Occupational effect of sugarcane biomass burning on the conjunctival mucin profile of harvest workers and residents of an adjacent town - A Brazilian panel study.

Pre-harvest burning of sugarcane fields produces large amounts of air pollutants which are known to cause health problems, including ocular surface abnormalities. In this study, we evaluated the effect of biomass burning on mucus quality and mucin gene expression (MUC1, MUC5AC, MUC16) in the conjunctiva of sugarcane workers (SWs) and residents of an adjacent town (RTs). Impression cytology samples of the inferior tarsal and bulbar conjunctiva of 78 SWs and 32 RTs were collected before (T1) and immediately after (T2) a 6-month harvest period. The neutral, acid and total mucus content of goblet cells was determined by PAS and AB staining. The levels of MUC5AC, MUC1 and MUC16 mRNA in the conjunctiva were measured by real-time PCR. Compared to RTs, SWs had higher levels of bulbar acid mucus and MUC16 mRNA and tarsal MUC5AC mRNA at T2 and lower levels of neutral mucus at T1 and T2. In the SW group, MUC1 mRNA levels were higher at T2 than at T1, but the levels of neutral and acid mucus were similar. In the RT group, acid mucus decreased and neutral mucus increased in the bulbar and tarsal conjunctiva at T2. In conclusion, our findings show that sugarcane harvesting is associated with abnormalities in mucus quality and content and changes in mucin mRNA levels on the ocular surface. This may help explain the ocular inflammatory signs and symptoms observed in subjects exposed to air pollutants and high temperatures from sugarcane biomass burning.

Mean air temperature as a risk factor for stroke mortality in São Paulo, Brazil.

In Brazil, chronic diseases account for the largest percentage of all deaths among men and women. Among the cardiovascular diseases, stroke is the leading cause of death, accounting for 10% of all deaths. We evaluated associations between stroke and mean air temperature using recorded mortality data and meteorological station data from 2002 to 2011. A time series analysis was applied to 55,633 mortality cases. Ischemic and hemorrhagic strokes (IS and HS, respectively) were divided to test different impact on which subgroup. Poisson regression with distributed lag non-linear model was used and adjusted for seasonality, pollutants, humidity, and days of the week. HS mortality was associated with low mean temperatures for men relative risk (RR) = 2.43 (95% CI, 1.12-5.28) and women RR = 1.39 (95% CI, 1.03-1.86). RR of IS mortality was not significant using a 21-day lag window. Analyzing the lag response separately, we observed that the effect of temperature is acute in stroke mortality (higher risk among lags 0-5). However, for IS, higher mean temperatures were significant for this subtype with more than 15-day lag. Our findings showed that mean air temperature is associated with stroke mortality in the city of São Paulo for men and women and IS and HS may have different triggers. Further studies are needed to evaluate physiologic differences between these two subtypes of stroke.

Are prematurity and environmental factors determinants for developing childhood-onset systemic lupus erythematosus?

OBJECTIVE: The objective of this study is to evaluate the influence of exposure to air pollutants and inhalable environmental elements during pregnancy and after birth until childhood-onset systemic lupus erythematosus(cSLE) diagnosis. METHODS: This case-control study comprised 30 cSLE patients and 86 healthy controls living in the Sao Paulo metropolitan area. A structured and reliable questionnaire (kappa index for test-retest was 0.78) assessed demographic data, gestational and perinatal-related-factors, and exposure to inhalable elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, and/or tobacco, as well as, the presence of industrial activities or gas stations near the home/work/daycare/school). Tropospheric pollutants included: particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) and carbon monoxide (CO). RESULTS: The median current age was similar between cSLE patients and healthy controls [16.0 (5-21) versus 15.0 (4-21) years, p = .32], likewise the frequency of female gender (87% versus 78%, p = .43). The frequencies of prematurity (30% versus 6%, p = .001), maternal occupational exposure during pregnancy (59% versus 12%, p < .001), exposure to volatile vapor (48% versus 8%, p < .001) and fetal smoking (maternal and/or secondhand) (37% versus 19%, p = .008) were significantly higher in cSLE patients compared with controls. In a multivariate analysis regarding the gestation period, maternal occupational exposure (OR 13.5, 95% CI 2.5-72.4, p = .002), fetal smoking (OR 8.6, 95%CI 1.6-47, p = .013) and prematurity (OR 15.8, 95%CI 1.9-135.3, p = .012) remained risk factors for cSLE development. Furthermore, exposure to secondhand smoking during pregnancy and after birth (OR 9.1, 95%CI 1.8-42.1, p = .002) was also a risk factor for cSLE development. CONCLUSIONS: Prematurity and environmental factors were risk factors for developing cSLE.

