Estimating the average length of hospitalization due to pneumonia: a fuzzy approach

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Efeitos da exposi����o aos poluentes do ar com base nas interna����es por doen��as cardiovasculares e respirat��rias no munic��pio de Taubat��, SP

P��s-gradua����o em Engenharia Civil e Ambiental - FEB

Polui����o atmosf��rica e paisagem urbana no munic��pio de S��o Paulo

This paper proposes an analysis of two major polluting elements of the atmosphere of S��o Paulo city, carbon monoxide (CO) and sulfur dioxide (SO2). This study was performed through analysis of data on the quality of air, by means of published reports and records obtained by experiment using measuring rate monitor for CO2. Atmospheric data were collected and sorted. From this work it was possible to identify the concentration of carbon dioxide in the center of S��o Paulo on September 14, 2012 using the infrared gas analyzer (IRGA). From the ratios of carbon monoxide and sulfur dioxide spatially analyzed could identify major emitters by comparing records of pollutants and their origin. The analysis makes it possible to map the intensity of air pollution in urban areas, identifying the polluting elements, their issuers and thereby contributes to the current understanding of atmospheric features, bringing a geographical spatial analysis of air pollutants in S��o Paulo, contributing to awareness of vulnerabilities, enabling a useful tool for planning and maintenance of the urban environment related public policies

Modelo fuzzy estimando tempo de interna����o por doen��as cardiovasculares

Abstract A fuzzy linguistic model based on the Mamdani method with input variables, particulate matter, sulfur dioxide, temperature and wind obtained from CETESB with two membership functions each was built to predict the average hospitalization time due to cardiovascular diseases related to exposure to air pollutants in S��o Jos�� dos Campos in the State of S��o Paulo in 2009. The output variable is the average length of hospitalization obtained from DATASUS with six membership functions. The average time given by the model was compared to actual data using lags of 0 to 4 days. This model was built using the Matlab v. 7.5 fuzzy toolbox. Its accuracy was assessed with the ROC curve. Hospitalizations with a mean time of 7.9 days (SD = 4.9) were recorded in 1119 cases. The data provided revealed a significant correlation with the actual data according to the lags of 0 to 4 days. The pollutant that showed the greatest accuracy was sulfur dioxide. This model can be used as the basis of a specialized system to assist the city health authority in assessing the risk of hospitalizations due to air pollutants.

The impact of atmospheric particulate matter on cancer incidence and mortality in the city of Sao Paulo, Brazil

This study aimed to verify the impact of inhalable particulate matter (PM10) on cancer incidence and mortality in the city of Sao Paulo, Brazil. Statistical techniques were used to investigate the relationship between PM10 on cancer incidence and mortality in selected districts. For some types of cancer (skin, lung, thyroid, larynx, and bladder) and some periods, the correlation coefficients ranged from 0.60 to 0.80 for incidence. Lung cancer mortality showed more correlations during the overall period. Spatial analysis showed that districts distant from the city center showed higher than expected relative risk, depending on the type of cancer According to the study, urban PM10 can contribute to increased incidence of some cancers and may also contribute to increased cancer mortality. The results highlight the need to adopt measures to reduce atmospheric PM10 levels and the importance of their continuous monitoring.

Micronucleus frequency in children exposed to biomass burning in the Brazilian Legal Amazon region: a control case study

Background: The Amazon represents an area of 61% of Brazilian territory and is undergoing major changes resulting from disorderly economic development, especially the advance of agribusiness. Composition of the atmosphere is controlled by several natural and anthropogenic processes, and emission from biomass burning is one with the major impact on human health. The aim of this study was to evaluate genotoxic potential of air pollutants generated by biomass burning through micronucleus assay in exfoliated buccal cells of schoolchildren in the Brazilian Amazon region. Methods: The study was conducted during the dry seasons in two regions of the Brazilian Amazon. The assay was carried out on buccal epithelial cells of 574 schoolchildren between 6-16 years old. Results: The results show a significant difference between micronucleus frequencies in children exposed to biomass burning compared to those in a control area. Conclusions: The present study demonstrated that in situ biomonitoring using a sensitive and low cost assay (buccal micronucleus assay) may be an important tool for monitoring air quality in remote regions. It is difficult to attribute the increase in micronuclei frequency observed in our study to any specific toxic element integrated in the particulate matters. However, the contribution of the present study lies in the evidence that increased exposure to fine particulate matter generates an increased micronuclei frequency in oral epithelial cells of schoolchildren.

