Sex and adrenal hormones in association with insecticide biomarkers among adolescents living in ecuadorian agricultural communities.

BACKGROUND: Organophosphate, pyrethroid, and neonicotinoid insecticides have resulted in adrenal and gonadal hormone disruption in animal and in vitro studies; limited epidemiologic evidence exists in humans. We assessed relationships of urinary insecticide metabolite concentrations with adrenal and gonadal hormones in adolescents living in Ecuadorean agricultural communities. METHODS: In 2016, we examined 522 Ecuadorian adolescents (11-17y, 50.7% female, 22% Indigenous; ESPINA study). We measured urinary insecticide metabolites, blood acetylcholinesterase activity (AChE), and salivary testosterone, dehydroepiandrosterone (DHEA), 17ß-estradiol, and cortisol. We used general linear models to assess linear (ß = % hormone difference per 50% increase of metabolite concentration) and curvilinear relationships (ß2 = hormone difference per unit increase in squared ln-metabolite) between ln-metabolite or AChE and ln-hormone concentrations, stratified by sex, adjusting for anthropometric, demographic, and awakening response variables. Bayesian Kernel Machine Regression was used to assess non-linear associations and interactions. RESULTS: The organophosphate metabolite malathion dicarboxylic acid (MDA) had positive associations with testosterone (ßboys = 5.88% [1.21%, 10.78%], ßgirls = 4.10% [-0.02%, 8.39%]), and cortisol (ßboys = 6.06 [-0.23%, 12.75%]. Para-nitrophenol (organophosphate) had negatively-trending curvilinear associations, with testosterone (ß2boys = -0.17 (-0.33, -0.003), p = 0.04) and DHEA (ß2boys = -0.49 (-0.80, -0.19), p = 0.001) in boys. The neonicotinoid summary score (ßboys = 5.60% [0.14%, 11.36%]) and the neonicotinoid acetamiprid-N-desmethyl (ßboys = 3.90% [1.28%, 6.58%]) were positively associated with 17ß-estradiol, measured in boys only. No associations between the pyrethroid 3-phenoxybenzoic acid and hormones were observed. In girls, bivariate response associations identified interactions of MDA, Para-nitrophenol, and 3,5,6-trichloro-2-pyridinol (organophosphates) with testosterone and DHEA concentrations. In boys, we observed an interaction of MDA and Para-nitrophenol with DHEA. No associations were identified for AChE. CONCLUSIONS: We observed evidence of endocrine disruption for specific organophosphate and neonicotinoid metabolite exposures in adolescents. Urinary organophosphate metabolites were associated with testosterone and DHEA concentrations, with stronger associations in boys than girls. Urinary neonicotinoids were positively associated with 17ß-estradiol. Longitudinal repeat-measures analyses would be beneficial for causal inference.

Associação entre ondas de calor e mortalidade por doenças cardiovasculares nas capitais brasileiras / Association between heat waves and mortality from cardiovascular disease in brazilian capitals

