Cuantificación económica de los beneficios en salud asociados a la reducción de la contaminación por MP10 en Concepción Metropolitano, Chile / Health and economic benefits of reducing 10 µm particulate matter (PM10) in Metropolitan Area of Concepción, Chile

Background: Several international studies show the effects of PM10 pollution on health but specific analyses for many cities in Chile are lacking. Aim: To relate PM10 concentrations to effects with population health and quantify the economic benefits of its reduction in Concepción Metropolitan Area. Material and Methods: Poisson regression and generalized additive models were used to analyze the short-term effects of PM10 on mortality and morbidity, controlling for lags, seasonal, trend and weather variables. The damage function method to determine the economic impact of pollution reduction was used. Results: The selected concentration-response (C-R) coefficients showed that PM10 concentrations had effects on hospital admissions with a two days lag for respiratory diseases in children under 15 years of age and with a one day lag for asthma in patients over 64 years. The effects on premature mortality had a six days lag. The decrease in 1 µg/m³ of PM10 concentration would generate benefits ranging from 1,025.8 to 32,490.9 million of Chilean pesos per year, with a confidence level of 95%, according the estimation based on concentration-response coefficients and their economic cost. Conclusions: Reduction of PM10 would have important health and economic benefits.

Demandas de cuidado domiciliar da criança nascida exposta ao HIV na ótica da teoria ambientalista / Demandas de cuidados en casa del niño nacido expuesto al VIH en la óptica de la teoría ambientalista / Demands of home care of children born exposed to HIV in the perspective of the environmental theory

Objetivou-se identificar as demandas de cuidado domiciliar da criança nascida exposta ao HIV, sob a perspectiva da teoria ambientalista. Trata-se de estudo qualitativo exploratório-descritivo realizado de janeiro a abril de 2011. Participaram dez mães infectadas pelo HIV, com crianças nascidas expostas ao vírus, em Fortaleza, Ceará. Constituíram-se como instrumentos de coleta de dados: câmera fotográfica descartável e digital e formulários para captação de informações em saúde associadas ao ambiente domiciliar. Os resultados foram contextualizados de acordo com a teoria e organizados em categorias: "vulnerabilidades associadas à estrutura física da moradia"; "ar intradomiciliar e peridomiciliar impuro"; "água utilizada para consumo"; "rede de esgoto e saneamento"; "iluminação e ventilação da residência". Conclui-se que o ambiente domiciliar oferece condições ambientais desfavoráveis para a criança. Urge a realização de intervenções focalizadas no ambiente domiciliar, para promover a saúde da criança nascida exposta ao HIV.

Se objetivó identificar las demandas de atención en el hogar de los niños nacidos expuestos al VIH en la perspectiva de la teoría ambientalista. Estudio cualitativo exploratorio-descriptivo realizado entre enero y abril de 2011. Participaron diez madres VIH-positivas con bebés expuestos al virus, en Fortaleza, Ceará. Fueron instrumentos de recolección de datos: cámara desechable y digital y formularios para capturar información sobre la salud asociada con el ambiente del hogar. Los resultados fueron contextualizados de acuerdo a la teoría y organizado en categorías: vulnerabilidades asociadas con la estructura física de la casa; aire intra y peridoméstico impuro; agua utilizada para el consumo; saneamiento y alcantarillado; iluminación y ventilación de la residencia. Se concluye que el hogar ofrece condiciones ambientales desfavorables para el niño. Hay necesidad de intervenciones específicas en el entorno del hogar para promover la salud de los niños nacidos expuestos al VIH.

The purpose of this study was to identify the demands of home care of children born exposed to HIV in the perspective of the environmental theory. It consists of an exploratory descriptive qualitative study, developed between January and April of 2011. Study participants were ten HIV-infected mothers with infants exposed to the virus, living in Fortaleza, Ceará. The data collection instruments included: a disposable digital camera and forms to obtain information on health associated with the home environment. Results were contextualized according to the theory and organized into the following categories: vulnerabilities associated with the physical structure of the house; contaminated intra and peridomestic air; unclean water used for drinking; sanitation and sewerage system; lighting and ventilation of the house. In conclusion, the home environment offers unfavorable environmental conditions for the child. Targeted interventions in the home environment are necessary so as to promote the health of children born exposed to HIV.

