Hermano Albuquerque de Castro

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.

Questões metodológicas para a investigação dos efeitos da poluição do ar na saúde

Urbanization and the growth of cities have contributed to increase the load of contaminants in the environment. Among contaminants, air pollutants remain a major cause of concern due to their capacity to affect large populations and the fact that several adverse health effects associated with exposure to air pollution have been described in the past few years. This article reviews and discusses some methodological issues involved in the assessment of these health effects. The first issue relates to environmental health indicators (EHI). These indicators can be seen as measures that summarize aspects of the relationship between health and the environment. The EHI methodology proposed by the World Health Organisation for the development of environmental health actions has been applied in the area of air quality. A second aspect relates to the assessment of exposure to air pollution. This is perhaps the most difficult task for studies in this area. Issues concerning different microenvironments (indoor and outdoor) are relevant and should be taken in to account in order to minimize the errors associated with the correct assessment of exposure to air pollutants. Lastly, a brief discussion of the main epidemiological study designs used to examine the association between air pollution and health effects is presented. The advantages and disadvantages of the main study types and their main applications are discussed. These are not the only essential issues when studying the deleterious health effects of air pollution on health. However, in order to have sound environmental health policies one needs well designed and conducted epidemiological studies taking in to account these main issues. In this manner, better information will be available to those involved in the decision-making process regarding air quality in our cities.

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.

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.

Mesothelioma Mortality in Brazil, 1980–2003

Abstract Although asbestos causes asbestosis, lung cancer, and mesothelioma, it remains widely used in Brazil, mostly in cement-fiber products. We report the Brazilian mesothelioma mortality trend 1980–2003, using records of the national System of Mortality Information of DATASUS, including all deaths with IX International Disease Classification (ICD9) codes 163.n—pleura cancer during the period 1980–1995; and ICD10 codes c45.n—mesotheliomas and c38.4—pleura cancer for the years 1996—2003. Mesothelioma mortality rates increased over the period studied, from 0.56 to 1.10 deaths per 100,000 habitants. The total number of mesothelioma deaths nationwide in the period studied was 2,414; the majority (1,415) were in the Southeast region. Mortality was highest among males and people over age 65. Given the history of asbestos exposure in Brazil, our findings support the need for policies that limit or ban the use of this product.

Air pollution and respiratory diseases in the Municipality of Vitória, Espírito Santo State, Brazil

In Brazil, increasing air pollution in urban areas has led to a rise in respiratory diseases among children and the elderly and has also been the main cause of hospital admissions. This study aims to evaluate the air pollution levels in Vitória, capital of Espírito Santo State, Brazil, in comparison to Brazilian legislation and recent World Health Organization (WHO) guidelines, analyzing the spatial distribution of asthma cases treated at local outpatient services. A descriptive epidemiological study was performed with daily records on air pollution and outpatient treatment for respiratory diseases from 2001 to 2003, for children under 6 years of age. A geographic information system (GIS) was used to identify asthma distribution in the municipality. Air pollution levels were relatively low when compared to the Brazilian legislation and WHO guidelines. Only mean PM10 and NO2 exceeded the annual quality standard. The three highest asthma outpatient treatment rates were observed in the districts of São José, Jabou, and Morro do Quadro.

Acute Effects of Particulate Matter and Black Carbon from Seasonal Fires on Peak Expiratory Flow of Schoolchildren in the Brazilian Amazon

Background Panel studies have shown adverse effects of air pollution from biomass burning on childrens health. This study estimated the effect of current levels of outdoor air pollution in the Amazonian dry season on peak expiratory flow (PEF). Methods A panel study with 234 schoolchildren from 6 to 15 years old living in the municipality of Tangará da Serra, Brazil was conducted. PEF was measured daily in the dry season in 2008. Mixed-effects models and unified modelling repeated for every child were applied. Time trends, temperature, humidity, and subject characteristics were regarded. Inhalable particulate matter (PM10), fine particulate matter (PM2.5), and black carbon (BC) effects were evaluated based on 24-hour exposure lagged by 1 to 5 days and the averages of 2 or 3 days. Polynomial distributed lag models (PDLM) were also applied. Results The analyses revealed reductions in PEF for PM10 and PM2.5 increases of 10 µg/m3 and 1 µg/m3 for BC. For PM10, the reductions varied from 0.15 (confidence interval (CI)95%: −0.29; −0.01) to 0.25 l/min (CI95%: −0.40; −0.10). For PM2.5, they ranged from 0.46 (CI95%: −0.86 to −0.06) to 0.54 l/min (CI95%:−0.95; −0.14). As for BC, the reduction was approximately 1.40 l/min. In relation to PDLM, adverse effects were noticed in models based on the exposure on the current day through the previous 3 days (PDLM 0–3) and on the current day through the previous 5 days (PDLM 0–5), specially for PM10. For all children, for PDLM 0–5 the global effect was important for PM10, with PEF reduction of 0.31 l/min (CI95%: −0.56; −0.05). Also, reductions in lags 3 and 4 were observed. These associations were stronger for children between 6 and 8 years old. Conclusion Reductions in PEF were associated with air pollution, mainly for lagged exposures of 3 to 5 days and for younger children.

