Air pollution is associated with poor health. Yet, more research is needed to reveal the association of long-term exposure to outdoor air pollution with less studied health outcomes like hospital ...admissions and general-practitioner (GP) visits and whether this association is stronger for ethnic minorities compared to the rest of population. This study investigates the association between air pollution and all-cause GP visits and hospital admissions by ethnicity in the United-Kingdom (UK). We used individual-level longitudinal data from the "UK Household Longitudinal Study" including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO.sub.2, SO.sub.2, and particulate-matter (PM10, PM2.5) outdoor pollution using the Lower Super Output Area (LSOA) of residence for each individual. Multilevel mixed-effects ordered logistic models were used to assess the association between air pollution and all-cause GP visits and hospital admissions. We found higher odds of hospital admissions per 1 mug/m.sup.3 increase in annual concentrations of NO.sub.2 (OR = 1.008; 95%CI = 1.004-1.012), SO.sub.2 (OR = 1.048; 95%CI = 1.014-1.083), PM10 (OR = 1.011; 95%CI = 1.003-1.018), and PM2.5 (OR = 1.018; 95%CI = 1.007-1.029) pollutants. Higher odds of GP visits were also observed with increased exposure to NO.sub.2 (OR = 1.010; 95%CI = 1.006-1.014) and SO.sub.2 (OR = 1.114; 95%CI = 1.077-1.152) pollutants. The observed associations did not differ across ethnic groups, but by country of birth, they were more pronounced in individuals born outside UK than those born in UK. This study supports an association between higher exposure to outdoor air pollution and increased all-cause hospital admissions and GP visits. Further longitudinal studies with longer follow-up time periods may be able to reveal more definite conclusions on the influence of ethnicity on the association between long-term outdoor air pollution and both hospital admissions and GP visits.
Air-pollution and weather exposure beyond certain thresholds have serious effects on public health. Yet, there is lack of information on wider aspects including the role of some effect modifiers and ...the interaction between air-pollution and weather. This article aims at a comprehensive review and narrative summary of literature on the association of air-pollution and weather with mortality and hospital admissions; and to highlight literature gaps that require further research.
We conducted a scoping literature review. The search on two databases (PubMed and Web-of-Science) from 2012 to 2020 using three conceptual categories of "environmental factors", "health outcomes", and "Geographical region" revealed a total of 951 records. The narrative synthesis included all original studies with time-series, cohort, or case cross-over design; with ambient air-pollution and/or weather exposure; and mortality and/or hospital admission outcomes.
The final review included 112 articles from which 70 involved mortality, 30 hospital admission, and 12 studies included both outcomes. Air-pollution was shown to act consistently as risk factor for all-causes, cardiovascular, respiratory, cerebrovascular and cancer mortality and hospital admissions. Hot and cold temperature was a risk factor for wide range of cardiovascular, respiratory, and psychiatric illness; yet, in few studies, the increase in temperature reduced the risk of hospital admissions for pulmonary embolism, angina pectoris, chest, and ischemic heart diseases. The role of effect modification in the included studies was investigated in terms of gender, age, and season but not in terms of ethnicity.
Air-pollution and weather exposure beyond certain thresholds affect human health negatively. Effect modification of important socio-demographics such as ethnicity and the interaction between air-pollution and weather is often missed in the literature. Our findings highlight the need of further research in the area of health behaviour and mortality in relation to air-pollution and weather, to guide effective environmental health precautionary measures planning.
Air pollution is associated with several adverse health outcomes. However, heterogeneity in the size of effect estimates between cohort studies for long-term exposures exist and pollutants like SO2 ...and mental/behavioural health outcomes are little studied. This study examines the association between long-term exposure to multiple ambient air pollutants and all-cause and cause-specific mortality from both physical and mental illnesses.
