The zero impact of the Vehicle Inspection Program on public health in São Paulo, SP.

OBJECTIVE To analyze the impact of two interventions (implementation and suspension of mandatory vehicle inspection) on morbidity and mortality due to conditions related to air pollution, from 2008 to 2017. METHODS Interrupted time series (ARIMA models), using data available in public repositories. RESULTS A total of 229,337 children of up to 5 years old were hospitalized due to respiratory diseases, and 1,053 died (average monthly mortality ratio for this population: 1.12/100,000). Exact 137,876 individuals over 40 years old were hospitalized for an acute myocardial infarction, and 19,492 died (3.7/100,000). A total of 11,010 individuals over 40 years old were hospitalized with malignant neoplasms of the respiratory system; 2,898 died (0.5/100,000). A total of 20,807 individuals over 60 years old were hospitalized with chronic obstructive pulmonary diseases; 2,627 died (1.5/100,000). As for strokes, 69,180 individuals were hospitalized, and 10,866 died (2.1/100,000). We found no significant regression coefficient for the implementation or suspension of the program regarding hospitalizations and deaths. 38,207 children of up to 14 years old were hospitalized with asthma, and 25 of them died (0.007/100,000). The coefficients show a monthly increase of 0.05 deaths/100,000 people (p = 0.01) in the post-inspection period. We found no correlation between the measured concentrations of the pollutants PM2.5 and CO - in a monitoring station, in the central region of the municipality - and the implementation or suspension of the inspection. CONCLUSIONS No evidence confirms that the program had a measurable beneficial impact on morbidity and mortality due to respiratory and circulatory diseases.

The zero impact of the vehicle inspection program on public health in São Paulo, SP / O impacto nulo do programa de inspeção veicular na saúde pública em São Paulo, SP

ABSTRACT OBJECTIVE To analyze the impact of two interventions (implementation and suspension of mandatory vehicle inspection) on morbidity and mortality due to conditions related to air pollution, from 2008 to 2017. METHODS Interrupted time series (ARIMA models), using data available in public repositories. RESULTS A total of 229,337 children of up to 5 years old were hospitalized due to respiratory diseases, and 1,053 died (average monthly mortality ratio for this population: 1.12/100,000). Exact 137,876 individuals over 40 years old were hospitalized for an acute myocardial infarction, and 19,492 died (3.7/100,000). A total of 11,010 individuals over 40 years old were hospitalized with malignant neoplasms of the respiratory system; 2,898 died (0.5/100,000). A total of 20,807 individuals over 60 years old were hospitalized with chronic obstructive pulmonary diseases; 2,627 died (1.5/100,000). As for strokes, 69,180 individuals were hospitalized, and 10,866 died (2.1/100,000). We found no significant regression coefficient for the implementation or suspension of the program regarding hospitalizations and deaths. 38,207 children of up to 14 years old were hospitalized with asthma, and 25 of them died (0.007/100,000). The coefficients show a monthly increase of 0.05 deaths/100,000 people (p = 0.01) in the post-inspection period. We found no correlation between the measured concentrations of the pollutants PM2.5 and CO - in a monitoring station, in the central region of the municipality - and the implementation or suspension of the inspection. CONCLUSIONS No evidence confirms that the program had a measurable beneficial impact on morbidity and mortality due to respiratory and circulatory diseases.

RESUMO OBJETIVO Analisar o impacto de duas intervenções (introdução e suspensão da inspeção veicular obrigatória) sobre a morbidade e mortalidade por condições associadas à poluição do ar no período de 2008 a 2017. MÉTODOS Séries temporais interrompidas (método Arima), com dados disponíveis em repositórios públicos. RESULTADOS Houve 229.337 internações por doenças respiratórias em crianças até 5 anos de idade, com 1.053 óbitos (coeficiente médio de mortalidade mensal para a população da idade: 1,12/100.000). Para infarto agudo do miocárdio em maiores de 40 anos, houve 137.876 internações, com 19.492 óbitos (3,7/100.000). Para as neoplasias malignas do aparelho respiratório em maiores de 40 anos, foram 11.010 internações, com 2.898 óbitos (0,5/100.000). Para doenças pulmonares obstrutivas crônicas em maiores de 60 anos, foram 20.807 internações, com 2.627 óbitos (1,5/100.000). Para os acidentes vasculares cerebrais, foram 69.180 internações e 10.866 óbitos (2,1/100.000). Não houve nenhum coeficiente de regressão significativo para a introdução ou suspensão do programa em relação às internações e óbitos. Para asma em crianças até 14 anos, houve 38.207 internações e 25 óbitos (0,007/100.000), e os coeficientes mostram aumento de 0,05 óbitos/100.000 pessoas por mês (p = 0,01) no período pós-introdução da inspeção. Em modelo para os poluentes MP2,5 e CO, em estação de monitoramento da região central do município, não houve correlação entre as concentrações medidas e a introdução ou a suspensão da inspeção. CONCLUSÕES Não há evidências de que o programa tenha tido qualquer efeito benéfico mensurável sobre a morbidade e a mortalidade por doenças respiratórias e do aparelho circulatório.

