Publications by authors named "Laura Nicolaou"
Background: Cardiovascular disease is the leading cause of global morbidity and mortality, disproportionately affecting people in low- and middle-income countries (LMICs). Biomass fuels used for cooking in LMICs contribute significantly to household air pollution (HAP), which has been associated with inflammation, oxidative stress, and other pathways linked to atherosclerosis. We evaluate the association between HAP exposure and atherosclerosis by use of carotid artery ultrasound.
View Article and Find Full Text PDFBackground: Exposure to household air pollution from burning coal and biomass for cooking is associated with higher blood pressure and other adverse indicators of cardiovascular disease, the leading cause of death worldwide. Evidence demonstrating that switching from biomass to liquefied petroleum gas (LPG) will reduce blood pressure is limited.
Methods: As part of a larger trial of 3200 households, we conducted a randomized trial of 342 women aged 40 to 79 years who lived in households using biomass for cooking in rural areas of Guatemala, India, Peru, and Rwanda to assess the effects of a free LPG stove and fuel intervention.
Background: Exposure to air pollutants, like fine particulate matter (PM), has been linked to higher blood pressure (BP). Few studies have examined this association in biomass-dependent settings. We seek to determine whether high exposure during a 16 month period was associated with an increase in BP among older adult women over the study period and to determine whether short-term increases in exposure were associated with higher coincident blood pressure.
View Article and Find Full Text PDFProvision of a liquefied petroleum gas cookstove and fuel during pregnancy and infancy and linear growth trajectories between birth and 12 months: evidence from the multi-center Household Air Pollution Intervention Network (HAPIN) trial.
medRxiv
June 2025
Objective: Exposure to particulate pollution from cooking with solid biomass fuels is associated with impaired child linear growth. We examined the effect of a liquefied petroleum gas (LPG) cookstove randomized control trial during pregnancy and infancy on linear growth trajectories among infants born to women enrolled during pregnancy.
Methods: The Household Air Pollution Intervention Network (HAPIN) randomized control trial enrolled 3195 pregnant women (9 to <20 weeks gestation) from rural areas in Guatemala, Peru, India, and Rwanda that relied primarily on biomass fuels for cooking.
Background: Burning biomass fuels for cooking is a widespread environmental exposure that may adversely affect child health. We conducted an 18-month randomized field trial comparing a liquefied petroleum gas (LPG) stove, continuous fuel delivery, and behavioral messaging intervention starting in pregnancy through infancy with usual cooking practices using biomass fuels in Puno, Peru. A total of 800 pregnant women were enrolled.
View Article and Find Full Text PDFBackground: Brick kiln workers (BKWs) may be exposed to high levels of respirable silica and other pollutants; however, few studies have measured personal exposures and health impacts in BKWs. We characterized exposures to brick kiln pollution and respiratory health among BKWs in Bhaktapur, Nepal.
Methods: We identified 64 brick kilns and selected a random sample of ten to conduct a household census and select a stratified random sample of 60 BKWs (makers, stackers, and haulers) aged ≥14 years with ≥10 years of kiln work, and household members aged ≥9 years.
Exposure to household air pollution has been linked to adverse health outcomes among women aged 40-79. Little is known about how shifting from biomass cooking to a cleaner fuel like liquefied petroleum gas (LPG) could impact exposures for this population. We report 24-h exposures to particulate matter (PM), black carbon (BC), and carbon monoxide (CO) among women aged 40 to <80 years participating in the Household Air Pollution Intervention Network trial.
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- Brick kiln workers in Nepal are often overlooked and face high exposure to harmful silica, yet few use personal protective equipment (PPE) to safeguard their health.
- A study conducted in Bhaktapur revealed that only 28.9% of surveyed workers used respiratory PPE, with many lacking awareness about silicosis and the effectiveness of proper protective gear.
- Key factors influencing PPE use included higher household income and education levels, highlighting the need for improved education and resources to address knowledge gaps and encourage safety practices.
Article Synopsis
- Residential biomass burning significantly contributes to black carbon (BC) exposure in rural communities, especially among pregnant women in low- and middle-income countries.
