Is the expansion of the subway network alone capable of improving local air quality? A study case in São Paulo, Brazil.

One of the policies adopted to reduce vehicular emissions is subway network expansion. This work fitted interrupted regression models to investigate the effects of the inauguration of subway stations on the mean, trend, and seasonality of the NO, NO2, NOx, and PM10 local concentrations. The regions investigated in the city of São Paulo (Brazil) were Pinheiros, Butantã, and St. Amaro. In Pinheiros, after the inauguration of the subway station, there were downward trends for all pollutants. However, these trends were not significantly different from the trends observed before. In Butantã, only regarding NO, there was a significant reduction and seasonal change after the subway station's inauguration. In St. Amaro, no trend in the PM10 concentration was noted. The absence of other transportation and land use policies in an integrative way to the subway network expansion may be responsible for the low air quality improvement. This study highlights that the expansion of the subway network must be integrated with other policies to improve local air quality.

A Multi-Pollutant and Meteorological Analysis of Cardiorespiratory Mortality among the Elderly in São Paulo, Brazil-An Artificial Neural Networks Approach.

Traditionally, studies that associate air pollution with health effects relate individual pollutants to outcomes such as mortality or hospital admissions. However, models capable of analyzing the effects resulting from the atmosphere mixture are demanded. In this study, multilayer perceptron neural networks were evaluated to associate PM10, NO2, and SO2 concentrations, temperature, wind speed, and relative air humidity with cardiorespiratory mortality among the elderly in São Paulo, Brazil. Daily data from 2007 to 2019 were considered and different numbers of neurons on the hidden layer, algorithms, and a combination of activation functions were tested. The best-fitted artificial neural network (ANN) resulted in a MAPE equal to 13.46%. When individual season data were analyzed, the MAPE decreased to 11%. The most influential variables in cardiorespiratory mortality among the elderly were PM10 and NO2 concentrations. The relative humidity variable is more important during the dry season, and temperature is more important during the rainy season. The models were not subjected to the multicollinearity issue as with classical regression models. The use of ANNs to relate air quality to health outcomes is still very incipient, and this work highlights that it is a powerful tool that should be further explored.

Health impact assessment of air pollution in Lisbon, Portugal.

BACKGROUND: Lisbon has about 500,000 inhabitants and it's the capital and the main economic hub of Portugal. Studies have demonstrated that exposure to Particulate Matter with an aerodynamic diameter<2.5 µm (PM2.5) have strong association with health effects. Researchers continue to identify new harmful air pollutants effects in our health even in low levels. OBJECTIVES: This study evaluates air pollution scenarios considering a Health Impact Assessment approach in Lisbon, Portugal. METHODS: We have studied abatement scenarios of PM2.5 concentrations and the health effects in the period from 2015 to 2017 using the APHEKOM tool and the associated health costs were assessed by Value of Life Year. RESULTS: The mean concentration of PM2.5 in Lisbon was 23 µg/m3 ± 10 µg/m3 (±Standard Deviation). If we consider that World Health Organization (WHO) standards of PM2.5 (10 µg/m3) were reached, Lisbon would avoid more than 423 premature deaths (equivalent to 9,172 life years' gain) and save more than US$45 million annually. If Lisbon city could even diminish the mean of PM2.5 by 5 µg/m3, nearly 165 deaths would be avoided, resulting in a gain of US$17 million annually. CONCLUSION: According to our findings, if considered the worst pollution scenario, levels of PM2.5 could improve the life's quality and save a significant amount of economic resources.Implications: The manuscript addresses the health effects and costs of air pollution and constitutes an important target for improving public policies on air pollutants in Portugal. Although Portugal has low levels of air pollution, there are significant health and economic effects that, for the most part, are underreported. The health impact assessment approach associated with costs had not yet been addressed in Portugal, which makes this study more relevant in the analysis of policies aimed to drive stricter control on pollutants' emissions. Health costs are a fundamental element to support decision-making process and to orientate the trade-offs in investments for improving public policies so that to diminish health effects, which can impact the management of the local health services and the population's quality of life, especially after the pandemic period when resources are scarce.