As ondas de calor têm sido associadas a morbimortalidade por doenças do aparelho circulatório em diferentes locais, principalmente nos grupos considerados vulneráveis. Esta tese apresenta estudos sobre as características das ondas de calor e abordou seus efeitos nas doenças do aparelho circulatório nas capitais brasileiras no período de 2000 a 2016. O primeiro estudo teve como objetivo examinar a intensidade, a frequência e a duração dos eventos de ondas de calor nas capitais brasileiras, por meio das análises de séries temporais foi possível caracterizar a ocorrência das ondas de calor, os resultados mostraram que estão mais frequentes, duradouras e intensas e ocorrem durante todo o ano, inclusive no inverno em cidades das regiões Sudeste e Sul. O segundo estudo teve como objetivo identificar as capitais brasileiras que apresentaram desconforto térmico para população, por meio da caracterização do índice de calor. Os resultados mostraram que se utilizando as definições de temperatura aparente e conforto e desconforto térmico do diagrama do conforto humano, na maioria das capitais foram constatadas condições de desconforto para a saúde humana. Algumas capitais localizadas no Sudeste e no Sul apresentaram condições definidas por conforto térmico. O terceiro estudo teve como objetivo estimar os efeitos de ondas de calor na mortalidade do aparelho circulatório no município do Rio de Janeiro no ano de 2010. A análise de séries temporais foi utilizada para estimar o percentual do Risco Relativo (%RR) do efeito das ondas de calor na mortalidade de pessoas adultas a partir de ≥ 30 anos de idade. Os resultados deste estudo evidenciaram o aumento do %RR nas mortalidades por DAC associadas às ondas de calor no município do Rio de Janeiro. O quarto estudo teve como objetivo estimar os efeitos de ondas de calor na mortalidade por doenças do aparelho cardiovascular nas capitais brasileiras, a análise de séries temporais foi utilizada para estimar o percentual do Risco Relativo (%RR) do efeito das ondas de calor na mortalidade de pessoas adultas ≥ 30 anos de idade. Os resultados indicam uma associação entre ondas de calor e a mortalidade por doenças cerebrovasculares e doenças isquêmicas do coração na população adulta. Os achados deste conjunto de estudo permitem concluir que as ondas de calor estão mais frequentes, intensas e duradouras nas capitais brasileiras e, as doenças do aparelho circulatório estão associadas com este fenômeno.

Heat waves have been associated with circulatory disease morbidity and mortality in different locations, especially in groups considered vulnerable. This thesis present studies on the characteristics of heat waves and addressed its effects on circulatory diseases in Brazilian capitals from 2000 to 2016. The first study aimed to examine the intensity, frequency and duration of heat wave events in the Brazilian capitals, through temporal series analysis, it was possible to characterize the occurrence of heat waves, the results showed that they are more frequent, lasting and intense and occur throughout the year, including winter in cities in the Southeast and South regions. The second study aimed to identify the Brazilian capitals that presented thermal discomfort for the population, through the characterization of the heat index. The results showed that using the apparent temperature definitions and comfort and thermal discomfort of the human comfort diagram, most capitals were found conditions of discomfort for human health. Some capitals located in the Southeast and South had conditions defined by thermal comfort. The third study aimed to estimate the effects of heat waves on the mortality of the circulatory system in the municipality of Rio de Janeiro in 2010. Time series analysis was used to estimate the percentage of relative risk (%RR) of the effect of heat waves on adult mortality from ≥ 30 years of age. The results of this study showed the increase of %RR in DAC mortality associated with heat waves in the municipality of Rio de Janeiro. The fourth study aimed to estimate the effects of heat waves on mortality from cardiovascular disease in Brazilian capitals, timely series analysis was used to estimate the percentage of relative risk (%RR) of the effect of heat waves on mortality of adults ≥ 30 years of age. The results indicate an association between heat waves and mortality from cerebrovascular diseases and ischemic heart disease in the adult population. The findings of this study set allow you to conclude that heat waves are more frequent, intense and lasting in Brazilian capitals and circulatory diseases are associated with this phenomenon.

The effect of ambient temperature on cardiovascular mortality in 27 Brazilian cities.

