Restricted Activity Days Research Articles

Health impact assessment of PM2.5 from uncovered coal trains in the San Francisco Bay Area: Implications for global exposures

Coal generates almost 40% of the world's electricity with 80 countries throughout the world using coal power. An inherent part of this generation is the rail transport of coal in uncovered cars, often up to a mile long. Existing studies document the subsequent increments of PM2.5 to the near-rail populations, which typically include a large number of economically disadvantaged residents and/or people of color. However, to date there is no assessment of the health implications of this stage in the use of coal. The present study quantifies such impacts on a region in the San Francisco Bay Area. The analysis shows important effects on mortality, hospitalization for cardiovascular and respiratory disease, asthma exacerbation, work loss, and days of restricted activity. Several of these outcomes exhibited a one to six percent increase over baseline. As such, it delineates the implications for the global effects of the transport of coal.

Assessment of dental morbidity in school-going children (6–10-year-old): A cross-sectional study

Background Restricted activity days are prevalent in children with oral health problems. Oral health issues cause over 50 billion hours of education to be lost each year, which has an impact on children’s school performance and the potential for success. Mostly it is concluded that dental caries is the most common disease among individuals. In addition, it may create chronic systemic conditions in healthy individuals. In children, it may induce deformities in the growth of the unerupted teeth. This study will help identify the factors and causes of risk factors for morbidities associated with dental problems. It also includes the educational status and socioeconomic condition of their parents, which is conducted in the Wardha district of Maharashtra in the field practice of villages among children. Aim To Assess dental morbidity among schoolchildren in rural areas and their relationship with their socioeconomic status in rural areas of Wardha District. Methodology A questionnaire-based face-to-face interview was conducted in this community-based cross-sectional study to assess dental morbidity in school-going children. The study participants will be children aged 6–10 years in the rural areas of the Wardha district. The variables of this study were the sociodemographic profile, habits, and morbidities of the children.

Air Pollution: A Challenge to Public Health and Healthcare Systems

Air Pollution: A Challenge to Public Health and Healthcare Systems

Low-cost PM2.5 sensors can help identify driving factors of poor air quality and benefit communities

Air quality is critical for public health. Residents rely chiefly on government agencies such as the Environmental Protection Agency (EPA) in the United States to establish standards for the measurement of harmful contaminants including ozone, sulfur dioxide, carbon monoxide, volatile organic chemicals (VOCs), and fine particulate matter at or below 2.5 μm. According to the California Air Resources Board [1], “short-term PM2.5 exposure (up to 24-h duration) has been associated with premature mortality, increased hospital admissions for heart or lung causes, acute and chronic bronchitis, asthma attacks, emergency room visits, respiratory symptoms, and restricted activity days”. While public agency resources may provide guidance, it is often inadequate relative to the widespread need for effective local measurement and management of air quality risks. To that end, this paper explores the use of low-cost PM2.5 sensors for measuring air quality through micro-scale (local) analytical comparisons with reference grade monitors and identification of potential causal factors of elevated sensor readings. We find that a) there is high correlation between the PM2.5 measurements of low-cost sensors and reference grade monitors, assessed through calibration models, b) low-cost sensors are more prevalent and provide more frequent measurements, and c) low-cost sensor data enables exploratory and explanatory analytics to identify potential causes of elevated PM2.5 readings. This understanding should encourage community scientists to place more low-cost sensors in their neighborhoods, which can empower communities to demand policy changes that are necessary to reduce particle pollution, and provide a basis for subsequent research.

New concentration-response functions for seven morbidity endpoints associated with short-term PM2.5 exposure and their implications for health impact assessment

