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1.
Acta Derm Venereol ; 104: adv34961, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38828609

RESUMO

Atopic diseases such as atopic dermatitis, food allergy, allergic rhinoconjunctivitis, and/or asthma are common. In Denmark, however, there are multiple referral pathways for these diseases in the healthcare system and they are poorly understood. To describe how children with atopic diseases navigate their way through the Danish healthcare system, a questionnaire was distributed to children aged ≤ 17 years, who were being treated for atopic diseases between August 2020 and June 2021, either by a practising specialist or a hospital department, in the Capital Region of Denmark. A total of 279 children completed the questionnaire and most were referred to a specialist or to a hospital by their general practitioner. No "common track" to hospital existed for patients with ≥ 3 atopic diseases. These patients were more often referred to a hospital compared with children with 2 atopic diseases or fewer (odds ratio [OR] 3.79; 95% CI 2.07-7.24). The primary determinants for hospital treatment were food allergy (OR 4.69; 95% CI 2.07-10.61) and asthma (OR 2.58; 95% CI 1.18-5.63). In conclusion, children with multiple atopic diseases were more likely to be referred to hospital departments than to practising specialists, mainly due to food allergies.


Assuntos
Encaminhamento e Consulta , Humanos , Dinamarca/epidemiologia , Criança , Masculino , Feminino , Adolescente , Pré-Escolar , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/diagnóstico , Lactente , Asma/epidemiologia , Asma/diagnóstico , Asma/terapia , Inquéritos e Questionários , Dermatite Atópica/epidemiologia , Dermatite Atópica/diagnóstico , Dermatite Atópica/terapia , Departamentos Hospitalares
2.
Int J Tuberc Lung Dis ; 28(6): 287-294, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38822484

RESUMO

BACKGROUNDGiven the high prevalence of asthma-chronic obstructive pulmonary disease overlap (ACO) in Vietnam, there is an urgent need to establish a simplified strategy for categorising patients as either having asthma or chronic obstructive pulmonary disease (COPD). This classification would streamline the application of treatment recommendations outlined by the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD).METHODSPatients with obstructive lung function were classified as having COPD, asthma, or ACO based on GINA/GOLD guidelines. We hypothesised that ACO-like asthma (ACO-A) would present with positive skin prick tests (SPTs) or early onset of symptoms without a history of tuberculosis (TB), while those with ACO-like COPD (ACO-B) would exhibit negative SPTs and late onset of symptoms and/or a history of TB.RESULTSAmong 235 patients, the prevalence of asthma, ACO-A, ACO-B, and COPD was respectively 21%, 22%, 17%, and 40%. Allergic history, rhinitis, and childhood asthma were associated with ACO-A, while high cumulative smoking was correlated with ACO-B. Socio-economic and demographic parameters, medical history, clinical features, smoking habits, lung function, and para-clinical investigations significantly differed between "all asthma" (i.e., individuals with asthma combined with ACO-A) and "all COPD" (i.e., individuals with COPD combined with ACO-B).CONCLUSIONBased on SPTs, history of TB, and onset age, ACO patients may be defined as people with asthma or COPD..


Assuntos
Asma , Fenótipo , Doença Pulmonar Obstrutiva Crônica , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto , Asma/epidemiologia , Asma/diagnóstico , Vietnã/epidemiologia , Idoso , Testes Cutâneos , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/epidemiologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/diagnóstico
3.
Iran J Allergy Asthma Immunol ; 23(2): 127-138, 2024 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-38822508

RESUMO

The tragic COVID-19 pandemic affected many children worldwide. Among the factors that may influence the course of viral infections including COVID-19, it is still uncertain whether atopy has a protective or predisposing role. The study aims to address the knowledge gap by investigating the prevalence and severity of COVID-19 among atopic children in Kerman, in 2022. A descriptive-analytical cross-sectional study on children with a history of atopy was performed in Kerman Medical University. Demographic information, type of atopy (including allergic rhinitis, Hyper-Reactive Airway Disease (HRAD) or asthma, eczema, urticaria, anaphylaxis, and food allergy), history of COVID-19 infection, and disease severity were recorded. A total of 1007 children and adolescents, (boys: 56.4%, girls: 43.6%, age:5.61±2.64 years) were included in the study. History of COVID-19 infection was positive in 53.5%, with 75.9% of the cases exhibiting mild disease severity. The frequency of atopies was HRAD or asthma (67.2%), allergic rhinitis (42.6%), and food allergy (27.4%). The frequency of COVID-19 cases was significantly higher among patients with HRAD or asthma, whereas it was significantly lower among those with food allergies, anaphylaxis, and eczema. Among atopic individuals, COVID-19 severity was significantly lower in those with allergic rhinitis, while the opposite trend was observed among food-allergic individuals. This study sheds light on the relationship between atopy and COVID-19 among pediatric patients. It seems specific types of atopies may influence the risk and severity of COVID-19 infection differently. A better understanding of these associations can inform clinical management and preventive measures for vulnerable pediatric populations.


