Cerebrovascular mortality: trend and seasonality in Brazilian capitals, 2000-2019.

OBJECTIVE: To evaluate the trend and seasonality of cerebrovascular mortality rates in the adult population of Brazilian capitals from 2000 to 2019. METHODS: This is an ecological and descriptive study of a time series of mortality due to cerebrovascular causes in adults (≥ 18 years) living in Brazilian capitals from 2000 to 2019, based on the Brazilian Mortality Information System. Descriptive statistical techniques were applied in the exploratory analysis of data and in the summary of specific, standardized rates and ratios by sociodemographic characteristics. The jointpoint regression model was used to estimate the trend of cerebrovascular mortality rates by gender, age groups, and geographic regions. The seasonal variability of rates by geographic regions was estimated using the generalized additive model by smoothing cubic splines. RESULTS: People aged over 60 years comprised 77% of all cerebrovascular deaths. Women (52%), white individuals (47%), single people (59%), and those with low schooling (57%, elementary school) predominated in our sample. Recife (20/1,000 inhab.) and Vitória (16/1,000 inhab.) showed the highest crude mortality rates. Recife (49/10,000 inhab.) and Palmas (47/10,000 inhab.) prevailed after we applied standardized rates. Cerebrovascular mortality rates in Brazil show a favorable declining trend for adults of all genders. Seasonality influenced rate increase from July to August in almost all region capitals, except in the North, which rose in March, April, and May. CONCLUSIONS: Deaths due to cerebrovascular causes prevailed in older single adults with low schooling. The trend showed a tendency to decline and winter, the greatest risk. Regional differences can support decision-makers in implementing public policies to reduce cerebrovascular mortality.

Cerebrovascular mortality: trend and seasonality in Brazilian capitals, 2000-2019 / Mortalidade cerebrovascular: tendência e sazonalidade nas capitais brasileiras, 2000-2019

ABSTRACT OBJECTIVE To evaluate the trend and seasonality of cerebrovascular mortality rates in the adult population of Brazilian capitals from 2000 to 2019. METHODS This is an ecological and descriptive study of a time series of mortality due to cerebrovascular causes in adults (≥ 18 years) living in Brazilian capitals from 2000 to 2019, based on the Brazilian Mortality Information System. Descriptive statistical techniques were applied in the exploratory analysis of data and in the summary of specific, standardized rates and ratios by sociodemographic characteristics. The jointpoint regression model was used to estimate the trend of cerebrovascular mortality rates by gender, age groups, and geographic regions. The seasonal variability of rates by geographic regions was estimated using the generalized additive model by smoothing cubic splines. RESULTS People aged over 60 years comprised 77% of all cerebrovascular deaths. Women (52%), white individuals (47%), single people (59%), and those with low schooling (57%, elementary school) predominated in our sample. Recife (20/1,000 inhab.) and Vitória (16/1,000 inhab.) showed the highest crude mortality rates. Recife (49/10,000 inhab.) and Palmas (47/10,000 inhab.) prevailed after we applied standardized rates. Cerebrovascular mortality rates in Brazil show a favorable declining trend for adults of all genders. Seasonality influenced rate increase from July to August in almost all region capitals, except in the North, which rose in March, April, and May. CONCLUSIONS Deaths due to cerebrovascular causes prevailed in older single adults with low schooling. The trend showed a tendency to decline and winter, the greatest risk. Regional differences can support decision-makers in implementing public policies to reduce cerebrovascular mortality.

RESUMO OBJETIVO Avaliar a tendência e a sazonalidade das taxas de mortalidade cerebrovascular na população adulta das capitais brasileiras de 2000 a 2019. MÉTODOS Estudo ecológico e descritivo de séries temporais de mortalidade por causas cerebrovasculares em adultos (≥ 18 anos) residentes nas capitais do Brasil no período 2000-2019, obtidas do Sistema de Informações sobre Mortalidade. Técnicas de estatística descritiva foram aplicadas na análise exploratória dos dados e no resumo de taxas específicas, padronizadas e razões por características sociodemográficas. A regressão de pontos de junção (jointpoint regression model) estimou a tendência das taxas de mortalidade cerebrovascular por sexo, grupos etários e regiões geográficas. A variabilidade sazonal por regiões geográficas das taxas foi estimada utilizando o modelo aditivo generalizado por meio de splines de suavização cúbica. RESULTADOS As pessoas maiores de 60 anos representaram 77% dos óbitos cerebrovasculares. Predominaram o sexo feminino (52%), a raça branca (47%), os solteiros (59%) e a baixa escolaridade (57%, ensino fundamental). As capitais Recife (20/1.000 hab.) e Vitória (16/1.000 hab.) apresentaram as maiores taxas brutas de mortalidade. Aplicando as taxas padronizadas Recife (49/10.000 hab.) e Palmas (47/10.000 hab.) prevaleceram. As taxas de mortalidade cerebrovascular no Brasil apresentam uma tendência favorável ao declínio em ambos os sexos e em adultos. A sazonalidade mostrou influenciar na elevação das taxas entre os meses de julho a agosto em quase todas as capitais das regiões, exceto na Norte, que se elevaram nos meses de março, abril e maio. CONCLUSÕES Os óbitos por causa cerebrovascular prevaleceram em pessoas idosas, solteiras e com baixa escolaridade. A tendência foi favorável ao declínio, sendo o inverno o período de maior risco. As diferenças regionais permitem subsidiar os tomadores de decisões em relação à implementação de políticas públicas para reduzir a mortalidade cerebrovascular.

