Perceptions and attitudes about the contribution of the environment to childhood cancer: a pilot study in a medical guild and undergraduate students.

BACKGROUND: Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children's health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer. METHODS: A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups. RESULTS: Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001). CONCLUSIONS: In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment.

La cultura médico ambiental en el desarrollo local de la comunidad

Se realizó un estudio con el objetivo de centrar la atención en reflexionar en la importancia de la formación de la cultura ambiental en la carrera de medicina, de relevancia en la comunidad médica y en la sociedad. Se utilizaron métodos como: análisis y síntesis, inductivo-deductivo, modelación, análisis documental, hermenéutico dialéctico. La aplicación de los métodos experimentales permitió la elaboración de un modelo para la formación de la cultura ambiental en los profesionales de la carrera de medicina con un basamento holístico-configuracional al revelar la lógica de la formación de esta cultura contextualizada se proyecta como una solución de impacto a las insuficiencias encontradas con significación, transformación y sistematización, en la práctica médica. La formación de los profesionales de la carrera de medicina en la Facultad de Ciencias Médicas de Bayamo no está acorde a las nuevas exigencias al currículo, que demanda nuestra sociedad debido a las insuficiencias en el proceso de formación de la cultura ambiental en la carrera de medicina.

A study was conducted with the objective of focusing attention on reflecting on the importance of the formation of environmental culture in the medical career, of relevance in the medical community and in society. Methods such as: analysis and synthesis, inductive-deductive, modeling, documentary analysis, dialectical hermeneutics were used. The application of the experimental methods allowed the elaboration of a model for the formation of the environmental culture in the professionals of the medical career with a holistic-configurational base when revealing the logic of the formation of this contextualized culture is projected as a solution of impact on the insufficiencies found with significance, transformation and systematization, in medical practice. The training of medical career professionals at the Faculty of Medical Sciences of Bayamo is not in line with the new requirements of the curriculum, which our society demands due to the inadequacies in the process of formation of environmental culture in the medical career.

Foi realizado um estudo com o objetivo de focalizar a atenção na reflexão sobre a importância da formação da cultura ambiental na carreira médica, de relevância na comunidade médica e na sociedade. Foram utilizados métodos como: análise e síntese, indutivo-dedutivo, modelagem, análise documental, hermenêutica dialética. A aplicação dos métodos experimentais permitiu a elaboração de um modelo para a formação da cultura ambiental nos profissionais da carreira médica com base holístico-configuracional ao revelar a lógica da formação dessa cultura contextualizada como uma solução de impacto nas insuficiências encontradas com significado, transformação e sistematização, na prática médica. A formação de profissionais da carreira médica na Faculdade de Ciências Médicas de Bayamo não está de acordo com os novos requisitos do currículo exigidos por nossa sociedade devido às inadequações no processo de formação da cultura ambiental na carreira médica.

Association between contextual and clinical factors and disability in people with chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) develops as a multifaceted and complex disorder, with clinical and functional repercussions. Objective: To investigate the association among contextual factors (personal and environmental) and clinical features and the disability of COPD patients, with emphasis on activity and social participation. Methods: A cross-sectional study with stable COPD participants (n = 47) was conducted to assess personal and clinical characteristics, activity of daily living using the London Chest Activity of Daily Living scale (LCADL), disability by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and environmental factors by the Craig Hospital Inventory of Environmental Factors (CHIEF). Statistical analysis was performed by the multivariate method. Results: In the LCADL predictive analysis, the variables forced expiratory volume in 1 second (FEV1), dyspnea levels 3-4 by the modified Medical Research Council scale (mMRC), and active level of regular physical activity were included in the final model (adjusted R 2 = 0.523). In addition, WHODAS was influenced by CHIEF physical structure score and mMRC 1-2 and mMRC 3-4 grades (adjusted R 2 = 0.500). Conclusions: Disability is a complex in COPD patients and encompasses a prominent role of dyspnea levels in the prediction of activity and participation. Multivariate models presented clinical and contextual factors as functional predictors that included the physical structure of the environment in the determination of social participation.

