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Background: The growing burden of respiratory disease, particularly in Asia, where mortality is higher and awareness and policy engagement lag, could be mitigated through rapidly advancing digital health tools that offer opportunities for improved management, prevention, and personal health empowerment. We aimed to map the existing evidence, technologies, opportunities, and gaps related to respiratory digital health interventions in South and Southeast Asia and propose relevant recommendations. Methods: We used a scoping review methodology, where we searched MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, PakMediNet, and MyMedR along with grey literature databases (ProQuest Thesis and Dissertations, Digital Health Atlas, Global Digital Health Monitor, Global Index Medicus) for reports on any technological interventions for pneumonia, tuberculosis, asthma, chronic obstructive pulmonary disease, and environmentally induced respiratory disease (air quality, smoking). We used the World Health Organization's Classification of Digital Health Interventions to categorise digital interventions and assessed how completely they were reported via the mHealth Evidence Reporting and Assessment checklist. Results: We extracted and analysed data from 87 studies conducted in 14 South and Southeast Asian countries and found that digital health interventions are primarily used for communication with patients and between patients and providers. Interventions targeting tuberculosis were the most numerous. There was a high prevalence of pilot interventions which failed to significantly address the respiratory health needs in the region. Artificial intelligence and machine learning interventions are promising, but lack clear guidelines and adherence to best ethical and equity practices. Conclusions: We collated and synthesised information and knowledge about the current state of digital health interventions. Our findings can inform future interventions so that they are planned, deployed, scaled, and evaluated to have long-lasting positive impacts on population health. Registration: Evans L, Evans J, Fletcher M, Abdullah A, Ahmed Z. Mapping Respiratory Health Digital Interventions in South and Southeast Asia: Protocol for a Scoping Review. 2024;13:e52517.

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INTRODUCTION: Poor respiratory health in childhood is common, and asthma is the most common chronic disease among children, for which there is no known cure. Maternal intake of vitamins (A, C, E) may be a modifiable nutritional exposure to reduce adverse respiratory health in offspring. OBJECTIVE: We aimed to systematically review the evidence for the association between maternal vitamin (A, C, E) intake during pregnancy (via questionnaire or blood assay) and respiratory outcomes in the offspring. METHODS: Studies identified through electronic databases were eligible if they assessed maternal levels and/or intake of vitamins A, C and/or E via dietary intake or supplements in pregnancy and respiratory outcomes in the first 5 years of life. Meta-analyses were conducted where possible. Outcomes included wheeze, cough, asthma, infant respiratory distress syndrome (RDS), respiratory tract infection (RTI) and lung function measurement. RESULTS: Of 1170 articles screened, 12 observational studies and six RCTs met the inclusion criteria (total sample size n = 58,769). Meta-analysis could not be performed for vitamin A; however, there was no evidence to suggest that maternal vitamin A intake improves early life respiratory outcomes in offspring. Two RCTs found that vitamin C supplementation (500 mg/day vs. placebo) reduced the incidence of wheeze at 12 months (n = 206 children) and 5 years (n = 213 children) in pregnancies exposed to smoking. In meta-analyses, maternal intake in the highest vitamin E quartile versus lowest reduced the odds of wheeze at 2 years by 36% (aOR: 0.64, 95% CI: 0.47-0.87, n = 2 observational studies, very low certainty); this was not true for vitamin C intake (aOR: 0.85, 95% CI: 0.63-1.16, n = 2 observational studies, very low certainty). Vitamin supplementation (C + E) was not associated with infant RDS (OR: 1.15, 95% CI: 0.80-1.64, n = 2 studies, moderate certainty) relative to placebo. CONCLUSION: There may be some benefit to vitamin C supplementation during pregnancy in the context of maternal smoking or higher maternal vitamin E intake during pregnancy, for reducing the risk of childhood wheeze in early life. This emerging evidence warrants further studies to enable translation into dietary guidelines.

