Effects of Ambient Air Pollutants on Hospital Admissions among Children Due to Asthma and Wheezing-Associated Lower Respiratory Infections in Mysore, India: A Time Series Study.

Air pollutants are known to trigger asthma and wheezing-associated lower respiratory infections in children, but evidence regarding their effect on hospital admissions in India is limited. We conducted a time-series study over a period of five years to assess the role of ambient air pollutants in daily asthma-related hospital admissions in children in Mysore, India. Daily asthma and wheeze (associated with lower respiratory infections) admissions were modelled using a generalised additive model (GAM) to examine the non-linear effects and generalised linear models (GLM) for linear effects, if any. Models were adjusted by day of the week and lag days, with smooth terms for time, maximum temperature, and relative humidity, and they were stratified by sex and age group. Of the 362 children admitted, more than 50% were boys, and the mean age was 5.34 years (±4.66). The GAMs showed non-linear associations between NO2, PM2.5, and NH3. For example, a 10 µgm-3 (or 10%) increase in NO2 increased admissions by 2.42. These non-linear effects were more pronounced in boys. A linear effect was detected for PM10 with a relative risk (95% CI) of 1.028, 1.013, and 1.043 with admission. Further research is needed to explore whether these findings can be replicated in different cities in India. Air pollution needs to be controlled, and policies that focus on lower cut-off levels for vulnerable populations are necessary.

The long-term effects of childhood adiposity on depression and anxiety in adulthood: A systematic review.

OBJECTIVE: This review aimed to evaluate the association between childhood adiposity and depression and anxiety risk in adulthood. METHODS: MEDLINE, PsychInfo, Embase, CINAHL, and Scopus were searched on June 6, 2022, to identify studies that investigated the association between childhood weight status (age ≤18 years) and outcomes of depression and/or anxiety in adulthood (age ≥19 years). Study quality was assessed using the Newcastle-Ottawa Scale and results were narratively synthesized. RESULTS: Sixteen studies were eligible for inclusion, with heterogeneity in methods and follow-up durations complicating comparisons. Six out of eight studies found a statistically significant association between childhood adiposity and increased likelihood of depression in adulthood, particularly in females. However, overall evidence was of moderate quality and study limitations prevented causal conclusions. In contrast, limited evidence and mixed findings were reported for the associations between childhood adiposity and depressive symptom severity or anxiety outcomes in adulthood. CONCLUSIONS: Evidence suggests that childhood adiposity is associated with greater vulnerability to depression in adulthood, particularly in females. However, further research is warranted to address the limitations discussed. Future research should also explore how changes in weight status from childhood to adulthood might differentially influence the likelihood of depression.

Do work-family conflict or family-work conflict mediate relationships between work-related hazards and stress and pain?

INTRODUCTION: Previous research has identified associations between work-family conflict (WFC) and health outcomes (e.g., musculoskeletal pain). This study investigated whether WFC and family-work conflict explain relationships between exposure to work-related hazards and musculoskeletal pain and stress for workers undertaking some or all of their work at home. Possible differences by home workspace location were also explored. METHODS: Longitudinal survey data were collected from workers in Australia engaged in work from home for at least two days per week. Data was collected at four timepoints approximately 6 months apart (Baseline [October 2020] n = 897; Wave 1 [May/June 2021] n = 368; Wave 2 [October/November 2021] n = 336; Wave 3 [May 2022] n = 269). Subjective measures of work-related psychosocial hazards, occupational sitting and physical activity, musculoskeletal pain, and stress were collected via an online questionnaire. Mediation analyses were conducted using the R package "mediation." Analyses were also conducted with the data set stratified by home office location, using R version 4.1.3. RESULTS: Both WFC and family-work conflict acted as mediators between psychosocial work-related hazards and musculoskeletal pain and stress. WFC mediated more relationships than family-work conflict. Location of home workspace was important, particularly for those working in a space at home where they may be subject to interruptions. CONCLUSION: Addressing WFC is a legitimate means through which musculoskeletal pain and stress can be reduced. Organizational risk management strategies need to address all work-related risks, including those stemming from work-life interaction.

The effect of preference and actual days spent working from home on stress and musculoskeletal pain in older workers.

