Cost of TB prevention and treatment in the Philippines in 2017.

BACKGROUND: The Philippines aims to accelerate TB reduction through the provision of universally accessible and affordable services. The objectives of this paper are to estimate the costs of TB services and interventions using a health systems´ perspective, and to explore cost differences in service delivery via primary care facilities or hospitals.METHODS: Data were collected from a multi-stage stratified random sampling of 28 facilities in accordance with Global Health Cost Consortium costing standards and analysis tools. Unit costs (in US$) estimated using top-down (TD) and bottom-up (BU) approaches, are summarised following Value TB reporting standards and by broad facility type.RESULTS: Cost of delivering 32 TB services and eight interventions varied by costing method and delivery platform. Average BU costs ranged from US$0.38 for treatment support visits, US$2.5 for BCG vaccination, US$19.48 for the Xpert® MTB/RIF test to US$3,677 for MDR-TB treatment using the long regimen. Delivering TB care in hospitals was generally more costly than in primary care facilities, except for TB prevention in children and MDR-TB treatment using the long regimen.CONCLUSION: Comprehensive costing data for TB care in the Philippines are now available to aid in the design, planning, and prioritisation of delivery models to End TB.

Understanding the local and remote source contributions to ambient O3 during a pollution episode using a combination of experimental approaches in the Guadalquivir valley, southern Spain.

The Guadalquivir Valley is one of three major O3 hotspots in Spain. An airborne and surface measurement campaign was carried out from July 9th to 11th, 2019 to quantify the local/regional O3 contributions using experimental approaches. Air quality and meteorology data from surface measurements, a microlight aircraft, a helium balloon, and remote sensing data (TROPOMI-NO2-ESA) were used to obtain the 3D distribution of O3 and various tracer pollutants. O3 accumulation over 2.5 days started with inputs from oceanic air masses transported inland by sea breezes, which drew O3 and its precursors from a local/regional origin to the northeastern end of the basin. The orographic-meteorological setting of the valley caused vertical recirculation of the air masses inside the valley that caused the accumulation by increasing regional background O3 concentration by 25-30 ppb. Furthermore, possible Mediterranean O3 contributions and additional vertical recirculation through the entrainment zone of the convective boundary layer also contributed. Using particulate matter finer than 2.5 µm (PM2.5), ultrafine particles (UFP), and black carbon (BC) as tracers of local sources, we calculated that local contributions increased regional O3 levels by 20 ppb inside specific pollution plumes transported by the breeze into the valley, and by 10 ppb during midday when flying over an area with abundant agricultural burning during the morning. Air masses that crossed the southern boundaries of the Betic system at mid-altitude (400-1850 m a.s.l.) on July 10th and 11th may have provided additional O3. Meanwhile, a decreasing trend at high altitudes (3000-5000 m a.s.l.) was observed, signifying that the impact of stratospheric O3 intrusion decreased during the campaign.

Hydrogen fluoride concentrations in ambient air of an urban area based on the emissions of a major phosphogypsum deposit (SW, Europe).

Hydrogen fluoride (HF) is one of the most toxic gaseous compounds in air, the primary anthropogenic source of which is industrial activity, specifically fertilizer and waste. HF concentrations in an urban area (Huelva, SW Spain) related to a nearby major phosphogypsum (PG) deposit were measured by passive sampling during summer and winter months from 2014 to 2017 and high-resolution sampling during 2017 and 2017-2018 using an HF analyser. An HF geochemical anomaly was found in the PG pond with average concentrations of up to 19.1 µg/m3, and concentrations of up to 1.6 µg/m3 were exhibited in the nearest urban area. The concentrations were associated with the HF emissions from the PG deposit. Emission factors were calculated by field and laboratory experiments, and the brines exhibited the highest emission factor (2.7 kg/ha day). Several impacts of HF (>0.1 µg/m3) in the city were recorded throughout the year, occurring at noon in the summer and during fog events in the winter. Consequently, the PG system should be restored to protect the population living in Huelva from the impacts of HF emission.

