Asma em escolares de 13 e 14 anos do Município de Nova Iguaçu, Rio de Janeiro, Brasil: estimativas de prevalência, gravidade e diferenças de gênero

[Uncontrolled asthma in children and adolescents exposed to pesticides in an area of intense agribusiness activity]

The study aimed to analyze factors associated with uncontrolled asthma in schoolchildren exposed to pesticides in a medium-sized municipality in the state of Mato Grosso, Brazil. This was a case-control study of children 6 to 7 and 13 to 14 years old in Primavera do Leste, in 2016. Cases were defined as schoolchildren that met the criteria for uncontrolled asthma based on International Study of Asthma and Allergies in Childhood (ISAAC) questions, and controls were selected from the same schools as the cases, after randomization, at a 1:1 ratio. Data collection used the questionnaires from Phases I and II of ISAAC and an additional questionnaire on pesticide exposure. Descriptive, bivariate, and logistic da e regression analyses were performed with the individual and environmental sociodemographic, and economic variables. 319 cases and 319 controls were selected, totaling 638 participants in the study. In the final da logistic model, the variables family income greater than 4 minimum wages (OR = 14.36; 95%CI: 8.89-23.20), maternal schooling up to incomplete secondary (OR = 16.32; 95%CI: 8.96-29.75), prematurity (OR = 13.25; 95%CI: 4.83-36.41), and low birthweight (OR = 17.08; 95%CI: 5.52-52.90) remained associated with uncontrolled asthma. Of the pesticide exposure variables, presence of household member working in agriculture (OR = 5.91; 95%CI: 2.11-16.53), living near farming activities (OR = 3.98; 95%CI: 1.47-11.76), and spraying areas near the household (OR = 4.20; 95%CI: 1.49-11.87) were related to the outcome. In this study, pesticides and sociodemographic, neonatal, and childhood conditions proved related to uncontrolled asthma in schoolchildren.

Risk of misinterpretation of trends in hospital admissions for primary care sensitive conditions in local contexts: Itaboraí, Rio de Janeiro State, Brazil, 2006-2011

The study's objectives were to describe hospital admissions for primary care sensitive conditions (PCSCs) among residents of Itaboraí, a municipality in Rio de Janeiro State, Brazil, with a high rate of such admissions, to identify associated factors, and to explore the impact from closing a hospital. The ultimate aim was to contribute to the debate on the indicator's indiscriminate use for inferences on the expansion and quality of primary care. The study was based on data from the Hospital Information System of the Brazilian Unified National Health System. Associations between admissions for PCSCs and demographic and hospital-related variables were analyzed with the χ2 test. Logistic regression models verified the year-by-year behavior of admissions for PCSCs. The most frequent admissions were for heart failure, asthma, gastroenteritis, chronic obstructive pulmonary disease, and diabetes mellitus. The odds of hospital admissions were higher in males, brown individuals, at age extremes, and in private and charity hospitals. The trend in the admissions rates for PCSCs over the years was influenced by the closing of a hospital, suggesting caution in attributing changes in admissions rates to quality improvement in primary care.

Temporal trends in the prevalence of asthma and rhinoconjunctivitis in adolescents

OBJECTIVE

To analyze the temporal trend of asthma and rhinoconjunctivitis prevalences as well as their symptoms in adolescents.

METHODS

Two cross-sectional studies were conducted using the same methodology and questionnaire as was used for adolescents aged 12 to 14 years in the Brazilian city of Florianopolis, SC, Southern Brazil. Based on the international protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) study, adolescents were evaluated in 2001 and 3,150 in 2012. The schools included in this study were the same as in the 2001 study. These schools were randomly selected after stratification by network (public and private) and geographic location. The total average percentage variation was estimated for the prevalence of asthma and rhinoconjunctivitis and their symptoms.

RESULTS

The prevalence of reported asthma was 10.9% in 2001 and 14.8% in 2012, with an average variation of 2.8% in the period. The highest average variation in the period was observed among female adolescents (4.1%). In parallel a significant increase occurred in reported physician-diagnosed asthma, 7.3% in 2001 and 11,1% in 2012, with an annual variation of 4.5%. The largest increases in reported physician-diagnosed asthma were seen in female (5.9%) and male (4.5%) public school pupils. In addition, a significant increase in reported rhinoconjunctivitis occurred, with the average variation in the period being 5.2%. Reports of severe asthma symptoms remained unchanged during the period, while the annual variation for reported current wheezing (-1.3%) and wheezing during exercise (-1.2%) decreased.