The influence of environmental factors related to Juvenile Dermatomyositis (JDM), its course and refractoriness to treatment.

OBJECTIVE: To evaluate the influence of environmental factors and prematurity relating to juvenile dermatomyositis (JDM), its course and refractoriness to treatment. METHODS: A case-control study with 35 patients followed up at a tertiary hospital and 124 healthy controls, all residents of São Paulo. Patients were classified according to monocyclic, polycyclic or chronic disease courses and refractoriness to treatment. The daily concentrations of pollutants (inhalable particulate matter-PM10, sulfur dioxide-SO2, nitrogen dioxide-NO2, ozone-O3 and carbon monoxide-CO) were provided by the Environmental Company of São Paulo. Data from the population were obtained through a questionnaire. RESULTS: Fifteen patients had monocyclic courses, and 19 polycyclic/chronic courses. Eighteen patients were refractory to treatment. Maternal occupational exposure to inhalable agents (OR = 17.88; IC 95% 2.15-148.16, p = 0.01) and exposure to O3 in the fifth year of life (third tertile > 86.28µg/m3; OR = 6.53, IC95% 1.60-26.77, p = 0.01) were risk factors for JDM in the multivariate logistic regression model. The presence of a factory/quarry at a distance farther than 200 meters from daycare/school (OR = 0.22; IC 95% 0.06-0.77; p = 0.02) was a protective factor in the same analysis. Prematurity, exposure to air pollutants/cigarette smoke/sources of inhalable pollutants in the mother's places of residence and work during the gestational period were not associated with JDM. Prematurity, maternal exposure to occupational pollutants during pregnancy as well as patient's exposure to ground-level pollutants up to the fifth year of life were not associated with disease course and treatment refractoriness. CONCLUSION: Risk factors for JDM were maternal occupational exposure and exposure to O3 in the fifth year of life.

Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU) and who had been previously treated with antimicrobials, especially third-generation cephalosporins. This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1) First period (September 1999 to February 2000); and 2) Second period (August 2000 to December 2000); empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004). Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002). Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004) and P. mirabilis (p=0.036), restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001) and reduction of ventilator-associated pneumonia rates (p<0.0001). However, there was an increase in P. aeruginosa incidence (p=0.005) and increases in ceftazidime (p=0.003) and meropenem (p<0.0001) susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.

The impact of sugar cane-burning emissions on the respiratory system of children and the elderly.

We analyzed the influence of emissions from burning sugar cane on the respiratory system during almost 1 year in the city of Piracicaba in southeast Brazil. From April 1997 through March 1998, samples of inhalable particles were collected, separated into fine and coarse particulate mode, and analyzed for black carbon and tracer elements. At the same time, we examined daily records of children (<13 years of age) and elderly people (>64 years of age) admitted to the hospital because of respiratory diseases. Generalized linear models were adopted with natural cubic splines to control for season and linear terms to control for weather. Analyses were carried out for the entire period, as well as for burning and nonburning periods. Additional models were built using three factors obtained from factor analysis instead of particles or tracer elements. Increases of 10.2 microg/m3 in particles

Air pollution effects on myocardial infarction.

