High prevalence of asthma symptoms in Warao Amerindian children in Venezuela is significantly associated with open-fire cooking: a cross-sectional observational study

Background

The International Study on Asthma and Allergies in Childhood (ISAAC) reported a prevalence of asthma symptoms in 17 centers in nine Latin American countries that was similar to prevalence rates reported in non-tropical countries. It has been proposed that the continuous exposure to infectious diseases in rural populations residing in tropical areas leads to a relatively low prevalence of asthma symptoms. As almost a quarter of Latin American people live in rural tropical areas, the encountered high prevalence of asthma symptoms is remarkable. Wood smoke exposure and environmental tobacco smoke have been identified as possible risk factors for having asthma symptoms.

Methods

We performed a cross-sectional observational study from June 1, 2012 to September 30, 2012 in which we interviewed parents and guardians of Warao Amerindian children from Venezuela. Asthma symptoms were defined according to the ISAAC definition as self-reported wheezing in the last 12 months. The associations between wood smoke exposure and environmental tobacco smoke and the prevalence of asthma symptoms were calculated by means of univariate and multivariable logistic regression analyses.

Results

We included 630 children between two and ten years of age. Asthma symptoms were recorded in 164 of these children (26%). The prevalence of asthma symptoms was associated with the cooking method. Children exposed to the smoke produced by cooking on open wood fires were at higher risk of having asthma symptoms compared to children exposed to cooking with gas (AOR 2.12, 95% CI 1.18 - 3.84). Four percent of the children lived in a household where more than ten cigarettes were smoked per day and they had a higher risk of having asthma symptoms compared to children who were not exposed to cigarette smoke (AOR 2.69, 95% CI 1.11 - 6.48).

Conclusion

Our findings suggest that children living in rural settings in a household where wood is used for cooking or where more than ten cigarettes are smoked daily have a higher risk of having asthma symptoms.     

益生菌减少婴幼儿频繁喘息的初步观察

目的 探讨益生菌对减少婴幼儿频繁喘息的临床疗效。方法 按照真实世界研究（real world research,RWR）原则,对诊断为婴幼儿喘息患儿,发作次数≥6次/年且其家长拒绝接受规则吸入糖皮质激素（ICS）或白三烯受体拮抗剂（顺尔宁）预防治疗者,根据家长意愿分为观察组和对照组。2010年1月至2013年6月入组患儿共84例,其中观察组41例,对照组43例,坚持按要求服药随访1年以上者观察组33例,对照组31例（分别脱落8例和12例）。两组患儿均在其喘息发作给予ICS、顺尔宁、抗组胺药等短期治疗,观察组在喘息间歇期给予双歧四联活菌片（0.5 g/次,3次/d）,疗程6个月,对照组不予任何预防性用药。观察用药后两组患儿在1年间喘息发作次数的差异。结果 用药后1年,观察组和对照组喘息发作次数分别为（2.81±1.24）次和（5.22±2.29）次,差异有统计学意义（t=5.23,P＜0.05）。结论 对于婴幼儿频繁喘息,长期应用益生菌制剂,可减少其喘息发作次数。     

Spatial Cluster Detection for Repeatedly Measured Outcomes while Accounting for Residential History

Spatial cluster detection has become an important methodology in quantifying the effect of hazardous exposures. Previous methods have focused on cross‐sectional outcomes that are binary or continuous. There are virtually no spatial cluster detection methods proposed for longitudinal outcomes. This paper proposes a new spatial cluster detection method for repeated outcomes using cumulative geographic residuals. A major advantage of this method is its ability to readily incorporate information on study participants relocation, which most cluster detection statistics cannot. Application of these methods will be illustrated by the Home Allergens and Asthma prospective cohort study analyzing the relationship between environmental exposures and repeated measured outcome, occurrence of wheeze in the last 6 months, while taking into account mobile locations.     

顺尔宁联合喘可治佐治小儿毛细支气管炎的临床疗效观察

目的：观察顺尔宁联合喘可治佐治小儿毛细支气管炎的临床疗效及其安全性。方法：选取2010年9月～2012年3月在我院儿科住院的70例毛细支气管炎患儿作为观察对象,按入院先后顺序随机分为治疗组和对照组,每组35例。两组均常规给予抗感染、解痉平喘、吸氧、镇静等综合治疗,治疗组在常规治疗的基础上加顺尔宁（孟鲁司特钠咀嚼片）口服,每天4 mg,每晚1次,以及喘可治注射液口服,每次半支,2次/日。治疗7天后观察和比较两组患儿的临床疗效,并对所有病例门诊随访3个月,观察各组患儿在此期间喘息再次发作的情况。结果：治疗7天后,治疗组的总有效率为97.1%,对照组的有效率为80.0%,两组间有显著性差异（X2=7.83,P〈0.05）。治疗组症状体征平均持续时间均较对照组明显缩短,差异有统计学意义（P〈0.05）。随访3个月内治疗组喘息反复发作的平均次数显著低于对照组,差异有统计学意义（P〈0.05）。两组均未见严重不良反应。结论：顺尔宁联合喘可治佐治毛细支气管炎临床疗效显著,并能缩短住院时间,由于顺尔宁可控制毛细支气管炎后的气道慢性炎症,喘可治注射液可增强呼吸道抵抗能力、减少呼吸道反复感染,对毛细支气管炎后喘息的反复发作有预防作用。