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1.
Lancet Glob Health ; 9(5): e639-e650, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33865472

RESUMO

BACKGROUND: Exposure to second-hand smoke from tobacco is a major contributor to global morbidity and mortality. We aimed to evaluate the efficacy and cost-effectiveness of a community-based smoke-free-home intervention, with or without indoor-air-quality feedback, in reducing second-hand-smoke exposure in homes in Bangladesh. METHODS: We did a three-arm, cluster-randomised, controlled trial in Dhaka, Bangladesh, and randomly assigned (1:1:1) mosques and consenting households from their congregations to a smoke-free-home intervention plus indoor-air-quality feedback, smoke-free-home intervention only, or usual services. Households were eligible if they had at least one resident attending one of the participating mosques, at least one adult resident (age 18 years or older) who smoked cigarettes or other forms of smoked tobacco (eg, bidi, waterpipe) regularly (on at least 25 days per month), and at least one non-smoking resident of any age. The smoke-free-home intervention consisted of weekly health messages delivered within an Islamic discourse by religious leaders at mosques over 12 weeks. Indoor-air-quality feedback comprised providing households with feedback on their indoor air quality measured over 24 h. Households in the usual services group received no intervention. Masking of participants and mosque leaders was not possible. The primary outcome was the 24-h mean household airborne fine particulate matter (<2·5 microns in diameter [PM2·5]) concentration (a marker of second-hand smoke) at 12 months after randomisation. Cost-effectiveness was estimated using incremental cost-effectiveness ratios (ICERs). This trial is registered with ISRCTN, 49975452. FINDINGS: Between April 11 and Aug 2, 2018, we enrolled 1801 households from 45 mosques. 640 households (35·5%) were assigned to the smoke-free-home intervention plus indoor-air-quality feedback group, 560 (31·1%) to the smoke-free-home intervention only group, and 601 (33·4%) to the usual services group. At 12 months, the adjusted mean difference in household mean 24-h PM2·5 concentration was -1·0 µg/m3 (95% CI -12·8 to 10·9, p=0·88) for the smoke-free-home intervention plus indoor-air-quality feedback group versus the usual services group, 5·0 µg/m3 (-7·9 to 18·0, p=0·45) for the smoke-free-home intervention only group versus the usual services group, and -6·0 µg/m3 (-18·3 to 6·3, p=0·34) for the smoke-free-home intervention plus indoor-air-quality feedback group versus the smoke-free-home intervention only group. The ICER for the smoke-free-home intervention plus indoor-air-quality feedback versus usual services was US$653 per quality-adjusted life-year (QALY) gained, which was more than the upper limit of the Bangladesh willingness-to-pay threshold of $427 per QALY. INTERPRETATION: The smoke-free-home intervention, with or without indoor-air-quality feedback, was neither effective nor cost-effective in reducing household second-hand-smoke exposure compared with usual services. These interventions are therefore not recommended for Bangladesh. FUNDING: Medical Research Council UK. TRANSLATION: For the Bengali translation of the abstract see Supplementary Materials section.


Assuntos
Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Poluição por Fumaça de Tabaco/economia , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh , Criança , Análise por Conglomerados , Análise Custo-Benefício/economia , Características da Família , Retroalimentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Material Particulado/análise , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Adulto Jovem
2.
J Environ Radioact ; 222: 106351, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892905

RESUMO

Radon, a gaseous radioactive decay product of naturally-occurring uranium is widely distributed in the environment in rocks and soils and, in certain circumstances, can accumulate in the built environment. Initial studies confirmed a direct link between exposure to both radon gas and its short-lived radioactive progeny, and increased lung-cancer incidence, and demonstrated that radon levels in domestic housing can be sufficiently high to expose occupants to increased risk of lung-cancer. Subsequent studies worldwide have shown that it is cost-effective to detect and reduce domestic radon levels in order to reduce this risk. Recent advances in the early detection of lung-cancer, coupled with the development of improved treatment procedures, have progressively improved survival from the disease, with the numbers surviving at 5 years doubling over recent years, during which period the real costs of lung cancer treatment have risen by around 30%. In the meantime, however, in addition to radon and tobacco-smoke, other airborne pollutants have been identified as risk-factors for lung-cancer. This paper reviews both these actual developments and anticipated future trends, and concludes that since these advances in diagnosis and treatment of lung-cancer have had only a modest effect on cost-effectiveness, it is still important to conduct radon monitoring and remediation programmes. While the general increase in life-expectancy improves the cost-effectiveness of radon remediation programmes significantly, reducing tobacco-smoking incidence reduces that cost-effectiveness but with the overall benefit of reducing radon-related lung-cancers. The challenge remains of encouraging affected householders to remediate their homes to reduce radon levels.