The effect of ambient temperature on blood pressure of patients undergoing hemodialysis in the Pantanal-Brazil.

The objective was to analyze the association of changes in pre-dialysis systolic and diastolic blood pressure with air temperature in a municipality in the Brazilian Pantanal, a tropical climate area. Longitudinal panel study, with analysis of mixed effects models of 133 hemodialysis patients in the city of Cáceres-Mato Grosso in 2014. Air temperature showed an inverse association with pre-dialysis systolic and diastolic blood pressure. With each increase of 1 °C in the mean air temperature, the pre-dialysis systolic blood pressure decreases -0.730mmHg (p ≤ 0.000) and the pre-dialysis diastolic blood pressure decreases -0.280mmHg (p ≤ 0.000). The estimated effect was greater for systolic blood pressure, but both pre-dialysis blood pressure measures are reduced with an increase in lag (up to two days), even when adjusted for relative air humidity. Air temperature is determinant for changes in pre-dialysis systolic and diastolic blood pressure in hemodialysis patients. The temperature effect was greater for systolic blood pressure than for diastolic blood pressure.

Port and industrial compound of Pecém: an epidemiological survey. / Complexo industrial e portuário do Pecém: um inquérito epidemiológico.

This research aimed to analyze the dwellers' knowledge of the territories, Pecém Port and Industrial Compound (CIPP), the quality of life of the communities living in the vicinity of the enterprises, and the prevalence of hypertension and overweight. This is a home-based, epidemiological survey of four areas of the Family Health Strategy (ESF) in São Gonçalo do Amarante and one area of the ESF in Caucaia, Ceará, Brazil. The study was carried out between 10/2017 and 03/2018. Anthropometric and blood pressure measurements were performed, and sociodemographic data and knowledge about community, the CIPP, and quality of life were collected. A total of 69.8% of the 503 adults interviewed were female, and the mean age was 44 years. Parada was the area reporting the highest percentage of problems related to air particles (51.1%), the worst concept regarding the CIPP (40.1% bad), the highest percentage of worse quality of life (29, 1%), and greater desire to move to another place (31.5%). Pecém had the highest percentage of community problems related to violence, consumption of illicit drugs, and prostitution. We concluded that there are signs of impact on local populations' health and quality of life without more significant direct work/income benefits.

Esta pesquisa busca analisar o conhecimento dos moradores sobre o território, Complexo Industrial e Portuário do Pecém (CIPP), qualidade de vida das comunidades que vivem no entorno dos empreendimentos, além da prevalência de hipertensão e excesso de peso. Trata-se de um inquérito epidemiológico, de base domiciliar, envolvendo quatro áreas da Estratégia de Saúde da Família (ESF) do Município de São Gonçalo do Amarante e uma de Caucaia, Ceará, Brasil. O estudo foi realizado entre 10/2017 e 03/2018, em que foram realizadas aferições antropométricas e pressão arterial e coletados dados sociodemográficos e o conhecimento sobre comunidade, CIPP e qualidade de vida. Dos 503 adultos entrevistados, 69,8% eram do sexo feminino e a média de idade foi 44 anos. Parada foi a área que relatou o maior percentual de problemas relacionados às partículas aéreas (51,1%), pior conceito em relação ao CIPP (40,1% ruim), maior percentual de piora da qualidade de vida (29,1%) e maior desejo de mudar (31,5%). Pecém apresentou maior percentual de problemas na comunidade relacionados à violência, consumo de drogas ilícitas e prostituição. Conclui-se que se apresenta indícios de impacto na saúde e qualidade de vida das populações locais sem maiores benefícios diretos no trabalho/renda.

Mortality Risk from Respiratory Diseases Due to Non-Optimal Temperature among Brazilian Elderlies.

Over the past decade, Brazil has experienced and continues to be impacted by extreme climate events. This study aims to evaluate the association between daily average temperature and mortality from respiratory disease among Brazilian elderlies. A daily time-series study between 2000 and 2017 in 27 Brazilian cities was conducted. Data outcomes were daily counts of deaths due to respiratory diseases in the elderly aged 60 or more. The exposure variable was the daily mean temperature from Copernicus ERA5-Land reanalysis. The association was estimated from a two-stage time series analysis method. We also calculated deaths attributable to heat and cold. The pooled exposure-response curve presented a J-shaped format. The exposure to extreme heat increased the risk of mortality by 27% (95% CI: 15-39%), while the exposure to extreme cold increased the risk of mortality by 16% (95% CI: 8-24%). The heterogeneity between cities was explained by city-specific mean temperature and temperature range. The fractions of deaths attributable to cold and heat were 4.7% (95% CI: 2.94-6.17%) and 2.8% (95% CI: 1.45-3.95%), respectively. Our results show a significant impact of non-optimal temperature on the respiratory health of elderlies living in Brazil. It may support proactive action implementation in cities that have critical temperature variations.