OBJECTIVES: The rapid shift to working from home (WFH) due to the COVID-19 pandemic provided a unique opportunity to examine the relationship between preferred and actual days spent working from home on employees musculoskeletal pain (MSP) and stress in older workers. METHODS: This study uses three waves of data from the Employees Working from Home (EWFH) study collected in May 2021 (n = 451), November 2021 (n = 358) and May 2022 (n = 320) during the COVID-19 pandemic. A generalised mixed-effect model was used to model the relationships between preference and actual days spent WFH, stress and MSP. Exploratory mediation analysis was conducted to further explore significant relationships between actual days WFH and outcomes. RESULTS: WFH was associated with increasing stress levels in older participants, when the actual number of days WFH increased (B: 0.051, 95% CI: 0.008, 0.094) and when the number of days WFH exceeded their preferences (B: 0.218, 95% CI: 0.087, 0.349). Actual number of days spent WFH and stress in older employees was mediated through their sense of community (Indirect effect: 0.014, 95% CI: 0.003, 0.03; p = 0.006). The relationship between WFH and MSP was variable. For older employees, WFH more than their preferred number of days was associated with a higher likelihood of reporting MSP (OR: 4.070, 95% CI: 1.204, 13.757). CONCLUSIONS: Findings from this study support the need for flexible policies to support WFH which take into account employees preferences. For older workers, a sense of community was found to be important and proactive attempts to restore this will be important for maintain their health and supporting sustainable employment.

Life course BMI trajectories from childhood to mid-adulthood are differentially associated with anxiety and depression outcomes in middle age.

BACKGROUND/OBJECTIVE: Obesity is a risk factor for multimorbidity, including depression and possibly anxiety. However, it is currently unclear how patterns of change in BMI over the life course differentially influence the magnitude in risk of depression and anxiety in mid-adulthood. We aimed to examine associations between BMI trajectories from childhood to adulthood and the risk of depression and anxiety in middle age. METHODS: In the Tasmanian Longitudinal Health Study (n = 2416), five distinct BMI trajectories were previously defined from age 5 to 45 years using group-based modelling. At age 53, current depression and anxiety were assessed using the Patient Health Questionnaire and the Generalized Anxiety Disorder scale, respectively. Logistic regression models adjusted for potential confounders estimated associations between BMI trajectories and these outcomes. RESULTS: Those belonging to the child average-increasing (OR = 2.24; 95%CI: 1.24, 4.06) and persistently high (OR = 2.64; 1.26, 5.52) trajectories were more likely to have depression in middle age, compared to the persistently average trajectory. However, the odds of experiencing greater severity of depressive symptoms was highest in the child average-increasing group (OR = 2.36; 1.59, 3.49). Despite finding no evidence of association between BMI trajectories and current anxiety, we observed less severe symptoms in the child high-decreasing trajectory (OR = 0.68; 0.51, 0.91). CONCLUSION: We found an increased risk of depression in middle age among individuals with a persistently high BMI from childhood to mid-adulthood and individuals with an average BMI in childhood which then increased consistently throughout adulthood. Encouragingly, resolving childhood adiposity by adulthood was associated with lesser anxiety symptoms. Taken together, these findings highlight the need to target mental health screening and treatment towards high-risk BMI trajectory groups and the importance of early interventions to prevent and resolve excess weight.

The effects of weight change from childhood to adulthood on depression and anxiety risk in adulthood: A systematic review.

This review aimed to evaluate the effects of weight change from childhood to adulthood on depression and/or anxiety risk in adulthood. We systematically searched MEDLINE, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, and Scopus for longitudinal studies assessing changes in weight status between childhood (≤18 years) and adulthood (≥19 years) in association with outcomes of depression and/or anxiety in adulthood. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale, and data were narratively synthesized. Seventeen articles met our inclusion criteria: 13 evaluated outcomes of depression, one evaluated outcomes of anxiety, and five evaluated composite measures of depression and anxiety. Evidence was most consistent regarding outcomes of depression, with most finding that persistent and/or increasing adiposity from childhood to adulthood is associated with an increased risk of depression, particularly in women. However, heterogeneity and limitations in the evidence preclude definitive conclusions and inconsistent findings were reported in the few studies that assessed anxiety and composite outcomes. Overall, it appears that early intervention to both prevent or resolve excess weight may aid in reducing the burden of depression, along with mental health support targeting adolescents with persistent and/or increasing adiposity. However, further high-quality research is needed to address the methodological limitations discussed.

