53 results found
Rao R, Bakolis I, Das-Munshi J, et al., 2020, Alcohol consumption of UK members of parliament: cross-sectional survey., BMJ Open, Vol: 10
OBJECTIVES: This study examined the prevalence of risky drinking by members of parliament (MPs), as well as the relationship between risky drinking and age, years spent as an MP, working outside parliament, awareness of the Parliamentary Health and Wellbeing Service, and probable mental ill health. DESIGN: A survey questionnaire assessed alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). Risky drinking was identified by combining categories of increasing (hazardous), higher (harmful) and probable dependent drinking for those with a total score of 8 or more. Comparator groups from the 2014 Adult Psychiatric Morbidity Survey (APMS) were used as controls. SETTING: UK House of Commons. PARTICIPANTS: 650 MPs. RESULTS: Compared with all 650 MPs, participants (n=146) were more likely to be female (p<0.05) or have an educational qualification (p<0.05). Weighted proportions on AUDIT items were higher than the APMS comparator group for participants who had a drink four or more times a week, 10 or more drinks on a typical drinking day, six or more drinks in one occasion, or felt guilty because of drinking (p<0.01). Weighted percentages for risky drinking were higher in MPs compared with the whole English population (p<0.05), but similar when compared with socioeconomic comparator groups. The odds of risky drinking were 2.74 times greater for MPs who had an additional work role outside parliament compared with those who did not (95% CI 0.98 to 7.65) and 2.4 times greater for MPs with probable mental ill health compared with those with no evidence of probable mental ill health (95% CI 0.78 to 7.43). CONCLUSIONS: A low level of awareness of the Parliamentary Health and Wellbeing Service has implications for improving the detection of risky drinking and improving access to this service by MPs. Possible increased likelihood of risky drinking in MPs who also had an additional work role outside Parliament and among those with probable mental
Kolliakou A, Bakolis I, Chandran D, et al., 2020, Mental health-related conversations on social media and crisis episodes: a time-series regression analysis., Sci Rep, Vol: 10
We aimed to investigate whether daily fluctuations in mental health-relevant Twitter posts are associated with daily fluctuations in mental health crisis episodes. We conducted a primary and replicated time-series analysis of retrospectively collected data from Twitter and two London mental healthcare providers. Daily numbers of 'crisis episodes' were defined as incident inpatient, home treatment team and crisis house referrals between 2010 and 2014. Higher volumes of depression and schizophrenia tweets were associated with higher numbers of same-day crisis episodes for both sites. After adjusting for temporal trends, seven-day lagged analyses showed significant positive associations on day 1, changing to negative associations by day 4 and reverting to positive associations by day 7. There was a 15% increase in crisis episodes on days with above-median schizophrenia-related Twitter posts. A temporal association was thus found between Twitter-wide mental health-related social media content and crisis episodes in mental healthcare replicated across two services. Seven-day associations are consistent with both precipitating and longer-term risk associations. Sizes of effects were large enough to have potential local and national relevance and further research is needed to evaluate how services might better anticipate times of higher risk and identify the most vulnerable groups.
