In low‐resource settings, there is a need to develop models that can address contributions of household and outdoor sources to population exposures. The aim of the study was to model indoor PM2.5 ...using household characteristics, activities, and outdoor sources. Households belonging to participants in the Mother and Child in the Environment (MACE) birth cohort, in Durban, South Africa, were randomly selected. A structured walk‐through identified variables likely to generate PM2.5. MiniVol samplers were used to monitor PM2.5 for a period of 24 hours, followed by a post‐activity questionnaire. Factor analysis was used as a variable reduction tool. Levels of PM2.5 in the south were higher than in the north of the city (P < .05); crowding and dwelling type, household emissions (incense, candles, cooking), and household smoking practices were factors associated with an increase in PM2.5 levels (P < .05), while room magnitude and natural ventilation factors were associated with a decrease in the PM2.5 levels (P < .05). A reasonably robust PM2.5 predictive model was obtained with model R2 of 50%. Recognizing the challenges in characterizing exposure in environmental epidemiological studies, particularly in resource‐constrained settings, modeling provides an opportunity to reasonably estimate indoor pollutant levels in unmeasured homes.
Quality assessment is a critical component of determining the value of medical services, including palliative care. The utilisation of palliative care quality measures could assist in assessing the ...degree to which patients living with cancer conform to best practice of palliative care, identifying gaps and monitoring changes in cancer care delivery models in different setting. This scoping review aims to map the available data on the usage of palliative care quality indicators that are relevant to cancer patients in low- and middle-income countries (LMICs).
To structure this study, we will use the framework developed by Arksey and O'Malley, the Levac et al. recommendations and the Joanna Briggs Institute recommendations. We will search EBSCOHost, Web of Science, ProQuest One Academic, MEDLINE and Google Scholar for evidence on palliative care quality measures applicable for patients living with cancer published from inception till 2022. We will search grey literature in the form of dissertations, conference proceedings and websites of international organisations such as the World Health Organisation (WHO) reporting palliative care quality measures applicable to patients living with cancer in LMICs.
The purpose of this study is to establish the extent of existing research on the palliative care quality measures in LMICs. Although palliative care is still a new phenomenon, understanding of the palliative care quality measures applicable for cancer patients will assist to improve care across all components of health systems.
No ethical approval is required for the study as the data collection and results of the proposed scoping review will be conducted and disseminated electronically using peer-reviewed journals, print and presentations at scientific conferences and stakeholder presentations.
BACKGROUND: Indoor air pollution (IAP) from environmental tobacco smoke (ETS) and biomass fuel smoke (BMS) poses respiratory health risks, with children and women bearing the major burden.OBJECTIVES: ...We used a systematic review and meta-analysis to investigate the relation between
childhood tuberculosis (TB) and exposure to ETS and BMS.METHODS: We searched three databases for epidemiological studies that investigated the association of childhood TB with exposure to ETS and BMS. We calculated pooled estimates and heterogeneity for studies eligible for inclusion in
the meta-analysis and stratified studies on ETS by outcome.RESULTS: Five case-control and three cross-sectional studies were eligible for inclusion in the meta-analysis and quality assessment. Pooled effect estimates showed that exposure to ETS is associated with tuberculous infection
and TB disease (OR 1.9, 95%CI 1.4-2.9) among exposed compared to non-exposed children. TB disease in ETS studies produced a pooled OR of 2.8 (95%CI 0.9-4.8), which was higher than the OR for tuberculous infection (OR 1.9, 95%CI 0.9-2.9) for children exposed to ETS compared
to non-exposed children. Studies on BMS exposure were too few and too small to permit a conclusion.CONCLUSION: Exposure to ETS increases the risk of childhood TB disease or tuberculous infection.
