Association between fine particulate matter and the peak expiratory flow of schoolchildren in the Brazilian subequatorial Amazon: a panel study.

BACKGROUND: Exposure to high levels of particulate matter with an aerodynamic diameter less than 2.5 µm (PM(2.5)) resulting from biomass burning is frequent in the subequatorial Amazon region. OBJECTIVE: To investigate whether or not current exposure to PM(2.5) in the Brazilian Amazon has adverse effects on the daily peak expiratory flow (PEF) of schoolchildren. METHODS: The study design consisted of a panel comprising 309 children aged 6 to 15 years from the same school. PEF was measured daily, except weekends and holidays, from August to December 2006. Each child contributed to the study up to 67 daily measurements. All together there were 19115 PEF measures. Participation rate was 90%. Daily measurements of PM(2.5), temperature, and humidity as well as passive smoking, and subject features were regarded in the statistical analysis. Various exposures of PM(2.5) were considered throughout the analysis, among them 24-hour, 12-hour, 6-hour, and 5-hour means. To account for subject responses to confounders, mixed effects models were applied. The effects were evaluated considering air pollution levels on the current day or at 1- or 2-day lags and the averages of 0-1-day lags, 1-2-day lags and 0-, 1-, and 2-day lags. RESULTS: The 24-hour PM(2.5) means ranged from 6.39 to 99.91 µg/m(3). The adjusted models for the entire group of children revealed adverse effects. For instance, for an increase of 10 µg/m(3) in PM(2.5,) the reduction in the PEF average varied between 0.26 l/min (95% Confidence Interval (CI): -0.49; -0.04) and 0.38 l/min (95% CI: -0.71; -0.04). Restricted to the subgroup of non-asthmatic children, classified as such according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, there was a reduction in the PEF ranging from 0.38 l/min (95% CI: -0.63; -0.13) to 0.53 l/min (95% CI: -0.90; -0.16) for an increase of 10 µg/m(3) in PM(2.5). There was no significant effect in the asthmatic group. When stratified by time of the day children were at school, the concurrent effects of air pollution on PEF were not significant, whereas the 6-hour exposure from 0 am to 5:30 am was significant for both morning and afternoon groups. Finally, the 24-hour mean lagged effect was only significant for the afternoon group of children. For an increase of 10 µg/m(3) in PM(2.5,) there was a reduction in the PEF that ranged from 0.41 l/min (95% CI: -0.76; -0.06) to 0.49 l/min (95% CI: -0.91; -0.07). CONCLUSION: Exposure to current levels of PM(2.5) in the Brazilian Amazon was associated with reductions in the lung function of schoolchildren. The adverse effects were more consistent in non-asthmatic children and with respect to the 6-hour mean from 0 am to 5.30 am.

Genetic polymorphisms and their effects on the severity of silicosis in workers exposed to silica in Brazil.

OBJECTIVE: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by inhalation of silica particles. Genetic factors might play a role in the severity silicosis. We sought to evaluate the influence of polymorphisms in the ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1, and TNF genes on the severity of silicosis. METHODS: Nine polymorphisms were genotyped by PCR in a sample of 143 patients with silicosis in the state of Rio de Janeiro, Brazil. RESULTS: Fifty-seven patients (40%) were classified as having simple silicosis and 86 (60%) were classified as having complicated silicosis. The TT genotype of rs1800469 in the TGFB1 gene showed a protective effect for complicated silicosis (OR = 0.35; 95% CI, 0.14-0.92; p = 0.028) when compared with the other two genotypes (CC+CT). The polymorphic T allele of rs763110 in the FASLG gene (OR = 0.56; 95% CI, 0.31-0.99; p = 0.047), as well as a dominant model for the T allele (TT+CT: OR = 0.37; 95% CI, 0.15-0.96; p = 0.037), also showed a protective effect. When patients with simple silicosis despite having been exposed to silica for a longer time (> 44,229 hours) were compared with patients with complicated silicosis despite having been exposed to silica for a shorter time, the T allele of rs763110 in the FASLG gene (OR = 0.20; 95% CI, 0.08-0.48; p < 0.0001), as well as dominant and recessive models (OR = 0.06; 95% CI, 0.00-0.49; p = 0.01 and OR = 0.22; 95% CI, 0.06-0.77; p = 0.014, respectively), showed a protective effect against the severity of silicosis. CONCLUSIONS: It appears that rs1800469 polymorphisms in the TGFB1 gene and rs763110 polymorphisms in the FASLG gene are involved in the severity of silicosis. Given the lack of studies relating genetic polymorphisms to the severity of silicosis, these results should be replicated in other populations.