Letter to editor: Blood pressure, hypertension and lead exposure.

A significant association of office diastolic blood pressure with low-level blood lead exposure was reported in a Brazilian adult population. However, caution should be taken to interpret these results. The multivariable-adjusted association with blood pressure was positive for diastolic blood pressure, but inverse for systolic blood pressure. The association sizes were infinitesimal without clinical relevance. The outcome measures, i.e. blood pressure and the prevalence of hypertension were analysed across categories of the blood lead distribution - not in relation to blood lead as continuous variable. Blood pressure was the average of two oscillometric office readings, whereas ambulatory monitoring is the state-of-the-art.

Environmental parasitology: soil analysis for geohelminth larvae contamination in Ilhéus, Bahia

The study of parasitic soil contamination is important for monitoring biohazards in densely populated areas or those with high anthropic activities. The present study quantified geohelminth larvae in two estuaries in the urban area of Ilhéus, Bahia; one to the north, formed by the Almada River and another to the south, in the Pontal Bay. The collections were performed following standard methodology considering climactic conditions and local tide tables; the Rugai method with modifications was used to analyze soil sediments. Morphological results showed a significantly higher number of Strongyloides stercoralis larvae in the estuary of the Almada River from September to December, coinciding with higher temperatures and lower rainfall and humidity. However, there was significant variation in climatic conditions and in the classification of anthropic activity interfering in the frequency and diversity of soiltransmitted helminth larvae, which justifies its monitoring to ensure environmental health in areas frequented by residents and tourists in Ilhéus, Bahia.

Revisão sistemática sobre a epidemiologia das doenças cardiovasculares e respiratórias e suas associações com a poluição do ar em Vitória/ES / Epidemiology of cardiovascular and respiratory diseases and its associations with air pollution in Vitória, Brazil: a systematic review

Introdução: A poluição do ar é um importante fator ambiental relacionado a doenças crônicas não transmissíveis, como doenças cardiovasculares e respiratórias. Essa relação torna-se importante em cidades com alta atividade industrial, como Vitória/ES. Esta pesquisa utilizou três revisões sistemáticas (RSs) distintas para avaliar a epidemiologia das doenças cardiovasculares (RS1), a epidemiologia das doenças respiratórias (RS2) e a associação entre poluição do ar e doenças cardiorrespiratórias (RS3) na cidade de Vitória. Métodos: A busca bibliográfica considerou três bases de dados (PubMed, Scopus e LILACS). Foi estabelecida uma quantidade mínima de três estudos para a condução de metanálises. A heterogeneidade de cada análise foi calculada pelo índice I2. Resultados: A busca bibliográfica resultou em 1.205 registros, dos quais 27 foram incluídos ­ 17 na RS1, cinco na RS2 e cinco na RS3. Apenas dois desfechos puderam ser avaliados por meio de metanálises: prevalência de hipertensão e prevalência de asma em crianças. Estima-se uma prevalência de 34% (IC95%: 24-45) de hipertensão e de 12% (IC95%: 1-32) de asma em crianças. Os poluentes mais avaliados foram MP10 e SO2, para os quais não se pôde realizar metanálises. Todas as análises apresentaram baixo número de registros incluídos e alta heterogeneidade. Conclusão: Há poucos dados disponíveis sobre a associação de doenças cardiorrespiratórias e poluição ambiental em Vitória. A heterogeneidade, a diversidade de desfechos e a baixa quantidade de estudos impediram a condução de análises mais profundas e limitaram o poder de síntese e conclusão dessas revisões, impossibilitando uma avaliação adequada dos objetivos propostos. São necessários mais estudos epidemiológicos com amostras de grande porte e representativas para que se tenha resultados conclusivos sobre a relação entre poluição ambiental e doenças cardiorrespiratórias em Vitória (AU)