Assuntos
COVID-19 , SARS-CoV-2 , Índice de Gravidade de Doença , Humanos , COVID-19/epidemiologia , COVID-19/imunologia , Irã (Geográfico)/epidemiologia , Feminino , Masculino , Estudos Transversais , Criança , Prevalência , Pré-Escolar , Adolescente , Asma/epidemiologia , Rinite Alérgica/epidemiologia , Hipersensibilidade Alimentar/epidemiologia
4.
Int J Epidemiol ; 53(3)2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38850276

RESUMO

BACKGROUND: COVID-19 is associated with cardiovascular outcomes in the general population, but it is unknown whether people with chronic respiratory disease (CRD) have a higher risk of cardiovascular events post-COVID-19 compared with the general population and, if so, what respiratory-related factors may modify this risk in these people. METHODS: Primary and secondary care data from the National Health Service England were used to define a population of adults in England with COVID-19 (index date) between 1 January 2020 and 30 November 2021. Adjusted Cox proportional hazard regression was used to quantify the association between CRD, asthma-related factors, chronic obstructive pulmonary disease (COPD)-related factors, and risk of cardiovascular events. Asthma-specific factors included baseline asthma control, exacerbations, and inhaled corticosteroid (ICS) dose. COPD-specific risk factors included baseline ICS and exacerbations. Secondary objectives quantified the impact of COVID-19 hospitalisation and vaccine dose on cardiovascular outcomes. RESULTS: Of 3 670 455 people, those with CRD had a higher risk of cardiovascular events [adjusted hazard ratio (HRadj), 1.08; 95% confidence interval (CI) 1.06-1.11], heart failure (HRadj, 1.17; 95% CI, 1.12-1.22), angina (HRadj, 1.13; 95% CI, 1.06-1.20) and pulmonary emboli (HRadj, 1.24; 95% CI, 1.15-1.33) compared with people without CRD. In people with asthma or COPD, baseline exacerbations were associated with a higher risk of cardiovascular outcomes (HRadj, 1.36; 95% CI, 1.27-1.00 and HRadj, 1.35; 95% CI, 1.24-1.46, respectively). Regardless of CRD, the risk of cardiovascular events was lower with increasing COVID-19 vaccine dose. CONCLUSIONS: Higher risk of cardiovascular events post-COVID-19 might be explained by the underlying severity of the CRD, and COVID-19 vaccines were beneficial to both people with and those without CRD with regards to cardiovascualr events.


Assuntos
Asma , COVID-19 , Doenças Cardiovasculares , Doença Pulmonar Obstrutiva Crônica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Asma/epidemiologia , Asma/complicações , Doenças Cardiovasculares/epidemiologia , Doença Crônica , COVID-19/complicações , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Inglaterra/epidemiologia , Hospitalização/estatística & dados numéricos , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Fatores de Risco
5.
Sci Rep ; 14(1): 13240, 2024 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-38853175

RESUMO

Several risk factors including environmental exposures, socioeconomic status, and dietary factors including dietary patterns have been considered for childhood Asthma. The present study tried to examine the association between a western-style pattern and the likelihood of asthma and its symptoms in Yazd, Iran. In the present cross-sectional study, dietary intakes of elementary and high-school children were obtained through a validated GAN questionnaire. The GAN questionnaire, derived from the ISAAC questionnaire was used to assess the symptoms of allergic diseases and their related risk factors. A western dietary pattern score considered 9 food groups including chicken eggs, margarine, butter, sugar, fast foods, soft drinks, snacks, sauce, and chocolate. In total 7667 children aged 10.9 ± 3.35 years were included in the current investigation. Boys with higher adherence to western dietary pattern had a higher risk of wheezing in the past 12 months (OR 1.37, 5% CI 1.01-1.87, P = 0.04) and this association was also observed in the whole population (OR 1.30, 5% CI 1.05-1.60, P = 0.01). However, after adjustment for confounders this relation did not remain significant in boys. Our results support the hypothesis that a western dietary pattern is associated with an increased risk of wheezing in the past 12 months in children with asthma. Future prospective studies are needed to confirm this finding.