BackgroundMorbidity burdens from ambient air pollution are associated with market and non-market costs and are therefore important for policymaking. The estimation of morbidity burdens is based on concentration–response functions (CRFs). Most existing CRFs for short-term exposures to PM2.5 assume a fixed risk estimate as a log-linear function over an extrapolated exposure range, based on evidence primarily from Europe and North America. ObjectivesWe revisit these CRFs by performing a systematic review for seven morbidity endpoints previously assessed by the World Health Organization, including data from all available regions. These endpoints include all cardiovascular hospital admission, all respiratory hospital admission, asthma hospital admission and emergency room visit, along with the outcomes that stem from morbidity, such as lost work days, respiratory restricted activity days, and child bronchitis symptom days. MethodsWe estimate CRFs for each endpoint, using both a log-linear model and a nonlinear model that includes additional parameters to better fit evidence from high-exposure regions. We quantify uncertainties associated with these CRFs through randomization and Monte Carlo simulations. ResultsThe CRFs in this study show reduced model uncertainty compared with previous CRFs in all endpoints. The nonlinear CRFs produce more than doubled global estimates on average, depending on the endpoint. Overall, we assess that our CRFs can be used to provide policy analysis of air pollution impacts at the global scale. It is however important to note that improvement of CRFs requires observations over a wide range of conditions, and current available literature is still limited. DiscussionThe higher estimates produced by the nonlinear CRFs indicates the possibility of a large underestimation in current assessments of the morbidity impacts attributable to air pollution. Further studies should be pursued to better constrain the CRFs studied here, and to better characterize the causal relationship between exposures to PM2.5 and morbidity outcomes.

Changes in the Mechanical Properties of Fast and Slow Skeletal Muscle after 7 and 21 Days of Restricted Activity in Rats.

Disuse muscle atrophy is usually accompanied by changes in skeletal muscle structure, signaling, and contractile potential. Different models of muscle unloading can provide valuable information, but the protocols of experiments with complete immobilization are not physiologically representative of a sedentary lifestyle, which is highly prevalent among humans now. In the current study, we investigated the potential effects of restricted activity on the mechanical characteristics of rat postural (soleus) and locomotor (extensor digitorum longus, EDL) muscles. The restricted-activity rats were kept in small Plexiglas cages (17.0 × 9.6 × 13.0 cm) for 7 and 21 days. After this, soleus and EDL muscles were collected for ex vivo mechanical measurements and biochemical analysis. We demonstrated that while a 21-day movement restriction affected the weight of both muscles, in soleus muscle we observed a greater decrease. The maximum isometric force and passive tension in both muscles also significantly changed after 21 days of movement restriction, along with a decrease in the level of collagen 1 and 3 mRNA expression. Furthermore, the collagen content itself changed only in soleus after 7 and 21 days of movement restriction. With regard to cytoskeletal proteins, in our experiment we observed a significant decrease in telethonin in soleus, and a similar decrease in desmin and telethonin in EDL. We also observed a shift towards fast-type myosin heavy chain expression in soleus, but not in EDL. In summary, in this study we showed that movement restriction leads to profound specific changes in the mechanical properties of fast and slow skeletal muscles. Future studies may include evaluation of signaling mechanisms regulating the synthesis, degradation, and mRNA expression of the extracellular matrix and scaffold proteins of myofibers.

Intraclass Correlation and Variance in the Characteristics of Primary Care Patients Managing Chronic Medical and Behavioral Conditions.

Background To avoid statistical errors, researchers who recruit patients from selected medical practices and analyze them at the individual level need to account for the clustered nature of their sample. This is most often done using the intraclass correlation coefficients (ICCs), a measure of how strongly subjects recruited from the same cluster (in this case patients from a clinic) resemble each other. Aims The aim is to support the design of cluster-randomized studies by supplying estimates of variance and ICC of various measures using a population of patients from multiple primary care clinics. Materials and methods ICCs were extracted from a large cluster-randomized pragmatic clinical trial of adult primary care patients managing multiple chronic conditions, the Integrating Behavioral Health and Primary Care study (IBH-PC). IBH-PC collected demographics and patient-reported health outcomes on over 3,000 adults from 44 primary care practices in 13 states across the US. We present estimates of the standard deviation and ICC for gender, race, ethnicity, marital status, employment, income, education, social determinants of health, PROMIS-29 functional status, Duke Activity Status Index (DASI), nine-item Patient Health Questionnaire (PHQ-9) depression score, Generalized Anxiety Disorder (GAD-7) anxiety score, Asthma Symptom Utility Index, restricted activity days, medication adherence, health care visits in the past month, emergency room visits in the past year, hospital days in the past year, perception of quality and patient-centeredness of care, alcoholic drinks per month, and the GAIN substance use disorder screener. Results ICCs varied broadly with the highest values found for race and income and the lowest for short-term estimates of the GAIN. Conclusions These values can be used to inform the design, especially power estimates and sample size requirements, of future studies.

Exploring the Effects of Gender Differences and Widowhood Status on the Days Spent in Poor Health: A Secondary Data Analysis from India.

