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Trickey A, Johnson LF, Bonifacio R, Kiragga A, Howard G, Biraro S, Wagener T, Low A, Vickerman P. Investigating the Associations between Drought, Poverty, High-Risk Sexual Behaviours, and HIV Incidence in Sub-Saharan Africa: A Cross-Sectional Study. AIDS Behav 2024; 28:1752-1765. [PMID: 38374246 DOI: 10.1007/s10461-024-04280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Abstract
Climate change is increasing the likelihood of drought in sub-Saharan Africa, where HIV prevalence is high. Drought could increase HIV transmission through various mediating mechanisms; we investigated these associations. We used data on people aged 15-59 from Population-Based HIV Impact Assessment surveys from 2016 in Eswatini, Lesotho, Tanzania, Uganda, and Zambia. Survey data were geospatially linked to precipitation data for 2014-2016, with local droughts defined as cumulative rainfall between 2014 and 2016 being in < 15th percentile of all 2-year periods over 1981-2016. Using multivariable logistic regression, stratified by sex and rural/urban residence, we examined associations between (a) drought and poverty, (b) wealth quintiles and sexual behaviours (transactional, high-risk, and intergenerational sex), (c) sexual behaviours and recently acquiring HIV, and (d) drought and recent HIV. Among 102,081 people, 31.5% resided in areas affected by drought during 2014-2016. Experiencing drought was positively associated with poverty for women and men in rural, but not urban, areas. For each group, increasing wealth was negatively associated with transactional sex. For rural women, intergenerational sex was positively associated with wealth. Women reporting each sexual behaviour had higher odds of recent HIV, with strong associations seen for high-risk sex, and, for urban women, intergenerational sex, with weaker associations among men. Women in rural areas who had been exposed to drought had higher odds of having recently acquired HIV (2.10 [95%CI: 1.17-3.77]), but not women in urban areas, or men. Droughts could potentially increase HIV transmission through increasing poverty and then sexual risk behaviours, particularly among women in rural areas.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Agnes Kiragga
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Guy Howard
- Department of Civil Engineering and Cabot Institute of the Environment, University of Bristol, Bristol, UK
| | - Samuel Biraro
- ICAP at Columbia University, Nakasero, Kampala, Uganda
| | - Thorsten Wagener
- Institute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany
| | - Andrea Low
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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Lo Y, Vosper E, Higgins JP, Howard G. Heat impacts on human health in the Western Pacific Region: an umbrella review. Lancet Reg Health West Pac 2024; 42:100952. [PMID: 38022710 PMCID: PMC10652124 DOI: 10.1016/j.lanwpc.2023.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Background High temperatures and heatwaves are occurring more frequently and lasting longer because of climate change. A synthesis of existing evidence of heat-related health impacts in the Western Pacific Region (WPR) is lacking. This review addresses this gap. Methods The Scopus and PubMed databases were searched for reviews about heat impacts on mortality, cardiovascular morbidity, respiratory morbidity, dehydration and heat stroke, adverse birth outcomes, and sleep disturbance. The last search was conducted in February 2023 and only publications written in English were included. Primary studies and reviews that did not include specific WPR data were excluded. Data were extracted from 29 reviews. Findings There is strong evidence of heat-related mortality in the WPR, with the evidence concentrating on high-income countries and China. Associations between heat and cardiovascular or respiratory morbidity are not robust. There is evidence of heat-related dehydration and stroke, and preterm and still births in high-income countries in the WPR. Some evidence of sleep disturbance from heat is found for Australia, Japan and China. Interpretation Mortality is by far the most studied and robust health outcome of heat. Future research should focus on morbidity, and lower income countries in continental Asia and Pacific Island States, where there is little review-level evidence. Funding Funded by the World Health Organization WPR Office.
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Affiliation(s)
- Y.T.Eunice Lo
- Cabot Institute for the Environment, University of Bristol, UK
- Elizabeth Blackwell Institute for Health Research, University of Bristol, UK
| | - Emily Vosper
- Cabot Institute for the Environment, University of Bristol, UK
- School of Geographical Sciences, University of Bristol, UK
| | - Julian P.T. Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Guy Howard
- Cabot Institute for the Environment, University of Bristol, UK
- School of Civil, Aerospace and Design Engineering, University of Bristol, UK
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Trickey A, Johnson LF, Fung F, Bonifacio R, Iwuji C, Biraro S, Bosomprah S, Chirimuta L, Euvrard J, Fatti G, Fox MP, Von Groote P, Gumulira J, Howard G, Jennings L, Kiragga A, Muula G, Tanser F, Wagener T, Low A, Vickerman P. Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies. BMC Infect Dis 2023; 23:889. [PMID: 38114912 PMCID: PMC10731689 DOI: 10.1186/s12879-023-08902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa. METHODS Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981-2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre's latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm3, viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre. RESULTS Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32-46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07-1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01-1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66-0.98] per 10 percentile rainfall rank decrease). CONCLUSIONS Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Fai Fung
- Department of Civil Engineering, University of Bristol, Bristol, UK
- UK Meteorological Office, Exeter, UK
| | - Rogerio Bonifacio
- Climate and Earth Observation Unit, Research Assessment and Monitoring Division, World Food Programme HQ, Rome, Italy
| | - Collins Iwuji
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Samuel Biraro
- ICAP at Columbia University, Nakasero, Kampala, Uganda
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Geoffrey Fatti
- Kheth'Impilo AIDS Free Living, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health and Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Per Von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Guy Howard
- Department of Civil Engineering and Cabot Institute of the Environment, University of Bristol, Bristol, UK
| | - Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Agnes Kiragga
- Research Division, African Population and Health Research Center, Nairobi, Kenya
| | - Guy Muula
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Frank Tanser
- Centre for Epidemic Response and Innovation, School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Thorsten Wagener
- Institute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany
| | - Andrea Low
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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Olalemi AO, Atiba R, Weston S, Howard G. Sanitary inspection and microbial health risks associated with enteric bacteria in groundwater sources in Ilara-Mokin and Ibule-Soro, Nigeria. J Water Health 2023; 21:1784-1794. [PMID: 38153712 PMCID: wh_2023_111 DOI: 10.2166/wh.2023.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
This study set out to determine the sanitary risk scores and microbial health risks associated with wells and boreholes in Ilara-Mokin and Ibule-Soro, Nigeria. Water samples (n = 96) were collected over a period of five months to determine the levels of enteric bacteria and to perform a Quantitative Microbial Risk Assessment (QMRA) of drinking water quality. Sanitary risk scores revealed `medium' and `low' overall risks for the wells and boreholes, respectively. Three risk factors (faulty fence; small apron; pollution sources) exhibited high significant (p < 0.01) association with the presence of E. coli and thermotolerant coliforms in water samples from the wells. E. coli and Salmonella ranged from 1.82 to 2.28 and 2.15 to 2.63 log10 CFU/100 ml respectively in water from the wells, but were below detection limit in water from the boreholes. Shigella and Campylobacter were detected in all water samples. Estimated risks of infection associated with Shigella (2.1 × 10-2 to 2.3 × 10-1) were higher than those of Campylobacter (6.7 × 10-2 to 1.9 × 10-1) and Salmonella (1.9×10-3 to 5.6×10-3). Adaption of water safety plans may be advantageous in these settings, since intentional ingestion of water from the wells and boreholes may pose potential risks of diarrheal illness to humans.
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Affiliation(s)
- Adewale Oluwasogo Olalemi
- Department of Microbiology, School of Life Sciences, Federal University of Technology, Akure, Ondo State P.M.B. 704, Nigeria E-mail:
| | - Roseline Atiba
- Department of Microbiology, School of Life Sciences, Federal University of Technology, Akure, Ondo State P.M.B. 704, Nigeria
| | - Sally Weston
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol BS8 1TR, UK
| | - Guy Howard
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol BS8 1TR, UK
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Vafeiadou A, Banissy MJ, Banissy JF, Higgins JP, Howard G. The influence of climate change on mental health in populations of the western Pacific region: An umbrella scoping review. Heliyon 2023; 9:e21457. [PMID: 38053883 PMCID: PMC10694052 DOI: 10.1016/j.heliyon.2023.e21457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/27/2023] [Accepted: 10/21/2023] [Indexed: 12/07/2023] Open
Abstract
The Western Pacific Region (WPR) is on the front line of climate change challenges. Understanding how these challenges affect the WPR populations' mental health is essential to design effective prevention and care policies. Thus, the present study conducted an umbrella scoping review that examined the influence of climate change on mental health in the WPR, using review articles as a source of information. Ten review articles were selected according to eligibility criteria, and the findings were synthesized according to the socio-economic status of the countries identified: Australia, the Republic of Korea, the Philippines, Vietnam, the Pacific Islands (broadly), and China. The findings revealed that each country and sub-region has its own unique profile of climate change-related challenges and vulnerable populations, highlighting the need for specific approaches to mental health care. Specifically, the influence of climate-related challenges differed according to populations' region (e.g., rural populations), demographic characteristics (e.g., age and gender), culture (e.g., traditional tights to land), and employment (e.g., farmers and fishers). The most frequently reported mental health outcomes in response to climate change-related challenges such as droughts, floods, storms, tornadoes, typhoons, and climate-related migration were the decline in mental well-being and the increase in post-traumatic stress disorder symptoms. In addition, using the GRADE framework for assessing the certainty of the findings, we identified that the number of articles discussing associations between a given climate change challenge and a mental health outcome was overall limited. Based on our findings and findings on a global scale, we identified several key research gaps in WPR and provided recommendations for future research and policy strategies.
