World Health Organization Interim Research Articles

‘This smoke will finish us’: impacts of cooking with polluting fuels on air quality, health and education in three schools in Nairobi, Kenya

Links between cooking with polluting fuels (e.g. wood and charcoal), air pollution and health in domestic settings are well-established. However, few studies have been conducted in schools that rely on such fuels for catering. This study is the first investigation of air pollution, cooking, and health in schools in Nairobi, Kenya. We carried out an in-depth mixed-methods study in three schools (two primary schools and a college) in an informal settlement using wood and/or charcoal for catering. In each school, repeated 24-hour air pollution measurements (fine particulate matter (PM2.5) and carbon monoxide (CO)) were collected to assess concentrations in the main kitchen and a nearby classroom, in addition to personal exposure for the main cook. Surveys with catering staff collected data on perspectives on air pollution and health symptoms. Focus groups were conducted with catering staff, teachers and senior management to understand perceived impacts on health and the school environment. 24 hour levels of PM2.5 were found to surpass world health organization interim target level 1 (IT-1) (35 μg m−3) in all schools—with levels three times higher (107.6 μg m−3) in classrooms, ten times higher (316.2 μg m−3) in kitchens and nearly six times higher (200.9 μg m−3) among cooks. Peak levels of pollution were closely linked to times of stove use, as concentrations doubled in classrooms and tripled in kitchens during cooking. Catering staff reported being concerned about their health, and reported experiencing wheezing, chest pains, eye irritation and headaches and attempted to avoid the smoke to reduce exposure. Disturbance to classes from cooking smoke was reported by teachers, with students reporting coughing and sneezing from exposure. Support is needed to enable clean cooking transitions in schools to create a healthy and safe learning environment.

A spatial approach to assessing PM2.5 exposure level of a brickmaking community in South Africa

ABSTRACT Globally, particulate matter with an aerodynamic diameter of 2.5 µm or less poses a significant threat to human health. The first step in quantifying human health impacts caused by exposure to PM2.5 pollution is exposure assessment. Population-weighted exposure level (PWEL) estimation is one of the methods that provides a more precise exposure assessment since it incorporates the spatiotemporal distribution of population with the pollution concentration estimate. In this study, PM2.5 exposure levels in the local communities around brickmaking industries were investigated, using the population census data of the study area and 1-year data from nine PM2.5 monitoring stations installed in and around the brickmaking industries. The observed PM2.5 data was spatially interpolated using inverse distance weight (IDW). Data on PM2.5 levels across the study area were classified based on the World Health Organization interim target (IT) guidelines and the South African National ambient air quality standard (NAAQS). An annual PM2.5 population weighted exposure level of 27.6 µg/m3 was estimated for the study area. However, seasonal exposure levels of 28.9, 37.6, 26.5, and 20.7 µg/m3 were estimated for the autumn, winter, spring, and summer seasons, respectively. This implies that local communities around the brick kiln in the Vhembe District are exposed to high levels of PM2.5, especially in winter. The PM2.5 levels in the brickmaking industries as well as its other sources in the Vhembe District, therefore, need to be lowered. Findings from population exposure level to pollutants can provide valuable data for formulating policies and recommendations on exposure reduction and public health protection. Implications: PM2.5 concentration in any given environment has high spatial and temporal variability due to the presence of diffused sources in the environment. Using ambient air concentrations to directly estimate population exposure without taking into consideration the disproportionate spatial and temporal distribution of the pollutant and the population may not yield accurate results on human exposure levels. It is, therefore, important to assess the aggregated PM2.5 exposure of a populace within a given area. This study therefore examines the PM2.5 population-weighted-exposure level of the host communities of the brickmaking industry in Vhembe District, South Africa.

Association of Inflammatory Markers With Disease Progression and the Severity of COVID-19.

