Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2019. / Background: A recent review on the effects of ambient air pollution on human health in sub-Saharan Africa, specifically calls for an urgent need for more epidemiological studies in developing countries due to a lack of data in these countries. Air pollution information on exposure is important for understanding and addressing its public health impact in developing countries. In many African countries, the spatial distribution of air pollutants has not been quantified even though air pollution is a global public health risk. The main goal of the study was to quantify and compare the seasonal spatial variation of household air pollution in the 4 Western Cape neighbourhoods. Methods: Weekly indoor and outdoor measurements of Particulate Matter (PM2.5), Sulphur dioxide (SO2), Ozone (O3), Carbon monoxide (CO) and Nitrogen dioxide (NO2) were conducted at 127 households in four informal settlement areas (Khayelitsha, Marconi-Beam, Masiphumulele and Oudtshoorn) during one month each in summer and winter. PM2.5 measurements were conducted using Mesa Labs GK2.05 (KTL) cyclone with the GilAir Plus Air Sampling Pump, Gases were measured using Passam passive samplers. Statistical analyses were performed using Stata V12. Simple linear regression was used to evaluate the relationship between continuous exposure levels and the respective predictor variables. These include distance to major roads, bus routes, open grills and waste burning sites. Results: The highest average weekly outdoor PM2.5 and NO2 concentrations for summer were recorded in Milnerton (8.76 µg/m3 and 16.32 µg/m3 respectively). However, the highest average concentrations during winter for PM2.5 were recorded in Oudtshoorn (PM2.5: 16.07 µg/m3), whilst the highest NO2, was recorded in Khayelitsha (NO2: 35.69 µg/m3). SO2 levels were consistently low during both seasons. Noordhoek generally recorded the lowest average levels for all pollutants. Winter average weekly concentrations were generally higher than the levels recorded in summer for all pollutants. In a sub-sample of indoor and outdoor measurements, the results were comparable for PM2.5, NO2 and CO. However, the results of Ozone (O3) showed relatively higher (~10 times) outdoor compared to indoor levels. Linear regression modelling results revealed that significant predictors of elevated exposure to PM2.5 were proximity to construction activities and open grills. Analysis demonstrated a clear dose-response relationship with distance, with open grills within 1000m associated with a 0.33 µg/m3 increase in PM2.5 to 6.77 µg/m3 at a distance of 25 meters. Results from the linear regression modelling revealed that significant predictors of exposure to NO2 were proximity to rapid transport bus stops, bus routes, taxi routes and major routes. Distance to rapid transport bus stops demonstrated an increase in NO2 between 0.09 µg/m3 (at 1km) to 2.16 µg/m3 (at 50m) during summer. A similar pattern was observed for taxi routes and bus routes displaying an increase of 6.26 μg/m3and 6.82 μg/m3 respectively within the proximity of 1000 meters. / MAUERBERGER Foundation Scholarship

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-06-13T12:25:00Z No. of bitstreams: 1 Gustavo Xavier Bassetto.pdf: 901809 bytes, checksum: b0bc7b95dec06efccf5f5e47baa49f09 (MD5) / Made available in DSpace on 2018-06-13T12:25:00Z (GMT). No. of bitstreams: 1 Gustavo Xavier Bassetto.pdf: 901809 bytes, checksum: b0bc7b95dec06efccf5f5e47baa49f09 (MD5) Previous issue date: 2018-04-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This paper analyzes the historical evolution of health and elderly standards, the influence of international events on Brazilian norms, the recognition of the right to health as a fundamental right, the Brazilian health system from the Federal Constitution of 1988, norms the protection of the elderly and their health. The effectiveness of norms for the protection of the rights of the elderly can be determined by indicators from the political matrix and its objectives / Este trabalho analisa a evolução histórica das normas de saúde e do idoso, as influências frente aos acontecimentos internacionais nas normas brasileiras, o reconhecimento do direito à saúde como um direito fundamental, o sistema de saúde brasileiro a partir da Constituição Federal de 1988, as normas de proteção à pessoa idosa e à sua saúde. A efetividade das normas de proteção dos direitos da pessoa idosa pode ser apurada por indicadores a partir das matrizes políticas e de seus objetivos