Complexo industrial e portuário do Pecém: um inquérito epidemiológico / Port and industrial compound of Pecém: an epidemiological survey

Resumo Esta pesquisa busca analisar o conhecimento dos moradores sobre o território, Complexo Industrial e Portuário do Pecém (CIPP), qualidade de vida das comunidades que vivem no entorno dos empreendimentos, além da prevalência de hipertensão e excesso de peso. Trata-se de um inquérito epidemiológico, de base domiciliar, envolvendo quatro áreas da Estratégia de Saúde da Família (ESF) do Município de São Gonçalo do Amarante e uma de Caucaia, Ceará, Brasil. O estudo foi realizado entre 10/2017 e 03/2018, em que foram realizadas aferições antropométricas e pressão arterial e coletados dados sociodemográficos e o conhecimento sobre comunidade, CIPP e qualidade de vida. Dos 503 adultos entrevistados, 69,8% eram do sexo feminino e a média de idade foi 44 anos. Parada foi a área que relatou o maior percentual de problemas relacionados às partículas aéreas (51,1%), pior conceito em relação ao CIPP (40,1% ruim), maior percentual de piora da qualidade de vida (29,1%) e maior desejo de mudar (31,5%). Pecém apresentou maior percentual de problemas na comunidade relacionados à violência, consumo de drogas ilícitas e prostituição. Conclui-se que se apresenta indícios de impacto na saúde e qualidade de vida das populações locais sem maiores benefícios diretos no trabalho/renda.

Abstract This research aimed to analyze the dwellers' knowledge of the territories, Pecém Port and Industrial Compound (CIPP), the quality of life of the communities living in the vicinity of the enterprises, and the prevalence of hypertension and overweight. This is a home-based, epidemiological survey of four areas of the Family Health Strategy (ESF) in São Gonçalo do Amarante and one area of the ESF in Caucaia, Ceará, Brazil. The study was carried out between 10/2017 and 03/2018. Anthropometric and blood pressure measurements were performed, and sociodemographic data and knowledge about community, the CIPP, and quality of life were collected. A total of 69.8% of the 503 adults interviewed were female, and the mean age was 44 years. Parada was the area reporting the highest percentage of problems related to air particles (51.1%), the worst concept regarding the CIPP (40.1% bad), the highest percentage of worse quality of life (29, 1%), and greater desire to move to another place (31.5%). Pecém had the highest percentage of community problems related to violence, consumption of illicit drugs, and prostitution. We concluded that there are signs of impact on local populations' health and quality of life without more significant direct work/income benefits.

Zika, dengue and chikungunya population prevalence in Rio de Janeiro city, Brazil, and the importance of seroprevalence studies to estimate the real number of infected individuals.

In the last 40 years, Latin America countries, including Brazil, have suffered from the emergence and reemergence of arboviruses, first Dengue (DENV) and recently Zika (ZIKV) and Chikungunya (CHIKV). All three arboviruses are currently endemic in Brazil and have caused major outbreaks in recent years. Rio de Janeiro city, host of the last Summer Olympic Games and the Football World Cup, has been specially affected by them. A surveillance system based on symptomatic reports is in place in Rio, but the true number of affected individuals is unknown due to the great number of Zika, Dengue and Chikungunya asymptomatic cases. Seroprevalence studies are more suitable to evaluate the real number of cases in a given population. We performed a populational seroprevalence survey in Rio, with recruitment of a sample of volunteers of all ages and gender from July to October 2018, within randomly selected census tracts and household. A total of 2,120 volunteers were interviewed and tested with rapid immunochromatographic test for ZIKV, DENV and CHIKV. Individuals with positive results for IgG and/or IgM from only one virus were classified accordingly, while those with test results positive for both ZIKV and DENV were classified as flaviviruses. We corrected for sample design and non-response in data analysis, and calculated point estimate prevalence and 95% confidence intervals for each virus. Arbovirus prevalence in the Rio's population (n = 6,688,927) was estimated at 48.6% [95% CI 44.8-52.4] (n = 3,254,121) for flaviviruses and at 18.0% [95% CI 14.8-21.2] (n = 1,204,765) for CHIKV. Approximately 17.0% [95% CI 14.1-20.1] (n = 1,145,674) of Rio´s population had no contact with any of the three arboviruses. The reported cases of Zika, Dengue and Chikungunya by the current surveillance system in place is insufficient to estimate their real numbers, and our data indicate that Zika seroprevalence could be at least five times and Chikungunya 45 times bigger. The high number of individuals having never been infected by any of the three arboviruses, may indicate a proper scenario for future outbreaks.

