lungs and contribute to deficits in later life. In addition, some risk factors, including tobacco smoke and cleaning products, can transmit effects across generations to increase the risk of asthma in subsequent generations. This review supports the hypothesis that risks of asthma and accelerated lung ageing are established in early life. The timing of exposure may be critical in the pathogenesis of respiratory diseases, in terms of future risk of asthma and reduced lung function in adults.
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Morakinyo, Oyewale Mayowa, and Matlou Ingrid Mokgobu. "Indoor Household Exposures and Associated Morbidity and Mortality Outcomes in Children and Adults in South Africa." International Journal of Environmental Research and Public Health 19, no. 15 (August 2, 2022): 9471. http://dx.doi.org/10.3390/ijerph19159471.
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Human exposure to indoor pollution is one of the most well-established ways that housing affects health. We conducted a review to document evidence on the morbidity and mortality outcomes associated with indoor household exposures in children and adults in South Africa. The authors conducted a scientific review of the publicly available literature up to April 2022 using different search engines (PubMed, ProQuest, Science Direct, Scopus and Google Scholar) to identify the literature that assessed the link between indoor household exposures and morbidity and mortality outcomes in children and adults. A total of 16 studies with 16,920 participants were included. Bioaerosols, allergens, dampness, tobacco smoking, household cooking and heating fuels, particulate matter, gaseous pollutants and indoor spray residue play a significant role in different morbidity outcomes. These health outcomes include dental caries, asthma, tuberculosis, severe airway inflammation, airway blockage, wheeze, rhinitis, bronchial hyperresponsiveness, phlegm on the chest, current rhinoconjunctivitis, hay fever, poor early life immune function, hypertensive disorders of pregnancy, gestational hypertension, and increased incidence of nasopharyngeal bacteria, which may predispose people to lower respiratory tract infections. The findings of this research highlight the need for more initiatives, programs, strategies, and policies to better reduce the negative consequences of indoor household exposures.
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Kimanya, M., B. De Meulenaer, B. Tiisekwa, M. Ndomondo-Sigonda, and P. Kolsteren. "Human exposure to fumonisins from home grown maize in Tanzania." World Mycotoxin Journal 1, no. 3 (August 1, 2008): 307–13. http://dx.doi.org/10.3920/wmj2008.x032.
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Fumonisins contaminate maize worldwide resulting in unacceptable fumonisin exposures in people relying on maize as staple food. This study determined fumonisins B1 (FB1) and B2 (FB2) in maize from 120 rural households: 30 from each of four main maize producing regions of Tabora, Ruvuma, Iringa and Kilimanjaro in Tanzania in order to estimate total fumonisin (FB1 + FB2) exposures to adult individuals in the households. The average daily per capita maize consumption of 771 g, recommended by the Tanzania Food and Nutrition Centre (TFNC) for an adult relying on it as a main meal, and also average daily per capita maize consumptions of 129, 308 and 356 g documented for Tanzania, were used in the exposure estimation. The fumonisins were determined by HPLC using fluorescence detection. Total fumonisins exposure (µg/kg body weight (bw)/day) was determined by multiplying average daily per capita maize consumption (kg) by fumonisin level in maize (µg/kg) from a given household and then dividing by an average bw of an adult of 60 kg. Of the 120 samples, 52% were contaminated with fumonisins at levels of up to 11,048 µg/kg (median; 363 µg/kg). Based on the recommended maize consumption of 771 g/person/day, fumonisin exposures to adult individuals in 38% of the households would exceed the provisional maximum tolerable daily intake (PMTDI) of 2 µg/kg bw, recommended by the Joint FAO/WHO Expert Committee on Food Additives. At the least documented maize consumption of 129 g/person/day, fumonisin exposures in 16% of the households were still above the PMTDI. Reduction of the maize consumption level to 40 g/person/day is an impractical, and reduction of the maximum contamination level to 155 µg/kg is a possibly practical, option for effective minimisation of fumonisin exposures in these communities. A relatively larger study is needed in order to generate comprehensive data for the formulation of appropriate strategies to minimise fumonisin exposures in Tanzania.
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Vadiveloo, Maya K., Haley W. Parker, Filippa Juul, and Niyati Parekh. "Sociodemographic Differences in the Dietary Quality of Food-at-Home Acquisitions and Purchases among Participants in the U.S. Nationally Representative Food Acquisition and Purchase Survey (FoodAPS)." Nutrients 12, no. 8 (August 7, 2020): 2354. http://dx.doi.org/10.3390/nu12082354.
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Insufficient research has explored whether sociodemographic differences in self-reported, individual-level diet quality are similarly reflected by grocery purchase quality. This cross-sectional analysis of n = 3961 U.S. households from the nationally representative Food Acquisition and Purchase Survey (FoodAPS) compared Healthy Eating Index (HEI)-2015 scores from 1 week of food-at-home acquisitions across self-reported demographic factors (race/ethnicity, Supplemental Nutrition Assistance Program (SNAP) participation, food security, and household-level obesity status). Multivariable-adjusted, survey-weighted regression models compared household HEI-2015 scores across sociodemographic groups. Respondents were primarily White and female, with a mean age of 50.6 years, 14.0% were food insecure, and 12.7% were SNAP-participating. Mean HEI-2015 scores were 54.7; scores differed across all sociodemographic exposures (p < 0.05). Interactions (p < 0.1) were detected between SNAP participation and (1) food insecurity and (2) household-level obesity, and race/ethnicity and (1) household-level obesity. HEI-2015 scores were higher among food secure, non-SNAP households than among food insecure, SNAP-participating households (53.9 ± 0.5 vs. 50.3 ± 0.7, p = 0.007); non-SNAP households without obesity had significantly higher HEI-2015 scores than other households. Household-level obesity was associated with lower HEI-2015 scores in White (50.8 ± 0.5 vs. 52.5 ± 0.7, p = 0.046) and Black (48.8 ± 1.5 vs. 53.1 ± 1.4, p = 0.018) but not Hispanic households (54.4 ± 1.0 vs. 52.2 ± 1.2, p = 0.21). Sociodemographic disparities in household HEI-2015 scores were consistent with previous research on individual-level diet quality.
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Saleh, Sepeedeh, Henry Sambakunsi, Debora Makina, Martha Chinouya, Moses Kumwenda, James Chirombo, Sean Semple, Kevin Mortimer, and Jamie Rylance. "Personal exposures to fine particulate matter and carbon monoxide in relation to cooking activities in rural Malawi." Wellcome Open Research 7 (October 11, 2022): 251. http://dx.doi.org/10.12688/wellcomeopenres.18050.1.
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Background: Air pollution is a major environmental risk factor for cardiorespiratory disease. Exposures to household air pollution from cooking and other activities, are particularly high in Southern Africa. Following an extended period of participant observation in a village in Malawi, we aimed to assess individuals’ exposures to fine particulate matter (PM2.5) and carbon monoxide (CO) and to investigate the different sources of exposure, including different cooking methods. Methods: Adult residents of a village in Malawi wore personal PM2.5 and CO monitors for 24-48 hours, sampling every 1 (CO) or 2 minutes (PM2.5). Subsequent in-person interviews recorded potential exposure details over the time periods. We present means and interquartile ranges for overall exposures and summaries stratified by time and activity (exposure). We employed multivariate regression to further explore these characteristics, and Spearman rank correlation to examine the relationship between paired PM2.5 and CO exposures. Results: Twenty participants (17 female; median age 40 years, IQR: 37–56) provided 831 hours of paired PM2.5 and CO data. Concentrations of PM2.5 during combustion activity, usually cooking, far exceeded background levels (no combustion activity): 97.9μg/m3 (IQR: 22.9–482.0), vs 7.6μg/m3, IQR: 2.5–20.6 respectively. Background PM2.5 concentrations were higher during daytime hours (11.7μg/m3 [IQR: 5.2–30.0] vs 3.3μg/m3 at night [IQR: 0.7–8.2]). Highest exposures were influenced by cooking location but associated with charcoal use (for CO) and firewood on a three-stone fire (for PM2.5). Cooking-related exposures were higher in more ventilated places, such as outside the household or on a walled veranda, than during indoor cooking. Conclusions: The study demonstrates the value of combining personal PM2.5 exposure data with detailed contextual information for providing deeper insights into pollution sources and influences. The finding of similar/lower exposures during cooking in seemingly less-ventilated places should prompt a re-evaluation of proposed clean air interventions in these settings.
