[Clinical characteristics of children on prolonged mechanical ventilation due to different primary diseases]. / ä¸åŒåŽŸå‘ç— å¯¼è‡´é•¿æœŸæœºæ¢°é€šæ°”æ‚£å„¿çš„ä¸´åºŠç‰¹å¾åˆ†æž.

OBJECTIVES: To investigate the differences in clinical characteristics among children on prolonged mechanical ventilation (PMV) due to different primary diseases. METHODS: A retrospective analysis was performed on the clinical data of 59 pediatric patients requiring PMV from July 2017 to September 2022. According to the primary disease, they were divided into respiratory disease (RD) group, central nervous system (CNS) group, neuromuscular disease (NMD) group, and other disease group. The four groups were compared in terms of general information, treatment, and outcome. RESULTS: There were significant differences among the four groups in age, body weight, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, Pediatric Risk of Mortality III (PRISM Ⅲ) score, analgesic and sedative treatment, nutrition supply, rehabilitation treatment, tracheotomy, successful ventilator weaning, and outcomes (P<0.05). Compared with the RD group, the CNS group and the other disease group had a significantly higher age and a significantly higher proportion of children receiving rehabilitation treatment, and the CNS group had a significantly higher proportion of children receiving tracheotomy (P<0.008). Compared with the other disease group, the CNS group and the NMD group had significantly lower PELOD-2 and PRISM III scores, and the CNS group had a significantly higher proportion of children with successful ventilator weaning and a significantly higher proportion of children who were improved and discharged (P<0.008). CONCLUSIONS: There are differences in clinical characteristics among children receiving PMV due to different etiologies. Most children in the RD group have a younger age, and children in the CNS group have a relatively good prognosis.

Associations between vaping and self-reported respiratory symptoms in young people in Canada, England and the US.

BACKGROUND: Prevalence of youth nicotine vaping has increased, heightening concerns around negative health effects. This study aimed to compare self-reported respiratory symptoms among youth by vaping behaviours. METHODS: Participants (n = 39,214) aged 16-19 from the 2020 and 2021 International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Surveys (Canada, England, US). Weighted multivariable logistic regression assessed associations between reporting any of five respiratory symptoms in the past week (shortness of breath, wheezing, chest pain, phlegm, cough) and: past 30-day smoking and/or vaping; lifetime/current vaping. Among past-30-day vapers (n = 4644), we assessed associations between symptoms and vaping frequency, use of nicotine salts, usual flavour and device type(s). RESULTS: Overall, 27.8% reported experiencing any of the five respiratory symptoms. Compared with youth who had only vaped, those who had only smoked had similar odds of symptoms [adjusted odds ratio, OR (95% confidence interval, CI): 0.97 (0.85-1.10)], those who both smoked and vaped had higher odds [1.26 (1.12-1.42)], and those who had done neither, lower odds [0.67 (0.61-0.72)]. Compared with those who had never vaped, past use, experimentation and current regular or occasional use were all associated with higher odds. Reporting usually using nicotine salts was associated with higher odds of symptoms [1.43 (1.22-1.68)] than non-salt but was often uncertain. Compared with tobacco flavour (including with menthol), menthol/mint and sweets flavours were associated with similar odds; fruit [1.44 (1.07-1.93)], multiple [1.76 (1.30-2.39)] and 'other' [2.14 (1.45-3.16)] flavours with higher odds. All device types were associated with similar odds. CONCLUSIONS: Among youth, vaping was associated with increased reporting of past-week respiratory symptoms. Among those who vaped, some flavour types and potentially nicotine salts were associated with respiratory symptoms.

[Primary antibody deficiencies and respiratory manifestations in adults].

Primary antibody deficiencies (PAD) are a group of congenital disorders caused by genetic defects that affect the development and function of the body's immune defence mechanisms. Patients with PAD may present with recurrent infections, lymphoproliferation, autoimmune diseases, autoinflammation, or malignancies. Respiratory system manifestations may include bronchiectasis, bronchial asthma, and interstitial lung disease, among others. A comprehensive understanding of PADs will help to distinguish these covert cases from more common respiratory diseases.

Research on the cascading mechanism of "urban built environment-air pollution-respiratory diseases": a case of Wuhan city.