Assuntos
Poluição do Ar em Ambientes Fechados , Neoplasias Pulmonares , Monitoramento de Radiação , Radônio , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/prevenção & controle , Análise Custo-Benefício , Habitação , Humanos , Neoplasias Pulmonares/epidemiologia , Reino Unido
3.
Health Policy ; 122(6): 687-692, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29576334

RESUMO

PURPOSE: Residential exposure to radon is considered as the second leading cause of lung cancer after smoking. The purpose of this study was to conduct a cost-effectiveness analysis of reducing the indoor radon levels in Sweden from the current reference level of 200 Bq/m3 to the WHO suggested reference level of maximum 100 Bq/m3. METHODS: We constructed a decision-analytic cost-effectiveness model using input data from published literature and administrative records. The model compared the increase in economic costs to the health benefits of lower indoor radon-levels in a Swedish policy context. We estimated the cost per life-year and quality adjusted life year (QALY) gained and assessed the robustness of the results using both deterministic and probabilistic sensitivity analysis. RESULTS: Including (excluding) costs of added life years the cost per QALY for existing homes was €130,000 (€99,000). For new homes the cost per QALY including (excluding) costs of added life years was €39,000 (€25,000). CONCLUSIONS: The results indicate that it is not cost-effective to reduce indoor radon levels from 200 Bq/m3 to a maximum of 100 Bq/m3 in existing homes, whereas it is cost-effective for new homes.


Assuntos
Análise Custo-Benefício , Habitação , Modelos Estatísticos , Radônio/toxicidade , Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/prevenção & controle , Humanos , Neoplasias Pulmonares/etiologia , Anos de Vida Ajustados por Qualidade de Vida , Suécia
4.
Artigo em Inglês | MEDLINE | ID: mdl-28561795

RESUMO

Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO2, CO, NO2, O3, CH2O, total volatile organic compounds (VOC), PM1, PM2.5, PM10, Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM2.5, PM10, CO2 and CH2O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO2. However, mitigation measures were not always sufficient to decrease the pollutants' concentrations till values considered safe to protect human health.


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Berçários para Lactentes , Instituições Acadêmicas , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/economia , Dióxido de Carbono/análise , Monóxido de Carbono/análise , Custos e Análise de Custo , Monitoramento Ambiental , Formaldeído/análise , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Radônio/análise , Compostos Orgânicos Voláteis/análise
5.
Environ Int ; 104: 14-24, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28395145

RESUMO

An evaluation of the socio-economic costs of indoor air pollution can facilitate the development of appropriate public policies. For the first time in France, such an evaluation was conducted for six selected pollutants: benzene, trichloroethylene, radon, carbon monoxide, particles (PM2.5 fraction), and environmental tobacco smoke (ETS). The health impacts of indoor exposure were either already available in published works or were calculated. For these calculations, two approaches were followed depending on the available data: the first followed the principles of quantitative health risk assessment, and the second was based on concepts and methods related to the health impact assessment. For both approaches, toxicological data and indoor concentrations related to each target pollutant were used. External costs resulting from mortality, morbidity (life quality loss) and production losses attributable to these health impacts were assessed. In addition, the monetary costs for the public were determined. Indoor pollution associated with the selected pollutants was estimated to have cost approximately €20 billion in France in 2004. Particles contributed the most to the total cost (75%), followed by radon. Premature death and the costs of the quality of life loss accounted for approximately 90% of the total cost. Despite the use of different methods and data, similar evaluations previously conducted in other countries yielded figures within the same order of magnitude.


Assuntos
Poluentes Atmosféricos/economia , Poluição do Ar em Ambientes Fechados/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Benzeno/análise , Benzeno/economia , Monóxido de Carbono/análise , Monóxido de Carbono/economia , Monitoramento Ambiental , Feminino , França , Humanos , Masculino , Morbidade , Mortalidade Prematura , Material Particulado/análise , Material Particulado/economia , Qualidade de Vida , Radônio/análise , Radônio/economia , Medição de Risco , Poluição por Fumaça de Tabaco/análise , Poluição por Fumaça de Tabaco/economia , Tricloroetileno/análise , Tricloroetileno/economia
6.
J Environ Radioact ; 164: 84-90, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27442258