Incompletude da variável profissão/ocupação nos bancos de síndrome gripal, síndrome respiratória aguda grave e mortalidade, Brasil, 2020-2021 / Incompleteness of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases, Brazil, 2020-2021

Resumo Objetivo: descrever a incompletude da informação sobre profissão/ocupação nas bases de dados de síndrome respiratória aguda grave (SRAG), síndrome gripal (SG) e no Sistema de Informações sobre Mortalidade (SIM) no Brasil. Métodos: estudo descritivo utilizando os bancos de dados de SRAG, SG e SIM. Calcularam-se percentuais de incompletude na variável profissão/ocupação segundo sexo, macrorregiões e unidades da federação, em 2020-2021. Resultados: o percentual de incompletude foi de 94,7% no banco de SG; 97,7% no de SRAG; e 17,0% no SIM. Em todas as macrorregiões a incompletude foi superior a 91,0% nos bancos de SG e SRAG; e superior a 13,0% no SIM. Todas as unidades da federação apresentaram percentuais de incompletude acima de 90,0% para SG; de 74,0% para SRAG; e de 6,8% para óbitos. Amapá apresentou maior percentual de incompletude na base de dados de SG (98,1%); Rio Grande do Sul (99,4%) na de SRAG; e Alagoas (45,0%) no SIM. Conclusões: observaram-se elevados percentuais de incompletude da variável profissão/ocupação nos sistemas de informação estudados. Recomenda-se uma articulação intersetorial, envolvendo representantes dos governos e dos trabalhadores, para formulação de estratégias que contornem a falta de informação sobre ocupação/profissão nas bases de dados relevantes para a vigilância em saúde.

Abstract Objective: to describe the incomplete filling out of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil. Methods: descriptive study with secondary data from flu-like syndrome (FLS), severe acute respiratory syndrome (SARS) and mortality databases (SIM). We calculeted the absolute and relative filling frequencies of the profession/occupation variable according to State, gender, regions, and federative units, for 2020 and 2021. Results: we found a 94.7% incompleteness on the FLS database, 97.7% of missing profession/occupation data on the SARS, and 17.0% on the SIM database. Incompleteness frequency was above 91.0% in all Brazilian regions for FLS and SARS. Incompleteness on the mortality database was over 13.0%. All federative units presented incompleteness above 90.0% for FLS, 74.0% for SARS, and 6.8% for mortality in all genders. Higher levels of missing data were found in the states of Amapá for FLS (98.1%), Rio Grande do Sul for SARS and Alagoas (45.0%) for mortality (99.4%). Conclusions: all databases showed a high incompleteness of the profession/occupation variable. We recommend an articulation between the Ministry of Health, Ministry of Labor and workers' representations to solve this lack of data on occupation/profession in public databases.

Air pollution and respiratory diseases in the Municipality of Vitória, Espírito Santo State, Brazil.

In Brazil, increasing air pollution in urban areas has led to a rise in respiratory diseases among children and the elderly and has also been the main cause of hospital admissions. This study aims to evaluate the air pollution levels in Vitória, capital of Espírito Santo State, Brazil, in comparison to Brazilian legislation and recent World Health Organization (WHO) guidelines, analyzing the spatial distribution of asthma cases treated at local outpatient services. A descriptive epidemiological study was performed with daily records on air pollution and outpatient treatment for respiratory diseases from 2001 to 2003, for children under 6 years of age. A geographic information system (GIS) was used to identify asthma distribution in the municipality. Air pollution levels were relatively low when compared to the Brazilian legislation and WHO guidelines. Only mean PM10 and NO2 exceeded the annual quality standard. The three highest asthma outpatient treatment rates were observed in the districts of São José, Jabou, and Morro do Quadro.