We used individual-level administrative data from the Scottish-Longitudinal-Study (SLS) on 202,237 individuals aged 17 and older, followed between 2002 and 2017. The SLS dataset was linked to annual concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution at 1 km2 spatial resolution using the individuals’ residential postcode. We applied survival analysis to assess the association between air pollution and all-cause, cardiovascular, respiratory, cancer, mental/behavioural disorders/suicides, and other-causes mortality.
Higher all-cause mortality was associated with increasing concentrations of PM2.5, PM10, NO2, and SO2 pollutants. NO2, PM10, and PM2.5 were also associated with cardiovascular, respiratory, cancer and other-causes mortality. For example, the mortality hazard from respiratory diseases was 1.062 (95%CI = 1.028–1.096), 1.025 (95%CI = 1.005–1.045), and 1.013 (95%CI = 1.007–1.020) per 1 μg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. In contrast, mortality from mental and behavioural disorders was associated with 1 μg/m3 higher exposure to SO2 pollutant (HR = 1.042; 95%CI = 1.015–1.069).
This study revealed an association between long-term (16-years) exposure to ambient air pollution and all-cause and cause-specific mortality. The results suggest that policies and interventions to enhance air quality would reduce the mortality hazard from cardio-respiratory, cancer, and mental/behavioural disorders in the long-term.
•Individual-level longitudinal data was linked to 1 km2 air pollution spatial data.•The association of 16 years exposure to air pollution and mortality was studied.•All-cause mortality hazard increased with higher exposure to all air pollutants.•PM10, PM2.5 and NO2 were associated with cardio-respiratory and cancer mortality.•SO2 pollutant was associated with mental and behavioural disorders mortality.
The impact of air pollution on individuals’ happiness and life satisfaction (LS), and its relationship to other factors became the focus of recent research. Though, the underlying mechanism of how ...air pollution impacts LS remains unclear. In this study, we examined the direct and indirect effect of air pollution on individuals’ LS through health mediation. We used longitudinal individual-level data from “Understanding-Society: the UK Household-Longitudinal Study” on 59,492 individuals with 347,377 repeated responses across 11 years (2009–2019) that was linked to yearly concentrations of NO
2
, SO
2
, and particulate-matter (PM10, PM2.5) pollution. Generalized structural equation models with multilevel ordered-logistic regression were used to examine the direct effect of air pollution on LS and the indirect effect from health impairment. Higher concentrations of NO
2
(coefficient = 0.009, 95%CI = 0.007,0.012,
p
< 0.001), SO
2
(coefficient = 0.025, 95%CI = 0.017,0.034,
p
< 0.001), PM10 (coefficient = 0.019, 95%CI = 0.013,0.025,
p
< 0.001), and PM2.5 (coefficient = 0.025, 95%CI = 0.017,0.033,
p
< 0.001) pollutants were associated with poorer health, while poorer health was associated with reduced LS (coefficient = -0.605, 95%CI = -0.614,-0.595,
p
< 0.001). Mediation path analysis showed that air pollution impacted individuals’ LS directly and indirectly. The percent of total effect mediated through health was 44.03% for NO
2
, 73.95% for SO
2,
49.88% for PM10, and 45.42% for PM2.5 and the ratio of indirect to direct effect was 0.79 for NO
2
, 2.84 for SO
2,
0.99 for PM10, and 0.83 for PM2.5. Health plays a major mediating role in the relationship between air pollution and LS. To alleviate the impact of air pollution on LS, future strategies should focus on health promotion besides reducing air pollution emissions.
Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data ...to investigate the spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnicity in the United-Kingdom (UK).
Longitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009-2019) were utilized and were linked to yearly concentrations of NO
, SO
, and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals' health (Likert scale: 1-5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health.
Higher concentrations of NO
, SO
, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO
and SO
pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO
, SO
, PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals.
Using longitudinal data on individuals' health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals' health, especially for ethnic minorities who are affected the most.
Objectives
Ischemic stroke is a common cause of morbidity and mortality especially in the increasingly older population. The variability in ischemic stroke subtypes and its risk factors across ...different populations suggest that more effort is needed to describe the stroke characteristics in order to develop a more tailored management for each population. We aim to describe the demographic characteristics, risk factors, and subtype distribution of subjects with ischemic stroke in the Lebanese population.
