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1.
J Bras Pneumol ; 45(3): e20180314, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271604

RESUMO

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.


Assuntos
Doenças Respiratórias/etiologia , Doenças Respiratórias/terapia , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Tabagismo/complicações , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco , Tabagismo/terapia , Tuberculose Pulmonar/etiologia , Tuberculose Pulmonar/terapia
2.
Wei Sheng Yan Jiu ; 48(2): 312-319, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31133114

RESUMO

OBJECTIVE: To introduce the Meta-analysis of acute health effects caused by atmospheric particulate matter and explore the R software implementation. METHODS: Used literature data as an example, pooled the risk estimates of mortality due to respiratory disease exposure to PM_(10) in the Chinese population from 1990 to 2013 using R software. RESULTS: The overall risk estimates RR was 1. 0041(95% CI 1. 0028-1. 0054), there was publication bias, the RR was reduced to 1. 0015(95%CI 1. 0002-1. 0029)after adjust the asymmetry with the trim-and-fill method. CONCLUSION: R software has relatively abundant software packages to conduct the Meta-analysis for assessing the acute health impact exposure to atmospheric particulate matter.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar , Material Particulado/efeitos adversos , Doenças Respiratórias/etiologia , Grupo com Ancestrais do Continente Asiático , Humanos , Doenças Respiratórias/mortalidade , Software
3.
Medicina (B Aires) ; 79(2): 123-136, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31048278

RESUMO

In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.


Assuntos
Alérgenos/efeitos adversos , Exposição Ambiental/efeitos adversos , Doenças Respiratórias/etiologia , Poluentes Atmosféricos/efeitos adversos , Asma/etiologia , Mudança Climática , Humanos , Fatores de Risco
4.
J Korean Med Sci ; 34(12): e105, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940999

RESUMO

Background: Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. Methods: This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. Results: The analysis included 672 Korean subjects (mean age, 44 years; range, 11-81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was 'live infant, no apparent congenital anomaly' in 195 subjects (92.42%) or 'lost to follow-up' in 16 subjects. Conclusion: Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. Trial Registration: ClinicalTrials.gov Identifier: NCT01929291.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Vigilância de Produtos Comercializados , Adolescente , Adulto , Idoso , Criança , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Feminino , Gastroenteropatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/etiologia , Gravidez , Estudos Prospectivos , Prurido/etiologia , República da Coreia , Doenças Respiratórias/etiologia , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-30889810

RESUMO

Epidemiological studies consistently show an association between wildfire-related smoke exposure and adverse respiratory health. We conducted a systematic review of evidence in published literature pertaining to heterogeneity of respiratory effects from this exposure in North America. We calculated the within-study ratio of relative risks (RRR) and 95% confidence intervals (CI) to examine heterogeneity of effect by population subgroup, and then summarized the RRRs using meta-analysis. We found evidence of a greater effect of wildfire smoke on respiratory health among females relative to males for asthma (RRR: 1.035, 95% CI: 1.013, 1.057) and chronic obstructive pulmonary disease (RRR: 1.018, 95% CI: 1.003, 1.032). There was evidence of a lower relative risk for all respiratory outcomes among youth compared to adults (RRR: 0.976, 95% CI: 0.963, 0.989). We also found wildfire smoke effects stratified by income, race, education, health behaviors, access to care, housing occupancy, geographic region, and urban/rural status. However, data were insufficient to quantitatively evaluate effect modification by these characteristics. While we found evidence that certain demographic subgroups of the population are more susceptible to respiratory health outcomes from wildfire smoke, it is unclear whether this information can be used to inform policy aimed to reduce health impact of wildfires.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Respiratórias/etiologia , Fumaça/efeitos adversos , Incêndios Florestais , Feminino , Humanos , Masculino , América do Norte/epidemiologia , Doenças Respiratórias/epidemiologia , Risco , População Rural , Fatores Sexuais
6.
Asian Cardiovasc Thorac Ann ; 27(4): 278-287, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30857395

