Modeling Air Pollution Health Risk for Environmental Management of an Internationally Important Site: The Salt Range (Kallar Kahar), Pakistan

This study aimed to assess the health effects of emissions released by cement industries and allied activities, such as mining and transportation, in the salt range area of district Chakwal, Pakistan. DISPER was used to estimate dispersion and contribution of source emission by cement industries and allied activities to surface accumulation of selected pollutants (PM2.5, PM10, NOx, and O3). To assess the long-term effects of pollutants on human health within the radius of 500 m to 3 km, Air Q+ software was used, which was designed by the World Health Organization (WHO). One-year average monitoring data of selected pollutants, coordinates, health data, and population data were used as input data for the model. Data was collected on lung cancer mortality among different age groups (25+ and 30+), infant post-neonatal mortality, mortality due to respiratory disease, and all-cause mortality due to PM2.5 and NO2. Results showed that PM2.5 with the year-long concentration of 27.3 ug/m3 contributes a 9.9% attributable proportion (AP) to lung cancer mortality in adults aged 25+, and 13.8% AP in adults age 30+. Baseline incidence is 44.25% per 100,000 population. PM10 with the year-long concentration of 57.4 ug/m3 contributes 16.96% AP to infant post-neonatal mortality and baseline incidence is 53.86% per 1000 live births in the country. NO2 with the year-long concentration of 14.33 ug/m3 contributes 1.73% AP to all-cause mortality. Results obtained by a simulated 10% reduction in pollutant concentration showed that proper mitigation measures for reduction of pollutants’ concentration should be applied to decrease the rate of mortalities and morbidities. Furthermore, the study showed that PM2.5 and PM10 are significantly impacting the human health in the nearby villages, even after mitigation measures were taken by the selected cement industries. The study provides a roadmap to policymakers and stakeholders for environmental and health risk management in the area.

An automated retrospective VAE-surveillance tool for future quality improvement studies

Ventilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation and is associated with substantial morbidity and mortality. Accurate diagnosis of VAP relies in part on subjective diagnostic criteria. Surveillance according to ventilator-associated event (VAE) criteria may allow quick and objective benchmarking. Our objective was to create an automated surveillance tool for VAE tiers I and II on a large data collection, evaluate its diagnostic accuracy and retrospectively determine the yearly baseline VAE incidence. We included all consecutive intensive care unit admissions of patients with mechanical ventilation at Bern University Hospital, a tertiary referral center, from January 2008 to July 2016. Data was automatically extracted from the patient data management system and automatically processed. We created and implemented an application able to automatically analyze respiratory and relevant medication data according to the Centers for Disease Control protocol for VAE-surveillance. In a subset of patients, we compared the accuracy of automated VAE surveillance according to CDC criteria to a gold standard (a composite of automated and manual evaluation with mediation for discrepancies) and evaluated the evolution of the baseline incidence. The study included 22′442 ventilated admissions with a total of 37′221 ventilator days. 592 ventilator-associated events (tier I) occurred; of these 194 (34%) were of potentially infectious origin (tier II). In our validation sample, automated surveillance had a sensitivity of 98% and specificity of 100% in detecting VAE compared to the gold standard. The yearly VAE incidence rate ranged from 10.1–22.1 per 1000 device days and trend showed a decrease in the yearly incidence rate ratio of 0.96 (95% CI, 0.93–1.00, p = 0.03). This study demonstrated that automated VAE detection is feasible, accurate and reliable and may be applied on a large, retrospective sample and provided insight into long-term institutional VAE incidences. The surveillance tool can be extended to other centres and provides VAE incidences for performing quality control and intervention studies.

Correction to: Baseline incidence of meningitis, malaria, mortality and other health outcomes in infants and young sub-Saharan African children prior to the introduction of the RTS,S/AS01E malaria vaccine

An amendment to this paper has been published and can be accessed via the original article.

The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis

Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysisattempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71–3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59–2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13–1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the “number needed-to-harm” analysis, 7246 (95% CI: 4329 to 14,085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.

