The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

Background: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. Methods: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants’ compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. Discussion: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February–May 2019), a total of 91 children participated in the trial while for the second study period (February–May 2020), another 120 children completed data collection. Recruitment for the third study period (February–May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. Trial registration: ClinicalTrials.gov: NCT03503812, April 20, 2018

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Diagnostic accuracy of nasal nitric oxide for establishing diagnosis of primary ciliary dyskinesia: a meta-analysis

Background: To date, diagnosis of Primary Ciliary Dyskinesia (PCD) remains difficult and challenging. We systematically evaluated the diagnostic performance of nasal Nitric Oxide (nNO) measurement for the detection of PCD, using either velum-closure (VC) or non-velum-closure (non-VC) techniques. Methods: All major electronic databases were searched from inception until March 2015 using appropriate terms. The sensitivity and specificity of nNO measurement was calculated in PCD patients diagnosed by transmission electron microscopy, high speed video-microscopy or genetic testing. Summary receiver operating characteristic (HSROC) curves were drawn using the parameters of the fitted models. Results: Twelve studies provided data for 13 different populations, including nine case-control (n=793) and four prospective cohorts (n=392). The overall sensitivity of nNO measured by VC techniques was 0.95 (95% CI 0.91-0.97), while specificity was 0.94 (95% CI 0.88-0.97). The positive likelihood ratio (LR+) of the test was 15.8 (95% CI 8.1-30.6), whereas the negative likelihood ratio (LR-) was 0.06 (95% CI 0.04-0.09). For non-VC techniques, the overall sensitivity of nNO measurement was 0.93 (95% CI 0.89-0.96) whereas specificity was 0.95 (95% CI 0.82-0.99). The LR+ of the test was 18.5 (95% CI 4.6-73.8) whereas the LR- was 0.07 (95% CI 0.04-0.12). Conclusions: Diagnostic accuracy of nNO measurement both with VC and non-VC maneuvers is high and can be effectively employed in the clinical setting to detect PCD even in young children, thus potentiating early diagnosis. Measurement of nNO merits to be part of a revised diagnostic algorithm with the most efficacious combination of tests to achieve PCD diagnosis

Heat related mortality in Cyprus under the A1B emissions scenario: Is additional air-conditioning an appropriate mitigation strategy?

While climate change is expected to increase average temperatures around the globe as well as the number of atypically hot days and nights, several studies had identified an increase in heat-related mortality during hot weather. Indoor cooling has been identified as an important protective factor against heat related mortality but could result in higher emissions from power plants and to increased air pollution related mortality. We aimed in calculating the impact of increasing temperatures on heat-related mortality in Cyprus for the present and the 2040-2050 decade and address the protective effect of air-conditioning as the main mitigation option

Prevalence of primary ciliary dyskinesia in consecutive referrals of suspect cases and the transmission electron microscopy detection rate: A systematic review and meta-analysis

Diagnostic testing for primary ciliary dyskinesia (PCD) usually includes transmission electron microscopy (TEM), nasal nitric oxide, high-speed video microscopy, and genetics. Diagnostic performance of each test should be assessed toward the development of PCD diagnostic algorithms. We systematically reviewed the literature and quantified PCD prevalence among referrals and TEM detection rate in confirmed PCD patients. Major electronic databases were searched until December 2015 using appropriate terms. Included studies described cohorts of consecutive PCD referrals in which PCD was confirmed by at least TEM and one additional test, in order to compare the index test performance with other test(s). Meta-analyses of pooled PCD prevalence and TEM detection rate across studies were performed. PCD prevalence among referrals was 32% (95% CI: 25-39%, I 2 = 92%). TEM detection rate among PCD patients was 83% (95% CI: 75-90%, I 2 = 90%). Exclusion of studies reporting isolated inner dynein arm defects as PCD, reduced TEM detection rate and explained an important fraction of observed heterogeneity (74%, 95% CI: 66-83%, I 2 = 66%). Approximately, one third of referrals, are diagnosed with PCD. Among PCD patients, a significant percentage, at least as high as 26%, is missed by TEM, a limitation that should be accounted toward the development of an efficacious PCD diagnostic algorithm

The long-term impact of restricting cycling and walking during high air pollution days on all-cause mortality: Health impact Assessment study.