Does air pollution explain COVID-19 fatality and mortality rates? A multi-city study in São Paulo state, Brazil.

Since air pollution compromise the respiratory system and COVID-19 disease is caused by a respiratory virus, it is expected that air pollution plays an important role in the current COVID-19 pandemic. Exploratory studies have observed positive associations between air pollution and COVID-19 cases, deaths, fatality, and mortality rate. However, no study focused on Brazil, one of the most affected countries by the pandemic. Thus, this study aimed to understand how long-term exposure to PM10, PM2.5, and NO2 contributed to COVID-19 fatality and mortality rates in São Paulo state in 2020. Air quality data between 2015 and 2019 in 64 monitoring stations within 36 municipalities were considered. The COVID-19 fatality was calculated considering cases and deaths from the government's official data and the mortality rate was calculated considering the 2020 population. Linear regression models were well-fitted for PM2.5 concentration and fatality (R2 = 0.416; p = 0.003), NO2 concentration and fatality (R2 = 0.232; p = 0.005), and NO2 concentration and mortality (R2 = 0.273; p = 0.002). This study corroborates other authors' findings and enriches the discussion for having considered a longer time series to represent long-term exposure to the pollutants and for having considered one of the regions with the highest incidence of COVID-19 in the world. Thus, it reinforces measures to reduce the concentration of air pollutants which are essential for public health and will increase the chance to survive in future respiratory disease epidemics.

Avaliação de impacto à saúde da incidência de dengue associada à pluviosidade no município de Ribeirão Preto, São Paulo / Health impact assessment of the incidence of dengue associated with precipitation in the city of Ribeirão Preto, São Paulo

Resumo Introdução A dengue é considerada um problema de saúde pública. O município de Ribeirão Preto possui condições climáticas e geográficas favoráveis à proliferação do Aedes aegypti , sendo reportadas altas taxas de incidência de dengue. Objetivo Avaliar a relação entre a precipitação pluviométrica e a incidência de casos confirmados de dengue. Método Foi utilizado o coeficiente de correlação de Spearman para a análise da relação entre a pluviosidade e a incidência de dengue. Resultados Encontrou-se associação entre a precipitação e os casos de dengue, com p < 0,01, considerando um intervalo de defasagem (time lag ) que ocorre a partir do primeiro mês e se estende até o quinto mês. Conclusão Estudos como este contribuem para o conhecimento sobre a influência de fatores climáticos na incidência e na dinâmica de transmissão da dengue, sendo essenciais para auxiliar os gestores na tomada de decisão para a prevenção e o controle da doença.

Abstract Background Dengue is considered a public health problem. The municipality of Ribeirão Preto has climatic and geographical conditions conducive to the proliferation of Aedes aegypti and high rates of dengue incidence are reported. Objective To evaluate the relationship between rainfall and the incidence of confirmed cases of dengue. Method The Spearman Correlation Coefficient was used to analyze the relationship between rainfall and the dengue incidence. Results An association between precipitation and dengue cases was found, with p < 0.01, considering a time lag, which occurs from the first month until the fifth month. Conclusion Studies such as this contribute to the knowledge about the influence of climatic factors on the incidence and transmission dynamics of dengue fever, being essential to guide managers in decision making for disease prevention and control.

Dengue incidence and associated costs in the periods before (2000-2008) and after (2009-2013) the construction of the hydroelectric power plants in Rondônia, Brazil. / Incidência de dengue e custos associados, nos períodos anterior (2000-2008) e posterior (2009-2013) à construção das usinas hidrelétricas em Rondônia.

OBJECTIVE: to describe the incidence of dengue cases and associated costs in the period before and after the construction of the Jirau and Santo Antônio hydroelectric power plants (HPP), in Rondônia State, Brazil. METHODS: economic evaluation study, based on data from the Notifiable Diseases Information System (SINAN) and the National Hospital Information System (SIH/SUS); dengue direct costs were calculated and segmented regression analysis was carried out. RESULTS: dengue incidence mean was higher in the period after HPP construction (880.29/100,000 inhabitants) than before them (356.34/100,000 inhabitants) (p≤0.05); direct costs were estimated at US$3.47 million in the pre-construction period and US$7.1 million in the post-construction period. CONCLUSION: there was an increase in the incidence and direct costs of dengue after HPP construction; the environmental licensing process should include more detailed health impact assessments.

