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Chemical characterization, sources and potential health risk of PM2.5 and PM1 pollution across the Greater Athens Area.

Pateraki, St; Asimakopoulos, D N; Maggos, Th; Assimakopoulos, V D; Bougiatioti, A; Bairachtari, K; Vasilakos, Ch; Mihalopoulos, N
| Idioma(s): Inglés
With the principal aim to assess the typical Mediterranean profile of the PM2.5 and PM1 pollution, three intensive monitoring campaigns took place simultaneously within different types of environment across an urban location of the basin. Focusing on the PM components with numerous anthropogenic sources and increased potential health risk, the samples were chemically analyzed for 20 p.m.-bound Polycyclic Aromatic Hydrocarbons (PAHs). Carbonaceous and ionic constituents were quantified as well. In order to uncover the spatiotemporal variation of the PM profile the key sources were identified, the seasonal effects and the role of the prevailing mesoscale atmospheric circulation were evaluated and most importantly the potential health risk was estimated. In general, the pollution status of the basin was the result of a complex interaction between the local and external input with Particulate Organic Matter (POM) and Secondary Inorganic Aerosols (SIA) being the main aerosols' components. PM1 was a better indicator of the anthropogenic emissions while according to the results of factor analysis the co-existence of various combustion sources was determinant. Chemically, the maxima of the ΣPAHs, the differentiation of their structure in accordance with their molecular weight and the distribution of the individual compounds confirmed the significance of the emission sources. Similarly, the estimated carcinogenicity/mutagenicity was emission-dependent with the maximum contribution coming from B[a]P, IndP, B[ghi]Per, B[e]P and B[b]F. Seasonally, the highest potential health risk of the PAHs' mixture was recorded during the cold season while meteorologically, it was mostly associated with the south flow.
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A comparative study of elemental pollution and health risk assessment in urban dust of different land-uses in Tehran's urban area.

Mihankhah, Taraneh; Saeedi, Mohsen; Karbassi, Abdolreza
| Idioma(s): Inglés
Pollution levels of potentially toxic metals (PTMs) were studied performing enrichment factor, geo-accumulation index and ecological risk index. The most enriched elements which categorize as very high and extremely high enriched in different land-uses were in order of: commercial Cu (73.79)>Hg (66.55)>Pb (55.73)>Zn (46.15)>Cd (37.31); residential Pb (48.35)>Zn (34.79)>Cu (27.69)>Hg (22.96)>Cd (22.61) and industrial Zn (55.43)>Pb (51.52)>Cu (40.20)>Cd (26.29). In green lands sampling points, there weren't any elements with enrichment factor more than twenty. Based on the result of geo-accumulation index, commercial land-use appeared to be highly polluted with Cu, Pb and Zn. Residential land-use were highly polluted just in case of lead and industrial land-use were categorized as highly polluted in case of Zn, Pb and Cu. Hakanson's ecological risk index classified all of the land-uses except for green lands as very high ecological risk category. Factor analysis revealed that Cr, Mn, Ni, Fe and to a lesser extent Pb, Zn and As are from similar anthropogenic sources. Carcinogenic risk of Cr, Pb, As, Ni and Cd were found to be negligible for all land-uses for adult and children except for chromium in commercial land-use which exceed the safe level and need more attention in the future.
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The crowding out effect of out-of-pocket medication expenses of two major non-communicable diseases in Pakistan.

Datta, Biplab K; Husain, Muhammad J; Fatehin, Sohani
| Idioma(s): Inglés
BACKGROUND: Elevated blood pressure (i.e. hypertension) and diabetes (BPD) are the two major noncommunicable diseases that expose households to high out-of-pocket treatment costs in low- and middle-income countries. Medication is the biggest share of BPD treatment expenses, and households with someone suffering from BPD may need to adjust consumption of other commodities to pay for essential BPD medicines. We assess how BPD medication expenditures are associated with crowding out of other household commodities in Pakistan. METHODS: We analyze self-reported household consumption data from the nationally representative Pakistan Household Income and Expenditure Survey 2015-16. We estimate conditional Engel curves under the Quadratic Almost Ideal Demand System framework to examine the differences in average consumption shares between BPD medication-consuming and not-consuming households. RESULTS: We find that BPD medication expenditures are associated with crowding out of food and crowding in of other medical expenditures for all households, but the magnitudes of crowding out and crowding in are larger for the poorer households. BPD medication spending is also associated with crowding out of education and personal care for middle-class and wealthier households. CONCLUSIONS: Our results indicate that allocations for essential commodities, like food and education, are lower for BPD medication-consuming households and inform policies for preventive health promotions and affordable treatment for hypertension and diabetes.
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Decomposition Analysis of Spending and Price Trends for Biologic Antirheumatic Drugs in Medicare and Medicaid.

