Wildfire-related PM2.5 and health economic loss of mortality in Brazil.

BACKGROUND: Wildfire imposes a high mortality burden on Brazil. However, there is a limited assessment of the health economic losses attributable to wildfire-related fine particulate matter (PM2.5). METHODS: We collected daily time-series data on all-cause, cardiovascular, and respiratory mortality from 510 immediate regions in Brazil during 2000-2016. The chemical transport model GEOS-Chem driven with Global Fire Emissions Database (GFED), in combination with ground monitored data and machine learning was used to estimate wildfire-related PM2.5 data at a resolution of 0.25°â€ˆ× 0.25°. A time-series design was applied in each immediate region to assess the association between economic losses due to mortality and wildfire-related PM2.5 and the estimates were pooled at the national level using a random-effect meta-analysis. We used a meta-regression model to explore the modification effect of GDP and its sectors (agriculture, industry, and service) on economic losses. RESULTS: During 2000-2016, a total of US$81.08 billion economic losses (US$5.07 billion per year) due to mortality were attributable to wildfire-related PM2.5 in Brazil, accounting for 0.68% of economic losses and equivalent to approximately 0.14% of Brazil's GDP. The attributable fraction (AF) of economic losses due to wildfire-related PM2.5 was positively associated with the proportion of GDP from agriculture, while negatively associated with the proportion of GDP from service. CONCLUSION: Substantial economic losses due to mortality were associated with wildfires, which could be influenced by the agriculture and services share of GDP per capita. Our estimates of the economic losses of mortality could be used to determine optimal levels of investment and resources to mitigate the adverse health impacts of wildfires.

Association Between Hydrological Conditions and Dengue Fever Incidence in Coastal Southeastern China From 2013 to 2019.

Importance: Dengue fever is a climate-sensitive infectious disease. However, its association with local hydrological conditions and the role of city development remain unclear. Objective: To quantify the association between hydrological conditions and dengue fever incidence in China and to explore the modification role of city development in this association. Design, Setting, and Participants: This cross-sectional study collected data between January 1, 2013, and December 31, 2019, from 54 cities in 4 coastal provinces in southeast China. The Standardized Precipitation Evapotranspiration Index (SPEI) was calculated from ambient temperature and precipitation, with SPEI thresholds of 2 for extreme wet conditions and -2 for extreme dry conditions. The SPEI-dengue fever incidence association was examined over a 6-month lag, and the modification roles of 5 city development dimensions were assessed. Data were analyzed in May 2022. Exposures: City-level monthly temperature, precipitation, SPEI, and annual city development indicators from 2013 to 2019. Main Outcomes and Measures: The primary outcome was city-level monthly dengue fever incidence. Spatiotemporal bayesian hierarchal models were used to examine the SPEI-dengue fever incidence association over a 6-month lag period. An interaction term between SPEI and each city development indicator was added into the model to assess the modification role of city development. Results: Included in the analysis were 70 006 dengue fever cases reported in 54 cities in 4 provinces in China from 2013 to 2019. Overall, a U-shaped cumulative curve was observed, with wet and dry conditions both associated with increased dengue fever risk. The relative risk [RR] peaked at a 1-month lag for extreme wet conditions (1.27; 95% credible interval [CrI], 1.05-1.53) and at a 6-month lag for extreme dry conditions (1.63; 95% CrI, 1.29-2.05). The RRs of extreme wet and dry conditions were greater in areas with limited economic development, health care resources, and income per capita. Extreme dry conditions were higher and prolonged in areas with more green space per capita (RR, 1.84; 95% CrI, 1.37-2.46). Highly urbanized areas had a higher risk of dengue fever after extreme wet conditions (RR, 1.80; 95% CrI, 1.26-2.56), while less urbanized areas had the highest risk of dengue fever in extreme dry conditions (RR, 1.70; 95% CrI, 1.11-2.60). Conclusions and Relevance: Results of this study showed that extreme hydrological conditions were associated with increased dengue fever incidence within a 6-month lag period, with different dimensions of city development playing various modification roles in this association. These findings may help in developing climate change adaptation strategies and public health interventions against dengue fever.

