[Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project]

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

Fifty Years of the National Rabies Control Program in Brazil under the One Health Perspective

In 1973, the National Rabies Program was created in Brazil through an agreement between the Ministry of Health and Agriculture. Since its beginning, it developed integrated action through access to free post-exposure prophylaxis (PEP) for people at risk, dog vaccination campaigns, a joint surveillance system, and awareness. This study aims to describe human rabies in Brazil under the One Health perspective in recent decades, including achievements in the control of dog-mediated cases and challenges in human cases transmitted by wild animals. This paper also explores possible drivers of human rabies in the Northeast Region with half of the cases. The first part of this study was descriptive, presenting data and examples by periods. Statistical analysis was performed in the last period (2010-2022) to explore possible drivers. Dog-mediated human cases decreased from 147 to 0, and dog cases decreased from 4500 to 7. A major challenge is now human cases transmitted by wild animals (bats, non-human primates, and wild canids). Most current human cases occur in municipalities with a tropical and subtropical moist broadleaf forest biome and a Gini index higher than 0.5. In the multivariable analysis, an association with temperature was estimated (OR = 1.739; CI95% = 1.181-2.744), and primary healthcare coverage (OR = 0.947; CI95% = 0.915-0.987) was identified as a protector. It is possible to significantly reduce the number of dog-mediated human rabies cases through the efforts presented. However, Brazil has wildlife variants of the rabies virus circulating. The association of human cases with higher temperatures in the Northeast is a concern with climate change. To reduce human cases transmitted by wild animals, it is important to continue distributing free PEP, especially in remote at-risk areas in the Amazon Region, and to increase awareness.

Metal exposure in a child population after a mine tailings dam failure. Projeto Bruminha

OBJECTIVE

This study aimed to analyze the urinary concentrations of As, Cd, Pb, Hg, and Mn in children living in areas directly affected by the tailings of the Brumadinho disaster.

METHODS

We performed a cross-sectional descriptive study on a population of 217 children aged 0 to 6 years, living in Córrego do Feijão (CF), Parque da Cachoeira (PC), Aranha (AR), and Tejuco (TJ), enrolled in the Longitudinal Study of Child Health in Brumadinho (Minas Gerais) - Projeto Bruminha. Socioeconomic data and urine samples were collected to determine the concentration of selected metals.

RESULTS

Children living in locations not directly affected by the disaster (AR and TJ) had higher concentrations of As and Mn than those in directly affected areas (CF and PC). Additionally, children living in locations not potentially exposed to dust from tailings mud or mining activity (AR) showed higher urinary As concentrations than those potentially exposed (CF, PC, and TJ).

CONCLUSION

Our results suggest the need to investigate possible sources of As exposure in children living in areas not directly affected by the disaster and not potentially exposed to dust.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review

OBJECTIVE

 The present review aimed to synthesize the evidence regarding mercury (Hg) exposure and hypertensive disorders of pregnancy (HDP).

DATA SOURCES

 The PubMed, BVS/LILACS, SciELO and UFRJ's Pantheon Digital Library databases were systematically searched through June 2021.

STUDY SELECTION

 Observational analytical articles, written in English, Spanish, or Portuguese, without time restriction.

DATA COLLECTION

 We followed the PICOS strategy, and the methodological quality was assessed using the Downs and Black checklist.

DATA SYNTHESIS

 We retrieved 77 articles, of which 6 met the review criteria. They comprised 4,848 participants, of which 809 (16.7%) had HDP and 4,724 (97.4%) were environmentally exposed to Hg (fish consumption and dental amalgam). Mercury biomarkers evaluated were blood (four studies) and urine (two studies). Two studies found a positive association between Hg and HDP in the group with more exposure, and the other four did not present it. The quality assessment revealed three satisfactory and three good-rated studies (mean: 19.3 ± 1.6 out 28 points). The absence or no proper adjustment for negative confounding factor, such as fish consumption, was observed in five studies.

CONCLUSION

 We retrieved only six studies, although Hg is a widespread toxic metal and pregnancy is a period of heightened susceptibility to environmental threats and cardiovascular risk. Overall, our review showed mixed results, with two studies reporting a positive association in the group with more exposure. However, due to the importance of the subject, additional studies are needed to elucidate the effects of Hg on HDP, with particular attention to adjusting negative confounding.

Human Health Risk Assessment Is Associated with the Consumption of Metal-Contaminated Groundwater around the Marituba Landfill, Amazonia, Brazil

Groundwater is present in its purest form beneath the earth's surface. However, metal contamination is potentially a problem faced by many countries. For this reason, the present study aims to make an assessment of the risks associated with groundwater consumption around the Marituba landfill in an Amazon region. The present study was characterized as transversal with the use of primary data. The sampling occurred in a stratified random way, performed in two radii of action being the 1st radius of 2.5 km away from the landfill and the 2nd radius of 3.5 km away from the landfill to the neighborhoods. A total of 184 points were collected. In all communities the average daily dose (ADD) was higher than the reference oral dose (Rfd), for the metals As, Pb and Mn the risk quotient (HQ) was greater than 1 (one) in all neighborhoods, the concentration of Mn in the least exposed neighborhood was greater than 10 µg.L^-1, even at a distance of 3.5 km from the landfill. The average concentrations for As and Pb did not exceed the recommended, however, they were more significant for the Beira Rio neighborhood, respectively 1.47 µg.L^-1 and 1.9 µg.L^-1. And the average concentration for Cu was more significant for the Uriboca neighborhood 18.20 µg.L^-1, but within the recommended. The average of the general concentration of Heavy Metals Pollution Index (HPI) of the water consumed was 80.03, indicating that the water consumed by the population is contaminated by metals.