OBJECTIVE: Myocardial infarction is an acute and severe cardiovascular disease that generally leads to patient admissions to intensive care units and few cases are initially admitted to infirmaries. The objective of the study was to assess whether estimates of air pollution effects on myocardial infarction morbidity are modified by the source of health information. METHODS: The study was carried out in hospitals of the Brazilian Health System in the city of São Paulo, Southern Brazil. A time series study (1998-1999) was performed using two outcomes: infarction admissions to infirmaries and to intensive care units, both for people older than 64 years of age. Generalized linear models controlling for seasonality (long and short-term trends) and weather were used. The eight-day cumulative effects of air pollutants were assessed using third degree polynomial distributed lag models. RESULTS: Almost 70% of daily hospital admissions due to myocardial infarction were to infirmaries. Despite that, the effects of air pollutants on infarction were higher for intensive care units admissions. All pollutants were positively associated with the study outcomes but SO2 presented the strongest statistically significant association. An interquartile range increase on SO2 concentration was associated with increases of 13% (95% CI: 6-19) and 8% (95% CI: 2-13) of intensive care units and infirmary infarction admissions, respectively. CONCLUSIONS: It may be assumed there is a misclassification of myocardial infarction admissions to infirmaries leading to overestimation. Also, despite the absolute number of events, admissions to intensive care units data provides a more adequate estimate of the magnitude of air pollution effects on infarction admissions.

[Effects of air pollution on children's health in a city in Southeastern Brazil]. / Efeitos da poluição atmosférica na saúde infantil em São José dos Campos, SP.

OBJECTIVE: Of the effects of air pollution on children's health, increased pneumonia admission rate is one of the most important. The study aimed at estimating the association between pneumonia admissions and increased air pollutants. METHODS: An ecological time-series study was carried out in the municipality of São José dos Campos, Southeastern Brazil, in the years 2000 and 2001. Daily records of pneumonia admissions, air pollutants (SO2, O3, and PM10) and weather conditions (temperature and humidity) were analyzed. The correlations between the study variables were estimated using Pearson's correlation. The associations between pneumonia and air pollutants were estimated using generalized additive Poisson regression models. The percentage increase (and their respective 95% CI) in pneumonia admission rate was estimated for the interquartile range of each air pollutant studied. RESULTS: The three pollutants analyzed presented lagged effects on pneumonia admission rate, beginning at lag 3 or 4 and lasting for no more than two days. The 8-day cumulative effect estimate showed that an increase of 24.7 mg/m3 in PM10 concentration increased pneumonia admission rate in 9.8%. CONCLUSIONS: The study corroborates that adverse health effects of air pollutants can be observed even in medium-sized cities. The magnitude of the effect was similar to that found in the city of São Paulo. Moreover, children are highly susceptible to air pollution exposure.

[Breast cancer mortality in women of Southern Brazil, 1980-1999]. / Mortalidade por câncer de mama em mulheres na Baixada Santista, 1980 a 1999.

OBJECTIVE: To analyze time and geographical trends of breast cancer mortality. METHODS: Annual mortality rates per 100,000 female inhabitants aged 20 to 59 years for the Baixada Santista metropolitan area, the city and state of São Paulo and Brazil, from 1980 to 1999, were standardized by age groups and analyzed. The analyses included regression models to estimate and compare time trends of each area.? RESULTS: Increasing mortality rate trends were observed for all areas. However, intrametropolitan variations have higher baselines and time trends than the other areas. Santos had standardized mortality rates between 25 and 35 per 100,000 women, which were the highest in the study. Differences between Santos rates and the rates of other cities included in the study were statistically significant (p<0.001). The cities of São Vicente, Cubatão and Peruíbe of the Baixada Santista metropolitan area also showed increased mortality rates trends and higher rates than those for the state of São Paulo and Brazil. CONCLUSIONS: A similar increasing trend in mortality rates was observed in all cities of the study area and higher rates were seen in Santos. There is a need for further studies in order to identify the determinant conditions for this trend.

