Environmental Control Measures Research Articles

FACTORS ASSOCIATED WITH THE PREVALENCE OF ALLERGIC CONJUNCTIVITIS AMONG PATIENTS RECEIVING EYE CARE SERVICES IN JINJA REGIONAL REFERRAL HOSPITAL EYE CLINIC. A CROSS-SECTIONAL STUDY.

The purpose of the study To determine the prevalence and associated factors of allergic Conjunctivitis among patients attending the eye clinic at Jinja Regional Referral Hospital. Methods This was a cross-sectional study design employing quantitative methods of data collection. The study area was the eye clinic of Jinja RRH. Results The study revealed that in the prevalence of allergic conjunctivitis, the majority 55/72 (76%) was seen mostly in children and only 17/72 (24%) were adults. The majority 58/72 (80%) of the respondents were living in dust places while 14/72 (19.4%) were not living in a dust place. The majority 48/72 (66.7%) of the respondents agreed that environmental allergen exposure was a factor contributing to allergic conjunctivitis while the least 24/72 (33.3%) disagreed. On the weather condition of the respondents, the majority 53/72 (73.6%) agreed while 19/72 (26.4%) disagreed that weather conditions could not bring about allergic conjunctivitis among patients. The majority, 43/72 (59.7%) of the respondents agreed that occupational exposure was also contributing to allergic conjunctivitis and the least 29/72 (40.3%) disagreed. Regarding airborne irritants, the majority, 52/72 (72.2%) of respondents agreed that it is a factor that contributes to allergic conjunctivitis among patients while the least disagreed 20/72 (27.8%) disagreed. Conclusion Children have been found to have a higher prevalence compared to adults, which can be attributed to factors such as immature immune systems, increased exposure to allergens, and higher susceptibility to environmental triggers. Recommendations: Environmental Control Measures should be put in place to reduce exposure to environmental triggers such as dust, pollen, and airborne irritants. This should include regular cleaning and dusting of living spaces, using air purifiers, minimizing outdoor activities during high pollen seasons, and avoiding exposure to known irritants or allergens.

Trends of aeroallergen sensitization among children with respiratory allergy in Southern Thailand

Background: Respiratory allergy significantly impacts children’s health and quality of life, with inhaled allergens serving as prevalent triggers for respiratory symptoms. Aeroallergen sensitization, confirmed through the skin prick test (SPT), naturally evolves over time and is influenced by environmental factors specific to each region. Objective: This study aimed to review the updated 6-year trend of aeroallergen sensitization among children with asthma and allergic rhinitis in Southern Thailand. Methods: This retrospective study involved a review of patients aged ≤15 years diagnosed with asthma and/or allergic rhinitis, who underwent the SPT using 12 standardized aeroallergens. Results: The medical records of 1,393 children were reviewed, with 63% being male, and the mean age was 7.4 ± 3.3 years. Among them, 55.5% presented with allergic rhinitis alone, followed by 31.6% with asthma and allergic rhinitis, and 12.9% with asthma alone. Over the 6-year period, house dust mites emerged as the most common sensitized allergen, followed closely by cockroaches, maintaining a consistent trend of sensitization. Dermatophagoides pteronyssinus ranked as the predominant sensitized allergen across all diagnoses (63% in asthma with allergic rhinitis, 52.7% in allergic rhinitis, and 43.5% in asthma). Children diagnosed with both asthma and allergic rhinitis exhibited a higher prevalence of sensitization to house dust mites, cockroaches, Johnson grass, acacia, Candida albicans, and cat pelts compared with those with asthma or allergic rhinitis alone. Additionally, the prevalence of house dust mite and cockroach sensitization was notably higher in older children (≥5 years old) with respiratory allergies. Conclusion: House dust mites and cockroaches emerge as the 2 most prevalent sensitized aeroallergens among children diagnosed with asthma and/or allergic rhinitis, exhibiting consistent trends of sensitization over the past 6 years. The persistence of these causative allergens underscores the importance of meticulous environmental control measures for children affected by respiratory allergies.

