RESUMO
BACKGROUND: Research demonstrates that chronic exposure to fine particulates (PM2.5) increases risks of neurodevelopmental conditions, such as intellectual disability (ID). Few studies have examined neurodevelopmental health impacts of pollution spikes exceeding 24-h (24-h) PM2.5 guidelines, despite relevance to the regulatory landscape. The current potential for regulatory changes to 24-h PM2.5 standards in the United States makes research on exceedances relevant. OBJECTIVE: To examine associations between 24-h PM2.5 exceedances and the risk of ID. METHODS: We conducted a retrospective case-control study of a sample of children in Utah, USA. We used generalized estimating equations to predict odds of ID based on the number of 24-h PM2.5 exceedance days during the preconception period and three trimesters of pregnancy. Exceedance days are defined as per current World Health Organization (WHO) [≥15 µg/m3] and current US Environmental Protection Agency (EPA) [≥35 µg/m3] 24-h guidelines. RESULTS: PM2.5 exceedances are associated with ID risk during the preconception and first trimester periods and not the second and third trimesters. During the preconception period, each day exceeding 15 µg/m3 or 35 µg/m3 was associated with a 1.023 (CI: 1.011-1.040) or 1.042 (CI: 1.026-1.059, p < 0.001) increase in odds of ID, respectively. During the first trimester, each day exceeding 15 µg/m3 or 35 µg/m3 was associated with a 1.032 (CI: 1.017-1.047) or 1.059 (CI: 1.030-1.088) increase in odds of ID, respectively. IMPACT STATEMENT: Potential regulatory movement on the US 24-h PM2.5 standard makes research that explicitly studies exceedances highly relevant. Yet few studies examine health effects of exceeding 24-h guidelines for any air pollutants. This study fills important gaps in the literature by examining associations between odds of intellectual disability and the count of days exceeding current 24-h PM2.5 guidelines, as established by the World Health Organization and US Environmental Protection Agency, during the prenatal period. We find that exceedances of both sets of guidelines, during the preconception and first trimester periods, are associated with ID risk.
RESUMO
El presente trabajo tiene por objetivo determinar las diferentes causas de angustia en el paciente, familia, personal medico y de enfermeria en el servicio de urgencias del Hospital San Jose de Bogota. El personal asignado al servicio de urgencias esta distribuido en tres turnos: manana, tarde y noche. Ademas del personal fijo de urgencias se cuenta con la colaboracion de los especialistas fijos de turno. El paciente que ingresa al servicio de urgencias del Hospital de San Jose, se siente angustiado principalmente por estar lejos de sus familiares, por el costo de hospitalizacion y por los cambios que debe realizar en sus actividades; ademas siente temor a dolor y la muerte. Desde el ingreso al servicio el paciente y la familia experimentan angustia, y aun antes; lo que nos hace ver la necesidad de tener una persona destinada a orientar y a informar al paciente y familia. Es necesario que el personal reconozca la necesidad del paciente y de la familia de tener informacion sobre su situacion para sentirse mas seguro e incluso colaborar mas en su recuperacion. Los pacientes consideran que el trato de los medicos es mas cordial que el dado por el personal de enfermeria. Cualquier procedimiento que se le realice al paciente le causa angustia, y mas si no sabe en que consiste el procedimiento y si este les va producir dolor. El personal medico y de enfermeria debe tener siempre presente que el paciente le teme a todo aquello que le es desconocido, por lo tanto les debe dar una explicacion de los procedimientos a realizar. Uno de los factores ambientales que mas..