The majority of research in India has focused on the impact of widowhood on health status and health care use, while little emphasis has beenpaid to the number of days spent in poor health among widowed population compare to other marital categories. Thus, the current study explores the relationship between widowhood and days spent with poor health outcomes among adultsin India. Additionally, gender differences in the relationship between widowhood and days with poor health outcomes are further studied.The research employed nationally representative cross-sectional data from the 75th round (2017-2018) of the National Sample Survey (NSS). To investigate the associations of marital status (married vs widowed) and other factors with days spent in poor health, a negative binomial regression model was used. Additionally, the interaction model of age and widowhood was estimated separately for men and women.The findings suggest that widowed individuals had consistently prolonged days with an illness, limited activity, and confinement to bed. After adjusting for socioeconomic and demographic characteristics, the findings suggested that widowed women (IRR = 1.141, 95% Confidence interval = 1.01-1.29) were more likely to spend days with limited acitivitiesthan married women. The marital status-age interaction indicated that older widowed women were more likely to have days of restricted activity and confinement to bed than married women, but such link is absent for men.In India, the elderly widow often spends her days confined to bed and prolonged days with limited activity. Policymakers and practitioners in public health should develop effective policies and programmes to enhance the health and well-being of widowed women, particularly those from socioeconomically disadvantaged backgrounds.

Health effects from heat waves in France: an economic evaluation.

BackgroundScarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019.MethodsHealth indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs.ResultsBetween 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion).ConclusionThe results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10198-021-01357-2.

Economic impact of 2015 transboundary haze on Singapore

We quantify and estimate the economic impact of the transboundary haze pollution in 2015 on Singapore following reliable quantitative methods and techniques in cost-benefit analysis. We include in the estimation both tangible and intangible costs associated to haze pollution. Specifically, in the estimation of the tangible costs of haze, the estimation includes (1) adverse impacts of haze on health, (2) loss in tourism, (3) loss in business as an indirect effect from loss of tourist receipts, (4) productivity loss due to restricted activity days and (5) cost of mitigation and adaptation by government agencies and households. For the estimation of the intangible costs, the value is derived from the contingent valuation study of Quah et al., 2018 which was conducted in 2018 to estimate Singapore residents’ willingness to pay for a pro-environment collaboration project that could effectively stop “slash and burn” practices and significantly reduce the annual haze pollution issue. The total cost of the 2015 haze episode on Singapore which lasted for 2 months is estimated at S$1.83 billion, amounting to 0.45 % of the country’s gross domestic product. Accordingly, the total tangible cost is estimated at S$1.46 billion equivalent to 0.36 % of GDP while the total intangible cost stands at S$0.36 billion equivalent to 0.09 % of GDP. The findings have important implications for public policy.

Fasting plasma metabolomic profiles are altered by three days of standardized diet and restricted physical activity

ObjectiveFew studies have examined the effects of participants’ diet and activity prior to sample collection on metabolomics profiles, and results have been conflicting. We compared the effects of overnight fasting with or without 3 days of standardized diet and restricted physical activity on the human blood metabolome, and examined the effects of these protocols on our ability to detect differences in metabolomics profiles in adolescent girls with obesity and polycystic ovary syndrome (PCOS) vs. sex and BMI-matched controls. MethodsThis was a cross-sectional study of 16 adolescent girls with obesity and PCOS and 5 sex and BMI-matched controls. Fasting plasma metabolomic profiles were measured twice in each participant: once without preceding restriction of physical activity or control of macronutrient content (“typical fasting visit”), and again after 12 h of monitored inpatient fasting with 3 days of standardized diet and avoidance of vigorous exercise (“controlled fasting visit”). Moderated paired t-tests with FDR correction for multiple testing and multilevel sparse partial least-squares discriminant analysis (sPLS-DA) were used to examine differences between the 2 visits and to compare the PCOS and control groups with the 2 visits combined and again after stratifying by visit. ResultsTwenty-three known metabolites were significantly different between the controlled fasting and typical fasting visits. Hypoxanthine and glycochenodeoxycholic acid had the largest increases in relative abundance at the controlled fasting visit compared to the typical fasting visit, while oleoyl-glycerol and oleamide had the largest increases in relative abundance at the typical fasting visit compared to the controlled fasting visit. sPLS-DA showed excellent discrimination between the 2 visits; however, when the samples from the 2 visits were combined, differences between the PCOS and control groups could not be detected. After stratifying by visit, discrimination of PCOS status was improved. ConclusionsThere were differences in fasting metabolomic profiles following typical fasting vs monitored fasting with preceding restriction of physical activity and control of macronutrient content, and combining samples from the two visits obscured differences by PCOS status. In studies performing metabolomics analysis, careful attention should be paid to acute diet and activity history. Depending on the sample size of the study and the expected effect size of the outcomes of interest, control of diet and physical activity beyond typical outpatient fasting may not be required.

