Air pollution seems to be continuously in the news nowadays and popular media report on it almost every single day. In many cities worldwide, including London, UK, it has become a political topic as well. Despite the fact that we hear about air pollution all of the time, many are unaware of the real nature or magnitude of the threat, the health risks and opportunities to reduce personal exposure. In this article we summarise in lay terms the current knowledge about air pollution and what city dwellers can do to stay healthy in a polluted environment. This article aligns with a strategy to communicate scientific knowledge to patients, practitioners and the larger public. It complements the excellent work being done by the European Lung Foundation in the context of the "Healthy Lungs for Life" campaign (www.europeanlung.org/en/projects-and-research/ projects/healthy-lungs-for-life/ home). In March 2016 the European Respiratory Society/European Lung Foundation hosted a workshop in Brussels (Belgium) to discuss the available evidence and derive clear messages. This article contributes to this initiative. We will summarise those facts that are undisputed and those for which there seems to be a broad consensus among scientists. Those facts can help us to derive strategies to avoid air pollution exposure.
Although unprecedented sensitivity and specificity values are reported, recent glaucoma detection deep learning models lack in decision transparency. Here, we propose a methodology that advances explainable deep learning in the field of glaucoma detection and vertical cup-disc ratio (VCDR), an important risk factor. We trained and evaluated deep learning models using fundus images that underwent a certain cropping policy. We defined the crop radius as a percentage of image size, centered on the optic nerve head (ONH), with an equidistant spaced range from 10-60% (ONH crop policy). The inverse of the cropping mask was also applied (periphery crop policy). Trained models using original images resulted in an area under the curve (AUC) of 0.94 [95% CI 0.92-0.96] for glaucoma detection, and a coefficient of determination (R-2) equal to 77% [95% CI 0.77-0.79] for VCDR estimation. Models that were trained on images with absence of the ONH are still able to obtain significant performance (0.88 [95% CI 0.85-0.90] AUC for glaucoma detection and 37% [95% CI 0.35-0.40] R-2 score for VCDR estimation in the most extreme setup of 60% ONH crop). Our findings provide the first irrefutable evidence that deep learning can detect glaucoma from fundus image regions outside the ONH. ; Research Group Ophthalmology, KU Leuven; VITO NV; Flemish Government; European Commission
Chronic inflammation is an HIV infection feature, contributing to elevated risk of cardiovascular disease among people with HIV, which can be induced by viral replication. A proportion of antiretroviral therapy (ART) recipients fail to achieve viral suppression, despite not meeting criteria for treatment failure, so-called low-level viremia (LLV). We investigated the relationship between LLV and an array of cardiovascular measures and biomarkers. South Africans with LLV (viral load = 50-999 copies/mL) and virological suppression (viral load <50 copies/mL) were selected from the EndoAfrica study (all receiving efavirenz-based ART) for cross-sectional comparison of vascular structure and function measures, as well as 21 plasma biomarkers related to cardiovascular risk and inflammation. Associations were investigated with univariate, multivariate, and binomial logistic regression analyses (having outcome measures above (cases) or below (controls) the 75th percentile). Among 208 participants, 95 (46%) had LLV, and 113 (54%) had viral suppression. The median age was 44 years, 73% were women, and the median ART duration was 4.5 years. Cardiovascular measures and biomarker levels were similar between these two categories. Cardiovascular function and structure measures were not associated with viremia status and having LLV did not increase the odds of having outcome measures above the 75th percentile. In this study among South African ART recipients, LLV did not associate with cardiovascular risk. ; The EndoAfrica study received funding under the ERAfrica call in the EU 7th Framework Program. Funding was distributed by the Department of Science and Innovation in South Africa (contract number for North West: DSI/CON 0133/2016 and for Western Cape: DSI/CON 0077/2014), the Belgian Science Policy in Belgium (contract number BL/67/eranet03), and Österreichische Agentur für internationale Mobilitätund Kooperation in Bildung, Wissenschaft und Forschung, OeAD GmbH (ÖAD) in Austria (Grant number: KEF-Projekt P202). The Knut ...
