A community approach to health

Improving the health and well-being of a community may seem like a daunting task-particularly when you consider the vast number of factors that can influence the quality of life of a neighborhood or a region. It's not impossible, however, as six widely different communities across the U.S. are discovering. The Accelerating Community Transformation (ACT) project--now underway by The Healthcare Forum through a five-year, $5 million grant from pharmaceutical joint venture Astra Merck Inc.--is an innovative attempt to create real-life learning laboratories in communities as diverse as an inner-city neighborhood on the west side of Chicago; the small southern town of Aiken, S.C.: the semi-desert city of San Bernardino, Calif.; a corner of America's heartland where Missouri, Kansas. Nebraska and Iowa meet; the new town of Celebration, Fla.; and St. Louis, Mo. The goals: to evaluate and accelerate community-wide efforts that result in healthier, more desirable places for people to live, work and play; to build community capacity; and to achieve measurable improved health and quality of life outcomes.     

Estimating human exposure to nitrogen dioxide: An indoor/outdoor modeling approach

Adverse health consequences associated with human exposure to nitrogen dioxide are well documented. In order for policymakers to assess health risks and implement appropriate control strategies, accurate information is required concerning (1) the number of people exposed, (2) the severity and patterns of exposure, and (3) the health-related effects of exposure. In the past, data from central monitoring sites have been used to establish air pollution exposures. However, it is now recognized that people spend much of their time indoors or in areas away from fixed monitors where pollutant concentrations may be drastically different. An attempt to provide a more realistic estimate of nitrogen dioxide exposures is made. A simple deterministic model is developed, relating exposure to background ambient levels, indoor values, and human activities. Ambient and indoor parameters are derived from monitoring programs in six U.S. cities. Results suggest indoor nitrogen dioxide concentrations in private dwellings vary primarily with outdoor levels and type of cooking fuel, but are also affected by factors such as air-exchange rates and strength of indoor sources. Estimates of population exposures are obtained by combining observed distributions of nitrogen dioxide concentrations from outdoor and indoor settings with information about number of people and time spent in each microenvironment.     

A new approach to community health

This article deals with the local health care among the Shipibo-Conibo in eastern Peru. A project called AMETRA--application of traditional medicine--is functioning in the area. The aim of AMETRA is to give courses and stimulate co-operation between traditional medical practice and Western medicine. The solutions to the health problems are seen in direct relation to the socio-economic structure and to the environmental prerequisites. The aim and purposes of AMETRA are described and analysed. It is proposed that the two medical systems should co-operate in such a manner that their complementary nature is emphasized and fully utilized.     

A tiered approach to deterministic models for indoor air exposures

There are a number of deterministic mathematical approaches available for modeling indoor air pollution concentrations. These models range in complexity from simple saturation vapor pressure models to models using computational fluid dynamics, with many in between these extremes. This range reflects the variety of ways pollutant generation, transport, and mixing are treated in the different models. In selecting which model to use, a tiered approach is useful. The tiered approach considers the goal of the modeling, the availability of model inputs, and the degree of uncertainty that is acceptable. The simpler models are easy to use and the inputs are often readily available. However, they usually have an inherently high degree of uncertainty which requires conservative assumptions that may result in overestimates of concentrations. The more complex models are more difficult to use and require more precise inputs. However, they have the potential to allow the modeler to reduce or quantify uncertainty. This ability to address uncertainty may be limited by the understanding of and the availability of the model inputs. An application example of the tiered approach using a completely mixed space model, a two-zone model, and a turbulent diffusion model illustrates the selection criteria for model use and the model performances. Ultimately, an understanding of the principles behind the models and their inherent strengths and weaknesses is required for their appropriate application to exposure assessment.     

A stakeholder approach to community health management

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.     

A community health education approach to occupant protection

The goal of enhancing motor vehicle occupant protection is vital to the public's health. Controversies about passive versus active protection and voluntary versus mandatory measures continue. A program which employed a combination of positive reinforcements (incentives) and wide-scale community education succeeded in raising the community seat belt usage rate from 24 to 41% in 6 months. This rate was sustained at 36% at six-month follow-up. This article reviews the major features of the "Seat Belts Pay Off" campaign and its evaluation and considers both theoretical and pragmatic issues pertinent to replicating the program in other community settings.     