RESUMO

BACKGROUND: Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity. METHODS: In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital. Respiratory complications included bronchospasm, atelectasis, pneumonia, respiratory failure, and adult respiratory distress syndrome within 30 days of surgery or before discharge. RESULTS: A total of 1488 patients were included over a 7-year period, and 15.8% (235 of 1488 patients) developed respiratory complications. The significant predictors of respiratory complications were chronic obstructive pulmonary disease, American Society of Anesthesiologist physical status ≥ 3, right-sided surgery, duration of surgery longer than 180 min, preoperative arterial oxygen saturation on room air < 96%, and open thoracotomy. The area under receiving operating characteristic curve was 0.78 (95% confidence interval: 0.75-0.82) and 0.76 (95% confidence interval: 0.70-0.83) for the derivation and validation cohorts, respectively. The model was well calibrated with a Hosmer-Lemeshow goodness-of-fit of 7.32 ( p = 0.293). CONCLUSIONS: This study developed and internally validated a simple clinical risk score for prediction of respiratory complications following thoracic surgery. This score can be used to stratify high-risk patients, address modifiable risk factors for respiratory complications, and provide preventive strategies for improving postoperative outcomes.


Assuntos
Técnicas de Apoio para a Decisão , Doenças Respiratórias/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Doenças Respiratórias/diagnóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
7.
Environ Sci Pollut Res Int ; 26(13): 12648-12661, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30903465

RESUMO

Ambient air pollution is nowadays one of the most crucial contributors to deteriorating health status worldwide. The components of air pollution include PM2.5 and PM10, NO2, SO2, CO, O3, and organic compounds. They are attributed to several health outcomes, for instance, cardiovascular diseases (CVD), respiratory diseases, birth outcomes, neurologic diseases, and psychiatric diseases. The objective of this study is to evaluate the association between different ambient air pollutants and the above-mentioned health outcomes. In this systematic review, a total of 76 articles was ultimately selected from 2653 articles, through multiple screening steps by the aid of a set of exclusion criteria as non-English articles, indoor air pollution assessment, work-related, occupational and home-attributed pollution, animal studies, tobacco smoking effects, letters to editors, commentaries, animal experiments, reviews, case reports and case series, out of 19,862 published articles through a systematic search in PubMed, Web of Science, and Scopus. Then, the associations between air pollution and different health outcomes were measured as relative risks and odds ratios. The association between air pollutants, PM2.5 and PM10, NO2, SO2, CO, O3, and VOC with major organ systems health was investigated through the gathered studies. Relative risks and/or odds ratios attributed to each air pollutant/outcome were ultimately reported. In this study, a thorough and comprehensive discussion of all aspects of the contribution of ambient air pollutants in health outcomes was proposed. To our knowledge up to now, there is no such comprehensive outlook on this issue. Growing concerns in concert with air pollution-induced health risks impose a great danger on the life of billions of people worldwide. Should we propose ideas and schemes to reduce ambient air pollutant, there will be dramatic reductions in the prevalence and occurrence of health-threatening conditions.


Assuntos
Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Exposição Ambiental/efeitos adversos , Doenças do Sistema Nervoso/epidemiologia , Doenças Respiratórias/epidemiologia , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Exposição Ambiental/análise , Feminino , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Neoplasias/epidemiologia , Neoplasias/etiologia , Doenças do Sistema Nervoso/etiologia , Material Particulado/efeitos adversos , Material Particulado/análise , Gravidez , Resultado da Gravidez , Doenças Respiratórias/etiologia
8.
Medicine (Baltimore) ; 98(10): e14694, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855460

RESUMO

The health effects of short-term exposure to air pollutants on respiratory deaths and its modifiers such as meteorological indexes have been widely investigated. However, most of the previous studies are limited to single pollutants or total respiratory deaths, and their findings are inconsistent.To comprehensively examine the short-term effects of air pollutants on daily respiratory mortality.Our analysis included 16,931 nonaccidental respiratory deaths (except lung cancer and tuberculosis) among older adults (>65 years) from 2011 to 2017 in Jinan, China. We used a generalized additive Poisson models adjusted for meteorology and population dynamics to examine the associations between air pollutants (particulate matter with an aerodynamic diameter of b2.5µm [PM2.5], particulate matter with an aerodynamic diameter of b10µm [PM10], SO2, NO2, O3) and daily mortality for the total patients, males, females, chronic airway diseases, pneumonia patients, and rest patients in Jinan.Outdoor air pollution was significantly related to mortality from all respiratory diseases especially from chronic airway disease in Jinan, China. The effects of air pollutants had lag effects and harvesting effects, and the effects estimates usually reached a peak at lag 1 or 2 day. An increase of 10 µg/m or 10 ppb of PM2.5, PM10, SO2, NO2, and O3 corresponds to increments in mortality caused by chronic airway disease of 0.243% (95% confidence interval [CI]: -0.172-0.659) at lag 1 day, 0.127% (95% CI: -0.161-0.415) at lag 1 day, 0.603% (95% CI: 0.069-1.139) at lag 3 day, 0.649% (95% CI: -0.808-2.128) at lag 0 day and 0.944% (95% CI: 0.156-0.1598) at lag 1 day, respectively. The effects of air pollutants were usually greater in females and varied by respiratory subgroups. Spearman correlation analysis suggested that there was a significant association between meteorological indexes and air pollutants.Sex, age, temperature, humidity, pressure, and wind speed may modify the short-term effects of outdoor air pollution on mortality in Jinan. Compared with the other pollutants, O3 had a stronger effect on respiratory deaths among the elderly. Moreover, chronic airway diseases were more susceptible to air pollution. Our findings provided new evidence for new local environmental and health policies making.


