Recent literature has highlighted the importance of transition from paediatric to adult care for children with chronic conditions. Non-cystic fibrosis bronchiectasis is an important cause of respiratory morbidity in low-income countries and in indigenous children from affluent countries; however, there is little information about adult outcomes of childhood bronchiectasis. We reviewed the clinical course of 31 Alaska Native adults 20-40 years of age from Alaska's Yukon Kuskokwim Delta with childhood bronchiectasis. In patients with chronic suppurative lung disease, a diagnosis of bronchiectasis was made at a median age of 4.5 years by computerised tomography (68%), bronchogram (26%), and radiographs (6%). The patients had a median of 75 lifetime respiratory ambulatory visits and 4.5 hospitalisations. As children, 6 (19%) experienced developmental delay; as adults 9 (29%) experienced mental illness or handicap. Four (13%) patients were deceased, four (13%) had severe pulmonary impairment in adulthood, 17 (54%) had persistent or intermittent respiratory symptoms, and seven (23%) were asymptomatic. In adulthood, only five were seen by adult pulmonologists and most had no documentation of a bronchiectasis diagnosis. Lack of provider continuity, remote location and co-morbidities can contribute to increased adult morbidity. Improving the transition to adult care starting in adolescence and educating adult providers may improve care of adults with childhood bronchiectasis.
This study was designed to examine differences in the respiratory health status of preadolescent school children, aged 7-11 years, who resided in 10 rural Canadian communities areas of moderate and low exposure to regional sulfate and ozone pollution. Five of the communities were located in central Saskatchewan, a low-exposure region, and five were located in southwestern Ontario, an area with moderately elevated exposures resulting from long-range atmospheric transport of polluted air masses. In this cross-sectional study, the child's respiratory symptoms and illness history were evaluated using a parent-completed questionnaire, administered in September 1985. Respiratory function was assessed once for each child in the schools between October 1985 and March 1986, by the measurement of pulmonary function for forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1.0), peak expiratory flow rate (PEFR), mean forced expiratory flow rate during the middle half of the FVC curve (FEF25-75), and maximal expiratory flow at 50% of the expired vital capacity (V50max). The 1986 annual mean of the 1-hr daily maxima of ozone was higher in Ontario (46.3 ppb) than in Saskatchewan (34.1 ppb), with 90th percentile concentrations of 80 ppb in Ontario and 47 ppb in Saskatchewan. Summertime 1-hr daily maxima means were 69.0 ppb in Ontario and 36.1 ppb in Saskatchewan. Annual mean and 90th percentile concentrations of inhalable sulfates were three times higher in Ontario than in Saskatchewan; there were no significant differences in levels of inhalable particles (PM10) or particulate nitrates. Levels of sulfur dioxide (SO2) and nitrogen dioxide (NO2) were low in both regions. After controlling for the effects of age, sex, parental smoking, parental education, and gas cooking, no significant regional differences were observed in rates of chronic cough or phlegm, persistent wheeze, current asthma, bronchitis in the past year, or any chest illness that kept the child at home for 3 or more consecutive days during the previous year. Children living in southwestern Ontario had statistically significant (P 0.05).
A comprehensive investigation forming part of a joint European study under the auspices of "WHO Long-Term Air Pollution Programme" uses 7-13 year old schoolchildren as the target group. The study has included social, housing, hygienic and epidemic factors as well as family smoking habits. The results indicate that, at exposure to low levels of air pollution, these factors dominate as causes for the impairment of health especially that of respiratory health.
The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P
Recent studies have identified several factors which may affect human health and life expectancy in northern Finland. They have shown that antioxidants, infections, genetic or environmental factors may affect the development of and morbidity/mortality from cardiovascular diseases, cancer, diabetes mellitus and other diseases in the northern provinces of this country. Both the occurrence and mortality from coronary heart disease (CHD) is low in the northernmost part of the country, i.e. Mountain Lapland or the Saami area, compared with that in whole country or a neighbouring region to the south in central Lapland. The mortality from all diseases is also low in communities in Mountain Lapland, and high in central Lapland in communities such as Kittilä and Kolari. High scrum antioxidants, alpha-tocopherol (vitamin E), albumin and selenium levels have been measured in men living in the northernmost part of the country, where the death rate from CHD is low. Low serum alpha-tocopherol and albumin levels were typical of men living in rural communities with high CHD mortality, e.g. Kittilä community. Serum antioxidant levels were related to the diet; alpha-tocopherol increased with the consumption of reindeer meat and selenium with fish consumption. Our earlier studies have also identified a low Chlamydia pneumoniae IgA antibody titer in men living in Mountain Lapland compared with men in the neighboring region to the south in central Lapland with high CHD mortality. An elevated Chlamydia pneumoniae IgA antibody titer was associated with low serum alpha-tocopherol level. The people of Saami origin, an ethnic minority living in northernmost Finland, have a high apolipoprotein (apo) E e4 allele frequency and high serum cholesterol. They also have more apo A-IV-2 allele than most of the studied populations, and their HDL cholesterol levels are higher in apo A-IV-2/1 than in apo A-IV-1/1 phenotypes. Our earlier studies indicate that people living in northeastern Finland, west of smelters in Kola Peninsula may be exposed to heavy metals such as cadmium and mercury. Blood cadmium was related to blood pressure and high in men with arterial hypertensive disease. The investigations presented in this article form a good basis for further studies that clarify underlying reasons the health problems in the north.
The objective of this paper was to reassess children's exposure to air pollution as well as investigate the importance of other covariates of respiratory health. We re-examined the Hamilton Children's Cohort (HCC) dataset with enhanced spatial analysis methods, refined in the approximately two decades since the original study was undertaken. Children's exposure to air pollution was first re-estimated using kriging and land-use regression. The land-use regression model performed better, compared to kriging, in capturing local variation of air pollution. Multivariate linear and logistic regression analysis was then applied for the study of potential risk factors for respiratory health. Findings agree with the HCC study-results, confirming that children's respiratory health was associated with maternal smoking, hospitalization in infancy and air pollution. However, results from this study reveal a stronger association between children's respiratory health and air pollution. Additionally, this study demonstrated associations with low-income, household crowding and chest illness in siblings.
The prevalence of respiratory diseases in the Primorye territory is discussed. Ecological risk of air pollution effects on respiratory morbidity is estimated. High ecological risk of respiratory diseases in the cities of the region is determined by car transport waste discharge. Children and adolescents are more sensitive to air pollution and more often suffer from respiratory diseases.