Ludmilla da Silva Viana Jacobson

Association between fine particulate matter and the peak expiratory flow of schoolchildren in the Brazilian subequatorial Amazon: A panel study ☆

BACKGROUND Exposure to high levels of particulate matter with an aerodynamic diameter less than 2.5 μm (PM(2.5)) resulting from biomass burning is frequent in the subequatorial Amazon region. OBJECTIVE To investigate whether or not current exposure to PM(2.5) in the Brazilian Amazon has adverse effects on the daily peak expiratory flow (PEF) of schoolchildren. METHODS The study design consisted of a panel comprising 309 children aged 6 to 15 years from the same school. PEF was measured daily, except weekends and holidays, from August to December 2006. Each child contributed to the study up to 67 daily measurements. All together there were 19115 PEF measures. Participation rate was 90%. Daily measurements of PM(2.5), temperature, and humidity as well as passive smoking, and subject features were regarded in the statistical analysis. Various exposures of PM(2.5) were considered throughout the analysis, among them 24-hour, 12-hour, 6-hour, and 5-hour means. To account for subject responses to confounders, mixed effects models were applied. The effects were evaluated considering air pollution levels on the current day or at 1- or 2-day lags and the averages of 0-1-day lags, 1-2-day lags and 0-, 1-, and 2-day lags. RESULTS The 24-hour PM(2.5) means ranged from 6.39 to 99.91 μg/m(3). The adjusted models for the entire group of children revealed adverse effects. For instance, for an increase of 10 μg/m(3) in PM(2.5,) the reduction in the PEF average varied between 0.26 l/min (95% Confidence Interval (CI): -0.49; -0.04) and 0.38 l/min (95% CI: -0.71; -0.04). Restricted to the subgroup of non-asthmatic children, classified as such according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, there was a reduction in the PEF ranging from 0.38 l/min (95% CI: -0.63; -0.13) to 0.53 l/min (95% CI: -0.90; -0.16) for an increase of 10 μg/m(3) in PM(2.5). There was no significant effect in the asthmatic group. When stratified by time of the day children were at school, the concurrent effects of air pollution on PEF were not significant, whereas the 6-hour exposure from 0 am to 5:30 am was significant for both morning and afternoon groups. Finally, the 24-hour mean lagged effect was only significant for the afternoon group of children. For an increase of 10 μg/m(3) in PM(2.5,) there was a reduction in the PEF that ranged from 0.41 l/min (95% CI: -0.76; -0.06) to 0.49 l/min (95% CI: -0.91; -0.07). CONCLUSION Exposure to current levels of PM(2.5) in the Brazilian Amazon was associated with reductions in the lung function of schoolchildren. The adverse effects were more consistent in non-asthmatic children and with respect to the 6-hour mean from 0 am to 5.30 am.

Acute Effects of Particulate Matter and Black Carbon from Seasonal Fires on Peak Expiratory Flow of Schoolchildren in the Brazilian Amazon

Background Panel studies have shown adverse effects of air pollution from biomass burning on childrens health. This study estimated the effect of current levels of outdoor air pollution in the Amazonian dry season on peak expiratory flow (PEF). Methods A panel study with 234 schoolchildren from 6 to 15 years old living in the municipality of Tangará da Serra, Brazil was conducted. PEF was measured daily in the dry season in 2008. Mixed-effects models and unified modelling repeated for every child were applied. Time trends, temperature, humidity, and subject characteristics were regarded. Inhalable particulate matter (PM10), fine particulate matter (PM2.5), and black carbon (BC) effects were evaluated based on 24-hour exposure lagged by 1 to 5 days and the averages of 2 or 3 days. Polynomial distributed lag models (PDLM) were also applied. Results The analyses revealed reductions in PEF for PM10 and PM2.5 increases of 10 µg/m3 and 1 µg/m3 for BC. For PM10, the reductions varied from 0.15 (confidence interval (CI)95%: −0.29; −0.01) to 0.25 l/min (CI95%: −0.40; −0.10). For PM2.5, they ranged from 0.46 (CI95%: −0.86 to −0.06) to 0.54 l/min (CI95%:−0.95; −0.14). As for BC, the reduction was approximately 1.40 l/min. In relation to PDLM, adverse effects were noticed in models based on the exposure on the current day through the previous 3 days (PDLM 0–3) and on the current day through the previous 5 days (PDLM 0–5), specially for PM10. For all children, for PDLM 0–5 the global effect was important for PM10, with PEF reduction of 0.31 l/min (CI95%: −0.56; −0.05). Also, reductions in lags 3 and 4 were observed. These associations were stronger for children between 6 and 8 years old. Conclusion Reductions in PEF were associated with air pollution, mainly for lagged exposures of 3 to 5 days and for younger children.