McCormick, Natalie; Wallace, Zachary S; Sacks, Chana A; Hsu, John; Choi, Hyon K
| Idioma(s): Inglés
OBJECTIVE: Billions of public dollars are spent each year on biologic disease-modifying antirheumatic drugs (DMARDs), but the drivers of recent increases in biologic DMARD spending are unclear. This study was undertaken to characterize changes in total spending and unit prices for biologic DMARDs in Medicare and Medicaid programs and quantified the major sources of these spending increases. METHODS: We accessed drug spending data from years 2012-2016, covering all Medicare Part B (fee-for-service), Medicare Part D, and Medicaid enrollees. After calculating 5-year changes in total spending and unit prices for each biologic DMARD as well as in aggregate, we performed standard decomposition analyses to isolate 4 sources of spending growth: drug prices, uptake (number of recipients), treatment intensity (mean number of doses per claim), and treatment duration (annual number of claims per recipient), both excluding and including time-varying rebates. RESULTS: From 2012 to 2016, annual spending on public-payer claims for the 10 biologic DMARDs included in this study more than doubled ($3.8 billion to $8.6 billion), with median drug price increases of 51% in Medicare Part D (mean 54%) and 8% in Medicare Part B (mean 21%). With adjustment for general inflation, unit price increases alone accounted for 57% of the 5-year, $3.0 billion spending increase in Part D, while 37% of the spending increase was from increased uptake. Accounting for time-varying rebates, prices were still responsible for 54% of increased spending. Unit prices and spending were lower under Medicaid than under Medicare Part D, though temporal trends and contributors were similar. CONCLUSION: Postmarket drug price changes alone account for the majority of the recent spending growth in biologic DMARDs. Policy interventions targeting price increases, particularly those under Medicare Part D plans, may help mitigate financial burdens for public payers and biologic DMARD recipients.
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Global Trends in Bumble Bee Health.

Cameron, Sydney A; Sadd, Ben M
| Idioma(s): Inglés
Bumble bees (Bombus) are unusually important pollinators, with approximately 260 wild species native to all biogeographic regions except sub-Saharan Africa, Australia, and New Zealand. As they are vitally important in natural ecosystems and to agricultural food production globally, the increase in reports of declining distribution and abundance over the past decade has led to an explosion of interest in bumble bee population decline. We summarize data on the threat status of wild bumble bee species across biogeographic regions, underscoring regions lacking assessment data. Focusing on data-rich studies, we also synthesize recent research on potential causes of population declines. There is evidence that habitat loss, changing climate, pathogen transmission, invasion of nonnative species, and pesticides, operating individually and in combination, negatively impact bumble bee health, and that effects may depend on species and locality. We distinguish between correlational and causal results, underscoring the importance of expanding experimental research beyond the study of two commercially available species to identify causal factors affecting the diversity of wild species.
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Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda.

Munyaneza, Martin; Jayaraman, Sudha; Ntirenganya, Faustin; Rickard, Jennifer
| Idioma(s): Inglés
BACKGROUND: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS: This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS: Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS: In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.
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Studying the impact of built environments on human mental health in everyday life: methodological developments, state-of-the-art and technological frontiers.

Reichert, Markus; Braun, Urs; Lautenbach, Sven; Zipf, Alexander; Ebner-Priemer, Ulrich; Tost, Heike; Meyer-Lindenberg, Andreas
| Idioma(s): Inglés
Rapid worldwide urbanization benefits humans in many aspects, but the prevalence of common psychiatric disorders is increased in urban populations. While the impact of city living and urban upbringing on mental health is well established, it remains elusive which of the multiple factors of urban living convey risk and resilience for mental disorders. For example, air pollutants, traffic noises and fragmented social networks are some of the highly interdependent and complex influences of city living suggested to be detrimental for mental health. In contrast, urban green spaces, social contacts and physical activity have been associated with increased well-being. Knowledge on underlying mechanisms of these associations is crucial for both city planning and healthcare as it informs on how to build environments and to intervene in a way that fosters mental health yet reduces psychiatric disorders. Thus, real-life studies in urban contexts have been launched making use of recent methodological advancements: Mobile devices (e.g. smartphones) to gather intensive longitudinal mental health data, stationary sensor output providing specific context information (e.g. on weather conditions and air pollution), combinations with traditional and modern neuroimaging techniques (e.g. functional near-infrared spectroscopy and portable magnetic-encephalogram caps) and modern virtual reality setups allowing for increasingly realistic and ecological valid simulation of complex urban environments. Here we review selected methodological developments, state-of-the-art approaches as well as technological frontiers and provide examples for their application, highlighting promising potential of these novel methods for tackling the urgent urbanicity societal issue of the 21st century with a view to improve urban contexts conducive to mental health.
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The high-resolution estimation of sulfur dioxide (SO2) concentration, health effect and monetary costs in Beijing.