Long term geochemical variation of brines derived from a major phosphogypsum pond of SW Europe.

The chemical evolution of brines resulting from an inactive phosphogypsum pond derived of fertilizer industry located in Huelva (Spain, SW Europe) has been studied based on a weekly sampling from 2014 to 2017. Long-range time variation of metals and ions concentrations in brines are expected to depend on environmental parameters such as rainfall and evaporation. The results show that brines are enriched in F- (1.7-2.0 g/l), Cl- (13-24 g/l), SO42- (7.2-9.3 g/l), V (70-128 mg/l) and U (55-98 mg/l). A great variation of chemical concentrations has been found, due to dilution, recharge and evaporation processes. Most of the elements show peak concentrations in summer, coinciding with the lowest pH values (<1), high conductivity (>133 mS/cm), and high evaporation rates as expected. Nonetheless, F- shows an opposite behaviour, varying its concentrations between 0.9 g/l in summer and 3.7 g/l in the rainy season. According to the results, a future restoration plan for PG ponds should include the removal of brines and layered salts during summer in order to avoid the annual generation of brines and their impact on the environment.

Trends and sources vs air mass origins in a major city in South-western Europe: Implications for air quality management.

This study presents a 17-years air quality database comprised of different parameters corresponding to the largest city in the south of Spain (Seville) where atmospheric pollution is frequently attributed to traffic emissions and is directly affected by Saharan dust outbreaks. We identify the PM10 contributions from both natural and anthropogenic sources in this area associated to different air mass origins. Hourly, daily and seasonal variation of PM10 and gaseous pollutant concentrations (CO, NO2 and SO2), all of them showing negative trends during the study period, point to the traffic as one of the main sources of air pollution in Seville. Mineral dust, secondary inorganic compounds (SIC) and trace elements showed higher concentrations under North African (NAF) air mass origins than under Atlantic. We observe a decreasing trend in all chemical components of PM10 under both types of air masses, NAF and Atlantic. Principal component analysis using more frequent air masses in the area allows the identification of five PM10 sources: crustal, regional, marine, traffic and industrial. Natural sources play a more relevant role during NAF events (20.6 µg · m(-3)) than in Atlantic episodes (13.8 µg · m(-3)). The contribution of the anthropogenic sources under NAF doubles the one under Atlantic conditions (33.6 µg · m(-3) and 15.8 µg · m(-3), respectively). During Saharan dust outbreaks the frequent accumulation of local anthropogenic pollutants in the lower atmosphere results in poor air quality and an increased risk of mortality. The results are relevant when analysing the impact of anthropogenic emissions on the exposed population in large cities. The increase in potentially toxic elements during Saharan dust outbreaks should also be taken into account when discounting the number of exceedances attributable to non-anthropogenic or natural origins.

Modeling and evaluation of urban pollution events of atmospheric heavy metals from a large Cu-smelter.

Metal smelting and processing are highly polluting activities that have a strong influence on the levels of heavy metals in air, soil, and crops. We employ an atmospheric transport and dispersion model to predict the pollution levels originated from the second largest Cu-smelter in Europe. The model predicts that the concentrations of copper (Cu), zinc (Zn), and arsenic (As) in an urban area close to the Cu-smelter can reach 170, 70, and 30 ng m−3, respectively. The model captures all the observed urban pollution events, but the magnitude of the elemental concentrations is predicted to be lower than that of the observed values; ~300, ~500, and ~100 ng m−3 for Cu, Zn, and As, respectively. The comparison between model and observations showed an average correlation coefficient of 0.62 ± 0.13. The simulation shows that the transport of heavy metals reaches a peak in the afternoon over the urban area. The under-prediction in the peak is explained by the simulated stronger winds compared with monitoring data. The stronger simulated winds enhance the transport and dispersion of heavy metals to the regional area, diminishing the impact of pollution events in the urban area. This model, driven by high resolution meteorology (2 km in horizontal), predicts the hourly-interval evolutions of atmospheric heavy metal pollutions in the close by urban area of industrial hotspot.