Introduction InDecember 2019, there was a massive outbreak of viral pneumonia, which had a high case fatality rate. Genetic sequencing of the virus showed similarity with severe acute respiratory syndrome coronavirus (SARS-CoV). It was later named novel coronavirus 2019 while the disease it caused was given the nomenclature of COVID-19. This deadly pneumonia outbreak was declared a pandemic by the World Health Organization (WHO). Aim To derive the strength of the correlation between blood levels of various inflammatory markers with the severity of COVID-19 pneumonia in patients affected with novel coronavirus 2019. Materials and methodology A prospective study was conducted on 300 confirmed cases of COVID-19 infection from August 2020 to July 2021 in SSG Hospital, Vadodara. Diagnosis of patients as confirmed cases of COVID-19 infection was done according to the WHO interim guidance for COVID-19. Their inflammatory markers were done for this study. All COVID-19-positive patients who had given negative consent for enrollment were excluded from the study. Patients were classified based on the severity of acute respiratory distress syndrome (ARDS). Comprehensive medical record information, encompassing biodata, clinical symptoms, comorbidities, and laboratory investigations, was systematically collected. Patients were given the standard treatment protocol as per guidelines. Patients were subjected to detailed investigations comprising complete blood counts and inflammatory markers like C-reactive protein (CRP), lactate dehydrogenase (LDH), serum ferritin, and D-dimer. Patients were further investigated by chest X-ray (posteroanterior view) or high-resolution computed tomography of the thorax. Results A total of 300 confirmed cases of COVID-19 infection were included in this study. Most of them were males (52%) with a mean age of 51 years and 48% were females with a mean age of 55 years. The majority of patients(40%) did not have ARDS, 23.3% of patients had mild, 16.7% of patients had moderate, and 20% of patients had severe ARDS. Higher CRP levels, serum ferritin, and serum D-dimer were significantly associated with the severity of COVID-19 infection as compared to those having no symptoms (p < 0.05). Increased levels were associated with severe clinical manifestations of COVID-19. The sensitivity of CRP is 69% and specificity is 100% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of ferritin is 88% and specificity is 81% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of D-dimer is 94% and specificity is 89% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of LDH is 93% and specificity is 84% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. Conclusions Current evidence from our study showed that higher levels of inflammatory markers such as CRP, LDH, D-dimer, and ferritin are associated with the severity of COVID-19 in terms of ARDS and thus could be used as significant prognostic factors of the disease.These indicators might support clinical decisions to identify highfatality casesand poor diagnosis in the initial admission phase.

Reconsidering gas as clean energy: Switching to electricity for household cooking to reduce NO2-attributed disease burden

Nitrogen dioxide (NO2) is a prevalent air pollutant in urban areas, originating from outdoor sources, household gas consumption, and secondhand smoke. The limited evaluation of the disease burden attributable to NO2, encompassing different health effects and contributions from various sources, impedes our understanding from a public health perspective. Based on modeled NO2 exposure concentrations, their exposure–response relationships with lung cancer, chronic obstructive pulmonary disease, and diabetes mellitus, and baseline disability-adjusted life years (DALYs), we estimated that 1,675 (655–2,624) thousand DALYs were attributable to NO2 in urban China in 2019 [138 (54–216) billion Chinese yuan (CNY) economic losses]. The transition from gas to electricity for household cooking was estimated to reduce the attributable economic losses by 35%. This reduction falls within the range of reductions achieved when outdoor air meets the World Health Organization interim target 3 and air quality guidelines for annual NO2, highlighting the significance of raising awareness of gas as a polluting household energy for cooking. These findings align with global sustainable development initiatives, providing a sustainable solution to promote public health while potentially mitigating climate change.

Sex-Specific Total Testosterone and Dehydroepiandrosterone Sulfate Status in Noncritically Ill Hospitalized Patients with Coronavirus Disease 2019: A Cross-Sectional Study.

In individuals with coronavirus disease 2019 (COVID-19), male subjects have consistently been linked to poor severity and prognosis. Data on sex hormones in non-critical COVID-19-infected patients are scarce. The aim of this study was to assess the status of total testosterone (TT) and dehydroepiandrosterone sulfate (DHEAS) among noncritical patients with COVID-19 according to sex and their associations with clinical and biochemical features. This cross-sectional observational study was done in the COVID-19 unit of a University hospital during the period of September 2021 to February 2022 among 91 adults (18-65 years) with reverse transcriptase- polymerase chain reaction confirmed noncritical COVID-19 patients. Blood was drawn by venipuncture before receiving steroids between 07:00 to 09:00 a.m. in a fasting state to measure serum TT and DHEAS by chemiluminescent microparticle immunoassay. Diagnosis and classification of COVID-19 were done according to World Health Organization's interim guidance. Age- and sex-specific laboratory reference values were used to classify the TT and DHEAS status of the patients. Only three males (8.1%) had low TT and the rest had normal TT. On the other hand, 15 (27.8%) of the females had high TT with normal levels in the rest. Similarly, 11 (29.7%) males had low DHEAS. Females had low, normal, and high DHEAS in four (7.4%), 48 (88.9%), and two (3.7%) cases respectively. Males with moderate severity of COVID-19 had significantly lower DHEAS (post hoc P=0.038) than the mild group. Both TT (P=0.008) and DHEAS (P=0.023) significantly correlated with neutrophils/lymphocytes ratio and only DHEAS with platelets/lymphocytes ratio (P=0.044) in males. In females, TT significantly correlated with serum sodium (P=0.034). In noncritical COVID-19 patients, substantial gender variations in TT and DHEAS were detected and correlated with severity markers in males.

