RESUMO
Objectives: This study aims to estimate the short-term preventable mortality and associated economic costs of complying with the World Health Organization (WHO) air quality guidelines (AQGs) limit values for PM10 and PM2.5 in nine major Latin American cities. Methods: We estimated city-specific PM-mortality associations using time-series regression models and calculated the attributable mortality fraction. Next, we used the value of statistical life to calculate the economic benefits of complying with the WHO AQGs limit values. Results: In most cities, PM concentrations exceeded the WHO AQGs limit values more than 90% of the days. PM10 was found to be associated with an average excess mortality of 1.88% with concentrations above WHO AQGs limit values, while for PM2.5 it was 1.05%. The associated annual economic costs varied widely, between US$ 19.5 million to 3,386.9 million for PM10, and US$ 196.3 million to 2,209.6 million for PM2.5. Conclusion: Our findings suggest that there is an urgent need for policymakers to develop interventions to achieve sustainable air quality improvements in Latin America. Complying with the WHO AQGs limit values for PM10 and PM2.5 in Latin American cities would substantially benefits for urban populations.
Assuntos
Poluição do Ar , Cidades , Material Particulado , Organização Mundial da Saúde , Material Particulado/análise , Material Particulado/economia , Humanos , América Latina , Poluição do Ar/economia , Poluição do Ar/prevenção & controle , Poluição do Ar/análise , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/economia , Mortalidade , Exposição Ambiental/prevenção & controle , Exposição Ambiental/economiaRESUMO
Background: Precipitation could affect the transmission of diarrheal diseases. The diverse precipitation patterns across different climates might influence the degree of diarrheal risk from precipitation. This study determined the associations between precipitation and diarrheal mortality in tropical, temperate, and arid climate regions. Methods: Daily counts of diarrheal mortality and 28-day cumulative precipitation from 1997 to 2019 were analyzed across 29 locations in eight middle-income countries (Argentina, Brazil, Costa Rica, India, Peru, the Philippines, South Africa, and Thailand). A two-stage approach was employed: the first stage is conditional Poisson regression models for each location, and the second stage is meta-analysis for pooling location-specific coefficients by climate zone. Results: In tropical climates, higher precipitation increases the risk of diarrheal mortality. Under extremely wet conditions (95th percentile of 28-day cumulative precipitation), diarrheal mortality increased by 17.8% (95% confidence interval [CI] = 10.4%, 25.7%) compared with minimum-risk precipitation. For temperate and arid climates, diarrheal mortality increases in both dry and wet conditions. In extremely dry conditions (fifth percentile of 28-day cumulative precipitation), diarrheal mortality risk increases by 3.8% (95% CI = 1.2%, 6.5%) for temperate and 5.5% (95% CI = 1.0%, 10.2%) for arid climates. Similarly, under extremely wet conditions, diarrheal mortality risk increases by 2.5% (95% CI = -0.1%, 5.1%) for temperate and 4.1% (95% CI = 1.1%, 7.3%) for arid climates. Conclusions: Associations between precipitation and diarrheal mortality exhibit variations across different climate zones. It is crucial to consider climate-specific variations when generating global projections of future precipitation-related diarrheal mortality.
RESUMO
Objective: To evaluate changes in RSV seasonality in the last 25 years and their correlation with the mean annual temperature. Methods: Cross-sectional study, based on RSV and temperature data from the City of Buenos Aires (1995-2019). For each year, we describe the beginning, end, and duration of the RSV season and the correlation with the mean annual temperature. Results: We identified 10,183 RSV infections. The duration of the RSV season decreased significantly (1995: 29 weeks vs. 2019: 18 weeks; R: 0.6 (p< 0.001)), due to an earlier ending (1995: week 45 vs. 2019: week 34; 0.6 (p<0.001)). No correlation was observed between mean annual temperature and the duration, start, or end of the RSV season. Conclusion: In the last 25 years, the duration of the RSV season has been significantly shortened due to an earlier ending, without correlation with temperature.
Introducción: El cambio climático global podría alterar la circulación del virus sincicial respiratorio (VSR). Objetivo: Evaluar modificaciones en la circulación de VSR en los últimos 25 años y su correlación con la temperatura ambiente. Métodos: Estudio transversal, utilizando registros de VSR y temperatura de la Ciudad de Buenos Aires (1995-2019). Para cada año, describimos inicio, fin y duración de la temporada de VSR y evaluamos su correlación con la temperatura media anual. Resultados: Se identificaron 10183 infecciones por VSR. La duración de la temporada disminuyó significativamente (1995: 29 semanas vs. 2019: 18 semanas; R: 0.6 (p< 0,001)), debido a una finalización más precoz (1995: semana 45 vs. 2019: semana 34; 0,6 (p<0,001)). No se observó correlación entre temperatura media anual y duración, comienzo ni finalización de la temporada de VSR. Conclusión: En los últimos 25 años, la duración de la temporada de VSR se acortó significativamente, sin correlación con la temperatura.