Background: Most existing studies have only investigated the direct effects of the built environment on respiratory diseases. However, there is mounting evidence that the built environment of cities has an indirect influence on public health via influencing air pollution. Exploring the "urban built environment-air pollution-respiratory diseases" cascade mechanism is important for creating a healthy respiratory environment, which is the aim of this study. Methods: The study gathered clinical data from 2015 to 2017 on patients with respiratory diseases from Tongji Hospital in Wuhan. Additionally, daily air pollution levels (sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM2.5, PM10), and ozone (O3)), meteorological data (average temperature and relative humidity), and data on urban built environment were gathered. We used Spearman correlation to investigate the connection between air pollution and meteorological variables; distributed lag non-linear model (DLNM) was used to investigate the short-term relationships between respiratory diseases, air pollutants, and meteorological factors; the impacts of spatial heterogeneity in the built environment on air pollution were examined using the multiscale geographically weighted regression model (MGWR). Results: During the study period, the mean level of respiratory diseases (average age 54) was 15.97 persons per day, of which 9.519 for males (average age 57) and 6.451 for females (average age 48); the 24 h mean levels of PM10, PM2.5, NO2, SO2 and O3 were 78.056 µg/m3, 71.962 µg/m3, 54.468 µg/m3, 12.898 µg/m3, and 46.904 µg/m3, respectively; highest association was investigated between PM10 and SO2 (r = 0.762, p < 0.01), followed by NO2 and PM2.5 (r = 0.73, p < 0.01), and PM10 and PM2.5 (r = 0.704, p < 0.01). We observed a significant lag effect of NO2 on respiratory diseases, for lag 0 day and lag 1 day, a 10 µg/m3 increase in NO2 concentration corresponded to 1.009% (95% CI: 1.001, 1.017%) and 1.005% (95% CI: 1.001, 1.011%) increase of respiratory diseases. The spatial distribution of NO2 was significantly influenced by high-density urban development (population density, building density, number of shopping service facilities, and construction land, the bandwidth of these four factors are 43), while green space and parks can effectively reduce air pollution (R2 = 0.649). Conclusion: Previous studies have focused on the effects of air pollution on respiratory diseases and the effects of built environment on air pollution, while this study combines these three aspects and explores the relationship between them. Furthermore, the theory of the "built environment-air pollution-respiratory diseases" cascading mechanism is practically investigated and broken down into specific experimental steps, which has not been found in previous studies. Additionally, we observed a lag effect of NO2 on respiratory diseases and spatial heterogeneity of built environment in the distribution of NO2.

Trends in work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK: descriptive findings from The Health and Occupation Research (THOR) network 1996-2019.

BACKGROUND: Occupational exposure to metals can be associated with respiratory diseases which can adversely affect the individual's health, finances and employment. Despite this, little is known about the incidence of these respiratory conditions over prolonged periods of time. AIMS: This study aimed to investigate the trends in the incidence of work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK. METHODS: Cases of occupational respiratory diseases caused by nickel, chromium or cobalt reported to Surveillance of Work-related and Occupational Respiratory Disease (SWORD), the UK-based surveillance scheme between 1996 and 2019 (inclusive), were extracted and grouped into six 4-year time periods. Cases were characterised by causative metal exposure, occupational and industrial sector. Incidence rates diseases (adjusted for physician participation and response rate) were calculated using ONS employment data. RESULTS: Of cases reported to SWORD during the study period, 1% (173 actual cases) of respiratory problems were attributed to nickel, chromium or cobalt. Diagnoses of asthma compromised the largest proportion of diagnoses (74.4%), followed by lung cancer (8.9%) and pneumoconiosis (6.7%). Cases had a mean age of 47 years (SD 13); 93% were men. The annual incidence fell from 1.6 per million employed in the first 4-year period, to 0.2 in the most recent period. CONCLUSIONS: Over 24 years, a decline in the incidence of metal-related occupational respiratory diseases was observed in the UK. This could be attributed to improvements in working conditions which resulted in reduced metal exposure but could also be due to closure of industries that might have generated case returns.

[A prospective study on the relationship between exposure to solid fuels for heating and its duration and the risk of morbidity of respiratory diseases among residents aged 30-79 years].

