Case-Crossover Analysis of Air Pollution Health Effects: A Systematic Review of Methodology and Application

Case-crossover is one of the most used designs for analyzing the health-related effects of air pollution. Nevertheless, no one has reviewed its application and methodology in this context. Objective: We conducted a systematic review of case-crossover (CCO) designs used to study the relationship between air pollution and morbidity and mortality, from the standpoint of methodology and application.Data sources and extraction: A search was made of the MEDLINE and EMBASE databases.Reports were classified as methodologic or applied. From the latter, the following information was extracted: author, study location, year, type of population (general or patients), dependent variable(s), independent variable(s), type of CCO design, and whether effect modification was analyzed for variables at the individual level. Data synthesis: The review covered 105 reports that fulfilled the inclusion criteria. Of these, 24 addressed methodological aspects, and the remainder involved the design’s application. In the methodological reports, the designs that yielded the best results in simulation were symmetric bidirectional CCO and time-stratified CCO. Furthermore, we observed an increase across time in the use of certain CCO designs, mainly symmetric bidirectional and time-stratified CCO. The dependent variables most frequently analyzed were those relating to hospital morbidity; the pollutants most often studied were those linked to particulate matter. Among the CCO-application reports, 13.6% studied effect modification for variables at the individual level.Conclusions: The use of CCO designs has undergone considerable growth; the most widely used designs were those that yielded better results in simulation studies: symmetric bidirectional and time-stratified CCO. However, the advantages of CCO as a method of analysis of variables at the individual level are put to little use

Genetic studies of the Roma (Gypsies): a review

Background: Data provided by the social sciences as well as genetic research suggest that the 8-10 million Roma (Gypsies) who live in Europe today are best described as a conglomerate of genetically isolated founder populations. The relationship between the traditional social structure observed by the Roma, where the Group is the primary unit, and the boundaries, demographic history and biological relatedness of the diverse founder populations appears complex and has not been addressed by population genetic studies. Results: Recent medical genetic research has identified a number of novel, or previously known but rare conditions, caused by private founder mutations. A summary of the findings, provided in this review, should assist diagnosis and counselling in affected families, and promote future collaborative research. The available incomplete epidemiological data suggest a non-random distribution of disease-causing mutations among Romani groups.Conclusion: Although far from systematic, the published information indicates that medical genetics has an important role to play in improving the health of this underprivileged and forgotten people of Europe. Reported carrier rates for some Mendelian disorders are in the range of 5 -15%, sufficient to justify newborn screening and early treatment, or community-based education and carrier testing programs for disorders where no therapy is currently available. To be most productive, future studies of the epidemiology of single gene disorders should take social organisation and cultural anthropology into consideration, thus allowing the targeting of public health programs and contributing to the understanding of population structure and demographic history of the Roma.