Can the UK meet the World Health Organization PM2.5 interim target of 10 μg m−3 by 2030?

The recent United Kingdom (UK) Environment Act consultation had the intention of setting two targets for PM2.5 (particles with an aerodynamic diameter less than 2.5 μm), one related to meeting an annual average concentration and the second to reducing population exposure. As part of the consultation, predictions of PM2.5 concentrations in 2030 were made by combining European Union (EU) and UK government’s emissions forecasts, with the Climate Change Committee’s (CCC) Net Zero vehicle forecasts, and in London with the addition of local policies based on the London Environment Strategy (LES). Predictions in 2018 showed 6.4% of the UK’s area and 82.6% of London’s area had PM2.5 concentrations above the World Health Organization (WHO) interim target of 10 μg m−3, but by 2030, over 99% of the UK’s area was predicted to be below it. However, kerbside concentrations in London and other major cities were still at risk of exceeding 10 μg m−3. With local action on PM2.5 in London, population weighted concentrations showed full compliance with the WHO interim target of 10 μg m−3 in 2030. However, predicting future PM2.5 concentrations and interpreting the results will always be difficult and uncertain for many reasons, such as imperfect models and the difficulty in estimating future emissions. To help understand the sensitivity of the model’s PM2.5 predictions in 2030, current uncertainty was quantified using PM2.5 measurements and showed large areas in the UK that were still at risk of exceeding the WHO interim target despite the model predictions being below 10 μg m−3. Our results do however point to the benefits that policy at EU, UK and city level can have on achieving the WHO interim target of 10 μg m−3. These results were submitted to the UK Environment Act consultation. Nevertheless, the issues addressed here could be applicable to other European cities.

COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries

BackgroundThe COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC).MethodsWe sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness.ResultsPlanning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability.ConclusionCountries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.

Breathing Room: Cleaner Fuels for Home Cooking in LMICs.

Breathing Room: Cleaner Fuels for Home Cooking in LMICs.

Impacts of the clean residential combustion policies on environment and health in the Beijing–Tianjin–Hebei area

The Chinese government has implemented a series of air pollution control measures in the residential combustion sector, especially in the Beijing–Tianjin–Hebei (BTH) area. The government launched the Three-year Action Plan for Winning the Blue Sky War in 2018. Cutting down the coal combustions in the residential sector has been highly addressed. To compare the environmental and health impacts, we set two scenarios: implementing the residential coal-switch policy and excluding the policy, through an integrated evaluation framework consisting of the GAINS IV Asia model and the IMED/HEL model. Results show that compared with the 2030 Baseline, emission of NOx, SO2, and PM2.5 in BTH would decline by 49.7 kt (3.8%), 216.2 kt (20.6%), and 199 kt (25.7%), respectively. Meanwhile, it leads to reductions of PM2.5 concentrations by 9.8 μg/m³ (19.9%), 3.1 μg/m³ (6.4%), 5.0 μg/m³ (10.7%) in Beijing, Tianjin, and Hebei, respectively. However, PM2.5 concentration in BTH would still exceed the World Health Organization Interim Target-1 of 35 μg/m3 by 2030. Carrying out the residential coal-switch policy can avoid 0.78 million morbidities (15.2%) and 0.01 million mortalities (5.6%) in BTH by 2030 compared to Baseline. Further, work time loss would decrease by 15.1% in 2030. The value of statistical life (VSL) of 9.58 billion USD (12.4%), 2.23 billion USD (3.8%), and 12.48 billion USD (6.6%) would be saved for Beijing, Tianjin, and Hebei by 2030. Regions with heavy pollution have benefited more from the clean residential combustion strategies and Hebei would account for 50.8%–62.3% of the total avoided health benefits in 2030. The benefit-cost ratio in Beijing is much higher than that in other regions. Implementing the residential coal-switch policies poses remarkable co-benefits on human health and the economy. This research lays a foundation for future environmental and health risks in other Chinese cities.

