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- ItemSomente MetadadadosHealth effects of air pollution exposure on children and adolescents in São Paulo, Brazil(Wiley-Blackwell, 2001-02-01) Braga, ALF; Saldiva, PHN; Pereira, LAA; Menezes, JJC; Conceicao, GMS; Lin, C. A.; Zanobetti, A.; Schwartz, J.; Dockery, D. W.; Harvard Univ; Universidade Federal de São Paulo (UNIFESP); Univ Santo AmaroChildren and adolescents have been considered more susceptible to the effects of air pollution than adults. in order to investigate the responses of children of different ages to air pollution exposure, daily records or hospital admissions for children in five age groups (equal or less than 2 years of age, 3-5, 6-13, 14-19, and all ages together, i.e., from 0-19 years of age) were obtained from January 1993 to November 1997 in São Paulo, Brazil, and were compared to daily records of PM10, O-3, SO2, CO and NO2 concentrations in ambient air. for each age group a generalized additive Poisson regression was fitted controlling for smooth functions of time, temperature, humidity, and days of the week, with an additional indicator for holidays. Polynomial distributed lag models were used to estimate the 7-day cumulative effect of each pollutant.Children 2 years or less were the most susceptible to the effects of all five pollutants with an increase of 9.4% (95% CI: 7.9,10.9) in respiratory admissions associated with each interquartile range increase in PM10. the oldest group was the second most susceptible to air pollutants, with each interquartile range increase in PM10 associated with a 5.1% (95% CI: 0.3,9.8) increase in respiratory admissions. An interquartile range increase in CO was associated with an 11.3% (95% CI: 5.9,16.8) increase in respiratory hospitalizations. When a multipollutant model was used, the effect of PM10 on respiratory admissions for all ages together was unchanged, while the SOP and the other pollutants effect was substantially reduced.This study showed that daily respiratory hospital admissions for children and adolescents in São Paulo increased with air pollution, and that the largest effects were found for the youngest (2 years or less) and oldest (14-19 years) age groups. Pediatr Pulmonol. 2001; 31:106-113. (C) 2001 Wiley-Liss, Inc.
- ItemAcesso aberto (Open Access)The impact of sugar cane-burning emissions on the respiratory system of children and the elderly(Us Dept Health Human Sciences Public Health Science, 2006-05-01) Cançado, J. E.; Saldiva, PHN; Pereira, LAA; Lara, LBLS; Artaxo, P.; Martinelli, L. A.; Arbex, Marcos Abdo [UNIFESP]; Zanobetti, A.; Braga, ALF; Universidade de São Paulo (USP); Catholic Univ Santos; Universidade Federal de São Paulo (UNIFESP); Harvard UnivWe analyzed the influence of emissions front burning sugar cane on the respiratory system during almost I year in the city of Piracicaba in southeast Brazil. From April 1997 through March 1998, samples of inhalable particles were collected, separated into fine and coarse particulate mode, and analyzed for black carbon and tracer elements. At the same time, we examined daily records of children (< 13 years of age) and elderly people (> 64 years of age) admitted to the hospital because of respiratory diseases. Generalized linear models were adopted with natural cubic splines to control for season and linear terms to control for weather. Analyses were carried out for the entire period, as well as for burning and rionburning periods. Additional models were built using three factors obtained from factor analysis instead of particles or tracer elements. Increases of 10.2 mu g/m(3) in particles <= 2.5 mu m/m(3) aerodynamic diameter (PM2.5) and 42.9 mu g/m(3) in PM10 were associated with increases of 21.4% [95% confidence interval (0), 4.3-38.5] and 31.03% (95% Cl, 1.25-60.21) in child and elderly respiratory hospital admissions, respectively. When we compared periods, the effects during the burning period were much higher than the effects during nonburning period. Elements generated from sugar cane burning (factor 1) were those most associated with both child and elderly respiratory admissions. Our results show the adverse impact of sugar cane burning emissions on the health of the population, reinforcing the need for public efforts to reduce and eventually eliminate this source of air pollution.
- ItemSomente MetadadadosLong-term home oxygen therapy in children and adolescents: analysis of clinical use and costs of a home care program(Soc Brasil Pediatria, 2011-01-01) Munhoz, Andrea S. [UNIFESP]; Adde, Fabiola V.; Nakaie, Cleyde M. A.; Doria Filho, Ulysses; Silva Filho, Luiz V. R. F.; Rodrigues, Joaquim C.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Objectives: To describe the clinical and laboratory characteristics of patients on long-term home oxygen therapy followed up by the home care program of Hospital das Clinicas, School of Medicine, Universidade de São Paulo, during a period of 8 years, and to compare groups with and without secondary pulmonary hypertension. To estimate the cost of the program using oxygen concentrators versus oxygen cylinders provided by the hospital.Methods: A descriptive, retrospective cohort study of patients on long-term home oxygen therapy followed up from 2002 to 2009 at the Unit of Pulmonology, Children's Institute, Hospital das Clinicas, School of Medicine, Universidade de São Paulo.Results: We studied 165 patients, of whom 53% were male, with the following medians: age at the beginning of oxygen therapy - 3.6 years; duration of oxygen therapy - 7 years; and survival time after beginning of oxygen therapy - 3.4 years. the main diagnoses were: cystic fibrosis (22%), bronchopulmonary dysplasia (19%), and bronchiolitis obliterans (15%). of the 33 patients who underwent spirometry, 70% had severe obstructive lung disease. Echocardiogram was performed in 134 patients; 51% of them had secondary pulmonary hypertension. There was a statistically significant association between pulmonary hypertension and need of higher oxygen flows (chi-square, p = 0.011), and pulmonary hypertension and longer duration of oxygen therapy (Logrank, p = 0.0001). There was no statistically significant difference between survival time after the beginning of oxygen therapy and pulmonary hypertension. the average monthly costs of the program were: US$ 7,392.93 for concentrators and US$ 16,630.92 for cylinders.Conclusions: Long-term home oxygen therapy was used to treat different chronic diseases, predominantly in infants and preschool children. There was a high frequency of pulmonary hypertension associated with longer periods of oxygen use and greater oxygen flow, without association with survival rate. the use of concentrators instead of cylinders may reduce costs significantly.