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Affiliation(s)
| | - Michael J. Banissy
- Department of Psychology, Goldsmiths, University of London, London, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Julian P.T. Higgins
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Guy Howard
- Cabot Institute, University of Bristol, Bristol, UK
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Poudel P, Ghimire A, Howard G, Evans B, Camargo-Valero MA, Mills F, Reddy O, Sharma S, Tuladhar S, Geremew A, Okurut K, Ngom B, Baidya M, Dangol S. Field-based methods for measuring greenhouse gases emissions from on-site sanitation systems: A systematic review of published literature. Heliyon 2023; 9:e19947. [PMID: 37809600 PMCID: PMC10559576 DOI: 10.1016/j.heliyon.2023.e19947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
On-site sanitation systems (OSS) are a source of greenhouse gas (GHG) emissions. Although efforts have been made recently to measure and quantify emissions from septic tanks using various field-based methods, the vast majority of published literature reporting GHG emissions from OSS units (e.g., pits and tanks) is based on non-empirical evidence. This systematic review presents an overview and limitations of field-based methods used for the quantification of GHG emissions from OSS. Papers published in English were searched in three databases: Google Scholar, PubMed, and Directory of Articles and Journals. Peer-reviewed papers that reported field-based methods applied to containment units in OSS were included in this study. Only eight out of 2085 papers met the inclusion criteria with septic tanks as the sole technology reported and were thus, considered for the review. Most of the studies have been conducted in middle- and high-income countries. Field-based measurements of GHGs are conducted using a flux chamber (FC) and the most commonly used FC methods are (a) the modified simple static FC, (b) automated static FC, and (c) floating FC. Data reported in published studies do not provide sufficient information on the calibration and validation of the results from the FCs used. The complex FC designs, laborious fieldwork operations, and reliance on expensive, specialist equipment, suggest that such methods may not be suitable in Low and Middle-Income countries (LMICs), where resources and access to laboratory facilities are limited. Also, the complexity of pits and tank typology in LMICs (i.e., unstandardised designs and sizes) may be a challenge to the use of FCs with fixed dimensions and set operational conditions. The variation in the quantification methods and resulting emission rates among the studies indicates that gaps prevail in the use of existing methods. Therefore, there is still a need for a simple field-based, easily adaptable FC method with adequate calibration and validation that can help in reliably quantifying the emissions from different OSS in any LMICs.
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Affiliation(s)
- Prativa Poudel
- Department of Environment Science and Engineering, Kathmandu University, Nepal
- Aquatic Ecology Centre, School of Science, Kathmandu University, Nepal
| | - Anish Ghimire
- Department of Environment Science and Engineering, Kathmandu University, Nepal
| | - Guy Howard
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol BS8 1TR, UK
| | - Barbara Evans
- WASH Research Group, School of Civil Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Miller A. Camargo-Valero
- BioResource Systems Research Group, School of Civil Engineering, University of Leeds, Leeds LS2 9JT, UK
- Departamento de Ingeniería Química, Universidad Nacional de Colombia, Campus La Nubia, Manizales, Colombia
| | - Freya Mills
- Institute for Sustainable Futures, University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia
| | - Olivia Reddy
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol BS8 1TR, UK
| | - Subodh Sharma
- Department of Environment Science and Engineering, Kathmandu University, Nepal
- Aquatic Ecology Centre, School of Science, Kathmandu University, Nepal
| | - Sarana Tuladhar
- Department of Environment Science and Engineering, Kathmandu University, Nepal
- Aquatic Ecology Centre, School of Science, Kathmandu University, Nepal
| | - Abraham Geremew
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Kenan Okurut
- Department of Civil and Environmental Engineering, Kyambogo University, Kampala, Uganda
| | - Baba Ngom
- Laboratoire Sciences et Techniques de l’Eau et de l’Environnement (LASTEE), Ecole Polytechnique de Thies (EPT), Thies, Senegal
| | - Manish Baidya
- Aquatic Ecology Centre, School of Science, Kathmandu University, Nepal
| | - Sheila Dangol
- Aquatic Ecology Centre, School of Science, Kathmandu University, Nepal
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Nguyen VA, Tran Thi Hien H, Nijhawan A, Howard G, Nghia Ton T. Evaluation of water safety plan implementation at provincial water utilities in Vietnam. J Water Health 2023; 21:47-65. [PMID: 36705497 DOI: 10.2166/wh.2022.192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study evaluated the experience of implementing water safety plans (WSPs) in Vietnam. WSPs were introduced in Vietnam by the World Health Organization (WHO) in collaboration with the Ministry of Construction in 2006 and have been a mandatory requirement for municipal water supplies since 2012. Using a mixed-methods approach, we collected data on the perceived benefits and challenges of WSP implementation from 23 provincial water companies between August and November 2021. Potential public health benefits of improved water quality were a key motivation; 87% of the water utilities were also motivated by the risk of climate change and prepared response plans to climate-related extreme events as part of WSPs. A decrease in E. coli and an improvement in disinfectant residual in treated water were reported by 61 and 83% of the water supplies, respectively. Sixty-five percent of the water supplies also reported improved revenue and cost recovery. Key barriers to WSP implementation were a lack of WSP guidance suitable for the local context (87%) and insufficient funds for WSP implementation (43%). Our study highlights the need for improved support and capacity building along with locally suited guidance on WSP implementation and audit.
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Affiliation(s)
- Viet-Anh Nguyen
- Institute of Environmental Science and Engineering (IESE), Hanoi University of Civil Engineering, Hanoi, Vietnam E-mail:
| | - Hoa Tran Thi Hien
- Institute of Environmental Science and Engineering (IESE), Hanoi University of Civil Engineering, Hanoi, Vietnam E-mail:
| | - Anisha Nijhawan
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol BS8 1TR, UK
| | - Guy Howard
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol BS8 1TR, UK
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Charles KJ, Howard G, Villalobos Prats E, Gruber J, Alam S, Alamgir ASM, Baidya M, Flora MS, Haque F, Hassan SMQ, Islam S, Lazaro A, Lwetoijera DW, Mahmud SG, Mahmud ZH, Matwewe F, Pasa K, Rahman M, Reza AAS, Selimuzzaman M, Sharif AR, Sharma S, Thomas JM, Campbell-Lendrum D. Infrastructure alone cannot ensure resilience to weather events in drinking water supplies. Sci Total Environ 2022; 813:151876. [PMID: 34826465 DOI: 10.1016/j.scitotenv.2021.151876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
Climate resilient water supplies are those that provide access to drinking water that is sustained through seasons and through extreme events, and where good water quality is also sustained. While surface and groundwater quality are widely understood to vary with rainfall, there is a gap in the evidence on the impact of weather and extremes in rainfall and temperature on drinking water quality, and the role of changes in water system management. A three-country (Bangladesh, Nepal and Tanzania) observational field study tracked 2353 households clustered around 685 water sources across seven different geographies over 14 months. Water quality (E. coli) data was modelled using GEE to account for clustering effects and repeated measures at households. All types of infrastructure were vulnerable to changes in weather, with differences varying between geographies; protected boreholes provided the greatest protection at the point of collection (PoC). Water quality at the point of use (PoU) was vulnerable to changes in weather, through changes in PoC water quality as well as changes in management behaviours, such as safe storage, treatment and cleaning. This is the first study to demonstrate the impact of rainfall and temperature extremes on water quality at the PoC, and the role that weather has on PoU water quality via management behaviours. Climate resilience for water supplies needs to consider the infrastructure as well as the management decisions that are taking place at a community and household level.
