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1. Let’s stop dumping cookstoves in local communities. It’s time to get implementation right

Author

Brakema, E.A., Kleij, R.M. van der, Vermond, D., Gemert, F.A. van, Kirenga, B., Chavannes, N.H., An, P.L., Anastasaki, M., Akylbekov, A., Barton, A., Bertsias, A., Binh, P.D.U., J.F.M. van boven, Burges, D., Cartwright, L., Chatzea, V.E., Cragg, L., Dang, T.N., Dautov, I., Emilov, B., Ferarrio, I., Hedrick, B., Hong, L.T.C., Hopkinson, N., Isaeva, E., Jones, R., Jong, C. de, Kampen, S. van, Katagira, W., Kjaergaard, J., Kocks, J., Lan, L.T.T., Linh, T.T.D., Lionis, C., Loan, K.X., Mademilov, M., McEwen, A., Musinguzi, P., Nantanda, R., Ndeezi, G., Papadakis, S., Pinnock, H., Pooler, J., Poot, C.C., Postma, M.J., Poulsen, A., Powell, P., Quynh, N.N., Reventlow, S., Sifaki-Pistolla, D., Singh, S., Sooronbaev, T., Sousa, J.C. de, Stout, J., Ostergaard, M.S., Tabyshova, A., Tsiligianni, I., Tuan, T.D., Tumwine, J., L. van, Vinh, N.N., Walusimbi, S., Warren, L., Williams, S., FRESH AIR Collaborators, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), and Microbes in Health and Disease (MHD)

Subjects
Pulmonary and Respiratory Medicine, COUNTRIES, ADOPTION, 010501 environmental sciences, IMPROVED COOKING STOVES, 01 natural sciences, SOLID-FUEL, 03 medical and health sciences, 0302 clinical medicine, Dumping, Medicine, 030212 general & internal medicine, Diffusion (business), 0105 earth and related environmental sciences, lcsh:RC705-779, BARRIERS, business.industry, Public Health, Environmental and Occupational Health, FRESH AIR collaborators, lcsh:Diseases of the respiratory system, Solid fuel, DIFFUSION, Commerce, ENABLERS, business, CLEAN FUELS, HOUSEHOLD AIR-POLLUTION
Abstract

We most welcome the comment by Thakur, van Schayck and Boudewijns on our article on the effects and acceptability of implementing improved cookstoves. Adoption rates of improved cookstoves by local communities are often strikingly low. The authors underline the urge to advance cookstove implementation strategies, and reinforce the approach used in the FRESH AIR project. They highlight several important factors to increase adoption success and call for further research on the topic. We want to build on this comment by reflecting on decades of substantial discrepancies between the disappointing adoption rates of improved cookstoves, and the subsequent failure to adapt implementation strategies accordingly. We argue that it is not necessarily the lack of evidence that impedes the success of implementation strategies for improved cookstoves. Moreover, it is the lack of use of the evidence by implementors. We propose several ideas for overcoming this evidence-to-practice gap.

Published
2020
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2. The socioeconomic burden of chronic lung disease in low-resource settings across the globe – an observational FRESH AIR study

Author

Brakema, E.A., Tabyshova, A., Kleij, R.M.J.J. van der, Sooronbaev, T., Lionis, C., Anastasaki, M., An, P.L., Nguyen, L.T., Kirenga, B., Walusimbi, S., Postma, M.J., Chavannes, N.H., J.F.M. van boven, Akylbekov, A., Barton, A., Bertsias, A., Binh, P.D.U., J.F. van boven, Burges, D., Cartwright, L., Chatzea, V.E., Cragg, L., Dang, T.N., Dautov, I., Emilov, B., Ferarrio, I., Gemert, F.A. van, Hedrick, B., Hong, L.H.T.C., Hopkinson, N., Isaeva, E., Jones, R., Jong, C. de, Kampen, S. van, Katagira, W., Kjaergaard, J., Kleij, R.M. van der, Kocks, J., Lan, L.T.T., Linh, T.T.D., Loan, K.X., Mademilov, M., McEwen, A., Musinguzi, P., Nantanda, R., Ndeezi, G., Papadakis, S., Pinnock, H., Pooler, J., Poot, C.C., Poulsen, A., Powell, P., Quynh, N.N., Reventlow, S., Sifaki-Pistolla, D., Singh, S., Sousa, J.C. de, Stout, J., Ostergaard, M.S., Tsiligianni, I., Tuan, T.D., Tumwine, J., L.T. van, Vinh, N.N., Warren, L., Williams, S., FRESH AIR Collaborators, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), PharmacoTherapy, -Epidemiology and -Economics, Methods in Medicines evaluation & Outcomes research (M2O), and Groningen Research Institute for Asthma and COPD (GRIAC)