Arsenic species in atmospheric particulate matter as tracer of the air quality of Doñana Natural Park (SW Spain).

Sampling and chemical analyses, including major compounds and trace elements, of atmospheric particulate matter (PM10 and PM2.5) have been performed during 2006-2007 in a regional background monitoring station located within the Doñana Natural Park (SW of Spain). This region is strategic for air quality and climate change studies, representing a meeting place of the European and African continents, and the Atlantic Ocean and Mediterranean Sea. The present study based on meteorological parameters demonstrated long-range transport and impact of industrial plumes on the Doñana Natural. Inorganic arsenic species (arsenate and arsenite) have been analyzed in particulate matter (PM) to characterize the impact of near Cu-smelter plumes and demonstrated the long-range transport of industrial pollutants. As(V) is the main specie of As and varies between 95% and 98% of total As in PM10 and 96-97% in PM2.5. The As(V)/As(III) ratio measured in emission plumes of a Cu-smelter are similar to the ratio found in the Doñana Natural Park. The application of Positive Matrix Factorization (PMF) to atmospheric particulate matter estimated the contributions and chemical profiles of natural and anthropogenic sources impacting the Natural Park, demonstrating the industrial origin of the As and other toxic elements in the air.

Characterization and origin of EC and OC particulate matter near the Doñana National Park (SW Spain).

In the South of Spain, major industrial estates (e.g. Huelva) exist alongside ecologically interesting zones (e.g. Doñana National Park). Between June 2005 and June 2006, PM10 and PM2.5 were measured, for total mass, organic carbon (OC) and elemental carbon (EC) chemical composition, at a station in an ecologically interesting area located near Doñana National Park and an urban background area with industrial influence. The mean OC concentration is higher in the urban background (3.5 microg m(-3)) than in the rural monitoring station (2.8 microg m(-3)) as a consequence of local emissions (e.g. traffic). A total of 82% of TC is OC in the rural station, while the urban background station reveals 70% and 73% of TC in the PM10 and PM2.5 mass, respectively. The study of air-mass origin and characterization of carbonaceous species in the course of simultaneous sampling in rural and urban background monitoring stations differentiated three long-range air-mass transports: a North-African dust outbreak, Atlantic Advection and Continental (N-NW) episodes, the origins of the first and last of which are more heavily influenced by the anthropogenic emissions from industrial estates located around the city of Huelva (Punta del Sebo and Nuevo Puerto). Higher values were measured for OC and EC in the study area during the North-African dust outbreak, similar to those obtained during the Continental episode (N-NW), which was clearly influenced by industrial emissions, followed by the Atlantic Advection episodes. The comparison of carbon species with air-mass origin can help to discriminate the origin and source of particulate matter, as well as to determine the urban impact on rural areas.

Estudo de óbitos por doença respiratória aguda (DRA) em crianças através de diagrama de controle / Study of acute respiratory disease in children by the method of the control diagnosis

Diagramas foram feitos a partir do número de mortes, por doenças respiratórias agudas (DRA), com o cálculo do número médio e dos desvios padröes, ocorridas semanalmente na capital e no interior do Estado do Rio Grande do Sul, no período entre 1984 e 1988. Desse modo, níveis de localizaçäo de pontos puderam ser delimitados. Estudando as mortes ocorridas em 1989 com esses diagramas, foi possível avaliar a utilidade dessa metodologia para o acompanhamento das atividades de um Programa de Controle em DRA. Além disso, apesar de a análise incluír um período curto para conclusöes definitivas, pode-se inferir que há tendência de declínio do programa, já que a maioria dos pontos se localizou abaixo da média dos últimos anos