Baseline incidence of meningitis, malaria, mortality and other health outcomes in infants and young sub-Saharan African children prior to the introduction of the RTS,S/AS01E malaria vaccine

Background The lack of background disease incidence rates in sub-Saharan countries where the RTS,S/AS01E malaria vaccine is being implemented may hamper the assessment of vaccine safety and effectiveness. This study aimed to document baseline incidence rates of meningitis, malaria, mortality, and other health outcomes prior to vaccine introduction through the Malaria Vaccine Implementation Programme. Methods An ongoing disease surveillance study is combining prospective cohort event monitoring and hospital-based disease surveillance in three study sites in Ghana and Kenya. An interim analysis was performed on the prospective cohort in which children were enrolled in two age-groups (the 5 to 17 months or 6 to 12 weeks age-group), capturing data in the framework of routine medical practice before the introduction of the malaria vaccine. Incidence and mortality rates were computed with 95% confidential intervals (CI) using an exact method for a Poisson variable. Results This analysis includes 14,329 children; 7248 (50.6%) in the 6 to 12 weeks age-group and 7081 (49.4%) in the 5 to 17 months age-group. In the 5 to 17 months age-group (where the malaria vaccine was planned to be subsequently rolled out) the meningitis, malaria, severe malaria and cerebral malaria incidences were 92 (95% CI 25–236), 47,824 (95% CI 45,411–50,333), 1919 (95% CI 1461–2476) and 33 (95% CI 1–181) per 100,000 person-years, respectively. The all-cause mortality was 969 (95% CI 699–1310) per 100,000 person-years. Conclusion Incidence estimates of multiple health outcomes are being generated to allow before-after vaccine introduction comparisons that will further characterize the benefit-risk profile of the RTS,S/AS01E vaccine. Trial registration: clinicaltrials.gov NCT02374450.

A New Method for Estimating the Incidence of Infectious Diseases

Ambitious World Health Organization targets for disease elimination require monitoring of epidemics using routine health data in settings of decreasing and low incidence. We evaluated two methods commonly applied to routine testing results to estimate incidence rates that assume uniform probability of infection between consecutive negative and positive tests based on: 1. the midpoint of this interval; and 2. a randomly selected point on this interval. We compared these with an approximation to the Poisson-binomial distribution which assigns partial incidence to time-periods based on the uniform probability of occurrence in these intervals. We assessed bias, variance and convergence of estimates using simulations of Weibull distributed failure times with systematically varied baseline incidence, and varying trend. We considered results for quarterly, half-yearly and yearly incidence estimation frequencies. We applied methods to assess human immunodeficiency virus (HIV) incidence in HIV-negative patients from the Treatment with Antiretrovirals and their Impact on Positive And Negative men study between 2012 and 2018. The Poisson-binomial method had reduced bias and variance at low levels of incidence and for increased estimation frequency, with increased consistency of estimation. Application of methods to real-world assessment of HIV incidence found decreased variance in Poisson-binomial model estimates, with observed incidence declining to levels where simulation results had indicated bias in midpoint and random-point methods.

Assessment of Health Impacts of PM2.5 by AirQ+ Software in the City of Sanandaj, Iran (2018-2019)

Background: Particulate or particle mattes in term of air pollution are particles with a diameter of 2.5 μm or less (PM2.5). PM2.5 is a natural source of air pollution and has harmful effects on citizens in Sanandaj City, located in the west of Iran. Methods: In this study, the hourly data of concentration of PM2.5 were taken from the Kurdistan Environmental Protection Agency. During the study period (2018-2019), the 24-hour concentration of PM2.5 exceeded 339 times the average level. By AirQ+ software, the relationship between data and Relative Risk (RR), Baseline Incidence (BI), and Attributable Proportion (AP) were estimated. Then chronic obstructive pulmonary disease, lung cancer, ischemic heart disease, and brain stroke in the range of over 30 years were estimated. Results: The main target of this study was to survey the relationship between PM2.5 concentration and the death rate of citizens of this non-industrial city. The long-term health effect (more than 6 months) of PM2.5 caused 326 deaths on average (except for accidents and poisoning). Conclusion: Increase the concentration of PM2.5 is one factor that affects a high percentage of mortality rate.

The Association Between Fluoroquinolones and Aortic Dissection and Aortic Aneurysms: A Systematic Review and Meta-Analysis

Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysis attempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71 – 3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59 – 2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13 – 1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the “number needed-to-harm” analysis, 7246 (95% CI: 4329 to 14085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.