Exposure to Air Pollutants and Disease Activity in Juvenile-Onset Systemic Lupus Erythematosus Patients.

OBJECTIVE: To investigate the association between exposure to air pollutants in the Sao Paulo metropolitan area and disease activity in juvenile-onset systemic lupus erythematosus (SLE) patients. METHODS: A longitudinal panel study based on 409 consecutive visits of juvenile-onset SLE patients living in the Sao Paulo metropolitan area was carried out. Disease activity was evaluated in accordance with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and the patients were divided into 2 groups: those with SLEDAI scores ≤8 and those with SLEDAI scores >8. Daily concentrations of inhaled particulate matter (PM10 ), sulfur dioxide, nitrogen dioxide (NO2 ), ozone, and carbon monoxide (CO) were evaluated on the 21 days preceding the medical visits. A generalized estimation equation model was used to assess the impact of these measurements on SLEDAI-2K scores, considering the fixed effects for repetitive measurements. The models were adjusted for erythrocyte sedimentation rate, corticosteroid use (daily and cumulative doses), antimalarial use, the use of immunosuppressive agents, the presence of infection 20 days preceding the medical appointment, and the minimum temperature and relative humidity outdoors. RESULTS: PM10 , NO2 , and CO were risk factors for juvenile-onset SLE disease activity (SLEDAI-2K score >8) approximately 2 weeks after exposure. A 13.4 µg/m(3) increase in the PM10 moving average (from lag 12 to lag 15) was associated with a 34% increase (95% confidence interval 7.0-68.0) in the risk of a SLEDAI-2K score >8. CONCLUSION: This is the first study to show that exposure to inhaled pollutants may increase the risk of disease activity in children with juvenile-onset SLE in a large urban center.

Lacrimal Cytokines Assessment in Subjects Exposed to Different Levels of Ambient Air Pollution in a Large Metropolitan Area.

BACKGROUND: Air pollution is one of the most environmental health concerns in the world and has serious impact on human health, particularly in the mucous membranes of the respiratory tract and eyes. However, ocular hazardous effects to air pollutants are scarcely found in the literature. DESIGN: Panel study to evaluate the effect of different levels of ambient air pollution on lacrimal film cytokine levels of outdoor workers from a large metropolitan area. METHODS: Thirty healthy male workers, among them nineteen professionals who work on streets (taxi drivers and traffic controllers, high pollutants exposure, Group 1) and eleven workers of a Forest Institute (Group 2, lower pollutants exposure compared to group 1) were evaluated twice, 15 days apart. Exposure to ambient PM2.5 (particulate matter equal or smaller than 2.5 µm) was 24 hour individually collected and the collection of tears was performed to measure interleukins (IL) 2, 4, 5 and 10 and interferon gamma (IFN-γ) levels. Data from both groups were compared using Student's t test or Mann- Whitney test for cytokines. Individual PM2.5 levels were categorized in tertiles (lower, middle and upper) and compared using one-way ANOVA. Relationship between PM2.5 and cytokine levels was evaluated using generalized estimating equations (GEE). RESULTS: PM2.5 levels in the three categories differed significantly (lower: ≤22 µg/m3; middle: 23-37.5 µg/m3; upper: >37.5 µg/m3; p<0.001). The subjects from the two groups were distributed unevenly in the lower category (Group 1 = 8%; Group 2 = 92%), the middle category (Group 1 = 89%; Group 2 = 11%) and the upper category (Group 1 = 100%). A significant relationship was found between IL-5 and IL-10 and PM2.5 levels of the group 1, with an average decrease of 1.65 pg/mL of IL-5 level and of 0.78 pg/mL of IL-10 level in tear samples for each increment of 50 µg/m3 of PM2.5 (p = 0.01 and p = 0.003, respectively). CONCLUSION: High levels of PM2.5 exposure is associated with decrease of IL-5 and IL-10 levels suggesting a possible modulatory action of ambient air pollution on ocular surface immune response.