Acute effects of particulate matter and black carbon from seasonal fires on peak expiratory flow of schoolchildren in the Brazilian Amazon.

BACKGROUND: Panel studies have shown adverse effects of air pollution from biomass burning on children's health. This study estimated the effect of current levels of outdoor air pollution in the Amazonian dry season on peak expiratory flow (PEF). METHODS: A panel study with 234 schoolchildren from 6 to 15 years old living in the municipality of Tangará da Serra, Brazil was conducted. PEF was measured daily in the dry season in 2008. Mixed-effects models and unified modelling repeated for every child were applied. Time trends, temperature, humidity, and subject characteristics were regarded. Inhalable particulate matter (PM10), fine particulate matter (PM2.5), and black carbon (BC) effects were evaluated based on 24-hour exposure lagged by 1 to 5 days and the averages of 2 or 3 days. Polynomial distributed lag models (PDLM) were also applied. RESULTS: The analyses revealed reductions in PEF for PM10 and PM2.5 increases of 10 µg/m(3) and 1 µg/m(3) for BC. For PM10, the reductions varied from 0.15 (confidence interval (CI)95%: -0.29; -0.01) to 0.25 l/min (CI95%: -0.40; -0.10). For PM2.5, they ranged from 0.46 (CI95%: -0.86 to -0.06) to 0.54 l/min (CI95%:-0.95; -0.14). As for BC, the reduction was approximately 1.40 l/min. In relation to PDLM, adverse effects were noticed in models based on the exposure on the current day through the previous 3 days (PDLM 0-3) and on the current day through the previous 5 days (PDLM 0-5), specially for PM10. For all children, for PDLM 0-5 the global effect was important for PM10, with PEF reduction of 0.31 l/min (CI95%: -0.56; -0.05). Also, reductions in lags 3 and 4 were observed. These associations were stronger for children between 6 and 8 years old. CONCLUSION: Reductions in PEF were associated with air pollution, mainly for lagged exposures of 3 to 5 days and for younger children.

Estudo transversal dos fatores associados ao uso de corticoide inalatório em crianças residentes no município de Cuiabá, Estado de Mato Grosso, Brasil, 2010 / Cross-sectional study of factors associated with the use of inhaled corticosteroids in children living in the city of Cuiabá, state of Mato Grosso/Brazil, 2010

Objetivo: analisar os fatores associados ao uso de corticoide inalatório em crianças menores de cinco anos de idade. Métodos: estudo transversal, realizado com 733 crianças no município de Cuiabá, Estado de Mato Grosso, Brasil; foram estimadas as odds ratios (OR) brutas e ajustadas e intervalos de confiança de 95 por cento (IC95 por cento) por meio da regressão logística. Resultados: a prevalência de uso de corticoide inalatório nos últimos 12 meses foi de 13,2 por cento (IC95 por cento: 8,4-18,0 por cento); este uso foi associado à utilização de serviço privado de saúde (ORaj 4,62; IC95 por cento: 2,41-8,85), diagnóstico médico de asma (ORaj 3,97; IC95 por cento: 1,37-11,48), hospitalização por bronquite (ORaj 2,31; IC95 por cento: 1,04-5,12) e três ou mais episódios de sibilos nos últimos 12 meses (ORaj 2,78; IC95 por cento: 1,10-7,03). Conclusão: o uso de corticoide inalatório foi associado ao atendimento na rede privada de saúde, diagnóstico médico de asma e indicadores de gravidade de asma.

Objective: to analyse factors associated with inhaled corticosteroid use in children under 5 years old. Methods: cross-sectional study carried out in Cuiabá with a sample of 733 children. Crude odds ratios (OR) and adjusted odds ratios (ORaj) and Confidence Intervals (95 per cent CI) were estimated using logistic regression models. Results: the prevalence of inhaled corticosteroid use in the past 12 months was 13.2 per cent (95 per cent CI = 8.4; 18.0 per cent). It was associated with the use of private health services (ORaj = 4.62; 95 per cent CI = 2.41; 8.85), asthma diagnosed by a doctor (ORaj = 3.97; 95 per cent CI = 1.37; 11.48), bronchitis hospitalization (ORaj = 2.31; 95 per cent CI = 1.04; 5.12), and three or more wheezing episodes in the past 12 months (ORaj = 2.78; 95 per cent CI = 1.10; 7.03). Conclusion: the use of inhaled corticosteroids was associated with private health services, medical diagnosis of asthma and severe asthma indicators.

[Prevalence of wheezing and associated factors in children under 5 years of age in Cuiabá, Mato Grosso State, Brazil]. / Prevalência de sibilância e fatores associados em crianças menores de 5 anos de Cuiabá, Mato Grosso, Brasil.