Assuntos
Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Humanos , Lactente , Temperatura , Estudos Transversais , Infecções por Vírus Respiratório Sincicial/epidemiologia , Estações do AnoRESUMO
Introducción: La contaminación del aire incrementaría el riesgo de infección respiratoria aguda (IRA) en pediatría. Objetivo: evaluar el impacto de la contaminación del aire en las consultas por IRA realizadas en efectores del Gobierno de la Ciudad de Buenos Aires. Método: estudio ecológico, de series temporales. Fuentes de información: Agencia de Protección Ambiental, Servicio Meteorológico Nacional e Historia de Salud Integral del Sistema de Gestión Hospitalaria. Población: Pacientes menores de 2 años que consultaron por IRA a un efector del GCBA y que residían en una comuna con monitoreo ambiental continuo, durante el 2018. Variables de predicción: Niveles diarios de CO, NO2, PM10 de las estaciones de monitoreo ambiental continuo de la Ciudad Autónoma de Buenos Aires. Variables de resultado: número de consultas totales y por IRA. Variables a controlar: efector, sexo y temperatura media. Se construyó una definición operativa para seleccionar en la base de datos a las consultas objeto de estudio. Resultados: Se registraron 80.287 consultas, 24.847 por IRA (30%). Las consultas por IRA tuvieron correlación positiva en la estación "Córdoba" con el N2O (RR: 1,13 [1,00-1,28]). El número de consultas por IRA en los meses fríos fue mayor que en los cálidos (19,9% vs 11,9%; RR:1,67 [1,61-1,72]). Conclusión: Los valores promedios de PM10 y N2O muestran correlación con el número de las consultas totales y por infección respiratoria aguda, respectivamente. Las consultas se incrementaron durante el invierno.
Assuntos
Encaminhamento e Consulta , Humanos , Criança , Lactente , Estudos RetrospectivosRESUMO
Introduction: Air pollution would increase the risk of severe infection repiratory in pediatrics. Research Sources: Environmental Protection Agency, National Meteorological. Service and Integral Health History of the Hospital Management System. Population: Patients under 2 years old who consulted for severe infection repiratory in effectors of Buenos Aires City Government and lived commune with continuous environmental monitoring during 2018. Predictors were daily levels of air pollutants (carbon monoxide, nitrous dioxide, particulate matter < 10 µ). Pollutants were measured at three monitoring stations. Temporal variables (media temperature), sex and effector were controlled. Result Variable: Total numbers of visits and total numbers of visits for severe infection respiratory. To select in the data base the visits to analyze an operative definition was made. Objective: Review impact of air pollution visits for severe infection repiratory in effectors of Buenos Aires City Government. Method: Ecologic research, time-series. Results: 80.287 visits were registered, 24.847 for severe infection respiratory (30%). The visits for severe infection respiratory had positive correlation in Cordoba station with N2O (RR: 1,13 [1,00-1,28]). The numbers of visits for severe infection respiratory was higher during cold months than warm months. (19,9% vs 11,9%; RR:1,67 [1,61-1,72]). Conclusion: average values of PM10 and N2O show correlation with the numbers of total visits and visits for severe infection respiratory. The visits increase during winter.
Introducción: La contaminación del aire incrementaría el riesgo de infección respiratoria aguda (IRA) en pediatría. Objetivo: evaluar el impacto de la contaminación del aire en las consultas por IRA realizadas en efectores del Gobierno de la Ciudad de Buenos Aires. Método: Estudio ecológico, de series temporales. Fuentes de información: Agencia de Protección Ambiental, Servicio Meteorológico Nacional e Historia de Salud Integral del Sistema de Gestión Hospitalaria. Población: Pacientes menores de 2 años que consultaron por IRA a un efector del GCBA y que residían en una comuna con monitoreo ambiental continuo, durante el 2018. Variables de predicción: Niveles diarios de CO, NO2, PM10 de las estaciones de monitoreo ambiental continuo de la Ciudad Autónoma de Buenos Aires. Variables de resultado: número de consultas totales y por IRA. Variables a controlar: efector, sexo y temperatura media. Se construyó una definición operativa para seleccionar en la base de datos a las consultas objeto de estudio. Resultados: Se registraron 80.287 consultas, 24.847 por IRA (30%). Las consultas por IRA tuvieron correlación positiva en la estación "Córdoba" con el N2O (RR: 1,13 [1,00-1,28]). El número de consultas por IRA en los meses fríos fue mayor que en los cálidos (19,9% vs 11,9%; RR:1,67 [1,61-1,72]). Conclusión: Los valores promedios de PM10 y N2O muestran correlación con el número de las consultas totales y por infección respiratoria aguda, respectivamente. Las consultas se incrementaron durante el invierno.
Assuntos
Encaminhamento e Consulta , Humanos , Criança , Lactente , Estudos RetrospectivosRESUMO
Introduction. Health care strategies based on information and communication technologies (ICTs) may perpetuate health inequity, especially among vulnerable populations. In our setting, there are few validated tools to assess access to ICTs in pediatrics. Objectives. To develop and validate a questionnaire to assess ICT access among caregivers of pediatric patients. To describe the characteristics of ICT access and assess whether there is a correlation among the three levels of the digital divide. Population and methods. We developed and validated a questionnaire and then administered it to the caregivers of children aged 0-12 years. The outcome variables were the questions in the three levels of the digital divide. We also assessed sociodemographic variables. Results. We administered the questionnaire to 344 caregivers. Among them, 93% had their own cell phone and 98.3% had Internet access via a data network; 99.1% communicated via WhatsApp messages; 28% had had a teleconsultation. The correlation among the questions was null or low. Conclusion. The validated questionnaire allowed us to establish that the caregivers of pediatric patients aged 0-12 years mostly own a mobile phone, access the Internet via a data network, communicate mainly through WhatsApp, and obtain few benefits through ICTs. The correlation among the different components of ICT access was low.