Objective: To research the association between exposure to solid fuels for heating and its duration and the risk of respiratory diseases morbidity. Methods: Data from the China Kadoorie Biobank project sited in Pengzhou City, Sichuan Province. Cox proportional hazard regression model was used to analyze the association between exposure to solid fuels for heating and its duration and the risk of total respiratory diseases and the association between exposure to solid fuels for heating and the risk of chronic obstructive pulmonary disease (COPD) and pneumonia among respiratory diseases. Results: A total of 46 082 participants aged 30-79 years were enrolled, with 11 634 (25.25%) heating during the winter, of whom 8 885 (19.28%) used clean fuels and 2 749 (5.97%) used solid fuels, of whom 34 448 (74.75%) did not heat. After controlling for multiple confounding factors, Cox proportional hazard regression model was used, which revealed that compared with clean fuels, unheating could reduce the risk of total respiratory disease (HR=0.81,95%CI:0.77-0.86), COPD (HR=0.86,95%CI:0.78-0.95) and pneumonia (HR=0.80,95%CI:0.74-0.86), respectively. Exposure to solid fuels increased the risk of total respiratory disease (HR=1.10, 95%CI:1.01-1.20) and were not associated with COPD and pneumonia. Compared with no solid fuel exposure, the risk of total respiratory disease (1-19 years:HR=1.23, 95%CI:1.10-1.37; 20-39 years:HR=1.25, 95%CI:1.16-1.35; ≥40 years:HR=1.26, 95%CI:1.15-1.39) and COPD (1-19 years: HR=1.21, 95%CI:1.03-1.42; 20-39 years: HR=1.30, 95%CI:1.16-1.46; ≥40 years:HR=1.35, 95%CI:1.18-1.54) increased with the length of exposure of solid fuels (trend test P<0.001). Solid fuels exposure for 1-19 years and 20-39 years increased the risk of COPD by 23% (HR=1.23,95%CI:1.02-1.49) and 16% (HR=1.16, 95%CI:1.00-1.35). Conclusion: Heating solid fuels exposure increases the risk of total respiratory disease, COPD, and pneumonia.

[Pesticide exposure and chronic respiratory diseases]. / Exposition aux pesticides et maladies respiratoires chroniques.

INTRODUCTION: Pesticides are used worldwide, mainly in agriculture as a means of controlling pests and protecting crops. That said, the entire world population is ultimately subject to pesticide exposure (consumption of fruits and vegetables, living near treated fields…), with varying degrees of toxicity involved. STATE OF THE ART: In recent decades, epidemiological studies have contributed to the identification of chemical pesticide families with detrimental effects on human health: cognitive disorders, Parkinson's disease, prostate cancer… and impairment in respiratory functioning. Current scientific evidence points to the implication of the active substances in insecticides, herbicides and fungicides in chronic respiratory diseases, two examples being chronic obstructive pulmonary disease (COPD) in exposed workers, and asthmatic wheezing in children during prenatal or postnatal exposure. PERSPECTIVES: The safety of individuals exposed to pesticides is of key importance in public health. Further epidemiological investigations are needed to identify the chemical families affecting certain populations. CONCLUSIONS: The scientific literature suggests strong links between pesticide exposure and respiratory health. Whether it be environmental or occupational, pesticide exposure can lead to respiratory disorders and symptoms of varying severity.

Preoperative GLP-1 Receptor Agonist Use and Risk of Postoperative Respiratory Complications.

This cohort study evaluates the risk of postoperative respiratory complications among patients with diabetes undergoing surgery who had vs those who had not a prescription fill for glucagon-like peptide 1 receptor agonists.

Cohort profile: The Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study.

BACKGROUND: The Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) study is a prospective cohort study of environmental influences on respiratory health in a rural, southeastern region of California (CA), which aims to longitudinally examine the contribution of a drying saline lake to adverse health impacts in children. OBJECTIVES: This cohort was established through a community-academic partnership with the goal of assessing the health effects of childhood exposures to wind-blown particulate matter (PM) and inform public health action. We hypothesize that local PM sources are related to poorer children's respiratory health. POPULATION: Elementary school children in Imperial Valley, CA. DESIGN: Prospective cohort study. METHODS: Between 2017 and 2019, we collected baseline information on 731 children, then follow-up assessments yearly or twice-yearly since 2019. Data have been collected on children's respiratory health, demographics, household characteristics, physical activity and lifestyle, via questionnaires completed by parents or primary caregivers. In-person measurements, conducted since 2019, repeatedly assessed lung function, height, weight and blood pressure. Exposure to air pollutants has been assessed by multiple methods and individually assigned to participants using residential and school addresses. Health data will be linked to ambient and local sources of PM, during and preceding the study period to understand how spatiotemporal trends in these environmental exposures may relate to respiratory health. PRELIMINARY RESULTS: Analyses of respiratory symptoms indicate a high prevalence of allergies, bronchitic symptoms and wheezing. Asthma diagnosis was reported in 24% of children at enrolment, which exceeds both CA state and US national prevalence estimates for children. CONCLUSIONS: The Children's AIRE cohort, while focused on the health impacts of the drying Salton Sea and air quality in Imperial Valley, is poised to elucidate the growing threat of drying saline lakes and wind-blown dust sources to respiratory health worldwide, as sources of wind-blown dust emerge in our changing climate.

