RESUMO
OBJECTIVE: To document a case series of 8 young First Nations patients diagnosed with acute rheumatic fever (ARF), a preventable disease that resulted in the death of 2 patients, in northwestern Ontario in the context of late diagnosis, overcrowded housing, and inadequate public health response. DESIGN: Retrospective case series over an 18-month period. SETTING: Remote First Nations communities in northwestern Ontario. PARTICIPANTS: Eight patients with ARF. MAIN OUTCOME MEASURES: Incidence, mortality, residual rheumatic heart disease, time to diagnosis, barriers to diagnosis and treatment, housing situation of patients, patient demographic characteristics (age, sex), and investigation results. RESULTS: The incidence of ARF in this population was 21.3 per 100,000, which is 75 times greater than the overall Canadian estimated incidence. The average patient age was 9.4 years. Most cases developed joint findings, and 5 of the surviving patients had rheumatic heart disease when they received echocardiography. The average time to diagnosis was 88 days. Two 4-year-old children died from ARF. Most patients lived in inadequate and crowded housing. CONCLUSION: This rare disease still exists in remote First Nations communities. These communities demonstrate an incidence equal to that in aboriginal communities in Australia and New Zealand, which have among the highest international incidence of ARF. Primordial prevention, including improved on-reserve housing, is urgently needed. Case detection and ongoing surveillance for primary and secondary prophylaxis requires a well resourced regional strategy.
Assuntos
Febre Reumática/diagnóstico , Febre Reumática/etnologia , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Indígenas Norte-Americanos , Masculino , Ontário/epidemiologia , Características de Residência , Estudos Retrospectivos , Adulto JovemRESUMO
Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 microm (PM2.5) and the number of respiratory disease (RD)-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.
Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Incêndios , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/efeitos adversos , Asma/epidemiologia , Asma/etiologia , Asma/terapia , Biomassa , Brasil/epidemiologia , Criança , Saúde Ambiental , Feminino , Incêndios/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Concentração Máxima Permitida , Pessoa de Meia-Idade , Doenças Respiratórias/etiologia , Doenças Respiratórias/terapia , ÁrvoresRESUMO
A poluição atmosférica é um importante problema de saúde pública, principalmente na Amazônia e grandes cidades brasileiras. Em setembro de 2005, observou-se elevada concentração de fumaça em Rio Branco, Acre, devido às queimadas. Para avaliar a relação entre a concentração diária de particulate matter < 2,5 µm (PM2,5) e o número de atendimentos diários de emergência por doença respiratória (DR), desenvolveu-se estudo ecológico. A concentração de PM2,5 ultrapassou o limite de qualidade do ar durante 23 dias. Observou-se maior incidência de DR em crianças < 10 anos e correlação positiva entre a concentração de PM2,5 e atendimentos por asma.
Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 µm (PM2.5) and the number of respiratory disease (RD)-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.