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1.
Aust J Rural Health ; 30(5): 697-701, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35384106

RESUMO

OBJECTIVE(S): The objective of the study was to validate a clinical aid to guide the assessment and management of a patient's listed beta-lactam antibiotic allergy for use in rural areas of Australia. DESIGN: Rural generalists, pharmacists and junior doctors completed an online assessment of eight patient case studies using the tool. SETTING: The study was conducted in the Southern Downs, QLD. PARTICIPANTS: Twenty-seven rural generalists, nine pharmacists and eight junior doctors. MAIN OUTCOME MEASURES: The sensitivity of the selected allergy phenotype and management option for each case study was calculated by profession and overall. Hazardous responses were reported by management category and profession. RESULTS: The sensitivity overall for phenotype selection was 82.4% (95% CI, 78.0-86.2) and for management 88.1% (95% CI, 84.2-91.2). The sensitivity for phenotype selection was lower for junior doctors than other professions 73.4% (95% CI, 60.9-83.7), but did not reach statistical significance (p = 0.08). A total of 10/308 responses for management recommended the least restrictive option of direct delabelling or oral challenge, where the correct answer was skin prick testing or referral to an allergist. CONCLUSION(S): With further education the tool could be a key component of increased antimicrobial stewardship in rural areas in Australia.


Assuntos
Hipersensibilidade a Drogas , Penicilinas , Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Humanos , Farmacêuticos , Testes Cutâneos
2.
Environ Res ; 178: 108613, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31450144

RESUMO

Environmental and behavioural factors assessed via an online questionnaire were compared to insecticide metabolite concentrations in urine collected from 61 children from South East Queensland, Australia. Metabolite concentrations (µg/L urine) were transformed using the natural logarithm prior to regression analysis and adjusted for age and creatinine. A significant dietary association was reported for vegetable intake and 3-phenoxybenzoic acid (3-PBA) (ß: 1.47 for top quartile of intake versus bottom quartile of intake 95% CI: 0.36, 2.57). Intake of vegetables and fruit were also positively associated with sum non-specific organophosphate metabolites (Æ©nsOP). Æ©nsOP concentrations were lower when fruits and vegetables were always or almost always washed prior to cooking or eating (ß: -0.69 95% CI: -1.25, -0.12). In multivariable modelling 3-PBA concentrations were also associated with hand-washing frequency (ß: 1.69 95% CI: 0.76, 2.61 for <1 day versus > 3 day), presence of a dog in the home (ß: 0.73 95% CI: 0.07, 1.38), frequency of pest-spray use in the summer months (ß: 0.88 95% CI: 0.22, 1.54 weekly versus less than weekly) and season (ß: 0.88 95% CI: 0.32, 1.44 for spring/summer versus winter/autumn). This is the first study in Australia to report dietary, behavioural and environmental factors associated with biomarkers of insecticide exposure in young children.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Poluentes Ambientais/urina , Inseticidas/urina , Animais , Austrália , Biomarcadores , Criança , Pré-Escolar , Cães , Humanos , Piretrinas/urina , Queensland , Inquéritos e Questionários
3.
Environ Res ; 164: 262-270, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29525639

RESUMO

In recent years, the production and usage volumes of organophosphate flame retardants (OPFRs) has increased substantially. Certain OPFRs are suspected reproductive toxins, carcinogenic, and neurotoxic. Insufficient information is available on human exposure pathways to these chemicals, particularly in Australia. We aim to assess the association between OPFR concentrations in the urine of children to environmental and behavioural risk factors. Concentrations of eight OPFRs and eleven metabolites were measured in the urine of 51 children, aged 3-29 months, in Southeast Queensland, Australia and compared to their behavioural and environmental risk factor data obtained by an online questionnaire. Of the 11 OPFR metabolites analysed, 55% were frequently detected in the majority (> 80%) of samples. The most frequently detected metabolite was bis(1,3-dichloroisopropyl) phosphate (BDCIPP) (detected in 100% of samples), followed by 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP) (96%), diphenyl phosphate (DPHP) (94%) and bis(1-chloroisopropyl) phosphate (BCIPP) (86%). In multivariable modelling, age was positively associated with concentrations of bis(2-butoxyethyl) phosphate (BBOEP) and negatively associated with concentrations of BCIPP and BCIPHIPP. Other non-age related factors, including vacuuming frequency, hand-washing frequency and presence and number of some electrical appliances in the home were also associated with concentrations of OPFR metabolites.