家庭装修室内空气污染对居民健康影响

目的探讨室内装修空气污染的主要污染物、污染程度及对人群健康的影响。方法采用随机整群抽样的方法,在长春市选择装修6个月内的住户,监测甲醛、氨和总挥发性有机物（TVOC）的浓度,同时进行问卷调查。结果甲醛和总挥发性有机物（VOCs）是家庭装修室内空气污染的主要污染物;甲醛暴露量每增加5 mg/m3,发生中枢神经系统反应、眼、鼻、喉刺激症状、呼吸系统反应和皮肤过敏反应的危险性分别增加2.833,8.751,2.452和3.102倍;随着TVOC暴露量的增加,发生中枢神经系统反应和呼吸道系统反应的危险性分别增加2.776和2.044倍。结论室内装修中甲醛暴露量与人群发生中枢神经系统反应、眼、鼻、喉刺激症状、呼吸系统反应和皮肤过敏反应有关。TVOC暴露量与人群发生中枢神经系统反应和呼吸系统反应有关。     

Association between indoor and outdoor air pollution and adolescent asthma from 1995 to 1996 in Taiwan

The study aim was to estimate the contribution of indoor and outdoor air pollution to the 1-year prevalence of adolescent asthma after personal susceptibility and other potential risk factors were taken into account. A large-scaled cross-sectional study was conducted among 165,173 high school students aged 11 to 16 years in the different communities of Kaohsiung and Pintong in Taiwan, from October 1995 to June 1996. Each student and his/her parents participating in the study completed a video and a written International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire about symptoms of wheezing and allergies, passive smoking, and demographic variables. After adjustment for potential confounders, adolescents exposed to cigarette smoking (odds ratio = 1.29, 95% confidence interval (CI), 1.17-1.42) and environmental tobacco smoke (odds ratio = 1.08, 95% CI, 1.05-1.12) were found to suffer from asthma at an increased frequency. We observed a statistically significant association between outdoor air pollution and asthma, after controlling for potential confound variables. Total suspended particulate, nitrogen dioxide, carbon monoxide, ozone, and airborne dust particles all displayed an independent association with asthma, respectively. There were no selection biases in this community-based study, which provides evidence that passive smoking and long-term, high average outdoor air pollution are independent risk factors of asthma.     

北京市室内外PM_(2.5)中有机碳和元素碳分布特征研究

目的研究室内外PM_(2.5)中有机碳(organic carbon,OC)和元素碳(elemental carbon,EC)的分布特征。方法选择7个典型地区,每个地区设置室内外两个监测点,2013年5月—2014年4月连续监测PM_(2.5)中OC和EC。结果室内OC和EC年均浓度(中位值和四分位值)分别为13.4μg/m~3(8.82~26.6μg/m~3)和3.79μg/m~3(2.09~6.98μg/m~3),室外分别为15.4μg/m~3(10.6~35.2μg/m~3)和4.96μg/m~3(2.92~9.39μg/m~3),室内外OC分别占总碳的78%和73%。统计发现,碳类物质室外高于室内,OC浓度高于EC;燃煤季室外OC浓度最高,其他季节无差异;周六日室外OC浓度最高,周一至周三最低;7个典型地区室外OC浓度为:扬尘区、航油区、工业区、轻工业区汽车尾气区、发电厂区清洁对照区。室外OC与室外EC呈直线关系(r=0.886),室内外OC呈直线关系(r=0.915),室内外EC呈直线关系(r=0.894),碳类物质与PM_(2.5)呈直线关系(rOC-PM 2.5=0.785,rEC-PM 2.5=0.775)。夏季OC类物质室内与室外比值(I/O值)最高且与另外三季的结果有差异。燃煤季室外OC与EC比值最高,夏季最低。结论北京空气中碳类物质污染值得关注,雾霾期间应特别加强对OC防护,应采取有的放矢的措施控制OC污染。     

Systematic review and meta-analysis of epidemiological time-series studies on outdoor air pollution and health in Asia

