[Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project]. / Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha.

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.

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha / Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project / Alteraciones respiratorias en niños expuestos al polvo de residuos de la minería en Brumadinho, Minas Gerais, Brasil: Proyecto Bruminha

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

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.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

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.

Exposure of pregnant women and their children to pyrethroid insecticides in Rio de Janeiro, Brazil.

Background: Pyrethroids are commonly used insecticides in Brazil. Gestational and early childhood exposure to pyrethroids has been linked to adverse health effects, including neurodevelopmental delays, behavioral issues, and endocrine disruption. This study evaluated the exposure of pregnant women and their children to pyrethroid insecticides in Rio de Janeiro, Brazil. Methods: Creatinine-adjusted levels of the pyrethroid metabolites 3-phenoxy benzoic acid (3-PBA) and 4-fluoro-3-phenoxybenzyl acid (4-FPBA) were measured in the urine of 142 pregnant women and their children at birth and in the first, third, and 6th months of life. Results: The geometric mean (GM) and 95% confidence interval (95% CI) of 3-PBA and 4-FPBA urinary concentrations in pregnant women were 0.50 (0.37-0.67) and 0.37 (0.05-2.90) ng/mg, detected in 47.2 and 10.6%, respectively. Urinary concentrations of 3-PBA in the children were 0.18 (0.15-0.23) ng/mg at birth, 0.36 (0.08-1.56) ng/mg at 1-month-old, 0.68 (0.36-1.27) ng/mg at 3-month-old, and 1.36 (0.77-2.42) ng/mg at 6-month-old, and the detection rates were respectively 10.8, 9.4, 20.9, and 20.7%. Discussion: This study is one of the few that has evaluated the urinary concentrations of pyrethroids in newborns and children in their 1st year of life. The results of this study show that children's exposure to pyrethroids significantly increases after birth.

Metal exposure in a child population after a mine tailings dam failure. Projeto Bruminha / Exposição a metais em uma população infantil após rompimento de barragem de rejeitos da mineração. Projeto Bruminha

ABSTRACT 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.

RESUMO Objetivo: Este estudo teve como objetivo analisar as concentrações urinárias de As, Cd, Pb, Hg e Mn em crianças residentes em localidades diretamente atingidas pelos rejeitos do desastre em Brumadinho. Métodos: Foi realizado um estudo descritivo transversal de uma população de 217 crianças de 0 a 6 anos, residentes no Córrego do Feijão (CF), Parque da Cachoeira (PC), Aranha (AR), e Tejuco (TJ) e inscritas no Estudo Longitudinal da Saúde Infantil em Brumadinho (MG) — Projeto Bruminha. Dados socioeconômicos e amostras de urina foram coletados para determinar a concentração dos metais selecionados. Resultados: Crianças residentes em localidades não diretamente atingidas pelo desastre (AR e TJ) apresentaram maiores concentrações de As e Mn do que aquelas em localidades diretamente atingidas (CF e PC). Adicionalmente, crianças residentes em localidades não potencialmente expostas à poeira da lama de rejeito ou da atividade de mineração (AR) apresentaram maiores concentrações urinárias de As do que aquelas potencialmente expostas (CF, PC e TJ). Conclusão: Nossos resultados sugerem a necessidade de se investigar possíveis fontes de exposição ao As em crianças residentes em localidades não diretamente atingidas pelo desastre e não potencialmente expostas à poeira.

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.