Introducción. Las estrategias sanitarias basadas en tecnologías de la información y la comunicación (TIC) podrían perpetuar la inequidad en salud, especialmente en poblaciones vulnerables. Existen escasas herramientas validadas para evaluar el acceso a las TIC en pediatría en nuestro medio. Objetivos. Construir y validar un cuestionario para evaluar el acceso a las TIC para cuidadores de pacientes pediátricos. Describir las características de acceso a las TIC y evaluar si existe correlación entre los tres niveles de la brecha digital. Población y métodos. Construimos y validamos un cuestionario que luego administramos a cuidadores de niños entre 0 y 12 años. Las variables de resultado fueron las preguntas del cuestionario para los tres niveles de brecha digital. Además, evaluamos variables sociodemográficas. Resultados. Administramos el cuestionario a 344 cuidadores. El 93 % poseía celular propio y el 98,3 % utilizaba internet por red de datos. El 99,1 % se comunicaba a través de mensajes de WhatsApp. El 28 % había realizado una teleconsulta. La correlación entre las preguntas fue nula o baja. Conclusión. Por medio del cuestionario validado, evaluamos que los cuidadores de pacientes pediátricos de 0 a 12 años poseen en su mayoría celular, se conectan por red de datos, se comunican principalmente a través de WhatsApp y obtienen pocos beneficios a través de TIC. La correlación entre los diferentes componentes del acceso a las TIC fue baja.
Assuntos
Telefone Celular , Exclusão Digital , Humanos , Criança , Cuidadores , Comunicação , Inquéritos e Questionários , InternetRESUMO
BACKGROUND: Collective risk factors such as climate and pollution impact on the risk of acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). There is limited data however on the precise temporal and independent association between these factors and STEMI, and the potentially interacting role of government policies against Coronavirus disease 2019 (COVID-19), especially for Latin America. METHODS: We retrospectively collected aggregate data on daily STEMI admissions at 10 tertiary care centers in the Buenos Aires metropolitan area, Argentina, from January 1, 2017 to November 30, 2020. Daily measurements for temperature, humidity, atmospheric pressure, wind direction, wind speed, and rainfall, as well as carbon monoxide (CO), nitrogen dioxide, and particulate matter <10 µm (PM10), were retrieved. Exploratory analyses focused on key COVID-19-related periods (e.g. first case, first lockdown), and Stringency Index quantifying the intensity of government policy response against COVID-19. RESULTS: A total of 1498 STEMI occurred over 1430 days, for an average of 0.12 STEMI per center (decreasing from 0.130 in 2018 to 0.102 in 2020, P=0.016). Time series analysis showed that lower temperature and higher concentration of CO and PM10 were all significantly associated with an increased rate of STEMI (all P<0.05), whereas COVID-19 outbreak, lockdown, and stringency of government policies were all inversely associated with STEMI (all P<0.05). Notably, environmental features impacted as early as 28 days before the event (all P<0.05), even if same or prior day associations proved stronger (all P<0.05). Multivariable analysis suggested that maximum temperature (P=0.001) and PM10 (P=0.033) were the strongest predictor of STEMI, even after accounting for COVID-19-related countermeasures (P=0.043). CONCLUSIONS: Lower temperature and higher concentrations of CO and PM10 are associated with significant increases in the rate of STEMI in a large Latin American metropolitan area. The reduction in STEMI cases seen during the COVID-19 pandemic is at least in part mediated by improvements in pollution, especially reductions in PM10.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , COVID-19/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/induzido quimicamente , Estudos Retrospectivos , Pandemias , Controle de Doenças Transmissíveis , Material ParticuladoRESUMO
Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days' minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: -0.33 to 1.69), 1.34% (95% CI: -0.14 to 2.73), 1.99% (95% CI: 0.29-3.57), and 2.73% (95% CI: 0.76-4.50) of total deaths for Q1-Q4 (first quartile-fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25-9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: -0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health.
RESUMO
Background: Due to ambiguities in terminology, acute lower respiratory infections (ALRI) in childhood are frequently not properly recorded, especially during outpatient visits. A tool that accurately identifies them, would assess the impact on respiratory health of massive harms, and design policies to prevent or mitigate their effects. We aimed to design an algorithm that allows identifying children with ALRI based on data from the electronic clinical record (ECR) of the Government of the City of Buenos Aires (GCBA). Methods: From the ECR-GCBA database, we randomly selected 1000 outpatient visits of patients aged under 2 years. Terms showing that the visit was due to LARI were searched using an algorithm based on hard rules. Another dataset including 800 visits was used to adjust the algorithm and, finally, its performance was tested in a third dataset of 800 queries corresponding to the entire year 2018. Results: In the validation set, our tool identified LARI with sensitivity 88.24%, specificity 97.5%, PPV 86.07% and NPV 97.93%. Conclusion: Our search algorithm allows us to identify with acceptable precision the outpatient visits related to LARI in children under 2 years of age from electronic clinical records.
