Spatial analysis of measles vaccination coverage in the State of São Paulo.

BACKGROUND: Measles is a contagious viral disease that seriously affects children. The measles vaccine is widely recommended in Brazil and in the world; however, the disease remains relevant for the health authorities. The aim of the present study was to evaluate first and second dose of measles vaccine coverage (VC) in the cities of São Paulo and its spatial dynamics between 2015 and 2020. METHOD: In this mixed-type ecological study, we used secondary, public domain data from 2015 to 2020, extracted from the Digital Information System of the National Immunization Program, Mortality Information System and the National Live Birth Information System. After calculating the VC, the following four categories were created: very low, low, adequate, and high, and the spatial autocorrelation of VC was analyzed using the Global and Local Moran's statistics. RESULTS: A steady decline in adherence to the vaccination was observed, which dynamically worsened until 2020, with a high number of cities fitting the classification of ineffective coverage and being potentially harmful to the effectiveness of the immunization activities of their neighbors. CONCLUSION: A direct neighborhood pattern was observed between the units with low vaccination coverage, which implied that the reduction in measles VC was somehow related to and negatively influenced by the geographic location and social culture of these areas.

Spatial analysis of vaccine coverage on the first year of life in the northeast of Brazil.

BACKGROUND: Over time, vaccination has been consolidated as one of the most cost effective and successful public health interventions and a right of every human being. This study aimed to assess the spatial dynamics of the vaccine coverage (VC) rate of children aged < 1 year per municipality in the Brazilian Northeast at 2016 and 2017. METHODS: This is a mixed-type ecological study that use a Public domain data Health Information. Vaccine doses were obtained from the Information System of the Brazilian National Immunization Program, and live births from the Brazilian Information System of Live Births of the Brazilian Unified Health System. Descriptive analysis of the coverage of all the vaccines for each year of the study was conducted, and Mann-Whitney U test was used to compare VC between the study years. Chi-squared test was used to evaluate the association between the years and VC, which was stratified into four ranges, very low, low, adequate, and high. Spatial distribution was analyzed according to both each study year and vaccine and presented as thematic maps. Spatial autocorrelation was analyzed using Moran's Global and Local statistics. RESULTS: Compared with 2017, 2016 showed better VC (p < 0.05), except for Bacillus Calmette-Guérin. In the spatial analysis of the studied vaccines, the Global Moran's Index did not show any spatial autocorrelation (p > 0.05), but the Local Moran's Index showed some municipalities, particularly the Sertão Paraibano region, with high VC, high similarity, and a positive influence on neighboring municipalities (p < 0.05). In contrast, most municipalities with low VC were concentrated in the Mata Paraibano region, negatively influencing their neighbors (p < 0.05). CONCLUSION: Uneven geographic regions and clusters of low VC for children aged < 1 year in the State of Paraíba were spatially visualized. Health policy makers and planners need to urgently devise and coordinate an action plan directed at each state's regions to fulfill the vaccination calendar, thereby reversing the vulnerability of this age group, which is at a higher risk of diseases preventable by vaccination.

Use of health services by the population living in contaminated areas in the region of the Santos and São Vicente estuarine system, Brazil.

Objective: To relate the socio-demographic profile with access to health services of the population living in environmentally degraded areas in an estuary region.Study design: A sectional field study of 8819 people, evaluating three contaminated areas of São Vicente.Methods: Households were divided by studied area. A structured and pre-tested questionnaire was applied to obtain the data. A probabilistic sample was used. The prevalence of each of the outcomes of interest by area was calculated. To verify the existence of an association between the outcomes of interest and other variables (qualitative), by area, a descriptive analysis and to compare percentages and a comparison test was used between two proportions, a Chi-square test and/or a Fisher's exact test and a Kruska-wallis and Dunn multiple comparison were used as well. The significance level was 5%.Results: Most residents (94%) reported the use of public health services at least once a year (p < 0.001), mainly through the Basic Health Units (BHU) (p < 0.001). Most of the studied population (65%) did not have private health insurance and their schooling was basically restricted to primary education (p < 0.001). The predominant family income (70%) in the three areas was between one and five minimum wages (p < 0.001), with a higher incidence of people receiving one to three minimum wages at the time. The demand for health services was not associated with education or income.Conclusion: The population of the regions analysed heavily rely on the Unified Health System - SUS, but there was no association between income and frequency of health services and there was also no association between education and use of health services.

