Respiratory diseases in Mexico: analysis from the Global Burden of Disease study 2021.

BACKGROUND: Respiratory diseases (RD) are often analyzed separately rather than collectively, possibly leading to an underestimation of their total burden. OBJECTIVE: To analyze the burden of RD in Mexico for population aged 20 or older from 1990 to 2021. MATERIAL AND METHODS: We present the burden of RD in Mexico based on estimates of the Global Burden of Disease study for mortality and disability-adjusted life years (DALYs), comprising counts, rates per 100,000, as well as age-standardized rates. RDs were categorized into three key groups: chronic respiratory diseases (CRD), respiratory infections (RI), and respiratory cancers. RESULTS: In 2021, among those aged 20+, RDs were responsible for 336,728 deaths, which accounts for 30.5% of total deaths -a nearly threefold increase since 2019, primarily due to the COVID-19 pandemic. CRDs contributed with 3.4% of total deaths; RIs, with 25.9%; and respiratory cancers, with 1.2%. CRDs showed a continuous rise in deaths, crude mortality, and DALY rates across genders, with no signs of leveling. RD burden varied widely across Mexican states. Age-standardized CRD mortality rates have generally declined since 1990, except for interstitial lung diseases, which have consistently increased. CONCLUSION: The significant burden of mortality and disability due to RDs in Mexico underscores the n|ecessity for enhanced prevention, research, and for addressing risk factors such as smoking and pollution. Ongoing healthcare training can help reduce RD burden.

ANTECEDENTES: Las enfermedades respiratorias (ER) se analizan individualmente, posiblemente con subestimación de su carga total. OBJETIVO: Analizar la carga de las ER en México para población de 20 años o más de 1990 a 2021. MATERIAL Y MÉTODOS: Se presenta la carga de ER en México a partir de estimaciones del estudio Global Burden of Disease en cuanto a mortalidad y años de vida saludable (AVISA) perdidos que comprenden recuentos, tasas por 100 000 y tasas estandarizadas por edad. Las ER se categorizaron en enfermedades respiratorias crónicas (ERC), infecciones respiratorias y cánceres respiratorios. RESULTADOS: En 2021, las ER causaron la muerte de 336 728 adultos mayores de 20 años, lo que representó 30.5 % del total de defunciones, incremento cercano al triple respecto a 2019, principalmente debido a COVID-19. Las ERC contribuyeron con 3.4 % del total de muertes, las infecciones respiratorias con 25.9 % y los cánceres respiratorios con 1.2 %. La mortalidad y AVISA perdidos por ERC se incrementaron persistentemente, con variaciones entre los estados. Las tasas de mortalidad ajustadas por edad de las ERC disminuyeron desde 1990, excepto las enfermedades pulmonares intersticiales, que se incrementaron constantemente. CONCLUSIÓN: Los significativos niveles de mortalidad y discapacidad debidos a enfermedades respiratorias en México exigen mejorar la prevención, investigación y abordar factores de riesgo como tabaquismo y contaminación, además de fomentar la capacitación médica continua.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. OBJECTIVE: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. METHOD: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon's test. RESULTS: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. CONCLUSION: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. OBJETIVO: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. MÉTODO: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. RESULTADOS: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. CONCLUSIÓN: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

The medical movement and Dr. Ismael Cosío Villegas. At half a century. / El movimiento médico y el doctor Ismael Cosío Villegas. A medio siglo.

In 1964, medical residents and interns of the Mexican Republic decided to carry out a work stoppage that stretched over for several months. Several prominent doctors decided to join the causes that motivated the movement, among which Dr. Ismael Cosío Villegas, who at that moment was the director general of the Huipulco hospital for tuberculosis patients; his participation and dedication are historical, and his determination caused for his resignation to be demanded. His trajectory remains practically unknown by the medical community.

En 1964, los médicos residentes e internos de la República Mexicana decidieron realizar un paro de labores que se extendió por meses; varios médicos notables decidieron unirse a las causas que motivaron dicho movimiento, entre ellos el director general en ese momento del Sanatorio para Tuberculosos de Huipulco, el doctor Ismael Cosío Villegas, cuya participación y entrega es histórica. La determinación del doctor Cosío Villegas provocó que se le exigiera su renuncia. La comunidad médica aún se desconoce su trayectoria.

Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain. / Atención farmacéutica en enfermedades respiratorias: situación y oportunidades de la farmacia hospitalaria en España.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF. CONCLUSIONS: Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Impact of the COVID-19 pandemic on diagnosis of respiratory diseases in the Northern Metropolitan Area in Barcelona (Spain).