Exposição ao mercúrio e anemia em crianças e adolescentes de seis comunidades da Amazônia Brasileira

Resumo O mercúrio (Hg) é uma substância tóxica, sendo o consumo de pescados uma das principais fontes de exposição da população. Este artigo visa avaliar a associação entre anemia e exposição ao Hg na população infanto-juvenil de seis comunidades ribeirinhas da Amazônia Brasileira. Realizou-se a análise secundária de dados de estudos seccionais, incluindo 1.318 indivíduos, divididos em dois grupos segundo a influência do garimpo (grupo A sob influência, e grupo B sem influência). Métodos de análise multivariada foram realizados para verificar a associação entre variável de exposição (Hg no cabelo) e anemia, estratificando pelos grupos. Foram observados 348 casos de anemia (27,1%), sendo 206 entre o grupo B e 142 no grupo A. Houve diferença na mediana dos níveis de Hg entre os grupos (A = 12,8µg/g e B = 4,3µg/g, p = 0,01). Foi observada associação entre Hg no cabelo ≥ 6,0µg/g e anemia (OR = 1,38; IC95% = 1,02-1,87), fato que foi magnificado para o grupo A quando realizada estratificação (OR = 2,23; IC95% = 1,28-3,90). O estudo mostrou elevados níveis de Hg, principalmente no grupo A, e que essa substância pode ser um possível fator de risco para anemia. Além disso, as áreas geográficas pareceram modificar esse efeito, apontando para influência de outros fatores, fato que deve ser melhor avaliado.

Protocol of the Longitudinal Study on Child Health in Brumadinho (MG): “Bruminha Project”

ABSTRACT: Objective: To present the research protocol and to describe the preliminary results of the Bruminha Project. Methods: This project is part of the set of health actions proposed under the Brumadinho Health Project. It is a prospective cohort study with periodic follow-ups for four years. The eligible population was all children aged 0 to 6 years living in four rural communities of the affected municipality. Sociodemographic and health data were collected, as well as urinary samples, for assessment of exposure to metals. Results: In the first year of study, we evaluated 62% (217) of the eligible population and collected 172 (79%) valid urine samples. At least one metal was detected in all samples, and in 50.6% (n=87) or them, the metal concentration was higher than the reference value. In 38% (n=82) of the children, neuropsychomotor development was considered at risk. Report of respiratory allergy was four times (4.27) more frequent and of bronchitis 62% higher (1.62) in children living in locations exposed to dust from ore residues, compared to those living more than 10 km away from the site of the dam disaster. Conclusion: The study protocol was proven adequate to evaluate the proposed outcomes. The strategy used for population selection required adjustments regarding the long-term community awareness process, with new participants in the upcoming follow-ups (2022 and 2023).

Protocolo do estudo longitudinal de saúde infantil em Brumadinho (MG): Projeto Bruminha

RESUMO: Objetivo: Apresentar o protocolo da pesquisa e descrever os resultados preliminares da linha de base da população de estudo do Projeto Bruminha. Métodos: Este projeto é parte do conjunto de ações propostas no âmbito do Programa de Ações Saúde Brumadinho. Trata-se de um estudo de coorte prospectiva, com seguimento periódico por quatro anos, cuja população elegível foi constituída de todas as crianças de 0 a 6 anos de idade residentes em quatro localidades situadas na zona rural do município afetado, com coleta de dados sociodemográficos e de saúde e de amostras urinárias para avaliação da exposição a metais. Resultados: No primeiro ano de estudo foi avaliada 62% (217) da população elegível e se coletaram 172 (79%) amostras de urina válidas. Em todas as amostras analisadas foi detectado pelo menos um metal, e em 50,6% (n=87) concentrações urinárias acima do valor de referência. Em 38% (n=82) das crianças a avaliação do desenvolvimento neuropsicomotor foi considerada de risco. O relato de alergia respiratória foi quatro vezes (4,27) mais frequente e de bronquite 61% maior (1,62) nas crianças residentes nas localidades expostas à poeira de resíduos de minério, proporcionalmente àquelas residentes a mais de 10 km do local do desastre. Conclusão: O protocolo do estudo mostrou-se adequado para avaliação dos desfechos propostos. A estratégia de captação da população de estudo necessitou de reajustes quanto ao processo de sensibilização da comunidade a longo prazo com entrada de novos participantes nos próximos seguimentos (2022 e 2023).

Prevalence of metal levels above the reference values in a municipality affected by the collapse of a mining tailings dam: Brumadinho Health Project

ABSTRACT Objective: To describe the prevalence of levels of arsenic, cadmium, mercury, lead and manganese above the reference values (RV) in the population of Brumadinho, after the rupture of the mining tailings dam and to verify the factors associated with these levels. Methods: Baseline study of a prospective cohort, in a representative sample of 3,080 residents (aged 12 and over) in Brumadinho, Minas Gerais. Exploratory variables (age, sex, skin color, household income, smoking and place of residence) were collected using a questionnaire and the levels of As, Cd and Hg in urine and Pb and Mn in blood were evaluated using the technique of inductively coupled plasma mass spectrometry. The distribution of prevalence of levels above the reference for metals was made, according to the exploratory variables. Multiple logistic regression analyzes were used to investigate the association between altered levels of metals and characteristics evaluated. Results: Concentrations above RV were found in 38.08% of the population for Mn, 33.37% for As, 5.04% for Pb, 0.76% for Hg and 0.17% for Cd. There was a significant association between age group and levels of Mn and Pb; and between place of residence and As level. Conclusion: The results show a high prevalence of levels above the reference for Mn, As and Pb, with small differences in relation to the other variables, suggesting that it is an exposure distributed throughout the municipality.