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This study assessed the performance of the Institute of Occupational Medicine (IOM) and Gesamtstaubprobenahme (GSP) personal inhalable aerosol samplers in measuring aerosol and soluble protein (SP) concentrations across 12 food industry environments. A total of 193 sampling pairs (GSP and IOM) were analyzed for inhalable aerosols, and 185 sampling pairs for SP. Median aerosol concentrations ranged from 0.2 mg/m³ in snacks, nuts, and chips production to 5.6 mg/m³ in spreads production. The IOM sample had a median aerosol concentration of 1.8 mg/m³, while the GSP had a slightly lower median of 1.4 mg/m³, generally collecting 17% less inhalable aerosol than the IOM in most environments. The IOM also included wall deposits in its gravimetric determinations, contributing an additional 10-30% to the overall aerosol concentrations. For SP concentrations, the IOM measured higher aerosol concentrations in environments with a particle size distribution dominated by larger particles, while the GSP showed higher SP concentrations in environments dominated by smaller, respirable particles. The Tobit mixed-effect models showed that the IOM had statistically significantly higher aerosol concentrations compared to the GSP, but significantly lower SP concentrations than the GSP. However, these differences between the samplers were relatively small, suggesting that in occupational hygiene practices, both samplers can be used.

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Introduction: Pollution (PM2.5) exposure can result in acute respiratory illness (ARI) and anaemia in children. We aimed to investigate if antioxidant nutrient intakes could mitigate the impact of PM2.5 on child health outcomes on a national scale in India. Methods: We triangulated satellite-derived PM2.5 exposure data at the primary sampling unit level, with ARI and anaemia prevalence data from national district-level survey, and antioxidant nutrient intakes from household food expenditure survey. Logistic mixed effects regression model was used to estimate the effect of PM2.5 at different levels of nutrient intake. Results: This study included 208,782 children with valid ARI and 197,289 children with valid hemoglobin measurements. The prevalence of ARI and anaemia were 2.8% (95% CI: 2.3, 3.2) and 57.6% (95% CI: 57.2, 57.9) respectively. The intake of selected antioxidant nutrients such as vitamin C, D, and selenium, when higher than their estimated average requirement (EAR), lowered the risk of ARI associated with high PM2.5 exposure, while intakes higher than the EAR of vitamins A, C, D, zinc, and selenium similarly lowered the risk of anaemia. In terms of foods, similar benefits were observed with daily consumption of small amounts of fruits and vegetables. Conclusion: The result of this study highlights the importance of antioxidant rich balance diet for neutralizing adverse health effects of air pollution exposure to some extent till the environmental policy of the country could reduce emission of hazardous pollutants below safe level for human health.

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OBJECTIVE: Compared with other diseases with similar global burdens, little is known about how lifestyle factors other than smoking affect respiratory health, and few studies have systematically investigated the combined associations between diet and respiratory health. The aim of this research was to examine the Dietary Inflammation Index (DII), Healthy Eating Index (HEI)-2015, and individual food and nutrient associations with multiple respiratory outcomes. METHODS: This study combined a cross-sectional study with a prospective cohort study to systematically evaluate data from adults aged 40 years or older (N = 13,227) from 4 National Health and Nutrition Examination Survey cycles (2005-2006 through 2011-2012) with lung function measures in a subset (n = 6337). DII, HEI-2015, and individual foods and nutrients were evaluated for their associations with respiratory symptoms (cough, phlegm problem, wheezing, and exertional dyspnea), chronic lung disease (asthma, chronic bronchitis, and emphysema), lung function (percentage of predicted forced expiratory volume in 1 second [FEV1pp], percentage of predicted forced vital capacity [FVCpp], forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), obstructive or restrictive spirometry patterns), respiratory cancer, all-cause mortality, and respiratory disease mortality. RESULTS: For each point increase in DII, the odds of cough (adjusted odds ratio [aOR], 1.036; 95% CI, 1.002-1.071), wheezing (aOR, 1.044; 95% CI, 1.013-1.075), exertional dyspnea (aOR, 1.042; 95% CI, 1.019-1.066), emphysema (aOR, 1.096; 95% CI, 1.030-1.166), and restrictive spirometry patterns (aOR, 1.066; 95% CI, 1.007-1.128) increased and FEV1pp (adjusted mean difference [aMD], -0.525%; 95% CI, -0.747% to -0.303%) and FVCpp (aMD, -0.566%; 95% CI, -0.762% to -0.371%) decreased. HEI-2015 scores were similarly associated with these respiratory outcomes. Each point increase in the DII was associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR], 1.048; 95% CI, 1.025-1.071) and respiratory disease mortality (aHR, 1.097; 95% CI, 1.013-1.189); each increase in the HEI-2015 score was associated with a decreased risk of all-cause mortality (aHR, 0.994; 95% CI, 0.991-0.997). The multiple adequacy components recommended in the HEI (fruits, vegetables, whole grains, seafood and plant proteins, and monounsaturated fatty acids) were associated with better respiratory outcomes; the moderation components of restricting refined grains, sugars, and saturated fats were associated with better respiratory outcomes, but restricting sodium intake was associated with increased respiratory symptoms. CONCLUSIONS: The results of this study suggest that a low-inflammatory diet and a healthy diet are consistently associated with better respiratory outcomes. These findings support the potential benefits of a "Food Is Medicine" strategy for respiratory health.