RESUMO

We demonstrate a strong correlation between domestic radon levels and socio-economic status (SES) in Great Britain, so that radon levels in homes of people with lower SES are, on average, only about two thirds of those of the more affluent. This trend is apparent using small area measures of SES and also using individual social classes. The reasons for these differences are not known with certainty, but may be connected with greater underpressure in warmer and better-sealed dwellings. There is also a variation of indoor radon levels with the design of the house (detached, terraced, etc.). In part this is probably an effect of SES, but it appears to have other causes as well. Data from other countries are also reviewed, and broadly similar effects seen in the United States for SES, and in other European countries for detached vs other types of housing. Because of correlations with smoking, this tendency for the lower SES groups to experience lower radon levels may underlie the negative association between radon levels and lung cancer rates in a well-known ecological study based on US Counties. Those conducting epidemiological studies of radon should be alert for this effect and control adequately for SES.


Assuntos
Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Radônio/análise , Classe Social , Poluição do Ar em Ambientes Fechados/análise , Habitação/economia , Habitação/estatística & dados numéricos , Humanos , Radônio/economia , Reino Unido
7.
Environ Health ; 15 Suppl 1: 35, 2016 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-26961383

RESUMO

BACKGROUND: The annual burden of disease caused indoor air pollution, including polluted outdoor air used to ventilate indoor spaces, is estimated to correspond to a loss of over 2 million healthy life years in the European Union (EU). Based on measurements of the European Environment Agency (EEA), approximately 90 % of EU citizens live in areas where the World Health Organization (WHO) guidelines for air quality of particulate matter sized < 2.5 mm (PM2.5) are not met. Since sources of pollution reside in both indoor and outdoor air, selecting the most appropriate ventilation strategy is not a simple and straightforward task. METHODS: A framework for developing European health-based ventilation guidelines was created in 2010-2013 in the EU-funded HEALTHVENT project. As a part of the project, the potential efficiency of control policies to health effects caused by residential indoor exposures of fine particulate matter (PM2.5), outdoor bioaerosols, volatile organic compounds (VOC), carbon oxide (CO) radon and dampness was estimated. The analysis was based on scenario comparison, using an outdoor-indoor mass-balance model and varying the ventilation rates. Health effects were estimated with burden of diseases (BoD) calculations taking into account asthma, cardiovascular (CV) diseases, acute toxication, respiratory infections, lung cancer and chronic obstructive pulmonary disease (COPD). RESULTS: The quantitative comparison of three main policy approaches, (i) optimising ventilation rates only; (ii) filtration of outdoor air; and (iii) indoor source control, showed that all three approaches are able to provide substantial reductions in the health risks, varying from approximately 20 % to 44 %, corresponding to 400 000 and 900 000 saved healthy life years in EU-26. PM2.5 caused majority of the health effects in all included countries, but the importance of the other pollutants varied by country. CONCLUSIONS: The present modelling shows, that combination of controlling the indoor air sources and selecting appropriate ventilation rate was the most effective to reduce health risks. If indoor sources cannot be removed or their emissions cannot be limited to an accepted level, ventilation needs to be increased to remove remaining pollutants. In these cases filtration of outdoor air may be needed to prevent increase of health risks.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar em Ambientes Fechados/efeitos adversos , Indicadores Básicos de Saúde , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Europa (Continente) , Habitação , Humanos , Modelos Teóricos
8.
Nicotine Tob Res ; 18(5): 1258-64, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26814194

RESUMO

INTRODUCTION: Many low- and middle-income countries (LMICs) have enacted legislation banning smoking in public places, yet enforcement remains challenging. The aim of this study was to assess the feasibility of using a validated low-cost methodology (the Dylos DC1700) to provide objective evidence of smoke-free (SF) law compliance in hospitality venues in urban LMIC settings, where outdoor air pollution levels are generally high. METHODS: Teams measured indoor fine particulate matter (PM2.5) concentrations and systematically observed smoking behavior and SF signage in a convenience sample of hospitality venues (bars, restaurants, cafes, and hotels) covered by existing SF legislation in Mexico, Pakistan, Indonesia, Chad, Bangladesh, and India. Outdoor air PM2.5 was also measured on each sampling day. RESULTS: Data were collected from 626 venues. Smoking was observed during almost one-third of visits with substantial differences between countries-from 5% in India to 72% in Chad. After excluding venues where other combustion sources were observed, secondhand smoke (SHS) derived PM2.5 was calculated by subtracting outdoor ambient PM2.5 concentrations from indoor measurements and was, on average, 34 µg/m(3) in venues with observed smoking-compared to an average value of 0 µg/m(3) in venues where smoking was not observed (P < .001). In over one-quarter of venues where smoking was observed the difference between indoor and outdoor PM2.5 concentrations exceeded 64 µg/m(3). CONCLUSIONS: This study suggests that low-cost air quality monitoring is a viable method for improving knowledge about environmental SHS and can provide indicative data on compliance with local and national SF legislation in hospitality venues in LMICs. IMPLICATIONS: Air quality monitoring can provide objective scientific data on SHS and air quality levels in venues to assess the effectiveness of SF laws and identify required improvements. Equipment costs and high outdoor air pollution levels have hitherto limited application in LMICs. This study tested the feasibility of using a validated low-cost methodology in hospitality venues in six LMIC urban settings and suggests this is a viable method for improving knowledge about SHS exposure and can provide indicative data on compliance with SF legislation.