Assuntos
Poluição do Ar , Exposição Ambiental , Mortalidade , Material Particulado , Doenças Respiratórias , Tempo (Meteorologia) , Idoso , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , China/epidemiologia , Correlação de Dados , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Masculino , Material Particulado/efeitos adversos , Material Particulado/análise , Saúde Pública/métodos , Doenças Respiratórias/classificação , Doenças Respiratórias/etiologia , Doenças Respiratórias/mortalidade , Fatores de Risco , Estações do Ano , Fatores Sexuais , Fatores de Tempo
9.
Cien Saude Colet ; 24(3): 1083-1090, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892528

RESUMO

Hospitalizations due to respiratory diseases generate financial costs for the Health System in addition to social costs. Objective of this study was to develop and validate a fuzzy linguistic model for prediction of hospitalization due to respiratory diseases. We constructed a fuzzy model for prediction of hospitalizations due to pneumonia, bronchitis, bronchiolitis and asthma second exposure to fine particulate matter (PM2.5) in residents of Volta Redonda, RJ, in 2012. The model contains two inputs, PM2.5 and temperature, with three membership functions for each input, and an output with three membership functions for admissions, which were obtained from DATASUS. There were 752 hospitalizations in the period, the average concentration of PM2.5 was 17.1 µg/m3 (SD = 4.4). The model showed a good accuracy with PM2.5, the result was between 90% and 76.5% for lags 1, 2 and 3, a sensitivity of up to 95%. This study provides support for creating executable software with a low investment, along with the use of a portable instrument could allow number of hospital admission due to respiratory diseases and provide support to local health managers. Furthermore, the fuzzy model is very simple and involves low computational costs, an implementation making possible.


Assuntos
Lógica Fuzzy , Hospitalização/estatística & dados numéricos , Modelos Teóricos , Doenças Respiratórias/epidemiologia , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Brasil/epidemiologia , Exposição Ambiental/efeitos adversos , Hospitalização/economia , Humanos , Material Particulado/toxicidade , Admissão do Paciente/estatística & dados numéricos , Reprodutibilidade dos Testes , Doenças Respiratórias/etiologia , Doenças Respiratórias/fisiopatologia , Sensibilidade e Especificidade
10.
J Emerg Med ; 56(5): 478-483, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30803847

RESUMO

BACKGROUND: Emergency departments (EDs) become more overcrowded during peak respiratory virus season. Distinguishing influenza from other viruses is crucial to implement social distancing practices, early treatment, and prompt disposition. OBJECTIVES: We sought to determine factors associated with influenza among a prospective cohort of consecutive ED patients with acute respiratory illness (ARI). METHODS: Between December 2016 and March 2017, trained research assistants screened consecutive ED patients with ARI symptoms. ARI criteria included measured fever at home or in the ED >38°C and a cough, sore throat, or rhinorrhea with a duration of symptoms >12 hours and <1 week. After consent, research assistants collected demographics and clinical history using a standardized data form, and patients had a polymerase chain reaction-based assay that is nearly 100% sensitive for influenza. Univariate analysis was conducted on all predictor variables. Significant variables were entered into a multivariate logistic regression model to find factors that were independently associated with influenza. RESULTS: One hundred nineteen patients consented to enrollment and 31% were found to be positive for influenza. Myalgia, the absence of gastrointestinal symptoms (no diarrhea or vomiting), sore throat, chills, headache, and oxygen saturation ≥97% were significant on univariate analysis and were entered into the multivariate model. Myalgia (adjusted odds ratio [AOR] 3.9), the absence of gastrointestinal symptoms (AOR 4.7), and oxygen saturation ≥97% (AOR 2.8) were significant independent factors of influenza. CONCLUSION: The presence of myalgia, the absence of gastrointestinal symptoms, and oxygen saturation ≥97% are factors that can help distinguish influenza from other acute respiratory illnesses in the ambulatory ED population.


