RESUMO

OBJECTIVE: To assess cardiac autonomic modulation, measured by short-term frequency domain analysis of heart rate variability (HRV), in children with asthma. METHODS: We conducted an observational study at a tertiary care teaching hospital. The sample consisted of 119 children aged 7 to 15 years with asthma and 56 age-matched healthy controls. Frequency domain HRV measures included low-frequency (LF; 0.04-0.15 Hz), high-frequency (HF; 0.15-0.4 Hz), and LF/HF ratio. The LF and HF components were expressed in both absolute values of power (ms2 ) and in normalized units (nu). RESULTS: Compared with healthy controls, asthmatic children had significantly higher value of HF (nu) (mean ± standard deviation: 45.9 ± 14.6 vs 40.7 ± 13.6; P = .02), and lower values of LF (nu) (54.1 ± 14.6 vs 59.3 ± 13.6; P = .02) and LF/HF ratio (median, interquartile range: 1.12, 0.82-1.88 vs 1.59, 1.02-2.08; P = .03). We did not find significant differences between children with persistent and intermittent asthma, and between children with well-controlled and partially-controlled or uncontrolled asthma, in terms of HRV measures. CONCLUSIONS: Children with stable chronic asthma may have a cardiac autonomic imbalance with a possible enhanced parasympathetic modulation, as assessed by short-term frequency domain analysis of HRV. Neither asthma severity nor asthma control was significantly associated with HRV measures, but the study did not have enough power to draw a firm conclusion on this point.

Assuntos

Asma/fisiopatologia , Frequência Cardíaca/fisiologia , Adolescente , Sistema Nervoso Autônomo/fisiologia , Criança , Feminino , Humanos , Masculino

RESUMO

OBJECTIVE: The objective of this study is to investigate the association between anti-Toxocara IgG seropositivity and asthma in children. METHODS: This was a case-control study conducted in a university hospital in south Brazil between May 2012 and June 2013. Were recruited 208 children up to 12 years old of whom 156 had asthma (cases) and 52 did not have asthma (controls), with a case-control ratio of 3:1 matched by age. Children's parents or guardians were interviewed using a structured questionnaire with closed questions. Serology was performed using enzyme-linked immunosorbent assay (ELISA) with excretory-secretory antigen of Toxocara canis (TES). RESULTS: The seroprevalence of IgG anti-T. canis antibodies was 12.8% in the cases and 7.7% in the controls. There was no significant association between seropositivity to T. canis and risk of asthma (adjusted odds ratio [OR]: 1.89, 95% CI: 0.52 to 6.89, p = 0.33). Household income < 2 minimum salaries, paternal school years < 9, allergic rhinitis in children, a positive family history of asthma and rhinitis and contact with cats were significantly associated with asthma, with adjusted ORs (95% CIs) of 3.05 (1.21 to 7.73), 2.83 (1.11 to 7.18), 10.5 (4.32 to 25.6), 2.65 (1.14 to 6.17), 2.49 (1.07 to 5.78) and 2.73 (1.03 to 7.27), respectively. CONCLUSIONS: This study did not find a statistically significant association between seropositivity to Toxocara sp. and risk of asthma in children. Low family income, low paternal education level, concomitant allergic rhinitis, family history of asthma and allergic rhinitis and contact with cats were independent factors associated with childhood asthma.

Assuntos

Asma/epidemiologia , Imunoglobulina G/sangue , Toxocara/imunologia , Toxocaríase/epidemiologia , Toxocaríase/imunologia , Animais , Anticorpos Anti-Helmínticos/sangue , Brasil/epidemiologia , Estudos de Casos e Controles , Gatos , Criança , Pré-Escolar , Cães , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Rinite Alérgica/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Toxocaríase/transmissão