Development and Assessment of a Brazilian Pilot Massive Open Online Course in Planetary Health Education: An Innovative Model for Primary Care Professionals and Community Training.

Introduction: Planetary health (PH) has emerged as a leading field for raising awareness, debating, and finding solutions for the health impacts of human-caused disruptions to Earth's natural systems. PH education addresses essential questions of how humanity inhabits Earth, and how humans affect, and are affected by, natural systems. A pilot massive open online course (MOOC) in PH was created in Brazil in 2020. This MOOC capitalized on the global online pivot, to make the course accessible to a broader audience. This study describes the process of course creation and development and assesses the impact evaluation data and student outcomes of the PH MOOC. Methods: The PH MOOC pilot was launched in Brazilian Portuguese, using the TelessaúdeRS-UFRGS platform on 4/27/2020 and concluded on 7/19/2020 with a total load of 80 h. It was composed of 8 content modules, pre and post-test, 10 topics in a forum discussion, and an optional action plan. This study analyzes the course database, profile of participants, answers to questionnaires, forum interaction, and action plans submitted. Results: Two thousand seven hundred seventy-seven participants enrolled in the course, of which 1,237 (44.54%) gave informed consent for this study. Of the 1,237 participants who agreed to participate in the research, 614 (49.8%) completed the course, and 569 (92.67%) were accredited by TelessaúdeRS-UFRGS. The majority of the participants were concerned with climate change, trained in the health area, and worked in primary health care in places that lacked ongoing sustainability programs. Two hundred forty-one action plans were submitted, major topics identified were food and nutrition, infectious diseases, and garbage and recycling. Discussion: The use of the PH lens and open perspective of the course centered the need to communicate planetary health topics to individuals. The local plans reflected the motto of "think global and act local." Brazil presents a context of an unprecedented social, political, and environmental crisis, with massive deforestation, extensive fires, and biomass burning altering the biomes, on top of an ongoing necropolitical infodemic and COVID-19 pandemic. In the face of these multiple challenges, this MOOC offers a timely resource for health professionals and communities, encouraging them to address planetary challenges as fundamental health determinants.

Spatial-temporal variability of metal pollution across an industrial district, evidencing the environmental inequality in São Paulo.

Although air pollution decreased in some cities that shifted from an industrial to a service-based economy, and vehicular emission regulation became more restrictive, it is still a major risk factor for mortality worldwide. In central São Paulo, Brazil, air quality monitoring stations and tree-ring analyses revealed a decreasing trend in the concentrations of particulate matter and metals. Such trends, however, may not be observed in industrial districts located in the urban periphery, where the usual mobile sources may be combined with local stationary sources. To evaluate environmental pollution in an industrial district in southeastern São Paulo, we assessed its spatial variability, by measuring magnetic properties and concentrations of Al, Ba, Ca, Cl, Cu, Fe, K, Mg, Mn, P, S, Sr, Zn in the bark of 62 trees, and its temporal trends, by measuring Cd, Cu, Ni, Pb, V, Zn in tree rings of three trees. Source apportionment analysis based on tree barks revealed two clusters with high concentrations of metals, one related to vehicular and industrial emissions (Al, Ba, Cu, Fe, Zn) in the east side of the industrial cluster, and the other related to soil resuspension (Cu, Zn, Mn) in its west side. These patterns are also supported by the magnetic properties of bark associated with iron oxides and titanium-iron alloy concentrations. Dendrochemical analyses revealed that only the concentrations of Pb consistently decreased over the last four decades. The concentrations of Cd, Cu, Ni, V, and Zn did not significantly decrease over time, in contrast with their negative trends previously reported in central São Paulo. This combined biomonitoring approach revealed spatial clusters of metal concentration in the vicinity of this industrial cluster and showed that the local population has not benefited from the decreasing polluting metal concentrations in the last decades.

