DE LA SALLE HEALTH SCIENCES INSTITUTE COLLEGE OF MEDICINE DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE CM2 SY 2011-2012 OUTPUT 2: LITERATURE

E REVIEW Group 1A, Dr. Abong

Research Question: Is there a difference in the prevalence of common colds and influenza in Grade 6 students of Dasmarinas, Cavite who have classes in air-conditioned class rooms and those without an airconditioning system? y General Objective: To determine if there is a difference between the prevalence of common colds and influenza in Grade 6 students of Dasmarinas, Cavite who have classes in air-conditioned class rooms and those without an air-conditioning system. Specific Objectives: o To identify the prevalence of common colds and influenza among Grade 6 students of Dasmarinas, Cavite who have classes in air conditioned class rooms. o To identify the prevalence of common colds and influenza among students Grade 6 students of Dasmarinas, Cavite who have classes in non-air conditioned class rooms. o To determine the different pathogens that can thrive under the two different class room conditions. o To determine which studying environment is more suitable in the prevention of respiratory diseases.

Background Information Regarding the Research Question: Ventilation and air-conditioning systems can be sources of microbial aerosols either from contaminated air entering the system or directly from microbial growth within the system. Poor ventilation may allow an accumulation of particulates, pollutants, and allergens inside school buildings and decreased air circulation may increase transmission of respiratory infections. Building structural problems, such as heating or air conditioning systems venting near an air intake may contribute to these exposures. Due to this, the associations between school absenteeism and poor ventilation, vermin, and cumulative exposure to building condition problems were greater for younger students. Young children are known to be more susceptible to airborne pollutants than older children or adults because of their greater activity, smaller airways, and faster ventilation rates. Having these been said, it is therefore important to look into which of the learning environments of the students is more likely to help achieve their full potential and keep them healthy as well as disease free. Research Hypothesis: There is a difference in the prevalence of common colds and influenza in Grade 6 students of Dasmarinas, Cavite who have classes in air-conditioned class rooms and those without an airconditioning system. Summary of Current Knowledge Regarding Disease and Exposure of Interest Common Colds The common cold is a viral disease in which the upper respiratory tract is infected due to rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever. There is currently no

known treatment that shortens the duration; however, symptoms usually resolve spontaneously in 7 to 10 days, with some symptoms possibly lasting for up to three weeks.[1] In 2005 alone, it was noted by the US Census Bureau that out of the total population of 86,241,697, 19,658,033 were accounted to have common colds.[2] Majority of those infected with common colds are those who live in places that are very crowded a not well-ventilated. As will be discussed later, a number of documented studies have shown that those more commonly affected are those of who belong to the marginalized group. Risk factors for common colds include the age, immunity, and the season or time of the year. It is noted that infants and preschool children are more susceptible to common colds because their resistance has not developed fully yet to most of the viruses that cause them. They also tend to spend much time with other children and frequently aren't careful about washing their hands and covering their mouths and noses when they cough and sneeze. Colds in newborns can be problematic if they interfere with nursing or breathing through the nose. Moreover, as one matures, one develops immunity to many of the viruses that cause common colds. One will have colds less frequently than he/she did as a child. However, one can still come down with a cold when he/she is exposed to cold viruses or have a weakened immune system. All of these factors increase ones risk of a cold. As regards time of the year, both children and adults are more susceptible to colds in fall and winter. In the Philippine setting, it would be the rainy and Christmas season. This is because children are in school, and most people are spending a lot of time indoors. [3]