OBJECTIVE: The COVID-19 pandemic has had a great effect on the management of chronic diseases, by limiting the access to primary care and to diagnostic procedures, causing a decline in the incidence of most diseases. Our aim was to analyze the impact of the pandemic on primary care new diagnoses of respiratory diseases. METHODS: Observational retrospective study performed to describe the effect of COVID-19 pandemic on the incidence of respiratory diseases according to primary care codification. Incidence rate ratio between pre-pandemic and pandemic period was calculated. RESULTS: We found a decrease in the incidence of respiratory conditions (IRR 0.65) during the pandemic period. When we compared the different groups of diseases according to ICD-10, we found a significant decrease in the number of new cases during the pandemic period, except in the case of pulmonary tuberculosis, abscesses or necrosis of the lungs and other respiratory complications (J95). Instead, we found increases in flu and pneumonia (IRR 2.17) and respiratory interstitial diseases (IRR 1.41). CONCLUSION: There has been a decrease in new diagnosis of most respiratory diseases during the COVID-19 pandemic.

Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project.

INTRODUCTION: The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma. OBJECTIVE: To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing). MATERIAL AND METHODS: A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development (SENDO) project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according to the NOVA classification, and the daily consumption was estimated along with the percentage of Kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds Ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings. RESULTS: In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76 g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR: 1.87, 95% CI: 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI: 1.10-4.05) the prevalence of bronchitis/recurrent wheezing. CONCLUSIONS: The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND: Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event. OBJECTIVES: To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities. METHODS: We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features. RESULTS: We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND: Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event. OBJECTIVES: To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities. METHODS: We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features. RESULTS: We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50

Factores predisponentes a Infecciones Respiratorias Agudas en preescolares de una comunidad desde la mirada de las madres / Predisposing factors to Acute Respiratory Infections in preschool children in a community from the mothers' perspective

Objetivo: Describir los factores predisponentes a Infecciones Respiratorias Agudas preescolares de una comunidad desde la mirada de las madres. Métodos: Investigación cualitativa, descriptiva, en una muestra de 12 madres de preescolares una comunidad de Lambayeque-Perú. Los datos se recolectaron mediante entrevista semiestructurada, la cual fue validada por juicio de expertos y por una prueba piloto en 2 madres que cumplían con los criterios de inclusión. Los datos fueron procesados mediante análisis de contenido temático. Resultados: a) Identificación de factores individuales como factor predisponente, b) Reconocimiento de factores en la vivienda como factor predisponente, c) Los factores familiares como factor predisponente y d) Reconocimiento de factores ambientales como factor predisponente. Conclusión: Las madres reconocen los factores predisponentes de las infecciones respiratorias agudas, sin embargo, estos factores, aún siguen presentes como causantes de estas enfermedades. Por tanto, urge realizar investigaciones que profundicen en porqué persisten, estudios que indaguen porqué el incumplimiento de las madres con el calendario de vacunación, de medidas preventivas que están en sus manos practicarlas. Por otro lado, existen factores que no están en sus manos, y que corresponde a los gobiernos, mejorar las políticas públicas para solventar este problema de salud pública. (AU)

Objective: To describe the predisposing factors to preschool Acute Respiratory Infections in a community from the mothers' point of view. Methods: Qualitative, descriptive research in a sample of 12 mothers of preschoolers in a community of Lambayeque, Peru. Data were collected through semi-structured interviews, which were validated by expert judgement and by a pilot test in 2 mothers who met the inclusion criteria. Data were processed using thematic content analysis. Results: a) identification of individual factors as a predisposing factor, b) recognition of housing factors as a predisposing factor, c) family factors as a predisposing factor and d) recognition of environmental factors as a predisposing factor. Conclusion: Mothers recognize the predisposing factors of acute respiratory infections, however, these factors are still present as the cause of these diseases. Therefore, it is urgent to carry out research that delves into why they persist, studies that investigate why mothers do not comply with the vaccination schedule, with preventive measures that are in their hands to practice. On the other hand, there are factors that are not in their hands, and that it is up to governments to improve public policies to solve this public health problem. (AU)

Encuesta a neumonólogos sobre la elección de guías de enfermedades respiratorias / Survey to Pulmonologists about the Choice of Guidelines for Respiratory Diseases

