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1.
Nat Commun ; 12(1): 2161, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846312

RESUMO

The 2014-15 Holuhraun eruption in Iceland was the largest fissure eruption in over 200 years, emitting prodigious amounts of gas and particulate matter into the troposphere. Reykjavík, the capital area of Iceland (250 km from eruption site) was exposed to air pollution events from advection of (i) a relatively young and chemically primitive volcanic plume with a high sulphur dioxide gas (SO2) to sulphate PM (SO42-) ratio, and (ii) an older and chemically mature volcanic plume with a low SO2/SO42- ratio. Whereas the advection and air pollution caused by the primitive plume were successfully forecast and forewarned in public advisories, the mature plume was not. Here, we show that exposure to the mature plume is associated with an increase in register-measured health care utilisation for respiratory disease by 23% (95% CI 19.7-27.4%) and for asthma medication dispensing by 19.3% (95% CI 9.6-29.1%). Absence of public advisories is associated with increases in visits to primary care medical doctors and to the hospital emergency department. We recommend that operational response to volcanic air pollution considers both primitive and mature types of plumes.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Respiratórias/epidemiologia , Erupções Vulcânicas/efeitos adversos , Adulto , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Asma/tratamento farmacológico , Assistência à Saúde , Serviço Hospitalar de Emergência , Humanos , Islândia/epidemiologia , Morbidade , Médicos de Atenção Primária , Saúde Pública , Análise de Regressão , Risco , Autorrelato , Dióxido de Enxofre/análise , Inquéritos e Questionários
2.
BMJ ; 372: n693, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789877

RESUMO

OBJECTIVE: To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. DESIGN: Retrospective cohort study. SETTING: NHS hospitals in England. PARTICIPANTS: 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. MAIN OUTCOME MEASURES: Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. RESULTS: Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). CONCLUSIONS: Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.


Assuntos
/complicações , Hospitalização/estatística & dados numéricos , Insuficiência de Múltiplos Órgãos/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , /mortalidade , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Inglaterra/epidemiologia , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , /isolamento & purificação
3.
Arch Virol ; 166(5): 1421-1426, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33656577

RESUMO

In November 2018, an outbreak of respiratory disease occurred in foals at an equestrian club in Changji, northern Xinjiang, China. We applied viral metagenomics to investigate this outbreak and identify potential pathogens involved in this equine respiratory syndrome. The metagenomics data revealed the presence of sequences matching those of equid herpesvirus (EHV) 2, 4, and 5. PCR with specific primers targeting ORF33 of EHV-4 and ORF8 of EHV-2 and EHV-5 revealed coinfection with these viruses in this respiratory syndrome. To investigate the prevalence of these viruses in China, 453 nasal swabs from clinically healthy thoroughbred foals (36/453, 7.9%) and horses (417/453, 92.1%) were collected from several equestrian clubs. Forty-five (9.9%) of the samples tested positive for EHV-5 DNA, and seven (1.5%) tested positive for EHV-2, but all were negative for EHV-4 DNA. Forty-nine (10.8%) samples tested positive for both EHV-5 and EHV-2 DNA. Using these samples, one complete EHV-4 ORF33, 10 partial EHV-2 ORF8, and 50 partial EHV-5 ORF8 sequences from the 10 diseased foals and 50 thoroughbred horses were then determined. Sequence analysis indicated that EHV-4 ORF33 and EHV-5 ORF8, in contrast to EHV-2 ORF8, had high sequence similarity to those of published sequences. Our data provide the first evidence that EHV-2, -4, and -5 co-circulate in China and that EHV-4 is potentially involved in this respiratory disease in foals.


