Investigating measurements of fine particle (PM2.5 ) emissions from the cooking of meals and mitigating exposure using a cooker hood.

There is growing awareness that indoor exposure to particulate matter with diameter ≤ 2.5 µm (PM2.5 ) is associated with an increased risk of adverse health effects. Cooking is a key indoor source of PM2.5 and an activity conducted daily in most homes. Population scale models can predict occupant exposures to PM2.5 , but these predictions are sensitive to the emission rates used. Reported emission rates are highly variable and are typically for the cooking of single ingredients and not full meals. Accordingly, there is a need to assess PM2.5 emissions from the cooking of complete meals. Mean PM2.5 emission rates and source strengths were measured for four complete meals. Temporal PM2.5 concentrations and particle size distributions were recorded using an optical particle counter (OPC), and gravimetric sampling was used to determine calibration factors. Mean emission rates and source strengths varied between 0.54-3.7 mg/min and 15-68 mg, respectively, with 95% confidence. Using a cooker hood (apparent capture efficiency > 90%) and frying in non-stick pans were found to significantly reduce emissions. OPC calibration factors varied between 1.5 and 5.0 showing that a single value cannot be used for all meals and that gravimetric sampling is necessary when measuring PM2.5 concentrations in kitchens.

'I've got to prioritise': being a parent with cystic fibrosis.

Due to advances in earlier diagnosis and treatment, the life expectancy of a person born with cystic fibrosis (CF) has increased. Therefore, more people with CF are becoming parents but the psychological understanding of CF has lagged behind advances in medical treatment; there is very limited applied psychological research on which parents and professionals can draw when considering issues of parenting in this context. This qualitative research explored how mothers and fathers with CF experience and manage the dual roles of being a parent and living with CF. The aim was to facilitate development of an understanding of experience rather than test existing theory. A qualitative methodology was chosen as it allowed participants to reflect openly on their individual experiences. Nine participants completed semi-structured interviews either in their own homes or a clinic base which examined parenting, CF and the interaction between the two roles. Four participants were male and five were female with an age range of 21-50. Interpretive Phenomenological Analysis was used to interpret the participants' accounts and generate super-ordinate and master themes. 'Being a parent on compressed time' was the super-ordinate theme which reflected the challenge of parenting within both a limited life trajectory and a complex treatment regime with daily adherence and time pressures. The findings have implications for parents with CF, those considering parenting and for health professionals working in CF services whose guidance needs to be grounded in an evidence-base. Further research is needed to explore the experiences of parents within different family structures, parents who have had a transplant and the perspectives of others in the wider system in which parents with CF are located.

Prophylactic Acetaminophen or Ibuprofen Results in Equivalent Acute Mountain Sickness Incidence at High Altitude: A Prospective Randomized Trial.

OBJECTIVE: Recent trials have demonstrated the usefulness of ibuprofen in the prevention of acute mountain sickness (AMS), yet the proposed anti-inflammatory mechanism remains unconfirmed. Acetaminophen and ibuprofen were tested for AMS prevention. We hypothesized that a greater clinical effect would be seen from ibuprofen due to its anti-inflammatory effects compared with acetaminophen's mechanism of possible symptom reduction by predominantly mediating nociception in the brain. METHODS: A double-blind, randomized trial was conducted testing acetaminophen vs ibuprofen for the prevention of AMS. A total of 332 non-Nepali participants were recruited at Pheriche (4371 m) and Dingboche (4410 m) on the Everest Base Camp trek. The participants were randomized to either acetaminophen 1000 mg or ibuprofen 600 mg 3 times a day until they reached Lobuche (4940 m), where they were reassessed. The primary outcome was AMS incidence measured by the Lake Louise Questionnaire score. RESULTS: Data from 225 participants who met inclusion criteria were analyzed. Twenty-five participants (22.1%) in the acetaminophen group and 18 (16.1%) in the ibuprofen group developed AMS (P = .235). The combined AMS incidence was 19.1% (43 participants), 14 percentage points lower than the expected AMS incidence of untreated trekkers in prior studies at this location, suggesting that both interventions reduced the incidence of AMS. CONCLUSIONS: We found little evidence of any difference between acetaminophen and ibuprofen groups in AMS incidence. This suggests that AMS prevention may be multifactorial, affected by anti-inflammatory inhibition of the arachidonic-acid pathway as well as other analgesic mechanisms that mediate nociception. Additional study is needed.