RESUMEN Introducción: Dada la existencia de variadas guías para enfermedades respiratorias, se buscó conocer cuáles eligen los médicos para utilizar en su práctica clínica. Materiales y Métodos: se realizó un estudio descriptivo, transversal, mediante una encuesta a neumonólogos de la Asociación Argentina de Medicina Respiratoria. Resultados: La guía más utilizada para EPOC fue la Iniciativa Global para la Enferme dad Pulmonar Obstructiva Crónica (GOLD) (82 %), seguida por GesEPOC (51 %). Para asma las más usadas fueron la Iniciativa Global para el Asma (GINA) 2022 (89 %) y GEMA 5.2 (68 %). En asma de difícil control, se prefirieron GINA 2022 (82 %) y GEMA 2022 (53 %). En espirometría, un 54 % de los respondedores se inclinó por NHANES III y un 22 % utilizó valores teóricos de referencia de Knudson. En neumonía, el 62 % eligió SADI, el 37 %, IDSA y el 20 %, BTS. Para nódulos pulmonares, el 62 % prefirió las guías Fleischner, 35 % se inclinó por Lung-RADS 1.1. Para neumonitis por hip ersensibilidad, un 83 % seleccionó las guías de las sociedades conjuntas ATS/JRS/ ALAT. Para imágenes de fibrosis pulmonar, el 89 % utilizó ALAT/ERS/JRS/ALAT y el 18 % White Paper. Discusión: si bien hay estudios sobre adherencia a guías, no los hay acerca de pref erencias de utilización entre varias referidas a un mismo tema. En EPOC y asma (in cluyendo la de difícil control) se eligieron GOLD y GINA y las de la Sociedad Española de Patología Respiratoria (GesEPOC y GEMA). El uso preferencial de la guía nacional para neumonía es coherente con la necesidad de contemplar la epidemiología local.

ABSTRACT Introduction: Since there are various guidelines for respiratory diseases, we aimed to know which are chosen by physicians in their daily clinical practice. Materials and Methods: A descriptive, cross-sectional study was conducted through a questionnaire sent to pulmonologists of the Argentinian Association of Respiratory Medicine. Results: The most commonly used guideline for COPD (chronic obstructive pulmonary disease) was the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (82 %), followed by GesEPOC (51 %). For asthma, the most commonly used guideline was the Global Initiative for Asthma (GINA) 2022 (89 %) and the Spanish Guideline on the Management of Asthma (known for its acronym in Spanish, GEMA), GEMA 5.2 (68 %). In difficult-to-control asthma, GINA 2022 (82 %) and GEMA 2022 (53 %) were used. With regard to spirometries, 54 % of respondents favored NHANES III (Third National Health and Nutrition Examination Survey) and 22 % used theoretical Knudson reference values. For pneumonia, 62 % chose the guidelines of the SADI (Argentinian Society of Infectious Diseases), 37 % preferred those of the IDSA (Infectious Diseases Society of America) and 20 %, chose the guidelines of the BTS (British Thoracic Society). For pulmonary nodules, 62 % used Fleischner guidelines, and 35 % favored Lung-RADS 1.1. For hypersensitivity pneumonitis, 83 % selected the ATS/JRS/ALAT Guidelines (American Thoracic Society/Japanese Respiratory Society/Latin American Thoracic Society). And with respect to pulmonary fibrosis imaging, 89 % used ALAT/ERS (Eu ropean Respiratory Society)/JRS recommendations, and 18 % preferred White Paper. Discussion: Although there are studies about adherence to guidelines, none of them shows which are the chosen recommendations within a group of guidelines of the same topic. In COPD and asthma (including difficult-to-control asthma) GOLD, GINA and the guidelines of the Spanish Society of Respiratory Disease (GesEPOC and GEMA) were chosen. The preference for the national guideline for pneumonia is consistent with the need to consider local epidemiology.

Nursing terminology for the care of people with respiratory diseases and Covid-19 / Terminología de enfermería para el cuidado de personas con enfermedades respiratorias y Covid-19 / Terminologia de enfermagem para o cuidado a pessoa com doençasrespiratórias e Covid-19

ABSTRACT Objectives: To build a specialized nursing terminology for the care of people with respiratory diseases and Covid-19 or who have respiratory diseases after Covid-19, based on ICNP®. Method: Methodological study developed in two stages: (1) identification of the relevant concepts for the health priority chosen from the literature; (2) cross-mapping of the identified concepts with the concepts contained in ICNP® version 2019/2020. Results: 9460 terms were extracted from the literature, of which 4065 terms were excluded because they were not related to the object of study and 5395 were submitted to the mapping technique, resulting in 290 constant terms in the ICNP® and 5134 non-constant terms. The constant terms were classified into the following axes: 120 in the Focus axis, 13 in Judgment, 48 in Action, 23 in Location, 38 in Means, eight in Time and one in Client. In addition, 36 nursing diagnoses/outcomes and three nursing interventions were mapped. Conclusion: The terminology will support the quality of care provided by the nursing team and the manual and electronic recording of patient data.