Associations of peak season ozone with blood pressure among older adults without hypertension in a high exposure country: evidence from the Chinese Longitudinal Healthy Longevity Survey from 2005 to 2018

BACKGROUND AND AIM: Evidence based on long-term prospective cohort studies is lacking to investigate the association between ambient ozone (O3) and blood pressure among older adults. We aim to evaluate the associations of peak season O3 with change of blood pressure in a long-term cohort study among older adults without hypertension. METHODS: We included 5940 older adults aged &amp;#x2265;65 years and with repeated measurements of blood pressure from 2005 to 2018 in 23 provinces of China, estimated monthly O3 exposures at 0.05 &amp;#xb0; ×0.05 &amp;#xb0; resolution were matched to each participant. Peak season O3 exposure was measured as the average from April to September. Outcomes include blood pressure measurements of SBP, DBP, PP and MAP. Linear mixed models were performed to evaluate the associations between O3 exposures and blood pressure. Natural splines were applied to explore the potential non-linear concentration-response associations. RESULTS: In this study, peak-season O3 ranges from 72.6 to 151.7 &amp;#x3bc;g/m3 in China. In fully adjusted model, per 10 &amp;#x3bc;g/m3 increase in peak season O3 was associated with increases of 2.46 mmHg (95% confidence interval [CI]: 1.85-3.06) in SBP, 2.46 mmHg (95%CI: 1.94-2.99) in PP and 0.74 mmHg (95%CI: 0.38-1.11) in MAP, but non-significant decrease in DBP. Female, ethnic minorities, and older adults who were not in marriage, underweight, with medium or low income levels were susceptible to O3 exposure. Non-linear curves indicated that the effect of O3 exposure on SBP, PP and MAP were monotone increasing, with faster increase in risk magnitude before WHO interim target 1 at 100 &amp;#x3bc;g/m3, but slow down thereafter. CONCLUSIONS: The study added evidence to support the World Health Organization interim targets for peak-season O3, however, lower interim targets should be set to maintain healthy blood pressure among populations in countries with high O3 concentrations. KEYWORDS:Ozone; blood pressure; older adult; cohort study

Health Rights of Prisoners and Prison Law Reforms during COVID-19 Pandemic in India

Background: The National Crime Record Bureau and the Prison Statistics India, 2020 report on the overcrowding and occupancy in jails has ripple effect on the spread of the COVID-19.The protection to health freedoms of detainees and prisoners reflected in the World Health Organization (WHO) Guidance on COVID-19 for Prisons and Detention, 2020. The Indian jails have congestion and inhabitance and prone to contagion disease. The COVID-19 has an expanding transmission among detainees in prisons, jails and detention homes. Objectives: The WHO Guidance on COVID-19 for Prisons and Detention, 2020 standardizes the essential instrument to manage the COVID-19 difficulties in penitentiaries and confinement homes. The direction secures the strength of detainees and convicts living in encased conditions. The ostensible purpose is to contain the COVID-19 disease from spreading to general population and release the under trials for the safe healthy conditions. Methodology: The methodology applied the canons of statutory interpretation of United Nations Principles of the Protection of Prisoners, 1982 and Basic Principles for the Treatment of Prisoners, 1990 alongside the Moscow Declaration on Prisons and Health, 2003 and Nelson Mandela Rules, 2015 in fostering the health equity and criminal justice during COVID-19 pandemic. The mandate of the WHO Interim Guidance on COVID-19 in Prisons and Other Places of Detention, 2020 is straight out in preventive and medicinal measures for the penitentiaries and confinement homes in the virus of COVID-19. Results: The paper tracks the salubrious results of the international legal norms and national precedents of High Courts and Supreme Court in heralding systemic prison reform. The compliance of WHO Interim Guidance on Preparedness, Prevention and Control of COVID-19 In Prisons and Other Places of Detention, 2020 cultivated robust criminal administration during COVID-19 pandemic and the lockdown in India. Conclusion: The judgment of High Courts and Supreme Court on prison reform during the COVID-19 pandemic in India has resulted in Health Rights of Prisoners and Prison Law Reforms during COVID-19 Pandemic in India. It also refurbished the medical services in correctional facilities and confinement homes in criminal justice system. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 893-900

Emission Sector Impacts on Air Quality and Public Health in China From 2010 to 2020.

Anthropogenic emissions and ambient fine particulate matter (PM2.5) concentrations have declined in recent years across China. However, PM2.5 exposure remains high, ozone (O3) exposure is increasing, and the public health impacts are substantial. We used emulators to explore how emission changes (averaged per sector over all species) have contributed to changes in air quality and public health in China over 2010–2020. We show that PM2.5 exposure peaked in 2012 at 52.8 μg m−3, with contributions of 31% from industry and 22% from residential emissions. In 2020, PM2.5 exposure declined by 36% to 33.5 μg m−3, where the contributions from industry and residential sources reduced to 15% and 17%, respectively. The PM2.5 disease burden decreased by only 9% over 2012 where the contributions from industry and residential sources reduced to 15% and 17%, respectively 2020, partly due to an aging population with greater susceptibility to air pollution. Most of the reduction in PM2.5 exposure and associated public health benefits occurred due to reductions in industrial (58%) and residential (29%) emissions. Reducing national PM2.5 exposure below the World Health Organization Interim Target 2 (25 μg m−3) would require a further 80% reduction in residential and industrial emissions, highlighting the challenges that remain to improve air quality in China.

