Gleice Margarete de Souza Conceição

Health effects of air pollution exposure on children and adolescents in São Paulo, Brazil

Children and adolescents have been considered more susceptible to the effects of air pollution than adults. In order to investigate the responses of children of different ages to air pollution exposure, daily records of hospital admissions for children in five age groups (equal or less than 2 years of age, 3–5, 6–13, 14–19, and all ages together, i.e., from 0–19 years of age) were obtained from January 1993 to November 1997 in São Paulo, Brazil, and were compared to daily records of PM10, O3, SO2, CO and NO2 concentrations in ambient air. For each age group a generalized additive Poisson regression was fitted controlling for smooth functions of time, temperature, humidity, and days of the week, with an additional indicator for holidays. Polynomial distributed lag models were used to estimate the 7‐day cumulative effect of each pollutant.

Association between air pollution and ischemic cardiovascular emergency room visits

This study observed the relationship between air pollutants and ischemic cardiac diseases such as angina and acute myocardial infarction in a representative cardiovascular center emergency room in São Paulo, Brazil. Daily emergency room admissions to the Institute of the Heart of the University of São Paulo, as well as data concerning daily air pollutant levels and meteorological variables, were collected from January 1994 to August 1995. Generalized additive Poisson regressions were fitted to the logarithm of the expected values of total emergency room visits due to angina or acute myocardial infarction, controlling for smooth functions of season and weather and indicators for days of the week. All investigated pollutants were positively associated with ischemic cardiovascular disease emergency room visits, and the time lags were relatively short, but only CO presented an effect that was statistically significant. An interquartile range increase in CO was associated with an increase of 6.4% (95% CI: 0.7-12.1) in daily angina or acute myocardial infarction emergency room visits. This result did not change when estimates were done using linear models and natural cubic splines. This study showed that air pollution has a role in cardiovascular morbidity in São Paulo, reinforcing the necessity for air pollutant emission-controlling polices in urban areas.

Effect of air pollution on pediatric respiratory emergency room visits and hospital admissions

In order to assess the effect of air pollution on pediatric respiratory morbidity, we carried out a time series study using daily levels of PM10, SO2, NO2, ozone, and CO and daily numbers of pediatric respiratory emergency room visits and hospital admissions at the Childrens Institute of the University of Sao Paulo Medical School, from August 1996 to August 1997. In this period there were 43,635 hospital emergency room visits, 4534 of which were due to lower respiratory tract disease. The total number of hospital admissions was 6785, 1021 of which were due to lower respiratory tract infectious and/or obstructive diseases. The three health end-points under investigation were the daily number of emergency room visits due to lower respiratory tract diseases, hospital admissions due to pneumonia, and hospital admissions due to asthma or bronchiolitis. Generalized additive Poisson regression models were fitted, controlling for smooth functions of time, temperature and humidity, and an indicator of weekdays. NO2 was positively associated with all outcomes. Interquartile range increases (65.04 microg/m3) in NO2 moving averages were associated with an 18.4% increase (95% confidence interval, 95% CI = 12.5-24.3) in emergency room visits due to lower respiratory tract diseases (4-day moving average), a 17.6% increase (95% CI = 3.3-32.7) in hospital admissions due to pneumonia or bronchopneumonia (3-day moving average), and a 31.4% increase (95% CI = 7.2-55.7) in hospital admissions due to asthma or bronchiolitis (2-day moving average). The study showed that air pollution considerably affects childrens respiratory morbidity, deserving attention from the health authorities.

Assessment of the Effects of Sugar Cane Plantation Burning on Daily Counts of Inhalation Therapy

ABSTRACT This study was designed to evaluate the association between sugar cane plantation burning and hospital visits in Araraquara in the state of São Paulo, Brazil. From June 1 to August 31, 1995, the daily number of visits of patients who needed inhalation therapy in one of the main hospitals of the city was recorded and used as health impairment estimation. Sedimentation of particle mass (the amount of particles deposited on four containers filled with water) was measured daily. The association between the weight of the sediment and the number of visits was evaluated by means of Poisson regression models controlled for seasonality, temperature, day of the week, and rain. We found a significant and dose-dependent relationship between the number of visits and the amount of sediment. The relative risk of visit associated with an increase of 10 mg in the sediment weight was 1.09 (1-1.19), and the relative risk of an inhalation therapy was 1.20 (1.03-1.39) on the most polluted days (fourth quartile of sediment mass). These results indicate that sugar cane burning may cause deleterious health effects in the exposed population.