Dregan A, Rayner L, Davis KAS, et al., 2020, Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study: A Mediation Analysis., JAMA Psychiatry
Importance: Previous research has linked a history of depression with arterial stiffness (AS) during midlife. Objective: To assess the association of depression with elevated midlife AS and to investigate the extent to which this association is mediated via metabolic syndrome (MetS). Design, Settings, and Participants: This population-based retrospective cohort study analyzed data collected between March 2006 and December 2010 from 124 445 participants aged 40 to 69 years from the UK Biobank. Participants without data on AS at baseline (n = 332 780) or who reported a previous diagnosis of cardiovascular disease (n = 45 374) were not eligible. Data analysis was performed from May to August 2019. Exposures: Lifetime history of depression was assessed via verbal interview and linked hospital-based clinical depression diagnosis. Metabolic syndrome was defined as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, and unhealthy waist circumference. Main Outcomes and Measures: Peripherally assessed AS index (ASI) using digital photoplethysmography. Results: Of 124 445 included participants with ASI assessed, 71 799 (57.7%) were women, and the mean (SD) age was 56 (8) years. A total of 10 304 participants (8.3%) reported a history of depression. Study findings indicated a significant direct association between depression and ASI levels (β = 0.25; 95% CI, 0.17-0.32). A significant indirect association was also observed between depression and ASI levels (β = 0.10; 95% CI, 0.07-0.13), indicating that 29% of the association of depression with ASI was mediated by MetS. The proportion of mediation increased to 37% when C-reactive protein was added to the MetS criteria (direct association: β = 0.21; 95% CI, 0.15-0.28; indirect association: β = 0.13; 95% CI, 0.10-0.17). Concerning components of MetS, the strongest indirect association wa
Soukup T, Hull L, Smith EL, et al., 2019, Effectiveness-implementation hybrid type 2 trial evaluating two psychoeducational programmes for severe hypoglycaemia in type 1 diabetes: implementation study protocol., BMJ Open, Vol: 9
INTRODUCTION: Two of the most acute and feared complications in type 1 diabetes (T1D) are hypoglycaemia and severe hypoglycaemia (SH). While impaired awareness of hypoglycaemia (IAH) can lead to SH with cognitive and motivational barriers implicated, the available education does not integrate behavioural change techniques to address these. A novel Hypoglycaemia Awareness Restoration Programme despite optimised care (HARPdoc) is currently being tested against an established blood glucose awareness training (BGAT) within a parallel, two-arm, group randomised, blinded trial (with its own protocol; NCT02940873) with adults with T1D whose problems with hypoglycaemia and SH have persisted despite otherwise optimised insulin management. While both programmes are aimed at reducing hypoglycaemia, SH and IAH, it is the former that integrates behavioural change techniques.The aim of the current (implementation) study is to evaluate delivery of both HARPdoc and BGAT and explore associations between implementation outcomes and trial endpoints; as well as to develop an evidence-based implementation blueprint to guide implementation, sustainment and scale-up of the effective programmes. METHODS AND ANALYSIS: Guided by the implementation science tools, frameworks, methods and principles, the current study was designed through a series of focus groups (n=11) with the key intervention stakeholders (n=28)-including (1) individuals with lived experience of T1D, IAH and a pilot version of the HARPdoc (n=6) and (2) diabetes healthcare professionals (n=22). A mixed-methods approach will be used throughout. Stakeholder engagement has underpinned study design and materials to maximise relevance, feasibility and impact. ETHICS AND DISSEMINATION: The protocol has been reviewed and received ethical approval by the Harrow Research Ethics Committee (18/LO/1020; 240752) on 1 October 2018. The findings will be submitted to a peer-reviewed journal and presented at scientific meetings. TRIAL REGISTR
Polling C, Bakolis I, Hotopf M, et al., 2019, Differences in hospital admissions practices following self-harm and their influence on population-level comparisons of self-harm rates in South London: an observational study., BMJ Open, Vol: 9