RESUMO

AIM: To investigate association between nutritional status, adiposity and asthma severity and control in children. METHODS: We conducted a case control study at two teaching hospitals in Brazil. Cases were children (3-12 years) with persistent asthma and age-matched controls were those with intermittent asthma. Nutritional status was assessed by body mass index (BMI). Adiposity was assessed by sum of skinfolds and waist circumference (WC). Crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using conditional logistic regression or multinomial logistic regression as appropriate. RESULTS: Two hundred sixty-eight cases and 126 controls were included. Obesity (>2 BMI z-score for age) was significantly associated with persistent asthma (adjusted OR 2.62; 95% CI 1.39-4.95). There was a significant linear relationship between BMI z-scores (≤1, >1 to ≤2, >2) and risk of having persistent asthma (P = 0.003 for linear trend). Children with WC >90th percentile had a higher risk of persistent asthma when compared with those with WC ≤90th percentile (adjusted OR 3.38; 95% CI 1.26-9.06). No significant difference was found in terms of nutritional status and adiposity between children whose asthma was controlled by inhaled corticosteroids and those requiring inhaled corticosteroids plus other medications for asthma control. CONCLUSIONS: Obesity measured by BMI and increased abdominal adiposity are significantly associated with risk of persistent asthma but not type of controller medications.

Assuntos

Adiposidade/fisiologia , Asma/fisiopatologia , Estado Nutricional , Índice de Massa Corporal , Brasil , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Masculino , Obesidade/fisiopatologia , Análise de Regressão , Fatores de Risco , Circunferência da Cintura

RESUMO

OBJECTIVE: To investigate association between dietary habits and asthma severity in children. DESIGN: Cross-sectional study. SETTING: Two teaching hospitals in Brazil. PARTICIPANTS: Cases (n=268) were children (3-12yr) with persistent asthma and age-matched controls (n=126) were those with intermittent asthma. MAIN OUTCOME MEASURES: Dietary habits were determined based on food consumption in the past 12 months classified as frequent (≥3 times per week) or infrequent (never or <3 times per week).Nutritional status was classified into two categories according to WHO Child Growth Standards: obese: >2Z-score of BMI-for-age; non-obese: ≤2Z-score of BMI-for-age. RESULTS: After adjusting for confounding factors, maternal smoking during pregnancy, preterm birth and obesity were significantly associated with persistent asthma, with adjusted ORs (95% CI) of 2.11 (1.08- 4.13), 2.61(1.07-6.35) and 2.89 (1.49-5.61), respectively. No significant association was observed between frequency of consumption of specific foods, food groups, or dietary pattern (pro- or contra-Mediterranean diet) and the severity of asthma. CONCLUSIONS: This study did not find a significant association between dietary habits and asthma severity in children. Maternal smoking during pregnancy, preterm birth and obesity were independent factors associated with persistent asthma.

Assuntos

Asma/epidemiologia , Comportamento Alimentar , Asma/fisiopatologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade , Fatores de Risco