Spatial analysis of vaccine coverage in children under the age of 1 year by mesoregions in Paraíba a northeastern Brazilian state.

Immunization is one of the most effective measures in public health, and it is responsible for the reduction of vaccine-preventable diseases. In the present study, vaccine coverage (VC) and the spatial dynamics of homogeneity of VC (HVC) were compared and analyzed in the terms of the immunobiologicals administered to children aged < 1 year in a state in Paraíba, Brazil. This is a mixed ecological study that used public-domain secondary data from the years 2016 and 2017 from the Information System of the Brazilian National Immunization Program (SI-PNI) and the Brazilian National Information System of Live Births (SINASC). VC rates were calculated by dividing the number of administered doses by the number of live births. Then, VC was classified into four categories. The Municipal HVC was considered adequate when the overall VC exceeds 75%. The study included a descriptive analysis and a spatial autocorrelation analysis for HVC using global and local Moran's statistics. The stratified VC analysis revealed a significant number of municipalities in each of the state's mesoregions with low or very low VC rates for all immunobiologicals, with the Mata Paraibana mesoregion having the worst percentages in both years studied. The spatial analysis of HVC revealed several clusters of inadequate homogeneity, with Mata Paraibana being the worst mesoregion in 2016. The analysis of spatial dynamics and spatial statistics techniques allows the precise identification of vulnerable areas, "vaccination pockets," making it possible to develop plans aimed at meeting the targets of the PNI.

Ambient levels of air pollution induce clinical worsening of blepharitis.

BACKGROUND: Even though air pollutants exposure is associated with changes in the ocular surface and tear film, its relationship to the clinical course of blepharitis, a common eyelid disease, had not yet been investigated. Our objective was to investigate the correlation between air pollution and acute manifestations of blepharitis. METHOD: We recorded all cases of changes in the eyelids and ocular surface, and rated clinical findings on a scale from zero (normal) to two (severe alterations). Daily values of carbon monoxide, particulate matter smaller than 10 µm in diameter and nitrogen dioxide concentrations and meteorological variables (temperature and relative humidity) in the vicinity of the medical service were obtained. Specific linear regression models for each outcome were constructed including pollutants as independent variables (single pollutant models). Temperature and humidity were included as confounding variables. RESULTS: increases of 28.8 µg/m(3) in the concentration of particulate matter and 1.1 ppm in the concentration of CO were associated with increases in cases of blepharitis on the day of exposure (5 cases, 95% CI: 1-10 and 6 cases, 95% CI: 1-12, respectively). CONCLUSION: Exposure to usual air pollutants concentrations present in large cities affects, in a consistent manner, the eyes of residents contributing to the increasing incidence of diseases of the eyelid margin.

Self-reported prevalence of asthma symptoms in adults living in a port city.

Air pollution is a worldwide health problem, and exposure to the pollution can cause damage to the human body, especially to the respiratory and cardiovascular systems. Asthma is the third most common chronic disease in Brazil, presenting high prevalence in some areas. The aim of this study was to evaluate the self-report the prevalence of asthma symptoms in Santos city, Brazil, and its associated factors in the adult population (between 18 and 59 years old). A cross-sectional study was applied in two different areas of the city. The participants of this study were selected by zip code estimated on a random sample. The ECHRS and a demographic questionnaire were used to collect data. Associations between categorical variables were tested using Pearson's chi-square test or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for asthma. Georeferencing was implemented to distribute the cases. The highest prevalence of asthma was found in Ponta da Praia neighborhood (16.4%; p=0.019), as well as waking up with a coughing crisis in the last 12 months (26.4%; p <0.001). The risk factors for asthma were the following: living next Santos Port area (OR: 2.90; 95%CI 1.13-7.44); and the presence of O3 (OR = 2.63; 95%CI 0.86-7.96). This pioneering study demonstrated that living near the port area increases the chances of adults having self-reported asthma symptoms.

Association between high-risk pregnancy and environmental contaminants in the Metropolitan Region of Baixada Santista, Brazil.