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Affiliation(s)
- Katrina J Charles
- School of Geography and the Environment, University of Oxford, South Parks Rd, Oxford, UK.
| | - Guy Howard
- Department of Civil Engineering and Cabot Institute of the Environment, University of Bristol, University Walk, Bristol BS8 1TR, UK.
| | | | - Joshua Gruber
- Center for Effective Global Action, University of California, Berkeley, Berkeley, CA, United States of America.
| | - Sadekul Alam
- Bangladesh Meteorological Department, Bangladesh
| | - A S M Alamgir
- Institute of Epidemiology Disease Control And Research (IEDCR), Bangladesh
| | | | | | - Farhana Haque
- Institute of Epidemiology Disease Control And Research (IEDCR), Bangladesh
| | | | | | | | | | | | | | | | | | - Mahmudur Rahman
- Institute of Epidemiology Disease Control And Research (IEDCR), Bangladesh
| | | | - M Selimuzzaman
- Institute of Epidemiology Disease Control And Research (IEDCR), Bangladesh
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Kapwata T, Kunene Z, Wernecke B, Lange S, Howard G, Nijhawan A, Wright CY. Applying a WASH Risk Assessment Tool in a Rural South African Setting to Identify Risks and Opportunities for Climate Resilient Communities. Int J Environ Res Public Health 2022; 19:ijerph19052664. [PMID: 35270357 PMCID: PMC8909929 DOI: 10.3390/ijerph19052664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
Climate change threatens the health and well-being of populations. We conducted a risk assessment of two climate-related variables (i.e., temperature and rainfall) and associated water, sanitation and hygiene (WASH)-related exposures and vulnerabilities for people living in Mopani District, Limpopo province, South Africa. Primary and secondary data were applied in a qualitative and quantitative assessment to generate classifications of risk (i.e., low, medium, or high) for components of hazard/threat, human exposure, and human vulnerability. Climate-related threats were likely to impact human health due to the relatively high risk of waterborne diseases and WASH-associated pathogens. Vulnerabilities that increased the susceptibility of the population to these adverse outcomes included environmental, human, physical infrastructure, and political and institutional elements. People of low socio-economic status were found to be least likely to cope with changes in these hazards. By identifying and assessing the risk to sanitation services and water supply, evidence exists to inform actions of government and WASH sector partners. This evidence should also be used to guide disaster risk reduction, and climate change and human health adaptation planning.
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Affiliation(s)
- Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (B.W.)
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (B.W.)
| | - Bianca Wernecke
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2094, South Africa; (T.K.); (Z.K.); (B.W.)
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
| | - Samantha Lange
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Guy Howard
- Department of Civil Engineering, Cabot Institute, University of Bristol, Bristol BS8 1TU, UK;
| | - Anisha Nijhawan
- Department of Civil Engineering, University of Bristol, Bristol BS8 1TU, UK;
| | - Caradee Y. Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0001, South Africa
- Correspondence: ; Tel.: +27-12-339-8543
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Nijhawan A, Howard G. Associations between climate variables and water quality in low- and middle-income countries: A scoping review. Water Res 2022; 210:117996. [PMID: 34959067 DOI: 10.1016/j.watres.2021.117996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/15/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
Understanding how climate change will affect water quality and therefore, health, is critical for building resilient water services in low- and middle-income countries (LMICs) where the effect of climate change will be felt most acutely. Evidence of the effect of climate variables such as temperate and rainfall on water quality can generate insights into the likely impact of future climate change. While the seasonal effects on water quality are known, and there is strong qualitative evidence that climate change will impact water quality, there are no reviews that synthesise quantitative evidence from LMICs on links between climate variables and water quality. We mapped the available evidence on a range of climate exposures and water quality outcomes and identified 98 peer-reviewed studies. This included observational studies on the impact of temperature and rainfall events (which may cause short-term changes in contaminant concentrations), and modelling studies on the long-term impacts of sea level rise. Evidence on links between antecedent rainfall and microbiological contamination of water supplies is strong and relatively evenly distributed geographically, but largely focused on faecal indicator bacteria and on untreated shallow groundwater sources of drinking water. The literature on climate effects on geogenic contaminants was sparse. There is substantial research on the links between water temperature and cyanobacteria blooms in surface waters, although most studies were from two countries and did not examine potential effects on water treatment. Similarly, studies modelling the impact of sea level rise on groundwater salinity, mostly from south-Asia and the Middle East, did not discuss challenges for drinking water supplies. We identified key future research priorities based on this review. These include: more studies on specific pathogens (including opportunistic pathogens) in water supplies and their relationships with climate variables; more studies that assess likely relationships between climate variables and water treatment processes; studies into the relationships between climate variables and geogenic contaminants, including risks from heavy metals released as glacier retreat; and, research into the impacts of wildfires on water quality in LMICs given the current dearth of studies but recognised importance.
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Affiliation(s)
- Anisha Nijhawan
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol, BS8 1TR, UK.
| | - Guy Howard
- Department of Civil Engineering and Cabot Institute for the Environment, University of Bristol, Bristol, BS8 1TR, UK.
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11
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Fisch U, von Felten S, Wiencierz A, Jansen O, Howard G, Hendrikse J, Halliday A, Fraedrich G, Eckstein HH, Calvet D, Bulbulia R, Becquemin JP, Algra A, Rothwell P, Ringleb P, Mas JL, Brown M, Brott T, Bonati L. Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled Trials. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Pedder H, Kapwata T, Howard G, Naidoo RN, Kunene Z, Morris RW, Mathee A, Wright CY. Lagged Association between Climate Variables and Hospital Admissions for Pneumonia in South Africa. Int J Environ Res Public Health 2021; 18:ijerph18126191. [PMID: 34201085 PMCID: PMC8228646 DOI: 10.3390/ijerph18126191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/16/2022]
Abstract
Pneumonia is a leading cause of hospitalization in South Africa. Climate change could potentially affect its incidence via changes in meteorological conditions. We investigated the delayed effects of temperature and relative humidity on pneumonia hospital admissions at two large public hospitals in Limpopo province, South Africa. Using 4062 pneumonia hospital admission records from 2007 to 2015, a time-varying distributed lag non-linear model was used to estimate temperature-lag and relative humidity-lag pneumonia relationships. Mean temperature, relative humidity and diurnal temperature range were all significantly associated with pneumonia admissions. Cumulatively across the 21-day period, higher mean daily temperature (30 °C relative to 21 °C) was most strongly associated with a decreased rate of hospital admissions (relative rate ratios (RR): 0.34, 95% confidence interval (CI): 0.14–0.82), whereas results were suggestive of lower mean daily temperature (12 °C relative to 21 °C) being associated with an increased rate of admissions (RR: 1.27, 95%CI: 0.75–2.16). Higher relative humidity (>80%) was associated with fewer hospital admissions while low relative humidity (<30%) was associated with increased admissions. A proportion of pneumonia admissions were attributable to changes in meteorological variables, and our results indicate that even small shifts in their distributions (e.g., due to climate change) could lead to substantial changes in their burden. These findings can inform a better understanding of the health implications of climate change and the burden of hospital admissions for pneumonia now and in the future.
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Affiliation(s)
- Hugo Pedder
- Population Health Sciences, University of Bristol, Canynge Hall, Bristol BS8 2PN, UK; (H.P.); (R.W.M.)
| | - Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2028, South Africa; (T.K.); (Z.K.); (A.M.)
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2028, South Africa
| | - Guy Howard
- School of Civil, Aerospace and Mechanical Engineering, University Walk, Bristol BS8 1TR, UK;
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban 4001, South Africa;
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2028, South Africa; (T.K.); (Z.K.); (A.M.)
| | - Richard W. Morris
- Population Health Sciences, University of Bristol, Canynge Hall, Bristol BS8 2PN, UK; (H.P.); (R.W.M.)
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2028, South Africa; (T.K.); (Z.K.); (A.M.)
- Environmental Health Department, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2028, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Caradee Y. Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0084, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0084, South Africa
- Correspondence:
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13
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Howard G, Bartram J, Brocklehurst C, Colford JM, Costa F, Cunliffe D, Dreibelbis R, Eisenberg JNS, Evans B, Girones R, Hrudey S, Willetts J, Wright CY. COVID-19: urgent actions, critical reflections and future relevance of 'WaSH': lessons for the current and future pandemics. J Water Health 2020; 18:613-630. [PMID: 33095188 DOI: 10.2166/wh.2020.162] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.