High temporal and spatial resolution PM2.5 dataset acquisition and pollution assessment based on FY-4A TOAR data and deep forest model in China

Due to urbanization and industrialization, PM2.5 (particulate matter with a diameter less than 2.5 μm) pollution has become a serious environmental problem. The low spatial resolution and insufficient coverage of PM2.5 observation stations affect research on pollution causes and human health risks. With the launch of FY-4A, new generation of Chinese geostationary weather satellites, it is possible to obtain PM2.5 with high temporal and spatial resolution covering all China. In this study, FY-4A top-of-the-atmosphere reflectance data, meteorological factors, and geographic information were input into the deep forest (DF) model to obtain the hourly PM2.5 in China. The samples based 10-fold cross validation of DF with an hourly R2 of 0.83–0.88, and the root mean square error is 8.81–14.7 μg/m3, while the R2 of the 10-fold cross validation result based on sites was 0.77. The monthly (R2 = 0.98) and seasonal (R2 = 0.99) estimated results showed high consistency with the observations. Feature importance showed that the contribution of estimated features to the model varies with regions and seasons. Estimation results indicated the substantial spatiotemporal differences in PM2.5, and pollution was the highest between 09:00–10:00 and then gradually decreased. Regions with highest pollution of PM2.5 in China were mainly distributed in the Tarim Basin and Central China. The pollution assessment results in China indicated that: 1) In more than 80% of the winter days PM2.5 was higher than the World Health Organization interim target 3 (37.5 μg/m3); 2) The bimodal distribution of PM2.5 indicated that there are obvious differences in pollution between cities and suburbs; 3) In autumn and winter, the regions where population-weighted PM2.5 was higher than IT-3 were mainly in Beijing-Tianjin-Hebei, Central China, Guanzhong Plain, Sichuan Basin, and Yangtze River Delta. Our results showed that FY-4A has advantages of high resolution and coverage and thus shows great potential for estimating pollutants.

Establishment and Evaluation of a Prediction Model of BLR for Severity in Coronavirus Disease 2019

Abstract Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease and has spread worldwide. Clinical risk factors associated with the severity in COVID-19 patients have not yet been well delineated. The aim of this study was to explore the risk factors related with the progression of severe COVID-19 and establish a prediction model for severity in COVID-19 patients. Methods: We retrospectively recruited patients with confirmed COVID-19 admitted in Enze Hospital, Taizhou Enze Medical Center (Group) and Nanjing Drum Tower Hospital between January 24 and March 12, 2020. Take the Taizhou cohort as the training set and the Nanjing cohort as the validation set. Severe case was defined based on the World Health Organization Interim Guidance Report criteria for severe pneumonia. The patients were divided into severe and non-severe groups. Epidemiological, laboratory, clinical, and imaging data were recorded with data collection forms from the electronic medical record. The predictive model of severe COVID-19 was constructed, and the efficacy of the predictive model in predicting the risk of severe COVID-19 was analyzed by the receiver operating characteristic curve (ROC). Results: A total of 402 COVID-19 patients were included in the study, including 98 patients in the training set (Nanjing cohort) and 304 patients in the validation set (Nanjing cohort). There were 54 cases (13.43%) in severe group and 348 cases (86.57%) in non-severe group. Logistic regression analysis showed that body mass index (BMI) and lymphocyte count were independent risk factors for severe COVID-19 (all P &lt; 0.05). Logistic regression equation based on risk factors was established as follows: Logit (BL)=–5.552–5.473 × L + 0.418 × BMI. The area under the ROC curve (AUC) of the training set and the validation set were 0.928 and 0.848, respectively (all P &lt; 0.001). The model was simplified to get a new model (BMI and lymphocyte count ratio, BLR) for predicting severe COVID-19 patients, and the AUC in the training set and validation set were 0.926 and 0.828, respectively (all P &lt; 0.001). Conclusions: Higher BMI and lower lymphocyte count are critical factors associated with severity of COVID-19 patients. The simplified BLR model has a good predictive value for the severe COVID-19 patients. Metabolic factors involved in the development of COVID-19 need to be further investigated.

