Respiratory symptoms related to flour dust exposure are significantly high among small and medium scale flour mill workers in Ethiopia: a comparative cross-sectional survey

BACKGROUND@#International Labour Organization (ILO) report indicates more than 2.4 million workers die from work-related diseases and accidents each year. Work-related respiratory ailments related to airborne particulate matter such as flour dust are responsible for about 386,000 deaths and 6.6 million illness-adjusted life years. Even though exposure to flour dust together with the extreme expansions of flour mill sectors is a priority health concern, extent of the problem is little investigated in Ethiopia. The aim of this study was to evaluate the magnitude and risk factors of work-related respiratory symptoms among flour mill workers in Bahir Dar City, Ethiopia.@*METHODS@#This study employed a comparative cross-sectional survey of 560 samples (280 exposed group from flour mill workers and 280 unexposed group from office workers) with a stratified random sampling technique. The study was conducted from March to April 2019 in Bahir Dar City, Northwest Ethiopia. We used the British Medical Research Council (BMRC) questionnaire to assess work-related respiratory symptoms. The questionnaire was pretested and interview administered to collect data. Binary logistic regression analysis was fitted to evaluate significant factors of respiratory symptoms at a < 0.05 p value. Adjusted odds ratio (AOR) with a confidence interval (CI) of 95% was calculated to determine a strength of association.@*RESULTS@#All the sampled participants had fully responded to the interview. The median age of exposed and unexposed groups was 28.5 interquartile range (IQR, 20) and 31 (IQR, 15) years, respectively. The prevalence of work-related respiratory symptoms among flour mill workers was substantially higher than that of among controls, 63.9% and 20.7%, respectively (Χ@*CONCLUSION@#Respiratory symptoms emanating from exposure to various flour dusts were significantly higher among flour mill workers than among the control group. Therefore, we recommend the need to effectively implement health and safety programs that account for the reduction of dust at a source, use of engineering controls (e.g., provision of adequate ventilation systems), use of administrative measures (e.g., training program and health surveillance) and provision of a suitable personal protective equipment (PPE). Furthermore, it is vital to integrate workplace health and safety programs to the wider public health policies and strategies to effectively mitigate the burden of work-related respiratory conditions. We also encourage future studies to evaluate concentration of flour dusts combined with physical examinations to establish plausible associations of respiratory symptoms with dusts of flour mill-related origin.

Prevalence of chronic respiratory disease in urban and rural Uganda

Objective To determine the prevalence of chronic respiratory diseases in urban and rural Uganda and to identify risk factors for these diseases. Methods The according to standard guidelines and completed questionnaires on respiratory symptoms, functional status and demographic characteristics.The presence of four chronic respiratory conditions was monitored: chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis and a restrictive spirometry pattern. Findings In total, 1502 participants (average age: 46.9 years) had acceptable, reproducible spirometry results: 837 (56%) in rural Nakaseke and 665 (44%) in urban Kampala. Overall, 46.5% (698/1502) were male. The age-adjusted prevalence of any chronic respiratory condition was 20.2%. The age-adjusted prevalence of COPD was significantly greater in rural than urban participants (6.1 versus 1.5%, respectively; P<0.001), whereas asthma was significantly more prevalent in urban participants: 9.7% versus 4.4% in rural participants (P<0.001). The age-adjusted prevalence of chronic bronchitis was similar in rural and urban participants (3.5 versus 2.2%, respectively; P=0.62), as was that of a restrictive spirometry pattern (10.9 versus 9.4%; P=0.82). For COPD, the population attributable risk was 51.5% for rural residence, 19.5% for tobacco smoking, 16.0% for a body mass index <18.5 kg/m2 and 13.0% for a history of treatment for pulmonary tuberculosis.Conclusion The prevalence of chronic respiratory disease was high in both rural and urban Uganda. Place of residence was the most important risk factor for COPD and asthma

Valoración mediante espirometría de mineros del carbón de Paipa, Colombia / Spirometry in a population of coal miners in Paipa, Colombia

RESUMEN Introducción: Las enfermedades respiratorias derivadas de la exposición a material en partículas, como sucede en la minería del carbón, continúa siendo un reto investigativo en el país y un problema de salud pública. La espirometría es una prueba de la función respiratoria, fundamental para el diagnóstico y la vigilancia de este tipo de enfermedades pulmonares crónicas. Objetivo. Determinar los valores de la espirometría en la población minera de carbón del municipio de Paipa, y su asociación con la edad y el tiempo de exposición laboral. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal. Se diligenció el cuestionario de enfermedad respiratoria ocupacional de la American Thoracic Society (ATS), se registraron las mediciones de la espirometría y se interpretaron siguiendo las recomendaciones internacionales. Resultados. La muestra incluyó 226 trabajadores de minas de carbón de Paipa; en 12,3 % (n=28) de ellos se registraron alteraciones leves, de tipo obstructivo o restrictivo. En 35 % (n=80) hubo disminución de la relación entre la capacidad vital forzada y el volumen espirado en el primer segundo (CVF/VEF1 ). Se encontró una asociación estadísticamente significativa entre el rango de edad (p=0,002) y los años de trabajo minero (p=0,34), además de trastornos restrictivos y obstructivos. Asimismo, hubo una asociación estadísticamente significativa entre el rango de edad (p<0,01) y los años de trabajo minero (p<0,01), de diferente seriedad en el patrón de las mediciones de la espirometría. Conclusiones. La espirometría es una prueba útil para detectar la presencia de trastornos respiratorios en la población minera del carbón. La enfermedad respiratoria en estos mineros estuvo significativamente asociada con el tiempo de exposición.