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Affiliation(s)
- Guy Howard
- Department of Civil Engineering, University of Bristol, Bristol, UK E-mail: ; † Co-first-authors
| | - Jamie Bartram
- School of Civil Engineering, University of Leeds, Leeds, UK; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; † Co-first-authors
| | - Clarissa Brocklehurst
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ‡ Authors in alphabetical order
| | - John M Colford
- Division of Epidemiology, University of California, Berkeley, CA, USA; ‡ Authors in alphabetical order
| | - Federico Costa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil; ‡ Authors in alphabetical order
| | - David Cunliffe
- Department for Health and Wellbeing, Adelaide, South Australia, Australia; ‡ Authors in alphabetical order
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK; ‡ Authors in alphabetical order
| | | | - Barbara Evans
- School of Civil Engineering, University of Leeds, Leeds, UK; ‡ Authors in alphabetical order
| | - Rosina Girones
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain; ‡ Authors in alphabetical order
| | - Steve Hrudey
- Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; ‡ Authors in alphabetical order
| | - Juliet Willetts
- Institute for Sustainable Futures, University of Technology Sydney, Sydney, Australia; ‡ Authors in alphabetical order
| | - Caradee Y Wright
- Environmental and Health Research Unit, South African Medical Research Council, Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa; ‡ Authors in alphabetical order
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14
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Kelly ER, Cronk R, Kumpel E, Howard G, Bartram J. How we assess water safety: A critical review of sanitary inspection and water quality analysis. Sci Total Environ 2020; 718:137237. [PMID: 32109810 DOI: 10.1016/j.scitotenv.2020.137237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 06/10/2023]
Abstract
Sanitary inspection is used in low-, medium- and high-income settings to assess the risk of microbial contamination at water sources. However, the relationship between sanitary inspection and water quality is not well understood. We conducted a critical literature review and synthesized the findings of 25 studies comparing the results of sanitary inspection and microbial water quality analysis. Most studies used sub-standard sanitary inspection and water quality analysis methods, and applied simplistic comparisons that do not characterize the complexity of the relationship. Sanitary risk score was used to represent sanitary inspection results in 21 (84%) studies; of which 12 (57%) found a significant association between score and microbial water quality and nine (43%) did not. Participatory sanitary inspection (12%) and reporting results back to communities (24%) were uncommon. Most studies relied on laboratory-based water quality analysis as an independently sufficient measure of safety, but reported inadequate quality control (52%) and/or sub-standard sample processing methods (66%). We found that sanitary inspections could contribute to improving water safety through four mechanisms: guiding remedial action at individual water sources, allowing operators and external support programs to prioritize repairs, identifying programmatic issues, and contributing to research. The purpose of the sanitary inspection should be considered when planning sanitary inspection execution, data analysis, and reporting to ensure appropriate methods are employed and results are fit for purpose. Further exploration should recognize that sanitary risk factors represent sources of contamination, pathways for contaminants to enter water supplies, and breakdowns in barriers to contamination. These different sanitary risk factor types have different and inter-dependent effects on water quality.
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Affiliation(s)
- Emma R Kelly
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - Ryan Cronk
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Emily Kumpel
- Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA 01003, USA
| | - Guy Howard
- Department of Civil Engineering, University of Bristol, UK
| | - Jamie Bartram
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; School of Civil Engineering, University of Leeds, UK
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15
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Poorthuis MHF, Bulbulia R, Morris DR, Pan H, Rothwell PM, Algra A, Becquemin JP, Bonati LH, Brott TG, Brown MM, Calvet D, Eckstein HH, Fraedrich G, Gregson J, Greving JP, Hendrikse J, Howard G, Jansen O, Mas JL, Lewis SC, de Borst GJ, Halliday A. Timing of procedural stroke and death in asymptomatic patients undergoing carotid endarterectomy: individual patient analysis from four RCTs. Br J Surg 2020; 107:662-668. [PMID: 32162310 DOI: 10.1002/bjs.11441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/11/2019] [Accepted: 10/31/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The effectiveness of carotid endarterectomy (CEA) for stroke prevention depends on low procedural risks. The aim of this study was to assess the frequency and timing of procedural complications after CEA, which may clarify underlying mechanisms and help inform safe discharge policies. METHODS Individual-patient data were obtained from four large carotid intervention trials (VACS, ACAS, ACST-1 and GALA; 1983-2007). Patients undergoing CEA for asymptomatic carotid artery stenosis directly after randomization were used for the present analysis. Timing of procedural death and stroke was divided into intraoperative day 0, postoperative day 0, days 1-3 and days 4-30. RESULTS Some 3694 patients were included in the analysis. A total of 103 patients (2·8 per cent) had serious procedural complications (18 fatal strokes, 68 non-fatal strokes, 11 fatal myocardial infarctions and 6 deaths from other causes) [Correction added on 20 April, after first online publication: the percentage value has been corrected to 2·8]. Of the 86 strokes, 67 (78 per cent) were ipsilateral, 17 (20 per cent) were contralateral and two (2 per cent) were vertebrobasilar. Forty-five strokes (52 per cent) were ischaemic, nine (10 per cent) haemorrhagic, and stroke subtype was not determined in 32 patients (37 per cent). Half of the strokes happened on the day of CEA. Of all serious complications recorded, 44 (42·7 per cent) occurred on day 0 (20 intraoperative, 17 postoperative, 7 with unclear timing), 23 (22·3 per cent) on days 1-3 and 36 (35·0 per cent) on days 4-30. CONCLUSION At least half of the procedural strokes in this study were ischaemic and ipsilateral to the treated artery. Half of all procedural complications occurred on the day of surgery, but one-third after day 3 when many patients had been discharged.
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Affiliation(s)
- M H F Poorthuis
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
| | - R Bulbulia
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D R Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - H Pan
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - P M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A Algra
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, Utrecht, the Netherlands.,Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands
| | - J-P Becquemin
- Vascular Institute of Paris East, Hôpital Paul D Egine, Champigny-sur-Marne, France
| | - L H Bonati
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Department of Neurology and Stroke Centre, Department of Clinical Research, University Hospital, University of Basle, Basle, Switzerland
| | - T G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - M M Brown
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - D Calvet
- Department of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, Département Hospitalo-Universitaire Neurovasc Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale U894, Paris, France
| | - H-H Eckstein
- Department for Vascular and Endovascular Surgery - Vascular Centre, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - G Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - J Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - J P Greving
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G Howard
- Department of Biostatistics, UAB School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - O Jansen
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J-L Mas
- Department of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, Département Hospitalo-Universitaire Neurovasc Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale U894, Paris, France
| | - S C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - G J de Borst
- Department of Vascular Surgery, University Medical Centre, Utrecht, the Netherlands
| | - A Halliday
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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16
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Humphrey JH, Brown J, Cumming O, Evans B, Howard G, Kulabako RN, Lamontagne J, Pickering AJ, Wang EN. The potential for atmospheric water harvesting to accelerate household access to safe water. Lancet Planet Health 2020; 4:e91-e92. [PMID: 32220676 DOI: 10.1016/s2542-5196(20)30034-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Jean H Humphrey
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
| | - Joseph Brown
- Georgia Institute of Technology, School of Civil and Environmental Engineering, Atlanta GA, USA
| | - Oliver Cumming
- Environmental Health Group, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Barbara Evans
- Water, Public Health and Environmental Engineering Group, University of Leeds, Leeds, UK
| | - Guy Howard
- Civil Engineering, University of Bristol, Bristol, UK
| | - Robinah N Kulabako
- Department of Civil and Environmental Engineering, Makerere University, Kampala, Uganda
| | | | | | - Evelyn N Wang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge MA, USA
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17
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Fleming L, Anthonj C, Thakkar MB, Tikoisuva WM, Manga M, Howard G, Shields KF, Kelly E, Overmars M, Bartram J. Urban and rural sanitation in the Solomon Islands: How resilient are these to extreme weather events? Sci Total Environ 2019; 683:331-340. [PMID: 31132712 DOI: 10.1016/j.scitotenv.2019.05.253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
The Solomon Islands, like other small island developing states in the Pacific, face significant challenges from a changing climate, and from increasing extreme weather events, while also lagging behind the rest of the world in terms of drinking water, sanitation and hygiene (WaSH) services. In order to support planning for the implementation of national WaSH strategies and policies, this study contextualizes representative urban and rural baselines for Sustainable Development Goal (SDG) 6 ("by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation"). We highlight specific threats to the current sanitation services under extreme weather events such as flooding and drought, both of which are commonly observed in the country, and provide suggestions for structural improvements to sanitation facilities to increase resiliency. As the first detailed nationally representative cross-sectional sanitation study in urban and rural areas in the Solomon Islands, the results of this paper inform national WaSH policy, strategic planning and programming by the Solomon Islands Government and stakeholders.