CONCLUSIONS

The results showed a significant increase in the annual average variation for asthma and rhinoconjunctivitis prevalence during the 2001 to 2012 period.

Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities

OBJECTIVE

To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil.

METHODS

We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication.

RESULTS

Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men.

CONCLUSIONS

Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.

Prevalence and severity of asthma and related symptoms in 6- to 7-year-old schoolchildren of Rio de Janeiro using of the ISAAC questionnaire by telephone survey

OBJECTIVE

To evaluate the prevalence and severity of asthma and its association with sex in 6- to 7-year-old schoolchildren from the city of Rio de Janeiro (RJ), obtained by a telephone survey.

METHODS

A cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) Written Questionnaire for Asthma adapted and validated by telephone interviews was conducted. The random sample was recruited systematically, without replacement, taking into account the proportion of school classes and students in each regional coordination of the Municipal Secretariat of Education, which supplied the students' telephone numbers. The data were collected by a polling company from May to July 2010. Prevalence ratios (PRs) and 95% confidence intervals (95% CI) were compared using the difference in proportions test suitable for large samples to analyze the association between asthma and sex.

RESULTS

In total, 3216 interviews from parents/caregivers of children were analyzed; 51.4% of the children were males. Mothers were the primary respondents (71.9%). The prevalence rates of "wheezing ever" and "wheezing in the last 12 months" were 52.2% and 20.9%, respectively, and were significantly higher among boys (PR: 1.10, 95% CI: 1.03-1.18 and PR: 1.27, 95% CI: 1.10-1.45). The same pattern was observed for "asthma ever" (PR: 1.44, 95% CI: 1.12-1.85) and for "severe asthma" (PR: 1.42, 95% CI: 1.11-1.82).

CONCLUSION

The prevalence of asthma was high among RJ's students. Most of the indicators of the disease were more prevalent among boys. Our results were similar to those observed in other Brazilian and international centers using the traditional ISAAC protocol. The use of this method can be an alternative for epidemiological studies of childhood asthma especially in areas where the telephone coverage is high.

Evaluation of oral functions of the stomatognathic system according to the levels of asthma severity

PURPOSE

To compare the orofacial functions (chewing, swallowing and speech) in children with asthma and healthy children.

METHODS

A cross sectional study including 54 children of both genders with ages between 7 and 10 years was conducted. Twenty-seven of these subjects composed the experimental group, and were subdivided into two severity levels of asthma: Group I - mild intermittent and persistent asthma; Group II - persistent moderate to severe asthma. Twenty-seven healthy children were included in the control group (Group III). Speech-language pathology evaluation used the adapted Orofacial Myofunctional Assessment Protocol. Adaptation consisted in the exclusion of the structural part of the test, since this was not the aim of the study. The structural part was excluded because it was not the aim of this study.

RESULTS

It was found alterations in oral functions, with significant differences between the three groups. These alterations showed no correlation with asthma severity, since the highest rate of alterations was found in Group I (mild asthma).

CONCLUSION

Regardless of the severity level, children with asthma have altered patterns of chewing, swallowing and speech.

[Asthma and associated factors in students 13 and 14 years of age in São Luís, Maranhão State, Brazil]

The aim of this study was to estimate the prevalence of asthma and associated factors among students 13 and 14 years of age in São Luís, Maranhão State, Brazil. A cross-sectional study was conducted using the questionnaire developed by ISAAC (International Study of Asthma and Allergies in Childhood) and an additional questionnaire from July 2008 to May 2009, including 3,069 adolescents. Asthma prevalence (wheezing in the previous 12 months) was 12.7%, lifetime prevalence was 32.4%, 3.9% reported difficulty speaking due to wheezing, and 9.8% reported wheezing after exercise. In the multivariate analysis, factors associated with increased asthma prevalence were family history of asthma, respiratory infection and wheezing in early life, eczema, allergic rhinitis, and passive smoking. Asthma prevalence was lower than for Brazil as a whole. Factors most strongly associated with asthma prevalence in these adolescents were family history of asthma (PR = 3.86), wheezing in early childhood (PR = 4.58), and allergic rhinitis (PR = 3.21).

[Asthma prevalence and risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil]

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fisher's exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.

