Publications
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Yang Y, Tang R, Qiu H, et al., 2018, Long term exposure to air pollution and mortality in an elderly cohort in Hong Kong, ENVIRONMENT INTERNATIONAL, Vol: 117, Pages: 99-106, ISSN: 0160-4120
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- Citations: 80
Moore E, Lewis A, hashmi M, et al., 2018, Recruitment of patients with Chronic Obstructive Pulmonary Disease (COPD) from the Clinical Practice Research Datalink (CPRD) for research, npj Primary Care Respiratory Medicine, Vol: 28, ISSN: 2055-1010
Databases of electronic health records (EHR) are not only a valuable source of data for health research but have also recently been used as a medium through which potential study participants can be screened, located and approached to take part in research. The aim was to assess whether it is feasible and practical to screen, locate and approach patients to take part in research through the Clinical Practice Research Datalink (CPRD). This is a cohort study in primary care. The CPRD anonymised EHR database was searched to screen patients with Chronic Obstructive Pulmonary Disease (COPD) to take part in a research study. The potential participants were contacted via their General Practitioner (GP) who confirmed their eligibility. Eighty two practices across Greater London were invited to the study. Twenty-six (31.7%) practices consented to participate resulting in a pre-screened list of 988 patients. Of these, 632 (63.7%) were confirmed as eligible following the GP review. Two hundred twenty seven (36%) response forms were received by the study team; 79 (34.8%) responded ‘yes’ (i.e., they wanted to be contacted by the research assistant for more information and to talk about enrolling in the study), and 148 (65.2%) declined participation. This study has shown that it is possible to use EHR databases such as CPRD to screen, locate and recruit participants for research. This method provides access to a cohort of patients while minimising input needed by GPs and allows researchers to examine healthcare usage and disease burden in more detail and in real-life settings.
Tang R, Tian L, Thuan-Quoc T, et al., 2018, Integrating travel behavior with land use regression to estimate dynamic air pollution exposure in Hong Kong, ENVIRONMENT INTERNATIONAL, Vol: 113, Pages: 100-108, ISSN: 0160-4120
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- Citations: 38
Krauskopf J, Caiment F, van Veldhoven K, et al., 2018, The human circulating miRNome reflects multiple organ disease risks in association with short-term exposure to traffic-related air pollution, Environment International, Vol: 113, Pages: 26-34, ISSN: 0160-4120
Traffic-related air pollution is a complex mixture of particulate matter (PM) and gaseous pollutants, such as nitrogen dioxide (NO2). PM exposure contributes to the pathogenesis of many diseases including several types of cancer, as well as pulmonary, cardiovascular and neurodegenerative diseases. Also exposure to NO2 has been related to increased cardiovascular mortality. In search of an early diagnostic biomarker for improved air pollution-associated health risk assessment, recent human studies have shown that certain circulating miRNAs are altered upon exposure to traffic-related air pollutants. Here, we present for the first time a global analysis of the circulating miRNA genome in an experimental cross-over study of a human population exposed to traffic-related air pollution. By utilizing next-generation sequencing technology and detailed real-time exposure measurements we identified 54 circulating miRNAs to be dose- and pollutant species-dependently associated with PM10, PM2.5, black carbon, ultrafine particles and NO2 already after 2 h of exposure. Bioinformatics analysis suggests that these circulating miRNAs actually reflect the adverse consequences of traffic pollution-induced toxicity in target tissues including the lung, heart, kidney and brain. This study shows the strong potential of circulating miRNAs as novel biomarkers for environmental health risk assessment.