Emission mitigation pathways to achieve PM2.5 interim target III of the world health organization in the Pearl River Delta in 2035

By participating in the construction of China's Guangdong-Hong Kong-Macao Greater Bay Area (GBA) and as the core zone of the GBA, the region (PRD) aims to have the ambient air quality basically reaching the level of the world-class bay areas by 2035. In this study, we developed three scenario strategies (Moderate Scenario (SM), Intensified Scenario (SI) and Radical Scenario (SR)) for the PRD in 2035 taking the average annual PM2.5 concentrations in the PRD reaching the world health organization interim target 3 (WHO-III, 15 μg/m3) as the constraint standard. Under each scenario, we formulated the structural adjustment and end-of-pipe control measures to predict the development of industry, transportation and energy in the PRD in 2035. The results show that the total emissions of SO2, NOx, PM (Particulate Matters) and NMVOCs (Non-methane Volatile Organic Compounds) were 152, 511, 205 and 382kt in the SM scenario, respectively, and were 114, 436, 177 and 325kt in the SI scenario, respectively, while they are 77, 344, 143 and 269kt in the SR scenario, respectively. We also consider the emission reduction of pollutants outside the PRD. In this study, the SM, SI and SR scenarios were combined with different national scenario inventories (DPEC) in 2035 and the WRF-CMAQ model was used to simulate these scenarios. The simulation results show that annual average concentrations of PM2.5 in the PRD under the SM-DPEC1, SI-DPEC2 and SR-DPEC3 scenarios were expected to reach 15.1, 14.6 and 14.8 μg/m3, respectively, which just meet the WHO-III standard. In the process of achieving WHO-III target in the future, the government and policy makers can match the most suitable scenario in the study by referring to the actual decline of air pollutant emissions in the main contributing regions outside the PRD under each scenario, so as to obtain the best feasible control strategy in the PRD.

Air pollution scenario over Pakistan: Characterization and ranking of extremely polluted cities using long-term concentrations of aerosols and trace gases

Pakistan ranks third in the world in terms of mortality attributable to air pollution, with aerosol mass concentrations (PM2.5) consistently well above WHO (World Health Organization) air quality guidelines (AQG). However, regulation is dependent on a sparse network of air quality monitoring stations and insufficient ground data. This study utilizes long-term observations of aerosols and trace gases to characterize and rank the air pollution scenarios and pollution characteristics of 80 selected cities in Pakistan. Datasets used include (1) the Aqua and Terra (AquaTerra) MODIS (Moderate Resolution Imaging Spectroradiometer) Level 2 Collection 6.1 merged Dark Target and Deep Blue (DTB) aerosol optical depth (AOD) retrieval products; (2) the CAMS (Copernicus Atmosphere Monitoring Service) reanalysis PM1, PM2.5, and PM10 data; (3) the MERRA-2 (Modern-Era Retrospective analysis for Research and Applications, Version 2) reanalysis PM2.5 data, (4) the OMI (Ozone Monitoring Instrument) tropospheric vertical column density (TVCD) of nitrogen dioxide (NO2), and VCD of sulfur dioxide (SO2) in the Planetary Boundary Layer (PBL), (5) the VIIRS (Visible Infrared Imaging Radiometer Suite) Nighttime Lights data, (6) MODIS Collection 6 Version 2 global monthly fire location data (MCD14ML), (7) population density, (8) MODIS Level 3 Collection 6 land cover types, (9) AERONET (AErosol RObotic NETwork) Version 3 Level 2.0 data, and (10) ground-based PM2.5 concentrations from air quality monitoring stations. Potential Source Contribution Function (PSCF) analyses were performed by integrating with ground-based PM2.5 concentrations and the NOAA (National Oceanic and Atmospheric Administration) HYSPLIT (Hybrid Single-Particle Lagrangian Integrated Trajectory) air parcel back trajectories to identify potential pollution source areas which are responsible for extreme air pollution in Pakistan. Results show that the ranking of the top polluted cities depends on the type of pollutant considered and the metric used. For example, Jhang, Multan, and Vehari were characterized as the top three polluted cities in Pakistan when considering AquaTerra DTB AOD products; for PM1, PM2.5, and PM10 Lahore, Gujranwala, and Okara were the top three; for tropospheric NO2 VCD Lahore, Rawalpindi, and Islamabad and for PBL SO2 VCD Lahore, Mirpur, and Gujranwala. The results demonstrate that Pakistan's entire population has been exposed to high PM2.5 concentrations for many years, with a mean annual value of 54.7 μg/m3, over all Pakistan from 2003 to 2020. This value exceeds Pakistan's National Environmental Quality Standards (Pak-NEQS, i.e., <15 μg/m3 annual mean) for ambient air defined by the Pakistan Environmental Protection Agency (Pak-EPA) as well as the WHO Interim Target-1 (i.e., mean annual PM2.5 < 35 μg/m3). The spatial analyses of the concentrations of aerosols and trace gases in terms of population density, nighttime lights, land cover types, and fire location data, and the PSCF analysis indicate that Pakistan's air quality is strongly affected by anthropogenic sources inside of Pakistan, with contributions from surrounding countries. Statistically significant positive (increasing) trends in PM1, PM2.5, PM10, tropospheric NO2 VCD, and SO2 VCD were observed in ~89%, ~67%, ~48%, 91%, and ~ 88% of the Pakistani cities (80 cities), respectively. This comprehensive analysis of aerosol and trace gas levels, their characteristics in spatio-temporal domains, and their trends over Pakistan, is the first of its kind. Results will be helpful to the Ministry of Climate Change (Government of Pakistan), Pak-EPA, SUPARCO (Pakistan Space and Upper Atmosphere Research Commission), policymakers, and the local research community to mitigate air pollution and its effects on human health.

