Eliane Ignotti

Impact on human health of particulate matter emitted from burnings in the Brazilian Amazon region

OBJECTIVE To analyze the impact on human health of exposure to particulate matter emitted from burnings in the Brazilian Amazon region. METHODS This was an ecological study using an environmental exposure indicator presented as the percentage of annual hours (AH%) of PM2.5 above 80 microg/m3. The outcome variables were the rates of hospitalization due to respiratory disease among children, the elderly and the intermediate age group, and due to childbirth. Data were obtained from the National Space Research Institute and the Ministry of Health for all of the microregions of the Brazilian Amazon region, for the years 2004 and 2005. Multiple regression models for the outcome variables in relation to the predictive variable AH% of PM2.5 above 80 microg/m3 were analyzed. The Human Development Index (HDI) and mean number of complete blood counts per 100 inhabitants in the Brazilian Amazon region were the control variables in the regression analyses. RESULTS The association of the exposure indicator (AH%) was higher for the elderly than for other age groups (beta = 0.10). For each 1% increase in the exposure indicator there was an increase of 8% in child hospitalization, 10% in hospitalization of the elderly, and 5% for the intermediate age group, even after controlling for HDI and mean number of complete blood counts. No association was found between the AH% and hospitalization due to childbirth. CONCLUSIONS The indicator of atmospheric pollution showed an association with occurrences of respiratory diseases in the Brazilian Amazon region, especially in the more vulnerable age groups. This indicator may be used to assess the effects of forest burning on human health.

Análise das internações por doenças respiratórias em Tangará da Serra - Amazônia Brasileira

OBJECTIVE To analyze hospitalizations for respiratory diseases among children under 15 years of age in an area with high levels of environmental pollution. METHODS A cross-sectional study of hospitalizations due to respiratory diseases of patients residing in the city of Tangará da Serra, located in the state of Mato Grosso (Brazilian Amazon region), from 2000 to 2005. Data on hospital admissions were obtained from the Brazilian Unified Health Care System and from Brazilian Institute of Geography and Statistics population estimates. RESULTS In 2005, the rate of hospitalization for respiratory diseases among children under 15 years of age in the microregion of Tangará da Serra was 70.1/1,000 children. Between 2000 and 2005, there were 12,777 such admissions, of which 8,142 (63.7%) were for respiratory diseases. During the dry season (May to October), the rate of admissions for respiratory diseases was 10% higher than during the rainy season (November to April). The principal causes of admission included pneumonia (90.7%) and respiratory insufficiency (8.5%). Admissions of children under 5 years of age for pneumonia were 4 times the expected number for the city. Children under 12 months of age were the most frequently hospitalized, with an average increase of 32.4 admissions per 1,000 children per year. CONCLUSIONS Tangará da Serra presented a high number of pediatric admissions for respiratory diseases. Therefore, it is logical to consider it a priority area for investigation and monitoring of the environmental risk factors for such diseases.

Air pollution and hospital admissions for respiratory diseases in the subequatorial Amazon: a time series approach

The objective of the study is to evaluate the effect of the daily variation in concentrations of fine particulate matter (diameter less than 2.5 microm--PM2.5) resulting from the burning of biomass on the daily number of hospitalizations of children and elderly people for respiratory diseases, in Alta Floresta and Tangará da Serra in the Brazilian Amazon in 2005. This is an ecological time series study that uses data on daily number of hospitalizations of children and the elderly for respiratory diseases, and estimated concentration of PM2.5. In Alta Floresta, the percentage increases in the relative risk (%RR) of hospitalization for respiratory diseases in children were significant for the whole year and for the dry season with 3-4 day lags. In the dry season these measurements reach 6% (95%CI: 1.4-10.8). The associations were significant for moving averages of 3-5 days. The %RR for the elderly was significant for the current day of the drought, with a 6.8% increase (95%CI: 0.5-13.5) for each additional 10 microg/m3 of PM2.5. No associations were verified for Tangará da Serra. The PM2.5 from the burning of biomass increased hospitalizations for respiratory diseases in children and the elderly.

