Abstract The interaction between genetic potential and the environment, especially increased urbanization and inadequate waste management, contributes to the manifestation of allergic diseases. Pediatric patients are the most vulnerable, due to the immaturity of the respiratory and immune systems. Prenatal and postnatal exposure to air pollutants, both indoors and outdoors, accelerates or aggravates morbidity and mortality from allergic diseases. The “exposome,” which encompasses all environmental exposures throughout life, influences health. Biological and chemical attacks alter the epithelial barrier, triggering inflammatory responses and favoring allergic diseases, such as food allergies. The uncontrolled use of toxic fuels, particulate matter, detergents and other factors contribute to the continuous deterioration of the intestinal epithelial barrier, increasing the risk of allergic diseases. It is important to take urgent action to address these issues and protect the health of the planet.

Resumen La interacción entre el potencial genético y el medio ambiente, especialmente el aumento de la urbanización y la gestión inadecuada de residuos contribuye con la manifestación de enfermedades alérgicas. Los pacientes pediátricos son los más vulnerables, debido a la inmadurez de los sistemas respiratorio e inmunológico. La exposición prenatal y posnatal a contaminantes del aire, tanto en exteriores como interiores, acelera o agrava la morbilidad y mortalidad por enfermedades alérgicas. El "exposoma", que abarca todas las exposiciones ambientales a lo largo de la vida, influye en la salud. Las agresiones biológicas y químicas alteran la barrera epitelial, desencadenando respuestas inflamatorias y favoreciendo enfermedades alérgicas, como alergias alimentarias. El uso descontrolado de combustibles tóxicos, material particulado, detergentes y otros factores contribuyen con el deterioro continuo de la barrera epitelial intestinal, aumentando el riesgo de enfermedades alérgicas. Es importante tomar medidas urgentes para abordar estos problemas y proteger la salud del planeta.

RESUMO A exposição ao radônio pode ter impacto na saúde humana. Esta é uma revisão não sistemática de artigos escritos em inglês, espanhol, francês ou português publicados na última década (2013-2023), utilizando bancos de dados como PubMed, Google Acadêmico, EMBASE e SciELO. Os termos de busca selecionados foram radônio, saúde humana, doenças respiratórias, crianças e adultos. Após a análise dos títulos e resumos, os pesquisadores inicialmente identificaram 47 estudos, que foram posteriormente reduzidos para 40 após a exclusão de revisões, dissertações, teses e estudos de caso-controle. Os estudos mostraram que ambientes fechados como residências e locais de trabalho apresentam maiores níveis de radônio do que ambientes externos. Além disso, o radônio é uma das principais causas de câncer de pulmão, especialmente em não fumates. Também foi observada associação entre exposição ao radônio e desenvolvimento de outras doenças pulmonares, como asma e DPOC. É crucial aumentar a conscientização do público e implementar medidas governamentais de controle para reduzir a exposição ao radônio. É fundamental quantificar os níveis de radônio em todos os tipos de edifícios e treinar profissionais para realizar essas medições segundo padrões de eficácia comprovada. Os profissionais de saúde também devem ser informados sobre essa ameaça e receber formação adequada para lidar com os efeitos do radônio na saúde humana. humana inglês espanhol 20132023, 20132023 2013 2023 , (2013-2023) PubMed Acadêmico SciELO respiratórias adultos resumos 4 revisões dissertações casocontrole. casocontrole caso controle. caso-controle externos disso pulmão fumates pulmonares DPOC comprovada 2013202 201 202 (2013-2023 201320 20 (2013-202 20132 2 (2013-20 (2013-2 (2013- (2013 (201 (20 (2 (

