PAH biomarkers for human health risk assessment: a review of the state-of-the-art

Polycyclic aromatic hydrocarbons (PAH) are widely distributed in the environment, and some are carcinogenic to human beings. The study of biomarkers has helped clarify the nature and magnitude of the human health risks posed by such substances. This article provides a review of the state-of-the-art on PAH biomarkers for human health risk assessment and also discusses their applicability within the context of environmental management in Brazil. The article discusses the methodologies for determination of some biomarkers such as 1-hydroxypyrene and PAH-DNA adducts. Cytogenetic markers, frequency of chromosomal aberrations, and micronucleus induction were considered for the evaluation of cancer risk. The current stage of studies on validation of such biomarkers was also approached.

Ratio of weight to height gain: a useful tool for identifying children at risk of becoming overweight or obese at preschool age

PURPOSE: To analyze the usefulness of the weight gain/height gain ratio from birth to two and three years of age as a predictive risk indicator of excess weight at preschool age. METHODS: The weight and height/length of 409 preschool children at daycare centers were measured according to internationally recommended rules. The weight values and body mass indices of the children were transformed into a z-score per the standard method described by the World Health Organization. The Pearson correlation coefficients (rP) and the linear regressions between the anthropometric parameters and the body mass index z-scores of preschool children were statistically analyzed (alpha = 0.05). RESULTS: The mean age of the study population was 3.2 years (± 0.3 years). The prevalence of excess weight was 28.8%, and the prevalence of overweight and obesity was 8.8%. The correlation coefficients between the body mass index z-scores of the preschool children and the birth weights or body mass indices at birth were low (0.09 and 0.10, respectively). There was a high correlation coefficient (rP = 0.79) between the mean monthly gain of weight and the body mass index z-score of preschool children. A higher coefficient (rP = 0.93) was observed between the ratio of the mean weight gain per height gain (g/cm) and the preschool children body mass index z-score. The coefficients and their differences were statistically significant. CONCLUSION: Regardless of weight or length at birth, the mean ratio between the weight gain per g/cm of height growth from birth presented a strong correlation with the body mass index of preschool children. These results suggest that this ratio may be a good indicator of the risk of excess weight and obesity in preschool-aged children.

Elevated Risk for HIV-1 Infection in Adolescents and Young Adults in São Paulo, Brazil

Background. Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Methodology/Principal Findings Subjects were identified from 2002-2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. ) Conclusions/Significance In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum

Prevalence and risk factors for aminoglycoside nephrotoxicity in intensive care units

In order to assess the prevalence of and risk factors for aminoglycoside-associated nephrotoxicity in intensive care units (ICUs), we evaluated 360 consecutive patients starting aminoglycoside therapy in an ICU. The patients had a baseline calculated glomerular filtration rate (cGFR) of ?30 ml/min/1.73 m2. Among these patients, 209 (58 per cent) developed aminoglycoside-associated nephrotoxicity (the acute kidney injury [AKI] group, which consisted of individuals with a decrease in cGFR of >20 per cent from the baseline cGFR), while 151 did not (non-AKI group). Both groups had similar baseline cGFRs. The AKI group developed a lower cGFR nadir (45 ± 27 versus 79 ± 39 ml/min/1.73 m2 for the non-AKI group; P < 0.001); was older (56 ± 18 years versus 52 ± 19 years for the non-AKI group; P = 0.033); had a higher prevalence of diabetes (19.6 per cent versus 9.3 per cent for the non-AKI group; P = 0.007); was more frequently treated with other nephrotoxic drugs (51 per cent versus 38 per cent for the non-AKI group; P = 0.024); used iodinated contrast more frequently (18 per cent versus 8 per cent for the non-AKI group; P = 0.0054); and showed a higher prevalence of hypotension (63 per cent versus 44 per cent for the non-AKI group; P = 0.0003), shock (56 per cent versus 31 per cent for the non-AKI group; P < 0.0001), and jaundice (19 per cent versus 8 per cent for the non-AKI group; P = 0.0036). The mortality rate was 44.5 per cent for the AKI group and 29.1 per cent for the non-AKI group (P = 0.0031). A logistic regression model identified as significant (P < 0.05) the following independent factors that affected aminoglycoside-associated nephrotoxicity: a baseline cGFR of <60 ml/min/1.73 m2 (odds ratio [OR], 0.42), diabetes (OR, 2.13), treatment with other nephrotoxins (OR, 1.61) or iodinated contrast (OR, 2.13), and hypotension (OR, 1.83). (To continue) In conclusion, AKI was frequent among ICU patients receiving an aminoglycoside, and it was associated with a high rate of mortality. The presence of diabetes or hypotension and the use of other nephrotoxic drugs and iodinated contrast were independent risk factors for the development of aminoglycoside-associated nephrotoxicity