Avaliação de Impacto à Saúde (AIS) no Brasil e América Latina: uma ferramenta essencial a projetos, planos e políticas / Health Impact Assessment (HIA) in Brazil and Latin America: an essential tool for projects, plans and policies / Evaluación de Impacto a la Salud (EIS) en Brasil y América Latina: una herramienta esencial para los proyectos, planes y las políticas

O presente artigo apresenta uma revisão de literatura e discute a aplicação da metodologia de Avaliação de Impacto à Saúde (AIS), divulgada pela Organização Mundial de Saúde (OMS), para o Brasil e América Latina. Esse estudo mostrou que a prática e a aplicação da AIS não é comum nestas regiões, e, além disso, a análise de impactos à saúde é realizada de forma superficial em licenciamentos ambientais e em políticas públicas, o que aponta para a necessidade da utilização de metodologias específicas, treinamento de profissionais e iniciativa governamental. A adoção da AIS no Brasil e América Latina evitaria a geração de efeitos adversos à saúde, potencializando os aspectos positivos, mitigando os efeitos negativos de projetos e políticas públicas, garantindo que a saúde da população não seja negligenciada.(AU)

The paper presents a literature review of the application of the Health Impact Assessment (HIA) methodology, disseminated by the World Health Organization in Brazil and Latin America. This study showed that the practice and application of the HIA is not common in Brazil or Latin America, as well as the analysis of health impacts is carried out in a superficial way regarding environmental licensing and public policies, indicating the need of the use of specific health impact assessment methodologies, professional training and government initiative. The adoption of HIA in Brazil could serve to avoid adverse health effects and could enhance the positive aspects, as well as to mitigate the negative aspects of projects and public policies, ensuring that people's health is not neglected.(AU)

Este artículo presenta una revisión de la literatura y discute la aplicación de la metodología de Evaluación del Impacto a la Salud (EIS), divulgada por la Organización Mundial de la Salud (OMS), para Brasil y América Latina. Ese estudio mostró que la práctica y la aplicación de EIS no es común en esas regiones y, además, el análisis de impactos a la salud se realiza de forma superficial en licencias ambientales y en políticas públicas, lo que señala la necesidad de la utilización de metodologías específicas, capacitación de profesionales e iniciativa gubernamental. La adopción de EIS en Brasil y en América Latina evitaría la generación de efectos adversos a la salud, potencializando los aspectos positivos, mitigando los efectos negativos de proyectos y políticas públicas, garantizando que no se descuide la salud de la población.(AU)

Incidência de dengue e custos associados, nos períodos anterior (2000-2008) e posterior (2009-2013) à construção das usinas hidrelétricas em Rondônia / Incidencia de dengue y costos asociados, en los períodos antes (2000-2008) y después (2009-2013) de la construcción de las centrales hidroeléctricas en Rondônia, Brasil / Dengue incidence and associated costs in the periods before (2000-2008) and after (2009-2013) the construction of the hydroelectric power plants in Rondônia, Brazil

Objetivo: descrever a incidência de dengue e os custos associados, nos períodos anterior (2000-2008) e posterior (2009-2013) à construção das usinas hidrelétricas (UHE) Jirau e Santo Antônio, em Rondônia, Brasil. Métodos: estudo de avaliação econômica, realizado com dados do Sistema de Informação de Agravos de Notificação (Sinan) e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); calcularam-se custos diretos da dengue e utilizou-se a análise de regressão segmentada. Resultados: a média de incidência de dengue foi maior no período posterior às construções (880,29/100 mil hab.) do que no período anterior (356,34/100 mil hab.) (p≤0,05); os custos diretos foram estimados em US$3,47 milhões no período anterior e US$7,1 milhões no posterior. Conclusão: houve crescimento da incidência e dos custos diretos da dengue após as construções; o processo de licenciamento ambiental deve incluir avaliações de impacto à saúde mais detalhadas.

