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1.
Sci Total Environ ; 804: 150091, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34517316

RESUMO

BACKGROUND: Ambient air pollution exposure has been associated with higher mortality risk in numerous studies. We assessed potential variability in the magnitude of this association for non-accidental, cardiovascular disease, respiratory disease, and lung cancer mortality in a country-wide administrative cohort by exposure assessment method and by adjustment for geographic subdivisions. METHODS: We used the Belgian 2001 census linked to population and mortality register including nearly 5.5 million adults aged ≥30 (mean follow-up: 9.97 years). Annual mean concentrations for fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) were assessed at baseline residential address using two exposure methods; Europe-wide hybrid land use regression (LUR) models [100x100m], and Belgium-wide interpolation-dispersion (RIO-IFDM) models [25x25m]. We used Cox proportional hazards models with age as the underlying time scale and adjusted for various individual and area-level covariates. We further adjusted main models for two different area-levels following the European Nomenclature of Territorial Units for Statistics (NUTS); NUTS-1 (n = 3), or NUTS-3 (n = 43). RESULTS: We found no consistent differences between both exposure methods. We observed most robust associations with lung cancer mortality. Hazard Ratios (HRs) per 10 µg/m3 increase for NO2 were 1.060 (95%CI 1.042-1.078) [hybrid LUR] and 1.040 (95%CI 1.022-1.058) [RIO-IFDM]. Associations with non-accidental, respiratory disease and cardiovascular disease mortality were generally null in main models but were enhanced after further adjustment for NUTS-1 or NUTS-3. HRs for non-accidental mortality per 5 µg/m3 increase for PM2.5 for the main model using hybrid LUR exposure were 1.023 (95%CI 1.011-1.035). After including random effects HRs were 1.044 (95%CI 1.033-1.057) [NUTS-1] and 1.076 (95%CI 1.060-1.092) [NUTS-3]. CONCLUSION: Long-term air pollution exposure was associated with higher lung cancer mortality risk but not consistently with the other studied causes. Magnitude of associations varied by adjustment for geographic subdivisions, area-level socio-economic covariates and less by exposure assessment method.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Adulto , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , Censos , Estudos de Coortes , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Humanos , Material Particulado/análise , Material Particulado/toxicidade
2.
Environ Res ; : 112159, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34606845

RESUMO

BACKGROUND: Temperature may trigger the risk of suicide, however, the extent and shape of the associations show geographical variation. Here, we investigate the short-term effects of temperature on suicide deaths occurring in Brussels between January 1st, 2002 and December 31st, 2011. METHODS: We conducted a bidirectional time-stratified case-crossover study with cases being suicide deaths occurring among Brussels residents aged 5 years or older. Cases were matched by day of the week with control days from the same month and year. The exposure was the daily average temperature measured at the Uccle station (Brussels) and obtained from the Belgian Royal Meteorological Institute. We combined conditional logistic regression with distributed lag non-linear models (DLNM) to obtain one week (lag 0-6) cumulative risk ratios (RR) and their 95% confidence intervals (CI) for the effects of moderate and extreme cold (5th and 1st percentiles of temperature, respectively) and moderate and extreme heat (95th and 99th percentiles of temperature, respectively), relative to the median temperature. RESULTS: In total, 1891 suicide deaths were included. The median temperature was 11.6 °C, moderate and extreme cold temperatures were 0 and -3.1 °C, respectively, and moderate and extreme high temperatures were 20.9 and 24.4 °C, respectively. The cumulative risk of suicide mortality was almost twice higher among lags 0 to 6 for both moderate and extreme heat, relative to the period median temperature (e.g. moderate heat RR = 1.80 CI:1.27-2.54). No statistically significant associations were observed for cold temperatures. CONCLUSIONS: In Brussels, a western European city with temperate climate, high temperatures may trigger suicide deaths up to one week later. In the context of climate change, adaptation strategies must take into consideration the effects of temperature on mental health.