The Metropolitan Region of Baixada Santista (MRBS) is a highly contaminated area. High-risk pregnancy is one factor that leads to a higher chance of both morbidity and mortality of the mother-fetus binomial. The purpose of this study is to analyze the association between exposure to environmental contaminants and high-risk pregnancy. Case-control study, using a probabilistic and random sample composed of 201 high-risk pregnant women (cases) and 201 no high-risk pregnant women (control) followed up during prenatal care at a Public Hospital. The instrument used was a self-administered questionnaire. Contaminated areas data were obtained from the Environmental Company of the São Paulo State. The participants were georeferenced by their place of residence. Descriptive analysis, Chi-square test, and univariate and multiple logistic regression analysis were performed. The multiple logistic regression model demonstrated that living in a contaminated area (OR = 1.565; 95%CI: 1.033; 2.370), preterm delivery in the current pregnancy (OR = 1.989; 95%CI: 1.239; 3.194), and more than 35 years old (OR = 2.822; 95%CI: 1.692; 4.706) are factors jointly related to high-risk pregnancy. Environmental contaminants play an important role in high-risk pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy.

Breast cancer in the Baixada Santista region and its relationship to contaminated areas.

The aim of this study was to analyze the temporal distribution of breast cancer and its relationship with contaminated areas in the Baixada Santista metropolitan region, São Paulo. It is an ecological study on the distribution of breast cancer in the municipalities of the region as well as in regions exposed to environmental contaminants. The population consisted of women aged 20 years and over, totaling 3233 cases in the 12 years of the study. First, we calculated the total annual breast cancer coefficients by municipality, then we standardized by age and the indicator of contamination density by municipality. We then performed cartographic sequencing that revealed the evolution of outcome and exposure. The results showed that the municipality of Santos presented a higher coefficient of the disease. Pearson's correlation was positive with r = 0.7 at a significance level of p = 0.036. Spatially, the most contaminated areas presented higher breast cancer coefficients, except for the municipality of Peruíbe, which despite its low environmental contamination index, presented a high disease coefficient. This study confirmed the hypothesis that environmental contamination affects breast cancer distribution, and the temporal trend shows an increase in the disease in eight of the nine municipalities in the region.

Importance of epidemiological surveillance of leprosy: analysis of the occurrence of leprosy in intra-domiciliary contacts in a capital in the Brazilian northeast region.

INTRODUCTION: Intra-domiciliary contacts are a group with the highest risk of developing leprosy. METHODS: A cross-sectional study of intra-domiciliary contacts of new leprosy cases was conducted. A descriptive analysis of the variables was performed. RESULTS: Among 190 contacts, 63% were invited to visit the health unit, and 54.2% received the BCG vaccine. The prevalence of leprosy among the contacts was 4.7%. CONCLUSIONS: The occurrence of leprosy among the contacts was high and similar to that found previously. There were failures in surveillance actions carried out by health units. Never-before treated cases were found.

Relationship between air pollution and hospitalizations for congestive heart failure in elderly people in the city of São Paulo.

To evaluate the effects of air pollutants on hospitalizations of elderly people for congestive heart failure (CHF) in the city of São Paulo, stratified by sex, exploring lag structures, from 2000 to 2013. Ecological time series study using information on hospitalization of elderly patients for CHF (ICD-10th: I50) obtained from DATASUS for the city of São Paulo. Information on O3, PM10, NO2, SO2, CO, temperature and humidity was obtained from CETESB. Descriptive analyses, Pearson correlation, and generalized linear Poisson regression model were applied to estimate the effects of pollutants. The interquartile variations of O3 (52.45 µg/m3), PM10 (24.28 µg/m3), NO2 (7.63 µg/m3), SO2 (50.22 µg/m3), and CO (1.28 ppm) were associated with increased hospitalizations for CHF. Air pollutants continue to be a factor that contributes to the increase in the number of hospitalizations due to CHF.

[Professional or household performance of patients with breast cancer undergoing chemotherapy]. / Desempenho profissional ou doméstico das pacientes em quimioterapia para câncer de mama.