Assuntos
Exposição Ambiental , Retardadores de Chama , Plastificantes , Austrália , Criança , Pré-Escolar , Retardadores de Chama/análise , Humanos , Lactente , Organofosfatos , Plastificantes/análise , Queensland , Urinálise
4.
Environ Res ; 158: 669-676, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28734253

RESUMO

The aim of our study was to investigate children's exposure to the flame retardants polybrominated diphenyl ethers (PBDEs) by analysing faecal content, a non-invasive matrix, as well as responses to an exposure-assessment questionnaire. A convenience sample of 61 parents with children (aged >3 months to <2 years) completed an online pre-tested questionnaire and provided faecal samples for analysis by high resolution gas chromatography/mass spectrometry. BDE-209 was the dominant congener in faecal samples adjusted to 8.3ng/g dry weight (dw), with >80% samples above the limit of detection (LOD). BDE-47 (0.23ng/g dw) and BDE-153 (0.03ng/g dw) were each detected above the LOD in approximately 60% of samples. Age was associated with BDE-47 (-7%/month) and BDE-153 (-12%/month) concentrations in faeces, but not BDE-209. Other variables associated with PBDE concentrations included features of the home (carpet, pets) and behaviour (hand-to-mouth, removing shoes, using a car sunshade, frequency of walks outdoors). However, given the small sample size of this study additional research is required to confirm these findings. In this study we demonstrated that faeces may be a viable alternative to monitor human exposure to PBDEs, but further validation studies are required.


Assuntos
Exposição Ambiental , Poluentes Ambientais/análise , Fezes/química , Retardadores de Chama/análise , Éteres Difenil Halogenados/análise , Monitoramento Ambiental , Poluentes Ambientais/metabolismo , Feminino , Retardadores de Chama/metabolismo , Cromatografia Gasosa-Espectrometria de Massas , Éteres Difenil Halogenados/metabolismo , Humanos , Lactente , Masculino , Queensland
5.
Rev Environ Health ; 30(1): 25-49, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25719288

RESUMO

BACKGROUND: Although infants and young children are particularly vulnerable to endocrine disrupting chemical (EDC) exposure, there is an absence of comprehensive exposure data for this age group. As young children spend the majority of their time indoors, improved methods of exposure assessment are needed to characterise the health risks from exposures in the home environment. Biologic assessment, which has been considered the gold standard for exposure assessment in recent years, is difficult to conduct in young children. Questionnaires are an alternative and indirect method of predicting exposure, which may overcome some of the limitations of direct exposure assessment. RESEARCH PROBLEM: The feasibility of using a questionnaire-based approach to predict exposure of young children to EDCs in the home has yet to be comprehensively reviewed. Moreover, there is no one questionnaire that has been validated for predicting the exposure of infants to common EDCs in the home. AIMS AND OBJECTIVES: The aim of this review is to discuss the use and validation of the questionnaire-based approach to predict exposure of children to chemicals from three common classes of EDCs in the home, namely, plasticisers, flame retardants, and insecticides. We discuss the strengths and weaknesses of the questionnaire-based approach as well as the important pathways of exposure in the home environment, by which to guide the design and validation of future exposure questionnaires. RESULTS: The findings from our review indicate that the questionnaire-based approach is a valuable tool in the prediction of exposure to persistent organic pollutants, as well as to toxicants that have consistent patterns of exposure. With improvements to the design and validation process, the questionnaire-based approach may also prove to be a reliable instrument in predicting exposure to EDCs with short-half lives, including bisphenol A, phthalates, and pyrethroid and organophosphate insecticides.