3.
Clin Epidemiol ; 13: 755-767, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34483687

RESUMO

"Theoretical design" comprises the development of an occurrence relation and the specification of the study domain. In explanatory research, the occurrence relation causally relates one determinant to the occurrence (of an event or a state) taking into account other relevant characteristics (confounders and modifiers). Conflicting results in explanatory research might be (partially) explained by differences in the "theoretical design" or by a mismatch between the "theoretical design" and the "design of data collection". In this critical review, the reporting of "theoretical design" is assessed in articles on the association between early life antibiotic use and the occurrence of asthma. Articles investigating a relationship between early life antibiotic use and the occurrence of asthma were searched in PubMed and systematically selected for critical review. The full text was read and important elements of study design were extracted (the research question/hypothesis, seven key elements of "theoretical design" (measure of occurrence, case (event or state) definition, conceptualization (and operationalization) of the exposure, temporal relation between outcome and exposure, confounders and effect modifiers taken into account and the domain of the study), the method of data collection and the method of data processing). A comparison was made between articles published before and after the publication of the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) statement (2007). Sixty-three articles were included for review. Thirteen articles reported the seven key elements of "theoretical design" that were questioned. No marked differences in reporting were observed pre- and post-STROBE. All articles reported some key elements of "theoretical design"; however, the reporting is not structured and not linked to the concept of "theoretical design". Conceptualizing, delineating and explicit reporting of "theoretical design" is quintessential for the quality and transparency of explanatory research.

4.
Environ Res ; 201: 111543, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34157273

RESUMO

BACKGROUND: The influence of outdoor green space on microbial communities indoors has scarcely been investigated. Here, we study the associations between nearby residential green space and residential indoor microbiota. METHODS: We collected settled dust from 176 living rooms of participants of the ENVIRONAGE birth cohort. We performed 16S and ITS amplicon sequencing, and quantitative PCR measurements of total bacterial and fungal loads to calculate bacterial and fungal diversity measures (Chao1 richness, Shannon and Simpson diversity indices) and relative abundance of individual taxa. Green spaces were estimated within 50m and 100m buffers around the residential address. We defined total residential green space using high-resolution land-cover data, further stratified in low-growing (height<3m) and high-growing green (height>3m). We used land-use data to calculate the residential nature. We ran linear regression models, adjusting for confounders and other potential determinants. Results are expressed as units change for an interquartile range (IQR) increase in residential green space and their 95% confidence intervals (CI). RESULTS: After adjustment, we observed statistically significant associations between the indoor microbial diversity indices and nearby residential green space. For bacteria, the Shannon index was directly associated with residential nature (e.g. 0.08 units increase (CI:0.02,0.13) per IQR increase in nature within a 50m buffer). Fungal diversity was directly associated with high-growing residential green and inversely with low-growing green. For example, an IQR increase in high-growing green within a 50m buffer was associated with increases in 0.14 (CI:0.01,0.27) and 0.02 (CI:0.008,0.04) units in the Shannon and Simpson indices, respectively. CONCLUSIONS: Nearby green space determines the diversity of indoor environment microbiota, and the type of green differently impacts bacterial and fungal diversity. Further research is needed to investigate in more detail possible microbial taxa compositions underlying the observed changes in indoor microbiota diversity and to explore their contribution to beneficial health effects associated with green space exposure.


Assuntos
Microbiota , Parques Recreativos , Bactérias/genética , Poeira/análise , Fungos/genética , Humanos
5.
Health Place ; 70: 102603, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34166885

RESUMO

This study examines the associations between residential urban green spaces (UGS) and self-perceived health and natural cause mortality, applying an intersectional approach across gender, education and migrant background. We used data from the 2001 Belgian census linked to register data on emigration and mortality for the period 2001-2014, including 571,558 individuals aged 16-80 residing in Brussels (80% response rate). Residential UGS were assessed with the Normalized Difference Vegetation Index (NDVI) within a 300 m buffer from the residential address and perceived neighbourhood greenness. Multilevel logistic and Cox proportional hazards regression models were conducted to estimate associations between UGS and poor self-perceived health at baseline and natural cause mortality during follow-up. Residential UGS were inversely associated with both outcomes, but there were differences between groups. The strongest beneficial associations among women were found in the lower educated, regardless of their migrant background. For men the strongest association was found in those with tertiary education and Belgian origin. No significant beneficial associations were found in men originating from low and middle-income countries. Applying an intersectionality approach is crucial to understand health inequalities related to UGS exposure. Further research in different geographical contexts is needed to contrast our findings.