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The aim is to identify and map studies on spiritual interventions in individuals with, or undergoing prevention of, more lethal chronic non-communicable diseases. A scoping review following the recommendations of the Joanna Briggs Institute and the PRISMA extension for scoping reviews was conducted in search of studies published from 2000 onwards on the influence of spiritual interventions on chronic cardiovascular and respiratory diseases, diabetes mellitus and cancer. Of the 1,564 studies identified, 26 experimental or quasi-experimental studies published between 2000 and 2022 were eligible, covering eight modalities of spiritual intervention and a total population of 3,103 participants. The influence of spirituality on cardiovascular diseases was addressed in 16.0% of those studies; on diabetes mellitus, in 11.5%; and on cancer, in 73.0%. No results were found relating to respiratory diseases. Spiritual care was found to have positive effects on the physical, mental, and spiritual health of individuals with chronic illnesses. It is suggested that specific modalities of intervention be studied for associations with participants' spirituality; this important object of investigation may afford the possibility of enhancing gains by these interventions.

O objetivo é identificar e mapear estudos sobre intervenções espirituais em indivíduos com ou em prevenção de doenças crônicas não transmissíveis de maior letalidade. Realizada revisão de escopo sob recomendações do Instituto Joanna Briggs e extensão PRISMA para scoping review, em busca de estudos publicados a partir do ano 2000 sobre a influência de intervenções espirituais nas doenças crônicas cardiovasculares, respiratórias, diabetes Mellitus e câncer. Foram identificados 1.564 estudos e elegíveis 26, do tipo experimentais ou quase-experimentais, publicados entre os anos de 2000 a 2022, com uma população de 3.103 participantes, distribuída entre oito modalidades de intervenção espiritual. A influência da espiritualidade nas doenças cardiovasculares foi apresentada em 16,0% dos estudos, no Diabetes Mellitus em 11,5% e no câncer em 73,0%, sem resultados relativos às doenças respiratórias. Identificados efeitos positivos da assistência espiritual na saúde física, mental e espiritual de indivíduos com doenças crônicas. Sugere-se a realização de estudos com modalidades específicas de intervenção, associando-as à avaliação da espiritualidade de seus participantes; importante objeto de investigação, pela possibilidade de interferir ou não nos ganhos das referidas intervenções.

El objetivo es identificar y mapear estudios sobre intervenciones espirituales en individuos con o en prevención de enfermedades crónicas no transmisibles de mayor letalidad. Se realizó una revisión de alcance bajo las recomendaciones del Instituto Joanna Briggs y la extensión PRISMA para scoping review, buscando estudios publicados a partir del año 2000 sobre la influencia de intervenciones espirituales en enfermedades crónicas cardiovasculares, respiratorias, diabetes mellitus y cáncer. Se identificaron 1.564 estudios y fueron elegibles 26 estudios experimentales o cuasiexperimentales, publicados entre 2000 y 2022, con una población de 3.103 participantes, distribuidos en ocho modalidades de intervención espiritual. La influencia de la espiritualidad en las enfermedades cardiovasculares se presentó en el 16,0% de los estudios, en la diabetes mellitus en el 11,5% y en el cáncer en el 73,0%, sin resultados relativos a enfermedades respiratorias. Fueron identificados efectos positivos de la atención espiritual en la salud física, mental y espiritual de los individuos con enfermedades crónicas. Se sugiere la realización de estudios con modalidades específicas de intervención, asociándolas a una evaluación de la espiritualidad de sus participantes; importante objeto de investigación, debido a la posibilidad de interferir o no en las ganancias de esas intervenciones.