OBJETIVO: A presente revisão busca sintetizar as evidências em relação à exposição ao mercúrio (Hg) e os distúrbios hipertensivos da gestação (DHG). FONTES DOS DADOS: Os bancos de dados PubMed, BVS/LILACS, SciELO e a Biblioteca Digital da UFRJ Pantheon foram sistematicamente pesquisadas durante junho de 2021. SELEçãO DE ESTUDOS: Artigos observacionais analíticos, escritos em inglês, espanhol ou português, sem restrição temporal. COLETA DE DADOS: A estratégia PICOS foi seguida e a qualidade metodológica foi avaliada usando o checklist Downs and Black. SíNTESE DE DADOS: Foram encontrados 77 artigos, dos quais 6 atenderam aos critérios da revisão. Foram 4.848 participantes, dos quais 80 (16,7%) tinham DHG e 4.724 (97,4%) estavam expostos ambientalmente ao Hg (consumo de peixe e amálgama dental). Os biomarcadores de mercúrio avaliados foram sangue (quatro estudos) e urina (dois estudos). Dois estudos encontraram associação positiva entre Hg e DHG no grupo com maior exposição e os outros quatro não a apresentaram. A avaliação de qualidade metodológica revelou 3 estudos satisfatórios e 3 bons (média: 19,3 ± 1,6 em 28 pontos). A ausência ou não de ajuste adequado para fator de confusão negativo, como consumo de pescado, foi observada em cinco estudos. CONCLUSãO: Recuperamos apenas seis estudos, embora o Hg seja um metal tóxico generalizado e a gravidez seja um período de maior suscetibilidade a ameaças ambientais e risco cardiovascular. No geral, nossa revisão mostrou resultados mistos, com dois estudos relatando associação positiva no grupo com maior exposição. No entanto, devido à importância do assunto, estudos adicionais são necessários para elucidar os efeitos do Hg sobre DHG, com atenção especial ao ajuste de confundimento negativo.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review / Exposição materna a mercúrio e distúrbios hipertensivos na gestação: Uma revisão sistemática

Abstract 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.

Resumo Objetivo A presente revisão busca sintetizar as evidências em relação à exposição ao mercúrio (Hg) e os distúrbios hipertensivos da gestação (DHG). Fontes Dos Dados Os bancos de dados PubMed, BVS/LILACS, SciELO e a Biblioteca Digital da UFRJ Pantheon foram sistematicamente pesquisadas durante junho de 2021. Seleção de estudos Artigos observacionais analíticos, escritos em inglês, espanhol ou português, sem restrição temporal. Coleta de Dados A estratégia PICOS foi seguida e a qualidade metodológica foi avaliada usando o checklist Downs and Black. Síntese de dados Foram encontrados 77 artigos, dos quais 6 atenderam aos critérios da revisão. Foram 4.848 participantes, dos quais 80 (16,7%) tinham DHG e 4.724 (97,4%) estavam expostos ambientalmente ao Hg (consumo de peixe e amálgama dental). Os biomarcadores de mercúrio avaliados foram sangue (quatro estudos) e urina (dois estudos). Dois estudos encontraram associação positiva entre Hg e DHG no grupo com maior exposição e os outros quatro não a apresentaram. A avaliação de qualidade metodológica revelou 3 estudos satisfatórios e 3 bons (média: 19,3 ± 1,6 em 28 pontos). A ausência ou não de ajuste adequado para fator de confusão negativo, como consumo de pescado, foi observada em cinco estudos. Conclusão Recuperamos apenas seis estudos, embora o Hg seja um metal tóxico generalizado e a gravidez seja um período de maior suscetibilidade a ameaças ambientais e risco cardiovascular. No geral, nossa revisão mostrou resultados mistos, com dois estudos relatando associação positiva no grupo com maior exposição. No entanto, devido à importância do assunto, estudos adicionais são necessários para elucidar os efeitos do Hg sobre DHG, com atenção especial ao ajuste de confundimento negativo.

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

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).

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

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.

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.

Acute Kidney Failure among Brazilian Agricultural Workers: A Death-Certificate Case-Control Study.

Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense use of pesticides, in the south and midwest. Using death certificate data, we investigated trends in AKF mortality (1980-2014). We used joinpoint regression to calculate annual percent changes in AKF mortality rates by urban/rural status and, in rural municipalities, by tertiles of per capita pesticide expenditures. We then compared AKF mortality in farmers and population controls from 2006 to 2014 using logistic regression to estimate odds ratios and 95% confidence intervals adjusted by age, sex, region, education, and race. AKF mortality increased in both regions regardless of urban/rural status; trends were steeper from the mid-1990s to 2000s, and in rural municipalities, they were higher by tertiles of pesticide expenditures. Agricultural workers were more likely to die from AKF than from other causes, especially at younger ages, among females, and in the southern municipalities. We observed increasing AKF mortality in rural areas with greater pesticide expenditures and an association of AKF mortality with agricultural work, especially among younger workers.

[Mercury exposure and anemia in children and adolescents from six riverside communities of Brazilian Amazon]. / Exposição ao mercúrio e anemia em crianças e adolescentes de seis comunidades da Amazônia Brasileira.

Mercury (Hg) is a toxic substance, and fish consumption is one of the main sources of exposure for the population. This article aims to evaluate the association between exposure to Hg and anemia among children and adolescents from six riverside communities in the Brazilian Amazon. Secondary data analysis from cross-sectional studies, including 1,318 individuals, divided into two groups according to gold mining exposure (group A under the influence, and group B without it). Multivariate analysis methods were performed to assess the association between exposure to Hg (hair Hg) and anemia, stratifying by groups. Three hundred and forty-eight anemia cases were observed (27.1%), with 206 from group B and 142 out of group A. There was a difference in the median of Hg levels between groups (A = 12.8µg/g and B = 4.3µg/g, p = 0.01). An association was observed between hair Hg levels ≥ 6.0µg/g and anemia (OR = 1.38; 95%CI = 1.02-1.87), a fact that was magnified for group A, when stratification was performed (OR = 2.23; 95%CI = 1.28-3.90). This study showed high Hg levels, especially in group A and this substance might be a possible risk factor for anemia. Also, geographical areas seemed to modify this effect, pointing to the influence of other factors, which should be better evaluated.

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.

Exposição ao mercúrio e anemia em crianças e adolescentes de seis comunidades da Amazônia Brasileira / Mercury exposure and anemia in children and adolescents from six riverside communities of Brazilian Amazon

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.

Abstract Mercury (Hg) is a toxic substance, and fish consumption is one of the main sources of exposure for the population. This article aims to evaluate the association between exposure to Hg and anemia among children and adolescents from six riverside communities in the Brazilian Amazon. Secondary data analysis from cross-sectional studies, including 1,318 individuals, divided into two groups according to gold mining exposure (group A under the influence, and group B without it). Multivariate analysis methods were performed to assess the association between exposure to Hg (hair Hg) and anemia, stratifying by groups. Three hundred and forty-eight anemia cases were observed (27.1%), with 206 from group B and 142 out of group A. There was a difference in the median of Hg levels between groups (A = 12.8µg/g and B = 4.3µg/g, p = 0.01). An association was observed between hair Hg levels ≥ 6.0µg/g and anemia (OR = 1.38; 95%CI = 1.02-1.87), a fact that was magnified for group A, when stratification was performed (OR = 2.23; 95%CI = 1.28-3.90). This study showed high Hg levels, especially in group A and this substance might be a possible risk factor for anemia. Also, geographical areas seemed to modify this effect, pointing to the influence of other factors, which should be better evaluated.

Prenatal Exposure to Metals and Neurodevelopment in Infants at Six Months: Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA Project).

The PIPA Project is a prospective birth cohort study based in Rio de Janeiro, Brazil, whose pilot study was carried out between October 2017 and August 2018. Arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) concentrations were determined in maternal (n = 49) and umbilical cord blood (n = 46). The Denver Developmental Screening Test II (DDST-II) was applied in 50 six-month-old infants. Metals were detected in 100% of the mother and newborn samples above the limits of detection. Maternal blood lead concentrations were higher in premature newborns (GM: 5.72 µg/dL; p = 0.05). One-third of the infants (n = 17-35.4%) exhibited at least one fail in the neurodevelopment evaluation (fail group). Maternal blood arsenic concentrations were significantly (p = 0.03) higher in the "fail group" (GM: 11.85 µg/L) compared to infants who did not fail (not fail group) (GM: 8.47 µg/L). Maternal and umbilical cord blood arsenic concentrations were higher in all Denver Test's domains in the "fail group", albeit non-statistically significant, showing a tendency for the gross motor domain and maternal blood (p = 0.07). These findings indicate the need to further investigate the toxic effects of prenatal exposure to metals on infant neurodevelopment.