6.
Eur Respir J ; 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863744

RESUMO

RATIONALE: Patients with concomitant features of asthma and chronic obstructive pulmonary disease (COPD) have a heavy disease burden. OBJECTIVES: Using data collected prospectively in the European Community Respiratory Health Survey, we compared the risk factors, clinical history, and lung function trajectories from early adulthood to the late sixties of middle aged subjects having asthma+COPD (n=179), past (n=263) or current (n=808) asthma alone, COPD alone (n=111), or none of these (n=3477). METHODS: Interview data and prebronchodilator FEV1 and FVC were obtained during three clinical examinations in 1991-1993, 1999-2002, and 2010-2013. Disease status was classified in 2010-2013, when the subjects were aged 40-68, according to the presence of fixed airflow obstruction (postbronchodilator FEV1/FVC below the lower limit of normal), a lifetime history of asthma, and cumulative exposure to tobacco or occupational inhalants. Previous lung function trajectories, clinical characteristics, and risk factors of these phenotypes were estimated. MAIN RESULTS: Subjects with asthma+COPD reported maternal smoking (28.2%) and respiratory infections in childhood (19.1%) more frequently than subjects with COPD alone (20.9 and 14.0%, respectively). Subjects with asthma+COPD had an impairment of lung function at age 20 that tracked over adulthood, and more than half of them had asthma onset in childhood. Subjects with COPD alone had the highest lifelong exposure to tobacco smoking and occupational inhalants, and they showed accelerated lung function decline during adult life. CONCLUSIONS: The coexistence between asthma and COPD seems to have its origins earlier in life compared to COPD alone. These findings suggest that prevention of this severe condition, which is typical at older ages, should start in childhood.

7.
Environ Res ; 196: 110835, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33582132

RESUMO

BACKGROUND: Microbial exposures in early childhood direct the development of the immune system and their diversity may influence the risk of allergy development. We aimed to determine whether the indoor microbial diversity at early-life is associated with the development of allergic rhinitis and inhalant atopy. METHODS: The study population included children within two birth cohorts: Finnish rural-suburban LUKAS (N = 312), and German urban LISA from Munich and Leipzig study centers (N = 248). The indoor microbiota diversity (Chao1 richness and Shannon entropy) was characterized from floor dust samples collected at the child age of 2-3 months by Illumina MiSeq sequencing of bacterial and fungal DNA amplicons. Allergic rhinitis and inhalant atopy were determined at the age of 10 years and analyzed using logistic regression models. RESULTS: High bacterial richness (aOR 0.19, 95%CI 0.09-0.42 for middle and aOR 0.12, 95%CI 0.05-0.29 for highest vs. lowest tertile) and Shannon entropy were associated with lower risk of allergic rhinitis in LISA, and similar trend was seen in LUKAS. We observed some significant associations between bacterial and fungal diversity measured and the risk of inhalant atopy, but the associations were inconsistent between the two cohorts. High bacterial diversity tended to be associated with increased risk of inhalant atopy in rural areas, but lower risk in more urban areas. Fungal diversity tended to be associated with increased risk of inhalant atopy only in LISA. CONCLUSIONS: Our study suggests that a higher bacterial diversity may reduce the risk of allergic rhinitis later in childhood. The environment-dependent heterogeneity in the associations with inhalant atopy - visible here as inconsistent results between two differing cohorts - suggests that specific constituents of the diversity may be relevant.