High-sensitivity cardiac troponin I and D-dimer are risk factors for in-hospital mortality of adult patients with COVID-19: A retrospective cohort study

Aim: This study aimed to evaluate the impact of high-sensitivity cardiac troponin I (Hs-cTnI) and D-dimer on in-hospital mortality of adult patients with Coronavirus disease 2019 (COVID-19). Materials and Methods: The COVID-19 outbreak, a global health disaster, has resulted in significant morbidity and mortality around the world since it emerged in December 2019. The outbreak has gradually spread nationwide. COVID-19 is associated with hemostatic abnormalities and cardiac injury. This retrospective cohort study included a total of 221 adult inpatients. The diagnosis of COVID-19 was made according to the World Health Organization's interim guideline and confirmed by RNA detection of SARS-CoV-2. Participants were divided into 2 groups, survivors and non-survivors. Results: Hs-cTnI and D-dimer levels on admission were significantly higher in non-survivors COVID-19 patients (p&amp;lt;0.05 for each). Forward stepwise logistic regression analysis demonstrated that age (OR=1.140, 95% CI: 1.045-1.244, p=0.003), baseline hs-cTnI level (OR=1.022, 95% CI: 1.004-1.041, p=0.018), and baseline D-dimer level (OR=1.790, 95% CI: 1.078-2.972, p=0.024) were independent predictors of in-hospital mortality of adult patients with COVID-19. The receiver operating characteristic curve analysis provided a cut-off value of &amp;gt;18.6 ng/L for hs-cTnI to predict in-hospital mortality of adult patients with COVID-19 with 100% sensitivity and 74% specificity, and a cut-off value of &amp;gt; 1.41 mg/L for D-dimer with 93.3% sensitivity and 71.5% specificity. Conclusion: High-sensitivity cardiac troponin I and D-dimer levels on admission predict in-hospital mortality of adult patients with COVID-19.

COVID \u2013 19 related knowledge and preventive practices early in the outbreak among health care workers in selected public health facilities of Illu aba Bor and Buno Bedelle zones, Southwest Ethiopia

BackgroundNovel-coronavirus 2019 (COVID-19) disease is currently a worldwide health risk and public health emergency concern. The virus is transmitted from an infected person to another person through close contact and droplets. Frontline health care workers are the most at risk of infection, and so a WHO interim guidance document was issued by the World Health Organization (WHO) which underscores the importance of proper sanitation and waste management practices for COVID- 19 in health-care settings. This study aimed at assessing knowledge and preventive practices towards Covid-19 among health care providers in selected health facilities of Illu Aba Bor and Buno Bedele zones, Southwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted from April to May 2020 among 330 health workers in selected health facilities of Illu Aba Bor and Buno-Bedelle Zones, Southwest Ethiopia. Data were collected using a self-administered structured questionnaire. The collected data were entered into Epidata version 3.1 and exported to SPSS version 23 for analysis. Bivariate and multivariable logistic regression analysis was used to identify independent predictors of preventive practices towards Covid-19. Statistical significance was declared at a p-value of < 0.05.ResultThe majority of respondents (93.3%) demonstrated good knowledge of COVID-19, and the mean (SD) knowledge score was 9.04 ± 1.06. Nearly two-thirds (64.2%) of the study participants had good infection prevention practices. Being male (AOR = 3.65, 95% CI: (1.96, 6.80)), education level (AOR = 1.82, 95% CI (1.02, 3.22)), profession (AOR = 3.17, 95% CI (1.08, 9.33)), service year (5–10 years) (AOR = 2.00 (1.02, 3.92)) and more than 10 years (AOR = 3.14 (1.51, 6.52)), availability of personal protective equipment (AOR = 1.96 (1.06, 3.61)) and Knowledge level (AOR = 2.61 (1.48, 4.62)) were independent predictors of COVID-19 preventive practices.ConclusionThe overall level of knowledge of HCWs was good. However, the practice was relatively low. Gender, educational status, profession, year of service, knowledge towards COVID-19, and availability of personal protective equipment were independent predictors of good infection prevention practices. Optimizing the infection prevention and control loop of the health facilities is recommended.

