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‣ Molecular Epidemiologic Typing Systems of Bacterial Pathogens: Current Issues and Perpectives

Struelens,Marc J
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/1998 Português
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The epidemiologic typing of bacterial pathogens can be applied to answer a number of different questions: in case of outbreak, what is the extent and mode of transmission of epidemic clone(s )? In case of long-term surveillance, what is the prevalence over time and the geographic spread of epidemic and endemic clones in the population? A number of molecular typing methods can be used to classify bacteria based on genomic diversity into groups of closely-related isolates (presumed to arise from a common ancestor in the same chain of transmission) and divergent, epidemiologically-unrelated isolates (arising from independent sources of infection). Ribotyping, IS-RFLP fingerprinting, macrorestriction analysis of chromosomal DNA and PCR-fingerprinting using arbitrary sequence or repeat element primers are useful methods for outbreak investigations and regional surveillance. Library typing systems based on multilocus sequence-based analysis and strain-specific probe hybridization schemes are in development for the international surveillance of major pathogens like Mycobacterium tuberculosis. Accurate epidemiological interpretation of data obtained with molecular typing systems still requires additional research on the evolution rate of polymorphic loci in bacterial pathogens.

‣ Comparison of Restriction Enzyme Analysis, Arbitrarily Primed PCR, and Protein Profile Analysis Typing for Epidemiologic Investigation of an Ongoing Clostridium difficile Outbreak

Rafferty, Mary Ellen; Baltch, Aldona L.; Smith, Raymond P.; Bopp, Lawrence H.; Rheal, Carol; Tenover, Fred C.; Killgore, George E.; Lyerly, David M.; Wilkins, Tracy D.; Schoonmaker, Dianna J.; Hannett, George E.; Shayegani, Mehdi
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /10/1998 Português
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During an outbreak of diarrhea in a general hospital in 1992, 166 Clostridium difficile isolates from 102 patients were typed by restriction enzyme analysis (REA), arbitrarily primed PCR (AP-PCR), and protein profile analysis (PP) techniques. A total of 18 types and 5 subtypes were identified by REA, 32 types were identified by AP-PCR, and 9 types were identified by PP. Analysis of the data indicated the presence of a predominant strain among 76, 75, and 84% of the isolates by REA, AP-PCR, and PP, respectively. Subsequently, 45 C. difficile isolates which had been collected in 1990 from 33 patients in the same hospital following a significant increase in the number of cases of diarrhea caused by C. difficile were studied by REA, AP-PCR, and PP typing techniques. Thirteen types and one subtype were identified by REA, 12 types were identified by AP-PCR, and 5 types were identified by PP. As with the isolates from 1992, a dominant strain was identified. This strain was represented by 53, 64, and 70% of the total number of isolates when the strains were typed by REA, AP-PCR, and PP, respectively. Every isolate (210 of 211) from both 1990 and 1992 that was available for typing was typeable by all three methods. Furthermore, the same dominant strain was identified in both 1990 and 1992 by each method. This study demonstrates that each of the three typing methods can be useful in epidemiologic investigations of C. difficile outbreaks and that one strain can be dominant in an institution over a number of years.

‣ Candida tropicalis in a Neonatal Intensive Care Unit: Epidemiologic and Molecular Analysis of an Outbreak of Infection with an Uncommon Neonatal Pathogen

