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Air pollution exposure—the (in)visible risk factor for respiratory diseases
Bălă, G.P.; Râjnoveanu, R.M.; Tudorache, E. et al.
Environmental Science and Pollution Research
(2021)
CC
There is increasing interest in understanding the role of air pollution as one of the greatest threats to human health worldwide. Nine of 10 individuals breathe air with polluted compounds that have a great impact on lung tissue. The nature of the relationship is complex, and new or updated
...
data are constantly being reported in the literature. The goal of our review was to summarize the most important air pollutants and their impact on the main respiratory diseases (chronic obstructive pulmonary disease, asthma, lung cancer, idiopathic pulmonary fibrosis, respiratory infections, bronchiectasis, tuberculosis) to reduce both short- and the long-term exposure consequences. We considered the most important air pollutants, including sulfur dioxide, nitrogen dioxide, carbon monoxide, volatile organic compounds, ozone, particulate matter and biomass smoke, and observed their impact on pulmonary pathologies. We focused on respiratory pathologies, because air pollution potentiates the increase in respiratory diseases, and the evidence that air pollutants have a detrimental effect is growing. It is imperative to constantly improve policy initiatives on air quality in both high- and low-income countries.
more
Long-term exposure of humans to air pollution enhances the risk of cardiovascular and respiratory diseases. A novel Global Exposure Mortality Model (GEMM) has been derived from many cohort studies, providing much-improved coverage of the exposure to fine particulate matter (PM2.5). We applied the GE
...
MM to assess excess mortality attributable to ambient air pollution on a global scale and compare to other risk factors.
Methods and results
We used a data-informed atmospheric model to calculate worldwide exposure to PM2.5 and ozone pollution, which was combined with the GEMM to estimate disease-specific excess mortality and loss of life expectancy (LLE) in 2015. Using this model, we investigated the effects of different pollution sources, distinguishing between natural (wildfires, aeolian dust) and anthropogenic emissions, including fossil fuel use. Global excess mortality from all ambient air pollution is estimated at 8.8 (7.11–10.41) million/year, with an LLE of 2.9 (2.3–3.5) years, being a factor of two higher than earlier estimates, and exceeding that of tobacco smoking. The global mean mortality rate of about 120 per 100 000 people/year is much exceeded in East Asia (196 per 100 000/year) and Europe (133 per 100 000/year). Without fossil fuel emissions, the global mean life expectancy would increase by 1.1 (0.9–1.2) years and 1.7 (1.4–2.0) years by removing all potentially controllable anthropogenic emissions. Because aeolian dust and wildfire emission control is impracticable, significant LLE is unavoidable.
Conclusion
Ambient air pollution is one of the main global health risks, causing significant excess mortality and LLE, especially through cardiovascular diseases. It causes an LLE that rivals that of tobacco smoking. The global mean LLE from air pollution strongly exceeds that by violence (all forms together), i.e. by an order of magnitude (LLE being 2.9 and 0.3 years, respectively).
more
Background
The objective of this study was to investigate the effects of reduction, cessation, and resumption of smoking on cancer development.
Methods
The authors identified 893,582 participants who currently smoked, had undergone a health screening in 2009, and had a follow-up screening in 20
...
11. Among them, 682,996 participated in a third screening in 2013. Participants were categorized as quitters, reducers I (≥50% reduction), reducers II (<50% reduction), sustainers (referent), or increasers (≥20% increase). Outcome data were obtained through December 31, 2018.
Results
Reducers I exhibited a decreased risk of all cancers (adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.93-0.99), smoking-related cancers (aHR, 0.95; 95% CI, 0.92-0.99), and lung cancer (aHR, 0.83; 95% CI, 0.77-0.88). Quitters had the lowest risk of all cancers (aHR, 0.94; 95% CI, 0.92-0.96), smoking-related cancers (aHR, 0.91; 95% CI, 0.89-0.93), and lung cancer (aHR, 0.79; 95% CI, 0.76-0.83). In further analysis with 3 consecutive screenings, additional smoking reduction (from reducers II to reducers I) lowered the risk of lung cancer (aHR, 0.74; 95% CI, 0.58-0.94) in comparison with sustainers. Quitting among reducers I further decreased the risk of all cancers (aHR, 0.90; 95% CI, 0.80-1.00), smoking-related cancers (aHR, 0.81; 95% CI, 0.81-0.92), and lung cancer (aHR, 0.66; 95% CI, 0.52-0.84) in comparison with sustainers. Smoking resumption after quitting, even at a lower level, increased the risk of smoking-related cancers (aHR, 1.19; 95% CI, 1.06-1.33) and lung cancer (aHR, 1.48; 95% CI, 1.21-1.80) in comparison with sustained quitting.