Objetivo: analizar la incidencia de dengue y costes asociados en el período antes y después de la construcción de centrales hidroeléctricas (CHE), estado de Rondônia, Brasil. Métodos: estudio de evaluación económica, considerando los costos directos del dengue, el número de casos notificados y las internaciones hospitalarias, con datos del Sistema Nacional de Enfermedades de Declaración Sistema de Información (Sinan) y del Sistema de Información Hospitalaria del Sistema Único de Salud (SIH-SUS), analizados por regresión lineal. Resultados: se encontraron diferencias significativas entre la tasa de incidencia en el pre (356,34/100.000 habitantes) y post-construcción (880,29/100.000 habitantes) (p≤0,05); además, los costos se estimaron en US$3.47 millones en período de pre-construcción de US$7.1 millones en el período posterior. Conclusión: se sugiere la aplicación de evaluaciones del impacto en la salud más detallada, para ayudar en el uso de los recursos y la gestión de la salud.

Objective: to describe the incidence of dengue cases and associated costs in the period before and after the construction of the Jirau and Santo Antônio hydroelectric power plants (HPP), in Rondônia State, Brazil. Methods: economic evaluation study, based on data from the Notifiable Diseases Information System (SINAN) and the National Hospital Information System (SIH/SUS); dengue direct costs were calculated and segmented regression analysis was carried out. Results: dengue incidence mean was higher in the period after HPP construction (880.29/100,000 inhabitants) than before them (356.34/100,000 inhabitants) (p≤0.05); direct costs were estimated at US$3.47 million in the pre-construction period and US$7.1 million in the post-construction period. Conclusion: there was an increase in the incidence and direct costs of dengue after HPP construction; the environmental licensing process should include more detailed health impact assessments.

Health Impact Assessment of Air Pollution in São Paulo, Brazil.

Epidemiological research suggests that air pollution may cause chronic diseases, as well as exacerbation of related pathologies such as cardiovascular and respiratory morbidity and mortality. This study evaluates air pollution scenarios considering a Health Impact Assessment approach in São Paulo, Brazil. We have analyzed abatement scenarios of Particulate Matter (PM) with an aerodynamic diameter <10 µm (PM10), <2.5 µm (PM2.5) and ozone concentrations and the health effects on respiratory and cardiovascular morbidity and mortality in the period from 2009 to 2011 through the APHEKOM tool, as well as the associated health costs. Considering World Health Organization (WHO) standards of PM2.5 (10 µg/m³), São Paulo would avoid more than 5012 premature deaths (equivalent to 266,486 life years' gain) and save US$15.1 billion annually. If São Paulo could even diminish the mean of PM2.5 by 5 µg/m³, nearly 1724 deaths would be avoided, resulting in a gain of US$ 4.96 billion annually. Reduced levels of PM10, PM2.5 and ozone could save lives and an impressive amount of money in a country where economic resources are scarce. Moreover, the reduced levels of air pollution would also lower the demand for hospital care, since hospitalizations would diminish. In this sense, Brazil should urgently adopt WHO air pollution standards in order to improve the quality of life of its population.

[Costs of air pollution in Brazilian metropolitan regions]. / Custos da poluição atmosférica nas regiões metropolitanas brasileiras.

This study evaluated the economic impact of health events associated with air pollution in Brazilian metropolitan regions. From the estimated mortality attributable to concentrations of particulate matter (PM) in 29 metropolitan areas, with a total of 20,050 deaths, the costs associated with mortality were calculated by means of the use of DALY (Disability Adjusted Life Years) methodology. The cost of premature deaths in Brazil resulted in $ 1.7 billion annually. Translating losses in public health to economic values served to compare this data with the expense budget of the Ministry of Health and highlight priorities in decision-making of public policies that minimize the magnitude of these impacts.