An Analysis and Research on Ways to Enhance the Identification of Traditional Chinese Culture in the Context of Cross-Cultural Communication

Any nation can only establish cultural self-confidence and national self-confidence by scrupulously abiding by its own cultural identity. A nation without cultural identity and cultural self-confidence is difficult to survive and develop in the increasingly fierce international competition. Cultivating and establishing cultural identity and cultural self-confidence is the cornerstone of a nation's development and progress. At present, we are facing a crisis of Chinese traditional cultural identity. In the current cross-cultural communication context, it is our urgent task to speed up the establishment of the Chinese traditional cultural identity. There are two ways to enhance the Chinese traditional cultural identity. Most of the epidemics from the 19th century to the 20th century were caused by the health environment, such as plague, cholera, and smallpox. To this end, Macau promulgated a series of environmental improvement systems, such as the "Urban Improvement Report" in 1883, the "Epidemic Prevention Regulations" and the "Epidemic Prevention Regulations" in 1894, and the later improved "New Epidemic Prevention Regulations". A series of measures to improve the sanitation environment, such as streets, rebuilding old houses, building new toilets, cleaning houses, cleaning sewers and planting plants to improve climate and air. In addition, in response to the characteristics of different epidemics, corresponding environmental control measures have been made, such as installing rodent-proof siphons at sewers during the plague outbreak.

Unprecedented Rise of Mucormycosis in COVID-19 Patients: Urgent Need for Protocol Adaptation and Awareness in India – A Review

Mucormycosis, a rare fungal infection, has seen a concerning surge in incidence among COVID-19 patients in India. Unlike infectious diseases, Mucormycosis spreads through fungal spores ubiquitous in the environment. COVID-19 patients with diabetes are particularly susceptible, presenting symptoms such as headache, fever, eye pain, nasal congestion, and vision loss. Early diagnosis is crucial for successful treatment. Management involves a multidisciplinary approach, including antifungal medications like liposomal amphotericin-B and posaconazole. However, treatment challenges arise due to limited availability, high cost, and prolonged administration of these drugs. Monitoring blood glucose levels during steroid therapy and raising awareness among healthcare workers and patients are essential preventive measures. Improved ventilation and hygiene practices in hospitals can reduce the risk of exposure to fungal spores. Early detection and prompt treatment are vital in preventing severe outcomes of Mucormycosis. Public education and environmental control measures are essential to mitigate the increasing incidence of this life-threatening fungal infection.

Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies.

(1) Background: Aspergillus spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies, with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to enable the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals. (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematologic malignancies. The Medline, Cochrane, and Scopus databases were consulted, following the PRISMA and STROBE guidelines. (3) Results: Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. Neutropenia, fungal contamination, insufficient environmental control measures in hospital and home settings, length of hospital stay, and anemia, are identified as independent risk factors. We show that HEPA, LAF, and Plasmair® systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not significantly influence IA reduction in our study. (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for the latter. Studies should also be undertaken to evaluate the efficiency of environmental control measures against IA at patients' homes.

Distribution, Source, and Ecological Risk of Heavy Metals in Sewage Irrigation of Taiyuan, Shanxi Province, China.

The pollution of agricultural soil by heavy metals is a significant environmental issue that has a serious impact on human health and food security. This study focused on investigating the presence of heavy metal pollution in sewage-irrigated soils in Taiyuan city. A total of 110 soil samples were analyzed for the presence of As, Hg, Cd, Pb, Cr, Cu and Zn. The results showed that the concentrations of these metals ranged from 0.06 to 26.74 mg/kg for As, 0.00 to 0.84 mg/kg for Hg, 0.03 to 0.69 mg/kg for Cd, 44.32 to 100.09 mg/kg for Pb, 9.85 to 42.19 mg/kg for Cr, 13.38 to 53.72 mg/kg for Cu, and 42.77 to 145.47 mg/kg for Zn. The average concentrations of these metals were found to be below the risk values specified in the "Soil environmental quality (GB15618-2018)", except for As and Cd in three sampling points in Xiaodian District. The heavy metal pollution in these areas can be attributed to various sources, such as industrial activities, the use of fertilizers and pesticides, and the irrigation process. According to the geo-accumulation index, the agricultural soil in the Taiyuan irrigation area was found to be uncontaminated by Zn, Cr, Cu, and As, and lightly contaminated by Cd, Hg, and Pb. The Nemerow Pollution Index indicated that the soil at all sampling points exhibited a slight level of pollution. Moreover, the ecological risk assessment indicated that all heavy metals posed a slight level of pollution. The findings of this study provide a scientific basis for the development of effective policies and measures for soil environmental protection and pollution control.