ABSTRACT Introduction: Respiratory diseases resulting from exposure to particulate matter such as in coal mining remains a research challenge in this country and a public health issue. Spirometry is a basic test of fundamental respiratory function for the diagnosis and monitoring of these types of chronic lung diseases. Objective: To determine spirometric values in the coal mining municipality of Paipa and their association with age and occupational exposure times. Materials and methods: We conducted a descriptive cross-sectional study. The occupational respiratory disease questionnaire of the American Thoracic Society (ATS) was completed while spirometric measurements were performed and interpreted in accordance with international recommendations for conducting the test. Results: The sample consisted of 226 coal mining workers of the municipality of Paipa. Twenty-eight subjects (12.3%) of the sample showed patterns of obstructive and restrictive respiratory disease with mild degrees of severity. Eighty subjects (35%) showed a decrease in the forced vital capacity ratio/expiratory volume in one second (FVC/FEV1 ). A statistically significant association between age range (p=0.002) and years of mining work (p=0.34) with the development of restrictive and obstructive disorders was found. Also, there was a statistically significant association between age range (p<0.01) and years of mining work (p<0.01) with various degrees of severity of the spirometric pattern. Conclusions: Spirometry is a useful test for detecting the presence of respiratory disorders in the population of coal miners. The time of exposure was significantly associated with the respiratory disease exhibited by these miners.

Prevalence of tuberculosis respiratory symptoms and associated factors in the indigenous populations of Paraguay (2012)

BACKGROUND The prevalence of respiratory symptoms and confirmed tuberculosis (TB) among indigenous groups in Paraguay is unknown. METHODS This study assessed the prevalence of respiratory symptoms, confirmed pulmonary TB, and associated socio-economic factors among indigenous Paraguayan populations. Indigenous persons residing in selected communities were included in the study. A total of 24,352 participants were interviewed at home between October and December 2012. Respiratory symptomatic individuals were defined as those with respiratory symptoms of TB. A hierarchical Poisson regression analysis was performed with four levels: individual characteristics, living conditions and environmental characteristics, source of food, and type of nutrition. FINDINGS In this study, 1,383 participants had respiratory symptoms (5.7%), but only 10 had culture-confirmed TB (41/100,000 inhabitants). The small number of cases did not allow evaluation of the risk factors for TB. Age older than 37 years was associated with a two-fold increased risk of symptoms. Female sex; family history of TB; type of housing; home heating; a lack of hunting, fishing, or purchasing food; and a lack of vegetable consumption were also associated with the presence of symptoms. A lack of cereal consumption had a protective effect. Members of the Ayoreo or Manjui ethnic groups had a three-fold increased risk of symptoms. MAIN CONCLUSION Individual characteristics, dietary habits, and belonging to specific ethnic groups were associated with respiratory symptoms.

Alterações respiratórias em trabalhadores: estudo de portuários avulsos / Alteraciones respiratorias en trabajadores: estudio de puertos independientes / Respiratory alterations in workers: study of single ports

Resumo OBJETIVO Identificar alterações no sistema respiratório em trabalhadores portuários por meio de exames radiográficos e de função pulmonar; identificar o uso de equipamentos de proteção individual durante as atividades portuárias; e relacionar a idade, tempo de trabalho, exposição a substâncias como os fertilizantes e uso de equipamentos de proteção individual, durante as atividades portuárias, às alterações no sistema respiratório em trabalhadores portuários. MÉTODO Descritivo e exploratório em um porto marítimo sul brasileiro, de julho de 2014 a janeiro de 2015. Realizou-se análise retrospectiva, quantitativo do resultado da radiografia de tórax e espirometria de 695 prontuários de trabalhadores e análise prospectiva de 66 trabalhadores. RESULTADOS a maioria dos trabalhadores não apresentou alterações radiográficas 98,7% e 11,4% apresentaram alterações ventilatórias. Identificou-se correlação positiva para as variáveis, idade, tempo de trabalho e resultado da espirometria. CONCLUSÃO Houve alteração da função respiratória de trabalhadores portuários avulsos, que pode estar relacionada à exposição aos fertilizantes.

RESUMEN OBJETIVO Identificar alteraciones en el sistema respiratorio en trabajadores portuarios por medio de exámenes radiográficos y de función pulmonar; identificar el uso de equipos de protección individual durante las actividades portuarias; y relacionar la edad, el tiempo de trabajo, la exposición a sustancias como los fertilizantes y el uso de equipos de protección individual, durante las actividades portuarias, a las alteraciones en el sistema respiratorio en trabajadores portuarios. MÉTODO Descriptivo y exploratorio, realizado en un puerto maritmo sur brasileño, de julio de 2014 a enero de 2015. Realizó un análisis retrospectivo, cuantitativo de la radiografía de tórax y la espirometría 695 registros de los trabajadores del puerto y la realización de análisis prospectivo de 66 trabajadores. RESULTADOS la mayoría de los trabajadores no se muestran las radiografías 98,7% y el 11,4% mostraron cambios ventilatorios. Se identificó una correlación positiva para las variables, la edad, el tiempo de trabajo y espirometría. CONCLUSIÓN Hubo un cambio de la función respiratoria de los estibadores temporales, que se puede asociar con un tratamiento de fertilizantes.

Abstract OBJECTIVE To identify alterations in the respiratory system in port workers through radiographic and pulmonary function tests; to identify the use of personal protective equipment during port activities; and to relate age, working time, exposure to substances such as fertilizers and the use of personal protective equipment during port activities, to changes in the respiratory system in port workers. METHOD Descriptive and exploratory study, in south Brazilian maritime port, from July of 2014 to January of 2015. A retrospective quantitative analysis of the results of chest x-ray and spirometry of 695 port workers' chart and prospective analysis of 66 workers were performed. RESULTS Most of the workers did not present radiographs 98.7% and 11.4% presented ventilatory alterations. A positive correlation was identified for the variables age, working time and spirometry results. CONCLUSION There was a change in the respiratory function of single port workers, which may be related to the exposure to fertilizers.

