The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health.

Objective To identify reported interventions that facilitate sustainable development and have had a positive impact on health in four areas: sustainable food production; sustainable energy use; sustainable jobs ("decent work"); and prevention of toxic exposure to chemicals. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted of at least 14 databases and 8 websites for each of the four overviews, using pre-defined protocols, including clear inclusion criteria. To qualify as "sustainable," interventions needed to aim (explicitly or implicitly) to positively impact at least two dimensions of the integrated framework for sustainable development and had to include measures of health impact. Results In total, 47 systematic reviews and 10 economic evaluations met the inclusion criteria. The most promising interventions, such as agricultural policies, were identified for each of the four topics. While the evidence for the interventions is not strong because of the limited number of studies, there is no evidence of a definite negative impact on health. The only possible exception is that of taxes and subsidies-though this intervention also has the potential to be pro-equity with higher relative impacts for lower income groups. Conclusions The evidence found for effective interventions is useful for guiding countries toward the best options for non-health sector interventions that can positively impact health. This overviews shows that intersectoral work benefits every sector involved.

Common mental disorders among civil aviation pilots.

INTRODUCTION: The purpose of this study was to estimate the prevalence of suspected cases of common mental disorders (CMD) on Brazilian civil aviation pilots and to investigate associations between CMD, demographics, and labor variables. METHODS: A quantitative cross-sectional study was conducted on 807 working pilots between October 2009 and October 2010 using a self-administered questionnaire to obtain sociodemographic data and information about workload. CMD prevalence was estimated with the Self-Reporting Questionnaire-20 items (SRQ-20). Multiple logistic regression was used in statistical data analyses. RESULTS: The overall prevalence of CMD was 6.7% with the cutoff point of 8 used in this study, i.e., scores greater than or equal to 8 in SRQ-20 define positive cases. Using alternative cutoffs, the prevalence was 9.2% (cut off point 7) or 12% (cutoff point 6). Among the individuals who did not exercise, 10.2% presented suspected CMD. Among those with a heavy workload, 23.7% presented scores indicating suspected CMD. Only variables relating to workload and the practice of physical activity were significantly correlated with the estimate of CMD after multivariate analysis. Regular physical exercise afforded a possible protective effect against suspected cases of CMD, while there was a higher prevalence of suspected cases among subjects with heavy workloads. DISCUSSION: The inclusion of the topic of mental health among the targets and priorities of civil aviation in Brazil is imperative. Addressing issues such as the regular practice of physical activity and workload can contribute to achieving a better balance between flight safety and productivity.

Persistent Organic Pollutant Levels in Maternal and Cord Blood Plasma and Breast Milk: Results from the Rio Birth Cohort Pilot Study of Environmental Exposure and Childhood Development (PIPA Study).

Levels of polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) were evaluated in the breast milk and maternal and umbilical cord blood of pregnant women and their newborns in Rio de Janeiro, Brazil. The concentration of 11 PCB and 17 OCP were measured in 135 samples of maternal, and 116 samples of cord blood plasma, as well as 40, 47, and 45 samples of breast milk at 1st, 3rd, and 6th months after birth, respectively, using gas chromatography-mass spectrometry (GC-MS-MS). Women were asked to answer an enrollment questionnaire with reproductive, lifestyle, residential and sociodemographic questions. The most commonly detected OCPs and PCBs in the maternal and cord blood were 4,4'-DDE; ß-HCH; É£-HCH; and PCB 28. 4,4'-DDE was also the most commonly detected OCP in breast milk samples. Although not statistically significant, ∑DDT levels were higher among women with pregestational BMI ≥ 30, and who were non-white and older (age > 40). Newborns with an Apgar score ≤ 8 at minute 5 of life showed significantly higher levels of ∑DDT in the cord blood. Persistent OCPs and PCBs were still detected in maternal and umbilical cord blood and breast milk, even after decades of their banishment in Brazil. They may pose a risk to maternal, fetal and children's health.

Acute Kidney Failure among Brazilian Agricultural Workers: A Death-Certificate Case-Control Study.

Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense use of pesticides, in the south and midwest. Using death certificate data, we investigated trends in AKF mortality (1980-2014). We used joinpoint regression to calculate annual percent changes in AKF mortality rates by urban/rural status and, in rural municipalities, by tertiles of per capita pesticide expenditures. We then compared AKF mortality in farmers and population controls from 2006 to 2014 using logistic regression to estimate odds ratios and 95% confidence intervals adjusted by age, sex, region, education, and race. AKF mortality increased in both regions regardless of urban/rural status; trends were steeper from the mid-1990s to 2000s, and in rural municipalities, they were higher by tertiles of pesticide expenditures. Agricultural workers were more likely to die from AKF than from other causes, especially at younger ages, among females, and in the southern municipalities. We observed increasing AKF mortality in rural areas with greater pesticide expenditures and an association of AKF mortality with agricultural work, especially among younger workers.

Prenatal Exposure to Metals and Neurodevelopment in Infants at Six Months: Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA Project).

The PIPA Project is a prospective birth cohort study based in Rio de Janeiro, Brazil, whose pilot study was carried out between October 2017 and August 2018. Arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) concentrations were determined in maternal (n = 49) and umbilical cord blood (n = 46). The Denver Developmental Screening Test II (DDST-II) was applied in 50 six-month-old infants. Metals were detected in 100% of the mother and newborn samples above the limits of detection. Maternal blood lead concentrations were higher in premature newborns (GM: 5.72 µg/dL; p = 0.05). One-third of the infants (n = 17-35.4%) exhibited at least one fail in the neurodevelopment evaluation (fail group). Maternal blood arsenic concentrations were significantly (p = 0.03) higher in the "fail group" (GM: 11.85 µg/L) compared to infants who did not fail (not fail group) (GM: 8.47 µg/L). Maternal and umbilical cord blood arsenic concentrations were higher in all Denver Test's domains in the "fail group", albeit non-statistically significant, showing a tendency for the gross motor domain and maternal blood (p = 0.07). These findings indicate the need to further investigate the toxic effects of prenatal exposure to metals on infant neurodevelopment.

Performance on neurological development tests by riverine children with moderate mercury exposure in Amazonia, Brazil.

The nervous system can be damaged when the population is exposed to methyl mercury (MeHg) by ingesting fish, and children deserve special attention due to their increased susceptibility as compared to adults. A comparative cross-sectional study was performed in order to investigate the use of a battery of neurological development tests in two groups of 209 riverine children from 3 to 7 years old: a group exposed to moderate levels of MeHg (n = 75) and a control group (n = 134). The study included a questionnaire, the collection of scalp hair samples for determination of total mercury concentration, and performance on a test for evaluating neurological function in children. Riverine children presented higher exposure to MeHg (mean hair Hg = 5.37 +/- 3.35 microg x g(-1)) in comparison to the control group (mean Hg = 2.08 +/- 1.37 microg x g(-1)). Both groups showed a high proportion of children with what was considered "non-normal" performance, suggesting that the results could not be related to mercury exposure and that this type of test presented limitations for use with river-dwelling Amazon communities.

[Psychosocial aspects of work and commonmental disorders among civil aviation pilots.] / Aspectos psicossociais do trabalho e transtornos mentais comuns em pilotos civis.

This study aimed to investigate associations between psychosocial aspects of work and prevalence of common mental disorders (CMD) among Brazilian civil aviation pilots. This was a quantitative cross-sectional study using the self-administered Job Content Questionnaire (JCQ) and Self-Reporting Questionnaire (SRQ-20). A total of 778 pilots answered the questionnaires. Multiple logistic regression showed a strong association with highly demanding work and prevalence of CMD, compared to pilots with less demanding work as the reference group (adjusted OR = 29.0). In the final adjusted model, only variables related to workload and physical activity maintained statistically significant associations. The expected CMD prevalence in pilots with highly demanding work, heavy workload, and no regular physical exercise was 39.7%, compared to the subgroup with less demanding work, regular physical exercise, and light workload, which showed an expected prevalence of 0.4%. Working conditions can be considered potential contributing factors to CMD, with probable impact on flight safety.

A systematic review of mercury ototoxicity.