ABSTRACT Exposure to radon can impact human health. This is a nonsystematic review of articles written in English, Spanish, French, or Portuguese published in the last decade (2013-2023), using databases such as PubMed, Google Scholar, EMBASE, and SciELO. Search terms selected were radon, human health, respiratory diseases, children, and adults. After analyzing the titles and abstracts, the researchers initially identified 47 studies, which were subsequently reduced to 40 after excluding reviews, dissertations, theses, and case-control studies. The studies have shown that enclosed environments such as residences and workplaces have higher levels of radon than those outdoors. Moreover, radon is one of the leading causes of lung cancer, especially in nonsmokers. An association between exposure to radon and development of other lung diseases, such as asthma and COPD, was also observed. It is crucial to increase public awareness and implement governmental control measures to reduce radon exposure. It is essential to quantify radon levels in all types of buildings and train professionals to conduct such measurements according to proven efficacy standards. Health care professionals should also be informed about this threat and receive adequate training to deal with the effects of radon on human health. health English Spanish French 20132023, 20132023 2013 2023 , (2013-2023) PubMed Scholar EMBASE SciELO diseases children adults abstracts 4 reviews dissertations theses casecontrol case outdoors Moreover cancer nonsmokers COPD observed standards 2013202 201 202 (2013-2023 201320 20 (2013-202 20132 2 (2013-20 (2013-2 (2013- (2013 (201 (20 (2 (

Resumo Objetivo: Determinar a prevalência de rinite alérgica e fatores associados em adolescentes e em seus pais/responsáveis. Métodos: Estudo transversal, com aplicação de questionário escrito padronizado e validado. Adolescentes (13–14 anos; n=1.058) e seus pais/responsáveis (média de idade=42,1 anos; n=896) residentes na cidade de Uruguaiana, Sul do Brasil, responderam aos questionários padrão da Global Asthma Network. Resultados: A prevalência de rinite alérgica em adolescentes foi de 28,0%, a de rinoconjuntivite alérgica foi de 21,3% e a de formas graves de rinite alérgica, de 7,8%. Nos adultos, a prevalência de rinite alérgica foi de 31,7%. Alguns fatores associados à rinite alérgica em adolescentes incluem fazer pouco exercício físico (odds ratio — OR 2,16; intervalo de confiança — IC95% 1,15–4,05), ter apenas um irmão mais velho (OR 1,94; IC95% 1,01–3,72) e consumir carne diariamente (OR 7,43; IC95% 1,53–36,11). Por outro lado, consumir açúcar (OR 0,34; IC5% 0,12–0,93) ou azeite de oliva (OR 0,33 IC95% 0,13–0,81) uma ou duas vezes por semana e comer vegetais diariamente (OR 0,39; IC95% 0,15–0,99) foram considerados fatores associados negativamente. Em adultos, a exposição a fungos no domicílio (OR 5,25; IC95% 1,01–27,22) e o consumo de carne uma ou duas vezes por semana (OR 46,45; IC95 2,12–1020,71) foram fatores associados ao diagnóstico médico de rinite alérgica, enquanto a baixa escolaridade (OR 0,25; IC95% 0,07–0,92) se mostrou como fator associado negativamente. Conclusões: A prevalência de rinite alérgica em adolescentes é alta, assim como seu diagnóstico médico em adultos residentes em Uruguaiana. Fatores ambientais, especialmente hábitos alimentares, foram associados aos achados em ambos os grupos. Objetivo paisresponsáveis pais responsáveis Métodos transversal validado 13–14 1314 13 14 (13–1 anos n=1.058 n1058 n 1 058 média idade421 idade 42 idade=42, n=896 n896 896 Uruguaiana Brasil Network Resultados 280 28 0 28,0% 213 21 3 21,3 78 7 8 7,8% 317 31 31,7% odds 2,16 216 2 16 IC 1,15–4,05, 115405 1,15–4,05 , 15 4 05 1,15–4,05) 1,94 194 94 1,01–3,72 101372 01 72 7,43 743 43 1,53–36,11. 1533611 1,53–36,11 . 53 36 11 1,53–36,11) lado 0,34 034 34 IC5 0,12–0,93 012093 12 93 033 33 0,3 0,13–0,81 013081 81 0,39 039 39 0,15–0,99 015099 99 negativamente 5,25 525 5 25 1,01–27,22 1012722 27 22 46,45 4645 46 45 IC9 2,12–1020,71 212102071 1020 71 0,25 025 0,07–0,92 007092 07 92 Conclusões alta ambientais alimentares grupos 13–1 131 (13– n=1.05 n105 idade42 idade=42 n=89 n89 89 28,0 21, 7,8 31,7 2,1 11540 1,15–4,0 1,9 19 9 1,01–3,7 10137 7,4 74 153361 1,53–36,1 03 0,12–0,9 01209 0, 0,13–0,8 01308 0,15–0,9 01509 5,2 52 1,01–27,2 101272 46,4 464 2,12–1020,7 21210207 102 0,2 02 0,07–0,9 00709 13– (13 n=1.0 n10 idade4 idade=4 n=8 n8 28, 7, 31, 2, 1154 1,15–4, 1, 1,01–3, 1013 15336 1,53–36, 0,12–0, 0120 0,13–0, 0130 0,15–0, 0150 5, 1,01–27, 10127 46, 2,12–1020, 2121020 10 0,07–0, 0070 (1 n=1. n1 idade= n= 115 1,15–4 1,01–3 101 1533 1,53–36 0,12–0 012 0,13–0 013 0,15–0 015 1,01–27 1012 2,12–1020 212102 0,07–0 007 ( n=1 1,15– 1,01– 153 1,53–3 0,12– 0,13– 0,15– 1,01–2 2,12–102 21210 0,07– 00 1,15 1,01 1,53– 0,12 0,13 0,15 2,12–10 2121 0,07 1,1 1,0 1,53 0,1 2,12–1 212 0,0 1,5 2,12– 2,12