Influenza Influenza, on the other hand, occurs in different outbreaks of varying degree almost yearly. This pattern of epidemiology is seen due to the changing nature of the antigenic properties of influenza viruses, and their succeeding spread depends upon the susceptibility of the population. Influenza A viruses, in particular, have a remarkable ability to undergo periodic changes in the antigenic characteristics of their envelope glycoproteins, the hemagglutinin and the neuraminidase. [4] Influenza hemagglutinin is a surface glycoprotein that binds to sialic acid residues on respiratory epithelial cell surface glycoproteins. This interaction is necessary for the initiation of infection. After viral replication, progeny virions are also bound to the host cell. Neuraminidase cleaves these links and liberates the new virions; it also counteracts hemagglutinin-mediated self-aggregation entrapment in respiratory secretions. [5] As of 2004, 379,910 of the Philippines population have been affected by Influenza. [6] Moreover, there are several risk factors involved in the contraction of Influenza. Seasonal influenza tends to target young children and people over 65. The pandemic H1N1 virus, which surfaced in 2009, appeared to be most common in teenagers and young adults. Also, health care workers and child care personnel are more susceptible to contracting the disease since they are likely to have close contact with people infected with influenza. Moreover, people who live in facilities along with many other residents, such as nursing homes or military barracks, are more likely to develop influenza. In addition to these, cancer treatments, anti-rejection drugs, corticosteroids and HIV/AIDS can weaken your immune system thus contracting the disease easier. This may also increase your risk of developing complications. A chronic illness is also a risk factor because conditions such as asthma, diabetes or heart problems may increase your risk of influenza complications. Pregnant women are also more likely to develop influenza complications, particularly in the second and third trimesters. [7]

Summary of Related/Similar Studies The crowding index is the composite variable composed of the number of household members as the numerator and the number of rooms used for sleeping as the denominator. The higher the index, the more congested is the household putting the household members at risk for indoor air pollution exposure as well as cross-infection of communicable diseases especially respiratory illnesses. [8] A similar study, in which the researchers determined the crowding index in 80 households, showed that location of room/s, floor area and type of housing are conditions in households that affect the crowding index. The incidence of common colds among the households is 34 percent. Crowding index and the incidence of common colds are significantly related, thus, the higher the crowding index the greater is the possibility that the incidence of common colds will rise. [9] Another study that concerns transmission of airborne diseases was conducted in Peru. Rooms which had only natural measures for encouraging airflow were compared with mechanically ventilated rooms which were built much more recently. A comparison was also done between rooms in old hospitals that were naturally ventilated with rooms in newer hospitals that were also naturally ventilated. Results showed that natural ventilation had high rates of air exchange, with an average of 28 air changes per hour. Hospitals of which are 50 years old had the highest ventilation, with an average of 40 air changes per hour, due to its structure. This rate is far higher compared to the 17 air changes per hour in naturally ventilated rooms in modern hospitals, which have lower ceilings and smaller windows. [10] A method used for the aforementioned study used the Wells-Riley model for airborne infection is typically used to predict the number of new cases infected over a period of time t (s), in an indoor environment ventilated at a constant rate Q (m3/s).[12] The Wells-Riley equation predicted that if an untreated person with tuberculosis was exposed to other people, within 24 hours this person would infect 39% of the people in the mechanically ventilated room, 33% of people in the naturally ventilated new hospital rooms, and only 11% of the people in the naturally ventilated old hospital rooms. [10] According to another study, room air should be changed 1012 times every hour to ensure sufficient dilution of the bacterial load. Actual room air changes often fall below this level because of deficiencies in the facility and lack of maintenance. Respiratory masks provide protection, but are often inadequately fitted to the face and are not used before diagnosis is reached. [11] The study later on concluded that the risk of spread of airborne diseases were far lower in rooms with open windows than the expensive mechanically ventilated rooms. For obvious reasons, low -cost natural ventilation seems to be a better option than negative pressure ventilation in tropical countries. The main disadvantage, however, is the possible contamination of adjacent areas when airflow is inward. This will still be a possible means of which transmission of the airborne diseases could be more rampant, especially in crowded places. In a similar study about the impact of school building conditions on student absenteeism in Upstate New York, researchers investigated this by obtaining data from the 2005 Building Condition Survey of Upstate New York schools with 2005 New York State Education department students absenteeism data at the individual school level and evaluated associations between building conditions and absenteeism at or above the 90th percentile. As a result, researchers associated absenteeism with visible molds, humidity, poor ventilation, vermin, and building condition problems, and building system or structural problems related to these conditions. They saw that schools in lower socioeconomic districts and schools attended by younger students showed the strongest association between poor building conditions and absenteeism. With this study, there were some limitations. Some confounding variables were the external exposures such as traffic pollution and exposures from a students home could have affected this study. In addition, absenteeism due to illness or