Assuntos
Asma , Dieta Ocidental , Humanos , Asma/epidemiologia , Asma/etiologia , Masculino , Criança , Adolescente , Feminino , Dieta Ocidental/efeitos adversos , Estudos Transversais , Fatores de Risco , Irã (Geográfico)/epidemiologia , Inquéritos e Questionários , Sons Respiratórios/etiologia
6.
Pediatr Allergy Immunol ; 35(6): e14168, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38873913

RESUMO

BACKGROUND: Poor asthma control may adversely affect mental health. Our study investigates the correlation between inadequate asthma control, exhaled nitric oxide (FENO) levels, and anxiety and depression among pediatric asthma patients with COVID-19. METHODS: This prospective case-control study enrolled 520 asthmatic children (8-15 years), including 336 patients diagnosed with COVID-19 after rapid antigen testing at home and 184 age-matched asthmatic patients without COVID-19 infection. FENO and spirometry were performed 1 month after COVID-19 infection. Scores for Child Anxiety-Related Disorders (SCARED) and depression screen derived from Patient Health Questionnaire-9 (PHQ-9) to assess their mental health status. Childhood asthma control test (C-ACT), FENO levels, and spirometry were correlated with the SCARED and PHQ-9 questionnaires. RESULTS: SCARED subscales, including generalized anxiety disorder, social anxiety disorder, school avoidance, and depression scores from PHQ-9, exhibited a significant increase in asthmatic patients diagnosed with COVID-19 (p < .05). Among asthmatic children with SARS-CoV-2 infection, the poor asthma control group exhibited the highest SCARED and PHQ-9 measurements (p < .01). Multiple linear regression analysis indicated that reduced C-ACT scores and elevated FENO levels in asthmatic children with COVID-19 were significant risk factors for both anxiety and depression scores (p < .05). Lower C-ACT scales were associated with high scores of SCARED (r = -0.471) and PHQ-9 (r = -0.329) in asthmatic children (p < .001). CONCLUSIONS: The current study emphasizes the need for healthcare professionals to closely monitor asthma control in asthmatic children to prevent heightened risks of depression and anxiety during the ongoing COVID-19 pandemic.


Assuntos
Ansiedade , Asma , COVID-19 , Depressão , SARS-CoV-2 , Humanos , COVID-19/psicologia , COVID-19/complicações , COVID-19/epidemiologia , Asma/epidemiologia , Asma/psicologia , Criança , Masculino , Feminino , Adolescente , Estudos Prospectivos , Depressão/epidemiologia , Depressão/etiologia , Estudos de Casos e Controles , Ansiedade/epidemiologia , Ansiedade/etiologia , Óxido Nítrico/análise , Óxido Nítrico/metabolismo , Espirometria , Inquéritos e Questionários
7.
Front Public Health ; 12: 1402908, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38868160

RESUMO

Background: Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children. Methods: A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique. Result: A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14-1.35) with extreme heterogeneity (I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14-1.57), with high heterogeneity (I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45-2.21) with nonsignificant low heterogeneity (I 2 = 30%, p-value = 0.18). Conclusion: This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.


Assuntos
Asma , Exposição Ambiental , Praguicidas , Sons Respiratórios , Infecções Respiratórias , Humanos , Asma/epidemiologia , Asma/induzido quimicamente , Sons Respiratórios/etiologia , Praguicidas/efeitos adversos , Infecções Respiratórias/epidemiologia , Criança , Exposição Ambiental/efeitos adversos , Pré-Escolar , Adolescente , Lactente
8.
PLoS One ; 19(6): e0304106, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870112

RESUMO

Air pollution causes and exacerbates allergic diseases including asthma, allergic rhinitis, and atopic dermatitis. Precise prediction of the number of patients afflicted with these diseases and analysis of the environmental conditions that contribute to disease outbreaks play crucial roles in the effective management of hospital services. Therefore, this study aims to predict the daily number of patients with these allergic diseases and determine the impact of particulate matter (PM10) on each disease. To analyze the spatiotemporal correlations between allergic diseases (asthma, atopic dermatitis, and allergic rhinitis) and PM10 concentrations, we propose a multi-variable spatiotemporal graph convolutional network (MST-GCN)-based disease prediction model. Data on the number of patients were collected from the National Health Insurance Service from January 2013 to December 2017, and the PM10 data were collected from Airkorea during the same period. As a result, the proposed disease prediction model showed higher performance (R2 0.87) than the other deep-learning baseline methods. The synergic effect of spatial and temporal analyses improved the prediction performance of the number of patients. The prediction accuracies for allergic rhinitis, asthma, and atopic dermatitis achieved R2 scores of 0.96, 0.92, and 0.86, respectively. In the ablation study of environmental factors, PM10 improved the prediction accuracy by 10.13%, based on the R2 score.