Mortalidade por doenças cardiorrespiratórias em idosos no estado de Mato Grosso, 1986 a 2006

OBJETIVO: Descrever a evolucao temporal da mortalidade por doencas cardiorrespiratorias em idosos. METODOS: Estudo epidemiologico descritivo com delineamento ecologico de series temporais realizado no estado do Mato Grosso, de 1986 a 2006. Foram utilizados dados sobre doencas dos aparelhos respiratorio e circulatorio obtidos do Sistema de Informacao sobre Mortalidade do Ministerio da Saude. Modelos de regressao linear simples foram ajustados para avaliar a tendencia das taxas especificas de mortalidade por grupos especificos de idade (60 a 69, 70 a 79 e 80 ou mais anos) e sexo. RESULTADOS: Houve aumento na proporcao de obitos por doencas respiratorias e diminuicao por doencas cardiovasculares. Na comparacao de taxas entre os sexos, as mulheres apresentaram taxas 15% menores para as causas cardiovasculares e taxas similares ao sexo masculino para as causas respiratorias. Foi observada taxa elevada de mortalidade por doencas respiratorias e cardiovasculares, com importante tendencia de incremento entre os grupos mais longevos. Em idosos com idade > 80 anos o aumento anual medio na taxa de mortalidade por doencas respiratorias foi de 1,99 obitos e de 3,43 por doencas do aparelho circulatorio. CONCLUSOES: O estado de Mato Grosso apresenta elevada taxa de mortalidade por doencas respiratorias e cardiovasculares em idosos, com importante tendencia de incremento entre os grupos mais longevos.OBJECTIVE To describe time trends of mortality due to cardiorespiratory diseases in elderly people. METHODS Epidemiological descriptive study with an ecological time series approach conducted in the state of Mato Grosso, Central-West Brazil, between 1986 and 2006. Data were obtained from the Brazilian Ministry of Health Mortality Database. Linear regression models were adjusted to analyze trends in mortality rates by age groups (60 to 69; 70 to 79; and 80 or more) and gender. RESULTS There was an increase in proportion of deaths due to respiratory diseases and a decrease in proportion of deaths due to cardiovascular diseases. As for gender, cardiovascular rates were 15% lower in women than men and respiratory rates were similar in both men and women. High mortality rates for respiratory and cardiovascular diseases were observed with increasing trends among the oldest-old groups. The annual average increase for respiratory and cardiovascular diseases in those aged 80 years and older was 1.99 and 3.43 deaths, respectively. CONCLUSIONS The state of Mato Grosso shows high mortality rates due to cardiorespiratory disease among elderly people with increasing trends among the oldest-old groups.

Effects of resistance exercise training on acyl-ghrelin and obestatin levels in hemodialysis patients.

Abstract Background: Patients undergoing hemodialysis (HD) present altered levels of appetite hormones such as acyl-ghrelin (orexigenic) and obestatin (anorexigenic), which may contribute to anorexia. Physical exercise may affect these hormones and improve appetite in these patients. Objectives: The objective of this study is to evaluate the effects of a resistance exercise program in appetite hormones, body composition, and nutritional status in HD patients. Design: Intervention study with the control group. Subjects: Fifty-two patients on regular HD program were enrolled into two groups: 37 patients performed exercises (56.7% male, 45 ± 12.8 years, 57 (9–192) months on HD) and 15 patients comprised the control group (66.7% men, 50 ± 10.6 years, 57 (11–153) months on HD). Measurements: Exercise program (performed with elastic bands and ankle cuffs in both lower limbs) was supervised three times a week during 6 months (72 sessions). Patients had their blood drawn in a regular HD day after overnight fasting, before and after 6 months of exercise program. Obestatin, acyl-ghrelin, routine biochemical parameters, quality of life, and anthropometric data were collected and analyzed before and after 6 months. Results: After 6 months of exercise, obestatin levels reduced [from 3.0 ng/mL (2.3–3.4) to 1.9 ng/mL (0.6–3.4)] and acyl-ghrelin levels increased [from 21.5 pg/mL (1.3–77.7) to 37.2 pg/mL (16.7–94.1)] and the control group presented no significant differences in both plasma levels of hormones. Body composition and physical functional assessed by SF-36 and albumin levels (3.7 ± 0.3 to 3.9 ± 0.2, p < 0.05) improved after exercises. Conclusion: Six months of resistance exercises contributed to changes in plasma appetite hormones, body composition, and nutritional status in hemodialysis patients.