Assuntos
Influenza Humana/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mialgia/etiologia , Razão de Chances , Faringite/etiologia , Reação em Cadeia da Polimerase/métodos , Estudos Prospectivos , Doenças Respiratórias/etiologia
11.
Rev Invest Clin ; 71(1): 64-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810539

RESUMO

Non-obstructed ever-smokers, with or without symptoms, have generated a great deal of information recently, but few reviews. Even individuals with normal spirometry can present changes in sputum with inflammatory biomarkers (cellular and molecular) and airways and parenchyma with remodeling; when symptomatic (cough, sputum, wheezing, and dyspnea) exacerbations are frequent affecting the individuals' quality of life, there is an increased use of health resources: more medication, emergency visits, and hospital admissions. Non-obstructed smokers may have exercise limitations, increased lung volumes, low diffusion capacity, air entrapment, peripheral airways obstruction, elevated airways resistance, and abnormal multiple breath nitrogen washout, as well as abnormalities in computed tomography studies, such as airway wall thickening, emphysema, or interstitial lung abnormalities. Quitting smoking comprises a first, inexpensive, and often abandoned intervention to arrest respiratory impairment. It is controversial whether or not this population should be treated with other medications. Further studies should be conducted to elucidate the consequences of follow-up and prognosis in this clinical entity.


Assuntos
Doenças Respiratórias/etiologia , Fumantes , Fumar/efeitos adversos , Humanos , Prognóstico , Qualidade de Vida , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/fisiopatologia , Abandono do Hábito de Fumar/métodos , Espirometria
12.
Rev Invest Clin ; 71(1): 17-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810544

RESUMO

Electronic cigarettes, handheld devices that generate an aerosol that may contain nicotine by heating a solution or e-liquid, have been increasingly used especially in the young population. The aerosol's composition is determined by temperature, and by the substances contained in the heated liquid: glycerin, propylene glycol, nicotine in variable concentrations, flavoring agents, and other non-nicotine compounds. >80 compounds (including known toxics, e.g., formaldehyde, acetaldehyde, metallic nanoparticles, and acrolein) have been found in e-liquid and aerosols. Airway irritation, mucus hypersecretion, and inflammatory response, including systemic changes, have been observed after the exposure to e-cigarettes, leading to an increase in respiratory symptoms and changes in respiratory function and the host defense mechanisms. E-cigarette has been linked with an increase of symptoms in individuals with asthma, cystic fibrosis, and chronic obstructive pulmonary disease. One of the major concerns in public health is the rise in e-cigarette experimentation among never-smokers, especially children and adolescents, which leads to nicotine addiction and increases the chances of becoming with time a conventional smoker. There is an urgent need to regulate e-cigarettes and electronic nicotine delivery systems, at least with the same restrictions to those applied to tobacco products, and not to consider them as harmless products.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/métodos , Nicotina/administração & dosagem , Vaping/efeitos adversos , Adolescente , Aerossóis , Criança , Humanos , Nicotina/efeitos adversos , Saúde Pública , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Doenças Respiratórias/fisiopatologia , Vaping/epidemiologia
13.
Respir Res ; 20(1): 27, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728013

