Panayiotis Kouis1,2, Stefania I Papatheodorou3,4, Maria G Kakkoura5,6, Nicos Middleton7, Emmanuel Galanakis8, Eleni Michaelidi8, Souzana Achilleos3, Nikolaos Mihalopoulos9, Marina Neophytou10, Gerasimos Stamatelatos11, Christos Kaniklides12, Efstathios Revvas13, Filippos Tymvios13, Chrysanthos Savvides14, Petros Koutrakis15, Panayiotis K Yiallouros5. 1. Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus. kouis.panayiotis@ucy.ac.cy. 2. Shiakolas Educational Center of Clinical Medicine, Palaios Dromos Lefkosias-Lemesou 215/6, 2029, Aglantzia, Nicosia, Cyprus. kouis.panayiotis@ucy.ac.cy. 3. Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus. 4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. 5. Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus. 6. Clinical Trial Service Unit and Epidemiological Studies Unit CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 7. Department of Nursing, Cyprus University of Technology, Limassol, Cyprus. 8. Medical School, University of Crete, Heraklion, Crete, Greece. 9. Department of Chemistry, University of Crete, Heraklion, Greece. 10. Department of Civil & Environmental Engineering, University of Cyprus, Nicosia, Cyprus. 11. E.n.A Consulting LP, Arachova Boeotia, Greece. 12. Cyprus Broadcasting Corporation, Nicosia, Cyprus. 13. Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Nicosia, Cyprus. 14. Department of Labor Inspection, Ministry of Labor, Welfare and Social Insurance, Nicosia, Cyprus. 15. Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA.
Abstract
BACKGROUND: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. METHODS: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. DISCUSSION: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03503812 , April 20, 2018.
RCT Entities:
BACKGROUND: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. METHODS: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. DISCUSSION: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03503812 , April 20, 2018.
Entities:
Keywords:
Asian dust; Asthma; Children; Desert dust; Public health intervention
Authors: Wanda Phipatanakul; Anne Bailey; Elaine B Hoffman; William J Sheehan; Jeffrey P Lane; Sachin Baxi; Devika Rao; Perdita Permaul; Jonathan M Gaffin; Christine A Rogers; Michael L Muilenberg; Diane R Gold Journal: J Asthma Date: 2011-10-20 Impact factor: 2.515
Authors: Tomasz A Leski; Anthony P Malanoski; Michael J Gregory; Baochuan Lin; David A Stenger Journal: Appl Environ Microbiol Date: 2011-05-13 Impact factor: 4.792
Authors: Michael S Breen; Thomas C Long; Bradley D Schultz; James Crooks; Miyuki Breen; John E Langstaff; Kristin K Isaacs; Yu-Mei Tan; Ronald W Williams; Ye Cao; Andrew M Geller; Robert B Devlin; Stuart A Batterman; Timothy J Buckley Journal: J Expo Sci Environ Epidemiol Date: 2014-03-12 Impact factor: 5.563
Authors: Nicos Middleton; Panayiotis Yiallouros; Savvas Kleanthous; Ourania Kolokotroni; Joel Schwartz; Douglas W Dockery; Phil Demokritou; Petros Koutrakis Journal: Environ Health Date: 2008-07-22 Impact factor: 5.984