Associação entre material particulado de queimadas e doenças respiratórias na região sul da Amazônia brasileira

OBJETIVO: Investigar os efeitos de curto prazo da exposicao ao material particulado de queimadas da Amazonia na demanda diaria de atendimento ambulatorial por doencas respiratorias de criancas e de idosos. METODOS: Estudo epidemiologico com delineamento ecologico de series temporais. Os registros diarios de atendimento ambulatorial foram obtidos nas 14 unidades de saude do municipio de Alta Floresta, Mato Grosso, regiao sul da Amazonia brasileira, no periodo de janeiro de 2004 a dezembro de 2005. Informacao sobre os niveis diarios de material particulado fino foi disponibilizada pelo Instituto Nacional de Pesquisas Espaciais. Para controlar possiveis fatores de confusao (situacoes nas quais uma associacao nao causal entre exposicao e doenca e observada devido a uma terceira variavel), foram adicionadas ao modelo variaveis referentes a tendencia temporal, sazonalidade, temperatura, umidade relativa do ar, precipitacao pluviometrica e efeitos de calendario (como ocorrencia de feriados e finais de semana). Utilizou-se regressao de Poisson via modelos aditivos generalizados. RESULTADOS: Um incremento de 10 µg/m³ nos niveis de exposicao ao material particulado esteve associado a aumentos de 2,9 e 2,6% nos atendimentos ambulatoriais por doencas respiratorias de criancas no 6o e 7o dias subsequentes a exposicao. Nao foram encontradas associacoes significativas nos atendimentos de idosos. CONCLUSOES: Os resultados sugerem que os niveis de material particulado das queimadas na Amazonia estao associados a efeitos adversos a saude respiratoria de criancas.

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.

Hanseníase, condições sociais e desmatamento na Amazônia brasileira

OBJETIVO: Analisar a associacao entre indicadores sociais e ambientais e o coeficiente de deteccao de hanseniase (CDH) na Amazonia brasileira. METODOS: Neste estudo ecologico, foram selecionados os registros de casos novos de hanseniase no ano de 2006 da base de dados do Sistema de Informacao de Agravos de Notificacao (SINAN) e calculados os CDHs por 10 000 habitantes. As analises foram realizadas considerando-se 105 microrregioes formadas por municipios adjacentes com semelhancas economicas e sociais. As variaveis independentes foram area total (km²) desmatada nas microrregioes ate 2006; proporcao de residentes em domicilios com fossa rudimentar; proporcao de residentes em domicilios abastecidos com agua de poco; e indice de desenvolvimento humano (IDH) do ano de 2000. O coeficiente CDH foi suavizado pelo metodo Bayesiano empirico local. As analises foram conduzidas por meio de correlacao e diferencas de medias (ANOVA) com nivel de significância de 5%. A tecnica de Kernel foi utilizada para investigar a distribuicao geografica dos eventos de interesse para todos os indicadores analisados. RESULTADOS: Verificou-se correlacao positiva dos CDHs com o total de area desmatada (r = 0,50; P < 0,000) e a proporcao de domicilios com fossa rudimentar (r = 0,49; P < 0,000). O IDH apresentou comportamento inverso ao CDH - quanto maior o IDH, menor o CDH (r = -0,36; P < 0,000). A variavel proporcao de domicilios com abastecimento de agua de poco nao apresentou associacao com o CDH quando analisada toda a regiao. CONCLUSOES: O coeficiente de deteccao de hanseniase, que representa a magnitude da doenca, esta associado aos indicadores de condicoes de vida e ao modo de ocupacao territorial da Amazonia.

A ocorrencia da dengue e variacoes meteorologicas no Brasil: revisao sistematica

INTRODUCTION Dengue is configures in recent decades as an important cause of morbidity and mortality in Brazil and around the world reaching the tropical and subtropical areas. OBJECTIVE To review the scientific literature on the occurrence of dengue in Brazil and its relationship with meteorological variables. METHOD A systematic review of studies published in databases (SciELO, PubMed, MEDLINE, Lilacs) using descriptors related to weather variations and dengue fever in Brazil, published between 1991 to 2010. It was selected 31 articles that had the study area nationwide. RESULTS Most epidemiological studies use ecological design, the studies make use of entomological trapping, are common also series of studies of the disease and spatial analysis. It is evident relationship between dengue incidence with temperature and rainfall, the association is more significant from the second to fourth months of the year. Comparative studies of drought and rain show seasonal behavior of the disease. There are difficulties in establishing unique pattern of seasonality of disease incidence and weather variables for the country. CONCLUSION Dengue is strongly related to meteorological variables. The seasonal variation in temperature and rainfall influences the dynamics of the vector and the incidence of the disease throughout the country, regardless of the climate category.

