Pathways to strengthen the climate resilience of health systems in the Peruvian Amazon by working with Indigenous leaders, communities and health officers.

BACKGROUND: Indigenous knowledge and responses were implemented during the COVID-19 pandemic to protect health, showcasing how Indigenous communities participation in health systems could be a pathway to increase resilience to emergent hazards like climate change. This study aimed to inform efforts to enhance climate change resilience in a health context by: (1) examining if and how adaptation to climate change is taking place within health systems in the Peruvian Amazon, (2) understanding how Indigenous communities and leaders' responses to climatic hazards are being articulated within the official health system and (3) to provide recommendations to increase the climate change resilience of Amazon health systems. METHODS: This study was conducted among two Peruvian Amazon healthcare networks in Junin and Loreto regions. A mixed methodology design was performed using a cross-sectional survey (13 healthcare facilities), semistructured interviews (27 official health system participants and 17 Indigenous participants) and two in-person workshops to validate and select key priorities (32 participants). We used a climate-resilient health system framework linked to the WHO health systems building blocks. RESULTS: Indigenous and official health systems in the Peruvian Amazon are adapting to climate change. Indigenous responses included the use of Indigenous knowledge on weather variability, vegetal medicine to manage health risks and networks to share food and resources. Official health responses included strategies for climate change and response platforms that acted mainly after the occurrence of climate hazards. Key pathways to articulate Indigenous and official health systems encompass incorporating Indigenous representations in climate and health governance, training the health work force, improving service delivery and access, strengthening the evidence to support Indigenous responses and increasing the budget for climate emergency responses. CONCLUSIONS: Key resilience pathways call for a broader paradigm shift in health systems that recognises Indigenous resilience as valuable for health adaptation, moves towards a more participatory health system and broadens the vision of health as a dimension inherently tied to the environment.

Environmental pollution challenges public health surveillance: the case of mercury exposure and intoxication in Brazil.

Pollution, causing millions of deaths annually, disproportionally affects low- and middle-income countries (LMICs). Mercury ranks among the three main chemicals of major public health concern, and even low levels can cause cardiovascular and nervous outcomes, with children and indigenous populations being especially vulnerable. Nearly 80% of all emissions in South America originate from the Amazon. Brazil, the fifth-largest contributor to global mercury emissions, exemplifies the challenges faced by LMICs in effectively monitoring and addressing mercury exposure/intoxication. Despite having powerful tools such as SINAN (a digital platform for compulsory disease reporting), and Community Health Agents, data reveals significant underreporting, especially in the Amazon. Furthermore, SINAN has important delays in its update: for instance, 196 cases of Munduruku Indigenous people in 2019 have only been included in 2023. In this Personal View, we outline insightful recommendations to enhance public health surveillance and implement enduring, effective strategies to monitor, report and address mercury exposure/intoxication, focusing on the Brazilian Amazon. Although these recommendations are tailored to the challenges of this country, they hold potential for adaptation by other Amazonian countries facing similar issues (high mercury emissions and the presence of vulnerable populations, among others).

Qualidade e acesso à água para consumo humano: um olhar sobre o estado do Amazonas, Brasil / Quality and access to water for human consumption: a look at the state of Amazonas, Brazil

Resumo Analisaram-se indicadores de vigilância da qualidade da água para consumo humano no Amazonas, de 2016 a 2020, utilizando 185.528 amostras provenientes de 11 microrregiões. Das amostras analisadas, 93,20% são da área urbana, 66,65% provinham do sistema público (SAA), 31,02% da Solução Alternativa Coletiva (SAC) e 2,33% da Solução de Alternativa Individual (SAI). Observou-se aumento do número de registros pelo SAA, com tendência de queda e oscilações de registros para a SAC e a SAI. Os indicadores de qualidade dos parâmetros químicos e físicos da área urbana foram superiores aos das áreas rurais e de comunidades tradicionais. A maior parte das amostras apresentou valores de pH abaixo do recomendado. Na quantificação dos parâmetros microbiológicos, identificou-se maior presença de coliformes totais e E.coli na área rural e em comunidades tradicionais. Em conclusão, verificaram-se inadequações nos parâmetros químicos, físicos e microbiológicos, assim como problemas relativos ao abastecimento, armazenamento e à vigilância da água distribuída para consumo humano. Tais achados indicam a necessidade de construir uma agenda, pela gestão pública, para o enfrentamento da insegurança hídrica e seus prováveis efeitos sobre a insegurança alimentar existente na região.