Introducción: Debido a ambigüedades en la nomenclatura, las infecciones respiratorias agudas bajas (IRAB) en la infancia frecuentemente no son debidamente registradas, especialmente durante las consultas ambulatorias. Contar con una herramienta que las identifique con precisión, permitirá evaluar el impacto en la salud respiratoria de noxas de alcance masivo y diseñar las políticas para prevenirlas o mitigar sus efectos. Nuestro objetivo fue construir un algoritmo que permita identificar niños con IRAB a partir de los datos de la historia clínica electrónica (HCE) del Gobierno de la Ciudad de Buenos Aires (GCBA). Métodos: Utilizando la HCE-GCBA, se seleccionaron aleatoriamente 1000 consultas ambulatorias de pacientes menores de 2 años. Se buscaron términos que hicieran referencia a que la consulta era motivada por IRAB, con los que se desarrolló un algoritmo basado en reglas duras. Se utilizó otro set de datos de 800 consultas para ajustar el algoritmo y, finalmente, se validó su desempeño en un tercer set de 800 consultas correspondientes a todo el año 2018. Resultados: En el set de validación, la herramienta desarrollada identificó IRAB con sensibilidad 88,24%, especificidad 97,5%, VPP 86,07% y VPN 97,93%. Conclusión: El algoritmo de búsqueda desarrollado permite identificar con aceptable precisión las consultas ambulatorias relacionadas con IRAB en niños menores de 2 años.
Assuntos
Algoritmos , Pediatria , Criança , Eletrônica , Humanos , Encaminhamento e ConsultaRESUMO
BACKGROUND: Minimum mortality temperature (MMT) is an important indicator to assess the temperature-mortality association, indicating long-term adaptation to local climate. Limited evidence about the geographical variability of the MMT is available at a global scale. METHODS: We collected data from 658 communities in 43 countries under different climates. We estimated temperature-mortality associations to derive the MMT for each community using Poisson regression with distributed lag nonlinear models. We investigated the variation in MMT by climatic zone using a mixed-effects meta-analysis and explored the association with climatic and socioeconomic indicators. RESULTS: The geographical distribution of MMTs varied considerably by country between 14.2 and 31.1 °C decreasing by latitude. For climatic zones, the MMTs increased from alpine (13.0 °C) to continental (19.3 °C), temperate (21.7 °C), arid (24.5 °C), and tropical (26.5 °C). The MMT percentiles (MMTPs) corresponding to the MMTs decreased from temperate (79.5th) to continental (75.4th), arid (68.0th), tropical (58.5th), and alpine (41.4th). The MMTs indreased by 0.8 °C for a 1 °C rise in a community's annual mean temperature, and by 1 °C for a 1 °C rise in its SD. While the MMTP decreased by 0.3 centile points for a 1 °C rise in a community's annual mean temperature and by 1.3 for a 1 °C rise in its SD. CONCLUSIONS: The geographical distribution of the MMTs and MMTPs is driven mainly by the mean annual temperature, which seems to be a valuable indicator of overall adaptation across populations. Our results suggest that populations have adapted to the average temperature, although there is still more room for adaptation.
RESUMO
BACKGROUND: Various retrospective studies have reported on the increase of mortality risk due to higher diurnal temperature range (DTR). This study projects the effect of DTR on future mortality across 445 communities in 20 countries and regions. METHODS: DTR-related mortality risk was estimated on the basis of the historical daily time-series of mortality and weather factors from Jan 1, 1985, to Dec 31, 2015, with data for 445 communities across 20 countries and regions, from the Multi-Country Multi-City Collaborative Research Network. We obtained daily projected temperature series associated with four climate change scenarios, using the four representative concentration pathways (RCPs) described by the Intergovernmental Panel on Climate Change, from the lowest to the highest emission scenarios (RCP 2.6, RCP 4.5, RCP 6.0, and RCP 8.5). Excess deaths attributable to the DTR during the current (1985-2015) and future (2020-99) periods were projected using daily DTR series under the four scenarios. Future excess deaths were calculated on the basis of assumptions that warmer long-term average temperatures affect or do not affect the DTR-related mortality risk. FINDINGS: The time-series analyses results showed that DTR was associated with excess mortality. Under the unmitigated climate change scenario (RCP 8.5), the future average DTR is projected to increase in most countries and regions (by -0·4 to 1·6°C), particularly in the USA, south-central Europe, Mexico, and South Africa. The excess deaths currently attributable to DTR were estimated to be 0·2-7·4%. Furthermore, the DTR-related mortality risk increased as the long-term average temperature increased; in the linear mixed model with the assumption of an interactive effect with long-term average temperature, we estimated 0·05% additional DTR mortality risk per 1°C increase in average temperature. Based on the interaction with long-term average temperature, the DTR-related excess deaths are projected to increase in all countries or regions by 1·4-10·3% in 2090-99. INTERPRETATION: This study suggests that globally, DTR-related excess mortality might increase under climate change, and this increasing pattern is likely to vary between countries and regions. Considering climatic changes, our findings could contribute to public health interventions aimed at reducing the impact of DTR on human health. FUNDING: Korea Ministry of Environment.