RESUMO

BACKGROUND: Treatment guidelines for asthma recommend inhaled corticosteroids (ICS) as first-line therapy for children with persistent asthma. Although ICS treatment is generally considered safe in children, the potential systemic adverse effects related to regular use of these drugs have been and continue to be a matter of concern, especially the effects on linear growth. OBJECTIVES: To assess the impact of ICS on the linear growth of children with persistent asthma and to explore potential effect modifiers such as characteristics of available treatments (molecule, dose, length of exposure, inhalation device) and of treated children (age, disease severity, compliance with treatment). SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register of trials (CAGR), which is derived from systematic searches of bibliographic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED and PsycINFO; we handsearched respiratory journals and meeting abstracts. We also conducted a search of ClinicalTrials.gov and manufacturers' clinical trial databases to look for potential relevant unpublished studies. The literature search was conducted in January 2014. SELECTION CRITERIA: Parallel-group randomised controlled trials comparing daily use of ICS, delivered by any type of inhalation device for at least three months, versus placebo or non-steroidal drugs in children up to 18 years of age with persistent asthma. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction and assessment of risk of bias in included studies. We conducted meta-analyses using the Cochrane statistical package RevMan 5.2 and Stata version 11.0. We used the random-effects model for meta-analyses. We used mean differences (MDs) and 95% CIs as the metrics for treatment effects. A negative value for MD indicates that ICS have suppressive effects on linear growth compared with controls. We performed a priori planned subgroup analyses to explore potential effect modifiers, such as ICS molecule, daily dose, inhalation device and age of the treated child. MAIN RESULTS: We included 25 trials involving 8471 (5128 ICS-treated and 3343 control) children with mild to moderate persistent asthma. Six molecules (beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone propionate and mometasone furoate) given at low or medium daily doses were used during a period of three months to four to six years. Most trials were blinded and over half of the trials had drop out rates of over 20%. Compared with placebo or non-steroidal drugs, ICS produced a statistically significant reduction in linear growth velocity (14 trials with 5717 participants, MD -0.48 cm/y, 95% CI -0.65 to -0.30, moderate quality evidence) and in the change from baseline in height (15 trials with 3275 participants; MD -0.61 cm/y, 95% CI -0.83 to -0.38, moderate quality evidence) during a one-year treatment period. Subgroup analysis showed a statistically significant group difference between six molecules in the mean reduction of linear growth velocity during one-year treatment (Chi(2) = 26.1, degrees of freedom (df) = 5, P value < 0.0001). The group difference persisted even when analysis was restricted to the trials using doses equivalent to 200 µg/d hydrofluoroalkane (HFA)-beclomethasone. Subgroup analyses did not show a statistically significant impact of daily dose (low vs medium), inhalation device or participant age on the magnitude of ICS-induced suppression of linear growth velocity during a one-year treatment period. However, head-to-head comparisons are needed to assess the effects of different drug molecules, dose, inhalation device or patient age. No statistically significant difference in linear growth velocity was found between participants treated with ICS and controls during the second year of treatment (five trials with 3174 participants; MD -0.19 cm/y, 95% CI -0.48 to 0.11, P value 0.22). Of two trials that reported linear growth velocity in the third year of treatment, one trial involving 667 participants showed similar growth velocity between the budesonide and placebo groups (5.34 cm/y vs 5.34 cm/y), and another trial involving 1974 participants showed lower growth velocity in the budesonide group compared with the placebo group (MD -0.33 cm/y, 95% CI -0.52 to -0.14, P value 0.0005). Among four trials reporting data on linear growth after treatment cessation, three did not describe statistically significant catch-up growth in the ICS group two to four months after treatment cessation. One trial showed accelerated linear growth velocity in the fluticasone group at 12 months after treatment cessation, but there remained a statistically significant difference of 0.7 cm in height between the fluticasone and placebo groups at the end of the three-year trial. One trial with follow-up into adulthood showed that participants of prepubertal age treated with budesonide 400 µg/d for a mean duration of 4.3 years had a mean reduction of 1.20 cm (95% CI -1.90 to -0.50) in adult height compared with those treated with placebo. AUTHORS' CONCLUSIONS: Regular use of ICS at low or medium daily doses is associated with a mean reduction of 0.48 cm/y in linear growth velocity and a 0.61-cm change from baseline in height during a one-year treatment period in children with mild to moderate persistent asthma. The effect size of ICS on linear growth velocity appears to be associated more strongly with the ICS molecule than with the device or dose (low to medium dose range). ICS-induced growth suppression seems to be maximal during the first year of therapy and less pronounced in subsequent years of treatment. However, additional studies are needed to better characterise the molecule dependency of growth suppression, particularly with newer molecules (mometasone, ciclesonide), to specify the respective role of molecule, daily dose, inhalation device and patient age on the effect size of ICS, and to define the growth suppression effect of ICS treatment over a period of several years in children with persistent asthma. PLAIN LANGUAGE SUMMARY: Do inhaled corticosteroids reduce growth in children with persistent asthma? Review question: We reviewed the evidence on whether inhaled corticosteroids (ICS) could affect growth in children with persistent asthma, that is, a more severe asthma that requires regular use of medications for control of symptoms. BACKGROUND: Treatment guidelines for asthma recommend ICS as first-line therapy for children with persistent asthma. Although ICS treatment is generally considered safe in children, parents and physicians always remain concerned about the potential negative effect of ICS on growth. Search date: We searched trials published until January 2014. Study characteristics: We included in this review trials comparing daily use of corticosteroids, delivered by any type of inhalation device for at least three months, versus placebo or non-steroidal drugs in children up to 18 years of age with persistent asthma. KEY RESULTS: Twenty-five trials involving 8471 children with mild to moderate persistent asthma (5128 treated with ICS and 3343 treated with placebo or non-steroidal drugs) were included in this review. Eighty percent of these trials were conducted in more than two different centres and were called multi-centre studies; five were international multi-centre studies conducted in high-income and low-income countries across Africa, Asia-Pacifica, Europe and the Americas. Sixty-eight percent were financially supported by pharmaceutical companies. Meta-analysis (a statistical technique that combines the results of several studies and provides a high level of evidence) suggests that children treated daily with ICS may grow approximately half a centimeter per year less than those not treated with these medications during the first year of treatment. The magnitude of ICS-related growth reduction may depend on the type of drug. Growth reduction seems to be maximal during the first year of therapy and less pronounced in subsequent years of treatment. Evidence provided by this review allows us to conclude that daily use of ICS can cause a small reduction in height in children up to 18 years of age with persistent asthma; this effect seems minor compared with the known benefit of these medications for asthma control. QUALITY OF EVIDENCE: Eleven of 25 trials did not report how they guaranteed that participants had an equal chance of receiving ICS or placebo or non-steroidal drugs. All but six trials did not report how researchers were kept unaware of the treatment assignment list. However, this methodological limitation may not significantly affect the quality of evidence because the results remained almost unchanged when we excluded these trials from the analysis.

