RESUMO
The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.
Assuntos
Transtornos de Estresse por Calor , Medicina Selvagem , Humanos , Medicina Ambiental , Transtornos de Estresse por Calor/prevenção & controle , Sociedades MédicasRESUMO
Background: Chronic obstructive pulmonary disease (COPD) develops as a multifaceted and complex disorder, with clinical and functional repercussions. Objective: To investigate the association among contextual factors (personal and environmental) and clinical features and the disability of COPD patients, with emphasis on activity and social participation. Methods: A cross-sectional study with stable COPD participants (n = 47) was conducted to assess personal and clinical characteristics, activity of daily living using the London Chest Activity of Daily Living scale (LCADL), disability by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and environmental factors by the Craig Hospital Inventory of Environmental Factors (CHIEF). Statistical analysis was performed by the multivariate method. Results: In the LCADL predictive analysis, the variables forced expiratory volume in 1 second (FEV1), dyspnea levels 3-4 by the modified Medical Research Council scale (mMRC), and active level of regular physical activity were included in the final model (adjusted R 2 = 0.523). In addition, WHODAS was influenced by CHIEF physical structure score and mMRC 1-2 and mMRC 3-4 grades (adjusted R 2 = 0.500). Conclusions: Disability is a complex in COPD patients and encompasses a prominent role of dyspnea levels in the prediction of activity and participation. Multivariate models presented clinical and contextual factors as functional predictors that included the physical structure of the environment in the determination of social participation.
Assuntos
Pessoas com Deficiência , Dispneia/fisiopatologia , Medicina Ambiental , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Atividades Cotidianas , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Growing concern about the risk associated with increasing environmental mercury (Hg) concentrations has resulted in a focus on the relationships between intercontinental emitted and accumulated Hg. We use a global biogeochemical Hg model with 8 continental regions and a global ocean to evaluate the legacy impacts of historical anthropogenic releases (2000BCE to 2008AD) on global source-receptor relationships of Hg. Legacy impacts of historical anthropogenic releases are confirmed to be significant on the source-receptor relationships according to our results. Historical anthropogenic releases from Asia account for 8% of total soil Hg in North America, which is smaller than the proportion (~17%) from previous studies. The largest contributors to the global oceanic Hg are historical anthropogenic releases from North America (26%), Asia (16%), Europe (14%) and South America (14%). Although anthropogenic releases from Asia have exceeded North America since the 1970s, source contributions to global Hg receptors from Asia have not exceeded North America so far. Future projections indicate that if Hg emissions are not effectively controlled, Asia will exceed North America as the largest contributor to the global ocean in 2019 and this has a long-term adverse impact on the future environment. For the Arctic Ocean, historical anthropogenic release from North America contributes most to the oceanic Hg reservoir and future projections reveal that the legacy impacts of historical releases from mid-latitudes would lead to the potential of rising Hg in the Arctic Ocean in the future decades, which calls for more effective Hg controls on mid-latitude releases.
Assuntos
Mercúrio/análise , Poluentes Químicos da Água/análise , Regiões Árticas , Ásia , Medicina Ambiental , Europa (Continente) , Modelos Teóricos , América do Norte , Oceanos e Mares , América do SulRESUMO
OBJETIVO: Analizar los efectos de la sequía 2013-2016 en las manifestaciones de ansiedad y depresión en hombres y mujeres de la comunidad rural La China, Ciudad Darío, Matagalpa y su percepción precedente al fenómeno. DISEÑO: Se trató de un estudio mixto cuali-cuantitativo, con diseño explicativo secuencial (DEXPLIS), de corte transversal. Se realizó con una muestra estadística del 44% de la población meta para un primer estudio exploratorio no probabilístico compuesta por 21 hombres y 47 mujeres subdivididos en tres franjas de edad comprendidas entre los 25- 60 años, que vivieron el período de la sequía, con capacidad mnemónica para recordar el período precedente a ella. Para recopilar la información, se utilizó el cuestionario de la OMS "A User's Guide to the Self Reporting Questionnaire" (SRQ) adaptado para fines de esta investigación y un grupo focal de 5 hombres y 3 mujeres realizado para comprender las causas y efectos de los trastornos afectivos de la comunidad dimensionados a partir de los presupuestos del SRQ y procesados a través del programa Atlas-ti. RESULTADOS: Las personas encuestadas manifestaron estados afectivos que se han producido o incrementado a raíz de tres años de sequía prolongada: agotamiento constante y enfermedades, pérdida de interés, baja autoestima, temblor de manos, aumento de nerviosismo, dolores de cabeza y de estómago, insomnio, e inclusive, ideación suicida. El principal factor ha sido mucha preocupación y estrés por falta de producción debido a la escasez de lluvias. El manejo del agua es un fenómeno que en la memoria del grupo focal, empieza a partir del huracán Mitch (1998). Es decir, los desastres provocan inestabilidad emocional incrementando las condiciones de vulnerabilidad ambiental y psico-social que aumentan las desigualdades en la salud y el bienestar. En el análisis de género, las mujeres resultaron con mayores trastornos afectivos; aun así, son más resilientes frente a las adversidades ya que buscan alternativas de sobrevivencia (migración laboral principalmente) y búsqueda de apoyo social que resulta ser un factor protector. Las edades de mayor riesgo, resultaron los hombres de 35-44 años y el grupo de edad 45-60 años
Assuntos
Humanos , Condições Sociais , Impactos da Poluição na Saúde , Efeitos do Clima , Medicina Ambiental , SecasRESUMO
Peru is a country located on the Pacific coast of South America with a population of more than 30 million inhabitants. In the past 10 years, Peru has had a steady economic growth. Peru is predominantly an extractive industry country, but the manufacturing and construction sectors are booming. It is in this context that regulations have been implemented to protect the safety and health of workers. One of the most important regulations is the Law on Safety and Health at Work, which has been recently promulgated. Regulations are complemented by training and education in occupational safety and health. The measures are yet to be fully implemented thus a positive effect in reducing accidents and occupational diseases at work has not yet been seen.
Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Saúde Ocupacional/legislação & jurisprudência , Medicina Ambiental , Ergonomia , Humanos , Saúde Ocupacional/educação , Enfermagem do Trabalho/educação , Medicina do Trabalho/educação , Peru/epidemiologiaRESUMO
Individuals in the developing world live in conditions of intense exposure to enteric pathogens due to suboptimal water and sanitation. These environmental conditions lead to alterations in intestinal structure, function, and local and systemic immune activation that are collectively referred to as environmental enteropathy (EE). This condition, although poorly defined, is likely to be exacerbated by undernutrition as well as being responsible for permanent growth deficits acquired in early childhood, vaccine failure, and loss of human potential. This article addresses the underlying theoretical and analytical frameworks informing the methodology proposed by the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study to define and quantify the burden of disease caused by EE within a multisite cohort. Additionally, we will discuss efforts to improve, standardize, and harmonize laboratory practices within the MAL-ED Network. These efforts will address current limitations in the understanding of EE and its burden on children in the developing world.
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Doenças Transmissíveis , Medicina Ambiental , Projetos de Pesquisa Epidemiológica , Enteropatias , Desnutrição , Pré-Escolar , Efeitos Psicossociais da Doença , Humanos , Lactente , Recém-Nascido , Estudos LongitudinaisRESUMO
La salud ambiental, según la organizacòn Mundial de la Salud es "una disciplina que comprende aquellos aspectos de la Salud_humana, incluìda la calidad de vida, el bienestar social,entre otros, que son determinados por factores ambientales físicos; químicos, biológicos, sociales y psicosociales. También se refiere a la teoría y práctica de evaluar, corregir, controlar y prevenir aquellos factores en el medio ambiente que pueden potencialmente afectar adversamente la salud de presentes y futuras generaciones". En este contesto la cultura ambiental es fundamental en una sociedad para establecer conductas y corrientes de opiniòn tendientes al cuidado del ambiente asociado a la salud.
Environmental health, according to the World Organizacon of Health is "a discipline that comprises those Salud_humana aspects, including quality of life, social welfare, etc., which are Physical determined by environmental factors; chemical, biological, social and psychosocial. It also refers to the theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the health of present and future generations". This answer is critical environmental culture in a society to establish behaviors and current opinion aimed at caring for the environment associated health.
Assuntos
Educação em Saúde Ambiental , Fenômenos Ecológicos e Ambientais , Medicina AmbientalRESUMO
La construcción de indicadores de salud ambiental para evaluar el efecto adverso de los cambios ambientales sobre el bienestar y la calidad de vida de la población es una meta todavía no alcanzada totalmente en América Latina y el Caribe. Por ello, el Programa de las Naciones Unidas para el Medio Ambiente y la Organización Panamericana de la Salud han convocado a instituciones y especialistas de toda la Región para desarrollar un método integral de evaluación del medio ambiente y la salud. En este trabajo se hace un análisis crítico de varias de las metodologías de evaluación ambiental y sanitaria (integrales o no) y se describen, desde una perspectiva histórica, los marcos conceptuales que fundamentan los principales métodos ordenadores o generadores de indicadores de salud ambiental utilizados en América Latina y el Caribe. Se identificaron dos limitaciones metodológicas recurrentes: a) la fuerte dependencia de datos secundarios, lo que implica la necesidad de una capacidad tecnológica instalada poco accesible en América Latina y el Caribe en la actualidad; y b) la falta de criterios claros para desarrollar instrumentos participativos que faciliten la evaluación de problemas de salud ambiental a nivel local. A pesar de los avances alcanzados en el campo de la salud ambiental en cuanto a la comprensión de su complejidad interdisciplinaria, aún se deben mejorar los mecanismos intersectoriales que favorezcan la discusión e implementación de políticas integradas de medio ambiente y salud.
The establishment of environmental health indicators for assessing the adverse effects of environmental changes on the population's health and quality of life is, as yet, a goal that has not been fully reached in Latin America and the Caribbean. As such, the United Nations Environment Program and the Pan American Health Organization (PAHO) have convened Region's institutions and experts to develop a comprehensive method for assessing environmental health. This paper evaluates several methodologies, comprehensive or otherwise, for assessing health and the environment, and describes the frameworks that have historically undergirded the key methods that have either structured or generated the environmental health indicators being used in Latin America and the Caribbean. The recurring, methodological limitations were identified: (a) relying heavily on secondary data, which points out the need for technological infrastructure that is rarely available in Latin America and the Caribbean today; and (b) a lack of clear criteria for developing inclusive tools that would facilitate the discussion of environmental health issues at the grass-roots level. Despite the progress made by the field of environmental health with regard to understanding its interdisciplinary complexities, intersectoral operations must be improved to favor open communication and implementation of integrated policies on environmental and health.