Elevated levels of indoor air pollutants may cause cardiopulmonary disease such as lower respiratory infection, chronic obstructive lung disease and lung cancer, but the association with tuberculosis ...(TB) is unclear. So far the risk estimates of TB infection or/and disease due to indoor air pollution (IAP) exposure are based on self-reported exposures rather than direct measurements of IAP, and these exposures have not been validated.
The aim of this paper was to characterize and develop predictive models for concentrations of three air pollutants (PM10, NO2 and SO2) in homes of children participating in a childhood TB study.
Children younger than 15 years living within the eThekwini Municipality in South Africa were recruited for a childhood TB case control study. The homes of these children (n=246) were assessed using a walkthrough checklist, and in 114 of them monitoring of three indoor pollutants was also performed (sampling period: 24h for PM10, and 2–3 weeks for NO2 and SO2). Linear regression models were used to predict PM10 and NO2 concentrations from household characteristics, and these models were validated using leave out one cross validation (LOOCV). SO2 concentrations were not modeled as concentrations were very low.
Mean indoor concentrations of PM10 (n=105), NO2 (n=82) and SO2 (n=82) were 64μg/m3 (range 6.6–241); 19μg/m3 (range 4.5–55) and 0.6μg/m3 (range 0.005–3.4) respectively with the distributions for all three pollutants being skewed to the right. Spearman correlations showed weak positive correlations between the three pollutants. The largest contributors to the PM10 predictive model were type of housing structure (formal or informal), number of smokers in the household, and type of primary fuel used in the household. The NO2 predictive model was influenced mostly by the primary fuel type and by distance from the major roadway. The coefficients of determination (R2) for the models were 0.41 for PM10 and 0.31 for NO2. Spearman correlations were significant between measured vs. predicted PM10 and NO2 with coefficients of 0.66 and 0.55 respectively.
Indoor PM10 levels were relatively high in these households. Both PM10 and NO2 can be modeled with a reasonable validity and these predictive models can decrease the necessary number of direct measurements that are expensive and time consuming.
•Measurements showed relatively high levels of indoor air pollutants in low and middle income South African households.•Size of the home, indoor smoking, and certain cooking fuels are determinants of higher indoor pollutant levels.•Predictive models for indoor air pollutants can be developed using household characteristics.
Crude measures of exposure to indicate indoor air pollution have been associated with the increased risk for acquiring tuberculosis. Our study aimed to determine an association between childhood ...pulmonary tuberculosis (PTB) and exposure to indoor air pollution (IAP), based on crude exposure predictors and directly sampled and modelled pollutant concentrations.
In this case control study, children diagnosed with PTB were compared to children without PTB. Questionnaires about children's health; and house characteristics and activities (including household air pollution) and secondhand smoke (SHS) exposure were administered to caregivers of participants. A subset of the participants' homes was sampled for measurements of PM
over a 24-h period (n = 105), and NO
over a period of 2 to 3 weeks (n = 82). IAP concentrations of PM
and NO
were estimated in the remaining homes using predictive models. Logistic regression was used to look for association between IAP concentrations, crude measures of IAP, and PTB.
Of the 234 participants, 107 were cases and 127 were controls. Pollutants concentrations (μg/m
) for were PM
median: 48 (range: 6.6-241) and NO
median: 16.7 (range: 4.5-55). Day-to-day variability within- household was large. In multivariate models adjusted for age, sex, socioeconomic status, TB contact and HIV status, the crude exposure measures of pollution viz. cooking fuel type (clean or dirty fuel) and SHS showed positive non-significant associations with PTB. Presence of dampness in the household was a significant risk factor for childhood TB acquisition with aOR of 2.4 (95% CI: 1.1-5.0). The crude exposure predictors of indoor air pollution are less influenced by day-to-day variability. No risk was observed between pollutant concentrations and PTB in children for PM
and NO
.
Our study suggests increased risk of childhood tuberculosis disease when children are exposed to SHS, dirty cooking fuel, and dampness in their homes. Yet, HIV status, age and TB contact are the most important risk factors of childhood PTB in this population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