Heparina intermitente não é eficaz em impedir a retirada por obstrução de cateteres centrais inseridos perifericamente em recém-nascidos de termo e prematuros / Intermittent heparin is not effective at preventing the occlusion of peripherally inserted central venous catheters in preterm and term neonates

OBJETIVO: Verificar se a heparina em lavagens intermitentes é eficaz em reduzir oclusões de cateteres centrais inseridos perifericamente em recém-nascidos. MÉTODOS: Estudo randomizado, aberto, controlado, prospectivo. Os recém-nascidos foram alocados em dois grupos para receber lavagens ("flushes") com 0,5 mL da solução de heparina 10UI/mL (Grupo 1, n = 64) ou com 0,5 mL de salina (Grupo 2, n = 69), a cada 4 horas através do cateter central inserido perifericamente. Foram realizadas manobras de desobstrução por pressão negativa ("3-way stopcock method") nos casos de oclusão. RESULTADOS: Foram incluídos 133 recém-nascidos. Não houve diferença significativa no número de oclusões inéditas entre os grupos (26 no grupo 1, ou 31/1000 dias de cateter; 36 no grupo 2, ou 36/1000 dias de cateter, P = 0,19). No grupo 1, 5 cateteres apresentaram 9 recidivas da obstrução, após uma tentativa de desobstrução bem sucedida. No grupo 2, 19 cateteres apresentaram 40 recidivas (P <0,0001), mostrando papel protetor da heparina contra recidivas da obstrução (risco relativo = 0,36). Contudo, a heparina não evitou a retirada por oclusão definitiva (3 cateteres no grupo 1 e 8 no grupo 2, P = 0,24). CONCLUSÃO: A heparina intermitente não é eficaz em evitar oclusão dos cateteres centrais inseridos perifericamente neonatais. Apenas reduz as recidivas, se realizadas manobras de desobstrução.

OBJECTIVE: To evaluate the effectiveness of intermittent 10 U/mL heparin flushes in reducing the occlusion of peripherally inserted central catheters in neonates. METHODS: In this randomized, open-label, prospective, controlled study, neonates were allocated either to receive 0.5 mL flushes of heparin (Group 1: n = 64) or saline (Group 2: n = 69) every 4 hours. Actions were taken to restore patency by using negative pressure (3-way stopcock method) in cases of occlusion. RESULTS: A total of 133 neonates were included. No significant intergroup difference was observed in the number of new occlusions (26 in Group 1, or 31/1,000 catheter-days; 36 in Group 2, or 36/1,000 catheter-days; P = 0.19). In Group 1, 5 catheters had 9 recurrent obstructions after successful clearance maneuvers. In Group 2, 19 catheters had 40 relapses (P < 0.0001), showing heparin's protective role against recurrence of obstruction (Relative Risk = 0.36). However, heparin failed to prevent catheter withdrawal due to permanent occlusion (3 catheters in Group 1 and 8 in Group 2; P = 0.24). CONCLUSION: Intermittent heparin is not effective for preventing the occlusion of peripherally inserted central catheters in neonates but reduces relapses when clearance maneuvers were successful.

Intermittent heparin is not effective at preventing the occlusion of peripherally inserted central venous catheters in preterm and term neonates. / Heparina intermitente não é eficaz em impedir a retirada por obstrução de cateteres centrais inseridos perifericamente em recém-nascidos de termo e prematuros.

OBJECTIVE: To evaluate the effectiveness of intermittent 10 U/mL heparin flushes in reducing the occlusion of peripherally inserted central catheters in neonates. METHODS: In this randomized, open-label, prospective, controlled study, neonates were allocated either to receive 0.5 mL flushes of heparin (Group 1: n = 64) or saline (Group 2: n = 69) every 4 hours. Actions were taken to restore patency by using negative pressure (3-way stopcock method) in cases of occlusion. RESULTS: A total of 133 neonates were included. No significant intergroup difference was observed in the number of new occlusions (26 in Group 1, or 31/1,000 catheter-days; 36 in Group 2, or 36/1,000 catheter-days; P = 0.19). In Group 1, 5 catheters had 9 recurrent obstructions after successful clearance maneuvers. In Group 2, 19 catheters had 40 relapses (P < 0.0001), showing heparin's protective role against recurrence of obstruction (Relative Risk = 0.36). However, heparin failed to prevent catheter withdrawal due to permanent occlusion (3 catheters in Group 1 and 8 in Group 2; P = 0.24). CONCLUSION: Intermittent heparin is not effective for preventing the occlusion of peripherally inserted central catheters in neonates but reduces relapses when clearance maneuvers were successful.