Mercury is neurotoxic, and numerous studies have confirmed its ototoxic effect. However, the diagnosis and follow-up of mercury exposure require understanding the pathophysiology of the chemical substance. Based on a systematic literature review, this study aimed to demonstrate whether mercury is ototoxic and to analyze its mechanism of action on the peripheral and central auditory system, in order to contribute to the diagnosis and follow-up of exposure. This was a systematic review of studies published on the effects of mercury exposure on the auditory system. The full text of the studies and their methodological quality were analyzed. The review identified 108 studies published on the theme, of which 28 met the inclusion criteria. All the articles in the analysis showed that mercury exposure is ototoxic and produces peripheral and/or central damage. Acute and long-term exposure produces irreversible damage to the central auditory system. Biomarkers were unable to predict the relationship between degree of mercury poisoning and degree of lesion in the auditory system.

The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health / El nuevo enfoque de las Naciones Unidas sobre el desarrollo sostenible después del 2015: Resultados de cuatro sinopsis de revisiones sistemáticas de intervenciones relacionadas con el desarrollo sostenible y la salud

ABSTRACT Objective To identify reported interventions that facilitate sustainable development and have had a positive impact on health in four areas: sustainable food production; sustainable energy use; sustainable jobs (“decent work”); and prevention of toxic exposure to chemicals. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted of at least 14 databases and 8 websites for each of the four overviews, using pre-defined protocols, including clear inclusion criteria. To qualify as “sustainable,” interventions needed to aim (explicitly or implicitly) to positively impact at least two dimensions of the integrated framework for sustainable development and had to include measures of health impact. Results In total, 47 systematic reviews and 10 economic evaluations met the inclusion criteria. The most promising interventions, such as agricultural policies, were identified for each of the four topics. While the evidence for the interventions is not strong because of the limited number of studies, there is no evidence of a definite negative impact on health. The only possible exception is that of taxes and subsidies—though this intervention also has the potential to be pro-equity with higher relative impacts for lower income groups. Conclusions The evidence found for effective interventions is useful for guiding countries toward the best options for non-health sector interventions that can positively impact health. This overviews shows that intersectoral work benefits every sector involved.

RESUMEN Objetivo Identificar las intervenciones notificadas que facilitan el desarrollo sostenible y han tenido un impacto positivo en la salud en cuatro áreas: producción sostenible de alimentos, uso sostenible de la energía, trabajo sostenible (“trabajo digno”), y prevención de la exposición a productos químicos tóxicos. Métodos Se usaron métodos de revisión sistemática para sintetizar la evidencia de múltiples revisiones sistemáticas y evaluaciones económicas. Sobre la base de protocolos predefinidos, incluidos criterios de inclusión claros, se realizó una búsqueda en al menos 14 bases de datos y ocho sitios web para cada una de las cuatro sinopsis de revisiones sistemáticas. Para ser consideradas “sostenibles,” las intervenciones debían estar dirigidas (explícita o implícitamente) a lograr efectos positivos en al menos dos dimensiones del marco integrado para el desarrollo sostenible e incluir mediciones de la repercusión en la salud. Resultados En total, 47 revisiones sistemáticas y 10 evaluaciones económicas cumplieron con los criterios de inclusión. Se identificaron las intervenciones más prometedoras, como las políticas agrícolas, para cada uno de los cuatro temas. Si bien la evidencia sobre las intervenciones no es sólida debido al número limitado de estudios, no hay indicios de un impacto negativo concreto en la salud. La única posible excepción se relaciona con los impuestos y subsidios, aunque esta intervención también tiene el potencial de favorecer la equidad con una repercusión relativa mayor en los grupos de menores ingresos. Conclusiones La evidencia sobre intervenciones eficaces es útil para guiar a los países hacia las mejores opciones de intervención en sectores que no son de salud pero cuya repercusión también será positiva en el de la salud. Estas sinopsis indican que el trabajo intersectorial beneficia a todos los sectores implicados.

Aspectos psicossociais do trabalho e transtornos mentais comuns em pilotos civis / Psychosocial aspects of work and commonmental disorders among civil aviation pilots / Aspectos psicosociales del trabajo ytrastornos mentales comunes en pilotos civiles