Assuntos
Hipersensibilidade Imediata , Microbiota , Rinite Alérgica , Alérgenos , Criança , Pré-Escolar , Poeira/análise , Fungos , Humanos , Lactente , Rinite Alérgica/epidemiologia
9.
Environ Int ; 148: 106365, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33444880

RESUMO

BACKGROUND: Epidemiological studies suggest that residing close to green space reduce mortality rates. We investigated the relationship between long-term exposure to residential green space and non-accidental and cardio-respiratory mortality. METHODS: We linked the Belgian 2001 census to population and mortality register follow-up data (2001-2011) among adults aged 30 years and older residing in the five largest urban areas in Belgium (n = 2,185,170 and mean follow-up time 9.4 years). Residential addresses were available at baseline. Exposure to green space was defined as 1) surrounding greenness (2006) [normalized difference vegetation index (NDVI) and modified soil-adjusted vegetation index (MSAVI2)] within buffers of 300 m, 500 m, and 1000 m; 2) surrounding green space (2006) [Urban Atlas (UA) and CORINE Land Cover (CLC)] within buffers of 300 m, 500 m, and 1000 m; and 3) perceived neighborhood green space (2001). Cox proportional hazards models with age as the underlying time scale were used to probe into cause-specific mortality (non-accidental, respiratory, COPD, cardiovascular, ischemic heart disease (IHD), and cerebrovascular). Models were adjusted for several sociodemographic variables (age, sex, marital status, country of birth, education level, employment status, and area mean income). We further adjusted our main models for annual mean (2010) values of ambient air pollution (PM2.5, PM10, NO2 and BC, one at a time), and we additionally explored potential mediation with the aforementioned pollutants. RESULTS: Higher degrees of residential green space were associated with lower rates of non-accidental and respiratory mortality. In fully adjusted models, hazard ratios (HR) per interquartile range (IQR) increase in NDVI 500 m buffer (IQR: 0.24) and UA 500 m buffer (IQR: 0.31) were 0.97 (95%CI 0.96-0.98) and 0.99 (95%CI 0.98-0.99) for non-accidental mortality, and 0.95 (95%CI 0.93-0.98) and 0.97 (95%CI 0.96-0.99) for respiratory mortality. For perceived neighborhood green space, HRs were 0.93 (95%CI 0.92-0.94) and 0.94 (95%CI 0.91-0.98) for non-accidental and respiratory mortality, respectively. The observed lower mortality risks associated with residential exposure to green space were largely independent from exposure to ambient air pollutants. CONCLUSION: We observed evidence for lower mortality risk in associations with long-term residential exposure to green space in most but not all studied causes of death in a large representative cohort for the five largest urban areas in Belgium. These findings support the importance of the availability of residential green space in urban areas.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Adulto , Bélgica/epidemiologia , Censos , Estudos de Coortes , Exposição Ambiental/análise , Seguimentos , Humanos , Parques Recreativos , Material Particulado
10.
Int Perspect Sex Reprod Health ; 46(Suppl 1): 25-34, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33326397

RESUMO

CONTEXT: In 2017, Chile reformed its abortion law to allow the procedure under limited circumstances. Exploring the views of Chilean medical and midwifery faculty regarding abortion and the use of conscientious objection (CO) at the time of reform can inform how these topics are being taught to the country's future health care providers. METHODS: Between March and September 2017, 30 medical and midwifery school faculty from universities in Santiago, Chile were interviewed; 20 of the faculty taught at secular universities and 10 taught at religiously affiliated universities. Faculty perspectives on CO and abortion, the scope of CO, and teaching about CO and abortion were analyzed using a grounded theory approach. RESULTS: Most faculty at secular and religiously affiliated universities supported the rights of clinicians to refuse to provide abortion care. Secular-university faculty generally thought that CO should be limited to specific providers and rejected the idea of institutional CO, whereas religious-university faculty strongly supported the use of CO by a broad range of providers and at the institutional level. Only secular-university faculty endorsed the idea that CO should be regulated so that it does not hinder access to abortion care. CONCLUSIONS: The broader support for CO in abortion among religious-university faculty raises concerns about whether students are being taught their ethical responsibility to put the needs of their patients above their own. Future research should monitor whether Chile's CO regulations and practices are guaranteeing people's access to abortion care.