Prevalência de sibilância e fatores associados em crianças menores de 5 anos de Cuiabá, Mato Grosso, Brasil

Wheezing is highly prevalent in Brazil, with variations in rates and risk factors between the regions of the country. This cross-sectional study aimed to analyze the prevalence of wheezing in children under 5 years of age (n = 733) in Cuiabá, Mato Grosso State, Brazil. The study used a brief version of the standardized instrument from the International Study of Wheezing in Infants (EISL). Analysis of factors associated used logistic regression with a hierarchical approach. Prevalence of wheezing in the previous 12 months was 43.2%. Factors associated with wheezing were: lack of at least 6 months of breastfeeding (adjusted OR = 1.91; 95%CI: 1.18-3.06), diagnosis of asthma in the family (adjusted OR = 2.02; 95%CI: 1.06-3.87), current respiratory infection (adjusted OR = 1.81; 95%CI: 1.05-3.14), and male gender (adjusted OR = 1.50; 95%CI: 1.07-2.11). The study concludes that prevalence of wheezing is high among children in this age bracket in Cuiabá and is associated with factors related to allergy, current respiratory infection, and male gender.A prevalencia de sibilância no Brasil e elevada, com variacoes entre as regioes do pais, bem como com fatores de risco diferenciados. Com o objetivo de analisar a prevalencia de sibilância e fatores associados em menores de 5 anos em Cuiaba, Mato Grosso, Brasil, realizou-se estudo transversal, cuja amostra constou de 733 criancas. Foi utilizado o instrumento padronizado, resumido do Estudio Internacional de Sibilancias en Lactantes (EISL). Para analise dos fatores associados a sibilância foi aplicada regressao logistica com abordagem hierarquizada. A prevalencia de sibilância nos ultimos 12 meses foi de 43,2%. Foram associados a sibilância: nao amamentacao ao seio por 6 meses ou mais (OR ajustada = 1,91; IC95%: 1,18-3,06), diagnostico de asma familiar (OR ajustada = 2,02; IC95%: 1,06-3,87), doenca previa (OR ajustada = 1,81; IC95%: 1,05-3,14) e sexo masculino (OR ajustada = 1,50; IC95%: 1,07-2,11). Concluiu-se que a prevalencia de sibilância em criancas dessa faixa etaria em Cuiaba e elevada e esta associada a fatores relacionados a provavel atopia, doenca previa e sexo masculino.

Mortality due to cardiorespiratory diseases in elderly people in Mato Grosso state, 1986 to 2006

OBJETIVO: Descrever a evolucao temporal da mortalidade por doencas cardiorrespiratorias em idosos. METODOS: Estudo epidemiologico descritivo com delineamento ecologico de series temporais realizado no estado do Mato Grosso, de 1986 a 2006. Foram utilizados dados sobre doencas dos aparelhos respiratorio e circulatorio obtidos do Sistema de Informacao sobre Mortalidade do Ministerio da Saude. Modelos de regressao linear simples foram ajustados para avaliar a tendencia das taxas especificas de mortalidade por grupos especificos de idade (60 a 69, 70 a 79 e 80 ou mais anos) e sexo. RESULTADOS: Houve aumento na proporcao de obitos por doencas respiratorias e diminuicao por doencas cardiovasculares. Na comparacao de taxas entre os sexos, as mulheres apresentaram taxas 15% menores para as causas cardiovasculares e taxas similares ao sexo masculino para as causas respiratorias. Foi observada taxa elevada de mortalidade por doencas respiratorias e cardiovasculares, com importante tendencia de incremento entre os grupos mais longevos. Em idosos com idade > 80 anos o aumento anual medio na taxa de mortalidade por doencas respiratorias foi de 1,99 obitos e de 3,43 por doencas do aparelho circulatorio. CONCLUSOES: O estado de Mato Grosso apresenta elevada taxa de mortalidade por doencas respiratorias e cardiovasculares em idosos, com importante tendencia de incremento entre os grupos mais longevos.OBJECTIVE To describe time trends of mortality due to cardiorespiratory diseases in elderly people. METHODS Epidemiological descriptive study with an ecological time series approach conducted in the state of Mato Grosso, Central-West Brazil, between 1986 and 2006. Data were obtained from the Brazilian Ministry of Health Mortality Database. Linear regression models were adjusted to analyze trends in mortality rates by age groups (60 to 69; 70 to 79; and 80 or more) and gender. RESULTS There was an increase in proportion of deaths due to respiratory diseases and a decrease in proportion of deaths due to cardiovascular diseases. As for gender, cardiovascular rates were 15% lower in women than men and respiratory rates were similar in both men and women. High mortality rates for respiratory and cardiovascular diseases were observed with increasing trends among the oldest-old groups. The annual average increase for respiratory and cardiovascular diseases in those aged 80 years and older was 1.99 and 3.43 deaths, respectively. CONCLUSIONS The state of Mato Grosso shows high mortality rates due to cardiorespiratory disease among elderly people with increasing trends among the oldest-old groups.