Roilides, Emmanuel; Farmaki, Evangelia; Evdoridou, Joanna; Francesconi, Andrea; Kasai, Miki; Filioti, Joanna; Tsivitanidou, Maria; Sofianou, Danai; Kremenopoulos, George; Walsh, Thomas J.
Fonte: American Society for Microbiology Publicador: American Society for Microbiology
Tipo: Artigo de Revista Científica
Publicado em /02/2003 Português
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From June to July 1998, two episodes of Candida tropicalis fungemia occurred in the Aristotle University neonatal intensive care unit (ICU). To investigate this uncommon event, a prospective study of fungal colonization and infection was conducted. From December 1998 to December 1999, surveillance cultures of the oral cavities and perinea of the 593 of the 781 neonates admitted to the neonatal ICU who were expected to stay for >7 days were performed. Potential environmental reservoirs and possible risk factors for acquisition of C. tropicalis were searched for. Molecular epidemiologic studies by two methods of restriction fragment length polymorphism analysis and two methods of random amplified polymorphic DNA analysis were performed. Seventy-two neonates were colonized by yeasts (12.1%), of which 30 were colonized by Candida albicans, 17 were colonized by C. tropicalis, and 5 were colonized by Candida parapsilosis. From December 1998 to December 1999, 10 cases of fungemia occurred; 6 were due to C. parapsilosis, 2 were due to C. tropicalis, 1 was due to Candida glabrata, and 1 was due to Trichosporon asahii (12.8/1,000 admissions). Fungemia occurred more frequently in colonized than in noncolonized neonates (P < 0.0001). Genetic analysis of 11 colonization isolates and the two late blood isolates of C. tropicalis demonstrated two genotypes. One blood isolate and nine colonization isolates belonged to a single type. The fungemia/colonization ratio of C. parapsilosis (3/5) was greater than that of C. tropicalis (2/17...

‣ Comparison of three typing methods for clinical and environmental isolates of Aspergillus fumigatus.

Lin, D; Lehmann, P F; Hamory, B H; Padhye, A A; Durry, E; Pinner, R W; Lasker, B A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1995 Português
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To evaluate procedures used for epidemiologic analysis of outbreaks of aspergillosis, we analyzed a collection of 35 Aspergillus fumigatus isolates using three typing methods: isoenzyme analysis (IEA), random amplified polymorphic DNA (RAPD) analysis, and restriction endonuclease analysis (REA). Twenty-one isolates were from a single hospital, with four isolates coming from different patients. Three clinical isolates came from a different hospital, and 11 clinical or environmental isolates were derived from a culture collection. With IEA, the patterns of alkaline phosphatase, esterase, and catalase discriminated nine types. In contrast, 22 types were obtained with five different RAPD primers, and 21 types could be detected with three of these (R108, R151, and UBC90). Restriction endonuclease analysis of genomic DNA, digested with either XbaI, XhoI, or SalI, detected 3, 17, and 13 different REA types, respectively, and 22 types were identified by combining the data from the XhoI and SalI REAs. Twenty-eight types were obtainable with a combination of REA, IEA, and RAPD patterns. Overall, the results pointed to substantial genetic variation among the isolates. Though two isolates had markedly distinct genotypes, their morphologic features and exoantigens were consistent with their being A. fumigatus. The analysis will help in planning epidemiologic studies of aspergillosis.

‣ Large restriction fragment patterns of genomic Mycobacterium fortuitum DNA as strain-specific markers and their use in epidemiologic investigation of four nosocomial outbreaks.

Hector, J S; Pang, Y; Mazurek, G H; Zhang, Y; Brown, B A; Wallace, R J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1992 Português
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Pulsed-field gel electrophoresis and restriction endonucleases with rare recognition sites were used to generate large restriction fragment (LRF) patterns of genomic DNA from 48 isolates of Mycobacterium fortuitum biovariant fortuitum. Epidemiologically unrelated isolates gave highly diverse patterns when AsnI, HpaI, AflII, DraI, NdeI, XbaI, SpeI, or SspI was used. Epidemiologically related isolates produced identical or minimally different LRF patterns. Minor variations in LRF patterns were seen in two epidemic isolates digested with XbaI, suggesting that genetic alteration had occurred. LRF patterns were used to study three cardiac surgery wound infection outbreaks and one respiratory disease nosocomial outbreak. In two outbreaks, LRF patterns confirmed the reported clustering of isolates on the basis of multiple phenotyping methods. In the remaining two outbreaks, isolates which could not be separated by prior typing methods were easily distinguished by LRF pattern analysis. Environmental water isolates from two outbreaks had LRF patterns identical to those of the disease-producing strains, confirming that the local environment was the source of infection. Pulsed-field gel electrophoresis of LRFs of genomic DNA offers great promise as an epidemiologic tool for the study of M. fortuitum.

