RESUMO
INTRODUCTION: Experiments in animals exposed to mercury (Hg) in different chemical states have shown thyroid parenchymal and hormone alterations. However, these experiments did not allow the establishment of dose-response curves or provide an understanding of whether these Hg effects on the thyroid parenchyma occur in humans. OBJECTIVE: To evaluate the association between chronic occupational exposure to metallic Hg and alterations in thyroid hormones and gland parenchyma 14 years after the last exposure. METHODS: A cross-sectional study including 55 males exposed in the past to metallic Hg and 55 non-exposed males, paired by age, was conducted in the Hospital das Clínicas (Brazil) from 2016 to 2017. Serum concentrations of total and free triiodothyronine (TT3 and FT3), free thyroxine (FT4), thyrotropin (TSH), reverse T3 (RT3), selenium and antithyroid antibody titers were obtained. The Hg and iodine concentrations were measured in urine. The thyroid parenchyma was evaluated by B-mode ultrasonography with Doppler. The nodules with aspects suspicious for malignancy were submitted to aspiration puncture with a thin needle, and the cytology assessment was classified by the Bethesda system. The t test or Mann-Whitney test, Chi-square test and Spearman correlation were used to compare the exposed and non-exposed groups and examine the relationships between the variables. Univariate and multivariate logistic regression models were used to trace determinants of the risk of thyroid hormone alteration. Statistical significance was defined by p < 0.05. RESULTS: The urinary Hg average was significantly higher in the exposed group than in the non-exposed group (p < 0.01). The mean TSH serum concentration in the exposed group was higher, with a statistically significant difference between the groups (p = 0.03). Serum concentrations of TSH exceeded the normality limit (4.20 µIU/ml) in 13 exposed individuals (27.3%) and 4 non-exposed individuals (7.3%), with a statistically significant association between the hormonal increase and exposure to Hg (p = 0.02). In the logistic regression model, exposure to Hg (yes or no) showed an odds ratio = 4.86 associated with an increase of TSH above the normal limit (p = 0.04). The serum concentrations of RT3 showed a statistically borderline difference between the groups (p = 0.06). There was no statistically significant difference between the mean TT3, FT3 and FT4 serum concentrations in the Hg-exposed group compared to the non-exposed group. The proportions of the echogenicity alterations were higher in the exposed group compared to the non-exposed group (27.3% versus 9.1%; p = 0.03). Papillary carcinomas were documented in three exposed individuals and one non-exposed individual. A follicular carcinoma was recorded in one non-exposed individual. CONCLUSIONS: Due to the higher serum TSH concentration and the prevalence of parenchymal alterations in the Hg-exposed group, even after cessation of exposure, it is recommended that the thyroid status of exposed workers be followed for a long period.
Assuntos
Mercúrio/toxicidade , Exposição Ocupacional/efeitos adversos , Glândula Tireoide/efeitos dos fármacos , Hormônios Tireóideos/sangue , Neoplasias da Glândula Tireoide/epidemiologia , Adulto , Idoso , Brasil , Carcinoma Papilar/epidemiologia , Estudos Transversais , Humanos , Iodo/urina , Masculino , Mercúrio/urina , Pessoa de Meia-Idade , Selênio/sangue , Glândula Tireoide/diagnóstico por imagem , Ultrassonografia DopplerRESUMO
In Brazil, cardiovascular diseases account for 33% of deaths and the prevalence of hypertension is of approximately 22%. The Santos and São Vicente Estuarine System is the most important example of environmental degradation by chemicals from industrial sources. The aim of the present study was to evaluate the prevalence of hypertension and its associated factors in the population of this estuary in the period 2006-2009. A cross-sectional study was conducted to assess the aforementioned prevalence of hypertension in the evaluated areas, as well as risk factors for this disease in four contaminated areas located in the Estuary, and one area outside Estuary, the city of Bertioga. Associations between categorical variables were tested using Pearson's chi-square test incorporating Yates' correction, or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for hypertension. The highest prevalence of hypertension was found in Continental São Vicente (28.4%). The risk factors for hypertension were the following: living in Center of Cubatão (OR: 1.3; IC95%: 1.0 - 1.6) and Continental São Vicente (OR: 1.4; IC95%: 1.1 - 1.8); illiterate (OR: 1.9; IC95%: 1.1 - 3.2); living in the area for more than 20 years (OR: 1.2; IC95%: 1.0 - 1.5); group of people aged 36-60 years (OR: 3.9; IC95%: 3.3 - 4.6) and who have had past occupational exposure (OR: 1.3; IC95%: 1.1 - 1.6). Results indicate that living in contaminated areas, especially for a longer time, is a risk factor for hypertension.