Australian Psychiatrists' Support for Psychiatric Advance Directives: Responses to a Hypothetical Vignette.

This study examines whether Australian psychiatrists would support requests in a psychiatric advance directive (PAD) and the reasons underlying their decisions in response to a hypothetical vignette. An online survey was completed by 143 psychiatrists. Fewer than 3 out of 10 psychiatrists supported the patient to create a PAD which requested cessation of pharmacotherapy (27%) or remaining out of hospital and not being subject to an involuntary treatment order (24%) should their depression condition deteriorate. A thematic analysis showed that patient autonomy was the strongest theme among those who supported the patient to create a PAD, whereas the clinical profile of and risk to the patient and the professional or ethical imperative of the psychiatrist were strongest among those who were unsure about supporting the patient or who did not support the patient. These findings provide a challenge about how to fulfil obligations under the United Nations Convention on the Rights of Persons with Disabilities (2006).

A measurement and modelling investigation of the indoor air chemistry following cooking activities.

Domestic cooking is a source of indoor air pollutants, including volatile organic compounds (VOCs), which can impact on indoor air quality. However, the real-time VOC emissions from cooking are not well characterised, and similarly, the resulting secondary chemistry is poorly understood. Here, selected-ion flow-tube mass spectrometry (SIFT-MS) was used to monitor the real-time VOC emissions during the cooking of a scripted chicken and vegetable stir-fry meal, in a room scale, semi-realistic environment. The VOC emissions were dominated by alcohols (70% of total emission), but also contained a range of aldehydes (14%) and terpenes (5%), largely attributable to the heating of oil and the preparation and heating of spices, respectively. The direct cooking-related VOC emissions were then simulated using the Indoor Chemical Model in Python (INCHEM-Py), to investigate the resulting secondary chemistry. Modelling revealed that VOC concentrations were dominated by direct emissions, with only a small contribution from secondary products, though the secondary species were longer lived than the directly emitted species. Following cooking, hydroxyl radical concentrations reduced by 86%, while organic peroxy radical levels increased by over 700%, later forming secondary organic nitrates, peroxyacylnitrates (PANs) and formaldehyde. Monoterpene emissions were shown to drive the formation of secondary formaldehyde, albeit to produce relatively modest concentrations (average of 60 ppt). Sensitivity analysis of the simulation conditions revealed that increasing the outdoor concentrations of ozone and NOx species (2.9× and 9×, respectively) resulted in the greatest increase in secondary product formation indoors (≈400%, 200% and 600% increase in organic nitrates, PANs and formaldehyde production, respectively). Given the fact that climate change is likely to result in increased ozone concentrations in the future, and that increased window-opening in response to rising temperatures is also likely, higher concentrations of indoor oxidants are likely in homes in the future. This work, therefore, suggests that cooking could be a more important source of secondary pollutants indoors in the future.

Air quality and mental health: evidence, challenges and future directions.

BACKGROUND: Poor air quality is associated with poor health. Little attention is given to the complex array of environmental exposures and air pollutants that affect mental health during the life course. AIMS: We gather interdisciplinary expertise and knowledge across the air pollution and mental health fields. We seek to propose future research priorities and how to address them. METHOD: Through a rapid narrative review, we summarise the key scientific findings, knowledge gaps and methodological challenges. RESULTS: There is emerging evidence of associations between poor air quality, both indoors and outdoors, and poor mental health more generally, as well as specific mental disorders. Furthermore, pre-existing long-term conditions appear to deteriorate, requiring more healthcare. Evidence of critical periods for exposure among children and adolescents highlights the need for more longitudinal data as the basis of early preventive actions and policies. Particulate matter, including bioaerosols, are implicated, but form part of a complex exposome influenced by geography, deprivation, socioeconomic conditions and biological and individual vulnerabilities. Critical knowledge gaps need to be addressed to design interventions for mitigation and prevention, reflecting ever-changing sources of air pollution. The evidence base can inform and motivate multi-sector and interdisciplinary efforts of researchers, practitioners, policy makers, industry, community groups and campaigners to take informed action. CONCLUSIONS: There are knowledge gaps and a need for more research, for example, around bioaerosols exposure, indoor and outdoor pollution, urban design and impact on mental health over the life course.