Desigualdade social e exposição a campos magnéticos na região metropolitana de São Paulo / Desigualdad social y exposición a campos magnéticos en la región metropolitana de Sao Paulo / Social inequality and exposure to magnetic fields in the metropolitan region of São Paulo, Southeastern Brazil

OBJETIVO: Estimar a prevalência de exposição aos campos magnéticos gerados por linhas de transmissão (LT) e caracterizar a população exposta. MÉTODOS: Informações sobre LT da Região Metropolitana de São Paulo foram fornecidas pelas concessionárias de energia e mapeadas usando sistema de informação geográfica (SIG). Dados demográficos e socioeconômicos foram obtidos por meio do Censo 2000 e incluídos no SIG em outra camada. Foram considerados expostos os domicílios e seus habitantes localizados a uma distância da LT suficiente para gerar um campo magnético 0,3 µT (microteslas). A prevalência foi estimada por meio da área de corredores de exposição ao longo das LT. A largura dos corredores de exposição se baseou em duas abordagens: uma consistiu em larguras pré-definidas pela tensão da LT e a outra por meio de cálculo do campo magnético. As informações socioeconômicas entre expostos e não expostos foram comparadas pela aplicação do teste de duas proporções (α= 5 por cento)...

OBJECTIVE: To estimate the prevalence of exposure to magnetic fields generated by transmission lines (TL) and characterize the exposed population. METHODS: Information about TL in the metropolitan region of São Paulo, Southeastern Brazil, was provided by the electricity companies and mapped out using geographic information system (GIS). Demographic and socioeconomic data were obtained from the 2000 Census and added to the GIS in another layer. Households and their inhabitants that were located at a distance from the TL that was sufficient to generate a magnetic field 0.3 µT (microteslas) were deemed to be exposed. The prevalence was estimated according to the area of the corridors of exposure along the TL. Two approaches were used to delimit the corridor width: one consisted of widths that were predefined by the TL voltage, and the other consisted of calculation of the magnetic field. The socioeconomic information on the exposed and non-exposed populations were compared by applying the two-proportion test (α= 5 percent)...

OBJETIVO: Estimar la prevalencia de exposición a los campos magnéticos generados por líneas de transmisión (LT) y caracterizar la población expuesta. MÉTODOS: Informaciones sobre LT de la Región Metropolitana de São Paulo (Sureste de Brasil) fueron providenciadas por las concesionarias de energía y mapeadas usando el sistema de información geográfica (SIG). Datos demográficos y socioeconómicos fueron obtenidos por medio del Censo 2000 e incluidos en el SIG en otra camada. Fueron considerados expuestos los domicilios y sus habitantes localizados a una distancia de la LT suficiente para generar un campo magnético 0,3 μT (microteslas). La prevalencia fue estimada por medio del área de corredores de exposición a lo largo de las LT. El ancho de los corredores de exposición se basó en dos abordajes: uno consistió en anchos pre-definidos por la tensión de la LT y la otra por medio del cálculo del campo magnético. Las informaciones socioeconómicas entre expuestos y no expuestos fueron comparadas por la aplicación de la prueba de dos proporciones (α=5 por ciento)...

Efficacy of a low cost protocol in reducing noise levels in the neonatal intensive care unit.

Objective. To examine the effectiveness and cost of implementing a noise reduction protocol in a level III neonatal intensive care unit (NICU). Methods. A prospective longitudinal study was done in a level III NICU, wherein a noise reduction protocol that included behavioral and environmental modification was implemented. The noise levels were measured sequentially every hour for 15 days before and after this intervention. The statistical significance of the reduction in noise levels after implementation of the protocol was tested by paired sample student's t-test. Cost was calculated using the generalized cost effectiveness model of the World Health Organisation. The present study has 80 % power with 95 % confidence to measure 2 dB differences between groups for the maximum recommended of 50 dB. Results. The protocol in the present study reduced noise levels in all the rooms of the NICU to within 60 dB with high statistical significance (p< 0.001). The extent of noise reduction in the rooms of the NICU was as follows : ventilator room by 9.58 dB (95 % confidence interval: 6.73 – 12.42, p < 0.001) , stable room by 6.54 dB (95 % confidence interval: 2.92 – 4.16 , p < 0.001), isolation room by 2.26 dB (95 % confidence interval: 1.21 – 3.30, p < 0.001) , pre-term room by 2.37 dB(95 % confidence interval: 1.22 – 3.51, p < 0.001)and extreme preterm room by 2.09 dB (95 % confidence interval: 1.14 – 3.02, p < 0.001). The intervention was most cost-effective in the ventilator room, requiring Rs. 81.09 to reduce 1 dB and least effective in the extreme pre-term room requiring Rs. 371.61 to reduce 1 dB. Conclusion. The high efficacy and affordability of noise reduction protocols justify the need for implementation of these measures as a standard of care in neonatal intensive care units.