Genetic polymorphisms and their effects on the severity of silicosis in workers exposed to silica in Brazil / Polimorfismos genéticos e seus efeitos na gravidade da silicose em trabalhadores expostos à sílica no Brasil

ABSTRACT Objective: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by inhalation of silica particles. Genetic factors might play a role in the severity silicosis. We sought to evaluate the influence of polymorphisms in the ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1, and TNF genes on the severity of silicosis. Methods: Nine polymorphisms were genotyped by PCR in a sample of 143 patients with silicosis in the state of Rio de Janeiro, Brazil. Results: Fifty-seven patients (40%) were classified as having simple silicosis and 86 (60%) were classified as having complicated silicosis. The TT genotype of rs1800469 in the TGFB1 gene showed a protective effect for complicated silicosis (OR = 0.35; 95% CI, 0.14-0.92; p = 0.028) when compared with the other two genotypes (CC+CT). The polymorphic T allele of rs763110 in the FASLG gene (OR = 0.56; 95% CI, 0.31-0.99; p = 0.047), as well as a dominant model for the T allele (TT+CT: OR = 0.37; 95% CI, 0.15-0.96; p = 0.037), also showed a protective effect. When patients with simple silicosis despite having been exposed to silica for a longer time (> 44,229 hours) were compared with patients with complicated silicosis despite having been exposed to silica for a shorter time, the T allele of rs763110 in the FASLG gene (OR = 0.20; 95% CI, 0.08-0.48; p < 0.0001), as well as dominant and recessive models (OR = 0.06; 95% CI, 0.00-0.49; p = 0.01 and OR = 0.22; 95% CI, 0.06-0.77; p = 0.014, respectively), showed a protective effect against the severity of silicosis. Conclusions: It appears that rs1800469 polymorphisms in the TGFB1 gene and rs763110 polymorphisms in the FASLG gene are involved in the severity of silicosis. Given the lack of studies relating genetic polymorphisms to the severity of silicosis, these results should be replicated in other populations.

RESUMO Objetivo: A silicose é uma pneumoconiose caracterizada por fibrose do parênquima pulmonar causada por inalação de partículas de sílica. Fatores genéticos podem desempenhar um papel na gravidade da silicose. Nosso objetivo foi avaliar a influência de polimorfismos dos genes ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1 e TNF na gravidade da silicose. Métodos: Nove polimorfismos foram genotipados por meio de PCR em uma amostra composta por 143 pacientes com silicose no estado do Rio de Janeiro, Brasil. Resultados: A silicose foi classificada em simples em 57 (40%) dos pacientes e em complicada, em 86 (60%). O genótipo TT do polimorfismo rs1800469 do gene TGFB1 teve efeito protetor contra a silicose complicada (OR = 0,35; IC95%: 0,14-0,92; p = 0,028) em comparação com os outros dois genótipos (CC+CT). O alelo T polimórfico do polimorfismo rs763110 do gene FASLG (OR = 0,56; IC95%: 0,31-0,99; p = 0,047) e um modelo dominante do alelo T (TT+CT: OR = 0,37; IC95%: 0,15-0,96; p = 0,037) também tiveram efeito protetor. Quando se compararam os pacientes que tinham silicose simples com um tempo maior de exposição à sílica (> 44.229 horas) àqueles que tinham silicose complicada com um tempo menor de exposição à sílica, o alelo T do polimorfismo rs763110 do gene FASLG (OR = 0,20; IC95%: 0,08-0,48; p < 0,0001) e modelos dominantes e recessivos (OR = 0,06; IC95%: 0,00-0,49; p = 0,01 e OR = 0,22; IC95%: 0,06-0,77; p = 0,014, respectivamente) tiveram efeito protetor contra a gravidade da silicose. Conclusões: Polimorfismos rs1800469 do gene TGFB1 e polimorfismos rs763110 do gene FASLG parecem estar envolvidos na gravidade da silicose. Como há poucos estudos que tenham estabelecido relações entre polimorfismos genéticos e a gravidade da silicose, esses resultados devem ser replicados em outras populações.

[Indicator of socio-environmental vulnerability in the Western Amazon. The case of the city of Porto Velho, State of Rondônia, Brazil]. / Indicador de vulnerabilidade socioambiental na Amazônia Ocidental. O caso do município de Porto Velho, Rondônia, Brasil.