Abstract Surveillance indicators of the quality of water for human consumption in the Amazon were analysed from 2016 to 2020 using 185,528 samples from 11 microregions. Of the samples analysed, 93.20% were from urban areas, 66.65% were from the public water supply system (WSS), 31.02% were from the Collective Alternative Solution-CAS, and 2.33% from the Individual Alternative Solution-IAS. There was an increase in the number of records by the WSS, with a downwards trend and fluctuations in records for the CAS and the IAS. The quality indicators of chemical and physical parameters for urban areas were higher than those for rural areas and traditional communities. Most of the samples presented pH values below the recommended level. In the quantification of microbiological parameters, a higher presence of total coliforms and E. coli was identified in samples from rural areas and in traditional communities. In conclusion, there were inadequacies in the chemical, physical and microbiological parameters as well as problems related to the supply, storage and surveillance of water distributed for human consumption. These findings indicate the need to build an agenda for public management to address water insecurity and its likely effects on food insecurity in the region.

EROD activity in the native fish Cnesterodon decemmaculatus as a biomarker for assessing aquatic pollution by AhR agonist chemicals within the Rio de la Plata Basin.

The 7-ethoxyresorufin-O-deethylase (EROD) activity was first time characterized in the neotropical fish Cnesterodon decemmaculatus as a biomarker for assessing environmental health in aquatic ecosystems of the Rio de la Plata Basin impacted by organic pollutants agonist of the aryl-hydrocarbon receptor (AhR). Both laboratory and field studies were conducted. Laboratory experiments were run using ß-naphthoflavone (BNF) as an AhR agonist model. A clear concentration-response relationship was found between 1 and 100 µg/L, with a NOEC and LOEC of 1 and 10 µg/L. A fast time-dependent response was observed with a significant induction after 24 h and a plateau from 24 to 48 h up to 264 h of exposure. Differences in basal activity were found between juveniles, females, and males, but induction levels were similar. Both basal activities and induction levels were distinct in the whole body, liver, gill, muscle, brain, and embryos. Fold-change inductions in the respective tissues were: 20, 114, 3, 5, 1, and 14. Maternal transfer and early cyp1a activation were unveiled by embryonic induction. Clear differences in EROD activity were found among juveniles collected in hydrocarbon-polluted streams, beside the La Plata Petrochemical hub, and a reference stream. Similar EROD activities were observed in laboratory and feral fish, usually with values below or above 1,000 pmol/min x mg protein for unexposed or exposed organisms. The study contributes with original information about EROD activity in C. decemmaculatus that encourages the use of both the response as a robust biomarker of exposure and the species as a good sentinel organism to be included in surveillant programs for assessing aquatic pollution by AhR agonist chemicals within the Rio de la Plata Basin within the One Health paradigm.

Knowledge, attitudes and practices about air pollution and its health effects in 6th to 11th-grade students in Colombia: a cross-sectional study.

Introduction: Globally, air pollution is the leading environmental cause of disease and premature death. Raising awareness through environmental education and adequate communication on air quality could reduce the adverse effects. We aimed to assess the knowledge, attitudes, and practices (KAP) regarding air pollution and health and determine the factors associated with these KAP in children and adolescents. Methods: In 2019-2020, a cross-sectional study was conducted on 6th-11th grade high school students in five municipalities in Colombia. Variables collected included: age, sex, private or public school, any medical history, emergency room visits due to respiratory symptoms in the last year, and whether students played sports. The main exposure was the School Environmental Project. The outcomes were the KAP scale [0% (the lowest score) to 100% (the highest score)]. The factors associated with KAP levels were evaluated with independent mixed regressions due to the multilevel structure of the study (level 1: student; level 2: school), and the exponential coefficients (95% confidence interval-CI) were reported. Results: Among 1,676 students included, 53.8% were females. The median knowledge score about air pollution and its health effects was 33.8% (IQR: 24.0-44.9), 38.6% knew the air quality index, 30.9% knew the air quality alerts that occurred twice a year in these municipalities and 5.3% had high self-perceived knowledge. Positive attitudes, pro-environmental practices, being female, grade level, attending a private school, having respiratory diseases, and the school environmental project importance were associated with higher knowledge scores. The median attitudes score was 78.6% (IQR: 71.4-92.9). Pro-environmental attitudes were associated with knowledge-increasing, being female, attending a private school, and the school environmental project. The median pro-environmental practices score was 28.6% (IQR: 28.6-42.9). During air quality alerts, 11.6% had worn masks, 19% had reduced the opening time of windows and 15.9% avoided leaving home. Pro-environmental practices were associated with knowledge-increasing and attitudes-increasing, and lower practices with higher grade levels, visiting a doctor in the last year, and practicing sports. Discussion: Children and adolescents have low knowledge scores and inadequate pro-environmental practices scores regarding air pollution. However, they demonstrate positive attitudes towards alternative solutions and express important concerns about the planet's future.

