Ambient pm2.5 and health: From exposure,health hazards to intervention北大核心CSCD

Ambient fine particulate (PM2.5) pollution has become one of the major environmental issues that endanger human health in China, and how to recognize and prevent its health hazards is one of current hot spots for scientific research. Ambient PM2.5 has maintained high levels over recent years, and accurate assessment of personal exposure to PM2.5 is the basis for in-depth investigation. Ambient PM2.5 contains various chemical constituents from multiple pollution sources, and can exert a series of short-term and long-term health hazards via a range of biological mechanisms. Epidemiological and toxicological studies are two major types of design used in the health hazards assessment of PM2.5. In addition, interventional studies on how to mitigate the adverse health effects of PM2.5 are emerging as a new important sphere for future scientific research.     

Health insurance literacy: How best to measure and does it matter to health care access and affordability?

BackgroundHealth insurance is complex, cost are continuously rising, and people are assuming more of these costs. Health insurance literacy (HIL) is related to healthcare access, yet there is no agreement about how best to measure HIL.ObjectivesContrast two HIL measures. First, evaluating their association with demographic characteristics, insurance type, and health status. Second, comparing how these distinct measures relate to access, forgone care, and financial burden of health care.MethodsData are from a 2017 telephone survey focused on health insurance coverage and access. Participants were randomly assigned either the 4-item likelihood of proactive use scale or a 4-item measure of confidence in use of insurance. Logistic regressions assess correlates of each HIL measure and their association with a range of access measures.ResultsFor both measures, 25% of insured adults report high HIL. Few demographic and health status measures are associated with high HIL and they are different for each measure. For both measures, high HIL translates into reports of having a usual source of care and confidence in getting care when needed. The HIL measures behave in opposite ways for forgone care due to costs and problems paying medical bills. Adults scoring high on the likelihood measure are more likely to forgo care and report financial burden. By contrast, adults scoring high on the confidence measure are less likely to forgo care and report burdensome medical bills.ConclusionsThe two measures capture different concepts and raise the question of whether reporting a likely behavior or being confident of that behavior are predictive when it is time to use health insurance. Because HIL is measured at the same time as the outcomes, we reason that the likelihood measure is capturing peoples’ past experience using insurance and may result in more proactive use of insurance in the future.     

Microparticles in health and disease: small mediators, large role?

Microparticles are circulating fragments derived from blebbing and shedding of cell membranes through several mechanisms that include activation, apoptosis and cell damage. In the past they were largely considered as unimportant cell "dust", but more refined detection techniques have revealed large variations in their relative proportion and concentration in numerous disease states. Importantly, these conditions include the most prevalent causes of death and disability in our societies, namely cardiovascular, neoplastic, and inflammatory diseases. Microparticles carry procoagulant, proapoptotic and neoangiogenetic materials in the blood stream, and can also be viewed as a technique cells may adopt to rapidly modify their phenotype, independently from genetic signals. In this review, we focus on the role of these very small ( 1 micron) particles, not only as mere markers of an underlying pathologic state, but also as primordial intercellular messengers and defense mechanism that every viable cell can exploit in distress conditions. In this view, we suggest that this old communication system could be the target of future high-tech interventions, with potential broad consequences.     

How to enhance public health service utilization in community pharmacy?: General public and health providers' perspectives