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-08-08T11:31:32Z No. of bitstreams: 1 Sonia Maria da Silva Balão.pdf: 990062 bytes, checksum: d661de8299c0d3453ea314d82c5dbbd6 (MD5) / Made available in DSpace on 2018-08-08T11:31:32Z (GMT). No. of bitstreams: 1 Sonia Maria da Silva Balão.pdf: 990062 bytes, checksum: d661de8299c0d3453ea314d82c5dbbd6 (MD5) Previous issue date: 2018-06-20 / Nowadays, a great number of young people present themselves in clinic with complaints of a lonely and isolated personal life, with an affective-social withdrawal and impoverishment, sadness, hopelessness, anguish, internal guilt, helplessness, lack of will to live, cranky, self agressive and self-multilation behaviors. These factors, beyond worrying, point to pathology and to complex emotional difficulties. Another common feature of these young patients is to dedicate a lot of time to the virtual world instead of real life. On the social network, they have a group of lots of friends and dedicate a lot of their time with unknown people. This clear dissociation between the cloistered real life and the active virtual life demands questioning the social network role and think its excessive use as a way of psychological defense. Therefore, through the case study of a 16 years old young woman (when she begins the analysis), this research project proposes to understand this dissociation and its possible relation of the phenomenon to some psychopathology, specially depression, covering the contradictory way of the young people to have a depressive, apathetic and isolated existence in real life and manifest themselves vitally, interactively and intensely in social networks. The theorical basis of this investigation is the Winnicott’s Theory of Personal Maturity and the focus was on the articulation between the clinical case and the theory through the theoretical-methodological research and the research-listening. Reports from the patience, written by the psychologist during her three first years of psychological treatment and WhatsApp and Facebook messages given by the patience were all the valid corpus for this investigation. By avoiding contact with the loneliness that her illness aroused, the patient presented herself to treatment incapacitated to be alone and think about herself. Because of the lack of limits, she made use of the virtual world and isolated herself from shared reality. With psychic action from the analytic process, she started to stay connected to the cyber world while she needs, returning to the real world whenever she feels strengthened. Therefore, based on the analysis of the results of this clinical case, the use of communication in social networks by young depressive people is based on a paradox: the defense of the maniac type by the performance of the false self, to avoid depressive psychopathology, and, at the same time, the attempt to be cured by the new possibilities when the patient can experience the false self in consigning thru it the emersion of the true self / Atualmente, muitos jovens apresentam-se em consultório com queixas de uma vida pessoal solitária e isolada, com retraimento e empobrecimento afetivo-social, tristeza, desesperança, angústia, culpabilidade interna, desamparo, falta de vontade de viver e comportamentos irritadiços, autoagressivos e de automutilação, fatores esses que, além de preocupantes, apontam para uma possível patologia e para dificuldades emocionais complexas. Outra característica