RESUMEN Objetivos: Construir una terminología enfermera especializada para el cuidado de personas con enfermedades respiratorias y Covid-19 o que presentan enfermedades respiratorias después de Covid-19, basada en la ICNP®. Método: Estudio metodológico desarrollado en dos etapas: (1) identificación de los conceptos relevantes para la prioridad sanitaria elegida a partir de la literatura; (2) mapeo cruzado de los conceptos identificados con los conceptos contenidos en la CIPN® versión 2019/2020. Resultados: 9460 términos fueron extraídos de la literatura, de los cuales 4065 términos fueron excluidos por no estar relacionados con el objeto de estudio y 5395 fueron sometidos a la técnica de mapeo, resultando 290 términos constantes en la ICNP® y 5134 términos no constantes. Los términos constantes se clasificaron en los siguientes ejes: 120 en el eje Enfoque, 13 en Juicio, 48 en Acción, 23 en Localización, 38 en Medios, ocho en Tiempo y uno en Cliente. Además, se mapearon 36 diagnósticos/resultados de enfermería y tres intervenciones de enfermería. Conclusión: La terminología va a subsidiar la calidad de los cuidados prestados por el equipo de enfermería y el registro manual y electrónico de los datos de los pacientes.

RESUMO Objetivos: Construir uma terminologia especializada de enfermagem para o cuidado à pessoa com doenças respiratórias e Covid-19 ou que apresentou doenças respiratórias após a Covid-19, fundamentada na CIPE®. Método: Estudo metodológico desenvolvido em duas etapas: (1) identificação dos conceitos relevantes para a prioridade de saúde escolhida a partir da literatura; (2) mapeamento cruzado dos conceitos identificados com os conceitos constantes na CIPE® versão 2019/2020. Resultados: Foram extraídos 9460 termos a partir da literatura. Desse total, 4065 termos foram excluídos por não estarem relacionados ao objeto de estudo e 5395 foram submetidos à técnica de mapeamento, resultando em 290 termos constantes na CIPE® e 5134 termos não constantes. Os termos constantes foram classificados nos eixos: 120 no eixo Foco, 13 no Julgamento, 48 no Ação, 23 no Localização, 38 no Meios, oito no Tempo e um no Cliente, além disso foram mapeados 36 diagnósticos/resultados de enfermagem e três intervenções de enfermagem. Conclusão: A terminologia subsidiará na qualidade da assistência da equipe de enfermagem e nos registros manual e eletrônico dos dados dos pacientes.

Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha / Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project / Alteraciones respiratorias en niños expuestos al polvo de residuos de la minería en Brumadinho, Minas Gerais, Brasil: Proyecto Bruminha

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

Factores sociodemográficos y ambientales relacionados con el uso de mascarillas en la población durante la pandemia por la COVID-19 / Sociodemographic and environmental factors associated with mask use during the COVID-19 pandemic

Fundamentos: Durante la pandemia de la COVID-19 se implementaron medidas de prevención con el propósito de reducir su transmisión comunitaria. El grado de cumplimiento con estas medidas estuvo influenciado por diversos factores sociodemográficos y ambientales. Sin embargo, existe escasa literatura científica que aborde el cumplimiento de las medidas preventivas en la población general. El objetivo de este estudio fue analizar la asociación entre factores sociodemográficos y ambientales, así como la adhesión al uso de mascarillas en contactos estrechos. Métodos: Se realizó un estudio transversal con 1.778 individuos, identificados mediante el rastreo de contactos estrechos de personas con SARS-CoV-2 por la Central de Coordinación de la COVID-19 de Mallorca, entre febrero y junio de 2021. Se realizó un análisis descriptivo y se utilizó un modelo de regresión logística para determinar los factores asociados al incumplimiento del uso de mascarillas.Resultados: La edad media de los participantes fue de 42,8±17,4 años (53,6% de mujeres). El 60,8% (IC 95%: 57,8-62,3) de los contactos estrechos no utilizó mascarilla durante su contacto. No se observaron diferencias estadísticamente significativas en función del sexo o grupo etario (p=0,497 y p=0,536, respectivamente). Las situaciones de mayor incumplimiento con el uso de mascarillas se dieron en el entorno domiciliario, espacios cerrados sin ventilación y al mantener distancias cortas (p<0,001). Conclusiones: Nuestros hallazgos indican una menor adhesión al uso de mascarillas en escenarios de mayor riesgo. Frente a futuras situaciones de crisis sanitaria, se deberían diseñar intervenciones que realcen la conciencia sobre los riesgos y que promuevan una mayor adhesión a medidas de prevención y control.(AU)