The Impact of Decarbonization Scenarios on Air Quality and Human Health in Poland—Analysis of Scenarios up to 2050

Poland faces two great challenges in the field of environment and atmosphere protection: improving air quality, especially by reducing particulate matter (PM) emissions, and reducing relatively high greenhouse gas emissions. The aim of this research was to investigate how the fuel and technological transformations in the power, road transport, and household and tertiary sectors aimed at reducing carbon dioxide (CO2) emissions in Poland would affect air quality, human health, and the associated external costs. The study was conducted for 2050 while considering 2015 as the base year. Ambient PM2.5 (particles with a diameter of less than 2.5 µm) concentration was used as a proxy air quality indicator. The analysis was based on decarbonization scenarios developed within the REFLEX Project (Analysis of the European energy system under the aspects of flexibility and technological progress). The three scenarios of the REFLEX Project focused on the reduction of CO2 emissions up to 2050 from various sectors, mainly by the means of fuel and technological switches. This also led to the changes in the emission levels of pollutants that directly affect air quality, which were calculated with the use of fuel- and technology-specific emission factors. Next, for each emission scenario, ambient concentrations of PM2.5 and others pollutants were calculated with the use of the Polyphemus—an Eulerian-type air quality modelling system. Subsequently, the health impact of population exposed to air pollution and associated external costs were calculated using the πESA (Platform for Integrated Energy System Analysis) platform. The health impacts considered were the number of years of life lost, restricted activity days, and number of chronic bronchitis cases. The results showed that the largest reductions in both greenhouse gas and PM emissions—and consequently improvements of air quality resulting in a decrease of negative impacts on human health and a decrease of external costs—can be achieved by the transformation of heat production in the household and tertiary sector. The results also showed that the decrease in PM2.5 emissions envisaged in the analyzed scenarios in 2050 will lead to a reduction in the number of lost years of life by about 35 thousand and an avoidance of external costs by EUR 2.4 billion.

Identifying Risk Factors from MSHA Accidents and Injury Data Using Logistic Regression

The global mining industry has recorded significant declines in accident and injury rates attributed to the advancement in technology, increased enforcement, and safety consciousness. A goal of the mining industry is to achieve zero injury and occupational illness on all mine sites, prompting increased research into ways to further reduce mine accidents. A machine learning technique known as multiclass logistic regression is applied on a 10-year injury dataset from the Mine Safety and Health Administration (MSHA) to determine a miner’s susceptibility to a class of injury and to help identify significant risk factors associated with different classes of injury. The data is aggregated based on injury classification to provide statistically relevant results. The analysis identifies specific risk factors that influence a mine worker’s susceptibility to a given class of injury, i.e., non-fatal with no days lost or restricted activity, non-fatal with days lost and/or days of restricted work activity, and fatal and total permanent or partial permanent disability. These factors include miner’s age, mine type (coal vs. non-coal), experience on the current job (years), shift start time, employment type (operator vs. contractor), mining district, and type of accident. The results of the analysis indicate that a miner’s experience on the job, i.e., the number of years worked in a current job, is a significant risk to injury occurrence, even for those with decades of total mining experience. We further show the differences and similarities between the surface and underground mine incidents.

The benefits of lower ozone due to air pollution emission reductions (2002–2011) in the Eastern United States during extreme heat