comum a esses jovens pacientes é dedicarem muito tempo ao mundo virtual em detrimento do real. Nas redes sociais, têm um grande grupo de amigos virtuais e dedicam muito tempo à interação com desconhecidos. Essa clara dissociação entre a vida real enclausurada e a vida virtual ativa impõe questionar o papel das redes sociais como uma forma de defesa psicológica. Frente a isso, a partir do estudo do caso clínico de uma jovem que, no início da análise, tinha 16 anos, esta pesquisa propõe compreender essa dissociação e a possível relação do fenômeno com alguma psicopatologia, em especial a depressão, abrangendo o modo contraditório dos jovens de ter um existir depressivo, apático e isolado na vida real e de se manifestarem de maneira vitalizada, interativa e intensa nas redes sociais. O fundamento teórico deste estudo é a Teoria do Amadurecimento Pessoal de Winnicott e o enfoque principal foi a articulação do caso clínico com a teoria por meio da pesquisa teórico-metodológica (pesquisa-investigação) e da pesquisa-escuta. Relatos da paciente anotados pela psicóloga em seus três primeiros anos de tratamento e mensagens de WhatsApp e de Facebook fornecidas pela paciente constituíram o corpus de base da pesquisa. Ao evitar contato com a solidão que seu adoecimento despertava, a paciente apresentou-se para tratamento incapaz de se manter sozinha e refletir sobre si mesma e, por não encontrar limites, fez uso patológico do mundo virtual, afastando-se da realidade compartilhada. Com a evolução psíquica a partir do processo analítico, ela passou a se conectar ao mundo cibernético dentro de sua necessidade, retornando ao mundo real sempre que se sentia fortalecida. Desse modo, a partir da análise desse caso clínico, chegou-se ao resultado de que o uso da comunicação nas redes sociais pelos jovens depressivos baseia-se num paradoxo: a defesa maníaca pela atuação do falso self, a fim de evitar o sofrimento da psicopatologia depressiva, e, ao mesmo tempo, a tentativa de cura por meio de novas experiências que o paciente pode vivenciar quando o falso self cede e consente a emersão do self verdadeiro

Leung, Yu Tim. / Thesis submitted in: November 2006. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 103-128). / Abstracts in English and Chinese. / Thesis Committee --- p.i / Acknowledgements --- p.ii / Abstract --- p.iii / 摘要 --- p.iv / Table of Contents --- p.v / List of Tables --- p.ix / List of Figures --- p.x / Abbreviations --- p.xiii / Chapter 1. --- Introduction / Chapter 1.1 --- Flower herbal teas --- p.1 / Chapter 1.2 --- R. rugosa --- p.3 / Chapter 1.2.1 --- The phytochemistry of R. rugosa --- p.3 / Chapter 1.3 --- Secondary metabolites --- p.4 / Chapter 1.4 --- Classification of secondary metabolites --- p.6 / Chapter 1.5 --- Phenolic compounds --- p.6 / Chapter 1.5.1 --- Phenylpropanoid compounds --- p.6 / Chapter 1.5.2 --- Lignins --- p.7 / Chapter 1.5.3 --- Coumarins --- p.7 / Chapter 1.5.4 --- Stilbenes --- p.8 / Chapter 1.5.5 --- Tannins --- p.8 / Chapter 1.5.6 --- Flavonoids --- p.9 / Chapter 1.6 --- Oxidative Stress --- p.13 / Chapter 1.6.1 --- Diseases related to ROS --- p.13 / Chapter 1.6.2 --- Significant chemical or biochemical conversion of ROS --- p.14 / Chapter 1.6.3 --- Sources of ROS --- p.15 / Chapter 1.7 --- Natural dietary antioxidants --- p.15 / Chapter 1.7.1 --- Vitamin C --- p.15 / Chapter 1.7.2 --- Vitamin E --- p.16 / Chapter 1.7.3 --- Carotenoids --- p.16 / Chapter 1.7.4 --- Phenolic compounds --- p.16 / Chapter 1.8 --- Cancinogenesis --- p.17 / Chapter 1.9 --- Cell cycle --- p.18 / Chapter 1.9.1 --- Cell cycle of eukaryotic cells --- p.18 / Chapter 1.9.2 --- Checkpoints of cell cycle --- p.18 / Chapter 1.10 --- Cancer cell lines --- p.19 / Chapter 1.11 --- The growth phases of cancer cell lines --- p.20 / Chapter 1.12 --- Antiproliferative effects of phenolic compounds --- p.21 / Chapter 1.13 --- Genotoxicity of phenolic compounds --- p.22 / Chapter 1.14 --- Objectives --- p.23 / Chapter 2. --- Methods and Materials / Chapter 2.1 --- Extraction