The impact of environmental conditions on non-communicable diseases in sub-Saharan Africa: A scoping review of epidemiologic evidence.

Background: The burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is increasing. Environmental conditions such as heavy metals and air pollution have been linked with the incidence and mortality of chronic diseases such as cancer, as well as cardiovascular and respiratory diseases. We aimed to scope the current state of evidence on the impact of environmental conditions on NCDs in SSA. Methods: We conducted a scoping review to identify environmental conditions linked with NCDs in SSA by identifying studies published from January 1986 through February 2023. We searched African Index Medicus, Ovid Medline, Scopus, Web of Science, and Greenfile. Using the PICOS study selection criteria, we identified studies conducted in SSA focussed on physical environmental exposures and incidence, prevalence, and mortality of NCDs. We included only epidemiologic or quantitative studies. Results: We identified 6754 articles from electronic database searches; only 36 met our inclusion criteria and were qualitatively synthesised. Two studies were conducted in multiple SSA countries, while 34 were conducted across ten countries in SSA. Air pollution (58.3%) was the most common type of environmental exposure reported, followed by exposure to dust (19.4%), meteorological variables (13.8%), heavy metals (2.7%), soil radioactivity (2.7%), and neighbourhood greenness (2.7%). The examined NCDs included respiratory diseases (69.4%), cancer (2.7%), stroke (5.5%), diabetes (2.7%), and two or more chronic diseases (19.4%). The study results suggest an association between environmental exposures and NCDs, particularly for respiratory diseases. Only seven studies found a null association between environmental conditions and chronic diseases. Conclusions: There is a growing body of research on environmental conditions and chronic diseases in the SSA region. Although some cities in SSA have started implementing environmental monitoring and control measures, there remain high levels of environmental pollution. Investment can focus on improving environmental control measures and disease surveillance.

[Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project]. / Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha.

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

Short term exposure to low level ambient fine particulate matter and natural cause, cardiovascular, and respiratory morbidity among US adults with health insurance: case time series study.

OBJECTIVE: To estimate the excess relative and absolute risks of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease associated with daily exposure to fine particulate matter (PM2.5) at concentrations below the new World Health Organization air quality guideline limit among adults with health insurance in the contiguous US. DESIGN: Case time series study. SETTING: US national administrative healthcare claims database. PARTICIPANTS: 50.1 million commercial and Medicare Advantage beneficiaries aged ≥18 years between 1 January 2010 and 31 December 2016. MAIN OUTCOME MEASURES: Daily counts of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease based on the primary diagnosis code. RESULTS: During the study period, 10.3 million hospital admissions and 24.1 million emergency department visits occurred for natural causes among 50.1 million adult enrollees across 2939 US counties. The daily PM2.5 levels were below the new WHO guideline limit of 15 µg/m3 for 92.6% of county days (7 360 725 out of 7 949 713). On days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 µg/m3, an increase of 10 µg/m3 in PM2.5 during the current and previous day was associated with higher risk of hospital admissions for natural causes, with an excess relative risk of 0.91% (95% confidence interval 0.55% to 1.26%), or 1.87 (95% confidence interval 1.14 to 2.59) excess hospital admissions per million enrollees per day. The increased risk of hospital admissions for natural causes was observed exclusively among adults aged ≥65 years and was not evident in younger adults. PM2.5 levels were also statistically significantly associated with relative risk of hospital admissions for cardiovascular and respiratory diseases. For emergency department visits, a 10 µg/m3 increase in PM2.5 during the current and previous day was associated with respiratory disease, with an excess relative risk of 1.34% (0.73% to 1.94%), or 0.93 (0.52 to 1.35) excess emergency department visits per million enrollees per day. This association was not found for natural causes or cardiovascular disease. The higher risk of emergency department visits for respiratory disease was strongest among middle aged and young adults. CONCLUSIONS: Among US adults with health insurance, exposure to ambient PM2.5 at concentrations below the new WHO air quality guideline limit is statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease, and respiratory disease, and with emergency department visits for respiratory diseases. These findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.