Background: During COVID-19 pandemic, prevention measures were implemented to mitigate the community transmission of SARS-CoV-2. Compliance with these measures was influenced by several sociodemographic and environmental factors. However, literature addressing compliance with these prevention measures among the general population remains limited. The study aimed to assess the association of sociodemographic and environmental factors and mask usage during close contact situations. Methods: A cross-sectional study was conducted with a sample of 1,778 individuals identified through close contact tracing of indivi-duals diagnosed with SARS-CoV-2 by the COVID-19 Coordination Center of Mallorca, from February to June 2021. A descriptive analysis was conducted, and a logistic regression model was utilized to evaluate factors associated with mask non-compliance. Results: The mean age of the participants was 42.8±17.4 years, with 53.6% being female. Among close contacts, 60.8% (95% CI: 57.8-62.3) did not use masks during their contact. No significant differences were observed between genders or across age groups (p=0.497 and p=0.536, respectively). Factors linked to mask non-compliance included the home setting, indoor spaces without venti-lation, and closer physical distances (p<0.001). Conclusions: Our findings indicate that mask adherence was notably lower among close contacts exposed to higher risk. In future public health crises, interventions should be developed to raise awareness about risks and promote adherence to preventive and control measures.(AU)

Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020 / Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020 / Impacto direto e indireto da COVID-19 na expectativa de vida ao nascer no Chile em 2020

Resumen: El artículo muestra el impacto directo e indirecto del COVID-19 en la esperanza de vida de Chile durante el año 2020, utilizando las estadísticas de defunciones definitivas publicadas en marzo del año 2023. Para ello, se estimó una mortalidad contrafactual para año 2020 sin el COVID-19, siguiendo el patrón de mortalidad según causas de muerte desde 1997 a 2019, se elaboraron tablas de mortalidad para calcular la esperanza de vida para los años 2015 a 2020 y para el año 2020 estimado, y luego se descompuso la diferencia entre la esperanza de vida esperada y observada del año 2020 según grupos de edad y causas de muerte. La esperanza de vida del año 2020 quiebra la tendencia a su aumento entre 2015 y 2019, mostrando un retroceso, en hombres y en mujeres, con respecto al año 2019, de 1,32 y 0,75 años respectivamente. Con respecto al año 2020 estimado, la esperanza de vida del 2020 observado es 1,51 años menor en hombres y 0,92 en mujeres, pero el impacto directo del COVID-19 en pérdida de esperanza de vida fue mayor, 1,89 para los hombres y 1,5 para las mujeres, concentrándose en las edades entre los 60 y 84 años en hombres y entre 60 y 89 años en mujeres. El impacto directo negativo del COVID-19 a la esperanza de vida en parte fue contrarrestado por impactos indirectos positivos significativos en dos grupos de causas de muerte, las enfermedades del sistema respiratorio y las enfermedades infecciosas y parasitarias. El estudio muestra la necesidad de distinguir los impactos directos e indirectos del COVID-19, por la incidencia que pueden tener en la salud pública cuando el COVID-19 baje su intensidad y se eliminen las restricciones de movilidad.