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Intramuscular vaccines present limitations in eliciting robust mucosal immunity and preventing respiratory pathogens transmission. Sublingual vaccine administration offers promising advantages, including interconnected mucosal protection. Despite these advantages, only a few clinical trials have explored sublingual vaccines, underscoring the necessity of optimizing next-generation vaccine formulas. Critical research priorities include understanding vector behavior in the oral environment, understanding their interactions with mucosal immunity and developing formulations enabling sustained mucosal contact to facilitate efficient transduction. Consequently, tonsil organoids, as representative human mucosal models, could offer critical insights into sublingual immunization. Thus, a multi-disciplinary approach integrating pharmacological, immunological, and manufacturing considerations is pivotal for sublingual vaccines in targeting pathogen-aggravated prevalent respiratory diseases including asthma, COPD and lung cancer, as well as the antimicrobial resistance crisis.

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Informe sobre el objetivo del abordaje de estas patologías, desde el Ministerio de Salud de la Ciudad de Buenos Aires: Medidas de prevención; Priorización de diagnóstico; Estrategia integrada de vigilancia de la Infecciones Respiratorias Agudas de posible origen viral; Vigilancia Universal; Vigilancia epidemiológica de coqueluche (tos convulsa); y Recomendaciones sobre el uso de antivirales para influenza; (AU)

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Respiratory diseases remain a major cause of morbidity and mortality worldwide. An imbalance of zinc, an essential trace element, is associated with a variety of lung diseases. We reviewed and summarized recent research (human subjects, animal studies, in vitro studies) on zinc in respiratory diseases to explore the protective mechanism of zinc from the perspective of regulation of oxidative stress, inflammation, lipid metabolism, and apoptosis. In the lungs, zinc has anti-inflammatory, antioxidant, and antiviral effects; can inhibit cancer cell migration; can regulate lipid metabolism and immune cells; and exerts other protective effects. Our comprehensive evaluation highlights the clinical and experimental effects of zinc in the pathogenesis of respiratory diseases. Our analysis also provides insight into the clinical application of zinc-targeted therapy for respiratory diseases.

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Respiratory diseases, including bronchial asthma in children and adolescents, constitute a global public health problem. Educational strategies are an important tool for their control. OBJECTIVE: To evaluate the impact of a health literacy program for the care and self-management of respiratory diseases and bronchial asthma after five years of implementation. PATIENTS AND METHOD: Prospective cohort study, non-probabilistic sample, and consecutive selection of patients < 17 years of age with asthma, recurrent bronchial obstructive syndrome, recurrent wheezing, or bronchiolitis, referred to the respiratory diseases literacy program in a pediatric hospital in Colombia during 2015-2020. Clinical, drug use, epidemiological history, risk exposures, and individual well-being data were collected. The impact was evaluated with the indicator of admission to the emergency room for resolution of respiratory crises, knowledge of the disease, and general well-being six months after leaving the program. RESULTS: 2841 patients were included, mean age 7 years, 55% were male, and 86% had previous management by a pediatrician. 54% of a sedentary lifestyle, 48% of adherence to treatment, 66% of prevalence of at-home risk factors, and 11% of tobacco smoke exposure were detected. On leaving the program, parents reported good knowledge of the disease (99.7%), with a decrease in the number of admissions to the emergency department for crisis management from 25.4% to 6.3%. Health wellbeing showed an increase in the absence of negative feelings of sadness, upset, or anxiety generated by cough attacks from 53.3% to 72.5% (p = 0.006), sleep disturbances decreased by 20% (p = 0.059), the practice of physical activity increased by 14.6% (p = 0.030), and the feeling that the disease no longer controlled the lives of parents and children increased from 59% to 75.9% (p = 0.113). CONCLUSIONS: The literacy program improved health outcomes, general well-being, and empowered and promoted better self-management skills in children and caregivers.