Assuntos
Infecções por Herpesviridae/veterinária , Herpesviridae/genética , Herpesviridae/isolamento & purificação , Doenças dos Cavalos/virologia , Doenças Respiratórias/veterinária , Animais , China/epidemiologia , Coinfecção/epidemiologia , Coinfecção/veterinária , Coinfecção/virologia , DNA Viral/genética , Surtos de Doenças , Variação Genética , Herpesviridae/classificação , Infecções por Herpesviridae/epidemiologia , Infecções por Herpesviridae/virologia , Doenças dos Cavalos/epidemiologia , Cavalos , Metagenômica , Fases de Leitura Aberta/genética , Filogenia , Prevalência , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/virologia
4.
Medicine (Baltimore) ; 100(12): e24971, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761654

RESUMO

BACKGROUND: An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus (SARS-CoV-2) emerged in December 2019 in Wuhan, China. Epidemiologic evidence suggests that patients with comorbidities and novel coronavirus disease 2019 (COVID-19) infection may have poor survival outcomes. However, the risk of these coexisting medical conditions in severe and non-severe cases has not been systematically reported. PURPOSE: The present study aimed to estimate the association of chronic comorbidities in severe and non-severe cases. METHODS: A literature search was conducted using the databases PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database, Chinese Scientific Journals Full-text Database (CQVIP) from the inception dates to April 1, 2020, to identify cohort studies assessing comorbidity and risk of adverse outcome. Either a fixed- or random-effects model was used to calculate the overall combined risk estimates. RESULTS: A total of 22 studies involving 3286 patients with laboratory-confirmed COVID-19 were included in the analysis. Overall, compared with the patients with non-severe cases, the pooled odds ratios (ORs) of hypertension, diabetes mellitus, and cardiovascular, cerebrovascular, and respiratory diseases in patients with severe cases were 2.79 (95% confidence intervals [95% CI]: 1.66-4.69), 1.64 (95% CI: 2.30-1.08), 1.79 (95% CI: 1.08-2.96), 3.92 (95% CI: 2.45-6.28), and 1.98 (95% CI: 1.26-3.12), respectively. CONCLUSIONS: This meta-analysis supports the finding that chronic comorbidities may contribute to severe outcome in patients with COVID-19. According to the findings of the present study, old age and 2 or more comorbidities are significantly impactful to COVID-19 outcomes in hospitalized patients in China.


Assuntos
/epidemiologia , Comorbidade , Fatores Etários , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Doença Crônica , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Doenças Respiratórias/epidemiologia , Índice de Gravidade de Doença
5.
Sci Total Environ ; 775: 145777, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-33631593

RESUMO

BACKGROUND: Few studies have explored the short-term effects of ultrafine particles (UFPs, particles < 0.1 µm) air pollution on the exacerbations of pediatric respiratory diseases. OBJECTIVES: We aimed to evaluate short-term association between UFP and emergency-department visits (EDVs) for main pediatric respiratory diseases. METHODS: We collected daily data on UFP and pediatric EDVs for main respiratory diseases [asthma, pneumonia, bronchitis and upper respiratory tract infections (URTI)] from 66 hospitals in Shanghai, China from 2016 to 2018. Generalized additive models combined with polynomial distributed lag models were applied to explore the associations between UFP level and pediatric EDVs for respiratory diseases. We fitted two-pollutant models with criteria air pollutants and performed stratified analyses by gender and age. RESULTS: UFP was associated with increased EDVs for all respiratory diseases in cumulative lags up to 2 d and 3 d. The greatest risk was found at cumulative lags (0-2 d) for all respiratory diseases. At cumulative lags (0-2 d), an interquartile range increase in concentrations of UFP (1800 particles/cm3) was associated with relative risks of EDVs due to asthma [1.35, 95% confidence interval (CI): 1.14-1.59], pneumonia (1.20, 95% CI: 1.04-1.38), bronchitis (1.17, 95% CI: 1.03-1.33) and URTI (1.14, 95% CI: 1.02-1.28). These associations were almost unchanged when controlling for criteria air pollutants, and there was no threshold below which the associations were not present. There were stronger associations in children aged 0-13 years. CONCLUSIONS: Short-term exposure to UFP may independently increase the risks of EDVs for asthma, pneumonia, bronchitis and URTI exacerbations among children.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Transtornos Respiratórios , Doenças Respiratórias , Adolescente , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Criança , Pré-Escolar , China/epidemiologia , Humanos , Lactente , Recém-Nascido , Material Particulado/efeitos adversos , Material Particulado/análise , Doenças Respiratórias/epidemiologia
6.
JAMA Netw Open ; 4(2): e2037227, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33576819