The accelerated process of urbanization in the State of Amazônia associated with changes in the patterns of exploitation of natural resources have resulted in several types of environmental impacts, such as urban air pollution produced by forest fires which alters the relationship between urban and rural areas and establishes new vulnerabilities. The scope of this study is to analyze the socio-environmental vulnerability in relation to forest fires and health effects in the urban area of Porto Velho, located in the Brazilian Amazon region. Data was analyzed using a synthetic indicator combining income and education aspects, housing infrastructure, environmental exposure and health effects. The findings indicate that 51% of the resident population, i.e. around 157,000 inhabitants, is exposed to conditions of high and extreme environmental vulnerability. Analysis of the dimensions used to construct the synthetic indicator reveals an intense heterogeneity in terms of socio-environmental vulnerability in the urban area of the city of Porto Velho. These results highlight the need for integrated actions from different government departments in order to enhance health promotion, ecological sustainability and also reduce social inequalities in health.

Formação profissional como ação estratégica para implementação da Política Nacional de Saúde do Trabalhador e da Trabalhadora / Professional qualification as a strategic action for the implementation of the Brazilian Workers' Health Policy

Resumo Introdução: a criação da Rede Nacional de Atenção Integral à Saúde do Trabalhador é considerada a principal estratégia para a Política Nacional de Saúde do Trabalhador e da Trabalhadora. O Ministério da Saúde priorizou a qualificação profissional das equipes dos centros de referência em saúde do trabalhador, considerados nucleares na rede. Foi firmado um convênio com o Centro de Estudos da Saúde do Trabalhador e Ecologia Humana, da Escola Nacional de Saúde Pública, da Fundação Oswaldo Cruz, para o desenvolvimento de um Curso de Especialização em Saúde do Trabalhador na modalidade a distância. Objetivo: descrever e analisar o desenvolvimento do curso no período de 2006 a 2015. Métodos: análise documental. Resultados: o curso ocorreu nas regiões Norte, Nordeste, Centro-Oeste e Sudeste, com 1.703 inscritos, 70% de concluintes aprovados e evasão de 28%. Valorizou-se a opinião dos profissionais participantes sobre o curso e o material didático e analisou-se sua relação com a política e o desempenho dos alunos e tutores. Conclusão: o processo pioneiro cumpriu os objetivos abrindo novos caminhos para ações em saúde do trabalhador e identificando evidências positivas da capacitação sobre os serviços e a rede.

Abstract Introduction: the creation of the National Workers' Health Comprehensive Care Network is considered the main strategy for the Brazilian Workers' Health Policy. The Ministry of Health prioritized the professional training of the teams from workers' health reference centers, which are considered crucial within the network. The Ministry of Health signed an agreement with the Centre of Studies for Worker's Health and Human Ecology of the Oswaldo Cruz Foundation National School of Public Health, aiming at organizing a distance education course on Workers' Health. Objective: to describe and analyze the course development from 2006 to 2015. Methods: documentary analysis. Results: the course was held in the North, Northeast, Midwest and Southeast regions of Brazil, with 1,703 enrollees, from which 70% were approved and 28% dropped out. The participants' opinions about the course and its materials were taken into account. We analyzed the relationship between the course and the workers' health policy, as well as the performance of students and tutors. Conclusion: the courses pioneering process achieved its objectives, carving new paths for actions in workers' health, and making it possible to identify positive evidence of the training on services and the network.

Alterações respiratórias, auditivas e citogenéticas em trabalhadores de um estaleiro no Rio de Janeiro: estudo de caso / Respiratory, audiologic and cytogenetic alterations in workers of a shipyard in Rio de Janeiro: case study

Resumo Introdução Este estudo avaliou alterações respiratórias, auditivas e citogenéticas em trabalhadores de um estaleiro em Angra dos Reis, no Estado do Rio de Janeiro, relacionadas à exposição de pintores a solventes, metais e ruído no ambiente de trabalho. Métodos Foram avaliados função pulmonar, perdas auditivas e índice de reconhecimento da fala, e alterações citogenéticas pelo teste de aberrações cromossômicas. Foram avaliados manganês e chumbo em sangue por espectrometria de absorção atômica. Os indicadores de efeito utilizados para chumbo foram ALAD e ALA-U, determinados por espectrofotometria e cromatografia líquida, respectivamente. Resultados Seis dos 9 trabalhadores avaliados apresentaram alteração funcional respiratória. Quase 70% dos 18 trabalhadores avaliados apresentaram audição reduzida, com associação entre PAIR e chumbo em sangue. O percentual médio de recuperação da ALAD foi de 32,9%, com médias de ALA-U de 1,7 mg g-1 creatinina, 4,65 µg dL-1 para Pb-S e 10 µg L -1 para Mn-S entre os trabalhadores. Foram observadas associações entre ALA-D ativada com Mn-S e com a presença de aberrações cromossômicas. As alterações citogenéticas identificadas foram aneuploidias, separação prematura centromérica e aberrações como formação de anéis, quebras e união de cromátides irmãs. Conclusão os trabalhadores do estaleiro apresentam alterações que podem ser associadas à exposição ocupacional.