Assuntos
Monitoramento Ambiental/economia , Pobreza/economia , Política Antifumo/economia , Fumar/economia , Poluição por Fumaça de Tabaco/análise , Poluição por Fumaça de Tabaco/economia , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/legislação & jurisprudência , Bangladesh , Monitoramento Ambiental/legislação & jurisprudência , Monitoramento Ambiental/métodos , Humanos , Renda , Índia , México , Paquistão , Material Particulado/análise , Pobreza/legislação & jurisprudência , Restaurantes , Política Antifumo/legislação & jurisprudência , Fumar/legislação & jurisprudência , Prevenção do Hábito de Fumar , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/legislação & jurisprudência
9.
Indoor Air ; 26(2): 318-30, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25660513

RESUMO

How building stakeholders (e.g. owners, tenants, operators, and designers) understand impacts of Indoor Air Quality (IAQ) and associated energy costs is unknown. We surveyed 112 stakeholders across the United States to ascertain their perceptions of their current IAQ and estimates of benefits and costs of, as well as willingness to pay for, IAQ improvements. Respondents' perceived IAQ scores correlated with the use of high-efficiency filters but not with any other IAQ-improving technologies. We elicited their estimates of the impacts of a ventilation-filtration upgrade (VFU), that is, doubling the ventilation rate from 20 to 40 cfm/person (9.5 to 19 l/s/person) and upgrading from a minimum efficiency reporting value 6 to 11 filter, and compared responses to estimates derived from IAQ literature and energy modeling. Minorities of respondents thought the VFU would positively impact productivity (45%), absenteeism (23%), or health (39%). Respondents' annual VFU cost estimates (mean = $257, s.d. = $496, median = $75 per person) were much higher than ours (always <$32 per person), and the only yearly cost a plurality of respondents said they would pay for the VFU was $15 per person. Respondents holding green building credentials were not more likely to affirm the IAQ benefits of the VFU and were less likely to be willing to pay for it.


Assuntos
Poluição do Ar em Ambientes Fechados/economia , Indústria da Construção , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Análise Custo-Benefício , Filtração , Estados Unidos , Ventilação/economia , Ventilação/estatística & dados numéricos
10.
Indoor Air ; 26(3): 501-12, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-25952610

RESUMO

This study involved the development of a model for evaluating the potential costs and benefits of ozone control by activated carbon filtration in single-family homes. The modeling effort included the prediction of indoor ozone with and without activated carbon filtration in the HVAC system. As one application, the model was used to predict benefit-to-cost ratios for single-family homes in 12 American cities in five different climate zones. Health benefits were evaluated using disability-adjusted life-years and included city-specific age demographics for each simulation. Costs of commercially available activated carbon filters included capital cost differences when compared to conventional HVAC filters of similar particle removal efficiency, energy penalties due to additional pressure drop, and regional utility rates. The average indoor ozone removal effectiveness ranged from 4 to 20% across the 12 target cities and was largely limited by HVAC system operation time. For the parameters selected in this study, the mean predicted benefit-to-cost ratios for 1-inch filters were >1.0 in 10 of the 12 cities. The benefits of residential activated carbon filters were greatest in cities with high seasonal ozone and HVAC usage, suggesting the importance of targeting such conditions for activated carbon filter applications.