RESUMO

Importance: In early 2020, the United States declared a public health emergency in response to coronavirus disease 2019 (COVID-19) and implemented a variety of social distancing measures. The association between the COVID-19 pandemic and the number of pediatric admissions is unclear. Objective: To determine the changes in patterns of pediatric admissions in 2020 compared with the prior decade. Design, Setting, and Participants: This cross-sectional study included 49 US hospitals contributing to the Pediatric Health Information Systems database. Inpatient admissions were transformed into time-series data, and ensemble forecasting models were generated to analyze admissions across a range of diagnoses in 2020 compared with previous years. The setting was inpatient admissions. All patients discharged between January 1, 2010, and June 30, 2020, from an inpatient hospital encounter were included. Main Outcomes and Measures: Number of hospital admissions by primary diagnosis for each encounter. Results: Of 5 424 688 inpatient encounters among 3 372 839 patients (median [interquartile range] age, 5.1 [0.7-13.3] years; 2 823 748 [52.1%] boys; 3 171 224 [58.5%] White individuals) at 49 hospitals, 213 571 (3.9%) were between January 1, 2020, and June 30, 2020. There was a decrease in the number of admissions beginning in March 2020 compared with the period from 2010 to 2019. At the nadir, admissions in April 2020 were reduced 45.4% compared with prior years (23 798 in April 2020 compared with a median [interquartile range] of 43 550 [42 110-43 946] in April 2010-2019). Inflation-adjusted hospital charges decreased 27.7% in the second quarter of 2020 compared with prior years ($4 327 580 511 in 2020 compared with a median [interquartile range] of $5 983 142 102 [$5 762 690 022-$6 324 978 456] in 2010-2019). Seasonal patterns were evident between 2010 and 2019 for a variety of common pediatric conditions, including asthma, atrial septal defects, bronchiolitis, diabetic ketoacidosis, Kawasaki syndrome, mental health admissions, and trauma. Ensemble models were able to discern seasonal patterns in admission diagnoses and accurately predicted admission rates from July 2019 until December 2019 but not from January 2020 to June 2020. All diagnoses except for birth decreased below the model 95% CIs between January 2020 and June 2020. Conclusions and Relevance: In this cross-sectional study, pediatric admissions to US hospitals decreased in 2020 across an array of pediatric conditions. Although some conditions may have decreased in incidence, others may represent unmet needs in pediatric care during the COVID-19 pandemic.


Assuntos
Hospitalização , Hospitais Pediátricos , Pandemias , Estações do Ano , Adolescente , Criança , Estudos Transversais , Cetoacidose Diabética/epidemiologia , Feminino , Comunicação Interatrial/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Transtornos Mentais/epidemiologia , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Admissão do Paciente , Doenças Respiratórias/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia
7.
Infect Dis (Lond) ; 53(5): 376-381, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33512254

