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BACKGROUND AND AIM: Traffic-related ultrafine particle pollution near highways is associated with adverse health. Reducing exposure by use of portable air purifiers in homes is one approach to reducing this risk. However, the reaction of residents to having air purifiers in homes is not well studied. METHODS: Within the framework of our randomized crossover trial of air purifiers in homes near a major highway, we collected data about participants' use and reactions to air purifiers using questionnaires at their 30-day and 90-day home visits, recorded electricity consumption using HOBO monitors, and conducted structured interviews with participants. RESULTS: Nearly all 150 participants reported running the air purifiers virtually 24 h every day in both their living room and their bedroom in the prior month. The units' HOBO electricity use, from a subset of 45 participants, supported the participants' responses from the questionnaire. Approximately 80% of participants reported setting their air purifier on the medium setting. Tolerance to air purifier noise increased significantly between the 30-day and 90-day home visits, with approximately two thirds reporting not being bothered at all by the noise. The qualitative interviews in a subset of 26 participants yielded consistent responses to those from the questionnaires. Size of unit, airflow, and energy consumption were additional concerns that emerged during the interviews. CONCLUSIONS: Results from the questionnaires, HOBO data, and structured interviews all suggest participants had positive reactions towards the presence of in-home APs, and therefore may be receptive to using air purifiers in their homes on a regular basis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04279249 . Registered 09 October 2019.
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Filtros de Aire , Estudios Cruzados , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Contaminación del Aire Interior/prevención & control , Contaminación del Aire Interior/efectos adversos , Emisiones de Vehículos/prevención & control , Emisiones de Vehículos/análisis , Contaminación por Tráfico Vehicular/efectos adversos , Contaminación por Tráfico Vehicular/prevención & control , Encuestas y Cuestionarios , Vivienda , Material Particulado/efectos adversos , Material Particulado/análisis , Factores de Tiempo , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/prevención & control , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisisRESUMEN
BACKGROUND: While it is well-established that exposure to dampness or mold in homes negatively affects physical health, the association with mental health remains less well evidenced. As plausible psychosocial and biological pathways exist between dampness and mold exposure and poor mental health, a review of evidence is required. OBJECTIVE: This State-of-the-Science review sought to assess what is known about the mental health effects of dampness or mold exposure and identify gaps in the literature and priorities for further research. METHODS: A comprehensive search of electronic databases (MEDLINE, Embase, PsycInfo, Global Health, Web of Science, and Scopus) was conducted to identify relevant studies published from 2003 to 2023. Eligible studies included observational study designs such as cohort and cross-sectional studies. Target studies for review assessed the effect of dampness and/or mold on mental health outcomes. RESULTS: Of the 1,169 records retrieved, 19 studies met the inclusion criteria. The available evidence described positive associations between residential dampness/mold exposure and poor mental health. In adults, associations were observed for outcomes such as depression, stress, and anxiety, while for children, associations were observed for emotional symptoms and emotional dysregulation. DISCUSSION: Identified studies generally reported associations between exposure to dampness/mold in the home and poorer mental and emotional health. Given the methodological limitations present in the current evidence base, it is recommended that more research be conducted. https://doi.org/10.1289/EHP14341.