Wheezing is highly prevalent in Brazil, with variations in rates and risk factors between the regions of the country. This cross-sectional study aimed to analyze the prevalence of wheezing in children under 5 years of age (n = 733) in Cuiabá, Mato Grosso State, Brazil. The study used a brief version of the standardized instrument from the International Study of Wheezing in Infants (EISL). Analysis of factors associated used logistic regression with a hierarchical approach. Prevalence of wheezing in the previous 12 months was 43.2%. Factors associated with wheezing were: lack of at least 6 months of breastfeeding (adjusted OR = 1.91; 95%CI: 1.18-3.06), diagnosis of asthma in the family (adjusted OR = 2.02; 95%CI: 1.06-3.87), current respiratory infection (adjusted OR = 1.81; 95%CI: 1.05-3.14), and male gender (adjusted OR = 1.50; 95%CI: 1.07-2.11). The study concludes that prevalence of wheezing is high among children in this age bracket in Cuiabá and is associated with factors related to allergy, current respiratory infection, and male gender.

Prevalência de sibilância e fatores associados em crianças menores de 5 anos de Cuiabá, Mato Grosso, Brasil / Prevalence of wheezing and associated factors in children under 5 years of age in Cuiabá, Mato Grosso State, Brazil / Prevalencia y factores asociados con sibilancias en niños menores de 5 años en Cuiabá, Mato Grosso, Brasil

A prevalência de sibilância no Brasil é elevada, com variações entre as regiões do país, bem como com fatores de risco diferenciados. Com o objetivo de analisar a prevalência de sibilância e fatores associados em menores de 5 anos em Cuiabá, Mato Grosso, Brasil, realizou-se estudo transversal, cuja amostra constou de 733 crianças. Foi utilizado o instrumento padronizado, resumido do Estudio Internacional de Sibilancias en Lactantes (EISL). Para análise dos fatores associados à sibilância foi aplicada regressão logística com abordagem hierarquizada. A prevalência de sibilância nos últimos 12 meses foi de 43,2%. Foram associados à sibilância: não amamentação ao seio por 6 meses ou mais (OR ajustada = 1,91; IC95%: 1,18-3,06), diagnóstico de asma familiar (OR ajustada = 2,02; IC95%: 1,06-3,87), doença prévia (OR ajustada = 1,81; IC95%: 1,05-3,14) e sexo masculino (OR ajustada = 1,50; IC95%: 1,07-2,11). Concluiu-se que a prevalência de sibilância em crianças dessa faixa etária em Cuiabá é elevada e está associada a fatores relacionados à provável atopia, doença prévia e sexo masculino.

Wheezing is highly prevalent in Brazil, with variations in rates and risk factors between the regions of the country. This cross-sectional study aimed to analyze the prevalence of wheezing in children under 5 years of age (n = 733) in Cuiabá, Mato Grosso State, Brazil. The study used a brief version of the standardized instrument from the International Study of Wheezing in Infants (EISL). Analysis of factors associated used logistic regression with a hierarchical approach. Prevalence of wheezing in the previous 12 months was 43.2%. Factors associated with wheezing were: lack of at least 6 months of breastfeeding (adjusted OR = 1.91; 95%CI: 1.18-3.06), diagnosis of asthma in the family (adjusted OR = 2.02; 95%CI: 1.06-3.87), current respiratory infection (adjusted OR = 1.81; 95%CI: 1.05-3.14), and male gender (adjusted OR = 1.50; 95%CI: 1.07-2.11). The study concludes that prevalence of wheezing is high among children in this age bracket in Cuiabá and is associated with factors related to allergy, current respiratory infection, and male gender.

La prevalencia de sibilancias en Brasil es alta, variando entre las distintas regiones del país y con factores de riesgo diferentes. Con el objetivo de analizar la prevalencia y los factores asociados con sibilancias en niños menores de 5 años en Cuiabá, Mato Grosso, Brasil, se llevó a cabo un estudio transversal, cuya muestra estuvo constituida por 733 niños. Utilizamos un instrumento estandarizado, resumido del Estudio Internacional de Sibilancias en Lactantes (EISL), con el fin de analizar los factores asociados con sibilancias se aplicó la regresión logística con un enfoque jerárquico. La prevalencia de sibilancias en los últimos 12 meses fue un 43,2%. Se asocia con las sibilancias: no lactancia durante un periodo de 6 meses o más (OR ajustada = 1,91; IC95%: 1,18-3,06), el diagnóstico de asma en familia (OR ajustada = 2,02; IC95%: 1,06-3,87), enfermedad previa (OR ajustada = 1,81; IC95%: 1,05-3,14) y el sexo masculino (OR ajustada = 1,50; IC95%: 1,07-2,11). Se concluye que la prevalencia de sibilancias en los niños de esta edad en Cuiabá es alta y se asocia a factores relacionados con el asma, enfermedad previa y sexo masculino.