Abstract Objective: To determine the prevalence of allergic rhinitis and associated factors in adolescents and in their parents/guardians. Methods: A cross-sectional study, applying a standardized and validated written questionnaire. Adolescents (13–14 years old; n=1,058) and their parents/guardians (mean age=42.1 years old; n=896) living in the city of Uruguaiana, southern Brazil, responded to the Global Asthma Network standard questionnaires. Results: The prevalence of allergic rhinitis in adolescents was 28.0%, allergic rhinoconjunctivitis, 21.3%, and severe forms of allergic rhinitis, 7.8%. In the adults, the prevalence of allergic rhinitis was 31.7%. Some associated factors with allergic rhinitis in adolescents include low physical exercise (OR 2.16; 95%CI 1.15–4.05), having only one older sibling (OR 1.94; 95CI 1.01–3.72) and daily meat consumption (OR 7.43; 95% CI 1.53–36.11). In contrast, consuming sugar (OR 0.34; 95%CI 0.12–0.93) or olive oil (OR 0.33; 95%CI 0.13–0 .81) once or twice a week, and eating vegetables daily (OR 0.39; 95%CI 0.15–0.99) were considered factors negatively associated. In adults, exposure to fungi at home (OR 5.25; 95%CI 1.01–27.22) and consumption of meat once or twice a week (OR 46.45; 95CI 2.12–1020.71) were factors associated with the medical diagnosis of allergic rhinitis, while low education (OR 0.25; 95%CI 0.07–0.92) was found to be a factor negatively associated. Conclusions: The prevalence of allergic rhinitis in adolescents is high, as well as its medical diagnosis in adults living in Uruguaiana. Environmental factors, especially food habits, were associated with findings in both groups. Objective parentsguardians parents guardians Methods crosssectional cross sectional study questionnaire 13–14 1314 13 14 (13–1 old n=1,058 n1058 n 1 058 mean age421 age 42 age=42. n=896 n896 896 Uruguaiana Brazil questionnaires Results 280 28 0 28.0% rhinoconjunctivitis 213 21 3 21.3% 78 7 8 7.8% 317 31 31.7% OR 2.16 216 2 16 95 1.15–4.05, 115405 1.15–4.05 , 15 4 05 1.15–4.05) 1.94 194 94 1.01–3.72 101372 01 72 7.43 743 43 1.53–36.11. 1533611 1.53–36.11 . 53 36 11 1.53–36.11) contrast 0.34 034 34 0.12–0.93 012093 12 93 0.33 033 33 0130 0.13– .81 81 0.39 039 39 0.15–0.99 015099 99 5.25 525 5 25 1.01–27.22 1012722 27 22 46.45 4645 46 45 2.12–1020.71 212102071 1020 71 0.25 025 0.07–0.92 007092 07 92 Conclusions high habits groups 13–1 131 (13– n=1,05 n105 age42 age=42 n=89 n89 89 28.0 21.3 7.8 31.7 2.1 9 11540 1.15–4.0 1.9 19 1.01–3.7 10137 7.4 74 153361 1.53–36.1 0.3 03 0.12–0.9 01209 013 0.13 .8 0.15–0.9 01509 5.2 52 1.01–27.2 101272 46.4 464 2.12–1020.7 21210207 102 0.2 02 0.07–0.9 00709 13– (13 n=1,0 n10 age4 age=4 n=8 n8 28. 21. 7. 31. 2. 1154 1.15–4. 1. 1.01–3. 1013 15336 1.53–36. 0. 0.12–0. 0120 0.1 0.15–0. 0150 5. 1.01–27. 10127 46. 2.12–1020. 2121020 10 0.07–0. 0070 (1 n=1, n1 age= n= 115 1.15–4 1.01–3 101 1533 1.53–36 0.12–0 012 0.15–0 015 1.01–27 1012 2.12–1020 212102 0.07–0 007 ( n=1 1.15– 1.01– 153 1.53–3 0.12– 0.15– 1.01–2 2.12–102 21210 0.07– 00 1.15 1.01 1.53– 0.12 0.15 2.12–10 2121 0.07 1.1 1.0 1.53 2.12–1 212 0.0 1.5 2.12– 2.12

