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1.
Niger J Clin Pract ; 24(9): 1268-1276, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34531336

RESUMO

Epidemiologic studies have reported increasing prevalence of childhood asthma in Nigeria and other developing countries where there are parallel increases in school enrolments. Children with asthma face lots of challenges in school which can affect their academic performance and quality of life. This narrative review highlights the challenges and the risks of schooling encountered by Nigerian children with asthma and the prospects of utilizing the School Health Programme (SHP) to overcome these challenges. An electronic search of relevant published articles from 2000 to 2020 was carried out using appropriate search engines for the following words: "schooling", "childhood asthma", "school health programme", "school environment," "health instructions", "school health services" and "asthma care in schools". The challenges and risks the school age asthmatics encounter in school include discrimination and victimization, exposure to triggers on the road and in the school environment, poor and non-existence asthma care services in schools, suboptimal knowledge of teachers and caregivers about childhood asthma hence poor asthma-related instructions and increased school absenteeism. The prospects of SHP as a tool to overcome these challenges are highlighted. These include the roles expected to be played by all stakeholders - the government and education authorities need to revise and more effectively implement the school health policy. The roles of asthma care professionals include the need to "adopt" schools to ensure optimal asthma care for the school population and the all-important enlightenment of teachers, school health workers, parents/caregivers and school children for overall improved asthma care delivery in Nigerian schools.


Assuntos
Asma , Qualidade de Vida , Asma/epidemiologia , Criança , Humanos , Nigéria/epidemiologia , Serviços de Saúde Escolar , Instituições Acadêmicas
2.
BMJ Open ; 11(9): e046769, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475151

RESUMO

OBJECTIVES: The association between hypertensive disorders in pregnancy (HDP) and an increased risk of asthma in offspring remains controversial. No systematic review of this topic has been performed. The aim of this systematic review was to summarise the available evidence regarding the association between HDP and the risk of asthma in offspring. DESIGN: Systematic review and meta-analysis. METHODS: On the basis of a prepared protocol, a systematic search of PubMed, EMBASE, the Cochrane Library and Web of Science was performed using a detailed search strategy from the database inception to 17 January 2020. Cohort, case-control and cross-sectional studies published in English reporting the diagnoses of maternal HDP and asthma in offspring were included. The Meta-analysis of Observational Studies in Epidemiology guidelines were followed throughout the study. The estimated pooled ORs of HDP and asthma in offspring were calculated from the studies, and the meta-analysis was performed using random-effects models. RESULTS: Ten cohort studies involving a total of 6 270 430 participants were included. According to the Newcastle-Ottawa Scale, the overall methodological quality was good since 8 studies were of high quality and 2 studies were of moderate quality. After controlling for potential confounders, HDP was associated with a possible increased risk of asthma in offspring, with a pooled adjusted OR (aOR) of 1.19 (95% CI 1.12 to 1.26). The subgroup analyses according to HDP subgroups, sibling design, study quality, study location, offspring ages, singleton status, exposure assessment, outcome assessment and adjusted factors showed similar results. CONCLUSIONS: Exposure to HDP may be associated with an increased risk of asthma in offspring. Further research is needed to verify the results and determine whether the observed relationship is causal. PROSPERO REGISTRATION NUMBER: CRD42020148250.


Assuntos
Asma , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Asma/epidemiologia , Asma/etiologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez
4.
BMJ Open ; 11(8): e048137, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353798

RESUMO

OBJECTIVE: This study will add to existing literature by examining the impact of smoke-free legislation in outdoor areas among children with asthma. We aimed to examine the effect of the 2015 Smoke-Free Ontario Act (SFOA) amendment, which prohibited smoking on patios, playgrounds and sports fields, on health services use (HSU) rates in children with asthma. METHODS: We conducted a population-based open cohort study using health administrative data from the province of Ontario, Canada. Each year, all Ontario residents aged 0-18 years with physician diagnosed asthma were included in the study. Annual rates of HSU (emergency department (ED) visits, hospitalisations and physician office visits) for asthma and asthma-related conditions (eg, bronchitis, allergic rhinitis, influenza and pneumonia) were calculated. Interrupted time-series analysis, accounting for seasonality, was used to estimate changes in HSU following the 2015 SFOA. RESULTS: The study population ranged from 618 957 individuals in 2010 to 498 812 in 2018. An estimated average increase in ED visits for asthma in infants aged 0-1 years of 0.42 per 100 individuals (95% CI: 0.09 to 0.75) and a 57% relative increase corresponding to the 2015 SFOA was observed. A significant decrease in ED visits for asthma-related conditions of 0.19 per 100 individuals (95% CI: -0.37 to -0.01) and a 22% relative decrease corresponding to the 2015 SFOA was observed. CONCLUSION: Based on the observed positive effect of restricting smoking on patios, playgrounds and sports fields on respiratory morbidity in children with asthma, other jurisdictions globally should consider implementing similar smoke-free policies.


