RESUMO
BACKGROUND: Epidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators. METHODS: The literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators. RESULTS: The literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress. CONCLUSION: The choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used.
Assuntos
Poluição Ambiental , Indicadores Básicos de Saúde , Saúde , Características de Residência , Autorrelato , Poluição Ambiental/efeitos adversos , Poluição Ambiental/análise , Poluição Ambiental/estatística & dados numéricos , Saúde/estatística & dados numéricos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Psicometria/métodos , Características de Residência/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Epidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. This second part presents the results of the studies. METHODS: Based on a literature review (51 papers), this article presents an analysis of the contribution of self-reported health to epidemiological studies investigating local sources of environmental pollution. It discusses the associations between self-reported health and exposure variables, and other risk factors that can influence health reporting. RESULTS: Studies using self-reported health showed that local sources can be associated with a wide range of health outcomes, including an impact on mental health and well-being. The perception of pollution, especially sensory information such as odors, affects self-reported health. Attitudes referring to beliefs, worries and personal behaviors concerning the source of pollution have a striking influence on reported health. Attitudes can be used to estimate the reporting bias in a biomedical approach, and also constitute the main explanatory factors in biopsychosocial studies taking into account not only the biological, physical, and chemical factors but also the psychological and social factors at stake in a situation of environmental exposure. CONCLUSION: Studying self-reported health enables a multifactorial approach to health in a context of environmental exposure. This approach is most relevant when conducted within a multidisciplinary framework involving human and social sciences to better understand psychosocial factors. The relevance of this type of approach used as an epidemiological surveillance tool to monitor local situations should be assessed with regard to needs for public health management of these situations.
Assuntos
Poluição Ambiental , Saúde , Características de Residência , Autorrelato , Interpretação Estatística de Dados , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Monitoramento Ambiental/métodos , Monitoramento Ambiental/estatística & dados numéricos , Poluição Ambiental/análise , Poluição Ambiental/estatística & dados numéricos , Estudos Epidemiológicos , Saúde/estatística & dados numéricos , Humanos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Características de Residência/estatística & dados numéricosRESUMO
PURPOSE: Streptococcus pneumoniae is one of the leading causes of bacterial pneumonia, meningitis and acute otitis media in children and adults worldwide. Polysaccharide pneumococcal vaccines have been available for approximately 50 years and conjugate vaccines, which generate immunological memory even at an early age but have limited serotype coverage, have recently been developed. CURRENT KNOWLEDGE AND KEY POINTS: Although the polysaccharide vaccine is considered effective in preventing invasive pneumococcal disease (IPD) in adults, its efficacy against pneumonia and among older or immunocompromised individuals is still controversial. On the other hand, the conjugate vaccine for children allows a large reduction in the incidence of IPD and in the rate of pneumococcal colonization in the general population through herd immunity, but its serotype coverage remains low in adults and serotype replacement may be expected in the long-term. FUTURE PROSPECTS: In the present context of widespread antibiotic resistance, it is of the utmost importance to assess the expected benefits of pneumococcal vaccination, in order to be able to use it optimally in all population parts.
Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Adulto , Humanos , Vacinas ConjugadasAssuntos
Educação em Saúde , Abuso de Maconha/prevenção & controle , Saúde Pública , Adolescente , Fatores Etários , Criança , Feminino , França/epidemiologia , Educação em Saúde/métodos , Humanos , Masculino , Abuso de Maconha/complicações , Abuso de Maconha/diagnóstico , Abuso de Maconha/epidemiologia , Rádio , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , TelevisãoAssuntos
Epidemiologia , Saúde Pública , Responsabilidade Social , Projetos de Pesquisa Epidemiológica , Epidemiologia/legislação & jurisprudência , Epidemiologia/normas , Medicina Baseada em Evidências , França , Humanos , Saúde Pública/legislação & jurisprudência , Saúde Pública/normas , Reprodutibilidade dos Testes , Medição de RiscoAssuntos
Idoso , Depressão/prevenção & controle , Transtorno Depressivo/prevenção & controle , Prática de Saúde Pública , Prevenção do Suicídio , Idoso/psicologia , Idoso/estatística & dados numéricos , Causas de Morte , Depressão/epidemiologia , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , França/epidemiologia , Planejamento em Saúde/organização & administração , Humanos , Masculino , Morbidade , Programas Nacionais de Saúde/organização & administração , Fatores de Risco , Suicídio/psicologia , Suicídio/estatística & dados numéricosAssuntos
Neoplasias Colorretais/prevenção & controle , Programas de Rastreamento , Idoso , Colonoscopia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/mortalidade , Medicina de Família e Comunidade , França , Humanos , Pessoa de Meia-Idade , Sangue Oculto , Guias de Prática Clínica como AssuntoAssuntos
Proteção da Criança , Política de Saúde , Criança , Humanos , Pediatria , Vigilância da População , Medicina PreventivaAssuntos
Atenção à Saúde/normas , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Saúde Pública/legislação & jurisprudência , Justiça Social , Adulto , Criança , Educação , Feminino , França , Humanos , Recém-Nascido , Seguro Saúde , Expectativa de Vida , Estilo de Vida , Masculino , Mães , Ocupações , Fatores de Risco , Fatores SocioeconômicosAssuntos
Prevenção do Hábito de Fumar , Fumar/legislação & jurisprudência , França/epidemiologia , Educação em Saúde , Humanos , Prevenção Primária/legislação & jurisprudência , Prevenção Primária/métodos , Fumar/epidemiologia , Abandono do Hábito de Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/prevenção & controleRESUMO
The aim of the SOLEX study was to estimate the personal exposure of workers to atmospheric polycyclic aromatic hydrocarbons (PAHs) on former gasworks sites in the Paris metropolitan area. Devices to sample gas and particulate phases for 9 PAHs were carried during one working day of a study week in November 1997 by 24 workers and in June 1998 by 19 workers with contrasted job profiles involving different opportunities for contact with the soil; among these volunteers, some were active in the process of contaminated soil remediation during the November study period. PAH concentrations were measured by high-performance liquid chromatography. Subjects working on the site under remediation were clearly more exposed (684.1 ng/m3 for total PAHs in November 1997) than workers, without close contact with soil, whose PAH exposure was similar to that measured by fixed monitors in the ambient air in Paris. The contrasts were weaker in June 1998, when soil remediation had nearly been completed. Only subjects involved in activities with close contact with the ground were found with exposures exceeding background levels. Further investigations are needed to improve our understanding of the influence of the pollutants present in the soil.