Asthma and Rhinitis in South America: How Different They are From Other Parts of the World

Asthma and rhinitis epidemiology has wide variations around the world. The aim of this review was verify the prevalence of asthma and rhinitis in South America and report differences from other regions of the world. We reviewed studies with International Study of Asthma and Allergies in Childhood (ISAAC) methodology in South America, Phases I and III. In South America the ISAAC Phase I ranked four countries among top ten in prevalence of asthma and three countries among top ten in prevalence of rhinoconjunctivitis. ISAAC Phase III showed little changes in asthma and rhinitis prevalence in South American countries. The prevalence increases of asthma and rhinitis in South American centers indicate that the burden of both is continuing to rise, but the differences in prevalence are lessening.

[Asthma and rhinitis prevalence and co-morbidity in 13-14-year-old schoolchildren in the city of Fortaleza, Ceará State, Brazil]

This study aimed to measure the prevalence rates for asthma and rhinitis and the association between the two conditions. This was a cross-sectional study of 3,015 adolescents (13-14 years of age) in Fortaleza, Ceará State, Brazil, in public and private schools, using the protocol from the International Study of Asthma and Allergies in Childhood (ISAAC), in 2006-2007. Prevalence rates were 22.6% for asthma, 43.2% for rhinitis, and 18.7% for rhinoconjunctivitis, with a predominance of females (p = 0.002, p < 0.001, and p < 0/001, respectively) and private school students (p < 0.001). Among adolescents that reported asthma, the rhinitis rate was 64.4% and the rhinoconjunctivitis rate was 35.3%. The rates of association were 14.6% between asthma and rhinitis and 8% between asthma and rhinoconjunctivitis, with a predominance of females (p < 0.001 and p < 0.001, respectively) and associated with speech-limiting wheezing (p = 0.037 and p = 0.004, respectively). The study can help call health professionals' attention to the importance of an integrated approach to these illnesses, considering the "single airway" concept and seeking treatment options that act on both asthma and rhinitis when the two conditions present simultaneously.

Sugar cane burning pollution and respiratory symptoms in schoolchildren in Monte Aprazível, Southeastern Brazil

OBJECTIVE

To estimate the prevalence of respiratory symptoms and to analyze associated factors as well as peak expiratory flow measurements in schoolchildren.

METHODS

This is a descriptive cross-sectional study with schoolchildren aged 10-14 from the city of Monte Aprazível (Southeastern Brazil). Questionnaires containing the asthma and rhinitis components of the International Study of Asthma and Allergies in Childhood were administered. The questionnaires also approached sociodemographic characteristics, predisposing factors, and family and personal medical history. Repeated measures of peak expiratory flow in the children, and of black carbon and particulate matter (PM2,5) concentration levels were carried out.

RESULTS

The prevalence of asthma and rhinitis symptoms was 11% and 33.2%, respectively. Among asthmatic children, 10.6% presented four or more wheezing attacks in the past 12 months. Past family history of bronchitis and rhinitis was associated with presence of asthma (p=0.002 and p <0.001) and rhinitis (p <0.001 and p<0.001, respectively). Regarding rhinitis, there was association with presence of mold or cracks on the house (p=0.009). Rhinitis was most frequent from June to October, a period that matches the sugarcane harvest season. Daily prevalence of peak expiratory flow below 20% of the median of each child's measurements was higher in days with greater PM2,5 concentration.

CONCLUSIONS

The prevalence of asthma symptoms is below and that of rhinitis is above the national average. Although within acceptable levels, pollution in the cane trash burn season may contribute to the exacerbation of asthma and rhinitis episodes.

[Prevalence of asthma symptoms and risk factors among adolescents in Tubarão and Capivari de Baixo, Santa Catarina State, Brazil]

This study aimed to measure the prevalence and severity of asthma symptoms and to investigate the association between asthma symptoms and personal, geographic, and socioeconomic variables in 13-14-year-old schoolchildren enrolled in the 7th and 8th grades in Tubarão and Capivari de Baixo, Santa Catarina State, Brazil. This was a cross-sectional study using the ISAAC (International Study of Asthma and Allergies in Childhood) written questionnaire, applied to 1,870 adolescents enrolled in 42 schools in the two cities, from March to May 2005. Prevalence of current asthma (defined as wheezing in the previous 12 months) was 11.8%, and there was a 7.8% lifetime prevalence of physician-diagnosed asthma. Prevalence of wheezing that interrupted sleep (one or more nights per week) was 2.1%; 8.1% had 1-3 wheezing attacks per year; and 3.7% had wheezing that disturbed their speech. According to multivariate analysis, female gender, family history, parental asthma, rental housing, and smoking inside the home were risk factors for current asthma. Prevalence and severity of current asthma were less than in other Brazilian studies.