RESUMO

BACKGROUND: To limit the spread of SARS-CoV-2 several countries implemented measures to reduce the number of contacts such as a national lockdown. We estimated the impact of the first lockdown on the burden of COVID-19 in the community in France. METHODS: Physicians participating in the French Sentinelles network reported the number of patients with an acute respiratory infection (ARI) seen in consultation and performed nasopharyngeal swabs in a sample of these patients (first patient of the week). The swabs were tested by RT-PCR for the presence of SARS-CoV-2. Clinical and virological data were combined to estimate ARI incidence attributable to SARS-CoV-2 from 17 March to 10 May 2020. RESULTS: The incidence of ARI attributable to COVID-19 decreased after the second week of the lockdown period from 142 (95%CI [101; 183]) to 41 (95%CI [21; 60]) per 100,000 population. A decrease was observed in all areas in metropolitan France. The youngest age groups (<15-years-old) were least affected with a cumulated incidence estimated to 14 per 100,000 population during the study period. CONCLUSIONS: The data collected in primary care suggests that the first lockdown implemented in France during spring 2020 significantly reduced the incidence of acute respiratory infections including COVID-19 in France and limited the geographic spread of SARS-CoV-2.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Controle de Doenças Transmissíveis , /diagnóstico , França/epidemiologia , Humanos , Doenças Respiratórias/epidemiologia
9.
BMC Infect Dis ; 21(1): 97, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478430

RESUMO

BACKGROUND: Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka. METHODS: This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy's electronic prescribing system. RESULTS: Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic recipients) and first-generation cephalosporins (38, 26.0%). Respiratory indications were the most common reason for antibiotic use, comprising 69 (47.3%) of all antibiotic prescriptions. Antibiotics were prescribed for 66.1% of patients presenting with cough and 78.8% of those presenting with rhinorrhea or nasal congestion. Among all antibiotic recipients, 6 (4.1%) underwent diagnostic studies. CONCLUSIONS: A high prevalence of antibiotic prescription was observed, in particular for treatment of respiratory conditions. These data support the need for improved antimicrobial stewardship in the Sri Lankan outpatient setting.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Prescrições/estatística & dados numéricos , Doenças Respiratórias/tratamento farmacológico , Adolescente , Adulto , Gestão de Antimicrobianos , Criança , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Padrões de Prática Médica , Prevalência , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Sri Lanka/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-33494244

RESUMO

Coronaviruses (CoVs) represent a large family of RNA viruses that can infect different living species, posing a global threat to human health. CoVs can evade the immune response, replicate within the host, and cause a rapid immune compromise culminating in severe acute respiratory syndrome. In humans, the immune system functions are influenced by physical activity, nutrition, and the absence of respiratory or cardiovascular diseases. This review provides an in-depth study between the interactions of the immune system and coronaviruses in the host to defend against CoVs disease.


Assuntos
Doenças Cardiovasculares , Dieta , Exercício Físico , Sistema Imunitário , Doenças Respiratórias , /epidemiologia , Doenças Cardiovasculares/epidemiologia , Humanos , Doenças Respiratórias/epidemiologia
11.
Ecotoxicol Environ Saf ; 210: 111884, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33421716

RESUMO

Ambient carbon monoxide (CO) has been linked with mortality and morbidity. Little evidence is available regarding the relation between CO and years of life lost (YLL). Using data from 48 major cities in China from 2013 to 2017, we applied generalized additive models and random effects meta-analyses to explore the effects of CO on YLL from various diseases. Stratified analyses and meta-regression were performed to estimate potential effect modifications of demographic factors, regions, meteorological factors, co-pollutants, urbanization rate, economic level and health service level. Additional life gains due to avoidable YLL under certain scenario were also evaluated. Results indicated that a 1-mg/m³ increase of CO concentrations (lagged over 0-3 d), was associated with 2.08% (95% confidence interval [CI], 1.35%, 2.80%), 2.35% (95% CI: 1.39%, 3.30%), 1.47% (95% CI: -0.01%, 2.93%), 2.28% (95% CI: 1.09%, 3.47%), 2.42% (95% CI: 1.31%, 3.54%), 2.09% (95% CI: 0.47%, 3.72%) increments in daily YLL from non-accidental causes, cardiovascular diseases, respiratory diseases, coronary heart disease, stroke and chronic obstructive pulmonary disease, respectively. These associations were robust to the adjustment of co-pollutants and varied substantially by geography and demographic characteristics. Associations were stronger in the elder people (≥65 years), females, population with low education attainment, and lived in south region, than younger people, males, high educated populations and those lived in north region. Moreover, the harmful impact of increasing CO concentration could be attenuated by city-level characteristics, including the growth of urbanization rate, gross domestic product (GDP), GDP per capita, number of hospital beds, doctors and hospitals. Finally, an estimated life of 0.081 (95% CI: -0.027, 0.190) years would be gained per deceased people if CO concentration could fall to 1 mg/m3. In conclusions, this nationwide analysis showed significant associations between short-term CO exposure and cause-specific YLL. The heterogeneity of both individual- and city-level characteristics should be considered for relevant intervention. These findings may have significant public health implications for the reduction of CO-attributed disease burden in China.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Monóxido de Carbono/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Exposição Ambiental/efeitos adversos , Doenças Respiratórias/epidemiologia , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Monóxido de Carbono/análise , China/epidemiologia , Cidades/epidemiologia , Exposição Ambiental/análise , Feminino , Humanos , Masculino
12.
Pediatr Clin North Am ; 68(1): 293-304, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33228939