Employees Working from Home: Do Leadership Factors Influence Work-Related Stress and Musculoskeletal Pain?

In March 2020, the COVID-19 pandemic necessitated a rapid public health response, which included mandatory working from home (WFH) for many employees. However, given the rapid change from traditional ways of working, evidence is limited on the role of leaders, managers, and supervisors in supporting their employees' physical and mental health whilst WFH. The study aimed to examine the impact of leaders through their management of psychosocial working conditions on employees' stress and musculoskeletal pain (MSP) levels whilst WFH. METHODS: Data from 965 participants (230 males, 729 females, 6 other) involved in the Employees Working from Home (EWFH) study, collected in October 2020, and April and November 2021, were analysed. Generalised mixed-effect models were used to test relationships between psychosocial leadership factors and employees' stress and MSP levels. RESULTS: Higher quantitative demands are associated with increased stress (B: 0.289, 95%CI 0.245, 0.333), presence of MSP (OR: 2.397, 95%CI 1.809, 3.177), and increased MSP levels (RR: 1.09, 95%CI 1.04, 1.14). Higher levels of vertical trust decreased stress (B: -0.094, 95%CI -0.135, -0.052) and presence of MSP (OR: 0.729, 95%CI 0.557, 0.954). Role clarity decreased stress (B: -0.055, 95%CI -0.104, -0.007) and levels of MSP (RR: 0.93, 95%CI 0.89, 0.96). Working with interruptions was associated with increased stress (B: 0.199, 95%CI 0.119, 0.280) and MSP (OR: 1.834, 95%CI 1.094, 3.072). CONCLUSION: Leaders will need to take a broad view of job design, taking into account physical and psychosocial aspects of work, to effectively support employees WFH and manage stress and MSP.

Working from home during the COVID 19 pandemic: a longitudinal examination of employees' sense of community and social support and impacts on self-rated health.

BACKGROUND: The COVID 19 pandemic resulted in the introduction of public health measures including mandated and recommended work from home orders to reduce transmission. This provided a unique opportunity to examine sense of community and social support within the workplace and self-rated general health. This paper examines employees' workplace sense of community and social support across one year of the COVID 19 pandemic and associated self-rated general health. METHODS: Analysis of longitudinal data (October 2020, May 2021, and November 2021) from the Employees Working from Home study conducted in Victoria, Australia during the COVID 19 pandemic was undertaken. Trajectory analyses were used to describe workplace sense of community and social support over time. Multinomial logistic regression was used to determine the associations between demographics, gender, caring responsibilities, and group membership based on the Growth Mixture Modelling. Generalised Mixed Models were used to measure effects of sense of community and social support on self-rated health. RESULTS: Increasing sense of community and social support in the workplace resulted in increased self-rated health. Trajectory analysis found two stable and distinct groups for sense of community. Social support varied with time; however, trajectory membership was not dependent on gender or caring responsibilities and had no relationship with return to the office. CONCLUSION: Sense of community and social support in the workplace are important determinants of employees' health, and as such, workplace strategies to improve sense of community and social support are required not only for employees working from home, but also those who have returned to the office, particularly as hybrid work arrangements become more common.

Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health?

BACKGROUND: The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman's experience - with likely adverse effects on mental health and wellbeing. AIM: To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. METHODS: Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. FINDINGS: Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (-1.17, 95% CI: -1.81, -0.53) and the EPDS (-0.83, 95% CI: -1.5, -0.15). DISCUSSION: The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. CONCLUSION: This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.

Time Trends of Greenspaces, Air Pollution, and Asthma Prevalence among Children and Adolescents in India.