Assuntos
Asma , Dermatite Atópica , Material Particulado , Rinite Alérgica , Humanos , Material Particulado/análise , Material Particulado/efeitos adversos , Asma/epidemiologia , Rinite Alérgica/epidemiologia , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Análise Espaço-Temporal , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/efeitos adversos , Redes Neurais de Computação , Hipersensibilidade/epidemiologia
9.
Sci Rep ; 14(1): 12803, 2024 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-38834753

RESUMO

We previously reported that asthma prevalence was higher in the United States (US) compared to Mexico (MX) (25.8% vs. 8.4%). This investigation assessed differences in microbial dust composition in relation to demographic and housing characteristics on both sides of the US-MX Border. Forty homes were recruited in the US and MX. Home visits collected floor dust and documented occupants' demographics, asthma prevalence, housing structure, and use characteristics. US households were more likely to have inhabitants who reported asthma when compared with MX households (30% vs. 5%) and had significantly different flooring types. The percentage of households on paved roads, with flushing toilets, with piped water and with air conditioning was higher in the US, while dust load was higher in MX. Significant differences exist between countries in the microbial composition of the floor dust. Dust from Mexican homes was enriched with Alishewanella, Paracoccus, Rheinheimera genera and Intrasporangiaceae family. A predictive metagenomics analysis identified 68 significantly differentially abundant functional pathways between US and MX. This study documented multiple structural, environmental, and demographic differences between homes in the US and MX that may contribute to significantly different microbial composition of dust observed in these two countries.


Assuntos
Poeira , Habitação , Poeira/análise , Arizona , Humanos , México , Asma/epidemiologia , Asma/microbiologia , Bactérias/genética , Bactérias/classificação , Bactérias/isolamento & purificação , Feminino , Características da Família , Masculino , Metagenômica/métodos
10.
Spat Spatiotemporal Epidemiol ; 49: 100663, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38876559

RESUMO

This paper contributes to the field by addressing the critical issue of enhancing the spatial and temporal resolution of health data. Although Bayesian methods are frequently employed to address this challenge in various disciplines, the application of Bayesian spatio-temporal models to burden of disease (BOD) studies remains limited. Our novelty lies in the exploration of two existing Bayesian models that we show to be applicable to a wide range of BOD data, including mortality and prevalence, thereby providing evidence to support the adoption of Bayesian modeling in full BOD studies in the future. We illustrate the benefits of Bayesian modeling with an Australian case study involving asthma and coronary heart disease. Our results showcase the effectiveness of Bayesian approaches in increasing the number of small areas for which results are available and improving the reliability and stability of the results compared to using data directly from surveys or administrative sources.


Assuntos
Asma , Teorema de Bayes , Efeitos Psicossociais da Doença , Análise Espaço-Temporal , Humanos , Austrália/epidemiologia , Asma/epidemiologia , Doença das Coronárias/epidemiologia , Prevalência , Masculino , Feminino , Modelos Estatísticos
11.
Nat Commun ; 15(1): 4934, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38858369

RESUMO

Sugar sweetened beverage consumption has been suggested as a risk factor for childhood asthma symptoms. We examined whether the UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in National Health Service hospital admission rates for asthma in children, 22 months post-implementation of SDIL. We conducted interrupted time series analyses (2012-2020) to measure changes in monthly incidence rates of hospital admissions. Sub-analysis was by age-group (5-9,10-14,15-18 years) and neighbourhood deprivation quintiles. Changes were relative to counterfactual scenarios where the SDIL wasn't announced, or implemented. Overall, incidence rates reduced by 20.9% (95%CI: 29.6-12.2). Reductions were similar across age-groups and deprivation quintiles. These findings give support to the idea that implementation of a UK tax intended to reduce childhood obesity may have contributed to a significant unexpected and additional public health benefit in the form of reduced hospital admissions for childhood asthma.