OBJECTIVES: To compare the proportions of emergency department (ED) attendances following self-harm that result in admission between hospitals, examine whether differences are explained by severity of harm and examine the impact on spatial variation in self-harm rates of using ED attendance data versus admissions data. SETTING: A dataset of ED attendances and admissions with self-harm to four hospitals in South East London, 2009-2016 was created using linked electronic patient record data and administrative Hospital Episode Statistics. DESIGN: Proportions admitted following ED attendance and length of stay were compared. Variation and spatial patterning of age and sex standardised, spatially smoothed, self-harm rates by small area using attendance and admission data were compared and the association with distance travelled to hospital tested. RESULTS: There were 20 750 ED attendances with self-harm, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30 to 2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours (54% of all admissions at highest admitting hospital vs 35% at lowest). A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm. This was not altered when distance travelled to hospital was adjusted for. CONCLUSIONS: Hospitals vary substantially in likelihood of admission after ED presentation with self-harm and this is likely due to the differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data could exacerbate existing health inequalities in inner-city areas
Bakolis I, Thornicroft G, Vitoratou S, et al., 2019, Development and validation of the DISCUS scale: A reliable short measure for assessing experienced discrimination in people with mental health problems on a global level, SCHIZOPHRENIA RESEARCH, Vol: 212, Pages: 213-220, ISSN: 0920-9964
Hull L, Goulding L, Khadjesari Z, et al., 2019, Designing high-quality implementation research: development, application, feasibility and preliminary evaluation of the implementation science research development (ImpRes) tool and guide, IMPLEMENTATION SCIENCE, Vol: 14, ISSN: 1748-5908
Poulter D, Votruba N, Bakolis I, et al., 2019, Mental health of UK Members of Parliament in the House of Commons: a cross-sectional survey, BMJ OPEN, Vol: 9, ISSN: 2044-6055
, 2019, Correction: Mental health of UK Members of Parliament in the House of Commons: a cross-sectional survey., BMJ Open, Vol: 9
Amiel SA, Choudhary P, Jacob P, et al., 2019, Hypoglycaemia Awareness Restoration Programme for People with Type 1 Diabetes and Problematic Hypoglycaemia Persisting Despite Optimised Self-care (HARPdoc): protocol for a group randomised controlled trial of a novel intervention addressing cognitions., BMJ Open, Vol: 9
INTRODUCTION: Severe hypoglycaemia (SH), when blood glucose falls too low to support brain function, is the most feared acute complication of insulin therapy for type 1 diabetes mellitus (T1DM). 10% of people with T1DM contribute nearly 70% of all episodes, with impaired awareness of hypoglycaemia (IAH) a major risk factor. People with IAH may be refractory to conventional approaches to reduce SH, with evidence for cognitive barriers to hypoglycaemia avoidance. This paper describes the protocol for the Hypoglycaemia Awareness Restoration Programme for People with Type 1 Diabetes and Problematic Hypoglycaemia Persisting Despite Optimised Self-care (HARPdoc) study, a trial to assess the impact on hypoglycaemia experience of a novel intervention that addresses cognitive barriers to hypoglycaemia avoidance, compared with an existing control intervention, recommended by the National Institute of Health and Care Excellence. METHODS AND ANALYSIS: A randomised parallel two-arm trial of two group therapies: HARPdoc versus Blood Glucose Awareness Training, among 96 adults with T1DM and problematic hypoglycaemia, despite attendance at education with or without technology use, in four centres providing specialist T1DM services. The primary outcome will be the SH rate at 12 and/or 24 months after randomisation to either course. Secondary outcomes include rates of SH requiring parenteral therapy, involving unconsciousness or needing emergency services; hypoglycaemia awareness status, overall diabetes control and quality of life measures. An implementation study to evaluate how the interventions are delivered and how implementation impacts on clinical effectiveness is planned as a parallel study, with its own protocol. ETHICS AND DISSEMINATION: The protocol was approved by the London Dulwich Research Ethics Committee, the Health Research Authority, National Health Service R&D and the Institutional Review Board of the Joslin Diabetes Center in the USA. Study findings will be di
Thornicroft G, Bakolis I, Evans-Lacko S, et al., 2019, Key lessons learned from the INDIGO global network on mental health related stigma and discrimination, WORLD PSYCHIATRY, Vol: 18, Pages: 229-230, ISSN: 1723-8617
Michelini G, Jurgiel J, Bakolis I, et al., 2019, Atypical functional connectivity in adolescents and adults with persistent and remitted ADHD during a cognitive control task, TRANSLATIONAL PSYCHIATRY, Vol: 9, ISSN: 2158-3188
Deb T, Lempp H, Bakolis I, et al., 2019, Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study, BMC Medical Education, Vol: 19, ISSN: 1472-6920
BackgroundStigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students’ ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding.Methods/designREAD training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students’ knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention.DiscussionThis is the first international study across high, middle and low income countries, which will evaluate
Polling C, Bakolis I, Hotopf M, et al., 2019, Spatial patterning of self-harm rates within urban areas, SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, Vol: 54, Pages: 69-79, ISSN: 0933-7954