Background: People from low- and middle-income countries are disproportionately affected by the global burden of adverse health effects caused by ambient air pollution (AAP). However, data from Sub-Saharan Africa (SSA) are still scarce. We systematically reviewed the literature to describe the existing knowledge on AAP and health outcomes in SSA. Methods: We searched PubMed, Medline-OVID, EMBASE and Scopus databases to identify studies of AAP and health outcomes published up to November 15, 2017. We used a systematic review approach to critically analyze and summarize levels of outdoor air pollutants, and data on health effects associated with AAP. We excluded occupational and indoor exposure studies. Results: We identified 60 articles, with 37 only describing levels of AAP and 23 assessing the association between air pollution and health outcomes. Most studies (75%) addressing the relation between AAP and disease were cross-sectional. In general, exposure data were only obtained for selected cities in the framework of temporary international collaborative research initiatives without structural long-term continuation. Measurements of AAP revealed 10-20 fold higher levels than WHO standards. Of the 23 studies reporting health effects, 14 originated from South Africa, and most countries within SSA contributed no data at all. No studies, except from South Africa, were based on reliable morbidity or mortality statistics at regional or country level. The majority of studies investigated self-reported respiratory symptoms. Children and the elderly were found to be more susceptible to AAP. Conclusion: AAP and its negative health effects have been understudied in SSA compared with other continents. The limited direct measurements of air pollutants indicate that AAP in SAA cities is high compared with international standards. Efforts are needed to monitor AAP in African cities, to identify its main sources, and to reduce adverse health effects by enforcing legislation. ; This research did not receive any specific grant from fundingagenciesinthepublic,commercial,ornot-for-profitsectors
Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region. ; This research was funded by the ERAfrica program of the EU 7th Framework Program (Grant number: IC-003), Department of Science and Technology in South Africa (Grant number: DST/CON 0077/2014), The Belgian Science Policy in Belgium (Grant number BL/67/eranet03), and the Osterreichische Agentur fur internationale Mobilitat und Kooperation in Bildung, Wissenschaft und Forschung, OeAD GmbH (OAD) in Austria (Grant number: KEF-Projekt P202). In addition, Frans Everson received a grant from Hasselt University in the context of BILA (bilateral) collaboration with Stellenbosch University (BOF16BL05).
Limited information on the effect of antiretroviral treatment (ART) on vascular function in South Africans of African descent living with human immunodeficiency virus (HIV) is available. The relationship between ART, vascular function and cardiovascular risk factors in South Africans of African ancestry with HIV was therefore studied. This cross-sectional study recruited 146 HIV-positive individuals on ART (HIV(+)ART(+)), 163 HIV-positive individuals not on ART (HIV(+)ART(-)) and 171 individuals without HIV (HIV-) in Mthatha, Eastern Cape Province of South Africa. Flow-mediated dilation (FMD) test was performed to assess endothelial function. Anthropometry and blood pressure parameters were measured. Lipid profile, glycaemic indices, serum creatinine as well as CD4 count and viral load were assayed in blood. Urinary albumin to creatinine ratio (ACR) was determined as a marker of cardiovascular risk. Obesity and albuminuria were positively associated with HIV, and HIV(+)ART(+) participants had significantly higher HDL cholesterol. Dyslipidaemia markers were significantly higher in hypertensive HIV(+)ART(+) participants compared with the controls (HIV(+)ART(-) and HIV- participants). FMD was not different between HIV(+)ART(+) participants and the controls. Moreover, HIV(+)ART(+) participants with higher FMD showed lower total cholesterol and LDL cholesterol comparable to that of HIV- and HIV(+)ART(-) participants. A positive relationship between FMD and CD4 count was observed in HIV(+)ART(+) participants. In conclusion, antiretroviral treatment was associated with cardiovascular risk factors, particularly dyslipidaemia, in hypertensive South Africans of African ancestry with HIV. Although, ART was not associated with endothelial dysfunction, flow-mediated dilatation was positively associated with CD4 count in HIV-positive participants on ART. ; The EndoAfrica-WSU study formed part of a broader consortium under the ERAfrica program of the European Union 7th Framework Program. Funding for this study was disbursed via the Department of Science and Innovation in South Africa (contract number DST/CON 0077/2014). PDB and NG received funding from the Belgian Science Policy in Belgium (grant number: BL/67/eranet03) and the Osterreichische Agentur fur internationale Mobilitat und Kooperation in Bildung, Wissenschaft und Forschung, OeAD GmbH (OAD) in Austria (grant number: KEF-Projekt P202), respectively. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ; Goswami, N (corresponding author), Med Univ Graz, Otto Loewi Res Ctr Vasc Biol Immunol & Inflammat, Physiol Div, Neue Stiftingtalstr 6,D-5, A-8036 Graz, Austria. bnkehchungag@wsu.ac.za; nandu.goswami@medunigraz.at; gengwa@wsu.ac.za; crusike@wsu.ac.za; vuyombo@gmail.com; iwebster@sun.ac.za; Patrick.DeBoever@uantwerpen.be; harald.kessler@medunigraz.at; evelyn.stelzl@medunigraz.at; jgstr@sun.ac.za