Serum levels of perfluorooctanoic acid and perfluorooctane sulfonic acid in pregnant women: Maternal predictors and associations with birth outcomes in the PIPA Project

AIM

Perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) are persistent pollutants associated with adverse birth outcomes. This study aimed to identify predictors of blood PFOA and PFOS concentrations in pregnant women and to estimate their associations with birth outcomes in Brazil.

METHODS

We conducted a cross-sectional study with 139 pregnant women enrolled in the pilot study of the Rio Birth Cohort Study on Environmental Exposure and Childhood Development (PIPA Project). Multiple linear regression was used to estimate associations between PFOA and PFOS with maternal predictors and birth outcomes.

RESULTS

Higher levels of PFOA were observed in women aged 16-19 and 20-39 years, while fish consumption from 0.6 to 2.0 times per week was associated with lower levels of the substance. PFOS levels were higher in women living in houses with up to four rooms but lower in those who reported passive exposure to smoking. Increased newborn length and head circumference were also associated with higher maternal levels of PFOA.

CONCLUSIONS

In our study, age, fish consumption, passive smoking, and the number of rooms in the house were predictors of maternal PFAS levels. However, we did not observe significant associations between maternal plasma PFAS concentrations and birth outcomes.

Comparative Study of Evoked Otoacoustic Emissions in Offshore and Onshore Seafaring Workers

PURPOSE

To evaluate the cochlear function of offshore and onshore seafaring workers of a naval company in the city of Rio de Janeiro and to estimate the degree of association between occupational exposure to noise and/or chemical substances and alteration in cochlear function.

METHODS

This study evaluated seafaring workers aged 20 to 49, of both genders, without auditory symptoms, divided into two groups: the Offshore Group, operating in the high seas with occupational exposure; and the Onshore Group, operating in offices without occupational exposure. Exams were performed to evaluate cochlear function, including transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE).

RESULTS

The TEOAE and DPOAE responses were on average lower in the Offshore Group, for all frequencies analyzed. The proportion of failures observed was also higher in the exposure group (Offshore), for general response and specific frequency, mainly for the frequencies of 4 kHz for TEOAE and 6 kHz for DPOAE.

CONCLUSION

The results suggest that exposure to noise and/or chemical substances can contribute to alterations in cochlear function in seafarers even without manifesting auditory symptoms.

Health and environment in the 25 years of ciência & Saúde coletiva

The Journal Ciência & Saúde Coletiva appeared in the 1990s simultaneously to essential events that addressed the relationships between production, environment, health, and development, which generated an essential set of initiatives and scientific production and contributed to the development of Health and Environment in Brazil. We analyzed the papers published on this topic over the past 25 years to examine this Journal's contribution to the field. We examined 24 volumes and 170 issues and supplements of the Journal from 1996 to 2019. The texts were classified according to 4 domains. A total of 243 texts were included in the analysis, which represents about 5% of all scientific production published on the Journal's pages in the period. The production is quite varied, highlighting discussions about inequalities, vulnerabilities, development or economic aspects related to environmental issues and their impacts on health, the analysis of the production system and its relationship with health, and the predominance of studies on pesticides. We concluded that production in this field has been growing and tending to include affected territories, populations, and communities to produce this knowledge.

A comparative study of cadmium levels in blood from exposed populations in an industrial area of the Amazon, Brazil

Chemical pollution from industrial sources is one of the main problems affecting the environment. In urban areas, the emission of toxic gases and particulates to the atmosphere can damage human health. Cadmium (Cd) is one of the most ecotoxic metals among these pollutants, even at low concentrations. In this study, environmental exposure to Cd was evaluated from the Cd blood levels (CdB) of the human populations living in two Amazonian districts. The first was Bairro Industrial (BIN), which is located next to the industrial complex in Barcarena City, while the second was Vila do Beja (VBJ), a control group located in the farthest area from industrial activities in Abaetetuba City. Sectional and comparative studies were applied for both districts. Sampling (N = 469) occurred in 2012 and 2013. Gender, age, residence time, drinking water source, alcohol consumption, and smoking were used as independent variables. CdB levels were analyzed by induced coupled plasma mass spectrometry (ICP-MS). In BIN, geometric mean and median CdB levels were 0.27 and 0.43 μg∙L^-1, respectively (range: ≤0.03-17.49 μg∙L^-1), while in VBJ these were 0.19 and 0.23 μg∙L^-1 (range: ≤0.03-2.38 μg∙L^-1). The higher CdB concentration in the blood of people from BIN was similar to levels previously found in people living near other industrial areas, and showed that the BIN residents were more exposed to Cd pollution. The studies showed the need for surveillance actions to evaluate possible routes of exposure, avoiding the future worsening of the health of the population living next to industrial areas in the Amazon.