Air pollution and pediatric respiratory hospital admissions in São Paulo, Brazil

In order to investigate the relation between air pollution and child morbidity in Sao Paulo, a time-series study was carried out. Daily records of hospital admissions for children under 13 years old were obtained at the Health State Secretary, covering 112 hospitals in the period from October 1992 to October 1993. Daily levels of PM10, ozone, SO2, CO and NO2 were obtained from the environmental state agency (CETESB), while both CETESB and the Institute of Astronomy and Geophysics (IAG) of the University of Sao Paulo provided daily measures of temperature and relative humidity. Daily counts of child respiratory admissions (RESP) were considered as the dependent variable of pollutants in regression models, controlled for months of the year, days of the week, weather factors, and the daily number of non respiratory admissions (NORESP). PM10 and ozone were the pollutants that exhibited the most robust association with RESP. The mean levels of PM10observed during the period of study (70 μg m−3) were associated with an increase of 12% in RESP. The association between air pollution and RESP was significant within a time lag between 1 to 7 days and was dose-dependent. This result indicates that air pollution represents a significant pediatric health problem in Sao Paulo. Copyright

Air pollution and neonatal deaths in São Paulo, Brazil

Air pollution has been associated with health effects on different age groups. The present study was designed to assess the impact of daily changes in air pollutants (NO2, SO2, CO, O3, and particle matter (PM10)) on total number of daily neonatal deaths (those that occur between the first and the 28th days of life) in São Paulo, from January 1998 to December 2000, since adverse outcomes such as neonatal deaths associated with air pollution in Brazil have not been evaluated before. Generalized additive Poisson regression models were used and nonparametric smooth functions (loess) were adopted to control long-term trend, temperature, humidity, and short-term trends. A linear term was used for holidays. The association between air pollutants and neonatal deaths showed a short time lag. Interquartile range increases in PM10 (23.3 microg/m(3)) and SO2 (9.2 microg/m(3)) were associated with increases of 4% (95% CI, 2-6) and 6% (95% CI, 4-8), respectively. Instead of adopting a two-pollutant model we created an index to represent PM10 and SO2 effects. For an interquartile range increase in the index an increase of 6.3% (95% CI, 6.1-6.5) in neonatal deaths was observed. These results agree with previous studies performed by our group showing the deleterious effects of air pollutants during the perinatal period. The method reported here represents an alternative approach to analyze the relationship between highly correlated pollutants and public health problems, reinforcing the idea of the synergic effects of air pollutants in public health.

Análise descritiva e de tendência de acidentes de transporte terrestre para políticas sociais no Brasil

Este artigo analisou a mortalidade por acidentes de transporte terrestre no Brasil em 2003 e sua tendencia de 1980 a 2003. Utilizaram-se os obitos por acidente de transporte terrestre captados pelo Sistema de Informacoes sobre Mortalidade (SIM). Para a analise de tendencia, adotaram-se taxas padronizadas, tendo, como referencia, a populacao brasileira no ano 2000. Houve 33.182 obitos em 2003 – 19 obitos por 100 mil habitantes. Atropelamentos e acidentes com motocicleta cresceram no periodo estudado, com declinio dos primeiros a partir de 1998 e crescimento dos ultimos, principalmente, a partir de 1995. Houve diferencial no risco de mortalidade segundo raca/cor e condicao social – escolaridade. Individuos pretos associaram-se a pior condicao social e mortes por atropelamento, enquanto brancos, a melhor condicao social e mortes como ocupantes de veiculo. Os resultados reforcam a importância da vigilância de acidentes de transporte no apoio a politicas de promocao da saude e prevencao desses eventos...

