ABSTRACT
BACKGROUND: Early life exposure to air pollution can affect lung health. Previous studies have not assessed the implications of both pre- and postnatal exposure to air pollutants on lung function at repeated ages during childhood. In addition, there is the need to identify potential mediators of such effect. OBJECTIVES: To longitudinally assess the association between pre- and postnatal air pollution exposure and lung function during childhood. We also aimed to explore the role of Club cell secretory protein (CC16) as a potential mediator in this association. METHODOLOGY: We included 487 mother-child pairs from the INMA (INfancia y Medio Ambiente) Sabadell birth cohort, recruited between 2004 and 2006. Air pollution exposure was estimated for pregnancy, pre-school age, and school-age using temporally adjusted land use regression (LUR) modelling. Lung function was measured at ages 4, 7, 9 and 11 by spirometry. At age 4, serum CC16 levels were determined in 287 children. Multivariable linear regression models and linear mixed modelling were applied, while considering potential confounders. RESULTS: Prenatal exposure to Particulate Matter (PM)10 and PMcoarse had the most consistent associations with reduced lung function in cross-sectional models. Associations with postnatal exposure were less consistent. Increasing CC16 levels at 4 years were associated with an increase in FEF25-75 (ß = 120.4 mL, 95% CI: 6.30, 234.5) from 4 to 11 years of age. No statistically significant associations were found between pre- or postnatal air pollution and CC16 at age 4. CONCLUSION: Increasing levels of air pollution exposure, particularly prenatal PM10 and PMcoarse exposure, were associated with a reduction in lung function. We were not able to confirm our hypothesis on the mediation role of CC16 in this association, however our results encourage further exploration of this possibility in future studies.
Subject(s)
Air Pollutants , Air Pollution , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/adverse effects , Air Pollution/analysis , Birth Cohort , Child, Preschool , Cross-Sectional Studies , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Female , Humans , Lung , Particulate Matter/analysis , Particulate Matter/toxicity , PregnancyABSTRACT
Background: Acute psychiatric inpatient care is recommended for people with borderline personality disorder (BPD) to manage a crisis. Qualitative research exploring service user experience is valuable for the development of evidence-based treatment guidelines. Aim: To conduct a meta-synthesis of qualitative research exploring the experiences of people with BPD on acute psychiatric inpatient wards. Methods: Literatures searches of five electronic databases. Data were analysed using a three-stage theme identification process. Results: Eight primary studies and three first-hand accounts met the inclusion criteria. Four overarching themes were found to explain the data: contact with staff and fellow inpatients; staff attitudes and knowledge; admission as a refuge; and the admission and discharge journey. Conclusions: Similar experiences of acute psychiatric inpatient care were reported by people with BPD across the studies. Opportunities to be listened to and to talk to staff and fellow inpatients, time-out from daily life and feelings of safety and control were perceived as positive elements of inpatient care. Negative experiences were attributed to: a lack of contact with staff, negative staff attitudes, staff's lack of knowledge about BPD, coercive involuntary admission and poor discharge planning.
Subject(s)
Borderline Personality Disorder/psychology , Hospitals, Psychiatric , Inpatients/psychology , Mental Health Services , Attitude of Health Personnel , Borderline Personality Disorder/therapy , Humans , Nurse-Patient Relations , Patient Admission , Patient Discharge , Professional-Patient Relations , Psychiatric Aides/psychology , Qualitative ResearchABSTRACT
Why should health care systems in the United States engage with the world's poorest populations abroad while tremendous inequalities in health status and access are pervasive domestically? Traditionally, three arguments have bolstered global engagement: (1) a moral obligation to ensure opportunities to live, (2) a duty to protect against health threats, and (3) a desire to protect against economic downturns precipitated by health crises. We expand this conversation, arguing that US-based clinicians, organizational stewards, and researchers should engage with and learn from low-resource settings' systems and products that deliver high-quality, cost-effective, inclusive care in order to better respond to domestic inequities. Ultimately, connecting "local" and "global" efforts will benefit both populations and is not a sacrifice of one for the other.