Assuntos
Aborto Induzido , Tocologia , Atitude do Pessoal de Saúde , Chile , Docentes , Feminino , Humanos , Gravidez
11.
Environ Res ; 189: 109914, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32980008

RESUMO

BACKGROUND: Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous. OBJECTIVE: To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium. METHODS: Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6-12 and 13-18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region. RESULTS: Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, ß = 0.15-0.17; garden, ß = 0.13-0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, ß = 0.10-0.14; garden, ß = 0.07-0.09). There was no association between OAD medication sales and forest cover. CONCLUSIONS: Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Poluição do Ar/análise , Asma/induzido quimicamente , Asma/tratamento farmacológico , Asma/epidemiologia , Bélgica/epidemiologia , Criança , Comércio , Exposição Ambiental/análise , Humanos , Parques Recreativos
12.
Soc Sci Med ; 261: 113220, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32736097

RESUMO

BACKGROUND AND OBJECTIVES: While Chile recently decriminalized abortion in cases of rape, lethal fetal anomaly, and to save a woman's life, most abortions are still criminalized. We assessed medical and midwifery school faculty and students' views on punishing and reporting people involved in unlawful abortion, and their understanding of their obligation to protect patient confidentiality and to report unlawful abortions. METHODS: We interviewed 30 medical and midwifery school clinician faculty from seven public, private, secular and Catholic-affiliated universities, all located in the metropolitan region of Santiago, Chile. Medical (n = 239) and midwifery (n = 79) students at these same seven universities completed an online survey. We coded faculty interview transcripts, and analyzed codes related to maintaining patient confidentiality and reporting unlawful abortion. We summarized student views related to reporting and imprisoning people involved in unlawful abortion, and used general estimating equation (GEE) models to identify the factors associated with support for criminalization. RESULTS: Faculty and students generally did not support reporting or imprisoning anyone involved in an unlawful abortion and believed that protecting patient information takes precedence over reporting. Yet, faculty described pressures to report in the public sector and several cases where they or their colleagues were involved in reports. Most students somewhat/strongly agreed (78%) that patient information concerning an unlawful abortion should be kept confidential; 35% strongly/somewhat agreed that a clinician involved in an unlawful surgical abortion should be imprisoned, and 18% agreed that the woman involved should be imprisoned, with students from secular universities being significantly less likely to support reporting and punishing people involved in unlawful abortion, than students from Catholic universities. DISCUSSION: There is a need to clarify clinicians' ethical obligations in abortion care, in particular in Catholic universities, so that they can ensure that their patients have access to high quality confidential health care services.


Assuntos
Aborto Induzido , Universidades , Chile , Confidencialidade , Docentes , Feminino , Humanos , Gravidez , Estudantes
13.
Environ Pollut ; 266(Pt 1): 115130, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32652373

