Acute respiratory infection risk associated with exposure to outdoor PM{{10}} emissions from domestic heating.

AIM: Woodsmoke exposure has known adverse respiratory health effects. However, most studies are based on exposure in developing countries or developed cities. Woodburners are commonly used for domestic heating in New Zealand, and in some areas they impact air quality. We investigated whether woodsmoke exposure at levels encountered in a mid-size township has health effects. METHOD: We performed a time-stratified case crossover analysis of 1,870 general practitioner (GP) visits for acute respiratory infections (ARI) over five consecutive winters (May-August 2014-2018). Daily air concentrations of particulate matter less than 10 µm (PM{{10}}) were obtained from a fixed-site monitoring station. Conditional logistic regression was used to estimate OR and 95% CI after adjusting for the effects of temperature. RESULTS: A 10 µg/m[[3]] increase in PM{{10}} concentration was associated with 8% (95% CI 1%-15%) and 20% (95% CI 4%-38%) increases in the odds of a GP visit for an ARI within 24 hours for women and girls, and Maori of both sexes, respectively. CONCLUSION: Woodsmoke pollution may negatively affect the respiratory health of residents in mid-size towns. However, those most affected by woodsmoke are also likely to be most affected by woodburner phase-out policies. Air quality and housing policies must be integrated to meet a mutual goal of improved health.

Risk of somatic hospitalization in parents after cancer in a child, a nationwide cohort study.

OBJECTIVE: The diagnosis of cancer in a child is a profoundly stressful experience. The impact on parents' somatic health, including lifestyle-related diseases, however, is unresolved. This paper assesses parents' risk of hospitalization with somatic disease after a child's cancer diagnosis. METHODS: We conducted a nationwide population- and register-based study with parents of all children under age 20 diagnosed with cancer in Denmark between 1998 and 2013 and parents of cancer-free children, matched (1:10) on child's age and family type. We estimated HR with 95% CI in Cox proportional hazard models for 13 major International Classification of Diseases-10 disease groups, selected stress- and lifestyle-related disease-groups, and investigated moderation by time since diagnosis, parental sex, and cancer type. RESULTS: Among n = 7797 parents of children with cancer compared with n = 74,388 parents of cancer-free children (51% mothers, mean age 42), we found no overall pattern of increased risk for 13 broad disease groups. We found increases in digestive system diseases (HR 1.06, 95% CI 1.01-1.12), genitourinary system diseases (HR 1.08, 95% CI 1.02-1.14), and neoplasms (HR 1.20, 95% CI 1.13-1.27), the latter attributable mostly to increased rates of tobacco-related cancers and mothers' diet-related cancers. CONCLUSIONS: This is the first attempt to document the impact of childhood cancer on parents' somatic health. With the exception of increased risk for neoplasms, likely due to shared genetic or lifestyle factors, our findings offer the reassuring message, that the burden of caring for a child with cancer does not in general increase parents' risk for somatic diseases.

Combining the best interest standard with shared decision-making in paediatrics-introducing the shared optimum approach based on a qualitative study.

Paediatric decision-making is the art of respecting the interests of child and family with due regard for evidence, values and beliefs, reconciled using two important but potentially conflicting concepts: best interest standard (BIS) and shared decision-making (SD-M). We combine qualitative research, our own data and the normative framework of the United Nations Convention on the Rights of Children (UNCRC) to revisit current theoretical debate on the interrelationship of BIS and SD-M. Three cohorts of child, parent and health care professional interviewees (Ntotal = 47) from Switzerland and the United States considered SD-M an essential part of the BIS. Their responses combined with the UNCRC text to generate a coherent framework which we term the shared optimum approach (SOA) combining BIS and SD-M. The SOA separates different tasks (limiting harm, showing respect, defining choices and implementing plans) into distinct dimensions and steps, based on the principles of participation, provision and protection. The results of our empirical study call into question reductive approaches to the BIS, as well as other stand-alone decision-making concepts such as the harm principle or zone of parental discretion.Conclusion: Our empirical study shows that the BIS includes a well-founded harm threshold combined with contextual information based on SD-M. We propose reconciling BIS and SD-M within the SOA as we believe this will improve paediatric decision-making. What is Known: • Parents have wide discretion in deciding for their child in everyday life, while far-reaching treatment decisions should align with the child's best interest. • Shared decision-making harbours potential conflict between parental authority and a child's best interest. What is New: • The best interest standard should not be used narrowly as a way of saying "Yes" or "No" to a specific action, but rather in a coherent framework and process which we term the shared optimum approach. • By supporting this child-centred and family-oriented process, shared decision-making becomes crucial in implementing the best interest standard.