- In a study involving 3103 pregnant women, those who received liquefied petroleum gas stoves showed much lower BC exposure (2.8 μg/m) compared to those using traditional biomass stoves (9.6 μg/m).
- The study identified primary stove type as the strongest predictor of BC exposure, and highlights the need to consider various factors, such as kitchen location and adherence to stove use, to improve the efficacy of cookstove intervention trials.
Brick kiln pollution and its impact on health: A systematic review and meta-analysis.
Environ Res
September 2024
Article Synopsis
- - Brick kilns produce harmful emissions that negatively impact air quality and the health of nearby workers and residents, with limited evidence on the extent of these effects; a systematic review was conducted to analyze the pollution and its health consequences.
- - Out of 104 studies reviewed, the majority were from South Asia, focusing on key pollutants like particulate matter (PM), sulfur dioxide (SO), and carbon monoxide (CO), with common health issues including respiratory problems and musculoskeletal disorders among brick kiln workers.
- - The findings showed that traditional brick kilns emitted higher levels of PM and CO compared to improved designs, and while brick kiln workers generally had poorer health outcomes than unexposed individuals, the overall quality of the studies was low, indicating
Article Synopsis
- Approximately 3 billion people, mainly in low- and middle-income countries, use unclean fuels for everyday energy needs, leading to significant health issues like pneumonia and chronic lung disease.
- A multidisciplinary group conducted a review of recent trials on clean cooking interventions to combat household air pollution (HAP) and reached 14 consensus recommendations for policy makers and practitioners.
- While some interventions showed reduced exposure to HAP, there was no clear agreement on their effectiveness in improving health outcomes, highlighting the need for continued research and collaboration with policymakers.
Background: Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth.
Methods: The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda.
Article Synopsis
- Household air pollution (HAP) from solid fuel cooking is linked to negative pregnancy outcomes, and the HAPIN trial aimed to assess the effects of using LPG stoves in various countries like Guatemala, India, Peru, and Rwanda.
- The study involved 3200 pregnant women who were either assigned to use LPG stoves or kept in a control group, with regular monitoring of fetal and neonatal outcomes as well as personal exposure to pollutants like particulate matter and carbon monoxide.
- Results indicated that the LPG intervention didn't significantly lower risks of stillbirth, congenital anomalies, or neonatal mortality, nor did higher exposure levels to pollutants show a strong statistical association with these adverse outcomes.
Article Synopsis
- Household air pollution from biomass cooking fuels may contribute to stunted growth in infants, raising questions about whether switching to cleaner liquefied petroleum gas (LPG) can help reduce this risk.
- A randomized trial with 3200 pregnant women in low- and middle-income countries was conducted, comparing the impact of using LPG cookstoves against traditional biomass cookstoves on infant growth at 12 months old.
- Results showed that the intervention group using LPG had significantly lower exposure to fine particulate matter and a stunting rate of 27.4%, while the control group had a slightly higher stunting rate of 25.2%, indicating a potential benefit of switching to LPG.
Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia.
N Engl J Med
January 2024
Article Synopsis
- * Conducted between May 2018 and September 2021, the trial involved 3,195 pregnant women who were randomly assigned to use either LPG stoves (intervention group) or biomass fuel (control group), and their children's exposure to air pollution was measured.
- * Results showed a slight reduction in severe pneumonia incidents among infants in the LPG group compared to the biomass group, but the difference was not statistically significant, suggesting that while LPG reduced air pollution exposure, it did not significantly lower pneumonia rates.
Article Synopsis
- The study assessed whether providing 12 months of free liquefied petroleum gas (LPG) and behavioral support would encourage continued use and purchase after the free period ended.
- 180 women participated, with half receiving free LPG while the other half served as a control group; measurements included stove usage and in-depth interviews to assess behavior change.
- Results showed that the intervention group sustained high LPG usage (85.4% of days) post-free fuel period, but continued use was influenced by affordability, cooking habits, and access to LPG delivery services.