O objetivo foi investigar a associação entre aspectos psicossociais do trabalho e prevalência de transtornos mentais comuns (TMC) em pilotos da aviação civil brasileira. Estudo transversal quantitativo utilizando os instrumentos de autopreenchimento Job Content Questionnaire (JCQ) e Self-Reporting Questionnaire (SRQ-20). Foram avaliados 778 pilotos. No modelo de regressão logística múltipla se observa forte associação entre alta exigência e prevalência de TMC, quando comparada com baixa exigência, definida como referência (OR ajustado = 29,0). No modelo ajustado final permaneceram estatisticamente associadas às variáveis carga de trabalho e prática regular de exercício físico. A prevalência esperada de TMC nos pilotos do subgrupo de alta exigência, com carga pesada de trabalho e que não realizavam exercícios físicos, foi de 39,7%, enquanto que para os indivíduos de baixa exigência, que praticam exercícios e têm carga leve de trabalho foi de 0,4%. As condições de trabalho podem ser consideradas como potenciais fatores contribuintes para o surgimento de TMC, com provável impacto na segurança de voo.

This study aimed to investigate associations between psychosocial aspects of work and prevalence of common mental disorders (CMD) among Brazilian civil aviation pilots. This was a quantitative cross-sectional study using the self-administered Job Content Questionnaire (JCQ) and Self-Reporting Questionnaire (SRQ-20). A total of 778 pilots answered the questionnaires. Multiple logistic regression showed a strong association with highly demanding work and prevalence of CMD, compared to pilots with less demanding work as the reference group (adjusted OR = 29.0). In the final adjusted model, only variables related to workload and physical activity maintained statistically significant associations. The expected CMD prevalence in pilots with highly demanding work, heavy workload, and no regular physical exercise was 39.7%, compared to the subgroup with less demanding work, regular physical exercise, and light workload, which showed an expected prevalence of 0.4%. Working conditions can be considered potential contributing factors to CMD, with probable impact on flight safety.

El objetivo fue investigar la asociación entre los factores psicosociales en el trabajo y la prevalencia de trastornos mentales comunes (TMC), en los pilotos de aviación civil brasileños. Estudio transversal con instrumentos cuantitativos Job Content Questionnaire (JCQ) y Self-Reporting Questionnaire (SRQ-20). Se evaluaron 778 pilotos. En el modelo de regresión logística múltiple se observó una fuerte asociación entre la alta demanda y TMC, en comparación con los de baja, que se define como referencia (OR ajustada = 29,0). En las variables del modelo ajustado final se mantuvo estadísticamente asociada la carga de trabajo y la práctica de ejercicio físico regular. La prevalencia esperada de TMC en el subgrupo de alta demanda, con gran carga de trabajo y sin ejercicio físico con regularidad fue del 39,7%, mientras que para las personas de baja demanda, deportistas y con carga ligera de trabajo fue del 0,4%. Las condiciones de trabajo pueden ser considerados como posibles factores que contribuyen a la aparición de TMC, con posibles repercusiones en la seguridad del vuelo.

Perfil de exposição ao chumbo em crianças escolares da rede municipal da cidade do Rio de Janeiro, Brasil / The lead exposure profile of municipal public schoolchildren in the city of Rio de Janeiro, Brazil

Descrever os níveis de exposição ambiental ao chumbo entre criancas de duas escolas localizadas em regiões com características socioambientais distintas no município do Rio de Janeiro. Métodos: estudo piloto em amostra de conveniência com 270 estudantes. A análise das amostras de sangue capilar foi realizada usando o método de Espectrometria de Massa Acoplado a Plasma Indutivo (ICP-MS). A exposição ao chumbo entre as crianças foi estimada através de comportamentos e habitos diarios e presença de fontes de chumbo no domicilio ou entorno. Resultados: a concentração média do chumbo no sangue capilar foi 3,59 μg/dL ± 2,25. Cinco crianças (1,85 por cento) apresentaram concentrações acima de 10 μg/dL. Observou-se uma diferença estatisticamente significativa na concentração média de chumbo em sangue capilar nas variáveis idade (p=0,034), renda per capita (p=0,005) e exposição a chumbo (p=0,044). As variáveis renda média familiar per capita e idade mostraram-se inversamente proporcionais à concentração de chumbo e o status de exposição diretamente proporcional. As escolas apresentaram diferença estatisticamente significativa (p=0,004) quanto à prevalência de crianças expostas ao chumbo. Conclusões: embora a variável escola não tenha sido boa preditora da concentração capilar de chumbo, a maior prevalência de crianças expostas a chumbo se encontra na escola localizada na área mais poluída...