Abstract Objective: The study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents. Method: A systematic review and meta-analysis were performed using the PRISMA method with the question “What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?” MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected. Results: Exposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29). Conclusions: Exposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review.

RESUMO As mudanças climáticas são uma ameaça enorme e presente para a saúde humana. Este artigo visa aprofundar o conhecimento sobre o impacto ambiental dos dispositivos inalatórios na pegada de carbono para pacientes e profissionais de saúde, fornecendo informações que permitem uma melhor escolha do tipo de dispositivo a ser prescrito para o tratamento da asma e da DPOC. Esta revisão narrativa e não sistemática foi realizada por meio de busca nas bases de dados PubMed, Google Acadêmico, SciELO e EMBASE de artigos publicados entre 2017 e 2022, escritos em português ou inglês, utilizando as palavras de busca “inhalation device” OR “environmental”. A revisão mostrou que o aquecimento global não pode ser abordado com foco em dispositivos inalatórios apenas. No entanto, os dispositivos que utilizamos para tratar doenças respiratórias como asma e DPOC, que são doenças agravadas pelas mudanças climáticas, também estão causando essa mudança. Portanto, profissionais de saúde, organizações de pacientes e indústrias devem assumir a liderança nas políticas de saúde para oferecer alternativas acessíveis aos inaladores contendo hidrofluoralcano. humana DPOC PubMed Acadêmico 201 2022 inglês inhalation device environmental. environmental . “environmental” apenas entanto mudança Portanto hidrofluoralcano 20 202 “environmental 2

ABSTRACT Climate change is a huge and present threat to human health. This article aims to deepen the knowledge about the environmental impact of inhaler devices on their carbon footprint for patients and health professionals, providing information that allows a better choice of the type of device to be prescribed for the treatment of asthma and COPD. This narrative and nonsystematic review was carried out by searching databases (PubMed, Google Scholar, SciELO, and EMBASE) for articles published between 2017 and 2022, written in Portuguese or in English, using the search words “inhalation device” OR “environmental.” The review showed that global warming cannot be addressed by focusing only on inhaler devices. However, the devices that we use to treat respiratory diseases such as asthma and COPD, which are diseases that are aggravated by climate change, are also causing that change. Therefore, health professionals, patient organizations, and industries should take a lead in health policies to offer affordable alternatives to inhalers containing hydrofluoroalkane. professionals COPD PubMed, PubMed (PubMed Scholar SciELO EMBASE 201 2022 English inhalation environmental. “environmental. However Therefore organizations hydrofluoroalkane 20 202 “environmental 2