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery / O efeito da exposição passiva à fumaça de tabaco em complicações respiratórias no perioperatório e a duração da recuperação

Abstract Background: The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Methods: Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. Results: A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Conclusion: Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Resumo Justificativa: A incidência de complicações respiratórias no perioperatório e o tempo em sala de recuperação pós-anestesia no pós-operatório em pacientes com exposição passiva à fumaça de tabaco foram avaliados de acordo com o grau de exposição. Métodos: Foram avaliados 270 pacientes entre 18-60 anos, estado físico ASA I ou II, passivamente expostos e não expostos à fumaça de tabaco, submetidos à anestesia geral para vários procedimentos cirúrgicos eletivos. Os pacientes foram divididos em dois grupos: passivamente expostos e não expostos à fumaça de tabaco. Aqueles com exposição passiva à fumaça também foram divididos em dois grupos de acordo com o grau de exposição. Os pacientes enviados à sala de recuperação pós-anestesia (SRPA) no fim da cirurgia foram monitorados até atingir 9 ou mais no escore modificado de Aldrete. As complicações respiratórias foram avaliadas e registradas nos períodos intraoperatório e pós-operatório. Resultados: Foram incluídos 251 pacientes, dos quais 63 (25,1%) apresentaram complicações respiratórias, 11 (4,4%) complicações no intraoperatório e 52 (20,7%) complicações no pós-operatório. Houve relação significativa entre a exposição passiva à fumaça de tabaco e a alta incidência de complicações respiratórias no perioperatório e pós-operatório. O risco de complicação como tosse, dessaturação e hipersecreção aumentou de acordo com o grau de exposição. Houve relação significativa entre o grau de exposição passiva à fumaça e o tempo de permanência em SRPA. Conclusão: Os pacientes com exposição passiva à fumaça de tabaco apresentaram altas taxas de complicações respiratórias no perioperatório e prolongamento da permanência em SRPA, em comparação com os pacientes não expostos.

Association between secondhand smoking in the home and respiratory morbidity in preschool children / Asociación entre tabaquismo pasivo domiciliario y morbilidad respiratoria en pre escolares / Associação entre tabagismo passivo domiciliar e morbidade respiratória em pré-escolares

Abstract OBJECTIVE Identifying the prevalence of secondhand smoking in the home and its association with morbidity and hospitalization from respiratory causes in preschool children. METHOD This is a cross-sectional study conducted in five early childhood education centers at a public university in São Paulo. Sample size calculation was performed and the participants were randomly determined. Data were collected through questionnaires completed by family members or caregivers of 215 children. Chi-square and Student's t-test were used for the statistical analysis, using a 0.05 significance level. RESULTS The prevalence of secondhand smoke in the household was 15.3%. Bivariate analysis revealed that secondhand smoke in the household was associated with the occurrence of rapid breathing, subdiaphragmatic retractions in the past three months, and treated ear infections/otitis. CONCLUSION A low prevalence of secondhand smoking in the home was found. Secondhand smoke was associated with a higher prevalence of respiratory symptoms and morbidity.

Resumen OBJETIVO Identificar la prevalencia de tabaquismo pasivo en domicilio y verificar su asociación con morbilidades y hospitalización por causas respiratorias en niños pre escolares. MÉTODOSe trata de estudio transversal conducido en cinco centros de educación infantil de una universidad pública de São Paulo. Se realizó cálculo de tamaño de muestra y se hizo la selección de los participantes por sorteo. Los datos fueron recogidos mediante cuestionarios rellenados por los familiares o cuidadores de 215 niños. En el análisis estadístico, se emplearon las pruebas Chi cuadrado y t de Student, considerándose un nivel de significación del 0,05. RESULTADOS La prevalencia de tabaquismo pasivo en domicilio fue del 15,3%. Se verificó en el análisis bivariado que el tabaquismo pasivo en domicilio estuvo asociado con la ocurrencia de respiración rápida, retracción subdiafragmática los último tres meses y otitis tratada. CONCLUSIÓN Se verificó una baja prevalencia de tabaquismo pasivo domiciliario. El tabaquismo pasivo estuvo asociado con una prevalencia mayor de síntomas y morbilidad respiratoria.

Resumo OBJETIVO Identificar a prevalência de tabagismo passivo em domicílio e verificar sua associação com morbidades e hospitalização por causas respiratórias em crianças pré-escolares. MÉTODO Trata-se de estudo transversal conduzido em cinco centros de educação infantil de uma universidade pública de São Paulo. Foi realizado cálculo de tamanho amostral, e a seleção dos participantes foi feita por sorteio. Os dados foram coletados por meio de questionários preenchidos pelos familiares ou cuidadores de 215 crianças. Na análise estatística foram empregados os testes Qui-quadrado e t-Student, considerando-se um nível de significância de 0,05. RESULTADOS A prevalência de tabagismo passivo em domicílio foi de 15,3%. Verificou-se na análise bivariada que o tabagismo passivo em domicílio esteve associado à ocorrência de respiração rápida, retração subdiafragmática nos últimos três meses, e otite tratada. CONCLUSÃO Verificou-se uma baixa prevalência de tabagismo passivo domiciliar. O tabagismo passivo esteve associado a uma prevalência maior de sintomas e morbidade respiratória.

Avaliação da condição respiratória em população rural exposta a agrotóxicos no município de São José de Ubá, Estado do Rio de Janeiro / Assessment of respiratory status in rural population exposed to pesticides in the community of Sao Jose de Uba, State of Rio de Janeiro, Brazil

O uso excessivo de produtos agrotóxicos na agricultura se tornou um problema de saúde pública e representa um risco à saúde humana, especialmente dos trabalhadores rurais e seus familiares. Os agrotóxicos são responsáveis por várias doenças e o sistema respiratório é especialmente sensível a esses contaminantes. Em São José de Ubá (SJU), a economia local é extremamente dependente do plantio de tomates, que demandam uso intensivo de agrotóxicos, principalmente organofosforados, carbamatos e piretróides. O monitoramento da saúde das populações expostas pode ser essencial para reduzir danos e mitigar riscos. Objetivo geral: Avaliar a prevalência de sintomas respiratórios e função pulmonar de trabalhadores rurais e familiares expostos a agrotóxicos no município de SJU. Materiais e Métodos: Estudo transversal com amostragem por conveniência em 48 trabalhadores rurais e 34 familiares. Foi realizada uma caracterização da área e população de estudo, entrevistas orientadas por questionário, levantamento de dados de morbidade e mortalidade, análise de marcadores biológicos, pesquisa de sintomas respiratórios e avaliação da função pulmonar.