BACKGROUND: There is limited evidence on the relationship between temperature and cardiovascular mortality in middle and low-income countries, particularly in Latin America. In this study, we investigated the total effect of temperature on cardiovascular mortality in 27 Brazilian cities, and the effect modification by geographic, socioeconomic, demographic and infrastructure characteristics within cities. METHODS: In the city-specific analysis, we used time-series analyses to estimate the relationship between mean temperature and daily cardiovascular mortality using quasi-Poisson generalized linear models combined with distributed lag non-linear models. In the second stage, a meta-analysis was used to pool the effects of temperature on cardiovascular mortality for Brazil and its five regions (Central-West, North, Northeast, South, and Southeast). We used a meta-regression to examine the effect modification of city-specific geographic, socioeconomic, demographic and infrastructure-related variables. RESULTS: The risks associated with temperature varied across the locations. Higher cardiovascular mortality was associated with low and high temperatures in most of the cities, Brazil and the Central-West, North, South, and Southeast regions. The overall relative risk (RR) for Brazil was 1.26 (95% confidence interval [CI]: 1.17-1.35) for the 1st percentile of temperature and 1.07 (95% CI: 1.01-1.13) for the 99th percentile of temperature versus the 79th percentile (27.7 °C), where RR was lowest. The temperature range was the variable that best explained the variation in effects among the cities, with greater effects in locations having a broader range. CONCLUSIONS: The results indicate effects of low and high temperatures on the risk of cardiovascular mortality in most of Brazil's capital cities, besides a pooled effect for Brazil and the Central-West, North, South, and Southeast regions. These findings can help inform public policies addressing the health impact of temperature extremes, especially in the context of climate change.

Spatiotemporal Error in Rainfall Data: Consequences for Epidemiologic Analysis of Waterborne Diseases.

The relationship between rainfall, especially extreme rainfall, and increases in waterborne infectious diseases is widely reported in the literature. Most of this research, however, has not formally considered the impact of exposure measurement error contributed by the limited spatiotemporal fidelity of precipitation data. Here, we evaluate bias in effect estimates associated with exposure misclassification due to precipitation data fidelity, using extreme rainfall as an example. We accomplished this via a simulation study, followed by analysis of extreme rainfall and incident diarrheal disease in an epidemiologic study in Ecuador. We found that the limited fidelity typical of spatiotemporal rainfall data sets biases effect estimates towards the null. Use of spatial interpolations of rain-gauge data or satellite data biased estimated health effects due to extreme rainfall (occurrence) and wet conditions (accumulated totals) downwards by 35%-45%. Similar biases were evident in the Ecuadorian case study analysis, where spatial incompatibility between exposed populations and rain gauges resulted in the association between extreme rainfall and diarrheal disease incidence being approximately halved. These findings suggest that investigators should pay greater attention to limitations in using spatially heterogeneous environmental data sets to assign exposures in epidemiologic research.

Income Inequality and Mortality Owing to Breast Cancer: Evidence From Brazil.

BACKGROUND: The relationship between breast cancer and inequality income is unclear. This study analyzed the correlation between income inequality and mortality standardized by age and proportional mortality owing to breast cancer among Brazilian women. PATIENTS AND METHODS: This is an ecological study using data of the federative units and Federal District of Brazil in 2010. The age-standardized mortality owing to breast cancer was estimated using data from the Department of Informatics of Brazil's Unified Health System. Income inequality indicators used included the Gini index, Theil-L index, Palma index, and the ratio of income distribution quintiles obtained from the United Nations Development Program. We used Pearson correlation and linear regression adjusted for income per capita and other variables. RESULTS: An increase of 0.1 in the Gini index was associated with increases of 9.8 deaths per 100,000 women (95% confidence interval [CI], 1.7-17.9); an increase in the Palma index was associated with increases in mortality of 0.7 deaths per 100,000 women (95% CI, 0.1-1.4), an increase in the Theil-L index was associated with increases in mortality of 4.9 deaths per 100,000 women (95% CI, 1.9-7.9), and of 0.8 (95% CI, 0.2-1.5) in the proportional mortality. CONCLUSION: Income inequality, as assessed by the Gini, Palma, and Theil-L indexes, is positively associated with an increase in breast cancer mortality in Brazil.