of active substances --- p.40 / Chapter 2.2 --- Determination of antioxidant activities TEAC assay --- p.40 / Chapter 2.3 --- Determination of hydroxy 1 radical scavenging activity by the deoxyribose assay --- p.41 / Chapter 2.4 --- Determination of phenolic contents by Folin´ؤCiocalteu assay --- p.43 / Chapter 2.5 --- Determination of total flavonoid by aluminum chloride colorimetric method --- p.43 / Chapter 2.6 --- Determination of oxidative DNA damage by comet assay --- p.44 / Chapter 2.7 --- Cell lines propagation --- p.49 / Chapter 2.8 --- Determination of antiproliferative activities by MTT assay (colorimetric) --- p.50 / Chapter 2.9 --- Determination of antiproliferative activities by BrdU labeling assay --- p.52 / Chapter 2.10 --- Cell cycle analysis by flow cytometry --- p.55 / Chapter 2.11 --- Determination of genotoxicity by SOS chromotest --- p.57 / Chapter 3. --- Results / Chapter 3.1 --- Dermination of antioxidant activities by TEAC assay --- p.59 / Chapter 3.1.1 --- Trolox Standard Reference --- p.59 / Chapter 3.1.2 --- TEAC of the seven flower extracts --- p.59 / Chapter 3.2 --- Hydroxyl radical scavenging activity by deoxyribose assay --- p.60 / Chapter 3.3 --- Determination of phenolic contents by Folin´ؤCiocalteu assay --- p.60 / Chapter 3.4 --- Determination of total flavonoids by colorimetirc aluminium chloride assay --- p.61 / Chapter 3.5 --- "The Inter-correlation between the antioxidant activities, total phenolic and flavonoid contents of flower extraction powders" --- p.61 / Chapter 3.6 --- Determination of oxidative DNA damage by comet assay --- p.62 / Chapter 3.7 --- Determination of antiproliferative activities by MTT assay --- p.63 / Chapter 3.7.1 --- Antiporoliferative activities on HepG2 --- p.63 / Chapter 3.7.2 --- Antiproliferative activities on MCF7 --- p.63 / Chapter 3.7.3 --- IC50 of R. rugosa extract on both HepG2 and MCF7 --- p.64 / Chapter 3.8 --- "The Inter-correlation between antioxidant activities, total phenolic contents, flavonoid contents, and the antiproliferative activities of flower extraction Powders" --- p.64 / Chapter 3.9 --- Determination of DNA synthesis by BrdU labeling analysis --- p.65 / Chapter 3.10 --- Cell cycle analysis by flow cytometry --- p.65 / Chapter 3.11 --- Determination of genotoxicity by SOS chromotest --- p.66 / Chapter 4. --- Discussions / Chapter 4.1 --- Extraction method --- p.90 / Chapter 4.2 --- Comparison of TEAC of the dry flowers with other foods --- p.90 / Chapter 4.3 --- Correlation between ABTS+ and hydroxyl scavenging ability of flower extraction powder --- p.91 / Chapter 4.4 --- Comparison of phenolic contents of the fry flowers with other foods --- p.92 / Chapter 4.5 --- Correlation between total phenolic contents and flavonoid contents of flower Eextraction powders --- p.92 / Chapter 4.6 --- "Correlation between total phenolic, flavonoid content and antioxidant activities of flower extraction powders" --- p.93 / Chapter 4.7 --- Factors affecting the antioxidant power besides total phenolic contents --- p.94 / Chapter 4.8 --- Synergistic effect of phenolic compounds --- p.94 / Chapter 4.9 --- Toxicity of drinking flower herbal tea --- p.95 / Chapter 4.10 --- Recommended dose of flower herbal teas --- p.96 / Chapter 4.11 --- Antiproliferative activities of flower extracts by MTT assay --- p.97 / Chapter 4.12 --- Antiproliferation activities of flower extraction Powders by Brdu labeling assay --- p.98 / Chapter 4.13 --- Protective effects of flower extraction powder on oxidative DNA damage determined by comet assay --- p.99 / Chapter 4.14 --- Cell cycle analysis --- p.100 / Chapter 4.15 --- Further Studies --- p.101 / Chapter 5. --- Conclusion --- p.102 / Chapter 6. --- References --- p.103