Assuntos
Mudança Climática/mortalidade , Mortalidade/tendências , Temperatura , Cidades , Temperatura Baixa/efeitos adversos , Saúde Global , Temperatura Alta/efeitos adversos , Humanos , Modelos Lineares , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Fatores de TempoRESUMO
This study aimed to analyze mortality during heat waves in the city of Buenos Aires, Argentina, in 2005-2015. We used a time series design with generalized additive models, linking mortality to days of heat waves throughout the period, and to days of the heat wave in 2013, the longest wave since 1906, controlling for time variables, mean temperature, and humidity. Risk of death from natural causes increased by 14% (RR = 1.140; 95%CI: 1.108-1.173) during heat waves when compared to the other days in the hot season. The increase occurred in both sexes and in all age groups, and individuals under 15 years of age were more affected (RR = 1.167; 95%CI: 1.019-1.335) as were those over 84 years (RR = 1.201; 95%CI: 1.098-1.313). The heat wave in December 2013 showed an increase of 43% (RR = 1.428; 95%CI: 1.399-1.457) in total daily deaths, increasing to 51% in individuals over 84 years (RR = 1.515; 95%CI: 1.372-1.674) and 65% (RR = 1.647; 95%CI: 1.367-1.986) for renal causes. We conclude that heat waves pose a significant risk of death, differing according to sex and age in the population of Buenos Aires.
El objetivo de este trabajo es analizar la mortalidad durante las olas de calor en la ciudad de Buenos Aires, Argentina, para el período 2005-2015. Utilizamos un diseño de series temporales con modelos aditivos generalizados, vinculando mortalidad con días de ola de calor en todo el período, y con días de la ola de calor de 2013, la más prolongada desde el año 1906, controlando por variables temporales, temperatura media y humedad. Encontramos que el riesgo de muerte por causas naturales se incrementa en un 14% (RR = 1,140; IC95%: 1,108-1,173) durante las olas de calor, respecto al resto de los días del semestre cálido. El incremento se da en ambos sexos y en todos los grupos de edad, siendo más afectados los menores de 15 (RR = 1,167; IC95%: 1,019-1,335) y los mayores de 84 años (RR = 1,201; IC95%: 1,098-1,313). En la ola de calor de diciembre de 2013 aumentaron 43% (RR = 1,428; IC95%: 1,399-1,457) las muertes diarias totales, valor que sube al 51% para el grupo de mayores de 84 años (RR = 1,515; IC95%: 1,372-1,674) y al 65% (RR = 1,647; IC95%: 1,367-1,986) para las causas renales. Concluimos que las olas de calor constituyen un factor significativo de riesgo de muerte, diferente según sexo y edad, para la población de la ciudad de Buenos Aires.
O objetivo deste trabalho é analisar a mortalidade durante as ondas de calor na cidade de Buenos Aires, Argentina, no período de 2005-2015. Foi usado um desenho de séries temporais com modelos aditivos generalizados, vinculando a mortalidade com dias de onda de calor em todo o período, e com dias da onda de calor em 2013, a mais prolongada desde o ano de 1906, controlando através de variáveis temporais, temperatura media e umidade. Encontramos que o risco de morte por causas naturais teve um incremento de 14% (RR = 1,140; IC95%: 1,108-1,173) durante as ondas de calor, ao respeito do resto dos dias do semestre cálido. O incremento se produz em ambos os sexos e em todos os grupos de idade, sendo mais afetados os menores de 15 (RR = 1,167; IC95%: 1,019-1,335) e os maiores de 84 anos (RR = 1,201; IC95%: 1,098-1,313). Na onda de calor que ocorreu em dezembro de 2013 aumentaram um 43% (RR = 1,428; IC95%: 1,399-1,457) as mortes diárias totais, valor que sobe a 51% para o grupo de pessoas maiores de 84 anos (RR = 1,515; IC95%: 1,372-1,674) e a 65% (RR = 1,647; IC95%: 1,367-1,986) para as causas renais, Concluímos que as ondas de calor constituem um fator significativo de risco de morte, diferente segundo o sexo e idade, para a população da cidade de Buenos Aires.
Assuntos
Calor Extremo/efeitos adversos , Mortalidade/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Transtornos Respiratórios/mortalidade , Adulto JovemRESUMO
INTRODUCTION: Pollution and climate have an impact on pediatric respiratory diseases; few studies have assessed this in the Autonomous City of Buenos Aires. OBJECTIVE: To assess the impact of the interaction between air pollutants and climate on the Emergency Department visits for acute lower respiratory tract infection (ALRTI) in a children's hospital. METHODS: Ecological, time-series study with generalized additive models that included total visits and visits for ALRTI to the Emergency Department between 2012 and 2016. A series with 7-day moving averages for ALRTI visits was founded as a bias control measure. Predictors were daily levels of air pollutants (carbon monoxide, nitrous dioxide, particulate matter < 10 µ) and meteorological variables (temperature, humidity). Pollutants were measured at three monitoring stations. Temporal variables (day of the week, warm/cold semester) were controlled. RESULTS: There were 455 256 total visits; 17 298 accounted for visits for ALRTI. A correlation was established only between total visits and day of the week (Mondays and Saturdays, more visits; Thursdays, less visits). Less visits for ALRTI were recorded in the warm semester compared to the cold semester (relative risk = 0.23; 95 % confidence interval: 0.29-0.18; p < 0.001). One monitoring station did not show any correlation; the other two stations showed a weak correlation between carbon monoxide and particulate matter < 10 µ and visits for ALRTI. CONCLUSION: The season accurately accounts for the increased number of total visits and visits for ALRTI. Although there was a correlation between the level of certain pollutants and the number of visits, its impact was irrelevant.