Background: Particulate matter (PM) exposure leads to premature death, mainly due to respiratory and cardiovascular diseases. Objectives: Identification of transcriptomic biomarkers of air pollution exposure and effect in a healthy adult population. Methods: Microarray analyses were performed in 98 healthy volunteers (48 men, 50 women). The expression of 8 sex-specific candidate biomarker genes (significantly associated with PM10 in the discovery cohort and with a reported link to air pollution-related disease) was measured with qPCR in an independent validation cohort (75 men, 94 women). Pathway analysis was performed using Gene Set Enrichment Analysis. Average daily PM2.5 and PM10 exposures over 2-years were estimated for each participant's residential address using spatiotemporal interpolation in combination with a dispersion model Results: Average long-term PM10 was 25.9 (± 5.4) and 23.7 (±2.3) µg/m3 in the discovery and validation cohorts, respectively. In discovery analysis, associations between PM10 and the expression of individual genes differed by sex. In the validation cohort, long-term PM10 was associated with the expression of DNAJB5 and EAPP in men and ARHGAP4 (p=0.053) in women. AKAP6 and LIMK1 were significantly associated with PM10 in women, although associations differed in direction between the discovery and validation cohorts. Expression of the 8 candidate genes in the discovery cohort differentiated between validation cohort participants with high vs low PM10 exposure (area under the receiver operating curve = 0.92; 95% CI: 0.85, 1.00; p=0.0002) in men, 0.86; 95% CI: 0.76, 0.96; p=0.004 in women). Conclusions: Expression of the sex-specific candidate genes identified in the discovery population predicted PM10 exposure in an independent cohort of adults from the same area. Confirmation in other populations may further support this as a new approach for exposure assessment, and may contribute to the discovery of molecular mechanisms for PM-induced health effects. ; The project was funded by the Environment, Nature and Energy Department of the Flemish government (LNE/OL201100023/13034/M&G), Steunpunt Milieu- en Gezondheid and European Research Council (ERC-2012-StG 310898). Karen Vrijens is a postdoctoral Fellow of the Research Foundation –Flanders (12D7714N).
Physical activity and ventilation rates have an effect on an individual's dose and may be important to consider in exposure−response relationships; however, these factors are often ignored in environmental epidemiology studies. The aim of this study was to evaluate methods of estimating the inhaled dose of air pollution and understand variability in the absence of a true gold standard metric. Five types of methods were identified: (1) methods using (physical) activity types, (2) methods based on energy expenditure, METs (metabolic equivalents of task), and oxygen consumption, (3) methods based on heart rate or (4) breathing rate, and (5) methods that combine heart and breathing rate. Methods were compared using a real-life data set of 122 adults who wore devices to track movement, black carbon air pollution, and physiological health markers for 3 weeks in three European cities. Different methods for estimating minute ventilation performed well in relative terms with high correlations among different methods, but in absolute terms, ignoring increased ventilation during day-to-day activities could lead to an underestimation of the daily dose by a factor of 0.08−1.78. There is no single best method, and a multitude of methods are currently being used to approximate the dose. The choice of a suitable method for determining the dose in future studies will depend on both the size and the objectives of the study. ; This work was supported by the European project Physical Activity through Sustainable Transportation Approaches (PASTA). PASTA (http://www.pastaproject.eu/) is a four-year project funded by the European Union's Seventh Framework Program (EU FP7) under European Commission Grant Agreement 602624. E.D. is supported by a postdoctoral scholarship from FWO-Research Foundation Flanders. M.L. holds a joint PASTA/VITO Ph.D. scholarship.
In this study, we report the results of a comprehensive phenotyping of the retina of the App(NL-G-F) mouse. We demonstrate that soluble A beta accumulation is present in the retina of these mice early in life and progresses to A beta plaque formation by midlife. This rising A beta burden coincides with local microglia reactivity, astrogliosis, and abnormalities in retinal vein morphology. Electrophysiological recordings revealed signs of neuronal dysfunction yet no overt neurodegeneration was observed and visual performance outcomes were unaffected in the App(NL-G-F) mouse. Furthermore, we show that hyperspectral imaging can be used to quantify retinal A beta, underscoring its potential as a biomarker for AD diagnosis and monitoring. These findings suggest that the App(NL-G-F) retina mimics the early, preclinical stages of AD, and, together with retinal imaging techniques, offers unique opportunities for drug discovery and fundamental research into preclinical AD. ; MV, LV, LuM and LDG are fellows of the Research Foundation Flanders (FWO). This research was supported by the Alzheimer's Research Foundation (SAO-FRA), the European Union Horizon 2020 Research and Innovation Program (2014-2020) (HERALD project, granted by the ATTRAC T consortium). The Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian Government. XH and PvW acknowledge funding support from the H & L Hecht Trust and the Yulgilbar Alzheimer's Research Program. ; De Groef, L (corresponding author), Univ Leuven KU Leuven, Dept Biol, Neural Circuit Dev & Regenerat Res Grp, Naamsestr 61,Box 2464, B-3000 Leuven, Belgium. Lies.Degroef@kuleuven.be