Excessive use of pesticides in agriculture has become a public health problem and poses a risk to human health, especially of rural workers and their families. Pesticides are responsible for various diseases and respiratory system is especially sensitive to these contaminants. In Sao Jose de Uba - SJU, the local economy is heavily dependent on the planting of tomatoes, which require intensive use of pesticides, especially organophosphates, carbamates and pyrethroids. Monitoring the health of exposed populations may be essential to reduce damage and mitigate risks. Objective: To evaluate the prevalence of respiratory symptoms and lung function of rural workers and family members exposed to pesticides in SJU. Materials and Methods: Cross-sectional study with convenience sampling composed by 48 rural workers and 34 family members. A characterization of the area and population, interviews guided by questionnaire of exposure data and respiratory symptoms, data collection of morbidity and mortality, analysis of biomarkers and evaluation of lung function was conducted in the period of season (2014).

Chronic symptoms and pulmonary dysfunction in post-tuberculosis Brazilian patients

ABSTRACTBACKGROUND: Questionnaire and spirometry were applied to post-tuberculosis indigenous and non-indigenous individuals from Dourados, Brazil, to investigate the prevalence of chronic respiratory symptoms and pulmonary dysfunction.METHODS:This was a cross-sectional study in cured tuberculosis individuals as reported in the National System on Reportable Diseases (SINAN) from 2002 to 2012.RESULTS:One hundred and twenty individuals were included in the study and the prevalence of chronic respiratory symptoms was 45% (95% CI, 34-59%). Respiratory symptoms included cough (28%), sputum (23%), wheezing (22%) and dyspnea (8%). These symptoms were associated with alcoholism, AOR: 3.1 (1.2-8.4); less than 4 years of schooling, AOR: 5.0 (1.4-17.7); and previous pulmonary diseases, AOR: 5.4 (1.7-17.3). Forty-one percent (95% CI, 29-56) had pulmonary disorders, of which the most prevalent were obstructive disorders (49%), followed by obstructive disorder with reduced forced vital capacity disorders (46%) and restrictive disorders (5%). The lifestyle difference could not explain differences in chronic symptoms and/or the prevalence of pulmonary dysfunction.CONCLUSION:The high prevalence of chronic respiratory symptoms and pulmonary dysfunction in post-tuberculosis patients indicates a need for further interventions to reduce social vulnerability of patients successfully treated for tuberculosis.

Síntomas respiratorios asociados con la exposición a la contaminación del aire en cinco localidades de Bogotá, 2008-2011, estudio en una cohorte dinámica / Respiratory symptoms associated with air pollution in five localities of Bogotá, 2008-2011, a dynamic cohort study

Introducción. En Bogotá, la morbilidad por enfermedad respiratoria en menores de cinco años aumenta a medida que lo hace la contaminación del aire. Objetivo. El objetivo de este estudio fue conocer la incidencia de los síntomas respiratorios en cinco localidades de Bogotá y su asociación con otros factores, entre 2008 y 2011. Materiales y métodos. Se hizo un estudio de cohorte dinámica. El tamaño de la muestra fue de 3.278 niños de cinco localidades, divididos en dos grupos de acuerdo con la exposición a material en partículas. Se hizo el seguimiento de la aparición de diez síntomas respiratorios mediante un diario de registro. El análisis estadístico incluyó el cálculo de la razón de tasas de incidencia (RTI) y la regresión de Poisson para cada síntoma evaluado. Resultados. La tos se presentó con mayor frecuencia en los niños más expuestos (RTI=1,23; IC 95% 1,13-1,34) y la incidencia de expectoración fue mayor en ellos (RTI=1,64; IC 95% 1,47-1,84). En cuanto a las sibilancias, se observó una asociación con la exposición a material en partículas (RR=2,29; IC 95% 1,78-3,00), la presencia de fábricas en la vivienda (RR=1,29; IC 95% 1,01-1,68) y la edad (RR=0,95; IC 95% 0,94-0,96). La proporción de riesgo atribuible a la exposición a la contaminación del aire, fluctuó según los síntomas entre 37 % para las sibilancias nocturnas (IC 95% 26-47,8) y 10,6 % para la tos (IC 95% 6,3-15). Conclusión. Los efectos de la contaminación del aire extramuros se vieron potenciados por las condiciones socioeconómicas en las que vive y trabaja la población de Bogotá. Es necesario adoptar una aproximación conceptual más amplia desde la perspectiva de la salud pública y fortalecer la acción intersectorial para reducir los efectos de la contaminación del aire en la salud de la población.

Introduction: High levels of air pollution increase respiratory morbidity in children under five years of age. Objective: To know the incidence of respiratory symptoms and its associated factors in five localities of Bogota. Materials and methods: A dynamic cohort study was undertaken with a sample size of 3,278 children from five localities split into two groups according to the degree of exposure to particulate matter. Monitoring was conducted at the outbreak of ten respiratory symptoms through a diary of those symptoms. Statistical analysis included incidence rate ratio (IRR) calculations and Poisson regression models for each assessed symptom. Results: Cough was more frequent in the highly exposed group (lRR=1.23, Cl 95% 1.13-1.34). The most exposed group had higher incidence of expectoration (lRR=1.64, Cl= 95% 1.47-1.84). Wheezing was associated with high exposure to particulate matter (RR=2.29, Cl 95% 1.78-3.00), cottage industries (RR=1.29, Cl 95% 1.01-1.68) and age (RR=0.95, Cl 95% 0.94-0.96). Risk attributable to air pollution exposure fluctuated according to symptoms from 37% for nocturnal wheezing (Cl 95% 26-47.8) to 10.6 for cough (Cl 95% 6.3-15%). Conclusion: Extradomiciliary air pollution effects are potentiated by socioeconomic living and working conditions of people in Bogota. A broader conceptual public health approach and the strengthening of intersector actions are required to reduce health effects of air pollution.

Association between respiratory problems and dental caries in children with bruxism.