The effect of weather on respiratory and cardiovascular deaths in 12 U.S. cities.

We carried out time-series analyses in 12 U.S. cities to estimate both the acute effects and the lagged influence of weather on respiratory and cardiovascular disease (CVD) deaths. We fit generalized additive Poisson regressions for each city using nonparametric smooth functions to control for long time trend, season, and barometric pressure. We also controlled for day of the week. We estimated the effect and the lag structure of both temperature and humidity based on a distributed lag model. In cold cities, both high and low temperatures were associated with increased CVD deaths. In general, the effect of cold temperatures persisted for days, whereas the effect of high temperatures was restricted to the day of the death or the day before. For myocardial infarctions (MI), the effect of hot days was twice as large as the cold-day effect, whereas for all CVD deaths the hot-day effect was five times smaller than the cold-day effect. The effect of hot days included some harvesting, because we observed a deficit of deaths a few days later, which we did not observe for the cold-day effect. In hot cities, neither hot nor cold temperatures had much effect on CVD or pneumonia deaths. However, for MI and chronic obstructive pulmonary disease deaths, we observed lagged effects of hot temperatures (lags 4-6 and lags 3 and 4, respectively). We saw no clear pattern for the effect of humidity. In hierarchical models, greater variance of summer and winter temperature was associated with larger effects for hot and cold days, respectively, on respiratory deaths.

Risk factors for juvenile dermatomyositis: exposure to tobacco and air pollutants during pregnancy.

OBJECTIVE: To evaluate the influence of exposure to inhaled environmental factors during pregnancy on the diagnosis of juvenile dermatomyositis (DM). METHODS: We performed a case­control study comprising 20 juvenile DM patients and 56 healthy controls matched by age and sex who were residents in the metropolitan region of a large city. A questionnaire assessed demographic data and environmental inhalation exposure during pregnancy (occupational exposure to demolition, chalk, construction and/or quarry dust, paints, varnish, gasoline vapor, and/or battery fluids; stationary sources of inhaled pollution near the mother's home; and maternal tobacco exposure). Daily concentrations of inhaled particulate matter, SO2, NO2, O3, and carbon monoxide (CO) were evaluated throughout the gestational period. RESULTS: Maternal occupational exposure to school chalk dust/gasoline vapor in the juvenile DM group was significantly higher compared with controls (50% versus 4.6%; P = 0.001). Smoking mothers and secondhand smoke exposure at home during pregnancy were significantly higher in the juvenile DM group versus controls (smoking mothers: 20% versus 1.7%; P = 0.01, and secondhand smoke: 35% versus 19%; P = 0.07). In univariate logistic regression models, maternal smoking, occupational exposure to inhaled agents, and the highest tertile of tropospheric CO (3.2­5.4 parts per million) in the third trimester were significantly associated with juvenile DM (P ≤ 0.05). In the multivariate analysis, smoking mother (odds ratio [OR] 13.26 [95% confidence interval (95% CI) 1.21­144.29], P = 0.03), occupational exposure (OR 35.39 [95% CI 1.97­632.80], P = 0.01), and CO (third tertile) exposure in the third trimester of gestation (OR 12.21 [95% CI 1.28­115.96], P = 0.03) remained risk factors for juvenile DM. CONCLUSION: Inhaled pollutants and tobacco smoking during fetal development may contribute to juvenile DM.

Ozone is associated with an increased risk of respiratory exacerbations in patients with cystic fibrosis.