Prevalence of asthma in children and adolescents in a city in the Brazilian Amazon region

OBJECTIVE To analyze the prevalence of asthma and asthma symptoms in students of two distinct age brackets residing in the city of Tangará da Serra, Brazil. METHODS Cross-sectional, population-based study of the prevalence of asthma in children from 6 to 7 years of age and adolescents from 13 to 14, using the standardized International Study of Asthma and Allergies in Childhood, phase 1 questionnaire, validated for use in Brazil. Students who responded affirmatively to question 2 (presence of wheezing in the preceding 12 months) were classified as suffering from asthma. RESULTS The study comprised 3,362 students, of whom 1,634 (48.6%) were children and 1,728 (51.4%) were adolescents. Of the 1,634 children, 816 (49.9%) were male, and 818 (50.1%) were female. Of the 1,728 adolescents, 773 (45.0%) were male, and 955 (55.0%) were female. The prevalence of asthma among the children was 25.2%, whereas that among the adolescents was 15.9% (chi2 = 8.34; p = 0.00). The children presented higher prevalences of the following symptoms of asthma than did the adolescents: wheezing ever (54.3%), nocturnal dry cough (43.9%), wheezing in the preceding 12 months (25.2%), and from 1 to 3 attacks of wheezing in the preceding 12 months (19.1%). There were no differences between the two groups regarding physician-diagnosed asthma (approximately 4.5%). There were no statistical differences regarding the prevalence of asthma by gender in the two groups. CONCLUSIONS Tangará da Serra has a high prevalence of asthma in children and adolescents, and this result is compatible with other studies carried out in Brazil and Latin America using the same methodology.

Risk assessment of PM2.5 to child residents in Brazilian Amazon region with biofuel production.

BackgroundExposure to fine fractions of particulate matter (PM2.5) is associated with increased hospital admissions and mortality for respiratory and cardiovascular disease in children and the elderly. This study aims to estimate the toxicological risk of PM2.5 from biomass burning in children and adolescents between the age of 6 and 14 in Tangará da Serra, a municipality of Subequatorial Brazilian Amazon.MethodsRisk assessment methodology was applied to estimate the risk quotient in two scenarios of exposure according to local seasonality. The potential dose of PM2.5 was estimated using the Monte Carlo simulation, stratifying the population by age, gender, asthma and Body Mass Index (BMI).ResultsMale asthmatic children under the age of 8 at normal body rate had the highest risk quotient among the subgroups. The general potential average dose of PM2.5 was 1.95 μg/kg.day (95% CI: 1.62 – 2.27) during the dry scenario and 0.32 μg/kg.day (95% CI: 0.29 – 0.34) in the rainy scenario. During the dry season, children and adolescents showed a toxicological risk to PM2.5 of 2.07 μg/kg.day (95% CI: 1.85 – 2 .30).ConclusionsChildren and adolescents living in the Subequatorial Brazilian Amazon region were exposed to high levels of PM2.5 resulting in toxicological risk for this multi-pollutant. The toxicological risk quotients of children in this region were comparable or higher to children living in metropolitan regions with PM2.5 air pollution above the recommended limits to human health.

A systematic review of the physical and chemical characteristics of pollutants from biomass burning and combustion of fossil fuels and health effects in Brazil

The aim of this study was to carry out a review of scientific literature published in Brazil between 2000 and 2009 on the characteristics of air pollutants from different emission sources, especially particulate matter (PM) and its effects on respiratory health. Using electronic databases, a systematic literature review was performed of all research related to air pollutant emissions. Publications were analyzed to identify the physical and chemical characteristics of pollutants from different emission sources and their related effects on the respiratory system. The PM2.5 is composed predominantly of organic compounds with 20% of inorganic elements. Higher concentrations of metals were detected in metropolitan areas than in biomass burning regions. The relative risk of hospital admissions due to respiratory diseases in children was higher than in the elderly population. The results of studies of health effects of air pollution are specific to the region where the emissions occurred and should not be used to depict the situation in other areas with different emission sources.