Dissertations / Theses on the topic 'Morbidité respiratoire'

Localisée sur le littoral tunisien, l'agglomération de Sfax (500 000 habitants) se caractérise par une forte demande en matière de soins élémentaires, matérialisée ici par la croissance de la morbidité respiratoire dans le secteur de la Santé de Base sur la période 1995-2004. La variabilité temporelle de cette morbidité, exprimée par la consultation médicale nous amène à suggérer une relation avec le contexte climatique à Sfax. Nous analysons les aspects de ce rapport entre la morbidité respiratoire et les types d'ambiances bioclimatiques, en particulier hivernales et estivales. L'objectif de cette étude est de mettre l'accent sur certains modes météopathologiques associés aux diverses ambiances biométéorologiques. La relation entre l'ambiance biométéorologique et la morbidité respiratoire montre un décalage temporel et une météosensibilite différente des maladies. L'angine et l'otite (d'origine bactérienne) présentent une sensibilité à la configuration thermo-hygrométrique alors que la rhinopharyngite, les broncho-pneumopathies et le syndrome grippal (d'origine virale) sont plutôt sensibles à la composante thermo-anémométrique. Les types de temps fréquents en été comme en hiver influencent les ambiances instaurées et par conséquent la météosensibilite des maladies respiratoires. La météosensibilite est liée également à l'âge puisque nos enquêtes reflètent une spécification pathologique au niveau des catégories d'âge, exprimant ainsi une variation d'exposition des personnes aux impacts de l'ambiance biométéorologique
Located on the coast of Tunisia, the agglomeration of Sfax (500000 inhabitants) is characterized by a high demand for basic care, which represented by the growth of respiratory morbidity in the basic Health sector over the period 1995-2004. The temporal variability of this morbidity, expressed by the medical consultation leads to suggest a relationship with the climate situation in Sfax. We analyse the aspects of the relationship between respiratory illness and the environments bioclimatic types, especially in winter and summer. The objective of this study is to focus on some meteopathological modes associated with the various biometeorologicals environments. The rapport between the biometeorological environment and the respiratory morbidity emerge the different interval time and meteosensibility of diseases. Angina and otitis (bacterial origin) are sensitive to thermo- humidity setting while nazofaringitis, pulmonary affections and influenza (viral origin) is rather sensitive to thermo-Anemometer component. The weather types frequent in summer and winter, which determinate the biometeorological environment and then the meteosensibility of the respiratory consultation. The meteosensibility is also related to the age, because our surveys reflect a pathological specification at the age categories, that meaning an exposure variation to the effects of the biometeorological environment

Problématique : La qualité de l’air intérieur est devenue une préoccupation majeure de santé publique, en raison du temps passé à l’intérieur des locaux et de la diversité des contaminants biologiques et des polluants chimiques présents. Objectifs : Il s’agit de renseigner et de modéliser l’exposition domestique à des polluants chimiques retrouvés dans l’air intérieur et d’en étudier le lien avec la morbidité respiratoire au cours de la première année de vie des nouveau-nés de la cohorte PARIS (Pollution and Asthma Risk : an Infant Study). Méthodes : À 1, 3, 6, 9 et 12 mois, des questionnaires sanitaires sont adressés aux parents pour renseigner la survenue des infections des voies respiratoires et des symptômes évocateurs d’asthme (sifflements, toux sèche nocturne, etc.). Des questionnaires environnementaux sont envoyés en parallèle pour documenter le cadre et le mode de vie des enfants. Pour pallier l’imprécision résultant d’une évaluation de l’exposition aux polluants de l’air intérieur par simple questionnaire, des investigations environnementales complémentaires ont été conduites, à 1, 6, 9 et 12 mois, au domicile d’un échantillon aléatoire de 196 nouveau-nés de la cohorte PARIS et dans des crèches parisiennes fréquentées par ces enfants. Les données issues des mesurages domestiques répétés ont été confrontées aux données recueillies par questionnaires afin d’établir des modèles prédictifs s concentrations domestiques annuelles de polluants. Ces modèles ont ensuite été appliqués à l’ensemble des logements fréquentés par les enfants de la cohorte afin de les classer au regard de leur exposition domestique annuelle pour étudier l’impact sanitaire de cette exposition. Résultats : Les modèles prédictifs des concentrations mesurées ont permis d’identifier les déterminants des niveaux de formaldéhyde, de dioxyde d’azote, de toluène et de tétrachloroéthylène : les sources continues et leur caractère récent (panneaux de particules, parquet vitrifié, stratifié, flottant et peinture), les sources discontinues (combustion et proximité au pressing) et les paramètres d’aération et de ventilation conditionnant l’entrée ou la sortie du polluant selon leur origine dominante. Au cours de la première année de vie, près d’un enfant sur deux présente une infection des voies respiratoires basses, 14,8 % une toux sèche nocturne. Concernant l’impact sanitaire de l’exposition aux polluants chimiques, après ajustement sur l’ensemble des facteurs de risque, seule l’exposition domestique au formaldéhyde majore la survenue des infections et plus particulièrement des infections sifflantes. L’exposition au formaldéhyde est aussi associée à la toux sèche nocturne et plus particulièrement chez les enfants sans antécédents parentaux d’allergie. Conclusion : Une exposition domestique aux polluants chimiques de l’air intérieur, tels que le formaldéhyde, peut être associée à la morbidité respiratoire du jeune enfant. Ces résultats viennent appuyer les mesures prises par les pouvoirs publics concernant les émissions des matériaux
There is a growing public health concern about indoor air quality due to the time spent indoors and the presence of numerous biological and chemical pollutants. Aims: To assess indoor chemical pollutant levels, to model domestic exposure and to examine the impact of indoor chemical pollutants on the respiratory health of infants from the PARIS birth cohort, during their first year of life. Methods: Multiple self-administered questionnaires were used to gather information from parents about respiratory infections and asthma-like symptoms (wheezing, nocturnal dry cough. . . ) in their infants at ages 1, 3, 6, 9 and 12 months. Details about home characteristics and family living conditions were also collected by phone interview when the child was 1 month old, and mailed questionnaires captured changes at 3, 6, 9 and 12 months. Pollutant air sampling (aldehyde, volatile organic compound, nitrogendioxide and nicotine) were conducted at 1, 6, 9 and 12 months in the bedrooms of a subset of randomly selected 196infants. Repeated pollutant measurements were joined with interview and questionnaire information to construct annual pollutant exposure models for all infants. Furthermore, an environmental investigation was performed in Parisian child day care centers to document chemical exposure levels. Results: Formaldehyde, toluene, nitrogen dioxide and perchlororethylene level determinants: continuous sources (particleboard, varnished parquet floor, wall coating), discontinuous sources (combustion, dry cleaning facilities) and aeration parameters were identified. At one year, around half of babies experienced at least one lower respiratory infection, and nearly half of those infections included wheezing, 14,8 % of babies suffered from a nocturnal dry cough. After known risk factors were considered, lower respiratory infections were associated with estimated formaldehyde levels, and formaldehyde exposure is also related to nocturnal dry cough, especially in infants without parental history of allergy. Conclusion: This study shows that formaldehyde exposure in early life is associated with respiratory health in infants, promoting public actions regarding emissions from materials

Problématique : La qualité de l'air intérieur est devenue une préoccupation majeure de santé publique, en raison du temps passé à l'intérieur des locaux et de la diversité des contaminants biologiques et des polluants chimiques présents. Objectifs : Il s'agit de renseigner et de modéliser l'exposition domestique à des polluants chimiques retrouvés dans l'air intérieur et d'en étudier le lien avec la morbidité respiratoire au cours de la première année de vie des nouveau-nés de la cohorte PARIS (Pollution and Asthma Risk : an Infant Study). Méthodes : À 1, 3, 6, 9 et 12 mois, des questionnaires sanitaires sont adressés aux parents pour renseigner la survenue des infections des voies respiratoires et des symptômes évocateurs d'asthme (sifflements, toux sèche nocturne, etc.). Des questionnaires environnementaux sont envoyés en parallèle pour documenter le cadre et le mode de vie des enfants. Pour pallier l'imprécision résultant d'une évaluation de l'exposition aux polluants de l'air intérieur par simple questionnaire, des investigations environnementales complémentaires ont été conduites, à 1, 6, 9 et 12 mois, au domicile d'un échantillon aléatoire de 196 nouveau-nés de la cohorte PARIS et dans des crèches parisiennes fréquentées par ces enfants. Les données issues des mesurages domestiques répétés ont été confrontées aux données recueillies par questionnaires afin d'établir des modèles prédictifs s concentrations domestiques annuelles de polluants. Ces modèles ont ensuite été appliqués à l'ensemble des logements fréquentés par les enfants de la cohorte afin de les classer au regard de leur exposition domestique annuelle pour étudier l'impact sanitaire de cette exposition. Résultats : Les modèles prédictifs des concentrations mesurées ont permis d'identifier les déterminants des niveaux de formaldéhyde, de dioxyde d'azote, de toluène et de tétrachloroéthylène : les sources continues et leur caractère récent (panneaux de particules, parquet vitrifié, stratifié, flottant et peinture), les sources discontinues (combustion et proximité au pressing) et les paramètres d'aération et de ventilation conditionnant l'entrée ou la sortie du polluant selon leur origine dominante. Au cours de la première année de vie, près d'un enfant sur deux présente une infection des voies respiratoires basses, 14,8 % une toux sèche nocturne. Concernant l'impact sanitaire de l'exposition aux polluants chimiques, après ajustement sur l'ensemble des facteurs de risque, seule l'exposition domestique au formaldéhyde majore la survenue des infections et plus particulièrement des infections sifflantes. L'exposition au formaldéhyde est aussi associée à la toux sèche nocturne et plus particulièrement chez les enfants sans antécédents parentaux d'allergie. Conclusion : Une exposition domestique aux polluants chimiques de l'air intérieur, tels que le formaldéhyde, peut être associée à la morbidité respiratoire du jeune enfant. Ces résultats viennent appuyer les mesures prises par les pouvoirs publics concernant les émissions des matériaux