‣ Epidemiologic application of a standardized ribotype scheme for Vibrio cholerae O1.

Popovic, T; Bopp, C; Olsvik, O; Wachsmuth, K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1993 Português
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A standardized scheme of 27 different BglI ribotypes and subtypes of Vibrio cholerae O1 strains is proposed on the basis of data from 214 human and environmental strains isolated in 35 countries and 14 U.S. states over the past 60 years. The ribotype patterns obtained are reproducible and stable over time. Seven different but very similar ribotypes (1a to 1g) were observed among 16 strains of the classical biotype. Twenty ribotypes and subtypes were identified among 198 V. cholerae O1 strains of the El Tor biotype. Six different patterns were found among the strains causing the current seventh pandemic. Strains of ribotype 8 originated only in central African countries, while those of ribotype 3 originated mainly in Asia and the Pacific Islands. The most widely distributed strains were those of ribotype 6, which was subdivided into three very similar but still distinguishable subtypes. The present Latin American epidemic is caused by strains of ribotype 5. Strains of this ribotype were isolated from several other geographic locations but can be differentiated from the Latin American strains by other molecular methods. Strains associated with two documented environmental reservoirs exhibited three distinct ribotype patterns; those isolated from patients who ate food from the U.S. Gulf waters were all of ribotype 2...

‣ A critical review of methods for comparing estrogenic activity of endogenous and exogenous chemicals in human milk and infant formula.

Borgert, Christopher J; LaKind, Judy S; Witorsch, Raphael J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2003 Português
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The two primary sources of nutrition for infants are human milk and infant formula. Both contain an array of endogenous and exogenous chemicals that may act through many separate hormonal mechanisms. The safety of infant nutrition sources has been questioned based on the possibility that exogenous chemicals may exert adverse effects on nursing or formula-fed infants through estrogen-mediated mechanisms. In response to these and other concerns, the National Research Council recommended assessing the estrogenic potency of natural and anthropogenic hormonally active agents. Furthermore, the Endocrine Disruptor Screening and Testing Advisory Committee of the U.S. Environmental Protection Agency specifically recommended testing chemicals present in human milk as a representative mixture to which large segments of the population are exposed. To date, no clinical or epidemiologic evidence demonstrates that levels of chemicals currently found in human milk or infant formulas cause adverse effects in infants. Nonetheless, the question is sufficiently important to warrant a consideration of how best to evaluate potential estrogenic risks. We reviewed the types of data available for measuring estrogenic potency as well as methods for estimating health risks from mixtures of chemicals in infant nutrition sources that act via estrogenic mechanisms. We conclude that the science is insufficiently developed at this time to allow a credible assessment of health risks to infants based on estimates of estrogenic potency or on an understanding of toxicologic effects mediated by estrogenic mechanisms. However...

‣ Letters on Epidemiologic Research Methods: II. Inconsistent with Time-tested Epidemiologic Methods

Maclure, Malcolm
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1990 Português
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‣ Uses of ecologic analysis in epidemiologic research.

Morgenstern, H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1982 Português
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Despite the widespread use of ecologic analysis in epidemiologic research and health planning, little attention has been given by health scientists and practitioners to the methodological aspects of this approach. This paper reviews the major types of ecologic study designs, the analytic methods appropriate for each, the limitations of ecologic data for making causal inferences and what can be done to minimize these problems, and the relative advantages of ecologic analysis. Numerous examples are provided to illustrate the important principles and methods. A careful distinction is made between ecologic studies that generate or test etiologic hypotheses and those that evaluate the impact of intervention programs or policies (given adequate knowledge of disease etiology). Failure to recognize this difference in the conduct of ecologic studies can lead to results that are not very informative or that are misinterpreted by others.