Brazil's landmark change on One Health, animal rights and protection.

The Sustainable Development Goals (SDG) launched by the United Nations in 2015 were a global challenge calling for ending poverty, protecting the environment, and guaranteeing peace and prosperity to world citizens by 2030. Brazil has changed gears, accepted the SDG challenge and moved one step forward. On the dawn of January 1st, 2023, the very first day of President Lula's office, Brazil issued the Decree no. 11,349/2023 and created an additional SDG itself on animal health by establishing the Department of Animal Protection and Rights (DAPR). The DAPR primarily aims to establish a Federal Animal Code and other nationwide standard procedures for pet population management and mass neutering/spaying programs, services against animal cruelty, welfare meat production, meat substitutes, and enforcement of native fauna protection. Meanwhile, Brazil's new government has reduced in 48% the Amazon deforestation and mining, enforced the inspections on national parks and preserved areas, limited wild boar hunting. On top of it, Lula's G20 Bloc presidency starting this coming December has shown the Brazil commitment to reestablish its historical prominence on international conversation and diplomacy. Finally, recognition of a clear and unquestionable nexus among animal welfare, environment, and sustainability, beyond the United Nations original proposition, in a country level, particularly with still-preserved nature areas, should be understood and invested as humanity heritage.

The GSTP1 rs1695 Polymorphism Is Associated with Mercury Levels and Neurodevelopmental Delay in Indigenous Munduruku Children from the Brazilian Amazon.

Genetic polymorphisms may influence mercury (Hg) toxicity. The aims of this study were to evaluate individual factors, such as the presence of the GSTP1 rs1695 polymorphism, associated with internal Hg dose and child neurodevelopment in indigenous people from the Brazilian Amazon chronically exposed to Hg. Eighty-two indigenous children were clinically evaluated, hair Hg was measured, and the GSTP1 rs1695 polymorphism was genotyped. The mean age was 4.8 years, the median Hg was 5.5 µg/g, and 93.8% of children exceeded the safe limit (2.0 µg/g). Fish consumption was associated with Hg levels (p = 0.03). The GSTP1 rs1695 A>G polymorphism was in the Hardy-Weinberg equilibrium and the highest prevalence of the GSTP1 AA genotype (80%) was found in Sawré Aboy, which had the highest Hg levels (10 µg/g) among the studied villages. The Hg levels tended to increase over the years in males and in carriers of the GSTP1 AA genotype (0.69 µg/g and 0.86 µg/g, respectively). Nine children failed the neurodevelopmental test, all of whom had Hg > 2.0 µg/g, and 88.9% carried the GSTP1 AA or AG genotypes, previously associated with the highest internal Hg doses and neurocognitive disorders. The genetic counseling of this population is important to identify the individuals at greater risk for neurodevelopmental disorders resulting from chronic Hg exposure.

Effects of sodium dodecylbenzene sulfonate (SDBS), active principle of detergents, on the liver and kidney of zebrafish (Danio rerio).

Sodium dodecylbenzene sulfonate (SDBS), a predominant component in detergents, requires an evaluation of its toxicological potential due to its hazardous environmental levels. Therefore, we evaluated the toxicological effects of SDBS on the liver and kidney of male D. rerio. Therefore, we evaluated the toxicological effects of SDBS on the liver and kidney of male D. rerio. The fish were divided into three groups: 0.0 (control), 0.25, and 0.5 mg/L of SDBS with exposure for up to 96 hours. After exposure, histopathological, histochemical (hepatic glycogen content), and biochemical analyses (SOD and CAT enzyme analysis) were performed on both organs. The results showed significant histopathological effects, such as circulatory disturbances and progressive and regressive alterations, leading to an altered histopathological alteration index. SOD and CAT enzymes exhibited prominent changes. Thus, it became clear that the surfactant SDBS can cause serious hepatic and renal problems in D. rerio fish, even with short-term exposure, necessitating more stringent control and regulation in the disposal of this surfactant.