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Saleh, Sepeedeh, Henry Sambakunsi, Debora Makina, Martha Chinouya, Moses Kumwenda, James Chirombo, Sean Semple, Kevin Mortimer, and Jamie Rylance. "Personal exposures to fine particulate matter and carbon monoxide in relation to cooking activities in rural Malawi." Wellcome Open Research 7 (February 21, 2023): 251. http://dx.doi.org/10.12688/wellcomeopenres.18050.2.
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Background: Air pollution is a major environmental risk factor for cardiorespiratory disease. Exposures to household air pollution from cooking and other activities, are particularly high in Southern Africa. Following an extended period of participant observation in a village in Malawi, we aimed to assess individuals’ exposures to fine particulate matter (PM2.5) and carbon monoxide (CO) and to investigate the different sources of exposure, including different cooking methods. Methods: Adult residents of a village in Malawi wore personal PM2.5 and CO monitors for 24-48 hours, sampling every 1 (CO) or 2 minutes (PM2.5). Subsequent in-person interviews recorded potential exposure details over the time periods. We present means and interquartile ranges for overall exposures and summaries stratified by time and activity (exposure). We employed multivariate regression to further explore these characteristics, and Spearman rank correlation to examine the relationship between paired PM2.5 and CO exposures. Results: Twenty participants (17 female; median age 40 years, IQR: 37–56) provided 831 hours of paired PM2.5 and CO data. Concentrations of PM2.5 during combustion activity, usually cooking, far exceeded background levels (no combustion activity): 97.9μg/m3 (IQR: 22.9–482.0), vs 7.6μg/m3, IQR: 2.5–20.6 respectively. Background PM2.5 concentrations were higher during daytime hours (11.7μg/m3 [IQR: 5.2–30.0] vs 3.3μg/m3 at night [IQR: 0.7–8.2]). Highest exposures were influenced by cooking location but associated with charcoal use (for CO) and firewood on a three-stone fire (for PM2.5). Cooking-related exposures were higher in more ventilated places, such as outside the household or on a walled veranda, than during indoor cooking. Conclusions: The study demonstrates the value of combining personal PM2.5 exposure data with detailed contextual information for providing deeper insights into pollution sources and influences. The finding of similar/lower exposures during cooking in seemingly less-ventilated places should prompt a re-evaluation of proposed clean air interventions in these settings.
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von Stackelberg, Katherine, Pamela R. D. Williams, and Ernesto Sánchez-Triana. "A Systematic Framework for Collecting Site-Specific Sampling and Survey Data to Support Analyses of Health Impacts from Land-Based Pollution in Low- and Middle-Income Countries." International Journal of Environmental Research and Public Health 18, no. 9 (April 28, 2021): 4676. http://dx.doi.org/10.3390/ijerph18094676.
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The rise of small-scale and localized economic activities in low- and middle-income countries (LMICs) has led to increased exposures to contaminants associated with these processes and the potential for resulting adverse health effects in exposed communities. Risk assessment is the process of building models to predict the probability of adverse outcomes based on concentration-response functions and exposure scenarios for individual contaminants, while epidemiology uses statistical methods to explore associations between potential exposures and observed health outcomes. Neither approach by itself is practical or sufficient for evaluating the magnitude of exposures and health impacts associated with land-based pollution in LMICs. Here we propose a more pragmatic framework for designing representative studies, including uniform sampling guidelines and household surveys, that draws from both methodologies to better support community health impact analyses associated with land-based pollution sources in LMICs. Our primary goal is to explicitly link environmental contamination from land-based pollution associated with specific localized economic activities to community exposures and health outcomes at the household level. The proposed framework was applied to the following three types of industries that are now widespread in many LMICs: artisanal scale gold mining (ASGM), used lead-acid battery recycling (ULAB), and small tanning facilities. For each activity, we develop a generalized conceptual site model (CSM) that describes qualitative linkages from chemical releases or discharges, environmental fate and transport mechanisms, exposure pathways and routes, populations at risk, and health outcomes. This upfront information, which is often overlooked, is essential for delineating the contaminant zone of influence in a community and identifying relevant households for study. We also recommend cost-effective methods for use in LMICs related to environmental sampling, biological monitoring, survey questionnaires, and health outcome measurements at contaminated and unexposed reference sites. Future study designs based on this framework will facilitate consistent, comparable, and standardized community exposure, risk, and health impact assessments for land-based pollution in LMICs. The results of these studies can also support economic burden analyses and risk management decision-making around site cleanup, risk mitigation, and public health education.
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Davanzo, F., F. Sesana, P. Maiozzi, P. Vignally, A. Pitidis, and L. Settimi. "Toxic exposures to household cleaning agents in Italy." Injury Prevention 16, Supplement 1 (September 1, 2010): A255. http://dx.doi.org/10.1136/ip.2010.029215.907.
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Choudhary, Neetu, Alexandra Brewis, Amber Wutich, and Pranita Bhushan Udas. "Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal." Journal of Water and Health 18, no. 4 (May 25, 2020): 579–94. http://dx.doi.org/10.2166/wh.2020.024.
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Abstract Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.
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GARGANO, J. W., A. L. FREELAND, M. A. MORRISON, K. STEVENS, L. ZAJAC, A. WOLKON, A. HIGHTOWER, M. D. MILLER, and J. M. BRUNKARD. "Acute gastrointestinal illness following a prolonged community-wide water emergency." Epidemiology and Infection 143, no. 13 (January 22, 2015): 2766–76. http://dx.doi.org/10.1017/s0950268814003501.
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SUMMARYThe drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1–5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4–9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.
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Riley, Tamara, Bonny Cumming, Joanne Thandrayen, Anna Meredith, Neil E. Anderson, and Raymond Lovett. "One Health and Australian Aboriginal and Torres Strait Islander Communities: A One Health Pilot Study." International Journal of Environmental Research and Public Health 20, no. 14 (July 20, 2023): 6416. http://dx.doi.org/10.3390/ijerph20146416.
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Many Aboriginal and Torres Strait Islander communities face barriers in accessing animal healthcare and are exposed to disproportionate environmental health exposures leading to increased risk of disease. A One Health approach has been promoted to address public health risks and improve human, animal, and environmental health outcomes in communities. We undertook a pilot One Health study in Aboriginal and Torres Strait Islander communities in Queensland collecting animal, human, and environmental health data from 82 households. We performed a descriptive analysis and assessed the association between human and environmental health exposures and animal health outcomes. Most households were not crowded (82.9%) but did report a high level of environmental health concerns (86.6%). The majority of households owned cats and dogs (81.7%), with most animals assessed as healthy. There was no association between human and environmental health exposures and animal health outcomes. As most households experienced concerns regarding housing conditions, environmental health programs should prioritise improving household factors. There was also strong support for animal healthcare (including access to medicines and veterinarians, education programs and population management), indicating that a One Health approach is desired by communities.
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Shupler, Matthew S., William Godwin, Joey Frostad, and Michael Brauer. "Modeling Household Air Pollution Exposures on a Global Scale." ISEE Conference Abstracts 2017, no. 1 (February 2018): 1002. http://dx.doi.org/10.1289/isee.2017.2017-1002.