Context: Bruxism is the habit of clenching or grinding one's teeth in non-functional activities and affects both children and adults alike. Respiratory problems, such as asthma and upper airway infections, are reported to be the etiological factors of bruxism. Aims: The aim of the present study was to determine whether there is an association between respiratory problems and dental caries in children who exhibit the habit of bruxism. Setting and Design: An observational cross-sectional study was carried out. Materials and Methods: Patient histories were taken and clinical exams were performed on 90 children for selection and allocation to one of two groups. For the determination of bruxism, a questionnaire was administered to parents/guardians and an oral clinical exam was performed based on the criteria of the American Academy of Sleep Medicine. Thirty-three male and female children between 4 and 7 years of age participated in the study - 14 children with bruxism and 19 children without bruxism. Statistical Analysis: The data were statistically analyzed using the chi-square test, with level of significance set at 5% (P < 0.05). Results: Mean age of the participants was 5.73 years. The male gender accounted for 45.5% (n = 15) of the sample and the female gender accounted for 54.5% (n = 18). A statistically significant association was found between respiratory problems and dental caries among the children with bruxism. Seventy-seven percent of the children with bruxism had caries and 62.5% the children with respiratory problems exhibited the habit of bruxism. Conclusions: There seems to be an association between bruxism, respiratory problems, and dental caries in children.

Poluição do ar e doenças respiratórias e cardiovasculares: estudo de séries temporais em Cubatão, São Paulo, Brasil / Air pollution and respiratory and cardiovascular diseases: a time series study in Cubatão, São Paulo State, Brazil / La contaminación del aire y las enfermedades respiratorias y cardiovasculares: estudio de series temporales en Cubatão, São Paulo, Brasil

Foi avaliado o impacto da poluição do ar nas internações por doenças respiratórias e cardiovasculares em residentes do Município de Cuba-tão, São Paulo, Brasil. Utilizaram-se modelos de séries temporais, com modelos aditivos generalizados, em regressão de Poisson, testando como variáveis independentes as concentrações diárias de material particulado (PM10); dióxido de enxofre (SO2) e o ozônio (O3). Como variáveis de controle a temperatura, umidade, dias da semana e feriados. Para cada incremento de 10µg/m³ de PM10, encontrou-se um excesso de internações de 4,25% (IC95%: 2,82; 5,71); 5,74% (IC95%: 3,80; 7,71) e 2,29% (IC95%: 0,86; 3,73) para doenças respiratórias totais, doenças respiratórias em menores de 5 anos e doenças cardiovasculares em maiores de 39 anos, respectivamente. O SO2 apresentou relação com as doenças cardiovasculares em maiores de 39 anos de 3,51% (IC95%: 1,24; 5,83) e o O3 com as doenças cardiovasculares em maiores de 39 anos: 2,85% (IC95%: 0,77; 4,98) e doenças respiratórias em menores de 5 anos: 3,91% (IC95%: 1,37; 6,51). Os efeitos da poluição atmosférica na saúde em Cubatão são pronunciados, indicando a necessidade de melhoria das políticas de controle.

This study evaluated the association between air pollution and hospital admissions due to respiratory and cardiovascular diseases in Cubatão, São Paulo State, Brazil. Generalized additive Poisson regression models were used to model daily concentrations of particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) and daily hospital admissions counts. Explanatory variables were temperature, relative humidity, day of the week, and holidays. For each increment of 10µg/m³ in PM10, we found an excess of 4.25 % (95%CI: 2.82; 71), 5.74% (95%CI: 3.80; 7.71), and 2.29% (95%CI: 0.86; 3.73) in admissions due to respiratory diseases for all ages, respiratory diseases in children under 5 years old, and cardiovascular diseases in adults over 39 years of age, respectively. For SO2, the increase was 3.51% (IC95%: 1.24; 5.83) for cardiovascular diseases in adults more than 39 years. For O3, the increase was 2.85% (IC95%: 0.77; 4.98) for cardiovascular diseases in adults more than 39 years of age and 3.91% (IC95%: 1.37; 6.51) for respiratory diseases in children under 5 years old. Air pollution has serious impacts on health in Cubatão, thus emphasizing the need for air quality control policies.

Se utilizaron análisis de series temporales con modelos aditivos generalizados en regresión de Poisson, además, para la prueba de las variables independientes se consideraron las concentraciones diarias de material particulado (PM10), dióxido de azufre (SO2) y ozono (O3). Como variables de control se consideraron: la temperatura, humedad, los días de la semana y festivos. Por cada incremento de PM10 10µg/m³, se encontró un exceso de hospitalizaciones de un 4,25% (IC95%: 2,82; 5,71), 5,74% (IC95%: 3,80; 7,71) y 2,29% (IC95%: 0,86; 3,73) para las enfermedades respiratorias en todas las edades, las enfermedades respiratorias en niños menores de 5 años y la enfermedad cardiovascular en adultos mayores de 39 años, respectivamente. El SO2 se relacionó con las enfermedades cardiovasculares en adultos mayores de 39 años en el 3,51% (IC95%: 1,24; 5,83) y O3 con enfermedades cardiovasculares en adultos mayores de 39 años: 2,85% (IC95%: 0,77; 4,98) y enfermedades respiratorias en niños menores de 5 años: 3,91% (IC95%: 1,37; 6,51). Los efectos de la contaminación atmosférica sobre la salud en Cubatão son elevados, lo que indica la necesidad de revisión en las políticas públicas de control.