Afetividade pessoa-ambiente nas hortas comunitárias: promoção da saúde e da sustentabilidade / People-environmental affectiveness in community gardens: health and sustainability promotion

RESUMO As hortas comunitárias inspiradas em modelos agroecológicos já são tendências nas cidades que buscam estimular ambientes positivos. Entre as possíveis estratégias, permitem integrar políticas que visam à erradicação da fome, a garantia de qualidade alimentar e o aumento da economia familiar. O presente estudo objetiva analisar os significados simbólicos e afetivos dos usuários diante de suas atividades nas hortas comunitárias urbanas. Foram 40 entrevistados com idade média entre 45 e 80 anos, por meio do Instrumento Gerador de Mapas Afetivos. A pesquisa foi realizada in loco e os participantes foram convidados a desenhar a horta e responder à entrevista. As imagens produzidas foram analisadas a partir de suas estruturas, sentimentos e sentidos. Constatou-se que as vivências nesses ambientes foram mediadas por sentimentos de agradabilidade, pertencimento e restauração. Entre os sentidos atribuídos, destacaram-se a conexão com a natureza e a interação social. Conclui-se que tais dimensões presentes nas hortas estudadas podem contribuir para a promoção da saúde, da sustentabilidade e a preservação ambiental.

ABSTRACT Community gardens inspired by agroecological models are trends in cities that seek to stimulate positive environments. Among the possible strategies, they allow us to integrate policies that aim to eradicate eradicate hunger, guarantee food quality and increase the family economy. This study aims to analyze the symbolic and emotional meanings of users during their activities in urban community gardens. There were 40 interviewees with average age between 45 and 80 years old, through the Affective Map Generator Instrument. The research was carried out on site and the participants were invited to develop the information and respond to the interview. The images produced are analyzed from their structures, feelings and senses. It is confirmed that experiences in these environments are mediated by feelings of pleasantness, belonging and restoration. Among the senses attributed, the connection with nature and social interaction stand out. It is concluded that these dimensions present in the studied gardens can contribute to the promotion of health, sustainability and environmental preservation.

A prática do kitesurf no litoral piauiense e suas implicações sobre este patrimônio natural / The practice of kitesurfing on the coast of piauí and its implications on this natural heritage

Considerado patrimônio natural, o litoral piauiense é referência nacional e internacional para o Kitesurf, esporte na natureza pouco estudado, embora conste em pesquisas sobre desenvolvimento turístico na região. Este artigo analisa implicações da prática do Kitesurf nesse litoral e identifica ações que podem contribuir para sua conservação. Realizou-se pesquisa qualitativa, exploratória, mediante pesquisa bibliográfica e documental. Em certas praias há conflitos entre kitesurfista, pescador e/ou banhista; além da prática oferecer riscos para animais silvestres. Todavia, há kitesurfista que recolhe lixo no mar e promove discussões sobre efeitos do esporte na região. Abordar a educação ambiental em clínicas de certificação de kitesurfistas e regulamentar o Kitesurf pode colaborar com a resolução de conflitos e perspectivar um turismo mais sustentável, almejando conservar esse patrimônio e suas potencialidades.

The coast of Piauí, considered a natural heritage, is a national and international reference for kitesurfing, sport in naturelittle studied, although it is part of research on the regional tourism development. This article analyzes the implications of the practice of kitesurfing on this coast and identifies actions that can contribute to its conservation. Qualitative, exploratory research was carried out through bibliographical and documentary research. On certain beaches there are conflicts between kitesurfers, fishermen and/ or bathers; in addition, its practice offers risks to wild animals. However, there are kitesurfers who collects garbage at sea and promotes discussions about the effects of the sport in the region. Addressing environmental education of kitesurfers in certification clinics and regulating kitesurfing can collaborate with conflict resolution and envisage a more sustainable tourism, aiming to conserve this heritage and its potential.

Assessment of genotoxicity of air pollution in urban areas using an integrated model of passive biomonitoring.