RESUMO

BACKGROUND: Animal production workers are persistently exposed to organic dust and can suffer from a variety of respiratory disease symptoms and annual decline in lung function. The role of high mobility group box-1 (HMGB1) in inflammatory airway diseases is emerging. Hence, we tested a hypothesis that organic dust exposure of airway epithelial cells induces nucleocytoplasmic translocation of HMGB1 and blocking this translocation dampens organic dust-induced lung inflammation. METHODS: Rats were exposed to either ambient air or swine barn (8 h/day for either 1, 5, or 20 days) and lung tissues were processed for immunohistochemistry. Swine barn dust was collected and organic dust extract (ODE) was prepared and sterilized. Human airway epithelial cell line (BEAS-2B) was exposed to either media or organic dust extract followed by treatment with media or ethyl pyruvate (EP) or anti-HMGB1 antibody. Immunoblotting, ELISA and other assays were performed at 0 (control), 6, 24 and 48 h. Data (as mean ± SEM) was analyzed using one or two-way ANOVA followed by Bonferroni's post hoc comparison test. A p value of less than 0.05 was considered significant. RESULTS: Compared to controls, barn exposed rats showed an increase in the expression of HMGB1 in the lungs. Compared to controls, ODE exposed BEAS-2B cells showed nucleocytoplasmic translocation of HMGB1, co-localization of HMGB1 and RAGE, reactive species and pro-inflammatory cytokine production. EP treatment reduced the ODE induced nucleocytoplasmic translocation of HMGB1, HMGB1 expression in the cytoplasmic fraction, GM-CSF and IL-1ß production and augmented the production of TGF-ß1 and IL-10. Anti-HMGB1 treatment reduced ODE-induced NF-κB p65 expression, IL-6, ROS and RNS but augmented TGF-ß1 and IL-10 levels. CONCLUSIONS: HMGB1-RAGE signaling is an attractive target to abrogate OD-induced lung inflammation.


Assuntos
Poeira , Proteína HMGB1/metabolismo , Pneumonia/tratamento farmacológico , Piruvatos/uso terapêutico , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Doenças Respiratórias/tratamento farmacológico , Transdução de Sinais/efeitos dos fármacos , Transporte Ativo do Núcleo Celular/efeitos dos fármacos , Animais , Linhagem Celular , Citocinas/biossíntese , Proteína HMGB1/efeitos dos fármacos , Humanos , Imuno-Histoquímica , Pneumonia/etiologia , Ratos , Receptor para Produtos Finais de Glicação Avançada/efeitos dos fármacos , Doenças Respiratórias/etiologia , Suínos
14.
Respir Res ; 20(1): 33, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764884

RESUMO

BACKGROUND: Early life exposure to tobacco smoke has been extensively studied but the role of second-hand smoke (SHS) for new-onset respiratory symptoms and lung function decline in adulthood has not been widely investigated in longitudinal studies. Our aim is to investigate the associations of exposure to SHS in adults with respiratory symptoms, respiratory conditions and lung function over 20 years. METHODS: We used information from 3011 adults from 26 centres in 12 countries who participated in the European Community Respiratory Health Surveys I-III and were never or former smokers at all three surveys. Associations of SHS exposure with respiratory health (asthma symptom score, asthma, chronic bronchitis, COPD) were analysed using generalised linear mixed-effects models adjusted for confounding factors (including sex, age, smoking status, socioeconomic status and allergic sensitisation). Linear mixed-effects models with additional adjustment for height were used to assess the relationships between SHS exposure and lung function levels and decline. RESULTS: Reported exposure to SHS decreased in all 26 study centres over time. The prevalence of SHS exposure was 38.7% at baseline (1990-1994) and 7.1% after the 20-year follow-up (2008-2011). On average 2.4% of the study participants were not exposed at the first, but were exposed at the third examination. An increase in SHS exposure over time was associated with doctor-diagnosed asthma (odds ratio (OR): 2.7; 95% confidence interval (95%-CI): 1.2-5.9), chronic bronchitis (OR: 4.8; 95%-CI: 1.6-15.0), asthma symptom score (count ratio (CR): 1.9; 95%-CI: 1.2-2.9) and dyspnoea (OR: 2.7; 95%-CI: 1.1-6.7) compared to never exposed to SHS. Associations between increase in SHS exposure and incidence of COPD (OR: 2.0; 95%-CI: 0.6-6.0) or lung function (ß: - 49 ml; 95%-CI: -132, 35 for FEV1 and ß: - 62 ml; 95%-CI: -165, 40 for FVC) were not apparent. CONCLUSION: Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes.