Abstract: This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

Resumo: Este artigo apresenta os impactos direto e indireto da COVID-19 na expectativa de vida no Chile em 2020 a partir de estatísticas de mortalidade publicadas em março de 2023. Para tanto, foi estimada uma mortalidade contrafactual para 2020 sem a COVID-19; a partir do padrão de mortalidade por causa de morte de 1997 a 2019, foram criadas tabelas de mortalidade para calcular a expectativa de vida para o período de 2015 a 2020 e para o ano estimado de 2020 e, em seguida, a diferença entre a expectativa de vida esperada e observada em 2020 foi separada por faixa etária e causa de morte. A expectativa de vida em 2020 interrompe a tendência de aumento entre 2015 e 2019, mostrando um declínio com relação a 2019 de 1,32 ano nos homens e 0,75 ano nas mulheres. Com relação ao ano estimado de 2020, a expectativa de vida observada é 1,51 ano menor nos homens e 0,92 nas mulheres, mas o impacto direto da COVID-19 na diminuição da expectativa de vida foi maior (1,89 para homens e 1,5 para mulheres), concentrando-se nas idades entre 60 e 84 anos nos homens e entre 60 e 89 anos nas mulheres. O impacto direto negativo da COVID-19 na expectativa de vida foi parcialmente atenuado por impactos indiretos positivos significativos em dois grupos de causas de morte: doenças do sistema respiratório e doenças infecciosas e parasitárias. Este estudo mostra a necessidade de diferenciar impactos diretos e indiretos da COVID-19, devido às implicações para a saúde pública quando a intensidade da COVID-19 diminuir e as restrições de mobilidade forem suspensas.

Prevalencia de Hipomineralización Molar-Incisica (HMI) en niños brasileños y asociación con enfermedades respiratorias o nacimientos prematuros / Prevalence of Molar Incisor Hypomineralization (MIH) in Brazilian children and investigation with respiratory diseases or premature births

La Hipomineralización Molar Incisiva (HMI) se describe como un defecto cualitativo en el desarrollo del esmalte que afecta al menos a un molar permanente, pudiendo o no afectar a los incisivos permanentes. La prevalencia reportada en la literatura mundial varía del 2,8% al 44%. Su etiología aún es incierta, y frecuentemente se asocia con factores prenatales, perinatales y posnatales. Objetivos: evaluar la prevalencia de HMI en pacientes atendidos en una Facultad de Odontología en la ciudad de Vitória-ES y su asociación con factores causales. Métodos: se evaluaron clínicamente 302 niños, con edades comprendidas entre los 5 y 14 años, en condiciones ideales en la Clínica Infantil de la Facultad de Odontología de MULTIVIX, y se les aplicó un cuestionario. Resultados: 66 niños (21,85%) presentaron HMI. No hubo diferencias significativas entre los sexos y no se encontró asociación con enfermedades respiratorias en la infancia ni parto prematuro. Conclusión: se encontró una alta prevalencia de HMI en niños brasileños y ninguna asociación con enfermedades respiratorias o partos prematuros. Se sugiere realizar nuevos estudios con criterios estandarizados para determinar la prevalencia y su relación con factores causales.

Molar Incisor Hypomineralization (MIH) is described as a qualitative enamel development defect that affects at least one permanent molar and may or may not affect the permanent incisors. The prevalence reported in the world literature ranges from 2.8% to 44%. Its etiology is still unclear, with prenatal, perinatal and postnatal factors often associated. Objectives: evaluate the prevalence of HMI in patients attented at a Dental School in the city of Vitória-ES and its association with causal factors. Methods: 302 children with the presence of first permanent molars, aged between 5 and 14 aged, were clinically evaluated under ideal conditions at the Children's Clinic of the Faculty of Dentistry of MULTIVIX and a questionnaire was applied. Results: 66 children (21.85%) had HMI. There was no significant difference between the sexes and there was no association with childhood respiratory diseases and preterm birth. Conclusion: High prevalence of MIH was found in Brazilian children and no association with respiratory diseases or premature births. It is suggested that further studies be carried out with standardized criteria to determine the prevalence and its relationship with causal factors.

[Impact of air pollution in paediatric consultations in Primary Health Care: Ecological study]. / Impacto de la contaminación ambiental en las consultas pediátricas de Atención Primaria: estudio ecológico.

OBJECTIVE: To study the correlation between the levels of environmental pollutants and the number of paediatric consultations related to respiratory disease in Primary Health Care. PATIENTS AND METHODS: An ecological study is performed, in which the dependent variable analysed was the number of paediatric consultations in an urban Primary Health Care centre in Madrid over a 3 year period (2013-2015), and specifically the consultations related to bronchiolitis, recurrent bronchospasm, and upper respiratory diseases. The independent variables analysed were the levels of environmental pollutants. Coefficients of correlation and multiple lineal regressions were calculated. An analysis has been carried out comparing the average of paediatric consultations when the levels of nitrogen dioxide (NO2) were higher and lower than 40µg/m3. RESULTS: During the period of the study, there were a total of 52,322 paediatric consultations in the health centre, of which 6,473 (12.37%) were related to respiratory diseases. A positive correlation was found between SO2, CO, NOx and NO2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO2 levels exceeded 40µg/m3. In the multiple lineal regression (P=.0001), the correlation was only positive between consultations and NO2 levels (3.630, 95% CI: 0.691-6.570), and negative with temperature (-5,957, 95% CI: -8.665 to -3.248). CONCLUSIONS: NO2 environmental pollution is related to an increase in respiratory diseases in children. Paediatricians should contribute to promote an improvement in urban air quality as a significant preventive measure.