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

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

Mortalidade por doenças cardiorrespiratórias em idosos no estado de Mato Grosso, 1986 a 2006 / Mortalidad por enfermedades cardiorrespiratorias en ancianos en el Estado de Mato Grosso, 1996 a 2006 / Mortality due to cardiorespiratory diseases in elderly people in Mato Grosso state, 1986 to 2006

OBJETIVO: Descrever a evolução temporal da mortalidade por doenças cardiorrespiratórias em idosos. MÉTODOS: Estudo epidemiológico descritivo com delineamento ecológico de séries temporais realizado no estado do Mato Grosso, de 1986 a 2006. Foram utilizados dados sobre doenças dos aparelhos respiratório e circulatório obtidos do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Modelos de regressão linear simples foram ajustados para avaliar a tendência das taxas específicas de mortalidade por grupos específicos de idade (60 a 69, 70 a 79 e 80 ou mais anos) e sexo. RESULTADOS: Houve aumento na proporção de óbitos por doenças respiratórias e diminuição por doenças cardiovasculares. Na comparação de taxas entre os sexos, as mulheres apresentaram taxas 15 por cento menores para as causas cardiovasculares e taxas similares ao sexo masculino para as causas respiratórias. Foi observada taxa elevada de mortalidade por doenças respiratórias e cardiovasculares, com importante tendência de incremento entre os grupos mais longevos. Em idosos com idade > 80 anos o aumento anual médio na taxa de mortalidade por doenças respiratórias foi de 1,99 óbitos e de 3,43 por doenças do aparelho circulatório. CONCLUSÕES: O estado de Mato Grosso apresenta elevada taxa de mortalidade por doenças respiratórias e cardiovasculares em idosos, com importante tendência de incremento entre os grupos mais longevos.

OBJETIVO: Describir la evolución temporal de la mortalidad por enfermedades cardiorrespiratorias en ancianos. MÉTODOS: Estudio epidemiológico descriptivo con delineamiento ecológico de series temporales realizado en el Estado de Mato Grosso, Centro-Oeste de Brasil, de 1986 a 2006. Se utilizaron datos sobre enfermedades de los aparatos respiratorio y circulatorio obtenidos del Sistema de Información sobre Mortalidad del Ministerio de la Salud. Modelos de regresión lineal simple fueron ajustados para evaluar la tendencia de las tasas específicas de mortalidad por grupos específicos de edad (60 a 69, 70 a 70 y 80 o más años) y sexo. RESULTADOS: Hubo aumento en la proporción de óbitos por enfermedades respiratorias y disminución por enfermedades cardiovasculares. En la comparación de tasas entre los sexos, las mujeres presentaron tasas 15% menores para las causas cardiovasculares y tasas similares al sexo masculino para las causas respiratorias Se observó tasa elevada de mortalidad por enfermedades respiratorias y cardiovasculares, con importante tendencia de incremento entre los grupos más longevos. En ancianos con edad ³80 años o aumento anual promedio en la tasa de mortalidad por enfermedades respiratorias fue de 1,99 óbitos y de 3,43 por enfermedades del aparato circulatorio.

Mortality due to cardiorespiratory diseases in elderly people in Mato Grosso state, 1986 to 2006.

OBJECTIVE: To describe time trends of mortality due to cardiorespiratory diseases in elderly people. METHODS: Epidemiological descriptive study with an ecological time series approach conducted in the state of Mato Grosso, Central-West Brazil, between 1986 and 2006. Data were obtained from the Brazilian Ministry of Health Mortality Database. Linear regression models were adjusted to analyze trends in mortality rates by age groups (60 to 69; 70 to 79; and 80 or more) and gender. RESULTS: There was an increase in proportion of deaths due to respiratory diseases and a decrease in proportion of deaths due to cardiovascular diseases. As for gender, cardiovascular rates were 15% lower in women than men and respiratory rates were similar in both men and women. High mortality rates for respiratory and cardiovascular diseases were observed with increasing trends among the oldest-old groups. The annual average increase for respiratory and cardiovascular diseases in those aged 80 years and older was 1.99 and 3.43 deaths, respectively. CONCLUSIONS: The state of Mato Grosso shows high mortality rates due to cardiorespiratory disease among elderly people with increasing trends among the oldest-old groups.

Wheezing in children and adolescents living next to a petrochemical plant in Rio Grande do Norte, Brazil.

OBJECTIVE: To examine the association between wheezing in children and adolescents and living downwind of the dispersion plume of atmospheric pollutants emitted by the Guamaré Petrochemical Complex, in the state of Rio Grande do Norte, Brazil. METHODS: Cross-sectional study of wheezing in children and adolescents (aged 0 to 14 years) living in the vicinity of the Guamaré petrochemical complex in 2006. The standardized International Study of Asthma and Allergies in Childhood questionnaire was used, with additional questions concerning tobacco use, income, living conditions, and educational achievement. Daily concentrations of PM10, PM2.5, black carbon, SO2, NO2, O3, benzene, toluene, and xylenes were measured at a fixed monitoring station. According to their position relative to wind direction, communities present in the area affected by plant emissions were categorized into one of two groups, exposed communities and reference communities. RESULTS: Two hundred and nine children and adolescents took part in the study. Mean daily concentrations of the monitored pollutants were consistently below established acceptable upper limits. The prevalence of wheezing in the 12 months prior to study was 27.3%. After adjustment, statistically significant associations were found between wheezing and living in exposed communities (adjusted odds ratio [ORadj] 2.01; 95% confidence interval [95%CI] 1.01-4.01), male gender (ORadj 2.50; 95%CI 1.21-5.18), and age 0 to 6 years (ORadj 5.00; 95%CI 2.41-10.39). CONCLUSION: Even with low levels of atmospheric pollutants, respiratory symptoms in children and adolescents were associated with living downwind of a petrochemical plant. Male preschoolers were the most vulnerable group.