Assuntos
Asma , Bebidas Gaseificadas , Hospitalização , Humanos , Asma/epidemiologia , Asma/etiologia , Criança , Adolescente , Pré-Escolar , Inglaterra/epidemiologia , Hospitalização/estatística & dados numéricos , Bebidas Gaseificadas/economia , Bebidas Gaseificadas/efeitos adversos , Bebidas Gaseificadas/estatística & dados numéricos , Masculino , Feminino , Análise de Séries Temporais Interrompida , Impostos/economia , Incidência , Obesidade Infantil/epidemiologia , Fatores de Risco , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/estatística & dados numéricos , Bebidas Adoçadas com Açúcar/economia
12.
BMJ Open Respir Res ; 11(1)2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38862238

RESUMO

BACKGROUND: Herpes zoster (HZ) is a painful condition caused by reactivation of the varicella-zoster virus. The objectives of this study were to compare HZ incidence in adults with asthma versus adults without asthma and to compare healthcare resource use as well as direct costs in adults with HZ and asthma versus adults with asthma alone in the USA. METHODS: This retrospective longitudinal cohort study included adults aged ≥18 years across the USA. Patients were identified from Optum's deidentified Clinformatics Data Mart Database, an administrative claims database, between 1 October 2015 and 28 February 2020, including commercially insured and Medicare Advantage with part D beneficiaries. Cohorts of patients with and without asthma, and separate cohorts of patients with asthma and HZ and with asthma but not HZ, were identified using International Classification of Diseases 10th Revision, Clinical Modification codes. HZ incidence, healthcare resource use and costs were compared, adjusting for baseline characteristics, between the relevant cohorts using generalised linear models. RESULTS: HZ incidence was higher in patients with asthma (11.59 per 1000 person-years) than patients without asthma (7.16 per 1000 person-years). The adjusted incidence rate ratio (aIRR) for HZ in patients with asthma, compared with patients without asthma, was 1.34 (95% CI 1.32 to 1.37). Over 12 months of follow-up, patients with asthma and HZ had more inpatient stays (aIRR 1.11; 95% CI 1.02 to 1.21), emergency department visits (aIRR 1.26; 95% CI 1.18 to 1.34) and outpatient visits (aIRR 1.19; 95% CI 1.16 to 1.22), and direct healthcare costs that were US dollars ($) 3058 (95% CI $1671 to $4492) higher than patients with asthma without HZ. CONCLUSION: Patients with asthma had a higher incidence of HZ than those without asthma, and among patients with asthma HZ added to their healthcare resource use and costs.


Assuntos
Asma , Custos de Cuidados de Saúde , Herpes Zoster , Humanos , Herpes Zoster/economia , Herpes Zoster/epidemiologia , Asma/economia , Asma/epidemiologia , Asma/terapia , Masculino , Feminino , Estudos Retrospectivos , Incidência , Pessoa de Meia-Idade , Adulto , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Estados Unidos/epidemiologia , Estudos Longitudinais , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Adulto Jovem , Efeitos Psicossociais da Doença , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Adolescente
13.
Sci Rep ; 14(1): 13048, 2024 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844482

RESUMO

Evidence linking maternal diet during pregnancy to allergic or respiratory diseases in children remains sparse, and outcomes were mainly studied separately. We aim to investigate these associations by considering clusters of allergic and respiratory multimorbidity among 9679 mother-child pairs from the Elfe birth cohort. Maternal diet quality was evaluated using a food-based score (Diet Quality score), a nutrient-based score (PANDiet score) and food group intakes. Adjusted multinomial logistic regressions on allergic and respiratory multimorbidity clusters up to 5.5 years were performed. Child allergic and respiratory diseases were described through five clusters: "asymptomatic" (43%, reference), "early wheeze without asthma" (34%), "asthma only" (7%), "allergies without asthma" (7%), "multi-allergic" (9%). A higher PANDiet score and an increased legume consumption were associated with a reduced risk of belonging to the "early wheeze without asthma" cluster. A U-shaped relationship was observed between maternal fish consumption and the "allergies without asthma" cluster. To conclude, adequate nutrient intake during pregnancy was weakly associated with a lower risk of "early wheeze without asthma" in children. No association was found with food groups, considered jointly or separately, except for legumes and fish, suggesting that maternal adherence to nutritional guidelines might be beneficial for allergic and respiratory diseases prevention.


Assuntos
Dieta , Humanos , Feminino , Gravidez , Pré-Escolar , Masculino , Dieta/efeitos adversos , Lactente , Adulto , Multimorbidade , Fenômenos Fisiológicos da Nutrição Materna , Coorte de Nascimento , Asma/epidemiologia , Asma/etiologia , Hipersensibilidade/epidemiologia , Sons Respiratórios , Criança , Efeitos Tardios da Exposição Pré-Natal/epidemiologia
14.
Environ Int ; 189: 108810, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38875815