Abstract Objective: To analyze the impacts of climate change on the development of immature respiratory and immune systems in children. Source of data: The authors of the present study performed a non-systematic review of English, Spanish, and Portuguese articles published in the last five years in databases such as PubMed, EMBASE, and SciELO. The terms used were air pollution OR climate changes OR smoke, AND children OR health. Synthesis of data: The increase in the prevalence of some diseases, such as allergic ones, is attributed to the interactions between genetic potential and the environment. However, disordered growth combined with inadequate waste management has caused problems for the planet, such as heatwaves, droughts, forest fires, increased storms and floods, interference in food crops and their nutritional values, changes in the infectious disease pattern, and air pollution resulting from the continuous use of fossil fuels. Children, beings still in the development stage with immature respiratory and immune systems, are the primary victims of the climate crisis. Conclusions: The authors documented that prenatal and postnatal exposure to ambient air pollutants will accelerate or worsen the morbidity and mortality of many health conditions, including allergic diseases. Ambient air pollutants change the microbiota, interfere with the immune response, and take direct action on the skin and respiratory epithelium, which facilitates the penetration of allergens. Understanding how the children and adolescent health and well-being are affected by climate change is an urgent matter.

RESUMO Este estudo de revisão teve como objetivo determinar a relação entre a exposição à fumaça da queima de biomassa na Floresta Amazônica e suas implicações para a saúde humana nessa região do Brasil. Foi realizada uma revisão não sistemática por meio de buscas nas bases de dados PubMed, Google Scholar, SciELO e EMBASE de artigos publicados entre 2005 e 2021, em português ou inglês, utilizando os termos de busca “biomass burning” OU “Amazon” OU “burned” E “human health”. A revisão mostrou que os efeitos negativos para a saúde resultantes da exposição à fumaça da queima de biomassa na Amazônia foram pouco estudados na região. Há uma necessidade urgente de identificar intervenções efetivas de saúde pública que possam ajudar a melhorar o comportamento das populações vulneráveis expostas à fumaça da queima de biomassa, reduzindo a morbimortalidade relacionada a essa exposição.

ABSTRACT This review study aimed to determine the relationship between exposure to smoke from biomass burning in the Amazon rain forest and its implications on human health in that region in Brazil. A nonsystematic review was carried out by searching PubMed, Google Scholar, SciELO, and EMBASE databases for articles published between 2005 and 2021, either in Portuguese or in English, using the search terms “biomass burning” OR “Amazon” OR “burned” AND “human health.” The review showed that the negative health effects of exposure to smoke from biomass burning in the Amazon have been poorly studied in that region. There is an urgent need to identify effective public health interventions that can help improve the behavior of vulnerable populations exposed to smoke from biomass burning, reducing morbidity and mortality related to that exposure.

Abstract Smoking is still the leading cause of illness and preventable death across the world. The financial cost of smoking is estimated at 1.4 billion USD per year around the world. The Report on Tobacco Control in the Region of The Americas aims to provide an overview of the current state of trends in the tobacco epidemic and the implementation of effective policies to combat it. This report presents updated and validated data about prevalence, tobacco-related mortality, and progress on adopting legislation and policies associated with the six known measures to stop smoking, MPOWER of the World Health Organization.

Resumen Fumar sigue siendo la principal causa de enfermedad y muerte prevenible en el mundo. El costo económico de fumar se estima en 1.4 mil millones de dólares anuales en todo el mundo. El Informe sobre el Control del Tabaco en la Región de las Américas tiene como objetivo proporcionar una visión general del estado actual de las tendencias en la epidemia del consumo de tabaco y la implementación de políticas efectivas para combatirla. Este informe presenta datos actualizados y validados sobre prevalencia, mortalidad relacionada con fumar tabaco y avances en la aprobación de leyes y políticas relacionadas con las seis medidas para dejar de fumar propuestas por la Organización Mundial de la Salud, conocidas como MPOWER.

