Evaluating complex interventions is complicated. The Medical Research Council9s evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance

https://www.bmj.com/content/bmj/337/bmj.a1655.full.pdf

Developing and evaluating complex interventions: The new Medical Research Council guidance

Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.

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Health effects of fine particulate air pollution: lines that connect

In 2004, the first American Heart Association scientific statement on “Air Pollution and Cardiovascular Disease” concluded that exposure to particulate matter (PM) air pollution contributes to card...

https://cdr.lib.unc.edu/downloads/p2676x621

Particulate Matter Air Pollution and Cardiovascular Disease An Update to the Scientific Statement From the American Heart Association

Air pollution is a heterogeneous, complex mixture of gases, liquids, and particulate matter. Epidemiological studies have demonstrated a consistent increased risk for cardiovascular events in relation to both short- and long-term exposure to present-day concentrations of ambient particulate matter. Several plausible mechanistic pathways have been described, including enhanced coagulation/thrombosis, a propensity for arrhythmias, acute arterial vasoconstriction, systemic inflammatory responses, and the chronic promotion of atherosclerosis. The purpose of this statement is to provide healthcare professionals and regulatory agencies with a comprehensive review of the literature on air pollution and cardiovascular disease. In addition, the implications of these findings in relation to public health and regulatory policies are addressed. Practical recommendations for healthcare providers and their patients are outlined. In the final section, suggestions for future research are made to address a number of remaining scientific questions.

https://cdr.lib.unc.edu/downloads/n870zt13s

Air Pollution and Cardiovascular Disease A Statement for Healthcare Professionals From the Expert Panel on Population and Prevention Science of the American Heart Association

INTRODUCTION Herein is the discussion of the 2006 A&WMA Critical Review1,2 on “Health Effects of Fine Particulate Air Pollution: Lines that Connect.” In the review, Drs. C. Arden Pope III and Douglas Dockery addressed the epidemiological evidence for the effects of particulate matter (PM) on human health indicators. The review documents substantial progress since the 1997 Critical Review3 in the areas of: (1) short-term exposure and mortality; (2) long-term exposure and mortality; (3) time scales of exposure; (4) the shape of the concentration-response function; (5) cardiovascular disease; and (6) biological plausibility. Invited and contributing discussants agree and disagree with points made in the review. Each discussion is self-contained and adds information relevant to the topic. Joint authorship of this article does not imply that a discussant subscribes to the opinions expressed by others. Commentaries are the opinions of the author only and do not necessarily reflect the positions of their respective organizations. In particular, Dr. Costa’s comments have not been reviewed by U.S. Environmental Protection Agency (EPA) and do not reflect official positions or policies of the agency. CRITICAL REVIEW DISCUSSION ISSN 1047-3289 J. Air & Waste Manage. Assoc. 56:1368–1380

Health effects of fine particulate air pollution: line that connect

Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study.

Objective: General psychiatric bed numbers in Ireland have reduced markedly in recent decades. In other jurisdictions such reductions have been accompanied by increases in the prevalence rates of severe mental illness among prisoners. We examined variations in per capita provision of local psychiatric beds and community residential places in Ireland for associations with forensic psychiatric service utilisation.Method: All admissions via the courts and prisons to the national forensic psychiatry service during the years 1997-1999 were assigned to the appropriate health board. Forensic admission and bed utilisation rates were compared with measures of general psychiatric service provision.Results: There were 476 admissions via the criminal justice system during the study period (0.74% of all psychiatric admissions in Ireland). A disproportionate number came from the most urbanised area. There were fivefold differences in overall bed and hostel place allocation between Irish health boards. Combined general psychiatric beds were inversely correlated with forensic bed utilisation (Spearman r = -0.75, p = 0.013). These differences showed a strong inverse correlation with forensic service utilisation.Conclusions: General psychiatric services are relatively under-resourced in areas of greatest predicted need in Ireland. This is associated with increased use of forensic psychiatric services and may reflect accumulation of the mentally ill in Irish prisons.

Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes?

The following are the principal findings of this report: â?¢ In 1996 unskilled manual men were twice as likely to die as higher professional men (standardised ratio 122 versus 64). â?¢ In 1996 unskilled manual men were eight times more likely to die from an accidental cause than higher professional men (standardised ratio 136 versus 17). â?¢ In 1996 you were almost four times as likely to be admitted to hospital for the first time for schizophrenia if you were in the unskilled manual category than if you were a higher professional (standardised ratio of 130 versus 35). â?¢ In the early 1990s women in the unemployed socio-economic group were over twice as likely to give birth to low birth weight babies as women in the higher professional group (standardised ratio of 140 versus 66). â?¢ Persons with socio-economic group â?~unskilled manualâ?T have worse health than professional groups in all years and for all the conditions which are analysed in this report. â?¢ Persons with socio-economic group â?~unknownâ?T have consistently worse health than those in socio-economic group â?~unskilled manualâ?T. â?¢ The proportion of persons where socio-economic group is unknown is growing in each database. â?¢ Mortality seems to be worse in medium sized towns than in cities or in rural areas. â?¢ Data from the Perinatal Reporting System has not been published for eight years. â?¢ HIPE is of practically no use in making comment on socio-economic differences.

Inequalities in health in Ireland - hard facts.

Trends in mortality attributed to asthma in children (0–14 years) and young adults (15–44 years) and the age group 5–34 years were examined for the Republic of Ireland over the period 1970–91. Childhood mortality rates were low with no clear trend. A recent rise in asthma mortality was observed in the 5–34 year olds but not in the 15–44 year age group. More detailed examination of these rates revealed that the rise in mortality in the 5–34 year olds derived from the age band 25–34 years. This increase is masked in the 15–44 year age group by wide fluctuations in mortality in the age band 35–44 years. A similar discrepancy in asthma mortality trends for the 15–44 and 5–34 year age groups has been reported in Britain. Possible reasons for the recent rise in asthma mortality in the 25–34 year age group are discussed.

Secular trends in mortality from asthma in children and young adults: Republic of Ireland, 1970-91.

Alcohol consumption has increased in the Irish population in recent years. It is not known to what extent the student population has been affected by this increase. The aim of this study was to determine levels of alcohol consumption among undergraduates in one Irish university and identify changes in drinking patterns in the years 1992-1999. Information on alcohol use was obtained by anonymous self-completed questionnaire in a stratified random cross-faculty sample of undergraduates in 1992 and 1999. The CAGE questionnaire to determine problem drinking was included in both surveys. A statistically significant (p=0.01) drop in weekly alcohol consumption by males was found, although the proportion of male problem drinkers increased. Consumption for females remained the same. Findings are contrary to recent figures for drinking patterns in young Irish people in general. The fall in alcohol consumption in male students may be linked to improved male insight into the negative effects of alcohol or to the substitution of cheaper available substances.

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Hamish Sinclair

Papers

Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study.

Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes?

Inequalities in health in Ireland - hard facts.

Secular trends in mortality from asthma in children and young adults: Republic of Ireland, 1970-91.

Trends in alcohol consumption in undergraduate third level students: 1992-1999