Assuntos
Filtros de Ar/economia , Poluição do Ar em Ambientes Fechados/economia , Carbono/análise , Filtração/economia , Habitação , Ozônio/análise , Ar Condicionado/economia , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/prevenção & controle , Cidades , Análise Custo-Benefício , Filtração/instrumentação , Humanos , Material Particulado/análise , Anos de Vida Ajustados por Qualidade de Vida , Estações do Ano
11.
Int J Environ Res Public Health ; 12(11): 14709-22, 2015 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-26593933

RESUMO

INTRODUCTION: Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption-Economic and environmental costs. METHODS: We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. RESULTS: Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than $40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a $6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. CONCLUSIONS: The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies.


Assuntos
Ar Condicionado/economia , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/prevenção & controle , Saúde Ambiental/economia , Calefação/economia , Ventilação/economia , Poluição do Ar em Ambientes Fechados/análise , Humanos , Estados Unidos
12.
Tob Control ; 24(2): 205-10, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24500272

RESUMO

OBJECTIVE: Healthcare and mortality costs of secondhand smoke (SHS) exposure at home among non-smokers in California were estimated for the year 2009. METHODS: Costs were estimated with an epidemiological model using California SHS home exposure rates and published relative risks. Healthcare costs included nine conditions, and mortality was estimated for four perinatal and three adult conditions. Three mortality-related measures were estimated: deaths, years of potential life lost (YPLL) and the value of lost productivity. RESULTS: SHS-attributable healthcare costs totalled over $241 million. The most costly conditions for children and adolescents were attention deficit hyperactivity disorder ($7.8 million) and middle ear disease ($5.6 million). For adults, the most costly conditions were ischaemic heart disease (IHD) ($130.0 million) and asthma ($67.4 million). Deaths of 821 Californians were attributable to SHS exposure in the home, including 27 infants whose mothers smoked while pregnant and 700 adults who died from IHD. These deaths represented a loss of over 13 000 YPLL and $119 million in lost productivity. CONCLUSIONS: The economic impact of SHS exposure in the home totalled $360 million in California in 2009. Policies that reduce exposure to SHS at home have great potential for reducing healthcare and mortality costs.


Assuntos
Poluição do Ar em Ambientes Fechados/economia , Custos de Cuidados de Saúde , Fumar/economia , Poluição por Fumaça de Tabaco/economia , Adolescente , Adulto , Asma/economia , Asma/etiologia , California , Criança , Pré-Escolar , Feminino , Habitação , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/economia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/mortalidade , Gravidez , Risco , Fumar/efeitos adversos , Adulto Jovem
13.
Tob Control ; 24(e3): e199-204, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25293955

RESUMO

OBJECTIVE: Smoke-free policies aiming to improve quality of indoor air and significantly reduce exposure to secondhand smoke in the hospitality industry are faced with strong opposition from the tobacco industry and hospitality venue owners claiming that they lead to reductions of revenues. The objective of our study was to examine the impact of a recently introduced smoke-free legislation on the revenues of the hospitality industry in Cyprus. METHODS: Anonymous information on revenues was obtained from the Cyprus government value added tax office for the entire hospitality industry in Cyprus including hotels, bars, restaurants and cafeterias between 2005 and 2011. Panel data methodology was used to examine the effect of a smoke-free legislation, on tourism, businesses' revenues adjusting for gross domestic product, inflation, unemployment rate, tourists' arrivals, seasonal variation and the economic crisis. RESULTS: Our study showed that the implementation of the smoke-free policy did not have negative effects on the hospitality industry profitability. CONCLUSIONS: We conclude that even in regions with relatively high smoking rates, pro-smoking societal attitudes and weak social norms against tobacco control, and even during periods of economic crisis, smoke-free legislation does not impact negatively on hospitality industry revenues and if anything may lead to a small positive increase.


Assuntos
Poluição do Ar em Ambientes Fechados/economia , Comércio , Renda , Indústrias/economia , Política Antifumo/economia , Fumar/economia , Poluição por Fumaça de Tabaco/economia , Chipre , Humanos , Restaurantes/economia , Viagem/economia
14.
J Environ Health ; 76(9): 26-31, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24909010

RESUMO

While a number of studies have addressed the economic cost associated with adverse health and productivity effects of poor indoor air quality (IAQ), few have addressed the value of economic expenditures and job creation associated with this industry. This article estimates that the annual sale of IAQ products and services is valued at $18-$30 billion and is associated with approximately 150,000-250,000 current jobs. Compared with other familiar industries, the IAQ market remains relatively small. Given the close association between good IAQ and both job performance of adults and learning performance of children, however, the expenditure to maintain good IAQ in commercial and educational facilities is a useful complement to programs designed to improve education and economic growth.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/economia , Gastos em Saúde , Poluição do Ar em Ambientes Fechados/efeitos adversos , Modelos Econométricos , Estados Unidos
15.
Health Estate ; 68(2): 17-20, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24620486

RESUMO

managing director of Mycologia & Mould Worx, MSc, B.(Env. Sci.), TAE40110, examines the topic of mould exposure in healthcare facilities, and the associated duty of care for hospital facility managers and engineers. The article, published here in slightly adapted form, also focuses on the need for additional training of key personnel on the risks associated with exposure to environmental microbial contamination.