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Benka-Coker, Megan, Maggie Clark, Sarah Rajkumar, Bonnie Young, Annette Bachand, John Balmes, Robert Brook, et al. "Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women." International Journal of Environmental Research and Public Health 15, no. 11 (November 13, 2018): 2544. http://dx.doi.org/10.3390/ijerph15112544.
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Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justa stoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO).
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Saleh, Sepeedeh, Henry Sambakunsi, Debora Makina, Moses Kumwenda, Jamie Rylance, Martha Chinouya, and Kevin Mortimer. "“We threw away the stones”: a mixed method evaluation of a simple cookstove intervention in Malawi." Wellcome Open Research 7 (June 10, 2022): 52. http://dx.doi.org/10.12688/wellcomeopenres.17544.3.
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Background: Air pollution exposure is responsible for a substantial burden of respiratory disease globally. Household air pollution from cooking using biomass is a major contributor to overall exposure in rural low-income settings. Previous research in Malawi has revealed how precarity and food insecurity shape individuals’ daily experiences, contributing to perceptions of health. Aiming to avoid a mismatch between research intervention and local context, we introduced a simple cookstove intervention in rural Malawi, analysing change in fine particulate matter (PM2.5) exposures, and community perceptions. Methods: Following a period of baseline ethnographic research, we distributed ‘chitetezo mbaula’, locally-made cookstoves, to all households (n=300) in a rural Malawian village. Evaluation incorporated village-wide participant observation and concurrent exposure monitoring using portable PM2.5 monitors at baseline and follow-up (three months post-intervention). Qualitative data were thematically analysed. Quantitative analysis of exposure data included pre-post intervention comparisons, with datapoints divided into periods of combustion activity (almost exclusively cooking) and non-combustion periods. Findings were integrated at the interpretation stage, using a convergent design mode of synthesis. Results: Individual exposure monitoring pre- and post-cookstove intervention involved a sample of 18 participants (15 female; mean age 43). Post-intervention PM2.5 exposures (median 9.9μg/m3 [interquartile range: 2.2–46.5]) were not significantly different to pre-intervention (11.8μg/m3 [3.8–44.4]); p=0.71. On analysis by activity, background exposures were found to be reduced post-intervention (from 8.2μg/m3 [2.5–22.0] to 4.6μg/m3 [1.0–12.6]; p=0.01). Stoves were well-liked and widely used by residents as substitutes for previous cooking methods (mainly three-stone fires). Commonly cited benefits related to fuel saving and shorter cooking times. Conclusions: The cookstove intervention had no impact on cooking-related PM2.5 exposures. A significant reduction in background exposures may relate to reduced smouldering emissions. Uptake and continued use of the stoves was high amongst community members, who preferred using the stoves to cooking over open fires.
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Saleh, Sepeedeh, Henry Sambakunsi, Debora Makina, Moses Kumwenda, Jamie Rylance, Martha Chinouya, and Kevin Mortimer. "“We threw away the stones”: a mixed method evaluation of a simple cookstove intervention in Malawi." Wellcome Open Research 7 (March 17, 2022): 52. http://dx.doi.org/10.12688/wellcomeopenres.17544.2.
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Background: Air pollution exposure is responsible for a substantial burden of respiratory disease globally. Household air pollution from cooking using biomass is a major contributor to overall exposure in rural low-income settings. Previous research in Malawi has revealed how precarity and food insecurity shape individuals’ daily experiences, contributing to perceptions of health. Aiming to avoid a mismatch between research intervention and local context, we introduced a simple cookstove intervention in rural Malawi, analysing change in fine particulate matter (PM2.5) exposures, and community perceptions. Methods: Following a period of baseline ethnographic research, we distributed ‘chitetezo mbaula’, locally-made cookstoves, to all households (n=300) in a rural Malawian village. Evaluation incorporated village-wide participant observation and concurrent exposure monitoring using portable PM2.5 monitors at baseline and follow-up (three months post-intervention). Qualitative data were thematically analysed. Quantitative analysis of exposure data included pre-post intervention comparisons, with datapoints divided into periods of combustion activity (almost exclusively cooking) and non-combustion periods. Findings were integrated at the interpretation stage, using a convergent design mode of synthesis. Results: Individual exposure monitoring pre- and post-cookstove intervention involved a sample of 18 participants (15 female; mean age 43). Post-intervention PM2.5 exposures (median 9.9μg/m3 [interquartile range: 2.2–46.5]) were not significantly different to pre-intervention (11.8μg/m3 [3.8–44.4]); p=0.71. On analysis by activity, background exposures were found to be reduced post-intervention (from 8.2μg/m3 [2.5–22.0] to 4.6μg/m3 [1.0–12.6]; p=0.01). Stoves were well-liked and widely used by residents as substitutes for previous cooking methods (mainly three-stone fires). Commonly cited benefits related to fuel saving and shorter cooking times. Conclusions: The cookstove intervention had no impact on cooking-related PM2.5 exposures. A significant reduction in background exposures may relate to reduced smouldering emissions. Uptake and continued use of the stoves was high amongst community members, who preferred using the stoves to cooking over open fires.
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Saleh, Sepeedeh, Henry Sambakunsi, Debora Makina, Moses Kumwenda, Jamie Rylance, Martha Chinouya, and Kevin Mortimer. "“We threw away the stones”: a mixed method evaluation of a simple cookstove intervention in Malawi." Wellcome Open Research 7 (February 14, 2022): 52. http://dx.doi.org/10.12688/wellcomeopenres.17544.1.
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Background: Exposure to air pollution is responsible for a substantial burden of respiratory disease globally. Household air pollution from cooking using biomass is a major contributor to overall exposure in rural low-income settings. Previous research in Malawi has revealed how precarity and food insecurity shape individuals’ daily experiences, contributing to perceptions of health. Aiming to avoid a mismatch between research intervention and local context, we introduced a simple cookstove intervention in rural Malawi, analysing change in fine particulate matter (PM2.5) exposures, and community perceptions. Methods: Following a period of baseline ethnographic research, we distributed ‘chitetezo mbaula’, locally made clay cookstoves, to all households (n=300) in a rural Malawian village. Evaluation incorporated village-wide participant observation and concurrent exposure monitoring using portable PM2.5 monitors at baseline and follow-up (three months post-intervention). Qualitative data were thematically analysed. Quantitative analysis of exposure data included pre-post intervention comparisons, with datapoints divided into cooking and non-cooking (‘baseline’) periods. Findings were integrated at the interpretation stage, using a convergent design mode of synthesis. Results: Individual exposure monitoring pre- and post-cookstove intervention involved a sample of 18 participants (15 female; mean age 43). Post-intervention PM2.5 exposures (median 9.9μg/m3 [interquartile range: 2.2–46.5]) were not significantly different to pre-intervention (11.8μg/m3 [3.8–44.4]); p=0.71. On analysis by activity, ‘baseline’ exposures were found to be reduced post-intervention (from 8.2μg/m3 [2.5–22.0] to 4.6μg/m3 [1.0–12.6]; p=0.01). Stoves were well-liked and widely used by residents as substitutes for previous cooking methods (mainly three-stone fires). Most cited benefits related to fuel saving and shorter cooking times. Conclusions: The cookstove intervention had no impact on cooking-related PM2.5 exposures. A significant reduction in baseline exposures may relate to reduced smouldering emissions. Uptake and continued use of the stoves was high amongst community members, who preferred using the stoves to cooking over open fires.
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Baumgartner, Jill, Ellison Carter, James J. Schauer, Majid Ezzati, Stella S. Daskalopoulou, Marie-France Valois, Ming Shan, and Xudong Yang. "Household air pollution and measures of blood pressure, arterial stiffness and central haemodynamics." Heart 104, no. 18 (February 9, 2018): 1515–21. http://dx.doi.org/10.1136/heartjnl-2017-312595.