Gazard B, Chui Z, Harber-Aschan L, et al., 2018, Barrier or stressor? The role of discrimination experiences in health service use, BMC PUBLIC HEALTH, Vol: 18, ISSN: 1471-2458
Carruthers S, Kinnaird E, Rudra A, et al., 2018, A cross-cultural study of autistic traits across India, Japan and the UK, MOLECULAR AUTISM, Vol: 9, ISSN: 2040-2392
Bakolis I, Hooper R, Bachert C, et al., 2018, Dietary patterns and respiratory health in adults from nine European countries – evidence from the GA2LEN study, Clinical and Experimental Allergy, Vol: 48, Pages: 1474-1482, ISSN: 0954-7894
Background: Dietary patterns defined using Principal Component Analysis (PCA) offer an alternative to the analysis of individual foods and nutrients and have been linked with asthma and allergic disease. However, results have not been reproducible in different settings.Objective: To identify dietary patterns common to different European countries and examine their associations with asthma and allergic symptoms. Methods: In sixteen study centres in nine European countries, 3206 individuals aged 15-77 years completed a common, internationally validated, Food Frequency Questionnaire and a respiratory symptoms questionnaire. The outcomes of interest were current asthma, asthma symptoms score (derived based on responses to 5 asthma symptom-related questions), atopy (positive skin prick test). Spirometry was used to estimate forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), the FEV1/FVC, spirometric restriction (FVC below the lower limit of normal (<LLN)) and FEV1/FVC < LLN. A novel meta-analytic approach was used to identify dietary patterns using PCA and to examine associations with asthma and allergic symptoms.Results: Two dietary patterns emerged, generally correlating with the same foods in different countries: one associated with intake of animal proteins and carbohydrates; the other with fruit and vegetables. There was evidence that the former pattern was associated with a higher asthma score (RR 1.63, 95% CI: 1.33-2.01), current asthma (RR 2.03, 95% CI: 1.52-2.71), wheeze (RR 1.84, 95%CI: 1.30-2.60), atopic status (RR 1.68, 95%CI: 1.16-2.44) and with decreased lung function, including an FVC <LLN (RR 4.57, 95% CI: 2.27-9.21). Conclusions & Clinical Relevance: Our findings suggest an increase in sensitisation to common allergens, an increase in asthma symptoms and a reduction in lung function in those eating a diet rich in animal proteins and carbohydrates. We found little evidence of an association between these outcomes and
Yoshimura Y, Bakolis I, Henderson C, 2018, Psychiatric diagnosis and other predictors of experienced and anticipated workplace discrimination and concealment of mental illness among mental health service users in England, SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, Vol: 53, Pages: 1099-1109, ISSN: 0933-7954
Sadler E, Khadjesari Z, Ziemann A, et al., 2018, Case management for integrated care of frail older people in community settings, Cochrane Database of Systematic Reviews, Vol: 2018
© 2018 The Cochrane Collaboration. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of case management for integrated care of frail older people compared to usual care.
Barnard S, Free C, Bakolis I, et al., 2018, Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis, SEXUALLY TRANSMITTED INFECTIONS, Vol: 94, Pages: 377-383, ISSN: 1368-4973
Garcia Larsen V, Morton V, Norat T, et al., 2018, Dietary patterns derived from Principal Component Analysis (PCA) and the risk of colorectal cancer: a systematic review and meta-analysis, European Journal of Clinical Nutrition, Vol: 73, Pages: 366-386, ISSN: 1476-5640
Background and aim: Colorectal cancer [CRC] is highly prevalent worldwide, with dietary habits being a major risk factor. We systematically reviewed and meta-analysed the observational evidence on the association between CRC and dietary patterns [DP] derived from Principal Component Analysis.Design: PRISMA guidelines were followed. Web of Science, Medline/PubMed, EMBASE, and The Cochrane Library were searched to identify all eligible papers published up to July 2017. Any pre-defined cancer in the colon was included, namely colon-rectal cancer (CRC), colon cancer (CC), rectal cancer (RC), or proximal and distal CC, if available. Western (WDP) and prudent (PDP) dietary patterns were compared as a proxy to estimate ‘unhealthy’ (Rich in meat and processed foods) and ‘healthy’ diets (containing fruits or vegetables), respectively. Meta-analyses were carried out using random effects model to calculate overall risk estimates. Relative risks (RR) and 95% confidence intervals were estimated comparing the highest versus the lowest categories of dietary patterns for any of the forms of colon cancer studied.Results: 28 studies were meta-analysed. A WDP was associated with increased risk of CRC (RR 1.25; 95% CI 1.11, 1.40), and of CC (RR 1.30; 95% CI 1.11, 1.52). A PDP was negatively associated with CRC (RR 0.81; 95% CI 0.73, 0.91). Sensitivity analyses showed that individuals from North- and South- American countries had a significantly higher risk of CRC than those from other continents. Conclusion: A PDP might reduce the risk of CRC. Conversely, a WDP is associated with a higher risk of disease.