Development and evaluation of physical properties of a low-cost handheld device for airway clearance therapy / Desenvolvimento e avaliação das propriedades físicas de um dispositivo portátil de baixo custo para higiene brônquica / Desarrollo y evaluación de propiedades físicas de un dispositivo portátil de bajo costo para la higiene bronquial

ABSTRACT Several respiratory diseases are characterized by hypersecretion, requiring airway clearance therapy (ACT). Oral high-frequency oscillation (OHFO) devices are effective to enable daily ACT; however, they are still too expensive to become available for low-income patients. We sought to develop a low-cost device (OHFO-LC) and compare its physical properties with those OHFO commercially available (Shaker and Flutter). The OHFO-LC was developed from polyvinyl chloride material and one stainless steel sphere. Pressures and frequencies were measured at flows of 4, 6, 8, 10 and 15L/min. Pressures at the mouthpieces were measured by a transducer connected to a microcomputer. The oscillation frequencies were obtained from the graph of the pressure. The frequencies and pressures were compared among groups using one-way Anova and Tukey's post hoc tests, p≤0.05. There were no differences among the frequencies of the three devices in all tested flows. The OHFO-LC device showed a higher positive expiratory pressure compared with the Shaker at all tested flows (4 L/min: 4.7±1.2 vs. 1.0±0.2 cmH2O; 6 L/min: 8.6±1.5 vs. 3.5±0.5 cmH2O; 8 L/min: 10.8±1.6 vs. 5.4±0.2 cmH2O; 10 L/min: 13.5±1.2 vs. 7.7±0.4 cmH2O; 15 L/min: 14.3±1.1 vs. 7.8±0.2 cmH2O; OHFO-LC vs. Shaker; p≤0.05) and at 10 and 15 L/min compared with Flutter (10 L/min: 13.5±1.2 vs. 7.5±1.2 cmH2O; 15 L/min: 14.3±1.1 vs. 8.2±1.2 cmH2O; OHFO-LC vs. Flutter, p≤0.05). The cost of the OHFO-LC device was much lower than both the Shaker and the Flutter. Our results showed that the OHFO-LC had physical properties with similar frequencies but higher pressures than other OHFO devices that are commercially available. Future studies are necessary to evaluate its clinical efficacy.

RESUMO Diversas doenças respiratórias são caracterizadas por hipersecreção com necessidade de higiene brônquica (HB). Osciladores orais de alta frequência (OOAF) são dispositivos que promovem HB diária; entretanto, seu custo pode ser inviável para aquisição por pacientes com baixa renda. Os objetivos deste estudo foram: desenvolver um OOAF de baixo custo (OOAF-BC) e comparar suas propriedades físicas com as dos disponíveis comercialmente (Shaker e Flutter). O OOAF-BC foi desenvolvido com material de polivinil clorido e uma esfera de aço inoxidável. As pressões e frequências foram mensuradas nos fluxos de 4, 6, 8, 10 e 15 L/min. As pressões nos bocais foram medidas por um transdutor conectado ao computador. As frequências de oscilação foram derivadas do gráfico de pressão. A comparação dos dispositivos foi feita por Anova com post hoc de Tukey, p≤0.05. Não houve diferença entre as frequências dos três dispositivos em todos os fluxos testados. O OOAF-BC apresentou pressão mais alta comparado ao Shaker em todos os fluxos testados (4 L/min: 4,7±1,2 vs. 1,0±0,2 cmH2O; 6 L/min: 8,6±1,5 vs. 3,5±0,5 cmH2O; 8 L/min: 10,8±1,6 vs. 5,4±0.2 cmH2O; 10 L/min: 13,5±1,2 vs. 7,7±0.4 cmH2O; 15 L/min: 14,3±1,1 vs. 7,8±0,2 cmH2O; OOAF-BC vs. Shaker; p≤0.05) e nos fluxos de 10 e 15 L/min comparado ao Flutter (10 L/min: 13,5±1,2 vs. 7,5±1,2 cmH2O; 15 L/min: 14,3±1,1 vs. 8,2±1,2 cmH2O; OOAF-BC vs. Flutter, p≤0.05). O custo do OOAF-BC foi pelo menos seis vezes menor. O OOAF-BC apresentou frequências similares e pressões mais altas que os outros OOAF comercialmente disponíveis. Estudos futuros são necessários para avaliar sua eficácia clínica.

