Where do the elderly die? The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in Flanders

BACKGROUND: Most of the research concerning place of death focuses on terminally ill patients (cancer patients) while the determinants of place of death of the elderly of the general population are not intensively studied. Studies showed the influence of gender, age, social-economical status and living arrangements on the place of death, but a facet not taken into account so far is the influence of the availability of nursing homes. METHODS: We conducted a survey of deaths, between January 1999 and December 2000 in a small densely populated area in Belgium, with a high availability of nursing homes (within 5 to 10 km of the place of residence of every elderly). We determined the incidence of total mortality (of subjects >60 years) from local official death registers that we consulted via the priest or the mortician of the local parish, to ask where the decedent had died and whether the deceased had lived in a nursing home. We compared the distribution of the places of death between parishes with a nursing home and with parishes without nursing home. RESULTS: 240 women and 217 men died during the two years study period. Only 22% died at home, while the majority (78%) died in an institutional setting, either a hospital (50%) or a nursing home (28%). Place of death was influenced by individual factors (age and gender) and the availability of a nursing home in the 'own' parish. The chance of in-hospital death was 65% higher for men (95% Confidence Interval [CI]: 14 to 138%; p = 0.008) and decreased by 4% (CI: -5.1% to -2.5%; p < 0.0001) for each year increase in age. Independent of gender and age, the chance of in-hospital death was 41% (CI: -60% to -13%; p = 0.008) lower in locations with a nursing home. CONCLUSION: Demographic, but especially social-contextual factors determine where elderly will end their life. The majority of elderly in Flanders die in an institution. Age, gender and living situation are predictors of the place of death but the embedment of a nursing home in the local community seems to be a key predictor

Profesionalna astma u radnika izloženih prašinama iz biljnih i voćnih čajeva

We performed a cross-sectional study to detect occupational asthma (OA) in 63 subjects occupationally exposed to herbal and fruit tea dust and in 63 corresponding controls. The evaluation included a questionnaire, skin prick tests to workplace and common inhalant allergens, spirometry, and histamine challenge test. The evaluation of the work-relatedness of asthma in the exposed workers was based on serial peak expiratory flow rate (PEFR) measurements and bronchoprovocation tests. We found a higher prevalence of respiratory symptoms in the exposed workers, whereas spirometric parameters were significantly lower. The prevalence of sensitisation to allergens and of bronchial hyperresponsivenss (BHR) did not differ significantly between the groups. The prevalence of asthma was also similar in both groups (8.0 % vs. 6.4 %; P=0.540). Work-relatedness of symptoms was reported by all asthmatic tea workers and by no control with asthma. Significant work-related changes in PEFR diurnal variations and in non-specific BHR, suggesting allergic OA, were found in one tea worker with asthma (1.6 %). No specific workplace agent causing OA in the affected subject was identified. None of the tea workers with asthma met the criteria for medical case definition of the reactive airway dysfunction syndrome (RADS). Our data confirm workplace exposure to herbal and fruit tea dust as a risk factor for OA.Svrha je ovoga presječnog ispitivanja bila otkriti profesionalnu astmu u skupini od 63 ispitanika koji su na radnome mjestu bili izloženi prašinama biljnih i voćnih čajeva. Kao kontrola uzet je jednak broj uredskih radnika koji nisu bili izloženi ovim prašinama. Ocjena izloženih i kontrolnih ispitanika obuhvatila je upitnik, skin prick testove na uobičajene i profesionalne inhalacijske alergene, spirometriju te histaminski test. Povezanost astme s profesionalnom izloženosti u radnika utvrđena je prema kriterijima Američkog kolegija pulmologa (American College of Chest Physicians, krat. ACCP), a na temelju mjerenja niza vršnih ekspiratornih protoka (engl. peak expiratory flow rate, PEFR) i niza bronhoprovokativnih testova. Izloženi su radnici iskazali veću prevalenciju respiratornih simptoma odnosno niže spirometrijske vrijednosti od kontrole. Izloženi ispitanici nisu se značajno razlikovali od kontrole u prevalenciji senzibilizacije na profesionalne i uobičajene inhalacijske alergene te prevalenciji pretjerane bronhalne reaktivnosti (engl. bronchial hyperresponsiveness, krat. BHR). Isto vrijedi i za prevalenciju astme (8,0 % u izloženih radnika prema 6,4 % u kontrola; P=0,540). Povezanost simptoma s poslom prijavili su svi radnici u obradi čaja oboljeli od astme te ni jedan kontrolni ispitanik s astmom. U jednoga astmatičnog radnika na čaju utvrđene su značajne promjene u dnevnim varijacijama PEFR-a te u nespecifičnom BHR-u koji upućuju na profesionalnu astmu (1.6 %). Nije utvrđeno koja je to tvar uzrokovala profesionalnu astmu u ovog ispitanika. Nitko od izloženih radnika s astmom nije zadovoljio sve medicinske kriterije za dijagnozu sindroma reaktivne disfunkcije dišnih putova (engl. reactive airway dysfunction syndrome, RADS). Naši podaci potvrđuju da je profesionalna izloženost prašinama iz biljnih i voćnih čajeva čimbenik rizika od profesionalne astme