Atmospheric pollution is a major public health issue and has become increasingly critical for human health. Urban atmospheric pollution is typically assessed through physicochemical indicators aligned with environmental legislation parameters, providing data on air quality levels. While the effects of pollution on sensitive organisms serve as a warning for public health decision-makers, there remains a need to explore the interpretation of environmental data on pollutants. The use of species adapted to urban environments as sentinels enables continuous and integrated monitoring of environmental pollution implications on biological systems. In this study, we investigated the use of the plant species Tradescantia pallida as a biomonitor to evaluate the genotoxic effects of atmospheric pollution under diverse vehicular traffic conditions. T. pallida was strategically planted at the leading urban intersections in Uberlândia, Brazil. During COVID-19 pandemic lockdowns, we compared indicators such as physical, biological, and traffic data at different intersections in residential and commercial zones. The reduction in vehicular traffic highlighted the sensitivity of plant species to changes in air and soil pollutants. T. pallida showed bioaccumulation of heavy metals Cd and Cr in monitored areas with higher traffic levels. Additionally, we established a multiple linear regression model to estimate genotoxicity using the micronucleus test, with chromium concentration in the soil (X1) and particulate matter (PM) in the atmosphere (X2) identified as the primary independent variables. Our findings provide a comprehensive portrait of the impact of vehicular traffic changes on PM and offer valuable insights for refining parameters and models of Environmental Health Surveillance.

Implications of environmental nanoparticles on neurodegeneration.

The ubiquity of nanoparticles, sourced from both natural environments and human activities, presents critical challenges for public health. While offering significant potential for innovative biomedical applications-especially in enhancing drug transport across the blood-brain barrier-these particles also introduce possible hazards due to inadvertent exposure. This concise review explores the paradoxical nature of nanoparticles, emphasizing their promising applications in healthcare juxtaposed with their potential neurotoxic consequences. Through a detailed examination, we delineate the pathways through which nanoparticles can reach the brain and the subsequent health implications. There is growing evidence of a disturbing association between nanoparticle exposure and the onset of neurodegenerative conditions, highlighting the imperative for comprehensive research and strategic interventions. Gaining a deep understanding of these mechanisms and enacting protective policies are crucial steps toward reducing the health threats of nanoparticles, thereby maximizing their therapeutic advantages.

Enfermagem no manejo da hipertensão arterial sistêmica na atenção primária: contribuições para a saúde planetária / Nursing in the management of systemic arterial hypertension in primary care: contributions to planetary health

Este estudo objetiva refletir sobre o papel da enfermagem na gestão da Hipertensão Arterial Sistêmica (HAS) na Atenção Primária à Saúde (APS), e como os princípios da saúde planetária influenciam sua redução. Método: Baseado em análise teórica, realizado em junho de 2023, abordou a HAS com embasamento em portarias ministeriais, documentos internacionais e diretrizes. Resultados: Enfermeiros, ao promoverem hábitos saudáveis como dieta equilibrada e exercícios, previnem obesidade, doenças cardiovasculares e outras condições associadas à HAS, reduzindo complicações como problemas renais e cardíacos. A APS e um local que oportuniza fornecer esses cuidados abrangentes aos pacientes com HAS. Esta abordagem não apenas beneficia a saúde individual dos pacientes, mas também promove a saúde do planeta ao reduzir as morbidades, promover pessoas conscientes e, consequentemente, mais saudáveis, e reduzir o uso de recursos médicos e naturais. Conclusão: Assim, a enfermagem na APS desempenha um papel significativo não só na saúde dos pacientes, mas também na conscientização da sustentabilidade ambiental e na promoção do bem-estar individual e, consequentemente, global.(AU)

This study aims to reflect on the role of nursing in the management of Systemic Arterial Hypertension (SAH) in Primary Health Care (PHC), and how the principles of planetary health influence its reduction. Method: Based on theoretical analysis, conducted in June 2023, it addressed SAH with a foundation in ministerial ordinances, international documents, and guidelines. Results: Nurses, by promoting healthy habits such as balanced diet and exercise, prevent obesity, cardiovascular diseases, and other conditions associated with SAH, reducing complications such as renal and cardiac problems. PHC is a setting that enables the provision of comprehensive care to patients with SAH. This approach not only benefits the individual health of patients but also promotes planetary health by reducing morbidities, fostering conscious individuals, and consequently, healthier ones, and reducing the use of medical and natural resources. Conclusion: Thus, nursing in PHC plays a significant role not only in the health of patients but also in raising awareness of environmental sustainability and promoting individual and, consequently, global well-being.(AU)