Aims To assess the impact of RSV and other viral lower respiratory tract infections (LRTIs) on chronic respiratory morbidity in prematurely born infants and to investigate whether there were any functional or genetic predisposing factors. Methods One hundred and fifty three prematurely born infants were followed until one year corrected age with approximately half followed until two years of age. Lung function was measured at 36 weeks postmenstrual age (PMA) and one year corrected age. Blood or buccal swabs were taken for single nucleotide polymorphism (SNP) analysis. Following neonatal unit discharge, a nasopharyngeal aspirate (NPA) was taken whenever an infant had a LRTI. NPAs were analysed by real time PCR for 13 viruses. At one and two years corrected age healthcare utilisation and costs of care were calculated and parents completed a respiratory health related questionnaire and a diary card for one month. Results Infants developing RSV or other viral LRTIs requiring hospitalisation had reduced premorbid lung function compared to infants not hospitalised. Infants developing rhinovirus LRTIs had increased healthcare utilisation, cost of care and wheeze at one year corrected age. Infants developing RSV LRTIs had reduced lung function at one year corrected age. Prematurity was found to be a risk factor for developing RSV or other viral LRTIs but not influenza A (H1N1) LRTIs. A SNP in ADAM33 was associated with an increased risk of developing RSV LRTIs, but not with significant differences in 36 week PMA lung function results. SNPs in several genes were associated with increased chronic respiratory morbidity (IL10, NOS2A, SFTPC, MMP16 and VDR) and reduced lung function at one year (MMP16, NOS2A, SFTPC and VDR) in infants who had had RSV LRTIs. Conclusion In prematurely born infants, RSV and other viral LRTIs were associated with increased chronic respiratory morbidity at follow up, with some infants being genetically predisposed to this after RSV LRTI. Premorbid abnormal lung function predisposed to severe RSV and a SNP in the ADAM33 gene predisposed to RSV LRTIs.

It has been established in New Zealand and internationally that morbidity and mortality tends to rise during colder winter months, with a typical 10-20% excess compared to the rest of the year. This study sought to investigate the spatial, temporal, climatic and demographic patterns and interactions of excess winter morbidity (EWMb) among the elderly in New Zealand. This was achieved through analysis of acute hospital admissions in New Zealand between 1996 and 2013 for all patients over the age of 60 with an element of circulatory or respiratory disease (N=1,704,317) including a primary diagnosis of circulatory (N=166,938) or respiratory (N=62,495) disease. A quantitative approach included ordinary least squares and negative binomial regression, graphical analysis and age standardisation processes. Admission rates and durations were regressed against a set of 16 cold spell indicators at a national and regional scale, finding significant spatial variation in the magnitude of EWMb. EWMb was ubiquitous across New Zealand despite climatic variation between regions, with an average winter excess of 15%, and an excess of 51% for chronic obstructive pulmonary disease (COPD). Statistically significant relationships were found between hospital admission durations and cold spells up to 28 days prior; however the magnitude would not be expected to have a significant impact on hospital resources. Nonetheless, there is potential for preventative public health strategies to mitigate less severe morbidity associated with cold spells. Patients over the age of 80 were particularly vulnerable to EWMb; however socioeconomic deprivation and ethnicity did not affect vulnerability. Patients residing in areas of high socioeconomic deprivation or identifying with Maori or Pacific Island ethnicity experienced significantly shorter admissions than other groups, and this warrants further investigation. Further investigation into winter COPD exacerbations and non-climatic factors associated with the EWMb are recommended. A comprehensive understanding of EWMb will enable preventative measures that can improve quality of life, particularly for the elderly population.

Calf health data and first lactation records for 2556 cows born in a commercial dairy herd between June 1998 and June 2001 were studied to determine the effects of calfhood disease on survival and performance. Operator-treated respiratory disease occurrences within the first year of life and digestive disease occurrences within the first 45 d of life were analyzed to determine their effects on calfhood morbidity, age at first calving, 305-d first lactation production, and mortality in first lactation. Of the 2556 records used, 2083 calves contracted respiratory or digestive disease at least once, 1254 calves had digestive disease only, 771 had respiratory disease only, and 191 calves had both diseases. Occurrence of calfhood digestive disease increased the chance of calfhood respiratory disease 2-fold. Age at first calving increased 0.53 mo with multiple occurrences of respiratory disease versus none. Calves born in the winter calved at 25.4 mo, whereas calves born in spring calved at 24.5 mo. Respiratory disease had the largest effect on calves born in the spring, resulting in 23.9 mo age at first calving for no occurrence and 25.4 mo for multiple occurrences. No significant effect of disease was detected for 305-d milk yield, fat yield, or SCC, but protein yield decreased by 0.05 kg/d with increased calf respiratory disease. Although calfhood disease had no influence on illness as a cow, disease-free calves had a 5% advantage in probability of remaining in the herd through 305-d, and an 8% advantage at 730-d compared with calves with 2 or more disease occurrences. In conclusion, calfhood occurrences of respiratory and digestive disease had a slight impact on age at first calving, depending on season of birth, and minimal impact on production performance through 305-d of first lactation. The occurrence of respiratory or digestive disease caused a decrease in survival rate from calving through 305-d in first lactation and 730 d after calving.
Master of Science