背景: 近代不少西方的實證心理治療方法都開始採納東方源來已久的身心治療，來醫治常見的情緒病，例如：抑鬱症，效果最為顯著。這個發展趨勢正好回應現存醫療制度及資源的限制，或其他社會文化及個人所造成的障礙。本研究旨在檢視一種促進身心健康的中國禪宗身心治療方法 － 以「德建身心療法」對比於 「認知行為治療法」及「等候對照組」，在治療一羣抑鬱症患者的抑鬱情緒、腦功能的改善及其身体健康等的療效。 / 研究方法: 在一個精神科門診部內，研究員召集了75 名成人的抑鬱症患者。他們都是有不同程度的抑鬱情緒或身體健康問題，同時有興趣參加為期十節的「德建身心療法」或「認知行為治療法」。 在對照基本資料後 (如年齡、學歷、抑鬱程度，初患或復發) ，他們被隨機分派到「德建身心療法」、「認知行為治療法」或「等候對照組」中。治療前及治療後，抑鬱症患者都會接受情緒、腦功能、健康狀況及腦電波的評估。 / 結果: 整體而言，相對於「等候對照組」，「德建身心療法」及「認知行為治療」更有效地減低患者的抑鬱症狀。此外，「德建身心療法」更帶來一些其他組別所末見的療效；包括有效地提昇患者的專注力、記憶、執行功能、腸道功能及睡眠質素。再者、研究亦發現「德建身心療法」的參加者，在有關正面情緒和專注力的兩個客觀量化腦電波(QEEG)指數上有顯著的攀升。意外地，在短短的十星期後「德建身心療法」參加者使用抗抑鬱药的份量亦有效地減少。 / 總結: 本研究的結果顯示中國的禪宗身心治療方法 －「德建身心療法」在治療抑鬱症患者的情緒捆纏、腦功能失衡、睡眠及腸道功能、提升正面情緒及專注力的量化腦電波指數都有明顯的功效。 / BACKGROUND: There are growing interests and encouraging findings of adapting and developing Mind-Body Intervention into evidence-based group treatment for common mental disorders such as depression. The advancement is a partial response to the limitations on the availability and accessibility of the existing treatment in the current health care system for depression, and/or a partial response to the socio-cultural and personal reasons in different communities. The present study aimed to evaluate the effectiveness of a newly developed Chinese Chan-based treatment the Dejian Mind-Body Intervention (DMBI), as compared to the groups of Cognitive-behavioural Therapy (CBT) and Wait-list control, in alleviating depressive mood and improving physical health of adult depressive patients. / METHOD: Seventy-five patients with the diagnosis of Major Depressive Disorder were recruited in the current study. They were stratified for age, education, level of depression, course of illness before random assignment to receive either 10-session DMBI or CBT, or placed on a wait-list. Pre-post measurements included primary outcome measures on psychiatrists’ rating and self-evaluated mood scores (HRSD and BDI) and secondary outcome measures on performance in different neuropsychological assessment (Executive function, Attention, Memory). The three groups also compared among different sleep (SOL, TST, and WASO), gastrointestinal parameters as well as neurophysiological QEEG indices. / RESULTS: Both the DMBI and CBT groups demonstrated significant reduction in depressive psychopathology after intervention. However, the DMBI group but not the CBT or Wait-list control groups demonstrated significant improvement in attention, verbal memory, executive function, gastrointestinal health and overall sleep quality. Besides, Dejian Mind-Body Intervention brought about significant increase in objective QEEG measures of positive affect and attention that were not evidenced in the other two groups. Participants in the DMBI group also demonstrated significant reduction in the use of anti-depressant after the end of 10-week treatment. / CONCLUSIONS: Findings of the current study suggested that a Chinese Chan-based Dejian mind-body intervention has positive effects on improving the mood and health conditions of individuals with depression. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wong, Yun Ping. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 79-109). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / ABSTRACT --- p.iii / CHINESE ABSTRACT --- p.v / ACKNOWLEDGEMENTS --- p.vii / TABLE OF CONTENTS --- p.ix / LIST OF TABLES --- p.x / LIST OF FIGURES --- p.xii / LIST OF APPENDICES --- p.xiii / LIST OF FIGURES --- p.xii / Chapter CHAPTER I: --- INTRODUCTION --- p.1 / PURPOSES OF THE PRESENT STUDY --- p.26 / Chapter CHAPTER II: --- METHODS --- p.29 / Chapter CHAPTER III: --- RESULTS --- p.47 / Chapter CHAPTER IV: --- DISCUSSION --- p.68 / GENERAL DISCUSSION --- p.70 / CLINICAL IMPLICATIONS --- p.76 / LIMITATION AND SUGGESTIONS FOR FUTURE DIRECTION --- p.77 / REFERENCES --- p.79 / TABLES --- p.110 / FIGURES --- p.124 / APPENDICES --- p.128