BackgroundCommunity pharmacists (PHs) in England are increasingly providing a range of public health services. However, the general public view pharmacists as drug experts and not experts in health, and therefore, services may be underutilized.ObjectivesTo explore experiences and views of 4 groups of participants, the general public, PHs, general practitioners (GPs), and other stakeholders (STs) on pharmacy-based public health services, and identify potential factors affecting service use.MethodsThe study was undertaken in a locality of North West England. Three focus groups were conducted with the general public (n = 16), grouped by socioeconomic status. Fourteen semistructured interviews were undertaken with PHs (n = 9), GPs (n = 2), and STs (n = 3). Discussions/interviews were audio recorded, transcribed verbatim, and analyzed thematically.ResultsAll 4 groups of participants agreed that community pharmacies are a good source of advice on medicines and minor ailments but were less supportive of public health services. Six factors were identified affecting utilization of pharmacy services: community pharmacy environment, pharmacist and support staff, service publicity, general public, GP services, and health care system and policies. Crucial obstacles that could inhibit service utilization are perceptions of both the general public and other health providers toward pharmacists' competencies, privacy and confidentiality in pharmacies, high dispensing workload, and inadequate financial support. Networking between local health professionals could enhance confidence in service delivery, general awareness, and thus utilization.ConclusionsCommunity pharmacy has the potential to deliver public health services, although the impact on public health may be limited. Addressing the factors identified could help to increase utilization and impact of pharmacy public health services.     

Nanotechnology, cosmetics and the skin: is there a health risk?

Cosmetic formulations may contain nano-emulsions and microscopic vesicles consisting of traditional cosmetic materials, although it is uncertain whether they should be qualified as actual nanomaterials. Vesicle materials do not penetrate into living human skin. Vesicle formulations may enhance or reduce skin absorption of ingredients, albeit at a limited scale. Sunscreens contain TiO2 or ZnO nanoparticles (NP), which are efficient UV filters. A number of studies suggest that insoluble NP do not penetrate into or through human skin. The results of in vivo toxicity tests showed that TiO2 and ZnO NP are non-toxic. In vitro and in vivo cytotoxicity, genotoxicity, photogenotoxicity, acute toxicity, sensitisation and ecotoxicology studies on TiO2 NP found no difference in the safety profile of micro- or nano-sized materials, all of which were non-toxic. Although some in vitro investigations on TiO2 particles reported cell uptake, oxidative cell damage or genotoxicity, these results may be secondary to phagocytosis of cells exposed to excessive particle concentrations. Studies on wear debris nano- and microparticles support the traditional view that toxicity of small particles is related to their chemistry, rather than their particle size. There is little evidence supporting a general rule that adverse effects of particles on the skin or other tissues increase with smaller particle size, or produce novel toxicities relative to those of larger particles. Overall, the current evidence suggests that nano-sized cosmetic or sunscreen ingredients pose no potential risk to human health, whereas their use in sunscreens has large benefits, such as the protection of human skin against skin cancer.     

The Orewa Speech: another threat to Maori health?

In early 2004, Dr Don Brash, leader of the National Party (New Zealand's opposition political party), gave a speech to a community group regarding what he perceived to be the preferential treatment of Maori in health and education policies. This viewpoint article is written by a group of concerned medical students at Otago University. It argues that epidemiological data provide strong support for specifically addressing Maori health need, whilst the Treaty of Waitangi represents a contractual obligation on behalf of the New Zealand Government to ensure equity of outcome for Maori. Underpinning both the epidemiological and legal arguments, are ethical principles. The central tenets of medicine (ie, to reduce suffering, and to improve and prolong the quality and length of life) should provide a strong driving force to address these inequalities.     

Acinetobacter baumannii: a universal threat to public health?

Acinetobacter spp. are non-fermentative, strictly aerobic, Gram-negative microorganisms with a confusing taxonomic history. The Acinetobacter baumannii-Acinetobacter calcoaceticus complex is the species most commonly isolated from clinical specimens. It is ubiquitous in nature and has been found as part of the normal skin, throat and rectal flora as well as in food and body lice. It colonises patients in Intensive Care Units and contaminates inanimate hospital surfaces and devices as well as wounds, including war injuries. Although a frequent coloniser, Acinetobacter can be the cause of severe and sometimes lethal infections, mostly of nosocomial origin, predominantly ventilator-associated pneumonia. Bacteraemic infections are rare but may evolve to septic shock. Acinetobacter also emerges as a cause of nosocomial outbreaks and is characterised by increasing antimicrobial multiresistance. Antibiotic use, especially carbapenems and third-generation cephalosporins, is recognised as the most important risk factor for multiresistance. Described resistance mechanisms include hydrolysis by beta-lactamases, alterations in outer membrane proteins and penicillin-binding proteins, and increased activity of efflux pumps. Today, Acinetobacter resistant to carbapenems, aminoglycosides and fluoroquinolones presents a challenge to the clinician. However, sulbactam, tigecycline and colistin represent the current therapeutic approaches, which are associated with satisfactory efficacy.     