Orientador: Maria Rita Donalísio Cordeiro
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução e objetivos: As infecções respiratórias estão entre as mais importantes causas de morbimortalidade no mundo. A sua alta incidência tem relevante impacto nos óbitos, como também na sobrecarga do sistema de saúde e absenteísmo no trabalho e escola Todas as faixas etárias são acometidas, porém, as mais afetadas são as crianças e os idosos. Também são particularmente susceptíveis os imunocomprometidos e os portadores de doenças crônicas em geral. Os vírus são os agentes responsáveis pela maior parte das infecções respiratórias, os principais vírus causadores de infecções respiratórias são o influenza A e B e o Vírus Sincicial Respiratório (VSR). Estes vírus têm comportamento biológicos distintos e o conhecimento de como estes vírus afetam a saúde da população é fundamental para embasar as ações de prevenção, profilaxia e tratamento de pacientes permitindo uma alocação adequada de recursos em quantidade e tempo adequados. No Brasil, no ano 2000, para monitorar a ocorrência destes vírus foi implantada a vigilância de síndromes gripais SIVEP-GRIPE, que através de 128 unidades sentinelas distribuídas em todas as regiões do país coletam semanalmente amostras de secreção de nasofaringe por semana de pacientes com síndromes gripais. Neste trabalho estudamos o impacto do influenza na mortalidade no estado de São Paulo, nas diferentes faixas etárias no período entre 2002 e 2011, incluindo o período da pandemia de 2009. Estudamos também a sazonalidade do VSR nas 5 diferentes regiões brasileiras e o impacto deste vírus nas internações por doenças respiratórias entre menores de 5 anos. Metodologia: Para o estudo da mortalidade associada ao influenza utilizamos o método de regressão de Serfling adaptado para dados semanais extraindo da série histórica os períodos de maior circulação viral a partir dos resultados do sistema de vigilância sentinela SIVEP-GRIPE. Comparar a mortalidade associada à pandemia de influenza de 2009, às epidemias prévias anuais de influenza nas diferentes faixas etárias e com diferentes subtipos de vírus influenza circulantes no estado de São Paulo. Para o estudo da sazonalidade do VSR utilizamos análise de Wavelets, análise de Fourier, análise simplificada de estações anuais comparando os resultados nas 5 regiões administrativas do Brasil. Para identificar possíveis correlações temporais entre a circulação dos vírus respiratórios utilizamos métodos de regressão de ranque de Spearman e de regressão parcial. Resultados e conclusões: A mortalidade por pneumonia e influenza associada à pandemia de 2009 no estado de São Paulo foi ligeiramente mais alta que nos outros anos de influenza sazonal, considerando a mortalidade geral, sem distinção de faixa etária. Houve diferenças no risco de morrer entre as faixas etárias. Entre os indivíduos de 5 a 19 anos, a mortalidade associada à pandemia de 2009 foi 2,6 maior (0,6 óbitos/100.000hab) que a de anos não pandêmicos. Na faixa etária de 20 a 59 anos, a mortalidade associada à pandemia de 2009 foi 5,1 maior (2,8 óbitos/100.000hab) que nos anos não pandêmicos. As taxas de mortalidade entre menores de 5 anos foi 0,9 óbitos/100.000hab e na população de mais 60 anos foi 13,1 óbitos/100.000hab, ou seja, foram menores que nos anos não pandêmicos. O método de análise utilizado permitiu a diferenciação entre a mortalidade associada a subtipos virais (A(H3N2), B ou sazonal A(H1N1) e A(H1N1) pdm 2009). Foi possível a comparação entre a mortalidade associada à pandemia de influenza de 2009 em São Paulo, às epidemias anuais de influenza nas diferentes faixas etárias e com diferentes subtipos de vírus influenza circulando. Isto é, o impacto da circulação do vírus pandêmico influenza A(H1N1) foi maior na mortalidade em adultos e jovens, enquanto em maiores de 65 anos foi discreto. Por outro lado, o excesso de mortalidade foi expressivo em maiores de 65 anos, nos anos de circulação do influenza A(H3N2). O modelo de Serfling adaptado a dados semanais com validação por meio de dados da vigilância sentinela de síndromes gripais (SIVEP-GRIPE) mostrou-se confiável para detectar picos de maior circulação viral do Influenza e supostos reflexos na mortalidade em diferentes faixas etárias em período pandêmico, epidêmico e de circulação sazonal do vírus Influenza. Sobre o VSR foi possível identificar padrões sazonais do VSR em todas as regiões administrativas do Brasil utilizando-se dados da vigilância de síndromes gripais (SIVEP-GRIPE). Houve diferenças entre os momentos de maior circulação do vírus em algumas das cinco regiões administrativas do Brasil. Os padrões sazonais de internação por doenças sabidamente relacionadas com o VSR [Pneumonia devida a vírus respiratório sincicial, Bronquite aguda devida a vírus sincicial respiratório, Bronquiolite aguda devida a vírus sincicial respiratório, Bronquiolite (aguda, não especificada),] foram semelhantes aos encontrados pela análise da circulação do VSR por meio de dados da vigilância de síndromes gripais (SIVEP-GRIPE). Houve correlação temporal entre a circulação do VSR e as taxas de internação por doenças do aparelho respiratório em geral (Capítulo-X da CID-10) entre menores de 5 anos, nas cinco regiões administrativas do Brasil. Houve correlação temporal entre as taxas de internação entre menores de 5 anos por doenças sabidamente relacionadas com o VSR [Pneumonia devida a vírus respiratório sincicial, Bronquite aguda devida a vírus sincicial respiratório, Bronquiolite aguda devida a vírus sincicial respiratório, Bronquiolite (aguda, não especificada),] e as taxas de internação por doenças respiratórias em geral nesta faixa etária nas cinco regiões administrativas do Brasil, indicando que este é o principal vírus associado às internações de crianças até 5 anos por doenças respiratórias. De acordo com as evidências encontradas neste estudo, os esquemas de profilaxia contra o VSR hoje utilizados precisam ser revistos e particularizados para cada região do país. Entre as ações a serem revistas estão a disponibilização do palivizumabe, bem como medidas de prevenção à circulação do VSR na comunidade
Abstract: Introduction and Objectives: Respiratory infections are amongst the most important causes of morbidity and mortality worldwide. Its high incidence has significant impact on deaths, but also burdens the health system and leads to absenteeism from work and school All age groups are affected, but the most affected are children and the elderly. Are also particularly susceptible immunocompromised and patients with chronic diseases in general. Viruses are the agents responsible for most respiratory infections, the main cause of respiratory virus infections are influenza A and B and Respiratory Syncytial Virus (RSV). These viruses have distinct biological behavior and knowledge of how these viruses affect people's health is fundamental to support the prevention, prophylaxis and treatment of patients allowing an adequate allocation of resources in quantity and adequate time. In Brazil, in 2000, to monitor the occurrence of these viruses was established surveillance of influenza-like syndromes SIVEP-FLU, which through 128 sentinel units distributed in all regions of the country collect weekly samples of nasopharyngeal secretions of patients per week with influenza-like illness. In this work we study the impact of influenza on mortality in the state of São Paulo , in different age groups between 2002 and 2011 , including the period of the 2009 pandemic. We also studied the seasonality of RSV in 5 different Brazilian regions and the impact of this virus in hospitalizations for respiratory diseases among children under 5 years. Methods: To study the mortality associated with influenza used the regression method of Serfling adapted for extracting weekly data of the time series periods of increased viral movement from the results of sentinel surveillance system SIVEP - FLU . Compare the mortality associated with pandemic 2009 influenza , annual epidemics of influenza prior at different ages and with different subtypes of influenza viruses circulating in the state of São Paulo . To study the seasonality of RSV , we use wavelet analysis , Fourier analysis , simplified analysis of annual seasons comparing the results in five administrative regions of Brazil . To identify possible temporal correlations between the circulation of respiratory viruses use regression methods of Spearman rank and partial regression. Results and Conclusions: The mortality from pneumonia and influenza associated with the 2009 pandemic in the state of São Paulo was slightly higher than in the other years of seasonal influenza, considering the overall mortality, irrespective of age. There were differences in the risk of dying between age groups. Among individuals 5-19 years, the mortality rate associated with the 2009 pandemic was 2.6 higher than that of non-pandemic years. (0.6 deaths /100,000 inhabitants) In the age group 20-59 years, the rate associated with the 2009 pandemic mortality was 5.1 higher than in non-pandemic years. (2.8 deaths /100,000 inhabitants). Mortality rates among children under five years was 0.9 deaths /100,000 inhabitants and in persons over 60 years was 13.1 deaths /100,000 inhabitants, ie were lower than in non- pandemic years . The method of analysis used allowed the differentiation between mortality associated with viral subtypes (A(H3N2), A(H1N1) and B or seasonal A(H1N1) pdm 2009) . It was possible to compare the mortality associated with the 2009 influenza pandemic in Sao Paulo, annual influenza epidemics in different ages and with different subtypes of influenza viruses circulating. That is, the impact of the circulation of influenza A(H1N1) pandemic virus was higher mortality in adults and children, while in adults over 65 years was low . On the other hand, the excess mortality was significant in adults over 65 years ago, in circulating influenza A H3N2. The Serfling model adapted to weekly data validation using data from sentinel surveillance of influenza-like illness (SIVEP - GRIPE) was reliable for detecting peaks of higher viral circulation of influenza and alleged impacts on mortality in different age groups in pandemic period , epidemic and seasonal circulation of influenza viruses . About RSV was possible to identify seasonal patterns of RSV in all administrative regions of Brazil using surveillance data of influenza syndromes (SIVEP -GRIPE). There were differences between the moments of greatest circulation of the virus in some of the five administrative regions of Brazil. Seasonal patterns of hospitalization for known diseases with RSV [ Pneumonia due to respiratory syncytial virus , acute bronchitis due to respiratory syncytial virus , acute bronchiolitis due to respiratory syncytial virus bronchiolitis ( acute , unspecified ) ] were similar to those found by analysis of the movement of data through RSV surveillance of influenza-like syndromes ( SIVEP - GRIPE) . There was a temporal correlation between the circulation of RSV and the rates of hospitalization for respiratory diseases in general (Chapter X of ICD- 10) among children under 5 diseases in the five administrative regions of Brazil . There was a temporal correlation between the rates of hospitalization among children under 5 years for known diseases with RSV [ Pneumonia due to respiratory syncytial virus , acute bronchitis due to respiratory syncytial virus , acute bronchiolitis due to respiratory syncytial virus bronchiolitis ( acute , unspecified ) ] and rates of hospitalization for respiratory diseases in general in this age group in the five administrative regions of Brazil , indicating that this is the main virus associated with hospitalizations of children under 5 years due to respiratory diseases . According to the evidence found in this study , the schemes of prophylaxis against RSV used today need to be reviewed and individualized for each region of the country . Among the actions to be reviewed are the availability of palivizumab , as well as measures to prevent the circulation of RSV in the community
Doutorado
Epidemiologia
Doutor em Saude Coletiva

Most of the epidemiological studies of long term exposure to air pollution showed increased risk of death from cardio-respiratory diseases. However the effect of long-term exposure to air pollution on morbidity is less clear. Additionally, questions as to which stage of life is more important in the effect of air pollution on health in adulthood are still unanswered. This project investigates the relationship between long-term exposure to air pollution and cardio-respiratory morbidity using the National Survey for Health and Development (NSHD) with consideration to lifestyle and socioeconomic factors. A comparison between early life and more recent exposures to air pollution will also be made. Finally, the effect of cumulative and change in air pollution over the life course will be explored. Lung function was measured and self-reported chronic bronchitis (CB) symptoms and ischaemic heart disease (IHD) were collected in 1989, 1999 and 2006/10 for more than 3000 participants. A residential history of the NSHD participants from 1962 onwards was constructed using addresses and/or postcodes and was geocoded and linked to model black smoke (BS) sulphur dioxide (SO2) in 1962, 1971, 1981 and 1991 and nitrogen dioxide (NO2) air pollution in 1991, 2001 and 2010-11. Earlier childhood exposures to air pollutants were assessed using the Douglas and Waller index. Relationships to air pollution were investigated using various statistical models. Contrary to expectations, some results suggested protective effects of air pollution on lung function and symptoms of CB. BS showed positive associations with lung function particularly from 1999 follow-up; 10 µg/m3 of BS in 1971 and 10 µg/m3 in 1991 were associated with 19.2ml (95%CI: 3.5-34.9) and 82.9ml (95%CI: 21.2-144.5) increase in Forced Vital Capacity (FVC) respectively. SO2 showed some positive (protective) associations; 10 µg/m3 of SO2 in 1962 was associated with 3.9 ml (95%CI: 0.1-7.9) increase in Forced Expiratory Volume in 1 second (FEV1) and 5.4 ml (95%CI: 0.2-10.7) increase in Forced Vital Capacity (FVC) in 1989. BS and SO2 both showed positive (protective) associations with lung function decline where 10 µg/m3 of BS in 1981 was associated with 80 ml (95%CI: 16-150) less decline in FVC ; and 10 µg/m3 of SO2 in 1991 was associated with 70 ml (95%CI: 22-120 ) less decline in FVC over the 20 year period. Change and cumulative BS did not show a clear pattern in generalized analyses, however results from stratified analyses suggested positive effects on men that indicate higher BS exposure was associated with better lung function. These protective effects were more consistently observed in SO2 analyses; 10 µg/m3 change (decrease) in SO2 between 1962 and 1991 was associated with 4.3ml (95%CI: 0.4-8.2) higher FEV1 in 1989, 6.1 ml (95%CI: 0.6-11.5) higher FVC in 1989, and 8.4ml (95% CI: 3.0-13.9) higher FVC in 1999. Higher cumulative exposure of 10 µg/m3 of SO2 was associated with 0.5 ml (95% CI: 0.1-0.9) increase in FVC in 1999. Air pollution was not associated with prevalence of CB, results indicated some protective effects. Air pollution was not associated with IHD prevalence; however detrimental effects were suggested. A healthy survivor effect would explain the findings for CB and lung function whereby the most exposed individuals who potentially experience more ill health are under-represented in the study and were differentially lost to follow up. Some evidence was found to suggest greater drop-out in individuals with higher exposure in more deprived areas. However, positive association between decline in air pollution and lung function may be related to the large falls in air pollution levels over the time period of study.

Abstract Despite the common recommendations of the criteria for the diagnosis of asthma there is still a wide variation within different regions in diagnoses, use of medications and hospitalisation rates especially among young children. This thesis elucidates the role of spesified environmental risk factors associated with the development of atopic diseases in childhood. In two prospective follow-up surveys we found that allergies and asthma associate with the consumption of margarines, butter and fish and that the common infection of childhood, RS-virus infection, does not increase asthma morbidity in adolescence. In a randomised set-up we were able to verify that the common childhood infections do not protect from allergies and asthma. In a retrospective survey we found that hospitalisation rates can reflect medication practices in different regions. Our results indicate that consumption of fat in the diet can be one triggering factor for allergies but common childhood infections are merely markers of susceptibility to allergies and asthma rather than the cause of it.