Over the past decade, efforts led by the U.S. Department of Health and Human Services (HHS) have reduced healthcare-associated infections in acute care settings nationally. In 2013, HHS identified that the next phase of these healthcare-associated infection reduction initiatives would target long-term care facilities through the publication of a new chapter in the National Action Plan to Prevent Health Care Associated Infections devoted to this setting. Long-term care facilities are nursing facilities that provide “medical, skilled nursing and rehabilitative services on an inpatient basis to individuals who need assistance preforming activities of daily living, such as bathing and dressing”. These facilities are the primary residence for 2.5 million, predominantly elderly Americans and represented $143 billion nationally in healthcare costs as of 2010. Accordingly, it is a national priority to reduce healthcare-associated infections in this setting and protect this vulnerable population. Healthcare-associated infections caused by multidrug-resistant organisms (MDROs) are a particular burden in the long-term care population. These pathogens, usually bacteria, are defined as being resistant to one or more classes of antimicrobial agents. However, MDROs frequently exhibit resistance to nearly all antimicrobial drugs. Clinical infection control guidelines recommend isolation precautions to prevent MDRO transmission, based on evidence collected in acute care settings. However, the limited evidence that is available from studies in long-term care facilities suggests that isolation precautions may not be effective in this setting. Given that the reduction of antibiotic resistant infections is a priority of the HHS, The White House, Healthy People 2020, and the World Health Organization, it is necessary to confirm and support the appropriate use of isolation precautions for MDROs with evidence specific to long-term care facilities. Therefore, this dissertation describes the current evidence for and use of isolation precautions in long-term care facilities for MDROs. Further, it offers the most comprehensive descriptions of both isolation precautions use and predictors of MDRO infection in nursing homes (NHs), a specific type of long-term care residential setting. To assist the reader, Chapter 1 will provide background for these studies including context for current infection control and prevention practices in long-term care facilities, the importance of MDRO infections and the need for new evidence regarding isolation precautions in long-term care. It will also discuss the aims and significance of this dissertation in context of a conceptual framework, gaps in the literature and potential to improve clinical practice. Next, Chapters 2 and 3 of this dissertation systematically review the current evidence regarding effectiveness of isolation precautions against MDROs and the cost of infection prevention and control in this setting, respectively. These chapters outline how publications focused on long-term care are lacking in quality and quantity and offer suggestions for improvement in future research. Chapter 4 qualitatively describes decision-making process regarding use of isolation-based infection prevention techniques in NHs, which depends on four key considerations: perceived risk of transmission, conflict with quality of life goals, resource availability and lack of understanding. Chapter 5 builds on this qualitative analysis by quantitatively examining predictors of isolation precautions use for MDRO infection in a large, national dataset. This analysis confirms that isolation is rarely used and there is variation across NHs’ practice. However, NH staff may be tailoring infection prevention and control practice to the needs of specific residents, as would be expected based on the results of the qualitative analysis. Chapter 6 presents an analysis of MDRO infection predictors among elderly NH residents across the U.S. This study confirms concepts associated with MDRO infection in previous studies (e.g., low functionality) and provides more specificity in operationalization of these concepts than has been previously determined (e.g., needing support with locomotion), which can inform future use of isolation precautions in NHs. Finally, Chapter 7 contains a synthesis and discussion of these findings, as well as recommendations for health policy and future research regarding contact isolation precautions against MDROs in NHs.