East K, Hitchman SC, Bakolis I, et al., 2018, The Association Between Smoking and Electronic Cigarette Use in a Cohort of Young People, JOURNAL OF ADOLESCENT HEALTH, Vol: 62, Pages: 539-547, ISSN: 1054-139X
Hansell AL, Bakolis I, Cowie CT, et al., 2018, Childhood fish oil supplementation modifies associations between traffic related air pollution and allergic sensitisation, Environmental Health, Vol: 17, ISSN: 1476-069X
BackgroundStudies of potential adverse effects of traffic related air pollution (TRAP) on allergic disease have had mixed findings. Nutritional studies to examine whether fish oil supplementation may protect against development of allergic disease through their anti-inflammatory actions have also had mixed findings. Extremely few studies to date have considered whether air pollution and dietary factors such as fish oil intake may interact, which was the rationale for this study.MethodsWe conducted a secondary analysis of the Childhood Asthma Prevention Study (CAPS) birth cohort, where children were randomised to fish oil supplementation or placebo from early life to age 5 years. We examined interactions between supplementation and TRAP (using weighted road density at place of residence as our measure of traffic related air pollution exposure) with allergic disease and lung function outcomes at age 5 and 8 years.ResultsOutcome information was available on approximately 400 children (~ 70% of the original birth cohort). Statistically significant interactions between fish oil supplementation and TRAP were seen for house dust mite (HDM), inhalant and all-allergen skin prick tests (SPTs) and for HDM-specific interleukin-5 response at age 5. Adjusting for relevant confounders, relative risks (RRs) for positive HDM SPT were RR 1.74 (95% CI 1.22–2.48) per 100 m local road or 33.3 m of motorway within 50 m of the home for those randomised to the control group and 1.03 (0.76–1.41) for those randomised to receive the fish oil supplement. The risk differential was highest in an analysis restricted to those who did not change address between ages 5 and 8 years. In this sub-group, supplementation also protected against the effect of traffic exposure on pre-bronchodilator FEV1/FVC ratio.ConclusionsResults suggest that fish oil supplementation may protect against pro-allergic sensitisation effects of TRAP exposure. Strengths of this analysis are that supplementat
Bakolis I, Hammoud R, Smythe M, et al., 2018, Urban Mind: Using Smartphone Technologies to Investigate the Impact of Nature on Mental-Well-Being in Real Time, BIOSCIENCE, Vol: 68, Pages: 134-145, ISSN: 0006-3568
Michelini G, Jurgiel J, Bakolis I, et al., 2017, Atypical functional connectivity in adolescents and adults with persistent and remitted ADHD
<jats:title>Abstract</jats:title><jats:p>We previously provided initial evidence for cognitive and event-related potential markers of persistence/remission of attention-deficit/hyperactivity disorder (ADHD) from childhood to adolescence and adulthood. In this follow-up study, using a novel brain-network connectivity approach, we aimed to examine whether functional connectivity reflects a marker of ADHD remission, or an enduring deficit unrelated to ADHD outcome. High-density EEG was recorded in 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 typically-developing individuals during an arrow-flanker task, eliciting cognitive control. Functional connectivity was quantified with network-based graph-theory metrics before target onset (pre-stimulus), during target processing (post-stimulus) and in the degree of change between pre-stimulus/post-stimulus. ADHD outcome was examined with parent-reported symptoms and impairment using both a categorical (DSM-IV) and a dimensional approach. Graph-theory measures converged in indicating that, compared to controls, ADHD persisters showed increased connectivity in pre-stimulus theta, alpha and beta and in post-stimulus beta (all p<.01), and reduced pre-stimulus/post-stimulus change in theta connectivity (p<.01). In the majority of indices showing ADHD persister-control differences, ADHD remitters differed from controls (all p<.05), but not from persisters. Similarly, connectivity measures were not associated with continuous outcome measures of ADHD symptoms and impairment in participants with childhood ADHD. These findings indicate that adolescents and young adults with persistent and remitted ADHD share atypical over-connectivity profiles and reduced ability to modulate connectivity patterns with task demands, compared to controls. Brain connectivity impairments may represent enduring deficits in individuals with childhood ADHD irrespective of diagno