O Homem é parte integrante do sistema Ambiental. O ambiente cria impactos Nele e por sua vez ele também pode provocar impactos no Ambiente. O objetivo da tese foi identificar qual a intensidade e freqüência do impacto que a poluição atmosférica e a variabilidade das variáveis meteorológicas na saúde da população da Área Metropolitana do Porto (Portugal), através de um estudo epidemiológico ecológico. Escolheu-se o período de 2002 a 2005 para estudar um conjunto de cidades que contam com espaços urbanos, suburbanos e industriais mesclados, perto do litoral Atlântico com clima Mediterrânico. Usando como métodos a análise descritiva e multivariada (ACP), de correlação e regressão múltipla (RM), assim como índices de conforto térmico (ID, H, Te e Tev), trabalharam-se dados de admissões hospitalares (4 hospitais públicos) de doenças cardiovasculares (DCV) (401-405, Hipertensão; 410-414, DCV Isquêmica, 426-428, Insuficiência Cardíaca) e respiratórias (490-496, Asma/Bronquite; 500-507, Pneumoconioses), informações meteorológicas do Instituto de Meteorologia de Portugal (Temperatura, Umidade, Precipitação e Pressão) e valores diários e mensais do índice de Oscilação do Atlântico Norte (OAN), da NOAA, assim como, saídas de normais de pressão e médias de velocidade de vento do modelo NOAA e de 10 estações fixas de qualidade do ar pertencentes à Agencia Portuguesa do Ambiente (O3; NO2, NO, CO, SO2, PM10, PM2,5). Identificaram-se alguns períodos de temperaturas elevadas (38°C) durante o verão e inversões térmicas durante o inverno (2004/05), as quais criaram situações de estresse térmico por calor e muito frio (dos 1461 mais de 930 dias -24°C< TEv tmin Urmáx vmáx < 0°C), por um lado, e aumento da poluição, por outro. Esse aumento da poluição contribuiu para se observar maior número de casos por doenças respiratórias por Asma/bronquite (lag 3 dias durante inverno 2004/05 correlação com PM2,5=0,33), doenças Cardíacas Hipertensivas (regressão multivariada para Primavera, para PM10 com Beta=0,80, R2ajustado=0,076), e Insuficiências Cardíacas (regressão para Outono NO2 Beta = 0,42 com R2ajustado= 0,060). Encontrou-se também relação significativa e forte entre a variabilidade da Oscilação do Atlântico Norte (OAN) e de alguns poluentes durante o inverno (ex: correlação PM10=0,71, em 2003; PM2,5= 0,91, em 2005; SO2=0,45, em 2004). Uma importante conclusão, também sugerida por outros autores, é que as mudanças climáticas podem modificar a intensidade e regularidade da OAN, afetando assim a circulação atmosférica o que terá impacto direto na dispersão dos poluentes em pequena escala e conseqüentemente irá influenciar a saúde publica.
Humans are part of environmental system. Environment impacts on Humans and we so can impact on earth ecosystems. The thesis aims identify the intensity and frequency of air pollution and meteorological impact on Porto Metropolitan Area (PMA) public health, although a ecological epidemiological study. The 2002- 2005 period was select to study climatologically Mediterranean seaside cities with typical urban, suburban and industrial mixed spaces. The statistical methods used were: descriptive and multivariate (ACP) analyze, correlation and multiple regression, as well as, discomfort indices (ID, Te, Tev, H). Data set from 3 different institutions was analyzed: admission from 4 public hospitals referent to heart (401-405, Hypertension; 410-414, Ischemic cardiac, 426-428, Heart Insufficiency) and respiratory diseases (490-496, Asthma/Bronchitis; 500-507, Pneumoconioses), meteorological information from Meteorological Institute of Portugal.(Temperature, Humidity, Precipitation, Wind speed, Pressure) and daily and monthly North Atlantic Oscillation index values, from NOAA, as well as, pressure daily normal and wind velocity daily mean NOAA model output and from 10 fixed air quality stations (Environmental Portuguese Agency) the pollutants (O3; NO2, NO, CO, SO2, PM10, PM2,5) time series. Some high temperature (38°C) periods was identified during summertime and thermal inversions in the wintertime (2004 and 2005), which provoked stress for heat and cold (from 1461 days, 930 days the thermal sensation was -24°C< TEv tmin Urmáx vmáx < 0°C), and pollution increase. The air pollution increased the hospital admissions for respiratory diseases special Asthma/bronquitis (lag 3 days during 2004/05 Winter correlation PM2.5= 0.33), Cardiac Hypertension (Spring multivariate regression Beta= 0.80, R2ajusted= 0.076), and Heart insufficiency (Autumn multivariate regression NO2 Beta = 0.42 with R2ajustaded= 0.060). Significant and strong association was found between North Atlantic Oscillation (NAO) and some pollutants during Wintertime (eg.: correlation PM10=0.71, 2003; PM2.5=0.91, 2005; SO2=0.45, 2004). ). It is important to notice that some studies have already suggested that climate change can modify the intensity and regularity of the NAO, affecting the atmospheric general circulation and it could have a direct impact on pollutants dispersion in small scale and on public health.

The study proposed to conduct a descriptive study related to the correlation of infant feeding (EFF or EBF) and occurrence of morbidity diarrhoea and/or respiratory infections, in infants by 14 weeks of age. The study adopted a quantitative epistemological approach in seeking to describe the correlation of infant feeding and the occurrence of diarrhoea or respiratory infections by 14 weeks of age. The researcher embarked on a descriptive survey design and employed the questionnaire method during the data collection process. The Amathole District of the Eastern Cape Province was selected due to the accessibility of the targeted population. The unique demographic profile and rural-urban setting allows for a potentially rich data source whilst simultaneously reducing the potential incidence of bias in the data collection. The study sample was drawn from routine immunization and growth monitoring clinics in the Amathole district.

Orientador: Roberto Wagner Lourenço
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Foi realizado um estudo ecológico entre os anos de 2003 a 2010 com dados mensais sobre o número de mortalidade e morbidade por doenças respiratórias, áreas destinadas a monocultura de cana de açúcar e a distribuição espacial dos focos de queimadas no município de Botucatu, SP. Os dados foram extraídos, respectivamente, das bases de dados DATASUS e do Instituto de Pesquisas Espaciais (INPE). A associação dos dados foi analisada considerando a determinação de cenários elaborados através da utilização de ferramentas de Sistema de Informação Geográfica - SIG e seus indicadores da transformação e ocupação do território do município estudado. Esse estudo teve como objetivo demonstrar a relação da mortalidade e morbidade por fatores respiratórios no município de Botucatu, a dispersão espacial dos registros dos focos de queimada e área plantada para monocultura de cana de açúcar, assim como analisar a correlação entre as variáveis de interesse. As análises sugerem uma relação entre as emissões de poluentes derivados da queima de cana de açúcar com os níveis de mortalidade e morbidade. Esse estudo possibilitou observar, na mesma perspectiva, dados sobre a exposição humana aos compostos produzidos em queimadas e os problemas de saúde respiratória que impactaram a população
Abstract: An ecological study conducted between the years 2003 to 2010 with monthly data on the number of mortality and morbidity from respiratory diseases, areas for monoculture of sugar cane and spatial distribution of outbreaks of fires in Botucatu, São Paulo. Data were extracted, respectively, of databases DATASUS AND THE Institute for Space Research (INPE). The association of the data was analyzed for determination of scenarios developed through the use of tools of Geographic Information System - GIS and these indicators of transformation and occupation of the territory of the municipality. This study aimed to demonstrate the relationship of mortality and morbidity due to respiratory factors in Botucatu, the spatial dispersion of records of outbreaks of fire and the area planted to sugar cane monoculture, as well as to analyze the correlation between variables of interest. The analyzes suggest a relationship between emissions of pollutants derived from burning of sugar cane with the levels of mortality and morbidity. This study allowed to observe in the same perspective, data on human exposure to the chemicals produced in fires and respiratory health problems that impacted the population
Mestrado
Epidemiologia
Mestre em Saude Coletiva

Apesar da cidade do Rio de Janeiro ser uma das mais importantes metrópoles brasileiras são muito pouco conhecidos os efeitos da exposição aos poluentes atmosféricos na saúde da população carioca. Este trabalho foi idealizado para suprir uma parte desta carência. Os poluentes investigados foram PM10, SO2, NO2, CO e O3 e os desfechos envolveram os atendimentos pediátricos de emergência por sintomas respiratórios em três unidades públicas de saúde de Jacarepaguá, entre abril de 2002 e março de 2003. As variáveis de confusão foram a tendência temporal, sazonalidade, temperatura, umidade relativa do ar, precipitação de chuva e infecções respiratórias. Também foram ajustados os efeitos do calendário, isto é, determinados dias do ano que apresentaram comportamentos anormais como feriados e finais de semana. Houve inúmeras falhas no monitoramento de todos os poluentes e devido ao reduzido volume de dados, optou-se por não incluir o SO2 nas análises. Uma vez que os determinantes e as conseqüências clínicas das exposições aos poluentes atmosféricos são bastante distintos nas vias aérias superiores e nas vias aéreas inferiores, um dos estudos verificou a associação dos poluentes do ar com transtornos nestes dois segmentos. Embora de pequena magnitude, somente o O3 apresentou resultado positivo e estatisticamente significativo, tanto com todos os atendimentos de emergência por queixas respiratórias como com os atendimentos motivados por sintomas nas vias aéreas inferiores. O efeito foi no mesmo dia da exposição (lag 0). No outro estudo, investigou-se a associação dos poluentes do ar com os atendimentos de emergência por sintomas de obstrução brônquica. Neste caso, as crianças foram categorizadads em três faixas etárias. Somente as crianças com idades menores que 2 anos tiveram um resultado positivo e estatisticamente significativo, de expressiva magnitude com PM10. Semelhante efeito foi visto com o O3, embora com significado estatístico limítrofe (p<0,06). Também neste estudo o efeito ocorreu no mesmo dia da exposição. Apesar das falhas no monitoramento, nos dois estudos, os parâmetros da poluição ambiental estiveram associados ao aumento do número de atendimentos pediátricos de emergência por motivos respiratórios em Jacarepaguá. Durante o período de estudos, os níveis de todos os poluentes monitorados permaneceram abaixo dos limites recomendados.
Rio de Janeiro is one of the most important Brazilian cities. Nevertheless, health effects of air pollutants on its population are scarcely known. This study was conduct to cover part of what is lacking on the subject. Air pollutants investigated were PM10, SO2, NO2, CO e O3 and the outcomes were emergency pediatric consultations due to respiratory complaints on 3 public health units, in Jacarepaguá, between April, 2002 and March 2003. Confounding variables were time trends, seasonality, temperature, humidity, rain volume and respiratory infections. Calendar effects (holidays and weekends) were also adjusted, There were several failures on pollutants monitoring, mainly SO2, which was not taken into consideration to this study, due to low amount of data. As determinants and clinical consequences of air pollutants are very different on upper or lower respiratory system, one of the articles estimated the association of air pollutants to ailments on both systems. Only O3 showed a positive and statistically significant result (although small), both related to emergency consultations due to respiratory complaints as to emergency consultations due to lower respiratory symptoms. Effect and exposure occurred on the same day. (lag0). On the second article, association between air pollutants and emergency consultations related to bronchic obstruction was studied. On this case, children were categorized in three groups, according to age. Only children under 2 years showed a strong, positive and statistically significant result with PM10. A similar effect was observed with O3, although with a boundary statistically significant (p<0,06). On this study, effect and exposure occurred on the same day, as well. Despite failures on monitoring, on both studies, environmental pollution parameters were related to an increased number of emergency pediatric consultations due to respiratory complaints in Jacarepaguá. During all period observed, monitored pollutants levels were under recommended limits.