OBJECTIVES: Evaluate patients with breast cancer undergoing chemotherapy with respect to their epidemiologic and clinical variables as well as performance at work or at home. METHODS: this was a cross-sectional study including 52 women interviewed during breast cancer chemotherapy, stratified in two groups: those who continued to work and do household tasks, and did not continue to work or do household tasks. Patients were from two public hospitals in the State of São Paulo, one in Santo Andre and the other in São Bernardo do Campo. The WPAI - GH (Work Productivity and Activity Impairment) questionnaire was used to evaluate work and household performance of professionals or housewives, respectively. RESULTS: Mean age of the patients was 55.7 (SD=13.8), most were Caucasian (88.5%), married (55.8%), employed (65.3%) and the majority had to stop working because of treatment (51.0%), at more advanced stage (p<0.05), fatigue and nausea (p<0.05). Mean WPAI - GH was 67.04 (|SD = 5.62) for patients who stopped working and 49.17 (SD = 6.89) for those who continued to work (Mann-Whitney U test: p = 0.04). CONCLUSION: Chemotherapy leads to a decrease in performance of a sizable fraction of women with breast cancer undergoing chemotherapy. A more advanced stage of neoplasia was positively associated with withdrawal from these activities probably due to side effects such as fatigue and nausea.

Análise espacial da tuberculose e sua relação com fatores socioeconômicos na Paraíba: um estudo ecológico / Spatial analysis of tuberculosis and its relationship with socioeconomic factors in Paraíba: an ecological study

OBJETIVO: Analisar a distribuição espacial da tuberculose e sua associação com fatores socioeconômicos. MÉTODO: Estudo ecológico, misto, com análise espacial dos casos de tuberculose no estado da Paraíba, notificados no período de 2015 a 2018. RESULTADOS: Foram notificados 6.082 casos, com incidência média de 37,4/100 mil habitantes. Nenhum município foi classificado com desenvolvimento "muito baixo", embora exista significância estatística entre as taxas de incidência e os fatores socioambientais. CONCLUSÃO: O índice de Moran apontou autocorrelação positiva entre as áreas com altas incidências. O Moran Map releva clusters que indicam concentração da infecção entre a Zona da Mata e o Agreste Paraibano, sendo o maior deles formado por 19 municípios.

OBJECTIVE: To analyze the spatial distribution of tuberculosis and its association with socioeconomic factors. METHOD: A mixed-methods ecological study with spatial analysis of tuberculosis cases in the state of Paraíba, reported from 2015 to 2018. RESULTS: A total of 6,082 cases were reported, with a mean incidence of 37.4/100,000 inhabitants. No municipality was classified as having "very low" development, although statistical significance exists between the incidence rates and the socioenvironmental factors. CONCLUSION: The Moran Index pointed out a positive autocorrelation between areas with high incidence values. The Moran Map reveals clusters that indicate a concentration of the infection between Zona da Mata and Agreste Paraibano, the largest of which comprises 19 municipalities.

Evaluation of peak expiratory flow in adolescents and its association with inhalable particulate in a Brazilian medium-sized city.

INTRODUCTION: High particulate matter (PM10) concentrations are associated with increased incidence of respiratory symptoms and decreased lung function. This study evaluates the air pollution effects in children's and adolescents' lung function using peak expiratory flow (PEF) measurements over a given period, in an area exposed to industrial emissions. METHODOLOGY: This was a panel study. The effects of air pollution on respiratory symptoms and PEF were investigated in 117 children and adolescents from three public schools in areas of exposure to air pollution from a mining company in a Brazilian medium-sized city, from 2008 to 2009. The average daily PM10, temperature and humidity were recorded by the monitoring network in the region. Association between daily records of PEF and PM10 was assessed in mixed-effect regression models, controlling for temperature, humidity, and body mass index. RESULTS: About 60,000 PEF measurements were performed. Increases of 14µg/m3 in PM10 were associated with decreased PEF in the morning (-1.04%, 95%CI -1.32; -0.77) and evening (-1.2%, 95%CI -1.49, -0.92). DISCUSSION: We found a significant negative association between particulate matter and peak expiratory flow rate in this population, and these remained significant even after adjusted for temperature, humidity, body mass index, coughing, wheezing and coryza. CONCLUSION: Adverse effects were found and it suggests an association between increase in PM10 and reduced lung function.