Background: This dissertation comprises research conducted on two distinct projects. Project I focuses on the connection between household air pollution (HAP) from cooking with biomass fuels and blood pressure (BP); this research is situated in the context of a large randomized trial of a cookstove intervention in Ghana, West Africa. The setting of Project II, meanwhile, is the residential environment of New York City, where we explore temperature and humidity conditions in homes and relate these conditions to summertime heat wave risk and to the survival and transmission of respiratory viruses in the winter. Although these projects are quite distinct, each relates to the complex relationship between climate change and health. Reducing HAP to improve health (the focus of Project I) will simultaneously reduce climate change through a reduction in emissions of short-lived climate pollutants into the atmosphere. Meanwhile, furthering our understanding of heat and humidity levels inside urban residences (the focus of Project II) is crucial to our ability to protect health in light of projections for a changing climate. Domestic activities associated with heating, cooling, and cooking are thus very relevant both to human health and to climate change mitigation and adaptation. Objectives and Methods: Our overall objective for Project I was to investigate exposure- response relationships between HAP and BP in a cohort of pregnant women taking part in the Ghana Randomized Air Pollution and Health Study (GRAPHS). We first explored this association in a cross-sectional study (Chapter 1), in which we used 72-hour personal monitoring to ascertain levels of exposure among the GRAPHS women to carbon monoxide (CO), one of the pollutants emitted by traditional wood-fed cooking fires. These exposure data were collected at enrollment into the GRAPHS study, prior to the initiation of cooking with improved cookstoves. We investigated the association between these “baseline” CO exposure levels and the women’s blood pressure at enrollment into GRAPHS. A limitation of this study was that BP was only measured once. We followed this with a second study of 44 women drawn from the same cohort (Chapter 2), for whom we designed BP protocols using 24-hour ambulatory blood pressure monitoring (ABPM), the current gold standard for clinical diagnosis of hypertension. As we were not aware of any prior research in Africa that had employed ABPM, we also designed a parallel BP protocol using home blood pressure monitoring (HBPM) equipment for comparison with ABPM. The use of ABPM with concurrent personal CO monitoring enabled us to investigate hourly associations between CO exposure and changes in BP. We also evaluated BP in these women both before and after the cookstove intervention; this allowed us to investigate whether any changes in BP were associated with switching to an improved cookstove. Our objectives for Project II were to understand the distribution of temperature and humidity conditions in a range of New York City homes during the summer and winter seasons, to evaluate the impact of structural and behavioral factors (e.g. building size, use of air conditioning, and use of humidifiers) on these conditions, and to build models that could help predict indoor conditions from more readily available outdoor measurements. We conducted this research in two ways. We first analyzed a set of indoor temperature and humidity measurements that were collected in 285 New York City apartments during portions of summers 2003-2011 and used these data to simulate indoor conditions during two heat wave scenarios, one of which was more moderate and the other of which was more extreme (Chapter 3). Second, we designed and conducted a new study in which temperature and humidity were monitored in a set of 40 NYC apartments between 2013 and 2015 (Chapters 4-6). This second study enabled us extend our research into the winter season, and also to explore how factors such as air conditioning and humidifier use impacted indoor temperature and humidity. We also investigated relationships between the monitored conditions, self-reported perceptions of the indoor environment, and symptoms that were experienced among household members. Results: In the cross-sectional analysis of CO and BP in the GRAPHS cohort (Chapter 1), we found a significant positive association between CO exposure and diastolic blood pressure (DBP): on average, each 1 ppm increase in exposure to CO was associated with 0.43 mmHg higher DBP [0.01, 0.86]. A non-significant positive trend was also observed for systolic blood pressure (SBP). In our study of the acute relationship between CO exposure and BP (Chapter 2), we determined that peak CO exposure (defined as above the 90th percentile of the exposure distribution, or an average of 4.1ppm) in the two hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. We also observed a non-significant trend toward lower BP following initiation of cooking with an improved cookstove. Lastly, we demonstrated that ABPM was a feasible and well-tolerated tool for BP assessment in a rural West African setting. For Project II in New York City, we first determined that there was a great deal of variability in indoor