Studies on the Prevalence Rate of Neoplastic Growth in Fish Johniuss Dussumieri (Valenciennes, 1833) of Karachi Coast Due to Polluted Sea Environment

Background: With the growing concern over the impacts of environmental pollution on marine life, this study addresses the critical issue of neoplastic growth in fish populations. The increasing prevalence of tumors in fish due to contaminated marine environments has raised alarms about ecosystem health and public health implications. Objective: The primary objective of this research was to assess the prevalence and seasonal variation of neoplastic growth in fish populations, particularly focusing on the impact of environmental pollution. Methods: Fish specimens were collected from various markets and examined for neoplastic growth. The study employed observational techniques, statistical analyses including ANOVA and Duncan's Multiple Range Test, and assessed seasonal variations from January 2019 to December 2022. Results: A total of 2,373 fish were examined, with 193 cases of neoplastic growth identified, indicating a substantial prevalence of tumors. The statistical analysis revealed significant variations in tumor prevalence, with a notable correlation to environmental factors. Conclusion: The study concludes that environmental pollution significantly impacts the prevalence of neoplastic growth in fish populations. This has profound implications for marine ecology and public health, emphasizing the need for effective environmental management and pollution control measures.

Prediction of air pollutant concentrations based on the long short-term memory neural network

In recent years, environmental problems caused by air pollutants have received increasing attention. Effective prediction of air pollutant concentrations is an important way to protect the public from harm. Recently, due to extreme climate and social development, the forest fire frequency has increased. During the biomass combustion process caused by forest fires, the content of particulate matter (PM) in the atmosphere increases significantly. However, most existing air pollutant concentration prediction methods do not consider the considerable impact of forest fires, and effective long-term prediction models have not been established to provide early warnings for harmful gases. Therefore, in this paper, we collected a daily air quality data set (aerodynamic diameter smaller than 2.5 µm, PM2.5) for Heilongjiang Province, China, from 2017 to 2023 and A novel Long Short-Term Memory (LSTM) model was proposed to effectively predict the situation of air pollutants. The model could automatically extract information of the effective time step from the historical data set and combine forest fire disturbance and climate data as auxiliary data to improve the model prediction ability. Moreover, we created artificial neural network (ANN) and permissive regression (support vector machine, SVR) models for comparative experiments. The results showed that the precision accuracy of the developed LSTM model is higher. Unlike the other models, the LSTM neural network model could effectively predict the concentration of air pollutants in long-term series. Regarding long-term observation missions (7 days), the proposed model performed well and stably, with R2 reaching over 88%.

Handling Externalities In Environmental Accounting at XYZ Hospital: A Perspective of Amanah Metaphors

This research aims to determine the handling of externalities and their implications for the implementation of environmental accounting at RSUD XYZ (XYZ Hospital) from the perspective of the amanah metaphor. The method used is qualitative research with a case study approach at XYZ Hospital. Data was collected through observation, interviews, and documentation. Data validity was also tested using two types of triangulation. The results show XYZ's Hospital commitment to maintaining environmental balance and reducing the negative impacts of its operations by taking health, safety, and environmental control measures in accordance with Minister of Health Regulation No. 7 of 2019 concerning hospital environmental health. In terms of the application of environmental accounting, XYZ Hospital still does not specifically separate environmental burdens from supply and service burdens. From the perspective of amanah metaphors XYZ Hospital has fulfilled its responsibilities, including those of the trust giver, the trust recipient, and the trust itself.

Indoor Environmental Exposures and Their Relationship to Allergic Diseases.

Cockroach, dust mite, cat, dog, mouse, and molds are major indoor allergens that have been associated with the development of allergic diseases and disease morbidity in allergen-sensitized individuals. Physical characteristics, such as allergen particle size, hydrophobicity, and charge, can determine an allergen's propensity to become airborne, location of respiratory tract penetration, and ability to elicit IgE responses in genetically predisposed individuals. Standardization and recent advancements in indoor allergen assessment serve to identify sources and distribution of allergens in a patient's home and public environment, inform public policy, and monitor the efficacy of allergen avoidance and therapeutics. Allergen exposure interventions have yielded mixed results with current US and international asthma guidelines differing on recommendations. A pragmatic, patient-centered approach to allergen avoidance includes: (1) tailoring intervention to the patient's sensitization and exposure status, (2) using a rigorous multifaceted intervention strategy to reduce allergen exposure as much as possible, and (3) beginning the intervention as soon as the patient is diagnosed. Further research into the risks/benefits of early allergen exposure, rapid and affordable in-home allergen assessment, and best practices for environmental control measures for asthma is needed.