Introducción: La contaminación y el clima tienen impacto en la patología respiratoria en niños; pocos estudios lo evaluaron en la Ciudad de Buenos Aires. Objetivo: Evaluar el impacto de la interacción entre contaminantes atmosféricos y clima en las consultas por infección respiratoria aguda baja (IRAB) en un hospital pediátrico. Métodos: Estudio ecológico, de series temporales con modelos aditivos generalizados, que incluyó todas las consultas y consultas por IRAB (urgencias) entre 2012 y 2016. Para controlar sesgos, se conformó una serie con promedios móviles de 7 días para consultas por IRAB. Los predictores fueron niveles diarios de contaminantes atmosféricos (monóxido de carbono, dióxido nitroso, material particulado < 10 µ) y variables meteorológicas (temperatura, humedad). Los contaminantes fueron medidos en 3 estaciones de monitoreo. Se controló por variables temporales (día de la semana, semestre cálido/frío). Resultados: Las consultas totales fueron 455 256 y por IRAB 17 298. Solo consultas totales correlacionaron con día de la semana (lunes y sábados, más consultas y jueves, menos). El semestre cálido registró menos consultas por IRAB que el frío (riesgo relativo = 0,23; intervalo de confianza 95 %: 0,29-0,18; p < 0,001). Una estación de monitoreo no presentó ninguna correlación; las otras mostraron correlación débil entre monóxido de carbono y material particulado < 10 µ y consultas por IRAB. Conclusión: La época del año explica con precisión el incremento del número de consultas totales y por IRAB. Aunque el nivel de algunos contaminantes muestra correlación con el número de consultas, su impacto es irrelevante.
Assuntos
Poluentes Atmosféricos/análise , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/análise , Infecções Respiratórias/epidemiologia , Argentina , Monóxido de Carbono/análise , Criança , Cidades , Clima , Hospitais Pediátricos , Humanos , Dióxido de Nitrogênio/análise , Material Particulado/análise , Estações do Ano , Fatores de TempoRESUMO
An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100â¯ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16⯰C/100â¯ppm) and Finland (1.14⯰C/100â¯ppm), while it is smallest in Ireland (0.62⯰C/100â¯ppm) and Argentina (0.63⯰C/100â¯ppm). In addition, for each 1⯰C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.
Assuntos
Saúde Global , Aquecimento Global , Previsões , Humanos , Mortalidade/tendências , TemperaturaRESUMO
BACKGROUND: There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature. OBJECTIVES: We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset. METHODS: In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques. RESULTS: Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly. DISCUSSION: The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430.
Assuntos
Exposição Ambiental/estatística & dados numéricos , Temperatura Alta , Umidade , Mortalidade/tendências , Cidades , Humanos , Dinâmica não Linear , Estações do AnoRESUMO
Introducción. Las estrategias sanitarias basadas en tecnologías de la información y la comunicación (TIC) podrían perpetuar la inequidad en salud, especialmente en poblaciones vulnerables. Existen escasas herramientas validadas para evaluar el acceso a las TIC en pediatría en nuestro medio. Objetivos. Construir y validar un cuestionario para evaluar el acceso a las TIC para cuidadores de pacientes pediátricos. Describir las características de acceso a las TIC y evaluar si existe correlación entre los tres niveles de la brecha digital. Población y métodos. Construimos y validamos un cuestionario que luego administramos a cuidadores de niños entre 0 y 12 años. Las variables de resultado fueron las preguntas del cuestionario para los tres niveles de brecha digital. Además, evaluamos variables sociodemográficas. Resultados. Administramos el cuestionario a 344 cuidadores. El 93 % poseía celular propio y el 98,3 % utilizaba internet por red de datos. El 99,1 % se comunicaba a través de mensajes de WhatsApp. El 28 % había realizado una teleconsulta. La correlación entre las preguntas fue nula o baja. Conclusión. Por medio del cuestionario validado, evaluamos que los cuidadores de pacientes pediátricos de 0 a 12 años poseen en su mayoría celular, se conectan por red de datos, se comunican principalmente a través de WhatsApp y obtienen pocos beneficios a través de TIC. La correlación entre los diferentes componentes del acceso a las TIC fue baja.