Barratt B, Lee M, Wong P, et al., 2018, A Dynamic Three-Dimensional Air Pollution Exposure Model for Hong Kong., Res Rep Health Eff Inst, Vol: 2018, Pages: 1-65, ISSN: 1041-5505
INTRODUCTION: High-density high-rise cities have become a more prominent feature globally. Air quality is a significant public health risk in many of these cities. There is a need to better understand the extent to which vertical variation in air pollution and population mobility in such cities affect exposure and exposure-response relationships in epidemiological studies. METHODS: We used a novel strategy to execute a staged model development that incorporated horizontal and vertical pollutant dispersion, building infiltration, and population mobility patterns in estimating traffic-related air pollution (TRAP) exposures in the Hong Kong Special Administrative Region (HK SAR). UNLABELLED: Two street-level spatial monitoring campaigns were undertaken to facilitate the creation of a two-dimensional land-use regression (LUR) model. A network of approximately 100 passive nitric oxide-nitrogen dioxide (NO-NO2) monitors was deployed for two-week periods during the cool and warm seasons. Sampling locations were selected based on population and road network density with a range of physical and geographical characteristics represented. Eight sets of portable monitors for black carbon (BC) and particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) were rotated so as to be deployed at 80 locations for a 24-hour period. Land-use, geographical, and emissions layers were combined with the spatial monitoring campaign results to create spatiotemporal exposure models. UNLABELLED: Vertical air pollution monitoring was carried out at six strategic locations for two weeks in the warm season and two weeks in the cool season. Continuous measurements were carried out at four different heights of a residential building and on both sides of a street canyon. The heights ranged from as close to street level as practically possible up to a maximum of 50 meters (i.e., below the 20th floor). Paired indoor monitoring was included to allow the calculation of infiltration coefficients to
Liu S, Grigoryan H, Edmands WMB, et al., 2018, Cys34 Adductomes Differ between Patients with Chronic Lung or Heart Disease and Healthy Controls in Central London, Environmental Science and Technology (Washington), Vol: 52, Pages: 2307-2313, ISSN: 0013-936X
Oxidative stress generates reactive species that modify proteins, deplete antioxidant defenses, and contribute to chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD). To determine whether protein modifications differ between COPD or IHD patients and healthy subjects, we performed untargeted analysis of adducts at the Cys34 locus of human serum albumin (HSA). Biospecimens were obtained from nonsmoking participants from London, U.K., including healthy subjects (n = 20) and patients with COPD (n = 20) or IHD (n = 10). Serum samples were digested with trypsin and analyzed by liquid chromatography-high resolution mass spectrometry. Effects of air pollution on adduct levels were also investigated based on estimated residential exposures to PM2.5, O3 and NO2. For the 39 adducts with sufficient data, levels were essentially identical in blood samples collected from the same subjects on two consecutive days, consistent with the 28 day residence time of HSA. Multivariate linear regression revealed 21 significant associations, mainly with the underlying diseases but also with air-pollution exposures (p-value < 0.05). Interestingly, most of the associations indicated that adduct levels decreased with the presence of disease or increased pollutant concentrations. Negative associations of COPD and IHD with the Cys34 disulfide of glutathione and two Cys34 sulfoxidations, were consistent with previous results from smoking and nonsmoking volunteers and nonsmoking women exposed to indoor combustion of coal and wood.
Sinharay R, Gong J, Barratt B, et al., 2018, Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study, The Lancet, Vol: 391, Pages: 339-349, ISSN: 0140-6736
Varaden D, McKevitt C, Barratt B, 2018, Making the invisible visible: Engaging school children in monitoring air pollution in London, Research for All, Vol: 2, Pages: 267-288
Exposure to air pollution is a public health concern accountable for numerous health problems and tens of thousands of premature deaths each year in the UK. Despite this evidence, public understanding and awareness of the issue is low in comparison to other public health risks. Improved methods for engaging with the public to communicate this risk are required. This study aimed to investigate the impact of collecting personalized air pollution exposure data on children and parents from a London primary school in terms of perceptions of and responses to air quality. Drawing on a participatory research approach, 400 children from a London primary school learnt about air pollution. A subset of ten children measured the air pollution they were exposed to as they travelled to and from school using portable exposure monitors and GPS watches, and shared the data they collected with the whole school. Data on the impact of the approach on the school community were collected using observations, surveys distributed to all school children and their parents, and interviews with the parents and children who collected the air pollution data. Most participants said that having access to personalized data that they themselves collected increased their air pollution awareness and their desire to reduce their air pollution exposure. The children's participation in the project inspired them to think about ways in which they could influence other people's behaviour, such as proposing anti-idling campaigns and encouraging their parents to cycle or walk to school. The use of participatory methods has the potential to facilitate the dissemination of information from a small group of individuals to a bigger audience. This study suggests that participatory methods can be implemented in practice, and they have the potential to be effective and engaging tools for raising awareness of air pollution as a health risk in communities.