Abstract Introduction This study evaluated respiratory, audiological and cytogenetic alterations in shipyard workers in Angra dos Reis, state of Rio de Janeiro/Brazil, and their correlation to the occupational exposure of painters to solvents, metals and noise present. Methods We evaluated pulmonary function, hearing loss and speech recognition, as well as cytogenetic alterations. Indicators of exposure to lead and manganese in blood were evaluated by atomic absorption spectrometry. The determination of ALAD and ALA-U was performed by spectrophotometry and liquid chromatography, respectively. Results Six of the 9 workers evaluated for lung function had respiratory functional impairment. Almost 70% of the 18 evaluated workers had reduced hearing, with association between PAIR and values of lead in blood. The average percentage of recovery of ALAD was 32.9%; average was 1.7 mg g-1 creatinine for ALA-U, 4.65 µg dL-1 for Pb-B and 10 µg L-1 for Mn-B. We observed associations between activated ALA-D with Mn-B and the presence of chromosomal aberrations. Furthermore, we identified cytogenetic alterations as aneuploidy, premature centromere separation; as well as ring formation, breakage, and sister chromatid union. Conclusion Shipyard workers presented alterations that can be associated with occupational exposure.

[Trend of mortality from respiratory disease in elderly and the forest fires in the state of Rondônia/Brazil - period between 1998 and 2005]. / Tendência da mortalidade por doenças respiratórias em idosos e as queimadas no Estado de Rondônia/Brasil: período entre 1998 e 2005.

The forest fires in the Amazon region have been a serious environmental problem. Few studies relate the effects of forest fires on the health of exposed populations. This article aims to study the trend of mortality from respiratory diseases in the elderly, in the period 1998 to 2005, in the state of Rondônia and to correlate with the number of fire focuses. This is a descriptive study of the type of ecological. The death certificates were obtained from the Mortality Information System and the registers of data on the focus of fire have been obtained through online database available publicly in the National Space Research Institute. The results had shown a trend of growth in mortality rates for respiratory disease and chronic obstructive pulmonary disease (COPD) among elderly over 65 years and also a growing trend in the number of focus of heat. There was a positive and significant correlation between the number of fire focuses and mortality rates respiratory diseases and COPD, which explains around 50% to 80% of deaths by diseases in the elderly in the region studied. These results demonstrate the gravity of the problem of forest fires and the impact on respiratory health of the population, mainly on mortality in the elderly.

Prevalence of asthma in children and adolescents in a city in the Brazilian Amazon region.

OBJECTIVE: To analyze the prevalence of asthma and asthma symptoms in students of two distinct age brackets residing in the city of Tangará da Serra, Brazil. METHODS: Cross-sectional, population-based study of the prevalence of asthma in children from 6 to 7 years of age and adolescents from 13 to 14, using the standardized International Study of Asthma and Allergies in Childhood, phase 1 questionnaire, validated for use in Brazil. Students who responded affirmatively to question 2 (presence of wheezing in the preceding 12 months) were classified as suffering from asthma. RESULTS: The study comprised 3,362 students, of whom 1,634 (48.6%) were children and 1,728 (51.4%) were adolescents. Of the 1,634 children, 816 (49.9%) were male, and 818 (50.1%) were female. Of the 1,728 adolescents, 773 (45.0%) were male, and 955 (55.0%) were female. The prevalence of asthma among the children was 25.2%, whereas that among the adolescents was 15.9% (chi2 = 8.34; p = 0.00). The children presented higher prevalences of the following symptoms of asthma than did the adolescents: wheezing ever (54.3%), nocturnal dry cough (43.9%), wheezing in the preceding 12 months (25.2%), and from 1 to 3 attacks of wheezing in the preceding 12 months (19.1%). There were no differences between the two groups regarding physician-diagnosed asthma (approximately 4.5%). There were no statistical differences regarding the prevalence of asthma by gender in the two groups. CONCLUSIONS: Tangará da Serra has a high prevalence of asthma in children and adolescents, and this result is compatible with other studies carried out in Brazil and Latin America using the same methodology.