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Para avaliar fatores de risco para hospitalizações por infecções respiratórias agudas (IRA), desenvolveu-se um estudo caso-controle com crianças de 4 a 24 meses de idade hospitalizadas devido a estas infecções, de julho de 2008 a julho de 2011, em instituições públicas/SUS de seis municípios brasileiros. Um grupo controle formado por crianças da mesma faixa etária hospitalizadas por doença não infecciosa e outro constituído por crianças que desde o nascimento tiveram, no máximo, apenas uma hospitalização por doenças respiratórias. Banco de Dados de um estudo sobre efetividade da vacina contra rotavírus, IBGE e Ministério da Saúde foram as fontes de dados. Variáveis individuais (relativas à mãe e à criança) e contextuais foram os fatores de risco examinados. As análises foram realizadas mediante Regressão Logística, assumindo p<0,05. Baixo peso ao nascer (OR=2,0), número total de internações desde o nascimento (OR=1,3), número de internações por doenças do aparelho respiratório (OR=3,2) e uso de cigarro na gestação (OR=1,5) mostraram-se associadas com o desfecho, na análise bivariada. Na análise estratificada, os grupos de municípios apresentaram-se como modificador de efeito para peso ao nascer, número de internações e fumo na gestação. A análise multinível indicou correlação linear entre as variáveis, as variáveis contextuais Índice de Gini<0,46 e temperatura média anual < 24 graus Celsius, mostraram-se associadas ao desfecho. Esses achados revelam a necessidade de investimentos sociais, tais como redução da desigualdade de renda e melhoria da qualidade da assistência prestada à gestante e à criança de modo a contribuir para reduzir as internações por IRA em crianças.
Salvador

Introdução: As disfunções respiratórias agudas por exposição à poluição atmosférica afetam a principalmente crianças e idosos. Estes grupos são mais vulneráveis, apresentando quadros de morbidade e mortalidade em função dos efeitos dos poluentes sobre a função respiratória. A qualidade do ar que respiramos tem sido de grande interesse científico, para que se possa minimizar os impactos da poluição sobre a saúde da população. Atualmente, sabe-se que os poluentes atmosféricos estão associados a uma grande variedade de sintomas, disfunções e doenças agudas e crônicas. Objetivo: O objetivo deste estudo foi verificar a associação entre poluição atmosférica e alterações da função pulmonar em crianças do ensino fundamental nas cidades Cubatão e Atibaia. Método: O método aplicado foi subdividido em fases. Inicialmente foi realizada mensuração de PTS, MP10 e O3 na cidade de Atibaia, para caracterização da concentração destes poluentes na região central do município e comparação com as concentrações da estação da CETESB Cubatão/Centro. Na seqüência foram aplicados questionários de sintomas respiratórios em ambos os municípios, em estudantes do ensino fundamental. Por ultimo foram realizados os testes espirométricos para verificar a função respiratória dos participantes. Resultados: Os resultados das medidas de concentração de poluentes em Atibaia indicam uma boa qualidade do ar. A média mensurada respectivamente foram de 36,25 µg/m para PTS, 30,04 µg/m para MP10 e de O 474 µg/m demonstrando que a qualidade do ar é Boa. As concentrações médias encontradas em Atibaia foram comparadas com àquelas observadas em Cubatão no mesmo período. As concentrações em Cubatão mostraram-se mais elevadas. Os resultados do questionário sócio clínico e de sintomas respiratórios mostraram após análise estatística, que ser portador de doença respiratória associada com causa pré-existente foi mais comum em Atibaia. Os sintomas respiratórios das vias aéreas se manifestaram de forma semelhante nas duas cidades. Na espirometria foi evidenciado o distúrbio ventilatório restritivo com significância em Cubatão (p<0,05). Este resultado teve significância ainda maior quanto ao decréscimo da função respiratória ao se constatar que a presença da alteração do teste de espirometria em crianças não portadoras de doenças respiratórias foi maior em Cubatão, na análise estatística obteve-se OR = 8,25 e p=0,007. Conclusão: Conclui-se que a exposição a poluentes atmosféricos, principalmente O3 e PM10 causa disfunção respiratória e pode ser responsável pela morbidade de crianças com idade de 6 a 12 anos na cidade de Cubatão, e que morar nesta cidade aumenta o risco de desenvolver doenças respiratórias
Introduction : Acute respiratory disorders from exposure to air pollution mainly affects children and elderlies. These groups are most vulnerable, showing pictures of morbidity and mortality due to the effects of pollutants on respiratory function. The quality of air we breathe is of great scientific interest, so you can minimize the impacts of pollution on health. Currently, it is known that air pollutants are associated with a variety of symptoms, disorders and acute and chronic diseases. Objective: The objective of this study was to assess the association between air pollution and lung function changes in elementary school children in the cities and Atibaia Cubatão. Method: The method used was divided into phases. Measurements of PTS, PM10 and O3 in the city of Atibaia were performed, to characterize the concentration of pollutants in the central city and compared to the concentrations of CETESB Cubatão station / center. Questionnaires were administered in the sequence of respiratory symptoms in both towns, with all participants, elementary school students. Finally spirometric tests were performed to verify the participants\' respiratory function. Results: The results of the measures of concentration of pollutants in Atibaia indicate good air quality, respectively the average measured was 36.25 mg/m3 for TSP, PM10 30.04 µg/m3 to 474 µg/m3 O3 showed that the air quality is good. The average concentrations found in Atibaia were compared with those observed in Cubatão the same period. Concentrations in Cubatão were more elevated. The results of clinical and social questionnaire of respiratory symptoms after statistical analysis showed that being a carrier of respiratory disease associated with pre-existing cause was more common in Atibaia. Symptoms of respiratory airways expressed similarly in both cities. Spirometry was evidenced in restrictive ventilatory disorder with significance in Cubatão (p <0.05), this result has even greater significance as the decrease in lung function in children not suffering from diseases breathing was higher in Cubatão in the statistical analysis we obtained OR = 8.25 and p = 0.007. Conclusion: Exposure to air pollutants, especially PM10 and O3 cause impairment of respiratory function and may be responsible for morbidity of children aged 6 to 12 years in the city of Cubatao, living in this city increases the risk of developing respiratory diseases