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Hongos , Vivienda , Salud Mental , Humanos , Humedad , Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminación del Aire Interior/estadística & datos numéricosRESUMEN
Background: Acute respiratory infection is an infectious illness caused by acute viral or bacterial infection. According to a 2018 WHO report, exposures to indoor and ambient air environmental pollution were contributing factors to a higher risk of respiratory problems following 7 million deaths of children under five globally. Housing conditions such as wall material, roof type, kitchen location, sanitation condition, and cooking fuel type are household-level predictors of acute respiratory disease among children under five years of age. Method: This research used EDHS-2016 secondary data, which are nationally representative. The data collection period was from January 18, 2016, to June 27, 2016. Among the 16,650 total surveys, 10,006 households that had children below 5 years of age. The outcome variable for this study was acute respiratory infection symptoms. Analyses were performed using STATA Version 17.1. The data were weighted before performing analysis to reinstate the representativeness of the sample. In the bivariable analysis, a p value <0.2 was used to screen for multivariable. Multicollinearity was checked using the variance inflation factor. Then, a multilevel multivariable regression model was used in this study for the analysis of acute respiratory infection symptoms and possible predictor variables. Variables with a p value <0.05 in multivariable regression analysis were considered statistically significant predictors. Results: Most (95.00%) households commonly used solid fuel for cooking, and household main construction materials: 81.44 and 91.03% of floors and walls of households were constructed with unprocessed natural materials, respectively. The prevalence of acute respiratory infection symptoms among children under five years of age was 7.955% (7.397, 8.551%). The findings indicated that acute respiratory infection symptoms among children under five years of age were significantly linked with the age of the children, diarrhea status, residence, region, fuel type, stool disposal, wall material, and floor material. Conclusion: Interventions should target modifiable factors such as proper stool disposal of the youngest child, informing the health effects of poor housing conditions such as improving wall and floor construction material to reduce acute respiratory infection symptoms among children under five years of age.
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Características de la Residencia , Infecciones del Sistema Respiratorio , Humanos , Infecciones del Sistema Respiratorio/epidemiología , Preescolar , Factores de Riesgo , Etiopía/epidemiología , Masculino , Femenino , Lactante , Características de la Residencia/estadística & datos numéricos , Modelos Logísticos , Vivienda/estadística & datos numéricos , Enfermedad Aguda , Contaminación del Aire Interior/efectos adversos , Contaminación del Aire Interior/estadística & datos numéricos , Recién Nacido , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/estadística & datos numéricosRESUMEN
OBJECTIVE: To investigate the black carbon (BC) pollution in the indoor air of typical residential houses in urban areas of Beijing, and to explore the relationship between indoor and outdoor BC concentrations as well as the main influencing factors. METHODS: The indoor and outdoor PM_(2.5) samples were collected simultaneously from 33 apartments in the urban areas of Beijing during both the heating season (January to March) and the non-heating season (June to August) in 2016. Subsequently, optical method were employed to analyze BC concentrations in PM_(2.5)samples. The Spearman correlation coefficient (r_s) and the indoor/outdoor (I/O) ratio of BC concentrations were both calculated to characterize the relationship between indoor and outdoor BC concentrations. The factors may influence indoor BC pollution was collected through a questionnaire, including the basic characteristics of the residential buildings and households, smoking, cooking, window opening behavior, the use of air conditioner or air purifier and so on. Additionally, a linear mixed-effects model or multiple linear regression model was applied to identify the main factors influencing the I/O ratio. RESULTS: The(M(P25, P75)) concentrations of indoor and outdoor BC for season-pooled analysis were2.84 (2.59, 3.26)µg/m~3 and 3.08 (2.90, 3.63)µg/m~3, respectively. There were significant seasonal differences in both indoor and outdoor concentrations (P<0.05), with higher levels observed during the heating season compared to the non-heating season. There was a strong correlation between indoor and outdoor BC (r_s=0.74). The correlation during the heating season (r_s=0.78) was stronger than that during the non-heating season (r_s=0.44). The â of I/O ratio was 0.90±0.11, with 93.5%(29/31)and 86.7%(26/30) of I/O ratios being less than 1 during the heating season and non-heating season, respectively. Statistical analysis also showed that outdoor BCconcentrations were significantly higher than indoors (P<0.05). In season-pooled analysis, the result of the linear mixed-effects model showed that window opening duration was the most important factor affecting the I/O ratio, explaining 21.3%of the total variation. The I/O ratio increased with longer window opening duration. In season-specific analysis, the characteristics of residential buildings (including building age and floor level) and window opening duration were the main factors affecting the I/O ratio during the heating season and non-heating season, respectively in 2016. CONCLUSION: Residents in the urban areas of Beijing experienced relatively high indoor levels of BCpollution, but lower than the outdoor concentration during the same period in 2016. The window opening and the characteristics of residential buildings were the most important factors affecting the I/O ratio of BC.
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Contaminantes Atmosféricos , Contaminación del Aire Interior , Monitoreo del Ambiente , Vivienda , Estaciones del Año , Hollín , Contaminación del Aire Interior/análisis , Beijing , Contaminantes Atmosféricos/análisis , Hollín/análisis , Humanos , Material Particulado/análisis , Población Urbana , Encuestas y Cuestionarios , CalefacciónRESUMEN
INTRODUCTION: There is a complex relationship between housing status and substance use, where substance use reduces housing opportunities and being unhoused increases reasons to use substances, and the associated risks and stigma. METHODS: In this descriptive analysis of people without housing who died of accidental substance-related acute toxicity in Canada, we used death investigation data from a national chart review study of substance-related acute toxicity deaths in 2016 and 2017 to compare sociodemographic factors, health histories, circumstances of death and substances contributing to death of people who were unhoused and people not identified as unhoused, using Pearson chi-square test. The demographic distribution of people who died of acute toxicity was compared with the 2016 Nationally Coordinated Point-In-Time Count of Homelessness in Canadian Communities and the 2016 Census. RESULTS: People without housing were substantially overrepresented among those who died of acute toxicity in 2016 and 2017 (8.9% versus <1% of the overall population). The acute toxicity event leading to death of people without housing occurred more often in an outdoor setting (24%); an opioid and/or stimulant was identified as contributing to their death more frequently (68%-82%; both contributed in 59% of their deaths); and they were more frequently discharged from an institution in the month before their death (7%). CONCLUSION: We identified several potential opportunities to reduce acute toxicity deaths among people who are unhoused, including during contacts with health care and other institutions, through harm reduction supports for opioid and stimulant use, and by creating safer environments for people without housing.
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Vivienda , Personas con Mala Vivienda , Trastornos Relacionados con Sustancias , Humanos , Canadá/epidemiología , Femenino , Masculino , Vivienda/estadística & datos numéricos , Vivienda/normas , Adulto , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/mortalidad , Trastornos Relacionados con Sustancias/epidemiología , Personas con Mala Vivienda/estadística & datos numéricos , Adulto Joven , Adolescente , Anciano , Sobredosis de Droga/mortalidad , Sobredosis de Droga/epidemiologíaRESUMEN
Characterized by early construction periods, as the concentration of low-income populations and a high level of aging, affordable housing communities face prominent challenges such as incongruence between age-friendly construction and the needs of the older adult population. It is urgent to provide pathways and tools for identifying age-friendly issues and optimizing the built environment. The systematic evaluation of age-friendly communities serves as the foundation for implementing intervention measures by developers. Therefore, the construction of a scientifically systematic evaluation system becomes an objective necessity for age-friendly community development. Building upon existing research, this study systematically outlines the subjects, processes, methods, and content involved in constructing an age-friendly community evaluation system. By the methods such as factor analysis and analytical hierarchy process (AHP), the study focuses on the public spaces of affordable housing communities in Shenzhen as a case for constructing an age-friendly evaluation system. The empirical validation of the indicator system is conducted, and the application results are resulted into concrete improvement recommendations and action items, aiming to provide a practical, quantitative tool for community age-friendliness evaluation. The study reveals that adhering to an effective evaluation process, exploring collaborations among multiple stakeholders, determining hierarchical evaluation criteria, and adopting diversified evaluation methods are key to constructing an age-friendly evaluation system for communities. Additionally, the specificity of the evaluation system is influenced by regional demographic structures, policy backgrounds, and the built environment.
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Entorno Construido , Humanos , China , Anciano , Vivienda Popular , Planificación Ambiental , Características de la Residencia , Vivienda , Persona de Mediana Edad , MasculinoRESUMEN
Background People with Multiple Sclerosis (MS) have unique housing and support needs that are essential for maintaining independence at home; however, there is limited research to guide the design of community living options for this population. The aim of this study was to examine housing and support needs and preferences of people with MS with the intention to inform the planning of a co-designed intervention based on the study's findings. Methods Using the Knowledge to Action (KTA) framework, quantitative (n =79) and qualitative (n =6) data from people with MS were extracted and integrated from projects completed by the research team that explored the housing and support needs and preferences of people with disability. Results were synthesised and presented to a reference group for validation, contextualisation, and adaptation to the Australian context. Results High physical support needs were common across participants. People most commonly required home modifications to improve accessibility, such as ramps, equipment such as heating and cooling, and assistive technology. Many people required more than 8 hours per day of paid support. Moving into individualised housing facilitated independence and community reintegration. People reported gaps between what they wanted from support workers and what they received, citing individual and systemic barriers. Conclusion People with MS have support needs that require proactive and responsive funding arrangements, housing design and support provision. In line with KTA principles, findings will inform the planning of a co-designed intervention that involves people with lived experience of MS and other stakeholders to influence policy and improve home and living outcomes for this population.
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Vivienda , Esclerosis Múltiple , Humanos , Esclerosis Múltiple/terapia , Esclerosis Múltiple/psicología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Australia , Personas con Discapacidad/psicología , Personas con Discapacidad/rehabilitación , Vida Independiente , Anciano , Apoyo SocialRESUMEN
This cohort study assesses the performance of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) Z59 codes for identifying housing instability during health care encounters.
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Clasificación Internacional de Enfermedades , Humanos , Vivienda , Masculino , Femenino , Personas con Mala Vivienda/estadística & datos numéricos , Adulto , Persona de Mediana EdadRESUMEN
Background: Secondhand smoke exposure (SHSe) among youth is a serious public health concern, leading to an increased risk of conditions such as asthma and respiratory infections. However, there is little research on SHSe among vulnerable populations, such as racial and sexual minorities. Understanding the factors associated with youth SHSe in homes and vehicles is crucial to developing better protective policies. Methods: This study utilized 2020 data from the National Youth Tobacco Survey, a representative sample of middle- and high-school students in the US. The primary outcomes were youth SHSe at home and while riding in a vehicle. Multinomial regression models were used to assess factors associated with SHSe. Results: The data included 9,912 students enrolled in grades 6 through 12 in the United States who reported never using any form of tobacco. Non-Hispanic Black students living with someone who does not use any form of tobacco products were significantly more likely to experience moderate [OR = 2.1 (1.1-3.9), p = 0.03] and severe [OR = 5.1 (2.2-11.7), p < 0.001] secondhand smoke exposure (SHSe) in homes compared to their non-Hispanic White counterparts. Heterosexual female students had lower odds of reporting moderate SHSe in the home compared to heterosexual males [OR = 0.7 (0.6-0.99), p = 0.02], whereas bisexual females had two-fold increased odds of severe SHSe in homes [OR = 2.0 (1.2-3.4), p = 0.01]. Conclusion: Significant efforts are needed to develop targeted interventions to reduce SHSe in homes and vehicles, particularly in these vulnerable populations.
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Minorías Sexuales y de Género , Contaminación por Humo de Tabaco , Humanos , Contaminación por Humo de Tabaco/estadística & datos numéricos , Femenino , Masculino , Adolescente , Minorías Sexuales y de Género/estadística & datos numéricos , Estados Unidos/epidemiología , Niño , Encuestas y Cuestionarios , Estudiantes/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Minorías Étnicas y Raciales/estadística & datos numéricos , Disparidades en el Estado de SaludRESUMEN
People experiencing homelessness in crisis have unique structural vulnerabilities and social needs, most importantly lack of housing. Ideal crisis services for people experiencing homelessness must safeguard against criminalization and displacement during periods of crisis, prioritize equity, and provide housing interventions alongside mental health treatment at every stage in the crisis continuum. By outlining how to tailor crisis system financing and accountability, service component and capacity, and clinical best practices, the authors aim to provide hope and guidance for communities aiming to create an ideal crisis system for people experiencing homelessness.
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Personas con Mala Vivienda , Humanos , Servicios de Salud Mental , Intervención en la Crisis (Psiquiatría)/métodos , Trastornos Mentales/terapia , Vivienda , Política de SaludRESUMEN
BACKGROUND: Age, gender and household infrastructure are important social determinants affecting health inequalities. This study aims to assess the ways that age and gender of the household head and household infrastructure intersect to create relative advantage and disadvantage in COVID-19 vulnerability. METHODS: Using household primary care survey data from Mamelodi, Gauteng, headed households were sorted into three risk categories for each of the relevant infrastructural determinants of COVID-19. Bivariate ordinal logistic regression was used to determine the odds of households falling into each risk category. The proportion of high-risk (HR) categories and dwelling types was also calculated. RESULTS: Households headed by someone ≥ 65 years were less likely to be in all HR categories and more frequently had formal houses. Male-head households were more likely to be HR for water, sanitation and hygiene infrastructure and indoor pollution; however, female-headed households (FHHs) were at higher risk for crowding. In Mamelodi, households headed by ≥ 65 years olds were relatively infrastructurally protected, likely because of pro-equity housing policy, as were FHHs, except for crowding. The care load on FHHs results in their infrastructural protection benefiting more community members, while simultaneously incurring risk. CONCLUSION: Infrastructural support based on the household head's age and gender could improve targeting and the effectiveness of health interventions. These results demonstrate the importance of a contextual understanding of gender and age inequalities and tailoring public health support based on this understanding.Contribution: This research describes patterns of health-related infrastructural inequality, identifies ways to improve health interventions, and demonstrates the importance of equity-focused policy in an African context.
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COVID-19 , Composición Familiar , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Masculino , Anciano , Persona de Mediana Edad , Adulto , Factores Sexuales , Factores de Edad , SARS-CoV-2 , Determinantes Sociales de la Salud , Factores Socioeconómicos , Adulto Joven , Disparidades en el Estado de Salud , Adolescente , Vivienda/estadística & datos numéricosRESUMEN
BACKGROUND: Most individuals with severe mental illness (SMI) strongly prefer independent living over living in an institution. Independent Supported Housing (ISH) provides housing rehabilitation for persons with SMI in their accommodations. However, most individuals who need housing rehabilitation live in institutional housing settings (housing rehabilitation as usual: HAU). We investigated which housing rehabilitation setting is effective on which variable in the long term to support service users to form an informed preference for either housing rehabilitation setting. METHODS: We conducted a two-year longitudinal observational non-inferiority study to test the effectiveness of ISH in improving participants' social inclusion, quality of life, emotional social support, capabilities, symptom severity, functioning, service utilisation and costs. Participants were assessed at baseline and after six, twelve, and 24 months. Mixed effects models were computed to test between-group and within-group effects. RESULTS: The study included 83 participants in ISH (n = 31) and HAU (n = 52) housing rehabilitation settings with a mean age of 36.2 years. Most participants were male (64%) and had a primary psychotic or schizophrenic (35%) or an affective diagnosis (24%). During the study, ISH participants significantly improved their quality of life (ß = 0.54; 95% CI: 0.26 to 0.82), symptoms (ß = -0.32; 95% CI: -0.60 to -0.03), and capabilities (ß = 4.46; 95% CI: 0.14 to 8.77) and decreased psychiatric hospitalisations (p = 0.04). HAU participants improved their quality of life (ß = 0.40; 95% CI: 0.12 to 0.69). Housing and rehabilitation support costs were almost half with ISH than with HAU. CONCLUSION: ISH has been shown to be much less expensive than HAU and was associated with several improvements like reduced psychiatric hospitalisations and improved quality of life. Therefore, our findings strongly argue for a preference-driven provision of housing rehabilitation services and to end the institutionalisation of persons with SMI. TRIAL REGISTRATION: The study was registered on December 04, 2018, at ClinicalTrials.gov (NCT03815604).
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Trastornos Mentales , Calidad de Vida , Humanos , Masculino , Femenino , Estudios Longitudinales , Adulto , Calidad de Vida/psicología , Trastornos Mentales/rehabilitación , Vida Independiente , Persona de Mediana Edad , Vivienda/economía , Apoyo Social , Esquizofrenia/rehabilitaciónRESUMEN
Addressing housing insecurity contributes to health care programs as stable housing has positive health benefits. Home environmental hazards may reduce these potential health benefits and could increase morbidity for conditions such as asthma. This study examined housing and indoor air quality among urban low-income households in Colorado to inform housing-insecurity interventions. We conducted a community-engaged study among residents of motels, mobile homes, apartments, and single-family homes that included a survey on the home environment, health, and sociodemographic factors, spirometry, and indoor air quality measurement. We enrolled 60 households: 50% single-family homes, 37% apartments, and 13% residential motels. Perceived stress and depression were higher among motel residents compared with other housing types. We did not find differences in lung function by housing type. Indoor fine particulate matter (PM2.5) and black carbon concentrations were higher in motels than in other housing types. The differential health impacts of housing type support housing programs that jointly address security and quality.
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Contaminación del Aire Interior , Vivienda , Pobreza , Humanos , Femenino , Masculino , Vivienda/estadística & datos numéricos , Contaminación del Aire Interior/análisis , Adulto , Persona de Mediana Edad , Colorado , Material Particulado/análisis , Estado de Salud , Estrés PsicológicoRESUMEN
BACKGROUND: For transition-aged youth experiencing homelessness (TAYEH) moving to transitional housing, a motivational network intervention (MNI) may help modify high-risk networks, thereby reducing substance use and strengthening prosocial connections. METHODS: Thirty-six TAYEH received a four-session MNI integrated into usual housing case management or usual case management. Intervention acceptability, feasibility, and motivational interviewing fidelity were evaluated. RESULTS: Nearly all participants would recommend the MNI to others, formed goals, and believed the program improved their lives. Case managers delivered the program with fidelity. However, sample size and number of sessions delivered fell short of targets due to COVID-19 disruptions and other factors and limited our ability to examine preliminary effects on substance use and network outcomes in a fully powered trial. CONCLUSION: Case managers can successfully deliver the MNI, but its use may not be feasible unless adaptations are made to accommodate the instability this population faces when they enter housing.
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Entrevista Motivacional , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Adolescente , Adulto Joven , Manejo de Caso/organización & administración , Adulto , Personas con Mala Vivienda/psicología , Jóvenes sin Hogar/psicología , COVID-19/prevención & control , COVID-19/epidemiología , Motivación , Vivienda , Estudios de FactibilidadRESUMEN
In Canada, extreme heat occurrences present significant risks to public health, particularly for vulnerable groups like older individuals and those with pre-existing health conditions. Accurately predicting indoor temperatures during these events is crucial for informing public health strategies and mitigating the adverse impacts of extreme heat. While current systems rely on outdoor temperature data, incorporating real-time indoor temperature estimations can significantly enhance decision-making and strengthen overall health system responses. Sensor-based technologies, such as ecobee smart thermostats installed in homes, enable effortless collection of indoor temperature and humidity data. This study evaluates the efficacy of deep learning models in predicting indoor temperatures during heat waves using smart thermostat data, to enhance public health responses. Utilizing ecobee smart thermostats, we analyzed indoor temperature trends and developed forecasting models. Our findings indicate the potential of integrating IoT and deep learning into health warning systems, enabling proactive interventions, and improving sustainable health care practices in extreme heat scenarios. This approach highlights the role of digital health innovations in creating the resilient and sustainable healthcare systems against climate-related health adversities.
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Aprendizaje Profundo , Predicción , Canadá , Humanos , Calor Extremo , Calor , ViviendaRESUMEN
BACKGROUND: Eave spaces are major entry points through which malaria vectors enter houses. Interventions that target mosquitoes at the eaves have recently been developed. However, most of these interventions are based on insecticides for which resistance has been reported. Here we evaluated the efficacy of mosquito electrocuting eave tubes (MEETs) against Anopheles gambiae sensu stricto (An. gambiae s.s.) and Anopheles funestus s.s. under semi-field conditions. METHODS: Experiments were conducted in two semi-field chambers, each containing one experimental hut. Six electrocuting eave tubes were installed in each hut to assess their impact on laboratory-reared An. gambiae s.s. and An. funestus s.s.. Each species was assessed separately over 10 nights by releasing 200 unfed females per night into each chamber. One volunteer slept in each hut from 7 p.m. to 5 a.m. Mosquitoes were collected indoors and outdoors using mouth and Prokopack aspirators. RESULTS: The placement of MEETs significantly reduced the nightly An. gambiae s.s. indoor and outdoor biting, by 21.1% and 37.4%, respectively. Indoor-biting An. funestus s.s. were reduced by 87.5% while outdoor-biting numbers of An. funestus s.s. declined by 10.4%. CONCLUSIONS: MEETs represent a promising tool for controlling mosquitoes at the point of house entry. Further validation of their potential under natural field conditions is necessary. Several advantages over insecticide-based eave tubes are indicated and discussed in this article.
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Anopheles , Control de Mosquitos , Mosquitos Vectores , Animales , Anopheles/fisiología , Control de Mosquitos/métodos , Control de Mosquitos/instrumentación , Tanzanía , Femenino , Mosquitos Vectores/fisiología , Humanos , Malaria/prevención & control , Malaria/transmisión , Vivienda , Insecticidas/farmacologíaRESUMEN
BACKGROUND: Housing is an important wider determinant of health. Private Rented Sector (PRS) housing is generally the worst quality of housing stock across tenures. Although a wide range of interventions are available to local governments to manage and improve the quality of PRS housing and therefore the health of tenants, there is limited evidence about the extent to which these are used. This study aims to explore what drives the use of different interventions in different local governments, to better understand and inform local strategies. METHODS: As the first realist evaluation on this topic, the range of available interventions was informed by a Local Government Association toolkit. Consistent with realist approaches, retroductive analysis of intervention-context-mechanism-outcome configurations helped to develop and refine Initial Programme Theories (IPTs). Data sources included local government housing documents, a survey and eleven semi-structured interviews with housing officers. RESULTS: Using data for 22 out of the 30 local governments in the South West region of the United Kingdom, eight IPTs were developed which act on different levels from individual PRS team leaders to system wide. The IPTs include a belief in market forces, risk adverse to legal challenge, attitude to enforcement, relational approaches to partnership working, job security and renumeration, financial incentives drive action, and system-level understanding of the drivers of poor health, inequalities and opportunities for cost-savings. The findings suggest that limited objective health outcomes are being used to understand impact, which hinders interpretation of the effectiveness of all mechanisms. CONCLUSION: Interventions that bring about positive outcomes in managing PRS housing are unlikely to be universal; they depend on the context which differs across place and over time. The proposed IPTs highlight the need for strategies to be tailored considering the local context and should be evaluated in subsequent phases of study.
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Vivienda , Gobierno Local , Humanos , Reino Unido , Vivienda/normas , Sector Privado , Evaluación de Programas y Proyectos de SaludRESUMEN
BACKGROUND: Modern housing has been shown to reduce the risk of malaria infections compared to traditional houses; however, it is unclear if the effects differ in different malaria transmission settings. This study evaluated the effects of modern housing on malaria among different endemic areas. METHODS: Electronic databases, clinical trial registries and grey literature were searched for randomized controlled trials, cohort studies, case-control studies, and cross-sectional surveys on housing done between 1987 and 2022. Forest plots were done, and the quality of evidence was assessed using the Grading of Recommendations, Assessments, Development and Evaluation Framework. RESULTS: Twenty-one studies were included; thirteen were cross-sectional, four were case-control and four were cohort studies. Cohort studies showed an adjusted risk ratio of 0.68 (95% CI 0.48-0.96), and cross-sectional studies indicated an adjusted odds ratio (aOR) of 0.79 (95%CI 0.75-0.83). By endemic transmission regions, the adjusted odds ratio in the high endemic settings was 0.80 (95%CI 0.76-085); in the moderate transmission regions, aOR = 0.76 (95%CI 0.67-0.85) and in the low transmission settings, aOR = 0.67 (95%CI 0.48-0.85). CONCLUSIONS: The evidence from observational studies suggests that there are no differences in the protective effects of modern houses compared to traditional houses on malaria by endemicity level. This implies that good quality modern housing protects against malaria regardless of the malaria transmission settings.
Asunto(s)
Vivienda , Malaria , Vivienda/estadística & datos numéricos , Malaria/prevención & control , Malaria/transmisión , Malaria/epidemiología , Humanos , Enfermedades Endémicas/estadística & datos numéricos , Enfermedades Endémicas/prevención & control , Estudios TransversalesRESUMEN
All humans are exposed to radon, the primary source of natural radiation, which can harm people due to natural processes rather than human activity. Thus, it is of significant importance to determine the levels of radon in indoor, soil gas, water, and outdoors. Radon concentration (CRn) was measured in Kiraz district, Izmir, and the correlation between the indoor and soil gas CRn values was investigated. The indoor CRn values measured in 40 randomly selected dwellings in Kiraz exhibited a wide range from 19.50 ± 2.50 to 204.70 ± 8.00 Bq m-3 with an average value of 61.11 ± 4.23 Bq m-3. The measured indoor CRn values were compared to the reference levels in the world to help control radon in the dwellings. Indoor CRn values were lower than the ICRP reference level of 300 Bq m-3 in all of the dwellings studied. Furthermore, in 34 dwellings (representing 85% of the total number of dwellings studied), indoor CRn values were lower than the WHO reference level of 100 Bq m-3. Health hazard indices, namely annual effective dose (AED) and excess lifetime cancer risk (ELCR), were also calculated for each dwelling and compared with internationally acceptable levels to estimate the risk to human health. The AED values varied from 0.49 ± 0.06 to 5.16 ± 0.20 mSv y-1 with an average value of 1.54 ± 0.11 mSv y-1, which exceeds the world average of 1.15 mSv y-1 as reported by UNSCEAR. The ELCR values ranged from 2.05 ± 0.26 × 10-3 to 21.55 ± 0.84 × 10-3 with an average value of 6.43 ± 0.44 × 10-3, exceeding the world average of 0.29 × 10-3 as reported by UNSCEAR. The soil gas CRn values measured exhibited a wide variation ranging from 129.25 ± 6.38 Bq m-3 to 6172.64 ± 44.06 Bq m-3 with an average value of 1291.79 ± 18.70 Bq m-3. The soil gas CRn values were less than 10,000 Bq m-3; hence, the research area is categorized as "low radon risk areas" according to Sweden Criteria, and so no special constructions are required in the studied area. When soil gas CRn values were compared to indoor CRn values, no linear relationship was found between the CRn values. However, a strong positive linear correlation was found between indoor and soil gas CRn values less than 200 Bq m-3 and 2500 Bq m-3, respectively.