Sibilância em crianças e adolescentes vizinhos a uma indústria petroquímica no Rio Grande do Norte, Brasil / Wheezing in children and adolescents living next to a petrochemical plant in Rio Grande do Norte, Brazil

OBJETIVO: Verificar a associação entre relato de sibilância em crianças e adolescentes e o local de residência em relação à dispersão dos poluentes atmosféricos emitidos pelo Pólo Petroquímico (PPQ) de Guamaré (RN). MÉTODOS: Estudo transversal de relato de sibilância em crianças e adolescentes de 0 a 14 anos de idade, residentes no entorno do PPQ de Guamaré, em 2006. Foi utilizado o questionário padronizado do International Study of Asthma and Allergies in Childhood, acrescido de questões relativas ao tabagismo, renda, moradia e escolaridade. Concentrações diárias de PM10, PM2,5, carbono grafítico, SO2, NO2, O3, benzeno, tolueno e xilenos foram medidas em uma estação de monitoramento fixa. As comunidades residentes na área de influência das emissões do PPQ foram classificadas, segundo a direção preferencial dos ventos, em expostas e de referência. RESULTADOS: Participaram do estudo 209 crianças e adolescentes. As concentrações médias diárias dos poluentes monitorados mantiveram-se abaixo dos limites estabelecidos nos padrões de qualidade do ar. A prevalência de sibilos nos últimos 12 meses foi de 27,3 por cento. Associações estatisticamente significantes com sibilos nos últimos 12 meses foram verificadas mesmo após ajustamentos para comunidades expostas [razão de chances (odds ratio, ORajust) = 2,01; intervalo de confiança de 95 por cento (IC95 por cento) 1,01-4,01], gênero masculino (ORajust = 2,50; IC95 por cento 1,21-5,18) e idade de 0 a 6 anos (ORajust = 5,00; IC95 por cento 2,41-10,39). CONCLUSÃO: Mesmo em baixas concentrações de poluentes atmosféricos, a ocorrência de sintomas respiratórios em crianças e adolescentes nas comunidades no entorno de um PPQ esteve associada a residência na direção preferencial dos ventos, mostrando-se mais vulnerável o grupo de pré-escolares do gênero masculino.

OBJECTIVE: To examine the association between wheezing in children and adolescents and living downwind of the dispersion plume of atmospheric pollutants emitted by the Guamaré Petrochemical Complex, in the state of Rio Grande do Norte, Brazil. METHODS: Cross-sectional study of wheezing in children and adolescents (aged 0 to 14 years) living in the vicinity of the Guamaré petrochemical complex in 2006. The standardized International Study of Asthma and Allergies in Childhood questionnaire was used, with additional questions concerning tobacco use, income, living conditions, and educational achievement. Daily concentrations of PM10, PM2.5, black carbon, SO2, NO2, O3, benzene, toluene, and xylenes were measured at a fixed monitoring station. According to their position relative to wind direction, communities present in the area affected by plant emissions were categorized into one of two groups, exposed communities and reference communities. RESULTS: Two hundred and nine children and adolescents took part in the study. Mean daily concentrations of the monitored pollutants were consistently below established acceptable upper limits. The prevalence of wheezing in the 12 months prior to study was 27.3 percent. After adjustment, statistically significant associations were found between wheezing and living in exposed communities (adjusted odds ratio [ORadj] 2.01; 95 percent confidence interval [95 percentCI] 1.01-4.01), male gender (ORadj 2.50; 95 percentCI 1.21-5.18), and age 0 to 6 years (ORadj 5.00; 95 percentCI 2.41-10.39). CONCLUSION: Even with low levels of atmospheric pollutants, respiratory symptoms in children and adolescents were associated with living downwind of a petrochemical plant. Male preschoolers were the most vulnerable group.