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde e a AIDS: uma proposta de core set

O advento da terapia anti-retroviral de alta potência (HAART) alterou a história natural da aids, diminuindo sua mortalidade e a incidência de doenças oportunistas e aumentando a esperança de vida das pessoas vivendo com aids.Como uma doença crônica, outras questões passam a ser relevantes, entre elas a adesão ao tratamento, seus efeitos adversos e a qualidade de vida das pessoas nessa condição. A CIF constitui um instrumento adequado para identificar as características da funcionalidade, do ambiente e condições pessoais que interferem na qualidade de vida. Instrumentos para a sua aplicação, core sets, têm sido desenvolvidos para várias condições de saúde. Com o objetivo de propor um core set para aids, foram desenvolvidas duas etapas preliminares do modelo proposto para a construção desses instrumentos. A primeira etapa, de revisão sistemática buscou no MEDLINE artigos com descritores HAART e qualidade de vida, publicados em inglês, de 2000 a 2004. Foram selecionados 31 estudos que resultou em 87 conceitos dos quais 66 puderam ser identificados como categorias da CIF. Estas formaram as perguntas da entrevista aplicada em 42 voluntários, pacientes de um centro de referência para DST e Aids de São Paulo. Entre as condições mais freqüentemente associadas ao tratamento, estão às mudanças na imagem corporal, conseqüência da lipodistrofia, apontada em 84 por cento dos estudos e em 93 por cento das entrevistas. Alterações das funções digestivas, das relações íntimas, e das funções sexuais foram condições importantes identificadas no estudo. As duas etapas definiram 40 categorias da CIF como proposta preliminar de um core set para pacientes com aids

Tendência da incidência e da mortalidade por Aids em mulheres na transição menopausal e pós-menopausa no Brasil, 1996-2005

Objetivo: Descrever a incidência e a mortalidade por Aids no Brasil e mulheres na fase menopausal e pós-menopausa. Métodos: Estudo retrospectivo de 1996 a 2005, utilizando dados secundários do Sistema de Informações de Saúde do DATASUS - Ministério da Saúde. Buscou-se por população residente em dados "Demográficos e Socioeconômicos, incidência no Sistema de Informação de Agravos de Notificação (SINAN) e mortalidade no Sistema de Informação sobre Mortalidade (SIM). Os coeficientes específicos de incidência e de mortalidade por Aids/100.000 mulheres foram calculados para cada década da faixa etária de 30 a 69 anos (30-39, 40-49, 50-59, 60-69), pois inclui a população de interesse; isto é, mulheres na transição menopausal e pós-menopausa, dos 35 aos 65 anos, Resultados: Houve aumento da incidência de Aids entre os anos de 1996 e 1998, a partir daí, observa-se tendência à ligeira queda até 2000 e posterior incremento até 2004. Em 2005, o coeficiente retorna a valores próximos dos encontrados em 1997. A mortalidade apresentou queda em todas as faixas etárias nos anos de 1996 e 1997, a partir de então, os coeficientes mantêm-se praticamente estáveis até 1999, exceto na faixa etária de 30 a 39 anos que continua estável até 2005. Já entre mulheres acima de 40 anos, o coeficiente de mortalidade apresentou aumento entre os anos 1999 a 2005. conclusão: Houve aumento no número de casos novos de Aids entre mulheres acima de 30 anos e o mesmo processo se repetiu com relação à mortalidade. O aumento e "envelhecimento" da epidemia entre brasileiras, sinalizam que medidas de promoção à saúde, prevenção da doença, diagnóstico precoce e tratamento efetivo devem ser oferecidos de maneira apropriada às mulheres de 30 a 69 anos, considerando as características pessoais, o contexto familiar e o papel social do sexo feminino nestas idades

Population-based multicentric survey of hepatitis B infection and risk factor differences among three regions in Brazil

This multicentric population-based study in Brazil is the first national effort to estimate the prevalence of hepatitis B (HBV) and risk factors in the capital cities of the Northeast, Central-West, and Federal Districts (2004-2005). Random multistage cluster sampling was used to select persons 13-69 years of age. Markers for HBV were tested by enzyme-linked immunosorbent assay. The HBV genotypes were determined by sequencing hepatitis B surface antigen (HBsAg). Multivariate analyses and simple catalytic model were performed. Overall, 7,881 persons were included; < 70 per cent were not vaccinated. Positivity for HBsAg was less than 1 per cent among non-vaccinated persons and genotypes A, D, and F co-circulated. The incidence of infection increased with age with similar force of infection in all regions. Males and persons having initiated sexual activity were associated with HBV infection in the two settings; healthcare jobs and prior hospitalization were risk factors in the Federal District. Our survey classified these regions as areas with HBV endemicity and highlighted the risk factors differences among the settings