Custos da poluição atmosférica nas regiões metropolitanas brasileiras / Costs of air pollution in Brazilian metropolitan regions

O presente estudo avaliou o impacto econômico de eventos de saúde associados com a poluição do ar em regiões metropolitanas brasileiras. A partir de estimativa da mortalidade atribuível às concentrações de Material Particulado (MP) em 29 Regiões Metropolitanas, que totalizaram 20.050 óbitos, foram calculados os custos associados a essa mortalidade por meio da metodologia DALY (Disability Adjusted Life Years). O custo das mortes prematuras no Brasil resultou em US$ 1,7 bilhão anualmente. A tradução de perdas em saúde pública para valores econômicos serviu para comparar com o orçamento de gastos do Ministério da Saúde e evidenciar as prioridades na tomada de decisão de políticas públicas que minimizem a magnitude desses impactos.

This study evaluated the economic impact of health events associated with air pollution in Brazilian metropolitan regions. From the estimated mortality attributable to concentrations of particulate matter (PM) in 29 metropolitan areas, with a total of 20,050 deaths, the costs associated with mortality were calculated by means of the use of DALY (Disability Adjusted Life Years) methodology. The cost of premature deaths in Brazil resulted in $ 1.7 billion annually. Translating losses in public health to economic values served to compare this data with the expense budget of the Ministry of Health and highlight priorities in decision-making of public policies that minimize the magnitude of these impacts.

Follow-up of the air pollution and the human male-to-female ratio analysis in Sao Paulo, Brazil: a times series study.

OBJECTIVES: In order to assess if ambient air pollution in urban areas could be related to alterations in male/female ratio this study objectives to evaluate changes in ambient particulate matter (PM10) concentrations after implementation of pollution control programmes in São Paulo city and the secondary sex ratio (SRR). DESIGN AND METHODS: A time series study was conducted. São Paulo's districts were stratified according to the PM10 concentrations levels and were used as a marker of overall air pollution. The male ratio was chosen to represent the secondary sex ratio (SSR=total male birth/total births). The SSR data from each area was analysed according to the time variation and PM10 concentration areas using descriptive statistics. The strength association between annual average of PM10 concentration and SSR was performed through exponential regression, and it was adopted as a statistical significance level of p<0.05. RESULTS: The exponential regression showed a negative and significant association between PM10 and SSR. SSR varied from 51.4% to 50.7% in São Paulo in the analysed period (2000-2007). Considering the PM10 average concentration in São Paulo city of 44.72 µg/m(3) in the study period, the SSR decline reached almost 4.37%, equivalent to 30 934 less male births. CONCLUSIONS: Ambient levels of PM10 are negatively associated with changes in the SSR. Therefore, we can speculate that higher levels of particulate pollution could be related to increased rates of female births.

Lean diesel technology and human health: a case study in six Brazilian metropolitan regions.

OBJECTIVE: Due to their toxicity, diesel emissions have been submitted to progressively more restrictive regulations in developed countries. However, in Brazil, the implementation of the Cleaner Diesel Technologies policy (Euro IV standards for vehicles produced in 2009 and low-sulfur diesel with 50 ppm of sulfur) was postponed until 2012 without a comprehensive analysis of the effect of this delay on public health parameters. We aimed to evaluate the impact of the delay in implementing the Cleaner Diesel Technologies policy on health indicators and monetary health costs in Brazil. METHODS: The primary estimator of exposure to air pollution was the concentration of ambient fine particulate matter (particles with aerodynamic diameters <2.5 µm, [PM2.5]). This parameter was measured daily in six Brazilian metropolitan areas during 2007-2008. We calculated 1) the projected reduction in the PM2.5 that would have been achieved if the Euro IV standards had been implemented in 2009 and 2) the expected reduction after implementation in 2012. The difference between these two time curves was transformed into health outcomes using previous dose-response curves. The economic valuation was performed based on the DALY (disability-adjusted life years) method. RESULTS: The delay in implementing the Cleaner Diesel Technologies policy will result in an estimated excess of 13,984 deaths up to 2040. Health expenditures are projected to be increased by nearly US$ 11.5 billion for the same period. CONCLUSIONS: The present results indicate that a significant health burden will occur because of the postponement in implementing the Cleaner Diesel Technologies policy. These results also reinforce the concept that health effects must be considered when revising fuel and emission policies.