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ObjectiveWe evaluated the exposure–response associations between personal exposure to air pollution from biomass stoves and multiple vascular and haemodynamic parameters in rural Chinese women.MethodsWe analysed the baseline information from a longitudinal study in southwestern China. Women’s brachial and central blood pressure and pulse pressure, carotid-femoral pulse wave velocity and augmentation index, and their 48-hour personal exposures to fine particulate matter (PM2.5) and black carbon were measured in summer and winter. We evaluated the associations between exposure to air pollution and haemodynamic parameters using mixed-effects regression models adjusted for known cardiovascular risk factors.ResultsWomen’s (n=205, ages 27–86 years) exposures to PM2.5 and black carbon ranged from 14 µg/m3 to 1405 µg/m3 and 0.1–121.8 µg/m3, respectively. Among women aged ≥50 years, increased PM2.5 exposure was associated with higher systolic (brachial: 3.5 mm Hg (P=0.05); central: 4.4 mm Hg (P=0.005)) and diastolic blood pressure (central: 1.3 mm Hg (P=0.10)), higher pulse pressure (peripheral: 2.5 mm Hg (P=0.05); central: 2.9 mm Hg (P=0.008)) and lower peripheral–central pulse pressure amplification (−0.007 (P=0.04)). Among younger women, the associations were inconsistent in the direction of effect and not statistically significant. Increased PM2.5 exposure was associated with no difference in pulse wave velocity and modestly higher augmentation index though the CI included zero (1.1%; 95% CI −0.2% to 2.4%). Similar associations were found for black carbon exposure.ConclusionsExposure to household air pollution was associated with higher blood pressure and central haemodynamics in older Chinese women, with no associations observed with pulse wave velocity.
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Matumba, L., M. Kimanya, W. Chunga-Sambo, M. Munthali, and A. Ayalew. "Probabilistic dietary based estimation of the burden of aflatoxin-induced hepatocellular carcinoma among adult Malawians." World Mycotoxin Journal 12, no. 4 (December 4, 2019): 409–19. http://dx.doi.org/10.3920/wmj2018.2346.
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The risk of aflatoxin-induced hepatocellular carcinoma (HCC) among adults (average body weight of 60 kg) in Malawi was assessed based on aflatoxin B1 (AFB1) exposure through groundnut and maize consumption, by Monte Carlo simulation. The risk (cases per year per 100,000 people) of aflatoxin-induced HCC was estimated based on the AFB1 exposures estimated by this study and hepatitis B virus infection prevalence published for Malawi. AFB1 exposures were estimated by probabilistically combining data of AFB1 contamination in 338 groundnut and 604 maize samples with data of per capita groundnut and maize consumption in 274 households. Aflatoxins in the samples were analysed using validated LC-MS/MS, HPLC and VICAM based methods. The groundnut and maize consumption survey was based on household expenditure technique. The simulated mean AFB1 exposures through consumption of groundnuts, maize, and combination thereof were 28±65, 42±174, and 71±211 ng/kg. body weight (bw)/day, respectively. The estimated HCC risks were 1.26±2.72, 1.86±6.66 and 3.10±6.85 cases per 100,000 persons per year, respectively. Further, hypothetical eradication of hepatitis B virus (HBV) reduced the risk of HCC by 78%. This reaffirms the need for integrating HBV vaccination in the fight of aflatoxin induced HCC.
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Johnston, James D., Scott C. Collingwood, James D. LeCheminant, Neil E. Peterson, Paul R. Reynolds, Juan A. Arroyo, Andrew J. South, et al. "Personal Exposure to Fine Particulate Air Pollution among Brick Workers in Nepal." Atmosphere 14, no. 12 (December 2, 2023): 1783. http://dx.doi.org/10.3390/atmos14121783.
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Prior studies suggest brick workers in Nepal may be chronically exposed to hazardous levels of fine particulate matter (PM2.5) from ambient, occupational, and household sources. However, findings from these studies were based on stationary monitoring data, and thus may not reflect a worker’s individual exposures. In this study, we used RTI International’s MicroPEMs to collect 24 h PM2.5 personal breathing zone (PBZ) samples among brick workers (n = 48) to estimate daily exposures from ambient, occupational, and household air pollution sources. Participants were sampled from five job categories at one kiln. The geometric mean (GM) PM2.5 exposure across all participants was 116 µg/m3 (95% confidence interval [CI]: 94.03, 143.42). Job category was significantly (p < 0.001) associated with PBZ PM2.5 concentrations. There were significant pairwise differences in geometric mean (GM) PBZ PM2.5 concentrations among workers in administration (GM: 47.92, 95% CI: 29.81, 77.03 µg/m3) vs. firemen (GM: 163.46, 95 CI: 108.36, 246.58 µg/m3, p = 0.003), administration vs. green brick hand molder (GM: 163.35, 95% CI: 122.15, 218.46 µg/m3, p < 0.001), administration vs. top loader (GM: 158.94, 95% CI: 102.42, 246.66 µg/m3, p = 0.005), firemen vs. green brick machine molder (GM: 73.18, 95% CI: 51.54, 103.90 µg/m3, p = 0.03), and green brick hand molder vs. green brick machine molder (p = 0.008). Temporal exposure trends suggested workers had chronic exposure to hazardous levels of PM2.5 with little to no recovery period during non-working hours. Multi-faceted interventions should focus on the control of ambient and household air pollution and tailored job-specific exposure controls.
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Acuña-Villaorduña, Carlos, Edward C. Jones-López, Geisa Fregona, Patricia Marques-Rodrigues, Mary Gaeddert, Carolina Geadas, David Jamil Hadad, et al. "Intensity of exposure to pulmonary tuberculosis determines risk of tuberculosis infection and disease." European Respiratory Journal 51, no. 1 (January 2018): 1701578. http://dx.doi.org/10.1183/13993003.01578-2017.
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Household contacts of pulmonary tuberculosis (TB) patients are at increased risk of TB infection and disease. However, their risk in relation to the intensity of exposure remains unknown.We studied smear-positive TB cases and their household contacts in Vitória, Brazil. We collected clinical, demographic and radiographic information from TB cases, and obtained tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) results from household contacts. We measured intensity of exposure using a proximity score and sleep location in relation to the TB index case and defined infection by TST ≥10 mm or QFT ≥0.35 UI·mL−1. We ascertained secondary TB cases by reviewing local and nationwide case registries.We included 160 TB index cases and 894 household contacts. 464 (65%) had TB infection and 23 (2.6%) developed TB disease. Risk of TB infection and disease increased with more intense exposures. In an adjusted analysis, the proximity score was associated with TB disease (OR 1.61, 95% CI 1.25–2.08; p<0.000); however, its diagnostic performance was only moderate.Intensity of exposure increased risk of TB infection and disease among household contacts; however, its diagnostic performance was still suboptimal. A biomarker to target preventive therapy is urgently needed in this at-risk population.
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Terfa, Zelalem G., Rebecca Nantanda, Maia Lesosky, Graham Devereux, Angela Obasi, Kevin Mortimer, Jahangir Khan, Jamie Rylance, and Louis Wihelmus Niessen. "Household food insecurity, maternal nutrition, environmental risks and infants’ health outcomes: protocol of the IMPALA birth cohort study in Uganda." BMJ Open 12, no. 3 (March 2022): e050729. http://dx.doi.org/10.1136/bmjopen-2021-050729.
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IntroductionIn low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of societies remains a major concern in LMICs. Biomass fuel use for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that early life nutritional and environmental exposures and their effect on infant lung function are important; however, data from sub-Saharan Africa are scarce.AimTo estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity.Methods and analysisPregnant women will be recruited in an existing Health and Demographic Surveillance Site in South-West Uganda. Household food insecurity, sources and uses of energy, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. Primary health outcomes will be infant lung function determined by tidal breath flow and volume analysis at 6–10 weeks of age. Infant weight and length will also be collected.A household Food Consumption Score and Minimum Dietary Diversity for Women (MDD-W) indicator will be constructed. The involved cost of dietary diversity will be estimated based on MDD-W. The association between household level and mothers’ food access indicators and infant lung function will be evaluated using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of households’ environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models.Ethics and disseminationEthical approvals have been obtained from Liverpool School of Tropical Medicine (18-059), the Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and Technology (SS 4846). Study results will be shared with participants, policy-makers, other stakeholders and published in peer-reviewed journals.