BACKGROUND: Tropospheric oxidant pollutants may injure the respiratory tract. Cystic fibrosis (CF) respiratory disease involves significant inflammation and excessive oxidative stress, and exposure to air pollutants can magnify the lung damage. The objective of this study was to investigate the association between the short-term variation in the concentration of air pollutants in metropolitan São Paulo, Brazil, and the occurrence of respiratory exacerbations in children and adolescents with CF. METHODS: A longitudinal panel of repeated measurements was obtained from 103 patients attending the outpatient center of our institution from September 6, 2006 through September 4, 2007. Daily concentrations of inhaled particulate matter, sulfur dioxide, nitrogen dioxide, ozone (O3), carbon monoxide, and meteorologic variables, such as the minimum temperature and relative humidity, were evaluated. The generalized estimation equation model for binomial distribution was used to assess the impact of these measurements on the occurrence of acute respiratory exacerbations. RESULTS: In total, 103 patients with CF (median age, 8.9 years) made 408 visits, with a mean ± SD of 4 ± 1.74 visits per patient (range, 2-9). A respiratory disease exacerbation was diagnosed on 142 visits (38.4%). An interquartile range increase in the O3 concentration (45.62 µg/m3) had a positive, delayed (2 days after exposure) effect on the risk of a respiratory exacerbation (relative risk = 1.86; 95% CI, 1.14-3.02). CONCLUSIONS: This study demonstrates that exposure to short-term air pollution in a large urban center increases the risk of a pulmonary exacerbation in patients with CF.

Pregnancy outcomes in contaminated areas, SP, Brazil.

OBJECTIVE: Estimate and compare prevalence of events related to pregnancy (pregnancy, low birth weight, premature delivery, spontaneous abortion, stillbirth, congenital malformation, and multiple births) in populations exposed and non-exposed to environmental contaminants in Santos and São Vicente Estuary. METHODS: This study was part of a large project financed by CNPq, which aimed to estimate health effects associated with environmental area, contaminants exposure among individuals of the Baixada Santista region. This cross-sectional study evaluated two neighborhoods of São Vicente near a contaminated area, and one neighborhood of Bertioga, the control area. A structured and previously tested questionnaire was applied at 236 households in São Vicente and 251 households in Bertioga in order to obtain the data. The chi-square test or Fisher's exact test were used to evaluate associations between area and qualitative variables; Student's t test or two proportion comparison test were used to evaluate differences between variables; and a significance level of 5% adopted. RESULTS: There was significant association between living in Bertioga (p = 0.01) and number of pregnancies in the past five years. In São Vicente, 64 (28.3%) childbearing age women became pregnant whereas in Bertioga there where 109 (38.8%). There were no statistical significant associations between living in any area and others pregnancy outcomes evaluated. CONCLUSION: Although no significant association was found, prevalence of low birth weight, preterm delivery and spontaneous abortion and prevalent odds ratio were higher in contaminated area. This study's evidence of a reduced number of pregnancies in contaminated area strengthens the need for additional more in-depth studies in Santos and São Vicente Estuary.

Air pollution in autoimmune rheumatic diseases: a review.

Air pollution consists of a heterogeneous mixture of gasses and particles that include carbon monoxide, nitrates, sulfur dioxide, ozone, lead, toxic by-product of tobacco smoke and particulate matter. Oxidative stress and inflammation induced by inhaled pollutants may result in acute and chronic disorders in the respiratory system, as well as contribute to a state of systemic inflammation and autoimmunity. This paper reviews the mechanisms of air contaminants influencing the immune response and autoimmunity, and it focuses on studies of inhaled pollutants triggering and/or exacerbating rheumatic diseases in cities around the world. Remarkably, environmental factors contribute to the onset of autoimmune diseases, especially smoking and occupational exposure to silica in rheumatoid arthritis and systemic lupus erythematosus. Other diseases such as scleroderma may be triggered by the inhalation of chemical solvents, herbicides and silica. Likewise, primary vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA) may be triggered by silica exposure. Only few studies showed that air pollutants could trigger or exacerbate juvenile idiopathic arthritis and systemic lupus erythematosus. In contrast, no studies of tropospheric pollution triggering inflammatory myopathies and spondyloarthropathies were carried out. In conclusion, air pollution is one of the environmental factors involved in systemic inflammation and autoimmunity. Further studies are needed in order to evaluate air pollutants and their potentially serious effects on autoimmune rheumatic diseases and the mechanisms involved in the onset and the exacerbation of these diseases.