summer heat index (HI) between homes in association with similar outdoor conditions, and that this variability increased with increasing outdoor heat (Chapter 3). Our simulation of a moderate heat wave led us to conclude that the hottest 5% of the homes would reach peak indoor heat index (HI) values of 39°C. In a more extreme heat wave simulation, HI in the hottest 5% of homes reached a peak of 41oC and did not drop below 34oC for the entire nine- day simulated heat wave period. Our second indoor monitoring study yielded the following findings: in the summer season (Chapter 4), we found significant differences in indoor temperature and heat index according to the type of air conditioning (AC) in the home. Homes with central AC were the coolest, followed by homes with ductless AC, window AC, and no AC. Apartments on the top floor of a building were significantly hotter than other apartments regardless of the presence of AC. During the winter season (Chapter 5), median vapor pressure in our sample of apartments was 6.5mb. Comparing humidity levels in the apartments to a threshold of 10mb vapor pressure that has been proposed as protective against influenza virus transmission, levels of absolute humidity in the homes remained below this threshold for 86% of the winter: a total of over three months. Residential use of humidifiers was not associated with higher indoor humidity levels. Larger building size (above 100 units) was significantly associated with lower humidity, while the presence of a radiator heating system was non-significantly associated with higher humidity. Lastly, perceptions of indoor temperature and measured temperature were significantly associated in both the summer and the winter (Chapter 6), while sleep quality was inversely related to measured indoor temperature in the summer season only. Reports of heat- stress symptoms were associated with perceived, but not measured, temperature in the summer season. Conclusions: The work presented in this dissertation adds to a growing body of evidence on the importance of exposures in the domestic environment to health and well-being. The research reported here on household air pollution in Ghana documents an exposure-response relationship between air pollution from cookstoves and elevations in blood pressure, on both a chronic and an acute basis. As elevated BP is a known risk factor for cardiovascular disease (CVD), our research provides support for a plausible factor linking HAP exposure to CVD. Meanwhile, our research on temperature and humidity in New York City residences provides concrete data to supplement the very slim literature to date documenting these conditions in the home environment, where Americans spend over half their time. We conclude, first, that AC may not be fully protective against summertime heat risk, and second, that the levels of humidity we observed in residential environments are consistent with levels that have been shown to promote enhanced survival and transmission of respiratory viruses in experimental settings. We suggest that interventions that can reduce exposure to household air pollution and excess indoor heat can also mitigate climate change, and that with thoughtful planning we can improve health at the same time as we foster resiliency in the face of a changing climate.

In the United States there exists a clear and disconcerting racial disparity in the distribution of good health, which can be seen in differential levels of morbidity and mortality affecting blacks and whites. Previous research has examined the role of SES in shaping racial health disparities and recent studies have looked specifically at the effect of education on health to explain the racial disparity in health. Higher levels of education are robustly associated with good overall health for both blacks and whites and this association has been examined over the life-course. This research explores racial differences in the effect of education on health in general as well as over the life-course. Specifically, this paper examines race differences in the effects of education on health over the life-course. Pooled data from the National Health Interview Survey were analyzed using multivariate logistic regression to estimate the effects of race, education and age on health. The results of these analyses indicate that blacks receive lower education returns on their health than whites. The effect of education on health was shown to grow in the beginning of the life-course and diminish at the end of the life course in accordance with the mortality-as-leveler hypothesis. The black white health disparity was shown to grow over the life-course among the highly educated, whereas the disparity was consistent over the life-course for the poorly educated.

Includes bibliographical references (leaves 115-120) Establishes a Bayesian Belief Network (BBN) to model uncertainty of aerosols released from cooling towers and Geographic Information Systems (GIS) to create a wind dispersal model and identify potential cooling towers as the source of infection. Demonstrates the use of GIS and BBN in environmental epidemiology and the power of spatial information in the area of health.

University of Macau / Faculty of Education