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Affiliation(s)
- Lisa Fleming
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Carmen Anthonj
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | | | | | - Musa Manga
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Guy Howard
- Department of Civil Engineering, University of Bristol, UK
| | - Katherine F Shields
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Department of Geography, University of Oregon, Eugene, OR, USA
| | - Emma Kelly
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Marc Overmars
- UNICEF Pacific, Fiji Development Bank Building, Suva, Fiji
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
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18
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Cumming O, Arnold BF, Ban R, Clasen T, Esteves Mills J, Freeman MC, Gordon B, Guiteras R, Howard G, Hunter PR, Johnston RB, Pickering AJ, Prendergast AJ, Prüss-Ustün A, Rosenboom JW, Spears D, Sundberg S, Wolf J, Null C, Luby SP, Humphrey JH, Colford JM. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement. BMC Med 2019; 17:173. [PMID: 31462230 PMCID: PMC6712663 DOI: 10.1186/s12916-019-1410-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/15/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. MAIN BODY Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health. CONCLUSION These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that - in any context - a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.
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Affiliation(s)
- Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Radu Ban
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE Atlanta, GA, USA
| | - Joanna Esteves Mills
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE Atlanta, GA, USA
| | - Bruce Gordon
- Department of Public Health, World Health Organization, Geneva, Switzerland
| | - Raymond Guiteras
- Department of Agricultural and Resource Economics, North Carolina State University, Raleigh, NC, USA
| | - Guy Howard
- Department of Civil Engineering, University of Bristol, Queens Building, Bristol, UK
| | - Paul R Hunter
- The Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard B Johnston
- Department of Public Health, World Health Organization, Geneva, Switzerland
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | | | | | | | - Dean Spears
- Department of Economics, The University of Texas at Austin, Austin, TX, USA
| | | | - Jennyfer Wolf
- Department of Public Health, World Health Organization, Geneva, Switzerland
| | - Clair Null
- Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington, DC, USA
| | - Stephen P Luby
- Department of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Jean H Humphrey
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
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19
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Wadley V, Howard V, Knopman D, Lal B, Meschia J, Howard G, Brott T, Lazar R. CENTRALIZED COGNITIVE ASSESSMENT IN A MULTICENTER TRIAL OF TREATMENT MODES FOR ASYMPTOMATIC CAROTID ARTERY DISEASE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Wadley
- Division of Gerontology, Geriatrics & Palliative Care, University of Alabama at Birmingham
| | - V Howard
- Department of Epidemiology, University of Alabama at Birmingham
| | | | - B Lal
- University of Maryland School of Medicine
| | - J Meschia
- Department of Neurology, The Mayo Clinic Jacksonville
| | - G Howard
- Department of Biostatistics, University of Alabama at Birmingham
| | - T Brott
- Department of Neurology, The Mayo Clinic Jacksonville
| | - R Lazar
- Department of Neurology, University of Alabama at Birmingham
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20
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Mendoza-Topaz C, Nelson G, Howard G, Hafner S, Rademacher P, Frick M, Nichols BJ. Cells respond to deletion of CAV1 by increasing synthesis of extracellular matrix. PLoS One 2018; 13:e0205306. [PMID: 30346954 PMCID: PMC6197626 DOI: 10.1371/journal.pone.0205306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
A range of cellular functions have been attributed to caveolae, flask-like invaginations of the plasma membrane. Here, we have used RNA-seq to achieve quantitative transcriptional profiling of primary embryonic fibroblasts from caveolin 1 knockout mice (CAV1-/- MEFs), and thereby to gain hypothesis-free insight into how these cells respond to the absence of caveolae. Components of the extracellular matrix were decisively over-represented within the set of genes displaying altered expression in CAV1-/- MEFs when compared to congenic wild-type controls. This was confirmed biochemically and by imaging for selected examples. Up-regulation of components of the extracellular matrix was also observed in a second cell line, NIH-3T3 cells genome edited to delete CAV1. Up-regulation of components of the extracellular matrix was detected in vivo by assessing collagen deposition and compliance of CAV1-/- lungs. We discuss the implications of these findings in terms of the cellular function of caveolae.
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Affiliation(s)
- C. Mendoza-Topaz
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - G. Nelson
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - G. Howard
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - S. Hafner
- Institute of Pathophysiological Anesthesiology and Process Engineering, University of Ulm, Ulm, Germany
| | - P. Rademacher
- Institute of Pathophysiological Anesthesiology and Process Engineering, University of Ulm, Ulm, Germany
| | - M. Frick
- Institute of General Physiology, University of Ulm, Ulm, Germany
| | - B. J. Nichols
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom
- * E-mail:
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Cheung KL, Zakai NA, Callas PW, Howard G, Mahmoodi BK, Peralta CA, Judd SE, Kurella Tamura M, Cushman M. Mechanisms and mitigating factors for venous thromboembolism in chronic kidney disease: the REGARDS study. J Thromb Haemost 2018; 16:1743-1752. [PMID: 29984467 PMCID: PMC6123283 DOI: 10.1111/jth.14235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Indexed: 12/26/2022]
Abstract
Essentials Chronic kidney disease (CKD) is associated with procoagulant and inflammatory biomarkers. We studied the association of CKD and venous thromboembolism (VTE) in a case-cohort study. Factor VIII, D-dimer and C-reactive protein appeared to explain the association of CKD and VTE. Statin use was protective against VTE in those with and without CKD. SUMMARY Background Chronic kidney disease (CKD) is associated with venous thromboembolism (VTE) risk via unknown mechanisms. Whether factors associated with reduced VTE risk in the general population might also be associated with reduced VTE risk in CKD patients is unknown. Objectives To determine whether thrombosis biomarkers attenuate VTE risk, and whether factors associated with reduced VTE risk are similarly effective in CKD patients. Methods Baseline biomarkers were measured in a cohort (294 VTE cases; 939 non-cases) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a nationwide prospective cohort study of 30 239 persons aged ≥45 years with 4.3 years of follow-up. The hazard ratio (HR) of VTE per 10 mL min-1 1.73 m-2 decrease in estimated glomerular filtration rate (eGFR), and the percentage attenuation of this HR by each biomarker, were calculated. Associations of protective factors (physical activity, lower body mass index [BMI], and aspirin, warfarin and statin use) with VTE were estimated in those with and without CKD. Results The HR for VTE with lower eGFR was 1.13 (95% confidence interval [CI] 1.02-1.25), and VTE risk was attenuated by 23% (95% CI 5-100) by D-dimer, by 100% (95% CI 50-100) by factor VIII, and by 15% (95% CI 2-84) by C-reactive protein. Normal BMI was associated with lower VTE risk in those without CKD (HR 0.47, 95% CI 0.32-0.70), but not in those with CKD (HR 1.07, 95% CI 0.51-2.22). Statin use, physical activity and warfarin use were associated with lower VTE risk in both groups. Conclusions Procoagulant and inflammatory biomarkers mediated the association of eGFR with VTE. Higher physical activity, statin use and warfarin use mitigated VTE risk in those with CKD and those without CKD, but normal BMI did not mitigate VTE risk in CKD patients.