Una universidad donde confluyen la educación, la investigación y la ciudadanía

El projecte de recerca s'ha basat en el projecte Miquel Martí i Pol, que ha consistit en la creació i manteniment d'un jardí dedicat a la memòria del poeta, amb persones en situació d'exclusió social (per motius de malaltia mental, immigració, pobresa) i estudiants de teràpia ocupacional de la Universitat de Vic, des d'una sinergia única entre la Universitat de Vic i institucions públiques, socials i empresarials. La recerca ve a cobrir la falta de coneixement sobre l'impacte terapèutic de la jardineria, com afirmava Sempik al 2003. Així mateix, genera coneixements sobre l'ocupació humana, la ciutadania, les comunitats inclusives, les aliances estratègiques i sobre noves praxis educatives en el marc del nou Espai Europeu d'Educació Superior (EEES). El marc teòric s'ha basat en una visió transdisciplinària, des de l'educació, la filosofia, la psicologia, la sociologia, la teràpia ocupacional, la política, l'ecologia i l'antropologia. S'ha desenvolupat una recerca inspirada per la investigació acció participativa que ha aprofundit en el significat que ha tingut aquesta experiència per a les persones implicades en el procés de creació del jardí: les persones procedents de col•lectius en situació d'exclusió, els estudiants, així com els representants de les institucions públiques, socials, empresarials i la pròpia Universitat de Vic. Així es van desenvolupar una sèrie d'entrevistes a fons i formularis amb 5 jardiners; 2 estudiants; la Consellera d'Acció Social de l'Ajuntament de Vic; el Conseller d'Acció Social del Consell Comarcal d'Osona; el President de Caritas; la terapeuta ocupacional de la Fundació Centre Mèdic Psicopedagògic d'Osona; la Rectora de la Universitat de Vic; la Directora de l'EUCS i el President del Rotary Club. Els temes que han sorgit en la recerca són: La construcció de l'ocupació significativa; la jardineria com a font de benestar; un espai de bellesa; la dignitat de la ciutadania; la creació de comunitats inclusives; una Universitat al servei de la Humanitat: noves praxis educatives; l'art de les aliances estratègiques i de les sinergies. Els coneixements generats tenen relació amb els estudis de teràpia ocupacional, així com per a educació social, infermeria, psicologia i ciències ambientals. A més a més són una aposta per al desenvolupament de noves praxis educatives en el nou EEES. El treball ha estat qualificat com a excel•lent per unanimitat del tribunal.

Beyond the first steps: Sustaining Health OER Initiatives in Ghana

The introduction of open educational resources (OER) in two Ghanaian universities through a grant-funded project was embraced with a lot of enthusiasm. The project started on a high note and the Colleges of Health Sciences in the two universities produced a significant number of e-learning materials as health OER in the first year. Growing challenges such as faculty time commitments, technological and infrastructural constraints, shortage of technical expertise, lack of awareness beyond the early adopters and non-existent system for OER dissemination and use set in. These exposed the fact that institutional policy and integration was essential to ensure effective implementation and sustainability of OER efforts. Informed by the early OER experiences at the two institutions, this paper proposes that institutions in low resource settings perhaps need to pay close attention to awareness creation, initiative structuring, funding, capacity building, systemization for scalability and motivation if OER sustainability is to be achieved.

A targeted association study of immunity genes and networks suggests novel associations with placental malaria infection

A large proportion of the death toll associated with malaria is a consequence of malaria infection during pregnancy, causing up to 200,000 infant deaths annually. We previously published the first extensive genetic association study of placental malaria infection, and here we extend this analysis considerably, investigating genetic variation in over 9,000 SNPs in more than 1,000 genes involved in immunity and inflammation for their involvement in susceptibility to placental malaria infection. We applied a new approach incorporating results from both single gene analysis as well as gene-gene interactionson a protein-protein interaction network. We found suggestive associations of variants in the gene KLRK1 in the single geneanalysis, as well as evidence for associations of multiple members of the IL-7/IL-7R signalling cascade in the combined analysis. To our knowledge, this is the first large-scale genetic study on placental malaria infection to date, opening the door for follow-up studies trying to elucidate the genetic basis of this neglected form of malaria.

Prenatal exposure to traffic-related air pollution and ultrasound measures of fetal growth in the INMA Sabadell cohort