Comunidade pomerana e uso de agrotóxicos: uma realidade pouco conhecida / Pomeranian community and the use of pesticides: an unknown reality

O objetivo deste trabalho foi caracterizar socioeconomicamente a comunidade pomerana do Alto Santa Maria, localizada no município de Santa Maria de Jetibá (ES) e investigar os principais fatores de exposição aos agrotóxicos. Trata-se de um estudo transversal realizado a partir de um questionário semi-estruturado, reunindo informações de 151 famílias. A análise foi baseada em estatísticas descritivas e modelos de regressão logística. Os resultados revelaram que a maioria dos membros da comunidade é o proprietário da terra. A participação das crianças nas atividades agrícolas é uma tradição da cultura pomerana. O uso de agrotóxicos nas lavouras nesta comunidade começou na década de oitenta e, desde então, diferentes tipos de agrotóxicos são frequentemente usados pela população rural. Os modelos de regressão logística que associam a presença de algum problema de saúde com o tipo de limpeza da terra, uso de agrotóxicos, frequência de aplicação dos agrotóxicos e uso de equipamento de proteção mostraram que a chance de um indivíduo apresentar algum problema de saúde está relacionada com o uso de agrotóxicos e o grau de escolaridade é um fator importante para o uso de equipamentos de proteção. A comunidade pomerana estudada possui hábitos culturais que contribuem para a exposição aos agrotóxicos.

The objective of this article is to characterize social and economically the Pomeranian community from "Alto Santa Maria" in the municipality of Santa Maria de Jetibá at Espírito Santo State and investigate the main factors of pesticides exposure in rural community. A cross-sectional study was carried out interviewing 151 members of a rural Pomeranian community using a semi-structured questionnaire. The analysis was based in descriptive statistics and logistics regression models. The results revealed that the majority of the community members own their land. The child participation in agricultural activities is a tradition in the Pomeranian culture. The use of pesticides by this community began in the 80s since then; different types of pesticides have frequently been used by rural residents. The logistic regression models that associate the presence of some health problem with how the land is cleaned, pesticides usage, pesticides application frequency and the use of protection equipment, showed that the chance of an individual to present some health problem is related with the use of pesticides. Another regression model showed that the education level is an important factor to the use of protection equipment. The Pomeranian community studied has some cultural habits that contribute for the exposure of pesticides.

Trend in mortality due to external causes in the State of Espírito Santo, Brazil, from 1994 to 2005 / Evolução da mortalidade por causas externas no estado do Espírito Santo, Brasil, no período de 1994 a 2005

The aim of this study was to analyze the trend in mortality due to external causes in the State of Espírito Santo, Brazil, from 1994 to 2005, according to specific groups (traffic injuries, poisoning, intentional self-harm, assault), age group and gender. The trend analysis was performed with polynomial regression models, based on data from the Brazilian Ministry of Health's Mortality Information System. For all external causes, the trend was not statistically significant, but when it was stratified by gender and age group the results showed a downward trend in some strata. According to gender, the yearly increase in mortality rate was higher for men. In general, this increase was observed in all age groups. For traffic injuries, there was a decrease in the mortality rate, mainly for men. There was a decrease in deaths from poisoning for both men and women. Intentional self-harm showed an upward trend, especially for 50 and over age group. As a specific group, assault also showed a significant upward trend for under-34 age groups and for men.

O presente estudo tem como objetivo analisar a tendência da mortalidade por causas externas no estado do Espírito Santo, Brasil, durante o período de 1994 a 2005, por seus grupos específicos (acidentes de transporte, envenenamento e intoxicação, lesões autoprovocadas voluntariamente, agressões), faixa etária e sexo. A análise da tendência foi realizada através de modelos de regressão polinomial, com base no Sistema de Informação sobre Mortalidade (SIM) do Ministério da Saúde. As causas externas de mortalidade não apresentaram tendência significativa, porém quando estratificados por faixa etária e sexo os resultados mostraram tendência decrescente em alguns estratos. Em todas as faixas etárias, a taxa de mortalidade foi maior nos homens. Entre o grupo de acidentes de transporte houve um decréscimo na taxa de mortalidade, principalmente nos homens. Houve redução nos óbitos referentes a envenenamento e intoxicação, tanto para o sexo feminino quanto para o masculino. As lesões autoprovocadas voluntariamente apresentaram tendência crescente principalmente para a faixa etária de 50 anos e mais. O grupo específico das agressões apresentou tendência de crescimento significativa para a faixa etária até 34 anos e para os homens.

[Pomeranian community and the use of pesticides: an unknown reality]. / Comunidade pomerana e uso de agrotóxicos: uma realidade pouco conhecida.

The objective of this article is to characterize social and economically the Pomeranian community from 'Alto Santa Maria' in the municipality of Santa Maria de Jetibá at Espírito Santo State and investigate the main factors of pesticides exposure in rural community. A cross-sectional study was carried out interviewing 151 members of a rural Pomeranian community using a semi-structured questionnaire. The analysis was based in descriptive statistics and logistics regression models. The results revealed that the majority of the community members own their land. The child participation in agricultural activities is a tradition in the Pomeranian culture. The use of pesticides by this community began in the 80s since then; different types of pesticides have frequently been used by rural residents. The logistic regression models that associate the presence of some health problem with how the land is cleaned, pesticides usage, pesticides application frequency and the use of protection equipment, showed that the chance of an individual to present some health problem is related with the use of pesticides. Another regression model showed that the education level is an important factor to the use of protection equipment. The Pomeranian community studied has some cultural habits that contribute for the exposure of pesticides.