Assuntos
Disruptores Endócrinos/toxicidade , Exposição Ambiental , Poluentes Ambientais/toxicidade , Criança , Pré-Escolar , Coleta de Dados , Humanos , Fatores de Risco , Inquéritos e Questionários
6.
Environ Pollut ; 235: 670-679, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29339336

RESUMO

Concentrations of nine organophosphate flame retardants (OPFRs) and eight polybrominated diphenyl ethers (PBDEs) were measured in samples of indoor dust (n = 85) and air (n = 45) from Australian houses, offices, hotels, and transportation (buses, trains, and aircraft). All target compounds were detected in indoor dust and air samples. Median ∑9OPFRs concentrations were 40 µg/g in dust and 44 ng/m3 in indoor air, while median ∑8PBDEs concentrations were 2.1 µg/g and 0.049 ng/m3. Concentrations of FRs were higher in rooms that contained carpet, air conditioners, and various electronic items. Estimated daily intakes in adults are 14000 pg/kg body weight/day and 330 pg/kg body weight/day for ∑9OPFRs and ∑8PBDEs, respectively. Our results suggest that for the volatile FRs such as tris(2-chloroethyl) phosphate (TCEP) and TCIPP, inhalation is expected to be the more important intake pathway compared to dust ingestion and dermal contact.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Retardadores de Chama/análise , Organofosfatos/análise , Adolescente , Adulto , Idoso , Austrália , Criança , Pré-Escolar , Poeira/análise , Exposição Ambiental , Monitoramento Ambiental , Éteres Difenil Halogenados/análise , Halogenação , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem
7.
Environ Int ; 107: 82-88, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28689110

RESUMO

Early-childhood biomonitoring of persistent organic pollutants (POPs) is challenging due to the logistic and ethical limitations associated with blood sampling. We investigated using faeces as a non-invasive matrix to estimate internal exposure to POPs. The concentrations of selected POPs were measured in matched plasma and faecal samples collected from 20 infants/toddlers (aged 13±4.8months), including a repeat sample time point for 13 infants (~5months apart). We observed higher rates of POP quantification in faeces (2g dry weight) than in plasma (0.5mL). Among the five chemicals that had quantification frequencies over 50% in both matrices, except for HCB, log concentration in faeces (Cf) and blood (Cb) were correlated (r>0.74, P<0.05) for p.p'-dichlorodiphenyldichloroethylene (p,p'-DDE), 2,3',4,4',5-pentachlorobiphenyl (PCB118), 2,2',3,4,4',5'-pentachlorobiphenyl (PCB138) and 2,2',4,4',5,5'-pentachlorobiphenyl (PCB153). We determined faeces:plasma concentration ratios (Kfb), which can be used to estimate Cb from measurements of Cf for infants/toddlers. For a given chemical, the variation in Kfb across individuals was considerable (CV from 0.46 to 0.70). Between 5% and 50% of this variation was attributed to short-term intra-individual variability between successive faecal samples. This variability could be reduced by pooling faeces samples over several days. Some of the remaining variability was attributed to longer-term intra-individual variability, which was consistent with previously reported observations of a decrease in Kfb over the first year of life. The strong correlations between Cf and Cb demonstrate the promise of using faeces for biomonitoring of these compounds. Future research on the sources of variability in Kfb could improve the precision and utility of this technique.