RESUMEN Varias enfermedades respiratorias se caracterizan por hipersecreción, que requiere higiene bronquial (HB). Los osciladores orales de alta frecuencia (OOAF) son dispositivos que promueven la HB diaria; sin embargo, su costo puede no ser factible para la adquisición por parte de pacientes con bajos ingresos. Los objetivos de este estudio fueron desarrollar un OOAF de bajo costo (OOAF-BC) y comparar sus propiedades físicas con las de los disponibles comercialmente (Shaker y Flutter). El OOAF-BC se desarrolló con material de polivinilo clorado y una bola de acero inoxidable. Las presiones y frecuencias se midieron en flujos de 4, 6, 8, 10 y 15 L/min. Las presiones de la boquilla se midieron mediante un transductor conectado a la computadora. Las frecuencias de oscilación se derivaron del gráfico de presión. Se compararon los dispositivos con la utilización de Anova con post hoc de Tukey, p≤0,05. No hubo diferencias entre las frecuencias de los tres dispositivos en todos los flujos probados. El OOAF-BC mostró una presión más alta en comparación con Shaker en todos los flujos probados (4 L/min: 4,7±1,2 vs. 1,0±0,2 cmH2O; 6 L/min: 8,6±1,5 vs. 3,5±0,5 cmH2O; 8 L/min: 10,8±1,6 vs. 5,4±0,2 cmH2O; 10 L/min: 13,5±1,2 vs. 7,7±0,4 cmH2O; 15 L/min: 14,3±1,1 vs. 7,8±0,2 cmH2O; OOAF-BC vs. Shaker; p≤0,05) y con flujos de 10 y 15 L/min en comparación con Flutter (10 L/min: 13,5±1,2 vs. 7,5±1,2 cmH2O; 15 L/min: 14,3±1,1 vs. 8,2±1,2 cmH2O; OOAF-BC vs. Flutter, p≤0,05). El costo de OOAF-BC fue al menos seis veces menor. El OOAF-BC mostró frecuencias similares y presiones más altas que otros OOAF disponibles comercialmente. Se necesitan estudios futuros para evaluar su eficacia clínica.

Quantification of three DNA Lesions by Mass Spectrometry and Assessment of Their Levels in Tissues of Mice Exposed to Ambient Fine Particulate Matter.

DNA adducts and oxidized DNA bases are examples of DNA lesions that are useful biomarkers for the toxicity assessment of substances that are electrophilic, generate reactive electrophiles upon biotransformation, or induce oxidative stress. Among the oxidized nucleobases, the most studied one is 8-oxo-7,8-dihydroguanine (8-oxoGua) or 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo), a biomarker of oxidatively induced base damage in DNA. Aldehydes and epoxyaldehydes resulting from the lipid peroxidation process are electrophilic molecules able to form mutagenic exocyclic DNA adducts, such as the etheno adducts 1,N2-etheno-2'-deoxyguanosine (1,N2-εdGuo) and 1,N6-etheno-2'-deoxyadenosine (1,N6-εdAdo), which have been suggested as potential biomarkers in the pathophysiology of inflammation. Selective and sensitive methods for their quantification in DNA are necessary for the development of preventive strategies to slow down cell mutation rates and chronic disease development (e.g., cancer, neurodegenerative diseases). Among the sensitive methods available for their detection (high performance liquid chromatography coupled to electrochemical or tandem mass spectrometry detectors, comet assay, immunoassays, 32P-postlabeling), the most selective are those based on high performance liquid chromatography coupled to tandem mass spectrometry (HPLC-ESI-MS/MS). Selectivity is an essential advantage when analyzing complex biological samples and HPLC-ESI-MS/MS evolved as the gold standard for quantification of modified nucleosides in biological matrices, such as DNA, urine, plasma and saliva. The use of isotopically labeled internal standards adds the advantage of corrections for molecule losses during the DNA hydrolysis and analyte enrichment steps, as well as for differences of the analyte ionization between samples. It also aids in the identification of the correct chromatographic peak when more than one peak is present. We present here validated sensitive, accurate and precise HPLC-ESI-MS/MS methods that were successfully applied for the quantification of 8-oxodGuo, 1,N6-dAdo and 1,N2-dGuo in lung, liver and kidney DNA of A/J mice for the assessment of the effects of ambient PM2.5 exposure.