The prevalence of childhood asthma contributes to the global burden of the disease substantially. Air pollution in India has increased. In this study, we examine the associations among greenspaces, air pollution, and asthma prevalence in children and adolescents over a large, diverse population in India. We used state-wide global burden of disease data on asthma from age 0 to 19 years in 2005, 2011, and 2017. For greenspace, we used the normalized differential vegetation index (NDVI), which is the surface reflectance of light during photosynthetic activity. NDVI, air pollutants (PM2.5, PM10, SO2, NO2, and O3), weather, and socio-demographic factors were included in generalized estimating equation (GEE) models to estimate their associations with childhood asthma prevalence over time. Novel data visualization illustrated the complex spatial distributions. NDVI was associated with asthma prevalence (ß = 0.144; 95% CI = 0.10, 0.186; p < 0.0001) for high PM2.5, along with high levels of both gaseous air pollutants, SO2, and NO2 ((ß = 0.12; 95% CI = 0.08, 0.16; p < 0.0001) and (ß = 0.09; 95% CI = 0.05, 0.13; p < 0.0001)). However, NDVI and high O3, had a strong negative association with asthma prevalence (ß = -0.19; 95% CI = -0.26, -0.11; p < 0.0001). We observed additional effects of the interaction between the NDVI and high concentrations of PM2.5, PM10, NO2, and O3, assuming that these associations share a common pathway, and found interaction effects for asthma prevalence. Given the changing environmental conditions that interplay over geographical characteristics on the prevalence of asthma, further studies may elucidate a better understanding of these complex associations.

Working From Home During COVID-19: Does Work-Family Conflict Mediate the Relationship Between Workplace Characteristics, Job Satisfaction, and General Health?

OBJECTIVE: The aim of the study is to investigate whether work-family conflict and/or family-work conflict mediated the relationship between workplace characteristics and general health and job satisfaction in a sample of workers working from home in a recommended/mandatory context due to COVID-19 measures. METHODS: Data were collected via online questionnaire as part of the Employees Working from Home study. Analyses in this article used data collected at 2 time points 6 months apart, including 965 complete responses from the first questionnaire and 451 complete responses from the second questionnaire. RESULTS: Relationships between predictor and outcome variables were in the directions expected, and both work-family conflict and family-work conflict mediated these relationships. CONCLUSIONS: Work-life interaction partly explains the relationship between work characteristics and general health and job satisfaction health in a population undertaking involuntary working from home.

Musculoskeletal pain trajectories of employees working from home during the COVID-19 pandemic.

OBJECTIVES: In March 2020, the COVID-19 pandemic necessitated a rapid public health response which included mandatory working from home (WFH) for many employees. This study aimed to identify different trajectories of multisite musculoskeletal pain (MSP) amongst employees WFH during the COVID-19 pandemic and examined the influence of work and non-work factors. METHODS: Data from 488 participants (113 males, 372 females and 3 other) involved in the Employees Working from Home (EWFH) study, collected in October 2020, April and November 2021 were analysed. Age was categorised as 18-35 years (n = 121), 36-55 years (n = 289) and 56 years and over (n = 78). Growth Mixture Modelling (GMM) was used to identify latent classes with different growth trajectories of MSP. Age, gender, working hours, domestic living arrangements, workstation comfort and location, and psychosocial working conditions were considered predictors of MSP. Multivariate multinomial logistic regression was used to identify work and non-work variables associated with group membership. RESULTS: Four trajectories of MSP emerged: high stable (36.5%), mid-decrease (29.7%), low stable (22.3%) and rapid increase (11.5%). Decreased workstation comfort (OR 1.98, CI 1.02, 3.85), quantitative demands (OR 1.68, CI 1.09, 2.58), and influence over work (OR 0.78, CI 0.54, 0.98) was associated with being in the high stable trajectory group compared to low stable. Workstation location (OR 3.86, CI 1.19, 12.52) and quantitative work demands (OR 1.44, CI 1.01, 2.47) was associated with the rapid increase group. CONCLUSIONS: Findings from this study offer insights into considerations for reducing MSP in employees WFH. Key considerations include the need for a dedicated workstation, attention to workstation comfort, quantitative work demands, and ensuring employees have influence over their work.

Working from home in Australia during the COVID-19 pandemic: cross-sectional results from the Employees Working From Home (EWFH) study.