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Affiliation(s)
- K L Cheung
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - N A Zakai
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - P W Callas
- University of Vermont, Burlington, VT, USA
| | - G Howard
- University of Alabama Birmingham, Birmingham, AL, USA
| | - B K Mahmoodi
- University of Groningen, Groningen, The Netherlands
| | - C A Peralta
- University of California San Francisco, San Francisco, CA, USA
| | - S E Judd
- University of Alabama Birmingham, Birmingham, AL, USA
| | - M Kurella Tamura
- Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - M Cushman
- Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Penson P, Long LD, Howard G, Toth PP, Muntner P, Howard VJ, Safford MM, Jones SR, Catapano AL, Banach M. P5086Associations between very low concentrations of LDL-Cholesterol, hsCRP and health outcomes in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Penson
- Liverpool John Moores University, School of Pharmacy & Biomolecular Sciences, Liverpool, United Kingdom
| | - L D Long
- University of Alabama Birmingham, Department of Biostatistics, Birmingham, United States of America
| | - G Howard
- University of Alabama Birmingham, Department of Biostatistics, Birmingham, United States of America
| | - P P Toth
- Johns Hopkins University of Baltimore, Division of Cardiology, Department of Medicine, Baltimore, United States of America
| | - P Muntner
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - V J Howard
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - M M Safford
- Weill Cornell Medical College, Department of Medicine, New York, United States of America
| | - S R Jones
- Johns Hopkins University of Baltimore, Division of Cardiology, Department of Medicine, Baltimore, United States of America
| | - A L Catapano
- San Raffaele Hospital of Milan (IRCCS), Department of Pharmacological and Biomolecular Sciences, Milan, Italy
| | - M Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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Mazidi M, Mikhailidis DP, Howard G, Graham I, Banach M. P5417Consumption of dairy product and its association with total and cause specific mortality - A population-based cohort study and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Mazidi
- Chalmers University of Technology, Department of Biology and Biological Engineering, Food and Nutrition Science, Gothenburg, Sweden
| | - D P Mikhailidis
- University College London, Department of Clinical Biochemistry, London, United Kingdom
| | - G Howard
- University of Alabama Birmingham, Department of Biostatistics, Birmingham, United States of America
| | - I Graham
- Trinity College Dublin, Dublin, Ireland
| | - M Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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Lichtman J, Jones M, Leifheit E, Sheffet A, Howard G, Lal B. Carotid Endarterectomy and Carotid Artery Stenting in the US Medicare Population, 1999-2014. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2017.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rantner B, Kollerits B, Roubin G, Ringleb P, Jansen O, Howard G. Early Endarterectomy Carries a Lower Procedural Risk Than Early Stenting in Patients With Symptomatic Stenosis of the Internal Carotid Artery. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Penson P, Long D, Howard G, Howard V, Jones S, Martin S, Mikhailidis D, Muntner P, Rizzo M, Rader D, Safford M, Sahebkar A, Toth P, Banach M. 3104Associations between cardiovascular disease, cancer and very low hdl cholesterol in the reasons for geographical and racial differences in stroke (REGARDS) study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P. Penson
- Liverpool John Moores University, Liverpool, United Kingdom
| | - D.L. Long
- University of Alabama Birmingham, Birmingham, United States of America
| | - G. Howard
- University of Alabama Birmingham, Birmingham, United States of America
| | - V.J. Howard
- University of Alabama Birmingham, Birmingham, United States of America
| | - S.R. Jones
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - S.S. Martin
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | - P. Muntner
- University of Alabama Birmingham, Birmingham, United States of America
| | - M. Rizzo
- University of Palermo, Palermo, Italy
| | - D.J. Rader
- University of Pennsylvania, Philadelphia, United States of America
| | - M.M. Safford
- Weill Cornell Medical College, New York, United States of America
| | - A. Sahebkar
- Mashad University of Medical Sciences, Mashad, Iran (Islamic Republic of)
| | - P.P. Toth
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - M. Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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Awad K, Serban M, Penson P, Mikhailidis D, Toth P, Jones S, Rysz J, Rizzo M, Howard G, Lip G, Banach M. 3100Effects of morning versus evening statin therapy on lipid profile: a systematic review and meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K. Awad
- Zagazig University, Zagazig, Egypt
| | - M.C. Serban
- University of Medicine Victor Babes, Timisoara, Romania
| | - P. Penson
- Liverpool John Moores University, Liverpool, United Kingdom
| | | | - P.P. Toth
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - S.R. Jones
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - J. Rysz
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
| | - M. Rizzo
- University of Palermo, Palermo, Italy
| | - G. Howard
- University of Alabama Birmingham, Birmingham, United States of America
| | - G.Y.H. Lip
- Birmingham City Hospital, Birmingham, United Kingdom
| | - M. Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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Penson P, Long D, Howard G, Toth P, Muntner P, Howard V, Safford M, Jones S, Catapano A, Banach M. P627Associations between very low concentrations of LDL-cholesterol and health outcomes in the reasons for geographical and racial differences in stroke (REGARDS) Study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P. Penson
- Liverpool John Moores University, Liverpool, United Kingdom
| | - D.L. Long
- University of Alabama Birmingham, Birmingham, United States of America
| | - G. Howard
- University of Alabama Birmingham, Birmingham, United States of America
| | - P.P. Toth
- CGH Medical Center, Sterling, United States of America
| | - P. Muntner
- University of Alabama Birmingham, Birmingham, United States of America
| | - V.J. Howard
- University of Alabama Birmingham, Birmingham, United States of America
| | - M.M. Safford
- University of Alabama Birmingham, Birmingham, United States of America
| | - S.R. Jones
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | | | - M. Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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Bivins AW, Sumner T, Kumpel E, Howard G, Cumming O, Ross I, Nelson K, Brown J. Estimating Infection Risks and the Global Burden of Diarrheal Disease Attributable to Intermittent Water Supply Using QMRA. Environ Sci Technol 2017; 51:7542-7551. [PMID: 28582618 DOI: 10.1021/acs.est.7b01014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Intermittent water supply (IWS) is prevalent throughout low and middle-income countries. IWS is associated with increased microbial contamination and potentially elevated risk of waterborne illness. We used existing data sets to estimate the population exposed to IWS, assess the probability of infection using quantitative microbial risk assessment, and calculate the subsequent burden of diarrheal disease attributable to consuming fecally contaminated tap water from an IWS. We used reference pathogens Campylobacter, Cryptosporidium, and rotavirus as conservative risk proxies for infections via bacteria, protozoa, and viruses, respectively. Results indicate that the median daily risk of infection is an estimated 1 in 23 500 for Campylobacter, 1 in 5 050 000 for Cryptosporidium, and 1 in 118 000 for rotavirus. Based on these risks, IWS may account for 17.2 million infections causing 4.52 million cases of diarrhea, 109 000 diarrheal DALYs, and 1560 deaths each year. The burden of diarrheal disease associated with IWS likely exceeds the WHO health-based normative guideline for drinking water of 10-6 DALYs per person per year. Our results underscore the importance water safety management in water supplies and the potential benefits of point-of-use treatment to mitigate risks.
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Affiliation(s)
- Aaron W Bivins
- School of Civil & Environmental Engineering, Georgia Institute of Technology , Atlanta, Georgia 30332, United States
| | - Trent Sumner
- School of Civil & Environmental Engineering, Georgia Institute of Technology , Atlanta, Georgia 30332, United States
| | - Emily Kumpel
- Civil & Environmental Engineering, University of Massachusetts , Amherst, Massachusetts 01003, United States
| | - Guy Howard
- Department for International Development, London, U.K
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine , London, U.K
| | - Ian Ross
- Oxford Policy Management, Oxford, U.K
| | - Kara Nelson
- Civil & Environmental Engineering, University of California Berkeley , Berkeley, California 94720, United States
| | - Joe Brown
- School of Civil & Environmental Engineering, Georgia Institute of Technology , Atlanta, Georgia 30332, United States
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Olson NC, Cushman M, Judd SE, Kissela BM, Safford MM, Howard G, Zakai NA. Associations of coagulation factors IX and XI levels with incident coronary heart disease and ischemic stroke: the REGARDS study. J Thromb Haemost 2017; 15:1086-1094. [PMID: 28393470 PMCID: PMC9797027 DOI: 10.1111/jth.13698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 12/31/2022]
Abstract
Essentials Coagulation factors (F) IX and XI have been implicated in cardiovascular disease (CVD) risk. We studied associations of FIX and FXI with incident coronary heart disease (CHD) and stroke. Higher FIX antigen was associated with incident CHD risk in blacks but not whites. Higher levels of FIX antigen may be a CHD risk factor among blacks. SUMMARY Background Recent studies have suggested the importance of coagulation factor IX and FXI in cardiovascular disease (CVD) risk. Objectives To determine whether basal levels of FIX or FXI antigen were associated with the risk of incident coronary heart disease (CHD) or ischemic stroke. Patients/Methods The REasons for Geographic And Racial Differences in Stroke (REGARDS) study recruited 30 239 participants across the contiguous USA between 2003 and 2007. In a case-cohort study within REGARDS, FIX and FXI antigen were measured in participants with incident CHD (n = 609), in participants with incident ischemic stroke (n = 538), and in a cohort random sample (n = 1038). Hazard ratios (HRs) for CHD and ischemic stroke risk were estimated with Cox models per standard deviation higher FIX or FXI level, adjusted for CVD risk factors. Results In models adjusting for CHD risk factors, higher FIX levels were associated with incident CHD risk (HR 1.19; 95% confidence interval [CI] 1.01-1.40) and the relationship of higher FXI levels was slightly weaker (HR 1.15; 95% CI 0.97-1.36). When stratified by race, the HR of FIX was higher in blacks (HR 1.39; 95% CI 1.10-1.75) than in whites (HR 1.06; 95% CI 0.86-1.31). After adjustment for stroke risk factors, there was no longer an association of FIX levels with ischemic stroke, whereas the association of FXI levels with ischemic stroke was slightly attenuated. Conclusions Higher FIX antigen levels were associated with incident CHD in blacks but not in whites. FIX levels may increase CHD risk among blacks.