Background People living with the Human Immunodeficiency Virus (PLHIV) have an increased susceptibility to develop non-communicable diseases such as cardiovascular disease (CVD). Infection with HIV contributes to the development of CVD independent of traditional risk factors, with endothelial dysfunction being the central physiological mechanism. While HIV-related mortality is declining due to antiretroviral treatment (ART), the number of deaths due to CVD is rising in South Africa - the country with the highest number of PLHIV and the world's largest ART programme. The EndoAfrica study was developed to determine whether HIV infection and ART are associated with cardiovascular risk markers and changes in vascular structure and function over 18 months in adults from different provinces of South Africa. This paper describes the rationale, methodology and baseline cohort profile of the EndoAfrica study conducted in the North West Province, South Africa. Methods In this case-control study, conducted between August 2017 and June 2018, 382 volunteers of African descent (276 women; 106 men), comprising of 278 HIV infected and 104 HIV free individuals were included. We measured health behaviours, a detailed cardiovascular profile, and performed biomarker analyses. We compared baseline characteristics, blood pressure, vascular function and biochemical markers between those infected and HIV free. Results At baseline, the HIV infected participants were older (43 vs 39 years), less were employed (21% vs 40%), less had a tertiary education (7% vs 16%) and their body mass index was lower (26 vs 29 kg/m(2)) than that of the HIV free participants. While the cardiovascular profile, flow-mediated dilation and pulse wave velocity did not differ, glycated haemoglobin was lower (p = 0.017) and total cholesterol, high density lipoprotein cholesterol, triglycerides, gamma-glutamyltransferase and tobacco use were higher (allp < 0.047) in PLHIV. Conclusion Despite PLHIV being older, preliminary cross-sectional analysis suggests that PLHIV being treated with ART do not have poorer endothelial or vascular function compared to the HIV free participants. More detailed analyses on the baseline and follow-up data will provide further clarity regarding the cardiovascular profile of South Africans living with HIV. ; The EndoAfrica-NWU study formed part of a broader consortium under the ERAfrica program of the European Union 7th Framework Program. Funding is disbursed via the Department of Science and Innovation in South Africa (contract number DST/CON 0077/2014). AES is funded by the South African National Research Foundation (SARChI GUN 86895) and South African Medical Research Council. PDB and NG received funding from the Belgian Science Policy in Belgium (Grant number BL/67/eranet03), and the Osterreichische Agentur fur internationale Mobilitat und Kooperation in Bildung, Wissenschaft und Forschung, OeAD GmbH (OAD) in Austria (Grant number: KEF-Projekt P202). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ; Fourie, CMT (corresponding author), North West Univ, Hypertens Africa Res Team HART, Private Bag X1290, Potchefstroom, South Africa; North West Univ, Fac Hlth Sci, South African Med Res Council, Unit Hypertens & Cardiovasc Dis, Potchefstroom, South Africa. carla.fourie@nwu.ac.za
Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10-4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62-8.96). Among women, chronic cough was associated with cooking >= 3 h daily (aOR 2.74, 95% CI: 1.25-6.07) and with HAP (aOR 3.93, 95% CI: 1.15-13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04-5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09-4.58) but not HAP (aOR 1.86, 95% CI: 0.61-5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention. ; Patrick D.M.C. Katoto is Fellow of the Fonds Marc Vervenne of the KU Leuven, Belgium. This work was supported by the ATS foundation and the PATS MECOR writing awards. We thank Olivier Rusumba, coordinator of the "Ambassadeur de la lutte contre la tuberculose" for helping to make field work possible. The views expressed in this publication are those of the author(s) and not necessarily those of the founders.
Little is known about the respiratory health damage related to household air pollution (HAP) in survivors of pulmonary tuberculosis (PTB). In a population-based cross-sectional study, we determined the prevalence and associated predictors of chronic cough and hemoptysis in 441 randomly selected PTB survivors living in 13 remote health zones with high TB burden in the South Kivu province of the Democratic Republic of Congo (DRC). Trained community and health-care workers administered a validated questionnaire. In a multivariate logistic regression, chronic cough was independently associated with HAP (adjusted odds ratios (aOR) 2.10, 95% CI: 1.10⁻4.00) and PTB treatment >6 months (aOR 3.80, 95% CI: 1.62⁻8.96). Among women, chronic cough was associated with cooking ≥3 h daily (aOR 2.74, 95% CI: 1.25⁻6.07) and with HAP (aOR 3.93, 95% CI: 1.15⁻13.43). Independent predictors of hemoptysis were PTB retreatment (aOR 3.04, 95% CI: 1.04⁻5.09) and ignorance of treatment outcome (aOR 2.24, 95% CI: 1.09⁻4.58) but not HAP (aOR 1.86, 95% CI: 0.61⁻5.62). Exposure to HAP proved a major risk factor for chronic cough in PTB survivors, especially in women. This factor is amenable to intervention.
