Two decades of tuberculosis in a city in Northeastern Brazil: advances and challenges in time and space

Abstract: INTRODUCTION This study presents two decades of epidemiological data on tuberculosis (TB), in order to understanding the disease profile and its spatiotemporal dynamics. METHODS This descriptive study was performed in the City of Olinda/Pernambuco, Brazil, from 1991-2010, and it analyzed new patients with TB living in the city. We used the χ²-test with a p-value <0.05 to identify differences in trends. Incidence and cluster distribution were identified using spatial scan statistics. RESULTS In total, 6202 new cases were recorded during the two decades. The highest incidence occurred in 1995 (110 cases/100,000 inhabitants), and the lowest occurred in 2009 (65 cases/100,000 inhabitants) (β=-1.44; R²=0.43; p=0.0018). The highest mortality occurred in 1998 (16 deaths/100,000 inhabitants), and the lowest occurred in 2008 (5 deaths/100,000 inhabitants) (β=-0.19; R²=0.17; p=0.07). There was a male predominance (65%), and ages ranged from 20-49 years (65%). There was a substantial increase in the number of patients that were cured after treatment (60% to 67%; p<0.001) as well as those tested for HIV (1.9% to 58.5%; p<0.001). During the first decade, clusters with p-values <0.05 included 29% of the total notified cases, and in the second decade, that percentage was 12%. CONCLUSIONS We observed a decreasing trend in incidence, which was significant, and mortality rates, which was not significant. The increased number of laboratory tests performed reflects advances in surveillance, and a reduction in the proportion of cases in primary clusters suggests, among other things, that the disease is spreading across the region

Acute Effects of Particulate Matter and Black Carbon from Seasonal Fires on Peak Expiratory Flow of Schoolchildren in the Brazilian Amazon

BACKGROUND: Panel studies have shown adverse effects of air pollution from biomass burning on children's health. This study estimated the effect of current levels of outdoor air pollution in the Amazonian dry season on peak expiratory flow (PEF). METHODS: A panel study with 234 schoolchildren from 6 to 15 years old living in the municipality of Tangará da Serra, Brazil was conducted. PEF was measured daily in the dry season in 2008. Mixed-effects models and unified modelling repeated for every child were applied. Time trends, temperature, humidity, and subject characteristics were regarded. Inhalable particulate matter (PM10), fine particulate matter (PM2.5), and black carbon (BC) effects were evaluated based on 24-hour exposure lagged by 1 to 5 days and the averages of 2 or 3 days. Polynomial distributed lag models (PDLM) were also applied. RESULTS: The analyses revealed reductions in PEF for PM10 and PM2.5 increases of 10 µg/m(3) and 1 µg/m(3) for BC. For PM10, the reductions varied from 0.15 (confidence interval (CI)95%: -0.29; -0.01) to 0.25 l/min (CI95%: -0.40; -0.10). For PM2.5, they ranged from 0.46 (CI95%: -0.86 to -0.06) to 0.54 l/min (CI95%:-0.95; -0.14). As for BC, the reduction was approximately 1.40 l/min. In relation to PDLM, adverse effects were noticed in models based on the exposure on the current day through the previous 3 days (PDLM 0-3) and on the current day through the previous 5 days (PDLM 0-5), specially for PM10. For all children, for PDLM 0-5 the global effect was important for PM10, with PEF reduction of 0.31 l/min (CI95%: -0.56; -0.05). Also, reductions in lags 3 and 4 were observed. These associations were stronger for children between 6 and 8 years old. CONCLUSION: Reductions in PEF were associated with air pollution, mainly for lagged exposures of 3 to 5 days and for younger children

As queimadas na região amazônica e o adoecimento respiratório Ground-clearing fires in the amazon and respiratory disease

A queima de biomassa florestal popularmente conhecida como "queimada" é uma prática recorrente e antiga no país e se caracteriza como um dos principais contribuintes mundiais para a emissão de gases de efeito estufa. Entretanto, a consciência global sobre seus possíveis impactos é relativamente recente. A ocorrência de grandes queimadas no cenário brasileiro e internacional despertou a atenção para o problema, mas as medidas tomadas para prevenir e/ou controlar os incêndios ainda são insuficientes. Na região amazônica, com circunstâncias geográficas e ambientais distintas do resto do país, aliadas a um processo histórico de ocupação do território, o uso do fogo expõe a cada ano, parcelas maiores da população tornando-as vulneráveis aos seus efeitos. Neste contexto, esta revisão não sistemática apresenta os trabalhos desenvolvidos nos últimos cinco anos sobre as queimadas na Amazônia Brasileira e o adoecimento respiratório. Tem como objetivo principal fornecer elementos para gestores e dirigentes ambientais sobre as questões que norteiam os problemas relacionados à queima de biomassa florestal na região amazônica.<br>The intentional burning of forest biomass commonly known as "ground-clearing fires" is an age-old and widespread practice in the country and is seen as a major contributor to global emissions of greenhouse gases. However, global awareness of their potential impact is relatively recent. The occurrence of large ground-clearing fires in the Brazilian and international scenarios drew attention to the problem, but the measures taken to prevent and/or control the fires are still insufficient. In the Amazon region, with distinct geographical and environmental features from the rest of the country, with its historic process of land occupation, every year the ground-clearing fires expose larger portions of the population making them vulnerable to its effects. In this context, this non-systematic review presents the papers written over the past five years about the fires in the Brazilian Amazon and respiratory illness. The main objective is to provide information for managers and leaders on environmental issues about the problems related to biomass burning in the Amazon region