Regular active commuting, such as cycling and walking to and from the workplace, is associated with lower all-cause mortality through increased physical activity (PA). However, active commuting may increase intake of fine particles (PM2.5), causing negative health effects. The purpose of this study is to estimate the combined risk of PA and air pollution for all-cause mortality among active commuters who, on days with high PM2.5 levels, switch to commuting by public transportation or work from home. Towards this purpose, we developed a Health Impact Assessment model for six cities (Helsinki, London, Sao Paulo, Warsaw, Beijing, New Delhi) using daily, city-specific PM2.5 concentrations. For each city we estimated combined Relative Risk (RR) due to all-cause mortality for the PA benefits and PM2.5 risks with different thresholds concentrations. Everyday cycling to work resulted in annual all-cause mortality risk reductions ranging from 28 averted deaths per 1000 cyclists (95% confidence interval (CI): 20-38) in Sao Paolo to 12 averted deaths per 1000 cyclists (95% CI: 5-19) in Beijing. Similarly, for everyday walking, the reductions in annual all-cause mortality ranged from 23 averted deaths per 1000 pedestrians (95 CI: 16-31) in Sao Paolo to 10 averted deaths per 1000 pedestrians (95%CI: 5-16) in Beijing. Restricting active commuting during days with PM2.5 levels above specific air quality thresholds would not decrease all-cause mortality risk in any examined city. On the contrary, all-cause mortality risk would increase if walking and cycling are restricted in days with PM2.5 concentrations below 150 μg/m3 in highly polluted cities (Beijing, New Delhi). In all six cities, everyday active commuting reduced all-cause mortality when benefits of PA and risk or air pollution were combined. Switching to working from home or using public transport on days with high air pollution is not expected to lead to improved all-cause mortality risks.MT and JW: The work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. This study was supported by the project “Towards an Integrated Global Transport and Health Assessment Tool (TIGTHAT)”, funded by Medical Research Council (MRC) Global Challenges Research Fund, UK (number: RG87632-SJ). Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. GY and PK were supported by Cyprus University of Technology Starting Grant (Stefania Papatheodorou). The sponsors had no role or involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication

The effect of ambient air temperature on cardiovascular and respiratory mortality in Thessaloniki, Greece

Objectives: There is a growing body of evidence linking ambient air temperature and adverse health effects, in the form of hospitalization or even increased mortality mainly due to respiratory and cardio/cerebro-vascular illnesses. In the present study, we examine the association between high ambient air temperature and cardiovascular as well as respiratory mortality for the population of the greater area of Thessaloniki, Greece, taking into account the role of particulate pollution as a potential confounder. Methods: A mixed Poisson regression model, using a quasi-likelihood function to account for potential over-dispersion in the outcome distribution given covariates, was combined with distributed lag non-linear models, to estimate the non-linear and lag patterns in the association between mortality and daily mean temperature from 1999 to 2012. Results: A direct heat effect was found, as the mortality risk increased sharply above the temperature threshold of 33 °C, suggesting a significant effect of high temperatures on mortality on the same and next day of the heat events (lags 0–1) which was retained for a week, whereas a harvesting effect was noticed for the following days. Cardiovascular and respiratory mortality risk increased by 4.4% (95% CI 2.7%–6.1%) and 5.9% (95% CI 1.8%–10.3%) respectively on the same and following day of a heat event, whereas the risk dropped steeply in the following days. Particulate matter did not confound the association between high temperature and mortality in this population. Conclusion: There is a significant association between mortality and hot temperatures in Thessaloniki, Greece. Reduction in exposure to increased temperatures, as part of prevention measures and strategies, should be considered for vulnerable subpopulations