How urban characteristics affect vulnerability to heat and cold: a multi-country analysis.

BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

Workers of São Paulo city, Brazil, exposed to air pollution: Assessment of genotoxicity.

Air pollution affects all major urban centers, particularly megacities with populations greater than 10 million people. Vehicular and industrial emissions are among the most important sources of air pollutants in these cities. Air pollution composition, dose, and time of exposure can cause differential effects on human health. We have evaluated the genotoxic effects of air pollution (PM2.5 and NO2) on São Paulo city workers. Fifty-seven male individuals, 28-66 years old, with occupational exposure to air pollution, participated in this study; all worked daily outdoor shifts in São Paulo. Participants were recruited from three occupations: traffic controllers (n = 18); taxi drivers (n = 21); and workers at the Forestry Institute (n = 18). These workers were classified into two groups based on their workplace locations: Downtown Group (DT): traffic controllers and taxi drivers; Outskirts of Town Group (OT): workers at the Forestry Institute. Individual samplers of air pollution (Harvard air impactor) were used to collect PM2.5 and NO2 pollutants. Genotoxicity analysis (micronucleus test) was performed on buccal mucosa epithelial cells and peripheral blood lymphocytes. PM2.5 concentrations were significantly different between the groups (DT = 32.92 µg m-3, OT = 25.77 µg m-3; p = 0.03); however, no difference was observed in NO2 concentrations. Micronucleus frequencies in both buccal mucosa (DT = 2.78%, OT = 1.16%; p < 0.0001) and in peripheral lymphocytes (DT = 1.51%, OT = 0.73%; p < 0.0001) were significantly different between the groups. We observed a direct correlation between the individual dose of PM2.5 and micronucleus frequency in the buccal mucosa (p = 0.0021). Our results indicate that workers in the most urban areas of São Paulo are exposed to higher concentrations of PM2.5 and showed higher micronucleus frequencies in both buccal mucosa and lymphocytes.

Gastos públicos com saúde: breve histórico, situação atual e perspectivas futuras / Public expenditure on health: brief history, current situation and future prospects

Apesar dos marcantes avanços de nosso sistema de saúde pública, hoje sintetizado em apenas três letras - SUS -, há ainda um grande caminho a percorrer para prover as condições de preservar a saúde da população do nosso Brasil. Neste texto abordamos de maneira despretensiosa conquistas e programas exitosos do SUS, mazelas do financiamento e má gestão, os desafios futuros e princípios que devem nortear as ações para alcançarmos um patamar mais eficiente de atenção à Saúde.(AU)

Despite the remarkable progress of the Brazilian public health system, nowadays better known by the acronym SUS (Sistema Único de Saúde), there is still a long way to go to ensure conditions to preserve the health of the Brazilian population. In this text, we unassumingly report the achievements and successful programs of SUS, the problems of financing and mismanagement, and the future challenges and principles that should guide actions to achieve more efficient health care in Brazil.(AU)

Como as cidades podem favorecer ou dificultar a promoção da saúde de seus moradores? / How cities can promote or hinder the promotion of health of its residents?

Morar próximo a um parque pode reduzir o risco de infarto do miocárdio, enquanto a exposição à poluição do ar ambiente aumenta o risco. Evidências associam a exposição crônica ao ruído do tráfego ao ganho de peso. Em 2014, mais de mil pessoas morreram no trânsito de São Paulo. No entanto, recomendar que as pessoas fiquem em casa com as janelas fechadas é inviável. A adoção de hábitos saudáveis é favorecida ou dificultada pelo ambiente construído e pelo modo como a cidade está organizada. Além disso, alguns fatores de risco para doenças, como a exposição à poluição do ar, vão além de escolhas individuais e dependem, em grande parte, de ações governamentais. Neste artigo discutimos os aspectos que podem favorecer ou dificultar a promoção da saúde nas cidades, a partir dos tópicos propostos por Rydin et al. (2012)...