Exposición a ceniza volcánica producida por el volcán Turrialba y enfermedades respiratorias, Costa Rica, 2016 / Exposure to volcanic ash produced by the Turrialba volcano and respiratory diseases, Costa Rica, 2016

Resumen Objetivo: Describir el comportamiento espacial de la contaminación por cenizas volcánicas y el efecto sobre la incidencia de enfermedades respiratorias agudas y crónicas, en las comunidades expuestas a la ceniza producida por la actividad del Volcán Turrialba, durante el año 2016. Materiales y métodos: Se realizó un estudio ecológico, observacional retrospectivo, transversal y correlacional, en donde se categorizaron 36 cantones a 50 km a la redonda del volcán Turrialba, según su nivel de contaminación. Resultados: Se constata un comportamiento diferenciado en el espacio geográfico de afectación de la pluma de ceniza volcánica, todos los territorios incluidos en el estudio resultaron con algún nivel de contaminación, sin embargo, se distinguen tres zonas, alta, media y baja contaminación. Un 46.6% de los eventos epidemiológicos estudiados poseen un mayor riesgo de presentarse en cantones con alta contaminación, sobre los cantones con media y baja contaminación. Conclusiones: Es posible que la afectación por contaminación debido a la ceniza volcánica haya incrementado el riesgo de exacerbación de enfermedades respiratorias crónicas, en la zona bajo la influencia directa de la pluma de cenizas volcánicas.

Abstract Objective: Describe the spatial behavior of contamination by volcanic ash and the effect on the incidence of acute and chronic respiratory diseases in communities exposed to the ash produced by the activity of the Turrialba Volcano during the year 2016. Materials and methods: An ecological, observational, retrospective, cross-sectional and correlational study was carried out, where 36 cantons within 50 km of the Turrialba volcano were categorized, according to their level of contamination. Results: A differentiated behavior is verified in the geographical space affected by the volcanic ash plume, all the territories included in the study resulted in some level of contamination, however three zones are distinguished, high, medium and low contamination. 46.6% of the epidemiological events studied have a higher risk of occurring in cantons with high contamination, over cantons with medium and low contamination. Conclusions: It is possible that the contamination due to volcanic ash has increased the risk of exacerbation of chronic respiratory diseases in the area under the direct influence of the volcanic ash plume.

La fibrosis quística en niños en el Ecuador / Cystic fibrosis in children in Ecuador

Objetivo: analizar la fibrosis quística en niños en el Ecuador. Metodología: Revisión sistemática de 21 publicaciones relacionadas al tema, específicamente 13 articulos de investigación en contexto ecuatoriano. Resultados y conclusión: En el Ecuador la incidencia de la enfermedad es de 1 por cada 11.110 habitantes y cada año nacen aproximadamente 23 niños con esta afección, teniéndose en cuenta las mutaciones en el CFTR, entorpecen el diagnóstico molecular, así como se ha estudiado un caso pediátrico de FQ con complicaciones en pancreatitis, siendo esto inusual en la población infantil, siendo considerable proseguir con investigaciones conducentes a tener una mejor referencia científica de la FQ en el Ecuador.

Objective: to analyze cystic fibrosis in children in Ecuador. Methodology: Systematic review of 21 publications related to the subject, specifically 13 research articles in the Ecuadorian context. Results and conclusion: In Ecuador the incidence of the disease is 1 for every 11,110 inhabitants and each year approximately 23 children are born with this condition, taking into account CFTR mutations, which hinder molecular diagnosis, as well as a study pediatric case of CF with complications in pancreatitis, this being unusual in the child population, it is important to continue with research leading to a better scientific reference of CF in Ecuador.