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BRUNELL, PHILIP A. "Varicella Exposure Time." Pediatrics 82, no. 5 (November 1, 1988): 810. http://dx.doi.org/10.1542/peds.82.5.810a.
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To the Editor.— The statement by Johnson et al1 that varicella was "protective against 96% of exposures" is misleading. Protection implies that disease was prevented. A continuing household exposure, eg, to a sibling, would be expected to produce an attack rate approaching 100%.2 Only four vaccinees had this type of exposure; 49 had other less intense types of exposure. The outcomes of other types of exposure are far less predictable but normally are not nearly as likely to result in varicella.3
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Seidelman, Jessica, Ibukunoluwa Akinboyo, Maya Rinehart, Matthew Stiegel, Rebekah W. Moehring, Deverick J. Anderson, Kristen Said, Carol A. Epling, Sarah S. Lewis, and Becky Smith. "418. Low Frequency of Healthcare Worker Infections Following Occupational Exposures to COVID-19." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S309—S310. http://dx.doi.org/10.1093/ofid/ofab466.618.
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Abstract Background Data on occupational acquisition of COVID-19 in healthcare settings are limited. Contact tracing efforts are high resource investments. Methods Duke Health developed robust COVID-19 contact tracing methods as part of a comprehensive prevention program. We prospectively collected data on HCW exposures and monitored for development of symptomatic (SYX) and asymptomatic (ASYX) COVID-19 infection after documented high-, medium, and low-risk exposures. HCWs were required to self-report exposures or were identified through contact tracing as potentially exposed to COVID-19 positive HCWs, patients or visitors. Contact tracers interviewed exposed HCWs and assessed the risk of exposure as high-, medium-, or low-risk based on CDC guidance (Table 1). Testing was recommended at 6 days after high- or medium-risk exposures and was provided upon HCW request following low-risk exposures. Our vaccination campaign began in 12/2020. Results 12,916 HCWs registered in the contact tracing database. From March 2020-May 2021, we identified 6,606 occupational exposures (0.51 exposures/HCW). The highest incidence of workplace exposures per number of HCWs in each job category was among respiratory therapists (RT) (0.95 exposures/RT), nursing assistants (NA) (0.79 exposures/NA), and physicians (0.64 exposures/physician). The most common exposure risk level was medium (51.4%), followed by low (35.5%), and then high (13.1%). A total of 260 (2%) HCW had positive tests/conversions; 28 (10.8%) were ASYX at the time of testing. High-risk exposures had a significantly greater number of post-exposure infections compared to medium- and low-risk exposures (12.5% vs. 4.2%, vs. 0.4%; p < 0.001). The rate of SYX infection following exposure to a fellow HCW (179/3,198; 5.6%) was higher than that following exposure to a patient (81/3,408; 2.4%; p< 0.001). Conclusion Conversion following exposure to COVID-19 in the healthcare setting with appropriate protective equipment was low. Incomplete testing of all exposed individuals was a limitation and our data may under-estimate the true conversion rate. Our findings support our local practice of not quarantining HCWs following non-household exposures. Limiting contact tracing to only high or medium risk exposures may best utilize limited personnel resources. Disclosures Rebekah W. Moehring, MD, MPH, UpToDate, Inc. (Other Financial or Material Support, Author Royalties)
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Leite, Isabel Cristina G., Francisco José Roma Paumgartten, and Sérgio Koifman. "Orofacial clefts in the newborn and environmental and occupational parental exposures: a case-control study in Rio de Janeiro, Brazil." Revista Brasileira de Saúde Materno Infantil 3, no. 4 (December 2003): 401–9. http://dx.doi.org/10.1590/s1519-38292003000400005.
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OBJECTIVES: to evaluate risk factors involving environmental and occupational parental exposures associated with occurrence of orofacial clefts in a group of Brazilian children. METHODS: a secondary base case-control study was conducted with 274 cases of cleft lip with or without cleft palate (CL±P) and cleft palate only, with 548 controls (1:2). The authors analyzed residential proximity to industrial areas, exposure to commercial insecticides, agricultural pesticides, and vector control spraying, as well as various occupational exposures. The results were obtained by conditional regression analysis. RESULTS: proximity to industrial installations as a risk factor (OR = 3,32; 95%CI: 2,18-5,05) for all orofacial clefts, as well as the combined use of household insecticides and urban vector control pesticide spraying (OR = 5,73; 95%CI: 2,51-11,28). A group of maternal occupations heavily associated with orofacial clefts was domestic services (OR = 2,89; 95%CI: 1,76-4,86). CONCLUSIONS: solvents are frequently associated with CL ± P and that they are contained in numerous industrial products and household cleaning products, the results pertaining to occupational exposure become plausible. Other associations such as the routine use of domestic insecticides require further specific research for confirmation of the hypothesis.
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Supariasa, I. Dewa Nyoman, Ibnu Fajar, Khairuddin Khairuddin, and Rany Adelina. "Analyzing Nutritional Factors that Affect Toddler’s Stunting in Malang Regency, Indonesia." Open Access Macedonian Journal of Medical Sciences 11, E (January 2, 2023): 59–69. http://dx.doi.org/10.3889/oamjms.2023.10199.
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BACKGROUND: The proportion of short and very short toddlers in Indonesia is 30.8%. East Java is among the 18 provinces with high prevalence (30%–<40%), having made Malang Regency included among the 100 regencies/cities prioritized for intervention. AIM: This study aimed to analyze sociodemographic and nutritional factors affecting toddler’s stunting in Malang Regency, Indonesia. DESIGN AND METHODS: A case–control analytic survey research with retrospective approach was used: An epidemiologic observation design to study the effect of exposures to diseases or other health problems occurrences. The investigation was conducted during July to August time period through observation, weight measurement and interview in order to collect the data about mother’s knowledge, childcare practices, household food security, healthcare services, access to clean water, economic and socio-cultural background, parenting practices, and causes of stunting. The data were processed using SPSS 16.0, bivariate analysis (Chi-square), and multivariate analysis using multiple logistic regression testing with odds ratio and confidence interval calculation. RESULTS: Parenting practices of the toddlers were not ideal, with only 60% of mothers had good knowledge about stunting. About 76% of the stunted toddlers’ households had insecure food availability and security. Up to 98% of the mothers with stunted toddlers received blood-boosting tablets during pregnancy from health-care services; however, interview results disclosed that they were not consumed. As many as, 98% of the households got access to clean water from Malang Municipal Waterworks and 2% from closed well. A total of 96% of the households made income fewer than Malang Regency’s minimum wage. The stunted toddlers’ households who had eating restrictions during pregnancy and breastfeeding were 13%. Most stunted toddlers as many as 76% were taken care of by their biological mothers, while the remaining 24% by grandmothers or other relatives. Thus, the causes of stunting from the most to the least dominant were as follows: Household’s income, exclusive breastfeeding, household size, father’s education, mother’s nutritional knowledge, household’s food security, mother’s level of education, toddler’s energy intake, appropriate feedings of weaning food, toddler’s fat intake, toddler’s history of infectious diseases, sociocultural background, toddler’s protein intake, mother’s occupation, household’s nutritional awareness behavior, and the completeness of immunization. CONCLUSION: Stunting main risk factors are household income, size, history of breastfeeding, father’s education and occupation. Factors which are not significantly related to stunting include household nutritional awareness and behavior, hygiene, socio-economic status, energy and micronutrients intake, toddler’s food and vitamin A compliment, toddler’s status and characteristics, and maternal health services.