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Migrant interior construction workers are increasing in China. Construction workers are at an increased risk of work-related illness (WRI) due to prolonged exposure to and inhalation of dust. Dust concentrations in the air can be reduced significantly with effective respiratory protection measures. We assessed the dust exposure and factors associated with respiratory protection of migrant interior construction workers. The total dust concentration in the workplace ranged from 0.07 to 335.27 mg/m3, with a total dust exceedance rate of 50.00%. The respiratory dust loading ranged from 0.03 to 220.27 mg/m3, with a respiratory dust exceedance rate of 71.42 %. The highest total dust concentration occurred when masons were polishing cement walls. We performed a questionnaire survey of 296 persons in two cities in China, in which 87.84% had no respiratory protection or only one protection measure. Gender, workplace, respiratory disease, and protective attitude all had an effect on the level of respiratory protection. The dust exposure in most jobs exceeds hygiene standards. The respiratory protection of migrant interior construction workers in China is inadequate.

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Contexto: A respiração é regulada por um complexo processo fisiológico que pode ser afetado em algumas patologias. No Brasil, a mortalidade por doenças respiratórias em relação ao total de mortes foi de 6%, no ano de 2016. Dados do período de 1995 a 2005 indicam que as doenças do aparelho respiratório estiveram entre as principais causas de internação do Sistema Único de Saúde (SUS) em todas as regiões brasileiras. A atividade física (AF) pode beneficiar a saúde de indivíduos com diagnóstico de problemas respiratórios, já que a prática regular permite a manutenção dos volumes e das capacidades respiratórias, diminuindo a restrição do movimento pela rigidez da caixa torácica e da coluna vertebral, além de manter a capacidade funcional e promover o bem-estar geral. Pergunta de pesquisa: A prática de atividade física é efetiva para a melhoria da capacidade respiratória e do desempenho das atividades de vida diária de usuários de serviços de saúde com diagnóstico de patologias respiratórias? Método: As buscas foram realizadas em quatro bases de literatura científica para identificar revisões sistemáticas (RS) sobre os efeitos da prática de AF na saúde de pessoas com doenças respiratórias. A qualidade metodológica das RS foi avaliada com a ferramenta AMSTAR 2. Resultados: De 1.045 registros recuperados nas bases, 21 revisões sistemáticas foram selecionadas para esta revisão rápida. Com relação à qualidade metodológica, três RS foram classificadas como de confiança alta, uma de confiança moderada, cinco de confiança baixa e doze de confiança criticamente baixa. Os dados extraídos das RS são apresentados conforme a condição da doença respiratória avaliada. Efeito de AF em pessoas com doença pulmonar obstrutiva crônica (DPOC): Onze RS analisaram AF em pessoas com DPOC ou obstrução crônica das vias aéreas. Oito indicaram que a maioria dos desfechos avaliados não apresentaram diferenças significativas ou foram incertos entre os grupos com AF combinando exercícios aeróbicos e anaeróbicos e o comparador. Três RS analisando apenas exercícios aeróbicos apontaram maioria de efeitos positivos dessa modalidade de AF em alguns desfechos de saúde dessas pessoas. Efeito de AF em pessoas com hipertensão pulmonar: Três RS utilizando exercícios combinados indicaram efeitos benéficos. Uma RS apresentou resultados incertos em relação à qualidade de vida. Efeito de AF em pessoas com fibrose pulmonar: Duas RS combinaram exercícios aeróbicos e anaeróbicos indicaram efeito positivo ou incerto para qualidade de vida. Houve efeitos positivos nos desfechos de distância de caminhada (DTC6), capacidade de exercício e dispneia, e efeitos incertos no pico de volume de oxigênio (pico de VO2) e no volume expiratório forçado no primeiro segundo e nenhuma diferença na participação em AF. Efeito de AF em pessoas com bronquiectasia: Uma RS apontou efeitos positivos de exercícios combinados para DTC6, qualidade de vida, distância incremental da caminhada, exacerbação de bronquiectasia, dispneia e fadiga. Indicou que não houve diferença de efeito entre os grupos para tosse. Efeito de AF em pessoas com câncer de pulmão de células não pequenas: Três RS apontaram que os efeitos foram em sua maioria positivos para pico de VO2 e DTC6. Houve efeitos inconclusivos para a melhora na qualidade de vida. Efeito de AF em pessoas com sarcoidose pulmonar: Uma RS indicou efeitos positivos para fadiga, força muscular e DTC6 de programas de tratamentos de reabilitação para pessoas com sarcoidose pulmonar. Segurança de AF para pessoas com doenças respiratórias: Cinco RS apresentaram resultados de eventos adversos. De modo geral, elas indicaram que as intervenções de AF foram seguras para pessoas com patologias respiratórias. Considerações finais: A atividade física mostrou relação com a melhoria da capacidade respiratória e física de pessoas com doenças respiratórias. Deve-se considerar, no entanto, as limitações metodológicas da maioria das RS incluídas, a heterogeneidade de intervenções e comparadores, além da escassez de estudos para algumas das condições de saúde.