‣ DATA ANALYSIS METHODS AND THE RELIABILITY OF ANALYTIC EPIDEMIOLOGIC RESEARCH

Prentice, Ross L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/2008 Português
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Publications that compare randomized controlled trial and cohort study results on the effects of postmenopausal estrogen plus progestin therapy are reviewed. The 2 types of studies agree in identifying an early elevation in coronary heart disease (CHD) risk, and a later — developing elevation in breast cancer risk. Effects among women who begin hormone therapy within a few years following the menopause may be comparatively more favorable for CHD and less favorable for breast cancer. These analyses illustrate the potential of modern data analysis methods to enhance the reliability and interpretation of epidemiologic data.

‣ Epidemiologic Responses to Anthrax Outbreaks: A Review of Field Investigations, 1950–2001

Bales, Michael E.; Dannenberg, Andrew L.; Brachman, Philip S.; Kaufmann, Arnold F.; Klatsky, Peter C.; Ashford, David A.
Fonte: Centers for Disease Control and Prevention Publicador: Centers for Disease Control and Prevention
Tipo: Artigo de Revista Científica
Publicado em /10/2002 Português
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We used unpublished reports, published manuscripts, and communication with investigators to identify and summarize 49 anthrax-related epidemiologic field investigations conducted by the Centers for Disease Control and Prevention from 1950 to August 2001. Of 41 investigations in which Bacillus anthracis caused human or animal disease, 24 were in agricultural settings, 11 in textile mills, and 6 in other settings. Among the other investigations, two focused on building decontamination, one was a response to bioterrorism threats, and five involved other causes. Knowledge gained in these investigations helped guide the public health response to the October 2001 intentional release of B. anthracis, especially by addressing the management of anthrax threats, prevention of occupational anthrax, use of antibiotic prophylaxis in exposed persons, use of vaccination, spread of B. anthracis spores in aerosols, clinical diagnostic and laboratory confirmation methods, techniques for environmental sampling of exposed surfaces, and methods for decontaminating buildings.

‣ Computational modeling and epidemiologic approaches: a new section of the journal of translational medicine

Liebman, Michael N; Molinaro, Sabrina
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 17/10/2012 Português
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A new section of the Journal of Translational Medicine is being introduced to encourage rapid communication of methods and results that utilize computational modeling and epidemiologic approaches in translational medicine. The focus will be on population-based studies that extend towards more molecular level analysis. Submission of studies involving methods development is encouraged where actual application and results can be shown in the healthcare and life sciences domains.

‣ Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs

Ording, Anne Gulbech; Sørensen, Henrik Toft
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Publicado em 01/07/2013 Português
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The proportion of older people in the world population is expected to increase rapidly during the upcoming decades. Consequently, the number of patients with multimorbidity will increase dramatically. In epidemiologic research, the concepts of multimorbidity, comorbidity, and complications have been confusing, and some of these concepts are used interchangeably. In this commentary, the authors propose a clear terminology for clinical concepts describing different aspects of multimorbidity and elucidate the relationship between these clinical concepts and their epidemiologic analogs. Depending on whether a study uses causal or predictive models, a proper distinction between concepts of multimorbidity is important. It can be very difficult to separate complications of the index disease under study from comorbidity. In this context, use of comorbidity indices as confounding scores should be done with caution. Other methodologic issues are type, duration, severity, and number of comorbidities included in the ascertainment methods, as well as sources included in the research. Studies that recognize these challenges have the potential to yield valid estimates of the comorbidity burden and results that can be compared with other studies.

‣ An Introduction to Epidemiologic and Statistical Methods Useful in Environmental Epidemiology

Nitta, Hiroshi; Yamazaki, Shin; Omori, Takashi; Sato, Tosiya
Fonte: Japan Epidemiological Association Publicador: Japan Epidemiological Association
Tipo: Artigo de Revista Científica
Publicado em 05/05/2010 Português
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Many developments in the design and analysis of environmental epidemiology have been made in air pollution studies. In the analysis of the short-term effects of particulate matter on daily mortality, Poisson regression models with flexible smoothing methods have been developed for the analysis of time-series data. Another option for such studies is the use of case–crossover designs, and there have been extensive discussions on the selection of control periods. In the Study on Respiratory Disease and Automobile Exhaust project conducted by the Japanese Ministry of the Environment, we adopted a new 2-stage case–control design that is efficient when both exposure and disease are rare. Based on our experience in conducting air pollution epidemiologic studies, we review 2-stage case–control designs, case–crossover designs, generalized linear models, generalized additive models, and generalized estimating equations, all of which are useful approaches in environmental epidemiology.

