Estudio primario

No clasificado

Año 2004
Revista Central European journal of public health
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The health effects in teachers of a mold-damaged school before and during an extensive remediation process were assessed. Health data were collected with self-administered questionnaires from teachers (n=31) working in a moisture and mold damaged school and from the reference group of teachers (n=13) working in a non-damaged school. The questionnaire study was repeated three times. Spirometry was measured in 33 individuals in the spring 1997 and repeated in the spring 1999 and 2000. In the damaged school, a cluster of eight asthma cases was identified, the prevalence of asthma being 26%. Before the remediation, the number of sinusitis episodes was higher (p=0.040) and the mean duration of sick leaves longer (p=0.015) among the study group than in the reference group. A higher prevalence of hoarseness and perceived poor quality of indoor air were reported. During the follow-up, no new asthma cases appeared. After the remediation, bronchitis, conjunctivitis, symptoms of allergic rhinitis and the sum of respiratory infection episodes decreased significantly. Some of the asthmatics had low values in the spirometry but no changes in the lung function were observed at the group level. The remediation of the mold damage had beneficial effects on teachers' health.

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Revisión sistemática

No clasificado

Año 2010
Revista Allergy
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El aumento en la prevalencia y carga de enfermedades atópicas, como eccema, rinitis y asma, en las últimas décadas, fue acompañado de un aumento en todo el mundo de diagnósticos de trastorno de déficit atencional con hiperactividad (TDAH). Revisamos sistemáticamente estudios epidemiológicos investigando la relación entre enfermedades atópicas y TDAH. Una búsqueda electrónica en la literatura en PubMed y PsycINFO (hasta 02/2010) complementada con una búsqueda manual arrojó 20 estudios relevantes con 170175 individuos. Se extrajo la información relevante por dos revisores de modo independiente. Seis estudios reportaron consistentemente una asociación positiva entre eccema y TDAH, con un estudio que sugirió una modificación del efecto por problemas de sueño. Doce estudios encontraron de forma consistente una asociación positiva entre asma y TDAH que, sin embargo, pareció estar al menos parcialmente explicada (confundida) por eccema concurrente o previo. Rinitis y el nivel de IgE en suero no se relacionaron con sintomatología de TDAH. Concluimos que no es la enfermedad atópica en general, sino el eccema, el que parece relacionarse de forma independiente con TDAH. Las conclusiones sobre temporalidad y si la asociación observada constituye una relación causal son imposibles, ya que la mayoría de los estudios fueron transversales (n = 14; 70%) o casos-controles sin medición de exposición incidente (n = 5; 25%). Otra preocupación metodológica es que los criterios para definir enfermedad atópica y TDAH fueron inadecuados en la mayoría de los estudios. Una limitación adicional fue que no se hizo ajuste por factores confundentes en la mayoría de los estudios, por lo que no se podía hacer meta-análisis. Se necesita investigación prospectiva interdisciplinaria de alta calidad para entender mejor los mecanismos tras las relaciones entre eccema y TDAH y eventualmente establecer estrategias preventivas y de tratamiento focalizadas.

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Síntesis amplia / Revisión panorámica de revisiones sistemáticas

No clasificado

Año 2013
Autores Verbeek J , Ivanov I
Revista Safety and health at work
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There is still a considerable burden of occupational diseases and injuries in the world. It is not well known which interventions can effectively reduce the exposures at work that cause this burden. The objective of this article is to summarize evidence from systematic reviews of interventions to prevent occupational diseases and injuries. We included systematic reviews of interventions to reduce the incidence of work-related cancer, dust-related diseases, occupational asthma, chronic obstructive pulmonary disease, noiseinduced hearing loss, back pain, and occupational injuries. We searched Medline and Embase with predefined search strategies to locate systematic reviews of these interventions. We found 23 systematic reviews of which the results are also applicable to low- and middle income countries. Effective measures to reduce exposure leading to work-related cancer, dust-related diseases, asthma, chronic obstructive pulmonary disease, noise, and injuries are available. However, better implementation of these measures is needed. Regulation, enforcement of regulation, and incentives for employers are effective interventions to achieve this goal. There is evidence that feedback and rewards for workers help in reducing occupational injuries. There is no evidence in many studies that back pain can be prevented. Personal protective equipment technically has the potential to reduce exposure but this is difficult to put into effect. There is no evidence in the studies regarding the effectiveness of education and training, preventive drugs, or health examinations. There is evidence that the implementation of technical measures enforced by regulation can prevent occupational diseases and injuries. For other interventions such as education or health examinations, there is no evidence that supports their effectiveness. More systematic reviews are needed in the area of injury prevention.