Elevated blood pressure (BP) is a leading risk factor for the global burden of disease. Household air pollution (HAP), resulting from the burning of biomass fuels, may be an important cause of elevated BP in resource-poor communities. We examined the exposure-response relationship of personal exposures to HAP -fine particulate matter (PM), carbon monoxide (CO), and black carbon (BC) - with BP measures in women aged 40-79 years across four resource-poor settings in Guatemala, Peru, India and Rwanda.
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- Around 3 to 4 billion people face household air pollution, which some studies link to higher blood pressure in pregnant women.
- A study involved 3,195 pregnant women from Guatemala, India, Peru, and Rwanda, comparing those who received gas stoves to those using solid fuels, analyzing blood pressure and air pollution exposure during pregnancy.
- The findings showed that the intervention group had increased blood pressure during gestation, contrary to expectations, and while higher exposure to household air pollution was linked to slightly higher blood pressure, these results were not statistically significant.
Article Synopsis
- Previous research hinted that COVID-19 severity might be lower at high altitudes, but this study investigates the relationship while accounting for factors like population density and healthcare access in Peru.
- The analysis covered 196 provinces at different altitudes up to 4,373 meters during the first wave of COVID-19, focusing on total mortality rates and their variations.
- Results show no clear trend linking higher altitude with lower COVID-19 mortality, indicating that residing at high altitude does not necessarily reduce the risk of death from the virus.
Facing the Realities of Pragmatic Design Choices in Environmental Health Studies: Experiences from the Household Air Pollution Intervention Network Trial.
Int J Environ Res Public Health
March 2022
Article Synopsis
- - The Household Air Pollution Intervention Network (HAPIN) study tested a non-drug intervention in four low- and middle-income countries to reduce household air pollution and enhance health outcomes by providing families with LPG stoves and ongoing support for 18 months.
- - Participants, made up of HAPIN investigators, evaluated the study design using a scale from very explanatory to very pragmatic, focusing on different trial aspects like recruitment and follow-up processes.
- - Results showed that only 17% of investigators viewed all design aspects as very explanatory, highlighting that many elements, especially those related to the delivery and relevance of the intervention, were considered more pragmatic by over 50% of respondents.
Inequities in air pollution exposure and gaps in air quality monitoring.
J Allergy Clin Immunol
July 2021
Article Synopsis
- - The study investigates why cigarette smoking and biomass smoke, both major risk factors for chronic obstructive pulmonary disease (COPD), result in different disease outcomes, focusing on the effects of particle size and inhalation conditions.
- - Using advanced computational modeling, researchers found that more particles from cigarette smoke deposit in the lungs compared to biomass smoke, which may explain the higher incidence of emphysema associated with smoking.
- - The research reveals significant differences in where smoke particles deposit in the lungs, with distinct patterns for cigarette and biomass smoke, highlighting a possible connection between these deposition patterns and the varying COPD phenotypes.
Article Synopsis
- The study investigated how head circumference (HC) relates to cognitive function and other risk factors in children from resource-poor settings in countries like Bangladesh, India, and South Africa.
- A cohort of 1210 children aged 0-24 months was analyzed using data on HC, weight, and cognitive development assessed through standardized tests.
- Results showed that while socioeconomic factors and maternal height positively influenced HC, no direct relationship was found between HC and cognitive abilities at different ages tested.
Exposure to high concentrations of particulate matter (PM) is associated with a number of adverse health effects. However, it is unclear which aspects of PM are most hazardous, and a better understanding of particle sizes and personal exposure is needed. We characterized particle size distribution (PSD) from biomass-related pollution and assessed total and regional lung-deposited doses using multiple-path deposition modeling.
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- Influenza viruses’ ability to spread and cause pandemics relies on their replication, survival in the environment, and initiation of infection in new hosts, but there’s limited knowledge on how they survive between hosts.
- Researchers developed a new method to isolate and study infectious H1N1 virus from respiratory droplets of infected ferrets, revealing that the virus is mainly released shortly after infection.
- A specific mutation in the virus reduced its survival in the air, while subsequent mutations allowed restabilization of a key surface protein (HA), highlighting the protein's role in the virus's survival between hosts.