Context: Breathing is regulated by a complex physiological process that can be affected in some pathologies. In Brazil, mortality from respiratory diseases in relation to total deaths was 6% in 2016. Data from 1995 to 2005 indicate that respiratory diseases were among the main causes of hospitalization in the Unified Health System (SUS) in all Brazilian regions. Physical activity (PA) can benefit the health of individuals diagnosed with respiratory problems, since regular practice allows for the maintenance of respiratory volumes and capacities, reducing movement restriction due to the rigidity of the rib cage and spine, in addition to maintain functional capacity and promote general well-being. Research question: Is the practice of physical activity effective for improving respiratory capacity and the performance of activities of daily living of users of health services diagnosed with respiratory pathologies? Method: Searches were carried out in four scientific literature databases to identify systematic reviews (SR) on the effects of PA practice on the health of people with respiratory diseases. The methodological quality of the SRs was evaluated using the AMSTAR 2 tool. Results: Of 1045 records retrieved from the databases, 21 systematic reviews were selected for this rapid review. Regarding methodological quality, three RS were classified as high confidence, one as moderate confidence, five as low confidence and twelve as critically low confidence. The data extracted from the RS are presented according to the condition of the respiratory disease evaluated. Effect of PA in people with chronic obstructive pulmonary disease (COPD): Eleven RS analyzed PA in people with COPD or chronic airway obstruction. Eight indicated that most of the outcomes evaluated did not show significant differences or were uncertain between the groups with PA combining aerobic and anaerobic exercises and the comparator. Three SRs analyzing only aerobic exercises showed the majority of positive effects of this PA modality on some health outcomes of these people. Effect of PA in people with pulmonary hypertension: Three RS using combined exercises indicated beneficial effects. One SR presented uncertain results in relation to quality of life. Effect of PA in people with pulmonary fibrosis: Two RS combined aerobic and anaerobic exercise indicated a positive or uncertain effect for quality of life. There were positive effects on outcomes of walking distance (6MWD), exercise capacity and dyspnea, and uncertain effects on peak oxygen volume (peak VO2) and forced expiratory volume in one second and no difference in PA participation. Effect of PA in people with bronchiectasis: An RS showed positive effects of combined exercise for 6MWD, quality of life, incremental walking distance, exacerbation of bronchiectasis, dyspnea and fatigue. It indicated that there was no difference in effect between the cough groups. Effect of AF in people with non-small cell lung cancer: Three RS showed that the effects were mostly positive for peak VO2 and 6MWD. There were inconclusive effects for improvement in quality of life. Effect of AF in people with pulmonary sarcoidosis: An RS indicated positive effects for fatigue, muscle strength and 6MWD of rehabilitation treatment programs for people with pulmonary sarcoidosis. Safety of PA for people with respiratory diseases: Five RS showed adverse event results. Overall, they indicated that PA interventions were safe for people with respiratory conditions. Final considerations: Physical activity showed a relationship with the improvement of respiratory and physical capacity of people with respiratory diseases. However, one should consider the methodological limitations of most of the SRs included, the heterogeneity of interventions and comparators, in addition to the scarcity of studies for some of the health conditions.