other reasons could not be distinguished. The study's ecological design did not allow collection of information on individual health outcomes or reasons for absenteeism. In conclusion, they found associations between student absenteeism and adverse school building conditions. As a recommendation, further studies should confirm these findings and prioritize strategies for school condition improvements. [12] In general, these findings suggest that encouraging airflow in a natural way (i.e. opening doors and windows) work well it could reduce an airborne disease to be carried from one person to another. Some aspects of the design (such as large windows and high ceilings) would more likely achieve better airflow and reduce the risk of passing infection. In developing countries, such as the Philippines where mechanical ventilation systems might be too expensive to install and maintain properly especially in public schools, rooms that are designed to naturally achieve good airflow might be the best choice.

Conceptual Framework:

**independent variable predictor **dependent variable outcome

Sources: [1] Heikkinen, T., Jrvinen, A. (2003). The common cold. Lancet 361 (9351): 519. Retrieved July 1, 2011 from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12162-9/fulltext [2] Statistics by Country for Common Cold. (2005). Retrieved July 1, 2011 from CureResearch website: http://www.cureresearch.com/c/cold/stats-country_printer.htm [3] Common cold risk factors. (2011). Retrieved July 2, 2011 from Mayo Clinic Website: http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=risk-factors [4] Dolin, R. (2011). Epidemiology of Influenza. UpToDate, 19, 1. Retrieved July 1, 2011 from http://www.uptodate.com/contents/epidemiology-of-influenza [5] Gubareva LV, Kaiser L, Hayden FG. Influenza virus neuraminidase inhibitors. Lancet 2000; 355:827. Retrieved July 1, 2011 from http://www.ncbi.nlm.nih.gov/pubmed?term=10711940 [6] Notifiable Diseases Reported Cases by Cause. (2011). Retrieved July 2, 2011 from National Statistical Coordination Board website: http://www.nscb.gov.ph/secstat/d_vital.asp [7] Influenza risk factors. (2011). Retrieved July 2, 2011 from Mayo Clinic Website: http://www.mayoclinic.com/health/common-cold/DS00056/DSECTION=risk-factors [8] Public Health Monitoring of the Metro Manila Air Quality Improvement Sector Development Program. (2004). Retrieved July 1, 2011 from http://www.wpro.who.int/internet/files/hse/Epidemiological_study_PHM.pdf

[9] Reblora, et.al. (2008). Crowding Index and Incidence of Common Colds in Urban Poor Households. The Trinitian Student Researcher, 1, No. 1, Retrieved July 1, 2011 from http://www.ejournals.ph/index.php?journal=TSR&page=article&op=viewArticle&path%5B%5D=968 [10] Escombe AR, Oeser CC, Gilman RH, Navincopa M, Ticona E, et al. (2007) Natural Ventilation for the Prevention of Airborne Contagion. PLoS Med 4(2): e68. doi:10.1371/journal.pmed.0040068 [11] Wilson P (2007) Is Natural Ventilation a Useful Tool to Prevent the Airborne Spread of TB? PLoS Med 4(2): e77. doi:10.1371/journal.pmed.0040077 [12] Simons, E., Hwang, S., Fitsgerald, E., Keilb, C. & Lin, S. (2009). The Impact of School Building Conditions on Student Absenteeism in Upstate New York. 100(9). Research and Practice.