Abstract Background: Allergic Rhinitis and its Impact on Asthma (ARIA) establishes guidelines for the treatment of allergic rhinitis (AR) and its comorbidities. Objective: To assess and compare the level of knowledge about AR and ARIA guidelines among primary care physicians (PCP) of Brazil, Paraguay and Uruguay. Methods: 336 PCPs (Brazil 109, Paraguay 127, Uruguay 100) answered a questionnaire about personal and professional data and knowledge on RA and the ARIA guidelines; the Google Forms tool was used. Results: There was a predominance of females (73, 50.4 and 70 % in Brazil, Paraguay and Uruguay, respectively); 124 worked in the community and 75 in emergency departments. Brazil and Uruguay PCPs recognized AR symptoms; 67 % of those from Uruguay did not ask about a history of AR diagnosis, 93 % about an asthma diagnosis and 90 % about rhinitis interference with daily activities. Intranasal corticosteroids use: 78, 92 and 54 % of Brazilian, Paraguayan and Uruguayan doctors; 100, 73.4 and 78 % of Paraguayan, Brazilian and Uruguayan PCPs, respectively, did not refer the patient to a specialist; 26.6, 62 and 6 % of PCPs in Brazil, Paraguay and Uruguay, respectively, knew the ARIA guidelines. Conclusions: AR is commonly looked after by PCPs, but the recognition of symptoms and knowledge about ARIA guidelines are low and treatment is not always optimal.

Resumen Antecedentes: En ARIA se establecen directrices para el tratamiento de la rinitis alérgica y sus comorbilidades. Objetivo: Evaluar y comparar el nivel de conocimiento sobre rinitis alérgica y la guía ARIA en médicos de atención primaria (MAP) de Brasil, Paraguay y Uruguay. Métodos: 336 MAP (Brasil 109, Paraguay 127, Uruguay 100) respondieron un cuestionario sobre datos personales, profesionales y conocimiento en rinitis alérgica y ARIA; se utilizó Google Forms. Resultados: Predominaron las mujeres (73, 50.4 y 70 % en Brasil Paraguay Uruguay); 124 trabajaban en la comunidad y 75 en servicios de urgencias. Los MAP de Brasil y Uruguay reconocieron los síntomas de rinitis alérgica; 67 % de Uruguay no preguntaba sobre antecedentes de diagnóstico de rinitis alérgica, 93 % sobre diagnóstico de asma y 90 % sobre la interferencia de la rinitis con las actividades diarias. Uso de corticosteroides intranasales: 78, 92 y 54 % de los médicos de Brasil Paraguay y Uruguay; 100, 73.4 y 78 % de Paraguay, Brasil y Uruguay no derivaban el paciente al especialista; 26.6, 62 y 6 % de Brasil, Paraguay y Uruguay conocían ARIA. Conclusiones: La rinitis alérgica frecuentemente es atendida por el MAP, pero el reconocimiento de los síntomas y el conocimiento sobre ARIA son reducidos y el tratamiento no siempre es óptimo.

Abstract The Global Alliance against Chronic Respiratory Diseases (GARD) is a network of organizations coordinated by the World Health Organization. It is a voluntary alliance of national and international organizations, institutions and agencies with global scope that are committed with actions to improve access to prevention, care and essential medications. On its last annual meeting, celebrated in Brussels (Belgium) in September 2017, the need for actions and representation to be grouped by geographic regions was discussed. There are several successful programs regarding morbidity and mortality control of these diseases, and others that improve cost-benefit and quality of life. Thus, SLaai proposes to contribute to the diffusion and knowledge of chronic respiratory diseases magnitude and risk factors, to identify successful programs in Latin America in order for them to be replicated in the region and to generate strategic alliances for the strengthening of joint actions.

Resumen La Alianza Global contra las Enfermedades Respiratorias Crónicas es una red de organizaciones coordinadas por la Organización Mundial de la Salud. Es una coalición voluntaria de organizaciones, instituciones y organismos nacionales e internacionales con alcance mundial comprometidos con acciones para mejorar el acceso a la prevención, asistencia y medicamentos esenciales. Durante su última reunión anual, efectuada en Bruselas, Bélgica, en septiembre de 2017, emergió la necesidad de agrupar acciones y representación por regiones geográficas. Existen diferentes programas exitosos en el control de la morbimortalidad de estas enfermedades y otros que mejoran el costo-beneficio y la calidad de vida. Así, desde SLaai se propone contribuir a la difusión y conocimiento de la magnitud y factores de riesgo en enfermedades respiratorias crónicas, identificar programas exitosos de Latinoamérica para ser replicados en la región y generar convenios estratégicos para el fortalecimiento de acciones conjuntas.