RESUMO

Short-term exposure to air pollution has pro-thrombotic effects and triggers thrombo-embolic events such as myocardial infarction or stroke in adults. This study evaluates the association between short-term variation in air pollution and treatments for acute thrombo-embolic events among the whole Belgian population. In a bidirectional time-stratified case-crossover design, we included 227,861 events treated with endovascular intervention and 74,942 with antithrombotic enzymes that were reimbursed by the Belgian Social Security between January 1st, 2009 and December 31st, 2013. We compared the concentrations of particulate matter (PM) air pollution (PM10 and PM2.5), as estimated at the municipality level on the day of the event (lag 0) and two days earlier (lag 1 and lag 2) with those of control days from the same month, matched by temperature and accounting for day of the week (weekend vs week days). We applied conditional logistic regression models to obtain odds ratios (OR) and their 95% CI for an increase of 10 µg/m3 (PM10) or 5 µg/m3 (PM2.5) in pollutant concentrations over three lag days (lag 0, 1 and 2). We observed significant associations of PM10 and PM2.5 with treatment of acute thrombo-embolic events at the three lags. The strongest associations were observed for air pollution concentrations on the day of the event (lag0). Increases of 10 µg/m3 PM10 and 5 µg/m3 PM2.5 on lag0 increased the odds of events treated with endovascular intervention by 2.7% (95%CI:2.3%-3.2%) and 1.3% (95%CI:1%-1.5%), respectively, and they increased the odds of events treated with antithrombotic enzymes by 1.9% (95%CI:1.1-2.7%) and 1.2% (95%CI:0.7%-1.6%), respectively. The associations were generally stronger during autumn months and among children. Our nationwide study confirms that acute exposure to outdoor air pollutants such as PM10 or PM2.5 increase the use of medication and interventions to treat thrombo-embolic events.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Adulto , Bélgica , Criança , Cidades , Estudos Cross-Over , Exposição Ambiental , Fibrinolíticos , Humanos , Material Particulado/análise
14.
BMC Med Ethics ; 21(1): 42, 2020 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448300

RESUMO

BACKGROUND: In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman's life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection (CO) in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students' support for CO, following legal reform. METHODS: From October 2017 to May 2018, we surveyed medical and midwifery students from seven universities located in Santiago, Chile. Universities included 4 secular (2 public and 2 private) and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology (ob-gyn) and five offering midwifery degrees. We used generalized estimating equations (GEE) to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level. RESULTS: 333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform (92%) and refer (91%) abortion-seeking patients, a minority (18%) would personally use conscientious objection to avoid caring for a patient seeking abortion (12% secular and 39% religious university students). About half of religious-university students (52%) and one-fifth of secular-university (20%) students support objections at the institutional level. CONCLUSIONS: Most students support the regulated use of CO which preserves patients' access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections.


Assuntos
Aborto Induzido , Tocologia , Atitude do Pessoal de Saúde , Chile , Consciência , Estudos Transversais , Feminino , Humanos , Gravidez , Recusa do Médico a Tratar , Estudantes
15.
Sex Reprod Healthc ; 24: 100502, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32234666

RESUMO

OBJECTIVE: Soon after Chile decriminalized abortion under three limited circumstances in 2017, we assessed medical and midwifery students' attitudes about abortion morality and legality when compared to national opinions. STUDY DESIGN: We administered an anonymous, online survey to medical and midwifery students from seven secular and religiously-affiliated universities in Santiago, Chile. We compared student responses to a nationally representative public opinion survey. MAIN OUTCOME MEASURES: We examined three main outcomes related to abortion attitudes: (1) moral acceptability of abortion and legal support for abortion in (2) one or (3) all listed circumstances. We used general estimating equations to examine whether university type, field of study, and other student characteristics are associated with each outcome and compared student views toward abortion legality with those of the general public. RESULTS: Among the 369 student respondents, most agreed that abortion can be a good thing for some women in some situations (82%). When compared to the general public, a larger proportion of students supported decriminalizing abortion in at least one (83% and 97%, respectively) or all (17% and 51%, respectively) seven listed circumstances. While secular university students held significantly more favorable views about abortion morality and legality than students from religiously-affiliated universities, the majority of students from both university types supported abortion in the three cases in which it was recently decriminalized. CONCLUSIONS: Medical and midwifery students from not only secular but also religiously-affiliated universities are very supportive of the recent decriminalization of abortion, which presents training opportunities for both types of universities.