Assuntos
Exposição Ambiental/estatística & dados numéricos , Estuários , Hipertensão/epidemiologia , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Cidades , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de RiscoRESUMO
The Santos and São Vicente Estuary has suffered extensively over the years from irregular industrial deposits. The present study aimed to evaluate liver disease prevalence and potential associated risk factors in four of the Estuary's areas (Pilões and Água-Fria, Cubatão Center, Continental São Vicente, and Guarujá) and a reference area (Bertioga). This study consisted of a cross-sectional study design, in which a questionnaire was used to collect information in 820 households at each of the study areas. The proportion of total liver diseases, hepatitis, cirrhosis, and cancer (liver, biliary tract, and pancreas) per area were estimated. Pearson's chi-square test and two proportion differences test were applied in order to evaluate associations between disease occurrence and areas and to test differences between two proportions, respectively. Single and multiple logistic regression models were applied to assess associations between disease prevalence and the different study areas. Liver disease prevalence was 1.5 % among all inhabitants and 1.4 % among those without any type of exposure. Among those who reported the presence of liver disease, a higher percentage of the participants that reported hepatitis (27.7 %) or other liver disease (48.7 %) did not report occupational or alcohol exposures. Hepatitis (77.8 %) was the most reported disease, and a statistical association between living in Pilões and Água-Fria and the occurrence of hepatitis was observed (Pearson's χ (2): z = 18.1; p = 0.001). The consumption of locally-produced groceries (2.88; CI: 1.24-6.70) and water (5.88; CI: 2.24-15.45) were shown to be risk factors for the occurrence of liver disease. Thus, environmental exposure is still a public health problem present in the estuary region.
Assuntos
Estuários , Hepatopatias/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos Transversais , Exposição Ambiental/análise , Feminino , Humanos , Hepatopatias/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Poluentes da Água/toxicidade , Adulto JovemRESUMO
OBJECTIVE: To investigate the lag structure effects from exposure to atmospheric pollution in acute outbursts in hospital admissions of paediatric rheumatic diseases (PRDs). METHODS: Morbidity data were obtained from the Brazilian Hospital Information System in seven consecutive years, including admissions due to seven PRDs (juvenile idiopathic arthritis, systemic lupus erythematosus, dermatomyositis, Henoch-Schönlein purpura, polyarteritis nodosa, systemic sclerosis and ankylosing spondylitis). Cases with secondary diagnosis of respiratory diseases were excluded. Daily concentrations of inhaled particulate matter (PM(10)), sulphur dioxide (SO(2)) nitrogen dioxide (NO(2)), ozone (O(3)) and carbon monoxide (CO) were evaluated. Generalized linear Poisson regression models controlling for short-term trend, seasonality, holidays, temperature and humidity were used. Lag structures and magnitude of air pollutants' effects were adopted to estimate restricted polynomial distributed lag models. RESULTS: The total number of admissions due to acute outbursts PRD was 1,821. The SO(2) interquartile range (7.79 µg/m(3)) was associated with an increase of 1.98% (confidence interval 0.25-3.69) in the number of hospital admissions due to outcome studied after 14 days of exposure. This effect was maintained until day 17. Of note, the other pollutants, with the exception of O(3), showed an increase in the number of hospital admissions from the second week. CONCLUSION: This study is the first to demonstrate a delayed association between SO(2) and PRD outburst, suggesting that oxidative stress reaction could trigger the inflammation of these diseases.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Hospitalização/estatística & dados numéricos , Doenças Reumáticas/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Modelos Lineares , Masculino , Estresse Oxidativo , Material Particulado/efeitos adversos , Distribuição de Poisson , Doenças Reumáticas/etiologia , Doenças Reumáticas/fisiopatologia , Fatores de TempoRESUMO
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can have recurrent disease exacerbations triggered by several factors, including air pollution. Visits to the emergency respiratory department can be a direct result of short-term exposure to air pollution. The aim of this study was to investigate the relationship between the daily number of COPD emergency department visits and the daily environmental air concentrations of PM(10), SO(2), NO(2), CO and O(3) in the City of São Paulo, Brazil. METHODS: The sample data were collected between 2001 and 2003 and are categorised by gender and age. Generalised linear Poisson regression models were adopted to control for both short- and long-term seasonal changes as well as for temperature and relative humidity. The non-linear dependencies were controlled using a natural cubic spline function. Third-degree polynomial distributed lag models were adopted to estimate both lag structures and the cumulative effects of air pollutants. RESULTS: PM(10) and SO(2) readings showed both acute and lagged effects on COPD emergency department visits. Interquartile range increases in their concentration (28.3 microg/m(3) and 7.8 microg/m(3), respectively) were associated with a cumulative 6-day increase of 19% and 16% in COPD admissions, respectively. An effect on women was observed at lag 0, and among the elderly the lag period was noted to be longer. Increases in CO concentration showed impacts in the female and elderly groups. NO(2) and O(3) presented mild effects on the elderly and in women, respectively. CONCLUSION: These results indicate that air pollution affects health in a gender- and age-specific manner and should be considered a relevant risk factor that exacerbates COPD in urban environments.
Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Brasil , Monóxido de Carbono/toxicidade , Monitoramento Ambiental , Monitoramento Epidemiológico , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/toxicidade , Ozônio/toxicidade , Medição de Risco , Dióxido de Enxofre/toxicidade , Saúde da População Urbana/estatística & dados numéricosRESUMO
Type 2 diabetes increases the risk of cardiovascular mortality and these patients, even without previous myocardial infarction, run the risk of fatal coronary heart disease similar to non-diabetic patients surviving myocardial infarction. There is evidence showing that particulate matter air pollution is associated with increases in cardiopulmonary morbidity and mortality. The present study was carried out to evaluate the effect of diabetes mellitus on the association of air pollution with cardiovascular emergency room visits in a tertiary referral hospital in the city of São Paulo. Using a time-series approach, and adopting generalized linear Poisson regression models, we assessed the effect of daily variations in PM10, CO, NO2, SO2, and O3 on the daily number of emergency room visits for cardiovascular diseases in diabetic and non-diabetic patients from 2001 to 2003. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear term seasonal usage and weather variables. In this period, 45,000 cardiovascular emergency room visits were registered. The observed increase in interquartile range within the 2-day moving average of 8.0 microg/m(3) SO2 was associated with 7.0% (95%CI: 4.0-11.0) and 20.0% (95%CI: 5.0-44.0) increases in cardiovascular disease emergency room visits by non-diabetic and diabetic groups, respectively. These data indicate that air pollution causes an increase of cardiovascular emergency room visits, and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/etiologia , Diabetes Mellitus , Serviço Hospitalar de Emergência/estatística & dados numéricos , Poluentes Atmosféricos/classificação , Poluição do Ar/estatística & dados numéricos , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Humanos , Material Particulado/toxicidade , Distribuição de PoissonRESUMO
Type 2 diabetes increases the risk of cardiovascular mortality and these patients, even without previous myocardial infarction, run the risk of fatal coronary heart disease similar to non-diabetic patients surviving myocardial infarction. There is evidence showing that particulate matter air pollution is associated with increases in cardiopulmonary morbidity and mortality. The present study was carried out to evaluate the effect of diabetes mellitus on the association of air pollution with cardiovascular emergency room visits in a tertiary referral hospital in the city of São Paulo. Using a time-series approach, and adopting generalized linear Poisson regression models, we assessed the effect of daily variations in PM10, CO, NO2, SO2, and O3 on the daily number of emergency room visits for cardiovascular diseases in diabetic and non-diabetic patients from 2001 to 2003. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear term seasonal usage and weather variables. In this period, 45,000 cardiovascular emergency room visits were registered. The observed increase in interquartile range within the 2-day moving average of 8.0 µg/m³ SO2 was associated with 7.0 percent (95 percentCI: 4.0-11.0) and 20.0 percent (95 percentCI: 5.0-44.0) increases in cardiovascular disease emergency room visits by non-diabetic and diabetic groups, respectively. These data indicate that air pollution causes an increase of cardiovascular emergency room visits, and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.
