published_or_final_version / Community Medicine / Master / Master of Public Health

Artists are exposed to numerous respiratory health hazards in the production of art. Little is known of artists' studio behaviors or of their health beliefs related to respiratory toxins. The Health Belief Model hypothesizes that individuals require a minimal level of relevant health motivation and knowledge before attempting to prevent a health condition, as well as a perception of their vulnerability to health conditions they view as threatening, conviction in the efficacy of preventive behaviors, and a perception that recommended preventive action entails few difficulties. This descriptive and exploratory study, conducted within the framework of the Health Belief Model, seeks to determine artists' knowledge, health beliefs, and preventive studio practices related to occupational respiratory health risks.

Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of acute attacks or exacerbation may occur in susceptible individuals. Asthma could be a controllable disorder and most people with asthma should be able to lead a n

Inorganic arsenic exposure is a well-known toxicant of which we are still discovering harmful effects. People are exposed to inorganic arsenic in the environment through either drinking arsenic-contaminated groundwater or consuming arsenic-contaminated food. Regarding global public health, drinking water is still the most important source of inorganic arsenic exposure and is the main focus of this work. The overall goal of this dissertation is to answer some pointing epidemiological questions about exposure to inorganic arsenic: How much do we know about inorganic arsenic and non-malignant lung disease in the general population? To what extent are adolescents with lifetime arsenic exposure susceptible to the respiratory consequences seen in adults? And what actions can be taken to effectively reduce exposure from arsenic-contaminated drinking water? First, we conducted a systematic review of 29 peer-reviewed articles from various populations around the world. The review focused on the different ways in which arsenic is associated with respiratory health to help inform policy makers and public health researchers on the existing evidence. In short, associations between arsenic and respiratory health were noted throughout the lifespan: in infancy, there was growing evidence that in utero arsenic exposure was associated with increased frequency and severity of respiratory tract infections; in childhood, evidence of respiratory symptoms also began to appear; and in adulthood, there was consistent evidence that arsenic exposure was associated with deficits in lung function and increased reports of coughing and breathing problems. The review also uncovered some research gaps, including few studies with strong exposure history from early life and few studies examining respiratory effects during adolescence. Next, we used a life course epidemiological approach to create a more precise understanding of arsenic exposure and respiratory health during the teenage years. This study examined the relationship between lifetime arsenic exposure and lung function in 14-17 year olds, thus studying the period of maximal lung function before natural decline. Overall, higher arsenic exposure was associated with lower lung function levels; however, these associations were only observed in males. This study used a sensitive marker of lung function to investigate early signs of small airway disease. Incorporating this common marker of small airway disease and airflow limitation in future studies on arsenic and respiratory health may help clarify how inorganic arsenic contributes to the development of chronic respiratory disease. Lastly, we evaluated the effectiveness of arsenic removal filters at the household-level in rural Bangladesh. Identifying sustainable ways of reducing exposure to arsenic from naturally contaminated groundwater has been a major environmental health challenge. Although lab-approved arsenic removal water filters exist, there was limited evidence of their prolonged efficacy in the field. To our knowledge, this was the largest and longest deployment of filters accompanied by monitoring of urinary arsenic. Our results demonstrated that filters can temporarily reduce arsenic exposure for weeks to a few months, but should not be considered as a long-term arsenic mitigation option. This failed attempt to reduce exposure confirmed that alternative mitigation strategies need to be employed in Bangladesh, particularly among more vulnerable populations, including pregnant women and young children. This dissertation has important policy implications for future arsenic research and mitigation efforts and should be effectively communicated to policy makers, public health officials, and the general population. Given the pervasive nature of arsenic exposure and the growing evidence of health consequences at different stages throughout the life course, the continued integration of information on inorganic arsenic and research collaborations across disciplines is critical for the prevention and mitigation of arsenic-induced health consequences.

Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of acute attacks or exacerbation may occur in susceptible individuals. Asthma could be a controllable disorder and most people with asthma should be able to lead a n / Magister Curationis

Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of acute attacks or exacerbation may occur in susceptible individuals. Asthma could be a controllable disorder and most people with asthma should be able to lead a n

[Truncated abstract] This thesis describes the development, clinical validation and initial application of a technique for taking measurements of the shape and dimensions of the human upper airway, called anatomical optical coherence tomography (aOCT). The technique uses a transparent catheter containing a rotating optical probe which is introduced transnasally and positioned in the airway and oesophagus. Optical coherence tomography is used to take calibrated cross-sectional images of the airway lumen as the probe rotates. The probe can also be advanced or withdrawn within the catheter during scanning to build up three-dimensional information. The catheter remains stationary so that the subject is not aware of the probe motion. The initial application of the system is research into obstructive sleep apnoea (OSA), a serious condition characterized by repetitive collapse of the upper airway during sleep and an independent risk factor for deaths by heart disease, strokes or car accidents. Measurement of upper airway size and shape is important for the investigation of the pathophysiology of OSA, and for the development and assesment of new treatments. . . We have used aOCT to capture three-dimensional data sets of the airway shape from upper oesophagus to the nasal cavity, undertaken measurements of compliance and other airway characteristics, and recorded dynamic airway shape during confirmed sleep apnoea events in a hospital sleep laboratory. We have shown that aOCT generates quantitative, real-time measurements of upper airway size and shape, allowing study over lengthy periods during both sleep and wakefulness. These features should make it useful for study of upper airway behavior to investigate OSA pathophysiology, and aid clinical management and treatment development.

Thesis (M. Phil.)--University of Hong Kong, 1996. / Includes bibliographical references (leaf 143-160).

Made available in DSpace on 2014-06-11T19:32:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-16Bitstream added on 2014-06-13T20:42:56Z : No. of bitstreams: 1 faganello_mm_dr_botfm.pdf: 465819 bytes, checksum: 7899369510ab22be938ad270a777ebd2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Nos últimos anos, vários estudos avaliaram os marcadores da doença associados à freqüência de exacerbação, hospitalização, readmissão e mortalidade em pacientes portadores de doença pulmonar obstrutiva crônica (DPOC). Entretanto, estudos que avaliaram os marcadores associados à ocorrência de exacerbação em pacientes ambulatoriais são limitados. Assim, o objetivo deste estudo foi identificar os fatores de predição da ocorrência de exacerbação no período de um ano em 120 pacientes com DPOC atendidos no Ambulatório de Pneumologia da Faculdade de Medicina de Botucatu - Unesp. Os pacientes tiveram o diagnóstico de DPOC confirmado e foram submetidos às seguintes avaliações: espirometria pré e pós-broncodilatador, composição do corpo (antropometria e bioimpedância), qualidade de vida por meio do Saint George s Respiratory Questionnaire (SGRQ), intensidade da dispnéia por meio da escala modificada Medical Research Council (MMRC) e do índice basal de dispnéia (BDI) e tolerância ao exercício (distância percorrida em 6 minutos DP6). Em seguida foi calculado o índice BODE de acordo com os pontos de corte do volume expiratório no primeiro segundo (VEF1), do índice de massa do corpo, do MMRC e da DP6. Durante o período de acompanhamento de um ano, 60 pacientes (50%) apresentaram pelo menos um episódio de exacerbação da doença e, em conseqüência da agudização, 25 pacientes foram hospitalizados. Comorbidades extra-pulmonares foram causa de hospitalização em oito pacientes e de óbito em cinco pacientes. Na avaliação inicial, os pacientes que exacerbaram tinham maior comprometimento da função pulmonar e da troca gasosa, valores mais elevados do índice BODE e maior proporção de pacientes com DPOC III e IV. Além disso, apresentavam menores valores de DP6, maior sensação de dispnéi... / Markers of disease severity have been associated with mortality, occurrence and frequency of hospitalization and readmission due disease exacerbation in chronic obstructive pulmonary disease (COPD) patients. However, information about predictor factors for the occurrence of exacerbation in ambulatory COPD patients is scarce. Therefore, the aim of the present study was to identify predictor factors for the occurrence of exacerbation in 120 patients with COPD followed during one year in the outpatient clinic at Universidade Estadual Paulista (UNESP, Paulista State University) School of Medicine at Botucatu, located in the State of São Paulo, Brazil. The patients had the diagnosis of COPD confirmed and underwent to the following evaluations: pre- and postbronchodilator spirometry, body composition (anthropometry and bioimpedance), health-related quality of life (Saint George s Respiratory Questionnaire -SGRQ), dyspnea scores (Medical Research Council MMRC and basal dispnea index -BDI) and exercise tolerance (6MWD). Bode index was calculated taking in consideration the cutt off points for forced volume in the first second (FEV1), body mass index, MMRC and 6MWD. During the followup period 60 patients (50%) presented at least one exacerbation episode and, as consequence, 25 patients were hospitalized. Eight patients were hospitalized and five died due to non-pulmonary comorbidities. At baseline, patients with exacerbations during the follow-up period presented lower values of airway obstruction indexes and of arterial blood gases and higher values of BODE score and proportion of COPD patients class III and IV. In addition, the values of 6MWD were lower, dyspnea sensation was higher and the health- related quality of life was more deteriorated in these patients. No significative associations were found between gender, corticosteroid use... (Complete abstract click electronic access below)