Air pollution from biomass burning and asthma hospital admissions in a sugar cane plantation area in Brazil.

OBJECTIVE: To evaluate the association between the total suspended particles (TSPs) generated from preharvest sugar cane burning and hospital admission due to asthma (asthma hospital admissions) in the city of Araraquara. DESIGN: An ecological time-series study. Total daily records of asthma hospital admissions (ICD 10th J15) were obtained from one of the main hospitals 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 Handi-vol equipment (Energética, Brazil) placed in downtown Araraquara. The local airport provided the daily mean figures of temperature and humidity. The daily number of asthma hospital admissions was considered as the dependent variable in Poisson's regression models and the daily concentration of TSP was considered the independent variable. The generalised linear model with natural cubic spline was adopted to control for long-time trend. Linear terms were used for weather variables. RESULTS: TSP had an acute effect on asthma admissions, starting 1 day after TSP concentrations increased and remaining almost unchanged for the next four days. A 10 microg/m(3) increase in the 5-day moving average (lag1-5) of TSP concentrations was associated with an increase of 11.6% (95% CI 5.4 to 17.7) in asthma hospital admissions. CONCLUSION: Increases in TSP concentrations were definitely associated with asthma hospital admissions in Araraquara and, despite using sugar cane alcohol to reduce air pollution from automotive sources in large Brazilian urban centres, the cities where sugar cane is harvested pay a high toll in terms of public health.

CA72-4 antigen levels in serum and peritoneal washing in gastric cancer. Correlation with morphological aspects of neoplasia.

BACKGROUND: Determining levels of tumor markers in peritoneal washing enables likelihood of peritoneal recurrence to be ascertained in patients with high marker levels, thereby allowing provision of more accurate adjuvant treatment and postoperative follow up. AIM: To analyze the relationship between levels of tumor marker CA72-4 in serum and peritoneal washing, and morphological aspects of gastric carcinoma. METHOD: This study analyzed 32 consecutively-operated patients with gastric carcinoma, who underwent subtotal, total or palliative gastrectomy. The variables studied were CA72-4 levels in serum and peritoneal washing, lesion site, stage, degree of cell differentiation, operation performed, and number of extirpated and involvement lymph nodes. Of the 32 patient sample, 21 (65.6%) were male and 11 (34.4%) female. Mean age was 62.6 +/- 14.2 years (29 to 91 years). Following anesthetic induction, peripherical venous blood was collected through percutaneous punction of an upper limb vein. After the procedure, 50 mL of physiologic solution at 37 degrees C was introduced into the cul-de-sac. A 10 mL volume of this liquid was aspirated from the cavity and the peritoneal washing tested for CA72-4 levels. Normal values for CA72-4 levels in serum were considered < or =7 U/mL and high levels as >7 U/mL, whilst for the peritoneal washing normal levels were < or =0.61 U/mL, and abnormal >0.61 U/mL. RESULTS: Mean pre-operative serum levels for CA72-4 were 6.55 U/mL +/- 15.30 (0.3 to 75.30 U/mL) whilst the mean level of CA72-4 in peritoneal washing was 8.50 U/mL +/- 26.72 (0.3 to 142.00 U/mL); correlation between these levels was significant. Lymph nodes involvement by the gastric carcinoma correlated significantly with higher CA72-4 levels in both serum and peritoneal wash. There was no statistically significant correlation between serum level of CA72-4 and invasion into serosa by the gastric carcinoma. There was however, significant correlation between peritoneal washing levels of CA72-4 and involvement of serosa by gastric carcinoma. There was also a significant correlation between more advanced stages of gastric carcinoma and higher levels of CA72-4 in the peritoneal washing, although serum levels of CA72-4 and more advanced stage of gastric neoplasia showed no significant correlation. Degrees of cellular differentiation in the gastric carcinoma did not differ significantly with CA72-4 levels in serum or peritoneal washing. CONCLUSION: High levels of CA72-4 in peritoneal washing correlated significantly with lymph node metastasis and serosa involvement by the neoplasia, and also with more advanced stage of gastric carcinoma. The levels of CA72-4 in the blood correlated significantly with lymph node involvement by the gastric carcinoma, but not with serosa invasion or more advanced stage of neoplasia.

