RESUMO
Este artículo revisa los principales desafíos éticos que plantea la investigación vinculada al genoma humano a la luz de la bibliografía internacional y entrega recomendaciones sobre su abordaje basada en nuestra experiencia en el Comité de Ética para la Investigación en Seres Humanos de la Facultad de Medicina, Universidad de Chile, incluyendo las regulaciones legales nacionales. Los estándares éticos de la investigación en seres humanos deben extremarse para proteger adecuadamente a los participantes en estudios involucrados con la genómica. Especialmente relevantes en este contexto son: la protección de la confidencialidad y anonimato; la política de entrega de resultados y la posibilidad de retirarse del estudio. Compartir datos resultantes de investigaciones genéticas permite optimizar recursos, otorga mayor transparencia y replicabilidad de los análisis y permite descubrir alteraciones genéticas responsables de enfermedades raras y genes involucrados en enfermedades hereditarias multifactoriales, además de contribuir al diseño de medicina de precisión y de nuevas estrategias terapéuticas. Sin embargo, plantea grandes desafíos: proteger la privacidad y evitar la re-identificación de los voluntarios, la entrega de resultados con asesoría pre y post estudio. Estos aspectos requieren la elaboración de un cuidadoso proceso de consentimiento informado para investigaciones genómicas cuyos componentes principales se analizan en este artículo.
This article reviews the main ethical challenges posed by human genome research in the light of the international literature and provides recommendations on how to approach them based on our experience in the Ethics Committee for Research on Human Subjects of the Faculty of Medicine, University of Chile, including national legal regulations. Ethical standards in human research must be extreme, in order to adequately protect participants in studies involving genomics. Particularly relevant in this context are the protection of confidentiality and anonymity; the policy of delivery of results and the possibility of withdrawing from the study. Sharing data resulting from genetic research optimizes resources, provides greater transparency, and replicability of the analyses and makes it possible to discover genetic alterations responsible for rare diseases and genes involved in multi-factorial hereditary diseases, as well as contributing to the design of precision medicine and new therapeutic strategies. However, it poses great challenges: protecting privacy and avoiding re-identification of volunteers, delivery of results with pre- and post-study counseling. These aspects require the elaboration of a careful informed consent process for genomic research, the main components of which are discussed in this article.
Assuntos
Humanos , Pesquisa em Genética/ética , Experimentação Humana/ética , Genoma Humano , Confidencialidade , Privacidade Genética , Comitês de Ética em Pesquisa , Consentimento Livre e EsclarecidoRESUMO
Climate changes evidenced by an increase in our planet's mean temperature, changes in rainfall, increased sea level and extreme weather conditions, favor air and soil contamination, ocean acidification, droughts, floods, heat waves and forest fires, which affect the health and wellbeing of exposed populations. These changes will exert negative effects on respiratory and cardiovascular systems, nutritional status, burden of infectious diseases, especially vector-borne infections, and human mental health. Moreover, environmental damages, such as loss of biodiversity, ecological collapse and deterioration of socioeconomic factors such as agricultural and fishery production, and the loss of habitable land, will impulse massive migrations. This article summarizes the impact that climate change is expected to have on respiratory, cardiovascular and infectious diseases and its repercussions on people of extreme ages. It is imperative to achieve the immediate commitment of worldwide national governments to control green-house gas emissions. The appropriate technology does exist, but political will is urgently needed to accomplish this goal.
Assuntos
Mudança Climática , Doenças Transmissíveis , Animais , Vetores de Doenças , Humanos , Concentração de Íons de Hidrogênio , Água do MarRESUMO
Climate changes evidenced by an increase in our planet's mean temperature, changes in rainfall, increased sea level and extreme weather conditions, favor air and soil contamination, ocean acidification, droughts, floods, heat waves and forest fires, which affect the health and wellbeing of exposed populations. These changes will exert negative effects on respiratory and cardiovascular systems, nutritional status, burden of infectious diseases, especially vector-borne infections, and human mental health. Moreover, environmental damages, such as loss of biodiversity, ecological collapse and deterioration of socioeconomic factors such as agricultural and fishery production, and the loss of habitable land, will impulse massive migrations. This article summarizes the impact that climate change is expected to have on respiratory, cardiovascular and infectious diseases and its repercussions on people of extreme ages. It is imperative to achieve the immediate commitment of worldwide national governments to control green-house gas emissions. The appropriate technology does exist, but political will is urgently needed to accomplish this goal.