Assuntos
Aborto Legal/ética , Aborto Legal/legislação & jurisprudência , Atitude do Pessoal de Saúde , Princípios Morais , Estudantes de Medicina/psicologia , Aborto Legal/classificação , Adolescente , Adulto , Catolicismo , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Opinião Pública , Secularismo , Universidades , Adulto Jovem
16.
Sci Total Environ ; 712: 136426, 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-31945528

RESUMO

Green space may improve cardiovascular (CV) health, for example by promoting physical activity and by reducing air pollution, noise and heat. Socioeconomic and environmental factors may modify the health effects of green space. We examined the association between residential green space and reimbursed CV medication sales in Belgium between 2006 and 2014, adjusting for socioeconomic deprivation and air pollution. We analyzed data for 11,575 census tracts using structural equation models for the entire country and for the administrative regions. Latent variables for green space, air pollution and socioeconomic deprivation were used as predictors of CV medication sales and were estimated from the number of patches of forest, census tract relative forest cover and relative forest cover within a 600 m buffer around the census tract; annual mean concentrations of PM2.5, BC and NO2; and percentages of inhabitants that were foreign-born from lower- and mid-income countries, unemployed or had no higher education. A direct association between socioeconomic deprivation and CV medication sales [parameter estimate (95% CI): 0.26 (0.25; 0.28)] and inverse associations between CV medication sales and green space [-0.71 (-0.80; -0.61)] and air pollution [-1.62 (-1.69; -0.61)] were observed. In the regional models, the association between green space and CV medication sales was stronger in the region with relatively low green space cover (Flemish Region, standardized estimate -0.16) than in the region with high green space cover (Walloon Region, -0.10). In the highly urbanized Brussels Capital Region the association tended towards the null. In all regions, the associations between CV medication sales and socioeconomic deprivation were direct and more prominent. Our results suggest that there may be an inverse association between green space and CV medication sales, but socioeconomic deprivation was always the strongest predictor of CV medication sales.


Assuntos
Fatores Socioeconômicos , Poluentes Atmosféricos , Poluição do Ar , Bélgica , Exposição Ambiental , Material Particulado
17.
Health Hum Rights ; 21(2): 121-131, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31885442

RESUMO

Until as recently as September 2017, Chile was one of the few countries in the world that did not permit abortion under any circumstances. Although the Health Code had permitted therapeutic abortion (i.e., on health grounds) from 1931, this was repealed in 1989 as one of General Pinochet's last acts in office. It took more than 25 years to reverse the ban. Finally, a new act was approved allowing abortion on three grounds: when a woman's life is in danger, when there are fetal anomalies incompatible with life, and in the case of rape. Since the law allows abortion only in limited cases, most women must continue to seek illegal abortions, as previously. In this paper, we explore the historical context in which Chile's 2017 bill was finally passed. We then analyze the legislative debate leading up to the passage of the law. Lastly, we present the results of a community-based participatory research effort carried out by an alliance between feminist and human rights organizations. Chile's law was passed almost two years ago, and this research shows the persistence of various obstacles that hinder women's access to legal abortion, such as the use of conscientious objection, a lack of trained health care providers, and a lack information for women.


Assuntos
Aborto Legal/legislação & jurisprudência , Atitude do Pessoal de Saúde , Dissidências e Disputas , Recusa do Médico a Tratar/legislação & jurisprudência , Direitos da Mulher/legislação & jurisprudência , Aborto Legal/ética , Chile , Pesquisa Participativa Baseada na Comunidade , Feminino , Feminismo , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Gravidez
18.
BMJ Open ; 9(10): e030797, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666266

RESUMO

OBJECTIVE: To assess Chilean medical and midwifery students' attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017. DESIGN: We fielded a cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought. SETTING: We recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile. PARTICIPANTS: Students seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey. PRIMARY AND SECONDARY OUTCOMES: Intentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision. RESULTS: Most students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%-79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities. CONCLUSION: Medical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.


