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      Association between Air Pollution and General Outpatient Clinic Consultations for Upper Respiratory Tract Infections in Hong Kong

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          Abstract

          Background and Objectives

          Many studies have shown the adverse effects of air pollution on respiratory health, but few have examined the effects of air pollution on service utilisation in the primary care setting. The aim of this study was to examine the association between air pollution and the daily number of consultations due to upper respiratory tract infections (URTIs) in general outpatient clinics (GOPCs) in Hong Kong.

          Methods

          Daily data on the numbers of consultations due to URTIs in GOPCs, the concentrations of major air pollutants, and the mean values of metrological variables were retrospectively collected over a 3-year period (2008–2010, inclusive). Generalised additive models were constructed to examine the association between air pollution and the daily number of consultations, and to derive the relative risks and 95% confidence intervals (95% CI) of GOPC consultations for a unit increase in the concentrations of air pollutants.

          Results

          The mean daily consultations due to URTIs in GOPCs ranged from 68.4 to 253.0 over the study period. The summary relative risks (and 95% CI) of daily consultations in all GOPCs for the air pollutants PM 10, NO 2, O 3, and SO 2 were 1.005 (1.002, 1.009), 1.010 (1.006, 1.013), 1.009 (1.006, 1.012), and 1.004 (1.000, 1.008) respectively, per 10 µg/m 3 increase in the concentration of each pollutant.

          Conclusion

          Significant associations were found between the daily number of consultations due to URTIs in GOPCs and the concentrations of air pollutants, implying that air pollution incurs a substantial morbidity and increases the burden of primary health care services.

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          Most cited references31

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          Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994.

          Air pollution in cities has been linked to increased rates of mortality and morbidity in developed and developing countries. Although these findings have helped lead to a tightening of air-quality standards, their validity with respect to public health has been questioned. We assessed the effects of five major outdoor-air pollutants on daily mortality rates in 20 of the largest cities and metropolitan areas in the United States from 1987 to 1994. The pollutants were particulate matter that is less than 10 microm in aerodynamic diameter (PM10), ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. We used a two-stage analytic approach that pooled data from multiple locations. After taking into account potential confounding by other pollutants, we found consistent evidence that the level of PM10 is associated with the rate of death from all causes and from cardiovascular and respiratory illnesses. The estimated increase in the relative rate of death from all causes was 0.51 percent (95 percent posterior interval, 0.07 to 0.93 percent) for each increase in the PM10 level of 10 microg per cubic meter. The estimated increase in the relative rate of death from cardiovascular and respiratory causes was 0.68 percent (95 percent posterior interval, 0.20 to 1.16 percent) for each increase in the PM10 level of 10 microg per cubic meter. There was weaker evidence that increases in ozone levels increased the relative rates of death during the summer, when ozone levels are highest, but not during the winter. Levels of the other pollutants were not significantly related to the mortality rate. There is consistent evidence that the levels of fine particulate matter in the air are associated with the risk of death from all causes and from cardiovascular and respiratory illnesses. These findings strengthen the rationale for controlling the levels of respirable particles in outdoor air.
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            The statistical basis of meta-analysis.

            Two models for study-to-study variation in a meta-analysis are presented, critiqued and illustrated. One, the fixed effects model, takes the studies being analysed as the universe of interest; the other, the random effects model, takes these studies as representing a sample from a larger population of possible studies. With emphasis on clinical trials, this paper illustrates in some detail the application of both models to three summary measures of the effect of an experimental intervention versus a control: the standardized difference for comparing two means, and the relative risk and odds ratio for comparing two proportions.
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              Generalized additive models for medical research.

              This article reviews flexible statistical methods that are useful for characterizing the effect of potential prognostic factors on disease endpoints. Applications to survival models and binary outcome models are illustrated.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                23 January 2014
                : 9
                : 1
                : e86913
                Affiliations
                [1 ]Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
                [2 ]Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
                [3 ]General Outpatient Clinics, Kwong Wah Hospital, Yaumatei, Hong Kong
                The Ohio State University, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: WWST TWW. Performed the experiments: WWST TWW LN SYSW KKLK. Analyzed the data: WWST TWW LN SYSW KKLK AHSW. Contributed reagents/materials/analysis tools: WWST TWW LN. Wrote the paper: WWST TWW LN SYSW KKLK AHSW.

                Article
                PONE-D-13-33059
                10.1371/journal.pone.0086913
                3900683
                24466288
                44d8f442-e7d0-40ad-bd90-d3e067bd76a3
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 12 August 2013
                : 15 December 2013
                Page count
                Pages: 6
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Biology
                Population Biology
                Epidemiology
                Environmental Epidemiology
                Earth Sciences
                Atmospheric Science
                Atmospheric Chemistry
                Air Quality
                Meteorology
                Medicine
                Clinical Research Design
                Epidemiology
                Epidemiology
                Environmental Epidemiology
                Public Health
                Environmental Health
                Pulmonology
                Respiratory Infections

                Uncategorized
                Uncategorized

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