Persistent Organic Pollutant Levels in Maternal and Cord Blood Plasma and Breast Milk: Results from the Rio Birth Cohort Pilot Study of Environmental Exposure and Childhood Development (PIPA Study).

Levels of polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP) were evaluated in the breast milk and maternal and umbilical cord blood of pregnant women and their newborns in Rio de Janeiro, Brazil. The concentration of 11 PCB and 17 OCP were measured in 135 samples of maternal, and 116 samples of cord blood plasma, as well as 40, 47, and 45 samples of breast milk at 1st, 3rd, and 6th months after birth, respectively, using gas chromatography-mass spectrometry (GC-MS-MS). Women were asked to answer an enrollment questionnaire with reproductive, lifestyle, residential and sociodemographic questions. The most commonly detected OCPs and PCBs in the maternal and cord blood were 4,4'-DDE; ß-HCH; É£-HCH; and PCB 28. 4,4'-DDE was also the most commonly detected OCP in breast milk samples. Although not statistically significant, ∑DDT levels were higher among women with pregestational BMI ≥ 30, and who were non-white and older (age > 40). Newborns with an Apgar score ≤ 8 at minute 5 of life showed significantly higher levels of ∑DDT in the cord blood. Persistent OCPs and PCBs were still detected in maternal and umbilical cord blood and breast milk, even after decades of their banishment in Brazil. They may pose a risk to maternal, fetal and children's health.

Prevalence of metal levels above the reference values in a municipality affected by the collapse of a mining tailings dam: Brumadinho Health Project / Prevalência dos níveis de metais acima dos valores de referência em município atingido pelo rompimento de barragem de rejeitos da mineração: Projeto Saúde Brumadinho

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.

RESUMO Objetivo: Descrever a prevalência dos níveis dos metais arsênio, cádmio, mercúrio, chumbo e manganês acima dos valores de referência (VR) na população de Brumadinho, após o rompimento da barragem de rejeitos de mineração, e verificar os fatores associados a esses níveis. Métodos: Estudo da linha de base de uma coorte prospectiva, em amostra representativa de 3.080 residentes (12 anos ou mais de idade) de Brumadinho, Minas Gerais. As variáveis exploratórias (idade, sexo, cor de pele, renda domiciliar, tabagismo e local de residência) foram coletadas por questionário, e os níveis de As, Cd e Hg na urina e de Pb e Mn no sangue foram avaliados pela técnica de espectrometria de massa com plasma indutivamente acoplado. Fez-se a distribuição das prevalências de níveis acima da referência para os metais, segundo as variáveis exploratórias. Análises de regressão logística múltipla foram utilizadas para averiguar associação entre os níveis alterados de metais e as características avaliadas. Resultados: Encontraram-se concentrações acima do VR em 38,08% da população para Mn, 33,37% para As, 5,04% para Pb, 0,76% para Hg e 0,17% para Cd. Houve associação significativa entre a faixa etária e os níveis de Mn e Pb; e entre o local de residência e o nível de As. Conclusão: Os resultados demonstram elevada prevalência de níveis acima da referência para Mn, As e Pb, com pequenas diferenças em relação às demais variáveis, sugerindo se tratar de uma exposição distribuída em todo o município.

Protocol of the Longitudinal Study on Child Health in Brumadinho (MG): "Bruminha Project" / Protocolo do estudo longitudinal de saúde infantil em Brumadinho (MG): Projeto Bruminha

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).