Molecular epidemiology of mycobacteria among herds in Marajó Island, Brazil, reveals strains genetically related and potential zoonotic risk of clinical relevance

Mycobacterium bovis is the main causative agent of bovine tuberculosis (bTB) being among the animal-adapted Mycobacterium tuberculosis complex. Herds can also be infected with non-tuberculous mycobacteria (NTM) causing a negative effect on the economy and on animal and human health through zoonotic infections. Molecular tools are required for mycobacteria identification; thus, it is laborious to determine the epidemiological information of mycobacteria among herds. We aimed to describe the mycobacterial pathogens associated with cases of suspected bTB lesions in cattle/buffaloes slaughtered for consumption and to investigate bTB transmission. We evaluated 74 lesion samples from 48 animals (27 bovine/21 buffaloes) from 16 mapped farms. Positives samples from nested-PCR were cultured in Lowenstein-Jensen (LJ), 2% pyruvate (LJ + P), and 2% glycerol (LJ + G) media, followed by Ziehl-Neelsen (ZN) staining technique and partial gene sequencing (hsp65, rpoB, and 16S-rRNA). Spoligotyping and 24-MIRU-VNTR were performed. The LJ + P increased the chance of obtaining bacilli. The respiratory tract and the oral cavity were the most important infection route. In addition, the calcified part of the lesions suggested chronic bTB. Spoligotypes of M. bovis (SIT986/SB0885) differed from others found in South America, and the MIRU-VNTR 24 loci suggested that bTB was associated to highly related strains. The NTM species found are of clinical importance in humans.

Human exposure to mercury and its hematological effects: a systematic review

Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (β) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.

Classification of containers with Aedes aegypti pupae using a Neural Networks model

Introduction

This paper discusses the presence of Aedes aegypti pupae in different types of containers considering: volume, pH of the container, among other variables.

Methods

A nonlinear method for selection was applied, based on Mutual Information, by placing in order of importance the most appropriate variables for identifying containers with and without Aedes aegypti pupae. Such variables were used for input into a Neural Network in layers for classification.

Results

Among the experiments carried out, the best result obtained used the first eight variables selected by order of importance. The percentage of hits for containers which had no Aedes aegypti pupae was 73.3%, and 80.9% for those which did have Aedes aegypti pupae in the containers. This Neural Network method, a model with the capacity to emulate non-linear data, got better results in comparison with the discriminant power of the Logistic Regression model. Thus, the outcomes of using the Neural Networks method achieved better separability in classifying the containers with pupae and those with no pupae.

Conclusion

This type of analysis will aid in the efforts to design an efficient program to control Aedes aegypti that can concentrate principally on containers which present the greatest productivity.

The authors discuss a nonlinear method, based on Mutual Information, for selection of the presence of Aedes aegypti pupae in different breeding sites. The authors compare this method with the logistic regression model. In this study, using the Neural Network model, the variables that better discriminate the containers with Aedes aegypti pupae from the containers without pupae were size—the larger the container volume the greater the proportion of containers positive for pupae–, the presence of another type of pupa other than Aedes aegypti and the location of the container outside the home. The Neural Network method, a model with the capacity to emulate non-linear data, got better results in comparison with the discriminant power of the Logistic Regression model. Thus, the outcomes of the Neural Networks method achieved better separability in classifying the containers with pupae and those with no pupae. This type of analysis will aid in the efforts to design an efficient program to control Aedes aegypti that can concentrate principally on containers which present the greatest productivity.

Modificação do conhecimento sobre acidentes de trabalho entre escolares residentes de uma área impactada por aterro sanitário

RESUMO: Introdução: A prevalência de acidentes de trabalho no Brasil é elevada, tendo impactos no sistema de saúde e na Previdência Social e requerem ações de prevenção, as quais devem ser iniciadas com estudantes da Educação Básica. Objetivo: Foi estimado o conhecimento sobre acidentes de trabalho, antes e depois de atividades de educação para a saúde, entre escolares que residem em área impactada por um aterro sanitário. Métodos: Foi realizado em 2013 um estudo transversal que incluiu a aplicação de um mesmo questionário entre alunos matriculados numa escola da rede municipal de Cuiabá-MT, Brasil, antes e depois de atividades de educação para a saúde voltadas para a definição dos acidentes de trabalho. Procedeu-se análise univariada de frequências absolutas e relativas e análise bivariada utilizando o Teste do χ2 e o Teste Exato de Fisher, com nível de 0,05 de significância e IC95%. Resultado: Verificou-se aumento estatisticamente significativo do conhecimento sobre acidente de trabalho de uma fase para outra do programa (p < 0,05). Conclusão: As atividades desenvolvidas evidenciaram a escola como espaço privilegiado para a valorização e a sistematização de saberes advindo da realidade dos escolares.

Audiometric profile of civilian pilots according to noise exposure

OBJECTIVE

To evaluate the audiometric profile of civilian pilots according to the noise exposure level.

METHODS

This observational cross-sectional study evaluated 3,130 male civilian pilots aged between 17 and 59 years. These pilots were subjected to audiometric examinations for obtaining or revalidating the functional capacity certificate in 2011. The degree of hearing loss was classified as normal, suspected noise-induced hearing loss, and no suspected hearing loss with other associated complications. Pure-tone air-conduction audiometry was performed using supra-aural headphones and acoustic stimulus of the pure-tone type, containing tone thresholds of frequencies between 250 Hz and 6,000 Hz. The independent variables were professional categories, length of service, hours of flight, and right or left ear. The dependent variable was pilots with suspected noise-induced hearing loss. The noise exposure level was considered low/medium or high, and the latter involved periods > 5,000 flight hours and > 10 years of flight service.

RESULTS

A total of 29.3% pilots had suspected noise-induced hearing loss, which was bilateral in 12.8% and predominant in the left ear (23.7%). The number of pilots with suspected hearing loss increased as the noise exposure level increased.