Assuntos
Humanos , Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/etiologia , Diabetes Mellitus , Serviço Hospitalar de Emergência/estatística & dados numéricos , Poluentes Atmosféricos/classificação , Poluição do Ar/estatística & dados numéricos , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Distribuição de Poisson , Material Particulado/toxicidadeRESUMO
OBJECTIVES: Air-pollution exposure has been associated with increased cardiovascular hospital admissions and mortality in time-series studies. We evaluated the relation between air pollutants and emergency room (ER) visits because of cardiac arrhythmia in a cardiology hospital. METHODS: In a time-series study, we evaluated the association between the emergency room visits as a result of cardiac arrhythmia and daily variations in SO(2), CO, NO(2), O(3) and PM(10), from January 1998 to August 1999. The cases of arrhythmia were modelled using generalised linear Poisson regression models, controlling for seasonality (short-term and long-term trend), and weather. RESULTS: Interquartile range increases in CO (1.5 ppm), NO(2) (49,5 microg/m(3)) and PM(10) (22.2 microg/m(3)) on the concurrent day were associated with increases of 12.3% (95% CI: 7.6% to 17.2%), 10.4% (95% CI: 5.2% to 15.9%) and 6.7% (95% CI: 1.2% to 12.4%) in arrhythmia ER visits, respectively. PM(10), CO and NO(2) effects were dose-dependent and gaseous pollutants had thresholds. Only CO effect resisted estimates in models with more than one pollutant. CONCLUSIONS: Our results showed that air pollutant effects on arrhythmia are predominantly acute starting at concentrations below air quality standards, and the association with CO and NO(2) suggests a relevant role for pollution caused by cars.
Assuntos
Poluição do Ar/efeitos adversos , Arritmias Cardíacas/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Arritmias Cardíacas/epidemiologia , Brasil/epidemiologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Monitoramento Ambiental/métodos , Monitoramento Epidemiológico , Feminino , Humanos , Umidade , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , TemperaturaRESUMO
Studies of cooking-generated NO2 effects are rare in occupational epidemiology. In the present study, we evaluated the lung function of professional cooks exposed to NO2 in hospital kitchens. We performed spirometry in 37 cooks working in four hospital kitchens and estimated the predicted FVC, FEV1 and FEF(25-75), based on age, sex, race, weight, and height, according to Knudson standards. NO2 measurements were obtained for 4 consecutive days during 4 different periods at 20-day intervals in each kitchen. Measurements were performed inside and outside the kitchens, simultaneously using Palm diffusion tubes. A time/exposure indicator was defined as representative of the cumulative exposure of each cook. No statistically significant effect of NO2 exposure on FVC was found. Each year of work as a cook corresponded to a decrease in predicted FEV1 of 2.5% (P = 0.046) for the group as a whole. When smoking status and asthma were included in the analysis the effect of time/exposure decreased about 10% and lost statistical significance. On predicted FEF(25-75), a decrease of 3.5% (P = 0.035) was observed for the same group and the inclusion of controllers for smoking status and asthma did not affect the effects of time/exposure on pulmonary function parameter. After a 10-year period of work as cooks the participants of the study may present decreases in both predicted FEV1 and FEF(25-75) that can reach 20 and 30%, respectively. The present study showed small but statistically significant adverse effects of gas stove exposure on the lung function of professional cooks.
Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Culinária , Pulmão/efeitos dos fármacos , Dióxido de Nitrogênio/toxicidade , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Feminino , Serviço Hospitalar de Nutrição , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fatores de TempoRESUMO
Studies of cooking-generated NO2 effects are rare in occupational epidemiology. In the present study, we evaluated the lung function of professional cooks exposed to NO2 in hospital kitchens. We performed spirometry in 37 cooks working in four hospital kitchens and estimated the predicted FVC, FEV1 and FEF25-75, based on age, sex, race, weight, and height, according to Knudson standards. NO2 measurements were obtained for 4 consecutive days during 4 different periods at 20-day intervals in each kitchen. Measurements were performed inside and outside the kitchens, simultaneously using Palm diffusion tubes. A time/exposure indicator was defined as representative of the cumulative exposure of each cook. No statistically significant effect of NO2 exposure on FVC was found. Each year of work as a cook corresponded to a decrease in predicted FEV1 of 2.5 percent (P = 0.046) for the group as a whole. When smoking status and asthma were included in the analysis the effect of time/exposure decreased about 10 percent and lost statistical significance. On predicted FEF25-75, a decrease of 3.5 percent (P = 0.035) was observed for the same group and the inclusion of controllers for smoking status and asthma did not affect the effects of time/exposure on pulmonary function parameter. After a 10-year period of work as cooks the participants of the study may present decreases in both predicted FEV1 and FEF25-75 that can reach 20 and 30 percent, respectively. The present study showed small but statistically significant adverse effects of gas stove exposure on the lung function of professional cooks.