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Affiliation(s)
- N C Olson
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - M Cushman
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - S E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - B M Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - M M Safford
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - G Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N A Zakai
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
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Petrov ME, Long L, Grandner MA, MacDonald L, Cribbet MR, Robbins R, Cundiff J, Molano JR, Hoffmann N, Howard G, Howard VJ. 0830 SLEEP DURATION BY SOCIODEMOGRAPHIC, SOCIOECONOMIC, AND GEOGRAPHICAL STATUS: THE REGARDS STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Landry KK, Alexander KS, Zakai NA, Judd SE, Kleindorfer DO, Howard VJ, Howard G, Cushman M. Association of stroke risk biomarkers with stroke symptoms: the Reasons for Geographic and Racial Differences in Stroke cohort. J Thromb Haemost 2017; 15:21-27. [PMID: 27813265 PMCID: PMC5280457 DOI: 10.1111/jth.13562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Indexed: 11/30/2022]
Abstract
Essentials Stroke symptom history predicts future stroke and may indicate prior unrecognized stroke. We studied associations of stroke symptoms with stroke risk biomarkers. Several stroke risk biomarkers were independently associated with stroke symptom history. Findings support a hypothesis that stroke symptoms may represent unrecognized stroke. SUMMARY Background History of stroke symptoms in the absence of prior diagnosed stroke or transient ischemic attack (TIA) is associated with future stroke risk, as are biomarkers of inflammation, cardiac function and hemostasis. Objective To better elucidate the pathobiology of stroke symptoms, we studied associations of these biomarkers with history of stroke symptoms. Methods The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-7. In cross-sectional analyses in a random sample of 960 participants without prior stroke or TIA, levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), fibrinogen, factor VIII (FVIII), factor XI (FXI), C-reactive protein (CRP) and D-dimer were studied in relation to self-reported history of six sudden onset stroke symptoms. Results There were 190 participants with at least one stroke symptom and 770 without. Adjusting for age, race, sex and stroke risk factors, NT-proBNP, FXI, CRP and D-dimer in the top vs. bottom quartile were associated with prevalent stroke symptoms with odds ratios 2.69 (95% confidence interval [CI], 1.45-4.98), 1.65 (95% CI, 1.00-2.73), 2.21 (95% CI, 1.32-3.71) and 2.14 (95% CI, 1.22-3.75), respectively. Conclusions Strong associations of stroke risk biomarkers with stroke symptoms in persons without a clinical history of cerebrovascular disease support a hypothesis that some of these stroke symptoms represent unrecognized cerebrovascular disease. Future work is needed to determine whether these biomarkers identify persons with stroke symptoms who have a particularly high stroke risk.
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Affiliation(s)
- K K Landry
- Department of Medicine, Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - K S Alexander
- Department of Medicine, Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - N A Zakai
- Department of Medicine, Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - S E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D O Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - V J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - G Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Cushman
- Department of Medicine, Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Howard G, Roubin G, Jansen O. Association Between Age and Risk of Stroke or Death From Carotid Endarterectomy and Carotid Stenting: A Meta-Analysis of Pooled Patient Data From Four Randomised Trials. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Edmunds KL, Elrahman SA, Bell DJ, Brainard J, Dervisevic S, Fedha TP, Few R, Howard G, Lake I, Maes P, Matofari J, Minnigh H, Mohamedani AA, Montgomery M, Morter S, Muchiri E, Mudau LS, Mutua BM, Ndambuki JM, Pond K, Sobsey MD, van der Es M, Zeitoun M, Hunter PR. Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach. Bull World Health Organ 2016; 94:424-32. [PMID: 27274594 PMCID: PMC4890207 DOI: 10.2471/blt.15.163931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/02/2016] [Accepted: 01/12/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. METHODS A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. FINDINGS The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. CONCLUSION The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.
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Affiliation(s)
- Kelly L Edmunds
- Centre for Ecology, Evolution and Conservation, University of East Anglia, Norwich, England
| | - Samira Abd Elrahman
- Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Diana J Bell
- Centre for Ecology, Evolution and Conservation, University of East Anglia, Norwich, England
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
| | - Samir Dervisevic
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
| | - Tsimbiri P Fedha
- Reproductive Health Department, Egerton University, Egerton, Kenya
| | - Roger Few
- School of International Development, University of East Anglia, Norwich, England
| | - Guy Howard
- Department for International Development, East Kilbride, Scotland
| | - Iain Lake
- School of Environmental Sciences, University of East Anglia, Norwich, England
| | - Peter Maes
- Médecins Sans Frontières, Bruxelles, Belgium
| | - Joseph Matofari
- Department of Dairy, Food Science and Technology, Egerton University, Egerton, Kenya
| | - Harvey Minnigh
- Centro de Educación, Conservación, e Interpretación Ambiental, Inter American University of Puerto Rico, San Germán, Puerto Rico
| | | | - Maggie Montgomery
- Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland
| | - Sarah Morter
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
| | - Edward Muchiri
- Faculty of Engineering and Technology, Egerton University, Egerton, Kenya
| | | | - Benedict M Mutua
- Faculty of Engineering and Technology, Egerton University, Egerton, Kenya
| | - Julius M Ndambuki
- Faculty of Engineering and Technology, Egerton University, Egerton, Kenya
| | - Katherine Pond
- Department of Civil and Environmental Engineering, University of Surrey, Guildford, England
| | - Mark D Sobsey
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Mike van der Es
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
| | - Mark Zeitoun
- Water Security Research Centre, University of East Anglia, Norwich, England
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
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Bond MG, Barnes RW, Riley WA, Wilmoth SK, Chambless LE, Howard G, Owens B. High-resolution B-Mode Ultrasound Scanning Methods in the Atherosclerosis Risk in Communities Study (ARIC). J Neuroimaging 2016. [DOI: 10.1111/jon19911268] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Xu S, Alexander K, Bryant W, Cohen N, Craig ME, Forbes M, Fulcher G, Greenaway T, Harrison N, Holmes-Walker DJ, Howard G, Jackson J, Jenkins A, Kamp M, Kaye J, Sinha A, Stranks S, O'Neal D, Colman P. Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia. Intern Med J 2015; 45:86-93. [PMID: 25370368 DOI: 10.1111/imj.12619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/22/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Healthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care. AIM This study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery. METHODS Twenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT. RESULTS Data on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 ± 6.4 weeks for 895 patients; age 35.4 ± 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 ± 2.8, dietitians 0.4 ± 0.2 and doctors 1.0 ± 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 ± 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively. CONCLUSIONS IPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.
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Affiliation(s)
- S Xu
- St Vincent's Hospital, Melbourne, Victoria, Australia
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Fisch U, von Felten S, Roubin G, Mali W, Jansen O, Howard G, Fraederich G, Chatellier G, Becquemin J, Algra A, Ringleb P, Mas J, Brown M, Brott T, Bonati L. Low Risk of Stroke or Death among Patients with Recently Symptomatic Carotid Stenosis Awaiting Revascularization—A Pooled Analysis of Recent Randomized Trials. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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39
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Zivin JA, Sehra R, Shoshoo A, Albers GW, Bornstein NM, Dahlof B, Kasner SE, Howard G, Shuaib A, Streeter J, Richieri SP, Hacke W. NeuroThera® Efficacy and Safety Trial-3 (NEST-3): a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study to assess the safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System for the treatment of acute ischemic stroke within 24 h of stroke onset. Int J Stroke 2014. [PMID: 23013107 DOI: 10.1111/j.1747-4949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
RATIONALE Transcranial laser therapy is undergoing clinical trials in patients with acute ischemic stroke. The NeuroThera® Efficacy and Safety Trial-1 was strongly positive for 90-day functional benefit with transcranial laser therapy, and post hoc analyses of the subsequent NeuroThera® Efficacy and Safety Trial-2 trial suggested a meaningful beneficial effect in patients with moderate to moderately severe ischemic stroke within 24 h of onset. These served as the basis for the NeuroThera® Efficacy and Safety Trial-3 randomized controlled trial. AIM The purpose of this pivotal study was to demonstrate safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System in the treatment of subjects diagnosed with acute ischemic stroke. DESIGN NeuroThera® Efficacy and Safety Trial-3 is a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study that will enroll 1000 subjects at up to 50 sites. All subjects will receive standard medical management based on the American Stroke Association and European Stroke Organization Guidelines. In addition to standard medical management, both groups will undergo the transcranial laser therapy procedure between 4·5 and 24 h of stroke onset. The study population will be randomized into two arms: the sham control group will receive a sham transcranial laser therapy procedure and the transcranial laser therapy group will receive an active transcranial laser therapy procedure. The randomization ratio will be 1:1 and will be stratified to ensure a balanced subject distribution between study arms. STUDY OUTCOMES The primary efficacy end point is disability at 90 days (or the last rating), as assessed on the modified Rankin Scale, dichotomized as a success (a score of 0-2) or a failure (a score of 3 to 6).