Conclusions
Smoking cessation and, to a lesser extent, smoking reduction decreased the risks of cancer. Smoking resumption increased cancer risks in comparison with sustained quitting.
more
Due to the heterogeneous distribution of malaria transmission and its determinants, subnational tailoring (SNT) provides an analytical framework to facilitate the targeting of each population with appropriate intervention packages for maximum impact to inform national strategic planning and prioriti
...
zation based on resources available. The WHO Global Malaria Programme recommends the use of subnational data on disease epidemiology and other relevant local contextual factors to facilitate the process of SNT. Once the strategies and intervention mixes have been defined, programmes can proceed to the prioritization of
interventions for effective programming, based on available resources
more
Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to mainta
...
in CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
more
With development, people around the world have become wealthier and live longer. At the same time, development can lead to growing inequalities within and between nations. This paper analyses inequalities related to disability and how they vary across countries by development level. Using internatio
...
nally comparable data on disability inequalities in 40 countries, we assess disability inequalities through the use of regression analyses with a variety of development measures. Results support the hypothesis only partially: disability inequalities related to education, employment, and multidimensional poverty are found to be significantly larger in countries at higher levels of development. However, this is not the case for rates of access to water, sanitation, clean fuel, electricity, housing, and assets. These results, overall, hold when using different development and
outcome indicators, and when focusing on specific subgroups of the population. The potential implications of these findings are discussed. Further research is needed to understand, for education and employment, the factors and processes that contribute to larger disability inequalities in countries at higher levels of development and what strategies might be pursued to reduce them.
more
Background: Disability is a complex concept involving physical impairment, activity limitation, and participation restriction. The
Washington Group developed a set of questions on six functional domains (seeing, hearing, walking, remembering, self-care, and
communicating) to allow collection of co
...
mparable data on disability. We aimed to improve understanding of prevalence and correlates of disability in this low-income setting in Malawi.
more
Similar to other parts of the world, the prevalence of type 2 diabetes mellitus (T2DM) in the Asia-Pacific Region has rapidly increased during the last few decades. The purposes of this pilot study were to determine the feasibility and the effects of a capacity building program for Village Health Vo
...
lunteers (VHVs) to support self-management in a T2DM high risk population from a rural subdistrict in Northeast Thailand. Both quantitative and qualitative data were collected using surveys, focus group discussions, and in-depth interviews. Data were analyzed and used to develop a 12-week capacity building program for VHVs. This program was then implemented on 60 subjects at high risk of T2DM in the selected community. According to the paired t-test and Wilcoxon-signed rank test, VHVs had higher scores on knowledge and self-efficacy of T2DM prevention after a 12 week intervention (p =.03 and p =.02, respectively). Study participants at risk for T2DM also had a significant increase in T2DM knowledge and self-management (p <.001). Implementation of the capacity building program for VHVs in Northeast Thailand was feasible. The key successes were strong community bonding, community empowerment, and support from family and public health nurses. Effects of the program should be examined with those in other Asia-Pacific countries.
more
The Noncommunicable Diseases Country Profiles 2018 by the World Health Organization (WHO) provides an in-depth look at the burden of noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes across WHO Member States. It includes
...
data on NCD mortality, risk factors like tobacco use, unhealthy diets, physical inactivity, and excessive alcohol consumption, as well as country-specific responses and health system capacities to manage and prevent NCDs.
more
This toolkit is a comprehensive set of practical tools and resources designed to support country-level risk communication and community engagement (RCCE) practitioners, decision-makers, and partners to plan and implement readiness and response activities for dengue fever outbreaks. The toolkit conta
...
ins: information about dengue fever; RCCE considerations for how to approach key issues during dengue fever outbreaks; tools for understanding the context in which dengue fever outbreaks occur; methods for collecting data to inform strategy development and bring evidence into planning and implementation of activities; guidance to support vector control and prevention activities; case studies; and links to existing RCCE tools and training. It is one of a suite of toolkits on RCCE readiness and response to a range of disease and response areas.
more
The report "Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases" provides an overview of the capacities of countries in the Eastern Mediterranean Region to address noncommunicable diseases (NCDs) based on a 2019 survey. It evaluates the progress of 22 countries in
...
areas such as governance, policy implementation, health infrastructure, data collection, and healthcare resources for NCD prevention. The report highlights achievements and gaps, emphasizing the need for strengthened health systems, surveillance, and cross-sectoral collaboration to meet the WHO's global NCD targets. The findings guide further actions to reduce the burden of NCDs in the region.
more
The Framework serves to guide efforts to deliver safe and sustainable water, sanitation and hygiene (WASH), health care waste management and reliable electricity in all health care facilities. The ultimate aim is to provide quality care for all. The Framework reflects a global consultative process a
...