Air pollution and low birth weight in an industrialized city in Southeastern Brazil, 2003-2006.

INTRODUCTION:: Birth weight is an important indicator of several conditions that manifest earlier (as fetal and neonatal mortality and morbidity, inhibited growth and cognitive development) and later in life such as chronic diseases. Air pollution has been associated with adverse pregnancy outcomes. OBJECTIVE:: Retrospective cohort study investigated the association between low birth weight (LBW) and maternal exposure to air pollutants in Volta Redonda city, Rio de Janeiro, Brazil, from 2003 to 2006. METHODS:: Birth data was obtained from Brazilian Information System. Exposure information (O3, PM10, temperature and humidity) was provided by Governmental Air Quality Monitoring System. Linear and Logistic models, adjusted for sex, type of pregnancy, prenatal care, place of birth, maternal age, parity, education, congenital anomalies and weather variables were employed. RESULTS:: Low birth weight (LBW) represented 9.1% of all newborns (13,660). For an interquartile range increase in PM10 it was found OR2 ndTrimester = 1.06 (95%CI 1.02 - 1.10), OR3 rdTrimester = 1.06 (95%CI 1.02 - 1.10) and, in O3 it was found OR2 ndTrimester = 1.03 (95%CI 1.01 - 1.04), OR3 rdTrimester = 1.03 (95%CI 1.02 - 1.04). The dose-response relationship and a reduction in birth weight of 31.11 g (95%CI -56.64 - -5.58) was observed in the third trimester of pregnancy due to an interquartile increase of O3. CONCLUSION:: This study suggests that exposures to PM10 and O3, even being below the Brazilian air quality standards, contribute to risks of low birth weight.

Dental enamel as biomarker for environmental contaminants in relevant industrialized estuary areas in São Paulo, Brazil.

Heavy metal contamination is a long-standing and very well-known public health problem, and its exposure can cause damage to several organs of human body, especially on the central nervous system of young children and teenagers. The aim of this article is to evaluate lead, cadmium, and manganese contamination in 125 children from 6 to 13 years old living in contaminated areas during the period from 2006 to 2009 (São Vicente, Cubatão Downtown, Bertioga and Cubatão Pilões/Água Fria). This estuary area is the most important example of environmental degradation by chemicals from industrial sources. This is a cross-sectional study through clinical examinations and dental enamel tests. All mothers from these children lived in the area since before the pregnancy. Lead, cadmium, and manganese levels (µg/g) were measured on dental enamel samples through graphite furnace atomic absorption spectrometry, searching for the occurrence of heavy metals. The mean lead concentrations were 139.48 µg/g in Cubatão Pilões/Água Fria, 170.45 µg/g in Cubatão Downtown, 213.52 µg/g in São Vicente, and 151.89 µg/g in Bertioga. The mean cadmium concentrations were 10.83 µg/g in Cubatão Pilões/Água Fria, 12.58 µg/g in Cubatão Downtown, 10.92 µg/g in São Vicente, and 14.57 µg/g in Bertioga. The mean manganese concentrations were 23.49 µg/g in Cubatão Pilões/Água Fria, 30.90 µg/g in Cubatão Downtown, 41.46 µg/g in São Vicente, and 42.00 µg/g in Bertioga. Dental surface enamel may be used as an efficient biomarker of past environmental exposure to lead, manganese, and cadmium which are associated to well-known sources of heavy metal contamination. The results suggest that the evaluated children were exposed to sources of lead, cadmium, and manganese since before their conceptions. Although Bertioga initially was chosen as a control area of this study, it was also was verified to have heavy metal contamination on examined children.

[Respiratory and cardiovascular hospitalizations associated with air pollution in the city of São Paulo, Brazil]. / Hospitalizações por causas respiratórias e cardiovasculares associadas à contaminação atmosférica no Município de São Paulo, Brasil.