Estudo transversal dos fatores associados ao uso de corticoide inalatório em crianças residentes no município de Cuiabá, Estado de Mato Grosso, Brasil, 2010

Objective: to analyse factors associated with inhaled corticosteroid use in children under 5 years old. Methods: cross-sectional study carried out in Cuiaba with a sample of 733 children. Crude odds ratios (OR) and adjusted odds ratios (OR aj ) and Confidence Intervals (95%CI) were estimated using logistic regression models. Results: the prevalence of inhaled corticosteroid use in the past 12 months was 13.2% (95%CI = 8.4; 18.0%). It was associated with the use of private health services (OR aj = 4.62; 95%CI = 2.41; 8.85), asthma diagnosed by a doctor (OR aj = 3.97; 95%CI = 1.37; 11.48), bronchitis hospitalization (OR aj = 2.31; 95%CI = 1.04; 5.12), and three or more wheezing episodes in the past 12 months (OR aj = 2.78; 95% CI = 1.10; 7.03). Conclusion: the use of inhaled corticosteroids was associated with private health services, medical diagnosis of asthma and severe asthma indicators.

Prevalence of wheezing and associated factors in children under 5 years of age in Cuiabá, Mato Grosso State, Brazil

Wheezing is highly prevalent in Brazil, with variations in rates and risk factors between the regions of the country. This cross-sectional study aimed to analyze the prevalence of wheezing in children under 5 years of age (n = 733) in Cuiabá, Mato Grosso State, Brazil. The study used a brief version of the standardized instrument from the International Study of Wheezing in Infants (EISL). Analysis of factors associated used logistic regression with a hierarchical approach. Prevalence of wheezing in the previous 12 months was 43.2%. Factors associated with wheezing were: lack of at least 6 months of breastfeeding (adjusted OR = 1.91; 95%CI: 1.18-3.06), diagnosis of asthma in the family (adjusted OR = 2.02; 95%CI: 1.06-3.87), current respiratory infection (adjusted OR = 1.81; 95%CI: 1.05-3.14), and male gender (adjusted OR = 1.50; 95%CI: 1.07-2.11). The study concludes that prevalence of wheezing is high among children in this age bracket in Cuiabá and is associated with factors related to allergy, current respiratory infection, and male gender.A prevalencia de sibilância no Brasil e elevada, com variacoes entre as regioes do pais, bem como com fatores de risco diferenciados. Com o objetivo de analisar a prevalencia de sibilância e fatores associados em menores de 5 anos em Cuiaba, Mato Grosso, Brasil, realizou-se estudo transversal, cuja amostra constou de 733 criancas. Foi utilizado o instrumento padronizado, resumido do Estudio Internacional de Sibilancias en Lactantes (EISL). Para analise dos fatores associados a sibilância foi aplicada regressao logistica com abordagem hierarquizada. A prevalencia de sibilância nos ultimos 12 meses foi de 43,2%. Foram associados a sibilância: nao amamentacao ao seio por 6 meses ou mais (OR ajustada = 1,91; IC95%: 1,18-3,06), diagnostico de asma familiar (OR ajustada = 2,02; IC95%: 1,06-3,87), doenca previa (OR ajustada = 1,81; IC95%: 1,05-3,14) e sexo masculino (OR ajustada = 1,50; IC95%: 1,07-2,11). Concluiu-se que a prevalencia de sibilância em criancas dessa faixa etaria em Cuiaba e elevada e esta associada a fatores relacionados a provavel atopia, doenca previa e sexo masculino.

