Depression, suicidal motivation and suicidal ideation among individuals with asthma: a cross-sectional study.

BACKGROUND: Asthma is a chronic disease associated with risk of depression and suicidal events. The present study estimated the frequency of depression, suicidal motivation (SM) and suicidal ideation (SI) and identified clinical and psychosocial factors associated with these outcomes among individuals with asthma. METHODS: Cross-sectional study of a non-probabilistic sample of 1,358 adults with asthma and controls without asthma. Asthma severity and asthma control were assessed by a physician according to WHO (2009) and GINA (2012) criteria. Depression, SM and SI were screened by Beck Depression Inventory (BDI). Psychosocial factors were evaluated by a Community Violence Questionnaire, a Social Support Scale, a Stress Perceived Scale and a Resilience Scale. Chi-Square Test, and logistic regression models were performed to evaluate association between variables and outcomes. RESULTS: Among all participants, 222 (16.30%) had depression, 331 (24.40%) SM and 73 (5.40%) SI. There were 138 (12.10%) individuals with mild depression and SM, and 14 (1.20%) with mild depression and SI. After adjustment, severe asthma (SA) increased the chance of depression by 53.00% whereas mild to moderate asthma (MMA) increased by eleven-fold the likelihood of SI. Perception of low social support increased the chance of depression (OR 3.59; 95% CI, 2.44-5.28) and low resilience by (OR 2.96; 95% CI, 2.00-4.38); distress increased the odds of SM by 37.00%, and low affective support perception raised the likelihood of SI by (OR 6.82; 95% CI, 1.94-2.90). CONCLUSIONS: Asthma, whether mild to moderate or severe, increased the chance of depression and SI. It is noteworthy that individuals with mild depression and MMA are at greater risk for SM and SI. Among the psychosocial variables, perception of low social support and low resilience were the variables associated with depression; distress impacted on SM, and the perception of low affective support raised the chance of SI.

Lung Cancer Mortality and the Availability of Chest Computerized Tomography: A Longitudinal Nationwide Study.

Lung-cancer screening with chest computerized tomography (CT) is not easy to introduce in low-medium resource countries due to cost issues. We investigated whether the increasing availability of chest CT exams in Brazil, in spite of no lung-cancer screening protocol, was associated with lung-cancer death rate along 10-year follow-up. We performed regressions to estimate the rate ratio between chest CT exams and lung-cancer deaths per 105 inhabitants. We stratified data per municipality. Regressions were adjusted for physicians and hospital beds per 105 inhabitants and per capita gross domestic product. Increasing availability of chest CT exams predicted decreasing lung-cancer death rate.

Dual exposure to smoking and household air pollution is associated with an increased risk of severe asthma in adults in Brazil.

BACKGROUND: The relationship between smoking, household pollution, dual exposure and severity of asthma in adults has not been sufficiently studied. We examined and compared the effects of cigarette smoking, domestic wood burning pollution and dual exposure (tobacco and wood burning) upon asthma severity in adults. METHODS: This was a cross-sectional study performed with 452 individuals with mild to moderate asthma and 544 patients with severe asthma (previously untreated). Smoking and exposure to wood smoke were identified and quantified through questionnaires to evaluate current and/or previous exposure; objective determination of cigarette exposure was obtained through the measurement of urinary cotinine. Asthma control was evaluated through Asthma Control Questionnaire; and severity was classified according to the Global Initiative for Asthma criteria. Subjects were grouped according to exposure type into 4 groups: smokers, household pollution, dual-exposure and no-exposure. Chi square, Mann-Whitney, and Kruskal-Wallis tests were used for comparisons between groups. RESULTS: Out of 996 included individuals, 78 (7.8%) were exposed to cigarette smoking alone, 358 (35.9%) to household pollution alone, 155 (15.6%) to the two exposures combined and 405 (40.7%) were not exposed. Compared to unexposed individuals, exposure to household pollution resulted in poorer asthma control, higher proportion of severe asthma, and worse indicators of lung function. The double-exposed individuals were worse off in all the evaluated parameters, and they were significantly worse than subjects with single exposure to household air pollution in relation to asthma severity and lung function. These subjects were predominantly females, older, with longer residence time in rural areas, lower income and lower schooling levels. Multivariate analysis showed that exposure to household pollution and double exposure were predictive factors associated with lack of control and increased severity of asthma. CONCLUSIONS: Exposure to household pollution is associated with poorer control, greater severity, and poorer pulmonary function; double-exposed individuals have a greater risk of severe asthma and decreased lung function than those exposed only to household pollution.