Este estudio tiene como objetivo reflexionar sobre el papel de la enfermería en la gestión de la Hipertensión Arterial Sistémica (HAS) en la Atención Primaria de Salud (APS), y cómo los principios de la salud planetaria influyen en su reducción. Método: Basado en análisis teórico, realizado en junio de 2023, abordó la HAS con fundamentos en normativas ministeriales, documentos internacionales y directrices. Resultados: Los enfermeros, al promover hábitos saludables como una dieta equilibrada y ejercicio, previenen la obesidad, enfermedades cardiovasculares y otras condiciones asociadas con la HAS, reduciendo complicaciones como problemas renales y cardíacos. La APS es un entorno que permite brindar atención integral a los pacientes con HAS. Este enfoque no solo beneficia la salud individual de los pacientes, sino que también promueve la salud planetaria al reducir morbilidades, fomentar individuos conscientes y, en consecuencia, más saludables, y reducir el uso de recursos médicos y naturales. Conclusión: Por lo tanto, la enfermería en APS juega un papel significativo no solo en la salud de los pacientes, sino también en la concienciación sobre la sostenibilidad ambiental y la promoción del bienestar individual y, en consecuencia, global.(AU)

Assessing the water quality in a World Heritage Site using biomarkers in top fish predators.

The use of biomarkers in fish for biomonitoring is a valuable approach to reveal effects of human impacts on biota health. Top predator fish are effective models for monitoring human activities' impacts on aquatic ecosystems. The Guaraguaçu River is the largest river-system on coastal region of South Brazil and a World Heritage site. The river receives contaminants from disorderly urban growth, including discharges of domestic sewage and small fishery boats, particularly during the tourist season. Our study aimed to assess impact of anthropogenic activities on water quality in the Guaraguaçu River by analyzing environmental contamination biomarkers in the top fish predator Hoplias malabaricus. Fish were collected using a fyke net trap across sectors representing a gradient of anthropic impact: sector 1 - pristine; sector 2 - impacted; and sector 3 - less impacted. Water samples were collected to analyze the presence of trace elements and pesticide. Biomarkers of the antioxidant system, histopathology, genotoxicity, neurotoxicity, and concentration of trace elements were analyzed in fish tissues. In water samples Al, Fe and Mn were detected, but no pesticides were found. In fish muscle, zinc and iron were detected. Brain acetylcholinesterase activity decreased in impacted sectors, indicating neurotoxic effects. The antioxidant system increased activity in gills and liver, and damage from lipoperoxidation was observed, particularly in sector 2 when compared to sector 1, suggesting oxidative stress. Histopathological biomarkers revealed lesions in the liver and gills of fish in impacted sectors. Micronuclei, a genotoxicity biomarker, were observed in organisms from all sectors. Our results demonstrate detrimental effects of poor water quality on biota health, even when contaminants are not detected in water.

Long-Term Environmental Methylmercury Exposure Is Associated with Peripheral Neuropathy and Cognitive Impairment among an Amazon Indigenous Population.

Widespread contamination of the Amazon basin with mercury has been reported to occur since at least the mid-80s due to heavy gold mining activity. Although initial studies have indicated that this may lead to deleterious neurological consequences to the indigenous populations living in the region, further research is needed to better characterize the neurological burden of such long-term exposure. With this aim, a cross-sectional exploratory study has been conducted with the Yanomami indigenous population residing in a northern Amazon region. All participants underwent a structured interview; detailed neurological examination, including assessment for cognitive, motor, coordination, and sensory functions; and laboratorial testing for serum hemoglobin, blood glucose, and methylmercury levels in hair samples. This study enrolled 154 individuals of 30.9 ± 16.8 years of age, of which 56.1% were female. Mean methylmercury levels in hair were 3.9 ± 1.7 µg/g. Methylmercury levels in hair > 6.0 µg/g were found in 10.3%. Among participants with hair methylmercury levels ≥ 6.0 µg/g, the prevalences of peripheral neuropathy and reduced cognitive performance were, respectively, 78.8% (95%CI 15-177%, p = 0.010) and 95.9% (95%CI 16-230.8%, p = 0.012) higher than those of individuals with lower levels. These results suggest that chronic mercury exposure may lead to significant and potentially irreversible neurotoxicity to Yanomami population living in the northern Amazon basin.