Assuntos
Exposição Ambiental/prevenção & controle , Fungos/patogenicidade , Ambiente de Instituições de Saúde/normas , Controle de Infecções/normas , Síndrome do Edifício Doente/prevenção & controle , Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/prevenção & controle , Austrália , Exposição Ambiental/efeitos adversos , Exposição Ambiental/economia , Ambiente de Instituições de Saúde/economia , Zeladoria Hospitalar/métodos , Zeladoria Hospitalar/normas , Humanos , Controle de Infecções/economia , Controle de Infecções/métodos , Serviço Hospitalar de Engenharia e Manutenção/economia , Serviço Hospitalar de Engenharia e Manutenção/métodos , Doenças Profissionais/economia , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Segurança do Paciente/economia , Segurança do Paciente/normas , Recursos Humanos em Hospital/educação , Síndrome do Edifício Doente/complicações , Síndrome do Edifício Doente/economia , Recursos Humanos
16.
Rev Gaucha Enferm ; 34(3): 64-71, 2013 Sep.
Artigo em Português | MEDLINE | ID: mdl-24344586

RESUMO

The purpose of this study was to identify the demands of home care of children born exposed to HIV in the perspective of the environmental theory. It consists of an exploratory descriptive qualitative study, developed between January and April of 2011. Study participants were ten HIV-infected mothers with infants exposed to the virus, living in Fortaleza, Ceará. The data collection instruments included a disposable digital camera and forms to obtain information on health associated with the home environment. Results were contextualized according to the theory and organized into the following categories: vulnerabilities associated with the physical structure of the house; contaminated intra and peridomestic air; unclean water used for drinking; sanitation and sewerage system; lighting and ventilation of the house. In conclusion, the home environment offers unfavorable environmental conditions for the child. Targeted interventions in the home environment are necessary so as to promote the health of children born exposed to HIV.


Assuntos
Exposição Ambiental , Saúde da Família , Infecções por HIV/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Habitação , Cuidado do Lactente , Determinantes Sociais da Saúde , Adolescente , Adulto , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Brasil , Exposição Ambiental/economia , Exposição Ambiental/estatística & dados numéricos , Saúde da Família/economia , Saúde da Família/estatística & dados numéricos , Feminino , Infecções por HIV/congênito , Infecções por HIV/transmissão , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Visita Domiciliar , Habitação/economia , Habitação/estatística & dados numéricos , Humanos , Higiene/economia , Higiene/normas , Lactente , Cuidado do Lactente/economia , Cuidado do Lactente/normas , Cuidado do Lactente/estatística & dados numéricos , Controle de Infecções , Transmissão Vertical de Doenças Infecciosas , Masculino , Modelos Teóricos , Fotografação , Pobreza , Gravidez , Complicações Infecciosas na Gravidez , Medição de Risco , Saneamento/economia , Saneamento/estatística & dados numéricos , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Poluição da Água/economia , Poluição da Água/estatística & dados numéricos , Abastecimento de Água/economia , Abastecimento de Água/estatística & dados numéricos , Adulto Jovem
17.
Environ Health ; 12(1): 77, 2013 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-24020494