Resumo Objetivo: Apesar dos programas de prevenção antitabagista, muitos adolescentes começam a fumar na idade escolar. Foram objetivos do estudo determinar a prevalência e os fatores de risco associados ao consumo de tabaco em adolescentes moradores do município de Uruguaiana, RS, Brasil. Métodos: Estudo transversal, feito com adolescentes de 12 a 19 anos, matriculados em escolas do município, que responderam questionário autoaplicável sobre tabagismo. Resultados: Participaram 798 adolescentes com igual distribuição entre os gêneros. A frequência de experimentação de tabaco (Alguma vez tentou fumar um cigarro, mesmo que uma ou duas tragadas) foi de 29,3%, 14,5% começaram a fumar antes dos 12 anos e 13% deles afirmaram ter fumado pelo menos um cigarro/dia no último mês. Foram identificados como associados ao tabagismo: ter amigo tabagista (OR: 5,67, IC95%: 2,06-7,09), ter oferta de cigarro pelo amigo (OR: 4,21, IC95%: 2,46-5,76) e facilidade de conseguir cigarros (OR: 3,82, IC95%: 1,22-5,41). Ter orientações dos pais sobre tabagismo (OR: 0,67, IC95%: 0,45-0,77), não ter contato com cigarro em casa na última semana (OR: 0,51, IC95%: 0,11-0,79) e saber os malefícios do cigarro eletrônico (OR: 0,88, IC95%: 0,21-0,92) foram identificados como de proteção. Conclusões: A prevalência de tabagismo entre os adolescentes de Uruguaiana é alta. A implantação de medidas nas escolas para reduzir ou acabar o consumo de tabaco e de suas novas modalidades, como os cigarros eletrônicos e o narguilé, é urgente e imperiosa.

Abstract Objective: Despite anti-smoking prevention programs, many adolescents start smoking at school age. The main objectives of this study were to determine the prevalence and risk factors associated with smoking in adolescents living in Uruguaiana, RS, Brazil. Methods: A prospective study was conducted in adolescents (12-19 years), enrolled in municipal schools, who answered a self-administered questionnaire on smoking. Results: 798 adolescents were enrolled in the study, with equal distribution between genders. The tobacco experimentation frequency (ever tried a cigarette, even one or two puffs) was 29.3%; 14.5% started smoking before 12 years of age and 13.0% reported smoking at least one cigarette/day last month. Having a smoking friend (OR: 5.67, 95% CI: 2.06-7.09), having cigarettes offered by friends (OR: 4.21, 95% CI: 2.46-5.76) and having easy access to cigarettes (OR: 3.82, 95% CI: 1.22-5.41) was identified as factors associated with smoking. Having parental guidance on smoking (OR: 0.67, 95% CI: 0.45-0.77), having no contact with cigarettes at home in the last week (OR: 0.51, 95% CI: 0.11-0.79) and knowing about the dangers of electronic cigarettes (OR: 0.88, 95% CI: 0.21-0.92) were identified as protection factors. Conclusion: The prevalence of smoking among adolescents in Uruguaiana is high. The implementation of measures to reduce/stop tobacco use and its new forms of consumption, such as electronic cigarettes and hookah, are urgent and imperative in schools.

Objetivo : Apresentar o Programa Infantil de Prevenção de Asma (PIPA), assim como as características dos pacientes nele acompanhados. Métodos : O PIPA, implantado em Uruguaiana (RS), tem como população alvo crianças e adolescentes com asma ou suspeita de asma, menores de 18 anos, referidos por pediatras, médicos de atenção primária ou por procura espontânea. Neste estudo retrospectivo, os participantes foram avaliados segundo um protocolo padronizado de atendimento. Resultados : Ao final do período do estudo, estavam em seguimento 646 pacientes. Desses, 298 (46,1%) tinham idade ≤ 3 anos. Nesse grupo de pacientes, houve sibilância recorrente em 60,7% e o primeiro episódio de sibilância ocorreu nos primeiros seis meses de vida em 86,0%. Sibilância grave foi apontada em 29,5% e 45,4% nas crianças com ≤ 3 anos e com > 3 anos, respectivamente. Houve diagnóstico médico de asma em 26,5% e 82,2%, respectivamente. Na amostra total, a prevalência de exposição passiva ao fumo foi elevada (> 36%), ocorrendo durante a gestação em > 15%; o número de nascimentos por cesariana foi > 40%, e o nível educacional materno foi inferior a 8 anos em 30%. Conclusões : Um programa de prevenção para atendimento de crianças com asma é uma estratégia eficaz para o controle da doença. O conhecimento das características epidemiológicas e ambientais da população local é primordial para que haja a redução das formas graves da asma, melhor utilização dos recursos de saúde e possível prevenção de alterações pulmonares que possam levar a DPOC no adulto.