Lee M, Brauer M, Wong P, et al., 2017, Land use regression modelling of air pollution in high density high rise cities: A case study in Hong Kong (vol 592, pg 306, 2017), SCIENCE OF THE TOTAL ENVIRONMENT, Vol: 603, Pages: 832-833, ISSN: 0048-9697
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- Citations: 1
Sinharay R, Gong J, Barratt B, et al., 2017, Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study, Lancet, Vol: 391, Pages: 339-349, ISSN: 0140-6736
BackgroundLong-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.MethodsIn this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.FindingsBetween October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ul
Whitehouse A, Miyashita L, Grigg J, et al., 2017, Oxidative stress, short-term exposure to air pollution, and lung function in children, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Barratt B, Chatzidiakou L, Moore E, et al., 2017, Characterisation of COPD exacerbations using personal environmental exposure monitoring, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Dove R, Whitehouse A, Barratt B, et al., 2017, Evaluating the utility of urinary metal concentrations as biomarkers of air pollutant exposures, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Lee M, Brauer M, Wong P, et al., 2017, Land use regression modelling of air pollution in high density high rise cities: A case study in Hong Kong, Science of The Total Environment, Vol: 592, Pages: 306-315, ISSN: 0048-9697
Land use regression (LUR) is a common method of predicting spatial variability of air pollution to estimate exposure. Nitrogen dioxide (NO2), nitric oxide (NO), fine particulate matter (PM2.5), and black carbon (BC) concentrations were measured during two sampling campaigns (April–May and November–January) in Hong Kong (a prototypical high-density high-rise city). Along with 365 potential geospatial predictor variables, these concentrations were used to build two-dimensional land use regression (LUR) models for the territory. Summary statistics for combined measurements over both campaigns were: a) NO2 (Mean = 106 μg/m3, SD = 38.5, N = 95), b) NO (M = 147 μg/m3, SD = 88.9, N = 40), c) PM2.5 (M = 35 μg/m3, SD = 6.3, N = 64), and BC (M = 10.6 μg/m3, SD = 5.3, N = 76). Final LUR models had the following statistics: a) NO2 (R2 = 0.46, RMSE = 28 μg/m3) b) NO (R2 = 0.50, RMSE = 62 μg/m3), c) PM2.5 (R2 = 0.59; RMSE = 4 μg/m3), and d) BC (R2 = 0.50, RMSE = 4 μg/m3). Traditional LUR predictors such as road length, car park density, and land use types were included in most models. The NO2 prediction surface values were highest in Kowloon and the northern region of Hong Kong Island (downtown Hong Kong). NO showed a similar pattern in the built-up region. Both PM2.5 and BC predictions exhibited a northwest-southeast gradient, with higher concentrations in the north (close to mainland China). For BC, the port was also an area of elevated predicted concentrations. The results matched with existing literature on spatial variation in concentrations of air pollutants and in relation to important emission sources in Hong Kong. The success of these models suggests LUR is appropriate in high-density, high-rise cities.