Atmospheric pollution: influence on hospital admissions in paediatric rheumatic diseases

Objective: To investigate the lag structure effects from exposure to atmospheric pollution in acute outbursts in hospital admissions of paediatric rheumatic diseases (PRDs). Methods: Morbidity data were obtained from the Brazilian Hospital Information System in seven consecutive years, including admissions due to seven PRDs (juvenile idiopathic arthritis, systemic lupus erythematosus, dermatomyositis, Henoch-Schonlein purpura, polyarteritis nodosa, systemic sclerosis and ankylosing spondylitis). Cases with secondary diagnosis of respiratory diseases were excluded. Daily concentrations of inhaled particulate matter (PM10), sulphur dioxide (SO2) nitrogen dioxide (NO2), ozone (O-3) and carbon monoxide (CO) were evaluated. Generalized linear Poisson regression models controlling for short-term trend, seasonality, holidays, temperature and humidity were used. Lag structures and magnitude of air pollutants' effects were adopted to estimate restricted polynomial distributed lag models. Results: The total number of admissions due to acute outbursts PRD was 1,821. The SO2 interquartile range (7.79 mu g/m(3)) was associated with an increase of 1.98% (confidence interval 0.25-3.69) in the number of hospital admissions due to outcome studied after 14 days of exposure. This effect was maintained until day 17. Of note, the other pollutants, with the exception of O-3, showed an increase in the number of hospital admissions from the second week. Conclusion: This study is the first to demonstrate a delayed association between SO2 and PRD outburst, suggesting that oxidative stress reaction could trigger the inflammation of these diseases. Lupus (2012) 21, 526-533.

Tr��fego veicular e mortalidade por doen��as do aparelho circulat��rio em homens adultos

OBJETIVO: Analisar a associa����o entre indicadores de exposi����o �� polui����o por tr��fego veicular e mortalidade por doen��as do aparelho circulat��rio em homens adultos. M��TODOS: Foram analisadas informa����es sobre vias e volume de tr��fego no ano de 2007 fornecidas pela companhia de engenharia de tr��fego local. Mortalidade por doen��as do aparelho circulat��rio no ano de 2005 entre homens ��� 40 anos foram obtidas do registro de mortalidade do Programa de Aprimoramento de Informa����es de Mortalidade do Munic��pio de S��o Paulo, SP. Dados socioecon��micos do Censo 2000 e informa����es sobre a localiza����o dos servi��os de sa��de tamb��m foram coletados. A exposi����o foi avaliada pela densidade de vias e volume de tr��fego para cada distrito administrativo. Foi calculada regress��o (�� = 5%) entre esses indicadores de exposi����o e as taxas de mortalidade padronizadas, ajustando os modelos para vari��veis socioecon��micas, n��mero de servi��os de sa��de nos distritos e autocorrela����o espacial. RESULTADOS: A correla����o entre densidade de vias e volume de tr��fego foi modesta (r�� = 0,28). Os distritos do centro apresentaram os maiores valores de densidade de vias. O modelo de regress��o espacial de densidade de vias indicou associa����o com mortalidade por doen��as do aparelho circulat��rio (p = 0,017). N��o se observou associa����o no modelo de volume de tr��fego. Em ambos os modelos ��� vias e volume de tr��fego (ve��culos leves/pesados) ��� a vari��vel socioecon��mica foi estatisticamente signi��� cante. CONCLUS��ES: A associa����o entre mortalidade por doen��as do aparelho circulat��rio e densidade de vias converge com a literatura e encoraja a realiza����o de mais estudos epidemiol��gicos em n��vel individual e com m��todos mais acurados de avalia����o da exposi����o.

The impact of atmospheric particulate matter on cancer incidence and mortality in the city of S��o Paulo, Brazil

This study aimed to verify the impact of inhalable particulate matter (PM10) on cancer incidence and mortality in the city of S��o Paulo, Brazil. Statistical techniques were used to investigate the relationship between PM10 on cancer incidence and mortality in selected districts. For some types of cancer (skin, lung, thyroid, larynx, and bladder) and some periods, the correlation coefficients ranged from 0.60 to 0.80 for incidence. Lung cancer mortality showed more correlations during the overall period. Spatial analysis showed that districts distant from the city center showed higher than expected relative risk, depending on the type of cancer. According to the study, urban PM10 can contribute to increased incidence of some cancers and may also contribute to increased cancer mortality. The results highlight the need to adopt measures to reduce atmospheric PM10 levels and the importance of their continuous monitoring.