Introduction. Health care strategies based on information and communication technologies (ICTs) may perpetuate health inequity, especially among vulnerable populations. In our setting, there are few validated tools to assess access to ICTs in pediatrics. Objectives. To develop and validate a questionnaire to assess ICT access among caregivers of pediatric patients. To describe the characteristics of ICT access and assess whether there is a correlation among the three levels of the digital divide. Population and methods. We developed and validated a questionnaire and then administered it to the caregivers of children aged 012 years. The outcome variables were the questions in the three levels of the digital divide. We also assessed sociodemographic variables. Results. We administered the questionnaire to 344 caregivers. Among them, 93% had their own cell phone and 98.3% had Internet access via a data network; 99.1% communicated via WhatsApp messages; 28% had had a teleconsultation. The correlation among the questions was null or low. Conclusion. The validated questionnaire allowed us to establish that the caregivers of pediatric patients aged 012 years mostly own a mobile phone, access the Internet via a data network, communicate mainly through WhatsApp, and obtain few benefits through ICTs. The correlation among the different components of ICT access was low.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adulto , Telefone Celular , Exclusão Digital , Inquéritos e Questionários , Cuidadores , Comunicação , InternetRESUMO
Objective: to evaluate the impact of air pollution and weather changes on the number of visits to a pediatric emergency department in Buenos Aires, Argentina. Materials and methods: we designed an ecological time-series study using generalized additive models (GAM) for the period 2012-2014. The outcome variable was the number of daily visits to a pediatric emergency department taking into account daily consultations. The potential predictors were the average daily air pollution levels (carbon monoxide -CO-, nitrogen dioxide -NO2-, particulate matter 10 microns or less in diameter -PM10-) and weather variables (temperature, humidity, wind speed and direction, and rainfall) and we controlled by weekday and long-time trend. Results: the number of visits during the winter months (286 daily) was significantly higher than those in the other seasons (p <0.0001). The change in air pollution levels did not show a significant and consistent correlation with the visits. Temperature, relative humidity, rainfall, and wind speed and direction were not significant variables for any of the examined lags. Conclusions: Considering the population and variables of our study, air pollution does not affect the health outcomes, as does seasonal epidemics. Studies that examine other health variables are necessary to establish the impact of air pollution on children's health in Buenos Aires.
Objetivo: evaluar el impacto de los contaminantes atmosféricos y el clima en el número de consultas al departamento de emergencias de un hospital pediátrico en Buenos Aires, Argentina. Material y métodos: estudio ecológico utilizando análisis de series temporales con modelos aditivos generalizados (GAM) para el período 2012-2014, analizando cantidad diaria de consultas en función de tres contaminantes del aire: monóxido de carbono (CO), dióxido de nitrógeno (NO2) y material particulado de diámetro menor a 10 micrones (PM10), temperatura diaria, humedad relativa, dirección y velocidad del viento y lluvia, controlando por día de la semana y tendencia de largo plazo. Resultados: las consultas en invierno (286 diarias) fueron significativamente mayores que en las demás estaciones (p<0.0001). La variación en el nivel de contaminación del aire no mostró correlación significativa y consistente con las consultas. La temperatura, humedad relativa, lluvia y viento no resultaron significativas en ninguno de los rezagos analizados. Conclusiones: en esta población y considerando las consultas de emergencia, la contaminación del aire no afecta significativamente el resultado en salud, pero sí lo hacen las epidemias estacionales. Estudios sobre otras variables de salud son necesarios para establecer el impacto de la contaminación del aire sobre la salud infantil en Buenos Aires.
Assuntos
Poluição do Ar/efeitos adversos , Mudança Climática/estatística & dados numéricos , Clima , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Adolescente , Poluição do Ar/estatística & dados numéricos , Argentina , Criança , Pré-Escolar , Humanos , Lactente , Risco , Estatísticas não ParamétricasRESUMO
INTRODUCTION: Global climate change circulation pattern respiratory syncytial virus (RSV). We assessed whether RSV season has changed over the past 20 years and its correlation with mean annual temperature. METHODS: Cross-sectional study that included records of RSV and temperatures from Buenos Aires (1995-2014). RSV season onset, offset and duration, and its correlation with mean annual temperature were described for each year. RESULTS: A total of 8109 RSV infections were identified. The duration of RSV season reduced significantly (1995: 29 weeks vs. 2014: 17 weeks; R: 0.6; p < 0.001) due to an early ending (1995: week 45 vs. 2014: week 33; R: 0.6; p < 0.001). No correlation was observed between mean annual temperature and RSV season start, end and duration. CONCLUSIONS: Over the past 20 years, RSV season shortened significantly, but no correlation with temperature was observed.
INTRODUCTION: El cambio climático global podría modificar la circulación del virus sincicial respiratorio (VSR). Evaluamos si la temporada de VSR se modificó en los últimos 20 años y su correlación con la temperatura media anual. METHODS: Estudio transversal, en el que se utilizaron registros de VSR y temperatura de la Ciudad de Buenos Aires (19952014). Para cada año, describimos el inicio, el fin y la duración de la temporada de VSR y su correlación con la temperatura media anual. RESULTS: Se identificaron 8109 infecciones por VSR. La duración de la temporada disminuyó significativamente (1995: 29 semanas vs. 2014: 17 semanas; R: 0,6; p < 0,001), debido a una finalización más precoz (1995: semana 45 vs. 2014: semana 33; R: 0,6; p < 0,001). No se observó correlación entre la temperatura media anual y la duración, el comienzo ni la finalización de la temporada de VSR. CONCLUSIONS: En los últimos 20 años, la duración de la temporada de VSR se acortó significativamente, sin correlación con la temperatura.