RESUMO

Previous studies of air pollution and respiratory disease often relied on aggregated or lagged acute respiratory disease outcome measures, such as emergency department (ED) visits or hospitalizations, which may lack temporal and spatial resolution. This study investigated the association between daily air pollution exposure and respiratory symptoms among participants with asthma and chronic obstructive pulmonary disease (COPD), using a unique dataset passively collected by digital sensors monitoring inhaled medication use. The aggregated dataset comprised 456,779 short-acting beta-agonist (SABA) puffs across 3,386 people with asthma or COPD, between 2012 and 2019, across the state of California. Each rescue use was assigned space-time air pollution values of nitrogen dioxide (NO2), fine particulate matter with diameter ≤ 2.5 µm (PM2.5) and ozone (O3), derived from highly spatially resolved air pollution surfaces generated for the state of California. Statistical analyses were conducted using linear mixed models and random forest machine learning. Results indicate that daily air pollution exposure is positively associated with an increase in daily SABA use, for individual pollutants and simultaneous exposure to multiple pollutants. The advanced linear mixed model found that a 10-ppb increase in NO2, a 10 µg m-3 increase in PM2.5, and a 30-ppb increase in O3 were respectively associated with incidence rate ratios of SABA use of 1.025 (95 % CI: 1.013-1.038), 1.054 (95 % CI: 1.041-1.068), and 1.161 (95 % CI: 1.127-1.233), equivalent to a respective 2.5 %, 5.4 % and 16 % increase in SABA puffs over the mean. The random forest machine learning approach showed similar results. This study highlights the potential of digital health sensors to provide valuable insights into the daily health impacts of environmental exposures, offering a novel approach to epidemiological research that goes beyond residential address. Further investigation is warranted to explore potential causal relationships and to inform public health strategies for respiratory disease management.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Material Particulado , Humanos , Poluição do Ar/efeitos adversos , Poluição do Ar/estatística & dados numéricos , California/epidemiologia , Material Particulado/análise , Material Particulado/efeitos adversos , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/efeitos adversos , Estudos Longitudinais , Ozônio/análise , Ozônio/efeitos adversos , Exposição Ambiental/efeitos adversos , Exposição Ambiental/estatística & dados numéricos , Asma/epidemiologia , Asma/induzido quimicamente , Masculino , Dióxido de Nitrogênio/análise , Dióxido de Nitrogênio/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Feminino , Pessoa de Meia-Idade , Monitoramento Ambiental/métodos , Idoso , Adulto , Saúde Digital
15.
Community Dent Health ; 41(2): 145-151, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38809691

RESUMO

BACKGROUND: Autoimmune diseases (AIDs) are linked to oropharyngeal cancer (OPC), but the exact nature of this association remains unclear. This study aims to examine the potential causal effect of AIDs on the risk of developing OPC. METHOD: Information regarding AIDs was collected from the UK Biobank dataset and the Finn Gen study. OPC data were sourced from the IEU Open GWAS project. All data were derived from European populations. Inverse variance weighted (IVW) to two-sample Mendelian randomization (MR) was complemented by weighted median and MR Egger validation analyses. RESULT: The development of asthma (AS), multiple sclerosis (MS), and rheumatoid arthritis (RA) influenced the risk of developing OPC. However, the reverse MR analysis did not provide evidence for the impact of OPC on AIDs. Sensitivity analysis using MR corroborated the IVW results. The IVW results indicate OR values of 1.004 for AS, 0.936 for MS, and 1.0002 for RA. CONCLUSION: This MR study supports a causal relationship between asthma and rheumatoid arthritis for OPC in a European population. Multiple sclerosis was protective against OPC.


Assuntos
Doenças Autoimunes , Neoplasias Orofaríngeas , Humanos , Análise da Randomização Mendeliana , Esclerose Múltipla/genética , Artrite Reumatoide , Asma/epidemiologia , Estudo de Associação Genômica Ampla , Fatores de Risco , Causalidade , Reino Unido/epidemiologia , Masculino , Feminino
16.
Hosp Pediatr ; 14(6): e254-e259, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38757173