Asia is experiencing rapid increases in industrialization, urbanization, and motor vehicle transport with correspondingly high levels of pollution. We undertook a systematic review and meta-analysis of the Asian time-series literature to assess the evidence from health effects of short-term exposure to outdoor air pollution. Eighty-two studies provided estimates suitable for quantitative meta-analysis. Summary estimates for daily mortality and hospital admissions were calculated for particulate matter with aerodynamic diameters less than 10 and 2.5???m (PM₁₀ and PM_2.5), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide. For 10???g/m³ increases in PM₁₀, daily mean numbers of deaths increased by 0.27% (95% confidence interval: 0.12%, 0.42%), 0.86% (0.34%, 1.39%), and 0.36% (0.09%, 0.62%) for all cause, respiratory, and cardiovascular deaths, respectively. Associations in the 65+ age group tended to be larger than those for all ages combined. All other pollutants were positively associated with both mortality and hospital admissions. We found no evidence to suggest that the size and direction of PM₁₀ estimates were modified by either the average level of particles in the city or the year of publication (a proxy for more up-to-date statistical methods and the most recent pollutant concentrations and sources). There were insufficient reports for PM_2.5 to enable a quantitative meta-analysis. Our findings were generally consistent with the range of effects found in other parts of the world and suggest that global guidelines and health impacts based largely on evidence derived from the USA and Europe are likely to be reasonably reliable.     

Environmental and biological monitoring of arsenic in outdoor workers exposed to urban air pollutants

The aim of this study is to evaluate personal exposure to As in urban air in two groups of outdoor workers (traffic policemen and police drivers) of a big Italian city through: (a) environmental monitoring of As obtained by personal samples and (b) biological monitoring of total urinary As. The possible influence of smoking habit on urinary As was evaluated. We studied 122 male subjects, all Municipal Police employees: 84 traffic policemen and 38 police drivers exposed to urban pollutants. Personal exposure to As in air was significantly higher in traffic policemen than in police drivers (p=0.03). Mean age, length of service, alcohol drinking habit, number of cigarettes smoked/day and BMI were comparable between the groups of subjects studied. All subjects were working in the same urban area where they had lived for at least 5 yrs. Dietary habits and consumption of water from the water supply and/or mineral water were similar in traffic policemen and in police drivers. The values of total urinary As were significantly higher in traffic policemen (smokers and non smokers) than in police drivers (smokers and non smokers) (p=0.02). In the subgroup of non-smokers the values of total urinary As were significantly higher in traffic policemen than in police drivers (p=0.03). In traffic policemen and in police drivers total urinary As values were significantly correlated to the values of As in air (respectively r=0.9 and r=0.8, p<0.001). This is the first research in literature studying the exposure to As in outdoor workers occupationally exposed to urban pollutants, such as traffic policemen and police drivers. Personal exposure to As in the air, as well as the urinary excretion of As, is significantly higher in traffic policemen compared to drivers. These results can provide information about exposure to As in streets and in car for other categories of outdoor workers similarly exposed.     

Study on suspended particulate matter and polycyclic aromatic hydrocarbons in indoor and outdoor air

Summary To study changes in the concentration of suspended particulate matter (SPM) in indoor and outdoor air, a new portable sampler (AND sampler) was designed that could separately collect particles exhibiting aerodynamic diameters of > 10 m, 2–10 m, and < 2 m. The relationship between the airborne particle concentration in indoor air and that in outdoor air varied with the aeordynamic diameter of the particles. The concentration of SPM in the indoor air increased in proportion to that in the outdoor air. The concentration of polycyclic aromatic hydrocarbons (PAH) in SPM also varied with the aerodynamic diameter of the particles. Fine particles exhibiting an aerodynamic diameter of < 2 m contained high concentration of PAH. The concentrations of benzo(k)fluoranthene, benzo(a)pyrene, and benzo (ghi) perylene in indoor air increased in proportion to those in outdoor air.     

Correlating health effect with indoor air quality in kindergartens

Summary In 24 kindergartens the relation between the presence of readily visible, man-made mineral-fiber products in the ceilings and the presence/frequency of symptoms or diseases and the correlations between complaints of symptoms or disease and the concentration of man-made mineral-fibres in the indoor environment was investigated. A combination of traditional epidemiological technique and a technical analysis of a number of indoor-air parameters did not support the hypothesis that the presence of readily visible man-made mineral-fiber products in the ceiling should be mainly responsible for the occurrence of symptoms and/or disease related to indoor exposure in kindergartens.