Prevalence and social distribution of risk factors for chronic noncommunicable diseases in Brazil

OBJETIVOS: Evaluar los factores de riesgo de enfermedades crónicas no transmisibles (ECNT) e identificar las desigualdades sociales relacionadas con su distribución en la población adulta brasileña.MÉTODOS: Se estudiaron los factores de riesgo de ECNT (entre ellos el consumo de tabaco, el sobrepeso y la obesidad, el bajo consumo de frutas y vegetales [BCFV], la insuficiente actividad física en el tiempo de ocio [IAFTO], el estilo de vida sedentario y el consumo excesivo de alcohol) en una muestra probabilística de 54369 adultos de 26 capitales estatales de Brasil y el Distrito Federal en 2006. Se utilizó el Sistema de Vigilancia de los Factores Protectores y de Riesgo para Enfermedades Crónicas No Transmisibles por Entrevistas Telefónicas (VIGITEL), un sistema de encuestas telefónicas asistido por computadora, y se calcularon las prevalencias ajustadas por la edad para las tendencias en cuanto al nivel educacional mediante la regresión de Poisson con modelos lineales. RESULTADOS: Los hombres informaron mayor consumo de tabaco, sobrepeso, BCFV, estilo de vida sedentario y consumo excesivo de alcohol que las mujeres, pero menos IAFTO. En los hombres, la educación se asoció con un mayor sobrepeso y un estilo de vida sedentario, pero con un menor consumo de tabaco, BCFV e IAFTO. En las mujeres, la educación se asoció con un menor consumo de tabaco, sobrepeso, obesidad, BCFV e IAFTO, pero aumentó el estilo de vida sedentario CONCLUSIONES: En Brasil, la prevalencia de factores de riesgo para ECNT (excepto IAFTO) es mayor en los hombres que en las mujeres. En ambos sexos, el nivel de educación influye en la prevalencia de los factores de riesgo para ECNT

The nutritional status of children and adolescents with HIV/AIDS on antiretroviral therapy

FAPESP n. 07/55777-9 e n. 07/50009-3

Nível de atividade física de crianças e adolescentes órfãos por aids

OBJETIVO: Estimar o nível de atividade física em crianças e adolescentes órfãos por aids, segundo características sociodemográficas e relativas à orfandade. MÉTODOS: Inquérito populacional realizado no município de São Paulo, SP, entre 2006 e 2007, com 235 crianças e adolescentes de 7 a 14 anos. As crianças foram classificadas como ativas e sedentárias com o ponto de corte em 300 minutos por semana de atividade física. Todas as variáveis foram comparadas entre os dois grupos e entre os sexos. RESULTADOS: Foi observada prevalência de 42 por cento de sedentarismo. A maioria das crianças e adolescentes apresentou locomoção e brincadeiras infantis como principais atividades físicas. Quanto ao nível de atividade física foi observada diferença significativa entre os sexos (p < 0,001). Os meninos eram mais ativos e brincavam mais na rua do que as meninas. CONCLUSÕES: Há alta magnitude de prevalência de sedentarismo entre crianças e adolescentes órfãos por aids, sendo maior entre as meninas

Mudanças no âmbito da testagem anti-HIV no Brasil entre 1998 e 2005

OBJETIVO: Analisar mudanças na realização de teste anti-HIV, as razões alegadas entre as pessoas que foram ou não testadas e o recebimento de aconselhamento. MÉTODOS: Estudos transversais conduzidos com homens e mulheres de 16 a 65 anos, com amostras representativas do Brasil urbano em 1998 (n=3.600) e 2005 (n=5.040). Características sociodemográficas, sexuais, reprodutivas e de experiências de vida e saúde foram consideradas na análise. A avaliação das possíveis diferenças nas distribuições das variáveis baseou-se nos testes qui-quadrado de Pearson e F design-based (±<5%). RESULTADOS: Em 1998, 20,2% dos entrevistados haviam realizado o teste e 33,6% em 2005. Foram testadas 60% das mulheres na faixa 25-34 anos, mas as que iniciaram a vida sexual antes dos 16 anos e reportaram quatro ou mais parceiros sexuais nos cinco anos anteriores à entrevista foram menos testadas. Não se observou aumento significativo da testagem entre homens, exceto para os de 55-65 anos, renda per capita entre 1-3 e 5-10 salários mínimos, aposentados, protestantes históricos e adeptos de cultos afro-brasileiros, moradores da região Norte/Nordeste e os que declararam parceria homo/bissexual ou não tiveram relações sexuais nos cinco anos anteriores à entrevista. Não aumentou a freqüência de testagem entre pessoas auto-avaliadas como sob alto risco para o HIV. Entre as mulheres, a freqüência de testagem pré-natal aumentou e a testagem por trabalho diminuiu entre os homens. Em 2005, metade dos testados não recebeu orientação antes ou após o teste. CONCLUSÕES: Houve expansão desigual na testagem, atingindo principalmente mulheres em idade reprodutiva, adultas e pessoas com melhores condições sociais. A testagem parece estar aumentando no País sem a devida atenção à decisão autônoma das pessoas e sem o provimento de maior e melhor oferta de aconselhamento