Characterization of ozone transport among metropolitan regions

The aim of this work is to determine the interaction in terms of ozone transport between two metropolitan regions of S��o Paulo State: The Metropolitan Region of Campinas (MRC) and Metropolitan Region of S��o Paulo (MRSP), with different characteristics and dimensions. In order to describe the interaction between both regions, 3-D Eulerian photochemical CIT model was used with a new approach for S��o Paulo regions since most previous studies deal with individual areas considering the contribution of other areas only as boundary conditions. The results from the photochemical simulations showed that the ozone concentration in the MRC is associated to local emissions and the transport of ozone and its precursors from the MRSP, demonstrating the significant impact of a megacity in its neighborhood and the importance of meteorological and topography conditions in the transport of air pollutants from the local source to distant regions.

Sviluppo di tecniche per la progettazione delle reti di monitoraggio della qualita' dell'aria

L���obiettivo del lavoro consiste nell���implementare una metodologia operativa volta alla progettazione di reti di monitoraggio e di campagne di misura della qualit�� dell���aria con l���utilizzo del laboratorio mobile, ottimizzando le posizioni dei dispositivi di campionamento rispetto a differenti obiettivi e criteri di scelta. La revisione e l���analisi degli approcci e delle indicazioni fornite dalla normativa di riferimento e dai diversi autori di lavori scientifici ha permesso di proporre un approccio metodologico costituito da due fasi operative principali, che �� stato applicato ad un caso studio rappresentato dal territorio della provincia di Ravenna. La metodologia implementata prevede l���integrazione di numerosi strumenti di supporto alla valutazione dello stato di qualit�� dell���aria e degli effetti che gli inquinanti atmosferici possono generare su specifici recettori sensibili (popolazione residente, vegetazione, beni materiali). In particolare, la metodologia integra approcci di disaggregazione degli inventari delle emissioni attraverso l���utilizzo di variabili proxy, strumenti modellistici per la simulazione della dispersione degli inquinanti in atmosfera ed algoritmi di allocazione degli strumenti di monitoraggio attraverso la massimizzazione (o minimizzazione) di specifiche funzioni obiettivo. La procedura di allocazione sviluppata �� stata automatizzata attraverso lo sviluppo di un software che, mediante un���interfaccia grafica di interrogazione, consente di identificare delle aree ottimali per realizzare le diverse campagne di monitoraggio

Entwicklung und Anwendung von mobilen Messstrategien und Analysemethoden zur Untersuchung urbanen Aerosols