RESUMO

OBJECTIVES: To characterize the prescribing trends and clinical outcomes related to azithromycin (AZI) among children hospitalized for critical asthma (CA). METHODS: We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry of children 3 to 17 years of age hospitalized in a PICU for CA from January 2011 to December 2022. We excluded for alternative indications for AZI (eg, atypical pneumonia, B. pertussis infection, acute otitis media, acute sinusitis, pharyngitis/tonsillitis, and urethritis). The primary outcome was AZI prescribing rate by hospital and calendar year (trends assessed by Joinpoint regression). Cohorts with and without AZI exposure were further characterized by demographics, CA treatments, and inpatient outcomes using descriptive and comparative (ie, χ2 and Wilcoxon rank tests) statistics. RESULTS: Of the 47 797 children studied, 9901 (20.7%) were prescribed AZI with a downward annual trend noted from 34.7% in 2011% to 12.4% in 2022 (-1.7% per year, R2 = 0.91). Median institutional AZI prescribing rate was 19.2% (interquartile range [IQR] 11.7%-28%; total range 5.6%-60%). Compared with children not prescribed AZI, those prescribed AZI were older (median 8.3 [IQR 5.7-11.6] vs 7.3 [4.9-10.8] years, P < .001) and experienced a more severe clinical trajectory with greater rates of bilevel positive airway pressure ventilation (19.7% vs 12.6%, P < .001), invasive ventilation (22.1% vs 13.5%, P < .001), extracorporeal life support (0.8% vs 0.1%, P < .001), and median length of stay (4 [IQR 3-6] vs 3 [IQR 2-4] days, P < .001). CONCLUSIONS: Between 2011 and 2022, 20.7% of children hospitalized for CA were prescribed AZI notwithstanding the absence of trial-derived efficacy or safety data for this indication and population.


Assuntos
Antibacterianos , Asma , Azitromicina , Humanos , Criança , Estudos Retrospectivos , Feminino , Pré-Escolar , Masculino , Asma/tratamento farmacológico , Asma/epidemiologia , Adolescente , Azitromicina/uso terapêutico , Antibacterianos/uso terapêutico , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Estado Terminal/terapia
17.
Proc Natl Acad Sci U S A ; 121(22): e2320338121, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38768355

RESUMO

Electric school buses have been proposed as an alternative to reduce the health and climate impacts of the current U.S. school bus fleet, of which a substantial share are highly polluting old diesel vehicles. However, the climate and health benefits of electric school buses are not well known. As they are substantially more costly than diesel buses, assessing their benefits is needed to inform policy decisions. We assess the health benefits of electric school buses in the United States from reduced adult mortality and childhood asthma onset risks due to exposure to ambient fine particulate matter (PM2.5). We also evaluate climate benefits from reduced greenhouse-gas emissions. We find that replacing the average diesel bus in the U.S. fleet in 2017 with an electric bus yields $84,200 in total benefits. Climate benefits amount to $40,400/bus, whereas health benefits amount to $43,800/bus due to 4.42*10-3 fewer PM2.5-attributable deaths ($40,000 of total) and 7.42*10-3 fewer PM2.5-attributable new childhood asthma cases ($3,700 of total). However, health benefits of electric buses vary substantially by driving location and model year (MY) of the diesel buses they replace. Replacing old, MY 2005 diesel buses in large cities yields $207,200/bus in health benefits and is likely cost-beneficial, although other policies that accelerate fleet turnover in these areas deserve consideration. Electric school buses driven in rural areas achieve small health benefits from reduced exposure to ambient PM2.5. Further research assessing benefits of reduced exposure to in-cabin air pollution among children riding buses would be valuable to inform policy decisions.


Assuntos
Poluição do Ar , Veículos Automotores , Material Particulado , Instituições Acadêmicas , Emissões de Veículos , Humanos , Estados Unidos , Emissões de Veículos/prevenção & controle , Material Particulado/efeitos adversos , Asma/epidemiologia , Asma/etiologia , Asma/mortalidade , Criança , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Exposição Ambiental/efeitos adversos , Eletricidade , Adulto
18.
JAMA ; 331(20): 1732-1740, 2024 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-38703403

RESUMO

Importance: Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. Objective: To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. Design, Setting, and Participants: This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Main Outcomes and Measures: Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Results: Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. Conclusions and Relevance: In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.


Assuntos
Asma , Disparidades nos Níveis de Saúde , Mortalidade , Transtornos Relacionados ao Uso de Substâncias , Suicídio , Ferimentos e Lesões , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Adulto Jovem , Causas de Morte/tendências , Estudos Transversais , Etnicidade/estatística & dados numéricos , Mortalidade/etnologia , Mortalidade/tendências , Suicídio/etnologia , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etnologia , Ferimentos e Lesões/mortalidade , Grupos Raciais/etnologia , Grupos Raciais/estatística & dados numéricos , Indígena Americano ou Nativo do Alasca/estatística & dados numéricos , Brancos/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Nativo Asiático-Americano do Havaí e das Ilhas do Pacífico/estatística & dados numéricos , Asma/epidemiologia , Asma/etnologia , Asma/mortalidade , Homicídio/etnologia , Homicídio/estatística & dados numéricos , Armas de Fogo/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Ferimentos por Arma de Fogo/mortalidade , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Acidentes de Trânsito/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade
19.
Environ Res ; 255: 119130, 2024 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-38735375