Perspectivas teóricas y metodológicas para el estudio del ambiente como determinante de la salud / Theoretical and methodological perspectives for studying the environment as a determinant of health / Perspectivas teóricas e metodológicas para o estudo do ambiente como determinante da saúde

RESUMEN Objetivo: Describir algunas de las perspectivas teóricas y metodológicas del ambiente como determinante de la salud, como un aporte desde lo conceptual a este complejo campo en constante construcción y deconstrucción. Metodología: Revisión de tema con un análisis de la literatura previa detección y consulta de documentos oficiales y artículos científicos que permitieron la estructuración del texto alrededor del tema. Resultados y discusión: A lo largo de la historia y en los diferentes discursos, vivencias individuales y colectivas, el ambiente ha estado presente en el continuo del proceso salud - enfermedad. La higiene y el saneamiento resuelven el problema en un escenario donde hay riesgos y peligros que deben ser identificados para controlarse o eliminarse. Sin embargo, desde las últimas décadas del siglo XX por intereses económicos, necesidad de conservar la salud, por los daños, problemas ambientales globales y locales, se ha dado lugar, al menos desde lo teórico y metodológico, al entendimiento del ambiente como un determinante de la salud, concepción que implica pasar del dominio y control del hombre sobre la naturaleza a entenderse como parte de ella misma. Conclusiones: A través del tiempo se ha observado y vivenciado que las intervenciones antrópicas del hombre sobre la naturaleza han sido poco respetuosas y ha pasado sistemáticamente de ser victimario de su ambiente y su entorno a ser víctima de los ambientes construidos. Los modelos de salud ambiental construidos con una mirada más desde la salud deben integrarse con otras disciplinas, para el análisis de situaciones complejas en salud ambiental.

ABSTRACT Objective: To describe some of the theoretical and methodological perspectives of the environment as a health determinant, this is a contribution from the conceptual standpoint to this complex field in constant construction and deconstruction. Methodology: The subject was reviewed through an analysis of the literature performed after finding and reading official documents and scientific papers that made it possible to structure the text around the subject. Results y discussion: Throughout history, in various discourses and in individual and collective experiences, the environment has been present in the continuum of the health-disease process. Hygiene and sanitation solve the problem in a scenario where there are risks and hazards that should be identified in order to be controlled or removed. However, since the last decades of the twentieth century, the economic interests, along with the global and local environmental damage and the need to preserve health, have caused the environment to be understood, at least theoretically and methodologically, as a determinant of health. This conception in turn implies considering mankind not as the master of nature but as part of it. Conclusions: Throughout time it has been observed and experienced that the anthropic interventions of humankind over nature have been disrespectful and have led it to consistently move from the status of victimizer of its surrounding to that of victim of the constructed environments. Environmental health models built with a stronger focus on health should be integrated with other disciplines for the analysis of complex situations in environmental health.

RESUMO Objetivo: Descrever algumas das perspectivas teóricas e metodológicas do ambiente como determinante da saúde, como um aporte desde o conceptual a este complexo campo em constante construção e desconstrução. Metodologia: Revisão de tema com uma análise da literatura previa detecção e consulta de documentos oficiais e artículos científicos que permitiram a estruturação do texto ao redor do tema. Resultados e discussão: Ao longo da historia e nos diferentes discursos, vivencias individuais e coletivas, o ambiente tem estado presente no continuo do processo saúde - doença. A higiene e o saneamento resolvem o problema num cenário onde ha riscos e perigos que devem ser identificados para controlar-se ou eliminar-se. Mas, desde as últimas décadas do século XX por interesses econômicos, necessidade de conservar a saúde, pelos danos, problemas ambientais globais e locais, se tem dado lugar, ao menos desde o teórico e metodológico, ao entendimento do ambiente como um determinante da saúde, conceição que implica passar do domínio e controle do homem sobre a natureza ao entender-se como parte dela mesma. Conclusões: A través do tempo se tem observado e vivenciado que as intervenções antrópicas do homem sobre a natureza tem sido pouco respeitosas e tem passado sistematicamente de ser carrasco do seu ambiente e o seu entorno pra ser vítima dos ambientes construídos. Os modelos de saúde ambiental construídos com una olhada mais desde a saúde devem integrar-se com outras disciplinas, para o análise de situações complexas em saúde ambiental.