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BACKGROUND: Smoke-free policies in outdoor areas and semi-private and private places (eg, cars) might reduce the health harms caused by tobacco smoke exposure (TSE). We aimed to investigate the effect of smoke-free policies covering outdoor areas or semi-private and private places on TSE and respiratory health in children, to inform policy. METHODS: In this systematic review and meta-analysis, we searched 13 electronic databases from date of inception to Jan 29, 2021, for published studies that assessed the effects of smoke-free policies in outdoor areas or semi-private or private places on TSE, respiratory health outcomes, or both, in children. Non-randomised and randomised trials, interrupted time series, and controlled before-after studies, without restrictions to the observational period, publication date, or language, were eligible for the main analysis. Two reviewers independently extracted data, including adjusted test statistics from each study using a prespecified form, and assessed risk of bias for effect estimates from each study using the Risk of Bias in Non-Randomised Studies of Interventions tool. Primary outcomes were TSE in places covered by the policy, unplanned hospital attendance for wheezing or asthma, and unplanned hospital attendance for respiratory tract infections, in children younger than 17 years. Random-effects meta-analyses were done when at least two studies evaluated policies that regulated smoking in similar places and reported on the same outcome. This study is registered with PROSPERO, CRD42020190563. FINDINGS: We identified 5745 records and assessed 204 full-text articles for eligibility, of which 11 studies met the inclusion criteria and were included in the qualitative synthesis. Of these studies, seven fit prespecified robustness criteria as recommended by the Cochrane Effective Practice and Organization of Care group, assessing smoke-free cars (n=5), schools (n=1), and a comprehensive policy covering multiple areas (n=1). Risk of bias was low in three studies, moderate in three, and critical in one. In the meta-analysis of ten effect estimates from four studies, smoke-free car policies were associated with an immediate TSE reduction in cars (risk ratio 0·69, 95% CI 0·55-0·87; 161 466 participants); heterogeneity was substantial (I2 80·7%; p<0·0001). One additional study reported a gradual TSE decrease in cars annually. Individual studies found TSE reductions on school grounds, following a smoke-free school policy, and in hospital attendances for respiratory tract infection, following a comprehensive smoke-free policy. INTERPRETATION: Smoke-free car policies are associated with reductions in reported child TSE in cars, which could translate into respiratory health benefits. Few additional studies assessed the effect of policies regulating smoking in outdoor areas and semi-private and private places on children's TSE or health outcomes. On the basis of these findings, governments should consider including private cars in comprehensive smoke-free policies to protect child health. FUNDING: Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation, Netherlands Thrombosis Foundation, and Health Data Research UK.

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Background: In southern Chile cities, the emission of air pollutants, especially the use of firewood for heating is restricted during critical air pollution periods. Aim: To analyze how restrictions applied during the management of air pollution critical episodes have contributed to reduce emergency room admissions for respiratory diseases in two Chilean cities between 2013 and 2019. Material and Methods: Poisson regression models were estimated with daily data including explanatory variables, such as the daily and lag concentration of respirable particulate material (PM10), temperature, relative humidity, rainfall, wind speed, seasonal factors, and implementation of different types of critical episodes. Results: The implementation of restrictions during the management of critical pollution episodes decreased emergency room admissions for upper respiratory infections and bronchial obstructive crises, especially when an environmental emergency was decreed during the critical episode. However, the effect on each group of respiratory diseases was heterogeneous between cities, which could be related to avoidance behavior, indoor air pollution, the composition of PM10, or the presence of other pollutants, and not just a reduction in the daily concentration of PM10. Conclusions: The management of critical pollution episodes with restrictions to pollutant emissions is a useful measure to improve population health in cities that have implemented environmental decontamination plans.

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El uso de las herramientas tecnológicas en salud permite llegar a puntos geográficos donde la medicina tradicional traza una brecha entre las instituciones de salud y los pacientes. Estas tecnologías pueden llegar a reducir las tasas de inasistencia médica, aumentar la adherencia al tratamiento y ayudar a garantizar la frecuencia apropiada de las visitas médicas. El presente trabajo se propuso realizar una revisión de la literatura sobre el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno, a través de herramientas tecnológicas. Se realizó una búsqueda en las bases de datos Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, con descriptores tipo Medical Subject Headings (MeSH) y Descriptores en Ciencias de la Salud (DeCS). El análisis de la literatura se realizó por medio de los elementos Strobe, Amstar. A partir de los estudios incluidos en el análisis final se puede evidenciar que la tecnología móvil en salud se ha convertido en una herramienta de gran importancia en el seguimiento y control de pacientes con enfermedades respiratorias, lo cual proporciona en tiempo real datos que pueden ser usados para minimizar complicaciones y ampliar la oportunidad de atención con calidad en pacientes con problemas respiratorios. No obstante, es necesaria la realización de ensayos clínicos que determinen los beneficios clínicos, al utilizar las herramientas tecnológicas en esta área(AU)

