Washington Leite Junger

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.

Macronutrient consumption and inadequate micronutrient intake in adults

OBJECTIVE To estimate energy and nutrient intake and prevalence of inadequate micronutrient intake among Brazilian adults. METHODS Data from the National Dietary Survey, from the 2008-2009 Household Budget Survey, were used. Food consumption was evaluated through food record on two non-consecutive days. A total of 21,003 individuals (52.5% women), between 20-59 years old, participated in the survey. Usual nutrient intake was estimated according to the National Cancer Institute method. The Estimated Average Requirement (EAR) cut-off points were used to determine the prevalence of inadequate micronutrient intake. For manganese and potassium, the Adequate Intake (AI) was used as cut-off. Sodium intake was compared with the Tolerable Upper Intake Level (UL). The probability approach was used to determine the prevalence of inadequate iron intake. The data were analyzed according to the location of the household (urban or rural) and macro regions of Brazil. RESULTS The mean energy intake was 2,083 kcal among men and 1,698 kcal among women. Prevalence of inadequacy equal to or greater than 70% were observed for calcium among men and magnesium, vitamin A, and sodium among both men and women. Prevalence equal to or greater than 90% were found for calcium in women and vitamins D and E in both genders. Prevalence lower than 5% were found for iron in men and for niacin in men and women. In general, prevalence of inadequate intake was higher in the rural area and in the Northeast region. CONCLUSIONS Energy intake was higher among individuals who live in urban areas and in the North region. The greatest risk groups of inadequate micronutrient intake were women and those living in rural areas and in the Northeast region.

Qualidade do ar e transtornos respiratórios agudos em crianças

OBJETIVO: Avaliar a relacao entre poluicao do ar e efeitos respiratorios agudos em criancas. METODOS: Foi realizado um estudo ecologico de series temporais em tres unidades publicas de saude do bairro de Jacarepagua, municipio do Rio de Janeiro, entre abril de 2002 e marco de 2003. Foram analisados dados diarios de PM10, SO2, NO2, CO e O3, e como variaveis de desfecho 45.595 atendimentos pediatricos de emergencia por sintomas respiratorios ou especificos por transtornos nas vias aereas superiores e nas vias aereas inferiores. Foram incluidas no modelo para controle de confundimento as variaveis referentes a tendencia temporal, sazonalidade, temperatura, umidade relativa do ar, precipitacao de chuva, infeccoes respiratorias e os efeitos do calendario (como feriados e finais de semana). Foi empregada a regressao de Poisson via modelos aditivos generalizados para estimar os efeitos dos poluentes e dos fatores de confusao. RESULTADOS: Somente o O3 apresentou resultado positivo e estatisticamente significativo, tanto com todos os atendimentos de emergencia por queixas respiratorias como com os atendimentos motivados por sintomas nas vias aereas inferiores. O efeito foi no mesmo dia da exposicao (lag 0). Associacao significativa e de sentido inverso ocorreu com o CO e os atendimentos pediatricos por queixas respiratorias. Nao se observou resultado significativo com os demais poluentes atmosfericos. CONCLUSOES: Foram encontradas associacoes entre indicadores de poluicao atmosferica e o numero de atendimentos pediatricos de emergencia por motivos respiratorios em Jacarepagua, apesar de os niveis de todos os poluentes monitorados permanecessem abaixo dos limites recomendados durante todo o periodo de estudos.

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.

Air quality and emergency pediatric care for symptoms of bronchial obstruction categorized by age bracket in Rio de Janeiro, Brazil

The objective of this study was to estimate the association between levels of air pollutants and respiratory symptoms in children. An ecological time-series study was conducted between April 2002 and March 2003 with daily data on PM10, SO2, CO, NO2, and O3 and paediatric care in emergency rooms due to symptoms indicating bronchial obstruction. The potential confounding factors considered were: time trend, seasonality, meteorological variables, respiratory infections and the effects of weekends and holidays. A semi-parametric Poisson regression was used to model the time series. Splines (data smoothing functions), indicator variables and cubic polynomials were used to adjust the effects of the confounding variables. A 5% significance level was adopted for the study. A statistically significant increase of 6.7% in paediatric visits of children of less than 2 years of age was associated with PM10. A 3% positive association with O3 showed borderline significance (p < 0.06) in this age bracket. Our findings highlight the existence of an acknowledged public health problem in Rio de Janeiro, Brazil, and also emphasize the need to identify the principal sources of air pollutants.

Consumo de macronutrientes e ingestão inadequada de micronutrientes em adultos

OBJETIVO: Estimar o consumo de energia e nutrientes e a prevalencia de ingestao inadequada de micronutrientes entre adultos brasileiros. METODOS: Foram analisados dados do Inquerito Nacional de Alimentacao da Pesquisa de Orcamento Familiar 2008-2009. O consumo alimentar foi avaliado por dois dias de registro alimentar nao consecutivos. Um total de 21.003 individuos (52,5% mulheres) entre 20 e 59 anos de idade participou do estudo. A ingestao usual de nutrientes foi estimada pelo metodo proposto pelo National Cancer Institute. As prevalencias de ingestao inadequada de micronutrientes foram obtidas pelo metodo da necessidade media estimada (EAR) como ponto de corte. Para manganes e potassio, a Ingestao Adequada (AI) foi usada como ponto de corte. A ingestao de sodio foi comparada com o nivel de ingestao maximo toleravel (UL). A prevalencia de inadequacao da ingestao de ferro foi determinada por abordagem probabilistica. Os dados foram analisados de acordo com a localizacao do domicilio (area urbana ou rural) e as macrorregioes do pais. RESULTADOS: A media do consumo energetico foi de 2.083 kcal entre os homens e 1.698 kcal entre as mulheres. Prevalencias de inadequacao maiores ou iguais a 70% foram observadas para calcio entre os homens e magnesio, vitamina A, sodio em ambos os sexos. Prevalencias maiores ou iguais a 90% foram encontradas para calcio entre as mulheres e vitaminas D e E em ambos os sexos. Prevalencias menores que 5% foram encontradas para ferro entre os homens e niacina para homens e mulheres. No geral, a prevalencia de ingestao inadequada foi mais acentuada na area rural e na regiao Nordeste. CONCLUSOES: O consumo de energia e maior entre individuos residentes em areas urbanas e da regiao Norte. Os grupos com maior risco de ingestao inadequada de micronutrientes sao as mulheres e os que residem na area rural e na regiao Nordeste.

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.

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.

Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

BackgroundStudies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance.MethodsThe effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region.Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008.ResultsThe ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95%CI 0.20 – 0.58) for the P. falciparum malaria incidence rates, 0.67 (95%CI 0.50 – 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95%CI 0.41 – 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported.ConclusionsIn the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.

Assessing usual dietary intake in complex sample design surveys: the National Dietary Survey

The National Cancer Institute (NCI) method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR), in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal) and fruit (g) intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.