Kawasaki Disease and Exposure to Fine Particulate Air Pollution.

OBJECTIVE: To analyze associations of short-term exposure to fine particulate matter (diameter ≤ 2.5 µm [PM2.5]), a measurable component of urban pollution, with the event date of fever onset for patients with Kawasaki disease (KD) residing in 7 metropolitan regions. STUDY DESIGN: A case-crossover study design was used. Time trends, seasonality, month, and weekday were controlled for by matching. We assembled PM2.5 exposure measurements from urban monitors and imputed PM2.5 to provide day-to-day temporal variability and resolution for time series indexes of exposures. Selected exposure windows (to 14 days) of PM2.5 were examined. RESULTS: A total of 3009 KD events were included for which the subject resided within a study metropolitan area and the event date occurred during years with available PM2.5. The estimated ORs (with 95% CIs) of an event of KD associated with a 10 µg/m(3) PM2.5 lagged moving average concentration of lagged exposure period (ie, concurrent, preceding day[s]) revealed no evidence of a consistent, statistically significant, positive association between elevated PM2.5 exposure and increased risk of KD. Extended analysis with stratification by city, sex, age, ethnic origin, incomplete or complete clinical manifestations, the presence of coronary aneurysm, and intravenous immunoglobulin resistance did not provide evidence of a consistent, statistically significant, positive association between elevated exposure to PM2.5 and increased risk of KD for any of the strata studied. CONCLUSIONS: This multicity study failed to establish a risk of the event of KD with short-term fine particulate exposure. Our negative findings add to the growing field of environmental epidemiology research of KD.

Caracterizacao da exposicao de populacao a organoclorados: uma aplicacao da analise de cluster / Characterization of population exposure to organochlorines: a cluster analysis application

O presente trabalho objetivou apresentar os resultados da aplicação da análise de agrupamento (cluster) para a caracterização da exposição a organoclorados, através de variáveis relacionadas ao tempo e à dose de exposição. Características de 354 sujeitos de uma população exposta a resíduos de pesticidas organoclorados relacionadas ao tempo e à dose de exposição foram submetidas à análise de cluster para separá-las em subgrupos. Foi realizada a análise de cluster hierárquico. Para avaliar a precisão da classificação, foram comparadas a variabilidade intragrupo e a variabilidade inter-grupos através do teste de ANOVA para cada dimensão. A estratégia de agregação foi realizada pelo método de Ward. Para criação dos clusters, foram comparadas as variáveis associadas à exposição e às rotas de contaminação. As informações referentes às doses estimadas de ingesta do composto foram usadas para ponderar os valores de tempo de exposição a cada uma das rotas, de forma a obter valores proxy de intensidade de exposição. Os resultados indicaram 3 clusters: o cluster 1 (n = 45), com características de maior exposição; o cluster 2 (n = 103), de exposição intermediária, e o cluster 3 (n = 206), de menor exposição. As análises bivariadas realizadas com os grupos evidenciaram que são grupamentos com diferença estatisticamente significativa. Este estudo evidenciou a aplicabilidade da análise de cluster para categorizar populações expostas a organoclorados, e aponta para a relevância de estudos tipológicos que possam contribuir para uma melhor classificação de sujeitos expostos a agentes químicos, condição típica dos estudos de epidemiologia ambiental, para uma mais ampla compreensão dos aspectos etiológicos, preventivos e terapêuticos da contaminação.