Assuntos
Nível de Saúde , Sistema Respiratório/fisiopatologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Asma/epidemiologia , Asma/etiologia , Bronquite Crônica/epidemiologia , Bronquite Crônica/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Europa (Continente)/epidemiologia , União Europeia , Seguimentos , Inquéritos Epidemiológicos , Humanos , Incidência , Prevalência , Testes de Função Respiratória , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/estatística & dados numéricos
15.
Int J Public Health ; 64(4): 547-559, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30790006

RESUMO

OBJECTIVES: Due to their small size, ultrafine particles (UFP) are believed to exert higher toxicity than larger particles. As numerous studies on health effects of UFP have been published since the last systematic review in 2013, we aim to systematically review the new literature. METHODS: We searched MEDLINE and the specialized LUDOK database for studies published between 01.01.2011 and 11.05.2017 investigating health effects of ambient air pollution-related UFP. We included epidemiologic studies containing UFP measures and quantifiable measures of associations. Relevant data were extracted on the basis of previously developed evaluation criteria. RESULTS: We identified 85 original studies, conducting short-term (n = 75) and long-term (n = 10) investigations. Panel (n = 32), scripted exposure with predefined settings (n = 16) or time series studies (n = 11) were most frequent. Thirty-four studies adjusted for at least one other pollutant. Most consistent associations were identified for short-term effects on pulmonary/systemic inflammation, heart rate variability and blood pressure. CONCLUSIONS: The evidence suggests adverse short-term associations with inflammatory and cardiovascular changes, which may be at least partly independent of other pollutants. For the other studied health outcomes, the evidence on independent health effects of UFP remains inconclusive or insufficient.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Tamanho da Partícula , Material Particulado/efeitos adversos , Doenças Respiratórias/etiologia , Doenças Respiratórias/mortalidade , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Humanos , Material Particulado/análise , Doenças Respiratórias/epidemiologia
16.
Photochem Photobiol Sci ; 18(3): 775-803, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30810564

RESUMO

The composition of the air we breathe is determined by emissions, weather, and photochemical transformations induced by solar UV radiation. Photochemical reactions of many emitted chemical compounds can generate important (secondary) pollutants including ground-level ozone (O3) and some particulate matter, known to be detrimental to human health and ecosystems. Poor air quality is the major environmental cause of premature deaths globally, and even a small decrease in air quality can translate into a large increase in the number of deaths. In many regions of the globe, changes in emissions of pollutants have caused significant changes in air quality. Short-term variability in the weather as well as long-term climatic trends can affect ground-level pollution through several mechanisms. These include large-scale changes in the transport of O3 from the stratosphere to the troposphere, winds, clouds, and patterns of precipitation. Long-term trends in UV radiation, particularly related to the depletion and recovery of stratospheric ozone, are also expected to result in changes in air quality as well as the self-cleaning capacity of the global atmosphere. The increased use of substitutes for ozone-depleting substances, in response to the Montreal Protocol, does not currently pose a significant risk to the environment. This includes both the direct emissions of substitutes during use and their atmospheric degradation products (e.g. trifluoroacetic acid, TFA).


Assuntos
Poluição do Ar/análise , Mudança Climática , Ozônio Estratosférico/análise , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Animais , Doenças Cardiovasculares/etiologia , Monitorização de Parâmetros Ecológicos , Ecossistema , Saúde , Humanos , Ozônio/efeitos adversos , Ozônio/análise , Perda de Ozônio , Reprodução , Doenças Respiratórias/etiologia , Raios Ultravioleta/efeitos adversos
17.
Artigo em Inglês | MEDLINE | ID: mdl-30781540

RESUMO

Air pollutants existing in the environment may have negative impacts on human health depending on their toxicity and concentrations. Remote sensing data enable researchers to map concentrations of various air pollutants over vast areas. By combining ground-level concentrations with population data, the spatial distribution of health impacts attributed to air pollutants can be acquired. This study took five highly populated and severely polluted provinces along the Huaihe River, China, as the research area. The ground-level concentrations of four major air pollutants including nitrogen dioxide (NO2), sulfate dioxide (SO2), particulate matters with diameter equal or less than 10 (PM10) or 2.5 micron (PM2.5) were estimated based on relevant remote sensing data using the geographically weighted regression (GWR) model. The health impacts of these pollutants were then assessed with the aid of co-located gridded population data. The results show that the annual average concentrations of ground-level NO2, SO2, PM10, and PM2.5 in 2016 were 31 µg/m³, 26 µg/m³, 100 µg/m³, and 59 µg/m³, respectively. In terms of the health impacts attributable to NO2, SO2, PM10, and PM2.5, there were 546, 1788, 10,595, and 8364 respiratory deaths, and 1221, 9666, 46,954, and 39,524 cardiovascular deaths, respectively. Northern Henan, west-central Shandong, southern Jiangsu, and Wuhan City in Hubei are prone to large health risks. Meanwhile, air pollutants have an overall greater impact on cardiovascular disease than respiratory disease, which is primarily attributable to the inhalable particle matters. Our findings provide a good reference to local decision makers for the implementation of further emission control strategies and possible health impacts assessment.