Materials and methods
We conducted a cross‐sectional study based on chart review on patients with ischemic stroke/transient ischemic attack at the American University of Beirut Medical center between 2015 and 2017. Results: A total of 284 cases were included with a mean age of 72 years, and 58% male gender. The most commonly identified risk factors were hypertension (77%), dyslipidemia (62%), and diabetes mellitus (42%), while atrial fibrillation was only found in 27% of cases. The cohort distribution according to TOAST classification was as follows: 15% large artery stroke, 31% cardioembolic stroke, 17% small artery stroke, 10% stroke of other determined causes, and 27% stroke of unknown cause.
Conclusion
This is the first study to address ischemic stroke characteristics in Lebanon.
Previous studies have investigated the impact of air pollution on health and mortality. However, there is little research on how this impact varies by individuals’ ethnicity. Using a sample of more ...than 2.5-million individuals aged 16 and older from the 2011 UK census linked to 10-years air pollution data, this article investigates the effect of air pollution on self-reported general health and limiting long-term illness (LLTI) in five main ethnic groups and by country of birth in UK. The association of air pollution with self-reported health and LLTI by individual’s ethnicity was examined using two levels mixed-effects generalised-linear models. Pakistani/Bangladeshi, Indian, Black/African/Caribbean, and other ethnic minorities and people born outside UK/Ireland were more likely to report poorer health and the presence of LLTI than White-group and UK/Ireland born individuals. Higher concentrations of NO
2
, SO
2
and CO pollutants were associated with poorer self-reported health and the presence of LLTI in the UK population. Analysis by ethnicity showed a more pronounced effect of NO
2
, PM10, PM2.5, and CO air pollution on poor self-reported health and the presence of LLTI among ethnic minorities, mostly for people from Black/African/Caribbean origin compared to White people, and among non-UK/Ireland born individuals compared to natives. Using a large-scale individual-level census data linked to air pollution spatial data, our study supports the long-term deteriorating effect of air pollution on self-reported health and LLTI, which is more pronounced for ethnic minorities and non-natives.
Background
Workload perception is of interest to researchers and policymakers as it captures subjective assessments of nurses' workload which has implications for staffing and patient outcomes.
Aims
...We aimed to describe repeated assessments of nurses' perceived workload among registered nurses (RNs) in day and night shifts and to examine the association of perceived workload with workdays, units, and nurse‐staffing.
Methods
Repeated data on the indictors of interest were collected from 90 RNs across 91 shifts in a Lebanese acute‐care hospital. Perceived workload was assessed using the NASA‐Task‐Load Index (NASA‐TLX). Linear mixed‐effect models were used for analysis.
Results
Mean perceived workload was high reaching 6.63 (95% confidence interval CI = 6.34, 6.92) in day and 5.90 (95% CI = 5.43, 6.36) in night shifts. In mixed‐effect models, perceived workload was lower on weekends/holidays as compared to weekdays in day (ß = −.32; 95% CI = −0.53, −0.12) and night (ß = −.46; 95% CI = −0.85, −0.07) shifts. Higher perceived workload (ß = .19; 95% CI = 0.04, 0.33) was associated with higher patient‐to‐nurse ratio in the day but not night shifts.
Conclusion
Repeated workload assessments support the presence of elevated perceived workload among RNs which is related to weekdays and higher patient‐to‐nurse ratio. Future investigations would benefit from better characterization of workload particularities to address perceived burden and improve organizational and management decisions.