Introdução: No Brasil, a poluição do ar tem se mostrado como problema de saúde pública nesses 30 anos e assim existem áreas onde encontramos redes de monitoramento da qualidade do ar. Muito se sabe sobre o efeito dos poluentes atmosféricos na morbidade e mortalidade por doenças respiratórias e cardiovasculares em crianças e idosos. Estudos recentes de vários autores sugerem que a visibilidade seja utilizada como indicador de poluição. Objetivo: Desenvolver indicador da concentração de MP10, a partir de variáveis meteorológicas, e aplicar em estudos de epidemiologia, verificando os efeitos das partículas inaláveis na saúde, em áreas desprovidas de sistemas de monitoramento de poluição do ar. Método: Este é um estudo ecológico de séries temporais. Foram obtidas. Informações sobre dados meteorológicos (temperatura, umidade relativa, visibilidade, temperatura de ponto de orvalho) junto a Companhia de Infra-Estrutura Aero-portuária (INFRAERO) para as cidades de São Paulo, Campinas, Ribeirão Preto, Bauru, Presidente Prudente e Curitiba. Dados diários de MP10 foram obtidos junto a Companhia de Saneamento e Técnologia Ambiental do Estado de São Paulo (CETESB). O número diário de internações hospitalares por doenças respiratórias (CID 10ª: 519-620, CID 10ª: J00 a J99), em crianças até 5 anos e idosos com 65 anos ou mais, e internações hospitalares por doenças cardiovasculares (CID 10ª: 329-429, CID 10ª: I00 a I99) em idosos com 65 anos ou mais, fornecidos pelo Sistema Único de Saúde (DATASUS). Período de Estudo de Janeiro de 2009 a Dezembro de 2011. Foi construído indicador de MP10 a partir de modelo de regressão. Neste modelo o MP10 foi estimado a partir variáveis meteorológicas. A seguir utilizamos equação polinomial para estimar os efeitos na saúde do MP10 inalado, comparando, MP10 Medidos e o Indicador de MP10 Estimados em cidades brasileiras, utilizando como variável dependente, o número diário de internações hospitalares por doenças respiratórias e cardiovasculares em crianças e idosos. Os resultados foram expressos por aumento percentual do numero de internações e respectivos intervalos de confiança. Resultados: (1) Correlação de Pearson entre MP10 Medidos pela CETESB e o Indicador de MP10 Estimado para São Paulo (r²=0,56); Campinas (r=0,57); Ribeirão Preto (r=0,68); Bauru (r=0,73); Presidente Prudente (r=0,71); em Curitiba, não houve correlação, por falta de MP10 Medido para o período de estudo. Para todas as cidades: p<=0,01. (2) Internações por doenças respiratórias em crianças: Em São Paulo; observam-se efeitos agudos no dia da internação (Dia 0), prolongando até o primeiro (1º) dia após a exposição para o MP10 Medido pela CETESB e até o quarto (4º) dia após a exposição para o MP10 Estimado. Para 10,0 (dez) ?g/m3 de aumento no MP10 Medido observa-se aumento nas internações de 2,98 % (IC 95%: 1,22-4,78), e para o MP10 Estimado, de 1,67 % (IC 95%: 0,25-3,10). Em Curitiba observam-se efeitos agudos no dia da internação (Dia 0), prolongando até o terceiro (3º) dia após a exposição para o MP10 Estimado. Para 10,0 (dez) ?g/m3 de aumento no MP10 Estimado observa-se aumento nas internações de 2,27 % (IC 95%: 0,89-3,64). (3) Internações por doenças respiratórias em idosos: Em São Paulo; observam-se efeitos agudos no dia da internação (Dia 0), prolongando até o primeiro (1º) dia após a exposição para o MP10 Medido pela CETESB e até o terceiro (3º) dia após a exposição para o MP10 Estimado. Para 10,0 (dez) ?g/m3 de aumento no MP10 Medido, observa-se aumento nas internações de 1,00 % (IC 95%: 0,19-1,81), e para o MP10 Estimado, de 2,45 % (IC 95%: 1,13-2,45). Em Curitiba observam-se efeitos agudos no dia da internação (Dia 0), prolongando até o terceiro (3º) dia após a exposição para o MP10 Estimado. Para 10,0 (dez) ug/m3 de aumento no MP10 Estimado observa-se aumento nas internações de 2,20 % (IC 95%: 1,38-3,03). (4) Internações por doenças cardiovasculares em idosos: Em São Paulo; observam-se efeitos agudos no dia da internação (Dia 0), prolongando até o primeiro (1º) dia após a exposição para o MP10 Medido pela CETESB e até primeiro (1º) dia após a exposição para o MP10 Estimado. Para 10,0 (dez) ug/m3 de aumento no MP10 Medido, observa-se aumento nas internações de 1,63 % (IC 95%: 0,37-2,99), e para o MP10 Estimado, de 1,68 % (IC 95%: 0,65-2,73). Em Curitiba observam-se efeitos agudos no dia da internação (Dia 0), prolongando até o primeiro (1º) dia após a exposição para o MP10 Estimado. Para 10,0 (dez) ug/m3 de aumento no MP10 Estimado observa-se aumento nas internações de 2,13 % (IC 95%: 0,98-3,29). As estimativas dos efeitos na saúde para São Paulo foram semelhantes entre o MP10 Medido e MP10 Estimado, validando assim o Indicador de MP10 Estimado para a Cidade de São Paulo. Nas estimativas dos efeitos, utilizando o MP10 Estimado em Curitiba; e de modo menos semelhante em Campinas e Ribeirão Preto, porém com características similares as de São Paulo quanto á estrutura de defasagem. Em Baurú e Presidente Prudente as estimativas dos efeitos apresentaram padrão distinto das demais cidades na defasagem, talvez devido ao reduzido numero de internações hospitalares por doenças respiratórias e cardiovasculares. Conclusão: Este Modelo Indicador de MP10 Estimado para mensurar os efeitos na saúde da população se mostrou uma alternativa confiável para cidades desprovidas de monitoramento da qualidade do ar
Introduction: In Brazil, air pollution has been shown as a public health problem in these 30 years and so there are areas where we network monitoring air quality. Much is known about the effect of air pollution on morbidity and mortality from respiratory and cardiovascular diseases in children and the elderly. Recent studies by several authors suggest that the visibility is used as indicator of pollution. Objective: To develop indicator of the concentration of PM10 from meteorological variables, and apply epidemiology studies verifying the effects of inhalable particles on health, in areas devoid of monitoring systems in the air pollution. Methods: This is an ecological study of time series. Meteorological data were obtained (temperature, relative humidity, visibility, dew point temperature) from the \"Companhia de Infra-estrutura Aero-portuária\" (INFRAERO) to the cities of São Paulo, Campinas, Ribeirão Preto, Bauru, Presidente Prudente and Curitiba. Daily data of PM10 were obtained from the Company of Environmental Technology and Sanitation, State of São Paulo (CETESB). The daily number of hospital admissions for respiratory diseases (ICD 10th: 519-620, ICD 10th: J00 to J99), in children under 5 years age and elderly of 65 years age or more, and hospital admissions for cardiovascular diseases (ICD 10th: 329- 429, ICD 10th: I00 to I99) in the elderly of 65 years age or more, provided by the Unified Health System (DATASUS). Period of study: January- 2009 to December-2011. It was built indicator of PM10 from the regression model. In this model the PM10 was estimated from Meteorological Variables. Then we use Polynomial Equation to estimate the effects of PM10 Measured and PM10 Estimated Indicators in the brazilians cities, using as a dependent variable the daily number of hospital admissions for respiratory and cardiovasculares diseases in children and elderly. The results were expressed as percentage increase in number of hospitalizations and confidence intervals. Results: (1) Pearson correlation between PM10 Measured by CETESB and the Indicators of PM10 Estimated to São Paulo (r = 0.56); Campinas (r = 0.57); Ribeirão Preto (r = 0.68); Bauru (r = 0.73); Presidente Prudente (r² = 0.71); in Curitiba, there was no correlation for lack of PM10 Measured for the same time. For all cities: p<=0,01. (2) Hospitalization for Respiratory diseases in children: In São Paulo; observed the acute effects on admission day (Day 0), extending until the first (1st) day after exposure to the PM10 Measured by CETESB and until the fourth (4th) day after exposure to the PM10 Estimated. To 10.0 (ten) ug/m³ increase in PM10 Measured, there is increase in admissions of 2.98% (95% CI: 1.22 to 4.78), and to the PM10 Estimated of 1.67% (95% CI: 0.25 to 3.10). In Curitiba are observed the acute effects on admission day (Day 0), extending until the third (3rd) day after exposure for the PM10 Estimated. To 10.0 (ten) ug/m³ increase to the PM10 Estimated observed increase in admissions of 2.27% (95% CI: 0.89 to 3.64). (3) Hospitalizations for Respiratory diseases in elderly: In São Paulo; observed the acute effects on admission day (Day 0), extending until the first (1st) day after exposure to the PM10 Measured by CETESB and until the third (3rd) day after exposure to the PM10 Estimated. To 10.0 (ten) ug/m³ increase in PM10 Measured, there is increase in admissions of 1.00% (95% CI: 0,19-1,81), and to the PM10 Estimated 2.45% (95% CI: 1.13 to 2.45). In Curitiba are observed the acute effects on admission day (Day 0), extending until the third (3rd) day after exposure to the PM10 Estimated. To 10.0 (ten) ug/m³ increase in PM10 Estimated observed increase in admissions of 2.20% (95% CI: 1.38 to 3.03). (4) Hospitalization for Cardiovascular disease in elderly: In São Paulo; observed the acute effects on admission day (Day 0), extending until the first (1st) day after exposure to the PM10 Measured by CETESB and until the first (1st) day after exposure to the PM10 Estimated. To 10.0 (ten) ug/m³ increase in PM10 Measured, there is increase in admissions of 1.63% (95% CI: 0.37 to 2.99), and to the PM10 Estimated of 1.68% (95 %: 0.65 to 2.73). In Curitiba are observed the acute effects on admission day (Day 0), extending until the first (1st) day after exposure for the PM10 Estimated. To 10.0 (ten) ug/m³ increase in PM10 Estimated observed increase in admissions of 2.13% (95% CI: 0.98 to 3.29). Estimating of health effects to São Paulo were similar between the PM10 Measured and the PM10 Estimated, thus validating the PM10 Estimated Indicator to the City of São Paulo. Estimates of the effect using the model PM10 Estimated to Curitiba and less similar in compare with Campinas and Ribeirão Preto showed similar characteristics in São Paulo for lag structure. In Bauru and Presidente Prudente estimating of the effects showed distinct pattern of other cities, perhaps due to the reduced number of hospital admissions for respiratory and cardiovascular.diseases. Conclusion: This Indicator PM10 Estimated to measure the effects on health of the population, proved to be a reliable alternative to cities devoid of monitoring air quality