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40
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Bell KJ, Gray R, Munns D, Petocz P, Howard G, Colagiuri S, Brand-Miller JC. Estimating insulin demand for protein-containing foods using the food insulin index. Eur J Clin Nutr 2014; 68:1055-9. [PMID: 25005674 DOI: 10.1038/ejcn.2014.126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/18/2014] [Accepted: 05/20/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE The Food Insulin Index (FII) is a novel algorithm for ranking foods on the basis of insulin responses in healthy subjects relative to an isoenergetic reference food. Our aim was to compare postprandial glycemic responses in adults with type 1 diabetes who used both carbohydrate counting and the FII algorithm to estimate the insulin dosage for a variety of protein-containing foods. SUBJECTS/METHODS A total of 11 adults on insulin pump therapy consumed six individual foods (steak, battered fish, poached eggs, low-fat yoghurt, baked beans and peanuts) on two occasions in random order, with the insulin dose determined once by the FII algorithm and once with carbohydrate counting. Postprandial glycemia was measured in capillary blood glucose samples at 15-30 min intervals over 3 h. Researchers and participants were blinded to treatment. RESULTS Compared with carbohydrate counting, the FII algorithm significantly reduced the mean blood glucose level (5.7±0.2 vs 6.5±0.2 mmol/l, P=0.003) and the mean change in blood glucose level (-0.7±0.2 vs 0.1±0.2 mmol/l, P=0.001). Peak blood glucose was reached earlier using the FII algorithm than using carbohydrate counting (34±5 vs 56±7 min, P=0.007). The risk of hypoglycemia was similar in both treatments (48% vs 33% for FII vs carbohydrate counting, respectively, P=0.155). CONCLUSIONS In adults with type 1 diabetes, compared with carbohydrate counting, the novel FII algorithm improved postprandial hyperglycemia after consumption of protein-containing foods.
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Affiliation(s)
- K J Bell
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - R Gray
- Sydney Insulin Pump Clinic, Sydney, NSW, Australia
| | - D Munns
- Sydney Insulin Pump Clinic, Sydney, NSW, Australia
| | - P Petocz
- Department of Statistics, Macquarie University, Sydney, NSW, Australia
| | - G Howard
- Sydney Insulin Pump Clinic, Sydney, NSW, Australia
| | - S Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - J C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
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Dunmore BJ, Howard G, Crosby A, Nichols BJ, Morrell NW. S138 Blood outgrowth endothelial cells isolated from patients with pulmonary arterial hypertension possess less caveolae and reduced cavin-2 expression. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Zivin JA, Sehra R, Shoshoo A, Albers GW, Bornstein NM, Dahlof B, Kasner SE, Howard G, Shuaib A, Streeter J, Richieri SP, Hacke W. NeuroThera® Efficacy and Safety Trial-3 (NEST-3): a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study to assess the safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System for the treatment of acute ischemic stroke within 24 h of stroke onset. Int J Stroke 2012; 9:950-5. [PMID: 23013107 DOI: 10.1111/j.1747-4949.2012.00896.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
Abstract
RATIONALE Transcranial laser therapy is undergoing clinical trials in patients with acute ischemic stroke. The NeuroThera® Efficacy and Safety Trial-1 was strongly positive for 90-day functional benefit with transcranial laser therapy, and post hoc analyses of the subsequent NeuroThera® Efficacy and Safety Trial-2 trial suggested a meaningful beneficial effect in patients with moderate to moderately severe ischemic stroke within 24 h of onset. These served as the basis for the NeuroThera® Efficacy and Safety Trial-3 randomized controlled trial. AIM The purpose of this pivotal study was to demonstrate safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System in the treatment of subjects diagnosed with acute ischemic stroke. DESIGN NeuroThera® Efficacy and Safety Trial-3 is a double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study that will enroll 1000 subjects at up to 50 sites. All subjects will receive standard medical management based on the American Stroke Association and European Stroke Organization Guidelines. In addition to standard medical management, both groups will undergo the transcranial laser therapy procedure between 4·5 and 24 h of stroke onset. The study population will be randomized into two arms: the sham control group will receive a sham transcranial laser therapy procedure and the transcranial laser therapy group will receive an active transcranial laser therapy procedure. The randomization ratio will be 1:1 and will be stratified to ensure a balanced subject distribution between study arms. STUDY OUTCOMES The primary efficacy end point is disability at 90 days (or the last rating), as assessed on the modified Rankin Scale, dichotomized as a success (a score of 0-2) or a failure (a score of 3 to 6).
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Howard V, Pulley L, Cushman M, McClure L, Wadley V, Howard G. Breaking the Paradigm of Clinic-Based Cohort Studies: the Reasons for Geographic and Racial Differences in Stroke (Regards) Study. Ann Epidemiol 2012. [DOI: 10.1016/j.annepidem.2012.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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44
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Voeks J, Howard G, Roubin G. Age and Outcomes After Carotid Stenting and Endarterectomy: The Carotid Revascularization Endarterectomy Versus Stenting Trial. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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45
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Kennedy R, Wadley V, McClure L, Unverzagt F, Crowe M, Kelley B, Nyenhuis D, Kana B, Marceaux J, Tamura M, Howard V, Howard G. Validation of the NINDS-CSN 5-Minute Battery for Vascular Cognitive Impairment (P04.200). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Lal B, Beach K, Roubin G, Lutsep H, Moore W, Malas M, Chiu D, Gonzales N, Burke J, Rinaldi M, Elmore J, Weaver F, Narins C, Foster M, Hodgson K, Shepard A, Meschia J, Bergelin R, Voeks J, Howard G, Brott T. Restenosis Following Carotid Artery Stenting and Endarterectomy in the Carotid Revascularization Endarterectomy Versus Stenting Trial (S09.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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47
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Howard G, Roubin G, Hopkins LN, Moore W, Gray W, Rosenfield K, Katzen B, Chakhtoura E, Morrish W, Ferguson R, Hye R, Shawl F, Harrigan M, Voeks J, Lal B, Meschia J, Brott T. Did Carotid Stenting and Endarterectomy Outcomes Change over Time in the Carotid Revascularization Endarterectomy Versus Stenting Trial? (S09.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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48
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Rhodes J, Aduroja O, Judd S, Kleindorfer D, Kissela B, Safford M, Anderson A, Howard V, Howard G. Do Demographic Disparities in Neuroimaging Utilization Exist in Stroke? The REGARDS Experience (S13.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s13.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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49
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Lal B, Beach K, Roubin G, Lutsep H, Moore W, Malas M, Chiu D, Gonzales N, Burke J, Rinaldi M, Elmore J, Weaver F, Narins C, Foster M, Hodgson K, Shepard A, Meschia J, Bergelin R, Voeks J, Howard G, Brott T. Restenosis Following Carotid Artery Stenting and Endarterectomy in the Carotid Revascularization Endarterectomy Versus Stenting Trial (IN2-1.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in2-1.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Unverzagt FW, McClure LA, Wadley VG, Jenny NS, Go RC, Cushman M, Kissela BM, Kelley BJ, Kennedy R, Moy CS, Howard V, Howard G. Vascular risk factors and cognitive impairment in a stroke-free cohort. Neurology 2011; 77:1729-36. [PMID: 22067959 DOI: 10.1212/wnl.0b013e318236ef23] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine vascular risk factors, as measured by the Framingham Stroke Risk Profile (FSRP), to predict incident cognitive impairment in a large, national sample of black and white adults age 45 years and older. METHODS Participants included subjects without stroke at baseline from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study with at least 2 cognitive function assessments during the follow-up (n = 23,752). Incident cognitive impairment was defined as decline from a baseline score of 5 or 6 (of possible 6 points) to the most recent follow-up score of 4 or less on the Six-item Screener (SIS). Subjects with suspected stroke during follow-up were censored. RESULTS During a mean follow-up of 4.1 years, 1,907 participants met criteria for incident cognitive impairment. Baseline FSRP score was associated with incident cognitive impairment. An adjusted model revealed that male sex (odds ratio [OR] = 1.59, 95% confidence interval [CI] 1.43-1.77), black race (OR = 2.09, 95% CI 1.88-2.35), less education (less than high school graduate vs college graduate, OR = 2.21, 95% CI 1.88-2.60), older age (10-year increments, OR = 2.11, per 10-year increase in age, 95% CI 2.05-2.18), and presence of left ventricular hypertrophy (LVH, OR = 1.29, 95% CI 1.06-1.58) were related to development of cognitive impairment. When LVH was excluded from the model, elevated systolic blood pressure was related to incident cognitive impairment. CONCLUSIONS Total FSRP score, elevated blood pressure, and LVH predict development of clinically significant cognitive dysfunction. Prevention and treatment of high blood pressure may be effective in preserving cognitive health.
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Affiliation(s)
- F W Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, 1111 W. 10th Street, Suite PB 218A, Indianapolis, IN 46202, USA.
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