Indicador de vulnerabilidade socioambiental na Amazônia Ocidental: o caso do município de Porto Velho, Rondônia, Brasil / Indicator of socio-environmental vulnerability in the Western Amazon: The case of the city of Porto Velho, State of Rondônia, Brazil

O acelerado processo de urbanização na Amazônia associado às mudanças no padrão de exploração dos recursos naturais resultou em vários tipos de impactos ambientais, tal como a poluição do ar urbano produzido pelo incêndio florestal que altera a relação entre as áreas urbana e rural e reconfigura novas vulnerabilidades. O objetivo deste estudo é analisar a vulnerabilidade socioambiental em relação às queimadas e aos efeitos a saúde na área urbana do município de Porto Velho, região amazônica brasileira. Para tanto, utiliza como método a construção de um indicador síntese, que conjugou a dimensão social, de infraestrutura habitacional, exposição ambiental e de saúde. Dentre os resultados, destaca-se que 51% da população residente, 157 mil habitantes, estão sob condições de extrema e alta vulnerabilidade socioambiental. Ao final, discute-se que a análise integrada das dimensões estudadas permitiu identificar importante heterogeneidade em termos de vulnerabilidade socioambiental às queimadas no interior da área urbana de Porto Velho, apontando para a necessidade de ações integradas de diferentes setores governamentais de forma a potencializar a promoção da saúde, a sustentabilidade ecológica e a redução das iniquidades sociais em saúde.

Indicador de vulnerabilidade socioambiental na Amazônia Ocidental. O caso do município de Porto Velho, Rondônia, Brasil / Indicator of socio-environmental vulnerability in the Western Amazon. The case of the city of Porto Velho, State of Rondônia, Brazil

O acelerado processo de urbanização na Amazônia associado às mudanças no padrão de exploração dos recursos naturais resultou em vários tipos de impactos ambientais, tal como a poluição do ar urbano produzido pelo incêndio florestal que altera a relação entre as áreas urbana e rural e reconfigura novas vulnerabilidades. O objetivo deste estudo é analisar a vulnerabilidade socioambiental em relação às queimadas e aos efeitos a saúde na área urbana do município de Porto Velho, região amazônica brasileira. Para tanto, utiliza como método a construção de um indicador síntese, que conjugou a dimensão social, de infraestrutura habitacional, exposição ambiental e de saúde. Dentre os resultados, destaca-se que 51% da população residente, 157 mil habitantes, estão sob condições de extrema e alta vulnerabilidade socioambiental. Ao final, discute-se que a análise integrada das dimensões estudadas permitiu identificar importante heterogeneidade em termos de vulnerabilidade socioambiental às queimadas no interior da área urbana de Porto Velho, apontando para a necessidade de ações integradas de diferentes setores governamentais de forma a potencializar a promoção da saúde, a sustentabilidade ecológica e a redução das iniquidades sociais em saúde.

The accelerated process of urbanization in the State of Amazônia associated with changes in the patterns of exploitation of natural resources have resulted in several types of environmental impacts, such as urban air pollution produced by forest fires which alters the relationship between urban and rural areas and establishes new vulnerabilities. The scope of this study is to analyze the socio-environmental vulnerability in relation to forest fires and health effects in the urban area of Porto Velho, located in the Brazilian Amazon region. Data was analyzed using a synthetic indicator combining income and education aspects, housing infrastructure, environmental exposure and health effects. The findings indicate that 51% of the resident population, i.e. around 157,000 inhabitants, is exposed to conditions of high and extreme environmental vulnerability. Analysis of the dimensions used to construct the synthetic indicator reveals an intense heterogeneity in terms of socio-environmental vulnerability in the urban area of the city of Porto Velho. These results highlight the need for integrated actions from different government departments in order to enhance health promotion, ecological sustainability and also reduce social inequalities in health.