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).

Parkinson's disease hospitalization rates and pesticide use in urban and non-urban regions of Brazil / Hospitalizações por doença de Parkinson e uso de agrotóxicos em áreas urbanas e não urbanas do Brasil

Abstract Background Few studies have evaluated the role played by pesticide exposure in the development of Parkinson's disease (PD) in Brazil. Objective This study aimed to investigate the association between pesticide use and PD hospitalization in Brazilian micro-regions. Method Pesticide expenditure per capita in 1985 and PD hospitalization rates (HR) from 1997 to 2007 were calculated for all 552 Brazilian micro-regions. The Spearman's correlation test was used to compare pesticide expenditure and PD HR by sex, age, and urban and non-urban micro-regions. Micro-regions were grouped according to the quintiles of pesticide expenditure. PD HR ratios (HRR) were calculated to compare PD HR across the quintiles of pesticide expenditure. Results Moderate correlation (r=0.518; p<0.001) between PD HR in non-urban micro-regions and pesticide expenditure was observed. In non-urban areas, compared with micro-regions of the first quintile of pesticide use, PD HRR ranged from 1.70 to 5.90 in micro-regions of higher pesticide use. In general, regardless of sex and age, the higher the use of pesticides, the greater the magnitude of PD HRR. Conclusion Our results suggest that pesticide use is associated with PD in Brazil, especially in non-urban areas where pesticides are used more intensively.

Resumo Introdução Poucos estudos avaliaram os efeitos da exposição a agrotóxicos sobre a doença de Parkinson (DP) no Brasil. Objetivo Este estudo teve por objetivo investigar essa associação em microrregiões brasileiras. Método As taxas de hospitalização (TH) por DP de 1997 a 2007 e os gastos per capita com agrotóxicos em 1985 foram calculados para todas as 552 microrregiões brasileiras. O coeficiente de correlação de Spearman foi utilizado para verificar relação entre as variáveis. Foi calculada a razão de TH (RTH) por DP entre quintis de gastos com agrotóxicos em microrregiões urbanas e não urbanas, usando o 1o quintil como referência. Resultados Uma moderada correlação (r = 0,518; p < 0,001) foi observada entre as TH por DP em microrregiões não urbanas e gastos com agrotóxicos. As associações entre gastos com agrotóxicos e RTH por PD foram maiores nas microrregiões não urbanas. Comparadas às microrregiões do 1o quintil, as TH por DP foram de 1,70 a 5,90 vezes maiores nas demais microrregiões. Foi observada uma relação dose-reposta entre as TH por PD e os quintis de uso de agrotóxicos, independentemente de sexo e idade. Conclusão Nossos resultados sugerem que o uso de agrotóxicos pode estar associado à DP no Brasil, especialmente em áreas não urbanas, onde o uso é mais intenso.

Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group.

Animal stings are environmental hazards that threaten millions annually and cause a significant socioeconomic impact. Snakebite envenoming affects 2.7 million people globally every year, mostly the poorest and rural communities, with approximately 27,000 annual cases in Brazil. This study's objective is to identify the most exposed racial group for snakebites in rural areas of Brazil and analyze possible differences in the outcome of an accident. A retrospective epidemiological study was conducted using a database of rural snakebite cases from Brazil's Ministry of Health (2017). Descriptive analysis and a regression model were performed to examine the association of bad outcomes after a snakebite with several covariables. While mixed-race individuals presented the highest number of cases (61.79%), indigenous and white populations were the racial groups with the highest and lowest exposure rates (194.3 and 34.1 per 100,000 population, respectively). The fatality rate was 3.5 times higher in the indigenous population compared to the white population. In the multivariable model, the number of hours between the accident and health care received and the case classification suggested an association with a bad outcome. Snakebite is prominent in Brazil, particularly among indigenous groups. Antivenom is available in the Brazilian Health System; however, efforts need to be made for decentralization.