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Revisión sistemática

No clasificado

Año 2010
Autores Linabery AM , Jurek AM , Duval S , Ross JA
Revista American journal of epidemiology
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Se postula que la enfermedad atópica protege contra varias enfermedades malignas, incluyendo leucemia infantil/adolescente. Para resumir la evidencia epidemiológica disponible, los autores realizaron un meta-análisis de asociaciones entre atopia/alergias, asma, eccema, fiebre del heno y urticaria y leucemia infantil/adolescente, leucemia linfoblástica aguda (LLA) y leucemia mieloide aguda (LMA). Buscaron en la literatura en MEDLINE (1952-marzo de 2009) y consultaron a expertos internacionales para identificar estudios elegibles. Se incluyeron 10 estudios de casos-controles. Los odds ratios resumen y los intervalos de confianza 95% se calcularon con un modelo de efectos aleatorios. Los odds ratios para atopia/alergias fueron 1.42 (intervalo de confianza (IC) 95%: 0.60, 3.35) para 3 estudios de leucemia en general, 0.69 (IC 95%: 0.54, 0.89) para 6 estudios de LLA, y 0.87 (IC 95%: 0.62, 1.22) para 2 estudios de LMA, con altos niveles de heterogeneidad detectados para leucemia en general y LLA. Se observaron asociaciones inversas para LLA y asma (odds ratio (OR) = 0.79, IC 95%: 0.61, 1.02), eccema (OR = 0.74, IC 95%: 0.58, 0.96) y fiebre del heno (OR = 0.55, IC 95%: 0.46, 0.66) examinados por separado. Los odds ratios para LLA difirieron por diseño de estudio, fuente de datos de exposición y período de latencia, indicando que estos factores afectan resultados de estudio. Estos resultados deben interpretarse con cuidado dado el modesto número de estudios, heterogeneidad sustancial y potencial clasificación errónea de exposición, pero son útiles en diseñar investigación futura.

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Estudio primario

No clasificado

Año 1996
Autores GlaxoSmithKline
No publicado SLGQ97 (SLGB4010) Phase IV
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OFFICIAL TITLE:

A multi-centre double-blind, parallel group study to evaluate the relative clinical benefits of three treatment interventions: i) salmeterol xinafoate 50 mcg bd plus fluticasone propionate 250 mcg bd; ii) fluticasone propionate 500 mcg bd; iii) fluticasone propionate 250 mcg bd, in adult asthmatic subjects poorly controlled on current inhaled corticosteroids.

RATIONALE:

Administration of corticosteroids is the most effective anti-inflammatory therapy available for the treatment of bronchial asthma. Current UK guidelines recommend that inhaled corticosteroids should be introduced at a very early stage of asthma management and encourage an increase in daily dose to ≥1500 mcg. However, guidelines on asthma management now include the addition of inhaled long-acting β 2 -agonists (e.g. salmeterol xinafoate [SX]) to inhaled corticosteroids, as an alternative option to increasing the inhaled corticosteroid dose, in subjects with asthma who remain symptomatic despite treatment with low-dose inhaled corticosteroids. The aim of this study was to evaluate the relative clinical benefits, in terms of asthma control, of either increasing the dose of inhaled corticosteroid or combining a lower dose of inhaled corticosteroid with SX.

OBJECTIVES:

The primary objective was to evaluate the relative clinical benefits (in terms of asthma control) of either increasing the dose of inhaled corticosteroid to FP 500 mcg bd, or combined treatment with FP 250 mcg and SX 50 mcg bd in asthmatic subjects poorly controlled on existing inhaled corticosteroid therapy.

STATISTICAL METHODS:

The study was designed to include 528 evaluable subjects (176 per treatment arm). This would achieve 90% power to detect a treatment difference at a significant level of 1.6% (adjusted for multiple treatment comparisons), of 5 percentage points in change from baseline in mean morning PEFR, as a percentage of the maximum achievable PEFR obtained at Visit 1. In the data analysis plan, written before the study was un-blinded, the PEFR primary efficacy variable was switched to change in mean morning PEFR, as this was considered of more clinical importance. Morning PEFR variables and most secondary variables were analysed using the Van Elteren test adjusted for country, and also adjusted for baseline if the variable was an absolute rather than a change from baseline value. Monthly data were compared using a repeated measures analysis. The proportion of withdrawals due to exacerbations was analysed using Fisher’s exact test. The secondary variables of evening PEFR, clinic FEV 1 , and FVC were summarised rather than being formally analysed. All analyses were conducted using the intent-to-treat (ITT) population. The ITT population consisted of all randomised subjects regardless of protocol compliance with the exception of 6 randomised subjects recruited at one investigator site that was subsequently found to have fabricated trial data.

SAFETY RESULTS:

An on-therapy adverse event (AE) was defined as any event that started during the treatment period up to the final visit.

CONCLUSION:

Mean improvement in morning PEFR was significantly greater for the SX +FP treatment group compared with each of the FP alone treatment groups after Months 1, 2, 3 and 6. There was no significant difference in morning PEFR between the FP 250 and the FP 500 treatment groups. There was no significant difference in the incidence and severity of asthma exacerbations per subject between any of the treatment groups. In total, 117 subjects (68%), 114 subjects (69%) and 121 subjects (76%) reported AEs in the SX + FP, FP 500 and FP 250 treatment groups, respectively. The most common AEs in all 3 treatment groups were exacerbation of asthma, upper respiratory tract infection and influenza. Nine subjects (5%), 4 subjects (2%) and 5 subjects (3%) reported SAEs in the SX + FP, FP 500 and FP 250 treatment groups, respectively. The most common SAE in the SX + FP treatment group was chest pain and the most common SAE in the FP 500 treatment group was exacerbation of asthma; no other SAEs were experienced by >1 subject. One subject in the SX + FP treatment group died from an SAE of pneumothorax.

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