Chamitava L, Bakolis I, Burney PGJ, et al., 2017, Respiratory health and dietary patterns in adults from ECRHS III, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Sampogna G, Bakolis I, Evans-Lacko S, et al., 2016, The impact of social marketing campaigns on reducing mental health stigma: Results from the 2009-2014 Time to Change programme., European Psychiatry, Vol: 40, Pages: 116-122, ISSN: 1778-3585
BACKGROUND: In England, during 2009-2014 the 'Time to Change' anti-stigma programme has included a social marketing campaign (SMC) using mass media channels, social media and social contact events but the efficacy of such approach has not been evaluated yet. METHODS: The target population included people aged between mid-twenties/mid-forties, from middle-income groups. Participants were recruited through an online market research panel, before and after each burst of the campaign (with a mean number of unique participants per each burst: 956.9±170.2). Participants completed an online questionnaire evaluating knowledge [Mental Health Knowledge Schedule (MAKS)]; attitudes [Community Attitudes toward Mental Illness (CAMI)]; and behaviours [Reported and Intended Behaviour Scale (RIBS)]. Socio-demographic data and level of awareness of the SMC were also collected. RESULTS: A total of 10,526 people were interviewed. An increasing usage of the SMC-media channels as well as of the level of awareness of SMC was found (P<0.001). Being aware of the SMC was found to be associated with higher score at MAKS (OR=0.95, CI=0.68 to 1.21; P<0.001), at 'tolerance and support' CAMI subscale (OR=0.12, CI=0.09 to 0.16; P<0.001), and at RIBS (OR=0.71, CI=0.51 to 0.92; P<0.001), controlling for confounders. CONCLUSION: The SMC represents an important way to effectively reduce stigma. Taking into account these positive findings, further population-based campaigns using social media may represent an effective strategy to challenge stigma.
Bartington SE, Bakolis I, Devakumar D, et al., 2016, Patterns of domestic exposure to carbon monoxide and particulate matter in households using biomass fuel in Janakpur, Nepal, Environmental Pollution, Vol: 220, Pages: 38-45, ISSN: 1873-6424
Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and particulate Matter (PM2.5) in 12 biomass fuel households in Janakpur, Nepal. We measured kitchen PM2.5 and CO concentrations at one-minute intervals for an approximately 48-h period using the TSI DustTrak II 8530/SidePak AM510 (TSI Inc, St. Paul MN, USA) or EL-USB-CO data logger (Lascar Electronics, Erie PA, USA) respectively. We also obtained information regarding fuel, stove and kitchen characteristics and cooking activity patterns. Household cooking was performed in two daily sessions (median total duration 4 h) with diurnal variability in pollutant concentrations reflecting morning and evening cooking sessions and peak concentrations associated with fire-lighting. We observed a strong linear relationship between PM2.5 measurements obtained by co-located photometric and gravimetric monitoring devices, providing local calibration factors of 4.9 (DustTrak) and 2.7 (SidePak). Overall 48-h average CO and PM2.5 concentrations were 5.4 (SD 4.3) ppm (12 households) and 417.6 (SD 686.4) μg/m(3) (8 households), respectively, with higher average concentrations associated with cooking and heating activities. Overall average PM2.5 concentrations and peak 1-h CO concentrations exceeded WHO Indoor Air Quality Guidelines. Average hourly PM2.5 and CO concentrations were moderately correlated (r = 0.52), suggesting that CO has limited utility as a proxy measure for PM2.5 exposure assessment in this setting. Domestic indoor air quality levels associated with biomass fuel combustion in this region exceed WHO Indoor Air Quality standards and are in the hazardous range for human health.
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