CONCLUSIONS

Hearing loss in civilian pilots may be associated with noise exposure during the period of service and hours of flight.

Mercury exposure in a riverside Amazon population, Brazil: a study of the ototoxicity of methylmercury

Introduction Mercury poisoning causes hearing loss in humans and animals. Acute and long-term exposures produce irreversible peripheral and central auditory system damage, and mercury in its various forms of presentation in the environment is ototoxic.

Objective We investigated the otoacoustic emissions responses in a riverside population exposed to environmental mercury by analyzing the inhibitory effect of the medial olivocochlear system (MOCS) on transient otoacoustic emissions (TEOAE).

Methods The purpose of the research was to evaluate the entire community independently of variables of sex and age. All of the participants were born and lived in a riverside community. After otolaryngologic evaluation, participants were received tympanometry, evaluation of contralateral acoustic reflexes, pure tone audiometry, and recording of TEOAEs with nonlinear click stimulation. Hair samples were collect to measure mercury levels.

Results There was no significant correlation between the inhibitory effect of the MOCS, age, and the level of mercury in the hair.

Conclusions The pathophysiological effects of chronic exposure may be subtle and nonspecific and can have a long period of latency; therefore, it will be important to monitor the effects of mercury exposure in the central auditory system of the Amazon population over time. Longitudinal studies should be performed to determine whether the inhibitory effect of the MOCS on otoacoustic emissions can be an evaluation method and diagnostic tool in populations exposed to mercury.

Cancer mortality among Brazilian dentists

BACKGROUND

Previous studies have variably shown excess risks of elected cancers among dentists.

METHODS

National Brazilian mortality data were used to obtain mortality patterns among dentists between 1996 and 2004. Cancer mortality odds ratios (MORs) and cancer proportional mortality ratios for all cancer sites were calculated, using the general population and physicians and lawyers as comparison groups.

RESULTS

Female dentists from both age strata showed higher risks for breast, colon-rectum, lung, brain, and non-Hodgkin lymphoma. Compared to physicians and lawyers, higher MOR estimates were observed for brain cancer among female dentists 20-49 yr. Among male dentists, higher cancer mortality was found for colon-rectum, pancreas, lung, melanoma, and non-Hodgkin lymphoma. Higher risk estimates for liver, prostate, bladder, brain, multiple myeloma and leukemia were observed among 50-79 yr old male dentists.

DISCUSSION

If confirmed, these results indicate the need for limiting occupational exposures among dentists in addition to establishing screening programs to achieve early detection of selected malignant tumors.

[Socio-ecological super-determination of health in rural areas in Humaitá, State of Amazonas, Brazil]

The scope of this article is to apply a trans-disciplinary socio-ecological approach to discuss the super-determination of health in rural areas of the southern Amazon region from a case study developed in Humaitá in the State of Amazonas in Brazil. Field data were collected using ethnographic techniques applied during three expeditions in Humaitá's rural area between 2012 and 2014. Based on the 'socio-ecological metabolism' analytical category, a descriptive and theoretical analysis of four crucial components in the process of super-determination of local health are presented: (1) the composition of the local rural population; (2) fixed and changing territorial aspects; (3) construction of socio-ecological identities; (4) ethnic conflict between Indians and non-Indians. The conclusion reached is that the incorporation of a socio-ecological approach in territorial-based health research provides input for analyses of the local health situation through the systematization of information related to the process of super-determination of health. It also helps in the construction of trans-disciplinarity, which is a necessary epistemological condition for addressing the complex reality at the interfaces of social production, the environment and health.

Zumbido em uma população ribeirinha exposta ao metilmercúrio

Objetivo : Estudar a prevalência de zumbido, verificando se há associação entre a queixa desse sintoma e o teor de mercúrio e mensurar seu impacto na qualidade de vida. Métodos : Estudo seccional em toda a população do Lago do Puruzinho, localizada na margem esquerda do Rio Madeira, cidade de Humaitá, Estado do Amazonas, Brasil. Todos os residentes maiores de 18 anos, de ambos os gêneros, foram submetidos à anamnese, avaliação otorrinolaringológica e exame audiológico. Os indivíduos que apresentaram queixa de zumbido responderam à versão traduzida do questionário Tinnitus Handicap Inventory (THI). Também foram pesquisados os teores de mercúrio total no cabelo desses indivíduos. Resultados: Para análise dos resultados sobre a queixa de zumbido, os sujeitos foram divididos em dois grupos quanto à presença ou não de zumbido. O Grupo 1 foi composto por indivíduos que apresentaram queixa de zumbido e o Grupo 2, por indivíduos sem zumbido. Foi observado que 40% dos indivíduos apresentaram escores do THI compatíveis com handicap leve. A análise da associação da presença de zumbido com os teores de mercúrio total no cabelo mostrou que ambos os grupos apresentaram níveis elevados de mercúrio, porém não ocorreram diferenças entre os grupos. Conclusão : Um quarto dos ribeirinhos apresentou queixa de zumbido e exposição significativa ao mercúrio, mas não houve associação entre o zumbido e os níveis elevados de mercúrio.