Seit Anbeginn der Menschheitsgeschichte beeinflussen die Menschen ihre Umwelt. Durch anthropogene Emissionen ��ndert sich die Zusammensetzung der Atmosph��re, was einen zunehmenden Einfluss unter anderem auf die Atmosph��renchemie, die Gesundheit von Mensch, Flora und Fauna und das Klima hat. Die steigende Anzahl riesiger, wachsender Metropolen geht einher mit einer r��umlichen Konzentration der Emission von Luftschadstoffen, was vor allem einen Einfluss auf die Luftqualit��t der windabw��rts gelegenen ruralen Regionen hat. In dieser Doktorarbeit wurde im Rahmen des MEGAPOLI-Projektes die Abluftfahne der Megastadt Paris unter Anwendung des mobilen Aerosolforschungslabors MoLa untersucht. Dieses ist mit modernen, zeitlich hochaufl��senden Instrumenten zur Messung der chemischen Zusammensetzung und Gr����enverteilung der Aerosolpartikel sowie einiger Spurengase ausgestattet. Es wurden mobile Messstrategien entwickelt und angewendet, die besonders geeignet zur Charakterisierung urbaner Emissionen sind. Querschnittsmessfahrten durch die Abluftfahne und atmosph��rische Hintergrundluftmassen erlaubten sowohl die Bestimmung der Struktur und Homogenit��t der Abluftfahne als auch die Berechnung des Beitrags der urbanen Emissionen zur Gesamtbelastung der Atmosph��re. Quasi-Lagrange���sche Radialmessfahrten dienten der Erkundung der r��umlichen Erstreckung der Abluftfahne sowie auftretender Transformationsprozesse der advehierten Luftschadstoffe. In Kombination mit Modellierungen konnte die Struktur der Abluftfahne vertieft untersucht werden. Flexible station��re Messungen erg��nzten den Datensatz und lie��en zudem Vergleichsmessungen mit anderen Messstationen zu. Die Daten einer ortsfesten Messstation wurden zus��tzlich verwendet, um die Alterung des organischen Partikelanteils zu beschreiben. Die Analyse der mobilen Messdaten erforderte die Entwicklung einer neuen Methode zur Bereinigung des Datensatzes von lokalen St��reinfl��ssen. Des Weiteren wurden die M��glichkeiten, Grenzen und Fehler bei der Anwendung komplexer Analyseprogramme zur Berechnung des O/C-Verh��ltnisses der Partikel sowie der Klassifizierung der Aerosolorganik untersucht. Eine Validierung verschiedener Methoden zur Bestimmung der Luftmassenherkunft war f��r die Auswertung ebenfalls notwendig. Die detaillierte Untersuchung der Abluftfahne von Paris ergab, dass diese sich anhand der Erh��hung der Konzentrationen von Indikatoren f��r unprozessierte Luftverschmutzung im Vergleich zu Hintergrundwerten identifizieren l��sst. Ihre eher homogene Struktur kann zumeist durch eine Gau��-Form im Querschnitt mit einem exponentiellen Abfall der unprozessierten Schadstoffkonzentrationen mit zunehmender Distanz zur Stadt beschrieben werden. Hierf��r ist haupts��chlich die turbulente Vermischung mit Umgebungsluftmassen verantwortlich. Es konnte nachgewiesen werden, dass in der advehierten Abluftfahne eine deutliche Oxidation der Aerosolorganik im Sommer stattfindet; im Winter hingegen lie�� sich dieser Prozess w��hrend der durchgef��hrten Messungen nicht beobachten. In beiden Jahreszeiten setzt sich die Abluftfahne haupts��chlich aus Ru�� und organischen Partikelkomponenten im PM1-Gr����enbereich zusammen, wobei die Quellen Verkehr und Kochen sowie zus��tzlich Heizen in der kalten Jahreszeit dominieren. Die PM1-Partikelmasse erh��hte sich durch die urbanen Emissionen im Vergleich zum Hintergrundwert im Sommer in der Abluftfahne im Mittel um 30% und im Winter um 10%. Besonders starke Erh��hungen lie��en sich f��r Polyaromaten beobachten, wo im Sommer eine mittlere Zunahme von 194% und im Winter von 131% vorlag. Jahreszeitliche Unterschiede waren ebenso in der Gr����enverteilung der Partikel der Abluftfahne zu finden, wo im Winter im Gegensatz zum Sommer keine zus��tzlichen nukleierten kleinen Partikel, sondern nur durch Kondensation und Koagulation angewachsene Partikel zwischen etwa 10nm und 200nm auftraten. Die Spurengaskonzentrationen unterschieden sich ebenfalls, da chemische Reaktionen temperatur- und mitunter strahlungsabh��ngig sind. Weitere Anwendungsm��glichkeiten des MoLa wurden bei einer ��berf��hrungsfahrt von Deutschland an die spanische Atlantikk��ste demonstriert, woraus eine Kartierung der Luftqualit��t entlang der Fahrtroute resultierte. Es zeigte sich, dass haupts��chlich urbane Ballungszentren von unprozessierten Luftschadstoffen betroffen sind, advehierte gealterte Substanzen jedoch jede Region beeinflussen k��nnen. Die Untersuchung der Luftqualit��t an Standorten mit unterschiedlicher Exposition bez��glich anthropogener Quellen erweiterte diese Aussage um einen Einblick in die Variation der Luftqualit��t, abh��ngig unter anderem von der Wetterlage und der N��he zu Emissionsquellen. Damit konnte gezeigt werden, dass sich die entwickelten Messstrategien und Analysemethoden nicht nur zur Untersuchung der Abluftfahne einer Gro��stadt, sondern auch auf verschiedene andere wissenschaftliche und umweltmesstechnische Fragestellungen anwenden lassen.