PM1 exposure and spatial transmission of nicotine from the simulated second-hand vapor of pod-based electronic cigarettes

Electronic cigarettes (E-cigarettes) have gained significant popularity in recent years as a substitute for combustible cigarettes. However, there is growing concern regarding the safety of E-cigarette products for both the users and those exposed passively to second-hand emissions, which contain nicotine and other toxic substances. In particular, the characteristics of second-hand PM1 exposure and the transmission of nicotine from E-cigarettes remain unclear. In this study, the untrapped mainstream aerosols from the E-cigarette and smoke from cigarettes were exhausted by the smoking machines which were operated under standardized puffing regimes to simulate second-hand vapor or smoke exposure. The concentrations and components of PM1 released from cigarettes and E-cigarettes were compared under varying environmental conditions and regulated using a heating, ventilation, and air conditioning (HVAC) system. Additionally, the ambient nicotine concentrations and the size distribution of the generated aerosols were determined at different distances from the release source. Results showed that PM1 accounted for the highest proportion (98 %) of the released particulate matter (PM1, PM2.5, and PM10). The mass median aerodynamic diameter (MMAD) of cigarette smoke (0.5 ± 0.01 μm, geometric standard deviation (GSD) 1.97 ± 0.1) was smaller than that of E-cigarette aerosols (1.06 ± 0.14 μm, GSD 1.79 ± 0.19). The PM1 concentrations and chemical components were effectively reduced when the HVAC system was utilized. Nicotine concentrations in E-cigarette aerosols were comparable to those of combustible cigarette emissions when close to the exposure source (0 m), while they declined more rapidly than cigarette smoke emissions with increasing distance from the source. Furthermore, the maximum nicotine concentrations occurred in 1 μm and 0.5 μm particles in E-cigarette and cigarette emissions, respectively. These results provide a scientific basis for the assessment of E-cigarette and cigarette aerosol passive exposure risks, guiding the development of environmental and human health control measures for these products.

COVID-19 outbreak in an acute psychiatric unit—Unique challenges and creative solutions

Background: We describe the management of a major COVID-19 outbreak in January 2022 during the SARS-CoV-2 omicron-variant winter surge involving the only inpatient psychiatric facility of Santa Clara County, California, which serves a population of 1.9 million. Methods: On January 14, 2022, infection prevention staff were notified of a symptomatic COVID-19 case in our locked inpatient psychiatric unit who had been admitted since October 2021. The index patient had no visitors or transfers outside the unit. The patients in this unit were noncompliant with masking and mingled with each other during meals. Initial testing identified 23 positive cases among 47 patients and 12 staff cases. Mitigating actions included closing the unit to new admissions, creating alternate care areas in the emergency psychiatric unit, and separating patients into “exposed but negative” and “infected” cohorts and housing them in “red,” and “yellow” zones, respectively. A “green” zone was created by clearance of positive cases. For the cohort exposed to COVID-19, masking was enforced by supervision, dining was scheduled in batches, and daily symptom screening and antigen testing were performed in addition to standard postexposure RT-PCR testing on day 4 and day 7. Mandatory N95 respirators and eye protection were implemented for staff on unit entry. Exposed staff followed employee health protocols for postexposure testing. Enhanced environmental control measures included terminal cleaning and UV-C disinfection of common areas and patient rooms and a thorough investigation of airflow. Discharged patients were contacted if they were residing in congregate facilities. Results: Of 47 patients, 39 (83%) tested positive for COVID-19. However, 8 patients remained negative; all 8 had received at least their primary vaccine series (Table 1). In total, 16 HCWs were SARS-CoV-2 positive in this outbreak. The outbreak officially ended 25 days after the first case. All SARS-CoV-2–positive patients had mild illness, not requiring treatment or hospitalization. We identified vaccine immune escape, staff presenteeism, patient noncompliance with masking, and comingling as major causes of transmission. We determined through contact tracing and temporality that the outbreak likely started from a positive staff member or visitor because most patients had been long-term residents. Conclusions: This outbreak was challenging due to the specialized behavioral needs of the involved patients. It was imperative to reopen this unit quickly and safely to provide psychiatric care to our county’s most vulnerable patients. Ongoing PPE education, repeated reinforcement, engagement in staff wellness to combat pandemic fatigue, and aggressive vaccination are all crucial to minimizing the impact of future outbreaks.Disclosures: None

Managing the risks of an asbestos bulk storage facility at a research institute.

