RESUMO
Snakebite envenoming affects close to 2.7 million people globally every year. In Brazil, snakebites are reported to the Ministry of Health surveillance system and cases receive antivenom free of charge. There is an urgent need to identify higher risk areas for antivenom distribution, and to develop prevention activities. The objective of this study is to provide an overview of the epidemiological situation of snakebite envenoming in Brazil and explore possible drivers; as well as to create a flowchart tool to support decision-makers identify higher risk areas. An ecological-type study was carried out using data by municipality (2013-2017). Study parts: 1) Create a geocoded database and perform a descriptive and cluster analysis; 2) Statistical analysis to measure the association of snakebite and possible environmental and socioeconomic drivers; 3) Develop a flowchart to support decision-makers and the application of this tool in one state (Rio Grande do Sul) as an example. An average of 27,120 snakebite cases per year were reported at the country level. Clusters of municipalities with high numbers of snakebites are mostly found in the Amazon Legal Region. The negative binomial regression model showed association with the snakebite case count: the type of major habitat, tropical or non-tropical; temperature; percentage of urbanization; precipitation; elevation; GDP per capita; a weaker relation with forest loss; and with venomous snake richness. The state where the instrument was applied reported 4,227 snakebites in the period. Most municipalities were considered as medium risk and 56/496 as high risk according to the tool created. Snakebite cases are distributed across the entire country with the highest concentration in the Legal Amazon Region. This creates a complex situation both for better understanding of the association of environmental and socioeconomic factors with snakebites and for the distribution and maintenance of antivenom to remote areas. Research into types of antivenom with a longer shelf life without the need for refrigeration is needed.
Assuntos
Mordeduras de Serpentes/epidemiologia , Animais , Antivenenos , Brasil/epidemiologia , Tomada de Decisões , Mapeamento Geográfico , Humanos , Incidência , Medição de Risco , Serpentes , Fatores SocioeconômicosRESUMO
BACKGROUND: Environmental metal exposure during pregnancy can affect intrauterine growth and disrupt child development. Metal exposure in urban areas can occur through the air, water and food routes. The city of Rio de Janeiro is the second more populous of Brazil and the sixth most populous in the American continent and is characterized by a significant social-economic inequality and a large range of urban organization problems. OBJECTIVES: To evaluate environmental heavy metal (arsenic, cadmium, lead and mercury) exposure in mother-newborns pairs in an urban area in Rio de Janeiro, Brazil. METHODS: All pregnant women, over 16 years of age, who came to the University Maternity School for newborn delivery orientation, between October and November 2017, were invited to participate in the project. Socioeconomic, cultural, leisure, and living conditions data of from the parents were collected via questionnaire; whole maternal blood and umbilical cord blood samples were also collected. RESULTS: Of the 209 eligible pregnant women 142 (68%) accepted the invitation to participate in the study. A total of 131 (92.3%) mothers delivered live born children, and maternal blood and umbilical cord blood were collected from 117 mother-newborn pairs. Metal concentrations above the detection limit were detected in all maternal and cord blood samples. Strong correlations of arsenic, cadmium, lead and mercury concentrations between maternal and umbilical cord blood were observed. Median lead and arsenic concentrations in maternal and umbilical cord blood were higher than values reported in other studies conducted in Brazil and worldwide. Lead concentrations in 25% of the umbilical cord blood samples were near of 5 µg/dL (P75 = 4.92 µg/dL). CONCLUSION: The results reported herein indicate the need for the establishment of health surveillance programs in Brazil, in order to investigate and monitor the health effects of environmental heavy metal exposure in children since the gestation period.
Assuntos
Desenvolvimento Infantil , Exposição Ambiental , Chumbo , Exposição Materna , Brasil , Criança , Estudos de Coortes , Feminino , Sangue Fetal , Humanos , Recém-Nascido , Chumbo/farmacocinética , GravidezRESUMO
There are few studies about children's environmental exposure to arsenic (As) in Brazil, most of them being in mining regions. The objective of this study was to contribute to the understanding of biologic concentrations of arsenic in children living in an urban area, in Brazil. A study of arsenic concentrations in capillary blood (n = 270), nail (n = 261), and urine (n = 99) samples, in male and female children, 8 to 10 years old, from two public schools in Rio de Janeiro, was conducted. Socio-economic and health data were obtained through questionnaires. The nail and capillary blood analysis were performed by inductively coupled plasma mass spectrometry (ICP-MS), while urine samples were analyzed using hydride generation atomic absorption spectrometry (HG-AAS). The median, geometric mean, and 95th percentiles of total arsenic concentrations were, respectively, 2.53, 2.40, and 3.58 µg/L in capillary blood; 0.09, 0.10, and 0.24 µg/g in nails; and 12.50, 10.97, and 39.45 µg/L in urine. The geometric mean of urinary arsenic level was above the values reported by international surveys for non-exposed populations. The arsenic concentrations in nails were compatible with the values found in national studies. These outcomes can contribute to the increase of knowledge on biologic concentrations of arsenic in children living in urban areas, in Brazil.