RESUMO

BACKGROUND: Previous global burden of disease (GBD) estimates for household air pollution (HAP) from solid cookfuel use were based on categorical indicators of exposure. Recent progress in GBD methodologies that use integrated-exposure-response (IER) curves for combustion particles required the development of models to quantitatively estimate average HAP levels experienced by large populations. Such models can also serve to inform public health intervention efforts. Thus, we developed a model to estimate national household concentrations of PM2.5 from solid cookfuel use in India, together with estimates for 29 states. METHODS: We monitored 24-hr household concentrations of PM2.5, in 617 rural households from 4 states in India on a cross-sectional basis between November 2004 and March 2005. We then, developed log-linear regression models that predict household concentrations as a function of multiple, independent household level variables available in national household surveys and generated national / state estimates using The Indian National Family and Health Survey (NFHS 2005). RESULTS: The measured mean 24-hr concentration of PM2.5 in solid cookfuel using households ranged from 163 µg/m3 (95% CI: 143,183; median 106; IQR: 191) in the living area to 609 µg/m3 (95% CI: 547,671; median: 472; IQR: 734) in the kitchen area. Fuel type, kitchen type, ventilation, geographical location and cooking duration were found to be significant predictors of PM2.5 concentrations in the household model. k-fold cross validation showed a fair degree of correlation (r = 0.56) between modeled and measured values. Extrapolation of the household results by state to all solid cookfuel-using households in India, covered by NFHS 2005, resulted in a modeled estimate of 450 µg/m3 (95% CI: 318,640) and 113 µg/m3 (95% CI: 102,127) , for national average 24-hr PM2.5 concentrations in the kitchen and living areas respectively. CONCLUSIONS: The model affords substantial improvement over commonly used exposure indicators such as "percent solid cookfuel use" in HAP disease burden assessments, by providing some of the first estimates of national average HAP levels experienced in India. Model estimates also add considerable strength of evidence for framing and implementation of intervention efforts at the state and national levels.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Efeitos Psicossociais da Doença , Exposição Ambiental , Material Particulado/análise , Doenças Respiratórias/epidemiologia , Poluentes Atmosféricos/economia , Poluição do Ar em Ambientes Fechados/economia , Culinária , Exposição Ambiental/economia , Monitoramento Ambiental , Geografia , Humanos , Índia/epidemiologia , Modelos Teóricos , Tamanho da Partícula , Material Particulado/economia , Análise de Regressão , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/economia
18.
Rev. gaúch. enferm ; 34(3): 64-71, set. 2013. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: lil-695257

RESUMO

Objetivou-se identificar as demandas de cuidado domiciliar da criança nascida exposta ao HIV, sob a perspectiva da teoria ambientalista. Trata-se de estudo qualitativo exploratório-descritivo realizado de janeiro a abril de 2011. Participaram dez mães infectadas pelo HIV, com crianças nascidas expostas ao vírus, em Fortaleza, Ceará. Constituíram-se como instrumentos de coleta de dados: câmera fotográfica descartável e digital e formulários para captação de informações em saúde associadas ao ambiente domiciliar. Os resultados foram contextualizados de acordo com a teoria e organizados em categorias: "vulnerabilidades associadas à estrutura física da moradia"; "ar intradomiciliar e peridomiciliar impuro"; "água utilizada para consumo"; "rede de esgoto e saneamento"; "iluminação e ventilação da residência". Conclui-se que o ambiente domiciliar oferece condições ambientais desfavoráveis para a criança. Urge a realização de intervenções focalizadas no ambiente domiciliar, para promover a saúde da criança nascida exposta ao HIV.


Se objetivó identificar las demandas de atención en el hogar de los niños nacidos expuestos al VIH en la perspectiva de la teoría ambientalista. Estudio cualitativo exploratorio-descriptivo realizado entre enero y abril de 2011. Participaron diez madres VIH-positivas con bebés expuestos al virus, en Fortaleza, Ceará. Fueron instrumentos de recolección de datos: cámara desechable y digital y formularios para capturar información sobre la salud asociada con el ambiente del hogar. Los resultados fueron contextualizados de acuerdo a la teoría y organizado en categorías: vulnerabilidades asociadas con la estructura física de la casa; aire intra y peridoméstico impuro; agua utilizada para el consumo; saneamiento y alcantarillado; iluminación y ventilación de la residencia. Se concluye que el hogar ofrece condiciones ambientales desfavorables para el niño. Hay necesidad de intervenciones específicas en el entorno del hogar para promover la salud de los niños nacidos expuestos al VIH.


The purpose of this study was to identify the demands of home care of children born exposed to HIV in the perspective of the environmental theory. It consists of an exploratory descriptive qualitative study, developed between January and April of 2011. Study participants were ten HIV-infected mothers with infants exposed to the virus, living in Fortaleza, Ceará. The data collection instruments included: a disposable digital camera and forms to obtain information on health associated with the home environment. Results were contextualized according to the theory and organized into the following categories: vulnerabilities associated with the physical structure of the house; contaminated intra and peridomestic air; unclean water used for drinking; sanitation and sewerage system; lighting and ventilation of the house. In conclusion, the home environment offers unfavorable environmental conditions for the child. Targeted interventions in the home environment are necessary so as to promote the health of children born exposed to HIV.