Desfechos relacionados à gravidez em áreas contaminadas, SP, Brasil / Pregnancy outcomes in contaminated areas, SP, Brazil

OBJETIVO: Estimar e comparar a prevalência dos eventos relacionados à gravidez (engravidar, baixo peso de nascimento, parto prematuro, aborto espontâneo, natimortalidade, malformações congênitas e gemelaridade) em populações exposta e não-exposta aos contaminantes ambientais na região do estuário de Santos e São Vicente. MÉTODOS: O estudo fez parte de um amplo projeto financiado pelo CNPq, que teve como objetivo estimar os efeitos à saúde associados à exposição aos contaminantes ambientais entre os moradores da Baixada Santista. O estudo transversal avaliou dois bairros do município de São Vicente, próximos a uma área contaminada, e um bairro no município de Bertioga, área controle. Para a obtenção dos dados foi aplicado um questionário estruturado e pré-testado em 236 domicílios em São Vicente e 251 domicílios em Bertioga. Para avaliar associações entre a área e as variáveis qualitativas utilizouse o teste qui-quadrado ou teste exato de Fisher; para avaliar as diferenças entre as variáveis, o teste t de Student ou o teste de comparação de duas proporções, e adotado nível de significância de 5 por cento. RESULTADOS: Houve associação significativa entre morar em Bertioga (p = 0,01) e o número de gestações ocorridas nos últimos cinco anos. Em São Vicente, 64 (28,3 por cento) mulheres em idade fértil engravidaram, enquanto em Bertioga foram 109 (38,8 por cento). Não houve associações estatísticas significativas nas áreas com os demais desfechos da gravidez avaliados. CONCLUSÕES: As prevalências e as razões de chances prevalentes de baixo peso ao nascer, nascimentos prematuros e abortos espontâneos foram maiores nas áreas contaminadas, sem associações significativas. A evidência do estudo de diminuição do número de gestações na área contaminada reforça a necessidade de aprofundamento de estudos na região do estuário de Santos e São Vicente.

OBJECTIVE: Estimate and compare prevalence of events related to pregnancy (pregnancy, low birth weight, premature delivery, spontaneous abortion, stillbirth, congenital malformation, and multiple births) in populations exposed and non-exposed to environmental contaminants in Santos and São Vicente Estuary. METHODS: This study was part of a large project financed by CNPq, which aimed to estimate health effects associated with environmental area, contaminants exposure among individuals of the Baixada Santista region. This cross-sectional study evaluated two neighborhoods of São Vicente near a contaminated area, and one neighborhood of Bertioga, the control area. A structured and previously tested questionnaire was applied at 236 households in São Vicente and 251 households in Bertioga in order to obtain the data. The chi-square test or Fisher's exact test were used to evaluate associations between area and qualitative variables; Student's t test or two proportion comparison test were used to evaluate differences between variables; and a significance level of 5 percent adopted. RESULTS: There was significant association between living in Bertioga (p = 0.01) and number of pregnancies in the past five years. In São Vicente, 64 (28.3 percent) childbearing age women became pregnant whereas in Bertioga there where 109 (38.8 percent). There were no statistical significant associations between living in any area and others pregnancy outcomes evaluated. CONCLUSION: Although no significant association was found, prevalence of low birth weight, preterm delivery and spontaneous abortion and prevalent odds ratio were higher in contaminated area. This study's evidence of a reduced number of pregnancies in contaminated area strengthens the need for additional more in-depth studies in Santos and São Vicente Estuary.

Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU) and who had been previously treated with antimicrobials, especially third-generation cephalosporins.This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1) First period (September 1999 to February 2000); and 2) Second period (August 2000 to December 2000); empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004). Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002). Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004) and P. mirabilis (p=0.036), restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001) and reduction of ventilator-associated pneumonia rates (p<0.0001). However, there was an increase in P. aeruginosa incidence (p=0.005) and increases in ceftazidime (p=0.003) and meropenem (p<0.0001) susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.

