A comprehensive analysis of children's blood lead levels in Latin America and the Caribbean over the last eight years: Progress and recommendations.

In 2017 we published a review on blood lead levels (BLL) in children from Latin America and the Caribbean (LAC) for data available up to 14th of March 2014 and recommended the identification and control of "lead hot spots". In the present study, an evaluation of progress toward reducing BLL in the region was carried out. A systematic review of the latest literature on lead exposure in the LAC region held on the PubMed, Web of Science and LILACS databases (January 2014 to March 2022) was conducted using the PRISMA methodology. Only original papers published in peer-reviewed English, Spanish, or Portuguese journals were eligible. A total of 558 papers were retrieved, 77 of which met the selection criteria and 31 (40.25 %) were carried out in Mexico. The prevalence of children with BLL above 10 µg. dL-1 was 22.08 % in the previous review versus 6.78 % in the current study. In the present review, the prevalence of children with BLL above 5 µg. dL-1 was 29.62 %, and only one study reported a BLL prevalence rate between 3.3 and 5 µg. dL-1. The highest BLLs were associated with well-known sources or occupational exposures. The number of countries (n = 13) that published data on BLL in children was lower compared to the previous review (n = 16). Most studies were conducted in areas with known lead exposure sources, similar to the earlier review. The percentage of children at risk of lead poisoning in the region remains unknown because few studies have published data on environmental exposure levels and most samples were relatively small. The recommendation to identify and control sources of lead exposure was maintained, while further suggestions for establishing a systematic public health surveillance system for lead were proposed to help reduce the knowledge gap and inform public health policy-making in LAC.

Blood lead and cadmium levels in preschool children and associated risk factors in São Paulo, Brazil.

In Brazil, there are scarce data on lead (Pb) and cadmium (Cd) contamination, especially for more vulnerable populations such as preschool children. In this paper, we answer two questions: (1) What are the exposure levels of lead and cadmium in preschool children, in Sao Paulo, Brazil? and (2) What are the risk factors associated with this exposure? This cross-sectional study included 50 day care centers (DCCs), totaling 2463 children aged 1-4 years. Venous blood samples were analyzed by ICP-MS. Questionnaires were administered to the parents. Multiple logistic regression models were used to identify associations between blood lead levels (BLLs) and blood cadmium levels (BCLs) and potential risk factors. The geometric mean for BLLs was 2.16 µg/dL (95% CI: 2.10-2.22 µg/dL), and the 97.5th percentile was 13.9 µg/dL (95% CI: 10.0-17.3 µg/dL). For cadmium exposure, the geometric mean for BCLs was 0.48 µg/L (95% CI: 0.47-0.50 µg/L), and the 95th percentile was 2.57 µg/L (95% CI: 2.26-2.75 µg/L). The DCCs' geographic region was associated with high BLLs and BCLs, indicating hot spots for lead and cadmium exposures. In addition, it was found that the higher the vehicles flow, the higher were the BLLs in children. Red lead in household gates was also an important risk factor for lead exposure. Comparing these results with the findings of the Fourth National Report on Human Exposure to Environmental Chemicals by CDC-2013, it was found that in Brazilian preschool children the BLLs are almost three times higher (97.5th percentile) and the BCLs are almost twelve times higher (95th percentile) than those in U.S. children. This information is essential to formulate public health policies.

Worker health and safety and climate change in the Americas: issues and research needs / Salud y seguridad laboral y cambio climático en las Américas: temas clave y necesidades de inves¬tigación

This report summarizes and discusses current knowledge on the impact that climate change can have on occupational safety and health (OSH), with a particular focus on the Americas. Worker safety and health issues are presented on topics related to specific stressors (e.g., temperature extremes), climate associated impacts (e.g., ice melt in the Arctic), and a health condition associated with climate change (chronic kidney disease of non-traditional etiology). The article discusses research needs, including hazards, surveillance, and risk assessment activities to better characterize and understand how OSH may be associated with climate change events. Also discussed are the actions that OSH professionals can take to ensure worker health and safety in the face of climate change.