Assuntos
Asma , Asma/epidemiologia , Asma/terapia , Criança , Estudos de Coortes , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Lactente , Ontário/epidemiologia
5.
BMJ Open ; 11(8): e045795, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34426461

RESUMO

INTRODUCTION: The hygiene hypothesis suggests that reduced exposure to microbes might have contributed to the increase in prevalence and incidence of asthma and allergy observed during the second half of the last century. Following this proposal, several studies have investigated the role of sibship size and birth order in the development of asthma and allergic diseases, but the underlying evidence is conflicting. The objective of the present systematic review will be to identify, critically appraise and synthesise previous primary studies investigating the association of sibship size and birth order with the risk of asthma and allergic diseases. METHODS AND ANALYSIS: The following databases will be searched: AMED, CABI, CINAHL, Embase, Google Scholar, OAIster, Open Access Theses and Dissertations, Open Grey, ProQuest Dissertations & Theses Global, PsycINFO, PubMed, SciELO, Scopus, Web of Science and WHO Global Index Medicus. Studies published up until 31 December 2020 will be eligible. There will be no restrictions by language and geographical location. Risk of bias in the included studies will be assessed using the Effective Public Health Practice Project quality assessment tool. The produced evidence will be synthesised narratively, and studies that present comparable numerical data will be included in meta-analyses using random effects model. ETHICS AND DISSEMINATION: Only data from the published literature will be included in this systematic review. Therefore, no ethical approval is required. The final review paper will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020207905.


Assuntos
Asma , Hipersensibilidade , Asma/epidemiologia , Asma/etiologia , Ordem de Nascimento , Humanos , Hipersensibilidade/epidemiologia , Metanálise como Assunto , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
6.
Environ Pollut ; 286: 117582, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34438500

RESUMO

Limitations of Normalized Difference Vegetation Index (NDVI) potentially contributed to the inconsistent findings of greenspace exposure and childhood asthma. The aim of this study was to use a novel greenness exposure assessment method, capable of overcoming the limitation of NDVI to determine the extent to which it was associated with asthma prevalence in Chinese children. During 2009-2013, a cross-sectional study of 59,754 children aged 2-17 years was conducted in northeast China. Tencent street view images surrounding participants' schools were segmented by a deep learning model, and streetscape greenness was extracted. The green view index (GVI) was used to assign exposure and higher value indicates more green coverage. Mixed-effects logistic regression models were used to calculate the adjusted odds of asthma per interquartile range (IQR) increase of GVI for trees and grass. Participants were further stratified to investigate whether particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) was a modifier. An IQR increase in GVI800m for trees was associated with lower adjusted odds of doctor-diagnosed asthma (OR: 0.76; 95%CI: 0.72-0.80) and current asthma (OR: 0.82; 95%CI: 0.75-0.89). An IQR increase in GVI800m for grass was associated with higher adjusted odds of doctor-diagnosed asthma (OR: 1.04; 95%CI: 1.00-1.08) and current asthma (OR: 1.08; 95%CI: 1.02-1.14). After stratification by PM2.5 exposure level, the negative association between trees and asthma, and the positive association between grass and asthma were observed only in low PM2.5 exposure levels (≤median: 56.23 µg/m3). Our results suggest that types of vegetation may play a role in the association between greenness exposure and childhood asthma. Exposure to trees may reduce the odds of childhood asthma, whereas exposure to grass may increase the odds. Additionally, PM2.5 may modify the associations of trees and grass with childhood asthma.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Aprendizado Profundo , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Asma/epidemiologia , Criança , Estudos Transversais , Exposição Ambiental , Humanos , Material Particulado/análise , Poaceae , Prevalência , Árvores
7.
Ann Clin Lab Sci ; 51(4): 540-545, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34452893