RESUMO

Objetivo: Avaliar a tendência de mortalidade por asma em crianças brasileiras de até 19 anos de idade no período de 1980 a 2007. Métodos: Foi realizado um estudo ecológico, de séries temporais, baseado em banco de dados do Departamento de Informática do Sistema Único de Saúde, do qual foi extraído o número de óbitos por asma e a popuação residente de até 19 anos de idade no país como um todo. O coeficiente de mortalidade foi calculado pelo número de óbitos por asma dividido pela população, multiplicando por 100.000. Utilizou-se o teste de regressão linear para avaliar a tendência temporal de mortalidade. Para a análise, estudaram-se separadamente três grupos etários: 1 a 4 anos, 5 a 9 anos e 10 a 19 anos. Resultados: No período estudado, ocorreram 9.051 óbitos por asma no Brasil em menores de 19 anos. Destes, 69% (6.270 registros) foram de menores de 5 anos. Observou-se um decréscimo significativo de mortalidade por asma no período em todos os grupos etários. A redução média anual do coeficiente de mortalidade por asma em crianças foi de 0,022 (p < 0,0001). De 1 a 4 anos foi de 0,076, de 5 a 9 anos foi de 0,005, e de 10 a 19 anos foi de 0,004 (p< 0,0001). Conclusão: A mortalidade por asma em crianças é baixa e mantém a tendência de queda no período estudado em todas as faixas etárias pediátricas.

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Objective: To evaluate asthma mortality among Brazilian children up to 19 years old in 1980 to 2007 . Methods: This ecological time-series study used the database of the Brazilian Unified Health System, from which data were collected about the number of asthma deaths and the population under 19 years of age in Brazil. Mortality rates were calculated as the number of asthma deaths divided by population and multiplied by 100,000. Linear regression was used to assess the trend of mortality. For the analysis, participants were assigned to three separate age groups: 1-4 years, 5-9 years and 10-19 years. Results: During the study period, there were 9,051 deaths due to asthma in children under 19 years of age. Of these, 69% (6,270 records) of the children were younger than 5 years. There was a significant decrease in asthma mortality during the study in all age groups. The mean annual reduction of asthma mortality rates among children was 0.022 (p < 0.0001). The reduction was 0.076, 0.005 and 0.004 for the 1 to 4, 5 to 9 and 10 to 19 year-old age groups (p < 0.0001). Conclusion: Asthma mortality among Brazilian children is low and has kept a downward trend during the study in all pediatric age groups.

RESUMO

BACKGROUND AND OBJECTIVE: Recent studies have raised concerns about the link between use of inhaled corticosteroids (ICS) and risk of pneumonia in patients with chronic obstructive pulmonary disease. This cross-sectional study aimed to investigate the association between ICS and oropharyngeal colonization by Streptococcus pneumoniae (S. pneumoniae) among children (up to 18 years old) with asthma. METHODS: Two age-matched groups of patients were consecutively recruited: (i) exposed group: children who had persistent asthma and were being treated with daily ICS for at least 30 days and (ii) non-exposed group: children who had asthma and were not being treated with ICS at study entry. Oropharyngeal specimens from the tonsillar area and posterior pharyngeal wall were collected. S. pneumoniae was identified according to National Committee for Clinical Laboratory Standards recommendations. RESULTS: A total of 200 consecutive patients were recruited and 192 (96 in each group) were included in the analysis. In the exposed group, the mean daily dose of ICS was 400 µg of beclomethasone or equivalent and the mean duration of treatment was 8.6 months. The prevalence of oropharyngeal colonization by S. pneumoniae was higher in the exposed group compared with the non-exposed group (27.1% vs 8.3%, P = 0.001). After adjusting for potential confounders, use of ICS was an independent risk factor for oropharyngeal carriage of S. pneumoniae, with an adjusted prevalence ratio of 3.75 (95% confidence interval: 1.72-8.18, P = 0.001). CONCLUSIONS: Regular use of ICS is associated with an increased risk of having oropharyngeal colonization by S. pneumoniae in children with asthma.