OBJECTIVES: To investigate the impacts, on mental and physical health, of a mandatory shift to working from home during the COVID-19 pandemic. DESIGN: Cross sectional, online survey. SETTING: Online survey was conducted from September 2020 to November 2020 in the general population. PARTICIPANTS: Australian residents working from home for at least 2 days a week at some time in 2020 during the COVID-19 pandemic. MAIN OUTCOME MEASURES: Demographics, caring responsibilities, working from home arrangements, work-related technology, work-family interface, psychosocial and physical working conditions, and reported stress and musculoskeletal pain. RESULTS: 924 Australians responded to the online questionnaire. Respondents were mostly women (75.5%) based in Victoria (83.7%) and employed in the education and training and healthcare sectors. Approximately 70% of respondents worked five or more days from home, with only 60% having a dedicated workstation in an uninterrupted space. Over 70% of all respondents reported experiencing musculoskeletal pain or discomfort. Gendered differences were observed; men reported higher levels of family to work conflict (3.16±1.52 to 2.94±1.59, p=0.031), and lower levels of recognition for their work (3.75±1.03 to 3.96±1.06, p=0.004), compared with women. For women, stress (2.94±0.92 to 2.66±0.88, p<0.001) and neck/shoulder pain (4.50±2.90 to 3.51±2.84, p<0.001) were higher than men and they also reported more concerns about their job security than men (3.01±1.33 to 2.78±1.40, p=0.043). CONCLUSIONS: Preliminary evidence from the current study suggests that working from home may impact employees' physical and mental health, and that this impact is likely to be gendered. Although further analysis is required, these data provide insights into further research opportunities needed to assist employers in optimising working from home conditions and reduce the potential negative physical and mental health impacts on their employees.

The association between outdoor allergens - pollen, fungal spore season and high asthma admission days in children and adolescents.

Periods when asthma admissions peaks have serious implications for asthma sufferers and hospitals. We assessed the association between aeroallergen exposure and childhood asthma peak periods during two grass pollen seasons using the Melbourne Air Pollen Children and Adolescent Health (MAPCAH) study conducted in Melbourne, Australia. Two peak periods were identified. Effect modifications by atopy and sex were considered. All pollen 2 days prior was associated with increased odds of these peak periods. Same day fungal spores, but not pollen, were important. Grass at lag 2 was associated with increased odds 1.03 (95%CI 1.01, 1.05) as was the same day Alternaria 1.02 (1.00, 1.04) per spore/m3 for boys. In addition to pollen, fungal spores particularly Alternaria may result in days of high exacerbations during pollen seasons. Further guidance is needed to better prepare families/carers with information about the increased risk of asthma attacks in children prior to pollen seasons.

Prospective BMI changes in preschool children are associated with parental characteristics and body weight perceptions: the ToyBox-study.

OBJECTIVE: To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. DESIGN: A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children's body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used. SETTING: Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). PARTICIPANTS: A sample of 6268 preschoolers aged 3·5-5·5 years (51·9 % boys). RESULTS: There was no intervention effect on the change in children's BMI percentile. However, parents' underestimation of their children's actual weight status, parental overweight and mothers' pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children's BMI percentile in multivariate modelling. CONCLUSIONS: As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children's weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.

Working at Home: The Impacts of COVID 19 on Health, Family-Work-Life Conflict, Gender, and Parental Responsibilities.

OBJECTIVE: To examine the impact of working at home on general health, pain, stress, and work-family and family-work conflict, and differences based on gender and parental responsibilities. METHODS: A convenience sample of 658 adults completed an online questionnaire. Regression modeling examined the effects and interactions of gender and parental responsibility on general health, musculoskeletal discomfort/pain frequency and severity, stress, and work-family and family-work conflict. RESULTS: Women reported more pain and discomfort, regardless of the presence of children, than men with children. Women with children experienced increased stress compared with men with children. Women without children experienced less work-family conflict, and those without children experienced less family-work conflict than men with children. CONCLUSIONS: The impact on pain, stress, and work-family and family-work conflict, due to mandated working at home, is gendered and influenced by parental responsibilities.

Potential role of folate status on pulmonary function in pediatric asthma.