Longitudinal assessment of mercury exposure in schoolchildren in an urban area of the Brazilian Amazon

This study was a longitudinal assessment of mercury exposure in schoolchildren in an urban area of the Brazilian Amazon. The study population consisted of 90 children whose exposure levels were assessed by testing mercury levels in the umbilical cord blood and mothers' blood samples in 2000-2001, and in the children's hair and blood samples. The study also used a questionnaire on demographic and socioeconomic data, fish consumption, and self-reported disease history. Mean mercury level in hair in 2010 was approximately 1µg/g, ranging up to 8.22µg/g, similar to 2004 and 2006. These figures can be explained by low fish consumption. Mean blood mercury levels at birth exceeded 10µg/L, ranging up to nearly 60µg/L, which indicates mercury transfer across the placenta. There was a significant increase in blood mercury from 2004 to 2006 (p < 0.001), suggesting exposure through air pollution. The main exposure to mercury was during pregnancy.

[Epidemiological assessment of the socioeconomic status as a factor associated with the occurrence of musculoskeletal disorders]

Musculoskeletal diseases are included as priorities among Public Health topics, particularly in Worker's Health, because of the high incidence and multiple factors that are associated with their occurrence. The purpose of this study is to assess the association between social and economic status of occupations, consolidated in the form of the socio-economic index of occupational status (ISEI) and the occurrence of musculoskeletal diseases.

METHODS

The population studied included 157,676 workers of both genders, with ages ranging from 18 to 65, included in the Brazilian National Household Survey (PNAD--"Pesquisa Nacional de Amostra de Domicílios") carried out in 2003. The types of occupations were classified using the Socio-Economic Index (ISEI), as proposed by Ganzeboom and Treiman (1996). Prevalence rates for self-referred pathologies such as tendinitis/tenosynovitis and back pain (low back pain) in large occupational groups and in speci fic occupations were calculated. Study variables were applied to a linear regression model with 95% confidence intervals calculated in conformity with the ISEI quintiles.

RESULTS

The highest socio-economic status presented the higher odds ratio for tendinitis or tenosynovitis (OR 2.93; 2.66-3.22), while the lowest status presented the highest odds ratio for spine or back problems (OR 1.31; 1.26-1.37), even when corrected by confounding variables, such as age, gender and educational status.

CONCLUSION

This result suggests that this indicator is an important factor for the occurrence of Musculoskeletal Diseases.

A agenda da sustentabilidade global e sua pauta oficial: uma análise crítica na perspectiva da Saúde Coletiva

O objetivo do presente artigo é realizar, na perspectiva da Saúde Coletiva, uma análise crítica do primeiro ponto da pauta da Rio+20: "Uma economia verde no contexto do desenvolvimento sustentável e da erradicação da pobreza". Metodologicamente, a análise será desenvolvida por meio de dois caminhos confluentes: (a) argumentativo - através de uma análise dialética de fatos e relatórios produzidos ao longo do processo; e, (b) pragmático - a partir de um perfil socioambiental das atuais vinte maiores economias do mundo, construído com indicadores pertencentes a bases de dados de agências internacionais. Os resultados sugerem que a maior pressão ambiental sobre os recursos naturais não é a pobreza, como entendida pela agenda dominante, mas as condições de produção historicamente determinadas.

Hearing thresholds in children exposed to mercury in the prenatal period

PURPOSE

To evaluate hearing thresholds in children with a history of exposure to mercury during the prenatal period.

METHODS

Participants were 90 children of both genders with ages from 8 to 10 years, divided into two groups according to prenatal mercury exposure levels. The study group was composed by 57 children who had mercury levels in the umbilical cord equal or above 8 µg/L, and the comparison group comprised 33 children who had mercury levels in the umbilical cord below 8 µg/L. Investigation procedures included the application of a questionnaire, pure-tone audiometry, speech reception threshold, and mercury level analysis in cord blood collected at birth.

RESULTS

The study group showed a median mercury level in the umbilical cord of 14.63 µg/L, and the median threshold for 500 Hz, 1 kHz and 2 kHz in pure-tone audiometry was 10 dB for both ears. The comparison group had a median cord blood mercury level of 4.88 µg/L, and the median threshold for 500 Hz, 1 kHz and 2 kHz in pure-tone audiometry was 10 dB for both ears. When the hearing thresholds were compared, both by the tritonal mean and by each frequency separately, there were no significant differences between groups.

CONCLUSION

The children had hearing thresholds within normal limits and there was no significant difference between the hearing thresholds of children exposed and not exposed prenatally to mercury.

[Auditory brainstem responses evaluation of retrocochlear disease in workers from a general hospital exposed to noise]

The main purpose of this cross-sectional study was to investigate the presence of retrocochlear disease in a group of maintenance workers from a general hospital, who presents a history of noise exposure. Thirty one workers of three engineering sections with age range from 25 to 60 years and continuous noise exposure from 2 and 45 years, were examined. The evaluation included an audiometric occupational selection and auditory brainstem responses (ABR). ABR abnormalities were detected in seven patients (22.6%) and it was found latency increase of waves III (14.3%) and V (28.6%), and interpeak prolongation I-III (71.4%), III-V (28.6%) and I-V (85.7%). Among 35 ears with normal audition - right, left or both -, four (11,4%) ears presented retrocochlear disease. The high retrocochlear disease prevalence in workers exposed to noise lead us to suppose that this disturbance is more frequent than usually found; therefore it is underestimated in workers diagnostic evaluation. The presence of this kind of disturbance, even with the absence of audiometric alterations, suggests that ABR is more sensitive than the tonal audiometry for noise induced hearing loss investigation.