Objective : To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program. Methods : Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents (< 18 years of age) with asthma or suspected asthma. Patients either enroll in PIPA spontaneously or are referred by pediatricians or primary care physicians. In this retrospective study, we use a standardized protocol to assess PIPA patients. Results : By the end of the study period, 646 patients were being followed. Of those, 298 (46.1%) were ≤ 3 years of age. In this group of patients, recurrent wheezing was identified in 60.7%, and the first episode of wheezing occurred in the first six months of life in 86.0%. Severe wheezing was identified in 29.5% and 45.4% in the children ≤ 3 and > 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling. Conclusions : A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood.

OBJETIVO: Deficiência de vitamina D (DVD) nas gestantes e seus filhos é problema de saúde, com consequências graves à saúde de ambos. Assim, esta revisão visou reavaliar a magnitude e as consequências da DVD na gestação, lactação e infância, fatores de risco associados, métodos de prevenção, além de explorar os mecanismos epigenéticos na vida fetal capazes de explicar benefícios não-esqueléticos da vitamina D (ViD). FONTES DE DADOS: Selecionaram-se artigos originais, de revisão e consensos com nível elevado de evidência para decisões clínicas relacionadas à DVD na saúde das gestantes e seus filhos e artigos sobre sua ação sobre os mecanismos epigenéticos da programação fetal de doenças crônicas na vida adulta, publicados no PubMed nos últimos 20 anos, empregando-se VitD status, e em combinação com Pregnancy, Offspring health, Child outcomes e Programming. SÍNTESE DOS DADOS: Abordou-se fisiologia, metabolismo, fatores de risco para a DVD e implicações na gravidez, lactação e infância, concentração de corte para definir DVD, variabilidade de métodos na sua detecção, recomendações sobre a reposição de ViD nas gestantes, no recém-nascido e na criança, bem como sobre ter as influências epigenéticas da ViD. CONCLUSÕES: DVD é frequente entre gestantes de alto risco e seus filhos. Monitorar rotineiramente os níveis séricos de 25(OH)D3 no período antenatal é imperativo. Medidas preventivas precoces devem ser instituídas à menor suspeita de DVD na gestante, para reduzir morbidades durante a gestação e a lactação, bem como seu posterior impacto sobre o feto, o recém-nascido e na infância.

OBJECTIVE: Vitamin D deficiency (VDD) in pregnant women and their children is an important health problem with severe consequences for the health of both. Thus, the objectives of this review were to reassess the magnitude and consequences of VDD during pregnancy, lactation and infancy, associated risk factors, prevention methods, and to explore epigenetic mechanisms in early fetal life capable of explaining many of the non-skeletal benefits of vitamin D (ViD). DATA SOURCE: Original and review articles, and consensus documents with elevated level of evidence for VDD-related clinical decisions on the health of pregnant women and their children, as well as articles on the influence of ViD on epigenetic mechanisms of fetal programming of chronic diseases in adulthood were selected among articles published on PubMed over the last 20 years, using the search term VitD status, in combination with Pregnancy, Offspring health, Child outcomes, and Programming. DATA SYNTHESIS: The following items were analyzed: ViD physiology and metabolism, risk factors for VDD and implications in pregnancy, lactation and infancy, concentration cutoff to define VDD, the variability of methods for VDD detection, recommendations on ViD replacement in pregnant women, the newborn and the child, and the epigenetic influence of ViD. CONCLUSIONS: VDD is a common condition among high-risk pregnant women and their children. The routine monitoring of serum 25(OH)D3 levels in antenatal period is mandatory. Early preventive measures should be taken at the slightest suspicion of VDD in pregnant women, to reduce morbidity during pregnancy and lactation, as well as its subsequent impact on the fetus, the newborn and the child.