The South African National Institute for Occupational Health (NIOH), formerly the Pneumoconiosis Research Unit, has previously milled about 544 kg of anthophyllite, crocidolite, amosite and chrysotile asbestos fibre materials. This endeavour came about in an attempt to address a recommendation, made by the International Union Against Cancer (UICC), to make asbestos standard reference samples available for research. Some of these reference samples, as well as the bulk, unprocessed materials are still within the care of the NIOH and can be obtained for the purpose of Public Health research under strict terms and conditions. Considering the hazardous nature of asbestos and regulated prohibitions imposed on this mineral, the NIOH asbestos storage facility is being subjected to various occupational and environmental control measures to ensure that any potential fibre release, and subsequent risk of exposure, are prevented.

Salt enrichment and its deterioration in earthen sites in Emperor Qin’s Mausoleum Site Museum, China

Salt enrichment in the topsoil, owing to one-way migration of moisture from earthen sites to air environment, is an important inducement to weathering of sites and relics, such as efflorescence, recess, slice-peeling, which becomes the most important challenge to the preservation of unearthed sites and relics. Further, salt enrichments in the topsoil of undulating earthen sites are usually inhomogeneous such that it is difficult to precisely prevent the deterioration from happening of salt enrichment in the topsoil. A case study of salt enrichment at the K9901 funerary pit of Emperor Qin’s Mausoleum Site Museum was conducted by soil column experiment and numerical simulation. The water and salt transport in the earthen sites were simulated and analyzed by HYDRUS software. The simulation of the salt enrichment process at the earthen sites demonstrated that the enrichment of soluble salt ions mainly occurs on the surface of rammed earth and increases annually; the salt damage at the earthen sites can be effectively delayed by taking an environmental control measure. These results provide a reference for the prevention of salt damage at earthen sites and facilitate the daily management of earthen sites.

Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures.

The spreading of multidrug resistance (MDR) strains in the hospital settings via contaminated surfaces have been increasingly reported where Gram-negative bacteria have been implicated in causing most nosocomial infections. This study aimed to determine the rate of contamination with multi-resistant gram-negative bacteria in the hospital environment. A cross-sectional study was conducted at Muhimbili National Hospital paediatric department, between July and August 2020. Non-repetitive surface swab samples were collected from predefined surfaces and medical device surfaces, and cultured on MacConkey agar with and without antibiotics. Isolates were identified using biochemical test and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method. The rate of hospital contamination with Gram-negative bacteria across the Pediatrics units was 30%, with a high rate observed in oncology units (34.8%) and the malnutrition/diarrhoea ward (32.1%). Sink/washing basin had the highest frequency of bacterial contamination (74.2%). We observed a high rate of ESBL (32.5%), with Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli being the predominant ESBL-producing Gram-negative bacteria, while carbapenemase-producing Gram-negative bacteria was detected at 22.8%. Highest resistance rates (63-100%) were observed against ceftriaxone and trimethoprim-sulfamethoxazole. Up to 51% of the Gram-negative bacteria showed resistant to meropenem. MDR strains were detected in 61.4% of Gram-negative bacteria isolated. In conclusion, we observed a high rate of MDR bacteria contaminating hospital surfaces. The higher rate of MDR calls for a need to strengthen infectious prevention control measures, including cleaning practices in the hospital environment, to reduce the risk of transmission of resistant strains to patients and healthcare workers.

Bacterial Community Characteristics Shaped by Artificial Environmental PM2.5 Control in Intensive Broiler Houses.

Multilayer cage-houses for broiler rearing have been widely used in intensive Chinese farming in the last decade. This study investigated the characteristics and influencing factors of bacterial communities in the PM2.5 of broiler cage-houses. The PM2.5 samples and environmental variables were collected inside and outside of three parallel broiler houses at the early, middle, and late rearing stages; broiler manure was also gathered simultaneously. The bacterial 16S rRNA sequencing results indicated that indoor bacterial communities were different from the outdoor atmosphere and manure. Furthermore, the variations in airborne bacterial composition and structure were highly influenced by the environmental control variables at different growth stages. The db-RDA results showed that temperature and wind speed, which were artificially modified according to managing the needs for broiler growth, were the main factors affecting the diversity of dominant taxa. Indoor airborne and manurial samples shared numerous common genera, which contained high abundances of manure-origin bacteria. Additionally, the airborne bacterial community tended to stabilize in the middle and late stages, but the population of potentially pathogenic bacteria grew gradually. Overall, this study enhances the understanding of airborne bacteria variations and highlighted the potential role of environmental control measures in intensive farming.

