The main aim of this study was to evaluate, in the design phase, the most environmentally sound alternative between two on-site small-scale wastewater treatment systems (designed for 15 inhabitants), ...namely an activated sludge compact system and a constructed wetland system (both in linear low-density polyethylene), using Life Cycle Assessment. The procedure considered three sensitive parameters with three values. All the 27 combinations were evaluated with three different impact assessment methods (generating 81 comparison cases): IPCC 2007 100 years, Ecological Footprint and ReCiPe 2008 H. The constructed wetland system was the best environmental choice in 93% of the cases. Realizing the two treatment systems in different European countries, the activated sludge system would be the best environmental choice in some cases. Considering the production of electricity with photovoltaic systems, the total impact of the activated sludge system, evaluated with the ReCiPe 2008 H method, would be smaller than that of the constructed wetland system. The variation of the operating lifetime parameter had a major influence on the constructed wetland system, where the greatest consumption of energy and resources occurs during the construction phase. There were significant differences among the results with ReCiPe 2008 H and those with Ecological Footprint and IPCC 2007 100 years. Therefore, in a Life Cycle Assessment study, it would be preferable to adopt several impact assessment methods in order to verify how the results can vary.
•Many on-site small-scale systems can produce enormous burdens.•Two on-site small-scale wastewater treatment systems have been evaluated.•Three different LCA impact assessment methods were considered (81 comparison cases).•The constructed wetland system was the best environmental choice in 93% of the cases.•The obtained results were influenced by the activated sludge electricity source.
The main aim of the study was to propose a useful methodological approach to define easily understandable indicators to use in communication campaigns organized to improve the efficacy of municipal ...solid waste collection. For this purpose, six economic-environmental indicators were defined, combining life cycle thinking and environmental communication. The indicators make it possible to obtain several combinations that can follow a variety of communication channels. Three indicators (quantity of recyclable materials recoverable from unsorted residual waste; total potential economic saving; number of jobs for young people as communicators) are expressed in absolute value and therefore refer to the whole community even if they are also good for single-targeted messages. The other three indicators (potential economic saving for each citizen; per capita saving of carbon dioxide equivalent; per capita saving of Disability Adjusted Life Years) are normalized with respect to the number of inhabitants and therefore refer to the individual citizen, but can also be used for global messages. As a case example, the methodology was applied to the collection of paper and cardboard in twelve Southern Italy cities obtaining very promising results. For example, the maximum quantity of paper and cardboard recoverable from unsorted waste would allow Naples and Palermo to recover more than €15 million. The maximum potential economic saving for each citizen was 25 €/capita. The economic saving obtained for Naples and Palermo could be translated in more than one thousand positions as young environmental communicators. Catania was the city with both the highest per capita potential saving of carbon dioxide (>60 kg CO2eq./capita) and maximum hypothetical per capita ‘life-time recovery’ (almost an hour). The innovative communication method used (‘Greenopoli’) assumed that school is the starting point to obtain a change of mindset because speaking with students (all potential communicators) means indirectly communicating with all other targets.
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•The study proposes a methodological approach with an example case.•Life cycle thinking and environmental communication have been combined.•The communicative approach is based on six easily understandable indicators.•Indicators allow obtaining many combinations to use in communication campaigns.•Communication campaigns should follow a pyramid approach with schools at the base.
Summary
Background
Mobile technology may help to better understand the adherence to treatment. MASK‐rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient‐centred ICT system. A ...mobile phone app (the Allergy Diary) central to MASK is available in 22 countries.
Objectives
To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App.
Methods
An observational cross‐sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach.
Results
A total of 12 143 users were registered. A total of 6 949 users reported at least one VAS data recording. Among them, 1 887 users reported ≥7 VAS data. About 1 195 subjects were included in the analysis of adherence. One hundred and thirty‐six (11.28%) users were adherent (MPR ≥70% and PDC ≤1.25), 51 (4.23%) were partly adherent (MPR ≥70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non‐adherent to medications (MPR <70%). Of those, the largest group was non‐adherent to medications and the time interval was increased in 442 (36.68%) users.
Conclusion and clinical relevance
Adherence to treatment is low. The relative efficacy of continuous vs on‐demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication‐taking behaviour in a real‐world setting.
This paper investigates the total and per capita environmental impacts of municipal wastewater treatment in the function of the population equivalent (PE) with a Life Cycle Assessment (LCA) approach ...using the processes of the Ecoinvent 2.2 database available in the software tool SimaPro v.7.3. Besides the wastewater treatment plant (WWTP), the study also considers the sewerage system. The obtained results confirm that there is a 'scale factor' for the wastewater collection and treatment even in environmental terms, in addition to the well-known scale factor in terms of management costs. Thus, the more the treatment plant size is, the less the per capita environmental impacts are. However, the Ecoinvent 2.2 database does not contain information about treatment systems with a capacity lower than 30 PE. Nevertheless, worldwide there are many sparsely populated areas, where it is not convenient to realize a unique centralized WWTP. Therefore, it would be very important to conduct an LCA study in order to compare alternative on-site small-scale systems with treatment capacity of few PE.