Evaluation of the air quality benefits of the subway system in São Paulo, Brazil.

Air pollution is a severe problem in major urban areas due to increasing numbers of vehicles, reduced road capacity and few investments in public transportation, especially in developing countries. Public transportation has a special role in avoiding congestion and consequent environmental and health impacts but is considered expensive. The objective of this paper was to analyze the benefits of the São Paulo subway in terms of the air pollution in the city through strikes events, analyzing both the health outcomes and the related economic burden. For the strike events, increases in air pollutant concentrations during the strike day was observed when compared to a similar day in terms of day of the week and meteorological conditions. Increases in mortality were also observed and the associated economic burden calculated. Despite the elevated construction and operation costs of the subway, when environment and social values are considered, cost-benefit analysis results would indicate a worthwhile investment. The consideration of these aspects is essential to sustainable transportation analyses, and in the case of the São Paulo subway, our analysis clearly demonstrated the important role of this system in the city's environmental, social and economic attributes.

Lean diesel technology and human health: a case study in six Brazilian metropolitan regions

OBJECTIVE: Due to their toxicity, diesel emissions have been submitted to progressively more restrictive regulations in developed countries. However, in Brazil, the implementation of the Cleaner Diesel Technologies policy (Euro IV standards for vehicles produced in 2009 and low-sulfur diesel with 50 ppm of sulfur) was postponed until 2012 without a comprehensive analysis of the effect of this delay on public health parameters. We aimed to evaluate the impact of the delay in implementing the Cleaner Diesel Technologies policy on health indicators and monetary health costs in Brazil. METHODS: The primary estimator of exposure to air pollution was the concentration of ambient fine particulate matter (particles with aerodynamic diameters <2.5 μm, [PM2.5]). This parameter was measured daily in six Brazilian metropolitan areas during 2007-2008. We calculated 1) the projected reduction in the PM2.5 that would have been achieved if the Euro IV standards had been implemented in 2009 and 2) the expected reduction after implementation in 2012. The difference between these two time curves was transformed into health outcomes using previous dose-response curves. The economic valuation was performed based on the DALY (disability-adjusted life years) method. RESULTS: The delay in implementing the Cleaner Diesel Technologies policy will result in an estimated excess of 13,984 deaths up to 2040. Health expenditures are projected to be increased by nearly US$ 11.5 billion for the same period. CONCLUSIONS: The present results indicate that a significant health burden will occur because of the postponement in implementing the Cleaner Diesel Technologies policy. These results also reinforce the concept that health effects must be considered when revising fuel and emission policies.

Health, environmental, and economic costs from the use of a stabilized diesel/ethanol mixture in the city of São Paulo, Brazil.

In Greater Metropolitan São Paulo, Brazil, fossil fuel combustion in the transportation system is a major cause of outdoor air pollution. Air quality improvement requires additional policies and technological upgrades in fuels and vehicle engines. The current study thus simulated the environmental and social impacts resulting from the use of a stabilized diesel/ethanol mixture in the bus and truck fleet in Greater Metropolitan São Paulo. The evaluation showed reductions in air pollutants, mainly PM10, which would help avert a number of disease events and deaths, as estimated through dose-response functions of epidemiological studies on respiratory and cardiovascular diseases. Valuation of the impacts using an environmental cost-benefit analysis considered operational installation, job generation, potential carbon credits, and health costs, with an overall positive balance of US$ 2.851 million. Adding the estimated qualitative benefits to the quantitative ones, the project's benefits far outweigh the measured costs. Greater Metropolitan São Paulo would benefit from any form of biodiesel use, producing environmental, health and socioeconomic gains, the three pillars of sustainability.

Increased levels of air pollution and a decrease in the human and mouse male-to-female ratio in São Paulo, Brazil.

