RESUMO
OBJECTIVE: To investigate relationships between secondhand smoke exposure in young children and several preclinical markers of cardiovascular risk that have been established as relevant to adult populations. STUDY DESIGN: There were 139 children, 2-5 years of age, enrolled in a cross-sectional study. Secondhand smoke exposure was objectively determined by hair nicotine level; a comprehensive panel of clinical markers (morning blood pressure, fasting glucose and insulin, lipid profiles, inflammation) and research markers (markers of oxidation, endothelial stress, and endothelial repair) of cardiovascular risk status were assessed. Univariate and multivariate linear regression were used to evaluate relationships between secondhand smoke exposure and cardiovascular risk markers. RESULTS: Hair nicotine levels were correlated directly with blood pressure and serum C-reactive protein, and inversely correlated with serum high-density lipoprotein cholesterol and endothelial cell progenitor cell prevalence. In multivariate analyses, these relationships remained when controlled for age, sex, body mass index z-score, maternal education, and method of payment. Additionally, in multivariate analyses, hair nicotine level was significantly negatively correlated with total antioxidant capacity. CONCLUSIONS: These results support the view that secondhand smoke exposure in the very young has a detectable relationship with several markers of cardiovascular risk, long before the emergence of clinical disease. Further studies to define mechanisms and strategies to prevent and mitigate these risks early in life are warranted.
Assuntos
Biomarcadores/análise , Doenças Cardiovasculares/sangue , Nicotina/análise , Poluição por Fumaça de Tabaco/análise , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Análise de Regressão , Fatores de Risco , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
OBJECTIVE: To assess whether geographic location influences hospitalizations for pulmonary exacerbations for patients with cystic fibrosis (CF) in the US, as there is no existing literature regarding this subject. STUDY DESIGN: The CF Foundation Patient Registry was analyzed during the years 2007-2012 via geographic grouping of states. The impact of geographic region on recovery from hospitalization, hospitalization length, and time to next hospitalization were analyzed using multivariate models. RESULTS: Posthospitalization lung function and nutritional measures were similar among regions for 1 year following hospitalization. The West region was associated with risk of longer hospital stays (OR 1.60, CI 1.45-1.77), however, dornase alfa use (OR 3.85, CI 1.15-12.92) was the only specific factor. History of allergic bronchopulmonary aspergillosis (OR 1.58, CI 1.11-2.25) and adult age (OR 2.48, CI 1.17-5.25) in the Northeast, chronic macrolide use in the South (OR 1.36, CI 1.03-1.79), and infection with Candida albicans (OR 1.47, CI 1.18-1.82) and Pseudomonas aeruginosa (OR 1.44, CI 1.02-2.04) in the Midwest were associated with increased hospitalization length. There was a significantly decreased risk for subsequent hospitalizations in the Northeast compared with other regions (P = .038). Sociodemographic analysis identified Caucasians in the South having a significantly lower risk of future hospitalization compared with African Americans (hazard ratio 0.79, CI 0.69-0.91, P = .0009). CONCLUSIONS: There is significant regional variability in hospitalization length and risks for subsequent hospitalizations for patients with CF in the US. Regional variation should be subject to further study to determine if benchmarking standards can be achieved nationally.
Assuntos
Fibrose Cística/terapia , Progressão da Doença , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Fibrose Cística/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Thyroid disorders are common in women of reproductive age, and thyroid dysfunction during pregnancy has been associated with adverse outcomes for mother and child. Thyroid function and thyroid function tests (TFTs) can be influenced by a variety of factors, such as ethnicity, the presence of autoimmune thyroid disease (AITD), dietary iodine intake, pregnancy, and methodological differences. However, no large-scale studies have been published which examine TFTs and prevalence of AITD in Mexican pregnant women and women of reproductive age. METHODS: TFTs and thyroid autoantibody testing were performed on 660 pregnant and 104 non-pregnant women from Mérida, Yucatán, Mexico. After removal of thyroid autoantibody positive individuals and women with thyroid stimulating hormone (TSH) >4.94 mIU/L, reference intervals were calculated for TFT for non-pregnant women and pregnant women by trimester. RESULTS: Anti-thyroidperoxidase antibodies (TPO-Ab) and/or anti-thyroglobulin antibodies (Tg-Ab) were positive in 14.4% and 13.5% of non-pregnant and pregnant women, respectively. TSH values were significantly higher in women who were positive for TPO-Ab and co-positive for TPO-Ab and Tg-Ab. TSH values were also significantly higher in Tg-Ab positive pregnant women. Other TFTs were not significantly different based on antibody status. Using antibody negative women, reference intervals were determined for TFTs in pregnant (gestational age-specific) and non-pregnant women. CONCLUSIONS: Laboratory evidence of AITD is common in this population of Mexican pregnant and non-pregnant women. TFT results and reference intervals are influenced by pregnancy and thyroid autoimmunity. For optimal interpretation of TFT results, gestational age-specific reference intervals established using a local patient population should be used.