Desde o início do século passado, estudos na literatura médica documentaram uma significativa associação entre poluição atmosférica decorrente da emissão de combustíveis fósseis e morbimortalidade na raça humana, inclusive para níveis de poluentes no ar considerado como seguro para a saúde da população exposta. Na década de 70, durante a crise do petróleo o governo brasileiro implementou um programa chamado Proálcool com o objetivo de produzir um combustível alternativo, renovável, e não poluente: o etanol, derivado da cana-de-açúcar. Esse programa culminou com uma grande produção de veículos movidos a álcool a partir da década de 80, e um grande incremento da cultura da cana-de-açúcar na região central do Estado de São Paulo. Com a crescente utilização do álcool como combustível em veículos automotores houve uma melhora na qualidade do ar nos grandes centros urbanos. Existe, porém, o contraponto: a cana-de-açúcar é uma cultura agrícola singular, uma vez que, por razões de produtividade e de segurança, a colheita é realizada após a queima dos canaviais, o que gera uma grande quantidade de elemento particulado negro denominado "fuligem da cana". Esse material particulado modifica as características do meio ambiente nas regiões onde a cana-de-açúcar é cultivada, colhida e industrializada. A queima da biomassa é a maior fonte de emissão de material particulado e de gases tóxicos no planeta, e não havia na literatura médica qualquer trabalho, que relacionasse a poluição atmosférica em conseqüência da queima desse tipo especifico de biomassa, com a saúde humana. Esse estudo epidemiológico de séries temporais avalia a associação entre o material particulado coletado durante a queima de plantações de cana-de-açúcar e um indicador de morbidade respiratória em Araraquara (SP). Entre 26 de maio e 31 de agosto de 1995, o número diário de pacientes que necessitaram inalações em um dos principais hospitais da cidade foi quantificado, e utilizado para estimar a morbidade respiratória. Para estimar o nível da poluição do ar foi quantificado diariamente o peso do sedimento do material particulado proveniente da fuligem da cana-de-açúcar, obtido por sedimentação simples, em dois pontos da cidade, um localizado no centro e o segundo na zona rural. A associação entre o peso do sedimento e o número de pacientes que necessitaram de terapia inalatória, foi avaliada pelo modelo aditivo generalizado da regressão de Poisson com controle para sazonalidade, temperatura e dias da semana. Encontrou-se uma associação positiva significante e dose dependente entre o número de terapia inalatória e o peso do sedimento. Um aumento de 10 mg no peso do sedimento está associado a um risco relativo de terapêutica inalatória de 1,09 (1-1,19). Nos dias mais poluídos o risco relativo de terapêutica inalatória é de 1,20 (1,03-1,39). Esses resultados indicam que a queima das plantações da cana-de-açúcar pode causar efeitos deletérios à saúde da população exposta.
This times series epidemiological study was designed to evaluate the association between particulate matter collected during sugar cane plantation burning and an indicator of morbidity respiratory in Araraquara, São Paulo State, Brazil. From May 26th to August 31st, 1995, the daily number of patients that received inhalation therapy in one of the main hospitals of the city was recorded and used as a morbidity respiratory estimation. In order to estimate air pollution levels the daily sediment weight from sugar cane particulate matter was measured after collected by simple sedimentation process, in two strategic points of the city: one in a central area and the other in a peripheral area. The association between the sediment weight and the number of patients who received inhalation therapy was evaluated by means of generalized additive Poisson regression models controlled for seasonality, temperature and days of the week. A positive significant and dose-dependent relationship was found between the number of inhalation therapy and the sediment weight. The relative risk of inhalation therapy associated with an increase of 10 mg in the sediment weight was 1.09 (1 - 1.19), and the relative risk of an inhalation therapy was 1.20 (1.03 -1.39) in the most polluted days. These results indicate that sugar cane plantations burning may cause deleterious health effects in the exposed population.

In der vorliegenden Arbeit wurde anhand der im Rahmen des Vermont-Oxford-Neonatal-Networks erhobenen Daten an der Berliner Klinik für Neonatologie der Charité Campus Mitte und der Abteilung für neonatologische Intensivmedizin der Universitätskinderklinik in Innsbruck ein Benchmarking-Projekt für die Jahre 1997 bis 2001 durchgeführt. Nach der Analyse des Outcomes wurde eine Analyse der externen Evidenz anhand von Literatursuche in PubMed und der Cochrane Datenbank für systematische Reviews durchgeführt. Danach wurde ein Fragebogen entworfen, der gezielt Handlungsstrategien und -richtlinien bezüglich der relevanten Outcome-Parameter erfragt. Für das Benchmarking-Projekt wurden das Atemnotsyndrom, die nekrotisierende Enterokolitis und die bakteriellen Infektionen ausgewählt. Die Analyse der Handlungsstrategien durch den Fragebogen zeigte, dass in den drei Bereichen respiratorische Interventionen, Nahrung und Ernährung sowie im Infektionsmanagement Unterschiede vorlagen. In der Diskussion zeigte sich, dass in vielen Bereichen noch Bedarf nach guter externer Evidenz und weiterer Forschung besteht.
This dissertation presents the results of a 1997 - 2001 benchmark project in co-operation with the "Berliner Klinik für Neonatologie der Charité Campus Mitte" and the "Abteilung für neonatologische Intensivmedizin der Universitätskinderklinik" in Innsbruck. The study is based on the Vermont-Oxford-Neonatal-Network''s data. After analysing the results, further evidence was analysed by way of literary research in PubMed and the Cochrane Database of Systematic Reviews. Afterwards, a questionnaire was created, lining out the clinical guidelines of the relevant outcome parameters. The respiratory distress syndrom, the necrotising enterocolitis and the bacterial infections were selected for the benchmark. The internal guidelines'' analysis showed that there were differences between the two clinics'' results in respiratory interventions, feeding and the management of infections. The discussion made clear that research based on further evidence is necessary in many fields.

Abstract Advances in perinatal treatment practices—such as antenatal corticosteroids, surfactant replacement therapy, and gentler ventilator modalities—have improved the survival of infants born preterm. Consequently, later morbidity and pulmonary outcome for survivors has attracted increasing interest. The incidence of bronchopulmonary dysplasia (BPD) remains high and the condition is manifesting in infants born at earlier gestational weeks than before. This so-called new BPD results from the arrest of alveolar development and is associated with less structural airway injury and interstitial fibrosis than previously. Long-term follow-up data on lung function, lung structure and respiratory morbidity of children treated with modern methods is insufficiently known. We performed a follow-up study of 88 preterm-born children and 88 matched term-born controls at school age. Children born preterm had lower values in lung function measurements than term-born peers. Reductions were most marked in those with a history of BPD. In accordance with the foetal origins hypothesis, children with intrauterine growth restriction (IUGR) had lower lung function than gestation-controls. This indicates that poor growth in utero is an additional burden on pulmonary health. Both IUGR and BPD predicted lower lung function independently. High-resolution computed tomography of the lung was obtained from 21 children with a history of BPD. Structural abnormalities were common, children with severe BPD being most affected. Preterm children were hospitalised more often than controls, mainly because of wheezing disorders. However, BPD did not influence the hospitalisations. According to the meta-analysis of the contemporary data available, the respiratory outcome of children who had only mild BPD may have improved in comparison to old follow-up data, whereas the results for those without BPD or moderate-to-severe BPD have remained remarkably stable despite progress in treatment practices during early life. In conclusion, preterm children had subtle impairments in lung function at school age. Although they were fairly asymptomatic, concern about the possible long-term effects of preterm birth on pulmonary health is justified. It has been proposed that BPD may predispose individuals to an early COPD-like disorder. Preterm children must be protected from any additional burden on respiratory health and should be monitored appropriately for early detection of lung disease
Tiivistelmä Keskosten tehohoito on kehittynyt viime vuosikymmeninä merkittävästi, ja yhä epäkypsempänä syntyvät keskoset selviävät hengissä syntymän jälkeen. Keskosten pitkäaikainen keuhkosairaus, bronkopulmonaalinen dysplasia (BPD), on perinteisesti johtunut hengityskonehoidon ja happikaasun aiheuttamasta keuhkovauriosta ja johtanut keuhkokudoksen arpeutumiseen. Aiempaa ennenaikaisemmilla keskosilla esiintyy kuitenkin nykyään niin sanottua uutta BPD:tä, jonka ajatellaan johtuvan enemmän keuhkorakkuloiden kehityshäiriöstä kuin hoitojen aiheuttamasta keuhkovauriosta. Selvitimme, miten nykyaikaisilla menetelmillä hoidettujen keskosten keuhkojen rakenne ja toiminta kehittyvät kouluikään mennessä. Seurantatutkimukseemme osallistui 88 ennenaikaisena syntynyttä, kouluikään ehtinyttä lasta ja 88 täysiaikaisena syntynyttä, kaltaistettua verrokkia. Keskosena syntyneiden lasten keuhkofunktio oli kouluiässä huonompi kuin täysiaikaisena syntyneiden verrokkien. Alhaisin keuhkofunktio oli niillä keskosena syntyneillä lapsilla, jotka olivat sairastaneet vastasyntyneenä BPD:n. Myös kohdunsisäiseen kasvuhäiriöön (intrauterine growth restriction, IUGR) liittyi alentunut keuhkofunktio. BPD ja IUGR ennustivat alentunutta keuhkofunktiota toisistaan riippumatta. Tutkimuksessa tehtiin myös keuhkojen ohutleiketietokonekuvaus 21 keskoselle, jotka olivat sairastaneet BPD:n. Lähes kaikilla havaittiin poikkeavia löydöksiä – eniten niillä, joilla oli ollut vastasyntyneenä BPD:n vaikea tautimuoto. Keskosina syntyneet joutuivat kahden ensimmäisen vuoden aikana verrokkeja useammin sairaalahoitoon. Yleisimpiä syitä olivat hengityksen vinkumista aiheuttavat taudit kuten ilmatiehyttulehdus, ahtauttava keuhkoputkitulehdus tai akuutti astmakohtaus. Vastasyntyneenä sairastettu BPD ei kuitenkaan lisännyt todennäköisyyttä joutua sairaalahoitoon. Tutkimuksessa tehtiin myös meta-analyysi nykyaikaisilla menetelmillä hoidettujen keskosten keuhkofunktiosta: lievää BPD:tä sairastavien tulokset näyttävät parantuneen, kun taas keskivaikeaa tai vaikeaa tautimuotoa sairastavien ja ilman BPD:tä selvinneiden keuhkofunktio ei ole muuttunut uusien hoitojen myötä. Yhteenvetona voidaan todeta, että keskosten keuhkojen toimintakyky on jonkin verran alentunut täysiaikaisiin verrattuna. Lievästi alentunut keuhkofunktio ei kuitenkaan yleensä aiheuttanut koululaisille oireita. Keskosena syntyneiden lasten hengityselinten toimintaa on syytä seurata, sillä niin sanotun uuden BPD:n pitkäaikaisesta ennusteesta ei ole vielä tietoa

