Implication of Air pollution on health effects in Nepal: Lessons from global research

The Nepal Health Research Council and recent National Health Policy of Nepal (2015/16) have included ‘air pollution’ as a priority research/public health agenda that is guaranteed by the Constitution. There is an urgent need to organise the future policies and actions to ensure the commitments to reduce air pollution

Informed consent in health research: challenges and barriers in low-and middle-income countries with specific reference to Nepal

Obtaining 'informed consent' from every individual participant involved in health research is a mandatory ethical practice. Informed consent is a process whereby potential participants are genuinely informed about their role, risk and rights before they are enrolled in the study. Thus, ethics committees in most countries require 'informed consent form' as part of an ethics application which is reviewed before granting research ethics approval. Despite a significant increase in health research activity in low-and middle-income countries (LMICs) in recent years, only limited work has been done to address ethical concerns. Most ethics committees in LMICs lack the authority and/or the capacity to monitor research in the field. This is important since not all research, particularly in LMICs region, complies with ethical principles, sometimes this is inadvertently or due to a lack of awareness of their importance in assuring proper research governance. With several examples from Nepal, this paper reflects on the steps required to obtain informed consents and highlights some of the major challenges and barriers to seeking informed consent from research participants. At the end of this paper, we also offer some recommendations around how can we can promote and implement optimal informed consent taking process. We believe that paper is useful for researchers and members of ethical review boards in highlighting key issues around informed consent

Diabetes prevention and management in South Asia: A call for action

Background: Globally, the number of people living with Diabetes Mellitus (DM) has increased by four-folds since 1980. South Asia houses one-fifth of the world’s population living with diabetes and it was the 8th leading cause of deaths in 2013 for South Asians. Aim: To review and discuss the context of diabetes in South Asia with a particular focus on a) contributing factors and impact; b) national health policies around non-communicable diseases in the region and; c) to offer recommendations for prevention and management of diabetes. Method: We assessed relevant publications using PubMed, Scopus and OvidSP. Similarly, the World health Organization (WHO) and relevant ministries of each South Asian country were searched for reports and policy documents. Results: Emerging evidence supports that the prevalence of diabetes (ranges from 3.3% in Nepal up to 8.7% in India) in South Asia follows the global trend over the past decades. Urban populations in the region demonstrate a higher prevalence of diabetes although is also a public health concern for rural areas. Changes in the pattern and types of diet along with increasingly sedentary lifestyles are major causes for diabetes. Overall agenda of health promotion to prevent diabetes has not yet been established in the region and majority of the countries in the region are inadequately prepared for the therapeutic services for diabetes. Conclusion: The early onset of the diabetes, longevity of morbidity and early mortality may have a significant impact on people's health expenditure and health system as well as on the region's demographic composition. There is an urgent need to reduce the diabetes prevalence in the region through evidence-based interventions ranging from prevention and early detection to appropriate treatment and care. We suggest that a multi-sectorial collaboration across all stakeholders is necessary to raise awareness about diabetes, its prevention, treatment and care in the region

Development of an occupational airborne chemical exposure matrix

Background Population-based studies of the occupational contribution to chronic obstructive pulmonary disease generally rely on self-reported exposures to vapours, gases, dusts and fumes (VGDF), which are susceptible to misclassification. Aims To develop an airborne chemical job exposure matrix (ACE JEM) for use with the UK Standard Occupational Classification (SOC 2000) system. Methods We developed the ACE JEM in stages: (i) agreement of definitions, (ii) a binary assignation of exposed/not exposed to VGDF, fibres or mists (VGDFFiM), for each of the individual 353 SOC codes and (iii) assignation of levels of exposure (L; low, medium and high) and (iv) the proportion of workers (P) likely to be exposed in each code. We then expanded the estimated exposures to include biological dusts, mineral dusts, metals, diesel fumes and asthmagens. \ud Results We assigned 186 (53%) of all SOC codes as exposed to at least one category of VGDFFiM, with 23% assigned as having medium or high exposure. We assigned over 68% of all codes as not being exposed to fibres, gases or mists. The most common exposure was to dusts (22% of codes with >50% exposed); 12% of codes were assigned exposure to fibres. We assigned higher percentages of the codes as exposed to diesel fumes (14%) compared with metals (8%). Conclusions We developed an expert-derived JEM, using a strict set of a priori defined rules. The ACE JEM could also be applied to studies to assess risks of diseases where the main route of occupational exposure is via inhalation