A significant negative association (R(2) = 0.7642; P=.013) between particulate matter and secondary sex ratio was found when evaluating people in the city of São Paulo, Brazil. An animal model with male mice raised in nonfiltered open-top chambers showed a significant reduction in the secondary sex ratio (P=.041), suggesting that ambient air pollution may interfere with sex distribution by altering the X:Y sperm proportion in pollution-exposed males.

Health, environmental, and economic costs from the use of a stabilized diesel/ethanol mixture in the city of São Paulo, Brazil

In Greater Metropolitan São Paulo, Brazil, fossil fuel combustion in the transportation system is a major cause of outdoor air pollution. Air quality improvement requires additional policies and technological upgrades in fuels and vehicle engines. The current study thus simulated the environmental and social impacts resulting from the use of a stabilized diesel/ethanol mixture in the bus and truck fleet in Greater Metropolitan São Paulo. The evaluation showed reductions in air pollutants, mainly PM10, which would help avert a number of disease events and deaths, as estimated through dose-response functions of epidemiological studies on respiratory and cardiovascular diseases. Valuation of the impacts using an environmental cost-benefit analysis considered operational installation, job generation, potential carbon credits, and health costs, with an overall positive balance of US$ 2.851 million. Adding the estimated qualitative benefits to the quantitative ones, the project's benefits far outweigh the measured costs. Greater Metropolitan São Paulo would benefit from any form of biodiesel use, producing environmental, health and socioeconomic gains, the three pillars of sustainability.

A poluição atmosférica na Região Metropolitana de São Paulo, Brasil, é devida principalmente à queima de combustíveis fósseis utilizados no sistema de transportes. A fim de melhorar a qualidade do ar, são necessárias políticas e melhorias tecnológicas em combustíveis e motores veiculares. Neste sentido, foi realizada uma avaliação dos impactos ambientais e sociais da mistura estabilizada do uso de diesel/etanol na frota de ônibus e caminhões na Região Metropolitana de São Paulo. Essa avaliação mostrou reduções nos poluentes atmosféricos, especialmente o MP10, o que contribuiu para um número de eventos de morbidade e mortalidade evitáveis estimados por meio de funções dose-resposta de estudos epidemiológicos em termos de doenças respiratórias e cardiovasculares. A valoração dos impactos representada através de uma análise custo-benefício ambiental resultou positiva em US$ 2,851 milhões. Adicionando-se a essa quantia os benefícios estimados em termos qualitativos, pode-se concluir que os benefícios sócio-econômicos do projeto superam os custos mensurados. A Região Metropolitana de São Paulo se beneficiará de qualquer tipo de biodiesel produzindo ganhos em termos ambientais, de saúde e de inclusão sócio-econômica, os três pilares da sustentabilidade.

An evaluation of air pollution health impacts and costs in São Paulo, Brazil.

The need to determine cost estimates of the hazardous effects of diseases is important in order to establish the priorities of actions for prevention and health management. The evaluation of air pollution impacts on health, based on expenditures, has been carried out, but there are obvious comparison difficulties among countries, as the health-per-capita investment varies enormously. In order to achieve a standard indicator, we applied the Disability-Adjusted Life Years (DALY) method to estimate the health burden and cost estimate due to air pollution in São Paulo, Brazil. The basic methodology was the utilization of dose-response curves of epidemiological studies conducted in São Paulo to assess air pollution and its health effects. DALY attributable to air pollution in São Paulo added up to 28,212 years annually. An indirect health cost attributable to air pollution resulted in 3,222,676 US dollars. This estimate refers to the children and the elderly population. These results give a preliminary and underestimated value of the burden of diseases promoted by air pollution.

Prótese total: análise comparativa da técnica convencional em relaçäo à técnica da zona neutra / Complete dentures: comparative study of the conventional and neutral zone techniques

O objetivo deste estudo foi avaliar a reabilitaçäo bucal em cinco pacientes, para os quais confeccionaram-se dois pares de próteses totais, pelas técnicas convencional e da zona neutra, verificando-se com qual técnica o paciente apresentava melhor adaptaçäo. A prótese confeccionada pela técnica convencional foi eleita como a melhor pela maioria dos pacientes (4) por apresentar menor peso e tamanho