OBJECTIVE: The aim of this study was to explore the relationship between plasma folate status and measures of airway disease (as reflected by spirometry) in children with asthma on a traditional Mediterranean diet. We hypothesized that folate deficiency is associated with lung function impairment in this group of children. METHODS: This cross-sectional study included 64 children with mild asthma (52% boys, mean age 8 ± 2 y) residing in Athens, Greece. Clinical assessments included spirometry and fractional exhaled nitric oxide (FeNO). Plasma 5-methyltetrahydrofolate (5-MTHF) was analyzed using high performance-liquid chromatography assay and examined in participants using quartiles (Q1-Q4). RESULTS: Of the 64 children, 45.3% were folate deficient (5-MTHF <10 nmol/L). A positive relationship was observed between 5-MTHF and forced vital capacity (FVC; ß = 0.79, 95% confidence interval (CI), 0.14-1.44; adjusted P = 0.019), forced expiratory volume in 1s (FEV1) (ß = 0.78; 95% CI, 0.01-1.55; adjusted P = 0.046), and peak expiratory flow (PEF; ß = 1.64; 95% CI, 0.14-3.15; adjusted P = 0.033) in girls only, adjusting for body mass index and regular exercise. Girls with low plasma folate concentrations (Q1), compared with girls with high concentrations (Q4) had 8.64% lower FVC (ß = -8.64; 95% CI, -16.18 to -1.09; adjusted P = 0.027), 10.35% FEV1 (ß = -10.35; 95% CI, -18.82 to -1.89; adjusted P = 0.019), and 18.72% PEF (ß = -18.72; 95% CI, -36.30 to -1.14; adjusted P = 0.038). CONCLUSION: The findings of this study highlighted the potential negative effects of folate deficiency on pulmonary function in girls with asthma, the importance of monitoring folate status in children with asthma, and early prevention strategies.

Ambient pollen concentrations and asthma hospitalization in children and adolescents: a systematic review and meta-analysis.

ObjectiveWe aimed to conduct a systematic review examining the association between outdoor pollen and childhood asthma hospitalizations.Data SourceA systematic search of articles in MEDLINE, EMBASE, CINAHL, ProQuest Central, Web of Science and Google Scholar published to 18 July 2019.Study selection: Studies that presented data on pollen exposure and childhood asthma hospitalization were included and evaluated for potential risk of bias by two independent authors. Random effects meta-analysis was performed where possible.ResultsA total of 1048 records were identified, and twelve studies included in the review. The synthesis suggested possible associations between outdoor pollen, especially for grass and birch and childhood asthma hospitalization. However, the results varied widely across geographical areas and settings for other pollen taxa. The meta-analysis of the case-crossover studies showed a positive association between grass and childhood asthma hospitalization, an increase in 10 grass pollen grains/m3 was associated with a 3% increase in childhood asthma admission (OR = 1.03; 95%CI:1.01, 1.04), but the pooled estimate was not significant for timeseries studies. The meta-analysis of the timeseries studies for birch pollen showed an increase in 10 pollen grains/m3 being significantly associated with a Mean Percentage Change (MPC) in childhood asthma admissions (MPC= 0.85; 95%CI:0.40, 1.30).Conclusion: Globally, grass and birch pollen are important triggers of childhood asthma hospitalization, but the association could not be ascertained for other pollen taxa. Pollen is a major environmental trigger of asthma exacerbations and more focus on early interventions to reduce this burden needs to be considered.

A systematic review of the evidence of outdoor air pollution on asthma hospital visits in children and adolescents in South Asia - a call for data.

Background: Outdoor air pollution and childhood asthma are increasing problems in South Asian countries. However, little is known about the associations between levels of air pollution and severe childhood asthma requiring hospital treatment in these regions. Methods: We undertook a systematic review to assess the evidence between outdoor air pollution exposure and childhood and adolescent asthma hospitalization in South Asia. MEDLINE, Web of Science, Google Scholar, CINAHL, Embase, Scopus, ProQuest Central databases were searched for peer-reviewed papers, and examination of reference lists was conducted for additional studies. We identified all the literature published in English up to January 2021 for the study population comprised of children aged less than 19 years. The search strategy was designed to identify all the studies and screen them as per the inclusion criteria. The method of qualitative synthesis using the standard tool determined the comprehensiveness of the assessment of bias. Results: Of the original 367 studies screened three studies were ultimately included from India, Pakistan and Sri Lanka and a narrative synthesis was conducted. Although studies reported adverse effects of outdoor pollution on asthma hospitalizations, limitations in exposure assessments, varying definitions of asthma hospitalizations and limited data analysis were identified. Conclusions: There is currently limited evidence that can provide meaningful risk estimates of the impact of outdoor air pollution on asthma hospitalizations during childhood and adolescence. Studies with comparable outcome definitions, appropriate exposure assessments and study designs are needed to inform future public and environmental health policy. PROSPERO registration: CRD42020156714 (28/04/2020).