Cargas e desgastes de trabalho vivenciados entre trabalhadores de saúde em um hospital de ensino / Descripción de cargas de trabajo y el desgaste experimentado entre trabajadores de salud en un hospital universitario / Description of workloads and fatigue experienced among health workers in a teaching hospital

Estudo exploratório, de caráter descritivo e de abordagem quantitativa, alicerçado nas categorias "processo de trabalho", "cargas de trabalho" e "desgaste" em um hospital de ensino em Curitiba, região sul do Brasil. Neste artigo, são caracterizadas as cargas e os desgastes vivenciados em um hospital universitário, captados pelo estudo prévio intitulado "Sistema de monitoramento da saúde do trabalhador de enfermagem" (SIMOSTE). Os resultados demonstram que o gênero feminino foi o mais acometido (85,9%); os profissionais mais afetados foram os auxiliares de enfermagem (53,1%). O maior número de afastamentos ocorreu por doenças do sistema osteoarticular (25,2%) e, dentre as cargas apresentadas, as mais expressivas foram as mecânicas e fisiológicas, com 33,06%, cada. Estes resultados poderão subsidiar estratégias de intervenção nas políticas direcionadas à saúde do trabalhador, para assegurar uma melhor qualidade de vida a este profissional e, por consequência, promover melhorias na qualidade da assistência prestada ao usuário.

Estudio exploratorio, descriptivo y cuantitativo, basado en el proceso de trabajo, las cargas de trabajo y el desgaste en un hospital universitario en Curitiba, sur de Brasil. En este artículo se caracteriza la carga y el estrés experimentado en un hospital universitario, planteada por un estudio previo titulado "Sistema de vigilancia de la salud de los trabajadores de enfermería". Los resultados muestran que las mujeres (85,9%) y los auxiliares de enfermería eran los profesionales más afectados (53,1%). El mayor número de ausencia del trabajo se debieron a enfermedades del sistema musculoesquelético (25,2%) y entre los cargos presentados, los más significativos fueron el mecánico y el fisiológico con el 33,06% cada uno. Estos resultados pueden apoyar las estrategias de intervención en las políticas dirigidas a la salud de los trabajadores, para garantizar una mejor calidad de vida a este trabajo y promover mejoras en la calidad de la atención prestada al usuario.

This is an exploratory, descriptive and quantitative study, based on the following categories: work process, workloads and fatigue in a teaching hospital in Curitiba in the southern region of Brazil. The article characterizes the load and stress experienced in a university hospital, based on a previous study entitled "System for monitoring the health of nursing workers" (SIMOSTE). The results show that females were the most affected (85.9%) and the most affected professionals were nursing assistants (53.1%). The highest number of sick leaves was due to diseases of the osteoarticular system (25.2%) and the most significant loads were mechanical and physiological with 33.06% each. These results may support intervention strategies in the policies directed toward the workers' health to ensure a better quality of life and consequently improve the quality of care provided to the user.

Enfermedad y síntomas respiratorios en niños de cinco municipios carboníferos del Cesar, Colombia / PM10 exposure-related respiratory symptoms and disease in children living in and near five coal-mining areas in the Cesar department of Colombia

Objetivos Establecer la prevalencia de síntomas respiratorios y enfermedad respiratoria en niños menores de 12 años de municipios de influencia de la zona carbonífera del departamento del Cesar y posibles factores asociados. Métodos Estudio transversal en 1 627 niños menores de 10 años habitantes de municipios carboneros del Cesar expuestos a diferentes niveles de MP10 en los años 2008-2010, en quienes se midieron enfermedades y síntomas respiratorios relacionados con exposición a PM10, buscando asociación con diferentes zonas de exposición al material particulado. Resultados Niños de corregimientos próximos a depósitos mineros y de corregimientos con tráfico tuvieron mayor proporción de casos probables de asma; mientras que los del corregimiento con tráfico se ausentaron más días por enfermedad respiratoria aguda; se encontró mayor frecuencia de síntomas respiratorios en niños expuestos al humo de cigarrillo o de leña intramurales, niños de viviendas con paredes de bareque o adobe, tenencia de animales, presencia de humedad en las viviendas, vehículos de carga a menos de 100 m de la vivienda; vivir en zonas con tráfico aumentó el riesgo de presentar síntomas respiratorios, enfermedad respiratoria aguda y ausentismo escolar. Discusión Todos los efectos estudiados estuvieron asociados a condiciones intramurales, factores del entorno cercano o individuales, coincidiendo con lo encontrado en estudios similares de salud y contaminación del aire. Se sugiere la creación de estrategias y políticas regionales para el control y monitoreo de la calidad del aire y la salud de los habitantes del departamento del Cesar.

Objectives Establishing the prevalence of respiratory symptoms and disease in children aged less than 12 years-old living within the Cesar department's coal-mining area and possible associated factors. Methods This was a cross-sectional study of 1,627 children aged less than 10 years-old living in and near coal-mining areas in the Cesar department who were exposed to different levels of PM10 from 2008-2010; their PM10 exposure-related symptoms and respiratory diseases were measured, seeking an association with living in areas exposed to particulate material. Results Children living in areas close to coal-mining activity which also had high traffic volume had a higher rate of probable cases of asthma; those living in areas with traffic (not no coal-mining) were absent from school for more days due to acute respiratory disease. Respiratory symptoms were most commonly found in children experiencing living conditions which exposed them to cigarette or firewood smoke indoors, living in houses made with wattle and daub or adobe walls, living where animals were kept, living in damp housing and diesel-powered dump trucks operating within 100 m or less of their housing. Living in areas having high traffic volume increased the risk of respiratory symptoms, acute respiratory disease and being absent from school. Discussion All the effects studied were associated with intramural conditions, individual factors or those associated with the immediate surroundings thereby coinciding with results found in similar studies regarding air pollution and health. It is thus suggested that regional strategies and policy be created for controlling and monitoring the air quality and health of people living in the Cesar department.

As queimadas na região amazônica e o adoecimento respiratório / Ground-clearing fires in the amazon and respiratory disease

A queima de biomassa florestal popularmente conhecida como "queimada" é uma prática recorrente e antiga no país e se caracteriza como um dos principais contribuintes mundiais para a emissão de gases de efeito estufa. Entretanto, a consciência global sobre seus possíveis impactos é relativamente recente. A ocorrência de grandes queimadas no cenário brasileiro e internacional despertou a atenção para o problema, mas as medidas tomadas para prevenir e/ou controlar os incêndios ainda são insuficientes. Na região amazônica, com circunstâncias geográficas e ambientais distintas do resto do país, aliadas a um processo histórico de ocupação do território, o uso do fogo expõe a cada ano, parcelas maiores da população tornando-as vulneráveis aos seus efeitos. Neste contexto, esta revisão não sistemática apresenta os trabalhos desenvolvidos nos últimos cinco anos sobre as queimadas na Amazônia Brasileira e o adoecimento respiratório. Tem como objetivo principal fornecer elementos para gestores e dirigentes ambientais sobre as questões que norteiam os problemas relacionados à queima de biomassa florestal na região amazônica.