RESUMO

Social inequality refers to disparities in society that have the effect of limiting a group's socioeconomic, educational, and intellectual potential. Inequity in health means any limitation to access comprehensive health services that also hinders the achievement of well-being and favorable health outcomes. Strategies for more equitable growth to eradicate global poverty would contribute to reducing health inequities and improve health care outcomes. Coordinated efforts between governments, private sector, families, and interested stakeholders are needed. This article discusses inequality and inequity in pediatric respiratory diseases, the challenges confronted, and the strategies needed to mitigate these disparities.


Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/terapia , Criança , Grupos Étnicos , Saúde Global , Acesso aos Serviços de Saúde , Humanos , Pobreza , Justiça Social
13.
Rev. enferm. UERJ ; 28: e46533, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1146249

RESUMO

Objetivo: analisar o perfil clínico epidemiológico de crianças admitidas na pediatria de um hospital público no interior do estado do Rio de Janeiro. Método: estudo descritivo, transversal, de abordagem quantitativa, desenvolvido com responsáveis de crianças admitidas na pediatria, através da aplicação de questionário. Resultados: 92 (100%) responsáveis participaram do estudo, dos quais, 57 (62,0%) não trabalham; 27 (29,4%) possuem quatro dependentes; 35 (38,0%) perfazem renda familiar de um salário mínimo. A maior proporção das crianças foi de lactentes, 47 (51,1%); com diagnóstico de afecção respiratória, 35 (38,0%). Conclusão: foi evidenciada associação entre determinantes sociais, sobretudo o socioeconômico, com o desenvolvimento de afecções respiratórias, especialmente em lactentes. Sugere-se que políticas direcionadas sejam intensificadas, não apenas para ação curativa, mas preventiva, através de educação em saúde direcionadas às famílias e aos responsáveis, visando reconhecer os fatores de risco para aquisição dessas doenças, bem como o reconhecimento dos sinais de gravidade.


Objective: to analyze clinical and epidemiologically profile of children admitted to pediatrics at a public hospital in Rio de Janeiro State. Method: this quantitative, descriptive, cross-sectional study was conducted by applying a questionnaire to parents and guardians of children admitted to pediatrics. Results: 92 (100%) parents and guardians participated, 57 (62.0%) of whom were out of work; 27 (29.4%) had four dependents; 35 (38.0%) received family income of one minimum wage. The children were mostly infants (47; 51.1%) and diagnosed with a respiratory condition (35; 38.0%). Conclusion: an association was found between social determinants, especially socioeconomic factors, and the development of respiratory disorders, particularly in infants. It is recommended that specific policies, for not only curative care, but also prevention, be intensified by health education to enable families, parents and guardians to recognize the risk factors for such diseases, as well as the signs of severity.