Living near a park can reduce the risk for myocardial infarction, while exposure to outdoor air pollution increases it. There is evidence associating chronic exposure to traffic noise and weight gain. In 2014, more than one thousand people died in the São Paulo’s traffic. However, recommending that people stay home with the windows closed is unfeasible. The adoption of healthy habits is aided or hindered by the man-made environment and by how the city is organized. Moreover, some risk factors for disease, such as exposure to air pollution, are beyond individual choices and call for governmental actions. In this paper, we discuss features that may aid or hinder the promotion of health in the city, based on a framework proposed by Rydin et al. (2012)...

Projeção da mortalidade e internações hospitalares na rede pública de saúde atribuíveis à poluição atmosférica no Estado de São Paulo entre 2012 e 2030 / Forecasting of mortality and hospital admissions from public healthcare attributable to air pollution in State of São Paulo between 2011 and 2030 / /Proyección de la mortalidad y las admisiones hospitalarias en la red pública de salud atribuibles a la contaminación atmosférica en el Estado de São Paulo entre 2011 y 2030

No Brasil, os padrões nacionais de qualidade do ar são da década de 1990, desatualizados em relação aos internacionais, o que dificulta um controle eficaz dos níveis de poluição e contribui para a continuidade de mortes e internações. A fim de quantificar o montante de desfechos desfavoráveis de saúde em decorrência da concentração de material particulado no Estado de São Paulo, esse trabalho tem como objetivo realizar projeções de mortes, internações e gastos com internações públicas atribuíveis à poluição atmosférica, para o período de 2012 a 2030. Para isso foram considerados distintos cenários de poluição por material particulado fino (MP2,5), tomando-se como referência o ano-base 2011. Os resultados mostram que, mantendo o mesmo nível de poluição observado em 2011, haverá um total de mais de 246 mil óbitos por todas as causas entre 2012 e 2030, cerca de 953 mil internações hospitalares públicas e um gasto público estimado em internações de mais de R$ 1,6 bilhão. A magnitude dos resultados aponta para a necessidade de implementação de medidas mais rigorosas para o controle da poluição do ar, formas alternativas de energia limpa de transporte, entre outras ações, como forma de reduzir os danos à saúde da população e os gastos governamentais...

Abstract National air quality standards in Brazil were established in the 1990s and are now outdated in relation to international patterns. This creates a challenge for effective control of air pollution levels and contributes to increasing mortality and hospital admissions rates. In order to quantify the impact of adverse health outcomes due to the concentration of particulate matter in São Paulo, this paper aims to project the number of deaths, hospitalizations and amounts spent on public hospital admissions from 2012 to 2030. It considers distinct scenarios of air pollution by fine particulate matter (PM2.5), using the year 2011 as baseline. The results show that if air pollution continues at the current levels, it will cause more than 246 thousand deaths from all causes between 2011 and 2030, as well as some 953 thousand hospital admissions and an estimated public health cost of R$ 1.6 billion due to hospitalizations. The magnitude of these results demonstrates the need to implement more rigorous measures to control air pollution and to encourage clean energy transportation, among other public actions, in order to reduce damage to the health of the population and to diminish government spending...

Resumen En Brasil, los estándares nacionales de calidad del aire datan de la década de 1990, es decir, están obsoletos en comparación con las normas internacionales, lo que dificulta un control eficaz de los niveles de contaminación y contribuye a la continuidad de las muertes y hospitalizaciones ocasionadas por esta razón. Con el fin de cuantificar el total de los resultados adversos para la salud debidas a la concentración de material particulado en el Estado de São Paulo, este trabajo tiene como objetivo realizar proyecciones de muertes, hospitalizaciones y gastos por internaciones en hospitales públicos atribuibles a la polución atmosférica en el período comprendido entre 2012 y 2030. Para ello se han considerado distintos escenarios de contaminación por material particulado fino (MP2,5), tomando como referencia el año base 2011. Los resultados muestran que, manteniendo el mismo nivel de contaminación observado en esa fecha, habrá un total de más de 246.000 muertes por todas las causas entre 2011 y 2030, alrededor de 953.000 ingresos hospitalarios en el sistema público de salud y un gasto público por internaciones estimado en más de R$ 1,6 billones. La magnitud de los resultados pone en evidencia la necesidad de implementar medidas más rigurosas para el control de la contaminación del aire, formas alternativas de transporte con energía limpia, entre otras acciones, con el fin de reducir los daños a la salud de la población y los gastos del gobierno...