Subjects
Lung Diseases, Male, Work, IMPACT, Respiratory System, Global Health, 0302 clinical medicine, Cost of Illness, Quality of life, QUALITY-OF-LIFE, Uganda, 030212 general & internal medicine, 1102 Cardiorespiratory Medicine and Haematology, ACTIVITY IMPAIRMENT, OUTCOMES, COPD, Greece, 1. No poverty, Low-income population, ASSOCIATION, Middle Aged, WORK PRODUCTIVITY, Obstructive lung disease, Chronic respiratory disease, 3. Good health, WPAI, Vietnam, Chronic lung disease, Absenteeism, Health Resources, Female, HEALTH, Adult, medicine.medical_specialty, OBSTRUCTIVE PULMONARY-DISEASE, Young Adult, 03 medical and health sciences, Environmental health, medicine, Humans, Kyrgyzstan, Poverty, Socioeconomic status, Aged, lcsh:RC705-779, Health economics, business.industry, Research, Public health, 1103 Clinical Sciences, lcsh:Diseases of the respiratory system, medicine.disease, Household air pollution, Cross-Sectional Studies, Social Class, 030228 respiratory system, Chronic Disease, Presenteeism, ASTHMA CONTROL, Low-resource countries, business
Abstract

Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.

Published
2019
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3. Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study

Author

Gemert, F. van, Jong, C. de, Kirenga, B., Musinguzi, P., Buteme, S., Sooronbaev, T., Tabyshova, A., Emilov, B., Mademilov, M., An, P.L., Quynh, N.N., Dang, T.N., Hong, L.H.T.C., Chartier, R., Brakema, E.A., J.F.M. van boven, Kocks, J., Nantanda, R., Katagira, W., Ndeezi, G., Tumwine, J., Walusimbi, S., Akylbekov, A., Binh, P.D.U., Tuan, T.D., Lan, L.T.T., Linh, T.T.D., Loan, K.X., L.T. van, Vinh, N.N., Chavannes, N.H., Kleij, R.M.J.J. van der, Poot, C., Anastasaki, M., Bertsias, A., Chatzea, V.E., Lionis, C., Papadakis, S., Sifaki-Pistolla, D., Tsiligianni, I., Singh, S., Burges, D., Hedrick, B., Stout, J., Warren, L., Ferarrio, I., Powell, P., Barton, A., Cartwright, L., Kampen, S. van, Jones, R., Pooler, J., Poulsen, A., Kjaergaard, J., Hopkinson, N., Cragg, L., Pinnock, H., Williams, S., McEwen, A., Reventlow, S., Stubbe-Ostergaard, M., Postma, M.J., Sousa, J.C. de, FRESH AIR, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), PharmacoTherapy, -Epidemiology and -Economics, Microbes in Health and Disease (MHD), Methods in Medicines evaluation & Outcomes research (M2O), and Universidade do Minho

Subjects
Male, Rural Population, Epidemiology, air pollution, Air pollution, medicine.disease_cause, Medicina Clínica [Ciências Médicas], 0302 clinical medicine, Chest infections, Who recommendations, Quantitative assessment, Medicine, awareness, middle income country, Uganda, Cooking, 030212 general & internal medicine, Child, Household Articles, Respiratory Tract Infections, child, Family Characteristics, Public health, quantitative analysis, adult, Incidence, Viet nam, Vietnam, Viet Nam, Air Pollution, Indoor, Child, Preschool, Scale (social sciences), Female, Adult, Pulmonary and Respiratory Medicine, comparative effectiveness, chest infection, Article, 03 medical and health sciences, Fresh air, Environmental health, Humans, controlled study, human, rural population, Kyrgyzstan, Ciências Médicas::Medicina Clínica, lcsh:RC705-779, Science & Technology, business.industry, practice guideline, Public Health, Environmental and Occupational Health, lcsh:Diseases of the respiratory system, dyspnea, household, 030228 respiratory system, Who guidelines, business
Abstract

The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6-12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5-126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5-39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7-40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations., European Union’s Horizon 2020 programme under grant agreement no. 680997, TRIAL ID NTR5759, http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=23332. The devices, measuring the personal HAP, were funded by Netherlands Enterprise Agency (RVO)

Published
2019
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4. COPD's early origins in low-and-middle income countries: what are the implications of a false start?