Background: Few studies have used longitudinal ultrasound measurements to assess the effect of traffic-related air pollution on fetal growth.Objective: We examined the relationship between exposure to nitrogen dioxide (NO2) and aromatic hydrocarbons [benzene, toluene, ethylbenzene, m/p-xylene, and o-xylene (BTEX)] on fetal growth assessed by 1,692 ultrasound measurements among 562 pregnant women from the Sabadell cohort of the Spanish INMA (Environment and Childhood) study.Methods: We used temporally adjusted land-use regression models to estimate exposures to NO2 and BTEX. We fitted mixed-effects models to estimate longitudinal growth curves for femur length (FL), head circumference (HC), abdominal circumference (AC), biparietal diameter (BPD), and estimated fetal weight (EFW). Unconditional and conditional SD scores were calculated at 12, 20, and 32 weeks of gestation. Sensitivity analyses were performed considering time–activity patterns during pregnancy.Results: Exposure to BTEX from early pregnancy was negatively associated with growth in BPD during weeks 20–32. None of the other fetal growth parameters were associated with exposure to air pollution during pregnancy. When considering only women who spent 2 hr/day in nonresidential outdoor locations, effect estimates were stronger and statistically significant for the association between NO2 and growth in HC during weeks 12–20 and growth in AC, BPD, and EFW during weeks 20–32.Conclusions: Our results lend some support to an effect of exposure to traffic-related air pollutants from early pregnancy on fetal growth during mid-pregnancy.

Why Mathematics is essential in Biomedical Sciences degree?

Improvement of mathematical education and motivation of students in the mathematics" area is needed. What can be done? We introduce some ideas to generate the student"s interest for mathematics, because they often present difficulties in appreciating the relevance of mathematics and its role in the health sciences. We consider that a cornerstone in the strategy to attract the students" interest is linking the mathematics with real biomedical situations. We proceed in the following manner: We first present a real biomedical situation to produce interest and to generate curiosity. Second, we ask thought-provoking questions to students as: Which is the biomedical problem presented? Which is my knowledge on this situation? What could I do to solve this biomedical situation? Do I need some new mathematical concepts and procedures? Thereupon, the teacher explains the mathematical concepts necessary to solve the case presented, providing definitions, properties and tools for graphical display and/or mathematical calculations. In this learning methodology, ICTs were cornerstones for reaching the proposed competences. Furthermore, ICTs can also be used in the evaluative task in its two possible aspects: formative and for obtaining a qualification. Comments from students about this new mathematics teaching method indicate that the use of real biomedical case studies kept the lessons in mathematics interesting.

Association between Long-Term Exposure to Traffic-Related Air Pollution and Subclinical Atherosclerosis: The REGICOR Study

Background: Epidemiological evidence of the effects of long-term exposure to air pollu tion on the chronic processes of athero genesis is limited. Objective: We investigated the association of long-term exposure to traffic-related air pollu tion with subclinical atherosclerosis, measured by carotid intima media thickness (IMT) and ankle–brachial index (ABI). Methods: We performed a cross-sectional analysis using data collected during the reexamination (2007–2010) of 2,780 participants in the REGICOR (Registre Gironí del Cor: the Gerona Heart Register) study, a population-based prospective cohort in Girona, Spain. Long-term exposure across residences was calculated as the last 10 years’ time-weighted average of residential nitrogen dioxide (NO2) estimates (based on a local-scale land-use regression model), traffic intensity in the nearest street, and traffic intensity in a 100 m buffer. Associations with IMT and ABI were estimated using linear regression and multinomial logistic regression, respectively, controlling for sex, age, smoking status, education, marital status, and several other potential confounders or intermediates. Results: Exposure contrasts between the 5th and 95th percentiles for NO2 (25 μg/m), traffic intensity in the nearest street (15,000 vehicles/day), and traffic load within 100 m (7,200,000 vehicle-m/day) were associated with differences of 0.56% (95% CI: –1.5, 2.6%), 2.32% (95% CI: 0.48, 4.17%), and 1.91% (95% CI: –0.24, 4.06) percent difference in IMT, respectively. Exposures were positively associated with an ABI of > 1.3, but not an ABI of < 0.9. Stronger associations were observed among those with a high level of education and in men ≥ 60 years of age. Conclusions: Long-term traffic-related exposures were associated with subclinical markers of atherosclerosis. Prospective studies are needed to confirm associations and further examine differences among population subgroups.key words: ankle–brachial index, average daily traffic, cardiovascular disease, exposure assessment, exposure to tailpipe emissions, intima media thickness, land use regression model, Mediterranean diet, nitrogen dioxide