Assuntos

Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Asma/tratamento farmacológico , Orofaringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Administração por Inalação , Adolescente , Beclometasona/administração & dosagem , Beclometasona/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco

RESUMO

OBJETIVO: Avaliar a tendência de mortalidade por asma em crianças brasileiras de até 19 anos de idade no período de 1980 a 2007. MÉTODOS: Foi realizado um estudo ecológico, de séries temporais, baseado em banco de dados do Departamento de Informática do Sistema Único de Saúde, do qual foi extraído o número de óbitos por asma e a população residente de até 19 anos de idade no país como um todo. O coeficiente de mortalidade foi calculado pelo número de óbitos por asma dividido pela população, multiplicando por 100.000. Utilizou-se o teste de regressão linear para avaliar a tendência temporal de mortalidade. Para a análise, estudaram-se separadamente três grupos etários: 1 a 4 anos, 5 a 9 anos e 10 a 19 anos. RESULTADOS: No período estudado, ocorreram 9.051 óbitos por asma no Brasil em menores de 19 anos. Destes, 69% (6.270 registros) foram de menores de 5 anos. Observou-se um decréscimo significativo de mortalidade por asma no período em todos os grupos etários. A redução média anual do coeficiente de mortalidade por asma em crianças foi de 0,022 (p < 0,0001). De 1 a 4 anos foi de 0,076, de 5 a 9 anos foi de 0,005, e de 10 a 19 anos foi de 0,004 (p < 0,0001). CONCLUSÃO: A mortalidade por asma em crianças é baixa e mantém a tendência de queda no período estudado em todas as faixas etárias pediátricas.

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OBJECTIVE: To evaluate asthma mortality among Brazilian children up to 19 years old in 1980 to 2007. METHODS: This ecological time-series study used the database of the Brazilian Unified Health System, from which data were collected about the number of asthma deaths and the population under 19 years of age in Brazil. Mortality rates were calculated as the number of asthma deaths divided by population and multiplied by 100,000. Linear regression was used to assess the trend of mortality. For the analysis, participants were assigned to three separate age groups: 1-4 years, 5-9 years and 10-19 years. RESULTS: During the study period, there were 9,051 deaths due to asthma in children under 19 years of age. Of these, 69% (6,270 records) of the children were younger than 5 years. There was a significant decrease in asthma mortality during the study in all age groups. The mean annual reduction of asthma mortality rates among children was 0.022 (p < 0.0001). The reduction was 0.076, 0.005 and 0.004 for the 1- to 4-, 5- to 9- and 10- to 19-year-old age groups (p < 0.0001). CONCLUSION: Asthma mortality among Brazilian children is low and has kept a downward trend during the study in all pediatric age groups.

Assuntos

Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Adulto Jovem , Asma/mortalidade , Distribuição por Idade , Asma/classificação , Brasil/epidemiologia , Mortalidade/tendências , Programas Nacionais de Saúde/estatística & dados numéricos , Estudos Retrospectivos

RESUMO

OBJECTIVE: To evaluate asthma mortality among Brazilian children up to 19 years old in 1980 to 2007. METHODS: This ecological time-series study used the database of the Brazilian Unified Health System, from which data were collected about the number of asthma deaths and the population under 19 years of age in Brazil. Mortality rates were calculated as the number of asthma deaths divided by population and multiplied by 100,000. Linear regression was used to assess the trend of mortality. For the analysis, participants were assigned to three separate age groups: 1-4 years, 5-9 years and 10-19 years. RESULTS: During the study period, there were 9,051 deaths due to asthma in children under 19 years of age. Of these, 69% (6,270 records) of the children were younger than 5 years. There was a significant decrease in asthma mortality during the study in all age groups. The mean annual reduction of asthma mortality rates among children was 0.022 (p < 0.0001). The reduction was 0.076, 0.005 and 0.004 for the 1- to 4-, 5- to 9- and 10- to 19-year-old age groups (p < 0.0001). CONCLUSION: Asthma mortality among Brazilian children is low and has kept a downward trend during the study in all pediatric age groups.