‣ Placental biomarkers of phthalate effects on mRNA transcription: application in epidemiologic research

Adibi, Jennifer J; Whyatt, Robin M; Thaker, Harshwardhan M; Nelson, Heather; Bhat, Hari K; Hauser, Russ B.; Williams, Paige L.; Herrick, Robert F.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
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Background: CYP19 and PPARγ are two genes expressed in the placental trophoblast that are important to placental function and are disrupted by phthalate exposure in other cell types. Measurement of the mRNA of these two genes in human placental tissue by quantitative real-time polymerase chain reaction (qPCR) offers a source of potential biomarkers for use in epidemiologic research. We report on methodologic challenges to be considered in study design. Methods: We anonymously collected 10 full-term placentas and, for each, sampled placental villi at 12 sites in the chorionic plate representing the inner (closer to the cord insertion site) and outer regions. Each sample was analyzed for the expression of two candidate genes, aromatase (CYP19) and peroxisome proliferator activated receptor protein gamma (PPARγ) and three potential internal controls: cyclophilin (CYC), 18S rRNA (18S), and total RNA. Between and within placenta variability was estimated using variance component analysis. Associations of expression levels with sampling characteristics were estimated using mixed effects models. Results: We identified large within-placenta variability in both transcripts (>90% of total variance) that was minimized to <20% of total variance by using 18S as an internal control and by modelling the means by inner and outer regions. 18S rRNA was the most appropriate internal control based on within and between placenta variability estimates and low correlations of 18S mRNA with target gene mRNA. Gene expression did not differ significantly by delivery method. We observed decreases in the expression of both transcripts over the 25 minute period after delivery (CYP19 p-value for trend = 0.009 and PPARγ (p-value for trend = 0.002). Using histologic methods...

‣ Dose–Response Relationship of Prenatal Mercury Exposure and IQ: An Integrative Analysis of Epidemiologic Data

Axelrad, Daniel A.; Woodruff, Tracey J.; Bellinger, David C.; Ryan, Louise Marie
Fonte: National Institute of Environmental Health Sciences Publicador: National Institute of Environmental Health Sciences
Tipo: Artigo de Revista Científica
Português
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Background: Prenatal exposure to mercury has been associated with adverse childhood neurologic outcomes in epidemiologic studies. Dose–response information for this relationship is useful for estimating benefits of reduced mercury exposure. Objectives: We estimated a dose–response relationship between maternal mercury body burden and subsequent childhood decrements in intelligence quotient (IQ), using a Bayesian hierarchical model to integrate data from three epidemiologic studies. Methods: Inputs to the model consist of dose–response coefficients from studies conducted in the Faroe Islands, New Zealand, and the Seychelles Islands. IQ coefficients were available from previous work for the latter two studies, and a coefficient for the Faroe Islands study was estimated from three IQ subtests. Other tests of cognition/achievement were included in the hierarchical model to obtain more accurate estimates of study-to-study and end point–to–end point variability. Results: We find a central estimate of −0.18 IQ points (95% confidence interval, −0.378 to −0.009) for each parts per million increase of maternal hair mercury, similar to the estimates for both the Faroe Islands and Seychelles studies, and lower in magnitude than the estimate for the New Zealand study. Sensitivity analyses produce similar results...

‣ Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.

Tulchinsky, T H; Varavikova, E A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/1996 Português
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OBJECTIVES. This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS. The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS. Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS. The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

‣ Behavioral effects of lead: commonalities between experimental and epidemiologic data.