This study aimed to show the results from a cluster analysis application in the characterization of population exposure to organochlorines through variables related to time and exposure dose. Characteristics of 354 subjects in a population exposed to organochlorine pesticides residues related to time and exposure dose were subjected to cluster analysis to separate them into subgroups. We performed hierarchical cluster analysis. To evaluate the classification accuracy, compared to intra-group and inter-group variability by ANOVA for each dimension. The aggregation strategy was accomplished by the method of Ward. It was, for the creation of clusters, variables associated with exposure and routes of contamination. The information on the estimated intake doses of compound were used to weight the values of exposure time at each of the routes, so as to obtain values proxy exposure intensity. The results showed three clusters: cluster 1 (n = 45), characteristics of greatest exposure, the cluster 2 (n = 103), intermediate exposure, and cluster 3 (n = 206), less exposure. The bivariate analyzes performed with groups that are groups showed a statistically significant difference. This study demonstrated the applicability of cluster analysis to categorize populations exposed to organochlorines and also points to the relevance of typological studies that may contribute to a better classification of subjects exposed to chemical agents, which is typical of environmental epidemiology studies to a wider understanding of etiological, preventive and therapeutic contamination.

Qualitative environmental health research: an analysis of the literature, 1991-2008 / Pesquisa qualitativa de saúde ambiental: uma análise da literatura, 1991-2008

Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. In this analysis, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. A primary search for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. This analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.

Pesquisa qualitativa usa dados não numéricos para entender opiniões, motivos e crenças sobre eventos e fenômenos. Nesta análise, o uso de métodos e de dados qualitativos é reportado no estudo da relação entre exposição ambiental e saúde humana. Uma pesquisa preliminar por artigos de 1991 a 2008 incluiu os três seguintes termos: qualitativo, ambiente e saúde. A pesquisa resultou em 3.155 registros. Dados foram extraídos e artigos analisados para determinar onde e por quem a pesquisa de saúde ambiental foi conduzida e publicada, os tipos de métodos e análises usados em estudos qualitativos de saúde ambiental e os tipos de dados de informação qualitativa que contribuem para a saúde ambiental. Os resultados ressaltam uma diversidade de disciplinas e técnicas entre pesquisadores que usaram métodos qualitativos para estudar saúde ambiental. Quase todos os estudos identificaram um aumento da compreensão científica de percepções de exposições de saúde ambiental. A análise demonstra o potencial de dados qualitativos para melhorar a compreensão de caminhos de exposição complexos, incluindo a influência de fatores sociais em saúde ambiental e resultados.

Epidemiologia y la relación salud-ambiente: reflexiones sobre el cambio ambiental, desarrollo sustentable y salud poblacional / Epidemiology and health-environment relationship: reflections on environmental change, sustainable development and population health

Ensayo que presenta una discusión sobre la problemática ambiental actual y su relación con la salud de las poblaciones. Se analizan las limitaciones del modelo de desarrollo económico y social, centrado en el incremento del capital y la producción industrial, y su impacto negativo sobre los recursos naturales, el equilibrio de los ecosistemas y la vulnerabilidad humana. Se expone los fundamentos metodológicos y los desarrollos del enfoque epidemiológico ambiental, analizando sus principales potenciales de aplicación. Por último, se formulan opciones de solución articuladas a las premisas del desarrollo sustentable y de la justicia ambiental, y se destaca la responsabilidad de la academia en la formación del recurso humano y científico en el área de epidemiologia ambiental, así como el papel protagónico de la comunidad en la toma de conciencia ambiental y la participación activa desde la postura crítica, responsable y propositiva para hacer parte de la solución del problema.

This essay presents a discussion on current environmental problems and their relationship to the health of populations. The limitations of the model of economic and social development are analyzed focusing on the augmentation of the capital and the industrial production and its negative impact on natural resources, the balance of ecosystems and human vulnerability. The methodology basics and the developments in environmental epidemiological approach are exposed analyzing their main potential application. Finally, options for solutions are formulated linking them to the premises of sustainable development and environmental justice. The responsibility of the academic environment is pointed out in the training of human and scientific resources in the field of environmental epidemiology, as well as the role of the community in terms of environmental awareness and active participation from a point of view that becomes critical, responsible and capable of defining proposals to make part of the solution.