Butland BK, Atkinson RW, Crichton S, et al., 2017, Air pollution and the incidence of ischaemic and haemorrhagic stroke in the South London Stroke Register: a case-cross-over analysis, Journal of Epidemiology and Community Health, Vol: 71, Pages: 707-712, ISSN: 0143-005X
Wang CM, Barratt B, Carslaw N, et al., 2017, Unexpectedly high concentrations of monoterpenes in a study of UK homes, Environmental Science: Processes & Impacts, ISSN: 2050-7887
The abundance of volatile organic compounds (VOCs) found in homes depends on many factors such as emissions, ventilation and the oxidative environment and these are evolving over time, reflecting changes in chemical use, behaviour and building design/materials. The concentrations of VOCs in 25 UK homes of varying ages, design and occupancy were quantified using continuous indoor air sampling over five days. Air was collected through low flow (1 mL min-1) constant flow restrictors into evacuated 6 L internally silica-treated canisters until the canisters reached atmospheric pressure. This was followed by thermal desorption-gas chromatography and high mass accuracy time-of-flight mass spectrometry (TD-GC-TOF/MS). A fully quantitative analysis was performed on the eight most abundant hydrocarbon-based VOCs found. Despite differences in building characteristics and occupant numbers 94% of the homes had d-limonene or [small alpha]-pinene as the most abundant VOCs. The variability seen across the 25 homes in concentrations of monoterpenes indoors was considerably greater than that of species such as isoprene, benzene, toluene and xylenes. The variance in VOCs indoors appeared to be strongly influenced by occupant activities such as cleaning with 5-day average concentrations of d-limonene ranging from 18 [small mu ]g m-3 to over 1400 [small mu ]g m-3, a peak domestic value that is possibly the highest yet reported in the literature.
Gabrys J, Pritchard H, Barratt B, 2016, Just good enough data: Figuring data citizenships through air pollution sensing and data stories, BIG DATA & SOCIETY, Vol: 3, ISSN: 2053-9517
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- Citations: 55
Moore E, Hashmi M, Sultana K, et al., 2016, Using the Clinical Practice Research Datalink (CPRD) to recruit participants from primary care to investigate Chronic Obstructive Pulmonary Disease (COPD) exacerbations., British Thoracic Society Winter Meeting 2016
Moore EA, Chatzidiakou L, Kuku M-O, et al., 2016, Global associations between air pollutants and Chronic Obstructive Pulmonary Disease (COPD) exacerbations: a systematic review, European Respiratory Society Congress 2016, Publisher: European Respiratory Society, Pages: PA1126-PA1126, ISSN: 0903-1936
Background: COPD exacerbations (AECOPD) affect lung function decline and quality of life. The effect of exposure to different air pollutants on AECOPD is unclear.Aim: We systematically reviewed the literature examining associations between air pollutants and hospital admissions for AECOPD.Methods: MEDLINE, EMBASE, BIOSIS & Science Citation Index were searched until September 2015. Inclusion criteria focused on studies presenting solely a COPD outcome defined by hospital admissions, and a measure of gaseous air pollutants and particle fractions. The association between each pollutant with COPD admissions was investigated in meta-analyses using random-effects models. Analyses were stratified by geographical clusters to investigate the evidence worldwide.Results: 46 studies were included and results showed marginal positive associations. The number of included studies was small with high heterogeneity between them and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly. The most consistent association was between a 1mg/m3 increase in carbon monoxide levels with COPD related admissions; Odds Ratio: 1.2 (95%CI: 1.01-1.03).Conclusions: There is mixed evidence on the effects of pollution on AECOPD. Limitations of previous studies include the low spatio-temporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignore personal characteristics. The need for personal exposure monitoring in a large number of geographical locations is evident.