The recognition that current air pollution levels cause harmful health effects makes the definition of the air quality regulatory process imperative. This study examines the association between exposure to air pollution and hospital admissions in the city of São Paulo, aiming to support the development of measures to reduce such health risks. The authors conducted an ecological time series study of hospital admissions for respiratory and cardiovascular diseases in children and the elderly in relation to daily air pollution levels, using generalized additive Poisson regression models. All air pollutants except ozone showed a statistically significant association with admissions for respiratory and cardiovascular diseases. An increase of 10 microg/m3 in fine particulate matter was associated with a 4.6% increase in asthma admissions in children and a 4.3% increase in admissions for chronic obstructive pulmonary disease and 1.5% for ischemic heart disease in the elderly. These associations are consistent with a large body of literature in this area and indicate that the current air pollution levels in São Paulo have an important negative impact on the population's health.

The effects of air pollution on cardiovascular diseases: lag structures.

OBJECTIVE: To assess the lag structure between air pollution exposure and elderly cardiovascular diseases hospital admissions, by gender. METHODS: Health data of people aged 64 years or older was stratified by gender in São Paulo city, Southeastern Brazil, from 1996 to 2001. Daily levels of air pollutants (CO, PM10, O3, NO2, and SO2) , minimum temperature, and relative humidity were also analyzed. It were fitted generalized additive Poisson regressions and used constrained distributed lag models adjusted for long time trend, weekdays, weather and holidays to assess the lagged effects of air pollutants on hospital admissions up to 20 days after exposure. RESULTS: Interquartile range increases in PM10 (26.21 microg/m(3)) and SO2 (10.73 microg/m(3)) were associated with 3.17% (95% CI: 2.09-4.25) increase in congestive heart failure and 0.89% (95% CI: 0.18-1.61) increase in total cardiovascular diseases at lag 0, respectively. Effects were higher among female group for most of the analyzed outcomes. Effects of air pollutants for different outcomes and gender groups were predominately acute and some "harvesting" were found. CONCLUSIONS: The results show that cardiovascular diseases in São Paulo are strongly affected by air pollution.

A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture.

OBJECTIVES: This study sought to verify the effects of acupuncture as an adjuvant treatment for the control of asthma. METHODS: This was a randomized, controlled, crossover trial conducted at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A total of 74 patients with mild/moderate, persistent asthma were randomized into two therapeutic groups: Group A - 31 patients underwent 10 real weekly acupuncture sessions, followed by a 3-week washout period and 10 sham weekly acupuncture sessions; and Group B - 43 patients underwent 10 sham weekly acupuncture sessions, followed by a 3-week washout period and 10 real weekly acupuncture sessions. Patients used short- and long-acting ß-2 agonists and inhaled corticosteroids when necessary. Prior to treatment and after each period of 10 treatment sessions, the patients were evaluated for spirometry, induced sputum cell count, exhaled nitric oxide (NO) and with the Short Form 36 (SF-36) and Questionnaire on Quality of Life-Asthma (QQLA) questionnaires. Daily peak flow and symptom diaries were registered. The level of significance adopted was 5% (α=0.05). RESULTS: In Group B, after real acupuncture, there was a decrease in eosinophils (p=0.035) and neutrophils (p=0.047), an increase in macrophages (p=0.001) and an improvement in peak flow (p=0.01). After sham acupuncture treatment, patients experienced less coughing (p=0.037), wheezing (p=0.013) and dyspnea (p=0.014); similarly, after real acupuncture, patients reported less coughing (p=0.040), wheezing (p=0.012), dyspnea (p<0.001) and nocturnal awakening episodes (p=0.009). In Group A, there was less use of rescue medication (p=0.043). After the sham procedure, patients in Group A experienced less coughing (p=0.007), wheezing (p=0.037), dyspnea (p<0.001) and use of rescue medication (p<0.001) and after real acupuncture, these patients showed improvements in functional capacity (p=0.004), physical aspects (p=0.002), general health status (p<0.001) and vitality (p=0.019). Sham acupuncture also led to significant differences in symptoms, but these were not different from those seen with real acupuncture. Spirometry and exhaled NO levels did not show a difference between sham and real acupuncture treatment. In addition, no significant difference was demonstrated between treatments regarding the quality of life evaluation. CONCLUSION: Real and sham acupuncture have different effects and outcomes on asthma control. The crossover approach was not effective in this study because both interventions led to improvement of asthma symptoms, quality of life and inflammatory cell counts. Thus, sham acupuncture cannot serve as a placebo in trials with acupuncture as the main intervention for asthma.