Single-Nucleotide Polymorphisms Associated with Mercury Levels and Neurological Symptoms: An Overview.

Mercury (Hg) pollution is a global public health concern because of its adverse effects on the environment and health. Single-nucleotide polymorphisms (SNPs) have been associated with Hg levels and outcomes. The aim of this review was to describe the research and discuss the evidence on the genetic susceptibility of Hg-exposed individuals to the development of neurocognitive disorders. A systematic review was performed to identify the genes/SNPs associated with Hg toxicokinetics and that, therefore, affect neurological function in exposed populations. Observational and experimental studies were identified by screening three databases. Thirteen articles were included (quality score 82-100%) and 8124 individuals were evaluated. Hg exposure was mainly fish consumption (77%) and, in 31% of the studies, the Hg levels exceeded the reference limits. Genetic susceptibility to higher Hg levels and neurotoxicity risk in Hg poisoning were associated with eight (ALAD rs1800435, CYP3A4 rs2740574, CYP3A5 rs776746, CYP3A7 rs2257401, GSTP1 rs1695, MT1A rs8052394, MT1M rs2270836, and MT4 rs11643815) and three (MT1A rs8052394, MT1M rs2270837, and MT2A rs10636) SNPs, respectively, and rs8052394 was associated with both outcomes. The MT1A rs8052394 SNP may be used as a susceptibility biomarker to identify individuals at greater risk for higher Hg levels and the development of neurocognitive disorders in metal-exposed populations.

Chlorine Water Taste Threshold and Acceptability among Indigenous and Non-Indigenous Populations in Rural Panama.

Although gains in access to water services over the past two decades have been large, more than two billion people still lack access to safely managed drinking water. This study examines and compares free chlorine taste and acceptability thresholds of rural Indigenous Ngäbe and rural Latino Panamanians to study if taste aversion may be a limiting factor in chlorination of community systems in Panama using the three-alternative forced choice test methodology. This study is the first to establish a best-estimate taste threshold for a rural Indigenous group and the only study in Latin America to report best-estimate taste thresholds using those methods. Median taste thresholds were 0.87 mg/L Cl2 for Indigenous Ngäbe participants (n = 82) and 1.64 mg/L Cl2 for Latino participants (n = 64), higher than both the minimum concentration for biologically safe water (0.2 mg/L) and the recommended concentration range in Panama (0.3-0.8 mg/L). Median acceptability thresholds were established much higher than taste thresholds at 3.45 mg/L Cl2. The results show that the ability to accurately taste chlorine may not be the limiting factor for adoption of safe water initiatives in remote and Indigenous communities.

Wildfire-related PM2.5 and cardiovascular mortality: A difference-in-differences analysis in Brazil.

Brazil has experienced unprecedented wildfires recently. We aimed to investigate the association of wildfire-related fine particulate matter (PM2.5) with cause-specific cardiovascular mortality, and to estimate the attributable mortality burden. Exposure to wildfire-related PM2.5 was defined as exposure to annual mean wildfire-related PM2.5 concentrations in the 1-year prior to death. The variant difference-in-differences method was employed to explore the wildfire-related PM2.5-cardiovascular mortality association. We found that, in Brazil, compared with the population in the first quartile (Q1: ≤1.82 µg/m3) of wildfire-related PM2.5 exposure, those in the fourth quartile (Q4: 4.22-17.12 µg/m3) of wildfire-related PM2.5 exposure had a 2.2% (RR: 1.022, 95% CI: 1.013-1.032) higher risk for total cardiovascular mortality, 3.1% (RR: 1.031, 95% CI: 1.014-1.048) for ischaemic heart disease mortality, and 2.0% (RR: 1.020, 95% CI: 1.002-1.038) for stroke mortality. From 2010 to 2018, an estimation of 35,847 (95% CI: 22,424-49,177) cardiovascular deaths, representing 17.77 (95% CI: 11.12-24.38) per 100,000 population, were attributable to wildfire-related PM2.5 exposure. Targeted health promotion strategies should be developed for local governments to protect the public from the risk of wildfire-related cardiovascular premature deaths.

Firearm-Related Lead Exposure and Child Lead Levels in the United States, 2012-2018.

OBJECTIVE: To determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead. STUDY DESIGN: For this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations. RESULTS: Prevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each IQR (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79). CONCLUSION: These data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level.