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.

Impact of outdoor biomass air pollution on hypertension hospital admissions.

BACKGROUND: This study aimed to evaluate the association between the total suspended particles (TSP) generated from burning sugar cane plantations and the incidence of hospital admissions from hypertension in the city of Araraquara. METHODS: The study was an ecological time-series study. Total daily records of hypertension (ICD 10th I10-15) were obtained from admitted patients of all ages in a hospital in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (microg/m(3)) was obtained using a Handi-Vol sampler placed in downtown Araraquara. The local airport provided daily measures of temperature and humidity. In generalised linear Poisson regression models, the daily number of hospital admissions for hypertension was considered to be the dependent variable and the daily TSP concentration the independent variable. RESULTS: TSP presented a lagged effect on hypertension admissions, which was first observed 1 day after a TSP increase and remained almost unchanged for the following 2 days. A 10 microg/m(3) increase in the TSP 3 day moving average lagged in 1 day led to an increase in hypertension-related hospital admissions during the harvest period (12.5%, 95% CI 5.6% to 19.9%) that was almost 30% higher than during non-harvest periods (9.0%, 95% CI 4.0% to 14.3%). CONCLUSIONS: Increases in TSP concentrations were associated with hypertension-related hospital admissions. Despite the benefits of reduced air pollution in urban cities achieved by using ethanol produced from sugar cane to power automobiles, areas where the sugar cane is produced and harvested were found to have increased public health risk.

Avaliação antropométrica e consumo alimentar em crianças menores de cinco anos residentes em um município da região do semiárido nordestino com cobertura parcial do programa bolsa família / Anthropometric assessment and food intake of children younger than 5 years of age from a city in the semi-arid area of the Northeastern region of Brazil partially covered by the bolsa família program

OBJETIVO: Avaliar as condições de saúde e nutrição de crianças menores de cinco anos, e associar a qualidade do consumo alimentar aos beneficiários do Programa Bolsa Família de um município do semiárido brasileiro. MÉTODOS: Foram avaliadas 189 crianças, a partir de uma amostragem de 411 domicílios do município de João Câmara (RN). Foram realizadas medidas de peso e altura, e levantadas às condições socioeconômicas e determinação dos hábitos alimentares. Para o diagnóstico nutricional das crianças foram utilizados os indicadores Peso/Idade, Altura/Idade e Peso/Altura. Análises univariadas foram realizadas e modelos bivariados e multivariados de regressão logística foram construídos para testar a hipótese do estudo. RESULTADOS: O déficit de peso foi de 4,3 por cento e o de altura de 9,9 por cento, e o excesso de peso de 14,0 por cento. Não foram encontradas diferenças estatísticas entre o estado nutricional de crianças beneficiárias e não beneficiárias do Programa Bolsa Família. Em ambos os grupos, os consumos de frutas, verduras e legumes foram baixos e semelhantes entre si. As crianças do programa bolsa família têm risco três vezes maior de consumir guloseimas (OR 3,06 - IC 1,35-6,95). CONCLUSÃO: Os resultados do padrão de consumo alimentar dessa população apontam para uma situação de "risco alimentar e nutricional", e exigem uma intervenção por parte dos profissionais de saúde para a promoção da alimentação saudável.

OBJECTIVE: The objective of this study was to assess the health and nutritional status of children under five years of age and to associate the quality of the foods consumed with the Bolsa Família Program in a city located in the Brazilian semi-arid region. METHOD: A total of 189 children from a sample of 411 households in the city of João Câmara (RN) were assessed. Weight and height were measured and socioeconomic and food habits were determined with the use of questionnaires. The nutritional status of the children was determined with the weight-for-age, height-for-age and weight-for-height indicators. Univariate analyses were done and bivariate and multivariate logistic regression models were constructed to test the hypothesis of the study. RESULTS: Of the studied children, 4.3 percent were underweight, 9.9 percent were stunted and 14.0 percent were overweight. The nutritional status of children whose families receive the Bolsa Família financial aid was not significantly different from those whose families do not receive the aid. In both groups, the consumption of fruits and non-starchy vegetables was low and similar. Children from families who receive the aid were 3 times more likely to eat junk food (OR 3.06 - CI 1.35-6.95). CONCLUSION: The food intake patterns of this population indicate that they are at food and nutritional risk. Health professionals need to intervene in order to promote healthier eating habits.