RESUMO

OBJECTIVE: Mycoplasma pneumoniae (M. pneumoniae), an extracellular pathogen lacking a cell wall, causes respiratory infection in adults and children and has been implicated in asthma exacerbation; immunoglobulin (Ig) E may be involved in these exacerbations. Specific IgM and IgG immune response to M. pneumoniae has been reported, but less is known about IgE M. pneumoniae antibody (Ab) responses in asthma. Previous studies in our laboratory demonstrated that asthmatic children have increased IgM M. pneumoniae levels, but not IgE. Thus, we sought to investigate whether past M. pneumoniae infection triggers production of M. pneumoniae-specific IgE Abs in adult subjects with/without asthma. METHODS: M. pneumoniae- IgE and -IgM Ab responses were studied in adult asthmatic (N=22) and non-asthmatic (N=22) subjects (ELISA). Data are reported as antibody index. Threshold detection levels: IgE, IgM: 0.2, 0.9, respectively. RESULTS: M. pneumoniae-IgE Ab levels were low and below the threshold of detection in both asthmatic and non-asthmatics (0.002±0.008 vs. 0.02±0.03; P=0.021). However, specific-IgM levels were slightly higher in non-asthmatics compared with asthmatics (0.96±0.37 vs. 0.79±0.31; P=0.054). M. pneumoniae-IgM Ab positivity was similar in both groups (P=1.0). CONCLUSION: IgM M. pneumoniae Abs may play an important role in non-asthma and persist for months after acute infection. IgE M. pneumoniae Abs may play a less important role in both groups.


Assuntos
Anticorpos Antibacterianos/sangue , Asma/imunologia , Imunoglobulina E/imunologia , Imunoglobulina M/sangue , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/imunologia , Adulto , Anticorpos Antibacterianos/imunologia , Asma/sangue , Asma/complicações , Asma/epidemiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/epidemiologia , Pneumonia por Mycoplasma/etiologia , Prognóstico
8.
BMJ Open ; 11(8): e046294, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408032

RESUMO

INTRODUCTION: Health systems in sub-Saharan African (SSA) countries are fragile and centralised. Consequently, majority of people have restricted access to healthcare services. Given the rise in the prevalence and burden of asthma in SSA, it is imperative to scrutinise the utilisation of healthcare services by people with asthma. We aim to understand, through this review, the extent of utilisation of healthcare services by asthma patients in SSA countries. METHODS AND ANALYSIS: Arksey and O'Malley's scoping review methodology framework will be used to guide the conduct of this scoping review. We will conduct a search of the literature on the electronic databases: Medline, (using PubMed interface), EMBASE, EBSCOHOST, Web of Science and Google Scholar, grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Registration of the proposed scoping review on the PROSPERO has indicated that no similar work has been or is being done elsewhere. We will review studies published on the subject from January 2009 to May 2020 in SSA. ETHICS AND DISSEMINATION: The proposed scoping review will contribute towards the knowledge base on utilisation of healthcare services particularly for people with asthma. This will provide a better understanding of the extent of utilisation of healthcare services by asthma patients and ultimately contribute to improvement of quality of care for people suffering from asthma. The results from the review will enlighten and guide healthcare practitioners and researchers on developing appropriate and feasible interventions to increase the utilisation of healthcare services by asthma patients in resource-constrained settings in SSA countries. Results of this scoping review will be disseminated through a peer-reviewed publication, conference presentations and a 1-day stakeholder meeting. PROSPERO REGISTRATION NUMBER: CRD42020154127.


Assuntos
Asma , Atenção à Saúde , África ao Sul do Saara/epidemiologia , Asma/epidemiologia , Asma/terapia , Instalações de Saúde , Serviços de Saúde , Humanos , Literatura de Revisão como Assunto
9.
Artigo em Inglês | MEDLINE | ID: mdl-34444242

RESUMO

Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs.


Assuntos
Asma , Creches , Asma/epidemiologia , Criança , Estudos Transversais , Saúde Ambiental , Política de Saúde , Humanos , Oklahoma/epidemiologia
10.
BMC Public Health ; 21(1): 1593, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445977