Using 14C of tree rings to study CO2 emissions from fossil sources at the sampling point of the Meteorological Tower in Beijing

Atmospheric fossil fuel CO2 information is an important reference for local government to formulate energy-saving and emission reduction in Beijing. We present a reconstruction of the fossil fuel CO2 mole fraction from 2007 to 2014 near the Beijing meteorological tower using AMS to measure 14C of cedar tree rings. The results show that the mole fraction of fossil fuel CO2 at the sampling point first decreased from 22.3 ± 0.7 ppm (2007) to 21.0 ± 0.9 ppm (2008), then increased to 22.5 ± 0.9 ppm (2010), and finally decreased to 18.7 ± 0.7 ppm (2014). This trend correlates (r = 0.958, p < 0.01) well with one third (May-August) of fossil source consumption of secondary industry in Beijing during 2007–2014. It is attributed to environmental policy programs and control measures at local scope in Beijing during 2007–2014. This study suggests that 14C measurements of tree rings by AMS provide an effective method to evaluate the effect of the environmental policies.

Effect of School Integrated Pest Management or Classroom Air Filter Purifiers on Asthma Symptoms in Students With Active Asthma: A Randomized Clinical Study

To determine if environmental control measures (1) school-wide integrated pest management (IPM) program and/or (2) use of high-efficiency particulate air (HEPA) filter purifiers in inner city elementary school classrooms would reduce asthma morbidity in students with active asthma.Forty-one inner city elementary schools in the Northeastern United States were recruited for this study. There were 236 students with active, physician-diagnosed asthma randomized to IPM (by school) and/or HEPA filter purifiers (by classroom). Physician-diagnosed asthma was defined as the child having had unscheduled doctor visits, hospitalization, corticosteroid bursts, symptoms, or controller medication use in the past year. Fifty seven percent of the children were Hispanic and 24% were Black. Mean age was 8.1 years, 48% female, mean FEV1 97% to 99.7% predicted at randomization. Forty-fifty percent of the children were using short acting β agonists alone and the rest were on inhaled corticosteroids and/or leukotriene modifiers. The study was conducted during the school years 2015 to 2020.All students with active physician-diagnosed asthma had a screening visit with questionnaires, skin testing, and spirometry as well as 2 follow-up visits with the same assessments during the year. Baseline environmental assessment for a panel of allergens (mouse, rat, dust mite, cockroach, cat, dog, Alternaria alternate, and Aspergillus fumigatus) were conducted at the schools by collecting a 1-week air sample, immediately followed by vacuum–settled dust samples from each students’ primary classroom and in the participants homes. The allergens were analyzed using a multiplex assay (MARIA, Indoor Biotechnologies). Follow-up environmental assessment after randomization took place once each winter and spring during the school year.The allocation to free standing classroom HEPA filter purifiers, active or sham, was blinded to the participants and those assessing the outcomes. The IPM program consisted of application of rodenticide, sealing entry points, trap placement, targeted cleaning, and brief educational handouts for the school staff. Infestation was assessed every 3 months and IPM reapplied as needed. Trained pest management specialists providing the school-wide IPM program were unblinded, but the student participants and trial investigators remained blinded throughout the trial.Four groups of 59 students each were randomized using a factorial design to either intervention alone, both interventions together, or neither for the entire school year. Classroom and home allergen and particle levels at randomization were balanced between the 4 groups.The asthma-related health outcomes of the students were assessed by parent survey at baseline and every 2 months until the end of the school year. The primary outcome was the number of symptom-days with asthma during a 2-week period assessed over the 10 months of randomization. Prespecified secondary outcomes were school absences, Composite Asthma Severity Index score, healthcare utilization, and spirometry measurements.Ninety eight percent of the classrooms had detectable levels of mouse allergen and 26% of the participants were sensitized to mouse allergen. More than 90% of baseline classroom allergen levels for cockroach, rat, Alternaria, Aspergillus and dust mite were undetectable.Use of the school-wide IPM program resulted in a mean of 1.5 symptom-days with asthma during a 2-week period versus 1.9 symptom-days for no IPM; use of HEPA filter purifiers resulted in a mean of 1.6 symptom-days with asthma versus 1.8 symptom-days for sham HEPA filter purifiers; neither comparison was statistically significant. Other prespecified secondary outcomes, including healthcare utilization or missed school days because of asthma also did not differ significantly between the intervention groups. The HEPA filter purifiers significantly reduced mouse and dog allergens in the classrooms. The IPM program did not significantly reduce concentrations of any of the allergens or particles measured. A post hoc exploratory analysis found a statistically significant association of reduction in asthma symptoms with the school wide IPM program but only for a limited time (mid-November to February).In an inner-city population of elementary school students with active asthma, use of a school-wide IPM program or HEPA filter purifiers in the classrooms did not significantly reduce symptom-days with asthma.It is possible that these children had asthma that was too mild to see a significant difference in these environmental interventions. Also unclear is whether resources to perform environmental control measures are best used at the school level or at home. As an accompanying editorial notes, “as allergen sensitization is related to the pathogenesis and pathophysiology of childhood asthma,” allergen avoidance should still be a basic tenet of treatment and worth continued investigation.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1001/jama.2021.11559