Parto cesáreo e outros riscos para hipertensão pulmonar persistente do recém-nascido / Cesarean deliveries and other risks for persistent pulmonary hypertension of the newborn

OBJETIVOS: Avaliar os riscos para hipertensão pulmonar persistente do recém-nascido, confirmada por ecocardiografia, associada a partos cesáreos e outros fatores. MÉTODOS: Coorte de todos os nascimentos com idade gestacional acima de 36 semanas em um período de 23 meses. Um estudo caso-controle aninhado foi feito em uma parte da coorte, envolvendo um grupo de recém-nascidos com diagnóstico de hipertensão pulmonar persistente do recém-nascido comparados com um grupo de controles normais, com aplicação de questionários às mães para identificação de riscos. Regressão logística foi utilizada para calcular odds ratios. RESULTADOS: De 9452 recém-nascidos, 8388 (88,7 por cento) nasceram de cesáreas, e 1064 (11,3 por cento) de parto vaginal. Questionários foram aplicados a 173 mães. Recém-nascidos de cesáreas apresentaram um risco 5 vezes maior de hipertensão pulmonar persistente do recém-nascido: 42 casos (0,5 por cento) versus 1 caso (0,09 por cento) entre os de partos vaginais (OR 5,32, p=0,027). Não foram observadas interações entre tabagismo, paridade, hipertensão arterial materna e trabalho de parto antes da cesárea e a hipertensão pulmonar persistente do recém-nascido. Apgar no 1º minuto <7 e diabetes materno se relacionaram a um risco aumentado. CONCLUSÃO: A redução do número de partos cesáreos poderia prevenir muitos casos graves de hipertensão pulmonar persistente do recém-nascido.

OBJECTIVES: To evaluate risks for persistent pulmonary hypertension in the newborn, confirmed by echocardiography, associated with cesarean deliveries and other factors. METHODS: Cohort of all deliveries >36 weeks within a period of 23 months. A nested case-control study was performed in a subset of the cohort, involving newborns admitted into neonatal intensive care unit with diagnosis of persistent pulmonary hypertension matched with normal controls, with application of questionnaires to mothers to identify risks. Logistic regression was used to calculate odds ratios. RESULTS: From 9452 newborns, 8388 (88.7 percent) were delivered by cesarean and 1064 (11.3 percent) by vaginal delivery. Questionnaires were applied to 173 mothers. Infants from cesareans had a fivefold increased risk of persistent pulmonary hypertension of the newborn: 42 (0.5 percent) versus 1 case (0.09 percent) in the vaginal group (OR 5.32, p=0.027). No interactions were found between smoking, parity, arterial hypertension and labor before cesarean section and persistent pulmonary hypertension of the newborn. First minute Apgar score <7 and maternal diabetes were related to increased risk. CONCLUSION: Reducing cesarean deliveries could prevent many cases of serious persistent pulmonary hypertension of the newborn.

Cesarean deliveries and other risks for persistent pulmonary hypertension of the newborn. / Parto cesáreo e outros riscos para hipertensão pulmonar persistente do recém-nascido.

OBJECTIVES: To evaluate risks for persistent pulmonary hypertension in the newborn, confirmed by echocardiography, associated with cesarean deliveries and other factors. METHODS: Cohort of all deliveries >36 weeks within a period of 23 months. A nested case-control study was performed in a subset of the cohort, involving newborns admitted into neonatal intensive care unit with diagnosis of persistent pulmonary hypertension matched with normal controls, with application of questionnaires to mothers to identify risks. Logistic regression was used to calculate odds ratios. RESULTS: From 9452 newborns, 8388 (88.7%) were delivered by cesarean and 1064 (11.3%) by vaginal delivery. Questionnaires were applied to 173 mothers. Infants from cesareans had a fivefold increased risk of persistent pulmonary hypertension of the newborn: 42 (0.5%) versus 1 case (0.09%) in the vaginal group (OR 5.32, p=0.027). No interactions were found between smoking, parity, arterial hypertension and labor before cesarean section and persistent pulmonary hypertension of the newborn. First minute Apgar score <7 and maternal diabetes were related to increased risk. CONCLUSION: Reducing cesarean deliveries could prevent many cases of serious persistent pulmonary hypertension of the newborn.