Objetivo: analizar el perfil clínico y epidemiológico de los niños ingresados en pediatría en un hospital público del estado de Río de Janeiro. Método: este estudio cuantitativo, descriptivo y transversal se realizó mediante la aplicación de un cuestionario a padres y tutores de niños ingresados en pediatría. Resultados: participaron 92 (100%) padres y tutores, de los cuales 57 (62,0%) estaban sin trabajo; 27 (29,4%) tenían cuatro dependientes; 35 (38,0%) recibieron ingresos familiares de un salario mínimo. Los niños eran en su mayoría bebés (47; 51,1%) y diagnosticados con una afección respiratoria (35; 38,0%). Conclusión: se encontró asociación entre los determinantes sociales, especialmente los socioeconómicos, y el desarrollo de trastornos respiratorios, particularmente en la infancia. Se recomienda que las políticas específicas, no solo de atención curativa, sino también de prevención, se intensifiquen mediante la educación en salud para que las familias, padres y tutores reconozcan los factores de riesgo de dichas enfermedades, así como los signos de gravedad.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Doenças Respiratórias/epidemiologia , Perfil de Saúde , Criança Hospitalizada , Hospitais Públicos , Pais , Fatores Socioeconômicos , Brasil , Epidemiologia Descritiva , Estudos Transversais , Morbidade , Determinantes Sociais da Saúde
15.
Nicotine Tob Res ; 22(Suppl 1): S61-S69, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320254

RESUMO

BACKGROUND: The link between e-cigarette use and subsequent development of respiratory diseases remains an open question. AIMS AND METHODS: A subset of a probability sample of U.S. adults from the Population Assessment of Tobacco and Health Study Waves 1 and 2 were selected for biospecimen analysis (n = 4614). Subjects were divided into three mutually exclusive groups at baseline: nonusers (n = 2849), exclusive e-cigarette users (n = 222), and poly e-cigarette/tobacco users (n = 1,543). Geometric mean concentrations of baseline biomarkers from five classes of harmful and potentially harmful constituents were reported. Multivariable linear regressions were conducted to examine the relationship between baseline biomarkers and subsequent respiratory symptoms among user groups. RESULTS: Baseline exclusive e-cigarette users (33.6%[confidence interval, CI: 26.7% to 41.4%]) and poly e-cigarette/tobacco users (50.8%[CI: 47.4% to 54.2%]) had higher prevalence of subsequent respiratory symptoms than nonusers (21.7%[19.2% to 24.4%]). As compared with nonusers, poly e-cigarette/tobacco users had higher concentrations in clinically relevant biomarkers at baseline than exclusive e-cigarette users. Among poly e-cigarette/tobacco users, baseline nicotine metabolites (TNE2, cotinine), tobacco-specific nitrosamine (NNAL), PAH (1-NAP, 3-FLU), and volatile organic compound (N-Acetyl-S-(2-carboxyethyl)-l-cysteine, N-acetyl-S-(2-cyanoethyl)-l-cysteine) were significantly higher among those reporting subsequent respiratory symptoms than those who did not. Among exclusive e-cigarette users, baseline NNAL was significantly higher among those reporting subsequent respiratory symptoms than those who did not. Within subjects with subsequent respiratory symptoms, NNAL was 2.5 times higher in exclusive e-cigarette users (10.7[6.5 to 17.5]) and 63.4 times higher in poly e-cigarette/tobacco users (199.6[176.7 to 225.4]) than nonusers (3.1[2.4 to 3.9]). CONCLUSIONS: E-cigarette use is associated with higher concentrations of known tobacco-related toxicants and risks of subsequent respiratory symptoms than nonusers. Poly e-cigarette/tobacco users exhibit higher risk than exclusive e-cigarette users. IMPLICATIONS: This longitudinal study identified positive associations between baseline urinary biomarkers of exposure to tobacco-related toxicants and increased risks of subsequent respiratory symptoms across varying e-cigarette use groups. E-cigarette use is associated with increased exposure to known tobacco-related toxicants, and certain toxicant exposure increases the risk of respiratory symptoms.