Rice, D C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1996 Português
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Enormous effort has been focused over the last decade and a half on characterizing the behavioral effects of lead in the developing organism. While age-appropriate standardized measures of intelligence (IQ) have been the dependent variable most often used to assess lead-induced cognitive impairment in epidemiologic studies, researchers have also used a variety of other methods designed to assess specific behavioral processes sensitive to lead. Increased reaction time and poorer performance on vigilance tasks associated with increased lead body burden suggest increased distractibility and short attention span. Assessment of behavior on teachers' rating scales identified increased distractibility, impulsivity, nonpersistence, inability to follow sequences of directions, and inappropriate approach to problems as hallmarks of lead exposure. Robust deficits in learned skills such as reading, spelling, math, and word recognition have also been found. Spatial organizational perception and abilities seem particularly sensitive to lead-induced impairment. Assessment of complex tasks of learning and memory in both rats and monkeys has revealed overall deficits in function over a variety of behavioral tasks. Exploration of behavioral mechanisms responsible for these deficits identified increased distractibility perseveration...

‣ Avaluació dels nivells de nitrats i duresa a l'aigua de consum a quatre zones d'Espanya participants a l'estudi epidemiològic Infància i Medi Ambientl (INMA)

Navarro Albiol, Anna; Villanueva Belmonte, Cristina; Font i Ribera, Laia,; Sala Serra, Maria
Fonte: Universidade Autônoma de Barcelona Publicador: Universidade Autônoma de Barcelona
Tipo: Trabalho de Conclusão de Curso Formato: application/pdf; application/pdf
Publicado em //2014 Português
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L'aigua és un dels components bàsics per a la vida i una font d'exposició a contaminants ubiqua, ja que tota la població en consumeix. L'estudi epidemiològic INMA avaluarà si l'exposició a nitrats durant l'embaràs i a la duresa de l'aigua durant la infància es relaciona amb el baix pes al néixer i l'èczema atòpica, respectivament. Objectiu: Fer una avaluació dels nivells de nitrats i duresa de l'aigua en aigua de consum de la població de l'estudi INMA. Metodologia: l'estudi descriptiu realitzat a quatre de les set cohorts INMA, a Astúries, Guipúscoa, Sabadell i València. S'ha recopilat dades dels nivells de nitrats i duresa a l'aigua de consum dels municipis durant el període d'interès (2003 al 2008 i 2004 al 2012), a través d'ajuntaments i companyies d'aigua. S'ha calculat la mitjana, la desviació estàndard, el màxim i el mínim dels nivells de nitrat i de duresa en total i segons l'àrea geogràfica, l'any i l'estació. A Sabadell s'han fet tres mostrejos d'aigua per analitzar la duresa a diferents punts de la ciutat. Resultats: el nivell promig de nitrats (mg/L NO3-) és de 4,2 a Astúries, 4,0 a Guipúscoa, 9,2 a Sabadell i 15,2 a València. El nivell promig de duresa (mg/L CaCO3) és de 89,1 a Astúries...

‣ Ambient air pollution as a risk factor for lung cancer

COHEN,AARON J; ARDEN POPE III,C.; SPEIZER,FRANK E
Fonte: Instituto Nacional de Salud Pública Publicador: Instituto Nacional de Salud Pública
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/1997 Português
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Epidemiologic studies over the last 40 years have observed that general ambient air pollution, chiefly due to the by- products of the incomplete combustion of fossil fuels, is associated with small relative increases in lung cancer. The evidence derives from studies of lung cancer trends, studies of occupational groups, comparisons of urban and rural populations, and case-control and cohort studies using diverse exposure metrics. Recent prospective cohort studies observed 30-50% increases in the risk of lung cancer in relation to approximately a doubling of respirable particle exposure. While these data reflect the effects of exposures in past decades, and despite some progress in reducing air pollution, large numbers of people in the US continue to be exposed to pollutant mixtures containing known or suspected carcinogens. These observations suggest that the most widely cited estimates of the proportional contribution of air pollution to lung cancer occurrence in the US, based largely on the results of animal experimentation, may be too low. It is important that better epidemiologic research be conducted to allow improved estimates of lung cancer risk from air pollution in the general population. The development and application of new epidemiologic methods...