The use of technological tools in health allows reaching geographical points where traditional medicine draws a gap between health institutions and patients. These technologies can reduce medical absence rates, increase adherence to treatment, and help ensure the appropriate frequency of medical visits. In the present work it was proposed to carry out a review of the literature on the control and follow-up in patients with oxygen and respiratory diseases through technological tools. A search was carried out in the databases Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, with descriptors such as Medical Subject Headings (MeSH) and Descriptors in Health Sciences (DeCS). The analysis of the literature was carried out using the elements Strobe, Amstar. From the studies included in the final analysis, it can be evidenced that mobile health technology has become a very important tool in the monitoring and control of patients with respiratory diseases, which provides data in real time that They can be used to minimize complications and expand the opportunity for quality care in patients with respiratory problems, however, it is necessary to carry out clinical trials to determine the clinical benefits, when using technological tools in this area(SU)

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O Estado do Rio de Janeiro vem monitorando a evolução das variantes da Covid-19 por meio de três processos de seleção de amostras. O primeiro é o monitoramento realizado pelos municípios que notifica e solicita o sequenciamento, seguindo os critérios e fluxos descritos na Nota técnica da SES-RJ Nº 09/2021. O segundo faz parte da Vigilância Genômica organizada pelo Ministério da Saúde, onde três amostras aleatórias são enviadas pelo Lacen/RJ para FUNED/MG, de acordo com os critérios estabelecidos pela SVS/ FUNED. O terceiro é através de um estudo com financiamento da Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) que iniciou em março de 2021 e irá realizar a genotipagem de um total de 4.800 amostras nos próximos seis meses, sendo 400 a cada 15 dias. Por fim, a Secretaria de Estado de Saúde tem envidado esforços em ações de redução de risco, como a vacinação, ampliação de testagem, monitoramento genômico e promoção de saúde em todo o estado do Rio de Janeiro. E é recomendado manter as medidas de proteção à vida: como evitar aglomeração, usar de máscara, lavar as mãos e fazer higienização das mãos com álcool 70°.

RESUMEN

BRD is associated with infectious agents, but management and transport-stress are trigger factors. Metaphylactic administration of antimicrobial reduces colonization of respiratory tract by pathogens, but the development of antibiotic-resistance raises public health concerns leading to propose new control strategies. The study analyzed nasopharyngeal swabs of 231 imported cattle, 10% of 49 trucks, transported from France to southern Italy and, through Real-time PCR identified the prevalence of the involved pathogens speculating on strategies to reduce the impact of BRD. The samples were tested by Real-time PCR, for the detection of bovine coronavirus (BCoV), bovine respiratory syncytial virus (BRSV), bovine parainfluenza virus (BPiV), bovine adenovirus (BAdV), Mannheimia haemolytica, Pasteurella multocida, Histophilus somni, and Mycoplasma bovis. Yates-corrected chi squared, or Fisher's exact test were used to compare both animal-health status and positivity/negativity to pathogens, and the relationship between presence/absence of clinical signs and Real-time PCR-positivity. H. somni and BCoV were the most frequently identified pathogens. In BRD-diagnosed cattle, BAdV was detected in 13.8% (19/138), BRSV in 14.5% (20/138) and BPiV in 4.3% (6/138). Healthy cattle were mostly positive for H. somni (89.2%, 83/93). A statistically significant association was observed between clinical signs and positivity to M. haemolytica (p value = 0.016). Although mass-medication and vaccination are used for BRD control, it still remains a primary health problem. Our results highlight that the nasopharyngeal microbiota could be affected by transport and that strategies to enhance calf immunity for reducing BRD-risk development would be more effective if applied at farm of origin prior to loading.