Assuntos
Fumar Cigarros/epidemiologia , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Fumantes/psicologia , Vaping/epidemiologia , Compostos Orgânicos Voláteis/efeitos adversos , Adolescente , Adulto , Idoso , Fumar Cigarros/psicologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças Respiratórias/induzido quimicamente , Fumantes/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Vaping/psicologia , Adulto Jovem
16.
BMJ ; 371: m4571, 2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33376083

RESUMO

OBJECTIVES: To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. DESIGN: A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. PARTICIPANTS: 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. MAIN OUTCOME MEASURE: A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. RESULTS: 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). CONCLUSION: This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.


Assuntos
Doenças Cardiovasculares , Calefação , Hospitalização/estatística & dados numéricos , Habitação , Doenças Respiratórias , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Eficiência Organizacional , Ambiente Controlado , Feminino , Calefação/métodos , Calefação/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Desenvolvimento de Programas , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/prevenção & controle , Doenças Respiratórias/terapia , Estudos Retrospectivos
17.
BMJ Open ; 10(12): e043165, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328263

RESUMO

OBJECTIVE: To model how known COVID-19 comorbidities affect mortality rates and the age distribution of mortality in a large lower-middle-income country (India), and to identify which health conditions drive differences with high-income countries. DESIGN: Modelling study. SETTING: England and India. PARTICIPANTS: Individual data were obtained from the fourth round of the District Level Household Survey and Annual Health Survey in India, and aggregate data were obtained from the Health Survey for England and the Global Burden of Disease, Risk Factors and Injuries Studies. MAIN OUTCOME MEASURES: The primary outcome was the modelled age-specific mortality in each country due to each COVID-19 mortality risk factor (diabetes, hypertension, obesity and respiratory illness, among others). The change in overall mortality and in the share of deaths under age 60 from the combination of risk factors was estimated in each country. RESULTS: Relative to England, Indians have higher rates of diabetes (10.6% vs 8.5%) and chronic respiratory disease (4.8% vs 2.5%), and lower rates of obesity (4.4% vs 27.9%), chronic heart disease (4.4% vs 5.9%) and cancer (0.3% vs 2.8%). Population COVID-19 mortality in India, relative to England, is most increased by uncontrolled diabetes (+5.67%) and chronic respiratory disease (+1.88%), and most reduced by obesity (-5.47%), cancer (-3.65%) and chronic heart disease (-1.20%). Comorbidities were associated with a 6.26% lower risk of mortality in India compared with England. Demographics and population health explain a third of the difference in share of deaths under age 60 between the two countries. CONCLUSIONS: Known COVID-19 health risk factors are not expected to have a large effect on mortality or its age distribution in India relative to England. The high share of COVID-19 deaths from people under age 60 in low- and middle-income countries (LMICs) remains unexplained. Understanding the mortality risk associated with health conditions prevalent in LMICs, such as malnutrition and HIV/AIDS, is essential for understanding differential mortality.


Assuntos
/mortalidade , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Neoplasias/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
18.
Rev Saude Publica ; 54: 133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331527

RESUMO

OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.


Assuntos
Depressão/induzido quimicamente , Fazendeiros , Cefaleia/induzido quimicamente , Exposição Ocupacional/estatística & dados numéricos , Praguicidas/envenenamento , Praguicidas/toxicidade , Envenenamento/epidemiologia , Doenças Respiratórias/induzido quimicamente , Taquicardia/induzido quimicamente , Adolescente , Adulto , Agricultura , Brasil/epidemiologia , Criança , Estudos Transversais , Depressão/epidemiologia , Família , Feminino , Cefaleia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Prevalência , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Taquicardia/epidemiologia , Adulto Jovem
19.
PLoS One ; 15(12): e0240276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33338057