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Kester, Janet E., and David A. Morgott. "Ethylbenzene exposure in North America - an update." Journal of Environmental Exposure Assessment 2, no. 1 (2023): 1. http://dx.doi.org/10.20517/jeea.2022.22.
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Chronic ethylbenzene exposures and attendant potential health risks for United States children and prospective parents were first evaluated under the United States Environmental Protection Agency’s Voluntary Children’s Chemical Evaluation Program. Using updated data and methods, a 2015 reevaluation observed declines in ethylbenzene releases and concentrations in ambient and indoor air. Both assessments identified inhalation as the dominant exposure route and smoking as the greatest contributor, with dietary intake much lower. Children’s exposure concentrations were similar to that of adults, but their intakes were higher. Neither breastfeeding nor toy mouthing was a significant source. This report updates the previous assessments, summarizing current ethylbenzene concentrations in air and foods, exposures during the use of household and consumer products, nationally representative biomonitoring data, including expanded demographic groups, and a new survey of worker exposures in styrene production facilities. General population ethylbenzene exposures appear to have declined for all age groups. The ethylbenzene/styrene chain of commerce contributes an estimated 0.1% to total air emissions and 7%-12% to dietary concentrations. Total estimated ethylbenzene intakes are consistent with biomonitoring data. Lactational transfer is not a significant exposure pathway for breastfed infants. Production workers’ exposure is well below occupational guidelines. Updated exposure estimates for each pathway suitable for potential health risk assessment are proposed.
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Kuhn, Emma J., G. Stewart Walker, Harriet Whiley, Jackie Wright, and Kirstin E. Ross. "Household Contamination with Methamphetamine: Knowledge and Uncertainties." International Journal of Environmental Research and Public Health 16, no. 23 (November 23, 2019): 4676. http://dx.doi.org/10.3390/ijerph16234676.
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Contamination of residential homes with methamphetamine is an emerging issue of significant concern to public health. Cooking or smoking methamphetamine in a residential property contaminates the house, furnishings and personal possessions within it, with subsequent exposure through ingestion, dermal absorption and/or inhalation causing adverse health effects. Current guidelines identifying levels of methamphetamine contamination that require remediation vary between countries. There is also no international standard protocol for measuring levels of contamination and research has shown that different materials give rise to different recovery rates of methamphetamine. There are a number of currently used remediation methods; however, they have varying levels of success with limited studies comparing their long-term efficacies. Most importantly, there are few guidelines available that are based on a transparent, health risk-based approach, and there are many uncertainties on exposures and health effects, making it difficult to ensure the health of people residing in homes that have been used to cook or smoke methamphetamine are sufficiently protected. This manuscript presents the current state of knowledge regarding the contamination of residential homes with methamphetamine and identifies the current gaps in knowledge and priority areas for future research. The current regulatory approach to public health protection associated with exposure to residential premises contaminated with methamphetamine in Australia, New Zealand and the USA is also discussed.
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Pettigrew, Stacy M., William K. Pan, James Harrington, Axel Berky, Elvis Rojas, and Beth J. Feingold. "Adult Exposures to Toxic Trace Elements as Measured in Nails along the Interoceanic Highway in the Peruvian Amazon." International Journal of Environmental Research and Public Health 19, no. 10 (May 23, 2022): 6335. http://dx.doi.org/10.3390/ijerph19106335.
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Deforestation, artisanal and small-scale gold mining (ASGM), and the rapid development related to highway expansion cause opportunities for toxic trace element exposure in the Amazon region of Madre de Dios (MDD), Peru, one of the most biologically diverse places in the world. The objective of this study was to assess the exposure to arsenic, cadmium, lead, and mercury among adults in Madre de Dios. In total, 418 adult (18+ years) participants in the Investigacion de Migracion, Ambiente, y Salud (IMAS) (Migration, Environment, and Health Study) participated in this study. Consent, survey data, and biospecimens were collected between August and November 2014. Nail elements were measured by inductively coupled plasma sector field mass spectrometry. Differences by selected individual and household characteristics and local land uses were tested using one-way ANOVAs and linear mixed models. Adults in ASGM-affected areas had higher nail arsenic and nail cadmium than their non-ASGM counterparts. Higher household fish consumption was positively associated with nail mercury and nail lead. The results indicate that adult exposure to arsenic, cadmium, lead, and mercury is heterogeneous across Madre de Dios, and the exposures related to ASGM communities and fish consumption suggest that exposures from artisanal and small-scale mining are environmentally widespread. Further investigation is warranted to ascertain potential health impacts.
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Hertz-Picciotto, Irva, Lora Delwiche, and Hansen Robin. "Prenatal Exposures to Household Insecticides and Early Childhood Developmental Delay." ISEE Conference Abstracts 2013, no. 1 (September 19, 2013): 5492. http://dx.doi.org/10.1289/isee.2013.p-2-23-23.
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Dodoli, Daniela, Maurizio Del Nevo, Carla Fiumalbi, Tonina Enza Iaia, Alfonso Cristaudo, Pietro Comba, Cecilia Viti, and Giuseppe Battista. "Environmental household exposures to asbestos and occurrence of pleural mesothelioma." American Journal of Industrial Medicine 21, no. 5 (1992): 681–87. http://dx.doi.org/10.1002/ajim.4700210508.
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Murphy, Michael J. "Toxin exposures in dogs and cats: Drugs and household products." Journal of the American Veterinary Medical Association 205, no. 4 (August 15, 1994): 557–60. http://dx.doi.org/10.2460/javma.1994.205.04.557.
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Demelash Enyew, Habtamu, Bethlehem Getachew Bogale, Abebe Beyene Hailu, and Seid Tiku Mereta. "Environmental exposures and adverse pregnancy outcomes in Ethiopia: A systematic review and meta-analysis." PLOS ONE 18, no. 7 (July 12, 2023): e0288240. http://dx.doi.org/10.1371/journal.pone.0288240.
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Background Maternal exposures to environmental hazards during pregnancy are key determinants of birth outcomes that affect health, cognitive and economic status later in life. In Ethiopia, various epidemiological evidences have suggested associations between environmental exposures such as household air pollution, cigarette smoking, and pesticide exposure and pregnancy outcomes such as low birth weight, preterm birth, and birth defects. Objective This review aimed at generating summarized evidence on the association between maternal exposure to environmental factors (household air pollution, cigarette smoking, and pesticide) and pregnancy outcomes (birth weight, preterm birth, and birth defects) in Ethiopia. Method A systematic literature search was performed using PubMed, Google Scholar, and the Cochrane Library databases. All observational study designs were eligible for inclusion in the review. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) quality assessment tools adopted for case-control and cross-sectional studies. The random-effects model was applied in computing the pooled estimates and their corresponding 95% confidence interval (CI). Funnel and Doi plots were used for detecting the potential publication bias. All statistical analyses were performed using comprehensive meta-analysis (CMA 2.0) and MetaXL version 5.3 software. Result The pooled estimates revealed that prenatal biomass fuel use increased the risk of giving a low birth weight baby by twofold (OR = 2.10, 95% CI: 1.33–3.31), and has no separate kitchen increases the risk of having low birth weight baby nearly by two and half times (OR = 2.48, 95% CI: 1.25–4.92). Overall, using biomass fuel as the main energy source for cooking and /or having no separate kitchen from the main house is 2.37 times more likely to give low birth weight babies (OR = 2.37, 95% CI: 1.58–3.53). Active cigarette smoker women were 4 times (OR = 4.11, 95% CI: 2.82–5.89) more prone to have low birth weight babies than nonsmokers; and passive smoker women were 2.6 times (OR = 2.63, 95% CI: 1.09–6.35) more risked to give low birth weight babies. It was also estimated that active cigarette smoker women were nearly 4 times (OR = 3.90, 95% CI: 2.36–6.45) more likely to give preterm birth babies. Pesticide exposure during pregnancy also increases the risk of the birth defect 4 times (OR = 4.44, 95% CI: 2.61–7.57) compared with non-exposed pregnant women. Conclusion Household air pollution from biomass fuel use, active and passive cigarette smoking, and pesticide exposures are significantly associated environmental risk factors for low birth weight, preterm birth, and birth defects in Ethiopia. Therefore, Pregnant and lactating women should be aware of these environmental hazards during pregnancy. Promoting clean energy and improved and efficient stoves at the household level will help to reduce household air pollution-related adverse health effects. Trial registration PROSPERO 2022: CRD42022337140.