Translocation and potential neurological effects of fine and ultrafine particles a critical update

ABSTRACT: Particulate air pollution has been associated with respiratory and cardiovascular disease. Evidence for cardiovascular and neurodegenerative effects of ambient particles was reviewed as part of a workshop. The purpose of this critical update is to summarize the evidence presented for the mechanisms involved in the translocation of particles from the lung to other organs and to highlight the potential of particles to cause neurodegenerative effects.Fine and ultrafine particles, after deposition on the surfactant film at the air-liquid interface, are displaced by surface forces exerted on them by surfactant film and may then interact with primary target cells upon this displacement. Ultrafine and fine particles can then penetrate through the different tissue compartments of the lungs and eventually reach the capillaries and circulating cells or constituents, e.g. erythrocytes. These particles are then translocated by the circulation to other organs including the liver, the spleen, the kidneys, the heart and the brain, where they may be deposited. It remains to be shown by which mechanisms ultrafine particles penetrate through pulmonary tissue and enter capillaries. In addition to translocation of ultrafine particles through the tissue, fine and coarse particles may be phagocytized by macrophages and dendritic cells which may carry the particles to lymph nodes in the lung or to those closely associated with the lungs. There is the potential for neurodegenerative consequence of particle entry to the brain. Histological evidence of neurodegeneration has been reported in both canine and human brains exposed to high ambient PM levels, suggesting the potential for neurotoxic consequences of PM-CNS entry. PM mediated damage may be caused by the oxidative stress pathway. Thus, oxidative stress due to nutrition, age, genetics among others may increase the susceptibility for neurodegenerative diseases. The relationship between PM exposure and CNS degeneration can also be detected under controlled experimental conditions. Transgenic mice (Apo E -/-), known to have high base line levels of oxidative stress, were exposed by inhalation to well characterized, concentrated ambient air pollution. Morphometric analysis of the CNS indicated unequivocally that the brain is a critical target for PM exposure and implicated oxidative stress as a predisposing factor that links PM exposure and susceptibility to neurodegeneration.Together, these data present evidence for potential translocation of ambient particles on organs distant from the lung and the neurodegenerative consequences of exposure to air pollutants.

Impact of traffic pollution on telomere length and chronic diseases: Results from the multi-ethnic study of atherosclerosis and the Mexican-American cohort study

Exposure to air pollutants in urban locales has been associated with increased risk for chronic diseases including cardiovascular disease (CVD) and pulmonary diseases in epidemiological studies. The exact mechanism explaining how air pollution affects chronic disease is still unknown. However, oxidative stress and inflammatory pathways have been posited as likely mechanisms. ^ Data from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Mexican-American Cohort Study (2003-2009) were used to examine the following aims, respectively: 1) to evaluate the association between long-term exposure to ambient particulate matter (PM) (PM10 and PM2.5) and nitrogen oxides (NO x) and telomere length (TL) among approximately 1,000 participants within MESA; and 2) to evaluate the association between traffic-related air pollution with self-reported asthma, diabetes, and hypertension among Mexican-Americans in Houston, Texas. ^ Our results from MESA were inconsistent regarding associations between long-term exposure to air pollution and shorter telomere length based on whether the participants came from New York (NY) or Los Angeles (LA). Although not statistically significant, we observed a negative association between long-term air pollution exposure and mean telomere length for NY participants, which was consistent with our hypothesis. Positive (statistically insignificant) associations were observed for LA participants. It is possible that our findings were more influenced by both outcome and exposure misclassification than by the absence of a relationship between pollution and TL. Future studies are needed that include longitudinal measures of telomere length as well as focus on effects of specific constituents of PM and other pollutant exposures on changes in telomere length over time. ^ This research provides support that Mexican-American adults who live near a major roadway or in close proximity to a dense street network have a higher prevalence of asthma. There was a non-significant trend towards an increased prevalence of adult asthma with increasing residential traffic exposure especially for residents who lived three or more years at their baseline address. Even though the prevalence of asthma is low in the Mexican-origin population, it is the fastest growing minority group in the U.S. and we would expect a growing number of Mexican-Americans who suffer from asthma in the future. Future studies are needed to better characterize risks for asthma associated with air pollution in this population.^