Assuntos
Mudança Climática , Infecções por Vírus Respiratório Sincicial/epidemiologia , Estações do Ano , Argentina/epidemiologia , Estudos Transversais , Humanos , Vírus Sincicial Respiratório Humano/isolamento & purificaçãoRESUMO
Resumen: El objetivo de este trabajo es analizar la mortalidad durante las olas de calor en la ciudad de Buenos Aires, Argentina, para el período 2005-2015. Utilizamos un diseño de series temporales con modelos aditivos generalizados, vinculando mortalidad con días de ola de calor en todo el período, y con días de la ola de calor de 2013, la más prolongada desde el año 1906, controlando por variables temporales, temperatura media y humedad. Encontramos que el riesgo de muerte por causas naturales se incrementa en un 14% (RR = 1,140; IC95%: 1,108-1,173) durante las olas de calor, respecto al resto de los días del semestre cálido. El incremento se da en ambos sexos y en todos los grupos de edad, siendo más afectados los menores de 15 (RR = 1,167; IC95%: 1,019-1,335) y los mayores de 84 años (RR = 1,201; IC95%: 1,098-1,313). En la ola de calor de diciembre de 2013 aumentaron 43% (RR = 1,428; IC95%: 1,399-1,457) las muertes diarias totales, valor que sube al 51% para el grupo de mayores de 84 años (RR = 1,515; IC95%: 1,372-1,674) y al 65% (RR = 1,647; IC95%: 1,367-1,986) para las causas renales. Concluimos que las olas de calor constituyen un factor significativo de riesgo de muerte, diferente según sexo y edad, para la población de la ciudad de Buenos Aires.
Abstract: This study aimed to analyze mortality during heat waves in the city of Buenos Aires, Argentina, in 2005-2015. We used a time series design with generalized additive models, linking mortality to days of heat waves throughout the period, and to days of the heat wave in 2013, the longest wave since 1906, controlling for time variables, mean temperature, and humidity. Risk of death from natural causes increased by 14% (RR = 1.140; 95%CI: 1.108-1.173) during heat waves when compared to the other days in the hot season. The increase occurred in both sexes and in all age groups, and individuals under 15 years of age were more affected (RR = 1.167; 95%CI: 1.019-1.335) as were those over 84 years (RR = 1.201; 95%CI: 1.098-1.313). The heat wave in December 2013 showed an increase of 43% (RR = 1.428; 95%CI: 1.399-1.457) in total daily deaths, increasing to 51% in individuals over 84 years (RR = 1.515; 95%CI: 1.372-1.674) and 65% (RR = 1.647; 95%CI: 1.367-1.986) for renal causes. We conclude that heat waves pose a significant risk of death, differing according to sex and age in the population of Buenos Aires.
Resumo: O objetivo deste trabalho é analisar a mortalidade durante as ondas de calor na cidade de Buenos Aires, Argentina, no período de 2005-2015. Foi usado um desenho de séries temporais com modelos aditivos generalizados, vinculando a mortalidade com dias de onda de calor em todo o período, e com dias da onda de calor em 2013, a mais prolongada desde o ano de 1906, controlando através de variáveis temporais, temperatura media e umidade. Encontramos que o risco de morte por causas naturais teve um incremento de 14% (RR = 1,140; IC95%: 1,108-1,173) durante as ondas de calor, ao respeito do resto dos dias do semestre cálido. O incremento se produz em ambos os sexos e em todos os grupos de idade, sendo mais afetados os menores de 15 (RR = 1,167; IC95%: 1,019-1,335) e os maiores de 84 anos (RR = 1,201; IC95%: 1,098-1,313). Na onda de calor que ocorreu em dezembro de 2013 aumentaram um 43% (RR = 1,428; IC95%: 1,399-1,457) as mortes diárias totais, valor que sobe a 51% para o grupo de pessoas maiores de 84 anos (RR = 1,515; IC95%: 1,372-1,674) e a 65% (RR = 1,647; IC95%: 1,367-1,986) para as causas renais, Concluímos que as ondas de calor constituem um fator significativo de risco de morte, diferente segundo o sexo e idade, para a população da cidade de Buenos Aires.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Mortalidade/tendências , Calor Extremo/efeitos adversos , Argentina/epidemiologia , Transtornos Respiratórios/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , Pessoa de Meia-IdadeRESUMO
Based on the theoretical framework of environmental risk, this article discusses the management of air quality in the Autonomous City of Buenos Aires in relation to current and potential impacts of toxic gases and global climate change on the health of the population. Information on historical and current management of the air was linked to the results of the South American Emissions, Megacities and Climate research project to assess danger, exposure, vulnerability and uncertainty as the dimensions of risk. By contextualizing public policies developed in recent decades on this subject, it was possible to identify emerging configurations of risk and uncertainties as accelerators of social vulnerability. On the one hand, the fact that there is a positive correlation between mortality, changes in temperature and air pollution was confirmed. On the other hand, it became clear that there is a disconnect between air quality management and health care management, while limitations were found in the proposed mitigation measures relating to emissions of greenhouse gases produced by fuel, revealing uncertainties regarding their efficacy.