Principais causas de mortalidade por doenças respiratórias em crianças de 0 a 4 anos de 2015 a 2020 / Main causes of mortality to respiratory diseases in children aged 0 to 4 years from 2015 to 2020 / Principales causas de mortalidad por enfermedades respiratorias en niños de 0 a 4 años del 2015 al 2020

Introdução:A maioria das doenças respiratórias se enquadram no grupo de causas evitáveis e, dessa forma, taxas elevadas de mortalidade em crianças são reflexo das condições de desenvolvimento socioeconômico, além de mensurar o acesso e qualidade dos serviços de saúde.Objetivo:Avaliar a mortalidade por doenças respiratórias em crianças menores de 0 a 4 anos de idade no Brasil, no período de 2015 a 2020.Metodologia:Trata-se deum estudo ecológico de série temporal, retrospectivo, de abordagem quantitativa, com ênfase nas cinco doenças respiratórias mais evidentes em crianças de até 4 anos no Brasil, entre os anos de 2015 a 2020. Realizou-se coleta de dados pelo DATASUS, sendo utilizado o software Microsoft Excel©para subsidiar as etapas de processamento e análise. Resultados:A análise mostra a pneumonia como a principal causa de morte no país e, a partir da análise regional, a Região Norte possui taxas que excedem as demais regiões dentro do período observado. A mesma tendência é observada na análise das demais infecções respiratórias, porém é importante ressaltar o declínio da mortalidade em todas as variáveis e regiões observadas em 2020.Conclusões:Conclui-se que as maiorestaxas de mortalidade entre crianças no Brasil ratificam a premissa de que as afecções respiratórias são diretamente proporcionais à vulnerabilidade socioeconômica, enquanto a cobertura vacinal e a disponibilidade de leitos contribuem na redução dos indicadores. Não obstante, em 2020 evidenciou-se queda abrupta decorrente das medidas preventivas do coronavírus e, a partir da menor procura por atendimento, maior probabilidade de subnotificação dos casos (AU).

Introduction:The majority of respiratory diseases fall into the group of preventable causes and, therefore, high mortality rates in children are a reflection of socioeconomic development conditions, beyond measurethe access and the quality of health services. Objective:Evaluate the mortality by respiratory diseases in children younger than 4 years of age in Brazil, in the period from 2015 to 2020. Methodology:It is about ecologic study from time series, retrospective, of quantitative approach, with emphasis on the five respiratory diseases more evident in children of up to 4 years in Brazil, between the years from 2015 to 2020. Data was collected by DATASUS, being used byMicrosoft Excel to subsidize the processing steps and analysis. Results:The analysis shows pneumonia as the main cause of death in the country, and, from the regional analysis, the North region can have rates that exceed other regions under the period observed. The same trend is observed in the analysis from the other respiratory infections, although it is important to emphasize the decline of mortality in all variables and regions observed in 2020. Conclusions:It is concluded that the higher rates of mortality between children in Brazil ratifies the premise that respiratory affections are directly proportional to socioeconomic vulnerability, while the vaccination coverage and the availability of beds contribute to the reduction of indicators. However, in 2020, there was an evident steep drop dueto coronavirus preventive measures and, from smaller demand to attendance, higher probability of underreporting of cases (AU).

Introducción: La mayoría de las enfermedades respiratorias se enmarcan en elgrupo de las causas prevenibles y, por tanto, las altas tasas de mortalidad infantil son un reflejo de las condiciones de desarrollo socioeconómico, además de medir el acceso y la calidad de los servicios de salud.Objetivo: Evaluar la mortalidad por enfermedades respiratorias en niños de 0 a 4 años en Brasil, de 2015 a 2020. Metodología: Se trata de un estudio ecológico, retrospectivo, de serie temporal, con abordaje cuantitativo, con énfasis en las cinco enfermedades respiratorias más evidentes en niños de hasta 4 años en Brasil, entre los años 2015 a 2020. Los datos fueron recolectados mediante DATASUS, utilizando Microsoft Software Excel© para apoyar los pasos de procesamiento y análisis. Resultados: El análisis muestra a la neumonía como la principal causa de muerte en el país y, con base en el análisis regional, la Región Norte presenta tasas que superan a las demás regiones dentro del período observado. La misma tendencia se observa en el análisis de otras infecciones respiratorias, pero es importantedestacar la disminución de la mortalidad en todas las variables y regiones observadas en 2020.Conclusiones: Se concluye que las mayores tasas de mortalidad infantil en Brasil confirman la premisa de que las condiciones respiratorias son directamente proporcionales a la vulnerabilidad socioeconómica, mientras que las coberturas de vacunación y la disponibilidad de camas contribuyen para la reducción de los indicadores. Sin embargo, en 2020 hubo una caída abrupta por las medidas preventivas por el coronavirus y, a partir de la menor demanda de atención, una mayor probabilidad de subregistro de casos (AU).