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Rabovsky, Jean. "Are Separate Standards for Occupational and Environmental Exposures Good Public Health Policy?" NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy 15, no. 3 (November 2005): 211–19. http://dx.doi.org/10.2190/42l9-4jyf-ga71-pfxp.
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Occupational and environmental exposures are treated as distinct entities for the purpose of public health protection. Yet workers and community members may experience the same exposures simultaneously or within a very narrow time frame. Agricultural chemicals applied by workers in the field drift into residential communities. Chemicals may be carried from a work site, with or without physical boundaries, into the home and delivered to household members. Meteorological conditions transport agricultural chemicals or stored ashes to residential communities during and after the work day. Occupational standards generally allow a higher level of exposure to workers than environmental standards allow for community exposures. For some chemicals, standards exist for only one exposure group, thus leaving the other exposed group without protection. The distinction between occupational and environmental exposures assumes the identification of specific human activities as work or non-work. However, not all human activity falls clearly into one specific category. The strict separation of occupational and environmental exposures therefore renders public health protection of all exposed people difficult to achieve. An in-depth discussion about the factors and assumptions that are used when occupational and environmental standards are separately applied to exposed populations is needed to enhance the public health of all people.
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Liu, Carol, Sasha Smith, Allison Chamberlain, Neel Gandhi, Fazle N. Khan, Steve Williams, and Sarita Shah. "187. Characterizing Household Clustering of COVID-19 Cases in Fulton County, Georgia, June 2020–April 2021." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S113—S114. http://dx.doi.org/10.1093/ofid/ofab466.187.
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Abstract Background Households are important for SARS-CoV-2 transmission due to close proximity in enclosed living spaces over long durations. Using contact tracing, the secondary attack rate in households is estimated at 18-20%, yet no studies have examined COVID-19 clustering within households, an important measure to inform testing and prevention. We sought to quantify and characterize household clustering of COVID-19 cases in Fulton County, Georgia. Methods We used state surveillance data to identify all PCR- or antigen-confirmed cases of COVID-19 in Fulton County. Clustered cases were defined as cases with matching street address, including unit number. Communal places (e.g., nursing homes, correctional facilities) were excluded, as were apartments missing unit number. Household clusters were defined as ≥2 COVID-19 cases at the same residential address with positive sample collection dates within 14 days of one another. We described proportion of COVID-19 cases that were clustered, stratified by age, sex, and race/ethnicity over time. Results There were 60,614 COVID-19 cases with available address reported in Fulton County during 6/1/20–4/30/21. Of these, 25,149 (41.6%) had an address that matched at least one other case; 20,793 (34.3%) were from 8,582 household clusters with positive sample collection dates within 14 days (Fig 1). Majority of clusters had 2 individuals (N=6119, 71%), though some had ≥6 individuals (N=79, 0.9%). Clustering increased through January 2021 (Fig 2). Children were more likely to be in household clusters (Fig 4) and 15% of clusters had a child as first diagnosed case with increases since January 2021 (Fig 3). Consistently higher clustering was observed among Hispanic persons, with rising clustering among Asian persons (Fig 5). Figure 1. Distribution of household-clustered COVID-19 cases in Fulton county between June, 2020 and April 2021 Figure 2. Proportion of COVID-19 cases that were part of a household cluster, Fulton County, June 2020–April 2021. Error bars denote 95% confidence interval around the point estimate. Figure 3. Age of first diagnosis among households with at least 2 cases diagnosed within 14 days Conclusion One-third of COVID-19 cases in Fulton County were part of a household cluster. The higher proportion of children in household clusters likely reflects higher probability of living in a home with an adult caregiver. Higher household clustering among Hispanic and Asian persons, regardless of age, may reflect larger households (supported by census data) or increased exposures outside the house. Timely testing for household members to prevent ongoing transmission remains essential. Figure 4. Proportion of COVID-19 cases that were part of a household cluster, by age – Fulton County, June 2020–March 2021 Proportion of COVID-19 cases that were part of a household cluster in Fulton County stratified by race/ethnicity over time Disclosures All Authors: No reported disclosures
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Raffee, Liqaa, Hamza M. Daradkeh, Khaled Alawneh, Aida I. Al-Fwadleh, Moath Darweesh, Nouran H. Hammad, and Sami A. Almasarweh. "Impact of COVID-19 lockdown on the incidence and patterns of toxic exposures and poisoning in Jordan: a retrospective descriptive study." BMJ Open 11, no. 12 (December 2021): e053028. http://dx.doi.org/10.1136/bmjopen-2021-053028.
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ObjectivesTo describe the effect of the COVID-19 lockdown in Jordan (21 March 2020–21 May 2020) on the incidence and patterns of toxic exposures and poisoning as compared with the same period from the previous year (21 March 2019–21 May 2019).DesignA retrospective descriptive study.MethodsCall data sourced from Pharmacy One Poison Center from the lockdown period (21 March 2020–21 May 2020) and the same period during 2019 (21 March 2019–21 May 2019) were revised. In addition, a database was established and analysed.ResultsWe noticed that not only did calls increased, but there was also a noticeable change in call patterns. Calls increased by 91% (544 vs 285 calls) during the lockdown period. Drugs were the most common among types of exposure, and the most prevalent route of exposure was ingestion. There was a notable increase in ocular exposure by 550% (13 vs 2 cases). The majority of exposures were at home and there were no occupational exposures. We found an increase in household cleaner exposure among males and an increase in alcohol exposure in females. Children aged below 5 years are the most affected. Even though there is an increase in the total number of cases, severe cases decreased.ConclusionThe lockdown effect on rates of toxic exposures was prominent, whether through the increase in calls or the change in patterns. As people spent more time at home, their exposure to toxic agents increased. Furthermore, cleaning recommendations led to the misuse of cleaning and disinfectant products, increasing exposures related to abating the COVID-19 infection.
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Apte, Komalkirti, and Sundeep Salvi. "Household air pollution and its effects on health." F1000Research 5 (October 28, 2016): 2593. http://dx.doi.org/10.12688/f1000research.7552.1.
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Household air pollution is a leading cause of disability-adjusted life years in Southeast Asia and the third leading cause of disability-adjusted life years globally. There are at least sixty sources of household air pollution, and these vary from country to country. Indoor tobacco smoking, construction material used in building houses, fuel used for cooking, heating and lighting, use of incense and various forms of mosquito repellents, use of pesticides and chemicals used for cleaning at home, and use of artificial fragrances are some of the various sources that contribute to household air pollution. Household air pollution affects all stages of life with multi-systemic health effects, and its effects are evident right from pre-conception to old age. In utero exposure to household air pollutants has been shown to have health effects which resonate over the entire lifetime. Exposures to indoor air pollutants in early childhood also tend to have repercussions throughout life. The respiratory system bears the maximum brunt, but effects on the cardiovascular system, endocrine system, and nervous system are largely underplayed. Household air pollutants have also been implicated in the development of various types of cancers. Identifying household air pollutants and their health implications helps us prepare for various health-related issues. However, the real challenge is adopting changes to reduce the health effects of household air pollution and designing innovative interventions to minimize the risk of further exposure. This review is an attempt to understand the various sources of household air pollution, the effects on health, and strategies to deal with this emergent risk factor of global mortality and morbidity.