RESUMO

INTRODUCTION: Biological drugs open new possibilities to treat diseases for which drug therapy is limited, but they may be associated with adverse drug reactions (ADRs). OBJECTIVE: To identify the ADRs associated with the use of biological drugs in Colombia. METHODS: This was a retrospective study of ADR reports from 2014 to 2019, contained in the database of Audifarma SA pharmacovigilance program. The ADRs, groups of associated drugs, and affected organs were classified. RESULTS: In total, 5,415 reports of ADRs associated with biological drugs were identified in 78 Colombian cities. A total of 76.1% of the cases corresponded to women. The majority were classified as type A (55.0%) and B (28.9%), and 16.7% were serious cases. The respiratory tract was the most affected organ system (16.8%), followed by the skin and appendages (15.6%). Antineoplastic and immunomodulatory drugs accounted for 70.6% of the reports, and the drugs related to the greatest number of ADRs were adalimumab (12.2%) and etanercept (11.6%). CONCLUSIONS: The reporting of ADRs has increased in recent years and these reactions are mostly classified as tyoe A or B, categorized as serious in almost one-fifth of the reported cases and associated mainly with immunomodulators and antineoplastic agents. This type of study can support decision makers in ways that benefit patient safety and interaction with health systems.


Assuntos
Antineoplásicos/efeitos adversos , Produtos Biológicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Fatores Imunológicos/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Colômbia/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Humanos , Incidência , Masculino , Segurança do Paciente , Farmacovigilância , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/epidemiologia , Estudos Retrospectivos , Dermatopatias/induzido quimicamente , Dermatopatias/epidemiologia
20.
Rev. patol. respir ; 23(supl.3): 251-255, dic. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-197100

RESUMO

La enfermedad COVID-19, causada por el coronavirus SARS-CoV-2, se ha extendido por todo el mundo. Se puede manifestar desde una forma asintomática hasta llegar a desarrollar un síndrome de distrés respiratorio agudo (SDRA). En este artículo se abordan aspectos relacionados con los factores de riesgo y las comorbilidades de los pacientes con COVID-19, así como el papel de las principales enfermedades respiratorias crónicas en su desarrollo y evolución, incluyendo la enfermedad pulmonar obstructiva crónica (EPOC), el asma y las enfermedades pulmonares intersticiales difusas (EPID). Las comorbilidades más prevalentes en los pacientes con COVID-19 son la hipertensión arterial (HTA), la diabetes mellitus (DM) y las enfermedades cardiovasculares. Además, se ha evidenciado que tanto el sobrepeso como la obesidad predisponen a la gravedad de la enfermedad COVID-19. Con respecto a las enfermedades respiratorias crónicas, parece que su prevalencia en pacientes con COVID-19 es inferior a la esperada


COVID-19 disease, caused by the SARS-CoV-2 coronavirus, has spread throughout the world. It can manifest from an asymptomatic form to the development of acute respiratory distress syndrome (ARDS). This article addresses aspects related to risk factors and comorbidities in patients with COVID-19, as well as the role of the main chronic respiratory diseases in their development and evolution, including chronic obstructive pulmonary disease (COPD), asthma and diffuse interstitial lung diseases (ILD). The most prevalent comorbidities in patients with COVID-19 are arterial hypertension (HTN), diabetes mellitus (DM) and cardiovascular diseases. In addition, it has been shown that both overweight and obesity predispose to the severity of the COVID-19 disease. With regard to chronic respiratory diseases, it seems that their prevalence in patients with COVID-19 is lower than expected


Assuntos
Humanos , Infecções por Coronavirus/complicações , Pneumonia Viral/epidemiologia , Pandemias , Doenças Respiratórias/epidemiologia , Doença Crônica/classificação , Doença Crônica/epidemiologia , Asma/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Fatores de Risco , Comorbidade , Índice de Gravidade de Doença
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