Assuntos
Humanos , Animais , Mudança Climática , Doenças Transmissíveis , Água do Mar , Vetores de Doenças , Concentração de Íons de HidrogênioRESUMO
La exposición a las emanaciones de incendios forestales es un importante problema de salud pública nacional e internacional. El cambio climático que conlleva sequía y aumento de la temperatura estival aumenta el riesgo y magnitud de los episodios de incendios forestales, generándose grandes incendios cuyas emanaciones pueden afectar a poblaciones distanciadas del epicentro. La asociación entre la exposición a las emanaciones de los incendios forestales, el aumento de las concentraciones de material particulado aéreo y la morbilidad respiratoria (exacerbación de asma y enfermedades respiratorias crónicas) ha sido evidenciada en diversos estudios. Sin embargo, es difícil realizar un metaanálisis de ellos, ya que la metodología empleada es muy disímil. Entre los principales mecanismos de morbilidad se encontrarían: la producción de citoquinas proinflamatorias, la activación endotelial y la disfunción del sistema nervioso autónomo. Ante la exposición al humo de incendios forestales, se produce daño tisular, aumento de los mecanismos protrombóticos, aumento de la presión arterial y cambios en el ritmo cardiaco, que explicaría los efectos cardiovasculares. Los sujetos con patología cardiovascular preexistente podrían tener mayor riesgo cardiovascular; sin embargo, existen factores confundentes en esta asociación. Por otra parte, el posible riesgo cancerígeno con la exposición a estas emanaciones requiere mayores estudios poblacionales.
Exposure to forest fire fumes is a major national and international public health issue. Climate change that leads to drought and increased summer temperature increases the risk and magnitude of wildfires episodes, generating mega-fires whose fumes not only affect the boundary population, but they may become transcontinental. Association between exposure to forest fire fumes, mainly increased concentrations of air born particulate matter and respiratory morbidity (exacerbation of asthma and chronic respiratory diseases) has been evidenced by diverse studies. However, it is difficult to carry out meta-analysis with them since the methodology used is dissimilar. Among the main causes of morbidity have been postulated the production of pro-inflammatory cytokines, endothelial activation and dysfunction of the autonomic nervous system. Occurrence of tissue damage, increased prothrombotic mechanisms, increased blood pressure and changes in heart rate, would explain the cardiovascular effects associated with exposure to smoke from these fires. However, epidemiological outcomes have not been entirely consistent, as the association between cardiovascular morbidity and exposure to wildfire fumes may be mixed with confounding factors. Despite this, patients with pre-existing cardiovascular pathology may be at increased risk. Finally, the potential risk of carcinogen with exposure to these fumes requires further population studies.
Assuntos
Humanos , Doenças Respiratórias/epidemiologia , Incêndios Florestais , Poluição do Ar/efeitos adversos , Material Particulado/efeitos adversos , Doenças Respiratórias/etiologia , Asma/etiologia , Asma/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/epidemiologia , Saúde PúblicaRESUMO
INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2.5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2,5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.
Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Hospitalização/estatística & dados numéricos , Material Particulado/toxicidade , Doenças Respiratórias/etiologia , Adolescente , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , Criança , Pré-Escolar , Chile/epidemiologia , Estudos Cross-Over , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Material Particulado/análise , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Fatores de RiscoRESUMO
INTRODUCCIÓN: Santiago de Chile con 7 millones de habitantes alcanza elevados niveles de contaminación atmosférica en invierno, el material particulado habitualmente excede los estándares de la OMS. OBJETIVO: Evaluar la influencia de la contaminación atmosférica por material particulado en las hospitalizaciones por enfermedades respiratorias en niños, entre 2001 y 2005 en la Región Metropolitana de Chile, independientemente de la presencia ambiental de virus sincicial respiratorio (VRS). MATERIAL Y MÉTODO: 72.479 hospitalizaciones públicas y privadas por enfermedades respiratorias de niños menores de 15 años residentes en la región del estudio se analizaron con un diseño de caso control alternante, con estratificación temporal. Se evaluó principalmente: hospitalizaciones por enfermedades respiratorias (J00-J99), neumonía (J12-J18); asma (J21.0 - J21.9) y bronquiolitis (J45 - J46). Recopilándose diariamente temperatura, MP10, MP2,5, ozono, virus respiratorios (VRS) y humedad ambientales. RESULTADOS: Los promedios de MP10 y MP2,5 fueron 81,5 y 41,2 pg/m3 respectivamente. El promedio de temperatura fue 12,8 °C y de la humedad del aire 72,6 %. Un aumento de 10 pg/m3 de MP25 con 1 y 2 días de rezago se asoció con un incremento de las hospitalizaciones por enfermedades respiratorias cercano a 2%, este porcentaje aumentó a 5% cuando la exposición fue con 8 días de rezago, reflejando sinergismo entre material particulado y virus respiratorio (VRS). CONCLUSIÓN: La exposición breve a contaminación atmosférica puede provocar hospitalizaciones por enfermedades respiratorias en niños.
INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2,5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2.5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Doenças Respiratórias/etiologia , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Material Particulado/toxicidade , Hospitalização/estatística & dados numéricos , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/epidemiologia , Modelos Logísticos , Chile/epidemiologia , Fatores de Risco , Estudos Cross-Over , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Material Particulado/análiseRESUMO
Los incendios forestales representan un problema creciente de la salud pública a nivel mundial, especialmente para la población más vulnerable (niños, ancianos, embarazadas y portadores de enfermedades cardiovasculares o respiratorias crónicas) expuesta al humo y a otros contaminantes aéreos. A diferencia de la contaminación atmosférica habitual de grandes urbes, aquella derivada de los incendios forestales tiene una composición diferente y su ocurrencia es esporádica y difícil de prever. La exposición a contaminantes atmosféricos derivados de incendios forestales se asocia a aumento de la morbilidad respiratoria y cardiovascular, mediada por una respuesta inflamatoria pulmonar y sistémica, estrés oxidativo y disfunción endotelial. En sujetos expuestos a humo de incendios forestales se ha observado un aumento en la producción de citoquinas pro-inflamatorias, activación endotelial y disfunción del sistema nervioso autónomo, que produce daño tisular, aumento de los mecanismos protrombóticos, aumento de la presión arterial y cambios en el ritmo cardiaco. Esta revisión analiza los mecanismos que han sido involucrados en generar efectos nocivos para la salud de seres humanos expuestos a material particulado y gases emanados de incendios forestales.
Wildfires represent a growing global public health issue, especially to the most vulnerable segment of the population (children, old people, pregnant women, patients with cardiovascular or respiratory diseases) exposed to smoke and other air borne contaminants generated from these events. In contrast to great cities ' usual atmospheric pollution, that derives from forest fires differ in composition and its occurrence is sporadic and usually unpredictable. Exposure to atmospheric pollutants derived from forest fires has been associated to increased respiratory and cardiovascular morbidity, mediated by an inflammatory systemic response, oxidative stress and endothelial dysfunction. In people exposed to forest fire smoke an increased production of pro-inflammatory cytokines, endothelial activation and autonomic nervous system dysfunction has been observed, that leads to tissue injury, increased prothrombotic response, increased blood pressure and changes in heart rhythm. This review analyzes the mechanisms that have been involved in generating harmful health effects in humans exposed to inhaled particulate matter and gases steaming from wildfires.