Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Supressão do tratamento medicamentoso nas epilepsias

Foi estudado um grupo de 36 pacientes epilépticos dos quais a medicação foi suspensa em 35 e não foi instituída em 1. Esse grupo foi comparado com 1217 pacientes epilépticos em geral no que se refere à idade de início, ao tempo de doença, à freqüência das crises, ao tipo de crise e ao padrão eletrencefalográfico. Levando em conta os resultados obtidos o autor chegou às seguintes conclusões: 1) no grupo estudado predominou o início da doença na segunda década da vida, sendo este considerado um elemento favorável no prognóstico da doença; 2) mais da metade dos casos que tiveram a medicação suspensa apresentavam tempo de doença inferior a 1 ano; 3) predominaram no grupo em estudo as formas mais benignas da doença, sendo de notar que mais da metade dos casos submeteu-se precocemente ao tratamento; 4) no grupo estudado predominaram os pacientes com convulsões puras relativamente àqueles com convulsões focais; 5) não houve diferenças significativas quanto ao padrão eletrencefalográfico, sendo semelhantes os índices de normalidade em ambos os grupos