Distribution, historical variations, and geochemical fractions of toxic trace metals and their ecological risks in sediments of the Nanliu River Estuary, South China

In this study, the historical variation (210Pb dating) and distribution of toxic trace metals in sediments of the Nanliu River Estuary (NRE) were studied to understand the spatiotemporal variation therein and related risks. Geochemical fractions of trace metals (Pb, Cu, Cr, Zn, and Ni) were also analyzed using the fractionation technique. The results suggested that the concentrations of trace metals are higher in the western part of the estuary, and that Pb was significantly enriched. The NRE has experienced rapid economic development during the past four decades, but a decreasing trend of trace metals content after 2000 was observed. This may be due to effective implementation of national environmental control measures. Zn, Ni, Cr, Cu, and Pb in the surface sediments of the NRE exist mainly in residual form. The order of trace metals based on the risk assessment code (RAC) is Zn > Cu > Ni > Pb > Cr. According to enrichment factor (EF) and geo-accumulation index (Igeo) values, Hg, As, and Pb in the sediment of the NRE cause moderate levels of pollution and require attention. Based on the geochemical method, anthropogenic contributions of Cd, Zn, Pb, and Cu in the sediments of the NRE exceeded 50 % after 1980, possibly corresponding to the rapid industrial development and economic growth in the NRE resulting from the “reform and opening up”.

Healthcare Workers' Perception of Measures to Reduce the Risk of New Tuberculosis Infections: A Qualitative Study Report.

Tuberculosis, which is an infectious airborne disease remained the main leading cause of death in South Africa for three consecutive years from 2016 to 2018. In 2020 alone, the country had an estimated 328,000 people who suffered from TB, with 61,000 dying from it. Collins Chabane Municipality had 129 and 192 new TB cases recorded in 2017 and 2018, respectively, which is far from reaching the END TB STRATEGY targets. WHO scientific evidence demonstrates that TB control measures are effective in reducing the spread and development of new cases. Though scientific evidence revealed negative attitudes towards the recommended TB control measures in public hospitals of the Vhembe district, a deeper understanding of these attitudes is needed to remedy the situation. This study aimed to describe healthcare workers' perceptions of TB control measures at Collins Chabane Municipality in South Africa. A qualitative, exploratory case study design was adopted. Multi-stage sampling technique was used to select both the healthcare facilities and the participants. Only 24 healthcare workers trained on tuberculosis management were voluntarily recruited. However, data were saturated at the twelfth (12) participant purposively selected from six healthcare facilities of Collins Chabane Municipality. Data collected through unstructured in-depth individual interviews were analyzed thematically. The proposal for this study was ethically cleared by the University of Venda Ethics Committee (SHS/20/PDC/35/1111). Results indicate that TB administrative, environmental and respiratory control measures are well understood by health workers even though there are challenges with implementation concerning some, such as closing windows during winter, UVGI lights that are non-functional and taking too long to be fixed, no specimen collection during weekends and holidays thereby delaying TB diagnosis and lack of skills concerning how to use respirators and cough etiquette. The Vhembe district TB control programme should intensify infection control training and continue monitoring giving the needed support.