The intentional burning of forest biomass commonly known as "ground-clearing fires" is an age-old and widespread practice in the country and is seen as a major contributor to global emissions of greenhouse gases. However, global awareness of their potential impact is relatively recent. The occurrence of large ground-clearing fires in the Brazilian and international scenarios drew attention to the problem, but the measures taken to prevent and/or control the fires are still insufficient. In the Amazon region, with distinct geographical and environmental features from the rest of the country, with its historic process of land occupation, every year the ground-clearing fires expose larger portions of the population making them vulnerable to its effects. In this context, this non-systematic review presents the papers written over the past five years about the fires in the Brazilian Amazon and respiratory illness. The main objective is to provide information for managers and leaders on environmental issues about the problems related to biomass burning in the Amazon region.

Influenza A (H1N1) was not associated with obesity in pregnant women living in Toluca, México / La Influenza A (H1N1) no se asoció con la obesidad en mujeres embarazadas en Toluca, México

Objective The aim was to verify whether being overweight could have played a critical role in cases of mortality caused byinfluenza A (H1N1) in pregnant women. This virus' prevalence was also analyzed among people suffering from acute respiratory disease being attended at the state of Mexico's Autonomous University's medical research centre. Methods The clinical files of women having influenza A (H1N1) attending the Monica Pretelini maternal-perinatal hospital's (HMPMP) intensive care unit in Toluca, Mexico, were reviewed. According to international recommendations, clinical detection of possible new cases of this disease was kept an open as a second step. Results Five women suffering influenza A (H1N1) was attended at HMPMP's intensive care unit during 2009; only one survived. No differences in body mass index were found when comparing the anthropometric characteristics to another group of women affected by acute respiratory diseases; in fact, this parameter was below the limits for being overweight in both cases. No new case of influenza A (H1N1) was found after the first eight months of 2010. Discussion It could not be verified whether being overweight was a factor of higher mortality due to influenza A (H1N1) amongst pregnant women in the state of Mexico. The key to better survival for pregnant women hospitalized with influenza A (H1N1) seemed to be early treatment with oseltamivir. The cases decreased dramatically after the severe wave of the new pandemic due to unknown reasons.

Objetivo Nuestro objetivo fue verificar si en los casos de mortalidad por influenza A (H1N1) en mujeres embarazadas, el sobrepeso tuvo un papel fundamental. También hemos analizado la prevalencia de este virus entre personas con enfermedad respiratoria aguda atendidas en el Centro de Investigación en Ciencias Médicas de la Universidad Autónoma del Estado de México. Métodos Se revisaron los expedientes clínicos de las mujeres con influenza A (H1N1) atendidos en la Unidad de Cuidados Intensivos Obstétricos del Hospital Materno Perinatal, Toluca, México. De acuerdo con las recomendaciones internacionales, como segunda etapa se mantuvo un programa de detección de este virus en la población general. Resultados Hubo cinco embarazadas con influenza A (H1N1), durante el año 2009, de las cuales sólo una sobrevivió. Al comparar las características antropométricas con otro grupo de mujeres afectadas por enfermedades respiratorias agudas no encontramos diferencias en el índice de masa corporal. De hecho, en ambos casos, este parámetro fue inferior a los límites de sobrepeso. Después de los primeros ocho meses del año 2010 no se encontraron nuevos casos de influenza A (H1N1). Discusión No hemos podido verificar que el sobrepeso sea un factor de mayor mortalidad en casos de infección por influenza A (H1N1) entre las mujeres embarazadas del Estado de México. La clave para una mejor supervivencia en mujeres embarazadas hospitalizadas con influenza A (H1N1) parece ser el tratamiento precoz con Oseltamivir. Por razones desconocidas después de la ola severa de la nueva pandemia los casos disminuyeron.

Outcomes and organ dysfunctions of critically ill patients with systemic lupus erythematosus and other systemic rheumatic diseases

Our objective was to compare the pattern of organ dysfunctions and outcomes of critically ill patients with systemic lupus erythematosus (SLE) with patients with other systemic rheumatic diseases (SRD). We studied 116 critically ill SRD patients, 59 SLE and 57 other-SRD patients. The SLE group was younger and included more women. Respiratory failure (61 percent) and shock (39 percent) were the most common causes of ICU admission for other-SRD and SLE groups, respectively. ICU length-of-stay was similar for the two groups. The 60-day survival adjusted for the groups’ baseline imbalances was not different (P = 0.792). Total SOFA scores were equal for the two groups at admission and during ICU stay, although respiratory function was worse in the other-SRD group at admission and renal and hematological functions were worse in the SLE group at admission. The incidence of severe respiratory dysfunction (respiratory SOFA >2) at admission was higher in the other-SRD group, whereas severe hematological dysfunction (hematological SOFA >2) during ICU stay was higher in the SLE group. SLE patients were younger and displayed a decreased incidence of respiratory failure compared to patients with other-SRDs. However, the incidences of renal and hematological failure and the presence of shock at admission were higher in the SLE group. The 60-day survival rates were similar.

Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy / Fisioterapia respiratória pós-operatória previne complicações respiratórias em pacientes submetidos à esofagectomia

BACKGROUND: Esophagectomy presents the highest rate of postoperative pulmonary complications among all types of upper abdominal surgery. The benefits of chest physical therapy in patients undergoing upper abdominal surgery have been shown by many studies; however, its specific effect in patients receiving esophagectomy has been seldom investigated. OBJECTIVES: This study aimed to compare the frequency of respiratory complications in patients undergoing esophagectomy receiving chest physical therapy compared to no treatment. METHODS: 70 consecutive patients were evaluated retrospectively and allocated to two groups: control group (CG=no physical therapy; n=30) and chest physical therapy group (PTG; n=40). Patients received chest physical therapy which includes lung re-expansion and airway clearance maneuvers. They were not submitted to either noninvasive ventilation or exercises with devices that generate airways positive pressure. All patients were instructed to early mobilization. Information about pre-operative and respiratory complications were collected. Statistic analysis to compare the frequency of respiratory complications was performed by the Z test. The significance level was set to 5 percent. RESULTS: Patients in the CG and PTG were similar in terms of age, BMI, smoking and drinking status, malignant diseases, surgical and anesthesia duration and types of esophagectomy (p>0.05). Our results show that patients received chest physical therapy after esophagectomy had a lower frequency of respiratory complications (15 percent vs. 37 percent, p<0.05). In addition, the PTG needed a shorter duration of antibiotic treatment and thoracic drainage as well as less re-intubation compared with the control group (p<0.05). CONCLUSIONS: Our results suggest that chest physical therapy treatment reduces respiratory complications and the need for care but does not influence on hospital length of stay.

CONTEXTUALIZAÇÃO: A esofagectomia apresenta a maior taxa de complicações pulmonares pós-operatórias dentre as cirurgias abdominais altas. Os benefícios da fisioterapia respiratória em pacientes submetidos à cirurgia abdominal alta convencional têm sido mostrados na literatura, porém esse efeito na esofagectomia tem sido pouco investigado. OBJETIVOS: Comparar a frequência de complicações respiratórias em dois grupos de pacientes submetidos à esofagectomia, tendo um recebido fisioterapia respiratória e o outro não. MÉTODOS: Setenta pacientes consecutivos (nenhuma exclusão) foram avaliados retrospectivamente e divididos em dois grupos: controle (GC=sem fisioterapia; n=30) e fisioterapia respiratória (GFT; n=40). O PTG recebeu manobras para expansão pulmonar e higiene das vias aéreas. Nenhum deles foi submetido à ventilação não-invasiva ou a exercícios com pressão positiva. Todos os pacientes foram orientados à mobilização ativa, progressiva e precoce. Foram coletadas informações sobre o perioperatório e complicações respiratórias. A frequência de complicações respiratórias entre os grupos foi analisada pelo teste z, considerando p<0,05. RESULTADOS: Pacientes de ambos os grupos foram similares quanto à idade, IMC, tabagismo e etilismo, doença maligna, tempos cirúrgico e anestésico e tipos de esofagectomia (p>0,05). Nossos resultados mostram que pacientes que receberam fisioterapia respiratória após a esofagectomia tiveram uma frequência menor de complicações respiratórias (15 por cento vs. 37 por cento, p<0,05). O PTG precisou de menos tempo de antibioticoterapia e de drenagem torácica, assim como teve menos reintubação, comparado com o controle (p<0,05). CONCLUSÕES: Os resultados sugerem que a fisioterapia respiratória após esofagectomia reduz as complicações respiratórias e a necessidade de cuidados clínicos, mas não reduz o tempo de hospitalização.

Sintomas respiratórios como indicadores de estado de saúde em trabalhadores de indústrias de cerâmicas / Respiratory symptoms as health status indicators in workers at ceramics manufacturing facilities

OBJETIVO: Analisar a prevalência de sintomas respiratórios e sua associação com as características sociodemográficas e do ambiente de trabalho. MÉTODOS: Estudo transversal realizado com 464 trabalhadores das indústrias de cerâmicas localizadas no município de Várzea Grande (MT). Para a coleta de dados, foi aplicado um questionário constituído de questões referentes às características sociodemográficas, ambiente de trabalho e sintomas respiratórios. Para a análise dos dados, foi utilizada a razão de prevalência e seu respectivo IC95 por cento entre a variável dependente (sintomas respiratórios) e as demais variáveis explicativas. Na análise multivariada, foram construídos dois modelos hierárquicos, tendo como resposta as variáveis "sintomas respiratórios gerais" e "sintomas respiratórios graves". RESULTADOS: Na população estudada, a prevalência de "sintomas respiratórios gerais" foi de 78 por cento, e aquela de "sintomas respiratórios graves" foi de 35 por cento. Os fatores associados a "sintomas respiratórios gerais" foram sexo, faixa etária, escolaridade, ocupação, exposição à poeira e exposição a produto químico. Os fatores associados a "sintomas respiratórios graves" foram escolaridade, exposição à poeira e exposição a produto químico. CONCLUSÕES: Os resultados apontam para a presença de doenças da via aérea superior e inferior na população estudada.

OBJECTIVE: To assess the prevalence of respiratory symptoms and their association with sociodemographic variables and with the characteristics of the work environment. METHODS: A cross-sectional study comprising 464 workers employed at ceramics manufacturing facilities located in the city of Várzea Grande, Brazil. Data were collected by means of a questionnaire comprising questions regarding sociodemographic variables, work environment characteristics, and respiratory symptoms. Data were analyzed by means of prevalence ratios and their respective 95 percent CIs between the dependent variable (respiratory symptoms) and the other explanatory variables. In the multivariate analysis, two hierarchical models were built, the response variables being "all respiratory symptoms" and "severe respiratory symptoms". RESULTS: In the sample studied, the prevalence of "all respiratory symptoms" was 78 percent, whereas that of "severe respiratory symptoms" was 35 percent. The factors associated with "all respiratory symptoms" were gender, age bracket, level of education, type of occupation, exposure to dust, and exposure to chemical products. The factors associated with "severe respiratory symptoms" were level of education, exposure to dust, and exposure to chemical products. CONCLUSIONS: Our results indicate the presence of upper and lower airway disease in the population studied.

Childhood Asthma

Asthma is the most common chronic disease of South African children; affecting growth and development and quality of life. Features supporting the diagnosis are a family or personal history of atopy; night cough; exercise-induced cough and/or wheeze and seasonal variation in symptoms. Asthma is on the increase in both developed and developing countries; in both rural and urban communities. The first part of this series aims to give a brief overview of the epidemiology; pathophysiology and diagnosis of childhood asthma