Efeitos da poluição atmosférica na saúde infantil em São José dos Campos, SP / Effects of air pollution on children's health in a city in Southeastern Brazil

OBJETIVO: Dentre os efeitos da poluição ambiental na saúde da criança, destaca-se o aumento de internações por pneumonias. O objetivo do estudo foi estimar a associação dessas internações com o aumento dos poluentes atmosféricos. MÉTODOS: Trata-se de estudo ecológico de séries temporais, realizado na cidade de São José dos Campos, SP, nos anos de 2000 e 2001. Foram utilizados dados diários sobre o número de internações por pneumonia, dados diários de poluentes (SO2, O3 e PM10) e de temperatura e umidade do clima. Foram estimadas as correlações entre as variáveis de interesse pelo coeficiente de Pearson. Para estimar a associação entre as internações por pneumonia e a poluição atmosférica, utilizaram-se modelos aditivos generalizados de regressão de Poisson. Foram estimados os acréscimos das internações por pneumonia para o intervalo interquartil para cada um dos poluentes estudados, com um intervalo de confiança de 95 por cento RESULTADOS: Os três poluentes apresentaram efeitos defasados nas internações por pneumonia, iniciada três a quatro dias após a exposição e decaindo rapidamente. Na estimativa de efeito acumulado de oito dias observou-se ao longo desse período que para aumentos de 24,7 æg/m na concentração média de PM10 houve um acréscimo de 9,8 por cento nas internações. CONCLUSÕES: O estudo confirma que o potencial deletério dos poluentes do ar sobre a saúde pode ser detectado, também, em cidades de médio porte. A magnitude do efeito foi semelhante ao observado na cidade de São Paulo. Além disso, mostra a elevada susceptibilidade das crianças aos efeitos adversos advindos da exposição aos contaminantes atmosféricos.

Air pollution effects on myocardial infarction

OBJETIVO: O infarto do miocárdio é uma doença cardiovascular grave que tem como indicação a internação em unidades de terapia intensiva, com poucos indicados para admissão em enfermarias. O objetivo do estudo foi investigar se as estimativas dos efeitos da poluição atmosférica nas internações por infarto do miocárdio são modificadas de acordo com a fonte de informações de saúde. MÉTODOS: Em hospitais do Sistema Unico de Saúde (SUS), na cidade de São Paulo, foi realizado estudo de séries temporais (1998-1999) tendo como desfechos as internações por infarto em unidades de terapia intensiva e em enfermarias, em pessoas acima de 64 anos. Foram utilizados modelos lineares generalizados, controlados para sazonalidade (de longa e curta duração) e variáveis climáticas. Foram construídos modelos distribuídos de defasagem polinomial de terceiro grau, para avaliar os efeitos acumulados nos oito dias anteriores à exposição.RESULTADOS: Aproximadamente 70 por cento das internações por infarto no miocárdio ocorreram em enfermarias. Apesar disso, os efeitos da poluição sobre os casos foram maiores nas internações em unidades de terapia intensiva. Todos os poluentes mostraram uma associação positiva com os desfechos, mas o SO2 apresentou uma associação mais robusta e estatisticamente significante. O aumento do intervalo interquartil para as concentrações observadas do SO2 foi associado ao aumento em 13 por cento (IC 95 por cento: 6-19) e 8por cento (IC 95por cento: 2-13) nas internações em unidade de terapia intensiva e enfermarias, respectivamente. CONCLUSÕES: Pode-se supor que exista um erro de classificação das internações por infarto nas enfermarias, superestimando o número de internações. No entanto, o menor número de internações por infarto do miocárdio em unidades de terapia intensiva, é o indicador mais adequado para estimar os efeitos da poluição atmosférica nas internações por infarto.