O etanol de cana-de-açúcar se consolida como combustível renovável, o que promove nova expansão da cultura da cana-de-açúcar no Brasil e, principalmente, no Estado de São Paulo. Como a queima prévia controlada da palha de cana-de-açúcar ainda é considerada uma prática agrícola necessária para a viabilização econômica da colheita, em mais de 70% dos municípios do Estado de São Paulo a população é obrigada a conviver com essa poluição. Para estudar a distribuição desse fator de risco e sua relação com a saúde, realizei um estudo epidemiológico ecológico nos 645 municípios de São Paulo. Usei um modelo Bayesiano de regressão multivariada relacionando os efeitos na saúde com a exposição à queima prévia da palha de cana-de-açúcar, sendo controlados os efeitos das variações socioeconômicas (saneamento, educação e renda) e climáticas (temperatura máxima, umidade mínima e precipitação), através da inserção das mesmas no modelo. O efeito sobre a saúde foi medido por meio da Razão de Mortalidade e Morbidade Padronizada (RMP) dos desfechos: óbitos por doenças respiratórias nas faixas etárias acima de 65 anos e internações por doença respiratória, nas faixas etárias menores de 5 anos e acima de 65 anos de cada um dos municípios. Usei como medida de exposição à queima prévia dados obtidos no INPE: percentual da área de cana colhida com queima (PMQ), níveis médios de Aerossol e Focos de queima, testadas separadamente. Para resolver a autocorrelação entre os dados, estes foram considerados conforme sua disposição espacial, através da construção de uma matriz de vizinhança dos 645 municípios do Estado. Utilizei o método de simulação de Monte Carlo via Cadeias de Markov (MCMC) para \'suavizar\' as estimativas da RMP. A análise demonstrou que existe associação entre a queima prévia da palha de cana-de-açúcar e a ocorrência de doenças respiratórias, porque o aumento nos focos de queima (Focos) esteve associado significativamente com o aumento das internações por doenças respiratórias, na faixa etária de menores de cinco anos. Os resultados mostraram que a queima prévia da palha da cana-de-açúcar oferece efetivamente risco à saúde da população e, adicionados aos mapas coropléticos gerados, oferecem subsídios para a vigilância epidemiológica e contribuem para o estabelecimento de políticas públicas para controle da poluição do ar, que contemplem além dos grandes centros urbanos, os pequenos municípios. A eliminação desse fator de risco deve fazer parte das medidas primordiais de prevenção à saúde a serem adotadas no Estado
Ethanol from sugarcane is consolidated as a renewable fuel which promotes further expansion of the culture of sugarcane in Brazil and especially in the State of São Paulo. As the controlled pre-harvest burning of sugarcane straw is still considered an agricultural practice necessary for the economic viability of this crop in more than 70% of municipalities in the State of São Paulo the population is forced to live with this pollution. To study the distribution of this risk factor and its relationship with the health of the population, I conducted an ecological study in the 645 municipalities of São Paulo. I used a Bayesian multivariate regression model relating the health effects and the exposure to previous straw burning of sugarcane, controlling the effects of socioeconomic factors (sanitation, education and income) and climate (maximum temperature, minimum humidity and precipitation) by the insertion of these variables in the model. The effect on health was measured by Standardized Mortality and Morbidity Ratio (SMR) of the outcomes: deaths from respiratory diseases in the age group above 65 years old and admissions for respiratory disease in children less than 5 years old and above 65 years old of each of the municipalities. I used as a measure of exposure to the pre-harvest burning data obtained at INPE: percent of sugarcane area harvest with burning (PMQ), levels of Aerosol and Spotlights of burning, tested separately. To solve the autocorrelation in the data these were considered as their spatial arrangement, by building a neighborhood matrix of the 645 municipalities in the state. I used the Markov Chain-Monte Carlo simulation method (MCMC) to \'soften\' the estimates of the SMR. The analysis showed that there is an association between previous straw burning of sugarcane and respiratory diseases, because the increase in outbreaks of burning (Spotlights) was significantly associated with increased hospital admissions for respiratory diseases in children aged under five years old. The results show that the previous straw burning of sugarcane effectively offers health risk to the population and added to the choropleth maps generated provide valuable information for epidemiological surveillance and contribute to the establishment of public policies for the control of air pollution, which should contemplate beyond the major urban centers, the small towns. The elimination of this risk factor should be part of a primordial prevention measure to be taken in the state

Background: Previous studies have found woodworkers to be at an increased risk for nonmalignant respiratory disease (NMRD) compared to control populations, and mould exposure has been suggested as a possible cause of NMRD in woodworkers. The main objectives of this thesis were to develop a predictive model of mould exposure among BC lumber mill workers and to assess the risk of NMRD associated with mould exposure within a cohort of BC lumber mill workers. Methods: In the first study, multivariate linear regression modeling was applied to 223 personal samples of B-(l,3)-glucan (a marker of mould exposure) collected at four BC lumber mills, to produce a predictive model of mould exposure among workers. In the second study, quantitative exposure values derived from the predictive model were assigned retrospectively to a cohort of 11,200 BC lumber mill workers (employed at one of fourteen BC mills between 1979 and 1994 for at least one year) to develop cumulative exposure estimates. Morbidity was assessed using hospital discharge records (April 1, 1985 and July 31, 1997) obtained from the BC linked Health Database. Exposure gradients among hospitalrzation rates for any NMRD (ICD9=460-519), chronic obstructive pulmonary disease (COPD, ICD9=490- 92, 496) and asthma (ICD9=493) were assessed using Poisson regression, with workers in low exposure categories acting as the reference population. Results: A total of 1097 cases of any NMRD, 256 cases of COPD and 97 cases of asthma were included in analyses. After controlling for age, calendar period and race (and employment in Western Red Cedar mills for asthma analyses), there was evidence of an increase in COPD risk among high and moderate exposed workers at no exposure lagging and lagging up to 5 years. There was some evidence of a link between exposure and asthma, though no clear trends were apparent, and no evidence of a link with any respiratory disease. Conclusion: This study provided evidence of a link between cumulative mould exposure and hospitalrzation due to COPD among woodworkers. Further studies with greater power and better control of possible conflunders are needed to fully assess dose-response relationships between mould exposure and NMRD morbidity among BC woodworkers.

碩士
東海大學
環境科學與工程學系
97
Over the past two decade, many studies have found the association between air pollutant and hospital respiratory and cardiovascular admission. Each study is from different countries, and each country has own distinctive weather, land and human activities. In hence we need more research for Taiwan’s epidemiology, especially in central Taiwan. Central Taiwan has the highest CO2 emitting power plants in the world, so we set this area to investigate. The impact of season, area and ages may have different influence, therefore, we discussed for four season and separated the central Taiwan for metropolis and suburb. The subjects in the study were classified in five groups: preschooler(0-4 years old), children(5-14 years old), Adults(15-65 years old), Elder(more than 65 years old) and all ages. Hospital admissions for respiratory and cardiovascular and air pollutant data were obtained for the National Health Insurance Research Database (NHIRD) and Taiwan Environmental Protection Administration (TEPA). Risk of morbidity for five pollutants, there had no positive correlation at metropolis. CO and NO2 had the significant results in four seasons at suburb, O3 had the positive correlation in spring and winter for respiratory and cardiovascular disease. In this study, we compare the Pollutant Standard Index (PSI) and Revised Air Quality Index (RAQI) with Relative Risk (RR). At final results, both of two Index have no significant correlation in metropolis, at suburb, we found the RAQI to hospital admission, the RR was higher than PSI, either season or groups.

This thesis is based on studies in Butajira district in the south central part of Ethiopia and one study in the Ethio-Swedish Children's Hospital in Addis Ababa. The Butajira project has a continuous demographic surveillance system, established in 1987 in a sample of 10 communities with a total baseline population of about 30,000. The project includes the development and evaluation of a system for continuous registration of vital events and provides a baseline population and sampling frame for health related research activities. The thesis used different study designs within the surveillance system. A carriership study was undertaken to determine the potential bacterial respiratory pathogens among under-five children. A clinical study was done to investigate aetiological agents among young infants (below 3 months) with pneumonia, sepsis and meningitis in a hospital setting. Interview studies were carried out on mothers' perceptions of illness and practices in the care of children with acute respiratory infections. Within the surveillance system, patterns of under-five mortality were analysed. A nested case-referent design was applied to assess public health and behavioural determinants of mortality. A cohort study was performed among under-fives in three communities to estimate the magnitude of illness burden, particularly from ARI, as well as to assess determinants of ARI morbidity. Among 1126 under-five children, 85% were found to harbour H. influenzae, 83% M. catarrhalis and 90% S. pneumoniae in the nasopharynx. The hospital-based study isolated S. pneumoniae, Streptococcus group A, Salmonella group B, E. coli and H. influenzae in the age group below 3 months. The study of mothers' perceptions and practices, showed that mothers do know the symptoms of measles and whooping cough, while they do not recognize pneumonia as an illness entity and are not aware of fast breathing as an important sign of pneumonia. The mortality studies showed a high infant and under-five mortality rate. ARI was responsible for one fifth of the under-five mortality and almost one third of the infant mortality rate. Cause of death in the case-referent study was determined using a validated verbal autopsy method. Breast-feeding and supplementary feeding were demonstrated to be strongly protective when controlling for parental and environmental determinants of mortality. A one year prospective home surveillance study showed that illness was reported in 5.8% of 1,216 person-years. ARI contributed half of this illness load and was particularly associated with parental factors. Among sanitation factors, the absence of piped water was an important determinant of morbidity. Among housing factors, the type of roof and lighting source for the house, and among parental factors, illiteracy of either parents and having a farmer as a father, were found to be independently associated with increased morbidity. Among health and behavioural factors, preterm delivery and lack of immunization were associated with increased morbidity. The results of the studies of this thesis have been utilized to design an intervention case management package. The intervention study and evaluation of its impact is now on-going.

Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 7 uppsatser.

digitalisering@umu.se

Population-based administrative data (2009-2012) from several sources were used to compare the health status and access to health services between a cohort of children in care with developmental disabilities (DD) (n=1,212) and a matched comparison group of children in care without DD (n=2,424). The two study groups were compared on a number of measures, including total respiratory morbidity, prevalence of diabetes, mood and anxiety disorders, continuity of care, injury-related hospitalizations, hospital-based dental care, and total number of ambulatory physician visits. Children in care with DD were significantly more likely to have a history of mood and anxiety disorders, respiratory illnesses, diabetes, hospital-based dental care, and injury-related hospitalizations compared to the matched comparison group. Children in care with DD also had significantly higher number of physician visits than children in the matched comparison group. No significant difference between the two study groups was found for continuity of care.
October 2015