RESUMO

BACKGROUND: Global asthma-related mortality tallies at around 2.5 million annually. Although asthma may be triggered or exacerbated by particulate matter (PM) exposure, studies investigating the relationship of PM and its components with emergency department (ED) visits for pediatric asthma are limited. This study aimed to estimate the impact of short-term exposure to PM constituents on ED visits for pediatric asthma. METHODS: We retrospectively evaluated non-trauma patients aged younger than 17 years who visited the ED with a primary diagnosis of asthma. Further, measurements of PM with aerodynamic diameter of < 10 µm (PM10), PM with aerodynamic diameter of < 10 µm (PM2.5), and four PM2.5 components (i.e., nitrate (NO3-), sulfate (SO42-), organic carbon (OC), and elemental carbon (EC)) were collected between 2007 and 2010 from southern particulate matter supersites. These included one core station and two satellite stations in Kaohsiung City, Taiwan. A time-stratified case-crossover study was conducted to analyze the hazard effect of PM. RESULTS: Overall, 1597 patients were enrolled in our study. In the single-pollutant model, the estimated risk increase for pediatric asthma incidence on lag 3 were 14.7% [95% confidence interval (CI), 3.2-27.4%], 13.5% (95% CI, 3.3-24.6%), 14.8% (95% CI, 2.5-28.6%), and 19.8% (95% CI, 7.6-33.3%) per interquartile range increments in PM2.5, PM10, nitrate, and OC, respectively. In the two-pollutant models, OC remained significant after adjusting for PM2.5, PM10, and nitrate. During subgroup analysis, children were more vulnerable to PM2.5 and OC during cold days (< 26 °C, interaction p = 0.008 and 0.012, respectively). CONCLUSIONS: Both PM2.5 concentrations and its chemical constituents OC and nitrate are associated with ED visits for pediatric asthma. Among PM2.5 constituents, OC was most closely related to ED visits for pediatric asthma, and children are more vulnerable to PM2.5 and OC during cold days.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Idoso , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Asma/induzido quimicamente , Asma/epidemiologia , Criança , Estudos Cross-Over , Serviço Hospitalar de Emergência , Exposição Ambiental/efeitos adversos , Humanos , Material Particulado/efeitos adversos , Material Particulado/análise , Estudos Retrospectivos
11.
Artigo em Inglês | MEDLINE | ID: mdl-34360155

RESUMO

BACKGROUND: Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. OBJECTIVE: The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. METHODS: We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. RESULTS: The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20-$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62-$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06-$144,269.18). CONCLUSION: This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP's impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population's exposure.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Poluição Relacionada com o Tráfego , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Asma/induzido quimicamente , Asma/epidemiologia , Criança , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Dióxido de Nitrogênio , Estados Unidos/epidemiologia
12.
Arch. argent. pediatr ; 119(4): S123-S158, agosto 2021. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1281031

RESUMO

En 1995 se publicó en Archivos Argentinos de Pediatría la primera "Guía de diagnóstico y tratamiento: asma bronquial en niños". En 2007 y 2016 se realizaron actualizaciones. Luego de 5 años se presentan los nuevos contenidos. Las modificaciones más relevantes, aunque no las únicas, se observan en las estrategias terapéuticas. En esta versión se estratifica el tratamiento en "niveles" (1 a 5). El paradigma de cambio en el tratamiento crónico del asma consiste en erradicar la prescripción de broncodilatadores (salbutamol) a demanda, por un lado, y por otro, aparece la opción de tratamiento combinado intermitente con corticoides inhalados y broncodilatadores acción prolongada (LABA) para las formas más leves (niveles 1 y 2), en niños de 12 años o mayores. Aún no se dispone de suficiente evidencia que avale estas opciones en menores de 12 años, por lo que se mantienen las normativas previas vigentes en este grupo. Para más detalles, sugerimos la lectura del documento completo


In 1995, the first Guideline on Diagnosis and Treatment for Childhood Asthma was published in Archivos Argentinos de Pediatría. Updates were made in 2007 and 2016. After 5 years, the new contents are presented. The most relevant modifications, although not the only ones, are observed in therapeutic strategies. In this version, treatment is stratified into "levels" (1 to 5). The current paradigm of change in chronic asthma treatment consists in eradicating the prescription of bronchodilators (salbutamol) on demand. Besides that, the option of intermittent treatment with inhaled corticosteroids plus long-acting bronchodilators (LABA) appears for milder forms (levels 1 and 2) in children > 12 years old. There is still not enough evidence to support these options in < 12 years old maintaining the previous recommendations in this group. For more details we suggest reading the full document.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Asma/diagnóstico , Asma/terapia , Asma/fisiopatologia , Asma/prevenção & controle , Asma/tratamento farmacológico , Asma/epidemiologia , Broncodilatadores/uso terapêutico , Anti-Inflamatórios/uso terapêutico
14.
Environ Health ; 20(1): 81, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34256787