Assuntos

Asma/mortalidade , Adolescente , Adulto , Distribuição por Idade , Asma/classificação , Brasil/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Mortalidade/tendências , Programas Nacionais de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem

RESUMO

BACKGROUND: Routine use of whole-cell pertussis (wP) vaccines was suspended in some countries in the 1970s and 1980s because of concerns about adverse effects. Following such action, there was a resurgence of whooping cough. Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis (B. pertussis) antigens, were developed in the hope that they would be as effective, but less reactogenic than the whole-cell vaccines. OBJECTIVES: To assess the efficacy and safety of acellular pertussis vaccines in children. SEARCH METHODS: We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to December week 4, 2011), EMBASE (1974 to January 2012), Biosis Previews (2009 to January 2012), and CINAHL (2009 to January 2012). SELECTION CRITERIA: We selected double-blind randomised efficacy and safety trials of aP vaccines in children up to six years old, with active follow-up of participants and laboratory verification of pertussis cases. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risk of bias in the studies. Differences in trial design precluded a meta-analysis of the efficacy data. We pooled the safety data from individual trials using a random-effects meta-analysis model. MAIN RESULTS: We included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. Most of the safety trials did not report the methods for random sequence generation, allocation concealment and blinding, which made it difficult to assess the risk of bias in the studies. The efficacy of multi-component (≥ three) vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis), and from 71% to 78% in preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). In contrast, the efficacy of one- and two-component vaccines varied from 59% to 75% against typical whooping cough and from 13% to 54% against mild pertussis disease. Multi-component acellular vaccines are more effective than low-efficacy whole-cell vaccines, but may be less effective than the highest-efficacy whole-cell vaccines. Most systemic and local adverse events were significantly less common with aP vaccines than with wP vaccines for the primary series as well as for the booster dose. AUTHORS' CONCLUSIONS: Multi-component (≥ three) aP vaccines are effective and show less adverse effects than wP vaccines for the primary series as well as for booster doses.

Assuntos

Vacinas contra Difteria, Tétano e Coqueluche Acelular/uso terapêutico , Coqueluche/prevenção & controle , Fatores Etários , Criança , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Vacina contra Difteria, Tétano e Coqueluche/uso terapêutico , Vacinas contra Difteria, Tétano e Coqueluche Acelular/efeitos adversos , Humanos , Vacina contra Coqueluche/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto

RESUMO

OBJECTIVE: To investigate factors associated with the severity of childhood asthma. METHODS: We conducted a case-control study in a group of Brazilian children (2-12 years old) with diagnosis of asthma attending the pediatric pulmonology clinic of a teaching hospital. The study sample consisted of cases (children with persistent asthma) and controls (children with intermittent asthma). Data were collected through an interview with the child's parent or caretaker using a standard questionnaire. Association between asthma severity and studied variables was assessed by calculating odds ratios (OR) and 95% confidence interval (95% CI) through logistic regression test. RESULTS: 171 children were included in this study, of which 104 (61%) had persistent asthma and 67 (39%) had intermittent asthma. Onset of the disease before 2 years of age, paternal educational level lower than 9 years, and low household income (≤1 minimum wage per month) were independent risk factors for persistent asthma, with adjusted OR (95% CI) of 2.56 (1.01-6.48), 2.49 (1.04-5.99), and 4.36 (1.06-17.87), respectively. Regular consumption of fruits during the last 30 days was inversely associated with the risk of having persistent asthma, with an adjusted OR (95% CI) of 0.19 (0.04-0.97). CONCLUSIONS: Early onset of the disease, low paternal education, and low household income are independent risk factors for persistent childhood asthma. Regular consumption of fruits appears to be a protective factor against more severe asthma in children.

Assuntos

Asma/diagnóstico , Asma/epidemiologia , Idade de Início , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Dieta/estatística & dados numéricos , Feminino , Frutas , Humanos , Masculino , Razão de Chances , Pais/educação , Pobreza/estatística & dados numéricos , Fatores de Risco

RESUMO

This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9% presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.

Assuntos

Proteção da Criança , Inquéritos Epidemiológicos , Infecções Respiratórias/epidemiologia , Brasil/epidemiologia , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Mães , Cuidado Pré-Natal , Classe Social , Fatores Socioeconômicos

RESUMO

This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9 percent presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.