ABSTRACT Using the Community Multiscale Air Quality (CMAQ) model and the Benefits Mapping and Analysis Program – Community Edition (BenMAP-CE) tool, we estimate the benefits of anthropogenic emission reductions between 2002 and 2011 in the Eastern United States (US) with respect to surface ozone concentrations and ozone-related health and economic impacts, during a month of extreme heat, July 2011. Based on CMAQ simulations using emissions appropriate for 2002 and 2011, we estimate that emission reductions since 2002 likely prevented 10– 15 ozone exceedance days (using the 2011 maximum 8-hr average ozone standard of 75 ppbv) throughout the Ohio River Valley and 5– 10 ozone exceedance days throughout the Washington, DC – Baltimore, MD metropolitan area during this extremely hot month. CMAQ results were fed into the BenMAP-CE tool to determine the health and health-related economic benefits of anthropogenic emission reductions between 2002 and 2011. We estimate that the concomitant health benefits from the ozone reductions were significant for this anomalous month: 160–800 mortalities (95% confidence interval (CI): 70–1,010) were avoided in July 2011 in the Eastern U.S, saving an estimated $1.3–$6.6 billion (CI: $174 million–$15.5 billion). Additionally, we estimate that emission reductions resulted in 950 (CI: 90–2,350) less hospital admissions from respiratory symptoms, 370 (CI: 180–580) less hospital admissions for pneumonia, 570 (CI: 0–1650) less Emergency Room (ER) visits from asthma symptoms, 922,020 (CI: 469,960–1,370,050) less minor restricted activity days (MRADs), and 430,240 (CI: −280,350–963,190) less symptoms of asthma exacerbation during July 2011. Implications: We estimate the benefits of air pollution emission reductions on surface ozone concentrations and ozone-related impacts on human health and the economy between 2002 and 2011 during an extremely hot month, July 2011, in the eastern United States (US) using the CMAQ and BenMAP-CE models. Results suggest that, during July 2011, emission reductions prevented 10-15 ozone exceedance days in the Ohio River Valley and 5-10 ozone exceedance days in the Mid Atlantic; saved 160-800 lives in the Eastern US, saving $1.3 - $6.5 billion; and resulted in 950 less hospital admissions for respiratory symptoms, 370 less hospital admissions for pneumonia, 570 less Emergency Room visits for asthma symptoms, 922,020 less minor restricted activity days, and 430,240 less symptoms of asthma exacerbation.

CHRONIC PAIN, FEAR OF FALLING, AND RESTRICTED ACTIVITY DAYS IN AN OLDER POPULATION

Both chronic pain and fear of falling can lead to activity restriction and increased fall risk among vulnerable elders. Little is known about pain characteristics that may be associated with fear of falling, contributing to restricted activity. We studied 765 adults aged ≥65y (mean=78.9y) in the MOBILIZE Boston Study, to evaluate the cross-sectional relationship between pain characteristics and fear of falling measured using the Falls Efficacy Scale (FES). In addition, we examined the impact of pain and fear of falling on restricted activity. We measured 3 domains of global pain: pain distribution (none, single site or multisite pain), and Brief Pain Inventory subscales of pain severity and pain interference. Restricted activity days (RADs) refer to the count of self-reported days of reduced activity due to illness or injury in the previous 12 months. We performed multivariable logistic regressions predicting fear of falling (FES<90/100) adjusted for sociodemographics, fall history and fall risk factors. Participants with multisite pain or moderate-to-high pain interference ratings were more likely to have fear of falling (adj.OR 1.97, 95%CI 1.05-3.67; adj.OR 4.02, 95%CI 2.0-8.06, respectively). Pain severity was not associated with FES. Older adults with multisite pain and fear of falling reported significantly more RADs than those with multisite pain without fear of falling (79±135 and 26±74 RADs, respectively; test for pain x FES interaction, p=0.01). Older adults with chronic pain have greater fear of falling which may contribute to restricted activity. Efforts are needed to increase activity and falls efficacy among older adults with chronic pain.

Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis

IntroductionThe evidence that teaching self-management techniques to children and young people with asthma in schools is effective has not, to date, been the subject of systematic review.MethodsWe conducted a systematic...

School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review.

School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review.

Fractures in school age children in relation to sex and ethnic background: The Generation R Study.

Fracture rate in childhood is increasing and its consequences may affect health and developmental processes and cause school absence and restricted activity days. There are scarce epidemiologic studies regarding fractures in children. The aim of this study was to evaluate if pediatric fractures show disparities across sexes and ethnic groups. This study was conducted based on data from 3632 participants of the Generation R Study. Prevalent fractures were assessed using a questionnaire at a mean age of 9.7 years. Child's ethnicity was determined based on country of birth of the parents using questionnaires (geographic ancestry) or admixture analysis (genetic ancestry). Associations between fracture occurrence and sex or ethnicity were evaluated using logistic regression models adjusted for age, weight, lean mass fraction, bone mineral density (BMD) and sex/ethnicity. Fracture was reported for 525 (14.5%) children. The great majority of these children were classified as European (N = 3164), followed by African (N = 283) and Asian (N = 185) based on geographic ancestry. Similarly, the highest proportion of Europeans was observed based on genetic ancestry. Prevalence of fractures was not different between boys and girls, even after adjustment for possible confounders (OR: 1.03, 95% CI 0.84-1.27, p-value = 0.8). However, odds of prevalent fractures were two times higher in European when compared to Asian children (OR: 2.01, 95% CI 1.17-3.45, p-value = 0.01), and 1.5 times higher when compared to African children (OR: 1.50, 95% CI 1.00-2.26, p-value = 0.05). Overall, in this study, European children showed a highest risk of prevalent fractures independently of factors such as body composition and BMD, while no difference in the prevalence of fractures between boys and girls was observed.