En este informe se resume y analiza el conocimiento actual sobre el impacto que el cambio climático puede tener sobre la seguridad y la salud laboral, en particular en la Región de las Américas. Se presentan temas clave de salud y seguridad de los trabajadores relacionados con factores de estrés específicos (por ej., temperaturas extremas), impactos asociados al clima (por ej., derretimiento de hielo en el Ártico) y una enfermedad asociada con el cambio climático (enfermedad renal crónica de etiología no tradicional). En el artículo se analizan las necesidades de investigación, incluso los peligros, la vigilancia y las actividades de evaluación de riesgo a fin de caracterizar y comprender mejor cómo la seguridad y la salud laboral se asocial con los sucesos del cambio climático. También se analizan las acciones que pueden emprender los profesionales de este campo para garantizar la salud y la seguridad de los trabajadores ante el cambio climático.

Enhancing the sustainability and climate resiliency of health care facilities: a comparison of initiatives and toolkits / Mejora de la sostenibilidad y la resistencia de las instalaciones de atención sanitaria ante el cambio climático: iniciativas y recursos

Extreme weather events have revealed the vulnerability of health care facilities and the extent of devastation to the community when they fail. With climate change anticipated to increase extreme weather and its impacts worldwide—severe droughts, floods, heat waves, and related vector-borne diseases—health care officials need to understand and address the vulnerabilities of their health care systems and take action to improve resiliency in ways that also meet sustainability goals. Generally, the health sector is among a country’s largest consumers of energy and a significant source of greenhouse gas emissions. Now it has the opportunity lead climate mitigation, while reducing energy, water, and other costs. This Special Report summarizes several initiatives and compares three toolkits for implementing sustainability and resiliency measures for health care facilities: the Canadian Health Care Facility Climate Change Resiliency Toolkit, the U.S. Sustainable and Climate Resilient Health Care Facilities Toolkit, and the PAHO SMART Hospitals Toolkit of the World Health Organization/Pan American Health Organization. These tools and the lessons learned can provide a critical starting point for any health system in the Americas.

Los sucesos climáticos extremos han puesto de manifiesto la vulnerabilidad de las instalaciones de atención sanitaria y el grado de devastación infligido a la comunidad cuando estas fallan. Ante un cambio climático que preanuncia un aumento de los sucesos climáticos extremos y sus respectivos impactos en todo el mundo (sequías, inundaciones y olas de calor intensas, así como enfermedades relacionadas transmitidas por vectores) los profesionales sanitarios deben comprender y hacer frente a las vulnerabilidades de sus sistemas de atención de salud, y emprender acciones que apunten a mejorar su resistencia de manera sostenible. Por lo general, el sector salud es uno de los mayores consumidores de energía de un país y una fuente significativa de emisión de gases de efecto invernadero. En la actualidad tiene la oportunidad de liderar las acciones de mitigación frente al cambio climático, y a la vez de reducir los costos de energía y agua, entre otros. En este informe especial se resumen varias iniciativas y se comparan tres recursos dirigidos a implementar medidas de sostenibilidad y resistencia para instalaciones de atención sanitaria: la Herramienta de Resistencia ante el Cambio Climático para Instalaciones de Atención Sanitaria (Canadá), la Herramienta de Resistencia ante el Cambio Climático para Instalaciones de Atención Sanitaria (Estados Unidos) y la Herramienta Hospitales Inteligentes de la Organización Panamericana de la Salud/ Organización Mundial de la Salud. Estas herramientas y las lecciones aprendidas a través de ellas proporcionan un punto de partida crucial para todos los sistemas de salud de la Región de las Américas.