Introduction: Air pollution is an important environmental factor related to chronic non-transmittable diseases, including cardiovascular and respiratory diseases. This relationship is especially relevant in cities with high industrial activity, such as Vitória, Brazil. This research used three systematic reviews (SRs) to evaluate the epidemiology of cardiovascular diseases (SR1), the epidemiology of respiratory diseases (RS2), and the association between air pollution and cardiorespiratory diseases (RS3) in Vitória, Brazil. Methods: A bibliographic search was conducted in three independent databases (PubMed, Scopus and LILACS). A minimum amount of three studies was established to perform meta-analyses. Heterogeneity was calculated using the I2 index. Results: The bibliographic search retrieved 1205 references, of which 27 were included ­ 17 in SR1, five in SR2, and five in SR3. Only two outcomes could be evaluated through meta-analysis: prevalence of hypertension and prevalence of asthma in children. The most frequently evaluated pollutants were PM10 and SO2. The estimated prevalence of hypertension was 34% (CI95%: 24-45) and of asthma in children was 12% (CI95%: 1-32). All analyses had a limited number of included references and showed high heterogeneity. Conclusions: There are limited data available regarding the association of cardiorespiratory diseases and air pollution in Vitória, Brazil. The heterogeneity, the diversity of outcomes, and the limited number of studies hampered the performance of a more detailed analysis and limited the conclusions of these reviews, preventing a proper appraisal of the proposed aims. Further epidemiological studies with bigger and more representative sample sizes are needed to generate conclusive data about the relationship between air pollution and cardiorespiratory diseases in Vitória, Brazil (AU)

Fatores ambientais e risco de quedas em idosos: revisão sistemática / Environmental hazards and risk of fall in the elderly: systematic review

A queda em idosos é resultado de uma interação complexa entre fatores intrínsecos e extrínsecos. Embora seja difícil separar esses fatores, estudos apontam que fatores de risco ambientais estão presentes em aproximadamente 40% das quedas. O objetivo deste estudo foi realizar uma revisão sistemática da literatura sobre o envolvimento de fatores ambientais nas quedas em idosos vivendo na comunidade. Para tanto, foram selecionados estudos publicados no período de janeiro de 2000 a maio de 2014 nas bases de dados eletrônicas MEDLINE, LILACS e SciELO. Apenas artigos disponíveis na íntegra e em inglês, português e espanhol foram considerados para esta revisão. Após a análise do título, do resumo e do texto na íntegra, dez artigos foram incluídos na revisão. Nos estudos analisados, aproximadamente metade das quedas ocorreu durante a locomoção e envolveu tropeços e escorregões. Os fatores de risco ambientais estão muito presentes nas quedas (20-58%), sendo que superfícies irregulares, superfícies molhadas/escorregadias, objetos/tapetes soltos e desníveis no chão/problemas com degraus foram os mais prevalentes. Observou-se tendência de aumento na ocorrência de quedas em ambientes externos, as quais são frequentemente precipitadas por fatores extrínsecos. Mais estudos são necessários na caracterização e no desenvolvimento de estratégias de prevenção de quedas em ambientes externos.

Falls in the elderly is the result of a complex interplay between intrinsic and extrinsic factors. Although it is difficult to separate these factors, studies indicate that environmental hazards are involved in approximately 40% of the falls. This study aimed to conduct a systematic review about the contribution of environmental hazards for falls in community-dwelling elderly. Studies published from January 2000 to May 2014 in the electronic databases MEDLINE, LILACS and SciELO were selected. Only free full-text articles written in English, Portuguese and Spanish were considered for this research. After title, abstract and full text analysis, ten articles were included in this review. In the studies analyzed, approximately half of the falls occurred during walk and involved tripping and slipping. The environmental risk factors are present in falls (20-58%), in which irregular surfaces, wet/slippery floors, objects/loose rugs and uneven floor/steps were the most prevalent hazards among the studies. There was tendency of increase in the occurrence of outdoor falls, which are often caused by extrinsic factors. More studies are needed to characterize and develop strategies to prevent outdoor falls among community-dwelling older adults.

