자연주의적 탐구조사(Naturalistic Inquiry)

Prospective Cohort Study

Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.

In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.

This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.

The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.

Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.

The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

/pdf/allergic-rhinitis-and-its-impact-on-asthma-aria-2008-update-13eqfzaw4u.pdf

Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascul...

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. 

https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001052

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

ContextLead, mercury, and arsenic intoxication have been associated with the
use of Ayurvedic herbal medicine product (HMPs).ObjectivesTo determine the prevalence and concentration of heavy metals in Ayurvedic
HMPs manufactured in South Asia and sold in Boston-area stores and to compare
estimated daily metal ingestion with regulatory standards.Design and SettingSystematic search strategy to identify all stores 20 miles or less from
Boston City Hall that sold Ayurvedic HMPs from South Asia by searching online
Yellow Pages using the categories markets, supermarkets, and convenience stores, and business names containing the word India,
Indian cities, and Indian words. An online national directory of Indian grocery
stores, a South Asian community business directory, and a newspaper were also
searched. We visited each store and purchased all unique Ayurvedic HMPs between
April 25 and October 24, 2003.Main Outcome MeasuresConcentrations (μg/g) of lead, mercury, and arsenic in each HMP
as measured by x-ray fluorescence spectroscopy. Estimates of daily metal ingestion
for adults and children estimated using manufacturers’ dosage recommendations
with comparisons to US Pharmacopeia and US Environmental Protection
Agency regulatory standards.ResultsA total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained
heavy metals: lead (n = 13; median concentration, 40 μg/g; range,
5-37 000), mercury (n = 6; median concentration, 20 225
μg/g; range, 28-104 000), and/or arsenic (n = 6; median
concentration, 430 μg/g; range, 37-8130). If taken as recommended by the
manufacturers, each of these 14 could result in heavy metal intakes above
published regulatory standards.ConclusionsOne of 5 Ayurvedic HMPs produced in South Asia and available in Boston
South Asian grocery stores contains potentially harmful levels of lead, mercury,
and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal
toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory.

Heavy Metal Content of Ayurvedic Herbal Medicine Products

Results Deaths from coronary heart disease were associated with suppressing a fire (32.1% of all such deaths), responding to an alarm (13.4%), returning from an alarm (17.4%), engaging in physical training (12.5%), responding to nonfire emergencies (9.4%), and performing nonemergency duties (15.4%). As compared with the odds of death from coronary heart disease during nonemergency duties, the odds were 12.1 to 136 times as high during fire suppression, 2.8 to 14.1 times as high during alarm response, 2.2 to 10.5 times as high during alarm return, and 2.9 to 6.6 times as high during physical training. These odds were based on three estimates of the time that firefighters spend on their duties. Conclusions Certain emergency firefighting duties were associated with a risk of death from coronary heart disease that was markedly higher than the risk associated with nonemergency duties. Fire suppression was associated with the highest risk, which was approximately 10 to 100 times as high as that for nonemergency duties.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa060357

Emergency Duties and Deaths from Heart Disease among Firefighters in the United States

Context Lead, mercury, and arsenic have been detected in a substantial proportion of Indian-manufactured traditional Ayurvedic medicines. Metals may be present due to the practice of rasa shastra (combining herbs with metals, minerals, and gems). Whether toxic metals are present in both US- and Indian-manufactured Ayurvedic medicines is unknown. Objectives To determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury, or arsenic and to compare the prevalence of toxic metals in US- vs Indian-manufactured medicines and between rasa shastra and non–rasa shastra medicines. Design A search using 5 Internet search engines and the search terms Ayurveda and Ayurvedic medicine identified 25 Web sites offering traditional Ayurvedic herbs, formulas, or ingredients commonly used in Ayurveda, indicated for oral use, and available for sale. From 673 identified products, 230 Ayurvedic medicines were randomly selected for purchase in August-October 2005. Country of manufacturer/Web site supplier, rasa shastra status, and claims of Good Manufacturing Practices were recorded. Metal concentrations were measured using x-ray fluorescence spectroscopy. Main Outcome Measures Prevalence of medicines with detectable toxic metals in the entire sample and stratified by country of manufacture and rasa shastra status. Results One hundred ninety-three of the 230 requested medicines were received and analyzed. The prevalence of metal-containing products was 20.7% (95% confidence interval [CI], 15.2%-27.1%). The prevalence of metals in US-manufactured products was 21.7% (95% CI, 14.6%-30.4%) compared with 19.5% (95% CI, 11.3%-30.1%) in Indian products (P = .86). Rasa shastra compared with non–rasa shastra medicines had a greater prevalence of metals (40.6% vs 17.1%; P = .007) and higher median concentrations of lead (11.5 μg/g vs 7.0 μg/g; P = .03) and mercury (20 800 μg/g vs 34.5 μg/g; P = .04). Among the metal-containing products, 95% were sold by US Web sites and 75% claimed Good Manufacturing Practices. All metal-containing products exceeded 1 or more standards for acceptable daily intake of toxic metals. Conclusion One-fifth of both US-manufactured and Indian-manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury, or arsenic.

https://jamanetwork.com/journals/jama/articlepdf/182460/joc80084_915_923.pdf

Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet

Cardiovascular disease (CVD) is the leading cause of on-duty death among firefighters (45% of on-duty fatalities) and a major cause of morbidity CVD in the fire service also has adverse public safety implications as well as significant cost impacts on government agencies Over the last decade, our understanding of CVD among firefighters has significantly improved and provides insight into potential preventive strategies The physiology of cardiovascular arousal and other changes that occur in association with acute firefighting activities have been well-characterized However, despite the strenuous nature of emergency duty, firefighters' prevalence of low fitness, obesity, and other CVD risk factors are high Unique statistical approaches have documented that on-duty CVD events do not occur at random in the fire service They are more frequent at certain times of day, certain periods of the year, and are overwhelmingly more frequent during strenuous duties compared with nonemergency situations Moreover, as expected on-duty CVD events occur almost exclusively among susceptible firefighters with underlying CVD These findings suggest that preventive measures with proven benefits be applied aggressively to firefighters Furthermore, all fire departments should have entry-level medical evaluations, institute periodic medical and fitness evaluations, and require rigorous return to work evaluations after any significant illness Finally, on the basis of the overwhelming evidence supporting markedly higher relative risks of on-duty death and disability among firefighters with established coronary heart disease, most firefighters with clinically significant coronary heart disease should be restricted from participating in strenuous emergency duties

Cardiovascular disease in US firefighters: a systematic review.

Objective:To examine the prevalence of overweight and obesity in firefighters.Methods:Body mass index (BMI), waist circumference, and body fat percentage (BF%) were assessed in 478 career and 199 volunteer male firefighters from randomly selected departments.Results:High prevalence rates of overweig

/pdf/the-prevalence-of-overweight-obesity-and-substandard-fitness-5073wveslj.pdf

Stefanos N. Kales

Papers

Heavy Metal Content of Ayurvedic Herbal Medicine Products

Emergency Duties and Deaths from Heart Disease among Firefighters in the United States

Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet

Cardiovascular disease in US firefighters: a systematic review.

The prevalence of overweight, obesity, and substandard fitness in a population-based firefighter cohort.