Desika A, Crichton S, Hoang U, et al., 2016, Effect of exhaust- and nonexhaust-related components of particulate matter on long-term survival after stroke, Stroke, Vol: 47, Pages: 2916-2922, ISSN: 0039-2499
Smith JD, Mitsakou C, Kitwiroon N, et al., 2016, London hybrid exposure model: improving human exposure estimates to NO2 and PM2.5 in an urban setting, Environmental Science and Technology (Washington), Vol: 50, Pages: 11760-11768, ISSN: 0013-936X
Here we describe the development of the London Hybrid Exposure Model (LHEM), which calculates exposure of the Greater London population to outdoor air pollution sources, in-buildings, in-vehicles and outdoors, using survey data of when and where people spend their time. For comparison and to estimate exposure misclassification we compared Londoners LHEM exposure with exposure at the residential address, a commonly used exposure metric in epidemiological research. In 2011, the mean annual LHEM exposure to outdoor sources was estimated to be 37÷ lower for PM2.5 and 63÷ lower for NO2 than at the residential address. These decreased estimates reflect, the effects of reduced exposure indoors, the amount of time spent indoors (95÷), and the mode and duration of travel in London. We find that an individual's exposure to PM2.5 and NO2 outside their residential address is highly correlated (Pearson's R of 0.9). In contrast, LHEM exposure estimates for PM2.5 and NO2 suggest that the degree of correlation is influe...
Barratt B, Quint JK, 2016, Asthma hospitalisations and air pollution, Thorax, Vol: 71, Pages: 1076-1077, ISSN: 1468-3296
Whitehouse A, Barratt B, Grigg J, 2016, Does modelled exposure of children to particulate matter air pollution for the school address reflect personal exposure to black carbon?, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Walton RT, Mudway IS, Dundas I, et al., 2016, Air pollution, ethnicity and telomere length in east London schoolchildren: An observational study, Environ Int, Vol: 96, Pages: 41-47, ISSN: 1873-6750
BACKGROUND: Short telomeres are associated with chronic disease and early mortality. Recent studies in adults suggest an association between telomere length and exposure to particulate matter, and that ethnicity may modify the relationship. However associations in children are unknown. OBJECTIVES: We examined associations between air pollution and telomere length in an ethnically diverse group of children exposed to high levels of traffic derived pollutants, particularly diesel exhaust, and to environmental tobacco smoke. METHODS: Oral DNA from 333 children (8-9years) participating in a study on air quality and respiratory health in 23 inner city London schools was analysed for relative telomere length using monochrome multiplex qPCR. Annual, weekly and daily exposures to nitrogen oxides and particulate matter were obtained from urban dispersion models (2008-10) and tobacco smoke by urinary cotinine. Ethnicity was assessed by self-report and continental ancestry by analysis of 28 random genomic markers. We used linear mixed effects models to examine associations with telomere length. RESULTS: Telomere length increased with increasing annual exposure to NOx (model coefficient 0.003, [0.001, 0.005], p<0.001), NO2 (0.009 [0.004, 0.015], p<0.001), PM2.5 (0.041, [0.020, 0.063], p<0.001) and PM10 (0.096, [0.044, 0.149], p<0.001). There was no association with environmental tobacco smoke. Telomere length was increased in children reporting black ethnicity (22% [95% CI 10%, 36%], p<0.001) CONCLUSIONS: Pollution exposure is associated with longer telomeres in children and genetic ancestry is an important determinant of telomere length. Further studies should investigate both short and long-term associations between pollutant exposure and telomeres in childhood and assess underlying mechanisms.