Biomonitoring: is body burden relevant to public health?

Biomonitoring is the study of the presence and concentration of chemicals in humans usually by the measurement of blood, urine or breath (exhaled air). Properly conducted, these data provide a picture of the amount of a chemical or agent actually absorbed into the body for a specific period of time. This review provides a history of biomonitoring, as well as the limitations and potential benefits of these studies. Examples of the proper and possibly improper use of biomonitoring and the impact made on our society are provided. Reasons for having comprehensive national biomonitoring programs are summarized, along with the societal benefits and risks. A brief discussion of the history of the NHANES program and select results from the 2005 Report are presented. By 2010, it has been predicted that the Centers for Disease Control (CDC) will be monitoring nearly 1000 chemicals in persons from all regions of the nation. The measurement of chemicals and biomarkers has revolutionized the field of exposure assessment. Overall, we recommend an approach of careful interpretation, understanding that the data obtained are useful for establishing baseline information about exposure, rather than equating detection with risk. We present suggestions for contextualizing biomonitoring results in order to provide the public with the tools to distinguish genuine health risks from trivial ones.     

Staging “Chileanness”: Ethnicity,illegal drug economy and social structures

Aim: Following a group of young men with Chilean background living in a Swedish territorially stigmatised area, the author analyses how the actors create, recreate and use ethnicity and on what structural grounds such creation is carried out. This analysis is done to provide a complex and socially constructed view of ethnicity. Method: Between 2003 and 2015, the author followed a group of 16 young men, born in the late 1970s and early 1980s. The fieldwork included interviews and participant observations in places that were important to the young men; the residential area where they lived in Sweden and the area in Chile that some of them visited during the time of the research and where they have their roots. Findings and conclusion: During childhood and adolescence, ethnic identification became a means to group identification. However, ethnic identity practiced in the street culture and the illegal economy cannot be seen as essential, but rather as something that is performed and staged in different situations, creating a sense of “Chileanness”. Producing Chileanness helps combating emotions related to sorrow, to being poor and not feeling welcomed in the Swedish society. This ethnicity is fragile and intertwined with social class and gender.     

Deposition, imaging, and clearance: what remains to be done?

Deposition and clearance studies are used during product development and in fundamental research. These studies mostly involve radionuclide imaging, but pharmacokinetic methods are also used to assess the amount of drug absorbed through the lungs, which is closely related to lung deposition. Radionuclide imaging may be two-dimensional (gamma scintigraphy or planar imaging), or three-dimensional (single photon emission computed tomography and positron emission tomography). In October 2009, a group of scientists met at the "Thousand Years of Pharmaceutical Aerosols" conference in Reykjavik, Iceland, to discuss future research in key areas of pulmonary drug delivery. This article reports the session on "Deposition, imaging and clearance." The objective was partly to review our current understanding, but more importantly to assess "what remains to be done?" A need to standardize methodology and provide a regulatory framework by which data from radionuclide imaging methods could be compared between centers and used in the drug approval process was recognized. There is also a requirement for novel radiolabeling methods that are more representative of production processes for dry powder inhalers and pressurized metered dose inhalers. A need was identified for studies to aid our understanding of the relationship between clinical effects and regional deposition patterns of inhaled drugs. A robust methodology to assess clearance from small conducting airways should be developed, as a potential biomarker for therapies in cystic fibrosis and other diseases. The mechanisms by which inhaled nanoparticles are removed from the lungs, and the factors on which their removal depends, require further investigation. Last, and by no means least, we need a better understanding of patient-related factors, including how to reduce the variability in pulmonary drug delivery, in order to improve the precision of deposition and clearance measurements.