Prevalencia y factores asociados con sibilancias en niños menores de 5 años en Cuiabá, Mato Grosso, Brasil

Wheezing is highly prevalent in Brazil, with variations in rates and risk factors between the regions of the country. This cross-sectional study aimed to analyze the prevalence of wheezing in children under 5 years of age (n = 733) in Cuiabá, Mato Grosso State, Brazil. The study used a brief version of the standardized instrument from the International Study of Wheezing in Infants (EISL). Analysis of factors associated used logistic regression with a hierarchical approach. Prevalence of wheezing in the previous 12 months was 43.2%. Factors associated with wheezing were: lack of at least 6 months of breastfeeding (adjusted OR = 1.91; 95%CI: 1.18-3.06), diagnosis of asthma in the family (adjusted OR = 2.02; 95%CI: 1.06-3.87), current respiratory infection (adjusted OR = 1.81; 95%CI: 1.05-3.14), and male gender (adjusted OR = 1.50; 95%CI: 1.07-2.11). The study concludes that prevalence of wheezing is high among children in this age bracket in Cuiabá and is associated with factors related to allergy, current respiratory infection, and male gender.A prevalencia de sibilância no Brasil e elevada, com variacoes entre as regioes do pais, bem como com fatores de risco diferenciados. Com o objetivo de analisar a prevalencia de sibilância e fatores associados em menores de 5 anos em Cuiaba, Mato Grosso, Brasil, realizou-se estudo transversal, cuja amostra constou de 733 criancas. Foi utilizado o instrumento padronizado, resumido do Estudio Internacional de Sibilancias en Lactantes (EISL). Para analise dos fatores associados a sibilância foi aplicada regressao logistica com abordagem hierarquizada. A prevalencia de sibilância nos ultimos 12 meses foi de 43,2%. Foram associados a sibilância: nao amamentacao ao seio por 6 meses ou mais (OR ajustada = 1,91; IC95%: 1,18-3,06), diagnostico de asma familiar (OR ajustada = 2,02; IC95%: 1,06-3,87), doenca previa (OR ajustada = 1,81; IC95%: 1,05-3,14) e sexo masculino (OR ajustada = 1,50; IC95%: 1,07-2,11). Concluiu-se que a prevalencia de sibilância em criancas dessa faixa etaria em Cuiaba e elevada e esta associada a fatores relacionados a provavel atopia, doenca previa e sexo masculino.

Mortalidad por enfermedades cardiorrespiratorias en ancianos en el Estado de Mato Grosso, 1996 a 2006

OBJETIVO: Descrever a evolucao temporal da mortalidade por doencas cardiorrespiratorias em idosos. METODOS: Estudo epidemiologico descritivo com delineamento ecologico de series temporais realizado no estado do Mato Grosso, de 1986 a 2006. Foram utilizados dados sobre doencas dos aparelhos respiratorio e circulatorio obtidos do Sistema de Informacao sobre Mortalidade do Ministerio da Saude. Modelos de regressao linear simples foram ajustados para avaliar a tendencia das taxas especificas de mortalidade por grupos especificos de idade (60 a 69, 70 a 79 e 80 ou mais anos) e sexo. RESULTADOS: Houve aumento na proporcao de obitos por doencas respiratorias e diminuicao por doencas cardiovasculares. Na comparacao de taxas entre os sexos, as mulheres apresentaram taxas 15% menores para as causas cardiovasculares e taxas similares ao sexo masculino para as causas respiratorias. Foi observada taxa elevada de mortalidade por doencas respiratorias e cardiovasculares, com importante tendencia de incremento entre os grupos mais longevos. Em idosos com idade > 80 anos o aumento anual medio na taxa de mortalidade por doencas respiratorias foi de 1,99 obitos e de 3,43 por doencas do aparelho circulatorio. CONCLUSOES: O estado de Mato Grosso apresenta elevada taxa de mortalidade por doencas respiratorias e cardiovasculares em idosos, com importante tendencia de incremento entre os grupos mais longevos.OBJECTIVE To describe time trends of mortality due to cardiorespiratory diseases in elderly people. METHODS Epidemiological descriptive study with an ecological time series approach conducted in the state of Mato Grosso, Central-West Brazil, between 1986 and 2006. Data were obtained from the Brazilian Ministry of Health Mortality Database. Linear regression models were adjusted to analyze trends in mortality rates by age groups (60 to 69; 70 to 79; and 80 or more) and gender. RESULTS There was an increase in proportion of deaths due to respiratory diseases and a decrease in proportion of deaths due to cardiovascular diseases. As for gender, cardiovascular rates were 15% lower in women than men and respiratory rates were similar in both men and women. High mortality rates for respiratory and cardiovascular diseases were observed with increasing trends among the oldest-old groups. The annual average increase for respiratory and cardiovascular diseases in those aged 80 years and older was 1.99 and 3.43 deaths, respectively. CONCLUSIONS The state of Mato Grosso shows high mortality rates due to cardiorespiratory disease among elderly people with increasing trends among the oldest-old groups.