El Estado y la educación Ambiental Comunitaria en el Perú / The State and community Environmental Education in Peru

La salud ambiental, según la organizacòn Mundial de la Salud es "una disciplina que comprende aquellos aspectos de la Salud_humana, incluìda la calidad de vida, el bienestar social,entre otros, que son determinados por factores ambientales físicos; químicos, biológicos, sociales y psicosociales. También se refiere a la teoría y práctica de evaluar, corregir, controlar y prevenir aquellos factores en el medio ambiente que pueden potencialmente afectar adversamente la salud de presentes y futuras generaciones". En este contesto la cultura ambiental es fundamental en una sociedad para establecer conductas y corrientes de opiniòn tendientes al cuidado del ambiente asociado a la salud.

Environmental health, according to the World Organizacon of Health is "a discipline that comprises those Salud_humana aspects, including quality of life, social welfare, etc., which are Physical determined by environmental factors; chemical, biological, social and psychosocial. It also refers to the theory and practice of assessing, correcting, controlling and preventing those factors in the environment that can potentially affect adversely the health of present and future generations". This answer is critical environmental culture in a society to establish behaviors and current opinion aimed at caring for the environment associated health.

Pediatria ambiental: um tema emergente / Environmental pediatrics: an emerging issue

OBJETIVO: Revisar os artigos mais relevantes sobre a pediatria ambiental, seus efeitos potenciais para a saúde e, especialmente, seus avanços na prevenção. FONTES DOS DADOS: Foi realizada uma pesquisa utilizando as bases de dados MEDLINE/PubMed e SciELO. Foram revisados artigos de 1990 a 2010, além de capítulos de livros relacionados à pediatria ambiental. SÍNTESE DOS DADOS: Há uma variedade significativa de fatores que tornam as crianças altamente vulneráveis à exposição a riscos ambientais, associados principalmente ao consumo comparativamente maior de água, comida e ar por parte da criança, em relação ao seu peso corporal. De acordo com a Organização Mundial de Saúde, mais de 3 milhões de crianças menores de 5 anos morrem devido a doenças relacionadas ao meio ambiente. Aproximadamente 30-40 por cento das doenças pediátricas estão relacionadas a fatores ambientais. As crianças estão constantemente expostas a vários riscos ambientais para a saúde, dentre os quais se destacam: água contaminada, falta de condições adequadas de saneamento, poluição do ar, vetores de doenças, perigos químicos, injúrias e acidentes. CONCLUSÕES: Atualmente, os pediatras são desafiados a tratar das necessidades de saúde ligadas à pediatria ambiental. A história pediátrica deve ser mais abrangente, acrescentando-se questões pontuais que ajudem a identificar potenciais riscos ambientais. A conscientização e o entendimento sobre os efeitos nocivos das várias condições ambientais e o conhecimento sobre as medidas de prevenção relacionadas resultarão em intervenções oportunas e adequadas que melhorarão a saúde e o desenvolvimento das nossas crianças.

OBJECTIVE: To review the most relevant articles regarding environmental pediatrics, its potential effects on health, and especially its advances in prevention. SOURCES: A literature search was conducted using MEDLINE/PubMed and SciELO databases. Articles from 1990 to 2010 were reviewed, in addition to book chapters related to environmental pediatrics. SUMMARY OF THE FINDINGS: There is a significant variety of factors that make children highly vulnerable to environmental hazard exposure, which are mainly associated with children’s comparatively greater consumption of water, food, and air in relation to body weight. According to the World Health Organization, every year more than 3 million children under the age of 5 die because of environment-related conditions. Approximately 30 to 40 percent of pediatric diseases are related to environmental factors. Children are constantly exposed to various environmental health hazards, among which the following stand out: contaminated water, lack of adequate sanitation facilities, air pollution, disease vectors, chemical hazards, injuries, and accidents. CONCLUSIONS: Nowadays, pediatricians are challenged to address environmental pediatrics health care needs. The pediatric health history needs to be more comprehensive by adding pointed questions to help identify potential environmental risks. Awareness and understanding of the noxious effects of various environmental conditions and knowledge of the related prevention measures will result in timely and adequate interventions that will improve our children’s health and development.