Crichton S, Barratt B, Spiridou A, et al., 2016, Associations between exhaust and non-exhaust particulate matter and stroke incidence by stroke subtype in South London, Sci Total Environ, Vol: 568, Pages: 278-284, ISSN: 1879-1026
BACKGROUND: Airborne particulate matter (PM) consists of particles from diverse sources, including vehicle exhausts. Associations between short-term PM changes and stroke incidence have been shown. Cumulative exposures over several months, or years, are less well studied; few studies examined ischaemic subtypes or PM source. AIMS: This study combines a high resolution urban air quality model with a population-based stroke register to explore associations between long-term exposure to PM and stroke incidence. METHOD: Data from the South London Stroke Register from 2005-2012 were included. Poisson regression explored association between stroke incidence and long-term (averaged across the study period) exposure to PM2.5(PM<2.5mum diameter) and PM10(PM<10mum), nitric oxide, nitrogen dioxide, nitrogen oxides and ozone, at the output area level (average population=309). Estimates were standardised for age and sex and adjusted for socio-economic deprivation. Models were stratified for ischaemic and haemorrhagic strokes and further broken down by Oxford Community Stroke Project classification and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. RESULTS: 1800 strokes were recorded (incidence=42.6/100,000 person-years). No associations were observed between PM and overall ischaemic or haemorrhagic incidence. For an interquartile range increase in PM2.5, there was a 23% increase in incidence (Incidence rate ratio=1.23 (95%CI: 1.03-1.44)) of total anterior circulation infarcts (TACI) and 20% increase for PM2.5 from exhausts (1.20(1.01-1.41)). There were similar associations with PM10, overall (1.21(1.01-1.44)) and from exhausts (1.20(1.01-1.41)). TACI incidence was not associated with non-exhaust sources. There were no associations with other stroke subtypes or pollutants. CONCLUSION: Outdoor air pollution, particularly that arising from vehicle exhausts, may increase risk of TACI but not other stroke subtypes.
Moore E, Chatzidiakou L, Kuku MO, et al., 2016, Global Associations between Air Pollutants and Chronic Obstructive Pulmonary Disease Hospitalizations. A Systematic Review, Ann Am Thorac Soc, Vol: 13, Pages: 1814-1827, ISSN: 2325-6621
RATIONALE: Exacerbations are key events in chronic obstructive pulmonary disease (COPD), affecting lung function decline and quality of life. The effect of exposure to different air pollutants on COPD exacerbations is not clear. OBJECTIVES: To carry out a systematic review, examining associations between air pollutants and hospital admissions for COPD exacerbations. METHODS: MEDLINE, Embase, BIOSIS, Science Citation Index, and the Air Pollution Epidemiology Database were searched for publications published between 1980 and September 2015. Inclusion criteria were focused on studies presenting solely a COPD outcome defined by hospital admissions and a measure of gaseous air pollutants and particle fractions. The association between each pollutant and COPD admissions was investigated in metaanalyses using random effects models. Analyses were stratified by geographical clusters for investigation of the consistency of the evidence worldwide. MEASUREMENTS AND MAIN RESULTS: Forty-six studies were included, and results for all the pollutants under investigation showed marginal positive associations; however, the number of included studies was small, the studies had high heterogeneity, and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly. CONCLUSIONS: The most consistent association was between a 1-mg/m(3) increase in carbon monoxide level and COPD-related admissions (odds ratio, 1.02; 95% confidence interval, 1.01-1.03). The heterogeneity was moderate, and there was a consistent positive association in both Europe and North America, although levels were clearly below World Health Organization guideline values. There is mixed evidence on the effects of environmental pollution on COPD exacerbations. Limitations of previous studies included the low spatiotemporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregate
Moore E, Chatzidiakou L, Jones RL, et al., 2016, Linking e-health records, patient-reported symptoms and environmental exposure data to characterise and model COPD exacerbations: protocol for the COPE study, BMJ Open, Vol: 6, ISSN: 2044-6055
INTRODUCTION: Relationships between exacerbations of chronic obstructive pulmonary disease (COPD) and environmental factors such as temperature, humidity and air pollution are not well characterised, due in part to oversimplification in the assignment of exposure estimates to individuals and populations. New developments in miniature environmental sensors mean that patients can now carry a personal air quality monitor for long periods of time as they go about their daily lives. This creates the potential for capturing a direct link between individual activities, environmental exposures and the health of patients with COPD. Direct associations then have the potential to be scaled up to population levels and tested using advanced human exposure models linked to electronic health records. METHODS AND ANALYSIS: This study has 5 stages: (1) development and deployment of personal air monitors; (2) recruitment and monitoring of a cohort of 160 patients with COPD for up to 6 months with recruitment of participants through the Clinical Practice Research Datalink (CPRD); (3) statistical associations between personal exposure with COPD-related health outcomes; (4) validation of a time-activity exposure model and (5) development of a COPD prediction model for London. ETHICS AND DISSEMINATION: The Research Ethics Committee for Camden and Islington has provided ethical approval for the conduct of the study. Approval has also been granted by National Health Service (NHS) Research and Development and the Independent Scientific Advisory Committee. The results of the study will be disseminated through appropriate conference presentations and peer-reviewed journals.