RESUMO

BACKGROUND: Many phenols and parabens are applied in cosmetics, pharmaceuticals and food, to prevent growth of bacteria and fungi. Whether these chemicals affect inflammatory diseases like allergies and overweight is largely unexplored. We aimed to assess the associations of use of personal care products with urine biomarkers levels of phenols and paraben exposure, and whether urine levels (reflecting body burden of this chemical exposures) are associated with eczema, rhinitis, asthma, specific IgE and body mass index. METHODS: Demographics, clinical variables, and self-report of personal care products use along with urine samples were collected concurrently from 496 adults (48% females, median age: 28 years) and 90 adolescents (10-17 years of age) from the RHINESSA study in Bergen, Norway. Urine biomarkers of triclosan (TCS), triclocarban (TCC), parabens and benzophenone-3, bisphenols and dichlorophenols (DCP) were quantified by mass spectrometry. RESULTS: Detection of the urine biomarkers varied according to chemical type and demographics. TCC was detected in 5% of adults and in 45% of adolescents, while propyl (PPB) and methyl (MPB) parabens were detected in 95% of adults and in 94% (PPB) and 99% (MPB) of adolescents. Women had higher median urine concentrations of phenolic chemicals and reported a higher frequency of use of personal care products than men. Urine concentration of MPB increased in a dose-dependent manner with increased frequency of use of several cosmetic products. Overall, urinary biomarker levels of parabens were lower in those with current eczema. The biomarker concentrations of bisphenol S was higher in participants with positive specific IgE and females with current asthma, but did not differ by eczema or rhinitis status. MPB, ethylparaben (EPB), 2,4-DCP and TCS were inversely related to BMI in adults; interaction by gender were not significant. CONCLUSIONS: Reported frequency of use of personal care products correlated very well with urine biomarker levels of paraben and phenols. Several chemicals were inversley related to BMI, and lower levels of parabens was observed for participants with current eczema. There is a need for further studies of health effects of chemicals from personal care products, in particular in longitudinally designed studies.


Assuntos
Asma/urina , Índice de Massa Corporal , Carbanilidas/urina , Eczema/urina , Poluentes Ambientais/urina , Parabenos/análise , Fenóis/urina , Rinite/urina , Adolescente , Adulto , Asma/epidemiologia , Monitoramento Biológico , Criança , Cosméticos , Eczema/epidemiologia , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Rinite/epidemiologia , Adulto Jovem
15.
Environ Res ; 200: 111760, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34324846

RESUMO

Phthalic acid esters (PAEs) have a negative impact on human health and are widely distributed in China. As part of the China, Children, Home, Health (CCHH) study, we investigated the associations between childhood asthmatic symptoms and PAEs in settled house dust in Shanghai, China. We found that di-2-ethylhexyl phthalate (DEHP), dibutyl phthalate (DBP), and diisobutyl phthalate (DiBP) were abundant in the indoor environment. A total of 27 % of children suffered from diagnosed asthma. The Mann-Whitney U test and multiple logistic regression were used to obtain the associations between PAEs and childhood asthmatic symptoms. Stratification analysis was performed to reveal the influence of gender on the associations between PAE exposure and target symptoms. Compared with low concentrations of PAEs, high concentrations of high molecular weight PAEs (HMW-PAEs) were significantly associated with childhood diagnosed asthma (adjusted odds ratios (AORs) > 1, P < 0.05). Moreover, significantly negative associations were found between high concentrations of DiBP and current cough (AORs<1, P < 0.05). All significantly positive associations were observed among girls, and most of the associations of dimethyl phthalate (DMP) and diethyl phthalate (DEP) exposure with the studied symptoms among girls were higher than those among boys. Exposure to PAEs may be a risk factor for asthmatic symptoms in children, especially in girls.


Assuntos
Asma , Ácidos Ftálicos , Asma/induzido quimicamente , Asma/epidemiologia , Criança , China/epidemiologia , Poeira/análise , Ésteres/análise , Humanos , Ácidos Ftálicos/análise , Ácidos Ftálicos/toxicidade
19.
Artigo em Inglês | MEDLINE | ID: mdl-34299734

RESUMO

Individuals living in areas with the potential for elevated metal exposure from industrial sources may have reduced pulmonary function. We evaluated cross-sectional associations of toenail concentrations of 17 metals within a community area of residence and asthma control in 75 children, and pulmonary function measures [forced expiratory volume in one second (FEV1; liters), forced vital capacity (FVC; liters), FEV1 to FVC ratio (FEV1:FVC), and mid-exhalation forced expiratory flow rate (FEF 25-75%; liters/second)], in a subsample of 39 children with diagnosed asthma in Chicago, Illinois. Linear regression models were used to estimate adjusted regression coefficients and standard errors (SE) for the associations between ≥ median versus

Assuntos
Asma , Pulmão , Asma/epidemiologia , Chicago/epidemiologia , Criança , Estudos Transversais , Volume Expiratório Forçado , Humanos , Capacidade Vital
20.
Lancet Public Health ; 6(8): e579-e586, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34274049

RESUMO

BACKGROUND: In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. METHODS: We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. FINDINGS: Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. INTERPRETATION: Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. FUNDING: None.


Assuntos
Asma/prevenção & controle , Hospitalização/estatística & dados numéricos , Veículos Automotores/legislação & jurisprudência , Política Antifumo/legislação & jurisprudência , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Asma/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Escócia/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos
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