Assuntos
Aborto Legal/psicologia , Atitude do Pessoal de Saúde , Enfermeiras Obstétricas/psicologia , Estudantes de Medicina/psicologia , Adolescente , Adulto , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Religião , Estudantes de Medicina/estatística & dados numéricos , Adulto Jovem
19.
Sci Rep ; 9(1): 17355, 2019 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-31758010

RESUMO

This study evaluates the association between indoor microbial diversity early in life and hyperactivity/inattention symptoms in children at ages 10 and 15 years.A random sample enriched with subjects with hyperactivity/inattention at age 15 years was selected from the German LISA birth cohort. Bedroom floor dust was collected at age 3 months and 4 bacterial and fungal diversity measures [number of observed operational taxonomic units (OTUs), Chao1, Shannon and Simpson indices] were calculated from Illumina MiSeq sequencing data. Hyperactivity/inattention was based on the Strengths and Difficulties Questionnaire at ages 10 and 15 (cut-off ≥7). Adjusted associations between 4 diversity measures in tertiles and hyperactivity/inattention were investigated with weighted and survey logistic regression models. We included 226 individuals with information on microbial diversity and hyperactivity/inattention. Early life bacterial diversity was inversely associated with hyperactivity/inattention at age 10 [bacterial OTUs (medium vs low: aOR = 0.4, 95%CI = (0.2-0.8)) and Chao1 (medium vs low: 0.3 (0.1-0.5); high vs low: 0.3 (0.2-0.6)], whereas fungal diversity was directly associated [Chao1 (high vs low: 2.1 (1.1-4.0)), Shannon (medium vs low: 2.8 (1.3-5.8)), and Simpson (medium vs low: 4.7 (2.4-9.3))]. At age 15, only Shannon index was significantly associated with hyperactivity/inattention [bacteria (medium vs low: 2.3 (1.2-4.2); fungi (high vs low: 0.5 (0.3-0.9))]. In conclusion, early life exposure to microbial diversity may play a role in the psychobehavioural development. We observe heterogeneity in the direction of the associations encouraging further longitudinal studies to deepen our understanding of the characteristics of the microbial community underlying the observed associations.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Poeira/análise , Microbiota , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Bactérias/isolamento & purificação , Criança , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Exposição Ambiental/análise , Características da Família , Feminino , Pisos e Cobertura de Pisos , Fungos/isolamento & purificação , Alemanha/epidemiologia , Humanos , Lactente , Estudos Longitudinais , Masculino , População , Inquéritos e Questionários
20.
Environ Res ; 177: 108644, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421443

RESUMO

BACKGROUND AND OBJECTIVES: Previous studies have suggested that air pollution is associated with depression and anxiety symptoms. Here, we investigate the association between personal exposure to NO2 and perceived stress and mood in a panel of healthy elderly persons. METHODS: In a one-year panel study, we included 20 healthy volunteers (10 male-female couples aged 58-76 years) with air pollution and health parameters measured every two months (120 observations). We measured personal exposure to NO2 in the previous 5 days, perceived stress using the Perceived Stress Scale (PSS) and positive and negative affect with the Positive and Negative Affect Schedule (PANAS). We used linear and Poisson mixed models to evaluate the associations between the health outcomes and NO2 adjusted for age, sex, temperature in the previous 5 days, sunlight in the previous day and physical activity (daily average number of steps on the previous week). Also, the interaction terms between NO2 and physical activity were tested. We report % changes for PSS scores and unit changes (ß) for positive and negative affect, and their 95% confidence intervals (CI), for changes in 10 µg/m3 of NO2. RESULTS: After adjustment, an increase by 10 µg/m3 in NO2 concentrations was associated with a decrease of 1.3 points in the positive affect (95% CI -2.49 to -0.17) and an increase of 0.11 points in the negative affect (95% CI 0.02 to 0.20). The association with positive affect was stronger when physical activity was below median value of 9,362 steps per day (ß = -2.68; CI: 4.87 to -0.49); p-value for interaction was 0.08. No statistically significant associations were observed with perceived stress. CONCLUSION: Short-term exposure to air pollution may produce non-pathological alterations in mood in healthy elderly population.


Assuntos
Afeto , Poluentes Atmosféricos , Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Idoso , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio , Material Particulado , Temperatura
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