Adverse Childhood Experiences (ACEs) in Adults with Cystic Fibrosis.

Objective: This exploratory study examines the prevalence of adverse childhood experiences (ACEs) in adults with cystic fibrosis (CF). Design: Childhood exposure to 16 ACEs was measured during an annual review assessment (N = 80). Methods: CF patients (n = 80) attending the All Wales Adult CF Service for a routine annual review assessment completed an adapted version of the Centers for Disease Control and Prevention (CDC) short-form ACE questionnaire alongside measures of psychological well-being. Results: In this sample, 65 (78%) reported at least one type of childhood adversity and 11 (14%) experienced four or more ACEs. Parental divorce or separation and verbal abuse were the most frequently reported ACEs. Illness related trauma in childhood was also prevalent with 52 (64%) reporting having experienced a painful or frightening medical procedure and 23 (28%) feeling forced to have treatment or a procedure. Conclusion: Individuals with CF reported a number of childhood traumas including trauma relating to medical procedures. Those with a history of ACEs may have increased risks of emotional and physical difficulties and may benefit from additional support from the CF psychosocial team.

Surgical Reconstruction Options for a Case of Near Total Intestinal Aganglionosis.

Hirschsprung's disease is a congenital anomaly affecting neural crest cell migration and proliferation in the myenteric plexi resulting in dysmotility, which can present as bilious emesis, delayed meconium passage, and bowel obstruction in neonates, or chronic constipation in older children. Depending on the extent of aganglionosis, this disease can involve the whole gut. Treatment involves a temporary ostomy and interval definitive surgical reconstruction. In patients with near or total intestinal aganglionosis, however, there is no consensus on the most effective surgical reconstruction as consideration of the length and function of the normal remnant bowel create concerns for complications with short bowel syndrome post-operatively. We present a case of near-total intestinal aganglionosis highlighting the various options for definitive surgical reconstruction.

Suicidal ideation among urban nine and ten year olds.

Little is known about rates and correlates of suicidal ideation among nonclinical samples of preadolescents from low-income urban backgrounds. Using the Children's Depression Inventory, we measured suicidal ideation in 131 preadolescent urban children (49% female, 90% African American/Caribbean) participating in an ongoing prospective longitudinal study of prenatal cocaine exposure and children's outcome. Suicidal ideation was reported by 14.5% of the children in this sample at 9 to 10 years of age. Children's reports of depressive symptoms, exposure to violence, and distress symptoms in response to witnessing violence were associated with suicidal ideation, but prenatal cocaine exposure, parent-rated child behavior, and caregivers' psychological distress symptoms were not. Suicidal ideation may be more prevalent among preadolescents from urban, low-income backgrounds than clinicians suspect, particularly among children exposed to violence.

Factors affecting optimal nutrition and hydration for people living in specialised dementia care units: A qualitative study of staff caregivers' perceptions.

AIM: To explore the perceptions of staff caregivers regarding factors affecting optimal nutrition and hydration for individuals living in Specialised Dementia Care Units in New Zealand. METHODS: Qualitative descriptive study using a semi-structured interview approach with 11 staff caregivers at two Specialised Dementia Care Units. Data were analysed using a general inductive approach. RESULTS: Two main themes were identified. The first theme 'It's about the individual' encompassed individual factors such as appetite, food appeal, and cognitive and functional abilities. The second theme 'It's about the environment' encompassed factors relating to the dining environment, the social aspects to dining and the provision of support with mealtime activities. CONCLUSIONS: Factors affecting nutrition and hydration in people living with dementia are complex and inter-related. Organisations providing specialised dementia care, their staff and foodservice providers should focus on both the individual and environment to ensure optimal nutrition and hydration for the people in their care.

Experiences of physical activity: A phenomenological study of individuals with cystic fibrosis.

Although extensive research has investigated the benefits of physical activity in cystic fibrosis, minimal exploration of the experiences for individuals from a qualitative, phenomenological perspective has been carried out. The aim of this study was to explore the subjective experiences of physical activity for individuals with cystic fibrosis. The health-care team, at an Adult Cystic Fibrosis Unit in the United Kingdom, recruited 12 participants to take part. Interview data were analysed using interpretative phenomenological analysis. A central theme of 'self-monitoring' emerged from the accounts and was embedded in the three super-ordinate themes.