Wu, Yu; Li, Rui; Cui, Lulu; Meng, Ya; Cheng, Hanyun; Fu, Hongbo
| Idioma(s): Inglés
Severe air pollution episodes with high SO2 loading have been frequently observed during the last decades in Beijing and have caused a noticeable damage to human health. To advance the spatiotemporal prediction of SO2 exposure in Beijing, we developed the monthly land use regression (LUR) models using daily SO2 concentration data collected from 34 monitoring stations during 2016 and 7 categories of potential independent variables (socio-economic factors, traffic and transport, emission source, land use, meteorological data, building morphology and Geographic location) in Beijing. The average adjusted R2 of 12 final LUR models was 0.62, and the root-mean-squared error (RMSE) was 4.12 µg/m3. The LOOCV R2 and RMSE of LUR models reached 0.56 and 5.43 µg/m3, respectively, suggesting that the LUR models achieved the satisfactory performance. The prediction results suggested that the average SO2 level in Beijing was 11.06 µg/m3 with the highest one up to 22.49 µg/m3 but the lowest one down to 3.86 µg/m3. The SO2 exposure showed strong spatial heterogeneity, which was much higher in the southern area than that in the northern in Beijing. The mortality and morbidity due to the excessive SO2 concentration were estimated to be 73 (95% CI:(38-125)) and 27854 (95% CI:(13852-41659)) cases per year in Beijing, leading to economic cost of 35.76 (95% CI:(16.45-54.06)) and 441.47 (95% CI:(318.31-562.04)) million RMB Yuan in 2016, respectively. This study clarified the intra- and inter-regional transport modeling of the SO2 pollution in Beijing and supplied an important support for the future air-quality and public health management strategies.
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Sociodemographics, lifestyle factors and health status indicators associated with alcohol consumption and related behaviours: a Brazilian population-based analysis.

Sandoval, G A; Monteiro, M G; De Pinho Campos, K; Shield, K; Marinho, F
| Idioma(s): Inglés
OBJECTIVES: To investigate how various alcohol-drinking behaviours are associated with sociodemographics, lifestyle factors and health status indicators in Brazil. STUDY DESIGN: This study is based on a household survey of 53,034 adults aged 18 + years from all 26 Brazilian capitals and the Federal District conducted in 2017. METHODS: Sex-stratified relationships were modelled using logistic regressions and controlled for capital-specific effects. Main outcome measures included regular alcohol use, weekly alcohol use, heavy episodic drinking (HED), frequent HED and drinking and driving. RESULTS: Overall (unadjusted) prevalence of regular alcohol consumption is 41%. Among drinkers, approximately 70% drink on a weekly basis, and 46% are heavy episodic drinkers. Among this latter group, close to 44% are frequent heavy episodic drinkers (i.e. at least four times in a month). Among regular drinkers who also are drivers, the prevalence of drinking and driving is 28%. These prevalences are considerably higher in men. The relationships investigated vary by drinking behaviour and sex, with some factors consistently associated with various behaviours, when present. Population (men or women) at greatest risk include (largely) younger individuals (up to 700% increase in odds) who are single or divorced, those who are less health conscious and watch television or use mobile devices during leisure time 4 + hours per day and do not have diabetes. For drinking and driving, the additional risk factors include speeding behaviour, the use of mobile devices while driving and HED. Education, race/ethnicity and other health status indicators are differently associated with various drinking behaviours. For women, in particular, the results also show differences in odds of up to 360% and 1430% across cities for frequent HED and drinking and driving, respectively. Similarly, indigenous women are at greatest risk of weekly alcohol use and HED. CONCLUSIONS: HED and drinking and driving are problematic, as the association with other factors suggests a clustering of risky behaviours that may exacerbate the consequences of drinking behaviours.
Resultados  1-10 de 203.687