Musculoskeletal disorders among Brazilian dentists

Dentists are exposed to several occupational risks. This study aimed at comparing the prevalence of referred morbidity among Brazilian dentists with that reported by doctors, lawyers, and the general population. Data on referred morbidity were obtained from the Brazilian Household Survey. Stratification by gender was performed, and prevalence rate ratios were calculated. Dentists were more likely to report back pain and arthritis than physicians or lawyers. Dentists also reported tendinitis more frequently than physicians, lawyers, and the general population. Stratification revealed that, when compared to physicians and lawyers, male dentists were more likely to refer to back pain and arthritis than did female dentists. However, female dentists were at higher risk to report tendinitis when compared to all 3 reference populations. This study suggests that Brazilian dentists are at higher risk to develop musculoskeletal disorders.

Avaliação do processamento auditivo central em adolescentes expostos ao mercúrio metálico

TEMA: processamento auditivo central e exposição ao mercúrio metálico. OBJETIVO: comparar o desempenho nos testes comportamentais de processamento auditivo central entre adolescentes expostos e não expostos ao mercúrio metálico. MÉTODO: foram avaliados 52 adolescentes de ambos os sexos que apresentavam limiares auditivos dentro dos padrões de normalidade. O grupo de estudo (GE) incluiu 21 adolescentes que referiram trabalhar na queima dos amálgamas de ouro-mercúrio, re-queimar ouro em lojas que comercializam este metal ou residir próximos às áreas de garimpos e às lojas que comercializam ouro. O grupo de comparação (GC) foi composto por 31 adolescentes que não apresentaram história de exposição ao mercúrio. Os procedimentos incluíram um questionário sobre a história clínica, laboral e da exposição ao mercúrio, audiometria tonal liminar e bateria de testes para avaliação do processamento auditivo central. RESULTADOS: As diferenças de desempenho na avaliação do processamento auditivo central entre o GE e o GC foram estatisticamente significantes para o teste de memória seqüencial para sons não verbais (p = 0,001), para os testes de padrão de freqüência (p = 0,000) e de duração (p = 0,000) e para o SSW em Português (p = 0,006). CONCLUSÃO: os adolescentes expostos ao mercúrio metálico apresentaram desempenho significativamente inferior aos não expostos para a maioria dos testes comportamentais do processamento auditivo central e a principal alteração encontrada nessa população foi no processamento de sons breves e sucessivos.

Perception of mercury contamination by Brazilian adolescents in a gold mining community: an ethnographic approach

This study used ethnographic methods to examine the perception of mercury contamination by adolescents in the mining community of Poconé, Mato Grosso, Brazil. In Phase I, 53 students aged 13 to 16 years in six schools presented theatrical sketches about community health risks to generate key terms for a pile sorting activity in Phase II. Mercury was reported by four of the 15 groups (26%). In Phase II, researchers conducted semi-structured interviews and pile sorts with 31 students to assess adolescent attitudes about mercury and to generate an ethnomedical model of mercury perception. The lack of consensus evident in the model reveals that while students view mercury as an overall threat, many of them do not understand how its presence can harm human health. Few adolescents felt confident about their knowledge (3%) or could accurately explain how it was used (9%), even though many of them had relatives working as miners (55%). Further analysis of pile sort data suggests that mercury may not belong in a "typical risks" domain. The authors argue that ethnographic methods are a useful tool for public health research, and hope that these findings can contribute to health education interventions in the field.

Assessment of human health risk from organochlorine pesticide residues in Cidade dos Meninos, Duque de Caxias, Rio de Janeiro, Brazil

This article presents the results of a heath risk assessment in Cidade dos Meninos, an area contaminated with organochlorine pesticide residues located in the county (municipality) of Duque de Caxias, Rio de Janeiro State, Brazil. The Agency for Toxic Substances and Disease Registry (ATSDR) risk assessment methodology was applied. The following organochlorine compounds exceeded the established limits and were considered target pollutants: HCH and its isomers (in eggs, milk, and soil); DDT and its metabolites; trichlorobenzenes; trichlorophenols; dioxins and furans (eggs and soil). For all the substances studied (with the exception of trichlorophenols), the estimated doses exceeded the minimum risk levels for chronically exposed children and adults. According to the ATSDR classification, the area was considered an "urgent public health hazard" because of its high and serious exposure to substances that are dangerous to human health.

Correlation between blood mercury levels in mothers and newborns in Itaituba, Pará State, Brazil

This study evaluated transplacental mercury transfer by measuring Hg in blood samples of mothers and newborns (umbilical cord) in hospitals in the municipality (county) of Itaituba, Pará State, Brazil. Epidemiological and mercury exposure data were collected, besides clinical birth data. Mercury tests were performed by cold-vapor atomic absorption spectrophotometry. A total of 1,510 women and an equal number of their newborns participated in the study. Mean blood mercury was 11.53µg/L in mothers and 16.68µg/L in newborns (umbilical cord). The highest Hg levels were in the 31-40-year maternal age group and their newborns, with 14.37µg/L and 21.87µg/L, respectively. However, in all age groups the mean mercury level was higher in newborns than in mothers. There was a strong positive correlation between Hg levels in newborns and mothers (r = 0.8019; p = 0.000), with a significant linear regression model (r = 0.5283; p = 0.000). The results highlight the importance of monitoring pregnant women exposed to mercury as part of public health surveillance.