Summary
Background
Visual Analogue Scale (VAS) is a validated tool to assess control in allergic rhinitis patients.
Objective
The aim of this study was to validate the use of VAS in the MASK‐rhinitis ...(MACVIA‐ARIA Sentinel NetworK for allergic rhinitis) app (Allergy Diary) on smartphones screens to evaluate allergic rhinitis symptoms and disease control.
Methods
Each user filled 4 different VAS measuring overall, nasal, ocular, and asthma symptoms at least once. Following COSMIN guidelines, we evaluated internal consistency, (Cronbach's alpha coefficient and test‐retest), reliability (intraclass correlation coefficients), sensitivity, and acceptability of the MASK‐Rhinitis VAS.
Results
Between 1 August 2015 and 31 July 2016, the app was used 14 612 times in 15 countries. A total of 1225 users used it more than once, during the evaluated period. The tool resulted to be statistically satisfactory, showing excellent internal consistency (Cronbach's test > 0.84, test‐retest > 0.7), reliability (>0.9), and acceptability. In addition, the tool had a good sensitivity when users (n = 521) answered the VAS twice in less than 3 hours.
Conclusions and Clinical Relevance
The MASK‐rhinitis VAS is a reliable and valid tool to assess allergic control on smartphone screens, at the population level.
Background
In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is ...a need to support the transformation of the health care system into integrated care with organizational health literacy.
Main body
As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real‐life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self‐care through technology‐assisted “patient activation”, (ii) Implementation of care pathways by pharmacists and (iii) Next‐generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real‐world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally‐enabled, integrated, person‐centred care.
Conclusion
In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
Background
In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK‐air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) ...for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom‐medication scores obtained concurrently.
Methods
All consecutive MASK‐air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self‐assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom‐medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra‐individual response variability (IRV) index was calculated.
Results
A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.
Conclusions
VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom‐medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.
VAS work can be used as a measure of cost‐effectiveness of interventions in allergic rhinitis. Strong correlations were observed between
VAS work and other VAS scores, which are unlikely to be explained by a low quality of data arising from repeated VAS measures. Lower
correlations were observed between VAS work and SMSs, suggesting that better SMSs need to be defined to investigate the effect of
allergic rhinitis treatments.
The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The ...EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA‐France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1‐year period of rhinitis and asthma multimorbidity at baseline (cross‐sectional study) and (iii) to follow‐up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.
The main aim of this study was to evaluate the costs and environmental impacts induced by a fixed model of MSW kerbside separate collection system for communities up to 10,000 inhabitants, in order ...to evaluate the convenience for the smaller municipalities to unite and form more economically and environmentally sound systems. This topic is important not only due to the large number of small municipalities (e.g. in Italy 72% of the municipalities has less than 5000 inhabitants) but also to the fact that separate collection systems are typically designed to take into account only the technical and economic aspects, which is a practice but not acceptable in the light of the sustainable development paradigm. In economic terms, between 1000 and 4000 inhabitants, the annual per capita cost for vehicles and personnel decreased, with a maximum at approximately 180€/inhabitants/year; while, from 5000 up to 10,000 inhabitants, the annual per capita cost was practically constant and equal to about 80€/inhabitants/year. For the municipalities of less than 5000 inhabitants, from an economic point of view the aggregation is always advantageous. The environmental impacts were calculated by means of the Life Cycle Assessment tool SimaPro 7.1, while the economic-environmental convenience was evaluated by combining in a simple multicriteria analysis, the annual total per capita cost (€/inhabitants/year) and the annual total per capita environmental impact (kEco-indicator point/inhabitants/year), giving the same importance to each criteria. The analysis was performed by means of the Paired Comparison Technique using the Simple Additive Weighting method. The economic and environmental convenience of the aggregation diminishes with the size of the municipalities: for less than 4000 inhabitants, the aggregation was almost always advantageous (91.7%); while, for more than or equal to 5000 inhabitants, the aggregation was convenient only in 33.3% of the cases. On the whole, out of 45 cases examined, for the municipalities from 1000 to 9000 inhabitants, the aggregation was both economically and environmentally convenient in 60.0% of the cases.
mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and ...results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence‐based approach to care pathways suited to real‐life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over‐the‐counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self‐management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self‐medicate, are often non‐adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.
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