To describe the levels of environmental exposure to lead among children from two schools in regions with distinct social and environmental features in the municipality of Rio de Janeiro. Methods: a pilot study was carried out in a convenience sample of 270 students. Analysis of capillary blood samples was conducted using the Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Lead exposure among the children was estimated on the basis of the their daily habits and behavior patterns and the presence of sources of lead in the household or surrounding area. Results: the mean concentration of lead in capillary blood was 3.59 μg/dL ± 2.25. Five children (1.85 percent) had concentrations higher than 10 μg/dL. A statistically significant difference was found in the mean concentration of lead in capillary blood for the variables age (p=0.034), per capita income (p=0.005) and exposure to lead (p=0.044). The variables mean household per capita income and age were inversely proportional to the concentration of lead and exposure status directly proportional. There was a statistically significant difference between the schools (p=0.004) in terms of the prevalence of children exposed to lead. Conclusions: although the school variable was not a good predictor of capillary concentrations of lead, the higher prevalence of children exposed to lead was found in the school situated in the most polluted area...

A systematic review of mercury ototoxicity / Uma revisão sistemática da ototoxicidade do mercúrio

Mercury is neurotoxic, and numerous studies have confirmed its ototoxic effect. However, the diagnosis and follow-up of mercury exposure require understanding the pathophysiology of the chemical substance. Based on a systematic literature review, this study aimed to demonstrate whether mercury is ototoxic and to analyze its mechanism of action on the peripheral and central auditory system, in order to contribute to the diagnosis and follow-up of exposure. This was a systematic review of studies published on the effects of mercury exposure on the auditory system. The full text of the studies and their methodological quality were analyzed. The review identified 108 studies published on the theme, of which 28 met the inclusion criteria. All the articles in the analysis showed that mercury exposure is ototoxic and produces peripheral and/or central damage. Acute and long-term exposure produces irreversible damage to the central auditory system. Biomarkers were unable to predict the relationship between degree of mercury poisoning and degree of lesion in the auditory system.

O mercúrio é neurotóxico e muitas pesquisas confirmam sua ação ototóxica. Porém, para o diagnóstico e acompanhamento da exposição é necessário entender a fisiopatologia da substância química. O objetivo do trabalho, por meio da revisão sistemática, é evidenciar se o mercúrio é ou não ototóxico e, sendo assim, qual seria sua forma de atuação no sistema auditivo periférico e central, de forma a contribuir para o diagnóstico e acompanhamento da exposição. É uma revisão sistemática dos trabalhos publicados sobre os efeitos da exposição ao mercúrio no sistema auditivo. Analisaram-se os estudos contemplados na íntegra e também sua qualidade metodológica. A pesquisa identificou 108 artigos publicados sobre o tema, sendo que 28 se enquadraram nos critérios de inclusão. Todos os artigos analisados evidenciaram que a exposição ao mercúrio é ototóxico e induz ao dano periférico e/ou central. A exposição aguda e de longo prazo produzem danos irreversíveis ao sistema auditivo central. Os biomarcadores não puderam predizer a relação do grau de intoxicação com o grau de lesão do sistema auditivo.

Performance on neurological development tests by riverine children with moderate mercury exposure in Amazonia, Brazil

O sistema nervoso pode ser afetado quando as pessoas, notadamente crianças, estão expostas ao metilmercúrio pela ingestão de peixes. Foi desenvolvido um estudo seccional, comparativo, para avaliar o desempenho de dois grupos de crianças ribeirinhas de 3 a 7 anos de idade na realização de uma bateria de testes de desenvolvimento neurológico. Um grupo estudo composto de crianças expostas a moderados níveis de mercúrio (n = 75) e um grupo controle (n = 134) de crianças que diferiam do primeiro grupo por uma ingestão menor de peixe. O estudo incluiu questionário, coleta de amostras de cabelo para determinação de mercúrio total e avaliação do desempenho das crianças na realização dos testes. As crianças do grupo estudo apresentaram maior média de concentração de mercúrio no cabelo (5,37 ± 3,35µg.g-1) em comparação com o grupo controle (2,08 ± 1,37µg.g-1). Observou-se uma elevada proporção de crianças que apresentaram desempenhos considerados como "não normais" em ambos os grupos, evidenciando que os resultados não poderiam ser relacionados com a exposição ao mercúrio e as limitações do uso deste tipo de teste para crianças ribeirinhas.