Impact of new fuel specifications on vehicle emissions in Mexico

Volatile Organic Compounds (VOCs) from vehicles are a significant contributor to Mexico's pollution, as a precursor to both ambient ozone and secondary particulate matter (PM). Recent updates to Mexico's gasoline specification NOM-016 allow ethanol blends up to 10 percent (E10) outside of the metropolitan areas of Mexico City, Guadalajara and Monterrey, and leave open the possibility of allowing E10 within these areas as well. The NOM-016 updates also permit E10 to have higher volatility (RVP) than previously allowed. The impact of these changes on vehicle emissions in Mexico was assessed, with a focus on evaporative VOC emissions driven by increased RVP and permeation. Roadside remote sensing (RSD) measurements from Mexico City were analyzed, finding that vehicle fleet hydrocarbon (HC) emissions are much higher than U.S. levels, with indication that high evaporative emissions contribute to this. The impact on vehicle emissions of the NOM-016 revisions and potential introduction of E10 in metropolitan zones was assessed for an ozone episode day using the MOVES-Mexico model, which reflects higher evaporative emissions from Mexico's vehicle fleet. Results show an increase in total motor vehicle VOC emissions of 13–18 percent in metropolitan areas and a 23 percent increase in other areas of the country for NOM-016 compliant E10 fuel, relative to fuel sold in Mexico prior to the NOM-016 update. Results for other pollutants showed an increase in PM2.5 and air toxics from E10 blends, a reduction in CO, and NOx impacts mixed depending on area. Total motor vehicle emissions for toluene, identified in prior work as the compound with the highest ozone forming potential in Mexico City, increased by 29–34 percent with E10 fuel in Mexico City and more in other metropolitan areas. Past studies linking emissions change with health outcomes in Mexico City suggest that the increase in vehicle emissions from NOM-016 updates would have a measurable negative effect on premature mortality, chronic bronchitis, hospital visits, and restricted activity days, with societal costs associated with health care and lost productivity.

Is A Combination of Antibiotics and Non-Steroidal Anti-Inflammatory Drugs More Beneficial Than Antibiotic Monotherapy For The Treatment of Female Acute Uncomplicated Cystitis? A Randomized Controlled Pilot Study.

Purpose: To compare the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) combination therapy to single-agent antibiotic therapy for the resolution of symptoms during two restricted activity days in patients with acute uncomplicated cystitis (AUC)Materials and Methods: We performed a prospective, randomized control pilot study. A total of 55 patients were enrolled. Group I (n=28) was treated with cepodoxime (100 mg twice per day), and Group II (n=27) was treated with cepodoxime (100 mg) and aceclofenac (100 mg) twice per day; both groups were treated for three days. Upon dysuria after each administration, the participants entered a value on a numerical pain scale. The primary outcome was whether there were any differences in the decrease rate in pain scale between the two groups.Result: The average age of the 55 patients was 49.9 ± 13.5 years, and prior to the clinical visit, the patients ex-perienced an average of 2.4 ± 2.2 days of dysuria symptoms. The average numerical pain scale score for dysuria was 4.98 ± 2.18. Thirty-four patients (61.8%) showed positive culture results, and E. coli was the most commonly found bacteria, cultured in 32 patients.Fifty-one patients visited the clinic on day 7, and 42 (76.4%) reported symptom improvement, while nine patients (16.3%) had persistent symptoms. The follow-up numerical pain score was 0.39 ± 1.02 points. The pain score was dramatically decreased after medication. No difference was observed in the magnitude of the pain scale reduction between the two groups (P = 0.134). However, group II showed faster symptom resolution (P = 0.035) at the third administration (day 1.5).Conclusion: Combination therapy with NSAIDs and antibiotics for AUC patients can improve symptoms faster during two restricted activity days when patients have difficulty performing daily living activities.