RESUMO

OBJECTIVES: This study aims to assess the specific PM2.5-bound metallic elements that contribute to asthma emergency department visits by using a case-crossover study design. METHODS: This study analyzed data from 11,410 asthma emergency department visits as case group and 22,820 non-asthma onset dates occurring one week and two weeks preceding the case day as controls from 2017 to 2020. PM2.5 monitoring data and 35 PM.2.5-bound metallic elements from six different regions in Taiwan were collected. Conditional logistic regression models were used to assess the relationship between asthma and PM2.5-bound metallic elements. RESULTS: Our investigation revealed a statistically significant risk of asthma emergency department visits associated with PM2.5 exposure at lag 0, 1, 2, and 3 during autumn. Additionally, PM2.5-bound hafnium (Hf), thallium (Tl), rubidium (Rb), and aluminum (Al) exhibited a consistently significant positive correlation with asthma emergency department visits at lags 1, 2, and 3. In stratified analyses by area, age, and sex, PM2.5-bound Hf showed a significant and consistent correlation. CONCLUSIONS: This study provides evidence of PM2.5-bound metallic elements effects in asthma exacerbations, particularly for Hf. It emphasizes the importance of understanding the origins of these metallic elements and pursuing emission reductions to mitigate regional health risks.


Assuntos
Poluentes Atmosféricos , Asma , Estudos Cross-Over , Serviço Hospitalar de Emergência , Material Particulado , Asma/epidemiologia , Asma/induzido quimicamente , Taiwan/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Material Particulado/análise , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Poluentes Atmosféricos/análise , Idoso , Adolescente , Adulto Jovem , Metais/análise , Criança , Exposição Ambiental/efeitos adversos , Pré-Escolar , Lactente , Visitas ao Pronto Socorro
20.
JAMA Netw Open ; 7(5): e2410740, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38758558

RESUMO

Importance: The association of use of electronic nicotine delivery systems (ENDS) with the age of asthma onset is unknown. Objective: To explore the association of past 30-day ENDS use with the age of asthma onset in adults and youths who did not have asthma or chronic obstructive pulmonary disease and never used cigarettes. Design, Setting, and Participants: This cohort study was a secondary analysis of waves 1 to 6 of the US nationally representative Population of Tobacco and Health Study (2013-2021). Eligible participants included adults (≥18 years) and youths (12-17 years) who did not have asthma or chronic obstructive pulmonary disease at the first wave of participation. Data analysis was conducted from September 2022 to April 2024. Exposure: Past 30-day ENDS use at the first wave of participation in the study preceding the onset of asthma. Main outcome and measures: Lower and upper age limits were estimated using the age reported at the first wave of participation and the number of weeks between follow-up waves until asthma was first reported or censored. The association of past 30-day ENDS use with the age of asthma onset was estimated using weighted interval-censoring Cox regression. The cumulative hazard function for the age of asthma onset was estimated using interval-censoring survival analysis. Results: A total of 24 789 participants were included, with 7766 adults (4461 female [weighted percentage, 59.11%] and 3305 male [weighted percentage, 40.89%]), representing 80.0 million adults, and 17 023 youths (8514 female [weighted percentage, 50.60%] and 8496 male [weighted percentage 49.32%]), representing 33.9 million youths. By age 27 years, 6.2 per 1000 adults reported asthma incidence (hazard ratio [HR], 0.62%; 95% CI, 0.46%-0.75%). While controlling for covariates, there was a 252% increased risk of the onset of asthma at earlier ages for adults who used ENDS in the past 30 days vs adults who did not (adjusted HR, 3.52; 95% CI, 1.24-10.02). For youths, there was no association of ENDS use in the past 30 days with age of asthma onset (adjusted HR, 1.79; 95% CI, 0.67-4.77), which could be due to a lack of statistical power. Conclusion and relevance: In this cohort study, past 30-day ENDS use among adults was associated with earlier ages of asthma onset. These findings suggest that prevention and cessation programs directed to adults who use ENDS are needed to educate the public, protect public health, prevent adverse health outcomes, and motivate users to stop. Furthermore, modifying symptom-screening asthma guidelines, resulting in earlier asthma detection and treatment, may reduce morbidity and mortality due to asthma.


Assuntos
Idade de Início , Asma , Sistemas Eletrônicos de Liberação de Nicotina , Humanos , Asma/epidemiologia , Feminino , Masculino , Adolescente , Adulto , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem , Estudos de Coortes , Criança , Pessoa de Meia-Idade , Vaping/epidemiologia
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