The long-term effect of short point of care ultrasound course on physicians' daily practice.

BackgroundThe benefits of Point of Care Ultrasound (POCUS) are well established in the literature. As it is an operator-dependent modality, the operator is required to be skilled in obtaining and interpreting images. Physicians who are not trained in POCUS attend courses to acquire the basics in this field. The effectiveness of such short POCUS courses on daily POCUS utilization is unknown. We sought to measure the change in POCUS utilization after practicing physicians attended short POCUS courses.MethodsA 13-statements questionnaire was sent to physicians who attended POCUS courses conducted at the Soroka University Medical Center between the years 2014-2018. Our primary objective was to compare pre-course and post-course POCUS utilization. Secondary objectives included understanding the course graduates' perceived effect of POCUS on diagnosis, the frequency of ultrasound utilization and time to effective therapy.Results212 residents and specialists received the questionnaire between 2014-2018; 116 responded (response rate of 54.7%). 72 (62.1%) participants were male, 64 (55.2%) were residents, 49 (42.3%) were specialists, 3 (2.5%) participants did not state their career status. 90 (77.6%) participants declared moderate use or multiple ultrasound use six months to four years from the POCUS course, compared to a rate of 'no use at all' and 'minimal use of 84.9% before the course. 98 participants [84.4% CI 77.8%, 91.0%] agree and strongly agree that a short POCUS course may improve diagnostic skills and 76.7% [CI 69.0%, 84.3%] agree and strongly agree that the POCUS course may shorten time to diagnosis and reduce morbidity.ConclusionsOur short POCUS course significantly increases bedside ultrasound utilization by physicians from different fields even 4 years from course completion. Course graduates strongly agreed that incorporating POCUS into their clinical practice improves patient care. Such courses should be offered to residents and senior physicians to close the existing gap in POCUS knowledge among practicing physicians

Contribution of Solar Radiation and Pollution to Parkinson’s Disease

Background. Parkinson’s disease (PD) is believed to develop from epigenetic modulation of gene expression through environmental factors that accounts for up to 85% of all PD cases. The main objective of this study was to examine the association between PD onset and a cumulative exposure to potentially modifiable ambient exposures. Methods. The study population comprised 3343 incident PD cases and 31,324 non-PD controls in Southern Israel. The exposures were determined based on the monitoring stations and averaged per year. Their association with PD was modeled using a distributed lag non-linear model and presented as an effect of exposure to the 75th percentile as compared to the 50th percentile of each pollutant, accumulated over the span of 5 years prior to the PD. Results. We recorded an adverse effect of particulate matter of size ≤10 μm in diameter (PM10) and solar radiation (SR) with odds ratio (OR) = 1.06 (95%CI: 1.02; 1.10) and 1.23 (95%CI: 1.08; 1.39), respectively. Ozone (O3) was also adversely linked to PD, although with a borderline significance, OR: 1.12 (95%CI: 0.99; 1.25). Immigrants arriving in Israel after 1989 appeared to be more vulnerable to exposure to O3 and SR. The dose response effect of SR, non-existent for Israeli-born (OR = 0.67, 95%CI: 0.40; 1.13), moderate for immigrants before 1989 (OR = 1.17, 95%CI: 0.98; 1.40) and relatively high for new immigrants (OR = 1.25, 95%CI: 1.25; 2.38) indicates an adaptation ability to SR. Conclusions. Our findings supported previous reports on adverse association of PD with exposure to PM10 and O3. Additionally, we revealed a link of Parkinson’s Disease with SR that warrants an extensive analysis by research groups worldwide

Novel Approaches to Air Pollution Exposure and Clinical Outcomes Assessment in Environmental Health Studies

An accurate assessment of pollutants’ exposure and precise evaluation of the clinical outcomes pose two major challenges to the contemporary environmental health research. The common methods for exposure assessment are based on residential addresses and are prone to many biases. Pollution levels are defined based on monitoring stations that are sparsely distributed and frequently distanced far from residential addresses. In addition, the degree of an association between outdoor and indoor air pollution levels is not fully elucidated, making the exposure assessment all the more inaccurate. Clinical outcomes’ assessment, on the other hand, mostly relies on the access to medical records from hospital admissions and outpatients’ visits in clinics. This method differentiates by health care seeking behavior and is therefore, problematic in evaluation of an onset, duration, and severity of an outcome. In the current paper, we review a number of novel solutions aimed to mitigate the aforementioned biases. First, a hybrid satellite-based modeling approach provides daily continuous spatiotemporal estimations with improved spatial resolution of 1 × 1 km2 and 200 × 200 m2 grid, and thus allows a more accurate exposure assessment. Utilizing low-cost air pollution sensors allowing a direct measurement of indoor air pollution levels can further validate these models. Furthermore, the real temporal-spatial activity can be assessed by GPS tracking devices within the individuals’ smartphones. A widespread use of smart devices can help with obtaining objective measurements of some of the clinical outcomes such as vital signs and glucose levels. Finally, human biomonitoring can be efficiently done at a population level, providing accurate estimates of in-vivo absorbed pollutants and allowing for the evaluation of body responses, by biomarkers examination. We suggest that the adoption of these novel methods will change the research paradigm heavily relying on ecological methodology and support development of the new clinical practices preventing adverse environmental effects on human health

Health effects of desert dust storm events in the south-eastern Mediterranean: perceptions and practices of local stakeholders

Background: The south-eastern Mediterranean experiences frequent desert dust storm events (DDS) that have been shown to be associated with adverse health effects. Aims: This study assessed the perceptions and practices towards DDS of local authorities and stakeholders from 3 countries in the region, Cyprus, Greece and Israel. Methods: Between October 2017 and April 2018, we administered a semi-structured questionnaire to regulatory authorities involved in public protection from DDS as well as social stakeholders in the 3 countries. The questionnaire addressed their knowledge regarding DDS, perceptions on the relationship between DDS and health effects and relevant actions taken towards public protection. Results: Out of 58 stakeholders contacted, 49 participated in the study (84.5% response rate). Fourteen (28.6%) were regulatory authorities and 35 (71.4%) were social stakeholders. All responders were familiar with DDS but several underestimated the frequency of events while the majority (73%) instinctively reported that elders, children and respiratory patients are susceptible subpopulations. Nevertheless, 71% were unaware of a national policy on DDS, or considered that this was lacking in their country. Although several stakeholders reportedly receive questions from the public regarding DDS effects, only few reply according to a pre-determined action plan. Conclusions: Regulatory authorities and social stakeholders in Cyprus, Greece and Israel are characterized by good knowledge of DDS and associated health effects, although implementation of pre-determined action plans for public protection is limited. Future efforts should concentrate on increasing awareness among stakeholders and the public and developing national policies, including effective measures to minimize DDS exposure