Assuntos
Poluentes Ambientais/análise , Poluentes Ambientais/sangue , Fezes/química , Pré-Escolar , Método Duplo-Cego , Monitoramento Ambiental/métodos , Feminino , Éteres Difenil Halogenados/análise , Éteres Difenil Halogenados/sangue , Humanos , Hidrocarbonetos Clorados/análise , Hidrocarbonetos Clorados/sangue , Lactente , Masculino
8.
Aust N Z J Public Health ; 40(5): 457-461, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27524790

RESUMO

OBJECTIVE: Data from the Queensland Poisons Information Centre (QPIC) was assessed to determine mechanisms of acute insecticide poisoning in young children (<5 years) and whether age affects insecticide-poisoning patterns. METHODS: Records of all insecticide-related calls placed to QPIC in 2014 were obtained. A stratified analysis of call patterns by age was conducted. RESULTS: Of 743 insecticide-related calls received by QPIC 364 (49.0%) were for young children. The number of calls peaked in children aged one. Ant and cockroach baits accounted for 39.0% of calls. Sprays, which were found to contain not only pyrethroids, pyrethrins and/or piperonly butoxide but also the organophosphate diazinon, accounted for 25.8% of calls. Mouthing or ingesting a pest-control product and consuming an item/insect after treatment were common mechanisms for children under the age of two. Topical exposure to sprays, via direct application, typically by the child or an older sibling, peaked in children aged two. In 12.3% of calls medical attention for the child was already sought or advised by QPIC. CONCLUSION: Normal behaviours associated with child development, particularly mouthing behaviours, explained the peak of exposure in one-year-olds. This finding should guide strategies to minimise poisonings in this vulnerable population.


Assuntos
Centros de Informação , Inseticidas/intoxicação , Distribuição por Idade , Pré-Escolar , Inibidores da Colinesterase/intoxicação , Humanos , Lactente , Queensland
9.
J Hazard Mater ; 320: 194-203, 2016 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-27544732

RESUMO

The commercial polybrominated diphenyl ether (PBDE) flame retardant mixture c-decaBDE is now being considered for listing on the Stockholm Convention on Persistent Organic Pollutants. The aim of our study was to review the literature regarding the use and detection of BDE-209, a major component of c-decaBDE, in consumer products and provide a best estimate of goods that are likely to contain BDE-209 in Australia. This review is part of a larger study, which will include quantitative testing of items to assess for BDE-209. The findings of this desktop review will be used to determine which items should be prioritized for quantitative testing. We identified that electronics, particularly televisions, computers, small household appliances and power boards, were the items that were most likely to contain BDE-209 in Australia. Further testing of these items should include items of various ages. Several other items were identified as high priority for future testing, including transport vehicles, building materials and textiles in non-domestic settings. The findings from this study will aid in the development of appropriate policies, should listing of c-decaBDE on the Stockholm Convention and Australia's ratification of that listing proceed.

10.
J Expo Sci Environ Epidemiol ; 25(6): 544-56, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26350983

RESUMO

Bisphenol A (BPA) is a plasticiser found in a number of household plastics, electronics, and food-packaging materials. Over the past 5 years, several human epidemiological studies have reported a positive association between BPA exposure and adverse health outcomes in children, including obesity, asthma, preterm birth, and neuro-behavioural disturbances. These findings are in conflict with international environmental risk assessment models, which predict daily exposure levels to BPA should not pose a risk to child health. The aim of this review is to provide an overview of the evidence for different exposure sources and potential exposure pathways of BPA in early childhood. By collating the findings from experimental models and exposure associations observed in human bio-monitoring studies, we affirm the potential for non-dietary sources to make a substantial contribution to total daily exposure in young children. Infants and toddlers have distinctive exposure sources, physiology, and metabolism of endocrine-disrupting chemicals. We recommend risk-assessment models implement new frameworks, which specifically address exposure and hazard in early childhood. This is particularly important for BPA, which is present in numerous products in the home and day-care environments, and for which animal studies report contradictory findings on its safety at environmentally relevant levels of exposure.


Assuntos
Compostos Benzidrílicos/efeitos adversos , Exposição Ambiental/efeitos adversos , Fenóis/efeitos adversos , Pré-Escolar , Exposição Ambiental/análise , Monitoramento Ambiental , Humanos , Modelos Teóricos , Medição de Risco
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