The clinical course of critically ill COVID-19 patients receiving invasive mechanical ventilation with subsequent terminal weaning: Primary data from 11 cases.

The coronavirus disease (COVID-19) outbreak was first reported in December 2019 in Wuhan, China. Specific information about critically ill COVID-19 patients receiving invasive mechanical ventilation (IMV) is rare.To describe the clinical course and complications of critically ill patients with COVID-19 who received IMV and were successfully weaned from it.This retrospective study included patients admitted to 3 intensive care units (ICUs) and 1 sub-ICU of Renmin Hospital of Wuhan University and Wuhan Jin Yin-tan Hospital between December 24, 2019, and March 12, 2020. Eleven patients who had been diagnosed with critically ill COVID-19 according to the World Health Organization interim guidance, received invasive ventilation, and were finally successfully weaned from it, were enrolled in our study. Their presenting symptoms, comorbidity conditions, laboratory values, ICU course, ventilator parameters, treatments, and relative complications were recorded.Of 108 critically ill COVID-19 patients who received invasive ventilation, 11 patients who underwent tracheal extubation or terminal weaning were included. The mean age of the 11 patients was 52.8 years (range, 38–70 years), 8 (72.7%) were male, and 2 were health care workers. The median time from onset of symptoms to dyspnea was 6.6 days (range, 3–13 days), and the median duration of IMV was 15.7 days (range, 6–29 days). All 11 patients presented with acute severe hypoxemic respiratory failure and received IMV, and 1 patient switched to extracorporeal membrane oxygenation assistance. A lung-protective strategy with lower tidal volume ventilation and proper driving pressure is the main strategy of IMV. All patients had extrapulmonary manifestations, including acute kidney injury, hepatic dysfunction, myocardial damage, and/or lymphopenia. Hospital-acquired infections occurred in 7 (63.6%) patients.Critical COVID-19 illness is characterized by acute hypoxemic respiratory failure and subsequent dysfunction of other organs with a high mortality rate. Correct ventilation strategies and other clinical strategies to improve oxygenation based on the skilled trained group and the availability of equipment are the key methods to rescue lives.

GENDER DIFFERENCES IN COVID-19 PATIENTS WITH ARTERIAL HYPERTENSION

Objective: To evaluate the gender differences in covid-19 patients with arterial hypertension. Design and method: This is a retrospective observational study comparing the association by gender of hypertensive status and with mortality among hospitalized patients with COVID-19. All patients admitted to our Hospitals, from 12 March to 12 April 2020 with confirmed COVID-19 were included in this study. Patients with COVID-19 included in this study were diagnosed according to World Health Organization interim guidance. Patients’ demographic characteristics and clinical data (symptoms, comorbidities, laboratory findings, and outcomes) during hospitalization were collected from electronic medical records. The primary endpoint was all-cause mortality by gender during hospitalization. Other endpoints included the time elapsed between onset of symptoms and discharge, the rates of use of invasive mechanical ventilation, and the differences by gender in the treatment. The diagnosis of hypertension was given by the patient's physician prior to the infection with SARS-CoV-2. Results: In total, 877 consecutive hospitalized patients with confirmed COVID-19 were enrolled in the study. The median time from symptom onset to hospitalization was 4.6 for men and 2.6 days for women (p &lt; 0.05). Among these patients, 58% had a medical history of hypertension (57% men and 46% for women), p &lt; 0.05. The spectrum of symptoms of COVID-19 at admission between the two cohorts did not differ significantly. A total of (15.0%) patients died in the hypertension cohort (14% for men and 16% for women; p ns) In particular, patients with hypertension had the propensity to develop more severe/critical COVID-19 disease (P for trend &lt; 0.001) and were more likely to receive invasive mechanical ventilation (P &lt; 0.001). Conclusions: Patients with COVID-19 and hypertension have been reported to have an increased risk of adverse outcomes. In particular female patients with hypertension require intensive care (16% vs 11% for men, p &lt; 0.05) but no differences by gender for mortality rate we report. As described above, these data showed that hypertensive patients are at the highest risk for outcomes adverse. To further verify our results, as well as this hypothesis, we have also designed a randomized controlled trial.