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Este estudo teve por objetivo determinar a prevalência de doenças respiratórias agudas baixas e identificar fatores associados à sua ocorrência entre crianças menores de cinco anos de idade em Rio Grande, Rio Grande do Sul, Brasil. Realizou-se estudo transversal de base populacional com aplicação de questionário em nível domiciliar às mães ou responsáveis pelas crianças. Foram coletadas informações sobre características sócio-econômicas, condições de habitação da família e tabagismo dos pais; sobre as crianças, investigou-se padrão de amamentação e dieta, estado nutricional, assistência à gestação e ao parto e utilização de serviços de saúde. A análise incluiu cálculo das razões de prevalência e regressão logística conforme modelo hierárquico previamente estabelecido. Dentre as 771 crianças estudadas, 23,9 por cento apresentavam doenças respiratórias agudas baixas. Os principais fatores de risco identificados foram antecedente de infecção respiratória, sibilância anterior, aglomeração, escolaridade materna menor que cinco anos, renda familiar menor que dois salários mínimos mensais, quatro ou mais pessoas no quarto da criança, história de asma na família e tabagismo materno. Idade materna igual ou superior a trinta anos mostrou-se protetor. Esses resultados podem contribuir para estabelecer medidas específicas visando a reduzir a morbimortalidade por doenças respiratórias agudas baixas nessa população.

Assuntos

Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Proteção da Criança , Inquéritos Epidemiológicos , Infecções Respiratórias/epidemiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Idade Materna , Mães , Cuidado Pré-Natal , Classe Social , Fatores Socioeconômicos

RESUMO

OBJECTIVE: To determine the prevalence of acute lower respiratory tract infections and the risk factors associated with living conditions among children up to 5 years of age in the city of Rio Grande, in the state of Rio Grande do Sul, Brazil. METHODS: A population-based cross-sectional study was carried out with 775 children. A standardized questionnaire was administered to the mother or other caregiver at the child's home in order to collect information on housing conditions, socioeconomic status, and smoking in the home. Additional variables examined included nutritional status, duration of breast-feeding, prenatal care, and utilization of health care services. Environmental variables were analyzed individually and were also grouped together in an "environmental score" that encompassed 10 variables: type of house construction, type of floor, home heating system, type of stove, dog in the child's room, dog in the house, cat in the child's room, cat in the house, number of people per room, and maternal smoking. The grouped environmental score ranged from 0 (best) to 10 (worst). The analysis included two stages: a bivariate stage, in which the prevalence ratio was calculated for each risk factor, and a multivariate stage, with logistic regression. RESULTS: The overall prevalence of acute lower respiratory tract infections was 23.9%. The main risk factors identified were: environmental score >/= 3 points, maternal schooling < 5 years, monthly family income < US$ 200, four or more people sharing the child's bedroom, and maternal smoking. Maternal age > or = 30 years was found to protect against the development of respiratory illness. CONCLUSIONS: Specific programs need to be implemented to control acute respiratory illnesses in the population studied. In future studies with this population, the environmental score that we developed could be used in place of the complete set of environmental variables that we tested. This environmental score should be applied in other contexts so as to determine its external validity.

Assuntos

Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Animais , Animais Domésticos , Brasil/epidemiologia , Gatos , Pré-Escolar , Cães , Escolaridade , Exposição Ambiental/estatística & dados numéricos , Feminino , Habitação , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Pobreza , Prevalência , Fatores de Risco , Salários e Benefícios , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/efeitos adversos , População Urbana