Saúde e ambiente: uma reflexão da Associação Brasileira de Pós-Graduação em Saúde Coletiva - ABRASCO

INTRODUÇÃO: O Brasil, apesar de sua extraordinária biodiversidade e do enorme potencial instalado para desenvolver ações integradas na temática do ambiente, não tem dado, do ponto de vista programático, a prioridade que o tema ambiente merece. A Associação Brasileira de Pós-Graduação em Saúde Coletiva-ABRASCO reconheceu a importância de organizar um Grupo Temático "Saúde e Ambiente" para, de maneira mais organizada, participar da luta pelo desenvolvimento sustentável, através da ação política no campo da saúde coletiva, em busca de ambientes saudáveis e da promoção da saúde. O OBJETIVO principal deste Grupo Temático-GT foi contribuir para que o tema da saúde ambiental seja internalizado no campo da Saúde Coletiva. MÉTODO: O Grupo escolheu três eixos para discussão em uma oficina do V Congresso Brasileiro de Epidemiologia, em Curitiba, no ano de 2002. O RESULTADO do debate ocorrido foi apresentado segundo três eixos: identificação do campo teórico-conceitual em Saúde Ambiente; a política de saúde e ambiente; o caminho metodológico. A CONCLUSÃO foi apresentada no formato de uma agenda do GT para o biênio 2002-2004.

Exposição ao mercúrio e ao arsênio em Estados da Amazônia: síntese dos estudos do Instituto Evandro Chagas/FUNASA

Este artigo é uma revisão das pesquisas da Seção de Meio Ambiente do Instituto Evandro Chagas/FUNASA sobre exposição ao mercúrio (Hg) no vale do rio Tapajós e Estado do Acre, e exposição ao arsênio (As) através de resíduos da exploração de manganês (Mn) realizada pela ICOMI deixados no Porto de Santana-AP. Em relação ao mercúrio, têm sido pesquisadas populações sob risco através da via respiratória ou alimentar. No primeiro caso, os trabalhadores de casas de compra e venda de ouro têm apresentado teores mais elevados de Hg em urina do que os garimpeiros estudados. No segundo caso, as populações ribeirinhas têm mostrado níveis diferenciados de exposição (Hg em cabelo). Comunidades ribeirinhas situadas em áreas não afetadas pelo mercúrio da garimpagem e com hábitos alimentares semelhantes às de área de risco têm sido avaliadas, visando a construção de parâmetros de normalidade regional. São também pesquisados os teores de Hg em materiais ambientais e na biota aquática. Os estudos de saúde humana e ambiente na cidade de Santana-AP objetivaram avaliar as fontes e possíveis vias de exposição da população da comunidade do Elesbão ao arsênio. Verificou-se a existência de fonte de risco através dos rejeitos de Mn, porém os níveis de As na água consumida pela população mostraram-se dentro dos parâmetros de normalidade. As médias encontradas em sangue e cabelo coincidem com médias de normalidade referidas na literatura, em populações não expostas, e as associações entre variáveis epidemiológicas, avaliação clínico-laboratorial e os teores de arsênio não mostraram significância estatística.

Considerações sobre o uso da epidemiologia nos estudos em saúde ambiental

No Brasil, a Saúde Ambiental incorporou como situações de risco questões como saneamento, água para consumo humano, poluição química, pobreza, eqüidade, condições psicossociais e a necessidade de um desenvolvimento sustentável para preservar as gerações futuras. As metodologias para estudos epidemiológicos e ações de vigilância que dizem respeito à relação da saúde com estas questões são necessariamente mais diversas e complexas do que nas outras áreas da Saúde Coletiva. Neste documento são discutidas as informações sobre as características da exposição e dos efeitos à saúde que constituem os principais substratos para a definição do desenho e da factibilidade dos estudos epidemiológicos voltados para o campo da Saúde Ambiental. Também é enfatizado o uso da Epidemiologia no desenvolvimento de ações de vigilância através da definição de indicadores de saúde para um sistema de informação, e do desenvolvimento de atividades de monitoramento dos impactos das ações de mitigação e controle. Finaliza realçando a necessidade de um trabalho integrado interdisciplinar e intersetorial, os preceitos éticos que devem nortear estes estudos, e as principais características que devem influir na definição dos recursos humanos para a formação das equipes científicas e técnicas.

[Mercury exposure evaluation among Pakaanóva Indians, Amazon Region, Brazil]

A cross-sectional study was conducted to evaluate mercury (Hg) exposure among 910 Pakaan va Indians from the counties of Guajar Mirim and Nova Marmor , Rond nia State, Brazil. Individual hair samples were taken from the occipital region, and Hg was measured by atomic absorption spectrometry with cold vapor generation. Mean Hg in hair samples was 8.37 micro g/g (range 0.52-83.89), indicating high exposure. Young children (< 2 years old) showed a mean Hg of 10.54 micro g/g, and children from 3 to 5 years old had a mean Hg of 9.34 micro g/g. Mercury levels in women (8,91 micro g/g) were higher than in men (7.55 micro g/g), and this difference was significant (t = 3.26; p < 0.01). These results indicate the need for surveillance programs and complementary studies including the Pakaan va Indians in Rond nia State.

A temática saúde e ambiente no processo de desenvolvimento do campo da saúde coletiva: aspectos históricos, conceituais e metodológicos

Neste artigo, pretende-se apresentar e discutir a incorporação da temática saúde e ambiente no campo de conhecimento e práticas de intervenção da "Saúde Coletiva". Essa discussão implica numa abordagem de questões teórico-conceituais, de aspectos históricos e dos resultados científicos em termos dos estudos realizados nesta área. Compreende, também, uma rápida incursão sobre as ações preconizadas para mitigação, prevenção e controle das situações ambientais potencialmente causadoras de agravos à saúde e destes próprios agravos. O eixo principal de abordagem será aquele das relações entre a produção, o ambiente e a saúde, enfatizando algumas possibilidades metodológicas deste campo do conhecimento científico.