Effect of air pollution on lung function in schoolchildren in Rio de Janeiro, Brazil.

OBJECTIVE: To assess the association between daily exposure to air pollution and lung function in school children. METHODS: Panel study with a random sample of 118 students (between 6 and 15 years of age), enrolled in a public school of the city of Rio de Janeiro, state of Rio de Janeiro, and living within 2 km of the study site. Data on students' characteristics were obtained with a questionnaire, including the International Study of Asthma and Allergies in Childhood - ISAAC. Daily peak expiratory flow measurements were taken to measure lung function. Daily data on PM10, SO2, O3, NO2 and CO levels, temperature and humidity were provided by a portable monitor. Repeated measurements of lung function were associated with pollutant levels with a multilevel model adjusted for time trend, temperature, air humidity, exposure to smoking at home, presence of asthma, height, sex, weight and age of children. RESULTS: Mean peak expiratory flow was 243.5 l/m (sd=58.9). The lowest mean peak expiratory flow was 124 l/m, and the highest, 450 l/m. For the 10 microg/m(3) increase in PM10, there was a 0.34 l/min decrease in mean peak flow on the third day. For the 10 microg/m(3) increase in NO2, there was a decrease between 0.23 l/min and 0.28 l/min in mean peak flow after exposure. CO and SO2 effects on students' peak flow were not statistically significant. O3 showed a protective result: an increase in 10 microg/m(3) of O3 would be associated, after a day of exposure, with a 0.2 l/min increase in mean lung function. CONCLUSIONS: Even within acceptable levels most of the time, air pollution, especially PM10 and NO2, was associated with a decrease in lung function in children living in the city of Rio de Janeiro.

Respiratory disease and climatic seasonality in children under 15 years old in a town in the Brazilian Amazon.

OBJECTIVE: To analyze the climatic seasonality of primary care visits for respiratory disease (RD) in children less than 15 years old. METHODS: This was a descriptive, epidemiological study based on data from the municipal records of primary care events from basic healthcare centers for the period 2004-2005, for the municipality of Tangará da Serra (MT), Brazil. Population estimates were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IGBE), and data on temperature and relative humidity of the air, from the National Meteorology Institute (Instituto Nacional de Meteorologia, INMET). Mean rates of primary care visits for RD were calculated according to sex, age group and anatomic location of complaint. The ratio of dry season to rainy season visits was calculated according to anatomic location of the RD. Data were analyzed using Epi-Info 3.2, testing differences between proportions using the chi-square test to a significance level of 5%. RESULTS: Male children had an almost 50% greater (37.3/25.0) rate of primary care visits for diseases of the lower respiratory tract than did females. The rates of primary care visits due to RD in children under 15 years of age varied as age increased, varying from 457.7 per thousand of children less than 1 year of age to 133.5 per thousand in the 10 to 14 years-of-age group. During the dry season there were an average of 21% (4,148/5,231) fewer visits for RD (p = 0.000). Peaks in numbers of visits were observed during the months of March and August, being more accentuated in March, which is the wet season in the region. CONCLUSION: Primary care visits for RD, especially those due to upper airway diseases, are related to the rainy season in this municipality.

Analysis of hospitalizations for respiratory diseases in Tangará da Serra, Brazil.

OBJECTIVE: To analyze hospitalizations for respiratory diseases among children under 15 years of age in an area with high levels of environmental pollution. METHODS: A cross-sectional study of hospitalizations due to respiratory diseases of patients residing in the city of Tangará da Serra, located in the state of Mato Grosso (Brazilian Amazon region), from 2000 to 2005. Data on hospital admissions were obtained from the Brazilian Unified Health Care System and from Brazilian Institute of Geography and Statistics population estimates. RESULTS: In 2005, the rate of hospitalization for respiratory diseases among children under 15 years of age in the microregion of Tangará da Serra was 70.1/1,000 children. Between 2000 and 2005, there were 12,777 such admissions, of which 8,142 (63.7%) were for respiratory diseases. During the dry season (May to October), the rate of admissions for respiratory diseases was 10% higher than during the rainy season (November to April). The principal causes of admission included pneumonia (90.7%) and respiratory insufficiency (8.5%). Admissions of children under 5 years of age for pneumonia were 4 times the expected number for the city. Children under 12 months of age were the most frequently hospitalized, with an average increase of 32.4 admissions per 1,000 children per year. CONCLUSIONS: Tangará da Serra presented a high number of pediatric admissions for respiratory diseases. Therefore, it is logical to consider it a priority area for investigation and monitoring of the environmental risk factors for such diseases.