RESUMO

OBJETIVO: Estabelecer a prevalência de doenças agudas do trato respiratório inferior e os fatores de risco relacionados às condiçöes de moradia em crianças de 0 a 59 meses na Cidade do Rio Grande, Estado do Rio Grande do Sul, Brasil. MÉTODOS: Foi realizado um estudo transversal de base populacional com 775 crianças. Foram aplicados questionários padronizados às mäes ou responsáveis pelas crianças, em seus domicílios, e coletadas informaçöes sobre condiçöes de habitaçäo, nível socioeconômico e tabagismo. Também foram investigados: o estado nutricional, a duraçäo da amamentaçäo, o atendimento pré-natal e a utilizaçäo dos serviços de saúde. As variáveis ambientais foram analisadas individualmente e em conjunto, em um escore ambiental que englobou 10 variáveis - tipo de construçäo, tipo de piso, aquecimento doméstico, tipo de fogäo, cäo no quarto da criança, cäo dentro de casa, gato no quarto da criança, gato dentro de casa, aglomeraçäo e fumo materno - variando de 0 (melhor) a 10 (pior). A análise incluiu duas etapas: bivariada, com o cálculo da razäo de prevalências de cada um dos fatores de risco, e multivariada, através de regressäo logística. RESULTADOS: A prevalência geral de doença respiratória aguda baixa foi de 23,9 por cento. Os principais fatores de risco identificados foram: escore ambiental > 3 pontos, menos de 5 anos de escolaridade materna, renda familiar mensal menor do que US$ 200,00, quatro ou mais pessoas dividindo o quarto da criança e tabagismo materno. A idade materna > 30 anos foi identificada como fator de proteçäo. CONCLUSÖES: É preciso implementar programas específicos de controle para as doenças respiratórias agudas na populaçäo estudada. O escore ambiental desenvolvido pode substituir as variáveis ambientais testadas, devendo ser aplicado em outros contextos para determinar a sua validade externa

Assuntos

Humanos , Animais , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Adulto , Gatos , Cães , Doenças Respiratórias/epidemiologia , Animais Domésticos , Brasil/epidemiologia , Escolaridade , Exposição Ambiental/estatística & dados numéricos , Habitação , Idade Materna , Pobreza , Prevalência , Fatores de Risco , Salários e Benefícios , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/efeitos adversos , População Urbana

Assuntos

Doenças Respiratórias , Brasil , Escolaridade , Exposição Ambiental , Habitação , Idade Materna , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco , População Urbana , Animais Domésticos , Pobreza , Salários e Benefícios

RESUMO

Objetivos: estudar a prevalência de doença aguda das vias aéreas inferiores e a influência dos fatores relacionados às condições de moradia e do tabagismo materno. Dentre os fatores de risco reconhecidos, tabagismo, aglomeração e condições de moradia desfavoráveis têm papel fundamental na cadeia causal dessas doenças.Métodos: foi obtida uma amostra de 775 crianças de zero a 59 meses, da cidade do Rio Grande, RS, Brasil, através de estudo transversal, de base populacional. Entrevistadores treinados aplicaramquestionário padronizado às mães ou responsáveis pelas crianças em seus domicílios, e coletaram informações sobre caracteristicas maternas, condições de habitação, nivel socioeconômico da familia e tabagismo. Os fatores ambientais foram estudados individualmente, e através de um escore capaz de avaliar a intensidade das associaçõescom doença respiratória. Foram realizadas análises bivariada, com o cálculo das razões de prevalência de cada um dos fatores de risco, e multivariada, através de regressão logistica não condicional. Resultados: estiveram diretamente associados com doença respiratória: ambiente desfavorável (p

Assuntos

Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Riscos Ambientais , Fumar

RESUMO

OBJECTIVE: To study the prevalence of acute disease of the lower airways and the role of the domestic environment and maternal smoking. Among the recognized risk factors, passive smoking, living in crowded environments and poor housing conditions play a fundamental role in the causal chain of these diseases. METHODS: A cross-sectional study was carried out in a sample of 775 children aged between 0 and 59 months living in Rio Grande, southern Brazil. Trained interviewers applied a standardized questionnaire to the mothers or guardians of these children in their homes and gathered information about maternal characteristics, housing conditions, socio-economic status of the family and smoking habits. Environmental factors were individually studied, and classified according to a score that evaluated the intensity of their association with respiratory diseases. Bivariate analyses were performed, calculating the prevalence ratios for each risk factor, as well as multivariate ones, by means of non-conditional regression analyses. RESULTS: The main risks identified were: unfavorable environment (P<0.01), less than five years of maternal educational level (P=0.01), monthly family income under US$ 200 (P=0.04), crowded environments (P=0.02), smoking during pregnancy (P=0.03) and present maternal smoking (P=0.01). A thirty-year-old or older mother was identified as offering a protection factor (P=0.05). CONCLUSIONS: These results indicate the need to improve the income distribution, improve the rates of educational level, and combat the smoking habit, particularly concerning mothers. The programs of control of respiratory diseases must address these critical points that represent an important risk to children's health.