Dampness can cause the development of moulds in buildings and pose a threat to the quality of the building structure, indoor air quality and health of the occupants. An emerging source of housing related problems are the building materials commonly used in housing construction, which can influence respiratory health. There is concern regarding the quality of the housing stock in the Durban Metropolitan area with regard to dampness and its the potential impact on the health of occupants. To elucidate this issue, a study was conducted to assess natural ventilation, dampness and mouldiness in dwellings of the Waterloo Housing development (Durban Metropolitan Area), between February 2001 and December 2003. A total of 491 randomly selected homes were visually inspected and residents were surveyed by means of a structured questionnaire. Three hundred and eighteen (318) air and surface mould samples were collected in duplicate, totalling 636 samples and analysed in the laboratory. Building characteristics and physical conditions were recorded and noted. Temperature and relative humidity readings were also taken during the survey. After the analysis of the 491 questionnaires, physical conditions of the dwellings were found to be poor and of concern. With the number (1178) and size of habitable rooms in the dwellings; the occupancy of 2414 people with an average of 2.05 persons per room, indicated overcrowding and congestion. About 51% (n=249) of the dwellings surveyed were found to be experiencing dampness (>3m2) and 47% (n=230) had visible surface moulds, primarily on the walls (at least an average of 1m2) . Predominant airborne fungal organism identified included; Aspergillus (23%-indoors, 26outdoors), Cladosporium (47%- indoors, 51%-outdoors), Penicillum (27%-indoors, 26%-outdoors) spp. Natural ventilation was also inadequate in 261 (53%) dwellings, which did not have airbricks. This inadequacy significantly promotes the occurrence of dampness and surface moulds (p < 0.05). With poor ventilation, dampness and mould growth in the dwellings, there was a high number of cases with upper respiratory tract health complaints; like Cough - 25% (n=122), Sinuses - 25% (n=121), flu symptoms 23% (n=llO) lower respiratory infections such as asthma - 27% (n=130), and chest infections - 23% (n=113). Asthma, wheeze, runny nose and allergy to dust were statistically associated with dampness (p < 0.05), mouldiness (p < 0.03) and lack of ventilation (p < 0.01). Buildings separate their occupants from hostile external environments and create a better internal environment for them, therefore dwellings must be constructed in a manner that promotes the health and well being of the occupants. In terms of guiding regulations, there were several omissions and non-compliance with existing local building bye-laws in the construction of houses, leading to adverse implications. Improved workmanship, appropriate material selection and compliance with the relevant guidelines during planning and construction inter alia, are recommended when addressing housing issues, thereby promoting the interest, health and well-being of the users. / Thesis-(M.Med)- University of KwaZulu-Natal, Durban, 2004.