Valeri E, Gatta V, Teobaldelli D, et al., 2016, Modelling individual preferences for environmental policy drivers, Empirical evidence of Italian lifestyle changes using a latent class approach, Vol: 65, Pages: 65-74, ISSN: 1462-9011
Degraded air quality severely affects the health of citizens worldwide. The design of effective policies requires exploring public preferences for environmental and air quality policy instruments. Within the EC-FP7 SEFIRA project, using a choice experiment that stresses the trade-offs between attributes, this study investigates public preferences for environmental policy drivers in Italy. The main objective is to investigate the role played by selected policy drivers in determining policy preferences, complemented by elasticity and willingness to pay estimations. Preference heterogeneity and the role of socio-economic and attitudinal variables are explored with a latent class model over 2400 respondents sampled across Italy. The results allow identifying the different role played by the policy drivers across the classes. It emerged that most of the respondents (43%) are particularly sensitive to the cost components (cost sensitive respondents). The remaining respondents instead show an important sensitivity towards personal engagement in term of changes in the mobility and eating habits (lifestyle-change sensitive respondents). However, while 29% of them perceive these habits’ changes as negatively impacting on the personal utility, the other 28% of respondents translate the potential changes in the habitual behaviour of driving and eating as environmental and health benefits. Based on the modelling results, potential policies are simulated reporting respondents’ reaction to selected scenarios. It shows the crucial role played by reduction of premature deaths due to atmospheric pollution and measure cost.
Milojevic A, Armstrong BG, Gasparrini A, et al., 2016, Methods to Estimate Acclimatization to the Urban Heat Island Effects on Heat- and Cold-Related Mortality, Environ Health Perspect, ISSN: 1552-9924
BACKGROUND: Investigators have examined whether heat mortality risk is increased in neighbourhoods subject to the urban heat island (UHI) effect, but not identified degree of difference in susceptibility to heat and cold between cooler and hotter area, which we call as acclimatization to the UHI. OBJECTIVES: To develop methods to examine and quantify the degree of acclimatization to heat- and cold-related mortality in relation to UHI anomaly, then apply to London, UK. METHODS: Case-crossover analyses were undertaken on 1993-2006 mortality data from London UHI decile groups defined by anomalies from the London average of modelled air temperature at 1km grid resolution. We estimated how (i) UHI anomalies modified excess mortality on days cold and hot for London overall and (ii) displaced a fixed shape temperature-mortality function ('shifted spline' model). For each we also compared observed associations with those expected under no or full acclimatization to the UHI. RESULTS: The relative risk of death on hot compared to normal days differed very little across UHI decile groups. A 1oC UHI anomaly multiplied the risk of heat death by 1.004 (95% CI 0.950, 1.061) (interaction rate ratio) compared with 1.070 (1.057, 1.082) expected if there were no acclimatization. The corresponding UHI interaction for cold was 1.020 (0.979, 1.063) against 1.030 (1.026, 1.034) expected. Fitted splines for heat shifted little across UHI decile groups, again suggesting acclimatization. For cold, they shifted somewhat in the direction of no acclimatization, but not excluding acclimatization. CONCLUSIONS: We have proposed two analytical methods for estimating the degree of acclimatization to the heat- and cold-related mortality burdens associated with UHI. The results for London suggest relatively complete acclimatization to the UHI effect on summer heat-related mortality, but less clear evidence for cold.
Crichton S, Barratt B, Hoang U, et al., 2015, Associations between exhaust and non-exhaust related components of particulate matter and stroke incidence by stroke subtype in South London, Publisher: WILEY-BLACKWELL, Pages: 31-31, ISSN: 1747-4930
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