Estimativa de Custo das Internações Hospitalares por Mesotelioma no Brasil / Estimate of cost of the Hospital Internments for Mesotelioma in Brazil

No Brasil, o amianto é usado em larga escala há muitas décadas. O mesotelioma - câncer de pleura relacionado à inalação da poeira de amianto - só costuma manifestar-se cerca de 20 anos após o contato ocupacional e/ou ambiental. O objetivo geral deste trabalho é estimar os gastos diretos das internações por mesotelioma no Brasil entre os anos de 1995 a 2007, a partir da base de dados do Sistema de Informações Hospitalares (SIH), disponibilizado pelo DATASUS. Foram selecionados a freqüência das internações por mesotelioma, o valor total destas e o tempo médio de permanência. Os gastos permitiram calcular os valores médios de uma internação e, por fim, da diária hospitalar. As informações foram obtidas, descritas e analisadas a partir do SIH/SUS, discriminando-as por Estado. Os resultados encontrados no SUS, entre 1995 e 2007, ocorreram, no total, 4.264 internações por mesotelioma, registrando-se uma média de 328 por ano. O tempo médio de permanência no hospital foi de 9,91 dias. O valor total despendido pelo SUS foi de R$4.757.441,74, isto é, R$ 365.957,05 anualmente. O gasto médio por internação foi de R$1.115,72, sendo o da diária hospitalar de R$112,60. Observou-se que o SUS, nas regiões Sudeste e Sul, apresentaram maior número de internações e gastos com os pacientes, podendo estar relacionado ao processo de trabalho e ao melhor acesso dos trabalhadores ao sistema de saúde nestas regiões.

A experiência do Observatório de Saúde do Trabalhador (Observatoriost) no Brasil / The experience of the Worker's Health Observatory (Observatoriost) in Brazil

Antecedentes históricos apontam a mobilização sindical e de pesquisadores para criar um Observatório de Saúde do Trabalhador (OST) que permitisse oferecer informações com credibilidade e subsidiar a defesa da saúde. Este trabalho teve o objetivo de rever e analisar os antecedentes internacionais e brasileiros da mobilização de sindicatos, centros de estudos sindicais e intersindicais e pesquisadores de instituições do setor que criaram um observatório presencial e virtual para comunicação e repositório de informações científicas. Foram utilizados métodos de intervenção e observação participantes e levantamento documental. O relato parte de iniciativas de superação das políticas neoliberais. Tais iniciativas impulsionaram a criação do Observatoriost em 2010 e o mantiveram ativo até 2013 compilando documentos, relatos de imprensa e agendas sindicais. O observatório foi conduzido em cogestão com seis centrais sindicais por meio do Comitê Editorial das centrais que respeitou a diversidade e a autonomia dos atores envolvidos. A coordenação rotativa do portal pelo comitê evidenciou a maturidade política e sua articulação. Os principais desafios postos para a continuação da iniciativa foram de integrar e formar pesquisadores e profissionais comprometidos organicamente com os trabalhadores na luta pela defesa da vida e saúde.

Historical antecedents led labor organizations and worker's health researchers to create a Worker's Health Observatory aimed at disseminating credible information and subsidizing the defense of workers' health. This paper reviews and analyzes the national and international backgrounds that mobilized the labor unions, labor unions study centers, and workers' health researchers to produce a virtual and in person observatory aimed at communicating and storing scientific information. Participant observation and intervention, as well as document review methods were used. The paper starts by discussing the initiatives to overcome neoliberal policies. These iniciatives allowed the "Observatoriost" to be created in 2010 and kept in activity, compiling documents, press reports and labor union agendas, until 2013. The observatory was co-managed by six associations of labor unions (the so called "Centrais" in Brazil) through the Editorial Committee, which complied with the diversity and autonomy of the involved actors. The "Observatoriost" rotatory coordination established by the associations of labor unions Editorial Committee proved they were politically mature and prepared to networking. The main challenges for keeping this initiative were to prepare and integrate researchers and other professionals who would be organically committed to workers' struggle for life and health.