Air pollution and childhood respiratory consultations in primary care: a systematic review.

BACKGROUND: Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care. OBJECTIVE: To evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses. METHODS: A search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle-Ottawa Scale (NOS) for cohort or case-control studies and an adjusted NOS for time series studies. RESULTS: From 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter ≤10 µm (PM10)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations. CONCLUSIONS: The evidence suggests CO, SO2, NO2, PM10 and PM2.5 are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution. PROSPERO REGISTRATION NUMBER: CRD42022259279.

From "Immunity Debt" to "Immunity Theft"-How COVID-19 Might Be Tied to Recent Respiratory Disease Surges.

This Medical News story discusses the relationship between the COVID-19 pandemic and recent increases in other respiratory diseases.

Long-term exposure to PM2.5 species and all-cause mortality among Medicare patients using mixtures analyses.

BACKGROUND: The relationship between long-term exposure to PM2.5 and mortality is well-established; however, the role of individual species is less understood. OBJECTIVES: In this study, we assess the overall effect of long-term exposure to PM2.5 as a mixture of species and identify the most harmful of those species while controlling for the others. METHODS: We looked at changes in mortality among Medicare participants 65 years of age or older from 2000 to 2018 in response to changes in annual levels of 15 PM2.5 components, namely: organic carbon, elemental carbon, nickel, lead, zinc, sulfate, potassium, vanadium, nitrate, silicon, copper, iron, ammonium, calcium, and bromine. Data on exposure were derived from high-resolution, spatio-temporal models which were then aggregated to ZIP code. We used the rate of deaths in each ZIP code per year as the outcome of interest. Covariates included demographic, temperature, socioeconomic, and access-to-care variables. We used a mixtures approach, a weighted quantile sum, to analyze the joint effects of PM2.5 species on mortality. We further looked at the effects of the components when PM2.5 mass levels were at concentrations below 8 µg/m3, and effect modification by sex, race, Medicaid status, and Census division. RESULTS: We found that for each decile increase in the levels of the PM2.5 mixture, the rate of all-cause mortality increased by 1.4% (95% CI: 1.3%-1.4%), the rate of cardiovascular mortality increased by 2.1% (95% CI: 2.0%-2.2%), and the rate of respiratory mortality increased by 1.7% (95% CI: 1.5%-1.9%). These effects estimates remained significant and slightly higher when we restricted to lower concentrations. The highest weights for harmful effects were due to organic carbon, nickel, zinc, sulfate, and vanadium. CONCLUSIONS: Long-term exposure to PM2.5 species, as a mixture, increased the risk of all-cause, cardiovascular, and respiratory mortality.

[Burning of sugarcane biomass and hospitalizations of children and older adults for respiratory problems in Pernambuco State, Brazil]. / Queima de biomassa da cana-de-açúcar e hospitalizações de crianças e idosos por agravos respiratórios em Pernambuco, Brasil.

This study aimed to analyze the relationship between hospitalizations for respiratory problems and the regular burning of sugarcane in Pernambuco State, Brazil. This is an ecological time series study corresponding to the period from 2008 to 2018. The rates of hospitalizations for respiratory diseases in children aged under 5 years and in adults older than 60 years in sugarcane-producing and non-producing municipalities were compared using nonparametric Mann-Whitney statistical analysis. Together, we observed the monthly distribution of the hot spots occurrences in the case and control municipalities and applied Pearson's correlation to analyze the association between both variables. For both age groups, hospitalization rates are higher in sugarcane-producing municipalities, with a statistically significant difference p < 0.005. The rate of hospitalization in older adults is 28% higher in the case municipalities, and is even higher in children aged under 5 years whose ratio of the medians is 40%. However, the seasonal behavior of hospitalizations for respiratory diseases differs from that observed in the monthly distribution of hot spots, without statistically significant correlation. These findings suggest a possible association with chronic exposure to particulates emitted by biomass burning, compromising the health of vulnerable groups, and endorse the need to replace fires in the monoculture of sugarcane and to structure public policies to protect human and environmental health.