Author

Brakema, E.A., Gemert, F.A. van, Kleij, R.M.J.J. van der, Salvi, S., Puhan, M., Chavannes, N.H., An, P.L., Anastasaki, M., Akmatalieva, M., Akylbekov, A., Barton, A., Bertsias, A., Binh, P.D.U., J.F.M. van boven, Burges, D., Cartwright, L., Chatzea, V.E., Cragg, L., Dang, T.N., Dautov, I., Emilov, B., Ferarrio, I., Hedrick, B., Hong, L.H.T.C., Hopkinson, N., Isaeva, E., Jones, R., Jong, C. de, Kampen, S. van, Katagira, W., Kirenga, B., Kjaergaard, J., Kocks, J., Lan, L.T.T., Linh, T.T.D., Lionis, C., Loan, K.X., Mademilov, M., McEwen, A., Musinguzi, P., Nantanda, R., Ndeezi, G., Papadakis, S., Pinnock, H., Pooler, J., Poot, C., Postma, M.J., Poulsen, A., Powell, P., Quynh, N.N., Reventlow, S., Sifaki-Pistolla, D., Singh, S., Sooronbaev, T., Sousa, J.C. de, Stout, J., Stubbe-Ostergaard, M., Tabyshova, A., Tsiligianni, I., Tuan, T.D., Tumwine, J., L.T. van, Vinh, N.N., Walusimbi, S., Warren, L., Williams, S., FRESH AIR Collaborators, University of Zurich, Brakema, E A, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), Microbes in Health and Disease (MHD), and PharmacoTherapy, -Epidemiology and -Economics

Subjects
Pulmonary and Respiratory Medicine, Respiratory System, MEDLINE, Pulmonary disease, Developing country, 610 Medicine & health, Vulnerable Populations, OBSTRUCTIVE PULMONARY-DISEASE, Pulmonary Disease, Chronic Obstructive, POLLUTION, Risk Factors, Environmental health, General & Internal Medicine, medicine, Humans, Developing Countries, Lung function, lcsh:RC705-779, COPD, Science & Technology, Primary Health Care, business.industry, Comment, Public Health, Environmental and Occupational Health, FRESH AIR collaborators, 10060 Epidemiology, Biostatistics and Prevention Institute (EBPI), 2739 Public Health, Environmental and Occupational Health, lcsh:Diseases of the respiratory system, medicine.disease, False start, LUNG-FUNCTION, LIFE, Socioeconomic Factors, 2740 Pulmonary and Respiratory Medicine, Low and middle income countries, HEALTH, business, Life Sciences & Biomedicine
Published
2019
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5. Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training.

Author

Mangione-Smith R, Robinson JD, Zhou C, Stout JW, Fiks AG, Shalowitz M, Gerber JS, Burges D, Hedrick B, Warren L, Grundmeier RW, Kronman MP, Shone LP, Steffes J, Wright M, and Heritage J

Subjects
Anti-Bacterial Agents therapeutic use, Child, Communication, Humans, Inappropriate Prescribing, Infant, Practice Patterns, Physicians', Respiratory Tract Infections drug therapy
Abstract

Objective: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes., Methods: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules., Results: After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005)., Conclusions: Our findings support the receipt fidelity of the intervention's communication training content., Practical Implications: Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Published
2022
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6. Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness.

Author

Kronman MP, Gerber JS, Grundmeier RW, Zhou C, Robinson JD, Heritage J, Stout J, Burges D, Hedrick B, Warren L, Shalowitz M, Shone LP, Steffes J, Wright M, Fiks AG, and Mangione-Smith R

Subjects
Acute Disease, Bronchitis drug therapy, Bronchitis virology, Chicago, Child, Child, Preschool, Communication, Confidence Intervals, Education, Distance methods, Female, Humans, Infant, Intention to Treat Analysis, Logistic Models, Male, Odds Ratio, Otitis Media drug therapy, Outpatients, Pediatric Nursing education, Pediatric Nursing statistics & numerical data, Pediatricians education, Pediatricians statistics & numerical data, Pharyngitis drug therapy, Pharyngitis microbiology, Pharyngitis virology, Program Development, Quality Improvement, Respiratory Tract Infections epidemiology, Respiratory Tract Infections virology, Sinusitis drug therapy, Streptococcal Infections drug therapy, Anti-Bacterial Agents therapeutic use, Education, Distance organization & administration, Inappropriate Prescribing prevention & control, Primary Health Care, Respiratory Tract Infections drug therapy
Abstract

Background: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits., Methods: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability., Results: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70)., Conclusions: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Published
2020
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