Exposure to household air pollution from solid cookfuels and childhood stunting: a population-based, cross-sectional study of half a million children in low- and middle-income countries

BACKGROUND: Household air pollution from the incomplete combustion of solid cookfuels in low- and middle-income countries (LMICs) has been largely ignored as a potentially important correlate of stunting. Our objective was to examine the association between solid cookfuel use and stunting in children aged <5 y. METHODS: We used data from 59 LMICs' population-based cross-sectional demographic and health surveys; 557 098 children aged <5 y were included in our analytical sample. Multilevel logistic regression was used to examine the association between exposure to solid cookfuel use and childhood stunting, adjusting for child sex, age, maternal education and number of children living in the household. We explored the association across key subgroups. RESULTS: Solid cookfuel use was associated with child stunting (adjusted OR 1.58, 95% CI 1.55 to 1.61). Children living in households using solid cookfuels were more likely to be stunted if they lived in rural areas, the poorest households, had a mother who smoked tobacco or were from the Americas. CONCLUSIONS: Focused strategies to reduce solid cookfuel exposure might contribute to reductions in childhood stunting in LMICs. Trial evidence to assess the effect of reducing solid cookfuel exposure on childhood stunting is urgently needed

Need and scope of global partnership on public health research

BACKGROUND:A large and growing body of "big data" is generated by internet search engines, such as Google. Because people often search for information about public health and medical issues, researchers may be able to use search engine data to monitor and predict public health problems, such as HIV. We sought to assess the feasibility of using Google search data to analyze and predict new HIV diagnoses cases in the United States. METHODS AND FINDINGS:From 2007 to 2014, we collected search volume data on HIV-related Google search keywords across the United States. State-level new HIV diagnoses data were collected from the Centers for Disease Control and Prevention (CDC) and AIDSVu.org. We developed a negative binomial model to predict HIV cases using a subset of significant predictor keywords identified by LASSO. The Google search data were combined with state-level HIV case reports provided by the CDC. We use historical data to train the model and predict new HIV diagnoses from 2011 to 2014, with an average R2 value of 0.99 between predicted versus actual cases, and average root-mean-square error (RMSE) of 108.75. CONCLUSIONS:Results indicate that Google Trends is a feasible tool to predict new cases of HIV at the state level. We discuss the implications of integrating visualization maps and tools based on these models into public health and HIV monitoring and surveillance

Photocatalytic Decomposition of Formic Acid on Mo2C-Containing Catalyst

Soluble components in the peripheral blood from experimental exposure of 14 healthy subjects to filtered air and wood smoke. Samples were collected before (pre), at 24 h and 44 h after exposure, to air and wood smoke. Data are given as medians with interquartile range. (DOCX 62 kb

Burden of non-communicable diseases among adolescents aged 10–24 years in the EU, 1990–2019: a systematic analysis of the Global Burden of Diseases Study 2019

Background: Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU. Methods: Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10–14 years, 15–19 years, and 20–24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State. Findings: In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5–88·8) of all YLDs and 38·8% (37·4–39·8) of total deaths in adolescents aged 10–24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62–4·25] per 100 000 population) and YLLs (281·78 [254·25–298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56–2773·47] per 100 000 population) and DALYs (2040·59 [1433·96–2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10–24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04–12·28] vs 7·89 [7·53–8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78–10 701·59] vs 6083·91 [4576·63–7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10–24 years substantially decreased (–40·41% [–43·00 to –37·61), and also the YLL rate considerably decreased (–40·56% [–43·16 to –37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=–0·46, p=0·015), neoplasms (rs=–0·57, p=0·0015), and sense organ diseases (rs=–0·61, p=0·0005). Interpretation: NCD-related mortality has substantially declined among adolescents in the EU between 1990 and 2019, but the rising trend of YLL attributed to mental disorders and their YLD burden are concerning. Differences by sex, age group, and across EU Member States highlight the importance of preventive interventions and scaling up adolescent-responsive health-care systems, which should prioritise specific needs by sex, age, and location. Funding: Bill &amp; Melinda Gates Foundation