BackgroundRecent studies suggest an association between ambient air pollution and mental well-being, though evidence is mostly fragmented and inconclusive and suffers from methodological limitations ...related to the study design. In this study, we aimed to investigate the effect of air pollution on mental well-being in the United Kingdom (UK) using a spatial-temporal (between-within) longitudinal design.MethodsData for 60,146 adult individuals (age:16+) with 349,748 repeated responses across 10-data collection waves (11-years: 2009–2019) from the “Understanding Society: The UK Household Longitudinal Study” were linked to annual concentrations of NO2, SO2, PM10, and PM2.5 pollutants using the individuals’ place of residence, given at the Lower Super Output Areas (LSOAs) geography level. Mental well-being was measured through the General Health Questionnaire (GHQ12) scale which is composed of 12 questions about the individuals’ experience of 12 mental well-being symptoms, each assessed on a 4-point Likert scale. The 12 questions are either summed up resulting in a total score between 0 and 36 (GHQ0–36) or dichotomised and then summed up resulting in a total score between 0 and 12 (GHQ0–12). Based on relevant literature, a cut-off of 12 for GHQ0–36 indicates poor mental well-being, while two cut-offs of 4 and 2 indicate poor mental well-being for GHQ0–12. Multilevel mixed-effect logit models were used to analyse the association between air pollution and the three binary mental well-being outcomes (GHQ0–36 ≥12; GHQ0–12 ≥2; GHQ0–12 ≥4).ResultsHigher odds of poor mental well-being were observed with every 10µg/m3 increase in NO2 (GHQ0–36 ≥12: OR=1.12, 95% CI=1.09–1.15; GHQ0–12 ≥2: OR=1.14, 95%CI=1.11–1.17; GHQ0–12 ≥4: OR=1.12, 95%CI=1.09–1.16), SO2 (GHQ0–36 ≥12: OR=1.30, 95% CI=1.18–1.44; GHQ0–12 ≥2: OR=1.29, 95%CI=1.17–1.42; GHQ0–12 ≥4: OR=1.31, 95%CI=1.17–1.47), PM10 (GHQ0–36 ≥12: OR=1.22, 95% CI=1.15–1.30; GHQ0–12 ≥2: OR=1.28, 95%CI=1.20–1.36; GHQ0–12 ≥4: OR=1.23, 95%CI=1.15–1.31) and PM2.5 (GHQ0–36 ≥12: OR=1.35, 95% CI=1.24–1.47; GHQ0–12 ≥2: OR=1.44, 95%CI=1.33–1.56; GHQ0–12 ≥4: OR=1.38, 95%CI=1.25–1.51) pollutants. Decomposing air pollution into between (spatial: average 11-years air pollution across LSOAs) and within (temporal: annual deviation in air pollution from the 11-years average within each LSOA) effects showed significant between, but not within effects.ConclusionUsing longitudinal individual-level and contextual-linked pollution data, this study demonstrates the negative effect of air pollution on individuals’ mental well-being which is mainly attributed to residing in more polluted areas rather than the air pollution variation across time within each geographical area. Thus, environmental policies to reduce air pollution emissions can eventually improve the mental well-being of people in the UK.
Aims
The aim of this study was to explore nurses’ shift‐work satisfaction variability across time and its shift‐specific predictors: perceived workload, patient‐to‐nurse ratio and rationing of ...nursing care.
Design
Longitudinal study of 90 Registered nurses (N = 1,303 responses) in a Lebanese hospital over 91 days of data collection.
Methods
Intraclass correlation coefficients (ICCs) were computed to determine shift‐work satisfaction variability between individual nurses and working‐unit clusters. Generalized linear mixed models were used to explore the workloads and rationed care predictors of nurses’ shift‐work satisfaction separately for day and night shifts.
Results
Variability in shift‐work satisfaction was noted between individual nurses in day (ICC = 0.43) and night shifts (ICC = 0.37), but not between medical/surgical units. Nurses satisfied with their shift‐specific work were less probably to ration necessary nursing care (OR = 0.68; 95% CI = 0.60–0.77) in day shifts and to perceive high workload demands in both, day (OR = 0.29; 95% CI = 0.23–0.37) and night (OR = 0.29; 95% CI = 0.18–0.47) shifts. Monitoring and lowering workload demands while observing rationing of care is necessary to improve nurses’ shift‐work satisfaction.
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