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Kurowski, Łukasz, and Katarzyna Sokal. "Polish household default risk and physical risk of climate change." Financial Internet Quarterly 19, no. 3 (September 1, 2023): 87–99. http://dx.doi.org/10.2478/fiqf-2023-0021.
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Abstract This paper aims to assess the level of credit risk (from the perspective of default risk) among Polish households associated with the physical risks of climate change. In order to determine the potential impact of the physical risk of climate change on household credit risk, we conducted CAWI interviews with 1,006 borrowers residing in different Polish voivodeships (to account for heterogeneity of credit exposures to extreme weather events). According to these respondents, wildfires and storms in Poland are the greatest source of physical risk of climate change. In the event of a wildfire or storm, approximately 13% of borrowers would not be able to repay their loans while not being insured, which potentially increases banks’ credit risk and exposes banks to losses. However, we find that households underestimate the credit risk that could arise from a drought.
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Nash, Denis, Saba Qasmieh, McKaylee Robertson, Madhura Rane, Rebecca Zimba, Sarah G. Kulkarni, Amanda Berry, et al. "Household factors and the risk of severe COVID-like illness early in the U.S. pandemic." PLOS ONE 17, no. 7 (July 21, 2022): e0271786. http://dx.doi.org/10.1371/journal.pone.0271786.
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Objective To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. Methods We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. Results In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7–19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2–6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0–6.1), and 0.8 (95% CI:0.15–4.1) among those living in single unit dwellings. Conclusion Early in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease.
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Kim, MyongHwan, Seungho Lee, Dongmug Kang, Ju Young Kim KJ, Yoon-Ji Kim, Youngki Kim, and Eun-Soo Lee. "O-328 ASSESSING LUNG CANCER RISKS AMONG VICTIMS IN ASBESTOS DAMAGE RELIEF SYSTEM IN KOREA: EXCESS LIFETIME CANCER RISK WITH EXPOSURE ASSESSMENT." Occupational Medicine 74, Supplement_1 (July 1, 2024): 0. http://dx.doi.org/10.1093/occmed/kqae023.1234.
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Abstract Introduction The compensation criteria for lung cancer in Asbestos Damage Relief Act (ADRA) in Korea mainly rely on the presence of radiologic findings of asbestosis or pleural plaque. Although exposure criteria with asbestos fiber concentration in lung tissue is supplementary, it has not been applied. Because only 30% of asbestos related lung cancer has asbestosis or pleural plaque, substantial lung cancers might not be compensated by ADRA. Exposure criteria for lung cancer need to be applied in ADRA. Methods Data of 1,784 lung cancer compensation applicants during 2011-2021 were analyzed. Comprehensive asbestos exposure assessment including occupational, environmental, and household/family exposures were evaluated. To evaluate lung cancer risk the Excess Lifetime Cancer Risk (ELCR) method was employed. Results The average age of applicants was 69.1 years, with a significant majority in their 60s (34.6%) and 70s (35.8%). There were 1,268 male (71.1%) and 516 female (28.9%) applicants. Reports of occupational, environmental and household/family exposure came from 512 (28.7%), 1,028 (57.6%) and 504 (28.3%) individuals, respectively. The overall approval rate was 58.1%, with 97.7% for applicants with radiologic evidence and 4.1% for applicants without such conditions. Notably, approval rates were higher for deceased (69.6%) versus living applicants (46.6%). ELCR computation is ongoing. Discussion Asbestos compensation should be extended to strong exposure cases even without radiologic evidence. Identifying high-risk cohorts with significant past exposures would improve early detection. Exposure assessment tools and ELCR calculation would promote epidemiological research. Conclusion Incorporating exposure assessment and ELCR into ADRA’s framework could augment the equity of compensation decisions.
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Kreslake, Jennifer M., Yunita Wahyuningrum, Angela D. Iuliano, Aaron D. Storms, Kathryn E. Lafond, Amalya Mangiri, Catharina Y. Praptiningsih, Basil Safi, Timothy M. Uyeki, and J. Douglas Storey. "The Intersection of Care Seeking and Clinical Capacity for Patients With Highly Pathogenic Avian Influenza A (H5N1) Virus in Indonesia: Knowledge and Treatment Practices of the Public and Physicians." Disaster Medicine and Public Health Preparedness 10, no. 6 (June 14, 2016): 838–47. http://dx.doi.org/10.1017/dmp.2016.81.
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AbstractBackgroundIndonesia has the highest human mortality from highly pathogenic avian influenza (HPAI) A (H5N1) virus infection in the world.MethodsA survey of households (N=2520) measured treatment sources and beliefs among symptomatic household members. A survey of physicians (N=554) in various types of health care facilities measured knowledge, assessment and testing behaviors, and perceived clinical capacity.ResultsHouseholds reported confidence in health care system capacity but infrequently sought treatment for potential HPAI H5N1 signs/symptoms. More clinicians were confident in their knowledge of diagnosis and treatment than in the adequacy of related equipment and resources at their facilities. Physicians expressed awareness of the HPAI H5N1 suspect case definition, yet expressed only moderate knowledge in questioning symptomatic patients about exposures. Self-reported likelihood of testing for HPAI H5N1 virus was high after learning of certain exposures. Knowledge of antiviral treatment was moderate, but it was higher among clinicians in puskesmas. Physicians in private outpatient clinics, the most heavily used facilities, reported the lowest confidence in their diagnostic and treatment capabilities.ConclusionsEducational campaigns can encourage recall of possible poultry exposure when patients are experiencing signs/symptoms and can raise awareness of the effectiveness of antivirals to drive people to seek health care. Clinicians may benefit from training regarding exposure assessment and referral procedures, particularly in private clinics. (Disaster Med Public Health Preparedness. 2016;10:838–847)
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Kalbus, Alexandra Irene, Laura Cornelsen, Andrea Ballatore, and Steven Cummins. "Associations between the neighbourhood food environment and food and drink purchasing in England during lockdown: A repeated cross-sectional analysis." PLOS ONE 19, no. 7 (July 17, 2024): e0305295. http://dx.doi.org/10.1371/journal.pone.0305295.
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Introduction Evidence for the effect of neighbourhood food environment (NFE) exposures on diet in the UK is mixed, potentially due to exposure misclassification. This study used the first national COVID-19 lockdown in England as an opportunity to isolate the independent effects of the NFE exposure on food and drink purchasing, and assessed whether these varied by region. Methods Transaction-level purchasing data for food and drink items for at-home (1,221 households) and out-of-home consumption (171 individuals) were available from the GB Kantar Fast Moving Consumer Goods Panel for London and the North of England. The study period included 23rd March to 10th May 2020 (‘lockdown’), and the same period in 2019 for comparison. NFE exposures included food outlet density and proximity, and NFE composition within a 1 km network buffer around the home. Associations were estimated for both years separately, adjusted for individual and household characteristics, population density and area deprivation. Interaction terms between region and exposures were explored. Results There were no consistent patterns of association between NFE exposures and food and drink purchasing in either time period. In 2019, there was some evidence for a 1.4% decrease in energy purchased from ultra-processed foods for each additional 500 m in the distance to the nearest OOH outlet (IR 0.986, 95% CI 0.977 to 0.995, p = 0.020). In 2020, there was some evidence for a 1.8% reduction in total take-home energy for each additional chain supermarket per km2 in the neighbourhood (IR 0.982, 95% CI 0.969, 0.995, p = 0.045). Region-specific effects were observed in 2019 only. Discussion Findings suggest that the differences in exposure to the NFE may not explain differences in the patterns or healthiness of grocery purchasing. Observed pre-pandemic region-specific effects allude to the importance of geographical context when designing research and policy. Future research may assess associations for those who relied on their NFE during lockdown.