Assuntos
Doenças Cardiovasculares/etiologia , Dióxido de Nitrogênio/efeitos adversos , Material Particulado/efeitos adversos , Doenças Respiratórias/etiologia , Dióxido de Enxofre/efeitos adversos , Poluentes Atmosféricos , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/mortalidade , China/epidemiologia , Cidades/epidemiologia , Monitoramento Ambiental/métodos , Humanos , Dióxido de Nitrogênio/análise , Material Particulado/análise , Tecnologia de Sensoriamento Remoto , Doenças Respiratórias/mortalidade , Rios , Dióxido de Enxofre/análise
18.
Ann Saudi Med ; 39(1): 29-36, 2019 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30712048

RESUMO

BACKGROUND: Pneumonia, the commonest lower respiratory tract infection, can result in respiratory and non-respiratory complications. Few studies have reported on the prevalence of many complications. OBJECTIVES: Identify the prevalence of 18 complications of pneumonia and compare complication rates by age group and type of pneu.monia. Identify most prevalent comorbidities, the effect of the number of comorbidities on the presence of complications, and the association between specific comorbidities and specific complications. DESIGN: Retrospective, cross-sectional prevalence study. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: The target population were patients aged 17 years and older, of different nationalities and both genders, diagnosed with pneumonia during the period of 2010 to 2017. Selection was by stratified sampling by year of admission. MAIN OUTCOME MEASURES: Complications of pneumonia. SAMPLE SIZE: 800. RESULTS: Complications were observed in 427 patients (53.4%). The complications were respiratory in 258 patients (32%), sepsis and septic shock in 186 (23%), cardiac in 125 (16%), neurological in 5 (0.6%), and cholestatic jaundice in 2 (0.3%). Pleural effusion was the commonest complication, observed in 230 patients. There was a significant difference (P less than .001) between the complication rates in older patients compared to younger (60% as compared to 41%). For the type of pneumonia, there was a significant difference (P less than .001) between community-acquired pneumonia and hospital-acquired pneumonia in the presence of complications (OR=2.41, 95% CI for OR=1.66, 3.49). The number of comorbidities was significantly associated with the presence of complications (P=.001) for those with multiple comorbidities (46% for patients with no comorbid illnesses versus 68% in patients with three or more comorbidities). CONCLUSION: These results suggest that Saudi Arabia needs to establish better prevention and intervention programs, especially for the high-risk groups identified in this study: older patients, patients with hospital-acquired pneumonia and patients with two or more comorbidities. LIMITATIONS: Retrospective design and single-centered. CONFLICT OF INTEREST: None.


Assuntos
Cardiopatias/epidemiologia , Icterícia Obstrutiva/epidemiologia , Pneumonia/complicações , Doenças Respiratórias/epidemiologia , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Infecções Comunitárias Adquiridas/complicações , Infecção Hospitalar/complicações , Estudos Transversais , Feminino , Cardiopatias/etiologia , Humanos , Icterícia Obstrutiva/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Prevalência , Doenças Respiratórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Sepse/etiologia , Centros de Atenção Terciária , Adulto Jovem
20.
Pediatr Dent ; 41(1): 52-55, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30803478

RESUMO

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (0.2 percent), two incidents of hypoxia (less than 0.1 percent), and six incidents of difficult airway (0.1 percent). When intubated versus nonintubated GA was compared for respiratory complication incidence, no significant association was found (P=0.81, odds ratio equals 0.93). Conclusion: No significant difference was found between the incidence of respiratory complications with intubated versus nonintubated GA provided by dentist anesthesiologists.


Assuntos
Anestesia Dentária/métodos , Anestesia Geral/métodos , Assistência Odontológica para Crianças/métodos , Intubação Intratraqueal , Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Criança , Pré-Escolar , Assistência Odontológica para Crianças/efeitos adversos , Feminino , Humanos , Incidência , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Masculino , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia
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