Not so simple as it seems: tackling climate change and implementing the sustainable development goals in the Americas

Human activities are causing unprecedented changes in the climate, and threatening environmental processes. This may seem a simple statement, but in order to make it, a great amount of scientific information was necessary. There is overwhelming evidence of the burden of disease from environmental risks (1). This burden is expected to increase with the changing climate. Anthropogenic drivers have been detected throughout the climate system and are extremely likely to be the dominant cause of the observed warming since the mid-20th century (2). This rapid changing climate poses direct human health challenges, and also indirect health effects due to disruptions and shifts in the services provided by the ecosystems (3). The “business-as-usual” approach has proven to fail to tackle those complex problems; thus, a new systemic approach is necessary, one that deals not only with those issues, but that is inclusive, universal, and that promotes health equity...

Air pollution management and control in Latin America and the Caribbean: implications for climate change / Gestión y control de la contaminación atmosférica en América Latina y el Caribe: implicaciones para el cambio climático

Objective. To assess the status of the legal framework for air quality control in all countries of Latin America and Caribbean (LAC); to determine the current distribution of air monitoring stations and mean levels of air pollutants in all capital and large cities (more than 100 000 inhabitants); and to discuss the implications for climate change and public policymaking. Methods. From January 2015–February 2016, searches were conducted of online databases for legislation, regulations, policies, and air pollution programs, as well as for the distribution of monitoring stations and the mean annual levels of air pollution in all LAC countries. Results. Only 117 cities distributed among 17 of 33 LAC countries had official information on ground level air pollutants, covering approximately 146 million inhabitants. The annual mean of inhalable particles concentration in most of the cities were over the World Health Organization Air Quality Guidelines; notably, only Bolivia, Peru, and Guatemala have actually adopted the guidelines. Most of the cities did not have information on particulate matter of 2.5 microns or less, and only a few measured black carbon. Conclusions. The air quality regulatory framework should be updated to reflect current knowledge on health effects. Monitoring and control of ground level pollutants should be extended and strengthened to increase awareness and protect public health. Using the co-benefits of air pollution control for health and climate as a framework for policy and decision-making in LAC is recommended.

Objetivo. Evaluar la situación del marco jurídico sobre el control de la calidad del aire en todos los países de América Latina y el Caribe; determinar la distribución actual de las estaciones de control del aire y la concentración media de los contaminantes atmosféricos de todas las capitales y ciudades grandes (de más de 100.000 habitantes); y analizar las implicaciones para el cambio climático y la formulación de políticas públicas. Métodos. Se efectuaron búsquedas en bases de datos en línea entre enero del 2015 y febrero del 2016 con el fin de localizar leyes, reglamentos, políticas y programas de lucha contra la contaminación atmosférica, así como de determinar la distribución de las estaciones de control y la concentración media anual de contaminantes atmosféricos de todos los países de América Latina y el Caribe. Resultados. Solo 77 ciudades ubicadas en 17 de 33 países de América Latina y el Caribe, lo que abarca a aproximadamente 146 millones de habitantes, disponían de información oficial sobre los contaminantes de la capa más baja de la atmósfera. En la mayoría de las ciudades, la concentración media anual de partículas inhalables supera los valores considerados aceptables en las directrices de la OMS sobre la calidad del aire; cabe destacar que, en realidad, solo Bolivia, Perú y Guatemala han adoptado estas directrices. La mayoría de las ciudades no tienen información sobre las PM2,5 y solo algunas miden el hollín. Conclusiones. Es preciso actualizar el marco jurídico sobre la calidad del aire incorporando los conocimientos actuales acerca de los efectos de la contaminación sobre la salud. Es necesario ampliar y fortalecer la vigilancia y el control de los contaminantes de la capa más baja de la atmósfera a fin de aumentar la concientización sobre este problema y proteger la salud pública. Se recomienda utilizar los beneficios colaterales para la salud y el clima que reporte el control de la contaminación atmosférica como marco para la formulación de políticas y la toma de decisiones en América Latina y el Caribe.