Poluição do ar e efeitos na saúde nas populações de duas grandes metrópoles brasileiras

Com a crescente preocupacao acerca dos efeitos nocivos da poluicao do ar na saude da populacao, faz-se necessario a investigacao e quantificacao destes efeitos em nosso meio. Realizou-se um estudo de series temporais com esse objetivo nas duas maiores metropoles brasileiras: Sao Paulo e Rio de Janeiro. Informacoes diarias sobre mortalidade, internacoes hospitalares, niveis atmosfericos dos principais poluentes do ar e de variaveis meteorologicas foram obtidos nas duas cidades, a partir de fontes de informacao secundarias. Esses dados foram analisados utilizandose tecnicas de analise de series temporais em modelos lineares por meio de Equacoes de Estimacao Generalizada e/ ou por meio de modelos nao-parametricos, com a utilizacao de Modelos Aditivos Generalizados. Foram encontradas associacoes estatisticamente significantes entre aumentos nos niveis de poluentes atmosfericos e aumentos na mortalidade e nas hospitalizacoes, por causas respiratorias e cardiovasculares, em criancas e idosos, em ambos municipios, mesmo apos ajuste por tendencias de longo prazo, sazonalidade, dia da semana, feriados, temperatura e umidade. Conclui-se que os niveis de poluicao vivenciados atualmente em Sao Paulo e no Rio de Janeiro sao suficientes para causar agravos a saude da populacao. Medidas articuladas entre os diversos setores que gerenciam a vida urbana nessas metropoles sao fundamentais para buscar a melhoria da qualidade do ar e, consequentemente, da saude da populacao nessas cidades. Palavras-chave: poluicao do ar, efeitos na saude; mortalidade; morbidade, series temporais.

Modelos MLG e MAG para análise da associação entre poluição atmosférica e marcadores de morbi-mortalidade: uma introdução baseada em dados da cidade de São Paulo

Este estudo, descreve e compara duas classes de modelos - os Modelos Lineares Generalizados (MLG) e os Modelos Aditivos Generalizados (MAG) - que podem ser utilizadas para avaliar a associacao entre poluicao atmosferica e marcadores de morbi-mortalidade. Enfoca os MAG como uma alternativa para a modelagem de relacoes nao lineares nao especificadas, e mostra que essa classe de modelos constitui uma boa opcao para representar tanto a sazonalidade quanto a relacao entre o desfecho e as variaveis meteorologicas. Como exemplo de aplicacao e avaliada a associacao entre mortalidade em idosos e poluicao atmosferica na cidade de Sao Paulo no periodo de 1994 a 1997. Os dados de mortalidade foram obtidos do Programa de Aprimoramento das Informacoes de Mortalidade (PRO-AIM) e as concentracoes diarias de poluentes (PM10, SO2, CO, e ozonio) foram obtidas da Companhia de Tecnologia de Saneamento Ambiental (CETESB). Informacoes acerca da temperatura e umidade relativa do ar foram obtidas do Instituto Astronomico e Geofisico da Universidade de Sao Paulo (IAG-USP). As duas classes de modelos produziram resultados coerentes, mas os modelos estatisticamente mais sofisticados tiveram mais poder para detectar efeitos significantes. Foram observadas associacoes entre mortalidade e os niveis de CO, SO2 e, em menor escala, PM10. As associacoes observadas foram dose-dependente e evidentes apos um curto periodo de exposicao.

Use of the Picrosirius-polarization method to age fibrotic lesions in the hepatic granulomas produced in experimental murine schistosomiasis

The state of collagen aggregation in hepatic granulomas produced in experimental murine schistosomiasis and harvested at different phases of the disease was estimated by staining histological sections in Picrosirius and studying them under polarized light. Two different types of collagenous fibres appeared successively during granuloma evolution, the first population, of thin, weakly birefringent, greenish fibres being replaced by thicker collagen fibres which display a stronger yellow-red birefringence. A simple morphometric technique (a point-counting procedure) was used to quantify the two distinct populations of collagenous fibres. Curve-fitting procedures were then employed, using the state of collagen aggregation as the dependent variable and time as the independent variable. The results showed that there is a progressive organization of the collagenous scaffolding of hepatic granulomas, such that quantitative study of the degree of collagen organization allows an adequate determination of the age of each granuloma. The combination of the Picrosirius-polarization method with simple and efficient morphometric approaches will clearly provide useful information on the natural history of schistosomal granuloma scarring.