Respiratory disease and climatic seasonality in children under 15 years old in a town in the Brazilian Amazon

OBJECTIVE To analyze the climatic seasonality of primary care visits for respiratory disease (RD) in children less than 15 years old. METHODS This was a descriptive, epidemiological study based on data from the municipal records of primary care events from basic healthcare centers for the period 2004-2005, for the municipality of Tangará da Serra (MT), Brazil. Population estimates were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IGBE), and data on temperature and relative humidity of the air, from the National Meteorology Institute (Instituto Nacional de Meteorologia, INMET). Mean rates of primary care visits for RD were calculated according to sex, age group and anatomic location of complaint. The ratio of dry season to rainy season visits was calculated according to anatomic location of the RD. Data were analyzed using Epi-Info 3.2, testing differences between proportions using the chi-square test to a significance level of 5%. RESULTS Male children had an almost 50% greater (37.3/25.0) rate of primary care visits for diseases of the lower respiratory tract than did females. The rates of primary care visits due to RD in children under 15 years of age varied as age increased, varying from 457.7 per thousand of children less than 1 year of age to 133.5 per thousand in the 10 to 14 years-of-age group. During the dry season there were an average of 21% (4,148/5,231) fewer visits for RD (p = 0.000). Peaks in numbers of visits were observed during the months of March and August, being more accentuated in March, which is the wet season in the region. CONCLUSION Primary care visits for RD, especially those due to upper airway diseases, are related to the rainy season in this municipality.

Tendência da mortalidade por doenças respiratórias em idosos e as queimadas no Estado de Rondônia/Brasil: período entre 1998 e 2005

The forest fires in the Amazon region have been a serious environmental problem. Few studies relate the effects of forest fires on the health of exposed populations. This article aims to study the trend of mortality from respiratory diseases in the elderly, in the period 1998 to 2005, in the state of Rondonia and to correlate with the number of fire focuses. This is a descriptive study of the type of ecological. The death certificates were obtained from the Mortality Information System and the registers of data on the focus of fire have been obtained through online database available publicly in the National Space Research Institute. The results had shown a trend of growth in mortality rates for respiratory disease and chronic obstructive pulmonary disease (COPD) among elderly over 65 years and also a growing trend in the number of focus of heat. There was a positive and significant correlation between the number of fire focuses and mortality rates respiratory diseases and COPD, which explains around 50% to 80% of deaths by diseases in the elderly in the region studied. These results demonstrate the gravity of the problem of forest fires and the impact on respiratory health of the population, mainly on mortality in the elderly.

A luta pelo banimento do amianto nas Américas: uma questão de saúde pública

This article has the aim of rescuing the fight for the banishment of asbestos in Americas. The authors emphasize the importance of the asbestos as a problem of Public Health, due to its carcinogenic potential to human health, passing through the constitution of nets of counterpower on behalf of the banishment of the fiber, pointing out the importance of social participation in this fight. The asbestos public policy of health, work and environment is pointed out as a central problem. There are some misconceptions in the field of Workers Health on facing the risks and damages caused by asbestos/amiantos and it is very important not to restrict the surveillance only to workstation. The discussion must be conducted taking in account Environmental Health and Health Policies. The lack of public policy is viewed as responsible for turning invisible the problems related to asbestos in Brazil. Today, the victims of the fiber are not recognized as such and their rights are denied in several instances of the public power. We conclude that the fight of the society for the end of the use of this fiber and for the end of the countless diseases provoked by its use, it is configured in a political and social movement committed with the social transformation in the search for a society fairer, equalitarian and healthy.