Environmental Mortality and Long-Run Growth

There is emerging evidence that environmental degradation increases human mortality. This paper provides a long-run consumer optimization model in which mortality is endogenous to emissions generated by production. Emissions are assumed to follow the EKC path, first rising and then falling along with ouput. In the optimum, some deaths are accepted as an exchange for consumption. The model is estimated for the European outdoor air pollution data, showing that Europe has reached the downward sloping sement of the EKC. Economic growth will thus decrease rather than increase air pollution and the associted deaths in most countries in Europe

Uso de morteros catalíticos sobre paneles, para el análisis de la reducción de partículas contaminantes en el aire

Trabajo de Investigación TecnológicaEste proyecto de grado se enfoca en la contaminación del aire y el uso de las nuevas tecnologías en la construcción para combatir este problema que genera afectaciones no solo ambientales, sino en la salud humana, en la flora y la fauna. La nanotecnología, es una rama que se desprende de las nuevas tecnologías y que se ha abierto paso en la industria de la construcción, por medio de la implementación de materiales y aditivos te tamaño nanométrico que mejoran y generan nuevas propiedades en los materiales comunes de construcción como el acero, concretos, morteros, pinturas, etc. En este proyecto se elaboró un concreto y mortero adicionando el Dióxido de titanio (TiO2), el cual actúa como un catalizador al combinarse con el cemento y los rayos ultra violeta, y su función principal es oxidar las partículas contaminantes suspendidas en el aire, por lo cual se categoriza como un descontaminante. Adicionalmente, el TiO2 puede mejorar las propiedades del concreto. Para comprobar el efecto del TiO2 en el concreto, se elaboraron cuatro cilindros de concreto común y de concreto adicionado, los cuales se fallaron en las edades típicas de falla y se compararon los resultados obtenidos. De igual manera, se fabricó un mortero adicionado, el cual se colocó sobre paneles y se dejó expuesto ocho días en un área de monitoreo de aire, y con los datos obtenidos se realizó el análisis correspondiente.1 INTRODUCCIÓN 2 ANTECEDENTES 3 PLANTEAMIENTO DEL PROBLEMA 4 OBJETIVOS 5 JUSTIFICACIÓN 6 DELIMITACIONES 7 MARCO DE REFERENCIA 8 METODOLOGÍA 9 DISEÑO METODOLÓGICO. 10 CONCLUSIONES 11 RECOMENDACIONES BIBLIOGRAFÍAPregradoIngeniero Civi

Traffic Air Pollution and Oxidized LDL

BACKGROUND: Epidemiologic studies indirectly suggest that air pollution accelerates atherosclerosis. We hypothesized that individual exposure to particulate matter (PM) derived from fossil fuel would correlate with plasma concentrations of oxidized low-density lipoprotein (LDL), taken as a marker of atherosclerosis. We tested this hypothesis in patients with diabetes, who are at high risk for atherosclerosis. METHODOLOGY/PRINCIPAL FINDINGS: In a cross-sectional study of non-smoking adult outpatients with diabetes we assessed individual chronic exposure to PM by measuring the area occupied by carbon in airway macrophages, collected by sputum induction and by determining the distance from the patient's residence to a major road, through geocoding. These exposure indices were regressed against plasma concentrations of oxidized LDL, von Willebrand factor and plasminogen activator inhibitor 1 (PAI-1). We could assess the carbon load of airway macrophages in 79 subjects (58 percent). Each doubling in the distance of residence from major roads was associated with a 0.027 µm(2) decrease (95% confidence interval (CI): -0.048 to -0.0051) in the carbon load of airway macrophages. Independently from other covariates, we found that each increase of 0.25 µm(2) [interquartile range (IQR)] in carbon load was associated with an increase of 7.3 U/L (95% CI: 1.3 to 13.3) in plasma oxidized LDL. Each doubling in distance of residence from major roads was associated with a decrease of -2.9 U/L (95% CI: -5.2 to -0.72) in oxidized LDL. Neither the carbon load of macrophages nor the distance from residence to major roads, were associated with plasma von Willebrand factor or PAI-1. CONCLUSIONS: The observed positive association, in a susceptible group of the general population, between plasma oxidized LDL levels and either the carbon load of airway macrophages or the proximity of the subject's residence to busy roads suggests a proatherogenic effect of traffic air pollution

Childhood Asthma and Environmental Exposures at Swimming Pools: State of the Science and Research Recommendations

OBJECTIVES: Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children's exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue. DATA SOURCES: A workshop was held in Leuven, Belgium, 21-23 August 2007, to evaluate the literature and to develop a research agenda to better understand children's exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs. SYNTHESIS: Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection. CONCLUSIONS: Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists