Current day concentrations of ambient air pollution have been associated with a range of adverse health effects, particularly mortality and morbidity due to cardiovascular and respiratory diseases. In this review, we summarize the evidence from epidemiological studies on long-term exposure to fine and coarse particles, nitrogen dioxide (NO2) and elemental carbon on mortality from all-causes, cardiovascular disease and respiratory disease. We also summarize the findings on potentially susceptible subgroups across studies. We identified studies through a search in the databases Medline and Scopus and previous reviews until January 2013 and performed a meta-analysis if more than five studies were available for the same exposure metric.
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It is likely that subject characteristics might explain part of the variability of air pollution effect estimates across studies where subgroup analyses are limited by power to detect differences. Hence, further research is required to study the effects of air pollution on women, smokers, obese participants, and diabetes mellitus with better measurement of the exposures. Gene-environment interactions have been shown for the (short-term) air pollution effects on inflammation markers [44, 45] Inflammation likely plays an important role in the mechanism of cardiovascular events [3, 4]. Gene-environment interactions have not yet been studied in the framework of mortality cohort studies.
A further important issue is for which period exposure is characterized. Air pollution data may not be available for the entire follow-up period. As an example in the ACS study, PM2.5 data were available at the start and end of follow-up [18]. When significant (often downward) trends in pollution occur with changing (often decreasing) spatial contrasts in the study, bias may occur in the estimated association between pollution and mortality. The follow-up study from the Harvard Six City study [14] and two studies in potentially at-risk populations [54, 55] suggested that the relevant exposure for cardiovascular effects may be the exposure in the past few years. These authors conclude that it does not take decades to bridge the gap between the short- and long-term exposure effect estimates, consistent with the effect of intervention studies showing reductions in mortality in the year after the intervention [54, 55]. These studies [54, 55] have made use of long-term temporal contrast within cities adjusting for secular trends. PM effect estimates were similar to the previously discussed studies exploiting spatial contrasts.
Two studies have reported significant associations between particulate matter air pollution and dysrhythmia, heart failure and cardiac arrest combined [39, 60]. These results are based upon smaller numbers of events, and require large cohort studies for further verification. The results are consistent with several studies documenting significant associations between short-term PM or NO2 exposure and mortality due to heart failure and dysrhythmia and defibrillator discharges [4, 80].
Our review suggests several specific research questions. Research into the reasons for the heterogeneity of effect estimates would be extremely useful for health impact assessment. Better exposure assessment including spatially resolved outdoor exposures and more chemically speciated PM might in part be able to resolve the observed heterogeneity. Chemical speciation would allow assessing particles from different sources e.g. particles from combustion sources and non-tailpipe emissions separately, a question clearly relevant for air pollution control policy. Specific attention to motorized traffic emissions is important because (road) traffic is an important source of ambient air pollution. More work on coarse particles and at the other side of the particle size spectrum, ultrafine particles is needed. Ongoing new research in the USA in the Multi-Ethnic study of Atherosclerosis and Air pollution (MESA-AIR) and the European Study of Cohorts for Air Pollution Effects (ESCAPE) that use large cohorts and state-of the art spatially-resolved exposure methods will likely contribute significant new answers in the near future to these questions.
Although more extensive IP provisions and longer monopoly periods are largely being driven by trade negotiations, most studies did not primarily examine trade agreements. Those that did, focused on US and EU trade agreements. This is not surprising given these jurisdictions are net exporters of medicines and therefore the most likely to seek TRIPS-plus IP provisions in trade agreements. The EU trade agreements studied included CETA and the EU-Andean FTA. The IP provisions in these EU trade agreements were found to have potential negative implications for access to medicines in Canada [22,23,24], Peru [37] and Columbia [38] by delaying the entry of generic competition and increasing pharmaceutical expenditure.
Clinic services, cost, and client demographic data were exported from Mobile Health Map website into Microsoft Excel. Aggregate client demographic information from the online impact and quality tools were uploaded to Qualtrics [15] and subsequently exported into Microsoft Excel. The estimated proportions across all clinics were derived from an unweighted mean of the estimate measurements provided by each individual clinic. For example, if clinic A reported that they served an estimated 50% Asian clients and clinic B estimated an average of 30% Asian clients, the reported average per clinic would be 40% Asian clients. This approach was used because the goal of the analysis was to provide averages across clinics with the clinic being the unit of observation, rather than summarizing data at the individual level. While the use of a weighted average was considered to give greater weight to clinics with higher volume, this type of analysis was not possible because only 168 of the clinics provided total patient volume. The number of clinics reporting on each variable differed and is depicted in the text, figured, and tables.
This study was supported by a Grant of the Korean Mental Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HM14C-2166-010,015). The funding body provided a financial support for the design of the study, literature reviews and writing the manuscript.
An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4%) had been reported by WHO. Meanwhile, several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human-to-human transmission, along with many exported cases across the globe. The clinical symptoms of COVID-19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
... the Spanish people have been engaged in a desperate struggle against a pitiless foe and have been exposed besides to the secret intrigues of the great imperialist powers of Europe. Despite this the Spanish revolutionaries have not grasped at the disastrous expedient of dictatorship, but have respected all honest convictions. Everyone who visited Barcelona after the July battles, whether friend or foe of the C.N.T., was surprised at the freedom of public life and the absence of any arrangements for suppressing the free expression of opinion.
On May 5, Companys obtained a fragile truce, on the basis of which the PSUC councilors were to retire from the regional government, and the question of the Telephone Company was left to future negotiation. That very night, however, Antonio Sesé, a UGT official who was about to enter the reorganized cabinet, was murdered. In any event, the Valencia authorities were in no mood to temporize further with the Catalan Left. On May 6 several thousand asaltos arrived in the city, and the Republican Navy demonstrated in the port.[83]
The fact that is concealed by the coalition of the Spanish Communist Party with the left Republicans and right wing Socialists is that there has been a successful social revolution in half of Spain. Successful, that is, in the collectivization of factories and farms which are operated under trade union control, and operated quite efficiently. During the three months that I was director of propaganda for the United States and England under Alvarez del Vayo, then Foreign Minister for the Valencia Government, I was instructed not to send out one word about this revolution in the economic system of loyalist Spain. Nor are any foreign correspondents in Valencia permitted to write freely of the revolution that has taken place.[111] 2ff7e9595c
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