Household Air Pollution and Adult Lung Function Change, Respiratory Disease, and Mortality across Eleven Low- and Middle-Income Countries from the PURE Study.

BACKGROUND: Globally, household air pollution (HAP) is a major environmental hazard that affects respiratory health. However, few studies have examined associations between HAP and lung function decline and respiratory disease and mortality. METHODS: We used data from the Prospective Urban and Rural Epidemiology study and examined adults residing in 240 rural communities in 11 low- and middle-income countries where HAP from cooking with solid fuels is common. Spirometry was conducted for 28,574 individuals at baseline and 12,489 individuals during follow-up (mean of 8 y between spirometry measures). In cross-sectional analyses, we compared lung function measurements [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio] in those who used solid fuels for cooking in comparison with clean fuels. Using repeated measurements of lung function, we examined the percent change in lung function measures per year, comparing individuals by baseline fuel type and individuals who used solid fuels at baseline but switched to clean fuels during follow-up. We also examined associations with prospective health events (any respiratory diseases, respiratory disease hospitalizations, and all-cause mortality). RESULTS: In adjusted cross-sectional models, use of solid fuel in comparison with clean fuels was associated with lower FEV1 of -17.5mL (95% CI: -32.7, -2.3) and FVC of -14.4mL (95% CI: -32.0, 3.2), but not FEV1/FVC. In longitudinal analyses, individuals who switched from solid fuels to clean cooking fuels during follow-up (n=3,901, 46% of those using solid fuel at baseline), showed no differences in the annual rate of change in FEV1 or FVC, but had small improvements in FEV1/FVC change (0.2% per year, 95% CI: 0.03, 0.3). Individuals who switched from solid to clean fuels had a decreased hazard ratio for respiratory events of 0.76 (95% CI: 0.57, 1.00) in comparison with persistent solid fuel users, which was not attenuated by lung function measures. CONCLUSION: We observed modest associations between HAP exposure and lung function, lung function change, and respiratory disease and mortality. https://doi.org/10.1289/EHP11179.

Effects of repeated exposures to experimental cold pain stimulus on pain perception in healthy young Indian men.

Background: The influence of repeated exposures to cold pain stimulus, a surrogate of clinical pain, has remained largely unexplored. The study was planned to test the effect of repeated exposures to cold pain through cold pressor task on pain sensitivity and vascular reactivity. Methods: Single-group experimental study. Thirty-seven healthy male volunteers (18-25 years) were exposed to cold pressor tasks for seven consecutive days and on the 14th day on the nondominant hand. The same was repeated on dominant hand on first and seventh days; 31 completed the protocol. Results: Pain threshold and tolerance in the nondominant hand increased from day 1 to day 7 (p < 0.001) and were positively correlated on day 1 ( ρ =0.45, p = 0.011) and day 7 ( ρ =0.38, p = 0.036). Diastolic blood pressure response was found to increase by day 7 (p < 0.0024) and positively correlated with tolerance. On the dominant hand, the threshold reduced from day 1 to day 7, while tolerance increased. Both threshold and tolerance remained lower than that of nondominant hand. Day 14 values of threshold and tolerance were in between day 1 and day 7 values but not significantly different from both. Conclusion: Habituation in pain threshold and tolerance was observed on repeated exposure to cold pain, which was not significantly retained till the 14th day. The same was not observed with subjective feeling of pain perception. The increased diastolic blood pressure response is suggestive of peripheral vasoconstriction. Increased tolerance in the dominant hand by day 7 demonstrates a systemic effect in habituation.

Reflective narratives on unfolding ethics case vignettes: integration into the physiology course of first-year medical students.

Reflective narrative writing on unfolding ethics case vignettes has the potential to promote values like empathy among medical students, which will prove useful in their future. The objective of this study was to explore the scope of guided reflective narratives on unfolding ethics case vignettes integrated into physiology teaching to promote empathy among first-year medical students. First-year medical students (n = 150) were presented with unfolding case vignettes exploring ethical issues, as part of their physiology curriculum, with questions and prompts for a guided reflective narrative. Feedback about the program was obtained through a semistructured questionnaire. The contents of the students' reflective narratives and feedback were analyzed. The narratives revealed that students empathized with the various individuals involved in medical treatment and research, which was also reflected in student feedback (n = 116; 79%) and high Likert scale scores (74%). The program was considered effective by students in broadening their perspective and promoting critical thinking (n = 129; 88%). Through analysis of reflections, a rubric that would enable the evaluation of students' empathy on a scale of increasing ability to look at a situation from another's point of view emerged. This rubric could be used to quantitatively assess the impact of similar programs. Although divided in their individual opinions, the study population was able to relate to all individuals involved in medical practice and research, recognizing the need for fair and ethical practices. The content analysis led to the development of a rubric to grade empathy.NEW & NOTEWORTHY Unfolding case vignettes exploring ethical issues were introduced into the physiology curriculum of first-year medical students. The effectiveness of guided reflections following the case vignettes was explored. The analysis of the reflections and feedback on the program revealed that students became more empathetic. The reflections broadened their perspective and encouraged critical thinking. The analysis led to development of a rubric to grade the level of empathy, which can be used for quantitative assessment of empathy.

Introducing reflective narrative for first-year medical students to promote empathy as an integral part of physiology curriculum.

Guided reflective narratives facilitate deeper understanding and learning. The study was aimed at exploring the scope of guided reflective narratives on early clinical exposure, for first-year medical students, in promoting empathy. Strengths and limitations of the process of reflective narratives were also explored. First-year medical students (n = 150) were exposed to guided reflective narrative writing following each of the three "early clinical exposure" sessions integrated into a physiology curriculum. A feedback on the entire program was obtained through a semistructured questionnaire. The contents of the reflective narratives and feedback on the program were analyzed. Students empathized with the situation and needs of patients and caregivers and could relate to responsibilities and challenges faced by members of health care team. They realized the importance of cooperation from patients and caregivers and work efficiency, communication, behavior, and teamwork from members of healthcare and thereby emerged with the idea of the coordinated effort in patient care. Students opined that reflective narratives made them reflect and empathize with people and situations. Too many narrative writing sessions and hesitation to share their thoughts were some of the suggested limitations. The process led to emergence of a working model for guided reflections to promote empathy. Guided reflective narratives made students reflect and relate to people and situations. While promoting empathy, the reflections also gave them an idea of holistic approach to patient-centered care. Inferences led to a conceptual model for guided reflections to promote empathy among medical students.

Integrating Ethics into the Physiology curriculum: a scale-up study in three medical colleges in Karnataka, South India.

A published pilot study showed the feasibility of integrating ethics into physiology in a single medical college. However, questions were raised about feasibility of scale-up and acceptance across different colleges. To assess feasibility of integrating ethics into Physiology, first year MBBS students of three medical colleges (n=449, College A=149; 59M, 90F; College B=150; 78M, 72F; College C=150; 48M, 102F) were exposed to the integrated ethics programme. Triggers related to theory or practicals were included. Faculty volunteers conducted the sessions with feedback from observers and students. Students across three colleges felt that the programme was relevant (92%-98%), effectively integrated (86%-98%) [significantly greater number of College A students: (p=0.003)], seldom interfered with physiology teaching (59%-66%). Greater number of students from College C followed by College B and A opined to continue the integrated programme for future years (p=0.004). A scale-up study of integration of ethics programme across different colleges was perceived to be feasible by students and observers.