Human Vection Perception Using Inertial Nulling and Certainty Estimation: The Effect of Migraine History.

Vection is an illusory perception of self-motion that can occur when visual motion fills the majority of the visual field. This study examines the effect of the duration of visual field movement (VFM) on the perceived strength of self-motion using an inertial nulling (IN) and a magnitude estimation technique based on the certainty that motion occurred (certainty estimation, CE). These techniques were then used to investigate the association between migraine diagnosis and the strength of perceived vection. Visual star-field stimuli consistent with either looming or receding motion were presented for 1, 4, 8 or 16s. Subjects reported the perceived direction of self-motion during the final 1s of the stimulus. For the IN method, an inertial nulling motion was delivered during this final 1s of the visual stimulus, and subjects reported the direction of perceived self-motion during this final second. The magnitude of inertial motion was varied adaptively to determine the point of subjective equality (PSE) at which forward or backward responses were equally likely. For the CE trials the same range of VFM was used but without inertial motion and subjects rated their certainty of motion on a scale of 0-100. PSE determined with the IN technique depended on direction and duration of visual motion and the CE technique showed greater certainty of perceived vection with longer VFM duration. A strong correlation between CE and IN techniques was present for the 8s stimulus. There was appreciable between-subject variation in both CE and IN techniques and migraine was associated with significantly increased perception of self-motion by CE and IN at 8 and 16s. Together, these results suggest that vection may be measured by both CE and IN techniques with good correlation. The results also suggest that susceptibility to vection may be higher in subjects with a history of migraine.

Perceived stress, stress attributions and psychological distress in psoriasis.

OBJECTIVE: The objective of this study was to measure causal beliefs in individuals with psoriasis and to explore their relationship with perceived stress, quality of life, psychological well-being and psoriasis severity. METHODS: This study was cross-sectional in design, and patients were required to complete validated questionnaires assessing perceptions of illness, quality of life, psoriasis severity, perceived stress and psychological mood. A total of 141 individuals were recruited from two settings: an outpatient skin clinic at King's College Hospital and the Psoriasis Association. RESULTS: A strong belief in stress/psychological attributes as a causal factor was found in 61% of the sample. This belief was significantly associated with higher levels of anxiety, depression and perceived stress (r > or = .38; P < or = .0001). Perceived stress in this sample was significantly associated with a poorer level of quality of life, higher levels of anxiety and depression (r > or = .27; P < or = .002) but not with psoriasis severity. CONCLUSIONS: The belief that stress is causal was associated with lower levels of psychological well-being. However, there was no association between perceived stress and more objective measures of psoriasis severity.

Causal attributions in parents of babies with a cleft lip and/or palate and their association with psychological well-being.

OBJECTIVE: This study aimed to assess causal attributions of parents of babies with a cleft lip and/or palate. Evidence from causal attribution theory and attribution studies in other medical conditions led to the hypothesis that parents who make internal attributions (self-blame) will have poorer psychological well-being. DESIGN: A cross-sectional survey. SETTING: Postal questionnaires were sent to parents of children under the care of the South Thames Cleft Service at Guy's Hospital. PARTICIPANTS: PARTICIPANTS were recruited if they had a baby between 12 and 24 months old with a cleft lip and/or palate. Of 204 parents, 42 responded. MAIN OUTCOME MEASURES: A semistructured questionnaire about causal beliefs was completed alongside validated questionnaires measuring anxiety, depression (Hospital Anxiety and Depression Scale), and perceived stress (Perceived Stress Scale). RESULTS: Causal attributions were grouped according to type (environmental, chance, self-blame, and no belief) and loci (external or internal). The most common attribution made was to external factors (54.4%), followed by no causal attribution (38.1%). Parents making an internal (self-blaming) attribution (16.7%) had significantly (p < .05) higher scores on the Hospital Anxiety and Depression Scale anxiety measure (r = .32) and Perceived Stress Scale (r = .33), but not on the Hospital Anxiety and Depression Scale depression measure (p = .283). CONCLUSIONS: The high number of parents making an external attribution can be explained by causal attribution theory. However, the percentage of parents making no causal attribution was higher than seen in previous research. Surprisingly, no parents blamed others. The main hypothesis was tentatively accepted because there were significantly higher anxiety and stress scores in parents who self-blamed; although, depression scores were not significantly higher.