Assuntos
Adolescente , Adulto , Feminino , Humanos , Lactente , Masculino , Gravidez , Adulto Jovem , Exposição Ambiental , Saúde da Família , Infecções por HIV/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Habitação , Cuidado do Lactente , Determinantes Sociais da Saúde , Poluição do Ar em Ambientes Fechados/economia , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Brasil , Exposição Ambiental/economia , Exposição Ambiental/estatística & dados numéricos , Saúde da Família/economia , Saúde da Família/estatística & dados numéricos , Infecções por HIV/congênito , Infecções por HIV/transmissão , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Visita Domiciliar , Habitação/economia , Habitação/estatística & dados numéricos , Higiene/economia , Higiene/normas , Cuidado do Lactente/economia , Cuidado do Lactente/normas , Cuidado do Lactente/estatística & dados numéricos , Controle de Infecções , Transmissão Vertical de Doenças Infecciosas , Modelos Teóricos , Fotografação , Pobreza , Complicações Infecciosas na Gravidez , Medição de Risco , Saneamento/economia , Saneamento/estatística & dados numéricos , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Poluição da Água/economia , Poluição da Água/estatística & dados numéricos , Abastecimento de Água/economia , Abastecimento de Água/estatística & dados numéricos
19.
Environ Health Perspect ; 121(7): 751-5, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23665813

RESUMO

BACKGROUND: Over the past two decades there has been a large migration of China's population from rural to urban regions. At the same time, residences in cities have changed in character from single-story or low-rise buildings to high-rise structures constructed and furnished with many synthetic materials. As a consequence, indoor exposures (to pollutants with outdoor and indoor sources) have changed significantly. OBJECTIVES: We briefly discuss the inferred impact that urbanization and modernization have had on indoor exposures and public health in China. We argue that growing adverse health costs associated with these changes are not inevitable, and we present steps that could be taken to reduce indoor exposures to harmful pollutants. DISCUSSION: As documented by China's Ministry of Health, there have been significant increases in morbidity and mortality among urban residents over the past 20 years. Evidence suggests that the population's exposure to air pollutants has contributed to increases in lung cancer, cardiovascular disease, pulmonary disease, and birth defects. Whether a pollutant has an outdoor or an indoor source, most exposure to the pollutant occurs indoors. Going forward, indoor exposures can be reduced by limiting the ingress of outdoor pollutants (while providing adequate ventilation with clean air), minimizing indoor sources of pollutants, updating government policies related to indoor pollution, and addressing indoor air quality during a building's initial design. CONCLUSIONS: Taking the suggested steps could lead to significant reductions in morbidity and mortality, greatly reducing the societal costs associated with pollutant derived ill health.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar em Ambientes Fechados/prevenção & controle , Exposição Ambiental , Política de Saúde/legislação & jurisprudência , Mudança Social , Poluição do Ar em Ambientes Fechados/economia , China , Cidades , Monitoramento Ambiental , Regulamentação Governamental , Humanos , Medição de Risco , Urbanização
20.
Ambio ; 41(3): 271-83, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22535426

RESUMO

Biomass fuels are used by the majority of resource poor households in low-income countries. Though biomass fuels, such as dung-briquette and firewood are apparently cheaper than the modern fuels indoor pollution from burning biomass fuels incurs high health costs. But, the health costs of these conventional fuels, mostly being indirect, are poorly understood. To address this gap, this study develops probit regression models using survey data generated through interviews from households using either dung-briquette or biogas as the primary source of fuel for cooking. The study investigates factors affecting the use of dung-briquette, assesses its impact on human health, and estimates the associated household health costs. Analysis suggests significant effects of dung-briquette on asthma and eye diseases. Despite of the perception of it being a cheap fuel, the annual health cost per household due to burning dung-briquette (US$ 16.94) is 61.3% higher than the annual cost of biogas (US$ 10.38), an alternative cleaner fuel for rural households. For reducing the use of dung-briquette and its indirect health costs, the study recommends three interventions: (1) educate women and aboriginal people, in particular, and make them aware of the benefits of switching to biogas; (2) facilitate tree planting in communal as well as private lands; and (3) create rural employment and income generation opportunities.


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Asma/etiologia , Biocombustíveis , Oftalmopatias/etiologia , Pobreza , População Rural , Poluição do Ar em Ambientes Fechados/economia , Asma/epidemiologia , Asma/prevenção & controle , Biocombustíveis/economia , Oftalmopatias/prevenção & controle , Características da Família , Feminino , Humanos , Nepal/epidemiologia
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