Este estudo buscou analisar a relação entre as hospitalizações por agravos respiratórios e a queima regular da cana-de-açúcar em Pernambuco, Brasil. Trata-se de um estudo ecológico de série temporal correspondente ao período de 2008 a 2018. Foram comparadas as taxas de hospitalizações por agravos respiratórios em crianças menores de 5 anos e em idosos maiores de 60 anos em municípios produtores e não produtores de cana-de-açúcar, por meio da análise estatística não paramétrica de Mann-Whitney. Conjuntamente, foi observada a distribuição mensal das ocorrências de focos de calor nos municípios casos e controles e aplicada a correlação de Pearson para analisar a associação entre ambas as variáveis. Foi verificado que, para ambos os grupos etários, as taxas de hospitalizações são maiores nos municípios produtores de cana-de-açúcar, com diferença estatística significativa p < 0,005. A taxa de internação hospitalar em idosos é 28% mais elevada nos municípios casos, sendo ainda maior em crianças menores de 5 anos, cuja razão das medianas é 40%. No entanto, foi identificado que o comportamento sazonal das hospitalizações por agravos respiratórios diverge do observado na distribuição mensal dos focos de calor, não havendo correlação estatística significativa. Esses achados sugerem possível associação com a exposição crônica aos particulados emitidos pela queima de biomassa, comprometendo a saúde de grupos vulneráveis, e endossam a necessidade de substituição das queimadas no monocultivo da cana-de-açúcar, bem como a estruturação de políticas públicas de proteção à saúde humana e ambiental.

Este estudio buscó analizar la relación entre las hospitalizaciones por enfermedades respiratorias y la quema regular de caña de azúcar en Pernambuco, Brasil. Se trata de un estudio ecológico de serie temporal correspondiente al período entre 2008 y 2018. Las tasas de hospitalizaciones por enfermedades respiratorias en niños menores de 5 años y en ancianos mayores de 60 años en municipios productores de caña de azúcar y en los municipios no productores de azúcar se compararon mediante el análisis estadístico no paramétrico de Mann-Whitney. Se observó en conjunto la distribución mensual de las ocurrencias de puntos calientes en los casos y controles de los municipios, y se aplicó la correlación de Pearson para analizar la asociación entre ambas variables. Se encontró que, para ambos grupos de edad, las tasas de hospitalización fueron más altas en los municipios productores de caña de azúcar, con una diferencia estadísticamente significativa p < 0,005. La tasa de hospitalización de los ancianos fue un 28% mayor en los municipios casos, y aún mayor que la de los niños menores de 5 años cuya relación de las medianas fue del 40%. Sin embargo, se identificó que el comportamiento estacional de las hospitalizaciones por enfermedades respiratorias difiere de lo observado en la distribución mensual de puntos calientes, sin correlación estadística significativa. Estos hallazgos evidencian una posible asociación con la exposición crónica a partículas emitidas por la quema de biomasa, lo que afecta la salud de los grupos vulnerables, además apuntan a la necesidad de implementar medidas contra los incendios en el monocultivo de la caña de azúcar y políticas públicas para proteger la salud humana y el medioambiente.

Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples.

OBJECTIVE: The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes. METHODS: We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates. RESULTS: Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey. CONCLUSIONS: Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.

Clinical and biochemical footprints of inherited metabolic diseases. XIII. Respiratory manifestations.

At any age, respiratory manifestations are a major cause of increased morbidity and mortality of inherited metabolic diseases (IMDs). Type and severity are extremely variable, this depending on the type of the underlying disorder. Symptoms and signs originating from upper or lower airways and/or thoracic wall and/or respiratory muscles involvement can occur either at presentation or in the late clinical course. Acute respiratory symptoms can trigger metabolic decompensation which, in turn, makes airway symptoms worse, creating a vicious circle. We have identified 181 IMDs associated with various types of respiratory symptoms which were classified into seven groups according to the type of clinical manifestations affecting the respiratory system: (i) respiratory failure, (ii) restrictive lung disease, (iii) interstitial lung disease, (iv) lower airway disease, (v) upper airway obstruction, (vi) apnea, and (vii) other. We also provided a list of investigations to be performed based on the respiratory phenotypes and indicated the therapeutic strategies currently available for IMD-associated airway disease. This represents the thirteenth issue in a series of educational summaries providing a comprehensive and updated list of metabolic differential diagnoses according to system involvement.