Metabolic syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study

Background: Coronary artery disease (CAD) is among the main causes of death in developed countries, and diet and lifestyle can influence CAD incidence. Objective: To evaluate the association of coronary artery disease risk score with dietary, anthropometric and biochemical components in adults clinically selected for a lifestyle modification program. Methods: 362 adults (96 men, 266 women, 53.9 +/- 9.4 years) fulfilled the inclusion criteria by presenting all the required data. The Framingham score was calculated and the IV Brazilian Guideline on Dyslipidemia and Prevention of Atherosclerosis was adopted for classification of the CAD risks. Anthropometric assessments included waist circumference (WC), body fat and calculated BMI (kg/m(2)) and muscle-mass index (MMI kg/m(2)). Dietary intake was estimated through 24 h dietary recall. Fasting blood was used for biochemical analysis. Metabolic Syndrome (MS) was diagnosed using NCEP-ATPIII (2001) criteria. Logistic regression was used to determine the odds of CAD risks according to the altered components of MS, dietary, anthropometric, and biochemical components. Results: For a sample with a BMI 28.5 +/- 5.0 kg/m(2) the association with lower risk (<10% CAD) were lower age (<60 years old), and plasma values of uric acid. The presence of MS within low, intermediary, and high CAD risk categories was 30.8%, 55.5%, and 69.8%, respectively. The independent risk factors associated with CAD risk score was MS and uric acid, and the protective factors were recommended intake of saturated fat and fiber and muscle mass index. Conclusion: Recommended intake of saturated fat and dietary fiber, together with proper muscle mass, are inversely associated with CAD risk score. On the other hand, the presence of MS and high plasma uric acid are associated with CAD risk score.

Risk optimization of a steel frame communications tower subject to tornado winds

The structural engineering community in Brazil faces new challenges with the recent occurrence of high intensity tornados. Satellite surveillance data shows that the area covering the south-east of Brazil, Uruguay and some of Argentina is one of the world most tornado-prone areas, second only to the infamous tornado alley in central United States. The design of structures subject to tornado winds is a typical example of decision making in the presence of uncertainty. Structural design involves finding a good balance between the competing goals of safety and economy. This paper presents a methodology to find the optimum balance between these goals in the presence of uncertainty. In this paper, reliability-based risk optimization is used to find the optimal safety coefficient that minimizes the total expected cost of a steel frame communications tower, subject to extreme storm and tornado wind loads. The technique is not new, but it is applied to a practical problem of increasing interest to Brazilian structural engineers. The problem is formulated in the partial safety factor format used in current design codes, with all additional partial factor introduced to serve as optimization variable. The expected cost of failure (or risk) is defined as the product of a. limit state exceedance probability by a limit state exceedance cost. These costs include costs of repairing, rebuilding, and paying compensation for injury and loss of life. The total expected failure cost is the sum of individual expected costs over all failure modes. The steel frame communications, tower subject of this study has become very common in Brazil due to increasing mobile phone coverage. The study shows that optimum reliability is strongly dependent on the cost (or consequences) of failure. Since failure consequences depend oil actual tower location, it turn,,; out that different optimum designs should be used in different locations. Failure consequences are also different for the different parties involved in the design, construction and operation of the tower. Hence, it is important that risk is well understood by the parties involved, so that proper contracts call be made. The investigation shows that when non-structural terms dominate design costs (e.g, in residential or office buildings) it is not too costly to over-design; this observation is in agreement with the observed practice for non-optimized structural systems. In this situation, is much easier to loose money by under-design. When by under-design. When structural material cost is a significant part of design cost (e.g. concrete dam or bridge), one is likely to lose significantmoney by over-design. In this situation, a cost-risk-benefit optimization analysis is highly recommended. Finally, the study also shows that under time-varying loads like tornados, the optimum reliability is strongly dependent on the selected design life.