Assuntos
Arsênio/análise , Exposição Ambiental/análise , Unhas/química , Adolescente , Arsênio/química , Brasil , Criança , Feminino , Humanos , Masculino , Mineração , Instituições Acadêmicas , Espectrofotometria AtômicaRESUMO
BACKGROUND: This study investigated the association between pesticide exposure in Brazil (2005-2013) with rates of central nervous system (CNS) and cardiovascular system (CVS) congenital abnormalities in 2014. METHOD: An exposure variable was established from data on production and sales of pesticides (kg) per crop area (ha) for 2012 and 2013 years. The Brazilian states were divided into three categories: high, medium, and low pesticide use and rate ratios were estimated for each group of states (CI: 95 %). RESULTS: In 2013 and 2014, the high use group presented a 100 and a 75 % increase, and the medium group a 65 and 23 % increase, respectively, in the risk of CNS and CVS congenital abnormalities at birth, compared to the low use group. CONCLUSION: These findings suggest that pesticide exposure could be associated with increased risk of congenital malformations at birth in Brazil.
Assuntos
Anormalidades Cardiovasculares/epidemiologia , Doenças do Sistema Nervoso Central/epidemiologia , Exposição Ambiental/efeitos adversos , Praguicidas/efeitos adversos , Brasil/epidemiologia , Anormalidades Cardiovasculares/etiologia , Doenças do Sistema Nervoso Central/congênito , Anormalidades Congênitas , HumanosRESUMO
In the region of the Americas, approximately 100,000 children under the age of 5 years die each year due to environmental hazards. Brazil, due to its large size and wide range of environmental challenges, presents numerous hazards to children's health. The aim of this study was to systematically review the scientific literature that describes children's exposures to environmental pollutants in Brazil and their effects on Brazilian children's health. A systematic review of the scientific literature was performed without language restrictions and time of publication (years). The literature search was conducted in the following key resources: PubMed (MEDLINE), Scopus and Web of Science with the MeSH Terms: Environmental exposure AND Brazil (filters: Human, Child [birth to 18 years] and Affiliation Author). The Virtual Health Library was also employed to access the databases Scielo and Lilacs. The search strategy was [DeCS Terms]: Child OR adolescent AND Environmental exposure AND Brazil. Health effects in children associated with exposure to environmental pollutants in Brazil were reported in 74 studies, during the period between 1995 and 2015. The most frequently cited effect was hospital admission for respiratory causes including wheezing, asthma, and pneumonia among children living in areas with high concentrations of air pollutants. A broad spectrum of other health effects possibly linked to pollutants also was found such as prematurity, low birth weight, congenital abnormality (cryptorchidism, hypospadia, micropenis), poor performance in tests of psychomotor and mental development, and behavioral problems. Exposure to pesticides in utero and postnatally was associated with a high risk for leukemia in children <2 years old. These results show that there is a need in Brazil for stricter monitoring of pollutant emissions and for health surveillance programs especially among vulnerable populations such as pregnant women and young children.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental/efeitos adversos , Saúde Ambiental , Nível de Saúde , Brasil , Criança , Meio Ambiente , Monitoramento Ambiental , Feminino , Humanos , Masculino , GravidezRESUMO
INTRODUCTION: The purpose of the current study was to estimate the prevalence of common mental disorders (CMDs) among Brazilian civil aviation flight attendants and to investigate associations between CMDs and sociodemographic and work-related variables. METHODS: This was a quantitative cross-sectional study conducted between October 2009-October 2010 using a self-reporting questionnaire about sociodemographic and work-related data and a screening instrument for the detection of psychiatric morbidity. RESULTS: A total of 453 flight attendants were evaluated. The prevalence of CMDs was found to be 29.8% (N = 135/453; 95% CI 25.7-34.10%). Female flight attendants presented higher prevalence (36.0%) than male flight attendants (19.7%). The prevalence among individuals who had completed their training more than 5 yr earlier was 35.7% versus 19.2% among those who had qualified less than 5 yr earlier. In the final adjusted model, only the following variables maintained a statistically significant association: sex (OR 2.83); regular physical activity practice (OR 1.68); time since completion of training (OR 2.56); involvement with religious belief (OR 1.66); and type of flight route (OR 1.71). DISCUSSION: Flight attendants are subjected to stressful situations determined both by specific occupational risks and by the form of work organization. Studies with civil aviation pilots found lower values for CMD prevalence (6.7%). This shows that although both categories are classified as aircrew members and share various similarities of occupational risks, they are also, at the same time, profoundly different regarding their professional profiles.
Assuntos
Medicina Aeroespacial , Transtornos Mentais/epidemiologia , Religião e Psicologia , Adulto , Ansiedade/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Emprego/psicologia , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/psicologiaRESUMO
More than 2.5 billion people, in more than 100 countries, are estimated to live in risk areas for the transmission of dengue. We investigated the production of Aedes aegypti immature forms in different types of containers. Larvae and pupae presence were inspected in 747 containers in 300 dwellings in Rio de Janeiro state, Brazil. The statistical significance of the differences of immature forms was calculated for different groups of recipients and classified according to the type of use, volume, and material. Containers used to store water and those classified as garbage enclosed 90.2% of the larvae and 88.9% of the pupae. We concluded that a wider covering of more regular water supply, as well as regular garbage collection, are decisive factors for an effective control of dengue vector.