Avaliação da deposição de colágeno após implante de fáscia lata e de gordura na prega vocal de coelho: estudo histomorfométrico / Assessment of collagen deposits after implant of fascia lata and fat in the vocal folds of rabbits: histomorphometric study

Vários materiais têm sido injetados ou inseridos em pregas vocais na tentativa de solucionar a incompetência glótica. Contudo, poucos são os estudos que avaliam o processo cicatricial decorrente da enxertia destes materiais. Objetivo: O objetivo desta pesquisa foi avaliar a concentração de colágeno após enxerto microcirúrgico de fáscia muscular e gordura na prega vocal de coelho. Forma de estudo: experimental. Material e Método: Dezenove coelhos foram submetidos à inserção de enxerto na prega vocal direita, sendo nove de fáscia e dez de gordura. A prega vocal esquerda foi submetida ao mesmo procedimento, sem enxertia. Os coelhos foram sacrificados após 90 e 180 dias. O colágeno foi analisado morfometricamente através do método da Picrossírius-polarização com a utilização do software Image Pro Plus. Resultados: Houve aumento do colágeno em todos grupos enxertados quando comparados com o grupo controle. A concentração do colágeno encontrada nos coelhos submetidos a enxerto de gordura foi significativamente maior quando comparados à concentração do colágeno nos coelhos submetidos a enxerto de fáscia muscular, tanto com 90 quanto com 180 dias. Conclusão: A enxertia de gordura e fáscia lata na prega vocal de coelho promoveu maior deposição de colágeno do que no grupo controle, sendo mais exuberante na inserção de gordura.

Several materials have been injected or introduced in the vocal folds in attempt of solving the glottic insufficiency. However, few studies have evaluated the cicatricial process due to the implantation of these materials. Aim: The objective of this research was to evaluate the concentration of collagen after microsurgery graft of muscular fascia and fat in the vocal folds of rabbit. Study design: experimental. Material and Method: Nineteen rabbits were submitted to the graft insert in the right vocal fold, being nine of fascia and ten of fat. The left vocal fold was submitted to the same process, except for the insertion of fat or fascial graft. The rabbits were sacrificed after 90 and 180 days. The collagen was analyzed through the method of the Picrosirius-polarization using the Image Pro Plus software. Results: There was prevalence of the collagen in all grafted groups when compared with the group control. The concentration of the collagen found in the rabbits submitted to fat graft was significantly larger when compared to the concentration of the rabbits submitted to graft of muscular fascia, either with 90 as with 180 days. Conclusion: The fat and muscular fascia implantation in the vocal folds of rabbit promoted production of collagen, being more intense with fat.

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.

Assessment of collagen deposits after implant of fascia lata and fat in the vocal folds of rabbits: histomorphometric study.

UNLABELLED: Several materials have been injected or introduced in the vocal folds in attempt of solving the glottic insufficiency. However, few studies have evaluated the cicatricial process due to the implantation of these materials. AIM: The objective of this research was to evaluate the concentration of collagen after microsurgery graft of muscular fascia and fat in the vocal folds of rabbit. STUDY DESIGN: experimental. MATERIAL AND METHOD: Nineteen rabbits were submitted to the graft insert in the right vocal fold, being nine of fascia and ten of fat. The left vocal fold was submitted to the same process, except for the insertion of fat or fascial graft. The rabbits were sacrificed after 90 and 180 days. The collagen was analyzed through the method of the Picrosirius-polarization using the Image Pro Plus software. RESULTS: There was prevalence of the collagen in all grafted groups when compared with the group control. The concentration of the collagen found in the rabbits submitted to fat graft was significantly larger when compared to the concentration of the rabbits submitted to graft of muscular fascia, either with 90 as with 180 days. CONCLUSION: The fat and muscular fascia implantation in the vocal folds of rabbit promoted production of collagen, being more intense with fat.