Oxcarbazepine versus Divalproex Sodium for the Continuing Treatment of Mania.

OBJECTIVES

The objective of this study is to assess the differences in environmental exposures of juvenile dermatomyositis (JDM) patients in Brazil versus the United States (U.S.).

METHODS

JDM patients from 4 centres [3 U.S. (n=66), 1 Brazil (n=36)] were enrolled. Exposures during pregnancy were assessed by questionnaire, including occupational exposures, sources of inhalable pollution near the mother's home and work, and exposure to tobacco/alcohol.

RESULTS

JDM mean age onset was 7.12 (SD±4.02) years for U.S. patients and 5.30 (SD±2.52) for Brazilians (p=0.004). During pregnancy, American mothers more frequently worked outside home than Brazilians (65.2% vs. 41.2%; p=0.032). Americans more often worked in offices (51.2% vs. 14.3%; p=0.027) and Brazilians, as teachers (28.6% vs. 4.8%; p=0.029). Americans commuted to work more frequently by subway (68.3% vs. 7.1%; p≤0.01), Brazilians, by bus (64.3% vs. 14.6%; p=0.001). Brazilians were more frequently exposed to dust (42.9% vs. 9.5%; p=0.01) and tobacco (50% vs. 23.1%; p=0.01). Places where Brazilians worked (35.7% vs. 9.1%; p=0.03) and lived (50% vs. 10.6%; p≤0.01) during pregnancy were closer to factories and quarries, as well as where the child was born (32.3% vs. 8.6%; p=0.007). After birth, Brazilian patients were more frequently exposed to tobacco, both through their fathers' smoking (26.5% vs. 6.2%; p=0.009) and other household residents (36.4% vs. 9.2%; p=0.002).

CONCLUSIONS

Earlier onset of symptoms, possibly related to early life environmental exposures, was observed in Brazilian patients. Their mothers lived and worked closer to factories and quarries, commuted to work by bus and were more exposed to dust and tobacco.