nd includes data and recommendations articulated in recent WHO/UNICEF global reports on WASH, waste and electricity in health care facilities. It also provides an operational roadmap for implementing the 2023 United Nations General Assembly (UNGA) resolution on WASH, waste and electricity in health care facilities. The target audiences for this Framework include health leaders and programme managers at the global and national levels; policymakers; WASH, waste and energy leaders and technical experts; development partners and finance institutions; and actors and experts on gender equality, disability and social inclusion and climate; and, more generally, civil society. The Framework addresses the WASH, waste and electricity elements of the WHO comprehensive approach to build safe, climate-resilient and environmentally sustainable health care facilities.
more
Implementing the global action plan on antimicrobial resistance: first quadripartite biennial report
The first quadripartite biennial report summarizes progress in the implementation of multisectoral national action plans, actions by the quadripartite organizations, actions by the global governance structures, key environmental dimensions, highlights areas for accelerated action, and shares case st
...
udies from six countries. An Annex with extensive data on the global action plan’s monitoring and evaluation indicators is included. The report was developed through contributions from all 6 WHO regions, member states, various headquarters departments and units, and technical teams from FAO, WOAH and UNEP.
more
This brief presents the guidelines and agreements in the information document Status of access to sexual and reproductive health services, prepared by the Pan American Health Organization (PAHO) at the request of its Member States at the 30th Pan American Sanitary Conference. It was presented and un
...
animously approved by the countries of the Region of the Americas at the 60th Meeting of the Directing Council, 75th session of the WHO Regional Committee for the Americas, held in Washington, D.C., USA, September 25-29, 2023. Its objective is to describe the status of access to sexual and reproductive health services in the Americas region, identify health responses and barriers to access, and suggest recommendations for countries. It was developed based on a review and systematization of data, plans and initiatives, scientific papers, United Nations reports, and legal and regulatory frameworks on sexual and reproductive health.
more
The webpage from the Institute for Health Metrics and Evaluation (IHME) features a podcast discussing chronic respiratory diseases and their global impact. It highlights the growing burden of diseases such as chronic obstructive pulmonary disease (COPD) and asthma worldwide. The podcast provides ins
...
ights into the challenges faced in managing and preventing these diseases, emphasizing the importance of early diagnosis, public health strategies, and global data to inform healthcare policies. Experts discuss the role of environmental and lifestyle factors in disease prevalence and outline ways to mitigate these risks through improved healthcare and awareness.
more
The Mekong Malaria Elimination (MME) programme is an initiative aimed at supporting Greater Mekong Subregion (GMS) countries – Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, Viet Nam, and Yunnan (China) – in achieving the goal of malaria elimination by 2030.
...
Data for this epidemiological summary were compiled from country reports.
more
The article "The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990–2019" provides an analysis of the prevalence, mortality, and disability-adjusted life-years (DALYs) due to COPD in the MENA region from 1990 to 2019.
...
The study uses data from the Global Burden of Disease (GBD) 2019 and shows that while age-standardized death and DALY rates have decreased over 30 years, COPD remains a significant health issue, especially among older populations. The main risk factors identified are smoking, ambient particulate pollution, and occupational exposure. The research underscores the impact of socioeconomic factors and recommends targeted public health initiatives to reduce the burden.
more
The article analyzes the prevalence and risk factors of chronic respiratory diseases, focusing on sub-Saharan Africa. It highlights that environmental exposures, such as biomass fuel usage and air pollution, significantly contribute to respiratory health issues in the region. The research underlines
...
the limited healthcare infrastructure, insufficient diagnostic tools, and the need for comprehensive data collection to better understand the burden of respiratory diseases. The authors advocate for targeted public health interventions, improved access to healthcare, and policies aimed at reducing exposure to risk factors to mitigate the prevalence of respiratory conditions.
more
An Estimate of the Prevalence of COPD in Africa: A Systematic Analysis
Adeloye, D.; Basquil, C.; Papana, A.; et al.
COPD: Journal of Chronic Obstructive Pulmonary Disease
(2014)
CC2
The article provides a systematic analysis estimating the prevalence of Chronic Obstructive Pulmonary Disease (COPD) across Africa. It highlights the significant health burden COPD imposes on the continent, emphasizing varying prevalence rates influenced by factors such as tobacco smoking, exposure
...
to biomass fuel, and occupational hazards. The analysis reveals substantial gaps in data and disparities in COPD diagnosis and management across different African countries. The authors call for more comprehensive data collection, increased awareness, and better healthcare infrastructure to effectively address and manage COPD in Africa.
more
The article investigates the effectiveness and challenges of remote monitoring systems for chronic respiratory diseases, focusing on COPD and asthma. It reviews various technologies and their potential to improve patient outcomes through better symptom tracking, medication adherence, and early detec
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tion of exacerbations. The study highlights that while remote monitoring has significant potential, challenges such as data accuracy, patient compliance, and integration with existing healthcare systems remain. The authors call for further research to standardize and validate remote monitoring tools and emphasize the need for patient-centric approaches to enhance engagement and adherence.
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